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Introduction: The biomechanical factors influencing metatarsalgia etiology have been well documented; however, patient characteristics of individuals suffering from this condition and the effectiveness of foot orthosis therapy remain unknown. Objectives: The objectives of this study were 1) to characterize the metatarsalgia profile of patients seeking treatment in a footwear and orthotic clinic, and 2) to explore the association between comfort and pain in patients with metatarsalgia who were treated with foot orthosis intervention. Study Design: This study is a retrospective chart review. Methods: Metatarsalgia assessment and follow-up data (case group n = 2137) were extracted from a research database (control group n = 82,822) from patients visiting a private foot care clinic. A clinical assessment was performed by a Canadian-certified pedorthist, and footwear recommendations and bilateral custom foot orthoses were provided to all patients. Feet were casted using a three-dimensional volumetric laser scanner. Orthoses (80% of cases) were manufactured from a direct mill polypropylene shell; additional rearfoot, forefoot postings, and/or metatarsal support was added according to the patient’s personalized treatment plan. Results: Eighty-one percent (81%) of metatarsalgia patients reported symptom improvement following custom orthoses treatment. The average pain reduction from the orthotic intervention was 58.55%. The average self-reported comfort scores were 7.7 ± 2.2/10 at follow-up. Compared with our control group, patients with metatarsalgia were more frequently self-identified as females, over 51 years of age, and the condition was observed in a higher prevalence of high cavus feet. Conclusions: Our results suggest that a pes cavus foot posture is a biomechanical risk factor to the development of metatarsalgia. Custom foot orthoses that are manufactured according to a patient’s personalized treatment plan are an effective conservative treatment option for pain reduction in patients suffering from metatarsalgia. [ABSTRACT FROM AUTHOR]

Introduction: There are numerous ways to transfer the alignment of a lower-limb prosthesis that have been used and adapted over the last several decades. The proposed glass tracing alignment method (GTAM) allows for a convenient and rapid transfer of prosthetic alignment in the coronal and sagittal planes with minimal equipment requirements. Objective: The aim of this article is to share a novel method for coronal and sagittal plane prosthetic alignment transfer, which may be done with minimal time, materials, and expense. Materials and Methods: Prosthetic alignment may be transferred in part or in whole by tracing the prosthesis in both the coronal and sagittal planes. The prosthesis must first be stabilized on a surface that allows for the prosthetic foot to be traced and is adjacent to a wall surface that allows for tracing of the prosthesis proximal to the foot. The line of progression (LOP) of the prosthesis should be parallel to the edge of the table it is traced upon and in a vertical orientation when tracing the entire prosthesis in the sagittal plane. When tracing the coronal plane alignment, the foot should be oriented vertically and placed in the LOP. Sagittal and coronal tracings should include as much of the prosthesis as possible to insure the most accurate alignment transfer of components. The GTAM was developed to be a clinical complement to traditional alignment transfer methods, which may include use a vertical or horizontal prosthetic alignment transfer jig. Results: Use of the described alignment tracing technique allows for the rapid alignment transfer of prosthetic componentry for a variety of applications. Conclusions: The GTAM proposed is an easy way for a busy practitioner to certify that alignment transfers have been performed correctly or to preserve alignment when replacing elements of a prosthesis for clinical and/or research applications. [ABSTRACT FROM AUTHOR]

Introduction: Plantar orthoses are widely used in the prevention and treatment of foot and lower-limb disorders. Plantar orthoses can generally be classified as prefabricated devices; however, many prefabricated devices can be customized. Customized orthotic insoles are usually prescribed with the goal of improving foot function. However, evidence that customized orthoses modify foot function in a predictable and dose-responsive manner is limited, and there is currently no consensus on how orthoses should be prescribed. Consequently, a high variability in orthotic prescriptions by physicians is observed. The aim of this study is to propose an orthotic insole prescription form (INSPECTOR) that is clear, easy, and replicable by all professionals involved. Methods: All known clinical assessments and tests with high sensitivity and specificity indices, positive and negative predictive value, positive likelihood ratio, and negative likelihood ratio were included in the form. Result: The result of this study is a form that guides the clinician step by step toward an appropriate and correct foot prescription. Conclusions: INSPECTOR has several potential advantages; it is a step-by-step guide for the physician, starting with basic tasks such as anamnesis, functional prognosis, and prescription of the foot orthosis, and ending with the choice of the target area for the foot orthosis and the material to be used. The module lists scientifically validated and internationally recognized tests, making it understandable by professionals in all countries. Finally, it can reduce the differences between prescribed and finished orthopedic insoles, thus avoiding wasting money or material on reconstruction or construction [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of cranial deformities, including nonsynostotic plagiocephaly, has been increasing, especially since the “Back to Sleep” campaign. Treatment of these deformities can use a cranial remolding orthosis or helmet. However, inconsistencies in results of studies of cranial remolding orthoses have made it increasingly more difficult for providers to accurately make recommendations for individuals with nonsynostotic plagiocephaly. Therefore, the purpose of this study was to assess the effectiveness of cranial remolding orthoses effective in treating nonsynostotic plagiocephaly by reducing cranial vault asymmetry (CVA) and to assess whether age and severity impact length and success of treatment. Materials and Methods: A retrospective analysis of patient files from September 2019–September 2020 was conducted. Paired samples of initial average and discharge average CVA measures and severity ratings were compared. Regression analyses were used to assess the relationship between all factors and severity rating at discharge. Results: A total of 106 infants (73 male, 33 female) were included in final analyses. Results indicated a significant difference between initial and discharge CVA and severity rating as a result of cranial remolding orthosis treatment. It was found that CVA at initial evaluation significantly predicted CVA at discharge (β = 0.73, P = 0.000) and severity at discharge (β = 0.52, P = 0.000), but all other variables were not significant predictors. Conclusions: The cranial remolding orthosis is an effective treatment in the correction of nonsynostotic plagiocephaly when used by a certified practitioner. In addition, this study found that treatment led to significant improvement regardless of age or initial severity. [ABSTRACT FROM AUTHOR]

Introduction: Upper-limb prostheses have undergone substantial technological improvements in the last two decades, but user complaints and abandonment rates have hardly changed. This may follow from the use of laboratory-based tests when assessing new technology instead of measuring prosthesis use in at-home situations. Serious games might be used to assess prosthesis use at home. Objectives: The aim of this study was to assess the feasibility, validity, and reliability of using serious games to measure myocontrol in at-home situations. Study Design: The design of this study is a cohort study with repeated measurements. Methods: All 10 participants (five males; seven transradial and three transhumeral defects) used pattern recognition (PR) to control their prosthesis. Two serious games were included in the PR software: Simon Says and In-The-Zone. Participants were instructed to use their prosthesis as they normally would for 2 weeks with the additional instruction to play at least 18 serious games (±90 minutes in total). Outcome measures for aspects of prosthesis use were wear time, months of prosthesis use, and user experiences, and serious games outcomes were success rate and completion time. Results: For feasibility, all but one participant completed the minimum of 18 games, and user experiences were mostly positive. For validity, no relationships were found between the aspects of prosthesis use and performance in the serious games. For reliability, testretest reliability for success rate was high (intraclass correlation [ICC], 0.79), but low for completion time (ICC, 0.18) in both games. Conclusions: Feasibility and reliability of using serious games as an assessment instrument for prosthesis control in at-home situations appeared to be good; however, validity could not be established. The serious games should be improved to increase validity. Furthermore, more outcome measures that reveal aspects of prosthesis use should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Cephalometry is the measurement and study of the proportions of the head and face, and infant skull deformities have been the subject of many clinical studies over the last 30 years. Clinical protocols to document change are especially critical during periods of growth and development, but reference values and norms are lacking for infants, especially in the first year after birth. Discussion: Key publications were reviewed by the authors to provide a narrative review of the 1) origin of the cephalic index (CI), 2) adaptations of the measure over time, 3) anatomical landmarks and alignments used, 4) clinical tools, 5) necessary considerations for different ethnic, sex, and cultural influences, 6) value and limitations of CI measurements, and 7) appropriate use of the CI in the documentation of infant skull deformities. The CI calculation has remained constant since the 1840s, although the cranial shape classifications have changed many times over the years. Conclusions: Used in isolation, the two-dimensional (2D) and linear nature of the CI fails to describe the magnitude of the three-dimensional (3D) head deformity. However, the CI can and should be used in conjunction with other 2D and 3D measurements to provide a more detailed description and understanding of the entire cranial deformity. For today's cranial clinicians and allied health care professionals, the commonly referenced CI chart fails to reflect 1) the natural skull changes noted with supine sleeping infants, and 2) the cultural diversity of the infant population currently treated. Although the CI provides information about one of the most obvious features of the dysmorphology, clinicians must also document and report other distinct features such as frontal flattening or bossing, parietal shape or involvement, sloping, displacement, and/or posterior asymmetry. Clinical Relevance: The CI should be used in conjunction with other 2D and 3D anthropometric measurements to provide a more detailed assessment of the entire cranial deformity. The CI results should be discussed with the medical team along with a complete review of other 2D and 3D measurements to determine the best course of action for orthotic treatment or nontreatment of the head shape. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective chart review aims to analyze the effects of initial severity and age on cranial remolding orthosis (CRO) treatment of deformational brachycephaly. It is predicted that younger cases will show greater rates of correction and more severe cases will require longer treatment times. With the data collected, statistical analysis will aid in the development of a measurement scale for categorizing severity for brachycephaly. Methods: Subjects were diagnosed with brachycephaly and started CRO treatment between 3 and 18 months of age. Subjects had a cranial vault asymmetry index lower than 3.5 and cranial index of 90% or higher. Subjects were excluded if they had comorbidities affecting growth, failed to complete treatment, or were noncompliant. In total, 2977 charts were retrospectively reviewed, and 253 subjects were included. Results: Statistical analyses showed that age at treatment initiation is significantly correlated with final cranial index and treatment duration, and initiation at a younger age allows for more correction and shorter treatment durations. In addition, a receiver operating characteristic curve analysis showed a statistically significant, inverse relationship between initial severity and the likelihood of achieving correction (milder head shapes are more likely to achieve correction). Conclusion: Together, these findings suggest that CRO treatment should be initiated as early as possible and the head shape deformation should not be allowed to progress without intervention. Clinical Relevance: Clinical decisions and caregiver expectations during orthotic treatment should be guided by historical treatment outcomes. This study examines the influence of initial age and cephalic index severity on CRO treatment outcomes for deformational brachycephaly. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthoses (AFOs) are devices used to control the position and motion of the ankle and foot, so a safe and more efficient gait pattern results for people with lower-limb dysfunction. To provide the ankle and foot control, an AFO is typically made of hard plastic material. Research has shown that discomfort, difficulty using the device, or perceived lack of walking improvement results in low adherence to AFO use. The purpose of this study was to investigate an AFO made of a more flexible material to see if these drawbacks are improved. Methods: Participants with a wide range of neurologic and musculoskeletal pathologies were issued a flexible AFO (FAFO). Performance and satisfaction data were collected at baseline, 2-week, and 3-month time points. Data collection included measures of balance (Berg Balance Scale) and temporal and spatial gait parameters (collected via the GAITRite Walkway System). Walking endurance was measured with the 6-minute walk test. Patient satisfaction was investigated using the Orthotic and Prosthetic User Satisfaction Survey (OPUS). Wearing adherence was measured as a percentage of the number of hours of wearing the FAFO per day. Results: Statistical analysis using a paired t -test showed improvement was found from baseline to 2 weeks for balance and gait parameters of normalized velocity, double-limb support, and the Functional Ambulation Profile. These improvements were maintained at the 3-month follow-up. No improvement was found in patient satisfaction or walking endurance. Wearing adherence (number of hours per day) was found to be at the highest level of traditional AFO adherence-reported prior research. Conclusions: This study found sufficient evidence to indicate the FAFO may be a feasible alternative to traditional hard material AFOs. Experimental trials comparing the FAFO to known gait improvements of currently accepted/traditional AFOs are needed. Clinical Relevance: The FAFO investigated in this study provides beginning support for the feasibility of using ethylene-vinyl acetate thermoplastic as the sole material (coupled with the FAFO strapping system) for manufacturing an AFO. If further investigation confirms our findings, the FAFO can provide patients and orthotists another option to materials currently used in the manufacturing of an AFO. [ABSTRACT FROM AUTHOR]

Introduction: Additive manufacturing has the potential to revolutionize the orthotic fabrication process for health professionals. Although there is evidence to suggest the benefits of additive manufacturing in rehabilitation-related fields, there is still fairly limited evidence supporting the use of 3D-printed orthoses as an effective and feasible alternative to manually fabricated devices used for the upper limb (UL). The purpose of this scoping review was to examine how 3D printers are currently being used in UL orthotic fabrication within the scope of rehabilitation professionals. Methods: A literature search was conducted using five databases from 2011 to 2021. Two independent researchers reviewed the abstracts and full text of the articles. The PRISMA process was used to report findings, and data extraction and charting were completed according to the JBI-suggested scoping review protocol. Results: Thirty-three studies were reviewed as determined by inclusion criteria from various disciplines and countries. Eight diagnostic categories identifying indications for use were derived from the studies including arthritic conditions, burns/contractures and wound care, finger deformities, neurological and neuromuscular disorders, and traumatic, strain, and nerve injuries. Both benefits and challenges are identified with the use of 3D-printed orthoses. Conclusions: The scope of the 3D-printed orthoses produced in this review is broad and internationally widespread. More evidence is needed to determine the effectiveness of 3D-printed orthoses for each of the identified conditions, but the benefits outside of healing are obvious. The current state of the evidence suggests that this technology remains exploratory in respect to UL orthoses and is therefore not yet ready to be implemented in clinics. With appropriate supports and more evidence, 3D printing still has the potential to revolutionize the UL orthotic fabrication process. Clinical Relevance: It may be unrealistic for rehabilitation professionals to design and fabricate 3D-printed orthoses without the proper education or time, but it is important for health care professionals to have an emphasized presence in this conversation, as it is their responsibility to treat the patients. This suggests that co-design, combining professionals' expertise, might be the best approach to fabricating these devices for patients. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar lordosis is important for the spine and pelvis to work in harmony in providing trunk control and maintaining sagittal balance. Children with cerebral palsy (CP) have difficulties in providing trunk postural control and balance, which is critical for independence in daily living activities. This study was planned to examine the immediate effect of a lower-trunk orthosis supporting physiological lumbar lordosis on trunk control and upper-limb functionality in children with CP. Objectives and Methods: A total of 30 children with CP, 13 diparetic, 11 hemiparetic, and 6 ataxic, 21 ambulatory (GMFCS I/II), and 9 nonambulatory (GMFCS III/IV) aged 3-16 years were included in the study. The Pediatric Functional Reach Test (PFRT) and the Seated Postural Control Measure (SPCM) were used to assess trunk control; the Pediatric Berg Balance Scale (PBBS) was used to assess balance; and the Box and Block Test (BBT) and the Nine-Hole Peg Test (9HPT) were used to evaluate upper-limb functions. All tests were performed with and without a soft lumbosacral brace. The braces were made of soft, elastic fabric with steel, and weremade by the orthotic technician in four different sizes. The angle of lordosis was adjusted with steel underwires according to each child. The existing physiological lordosis of the child is supported by the brace. It is not intended to increase or decrease. Results: In the study, the results of all evaluations with a brace were better than those without a brace (P < 0.05). No significant difference was found only in the functional part of the SPCM test (P > 0.05). Conclusions: Our study revealed that soft lumbosacral orthosis, which supports physiological lordosis, has a positive effect on trunk stability and upper-limb functionality in children with CP. Clinical Relevance: In children's trunk stability and upper-limb functionality studies, the use of soft lumbosacral orthosis that supports physiological lordosis can be added to rehabilitation programs and daily living activities as a support. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Orthosis and physical therapy are two conservativemanagements for knee osteoarthritis (OA), but the question is which is better for alleviating pain and improving function? The aim of this study was to compare two interventions of orthosis and physical therapy on pain and function in patients with knee OA. Methods: In this quasi-experimental study, 31 individuals with medial knee OA were recruited into two groups including orthosis group (combination of insole and brace [n = 14]) and physical therapy group (n = 17). Pain severity was measured by visual analog scale (VAS) andWestern Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Also, daily activity was measured by the WOMAC questionnaire at baseline and after 6-week follow-up. Wilcoxon signed rank and Mann-Whitney U tests were used to determine significant difference for intragroup and intergroup comparisons, respectively. Results: The orthosis group (using both knee brace and LWLs) had a better result for pain score related to VAS than the physical therapy group immediately after and 6 weeks of using the intervention, with a significant difference between the two groups (P = 0.006). Regarding the WOMAC items including pain and daily activity, both groups had significant differences after the 6-week period of using the intervention, with no significant difference between the groups. Conclusions: Based on the findings, pain and daily activity related to the WOMAC questionnaire were improved in both orthosis and physical therapy groups, with no differences between the two interventions. The orthosis group had better results in pain related to VAS. Clinical Relevance: The aim of this study was to find whether physical therapy or orthosis best improves pain and function of knee OA patients. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate expert opinions regarding the current status of and mitigation solutions for thermal discomfort associated with the use of thoracic-lumbar-sacral orthoses (TLSOs) in treating patients with idiopathic scoliosis (IS). Materials and Methods: Qualitative data were gathered via interviews with experts in a variety of fields. Three primary categories of discussion were established: current status of thermal discomfort experienced by patients with IS treated with TLSOs, current mitigation strategies, and obstacles to implementation of a hypothetical novel TLSO. Data were analyzed utilizing Pell Institute's six-step method for qualitative data analysis. Results: Six experts participated in this study: three spinal orthotics experts, who are orthotists currently treating IS with TLSOs; one thermal discomfort expert, who has been studying thermal discomfort for prosthetic devices; and two mechanical engineering experts, who conduct college courses on thermodynamics. Primary signs and symptoms of thermal discomfort identified by experts were heat rash, verbal complaint, and excessive sweating. Factors identified by experts as related to the occurrence of thermal discomfort fell into three categories: orthotic design, surrounding environment, and patient conditions. Experts also identified possible strategies used tomitigate thermal discomfort, which involved orthotic fabrication options, orthotic modification options, and patient behavioral changes. Conclusions: Anecdotally, thermal discomfort experienced by TLSO users exists to varying degrees. The orthotic design, the environment, and the patientmay impact the occurrence. Factors correlating to thermal discomfortmay be skin temperature, friction, and moisture. Minimizing the quantity of skin surface area covered by the orthosis may be a primary thermal discomfort mitigation strategy. However, further investigation into the relationship between skin surface area coverage and thermal discomfort is required. Clinical Relevance: This study introduces concepts and strategies that may be used by clinicians to reduce thermal discomfort experienced by patients with IS treated with a TLSO. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic fractures of the thoracolumbar junction (T10-L3) are the most common fractures of the spinal column. Themanagement of these injuries can be operative or nonoperative, and braces are often used, including the Boston Overlap Brace (BOB), a type of thoracolumbosacral orthosis (TSLO). Methods: All patients admitted to the Alfred Hospital in 2015 and managed in a BOB for 2- or 3-column thoracolumbar burst fractures (without neurology) were included in the study. In-hospital and 6- and 12-month patient-reported outcome measures were collected. A random-effects regression model analysis for each outcome (self-reported) pain and functional outcome measures by the Glasgow Outcomes Scale-Extended (GOS-E) was undertaken. Results: A total of 115 patients (62 male) were included with a median age of 53 years. Using a random-effects model, having a lower-limb fracture or a regional kyphosis angle >8° was associated with not having a good recovery after taking into account all other factors with a univariate relationship with this outcome. In terms of the outcome of self-reported pain, only female sex was associated with reporting pain. Conclusions: This study included a large cohort of patients withmanagement of a traumatic fracture with a BOB-type TLSO and provided information that should guide a larger study to review whether the factors associated with poorer outcome, including female sex and local kyphotic angle, need to be considered before deciding on the management of these fractures. Clinical Relevance: The association between degree of deformity of fracture (>8°) and associated lower-limb injury with poorer patient outcomesmay need to be taken into account before deciding to manage thoracolumbar fractures with a BOB-type TLSO although further longitudinal studies are required. [ABSTRACT FROM AUTHOR]

Introduction: Effective communication is key to the development of a successful interdisciplinary team, and effective communication cannot be achieved without an accurate understanding of role awareness. Communication within interdisciplinary teams may be particularly important for orthotists given their highly specialized scope of practice, the limited public awareness of the profession, and relatively recent increases to minimum education requirements. Because physical therapists (PTs) and orthotists commonly work together to restoremobility, the purpose of this study was to determine if there are factors associated with the perceived value of orthotists as members of the health care team among PTs. Materials and Methods: This study consisted of a cross-sectional survey assessing demographic characteristics and four value variables. The survey was distributed via email using snowball sampling to health care teammembers. Responses fromPTs were analyzed through a series of statistical testing for significant correlations of the demographic characteristics and value variables. Results: A total of 68 responses from PTs were included in the final analysis. Mutual patient goal setting contact showed a statistically significant relationship with frequency of contact and the perceived skill level of orthotists. The mean orthotist skill level was 86.57 (±10.24, min = 59, max = 100). The frequency of mutual patient goal setting contact was higher for PTs who were younger, had a higher level of education, and fewer years of experience. Conclusions: Despite its rich history, orthotics may be considered relatively new as a profession, and orthotists are often still establishing their role within a teamsetting. Mutual patient goal settingmay provide a key opportunity for orthotists to increase awareness of their skill set and demonstrate their value as professional members of the health care team. Interprofessional education is another opportunity to increase role awareness and may explain why younger PTs with higher levels of education and fewer years of experience were more likely to set mutual patient goals with orthotists. Clinical Relevance: The results of this study show that engaging in mutual patient goal setting with PTs may be an avenue for orthotists to demonstrate their skills, knowledge, and, ultimately, their value. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to examine the short-termeffectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods: A total of 109 patients withmild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results: Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores ( P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening ( P = 0.005--0.029). Clinical Relevance: Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance. [ABSTRACT FROM AUTHOR]

Introduction: The hallux valgus, a painful forefoot deformity, is defined as lateral deviation of the hallux, which is highly correlated with forefoot pronation. This study aimed to compare the effect of two types of foot orthoses, one with and one without a varus forefoot wedge, on self-reported outcomes of pain, function, and QOL (by FAOS questionnaire) in patients with moderate hallux valgus. Materials and Methods: Sixteen patients with hallux valgus were assigned to two equal groups randomly in a before-after trial. Results: The within-group comparison showed significant improvements in all subscales of the FAOS questionnaire for both groups (P < 0.05). The between-group analysis showed no statistically significant difference. Conclusions: It seems the addition of varus forefoot wedge to foot orthoses may have no adverse effect on self-reported outcomes. Clinical Relevance: It seems in conservative treatment of hallux valgus by medical insoles to correct forefoot pronation may be useful for relieving pain. [ABSTRACT FROM AUTHOR]

Introduction: Patients with partial foot amputations are prone to skin breakdown due to concentrated contact stress and shearing. A custom silicone foot orthosis (FO) can be used to redistribute the concentrated stress and reduce the shearing and discomfort of the skin of a patient with partial calcanectomy. This study presents a custom silicone FO, which is molded using a 3D-printed mold. Methods: The subject's left (amputated) partial foot and right (intact) foot were scanned using a 3D scanner. A custom silicone FO was designed by modifying the models of both feet. A mold for the FO was designed using computer-aided design software and fabricated by 3D printing. Room temperature vulcanization silicone was molded to fabricate the FO. The fit of the FO was clinically evaluated by the subject walking with the FO. Results: A custom silicone FO was fabricated using a 3D-printed mold. Conclusions: The custom silicone FO follows the contour of the residual foot to distribute pressure away from bony prominences during standing and ambulation. 3D printing of the mold can reduce labor time and material cost while facilitating the digital record when compared with a conventional plaster casting approach. Clinical Relevance: The 3D printing approach used to fabricate the custom silicone FO may be applied to develop custom silicone orthotic/prosthetic devices for other types of partial foot amputations. [ABSTRACT FROM AUTHOR]

Introduction: Poliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance. Materials and Methods: A case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants' gait performance. Results: Five participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer. Conclusions: The knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower. Clinical Relevance: The application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Disc protrusion, as a type of lumbar disc herniation, is one of the most common causes of acute lower back pain. Lumbosacral orthoses (LSOs) can be used as a conservative treatment along with routine treatment (physiotherapy and medication). The aim of this study was to investigate the impact of routine therapy in association with two types of rigid and semirigid LSOs compared with routine treatment alone on pain, fear of movement, and disability in patients with herniated lumbar disc. Materials and Methods: In this quasi-experimental study, 27 patients with lumbar disc herniation (protrusion type) were assigned into three groups including 1, semirigid LSO with routine treatment (n = 8); 2, rigid LSOs with routine treatment (n = 8); and 3, only routine treatment (n = 11). Before using any therapeutic interventions in each group, the pain, disability, and fear of movement were recorded using the visual analog scale, Oswestry questionnaire, and Tampa questionnaire, respectively. Patients in each group then used their allocated intervention for 4 weeks. After 4 weeks, variables were recorded under the same protocol. Results: In between-group comparison after 4 weeks, no significant difference was observed between them in all variables (P > 0.05). In intragroup comparison, in the group of routine treatment wearing semirigid LSO, a significant decrease in disability, pain, and fear of movement was observed after 4 weeks' use of intervention compared with before (P < 0.05). Routine treatment using rigid LSO caused a significant reduction in pain and disability and use of routine treatment significantly reduced only disability score (P < 0.05). Conclusions: Based on the findings, no significant difference was found between interventions in measured outcomes. However, the use of physiotherapy and medication along with semirigid LSO improved all outcomes compared with before using. Clinical Relevance: Both routine treatment alone and routine treatment along with an LSO can be used in people with herniated lumbar disc. Use of physiotherapy and medication along with semirigid LSO could improves pain, fear of movement, and disability in these patients. [ABSTRACT FROM AUTHOR]

Introduction: A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods: Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results: The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions: The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement: The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs. [ABSTRACT FROM AUTHOR]

Introduction: Prosthetic and orthotic (P&O) education summits and strategic planning meetings have been held periodically since 1970 to review the current state of practice and education and to advance the profession. These meetings typically included a panel of acknowledged experts from the ranks of educators, researchers, consumers, industry representatives, and practitioners. Materials and Methods: A narrative review of education summit and strategic planning meeting reports was performed. The authors defined concrete aims and specific questions before conducting the review. The authors independently reviewed the reports to identify the purpose of each meeting and the perceived challenges of the time. Lastly, the authors performed a qualitative thematic analysis to clarify the findings. Results: The recurring themes identified from the five education summit reports, joint task force report, and three National Commission on Orthotic and Prosthetic Education (NCOPE) strategic planning meeting reports include 1) workforce shortages, 2) continuous development and oversight of uniform, recognized, national academic standards, 3) sustainability of P&O academic programs, 4) development and oversight of uniform, recognized, national residency standards, 5) communication with stakeholders, including related health professionals, and 6) data collection and usage. Conclusions: Recurring themes and challenges that existed previously in P&O education still exist today. Communication between academic programs and community partners (e.g., clinical practitioners, paraprofessionals, patients, payers, and interdisciplinary professionals) is a continuing priority to clarify the expectations of P&O professionals and to advance the profession. Use of a systematic approach could help map the patterns and needs of the profession to demonstrate progress over time and to facilitate future strategic planning. Clinical Relevance: P&O education is designed to meet the needs of practitioners and paraprofessionals who implement P&O services (i.e., fitting, fabrication, and patient management). Maintaining communication between academia and its community partners is critical to advancing the profession. [ABSTRACT FROM AUTHOR]

Introduction: Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method: A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion: This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion: After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance: This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR. [ABSTRACT FROM AUTHOR]

Introduction: Osteoarthritis (OA) is a destructive joint disease and a major cause of pain in the elderly. The use of supportive orthoses including valgus knee brace, lateral wedged insole, and ankle-foot orthosis (AFO) is a common treatment for these people. The purpose of this review of the literature is to evaluate the effect of orthoses on pain, function, and adduction moment (AM) of individuals with medial knee OA. Method: The search was conducted among articles published from 2010 to 2021 in bibliographic online databases including ISI Web of Science, PubMed, Scopus, and Google Scholar. The potential titles and abstracts were reviewed based on the study inclusion criteria. All randomized controlled trial (RCT) studies on the effectiveness of valgus knee brace, AFO, and lateral wedged insoles in subjects with medial knee OA were reviewed. The search terms were OA, medial knee osteoarthritis, medial joint arthritis, unloader knee brace, valgus knee brace, knee sleeve, lateral wedge insole, AFO, ankle-foot orthosis, function, pain, alignment, kinetic, kinematic, and AM. Result: Forty-two articles were reviewed to determine the current research process. Thirteen studies evaluated the effect of lateral wedge insole on pain, function, and AM in subjects with medial compartment knee OA. Ten studies evaluated unloader knee braces. Nine studies evaluated unloader knee brace compared with lateral wedge insole, three studies evaluated AFO, and seven studies examined the combination of knee braces and lateral wedge insoles on pain, function, and AM. Conclusion: All three orthoses in short-term follow-up reduced the AM in subjects with medial knee OA. Lateral wedge insoles did not support pain reduction in studies. The results of this study showed that knee braces may have a more lasting effect on the knee joint in the long run than lateral wedge insoles. Although the number of studies that evaluated the effect of AFOs on outcomes of subjects with knee OA is low, this intervention was found to be effective in relieving pain and reducing AM. Clinical Relevance: In clinical studies, clinical relevance in patients with medial knee OA, orthoses effectively reduced external knee AM and pain sensation during daily activities. Thus, use of orthoses effectively supports conservative treatment in medial knee OA. [ABSTRACT FROM AUTHOR]

Introduction: Over the years, several studies have been published reporting the use of distinct sources of information used for pattern recognition that can be translated into commands to control human-machine interface system, for example, electromyography (EMG), pressure sensors, and accelerometers. Studies using muscle motion patterns and its combination with EMG in the context of pattern recognition for evaluation of the muscles and human-machine interface system in able-bodied individuals and limb-absent subjects are scarce. Material and Methods: In this context, this research presents the assessment of the classification of patterns formed by features extracted from both muscle motion and electromyographic signals. Data sets were collected from both arms of five unilateral transradial limb-absent subjects and seven able-bodied subjects in the control group. The features from the EMG and the muscle motion such as amplitude, frequency, predictability, and variability of the signals were estimated. Results: The results were presented in terms of the sensitivity, specificity, precision, and accuracy of the classifier. The combination of both measurements, EMG and muscle motion, defined the six basic movements for limb-absent subjects within an accuracy of 98% ± 1% for the sound forearm against 96% ± 4% for the amputated forearm. Conclusions: For future work, it is expected that the strategy of classification and the combination of inertial and electromyographic activity will be used in actual scenarios for the controlling of artificial limbs and other applications related to human-machine interaction. Clinical Relevance: The use of inertial sensors may increase the usability and accuracy of systems used for diagnosing, training, therapy, or controlling devices such as orthoses and prostheses. [ABSTRACT FROM AUTHOR]

Introduction: Lower-limb orthoses are usually part of conservative therapy in patients with pathological gait due to neurological disorders. A modular design, defined as a detachable combination of different orthotic designs, offers the possibility to adapt orthosis functionality to individual needs. Currently, however, knowledge about the actual impact of modularity on wearing times is limited. The aim of the present study was therefore to examine the wearing time of modular and nonmodular orthoses to determine whether there are differences between the different orthotic concepts of the lower limb on weekdays and weekends and whether modularity affects wearing time. Material and Methods: In this prospective clinical study, 53 patients with neurological gait disorder were included. All wore modular or nonmodular orthoses in one of these three groups: dynamic ankle-foot orthoses (DAFOs), ankle-foot orthoses (AFOs), and knee-ankle-foot orthoses (KAFOs). Wearing time was recorded by temperature sensors for 3 months. Data analysis included both descriptive and further parametric statistical testing (t -test for dependent and independent samples) as well as Pearson correlations. A univariate analysis of variance was used when comparing multiple groups. Results: Participants wore DAFOs and AFOs, but not KAFOs, significantly longer on weekdays. Wearing time correlated significantly between weekdays and weekends for all groups. There is no significant difference in the mean daily wearing time between the groups. Modularity influenced the wearing time only for the DAFO/AFO combination. Conclusion: Orthotic design and anatomic height affect the average daily wearing time. A change in wearing behavior between weekdays and weekends and influences by modularity can be found solely in DAFOs and AFOs. [ABSTRACT FROM AUTHOR]

Introduction: This article describes the benefit of combining a thoracic lumbar sacral orthosis (TLSO) and a hip spica orthosis (HSO) to create a sitting frame for children with emerging neck and trunk control who cannot sit by themselves. Materials and Methods: A child with motor disabilities who cannot sit independently benefits from a custom floor sitting frame. The sitting frame's thoracic lumbar sacral orthosis and hip spica orthosis are separate entities but are used together to allow a child to sit on the floor independently. Although the presented child does not need added head support, the TLSO-HSO sitting frame can be fabricated with cervical support. This sitting frame has a versatile joint allowing for movement between upright sitting and sitting with upper-limb weight bearing. The frame's hip joint can also be locked in different degrees of tilt. The described child uses the frame in a locked 90° upright position. Evaluation, fitting, fabrication, and reimbursement submission is explained. Conclusions: Floor sitting is an important developmental milestone. Available equipment, such as floor sitters and compression garments intended to support a child in sitting, fail to sufficiently support all children with significant motor disabilities who have floor sitting goals. The TLSO-HSO sitting frame is a custom-made floor sitter that may give children with significant motor disabilities who have emerging neck and trunk control the support they need to independently sit on the floor. This orthosis has the potential to improve the lives of many children and their families as it can be used in both home and classroom settings and can give children with significant motor disabilities the opportunity to use their hands freely to play and to interact with peers during floor play time. Clinical Relevance: Some children with severe motor disabilities cannot floor sit independently. The present study describes a new floor sitting frame that closes the gap between available products designed as these products do not meet the needs of all children with severe motor disabilities who have emerging neck and trunk control. [ABSTRACT FROM AUTHOR]

Introduction: In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain. Materials and Methods: This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale. Results: The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05). Conclusions: This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities. Clinical Relevance: The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain. [ABSTRACT FROM AUTHOR]

Introduction: The provision of orthoses is a specialized practice within healthcare that requires collaboration among professionals for successful treatment outcomes. Although orthotists are an integral part of the process, the role of the orthotists may not be commonly understood or appreciated. Among the rehabilitative health care team, physical therapists (PTs) and orthotists are especially aligned, with overlapping roles in each profession's scope of practice. Materials and Methods: A cross-sectional survey was distributed to members of the health care team, including certified prosthetist orthotists and PTs. Chi-squared tests were calculated to compare PT and orthotist responses to a question regarding role responsibilities of each team member. We hypothesized that there would be disagreement among the professions as to which tasks orthotists are responsible for performing. Results: The results of this study suggest that PTs and orthotists agree that orthotists are responsible for recommending a patient-specific orthosis. Interestingly, PTs did not identify orthotists as a team member responsible for performing patient assessment and evaluation tasks, despite these tasks being a key driver of patient-specific orthosis recommendations. Conclusions: Interprofessional education to increase knowledge of orthotic management principles among PTs may improve collaboration and communication within the health care team. Clinical Relevance: The present study identified a potential gap in PT awareness of the scope of practice and training of certified orthotists. Provision of optimal patient management requires clear understanding of respective roles and responsibilities of the health care team. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires. Methods: The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used. Results: Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP–Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP–Energy Level, NHP–Emotional Reaction, NHP–Social Isolation, and NHP–Sleep. A moderate negative correlation was found between DPUT and TAPES–Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT. Conclusions: This study showed that "the average DPUT" may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, "the average DPUT," may be used effectively in a shorter period and is helpful for organizing a rehabilitation program. Clinical Relevance: A single-item question, "The average daily prosthesis usage time (DPUT)," be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program. [ABSTRACT FROM AUTHOR]

Introduction: Adjustable-volume prosthetic sockets have been available for many years to address residual limb volume changes, although little research has been conducted regarding their efficacy. As such, prosthetists are guided by patient preference, personal experience, and professional perception. The purpose of this study was to explore clinician perceptions and experiences fitting adjustable-volume prosthetic sockets. Materials and Methods: An anonymous online survey was distributed to certified prosthetists. The survey contained questions about prosthetists' demographics, whether they had previously fit an adjustable-volume prosthetic socket, whether these fittings were successful, and what challenges they experienced. Those who had not previously fit adjustable sockets were asked what barriers had prevented them from doing so. Results: A total of 221 certified prosthetists completed the survey. Of the 195 eligible respondents, 82% had experience in fitting adjustable prosthetic sockets. The most commonly fit socket styles were the RevoFit (n = 123), Socket-less (n = 67), and Infinite (n = 66) sockets. Prosthetists had varied success with the different socket styles, with the RevoFit being the most successful, and the Infinite and Socket-less sockets the least successful. Respondents most frequently noted increased bulk (93% of respondents; n = 181), complicated fabrication (72%; n = 141), and poor cosmesis (65%; n = 127) as challenges faced when fitting adjustable-volume sockets. Some respondents felt these sockets were a useful clinical tool; however, common themes regarding clinical perception of adjustable sockets included issues with cost/reimbursement and appropriateness for only a subset of the population of individuals with amputation only. Other respondents felt that adjustable sockets were either not adequate for clinical use or required improvements before their use would be beneficial. Conclusions: There is no majority opinion regarding the benefits and challenges of adjustable sockets among prosthetists. In general, prosthetists feel that adjustable sockets can be used as one of the various tools to accommodate complicated lower-limb fittings. Additional work is needed to provide clinicians with a best practice guideline for providing adjustability within lower-limb sockets. Clinical Relevance: The study showed that prosthetists feel that adjustable sockets can be one of the tools used for complicated lower-limb fittings. Additional work is needed to develop a best practice guideline for providing adjustability in lower-limb sockets. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods: A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results: Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions: The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance: When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles. [ABSTRACT FROM AUTHOR]

Introduction: Clubfoot, mainly CTEV, is a complex three-dimensional deformity challenging physicians from ancient times. Among a thousand babies born, one to six suffer from clubfoot deformity; that is, in India alone, around 35,000 need treatment for clubfoot annually. This review summarizes the various practices of clubfoot assessment, noninvasive treatment, and engineering aspects of clubfoot treatment. The shortcomings of assessment methods and challenges with implementation of treatment methods are also presented. Methods: A narrative review of all related research papers available to authors was carried out. Results: Various clubfoot assessment methods have been developed to help physicians understand the severity of the problem and predict treatment parameters. The Pirani score and Dimeglio score are used predominantly for the assessment of deformity. However, these methods suffer from implementation-related limitations. Noninvasive methods, namely, Kite's method, functional physiotherapy method, and Ponseti method, are used in practice for treatment. The Ponseti method is the most popular with parents and physicians and is considered the gold standard for the treatment of clubfoot. However, it also suffers from various implementation issues, like treatment cost and lack of experts, particularly in low- and middle-income countries (LMICs). Engineers are using various technologies like computer-aided design (CAD)/computer-aided engineering (CAE) and additive manufacturing for modeling and analysis of clubfoot. Engineers have also attempted to develop corrective and maintenance orthosis for CTEV treatment. Conclusions: Because newer and newer technologies are becoming accessible for interdisciplinary use, there is a need to apply contemporary technologies, especially to develop a corrective orthosis so that the current challenges of clubfoot assessment and treatment are addressed. The corrective orthosis should be based on Dr Ponseti's insights into clubfoot biomechanics. Clinical Relevance: There is a need to explore contemporary technologies like data acquisition and CAD/CAE to address CTEV assessment–related issues. A corrective orthosis based on the understanding of the foot biomechanics for treatment can solve the various implementation-related challenges of the Ponseti method, particularly in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent idiopathic scoliosis is often treated orthotically with thoracic lumbar sacral orthoses (TLSOs). The goal of these TLSOs is to improve the scoliotic curve during wear to prevent further curve progression. To achieve this in-orthosis curve improvement, clinicians often apply corrective modifications to a 3D model of the patient's trunk through computer-aided design (CAD) software, which are fabricated into the TLSO. Modifications often include laterally shifting certain portions of the orthosis to apply corrective forces to the scoliotic curve. The amount and magnitude of the shifting applied are loosely based on clinical experience and patient characteristics, but the decision is somewhat arbitrary. The purpose of this study is to determine any existing correlation between applied coronal translation (shift) through CAD modifications of TLSOs and resulting coronal curve correction in female subjects with idiopathic scoliosis. Materials and Methods: Female subjects with idiopathic scoliosis who were prescribed a TLSO were included in this study. Demographic and clinical data were collected from medical records on age, sex, hours of TLSO wear, body mass index (BMI), and Risser sign. Radiographic Cobb angle, data regarding curve flexibility, and the amount of coronal translation used during the CAD modification process were recorded. Differences in the primary scoliotic curve were then assessed based on initial x-rays and in-orthosis x-rays to calculate the change in Cobb angle, apical vertebra translation (AVT), coronal balance (CB), and thoracic trunk shift (TTS). Results : Seventeen participants were included in the study. Average measured curve flexibility was 59.64%, and applied coronal translation to the CAD model ranged from 3 to 19 mm. Average Cobb angle improvement from the initial x-ray to the first in-orthosis x-ray was 23.57%, which was statistically significant (P < 0.01). Average improvement of AVT was 6.52 mm, which was statistically significant (P < 0.05). CB improved by an average of 5.29 mm, and TTS improved by an average of 2.33 mm, neither of which was found to be a statistically significant improvement. No correlation was found between applied shifting in CAD modifications and Cobb angle improvement, AVT improvement, CB improvement, or TTS improvement. Conclusions : These results do not support the hypothesis that greater applied lateral shifting in TLSO CAD modifications leads to greater coronal scoliotic curve correction. Orthotists are not able to predict in-orthosis coronal curve correction based on CAD modifications, spinal flexibility, and BMI alone. Additional factors play a role in the complexity of AIS treatment. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this article is to review the literature on the effect of immobilization of the cervical spine using orthotic devices. The review focused on the methodologies of the studies to see if this might be a contributing factor to the lack of available clinical guidelines on spinal immobilization using orthoses. Methods : This review was conducted using PRISMA guidelines (PLoS Med. 2009;6:e1000097). The search was conducted in August 2019 within all major databases using relevant phrases. No date restrictions were applied, but the search was restricted to full manuscripts published in English. These searches were then supplemented by tracking all key references from the appropriate articles identified. Articles were selected according to a priori-defined criteria. Initially, data were extracted regarding publication details, orthosis name and group, spinal level studied, and whether cervical range of motion was measured. Results : A total of 52 articles fulfilled the inclusion criteria. This article discusses the methodology of the included studies. Conclusions : There is a clear paucity of well-designed research on immobilization of the cervical spine using orthotic devices. Comparing the results of studies using different types of orthoses is difficult due to the type and age of the participants involved (healthy, pathological, cadaver) and the different techniques of measurement used. This lack of standardization prevents meta-analyses from being performed and may be a contributing factor to the lack of available clinical guidelines. An agreed structured methodology is required to enable meta-analyses and determine clinical guidelines for the prescription of spinal orthoses for cervical spine pathology. RATIONALE [ABSTRACT FROM AUTHOR]

Introduction: Robot-assisted therapy is an innovative approach to upper-limb rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning. An example of upper-limb robot-assisted therapy is the myoelectric orthosis MyoPro (Myomo Inc, Cambridge, USA). It is a custom-fabricated myoelectric elbow-wrist-hand orthosis (MEWHO) with built-in surface sensors that detect the user's electromyographic (EMG) signals during muscle contraction. Studies on the MEWHO have focused mostly on elderly chronic stroke patients. None have discussed its use on the adolescent population and the considerations they face in wearing the orthosis. Case Presentation : A 15-year-old male 10th grade student with a diagnosis of right spastic hemiplegia secondary to cerebral palsy was prescribed a MEWHO because of muscle weakness of his right upper extremity, decreased functional status, and fine motor skills deficits. Results : After two occupational therapy cycles, the patient demonstrated improvements in functional strength and performance of physical activities. Despite these improvements, the patient only used the MEWHO during therapy and was less engaged with its use at home and school. Discussion : This case report presents insights on why the patient was not as proficient and interested in using the orthosis at home and school. Recommendations to address these issues include peer modeling, community outings, early intervention, and the use of family-centered approaches. Future studies are also suggested to further understand MEWHO use and the considerations for successful orthotic management in this group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore. Methods : This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall. Results : The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060. Conclusions : The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall. Clinical Relevance: Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands. [ABSTRACT FROM AUTHOR]

Introduction: This case report describes orthotic design using computed tomography and three-dimensional printing technology combined with traditional orthotic modalities in a newborn patient with chondrodysplasia punctata and cervical spinal stenosis. At day 5 of life, the infant was referred for fitting with a prefabricated cervical collar. Because of the infant's unique stature and small size, traditional prefabricated devices could not be used. The spinal instability and critical nature of the infant prevented traditional methods of orthosis fabrication. A multidisciplinary team used imaging, 3D printing technology, and traditional orthosis fabrication methods to construct a cervical thoracic lumbosacral orthosis (CTLSO). Materials and Methods: Using computed tomography scans, data-segmenting software, and a 3D printer, a life-sized model of the patient's upper body was constructed. Traditional plaster molding and high-temperature orthoplastic techniques were used to fabricate a custom cervical thoracic lumbosacral orthosis for spinal stabilization, necessary for safe patient transport and handling. Results: The custom orthosis demonstrated proper fit and stability, as evidenced by postfitting scans. With orthosis in place, needed care could be provided to the patient more safely and efficiently. In addition, the infant could be held by the caregivers, increasing parental/infant bonding. Conclusions : Technological advances, including the ability to use computer tomography scans in combination with three-dimensional printers, can be a safe and effective option in situations of difficult orthosis fabrication for medically fragile patients. [ABSTRACT FROM AUTHOR]

Introduction: Children with achondroplasia experience numerous impairments in body structure and function, including hypotonicity, weakness, joint laxity/hypermobility, skeletal malalignment, and delays in gross motor development. Atypical patterns of movement are often used to compensate for short limbs, weakness, laxity at the joints, and bony malalignment. As a result of these atypical patterns, pain and self-restricted movement frequently begin at a young age. Surgical interventions are the general recommendation to address progressive deformity and resultant pain. Lower-limb bracing to address alignment and motor control in children with other diagnoses that include hypotonia has had positive results, including improved alignment and gross motor skills, but has not been explored in children with achondroplasia. Materials and Methods: A 3-year-old child with achondroplasia participated in an intervention using a neoprene knee orthosis with hyperextension resistance at the knee combined with a play-based, proprioceptive-intensive home exercise program. We hypothesized that the knee orthosis would increase proprioceptive input, improve alignment, and have a positive effect on gross motor skill acquisition and refinement. Early training may also have a positive impact on potential future pain and disability. Results : Improvements in alignment and motor control were seen in this child after 12 weeks of this intervention but were not initially sustained. After an additional 6 weeks of intervention, significant progress was demonstrated in lower-limb alignment and motor control, as evidenced by independent use of proper movement patterns. Delay in gross motor skill was reduced from 27% to 22%. Discussion : Motor skills training in proper alignment with aid of neoprene knee orthosis resulted in positive gains for a 3-year old with achondroplasia. Conclusion: This intervention may be helpful for other children with achondroplasia who experience hypotonia, malalignment, and atypical movement patterns. Sufficient amounts of practice and intensity are recommended for permanent motor learning to occur. [ABSTRACT FROM AUTHOR]

Introduction: There are limited examples in the literature of detailed orthotic management related to triplanar control of the ankle-foot complex. The aim of this case report was to describe year-long use of an ankle-foot orthosis-footwear combination (AFO-FC) augmented with a talar flange that aimed to stabilize the subtalar joint during gait in an individual with poststroke hemiplegia who presented with both knee hyperextension and an unstable subtalar joint. Materials and Methods : A 40-year-old woman 1-year poststroke with right hemiplegia presented with right equinovarus and knee hyperextension, with complaint of pain in the ankle and knee. Her right talocrural joint measured 15[degrees] plantarflexion with clinically significant inversion instability. Results : A right solid AFO-FC, designed using published algorithms, was provided. In addition, a talar flange modification was incorporated to control subtalar inversion. During year-long use of the AFO-FC, the patient was able to return to community ambulation without pain. Successful orthotic intervention required that the device met not only biomechanical goals but also broader patient goals, which changed over time. Therapy with the device was also important for successful orthotic intervention. Conclusions: This case illustrates use of a talar flange in an AFO-FC to provide triplanar control of the ankle-foot complex and improve gait in a person poststroke. [ABSTRACT FROM AUTHOR]

Introduction: Despite successful bracing for adolescent idiopathic scoliosis (AIS), some curves progress after brace cessation. The purpose of this study was to identify the incidence, rate, and risk factors for progression after successful brace management of AIS. Materials and Methods : Patients treated with orthoses for AIS were prospectively enrolled at brace initiation, followed through successful brace completion and, on average, for 33 months (range 12-95) after brace cessation. Inclusion criteria were curves 25[degrees] to 45[degrees] and Risser 0 to II at brace initiation with cessation at Risser IV with curves measuring <50[degrees]. Exclusion criteria were cessation before Risser IV or curve progression >50[degrees] during bracing. Demographics and radiographic measures were collected. Brace compliance was measured using Thermachron temperature sensor. Postbrace progressors were compared with nonprogressors using Mann-Whitney U test, Fisher exact test, and two-sample t -test. Results : Eighty-five patients who completed bracing with final curves <50[degrees] were followed after brace discontinuation >1 year. Twenty-seven/85 (31.8%) progressed postbracing to surgical curve magnitude >50[degrees] (n = 12) or progressed >5[degrees] after brace cessation without progression to surgical magnitude (n = 15). There was no difference between progressors and nonprogressors in age or menarchal status at brace initiation or completion, nor was there a difference in curve magnitude or morphology at initiation. There was no difference in duration of or compliance with bracing. Patients with postbrace surgical progression completed bracing at 46[degrees] on average compared with 33[degrees] for those who did not progress to surgical magnitude (P < 0.0001). Patients who completed bracing at >45[degrees] had an incidence of postbrace surgical progression of 67%. No patients who completed bracing with curves <40[degrees] showed progression after brace cessation. Conclusions: A total of 14.1% of patients successfully treated for AIS with bracing later progressed to surgical magnitude, and an additional 17.6% progressed >5[degrees] after brace completion. Findings suggest that patients with curves measuring >40[degrees] at brace completion should be followed into young adulthood. Counseling regarding the potential future need for surgery is warranted once a curve exceeds 45[degrees] in braced patients. Level of Evidence: Level 2 prospective cohort study [ABSTRACT FROM AUTHOR]

Introduction: Complete or partial finger loss is the most frequently encountered form of partial hand loss, which can result in physical, psychosocial, and economic damage to an individual. Thus, fabrication of a prosthesis that can offer a psychological, functional, and rehabilitative advantage can be a big morale booster to such individuals. Materials and Methods: This clinical report presents a novel technique of prosthetic rehabilitation of a left thumb with thermoplastic resin and silicone material. Methods include making impressions of the donor and recipient finger, duplication of wax patterns of the donor finger, fabrication of a master cast for the fabrication of the finger using thermoplastic resin and silicone material, and external characterization. Results: The thermoplastic resin silicone elastomeric prosthesis clearly fulfilled the patient's objective of restoring his defect with an aesthetically superior, lightweight prosthesis without the need to undergo any surgical procedures. The patient was comfortable using the prosthesis and was satisfied with the retention of the prosthesis. However, application of external characterization was required every 6 months. Discussion : This article presents a new application of thermoplastic resin in maxillofacial prosthesis. This technique eliminates lengthy laboratory and clinical procedures and reduces the chair side time for practitioner and patient. It also is a cost-effective technique. Conclusion : A convenient and affordable method of prosthetic rehabilitation of amputated fingers has been presented. The morale of the patient was also boosted to a great extent. [ABSTRACT FROM AUTHOR]

Introduction: Past research suggests that able-bodied individuals actively control their gait kinematics to produce one invariant roll-over shape (ROS). The ROS is a spatial representation of the center of pressure in a shank-based coordinate system. Because individuals with an amputation do not have adaptive control over their center of pressure during gait, the ankle-foot prosthesis determines the resultant ROS. This study aimed to design the mechanical properties of ankle-foot prostheses to achieve specific ROSs during gait. Methods: The authors developed a mathematical model that, when used in combination with ground reaction force and shank angle experimental data, predicts the ROS created by the novel Compliant and Articulating Prosthetic Ankle (CAPA) foot. The CAPA consists of four articulating components connected by torsion springs. Able-bodied individuals walked wearing a prosthetic simulator with the solid ankle cushioned heel foot, a dynamic response foot (the Renegade AT), and versions of the CAPA with distinctly different predicted ROSs. The experimental ROS of each trial was presented, and quantitative ROS characteristics were evaluated for statistical significance. Predicted and experimental shapes for each version of the CAPA were compared by computing the distance between the shapes and ROS characteristics. Finally, we evaluated whether our method predicts the same ROS regardless of the experimental data used for the prediction. Results: Changes to themechanical properties of the CAPA resulted in statistically significant differences in ROS characteristics, notably forward position, forward length, and orientation (P < 0.05). The mean distance between points on the predicted and experimental ROSs is 1.54% of the length of the CAPA. We demonstrated that experimental ROSs can be predicted using gait data from a different version of the CAPA and a different individual. Conclusions: This study presents and experimentally validates a method to predict the ROSs created by eight versions of the CAPA during gait. The method enables prosthetists and researchers to design ankle-foot prostheses based on the ROS created during gait. [ABSTRACT FROM AUTHOR]

Study Design: This is a narrative review. Introduction: Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective: The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods: A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results: Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion: Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry. [ABSTRACT FROM AUTHOR]