Yes / If a prosthetic foot creates resistance to forwards shank rotation as it deforms during loading, it will exert a braking effect on centre of mass progression. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device. Nineteen lower limb amputees (eight trans-femoral, eleven trans-tibial) walked overground using their habitual dynamic-response foot with rigid ‘ankle’ or ‘Echelon’ hydraulic ankle–foot device. Analysis determined changes in how the centre of mass was transferred onto and above the prosthetic-foot, freely chosen walking speed, and spatio-temporal parameters of gait. When using the hydraulic device both groups had a smoother/more rapid progression of the centre of pressure beneath the prosthetic hindfoot (p ≤ 0.001), and a smaller reduction in centre of mass velocity during prosthetic-stance (p < 0.001). As a result freely chosen walking speed was higher in both groups when using the device (p ≤ 0.005). In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p < 0.07) to increase bilaterally when using the hydraulic device. Effect size differences between foot types were comparable across groups. Use of a hydraulic ankle–foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance.

Yes / Normal ankle function provides a key contribution to everyday activities, particularly step/stair ascent and descent, where many falls occur. The rising to up-on-the-toes (UTT) 30 second test (UTT-30) is used in the clinical assessment of ankle muscle strength/function and endurance and is typically assessed by an observer counting the UTT movement completed. The aims of this study are: (i) to determine whether inertial measurement units (IMUs) provide valid assessment of the UTT-30 by comparing IMU-derived metrics with those from a force-platform (FP), and (ii) to de-scribe how IMUs can be used to provide valid assessment of the movement dynamics/stability when performing a single UTT movement that is held for 5 s (UTT-stand). Twenty adults (26.2 ± 7.7 years) performed a UTT-30 and a UTT-stand on a force-platform with IMUs attached to each foot and the lumbar spine. We evaluate the agreement/association between IMU measures and measures de-termined from the FP. For UTT-30, IMU analysis of peaks in plantarflexion velocity and in FP’s centre of pressure (CoP) velocity was used to identify each repeated UTT movement and provided an objective means to discount any UTT movements that were not completed ‘fully’. UTT movements that were deemed to have not been completed ‘fully’ were those that yielded peak plantarflexion and CoP velocity values during the period of rising to up-on-the-toes that were below 1 SD of each participant’s mean peak rising velocity across their repeated UTT. The number of UTT movements detected by the IMU approach (23.5) agreed with the number determined by the FP (23.6), and each approach determined the same number of ‘fully’ completed movements (IMU, 19.9; FP, 19.7). For UTT-stand, IMU-derived movement dynamics/postural stability were moderately-to-strongly correlated with measures derived from the FP. Our findings highlight that the use of IMUs can provide valid assessment of UTT test(s).

Hip-knee-ankle-foot (HKAF) prostheses are full lower limb devices for people with hip amputations. They are designed to enable individuals to regain their mobility and move freely with little restriction. HKAFs typically have high rejection rates among users, as well as gait asymmetry and increased trunk anterior-posterior lean and pelvic tilt. In this thesis, a novel integrated hip-knee (IHK) unit was designed and evaluated to address the limitations of existing solutions. This IHK combines powered hip and microprocessor controlled knee joints into one structure, with shared electronics, sensors, and batteries. The unit is also adjustable to the user leg length by a prosthetist. ISO-10328 standard mechanical testing demonstrated acceptable structural safety and rigidity. Successful functional testing involved three able-bodied participants walking with the IHK in a hip prosthesis simulator. Hip and knee joint angles and pelvic tilt angles were recorded, gait characteristics were analyzed using video recordings. Testing showed that the participants were able to walk using the IHK, and data showed that participants used different walking strategies. Points of improvement were identified for future development of the thigh unit, including completion of a synergistic gait control system, improved battery holding mechanism, and amputee user testing.

Background: Fresh osteochondral allograft (OCA) transplantation represents a biologic restoration technique as an alternative treatment option for larger osteochondral lesions of the talus (OLT). The purpose of this study was to evaluate midterm outcomes after OCA transplantation for the treatment of OLT. Methods: Nineteen patients (20 ankles) received partial unipolar OCA transplant for symptomatic OLT between January 1998 and October 2014. The mean age was 34.7 years, and 53% were male. The average graft size was 3.8 cm2. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), the Olerud-Molander Ankle Score (OMAS), and pain and satisfaction questionnaires. Failure of OCA was defined as conversion to arthrodesis or revision OCA transplantation. Results: Five of 20 ankles (25%) required further surgery, of which 3 (5%) were considered OCA failures (2 arthrodesis and 1 OCA revision). The mean time to failure was 3.5 (range, 0.9 to 6.7) years. Survivorship was 88.7% at 5 years and 81.3% at 10 years. The median follow-up of the 17 patients with grafts in situ was 9.7 years. The mean OMAS improved significantly from 40 points preoperatively to 71 points postoperatively (P < .05; range, 5 to 55). The mean postoperative AAOS-FAM core score was 81.5 ± 15 (range, 40.5 to 96.6). Fifteen of 17 patients responded to follow-up questions regarding their ankle; 14 patients reported less pain and better function, and 13 patients were satisfied with the results of the procedure. Conclusion: Our study of midterm results after OCA transplantations showed that this procedure was a reasonable treatment option for large OLT. Level of Evidence: Level IV, case series.

Bakgrund: Tio till tjugo procent av akuta skador på ligamenten kring fotleden resulterar ikronisk fotledsinstabilitet, vilket innebär en instabilitetskänsla, stukningstendens, smärta ochsvullnad i fotleden. Det är värdefullt att som fysioterapeut ha kunskap om vilkenrehabiliteringsmetod som förbättrar balans i syfte att öka stabiliteten i foten. Syfte: Sammanställa litteraturen och bedöma det vetenskapliga underlaget gällande effektenpå balansen hos individer med kronisk fotledsinstabilitet genom träning med balansbräda.Detta ställs upp i två sammanvägningar: balansbräda jämfört med styrketräning, ochbalansbräda jämfört med ingen behandling. Metod: En systematisk litteratursökning efter randomiserade kontrollerade studier utfördes idatabaserna PubMed, Uppsala universitetsbibliotek, samt Cochrane Library. Totaltinkluderades åtta studier med sammanlagt 286 deltagare. Samtliga studier kvalitetsgranskadesenligt PEDro-skalan, och GRADEstud användes för bedömning av det sammanvägdaresultatets tillförlitlighet. Resultat: Signifikant förbättring av balans kopplat till styrketräning samt balansträning medbalansbräda, men liten fördel för en kombination för de båda kopplat till statisk balans. Kvalitetsgranskning enligt PEDro visade på att sex studier hade en måttlig kvalité och tvåstudier hade hög kvalité. Utifrån evidensbedömningen anses det föreligga en lågtillförlitlighet till det vetenskapliga underlaget för styrketräning med motståndsband förfotleden samt balansträning med balansbräda. Konklusion: Både styrketräning för relevant muskulatur och balansträning med balansbrädaförbättrar balansen efter ett ≥4 veckor långt protokoll med ≥3 träningssessioner/vecka.Evidensen talar för att båda rehabiliteringsmetoder ger liknande utfall, men fler studierbehövs för att bekräfta resultatet då de sammanvägda resultaten har låg tillförlitlighet. / Background: Ten to twenty percent of acute ankle injuries result in chronic ankle instability,which results in instability in the foot, distorsion tendency, and pain and swelling around theankle. Thus it´s valuable for physiotherapists to have knowledge regarding whichrehabilitation methods yield the most positive effect on balance in order to increase stabilityin the foot. Purpose: To compile the literature and assess the evidence regarding the effects on balanceof people diagnosed with chronic ankle instability through rehabilitation with awobble-board. This is set up in two comparisons: wobble-board compared tostrength-training, and wobble-board compared to no treatment. Method: A systematic literature search for randomized controlled trials was done inPubMed, Uppsala University Library, and CochraneLibrary. A total of eight studies wereincluded in this review, with a total of 286 participants. Study quality was judged by using the PEDro-scale, and GRADEstud was used to assess the reliability of the combined results. Results: Significant improvement in balance related to resistance training and balancetraining with wobble-board, with a small advantage to training with a combination of the twowhen measuring static balance. Quality according to PEDro showed six studies of moderatequality and two studies of high quality. Grading of the evidence is deemed insufficient whenit comes to training with resistance bands and training with a wobble-board. Conclusion: Both strength-training for the relevant muscles and balance-training using thewobble-board improves the balance after a ≥4 week-long protocol with ≥3 sessions/week.The evidence shows that both methods give similar results, however further research isrequired to confirm the results because the reliability of the combined results was deemedinsufficient.

Soft robotic sensors (SRSs) are a class of pliable, passive sensors which vary by some electrical characteristic in response to changes in geometry. The properties of SRSs make them excellent candidates for use in wearable motion analysis technology. Wearable technology is a fast-growing industry, and the improvement of existing human motion analysis tools is needed. Prior research has proven the viability of SRSs as a tool for capturing motion of the foot-ankle complex; this work covers extensive effort to improve and ruggedize a lab tool utilizing this technology. The improved lab tool is validated against a camera-based motion capture system to show either improvement or equivalence to the previous prototype while introducing enhanced data throughput, reliability, battery life, and durability.

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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