The aim of the current study is to investigate novel therapeutic/treatment methods and outcome measurement for children with Idiopathic Toe Walking (ITW). Fifteen typically developing (TD) children and 15 children with ITW, aged between 4 to 10 years old, participated. The participants performed a gait exam including 30 barefoot walking trials over three 4-meter walkways before and after a whole-body vibration intervention. Vibration perception threshold tests were also conducted before and after the vibration intervention. In the gait exams, each of the walking surfaces represented a different tactile stimulus and the vibration intervention included standing on a whole body vibration platform for 60 seconds. Kinematics were collected at 100 Hz with a seven-camera 3-D motion analysis system. Walking surface and vibration intervention were the independent variables. Temporal-spatial gait parameters such as velocity, cadence, step length, and step width were measured. Heel rise occurrence (HR32) and vibration perception threshold (VPT) were also calculated as dependent variables. Walking surface significantly altered the gait parameter of both TD children and children with ITW. Vibration intervention altered the VPT scores of both TD children and children with ITW. Manipulated surface and excessive vibration may be important in the development of therapeutic/treatment methods for children with Idiopathic Toe Walking. HR32 is a novel calculation designed to distinguish on aspect of the toe-walking gait pattern. It significantly identified toe-walking patterns and quantified treatment results. Children with ITW appeared to have less toe-walking on the gravel surface. Walking on gravel surface is a potential novel method to reduce toe-walking immediately with no negative after-effects.

Background:Idiopathic toe walking (ITW) is a diagnosis of exclusion and represents a spectrum of severity. Treatment for ITW includes observation and a variety of conservative treatment methods, with surgical intervention often reserved for severe cases. Previous studies reviewing treatment outcomes are often difficult to interpret secondary to a mixture of case severity. The goal of this study was to review surgical outcomes in patients with severe ITW who had failed prior conservative treatment, as well as determine differences in outcomes based on the type of surgery performed.Methods:After IRB approval, all patients with surgical management of severe ITW at a single institution were identified. Zone II or zone III plantar flexor lengthenings were performed in all subjects. Clinical, radiographic, and motion analysis data were collected preoperatively and at 1 year following surgery.Results:Twenty-six patients (46 extremities) with a diagnosis of severe ITW from 2002 to 2017 were included. Zone II lengthenings were performed in 25 extremities (mean age=9.9 y) and zone III lengthenings were performed in 21 extremities (mean age=8.6 y). At the most recent follow-up, 100% of zone III lengthening extremities and 88% of zone II lengthening demonstrated decreased severity of ITW. Six extremities required additional treatment, all of which were initially managed with zone II lengthenings.Conclusions:Severe ITW or ITW that has not responded to conservative treatment may benefit from surgical intervention. More successful outcomes, including continued resolution of toe walking, were observed in subjects treated with zone III lengthenings.Level of Evidence:Level III - case series.

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Denna rapport behandlar konstruktionen av en sensorbaserad skosula. Skosulan designades med en mängd trycksensorer som sedan visualiseras på en mobilapplikation. Mobilapplikationen anslöts till sulan via Bluetooth. Det är vanligt att majoriteten av små barn går på tå. Ifall barnet inte slutar gå på tå efter barnet fyllt 2–3 år bör man kontakta läkare. Det finns olika teorier angående vilken typ av behandling som är bäst för barnen. I dagsläget finns det ingen bra lösning för att följa upp behandlingarna på barnen. Prototypen är designad för att uppfylla de krav som behövs för att ge en bra bedömning ifall behandlingen som barnet fått förbättrat barnets belastning på foten. Rapporten går även in på andra användningsområden som sulan skulle kunna användas inom. Slutsatsen i rapporten är att utveckling av produkten är möjlig men kräver mer forskning inom området samt vidareutveckling av prototypen. Prototypen är i för tidigt stadie för att utföra riktiga tester på en försöksgrupp. För att validera sensorernas precision bör lämpliga testfall utvecklas. / This report goes through the development of a sensor-based insole. The insole was designed with multiple pressure sensors which are then visualized on a mobile application. The mobile application was connected to the insole via Bluetooth. It is common for toddlers to prefer toe walking. If the child does not stop toe walking after the age of 2-3 years, you should contact a doctor. There are different kinds of treatment for these children. Today there isn’t a good solution to evaluate the children post treatment. The prototype is designed to meet the requirements needed to give a good assessment of whether the child has improved or not. The report also addresses other use cases for the insole. The conclusion on the report is that development of the product is possible but requires more research in the field as well as further development of the prototype. The prototype is in a too early stage to perform true tests on a trial group. To validate the sensor's precision, appropriate test cases should be developed.

Increasingly, virtual reality therapy (VRT) technologies are being used to augment pediatric rehabilitation. The mechanisms underlying success/failure of VRTs are not well understood. This thesis proposed an innovative 3-phase framework for evaluating VRT technologies with respect to neuroplasticity based on results of a scoping review of 21 studies. A case study was undertaken to demonstrate use of the framework to design and evaluate ‘Musical Steps’, a VRT technology aimed at promoting heel contact in toe-walking children. 5 therapists and 4 children were engaged in this study. The system accurately detected 88%(SD=7%) of heel contacts and was rated positively in usability testing (phase 1). Feasibility studies indicated that, while enjoyable, children did not understand the feedback provided and hence, heel contact was not increased (phase 2). These findings will direct future reiterations prior to evaluating clinical impact (phase 3). The proposed framework may enhance design and translation of therapeutically relevant VRTs.

Increasingly, virtual reality therapy (VRT) technologies are being used to augment pediatric rehabilitation. The mechanisms underlying success/failure of VRTs are not well understood. This thesis proposed an innovative 3-phase framework for evaluating VRT technologies with respect to neuroplasticity based on results of a scoping review of 21 studies. A case study was undertaken to demonstrate use of the framework to design and evaluate ‘Musical Steps’, a VRT technology aimed at promoting heel contact in toe-walking children. 5 therapists and 4 children were engaged in this study. The system accurately detected 88%(SD=7%) of heel contacts and was rated positively in usability testing (phase 1). Feasibility studies indicated that, while enjoyable, children did not understand the feedback provided and hence, heel contact was not increased (phase 2). These findings will direct future reiterations prior to evaluating clinical impact (phase 3). The proposed framework may enhance design and translation of therapeutically relevant VRTs.

No description available.