Inverse Kinematic Assessment of Rehabilitative Therapy in Children Using Orthotics

Pathologic movement patterns are characterized by abnormal kinematics that alter how muscles support the body during walking. Individual muscles are often the target of interventions with physical therapy and surgery alike, yet the tools to assess individual muscles clinically remain limited. The aim of this study is to assess OpenSim as a clinical tool for individualized rehabilitative evaluation of children using orthotics. This anatomic and kinematic modeling study was focused on pre- and post-treatment assessment of gait characteristics in fourteen children using orthotic devices. A range of four to twelve acceptable gait capture trials was collected for each child before therapy began and again after four weeks of treatment. The effects of therapy were significant in four of the lower extremity muscle analyses, three of the temporal parameters, and eighteen of the spatial parameters. All muscle lengths showed less deviation from normal values after physical therapy across all subjects. Results of this study support the further evaluation of OpenSim as a tool to improve quantitative assessment of musculoskeletal dynamics during the course of rehabilitative therapy in children using orthotics

Bibliographic Comparison of the Treatments in Children with Flatfoot

Treball Final de Grau de Podologia, Escola Universitària d'Infermeria, Universitat de Barcelona, curs: 2014-2015, Tutor: Laura Pérez PalmaBackground: The flat foot is a common syndrome seen in the practice of pediatric health and there is no universally accepted definition and precise to define flat feet therefore the main aim of this study is better understand and manage paediatric flatfoot to make the best diagnosis, to find evidence supporting use of custom made orthotics by using the latest research available and to clarify if there is any difference in development between children with flat feet who receive a treatment for pes planus in scholar and pre-schooler and the ones that do not. Methods: The studies included in this bibliographic review examine the association between pes planus in children and the ideal treatment for those cases. Studies included were from 2006 to 2015 to ensure up-to-date results. Patient case studies between 3-14 years and adolescents up to 17 years old were used. Results: 45 studies were found with the selected keywords, 25 were excluded because they didn't meet the selection criteria. Of the 20 remaining studies, 12 were of conservative treatments for Pes planus, 2 of surgical treatments and 6 were articles related to factors that would potentially be useful as a part of a treatment. We classified the treatments listed in the studies as surgical or conservative. Conclusion: Flatfoot has a good established clinical term and a common diagnosis but there is a lack of consensus on the methods of evaluation. Flexible asymptomatic flatfoot in children under the age of seven, does not need use orthotic insoles, but periodically observation. Symptomatic flexible flatfoot should be treated with activity modification, stretching exercises and orthoses. If the response is not satisfactory, surgical intervention should be considered. Conservative management for rigid flatfoot indicated if it’s asymptomatic, but when nonsurgical options failed, operative interventions are warranted for painful flatfeet. Age is the primary predictor for flatfoot and the weight it’s a factor of prevalence. Patient’s control that didn’t follow any treatment (younger and older than 6 and older) reported improvement as wel

Design of a wearable active ankle-foot orthosis for both sides

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Biomateriais, Reabilitação e Biomecânica)Portugal is the west European country with the highest rate of stroke-related mortality, being that, of those who suffer cerebrovascular accidents, 40% feature an impairment which can manifest itself through motor sequelae, namely drop foot. An ankle-foot orthosis is often recommended to passively accommodate these motor problems; however, active/powered exoskeletons are also a suitable solution for post-stroke patients. Due to the high complexity of the human ankle joint, one of the problems regarding these active devices is the misalignment occurring between the rehabilitation device and the human joint, which is a cause of parasitic forces, discomfort, and pain. The present master dissertation proposes the development of an adjustable wearable active ankle-foot orthosis that is able to tackle this misalignment issue concerning commercially available lower limb orthotic devices. This work is integrated on the SmartOs – Smart, Stand-alone Active Orthotic System – project that proposes an innovative robotic technology (a wearable mobile lab) oriented to gait rehabilitation. The conceptual design of a standard version of the SmartOs wearable active orthosis was initiated with the analysis of another ankle-foot orthosis – Exo-H2 (Technaid) – from which the necessary design changes were implemented, aiming at the improvement of the established device. In order to achieve a conceptual solution, both the practical knowledge of the Orthos XXI design team and several design methods were used to ensure the accomplishment of the defined requirements. The detailed design process of the standard SmartOs wearable active orthosis prototype is disclosed. With the purpose of validating the design, the critical components were simulated with the resources available in SolidWorks®, and the necessary CAD model’s adaptations were implemented to guarantee a reliable and safe design. The presented design is currently set for further production in Orthos XXI, followed by the mandatory mechanical tests.Portugal é o país da Europa ocidental com maior taxa de mortalidade por acidente vascular cerebral (AVC), sendo que, dos que sofrem acidentes vasculares cerebrais, 40% apresentam uma deficiência que pode manifestar-se por sequelas motoras, nomeadamente o pé pendente. Uma ortótese do tornozelo é recomendada frequentemente para acomodar passivamente esses problemas motores; no entanto, exoesqueletos ativos são também uma solução adequada para pacientes pós-AVC. Devido à alta complexidade da articulação do tornozelo humano, um dos problemas associados a esses dispositivos ativos é o desalinhamento que ocorre entre o dispositivo de reabilitação e a articulação humana, que é uma causa de forças parasitas, desconforto e dor. A presente dissertação de mestrado propõe o desenvolvimento de uma ortótese ativa do tornozelo ajustável e vestível, que seja capaz de resolver esse problema de desalinhamento relativo aos dispositivos ortóticos de membros inferiores disponíveis comercialmente. Este trabalho está integrado no projeto SmartOs - Smart, Stand-alone Active Orthotic System - projeto que propõe uma tecnologia robótica inovadora (wearable mobile lab) direcionada para a reabilitação da marcha. O projeto conceptual de uma versão padrão da ortótese ativa vestível do projeto SmartOs foi iniciado com a análise de outra ortótese do tornozelo – Exo-H2 (Technaid) - a partir da qual foram implementadas as alterações de projeto necessárias, visando o aprimoramento do dispositivo estabelecido. Para se chegar a uma solução conceptual, tanto o conhecimento prático da equipa de projeto da Orthos XXI como os diversos métodos de projeto foram utilizados para garantir o cumprimento dos requisitos definidos. O processo do desenho detalhado da versão padrão da ortótese ativa SmartOs será também divulgado. Com o objetivo de validar o projeto, os componentes críticos foram simulados com os recursos disponíveis no SolidWorks® e as adaptações necessárias do modelo CAD foram implementadas para garantir um projeto fidedigno e seguro. O projeto apresentado está atualmente em preparação para produção na empresa Orthos XXI, depois do qual se seguem os ensaios mecânicos obrigatórios

Analyse biomécanique des pieds SACH et Seattle-Light durant la locomotion chez les personnes âgées amputées du membre inférieur

In North America and Europe, the elderly represent the largest percentage of individuals with a below the knee amputation. The purpose of this thesis was to compare two types of prosthetic feet, the Solid Ankle Cushion Heel (SACH) foot and the Seattle Light (SEAT-L) foot in a group of elderly unilateral below knee amputees (EBKA) during walking at a natural cadence. Ten EBKA aged 70.4 « 9.5 years and 18 healthy elderly (HE) subjects aged 70.8 « 7.0 years participated in this study; selection criteria required that the EBKA demonstrate sufficient locomotor potential in order to benefit from the SEAT-L foot's energy return capability. The EBKA underwent an initial gait evaluation with the SACH foot, this was followed by an eight session gait retraining program specific to the SEAT-L foot. Upon completion of the gait program, the EBKA underwent a final gait evaluation with the SEAT-L foot. In order to serve as a reference group, the 18 HE subject's gait was also evaluated once."--Résumé abrégé par UMI

Biomechanical Assessment of Ertl and Burgess Transtibial Amputation Techniques

In this dissertation, a model was developed to predict the inertial properties of the shank and foot of persons with TTA and functional differences between Ertl and Burgess amputees during curb negotiation and the sit-to-stand tasks were evaluated. The developed inertial model was able to predict the shank and foot segment mass, COM location, and MOI more accurately than using the intact limb inertial properties. Used as inputs into inverse dynamics equations, the general model predictions produced joint moments which were also similar to the subject-specific measures. Thus, this model is a better predictor than the current method of using the intact limb inertial measures for the amputated limb. The second and third studies showed differences between the Ertl and Burgess amputated limbs in functional ability. During curb negotiation the Ertl amputated limb produced net limb work (sum of ankle, knee, and hip work) similar to that of the intact limbs of both groups on the curb step. This net limb work was produced by the hip early in stance phase as a compensatory mechanism to help propel the body forward. During the sit-to-stand task, the Ertl group was able to perform the task more quickly than the Burgess group. The faster performance time was due in part to larger ground reaction forces in the Ertl amputated limb compared to the Burgess amputated limb. This suggested the Ertl limb was able to bear higher loads overall during this task. While no other differences were found between the amputated limbs, the Ertl intact limb showed unexpected differences. Where the Burgess limbs and Ertl amputated limb adopted a hip strategy to complete the task, the Ertl intact limb adopted a knee strategy. This knee strategy is more similar to the way non-amputees complete the task. Both study 2 and 3 highlighted functional advantages of the Ertl procedure over the Burgess procedure for these tasks and is, to our knowledge, the first study of its kind. Based on these outcomes, it appears that the Ertl procedure does lead to better functional performance during prosthesis use, and further consideration should be given to using this procedure at the time of amputation. Future work needs to continue to focus on functional performance in both groups and begin to contrast the outcomes with post-operative risks following the amputation to better inform patients and clinicians about potential advantages of either technique

Scoliosis Analog Model for the Evaluation of Bracing Technology

Thoracolumbar braces are commonly used to treat Adolescent Idiopathic Scoliosis (AIS). Braces serve to reduce and prevent progression of the spinal curve by applying corrective forces. The magnitude and direction of these corrective forces applied by the brace to the spine remain unknown. Additionally the brace fitting process involves making alterations to the brace that affect its corrective force capacity. The objective was to design and validate an analog model of a mid-thoracic single curve scoliotic deformity for quantifying structural properties of the brace and the force response of the brace on the spine. This model was used to investigate the effects of strap-related brace design alterations. Additionally, the model was customized and demonstrated to be representative of a clinical case study. A novel mechanically-equivalent analog model of the AIS condition was designed and developed to simulate up to 40 degrees of spinal correction. The linkage-based model was used in conjunction with a biorobotic testing platform to test a scoliosis brace. Measurements of the force components applied to the model and angular displacement of the linkage assembly were used to calculate the brace structural stiffness properties. The brace was tested using two types of straps (Velcro and buckle) applied in various configurations and compared to an unconstrained configuration and rigidly constrained configuration to demonstrate the capacity of the model to study brace design alterations. Calculated stiffness was expressed as a resistive force relative to the angular change of the linkage system. Addition of either strap type significantly increased the stiffness values relative to the unconstrained configuration. An optimal brace radial stiffness was achieved with three Velcro straps, i.e., there was no significant stiffness gained by adding a fourth strap. For the case of the buckle straps, no significant stiffness gain occurred when more buckle straps were added. Structural properties provide a means to compare bracing technology and better understand design features. The testing of design alterations, i.e. variable strap configurations, show a measureable difference in brace force response and structural properties between each configuration. Also, interpretation of the measured force components revealed that the brace applied inward and upward forces to the spine. A novel scoliosis analog model and testing assembly were developed to provide first time measures of the forces applied to the spine by a thoracolumbar brace. In addition to quantifying brace structural properties, this test assembly could be used as a design and testing tool for scoliosis brace technology

Design and Evaluation of a Novel Ankle Joint for an Ankle Foot Orthosis for Individuals with Drop-Foot

Individuals who have had a stroke often ambulate with an ankle foot orthosis (AFO) to treat drop-foot, a common impairment preventing active ankle dorsiflexion. AFOs limit ankle plantarflexion or drop-foot, but also restrict ankle motion that introduces additional gait pathologies during ambulation. The goal of this study was to design a mechanical ankle joint for an articulated thermoplastic AFO to permit enhanced motion during stance. This novel ankle joint operated in two stages: 1) locked during swing to prevent drop-foot and 2) unlocked during stance to allow motion. This novel ankle joint was first tested with able-bodied subjects to ensure device function and safety, subsequent testing was conducted with post-stroke subjects to determine whether the novel design contributed to functional improvements during walking. Three able-bodied (23-26 years) and three post-stroke individuals (52-67 years) were recruited to complete custom AFO casting, fitting, and testing sessions with conventional and novel orthotic ankle joints. Testing included overground and variable slope treadmill walking trials. These gait analyses incorporated motion capture and kinetic data to calculate spatiotemporal, kinematic, and joint moment data. A survey was administered after testing to determine subject perception of the novel ankle joint in terms of comfort, walking performance, and perceived exertion. Paired t-tests were conducted to identify significant differences between orthotic ankle joint conditions.Significant differences between ankle joint conditions were observed for stance duration, step length, and ankle plantarflexion during swing. Stance duration and step length increased for the paretic limb, and corresponding improved inter-limb symmetry for level and non-level terrain. Ankle plantarflexion during swing with the novel ankle joint was controlled, providing adequate foot clearance and increased ankle range of motion during early stance. These improvements in ankle mobility, however, did not contribute to consistent improvements in hip kinematics, nor significant differences in knee and hip kinetics.Design refinement is recommended to support joint tuning and accommodate greater variation in spring stiffnesses. This novel orthotic ankle joint demonstrates promise and clinical potential to treat post-stroke individuals with drop-foot

Motor Ability Assessment in Lower-Limb Amputees

This work investigates the necessary aspects for the motor ability assessment in persons with lower-limb amputation, following the evaluation approaches suggested by the World Health Organization. In the specific case of the lower-limb amputee patient, the assessement can be articulated on two different levels: a first general, concerning the motor ability and quality of life as a function of that (level of independence), and a second local one, concerning the specificity of each single prosthetic module which composes the entire prosthetic chain, in the relationship with the user's motor function. The general purpose is therefore to provide fact-finding and operational tools in order to identify an accurate and reliable methodology for the motor ability assessment of prosthetized lower-limb amputees, both during gait and stereotypic locomotor tasks. This methodology is intended to constitute a valid and conventionally recognized reference for the amputee rehabilitation team, both for the functional patient assessment and for the technical-clinical evaluation of the prosthetic modules used. The perspective purpose is to verify the extractability of parameters particulary sensitive to the variability of clinical aspects related to the the lower-limb amputee motor ability, that can therefore be measured by a simple, low cost, wearable instrumentation, making them intelligible and useful to the clinical team and exportable in a remote supervision context. The main aims of the present thesis can be summarized in: 1. Identification of parameters of evaluation sensitive to the motor ability changes in lower-limb amputee subjects; 2. Definition of experimental methodological protocols ad hoc for the functional evaluation of the subject and for the appropriateness of the single prosthetic components. The research activity of the present thesis has been oriented on different works, each of which presents various peculiar aspects for the identification of specific indices for the assessment of the lower-limb amputee’s motor ability

Biomechanical study of rigid ankle-foot orthoses in the treatment of stroke patients

Error on title page, date of award is 2021.Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed for stroke patients who exhibit equinovarus deformity as an orthotic intervention. The main purpose of prescribing a rigid AFO is to provide appropriate control of unwanted ankle and foot motions in any plane. To achieve the optimal effects of the AFO, appropriate stiffness and alignment optimisation (tuning) should be considered. The AFO provides moments (referred to as the orthotic moments) to control ankle motion. Orthotic moments are different from the moments generated by ground reaction forces, the later are known as total ankle moments. Reviewing the literature showed limited research in this area. The aims of this study are to investigate the biomechanical effects of using rigid AFO (before and after tuning) and to investigate the orthotic moment during walking in stroke patients. Gait data were collected from six stroke participants (2 females, 4 males) and six healthy participants (3 females, 3 males) using a Motekforce Link dual belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant was fitted with a custom made rigid AFO instrumented using four strain gauges. Walking at a self-selected speed was investigated while wearing: (1) Standard shoes only (2) Rigid AFO with standard shoes (3) Rigid Tuned-AFO with standard shoes. Lower limb temporal-spatial, kinetic and kinematic parameters, and electromyographic activity (Delsys TrignoTM) of the knee muscles were compared among the test conditions. The orthotic moments were also quantified using the strain gauges data combined with gait analysis. Repeated measures ANOVA and Friedman’s ANOVA were used for statistical analysis. The rigid AFO showed immediate improvement in the temporal-spatial parameters and the kinematics and the kinetics of post stroke gait. Greater improvement in knee kinematics and kinetics was achieved when tuning the rigid AFO. The rigid AFO (before and after tuning) increased quadriceps muscle activity and reduced hamstring muscle activity compared to walking with standard shoes only. Tuning a rigid AFO further increased quadriceps muscle activity and reduced hamstring muscle activity compared to AFO before tuning. Strain gauges data combined with gait analysis can be used in evaluating the orthotic moment around the ankle in sagittal and frontal planes. Tuning a rigid AFO had no clear changes in the orthotic moment, and it did not alter the anatomical moments at the ankle joint in sagittal and at the subtalar joint in frontal plane.Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed for stroke patients who exhibit equinovarus deformity as an orthotic intervention. The main purpose of prescribing a rigid AFO is to provide appropriate control of unwanted ankle and foot motions in any plane. To achieve the optimal effects of the AFO, appropriate stiffness and alignment optimisation (tuning) should be considered. The AFO provides moments (referred to as the orthotic moments) to control ankle motion. Orthotic moments are different from the moments generated by ground reaction forces, the later are known as total ankle moments. Reviewing the literature showed limited research in this area. The aims of this study are to investigate the biomechanical effects of using rigid AFO (before and after tuning) and to investigate the orthotic moment during walking in stroke patients. Gait data were collected from six stroke participants (2 females, 4 males) and six healthy participants (3 females, 3 males) using a Motekforce Link dual belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant was fitted with a custom made rigid AFO instrumented using four strain gauges. Walking at a self-selected speed was investigated while wearing: (1) Standard shoes only (2) Rigid AFO with standard shoes (3) Rigid Tuned-AFO with standard shoes. Lower limb temporal-spatial, kinetic and kinematic parameters, and electromyographic activity (Delsys TrignoTM) of the knee muscles were compared among the test conditions. The orthotic moments were also quantified using the strain gauges data combined with gait analysis. Repeated measures ANOVA and Friedman’s ANOVA were used for statistical analysis. The rigid AFO showed immediate improvement in the temporal-spatial parameters and the kinematics and the kinetics of post stroke gait. Greater improvement in knee kinematics and kinetics was achieved when tuning the rigid AFO. The rigid AFO (before and after tuning) increased quadriceps muscle activity and reduced hamstring muscle activity compared to walking with standard shoes only. Tuning a rigid AFO further increased quadriceps muscle activity and reduced hamstring muscle activity compared to AFO before tuning. Strain gauges data combined with gait analysis can be used in evaluating the orthotic moment around the ankle in sagittal and frontal planes. Tuning a rigid AFO had no clear changes in the orthotic moment, and it did not alter the anatomical moments at the ankle joint in sagittal and at the subtalar joint in frontal plane

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses