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Traditionally, the mechanical testing of ankle-foot orthoses (AFOs) has been performed with simple limb surrogates, typically with a single axis ankle joint and rigid foot and shank components. Since many current AFO designs allow 3D motion, a surrogate lower limb (SLL) that provides anatomically similar motion in all planes is needed to enable realistic load testing and cyclic testing in a controlled manner. The aim of this thesis was to design, fabricate and test a novel SLL that provides anatomically realistic 3D foot motion, based on a consensus of the passive lower limb range of motion (RoM) found in the literature. The SLL design was inspired by the Rizzoli model, sectioning the lower limb into five segments (shank, hindfoot, midfoot, forefoot, toes). Ball and socket joints were used for the shank-hindfoot, hindfoot-midfoot, and midfoot-forefoot. Forefoot-toes used a hinge-type joint. 3D printed flexible thermoplastic polyurethane (TPU) snap-fit connectors connected the 3D printed nylon foot blocks. A threaded ball stud connected the shank shaft and hindfoot. This shank shaft was surrounded by a 3D printed polylactic acid (PLA) shank cover. The foot was cast in silicone rubber to emulate soft tissue, with a PLA custom mould based on a Össur prosthetic foot cover model. The SLL was successfully designed for easy fabrication using readily available techniques, materials, and components. Only the metal shaft required additional machining. 3D printed components used an affordable 3D printer (Artillery Sidewinder X1), and readily available nylon, PLA, and TPU. Using motion capture testing, SLL foot rotation angles were found to be within standard deviation of mean foot passive rotation angle ranges found in the literature, showing that most joints were within 5° of target maximum rotation angles. With load testing, the SLL was shown to survive static loads representing 1.5 times body weight for a 100 kg individuals and cyclic loads representing normal gait loading for 500,000 cycles.

No description available.

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

No description available.

No description available.

This master thesis deals with the engineering design of a knee-ankle orthosis and subsequent implementation of a functional sample. The subject of the first part of the thesis is the design of internal shape of the shell on the basis of the patient's leg using CAD software. The second part deals with the design of the hydraulic knee. The knee joint with hydraulic controlled bending enables easier movement for patients who are not able to bring up stairs and uneven surfaces than existing joints. In the implementation was used SolidWorks 2012 and Geomagic Studio 12.

Limited knowledge of the neuromechanical response to use of an ankle foot orthosis-footwear combination (AFO-FC) has created a lack of consensus in understanding orthotic motion control as a therapeutic treatment. Lack of consensus may hinder the clinician’s ability to target the motion control needs of persons with movement impairment (e.g., peripheral nerve injury, stroke, etc.). Some evidence suggests a proportional relationship between joint motion and neuromuscular activity based on the notion that use of lower limb orthoses that constrain joint motion may invoke motor slacking and decreasing levels of muscle activity. Use of AFO-FCs likely alters the biomechanical and neuromuscular output as the central control system gradually forms new movement patterns. If there is proportional relationship between muscle activation and joint motion, then it could be examined by quantifying joint motion and subsequent neuromuscular output. Considering principles of neuromechanical adjustment, my general hypothesis examines whether orthotic control of lower limb motion alters neuromuscular output in proportion to the biomechanical output as a representation of the limb’s dynamics are updated by the neural control system. The rationale for this approach is that reference knowledge of the neuromechanical response is needed to inform clinicians about how a person responds to walking with motion controlling devices such as ankle foot orthoses combined with footwear. In the first line of research, I hypothesize that a newly developed AFO which maximizes leverage and stiffness will constrain the talocrural joint and alter joint kinematics and ground reaction force patterns. To answer the hypothesis, I sampled kinematics and kinetics of healthy subjects’ treadmill walking using an AFO-FC in a STOP condition and confirmed that the AFO substantially limited the range of talocrural plantarflexion and dorsiflexion motion to 3.7° and in a FREE condition maintained talocrural motion to 24.2° compared to 27.7° in a CONTROL (no AFO) condition. A follow up controlled static loading study sampled kinematics of matched healthy subjects limbs and cadaveric limbs in the AFO STOP and FREE conditions. Findings revealed healthy and cadaveric limbs in the AFO STOP condition substantially limited their limb segment motion similar to matched healthy subjects walking in the STOP condition and in the AFO FREE condition healthy and cadaveric limbs maintained similar limb segment motion to matched healthy subjects walking in the FREE condition. In a second line of research, I hypothesize that flexibility of a newly developed footwear system will allow normal walking kinetics due to the shape and flexibility of the footwear. To answer the hypothesis, I utilized a curved-flexible footwear system integrated with an AFO in a STOP condition and sampled kinematics and kinetics of healthy subjects during treadmill walking. Results revealed subjects elicited similar cadence, stance and swing duration and effective leg-ankle-foot roll over radius compared to walking in the curved-flexible footwear integrated with the AFO in a FREE condition and a CONTROL (no AFO) condition. To validate rollover dynamics of the curved-flexible footwear system, a follow up study of healthy subjects’ treadmill walking in newly developed flat-rigid footwear system integrated with the AFO in a STOP condition revealed interrupted leg-ankle-foot rollover compared to walking in curved-flexible footwear in STOP, FREE and CONTROL conditions. In a third line of research, I hypothesize that use of an AFO that limits talocrural motion in a STOP condition will proportionally reduce activation of Tibialis Anterior, Soleus, Medial and Lateral Gastrocnemii muscles compared to a FREE and CONTROL condition due to alterations in length dependent representation of the limb’s dynamics undergoing updates to the central control system that modify the pattern of motor output. To answer the question, the same subjects and AFO-footwear presented in the first two lines of research were used in a treadmill walking protocol in STOP, FREE, and CONTROL conditions. Findings revealed the same subjects and ipsilateral AFO-footwear system presented in Aim 1 exhibited an immediate yet moderate 30% decline in EMG activity of ipsilateral Soleus (SOL), Medial Gastrocnemius (MG) and Lateral Gastrocnemius (LG) muscles in the STOP condition compared to the CONTROL condition. The reduction in EMG activity in ipsilateral SOL, MG and LG muscles continued to gradually decline during 15 minutes of treadmill walking. On the contralateral leg, there was an immediate yet small increase of 1% to 14% in EMG activity in SOL, MG, LG muscles above baseline. After 10 minutes of walking, the EMG activity in contralateral SOL, MG and LG declined to a baseline level similar to the EMG activity in the contralateral CONTROL condition. These collective findings provide compelling evidence that the moderate 30% reduction in muscle activation exhibited by subjects as they experience substantial (85%) constraint of total talocrural motion in the AFO STOP condition is not proportionally equivalent. Further, the immediate decrease in muscle activation may be due to a reactive feedback mechanism whereas the continued decline may in part be explained by a feedforward mechanism. The clinical relevance of these findings suggests that short term use of orthotic constraint of talocrural motion in healthy subjects does not substantially reduce muscle activation. These preliminary findings could be used to inform the development of orthoses and footwear as therapeutic motion control treatments in the development of motor rehabilitation protocols.

Bakgrund: Många individer oftast äldre drabbas av gonartros, denna diagnos kan orsaka smärta och nedsatt funktion vilket i sin tur kan leda till begränsningar i det dagliga livet. Detta är en systematisk litteraturöversikt över studier som har undersökt laterala kil-inlägg som behandlingsmetod för att minska smärta och förbättra funktion hos patienter med medial gonartros. Syfte: Att studera om laterala kil-inlägg leder till reducerad smärta och främjad funktion jämfört med neutrala inlägg. Vidare utreds också om resultatet är baserat på olika undergrupper. Metod: En systematisk sökning i databaserna PubMed, MEDLINE, AMED, CINAHL och Cochrane Library utfördes för att hitta relevanta studier som sedan inkluderades utifrån förutbestämda kriterier. Data analyserades utifrån dessa artiklar för att besvara frågeställningen i detta arbete. Artiklarnas evidens och validitet/reliabilitet har bedömts. Resultat: Resultaten visar att laterala kilinlägg inte ger reducerad smärta och främjad funktion. Det finns heller inga samband kopplat till undergrupperna som studeras i denna systematiska översikt. Slussats: Det finns i denna rapport blandat med bevis för huruvida laterala kilinlägg reducerar smärta och främjar funktion. Även om ett antal studier påvisar positiva effekter är detta inte tillräckligt för att på ett statistiskt signifikant sätt säga att det hjälper. Det går inte att säga om behandlingen är mer lämpad för någon specifik undergrupp. / Background: Many individuals often the elderly suffering of gonatros, this diagnosis can cause pain and impaired function which in turn can lead to limitations in daily living. This is a systematic review of studies that have investigated lateral wedged insoles as a treatment to reduce pain and improve function in patients with medial gonartros. Aim: To study whether lateral wedge insoles lead to reduced pain and improved function compared with neutral insoles. Furthermore, it is also investigated if the result is based on different sub-groups. Method: A systematic search in the databases PubMed, MEDLINE, AMED, CINAHL and Cochrane Library was performed to find relevant studies which then were included based of predetermined criteria. Data from these articles where analysed to answer our question in this paper. The articles were examined for risk of bias and validity/reliability. Results: The results show that lateral wedge insoles do not reduce pain and improve function. There are also no signs that a certain sub-group would be more suited for the treatment. Conclusion: There is in this paper a contradictory result of whether lateral wedge insoles reduce pain and improve function. Although several studies indicate positive effects it is not enough to prove in a statistically significant way that it helps. It is not possible to say whether the treatment is more suitable for any specific subgroup.

The raw data related to the second study of this thesis (Chapter 3) is available online in the section of supporting information at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232677. These files present the following data: S1 File. The pattern of foot orthosis depression/reformation for healthy subjects during walking with sport versus regular foot orthosis. S2 File. Raw data for the training session of sport foot orthosis. This Excel file consists three sheets in which the position of triad markers, the orientation of triad markers and the position of markers on plantar surface of foot orthosis are provided respectively. S3 File. Raw data for walking with sport foot orthosis. This Excel file consists two sheets in which the position of triad markers and the orientation of triad markers are provided respectively for subject 1. S4 File. The results of each participant during walking with sport foot orthosis. This .mat file includes “DispEachPoint” and “DispEachPointMean” which shows the displacement of each predicted marker on foot orthosis plantar surface during stance phase of walking relative to its corresponding position in static non weight-bearing for each trial and the average of trials respectively. In addition, “loc_stance” and “loc_meanstance” show the location of each predicted marker during stance phase of walking. “peaks” and “peaksMean” represent the minimum (depression) and maximum (reformation) value of displacement during walking S5 File. The results of each participant during walking with regular foot orthosis. This .mat file includes “DispEachPoint” and “DispEachPointMean” which shows the displacement of each predicted marker on foot orthosis plantar surface during stance phase of walking relative to its corresponding position in static non weight-bearing for each trial and the average of trials respectively. In addition, “loc_stance” and “loc_meanstance” show the location of each predicted marker during stance phase of walking. “peaks” and “peaksMean” represent the minimum (depression) and maximum (reformation) value of displacement during walking / Les orthèses plantaires (OP) sont des dispositifs médicaux fréquemment utilisés pour réduire les douleurs et blessures de surutilisation, notamment chez les personnes ayant les pieds plats. Le port d'OP permettrait de corriger les altérations biomécaniques attribuées à la déformation du pied plat, que sont la perte de l’arche longitudinale médiale et la pronation excessive du pied. Cependant, le manque de compréhension de la fonction des OP entraine une grande variabilité des OP prescrites en milieu clinique. L'objectif de cette thèse est d'approfondir les connaissances sur l’effet des OP sur la biomécanique, de quantifier les déformations des OP à la marche et de mettre en relation ces déformations avec la biomécanique du pied. La première étude a évalué la manière dont les différentes conceptions d'OP imposent des modifications dans le mouvement et le chargement appliqué sur le pied. Cet objectif a été atteint grâce à une revue systématique traitant des effets des OP sur la cinématique et la cinétique du membre inférieur pendant la marche chez des personnes ayant des pieds normaux. Les critères d'inclusion ont réduit les études à celles qui ont fait état des résultats pour les géométries les plus fréquentes des OP, à savoir les biseaux, les supports d’arche et les stabilisateurs de talon. La revue a mis en évidence que les orthèses avec un biseau médial peuvent réduire le moment d'éversion de la cheville. Aucune évidence significative n'a été trouvée dans notre méta-analyse sur l'efficacité des orthèses incluant des supports d’arche ou des stabilisateurs de talon. Les différents procédés et matériaux utilisés dans la conception des OP ainsi que les caractéristiques des pieds des participants pourraient expliquer la variabilité retrouvée au regard des effets des OP sur la biomécanique. La deuxième étude a apporté des informations précieuses et inédites sur le comportement dynamique des OP à la marche. La cinématique du contour des OP a été utilisée pour prédire la déformation de leur surface plantaire pendant la marche chez 13 individus ayant des pieds normaux en utilisant un réseau de neurones artificiels. Une erreur moyenne inférieure à 0,6 mm a été obtenue pour nos prédictions. En plus de la précision des prédictions, le modèle a été capable de différencier le patron de déformations pour deux OP de rigidités différentes et entre les participants inclus dans l’étude. Enfin, dans une troisième étude, nous avons identifié la relation entre la déformation des OP personnalisées et la biomécanique du pied à la marche chez 17 personnes avec des pieds plats. L'utilisation de modèles linéaires mixtes a permis d’exprimer les variations de la déformation des OP dans différentes régions en fonction des variables cinématiques du pied et de pressions plantaires. Cette étude a montré que l'interaction pied-OP varie selon les différentes régions de l’OP et les différentes phases du cycle de marche. Ainsi, des lignes directrices préliminaires ont été fournies afin de standardiser et optimiser la conception des OP. Dans l'ensemble, les résultats de cette thèse justifient l'importance d’'intégrer des caractéristiques dynamiques du pied de chaque individu dans la conception d'OP personnalisées. Des études futures pourraient étendre les modèles de prédiction de l'interaction pied-OP en incluant d'autres paramètres biomécaniques tels que les moments articulaires, les activations musculaires et la morphologie du pied. De tels modèles pourraient être utilisés pour développer des fonctions coût pour l'optimisation de la conception des OP par une approche itérative utilisant la simulation par les éléments finis. / Foot orthoses (FOs) are frequently used medical devices to manage overuse injuries and pain in flatfoot individuals. Wearing FOs can result in improving the biomechanical alterations attributed to flatfoot deformity such as the loss of medial longitudinal arch and excessive foot pronation. However, a lack of a clear understanding of the function of FOs contributes to the highly variable FOs prescribed in clinical practice. The objective of this thesis was to deepen the knowledge about the biomechanical outcomes of FOs and to formulate the dynamic behaviour of FOs as a function of foot biomechanics during gait. The primary study investigated how different designs of FOs impose alterations in foot motion and loading. This objective was achieved through a systematic review of all literature reporting the kinematics and kinetics of the lower body during walking with FOs in healthy individuals. The inclusion criteria narrowed the studies to the ones which reported the outcomes for common designs of FOs, namely posting, arch support, and heel support. The review identified some evidence that FOs with medial posting can decrease ankle eversion moment. No significant evidence was found in our meta-analysis for the efficiency of arch supported and heel supported FOs. The findings of this study revealed that differences in FO design and material as well as foot characteristics of participants could explain the variations in biomechanical outcomes of FOs. The second study provided valuable information on the dynamic behaviour of customized FOs. The kinematics of FO contour was used to predict the deformation of FO plantar surface in 13 healthy individuals during walking using an artificial intelligence approach. An average error below 0.6 mm was achieved for our predictions. In addition to the prediction accuracy, the model was capable to differentiate between different rigidities of FOs and between included participants in terms of range and pattern of deformation. Finally, the third study identified the relationship between the deformation of customized FOs and foot biomechanics in 17 flatfoot individuals during walking. The use of linear mixed models made it possible to identify the variables of foot kinematics and region-dependent plantar pressure that could explain the variations in FO deformation. This study showed that the foot-FO interaction changes over different regions of FO and different phases of gait cycle. In addition, some preliminary guidelines were provided to standardize and optimize the design of FOs. Overall, the results of this thesis justify the importance of incorporating the dynamic characteristics of each individual’s foot into the design of customized FOs. Future studies can extend the predictive models for foot-FO interactions by including other determinants of foot biomechanics such as joint moments, muscle activation, and foot morphology. Based on such extended models, the cost functions could be devised for optimizing the designs of customized 3D printed FOs through an iterative approach using finite element modeling.