The physiological cost index of walking with a powered knee ankle foot orthosis in subjects with poliomyelitis : A pilot study

Background: A powered knee ankle foot orthosis (KAFO) was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. Objectives: The purpose of this study was to determine its effect on the physiological cost index (PCI), walking speed and the distance walked in people with poliomyelitis compared to when walking with a KAFO with drop lock knee joints. Methods: Seven subjects with poliomyelitis volunteered for the study, and undertook gait analysis with both types of KAFO. Results: Walking with the powered KAFO significantly reduced walking speed (p=0.015) and the distance walked (p=0.004), and also it did not improve PCI values (p =0.009) compared to walking with the locked KAFO. Conclusion: Using a powered KAFO did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects

Comparison of the efficacy of a neutral wrist splint and wrist splint with lumbrical unit for the treatment of patients with carpal tunnel syndrome

Purpose: The purpose of this study was to compare the effect of a neutral wrist splint or a wrist splint with an additional metacarpophalangeal (MCP) unit on pain, function, grip and pinch strength in patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Twenty four patients received conservative treatment using either the neutral wrist splint or wrist splint with the MCP unit for a period of 6 weeks. Primary outcome measures were pain, function, grip and pinch strength. Data was collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and independent T-test. Results: Compared to baseline, both the neutral wrist splint and the wrist splint with an MCP unit significantly decreased pain, increased function and pinch and grip strength. Comparisons of the two types of splints for grip (P =0.675) and pinch strength (P =0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P =0.022) and the DASH score (P =0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with an MCP unit was more effective than the neutral wrist splint in pain reduction and improvement of function

Evaluation of gait symmetry in poliomyelitis subjects : Comparison of a conventional knee ankle foot orthosis (KAFO) and a new powered KAFO.

Background: Compared to able-bodied subjects, subjects with post polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. Objectives: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop- locked knee ankle foot orthosis (KAFO) or a newly developed powered KAFO. Methods: Seven subjects with poliomyelitis who routinely wore conventional KAFOs participated in this study, and received training to enable them to ambulate with the powered KAFO on level ground, prior to gait analysis. Results: There were no significant differences in the gait symmetry index (SI) of step length (P=0.085), stance time (P=0.082), double limb support time (P=0.929) or speed of walking (p=0.325) between the two test conditions. However, using the new powered KAFO improved the SI in step width (P=0.037), swing time (P=0.014), stance phase percentage (P=0.008) and knee flexion during swing phase (p≤0.001) compared to wearing the dropped locked KAFO. Conclusion: The use of a powered KAFO for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage and knee flexion during swing phase

Design, construction, and evaluation of �sensor lock�: an electromechanical stance control knee joint

Background and aim: Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost. Method: Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system. Results: For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users. Conclusions: The feasibility of this new knee joint with AB people was demonstrated.Implications for rehabilitation Stance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking. Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially. The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Design, construction, and evaluation of �sensor lock�: an electromechanical stance control knee joint

Background and aim: Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost. Method: Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system. Results: For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users. Conclusions: The feasibility of this new knee joint with AB people was demonstrated.Implications for rehabilitation Stance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking. Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially. The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Effect of prefabricated and custom- made splints on quality of life in the first carpometacarpal joint osteoarthritis

Background and Objective: The first carpometacarpal joint osteoarthritis reduced the ability of upper limb in elderly with subsequent disability in physical activities. This study was carried out to determine the effect of prefabricated and custom-made splints on quality of life in the first carpometacarpal joint osteoarthritis. Materials and Methods: This quasi-experimental study was done on 24 elderly (>60 years of age) patients with the first carpometacarpal joint osteoarthritis and 12 matched healthy subjects in Tehran rehabilitation University during 2010-11. Patients assigned randomly in two groups with 8 weeks treatment period, prefabricated thumb and custom-made splints. Persian version of The Short Form 36 quastioner (SF36) was used to assess the quality of life. Data were analyzed using SPSS-16 and paired t-test. Results: There were significant differences between osteoarthritis patients and healthy subjects in the quality of life according to SF36 score physical health problem (P<0.05), general health (P<0.05), limitations of activities (P<0.05), emotional health problem (P<0.05), social activities (P<0.05), pain (P<0.05), energy and emotions (P<0.05). Using splints significantly improved the quality of life of patients, but there was no significant difference between two splints in improving the quality of life. Conclusion: Prefabricated and custom-mad

The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis

Purpose: The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis (excessive spinal forward curvature) amongst elderly people. This condition can in turn impair mobility, reduce balance, and increase the risk of falling and mortality in affected individuals. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. However, there is little evidence that evaluates the use of corrective braces on foot pressure changes in these subjects. Methods: In this study, we evaluated the use of a thoracolumbosacral orthosis (TLSO) on 19 subjects over 60 years old who presented with hyperkyphosis. We measured foot pressure using the Pedar-X system before (without brace) and after (with brace) immediate using a TLSO in both static (quite standing) and dynamic (walking on a 5 meters freeway) scenarios. Results: The results demonstrated that using a TLSO immediately decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions. Hindfoot pressures were increased, but not significantly. Conclusion: This study showed that using a TLSO can be beneficial for elderly people with hyperkyphosis. Implications for rehabilitation The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. Using a TLSO decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions

The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis – a pilot study

Objective: When walking with an advanced reciprocating gait orthosis (ARGO), ankle and knee joint motion is restricted which causes an un-cosmetic gait compared to normal walking. The purpose of this study was to develop and evaluate a rocker modification for use with the ARGO in order to improve hip joint kinematics, walking speed, step length and cadence. Method: Spinal cord injury patients (n = 4) with thoracic-level injury participated in this study, and walked with a standard ARGO and one which was also adapted with a rocker sole in a randomized order. Results: Mean walking speed and step length were both significantly increased by volunteer SCI subjects when ambulating using the ARGO adapted with a rocker sole compared to the standard ARGO. Cadence was not significantly affected, but swing time was significantly reduced and mean hip flexion and extension were both significantly increased when walking with the adapted ARGO. Conclusion: The rocker sole modification produced an increase in walking speed and step length, and improved sagittal plane hip joint kinematics when ambulating using an ARGO. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard unmodified version. •Implications for Rehabilitation •The ARGO adapted with a rocker sole could be used by spinal cord injury patients. •A major advantage of the walking with the ARGO adapted with a rocker sole was increased of walking speed and step length, and improvement of the sagittal plane hip joint kinematics. •The findings of this study would appear to provide useful data for rehabilitation teams who utilize orthoses to walk and rehabilitate SCI subjects. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard un-modified version

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients.Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint.Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline.Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis

Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome

Background: Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. Objectives: The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Study design: Quasi experimental design. Methods: A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Results: Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. Clinical relevance A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel syndrome. © International Society for Prosthetics and Orthotics