Anthony McGarry

Head shape measurement standards and cranial orthoses in the treatment of infants with deformational plagiocephaly

This review aims to determine how head shape is measured and describes the use of orthoses in the management of deformational plagiocephaly. A systematic review was conducted and papers published in English up to and including 2006 were sourced from nine databases. After initial screening, 20 papers were included; three literature reviews and 17 original papers. Of the original papers, eight concerned the method of head shape measurement. Measurements are important in determining clinical classification and treatment modality of deformational plagiocephaly. All studies were appraised and assigned a level of evidence according to the Scottish Intercollegiate Guidelines Network. Methodological quality was inadequate. Publications involving the use of cranial orthoses used convenience samples, were not blinded, and used different measurement techniques. No comparison groups were included and participants were not randomized. Evidence suggests that conservative treatments might reduce skull deformity although the quality is poor. Clinical studies investigating the use of cranial orthoses reported beneficial effects. Further research is required to identify the efficacy of cranial orthoses in the treatment of deformational plagiocephaly based on a standardized measurement technique to facilitate classification of this condition.

Motivations and barriers to prosthesis users participation in physical activity, exercise and sport: a review of the literature:

Background: The UK will host the Paralympics in 2012 and the Commonwealth Games in 2014 showcasing the talents of elite athletes and aiming to inspire the population to become involved. However, low levels of physical activity are prevalent: only 40% of men and 28% of women meet the minimum UK physical activity recommendations. The population of people with limb absence is no exception. Objectives: To determine if people with amputation are participating in physical activity and sport; whether post-amputation activity levels match pre-amputation levels; and if there are motivations and barriers to participation. Study Design: Literature review. Methods: Five reviewers systematically searched all peer reviewed and gray literature in seven bibliographic databases and the Cochrane Library. Results: Following rigorous elimination, 12 articles were finally included in the review and critically appraised. Four themes were identified: components; rehabilitation outcomes; body image; and motivations and barriers to participation. Conclusion: People with limb absence are not participating in physical activity conducive to health benefits, and only a minority participate in exercise and sports. Participation following amputation does not mirror that of pre-amputation levels, and more barriers than motivations exist to adopting or maintaining a physically active lifestyle. Clinical relevance This literature review aims to inform those involved in rehabilitation and ongoing care of those with limb absence about what motivates or precludes their participation in physical activity, exercise and sport. Such knowledge could be applied to improving health and wellbeing in this population.

Provision of prosthetic and orthotic services in low-income countries: a review of the literature.

Background: Disability is inextricably linked to poverty. A total of 80% of the disabled population lives in low-income countries. The demand for prosthetic and orthotic services in these countries is increasing, and a variety of methods to provide services are currently used. Objectives: To assess current models of provision to facilitate sustainable, evidence-based prosthetic and orthotic services. Study Design: Literature review. Methods: A literature search was performed through Medline (Ovid), PubMed, ISI Web of Knowledge, EMBASE and RECAL Legacy using combinations of subject heading and text word searching strategies. Full-text publications were critically appraised and ranked according to the Scottish Intercollegiate Guidelines Network guidelines. Results: Three areas were deemed pertinent to the research question. Studies were grouped into one or more of these categories based on the issues addressed: instigators, types of service provision, demographics and region-specific issues. It was found that many complex factors influence prosthetic and orthotic services in low-income countries. Demographic and regional idiosyncrasies require prosthetic and orthotic services to be tailored to address the specific needs of individual countries. Conclusions: The lack of and quality of available research made efficacy of methods used to provide services in low-income countries difficult to determine. Clinical relevance This review aims to highlight areas of best practice in prosthetic and orthotic services in low-income countries and to show where further research is required in order to develop evidence-based prosthetic and orthotic services.

Repeatability of a new observational gait score for unilateral lower limb amputees

The aim of this study was to assess the repeatability of an observational gait analysis score that was developed specifically for unilateral amputees. Ten videotaped sequences were analysed by six experienced observers on two separate occasions. Data were analysed using percentage agreement, the kappa statistic and the coefficient of repeatability. The score demonstrated good intraobserver repeatability with an average repeatability coefficient of 3 (range 1.5-4.6). Interobserver repeatability was poor with a repeatability coefficient of 5.9. This score could be used in practice to assess amputees and is most repeatable if used by the same observer to evaluate changes in patients over time.

The effect that energy storage and return feet have on the propulsion of the body: A pilot study

A variety of energy storage and return prosthetic feet are currently available for use within lower limb prostheses. Designs claim to provide a beneficial energy return during push-off, but the extent to which this occurs remains disputed. Techniques currently used to measure energy storage, dissipation and return within the structure of the prosthetic foot are debatable, with limited evidence to support substantial elastic energy storage and return from existing designs. The aim of this study was to evaluate the performance of energy storage and return foot designs through considering the ankle power during push-off and the effect on body centre of mass propulsion. To achieve this aim, the gait patterns of six trans-tibial prosthetic users wearing different designs of energy storage and return feet were analysed while ascending a ramp. Three examples of energy storage and return feet (suitable for moderate activity) were selected and randomly evaluated: the Blatchford’s Epirus, Össur Assure and College Park Tribute feet. The power at the anatomical and mechanical ankle joints was integrated to evaluate the work done over the gait cycle. The direction of the inertial force, and therefore propulsion of the body centre of mass, was used to indicate the effect of the energy return by the energy storage and return feet. Results indicate that although energy storage and return feet may provide energy return, the work done around the prosthetic ankle indicates net power absorption. Therefore, the prosthetic limb is unable to contribute to the body centre of mass propulsion to the same extent as the biological limb.

Design of manikin for testing of residual-limb shape-capture method: technical note.

Consensus is still lacking on how best to capture the shape of a residual limb. Computer-aided design systems have not proven more accurate, repeatable, or reliable than traditional plaster of paris methods. Research is limited in design, relates to clinical trials, and is based on opinions and clinical experience. Many outcome measurements are based on qualitative estimations of prosthetic fit or patient feedback rather than quantitative measurements. Research must identify the most accurate, repeatable, and reliable methods for residual-limb shape capture under conditions most likely to enhance socket fit. Measurement is difficult because a reference grid is required for identifying the residual limbs axis for ensuring direct comparison. This article describes a manikin production method for testing the shape capture of the residual limb. Diameters and volume were measured at specific levels with a programmable computer numerical control milling machine and a displacement tool, with a combined accuracy of 5 micrometers.

Evaluation of the magnitude of hip joint deformation in subjects with avascular necrosis of the hip joint during walking with and without Scottish Rite orthosis

The femoral head in subjects with leg calve perthes disease (LCPD) is generally considerably deformed. It is debatable whether this deformation is due to an increase in applied loads, a decrease in bone mineral density or a change in containment of articular surfaces. The aim of this study was to determine the influence of these factors on deformation of the femoral head. Two subjects with LCPD participated in this study. Subject motion and the forces applied on the affected leg were recorded using a motion analysis system (QualsisTM) and a Kistler force plate. OpenSim software was used to determine joint contact force of the hip joint whilst walking with and without a Scottish Rite orthosis. 3D Models of hip joints of both subjects were produced by Mimics software. The deformation of femoral bone was determined by Abaqus. Mean values of the force applied on the leg increased while walking with the orthosis. There was no difference between bone mineral density (BMD) of the femoral bone of normal and LCPD sides (p-value>0.05) and no difference between hip joint contact force of normal and LCPD sides. Hip joint containment appeared to decrease follow the use of the orthosis. It can be concluded that the deformation of femoral head in LCPD may not be due to change in BMD or applied load. Although the Scottish Rite orthosis is used mostly to increase hip joint containment, it appears to reduce hip joint contact area. It is recommended that a similar study is conducted using a higher number of subjects.

Evaluation of the influences of various force magnitudes and configurations on scoliotic curve correction using finite element analysis

Scoliosis is a lateral curvature in the normally straight vertical line of the spine, and the curvature can be moderate to severe. Different treatment can be used based on severity and age of subjects, but most common treatment for this disease is using orthosis. To design orthosis types of force arrangement can be varied, from transverse loads to vertical loads or combination of them. But it is not well introduced how orthoses control scoliotic curve and how to achieve the maximum correction based on force configurations and magnitude. Therefore, it was aimed to determine the effect of various loads configurations and magnitudes on curve correction of a degenerative scoliotic subject. A scoliotic subject participated in this study. The CT-Scan of the subject was used to produce 3D model of spine. The 3D model of spine was produced by Mimics software and the finite element analysis and deformation of scoliotic curve of the spine under seven different forces and in three different conditions was determined by ABAQUS software. The Cobb angle in scoliosis curve decreased significantly by applying forces. In each condition depends on different forces, different corrections have been achieved. It can be concluded that the configurations of the force application mentioned in this study is effective to decrease the scoliosis curve. Although it is a case study, it can be used for a vast number of subjects to predict the correction of scoliosis curve before orthotic treatment. Moreover, it is recommended that this method and the outputs can be compared with clinical findings.

Factors influencing the reliability of the universal goniometer in measurement of lower limb range of motion : a literature review

ABSTRACT Introduction: The universal goniometer (UG) is commonly used in clinical practice to measure lower-limb joint range of motion (ROM). Reliability of the UG is essential to ensure consistency of measurement between and within practitioners. Clinically, it is important to understand how reliability may be affected by various factors. Materials and Methods: An electronic and manual literature search was conducted to determine the reliability of the UG. A variety of search terms were used to search between 1980 and July 2015. Articles sourced were graded according to the Scottish Intercollegiate Guideline Network guidelines. Articles reviewed included both measurements of healthy subjects and those with different pathologies. Active and passive lower-limb ROMs were studied, and intratester and intertester reliability were examined. Results: Twenty-one studies were included and fully reviewed. Most studies indicated that UG reliability was best when used to measure ROM in healthy subjects in comparison to patients. The limited number of studies measuring active motion compromised the ability to make comparisons with measuring of passive ROM. It was reported from the studies investigating both intratester and intertester reliability that intratester reliability was higher than intertester reliability. Reliability of measurements varied depending on the joint measured. Tester training and standardization of the measurement procedure led to increased reliability, and there was a suggestion that involving two testers in the measurement procedure may have a beneficial effect. Conclusions: This literature review highlights variation in study methodology used, which reduces the ability to directly compare studies. Clinicians should be aware of the variability of reliability of the UG and the effect of different factors when interpreting measurements taken with this instrument. Further research is required to investigate the effect different factors may have on the reliability of the UG and the possibility of using protocols and technology to increase reliability when measuring joint ROM.