Gait and muscle activity measures after biomechanical device therapy in subjects with ankle instability: A systematic review.

INTRODUCTION: Health specialists suggest a conservative approach comprising non-pharmacological interventions as the initial course of action for individuals with repetitive ankle sprain due to ankle instability. This systematic review aimed to assess the effectiveness of biomechanical devices (Foot Orthoses, Ankle Orthoses, and Taping) on gait and muscle activity in individuals with ankle instability. METHODS: A systematic search was performed on electronic databases, including PubMed, EMBASE, Clinical Trials.gov, Web of Science, and Scopus. The PEDro scoring system was used to evaluate the quality of the included studies. We extracted data from population, intervention, and outcome measures. RESULTS: In the initial search, we found 247 articles. After following the steps of the PRISMA flowchart, only 22 reports met the inclusion criteria of this study. The results show that biomechanical device therapy may increase swing time, stance time, and step. Additionally, studies suggest that these devices can reduce plantar flexion, inversion, and motion variability during gait. Biomechanical devices have the potential to optimize the subtalar valgus moment, push-off, and braking forces exerted during walking, as well as enhance the activity of specific muscles including the peroneus longus, peroneus brevis, tibialis anterior, gluteus medius, lateral gastrocnemius, rectus femoris, and soleus. CONCLUSION: Biomechanical devices affect gait (spatiotemporal, kinetic, and kinematic variables) and lower limb muscle activity (root mean square, reaction time, amplitude, reflex, and wave) in subjects with ankle instability.

A case series on the effect of dynamic neoprene orthosis on lower limb kinematic variables in children with cerebral palsy.

PURPOSE: This study examined the effects of a dynamic neoprene orthosis on kinematic variables of gait in children with spastic bilateral cerebral palsy (CP). METHODS: Five children (whose median age was 9.6 years and who ranged in age from six to 12) with spastic bilateral CP and flexed knee at levels I-III of the Gross Motor Function Classification System were examined using kinematic gait analysis in three different conditions: 1) with dynamic neoprene orthosis; 2) without dynamic neoprene orthosis (immediate effect); and 3) without orthosis after six weeks of intervention. RESULTS: The comparison between condition one (with dynamic neoprene orthosis) and condition two (without dynamic neoprene orthosis) demonstrated the existence of improvements in minimum hip and knee flexion variables. Moreover, the results indicated that the improvements remained constant in several key gait variables after six weeks. CONCLUSION: The results varied from subject to subject, and there were signs of improvement in some of the subjects. Therefore, it was not possible to draw conclusions at a group level. Nonetheless, a number of individuals may benefit from this type of orthosis.

Validity and Reliability of the Persian Version of Barriers to Physical Activity Questionnaire for People With Mobility Impairments.

BACKGROUND: Although physical activity (PA) is an important determinant of health, physically disabled individuals tend to have a sedentary lifestyle. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) is a self-report instrument evaluating PA barriers. This study was intended to evaluate the validity and reliability of the Persian version of BPAQ-MI (P-BPAQ-MI) and to report the prevalence and severity of PA barriers among Persian-speaking individuals. METHODS: The translation and back translation of the BPAQ-MI was conducted according to an internationally accepted guideline and tested on 163 participants to assess its reliability and validity. Internal consistency and test-retest reliability were analyzed using Cronbach alpha and Spearman correlation coefficient. Convergent construct validity was established by comparing the scores of P-BPAQ-MI and The Baecke Habitual Physical Activity Questionnaire. Known-groups construct validity was assessed with regard to type of assistive device and sex of the individual. Prevalence and severity of the barriers were reported by computing the percentage and means of "yes" answers. RESULTS: The P-BPAQ-MI domains demonstrated very good internal consistency (Cronbach alpha of .77-.95) and excellent test-retest reliability (Spearman rho of .73-.96) with a significant inverse small correlation with Baecke Habitual Physical Activity Questionnaire indexes. The P-BPAQ-MI successfully discriminated between individuals with different assistive devices and sex. Community Built Environment barriers were the most prevalent and severe. CONCLUSIONS: The P-BPAQ-MI is a valid and reliable instrument to assess the PA barriers of people with physical disability. The community barriers were the most frequently reported obstacles to PA.

The Efficacy of "Anatomical Posture Control Orthosis" on the Activity of Erector spinae Muscle, Risk of Falling, Balance Confidence, and Walking Speed in Osteoporotic Hyperkyphotic Subjects.

Background: Osteoporosis is a silent and asymptomatic disease that leads to thoracic hyperkyphosis, which can interfere with the normal function of the paraspinal musculature and balance control. There is no evidence regarding the effect of the anatomical posture control (APC) orthosis in older people with osteoporotic thoracic hyperkyphosis. This study aimed to examine the effects of this novel orthosis on the electromyography (EMG) of the erector spinae (ES) and balance control in this group of patients. Methods: In total, 22 elderly osteoporotic subjects with thoracic hyperkyphosis were enrolled in this study. The participants used the orthosis for 4 weeks. The clinical balance assessment scales assessing fall risk and surface EMG (sEMG) signals were recorded from the erector spinae muscles bilaterally before and after the use of orthosis. The marginal model was used with the generalized estimating equation analysis for investigating the effect of this orthosis on the sEMG of the paraspinal muscles and the balance control in this longitudinal study. Results: The normalized root mean square of sEMG of the lumbar and thoracic ES muscles reduced significantly (P<0.05), and significant improvement was observed (P<0.05) in the balance control test when the participants used this new-designed orthosis (P<0.05). Conclusion: APC orthosis can decrease the activity of ES muscles during static standing and improve the static and dynamic balance in the hyperkyphotic osteoporotic subjects.

Effects of vibro-medical insoles with and without vibrations on balance control in diabetic patients with mild-to-moderate peripheral neuropathy.

The purpose of this study was to investigate the effects of a total-contact insole with and without subthreshold mechanical random noise on the balance control in diabetic patients with mild-to-moderate peripheral neuropathy. Twenty diabetic patients with mild-to-moderate neuropathy was recruited to this study. A total-contact insole was prototyped and vibratory motors were embedded into it. The parameters of the center of pressure (amplitude, velocity, and phase plane portrait) were analyzed after 30-minute walks with the shoe only, the shoe with vibro-medical insole with and without vibrations in eyes open and closed condition. The center of pressure amplitude, velocity, and phase plane portrait in the anterior-posterior and medio-lateral directions were significantly decreased using a vibro-medical insole without vibration in the eyes open condition (p < 0.05), as compared to the shoe, and with vibro- medical insole with vibration in both eyes open and closed conditions (p < 0.05) compared to the shoe. A significant drop was observed in the center of pressure amplitude, velocity and phase plane portrait parameters when the vibro-medical insole with vibration was used compared to vibro- medical insole without vibration in eyes closed condition (p < 0.05). The use of vibro-medical insoles was found to improve the patient's balance control, as compared to the shoe. In the eyes closed condition, an improvement in the balance control was observed only with vibro-medical insole with vibration rather than vibro-medical insole without vibration or the shoe. Current finding suggest that a combination of the total-contact insole with vibration may improve the balance control remarkably in diabetic patients with mild-to-moderate neuropathy.

Comparison of the effect of foot orthoses on Star Excursion Balance Test performance in patients with chronic ankle instability.

BACKGROUND:: Chronic ankle instability as a prevalent consequence of ankle sprain causes various impairments such as balance and postural control deficits. Foot orthoses are one of the common interventions for rehabilitation of patients with chronic ankle instability. OBJECTIVES:: To investigate the effect of custom-molded foot orthoses with textured surfaces on dynamic balance of chronic ankle instability patients and to compare their effects with other types of foot orthoses. STUDY DESIGN:: This is a repeated measure design. METHODS:: A total of 30 participants were recruited based on the guideline introduced by the International Ankle Consortium. The effect of prefabricated, custom-molded, and custom-molded with textured surface foot orthoses was evaluated on dynamic balance by the Star Excursion Balance Test. Normalized reach distances in anteromedial, medial, and posteromedial directions of the test were computed to be used for statistical analysis. RESULTS:: The foot orthoses increased reach distances compared to the no-orthosis conditions in all three directions. The custom-molded with textured surface foot orthosis has significant differences compared with prefabricated foot orthosis ( p = 0.001) in all measured directions and with custom-molded foot orthosis ( p < 0.01) in medial and posteromedial directions. CONCLUSION:: Foot orthoses improve reach distances in patients with chronic ankle instability. Custom-molded with textured surface foot orthosis has a more pronounced effect compared with other foot orthoses. CLINICAL RELEVANCE: The custom-molded foot orthosis with textured surface could be an effective device to improve dynamic balance in chronic ankle instability (CAI) patients. It may be considered as an efficient intervention to reduce ankle sprain recurrence in these individuals, although further research should be conducted.

First prototype of EMG-controlled power hand orthosis for restoring hand extension in stroke patients.

Weakness in finger extensors is a common post-stroke deficit that can disturb hand functioning. Despite introducing several powered hand orthoses in literature, most of these devices focused on providing finger flexion. There is a little consideration for providing active hand extension in stroke patients. Moreover, in many devices, the finger extensions were restored passively by spring component. In this study, a new Electromyography (EMG)-controlled powered hand orthosis was designed to improve hand function by restoring and training hand extension in stroke patients with paretic hand. This orthosis was a glove-like device that was developed from two mechanical and electrical sections. After construction and verifying of the orthosis, its applicability was tested on two patients with Cerebrovascular accident (1 woman and 1 man) with paretic hands in an 18-session therapeutic approach. To evaluate the effectiveness of orthosis, Wolf Motor Function Test and Box and Block test were conducted before and after the training sessions. The primary assessment of the prototype was conducted on a healthy subject and three stroke patients. These evaluations showed that the new powered hand orthosis could be effective for finger extension task and training. Furthermore, after the 18-session training approach, significant improvements were seen in the scores of both Wolf and Box and Block tests. The preliminary findings suggested that the first prototype of orthosis could provide a desirable function for stroke patients with paretic hand. Moreover, it could be used as a training device in the rehabilitation of these patients.

The effects of vibro-medical insole on sensation and plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy.

BACKGROUND: The first aim of this study was to determine the effect of a vibro-medical insole on pressure sensation and the second was to measure the effects of a vibro-medical insole with and without random noise on plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy. METHODS: Twenty patients with mild-to-moderate diabetic neuropathy were recruited in the clinical trial pre-test, post-test study. A medical insole was made for each participant and a vibratory system was inserted into it. Pressure sensation was evaluated before and after the 30-min walk using the vibro-medical insole with added random noise by Semmes-Weinstein Monofilaments. Peak pressure data was measured before and after 30-min walking with a vibro-medical insole with and without random noise by the Pedar-x system. FINDINGS: Pressure sensations showed improvement after 30-min walking with the vibro-medical insole with added random noise at the heel, metatarsophalangeal heads and hallux of both feet in all participants (p < 0.05). Peak pressure decreased significantly in the heel, MTP2,3, MTP4,5 and hallux (p < 0.05) and increased in midfoot (p < 0.05) using the vibro-medical insole with and without random noise compared to the shoe only condition. Only the peak pressure of the heel region decreased using the vibro-medical insole with random noise compared to without random noise (p = 0.006). INTERPRETATION: Thirty minute walking with a vibro-medical insole seems to improve pressure sensation and alter peak pressure in diabetic patients with mild-to-moderate peripheral neuropathy. This work suggests that vibro-medical insoles can be used for daily living activities and possibly decreases the risk of ulceration in diabetic neuropathy patients.

The effects of Vibro-medical insole on vibrotactile sensation in diabetic patients with mild-to-moderate peripheral neuropathy.

Peripheral sensory neuropathy seems to be the main risk factor for diabetic foot ulceration. Previous studies demonstrated that stochastic resonance can improve the vibrotactile sensation of diabetic patients. The aim of this study was to evaluate the effects of Vibro-medical insole on pressure and vibration sensation in diabetic patients with mild-to-moderate peripheral neuropathy. A total of 20 patients with mild-to-moderate diabetic neuropathy were included in the pre-test and post-test clinical trial study. Vibro-medical insole consists of medical insole and vibratory system. Medical insole was made independently for each participant and vibratory system was inserted in it. Pressure and vibration sensation were evaluated before and after 30-min walking with Vibro-medical insole. Semmes-Weinstein monofilaments and tuning fork were used to evaluate pressure and vibration sensation, respectively. Pressure sensation showed significantly improvement using Vibro-medical insole at the heel, first and fifth metatarsophalangeal heads, and hallux of both feet in all participants (p < 0.001). Vibration sensation also improved at the big toe of both feet with 256 Hz tuning fork (p < 0.05) but no statistically significant effect was found with 128 Hz tuning fork (p > 0.05). Vibro-medical insole significantly improved pressure and vibration sensation of the foot in diabetic patients with mild-to-moderate peripheral neuropathy. The results suggest that Vibro-medical insole can be used for daily living activities to overcome sensory loss in diabetic neuropathy patients.

Design and evaluation of vibratory shoe on balance control for elderly subjects: technical note.

BACKGROUND AND AIM: Aging often results in a decline in somatosensory function, and such changes are associated with diminished motor performance. Input noise can enhance sensory and motor function through a mechanism known as stochastic resonance (SR). This paper describes the development and testing of a new vibrating shoe to possibly assist the elderly patients in controlling their balance and decreasing their falling risks. TECHNIQUE: The new vibrating shoe was evaluated to ascertain its ability to generate appropriate random and nonlinear vibrations. The vibratory shoe performance in two young subjects with decreased foot sensation and two elderly subjects in different static and dynamic balance situations was also evaluated. The postural control, expressed by the stability index (SI), was significantly affected by SR in the older subjects. DISCUSSION: The vibrating motors could be recommended as a suitable solution for dynamic balance situations. Moreover, the new vibrating shoe could improve the age-related balance impairments in elderly subjects with balance deficiencies and others with impaired foot sensations. Implications for rehabilitations Older adults exhibited decreased postural stability. Noise signal improves sensation and proprioception in older people. New shoe with vibrating motors can operate in different dynamic situations.

Effect of vibration on postural control and gait of elderly subjects: a systematic review.

BACKGROUND AND AIM: Gait and balance disorders are common in the elderly populations, and their prevalence increases with age. This systematic review was performed to summarize the current evidence for subthreshold vibration interventions on postural control and gait in elderly. METHOD: A review of intervention studies including the following words in the title/abstract: insole, foot and ankle appliances, vibration, noise and elderly related to balance and gait. Databases searched included PubMed, ISI Web of Knowledge, Ovid, Scopus, and Google Scholar. Fifteen articles were selected for final evaluation. The procedure was followed using the preferred reporting items for systematic reviews and meta-analysis method. RESULTS: There was reduction in center of pressure velocity and displacement especially with eyes closed using vibration in healthy elderly subjects and this effect was greater in elderly faller and patients with more balance deficiency. Vibration programme training increased speed of walking, cadence, step time and length in stroke subjects. The vibratory insoles significantly improved performance on the Timed Up and Go and Functional Reach tests in older people. CONCLUSION: Vibration was effective on balance improvement in elderly subject especially elderly with more balance deficiency and it can improve gait parameters in patients with greater baseline variability.

Influence of Reciprocating Link When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord Injury: A Pilot Study.

Background: Studies collectively imply that the reciprocal link has no effect on walking when using reciprocating gait orthoses (RGOs). There may be differences between the 2 configurations of the RGO (eg, isocentric reciprocating gait orthosis [IRGO] and IRGO without reciprocating link), but the specific benefits and problems encountered in their use must be understood. Purpose: To highlight more evidence for the mechanical function of the reciprocal link in RGOs used for walking by individuals with spinal cord injury (SCI). Methods: Nine people with SCI participated in this study. Gait analysis was performed in 2 conditions (walking with IRGO and walking with IRGO without reciprocating link) in a random order. The Vicon digital capture system was used to obtain kinematic data. Results: There were significant differences between each orthotic configuration in terms of speed of walking (p = .029), step length (p = .048), hip joint range of motion (ROM) (p ≤ .001), and lateral and vertical compensatory motions (p ≤ .001). There was no significant difference between each orthotic configuration in cadence (p = .162). Conclusion: The reciprocating link in IRGO improved the walking parameters in SCI patients.

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study.

BACKGROUND: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait. AIM: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs. METHOD: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters. RESULTS: Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence. CONCLUSIONS: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced. The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.

The Influence of Rocker Bar Ankle Foot Orthosis on Gait in Patients with Chronic Hemiplegia.

BACKGROUND: This study aimed to evaluate the effect of rocker bar ankle foot orthosis (RAFO) on the spatiotemporal characteristics of gait in chronic hemiplegic patients compared with the effect of solid ankle foot orthosis (SAFO). METHODS: Following ethical approval, 18 patients with chronic hemiplegia, at least 6 months post stroke, were investigated in barefoot condition, with SAFO and RAFO in random sequences. Their spatiotemporal characteristics were examined by 2 force platforms and a Vicon motion analysis system. RESULTS: There were significant changes in spatiotemporal outcome measures between barefoot condition and using SAFO and RAFO (P < .05). Compared with SAFO, RAFO resulted in significantly more step length, faster gait velocity, and less preswing time (P < .05), although no significant differences were seen regarding step width and cadence (P > .05). Furthermore, RAFO led to significant increases in hip extension and knee flexion at toe-off, whereas SAFO did not change these parameters (P < .05). CONCLUSION: Findings of the present study showed that RAFO further improves gait abilities in chronic hemiplegic patients compared with SAFO, which could be due to the positive effect of added rocker bar on push-off function during the late stance phase of gait.

The clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people: A systematic review.

BACKGROUND: Central nervous system receives information from foot mechanoreceptors in order to control balance and perform movement tasks. Subthreshold random noise seems to improve sensitivity of the cutaneous mechanoreceptor. OBJECTIVES: The purpose of this study was to systematically review published evidence conducted to evaluate the clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people. STUDY DESIGN: Systematic review. METHODS: A literature search was performed in PubMed, Scopus, ScienceDirect, Web of Knowledge, CINAHL, and EMBASE databases based on population, intervention, comparison, outcomes, and study method. Quality of studies was assessed using the methodological quality assessment tool, using Physiotherapy Evidence Database scale. RESULTS: In all, 11 studies were selected for final evaluation based on inclusion criteria. Five studies evaluated the effects of subthreshold random noise in diabetic patients and six in elder people. In seven studies, biomechanical (balance and gait parameters) effects and in four studies clinical (pressure and vibration sensations) effects of subthreshold random noise were investigated. All reviewed studies were scored fair (2) to good (9) quality in terms of methodological quality assessment using Physiotherapy Evidence Database scale. CONCLUSION: The results indicated that subthreshold random noise improves balance and sensation in diabetic patients and elder people. Also gait variables can be improved in elder people with subthreshold random noise. However, further well-designed studies are needed. CLINICAL RELEVANCE: The previous studies reported that subthreshold random noise may improve gait, balance, and sensation, but more studies are needed to evaluate the long-term effect of subthreshold random noise in shoe or insole for daily living tasks in diabetic patients and elder people.

Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis.

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 physiological cost index of walking with a powered knee-ankle-foot orthosis in subjects with poliomyelitis: A pilot study.

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.

Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome.

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.

Comparison of gait between healthy participants and persons with spinal cord injury when using the advanced reciprocating gait orthosis.

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 influence of thermoplastic thoraco lumbo sacral orthoses on standing balance in subjects with idiopathic scoliosis.

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.