Dans la littérature, les résultats, dans le domaine de la rééducation neurologique des patients hémiplégiques, montraient que la performance motrice du membre atteint était améliorée lorsque les deux membres homolatéraux étaient mobilisés dans des mouvements symétriques. Il a alors été suggéré que le système nerveux avait plus de facilité à adapter une commande bilatérale symétrique, qu’une commande bilatérale asymétrique.L’objet des travaux dans cette thèse est de tester la généralité de ces résultats dans le cas du processus d’initiation de la marche (IM). Le handicap est simulé par une hypomobilité de la cheville, induite avec strapping et orthèse unilatéralement ou bilatéralement. Les résultats montrent que, dès la présence d’une contrainte, la biomécanique et les activités électromyographiques, des phases de préparation posturale et d’exécution du processus d’IM, sont modifiées. De plus, la performance motrice est également perturbée. Toutefois, il apparaît des différences « locales » selon où s'applique la contrainte. Un résultat est à souligner tout particulièrement : comme pour les patients hémi-handicapés, la performance motrice (i.e. vitesse du centre des masses à la fin du premier pas) est supérieure dans la condition « contrainte bilatérale i.e. hypomobilité des deux chevilles » versus « contrainte unilatérale i.e. hypomobilité du pied d’appui ». L’ensemble des résultats est discuté dans le cadre des processus d’adaptation de la commande motrice face aux contraintes biomécaniques unilatérales et bilatérales induites sur les appuis. En d'autres termes, tout se passe comme si un rééquilibrage des capacités fonctionnelles s’opère, permettant ainsi de générer une meilleure performance motrice. Enfin, les résultats permettent d’envisager des perspectives dans le domaine de la rééducation fonctionnelle. / In the literature, the rehabilitation of hemiplegic patients showed that motor performance of the affected limb is improved when both limbs are mobilised in a symmetrical movement. It has been suggested that it was easier for the nervous system to adapt to symmetrical bilateral command. The aim of this dissertation is to test the validity of these results in gait initiation (GI). Handicap was simulated by means of blocking the ankle unilaterally or bilaterally with a strap or orthosis.Results showed that in the presence of a constraint, electromyographic activity and the kinematics of both postural preparation and step execution phase of GI declined. Furthermore, the motor performance was also perturbed.However, « Local » differences appeared according to the localisation of the constraint, reflecting the adaptation of the motor command. Nonetheless, a result needs to be particularly underlying.Like in hemi-handicapped patients, the motor performance (i.e. centre of mass velocity at the end of the first step) was higher in « bilateral constraint, hypomobility on both ankles » versus « unilateral constraint, hypomobility on stance ankle ».In the dissertation, the results are discussed in terms of the adaptation of the motor command of unilateral and bilateral induced biomechanical constraint. More specifically, we discuss how rebalancing the functional capacity of both legs should allow to increase motor performance. These results put forward new perspectives in the domain of functional rehabilitation.

Made available in DSpace on 2016-12-12T20:17:56Z (GMT). No. of bitstreams: 1 120540.pdf: 27415901 bytes, checksum: e03c3666fff42b314d4f3ee99e734fb3 (MD5) Previous issue date: 2014-11-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present study aims to evaluate the temporal evolution of the temperature and humidity provided by different materials used in the lining of sports orthotics neoprene knee with the interface. This is a study of exploratory and descriptive and experimental nature, combined with quantitative and qualitative data collection methods and analysis of thermographic images approach. Measurements occurred in six alternate days in the morning. Identical orthoses made with smooth, neoprene lined on the outside with black polyamide fabric, with different liners (100 % polyester, 100 % polyamide, Emana® 270g, double frontura, Emana® 350g) and identical orthoses made from perforated neoprene lined were evaluated on the outside with black polyamide fabric and various lining (100 % polyester, 100 % polyamide, Emana® 270g, double frontura, Emana® 350g). Volunteers (men) were selected according to age, sex, BMI, duration of practice, hours of weekly practice, to have a physical integrity. For the tests used the same garments clo value. The instruments used were: a thermographic camera Eletrophysics model PV 320 and a precision scale BEL Engenering - Mark 160 - Class II. Temperature data were analyzed by thermography knees and moisture with the mass difference of bracing before and after the test. Of the materials tested, the combination of double polyester lining, perforated neoprene and nylon on the outside of the orthosis showed the best performance in knee - brace interaction. / O presente estudo tem por objetivo desenvolver um método para avaliar a evolução temporal da temperatura e umidade proporcionado por diferentes materiais utilizados no forro das órteses esportivas de neoprene com a interface do joelho. Trata-se de um estudo de cunho exploratório-descritivo e experimental, com abordagem combinada de métodos quantitativos e qualitativos de coleta e análise de imagens termográficas. As medições ocorreram em seis dias alternados no período da manhã. Foram avaliadas órteses idênticas confeccionadas com neoprene liso, forrado na parte externa com tecido poliamida preto, com diferentes forros: 100% poliéster, 100% poliamida, Emana® 270g, dupla frontura e Emana® 350g. Órteses idênticas confeccionadas com neoprene perfurado, também foram avaliadas, forradas na parte externa com tecido poliamida preto e diferentes forros:100% poliéster, 100% poliamida, Emana® 270g, dupla frontura e Emana® 350g. Os voluntários (homens) foram selecionados segundo a idade, sexo, IMC, tempo de prática, horas de treinos semanais, para ter uma integridade física. Para os testes utilizaram vestimentas com o mesmo valor em clo que é a unidade utilizada para medir o isolamento térmico das roupas. Os instrumentos de medida utilizados foram: uma Câmera Termografica Eletrophysics modelo PV 320 e uma balança de precisão BEL Engenering - Mark 160 - Classe ll. Foram analisados dados de temperatura através da termografia dos joelhos e a umidade com a diferença de massa da órtese antes e depois do ensaio. Dos materiais testados, a combinação forro de duplo poliéster, neoprene perfurado e a poliamida na parte externa da órtese apresentou o melhor desempenho na interação joelho-órtese.

Submitted by Livia Mello (liviacmello@yahoo.com.br) on 2016-09-28T13:53:41Z No. of bitstreams: 1 TeseCSNC.pdf: 3579352 bytes, checksum: 2cb5a49e01d350edcd02d649fed51267 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-04T19:02:06Z (GMT) No. of bitstreams: 1 TeseCSNC.pdf: 3579352 bytes, checksum: 2cb5a49e01d350edcd02d649fed51267 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-04T19:02:14Z (GMT) No. of bitstreams: 1 TeseCSNC.pdf: 3579352 bytes, checksum: 2cb5a49e01d350edcd02d649fed51267 (MD5) / Made available in DSpace on 2016-10-04T19:02:23Z (GMT). No. of bitstreams: 1 TeseCSNC.pdf: 3579352 bytes, checksum: 2cb5a49e01d350edcd02d649fed51267 (MD5) Previous issue date: 2015-07-30 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / The general objective is to investigate the manipulation of extrinsic factors on sitting postural control in children with Cerebral Palsy (CP). For better understanding we divided this thesis in 4 studies. Study 1 aims to systematically review studies evaluating sitting postural control in children with CP. We intend to describe the characteristics of sitting postural control, the methodological procedures used for analysis, and factors that influence it, and the main results of intervention protocols for sitting postural control in children with CP. In context of extrinsic factors studied, little is known about how children with CP use and integrate sensory information into motor activity in order to maintain postural orientation and stability. This gap in the literature guides the study 2. For that, in the Study 2, we investigate and compare sitting postural control under challenging visual and somatosensory inputs between typical children and children with CP with a Gross Motor Functional Classification System (GMFCS) levels I-IV. For that, 35 typical children and 36 children with spastic CP with GMFCS levels I (10), II (8), III (10) e IV (8) were recruited. Eletrocmyoghapy electrodes were placed billaterally properly on thoracal extensors, lumbar extensors and rectus abdominais. The children were asked to sit without back and foot support on a force plate (100Hz) placed on a bench. Participants’ hands are on their laps, and they fixated on a target located 1-m in front of them at eye level. To challenge somatosensory inputs, children sat on 30Kg/m3 (50x50cm) foam that was placed atop the force plate. Four randomized quiet sitting conditions namely eyes opened (EA), eyes closed (EF), foam surface and eyes opened (IA) and foam surface and eyes closed (IF). Each condition was maintained for 20 seconds for three times. There was a rest period of 30-50 seconds between each trial. The measures from force plate chosen were range displacement or amplitude for anterior-posterior (AP) and medial-lateral (ML) directions, AP and ML velocity and area of Center of Pressure (CoP). EMG variables were muscles activitiy (root-mean square - RMS) and muscle symmetry. When exposed to changes on somatosensory information added to eyes closed, children with CP GMFCS level III and IV present increased extensor muscles activity and musces asymmetry, reflecting their inability to reweight sensory information and increased dependence on somatosensory information for maintaining sitting balance when compared to typical children. In the Study 3, we investigate the immediate effects of wearing the suit on sitting posture in different sensory conditions in children with CP, comparing to typical children. For that, we used the same experimental protocol from study 2 and each condition was done with and without wearing an orthotic suit Pediasuit with bungee set up, individualized for each child. Nonlinear measures of CoP variability were added and analyzed by AP and ML approximate entropy (ApEn) and AP and ML Correlation Dimensional (CoD). Suit affects the control of sitting posture in children with CP with different GMFCS levels, decreasing amount of variability, but improves complexity and dimensionaty of degrees-of-freedom, especially in conditions demanding sensory adaptability. The objective of Study 4 was to compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control. We used an adjustable external support to isolate and differentiate the effects of biomechanical constraint on specific regions of the trunk. The posterior support was raised or lowered to allow evaluation of four different trunk segments: axillae support, mid-thoracic, waist support and hip support. Data from a previous cross-sectional study and longitudinal study of Saavedra et al. (2015) were used. However, we apply nonlinear measures (complexity –ApEN; dimesionality or CoD; predictability –LyE) specifically to head stability. The effect of external support varies depending on the child’s level of control and diagnostic status. Children with GMFCS V and young TD infants had better outcomes with external support, but external support was not enough to completely correct for influence of CP. Surprisingly, GMFCS IV responded with better outcomes below the level where trunk control was lost, suggesting that they used different compensatory strategies. / O objetivo do presente estudo é investigar os efeitos de fatores extrínsecos no controle da postura sentada em crianças com paralisia Cerebral (PC). Para a melhor discussão dos resultados, dividimos o projeto em 4 estudos. O estudo 1 objetivou descrever sistematicamente as principais características atípicas da postura sentada, os procedimentos metodológicos utilizados, os fatores que influenciam e os principais resultados de protocolos de intervenção no controle da postura sentada em crianças com PC. Evidenciou-se, assim, uma escassez de estudos que investigaram o efeito da manipulação sensorial no controle da postura sentada em crianças com PC. De fato, pouco se conhece sobre como as crianças com PC se adaptam às diferentes informações sensoriais com intuito de manter a orientação postural e a estabilidade. Essa lacuna na literatura incitou a realização de um estudo 2, o qual objetivou comparar o controle da postura sentada entre crianças típicas e de diferentes níveis de GMFCS (Gross Motor Functional Classification System) sob diferentes condições de manipulação sensorial. Para isto, 35 crianças típicas e 36 crianças com PC em níveis de GMFCS I (10), II (8), III (10) e IV (8) foram avaliadas. Eletrodos de eletromiografia foram colocados adequadamente nos músculos eretores espinhais torácicos, lombares e flexores abdominais em ambos os lados. Assim, as crianças foram posicionadas sentadas sobre a plataforma de força. Randomicamente, foram realizadas três coletas de 20 segundos com a criança de olhos abertos (EA) com um período de descanso de 60 segundos entre cada uma delas. Em seguida, foram utilizadas as condições de manipulação sensorial superfície estável olhos fechados (EF), superfície instável, olhos abertos (IA), superfície instável, olhos fechados (IF). As variáveis advindas da análise cinética foram amplitudes anteroposterior (AP) e médio-lateral (ML), velocidades AP e ML, área de oscilação do CoP. As variáveis advindas da análise eletromiográfica foram ativação muscular (root-mean square - RMS) e índice de simetria. Concluiu-se, assim, que em todos os níveis severidade e mobilidade foram capazes de se adaptar à todas as condições de manipulação sensorial na postura sentada. Porém, crianças mais severas parecem ativar excessivamente e de maneira mais assimétrica músculos extensores e flexores de tronco quando submetidas às condições de superfície instável, evidenciando dificuldades no processo de ajuste e organização multissensorial. O estudo 3 objetivou verificar como a órtese Pediasuit influencia na capacidade de adaptação no controle da postura sentada de crianças com PC em diferentes níveis de GMFCS; utilizando assim diferentes condições sensoriais, comparando-as com crianças típicas. Para isto, os mesmos procedimentos do estudo 2 foram utilizados e todas as condições sensoriais foram comparadas sem e com o órtese Pediasuit. As variáveis não-lineares entropia AP, entropia ML, correlação dimensional (COD) AP e ML foram acrescidas. Nesse sentido, abordou-se os benefícios da órtese no controle da postura sentada para todos os grupos GMFCS, evidenciados tanto pela diminuição da variabilidade na oscilação do CoP, como também pela melhora da qualidade da trajetória o CoP, refletida pelo aumento da complexidade e do número de dimensões utilizadas. O estudo 4 objetivou avaliar o efeito das restrições biomecânicas sobre o controle de cabeça em crianças típicas e com PC. Foram utilizados métodos sistemáticos para diferenciar os efeitos da restrição biomecânica em regiões específicas do tronco. Assim, 4 níveis de suporte externo de tronco foram avaliados (axilar, torácico médio, cintura, e quadril-apenas com o cinto pélvico). Para isto, os mesmos dados referentes ao estudo de Saavedra et al. (2015), porém com o uso das medidas não-lineares de complexidade, predictabilidade, graus de liberdade ou dimensionalidade (COD) para ambas as direções AP e ML. O efeito do suporte de tronco se diferenciou de acordo com o nível de controle segmentar de tronco. O suporte axilar ou torácico médio permitiu aos lactentes mais imaturos e às crianças com PC nível de GMFCS V maior complexidade e menor predictabilidade dos movimentos de cabeça. Em contrapartida, as crianças do grupo GMFCS IV apresentaram maior complexidade e menor predictabilidade quando o suporte foi pélvico, ou seja, bem abaixo do nível de controle segmentar dessas crianças; demonstrando que os fatores testados influenciam a organização e a estrutura dos movimentos de cabeça dessas crianças com PC de maneira única. / FAPESP 2012/01252-0

Robôs de reabilitação como próteses ativas e exoesqueletos necessitam de atuadores capazes de atender certos requisitos como baixa impedância de saída, backdrivability, geração de torques grandes e precisos, e uma estrutura leve e compacta. Este trabalho apresenta o projeto de um Atuador Elástico em Série rotacional (AESr) para ser usado em uma prótese ativa para auxiliar na flexão/extensão da articulação do joelho durante a fisioterapia. O dispositivo é constituído de um motor de corrente contínua, um redutor de velocidade do tipo coroa e rosca sem-fim e uma mola torcional personalizada. Uma vez que o elemento elástico é o componente mais importante no projeto do AESr, um procedimento de análise baseado no Método dos Elementos Finitos (MEF) é utilizado para cumprir os requisitos definidos para a reabilitação do joelho. Com uma massa total de 2,53 Kg, é possível montar diretamente o atuador proposto em uma estrutura de prótese de joelho. Controladores de torque e impedância são implementados para assegurar uma interação segura com o paciente, permitindo que novas estratégias de reabilitação sejam avaliadas. As especificações do projeto bem como o desempenho dos controladores são validados experimentalmente. / Wearable robots, like prostheses, active orthosis and exoskeletons need of actuators able to meet certain requirements as low output impedance, backdrivability, precise and large torque generation, and a compact and lightweight design. This work presents the design of a rotary Series Elastic Actuator (rSEA) to be used in an active orthosis to assist in flexion/extension of the knee joint during physical therapy. The device includes a DC motor, a worm gear and a customized torsion spring. Since the elastic element is the most important component in the design of the rSEA, an analysis procedure based on Finite Element Method (FEM) is used in order to meet the requirements for the specific application. With a total weight of 2.53 kg, it is possible to directly mount the actuator on the frame of a knee orthosis. Torque and impedance controllers are implemented to ensure secure interaction with the patient and enable new strategies for rehabilitation. The design specifications as well as the controllers performance are verified by experiments.

Bakgrund: Många individer oftast äldre drabbas av gonartros, denna diagnos kan orsaka smärta och nedsatt funktion vilket i sin tur kan leda till begränsningar i det dagliga livet. Detta är en systematisk litteraturöversikt över studier som har undersökt laterala kil-inlägg som behandlingsmetod för att minska smärta och förbättra funktion hos patienter med medial gonartros. Syfte: Att studera om laterala kil-inlägg leder till reducerad smärta och främjad funktion jämfört med neutrala inlägg. Vidare utreds också om resultatet är baserat på olika undergrupper. Metod: En systematisk sökning i databaserna PubMed, MEDLINE, AMED, CINAHL och Cochrane Library utfördes för att hitta relevanta studier som sedan inkluderades utifrån förutbestämda kriterier. Data analyserades utifrån dessa artiklar för att besvara frågeställningen i detta arbete. Artiklarnas evidens och validitet/reliabilitet har bedömts. Resultat: Resultaten visar att laterala kilinlägg inte ger reducerad smärta och främjad funktion. Det finns heller inga samband kopplat till undergrupperna som studeras i denna systematiska översikt. Slussats: Det finns i denna rapport blandat med bevis för huruvida laterala kilinlägg reducerar smärta och främjar funktion. Även om ett antal studier påvisar positiva effekter är detta inte tillräckligt för att på ett statistiskt signifikant sätt säga att det hjälper. Det går inte att säga om behandlingen är mer lämpad för någon specifik undergrupp. / Background: Many individuals often the elderly suffering of gonatros, this diagnosis can cause pain and impaired function which in turn can lead to limitations in daily living. This is a systematic review of studies that have investigated lateral wedged insoles as a treatment to reduce pain and improve function in patients with medial gonartros. Aim: To study whether lateral wedge insoles lead to reduced pain and improved function compared with neutral insoles. Furthermore, it is also investigated if the result is based on different sub-groups. Method: A systematic search in the databases PubMed, MEDLINE, AMED, CINAHL and Cochrane Library was performed to find relevant studies which then were included based of predetermined criteria. Data from these articles where analysed to answer our question in this paper. The articles were examined for risk of bias and validity/reliability. Results: The results show that lateral wedge insoles do not reduce pain and improve function. There are also no signs that a certain sub-group would be more suited for the treatment. Conclusion: There is in this paper a contradictory result of whether lateral wedge insoles reduce pain and improve function. Although several studies indicate positive effects it is not enough to prove in a statistically significant way that it helps. It is not possible to say whether the treatment is more suitable for any specific subgroup.

No description available.

The raw data related to the second study of this thesis (Chapter 3) is available online in the section of supporting information at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232677. These files present the following data: S1 File. The pattern of foot orthosis depression/reformation for healthy subjects during walking with sport versus regular foot orthosis. S2 File. Raw data for the training session of sport foot orthosis. This Excel file consists three sheets in which the position of triad markers, the orientation of triad markers and the position of markers on plantar surface of foot orthosis are provided respectively. S3 File. Raw data for walking with sport foot orthosis. This Excel file consists two sheets in which the position of triad markers and the orientation of triad markers are provided respectively for subject 1. S4 File. The results of each participant during walking with sport foot orthosis. This .mat file includes “DispEachPoint” and “DispEachPointMean” which shows the displacement of each predicted marker on foot orthosis plantar surface during stance phase of walking relative to its corresponding position in static non weight-bearing for each trial and the average of trials respectively. In addition, “loc_stance” and “loc_meanstance” show the location of each predicted marker during stance phase of walking. “peaks” and “peaksMean” represent the minimum (depression) and maximum (reformation) value of displacement during walking S5 File. The results of each participant during walking with regular foot orthosis. This .mat file includes “DispEachPoint” and “DispEachPointMean” which shows the displacement of each predicted marker on foot orthosis plantar surface during stance phase of walking relative to its corresponding position in static non weight-bearing for each trial and the average of trials respectively. In addition, “loc_stance” and “loc_meanstance” show the location of each predicted marker during stance phase of walking. “peaks” and “peaksMean” represent the minimum (depression) and maximum (reformation) value of displacement during walking / Les orthèses plantaires (OP) sont des dispositifs médicaux fréquemment utilisés pour réduire les douleurs et blessures de surutilisation, notamment chez les personnes ayant les pieds plats. Le port d'OP permettrait de corriger les altérations biomécaniques attribuées à la déformation du pied plat, que sont la perte de l’arche longitudinale médiale et la pronation excessive du pied. Cependant, le manque de compréhension de la fonction des OP entraine une grande variabilité des OP prescrites en milieu clinique. L'objectif de cette thèse est d'approfondir les connaissances sur l’effet des OP sur la biomécanique, de quantifier les déformations des OP à la marche et de mettre en relation ces déformations avec la biomécanique du pied. La première étude a évalué la manière dont les différentes conceptions d'OP imposent des modifications dans le mouvement et le chargement appliqué sur le pied. Cet objectif a été atteint grâce à une revue systématique traitant des effets des OP sur la cinématique et la cinétique du membre inférieur pendant la marche chez des personnes ayant des pieds normaux. Les critères d'inclusion ont réduit les études à celles qui ont fait état des résultats pour les géométries les plus fréquentes des OP, à savoir les biseaux, les supports d’arche et les stabilisateurs de talon. La revue a mis en évidence que les orthèses avec un biseau médial peuvent réduire le moment d'éversion de la cheville. Aucune évidence significative n'a été trouvée dans notre méta-analyse sur l'efficacité des orthèses incluant des supports d’arche ou des stabilisateurs de talon. Les différents procédés et matériaux utilisés dans la conception des OP ainsi que les caractéristiques des pieds des participants pourraient expliquer la variabilité retrouvée au regard des effets des OP sur la biomécanique. La deuxième étude a apporté des informations précieuses et inédites sur le comportement dynamique des OP à la marche. La cinématique du contour des OP a été utilisée pour prédire la déformation de leur surface plantaire pendant la marche chez 13 individus ayant des pieds normaux en utilisant un réseau de neurones artificiels. Une erreur moyenne inférieure à 0,6 mm a été obtenue pour nos prédictions. En plus de la précision des prédictions, le modèle a été capable de différencier le patron de déformations pour deux OP de rigidités différentes et entre les participants inclus dans l’étude. Enfin, dans une troisième étude, nous avons identifié la relation entre la déformation des OP personnalisées et la biomécanique du pied à la marche chez 17 personnes avec des pieds plats. L'utilisation de modèles linéaires mixtes a permis d’exprimer les variations de la déformation des OP dans différentes régions en fonction des variables cinématiques du pied et de pressions plantaires. Cette étude a montré que l'interaction pied-OP varie selon les différentes régions de l’OP et les différentes phases du cycle de marche. Ainsi, des lignes directrices préliminaires ont été fournies afin de standardiser et optimiser la conception des OP. Dans l'ensemble, les résultats de cette thèse justifient l'importance d’'intégrer des caractéristiques dynamiques du pied de chaque individu dans la conception d'OP personnalisées. Des études futures pourraient étendre les modèles de prédiction de l'interaction pied-OP en incluant d'autres paramètres biomécaniques tels que les moments articulaires, les activations musculaires et la morphologie du pied. De tels modèles pourraient être utilisés pour développer des fonctions coût pour l'optimisation de la conception des OP par une approche itérative utilisant la simulation par les éléments finis. / Foot orthoses (FOs) are frequently used medical devices to manage overuse injuries and pain in flatfoot individuals. Wearing FOs can result in improving the biomechanical alterations attributed to flatfoot deformity such as the loss of medial longitudinal arch and excessive foot pronation. However, a lack of a clear understanding of the function of FOs contributes to the highly variable FOs prescribed in clinical practice. The objective of this thesis was to deepen the knowledge about the biomechanical outcomes of FOs and to formulate the dynamic behaviour of FOs as a function of foot biomechanics during gait. The primary study investigated how different designs of FOs impose alterations in foot motion and loading. This objective was achieved through a systematic review of all literature reporting the kinematics and kinetics of the lower body during walking with FOs in healthy individuals. The inclusion criteria narrowed the studies to the ones which reported the outcomes for common designs of FOs, namely posting, arch support, and heel support. The review identified some evidence that FOs with medial posting can decrease ankle eversion moment. No significant evidence was found in our meta-analysis for the efficiency of arch supported and heel supported FOs. The findings of this study revealed that differences in FO design and material as well as foot characteristics of participants could explain the variations in biomechanical outcomes of FOs. The second study provided valuable information on the dynamic behaviour of customized FOs. The kinematics of FO contour was used to predict the deformation of FO plantar surface in 13 healthy individuals during walking using an artificial intelligence approach. An average error below 0.6 mm was achieved for our predictions. In addition to the prediction accuracy, the model was capable to differentiate between different rigidities of FOs and between included participants in terms of range and pattern of deformation. Finally, the third study identified the relationship between the deformation of customized FOs and foot biomechanics in 17 flatfoot individuals during walking. The use of linear mixed models made it possible to identify the variables of foot kinematics and region-dependent plantar pressure that could explain the variations in FO deformation. This study showed that the foot-FO interaction changes over different regions of FO and different phases of gait cycle. In addition, some preliminary guidelines were provided to standardize and optimize the design of FOs. Overall, the results of this thesis justify the importance of incorporating the dynamic characteristics of each individual’s foot into the design of customized FOs. Future studies can extend the predictive models for foot-FO interactions by including other determinants of foot biomechanics such as joint moments, muscle activation, and foot morphology. Based on such extended models, the cost functions could be devised for optimizing the designs of customized 3D printed FOs through an iterative approach using finite element modeling.

Dans le secteur industriel, la nécessité de fournir des données cliniques lors de la mise sur le marché d’un nouveau dispositif médical s’est sensiblement accrue suite à de récentes évolutions juridiques. L’objectif de ce travail de thèse était de recueillir des données cliniques relatives à l’utilisation d’un nouveau modèle d’orthèse de type releveur de pied pour valider son intérêt vis-à-vis de produits standards. Pour formuler des hypothèses raisonnées et interpréter objectivement ces données, la connaissance des caractéristiques mécaniques des orthèses étudiées a constitué l’étape préalable nécessaire. Après s’être assuré de la faisabilité et de la pertinence du protocole expérimental sur des sujets sains, l’analyse des effets du port des dispositifs lors de tâches motrices élémentaires que sont la station debout et la marche chez des patients (avec atteinte uni ou bilatérale, d’origine périphérique, des muscles fléchisseurs dorsaux de cheville) a constitué le cœur de nos investigations. Celles-ci ont ainsi pu mettre en évidence que le port d’orthèse induit des effets communs et d’autres spécifiques à chaque modèle. Dès lors, de façon originale, nous nous sommes proposés d’identifier, par des moyens simples et rapides, les patients qui tirent davantage profit d’un des modèles d’orthèse. Outre le prérequis indispensable qui est l’acceptation de l’appareillage par le patient, nos résultats précisent que le dispositif orthopédique le plus adapté est celui qui compense le(s) déficit(s) en restaurant la fonction motrice, sans contraindre les capacités préservées / In the industrial field, the necessity of providing some clinical data during the launching of a new medical device has noticeably increased after some recent legal evolutions. The aim of this thesis was to collect some clinical data concerning the use of a new ankle-foot orthosis in order to confirm its relevance in comparison with standard products. To formulate some reasoned hypotheses and objectively interpret these data, the knowledge of the mechanical characteristics of the studied orthoses has constituted the preliminary necessary step. After checking the feasibility and the relevance of the experimental protocol on healthy subjects, the analysis of the effects of the ankle-foot orthoses during some elementary motor tasks, which are the stance and gait, in patients (suffering from a uni or bilateral affection, of a peripheral origin, ankle dorsal flexor muscles) has been the core of our research. As a consequence, it results from this that the ankle-foot orthosesinfer some common effects and some other, specific to each model. From that moment on, in an original way, we were bound to identify, with some simple and fast ways the patients taking the larger advantage from one of the orthosis models. In addition to the necessary prerequisite which is the acceptance of the equipment by the patient, our results specify that the most adapted orthopaedic device compensates for the deficiency(ies) by restoring the motor function, without restraining the preserved abilities

One of the most devastating effects of tetraplegia is the inability to grasp and manipulate everyday objects necessary to living an independent life. Currently surgery is widely accepted as the solution to improve hand functionality. However, surgery becomes difficult when the user has paralysed wrists as is the case with C5 tetraplegia. The aim of this research was to develop a solution which provided controlled wrist flexion and extension which, when combined with surgery, achieves a 'key pinch' grip. This particular grip is critically important for people with C5 tetraplegia as it is used for countless grasping activities, necessary on a day-to-day basis. A systematic design process was used to evolve the solution to provide controlled wrist flexion and extension. Concept brainstorming identified four alternative solutions which were evaluated to find the preferred concept. The chosen solution was called the Self Powered Wrist Extension Orthosis, more commonly referred to as the 'orthosis'. This concept contained a shoulder harness which provided both energy and control to the wrist harness, which in turn changed the wrist position. The orthosis was developed with the use of a mathematical model which theoretically predicted the functional performance by comparing the required force needed to move the wrist harness to the achievable force supplied by the user's shoulders. Using these parameters, the orthosis was optimized using the matlab Nelder-Mead algorithm which adjusted the wrist harness geometries to maximize the functional performance. A prototype was constructed and tested with the help of two participants who when combined, achieved an average of 18.5° of wrist rotation. The theoretical model however predicted an average range of motion of 28.4°. The discrepancy found between the theoretical and experimental result can be contributed to incorrect assumptions in the theoretical model. This included unaccounted friction and inaccurate modeling of the orthosis dynamics. The feedback from potential users of the orthosis was enthusiastic and encouraging especially towards the simplicity, usability and practicality of the design.

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