Pub Date : 2022-03-07DOI: 10.1097/JPO.0000000000000426
M. Christ, J. Ha, Timothy Baerg, G. Green
ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.
{"title":"Modified Minerva Orthosis for Postoperative Management of Cricotracheal Resection in Children","authors":"M. Christ, J. Ha, Timothy Baerg, G. Green","doi":"10.1097/JPO.0000000000000426","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000426","url":null,"abstract":"ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e62 - e65"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41777386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-07DOI: 10.1097/JPO.0000000000000421
J. Shaw, J. Hackney, Kristi Shook Vandeloecht, Sean C. Newton, Matthew A. Rainey, Joshua J. Reed, D. Suess, Jennifer N. Tinker
ABSTRACT Introduction Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position. Methods Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position. Results and Discussion The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028). Conclusions Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly. Clinical Relevance Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.
{"title":"Is Maximum Available Hip Extension Range of Motion of the Residual Limb Reached During Passive Prone Lying in the Acute Stage After Dysvascular Transtibial Amputation?","authors":"J. Shaw, J. Hackney, Kristi Shook Vandeloecht, Sean C. Newton, Matthew A. Rainey, Joshua J. Reed, D. Suess, Jennifer N. Tinker","doi":"10.1097/JPO.0000000000000421","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000421","url":null,"abstract":"ABSTRACT Introduction Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position. Methods Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position. Results and Discussion The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028). Conclusions Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly. Clinical Relevance Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"165 - 173"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43165409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Introduction Foot orthoses have injury prevention and human performance benefits. The carbon fiber foot plate (CFFP) is a possible orthotic intervention for preventing foot injury and enhancing sports performance. However, the cost of these devices is generally acceptable for developed settings but might serve as a barrier for use in developing settings. In this study, we aimed to develop an affordable locally custom-made CFFP and evaluate its function along with subjective feedback. Materials and Methods Three types of foot plates were designed each with a unique layup and fabric orientation. Carbon fiber preimpregnated with activated resin was used for foot plate fabrication. Three participants were provided with each prototype of the foot plate. Outcome measurements include walking speed (20-m walk test [20MWT]), treadmill jogging energy expenditure, and user feedback. Results The 20MWT self-selected speed increased for two participants with the CFFP. The maximum average walking speed increased in two participants with CFFP prototype B (8%–11%). Moreover, the average increase of walking speed for prototypes A and C were 2%–2.6% and 4%–4.6%, respectively. The third participant showed a 5% reduction of speed with CFFP prototype B and 3%–5% with prototypes A and B. For all participants, no improvements of energy expenditure were observed with all prototypes compared to without foot plate. Conversely, an increase in energy expenditure was found with all prototypes at all speeds. The subjective feedback in each prototype showed that all participants were satisfied with the CFFP prototype A, but the first participant was identified with metatarsal head pain. Prototype B also evidenced a consensus among participants with increased comfort compared with prototype A, especially at the metatarsal heads. Conclusions The study describes the development and effects of using three types of CFFPs. Although prototypes increased the energy expenditure, prototype B improved walking speed. Prototypes A and B were useful and accepted by all participants. Further exploration is required in a larger heterogeneous sample of able-bodied persons and sport-specific athletes. Clinical Relevance The study demonstrates the effect of the CFFP on walking ability, which can better inform the clinician when considering the prescription for patients with foot problems and sports activities.
{"title":"Effects of Carbon Fiber Foot Plate on Able-bodied Gait: Pilot Study","authors":"Yuparat Premprasopchok, Sasithon Sukthomya, Wareerat Petmunee, P. Rayothee, Kwannate Permpool, Saw Naing Naing Eh, Feryanda Utami","doi":"10.1097/JPO.0000000000000418","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000418","url":null,"abstract":"ABSTRACT Introduction Foot orthoses have injury prevention and human performance benefits. The carbon fiber foot plate (CFFP) is a possible orthotic intervention for preventing foot injury and enhancing sports performance. However, the cost of these devices is generally acceptable for developed settings but might serve as a barrier for use in developing settings. In this study, we aimed to develop an affordable locally custom-made CFFP and evaluate its function along with subjective feedback. Materials and Methods Three types of foot plates were designed each with a unique layup and fabric orientation. Carbon fiber preimpregnated with activated resin was used for foot plate fabrication. Three participants were provided with each prototype of the foot plate. Outcome measurements include walking speed (20-m walk test [20MWT]), treadmill jogging energy expenditure, and user feedback. Results The 20MWT self-selected speed increased for two participants with the CFFP. The maximum average walking speed increased in two participants with CFFP prototype B (8%–11%). Moreover, the average increase of walking speed for prototypes A and C were 2%–2.6% and 4%–4.6%, respectively. The third participant showed a 5% reduction of speed with CFFP prototype B and 3%–5% with prototypes A and B. For all participants, no improvements of energy expenditure were observed with all prototypes compared to without foot plate. Conversely, an increase in energy expenditure was found with all prototypes at all speeds. The subjective feedback in each prototype showed that all participants were satisfied with the CFFP prototype A, but the first participant was identified with metatarsal head pain. Prototype B also evidenced a consensus among participants with increased comfort compared with prototype A, especially at the metatarsal heads. Conclusions The study describes the development and effects of using three types of CFFPs. Although prototypes increased the energy expenditure, prototype B improved walking speed. Prototypes A and B were useful and accepted by all participants. Further exploration is required in a larger heterogeneous sample of able-bodied persons and sport-specific athletes. Clinical Relevance The study demonstrates the effect of the CFFP on walking ability, which can better inform the clinician when considering the prescription for patients with foot problems and sports activities.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"61 - 66"},"PeriodicalIF":0.6,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45245337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-04DOI: 10.1097/JPO.0000000000000413
W. Hill, L. Hermansson
ABSTRACT Introduction To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design A descriptive survey was carried out in this study. Objectives The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children’s clinics. Clinical Relevance This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference.
{"title":"Treatment for Children with Upper-Limb Differences in Various Parts of the World: Preliminary Findings","authors":"W. Hill, L. Hermansson","doi":"10.1097/JPO.0000000000000413","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000413","url":null,"abstract":"ABSTRACT Introduction To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design A descriptive survey was carried out in this study. Objectives The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children’s clinics. Clinical Relevance This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"149 - 155"},"PeriodicalIF":0.6,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48359094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-02DOI: 10.1097/JPO.0000000000000417
W. N. Qa'dan, Mohammad A. Damhoureyeh, Sarah Day
ABSTRACT Introduction Amputations lead to great challenges for individuals with amputation that can affect their quality of life (QoL). Clinical and nonclinical factors are expected to affect QoL of individuals with amputation. Materials and Methods Seventy-nine individuals with lower-limb amputation participated in the study. The Arabic version of the PEQ and a short added questionnaire evaluating the studied factors were used to evaluate QoL of individuals with amputation. Exploratory factor analysis was used to investigate which factors may have greater effect on QoL. Results Age at amputation, etiology, and age of the person with amputation were found to be the factors explaining most of the variance. Discussion Age at amputation dictates how much time is available for the individual to adapt to using the prosthesis. Etiology controls how well the individual is. Age is a decisive factor in the general well-being of the person with amputation. Conclusions This study shows that age at amputation, etiology, and age of the individual with amputation are the most important factors affecting the QoL of individuals with amputation. Clinical Relevance As QoL determines the success of prosthetic rehabilitation, and as several factors affect QoL in individuals with amputation, determining these factors enables providing a better prosthetic experience, resulting in improved prosthetic satisfaction.
{"title":"Clinical and Nonclinical Factors Affecting Quality of Life in Individuals with Lower-Limb Amputation","authors":"W. N. Qa'dan, Mohammad A. Damhoureyeh, Sarah Day","doi":"10.1097/JPO.0000000000000417","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000417","url":null,"abstract":"ABSTRACT Introduction Amputations lead to great challenges for individuals with amputation that can affect their quality of life (QoL). Clinical and nonclinical factors are expected to affect QoL of individuals with amputation. Materials and Methods Seventy-nine individuals with lower-limb amputation participated in the study. The Arabic version of the PEQ and a short added questionnaire evaluating the studied factors were used to evaluate QoL of individuals with amputation. Exploratory factor analysis was used to investigate which factors may have greater effect on QoL. Results Age at amputation, etiology, and age of the person with amputation were found to be the factors explaining most of the variance. Discussion Age at amputation dictates how much time is available for the individual to adapt to using the prosthesis. Etiology controls how well the individual is. Age is a decisive factor in the general well-being of the person with amputation. Conclusions This study shows that age at amputation, etiology, and age of the individual with amputation are the most important factors affecting the QoL of individuals with amputation. Clinical Relevance As QoL determines the success of prosthetic rehabilitation, and as several factors affect QoL in individuals with amputation, determining these factors enables providing a better prosthetic experience, resulting in improved prosthetic satisfaction.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"246 - 251"},"PeriodicalIF":0.6,"publicationDate":"2022-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49583729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01DOI: 10.1097/JPO.0000000000000403
Fredrik A Nilsen, Marius Molund, Eva Marie Lium, K. Hvaal
ABSTRACT Introduction Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles.
{"title":"Material Selection for Diabetic Custom Insoles: A Systematic Review of Insole Materials and Their Properties","authors":"Fredrik A Nilsen, Marius Molund, Eva Marie Lium, K. Hvaal","doi":"10.1097/JPO.0000000000000403","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000403","url":null,"abstract":"ABSTRACT Introduction Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e131 - e143"},"PeriodicalIF":0.6,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46502118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-27DOI: 10.1097/JPO.0000000000000414
T. Schmalz, Thomas Maximilian Köhler, Katharina Burkhardt, Annika Dlugoszek, Etienne Overdevest, A. Kannenberg, M. Bellmann
ABSTRACT Introduction A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs.
{"title":"Evaluation of Biomechanical Effects and Patient Benefits of a New Orthotic Ankle Joint in Stance Control Orthosis Fittings","authors":"T. Schmalz, Thomas Maximilian Köhler, Katharina Burkhardt, Annika Dlugoszek, Etienne Overdevest, A. Kannenberg, M. Bellmann","doi":"10.1097/JPO.0000000000000414","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000414","url":null,"abstract":"ABSTRACT Introduction A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"164 - 171"},"PeriodicalIF":0.6,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47490347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Introduction Orthotic devices can be successfully used to treat lower-limb injuries. However, their high cost is a major obstacle. Some orthotic companies have offered the semicustom alternatives at reasonable prices. The purpose of this study was to examine whether semicustom UCBL orthoses can provide similar rearfoot control as custom UCBL orthoses in individuals with flexible flatfoot. Material and Methods Eighteen subjects walked through the motion analysis laboratory under three conditions: no orthosis, custom UCBL orthosis, and semicustom UCBL orthosis. The rearfoot kinematics were assessed for each device. Results Both devices effectively reduced eversion excursion. Compared with the no orthotic condition, the custom and semicustom UCBL orthoses significantly decreased eversion excursion (P < .05), whereas peak eversion angle and velocity were not affected by any type of orthoses (P > .05). Conclusion Regarding the ability of semicustom UCBL orthoses to control rearfoot motion, they can be considered as a feasible alternative to custom UCBL orthoses for individuals with flexible flatfoot. Clinical Relevance This study provides evidence that semicustom UCBL orthoses are as effective as custom UCBL orthoses in controlling the rearfoot motion in flexible flatfoot. Therefore, owing to less fabrication time and lower price, semicustom UCBL orthoses are reasonable alternatives to custom UCBL orthoses.
{"title":"Comparison of Semicustom and Custom UCBL on Lower-Limb Kinematics in Flexible Flatfoot","authors":"Lesani Atefe, Tabatabai Ghomshe, Bahramizadeh Mahmood","doi":"10.1097/JPO.0000000000000410","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000410","url":null,"abstract":"ABSTRACT Introduction Orthotic devices can be successfully used to treat lower-limb injuries. However, their high cost is a major obstacle. Some orthotic companies have offered the semicustom alternatives at reasonable prices. The purpose of this study was to examine whether semicustom UCBL orthoses can provide similar rearfoot control as custom UCBL orthoses in individuals with flexible flatfoot. Material and Methods Eighteen subjects walked through the motion analysis laboratory under three conditions: no orthosis, custom UCBL orthosis, and semicustom UCBL orthosis. The rearfoot kinematics were assessed for each device. Results Both devices effectively reduced eversion excursion. Compared with the no orthotic condition, the custom and semicustom UCBL orthoses significantly decreased eversion excursion (P < .05), whereas peak eversion angle and velocity were not affected by any type of orthoses (P > .05). Conclusion Regarding the ability of semicustom UCBL orthoses to control rearfoot motion, they can be considered as a feasible alternative to custom UCBL orthoses for individuals with flexible flatfoot. Clinical Relevance This study provides evidence that semicustom UCBL orthoses are as effective as custom UCBL orthoses in controlling the rearfoot motion in flexible flatfoot. Therefore, owing to less fabrication time and lower price, semicustom UCBL orthoses are reasonable alternatives to custom UCBL orthoses.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"7 1","pages":"174 - 179"},"PeriodicalIF":0.6,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61792214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-16DOI: 10.1097/JPO.0000000000000411
A. Kannenberg, Russell L Lundstrom, K. Hibler, Shawn Swanson Johnson
ABSTRACT Introduction Research with multiarticulating prosthetic hands on patient-reported ease of activities of daily living (ADLs) and usefulness is still limited. This study aimed at comparing ease of ADL performance and usefulness of two common multiarticulating prosthetic hands. Methods Twenty subjects with transradial amputation wearing the bebionic (n = 10) or i-Limb (n = 10) hands were assessed with a hybrid Orthotics and Prosthetics User Survey–Upper Extremity Functional Status (OPUS-UEFS)/Prosthetic Upper Extremity Functional Index (PUFI) outcome measure previously used in a study with another multigrip prosthetic hand. Results There were no significant differences between the bebionic and i-Limb hands. However, the analysis of individual activities revealed that each multiarticulating hand had specific strengths and weaknesses compared with a historic control group with conventional myoelectric hands. Discussion Both multiarticulating hands may improve ease of performing ADLs compared with conventional myoelectric hands. However, more grip types available do not necessarily result in greater ease or usefulness compared with advanced hands with fewer grip types. Conclusions Clinicians must match the patients' functional needs with the differential functional profiles of the available multiarticulating hands. Clinical Relevance The present study is the first to provide comparative patient-reported outcomes on 3 multigrip prosthetic hands as well as standard myoelectric hands in 23 common ADLs. The distinct patient-reported ease and usefulness profiles of the different hands may inform and support clinicians' decision-making on hand selection for individual patients with transradial amputation.
{"title":"Differences in Two Multiarticulating Myoelectric Hands for Facilitating Activities of Daily Living in Individuals with Transradial Amputation: A Cross-Sectional Study","authors":"A. Kannenberg, Russell L Lundstrom, K. Hibler, Shawn Swanson Johnson","doi":"10.1097/JPO.0000000000000411","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000411","url":null,"abstract":"ABSTRACT Introduction Research with multiarticulating prosthetic hands on patient-reported ease of activities of daily living (ADLs) and usefulness is still limited. This study aimed at comparing ease of ADL performance and usefulness of two common multiarticulating prosthetic hands. Methods Twenty subjects with transradial amputation wearing the bebionic (n = 10) or i-Limb (n = 10) hands were assessed with a hybrid Orthotics and Prosthetics User Survey–Upper Extremity Functional Status (OPUS-UEFS)/Prosthetic Upper Extremity Functional Index (PUFI) outcome measure previously used in a study with another multigrip prosthetic hand. Results There were no significant differences between the bebionic and i-Limb hands. However, the analysis of individual activities revealed that each multiarticulating hand had specific strengths and weaknesses compared with a historic control group with conventional myoelectric hands. Discussion Both multiarticulating hands may improve ease of performing ADLs compared with conventional myoelectric hands. However, more grip types available do not necessarily result in greater ease or usefulness compared with advanced hands with fewer grip types. Conclusions Clinicians must match the patients' functional needs with the differential functional profiles of the available multiarticulating hands. Clinical Relevance The present study is the first to provide comparative patient-reported outcomes on 3 multigrip prosthetic hands as well as standard myoelectric hands in 23 common ADLs. The distinct patient-reported ease and usefulness profiles of the different hands may inform and support clinicians' decision-making on hand selection for individual patients with transradial amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"38 - 43"},"PeriodicalIF":0.6,"publicationDate":"2022-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42383203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-12DOI: 10.1097/JPO.0000000000000412
Ehsan Norouzi, Mahtab Bagheri, Behnaz Alafchi, N. Tafti
ABSTRACT Introduction The hallux valgus, a painful forefoot deformity, is defined as lateral deviation of the hallux, which is highly correlated with forefoot pronation. This study aimed to compare the effect of two types of foot orthoses, one with and one without a varus forefoot wedge, on self-reported outcomes of pain, function, and QOL (by FAOS questionnaire) in patients with moderate hallux valgus. Materials and Methods Sixteen patients with hallux valgus were assigned to two equal groups randomly in a before-after trial. Results The within-group comparison showed significant improvements in all subscales of the FAOS questionnaire for both groups (P < 0.05). The between-group analysis showed no statistically significant difference. Conclusions It seems the addition of varus forefoot wedge to foot orthoses may have no adverse effect on self-reported outcomes. Clinical Relevance It seems in conservative treatment of hallux valgus by medical insoles to correct forefoot pronation may be useful for relieving pain.
{"title":"Analyzing the Effect of Varus Forefoot Wedge in Addition to Arch Support on Self-Reported Pain, Function, and Quality of Life in Patients with Moderate Hallux Valgus: A Pilot Study","authors":"Ehsan Norouzi, Mahtab Bagheri, Behnaz Alafchi, N. Tafti","doi":"10.1097/JPO.0000000000000412","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000412","url":null,"abstract":"ABSTRACT Introduction The hallux valgus, a painful forefoot deformity, is defined as lateral deviation of the hallux, which is highly correlated with forefoot pronation. This study aimed to compare the effect of two types of foot orthoses, one with and one without a varus forefoot wedge, on self-reported outcomes of pain, function, and QOL (by FAOS questionnaire) in patients with moderate hallux valgus. Materials and Methods Sixteen patients with hallux valgus were assigned to two equal groups randomly in a before-after trial. Results The within-group comparison showed significant improvements in all subscales of the FAOS questionnaire for both groups (P < 0.05). The between-group analysis showed no statistically significant difference. Conclusions It seems the addition of varus forefoot wedge to foot orthoses may have no adverse effect on self-reported outcomes. Clinical Relevance It seems in conservative treatment of hallux valgus by medical insoles to correct forefoot pronation may be useful for relieving pain.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"198 - 202"},"PeriodicalIF":0.6,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47081632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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