An Orthotic Joint Design for Enhancing Ankle Mobility With Ankle Foot Orthoses Use

2020 ◽  
Vol 14 (4) ◽  
Author(s):  
Eileen Baker ◽  
Philip Voglewede ◽  
Thomas Current ◽  
Barbara Silver-Thorn

Abstract Articulated ankle foot orthoses (AFOs) are prescribed to treat drop-foot, a common neuromuscular weakness observed after a stroke. These assistive devices prevent the toe from dragging during swing (drop-foot) by providing a resistive moment at the ankle. However, existing ankle joint designs for articulated AFOs introduce additional gait pathologies as they also constrain ankle mobility during stance. A novel ankle joint for AFOs to prevent drop-foot during swing and improve ankle mobility during stance was developed, thereby reducing compensatory knee motion during stance. The design intent was to mimic the unconstrained kinematic response of a nonpathologic ankle at initial contact while preventing drop-foot during swing. The design incorporated two modes of operation: locked during swing for support and unlocked during stance for enhanced range of motion. Proof of concept testing with able-bodied subjects was conducted to test walking ability over level ground based on kinetic and kinematic parameters. The comparative tests confirmed the ability of the novel design to prevent drop-foot and its potential for enhanced ankle mobility during stance. Preliminary results indicate that the novel ankle joint should be refined to facilitate smooth and consistent unlocking but can be safely used in its current form with mobility impaired individuals.

2010 ◽  
Vol 34 (3) ◽  
pp. 327-335 ◽  
Author(s):  
Jaap Harlaar ◽  
Merel Brehm ◽  
Jules G. Becher ◽  
Daan J. J. Bregman ◽  
Jaap Buurke ◽  
...  

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.


PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S129-S130
Author(s):  
Frederick T. Klingbeil ◽  
Xue-Cheng Liu ◽  
Elizabeth Moberg-Wolff

2009 ◽  
Vol 17 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Noriaki Maeda ◽  
Junichi Kato ◽  
Yuji Azuma ◽  
Sou Okuyama ◽  
Satoshi Yonei ◽  
...  

2010 ◽  
Vol 34 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Daan J. J. Bregman ◽  
Vincent De Groot ◽  
Peter Van Diggele ◽  
Hubert Meulman ◽  
Han Houdijk ◽  
...  

The aim of this study was to assess the functional effects and mechanical contribution of Ankle Foot Orthoses (AFO) prescribed to overcome drop-foot gait. We hypothesized that poor functional effects of the AFO relate to insufficient mechanical contribution of the AFO during the swing phase, or unwanted constraining of the ankle during the stance phase. In seven patients with Stroke or Multiple Sclerosis, we determined changes in energy cost of walking resulting from wearing an AFO, as a measure of the functional effects. In addition, an instrumented gait analysis was performed, and the mechanical AFO properties were measured, to calculate the mechanical contribution of the AFO. The AFO was sufficiently stiff to effectively support the foot in swing, without hampering the ankle during stance. For the whole group, there was a significant improvement in walking speed and energy cost (12%). However, the AFO had no functional benefit in terms of a reduced energy cost of walking for three patients, who coherently demonstrated no pathological plantar flexion during swing without their AFO. We conclude that functional benefit from the AFO was only found when the mechanical AFO characteristics met the need to support the patients‘ mechanical deficiencies.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hanieh Seyyedzadeh ◽  
Mokhtar Arazpour ◽  
Hassan Saeedi ◽  
Mohammad Ebrahim Mousavi ◽  
Navid Golchin

2012 ◽  
Vol 37 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Veerle Creylman ◽  
Luiza Muraru ◽  
Jari Pallari ◽  
Helga Vertommen ◽  
Louis Peeraer

Background: Recently, additive fabrication has been proposed as a feasible engineering method for manufacturing of customized ankle foot orthoses (AFOs). Consequently, studies on safety, comfort and effectiveness are now carried out to assess the performance of such devices. Objective: Evaluate the clinical performance of customized (selective laser sintering) SLS-AFOs on eight subjects with unilateral drop foot gait and compare to clinically accepted (polypropylene) PP-AFOs. Study Design: Active control trial. Methods: For each subject two customized AFOs were fabricated: one SLS-AFO manufactured following an additive fabrication framework and one thermoplastic PP-AFO manufactured according to the traditional handcraft method. Clinical performance of both AFOs was evaluated during gait analysis. Results: A significant beneficial effect of both custom-moulded PP-AFO and customized SLS-AFO in terms of spatial temporal gait parameters and ankle kinematic parameters compared to barefoot gait of adults with drop foot gait are observed. No statistically significant difference between the effect of PP-AFO and of SLS-AFO was found in terms of spatial temporal gait parameters and ankle kinematic parameters. Conclusion: AFOs manufactured through the SLS technique show performances that are at least equivalent to the handcrafted PP-AFOs commonly prescribed in current clinical practice. Clinical relevance Manufacturing personalized AFOs with selective laser sintering (SLS) in an automated production process results in decreased production time and guarantees the consistency of shape and functional characteristics over different production time points compared to the traditional manufacturing process. Moreover, it reduces the dependency of the appliance on the experience and craftsmanship of the orthopaedic technician.


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