Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains ...lacking.
Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols?
Scoping review was performed.
Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture.
Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes.
4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0–C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute.
This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use.
This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review.
Since ancient Egypt, orthosis was generally made from wood and then later replaced with metal and leather which are either heavy, bulky, or thick decreasing comfort among the wearers. After the age ...of revolution, the manufacturing of products using plastics and carbon composites started to spread due to its low cost and form-fitting feature whereas carbon composite were due to its high strength/stiffness to weight ratio. Both plastic and carbon composite has been widely applied into medical devices such as the orthosis and prosthesis. However, carbon composite is also quite expensive, making it the less likely material to be used as an Ankle-Foot Orthosis (AFO) material whereas plastics has low strength. Kenaf composite has a high potential in replacing all the current materials due to its flexibility in controlling the strength to weight ratio properties, cost-effectiveness, abundance of raw materials, and biocompatibility. The aim of this review paper is to discuss on the possibility of using kenaf composite as an alternative material to fabricate orthotics and prosthetics. The discussion will be on the development of orthosis since ancient Egypt until current era, the existing AFO materials, the problems caused by these materials, and the possibility of using a Kenaf fiber composite as a replacement of the current materials. The results show that Kenaf composite has the potential to be used for fabricating an AFO due to its tensile strength which is almost similar to polypropylene's (PP) tensile strength, and the cheap raw material compared to other type of materials.
BACKGROUND: A posterior dynamic element ankle-foot orthosis (PDEAFO) uses a stiff carbon fibre strut to store and release energy during various mobility tasks, with the strut securely attached to the ...foot and shank-cuff sections. A design that allows the user to swap struts for specific activities could improve mobility by varying PDEAFO stiffness, but current approaches where bolts securely connect the strut to the orthosis make quick strut swapping time-consuming and impractical.
OBJECTIVES: Design a novel quick release AFO (QRAFO) that can enable daily living strut-swapping and thereby enable better ankle biomechanics for the person’s chosen activity.
METHODOLOGY: The novel QRAFO enables device stiffness changes through a quick release mechanism that includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. A prototype was modelled and simulated with SolidWorks. Mechanical tests were performed with an Instron 4482 machine to evaluate quick release mechanism strength with running and 20° slope downhill walking loads. Quick release efficiency was then evaluated via two quick release functional tests, with four participants wearing a 3D printed QRAFO.
FINDINGS: Simulated stress on the weight bearing pin, anchor, and surrounding carbon fibre structure under running and downhill walking loads did not exceed the yielding stress. Mechanical tests verified the simulation results. Four participants successfully swapped the strut within 25.01 ± 3.66 seconds, outperforming the 60.48 ± 10.88 seconds result for the hand-tightened bolted strut. A learning evaluation with one participant showed that, after approximately 30 swapping iterations, swap time was consistently below 10 seconds.
CONCLUSION: The quick release mechanism accommodated running and slope walking loads, and allowed easy and fast strut removal and attachment, greatly reducing strut swap time compared to screw-anchor connections. Overall, the novel quick release AFO improved strut-swapping time without sacrificing device strength, thereby enabling people to use the most appropriate AFO stiffness for their current activity and hence improve mobility and quality of life.
Layman's Abstract
An advancement in ankle foot orthosis (AFO) design, named Posterior Dynamic Strut AFO (PDEAFO), securely attaches a strut to the foot and shank-cuff sections via bolts, to better match a user’s activity level. The PDEAFO design approach makes quick strut swapping impractical. A novel quick release PDEAFO design was created to enable AFO users to quickly switch struts when desired, therefore enabling better ankle biomechanics for the person’s chosen activity. The novel quick release AFO (QRAFO) includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. To ensure appropriate QRAFO strength, simulated loads were tested before prototyping. The prototype was mechanical testing under maximum loads. To prove quick release mechanism efficiency, the author conducted controlled experiments between screw-anchor mechanism (used by PDEAFO) and quick release mechanism on 3D printed AFOs. Simulations demonstrated safe performance under walking, running, and downhill walking conditions. Mechanical testing proved component strength under maximum loads. Functional testing showed that participants can swap struts within 25.01± 3.66 seconds on the quick release AFO, outperforming the 60.48 ± 10.88 seconds result for the screw anchor mechanism. In conclusion, the quick release AFO improved strut-swapping time without sacrificing device strength, thereby enabling people to use the most appropriate AFO stiffness for their current activity and hence improve mobility and quality of life.
Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/38802/30399
How To Cite: Li W, Baddour N, Lemaire E.D. A novel quick release mechanism for ankle foot orthosis struts. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 2, No.3. https://doi.org/10.33137/cpoj.v5i2.38802
Corresponding Author: Edward D. Lemaire, PhDCentre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada.E-Mail:elemaire@ohri.ca ORCID ID: https://orcid.org/0000-0003-4693-2623
Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional ...recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord（below T4） injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.
Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential ...problems including contractures, deformities and loss of motion.
To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option.
Retrospective cohort.
We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles.
Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses.
We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained.
•Traction orthoses may be an option for conservatively managed phalangeal fractures.•Hand-based traction orthoses require less traction time than forearm-based ones.•Regular review and x-rays needed to maintain fracture alignment and traction forces.
INTRODUCTIONThe C-Brace microprocessor stance and swing control orthosis was designed to overcome safety and functional limitations of traditional knee-ankle-foot orthoses (KAFOs) for individuals ...with lower limb paresis. However, a systematic comparison to established KAFO types has not been performed in a bigger sample. METHODSInternational multicenter, randomized, controlled, cross-over clinical trial. Legacy KAFO users at risk of falling were randomized to KAFO/C-Brace or C-Brace/KAFO use for three months with each orthosis. Primary outcome was balance assessed with the Berg Balance Scale (BBS). Secondary outcomes were falls, mobility, function, and quality of life. RESULTSIntention-to-treat analysis with 102 participants. With the C-Brace, the BBS improved by 3.3 ± 6.3 points (p < 0.0001). Significantly fewer participants presented BBS scores <40 indicative of increased fall risk (16 vs. 36, p = 0.018). Mean falls reduced from 4.0 ± 16.8 to 1.1 ± 3.3 (p = 0.002). Outcomes for function, mobility, and quality of life showed significant improvements with the C-Brace. DISCUSSIONThe improvements in fall risk and mobility can be attributed to the stumble recovery and controlled knee flexion during weight bearing of the C-Brace and have a positive impact on the quality of life of users. CONCLUSIONThe C-Brace represents an option for KAFO users with increased fall risk and reduced mobility.
Canine rehabilitation optimizes recovery and the quality of life in dogs with musculoskeletal conditions or after surgery. Achieving proper range of motion (ROM) is vital post-stifle surgery, often ...accomplished through manual therapy and active exercises. We investigated the mechanical performance of a continuous passive motion (CPM) device for dogs and its potential use in canine rehabilitation therapy.
In the ethical review process, our research was accepted to be evaluated in a sample of four dogs that had undergone left stifle surgery. Each dog underwent four sessions with the device at three different speeds. Results showed the device replicated extension angles close to goniometer measurements used in manual therapy. Flexion was also achieved, but not to the same extent. A force threshold stopped the device, avoiding discomfort in dogs with restricted ROM. Dog-specific factors like body position, opposition to movement, limb size, stage of recovery, haircoat, and discomfort, appeared to influence device operation. Mechanical improvements to allow for enhanced flexion are recommended in future CPM device designs, including a resistance threshold that could be adjusted for individual dogs and stages of healing. This study serves as a foundation for future advancements in canine rehabilitation systems. A canine CPM device may provide an affordable option to improve ROM. This could be beneficial for dog owners, who may not be comfortable with manual therapy, to assist with home rehabilitation exercises.
•Continuous passive motion (CPM) exercises help in improving the range of motion.•CPM exercise in dogs is performed manually and is important in post-surgery therapy.•Extension and flexion angles in dogs could be affected by pain and discomfort.•This study illuminates the constraints in using devices for canine rehabilitation.
INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated ...through telemonitoring. OBJECTIVE: This study aimed to monitor the foot’s flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot’s flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.
PURPOSEMetatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad placement location remains a debated issue. We aimed to identify the most ...effective insole design that reduces forefoot plantar pressure and determine the optimal position for metatarsal pad placement. MATERIALS AND METHODSWe recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking while using an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control), 1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole (P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking protocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proximal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale. RESULTSThe SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the location of the metatarsal pad placement. CONCLUSIONConsidering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shock absorption may be more clinically useful.
PDF
