Effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions: A scoping review

Background In the field of orthotics, the use of three-dimensional (3D) technology as an alternative to the conventional production process of orthoses is growing. Purpose This scoping review aimed to systematically map and summarize studies assessing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions, and to identify knowledge gaps. Methods The Cochrane Library, PubMed, EMBASE, CINAHL, Web of Science, IEEE, and PEDro were searched for studies of any type of 3D-printed orthoses for traumatic and chronic hand conditions. Any outcome related to the effectiveness of 3D-printed orthoses was considered. Two reviewers selected eligible studies, charted data on study characteristics by impairment type, and critically appraised the studies, except for case reports/series. Results Seventeen studies were included: Four randomized controlled trials, four uncontrolled trials, four case series and five case reports. Only three studies had a sample size >20. Impairments described were forearm fractures (n = 5), spasticity (n = 5), muscle weakness (n = 4), joint contractures (n = 2) and pain (n = 1). Four poor to fair quality studies on forearm fractures supported the effectiveness of 3D-printed orthoses on hand function, functionality, and satisfaction. One good quality study on spasticity demonstrated the effectiveness of 3D-printed orthoses on hand function. One poor quality pain study reported limited positive effects on satisfaction. Studies on muscle weakness and joint contractures showed no benefits. Conclusion Current literature addressing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions consists primarily of small and poor methodological quality studies. There is a need for well-designed controlled trials including patient-related outcomes, production time and cost analyses

Selección de materiales para el diseño de ortesis aplicando Métodos Multicriterios, Simulación y Optimización Topológica

Currently, one of the main causes of morbidity in Ecuador are fractures in the forearm section in adolescents, using plaster for patient recovery, causing difficulty of movement and skin irritation. An alternative to this device is 3D printed orthoses, which meet the main characteristics of stability, rigidity, and density. In this research, the design of an orthosis was conducted using material selection, simulation, and topological optimization. It was determined that the optimal material is PLA, while in the simulation it was obtained that the minimum thickness of the orthosis is 4 mm, meeting the requirements of allowable stresses and deformations for the four movements exerted by the wrist, as well as a representative reduction of 9.58% of mass of the preliminary design during the topological optimization.En la actualidad, una de las principales causas de morbilidad en el Ecuador son las fracturas producidas en la sección del antebrazo en adolescentes empleándose yeso para la recuperación del paciente, provocando dificultad de movimiento e irritaciones sobre la piel. Una alternativa a este dispositivo son las ortesis impresas en 3D, las cuales cumplen con características principales de estabilidad, rigidez y densidad. En esta investigación se realizó el diseño de una ortesis empleando la selección de material, simulación y optimización topológica. Se determinó que el material óptimo es el PLA, mientras que en la simulación se obtuvo que el espesor mínimo de la ortesis es de 4 mm, cumpliendo con los requerimientos de esfuerzos y deformaciones admisibles para los cuatro movimientos que ejerce la muñeca, así como una reducción representativa del 9,58% de masa del diseño preliminar durante la optimización topológica

A data-driven method to reduce excessive contact pressure of hand orthosis using a soft sensor skin

Discomfort under customised hand orthosis has been commonly reported in clinics due to excessive contact pressures, leading to low patient adherence and decreased effectiveness of orthosis. However, the current orthosis adjustment by clinicians to reduce pressures based upon subjective feedback from patients is inefficient and prone to variability. Therefore, a quantitative method to guide orthosis adjustment was proposed here by developing a data-driven method. Firstly, Verbal Protocol Analysis was employed to convert the implicit process of orthosis customisation into working models of clinicians. Relevant data to inform a new solution development to reduce excessive contact pressure were extracted from the working models in terms of time consumption and iterations of tasks. Secondly, a new soft sensor skin with strategically placed sensing units to measure static contact pressures under hand orthoses was developed. Finite element simulations were conducted to reveal the required contact pressure range (0.02 – 0.078 MPa) and the distribution of relatively high pressures in 12 key areas. A new fabrication method was proposed to produce the sensor skin, which was then characterised and tested on the subject. The results show that the sensor unit has a pressure range from 0.01 MPa to 0.1 MPa with the maximum repeatability error of 6.4% at 0.014 MPa, and the maximum measurement error of 8.26% at 0.023 MPa. Thirdly, a new method was proposed to predict contact pressures associated with the moderate level of discomfort at critical spots under hand orthoses. 40 patients were recruited to collect contact pressures under two types of orthoses using the sensor skin, and their discomfort perceptions were measured with a categorical scale. Based on these data, artificial neural networks for five identified critical spots on the hand were built to predict pressure thresholds that clinicians can use to adjust orthoses, thus reducing excessive contact pressures. The neural networks show satisfactory prediction accuracy with R2 values over 0.89 of regression between network outputs and measurements. Collectively, this thesis proposed a novel method for clinicians to adjust orthoses quantitatively and reduce the need for subjective assessment for patients. It provided a platform to further investigate the pressure for patients with other conditions.Open Acces

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

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

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

Development of a Wearable Mechatronic Elbow Brace for Postoperative Motion Rehabilitation

This thesis describes the development of a wearable mechatronic brace for upper limb rehabilitation that can be used at any stage of motion training after surgical reconstruction of brachial plexus nerves. The results of the mechanical design and the work completed towards finding the best torque transmission system are presented herein. As part of this mechatronic system, a customized control system was designed, tested and modified. The control strategy was improved by replacing a PID controller with a cascade controller. Although the experiments have shown that the proposed device can be successfully used for muscle training, further assessment of the device, with the help of data from the patients with brachial plexus injury (BPI), is required to improve the control strategy. Unique features of this device include the combination of adjustability and modularity, as well as the passive adjustment required to compensate for the carrying angle

Design of Customized TPU Lattice Structures for Additive Manufacturing: Influence on the Functional Properties in Elastic Products

[Abstract] This work focuses on evaluating and establishing the relationship of the influence of geometrical and manufacturing parameters in stiffness of additively manufactured TPU lattice structures. The contribution of this work resides in the creation of a methodology that focuses on characterizing the behavior of elastic lattice structures. Likewise, resides in the possibility of using the statistical treatment of results as a guide to find favorable possibilities within the range of parameters studied and to predict the behavior of the structures. In order to characterize their behavior, different types of specimens were designed and tested by finite element simulation of a compression process using Computer Aided Engineering (CAE) tools. The tests showed that the stiffness depends on the topology of the cells of the lattice structure. For structures with different cell topologies, it has been possible to obtain an increase in the reaction force against compression from 24.7 N to 397 N for the same manufacturing conditions. It was shown that other parameters with a defined influence on the stiffness of the structure were the temperature and the unit size of the cells, all due to the development of fusion mechanisms and the variation in the volume of material used, respectivel

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs