Comparison of Sagittal Plane Stiffness of Nonarticulated Pediatric Ankle-Foot Orthoses Designed to be Rigid.

INTRODUCTION: When studying the effect of ankle-foot orthoses (AFOs) on gait, it is important to know their sagittal plane stiffness. However, there are no established thresholds for stiffness of non-articulated AFOs designed to be rigid. If wanting to implement published algorithms for ankle-foot orthosis-footwear combinations (AFO-FCs), the AFOs must be equally as stiff as those of the developer of the published AFO-FC algorithms. Hence, the aim of this work was to compare the sagittal plane stiffness of AFOs designed to be rigid, made for a clinical trial in the USA, and following algorithms for AFO-FC designs, to those made and used clinically in the UK by the developer of the AFO-FC algorithms. MATERIALS AND METHODS: Stiffness of 9 pediatric polypropylene AFOs was tested (UK: 6; USA: 3). A computer-controlled motorized device was used in which all AFOs were clamped with the calf shell in a fixed vertical component and the foot section in a rotating plate. Each AFO was tested for 3 trials, loading the foot plate 30 Nm towards dorsiflexion and 20 Nm towards plantarflexion. Torque-angle graphs were plotted and deflection and stiffness compared descriptively across AFOs. RESULTS: Average deflection of AFOs was UK: 3.42±0.83° and USA: 4.81±1.05°. Average stiffness of AFOs was UK: 14.34±3.34 Nm/° and USA: 10.30±1.92 Nm/°. CONCLUSIONS: All tested AFOs deflected only a few degrees in either direction (range: 2.59° to 6.02°), providing the first information reported for the stiffness of rigid pediatric non-articulated AFOs. Overall, the UK AFOs were stiffer and deflected less than the USA study AFOs. AFO design features should be carefully considered as they likely influence sagittal plane stiffness and deflection under load.

Effect of walking in footwear with varying heel sole differentials on shank and foot segment kinematics.

BACKGROUND: When walking in footwear with a positive "heel sole differential", the sagittal kinematics of the base of the footwear appear to mimic normal barefoot foot kinematics, creating an "effective foot," yet sagittal shank, thigh, and trunk kinematics appear to remain unchanged. These observations have not been quantified. OBJECTIVES: To quantify these observations by assessing the effect of different heel sole differentials on sagittal shank and foot segment kinematics of able-bodied walking. STUDY DESIGN: Cross-sectional study. METHODS: Gait data from 10 nondisabled females were collected while they walked with no-heel (mean heel sole differential = 0 (standard deviation = 0) mm), mid-heel (mean heel sole differential = 37 (standard deviation = 10) mm), and high-heel shoes (mean heel sole differential = 71 (standard deviation = 17) mm) to calculate the shank-to-vertical angle and foot-to-horizontal angle. RESULTS: There were no significant differences between shoe conditions in stride lengths ( p = 0.056) or shank kinematics between 0% and 50% gait cycle ( p = 0.079). There were significant differences in foot kinematics ( p = 0.000), with foot segment angle increasing with increasing heel sole differential. CONCLUSION: The ankle joint and actual foot segment adapt their kinematics to maintain consistent shank kinematics. The finding that heel sole differential and foot segment angle can be varied without influencing shank segment kinematics has implications for orthotic and prosthetic practice. Clinical relevance Heel sole differentials of footwear can be varied without implications for shank kinematics, which is relevant for both orthotics and prosthetics. Assessments and interventions with varying heel sole differential footwear may be helpful in patients with short calf muscle or restricted ankle motion who may walk more normally if an appropriate heel sole differential were provided.

End-of-life conversations and care: an asset-based model for community engagement.

BACKGROUND: Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. AIMS: (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. METHODS: An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. FINDINGS: The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. CONCLUSIONS: A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach provides a framework for other communities seeking to engage with public awareness in end-of-life issues.

Phylogenetic and ecological relationships of the Hawaiian Drosophila inferred by mitochondrial DNA analysis.

The Hawaiian Drosophilidae are comprised of an estimated 1000 species, all arising from a single common ancestor in the last 25 million years. This group, because of its species diversity, marked sexual dimorphism and complex mating behavior, host plant specificity, and the well-known chronology of the Hawaiian Archipelago, is an excellent model system for evolutionary studies. Here we present a phylogeny of this group based on ~2.6 kb of mitochondrial DNA sequence. Our taxon sampling is the most extensive to date, with nearly 200 species representing all species groups and most subgroups from the larger clades. Our results suggest that the picture wing and modified mouthpart species, long believed to be derived within this radiation, may actually occupy a basal position in the phylogeny. The haleakale species group, in contrast, is strongly supported as sister to the AMC clade. We use the phylogenetic results to examine the evolution of two important ecological characters, the host family and type of substrate used for oviposition and larval development. Although both host and substrate transitions are common in the group, oviposition substrate is more conserved among species groups than host plant family. While the ancestral host plant family is equivocally reconstructed, our results suggest that the ancestor of this group may have used rotting bark as a primary oviposition substrate.

The importance of being earnest about shank and thigh kinematics especially when using ankle-foot orthoses.

This paper reviews and summarizes the evidence for important observations of normal and pathological gait and presents an approach to rehabilitation and orthotic management, which is based on the significance of shank and thigh kinematics for standing and gait. It discusses normal gait biomechanics, challenging some traditional beliefs, the interrelationship between segment kinematics, joint kinematics and kinetics and their relationship to orthotic design, alignment and tuning. It proposes a description of four rather than three rockers in gait; a simple categorization of pathological gait based on shank kinematics abnormality; an algorithm for the designing, aligning and tuning of AFO-Footwear Combinations; and an algorithm for determining the sagittal angle of the ankle in an AFO. It reports the results of research on Shank to Vertical Angle alignment of tuned AFO-Footwear Combinations and on the use of 'point loading' rocker soles.

The effects of tuning an ankle-foot orthosis footwear combination on kinematics and kinetics of the knee joint of an adult with hemiplegia.

The effects of tuning the AFO footwear combination (AFOFC) for an adult with post-stroke hemiplegia were investigated. Gait analysis and tuning were carried out using a Vicon 3D motion analysis system and two force plates. Tuning of the AFOFC was accomplished by gradually modifying its design over a number of gait trials, to achieve optimal (i.e., as close as possible to normal, within the capability of the patient) knee kinematics and alignment of the Ground Reaction Force vector (GRF) relative to the knee joint. Heel wedges and a stiff rocker were used to tune mid-stance and terminal stance, respectively. Temporal-spatial parameters and selected kinetic and kinematic variables were compared between the non-tuned AFOFC, the tuned AFOFC immediately after tuning, and the tuned AFOFC after three months. There were several changes after three months compared to the non-tuned AFOFC, including improvement in stride length and a reduction in knee hyperextension. A subjective reduction in knee pain and improvement in function were also reported. The feasibility and the lack of objective evidence of tuning AFOFCs as a part of a clinical service need to be addressed in future research.