Functional Orthosis Research Articles

Use of Strutter Orthoses for an Adolescent with Myelodysplasia

To describe the functional gains made through the use of the Strutter Functional Orthosis System (SFOS) in an adolescent with myelodysplasia. A 12-year-old boy with lumbar level myelodysplasia was not functional when ambulating with Lofstrand crutches. He required a wheelchair for community mobility because of complaints of fatigue and upper extremity discomfort. He was introduced to the SFOS and became a functional community ambulator, reporting greater walking endurance and decreased pain. This report provides some case evidence to suggest that the SFOS can improve functional mobility in a child with myelodysplasia. With the SFOS this child progressed from being nonfunctional when ambulating to being classified as a "community ambulator," resulting in physiological, functional, and psychosocial gains. We suggest future investigations to explore the reasons for greater walking ability with the SFOS.

Design and Testing of a Functional Arm Orthosis in Patients With Neuromuscular Diseases

The objective of this study was to determine the utility of a passive gravity-balanced arm orthosis, the Wilmington robotic exoskeleton (WREX), for patients with neuromuscular diseases. The WREX, a four-degrees-of-freedom functional orthosis, is energized by rubber bands to eliminate gravity and is attached to the wheelchair. The development and clinical testing of WREX is described in this report. Seventeen patients (14 boys and 3 girls) with muscular disabilities participated in the study. Ages ranged from 4 to 20 years. Criteria for inclusion included a weakened arm, use of a wheelchair, the ability to grasp and release objects, and the ability to provide feedback on device use. Testing consisted of administering the Jebsen test of hand function without WREX and then testing again after approximately two weeks of wearing the WREX orthosis. The timed results of each task within the test then were compared. Specific tasks related to vertical movement required less time to perform with the WREX. A large number of subjects were able to perform the Jebsen tasks with the WREX, where they were unable to perform the task without the WREX. Patients can benefit from WREX because it increases their performance in daily living activities and makes many tasks possible. The range-of-motion in the patients' arms increased considerably, while the time required to complete some of the Jebsen test tasks decreased. Most patients were very receptive to WREX, although a few were ambivalent.

Comparison of the Easy Strutter Functional Orthosis System and axillary crutches during modified 3-point gait

The Easy Strutter Functional Orthosis System (ESFOS) was designed to improve assistive device ambulatory efficiency. This crossover design study compared the ESFOS to axillary crutches during modified 3-point gait. Thirty-eight subjects (40-65 years of age) at > 1 year after unilateral total knee or hip replacement participated in this study. Heart rate, mean peak palmar and plantar force magnitude, and onset timing were monitored during self-directed pace ambulation. Between trials, subjects responded to questions on perceived exertion, stability/security, and comfort. One-way analyses of variance were used to evaluate condition differences for ratio or interval data (p < or = 0.01). Statistically significant differences were noted for mean peak palmar forces (reduced 45% and delayed 31%), mean peak plantar force onsets (delayed 30%), and energy expenditure index (EEI) (reduced 25%). Wilcoxon signed rank tests were used to evaluate condition differences for ordinal data. Subjects preferred the ESFOS to axillary crutches for comfort and security/stability on flat surfaces and stairs (p < or = 0.001). Results suggest greater ambulatory gait efficiency during ESFOS use. Further study is indicated with other patient populations.

The meta Pathway as a Potential Energy-Generating Sequence and its Effects on the Growth Rate during the Utilisation of Aromatics

Pseudomonas putida was grown on benzoate in order to determine the maximum growth rate depending on the ortho and/or meta assimilation pathway. Strain KT2440(pWW0), which expressed both the ortho (catechol 1,2-dioxygenase) and meta (catechol 2,3-dioxygenase) pathway under C-limited growth conditions, resulted in a maximum growth rate of μmax of 0.27 h-1 as determined by a transient-state cultivation technique. This rate was similar to the μmax of a strain in which the meta pathway was inactivated by Tn5 transposon mutagenesis. With strain KT2440, in which the meta pathway was eliminated by curing of the plasmid, a maximum growth rate of 0.44 h-1 was reached. By contrast, when using strain PaW94, which was deficient in a functional ortho pathway, the μmax amounted to 0.31 h-1 with transconjugants bearing plasmid pWW0 as a harbour of the meta pathway. Moreover, with transconjugant strains harbouring the TOL≔RP4 hybrid plasmid pWW53-4, the maximum growth rate was as high as 0.58 h-1. Such a high rate was also attained (but not exceeded) by a plasmid-less strain of PaW94 in which the meta pathway was integrated into the chromosome. According to these results, the maximum growth rate was 1.3 times faster when the meta pathway was used compared to the ortho pathway in a chromosomal localisation of both routes. These effects are discussed in terms of an advantage attributed to the manner of energy generation by assimilating phenolic substrates via the meta pathway in comparison with the ortho pathway. The effects on the maximum growth rates may be modulated by the presence or absence of plasmids.

Easy Strutter System Improves Biomechanical Gait Efficiency of Total Knee Arthoplasty Patients

Introduction: Controlled weight bearing is paramount to having a successful outcome following knee surgery. Recent advances in total knee replacement arthroplasty, re-alignment osteotomies, and articular cartilage surgical repair procedures have prompted the need for greater control over post-operative weight bearing progressions. Unilateral lower extremity weight bearing reduction is usually achieved by the application of upper extremity forces through crutch handles. The purpose of this study was to compare the axillary weight bearing Easy Strutter Functional Orthosis System (ESFOS) (Orthotic Mobility Systems, Inc., Kensington, MD) to axillary crutches for peak palmar and plantar force and pressure magnitude and onset timing. Methods: Thirty eight subjects (14 female, 24 male) between 40–65 years of age who were ≥ 1 year status post patient confirmed successfully rehabilitated unilateral total knee or total hip replacement surgery participated in this crossover effect controlled study. The involved (surgical side) foot and hand were instrumented with force/pressure sensors (Pedar System, Novel, Minneapolis, MN). Data were collected while subjects performed modified 3-point gait using a heel - toe progression, while attempting to maintain approximately 50% weight bearing at the involved lower extremity. During testing, subjects ambulated at a self determined comfortable pace for 20 feet on a flat surface followed by ascending a single flight of stairs, turning, descending the stairs, and ambulating 20 feet to a chair (50 ft total distance). Statistical analysis assessed mean differences between involved side palmar and plantar force and pressure magnitudes and onset timing (p < 0.05). Results: Peak plantar forces and pressures did not differ between devices. Peak plantar force timing relative to initial ground contact was delayed using the ESFOS (1.03 sec vs. .62 sec). Peak palmar forces (Fig. 1) and pressures (Fig. 2) were decreased at the upper extremity ipsilateral to the involved lower extremity during flat surface ambulation with the ESFOS (45% reduction in peak palmar force and a 50% reduction in peak palmar pressure). Peak palmar force onset timing (Fig. 3) was also delayed when subjects used the ESFOS.Fig. 1: Crutches Easy Strutters Peak Palmar ForceFig. 2: Crutches Easy Strutters Peak Palmar PressureFig. 3: Crutches Easy Strutters Peak Palmar Force OnsetDiscussion: Reduced and delayed peak palmar forces and pressures, and delayed peak plantar force onset timing suggest that the ESFOS helped facilitate a biomechanically more efficient gait pattern than axillary crutches. Reduced and delayed peak palmar forces and pressures provide evidence of decreased upper extremity loads during the impact forces of initial stance phase. Delayed peak plantar force and peak palmar force onset timing suggests that peak forces were generated more to assist with forward propulsion during terminal stance phase rather than for impact force attenuation purposes during early stance phase. The improved gait characteristics provided by the ESFOS may enhance the ambulatory function of a wide variety of patients with disabilities related to musculoskeletal, cardiopulmonary, or neuromuscular impairments.

Comparison of a stiff and a spring-type ankle-foot orthosis to improve gait in spastic hemiplegic children.

The effect of two different types of functional ankle-foot orthosis on the gait of patients with spastic hemiplegia was studied. A gap was cut into the conventional stiff orthosis to allow a limited dorsiflexion of 10-15 degrees, while plantarflexion was blocked (spring type). This gap was bridged by an aluminum bar to stiffen the orthosis for the experiment. Fourteen patients of different ages (6.5-20.1 years) walked barefoot and with the orthosis, once springy and once stiff. Kinetics and kinematics were analyzed. Gait was significantly improved into normal pattern by using any type of ankle-foot orthosis. While walking barefoot with a toe-heel-toe gait, the physiological heel-toe gait was restored with any type of orthosis. The spring type of orthosis was significantly superior to the stiff orthosis. This was most clearly expressed in the general parameters of gait-like cadence, velocity, and step length. Kinetic data gave a significant improvement by using any ankle-foot orthosis. Whereas break force was similar with both types, push-off was further improved with the spring type. Kinematics revealed little statistical difference between the two types, although gait was more dynamic and physiological with the spring type of orthosis. Any functional ankle-foot orthosis ameliorates the gait pattern in patients with spastic hemiplegia, but a spring type of orthosis renders the gait more dynamic and best corrects the pathology of gait.

Functional foot orthoses

then there are a wide range of devices which are foot orthoses. This range would include footwear with adaptions, ‘simple’ insoles and pads and the rigid foot orthoses produced from casts of the foot. It is the latter of these on which this article concentrates as it is these orthoses which suffer from a general lack of understanding of their principles and applications. This is not to say that the simpler insoles are always used to their best effect, to which many practitioners will readily attest, but it is because the claims made for the rigid foot orthoses seem to be rather extensive. These orthoses were developed in the late 1950s and early 1960s largely by a trial and error process, by a podiatrist in California, USA, Merton Root. His work, in association with other key colleagues, led to the Root functional foot orthosis which has been further developed over the years into a number of different designs. However, the basis behind all of them is the assessment and prescription techniques developed by Root and his colleagues.z.3 This article will review the biomechanical basis for foot orthoses and explain the processes by which dramatic functional improvements in the foot and proximal structures can be achieved.

足関節外側側副靭帯損傷新鮮例における早期運動

Ten patients with acute lateral ligament injuries were treated by early non-bracing mobilization which involved early weight bearing and dynamic joint control training. No functional orthosis was needed using this method. A paired Student's t test was used to compare side-to-side difference on stress radiograph. Significant decrease occurred for both mean talar tilt angle from 10.9° to 1.0° (p<0.0001) and mean anterior drawer distance from 4.3mm to 0.3mm (p<0.0005). This early motion seems to have resulted in a number of benefits. It mechanically stimulated the injured ligaments to heal, and enabled immediate neuromuscular coordination retraining and financial savings compared to other methods. Early mobilization and weight bearing is considered as the method of choice and provided quick recovery in ankle mobility.

Rehabilitation of the Surgically Repaired Achilles Tendon Using a Dorsal Functional Orthosis: A Preliminary Report

The efficacy of the nonoperative and operative approaches to Achilles tendon rapture has been debated in the literature. In addition, there is little consensus regarding postoperative immobilization with regard to immobilization type, casting position, cast time, and weight-bearing progression. The rehabilitation of the surgically repaired Achilles tendon has not been well described in the literature. The epidemiology and biomechanics of Achilles tendon rupture as well as splint fabrication and rehabilitation protocol for the surgically repaired Achilles tendon in two patients will be presented.

Functional postoperative treatment of Achilles tendon repair.

Twenty-one patients with surgically repaired Achilles tendon tears that were treated postoperatively with a functional orthosis rather than routine cast immobilization were evaluated. The orthosis allowed unrestricted plantar flexion and limited dorsiflexion to neutral. Toe-touch weightbearing crutch ambulation was allowed immediately and was gradually increased over the 6 to 8 weeks of treatment. Of the 21 patients, 14 were men and 7 were women; the average age at injury was 35.6 years (range, 19 to 65). The minimum followup was 2 years, with an average of 31 months. The repairs were acute in 18 of the patients and chronic in 3. Subjectively, 16 patients felt they returned to their preinjury level of activity and only 1 was not satisfied with his result. Objectively, there were no significant alterations in ankle range of motion when compared to the contralateral limb, with plantar flexion unchanged and dorsiflexion increased an average of only 2 degrees. The average plantar flexion and dorsiflexion strength, power, and endurance of the ankles as measured by isokinetic testing revealed no significant differences when comparing the operated leg to the nonoperated side: strength, 99% and 93%, respectively; power, 98% and 96%, respectively; and endurance, 93% and 91%, respectively. The angles at which the peak torques occurred were similarly not statistically different. Two patients had superficial wound infections, and 1 had scar adherence of the skin to the tendon. No one had rerupture of the tendon. In conclusion, while the many benefits of postoperative early motion are well proven, there has been hesitation to implement this after Achilles tendon surgery due to the concern of compromising the repair. As shown by this study, early controlled motion can safely and effectively be used following Achilles tendon repair in the motivated, reliable patient.

Functional Neutral Orthoses and Shoe Modifications

The functional foot orthoses have become a valuable contribution to medicine. Understanding the biomechanics of the lower extremity helps the physician see the correlation between poor alignment and injury. By understanding proper alignment, one can see why functional orthoses can be used to correct structural pathology.

Orthotic effect on metatarsophalangeal joint extension. A preliminary study

The authors evaluated the effect of modified Root orthoses on first metatarsophalangeal joint extension. Motion within the joint was measured dynamically following the insertion of bone markers into the first metatarsal and the hallux. Extension at the joint was greatest when the subjects were barefoot, the mean angle being 62 degrees. Plimsolls restricted extension of the joint to a mean angle of 57 degrees, while orthoses further reduced the angle of metatarsophalangeal joint extension to a mean angle of 55 degrees. The marginal reduction in first metatarsophalangeal joint extension caused by functional orthoses may be of therapeutic value in the early stages of hallux rigidus, when restricting motion at the joint may slow or prevent development of subchondral sclerosis.

The Functional Foot Orthosis

The Functional Foot Orthosis

The state of technical orthopaedics in spina bifida.

The Aschau experiences with different types of functional orthosis in children with MMC are described. The new type of orthosis allows maximal function and especially in lower level lesions, independent walking and free standing. The majority of the patients walk without help so that they have free hands. This helps them to accept the orthosis. The choice of the patients who are fitted with the functional orthosis must be very skillful.

The functional shoulder orthosis in hemiplegic shoulder subluxation: a pilot study

Hemiplegic shoulder pain is a common problem and in many cases is due to subluxation. Existing treatments are often unsatisfactory. The Functional Shoulder Orthosis has been reported to be effective in this condition and we sought to reproduce the results of the originator of the orthosis. We had a great deal of difficulty in identifying patients who satisfied the selection criteria. The patients we studied found it cumbersome, and it offered little advantage over a sling. We cannot recommend this orthosis for widespread use.

Assemblage of ortho cleavage route for simultaneous degradation of chloro- and methylaromatics.

Genetic engineering is a powerful means of accelerating the evolution of new biological activities and has considerable potential for constructing microorganisms that can degrade environmental pollutants. Critical enzymes from five different catabolic pathways of three distinct soil bacteria have been combined in patchwork fashion into a functional ortho cleavage route for the degradation of methylphenols and methylbenzoates. The new bacterium thereby evolved was able to degrade and grow on mixtures of chloro- and methylaromatics that were toxic even for the bacteria that could degrade the individual components of the mixtures. Except for one enzymatic step, the pathway was fully regulated and its component enzymes were only synthesized in response to the presence of pathway substrates.

Functional orthoses with intrinsic rearfoot post.

Functional orthoses with intrinsic rearfoot post.

Prescription of Functional Orthosis for the Spastic Hand in Cerebral Palsy: An Assessment Profile

Facilitation of functional hand use in children with cerebral palsy is a priority of occupational therapists working in this area. This paper describes an orthotic assessment profile developed at the Spastic Welfare Association of Western Australia to assist therapists in defining objectives for inclusion of a functional orthosis as part of the occupational therapy treatment programme. Several objectives of an orthotic regime for cerebral palsied children and some of the orthoses used to fulfil these objectives are also described.

A biplanar grind for rear posts on functional orthoses.

A biplanar grind for rear posts on functional orthoses.