A hanseníase é doença crônica causada pelo Mycobaterium leprae e possui como característica a alteração de sensibilidade cutânea, causando deformidades de mãos e pés. O tratamento compreende o uso de medicamentos (PQT) e o Ministério da Saúde (MS) preconiza o uso de palmilhas tipo Plataforma para Tarso (PT) como tratamento complementar. Há na literatura muitos artigos sobre o uso de palmilhas para melhora do equilíbrio e redistribuição da pressão plantar em pacientes neuropáticos, mas não foram encontrados estudos que incluíssem as palmilhas PT. Neste estudo comparou-se o equilíbrio do paciente hanseniano com valores de normalidade pré-definidos e também comparou-se prospectivamente a influência da palmilha PT no paciente com hanseníase, por meio de testes de equilíbrio estático e dinâmico realizados com o aparelho Balance Master (NeuroCom Int. Inc.) antes e após 3 meses de uso. Foram selecionados 40 pacientes em tratamento no HCFMRP, dos quais 19 mantiveram o seguimento à pesquisa (68,4% do sexo masculino, com média etária de 51,95), e todos com mesma classificação operacional Multibacilar. Os testes delinearam o comportamento destes pacientes com relação aos controles involuntário de equilíbrio (sistemas sensoriais-teste modifCTSIB) e voluntário de excursão do Centro de Gravidade Corporal (COG; teste LOS), bem como a estabilidade da marcha (teste WA). Os resultados obtidos com o modifCTSIB mostraram que os pacientes com hanseníase, para o controle do equilíbrio (de acordo com a relação entre testes com olhos abertos e fechados, e para superfície estável e instável; valor p<0,01 para todas as correlações aplicadas), são mais dependentes do sistema visual que do somatossensorial, em relação à normalidade. As palmilhas PT não influenciaram na modulação dos sistemas sensoriais (p>0,05). No entanto o uso das palmilhas interferiu negativamente no teste LOS, para as variáveis distância final percorrida e máxima excursão do COG somente no ponto para frente e para esquerda (p<0,01), e favoreceu o controle direcional do COG no mesmo ponto (p=0,02). Na análise dos prontuários foram identificados déficits sensitivos com maior frequência nos antepés esquerdos. O teste WA revelou que os pacientes apresentaram a marcha mais lenta em relação ao padrão de normalidade, e aumentaram a velocidade de marcha (p=0,04) e o comprimento do passo (p=0,04) após o uso das palmilhas. Concluiu-se que as palmilhas tipo PT favoreceram a estabilidade para a marcha e para o controle voluntário do equilíbrio. E ainda foi observado que os pacientes tornaram-se dependentes das palmilhas, fator importante a ser considerado pelo serviço de Saúde após a alta medicamentosa / Leprosy is a chronic disease caused by the Mycobacterium leprae with sensitivity impairment as a characteristic that could lead to deformities of hands and feet. The Ministry of Health of Brazil (MS) recommends the use of platform for Tarsus (PT) insoles as a complementary treatment to the Multi-drug Therapy (MDT). Many articles in literature discussed the use of insoles for improving balance and redistribution of plantar pressure in neuropathic patients, but there are no studies that included PT insoles. This study compared the balance control values for the leprosy patient with normal standards and also prospectively compared the influence of PT insole in patients with leprosy, by means of static and dynamic tests performed with the Balance Master (NeuroCom Int. Inc.) device, before and after 3 months. 40 patients following treatment in HCFMRP were selected, of which 19 completed the follow-up to the survey (68.4% male, mean age 51.95), all classified operationally as Multibacillary. The tests outlined the behavior of these patients with regard to involuntary balance control (modifCTSIB sensory test) and voluntary excursion of the Body Center of Gravity (COG; LOS test) as well as the gait stability (WA test). The results obtained with the modifCTSIB showed that patients with leprosy are more dependent on the visual system than the somatosensation for balance controlwhen compared to normal values (according to the relationship between tests with open and closed eyes, and stable and unstable surface; p <0.01 for all applied correlations). The insoles PT did not influence the modulation of the sensory systems (p> 0.05). However the use of insoles interfered negatively in the LOS test for the variables end point and maximum excursion of the COG only on the forward to left position (p <0.01), and favored the directional control of COG at the same position (p= 0.02). The analysis of the patients file revealed that sensitivity deficits were identified more frequently in the left forefeet, which might explain the observed differences for the excursion of the COG only in this region. The WA test showed that patients have slower walking patters compared to normal values but had their walking speed (p = 0.04) and the length of their step increased (p = 0.04) after the use of the insoles. It was concluded that the PT insoles favored gait stability and voluntary control of body balance. It was also observed that patients become dependent on the insoles, an important factor to be considered by the Health service after the PQT discharge

Στον τομέα της κινητικής αποκατάστασης, η έννοια της βιοανάδρασης για τη βελτίωση του ταλάντευσης της στάσης του ανθρώπινου σώματος και του ελέγχου της ισορροπίας είναι αρκετά διαδεδομένη. Στις περισσότερες περιπτώσεις, το υποκείμενο προσπαθεί να ελέγξει τη θέση του με μια οπτική, προφορική ή αφής ανατροφοδότηση που παρέχεται από ένα ηλεκτρονικό σύστημα ή έναν νοσοκομειακό γιατρό. Πρόσφατες μελέτες αφορούν ασθενείς με κάποια νευρολογική ασθένεια που ελάμβαναν την οπτική ανατροφοδότηση στεκόμενοι σε μια δυναμοπλατφόρμα, ώστε να ελέγχουν την θέση του σημείου κεντρικής τους πίεσης (CoP). Στην έρευνά μας, καταγράφουμε τη κατανομή πίεσης κάτω από τα πόδια του υποκειμένου και παρέχουμε τις σχετικές ακουστικές πληροφορίες βιοανάδρασης (ABF) στην κατεύθυνση της βελτίωσης της ισορροπίας στάσης του. Με την παροχή αυτών των πρόσθετων ακουστικών πληροφοριών, στόχος μας είναι να διευκολύνουμε τη διαδικασία αντιστάθμησης της ελλείπουσας ή ανεπαρκούς αισθητήριας πληροφορίας από το κεντρικό νευρικό σύστημα (CNS). Έχουμε αναπτύξει και σε προκαταρκτικό στάδιο δοκιμάσει ένα σύστημα ακουστικής βιοανάδρασης βασιζόμενο σε μεσοσόλες με αισθητήρες πίεσης. Ο χρησιμοποιούμενος αλγόριθμος ABF έχει την ίδια βάση με αυτον που εφαρμόζεται σε ένα πρωτοτύπο ABF σύστημα, ήδη αναπτύγμενο και δοκιμασμένο, το οποίο ελέγχει τις μετακινήσεις επιτάχυνσης του σώματος. Οι μετρήσεις των τιμών πίεσης στα πόδια γίνονται μέσω ενός ζευγαριού εύκαμπτων μεσοσολών με 24 ειδικούς ενσωματωμένους αισθητήρες πίεζο-αντίστασης που περικλύονται σε κυτταρική δομή γεμάτη υγρό (Paromed). Η εφαρμογή ελέγχου αναπτύχθηκε σε περιβάλλον LabView και επιτρέπει τη συλλογή δεδομένων πίεσης σε 100Hz και την επεξεργασία αυτών σε πραγματικό χρόνο για τον υπολογισμό μιας εκτίμησης της τιμής του στιγμιαίου CoP. Η συμπεριφορά ταλάντευσης του CoP στα δυο επίπεδα, εμπρόσθια-οπίσθια AP και διάμεσα-πλευρικά ML, αποτυπώνεται σε ένα στερεοφωνικό ακουστικό σήμα που αλλάζει στο εύρος, τη συχνότητα και την ισορροπία L/R και μέσω των ακουστικών παρέχεται στο υποκείμενο. Το πειραματικό μας πρωτόκολλο περιέλαβε μια σειρά μετρήσεων με υγιείς εθελοντές εκτελώντας συγκεκριμένους στατικούς στόχους, με και χωρίς παρεχόμενο ABF. Κατά τη διάρκεια αυτών των στόχων προσπαθήσαμε να εξομοιώσουμε τις συνθήκες όπου η αισθητήρια πληροφορία είναι ελλείπουσα ή ανεπαρκής. Προκαταρκτικά αποτελέσματα στην ML κατεύθυνση, έδειξαν οτι με την ύπαρξη του ABF το ανθρώπινο σώμα ταλαντεύθηκε λιγότερο, γεγονός ενδεικτικό του ότι αυτό το νέο-αναπτυγμένο σύστημα βιοανάδρασης βασιζόμενο στις πίεζο-μεσοσόλες μπορεί να χρησιμοποιηθεί για να βελτιώσει την ισορροπία. Περισσότερα πειράματα και αναλυτική στατιστική ανάλυση πρέπει να ακολουθήσουν ώστε να γίνει κατανοητή η επιρροή αυτού του ABF στην ισορροπία του ανθρώπινου σώματος. / In the area of motor rehabilitation, the concept of biofeedback for improving postural sway and balance control is quite common. In most cases, the subject tries to control his position by a visual, oral or tactile feedback provided by an electronic system or a clinician. Recent studies involved patients with neurological disease that were receiving visual feedback as were standing in a force plate, for the monitoring of their centre of pressure (CoP) position. In our research, we record the pressure distribution beneath the subject's feet and provide related audio biofeedback (ABF) info in the direction of improving posture balance. By providing this extra audio information to the subject our aim is to facilitate the compensation process of the missing or inadequate sensory information by its central nervous system (CNS). We have developed and preliminary validated an insole pressure sensor-based, ABF system. The ABF concept followed is the same with the one applied in a prototype ABF system, already developed and validated, which monitors trunk acceleration movements. Foot pressure values were acquired through a pair of flexible insoles with 24 embedded discrete piezo-resistive sensors contained in a fluid-filled cell (Paromed). The control application was developed in LabView environment and permits pressure data collection in 100Hz and real-time processing for the calculation of an estimated value of the instant CoP. Swaying CoP behaviour in both AP and ML planes is mapped in a stereo audio signal changing in amplitude, frequency and L/R balance, which through the earphones is provided to the subject. Our experimental protocol involved a series of measurements with normal subjects performing specific static tasks, with and without ABF provided. During these tasks we tried to simulate conditions of missing or inadequate sensory information. Preliminary results about ML direction, shown that when ABF was provided the subject swayed less, suggesting that this new-developed biofeedback pressure-sensor insole-based system can be used to improve balance. More experiments and appropriate statistical analysis has to be done so as to understand the influence of this ABF on subject’ s balance.

Title: 3D analysis of immediate effect on posture of shoe with postural insoles based on Rašev and with proceptor insoles PodoAktiv® Objectives: The thesis aims to show the immediate effect of application of custom-made insole on postural hold of chosen body segments and we would like to determine whether it is possible to use PodoAktiv® or insole based on Rašev to correct body posture. Methodology: In this thesis we examined 9 participants who agreed joining the study. We used the Balance®4D device made by Paromed company. The selected body segments were marked by white spheric stickers. To compare postural hold of selected body segments we examined the participants in altogether 4 situations. Barefoot stand, stand in shoes without insoles, stand in shoes with postural insoles based on Rašev and stand in shoes with proceptor insoles PodoAktiv®. Results: The results of this study show that there is a slight immeadiate effect of the custom- made insoles on postural hold of body segments. Larger effect was observed in the participants who already had a bad postural barefoot hold. Of all 6 parameters, the biggest effect was observed in the shift of overall body axis after application of PodoAktiv® insoles. Keywords: Shoe insoles, proprioceptors, somatosensory system, 3D static analysis, postural hold

Author: Bc. Simona Bartošová Title: Effect of sensomotoric insoles on postural stability in children with cerebral palsy Objectives: Objectively assess the effect of sensomotoric insoles on children with cerebral palsy (CP) via COP (Centre of Pressure) parameters recorded on Kistler force plate. Methods: This thesis is designed as an experimental study. Selected paramaters of static postural balance were recorded via force plate to assess the effect of sensomotoric insoles. Five subjects (average age 7.2 years) with diagnosis of cerebral palsy were enrolled into the study. Data collection was carried out in two separated sessions - first before therapy and second after using the insoles for one month. The validity of the data was supported by three repetitions for each modification - upright plain stand with open eyes, upright stand with feet together and upright plain stand with closed eyes. Monitored parameters were: total trajectory of COP, amplitude of mediolateral displacement of COP, amplitude of anteroposterior displacement of COP and mean velocity of movement of COP. The data were analyzed in MATLAB® version R2019b. The statistical analysis was performed including the outliers elimination. The normality of data was checked by Lilliefors' test. In the case of normality a two-sample Student's...

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Title: 3D analysis of immediate effect on posture of shoe with postural insoles based on Rašev and with proceptor insoles PodoAktiv® Objective: The aim of this study is to evaluate the immediate effect of shoe insoles with postural pelote by Rašev and shoe insoles with proceptors PodoAktiv® on the postural hold with main focus at the pelvis and shoulder. Methodology: In this thesis we examined 9 participants who agreed joining the study. To messure postural hold body segments which we have chosen, we have used the Balance® 4D device. The selected body segments were marked by white spheric stickers. To compare postural hold of selected body segments we examined the participants in altogether 4 situations. Barefoot stand, stand in shoes without insoles, stand in shoes with custom-made postural insoles based on Rašev and stand in shoes with custom-made insoles PodoAktiv® . Results: In this study we confirmed that postural insoles based on Rašev have immediate effect on the hold of pelvis and shoulders. The insoles PodoAktiv® don't show such an effect on the hold of those segments we have tested. The hypothesis H1 and H2 have been confirmed, hypothesis H3 and H4 have been rejected. There was not found any trend which would describe the immediate reaction of the participants (postural hold with main...

Les problèmes liés à l'équilibre sont diagnostiqués à l'aide de systèmes de cartographies des pressions plantaires ou de plateformes de force mesurant le déplacement du centre de pressions. Ces systèmes professionnels sont restreints à une utilisation en milieu médical, et on constate qu'aucun dispositif de surveillance de l'équilibre ne donne entière satisfaction en termes de mobilité et d'acceptabilité. Dans le contexte de la télémédecine et de l'e-santé, notre objectif a consisté à développer des outils pour la surveillance ambulatoire de l'équilibre postural, et contribuer à la compréhension du contrôle de l'équilibre. Nous avons d'abord entrepris une étude théorique de la faisabilité de la mesure des pressions plantaires et du déplacement dynamique du centre de pression, à partir d'un nombre très réduit de capteurs. Nous avons proposé pour cela un modèle mécanique simplifié du pied, ainsi que les hypothèses spécifiques à ces applications. Le modèle décrit la relation physique entre la posture du pied et la répartition des pressions plantaires suivant ses caractéristiques biomécaniques. Sur la base d'un prototype de semelle instrumentée à 3 capteurs uniquement, nous avons vérifié expérimentalement la capacité du système et des méthodes à générer le stabilogramme et les cartographies de pressions plantaires. Ceux-ci ont été comparés à un système matriciel de référence, et caractérisés en termes d'incertitude dans le cas du pied normal en position debout et durant la marche. Les stabilogrammes ainsi mesurés peuvent être analysés pour caractériser la signature de l'équilibre. Nous proposons un modèle spécifique à trois dimensions, décrivant la dynamique de l'équilibre et permettant d'identifier, par simulation, les principaux paramètres physiologiques qui assurent le maintien de l'équilibre postural. / Problems of balance are often diagnosed thanks to plantar pressure cartography systems or forces platform that measure the center of pressure displacement. These professional systems are restricted in use to medical environments, and until now, the balance monitoring systems do not offer complete satisfaction in terms of mobility and acceptability. In order to overcome these limitation and in the context of telemedicine and e-health, we aimed to develop tools for ambulatory monitoring of postural equilibrium and to understand the balance control. We have first undertaken a theoretical study on the feasibility of measuring plantar pressure and dynamic displacement of the center of pressure, from a very small number of sensors. For these applications, we have proposed a simplified mechanical foot model, as well as related assumptions. The model describes the physical relationship between foot posture and distribution of plantar pressures following its biomechanical characteristics. Based on a prototype of an instrumented insole with only 3 sensors, we have verified experimentally the ability of the system and the methods to generate both the stabilogram and the plantar pressure maps. Comparison is made with a matrix reference system, and characterization in terms of uncertainty in the case of normal foot in standing position and during walking is detailed. The measured stabilogram can be analyzed to characterize the signature of balance. We have also proposed a specific three-dimensional model describing the dynamics of balance. Based on simulation, it leads to identify the main physiological parameters related to balance control.

When performing a biomechanical analysis of human movement, knowledge about the ground reaction force (GRF) is necessary to compute forces and moments within joints. This is important when analysing a movement and its effect on the human body. To obtain knowledge about the GRF, the gold standard is to use force plates which directly measure all three components of the GRF (mediolateral, anteroposterior and normal). However, force plates are heavy, clunky and expensive, setting constraints on possible experimental setups, which make it desirable to exclude them and instead use a predictive method to obtain the full GRF. Several predictive methods exist. The node model is a GRF predictive method included in a musculoskeletal modeling software. The tool use motion capture and virtual actuators to predict all three GRF components. However, this model has not yet been validated during weighted leg press and weighted squat. Furthermore, the normal component of the GRF can be measured continuously during the activity with pressure sensitive insoles (PSIs), which might provide better accuracy of the GRF prediction. The objectives of this thesis were to investigate whether force plates can be exluded during weighted leg press and weighted squat and to investigate whether PSIs can improve the GRF prediction. To investigate this, the node model and a developed shear model was validated. The shear model computes the two shear GRF components based on data from PSIs, an external load acting upon the body and data from a motion capture system. Both the node model and the shear model were analysed with two test subjects performing two successive repetitions of both weighted squat and weighted leg press in a flywheel exercise device. During the leg press exercise, the node model had a mean coeffcient of correlation (Pearson's) ranging from 0.70 to 0.98 for all three directions with a mean root mean square error ranging between 8 % to 20 % of the test person's body weight. The developed shear model had a coeffcient of correlation (Pearson's) between 0.64 to 0.99 and a mean root mean square error between 3 % and 21 % of the test person's body weight. This indicates that it is possible to exclude force plates and instead predict the GRF during weighted leg press. During squat, neither the node model nor the shear model provided accurate results regarding the mediolateral and anteroposterior components of the GRF, suggesting that force plates can not yet be excluded to obtain the full GRF during weighted squat. The results of the normal component during leg press was somewhat improved with the shear model compared to the node model, indicating that using PSIs can improve the results to some extent.

Purpose: A common prescription in Prosthetic and orthotic clinics in Sweden is custom-made foot orthoses (CmFO). These must be placed in shoes. The aim of this study was to investigate whether the shoe type will have an impact on the effectiveness of CmFO regarding plantar pressure (PP).  Method: PP data was collected during gait from two healthy participants while wearing two pairs of different shoe types, a stable walking shoe and a flexible canvas shoe, with CmFO and original shoe insoles (OSI) respectively. The in-shoe F-scan system was used for data collection. Results: Going from canvas shoe to walking shoe showed reduced peak PP with around 40% in the forefoot and 27-50% in the heel. The walking shoe increased midfoot pressure &gt;90% for both participants compared to the canvas shoe. The use of CmFO reduced the peak PP in the heel by 35-41% in the walking shoe and 9-44% in the canvas shoe.  Conclusion: The CmFO reduced peak PP in the heel and spread the pressure to the midfoot in both types of shoes but had bigger impact in the walking shoe. The walking shoe with OSI generated lower peak PP under the forefoot and heel than the canvas shoe with CmFO. / Syfte: En vanlig förskrivning på ortopedtekniska kliniker i Sverige är individuellt formgjutna fotortoser vilka måste placeras i skor. Syftet med denna studie var att undersöka huruvida skotypen påverkar effekten av sådana fotortoser med hänsyn till plantartryck.  Metod: Data för plantartryck samlades in under gång från två friska deltagare bärandes två olika par av skor, en stabil Walking-sko och en flexibel canvassko, med individuellt formgjutna fotortoser respektive originalsulor genom att använda in-shoe  F-Scan systemet.  Resultat: Vid övergång från canvasskon till walking-skon minskade högsta plantartryck med ca 40% i framfot och 27-50% i hälen. Walking-skon ökade trycket i mellanfoten med över 90% för båda deltagarna jämfört med canvasskon. Användandet av individuellt formgjutna fotortoser sänkte högsta plantartryck i hälen med 35-41% i walkingskon och 9-44% i canvasskon.  Slutsats: De individuellt formgjutna fotortoserna sänkte högsta plantartryck i hälen och spred trycket mot mellanfoten i båda typerna av skor men hade en större påverkan i walking-skon. Walking-skon med originalsulor genererade lägre högsta plantartryck under framfoten och hälen än canvasskon med individuellt formgjutna fotortoser.

The topic of this diploma thesis is "Influence of footwear on foot deformities in women - the role of nurses in prevention". The theoretical part is devoted to the foot anatomy, it describes the issue of heels on the foot and represents the Giraffe certification. The practical part of the qualitative research shows the role of nurses in preventing foot deformities for patients. This thesis has two goals. To find out what footwear affects the deformities of the legs in women and to find out what role the nurse plays in preventing this issue. The research questions are 1. What is the importance of wearing high-heeled shoes for women and how will this be reflected later? 2. What role do nurses attribute to the prevention in this issue? Data collection was collected by semi-structured interviews with nurses in the orthopaedic ward and orthopaedic clinics. The research sample consists of 20 respondents, the choice was deliberate and formed by snowball sampling. In February 2019, data was collected, which was subsequently terminated at the moment of theoretical saturation. The interview covered themes: wearing high-heeled shoes, leg deformities caused by high-heeled shoes, nurse-led prevention and education. The results show that only a fraction of nurses adhere to the role of a nurse who helps patients prevent leg deformities. The rest of the nurses leave prevention and education to doctors. This diploma thesis presents as a work output a poster, which can be an information material for nurses from the orthopaedic clinics and beds. The output of the thesis is an educational poster that will reflect the entire nursing issue in prevention (the role of a nurse, the deformity of the feet caused by high-heeled shoes, etc.).