Functional Comparison of Conventional AFOs with the Dynamic Response AFO

Ankle foot orthoses (AFOs) are commonly prescribed to provide stability and foot clearance for patients with weakened or injured musculature. The Dynamic Response AFO (DRAFO) was designed to improve proprioception at heel strike. The design includes a rigid outer shell with a cut out heel and a soft inner lining; it is typically aligned in plantarflexion and may incorporate external heel wedges. The objective of this study was to investigate the effects of the DRAFO design features and contrast its biomechanical function with that of conventional locked and articulating AFOs. The research hypotheses were: 1) DRAFO-assisted gait parameters (e.g. ankle plantarflexion during early stance, cross-over times of the shank and thigh vertical angles during stance, step width, dorsi activity duration during stance, and center of pressure progression during loading response) will approximate the no AFO condition and 2) DRAFO-assisted gait parameters (e.g. ankle and knee kinematics, cross-over times of the shank and thigh vertical angles during stance, peak foot progression angle, step width, stance phase dorsiflexion activity duration, and mediolateral motion of the center of pressure) will differ from the locked and articulating AFOs. Ten young healthy subjects were recruited for gait analyses during level treadmill walking; four AFO conditions were contrasted. After five minutes of AFO and treadmill acclimation, each subject walked for two minutes at the self-selected walking speed on a level treadmill. Acquired data included lower extremity joint and segment kinematics, dorsiflexion and plantarflexion muscle activity, and treadmill kinetic data. Ambulation in the DRAFO demonstrated significantly greater knee flexion and ankle plantarflexion than with conventional AFOs, the foot progression angle was reduced in the DRAFO relative to the no AFO condition, the center of pressure progression for the DRAFO was more medial than that observed during the no and articulating AFO conditions, and the time to transition from an inclined to a reclined shank during swing was delayed. These findings suggest that the plantarflexed alignment, external heel wedges, and perhaps the soft heel features of the DRAFO design affect lower limb joint and segment kinematics, while the rigid structure provides stability to the ankle and subtalar joints

Mobile, Game-Based Training for Myoelectric Prosthesis Control

Myoelectric prostheses provide upper limb amputees with hand and arm movement control using muscle activity of the residual limb, but require intensive training to effectively operate. The result is that many amputees abandon their prosthesis before mastering control of their device. In the present study, we examine a novel, mobile, game-based approach to myoelectric prosthesis training. Using the non-dominant limb in a group of able-bodied participants to model amputee pre-prosthetic training, a significant improvement in factors underlying successful myoelectric prosthesis use, including muscle control, sequencing, and isolation were observed. Participants also reported high levels of usability, and motivation with the game-based approach to training. Given fiscal or geographic constraints that limit pre-prosthetic amputee care, mobile myosite training, as described in the current study, has the potential to improve rehabilitation success rates by providing myosite training outside of the clinical environment. Future research should include longitudinal studies in amputee populations to evaluate the impact of pre-prosthetic training methods on prosthesis acceptance, wear time, abandonment, functional outcomes, quality of life, and return to work

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

Background: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness, skills such as social functioning and play, participation outcomes such as social inclusion, and parent and family impact. Objectives: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. Methods: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013, systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD, and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. Results: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184, in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular,there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). Conclusions: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. Future work: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. Study registration: This study is registered as PROSPERO CRD42012002223. Funding: The National Institute for Health Research Health Technology Assessment programme