Sensor based braces: Challenges ahead

Sensor based brace is a new technology driven initiative to address the adherence issues associated with clubfoot treatment. It encompasses various engineering fields (sensors, batteries, data transfer) to measure precise brace wear timings. Still in preliminary usage, yet they have lead to several significant findings; foremost being that caretakers tend to over report their brace usage. Enhanced surveillance and reinforcements is thus possible with sensor devices as defaulters can be picked up early. The introduction of these devices in common practice is postulated to lessen relapse rates by upto 40%. However, many challenges obscure the path of newer braces. Robust study designs and longer follow up is lacking in majority of studies detailing sensor based clubfoot braces. None of the currently available studies demonstrate effectiveness of patient interventions/changes based on the research data. Behavioral changes in caretakers may be difficult to achieve and could require repeated reinforcements. Since braces need to be worn for prolonged periods in clubfoot treatment, sensor data generated per patient would be colossal. It's processing and interpretation would be an uphill task. The cost of advanced inventory may burden ongoing clubfoot care programmes in low income countries. There is also a possibility that the newer technology may tone up the bracing protocol into a highly sophisticated and supervised medical intervention rather than a simplified maintenance phase. Till further development and evidence, sensor based clubfoot braces may find their initial application for high risk groups susceptible to relapse.

Impact of COVID Pandemic on the Children with Cerebral Palsy

BACKGROUND

The COVID pandemic has been raging across the world for the past 18 months and has severely impacted healthcare and resources. Children with special needs have been adversely affected by the COVID pandemic, due to lack of formal schooling, access to rehabilitation and limited physical and social activity. The aim of this online survey was to understand the effect of the pandemic on the children with Cerebral Palsy (CP).

METHODS

An online survey was conducted using a nine parts questionnaire comprising 26 questions. Survey included questions pertaining to demographic data, ambulatory status, lack of access to physiotherapy, orthotic adjustment, surgery, deterioration of function, and behaviour. A simple binary answer was sought to cover all social strata of society.

RESULTS

Responses were received from 101 caregivers who participated in an online questionnaire. 25.7% had no therapy sessions, 74.2% were on therapy of which 23.7% had online sessions. The lockdown restrictions coupled with lack of rehabilitation and orthotic support led to deterioration in physical function in 54 children and worsening of deformity in 34. Changes in behavioural pattern was observed in 45 children.

CONCLUSION

The survey revealed major disruptions in the care of Children with CP. The parents reported difficulties in managing the child therapy at home. There is always a possibility that the pandemic will result in a lockdown again, and hence our approach toward physical therapy assessment and rehabilitation needs to be towards home-based and family-centred care.

Small touches to big walks -the impact of rehabilitation on Sjögren-Larsson syndrome: A case report

Sjögren-Larsson syndrome (SLS) is a rare neurocutaneous disorder characterized by the presence of congenital ichthyosis, spasticity, and mental retardation. As with other rare genetic diseases, treatment is mainly symptomatic. Due to the absence of definitive treatment, lifelong follow-up and support of patients are important to improve the quality of life. A 7-year-old female child who was diagnosed as having SLS was referred to the rehabilitation clinic. After 20 sessions of a rehabilitation program, she started walking independently with the additional contribution of ankle-foot orthoses (AFOs). The contribution of the short-term rehabilitation approach and especially the administration of AFOs to the independence level of the patient is emphasized herein.

Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

Background:

Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution.

Methods:

This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma.

Results:

The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment.

Conclusion:

Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

IDEO energy-storing orthosis: Effects on lower extremity function and preservation

INTRODUCTION

The Intrepid Dynamic Exoskeletal Orthosis (IDEO) brace is a custom energy-storing orthosis design meant to improve gait, stability, and function after lower extremity injury or limb salvage. Early studies demonstrated the potential for the IDEO to improve functional performance, in conjunction with its paired return to run (RTR) rehabilitation program, compared to other brace types, and an impressively decreased rate of late amputation. The current study aimed to investigate these functional and revision outcomes from our institution to determine which patients may benefit most from IDEO bracing and what factors of the IDEO design and rehabilitation program are most important for improved outcomes after lower extremity trauma and/or loss of function.

METHODS

We performed a retrospective review of all patients treated with a IDEO style brace at a single military lower extremity trauma referral center between May 2003 and November 2017. We reviewed the medical records for initial diagnosis, post-orthotic rehabilitation program, IDEO use characteristics, pain, change in desire for amputation, and whether patient underwent eventual amputation.

RESULTS

We identified 213 patients with 222 lower extremities treated with IDEO brace. Of these, 76 limbs were treated for combat-related injuries. At one year follow-up, use status could not be determined for 37 extremities (16.7%). Of the 185 limbs with use data available, 116 (61.1%) continued regular brace use, and 37 (15.7%) reported intermittent use. Patients diagnosed with footdrop or weakness were more likely to continue use (OR 2.33, p=0.04), while patients with a previous fusion were less likely to continue use (OR 0.45, p=0.049). Undergoing any dedicated therapy increased chances of continued use (OR 3.37, p<0.001). At final follow-up, 16 patients (7.5%) underwent delayed lower extremity amputations following IDEO treatment. Overall, 27.2% of patients who initially desired amputation eventually underwent amputation despite IDEO brace use. Patients who underwent amputation reported higher pain levels (2 versus 5, p<0.001).

DISCUSSION

In select patients, the IDEO may decrease the desire for delayed amputation and permit higher levels of activity; however, its efficacy appears tied to the rehabilitative regimen, pain levels, and initial diagnosis. These findings should guide post-surgical extremity bracing prescriptions and expectations.

Patient satisfaction with the CMC controller: A cohort study

STUDY DESIGN

Cohort study.

INTRODUCTION

The evidence specific to understanding patient satisfaction, preference and the effects on occupational performance using a CMC orthosis is sparse.

PURPOSE OF THE STUDY

The main purpose of this study was to determine patient satisfaction, aspects of the orthotic preference, and the effect on pain and function of the CMC Controller Plus neoprene orthotic device.

METHODS

This research was conducted at two outpatient clinics located in Pennsylvania and Florida during 2019. The subjects of this study included any individuals referred to one of two participating hand therapy facilities with either a primary or secondary diagnosis of thumb CMC joint arthritis or present with this diagnosis as a comorbidity. The CMC Controller Plus orthosis (Hely & Weber) was provided to each patient by the treating therapist at no cost to the patient after the patient agreed to take part in the study. None of the patients received hand therapy treatment for the CMC pain; the only intervention provided was the CMC Controller Plus.

RESULTS

The CMC Controller Plus orthosis improved the patients' functional status and reduced their pain. The effect size for the change in function was large (1.29) compared to the effect size for the reduction in pain which approached moderate at 0.49.

DISCUSSION

The CMC Controller Plus orthosis improved the patient's functional status by 52% and reduced their pain by 29%.

CONCLUSION

The results were both statistically and clinically significant.

Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

STUDY DESIGN

Electronic Web-based survey.

INTRODUCTION

Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide.

PURPOSE OF THE STUDY

The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries.

METHODS

Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their "most used" approach in the previous year.

RESULTS

There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%).

DISCUSSION

In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis.

CONCLUSIONS

The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.

Design and fabrication of the radial and ulnar wrist articulating control orthoses

STUDY DESIGN

Case series.

INTRODUCTION

Pain and injury at the radial and ulnar aspects of the wrist due to overuse or trauma are commonly treated in hand therapy clinics.

PURPOSE OF STUDY

Describe two orthoses that allow targeted rest and recovery of involved anatomical structure(s) while preserving function of surrounding uninvolved structures in patients who have sustained overuse or traumatic injury at the radial or ulnar aspect of the wrist.

METHODS

Outline the fabrication of the Ulnar-Wrist Articulating Control Orthosis (U-WACO) and Radial-Wrist Articulating Control Orthosis (R-WACO) as well as presents case examples for each orthosis.

RESULTS

The U-WACO and R-WACO designs may improve comfort, compliance, and functional ability to complete daily tasks while allowing targeted rest and recovery of involved anatomical structure(s) at the radial and ulnar aspects of the wrist due to overuse or trauma.

CONCLUSION

Dynamic orthoses that allow for movement in one plane while restricting movement in another may overcome the shortcomings of some static orthotic designs.

Relative motion extension management of zones V and VI extensor tendon repairs: Does international practice align with the current evidence?

STUDY DESIGN

Electronic Web-based survey.

INTRODUCTION

Therapists participating in an international survey selected relative motion extension (RME) as the "most used" approach for the postoperative management of zones V and VI extensor tendon repairs. A subgroup of respondents identified RME as their preferred approach and were asked about their routine RME practices.

PURPOSE OF THE STUDY

The purpose of this study was to capture data from routine RME users about their practices and compare this with the RME evidence.

METHODS

An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy full-member countries. Participation required therapists to have postsurgically managed at least one extensor tendon repair within the previous year. Those who selected RME as their "most used" approach were asked to identify which variation of the RME approach they favored: RME plus (with wrist orthosis), RME only, or "both" RME plus and RME only, and then were directed to additional questions related to their choice.

RESULTS

Respondents from 28 International Federation of Societies for Hand Therapy full-member countries completed the survey. RME users (N = 368; 41.5% of sample) contributed to this secondary data. Respondents favored the RME variation "RME plus" (47%), followed by "both" (44%), then "RME only" (9%) with most managing single digit/simple injuries (n = 287, 81%) versus multiple digit/complex injuries (n = 96, 27%), and partial repairs (n = 278, 79%).

DISCUSSION

Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four-finger orthotic design; and restricting use to only repairs of one or two fingers.

CONCLUSIONS

RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus, from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function.

A comparison of the effectiveness of three types of trunk orthoses on the balance performance of older people with osteoporotic hyperkyphosis: A cross-over study

BACKGROUND

Orthotic immobilization is an early treatment for osteoporotic vertebral fracture at the hyperkyphotic thoracic spine.

OBJECTIVE

This exploratory study compared the immediate impact of three types of trunk orthoses on the balance parameters of older people with osteoporosis hyperkyphosis.

METHODS

Twenty older people (aged 60-65 years) with osteoporosis kyphosis and a history of falls participated in a pilot cross-over study. Four randomized comparisons were carried out, including either soft, semi-rigid, and rigid trunk orthoses worn on the participants compared to "no orthosis" as the control condition. Kyphosis angle, Forward Reach Test, Timed Up and Go test, and postural stability during standing on a force plate were recorded and compared between study conditions using one-way repeated measures analysis of variance test.

RESULTS

All orthoses significantly reduced the kyphosis angle (p < 0.01). None of the orthoses has a significant change in the Timed Up and Go test (p > 0.01). Rigid orthosis significantly reduced the forward reach compared to "no orthosis" (p = 0.003, 95% CI: 1.08-6.3 cm). None of the orthosis induced a significant change in postural sway velocity in anteroposterior and mediolateral directions compared to the control condition (p > 0.01).

CONCLUSION

These findings suggest that using rigid orthosis in older people with osteoporosis hyperkyphosis reduces the balance performance.

Evaluation of a Customized 3D Printed ORGAN-Hand Orthotic Device for Unilateral Cerebral Palsy: a Pilot Study

To achieve intensive activity-based and goal-directed rehabilitation for unilateral cerebral palsy (UCP), several static and functional upper limb orthoses have been used but with limited robust evidence-base. The current pilot study evaluated the feasibility and efficacy of a customized 3D-printed orthotic device in children with UCP. The attainment of a prespecified goal and Shriners Hospital Upper Extremity Evaluation (SHUEE) at 3 and 6 mo were the efficacy measures. Of the 14 screened children, 5 (median age: 7.9 y; 3 boys) were included. The 3-mo follow-up could be completed for 3 children while 6-mo follow-up could be completed for 1 child. Rest could not be assessed due to pandemic restrictions. Although none attained set goals till the last follow-up, all 3 children (at 3-mo follow-up) showed improvement in SHUEE scores without any significant safety concerns. Further studies on 3D-printed orthosis in UCP are the need of the hour.

Use of a relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair: A retrospective consecutive case series

STUDY DESIGN

A retrospective, single-center, consecutive case series.

INTRODUCTION

In concept, a relative motion flexion (RMF) orthosis will induce a "quadriga effect" on a given flexor digitorum profundus (FDP) tendon, limiting its excursion and force of flexion while still permitting a wide range of finger motion. This effect can be exploited in the rehabilitation of zone I and II FDP repairs.

PURPOSE OF THE STUDY

To describe the use of RMF orthoses to manage zone I and II FDP 4-strand repairs.

METHODS

Medical record review of 10 consecutive zone I and II FDP tendon repairs managed with RMF orthosis for 8 to 10 weeks in combination with a static dorsal blocking or wrist orthosis for the initial 3 weeks.

RESULTS

Indications included sharp lacerations (n = 6), ragged lacerations (n = 2), staged flexor tendon reconstruction (n = 1), and type IV avulsion (n = 1). In 8 of the 10 cases that completed follow-up, the mean arc of proximal interphalangeal/distal interphalangeal active motion were as follows: sharp, 0° to 106°/0° to 75°; ragged, 0° to 90°/0° to 25°; reconstruction, 0° to 90°/10° to 45°; and avulsion, 0° to 95°/0° to 20°. Grip performance available for 6 of 10 cases was 62% to 108% of the dominant hand. There were no tendon ruptures, secondary surgeries, or proximal interphalangeal joint contractures.

CONCLUSION

Based on this small series, the RMF approach appears to be safe and effective. It can lead to similar mobility and functional recovery as other early active motion protocols, with certain practical advantages and without major complications. Further investigation with larger, multicenter, prospective, longitudinal cohorts and/or randomized clinical trials is necessary.

Muscle activation of the upper trapezius and functional typing performance during computer typing task: A comparison of two different wrist immobilization methods

BACKGROUND

The aim of this study was to examine the effect of two different wrist immobilization methods on the muscle activation of the upper trapezius muscle and functional typing performance during computer typing tasks in office workers.

METHODS

The study was conducted on 11 healthy office workers. The study subjects were asked to type on a computer for 5 min (1) without splint or taping, (2) with a splint, (3) with rigid taping which limits the wrist flexion at the dominant side. The upper trapezius muscle activation was recorded by surface EMG during the task. The mean values obtained from EMG were normalized according to Maximum Voluntary Isometric Contraction (MVIC), comparisons were made according to %MVIC.

RESULTS

The office workers' mean age was 27.45 ± 3.64 years. There was no significant difference in immobilization methods between %MVIC on dominant (p = .508) and non-dominant (p = .213) sides. The upper trapezius of the non-dominant side showed higher electromyographic activity when the subjects used a splint (p = .013). There was a significant difference between splinting and rigid taping methods in typing performance (z = -2,491, p = .013).

CONCLUSION

There is no significant difference in the upper trapezius muscle activation between the splint and rigid taping methods during the computer typing task on the dominant side. The typing performance was affected more during splint use compared to rigid tape application. Considering the importance of work efficiency in employees, rigid taping might be considered as an alternative splinting for wrist immobilization in office workers.

[Physiotherapeutic and rehabilitative options for neuromuscular scolioses : Areas of physiotherapy techniques in the field of tension between hypertonic and hypotonic forms of neuromuscular scoliosis]

Conservative treatment and physiotherapy (PT) of neuromuscular scoliosis and its underlying systemic causes is dominated by a pragmatic approach. In the choice of treatment, the observance of the underlying muscle tone sets the essential course to select an appropriate PT technique. Hypertonic forms need the reflex-modulation techniques included in Bobath or Vojta programmes. They sometimes necessitate tone-reducing medication and additional orthotics with a likely risk of pressure sores. In hypotonic forms of scoliosis on the other hand, gravity and spine collapse with pulmonal dysfunction are the key issues addressed by conservative treatment. Sustained quality of life and supported partaking in social life through maintenance of pulmonary function and upright sitting ability are of continuing concern. PT programmes with a neurophysiologic background such as those of Bobath and Vojta are of central significance.

Effects of orthopedic insoles on postural balance in patients with chronic stroke: A randomized crossover study

BACKGROUND

Orthopedic insoles (OIs) with medial arch support and heel cushion are widely used to manage lower extremity injuries, but their effects on postural balance in patients with chronic stroke have not been adequately explored.

METHODS

Design: Double-blinded, sham-controlled, randomized crossover trial.

PARTICIPANTS

A total of 32 ambulatory patients (20 men and 12 women, aged between 30 and 76 years) with more than 6 months since stroke onset.

INTERVENTIONS

All participants received one assessment session wearing OIs and one session wearing sham insole (SI) in a random order with a 1-day interval.

OUTCOMES

Our primary outcome was the Berg Balance Scale score. Secondary outcomes included the Functional Reach Test, Timed Up and Go test, and computerized posturography. All were performed in both sessions. Subgroup analyses regarding demographic and functional variables were conducted to identify potential responders.

RESULTS

Significant between-insole differences favoring OIs were seen in all clinical tests (P < 0.05), but were seen only in the static medial-lateral sway in computerized posturography assessment (P = 0.04). An approximate 2-point difference in the BBS score favoring OIs was observed in all subgroups, not reaching the minimal clinically important difference.

CONCLUSION

The use of OIs generated small but significant positive effects on improving postural balance among patients with chronic stroke. Additional biomechanical and clinical studies are required to evaluate their potential for routine clinical use.

TRIAL REGISTRATION

NCT03194282.

Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

BACKGROUND

Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.

METHODS

A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance.

DISCUSSION

Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN76410775 . Retrospectively registered on 30 June 2019.

The use of static progressive and serial static orthoses in the management of elbow contractures after complex fracture dislocation injuries: A pediatric case study

INTRODUCTION

Contractures are the most common complication after traumatic injury to the elbow. Although evidence supporting the use of static progressive and serial static orthoses to help recover range of motion after these complex injuries is growing, there is currently a paucity of literature exploring its efficacy in pediatric populations.

CASE DESCRIPTION

The following case study presents the results of the use of static progressive and serial static orthoses with a young patient who presented with both elbow extension and flexion contractures after a complex fracture dislocation injury.

RESULTS

A noted and consistent improvement in both elbow extension and flexion can be observed after commencement of the static progressive and serial static orthoses. These results are consistent with the literature exploring the efficacy of these orthoses with adult populations with traumatic elbow injuries.

DISCUSSION

Further studies evaluating the use of static progressive and serial static orthoses in the management of elbow contractures after traumatic injuries in pediatric populations is needed to establish best practices with this particular patient population.

A randomized clinical trial comparing early active motion programs: Earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs

STUDY DESIGN

Randomized clinical trial with parallel groups.

INTRODUCTION

Early active mobilization programs are used after zones V and VI extensor tendon repairs; two programs used are relative motion extension (RME) orthosis and controlled active motion (CAM). Although no comparative studies exist, use of the RME orthosis has been reported to support earlier hand function.

PURPOSE OF THE STUDY

This randomized clinical trial investigated whether patients managed with an RME program would recover hand function earlier postoperatively than those managed with a CAM program.

METHODS

Forty-two participants with zones V-VI extensor tendon repairs were randomized into either a CAM or RME program. The Sollerman Hand Function Test (SHFT) was the primary outcome measure of hand function. Days to return to work, QuickDASH (Disabilities of Arm, Shoulder and Hand) questionnaire, total active motion (TAM), grip strength, and patient satisfaction were the secondary measures of outcome.

RESULTS

The RME group demonstrated better results at four weeks for the SHFT score (P = .0073; 95% CI: -10.9, -1.8), QuickDASH score (P = .05; 95% CI: -0.05, 19.5), and TAM (P = .008; 95% CI: -65.4, -10.6). Days to return to work were similar between groups (P = .77; 95% CI: -28.1, 36.1). RME participants were more satisfied with the orthosis (P < .0001; 95% CI: 3.5, 8.4). No tendon ruptures occurred.

DISCUSSION

Participants managed using an RME program, and RME finger orthosis demonstrated significantly better early hand function, TAM, and orthosis satisfaction than those managed by the CAM program using a static wrist-hand-finger orthosis. This is likely due to the less restrictive design of the RME orthosis.

CONCLUSIONS

The RME program supports safe earlier recovery of hand function and motion when compared to a CAM program following repair of zones V and VI extensor tendons.

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

PURPOSE

The analysis determined the relapses in clubfoot children treated with Ponseti technique and standard bracing protocol and their correlation with overall follow up duration using pooled data from various series. It also tested the prescribed timelines of 5 and 7 years for slow-down/cessation of relapses in clubfoot children.

METHODS

A systematic literature search was performed for articles published in "Pubmed (includes Medline indexed journals)" electronic databases using key words: "Clubfoot or CTEV or congenital talipes equinovarus", "Ponseti" for years 1^st January 2001 to 15^th November 2020. Included were studies that addressed treatment of idiopathic clubfoot using the standard Ponseti technique, followed a well defined brace protocol (maintenance of corrected deformity using a central bar based brace and prescribed duration mentioned), reported a minimum mean follow up of 4 years and having relapse as one of their outcome measure. Studies reporting Ponseti technique for non-idiopathic clubfoot, child's age older than 1 year at the time of primary treatment, clubfoot with previous interventions before Ponseti treatment, where relapse and residual deformities were not identified distinctly in follow up, abstract only publications, letter to the editors, case reports, technique papers and review articles were excluded. The following characteristics of clubfoot patients in the selected articles were included for analysis: Patient numbers/feet treated with Ponseti technique; follow up years (<5; 5-7 and >7 years; overall) and corresponding relapse percentages for patients.

RESULTS

There were total 2206 patients in the included 24 studies. Average follow up was 6 years. The average relapse rates for clubfoot patients in the pooled data stood at 30%. The overall relapse rates increased with a longer follow up and the curve befitted a linear regression equation with weak positive correlation (Pearson correlation coefficient = 0.08). The relapse rates in follow up categories of <5 years (26.6 ± 15.6%), 5-7 years (30.8 ± 16.3%) and >7 years (28.4 ± 6.2%) were similar statistically (Analysis of variance, ANOVA).

CONCLUSIONS

Approximately 1 in 3 clubfoot patients suffer relapse post Ponseti technique and standard bracing protocol. A weak positive correlation was observed for relapses when correlated with increasing follow up years. The relapses however tend to slow down after initial growth years. There is a need to educate the care receivers regarding the possibility of late relapses despite proper Ponseti treatment and accordingly to keep them under supervised follow up for longer periods.

Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis: a randomised trial

OBJECTIVE

To evaluate the efficacy of carbon-fibre shoe-stiffening inserts in individuals with first metatarsophalangeal joint osteoarthritis.

DESIGN

This was a randomised, sham-controlled, participant- and assessor-blinded trial. One hundred participants with first metatarsophalangeal joint osteoarthritis received rehabilitation therapy and were randomised to receive either carbon fibre shoe-stiffening inserts (n = 49) or sham inserts (n = 51). The primary outcome measure was the Foot Health Status Questionnaire (FHSQ) pain domain assessed at 12 weeks.

RESULTS

All 100 randomised participants (mean age 57.5 (SD 10.3) years; 55 (55%) women) were included in the analysis of the primary outcome. At the 12 week primary endpoint, there were 13 drop-outs (7 in the sham insert group and 6 in the shoe-stiffening insert group), giving completion rates of 86 and 88%, respectively. Both groups demonstrated improvements in the FHSQ pain domain score at each follow-up period, and there was a significant between-group difference in favour of the shoe-stiffening insert group (adjusted mean difference of 6.66 points, 95% CI 0.65 to 12.67, P = 0.030). There were no between-group differences for the secondary outcomes, although global improvement was more common in the shoe-stiffening insert group compared to the sham insert group (61 vs 34%, RR 1.73, 95% CI 1.05 to 2.88, P = 0.033; number needed to treat 4, 95% CI 2 to 16).

CONCLUSION

Carbon-fibre shoe-stiffening inserts were more effective at reducing foot pain than sham inserts at 12 weeks. These results support the use of shoe-stiffening inserts for the management of this condition, although due to the uncertainty around the effect on the primary outcome, some individuals may not experience a clinically worthwhile improvement.

Combined clinic and home-based therapeutic approach for the treatment of bilateral radial deficiency for a young child with Holt-Oram syndrome: A case report

BACKGROUND

Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking.

PURPOSE

The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization.

STUDY DESIGN

Case report.

METHODS

A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP).

RESULTS

Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention.

CONCLUSIONS

A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.

The influence of an orthopaedic walker boot on forefoot force

BACKGROUND

In the treatment of an Achilles tendon rupture the patients are commonly equipped with an orthopaedic walker boot with wedges. To what extent this influences the tensile force placed on the Achilles tendon is unclear.

PURPOSE

To assess the forefoot force and describe changes in muscle activity of the medial gastrocnemius, soleus and tibialis anterior when using one or three wedges during ambulation in a weightbearing orthopaedic walker boot.

METHODS

The force on the forefoot was measured with a force sensor insole and muscle activity of the medial gastrocnemius, soleus and tibialis anterior were measured using surface electromyography in 10 healthy participants. Three different types of ambulation were performed (walking without crutches (unass.), walking with crutches (+crutch) and walking with crutches and verbal instructions to place body weight on heel (heel+crutch) with one and three heel wedges respectively.

FINDINGS

The total peak force displayed an interaction where forefoot force decreased when wearing three wedges only for the +crutch ambulation type (80N, p=0.001) although there was a trend to decrease with three wedges also for the heel+crutch ambulation type (48N, p=0.05). The relative peak force on the forefoot showed a main effect with a significant decrease when using three wedges compared to one wedge across all three ambulation types (19.1%, p=0.009).

INTERPRETATION

The force on the forefoot and hereby the Achilles tendon significantly decreased when using three wedges compared to one wedge. These findings have important implications for the rehabilitation post Achilles tendon rupture.

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis

Objectives

Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA.

Methods

This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data.

Results

Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force.

Conclusion

The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.

The Impact of Ankle-foot Orthoses on Balance in Older Adults: a Scoping Review

BACKGROUND

Balance impairment is a contributing factor to falls. Falls are a leading cause of injury and death in older adults. An ankle-foot orthosis (AFO) is a device that can be prescribed as an intervention to help individuals with compromised balance to ambulate safely.

OBJECTIVE

The purpose of this review was to investigate the role ankle-foot orthoses have in affecting balance in community-dwelling older adults.

METHODOLOGY

A scoping review was conducted searching MEDLINE, CINAHL, EMBASE, and REHABDATA databases to obtain the appropriate literature to meet the following criteria: 1) quantitative research design; 2) studies with participants over age 65; 3) studies with participants with drop-foot or sensory deficits in the lower extremity; 4) the treatment intervention was unilateral or bilateral AFOs; 5) the outcome measure was balance or stability. The retrieved articles were assessed based on the internal validity, external validity, objectivity, and reliability of the study design and the interpretation of results.

FINDINGS

11 articles were identified that met the inclusion criteria. Four major themes emerged in the analysis about the impact that ankle-foot orthoses have on balance in older adults: (1) AFOs improved lateral stability, (2) AFOs improved balance under static conditions, (3) AFOs provided a reduction in postural sway and (4) AFOs increased walking speed in community-dwelling older adults.

CONCLUSIONS

The evidence from the findings of the review indicate that ankle-foot orthoses have a generally positive affect on balance in older adults. Clinicians can consider the ankle-foot orthosis an effective intervention that can improve balance in some older adult patient populations.

Objective measurement of adherence to wearing foot orthoses using an embedded temperature sensor

The objective of this study was to evaluate the validity of a temperature sensor for the measurement of adherence to wearing foot orthoses. Ten participants were provided with foot orthoses containing an embedded temperature sensor and wore the orthoses for a randomly-determined duration over a five-day period. Sensor-detected wear time was compared to a reference standard (objectively measured wear time using a smart-phone application). Ambient temperature and physical activity were recorded with a temperature gauge and wearable activity tracker, respectively. A simple peak detection algorithm which identified the largest one-minute changes in sensor temperature provided highly accurate wear time values (r = 0.999, coefficient of variation=0.2%). Ambient temperature and physical activity did not significantly influence temperature sensor scores. These findings demonstrate that the temperature sensor provides accurate foot orthosis wear time data and may therefore be a useful tool for documenting adherence in clinical practice and intervention studies.