Safety, walking ability, and satisfaction outcomes of the NEURO TRONIC stance-control knee-ankle-foot orthosis (SCKAFO): A comparative evaluation to the E-MAG active SCKAFO.

BACKGROUND: Stance control knee-ankle-foot orthoses (SCKAFOs) ensure knee stability by locking during stance while allowing knee flexion during swing. Differences in function of the knee joints and building principles between devices may affect their effectiveness. OBJECTIVE: To investigate the preliminary effectiveness of a NEURO TRONIC on safety outcomes, net energy cost (EC), and user experiences in individuals already using an E-MAG Active SCKAFO. STUDY DESIGN: Prospective uncontrolled intervention study. METHODS: A convenience sample of 10 subjects with flaccid lower extremity muscle weakness, including the quadriceps, due to neuromuscular disorders already using an E-MAG Active SCKAFO were provided with a newly fabricated NEURO TRONIC SCKAFO. Outcomes included knee joint locking failures and unlocking failures (ULFs) (i.e., percentage of steps the knee joint failed to lock/unlock) when walking under challenging conditions on an instrumented treadmill while wearing a safety harness; net EC (J/kg per meter) assessed with a 6-min walk test at comfortable speed; 3D gait kinematics and kinetics; and patient-reported outcomes. RESULTS: No differences between devices were found for knee joint locking failures (both devices 0%) and ULFs (9.9% for the NEURO TRONIC vs. 13.9% for the E-MAG Active SCKAFO). The mean (standard deviation) net EC with the NEURO TRONIC SCKAFO was 8.2% (from 3.68 [0.81] to 3.38 [0.75] J/kg per meter, p = 0.123) lower, although not significantly, compared with that with the E-MAG Active SCKAFO. Significant improvements with the NEURO TRONIC SCKAFO were found for ankle power ( p = 0.003), perceived walking effort ( p = 0.014), and reported falls ( p = 0.034). CONCLUSION: Both the NEURO TRONIC SCKAFO and the E-MAG Active SCKAFO were safe in terms of knee joint locking, while ULFs were frequent with both devices. The net EC with the NEURO TRONIC SCKAFO decreased, although not significantly, by 8.2%, likely due to insufficient power. Perceived walking effort was in favor of the NEURO TRONIC SCKAFO.

Relationship Between Heart Rate and Perceived Exertion in Neuromuscular Diseases: How do Laboratory-Based Exercise Testing Results Translate to Home-Based Aerobic Training Sessions?

OBJECTIVE: To examine the heart rate-perceived exertion relationship between maximal exercise testing and home-based aerobic training in neuromuscular diseases. DESIGN: Multicentre randomized controlled trial, intervention group data. PARTICIPANTS: Individuals with Charcot-Marie-Tooth disease (n = 17), post-polio syndrome (n = 7) or other neuromuscular diseases (n = 6). METHODS: Participants followed a 4-month, homebased aerobic training programme guided by heart rate. Heart rate and ratings of perceived exertion (6-20 Borg Scale) were assessed for each minute during a maximal exercise test, and at the end of each exercise interval and recovery period during training. Heart rate and corresponding ratings of perceived exertion values of individual participants during training were visualized using plots, together with the exercise testing linear regression line between heart rate and ratings of perceived exertion. RESULTS: High correlation coefficients (i.e. > 0.70) were found between heart rate and ratings of perceived exertion, in all participants during testing (n = 30), and in 57% of the participants during training. Based on the plots the following distribution was found; participants reporting lower (n = 12), similar (n = 10), or higher (n = 8) ratings of perceived exertion values for corresponding heart rates during training compared with testing. CONCLUSION: Most participants had a different perception of effort for corresponding heart rates during training in comparison with exercise testing. Healthcare professionals should be aware that this may imply under- and over-training.

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey.

OBJECTIVE: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users. DESIGN: Cross-sectional survey study. SUBJECTS: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital. METHODS: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard. RESULTS: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001). CONCLUSION: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Polio survivors have poorer walking adaptability than healthy individuals.

BACKGROUND: Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role. RESEARCH QUESTION: Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals? METHODS: In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection. RESULTS: 46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001). SIGNIFICANCE: Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.

Differences in the course of daily activity level between persons with and without chronic pain.

OBJECTIVE: The aim of this study was to determine differences in (the course of) daily activity level between persons with and persons without chronic pain. DESIGN: A total of 18 participants with chronic pain and 19 age-matched healthy controls wore an accelerometer for 7 days, of which two weekdays were taken for analysis. Average movement intensity, peak movement intensity, and postures were compared between the persons with and persons without chronic pain over the day. The course of daily activities was analyzed by comparing the activity in the morning, afternoon, and evening. RESULTS: The participants with chronic pain spent significantly more time in lying and less time in sitting and standing. Total step count showed a trend (P = 0.07) to be lower in participants with chronic pain. Participants with chronic pain showed lower average movement intensity and peak movement intensity (P < 0.01) over the whole day. No differences were found in the course of daily activity between the two groups in both average movement intensity and peak movement intensity. CONCLUSIONS: Persons with and persons without chronic pain differed in daily activity level with regard to average movement intensity, peak movement intensity, and postures. No differences were found in the course of daily activity between the two groups.