Sarah Curran

The influence of a bespoke unloader knee brace on gait in medial compartment osteoarthritis: A pilot study:

Background: Patients suffering from mild-to-moderate medial compartment knee osteoarthritis may be treated with an unloader knee orthosis. However, compliance has been shown to be an issue with such devices. Objectives: The aim of this study was to identify the effects of a new design of knee unloader orthosis on specific gait parameters in patients with mild-to-moderate medial knee osteoarthritis. Methods: The gait of seven patients was assessed in two conditions: without an orthosis and when wearing a new design of unloader knee orthosis. Gait analysis was performed to determine alterations to the adduction moment, speed of walking, step length, cadence and knee sagittal plane range of motion during ambulation for the two test conditions. Results: The knee adduction moment was significantly reduced (p = 0.001), and the speed of walking significantly increased (p < 0.001) when wearing the orthosis. However, a reduction in knee range of motion (p = 0.002) and an increase in step length (p < 0.001) were observed with the orthosis donned. Cadence was not significantly altered (p = 0.504). Conclusion: The use of a new design of unloader knee orthosis as a conservative treatment approach for patients with mild-to-moderate medial compartment osteoarthritis appears warranted. Clinical relevance Various conservative modalities have been used to reduce pain and improve function in medial compartment osteoarthritis. A new design of an unloader knee orthosis has been developed and is shown to have immediate benefits in patients with mild medial knee osteoarthritis.

Biomechanical analyses of the performance of Paralympians: from foundation to elite level:

A biomechanical analysis of sports performance provides an objective method of determining performance of a particular sporting technique. In particular, it aims to add to the understanding of the mechanisms influencing performance, characterization of athletes and provide insights into injury predisposition. While the performance in sport of able-bodied athletes is well recognized in the literature, less information and understanding are known on the complexity, constraints and demands placed on the body of an individual with a disability. This article provides a dialogue that outlines scientific issues of the performance analysis of multi-level athletes with a disability, including Paralympians. Four integrated themes are explored, the first of which focuses on how biomechanics can contribute to the understanding of sports performance in athletes with a disability and how it may be used as an evidence-based tool. This latter point questions the potential for a possible cultural shift led by the emergence of user-friendly instruments. The second theme briefly discusses the role of reliability of sports performance and addresses the debate of two-dimensional and three-dimensional analyses. The third theme addresses key biomechanical parameters and provides guidance to clinicians and coaches on the approaches adopted using the biomechanical/sports performance analysis for an athlete with a disability starting out, to the emerging and elite Paralympian. For completeness of this discourse, the final theme is based on the controversial issues on the role of assisted devices, and the inclusion of Paralympians into able-bodied sport. All combined, this dialogue highlights the intricate relationship between biomechanics and training of individuals with a disability. Furthermore, it illustrates the complexity of modern training of athletes, which can only lead to a better appreciation of the performances to be delivered in the London 2012 Paralympic Games. Clinical relevance Biomechanical analysis can play a fundamental role in optimizing the performance of an athlete with a disability. Clinicians should be aware and understand the mechanisms that may influence performance and have an appreciation of the factors that may predispose such athletes to injury.

Systematic Review of Contracture Reduction in the Lower Extremity with Dynamic Splinting

IntroductionJoint contractures are relatively common disorders that can result in significant, long-term morbidity. Initial treatment is non-operative and often entails the use of mechanical modalities such as dynamic and static splints. Although widely utilized, there is a paucity of data that support the use of such measures. The purpose of this systematic review was to evaluate the safety and efficacy of dynamic splinting as it is used to treat joint contracture in lower extremities, and to determine if duration on total hours of stretching had an effect on outcomes.MethodsReviews of PubMed, Science Direct, Medline, AMED, and EMBASE websites were conducted to identify the term ‘contracture reduction’ in manuscripts published from January 2002 to January 2012. Publications selected for inclusion were controlled trials, cohort studies, or case series studies employing prolonged, passive stretching for lower extremity contracture reduction. A total of 354 abstracts were screened and eight studies (487 subjects) met the inclusion criteria. The primary outcome measure was change in active range of motion (AROM).ResultsThe mean aggregate change in AROM was 23.5º in the eight studies examined. Dynamic splinting with prolonged, passive stretching as home therapy treatment showed a significant direct, linear correlation between the total number of hours in stretching and restored AROM. No adverse events were reported.DiscussionDynamic splinting is a safe and efficacious treatment for lower extremity joint contractures. Joint specific stretching protocols accomplished greater durations of end-range stretching which may be considered to be responsible for connective tissue elongation.

Preparing our Paralympians: research and development at Össur, UK

In the last 25 years, the continuous evolution in the design of prostheses for individuals with transfemoral and transtibial amputations has been remarkable. Mirroring this development is the dependency and expectancy of the prosthesis technology by the athletes, coaches and other personnel involved in creating Paralympians of today and the future. Össur is recognised as a leader in designing innovative prosthetic products that have contributed worldwide to developing leading Paralympians. The opening section of this article presents an overview of the new Össur products for 2012. Discussion is also focussed on how Össur’s high-function prosthetic products are integrated into an athlete’s training regime. With involvement of the clinical team discussion is also expanded to recognise the important contribution coaching staff has on optimising performance of a Paralympian’s training regime. The dialogue continues with a viewpoint on whether Oscar Pistorius, the face of Össur who wears Flex-Foot Cheetah blades, should participate in the Olympics and Paralympics. While the conclusion of this article may leave more questions than answers, the technology and products offered by Össur provide for a credible foundation and preparation for future challenges beyond the London 2012 Paralympic Games. Clinical relevance Prosthetic technology continues to evolve and the possibilities for individuals with transfemoral and transtibial amputation to participate in high levels of sport increase. Clinicians should be aware of the demands and issues related to the use of such technology within sport.

The influence of thermoplastic thoraco lumbo sacral orthoses on standing balance in subjects with idiopathic scoliosis

Background: Idiopathic scoliosis patients have postural equilibrium problems. Objective: The objective of this study was to assess postural control in subjects with idiopathic scoliosis following a 4-month intervention in an unbraced position. Study design: Quasi-experimental. Methods: Eight healthy girls and eight girls with idiopathic scoliosis took part. A Kistler force platform was used with a frequency of 100 Hz for recording data. The center of pressure was recorded in different positions out of brace for scoliosis and healthy subjects. Test conditions were single limb and double limb stance, with eyes open and closed, and foam and rigid surfaces. Results: The data reflected a weak balance of idiopathic scoliosis subjects compared to healthy subjects. After 1 and 4 months of wearing the brace, center of pressure and center of gravity sway increased in the majority of the tests, although there were no significant differences in any of the test conditions (p > 0.05). While the center of pressure sway in medio-lateral direction decreased after 4 months of wearing a brace, in other variables center of pressure and center of gravity sway increased. Conclusion: Idiopathic scoliosis patients have weak balance in comparison to healthy subjects. In addition, following a period of 4 months of wearing a brace, balance parameters in the scoliosis subjects did not improve. The results show that we need more follow-up of orthoses wearing in idiopathic scoliosis subjects and suggest more studies at least 1-year follow-up to identify the efficiency of brace wear on balance. Clinical relevance Scoliosis can alter postural stability and balance performance during quiet standing. Spinal deformity can alter a subject’s ability to compensate for postural changes and cause gait deviations. This study investigated balance differences between the healthy and idiopathic scoliosis patients and the results of thoraco lumbo sacral orthosis brace wear. It might provide some new insight into the conservative treatment of idiopathic scoliosis patients for clinicians and researchers.

Design and construction of custom-made neoprene thumb carpo-metacarpal orthosis with thermoplastic stabilization for first carpo-metacarpal joint osteoarthritis

Individuals with first carpo-metacarpal (CMC) osteoarthritis (OA) often experience pain and difficulty with functional activities. Thus, designing orthotics to improve function and decrease pain is common practice. These therapists designed an orthosis using a combination of neoprene and thermoplastic materials to create a soft orthosis that provides support to the first CMC joint - Victoria Priganc, PhD, OTR, CHT, CLT.

Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome

Background: Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. Objectives: The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Study design: Quasi experimental design. Methods: A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Results: Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. Clinical relevance A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel syndrome.

Research and development at novel GmbH, Germany for prosthetics and paraplegics

Pressure distribution measurement offers an objective and quantifiable method of determining the loads applied to the human body during static and dynamic situations such as walking and the more demanding tasks associated with sporting activities. While there are various systems available on the market, the technology and developments offered by novel (novel.de) a company based in Munich, Germany are regarded as innovative. The intent of this article is to outline the development of novel’s pressure measurement technology and explore how the pliance® system can assist in determining an optimal fit of a prosthesis in an athlete. The discussion also focuses on the introduction of a new Elastisens® technology of the novel sensor pads to enable analysis of very contoured surfaces. Key pressure parameters for determining optimal performance are also explored; however, clinicians and researchers are guided to acknowledging the need to direct and perform their analysis within context – in other words, the analysis must be hypothesis driven. Clinical relevance Pressure measurement analysis can play an important role in clinical assessment and various treatment modalities. As technology increases, so does the ability of pressure systems. Clinicians should be cognisant of evolving technology such as Elastisens®, which can aid in prosthetic and wheelchair assessment.

Adaptive Sports Ankle Prosthetics

Participating in sport at all levels is gaining a dedicated following and this is also apparent in individuals with an amputation. Currently, there is a wide variety of ankle prostheses available which attempt to provide function, control, and comfort, as well as good aesthetic appeal. Participation in sport, however, increases the demands placed upon ankle prostheses. This can compromise function and performance, and constrain the opportunities of participation in various outdoor and water sports. In acknowledging this limitation and the need to develop more versatile ankle prostheses, this article introduces the evolution of a prototype ankle prosthesis referred to as “Adaptive Sports Ankle.” The ankle prosthesis, which is compatible with any foot pyramid adapter, offers the same range of motion as the normal human ankle joint and is made up of components that are chemical and corrosion resistant. These design features that are specifically created to accommodate below-the-knee amputees provide an ideal prosthesis for those wishing to lead an active lifestyle and participate in aquatic (i.e. swimming, surfing, and scuba diving), snowboarding, and equestrian activities. Although it is acknowledged that there is a need to establish research on the Adaptive Sports Ankle, its introduction to the market will enhance and expand opportunities of those individuals with a lower limb amputation to lead an active and healthy lifestyle. Clinical relevance The introduction of the Adaptive Sports Ankle Prosthesis provides versatility in terms of motion of the device and robust material. Although in its infancy, clinicians should be aware of the potential of this product for individuals who have had a below-the-knee amputation and express a desire to participate in water sports and other outdoor activities.

Influence and benefits of foot orthoses on kinematics, kinetics and muscle activation during step descent task

BACKGROUND Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. RESEARCH QUESTION The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). METHODS Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5o rearfoot medial wedge (R), a 5o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). RESULTS Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but reduced knee internal rotation moment compared to the C insole. Abductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. SIGNIFICANCE Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.BACKGROUND Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. RESEARCH QUESTION The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). METHODS Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5o rearfoot medial wedge (R), a 5o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). RESULTS Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but reduced knee internal rotation moment compared to the C insole. Abductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. SIGNIFICANCE Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.