Extremity Orthosis Research Articles

Lower Extremity Orthosis fabrication for the Plastics Patient: Management of Wounds, Burns, and Soft Tissue Defects

Lower Extremity Orthosis fabrication for the Plastics Patient: Management of Wounds, Burns, and Soft Tissue Defects

Design and fabrication of a custom molded splint for tetraplegics

BackgroundThe key rehabilitation goal for cervical cord injury is promoting functional hand movement. Patients with mid to low-level cervical spinal cord injury can achieve the useful tenodesis grasp with the assistance of upper extremity orthosis. In this study, a custom molded writing device was fabricated and applied on cervical cord injured patients with the aim of hand rehabilitation. MethodsA total of fourteen individuals with cervical spinal cord injury at C6–C7 level were recruited for the study. They were divided into two groups, where the experimental group was prescribed with the custom molded writing device and the standard-of-care group was prescribed with the traditionally available writing device. The performance of the devices was evaluated using the Quest 2.0 questionnaire and the quality of writing after an intervention time of 4 weeks. ResultThe group that used custom molded writing device performed comparatively better when compared to the conventional design. The data showed a significant difference with average QUEST scores of 4.47 ± 0.33 for the group using the wrist-driven writing device and 3.04 ± 0.70 for group using the conventional design. For better understanding of the device's performance, the writing with both the splints was also assessed. ConclusionA writing device using the tenodesis grasp was fabricated to rehabilitate the writing skills of individuals with cervical spinal cord injuries. The performance of the device provided a favorable result indicating to elaborate the study for future references.

Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study.

Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. Pilot study. Assessments were performed pretreatment and immediately posttreatment. Hospital-based outpatient occupational therapy department. Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.

398 The Feasibility of Designing and Using a 3-D Printed Dynamic Upper Extremity Orthosis (DUEO) with Children with Cerebral Palsy and Severe Upper Extremity Involvement

OBJECTIVES/GOALS: To evaluate whether a low cost, functional dynamic 3-D printed upper extremity (UE) orthosis could be designed, fabricated and used by children with cerebral palsy (CP) with severe unilateral UE involvement and the ability of common standardized instruments to assess its effectiveness. METHODS/STUDY POPULATION: Five patients, ages 13-17 years, with CP and unilateral UE involvement, MACS levels III-IV, were enrolled. Custom forearm thumb opponens orthosis and dynamic upper extremity orthosis (DUEO) were designed and fabricated by a multidisciplinary team for use during 8 one-hour occupational therapy sessions targeting bimanual UE training. Pre- and post-assessments included Assisting Hand Assessment(AHA), Melbourne-2(MA-2), Pediatric Motor Activity Log-Revised(PMAL-R), and PedsQL Measurement Model for the Pediatric Quality of Life Inventory: CP Module(Peds-QL). RESULTS/ANTICIPATED RESULTS: The 3D printed orthotic device is custom fit to the patient based on scans of their arm and is designed with a tensioning system that allows for functional usage of the arm. It incorporates a rigid polymer to provide support and flexible material for comfort where appropriate. Overall, higher post-treatment scores were found for the majority of participants using the custom orthotic. Four made minimal clinically important differences (MCID) in the AHA. Three met MCID scores in subtests of MA-2 (two positive and one negative). Patient-reported outcome improvements were found for PMAL-R for four, but only one met MCID and at least three reported improvements in more than one domain of PedsQL. DISCUSSION/SIGNIFICANCE: Children with CP may often present with UE impairment, yet current therapeutic orthoses only target the progression of contractures and are still limited by cost and discomfort. Our team designed and fabricated a functional, low cost, 3D printed orthosis that showed significant gains in UE function.

Myoelectric Arm Orthosis in Motor Learning-Based Therapy for Chronic Deficits After Stroke and Traumatic Brain Injury.

BackgroundTechnologies that enhance motor learning-based therapy and are clinically deployable may improve outcome for those with neurological deficits. The MyoPro™ is a customized myoelectric upper extremity orthosis that utilizes volitionally generated weak electromyographic signals from paretic muscles to assist movement of an impaired arm. Our purpose was to evaluate MyoPro as a tool for motor learning-based therapy for individuals with chronic upper limb weakness.MethodsThis was a pilot study of thirteen individuals with chronic moderate/severe arm weakness due to either stroke (n = 7) or TBI (n = 6) who participated in a single group interventional study consisting of 2 phases. The in-clinic phase included 18 sessions (2x per week, 27hrs of face-to-face therapy) plus a home exercise program. The home phase included practice of the home exercise program. The study did not include a control group. Outcomes were collected at baseline and at weeks 3, 5, 7, 9, 12, 15, and 18. Statistics included mixed model regression analysis.ResultsStatistically significant and clinically meaningful improvements were observed on Fugl-Meyer (+7.5 points). Gains were seen at week 3, increased further through the in-clinic phase and were maintained during the home phase. Statistically significant changes in Modified Ashworth Scale, Range of Motion, and Chedoke Arm and Hand Activity Inventory were seen early during the in-clinic phase. Orthotic and Prosthetic User's Survey demonstrated satisfaction with the device throughout study participation. Both stroke and TBI participants responded to the intervention.ConclusionsUse of MyoPro in motor learning-based therapy resulted in clinically significant gains with a relatively short duration of in-person treatment. Further studies are warranted.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03215771.

Use of lower extremity orthoses in patients with cerebral palsy and related factors.

The purpose of this study was to investigate the frequency of using lower extremity orthosis prescribed for patients with cerebral palsy (CP) and to determine the factors associated with orthosis use. The study had a retrospective and descriptive design. One hundred and twenty-nine patients with CP who were prescribed orthoses were included in this study. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. The study had a retrospective and descriptive design and included 129 patients with CP (53 females and 76 males) who were prescribed orthosis. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. A total of 53 patients who were included in the study were female, and 76 were male. The most commonly used orthosis was Ankle-Foot Orthosis. The number of patients who used orthosis every day was 45 (34.8%). The most common reason for not using orthosis was difficulty in wearing it. The mean age was significantly lower in the group that used orthosis regularly (P < 0.05). Spasticity and range of motion limitations were low in the group that used orthosis regularly at significant levels (P < 0.05). A significant relation was detected in logistic regression analysis between age and orthosis use (P < 0.05). Regular orthosis use is at quite low levels in patients with CP. The decision for prescribing orthosis should be made with a rehabilitation team, with the patient included before orthosis is prescribed. Problems related to orthosis use should be addressed at regular intervals after prescribing orthosis.

A Pilot Study to Assess the Immediate Effect of Dynamic Carbon Ground Reaction Ankle Foot Orthoses on Balance in Individuals with Charcot-Marie-Tooth in a Clinical Setting

Charcot-Marie-Tooth (CMT) causes muscle weakness and atrophy generally in distal extremities, with or without sensory changes. These impairments contribute to impaired balance and gait and increase risk for falls and secondary injuries. Dynamic Carbon Ground Reaction Ankle Foot Orthoses (DCGR-AFOs) are one type of lower extremity orthosis that can be prescribed to help improve gait and balance in this patient population. To our knowledge, no studies have evaluated the immediate impact of DCGR-AFOs on gait and balance in this population. In this pilot study, 9 individuals with CMT and gait impairment were seen in clinical setting by a physical therapist and orthotist. Participants were asked to complete the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) and tasks on the 4-Item Dynamic Gait Index (DGI) with and without bilateral DCGR-AFOs to assess static and dynamic balance. The average DGI scores were 6/12 without the DCGR-AFOs and 10/12 with the DCGR-AFOs. Improvements on the mCTSIB varied. The findings in this study suggest an immediate improvement in dynamic balance during ambulation with the use of DCGR-AFOs, as assessed by the 4-Item DGI. Data on static balance did not reach significance suggesting the need for future studies to further assess the effects of DCGR-AFOs on static standing balance, as well as the impact of training with physical therapists. This pilot study demonstrates that it is possible to demonstrate potential benefits of DCGR-AFOs with a gross fitting in a clinical setting, prior to referral to an orthotist for custom fitting.

Home Use of an Upper Extremity Exoskeleton in Children with SMA: A Pilot Study

Background: People with spinal muscular atrophy (SMA) often have arm weakness resulting in restricted independence and challenges with activities of daily living. An upper extremity (UE) orthosis, the Wilmington Robotic Exoskeleton (WREX), which augments arm movement by providing gravity assistance, was provided to a small cohort of subjects for 1 year. Resulting changes in the subjects’ performance were assessed.

The topics of lower extremity orthosis and wheel chair

The topics of lower extremity orthosis and wheel chair

Use of Lower Extremity Orthosis in Physical Therapy after Stroke Based on Evidence

現在，脳卒中者の歩行再獲得に向けた理学療法においては，短下肢装具と長下肢装具の両者が，装着による即時効果に加えて継続的使用による治療効果をも期待して使用されている．短下肢装具には歩行速度の向上などの効果が確認されているが，歩行相や関節運動によって運動学的影響の有無が異なり，適応を検討して用いる必要がある．長下肢装具についてはエビデンスがないものの，歩行未自立者のトレーニングのためのデバイスとして，一部ロボット制御も加えて活用され始めている．今後，両者の特性の差が生じると推測される股関節に対する作用や，長期的な使用による変化について十分な検証を行うことが，エビデンス構築の一助となるであろう．

Development and Research of Lower Extremity Orthosis

Development and Research of Lower Extremity Orthosis

Practical Rehabilitation Approach with Lower Extremity Orthosis for Hemiplegia Due to Cerebrovascular Accident

Practical Rehabilitation Approach with Lower Extremity Orthosis for Hemiplegia Due to Cerebrovascular Accident

Prescribing upper limb orthoses for children with cerebral palsy: a Q methodology study of occupational therapists’ decision making

Purpose: This study identified occupational therapists’ viewpoints that guide their practice of upper limb orthosis prescription for children with cerebral palsy (CP).Methods: A qualitative study utilising Q methodology explored participants’ viewpoints. Thirty-nine occupational therapists (38 females) were purposively recruited to rank statements generated from interviews of experienced clinicians and peer reviewed and published literature. Statements about reasons for orthoses prescription, were ranked according to what guides decision making the most to least. Data from ranked statements were analysed using by-person factor analysis to reveal the different ways statements were grouped. The resultant factors, based on the average arrangement of statements associated with each factor, were interpreted and named as viewpoints.Results: Viewpoints identified: 1. Potential effect of the orthosis (n = 12 sorts); 2. Biomechanical presentation (n = 12 sorts); and 3. Client/therapist relationship (n = 10 sorts). The “Client’s goals” statement was ranked highest across all viewpoints.Conclusions: Viewpoints identified may inform development of clinical guidelines. Further research is required to (i) identify valid and reliable classification and assessment tools to guide decision making; and (ii) establish the mechanism of the effect of orthotic intervention by considering the link between the biomechanical purpose of the orthosis (e.g., mobilise tissue) and aim of intervention (prevent contracture).Implications for rehabilitationQ methodology provided an opportunity to identify viewpoints of occupational therapists that guide their upper extremity orthosis prescription decision making.Consistent with best-practice, clients’ goals were the primary focus of decision making in each viewpoint.It is recommended that clinicians consider the identified viewpoints; 1) the potential effects of the orthosis, 2) the biomechanical presentation of the child, within 3) an established client/therapist relationship when prescribing upper extremity orthoses.Practice guidelines to inform upper limb orthotic intervention may be developed using the identified viewpoints.

PLA TABANLI ÜST EKSTREMITE PARMAK ORTEZI 3 BOYUTLU TASARIMI VE BASKISI

Orthosis is a 3D material that supports the deformed field. These orthotic materials are used to help weak muscle function, to support muscles and joints, to correct posture, to continue to work despite unbalanced movements, and to heal fractures. Upper and lower extremity orthosis practices are available. Upper limb orthosis; shoulder, elbow, wrist, hand or fingers. Prevents or supports unwanted movements. There are various upper extremity orthoses called fingers, hand splints, hand and wrist atrophy, elbow orthosis, shoulder orthosis according to the region where they are practiced. Orthoses applied to the hand and arm are usually provided for short-term use. Nowadays, with the new generation of the industrial orthosis and 3D designs, the treatment of deformity has become possible by using simulation techniques on the biomechanical data. The purpose of this study is to discuss the advantage of the 3-dimensional PLA-based finger-tipped orthosis on the individual's superiority against other conventional methods and designs in the treatment of upper limb finger conservative treatment.

Development and simulation of a passive upper extremity orthosis for amyoplasia.

IntroductionPeople who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort.MethodsThis study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL.ResultsFor a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400 Nm−1 and of 1029 Nm−1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized.ConclusionBy augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.

Quantitative measures with WREX usage.

This paper presents the results of two surveys conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. An online user survey with 55 patients was conducted to determine the benefits of the WREX. The survey asked 10 questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. A second survey used a phone interview based on the Canadian Occupational Performance Measure (COPM). Parents rated their child's performance and satisfaction while partaking in important activities both with and without the exoskeleton device. Scores were assessed for change between the two conditions. Twenty-five families responded to this survey. Twenty-four out of 25 subjects reported greater levels of performance and satisfaction when they were wearing the WREX. The mean change in performance score was 3.61 points, and the mean change in satisfaction score was 4.44 points. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Relationship between the Community-based integrated care systems and follow-up of lower extremity orthosis at specific cold region in Hokkaido

Relationship between the Community-based integrated care systems and follow-up of lower extremity orthosis at specific cold region in Hokkaido

User Evaluation of a Dynamic Arm Orthosis for People With Neuromuscular Disorders.

This paper presents the results of an online survey conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. The paper also describes the design of a novel lightweight 3-D printed WREX used for ambulatory children. Three different versions of the WREX are now offered to patients. Two can be mounted on a wheelchair and one to a body jacket for ambulatory patients. An online user survey with 55 patients was conducted to determine the benefits of the various WREXs. The survey asked ten questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Investigating the status of using lower extremity orthoses recommended to patients with spinal cord injury.

Retrospective descriptive study. The present study aimed to investigate the rate of using orthosis among spinal cord injury (SCI) patients for whom orthosis was recommended for standing and walking, the relationship between the clinical and demographic characteristics of SCI and the use of orthosis and the reasons for not using orthosis. Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. The study included 62 SCI patients for whom orthosis was recommended for standing and ambulation. The patients were classified into two groups as individuals using and not using the recommended orthosis every day in order to evaluate the effect of age, gender, residence, duration of disease/recommended duration of orthosis, recommended orthosis, lesion level-degree, lower extremity tonus-range of motion and ambulation level on the frequency of orthosis use. The orthosis most commonly recommended was hip-knee-ankle-foot orthosis with waist or pelvic belt (45.2%). Of the patients, 25.8% have never used the orthosis. The most common reason for not using the recommended orthosis was the failure to facilitate the daily life activities of the patient (30%), the difficulties in putting them on and taking them off (20%), the belief that it is unnecessary (15%) and the pressure (15%). In addition, the assessed clinical and demographic features were detected as not important risk factors for not using orthosis. At least one out of four patients with SCI do not use the recommended lower extremity orthosis. Selecting eligible patients, patient training and follow-up are important for increased frequency of orthosis usage.

The therapy of upper extremity orthosis : upper extremity reconstruction, activity, participation and support

The therapy of upper extremity orthosis : upper extremity reconstruction, activity, participation and support