Ankle-foot orthosis in patients with Duchenne muscular dystrophy: a retrospective study / Órtese tornozelo-pé em pacientes com distrofia muscular de Duchenne: um estudo retrospectivo

Abstract Introduction: Duchenne muscular dystrophy (DMD) is a recessive genetic disease linked to the X chromosome, leading to progressive muscle tissue loss. Initially, there is difficulty getting up from the floor and an increased frequency of falls. Maintaining ambulation as long as possible is essential, and the use of ankle-foot orthosis (AFO) has been investigated as an ally in this process. Objective: To verify the prescription and use of an AFO for ambulant boys with DMD. Methods: Information was collected using the medical records of 181 patients with DMD from the Neuropediatric Service of the Instituto de Puericultura e Pediatria Martagão Gesteira of the Universidade Federal do Rio de Janeiro. Variables used were: age at the first medical appointment, age at first symptoms, age at loss of independent gait, time between the first symptoms and loss of gait, prescription of orthosis, time of use, and surgical intervention in the lower limbs. Results: The orthosis was prescribed for 63.5% of patients and used by 38.1%. The range of orthosis time was 2 to 4 years (62.3%). The night sleep period was the most prescribed for orthosis use, with 67.2%. Patients who used the orthosis for a longer time were older at gait loss. However, the children who arrived earlier for the first appointment had a higher frequency of orthosis prescriptions and later loss of gait. Conclusion: The use of AFO can help maintain ambulation for longer in boys with DMD.

Resumo Introdução: A distrofia muscular de Duchenne (DMD) é uma doença genética recessiva ligada ao cromossomo X, que cursa com a perda progressiva do tecido muscular. Inicialmente, observa-se dificuldade para levantar do chão e aumento dafrequência de quedas. A manutenção da deambulação pelo maior tempo possível é importante e o uso de órtese tornozelo-pé (OTP) tem sido investigado como aliado nesse processo. Objetivo: Verificar a prescrição e uso de OTP para meninos deambulantes com DMD. Métodos: As informações foram coletadas dos prontuários de 181 pacientes com DMD do Serviço de Neuropediatria do Instituto de Puericultura e Pediatria Martagão Gesteira, da Universidade Federal do Rio de Janeiro. As variáveis utilizadas foram: idade na primeira consulta, idade aos primeiros sintomas, idade na perda da marcha independente, tempo entre os primeiros sintomas e a perda da marcha, prescrição de órtese, tempo de uso e intervenção cirúrgica nos membros inferiores. Resultados: A órtese foi prescrita para 63,5% dos pacientes e utilizada por 38,1%. A variação do tempo de uso foi de 2 a 4 anos (62,3%). O período noturno foi o mais prescrito para uso da órtese, com 67,2%. Os pacientes que a usaram por mais tempo apresentaram maiores idades na perda da marcha. Crianças que chegaram mais precocemente à primeira consulta tiveram maior frequência de prescrição de órtese e perda da marcha mais tardiamente. Conclusão: O uso de OTP pode ajudar a manter a deambulação por mais tempo em meninos com DMD.

Customized orthotic insoles improve the gait and balance of hemiplegic stroke survivors more effectively than an ankle-foot orthosis / 中华物理医学与康复杂志

Objective:To observe the effect of customized orthotic insoles on the gait and balance of hemiplegic stroke survivors.Methods:Sixty stroke survivors with gait abnormalities were randomly divided into a group fitted with ankle foot orthoses (AFO) ( n=30) and a group who received customized orthotic insoles ( n=30). All received conventional rehabilitation training for 4 weeks. Before the fitting, as well as 8 hours and 4 weeks afterward, both groups were evaluated using the Tinetti gait scale (TGS), the plantar pressure balance index, the difference in length between their right and left step, step width, the Timed Up and Go test (TUGT), the Fugl-Meyer lower extremity assessment (FMA-LE), the 6-minute walk test (6MWT), a trunk impairment scale (TIS), the Berg Balance Scale (BBS) and the Barthel Index (BI). Results:At 8 hours after the fitting all of the insole group′s measurements were better than those of the AFO group, on average, but the differences were not statistically significant. After 4 weeks the average TGS, balance index barefoot and wearing the orthosis, step length difference, BBS and BI of the insoles group were significantly better than the AFO group′s averages. The other indicators were not significantly different.Conclusions:Customized orthotic insoles are more effective than an AFO in relieving the biomechanical abnormalities in hemiplegic patients′ feet and ankles, and enhancing their balance and gait.

Current Concepts in the Management of Patellofemoral Pain Syndrome / Conceptos Actuales en el Manejo del Síndrome de Dolor Patelofemoral

Introduction Patellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methods State of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. Results Hip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. Discussion Conservative treatment remains as the mainstream in the management of patellofemoral pain syndrome.

Introducción El síndrome de dolor patelofemoral (SDPF) es una de las principales causas de dolor de rodilla y se presenta con actividades diarias de la vida cotidiana. Este estudio presenta una revisión de la literatura acerca de las modalidades de tratamiento actual para el SDPF. Materiales y métodos Revisión estado del arte acerca del tratamiento del SDPF con grados de recomendación según la evidencia. Se revisan las intervenciones conservadoras activas y pasivas, así mismo las alternativas quirúrgicas. Resultados El fortalecimiento de los músculos de la cadera y del miembro inferior, así como el estiramiento, son intervenciones activas que ofrecen beneficios en el largo plazo para el SDPF. Las intervenciones pasivas como las rodilleras, el kinesiotaping y las ortesis para los pies, ofrecen alivio rápido pero de corta duración. El tratamiento quirúrgico solamente se recomienda en un subgrupo de pacientes que no han respondido a otros tratamientos y que tienen ciertas anormalidades anatómicas específicas que alteran la articulación patelofemoral. Discusión El tratamiento conservador continúa siendo la piedra angular en el tratamiento del síndrome de dolor patelofemoral

Impresión en tres dimensiones: Estudio descriptivo de la percepción estudiantil en una experiencia de enseñanza en Terapia Ocupacional / Three-Dimensional Printing: Descriptive Study Of Student Perception In A Teaching Experience In Occupational Therapy

Introducción: La impresión en tres dimensiones (3D) se posiciona como complemento para la educación en ciencias de la salud debido a su versatilidad y aplicaciones concretas en diversos ámbitos. Objetivo: Describir la percepción de estudiantes de Terapia Ocupacional sobre una experiencia de diseño y fabricación de órtesis/prótesis. Métodos: Estudio cuantitativo, descriptivo y de corte transversal. La población correspondió a estudiantes de la carrera de Terapia Ocupacional cursando quinto semestre. La muestra fue de tipo intencionada. Se implementó una experiencia académica. Se evaluó la percepción que los estudiantes tuvieron sobre la experiencia a través de encuesta estructurada en formato tipo Likert, las respuestas fueron analizadas según frecuencia de respuestas para cada ítem. Se resguardaron aspectos éticos a través de consentimientos informados. Resultados: Participaron ocho estudiantes, quienes estuvieron Muy de acuerdo o De acuerdo con la mayoría de las aseveraciones, destacando el aporte de la intervención con fines docentes. Conclusión: La impresión 3D aplicada al ámbito de diseño y fabricación de órtesis/prótesis fue una experiencia bien evaluada. Es posible de ser implementada para la adquisición de las habilidades necesarias para la confección de órtesis/prótesis. Se concluye que el uso de la impresión 3D en la educación, así como en aplicaciones clínicas tiene opciones concretas de implementación(AU)

Introduction: Three-dimensional (3D) printing is positioned as a complement to health sciences education due to its versatility and specific applications in various areas. Objective: Describe the perception of Occupational Therapy students about an experience of design and manufacture of orthoses/prostheses. Methods: Quantitative, descriptive and cross-sectional study. The population corresponded to students of Occupational Therapy career, studying fifth semester. The sample was of an intentional type. An academic experience was implemented. The perception that the students had about the experience was evaluated through a structured survey in a Likert format, the answers were analyzed according to the frequency of responses for each item. Ethical aspects were safeguarded through informed consents. Results: Eight students participated, who Strongly agree or Agree with most of the statements, highlighting the contribution of the intervention for teaching purposes. Conclusion: 3D printing applied to the field of design and manufacture of orthoses/prostheses was a well-evaluated experience. It is possible to be implemented for the acquisition of the necessary skills for orthoses/prostheses manufacture. It is concluded that the use of 3D printing in education, as well as in clinical applications has concrete options for implementation(AU)

Eficácia das palmilhas customizadas na melhora da distribuição da pressão plantar em pacientes com neuropatia diabética: Protocolo de um ensaio clínico randomizado e controlado / Efficacy of customized insoles in the improvement of plantar pressure in patients with diabetic neuropathy: Protocol of a randomized and controlled clinical trial

OBJETIVO: Avaliar a influência das palmilhas customizadas na pressão plantar de diabéticos com neuropatia em comparação ao grupo sham. MÉTODOS: O método do estudo, devidamente registrado no Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, incluiu um ensaio clínico randomizado, controlado, prospectivo, duplo-cego, com uma amostra de 46 voluntários que serão randomizados aleatoriamente numa razão de 1: 1 para serem direcionados aos grupos intervenção e controle. O grupo intervenção receberá palmilhas customizadas, com barra retrocapital e placa de etil vinil acetato (EVA) no mesmo formato da barra retrocapital, com a finalidade de reduzir a pressão no antepé. No grupo controle, as palmilhas planas serão confeccionadas sem nenhum objetivo terapêutico. Este projeto foi conduzido de acordo com o padrão de protocolo para ensaios clínicos randomizados (SPIRIT). Junto com a avaliação clínica, serão coletados dados demográficos da amostra para identificar e confirmar a presença de neuropatia periférica, em seguida, será avaliada a podobarografia e, por fim, os pacientes responderão ao questionário FAAM para avaliação da funcionalidade do pé. O desfecho primário será a análise dos pontos de pressão em KiloPascal (kPa) no pé dos pacientes com neuropatia diabética por meio da podobarografia nos pacientes do grupo intervenção e controle. O desfecho secundário será a funcionalidade do pé nas atividades de vida diária através do questionário FAAM (Foot and Ankle Ability Measure), considerando os voluntários na avaliação inicial, 3º e 6º meses. CONSIDERAÇÕES FINAIS: os futuros resultados deste estudo nos mostrarão principalmente se há ou não uma alteração estrutural na análise da pressão plantar decorrente do uso contínuo da palmilha, além de avaliar se o uso da palmilha terapêutica é eficaz na funcionalidade do pé nos mesmos portadores quando comparado à palmilha sham.

| OBJECTIVE: To evaluate the influence of customized insoles in the plantar pressure of diabetes patients with neuropathy in comparison to the sham group. METHODS: The work method, duly registered at the Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, includes a randomized, controlled, prospective, doubleblinded clinical trial, with a sample of 46 volunteers that will be randomly randomized in a 1: 1 ratio to be referred to intervention and control groups. The intervention group will receive customized insoles, with a retrocapital bar and an ethyl vinyl acetate plaque (EVA) in the same shape as the retrocapital bar, in order to reduce the pressure on the forefoot. In the control group, flat insoles will be prepared without any therapeutic objective. This project was developed according to the standard protocol for randomized clinical trials (SPIRIT). Along with the clinical evaluation, demographic data of the sample will be collected to identify and confirm the presence of peripheral neuropathy, next, the pedobarographic will be evaluated, and finally, the patients will answer the FAAM questionnaire to assess foot functionality. The primary outcome will be analyzing pressure points in KiloPascal (kPa) in the patients' feet through pedobarographic of the patients in the intervention and control groups. The secondary outcome will be the foot functionality in activities of daily living through the FAAM (Foot and Ankle Ability Measure), considering the volunteers in the initial evaluation, third and sixth months. FINAL CONSIDERATIONS: Mainly, results of this study will show whether there is a structural alteration in the analysis of the plantar pressure due to the continuous use of insoles and present the evaluation of whether the use of therapeutic insoles improves the foot functionality of the same users when compared to sham insoles.

Effects of a walking orthosis on the walking ability of patients with spinal cord injury at L 2 / 中华物理医学与康复杂志

Objective:To compare the effect of a knee-ankle-foot orthosis (KAFO) and a paraplegic walking orthosis (WO) on the walking ability and the physiological cost index (PCI) of persons suffering from AIS A-B spinal cord injury (SCI) at the L 2 level. Methods:Thirty subjects with AIS A-B SCI at L 2, aged 20 to 45, were assigned randomly into a KAFO group ( n=15) or a WO group ( n=15). All received muscle strength, range of motion, standing, balance and weight shifting training and training in the activities of daily life. Electrotherapy and acupuncture were also administered. Both groups underwent 60 minutes of walking training 6 times per week for 12 weeks, wearing either a KAFO or a WO. Step length, gait speed, step frequency, 10-metre walk time, 6-minute walk distance and PCI were compared after 2 and 12 weeks. Results:The average step length, gait speed, step frequency, 10-metre walk time, 6-minute walk distance and PCI of both groups had improved significantly between the 2-week and 12-week evaluations, with significantly greater average improvement among the WO group at both time points.Conclusion:A WO or KAFO facilitates better walking after an AIS A-B spinal cord injury at L 2. Wearing a WO is more effective than wearing a KAFO, on average.

The efficacy of an orthotic helmet in cranial remodeling of infants with deformational plagiocephaly / 中华物理医学与康复杂志

Objective:To observe the clinical effect of helmet therapy in cranial remodeling of infants with deformational plagiocephaly.Methods:A total of 114 infants with plagiocephaly received helmet therapy at the age of 4 to 12 months over the period from 2016 to 2018 and the results were analyzed retrospectively. Seventy-four were male and forty female. The average ages were (7.49±1.91) and (7.54±2.10) months, respectively. A Spectra scanner was used to quantify each head′s radial symmetry index (RSI), cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) before and after 100 days of treatment, and those data were related with age (4-6 months, 7-9 months and 10-12 months), gender and severity of deformity (levels III-V).Results:The average RSI, CVA and CVAI improved significantly for all of the infants studied. The average RSI, CVA and CVAI improved the most for those 4-6 months old. Those with level-IV deformity showed significantly better improvement than those with level III or V deformity.Conclusions:Helmet therapy is an effective way to improve deformities due to plagiocephaly among infants. The best age for treatment is 4-6 months. Patients with less malformation are more easily corrected.

Results of orthoses used on ambulatory patients with bilateral cerebral palsy / Resultados do uso de órteses em pacientes deambuladores com paralisia cerebral

ABSTRACT Objective: To investigate the impact of ankle-foot orthoses (AFO) on subjects diagnosed with bilateral cerebral palsy (CP) using the gait index and temporal data parameters. Methods: Twenty-four subjects, 14 male and 10 female, with a mean age of 11 (5-17 years old), underwent a comprehensive gait analysis under both barefoot (BF) and braced walking conditions. All children had been wearing the orthoses for at least 2 months before the gait analysis. Results: The overall values for the left and right Gait Profile Scores (GPS) did not show statistically significant variations when comparing the same individuals with and without orthoses. Gait velocity increased by 19.5% (p < 0.001), while the cadence decreased by 4% with use of orthosis, although it was not statistically significant (p > 0.05). The stride and the step lengths on both the right and left sides, however, resulted in statistically significant increases, when wearing AFO. Conclusion: AFO, prescribed for assistance by professionals without using gait data, did not significantly affect the gait index (GPS), but improved temporal data. The determination of quantitative clinical parameters for the prescription of orthotics in patients with bilateral CP, as well as orthotics that meet the specific requirements are points to be addressed in the future to obtain more significant effects. Level of evidence III, Case control study.

RESUMO Objetivo: Investigar o impacto das órteses suropodálicas (AFOs) utilizando índices da análise computadorizada da marcha (ACM) e dados de tempo e espaço, em indivíduos com diagnóstico de paralisia cerebral (PC) bilateral. Métodos: 24 indivíduos, 14 do sexo masculino e 10 do sexo feminino, com média de idade de 11 anos (5-17 anos), foram submetidos a uma análise da marcha, tanto na condição de andar descalço (AD) quanto com uso das órteses. Todas as crianças usavam as órteses há no mínimo 2 meses antes da ACM. Resultados: Os valores do perfil global da marcha (GPS) dos lados direito e esquerdo não apresentaram variações estatisticamente significativas quando os mesmos indivíduos foram comparados, com e sem órteses. Com o uso de órtese a velocidade da marcha aumentou 19,5% (p < 0,001), enquanto a cadência diminuiu 4%, embora não tenha sido estatisticamente significativa (p > 0,05). No entanto, com o uso da órtese, a passada e o comprimento do passo dos lados direito e esquerdo tiveram aumentos estatisticamente significativos. Conclusão: As AFOs, quando prescritas por profissionais sem o uso de dados da ACM, não alteraram significativamente o índice da marcha (GPS), mas melhoraram os dados de tempo e espaço. A determinação de parâmetros clínicos quantitativos para a prescrição de órteses em pacientes com PC bilateral, bem como órteses que atendam a requisitos específicos, são pontos a serem abordados no futuro, a fim de obter efeitos mais significativos. Nível de evidência III, Estudo de caso e controle.

The use of orthoses in children with cerebral palsy: perception of caregivers / O uso de órteses em crianças com paralisia cerebral: percepção dos cuidadores

Abstract The orthoses can be used as an adjuvant in the rehabilitation of children with Cerebral Palsy(CP). Studies that investigate caretakers' opinions over the use of the orthoses are fundamental, especially for propositions that aim to produce a positive impact on the use of orthoses by the children. This study's objective was to identify the perception of caretakers of children with CP over the functionality, benefits, and satisfaction over the use of the orthoses. Eighteen caretakers of children with CP, who used upper and/or lower limb orthoses, participated in this study. The data was obtained with questionnaires with open and closed questions. Descriptive and quantitative analysis of the data was made. The results suggest that the satisfaction with the orthoses is linked to the consideration of the caretaker's opinions during the period of prescription and confection of the orthoses; to the guidance provided by professional; to the noticed improvement of the range of movement of fingers and wrists and the increase of the child's balance and confidence while walking. Disconsidering the caretaker's opinions over the orthosis and the perception that the orthoses cause pain or discomfort contributed to the dissatisfaction and/or partial satisfaction of the caretakers. The results of this study may be useful for professionals from many areas of knowledge because they provide a basis to contribute for the efficacy of prescription and intervention by healthcare professionals, as well as elements that may help designers to make orthoses that fulfill the user's expectations and so increase usability, comfort, and satisfaction.

Resumo A órtese pode ser utilizada como adjuvante no tratamento de reabilitação de crianças com paralisia cerebral (PC). Estudos que investigam a opinião dos cuidadores em relação ao uso da órtese são de fundamental importância, especialmente para proposição de melhorias que visem impactar positivamente no seu uso pela criança. Objetivou-se neste estudo identificar a percepção de cuidadores de crianças com PC sobre a função, os benefícios e a satisfação com o uso das órteses. Participaram 18 cuidadores de crianças com PC usuárias de órteses de membros inferiores e/ou superiores. A coleta de dados foi feita por meio de questionário contendo questões abertas e fechadas. Realizou-se análise descritiva e quantitativa dos dados. Os resultados sugerem que a satisfação dos cuidadores se relacionava com o fato de terem sua opinião considerada durante o processo de prescrição e confecção das órteses; com as orientações fornecidas pelos profissionais; com os benefícios percebidos pela melhora na amplitude de movimento de punho e dedos e pela maior confiança e equilíbrio da criança ao andar. Desconsiderar a opinião sobre a órtese, a percepção de que a mesma causa dor e desconforto contribuíram para a insatisfação e/ou satisfação parcial dos cuidadores. Os resultados deste estudo podem ser úteis para profissionais de diferentes áreas do conhecimento, pois trazem subsídios que podem contribuir para a eficácia da prescrição e intervenção por parte dos profissionais da saúde, bem como elementos que podem colaborar para que profissionais do design projetem órteses que atendam aos requisitos do usuário com vistas a favorecer a usabilidade, conforto e satisfação.

Long-Term Effect of Rigid Foot Orthosis in Children Older Than Six Years With Flexible Flat Foot

OBJECTIVE: To evaluate the long-term effect of a custom-made rigid foot orthosis (RFO) in children older than 6 years with pes planus (flat foot). METHODS: Medical records of 42 children diagnosed with flexible pes planus who were fitted with RFOs based on the inverted technique and underwent more than four consecutive radiological studies were reviewed. Resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle, lateral talocalcaneal angle, lateral talometatarsal angle, and calcaneal pitch were initially measured in both feet to evaluate alignment. Followup clinical and radiological evaluations were then performed at 12–18, 24–30, 36–42, and ≥48 months after RFO application. Repeated measures analysis of variance was used to evaluate significant differences. RESULTS: Significant improvements in all radiological indicators and significant progression of RCSP toward the corrective direction were observed after RFO application relative to baseline measurements. CONCLUSION: According to our findings, RFO can induce significant improvements in calcaneus-related radiographic indices and subsequently improve talus-related radiologic indices.

Current Situation of Assistive Devices and Appliances Provision for Persons with Cerebral Palsy in Korea / 보건행정학회지

BACKGROUND: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. METHODS: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. RESULTS: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, 90° limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. CONCLUSION: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.

Correlation of Radiographic and Patient Assessment of Spine Following Correction of Nonstructural Component in Juvenile Idiopathic Scoliosis

OBJECTIVE: To evaluate the association between progression of curvature of scoliosis, and correction for functional component in patients with juvenile idiopathic scoliosis (JIS). METHODS: We retrospectively reviewed medical data of patients prescribed custom molded foot orthosis (FO) to correct inequality of RCSPA (resting calcaneal stance position angle), and chose 52 patients (26 females, 26 males) with Cobb angle ≥10° in radiology and uneven pelvic level at iliac crest by different RCSPA (≥3°) as a factor of functional scoliosis. They had different hump angle ≥5° in forward bending test, for idiopathic scoliosis component. Their mean age and mean period of wearing FO were 79.5±10.6 months and 18.6±0.70 months. RESULTS: Cobb angle was reduced from 22.03°±4.39° initially to 18.86°±7.53° after wearing FO. Pelvis height difference and RCSPA difference, were reduced from 1.07±0.25 cm initially to 0.60±0.36, and from 4.25°±0.71° initially to 1.71°±0.75° (p < 0.01). Cobb angle improved most in 9 months. However, there was no significant improvement for those with more than 25° of Cobb angle initially. Mean Cobb angle improved in all age groups, but patients less than 6 years had clinically significant improvement of more than 5°. CONCLUSION: JIS can have functional components, which should be identified and managed. Foot orthosis is useful in correcting functional factors, in the case of pelvic inequality caused by different RCSPA, for patients with juvenile idiopathic scoliosis.

Long Term Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children with Symptomatic Flexible Flat Feet

OBJECTIVE: To evaluate the long termeffect of custom-molded foot orthoses on foot pain and balance ability in children with symptomatic flexible flat feet after 1 year.METHOD: A total of 35 children over 6 year-old with flexible flat feet and foot pain for at least 6 months were recruited. Individual custom-molded rigid foot orthoses fabricated with the inverted orthotic technique was prescribed. Pain related parameters (pain sites, degree, and frequency) were obtained through questionnaires. Pain assessment was performed prior to application of the foot orthoses, and 1, 3, 6, 12 months after applying the orthoses. Balance ability was tested by computerized posturography. Such measures were evaluated prior to, 3 months, and 12 months after applying the foot orthoses. Additionally, the difference inbalance ability between barefoot and withfoot orthosesat 12 months was assessed to estimate carryover effect.RESULTS: 17 out of 35 children completed the study. Significant improvements were noted upto 12 months in pain parameters and balance ability. The carry over effect of the orthoses was confirmed.CONCLUSION: There were significant improvements offoot pain and balance ability in children with symptomatic flexible flat foot after wearing foot orthoses fabricated with the inverted orthotic technique over 1year period.

Occipital Neuralgia: a noninvasive therapeutic approach / Neuralgia Occipital: uma abordagem terapêutica não invasiva / Neuralgia Occipital: un abordaje terapéutico no invasivo

ABSTRACT Objective: to evaluate the application of a noninvasive intervention consisting of a postural modification using personalized models and osteopathy in people with occipital neuralgia. Method: retrospective study of the intervention performed in adult population with occipital neuralgia, consisting of postural modification using personalized plantar orthoses and osteopathy, in a study period of four years. The observed variables were: persistence of headache, alignment of the axes, plantar support, center of gravity and center of mass; medical interview data, visual analogue scale, Win-Track gait analysis system and Kinovea software for video analysis (clinical assessment instruments used). Results: a total of 34 records of people with occipital neuralgia were studied. A fraction of 58.8% of the patients reported improvement after the intervention. The visual analogue scale data were provided for 64.7% of the records and significant differences (p <0.001) between the means before (8.4 ± 1.7) and after the intervention (2.6 ± 2.7) were found. Conclusion: postural modification using personalized orthoses and osteopathy substantially improves the symptomatology of patients with occipital neuralgia.

RESUMO Objetivo: avaliar a aplicação de uma intervenção não invasiva que consiste em uma modificação postural usando modelos personalizados e osteopatia em pessoas com neuralgia occipital. Método: estudo retrospectivo da intervenção realizada em população adulta com neuralgia occipital que consiste de modificação postural empregando órteses plantares personalizadas e osteopatia, em um período de estudo de quatro anos. As variáveis observadas foram: persistência de cefaleia, alinhamento dos eixos, apoio plantar, centro de gravidade e centro de massa; dados da entrevista médica, escala visual analógica, sistema de análise de marcha Win-Track e o software Kinovea para análise de vídeo (instrumentos de avaliação clínica utilizados). Resultados: foram estudados no total 34 registros de pessoas com neuralgia occipital. Uma fração de 58,8% dos pacientes informou apresentar melhoria após a intervenção. Os dados da escala visual analógica foram fornecidos para 64,7% dos registros, encontrando diferenças significativas (p<0,001) entre as médias antes (8,4±1,7) e depois da intervenção (2,6±2,7). Conclusão: a modificação postural empregando órteses personalizadas e osteopatia melhora substancialmente a sintomatologia dos pacientes com neuralgia occipital.

RESUMEN Objetivo: evaluar la aplicación de una intervención no invasiva consistente en una modificación postural empleando plantillas personalizadas y osteopatía en personas con neuralgia occipital. Método: estudio retrospectivo de la intervención llevada a cabo en población adulta con neuralgia occipital, de modificación postural empleando órtesis plantares personalizadas y osteopatía, en un período de estudio de cuatro años. Las variables observadas fueron: persistencia de cefalea, alineación de los ejes, apoyo plantar, centro de gravedad y centro de masa; datos de la entrevista médica, la escala visual análoga, el sistema de análisis de la marcha Win-Track y el software Kinovea para análisis de vídeo (instrumentos de valoración clínica utilizados). Resultados: un total de 34 registros de personas con neuralgia occipital fueron estudiados. Un 58,8% refería presentar mejoría tras la intervención. Los datos de la escala visual análoga eran proporcionados un 64,7% de los registros, encontrándose diferencias significativas (p<0,001) entre las medias previas a la intervención (8,4±1,7) y aquellas posteriores (2,6±2,7). Conclusión: la modificación postural empleando órtesis personalizadas y osteopatía mejora sustancialmente la sintomatología de los pacientes con neuralgia occipital.

Comparison between two types of abduction orthotics in treating congenital clubfoot / Comparação entre duas órteses de abdução no tratamento do pé torto congênito

ABSTRACT Objective: The objective of this study was to analyze and compare the effectiveness of two types of abduction orthotics used for the feet, the Denis-Browne type (traditional) and the Dobbs type (dynamic), with regard to maintenance of deformity correction and prevention of recurrence . Method: In this comparative retrospective case study, information was collected from the medical records of children with idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet in 28 patients, which were divided into two groups. Group 1 was comprised of 16 patients with a total of 24 CCFs treated with the traditional orthotic device. Group 2 consisted of 12 patients with a total of 19 CCFs treated with the dynamic orthotic device. The statistical analysis used the ANOVA test to compare the categorical variables between the groups. A significance level of 5% was adopted (p-value≤0.05) . Results: In Group 1, recurrence was observed in 2 feet (8.33%), and in 1 foot in Group 2 (5.26%). No significant difference in effectiveness was seen between the two types of orthotic devices . Conclusion: Both abduction devices were seen to be effective in maintaining correction of congenital clubfoot deformities. There was no statistical significance between type of orthotic device and recurrence. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Analisar e comparar a eficácia entre dois tipos de órtese de abdução para o pé, tipo Denis-Browne (tradicional) e a proposta por Dobbs (dinâmica), quanto à manutenção da correção das deformidades e da prevenção das recidivas. Método: Estudo de casos, retrospectivo e comparativo, com levantamento de prontuários de crianças com PTCI. Foram avaliados 28 pacientes, totalizando 43 pés, divididos em dois grupos: Grupo 1 - tratados com aparelho tradicional, 16 pacientes, 24 PTCI. Grupo 2 - tratados com aparelho dinâmico, 12 pacientes, totalizando 19 PTCI. A análise estatística comparou as variáveis categóricas entre os grupos com o teste ANOVA. Foi adotado nível de significância de 5% (p ≤ 0,05). Resultados: No grupo 1, a recidiva ocorreu em dois pés (8,33%) e no grupo 2 em um pé (5,26%). Na comparação das duas órteses, a eficácia não apresentou diferença significante. Conclusão: Ambos os aparelhos de abdução mostraram-se eficazes na manutenção da correção das deformidades do pé torto congênito. Não ocorreu significância estatística em relação às órteses e a ocorrência de recidivas. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Comparison of the Immediate Effect between Functional Electrical Stimulation and Ankle Foot Orthoses on Gait Parameters in Cerebral Palsy.

Aim: To compare the immediate effect of functional electrical stimulation (FES) to solid ankle foot orthosis (SAFO) concerning spatiotemporal parameters and ankle kinematics during gait in hemiplegic cerebral palsy (CP). Methodology: Thirty spastic hemiplegic cerebral palsied children were randomly distributed into two equal groups; group A, who used the functional electrical stimulation (FES) and group B, who worn the solid ankle foot orthosis (SAFO). Vicon 3D motion analysis system was used to measure the spatiotemporal parameters of gait and ankle dorsiflexion angle at initial contact and mid-swing before intervention and with application of either FES or SAFO. Spasticity was ranged between 2 and 1+ and determined by Modified Ashworth Scale score. Results: Following the application of solid AFO, stride length and walking speed significantly increased than next to FES (p=0.0001, p=0.001) respectively. Whereas, number of steps/minute significantly decreased (p=0.001). Further, Solid AFO increased ankle dorsiflexion at initial contact (6.2±4.7º) and mid-swing (3.4±0.6º) more than FES at initial contact (1.86±3.9º) and mid-swing (-4.6± 5º). Conclusion: FES, unlikely found to evoke an immediate effect of spatiotemporal parameters while solid AFO improved the gait efficiency by enhancing spatiotemporal parameters. Both treatment interventions increased ankle dorsiflexion at initial contact and mid-swing but solid AFO was more effective immediately than FES.

Analysis on Medical Device Supervision of Orthoses / 中国康复理论与实践

Objective To discuss the key problem of medical device supervision of orthoses and its effect on orthoses market. Methods The meaning of orthoses was discriminated, the status of regulation was revealed, the generic names of orthoses was designed, and the effect of supervision on different body of orthoses market was analyzed. Results Difficulties are brought to the medical device regulation because of different meanings of orthoses in the fields of assistive devices and medical devices. Scientific classification and naming was the right way to solve the problem. Conclusion All the organizations on chains of orthoses are within the category of medical device supervision. Fit-ting organizations of orthoses should also accept regulation of China Food and Drug Administration, at the same time gaining qualification from China Ministry of Civil Affairs. The problem of personalized orthoses supervision needs to be solved properly.

Foot Overpronation: Influence on Body Alignment and Managements (review) / 中国康复理论与实践

@#The foot overpronation is termed as pronation persisting more than 25%of stance phase in a walking cycle, which may re-sult from some antenatal or postnatal conditions. Overpronation would lead to abnormal alignment of ankle, knee, pelvis and spine, and re-sult in a set of syndromes of chronic pain. The Navicular Drop Test and the Foot Posture Index are often used as the assessment tools, how-ever, there are several empirical ways for clinic. Foot orthoses, special shoes, taping and training of muscle strength are effective on overpro-nation as well as chronic pain.

Correcting of pronated feet reduce skeletal muscle injury in young women with biomechanical abnormalities / 대한해부학회지

Biomechanical abnormalities of pronated feet accompanied by functional leg length disparity may increase the risk of skeletal muscle injury. Objective of the study is to prove that correction of pronated feet by the foot orthoses will reduce the creatine kinase-MM (CK-MM) concentrations as the muscle injury indicator. The design study was double blind randomized clinical trials with control. Research subjects were divided into two groups, group 1 used the foot orthoses while group 2 did not used the foot orthoses. The whole subject examined the concentrations of the CK-MM enzyme before, and 24–72 hours after the walking test. The walking test was conducted 15 minutes with maximum speed. The concentration of the CK-MM enzyme before walking test on treatment group was 70.07±15.33 International Unit (IU), similar with the control group was 69.85±17.03 IU (P=0.971). The increased in CK-MM enzyme concentrations 45 hours after the walking test was lower in the treatment group (7.8±9 IU) than the control group (22.0±11.5 IU) (P=0.001). The CK-MM enzyme concentrations continued to decline in the treatment group after the second walking test (77.21±17.47 IU), and after the third walking test (69.86±11.88 IU) (P=0.018). The foot orthoses for correcting the pronated feet on the young women with biomechanical abnormalities is able to reduce the degree of the skeletal muscle injury after walking activity.