Individuals with various lower-limb neuromuscular and musculoskeletal impairments are often prescribed passive-dynamic ankle-foot orthoses (PD-AFOs) to compensate for impaired ankle muscle weakness. Several studies have demonstrated the beneficial effects of PD-AFOs on pathological gait, but few studies have examined the influence of the AFO stiffness characteristics on gait performance. One challenge to performing such studies is the difficulty of manufacturing custom AFOs with a wide range of controlled stiffness levels. However, selective laser sintering (SLS) is a well-suited additive manufacturing technique for generating subject-specific PD-AFOs of varied stiffness. Therefore, the overall goal of this study was to use SLS manufactured PD-AFOs to identify the relationships between AFO stiffness and gait performance in patients with various lower-limb neuromuscular and musculoskeletal impairments. Six subjects with unilateral impairments were enrolled in this study. For each subject, one subject-specific PD-AFO equivalent to the subject’s clinically prescribed carbon fiber PD-AFO (nominal), one 20% more compliant and one 20% more stiff were manufactured using SLS. Three-dimensional kinematic and kinetic data were collected from each subject while ambulating with each PD-AFO at two different speeds to allow a comprehensive biomechanical analysis to assess the influence of PD-AFO stiffness on gait performance. The results showed that in the compliant AFO condition, the AFO limb vertical ground reaction force (GRF) impulse during loading and the non-AFO limb medial GRF impulse during push-off decreased. In addition, the AFO limb braking GRF impulse during loading and the non-AFO limb braking GRF impulse in early single-limb stance decreased. Furthermore, in the compliant AFO condition, negative knee work during early single-limb stance increased while positive hip work in early swing decreased in the AFO limb. Overall, as AFO stiffness decreased, the AFO limb contributed less to body support and braking. In addition, a decreased medial GRF impulse coupled with an increased vertical GRF impulse during non-AFO single-limb stance suggests that walking stability may be compromised as AFO stiffness decreases. Thus, a tradeoff may exist between preserving stability and increasing net propulsion, which should be considered when assessing the mobility needs of individuals prescribed PD-AFOs as a result of various neuromuscular and musculoskeletal impairments. / text

Este trabalho tem por objetivo principal a elaboração de fichas técnicas de materiais utilizados na fabricação de órteses de membro superior e inferior. Para a escolha dos materiais a serem elencados e caracterizados, selecionou-se as instituições de apoio ao deficiente da área metropolitana de Porto Alegre, RS. As selecionadas para a pesquisa foram a Associação de Assistência à Criança com Deficiência (AACD) e Associação Canoense de Deficientes Físicos (ACADEF). A metodologia abordou a listagem e seleção, e as etapas seguintes se deram a partir da organização dos materiais em grandes grupos: materiais poliméricos, materiais metálicos, materiais naturais e fibras. Assim agrupados, seguiu-se a caracterização e a análise dos materiais por meio de microscopia eletrônica de varredura (MEV), espectroscopia por energia dispersiva (EDS), espectroscopia no infravermelho por transformada de Fourier (FT-IR), espectrometria de fluorescência de raios-X e ensaio de tração e compressão. Os resultados práticos e as pesquisas em materiais bibliográficos e bancos de dados como o Granta Design permitiram a elaboração das fichas técnicas de cada material, apresentando as características gerais, propriedades físicas, mecânicas e químicas e aplicação. Essas fichas têm finalidade multidisciplinar, buscando auxiliar profissionais que trabalham no processo de fabricação destas órteses, como fisioterapeutas, terapeutas ocupacionais, técnicos de oficina, designers e projetistas, permitindo acesso direto e praticidade na fabricação destes produtos. / The main objective of this study is to develop technical sheets of materials utilized in the manufacturing of superior and inferior limb orthoses. Institutions that support disabled persons in the metropolitan area of Porto Alegre, RS, were selectioned in order to decide which materials were to be listed and characterized. The Association of Assistance for Children with Disability (AACD) and the Canoense Association of persons with Physical Disability (ACADEF) were selected for this research. Methods included listing and selection, and the following steps were conducted through the categorization of materials into large groups: polymeric materials, metal materials, natural materials and fibers. Thus grouped, the study continued with the characterization and analysis of materials through scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FT-IR), X-ray fluorescence spectrometry and tension and compression testing. Practical results and research in bibliographical material and databases such as Granta Design enabled the development of technical sheets for each material, presenting general characteristics, physical, mechanical and chemical properties and application. Such sheets have multidisciplinary purposes, seeking to assist health professionals who work in the manufacturing process of these orthoses, such as physiotherapists, occupational therapists, workshop technicians, designers and drafters, allowing for direct access and convenience in the manufacturing of these products.

Este trabalho tem por objetivo principal a elaboração de fichas técnicas de materiais utilizados na fabricação de órteses de membro superior e inferior. Para a escolha dos materiais a serem elencados e caracterizados, selecionou-se as instituições de apoio ao deficiente da área metropolitana de Porto Alegre, RS. As selecionadas para a pesquisa foram a Associação de Assistência à Criança com Deficiência (AACD) e Associação Canoense de Deficientes Físicos (ACADEF). A metodologia abordou a listagem e seleção, e as etapas seguintes se deram a partir da organização dos materiais em grandes grupos: materiais poliméricos, materiais metálicos, materiais naturais e fibras. Assim agrupados, seguiu-se a caracterização e a análise dos materiais por meio de microscopia eletrônica de varredura (MEV), espectroscopia por energia dispersiva (EDS), espectroscopia no infravermelho por transformada de Fourier (FT-IR), espectrometria de fluorescência de raios-X e ensaio de tração e compressão. Os resultados práticos e as pesquisas em materiais bibliográficos e bancos de dados como o Granta Design permitiram a elaboração das fichas técnicas de cada material, apresentando as características gerais, propriedades físicas, mecânicas e químicas e aplicação. Essas fichas têm finalidade multidisciplinar, buscando auxiliar profissionais que trabalham no processo de fabricação destas órteses, como fisioterapeutas, terapeutas ocupacionais, técnicos de oficina, designers e projetistas, permitindo acesso direto e praticidade na fabricação destes produtos. / The main objective of this study is to develop technical sheets of materials utilized in the manufacturing of superior and inferior limb orthoses. Institutions that support disabled persons in the metropolitan area of Porto Alegre, RS, were selectioned in order to decide which materials were to be listed and characterized. The Association of Assistance for Children with Disability (AACD) and the Canoense Association of persons with Physical Disability (ACADEF) were selected for this research. Methods included listing and selection, and the following steps were conducted through the categorization of materials into large groups: polymeric materials, metal materials, natural materials and fibers. Thus grouped, the study continued with the characterization and analysis of materials through scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FT-IR), X-ray fluorescence spectrometry and tension and compression testing. Practical results and research in bibliographical material and databases such as Granta Design enabled the development of technical sheets for each material, presenting general characteristics, physical, mechanical and chemical properties and application. Such sheets have multidisciplinary purposes, seeking to assist health professionals who work in the manufacturing process of these orthoses, such as physiotherapists, occupational therapists, workshop technicians, designers and drafters, allowing for direct access and convenience in the manufacturing of these products.

Artrite reumatóide (AR) é uma doença crônica e multisistêmica, que afeta o indivíduo como um todo. De etiologia desconhecida, possui como característica uma inflamação sinovial, efeitos periarticulares, simétricas e cumulativas. Os principais sinais e sintomas apresentados na fase aguda são as dores nas articulações, edemas e rigidez matinal. E em 75% dos casos acometem membro superiores, com um grande impacto nas habilidades funcionais. Nas mãos, as deformidades podem atingir todas as articulações causando subluxações e deformidades em metacarpofalangenas (MF), interfalangeanas (IF) e punhos. Quando há a destruição dos ligamentos e cartilagens do punho as forças musculares e fatores anatômicos causam o colapso do punho em desvio radial e as articulações MF, como consequência a essas forças anatômicas, também entram em colapso e favorecem o desvio ulnar dessas articulações. Há diferentes recursos utilizados no tratamento desta patologia, sendo um deles o uso de órtese. Assim, este estudo tem por objetivo projetar e desenvolver uma órtese, articulada e original, com função de corrigir a deformidade em desvio ulnar dos dedos e favorecer a funcionalidade. Para tanto os procedimentos metodológicos foram divididos em: Reconhecimento de Necessidades; Especificação e Conceito. Após levantamento Bibliográfico, estudo antropométrico chegou-se ao esboço e ao conceito do projeto. Como resultado obteve-se o primeiro protótipo em material disponível e utilizando o programa CAD solid edge Insight foi proposto um protótipo digitalizado da órtese, definindo as propostas e requisitos necessários para o desenvolvimento da órtese. Como resultados obteve-se dois desenhos digitalizados do protótipo e quatro protótipos em materiais diferentes entre si, compostos por 9 peças (2 hastes laterais, 1 bloqueio ulnar, 3 pulseiras e 3 anéis), que montadas mostram uma órtese articulada. Observou-se que houve bloqueio do desvio ulnar mesmo em pacientes com deformidades mais graves dos dedos. A mesma permitia a flexão e extensão de MFs e punho. Houveram ajustes nos desenhos com o decorrer do estudo, após realização dos testes de bancada. Verificou-se que a órtese poderá ser utilizada bilateralmente, com uso dorsal da haste redonda em mão direita e uso ventral em mão esquerda. A órtese permite a função da mão e possui fácil colocação e manuseio. / Rheumatoid arthritis (RA) is a chronic, multisystem, which affects the individual as a whole. Of unknown etiology, is characterized as a synovial inflammation, periarticular effects, and cumulative symmetrical. The main signs and symptoms in the acute phase are joint pain, swelling and stiffness. And 75% of cases involve upper limb, with a great impact on functional abilities. Deformities in the hands can reach all the joints causing deformities and subluxations metacarpophalangeal (MF), interphalangeal (IF) and wrists. When there is destruction of cartilage and ligaments of the wrist muscle forces and anatomical factors cause the collapse of the wrist in radial deviation and MP joints, the effect of these anatomical forces also favor collapse and ulnar deviation of these joints. There are different resources used in the treatment of this pathology, one being the use of bracing. Thus, this study aims to design and develop a bracing, articulate and original, with the function to correct the deformity in ulnar deviation of fingers and promote functionality. For both methodological procedures were divided into: Recognition of Needs; Specification and Concept. After Bibliographic survey, anthropometric study came to the sketch and the concept of the project. As a result we obtained the first prototype in material available and using the CAD program Solid Edge Insight has been proposed a prototype scanned of the orthosis, setting out proposals and requirements for the development of bracing. The results we obtained two scanned drawings of the prototype and four prototypes in different materials, composed of nine parts (two lateral branches, an ulnar block, three bracelets and three rings), which show a stent mounted articulated. It was observed that the blockade of Ulnar deviation of fingers and allow flexion and extension and the MF\'s wrist. There were adjustments to the drawings in the course of the study, after completion of bench testing. We also found that the orthosis can be used bilaterally, using dorsal round rod in his right hand and left hand use ventral. The stent allows the function of the hand and has easy handling and placement.

Orientador: Helder Anibal Hermini / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-06T10:05:57Z (GMT). No. of bitstreams: 1 Filippo_ThaisRaquelMartins_M.pdf: 2231528 bytes, checksum: 9b77de85b3c42da8cc3f8d4854ac9569 (MD5) Previous issue date: 2006 / Resumo: Neste trabalho foram desenvolvidas metodologias necessárias para a implementação de órteses ativas de membros inferiores, aplicáveis em servo-assistência de processos fisioterápicos de reabilitação. Para viabilizar e concretizar os objetivos propostos foram elaborados estudos anatômicos e cinesiológicos da locomoção humana, enfocando em especial os membros inferiores, que foram analisados a partir de experimentos de antropometria aplicada, através de instrumentação dedicada. A partir dos resultados obtidos foi elaborado o modelo geométrico de uma órtese de membro inferior, do qual foi desenvolvida a modelagem cinemática visando a futura aplicação de controle cinemático direto. Baseando-se nos parâmetros obtidos de simulações computacionais geradas a partir da aplicação da modelagem cinemática foram dimensionados os parâmetros do dispositivo eletro-mecânico sendo que a ativação dos atuadores das articulações foi gerenciada por um microcontrolador dedicado, sendo que o algoritmo de controle relevou a seqüência da marcha e os respectivos parâmetros cinemáticos inerentes a este processo / Abstract: In this work necessary methodologies were developed for the implementation of active orthosis of lower limbs, applicable in servant-assistance of physiotherapies processes of rehabilitation. To make possible and to materialize the considered objectives, anatomical and kinesiology¿s studies of human locomotion had been elaborated, focusing in lower limbs that had been analyzed from experiments of applied anthropometry with dedicated instrumentation. With the results, a geometric model of lower limbs orthosis was elaborated and a kinematics model was developed aiming future application in direct kinematics¿ control. Based on the outputs of computational simulations of the kinematics model, the electromechanical device was selected. The actuators of the joints were managed by a dedicated microcontroller and an algorithm controlled the sequence of the march and the kinematics parameters to this process / Mestrado / Mecanica dos Sólidos e Projeto Mecanico / Mestre em Engenharia Mecânica

Orientador: Manoel Barros Bertolo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T00:50:53Z (GMT). No. of bitstreams: 1 Bernardes_CynaraFerreira_M.pdf: 2007451 bytes, checksum: e391b0c846a262e5780f400dd970089f (MD5) Previous issue date: 2013 / Resumo: Objetivos: Avaliar a eficácia do uso das palmilhas em pacientes com Artrite Reumatóide (AR) na redução da dor, melhora da função e redução da média dos picos de pressão plantar. Material e Métodos: Vinte e sete pacientes com AR e dor nos pés foram avaliados em relação à dor, presença de deformidade e calosidades, incapacidade (Heath Assessment Questionnaire - HAQ-DI) e atividade de doença (Clinical Disease Activity Index - CDAI). Palmilhas foram prescritas de acordo com a necessidade de cada sujeito com objetivo de suporte articular e redução de dor. Os pacientes foram submetidos à avaliação pelo Foot Function Index (FFI) e podobarometria (Sistema F-SCAN) com a avaliação da média dos picos de pressão plantar em consulta inicial e após duas semanas de intervenção. Resultados: Houve redução do FFI após a intervenção em todas sub escalas. Os escores iniciais mais elevados do FFI total e suas subescalas de incapacidade (FFI-inc) e limitação da atividade (FFI-la) foram significativamente relacionados aos maiores escores do CDAI e HAQ-DI (p < 0.05). A melhora do FFI foi independente da idade dos sujeitos, tempo de doença, CDAI e HAQ-DI. Não houve redução significativa na média dos picos de pressão plantar após a intervenção, mesmo quando foram avaliados separadamente os pacientes com dor predominante em ante pé e retro pé. As palmilhas foram usadas em média 7,08 horas por dia. Efeitos adversos menores foram observados em sete pacientes, nenhum resultando em interrupção do tratamento. Conclusão: Foi observado redução de dor e incapacidade em indivíduos com AR após o uso de palmilhas, sem redução significativa das médias dos picos de pressão plantar. Os benefícios do uso das órteses em pés reumatóides podem ser multifatoriais, não somente relacionado à melhor distribuição da pressão plantar, mas à melhor acomodação do pé e aumento do estímulo proprioceptivo / Abstract: Objective: To evaluate the efficacy of insoles in Rheumatoid Arthritis (AR) patients reducing pain, improving function and reducing the mean peak plantar pressure. Methods: Twenty-seven rheumatoid patients with foot pain were evaluated regarding foot deformity, disability (Health Assessment Questionnaire - HAQ-DI) and disease activity (Clinical Disease Activity Index - CDAI). Foot orthosis were prescribed according to each patient's needs aiming to provide a better joint support and to reduce pain. The Foot Function Index (FFI) and the mean peak plantar pressure (FSCAN system) were evaluated at baseline and after two weeks of intervention. Results: FFI values decreased in all subscales after intervention. Higher initial disability and activity limitation FFI subscales and FFI total scores were significantly related to higher CDAI and to higher HAQ-DI scores (p < 0.05). FFI improvement was independent from age, disease duration, CDAI and HAQ-DI. No significant reduction in the mean peak plantar pressure was noted, even if evaluating separately the patients with pain mainly on the forefoot or on the hindfoot. Orthosis were worn 7.08 hours-day on average. Minor adverse effects were noted in seven patients, none of them resulting in treatment interruption. Conclusion: Foot orthosis reduces patient's referred foot pain and foot disability with no significant reduction in the mean peak plantar pressure. The benefits of foot orthosis in RA may be multifactorial, not only related to plantar pressure distribution, but also to a better foot accommodation and increased proprioceptive stimulus / Mestrado / Clinica Medica / Mestra em Clínica Médica

Background: Osteoarthritis of the knee is a condition that can emerge without any known reason, though most commonly it is caused by previous damage to the anatomical structures inside the joint. The most common symptom is pain during rest and activity. Individuals diagnosed with osteoarthritis often experience difficulties with performing certain types of movements and activities due to pain. Aim: Based upon a qualitative inductive content analysis, the aim is to investigate on a subjective level how individuals diagnosed with medial osteoarthritis experience pain and function, in relation to brace usage. Method: This study is based on recorded semi structured open-ended interviews with three individuals diagnosed with medial osteoarthritis whom uses a knee brace or knee orthosis. Results: The study generated six sub-categories which created two main categories describing the experience of medial osteoarthritis by the individuals. The results showed experience of affected physical ability and adaptation to pain. Conclusion: Individuals diagnosed with medial osteoarthritis experience limitation in activity and ADL mostly due to pain, though decreased function of the knee joint seems to be a contributing factor to limitation as well. Using a knee brace eases pain to some degree and enable individuals to perform some activities in comparison to when not using a knee brace. These conclusions should be considered with caution since the number of individuals interviewed in this study is small and may not provide the same information as of a larger number of individuals with medial osteoarthritis.

Sammanfattning Bakgrund: Ortopedtekniska hjälpmedel har som övergripande syfte att göra det möjligt för människor att i sin vardag och livsstil vara rörliga, aktiva och delaktiga trots en fysisk funktionsnedsättning. För finansiering av ortopedtekniska hjälpmedel i Sverige ansvarar uteslutande det offentliga i form av landsting och regioner, vilka har en begränsad summa pengar att hushålla med. Det ligger därför i samhällets intresse att dessa pengar satsas på insatser som är av god kvalitet och främjar medborgarnas hälsa. Hälsoekonomiska utvärderingar som jämför kostnader och effekter av olika alternativ utgör en del av beslutsunderlaget för sådana prioriteringar. Det saknas emellertid användbara utvärderingar av ortoser och proteser, både vad gäller effekt och kostnadseffektivitet. Syfte: Syftet med studien var att analysera ortoser för nedre extremiteten ur ett hälsoekonomiskt perspektiv baserat på sjukvårdens direkta kostnader och förändring i patienters självupplevda hälsa. Metod: Totalt 17 patienter, vid fyra ortopedtekniska mottagningar, som ordinerats ortoser för nedre extremiteten, genomförde EQ-5D-3L-enkäten före och sex veckor efter utprovningstillfället. Hälsoprofiler från enkäterna överfördes via nationella tariffer till hälsoindex som representerar hälsokomponenten i QALY. Nyttan bedömdes genom att jämföra hälsoindex före och sex veckor efter utprovningstillfället. Kostnadsanalysanalys utfördes sedan genom att dividera landstingets/regionens direkta kostnad för ortoserna med skillnaden i hälsoindex. Resultat: Studien visar att ortoser för nedre extremiteten inte medför någon förändring i patienters självupplevda hälsa och därför inte kan anses vara kostnadseffektivt. För att kunna utvärdera metoden och göra dra några statistiska slutsatser behöver fler enkäter samlas in. Implikation: På lång sikt kan resultat från en kostnadsnyttoanalys, genom att visa patientnyttan med ortopedtekniska hjälpmedel, bidra till en högre kvalitet på den ortopedtekniska verksamheten och även fungera som beslutsstöd vid val av lämpligt hjälpmedel.

Thesis (MScPhysio)--Stellenbosch University, 2012 / ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

Anterior knee pain (AKP) is a common, chronic lower limb musculoskeletal overuse condition that represents substantial morbidity to those affected, and has a significant impact on the health care industry. Health practitioners frequently prescribe foot orthoses in the management of AKP as an alternative or adjunct to multimodal physiotherapy. The primary aim of this thesis was to investigate the clinical efficacy of foot orthoses in AKP, utilising high-quality research methodologies. The two systematic reviews conducted have identified a significant gap in the literature regarding evidence from randomised clinical trials (RCTs) for foot orthoses in AKP and other lower limb overuse conditions. While the best evidence for AKP management was for multimodal physiotherapy, there was insufficient evidence to support or refute the use of foot orthoses in the treatment of lower limb overuse conditions, including AKP. Meta-analysis provided evidence to support the use of foot orthoses in the prevention of the first incidence of lower limb overuse conditions. An interesting finding was evidence from pooled and individual study data of no difference between custom and prefabricated foot orthoses in both treatment and prevention of lower limb overuse conditions, inferring that either type of orthosis may be utilised. Both systematic reviews highlighted substantial methodological flaws of the included studies, and recommended that future studies include larger participant numbers, longer participant follow-up, more consistent use of reliable and valid outcome measures and reporting of outcome data, and utilisation of the CONSORT guidelines in the design and reporting of RCTs. A 12-month prospective RCT investigated the short- and long-term clinical efficacy of prefabricated foot orthoses in the treatment of 179 participants with AKP. Foot orthoses were more effective than flat shoe inserts in the short term, implying that their contoured form has some therapeutic effect. Foot orthoses were not significantly different to multimodal physiotherapy over 12 months, nor was there any benefit in adding foot orthoses to physiotherapy. Considering that all groups experienced clinically meaningful long-term improvements in pain and function, clinicians may prescribe foot orthoses for AKP to hasten recovery. Findings of post-hoc analyses to develop a clinical prediction rule indicate that those of older age and shorter height, who have a lower severity of AKP and a more mobile midfoot, are more than twice as likely to experience a successful outcome with foot orthoses. As a secondary aim, this thesis has provided a more comprehensive profile of AKP as a condition. Baseline data from the RCT participants confirms previous reports of higher rates of AKP in females, and a tendency towards bilaterality and chronicity. This AKP sample did not differ from asymptomatic individuals in terms of body mass index, physical activity level, general and mental health, and foot posture, although they tended to have a more mobile foot under load. These characteristics tend to be homogenous across a number of published RCTs, indicating that the findings of the RCT described above are likely to be generalisable to the broader population with AKP. An additional finding in this group was that those with AKP of long duration, higher pain levels, lower functional levels, and an overall lower score on a specific measure of AKP have a poorer prognosis over 12 months, irrespective of their age, gender or morphometry. These findings suggest that, in order to improve prognosis and the chance of a successful outcome, the primary goals of intervention should be to reduce the severity and duration of AKP, through the use of early intervention with foot orthoses, multimodal physiotherapy, or a combination of the two.