Effect of Virtual Reality Therapy on Quality of Life and Self-Sufficiency in Post-Stroke Patients.

Background and Objectives: The consequences of stroke have a significant impact on self-sufficiency and health-related quality of life (HRQoL). Virtual reality (VR)-based rehabilitation has the potential to impact these modalities, but information on timing, volume, and intensity is not yet available. The aim of this randomized controlled trial (1:1) was to evaluate the impact of conventional rehabilitation combined with VR on self-care and domains of HRQoL in patients ≤6 months post-stroke. Materials and Methods: The intervention group completed a total of 270 min of conventional VR + rehabilitation sessions. The control group underwent conventional rehabilitation only. Primary assessments with the WHO disability assessment schedule 2.0 (WHODAS 2) questionnaire were conducted before rehabilitation (T0), after completion of the intervention (T1), and at the 4-week follow-up (T2); secondary outcomes included self-sufficiency and balance assessments. Results: Fifty patients completed the study (mean age 61.2 ± 9.0 years, time since stroke 114.3 ± 39.4 days). There were no statistically significant differences between the groups in WHODAS 2, self-sufficiency, and balance scores (p > 0.05). Conclusions: In the experimental group, there was a statistically significant difference in WHODAS 2, assessment of self-sufficiency, and balance scores before and after therapy (p < 0.05). VR appears to be a suitable tool to supplement and modify rehabilitation in patients after stroke.

Postural Control Strategies and Balance-Related Factors in Individuals with Traumatic Transtibial Amputations.

Mechanisms behind compromised balance control in people with transtibial amputation need to be further explored, as currently little is known specifically about postural control strategies in people with traumatic transtibial amputation (tTTA). The aim of this study is to assess automatic and voluntary postural control strategies in individuals with unilateral tTTA compared to those in control subjects and to define the effect of balance-related factors on these strategies. Automatic posture reactions and volitional motion toward given direction using standardized posturographic protocols (NeuroCom) of the Motor Control Test (MCT) and Limits of Stability (LOS) were assessed in eighteen participants with tTTA and eighteen age-matched controls. Compared to the controls, the participants with tTTA bore less weight on the prosthetic leg (p < 0.001) during the MCT and had reduced inclination toward the prosthetic leg (p < 0.001) within the LOS. In the tTTA group, the weight-bearing symmetry and the inclination toward the prosthetic leg (p < 0.05) was positively correlated with prosthesis use duration (p < 0.05). The current study indicates that decreased utilization of the prosthetic leg in tTTAs represents adaptive postural control strategy, but as prosthesis use duration increased, the engagement of the prosthetic leg improved.

Immediate effect of individual bars of insoles and their combination on gait parameters in asymptomatic healthy adults.

Objective: The way how individual bars of sensorimotor insoles influence the gait kinematics is not fully understood yet. Therefore, this study aimed to explore the effect of three sensorimotor orthotic conditions (the medial calcaneal and retrocapital lateral bars and their combination) on the gait parameters in healthy adults during the stance phase of gait cycle.Materials and methods: Twenty-six young adults performed 20 gait cycles in each condition using their self-selected cadence and provided standardised shoes with the base-sole and the three types of orthotics. A three-dimensional motion analysis system (8 cameras; 200 Hz) was used and a six-degrees of freedom model was applied. The cadence, the stride length, the first peaks of foot external rotation, eversion and dorsal flexion as well as the first peak of hip adduction were analysed.Results: Significant differences (p < 0.05) were found for all parameters between the orthotic conditions, except the cadence. Significant difference in the first peak of hip adduction (p = 0.008) was found between the dominant and non-dominant leg. There were no significant interactions between the factors of condition and leg dominance (p > 0.05).Conclusions: There seems to be overall tendencies in immediate changes in ankle joint kinematics caused by all three sensorimotor orthotic conditions and besides the mechanical principles, also 'proprioceptive mechanism' seems to play a role. However, maximum observed average angular change was 2° and some variability in reactions to each orthotic condition exists among the individuals. Therefore, clinical relevance of such changes remains unclear and careful analysis of expected outcomes should be the common part of every orthotic intervention.

Comparison of Plantar Pressure Distribution During Walking After Two Different Surgical Treatments for Calcaneal Fracture.

The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.

The effect of balance training intervention on postural stability in children with asthma.

OBJECTIVE: Pulmonary rehabilitation is mainly focused on exercise training and breathing retraining in children with asthma. Conversely, balance training is not usually recommended for the treatment, although postural deficits were found in these patients. Therefore, this study assessed the effect of balance training intervention on postural stability in children with asthma. METHODS: Nineteen children with mild intermittent asthma (age 11.1 ± 2.1 years, height 147.6 ± 13.9 cm, weight 41.8 ± 13.3 kg) were randomly assigned to an experimental group or a control group and completed a four-week physiotherapy program including breathing exercises and aerobic physical training (six times/week, 45 minutes). Both groups performed the same training, but only the experimental group underwent exercises on balance devices. The center of pressure (CoP) velocity in the anteroposterior (Vy) and mediolateral (Vx) directions, and total CoP velocity (Vtot) were recorded before and after training in the preferred and the adjusted stances under eyes open (EO) and eyes closed (EC) conditions. RESULTS: The addition of balance intervention led to significant improvements of Vtot (p = 0.02, p = 0.04) in both types of stance, Vx in the preferred stance (p = 0.03) and Vy in the adjusted stance (p = 0.01) under EO conditions. Significant improvements were also found in Vy in the adjusted stance (p = 0.01) under EC conditions. CONCLUSIONS: Results of this study support the effectiveness of balance training as a part of physiotherapy treatment for improving balance performance, predominantly under EO conditions, in children with mild asthma.

Comparison of gait kinematics between professional ballet dancers and non-dancers.

OBJECTIVES: The aims of the study were to assess the kinematics of the lower limbs and pelvis during normal walking in professional ballet dancers and to investigate relationships between movements of segments of the lower limbs and pelvis. METHODS: Thirty one professional ballet dancers and twenty eight controls completed five walking trials at their preferred speed. Kinematic data in the basic anatomical planes for ankle, knee, and hip joints as well as for the pelvis were collected with an optoelectronic motion system. RESULTS: The female ballet dancers had in comparison with the controls significantly larger (p < 0.01) knee flexion in the swing phase and hip abduction in the preswing phase. Compared to the control group, the male ballet dancers had significantly larger dorsiflexion in the final stance and the total pelvic tilt range of motion. The number of significant correlations between kinematic parameters was higher in the female ballet dancers. CONCLUSIONS: It can be concluded that specific movement techniques and compensatory strategies used in ballet dance can alter relationships between movements of segments of the lower limbs during normal walking. The relationships between movements in the joints of the lower limbs and pelvis are stronger in women.

The Effects of Nordic Walking and Slope of the Ground on Lower Limb Muscle Activity.

Psurny, M, Svoboda, Z, Janura, M, Kubonova, E, Bizovska, L, Martinez Lemos, RI, and Abrantes, J. The effects of Nordic walking and slope of the ground on lower limb muscle activity. J Strength Cond Res 32(1): 217-222, 2018-Nordic walking (NW) has proven to be a simple and safe mode of exercise that can be used in various types of sport, recreation, and rehabilitation activities. The aim of this study was to assess the effect of Nordic walking and slope of the ground on lower limb muscle activity. The experimental group consisted of 22 healthy men (aged 22.8 ± 1.4 years). The subjects walked on a treadmill at a self-selected speed. Two walking conditions (NW and walking) and 2 ground slopes (level ground and uphill walking at an 8% incline) were used. The surface electromyographic signals of the gastrocnemius lateralis, tibialis anterior, vastus medialis, rectus femoris, biceps femoris and gluteus medius were recorded. Nordic walking resulted in increased activity of some lower limb muscles, particularly during the first half of the stance phase, and decreased muscle activity during the first half of the swing phase. Uphill walking elicited increased muscle activity compared with level walking, particularly during the stance phase and the second half of the swing phase during both walking and NW, and the change was more pronounced during walking. We concluded that NW increased muscle activity in the lower extremities compared with walking, particularly on level ground. Increasing the ground slope enhanced the muscle activity to a much greater extent than NW.

Postural stability in school-age children with mild bronchial asthma disease (a pilot study).

OBJECTIVE: This study assessed the postural stability in children with asthma using balance tests under conditions of a comfortable foot placement and with a foot placement provoking instability. METHODS: A group of 10 school children from 8 to 10 years old with mild intermittent asthma and 10 healthy children of the same age range performed four balance tests in a randomized order: preferred stance, adjusted stance, and tandem stance each under both conditions of eyes opened (EO) and eyes closed (EC), as well as a one-legged stance with eyes-opened conditions. To determine postural stability, the center of pressure (CoP) movement was recorded. Basic stabilographic parameters were calculated: CoP velocity in the anterior-posterior direction, CoP velocity in the medial-lateral direction, and the total CoP velocity. RESULTS: Statistically significant differences between the groups were found only for the one-legged stance. Significantly greater anterior-posterior CoP velocity (p = 0.05) and total CoP velocity (p = 0.03) were found in children with asthma when standing on the preferred foot. A significantly greater medial-lateral velocity (p = 0.02) was also found in the non-preferred foot of children with asthma. CONCLUSIONS: We can conclude that standing on one leg might be an appropriate test with which to identify balance differences between young children with mild intermittent asthma and healthy children.

Evaluation of Explosive Power Performance in Ski Jumpers and Nordic Combined Competitive Athletes: A 19-Year Study.

Between 1992 and 2010, a total of 334 males participated in this study that assessed the differences and relationships between anthropometric variables and lower limb muscle strength in young and adult ski jumpers (n = 207) and Nordic combined (NC, n = 127) athletes. All athletes completed a maximal vertical jump from an in-run position and a maximal relative isometric force (MRIF) of the knee extensor measurement in a laboratory setting. The body mass index (BMI) in young competitors was lower than in adult groups (NC: p < 0.001; ski jumping [SJ]: p < 0.001). Similarly, the MRIF in both limbs was lower for both disciplines in the groups of young competitors. The vertical jump height (VJH) was lower for young competitors than for adults (NC: p ≤ 0.05; SJ: p < 0.001). When comparing SJ and NC athletes, BMI was lower in SJ athletes. In addition, the adult SJ competitors exhibited greater values of bilateral MRIF (p ≤ 0.05) and VJH (p < 0.01). There was a strong positive correlation in MRIF between the left and right lower limbs (p < 0.001) for all groups of SJ and NC athletes; therefore, it was determined to be sufficient to measure the MRIF on a single limb. Application of the new training methods (e.g., less emphasis on maximum resistance exercises) resulted in improved explosive power in ski jumpers even at lower-body weights. These changes are in accordance with the change in ski jump techniques.

Effect of repeated therapeutic horse riding sessions on the trunk movement of the rider.

OBJECTIVE: To assess the rider's movement during walking the horse in repeated therapeutic horse riding sessions and to determine the relationship between movements of the horse's back and the rider's trunk. METHOD: A total of 12 healthy females (age: 23.3±2.8 years; height: 167.3±4.2 cm; weight: 59.2±5.3 kg) participated in 10 therapeutic horse riding sessions. Two English Thoroughbreds with similar body constitution (aged 19 and 14 years) were used in the experiment. Nine markers were placed on the rider's body and the horse's back, and four video cameras with a 25 Hz frequency were used. Collected data were processed with APAS software. RESULTS: The mediolateral displacements of C7, Th12, and L5 were gradually decreasing in each of the first three sessions. Statistically significant differences (p<0.05) were found between individual sessions in the displacement of C7, Th12 and L5 in the mediolateral and vertical directions as well as in the shoulder and pelvic lateral tilt and rotation. These differences did not show any general tendencies regarding the riders' increasing experiences with riding. The relationships between the displacement of C7, Th12, and L5 and the sacral tuber on the horse's back in the vertical direction were statistically significant (p<0.01) during all sessions. CONCLUSIONS: The displacement of C7, Th12 and L5 in the mediolateral direction decreased during riding sessions. A significant relationship was found between the vertical movement of the horse's back and the rider's trunk. These relationships differed between the horses.

The role of lateral preference of lower limbs in a postural stabilization task.

OBJECTIVE: Postural control is a complex skill based on the interaction of dynamic sensorimotor processes. This study assessed the effect of lateral perturbations on postural re-stabilization regarding lower limb preference. METHODS: A group of 14 physically active individuals (9 male, 5 female) randomly underwent postural perturbations in lateral-left and lateral-right directions at a velocity of 0.2 m.s-1 and a platform shift of 6 cm. Perturbation to the preferred limb side (PS) was noted when the contralateral body movement was primarily controlled by the preferred limb and perturbation to the non-preferred limb side (NS) was noted when the contralateral body movement was primarily controlled by the non-preferred (stabilizing) limb. Prior to, during and after the perturbation centre of pressure (CoP) was registered using a computerized motor driven FiTRO Dynamic Posturography System based on force plate (Fitro Sway Check) with a sampling rate of 100 Hz. The basic stabilographic parameters of peak displacement (Peak 1), peak-to-peak displacement (Peak 2), time to peak displacement (Time 1), time to peak-to-peak displacement (Time 2) and re-stabilization time (Time 3) were analyzed. RESULTS: Results showed significantly larger Time 3 on PS than on NS (2.81 ± 1.32 s and 1.73 ± 1.10 s; p=0.02). However, there were no significant differences in other parameters between PS and NS. CONCLUSION: It may be concluded that the observed shorter re-stabilization time at NS was due to the stabilization role of the non-preferred limb.

Ski-jumpers' performance in a laboratory setting: a 29-year longitudinal study.

This study assesses the longitudinal changes in anthropometric and motor parameters of ski jumpers. Male ski jumpers (n = 329) at various competitive levels participated in this study. These competitors were divided into two groups by age (18 years and younger, and over 18 years), and then divided into seven even intervals within those groups. Basic anthropometric parameters, maximal relative isometric knee extensor force, reaction time, knee extension time, and vertical jump height were measured. The conditions, instruments, and systems of measurement were consistent throughout the study. A reduced body mass index (BMI) in the adult jumpers was significant (P < .01) in the first three (1982-1993) and in the last three (1998-2010) intervals. Adults had an increase of maximal relative isometric knee extensor force (P < .01) in the last three intervals (1998-2010). They had greater maximal relative isometric knee extensor force (with exception of the first interval, 1982-1985) and vertical jump height than younger competitors (P < .01). Both young and adult jumpers exhibited the increase of strength and power in the lower limbs and a decrease in BMI during the whole observed period.

Limits of stability in persons with transtibial amputation with respect to prosthetic alignment alterations.

OBJECTIVES: To evaluate the limits of stability (LOS) in persons with transtibial amputation (TTA), and to determine the effects of prosthetic alignment alterations on motor control strategies. DESIGN: Before-and-after trial. SETTING: A kinesiology laboratory at a university hospital. PARTICIPANTS: Male patients with TTA (n=10) and controls (n=17). INTERVENTIONS: Prosthetic alignment. MAIN OUTCOME MEASURES: For the LOS test, the maximum excursion, endpoint excursion, direction control, movement velocity, and reaction time with inclination in the forward direction, toward the amputated leg/right leg, and in the backward direction, and toward the nonamputated leg/left leg. Measurements were performed using the following 5 prosthetic alignments: the optimal alignment, with the prosthesis shorter by 1cm, with the prosthesis longer by 1cm, and with the prosthetic foot in 5° of extra plantar flexion and 5° of extra dorsiflexion. RESULTS: Compared with the control group, maximum excursion and direction control were lower (P<.05) in patients with TTA with backward body inclination for all tested prosthetic alignments. Direction control in backward inclination was reduced (P<.05) compared with other tested directions for all assessed prosthetic alignments. Differences between the tested alignments were not significant in any of the tested directions. CONCLUSIONS: Patients with TTA have decreased voluntary body inclination backward within the LOS for all tested prosthetic alignments. Compared with controls, changes in prosthetic foot settings by means of rotation in the sagittal plane had a larger impact on movement strategy in patients with TTA than did changes to the length of the prosthesis.

Effect of age and activity level on lower extremity gait dynamics: an introductory study.

Elderly adults should perform exercises that maintain or improve balance to reduce risk of injury from falls. Bone fractures secondary to falls in the elderly, particularly sedentary females, continue to pose a major health and economic problem. A greater understanding of the processes that contribute to the propensity for falling may be obtained by considering changes in gait biodynamics with age and activity level. Therefore, the purpose of this study was to quantify the relationships between age/activity level and selected biodynamic parameters of the lower extremity during normal gait. Seventeen healthy women, 9 young and 8 elderly, were divided into groups of 9 active and 8 sedentary subjects. Three-dimensional (3D) video motion and force platform kinematic and kinetic data were collected from the hip, knee, and ankle of the right lower extremity as the subjects walked at self-selected speeds. Data were analyzed as functions of age and activity level by using a 2-way analysis of variance. As expected, our results show that the elderly group had significantly greater (p < 0.05) functional and mobility limitations in their lower extremity joints than did the younger group. Significant, age-related lower-limb gait alterations were manifested primarily at the ankle, whereas activity-related alterations were manifested most prominently at the hip. The knee showed the fewest changes accompanying age or activity level. Thus, age and activity level affect gait, which may have a role in the subsequent development of a predisposition to gait-related imbalances and resultant falling and increased hip fracture risk. Strength and conditioning professionals may consider these factors related to age and activity level when individualizing exercise regimens for their older, or sedentary, clients. Prophylactic physical activities involving specific, controlled 3D body movements may help prevent abnormal lower-limb joint kinematics (and their hypothetically coupled, intrinsic postural control strategies), thereby reducing fall and fracture propensity.

Comparison of spatiotemporal gait parameters and their variability in typically developing children aged 2, 3, and 6 years.

Independent walking is an important milestone in a child's development. The maturation of central nervous system, changes in body proportions, spatiotemporal parameters of gait and their variability change are dependent on age. The first aim of this study was to compare non-normalized and normalized spatiotemporal parameters and their variability in children. The second aim was to determine which spatiotemporal parameters are most affected by aging. Data from 64 typically developing children (age: 2.0-6.9 years), who walked at a self-selected speed along a 10m walkway, were collected with a motion capture system. Spatiotemporal parameters were normalized based on leg length. The main effect of the non-normalized walking speed revealed a moderate effect size (ES = 0.72) comparing 2- and 3-years-old, a large effect size comparing 2- and 6-years-old (ES = 1.77), and a large ES comparing 3- and 6-years-old (ES = 1.22). The normalized stride width parameter showed a statistically significant difference with large effect size between 2 vs 3 (ES = 1.00), 2 vs 6 (ES = 3.17), and 3 vs 6 (ES = 1.96). A statistically significant decrease in intra-individual gait variability with increasing age was observed in all parameters except for stride width. The variability of stride width may serve as a parameter in 2-year-olds to assess deviations from typically developing children. The assessment of effect size could be a useful indicator for clinical practice.

How Posture and Previous Sensorimotor Experience Influence Muscle Activity during Gait Imagery in Young Healthy Individuals.

This study explores how gait imagery (GI) influences lower-limb muscle activity with respect to posture and previous walking experience. We utilized surface electromyography (sEMG) in 36 healthy young individuals aged 24 (±1.1) years to identify muscle activity during a non-gait imagery task (non-GI), as well as GI tasks before (GI-1) and after the execution of walking (GI-2), with assessments performed in both sitting and standing postures. The sEMG was recorded on both lower limbs on the tibialis anterior (TA) and on the gastrocnemius medialis (GM) for all tested tasks. As a result, a significant muscle activity decrease was found in the right TA for GI-1 compared to GI-2 in both sitting (p = 0.008) and standing (p = 0.01) positions. In the left TA, the activity decreased in the sitting posture during non-GI (p = 0.004) and GI-1 (p = 0.009) in comparison to GI-2. No differences were found for GM. The subjective level of imagination difficulty improved for GI-2 in comparison to GI-1 in both postures (p < 0.001). Previous sensorimotor experience with real gait execution and sitting posture potentiate TA activity decrease during GI. These findings contribute to the understanding of neural mechanisms beyond GI.

Evaluation of the Usability of the Tiger Full-Foot Three-Dimensional Scanner for the Measurements of Basic Foot Dimensions in Clinical Practice.

BACKGROUND: Foot dimension information is important both for footwear design and clinical applications. In recent years, noncontact three-dimensional (3-D) foot digitizers/scanners have become popular because they are noninvasive and are valid and reliable for most of the measures. Some of them also offer automated calculations of basic foot dimensions. We aimed to determine test-retest reliability, objectivity, and concurrent validity of the Tiger full-foot 3-D scanner and the relationship between manual measures of the medial longitudinal arch of the foot and alternative parameters obtained automatically by the scanner. METHODS: Intraclass correlation coefficients and minimal detectable change values were used to assess the reliability and objectivity of the scanner. Concurrent validity and the relationships between the arch height measures were determined by the Pearson correlation coefficient and the limits of agreement between the scanner and the caliper method. RESULTS: The relative and absolute agreement between the repeated measurements obtained by the scanner show excellent reliability and objectivity of linear measures and only good to nearly good test-retest reliability and objectivity of arch height. Correlations between the values obtained by the scanner and the caliper were generally higher in linear measures (rp ≥ 0.929). The representativeness of state of bony architecture by the soft-tissue margin of the medial foot arch demonstrates the lowest correlation among the measurements (rp ≤ 0.526). CONCLUSIONS: The Tiger full-foot 3-D scanner offers excellent reliability and objectivity in linear measures, which correspond to those obtained by the caliper method. However, values obtained by both methods should not be used interchangeably. The arch height measure is less accurate, which could limit its use in some clinical applications. Orthotists and related professions probably appreciate the scanner more than other specialists.

Influence of Rehabilitation Aid with Biofeedback on the Rehabilitation Process during Remote Home-Based Rehabilitation.

Ensuring the regularity and correctness of rehabilitation exercises in the home environment is a prerequisite for successful treatment. This clinical study compares balance therapy in the home environment on a conventional balance mat and an instrumented wobble board, with biofeedback supported by a rehabilitation scheme realized as web-based software that controls the course of rehabilitation remotely. The study included 55 patients with knee injuries. The control group consisted of 25 patients (12 females and 13 males, mean age 39 ± 12 years) and the study group of 30 patients (19 females and 11 males, mean age 40 ± 12 years). Treatment effects were compared using the ICS Balance Platform measurement system. Measurements showed significant differences in the change in ICS Balance platform parameters representing the dynamic stability of the patients. The dynamic stability improved more with the instrumented wobble board. The study did not show an influence of different methods of communication with patients during home-based rehabilitation.

Do different multi-segment foot models detect the same changes in kinematics when wearing foot orthoses?

BACKGROUND: Different multi-segment foot models have been used to explore the effect of foot orthoses. Previous studies have compared the kinematic output of different multi-segment foot models, however, no study has explored if different multi-segment foot models detect similar kinematic changes when wearing a foot orthoses. The aim of this study was to compare the ability of two different multi-segment foot models to detect kinematic changes at the hindfoot and forefoot during the single and double support phases of gait when wearing a foot orthosis. METHODS: Foot kinematics were collected during walking from a sample of 32 individuals with and without a foot orthosis with a medial heel bar using an eight-camera motion capture system. The Oxford Foot Model (OFM) and a multi-segment foot model using the Calibrated Anatomical System Technique (CAST) were applied simultaneously. Vector field statistical analysis was used to explore the kinematic effects of a medial heel bar using the two models, and the ability of the models to detect any changes in kinematics was compared. RESULTS: For the hindfoot, both models showed very good agreement of the effect of the foot orthosis across all three anatomical planes during the single and double support phases. However, for the forefoot, the level of agreement between the models varied with both models showing good agreement of the effect in the coronal plane but poorer agreement in the transverse and sagittal planes. CONCLUSIONS: This study showed that while consistency exists across both models for the hindfoot and forefoot in the coronal plane, the forefoot in the transverse and sagittal planes showed inconsistent responses to the foot orthoses. This should be considered when interpreting the efficacy of different interventions which aim to change foot biomechanics.

Review of ankle rehabilitation devices for treatment of equinus contracture.

INTRODUCTION: Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery. AREAS COVERED: This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market. EXPERT OPINION: This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.