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Background: Compared to able-bodied subjects, subjects with post-polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry., Objectives: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop-locked knee-ankle-foot orthosis or a newly developed powered knee-ankle-foot orthosis., Study Design: Quasi experimental study., Methods: Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis., Results: There were no significant differences in the gait symmetry index of step length (p = 0.085), stance time (p = 0.082), double-limb support time (p = 0.929), or speed of walking (p = 0.325) between the two test conditions. However, using the new powered knee-ankle-foot orthosis improved the symmetry index in step width (p = 0.037), swing time (p = 0.014), stance phase percentage (p = 0.008), and knee flexion during swing phase (p ⩽ 0.001) compared to wearing the drop-locked knee-ankle-foot orthosis., Conclusion: The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase., Clinical Relevance: A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis., (© The International Society for Prosthetics and Orthotics 2015.)

Background: People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users., Objective: The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension., Study Design: Quasi experimental study., Methods: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate., Results: Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ., Conclusion: Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis., Clinical Relevance: It is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being., (© The International Society for Prosthetics and Orthotics 2015.)

Background: Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking., Objectives: The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome., Study Design: Quasi experimental design., Methods: A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test., Results: Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks., Conclusion: The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function., Clinical Relevance: A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel syndrome., (© The International Society for Prosthetics and Orthotics 2015.)

Background: A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait., Objective: The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints., Study Design: Quasi experimental study., Methods: Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis., Results: Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis., Conclusion: Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects., Clinical Relevance: This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted., (© The International Society for Prosthetics and Orthotics 2015.)

Background: Idiopathic scoliosis patients have postural equilibrium problems., Objective: The objective of this study was to assess postural control in subjects with idiopathic scoliosis following a 4-month intervention in an unbraced position., Study Design: Quasi-experimental., Methods: Eight healthy girls and eight girls with idiopathic scoliosis took part. A Kistler force platform was used with a frequency of 100 Hz for recording data. The center of pressure was recorded in different positions out of brace for scoliosis and healthy subjects. Test conditions were single limb and double limb stance, with eyes open and closed, and foam and rigid surfaces., Results: The data reflected a weak balance of idiopathic scoliosis subjects compared to healthy subjects. After 1 and 4 months of wearing the brace, center of pressure and center of gravity sway increased in the majority of the tests, although there were no significant differences in any of the test conditions (p > 0.05). While the center of pressure sway in medio-lateral direction decreased after 4 months of wearing a brace, in other variables center of pressure and center of gravity sway increased., Conclusion: Idiopathic scoliosis patients have weak balance in comparison to healthy subjects. In addition, following a period of 4 months of wearing a brace, balance parameters in the scoliosis subjects did not improve. The results show that we need more follow-up of orthoses wearing in idiopathic scoliosis subjects and suggest more studies at least 1-year follow-up to identify the efficiency of brace wear on balance., Clinical Relevance: Scoliosis can alter postural stability and balance performance during quiet standing. Spinal deformity can alter a subject's ability to compensate for postural changes and cause gait deviations. This study investigated balance differences between the healthy and idiopathic scoliosis patients and the results of thoraco lumbo sacral orthosis brace wear. It might provide some new insight into the conservative treatment of idiopathic scoliosis patients for clinicians and researchers., (© The International Society for Prosthetics and Orthotics 2015.)

Background: Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait., Objective: The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation., Study Design: Quasi-experimental design., Methods: Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system., Results: Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis., Conclusion: The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis., Clinical Relevance: This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities., (© The International Society for Prosthetics and Orthotics 2015.)

Background: While the effectiveness of orthoses prescribed for tennis elbow has been reported in several studies, the effect of how they may limit movements which aggravate this condition has not yet been explored., Objective: The purpose of this study was to evaluate the effect of a new spiral hand-forearm splint that restricts the movement of the wrist and forearm, on grip strength, pain, and function in patients with tennis elbow., Study Design: Quasi-experimental design., Methods: A total of 15 patients with tennis elbow (mean age 43 years) took part in this study. The amount of pain, grip force, and function were compared using a visual analog scale, Jamar dynamometer, and the Disability of the Arm, Shoulder, and Hand questionnaire, respectively. This was performed at baseline and repeated after 4 weeks of splint use. Active motion of the forearm was measured by a goniometer., Results: The spiral splint significantly relieved pain and improved function and grip force in patients after 4 weeks of application (P < 0.05)., Conclusion: The new splint design had a positive effect on the treatment of tennis elbow symptoms which included pain, grip strength, and function. Restriction of rotational movement (e.g. reduction of the supination and pronation of forearm) may have played the main role in this., Clinical Relevance: This new splint design may be considered as a new approach in the conservative treatment and rehabilitation of patients with tennis elbow., (© The International Society for Prosthetics and Orthotics 2015.)

Background: The advanced reciprocating gait orthosis (ARGO) has a rigid structure which provides restricted movement at the hip, knee, and ankle joints and incorporates a pelvic section with an extended section in the lumbar region. Healthy subjects, when walking with an RGO in situ, could feasibly demonstrate the level of limitation in movement imposed by ARGO-assisted ambulation., Objective: The aim of this study was to compare the function of the advanced reciprocating gait orthosis when fitted with the dorsiflexion-assist ankle-foot orthoses on temporal-spatial parameters and kinematics of walking in both able-bodied people and those with spinal cord injury., Study Design: Quasi experimental design., Methods: Data were acquired from six able-bodied and four spinal cord injury subjects who used an advanced reciprocating gait orthosis which incorporated dorsiflexion-assist ankle-foot orthoses. Kinematics and temporal-spatial parameters were calculated and compared., Results: All able-bodied individuals walked with speeds which were only approximately one-third that of when walking without an orthosis. The mean step length and cadence were both reduced by 48% and 6%, respectively. There were significant differences in hip, knee, and ankle joint range of motions between normal walking and walking with the advanced reciprocating gait orthosis both in able-bodied subjects and patients with spinal cord injury. There were also significant differences in the speed of walking, cadence, step length, hip range of motion, and ankle range of motion when using the advanced reciprocating gait orthosis between the two groups., Conclusion: Temporal-spatial parameters and lower limb sagittal plane kinematics of walking were altered compared to normal walking, especially when spinal cord injury subjects walked with the advanced reciprocating gait orthosis compared to the able-bodied subjects., Clinical Relevance: To produce an improvement in RGO function, an increase in walking performance should involve attention to improvement of hip, knee, and ankle joint kinematics, which differs significantly from normal walking., (© The International Society for Prosthetics and Orthotics 2015.)

Background: The use of knee-ankle-foot orthoses with drop locked knee joints produces some limitations for walking in subjects with quadriceps muscle weakness. The development of stance control orthoses can potentially improve their functionality., Objectives: The aim of this review was to compare the evidence of the effect of stance control orthoses to knee-ankle-foot orthoses with drop locked knee joints in improving kinematic variables and energy efficiency of walking by subjects with quadriceps muscle weakness caused by different pathologies., Study Design: Literature review., Methods: Based on selected keywords and their composition, a search was performed in Google Scholar, PubMed, ScienceDirect, and ISI Web of Knowledge databases. In total, 18 articles were finally chosen for review., Results: The results of this study demonstrated that this type of orthosis can improve the walking parameters of subjects with quadriceps muscle weakness and spinal cord injury patients when compared to a locked knee-ankle-foot orthosis., Conclusion: There is evidence to show that stance control orthosis designs improve the gait kinematics but not energetic of knee-ankle-foot orthosis users. Development of new designs of stance control orthoses to provide a more normal pattern of walking is still required., Clinical Relevance: Stance control orthoses are a new generation of orthotic intervention that could potentially be significant in assisting to improve the gait kinematics by knee-ankle-foot orthosis users., (© The International Society for Prosthetics and Orthotics 2015.)

Background: Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented., Objectives: The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients., Study Design: Literature review, Methods: According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria., Results: The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee., Conclusion: Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis., Clinical Relevance: Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis., (© The International Society for Prosthetics and Orthotics 2014.)

Background: Foot orthoses are used to optimize lower extremity function and can improve postural stability by enhancing the afferent somatosensory feedback available to the central nervous system., Objective: The aim of this review was to evaluate the effect of foot orthoses on balance control in older subjects., Study Design: Systematic review., Methods: The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases by using selected keywords. A total of 22 articles were selected for final evaluation., Results: The results demonstrated that older people should be advised to wear thin, hard-soled footwear with high collars to reduce the risk of falling. The findings for insoles demonstrated an increase in balance control via vibratory or magnetic insoles, but textured insoles do not appear to be beneficial for balance improvement., Conclusion: Foot orthoses improve postural stability via a somatosensory or biomechanical effect. Use of footwear with the proper features can be an appropriate intervention in order to increase the balance in the older population and reduce falls., Clinical Relevance: Loss of balance is an important factor in increasing the risk of falling in older subjects. Foot orthoses can improve functional measures of stability in older adults. In this review, results from studies suggest a number of recommendations regarding the optimal footwear for older people to reduce the risk of falling., (© The International Society for Prosthetics and Orthotics 2015.)

Background: Usable myoelectric control relies on secure and intimate contact at all times between the electrode, the socket and the residual limb. At present, there is little post-fitting socket adjustment available to prosthetists with respect to electrode contact security or alignment. Failure to provide secure electrode contact could result in the development of motion artefacts, poor prehensor response and subsequent prosthesis non-usage., Objectives: To establish the effect of alteration to electrode contract security and alignment on prosthesis functionality using a bespoke electrode housing unit., Study Design: This study investigated the effect of electrode contact security and alignment on upper limb myoelectric prosthesis functionality., Methods: Four different electrode housing arrangements were assessed within prosthetic sockets fitted to six transradial prosthesis subjects using the Southampton Hand Assessment Procedure, which is a reliable and validated prosthesis functionality assessment tool., Results: Significantly higher functionality scores were achieved with the bespoke housing unit compared to when using conventional electrode housings., Conclusion: Myoelectric prosthesis functionality is closely linked to electrode contact security and to electrode alignment with respect to the residual limb. Both of these factors can be improved locally using an adjustable electrode housing unit., Clinical Relevance: Provision of an electrode housing system that enables adjustments to be made to electrode orientation can improve prosthesis functionality, particularly in cases where tight-fitting sockets are not possible, and/or where the prosthetist may be inexperienced with regard to myoelectric prosthesis fitting., (© The International Society for Prosthetics and Orthotics 2014.)

Background: Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users., Objectives: To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension., Study Design: Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses., Methods: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed., Results: Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation., Conclusion: Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk., Clinical Relevance: Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters., (© The International Society for Prosthetics and Orthotics 2014.)

Background: Powered orthoses are a new generation of assistive devices for people with spinal cord injury, which are designed to induce motion to paralyzed lower limb joints using external power via electric motors or pneumatic or hydraulic actuators., Objective: Powered gait orthoses provide activated movement of lower limb joints to limit the forces applied through the upper limb joints and trunk muscles during ambulation due to the need to use an external walking aid, while simultaneously improving the kinetics and kinematics of walking in subjects with spinal cord injury. This article reviews their walking efficacy when used by people with paraplegia., Study Design: Literature review., Method: A literature search was performed in ISI Web of Knowledge, PubMed, Google Scholar, ScienceDirect, and Scopus databases., Results: Efficacy was demonstrated in producing activated motion of lower limb joints. Powered gait orthoses have a beneficial effect on the kinetics, kinematics, and temporal-spatial parameters of gait, but their effect on muscle activity in individuals with spinal cord injury is still unclear., Conclusions: Further research is needed regarding the design and construction of powered gait orthoses using significant power application to the ankle joints and their effect on lower limb muscle activity and gait patterns in spinal cord injury subjects., Clinical Relevance: Powered orthoses is a new generation of orthotic intervention that could potentially be significant in assisting in improving the walking parameters and energy consumption of spinal cord injury subjects., (© The International Society for Prosthetics and Orthotics 2014.)

Background: Current investigation of treatment outcomes by clinicians is currently hampered by a lack of clinically viable tools. The use of activity monitors specifically validated for a population could help resolve this situation., Objectives: The purpose of the study was to validate an activity monitor for monitoring children with cerebral palsy. The study was designed to validate the duration of time spent sitting, standing and walking and the number of steps taken when being measured by the activPAL activity monitor., Study Design: A validation study was undertaken., Methods: Observations of participants were carried out while completing a specifically designed activity course using video footage, which were then compared to the output from the activity monitor., Results: The activity monitor was found to be valid for the time spent standing and walking, the number of steps taken and the number of transitions., Conclusions: The results demonstrated that the monitor may prove useful to clinicians as a measurement outcome device for children with hemiplegic gait patterns resultant from cerebral palsy. However, the sensitivity of the device is variable, and further investigations are necessary to confirm it would also be able to detect minor changes after interventions., Clinical Relevance: The monitor may provide clinicians with a simplistic tool that is easily utilised, to enable audit exercises of current and future treatments., (© The International Society for Prosthetics and Orthotics 2013.)

Background: Patients suffering from mild-to-moderate medial compartment knee osteoarthritis may be treated with an unloader knee orthosis. However, compliance has been shown to be an issue with such devices., Objectives: The aim of this study was to identify the effects of a new design of knee unloader orthosis on specific gait parameters in patients with mild-to-moderate medial knee osteoarthritis., Methods: The gait of seven patients was assessed in two conditions: without an orthosis and when wearing a new design of unloader knee orthosis. Gait analysis was performed to determine alterations to the adduction moment, speed of walking, step length, cadence and knee sagittal plane range of motion during ambulation for the two test conditions., Results: The knee adduction moment was significantly reduced (p = 0.001), and the speed of walking significantly increased (p < 0.001) when wearing the orthosis. However, a reduction in knee range of motion (p = 0.002) and an increase in step length (p < 0.001) were observed with the orthosis donned. Cadence was not significantly altered (p = 0.504)., Conclusion: The use of a new design of unloader knee orthosis as a conservative treatment approach for patients with mild-to-moderate medial compartment osteoarthritis appears warranted., Clinical Relevance: Various conservative modalities have been used to reduce pain and improve function in medial compartment osteoarthritis. A new design of an unloader knee orthosis has been developed and is shown to have immediate benefits in patients with mild medial knee osteoarthritis., (© The International Society for Prosthetics and Orthotics 2014.)

Background: This article describes the development and evaluation of a new medial linkage orthosis to potentially assist paraplegic patients to ambulate., Case Description and Methods: The orthosis was initially designed using the solid works program and was subsequently evaluated when used by a spinal cord injury subject to test the structure during standing and walking. Gait analysis was used to compare the medial linkage orthosis to a standard hip-knee-ankle-foot orthosis., Findings and Outcomes: The results demonstrated improvements in gait velocity, step length, and decreased compensatory motions in the new orthosis compared to the hip-knee-ankle-foot orthosis., Conclusions: The results propose that this new Araz medial linkage orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to stand and walk. Clinical relevance The Araz medial linkage orthosis can potentially provide standing and walking assistance for spinal cord injury patients.

Background: Knee-ankle-foot orthoses are utilized for walking by patients with lower limb weakness. However, they may be rejected by patients due to the lack of knee flexion available when using them for walking activities., Aim: The aim of this study was to perform a pilot study investigating the effect of a new powered knee-ankle-foot orthosis on walking in healthy persons before testing with patients with lower limb weakness., Methods: Walking evaluation was performed on five healthy subjects (mean age: 26 ± 5.6 years). Walking trials were randomly performed in three test conditions: normal walking without an orthosis, walking with a conventional knee-ankle-foot orthosis unilaterally, and also with a new powered knee-ankle-foot orthosis applied to the same leg., Results: The means of walking speed, cadence, and knee flexion during swing and step length were all decreased. Compensatory motions were increased by both orthoses compared to normal walking. More knee flexion was observed in both swing and stance phases when walking with the powered knee-ankle-foot orthosis compared to the conventional knee-ankle-foot orthosis., Conclusion: The results demonstrated the potential of a powered orthosis in providing improvements in gait parameters compared to a conventional device in healthy subjects but are yet untested in subjects with lower limb weakness., Clinical Relevance: The results of this study demonstrated that a powered knee-ankle-foot orthosis could lock the knee during stance and provide active knee flexion during swing to potentially reduce the tripping during ambulation.

Background and Aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients., Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint., Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline., Clinical Relevance: A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

Background: Although knee braces are used by individuals with patellofemoral pain syndrome, the effect of patellofemoral bracing on knee flexion during walking has not been elucidated., Aim: The purpose of this study was to evaluate the effect of patellofemoral bracing on sagittal plane knee joint kinematics and temporal spatial parameters during walking in individuals with patellofemoral pain syndrome., Study Design: Quasi-experimental., Methods: Ten subjects with a diagnosis of patellofemoral pain syndrome were fitted with a knee brace incorporating an infrapatellar strap. Testing was performed at baseline and after 6 weeks of use. Gait analysis and a visual analog scale were used to assess outcomes in this study., Results: A 59.6% decrease in pain was reported by using bracing. Bracing significantly improved speed of walking (p ≤ 0.001) and step length (p ≤ 0.001). The mean cadence was also increased following 6 weeks of patellofemoral brace use, but this was not significant (p = 0.077). Knee flexion angles improved during initial contact, loading response, and mid-swing (p ≤ 0.001) after 6 weeks of patellofemoral brace use., Conclusion: Knee orthoses resulted in decreased pain, improved temporal spatial parameters (speed of walking and step length), and increased knee flexion angles during ambulation in patients with patellofemoral pain syndrome.

Background: Patients with medial compartment osteoarthritis of the knee suffer from pain and stiffness. However, current unloader braces are not being used for extended periods by knee osteoarthritis patients due to interface problems, so compliance is an issue. The aim of this study was to design a new bespoke orthosis that could be comfortable to wear while also providing the required correction to reduce medial compartment loading., Case Description and Methods: A new knee orthosis design was initially tested for its frontal plane correction of knee varus using a surrogate knee model. It was then assessed by a volunteer subject with grade 2 medial compartment knee osteoarthritis using a static standing radiograph., Findings and Outcomes: When fitted to the surrogate knee model, the brace corrected the knee from 10° of varus to neutral alignment in the frontal plane. When worn in situ during static stance on the affected leg of the volunteer patient, it corrected the knee by 6° to a less varus position., Conclusion: The orthosis provided frontal plane correction of the knee during static standing. It could therefore prove to be suitable for use by knee osteoarthritis patients.

Background and Aim: The most commonly prescribed external shoe modification is the use of rocker soles. The aim of this study was to evaluate the effect of a heel-to-toe rocker sole profile on specific temporal-spatial parameters and the kinematics of walking when added to footwear., Method: Seventeen healthy adult volunteers participated in this study. For each subject, gait analysis was performed under two conditions that were tested in a random order: walking with either a baseline shoe with a flat sole or a modified shoe adapted with a heel-to-toe rocker sole., Results: Significant differences were observed between rocker sole conditions during initial double-limb support and second double-limb support during stance phase. In frontal plane movement, significant differences were observed between the rocker sole conditions but only during second double-limb support phase., Conclusions: This heel-to-toe rocker sole may be useful for patients with conditions such as ankle arthrodesis or for use with ankle-foot orthoses where limited ankle motion is required.

Background: The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis., Case Description and Methods: A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis., Findings and Outcomes: Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used., Conclusion: The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

Background and Aim: Finger amputation is one of the most common types of amputation. Prosthesis with adequate suspension, user-friendly design, and an aesthetic appearance can be effective in the rehabilitation of these patients. The aim of this technical note was to propose a technique for fabrication of finger prosthesis with a new suspension approach for such patients., Technique: To design and accurately fabricate the socket of finger prosthesis, the socket was reduced by 2 mm less than the original value, and a central tunnel with 4 mm width and depth with length matching the distance between the end of the stump and the nail section was provided, so that the silicone material extended to the stump to provide appreciable suspension., Discussion: This study demonstrated the design and fabrication of a silicone finger prosthesis. It also showed silicone finger prosthesis with acceptable suspension, a user-friendly and light design, and a cosmetic appearance constructed for a patient with finger amputation., Clinical Relevance: Patients with finger amputation usually use prostheses with a simple suspension technique, but evidence suggests that the residuum of these patients experience atrophy and subsequently loss of appropriate suspension. Therefore, this study was required to provide an alternative suspension method in patients with finger amputations.

Background: The important purpose of a powered gait orthosis is to provide active joint movement for patients with spinal cord injury., Objectives: The aim of this study was to clarify the effect of a powered gait orthosis on the kinematics and temporal-spatial parameters in paraplegics with spinal cord injury., Study Design: Quasi-experimental., Methods: Four spinal cord injury individuals experienced gait training with a powered gait orthosis for a minimum of 6 weeks prior to participating in the following walking trials: walking with an isocentric reciprocating gait orthosis and walking with both separate and synchronized movements with actuated orthotic hip and knee joints in a powered gait orthosis. Specific parameters were calculated and compared for each of the test conditions., Results: Using separate and synchronized actuated movement of the hip and knee joints in the powered gait orthosis increased gait speed and step length and reduced lateral and vertical compensatory motions when compared to the isocentric reciprocating gait orthosis, but there were no significant differences in these parameters. Using the new powered gait orthosis improved knee and hip joint kinematics., Conclusions: The powered gait orthosis increased speed and step length as well as hip and knee joint kinematics and reduced the vertical and lateral compensatory motions compared to an isocentric reciprocating gait orthosis in spinal cord injury patients., Clinical Relevance: This new powered gait orthosis has the potential to improve hip and knee joint kinematics, the temporal-spatial parameters of gait in spinal cord injury patients walking.

Background and Aim: Microtia is one of the forms of ear loss and deformity. A prosthesis that is simple to apply, and which has adequate suspension and acceptable aesthetics, can be useful in the rehabilitation of patients with this deficit and can improve the social and psychological effects of patients with ear amputation. The aim of this article was to describe a novel technique for fabricating ear prosthesis in a patient with congenital ear deformity., Technique: This method involves a novel method to produce an ear prosthesis using clips that were located within the layers of the final silicone ear., Discussion: This study demonstrated ease of use and acceptance by the patient. Design and fabrication of silicone ear prosthesis via this new method of suspension could also be suitable for provision to children with ear microtia who are not yet suitable for surgery or would not be suited to other methods of suspension., Clinical Relevance: The new method of suspension demonstrated that this approach could be used to provide low cost and acceptable silicone ear prosthesis for patients with microtia and partial ear amputation.

Background: Mechanical orthoses are used for standing and walking after neurological injury. Most orthoses such as the advanced reciprocating gait orthosis typically use solid ankle-foot orthoses., Objectives: The goal of this study was to test the effects of ankle dorsiflexion assistance in patients with spinal cord injury when ambulating with an advanced reciprocating gait orthosis compared to walking with fixed ankles., Study Design: Quasi-experimental., Methods: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis equipped with solid and dorsiflexion assist-type ankle-foot orthoses and walked at their self-selected speed. Joint angles and spatial-temporal parameters were measured and analyzed., Results: The mean walking speed and stride length were both significantly increased along with cadence by the volunteer subjects when ambulating using the advanced reciprocating gait orthosis fitted with dorsiflexion assist ankle-foot orthoses compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. The mean ankle joint ranges of motion were significantly increased when walking with the advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses compared to when using the advanced reciprocating gait orthosis with the solid ankle-foot orthoses. Knee joint ranges of motion were reduced, and hip joint ranges of motion were increased but not significantly., Conclusion: The advanced reciprocating gait orthosis fitted with the dorsiflexion assist ankle-foot orthoses had the effect of improving gait parameters when compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. Clinical relevance The advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses has the potential to improve hip and ankle joint kinematics and the temporal-spatial parameters of gait in spinal cord injury patients' walking.

Background: Pain, reduced grip strength, loss of range of motion, and joint stiffness, leading to impaired hand function, and difficulty with daily activities are documented symptoms of first carpometacarpal joint osteoarthritis. Splinting is a common type of conservative treatment for this injury., Objectives: The aim of this study was to evaluate the effect of custom-made thumb splints on pain, function, grip strength, and key pinch in patients with first carpometacarpal joint osteoarthritis., Study Design: Quasi experimental., Methods: Patients with first carpometacarpal grade I and II osteoarthritis (n = 18) participated in a repeated measure study. The patients all wore custom-made thumb splints. All parameters were measured at baseline, and also after 30, 60, and 90 days from initial supply. A visual analogue scale, along with a disability of the arm, shoulder, and hand questionnaire, a dynamometer and pinch gauge were used to assess pain, function, grip strength, and pinch, respectively., Results: After 60 days of splint usage, grip strength was improved. However, a reduction in pain was demonstrated after only 30 days and this continued to improve with time. Function and pinch strength also increased significantly and continued to do so during the study period when compared to baseline., Conclusions: The use of a custom-made splint for patients with osteoarthritis of the first carpometacarpal joint produced decreased pain and increased grip strength, pinch strength, and hand function. Clinical relevance Custom-made splints may be recommended for the treatment of first carpometacarpal joint osteoarthritis.

Background: Ankle foot orthoses (AFOs) are usually used for patients with incomplete spinal cord injury (ISCI) to provide support in walking., Objectives: The aim of this study was to compare the effect of AFOs, with and without ankle hinges, on specific gait parameters during treadmill training by subjects with ISCI., Study Design: Quasi-experimental., Methods: Five patients with ISCI at the thoracic level participated in this study. Gait evaluation was performed when walking 1) barefoot 2) wearing a solid AFO and 3) wearing a hinged AFO., Results: The mean step length when walking barefoot was 26.3 ± 16.37 cm compared to 31.3 ± 17.27 cm with a solid AFO and 28.5 ± 15.86 cm with a hinged AFO. The mean cadence for walking barefoot was 61.59 ± 25.65 steps/min. compared to 50.94 ± 22.36 steps/min. with a solid AFO and 56.25 ± 24.44 steps/min with a hinged AFO. Significant differences in cadence and step length during walking were only demonstrated between the barefoot condition and when wearing a solid AFO. Significant difference was not observed between conditions in mean of ankle range of motion., Conclusion: The solid AFO was the only condition which improved cadence and step length in patients during ISCI gait training. Clinical relevance A solid AFO could be used permanently to compensate for impaired ankle function or it could be used while retraining stepping.

Background: Using mechanical orthoses have some limitations for walking in paraplegic patients. The development of powered orthoses could potentially overcome some of the limitations of those currently available., Objectives: The aim of this review was to compare the evidence of the effect of powered gait orthoses (PGOs) when compared to reciprocating gait orthoses (RGOs) and also hip guidance orthoses (HGOs) in improving gait parameters and the energy efficiency of walking by spinal cord injury (SCI) patients., Study Design: Literature review., Methods: Using the PRISMA method, and based on selected keywords and their composition, a search was performed in PubMed, Science Direct, and ISI Web of Knowledge databases. Eight articles were selected for final evaluation., Results: The results of the analysis demonstrated that there is lack of evidence to show that currently-developed powered orthoses improve the walking parameters of SCI patients when compared to RGOs and HGOs., Conclusions: The changes offered by PGOs are not substantial enough for such orthoses to be currently considered preferable by SCI subjects for ambulatory purposes. Clinical relevance The development of powered orthoses is still in its infancy and progress needs to be made to improve their functionality and performance envelopes.

Background: Patients suffering from medial compartment knee osteoarthritis (OA) may be treated with unloader knee orthoses or laterally wedged insoles., Objectives: The aim of this study was to identify and compare the effects of them on the gait parameters and pain in these patients., Study Design: Quasi-experimental., Methods: Volunteer subjects with medial compartment knee OA (n = 24, mean age 59.29 ± 2.23 years) were randomly assigned to two separate groups and evaluated when wearing an unloader knee orthosis or insoles incorporating a 6° lateral wedge. Testing was performed at baseline and after six weeks of each orthosis use. A visual analog scale score was used to assess pain and gait analysis was utilized to determine gait parameters., Results: Both orthoses improved all parameters compared to the baseline condition (p = 0.000). However, no significant differences in pain (p = 0.649), adduction moment (p = 0.205), speed of walking (p = 0. 056) or step length (p = 0.687) were demonstrated between them. The knee range of motion (p = 0.000) were significantly different between the two interventions., Conclusion: Both orthoses reduced knee pain. Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis. Clinical relevance Both orthoses reduce pain and improve gait anomalies in medial compartment knee OA. Our results suggest a laterally wedged insole can be an alternative conservative approach to unloader knee orthosis for treating symptoms of medial compartment knee OA.

Background: The aim of this case study was to analyze the effect on gait parameters of a new design of powered gait orthosis which applied synchronized motions to both the hip and knee joints when utilized for walking by a spinal cord injury (SCI) patient., Case Description and Methods: Two orthoses were evaluated while worn by an incomplete SCI subject. Gait evaluation was performed when walking with an isocentric reciprocating gait orthosis (IRGO) and compared to that demonstrated by a newly developed powered version. This new orthosis was based on the IRGO superstructure but incorporated powered hip and knee joints using electrically motorized actuators., Findings and Outcomes: These gait parameters were improved when compared to standard IRGO and initial testing with the orthosis with only the hip or the knee joints activated in isolation. Maximum hip flexion and extension angles, as well as the maximum knee flexion and extension angles all increased when walking with the powered RGO compared to the IRGO., Conclusions: Gait evaluation of this newly developed orthosis showed improvement in measured parameters when compared to walking with an IRGO. Clinical relevance This case study gave the authors confidence to extend the research to a more extensive study with a group of SCI patients.

Background and Aim: This article describes the development and testing of a new powered gait orthosis to potentially assist spinal cord injury patients to walk by producing synchronized hip and knee joint movements., Technique: The first evaluation of the orthosis was performed without users, and was followed by evaluation of the orthosis performance using three healthy subjects to test the structure under weight-bearing conditions. The orthosis was primarily evaluated to ascertain its ability to generate appropriate hip and knee motion during walking. The walking experiments replicated the flexion and extension of both the hip and knee produced by the actuators which had previously been demonstrated during the initial computer simulations., Discussion: The results suggest that this new orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to ambulate, and may also be suitable for other subjects with impaired lower limb function (e.g. stroke, poliomyelitis, myelomeningocele and traumatic brain injury provided they do not have increased tone or movement disorders.

Background: The aim of this case study was to identify the effect of a powered hip orthosis on the kinematics and temporal-spatial parameters of walking by a patient with spinal cord injury (SCI)., Case Description and Methods: Two orthoses were evaluated while worn by an incomplete SCI subject with a T-8level of injury. Gait evaluation was performed when walking with an Isocentric Reciprocating Gait Orthosis (IRGO) and compared to that demonstrated by a newly powered version of the orthosis; based on the IRGO superstructure but incorporating powered hip joints using an electrically motorized actuator that produced active hip joint extension and flexion., Findings and Outcomes: The powered hip orthosis, when compared to the IRGO, increased the speed of walking, the step length and also the cadence demonstrated by this subject. Vertical and horizontal compensatory motions with new orthosis decreased. Hip angles when walking with this orthosis were comparative to those demonstrated by normal walking patterns., Conclusions: The hip actuator produced positive effects on the kinematics and temporal-spatial parameters of gait during level-ground walking trials, resulting in an alternative approach to walking by SCI patients.

Background and Aim: Ankle joint stiffness and its range of motion (ROM) are commonly assessed to determine the appropriate mechanical characteristics required in an effective ankle-foot orthosis (AFO) prescription. The aim of this technical note is to present the design of a manual device that enables their convenient measurement in the clinical setting and to demonstrate its reliability., Technique: The manual device was designed with a torquemeter, a potentiometer, a steering wheel, a rotary plate, and a foot plate. The measurement of resistive torque at 0° (neutral), 5° (dorsiflexion) and 10° (dorsiflexion) ankle angular positions demonstrated the high reliability of the device with Intraclass Correlation Coefficient (ICC) (1,k) values over 0.97., Discussion: Quantitative measurement of ankle joint stiffness and ROM by this manual device would provide objective information that could potentially assist AFO prescriptions. A future study should investigate how to incorporate the measurement obtained from the device into the prescription of an AFO.

Background and Aim: Partial ear amputations are one of the forms of ear loss. A user-friendly design of prosthesis with safe suspension and an aesthetic appearance can be helpful to a patient who has lost part of their ear due to congenital absence or trauma. Prosthetic use has social and psychological effects on the patient and their family. The aim of this paper is to describe a technique of ear prosthesis fabrication with self suspension for these patients., Technique: To provide a snugly fitting prosthesis, the only parts of the residual ear that were covered by the prosthesis were accurately manufactured and reduced in thickness to 0.5-1 mm and 10 mm in width, so that the silicone extended over the stumps to provide adequate suspension., Discussion: This paper proposes the designing and constructing of a silicone ear prosthesis which had good suspension, low cost, was easy to use and was acceptable in appearance to the patient.

The purpose of this study was to design a new automated stiffness measurement device which could perform a simultaneous measurement of both dorsi- and plantarflexion angles and the corresponding resistive torque around the rotational centre of an articulated ankle-foot orthosis (AAFO). This was achieved by controlling angular velocities and range of motion in the sagittal plane. The device consisted of a hydraulic servo fatigue testing machine, a torque meter, a potentiometer, a rotary plate and an upright supporter to enable an AAFO to be attached to the device via a surrogate shank. The accuracy of the device in reproducing the range of motion and angular velocity was within 4% and 1% respectively in the range of motion of 30° (15° plantarflexion to 15° dorsiflexion) at the angular velocity of 10°/s, while that in the measurement of AAFO torque was within 8% at the 0° position. The device should prove useful to assist an orthotist or a manufacturer to quantify the stiffness of an AAFO and inform its clinical use.

Objective: The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T(12) - L(1) spinal cord lesions., Methodology: Six chronic paraplegic subjects who had T(12) - L(1) spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison., Results: Ambulation using the IRGO (10.46 +/- 2.00 m/min) was significantly faster (p = 0.009) than ambulation using the bilateral KAFOs (5.51 +/- 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 +/- 0.77 beats/m) was significantly lower (p = 0.0306) than that of the bilateral KAFOs (6.77 +/- 3.28 beats/m)., Conclusion: Paraplegic patients with T(12) - L(1) spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.