Orthosis Research Articles

Diagnosis and Treatment of Cervical Spine Fractures in Children

Background. Cervical spine injuries in children are relatively uncommon and account for approximately 1.5% of trauma admissions. The aim of our study was to determine the incidence and patterns of pediatric cervical spine fractures in a single Trauma Center over the last decade.Material and methods. The hospital’s medical database was queried for data from the period between January 2014 and December 2023. An initial search revealed that 511 patients had been hospitalized with neck injuries in that time frame. Among these records, we identified 24 patients with a fracture of the cervical spine. The inclusion criteria were: (1) age under 18 yo, (2) fracture of the cervical spine (3) follow-up of at least 6 months. A thorough analysis was performed, including injury mechanism, diagnosis, medical procedures and final outcome., A Neck Disability Index (NDI) was assessed for all patients at the six months’ follow-up visit to evaluate treatment outcomes.Results. The study group consisted of 14 boys and 10 girls aged 4.6 to 18 years (average age 14.2). We diagnosed one case of an isolated C1 fracture, six C2 fractures, two C4 fractures, two C5 fractures, two C7 fractures, and nine cases of multiple spinal fractures. Additionally, we diagnosed two cases of cervical spine dislocation: one of right-sided rotational dislocation of C6/C7 and one of complete dislocation of C2/C3. Eight patients were treated surgically by open reduction combined with anterior plate fixation. Four patients were treated using a halo vest. Eleven patients were treated conservatively: six using a Minerva orthosis, four with a cervical-thoracic orthosis, and one with a rigid cervical collar. The highest NDI values were encountered in the group of patients with concomitant intracerebral injury, where the mean value was 18.6/45 (12-26/45). The mean NDI score for the remaining patients was 4/45 (0 - 9/45).Conclusions. 1. The incidence of cervical spine fractures in children is low. 2. Most cervical spine injuries in children are treated conservatively with good outcomes. 3. Both conservative and surgical treatment of cervical spine fractures in children produces good results 4. Computed Tomography remains the gold standard for diagnosing cervical spine fractures in children. 5. The halo-vest in pediatric patients suffering from C2 fractures was well tolerated and provided good outcomes. 6. Surgical treatment of lower cervical fractures by open reduction with anterior fusion is efficient in terms of fusion status and patient satisfaction. 7. Prospective, randomized, multicenter studies are required to assess the epidemiology, methodology, and treatment effects of cervical spine fractures in children.

Repeatability of gait of children with spastic cerebral palsy in different walking conditions

Three-dimensional gait analysis is the ‘gold standard’ for measurement and description of gait. Gait variability can arise from intrinsic and extrinsic factors and may vary between walking conditions. This study aimed to define the inter-trial and inter-session repeatability in gait analysis data of children with cerebral palsy (CP) who were walking in four conditions, namely barefoot or with ankle–foot orthosis (AFO), and overground or treadmill. Ten children with spastic CP (7♀; 9.9y ± 3.5y; GMFCS-level I-III) were included in this study. Overall, we found good to excellent intra-class correlation (ICC)-values and favourable standard error of measurement (SEM)-values for the inter-session Gait Profile Score (ICC = 0.85–0.98, SEM = 0.45–0.91°) and Gait Variable Scores (ICC = 0.85–0.99, SEM = 0.22–1.11°) for the lower-limb joints. Taking the total joint-range-of-motion into account, the knee joint showed the most repeatable motion (%SEM = 0.5–1.8 %), while ankle motions showed the lowest repeatability (%SEM = 0.8 %–3.0 %). For the continuous waveform data, only the ankle joint showed repeatability differences between walking conditions, namely, smaller SEM-values for the AFO-condition (mean inter-trial = 0.14°; mean inter-session = 1.121°) in comparison to the barefoot-condition (mean inter-trial = 0.55°; mean inter-session = 2.22°). For all the kinetic parameters, the treadmill conditions showed smaller SEM-values in comparison to the overground condition. In conclusion three-dimensional gait analysis was found to be reliable in all four walking conditions for children with CP. The resulting measurement errors can be used as a reference during clinical interpretations of gait analyses.Clinical trial registration number: Trial ID from an internationally recognized trial registry (ClinicalTrials.gov): NCT06355869

The impact of ankle-foot orthotics on selective motor control during gait in children and adolescents with cerebral palsy

BackgroundChildren with cerebral palsy (CP) often exhibit altered selective motor control during gait (SMCg). Ankle-foot-orthoses (AFOs) are used in this population to improve gait, by reducing the degrees of freedom at the ankle joint. However, the specific impact of AFOs on SMCg and whether this effect is more related to gait deviations or motor development remains unclear. Research questionDo AFOs impact SMCg, and is the change related to joint kinematics or age? MethodsGait analysis data from 53 children and adolescents with spastic CP, walking both barefoot and with AFOs, were included. Electromyography data from six lower-limb muscles, and lower limb joint kinematics were analyzed for both walking conditions. SMCg was quantified by the total variance in electromyography activity accounted for by one synergy (tVAF1), where an increase in tVAF1 indicates a decrease in SMCg. Kinematic gait deviation was assessed using the Gait-Profile-Score (GPS) and sagittal plane ankle Gait-Variable-Score (ankle-GVS). All analyses were performed for the more clinically involved leg only. ResultsWalking with AFOs resulted in a mean increase in tVAF1 of 0.02±0.07 (p=0.015) and a median increase in ankle-GVS of 3.4º (p>0.001). No significant changes were observed in GPS, and no correlation was found between the changes in tVAF1 and ankle-GVS. A significant positive moderate correlation was found between the change in tVAF1 and age, even with ankle-GVS as a covariate (r=0.45; p>0.001). SignificanceWalking with an AFO resulted in a small decrease in SMCg, with large inter-participant variability. Younger participants showed a greater decrease in SMCg, which may indicate greater neuromuscular plasticity in early developmental stages.

Psychosocial Correlates and Behavioral Response to a Carbon Fiber Orthosis and Intensive Rehabilitation Program

Introduction Carbon fiber custom dynamic orthoses (CDOs), a type of ankle-foot orthosis (AFO), have been shown to improve function and mobility. Psychosocial aspects of disability can influence outcomes in prosthetic and orthotic users, but their association with outcomes in CDO users is unknown. Objective The aim of this study was to examine the relationships between physical and psychosocial outcomes following an intensive rehabilitative program including a carbon fiber ankle-foot orthosis, and identify factors related to continued orthosis use. Study Design Retrospective cohort with long-term follow-up. Methods An online survey including questions about device behaviors, self-reported function, pain, global health, self-efficacy, pain interference, resilience, and kinesiophobia was completed by participants who received a custom carbon fiber ankle-foot orthosis and intensive training because of chronic neuromusculoskeletal lower-limb disability. Results The mean follow-up was 4.0 (±1.0) years. Sixty-three adult participants responded to the survey (21 women, 42 men; mean age, 41 ± 12 years). All psychosocial outcomes at follow-up were within “good” or “normal” limits (<1 SD from reference population mean) on average. Strong correlations were observed between self-reported physical function and psychosocial outcomes, and moderate correlations were observed among psychosocial outcomes, between baseline physical outcomes and psychosocial outcomes, and between long-term outcomes and psychosocial outcomes. Device continuation at long-term follow-up was 68%. Conclusions Four years after the intervention, respondents with chronic lower-limb disabilities reported scores that were comparable to normative values for kinesiophobia, health-related quality of life, self-efficacy for managing their condition, pain interference, and psychological resilience. Clinical Relevance Psychosocial variables can affect the outcomes with, and perception of, orthotic devices in individuals with lower-limb neuromusculoskeletal deficits. A goal-oriented care program with emphasis on technique training, postdelivery follow-up, and psychosocial status may help explain long-term outcomes with CDOs and continued device use.

Establishing Tolerance for Orthotics Casting in a Child With Autism Spectrum Disorder and Idiopathic Toe Walking

Failure to tolerate medical practices and healthcare routines can deter pediatric patients with neurodevelopmental disabilities from receiving required services. This case study evaluated behavioral intervention to establish tolerance of casting procedures in a 10-year-old boy with autism spectrum disorder (ASD) so that custom ankle-foot orthotics could be prepared as treatment for his idiopathic toe walking. At baseline, casting could not be completed because the boy displayed unsafe resistant behavior. An intervention plan combining graduated exposure, positive reinforcement, and non-contingent access to preferred objects allowed the boy to tolerate a simulated casting protocol and actual casting performed by an orthotist. Service practitioners who implemented intervention rated the plan positively.

Effectiveness of Shoe Rotation in Managing Plantar Fasciitis in Patients.

Background/Objectives: Plantar fasciitis (PF) is a common condition that causes heel pain. While various conservative treatment modalities for PF exist, no previous studies have investigated the effectiveness of shoe rotation (ShR) in patients with PF pain. This study aimed to compare the therapeutic effectiveness of ShR with that of two conventional treatments for PF-namely, foot orthosis (FO) and physical therapy (PT). Methods: Charts of 42 patients with heel pain were retrospectively reviewed. Participants were allocated to one of three treatment groups: the ShR group, the customized FO group, and the PT group. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS), Digital Pain Scale (DPS), Foot Function Index (FFI), Foot Pain and Function Scale (FPFS), and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) at baseline and at 4 and 12 weeks after the intervention. Results: The ShR, FO, and PT groups all showed improvements, with statistically significant decreases in VAS, DPS, and FFI scores and significant increases in FPFS and AOFAS-AHS scores over time (p < 0.05). All three interventions resulted in significant improvements from baseline to 4 weeks and further to 12 weeks (p < 0.05). The ShR group exhibited a slightly larger effect on all measurements than the other groups. Conclusions: ShR, FO, and PT contributed to pain reduction and functional improvement, and alternating the shoes alleviated PF pain. These results suggest a new approach to managing PF and serve as a basis for providing convenient treatment for patients with PF.

REVERSE ENGINEERING MODELING PROCESSING AND FABRICATION OF VORONOI PERFORATED ANKLE-FOOT ORTHOSIS

The ankle may not function optimally because of an ankle foot injury due to torn ligaments or foot drop, a post-stroke effect of hemiplegia. One treatment that can be done for sufferers of ankle foot injury and foot drop is using an ankle foot orthosis (AFO). Reverse engineering (RE) and additive manufacturing (AM) technologies can be utilized within the medical domain, specifically for producing prosthetic devices and orthoses that include optimal fit, lightweight characteristics, and cost-effectiveness. This study aims to create an optimized design for an ankle-foot orthosis by utilizing reverse engineering techniques, followed by an analysis of its performance using finite element simulation. The research process involved several key steps, namely 3D Scanning, CAD modeling, model analysis, and 3D printing. The findings of the model study after the implementation of Voronoi ventilation holes indicated that the highest equivalent stress observed in the model, with a shell element thickness of 1.4 mm, amounted to 21.12 MPa. This result represented an elevation of 11.74% compared to the model before introducing Voronoi ventilation holes. Nevertheless, there was a reduction in the model's mass by 20.3%, specifically from an initial weight of 400.86 grams to a final weight of 319.51 grams. On the contrary, despite a fall in the safety factor, it continues to be considered safe, with a value of 2.84.

A usability study on the inGAIT-VSO: effects of a variable-stiffness ankle-foot orthosis on the walking performance of children with cerebral palsy

BackgroundAnkle-foot orthoses (AFOs) are commonly used by children with cerebral palsy (CP), but traditional solutions are unable to address the heterogeneity and evolving needs amongst children with CP. One key limitation lies in the inability of current passive devices to customize the torque–angle relationship, which is essential to adapt the support to the specific individual needs. Powered alternatives can provide customized behavior, but often face challenges with reliability, weight, and cost. Overall, clinicians find certain barriers that hinder their prescription. In recent work, the Variable Stiffness Orthosis (VSO) was developed, enabling stiffness customization without the need for motors or sophisticated control.MethodsThis work evaluates a pediatric version of the VSO (inGAIT-VSO) by investigating its impact on the walking performance of children with CP and its potential to be used as a tool for assessing the effect of variable stiffness on pathological gait. Data was collected for three typical developing (TD) children and six pediatric participants with CP over two sessions involving walking/balance tasks and questionnaires.ResultsThe sensors of the inGAIT-VSO provided useful information to assess the impact of the device. Increasing the stiffness of the inGAIT-VSO significantly reduced participants’ dorsiflexion and plantarflexion. Despite reduced range of motion, the peak restoring torque increased with stiffness. Overall the participants’ gait pattern was altered by reducing crouch gait, preventing drop-foot and supporting body weight. Participants with CP exhibited significantly lower (p < 0.05) physiological cost when walking with the inGAIT-VSO compared to normal condition (own AFO or shoes only). Generally, the device did not impair walking and balance of the participants compared to normal conditions. According to the questionnaire results, the inGAIT-VSO was easy to use and participants reported positive experiences.ConclusionThe inGAIT-VSO stiffnesses significantly affected participants’ plantarflexion and dorsiflexion and yielded objective data regarding walking performance in pathological gait (e.g. ankle angle, exerted torque and restored assistive energy). These effects were captured by the sensors integrated in the device without using external equipment. The inGAIT-VSO shows promise for customizing AFO stiffness and aiding clinicians in selecting a personalized stiffness based on objective metrics.

Improvement of ankle foot orthotics fabrication using 3D printing method

Orthotics are the body support devices used for correction, immobilization, fixation, and prevention of paralysis. The greatest number of orthotics utilized by people suffering from plantarflexion and dorsiflexion disability, especially in Indonesia, is ankle foot orthotic (AFO). However, the duration associated with fabricating AFO through conventional methods is considered time-consuming. This paper aims to fabricate ankle foot orthotics (AFO) using innovative combinations of 3D scanning and 3D printing. The method begins with 3D scanning of the patient’s lower limb using photogrammetry (3DF Zephyr). The design is generated and adjusted, afterwards, the orthotic prototype is produced by fused deposition modeling (FDM) 3D printing using polypropylene (PP) material. This choice is attributed to the material's advantages, such as being lightweight, rigid, durable, and cost-effective. The 3D mesh model scanned using 3DF Zephyr shows good quality and more precise results. In addition, the prototype produced using 3D printing was tested by walking based on normal gait analysis’s angle of foot and calf measurement, which shows a maximum range of motion (ROM) of 16.1˚. The proposed methods of fabricating orthotic prototypes can successfully reduce the processing time by approximately 70% compared to the conventional method.

The Immediate Effect of the Novel Hybrid Passive Spring Damper Ankle-Foot Orthosis on Spatiotemporal Parameters of Walking in Patients with Multiple Sclerosis

ABSTRACT Introduction Patients with multiple sclerosis (PwMS) experience damage to their central nervous system, which can lead to unilateral or bilateral drop foot. The presently utilized ankle-foot orthoses (AFOs) for PwMS have exhibited limited clinical efficacy. Objective This current study evaluated the immediate effects of the Novel Hybrid Passive Spring Damper Ankle-Foot Orthosis (HPSDAFO) on walking in PwMS. Study design A cohort trial. Methods Twelve PwMS suffering of unilateral drop foot took part in this study. They were given the novel HPSDAFO and underwent kinematic assessment including walking along a 10-m walkway at a self-selected speed, both with and without the HPSDAFO. Results The novel HPSDAFO device significantly changed gait parameters of ankle range of motion, single limb support duration, and step and stride length of the affected side (P &lt; 0001). Furthermore, the device also improved the symmetry index and resulted in increased walking speed and cadence. Conclusions The application of the novel HPSDAFO on the affected side of PwMS resulted in a notable enhancement in the symmetry of spatial parameters, which highlights the need for additional research in this area. Clinical Relevance Using the novel HPSDAFO, PwMS can walk without adverse effects, promoting the normalization of their spatiotemporal walking parameters.

The effect of impaired unilateral ankle propulsion on contralateral knee joint loading

BackgroundImpairments in unilateral ankle propulsion may result from restriction by an external device or pathology such as lower limb amputation. Models of gait suggest this reduction may lead to increased collisional force on the contralateral side, potentially increasing force through the knee and increasing the risk of knee pain or osteoarthritis. Research questionHow do restrictions in unilateral ankle propulsive force affect contralateral knee joint loading in otherwise healthy individuals? Methods18 individuals without impairment walked on a treadmill at 1.5 m/s for two conditions: one free of restrictions, and one where a randomized limb’s ankle propulsive force was restricted using an off-the-shelf ankle-foot orthosis (AFO). Ankle propulsive power, lower extremity joint work, and ground reaction force variables were calculated for the final 3 gait cycles of each condition. Tibiofemoral joint contact force (TJCF) for the limb contralateral to the AFO was calculated through a standard OpenSim workflow utilizing the gait2392 model. Intra-limb pair-wise comparisons were made between conditions. ResultsCompared to walking unrestricted, the limb wearing the AFO demonstrated a significant reduction in peak ankle propulsive power and positive ankle work by approximately 50 % each (p<0.01). With ankle restriction, the ipsilateral knee significantly increased positive work (p<0.01). The overall propulsion produced by that limb did not change between conditions, demonstrated by a lack of change in anterior ground reaction force impulse (p=0.11). The knee of the limb contralateral to the AFO did not display differences in any TJCF variable between conditions (all p>0.07). SignificanceThese results suggest a unilateral deficit in ankle propulsion will not increase contralateral knee joint forces in individuals who are able to use other joints of the limb to compensate for the loss of ankle function. However, further research should investigate this relationship in those who display pathologies that may prevent more proximal compensations.

A Review of Knee Ankle-Foot Orthoses in Managing Neuromuscular Disorders: Focus on Children with Cerebral Palsy

Neuromuscular disorders (NMDs) significantly impact the musculoskeletal system, leading to lower extremity muscle weakness and impaired coordination, notably affecting the quadriceps. These impairments compromise knee stability during standing and walking, increasing fall risks and hindering mobility and independence. Knee-ankle-foot orthoses (KAFOs) are vital in enhancing gait efficiency and knee stability. Traditional locked KAFOs rigidly immobilize the knee throughout the gait cycle, offering maximal stability but limited natural movement. Advances in orthotic technology have led to the development of stance control KAFOs (SCKAFOs), which dynamically lock the knee only during the stance phase, promoting a more natural and energy-efficient gait. The E-MAG Active and NEURO TRONIC knee joints are prominent examples of SCKAFOs, featuring sophisticated electronic control mechanisms to improve functional outcomes in individuals with NMDs. This review also focuses on the application of SCKAFOs in children with cerebral palsy (CP), the most common neuromotor disorder affecting movement, posture, and muscle tone due to early brain injury. The prevalence and diverse etiologies of CP necessitate individualized therapeutic interventions. The review aims to evaluate the efficacy and satisfaction of orthotic management in pediatric CP, providing evidence-based recommendations for optimizing orthotic interventions and enhancing quality of life for affected children and their families.

Innovation of Adjustable Ankle Joint Orthoses for Patients with Flexible Equinus Deformity

The limited dorsiflexion at the ankle joint is characterized by Equinus deformity. It has a large impact on mobility and functionality at all ages. Usually, Achilles tendon stretching and Ankle Foot Orthosis (AFOs) are used as a treatment but have low efficiency and flexibility. Frequently adjustment to AFOs required through dynamic foot positioning makes this treatment very expensive due to repeated molding. An experimental research design was used to measure plantar flexion angles with a goniometer at many follow-ups. This research showed that a decreased plantar flexion angle, this study indicated the effectiveness of locally made adjustable ankle joints. Developing an adjustable ankle joint addresses both the practical and economic challenges of traditional orthotic treatments. This innovation not only provides clinical outcomes but also expands the opportunity to care for patients with equinus deformity. This adjustable joint gives a flexible and cost-effective solution and improves the management of equinus deformity.

The impact of shoes versus ankle-restricted orthoses on sit-to-stand kinematics and centre of mass trajectories in adults with myelomeningocele

BackgroundIndividuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. Research questionHow are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? MethodsTwenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. ResultsThe AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle). SignificanceThe differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.

Efficacy of rehabilitation physiotherapy combined with brace correction in patients with mild to moderate scoliosis secondary to cerebral palsy.

Scoliosis secondary to cerebral palsy is one of the common complications of cerebral palsy in children with cerebral palsy. This study aimed to explore the efficacy of rehabilitation combined with brace correction in patients with scoliosis secondary to cerebral palsy. A total of 52 patients with scoliosis secondary to cerebral palsy were selected from our hospital from April 2019 to April 2022 and divided into the control group and experimental group according to the statistical randomization method (n= 26 in each group). Control group: mean age (14.28 ± 2.31) years; 16 males and 10 females. Experimental group: average age (14.24 ± 2.35) years; 15 males and 11 females. The control group wore scoliosis orthopedic brace, while the experimental group was treated with rehabilitation manipulation and rehabilitation training (including gymnastic training and weight training) on the basis of the control group for 1 year. The clinical efficacy of the two groups was compared and observed; the number of degrees of scoliosis (Cobb angle), the angle of vertebral rotation (AVR) and the distance of the parietal vertebrae from the sacral midline (AVT) were compared before and after treatment; the incidence of adverse events during treatment was observed in the two groups. After treatment, both groups showed significant improvement in the overall effectiveness of treatment, Cobb's angle, AVR and AVT compared with those before treatment (P< 0.05). The experimental group had a significantly higher overall effective rate of treatment than the control group (P< 0.05), a significantly smaller Cobb's angle and AVR than the control group (P< 0.05) and a significantly shorter AVT than the control group (P< 0.05). The incidence of adverse events during treatment was lower in both groups and was not significantly different (P> 0.05). The combination of rehabilitation physiotherapy and bracing is effective in optimizing the clinical outcome of patients with scoliosis secondary to cerebral palsy, improving their scoliosis dysfunction and providing a high level of safety in treatment.

Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial.

Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. Therapeutic study level I randomised crossover trial.

DE-AFO: A Robotic Ankle Foot Orthosis for Children with Cerebral Palsy Powered by Dielectric Elastomer Artificial Muscle.

Conventional passive ankle foot orthoses (AFOs) have not seen substantial advances or functional improvements for decades, failing to meet the demands of many stakeholders, especially the pediatric population with neurological disorders. Our objective is to develop the first comfortable and unobtrusive powered AFO for children with cerebral palsy (CP), the DE-AFO. CP is the most diagnosed neuromotor disorder in the pediatric population. The standard of care for ankle control dysfunction associated with CP, however, is an unmechanized, bulky, and uncomfortable L-shaped conventional AFO. These passive orthoses constrain the ankle's motion and often cause muscle disuse atrophy, skin damage, and adverse neural adaptations. While powered orthoses could enhance natural ankle motion, their reliance on bulky, noisy, and rigid actuators like DC motors limits their acceptability. Our innovation, the DE-AFO, emerged from insights gathered during customer discovery interviews with 185 stakeholders within the AFO ecosystem as part of the NSF I-Corps program. The DE-AFO is a biomimetic robot that employs artificial muscles made from an electro-active polymer called dielectric elastomers (DEs) to assist ankle movements in the sagittal planes. It incorporates a gait phase detection controller to synchronize the artificial muscles with natural gait cycles, mimicking the function of natural ankle muscles. This device is the first of its kind to utilize lightweight, compact, soft, and silent artificial muscles that contract longitudinally, addressing traditional actuated AFOs' limitations by enhancing the orthosis's natural feel, comfort, and acceptability. In this paper, we outline our design approach and describe the three main components of the DE-AFO: the artificial muscle technology, the finite state machine (the gait phase detection system), and its mechanical structure. To verify the feasibility of our design, we theoretically calculated if DE-AFO can provide the necessary ankle moment assistance for children with CP-aligning with moments observed in typically developing children. To this end, we calculated the ankle moment deficit in a child with CP when compared with the normative moment of seven typically developing children. Our results demonstrated that the DE-AFO can provide meaningful ankle moment assistance, providing up to 69% and 100% of the required assistive force during the pre-swing phase and swing period of gait, respectively.

Tuning the mechanical responses of 3D-printed ankle-foot orthoses: A numerical study

Ankle-foot orthoses (AFOs) are frequently prescribed for children with cerebral palsy (CP) to correct specific features of abnormal gait. However, traditional AFO manufacturing and design involve labor-intensive processes and rely on subjective evaluations of clinicians. Recent advances in three-dimensional (3D) printing allow the rapid prototyping of AFOs, but the expanded design options complicate decision-making. This study aims to evaluate how AFO design affects the mechanical responses of 3D-printed AFOs. The lower limb geometry is established by a 3D-scanning system, and a prototypical AFO is designed, 3D printed, and tested under compression. A parametric study on the effect of base materials, thickness, and trimline location is conducted based on a validated numerical model. The results reveal that AFOs exhibit distinct behaviors under plantarflexion and dorsiflexion motions, with AFO stiffness correlating to thickness through a power function. AFO stiffness is more sensitive to posterior trim depth than inferior, while both trim depths significantly influence stress concentration around the ankle region. This investigation demonstrates the potential of combining 3D printing and computational modeling to improve the design and fabrication process of AFOs, providing insights into the development and customization of 3D-printed AFOs.

Outcomes Following Surgical Correction of Talocalcalcaneal Joint Dislocation in Diabetes Associated Charcot Foot Arthropathy.

Growing clinical interest in the treatment of acquired foot deformity due to diabetes-associated Charcot foot arthropathy has led to multiple reports of favorable clinical outcomes in patients when their acquired deformity is at the midfoot level. Clinical failures and less than optimal clinical outcomes are achieved when the deformity is at the hindfoot or ankle levels. A retrospective review was performed of all patients who underwent surgical correction of diabetes-associated Charcot foot arthropathy with talocalcaneal dislocation over an 18-year period. Reduction of the talocalcaneal dislocation, and maintenance of the correction with percutaneous pins and circular external fixation after subtalar joint preparation for fusion, was used as the method of surgically achieving a clinically plantigrade foot. Clinical outcomes were based on resolution of infection, limb salvage, and the ability to ambulate with commercially available therapeutic footwear. Forty-three feet in 39 patients were included. A favorable clinical outcome was achieved in 32 of 43 feet (74%) with 26 (60%) considered to have an "excellent" result with minimal shoeing issues and 6 (14%) considered to have a "good" outcome based on their need for a custom shoe modification and/or some form of short ankle-foot orthosis. Eleven feet (26%) were judged to have a "poor" clinical outcome and among those 11 feet, 6 underwent partial, or whole-foot amputation, 2 had persistent wounds, and 5 required the use of a standard ankle foot orthosis or Charcot Restraint Orthotic Walker (CROW). Subtalar dislocation in Charcot arthropathy is a complex clinical problem. In our series, reduction and maintenance of the reduction after subtalar dislocation was essential for a favorable clinical outcome.

Clinical Response of Levodopa in CTNNB1-Related Dystonia

Abstractβ-catenin, which is encoded by the CTNNB1 gene, is essential for the development and functioning of the brain. There are a few documented cases of dystonia related to CTNNB1. Here, we report the case of an 11-year-old Spanish boy referred for movement disorders and gait disturbance. He had motor developmental delay and achieved unassisted walking at 3 years, with a tiptoe gait and valgus foot posture requiring ankle-foot orthoses. Blood tests showed elevated creatine kinase levels (1684 U/L, normal range 62–235). Molecular analysis revealed a deletion in exons 3-9 of the DMD gene, leading to the diagnosis of Becker muscular dystrophy. By age 8, he presents frequent falls due to a dystonic posture of the feet and abnormal movements in the upper and lower limbs. Whole-exome sequencing revealed a novel heterozygous, de novo pathogenic frameshift variant in the CTNNB1 gene (NM_001098209.1):p.Thr297fs/ c.889dupA. Treatment with levodopa/carbidopa (5.3 mg/kg/day) led to a partial clinical improvement, including a decrease in dystonia, measured by the Burke-Fahn-Marsden Dystonia Rating Scale, and choreic movements in all four limbs. We suggest that levodopa contributes to motor improvement in patients with CTNNB1-related dystonia, supporting its inclusion in the differential diagnosis of childhood dopa-responsive dystonia.