A novel passive neck orthosis for patients with degenerative muscle diseases: Development & evaluation.

The current study evaluated the effect of a passive neck orthosis, developed for patients suffering from progressive muscular diseases, on neck muscle activity in 10 adult healthy participants. The participants performed discrete head movements involving pure neck flexion (-10 to 30°), pure neck rotation (up to 30° left and right) and combined neck flexion-rotation (-10 to 30°) in steps of 10° by moving a cursor on a screen to reach predefined targets and staying on target for 10 s. Surface electromyography (EMG) was recorded from upper trapezius and sternocleidomastoid muscles and amplitudes were averaged over the static phases in trials with and without the orthosis. Moreover, the variability in head position and time required to perform the tasks were compared between conditions. Wearing the orthosis caused significant reductions (p = 0.027) in upper trapezius activity (a change of 0.2-1.5% EMGmax) while working against gravity. The activity level of the sternocleidomastoid muscle increased (p ≤ 0.025) by 0.3-1.0% EMGmax during pure and combined rotations without any pain reported. The orthosis showed potential to reduce the activity level of the upper trapezius muscle, the main load bearing muscle of the neck. Further study will be carried out to evaluate the effect in different patient groups.

Effect of motor-assisted elliptical training speed and body weight support on center of pressure movement variability.

BACKGROUND: A motor-assisted elliptical trainer is being used clinically to help individuals with physical disabilities regain and/or retain walking ability and cardiorespiratory fitness. Unknown is how the device's training parameters can be used to optimize movement variability and regularity. This study examined the effect of motor-assisted elliptical training speed as well as body weight support (BWS) on center of pressure (CoP) movement variability and regularity during training. METHODS: CoP was recorded using in-shoe pressure insoles as participants motor-assisted elliptical trained at three speeds (20, 40 and 60 cycles per minute) each performed at four BWS levels (0 %, 20 %, 40 %, and 60 %). Separate two-way repeated measures ANOVAs (3 × 4) evaluated impact of training speed and BWS on linear variability (standard deviation) and non-linear regularity (sample entropy) of CoP excursion (anterior-posterior, medial-lateral) for 10 dominant limb strides. FINDINGS: Training speed and BWS did not significantly affect the linear variability of CoP in the anterior-posterior or medial-lateral directions. However, sample entropy in both directions revealed the main effect of training speed (p < 0.0001), and a main effect of BWS was observed in the medial-lateral direction (p = 0.004). Faster training speeds and greater levels of BWS resulted in more irregular CoP patterns. INTERPRETATION: The finding that speed and BWS can be used to manipulate CoP movement variability when using a motor-assisted elliptical has significant clinical implications for promoting/restoring walking capacity. Further research is required to determine the impact of motor-assisted elliptical speed and BWS manipulations on functional recovery of walking in individuals who have experienced a neurologic injury or illness.

The impact of ankle-foot-orthosis (AFO) use on the compensatory stepping response required to avoid a fall during trip-like perturbations in young adults: Implications for AFO prescription and design.

Ankle-foot-orthoses (AFOs) are commonly prescribed to treat foot drop and enhance walking in fall-prone individuals (e.g. stroke). AFOs improve static balance but AFO-users are still at high fall risk. To our knowledge, no one has studied the biomechanical effect of AFO-use on the compensatory stepping response required to avoid falling during dynamic conditions such as trip, the leading cause of falls. The objective of this study is to evaluate the impact of a semi-rigid thermoplastic AFO on the compensatory stepping response in young healthy individuals following trip-like treadmill perturbations. We found that the AFO on the stepping leg (AFO-step) decreased trunk stability (increased trunk angle and angular velocity), shortened the compensatory step length, and reduced dynamic stability (smaller COM-BOS). AFO on the support leg (AFO-support) was only marginally different from the No-AFO condition. Detrimental changes in compensatory stepping response (e.g. decreased trunk stability) were linearly correlated to diminished propulsive impulse of the step. In summary, AFO-use on the stepping leg is associated with impaired compensatory stepping response (e.g. reduced trunk stability) and decreased propulsive impulse in young adults. It is important to note that AFO-use enhances static stability and decreases the probability of a trip/stumble occurring indicating they are important for fall prevention. Still, our results suggest that AFO-use may impair the compensatory stepping response after a trip/stumble has occurred and may suggest that preserving plantarflexion function may support the compensatory stepping response. Further study of these devices and their impact on compensatory stepping response in fall-prone individuals is warranted.

Description of orthotic properties and effect evaluation of ankle-foot orthoses in non-spastic calf muscle weakness.

OBJECTIVE: To describe the orthotic properties and evaluate the effects of ankle-foot orthoses for calf muscle weakness in persons with non-spastic neuromuscular disorders compared with shoes-only. DESIGN: Cross-sectional study. SUBJECTS: Thirty-four persons who used ankle-foot orthoses for non-spastic calf muscle weakness. METHODS: The following orthotic properties were measured: ankle-foot orthosis type, mass, and ankle and footplate stiffness. For walking with shoes-only and with the ankle-foot orthoses, walking speed, energy cost and gait biomechanics were assessed. RESULTS: Four types of ankle-foot orthosis were identified: shaft-reinforced orthopaedic shoes (n = 6), ventral ankle-foot orthoses (n = 10), dorsal leaf ankle-foot orthoses (n = 12) and dorsiflexion-stop ankle-foot orthoses (n = 6). These types differed significantly with regards to mass, ankle-and footplate stiffness. Compared with shoes-only, all ankle-foot orthoses/orthopaedic shoes groups combined increased walking speed by 0.18 m/s (95% confidence interval (95% CI) 0.13-0.23), reduced energy cost by 0.70 J/kg/m (95% CI 0.48-0.94) and limited ankle dorsiflexion by -3.0° (95% CI 1.3-4.7). Higher ankle-foot orthoses ankle stiffness correlated with greater reductions in walking energy cost and maximal ankle dorsiflexion angle. CONCLUSION: Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait. The large variation in effectiveness may be due to differences in ankle stiffness, although this requires further prospective evaluation.

Scoliosis Progression After the Nuss Procedure for Pectus Excavatum: A Case Report.

INTRODUCTION: Pectus excavatum and scoliosis are associated conditions with a high rate of coincidence. However, there are no reports to guide surgeons on the management of adolescents with moderate scoliosis and pectus excavatum, because there are conflicting conclusions in the literature regarding how the Nuss procedure with substernal bar affects scoliosis. CASES: In 2017, we encountered two patients with moderate scoliosis treated with a spinal orthosis. After undergoing the Nuss procedure for pectus excavatum, their scoliosis acutely progressed into surgical magnitude requiring posterior instrumented spinal fusion. The first patient progressed 26° despite the pre-Nuss radiographs showing him to be Risser 4/5, while the second patient also progressed 26° from the Nuss procedure. Both patients acknowledged noncompliance with brace wear because of discomfort after the Nuss procedure. However, their progression rate still doubles the rate of reported rapid accelerators, indicating that a significant component of curve progression is directly attributed to forces on the spine from the corrective maneuver with substernal bar. CONCLUSION: The purpose of this case report is to describe the features of these two patients to help with clinical decision-making in patients with moderate scoliosis (curves >25°) who are contemplating the Nuss procedure for correction of pectus excavatum. We caution patients and providers that spinal deformity could worsen with surgical intervention of the pectus excavatum via the Nuss procedure and necessitate scoliosis surgery.

Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?

OBJECTIVE: To investigate the quantity and quality of orthotic service provision within the UK. DESIGN: Cross-sectional survey obtained through freedom of information request in 2017. SETTING: National Health Service (NHS) Trusts/Health Boards (HBs) across the UK. MAIN OUTCOME MEASURES: Descriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators. RESULTS: Responses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs. CONCLUSIONS: The aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.

Evaluation of Alternative Halo Ring Positions in Children Using Tomography.

OBJECTIVES: The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and pathologies related to deformities. However, the procedure is associated with various complications, such as infection, pin loosening, and respiratory and neurological problems. Although widely studied in adults, the best pin insertion site in children and the correlations of pin insertion sites with outcomes and complications have not been completely elucidated. This study aimed to determine alternative pin placement sites based on a morphological analysis of the infant skull by computerized tomography (CT). METHODS: An analytical-descriptive study was performed using 50 CT scans from children. The Wilcoxon and Friedman tests were used. RESULTS: A linear and directly proportional relation was found between cranial thickness and patient age. The average thicknesses of the anterior points across all ages analyzed ranged from 4.16 mm to 4.98 mm. The thicknesses of the posterior points varied from 3.94 mm to 4.27 mm. Within each age range, points 1 cm above the standard insertion sites had thicknesses similar to those of the standard sites, and points 2 cm above the standard insertion sites had thicknesses greater than those of the standard sites. CONCLUSIONS: The cranial thickness at all points increases linearly with age. Points 1 and 2 cm above the standard insertion sites are viable alternatives for the placement of halo pins. Preoperative CT can aid in choosing the best positioning sites for pins in the skull.

Wearables for Pediatric Rehabilitation: How to Optimally Design and Use Products to Meet the Needs of Users.

This article will define "wearables" as objects that interface and move with users, spanning clothing through smart devices. A novel design approach merging information from across disciplines and considering users' broad needs will be presented as the optimal approach for designing wearables that maximize usage. Three categories of wearables applicable to rehabilitation and habilitation will be explored: (1) inclusive clothing (eg, altered fit, fasteners); (2) supportive wearables (eg, orthotics, exoskeletons); and (3) smart wearables (eg, with sensors for tracking activity or controlling external devices). For each category, we will provide examples of existing and emerging wearables and potential applications for assessment and intervention with a focus on pediatric populations. We will discuss how these wearables might change task requirements and assist users for immediate effects and how they might be used with intervention activities to change users' abilities across time. It is important for rehabilitation clinicians and researchers to be engaged with the design and use of wearables so they can advocate and create better wearables for their clients and determine how to most effectively use wearables to enhance their assessment, intervention, and research practices.

Clinical Outcomes with the Intrepid Dynamic Exoskeletal Orthosis: A Retrospective Analysis.

INTRODUCTION: Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Clinical outcomes were routinely collected on patients fit with IDEOs at the Center for the Intrepid, Brooke Army Medical Center. The purpose of this retrospective study was to analyze the clinical outcomes collection process and the patient outcomes collected as part of routine clinical care. METHODS: The Brooke Army Medical Center IRB approved this study and granted waivers of informed consent and HIPAA authorization. Electronic medical records were reviewed over an 18-month period from July 2014 to January 2016. Records were examined to obtain the date of IDEO delivery, date of outcomes form completion, responses on the forms, and to verify diagnosis or injury. Data gathered included wear time, IDEO comfort, pain with and without the IDEO, Lower Extremity Functional Scale scores with and without the IDEO, and global rating of change questions for everyday activities and high impact activities. Wilcoxon signed-ranked tests were used to compare pain and function with vs. without the IDEO. RESULTS: During the 18-month period, new IDEOs were delivered to 156 unique patients. Outcomes forms were collected as part of routine clinical care from 90 of these 156 patients (58%). An additional nine forms were collected from patients who received their IDEOs prior to July 2014. In all, 99 outcomes forms were collected. Mean follow-up time from IDEO delivery to outcomes form completion was 35 ± 31 days for the original 90 patients. The most common patient diagnoses were fracture, nerve injury, arthritis, and fusion. Responses on the forms indicated that patients were generally comfortable wearing their IDEOs (8.3 ± 1.3 on a 0-10 scale) and wore them most of the day (10.7 ± 3.4 hours per day). Improvement in pain (from 5.2 ± 2.9 to 1.7 ± 1.6 points on a 0-10 scale) and Lower Extremity Functional Scale scores (from 29.7 ± 16.6 to 59.5 ± 13.6 points) with the IDEO were both more than the minimal clinically important difference and were statistically significant (p < 0.001). CONCLUSION: This descriptive retrospective study demonstrated that it was feasible to collect clinical outcomes data which were relevant for characterizing the effects of IDEO use and enabled quantification of improvements in self-reported function and walking pain with the IDEO. Due to the retrospective nature of this study, limitations include missing data and the lack of any performance measures to complement the self-reported data. Clinical outcomes collection continues as a routine part of clinical care and there remains an ongoing aim to collect information on all patients to obtain an accurate assessment of devices and services and ultimately better serve our patients.

Evaluation of alternative halo ring positions in children using tomography

OBJECTIVES: The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and pathologies related to deformities. However, the procedure is associated with various complications, such as infection, pin loosening, and respiratory and neurological problems. Although widely studied in adults, the best pin insertion site in children and the correlations of pin insertion sites with outcomes and complications have not been completely elucidated. This study aimed to determine alternative pin placement sites based on a morphological analysis of the infant skull by computerized tomography (CT). METHODS: An analytical-descriptive study was performed using 50 CT scans from children. The Wilcoxon and Friedman tests were used. RESULTS: A linear and directly proportional relation was found between cranial thickness and patient age. The average thicknesses of the anterior points across all ages analyzed ranged from 4.16 mm to 4.98 mm. The thicknesses of the posterior points varied from 3.94 mm to 4.27 mm. Within each age range, points 1 cm above the standard insertion sites had thicknesses similar to those of the standard sites, and points 2 cm above the standard insertion sites had thicknesses greater than those of the standard sites. CONCLUSIONS: The cranial thickness at all points increases linearly with age. Points 1 and 2 cm above the standard insertion sites are viable alternatives for the placement of halo pins. Preoperative CT can aid in choosing the best positioning sites for pins in the skull.

Diretriz Técnica da ANAMT (DT 05): prevenção de lombalgia ocupacional por uso de cinta, suporte ou órtese lombar / ANAMT Technical Guideline (DT 05): prevention of occupational low back pain through back belts, lumbar support or braces

Introdução: Lombalgia é um problema internacional importante de saúde pública. O uso de cinta lombar no meio ocupacional emerge da expectativa de inúmeros benefícios biomecânicos que, em conjunto, promoveriam a prevenção desse problema. Objetivo: Orientar estudantes, médicos e estabelecimentos de saúde sobre o uso de cinta lombar, suporte ou órtese lombar como prevenção da lombalgia ou de lesões lombares em trabalhadores sem sintomatologia atual. Método: Ela foi desenvolvida a partir da revisão sistemática da literatura: da base de dados MEDLINE, foram recuperados 809 trabalhos e das bases EMBASE e Central Cochrane, 571. Avaliar a cinta lombar como intervenção preventiva de lombalgia envolve a quantificação de benefícios, malefícios e facilidade de sua implementação, assim como a qualidade metodológica dos estudos primários. Conclusão: Apesar do benefício demonstrado fracamente em resultados individuais, parciais e isolados em poucos estudos, não há evidência consistente que sustente a utilização de cinta lombar, suporte ou órtese lombar na prevenção primária da lombalgia ou de lesões lombares ocupacionais em trabalhadores. As evidências, agrupadas, apontam para ausência de redução de absenteísmo com o uso da cinta lombar.

Background: Low back pain is a considerable global public health problem. Use of back belts in occupational settings arises from the expectation of countless biomechanical benefits, which together would contribute to the prevention of this problem. Objective: To orient students, physicians and health institutions on the use of back belts, lumbar support or braces for prevention of low back pain or injury among asymptomatic workers. Method: The present guideline was developed based on a systematic literature review; 809 studies were located in database MEDLINE and 571 in EMBASE and Cochrane CENTRAL. Evaluating back-belt use as preventive intervention against low back pain demands quantifying benefits, harms and difficulties to implementation, as well as the methodological quality of primary studies. Conclusion: Despite the weak benefits reflected in the individual, partial and isolated results of a few studies, there is no consistent evidence for the use of back belts, lumbar supports or braces for primary prevention of low back pain or occupational low back injury among workers. According to the available evidence, back-belt use is not associated with reduction of absenteeism

Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy.

AIM: To investigate suit-orthosis effects on postural sway during anticipatory and compensatory postural adjustments (APA and CPA, respectively) in a seated reaching task performed by children with cerebral palsy (CP). METHODS: Twenty-nine children were divided according to Manual Ability Classification System (MACS) I and II-III. Participants were instructed to reach forward toward an object both in a no-suit condition and in a suit-orthosis condition. RESULTS: Using the suit-orthosis, children at MACS II-III decreased velocity of center-of-pressure (CoP) sway during APA, whereas children at MACS I increased the anterior-posterior CoP displacement during CPA. CONCLUSION: Suit-orthosis improved postural stability in children at MACS II-III during APA. The suit may assist with arm function control during postural sway when preparing to reach for objects. CLINICAL IMPLICATIONS: Suit-orthoses in therapy should be individually prescribed considering the intended activity and person's motor impairment.

Assessment of the care process with orthotics, prosthetics and special materials.

OBJECTIVE: to assess potential failures in the care process with orthotics, prosthetics and special materials in a high-complexity hospital. METHOD: an intervention study conducted from March to October 2013. This process was assessed with the Failure Mode and Effects Analysis (FMEA) service tool. The data were analysed according to the risk and the corrective measures were defined. RESULTS: no failure was classified as high risk and the corrective measures indicated as low and moderate risk had the following improvement initiatives suggested: standardize the material records in the information system; create a specific form to require materials; hire specialized technical personnel and create a continuous education program. CONCLUSION: all the suggested initiatives were implemented and helped to reduce the assistance risks for patients due to failures in this process. The actions increase safety levels and provide higher quality of service.

Assessment of the care process with orthotics, prosthetics and special materials / Evaluación del proceso de cuidado con ortesis, prótesis y materiales especiales / Avaliação do processo de cuidado com órteses, próteses e materiais especiais

ABSTRACT Objective: to assess potential failures in the care process with orthotics, prosthetics and special materials in a high-complexity hospital. Method: an intervention study conducted from March to October 2013. This process was assessed with the Failure Mode and Effects Analysis (FMEA) service tool. The data were analysed according to the risk and the corrective measures were defined. Results: no failure was classified as high risk and the corrective measures indicated as low and moderate risk had the following improvement initiatives suggested: standardize the material records in the information system; create a specific form to require materials; hire specialized technical personnel and create a continuous education program. Conclusion: all the suggested initiatives were implemented and helped to reduce the assistance risks for patients due to failures in this process. The actions increase safety levels and provide higher quality of service.

RESUMEN Objetivo: evaluar las fallas potenciales en el proceso de trabajo del cuidado con ortesis, prótesis y materiales especiales en un hospital de alta complejidad. Método: estudio de intervención realizado de marzo a octubre de 2013. El proceso fue evaluado utilizando la herramienta de Análisis del Modo y Efecto de Fallas del tipo servicio. Los datos fueron analizados conforme el riesgo y se definieron las medidas correctivas. Resultados: ninguna falla fue clasificada como alto riesgo y las medidas correctivas apuntadas como de bajo y moderado riesgo han tenido propuestas de acciones de perfeccionamiento: estandarización de los registros de materiales en el sistema de información; creación de un formulario específico para la solicitud de material; contratación de personal técnico especializado y creación de un programa de educación permanente. Conclusión: todas las acciones propuestas fueron implantadas y ayudaron en la reducción del riesgo asistencial a los pacientes por fallas en este proceso, aumentando los niveles de seguridad y proporcionando más calidad en el servicio.

RESUMO Objetivo: avaliar as falhas potenciais, no processo de trabalho do cuidado com órteses, próteses e materiais especiais em um hospital de alta complexidade. Método: estudo de intervenção realizado de março a outubro de 2013. O processo foi avaliado utilizando a ferramenta de Análise de Modos de Falhas e Efeitos do tipo serviço. Os dados foram analisados conforme o risco e foram definidas as medidas corretivas. Resultados: nenhuma falha foi classificada de alto risco e as medidas corretivas apontadas como de baixo e moderado risco tiveram propostas de ações de melhoria, como: padronização dos cadastros de materiais no sistema de informação; criação de um formulário específico para a solicitação de material; contratação de pessoal técnico especializado e criação de um programa de educação permanente. Conclusão: todas as ações propostas foram implantadas e auxiliaram na redução do risco assistencial aos pacientes por falhas neste processo, aumentando os níveis de segurança e proporcionando maior qualidade no serviço.

Competency standards for newly graduated prosthetist/orthotists in Sweden.

BACKGROUND: There are currently no national competency standards upon which to develop educational objectives for prosthetist/orthotists in Sweden. While standards have been developed in other countries, they cannot be applied without confirming their relevance in a Swedish context. OBJECTIVES: To describe and obtain consensus on core competencies required for newly graduated prosthetist/orthotists in Sweden. STUDY DESIGN: Modified Delphi process. METHODS: A modified Delphi technique was carried out. Focus groups were initially used to identify core competency domains. Two consecutive questionnaires, containing a list of potential competency items, were sent to a group of stakeholders with ties to the prosthetic and orthotic profession. Stakeholders were requested to rate their level of agreement with each competency item and provide written comments. Finally, two focus groups were conducted to obtain feedback on the draft competency standards. RESULTS: Forty-four competency items, listed under five key domains of practice, were identified as essential for newly graduated prosthetist/orthotists in Sweden. CONCLUSIONS: Many similarities exist in core competency descriptions for prosthetist/orthotists in Sweden when compared to other countries. Regional differences do however exist, and it is important to confirm the relevance of core competency items at a national level before they are applied. Clinical relevance Competency standards developed in this study can be used to guide development of learning objectives within an undergraduate prosthetic and orthotic program, provide a framework for workforce development, assist professional organizations in understanding the needs of their members, and prepare for international accreditation.

Design-validation of a hand exoskeleton using musculoskeletal modeling.

Exoskeletons are progressively reaching homes and workplaces, allowing interaction with virtual environments, remote control of robots, or assisting human operators in carrying heavy loads. Their design is however still a challenge as these robots, being mechanically linked to the operators who wear them, have to meet ergonomic constraints besides usual robotic requirements in terms of workspace, speed, or efforts. They have in particular to fit the anthropometry and mobility of their users. This traditionally results in numerous prototypes which are progressively fitted to each individual person. In this paper, we propose instead to validate the design of a hand exoskeleton in a fully digital environment, without the need for a physical prototype. The purpose of this study is thus to examine whether finger kinematics are altered when using a given hand exoskeleton. Therefore, user specific musculoskeletal models were created and driven by a motion capture system to evaluate the fingers' joint kinematics when performing two industrial related tasks. The kinematic chain of the exoskeleton was added to the musculoskeletal models and its compliance with the hand movements was evaluated. Our results show that the proposed exoskeleton design does not influence fingers' joints angles, the coefficient of determination between the model with and without exoskeleton being consistently high (R2¯=0.93) and the nRMSE consistently low (nRMSE¯ = 5.42°). These results are promising and this approach combining musculoskeletal and robotic modeling driven by motion capture data could be a key factor in the ergonomics validation of the design of orthotic devices and exoskeletons prior to manufacturing.

Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties.

BACKGROUND: Foot drop in people with multiple sclerosis (pwMS) often managed with assistive technologies, such as functional electrical stimulation and ankle foot orthoses. No evidence synthesis exists for the psychometric properties of outcomes used to evaluate the efficacy of these interventions. OBJECTIVE: This systematic review aimed to identify the outcome measures reported to assess the benefits of assistive technology for pwMS and then synthesize the psychometric evidence in pwMS for a subset of these measures. METHODS: Two searches in eight databases were conducted up to May 2017. Methodological quality was rated using the COSMIN guidelines. Overall level of evidence was scored according to the Cochrane criteria. RESULTS: The first search identified 27 measures, with the 10 m walk test, gait kinematics and Physiological Cost Index (PCI) most frequently used. The second search resulted in 41 studies evaluating 10 measures related to walking performance. Strong levels of evidence were found for the internal consistency and test-retest reliability of the Multiple Sclerosis Walking Scale-12 and for the construct validity for Timed 25 Foot Walk. No psychometric studies were identified for gait kinematics and PCI in pwMS. There was a lack of evidence for measurement error and responsiveness. CONCLUSION: Although a strong level of evidence exists for some measures included in this review, there was an absence of psychometric studies on commonly used measures such as gait kinematics. Future psychometric studies should evaluate a wider range of walking related measures used to assess the efficacy of interventions to treat foot drop in pwMS.

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review.

BACKGROUND: Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. OBJECTIVE: This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? STUDY DESIGN: Scoping review. METHODS: A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. RESULTS: Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. CONCLUSION: Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO).

OBJECTIVE: To compare the energy efficiency of Wearable Power-Assist Locomotor (WPAL) with conventional knee-ankle-foot orthoses (MSH-KAFO) such as Hip and Ankle Linked Orthosis (HALO) or Primewalk. STUDY DESIGN: Cross over case-series. SETTING: Chubu Rosai Hospital, Aichi, Japan, which is affiliated with the Japan Organization of Occupational Health and Safety. METHODS: Six patients were trained with MSH-KAFO (either HALO or Primewalk) and WPAL. They underwent 6-minute walk tests with each orthosis. Energy efficiency was estimated using physiological cost index (PCI) as well as heart rate (HR) and modified Borg score. Trial energy efficiency with MSH-KAFO was compared with WPAL to assess if differences in PCI became greater between MSH-KAFO and WPAL as time goes on during the 6-minute walk. Spearman correlation coefficient of time (range: 0.5-6.0 minutes) with the difference was calculated. The same statistical procedures were repeated for HR and modified Borg score. RESULTS: Greater energy efficiency, representing a lower gait demand, was observed in trials with WPAL compared with MSH-KAFO (Spearman correlation coefficients for PCI, HR and modified Borg were 0.93, 0.90 and 0.97, respectively, all P < 0.0001). CONCLUSIONS: WPAL is a practical and energy efficient type of robotics that may be used by patients with paraplegia.