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Snowdon N, McLean S, Piercy H, Brodie MA, Wheat J. Orthotic shorts for improving gait and walking in multiple sclerosis: a feasibility study. Disabil Rehabil 2023; 45:3000-3011. [PMID: 36000829 DOI: 10.1080/09638288.2022.2114018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the acceptability and potential efficacy of orthotic shorts in people with multiple sclerosis. MATERIALS AND METHODS This mixed-methods, cross-over study utilised qualitative data to investigate acceptability, including perceived effectiveness. Quantitative data included wear times, self-selected walking speed, spatiotemporal gait parameters, and participant-perceived walking ability. Fifteen participants were assessed with and without two pairs of custom-made shorts: one designed as an orthotic and a second looser pair. Each were worn at home for two weeks. Semi-structured interviews were conducted at the first and final appointments. Quantitative data were analysed using Cohen's d; qualitative analysis used a thematic framework. A triangulation protocol integrated qualitative and quantitative data. RESULTS Orthotic shorts were acceptable to most users who described improved control, stability, and function. Where shorts were less acceptable, this was due to restriction of hip flexion or appearance. Effect sizes were in the moderate category for participant-perceived walking ability and for those spatiotemporal gait parameters that reflect mediolateral stability. Small effect sizes were seen for walking speed and related spatiotemporal parameters, such as step length. CONCLUSION Orthotic shorts are acceptable and potentially efficacious for improving walking, stability, and function in people with multiple sclerosis. Further research and design development are warranted.Implications for rehabilitationOrthotic shorts are a type of fabric orthosis that have not been previously researched but might assist pelvic stability.Orthotic shorts appear to be acceptable to those people with multiple sclerosis who perceive themselves to be unstable around the trunk and hips.Orthotic shorts might improve gait stability and self-perceived walking ability.
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Affiliation(s)
- Nicola Snowdon
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Sionnadh McLean
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Hilary Piercy
- Department of Nursing and Midwifery, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Matthew A Brodie
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Jon Wheat
- Academy of Sport and Physical Activity, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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Higo A, Pearce G, Palmer S, Grant L. The value of dynamic elastomeric fabric orthoses in the management of a complex hypermobile Ehlers-Danlos syndrome patient: A case report. Clin Case Rep 2023; 11:e6821. [PMID: 36694653 PMCID: PMC9842784 DOI: 10.1002/ccr3.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023] Open
Abstract
The use of dynamic elastomeric fabric orthoses is examined in a young woman with hypermobile Ehlers-Danlos syndrome (hEDS) referred for physiotherapy with hip dysplasia, prior to a right periacetabular osteotomy. Dynamic elastomeric fabric orthoses plus rigorous subjective examination, therapists' listening skills, and patient-centered goals were useful for this hEDS patient.
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Affiliation(s)
- Anna Higo
- Centre for Healthcare ResearchCoventry UniversityCoventryUK,Physiocure Physiotherapy ClinicLeedsUK
| | - Gemma Pearce
- Centre for Healthcare ResearchCoventry UniversityCoventryUK
| | - Shea Palmer
- Centre for Care ExcellenceCoventry University and University Hospitals Coventry & Warwickshire NHS TrustCoventryUK
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The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:980-989. [PMID: 35190896 DOI: 10.1007/s00586-022-07131-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.
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Raschke SU. Limb Prostheses: Industry 1.0 to 4.0: Perspectives on Technological Advances in Prosthetic Care. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:854404. [PMID: 36188935 PMCID: PMC9397934 DOI: 10.3389/fresc.2022.854404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022]
Abstract
Technological advances from Industry 1.0 to 4.0, have exercised an increasing influence on prosthetic technology and practices. This paper explores the historical development of the sector within the greater context of industrial revolution. Over the course of the first and up the midpoint of the second industrial revolutions, Industry 1.0 and 2.0, the production and provision of prosthetic devices was an ad hoc process performed by a range of craftspeople. Historical events and technological innovation in the mid-part of Industry 2.0 created an inflection point resulting in the emergence of prosthetists who concentrated solely on hand crafting and fitting artificial limbs as a professional specialty. The third industrial revolution, Industry 3.0, began transforming prosthetic devices themselves. Static or body powered devices began to incorporate digital technology and myoelectric control options and hand carved wood sockets transitioned to laminated designs. Industry 4.0 continued digital advancements and augmenting them with data bases which to which machine learning (M/L) could be applied. This made it possible to use modeling software to better design various elements of prosthetic componentry in conjunction with new materials, additive manufacturing processes and mass customization capabilities. Digitization also began supporting clinical practices, allowing the development of clinical evaluation tools which were becoming a necessity as those paying for devices began requiring objective evidence that the prosthetic technology being paid for was clinically and functionally appropriate and cost effective. Two additional disruptive dynamics emerged. The first was the use of social media tools, allowing amputees to connect directly with engineers and tech developers and become participants in the prosthetic design process. The second was innovation in medical treatments, from diabetes treatments having the potential to reduce the number of lower limb amputations to Osseointegration techniques, which allow for the direct attachment of a prosthesis to a bone anchored implant. Both have the potential to impact prosthetic clinical and business models. Questions remains as to how current prosthetic clinical practitioners will respond and adapt as Industry 4.0 as it continues to shape the sector.
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Affiliation(s)
- Silvia Ursula Raschke
- British Columbia Institute of Technology, Applied Research, MAKE+, Burnaby, BC, Canada
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Snowdon N, Booth S, McLean S, Wheat J, Piercy H. Meaning of fabric orthoses to long-term users with multiple sclerosis: An interpretative phenomenological analysis. Prosthet Orthot Int 2021; 45:246-253. [PMID: 33856158 DOI: 10.1097/pxr.0000000000000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fabric orthoses are elasticated garments designed to provide support to the musculoskeletal system. They may benefit people with multiple sclerosis; however, in this population, their acceptability is largely unexplored. OBJECTIVES This study aimed to explore the meaning that fabric orthoses hold for people with multiple sclerosis and factors influencing acceptability. STUDY DESIGN This is a qualitative study using an interpretative phenomenological analysis to explore the meaning ascribed to lived experience. METHODS Four people with multiple sclerosis participated in face-to-face semi-structured interviews. Two used upper limb orthotic sleeves for involuntary movement control, one used orthotic shorts, and one used a soft ankle brace. Three participants had fabric orthoses they no longer used. Themes were validated by peer review. FINDINGS Two themes were identified. "Giving back control" describes how perceived physical benefits, such as decreased involuntary movement and improved stability, led to important benefits in autonomy and self-image. Orthoses were not worn longer-term where self-image was not improved. "Learning to live with an orthosis" captures the way in which participants learnt from experience over months or years how to maximize effectiveness and overcome disadvantages. Acceptability was determined specific to the contexts in which the orthoses were used, with the social appropriateness of appearance and the demands of tasks being important considerations. CONCLUSIONS Fabric orthoses can be acceptable to people with multiple sclerosis. Professionals should be mindful of the active learning process that users engage in as they learn about the pros and cons of orthotic use. Further research into effectiveness is needed.
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Affiliation(s)
- Nicola Snowdon
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, S10 2BP
| | - Susan Booth
- Bolton Foundation NHS Trust, Bolton, United Kingdom
| | - Sionnadh McLean
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, S10 2BP
| | - Jon Wheat
- School of Sport and Biological Sciences, University of Bolton, United Kingdom
| | - Hilary Piercy
- Department of Nursing and Midwifery, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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Shaari IH, Abu Osman NA, Shasmin HN. A case study on interface pressure pattern of two garment orthoses on a child with cerebral palsy. Proc Inst Mech Eng H 2020; 234:884-894. [DOI: 10.1177/0954411920923541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many studies have shown that medical compression products produce different levels of interface pressure during the usage of the products. However, limited studies have explored the pattern of interface pressure exerted by orthotic garments. This case study aimed to investigate the pattern of interface pressure exerted by two types of orthotic garments on a child with cerebral palsy. A 13-year-old child diagnosed with ataxic spastic diplegia cerebral palsy has difficulty to perform sit-to-stand motion even with a walking frame due to his truncal ataxia. A TheraTogsTM orthosis and a Dynamic Lycra® Fabric Orthosis (DLFO) were prepared for the child. The child’s sit-to-stand ability without and with the usage of orthoses was recorded using five sit-to-stand tests. The garments’ interface pressure was measured using F-scan (9811E) and F-scan 6.5.1 version software. The pressure was recorded when the child was in sitting position and performing sit-to-stand-to-sit motion. Overall, the child completed the five sit-to-stand test duration within 2.53 ± 0.04 s and 2.51 ± 0.09 s with the usage of TheraTogsTM orthosis and DLFO, respectively. Higher pressure was exerted by Dynamic Lycra Fabric Orthosis (axillary = 122 mmHg) in contrast to TheraTogsTM orthosis (77 mmHg) when the child was in a sitting position. Lower pressure was exerted by DLFO (7 mmHg), over xiphoid level and for TheraTogsTM orthosis is 1.2 mmHg over axillary level when the child was performing sit-to-stand motion. The largest range of pressure was exerted by TheraTogsTM orthosis with a minimum pressure of 5 mmHg and a maximum pressure of 155 mmHg during sit-to-stand motion. Overall, the DLFO exerted higher mean interface pressure on the child in comparison to TheraTogsTM orthosis when the child’s body was in a sitting position wearing both upper garment and pants. Both TheraTogsTM orthosis and DLFO presented a different range of interface pressure over different body segments and activities.
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Affiliation(s)
- Ida Hasni Shaari
- Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Physiotherapy Study, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Noor Azuan Abu Osman
- Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hanie Nadia Shasmin
- Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Karadağ-Saygı E, Giray E. The clinical aspects and effectiveness of suit therapies for cerebral palsy: A systematic review. Turk J Phys Med Rehabil 2019; 65:93-110. [PMID: 31453550 PMCID: PMC6648185 DOI: 10.5606/tftrd.2019.3431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/18/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this review to evaluate the clinical aspects and effectiveness of suit therapy for patients with cerebral palsy (CP). MATERIALS AND METHODS A literature search was performed in the PubMed, SCOPUS, Web of Science, and PEDro databases within the period from the establishment of the relevant database to July 2018. The articles were categorized according to their study design. We included studies published in peer-review journals focusing on the efficacy of suit therapies for CP and excluded review articles, duplications, non-related articles. A narrative synthesis approach was used, as it was not possible to classify extracted and analyzed data, and the overall effect size was unable to be calculated. Data regarding study subjects (number, age, CP type, Gross Motor Function Classification System [GMFCS] level), suit type, intervention including dose of suit therapy, outcome measurements, outcomes, adverse effects, and funding were extracted. The method introduced by Furlan, Pennick, Bombardier, and van Tulder was used to evaluate the risk of bias for the assessment of methodological quality of randomized-controlled trials (RCTs). RESULTS A total of 29 studies were included of which 10 were Class I, eight were Class II-III, and 11 were Class IV studies. Studies were heterogenous in design, sample size, study population, and outcomes measured. The methodological quality score of RCTs varied between 4 and 10. The results of the high-quality RCTs showed that wearing the suit along with conventional therapy improved proximal stability, gross motor function, and gait. The Class II-III and IV studies supported the findings of the Class I studies. CONCLUSION The major improvements from the RCTs were seen in proximal stability, gross motor function and gait, although grading was unable to be done due to the heterogeneity of included studies. In order to obtain gains in the function, it is important to carefully consider intended use, patient selection criteria, and suit type.
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Affiliation(s)
- Evrim Karadağ-Saygı
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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