The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity

Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a stripshaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results: There were four indications for treatment: cryptotia with helix adhesion;cryptotia with grade I microtia;cryptotia with excessive helix thickness;and auricular deformity beyond the treatment time window(≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion: The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.

A Novel Knee Orthosis in the Treatment of Patellofemoral Pain Syndrome

Context: Patellofemoral Pain (PFPS) accounts for up to 25% of knee injuries in sports medicine clinics, with up to 91% of symptoms unresolved after conservative treatment at 5 years. The variability of response to treatment reflects its multi-factorial biomechanical etiologies. Bracing has been utilized to modify patellofemoral kinematics, generally by increasing patellofemoral contact area. The DJO Reaction orthosis is unique in its shock-absorbing elastomeric design, which is created to dissipate peak stress and enhance patellar tracking. Objective: To assess whether the DJO Reaction Brace reduces pain and improves functional outcomes in patients with chronic PFPS. Design: Cohort Series. Setting: Academic Sports Medicine Clinic. Patients: Twenty-two individuals between 18 and 40 years old with chronic patellofemoral pain have failed conservative treatment. Intervention: DJO Reaction Brace. Main Outcome Measures: Kujala Anterior Knee Pain Scale, Knee Injury and Osteoarthritis Outcome Score. Results: Seven males and 10 females with an age range of 19 - 39 years old complete the study. At an average follow-up time of 55 days, the Kujala score significantly improves by 9.8%, and KOOS Scores increase by the following statistically significant amounts: symptom 3.2%, pain 10.7%, sports and recreation 12.9%, quality of life 20.2%. Conclusion: The DJO Reaction orthosis reduces knee pain, increases function, and enhances quality of life with individuals with PFPS and is effective in the conservative care of patellofemoral pain syndrome.

Application of a paraplegic gait orthosis in thoracolumbar spinal cord injury

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.

Customized Foot Orthosis Development by 3D Reconstruction of the CT Images

Clinicians can provide a means to better distribute the pressure around the foot, and can also correct the biomechanics of the foot by using a customized shoe insole. If detected early enough, orthopedic insoles can correct or prevent further complications. In this study the 3 Dimensional (D) model of the foot was used to fabricate a customized orthosis. The Computed Tomography (CT) images of patient’s foot having no muscle weakness and joint restriction were acquired. The gray intensities corresponding to the bones of the foot from the CT images were 3 dimensionally reconstructed. The 3D model of the foot was then imported into the CAD Software. Boolean operations were carried out in between the 3D foot model and a solid rectangular surface to create a customized foot orthosis. The exact contours and shape of the subject’s foot was acquired using the computerized method of fabricating an orthosis. The novel idea described in this study support, automating the process of designing a customized orthosis with the impression got from the 3 dimensionally modeled feet, thereby reducing the modeling time considerably. The simple technique used in this process will help in giving comfort and stability to the patient’s feet while walking.

Heat Setting Technology for the Glove of Flexible Medical Orthosis

In order to meet the curative effect,the glove of the flexible medical orthosis was designed to use nylon / spandex and polyester / spandex covered yarns to knit the glove by parts.For the purpose of confirming the best heat setting technology of the glove knitted by multicomponent materials, different heat setting technologies with different temperature and time were tested on the nylon / spandex and the polyester / spandex knitted fabrics.And the effects of the heat setting technology on dimensional stability and elastic recovery of the two kinds of fabrics were analyzed as well.The results show that in the proper range of temperature and time,dimensional stability and elastic recovery of the nylon / spandex knitted fabric become better with the increases of temperature and time.And dimensional stability of the polyester / spandex knitted fabric also turns good.But its elastic recovery doesn't change obviously.All the measured values were compared with each other.And the results indicate that dimensional stability and elastic recovery of these two kinds of fabrics both are great after the heat setting technology of temperature 180 ℃ and time 60 s.

Effects of a Cordura Material Ankle-Foot Orthosis on Balance Performance in Patients with Foot Drop

As one of the clinical manifestations in patients with hemiplegia after stroke,most of the patients with foot drop suffer from gait disturbance and balance dysfunction, generally accompanied by strephenopodia. There are relatively few researches on the balance ability of patients with foot drop worldwide,while the balance ability will directly affect the walking ability for recovery,so the research is significant in the rehabilitation of foot drop. In the experiment,the Cordura material ankle-foot orthosis (AFO),one of the world leading technology products,is chosen as the experimental equipment because of its well-known durability and strength. The experiment studied the balance performance of patients with foot drop before and after wearing Cordura material AFO. The Berg scale was evaluated to discuss the effect of the orthosis on balance ability in patients with foot drop. It has been found that the wearing equipment BBS scores were significantly improved. There were significant differences comparing with the control group( P<0.05).But in the course of treatment the Berg balance scale (BBS) scores reduced individually,mainly in terms of leg flexibility.

Design and Fabrication of a Passive Pelvic Orthosis for Treadmill Walking Rehabilitation

The pelvis plays a significant role in creating smooth and efficient motion during gait. In this study, an orthosis is designed to support pelvis motion of patients with the inability to walk. This assistive device is un-powered and consists of only passive elements. By focusing on the motion of the lower extremities during treadmill walking, a 3D dynamic model of the human body is simulated through a coupled optimization process. Based on two approaches of direct and inverse dynamics, the optimization problems are defined to derive optimum structural parameters of the pelvic orthosis. The optimization results of the direct dynamics problem indicate good matches between the optimized time plots of pelvis rotations with corresponding desired ones. Moreover, by solving the inverse dynamics problem, the minimum value of torque vector of the hip joint of the stance leg during a gait cycle is obtained. Furthermore, by utilizing a prototype of the orthosis, preliminary experiments are conducted on a normal user to validate the model and to investigate the feasibility of using the device for rehabilitation. For this purpose, the rotational movements of the pelvis and energy consumption of the subject in two cases with and without the device are compared during gait on a treadmill. Decreased energy consumption and the compliant motion of the pelvis while using the device verify simulation results and confirm the favorable performance of the assistive device for pelvic support during walking rehabilitation.

Association between improved trunk stability and walking capacity using ankle-foot orthosis in hemiparetic patients with stroke： evidence from three-dimensional gait analysis

Background Restoration of both normal movement of the pelvis and centre of mass is a primary goal of walking rehabilitation in post-stroke patients because these movements are essential components of effective gait. The aim of this study is to quantitatively analyze the effect of ankle-foot orthosis on walking ability, and to investigate the correlation between improvements in trunk motion and walking capacity.

Classification of human movements with and without spinal orthosis based on surface electromyogram signals

Spinal orthoses were designed to correct poor posture;however,they may restrict trunk movements at all times,making daily activities difficult.Detecting trunk movements can provide instructions for adjusting the stiffness of the spinal orthosis.This study evaluated the feasibility of identifying movements based on surface electromyography(sEMG)signals.Ten participants were tested for different movements with two different modalities:motion without the spinal orthosis(Normal)and with the spinal orthosis(Spinal orthosis).The sEMG signals were collected from eight muscles using surface electrodes during four movements[flexion-extension,lateral bending,axial rotation,and stand to sit to stand].Four time domain features were extracted,with a total of 32 feature vectors.The principal component analysis(PCA)method was adopted to feature selection,and it was found that eight feature dimensions can make cumulative explained variance exceed 95%.The results showed that machine learning algorithms could not only identify Normal and Spinal orthosis movement modalities,but also distinguish four daily movements.Moreover,the classification performance of Random Forest(RF),k-Nearest Neighbor(kNN),and Support Vector Machine(SVM)algorithms were also compared.The results showed that all three machine algorithms have high classification accuracy.The machine learning methods can accurately identify movement patterns by considering sEMG signals,which may provide instructions for adjusting the stiffness of the spinal orthosis.In the future,the spinal orthosis with adjustable stiffness controlled by sEMG signals could help correct poor posture,and permit the wearer to achieve free movement when needed.

Orthotic approach to prevention and management of diabetic foot:A narrative review

Diabetic foot is a common complication affecting more than one-fifth of patients with diabetes.If not treated in time,it may lead to diabetic foot ulcers or Charcot arthropathy.For the management of diabetic foot,shoe modifications and orthoses can be used to reduce pressure on the affected foot or provide the foot with increased stability.In addition,the shoe modifications and orthotic devices can relieve patient discomfort during walking.Appropriate shoe modifications include changing the insole material,modifying the heel height,adding a steel shank or rocker sole,and using in-depth shoes.Alternatively,a walking brace or ankle-foot orthosis can be used to reduce the pressure on the affected foot.The purpose of this narrative review was to provide a reference guide to support clinicians in prescribing shoe modifications and foot orthoses to treat diabetic foot ulcers and Charcot arthropathy.

Resection with limb salvage in an Asian male adolescent withEwing’s sarcoma: A case report

BACKGROUNDEwing’s sarcoma is a highly malignant primary bone tumor that commonly affectschildren. For young patients, multidisciplinary treatment and limb salvage arerecommended, and surgical plans considering the growth potential and boneactivity after tumor resection are essential.CASE SUMMARYAn 11-year-old Asian boy had a 1-mo history of a right-sided limping gait.Imaging revealed a proximal tumor with bone destruction and physealinvolvement over the right femoral neck. He was diagnosed with stage IV(T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvantchemotherapy decreased the tumor size and confined it to the metaphysealregion. The patient underwent four stages of surgery: wide tumor excision plusreconstruction with vascular fibular bone graft plus internal fixation;repeat openreduction and internal fixation;femoral lengthening with orthosis after physealmaturity;and orthosis removal and bone elongation (approximately 6 cm).Following surgery, he could walk without discomfort and had almost equal-sizedbilateral femoral heads, indicating physis preservation. The surgery wassuccessful, and normal femoral head growth was achieved after completeremission. The patient was able to resume normal activities with equal length ofthe bilateral lower limbs.CONCLUSIONTumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.

The Role of Orthotic Service in Modern Rehabilitation of Patients with Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth (CMT) disease, which encompasses several hereditary motor and sensory neuropathies, is one of the most common neuro-muscular disorders. 80% of patients having CMT disease are diagnosed with per cavus deformity. Orthosis is widespread and varies widely in forms. The paper arises the necessity of habilitation at the earliest possible stage as only a few patients use it. The meta-analysis of 412 scientific papers concerning this problem demonstrates the getting better gate, balance and the stopping CMT progression which is scientifically proven. It is also shown that patients with CMT use low prevalence of orthotics, and demonstrate low compliance of patients (for various reasons), high expectations from this habilitation technique.

Botulinum toxin type-A (BoNTA) and dynamic wrist-hand orthoses versus orthoses alone for the treatment of spastic-paretic upper extremity in chronic stroke patients

Purpose: The purpose of this study was to investigate the potential functional improvement of the spastic-paretic upper extremity of individuals with chronic hemiparesis when using a dynamic wrist-hand orthosis with and without concurrent botulinum toxin type-A (BoNTA) injections into the spastic upper extremity muscles. Methods: A three-year retrospective chart review was conducted on all stroke patients referred to out-patient occupational therapy for an upper extremity rehabilitation program, which included use of a dynamic wrist-hand orthosis (DWHO). Three charts documented concurrent treatment with a DWHO + BoNTA. Eleven charts documented DWHO use without concurrent BoNTA treatment. Pre- and post-intervention outcome measure scores were compared between the two groups. Pre- and post-interven- tion scores were also analyzed irrespective of treatment group. Results: Although improvement approached significance on three of the documented outcome measures when comparing the DWHO + BoNTA and DWHO groups, no statistically significant changes were found. A significant difference (p < 0.05) however, was found between the pre- and post-intervention scores irrespective of treatment group in 13 of 14 of the outcome measures documented. Conclusions: Further research with a larger sample size is suggested to assess the combined effect of using a dynamic wrist-hand orthosis and BoNTA injections into the spastic upper extremity muscles of individuals with chronic hemiparesis post stroke.

Brain abscess from halo pin penetration

Halo fixation devices are often employed for critically ill or trauma patients with unstable cervical pathologies. These include fractures, spinal decompression and reconstruction procedures. However, the critical care literature has surprisingly little information in regard to associated complications. Perry and Nickel pioneered the initial halo device in 1959 and soon afterward recognized complications associated with its use [1]. They developed a detailed regimen to prevent abnormal pin placement and infections. The details include pin placement in “safe” zones, specific degrees of torque, and techniques to minimize infection risk. Despite a low death rate, a cerebral brain abscess often leads to prolonged neurological morbidity [2]. Seizures and pneumocranium have also been ascribed to intracranial penetration of halo pins [3,4]. The following describes a patient with cerebral abscess secondary to halo pin penetration. He then developed several other associated complications during hospitalization.

Static and Dynamic Analysis of Osteoarthritic and Orthotic Human Knee

The first objective of this paper is to study the influence of the orthotic device on the maximum values of stresses in knee cartilages by using Ansys Workbench 14.5 software and applying the Finite Element Analysis (FEA) on a virtual assembly composed by an orthotic device and osteoarthritic knee (OAK). The second objective consists into quantifying and investigating the nonlinear motion of the human knee joint for OAK patients, with and without the orthotic device mounted on OAK, using tools of dynamics stability analysis. The short Lyapunov Exponents (LEs) are calculated, as measures of human knee and ankle joints stability, based on the experimental time series collected by using the biometrics acquisition system during walking on horizontal and inclined treadmills from a sample of healthy subjects and a sample of patients suffering by OAK disease. The values of LEs obtained for OAK patients are larger on the inclined treadmill than on horizontal treadmill and are larger than those obtained for healthy knees, being associated with more divergence and less stability. The results confirm that the influence of an orthotic device mounted on OAK on its stability is significant, the values obtained for LEs being smaller than those calculated for OAK, and closer to the values of normal knees of patients and of healthy subjects.

Design of active orthoses for a robotic gait rehabilitation system

An active orthosis （AO） is a robotic device that assists both human gait and rehabilitation therapy. This work proposes portable AOs, one for the knee joint and another for the ankle joint. Both AOs will be used to complete a robotic system that improves gait rehabilitation. The requirements for actuator selection, the biomechanical considerations during the AO design, the finite element method, and a control approach based on electroencepha-lographic and surface electromyographic signals are reviewed. This work contributes to the design of AOs for users with foot drop and knee flexion impairment. However, the potential of the proposed AOs to be part of a robotic gait rehabilitation system that improves the quality of life of stroke survivors requires further investigation.

Prosthetic and orthotic options for lower extremity amputation and reconstruction

Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners.This decision is largely dependent on the patient's premorbid health and function, functional goals and preferences,and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing.When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise,the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.