Unloading shoes for intermittent claudication: a randomised crossover trial.

BACKGROUND: The purpose of this study was to assess the functional effects and acceptability of rocker-soled shoes that were designed to relatively "unload" the calf muscles during walking in people with calf claudication due to peripheral arterial disease. METHODS: In this randomised AB/BA crossover trial, participants completed two assessment visits up to two weeks apart. At each visit, participants completed walking tests whilst wearing the unloading shoes or visually-similar control shoes. At the end of the second visit, participants were given either the unloading or control shoes to use in their home environment for 2 weeks, with the instruction to wear them for at least 4 h every day. The primary outcome was 6-min walk distance. We also assessed pain-free walking distance and gait biomechanical variables during usual-pace walking, adverse events, and participants' opinions about the shoes. Data for continuous outcomes are presented as mean difference between conditions with corresponding 95% confidence interval. RESULTS: Thirty-four participants (27 males, mean age 68 years, mean ankle-brachial index 0.54) completed both assessment visits. On average, the 6-min walk distance was 11 m greater when participants wore the control shoes (95% CI -5 to 26), whereas mean pain-free walking distance was 7 m greater in the unloading shoes (95% CI -17 to 32). Neither of these differences were statistically significant (p = 0.18 and p = 0.55, respectively). This was despite the unloading shoes reducing peak ankle plantarflexion moment (mean difference 0.2 Nm/kg, 95% CI 0.0 to 0.3) and peak ankle power generation (mean difference 0.6 W/kg, 95% CI 0.2 to 1.0) during pain-free walking. The survey and interview data was mixed, with no clear differences between the unloading and control shoes. CONCLUSIONS: Shoes with modified soles to relatively unload the calf muscles during walking conferred no substantial acute functional benefit over control shoes. TRIAL REGISTRATION: Clinicaltrials.gov, Trial Registration Number: NCT02505503 , First registered 22 July 2015.

Effect of ankle-foot orthoses on the sagittal plane displacement of the center of mass in patients with stroke hemiplegia: a pilot study.

BACKGROUND: Ankle-foot orthoses (AFOs) have been reported to have positive effects on the temporal-spatial parameters and kinematics and kinetics of gait in patients with stroke. The center of mass (COM) may be used to represent whole body movement and energy cost in gait, and therefore COM movement would also be positively influenced with use of an appropriate AFO. OBJECTIVE: To investigate the effect of AFOs on the sagittal plane displacement of the COM in patients with stroke hemiplegia. METHODS: Five male subjects with stroke hemiplegia participated in this pilot study. The trajectory of the COM in the sagittal plane, gait speed, bilateral step length, step width, and bilateral stance time were analyzed while participants ambulated under 2 test conditions: with an AFO or with footwear only. The height of the 2 peaks of the vertical displacement of the COM in a gait cycle was subsequently measured and normalized to body height. Statistical analyses were conducted using a nonparametric Friedman test. RESULTS: Gait speed, bilateral step length, and the normalized peak height of the vertical COM trajectory during stance phase on the affected leg all revealed statistically significant increases (P < .05), and step width showed significant decreases (P < .05) under the AFO condition when compared to the footwear-only condition. CONCLUSIONS: An AFO may influence the vertical displacement of the COM in patients with stroke hemiplegia. The results of this pilot study therefore suggested that vertical movement of COM could potentially serve as a useful parameter to evaluate the effect of an AFO.

Evaluating the contribution of a neural component of ankle joint resistive torque in patients with stroke using a manual device.

PRIMARY OBJECTIVE: To investigate the methodology using a manual ankle joint resistive torque measurement device to evaluate the contribution of the neural component of ankle joint resistive torque in patients with stroke. RESEARCH DESIGN: Within-subject comparison to compare the ankle joint resistive torque between fast and slow stretching conditions. METHODS AND PROCEDURES: Ten patients with stroke participated in this study. The incremental ratio of ankle joint resistive torque at the ankle angular position of 5degrees dorsiflexion under the fast stretching condition in comparison to the slow one was calculated in each patient. MAIN OUTCOMES AND RESULTS: A significant increase (p<0.01) in the ankle joint resistive torque was demonstrated under the fast stretching condition in comparison to the slow one in all patients and the mean ankle joint resistive torque was 4.6 (SD=1.7) Nm under the slow stretching condition, while it was 8.4 (SD=4.1) Nm under the fast stretching condition at the ankle angular position of 5 degrees dorsiflexion. The incremental ratio ranged from 9.4-139.3% among the patients. CONCLUSIONS: The results of this study demonstrated the potential advantage of the device to evaluate the contribution of the neural component of ankle joint resistive torque.

Three-curve rocker-soled shoes and gait adaptations to intermittent claudication pain: A randomised crossover trial.

BACKGROUND: Intermittent claudication (IC) is a symptom of peripheral arterial disease where a cramp-like leg pain is exhibited during walking, which affects gait and limits walking distance. Specifically-designed rocker-soled shoes were purported to mechanically unload the calf musculature and increase walking distances until IC pain. RESEARCH QUESTIONS: Do three-curve rocker-soled shoes increase walking distance and what are the biomechanical differences during pain-free walking and IC pain-induced walking, when compared with control shoes? METHODS: Following NHS ethical approval, 31 individuals with claudication (age 69 ± 10 years, stature 1.7 ± 0.9 m, mass 83.2 ± 16.2 kg, ankle-brachial pressure index 0.55 ± 0.14) were randomised in this cross-over trial. Gait parameters whilst walking with rocker-soled shoes were compared with control shoes at three intervals of pain-free walking, at onset of IC pain (initial claudication distance) and when IC intensifies and prevents them walking any further (absolute claudication distance). Two-way repeated measures ANOVA were performed on gait variables. RESULTS: When compared with control shoes, rocker-soled shoes reduced ankle power generation (mean 2.1 vs 1.6 W/kg, respectively; p = 0.006) and altered sagittal kinematics of the hip, knee and ankle. However, this did not translate to a significant increase in initial (138 m vs 146 m, respectively) or absolute (373 m vs 406 m, respectively) claudication distances. In response to IC pain, similar adaptations in temporal-spatial parameters and the sagittal kinematics were observed between the shoe types. SIGNIFICANCE: The three-curved rocker shoes, in their current design, do not augment gait sufficiently to enhance walking distance, when compared with control shoes, and therefore cannot be recommended for the intermittent claudication population. Clinical Reg No. (ClinicalTrials.gov): NCT02505503.

Correlations between Berg balance scale and gait speed in individuals with stroke wearing ankle-foot orthoses - a pilot study.

PURPOSE: The Berg balance scale (BBS) is commonly used to assess balancing ability in patients with stroke. The BBS may be a good candidate for clinical assessment prior to orthotic intervention, if it correlates well with outcome measures such as gait speed. The purpose of this study was to investigate the correlation between the BBS measured prior to walking with an ankle-foot orthosis (AFO) and specific temporal-spatial parameters of gait when walking with an AFO donned. METHODS: Eight individuals with chronic stroke participated in this study. Balancing ability was assessed using the BBS, while temporal-spatial parameters of gait (gait speed, bilateral step length, stride length and step width) were measured using a three-dimensional motion analysis system. The correlations between the BBS and gait parameters were investigated using a non-parametric Kendall's Tau (τ) correlation analysis. RESULTS: The BBS showed correlations with gait speed (τ = 0.64, p < 0.05), the step length of the affected side (τ = 0.74, p < 0.05), and the stride length (τ = 0.64, p < 0.05). CONCLUSIONS: Assessment of the BBS prior to AFO prescription may potentially help clinicians to estimate the gait speed achievable following orthotic intervention in patients with stroke. Implications for Rehabilitation Assessment of the BBS prior to AFO prescription may help orthotists to estimate the gait speed following an orthotic intervention in patients with stroke. Assessment of the BBS prior to AFO prescription may help orthotists to understand overall balance and postural control abilities in patients with stroke. A larger scale multifactorial analysis is warranted to confirm the results of this pilot study.

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

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 or a newly developed powered knee-ankle-foot orthosis. STUDY DESIGN: Quasi experimental study. METHODS: Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis. RESULTS: There were no significant differences in the gait symmetry index 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 knee-ankle-foot orthosis improved the symmetry index 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 drop-locked knee-ankle-foot orthosis. CONCLUSION: The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase. CLINICAL RELEVANCE: A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis.

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.

The use of an adjustable electrode housing unit to compare electrode alignment and contact variation with myoelectric prosthesis functionality: A pilot study.

BACKGROUND: Usable myoelectric control relies on secure and intimate contact at all times between the electrode, the socket and the residual limb. At present, there is little post-fitting socket adjustment available to prosthetists with respect to electrode contact security or alignment. Failure to provide secure electrode contact could result in the development of motion artefacts, poor prehensor response and subsequent prosthesis non-usage. OBJECTIVES: To establish the effect of alteration to electrode contract security and alignment on prosthesis functionality using a bespoke electrode housing unit. STUDY DESIGN: This study investigated the effect of electrode contact security and alignment on upper limb myoelectric prosthesis functionality. METHODS: Four different electrode housing arrangements were assessed within prosthetic sockets fitted to six transradial prosthesis subjects using the Southampton Hand Assessment Procedure, which is a reliable and validated prosthesis functionality assessment tool. RESULTS: Significantly higher functionality scores were achieved with the bespoke housing unit compared to when using conventional electrode housings. CONCLUSION: Myoelectric prosthesis functionality is closely linked to electrode contact security and to electrode alignment with respect to the residual limb. Both of these factors can be improved locally using an adjustable electrode housing unit. CLINICAL RELEVANCE: Provision of an electrode housing system that enables adjustments to be made to electrode orientation can improve prosthesis functionality, particularly in cases where tight-fitting sockets are not possible, and/or where the prosthetist may be inexperienced with regard to myoelectric prosthesis fitting.

The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review.

BACKGROUND: Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented. OBJECTIVES: The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients. STUDY DESIGN: Literature review METHODS: According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria. RESULTS: The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee. CONCLUSION: Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis. CLINICAL RELEVANCE: Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis.

Effect of a new hand-forearm splint on grip strength, pain, and function in patients with tennis elbow.

BACKGROUND: While the effectiveness of orthoses prescribed for tennis elbow has been reported in several studies, the effect of how they may limit movements which aggravate this condition has not yet been explored. OBJECTIVE: The purpose of this study was to evaluate the effect of a new spiral hand-forearm splint that restricts the movement of the wrist and forearm, on grip strength, pain, and function in patients with tennis elbow. STUDY DESIGN: Quasi-experimental design. METHODS: A total of 15 patients with tennis elbow (mean age 43 years) took part in this study. The amount of pain, grip force, and function were compared using a visual analog scale, Jamar dynamometer, and the Disability of the Arm, Shoulder, and Hand questionnaire, respectively. This was performed at baseline and repeated after 4 weeks of splint use. Active motion of the forearm was measured by a goniometer. RESULTS: The spiral splint significantly relieved pain and improved function and grip force in patients after 4 weeks of application (P < 0.05). CONCLUSION: The new splint design had a positive effect on the treatment of tennis elbow symptoms which included pain, grip strength, and function. Restriction of rotational movement (e.g. reduction of the supination and pronation of forearm) may have played the main role in this. CLINICAL RELEVANCE: This new splint design may be considered as a new approach in the conservative treatment and rehabilitation of patients with tennis elbow.

The gait and energy efficiency of stance control knee-ankle-foot orthoses: A literature review.

BACKGROUND: The use of knee-ankle-foot orthoses with drop locked knee joints produces some limitations for walking in subjects with quadriceps muscle weakness. The development of stance control orthoses can potentially improve their functionality. OBJECTIVES: The aim of this review was to compare the evidence of the effect of stance control orthoses to knee-ankle-foot orthoses with drop locked knee joints in improving kinematic variables and energy efficiency of walking by subjects with quadriceps muscle weakness caused by different pathologies. STUDY DESIGN: Literature review. METHODS: Based on selected keywords and their composition, a search was performed in Google Scholar, PubMed, ScienceDirect, and ISI Web of Knowledge databases. In total, 18 articles were finally chosen for review. RESULTS: The results of this study demonstrated that this type of orthosis can improve the walking parameters of subjects with quadriceps muscle weakness and spinal cord injury patients when compared to a locked knee-ankle-foot orthosis. CONCLUSION: There is evidence to show that stance control orthosis designs improve the gait kinematics but not energetic of knee-ankle-foot orthosis users. Development of new designs of stance control orthoses to provide a more normal pattern of walking is still required. CLINICAL RELEVANCE: Stance control orthoses are a new generation of orthotic intervention that could potentially be significant in assisting to improve the gait kinematics by knee-ankle-foot orthosis users.

A systematic review of the effect of foot orthoses and shoe characteristics on balance in healthy older subjects.

BACKGROUND: Foot orthoses are used to optimize lower extremity function and can improve postural stability by enhancing the afferent somatosensory feedback available to the central nervous system. OBJECTIVE: The aim of this review was to evaluate the effect of foot orthoses on balance control in older subjects. STUDY DESIGN: Systematic review. METHODS: The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases by using selected keywords. A total of 22 articles were selected for final evaluation. RESULTS: The results demonstrated that older people should be advised to wear thin, hard-soled footwear with high collars to reduce the risk of falling. The findings for insoles demonstrated an increase in balance control via vibratory or magnetic insoles, but textured insoles do not appear to be beneficial for balance improvement. CONCLUSION: Foot orthoses improve postural stability via a somatosensory or biomechanical effect. Use of footwear with the proper features can be an appropriate intervention in order to increase the balance in the older population and reduce falls. CLINICAL RELEVANCE: Loss of balance is an important factor in increasing the risk of falling in older subjects. Foot orthoses can improve functional measures of stability in older adults. In this review, results from studies suggest a number of recommendations regarding the optimal footwear for older people to reduce the risk of falling.

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 was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. OBJECTIVE: The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints. STUDY DESIGN: Quasi experimental study. METHODS: Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis. RESULTS: Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis. CONCLUSION: Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. CLINICAL RELEVANCE: This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted.

Comparison of gait between healthy participants and persons with spinal cord injury when using the advanced reciprocating gait orthosis.

BACKGROUND: The advanced reciprocating gait orthosis (ARGO) has a rigid structure which provides restricted movement at the hip, knee, and ankle joints and incorporates a pelvic section with an extended section in the lumbar region. Healthy subjects, when walking with an RGO in situ, could feasibly demonstrate the level of limitation in movement imposed by ARGO-assisted ambulation. OBJECTIVE: The aim of this study was to compare the function of the advanced reciprocating gait orthosis when fitted with the dorsiflexion-assist ankle-foot orthoses on temporal-spatial parameters and kinematics of walking in both able-bodied people and those with spinal cord injury. STUDY DESIGN: Quasi experimental design. METHODS: Data were acquired from six able-bodied and four spinal cord injury subjects who used an advanced reciprocating gait orthosis which incorporated dorsiflexion-assist ankle-foot orthoses. Kinematics and temporal-spatial parameters were calculated and compared. RESULTS: All able-bodied individuals walked with speeds which were only approximately one-third that of when walking without an orthosis. The mean step length and cadence were both reduced by 48% and 6%, respectively. There were significant differences in hip, knee, and ankle joint range of motions between normal walking and walking with the advanced reciprocating gait orthosis both in able-bodied subjects and patients with spinal cord injury. There were also significant differences in the speed of walking, cadence, step length, hip range of motion, and ankle range of motion when using the advanced reciprocating gait orthosis between the two groups. CONCLUSION: Temporal-spatial parameters and lower limb sagittal plane kinematics of walking were altered compared to normal walking, especially when spinal cord injury subjects walked with the advanced reciprocating gait orthosis compared to the able-bodied subjects. CLINICAL RELEVANCE: To produce an improvement in RGO function, an increase in walking performance should involve attention to improvement of hip, knee, and ankle joint kinematics, which differs significantly from normal walking.

The influence of thermoplastic thoraco lumbo sacral orthoses on standing balance in subjects with idiopathic scoliosis.

BACKGROUND: Idiopathic scoliosis patients have postural equilibrium problems. OBJECTIVE: The objective of this study was to assess postural control in subjects with idiopathic scoliosis following a 4-month intervention in an unbraced position. STUDY DESIGN: Quasi-experimental. METHODS: Eight healthy girls and eight girls with idiopathic scoliosis took part. A Kistler force platform was used with a frequency of 100 Hz for recording data. The center of pressure was recorded in different positions out of brace for scoliosis and healthy subjects. Test conditions were single limb and double limb stance, with eyes open and closed, and foam and rigid surfaces. RESULTS: The data reflected a weak balance of idiopathic scoliosis subjects compared to healthy subjects. After 1 and 4 months of wearing the brace, center of pressure and center of gravity sway increased in the majority of the tests, although there were no significant differences in any of the test conditions (p > 0.05). While the center of pressure sway in medio-lateral direction decreased after 4 months of wearing a brace, in other variables center of pressure and center of gravity sway increased. CONCLUSION: Idiopathic scoliosis patients have weak balance in comparison to healthy subjects. In addition, following a period of 4 months of wearing a brace, balance parameters in the scoliosis subjects did not improve. The results show that we need more follow-up of orthoses wearing in idiopathic scoliosis subjects and suggest more studies at least 1-year follow-up to identify the efficiency of brace wear on balance. CLINICAL RELEVANCE: Scoliosis can alter postural stability and balance performance during quiet standing. Spinal deformity can alter a subject's ability to compensate for postural changes and cause gait deviations. This study investigated balance differences between the healthy and idiopathic scoliosis patients and the results of thoraco lumbo sacral orthosis brace wear. It might provide some new insight into the conservative treatment of idiopathic scoliosis patients for clinicians and researchers.

The effect of trunk extension on physiological cost index in spinal cord injury patients when using the advanced reciprocating gait orthosis: A pilot study.

BACKGROUND: People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users. OBJECTIVE: The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Quasi experimental study. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate. RESULTS: Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ. CONCLUSION: Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis. CLINICAL RELEVANCE: It is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

BACKGROUND: Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. OBJECTIVE: The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. STUDY DESIGN: Quasi-experimental design. METHODS: Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. RESULTS: Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. CONCLUSION: The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. CLINICAL RELEVANCE: This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities.

The Araz medial linkage orthosis: a new orthosis for walking in patients with spinal cord injury: a single patient study.

BACKGROUND: This article describes the development and evaluation of a new medial linkage orthosis to potentially assist paraplegic patients to ambulate. CASE DESCRIPTION AND METHODS: The orthosis was initially designed using the solid works program and was subsequently evaluated when used by a spinal cord injury subject to test the structure during standing and walking. Gait analysis was used to compare the medial linkage orthosis to a standard hip-knee-ankle-foot orthosis. FINDINGS AND OUTCOMES: The results demonstrated improvements in gait velocity, step length, and decreased compensatory motions in the new orthosis compared to the hip-knee-ankle-foot orthosis. CONCLUSIONS: The results propose that this new Araz medial linkage orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to stand and walk. Clinical relevance The Araz medial linkage orthosis can potentially provide standing and walking assistance for spinal cord injury patients.

The influence of a bespoke unloader knee brace on gait in medial compartment osteoarthritis: a pilot study.

BACKGROUND: Patients suffering from mild-to-moderate medial compartment knee osteoarthritis may be treated with an unloader knee orthosis. However, compliance has been shown to be an issue with such devices. OBJECTIVES: The aim of this study was to identify the effects of a new design of knee unloader orthosis on specific gait parameters in patients with mild-to-moderate medial knee osteoarthritis. METHODS: The gait of seven patients was assessed in two conditions: without an orthosis and when wearing a new design of unloader knee orthosis. Gait analysis was performed to determine alterations to the adduction moment, speed of walking, step length, cadence and knee sagittal plane range of motion during ambulation for the two test conditions. RESULTS: The knee adduction moment was significantly reduced (p = 0.001), and the speed of walking significantly increased (p < 0.001) when wearing the orthosis. However, a reduction in knee range of motion (p = 0.002) and an increase in step length (p < 0.001) were observed with the orthosis donned. Cadence was not significantly altered (p = 0.504). CONCLUSION: The use of a new design of unloader knee orthosis as a conservative treatment approach for patients with mild-to-moderate medial compartment osteoarthritis appears warranted. CLINICAL RELEVANCE: Various conservative modalities have been used to reduce pain and improve function in medial compartment osteoarthritis. A new design of an unloader knee orthosis has been developed and is shown to have immediate benefits in patients with mild medial knee osteoarthritis.

Reciprocal gait orthoses and powered gait orthoses for walking by spinal cord injury patients.

BACKGROUND: Using mechanical orthoses have some limitations for walking in paraplegic patients. The development of powered orthoses could potentially overcome some of the limitations of those currently available. OBJECTIVES: The aim of this review was to compare the evidence of the effect of powered gait orthoses (PGOs) when compared to reciprocating gait orthoses (RGOs) and also hip guidance orthoses (HGOs) in improving gait parameters and the energy efficiency of walking by spinal cord injury (SCI) patients. STUDY DESIGN: Literature review. METHODS: Using the PRISMA method, and based on selected keywords and their composition, a search was performed in PubMed, Science Direct, and ISI Web of Knowledge databases. Eight articles were selected for final evaluation. RESULTS: The results of the analysis demonstrated that there is lack of evidence to show that currently-developed powered orthoses improve the walking parameters of SCI patients when compared to RGOs and HGOs. CONCLUSIONS: The changes offered by PGOs are not substantial enough for such orthoses to be currently considered preferable by SCI subjects for ambulatory purposes. Clinical relevance The development of powered orthoses is still in its infancy and progress needs to be made to improve their functionality and performance envelopes.