Mass Customization of Foot Orthosis for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory disease, which can cause pain, stiffness, and swelling in the joints of hands and feet. The foot is a major site for RA involvement and a major source of disability resulting from this disease. This paper introduces research which aims to create a mass customisation process for customised orthoses for patients with RA. 3D laser scanning, and gait analysis will be used to generate the orthosis geometry and rapid manufacturing, namely the selective laser sintering (SLS) process, will be used to produce the orthoses. The SLS process enables the incorporation of compositional functional elements, such as locally adjusted stiffness or flexibility, into the orthosis design. The process involved two central elements. The first was a literature survey to identify orthotic design rules for foot impairments in RA. This survey will form a platform for the design rule development and will be complemented by data obtained from two patient trials. The second is a virtual three-segment foot model, created in Anybody dynamics modelling software which can be motivated by data measured from patients using 3D motion capture and force plate systems. Once the measured data has been applied to the model, a virtual insole can be used to simulate the effects of various features in the orthosis. Considerable variation was noted in the literature for types of material, design and methods of orthotic construction. Pressure redistribution using cushioning materials was consistently mapped to painful deformed joints. Orthoses with contoured surfaces, either custom- or mass produced in thermoplastic materials of varying stiffness and density were mapped to joint motion control and deformity prevention. The paper will also describe applying patient gait data to the Anybody model, and then altering the gait pattern by applying the insole model. Future work will also be discussed.Mechanical Engineerin

The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series

BACKGROUND Foot involvement occurs early in rheumatoid arthritis but the extent to which this impacts on the structure and function leading to impairment and foot related disability is unknown. The purpose of this study was to compare clinical disease activity, impairment, disability, and foot function in normal and early rheumatoid arthritis (RA) feet using standardised clinical measures and 3D gait analysis. METHODS Twelve RA patients with disease duration ≤2 years and 12 able-bodied adults matched for age and sex underwent 3D gait analysis to measure foot function. Disease impact was measured using the Leeds Foot impact Scale (LFIS) along with standard clinical measures of disease activity, pain and foot deformity. For this small sample, the mean differences between the groups and associated confidence intervals were calculated using the t distribution RESULTS Moderate-to-high foot impairment and related disability were detected amongst the RA patients. In comparison with age- and sex-matched controls, the patients with early RA walked slower (1.05 m/s Vs 1.30 m/s) and had a longer double-support phase (19.3% Vs 15.8%). In terminal stance, the heel rise angle was reduced in the patients in comparison with normal (-78.9° Vs -85.7°). Medial arch height was lower and peak eversion in stance greater in the RA patients. The peak ankle plantarflexion power profile was lower in the patients in comparison with the controls (3.4 W/kg Vs 4.6 W/kg). Pressure analysis indicated that the RA patients had a reduced lesser toe contact area (7.6 cm2 Vs 8.1 cm2), elevated peak forefoot pressure (672 kPa Vs 553 kPa) and a larger mid-foot contact area (24.6 cm2 Vs 19.4 cm2). CONCLUSION Analysis detected small but clinically important changes in foot function in a small cohort of RA patients with disease duration <2 years. These were accompanied by active joint disease and impairment and disability

Topics in student-coach reflective journals : a study on coach reflection during undergraduate internships

Le Baccalauréat en Intervention Sportive (BIS) de l’Université Laval est un programme qui se spécialise dans la formation des entraineurs sportifs et qui comprend trois stages dans son curriculum. Durant leurs stages, les étudiants-entraineurs doivent compléter un journal réflexif. L’objectif de cette étude est d’identifier les sujets que les étudiants-entraineurs abordent dans leurs journaux réflexifs de stage durant une période de deux ans. Les données proviennent des journaux de six étudiants-entraineurs et démontrent le répertoire des sujets abordés par le biais de thèmes émergents. Les résultats offrent un regard sur les expériences de ces six entraineurs et suggèrent que ces entraineurs novices ont écrit plus souvent sur les actions – celles de leur mentor et les leurs. En exprimant leur accord ou leur désaccord (en écrivant qu’ils auraient agi différemment que leurs mentors) avec les actions de leurs mentors, ils ont abordé les thèmes de planification à court terme, de planification à long terme et d’enseignement en situation de pratique. En situation de compétition, ils ont abordé les thèmes choix de stratégie, management du jeu et motivation des athlètes. En exprimant leur accord avec leurs propres actions, ils ont abordé les thèmes de planification à court terme/enseignement, leur initiative/leadership, et les liens établis avec les athlètes. En exprimant leur désaccord avec leurs propres actions (en indiquant qu’ils agiraient différemment la prochaine fois), ils ont abordé les thèmes de planification à court terme/enseignement et leur initiative/leadership. En écrivant sur leurs actions, ils ont aussi proposé des actions qu’ils devront entreprendre et qui touchent trois objectifs : contribuer à leur apprentissage, élargir leur champ de compétences, et améliorer leur enseignement. Ces conclusions principales suggèrent que les réflexions des étudiants-entraineurs sont stimulées par l’action et qu’ils semblent juger ces actions en fonction d’un cadre de référence implicite sur l’efficacité de l’entrainement sportif. Les résultats contribuent à la recherche empirique actuellement limitée sur l’entraineur comme praticien réflexif en offrant des informations sur ce que les entraineurs novices remarquent. Ces résultats constituent un point de départ afin de mieux comprendre comment ils perçoivent la pratique complexe qu’est l’entrainement sportif ainsi qu’un premier pas important pour amorcer un processus réflexif. Le BIS offre un milieu avantageux pour étudier la pratique réflexive des entraineurs novices en contexte développemental. Cette population d’entraineurs, outre qu’au BIS, est transitoire et davantage bénévole, ce qui rend la recherche sur leur développement un défi. Cette étude représente le début d’une piste de recherche sur comment les entraineurs en contexte développemental apprennent à entrainer, et plus particulièrement sur leur développement comme praticiens réflexifs.The Baccalauréat en Intervention sportive (BIS) is a three-year, undergraduate program at Université Laval that specializes in coach education and includes three internships as part of its curriculum. During their internships, student-coaches were required to complete a reflective journal. The objective of this study was to identify the topics the student-coaches chose to write about in their reflective journals during their two-year internships in the BIS. Data were gathered from the journal entries of six novice student-coaches of team sports over two seasons, showing the breadth and the reoccurrence of topics by way of emerging themes. The results offered insight into the experiences of these novice student-coaches and suggested that they most often write about actions – their mentor coaches’ and their own. Through agreeing or disagreeing (saying they would do something differently than their mentor) with their mentors’ actions, they wrote about short-term planning, long-term planning and teaching in practice situations, and in game situations about choice of strategy, game management and motivating athletes. When agreeing with their own actions they wrote about short-term planning/teaching choices, taking initiative/showing leadership, and connecting with athletes. When disagreeing with their own actions (saying they would do something differently next time) they wrote about short-term planning/teaching choices and taking initiative/showing leadership. When writing about their own actions, they also proposed actions they should take that communicated three objectives: to enhance their learning, to broaden their competencies, and to improve their teaching. These principle conclusions suggest that the student-coaches notice actions as triggers for their reflection, and that they seem to judge the actions they notice against an implicit vision of coaching effectiveness. They contribute to the limited empirical research on the coach as a reflective practitioner by providing insight into what novice coaches notice, a starting point for better understanding how they see the complex practice that is coaching, and an important first step in beginning a reflective process. The principle advantage that the BIS internships can offer is a context in which to investigate reflective practice with novice developmental coaches. This coaching population, outside of the BIS context, is transient and mostly volunteer-based, making research on their development a challenge. This study is the first of what will be a sustained line of inquiry on how development coaches learn to coach, and more specifically on their development as reflective practitioners

Elevation of the Diaphragm; Unilateral Phrenic Paralysis: A Radiological Study, with Special Reference to the Differential Diagnosis

My thesis is mainly a radiological study of Elevation of the diaphragm with some observations on the differential diagnosis. I have added to the title that of Unilateral phrenic paralysis for two reasons; firstly, I hope to show during the course of this paper that certain forms of congenital elevation of the diaphragm are probably due to a unilateral phrenic paralysis, and secondly, to present for consideration a number of cases in which paralysis of one or other leaflet of the diaphragm was caused by a definite pathological lesion involving the phrenic nerve in its pasage through the thorax

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off-the-Shelf in Rheumatoid Arthritis]

Abstract Background Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months. Methods/design This is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken. Discussion Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future. Trial registration ISRCTN13654421. Registered 09 February 2016

A review of urban consolidation centres in the supply chain based on a case study approach

The paper considers how urban consolidation centres (UCCs) can be used in the supply chain to reduce goods vehicle traffic and its associated environmental impacts, while also helping to make supply chains more responsive and efficient and thereby generate commercial benefits. The role of UCCs is presented and the various types discussed. The potential supply chain impacts of UCCs are considered. Case studies of six UCC schemes and trials are included, with their objectives, operational characteristics and impacts compared. The critical success factors associated with UCCs are identified