Posts Tagged orthosis

[Abstract] Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

Abstract:

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow–wrist–hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user’s electromyographic signal. Experience with the MEWHO and associated outcomes are reported.

Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl–Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers’ survey to track usage and user satisfaction over a 6-month period.

Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors.

Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.

Source: EBSCOhost | 123998452 | Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

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[Conference paper] Virtual Environments for Motor Fine Skills Rehabilitation with Force Feedback – Abstract+References

Abstract

In this paper, it is proposed an application to stimulate the motor fine skills rehabilitation by using a bilateral system which allows to sense the upper limbs by ways of a device called Leap Motion. This system is implemented through a human-machine interface, which allows to visualize in a virtual environment the feedback forces sent by a hand orthosis which was printed and designed in an innovative way using NinjaFlex material, it is also commanded by four servomotors that eases the full development of the proposed tasks. The patient is involved in an assisted rehabilitation based on therapeutic exercises, which were developed in several environments and classified due to the patient’s motor degree disability. The experimental results show the efficiency of the system which is generated by the human-machine interaction, oriented to develop human fine motor skills.

References

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Source: Virtual Environments for Motor Fine Skills Rehabilitation with Force Feedback | SpringerLink

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[BLOG POST] Which Saebo Hand Rehabilitation Device is Right For You? – Saebo

 


In 2001, two occupational therapists had one goal: to provide neurological clients access to transformative and life-changing products for improving arm and hand function. Frustrated with the current devices on the market that were limited, expensive, and inaccessible for home use, the founders were inspired to create new, revolutionary solutions.

What started as a dream has now become Saebo, a global provider of affordable rehabilitative products designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 200,000 clients around the globe achieve a new level of independence.

At Saebo, we have three core product lines for hand rehabilitation: The SaeboFlex, SaeboGlove, and SaeboStretch. These three products have helped numerous people overcome limited motor function after suffering a stroke or other neurological or orthopedic condition.

We would love for you to get to know more about these three products and learn about why they work, and more importantly, who they can help. We have committed to making products that are unique and based on the most recent research and evidence available. Learn about three of our unique products:

 

 

SaeboFlex

The SaeboFlex is a high-profile orthosis with an outrigger system that covers the back of hand, fingertips and forearm. This orthosis positions the wrist and fingers into extension to prepare them for object manipulation. With the assistance of the SaeboFlex, the user is able to grasp objects by voluntarily flexing his or her fingers. Once the fingers relax (stop gripping), the extension spring system assists in re-opening the hand to release the object.

Saebo’s functional dynamic orthoses are specifically designed for people suffering from a neurological injury such as a stroke, head injury, and incomplete spinal cord injury. The SaeboFlex gives people the ability to perform grasp-and-release activities, which allows them to participate in task-oriented hand training. Evidence-based research supports this training as critical to recovery. The SaeboFlex is appropriate for individuals with minimal to severe tone/spasticity.

Here is an example of a man trying to pick up a ball six weeks after his stroke with and without the SaeboFlex. You can also see his improvement after six months of training:

SaeboGlove

The SaeboGlove is a low-profile, lightweight glove that helps clients suffering from neurological and orthopedic injuries incorporate their hand functionally in therapy and at home. The proprietary tension system has elastic bands that offer various tensions for individual finger joints. The tension system extends the client’s fingers and thumb following grasping and assists with hand opening.

The ideal candidate for the SaeboGlove is suffering from minimal to no spasticity or contracture. People with more severe soft-tissue shortening would need a high-profile orthosis like the SaeboFlex. For appropriate candidates, the SaeboGlove can be worn to assist with day-to-day functional tasks and during grasp-and-release exercises/activities. This new-found freedom leads to improved motor recovery and functional independence.

This video shows a man attempting grasp-and-release activities with and without the assistance of the SaeboGlove:

SaeboStretch

The SaeboStretch is a soft and adjustable dynamic resting hand splint recognizable for its unique strapping system. This splint is worn to stretch and prevent soft-tissue shortening and helps neurologically impaired clients maintain or improve motion. Saebo’s energy-storing technology allows individuals suffering from spasticity to stretch comfortably and safely, resulting in increased motivation and compliance.

The SaeboStretch is appropriate for people suffering from minimal to moderate spasticity. The orthosis includes the choice of three tension plates that offer various levels of resistance depending on the amount of tone and spasticity the individual has. The flexible hand plates also prevent or minimize joint pain and deformities. The SaeboStretch can be worn during the day or when sleeping.

See how the SaeboStretch is custom fit to the individual in this video:

Our Expert Recommendations

Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. We are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more available than ever.

If your loved one is recovering from a neurological or orthopedic injury and wants to know if one of Saebo’s products is right for them, take our free 5-minute evaluation. Completing this survey will provide all of the information needed to ensure the best possible product recommendations. Upon completion of your survey, you will receive personalized suggestions tailored to your specific needs and abilities. In addition, our Product Specialists will be happy to review these recommendations with your physician or therapist.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Which Saebo Hand Rehabilitation Device is Right For You? | Saebo

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[WEB SITE] Foot Drop: Causes, Prevention and How You can Treat It

What is foot drop & what causes it?

Foot drop is a simple name but its cause and treatment may be less than simple.

If you are unable to lift your foot up at the ankle and it makes walking difficult, you may have something called foot drop. This could be due to weakness in one of the muscles responsible for lifting, or dorsiflexing, your foot. It could also be caused by tightness or spasticity in the calf muscles of your leg that cause your toes to point downward.

The cause of foot drop can be from several different sources – neurological, muscular, a side effect from medication, or from a lack of movement.

People with stroke, multiple sclerosis, acquired brain injury, spinal cord injury, or cerebral palsy have a central neurological reason causing weakness, tightness or spasticity. People with peripheral neurologic disease may also have foot drop. These diagnoses could include neuropathy, injury to the lower spinal cord, nerve damage, or illnesses like Guillain-Barre syndrome.

Those who have a traumatic accident or muscular damage could also suffer from foot drop because of damage from swelling and compression.

Certain medications are known to potentially cause foot drop. Talk to your doctor about your medications.

Foot drop can also occur in people who are in bed for a prolonged amount of time. When lying on your back, gravity pulls down your foot, and can cause weakness and overstretch the muscles and nerves on the front of your lower leg.

Can foot drop be prevented?

If you or your loved one is required to be on bedrest or immobile, you can help to prevent foot drop by using a padded splint, by doing stretching, and by doing active exercises like ankle pumps.

If you have an underlying condition, it may be impossible to fully prevent foot drop from occurring. But often you can improve the flexibility and strength in your leg, or use an orthosis or splint to help maintain your foot in a position that will allow you to walk and move safely.

How can foot drop be treated?

The treatment of foot drop depends on the cause and the symptoms you have. Below are some suggestions on what you can do, but make sure to talk to your doctor, therapist or orthotist about the best treatment options for you.

Keep your foot and ankle flexible:

  • Use a foot splint at night

  • Complete daily stretches. The ProStretch gives a great stretch

Improve the tone in your leg:

  • Use an orthosis that puts your ankle in a slight stretch

Strengthen your leg:

  • Use neuromuscular electrical stimulation

  • Complete exercises against gravity or with resistance like a Theraband

  • Stand on a variety of surfaces like an Airex balance pad or a Bosu ball to challenge your muscles in your legs. Hold onto something sturdy or have someone nearby to help

Improve the safety of your walking and prevent falls:

  • Use an ankle foot orthosis to keep your toes up when walking. Depending on your strength level, you may need a flexible one or a rigid one

  • Walk with an assistive device, like a walker or cane

  • Modify your home to prevent you from tripping or falling – consider removing rugs and floor clutter, sitting on a shower chair instead of standing, and observe your home for other potential hazards

Prevent skin problems with the use of splints and orthotics:

  • Make sure to check your skin after you’ve been wearing it, and more often if you have impaired sensation in your legs, diabetes, or a history of wounds. Use a hand held inspection mirror to help

Keep the rest of yourself of healthy:

  • Consider activities like stationary biking or swimming to complete overall strengthening and conditioning

  • Strengthen your core muscles to improve your overall balance and stability

What are the dangers of not treating foot drop?

The biggest risk of not treating foot drop is tripping and falling. Falls lead to injury and other unnecessary treatments or hospitalizations. In order to clear your toes to avoid falling, you will have to change the way you walk. Over time, this could lead to pain or discomfort in your back or legs. Also, if your ankle loses flexibility and you cannot move it at you may need surgery.

Most importantly, without treatment you will have more difficulty doing the things in life that you enjoy doing. Unfortunately, there may be no cure, but there are things you can do to help improve the quality of your life.

Who should I ask for more information?

If you have already been diagnosed or are concerned about your risk for foot drop, you should speak with your healthcare provider about what you can do to prevent and treat it.

Source: Foot Drop: Causes, Prevention and How You can Treat It

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[Abstract] Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke. – Australian Occupational Therapy Journal

Abstract

Background/aim

Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex device.

Methods

Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale.

Results

Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes.

Conclusions

This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flexdevice, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

Source: Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke – Lannin – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[ARTICLE] SCRIPT passive orthosis: design of interactive hand and wrist exoskeleton for rehabilitation at home after stroke – Full Text PDF

Abstract

Recovery of functional hand movements after stroke is directly linked to rehabilitation duration and intensity. Continued therapy at home has the potential to increase both. For many patients this requires a device that helps them overcome the hyperflexion of wrist and fingers that is limiting their ability to open and use their hand. We developed an interactive hand and wrist orthosis for post-stroke rehabilitation that provides compliant and adaptable extension assistance at the wrist and fingers, interfaces with motivational games based on activities of daily living, is integrated with an off-the-shelf mobile arm support and includes novel wrist and finger actuation mechanisms. During the iterative development, multiple prototypes have been evaluated by therapists in clinical settings and used intensively and independently by 33 patients at home. This paper details the final design of the SCRIPT passive orthosis resulting from these efforts.

Source: SCRIPT passive orthosis: design of interactive hand and wrist exoskeleton for rehabilitation at home after stroke | SpringerLink

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[REVIEW] A structured overview of trends and technologies used in dynamic hand orthoses – Full Text

Abstract

The development of dynamic hand orthoses is a fast-growing field of research and has resulted in many different devices. A large and diverse solution space is formed by the various mechatronic components which are used in these devices. They are the result of making complex design choices within the constraints imposed by the application, the environment and the patient’s individual needs. Several review studies exist that cover the details of specific disciplines which play a part in the developmental cycle. However, a general collection of all endeavors around the world and a structured overview of the solution space which integrates these disciplines is missing. In this study, a total of 165 individual dynamic hand orthoses were collected and their mechatronic components were categorized into a framework with a signal, energy and mechanical domain. Its hierarchical structure allows it to reach out towards the different disciplines while connecting them with common properties. Additionally, available arguments behind design choices were collected and related to the trends in the solution space. As a result, a comprehensive overview of the used mechatronic components in dynamic hand orthoses is presented.

Background

Human hands are complex and versatile instruments. They play an essential role in the interaction between a person and the environment. Many people suffer from hand impairments like spasticity, lack of control or muscle weakness, which may be due to the consequences of stroke, paralysis, injuries or muscular diseases. Such impairments may limit an individual’s independence in performing activities of daily living (ADL) and the ability to socially interact (e.g. non-verbal communication). Devices like hand exoskeletons, rehabilitation robots and assistive devices, here collectively termed as dynamic hand orthoses, aim to overcome these limitations. Their development is a fast-growing field of research and has already resulted in a large variety of devices [1, 2, 3, 4].

Each individual has different demands for a dynamic hand orthoses. Some patients benefit from rehabilitation therapy (e.g. stroke patients [5]) while others would more likely benefit from daily assistance (e.g. Duchenne Muscular Dystrophy [6]). The resulting diversity between the different devices can be illustrated by the elaborate overviews on robotic devices [4], training modalities [3] and intention detection systems [7] they use. Clearly, there are many mechatronic components to choose from and are often the result of making particular design choices within the imposed design constraints. However, not everybody has the resources (i.e. time, accessibility) to investigate all possible design choices within these constraints. Moreover, not always are design choices reported in literature and are therefore hard to retrieve. The full potential of learning from each other’s endeavors is therefore not yet fully exploited, leaving several questions in this field of research unanswered. For example, there is the discussion whether pneumatic or electric actuation is better for some applications.

The goal of this study is to collect a high quantity of dynamic hand orthoses and extract the mechatronic components which are used. Their collective properties are analyzed by using a framework which uses a generic categorization applicable for any mechatronic system: a signal domain (e.g. controllers, sensors), energy domain (e.g. energy sources, actuators) and mechanical domain (e.g. cables, linkages). Additionally, feasible technologies from other, but similar, disciplines are included (e.g. prosthetics, haptics). Trends are then visualized using bar charts and compared to available arguments behind design choices. This not only includes arguments from often-cited success-stories, but also from small-scale projects. Referring to the case of using pneumatic or electric actuation, this approach can answer how often each method is used and what arguments are reported, which may help in scoping further research and making a well-considered choice.

This paper is structured in different sections. The “Scope” section describes the boundaries and limitations of this study and Framework introduces the basis of the framework structure that is proposed. The “Results” section describes the quantitative results which illustrate the trends. How this relates to the functionality of the components, is discussed and summarized in the “Discussion” and “Conclusion” section, respectively.

Continue —> A structured overview of trends and technologies used in dynamic hand orthoses | Journal of NeuroEngineering and Rehabilitation | Full Text

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[WEB SITE] Foot Drop Treatment: Timing Is Everything.

Patient suffered CVA with resultant right sided hemiparesis. Here, he dons a custom molded ankle foot orthosis and is educated about proper donning/doffing, skin care, and wearing schedule. This particular brace is used to enhance clearance of right lower extremity during ambulation as well as provide joint alignment and stability.

Patient suffered CVA with resultant right sided hemiparesis. Here, he dons a custom molded ankle foot orthosis and is educated about proper donning/doffing, skin care, and wearing schedule. This particular brace is used to enhance clearance of right lower extremity during ambulation as well as provide joint alignment and stability.

In the rehabilitation world, there are a number of approaches to manage the physical sequelae that occur post-stroke. One of those sequelae is foot drop, which is most common among the impairments characteristic of post-stroke patients, and experienced by an estimated 20% of all stroke survivors.1 Since foot drop affects ability to safely ambulate throughout the home and community, retraining the impaired muscles that contribute to foot drop becomes a priority. Lower-extremity bracing is one measure that can be used to manage foot drop. Correctly timing the decision to fit a patient with a brace or other orthosis has been heavily discussed in the literature, and understanding the considerations that can help pinpoint that optimum time are explored in this article.

Multidisciplinary Expertise is Essential

At the Kessler Institute for Rehabilitation, patients affected by stroke are seen for initial bracing evaluations during the inpatient and outpatient phases of recovery. They are also reassessed as needed throughout the continuum of care. For some patients, a brace or orthosis for daily use may be prescribed. In such cases, a team of rehabilitation professionals is called on to participate in the decision-making process.

The team physician leads the decision-making process and is ultimately responsible for determining which orthotic best suits the patient’s needs. The physical therapist assists with the bracing decision-making process by contributing gait analysis expertise. An orthotist designs and fabricates an ankle-foot orthosis (AFO) when prescribed, provides expertise in biomechanical gait principles, and integrates that expertise with orthotic-based materials. The patient/caregiver provides feedback for discussion among the other team members and ultimately makes the decision about bracing based on recommendations made by the team.

Other factors weighed during the decision-making process for bracing include limited insurance or financial restrictions put on custom bracing, limited access to an orthotist, and likelihood of compliance.

Timing Variables

Making the decision about the optimal point in time to fit a patient with an orthosis is multifactorial. This decision can be dependent on discharge disposition with particular regard to whether the patient is discharging to home, and if safety is a primary concern secondary to a lack of ankle control. The level of impairment as well as weakness and instability should be taken into consideration, coupled with any prognostic indicators for a positive return in muscle control.

Many variables can account for how an AFO can improve walking endurance and functional ambulation long-term among patients affected by chronic stroke. For example, the AFO will create ankle joint stability and enhance foot clearance through swing phase of gait. This will alter gait mechanics and ultimately help to enhance the patient’s confidence in their own gait ability. An AFO preserves first ankle rocker with hemiplegic patients and provides a more efficient weight acceptance at initial contact to allow for enhanced double limb support and, thus, increased gait speed.2 Gait efficiency is also an important factor to consider when discussing energy expenditure and a patient’s ability to perform functional ambulation. Dynamic AFOs were shown to decrease energy cost of walking, as demonstrated from the Physiological Cost Index when compared to shoes only with chronic stroke patients.3

Comparing Braces and Orthoses

There are important pros and cons for each type of orthosis, with cost and weight the two most common factors. Also, there are drawbacks generally associated with the use of an orthosis that include compliance secondary to comfort, limited ankle motion, and a relatively fixed position (unless an articulating AFO is prescribed).

Part of the decision about bracing may come down to trade-offs between a customized AFO and an “off the shelf,” prefabricated brace. The advantages each confers are distinct. For example, a custom molded AFO offers the ability to create an optimal fit and provides maximum control of the limb. In contrast, while mass-produced prefabricated orthoses may sacrifice quality of fit and limb control, they can be used as an evaluative tool or a short-term fix during the rehabilitation process.

The conventional double upright AFO is another common bracing solution that may require review by the multidisciplinary team. This design is used when there is significant or fluctuating edema that may constrict the limb and present pressure-related issues with the fit of an AFO. An articulating (hinge) AFO is used to assist with continued dorsiflexion and allow for great ankle ROM. It is not appropriate if spasticity is present, and can be challenging for shoe wear because width is typically wider to accommodate joint of brace.

Carbon composite AFOs are a dynamic bracing option that allow for push-off during third (forefoot) ankle rocker of gait. These AFOs are made to keep the foot up during swing phase, and provide a soft heel strike and stability in stance. This type of brace is contraindicated for patients affected by significant edema, ulcers, and spasticity. Several types of carbon composite AFOs are offered by Allard USA, Rockaway, NJ, including the ToeOFF, ToeOFF Short, BlueROCKER, KiddieROCKER, KiddieGAIT, and Ypsilon. Each brace in this carbon fiber AFO product line is designed to offer specific benefits such as increased rigid orthotic control, size optimized to wearer’s stature, and to accommodate varying levels of spasticity.

Posterior Leaf Spring (PLS) is another common bracing option usually offered as a prefabricated product. The Superior C-90 from AliMed, Dedham, Mass, is an example of this type of brace, and built to provide a full range of plantar and dorsiflexion. The Superior C-90 also provides a thin trim line and allows for eccentric lowering of foot and dorsiflexion for tibial advancement over foot through mid-stance. One drawback to this design, however, is the lack of medial/lateral stability of ankle and poor knee control. It is also contraindicated for patients with spasticity and genu recurvatum or extensor thrust.

Functional Electrical Stimulation is an Option

Orthoses engineered to provide functional electrical stimulation (FES) to the wearer during use can be an alternative to traditional AFOs. The use of FES, particularly for lower extremity bracing, has been associated with increased gait velocity, decreased energy expenditure with gait, and improved gait symmetry. Two manufacturers that provide these devices include Reno, Nevada-based Innovative Neurotronics, which manufactures the WalkAide, and Valencia, Calif-headquartered Bioness, which manufactures the Bioness L300. Among the two products’ distinguishing structural characteristics, the WalkAide has a built-in tilt sensor while the L300 is designed with a heel switch sensor. Both products are considered FES devices, yet the mechanism of action used by each differs slightly.

At Kessler, the Bioness L300 is available for patients to trial. In my experience, and one of the advantages of using the L300, is the result in physiological changes such as increased muscle strength, improved volitional control, and increased joint range of motion. These changes indicate an increased therapeutic effect not associated with the use of traditional AFOs. Another advantage is highlighted in a study by Everaert et al that examined patient preferences for devices and revealed a statistical difference between patients who preferred to use the WalkAide versus an AFO.4 An additional benefit of using FES devices is a purported decrease in spasticity, which further improves the therapeutic effect.

There are some drawbacks associated with the use of an FES device, however, and the most common is cost. Third-party payors often decline coverage for FES devices, so the cost typically falls to the patient. The patient must also tolerate the stimulation so the motor nerve can be activated. Skin irritation is an undesirable side effect, and the wearer’s tolerance must be carefully monitored. Contraindications for these devices include demand-type pacemakers, any cancerous lesion, fractures, or dislocation. Cognitive impairment that could affect ability to use the device is another important consideration. Ultimately, the decision to use a brace as therapeutic treatment for foot drop is a collaboration with one goal: to improve a patient’s ability to safely ambulate and maximize functional independence. PTP

Farris Fakhoury, PT, DPT, has been a physical therapist in the Outpatient Neurologic Gym at Kessler Institute for Rehabilitation for 4 years, and is also the physical therapy lead for the facility’s amputee program. Fakhoury is the physical therapy lead for Kessler’s Amputees Coming Together (ACT) support group as well as for the Bioness program for outpatient services. He earned a bachelor of arts in psychology from Villanova University and a doctor of physical therapy from the joint program of Rutgers University/University of Medicine and Dentistry of New Jersey PT Program in Stratford, NJ. For more information, contactPTProductsEditor@allied360.com.

Rich Klager, PT, DPT, NCS, has been a physical therapist at the Kessler Institute for Rehabilitation in West Orange, NJ, for more than 8 years. His clinical practice experience expands over the Inpatient and Outpatient facilities in the neurologic population. He currently assists with the Outpatient orthotic clinic decision-making process with the Team Physician and Orthotist for patient bracing needs.

References
1. Bethoux F, Rogers HL, Nolan K, et al. Long term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair. 2015;29(10):911-922.
2. Nolan KJ, Yarossi M. Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO. Clin Biomech (Bristol, Avon). 2011;26(6):655-660.
3. Erel S, Uygur F, Engin Simsek I, Yakut Y. The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial. Clin Rehabil. 2011;25(6):515-523.
4. Everaert DG, Stein RB, Abrams GM, et al. Effect of foot-drop stimulator and ankle-foot orthosis on walking performance after stroke: A multicenter randomized controlled trial.Neurorehabil Neural Repair. 2013;27(7):579-591.

Additional reference:
Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation. St Louis: Saunders Elsevier, 2007.

Source: Foot Drop Treatment: Timing Is Everything – Physical Therapy Products

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[Book Chapter] User Intention Driven Adaptive Gait Assistance Using a Wearable Exoskeleton – Springer


Abstract

A user intention based rehabilitation strategy for a lower-limb wearable robot is proposed and evaluated. The control strategy, which involves monitoring the human-orthosis interaction torques, determines the gait initiation instant and modifies orthosis operation for gait assistance, when needed. Orthosis operation is classified as assistive or resistive in function of its evolution with respect to a normal gait pattern. The control algorithm relies on the adaptation of the joints’ stiffness in function of their interaction torques and their deviation from the desired trajectories. An average of recorded gaits obtained from healthy subjects is used as reference input. The objective of this work is to develop a control strategy that can trigger the gait initiation from the user’s intention and maintain the dynamic stability, using an efficient real-time stiffness adaptation for multiple joints, simultaneously maintaining their synchronization. The algorithm has been tested with five healthy subjects showing its efficient behavior in initiating the gait and maintaining the equilibrium while walking in presence of external forces. The work is performed as a preliminary study to assist patients suffering from incomplete Spinal cord injury and Stroke.

Source: User Intention Driven Adaptive Gait Assistance Using a Wearable Exoskeleton – Springer

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[WEB SITE] The future of footwear and orthoses is here. Now what?

A shift in tone was apparent at this year’s Ortho Technology Forum (OTF), and not just because the focus of the event has been expanded to include design and manufacturing technologies for footwear as well as foot orthoses. Speakers and attendees are no longer just speculating about how technology will change the footwear and foot orthosis industries—because those changes are already occurring in mainstream, high-profile ways.

The key difference between 3D laser scanning (left) and photogrammetry (right) is accuracy, experts say.

The questions now focus on how foot care specialists’ role will change in an industry in which start-up companies often champion technical bells and whistles at the expense of accuracy and clinical relevance, and how clinicians themselves can use technology to their advantage to stay competitive.

“The war has started,” said Chris Lawrie, Healthcare Business Development Manager for Birmingham, UK-based Delcam Healthcare Solutions, which organized the April event held in Vancouver, Canada.

Lawrie was speaking specifically about how the growing accessibility of 3D printing technology has created a market for entrepreneurial footwear and orthoses manufacturers who are less con­- cerned with clinical effectiveness than their bottom line. But the assessment could as easily be applied to other aspects of technology being used by entrepreneurs to battle clinicians for a share of those markets.

“There isn’t a part of our industry that isn’t being affected by technology right now,” said Graham Archer, CPed(C), vice president of pedorthic services at Kintec Footlabs and president of Kiwi Software Solutions, both in Vancouver, in an OTF presentation.

The challenge for clinicians, and for other players in the footwear and orthotics markets for whom quality is a priority, will be to prove that new technologies aren’t just for newcomers. OTF presenters detailed multiple ways in which new tools and processes can help even established labs and clinics become more efficient, more accurate, and more profitable.

“The key is how to get around the paradigm shift to take advantage of things like new materials and new design opportunities,” Lawrie said.

3D printing

Feetz prototype custom shoes

It’s tempting to dismiss 3D printing, also known as additive manufacturing, as the province of start-up companies looking to make a quick buck off drugstore-grade insoles or creative types designing futuristic-looking shoes that nobody in the real world would ever wear. But 3D printing is also being employed by a number of companies in ways that could potentially have much more practical and even clinical applications.

Chattanooga, TN-based Feetz is currently in the beta-testing phase of its personalized shoe business, which aims to 3D-print individual pairs of shoes based on either an in-store scan or on customers’ digital photos of their feet taken with the company’s app.

“One in three consumers are seeking personalization in their shoe purchases, and one in five Americans have foot issues that affect their shoe purchases,” Feetz CTO Nigel P. Beard said in an OTF presentation, while modeling a bright green prototype pair of Feetz shoes. “Our motto is: ‘You’ll never try on another pair of shoes again.’”

With few footwear-specific materials available that are compatible with 3D printing, the company ended up developing its own materials, ranging from ceramics to antimicrobials to scented polymers, Beard said.

Continue —> The future of footwear and orthoses is here. Now what? | Lower Extremity Review Magazine.

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