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1.
Arch Acad Emerg Med ; 12(1): e9, 2024.
Article in English | MEDLINE | ID: mdl-38162387

ABSTRACT

Introduction: The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults. Methods: This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression. Results: Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls. Conclusion: This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities.

2.
Prosthet Orthot Int ; 47(3): 241-252, 2023 Jun 01.
Article in English | MEDLINE | ID: mdl-36037272

ABSTRACT

BACKGROUND: Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia supports the longitudinal arch and absorbs ground reaction forces during the static and dynamic phase(s) of weight-bearing. The purpose of this randomized controlled trial study was to determine the effects of CAD/CAM foot orthoses that were designed based on the dynamic plantar pressure in patients with plantar fasciitis. METHODS: This study was performed on 34 patients with plantar fasciitis. Outcomes were compared based on plantar fascia thickness; peak pressure, mean pressure, and maximum force; and pain, activity of daily living, quality of life, and sports activity that were evaluated by ultrasound, plantar pressure platform, and the Foot and Ankle Outcome Score, respectively. The patients were randomly assigned into two groups: the experimental group (CAD/CAM orthoses and night splint) and the control group (night splint only). All data were recorded again after 4 weeks. RESULTS: Pain ( P = 0.002) and plantar fascia thickness ( P = 0.001) decreased significantly after 1 month of intervention. Activity of daily living ( P = 0.044) and quality of life ( P = 0.001) showed a significant increase. There was a trend in increasing peak pressure in all masking regions in both groups. The maximum force remarkably reduced in the experimental group in all regions. CONCLUSIONS: The results demonstrated that CAD/CAM foot orthoses designed based on dynamic plantar pressure with night splint can reduce the plantar fascia thickness and pain associated with plantar fasciitis and increase the activity of daily living, quality of life, and sports activity.


Subject(s)
Fasciitis, Plantar , Foot Orthoses , Humans , Fasciitis, Plantar/complications , Quality of Life , Pain/etiology , Lower Extremity
3.
J Am Podiatr Med Assoc ; 108(3): 231-235, 2018 May.
Article in English | MEDLINE | ID: mdl-29932758

ABSTRACT

BACKGROUND: Rocker shoes are commonly prescribed to healthy and pathologic populations to decrease stress on the lower limbs. An optimal rocker shoe design must consider both toe and heel rockers. Heel rockers are as effective as toe rockers in relieving foot plantar pressures. However, most studies have focused on the position of toe rockers. The aim of this study was to assess the effect of different heel rocker apex placements on lower-limb kinetics and kinematics. METHODS: Eighteen healthy females participated in this study. Three pairs of rocker shoes with rocker apex positions anterior to the medial malleolus (shoe A), at the medial malleolus (shoe B), and posterior to the medial malleolus (shoe C) were fabricated and then compared with a flat shoe (shoe D). Kinetic and kinematic data were collected, and lower-extremity joint ranges of motion and moments were calculated. RESULTS: Ankle range of motion was increased by shoe C ( P = .04) during initial contact and by shoe A ( P = .02) during single-limb support. Peak knee moment was significantly larger for shoes A and B ( P < .05) during single-limb support. CONCLUSIONS: Results showed that forward and backward shifting of the heel rocker apex could change the knee moment and ankle joint range of motion in the stance phase of gait. Therefore, placement of the heel rocker in a rocker-bottom shoe can be manipulated to promote the desired lower-limb motion, at least in healthy individuals.


Subject(s)
Lower Extremity/physiology , Range of Motion, Articular/physiology , Shoes , Adult , Biomechanical Phenomena , Equipment Design/methods , Female , Gait/physiology , Humans , Kinetics , Walking/physiology , Young Adult
4.
Prosthet Orthot Int ; 41(1): 58-64, 2017 Feb.
Article in English | MEDLINE | ID: mdl-26271261

ABSTRACT

BACKGROUND: Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients. OBJECTIVES: The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients. STUDY DESIGN: Cross-sectional study. METHODS: An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform. RESULTS: The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support. CONCLUSION: The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.


Subject(s)
Ankle Joint , Joint Instability/physiopathology , Orthotic Devices , Postural Balance/physiology , Adult , Case-Control Studies , Chronic Disease , Cross-Sectional Studies , Female , Humans , Male , Range of Motion, Articular , Young Adult
5.
Spinal Cord Ser Cases ; 2: 15033, 2016.
Article in English | MEDLINE | ID: mdl-28053735

ABSTRACT

In an effort to overcome the disadvantages of reciprocating gait orthoses (RGOs) and medial linkage orthoses (MLOs), a new design of MLO was developed. Therefore the aim of this study was comparison effect of a new reciprocating MLO and traditional isocentric RGO on gait parameters and functional independence (orthosis donning and doffing time) in spinal cord injury (SCI) subjects to provide more evidence of its efficacy. Four people with motor incomplete SCI participated in this study. Each participant was fitted with an MLO and isocentric reciprocating gait orthosis (IRGO) to enable a comparison of walking speed, cadence and endurance to be performed. There were no statistically significant differences demonstrated in temporal-spatial parameters between the orthotic walking conditions in this study, but walking with the MLO improved the stride length and speed of walking by 28.57 and 40.9% compared with walking with an IRGO as a control condition. Hip flexion occurred predominantly during single-support phases, with negligible motion during double-support phases. The first and second Subjects had hip kinematic pattern more near normal when they walked with medial linkage reciprocal gait orthosis (MLRGO) in comparison with IRGO. There was significant difference between donning and doffing in two conditions (P=0.046) but there was not significant difference between two conditions in standing and sitting although these two conditions improved by new MLO. The new MLO provided a quicker and more independent gait compared with IRGO, in addition the new MLO made it easier for subjects to get from sitting to standing and from standing to sitting.

6.
Prosthet Orthot Int ; 40(6): 689-695, 2016 Dec.
Article in English | MEDLINE | ID: mdl-26269446

ABSTRACT

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.


Subject(s)
Foot Orthoses , Gait/physiology , Postpoliomyelitis Syndrome/physiopathology , Equipment Design , Female , Humans , Male , Middle Aged , Postpoliomyelitis Syndrome/rehabilitation , Posture , Range of Motion, Articular , Weight-Bearing
7.
Prosthet Orthot Int ; 39(4): 286-92, 2015 Aug.
Article in English | MEDLINE | ID: mdl-24821714

ABSTRACT

BACKGROUND: Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users. OBJECTIVES: To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed. RESULTS: Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation. CONCLUSION: Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk. CLINICAL RELEVANCE: Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.


Subject(s)
Braces , Foot Orthoses , Gait Disorders, Neurologic/rehabilitation , Spinal Cord Injuries/rehabilitation , Adult , Female , Hip Joint , Humans , Knee Joint , Male , Pilot Projects , Range of Motion, Articular , Young Adult
8.
Ultrasound Med Biol ; 40(8): 1737-54, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24798393

ABSTRACT

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.


Subject(s)
Fascia/diagnostic imaging , Fasciitis, Plantar/diagnostic imaging , Foot/diagnostic imaging , Humans , Ultrasonography
9.
Disabil Rehabil Assist Technol ; 9(3): 226-30, 2014 May.
Article in English | MEDLINE | ID: mdl-24749556

ABSTRACT

OBJECTIVES: Gait training has been shown to improve the walking performance of spinal cord-injured (SCI) patients. The use of powered hip orthoses (PHO) during gait training is one approach which could potentially improve rehabilitative outcomes for such subjects. The aim of this study was therefore to evaluate the influence of a PHO on the kinematics and temporal-spatial parameters of walking by SCI patients. METHODS: Four SCI patients participated in this study. Gait evaluation was performed at baseline and at 10 weeks following intervention with the use of a PHO and gait re-training. Walking speed, step length, vertical and horizontal compensatory motions and hip joint kinematics were analysed prior to and following the training regime. RESULTS: Significant increases in walking speed and step length were demonstrated by the SCI patients when walking with the PHO following orthotic gait training. Sagittal plane hip range of motion also increased, but not significantly. However, vertical and horizontal compensatory motions decreased significantly. CONCLUSIONS: Positive effects on the kinematics and temporal-spatial parameters of gait by SCI subjects were demonstrated following a period of gait training with a PHO. Further studies are therefore warranted to confirm their long term effects on the rehabilitation of SCI subjects. IMPLICATIONS FOR REHABILITATION: Powered hip orthosis could be used by spinal cord injury patients. A major advantage of the orthotic gait training with powered hip orthosis was regeneration of hip movement closer to that of normal human walking. The orthotic gait training with the powered hip orthosis improved the kinematics and temporalspatial parameters in a spinal cord injury patient which also produced near-normal hip joint angle patterns during gait.


Subject(s)
Electric Power Supplies , Gait Disorders, Neurologic/rehabilitation , Orthotic Devices , Paraplegia/rehabilitation , Spinal Cord Injuries/rehabilitation , Walking/physiology , Acceleration , Adult , Biomechanical Phenomena , Female , Follow-Up Studies , Gait Disorders, Neurologic/etiology , Hip Joint , Humans , Male , Paraplegia/complications , Paraplegia/diagnosis , Range of Motion, Articular , Risk Assessment , Sampling Studies , Spinal Cord Injuries/complications , Spinal Cord Injuries/diagnosis , Statistics, Nonparametric , Treatment Outcome , Young Adult
10.
J Sci Med Sport ; 17(4): 430-3, 2014 Jul.
Article in English | MEDLINE | ID: mdl-23810776

ABSTRACT

OBJECTIVES: To evaluate the effect of soft and semirigid ankle orthoses on dynamic balance assessed using Star Excursion Balance Test in patients with functional ankle instability compared with healthy individuals. DESIGN: Non-experimental, observational study with multiple-factor design, including group (functional ankle instability and healthy) as the between-subjects factor and orthotics condition (no orthosis, soft orthosis and semirigid orthosis) as the within-subjects factor. METHODS: Sixteen unilateral functional ankle instability patients and a group of 16 healthy control individuals, matched for age, height and weight, participated in the study. Dynamic balance was tested with and without wearing ankle orthosis. Reach distance of participants in 3 bracing conditions were measured in anteromedial, medial and posteromedial directions of Star Excursion Balance Test. Average of 3 trials in 3 measured directions, normalized to leg length of each participant, was used for statistical analysis. RESULTS: There were no differences among orthotics conditions in healthy people. However, normalized reach distance increased from no-orthosis to semirigid to soft orthoses in FAI patients. Differences were significant between soft and no-orthosis (13% in anteromedial, 14% in medial and 15% in posteromedial direction p=0.01) and between semirigid and no-orthosis (10% in anteromedial, 8.5% in medial and 8.5% in posteromedial direction, p=0.01) conditions in all 3 measured directions. The difference between soft and semirigid orthoses was significant (6% difference, p<0.05) only in PM direction. CONCLUSIONS: Ankle orthoses improve reach distance in functional ankle instability patients in various reach directions. Soft orthosis has a more pronounced effect on dynamic balance, especially in posteromedial direction, compared with semirigid orthosis.


Subject(s)
Ankle Joint , Joint Instability/physiopathology , Orthotic Devices , Postural Balance/physiology , Adult , Exercise Test , Female , Humans , Joint Instability/rehabilitation , Male , Young Adult
11.
Disabil Rehabil Assist Technol ; 8(3): 232-7, 2013 May.
Article in English | MEDLINE | ID: mdl-22804902

ABSTRACT

AIM: The objective of this study was to compare the effect of prefabricated and custom made thumb splints on pain, function, grip strength and key pinch In patients with basilar joint osteoarthritis. METHOD: Volunteer patients (n = 35) with first carpometacarpal joint osteoarthritis were assigned randomly to wear either a prefabricated or custom-made thumb splint or assigned to a control group. This was designed as a cross over study with two 4-week treatment periods, 2 weeks of wash out time for intervention groups between the test conditions and 10-weeks follow-up for the control group. All parameters were measured at the first visit and during the 4th, 6th and 10th weeks In the three groups. RESULTS: In the control group, paIn increased and pinch strength decreased but no statistically significant differences were found In function and grip strength. Both splints changed grip strength with no significant differences between them. PaIn was reduced with the splints, and functions and pinch strength increased significantly as compared to the baseline and control groups. In comparing the two splints only significant differences were observed In pain. CONCLUSION: In comparing two splints, paIn was the only significantly different parameter between tested parameters; with the custom-made splints demonstrating better results In paIn reduction.


Subject(s)
Carpometacarpal Joints , Neoprene , Osteoarthritis/rehabilitation , Splints , Adult , Cross-Over Studies , Equipment Design , Female , Hand Strength , Humans , Male , Middle Aged , Osteoarthritis/physiopathology , Recovery of Function , Thumb , Treatment Outcome
12.
Prosthet Orthot Int ; 37(4): 261-7, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23172910

ABSTRACT

BACKGROUND: The important purpose of a powered gait orthosis is to provide active joint movement for patients with spinal cord injury. OBJECTIVES: The aim of this study was to clarify the effect of a powered gait orthosis on the kinematics and temporal-spatial parameters in paraplegics with spinal cord injury. STUDY DESIGN: Quasi-experimental. METHODS: Four spinal cord injury individuals experienced gait training with a powered gait orthosis for a minimum of 6 weeks prior to participating in the following walking trials: walking with an isocentric reciprocating gait orthosis and walking with both separate and synchronized movements with actuated orthotic hip and knee joints in a powered gait orthosis. Specific parameters were calculated and compared for each of the test conditions. RESULTS: Using separate and synchronized actuated movement of the hip and knee joints in the powered gait orthosis increased gait speed and step length and reduced lateral and vertical compensatory motions when compared to the isocentric reciprocating gait orthosis, but there were no significant differences in these parameters. Using the new powered gait orthosis improved knee and hip joint kinematics. CONCLUSIONS: The powered gait orthosis increased speed and step length as well as hip and knee joint kinematics and reduced the vertical and lateral compensatory motions compared to an isocentric reciprocating gait orthosis in spinal cord injury patients. CLINICAL RELEVANCE: This new powered gait orthosis has the potential to improve hip and knee joint kinematics, the temporal-spatial parameters of gait in spinal cord injury patients walking.


Subject(s)
Gait/physiology , Orthotic Devices , Paraplegia/physiopathology , Paraplegia/rehabilitation , Walking/physiology , Adult , Biomechanical Phenomena/physiology , Electric Power Supplies , Equipment Design , Female , Hip Joint/physiopathology , Humans , Knee Joint/physiopathology , Male , Paraplegia/etiology , Range of Motion, Articular/physiology , Spinal Cord Injuries/complications
13.
Prosthet Orthot Int ; 37(2): 161-7, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22988045

ABSTRACT

BACKGROUND: Mechanical orthoses are used for standing and walking after neurological injury. Most orthoses such as the advanced reciprocating gait orthosis typically use solid ankle-foot orthoses. OBJECTIVES: The goal of this study was to test the effects of ankle dorsiflexion assistance in patients with spinal cord injury when ambulating with an advanced reciprocating gait orthosis compared to walking with fixed ankles. STUDY DESIGN: Quasi-experimental. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis equipped with solid and dorsiflexion assist-type ankle-foot orthoses and walked at their self-selected speed. Joint angles and spatial-temporal parameters were measured and analyzed. RESULTS: The mean walking speed and stride length were both significantly increased along with cadence by the volunteer subjects when ambulating using the advanced reciprocating gait orthosis fitted with dorsiflexion assist ankle-foot orthoses compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. The mean ankle joint ranges of motion were significantly increased when walking with the advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses compared to when using the advanced reciprocating gait orthosis with the solid ankle-foot orthoses. Knee joint ranges of motion were reduced, and hip joint ranges of motion were increased but not significantly. CONCLUSION: The advanced reciprocating gait orthosis fitted with the dorsiflexion assist ankle-foot orthoses had the effect of improving gait parameters when compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. Clinical relevance The advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses has the potential to improve hip and ankle joint kinematics and the temporal-spatial parameters of gait in spinal cord injury patients' walking.


Subject(s)
Ankle Joint/physiology , Equipment Design , Foot Orthoses , Gait/physiology , Paraplegia/therapy , Range of Motion, Articular/physiology , Adult , Biomechanical Phenomena , Female , Hip Joint/physiology , Humans , Knee Joint/physiology , Male , Paraplegia/etiology , Paraplegia/physiopathology , Spinal Cord Injuries/complications , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/therapy , Treatment Outcome , Walking/physiology
14.
Prosthet Orthot Int ; 36(2): 239-46, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22368113

ABSTRACT

BACKGROUND: The aim of this case study was to analyze the effect on gait parameters of a new design of powered gait orthosis which applied synchronized motions to both the hip and knee joints when utilized for walking by a spinal cord injury (SCI) patient. CASE DESCRIPTION AND METHODS: Two orthoses were evaluated while worn by an incomplete SCI subject. Gait evaluation was performed when walking with an isocentric reciprocating gait orthosis (IRGO) and compared to that demonstrated by a newly developed powered version. This new orthosis was based on the IRGO superstructure but incorporated powered hip and knee joints using electrically motorized actuators. FINDINGS AND OUTCOMES: These gait parameters were improved when compared to standard IRGO and initial testing with the orthosis with only the hip or the knee joints activated in isolation. Maximum hip flexion and extension angles, as well as the maximum knee flexion and extension angles all increased when walking with the powered RGO compared to the IRGO. CONCLUSIONS: Gait evaluation of this newly developed orthosis showed improvement in measured parameters when compared to walking with an IRGO. Clinical relevance This case study gave the authors confidence to extend the research to a more extensive study with a group of SCI patients.


Subject(s)
Electric Power Supplies , Gait/physiology , Orthotic Devices , Spinal Cord Injuries/rehabilitation , Walking/physiology , Biomechanical Phenomena , Energy Metabolism/physiology , Equipment Design , Female , Humans , Physical Endurance/physiology , Treatment Outcome , Young Adult
15.
Prosthet Orthot Int ; 36(1): 125-30, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22235109

ABSTRACT

BACKGROUND AND AIM: This article describes the development and testing of a new powered gait orthosis to potentially assist spinal cord injury patients to walk by producing synchronized hip and knee joint movements. TECHNIQUE: The first evaluation of the orthosis was performed without users, and was followed by evaluation of the orthosis performance using three healthy subjects to test the structure under weight-bearing conditions. The orthosis was primarily evaluated to ascertain its ability to generate appropriate hip and knee motion during walking. The walking experiments replicated the flexion and extension of both the hip and knee produced by the actuators which had previously been demonstrated during the initial computer simulations. DISCUSSION: The results suggest that this new orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to ambulate, and may also be suitable for other subjects with impaired lower limb function (e.g. stroke, poliomyelitis, myelomeningocele and traumatic brain injury provided they do not have increased tone or movement disorders.


Subject(s)
Computer Simulation , Equipment Design/methods , Gait/physiology , Orthotic Devices , Paraplegia/rehabilitation , Spinal Cord Injuries/rehabilitation , Biomechanical Phenomena , Hip Joint/physiopathology , Humans , Knee Joint/physiopathology , Male , Paraplegia/etiology , Paraplegia/physiopathology , Range of Motion, Articular/physiology , Spinal Cord Injuries/complications , Spinal Cord Injuries/physiopathology , Weight-Bearing/physiology
16.
Prosthet Orthot Int ; 36(1): 105-12, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22235110

ABSTRACT

BACKGROUND: The aim of this case study was to identify the effect of a powered hip orthosis on the kinematics and temporal-spatial parameters of walking by a patient with spinal cord injury (SCI). CASE DESCRIPTION AND METHODS: Two orthoses were evaluated while worn by an incomplete SCI subject with a T-8level of injury. Gait evaluation was performed when walking with an Isocentric Reciprocating Gait Orthosis (IRGO) and compared to that demonstrated by a newly powered version of the orthosis; based on the IRGO superstructure but incorporating powered hip joints using an electrically motorized actuator that produced active hip joint extension and flexion. FINDINGS AND OUTCOMES: The powered hip orthosis, when compared to the IRGO, increased the speed of walking, the step length and also the cadence demonstrated by this subject. Vertical and horizontal compensatory motions with new orthosis decreased. Hip angles when walking with this orthosis were comparative to those demonstrated by normal walking patterns. CONCLUSIONS: The hip actuator produced positive effects on the kinematics and temporal-spatial parameters of gait during level-ground walking trials, resulting in an alternative approach to walking by SCI patients.


Subject(s)
Hip Joint/physiology , Orthotic Devices , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/therapy , Walking/physiology , Biomechanical Phenomena/physiology , Electric Power Supplies , Equipment Design , Female , Gait/physiology , Humans , Treatment Outcome , Young Adult
17.
Prosthet Orthot Int ; 36(1): 71-6, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22130910

ABSTRACT

BACKGROUND: Children with cerebral palsy (CP) often demonstrate postural control difficulties. Orthotic management may assist in improving postural control in these children. OBJECTIVE: The purpose of this investigation was to examine the influence of floor reaction ankle foot orthosis (FRAFO) on postural flexion called the crouch position in children with CP. STUDY DESIGN: Quasi-experimental. METHODS: Eight children with spastic diplegic CP and eight matched typically developing children participated in this study. Postural control of children with CP was assessed in a static standing position on a force platform with/without a FRAFO. The parameters used were centre of pressure (CoP) measures, calculated from force platform signals including the standard deviation (SD) of excursion; phase plate portrait and SD of velocity in anteroposterior (AP) and mediolateral (ML) directions. RESULTS: The maximum knee extension was statistically significant in children with CP when barefoot compared to wearing braced footwear (p < 0.05, t = 10.01). AP and ML displacement, AP velocity and AP phase plate portrait of CoP were not statistically significant between children with CP with/without a FRAFO (p < 0.05). CONCLUSION: FRAFO can improve the alignment of the knee, but may not be helpful in improving postural control in children with CP in a short time period.


Subject(s)
Ankle Joint/physiology , Cerebral Palsy/physiopathology , Cerebral Palsy/therapy , Foot/physiology , Orthotic Devices , Posture/physiology , Walking/physiology , Biomechanical Phenomena , Bone Malalignment/prevention & control , Braces , Case-Control Studies , Child , Female , Floors and Floorcoverings , Humans , Knee Joint/physiology , Male , Range of Motion, Articular/physiology
18.
J Sci Med Sport ; 14(5): 370-5, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21237708

ABSTRACT

Some studies have demonstrated improvement of postural control following use of ankle supports, whereas others reported no effect or even negative effects of bracing. The present study aimed to investigate the immediate effects of soft and semi-rigid orthosis on postural sway in patients with functional ankle instability (FAI). Twenty patients with unilateral FAI and twenty matched healthy individuals participated in the study. Balance in single limb stance on force platform with eyes-open was assessed for both legs while wearing no orthosis (control condition), soft or semi-rigid orthosis. The center of pressure (COP) measures derived from force platform signals were mean total velocity, standard deviation (SD) of velocity and phase plane portrait. A 2 × 2 × 3 (group by foot by orthotics) mixed model analysis of variance was used for statistical analysis. In the FAI group, there was a tendency to lower COP parameters while wearing either of the orthoses, with soft brace having a greater effect. For 2 dependent variables, significant effect of brace was found only for the injured limb. In the healthy group, postural sway increased from no-brace condition, to soft, to semi-rigid orthosis. Both injured and non-injured limbs of patients with FAI had greater postural sway compared to control limbs of healthy individuals.


Subject(s)
Ankle/physiopathology , Orthotic Devices , Postural Balance/physiology , Adult , Ankle Injuries/physiopathology , Ankle Injuries/therapy , Female , Humans , Joint Instability/physiopathology , Joint Instability/therapy , Male , Sprains and Strains/physiopathology , Sprains and Strains/therapy , Young Adult
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