Energy consumption of paraplegic locomotion using reciprocating gait orthosis

The energy cost of walking using a reciprocating gait orthosis (RGOII) with functional electrical stimulation (FES) was assessed in 14 patients with spastic complete paraplegia from six rehabilitation centres. Before and after training asing RGOII with FES, the subjects performed a progressive maximal test on an arm-crank ergometer to obtain their laboratory peak oxygen uptake heart rate (HR) and blood lactate concentration changes. At the end of the training session, oxygen uptake was measured during a walking test with orthosis at different speeds (6 min steady state at 0.1 m · s⁻¹, followed by 2-min stages at progressively increasing speeds up to exhaustion). Of the subjects 4 repeated this test using orthosis without FES. At a speed of 0.1 m · s⁻¹, represented 47 (SD 23)% of , mean HR was 137 (SD 21) beats · min⁻¹ and mean blood lactate concentration 2.4 (SD 1.4) mmol · l⁻¹. Maximal speed ranged from 0.23 to 0.5 m · s⁻¹. At maximal speed, was 91 (SD 18) % of mean HR reached 96 (SD 7)% and mean blood lactate concentration only 52 (SD 19)% of the maximal values measured during the laboratory test. Walking without electrical stimulation induced an increase in HR but there was no difference in and blood lactate compared to walking with stimulation. The training period did not result in any improvement in maximal physiological data. We concluded that the free cadence walking speed with orthosis remains much lower than that of able-bodied people or wheelchair users. The metabolic cost at a given speed is much higher even if, using a stimulation device, the cardiovascular stress is reduced.     

Effect of ankle-foot orthosis on active ankle moment in patients with hemiparesis

The paper investigates the effect of dorsi/plantar rigidity and the initial angle of ankle-foot orthoses (AFOs) on the moment generated by ankle musculature (referred to as active ankle moment) during gait in patients with hemiparesis. In the early stance phase, the active ankle moment in the direction of dorsiflexion is negligible, and AFOs play an important role in supplementing weak dorsiflexion. In mid to late stance, the moment generated by AFOs is very small compared with the active ankle moment in the direction of plantarflexion. AFOs therefore play only a limited role in assisting plantar flexors during this period. The active ankle moment in the direction of plantarflexion varies significantly with changes in the rigidity and initial angle of AFOs in 11 out of 20 subjects. The implication of this finding is discussed in relation to the need for dynamic matching of AFOs in individual patients with hemiparesis.     

矫形器联合中药外洗治疗儿童平足症临床观察

目的观察矫形器联合中药外洗治疗儿童平足症的临床效果。方法随机选取38例于2017年6月-2018年7月进行平足治疗的儿童,所有儿童均行矫形器联合中药外洗治疗,根据儿童的足印图进行步态观察,通过姿势控制、测量参数与家长对病情的主诉来观察治疗效果。结果经治疗后,38例平足儿童中有29例显效,7例有效,2例无效,总疗效率为94.74%;将男童与女童之间的疗效进行对比无明显差异(P>0.05),差异无统计学意义。结论应用矫形器联合中药外洗的方式治疗儿童平足症是比较理想的一种临床治疗方式。     

颅颈交界畸形外科治疗中辅助外固定支具的应用

目的探讨在颅颈交界畸形外科治疗中辅助外固定支具的选择和应用。方法回顾48例先天性颅颈交界畸形外科治疗中辅助外固定支具的应用,其中包括颈围、头环胸衣(Halo-vest)、胸骨-枕骨-下颔固定器(SOMI)3种颈部支具。结果后路内固定术后辅助外固定支具初选分别为费城式颈围(20例)、SOMI(16例)、头环胸衣(12例),应用效果优良率分别为80.0%、87.5%和91.7%。初选支具效果不满意者经更改支具后,最终在康复期应用的支具分别为费城式颈围16例、SOMI15例、头环胸衣17例35例(72.9%)获得了随访4个月以上,支具固定时间均超过3个月,满足所需术后支具外固定时间。结论颈围、头环胸衣、SOMI3种颈部支具在颅颈交界畸形外科治疗的围手术期和康复期的应用具有重要临床价值,需结合患者的病情特点和外科治疗不同阶段加以选择应用。     

矫形器和自助具在偏瘫上肢的应用

对中风后偏瘫上肢应用矫形器和自助具进行了综述。根据上肢矫形器的功能 ,可将其分为4大类 :主要用于支持、制动和预防畸形的矫形器 ,矫正挛缩畸形的矫形器 ,主要用于减轻痉挛的夹板和用于恢复运动功能的动力性夹板 ,对常见的日常生活自助具也作了简单介绍 ,介绍了应用矫形器的原则和注意事项 ,应根据病情选择合适的矫形器 ,配合其他多种康复措施综合治疗 ,才能提高康复效果。     

Posturographic evaluation of the proprioceptive effect of ankle orthoses in healthy volunteers

This study analyses the proprioceptive effect of wearing a unilateral and then bilateral ankle orthosis on 34 healthy volunteer subjects by posturography. An elastic orthosis with a ligamentous support band was used, and evaluation was performed by a posturographic statokinesimetric platform. Three tests, one without an orthosis, one with one orthosis, and one with two orthoses, were recorded for each volunteer. The results and statistical analyses demonstrated a significant difference in the antero-posterior measurement between the test without ankle orthosis and the tests with one and with two orthoses. This study provides information about the prophylactic effect of wearing a flexible support; it appears that there are important inter-individual variations in postural equilibrium, and the wearing of prophylactic ankle orthoses should be reserved for subjects after a posturographic examination.     

Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke

BackgroundAnkle-foot-orthoses (AFOs) and functional electrical stimulators (FES) are commonly prescribed to treat foot-drop in individuals with stroke. Despite well-established positive impacts of AFO and FES devices on balance and gait, AFO and FES-users still fall at a high rate.ObjectiveThe objective of this study was to investigate 1) the underlying biomechanical mechanisms leading to a fall in long-term AFO and FES-users with chronic stroke and 2) the impacts of AFOs and FES devices on fall outcomes and compensatory stepping response of long-term users with chronic stroke.MethodsFall outcomes as well as kinematics and kinetics of compensatory stepping response of 42 individuals with chronic stroke (14 AFO-users, 10 FES-users, 18 Non-users) were evaluated during trip-like treadmill perturbations. AFO and FES-users were evaluated with and without their device.ResultsChronic AFO and FES-users fell 2.50 and 2.77 times more than Non-users. The most robust differences between AFO/FES-users and Non-users were 1) Reduced capacity to stabilize the trunk through reduction in forward whole-body angular momentum and 2) diminished capability to prepare and generate a second step using the paretic leg. Provocatively, the removal of AFO and FES devices did not decease/increase falls or change kinematics.SignificanceIt is well-established that AFOs/FES devices have a positive impact on static balance and decrease community falls by increasing toe clearance thus preventing trips/stumbles. However, our results suggest that once a trip occurs, these devices do not adequately assist recovery of balance. Specifically, current AFO and FES devices do not assist with second step generation or trunk control. Future studies should explore new devices or training paradigms that target enhancing trunk control and paretic compensatory stepping to decrease falls in this population.     

Foot orthotics for low back pain: The state of our understanding and recommendations for future research

PurposeThe purpose of the article is to evaluate the literature on the use of foot orthotics for low back pain and to make specific recommendations for future research.MethodsDatabase searches were conducted using PubMed, EBSCO, GALE, Google Scholar, and clinicaltrials.gov. The biomedical literature was reviewed to determine the current state of knowledge on the benefits of foot orthotics for low back pain related to biomechanical mechanisms and clinical outcomes.ResultsIt may be argued that foot orthotics are experimental, investigational, or unproven for low back pain due to lack of sufficient evidence for their clinical effectiveness. This conclusion is based upon lack of high quality randomized controlled trials (RCTs). However, there is extensive research on biomechanical mechanisms underlying the benefits of orthotics that may be used to address this gap. Additionally, promising pilot studies are beginning to emerge in the literature and ongoing large-scale RCTs are addressing effects of foot orthotics on chronic low back pain.ConclusionsBased upon the critical evaluation of the current research on foot orthotics related to biomechanical mechanisms and clinical outcomes, recommendations for future research to address the evidence-practice gaps on the use of foot orthotics for low back pain are presented.