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A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern.
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To investigate the effects of a shoulder sling on balance in patients with hemiplegia.
Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order.
The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (p<0.05). This weight asymmetry pattern did not improve with either the Bobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition.
The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position.
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To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities.
Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later.
Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability.
The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg.
Citations
To evaluate the feasibility and effectiveness of a knee-ankle-foot orthosis powered by artificial pneumatic muscles (PKAFO).
Twenty-three hemiplegic patients (age, 59.6±13.7 years) were assessed 19.7±36.6 months after brain lesion. The 10-m walking time was measured as a gait parameter while the individual walked on a treadmill. Walking speed (m/s), step cycle (cycle/s), and step length (m) were also measured on a treadmill with and without PKAFO, and before and after gait training. Clinical parameters measured before and after gait training included Korean version of Modified Bathel Index (K-MBI), manual muscle test (MMT), and Modified Ashworth Scale (MAS) of hemiplegic ankle. Gait training comprised treadmill walking for 20 minutes, 5 days a week for 3 weeks at a comfortable speed.
The 10-m walking time, walking speed, step length, and step cycle were significantly greater with PKAFO than without PKAFO, and after gait training (both p<0.05). K-MBI was improved after gait training (p<0.05), but MMT and MAS were not.
PKAFO may improve gait function in hemiplegic patients. It can be a useful orthosis for gait training in hemiplegic patients.
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To compare the effect of foot orthotics and rehabilitation exercises by assessing balancing ability and joint proprioception in athletes who have chronic ankle instability.
Forty-one athletes who visited hospitals due to chronic ankle instability were randomly assigned to two groups. One group had ankle rehabilitation exercises while the other group had the same rehabilitation exercises as well as foot orthotics. Joint position sense of the ankle joint was examined by using an isokinetic exercise machine. Balancing abilities categorized into static, dynamic and functional balance abilities were evaluated by using computerized posturography. We tested the subjects before and after the four-week rehabilitation program.
After the four-week treatment, for joint reposition sense evaluation, external 75% angle evaluation was done, revealing that the group with the application of foot orthotics improved by -1.07±1.64 on average, showing no significant difference between the two groups (p>0.05). Static, dynamic and functional balancing abilities using balance masters were evaluated, revealing that the two groups improved in some items, but showing no significant difference between them (p>0.05).
This study found that athletes with chronic ankle instability who had foot orthotics applied for four weeks improved their proprioceptive and balancing abilities, but did not show additional treatment effects compared with rehabilitation exercise treatment.
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To know the effectiveness of a custom molded fitting chair between pre- and post-chair status through comparison of musculoskeletal indices in severely disabled children.
We researched 34 severely disabled patients who had used a custom molded fitting chair continuously for more than a year. There were 27 cerebral palsy patients and 7 patients with other kinds of diseases that affect the brain such as chromosomal disease or metabolic disease. By radiographic studies, Cobb's angle, the femoral neck-shaft angle of the femur, and Reimers migration percentage were measured. The indices are analyzed before and after application.
The average period of application was 24 months. There was a significant reduction in the angles of femur neck-shaft, 163.4 degree before and 158.2 degree after the use of the chair (p<0.05), and 23 of 34 had demonstrated a reduced angle. Cobb's angle and Reimers migration percentage increased but the difference of pre- and post-chair status was not statistically significant. Seventeen of 33 children showed reduced Cobb's angle. Also, 19 of 37 showed a reduced degree of dislocation of the hip joints.
In spite of the use of a custom molded fitting chair, a significant improvement did not emerge for musculoskeletal deformity indices in severely disabled children. However, there was no significant aggravation of Cobb's angle or Reimers migration percentage in developing children. Therefore, it is thought be helpful to prevent rapid aggravation of musculoskeletal deformities.
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To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures.
We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks.
The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05).
The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.
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