Validity and Reliability of the Persian Version of Barriers to Physical Activity Questionnaire for People With Mobility Impairments.

BACKGROUND: Although physical activity (PA) is an important determinant of health, physically disabled individuals tend to have a sedentary lifestyle. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) is a self-report instrument evaluating PA barriers. This study was intended to evaluate the validity and reliability of the Persian version of BPAQ-MI (P-BPAQ-MI) and to report the prevalence and severity of PA barriers among Persian-speaking individuals. METHODS: The translation and back translation of the BPAQ-MI was conducted according to an internationally accepted guideline and tested on 163 participants to assess its reliability and validity. Internal consistency and test-retest reliability were analyzed using Cronbach alpha and Spearman correlation coefficient. Convergent construct validity was established by comparing the scores of P-BPAQ-MI and The Baecke Habitual Physical Activity Questionnaire. Known-groups construct validity was assessed with regard to type of assistive device and sex of the individual. Prevalence and severity of the barriers were reported by computing the percentage and means of "yes" answers. RESULTS: The P-BPAQ-MI domains demonstrated very good internal consistency (Cronbach alpha of .77-.95) and excellent test-retest reliability (Spearman rho of .73-.96) with a significant inverse small correlation with Baecke Habitual Physical Activity Questionnaire indexes. The P-BPAQ-MI successfully discriminated between individuals with different assistive devices and sex. Community Built Environment barriers were the most prevalent and severe. CONCLUSIONS: The P-BPAQ-MI is a valid and reliable instrument to assess the PA barriers of people with physical disability. The community barriers were the most frequently reported obstacles to PA.

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.

The effect of toe-only rocker sole shoes on gait variability of the elderly.

Gait variability could associate with fall risk in older people. Rocker sole shoes are commonly prescribed to reduce plantar pressure and facilitate forward movement. Thus, it may affect gait stability. The purpose of this study was to investigate the effects of toe-only rocker shoes on gait variability in the elderly. Seventeen healthy elderly participants walked on a treadmill under six different conditions including barefoot (BF), normal shoe (NS), and four types of toe-only rocker sole shoes with various degrees of rocker angle (RS10, RS20, RS30, and RS40). Then the step length variability (SLV), the step time variability (STV), the step width variability (SWV), and the stance time variability were measured. Increasing rocker angle in toe-only rocker did not significantly affect gait variability more than the standard shoe. It seems that different rocker angles in toe-only rocker sole shoes do not pose a threat to gait variability compared to the standard shoes in healthy elderly. Findings of the study suggested that the toe-only rocker sole can be used to facilitate forward progression in the elderly. Further investigation is also required to examine the long-term effects of toe-only rocker sole shoes on gait variability in frail elderly.

Comparison of the Modified Lumbar Pelvic Belt with the Current Belt on Low Back and Pelvic Pain in Pregnant Women.

Background: Low back pain is one of the most common problems for pregnant women during pregnancy. Most belts are designed for supporting the surface of the symphysis pubis or upper anterior iliac spine without any support in the lumbar region. Objective: This study aimed to compare the related effects between the new design and the current belt on the pain and function of pregnant women. Material and Methods: In this randomized control trial study, 48 pregnant women with pelvic and lumbar pain participated. The participants were randomly divided into three groups: current belt, modified belt, and control. Pain intensity assessment, pelvic girdle (PG), and Oswestry disability index (ODI) questionnaires were utilized at the beginning of the study and three weeks later. Results: The pain intensity decreased more in the modified belt group than in the current belt group. ODI and PG scores decreased in two belt groups after three weeks of follow-up. However, this decrease was greater in the modified belt group, there was no statistically significant difference. Conclusion: The disability decreased in both groups using the belts, and their function was improved. Accordingly, the use of a modified belt with lumbar and PG support can significantly reduce back and pelvic pain in pregnant women compared to the current pelvic belt.

Nonlinear analysis of dynamic stability in walking with toe-only rocker sole shoes in elderly.

BACKGROUND: Elderly subjects are at the risk of falling. One type of shoe intervention used for this group of the subjects is the shoe with rocker. The aim of this study was to investigate the effects of shoes with various degrees of rockers on dynamic stability of elderly subjects while walking. METHOD: 15 elderly subjects were recruited in this study. A motion analysis system was used to record the motions of body while walking on a treadmill. The local dynamic stability (LDS) was evaluated based on use of Lyapunov exponent of center of mass (COM) movement. The subjects were asked to walk barefoot, with shoe with no rocker and with shoe with various rockers (10, 20, 30 and 40°). RESULTS: The mean values of LDS (λmax-S) in anteroposterior direction were 0.95 ± 0.46, 0.78 ± 0.51 and 0.74 ± 0.54 in bare foot, shoes with no rocker and shoe with 10° rocker, respectively. The mean value of LDS (λmax-S) in vertical direction varied between 1.21 and 1.23. There was no significant difference between LDS of elderly subjects while walking with shoes with various rocker angles. DISCUSSION: Use of shoes with various rocker angles dose not influence on dynamic stability of elderly subjects while walking. Therefore, it is recommended to use this kind of shoe intervention for other trapeutic purposes.

Development and preliminary evaluation of a new anatomically based prosthetic alignment method for below-knee prosthesis.

The objectives of current study were to a) assess similarities and relationships between anatomical landmark-based angles and distances of lower limbs in unilateral transtibial amputees and b) develop and evaluate a new anatomically based static prosthetic alignment method. First substudy assessed the anthropometrical differences and relationships between the lower limbs in the photographs taken from amputees. Data were analyzed via paired t-test and regression analysis. Results show no significant differences in frontal and transverse planes. In the sagittal plane, the anthropometric parameters of the amputated limb were significantly correlated to the corresponding variables of the sound limb. The results served as bases for the development of a new prosthetic alignment method. The method was evaluated on a single-subject study. Prosthetic alignment carried out by an experienced prosthetist was compared with such alignment adjusted by an inexperienced prosthetist but with the use of the developed method. In sagittal and frontal planes, the socket angle was tuned with respect to the shin angle, and the position of the prosthetic foot was tuned in relation to the pelvic landmarks. Further study is needed to assess the proposed method on a larger sample of amputees and prosthetists.

Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury.

BACKGROUND: The aim of this study was to assess the performance of an original powered foot clearance creator (PFCC) mechanism worn in conjunction with an isocentric reciprocal gait orthosis (IRGO) and evaluate its effect on trunk compensatory movements and spatiotemporal parameters in nine healthy subjects. METHOD: A PFCC motorized mechanism was designed that incorporated twin sole plates, the movements of which enabled increased toe to floor clearance during swing phase. A prototype was constructed in combination with an IRGO, and hence was re-named as an IRGO-PFCC orthosis. The effects of IRGO-PFCC usage on the spatiotemporal parameters and trunk compensatory movements during walking were then analyzed under two conditions, firstly with the PFCC 'active' i.e., with the motorized device functioning, and secondly inactive, where floor clearance was standard. RESULTS: Ambulating with IRGO-PFCC orthosis resulted in reduction in the spatiotemporal parameters of gait (speed of walking, cadence and stride length) in nine healthy subjects. Walking with IRGO-PFCC orthosis led to significant differences in lateral (p = .007) and vertical (p = .008) trunk compensatory movements. In other words, through using IRGO-PFCC orthosis, the lateral and vertical trunk compensatory movements decreased by 51.32% and 42.7%, respectively. CONCLUSION: An adapted PFCC mechanism, with a relatively small motor and power supply could effectively increase toe to floor clearance during swing phase and thereby decrease trunk compensatory motions and potentially improve energy consumption. Implications for rehabilitations •The High rejection rates of reciprocal gait orthoses are related to the increasing in energy expenditure and burden loads on the upper limb joints during walking following trunk compensatory movements.•An original powered foot clearance creator mechanism was designed and constructed to assisting floor clearance capability and reduce trunk compensatory movements in subjects with spinal cord injury during swing phase of gait.•This original powered foot clearance creator mechanism by using moveable soleplates and motorized actuation could decrease the trunk compensatory motions during the ambulation of nine healthy subjects.•More experiments are needed to investigate this mechanism on trunk compensatory movements of SCI subjects.

Effects of Two Different Hip-Knee-Ankle-Foot Orthoses on Postural Stability in Subjects with Spinal Cord Injury: A Pilot Study.

STUDY DESIGN: Pilot study. PURPOSE: Evaluation of two different hip-knee-ankle-foot orthoses (HKAFOs; medial linkage reciprocating gait orthosis [MLRGO] and isocentric reciprocating gait orthosis [IRGO]) using gait and postural stability analysis in four subjects with spinal cord injury (SCI). OVERVIEW OF LITERATURE: To the best of our knowledge, no study has evaluated postural stability in subjects with SCI when using MLRGO and IRGO. METHODS: The relative efficacy of each orthosis was evaluated with relevant gait parameters, and an assessment of postural stability and sway during usage was made. Each analysis was conducted following an appropriate period of training and acclimatization. The gait parameters employed in the study were walking speed, cadence, and endurance; these were recorded and analyzed using current, validated methods. Postural stability was assessed using a verified force plate measurement system, and a modified Falls Efficacy Scale (mFES) was used for the measurement of postural sway and the perceived fear of falling. RESULTS: Walking speed, cadence, and endurance increased with the use of both HKAFOs. When the two types of HKAFOs were compared, all the parameters showed a slight (but not significant) increase with the use of MLRGO compared with the use of IRGO. In contrast, there were slight but insignificant improvements in postural sway with the use of IRGO. However, although there were no significant differences between the two sets of mFES scores, there was a slightly reduced fear of falling with the use of MLRGO compared with the use of IRGO in the static standing position. CONCLUSIONS: It is noteworthy that meaningful interpretations of results can only be drawn if a larger sample is employed. This pilot study showed no significant data; however, the results indicate that the use of MLRGO is superior to that of IRGO in terms of potential improvement in the mobility and confidence levels of subjects with SCI.

A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature.

Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before-after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure-related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.

The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis - a pilot study.

OBJECTIVE: When walking with an advanced reciprocating gait orthosis (ARGO), ankle and knee joint motion is restricted which causes an un-cosmetic gait compared to normal walking. The purpose of this study was to develop and evaluate a rocker modification for use with the ARGO in order to improve hip joint kinematics, walking speed, step length and cadence. METHOD: Spinal cord injury patients (n = 4) with thoracic-level injury participated in this study, and walked with a standard ARGO and one which was also adapted with a rocker sole in a randomized order. RESULTS: Mean walking speed and step length were both significantly increased by volunteer SCI subjects when ambulating using the ARGO adapted with a rocker sole compared to the standard ARGO. Cadence was not significantly affected, but swing time was significantly reduced and mean hip flexion and extension were both significantly increased when walking with the adapted ARGO. CONCLUSION: The rocker sole modification produced an increase in walking speed and step length, and improved sagittal plane hip joint kinematics when ambulating using an ARGO. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard unmodified version. Implications for Rehabilitation The ARGO adapted with a rocker sole could be used by spinal cord injury patients. A major advantage of the walking with the ARGO adapted with a rocker sole was increased of walking speed and step length, and improvement of the sagittal plane hip joint kinematics. The findings of this study would appear to provide useful data for rehabilitation teams who utilize orthoses to walk and rehabilitate SCI subjects. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard un-modified version.

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: an orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis.

BACKGROUND AND AIM: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. TECHNIQUE: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. DISCUSSION: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. CLINICAL RELEVANCE: A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

A novel technique for fabricating an ear prosthesis in a patient with congenital ear deformity.

BACKGROUND AND AIM: Microtia is one of the forms of ear loss and deformity. A prosthesis that is simple to apply, and which has adequate suspension and acceptable aesthetics, can be useful in the rehabilitation of patients with this deficit and can improve the social and psychological effects of patients with ear amputation. The aim of this article was to describe a novel technique for fabricating ear prosthesis in a patient with congenital ear deformity. TECHNIQUE: This method involves a novel method to produce an ear prosthesis using clips that were located within the layers of the final silicone ear. DISCUSSION: This study demonstrated ease of use and acceptance by the patient. Design and fabrication of silicone ear prosthesis via this new method of suspension could also be suitable for provision to children with ear microtia who are not yet suitable for surgery or would not be suited to other methods of suspension. CLINICAL RELEVANCE: The new method of suspension demonstrated that this approach could be used to provide low cost and acceptable silicone ear prosthesis for patients with microtia and partial ear amputation.

Design and fabrication of a finger prosthesis based on a new method of suspension.

BACKGROUND AND AIM: Finger amputation is one of the most common types of amputation. Prosthesis with adequate suspension, user-friendly design, and an aesthetic appearance can be effective in the rehabilitation of these patients. The aim of this technical note was to propose a technique for fabrication of finger prosthesis with a new suspension approach for such patients. TECHNIQUE: To design and accurately fabricate the socket of finger prosthesis, the socket was reduced by 2 mm less than the original value, and a central tunnel with 4 mm width and depth with length matching the distance between the end of the stump and the nail section was provided, so that the silicone material extended to the stump to provide appreciable suspension. DISCUSSION: This study demonstrated the design and fabrication of a silicone finger prosthesis. It also showed silicone finger prosthesis with acceptable suspension, a user-friendly and light design, and a cosmetic appearance constructed for a patient with finger amputation. CLINICAL RELEVANCE: Patients with finger amputation usually use prostheses with a simple suspension technique, but evidence suggests that the residuum of these patients experience atrophy and subsequently loss of appropriate suspension. Therefore, this study was required to provide an alternative suspension method in patients with finger amputations.

Prosthetic rehabilitation of a patient with partial ear amputation using a self suspension technique.

BACKGROUND AND AIM: Partial ear amputations are one of the forms of ear loss. A user-friendly design of prosthesis with safe suspension and an aesthetic appearance can be helpful to a patient who has lost part of their ear due to congenital absence or trauma. Prosthetic use has social and psychological effects on the patient and their family. The aim of this paper is to describe a technique of ear prosthesis fabrication with self suspension for these patients. TECHNIQUE: To provide a snugly fitting prosthesis, the only parts of the residual ear that were covered by the prosthesis were accurately manufactured and reduced in thickness to 0.5-1 mm and 10 mm in width, so that the silicone extended over the stumps to provide adequate suspension. DISCUSSION: This paper proposes the designing and constructing of a silicone ear prosthesis which had good suspension, low cost, was easy to use and was acceptable in appearance to the patient.