Tuesday 27 May 2014

Optimising the effects of rigid ankle foot orthoses on the gait of children with cerebral palsy (CP) – an exploratory trial

Kavi C. Jagadamma, kjagadamma@qmu.ac.uk Fiona J. Coutts, Thomas H. Mercer, Janet Herman, Jacqueline Yirrell, Lyndsay Forbes, and Marietta L. van der Linden


Disability and Rehabilitation: Assistive Technology
Vol. 0: 1-7
DOI: 10.3109/17483107.2014.908244
Abstract

Purpose: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO – Footwear Combination (AFO-FC) further affected gait. Methods: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions – barefoot, non-tuned AFO-FC and tuned AFO-FC. Results: In comparison to barefoot gait, walking with a non-tuned AFO-FC produced significant (p < 0.05) improvements in several key gait parameters. Compared to the non-tuned AFO-FC, on average a tuned AFO-FC produced a significant reduction in peak knee extension and knee ROM during gait. However, when examined as case studies, it was observed that the type of gait pattern demonstrated while wearing a non-tuned AFO-FC affected the outcomes of tuning. Conclusions: The findings of the current study indicate the potential benefits of using rigid AFO-FC with optimal AAAFO and tuning of AFO-FCs. This study emphasises the need for categorising children with CP based on their gait patterns when investigating the effects of interventions such as AFOs.Implications for Rehabilitation

Rigid ankle foot orthoses (AFO) cast at an optimal angle to accommodate the length of gastrocnemius muscle may positively influence walking in children with Cerebral Palsy (CP).

Tuning of the AFO-Footwear Combination (AFO-FC) has potential benefits to the walking of children with CP, depending on their gait abnormalities.

When investigating the effects of interventions such as AFOs, it is important to categorise children with CP based on their gait abnormalities.

Keywords: AFO , ankle foot orthosis , cerebral palsy , gait , tuning


http://informahealthcare.com/doi/abs/10.3109/17483107.2014.908244

Friday 23 May 2014

Foot drop in MS: Experiences of using functional electrical stimulation (FES) or orthotic devices

Summary

Foot drop is a symptom experienced by some people with multiple sclerosis. It is caused by a disruption in the nerve pathway to and from the brain, which results in an inability to lift the foot and toes properly when walking. To improve walking and reduce the risk of trips or falls, foot drop can be treated using two types of device. Functional electrical stimulation (FES) uses small electrical charges to force the foot into a more natural position for walking. An ankle-foot orthoses (AFO) is a device made of plastic or carbon fibre that holds the foot and ankle in a correct position during walking.

This study aimed to explore the experiences and satisfaction with FES and AFO in people with MS who had foot drop.

10 participants took part in the study and were split into two groups, the first group was made up of people using FES (six participants) and the second used AFO (four participants). The groups were questioned and encouraged to discuss their experiences of using the devices.

A similar number of positive and negative aspects were described for FES and AFO. In both groups the participants said that their device had reduced their fatigue, improved their gait (the pattern of walking), reduced trips and falls and increased their confidence. The negative aspects mentioned by both groups included the implications for shoes and clothing, for example users had found it difficult to concealtheir device under their clothes for social occasions.

In conclusion both groups considered that the benefits to them from wearing the device were more important and outweighed any problems.

This study highlights the importance of a health professional taking the individual's experiences and preferences into account, when selecting and prescribing a device to manage foot drop.


Source: http://www.mstrust.org.uk/research/updates/articles/update140520.jsp?utm_medium=email&utm_source=MS+Trust&utm_campaign=4174715_Research+update+140520+AGAIN&dm_i=157R,2HH8B,EDBPM9,91P2X,1#item01


Bulley C, Mercer TH, Hooper JE , et al.
Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis..
Disabil Rehabil Assist Technol. 2014 May 6. [Epub ahead of print]
abstract

Tuesday 6 May 2014

HCPC Prosthetist/Orthotist Panel Member

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Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

Jan S. Ulbrecht, Timothy Hurley, David T. Mauger and Peter R. Cavanagh

Abstract

OBJECTIVE To assess the efficacy of in-shoe orthoses designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration.

RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion), or to study termination. Proportional hazards regression was used for analysis.

RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study.

CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses but they did not significantly reduce nonulcerative lesions.