Can Insoles Be Used to Improve Static and Dynamic Balance of Community-Dwelling Older Adults? A Systematic Review on Recent Advances and Future Perspectives.

This systematic review investigated the effects of orthopedic, vibrating, and textured insoles on the postural balance of community-dwelling older adults. Articles published in English from 1999 to 2019 investigating the effects of (a) orthopedic, (b) vibrating, and (c) textured insoles on static and dynamic balance in community-dwelling older adults were considered. Twenty-four trials with a total of 634 older adults were identified. The information gathered generally supported the balance-improving effects of orthopedic, vibrating, and textured insoles in both static and dynamic conditions among community-dwelling older adults. Further examination found that rigidity, texture patterns, vibration thresholds, and components like arch supports and heel cups are important factors in determining whether insoles can improve balance. This review highlights the potential of insoles for improving the static and dynamic balance of community-dwelling older adults. Good knowledge in insole designs and an understanding of medical conditions of older adults are required when attempts are made to improve postural balance using insoles.

Printing a static progressive orthosis for hand rehabilitation.

BACKGROUND: Static progressive orthosis is used for the treatment of severe joint contracture after trauma and/or surgery. However, a custom-fabricated static progressive splint would be expensive and labor intensive. Especially, owing to very limited payment under the current Taiwanese National Health Insurance, the incentives to fabricate a patient-specific splint are insufficient for a therapist. To ease splint construction, we introduced three-dimensional (3D)-printed "shark fin"-shaped device works as a static progressive orthosis for the hand rehabilitation. The aim of this study was to describe and demonstrate the newly designed device. METHODS: This study included a 46-year male suffered from a left distal radius fracture and underwent open reduction internal fixation and a 23-year male with the right thumb flexor pollicis longus rupture, requiring tendon repair. Both subjects used this "shark fin"-shaped device to stretch for increasing range of motion (ROM) of wrist extension and the thumb. RESULTS: The patient receiving ulnar shortening surgery used this device to stretch for increasing ROM of wrist extension. The active ROM of wrist extension improved from 30° to 50°. The other patient with the right thumb flexor pollicis longus rupture suffered from thumb contracture; the ROMs of the metacarpophalangeal (MCP) joint and interphalangeal (IP) joint were 40°-55° and 20°-25°, respectively. After tenolysis surgery, his ROMs of the MCP and IP joints were improved to 10°-35° and 40°-65°, respectively. Following physical therapy by applying the device, his ROMs of the MCP and IP joints were further increased to 0°-40° and 25°-70°, respectively. CONCLUSION: Incorporating the "shark fin"-shaped orthosis into hand rehabilitation increased the ROM of wrist extension for a patient with distal radius fracture and improved the ROM of the MCP and IP joints in another patient after tenolysis surgery.

Printing a 3-dimensional, Patient-specific Splint for Wound Immobilization: A Case Demonstration.

Three-dimensional (3D) printing technology can generate objects in almost any shape and geometry. This technique also has clinical applications, such as the fabrication of specific devices based on a patient's anatomy. A demonstration study is presented of a 54-year-old man who needed a thermoplastic splint to limit arm movement while a dehisced left shoulder wound healed. The patient's upper extremity was scanned using the appropriate noncontact scanner and 3D technology software, and the polylactic acid splint was printed over the course of 66 hours. This patient-specific splint was worn during the day, and after 2 weeks the wound was healed sufficiently to permit hospital discharge. Creation of an individualized splint is one of many potential medical uses of 3D technology. Although the lengthy printing time imposes limitations, the implications for practice are positive.

The pincer chopsticks: the investigation of a new utensil in pinching function.

The manipulation of chopsticks requires skillful motions of fingers. Therefore, it would be difficult to manipulate chopsticks for people with hand dysfunction. We designed a simple and convenient utensil, the pincer chopsticks, to simulate the pincers-pinching operation of traditional chopsticks. To compare the performance of the new device with that of traditional chopsticks and spoons, 32 volunteers applied these utensils to pick up four kinds of fool with either hand. For dominant hands, the manipulation time of both pincer and traditional chopsticks was shorter than that of spoons, while using pincer chopsticks with non-dominant hands revealed the best performance among the three experimental utensils for users without experience. In this study, the newly designed pincer chopsticks demonstrated advantages for operation and performance. It has the potential to benefit patients with impaired hands.

An assistive device for donning compression stockings.

Use of compression stockings has been demonstrated to be effective in helping heal venous leg ulcers and in reducing associated pain. During the past 5 years or more, patients suffering from edema, varices, or ulcers at the Taipei Veterans General Hospital and Taipei Vein Center, Taiwan, have been encouraged to use compression stockings. However, patients frequently reported difficulty donning the stockings, even with the help of a foot slip or slip-on stocking aid. Because a stocking aid did not function effectively above the heel position, the authors re-engineered and fabricated a reusable stocking aid that features a larger donning cup. This new device has been used successfully on at least 90 patients, who report enhanced willingness to use compression therapy and/or improved ease of stocking use as compared to previously used products or not using an assistive device. The design and use of this stocking aid is described.

The newly filed patent applications for vaccines against staphylococcus aureus.

Staphylococcus aureus (S. aureus) frequently causes life threatening disease. To release the threat, vaccine has been proposed as a preventive intervention against the cause. However, the development of the vaccines is still in early stages. Thus, highlighting the related newly filed patent applications would stimulate further developments.

The limited benefit of "product-by-process" claim.

A product-by-process claim was initially developed when the invention could not otherwise be adequately defined. In the US, a patent applicant can use a product-by-process claim for a new product, no matter whether the product can also be defined by using structure features. However, the applicant mainly bears the burden to establish the novelty between the claimed product and the prior art product. Moreover, in terms of infringement, the very recent CAFC cases indicate that the product must be made by a process recited in the claim to infringe a product-by-process claim. Thus, an assignee almost can not take advantage from product-by-process claims during the patent enforcement by comparing with process claims. From the points of the burden during patent prosecution and confined scope in determining infringement, the benefit of using a product-by-process claim would be very limited.

The shadow of inequitable conduct in the US patent application.

Inequitable conduct regarding any single claim can render the entire patent unenforceable and further damage other related patents and applications in the assignee's patent portfolio. The adverse impact of inequitable conduct significantly became a litigation strategy. The US Federal Circuit (CAFC) observed that inequitable conduct as a patent litigation strategy had become a plague and thus tightened the standard for finding inequitable conduct in a case with full court judges. However, under the shadow of previous adverse impact of inequitable conduct, patent applicants may still submit many marginal related references. This study demonstrates that an applicant even prepared an information disclosure statement (IDS) as many as 50 pages. Actually, under the new standard, inequitable conduct would not further produce significant impact in the US patent system. Thus, a patent applicant need not submit marginal references but should distinguish the prior art from the current application, especially for those listed in the IDS, to avoid the novelty rejection.

The impact of patent eligibility on biotech patents: A flow chart for determining patent eligibility and an immune therapy case study.

US common law recites a natural law, natural phenomenon or abstract idea as exceptions to the 4 statutory patentable categories to guard against the wholesale preemption of fundamental principles. The very recent evolutions of patent exceptions in the US may increase the difficulty of patenting and may create uncertainty in determining patent eligibility. To solve the thorny problem of eligibility, this study presents a flow chart based on the courts' decisions that can serve as a set of guidelines for determining patent eligibility. A case related to prostate cancer immune therapy is presented for discussion.

Plantar pressure analysis of accommodative insole in older people with metatarsalgia.

Foot pain frequently reduces physical activity and increases the risk of falls in older people. In current orthotic management of forefoot pain, metatarsal padding is the main strategy to reduce metatarsal pressure. However, pressure reductions are usually diverse and limited. The multi-step accommodative insole is fabricated by sequential foam padding on Plastazote under dynamic accommodation in daily walking. The aims of this study were to investigate the effectiveness and mechanisms of accommodative insole on plantar pressure redistribution in older people with metatarsalgia. The study was conducted on 21 old outpatients with moderate to severe metatarsalgia, using the ethylene vinyl acetate control, 9-mm flat Plastazote, and accommodative insoles with and without metatarsal and arch support. Outcome measures included pressure-related variables measured by a Pedar-X system, and pain scores assessed with a 0-10 Visual Analog Scale. The accommodative insole significantly decreased peak pressure under the metatarsal heads by 47.2% (p<0.001) and the pain scores from 8.2 to 1.1 (p<0.001). Plantar pressure analyses indicated that the effects of dynamic metatarsal contouring and cushioning on reducing peak pressure were greater than those of metatarsal padding. The temporo-spatial relationships between the toe and metatarsal head can assist in explaining an elevated metatarsal pressure and higher risk of falls in older people with toe deformities. The multi-step insole is simple in orthotic fabrication and ensures an even distribution of plantar pressure loading in walking. It can effectively relieve metatarsalgia and help to preserve regular walking activity for older people with metatarsalgia.

Dynamic impression insole in rheumatoid foot with metatarsal pain.

BACKGROUND: Custom molded insoles with metatarsal supports are used to redistribute excessive loading under the metatarsal heads in patients with metatarsalgia. However, these pressure reductions are usually insufficient for the rheumatoid foot with painful deformed metatarsal heads. We developed an effective insole made by sequential foam padding under successive walking impression. METHODS: Seventeen consecutive rheumatoid arthritic outpatients with metatarsal pain participated in this repeated measures study of 7-mm flat Ethylene Vinyl Acetate, custom molded and dynamic impression insoles. Peak plantar pressure, pressure-time integral, contact area and mean force were measured by a Pedar-X mobile system. Pain levels were assessed using a Visual Analog Scale (0-10). FINDINGS: Compared to the Ethylene Vinyl Acetate control, the metatarsal head peak pressure and pressure-time integral were significantly reduced in dynamic impression insoles by 46.3% (P<0.001) and 48.9% (P<0.001), respectively. Compared to the custom molded insole, the dynamic impression insole significantly reduced 18.3% of peak pressure (P<0.001) and 20.1% of pressure-time integral (P<0.001) by increasing 8.1% of contact area (P=0.005) at the metatarsal heads, but there were no significant differences in all variables at the heel. After using the dynamic impression insole, the mean pain score was significantly reduced from 7.6 to 1.1 (P<0.001), and six participants experienced total pain-relief in walking. INTERPRETATION: Dynamic impression insoles effectively relieve metatarsal pain because of a larger weight-bearing area. Forefoot shape during walking should be taken into consideration in orthotic designs for maximum pressure reduction. Consequently, we recommend using materials with memory properties to dynamically accommodate painful metatarsal heads.

A new type of chopsticks for patients with impaired hand function.

OBJECTIVES: To present a method for adapting chopsticks to persons with hand impairments and to compare the efficiency of the adapted chopsticks with spoons among adults with cervical spinal cord injury (SCI). DESIGN: Equipment development and pilot evaluation. SETTING: Rehabilitation center. PARTICIPANTS: Two adults with complete C8-level SCI and 9 adults with incomplete SCI from the C6 to C8 level. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Instructions for adapting chopsticks and the time to pick up and manipulate 4 types of food (noodle strips, cubed carrots, unshelled peanuts, tofu cube) by using adapted chopsticks as compared with spoons. RESULTS: The mean time for manipulating tofu was comparable between the adapted chopsticks and spoon, but the adapted chopsticks were sufficiently faster than spoons for noodle strips, carrots, and unshelled peanuts. CONCLUSIONS: Adapted chopsticks convert gross grasp into 2-point pinch. They are inexpensive, easily constructed, and may benefit patients with lower cervical SCI and residual gross grasp.