Post-stroke patients often experience less control and coordination of one of their legs, which could result in a condition known as foot drop. Foot drop is characterized by an inability to properly dorsiflex at the ankle and could lead to problems with foot clearance during gait and ultimately result in the person falling. It is assumed that the Allard Medical ToeOFF® ankle foot orthosis (AFO) is associated with shorter rehabilitation times and better rehabilitation outcomes than the standard fixed plastic AFO, but quantitative data is missing to prove this. We compared people who were prescribed the Allard Medical ToeOFF® AFO (n = 7) with the standard fixed plastic AFO (n = 3) for several different measures. The resulting data was analyzed for trends and the presence of statistically significant differences with the Wilcoxon Rank Sum test. Our statistical significance analysis was inconclusive, but we did identify a trend between the use of the Allard Medical ToeOFF® with greater increases of fractional change in the number of dorsiflexions before fatigue than with the use of the standard fixed plastic AFO. Also, the use of the standard fixed plastic AFO was associated with greater increases in fractional change of gait speed over the 6 week testing period than the use of the Allard Medical ToeOFF®. Further study with larger sample sizes is warranted and is expected to lead to more conclusive results about the presence of significant differences between the subjects using an Allard Medical ToeOFF® AFO and those using a standard fixed plastic AFO. These results could enable physicians in the future to make a more informed decision about which type of brace to prescribe for their patients. / 1 / Emily Sarah Relle

Context: Dorsiflexion range of motion (DFROM) is often limited in patients with chronic ankle instability (CAI). Whole-body vibration (WBV) may enhance DFROM by helping to reposition the talus and assisting with talocrural arthrokinematics. Objective: To determine if WBV can enhance DFROM in patients with ankle instability and determine if talar position is affected. Setting: Cohort study. Patients or Other Participants: A total of 25 subjects with CAI (17 women, 8 men; age = 22 ±2.101 years, mass = 72.4 ±17.9 kg, height = 171.2 ± 11.6 cm) participated. Intervention(s): Participants in the WBV group completed a 4-week (12 session) WBV program consisting of 6 sets of 30 s at 35 Hz High amplitude with 30 s rest in between standing on a 30° slant board. Participants in the dorsiflexion (DF) group completed a 4-week program without WBV consisting of 6 sets of 30 s standing on a 30° slant board with 30 s rest in between. Participants in the control (C) group did not receive any intervention. Main Outcome Measure(s): Lateral talus position via radiographic imaging, non-weight-bearing (NWB) DFROM, and weight-bearing (WB) DFROM were assessed preintervention, immediately postintervention, and 24 hours after the final intervention. Results: No significant change was detected in talus position measured by X-ray (F = 1.561; p < .05). NWB DFROM (F = 1.543; p < .05) and WB DFROM (F = .774; p < .05) measurements also did not result in significant changes after the WBV program. Conclusions: Four weeks of WBV treatments did not improve talus position or DFROM in ankle instability subjects.

BACKGROUND: Whole body vibration (WBV) platforms are currently used as adjunctive training devices for exercise programs, and have been shown to facilitate flexibility. One of the biggest contributing factors to chronic ankle instability (CAI) is the lack of dorsiflexion after lateral ankle sprains and WBV may be an effective way to increase range of motion in this population. PURPOSE: Determine if WBV done concurrently with static stretching (SS) is more effective then SS alone in improving dorsiflexion ROM in subjects with CAI. METHODS: Subjects were divided into 3 groups (control, static stretch, and static stretch and vibrate). Subjects stretched 4 days/wk for 3 wks for 4 sets of 30 seconds alternating 2 different positions to stretch both the soleus and the gastrocnemius. Imposed vibration at 34 Hz 2mm during the stretches for the stretch group. ANALYSIS: Repeated measures ANOVA was performed using SPSS (version 19), with post-hoc Tukey tests as needed (p<.05). RESULTS: In both the straight and bent leg position, a significant group x time interaction was found for dorsiflexion range of motion. Post hoc tests revealed significance in the SV group between pre-tx and post-tx 1 and pre-tx and post-tx 2. No statistical significance was found between post-tx 1 and post-tx 2 in the SV group or at any time in the N or SS group. DISCUSSION: Static Stretching with vibration increases dorsiflexion ROM in subjects with CAI better than static stretching alone.

No description available.

Yes / Most clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p= 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping.

Thesis (MEng) -- Stellenbosch University, 2014. / ENGLISH ABSTRACT: The Dorsiflexometer is a device designed and built for the assessment of a patient’s balance capabilities. The birth of the Dorsiflexometer is due to a serious need for physiological balance assessment equipment, capable of conducting dynamic tests in the clinical setting. This is accomplished by recording and analysing the patient’s response to sagittal plane perturbations. The Dorsiflexometer is operated from a computer software interface program. It uses the measurements from a single force plate to calculate four balance metrics’ characterising a patient’s ability to maintain balance. These balance metrics include the sway index, equilibrium score, postural stability index and radius parameter. A single and a double inverted pendulum model of the human body is derived to calculate a patient’s centre of mass movement in the sagittal plane with the measured force plate data and body parameters. Three experiments, involving 48 subjects, were conducted. The experimental tests proved the competency of the machine, the accuracy of both inverted pendulum models and the balance response of seafarers aboard an Antarctic research and supply vessel during rough sea conditions. The tests concluded that the inverted pendulum models can be used to calculate the body centre of mass displacement. The double inverted pendulum model results are more accurate compared with the single inverted pendulum model. During rough sea conditions, the body movement and postural response of seafarers are increased in order to keep themselves upright. The body is furthermore exposed to a fluctuating ground reaction force which may lead to the progression of osteoarthritis and musculoskeletal injuries. The Dorsiflexometer proved to be capable of conducting repeatable assessments and yielding accurate results which can be used to distinguish between balance capabilities. / AFRIKKANSE OPSOMMING: Die Dorsiflexometer is ’n apparaat wat die balansvermoë van pasiënte analiseer. Die masjien is ontwerp en vervaardig weens die groot behoefte aan fisiologiese balans assesserings toerusting wat dinamiese toetse in die mediese sektor kan bepaal. Dit word bereik deur pasiënte se liggaamsreaksie in die sagittale vlak te meet en te assesseer. Die Dorsiflexometer is beheerbaar vanaf ’n rekenaar sagteware koppelvlak program. Die masjien maak gebruik van ’n enkele kragplaat om pasiënte se balans statistieke te meet. Hierdie balans statistieke wat die pasiënte se balans vermoë beskryf en karakteriseer behels die sogenaamde: swaai indeks, balans telling, posturale stabiliteit indeks en die radius parameter. ’n Enkel en dubbel inverse slinger model van die liggaam is afgelei. Hierdie modelle maak gebruik van ’n pasiënt se kragplaat metings en sy liggaamlike parameters om die swaartepunt tydens beweging te bereken. Drie eksperimente, waarin 48 persone betrokke was, is gedoen. Die eksperimente is gedoen om die apparaat se bevoegdheid te bewys, die akkuraatheid van altwee inverse slinger modelle te toets en verder die balans van seevaarders op die Antarktiese navorsings en toevoer skip tydens rowwe see toestande te analiseer. Die toetse het bewys dat die inverse modelle gebruik kan word om die liggaam se swaartepunt te bereken. Die dubbel inverse slinger model resultate is wel akkurater as die enkel slinger model. Daar is bevind dat seevaarders van meer liggaamsbeweging en posturale reaksies gebruik moet maak om orent te bly tydens rowwe seetoestande. Verder word hul liggame blootgestel aan ’n wisselende grond reaksie krag wat kan lei tot die ontwikkeling van osteoarthritis en muskuloskeletale beserings. Die Dorsiflexometer is bewys as ’n aparaat wat wat akurate resultate lewer vir herhaalbare assesserings. Dit kan gebruik word om te onderskei tussen verskillende balans vermoëns.

L’objectif de ce travail de thèse est de caractériser, chez les amputés unilatéraux du membre inférieur, les modalités posturales qui interviennent dans la régulation de l’équilibre orthostatique et d’étudier l’impact de l’amputation sur la production de force à la cheville physiologique. Une première étude a révélé la présence de trois modalités posturales afin de réguler le contrôle postural : les amputés transfémoraux adoptent une modalité posturale basée sur les paramètres de stabilité, les amputés transtibiaux optent pour une modalité posturale mixte et les non amputés se réfèrent aux paramètres de l’attitude posturale. Etant donné que l’articulation de la cheville joue un rôle essentiel dans la régulation de l’équilibre postural, il était alors pertinent d’investiguer la production de force à la cheville physiologique. Toutefois, les ergomètres permettant d’étudier l’articulation de la cheville présentent des biais de mesure majeurs. Dans ce cadre, une deuxième étude a été menée afin de développer et valider un nouvel ergomètre pour cheville : le B.O.T.T.E. Parallèlement, la mise en place d’une méthode de mesure basée sur le retour visuel permettant une quantification fiable du couple de force a fait l’objet d’une troisième étude. Ensuite, une quatrième étude visait à utiliser le B.O.T.T.E. pour investiguer l’impact de l’amputation sur la production de force à la cheville physiologique. Les résultats de cette étude confirment la présence d’un déficit au niveau du couple de force généré en flexion plantaire (conditions maximale et sous maximale) chez les amputés transfémoraux. Enfin, ce travail de thèse vise à aider les rééducateurs et les cliniciens à optimiser la prise en charge des patients amputés. / This Ph.D. thesis aims to evaluate the standing posture modalities and the ankle joint torque in the intact limb in unilateral lower limb amputees. A first study shows the presence of three posture modalities: the non-amputee group relied on standing erect, the transfemoral amputees’ stance depended on balance control and the transtibial amputees exhibited a mixed modality of simultaneously maintaining an upright stance and standing balance. Since the ankle muscles have a functional importance in standing posture modalities, it is imperative to investigate the ankle joint torque in the intact limb. However, the current devices used to assess the ankle joint present substantial limitations for the measurement. Thus, a second study was designed to develop and to validate a new ankle ergometer B.O.T.T.E. Moreover, a third study was achieved in order to estimate the effect of visual feedback on enhancing isometric maximal voluntary contractions. A fourth study was realized to investigate the ankle joint torque in the intact leg of unilateral lower limb amputees. The results show that transfemoral amputees produce less torque and are less steady compared to transtibial amputees and able-bodied individuals. Overall, the present findings of this Ph.D. thesis could have implications for clinical practice and for rehabilitation of patients with a lower limb amputation.