Effects of short-term brace wearing on the pendulum-like mechanism of walking in healthy subjects

Progressive spinal deformities, such as scoliosis, often need orthotic management to prevent deterioration. Such braces may alter spinal segmental movements, which contribute in minimizing energy requirements during gait. The goal of this study was to isolate the immediate effect of bracing on mechanical work and energy cost in 13 healthy subjects. Gait was assessed by a conventional motion analysis system. Our results showed a decrease in pelvis and shoulder motion, an increase in external work, and an alteration in pendulum-like mechanism of walking when wearing the brace. However, no significant difference was observed in total mechanical work, electromyographic activity and energy cost.The loss of efficiency of this pendulum mechanism could be due to the reduction of pelvis and shoulder motion brought about by the brace.     

不同矫形器对脊髓损伤患者临床康复效果的影响

目的探讨不同矫形器对脊髓损伤患者临床康复效果的影响。方法选取2016年9月～2019年3月我院收治的脊髓损伤患者124例为研究对象。按照随机数字表法分为A组和B组,每组62例。A组患者装配重心移动式步行矫形器,B组患者装配往复式截瘫步行器。比较两组患者矫形器装配前后的行走能力、日常生活能力、生活自理能力以及肠道功能的改善情况。结果矫形器装配前和装配后6周时,A组与B组患者的行走能力、Barthel和FIM评分以及肠道功能比较,差异无统计学意义(P0.05);与矫形器装配前比较,两组患者装配后6周时的行走能力、Barthel评分和FIM评分以及肠道功能均显著改善,差异有统计学意义(P0.05)。结论两种矫形器均能改善脊髓损伤患者的行走能力、日常生活能力、生活自理能力以及肠道功能,有利于患者的康复;但由于本次研究的样本量较少,仍需进一步的研究来阐明矫形器促进脊髓损伤患者康复的机制。     

Conservative management of trigger finger: A systematic review

Study DesignSystematic reviewIntroductionTrigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective.MethodsAll studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence.ResultsFour authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses.ConclusionAll authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed.     

Sensor based braces: Challenges ahead

Sensor based brace is a new technology driven initiative to address the adherence issues associated with clubfoot treatment. It encompasses various engineering fields (sensors, batteries, data transfer) to measure precise brace wear timings. Still in preliminary usage, yet they have lead to several significant findings; foremost being that caretakers tend to over report their brace usage. Enhanced surveillance and reinforcements is thus possible with sensor devices as defaulters can be picked up early. The introduction of these devices in common practice is postulated to lessen relapse rates by upto 40%. However, many challenges obscure the path of newer braces. Robust study designs and longer follow up is lacking in majority of studies detailing sensor based clubfoot braces. None of the currently available studies demonstrate effectiveness of patient interventions/changes based on the research data. Behavioral changes in caretakers may be difficult to achieve and could require repeated reinforcements. Since braces need to be worn for prolonged periods in clubfoot treatment, sensor data generated per patient would be colossal. It's processing and interpretation would be an uphill task. The cost of advanced inventory may burden ongoing clubfoot care programmes in low income countries. There is also a possibility that the newer technology may tone up the bracing protocol into a highly sophisticated and supervised medical intervention rather than a simplified maintenance phase. Till further development and evidence, sensor based clubfoot braces may find their initial application for high risk groups susceptible to relapse.     

Foot orthoses and dental appliances—Is there a relationship?

BackgroundThis investigation was aimed at examining whether subjects who wear a combination of functional foot orthoses and dental appliances have less postural sway and furthermore to study if these changes are direction dependent.MethodsCentre of pressure (CoP) displacement in seven subjects, mean age 49 range (39–58) who met the inclusion criteria were evaluated using a pressure platform. Total displacement of the centre of pressure, the reduction in the displacement about the origin, area of the ellipse, total displacement along the x- and y-axes and frequency of sway along the anterior–posterior and mediolateral axes were estimated under four conditions, namely wearing orthoses and appliances, wearing only orthoses, only appliances and finally wearing neither orthoses nor appliances.ResultsIn the six patients who had class II malocclusion there was no significant difference between the displacement (z = 0.314 and p = 0.753) and the frequency (z = 0.680 and p = 0.496) of sway along the medio-lateral or anterior–posterior axes. Under control conditions the mean path length was 780 (SD 415) mm, the mean deviation from origin was 4.76 (SD 5.8) mm and the mean area was 0.83 (SD 1.87) mm²/cm². The mean deviation from origin was seen to reduce under all experimental conditions. Wearing the dental appliance alone was seen to be the most effective although the difference was not statistically significant. The sway area was also seen to reduce under all experimental conditions. The sway was most reduced when participants were wearing orthoses (i.e. conditions 1 and 3) with the reduction being the greatest when the orthoses was worn on its own (i.e. condition 3).ConclusionWhile, foot orthoses have been used for the relief of symptoms either within or extrinsic to the foot, they could have a much wider role in the management of patients with stability problems. Results from this study highlight the need for further research in this exciting and as yet unexplored area.     

Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach

Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.     

Effects of orthopedic insoles on postural balance in patients with chronic stroke: A randomized crossover study

BackgroundOrthopedic insoles (OIs) with medial arch support and heel cushion are widely used to manage lower extremity injuries, but their effects on postural balance in patients with chronic stroke have not been adequately explored.MethodsDesign: Double-blinded, sham-controlled, randomized crossover trial. Participants: A total of 32 ambulatory patients (20 men and 12 women, aged between 30 and 76 years) with more than 6 months since stroke onset. Interventions: All participants received one assessment session wearing OIs and one session wearing sham insole (SI) in a random order with a 1-day interval. Outcomes: Our primary outcome was the Berg Balance Scale score. Secondary outcomes included the Functional Reach Test, Timed Up and Go test, and computerized posturography. All were performed in both sessions. Subgroup analyses regarding demographic and functional variables were conducted to identify potential responders.ResultsSignificant between-insole differences favoring OIs were seen in all clinical tests (P < 0.05), but were seen only in the static medial-lateral sway in computerized posturography assessment (P = 0.04). An approximate 2-point difference in the BBS score favoring OIs was observed in all subgroups, not reaching the minimal clinically important difference.ConclusionThe use of OIs generated small but significant positive effects on improving postural balance among patients with chronic stroke. Additional biomechanical and clinical studies are required to evaluate their potential for routine clinical use.Trial registrationNCT03194282     

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

PurposeThe analysis determined the relapses in clubfoot children treated with Ponseti technique and standard bracing protocol and their correlation with overall follow up duration using pooled data from various series. It also tested the prescribed timelines of 5 and 7 years for slow-down/cessation of relapses in clubfoot children.MethodsA systematic literature search was performed for articles published in “Pubmed (includes Medline indexed journals)” electronic databases using key words: “Clubfoot or CTEV or congenital talipes equinovarus”, “Ponseti” for years 1^st January 2001 to 15^th November 2020. Included were studies that addressed treatment of idiopathic clubfoot using the standard Ponseti technique, followed a well defined brace protocol (maintenance of corrected deformity using a central bar based brace and prescribed duration mentioned), reported a minimum mean follow up of 4 years and having relapse as one of their outcome measure. Studies reporting Ponseti technique for non-idiopathic clubfoot, child's age older than 1 year at the time of primary treatment, clubfoot with previous interventions before Ponseti treatment, where relapse and residual deformities were not identified distinctly in follow up, abstract only publications, letter to the editors, case reports, technique papers and review articles were excluded. The following characteristics of clubfoot patients in the selected articles were included for analysis: Patient numbers/feet treated with Ponseti technique; follow up years (<5; 5-7 and >7 years; overall) and corresponding relapse percentages for patients.ResultsThere were total 2206 patients in the included 24 studies. Average follow up was 6 years. The average relapse rates for clubfoot patients in the pooled data stood at 30%. The overall relapse rates increased with a longer follow up and the curve befitted a linear regression equation with weak positive correlation (Pearson correlation coefficient = 0.08). The relapse rates in follow up categories of <5 years (26.6 ± 15.6%), 5-7 years (30.8 ± 16.3%) and >7 years (28.4 ± 6.2%) were similar statistically (Analysis of variance, ANOVA).ConclusionsApproximately 1 in 3 clubfoot patients suffer relapse post Ponseti technique and standard bracing protocol. A weak positive correlation was observed for relapses when correlated with increasing follow up years. The relapses however tend to slow down after initial growth years. There is a need to educate the care receivers regarding the possibility of late relapses despite proper Ponseti treatment and accordingly to keep them under supervised follow up for longer periods.