The effect of minimally invasive suturectomy with postoperative cranial remolding orthotic treatment for an infant with bilateral coronal craniosynostosis.

Minimally invasive suturectomy has been reported to significantly decrease the economic cost of treating infants with craniosynostosis. Nonetheless, treatment should be accompanied by a cranial remolding orthosis to maintain the constant correction and reshaping of the skull throughout the infant's development.

Immediate effect of textured insoles on the balance in patients with diabetic neuropathy.

AIMS/INTRODUCTION: Neuropathy is a common complication of diabetes that reduces balance by disrupting vision, and the sensory and vestibular systems. This is important in older adults who are more at risk of falling. Studies show that improving the sensory mechanisms through insoles can improve balance in people with balance disorders. As textured insoles have recently been considered for improving balance disorders, this study aimed to investigate the immediate effect of textured insoles on the balance of patients with diabetic neuropathy. MATERIALS AND METHODS: A total of 17 patients with diabetic neuropathy participated in this quasi-experimental study. The studied variables were the general balance index, posterior-anterior balance index and medial-lateral balance index, which were measured in three conditions: (i) soft textured insoles; (ii) hard textured insoles; and (iii) without textured insoles. A Biodex balance device was used for this purpose. RESULTS: In the general balance index, there was a significant difference between all the studied conditions. In the posterior-anterior balance index, there was a significant difference between without textured insole and hard textured insoles, and also soft and hard textured insoles. In the medial-lateral balance index, there was a significant difference between the hard textured insoles and without textured insoles, and also soft and hard textured insoles (P < 0.05). CONCLUSIONS: Wearing textured insoles can increase the balance in patients with diabetic neuropathy. This can be due to its effect on the sensory feedback of the soles, improving the proprioception and tactile sensors that are the main sources of balance.

Comparison of Immediate Effect of New Knee brace and Conventional Three-Points Knee Valgus Brace on Knee Adduction Moment and ROM in Patients with Medial Knee Osteoarthritis.

The knee unloader brace can change loading on knee which may be effective in reducing symptoms and progression of disease in people with knee osteoarthritis. The purpose of this study was to evaluate the effect of a new knee brace during walking in a patient with medial compartment knee osteoarthritis. Two brace types were used: new brace and conventional brace. A pneumatic cuff of novel brace was fitted in the bottom of the medical slipper that was connected to the cuff section of the knee through the tube. After the knee brace is deployed, its force can vary in different stages of the gait. During the heel strike, the weight of the cuff is compressed on the floor, causing the air to flow inside it and entering the volume of air into the knee pad. The results of using this pneumatic knee brace compared with conventional knee braces on a patient showed that in both cases, the open and closed palatal pump, the adduction moment and ROM was decreased in the stance phase. But the three-point knee pressure, however, was less effective in reducing the adduction moment but also reduced the knee ROM. Using novel brace can eliminate the patient's need for painful and costly surgery to reduce the symptoms of osteoarthritis.

Design and evaluation of a prosthetic socket for a patient with diabetic-related transtibial amputation: A case report.

This is a report of a diabetic transtibial amputee with severe pain and ulcer in the antero-distal of the tibia. A novel prosthetic socket with an antero-distal silicone wall was designed. The result showed that the patient's satisfaction was increased and the average peak pressure was reduced by using the new socket design.

Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: A case report.

CASE DESCRIPTION: This is a report of a 2.5-month-old infant with bilateral lambdoid and sagittal synostosis who underwent minimally invasive suturectomy followed by cranial remolding orthosis (CRO). OBJECTIVES: To evaluate the result of minimally invasive suturectomy followed by CRO treatment in an infant with bilateral lambdoid and sagittal synostosis. STUDY DESIGN: This is a case report. TREATMENT: We fabricated the orthosis based on a computer-aided design and with computer-aided manufacturing technology. Cranial remolding orthosis compliance was measured subjectively. The child's parents were asked to complete a survey using visual analog scales to assess their satisfaction of their child's head appearance, problems with donning/doffing the orthosis, and feedback received from other people. OUTCOMES: At the time of fitting, the posterior skull hemisphere volume was 389.4 cm3. The values of cephalic index and cranial vault asymmetry index (CVAI) were 81% and 5%, respectively. After 6 months of CRO treatment, the cephalic index and CVAI were 83% and 1.5%, respectively. Moreover, the posterior skull hemisphere volume was 589.2 cm3. Average compliance with CRO wear was 88%. According to the parental questionnaire results, pressure sores occurred 0% of the time, displacement occurred 15% of the time, contact dermatitis occurred 10% of the time, problems with donning/doffing of the orthosis occurred 27% of the time, difficulties in breastfeeding occurred 30% of the time, negative feedback from other people upset them 55% of the time, and they were 100% satisfied with treatment. CONCLUSIONS: After 6 months of using CRO, the CVAI and skull volume improved and reached their normal proportions. Our results may help ongoing research and clinical care regarding the role of postoperative CRO treatment in patients with complex synostosis.

Experimental study of prosthesis modifications based on passive dynamic walking model: A limit cycle stability analysis.

The aim of the current study was to examine the effect of asymmetric prosthesis derived from the passive dynamic walking (PDW) concept on dynamic stability and symmetry in unilateral transfemoral amputees. Seventeen transfemoral amputees were asked to walk on 77.8 m in preferred speed under four conditions: 1) no added mass, 2) the knee joint relocated downwards by 18% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7%, 3) the knee joint relocated downwards by 37% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7% and 4) thigh mass increased 17%, shank mass decreased by 38%. Trunk accelerations were recorded by a triaxle accelerometer, attached at the L3 level of spine. For each condition, stability (orbital and local), intra-limb step length and step time variability, step length and step time symmetry, were estimated from the vertical acceleration. Our findings showed no significant change in the orbital stability (P = 0.627) and the local stability (P = 0.748). In addition, no significant difference was found in the step length symmetry (P = 0.891), intra-limb step length variability (P > 0.234), the step time symmetry (P = 0.960) and intra-limb step time variability (P > 0.847) with the new prosthetic configurations. Our empirical findings indicate that contrary to the modeling predictions, manipulating physical parameters does not improve gait pattern in terms of stability, variability and symmetry in transfemoral amputees. It suggests that proposed modifications based on PDW cannot be directly applied to real human conditions without further elaborations.

The effect of hydrodynamic insole on foot kinematics in individuals with flexible flatfoot: Case series using a single-subject design.

The medial longitudinal arch of the foot is a dynamic structure while walking. The mobility of this structure in people with flexible flatfoot is partially or completely absent. The aim of this study was to investigate the efficacy of an insole that was designed to retrieve the medial longitudinal arch mobility in people with flatfoot. The study was a case series using a single-subject design. This single-subject design study was based on three subjects with flexible flatfoot. This study was designed in two phases: the baseline phase and the intervention phase. Each phase included five measurement sessions that were done in 5 consecutive weeks. We used the celeration-line method to detect the significant differences between the phases. Significant differences were recorded in the walking velocity, step length, and medial longitudinal arch mobility parameters when using the hydrodynamic insole. The results of this study showed that using the hydrodynamic insole may have a positive effect on the foot kinematics and gait parameters in people with flexible flatfoot.

A comparison between the dimensions of positive transtibial residual limb molds prepared by air pressure casting and weight-bearing casting methods.

BACKGROUND: Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method. METHODS: Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort. RESULTS: Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015). CONCLUSION: The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements.

Open-Design Collar vs. Conventional Philadelphia Collar Regarding User Satisfaction and Cervical Range of Motion in Asymptomatic Adults.

OBJECTIVE: The current study aimed to compare the Philadelphia collar and an open-design cervical collar with regard to user satisfaction and cervical range of motion in asymptomatic adults. DESIGN: Seventy-two healthy subjects (36 women, 36 men) aged 18 to 29 yrs were recruited for this study. Neck movements, including active flexion, extension, right/left lateral flexion, and right/left axial rotation, were assessed in each subject under three conditions--without wearing a collar and while wearing two different cervical collars--using a dual digital inclinometer. Subject satisfaction was assessed using a five-item self-administered questionnaire. RESULTS: Both Philadelphia and open-design collars significantly reduced cervical motions (P < 0.05). Compared with the Philadelphia collar, the open-design collar more greatly reduced cervical motions in three planes and the differences were statistically significant except for limiting flexion. Satisfaction scores for Philadelphia and open-design collars were 15.89 (3.87) and 19.94 (3.11), respectively. CONCLUSION: Based on the data of the 72 subjects presented in this study, the open-design collar adequately immobilized the cervical spine as a semirigid collar and was considered cosmetically acceptable, at least for subjects aged younger than 30 yrs.

Influence of modified solid ankle-foot orthosis to be used with and without shoe on dynamic balance and gait characteristic in asymptomatic people.

BACKGROUND: Ankle-foot orthoses are usually used in combination with footwear. Shoe design can have a significant effect on kinematics of the lower limb joints and line of action of the ground reaction force during walking. But, ankle-foot orthosis-footwear combination is not appropriate for indoor barefoot walking in some Asian cultures. In this study, we have modified a solid ankle-foot orthosis in order to set it in the same position as a solid ankle-foot orthosis-footwear combination. OBJECTIVE: To investigate the effect of a modified solid ankle-foot orthosis; a solid ankle-foot orthosis which can be locked in different positions on gait and balance performance in comparison with a conventional solid ankle-foot orthosis, a common solid ankle-foot orthosis-shoe combination in asymptomatic adults. STUDY DESIGN: Cross sectional. METHODS: Two standard solid ankle-foot orthoses were manufactured with the ankle joint in neutral position. Then, one of these solid ankle-foot orthoses was modified in order to allow locking in a different alignment. Walk across, limit of stability, and sit-to-stand tests of the balance master system were performed while participants wore the modified solid ankle-foot orthosis aligned in 5°-7° anterior inclination without a shoe and a conventional solid ankle-foot orthosis-shoe combination. RESULTS: There was no significant change in walking speed, step length, and step width with the conventional and modified solid ankle-foot orthoses. In addition, movement velocity and maximum excursion of the center of gravity during the limit of stability test were not different, although the maximal forward excursion of the center of gravity was longer when wearing the modified solid ankle-foot orthosis compared to the conventional solid ankle-foot orthosis-shoe combination (P = 0.000). Sway velocity of the center of gravity did not change during the sit-to-stand test. CONCLUSION: The results demonstrated that the modified solid ankle-foot orthosis had the same effects as the conventional solid ankle-foot orthosis-shoe combination on the gait and balance performance of asymptomatic adults. Clinical relevance The findings of the present study can be used as the basis for further investigations on the efficacy of the modified solid ankle-foot orthoses in different neuromuscular populations in order to help people who do not wear shoes at home, as is the custom in some Asian cultures.