Effect Of Orthotics Research Articles

Mechanical Modeling of Healthy and Diseased Calcaneal Fat Pad Surrogates.

The calcaneal fat pad is a major load bearing component of the human foot due to daily gait activities such as standing, walking, and running. Heel and arch pain pathologies such as plantar fasciitis, which over one third of the world population suffers from, is a consequent effect of calcaneal fat pad damage. Also, fat pad stiffening and ulceration has been observed due to diabetes mellitus. To date, the biomechanics of fat pad damage is poorly understood due to the unavailability of live human models (because of ethical and biosafety issues) or biofidelic surrogates for testing. This also precludes the study of the effectiveness of preventive custom orthotics for foot pain pathologies caused due to fat pad damage. The current work addresses this key gap in the literature with the development of novel biofidelic surrogates， which simulate the in vivo and in vitro compressive mechanical properties of a healthy calcaneal fat pad. Also, surrogates were developed to simulate the in vivo mechanical behavior of the fat pad due to plantar fasciitis and diabetes. A four-part elastomeric material system was used to fabricate the surrogates, and their mechanical properties were characterized using dynamic and cyclic load testing. Different strain (or displacement) rates were tested to understand surrogate behavior due to high impact loads. These surrogates can be integrated with a prosthetic foot model and mechanically tested to characterize the shock absorption in different simulated gait activities, and due to varying fat pad material property in foot pain pathologies (i.e., plantar fasciitis, diabetes, and injury). Additionally, such a foot surrogate model, fitted with a custom orthotic and footwear, can be used for the experimental testing of shock absorption characteristics of preventive orthoses.

Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

ObjectiveTo compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics. DesignProspective cohort study with propensity score matching. SettingData collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands. ParticipantsA consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes. InterventionsExercises and orthotics versus orthotics alone. Main Outcome MeasuresPrimary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100). ResultsA larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131). ConclusionsNon-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

P 172 - Pre-compressing springs in orthotic ankle joints enhance the effect of a dynamic dorsiflexion stop on patients with weak plantar flexors

Lateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use.We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up.45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month.We found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).

Effectiveness of proximal interphalangeal joint–blocking orthosis vs metacarpophalangeal joint–blocking orthosis in trigger digit management: A randomized clinical trial

Study DesignPatients with Green's classification grade 2 or 3 A1-pulley trigger digit (TD) were recruited and randomized to receive the proximal interphalangeal joint–blocking orthosis (PIPJ-BO) or metacarpophalangeal joint–blocking orthosis (MCPJ-BO). IntroductionTD is a common hand condition that can affect one's performance in activities of daily living. Conservative management of TD involves prescription of orthoses to facilitate recovery. No studies have evaluated the effectiveness of PIPJ-BO, optimal orthosis wear regime, and other factors affecting orthotic effectiveness. Purpose of the StudyTo compare the effectiveness of PIPJ-BO vs MCPJ-BO in TD management. MethodsOutcome measures included pain numerical rating scale, Green's classification grading, and Quick Disability of the Arm, Shoulder and Hand. Orthosis wear duration was also collated. Patients were followed up for 2 months, and changes between initial and final assessment score within each group and between both groups were analyzed. ResultsThirty-five patients with 43 TD were included in final analysis. Twenty-three TD were allocated PIPJ-BO while 20 with MCPJ-BO. Pain reduction was observed in both groups, but reduction was greater in PIPJ-BO group (P = .02). About 47.83% in PIPJ-BO group and 40% in MCPJ-BO group improved by at least 1 Green's classification grade. There was only significant improvement in Quick Disability of the Arm, Shoulder and Hand score for PIPJ-BO group (P = .0007), and duration of orthosis wear was significantly longer in the PIPJ-BO group (P = .0010). Advancing age was found to have higher rate of orthosis failure. DiscussionFindings suggest that both orthoses are effective in reducing pain and disability and improve in triggering symptoms, with PIPJ-BO being more superior. Moreover, PIPJ-BO is less restrictive, has better cosmesis and allowed better functional performance than MCPJ-BO. ConclusionPIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. Orthosis wear of 24 hours for more than 8 weeks is recommended.

The Effect of Balance Exercise and Foot Orthotics on Forward Head Posture

The Effect of Balance Exercise and Foot Orthotics on Forward Head Posture

The Pediatric SmartShoe: Wearable Sensor System for Ambulatory Monitoring of Physical Activity and Gait.

Cerebral palsy (CP) is a group of nonprogressive neuro-developmental conditions occurring in early childhood that causes movement disorders and physical disability. Measuring activity levels and gait patterns is an important aspect of CP rehabilitation programs. Traditionally, such programs utilize commercially available laboratory systems, which cannot to be utilized in community living. In this study, a novel, shoe-based, wearable sensor system (pediatric SmartShoe) was tested on 11 healthy children and 10 children with CP to validate its use for monitoring of physical activity and gait. Novel data processing techniques were developed to remove the effect of orthotics on the sensor signals. Machine learning models were developed to automatically classify the activities of daily living. The temporal gait parameters estimated from the SmartShoe data were compared against reference measurements on a GAITRite mat. A leave-one-out cross-validation method indicated a 95.3% average accuracy of activity classification (for sitting, standing, and walking) for children with CP and 96.2% for healthy children. Average relative errors in gait parameter estimation (gait cycle, stance, swing, and step time, % single support time on both lower extremities, along with cadence) ranged from 0.2% to 6.4% (standard deviation range = 1.4%-9.9%). These results suggest that the pediatric SmartShoe can accurately measure physical activity and gait of children with CP and can potentially be used for ambulatory monitoring.

A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis.

BackgroundFoot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS.Method and materialsSeventy-eight pwMS were randomised to receive AFO or FES (ODFS PACE (OML, Salisbury, UK)). Participants completed the 25-ft walk test (25ftWT) and 5-min self-selected walk test (5minSSWT), from which oxygen cost was determined, with and without their device. Between-, within- and sub-group analyses (based on baseline walking speed of <0.8 m/s (slow) or ≥0.8 m/s (fast)) were undertaken.ResultsNo significant differences between baseline measures were observed. The AFO group walked significantly slower than the FES group (5minSSWT, p = 0.037, 0.11 m/s). The AFO group walked significantly slower with than without AFO (25ftWT, p = 0.037), particularly in the fast-walking group ( p = 0.011). The slow-walking FES group walked significantly faster with FES than without (25ftWT; p = 0.029, 5minSSWT; p = 0.037). There were no differences in the fast-walking FES group or in the oxygen cost for either device.ConclusionAFO reduced walking speed, particularly in fast walkers. FES increased walking speed in slow, but not fast walkers.

Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis.

Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001). Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.

Evaluating the immediate effects of wearing foot orthotics in children with Joint Hypermobility Syndrome (JHS) by analysis of temperospatial parameters of gait and dynamic balance: A preliminary study

Joint Hypermobility Syndrome (JHS) in children, presents with increased joint range of motion and can lead to altered gait strategies and reduced dynamic balance. Despite limited evidence foot orthoses are sometimes prescribed to patients with JHS with the aim to improve the stability of their gait pattern and theoretically reduce associated symptoms of fatigue and joint pain. The purpose of this study was therefore to analyse the immediate effects of ‘off the shelf’ orthoses on temporospatial parameters of gait and dynamic balance in this cohort. MethodsA total of 21 patients were recruited for the study (13 female) with a median age of 10 years (IRQ = 4.12). Each patient had their gait analysed using the GAITRite walkway in their own footwear and immediately after being prescribed the orthoses. Gait was tested at both the patients’ preferred speed and when asked to walk slower to challenge their dynamic balance. ResultsGait appeared more synchronised, with a reduction in step length and width variability, when participants were provided with orthotics. The variation was greatest when participants were asked to walk slower. Double stance was significantly less at slower speeds when orthotics were added (1.61%, 95% CI = 0.34, 2.89, p = 0.015) ConclusionResults of this study indicate that orthotics have a definite immediate influence on gait patterns in patients with JHS. Future studies should investigate the long-term effects of orthotics in this population and include outcome measures for symptoms such as pain.

Acute effect of biomechanical foot orthotics on gross efficiency in cyclists affected by an anatomic asymmetry in time trial position

Cyclist position on his bicycle and individual anthropometric parameters are very important to optimise pedalling biomechanics (Bini et al. 2011). Postural imbalance can lead to increase joint stre...

Is functional electrical stimulation an alternative for orthotics in patients with cerebral palsy? A literature review.

Functional electrical stimulation (FES) is a well-known intervention used during walking to improve walking abilities and correct gait deviations by facilitating the proper muscle group at the appropriate timing in the gait cycle. Our aim was to study the types of surface FES currently used in a cerebral palsy (CP) population and examine the evidence of its ability to improve gait deviations, functional ability and therapeutic effects. A computerized database search was conducted from inception until 6/2016. Included were all clinical trials performing gait analysis of children with CP applying surface FES to any lower leg muscles evaluating the efficiency of the stimulation and any carry-over effect. Fifteen studies met the inclusion criteria. The most common FES stimulated the dorsi flexors muscles with a positive orthotic effect, improved dorsi flexion during the swing phase and enhanced the foot contact pattern. A smaller positive effect was found for knee extensors stimulation facilitating knee extension during the stance phase and for hip abductors stimulation improving frontal plane knee alignment. No evidence was found to support the use of plantar flexors stimulation in correcting gait deviations. There is scarce evidence of any retention effect. We encourage the clinician to evaluate the use of FES on a case to case basis. Controlled investigations with larger numbers of participants are warranted to determine the orthotic and therapeutic efficacy of FES.

The Effect of Boston Brace on Lower Limb and L5-S1 Joint Contact Forces during Walking in Patients with Idiopathic Scoliosis

Introduction: Scoliosis is a lateral curvature of the spine that affects walking in these patients. Using orthotics is one of the most common treatments for scoliosis patients. There is little knowledge about the effect of orthotics on joint contact forces during walking. Therefore the aim of this study was to assess the effect of Boston brace on lower limb and L5-S1 joint contact forces during walking in scoliosis patients. Materials & methods: 5 girls with idiopathic scoliosis participated in this study. Qualysis motion analysis system and a Kistler forceplate were used to record data. SPSS software (independent t-test) was used to analyze data at the set point of 0.05. Finding: The first (α=0.02) and second (α=0.04) peak of vertical ground reaction force were 18.8 and 20.05 N/BW respectively during walking with brace which was significantly greater than that of these forces during walking without brace. The excursion of the trunk in sagittal plane significantly decreased during walking with brace (α=0.02). Discussion & conclusions: Boston brace did not affect gait kinetics and kinematics significantly in self-selected speed except L5-S1 range of motion and first and second vertical ground reaction forces. So Boston brace has no negative effect on lower limb joints and L5-S1 joint during walking with self-selected speed.

The Effect of Orthotics on Ankle and Subtalar Joint Orientation and Load Distribution Utilizing a Novel System to Simulate Weight Bearing in a Cadaveric Model

Category: Ankle, Basic Sciences/Biologics, Hindfoot, Biomechanics Introduction/Purpose: Orthotics are commonly prescribed by orthopaedic surgeons to address the hindfoot and midfoot deformity resulting from posterior tibial tendon dysfunction. The public however will often purchase over the counter orthotics for generalized complaints of foot pain that is not associated with any significant deformity or foot pathology. The mechanical axis of the lower limb may be altered in patients who use orthotics despite a normal foot alignment. We hypothesize that patients with normal alignment who use orthotics may adversely change ankle and subtalar joint orientation and load distribution. Methods: Five fresh frozen lower limb cadaveric specimens without known skeletal condition were used. The femoral head was potted with PMMA and TekScan pressure sensors were inserted into the ankle and subtalar joint. The specimens were placed on a custom jig, which allowed for load cell modulated loading of the leg; 75 lb load (half body weight) was applied at the femoral head while the foot was supported against a fixed plate keeping the ankle in neutral position. Testing was achieved by placing an orthotic under the medial half of the plantar talonavicular joint level. Mean pressure (MP), peak pressure (PP), contact area (CA), and center of force (COF) were measured in both the ankle and subtalar joints under three conditions; barefoot (BASE), with a 1.5 cm (ORT1) and 3 cm (ORT2) height orthotic. Each condition was tested three times per specimen. Displacement of COF was calculated relative to its location at baseline. Results: The MP, PP and CA showed a constant decrease from BASE to ORT1 and ORT2. Despite this relation, the only comparison that was significantly different was that between peak pressure values of the baseline and ORT2 conditions of the subtalar joint. The average displacement of COF from BASE was 0.14 mm and 0.42 mm medially, and 0.26 mm and 0.46 mm posteriorly at the ankle joint with ORT1 and ORT2 respectively. The average displacement of COF from BASE was 0.03 mm laterally and 0.08 mm posteriorly with ORT1, and 0.2 mm medially and 0.46 mm posteriorly with ORT2 at the subtalar joint. Conclusion: Foot deformities have an impact on the articular forces in the lower limb. Our results agree with previous studies about the role of foot deformity on the distribution of body weight forces and its consequences across the ankle and subtalar joint. Our novel study also demonstrates that orthotics and orthotics of varying sizes can change the mean pressure, peak pressure, contact area center of force in the ankle and subtalar joint. This study proves the feasibility of its design for studying intra-articular pressure changes in a lower limb cadaveric model with simulated weight bearing.

Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke.

To examine the evidence for a training effect on the lower limb of functional electrical stimulation. Cohort study. A total of 133 patients >6 months post-stroke. Training and orthotic effects were determined from walking speed over 10 m, associated minimal and substantial clinically important differences (i.e. >0.05 and >0.10 m/s), and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. An overall significant (p < 0.01) training effect was found that was not a clinically important difference (0.02 m/s); however, "community" FAC (≥ 0.8 m/s) and "most limited community walkers" FAC (0.4-0.58 m/s), but not "household walkers" (< 0.4 m/s), benefitted from a clinically important difference. A highly significant (p< 0.001), substantial clinically important orthotic effect (0.10 m/s) was found. In terms of overall improvement of one or more FACs, 23% achieved this due to a training effect, compared with 43% due to an orthotic effect. The findings suggest that functional electrical stimulation provides a training effect in those who are less impaired. Further work, which optimizes the use of the device for restoration of function, rather than as an orthotic device, will provide greater clarity on the effectiveness of functional electrical stimulation for eliciting a training effect.

Is Functional Electrical Stimulation Effective in improving Gait in People with Multiple Sclerosis? A Systematic Review

Introduction: One of the reasons for difficulty with walking in people with multiple sclerosis (PwMS) is foot drop; the inability to dorsiflex the ankle during the swing phase of the gait. One approach to correct foot drop is to passively support the ankle joint with an ankle foot orthosis (AFO) or a foot up splint. Another approach is to use functional electrical stimulation (FES). Objective: Is FES effective in improving gait in people with foot drop due to multiple sclerosis (MS)? Materials and methods: AMED, EMBASE, BNI, MEDLINE, and CINAHL were searched. Meta-analysis, randomized control trials (RCTs) and non-RCTs, and case series involving investigating FES for foot drop in PwMS were reviewed. Conference abstracts, non-English articles, expert opinions, and FES for other indications were excluded. Full texts of the articles were reviewed by two authors independently using the Physiotherapy Evidence Database (PEDro) scale. The strength of evidence was graded from 1 to 5. Results: Among the 172 results, we excluded 130 after reading the titles (duplicates, articles not in English, and articles on use of FES for indications other than foot drop). After reviewing the abstracts, we excluded further 27 (conference presentations, opinions, and reviews). The PEDro scores of the articles varied between 3 and 7. None of the studies blinded the participants and only one study used blinded assessors. Two RCTs and one meta-analysis found an orthotic effect of FES causing improvement in speed of walking by 0.05 to 0.08 m/s. Two RCTs reported 73 to 83% reduction in number of falls. There were no RCTs comparing effect of FES with AFO in this cohort. Conclusion: There is level-1 evidence that the FES increases speed of walking through an orthotic effect. There is level-2 evidence that it reduces number of falls in PwMS. Further appropriately powered multicenter studies are required to assess the comparison of FES with AFO in this cohort.

Impact of wearing a functional foot orthotic on the ankle joint angle of frontal surface of young adults with flatfoot

[Purpose] This study investigated the effects of proprietary foot orthotics in young adults with flatfoot to determine changes in the ankle joint angle in the coronal plane during the midstance phase. [Subjects and Methods] The subjects were 15 college students diagnosed with flatfoot. Changes in the ankle joint angle in the coronal plane in the midstance phase were measured using the Vicon Motion System before and after use of the orthotic. The data were analyzed using Statistical Package for the Social Sciences Win 16.0. [Results] The subjects showed significant increases in left and right ankle joint angles in the coronal plane during the midstance phase of the gait cycle after use of the orthotics. However, the difference between the left and right ankle joint angles showed no significant change, even though the difference increased after use of the orthotics. [Conclusion] Young adults with flatfoot showed increased ankle joint angles after use of the orthotics. This suggests that orthotic footwear can shape the plantar arch and affect the ankle joint, and that constant use of orthotics would cause a dynamic change in normal walking.

Preliminary study: the effect of biomechanical foot orthotics in bilateral pedalling asymmetry in three cyclists affected by an anatomic asymmetry

Background: The optimization of the cyclist's position aims to increase performance and may prevent injuries. To find the optimum posture, taking into account anthropometry of the cyclist is essential [1] because an anatomic asymmetry (short leg) could alter the cyclist's balance causing a decrease of power output for one of the two lower limbs. Bilateral pedalling asymmetry may amplify the risk of premature fatigue and injuries [2]. Biomechanical foot orthotics (FO) are used to reduce injuries [3] and to increase performance [4] improving left/right balance between the two legs. The aim of this study was to analyse the effect of the installation of a new FO (just after the laying) on a bilateral pedalling asymmetry in cyclist affected by an anatomic asymmetry (short leg).  Methods: Three high-level cyclists with an anatomic asymmetry were recruited. The differences between the two legs were spotted with a questionnaire that focuses on leg balance and pains during practice. A podiatrist estimated the level of asymmetry and created individualised FO to reduce the biomechanical balance. The subjects performed a test without and with a FO (T1 and T2 randomly) on a track bicycle (fixed-gear bicycle which reduces the impact of the leg during the upstroke). The bike was positioned on a home-trainer CYCLUS (RBM elektronik-automation GmbH, Leipzig, Germany) allowing for control to the break resistance. The crank torque was measured with a SRM crank dynamometer (Ptnews Torque Analysis Software, SRM Science, Welldorf, Germany). Each test was performed at three levels of maximal aerobic power: 1 min at 60% (I1), 1 min at 75% (I2) and 1 min at 90% (I3). The recovery was 3 min between the different bouts of exercise and 30 min between the tests. Asymmetry Index (AI, %) [2] was used to quantify the bilateral pedalling asymmetry between the dominant (DO, N.m) and the non-dominant (ND, N.m) lower limb following:  (DO, the lower limb which produced the higher crank torque and ND the inverse). The crank peak torque was the maximal value measured for each leg between 0 and 180° for the left and right crank cycle. It was extracted from the average torque measured over one minute. After the two tests (without and with FO), the three subjects answered a subjective scale about pedalling comfort (0/10 = discomfort and pain; 10/10 = optimal comfort).  Results: The results show (Table 1) that AI is similar for the two experimental conditions without (6.6%) and with FO (6.7%). However, the subjective scale shows that the cyclists feel better (+ 39%) in terms of comfort when pedalling with a FO.  Discussion: This study showed that FO had no direct impact on bilateral asymmetry during exercise just after the correction. However, FO allowed to significantly improve the comfort of the cyclist just after the laying. A study reported that a long-term adaptation is needed to induce a modification of the pedalling pattern by neuromuscular adaptation [5]. Thus, before to have a significant improvement of AI, the cyclist had to ride several hundred kilometres.  Conclusion: In spite of an improvement of comfort with FO during the pedalling movement, no change in bilateral pedalling asymmetry was measured in short-term analysis. A certain training load would be necessary to induce a neuromuscular adaptation of the pedalling pattern [5] to improve the biomechanical balance between the two lower limbs.

Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial.

BackgroundMany stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly limited to the orthotic effects of peroneal functional electrical stimulation in the chronic phase after stroke. The aim of this study is to investigate the therapeutic effects of up to 10 weeks of multi-channel functional electrical stimulation (MFES)-assisted gait training on the restoration of spatiotemporal gait symmetry and walking capacity in subacute stroke patients.MethodsIn a proof-of-principle study with a randomised controlled design, 40 adult patients with walking deficits who are admitted for inpatient rehabilitation within 31 days since the onset of stroke are randomised to either MFES-assisted gait training or conventional gait training. Gait training is delivered in 30-minute sessions each workday for up to 10 weeks. The step length symmetry ratio is the primary outcome. Blinded assessors conduct outcome assessments at baseline, every 2 weeks during the intervention period, immediately post intervention and at 3-month follow-up.DiscussionThis study aims to provide preliminary evidence for the feasibility and effectiveness of MFES-assisted gait rehabilitation early after stroke. Results will inform the design of a larger multi-centre trial.Trial registrationThis trial is registered at the Netherlands Trial Register (number NTR4762, registered 28 August 2014)Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1604-x) contains supplementary material, which is available to authorized users.

Long-term effects of lateral wedge orthotics on hip and ankle joint space widths

BackgroundLateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use. MethodsWe prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up. Findings45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month. InterpretationWe found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).

An exploratory study of gait and functional outcomes after neuroprosthesis use in children with hemiplegic cerebral palsy

Purpose: To evaluate the immediate orthotic, total and therapeutic effects of functional electrical stimulation (FES) neuroprosthesis use on clinic based measures of gait and function in children with hemiplegic cerebral palsy.Methods: Eleven children (mean 9 years 11 months) participated in an FES neuroprosthesis (Ness L300) intervention (4 week accommodation period followed by 12 weeks of daily use) and were assessed at baseline and post in stimulation off and stimulation on conditions. Measures included clinic based outcomes of gait and function.Results: No significant immediate orthotic effects were observed. Significant (p < 0.01) total effects were noted for dorsiflexion at initial contact, Six-Minute Walk Test (6MWT), and walking speed. A significant therapeutic effect was found for steps off path on the Standardized Walking Obstacle Course (SWOC).Conclusions: Results support previous findings of neuroprosthesis total effects on gait and provide some evidence for effects on function. Therapeutic effects remain unclear.Implications for RehabilitationIn this study, children with hemiplegic CP did not demonstrate immediate improvements in gait or function at their first clinic visit using the FES neuroprosthesis device suggesting one visit using the device is not sufficient to determine potential benefits.Over time with daily use of the FES neuroprosthesis, ankle dorsiflexion in swing and at initial contact, walking speed and endurance increased with the device worn.Overtime, no carryover effects in ankle dorsiflexion in swing and at initial contact were noted at the end of the intervention period with the device off.Clinicians should consider purchasing units to loan or rent to individuals to trial a device at home before determining long-term potential for benefit.