acase@tulane.edu / 1 / Antonius Prader

An increase in postural sway is one of the risk factors that have been linked to an increased incidence of falls in the older adult population. Researchers have shown that peripheral sensation is crucial in maintaining a static posture for adults of all ages. It has been reported that older adults have decreased tactile sensation of the plantar surface of their feet. and when the sensory feedback was increased older adults had improved postural control. It was hypothesized that facilitation of the sole of the foot with the use of a semirigid foot orthotic would result in improved postural stability in older adults. Twenty-seven volunteers (19 females, 8 males, mean age: 87 ± 5 yrs) were recruited as subjects from a retirement community. All subjects were supplied with the SmartStep™ Stabilization System. There were a total of 5 Test Days for each subject. The first 2 Test Days were performed while the subjects wore their own shoes, while the last 3 Test Days were performed while the subjects wore the SmartStep™. Test Days 1 and 2 were performed 48 hours apart. Test Day 3 occurred 2 to 4 weeks after Test 2. Test Days 4 and 5 occurred 4-weeks after the prior Test Day. During the 8-weeks between Test Days 3 and 5, subjects were asked to wear the SmartStep™ as their daily shoe. Clinical measures of balance, force plate measurements, sensation testing, and confidence and activity scales were collected on all subjects throughout the eight week test period. Statistical significance was found for 3 of the clinical measures. The Timed “Up & Go” improved from 17.25 to 15.47 sec. The Functional Reach and Lateral Reach Tests demonstrated a decline in scores during the eight weeks. There was only 1 statistically significant finding for the force plate measures. The center of pressure displacement in the anteriorposterior direction was increased from 4.6 to 5.3 cm. No significant differences where reported for any other dependent variable. The results did not indicate statistically that the in-shoe orthotic enhanced postural stability in this group of subjects. However, there were indications that there was a subset of the current population that benefited from the intervention and this needs to be investigated further.

Lai, Wai Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 106-108). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Orientadores: Manoel Barros Bertolo, Linamara Rizzo Battistella / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:49:39Z (GMT). No. of bitstreams: 1 Magalhaes_EduardodePaiva_D.pdf: 4850874 bytes, checksum: 30c39d8223abecede7d6fcaa1901152c (MD5) Previous issue date: 2007 / Resumo: Objetivo: Avaliar a eficácia de palmilhas em pacientes com artrite reumatóide (AR) utilizando o Índice de Função dos Pés (FFI) durante 6 meses. Estudar a alteração na distribuição da pressão plantar em pés reumatóides após 15 dias em uso de palmilhas. Material e Métodos: Foram avaliados trinta e seis pacientes com AR e dor nos pés e prescritas palmilhas conforme as necessidades individuais. Todos os pacientes foram reavaliados em 30, 90 e 180 dias da avaliação inicial. Em cada consulta foi aplicado FFI e verificados o tempo de utilização das órteses e eventuais efeitos adversos. O Health Assessment Questionaire (HAQ) foi verificado na consulta inicial para avaliar a influência da condição física na evolução do FFI. Quinze mulheres com AR e dor nos pés foram submetidas a avaliação da pressão na superfície plantar pelo programa F-SCAN em avaliação inicial e após 15 dias em uso de palmilhas. Resultados: Durante o estudo os valores do FFI reduziram em todas as sub-escalas (dor, incapacidade e limitação de atividade). Esta redução foi notada no primeiro mês e mantida durante todo o período de avaliação. Os pacientes que utilizaram palmilhas com EVA convencionais (n=28) apresentaram melhores resultados. Pacientes utilizando palmilhas sob molde de gesso (n=8) apresentaram valores mais elevados do FFI na consulta inicial e menor redução deste índice com resultados ainda significantes para as sub-escalas de dor e incapacidade, mas não para limitação de atividade. Efeitos adversos menores foram verificados sem resultar em interrupção do tratamento. Os pacientes utilizaram a palmilha durante um período médio de 7,14 horas por dia durante o primeiro mês sem diferenças significativas nas avaliações subseqüentes. Não foi verificada relação entre o HAQ e a evolução do FFI. Com o uso de palmilhas foi verificada significativa redução dos valores de pressão plantar em ante-pé e retro-pé. Conclusões: As palmilhas foram efetivas como adjuvantes no tratamento de pés reumatóides com redução dos índices de dor, incapacidade e limitação de atividade avaliados pelo FFI, com poucos efeitos adversos. Também proporcionaram melhor distribuição da pressão na superfície plantar com redução dos seus valores em ante-pé e retro-pé / Abstract: Objective: To evaluate the effectiveness of foot orthoses, using the Foot Function Index (FFI), in a group of patients with rheumatoid arthritis (RA) in a period of six months. To compare the foot pressures in rheumatoid patients after the use of foot orthoses during a period of fifteen days. Methods: Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient needs. All the patients were evaluated in 30, 90 and 180 days after baseline visit. FFI values, daily wearing time and adverse effects were noted in each appointment. The Stanford Health Assessment Questionnaire (HAQ) was obtained in the initial visit and it was used to evaluate the influence of physical condition on FFI response. Fifteen women with RA and foot pain were also examined and their foot pressure values measured using the F-SCAN program in first appointment and after fifteen days using appropriate insoles. Results: After the use foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation) for the patients studied. This reduction was noted early, in the first month and maintained during all the trial. Those using EVA (n=28) orthoses presented similar results to the total group. Otherwise, patients with made to measure orthoses (n=8) exhibited higher initial FFI values and worse evolution during the trial, still significant for pain and disability, but not for activity limitation. Minor adverse reactions were noted and none of them required treatment interruption. Orthoses were worn on an average for 7.14 hours in the first month without significant differences in the others visits. There was no relation between HAQ and FFI evolution. The patients using the foot orthoses achieved a significant plantar pressure reduction in forefoot and hindfoot. Conclusions: Foot orthoses were effective as an adjuvant management of rheumatoid foot. They significantly reduced pain, disability and activity limitation accessed by the FFI, with minor adverse effects. They also promote a better plantar pressure distribution and relief in forefoot and hindfoot / Doutorado / Clinica Medica / Doutor em Clínica Médica

Residual gait abnormalities are common following lower limb injury and/or stroke and can have several negative impacts on an individual’s life. Without continuous treatment and follow up, individuals can be prone to chronic pain as abnormal gait may lead to non-physiological loading of the musculoskeletal system. The current industry gold standard for diagnosing abnormal gait requires specialty equipment that is generally only available at designated gait facilities. Due to the inaccessibility and high cost associated with these facilities, a wearable SmartSole device to continuously detect abnormal gait was proposed. A previous iteration of the SmartSole was unable to properly detect abnormal gait and also experienced fracturing throughout the 3D printed body. In this present study, sensor placement and material selection were reconsidered to address these limitations. The objective of this study was to determine if a redesigned SmartSole could identify events of abnormal gait through validation and verification testing against the industry standard force plates. In total, 14 participants were selected for gait studies, 7 with pronounced gait abnormalities (e.g. limps), and 7 with physiological gait. Parameters of interest included stance time, gait cycle time, and the ratio of the force magnitudes recorded during heel strike and toe off. Results indicated that the SmartSole was effective at determining overall event timings within the gait cycle, as both stance and cycle time had strong, positive correlations (left stance: r = 0.761, right stance: r = 0.560, left cycle: r = 0.688) with the force plates, with the exception of right foot cycle time. The sole was not effective at measuring actual values of events during gait as there were weak correlations with the force plates. Furthermore, when comparing parameters of interest between the injured and non-injured sides for test participants with gait abnormalities, neither the SmartSole nor the force plates were able to detect significant differences. The inability of the sole to accurately collect force magnitudes or to detect abnormal gait leads to the conclusion that additional sensors may need to be implemented. Future iterations may consider placement of additional sensors to allow for a “fuller picture” and the inclusion of other types of sensors for improved, continuous tracking of gait abnormalities.

Individuals with stroke often demonstrate impaired ankle-foot function, commonly termed dropped foot that affects their ability to walk safely at home and within their community. While interventions are available to improve gait function, they have inconsistency demonstrated positive effects due to the lack of evidence-based practice guidelines and a limited understanding of the mechanisms leading to dropped foot. The aim of this dissertation was to 1) determine the relationship between dropped foot gait deviations and impaired sensorimotor control, 2) compare gait biomechanics between stroke survivors with and without dropped foot impairment, and 3) evaluate the immediate effects of an ankle-foot orthotic (AFO) and functional electrical stimulation (FES) device among stroke survivors with dropped foot impairment. Our evaluation combined standardized clinical measures of ankle-foot function (i.e. sensorimotor control, strength, spasticity and range of motion) and gait analysis using advanced laboratory techniques (i.e. electromyography and electrical goniometers) to quantify mechanisms of dropped foot impairment. Fifty-five stroke survivors completed the assessment prior to discharge from inpatient rehabilitation. Individuals with poor generation of isometric dorsiflexor force and reduced passive ankle range of motion were likely to demonstrate greater plantarflexion in swing and limited stance phase ankle joint excursion, respectively. Results from the gait analysis revealed a delayed onset and reduced activation time of the ankle dorsiflexors, and decreased co-activation time in the stance phase as possible mechanisms leading to dropped foot. A detailed case series was performed with four stroke survivors with dropped foot currently using an AFO. Application of an AFO immediately improved peak dorsiflexion in the swing phase and limited ankle range of motion during stance. When walking with the FES device, individuals with moderate dorsiflexor muscle weakness improved their ankle position at initial contact and increased peak dorsiflexion during stance, while no significant changes were observed among individuals with greater impairment. Overall, the results highlighted individual differences in response to interventions aimed at improving dropped foot gait deviations. These findings contribute to a greater understanding of gait dysfunction post stroke, and may lead to the development of a more effective clinical assessment and intervention strategies to improve dropped foot impairment.

Leung Kam Lun. / "July 2003." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 187-201). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Powered orthotic devices can be used to restore mobility to the impaired user, and may thereby assist them in daily living tasks. An investigation is performed herein to examine the feasibility of a powered lower-limb orthotic in assisting the sit-to-stand task by 50% of the required torque. Feasibility is considered via simulation. A three-link sit-to-stand model, which is driven by kinematic data, is developed. Models of a Pneumatic Muscle Actuator and a DC motor are used to determine which of the two technologies can make a more appropriate contribution to the sit-to-stand task. Simulation revealed that both the Pneumatic Muscle Actuator and the DC motor are reasonable actuator choices, and neither limited the ability to achieve 50% torque assistance. The ability to assist the task was, however, limited by the ability to derive a control signal for the actuator from the user-orthotic interface. It was concluded that the user-orthotic interface requires further investigation. It was also found that while both actuator technologies are suitable for contributing 50% of the required torque, the Pneumatic Muscle Actuator is preferable due to its ability to scale to greater torques.

Powered orthotic devices can be used to restore mobility to the impaired user, and may thereby assist them in daily living tasks. An investigation is performed herein to examine the feasibility of a powered lower-limb orthotic in assisting the sit-to-stand task by 50% of the required torque. Feasibility is considered via simulation. A three-link sit-to-stand model, which is driven by kinematic data, is developed. Models of a Pneumatic Muscle Actuator and a DC motor are used to determine which of the two technologies can make a more appropriate contribution to the sit-to-stand task. Simulation revealed that both the Pneumatic Muscle Actuator and the DC motor are reasonable actuator choices, and neither limited the ability to achieve 50% torque assistance. The ability to assist the task was, however, limited by the ability to derive a control signal for the actuator from the user-orthotic interface. It was concluded that the user-orthotic interface requires further investigation. It was also found that while both actuator technologies are suitable for contributing 50% of the required torque, the Pneumatic Muscle Actuator is preferable due to its ability to scale to greater torques.

Individuals with stroke often demonstrate impaired ankle-foot function, commonly termed dropped foot that affects their ability to walk safely at home and within their community. While interventions are available to improve gait function, they have inconsistency demonstrated positive effects due to the lack of evidence-based practice guidelines and a limited understanding of the mechanisms leading to dropped foot. The aim of this dissertation was to 1) determine the relationship between dropped foot gait deviations and impaired sensorimotor control, 2) compare gait biomechanics between stroke survivors with and without dropped foot impairment, and 3) evaluate the immediate effects of an ankle-foot orthotic (AFO) and functional electrical stimulation (FES) device among stroke survivors with dropped foot impairment. Our evaluation combined standardized clinical measures of ankle-foot function (i.e. sensorimotor control, strength, spasticity and range of motion) and gait analysis using advanced laboratory techniques (i.e. electromyography and electrical goniometers) to quantify mechanisms of dropped foot impairment. Fifty-five stroke survivors completed the assessment prior to discharge from inpatient rehabilitation. Individuals with poor generation of isometric dorsiflexor force and reduced passive ankle range of motion were likely to demonstrate greater plantarflexion in swing and limited stance phase ankle joint excursion, respectively. Results from the gait analysis revealed a delayed onset and reduced activation time of the ankle dorsiflexors, and decreased co-activation time in the stance phase as possible mechanisms leading to dropped foot. A detailed case series was performed with four stroke survivors with dropped foot currently using an AFO. Application of an AFO immediately improved peak dorsiflexion in the swing phase and limited ankle range of motion during stance. When walking with the FES device, individuals with moderate dorsiflexor muscle weakness improved their ankle position at initial contact and increased peak dorsiflexion during stance, while no significant changes were observed among individuals with greater impairment. Overall, the results highlighted individual differences in response to interventions aimed at improving dropped foot gait deviations. These findings contribute to a greater understanding of gait dysfunction post stroke, and may lead to the development of a more effective clinical assessment and intervention strategies to improve dropped foot impairment.