The impact forces at landing are predominately absorbed by the hip, knee and ankle joints. Fatigue has been shown to increase the amount of work performed by the ankle and to reduce the work performed by the knee during landings. The purpose of this study was to assess the kinematic lower extremity motion and kinetic patterns during landings to fatigue, with and without ankle brace usage. Nine recreationally active males (n = 7) and females (n = 2) performed repetitive drop jumps to fatigue for an un-braced and braced condition. Kinematic and kinetic variables were assessed during the first 100 ms after ground impact. Due to the high skill level of the participants, none of the individuals reached a fatigued state. No significant main effect of fatigue was demonstrated on ankle work (p= 0.260). There was no significant main effect due to fatigue on the hip (p= 1.000), knee (p= 1.000) or ankle (p= 0.636) relative work contributions. Fatigue caused a shift toward a more erect landing position at initial ground contact (IGC). No significant main effect of the brace on hip (p= 0.437), knee (p= 0.283) or ankle (p= 0.314) angles was observed at IGC angles. The use of Ankle Stabilizing Orthosis® (ASO) ankle braces caused a shift toward greater knee contribution in a fatigued state. Plantar flexion angles were decreased the most during the braced un-fatigued condition. There was an inverse relationship between knee and hip angles as compared to ankle angles at IGC. When the hip and knee joint displayed less flexion at IGC, the ankle balanced the positions out by landing in more plantar flexion. / School of Physical Education, Sport, and Exercise Science

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005. / Includes bibliographical references (leaves 109-114). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005. / Includes bibliographical references (leaves 109-114).

Moving the head-neck freely is an everyday task that a healthy person takes for granted. Such a simple movement, however, may be very challenging for individuals with neurological disorders such as amyotrophic lateral sclerosis. These individuals often do not have enough neck muscle strength to stabilize the head at the upright neutral or to move it in a controlled manner. Static braces are commonly prescribed to these patients. However, these braces often fix the head at a single configuration, which makes them uncomfortable to wear for an extended period of time. In this thesis, a robotic neck brace is developed. It accommodates three rotations and covers roughly 70% range of motion of the head-neck of a typical able-bodied adult. The hardware is lightweight (1.5 kilogram) and wearable, with a pair of pads and a soft band attached to the shoulders and the forehead, respectively. A parallel mechanism connecting the shoulder pads and the headband was designed to meet the empirical human movement data. This design choice is novel where the parasitic motion (translation of the head) was parameterized and optimized to address misalignment between the robot and the user's head. A user can control this neck brace to assist intended head-neck movement through input devices, including hand-held joysticks, keyboards, and eye-trackers. This provides a potential solution to remediate head drop. Additionally, this robotic brace is developed into a versatile platform to train and study head-neck movements. The robot was designed to be highly transparent to the user and features different force controllers. Therefore, it can be used to assess the free movement of the head-neck and mimic different interactions between a therapist and a patient. The modalities of this neck brace have been validated with different users. To the best of our knowledge, this robotic neck brace is the first in the literature to assist, train, and study head-neck movements.

The use of knee braces in the past has been to protect and prevent further injury to a previously damaged knee. An Example of one such knee brace is the Lennox-Hill Derotation knee brace. This brace is used to assist the athlete who has a rotatory knee instability from a previous injury. (Klafs and Arnheim, 1977.) The problem of this study is to determine the possible effects of the Anderson Knee Stabler on mean isometric torque output in the knee extensor, mean isokinetic torque output at several speeds in the knee extensors and performance on the SEMO Agility Test in college football This study is important because it will assess the functional capability of an athlete wearing this given brace. Also, if significant differences are not achieved it will serve as a means of promoting this brace to those who may be reluctant to use it. If significant results are achieved then athletic trainers and coaches may have to rethink whether this brace is impairing the performance of their athletes.

Thesis (MScPhysio)--Stellenbosch University, 2012 / ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

Knee osteoarthritis (KOA) is the primary cause of chronic immobility in populations over the age of 65. It is a joint degenerative disease in which the articular cartilage in the knee joint wears down over time, leading to symptoms of pain, instability, joint stiffness, and misalignment of the lower extremities. Without intervention, these symptoms gradually worsen over time, decreasing the overall knee range of motion (ROM) and ability to walk. Current clinical interventions include offloading braces, which mechanically realign the lower extremities to alleviate the pain experienced in the medial compartment of the knee joint. Though these braces have proven effective in pain management, studies have shown a significant decrease in knee ROM while using the brace. Concurrently, development of active exoskeletons for rehabilitative gait has increased within recent years in efforts to provide patients with a more effective intervention for dealing with KOA. Though some developed exoskeletons are promising in their efficacy of fostering gait therapy, these devices are heavy, tethered, difficult to control, unavailable to patients, or costly due to the number of complicated components used to manufacture the device. However, the idea that an active component can improve gait therapy for patients motivates this study. This study proposes the design of an adjustable lower extremity exoskeleton which features a single linear actuator adapted onto a commercially available offloading brace. This design hopes to provide patients with pain alleviation from the brace, while also actively driving the knee through flexion and extension. The design and execution of this exoskeleton was accomplished by 3D computer simulation, 3D CAD modeling, and rapid prototyping techniques. The exoskeleton features 3D printed, ABS plastic struts and supports to achieve successful adaptation of the linear actuator to the brace and an electromechanical system with a rechargeable operating capacity of 7 hours. Design validation was completed by running preliminary gait trials of neutral gait (without brace or exoskeleton), offloading brace, and exoskeleton to observe changes between the different gait scenarios. Results from this testing on a single subject show that there was an observed, significant decrease in average knee ROM in the offloading brace trials from the neutral trials and an observed, significant increase in average knee ROM in the exoskeleton trials when compared to the brace trials as hypothesized. Further evaluation must be completed on the clinical efficacy of this device with a larger, and clinically relevant sample size to assess knee ROM, pain while using the device, and overall comfort level. Further development of this design could focus on material assessment, cost analysis, and risk mitigation through failure mode analysis.