Effects Of Orthoses Research Articles

Effect of Foot Orthoses on the Timing of Lower Limb Muscles Activity during Walking in Older Adults

Introduction: As a person gets older, their gait patterns change and their ability to walk decreases. Orthoses are used to relieve musculoskeletal disorders, skeletal problems, disabilities, etc. Therefore, the aim of this study was to investigate the effect of orthoses on timing of lower limb muscles in the older adults during gait. Methods: The present study was a clinical trial. 14 females (with average age of 60.50±4.40 years) and 14 males (with average age of 63.35±5.55 years) were selected with available sampling, voluntarily participated in this research. Eight electrodes were placed on the selected muscles (tibialis anterior, gastrocnemius medial, vastus medialis, vastus lateralis, biceps femoris, semitendinosus, gluteus medius, erector spinae) to record electrical activity during the gait with and without orthoses. To analyze the data SPSS software (version 16), and a repeated analysis of variance test was used. The significance levels in all tests were considered to be 0.05. Results: The main effects of orthoses and the interaction effects of orthoses and sex for the onset of selected muscles activities did not show any significant differences (P>0.05). The effect of sex for the onset of activities in medial gastrocnemius (P=0.007), vastus medialis (P=0.002), vastus lateralis (P=0.027), semitendinosus (P=0.004), gluteus medius (P=0.030), and erector spinae (P=0.039) muscles was significant, so that the onset of muscle activity in the female group was earlier than in the male group. Conclusion: Orthoses showed no improvement on onset of selected muscles activities, although significant differences were observed between the male and female groups.

Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature.
 AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine.
 MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature.
 RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses.
 CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

Commentary on "Effects of Orthoses on Standing Postural Control and Muscle Activity in Children With Cerebral Palsy".

Commentary on "Effects of Orthoses on Standing Postural Control and Muscle Activity in Children With Cerebral Palsy".

Effects of Orthoses on Standing Postural Control and Muscle Activity in Children With Cerebral Palsy.

This exploratory study assessed postural control and muscle activity in children with cerebral palsy while standing barefoot (BF), in prescribed ankle-foot orthoses (AFOs) and in distal control orthoses (DCOs), which stabilized foot-ankle and deliberately aligned the shank. This within-subject study evaluated 10 participants, Gross Motor Functional Classification System level III, across the 3 ankle-foot conditions in: (1) static standing duration and (2) modified Clinical Test of Sensory Interaction on Balance with electromyography (EMG) on 7 muscles. Participants had significantly decreased center of gravity (COG) velocity sway in DCO versus BF and AFO, decreased loss of balance (LOB), and increased standing for DCO versus BF. DCO had minimal effect on EMG activity. DCO provided significant stabilizing effects on COG sway velocity, standing duration, and LOB. DCO may be effective in balance training. It is unclear whether benefit was derived from stabilization of the ankle joint, the resultant shank alignment, or both.

Tibialis posterior muscle activity alteration with foot orthosis insertion measured by fine-wire electromyography

Orthoses are often used for the treatment or prevention of injuries. The effect of orthoses on the activity of calf muscles such as the tibialis posterior (TP), flexor digitorum longus (FDL), and peroneus longus (PL) during running is unclear. The purpose of this study was to measure the muscle activity alteration of the TP, FDL, and PL when running with orthoses. Sixteen healthy men participated in this study. Fine-wire and surface electromyography (EMG) were used to measure the TP, FDL, and PL. Participants ran in three conditions: barefoot, footwear only, and footwear with orthoses. The EMG data of the muscles were measured in three successful running trials in each condition. Then, the EMG data from the stance phase of each running trial were used for analysis. The stance phase was further divided into the contact and propulsion phases based on the force plate data. Data from eight participants were used for final analysis because the EMG measurements were unsuccessful for the other eight. The results showed that the TP EMG activity significantly decreased in the orthosis condition in comparison to that in the barefoot condition in all phases. There were no significant differences between barefoot and footwear and footwear and orthosis conditions. No significant changes in the FDL and PL EMG activities were detected in any phase for any of the three conditions. Orthotic use reduces the TP EMG activity level while running, and this result may be beneficial for patients with injuries related to TP overactivity.

Implementation of Dynamic Lycra® Orthoses for Arm Rehabilitation in the Context of a Randomised Controlled Feasibility Trial in Stroke: A Qualitative study Using Normalisation Process Theory.

Objective:To explore how non-research funded rehabilitation practitioners implemented dynamic Lycra® orthoses for arm recovery after stroke into rehabilitation practice, as part of a feasibility randomised controlled trial.Design:Qualitative interview study.Setting:Two in-patient stroke units and associated rehabilitation units.Subjects:Fifteen purposefully selected stroke rehabilitation practitioners involved in delivery of dynamic Lycra® orthoses as part of a feasibility randomised controlled trial.Methods:Semi-structured interviews conducted at the end of the trial. Interviews examined their experiences of orthosis implementation. Normalisation Process Theory structured the interview guide and informed data analysis. NVivo software supported data analysis.Results:Practitioners intuitively made sense of the intervention in the face of uncertainty about its precise mechanisms of action (Normalisation Process Theory construct: coherence) and espoused commitment to the research, despite uncertainty about orthosis effectiveness (cognitive participation). They did however adapt the intervention based on perceived therapeutic need, their own skillsets and stroke survivor preference (collective action). They were uncertain about benefits (reflexive monitoring). Across the 4 theoretical constructs, ambivalence about the intervention was detected.Conclusions:Ambivalence interfered with implementation – but only to an extent. ‘Good-enough’ coherence, cognitive participation, collective action and reflexive monitoring were sufficient to initiate normalisation – as long as implementation did not undermine the relationship between practitioner and stroke survivor. Ambivalence stemmed from practitioners’ uncertainty about the intervention theory and mechanisms of action. Making intervention mechanisms of action more explicit to practitioners may influence how they implement and adapt a research intervention, and may determine whether those processes undermine or enhance outcomes.

Effects of a foot orthosis inspired by the concept of a twisted osteoligamentous plate on the kinematics of foot-ankle complex during walking: A proof of concept

It has been suggested that the foot acts as a twisted osteoligamentous plate to control pronation and facilitate supination during walking. The aim of this study was to investigate the effect of an orthosis inspired by the concept of a foot’s twisted osteoligamentous plate on the kinematics of foot-ankle complex. Thirty-five subjects underwent a kinematic assessment of the foot-ankle complex during walking using three different orthoses: (1) Twisted Plate Spring (TPS) orthosis: inspired by the concept of a twisted osteoligamentous plate shape and made with a spring-like material (carbon fiber); (2) Flat orthosis: control orthosis made of a non-elastic material with a non-inclined surface; and (3) Rigid orthosis: control orthosis made of a non-elastic material, with the same shape of the TPS. Repeated measures analyses of variance demonstrated that the TPS reduced the duration and magnitude of rearfoot eversion (p ≤ 0.03), increased rearfoot inversion relative to shank (p < 0.01), increased forefoot eversion relative to rearfoot (p < 0.01), and increased peak of plantar flexion of forefoot relative to rearfoot during the propulsive phase (p = 0.01) compared to Flat orthosis. The effects of the TPS were different from the Rigid orthosis, demonstrating that, alongside shape, material properties were a determinant factor for the obtained results. The findings of this study help clarify the role of a mechanism similar to a twisted osteoligamentous plate on controlling foot pronation and facilitating supination during the stance phase of walking.

Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination

Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis-footwear combination on the acquisition of walking in a single subject with cerebral palsy. This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. The subject developed the ability to stand and walk using an ankle-foot orthosis-footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis-footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. An ankle-foot orthosis-footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.

Effectiveness of abduction orthosis for the treatment of acetabular dysplasia.

This study aims to evaluate the effectiveness of full-time bracing in residual acetabular dysplasia (RAD) and the effect of previous Pavlik harness usage on the results of treatment with abduction orthosis. We retrospectively reviewed 80 patients (9 males, 71 females; mean age 6±0.8 months; range, 5 to 7 months) with developmental dysplasia of the hip (119 dysplastic hips) treated with hip abduction orthosis. Patients with an acetabular index (AI) measurement of 30° and over who used full-time hip abduction brace for six months were included in the study. Acetabular index values were measured at the initiation, third, and sixth months of treatment and the effectiveness of abduction orthosis was evaluated. The patients were analyzed for the effect of prior Pavlik harness application on abduction orthosis treatment. Mean AI value of the dysplastic hips (n=119) was 33.4°±2.6°, which decreased to 28.5°±2.6° after treatment (p<0.001). The AI improvement in the first three-month period was significantly faster than the second three-month period (2.9°±1.9° vs. 1.9°±1°; p=0.013). No difference was observed in AI development between patients with or without prior Pavlik treatment (p=0.1). In patients with unilateral dysplasia, dysplastic hips improved significantly faster than normal hips (p<0.001). As a result of a mean follow-up duration of 20.2±9.8 months from the onset of brace treatment, 32 (32%) hips were grouped as normal, 49 (48%) as mildly dysplastic, and 22 (20%) as severely dysplastic based on Tönnis criteria. Hip abduction orthosis may be used in patients with RAD between 6 to 12 months of age. Acetabular index improvement was faster in the first three months of brace treatment. Dysplastic hips improved faster than normal hips, and prior Pavlik harness treatment did not alter the effectiveness of orthosis.

First prototype of EMG-controlled power hand orthosis for restoring hand extension in stroke patients.

Weakness in finger extensors is a common post-stroke deficit that can disturb hand functioning. Despite introducing several powered hand orthoses in literature, most of these devices focused on providing finger flexion. There is a little consideration for providing active hand extension in stroke patients. Moreover, in many devices, the finger extensions were restored passively by spring component. In this study, a new Electromyography (EMG)-controlled powered hand orthosis was designed to improve hand function by restoring and training hand extension in stroke patients with paretic hand. This orthosis was a glove-like device that was developed from two mechanical and electrical sections. After construction and verifying of the orthosis, its applicability was tested on two patients with Cerebrovascular accident (1 woman and 1 man) with paretic hands in an 18-session therapeutic approach. To evaluate the effectiveness of orthosis, Wolf Motor Function Test and Box and Block test were conducted before and after the training sessions. The primary assessment of the prototype was conducted on a healthy subject and three stroke patients. These evaluations showed that the new powered hand orthosis could be effective for finger extension task and training. Furthermore, after the 18-session training approach, significant improvements were seen in the scores of both Wolf and Box and Block tests. The preliminary findings suggested that the first prototype of orthosis could provide a desirable function for stroke patients with paretic hand. Moreover, it could be used as a training device in the rehabilitation of these patients.

The effect of dynamic elastomeric fabric orthosis (DEFO) on sitting balance and gross manual dexterity in children with cerebral palsy: A single-blinded randomized controlled study

The aim of this study was to investigate if the use of a vest type dynamic elastomeric fabric orthosis (DEFO) will lead to improvement in sitting balance, hip lateralization and gross manual dexterity. Twenty-four children with CP between the ages of 3–7 with impaired trunk control were allocated to either of three groups: Control group who received only conventional exercise therapy, DEFO 2 hours group who wore DEFO 2 hours during therapy and DEFO 6 hours group who wore DEFO 4 hours in addition to 2 hours of wear during therapy. Children were evaluated with sitting domain of Gross Motor Function Measure (GMFM), Sitting Assessment Scale (SAS), Box and Block Test (BBT) and Parent Satisfaction Questionnaire before treatment (BT), at posttreatment, at 1 month posttreatment (MPT) and at 3 MPT. SAS and BBT were also assessed when immediately after wearing the orthosis. To measure trunk asymmetry and effect of orthosis in hip lateralization, changes in Cobb (CA) and kyphotic angles (KA) and Migration index (MI) between BT and 6 MPT were determined. All groups showed similar improvements except the control group showing less improvement in SAS scores than DEFO groups. SAS and BBT scores also improved immediately after wearing the orthosis. While CA and KA decreased significantly at 6 MPT, MI did not show statistically significant difference. Changes in radiographic assessments were similar between groups except kyphotic angle values. KA values showed less change in control group. When DEFO groups compared with each other, there were no significant differences in any of the assessments. DEFO vest has an immediate effect on sitting balance and gross manual dexterity. DEFO provides improvements in posture and balance during sitting. Using DEFO vest for 2 hours and 6 hours yielded similar outcomes. Wearing DEFO vest improves kyphotic posture but not scoliosis and hip lateralization.

Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses.

Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.

Evaluating the effectiveness of orthoses in adults with rheumatoid arthritis: A systematic review

Evaluating the effectiveness of orthoses in adults with rheumatoid arthritis: A systematic review

Use of high speed stereo radiography to assess the foot orthoses effectiveness in controlling midfoot posture during walking: A pilot study

BackgroundThe intent of this pilot study was to determine the feasibility of using high-speed stereo radiography (HSSR) to assess the effectiveness of footwear and foot orthoses in controlling the change in the position of the midfoot during walking in individuals with a flexible pes planus foot type. MethodsFour individuals (1 female; 3 male) with a mean age of 25 years (range 22–29) and a bilateral flexible pes planus foot type participated in the study. The HSSR system was used to measure 3-dimensional changes in the longitudinal arch angle (LAA) with each participant walking barefoot, shoe only and shoes with orthoses. ResultsThe HSSR system was found to be highly effective in measuring the change in the position of the midfoot, as measured using the LAA, when wearing footwear with or without foot orthoses. Based on an assessment of mean values, three out of the four participants demonstrated a change in the LAA as a result of using either shoes only or shoes with orthoses. The methodology used in this pilot study for assessing the effect of footwear and foot orthoses on the posture of the midfoot was highly effective with no side-effects noted by any of the study participants. ConclusionsFuture studies using the HSSR will require modifications to participant inclusion criteria as well as alterations to the data collection methodology. The HSSR system used in this study is feasible for use in larger cohort studies assessing footwear and foot orthosis effectiveness with the described modifications.

P.170 - The effect of orthosis and foot surgery in a cohort of Charcot-Marie-Tooth disease children

Charcot-Marie-Tooth disease (CMT) is the most common inherited neuromuscular disease. It is clinically characterised by distal weakness and sensory loss in the upper and lower limbs, and frequent foot deformities. Management of this condition includes use of orthoses and/or corrective surgery. Nevertheless, there have been limited studies looking at the effect of those interventions. As part of an ongoing International natural history study we analysed the six-minute walking test (6MWT) performed as part of a validated scale to assess impairment in children with CMT (CPTPaediatric score (CMTPeds)). We also assessed the impact of both orthoses (by comparing outcome of 6MWT with and without them) and surgical intervention to correct foot deformities in children with CMT. A total of 103 patients with confirmed diagnosis of CMT have been recruited since 2010. Four (4) patients had surgery and eight (8) patients performed the 6MWT with and without orthoses. The mean 6MWT score for preoperative patients was 315 meters (50- 477m) and 212m (0– 448m) for patients who have done the test postoperatively where the minimal time allowed before the first postoperative assessment was 5 months (average of 9 months for all 4 patients). Furthermore, only two of the children had more than one postoperative assessment but in both the 6MWT showed decline (mean = 171,5m) over the 2-year follow up measurement. When the 6MWT was reviewed with patients who used orthoses the results revealed an improvement in the covered distance when wearing assistive devices (mean = 430m, 305 – 599m) compared to the results of when the test was done without orthoses (mean = 384m, 258 – 515m). Data collected to date suggested that surgery intervention did not improve walking distance in this limited CMT patient population. However more studies are needed to support these findings due to the small sample size. Conversely, the usage of orthoses did prove to sustain gait and muscle capacity.

Postoperative braces for degenerative lumbar diseases

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to evaluate the effectiveness of orthosis following lumbar spinal surgery for people with degenerative disease on pain reduction and improvement of functional status. Secondary objectives are to examine the effect of the intervention on overall health or health-related quality of life and treatment success (from the patient's perspective). We will compare the effect of the intervention to no immobilization.

Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis

Foot orthoses are often used to correct altered gait patterns. The purpose of this study was to investigate how foot orthoses can modify the magnitude of three dimensional moments of ankle, knee, and hip joints during a stride of gait in children with flexible flat feet. Bilateral gait data were collected from fourteen male children (age 10.2 ± 1.4 years) suffering from flat feet syndrome. In order to obtain the kinematics data, a Vicon system with six cameras (100 Hz) was used and two Kistler force plates (1000 Hz) to record the kinetics data under each leg. Arc support foot orthoses were used as an intervention. Paired-sample T-test was used for within-group comparisons (α = 0.05). The results of data analysis showed that foot orthoses can decrease the ankle evertor moment, knee and hip abductor moments and hip flexor moment in dominant lower limb. In non-dominant lower limb, using the orthoses can decrease evertor and internal rotator moments at the ankle, flexor and internal rotator moments at the knee and extensor moment at the hip, while it can increase dorsiflexor moment at the ankle. The findings imply that effects of orthoses on three dimensional moments differ in dominant and non-dominant lower limbs. Furthermore, results demonstrated that dominant and non-dominant lower limbs would also show different responses to the same intervention.

Three-dimensional gait analysis of cerebral paralysis patients after operation and effect of orthoses

Three-dimensional gait analysis of cerebral paralysis patients after operation and effect of orthoses

Contributions of quantified movement analysis (QMA) in assessment of medical devices such as orthosis

QMA brings together the different measurement methods that can help the clinician in providing relevant evidence concerning orthosis effectiveness according to its functional purpose: immobilize, stabilize, fix, supply, and control. The choice of sensors and variables which can be analyzed (kinetic, cinematic, energy, attention load) will be adapted to the objectives of the study with regard to measuring capacity and/or performance or use optimization of the medical device (biofeedback). While the patient is still ‘in fine’ the indirect beneficiary of a clinical study, the choice of the measuring tool will depend on the direct beneficiary of the results (patient, prescriber, prosthetist, rehabilitation team, manufacturer, Medicare…); this amounts to defining the main criterion of the study. QMA provides such a substantial amount of data that it is always possible to find a significant variable, but is it relevant with regard to the framework used and the sponsor of the study, the environmental conditions, or coherent with the patient and his orthosis's journey? This presentation illustrates the relevance of QMA in medical device assessment using, as a common thread, examples of research hypotheses from various actors involved in orthosis choices.

Clinical and Radiographic Outcomes of Foot Orthosis for Hallux Valgus

Category: Bunion Introduction/Purpose: Nonoperative care, which is safer and costs less than operative treatment, is the first-line treatment for hallux valgus. Despite numerous studies have reported results of operative treatments, little information is available on the efficacy of nonoperative treatments for hallux valgus. Foot orthosis, or shoe insole, is one of the most widely used nonoperative treatments. Torkki et al. compared orthotic treatment with operative treatment in a randomized controlled trial, however the subjects were patients who planned to undergo hallux valgus surgery, and thus the patient background was different from clinical setting. It is also controversial whether orthotic treatment can prevent the progression of toe deformity. This prospective one- year follow-up study was conducted to evaluate clinical and radiographic outcomes of foot orthosis for painful hallux valgus. Methods: Patients were recruited prospectively at the foot and ankle clinic of our university hospital from 2011 to 2014. Inclusion criteria were patients over 20 years old, with hallux valgus angle (HVA) greater than 20 degrees, and having a painful hallux and/or forefoot. Patients were informed of both surgical and orthotic treatments regardless of the severity of deformity, and those who selected orthotic treatment were included. One certified orthotist made custom-made total contact insoles, and patients were instructed to wear them as long as possible. Clinical evaluations were performed at baseline, 6 and 12 months. The evaluations included visual analog scale (VAS) for pain, American Academy of Orthopaedic Surgeons (AAOS) foot and ankle score, and SF-36. Patients also reported mean hours a day to wear the orthosis, and treatment satisfaction using VAS at 6 and 12 months. HVA and intermetatarsal angle were measured with the radiographs at baseline and 12 months. Results: Of 158 patients visiting the clinic, 65 patients selected orthotic treatment, and thus included in this study. Mean pain VAS was 48.1 at baseline, and it decreased significantly at 6 months (27.7, p &lt; 0.001). However, it increased slightly at 12 months, although it was still lower than the baseline value (30.6, p=0.002). The AAOS Core Scale was 36.1 at baseline, and it improved significantly at 6 months (42.3, p &lt; 0.001). However the effect of orthosis diminished at 12 month (39.8, p=0.2). The same trend was found for the bodily pain of the SF-36. Patient satisfactions were 54.1 and 54.7 at 6 and 12 months, respectively. The mean HVA and intermetatarsal angle were 41.1 degrees and 17.4 degrees at baseline, and they did not change at 12 months. Conclusion: Wearing total contact shoe insole improved pain and functional outcomes for patients with painful hallux valgus, and the treatment effect lasted for at least 12 months. However, the effect was maximal at 6 months, and diminished slightly at 12 months. Therefore a longer follow-up study is necessary to assess how long the effect will continue. Additionally, the orthotic treatment in this study had no effect on hallux valgus deformity over a 12 month period.