Orthotic Fabrication Research Articles

Material Performance Evaluation for Customized Orthoses: Compression, Flexural, and Tensile Tests Combined with Finite Element Analysis.

Orthoses are commonly used for treating injuries to improve the quality of life of patients, with customized orthoses offering significant benefits. Additive manufacturing, especially fused deposition modelling, enhances these benefits by providing faster, more precise, and more comfortable orthoses. The present study evaluates nine polymeric materials printed in horizontal and vertical directions by assessing their performance through compressive, flexural, and tensile tests. Among all materials, polycarbonate, polylactic acid, and ULTEMTM 1010 showed the most promising results, not only because they had the highest mechanical values, but also due to their minimal or no difference in performance between printing directions, making them advantageous in orthoses fabrication. Based on this, a finite element model of an ankle-foot orthosis was developed to simulate the deformation, strain, and stress fields under static conditions. The findings aim to optimize material selection for orthotic fabrication, where ULTEMTM 1010 is presented as the material with improved performance and durability.

Sustainable practices in hand therapy: a global perspective.

Given its significant environmental footprint, healthcare sustainability is paramount. This study delves into the contributory role of hand therapy, assessing hand therapists' comprehension, implementation and barriers to sustainable practices, focusing on orthotic fabrication. A global survey distributed via social media and professional networks collected data on sustainability awareness, practices and educational needs from 113 respondents, primarily from North America (34%) and Europe (32%). Although 91% recognized climate change, only 34% practised sustainability. Despite 57% attempting eco-friendly actions in orthotic fabrication, such as reusing components (65%), knowledge of reusable materials was low (17%) and recycling thermoplastics was inadequate (74.3%). The main barriers were lack of awareness (59%), material scarcity (56.6%) and time constraints (54%). The findings underscore the urgent need for enhanced education, better resource availability and policy reforms to close the gap between awareness and action, promoting sustainability in hand therapy.

Perspectives on remote learning of orthotic fabrication by certified hand therapists

BackgroundThe COVID-19 pandemic caused disruption to continuing educational opportunities for hand therapists. In response, some courses were offered via online platforms, including virtual orthotic fabrication courses. It is important to determine the effectiveness and benefits of these courses for educating certified hand therapists and examine if remote learning of orthotic fabrication skills has continued merit and relevance. PurposeTo investigate the value and effectiveness of orthotic fabrication courses taught in a virtual format. Study DesignCross-sectional, mixed methods survey study. MethodsA 31-item survey consisting of Likert-type, direct response, and open-ended questions about experiences and opinions of virtual orthotics courses was electronically delivered to certified hand therapists. Data analysis included descriptive and correlational statistics to highlight frequencies, ranges, and relationships between the participant demographics and opinions/experiences. Thematic analysis guided the coding of the qualitative data. ResultsA total of 459 responded, with a response rate of 9.7%. Most respondents had not participated in online courses on orthotic fabrication. Those that did reported high satisfaction but noted that clinical experience and knowledge from previous courses influenced this experience. Most participants felt that novice clinicians and students would not gain enough skills and confidence from online courses. However, participants with all levels of experience found the courses to be of value. ConclusionsResults suggest that while online learning of this skill set is valuable and effective, it is most beneficial for experienced clinicians. Disadvantages included the lack of instructor feedback necessary for hands-on skill development and the lack of peer interaction. Advantages included convenience of time, cost, accessibility, and the ability to revisit the topic as needed. Online learning of orthotic fabrication skills is a sustainable option for clinicians seeking to advance their skills. Nevertheless, it is not a substitute for initial training for novice hand therapists due to the lack of feedback and skill development.

Remote Orthotic Fabrication Method Using Small Three-Dimensional Printers and Computed Tomography Data:A Technical Report.

Computer-aided design and manufacturing (CAD/CAM) methods have gained prominence in early orthotic provision. This study introduces an innovative approach using compact three-dimensional (3D) printers and computed tomography data to generate segmented body models for traditional Damen corset orthoses. The goals included evaluating the comfort and fit of orthoses and assessing the effectiveness of our approach for prosthetic companies with limited financial resources. Lumbar and thoracolumbar orthoses were crafted via CAD/CAM. Four healthy patients wore the orthoses, with whom immediate and 1-week comfort and fit assessments were conducted. A prosthetist assessed fit, and the Japanese edition of OPUS-CSD, the Orthotics Prosthetics Users' Survey-Client Satisfaction with Device, was used for subjective assessment of comfort and fit. The fit evaluations were satisfactory for all patients with positive predefined criteria. Questionnaire responses confirmed high satisfaction and comfort, confirming a successful orthosis fit. We established an orthotic fabrication method using CAD/CAM methods with 3D printers. Additionally, we confirmed the comfort and fit of the corsets so produced. The initial cost of 3D printers is lower than that of traditional carving machines, enabling even small-scale orthotic fabrication facilities to utilize CAD/CAM methods. Further research and refinements of this manufacturing approach are expected to expand its applicability.

Thermoplastic Material Selection and Barriers to Custom Orthotic Fabrication: A Survey of Occupational and Physical Therapists

Thermoplastic Material Selection and Barriers to Custom Orthotic Fabrication: A Survey of Occupational and Physical Therapists

A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: An interpretive description approach

BackgroundTelerehabilitation is increasingly being used to meet the rehabilitation needs of situations where face-to-face therapy is not possible. Nevertheless, reports on barriers and facilitators of implementing this method from the perspective of therapists still need to be made available. PurposeTo investigate the experiences of hand therapists when implementing telerehabilitation, examining the difficulties, barriers, and facilitators encountered during its implementation. Study DesignQualitative study. MethodsThis study used a purposive sampling method to recruit therapists with varying experiences in telerehabilitation and conducted semi-structured interviews. Data collection and analysis continued iteratively until thematic saturation was achieved. A total of 14 therapists were interviewed via Zoom. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The process of interpretive description guided interviews and analysis of the interviews to identify key barriers and facilitators in providing telerehabilitation. Results/DiscussionSix main themes and 10 corresponding sub-themes were constructed concerning facilitators and barriers to telerehabilitation: factors related to the patient, therapy, therapists, injury, technology, and policy. Therapists implemented different coping strategies in their interventions and measurements to facilitate treatment. However, some interventions, such as orthotic fabrication, could not be done online. Educating therapists, providing a standard method, and integrating with in-person rehabilitation can overcome the barriers to telerehabilitation in hand therapy. ConclusionsTechnology was the main facilitator and, on the other hand, a barrier to providing online hand therapy interventions. Therapists generally reported high satisfaction and usability of this method. Despite all barriers, telerehabilitation can be implemented as a part of hand therapy interventions alongside face-to-face therapy as a hybrid method. The barriers and facilitators experienced and raised by therapists can be added to what is already known regarding telerehabilitation in hand therapy. They might be applied to guide therapeutic procedures and upcoming studies.

Additive Manufacturing and Upper-Limb Orthoses: A Scoping Review

ABSTRACT Introduction Additive manufacturing has the potential to revolutionize the orthotic fabrication process for health professionals. Although there is evidence to suggest the benefits of additive manufacturing in rehabilitation-related fields, there is still fairly limited evidence supporting the use of 3D-printed orthoses as an effective and feasible alternative to manually fabricated devices used for the upper limb (UL). The purpose of this scoping review was to examine how 3D printers are currently being used in UL orthotic fabrication within the scope of rehabilitation professionals. Methods A literature search was conducted using five databases from 2011 to 2021. Two independent researchers reviewed the abstracts and full text of the articles. The PRISMA process was used to report findings, and data extraction and charting were completed according to the JBI-suggested scoping review protocol. Results Thirty-three studies were reviewed as determined by inclusion criteria from various disciplines and countries. Eight diagnostic categories identifying indications for use were derived from the studies including arthritic conditions, burns/contractures and wound care, finger deformities, neurological and neuromuscular disorders, and traumatic, strain, and nerve injuries. Both benefits and challenges are identified with the use of 3D-printed orthoses. Conclusions The scope of the 3D-printed orthoses produced in this review is broad and internationally widespread. More evidence is needed to determine the effectiveness of 3D-printed orthoses for each of the identified conditions, but the benefits outside of healing are obvious. The current state of the evidence suggests that this technology remains exploratory in respect to UL orthoses and is therefore not yet ready to be implemented in clinics. With appropriate supports and more evidence, 3D printing still has the potential to revolutionize the UL orthotic fabrication process. Clinical Relevance It may be unrealistic for rehabilitation professionals to design and fabricate 3D-printed orthoses without the proper education or time, but it is important for health care professionals to have an emphasized presence in this conversation, as it is their responsibility to treat the patients. This suggests that co-design, combining professionals' expertise, might be the best approach to fabricating these devices for patients.

45 A Three Year Analysis of a Multi-tiered Orthotic Protocol

Abstract Introduction A variety of factors affect the fit of custom orthoses in those with burn injuries. A resting hand orthosis (RHO) is a common device within burn care, yet fabrication and fitting of this custom orthosis requires precision and expert assessment. However, burn therapists have varying degrees of education and credentials and previously we had noted preventable complications. Our center implemented a multi-tiered protocol focused on custom RHOs and found a marked decrease in complications immediately following implementation. The purpose of this QI project was to evaluate whether these improvements had been sustained over the following three-year period. Methods This was a retrospective chart review. Per protocol an RHO could be fabricated by a single certified hand therapist (CHT) or co-fabricated by two (non-CHT) therapists. Incidence of orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) was the primary outcome measure. Other data collected were average time to fabricate & modify devices and average refabrication(s) required between CHT vs non-CHT devices. Patients with missing data points was excluded. Results Eighty-five patient hands were examined from 2019-2022. Prior to implementation, total erythema occurrences were reported in 23.4% of orthoses (n=18) and total orthotic induced partial thickness injury occurred in 11.7% (n=9) of cases. Post protocol implementation erythema occurred in 5% of cases (n=5), and partial thickness injury in 0% of cases (n=0). This represents a decrease of 95% and 100%, respectively. On average CHTs fabricated RHOs in 59 minutes vs 48 minutes for non CHTs. CHTs had a complication rate of 0.0% vs 10.98% for non-CHTs. Potential complication was also limited to 0.0% for CHTS and 27% of non-CHTs. Modification rates were limited to 18.75% for CHTS vs 47.56% of non-CHTs. Conclusions Data from this QI project showed a clinically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses. Since instituting our protocol focusing on RHOs, our center has decreased complications and potential complications to improve patient outcomes. Although, most therapists receive standard education, it can be inferred that CHTs may approach orthotic fabrication through a different lens. The required studying and education required to maintain an advanced practice certification may benefit burn therapy departments. Therapists without this specialty certification can enhance skill and outcomes via co-fabrication and assessment. Applicability of Research to Practice Orthotic induced erythema may be decreased by utilizing CHTs or two non-CHTs to manage RHOs. This protocol can be expanded to include other orthoses or with other advanced certifications.

Hand Therapy Regimen for Functional Recovery Following Combined Face and Bilateral Hand Transplantation.

Intensive postoperative rehabilitation therapy is associated with positive functional recovery in hand transplants (HTs). Our goal is to share the hand therapy protocol developed for our patient who underwent a combined face and bilateral HT. The patient is a 23-year-old right-hand-dominant male with a history of third-degree burns to 80% of his body following a motor vehicle accident. A multidisciplinary evaluation established his candidacy for a combined face and bilateral HT, and surgery took place in August 2020. Our individualized hand therapy protocol consisted of 4 phases. The pre-surgery phase focused on planning the orthotics and patient/caregivers' education on the rehabilitation process. The intensive care unit (ICU)/acute care phase involved hand allograft protection and positioning via orthotic fabrication, safe limb handling, and edema/wound management. The inpatient rehabilitation phase aimed to prepare the patient for independent living via neuromuscular and sensory re-education, improvement of upper extremities strength/flexibility, training basic activities of daily living, and providing a home exercise program (HEP). Finally, the outpatient phase aimed to maximize our patient's range of motion and independency in performing his routine activities and HEP. The patient's post-transplant functional outcomes showed a significant improvement compared to the pre-operative baseline. We hope this report sheds light on a comprehensive hand therapy program in HT.

Expert Opinions on Thermal Discomfort Related to Idiopathic Scoliosis Orthoses

ABSTRACT Introduction The purpose of this study was to investigate expert opinions regarding the current status of and mitigation solutions for thermal discomfort associated with the use of thoracic-lumbar-sacral orthoses (TLSOs) in treating patients with idiopathic scoliosis (IS). Materials and Methods Qualitative data were gathered via interviews with experts in a variety of fields. Three primary categories of discussion were established: current status of thermal discomfort experienced by patients with IS treated with TLSOs, current mitigation strategies, and obstacles to implementation of a hypothetical novel TLSO. Data were analyzed utilizing Pell Institute's six-step method for qualitative data analysis. Results Six experts participated in this study: three spinal orthotics experts, who are orthotists currently treating IS with TLSOs; one thermal discomfort expert, who has been studying thermal discomfort for prosthetic devices; and two mechanical engineering experts, who conduct college courses on thermodynamics. Primary signs and symptoms of thermal discomfort identified by experts were heat rash, verbal complaint, and excessive sweating. Factors identified by experts as related to the occurrence of thermal discomfort fell into three categories: orthotic design, surrounding environment, and patient conditions. Experts also identified possible strategies used to mitigate thermal discomfort, which involved orthotic fabrication options, orthotic modification options, and patient behavioral changes. Conclusions Anecdotally, thermal discomfort experienced by TLSO users exists to varying degrees. The orthotic design, the environment, and the patient may impact the occurrence. Factors correlating to thermal discomfort may be skin temperature, friction, and moisture. Minimizing the quantity of skin surface area covered by the orthosis may be a primary thermal discomfort mitigation strategy. However, further investigation into the relationship between skin surface area coverage and thermal discomfort is required. Clinical Relevance This study introduces concepts and strategies that may be used by clinicians to reduce thermal discomfort experienced by patients with IS treated with a TLSO.

Immediate comfort perception of 3D-printed foot orthoses in individuals with unilateral heel pain.

Background:Custom-made foot orthoses (FOs) play an integral part in managing foot disorders. Traditional FO fabrication is time-consuming and labor intensive. Three-dimensional (3D) printed FOs save time and cost compared with the traditional manufacturing process. To date, the differences in dimensions and comfort perception of these orthoses have not been compared in a pathological population.Objective:Compare the dimensions between 3D-printed and traditionally made FOs and comfort perception between 3D-printed, traditionally made, and no FOs in individuals with flatfeet and unilateral heel pain.Study design:Within-subject single-blinded randomized crossover study design.Methods:Thirteen participants had custom-made FOs using 3D-printing and traditional processes. Orthotic lengths, widths, arch heights, and heel cup heights were compared. Participants performed walking trials under three conditions: (1) no orthoses, (2) 3D-printed orthoses, and (3) traditionally made orthoses. Comfort perception was recorded. Orthotic dimensions were compared using paired t tests, and comfort perception were compared using one-way multiple analysis of variance and Bonferroni post hoc tests.Results:Three-dimensional–printed orthoses were wider, have higher arch heights, and heel cup heights compared with traditionally made FOs (medium to large effect sizes). There was a difference in comfort perception between the three orthotic conditions, F(12,62) = 1.99, P = 0.04; Wilk Λ = 0.521, ηp2 = 0.279. Post hoc tests show that there is no difference in comfort perception between the 3D-printed and traditionally made FOs. Both FOs were significantly more comfortable than no orthoses.Conclusions:Three-dimensional printing seems to be a viable alternative orthotic fabrication option. Future studies should compare the biomechanical effects of 3D-printed and traditionally made FOs.

Comfort perception of 3D printed orthotics in individuals with symptomatic pes planus

Introduction: Custom-made foot orthoses are an integral part of managing of foot disorders in individuals with symptomatic pes planus (flat feet). Traditional orthotic fabrication is time-consuming and labour intensive. Technological advancement means that the orthotic design process can be automated, and manufacture could include the use of 3D printing. Purported benefits include reduced design and manufacturing time, ability to replicate subsequent orthotic devices, a reduction in waste production and improved fit and comfort. This study compared the structural dimensions of 3D printed and traditionally-made foot orthoses, and comfort perception in individuals with symptomatic pes planus. Methods: Thirteen flat-footed individuals with unilateral heel pain participated in this study. Participants’ feet were measured using a foot scanner and plaster casting. Foot scans and plaster casts were sent to a single orthotic laboratory which produced a 3D printed and a traditional foot orthotic device. Orthotic length, width, arch height and heel cup height were measured using callipers. Following fitment, participants performed three walking trials 1) no orthoses, 2) 3D printed orthoses and 3) traditionally-made orthoses. Comfort perception was recorded with a comfort survey on a scale of -50 (most uncomfortable) to +50 (most comfortable), with ‘zero’ being neither comfortable nor uncomfortable. Paired t-tests examined differences in orthotic dimensions and one-way ANOVA was used to analyse comfort perception. Statistical significance was accepted at p<0.05. Results: Traditionally-made orthoses were narrower (p<0.001), had lower arch heights at the sustentaculum tali (p=0.005) and navicular (p=0.003), and lower heel cup height (p<0.001) compared to 3D printed orthoses. There was no difference in orthoses length (p=0.286). A significant difference in comfort perception in overall experience (F(2,36) = 4.81, p =0.014), heel cushioning (F(2,36) = 6.20, p =0.005), forefoot cushioning (F(2,36) = 6.30, p =0.004), medio-lateral control (F(2,36) = 8.17, p =0.001), arch support (F2,36 = 11.16, p <0.001) and heel cup fit (F(2,36) = 12.45, p <0.001) was observed. Post hoc tests with Bonferroni correction revealed that 3D printed orthoses and traditionally made orthoses were both rated more comfortable than no orthoses. There was no difference in ratings between 3D printed orthoses and traditionally-made foot orthoses. Discussion: Traditionally-made orthoses are narrower, have lower arch heights, and have lower heel cup heights compared to 3D printed orthoses. These differences do not affect the comfort perception in wearers with symptomatic pes planus. 3D printing appears to be a viable alternative orthotic fabrication option but future studies comparing the biomechanical impact of 3D printed orthoses is needed. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

104 A Quality Improvement Project to Reduce Orthoses Complications

Abstract Introduction Anatomical structures of the hand are complex and delicate making hand burns particularly challenging to manage. Orthoses are a cornerstone treatment modality and unsuccessful therapeutic interventions can result in hand contracture and deformities, which can result in up to 95% impairment in upper extremity function. Therapists at our burn center have varying degrees of education and credentials, and we had noticed increased incidence of orthotic induced complications in the hand. The purpose of this QI project was to implement a formal protocol that provided guidelines around fabricating and fitting hand orthoses. Methods The protocol mandated that custom fabricated resting hand orthoses should be fabricated by a single CHT or co-fabricated by two (non-CHT) therapists. Orthoses were fabricated as indicated. Orthosis modifications and orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) were documented. For the purposes of our study, breakdown was limited to the index finger. These modifications and complication totals were compared to pre-implementation data. Any patient with missing data points was excluded. Results Seventy-seven patient hands were examined from 2016–2019. Prior to implementation of the protocol, erythema occurred with 23.4% (n=18) of orthoses and orthosis induced partial thickness injury was found in 11.7% (n=9) of cases. Post protocol implementation involved examination of 51 hands. Erythema occurred in just 2.0% of cases (n=1) and partial thickness injury in 3.9% of cases (n=2) This represents a decrease of 94.4% and 77.7%, respectively. Number of modifications was reduced by 40.9%, from 22 to 13. Conclusions Orthosis fabrication is a specialized therapy skill, requiring hands-on training and advanced anatomical knowledge. While orthotic fabrication is part of general therapy education, the depth and breadth of this education is limited by the clinical opportunities presented to each therapist. CHT’s have undergone rigorous study and testing to make them experts in orthosis management and can bolster skills in a burn therapy department. For therapists without this specialty certification, co-fabrication can also lead to improved outcomes, through real time peer review. Data from this QI project showed a statistically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses.

Teaching orthotic design and fabrication content in occupational therapy curricula: Faculty perspectives

Study DesignCross-sectional survey study. IntroductionOccupational therapy (OT) programs must provide students with the skills necessary to fabricate orthoses. Input from OT educators can provide valuable insight into how these skills are taught and the resources used. Purpose of the StudyExplore how instruction in orthotic fabrication is addressed in OT education programs. MethodsSurveys were distributed to all accredited OT programs in the United States. Quantitative data were analyzed using descriptive statistics, and content analysis was done on qualitative data to identify themes. ResultsOverall response rate was 25%. Most programs teach orthotic fabrication with demonstration and hands-on laboratory time. Almost half add digital videos in their orthotic course content. The average number of orthoses made ranged from 2 to 5, and the resting hand, wrist, and short opponens immobilization orthoses are the most commonly taught. DiscussionThis study examined the orthotic fabrication curricula in OT programs in the United States, including the time devoted to this topic, types of orthoses covered, course structure and pedagogical strategies used, and whether faculty anticipated changes in their orthotic content. The majority of programs offer this content within other existing courses within the curriculum, including coursework in physical dysfunction, OT interventions, orthopedics, and biomechanics. Only 15% of participants in the current study reported teaching orthotic content as a separate course in their curricula. Interestingly, some participants reported that they plan to offer a full separate orthotics course in their future curricula, whereas others reported combining orthotics content with other coursework or reducing the time spent making custom orthoses in the classroom. It would appear that there is still considerable variability in course structure and content in current OT programs. ConclusionParticipants feel that orthotic fabrication is an essential and integral component of their curricula and that the importance of hands-on learning experiences contributes to students' preparedness and ability to use this knowledge. Student feedback indicated that more time and instruction is desired. Sharing teaching experiences can enhance emerging OT curricula and can impact future practice. Educators must strive to improve and refine curricular content to ensure that graduates have the skills necessary to meet the orthotic needs of their clients.

Necessity of Immobilizing the Metacarpophalangeal Joint in Carpometacarpal Osteoarthritis: Short-term Effect.

Conservative treatment for carpometacarpal (CMC) joint osteoarthritis (OA) may include orthotic fabrication to decrease pain. Different types of orthoses have been used as conservative interventions to improve symptoms, but there are no guidelines specifying if inclusion of the thumb metacarpophalangeal (MCP) in an orthosis is required in the treatment of thumb CMC joint OA. The main objective of this study is to determine the effectiveness of 2 different thumb CMC joint orthotic designs on pain reduction and improved hand function: one design immobilizes both the MCP joint and the CMC joint and the other design immobilizes only the CMC joint. A total of 66 patients were included in the study. One group of 33 patients received a short thumb orthosis with the MCP joint excluded, and the other group of 33 patients received a short thumb orthosis with the MCP joint included. Outcomes measures included the visual analog scale for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; Spanish version) for function. In both patient groups, the orthoses contributed to decreased pain levels and improved functional abilities ( F1.0 = 315.467 and F1.0 = 72.419; both, P < .001). There was no significant difference between the 2 groups regarding pain or improvement in daily activities ( F1.0 = 0.553 and F1.0 = 2.539; both, P > .05). There are benefits of either thumb orthotic design on pain reduction and functional improvement even after 1 week of using the orthoses as the sole conservative treatment.

Finite element model-based evaluation of tissue stress variations to fabricate corrective orthosis in feet with neutral subtalar joint.

The subtalar joint position during static stance is a crucial determinant of the peak plantar pressures and forms ideal reference point for any intervention in foot-related problems for leprosy-affected patients. The study pursued the hypothesis through a three-dimensional model that stress will be minimal in the distal joints of the foot when the subtalar joint is in neutral static stance position. Finite element model. The computed tomography images of the feet for five patients suffering from Hansen's disease having no muscle weakness and joint restriction were acquired. The gray intensities corresponding to the bones of the foot from the computed tomography images were three-dimensionally reconstructed. The three-dimensional model of the human foot, incorporating the realistic geometry, and the material properties of the hard tissues were then analyzed using a finite element solver for the stress distribution on bones of the foot. The results demonstrate that the position of the calcaneum in the static stance position does contribute to the varying stress in the foot. The stresses in the bones of the foot are minimal while the subtalar is in neutral position; this position will be suitable for foot orthotic fabrication. Clinical relevance The clinicians, therapists, and podiatrists having less engineering skills can quickly assess the patient and get optimal results on the stress associated with the joints of the foot.

The effectiveness of orthoses in the conservative management of thumb CMC joint osteoarthritis: An analysis of functional pinch strength

Study DesignThe study was a retrospective cohort analysis for a 19-month period from May 2013 to December 2014. IntroductionAlthough the use of orthoses has long been a staple of conservative treatment measures for individuals with osteoarthritis of the thumb carpometacarpal (CMC) joint, there remains little evidence exploring its effectiveness in improving functional outcomes for this client population. Purpose of the StudyThe purpose of this study was to assess the effectiveness of 3 frequently used orthoses in improving the functional pinch strength of adults with a diagnosis of thumb CMC joint osteoarthritis. MethodsA retrospective cohort analysis was conducted to determine whether pinch strength improved after orthotic fabrication, and fitting in patients referred to a hand therapy clinic. ResultsPatients who received a Colditz design orthosis had a mean increase of 2.64 lb with regard to functional pinch strength after orthotic fabrication and fitting. Patients who received a Comfort Cool orthosis (North Coast Medical, Morgan Hill, CA) had a mean increase of 2.47 lb, whereas patients who received a Thumb Spica orthosis had a mean increase of 3.25 lb. There was no evidence of any statistically significant difference in the average improvements in pinch strength between the Colditz design orthosis and the Comfort Cool orthosis. ConclusionsResults from this study demonstrate that orthosis wear consistently increases the functional pinch strength of individuals with thumb CMC joint osteoarthritis. Large-scale multisite research studies comparing various orthotic designs are necessary to help therapists determine best practice interventions for the conservative management of thumb CMC joint osteoarthritis. Level of evidence2(c).

Functional orthosis post pectoralis muscle rupture

This author described her success at fabricating a chest compression orthosis for a patient who underwent repair of a pectoralis major muscle rupture. The repair occurred nine months prior to orthotic fabrication, but the patient continued to experience weakness and pain which limited motion. The design of the orthotic allowed him increased mobility and functional use. - Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

Customized Insole Fabrication for Foot Deformities in Leprosy Patients1

Customized Insole Fabrication for Foot Deformities in Leprosy Patients1

Simplified finite model based evaluation of tissue stress distribution on anesthetic feet of Leprosy patients for 3 dimensional orthosis fabrication

Results The Computed Tomography (CT) images of the feet for 5 patients suffering from Hansen’s disease having no muscle weakness and joint restriction were acquired. The gray intensities corresponding to the bones of the foot from the CT images were 3 dimensionally reconstructed. The three dimensional model of the human foot, incorporating the realistic geometry and the material properties of the hard tissues were then analyzed using a finite element solver. Stress distribution on bones of the foot while on static stance with the subtalar joint in neutral position were acquired. The results demonstrate that the weight of the patient and the position of the calcaneum in the static stance position contribute to the high stresses in the foot. The stresses in the bones of the foot are minimal when the subtalar is in neutral position, suggesting that this position is an optimal aim for foot orthotic fabrication. Conclusion The automating process of designing a customized orthosis with the impression go tf rom the 3d imensionally modeled feet reduced the modeling time considerably. The simple technique used will help in giving comfort and stability to the patient’s feet while walking.