Knee Ankle Foot Orthosis Research Articles

Gait Kinematics and Energy Expenditure of Users Walking with Semiflexion Knee-Ankle-Foot Orthosis: A Pilot Study

ABSTRACT Introduction The knee joint of a conventional knee-ankle-foot orthosis (KAFO) is locked during walking. This study aims to evaluate the effects of stance phase knee flexion on the kinematics, spatiotemporal parameters, and energy consumption of KAFO users. Materials and Methods A retrofitting drop lock that allows 12° of stance flexion in a single-axis knee joint was developed (called the semiflexion knee joint). Four subjects with quadriceps weakness volunteered to participate in the study. Gait analysis was conducted for the locked knee and the semiflexion knee orthosis using a calibrated eight-camera three-dimensional motion capture system. Preceding each trial, participants were given 5 days of gait training with the corresponding KAFO. Subjective feedback about the performance of the new KAFO was collected. Results Walking with the semiflexion KAFO did not significantly improve the speed (p = 0.161), cadence (p = 0.232), and stride length (p = 0.95) compared with walking with a locked KAFO. Although not significant (p = 0.132), trends of Physiological Cost Index (PCI) seemed to reduce in all subjects while walking with the semiflexion knee. Conclusions Using the KAFO with stance flexion did not significantly improve any of the locked knee gait parameters. However, there was a trend of reduction in the PCI score while walking with the semiflexion KAFO, and it also improved the ease of doing some activities of daily living.

Abandonment of assistive products: assessing abandonment levels and factors that impact on it

Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center.Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery.Implications for RehabilitationData about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings.The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users.The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels.As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.

Difference in independent mobility improvement from admission to discharge between subacute stroke patients using knee-ankle-foot and those using ankle-foot orthoses.

[Purpose] To verify differences in independent mobility improvements between people with subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses (AFOs) from admission to discharge, and to identify the relationship between mobility improvements and their characteristics. [Participants and Methods] This study included 381 hospitalized patients with subacute stroke who required complete mobility assistance at admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after admission. The functional independence measure (FIM) score at admission and discharge, FIM gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period from admission to prescription for lower limb orthoses were investigated. [Results] Repeated-measures two-way analysis of variance revealed a significant group × time interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in the scores in the KAFO group were significantly lower than those in the AFO group. Age, BS, FIM at admission, and period from admission to lower limb orthosis prescription significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items. [Conclusion] A more effective intervention using lower limb orthoses with consideration of the influence of age, motor paralysis, and activities of daily living at admission is required to promote the improvements of people with subacute stroke prescribed KAFOs or AFOs.

Identification and analysis of knee–ankle–foot orthosis design requirements based on a feedback survey of orthosis users in India

Purpose: The world is advancing towards a technological revolution in various fields, yet the assistive devices available for people with disability, especially in developing countries, are in the most primitive stage. For many years, lower limb orthotics has been a neglected area of research and there is an urgent need to address the problems faced by lower limb orthosis users to enable them to lead an independent life. This work is a first step in this direction and aims to identify and analyse the needs of knee–ankle–foot orthosis (KAFO) users in India.Method: A structured feedback survey of 29 KAFO users was conducted at three rehabilitation centres located in South India. A feedback questionnaire and a novel outcome measure tool (trigger cards) were used as means to assess user satisfaction about their existing KAFOs. The results of the survey were analysed to obtain quantitative and qualitative outcomes.Results: The survey identifies various biomechanical and functional issues associated with lower limb orthosis design. The results of the survey imply that there is an urgent need to solve issues, especially related to locked orthotic knee joint design. Additionally, it sheds light on the lifestyle and socio-economic issues of KAFO users that are likely prevalent in many other low- and middle-income countries.Conclusions: The outcomes of this survey can motivate and guide researchers to design improved orthotic solutions to meet the needs of lower limb orthosis users all over the world.Implications for Rehabilitation • This is a first of its kind survey that brings forth the needs of lower limb orthosis users in India, and is an important step towards rehabilitation and empowerment of people with lower limb disability. • The pilot survey helps to identify critical areas for design improvements in a knee–ankle–foot orthosis. • The outcomes of this survey can help researchers to design functionally improved assistive devices that better meet the needs of users than currently available technology in developing countries such as India.

Feasibility of a Powered Knee Joint in Providing Stance and Swing Phase Knee Flexion when Using a Knee-Ankle-Foot Orthosis

ABSTRACT Background The aim of this study was to develop a new stance control knee-ankle-foot orthosis (SCKAFO) and determine its efficacy on specific spatiotemporal and kinematic parameters. Method Seven healthy volunteer subjects participated in this study. After orthotic gait training, subjects participated in a four-part data collection session that consisted of gait evaluation with normal walking, SCKAFO with locked knee joint, SCKAFO without initial flexion (IF) mode, and SCKAFO with IF mode. Results Walking with any of the control knee-ankle-foot orthoses (KAFOs) produced a significant reduction in walking speed compared with normal walking. There was no significant difference in walking speed between the SCKAFO with and without IF. There was significantly higher knee flexion in stance phase when walking with the SCKAFO with IF compared with the other types of KAFO, but there was no significant difference between normal walking and SCKAFO with IF. In wearing SCKAFO with IF, the mean of the hip flexion was not significantly altered compared with normal walking. Hip abduction was also significantly reduced during walking with stance control (SC) mode compared to KAFO with locked knee joint. Conclusion Knee-ankle-foot orthosis with new powered knee joint has benefits over existing assistive KAFOs with locked and SC knee joints.

Activity Recognition in Individuals Walking With Assistive Devices: The Benefits of Device-Specific Models.

BackgroundWearable sensors gather data that machine-learning models can convert into an identification of physical activities, a clinically relevant outcome measure. However, when individuals with disabilities upgrade to a new walking assistive device, their gait patterns can change, which could affect the accuracy of activity recognition.ObjectiveThe objective of this study was to assess whether we need to train an activity recognition model with labeled data from activities performed with the new assistive device, rather than data from the original device or from healthy individuals.MethodsData were collected from 11 healthy controls as well as from 11 age-matched individuals with disabilities who used a standard stance control knee-ankle-foot orthosis (KAFO), and then a computer-controlled adaptive KAFO (Ottobock C-Brace). All subjects performed a structured set of functional activities while wearing an accelerometer on their waist, and random forest classifiers were used as activity classification models. We examined both global models, which are trained on other subjects (healthy or disabled individuals), and personal models, which are trained and tested on the same subject.ResultsMedian accuracies of global and personal models trained with data from the new KAFO were significantly higher (61% and 76%, respectively) than those of models that use data from the original KAFO (55% and 66%, respectively) (Wilcoxon signed-rank test, P=.006 and P=.01). These models also massively outperformed a global model trained on healthy subjects, which only achieved a median accuracy of 53%. Device-specific models conferred a major advantage for activity recognition.ConclusionsOur results suggest that when patients use a new assistive device, labeled data from activities performed with the specific device are needed for maximal precision activity recognition. Personal device-specific models yield the highest accuracy in such scenarios, whereas models trained on healthy individuals perform poorly and should not be used in patient populations.

Lower Limb Orthotic Therapy for Stroke Patients in a Rehabilitation Hospital and Walking Ability at Discharge

Background: The purpose of this study was to clarify the use of orthotic therapy and the ability to walk at discharge among stroke patients who were treated at our rehabilitation hospital. Methods: This retrospective, observational cohort study included 1040 patients with first-ever stroke who were referred to our rehabilitation hospital between January 2013 and December 2015. The patients were divided into knee-ankle-foot orthosis (KAFO), ankle-foot orthosis (AFO), and no orthosis groups. Neurological symptoms, cognitive function, daily activities, duration from hospitalization to orthosis creation, hospitalization duration, and walking ability at discharge were compared. Results: The age of the patients ranged from 12 to 94 years. The mean duration from onset to hospitalization was 34.1 ± 17.8 days, and the mean length of hospital stay was 64.3 ± 35.3 days. Of the 1040 patients, 414 received orthotic therapy (220 in the KAFO group and 194 in the AFO group). The AFO group had patients with lower age than those in the no orthosis group, and neurological symptoms and cognitive function were more severe in the KAFO group than in the other groups. Their own KAFO was prescribed in 156 patients and AFO was prescribed in 230 patients. The mean period from hospitalization to orthosiscompletion was 11.3 ± 5.8 days in the KAFOs and 33.9 ± 20.9 days in the AFOs. Orthosis was needed by 375 patients (47 KAFOs and 328 AFOs) at discharge from the rehabilitation hospital. Among the patients, 540 patients could walk independently and these included 43.2% patients from the KAFO group and 66.5% patients from the AFO group. Conclusion: An orthosis was required in a number of patients who have been transferred to a rehabilitation hospital. We believe that it is clear that orthosis therapy is indispensable for rehabilitation of stroke patients.

The effect of 'Sensor Lock', a knee–ankle–foot orthosis with an electromechanical stance control knee joint, on walking parameters and gait symmetry of subjects with quadriceps weakness: a pilot study

Pilot study. This study aimed to evaluate an electromechanical stance control (SC) knee joint, 'sensor lock', which could potentially solve the problems of walking parameters and gait symmetry in subjects with poliomyelitis. University of Social Welfare and Rehabilitation Sciences. Six subjects with quadriceps weakness were enrolled in this study. A custom-made stance-control knee–ankle–foot orthosis (SCKAFO) with the same set of components was constructed for each participant. A motion analysis system was used for analysis of lower limb kinematics. There were no significant differences between the knee–ankle–foot orthoses (KAFOs) and the two types of knee joints with regard to temporal–spatial parameters. Walking speed and cadence reduced and stride length increased in the stance control (SC) mode compared to the knee joint locked mode. The maximum knee flexion angle during swing phase increased when walking with SC mode compared to walking with the KAFO in knee joint lock mode. There was a significant difference between two test conditions with regard to hip flexion. There were only significant differences in the symmetry index of the knee flexion between two test conditions. Compared to locked knee mode, SC mode demonstrated a slower speed of walking and increased peak knee flexion during swing. Regarding gait symmetry, the symmetry index of the knee flexion and speed of walking decreased when the KAFO with SC mode was used compared to KAFO with knee joint locked mode.

A Method for Optimal Synthesis of a Biomimetic Four-Bar Linkage Knee Joint for a Knee-Ankle-Foot Orthosis

A Knee-Ankle-Foot orthosis (KAFO) is used as a supportive device by individuals with lower limb disability. A type of KAFO that allows knee flexion-extension is prescribed for people who need knee stability in the transverse and frontal planes. In such an orthosis, mimicking the human knee motion is vital to avoid relative motion (called pistoning) between the limb and the orthosis. A four-bar mechanism, owing to its polycentric nature, simplicity and ease of fabrication can provide a customizable, biomimetic solution. This paper presents an improved and robust optimization approach to synthesize a four-bar mechanism to closely mimic the anatomical knee motion. The reference human knee centrode is obtained from literature. A genetic algorithm is used for optimal synthesis of the fourbar mechanism. Results show that the average error between the reference centrode and the centrode of the synthesized four-bar mechanism is very small (0.2 mm). Thus, the synthesized crossed four-bar linkage can reproduce better anthropomorphic characteristics of the knee joint. The methodology can be used for the design of customized orthotic knee joints for KAFOs and knee braces.

Paraplegia and transtibial amputation: successful ambulation after dual disability: a retrospective case report.

This is a single-subject case report. The objective is to describe the unique rehabilitation outcome of an individual with motor complete T12 paraplegia and a right transtibial amputation. This study was conducted at the Department of Physical Medicine and Rehabilitation of Christian Medical College in India. A 42-year-old policeman presented to our rehabilitation centre with motor complete T12 paraplegia and right transtibial amputation, 3 months following a road traffic accident. As the patient's goal was to walk, he was given a trial of independent ambulation with a customized prosthesis on the right side and a regular knee ankle foot orthosis (KAFO) on the left side. At the end of 12 weeks of rehabilitation, the patient was able to walk independently with the prosthesis/orthosis and bilateral elbow crutches. His Walking Index for Spinal Cord Injury (WISCI) score improved from 0/20 to 12/20 points. The scope of functional ambulation should not get restricted for a person with low thoracic spinal cord injury even when there is concurrent transtibial amputation.

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study

Background: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait.Aim: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs.Method: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters.Results: Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence.Conclusions: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs.Implications for RehabilitationThe poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using.Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear.The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis.In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced.The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.

Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement

Purpose state: Orthotic wearing time may be an important confounder in efficacy studies of treatment in children with spastic cerebral palsy (SCP). Most studies measure parent-reported wearing time (WTparent) with questionnaires, but it is questionable whether this yields valid results. This study aims to compare WTparent with objectively measured wearing time (WTobj) in children with SCP receiving orthotic treatment.Method: Eight children with SCP participated in this observational study. For one year, they received knee-ankle-foot orthosis (KAFO) treatment. WTparent was measured using questionnaires. WTobj was measured using temperature sensor-data-loggers that were attached to the KAFOs. The 2.5th and 97.5th percentiles and median of differences between methods (per participant) were used to calculate limits of agreement and systematic differences.Results: There was no systematic difference between WTparent and WTobj (0.1 h per week), but high inter-individual variation of the difference was found, as reflected by large limits of agreement (lower limit/2.5th percentile: −1.7 h/week; upper limit/97.5th percentile: 11.1 h/week).Conclusions: Parent-reported wearing time (WTparent) of a KAFO differs largely from objectively measured wearing time (WTobj) using temperature sensors. Therefore, parent-reported wearing time (WTparent) of KAFOs should be interpreted with utmost care.Implications for RehabilitationLow wearing time of orthoses may be a cause of inefficacy of orthotic treatment and incorrect reported wearing time may bias results of efficacy studies.Results of this study show that parent-reported wearing time is not in agreement with objectively measured wearing time.Parent-reported wearing time of KAFOs should be interpreted with utmost care.Objective methods are recommended for measuring orthotic wearing time.

The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review.

Study Design Systematic review. Clinical Questions (1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury? Methods PubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury. Results No comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure–Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton. Conclusion There is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs. There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury. Trials comparing later-generation exoskeletons are needed.

Effect of a Knee-Ankle-Foot Orthosis on Knee Kinematics and Kinetics in an Individual with Varus Knee Alignment

ABSTRACT Background Knee valgus braces are used to reduce knee load and varus deformities in individuals with medial compartment osteoarthritis (OA). The purpose of this study was to determine whether the kinematics and kinetics of the knee are improved when wearing a knee-ankle-foot orthosis (KAFO) compared with knee valgus braces while walking and stair climbing. Materials and Methods One male individual (with 10° of knee varus) was assessed with a control shoe, custom, and off-the-shelf (OTS) Unloader knee valgus braces, and a custom-made KAFO in situ during walking and stair climbing. Results The KAFO significantly reduced the knee varus angle compared with the shoe and both knee valgus braces during walking and stair climbing, as well as the first peak of the external knee adduction moment (EKAM) during walking and the knee adduction angular impulse (KAAI) during ascending compared with the shoe. No significant differences were noted between the custom and OTS knee valgus braces in any measures. Conclusions Knee-ankle-foot orthoses may be recommended for individuals with high knee varus angles.

A Biologically Inspired Knee Actuator for a KAFO

Knee–ankle–foot orthoses (KAFOs) are prescribed to improve abnormal ambulation caused by quadriceps weakness. There are three major types of KAFOs: passive KAFOs, semidynamic KAFOs, and dynamic KAFOs. Dynamic KAFOs are the only type that enables to control knee motions throughout the entire walking gait cycle. However, those available in the market are heavy, bulky, and have limited functionality. The UT dynamic KAFO is developed to allow knee flexion and assist knee extension over the gait cycle by using a superelastic nitinol actuator, which has the potential to reduce volume and weight and reproduce normal knee behavior. In order to match the normal knee stiffness profile, the dynamic actuator consists of two actuating parts that work in the stance and swing phases, respectively. Each actuating part combines a superelastic torsional rod and a torsional spring in parallel. Geometries of the two superelastic rods were determined by matlab-based numerical simulations. The simulation response of the dynamic actuator was compared with the normal knee stiffness, verifying that the proposed design is able to mimic the normal knee performance. The surrounding parts of the dynamic knee joint have then been designed and modeled to house the two actuating parts. The dynamic knee joint was fabricated and mounted on a conventional passive KAFO, replacing its original knee joint on the lateral side. Motion analysis tests were conducted on a healthy subject to evaluate the feasibility of the UT dynamic KAFO. The results indicate that the UT dynamic KAFO allows knee flexion during the swing phase of gait and provides knee motion close to normal.

Evaluation of a variable resistance orthotic knee joint.

Knee-ankle-foot orthoses (KAFOs) are full leg braces for individuals with knee extensor weakness, designed to support the person during weight bearing activities by preventing knee flexion. KAFOs typically result in an unnatural gait pattern and are primarily used for level ground walking. A novel variable resistance orthotic knee joint, the Ottawalk-Variable Speed (OWVS), was designed to address these limitations. This paper presents a pilot test to evaluate the OWVS functional performance during walking and stair descent. A carbon-fiber KAFO was adjusted for an able-bodied participant by a certified orthotist, with a standard orthotic single axis knee joint on the medial side and the OWVS on the lateral side. The participant performed level ground walking (stance-control, open, closed) and stair descent tests. The operator was able to manually switch between closed mode in terminal swing to open mode in terminal stance for stance-control walking. Knee angle kinematics were similar between open and stance control modes. For stair descent, resistance settings supported the participant as they lowered their body to the next step, but with smaller range of motion compared to the open setting. The Ottawalk-Variable Speed design successfully controls knee flexion during stance and stair descent, with one lateral control joint. Mode switching was fast and appropriate. This microprocessor controlled SCKAFO has a low profile that fits beneath clothing and the variable resistance design will allow people to negotiate different terrain types.

Activity recognition in patients with lower limb impairments: do we need training data from each patient?

Machine learning allows detecting specific physical activities using data from wearable sensors. Such a quantification of patient mobility over time promises to accurately inform clinical decisions for physical rehabilitation. There are two strategies of setting up the machine learning problem: detect one patient's activities using data from the same patient (personal model) or detect their activities using data from other patients (global model), and we currently do not know if personal models are necessary. Here we consider the problem of detecting physical activities from a waist-worn accelerometer in patients who use a knee-ankle-foot orthosis (KAFO) to walk. We show that while a model based on healthy subjects has low accuracy, the global model performs as well as the personal model. This is encouraging because it suggests that condition-specific activity recognition algorithms are sufficient and that no data from individual patients is necessary.

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis.

Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review - a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis - in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553. Various types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users. The population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs. Future work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery. This study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228. The National Institute for Health Research Health Technology Assessment programme.

Therapeutic Experience on Stance Control Knee-Ankle-Foot Orthosis With Electromagnetically Controlled Knee Joint System in Poliomyelitis.

A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern.

Evaluation of the performance of paraplegic subjects during walking with a new design of reciprocal gait orthosis

Background: Spinal cord injury (SCI) influences a person's ability to stand and walk. Various orthoses have been developed to solve these standing and walking problems, however, patients still experience high energy consumption during walking and high forces on the upper limbs. A new reciprocal gait orthosis (RGO) was designed to address these problems. The aim of this study was to evaluate the performance of the new orthosis design with paraplegic subjects. Method: Three paraplegic subjects with the lesion at level T12 and three able-bodied subjects were included in this study. Hip and pelvis range of motion and vertical ground reaction force were evaluated using the Qualysis motion analyzer system and a Kistler force plate. Energy consumption was measured with the Polar heart rate monitoring system. The differences between SCI individuals when walking with a Knee Ankle Foot Orthosis (KAFO) and the new RGO, and the differences between able-bodied and paraplegic subjects were evaluated by the use of paired sample and two sample t test, respectively. Result: The results showed that energy consumption and gait analysis outcomes with new RGO orthosis were better than the KAFO. However, there was a large difference between paraplegic and able-bodied subjects while walking with the new orthosis. Conclusion: The new RGO design performed better than a KAFO in terms of energy consumption, walking style and vertical ground reaction force. Therefore, it appears that RGO may be a useful orthosis for patients with paraplegia.Implications for RehabilitationWalking and standing of the subjects with spinal cord injury (SCI) improve their physiological and physiological health.This study introduces a new type of orthosis design in order to improve the abilities of SCI subjects during walking and standing.It seems that the new design works better than available orthoses (KAFO).