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Silva R, Morouço P, Lains J, Amorim P, Alves N, Veloso AP. Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial. JMIR Res Protoc 2024; 13:e52365. [PMID: 38564249 PMCID: PMC11022130 DOI: 10.2196/52365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. OBJECTIVE This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. METHODS A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. RESULTS Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. CONCLUSIONS Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52365.
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Affiliation(s)
- Rui Silva
- Centre for Rapid and Sustainable Product Development, Polytechnic University of Leiria, Marinha Grande, Portugal
- CIPER, Faculdade de Motricidade Humana, Lisboa, Portugal
| | - Pedro Morouço
- Escola Superior de Educação e Ciências Sociais, Polytechnic University of Leiria, Leiria, Portugal
| | - Jorge Lains
- Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal
- Faculty of Medicine, University Coimbra, Coimbra, Portugal
| | - Paula Amorim
- Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal
| | - Nuno Alves
- Centre for Rapid and Sustainable Product Development, Polytechnic University of Leiria, Marinha Grande, Portugal
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Demeco A, Foresti R, Frizziero A, Daracchi N, Renzi F, Rovellini M, Salerno A, Martini C, Pelizzari L, Costantino C. The Upper Limb Orthosis in the Rehabilitation of Stroke Patients: The Role of 3D Printing. Bioengineering (Basel) 2023; 10:1256. [PMID: 38002380 PMCID: PMC10669460 DOI: 10.3390/bioengineering10111256] [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: 09/21/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Ruben Foresti
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Nicola Daracchi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Francesco Renzi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Margherita Rovellini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Laura Pelizzari
- AUSL Piacenza, Neurorehabilitation and Spinal Unit, Department of Rehabilitative Medicine, 29121 Piacenza, Italy;
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
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Beldame J, Sacco R, Munoz MA, Masse M, Lalevée M. Assessment of the Efficiency of Measuring Foot and Ankle Edema with a 3D Portable Scanner. Bioengineering (Basel) 2023; 10:bioengineering10050549. [PMID: 37237619 DOI: 10.3390/bioengineering10050549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Background: To prospectively evaluate the reliability of a portable optical scanner compared to the water displacement technique for volumetric measurements of the foot and ankle and to compare the acquisition time associated with these two methods. Methods: Foot volume was measured in 29 healthy volunteers (58 feet, 24 females and 5 males) by a 3D scanner (UPOD-S 3D Laser Full-Foot Scanner®) and by water displacement volumetry. Measurements were performed on both feet, up to a height of 10 cm above the ground. The acquisition time for each method was evaluated. The Kolmogorov-Smirnov test, Lin's Concordance Correlation Coefficient, and a Student's t-test were performed. Results: Mean foot volume was 869.7 +/- 165.1 cm3 (3D scanner) versus 867.9 +/- 155.4 cm3 (water-displacement volumetry) (p < 10-5). The concordance of measurements was 0.93, indicative of a high correlation between the two techniques. Volumes were 47.8 cm3 lower when using the 3D scanner versus water volumetry. After statistically correcting this underestimation, the concordance was improved (0.98, residual bias = -0.03 +/- 35.1 cm3). The mean examination time was 4.2 +/- 1.7 min (3D optical scanner) versus 11.1 +/- 2.9 min (water volumeter) (p < 10-4). Conclusions: Ankle/foot volumetric measurements performed using this portable 3D scanner are reliable and fast and can be used in clinical practice and research.
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Affiliation(s)
- Julien Beldame
- ICP-Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France
- Clinique Megival, 1328 Avenue de la Maison Blanche, 76550 Saint Aubin sur Scie, France
| | - Riccardo Sacco
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000 Rouen, France
| | - Marie-Aude Munoz
- Centre Médical Achille, 200 Avenue des Prés d'Arènes, 34070 Montpellier, France
| | - Marion Masse
- CKS, Centre kiné sport Dieppe, 32 Rue Louis Blériot, Neuville les Dieppe, 76370 Dieppe, France
| | - Matthieu Lalevée
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000 Rouen, France
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, 76821 Mont-Saint-Aignan, France
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Nazha HM, Szávai S, Darwich MA, Juhre D. Passive Articulated and Non-Articulated Ankle-Foot Orthoses for Gait Rehabilitation: A Narrative Review. Healthcare (Basel) 2023; 11:healthcare11070947. [PMID: 37046871 PMCID: PMC10094319 DOI: 10.3390/healthcare11070947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this work was to study the different types of passive articulated and non-articulated ankle-foot orthoses for gait rehabilitation in terms of working principles, control mechanisms, features, and limitations, along with the recent clinical trials on AFOs. An additional aim was to categorize them to help engineers and orthotists to develop novel designs based on this research. Based on selected keywords and their composition, a search was performed on the ISI Web of Knowledge, Google Scholar, Scopus, and PubMed databases from 1990 to 2022. Forty-two studies met the eligibility criteria, which highlighted the commonly used types and recent development of passive articulated and non-articulated ankle-foot orthoses for foot drop. Orthotists and engineers may benefit from the information obtained from this review article by enhancing their understanding of the challenges in developing an AFO that meets all the requirements in terms of ease of use, freedom of movement, and high performance at a relatively low cost.
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Affiliation(s)
- Hasan Mhd Nazha
- Faculty of Mechanical Engineering, Institute of Mechanics, Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Szabolcs Szávai
- Faculty of Mechanical Engineering and Informatics, University of Miskolc, 3515 Miskolc, Hungary
| | - Mhd Ayham Darwich
- Faculty of Biomedical Engineering, Al-Andalus University for Medical Sciences, Tartous, Syria
| | - Daniel Juhre
- Faculty of Mechanical Engineering, Institute of Mechanics, Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
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Raj R, Dixit AR, Łukaszewski K, Wichniarek R, Rybarczyk J, Kuczko W, Górski F. Numerical and Experimental Mechanical Analysis of Additively Manufactured Ankle-Foot Orthoses. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6130. [PMID: 36079510 PMCID: PMC9457881 DOI: 10.3390/ma15176130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Growing age and different conditions often require the replacement of orthoses, and FDM-based 3D printing can produce them quickly with less investment. In today's market for orthotics, these characteristics are highly desired. Therefore, this study is fully focused on the optimization and strength analysis of FDM 3D-printed ankle-foot orthoses (AFO) fabricated using PLA and PLA reinforced with carbon fiber (PLA-C). An increase in ankle plantar-flexor force can be achieved by reinforcing thermoplastic AFOs with CFs. Specially designed mechanical strength tests were conducted at the UTM to generate force-displacement curves for stored elastic energy and fracture studies. The mechanical behavior of both AFOs was predicted with the help of an FEA. The model predictions were validated by comparing them with mechanical strength testing conducted under the same loading and boundary conditions as the FEA. In both the prediction and experimental analysis, the PLA-C-based AFOs were stiffer and could withstand greater loads than the PLA-based AFOs. An area of high stress in the simulation and a fracture point in experimentation were both found at the same location. Furthermore, these highly accurate models will allow the fabrication of AFOs to be improved without investing time and resources on trials.
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Affiliation(s)
- Ratnesh Raj
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, Jharkhand, India
| | - Amit Rai Dixit
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, Jharkhand, India
| | - Krzysztof Łukaszewski
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 STR, 61-138 Poznan, Poland
| | - Radosław Wichniarek
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 STR, 61-138 Poznan, Poland
| | - Justyna Rybarczyk
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 STR, 61-138 Poznan, Poland
| | - Wiesław Kuczko
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 STR, 61-138 Poznan, Poland
| | - Filip Górski
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 STR, 61-138 Poznan, Poland
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