Characteristics of biomechanical properties of child's foot 5-6 years old in the physical rehabilitation process

Actuality. Pre-school age is the most responsible period in the physical development process and in a child's personality formation. The disorders in the motor function of the foot are the most common among the various pathologies of a child’s lower extremities. Many researchers have found that unfixed disorders with child's foot can eventually lead to serious changes throughout the organism and cause pathology. The study of the foot support-spring function peculiarities of children 5-6 years old in the physical rehabilitation process is not sufficiently highlighted in the available special literature. Research objective: to study the support-spring properties of a child’s foot 5-6 years old as a development precondition for the technology of the correction of unfixed disorders in children’s support-motional apparatus with physical rehabilitation using. Research results. It was established that the foot length of preschool children was within the age norm, the minimum length was 135.1 mm, and the maximum one was 201.2 mm. The obtained average statistical data of the metatarsal angle α ° and the heel angle β ° in children 5-6 years old indicate the heterogeneity of the group; the range of the metatarsal angle was in the interval from 0.24° tо 21.52° and the range of the heel angle was from 12.46° to 32.38 ° respectively. We have not established statistically significant differences at the level p> 0.05 in all indicators of the foot support-spring functions of children 5-6 years old with posture disorders and with normal posture. Conclusions. There are three main functions which characterize a normal foot: spring, balancing and pushing. The development process of the support-motional apparatus of children 5-6 years old is influenced by various factors and is subjected to some changes, including pathological. The disorders of the foot motor function occupy the first place among the various pathologies of the lower extremities in children of preschool age. It is known that, in the preschool age, the foot is in the stage of intensive development; its formation has not yet been completed, so any adverse actions can lead to the certain functional changes. Prospects for further research are related to the development and implementation of the concept for the correction and prevention of functional disorders in the support-motional apparatus of senior preschool aged children in the physical rehabilitation process

Prescription of Ankle-Foot Orthoses for Children with Cerebral Palsy

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to address gait impairments for children with cerebral palsy (CP). Successful treatment with AFOs depends on optimal prescription, matching the design of the brace to the individual child’s physical impairments; however, research evidence does not exist to help health care professionals decide on the best AFO design to meet each child’s needs. Therefore, this thesis explored current AFO prescription practices, and aimed to improve evidence to assist clinicians in making prescription decisions for children with CP. Methods and Results: To examine the experiences and perspectives of clinicians on AFO prescription for children with CP, we conducted focus groups and semi-structured interviews with 32 clinicians who were involved with AFO prescription for children with CP in five Canadian rehabilitation facilities. Using Interpretive Description as a framework for analysis, we identified three categories from the data: 1) What is made, 2) How it is used, and 3) Factors that support or challenge outcomes. Throughout the interviews, the theme of prescription as a collaborative, iterative, and individualized process emerged. To explore evaluation and clinical decision-making practices of physical therapists for AFO prescription and follow-up, we invited Canadian physical therapists (PTs) working with children who have CP to complete an online survey. Sixty completed responses were received. Three researchers conducted a conventional content analysis to examine the open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Three themes were identified: 1) Focus on impairment level measures, 2) Inconsistent practices between PTs, and 3) Lack of confidence/knowledge about casting positions and AFO types. To investigate the effects of individualizing the angle of the ankle in the AFO on walking mechanics and function, gait biomechanics were studied in ten children with CP. Fifteen typically-developing children provided normative data. Using three-dimensional gait analysis, kinematics and kinetics were compared between the child’s usual AFO(s) and AFOs that were fabricated with an ankle angle that was individualized for each child. Net responses to the individualized ankle angle were positive for 60% of limbs, negative for 40%. The greatest benefits were observed at the knee, suggesting that this may be a beneficial approach to orthotic intervention for some children with CP. Conclusions: There is limited understanding of how AFOs are prescribed for children with CP in Canada. This thesis highlights the importance of multidisciplinary collaboration, objective evaluation, and individualized clinical problem-solving to facilitate the evolution of the AFO prescription from a medical directive to an orthotic device that optimally benefits the child. This is the first step toward the development of guidelines to help clinicians improve AFO prescription for children with CP

Theoretical and methodological foundations of the physical rehabilitation technology of children 5-6 years old, with functional disorders of the support-motional apparatus

Actuality. Preschool age is an important stage in the child's personality formation, in the motor skills formation, in the development of physical qualities and in the provision of conditions for normal biological development. The child's organism is subjected and varied to various external factors, both negative and positive, which have a significant influence on its development. The most important factor of external influence on the child’s organism is regular physical exercises, and the exercises of physical culture which are built methodically correctly affect favorably their physical development and health promotion. Research objective: to develop a technology for the prevention and correction of non-fixed disorders in support-motional apparatus of children aged 5–6 years with physical rehabilitation using under the conditions of preschool educational establishments. Research results. The technology was developed taking into account the individual child’s characteristics: the significance level and plane of posture disorder, the peculiarities of the varus or valgus deformity of the lower extremities and the flatfoot form, the consistent patterns between them; results of test tasks; associated diseases; the ability to learn new exercises, which allows to increase the effectiveness of the impact and to reduce the volume of applied means. The functional diagram of the prevention and correction technology of non-fixed disorders in child’s support-motional apparatus in senior preschool age makes it possible to display it from the position of a system-structural approach. The physical rehabilitation technology in the conditions of preschool educational institutions for children 5-6 years old includes theoretical lessons (thematic fairy tales), morning hygienic gymnastics, correctional exercises as part of physical education lesson, physical cultural pauses, therapeutic gymnastics, massage and physical therapy elements. All impacts were carried out in the game form. Conclusions. The physical rehabilitation technology for children 5-6 years old with non-fixed disorders in support-motional apparatus is built with consideration of the variable and basic components depending on the revealed correlation interconnection between posture disorders in the frontal and sagittal planes and spring-support function of the feet. It allows to differentiate the program of rehabilitation measures and to reduce significantly their volume without loss of efficiency. Prospects for further research are related to the development and implementation of the correction and prevention concept of functional disorders within the child’s support-motional apparatus in senior preschool age during the physical rehabilitation process

Effects of extraosseous talotarsal stabilization on the biomechanics of flexible flatfoot subtalar joints in children: a finite element study

Background: Objective of the study was to generate an experimental foundation for the clinical application of extraosseous talotarsal stabilization (EOTTS) in treatment of flexible flatfeet in children by investigating the biomechanical characteristics of flexible flatfoot and the effects of EOTTS on hindfoot biomechanics.Methods: Three-dimensional finite element models of the foot and ankle complex were generated from computer tomography images of a volunteer’s left foot in three states: normal, flexible flatfoot, and post-EOTTS. After validation by X-ray, simulated loads were applied to the three models in a neutral position with both feet standing.Results: In the flexible flatfoot model, the contact stress on the subtalar joint increased and contact areas decreased, resulting in abnormal stress distribution compared to the normal model. However, following treatment of the foot with EOTTS, these parameters returned to close to normal. Subtalar joint instability leads to a flexible flat foot. Based on this study, it is proposed that EOTTS can restore the normal function of the subtalar joint in and is an effective treatment for flexible flatfoot in children. We and many clinical data studies provide evidence for sinus tarsi implants in pediatric patients. It is showed that the formation of flexible flatfoot is induced by subtalar joint instability.Conclusions: Because of the EOTTS provides the best biomechanical solution to subtalar joint instability, the EOTTS became an effective form for subtalar joint instability treatment

The effect of unsupportive and supportive footwear on children’s multi-segment foot dynamics during gait

Footwear is necessary for children’s foot comfort and protection. Despite the popularity of flip-flop (thongs) footwear among children, strong clinical opinion endures of the potential deleterious effect this footwear may have on developing feet. On the contrary, thongs may be beneficial for children’s developing feet due to the footwear’s flexible and unrestrictive nature, as children who mature within habitually barefoot communities are observed to develop stronger and healthier feet. This thesis considers the developing nature of human ambulation and the physiological basis for children’s foot maturation. It then explores the effect of thong footwear on childrens barefoot dynamics with comparisons to traditionally advocated supportive footwear. Foot compensations were observed when thongs were worn while walking and to a lesser extent while jogging. Greater ankle dorsiflexion and reduced hallux dorsiflexion suggests a mechanism to retain the thong. Greater midfoot plantarflexion indicates a gripping action to sustain the thong. Barefoot motions were unaffected by thongs during the sidestep. The midfoot splinting effect of supportive shoes was reinforced while walking, jogging and sidestepping. Thongs had a minimal effect on barefoot dynamics, while supportive shoes limited midfoot power generation with a corresponding increase in ankle power generation. Overall findings suggest that foot motion when wearing thongs may be more replicable of barefoot motion than originally believed. In terms of foot arch development, thongs may be more beneficial than supportive shoes, due to the minimal alterations to barefoot motions when they are worn. The reported midfoot plantarflexion required to grip the thong may be beneficial to children’s foot arch strengthening and overall foot development. While supportive shoes have the necessary protective features, they have been shown to inhibit midfoot and hallux motions with a compensatory increase in ankle motions

The biomechanics of human locomotion

Includes bibliographical references. The thesis on CD-ROM includes Animate, GaitBib, GaitBook and GaitLab, four quick time movies which focus on the functional understanding of human gait. The CD-ROM is available at the Health Sciences Library

Investigation of a mechatronic device for the remedial treatment of brain injured children.

To speed the recovery of brain injured children using the method of patterning; it must be made efficient. Efficiency can be achieved by automating the manual method, which will provide the patients with the necessary stimuli needed to help them enhance/restore their natural mobility. This thesis describes research into a novel moderate-cost single-axis Mechatronics device for the remedial treatment of brain injured patients. The device will enhance and/or improve their natural mobility by stimulating the undamaged brain cells responsible for mobility in the central nervous system through physical activity. A detailed review of rehabilitation robotics was undertaken, covering more than seventy projects relating to disabled people. This review helped to identify the main areas of this research regarding the most suitable structure of the machine and setting up the design specifications for the device. A critical investigation of past and present patterning machines and workstations helped avoid the mistakes made by previous designers in not including brain-injured patients in the initial stages of the design. Use of high technology video equipment has made practicable the development of mathematical expressions based on experimental data for the movements of human arms, feet and head. Measurements taken and ergonomic data used made it possible to implement a realistic practical novel kinematic arrangement for the patterning machine. A thorough review of direct drive electrical actuators, and surveys and measurements of the human body with respect to the kinematic arrangements, resulted in the selection of the most appropriate actuator for each axis. The selection of the motor and gearbox was based on the mass of each part of the human body in the prone position, the criteria of high peak torque to motor ratio, low cost, minimum maintenance, safety and compatibility. A computer model of the kinematic arrangement designed was created including the necessary motion constrains, using ADAMS and 3D Working Model simulation packages to test, verify and analyse the static and dynamic stability of the kinematic arrangements and the force interaction between the system and the patient. The simulation results led to some modification in the design regarding the kinematics and dynamic stability of the system by varying different design variables. A walking model of a human was created to simulate the real patient. The model was placed on two units where the feet were the only contact points with the moving belts; the model torso was supported by a harness to hold it in the upright standing position. The results obtained showed the movements of both feet (knees. hips and ankles) in addition to the right and left elbows. The system hardware was designed and implemented using custom-made safety critical software to control the device to carry out the desired tasks. Safety is considered to be one of the main issues that this research program has developed and implemented. An optimal control strategy was developed to drive the prototype. Smooth movements of the system were achieved through a PD control system enhanced with velocity feed forward gain with position accuracy of ± 0.168 mm. The desired positional accuracy of the Patterner Machine was ± 0.632 mm

Children’s Off-the-Shelf Stability Therapeutic Footwear: a mixed method analysis to define their design and purpose.

Footwear is commonly used within the first line of clinical intervention option in children with mobility impairments. It has been used in many roles to assist mobility, from correction of congenital skeletal alignment to support of foot and ankle structures. However, an evidence-based consensus of the different roles and types of clinical footwear has never been achieved. Off-the-shelf stability therapeutic footwear (OSSTF) is a range of commercial clinical footwear that is not bespoke but is taken from stock that is available immediately. Manufacturers propose that this footwear assists stability in gait for mobility-impaired children, however, as identified through scoping and systematic reviews within this thesis this footwear has not been defined. There is a paucity of information on the terms and definitions to identify this footwear and for what mobility impairments it should be prescribed including the purpose of treatment. Also, the design characteristics that will influence its effect as an intervention are not defined. A lack of uniform understanding of intervention leads to inconsistent practice for all stakeholders, clinicians, researchers, and manufacturers. This thesis has utilised a mixed method approach across a series of studies to provide consistency to the disparate nature of the evidence base concerning footwear interventions, with a specific focus on OSSTF. A conceptual framework for children’s clinical footwear has been established with definitions for therapeutic footwear and its groups/subgroups provided. Assessment of the design and material characteristics of a range of available OSSTF informed a Delphi study which provided expert consensus on prescription criteria, purpose, and clinical outcomes for OSSTF. It also provided consensus on salient design characteristics of OSSTF to assist stability and ergonomic function. The effect of these design characteristics were then quantitatively tested in-situ on footwear using a novel mechanical testing methodology. The testing demonstrated which design characteristics had the greatest effect on the stiffness of OSSTF to simulated foot and ankle movements. Building on these results a preliminary assessment tool to assist clinicians in identifying and scoring OSSTF footwear was developed. This collective work in this thesis has provided consistent terms and definitions to define and group children’s therapeutic footwear. It has also provided an expert consensus preliminary criteria prescription for OSSTF and objectively identified how this footwear will act as an intervention. Although further in-vivo testing of the effects of OSSTF on children identified from the prescription criteria is still required, the conceptual basis of OSSTF established in this thesis will inform clinical decision-making, research reporting and manufacturing of OSSTF for children living with mobility impairments