Prosthetics and Orthotics International最新文献

Background: Charcot-Marie-Tooth (CMT) is a progressive disease resulting in distal sensory deficit and muscular weakness. As the disease progresses, most children develop a cavovarus foot deformity. Foot orthoses (FO) are widely prescribed in CMT to support the foot and improve gait, but there is a lack of guidelines for their conception. The aim of this pilot study was to report the methodology used for the design of FO (FOmax) based on an evaluation of foot deformities and to assess its effects on gait in children with CMT.

Methods: This study included 11 children with CMT. Participants were provided with a classic pair of FO (FOclass) and a pair of FOmax. A full evaluation of foot deformities was performed, and a decision-making algorithm was used for the FOmax design. A gait analysis was performed with both FO after 3 months of wear.

Results: Wearing FOmax compared with FOclass increased walking speed, step length, and single stance time. Hip flexion/extension range of motion during stance also increased. The pressure-time integral decreased on the lateral midfoot with FOmax.

Conclusions: These results suggest that the FOmax, based on the algorithm, offers benefits for walking in children with CMT. The increased step length could be related to the increase of hip range of motion. The increase in walking speed and single support times could result from a better distribution of the plantar pressure that optimizes stability during walking. The present results need to be confirmed with a larger sample.

Background: Hallux valgus (HV) is a condition characterized by the lateral deviation of the first phalanx and medial deviation of the first metatarsal, leading to subluxation of the first metatarsophalangeal joint. Various orthotic applications are employed in the treatment of HV deformity. This study aimed to compare the effects of a toe separator (TS) and dynamic orthosis (DO) on hallux valgus angle (HVA), plantar pressure (PP), and quality of life (QoL).

Methods: Thirty individuals aged between 18 and 65 years who had mild to moderate HV deformity were included in our study. Participants were randomized into TS and DO groups. Pretest and post-test evaluations at 4 weeks included goniometric measurement for HVA, PP measurement using the Sensor Medica device, QoL assessment using the American Orthopaedic Foot & Ankle Society-Hallux MTP-IP Scale and Manchester-Oxford Foot Questionnaire, and numerical evaluation scale for orthosis satisfaction.

Results: No statistically significant changes were observed in HVA measurements ( p > 0.05). In the DO group, significant differences were observed in PP assessment for right rearfoot loading ( p = 0.048) and total average pressure measurement of the right foot ( p = 0.025). QoL assessments were observed significant differences in the DO group compared with the TS group ( p < 0.05).

Conclusions: After a 4-week period of wearing the TS and DO orthoses, no change in HVA was observed. In the DO group, a more balanced load distribution between the right and left foot (50.2% left, 49.8% right) and a more pronounced effect in reducing deformity-related pain and improving QoL by increasing functionality were noted.

Background: In some cultures, shoes are not worn indoors. Prosthesis use barefoot can lead to pressure injuries and loss of balance due to abnormal residual limb loading.

Objective: This study aimed to compare the effect of wearing standard alignment prostheses using barefoot at home and visual alteration on static balance and pressure distribution in individuals with unilateral transfemoral amputations (TFAs) or transtibial amputations (TTAs).

Study design: Prospective parallel experimental study.

Methods: Participants with unilateral TTAs (n = 44) and TFAs (n = 37) were included. Balance and load distribution were assessed using MatScan pressure platforms, both with a heel (3 × 2 cm 2 area; 1.8 cm height) support (the use of shoes with a heel is mimicked) and barefoot.

Results: Balance parameters were disrupted in all groups when eyes closed position ( p < 0.05). Using heels reduced anterior-posterior and medial-lateral sway in TTA group during eyes closed ( p < 0.05). When standing barefoot with the eye open position, TFA group had more load on the rear foot of the prosthetic foot and less load on the forefoot than TTA group ( p < 0.05). The opposite pattern was observed in the intact foot ( p < 0.05). Using heels in TTA group increased the load on the front of the intact side and the rear of the prosthetic side ( p < 0.05).

Conclusion: The balance parameters were impaired in both groups while standing barefoot in the absence of vision. However, using heel supports improved static balance in the TTA but not in the TFA group. Using heel support changed this load distribution in both groups, especially in the TTAs, and created positive changes.

This study aimed to better understand the various objective techniques employed for evaluating and correcting prosthetic alignment and examine proposed methods to define a predefined (a priori) alignment criterion grounded in clinically accepted alignment. A comprehensive search of 5 online databases and a hand search of reference lists of the included papers were conducted. The American Academy of Orthotics and Prosthetics checklists were used to assess the quality of included studies. A total of 247 adults with transtibial amputations participated in the 20 studies included in this study. These studies vary in methodology, approach, instrumentation, and alignment steps. The results indicate that none of the tested methods can replace the current clinical approach. Nevertheless, some techniques can assist the prosthetist in quantifying and adjusting alignment, such as using instruments to measure the moments at the base of the socket or visualizing the ground reaction force. Based on current evidence, it is not possible to define a universal priori alignment because of individual differences and the complexity and multifactorial nature of alignment. However, each prosthetic user appears to have a specific alignment configuration that they find acceptable. Combining various techniques, such as anatomical-based alignment and biomechanical measurement tools, may help to objectively quantify a priori alignment for an individual.

Introduction: Upper limb prosthetics aim to restore function and aesthetics of a lost arm and/or hand, which affects a growing population. A "Golden Period," the first month after the amputation, has been identified as the optimal time when a prosthesis should be fitted to amputees to maximize their chances for a fast and successful return to their daily life. This time window is often surpassed because of delays in approvals by health insurance companies and time requirements for producing personally customized and costly sockets. This study aims to develop an adaptable and versatile temporary transradial socket design capable of multidimensional adjustments and easy user fitting to better capitalize on the "Golden Period" and allow for early prosthetic training. In addition, the socket should be useable within research in need for flexible prosthesis as well as a hybrid prosthesis within the context of bionic reconstruction.

Methods and material: The socket was designed, 3D printed, and assembled as a wearable prototype, hosting all relevant myoelectric hand components. The estimated satisfaction with the socket was evaluated in a monocentric, explorative study with both, prosthetic users and experts in the field.

Results and discussion: The proposed design is able to change its diameter and length. Moreover, according to the conducted survey, it is perceived as satisfactory with respect to both user needs and expectations of the experts. "Weight," "ease in donning and doffing," and "breathability" were rated particularly well, whereas an improved, more versatile, and smaller design is needed for broad clinical use.

Background: Cranial remolding orthoses are an effective treatment of deformational plagiocephaly. Typical treatment durations are well documented. However, treatment duration can be affected by multiple factors and may not be a true representation of the time necessary to achieve a successful clinical outcome.

Objective: This study compared the time to achieve a successful clinical outcome against the total treatment duration for cranial remolding orthosis therapy in infants with deformational plagiocephaly.

Study design: This is a retrospective study of infants treated for deformational plagiocephaly with a cranial remolding orthosis.

Methods:  A total of 300 infants with deformational plagiocephaly who were treated with a cranial remolding orthosis were grouped by corrected age at initiation of treatment and by severity of deformity. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. For the 226 infants who achieved a successful outcome, time to successful outcome and treatment duration were compared between the groups.

Results: The time to successful outcome depended on severity but not on age at initiation. The median time to successful outcome ranged from 6 weeks to 17.5 weeks, depending on the severity of the deformity. Time to successful outcome was significantly shorter than treatment duration for infants with an initial cranial vault asymmetry of less than 17 mm.

Conclusion: Current treatment durations for infants with moderate plagiocephaly may be longer than necessary. Estimated treatment time lines should be based on the initial severity of the infant's deformity.

There is an increased clinical use of elbow orthoses. It is important to consider patient experiences in their use. Patient-reported outcome measures (PROMs) serve as essential tools for gathering patient perspectives. This review provides a comprehensive list of PROMs used in clinical trials of elbow orthoses, and documents their properties, uses, and quality. A systematic literature search across PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science identified 31 clinical trials of elbow orthoses that used PROMs as outcome measures. Subsequently, manual searches were conducted to report on each PROM's characteristics. A total of 15 different PROMs were used as outcome measurements in clinical trials that used an elbow orthosis as an intervention for 11 different conditions. Researchers can use this review to aid in making informed decisions about which PROMs to use for future clinical trials.

Stiffness of ankle-foot orthoses (AFOs) has been assessed using many methods; however, results are unstandardized due to varied testing conditions such as range of motion and speed. Therefore, the aim of this scoping review was to provide a state-of-the-space review of the studies that investigate AFO ankle stiffness in the sagittal plane and then provide insight into the details of the developed devices and protocols. Six electronic databases (MEDLINE, SCOPUS, Web of Science, CINAHL, EMBASE, and IEEE Xplore) were searched for studies from when indexing began to April 2024. Articles of any design that developed or used testing devices and/or protocols to assess AFO ankle stiffness in the sagittal plane were eligible. Seventy-two articles were included in this review, of which 51 developed mechanical testing devices/protocols to quantify AFO stiffness while 21 articles referenced existing methods. The most common apparatuses used in the primary studies were the universal testing machine and customized manual machines. Other methods included specialty automated devices, manual devices in a gait analysis laboratory, hanging weights, universal testing machine combined with motion capture, muscle training machine, and 6-axis robot arm. Ankle angle of the AFO was the most common controlled variable, followed by loading force. This scoping review comprehensively outlines the variety of devices and protocols used to assess AFO ankle stiffness in the sagittal plane. Many researchers chose methods that leveraged their available resources, demonstrating a variety of approaches. For future studies, we recommend that parameters chosen are justified, reliability studies are undertaken, and AFO design is adequately reported.

Background: Tilt-in-space and reclining functions are commonly used to improve comfort in ergonomic seating. However, fluctuations in shear (parallel) forces on the buttocks during postural changes may cause discomfort, yet this relationship is not well understood.

Objectives: To examine how combined use of tilt-in-space and reclining functions affects fluctuations in parallel forces on the buttocks, and how these fluctuations relate to subjective discomfort.

Study design: Cross-sectional experimental study.

Methods: Nineteen healthy adult males (mean age: 27.7 ± 10.3 years) participated. An experimental ergonomic chair was used under 2 conditions: 1 with a seat-cover assembly that conforms to the back shape, and a control condition with a flat back-support. Participants experienced a 10 degrees tilt-in-space and reclining angles from 100 degrees to 130 degrees. Fluctuations in parallel forces on the buttocks were measured using a force plate, and subjective discomfort was assessed with a visual analog scale. Stepwise multiple regression was used to analyze associations between force fluctuation and discomfort.

Results: The seat-cover assembly condition resulted in significantly lower visual analog scale scores (median: 4, interquartile range: 0-13) compared to the control (median: 46, interquartile range: 24-72; p < 0.01). Regression analysis revealed that only the fluctuation in parallel forces significantly predicted discomfort (β = 0.722, R² = 0.507, p < 0.01).

Conclusions: Fluctuations in parallel forces during tilt and recline use are significantly associated with discomfort. Ergonomic designs that reduce shear force variability may enhance seating comfort during postural adjustments.

Objectives: To explore the facilitators and barriers to community accessibility from the perspective of persons with lower limb amputation (LLA).

Methods: A qualitative study using an adapted version of the Photovoice methods described by Wang and Burris was undertaken. Analysis of the interviews and photos was conducted following thematic content analysis.

Results: Seven adults with LLA who were ambulating with a prosthesis at the time of the interview participated in the Photovoice interviews. From the interviews with the participants, 3 main themes were developed: (1) current state of accessibility, (2) impact of community inaccessibility, and (3) hope for the future. Participants described what accessibility currently involved in their community (eg, the positive and negative structures) as well as the impact of inaccessibility on their physical and emotional health. Participants also spoke about what improvements they would like to see in the future regarding community accessibility.

Conclusions: By using the Photovoice methods, participants were able to provide tangible examples of what influences their community accessibility. This study highlights the broad range of changes that could provide accessibility opportunities for individuals with LLA from simple changes (eg, adding handrails to arenas) to more complex changes (eg, improvements in parking lot accessibility).