Abstract Background Context The lumbosacral orthosis (LSO) is prescribed by general practitioners for the management of low back pain. It may be speculated that continuous use of the LSO for a ...prolonged period reduces mechanical loading to the trunk muscle in daily living and results in impairments of the trunk muscle. Purpose To investigate whether the trunk motor performances are impaired by continuous use of the lumbosacral orthosis. Study Design/Setting Systematic review with meta-analysis. Methods Systematic search in the PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS and Cochrane library, from inception to November 2016. Inclusion criteria were: 1) the use of the LSO for ≥2 days; 2) the use of a soft LSO designed for musculoskeletal conditions; 3) no co-intervention except education; and 4) measures of trunk motor performance. The following studies were excluded: 1) studies with insufficient data; and 2) studies with poor methodological quality (<9/16) in the modified McMaster Critical Review Form for Quantitative Studies. The GRADE system was used to determine the quality of evidence. Results Data of eight studies were analyzed. The most common measures for motor performances were the maximum strength of the trunk flexors and extensors and the endurance and fatigability of the trunk extensors. In all measures, 95% CIs of the pooled standardized mean difference between the control/pre-intervention group and the intervention/post-intervention group included zero. Further, quality of evidence ranged from low to very low in the GRADE system in all findings of the meta-analyses. Conclusions The meta-analyses demonstrated no negative effect by continuous use of the LSO for 1-6 months. However, the quality of evidence ranged from low to very low and more high quality trials are required to draw a definitive conclusion on the impact of continuous use of LSO on trunk motor performances.
To propose and validate a new method for estimating upper limb orthosis wear time using miniature temperature loggers attached to locations on the upper body.
Observational study.
Fifteen healthy ...participants.
Four temperature loggers were attached to the arm and chest with straps. Participants were asked to remove and re-attach the straps at specified time-points. The labelled temperature data obtained were used to train a decision tree classification algorithm to estimate wear time. The final performance (mean error and 95% confidence interval) of the trained classifier and the wear time estimation were assessed with a hold-out data-set.
The trained algorithm can correctly classify unseen temperature data with a mean classification error between 1.1% and 3.1% for the arm, and between 1.8% and 4.0% for the chest, depending on the sampling time of the temperature logger. This resulted in mean wear time errors between 0.5% and 8.3% for the arm, and 0.13% and 13.0% for the chest.
The proposed method based on a classifier can accurately estimate upper limb orthosis wear time. This method could enable healthcare professionals to gain insight into the wear time of any upper limb orthosis.
To characterize trends in the acute management (within 30 days) after lateral ankle sprain (LAS) in the United States.
Descriptive epidemiology study.
Of note, 825 718 ankle sprain patients were ...identified; 96.2% were patients with LAS. Seven percent had an associated fracture and were excluded from the remaining analysis.
Primary and tertiary care settings.
We queried a database of national health insurance records for 2007 to 2011 by ICD-9 codes for patients with LAS while excluding medial and syndesmotic sprains and any LAS with an associated foot or ankle fracture.
The percentage of patients to receive specific diagnostic imaging, orthopedic devices, or physical therapy treatments within 30 days of the LAS diagnosis and the associated costs.
Over two-thirds of patients with LAS without an associated fracture received radiographs, 9% received an ankle brace, 8.1% received a walking boot, 6.5% were splinted, and 4.8% were prescribed crutches. Only 6.8% received physical therapy within 30 days of their LAS diagnosis, 94.1% of which performed therapeutic exercise, 52.3% received manual therapy, and 50.2% received modalities. The annual cost associated with physician visits, diagnostic imaging, orthopedic devices, and physical therapy was 152 million USD, 81.5% was from physician evaluations, 7.9% from physical therapy, 7.2% from diagnostic imaging, and 3.4% from orthopedic devices.
Most patients with LAS do not receive supervised rehabilitation. The small proportion of patients with LAS to receive physical therapy get rehabilitation prescribed in accordance with clinical practice guidelines. The majority (>80%) of the LAS financial burden is associated with physician evaluations.
Objectives: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. ...Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?"
Materials and methods: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles.
Results: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics.
Discussion and conclusion: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices.
Implications for Rehabilitation
International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world.
Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits.
This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.
The aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory functions.
This was an open, ...noncomparative, nonrandomized study of the safety and performance of the ReWalk powered exoskeleton. All 12 subjects have completed the active intervention; three remain in long-term follow-up.
After training, all subjects were able to independently transfer and walk, without human assistance while using the ReWalk, for at least 50 to 100 m continuously, for a period of at least 5 to 10 mins continuously and with velocities ranging from 0.03 to 0.45 m/sec (mean, 0.25 m/sec). Excluding two subjects with considerably reduced walking abilities, average distances and velocities improved significantly. Some subjects reported improvements in pain, bowel and bladder function, and spasticity during the trial. All subjects had strong positive comments regarding the emotional/psychosocial benefits of the use of ReWalk.
ReWalk holds considerable potential as a safe ambulatory powered orthosis for motor-complete thoracic-level spinal cord injury patients. Most subjects achieved a level of walking proficiency close to that needed for limited community ambulation. A high degree of performance variability was observed across individuals. Some of this variability was explained by level of injury, but other factors have not been completely identified. Further development and application of this rehabilitation tool to other diagnoses are expected in the future.
Passive and hybrid passive Ankle foot orthoses (AFOs) are the prevalent prescription in drop foot patients to prevent toe dragging during the swing phase. While, these AFOs have some limitations like ...inability to overcome foot slap, limitation in forward propulsion and inappropriate power generate at the push off. The aim of this study was to design a novel spring damper and evaluate the immediate effects of this AFO on improving the ankle kinetic and kinematic in drop foot patients. This AFO was generated from carbon composite frame and foot section with posterior hinge and spring damper actuator that controlled plantar flexion resistance at the early stance, freely dorsi flexion movement with the ability to store energy during mid-stance movement as well as restore this energy at the pre swing phase. This AFO was assessed on ten drop foot patients who used Posterior Leaf Spring AFO conditions and walked at their self-comfortable walking speed. Then the ankle kinetic and kinematic data in two conditions of with PLS (Posterior Leaf Spring) AFO, and novel spring damper AFO were assessed. Results showed a significant improve in the immediate effect of the kinetic and kinematic parameters. In conclusion, spring damper AFO improved all ankle angles in entire gait cycle as well as the ankle moments and power. Therefore, this AFO should be consider as a selective AFO in drop foot patients.
Rapid developments of robotics and virtual reality technology are raising the requirements of more advanced human-machine interfaces for achieving efficient parallel control. Exoskeleton as an ...assistive wearable device, usually requires a huge cost and complex data processing to track the multi-dimensional human motions. Alternatively, we propose a triboelectric bi-directional sensor as a universal and cost-effective solution to a customized exoskeleton for monitoring all of the movable joints of the human upper limbs with low power consumption. The corresponding movements, including two DOF rotations of the shoulder, twisting of the wrist, and the bending motions, are detected and utilized for controlling the virtual character and the robotic arm in real-time. Owing to the structural consistency between the exoskeleton and the human body, further kinetic analysis offers additional physical parameters without introducing other types of sensors. This exoskeleton sensory system shows a great potential of being an economic and advanced human-machine interface for supporting the manipulation in both real and virtual worlds, including robotic automation, healthcare, and training applications.
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