Lower Limb Orthosis Research Articles

Design and Simulation of Under Limb Orthosis for Rehabilitation of Paraplegics

Lower limb orthosis can be used to replace the loss of functioning of lower limb that causes a lot of inconvenience in carrying out day to day activities. However, wheelchair may assist to some extent it might lead to medical issues. Replacing the wheelchair with rehabilitation devices helps in sorting this issue. Various rehabilitation techniques and devices that are developed are reviewed and their specifications and comparisons are mentioned in brief. A lower limb orthosis is designed using solidworks and the design imported into MATLAB using simmechanics is simulated using simscape multibody and the resulting torques for each joint namely hip, ankle and knee joints are obtained.

Microscopic Damage Characterization on L-shaped CFRP Laminates for Lower Limb Orthosis with Acoustic Emission Measurement

Microscopic Damage Characterization on L-shaped CFRP Laminates for Lower Limb Orthosis with Acoustic Emission Measurement

Analysis of Functional Independence Measure Factors Influencing the Discharge Destination of Convalescent Stroke Patients with Lower Limb Orthoses

Analysis of Functional Independence Measure Factors Influencing the Discharge Destination of Convalescent Stroke Patients with Lower Limb Orthoses

Assistive devices: Regaining mobility in myositis

Assistive devices (ADs) refer to external devices adapted to improve tasks and function. The common types of ADs include those improving mobility such as wheelchairs and walkers, positioning devices such as standing frames, custom-made devices (orthotics) such as fitted shoes and braces, and daily living devices. In inflammatory myositis, ADs are of utility in combating weakness, improving mobility, preventing and treating contractures, preventing falls, and assisting in daily chores. This narrative review looks at the evidence for the use of ADs in myositis and disorders with a similar pattern of muscle weakness (e.g., muscular dystrophy) subsequent to a literature search. A range of devices, from ankle orthoses to robotic exoskeletons, has been used in children with these diseases, and is part of the rehabilitation process. Evidence for their use in inflammatory myositis comes mainly from inclusion body myositis where progression is usual, and distal movement loss additionally affects functionality. In these patients, gait ADs and lower limb orthoses have been shown to be useful. Patient acceptability of these interventions is paramount in choosing the correct device and fit. An interaction of the treating rheumatologist with the physiatrist, the physical therapist, the occupational therapist, and the patient is paramount in ensuring compliance and benefit.

Orthopedic services as a tool of medical rehabilitation of patients with foot drop syndrome

To study the features of the rehabilitation of patients with foot drop syndrome and to develop recommendations for the appointment of technical means of rehabilitation (TMR) for this pathology. Retrospective analysis of the survey data of 375 patients in need of lower limb orthosis was carried out. General clinical and biomechanical methods were used to study the disturbances of statodynamic function of the musculoskeletal system. The results confirm that patients with foot drop syndrome have disturbances of support, stability, symmetry and rhythmicity of walking and, as a result, a significant deterioration in the quality of life. It has been established that the patients is not fully provided with orthoses and orthopedic shoes appointed to compensate for impaired function. Practitioners and rehabilitation specialists have difficulties in substantiating the needs and recommendations of TMR for a particular patient. The presented medical and technical requirements for product designs, the methodology for determining the need for them and recommendations for the appointment of TMR will contribute to the successful rehabilitation of patients with foot drop syndrome.

Development of a Lower Limb Orthosis for Stroke Patients ― Specification Based on the Gait Analysis and Resources for Clinical Usage ―

Development of a Lower Limb Orthosis for Stroke Patients ― Specification Based on the Gait Analysis and Resources for Clinical Usage ―

Orthopedic services as a tool of medical rehabilitation of patients with foot drop syndrome

To study the features of the rehabilitation of patients with foot drop syndrome and to develop recommendations for the appointment of technical means of rehabilitation (TMR) for this pathology. Retrospective analysis of the survey data of 375 patients in need of lower limb orthosis was carried out. General clinical and biomechanical methods were used to study the disturbances of statodynamic function of the musculoskeletal system. The results confirm that patients with foot drop syndrome have disturbances of support, stability, symmetry and rhythmicity of walking and, as a result, a significant deterioration in the quality of life. It has been established that the patients is not fully provided with orthoses and orthopedic shoes appointed to compensate for impaired function. Practitioners and rehabilitation specialists have difficulties in substantiating the needs and recommendations of TMR for a particular patient. The presented medical and technical requirements for product designs, the methodology for determining the need for them and recommendations for the appointment of TMR will contribute to the successful rehabilitation of patients with foot drop syndrome.

Orthotic care needs in a cohort of neurological rehabilitation inpatients

Aim Orthotic management is frequently part of the rehabilitation of various neurological conditions in adults such as stroke, peripheral neuropathies, spinal cord injuries and multiple sclerosis. Despite this, there are limited data available on the implementation of orthotic care in practice. The primary aim of this study is to establish the proportion of inpatients in a mixed neurorehabilitation cohort which receive orthotic assessment and treatment. The secondary aim was to document the overall care pathway. Methods Existing data were reviewed retrospectively. Data gathered included patient demographics such as age, gender and diagnosis, type of orthoses prescribed, number of orthotic treatment sessions required and outcome measures used. The paper was prepared in accordance with the STROBE statement for observational studies. Results During a 6 month period, 54 patients were admitted as inpatients. Of these, 25 (46%) were referred to the orthotic service for assessment, with 23 (43%) receiving a lower limb orthosis and 19 (35%) subsequently being discharged using either an ankle-foot orthosis or knee-ankle-foot orthosis. The conditions most commonly seen were stroke (40%), incomplete spinal cord injuries (28%) and peripheral neuropathies (16%). Significant improvements were recorded at discharge using the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Various aspects of the orthotic care process are described. Conclusions This study suggests that orthotic treatment is needed with high frequency in a mixed inpatient neurorehabilitation cohort. In terms of service planning, these data support existing the recommendation that neurological rehabilitation centres should have good access to orthotic services. Implications for rehabilitation Custom orthoses such as AFOs and KAFOs are frequently needed by neurological rehabilitation inpatients. Orthoses may facilitate standing and walking at an earlier stage during rehabilitation. Those responsible for neurological rehabilitation services should ensure appropriate access to orthotic services.

Robust Control of the Sit-to-Stand Movement for a Powered Lower Limb Orthosis

The sit-to-stand movement is a key feature for wide adoption of powered lower limb orthoses for patients with complete paraplegia. In this paper we study the control of the ascending phase of the sit-to-stand movement for a minimally actuated powered lower limb orthosis at the hips. First, we generate a pool of finite horizon Linear Quadratic Regulator feedback gains, designed under the assumption that we can control not only the torque at the hips but also the loads at the shoulders that in reality are applied by the user. Next we conduct reachability analysis to define a performance metric measuring the robustness of each controller against parameter uncertainty, and choose the best controller from the pool with respect to this metric. Then, we replace the presumed shoulder control with an Iterative Learning Control algorithm as a substitute for human experiments. Indeed this algorithm obtains torque and forces at the shoulders that result in successful simulations of the sit-to-stand movement, regardless of parameter uncertainty and factors deliberately introduced to hinder learning. Thus it is reasonable to expect that the superior cognitive skills of real users will enable them to cooperate with the hip torque controller through training.

Robust adaptive super twisting controller: methodology and application of a human-driven knee joint orthosis

PurposeThe application of the sliding mode control has two obstacle phenomena: chattering and high activity of control action. The purpose of this paper concerns a novel super-twisting adaptive sliding mode control law of a human-driven knee joint orthosis. The proposed control approach consists of using dynamically adapted control gains that ensure the establishment, in a finite time, of a real second-order sliding mode. The efficiency of the controller is evaluated using an experimental set-up.Design/methodology/approachThis study presents the synthesis of a robust super-twisting adaptive controller for the control of a lower limb–orthosis system. The developed control strategy will take into consideration the nonlinearities as well as the uncertainties resulting from the dynamics of the lower limb–orthosis system. It must also guarantee a good follow-up of the reference trajectory.FindingsThe authors first evaluated on a valid subject, the performances of this controller which were studied and compared to several criteria. The obtained results show that the controller using the Adaptive Super-Twisting algorithm is the one that guarantees the best performance. Validation tests involved a subject and included robustness tests against external disturbances and co-contractions of antagonistic muscles.Originality/valueThe main contribution of this paper is in developing the adaptation super-twisting methodology for finding the control gain resulting in the minimization of the chattering effect.

Gait Guidance Control for Damping of Unnatural Motion in a Powered Pediatric Lower-Limb Orthosis.

The nominal gait of each individual is unique and varies with the walking speed of the person. This poses a difficult problem for powered rehabilitative orthoses since control strategies often require a reference trajectory and give little control to the patient. This paper describes a simple control approach which applies torque resistive to joint movement that is unnatural for healthy individuals in the hip and knee joints during the swing phase of gait. The controller uses a configuration-dependent orthonormal basis to represent vectors in terms of components which are tangent and normal to healthy gait patterns for a continuum of gait speeds. The controller damps motion in the normal direction, thereby resisting movement which is unnatural for healthy individuals. With this control law, subjects are not restricted to a particular reference trajectory and have a large degree of volition over spatiotemporal gait parameters (e.g., stride length, swing time, and cadence). Experiments are conducted to check the feasibility of the control law in a provisional powered pediatric lower-limb orthosis. The gait guidance controller is used in conjunction with a human controller representing an individual with gait impairment. The main results compare gait shape quality when the gait guidance controller is enabled versus disabled, and show how the gait guidance controller is able to reshape gait to more closely resemble that of a healthy individual for various cadences.

Gait Analysis of Lower Limb Orthosis

Gait Analysis of Lower Limb Orthosis

Additive Manufacturing Applications on Flexible Actuators for Active Orthoses and Medical Devices.

This paper describes the results of research projects developed at the University of L'Aquila by the research group of the authors in the field of biomedical engineering, which have seen an important use of additive manufacturing technologies in the prototyping step and, in some cases, also for the realization of preindustrialization prototypes. For these projects, commercial 3D printers and technologies such as fused deposition modelling (FDM) were used; the most commonly used polymers in these technologies are acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). The research projects concern the development of innovative actuators, such as pneumatic muscles and soft pneumatic actuators (SPAs), the development of active orthoses, such as a lower limb orthosis and, finally, the development of a variable-stiffness grasper to be used in natural orifice transluminal endoscopic surgery (NOTES). The main aspects of these research projects are described in the paper, highlighting the technologies used such as the finite element analysis and additive manufacturing.

A scoping literature review of studies assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions

Purpose: Approximately 1.5% of the world’s population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development.Methods: Fourteen databases were searched from 1995–2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies.Results: The searches resulted in a total of 28,958 articles, a focus on studies with the words “randomized” OR “randomized” OR “cost” OR “economic” in their citation reduced this total to 2644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. A total of 346 randomized controlled trials were identified, with only four randomized controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures.Conclusions: While various international organizations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments.Implications for rehabilitationResearch into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations.Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research.This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.

Mechanical Properties of Lower Limb Orthosis using Carbon Fiber Reinforced Plastics

Mechanical Properties of Lower Limb Orthosis using Carbon Fiber Reinforced Plastics

Established Indications and Benefits of Lower Limb Orthoses in Stroke Rehabilitation: Clinical Practice Guideline

Established Indications and Benefits of Lower Limb Orthoses in Stroke Rehabilitation: Clinical Practice Guideline

Poster 94: Can the PROMIS Global Physical Health Score Distinguish Among Lower Limb Orthosis Users with Different Clinical Presentations?

PM&RVolume 10, Issue 9S1 p. S37-S37 Poster 94: Can the PROMIS Global Physical Health Score Distinguish Among Lower Limb Orthosis Users with Different Clinical Presentations? Eric Weber LCPO, FAAOP, Eric Weber LCPO, FAAOP Hanger Inc, Austin, TX, United StatesSearch for more papers by this authorDwiesha England MS, Dwiesha England MSSearch for more papers by this authorShane R. Wurdeman PhD, CP, Shane R. Wurdeman PhD, CPSearch for more papers by this authorDagmar Amtmann PhD, Dagmar Amtmann PhDSearch for more papers by this authorBrian J. Hafner PhD, Brian J. Hafner PhDSearch for more papers by this authorPhil Stevens MEd, CPO, FAAOP, Phil Stevens MEd, CPO, FAAOPSearch for more papers by this author Eric Weber LCPO, FAAOP, Eric Weber LCPO, FAAOP Hanger Inc, Austin, TX, United StatesSearch for more papers by this authorDwiesha England MS, Dwiesha England MSSearch for more papers by this authorShane R. Wurdeman PhD, CP, Shane R. Wurdeman PhD, CPSearch for more papers by this authorDagmar Amtmann PhD, Dagmar Amtmann PhDSearch for more papers by this authorBrian J. Hafner PhD, Brian J. Hafner PhDSearch for more papers by this authorPhil Stevens MEd, CPO, FAAOP, Phil Stevens MEd, CPO, FAAOPSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.119Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S37-S37 RelatedInformation

Poster 74: Known Groups Construct Validity of the PROMIS Physical Function Short Form Among Lower Limb Orthosis Users

Poster 74: Known Groups Construct Validity of the PROMIS Physical Function Short Form Among Lower Limb Orthosis Users

Assessment of orthotic needs in Iranian veterans with ankle and foot disorders

BackgroundWar-related traumas can lead to orthopedic and neurological disorders in victims. However, the scope of such disorders may expand months or even years after the trauma. Orthotic treatment as a rehabilitation process aims to enable people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This study aimed to investigate the rate of using orthoses among Iranian veterans with neuromuscular and skeletal disorders of the ankle and foot. Furthermore, the priorities of orthotic treatment in those veterans were explored.MethodsThis qualitative study was a national health needs assessment conducted in 11 provinces of Iran during 2011–2016. A stakeholder research group was established to survey the veterans in respect to their demographic variables, activities of daily living, current health conditions, and rate of using orthoses.ResultsOverall, 907 of the 1124 veteran participants completed the survey (response rate: 80.7%). Most of the veterans were men (97.7%), and their age and disability rate were 52.07 ± 8.13 years and 31.92% ± 14.93%, respectively. Nearly 42% of the veterans had experience in using orthoses on a daily and weekly basis. As physical ambulation was the main problematic activity in veterans, most of them were using medical shoes and foot orthoses. Nearly 37% of veterans were in need of some type of lower limb orthoses on the contralateral side to compensate for their hip inequality. In sequential order, the most in need orthoses for veterans were foot orthoses (n = 538), medical shoes (n = 447), lower limb orthoses on the contralateral side (n = 320), spinal orthoses (n = 273), and upper limb orthoses (n = 86).ConclusionsIn spite of the high demands for orthoses among Iranian veterans with ankle and foot disorders, the use of orthoses is insufficient. Hence, there is a discrepancy between the current rate of orthoses use and its ideal situation, and more resources should be provided for service providers to be able to serve veterans. Moreover, veterans should be educated regarding orthoses, their use, and their impacts on the user’s health status. The findings of a needs assessment of orthoses can be used in strategic planning and decision making to improve health care services for Iranian veterans.

O-2-17. Influence of different types of orthoses on muscle synergy control during gait in stroke patients with hemiparesis

The purpose of this study was to verify the influence of lower limb orthoses on muscle synergy control during gait in stroke patients with hemiparesis. In four subjects with acute stroke, surface EMG signals from eight muscles of the paretic lower limb were measured during gait in two conditions (ankle foot orthosis; AFO or knee ankle foot orthosis; KAFO). The number of modules, muscle weightings and activation timing profile of each module were analyzed using non-negative matrix factorization. In two subjects (Fugl Meyer Assessment; FMA > 20) who walked with mild assistance, three modules were identified during gait with KAFO, whereas two modules were identified with AFO. The third module was composed of triceps surae activities in the late stance phase of the gait cycle. In two subjects (FMA