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Sharma S, Anderson KM, Pacha MS, Falbo KJ, Severe C, Hansen AH, Hendershot BD, Wilken JM. The effect of carbon fiber custom dynamic orthosis use and design on center of pressure progression and perceived smoothness in individuals with lower limb trauma. Clin Biomech (Bristol, Avon) 2024; 117:106284. [PMID: 38870878 DOI: 10.1016/j.clinbiomech.2024.106284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/12/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Carbon-fiber custom dynamic orthoses are used to improve gait and limb function following lower limb trauma in specialty centers. However, the effects of commercially available orthoses on center of pressure progression and patient perception of orthosis smoothness during walking are poorly understood. METHODS In total, 16 participants with a unilateral lower extremity traumatic injury underwent gait analysis when walking without an orthosis, and while wearing monolithic and modular devices, in a randomized order. Device alignment, stiffness, participant rating of perceived device smoothness, center of pressure velocity, and ankle zero moment crossing were assessed. FINDINGS The modular device was approximately twice as stiff as the monolithic device. Alignment, smoothness ratings, peak magnitude of center of pressure velocity, and zero moment crossing were not different between study devices. The time to peak center of pressure velocity occurred significantly later for the modular device compared to the monolithic and no orthosis conditions, with large effect sizes observed. INTERPRETATION Commercially available orthoses commonly used to treat limb trauma affect the timing of center of pressure progression relative to walking without an orthosis. Despite multiple design differences, monolithic and modular orthoses included in this study did not differ with respect to other measures of center of pressure progression. Perceived smoothness ratings were approximately 40% greater with the study orthoses as compared to previous studies in specialty centers, which may be due to a more gradual center of pressure progression, as indicted by lower peak magnitude of center of pressure velocity with both study orthoses.
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Affiliation(s)
- Sapna Sharma
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
| | - Kirsten M Anderson
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Molly S Pacha
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Kierra J Falbo
- Rehabilitation and Engineering Center for Optimizing Veteran Engagement and Reintegration (RECOVER), Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Clare Severe
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Andrew H Hansen
- Rehabilitation and Engineering Center for Optimizing Veteran Engagement and Reintegration (RECOVER), Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Brad D Hendershot
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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McGrath RL, Price CA, Johnson WB, Childers WL. Advancing Exoskeleton Development: Validation of a Robotic Surrogate to Measure Tibial Strain. Bioengineering (Basel) 2024; 11:490. [PMID: 38790357 PMCID: PMC11118925 DOI: 10.3390/bioengineering11050490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Bone stress injuries are prevalent among athletes and military recruits and can significantly compromise training schedules. The development of an ankle-foot orthosis to reduce tibial load and enable a faster return to activity will require new device testing methodologies capable of capturing the contribution of muscular force on tibial strain. Thus, an actuated robotic surrogate leg was developed to explore how tibial strain changes with different ankle-foot orthosis conditions. The purpose of this work was to assess the reliability, scalability, and behavior of the surrogate. A dual actuation system consisting of a Bowden cable and a vertical load applied to the femur via a material testing system, replicated the action-reaction of the Achilles-soleus complex. Maximum and minimum principal strain, maximum shear strain, and axial strain were measured by instrumented strain gauges at five locations on the tibia. Strains were highly repeatable across tests but did not consistently match in vivo data when scaled. However, the stiffness of the ankle-foot orthosis strut did not systematically affect tibial load, which is consistent with in vivo findings. Future work will involve improving the scalability of the results to match in vivo data and using the surrogate to inform exoskeletal designs for bone stress injuries.
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Affiliation(s)
- Robert L. McGrath
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD 20817, USA
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - Ciera A. Price
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD 20817, USA
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - William Brett Johnson
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
- DoD/VA Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
| | - Walter Lee Childers
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
- DoD/VA Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
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