Title: Quantifying aspects of orthosis in relation to ankle sprain Objectives: To detect whether various types of ankle bracing affect dynamic postural stability. Investigation of attenuation of vertical forces in different conditions. To determine range of motion for each orthosis. Methods: Monitoring of dynamic variables by piezoelectric measuring device - Kistler recording of dynamic changes. Mathematical modeling of damping characteristics and detected variables. Measuring of range of motion by goniometer with and without orthosis. Results: Results suggest, that bracing conditions have an effect on dynamic postural stability and orthosis limit range of motion. Attenuation of vertical forces is affected by using orthosis. Keywords: ankle instability, orthosis, mathematical modeling, stabilization

Background:People who have survived a stroke often have post-stroke complications. One common complication is muscle weakness in the lower extremities. To treat this, patients can use an ankle-foot orthosis (AFO). The purpose of this study was to investigate muscle morphology in the quadriceps when walking with an AFO. Method:This feasibility cross over study was made on 7 healthy adults. To measure the morphology, an SMG device was used. The device measured muscle area change, EMG -and MMG activation, knee angle and plantar forces. Statistical analyzes was made for all measured data except knee angle.  Result:The area of the quadriceps was significantly smaller when walking with the AFO in mid-swing phase than without (p=0,035). A significant reduction in force could also be found under the MTP1 (p=0,016) and under the calcaneus (p=0,042) in toe off (60%). The result did not show any significant differences in initial contact (p=0,617), mid stance (p=0,287), toe off (p=0,527) or terminal swing (p=0,712) for muscle area change of quadriceps, or plantar force at MTP5 in toe off (p=0,704). Conclusion:The results suggest that the subjects needed to work more with the quadriceps muscles when walking with the AFO. More studies are needed to reach clinical relevance. / Bakgrund:Personer som har genomgått en stroke lider ofta av diverse komplikationer. En vanlig komplikation är muskelsvaghet i den nedre extremiteten. Ett vanligt hjälpmedel för personer med dessa problem är en ankel-fot-ortos (AFO). Denna studies syfte var att undersöka muskelmorfologi (areaförändringar) i quadriceps muskeln när man går med en AFO jämfört med att gå utan.  Metod:Denna förstudie är en korsstudie som utfördes på 7 friska unga vuxna. Ett SMG-system användes på quadriceps för att mäta muskelarean. Enheten mätte muskelarea förändringar, EMG –och MMG aktivering, knävinkel samt plantara krafter. Statistiska analyser genomfördes på all insamlade data förutom knävinkeln.  Resultat:Arean för quadriceps var signifikant mindre när deltagarna gick med AFO i mid swing jämfört med utan (p=0,035). En signifikant skillnad visade sig i den plantara kraften under MTP1 (p=0,016) och under hälen (p=0,042) i toe off (60%).  Resultatet visade inga signifikanta skillnader i initial contact (p=0,617), mid stance (p=0,287), toe off (p=0,527) eller i terminal swing (p=0,712) för quadriceps, eller plantara krafter på MTP5 under toe off (p=0,704). Slutsats:Resultaten pekar på att deltagarna behöver använda sin quadriceps mer i mid swing när de går med en AFO. Fler studier på området behöver göras för att uppnå klinisk relevans.

Aim: The aim with this study is to compare different orthotic solutions for pediatric patients with congenital talipes equnivarus.  Method: A search in the databases MEDLINE, CINAHL, PubMed and Scopus were made, and studies was included after the predefined criteria. The included studies were reviewed for risk of bias and validity, relevant data was extract and analyzed with regards to the research question.  Result: The result was presented on 15 different orthotic interventions in 21 different articles. The reported outcome measures were compliance, recurrence of deformity, Pirani- and Dimeglio score, range of motion and functional outcomes.  Conclusion: Based on the results a recommendation cannot be made on what orthosis that gives the best result. Future research should focus on developing and designing an orthosis that satisfies the patient's needs. / Syfte: Syftet med detta arbete är att undersöka olika ortos-lösningar med dess inkluderade resultat för patienter med kongenital idiopatisk klumpfot. Metod: En systematisk sökning i databaserna MEDLINE, CINAHL, PubMed and Scopus genomfördes och väsentliga studier inkluderades utefter de förbestämda kriterierna. Inkluderade studiers validitet och möjliga partiskhet bedömdes samt att relevant data utifrån frågeställningen analyserades och besvarades.  Resultat: Resultatet presenterade 15 olika typer av ortoser, i 21 olika artiklar. De presenterade utfallsmåtten var inom komplians, återfall av deformationen, Pirani- och Dimeglio poäng, rörelseomfång samt inom funktionellt resultat. Slutsats: Baserat på resultat går det inte att presentera en övervägande slutsats om vilken ortos-lösning som ger bäst resultat. Framtida forskning måste utveckla och framställa ortoser som tillfredsställer och möter patienternas behov.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Ambulation is critical to a child’s participation, development of selfconcept, and quality of life. Children with cerebral palsy (CP) frequently exhibit limitation in walking proficiency which has been identified as the primary physical disability. Traditional rehabilitative treatment techniques to improve ambulation for children with CP reveal inconsistent results. Driven gait orthosis (DGO) training is a novel approach focusing on motor learning principles that foster cortical neural plasticity. Objective: The objectives are to determine if: (i) the lower extremity muscle activation patterns of children with CP are similar to age-matched TD children in overground (OG) walking, (ii) DGO training replicates muscle activation patterns in OG ambulation in TD children, (iii) the lower extremity muscle activation patterns in OG walking of children with CP are similar to their muscle activation patterns with DGO assistance, and (iv) DGO training promotes unimpaired muscle activation patterns in children with CP. Methods: Muscle activity patterns of the rectus femoris, semitendinosus, gluteus maximus and gluteus medius were recorded in the OG and DGO walking conditions of children with CP and age-matched TD. The gait cycles were identified and the data was averaged to produce final average gait cycle time normalized values. Results: In comparing the variability of the muscle activation patterns within the subject groups, CP DGO walking was considerably lower than CP OG. In comparing the muscle activation patterns in each condition, consistent differences (p < .05) were noted in terminal stance, pre-swing and initial swing phases of gait with the DGO condition consistently revealing greater muscle unit recruitment. Conclusion: The results indicate that training in the DGO provided the ability to practice with measurably repetitive movement as evidenced by decreased variability. Consistent differences were noted in muscle activation patterns in the terminal stance, pre-swing and initial swing phases of gait when most of these muscles are primarily inactive. The alteration in ground reaction force within the DGO environment may play a role in this variance. With the goal of normalizing gait, it is important that the effect of these parameters on ground reaction forces be considered in the use of DGO rehabilitation.

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京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24095号 / 人健博第102号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 稲富 宏之, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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