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Journal of Hand Therapy : Official... 2023Relative Motion (RM) orthoses are an extremely important and beneficial intervention in hand rehabilitation. They can be used for a variety of hand conditions including...
Relative Motion (RM) orthoses are an extremely important and beneficial intervention in hand rehabilitation. They can be used for a variety of hand conditions including for positioning, protection, alignment and exercise. In order to achieve the intended goals of this orthotic intervention, the clinician must pay attention to detail during its fabrication. The purpose of this manuscript is to offer some simple and practical fabrication tips for hand therapists who want to include the use of RM orthoses to manage these different clinical conditions. Photos are provided to reinforce some of the key concepts.
Topics: Humans; Orthotic Devices; Hand; Exercise Therapy; Exercise; Range of Motion, Articular
PubMed: 37032245
DOI: 10.1016/j.jht.2022.12.004 -
Prosthetics and Orthotics International Apr 2020Orthotic and prosthetic residency preceptors have little guidance transitioning residents between observing and performing patient care. Understanding current...
BACKGROUND
Orthotic and prosthetic residency preceptors have little guidance transitioning residents between observing and performing patient care. Understanding current entrustment trends and factors can help guide resident progression during residency.
OBJECTIVES
To identify entrustment trends and factors within an orthotics and prosthetics residency affecting a supervisor's decision to entrust residents with independent patient care.
STUDY DESIGN
Cross-sectional study.
METHODS
In this cross-sectional study, 831 National Commission of Orthotic and Prosthetic Education preceptors were invited to complete a 26-question, online questionnaire that examined possible entrustment factors.
RESULTS
A total of 77 preceptors completed the questionnaire. The top-reported behavioral qualities impacting entrustment were recognition of limitations and willingness to ask for help ( = 45) and competence ( = 37). Preceptors ranked evaluation ( = 27) as the professional skill which most affected entrustability; technical skill least affected entrustability ( = 4). Preceptors of 12-month residencies entrust residents to indirect supervision when they have completed approximately 75% (i.e. 9 months) of the program. Preceptors of 18-month residencies reported that they entrust their residents by the time they reach 50% (i.e. 9 months) of their training. A small number of preceptors ( = 19) never allow a resident to independently perform practice management.
CONCLUSION
Residency supervisors value interpersonal and evaluation skills when making entrustment decisions. Residency mentors can use these findings to inform their entrustment decisions and support a resident's progression toward independent practice.
CLINICAL RELEVANCE
This study presents information which can inform clinical preceptors and residents on what factors contribute to the decision to progress a resident from observation to independent patient care. These findings may influence clinical education standards which aim to promote both resident training and patient access to quality care.
Topics: Adult; Aged; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Female; Humans; Internship and Residency; Male; Middle Aged; Orthotic Devices; Prostheses and Implants; Surveys and Questionnaires; Trust
PubMed: 32133918
DOI: 10.1177/0309364620909236 -
Disability and Rehabilitation.... Jan 2020Approximately 1.5% of the world's population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the... (Review)
Review
Approximately 1.5% of the world's population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development. Fourteen databases were searched from 1995-2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies. The searches resulted in a total of 28,958 articles, a focus on studies with the words "randomized" OR "randomized" OR "cost" OR "economic" in their citation reduced this total to 2644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. A total of 346 randomized controlled trials were identified, with only four randomized controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures. While various international organizations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments.Implications for rehabilitationResearch into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations.Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research.This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.
Topics: Cost-Benefit Analysis; Disabled Persons; Humans; Orthotic Devices; Prostheses and Implants; Randomized Controlled Trials as Topic
PubMed: 30652522
DOI: 10.1080/17483107.2018.1523953 -
Prosthetics and Orthotics International Oct 2023Carbon fiber is increasingly being used in ankle-foot orthoses (AFOs). Orthotic devices and carbon fiber-containing devices have been shown to reduce pain and improve...
BACKGROUND
Carbon fiber is increasingly being used in ankle-foot orthoses (AFOs). Orthotic devices and carbon fiber-containing devices have been shown to reduce pain and improve function in multiple patient populations. Although the number of publications and interest in carbon fiber AFOs is growing, a systematic evaluation of their effects is lacking.
OBJECTIVES
To characterize the effects of carbon fiber AFOs in impaired individuals.
STUDY DESIGN
Qualitative systematic review.
METHODS
Systematic searches in PubMed, Embase, CINAHL, and Cochrane Library were completed in July 2020. The results were deduplicated, screened, and assessed for quality by independent reviewers. Articles were excluded if they had nonhuman subjects, only healthy subjects, or included active control systems, motors, or other power sources.
RESULTS
Seventy-eight articles were included in the qualitative synthesis. Most articles were of low to moderate methodological quality. Five commonly used devices were identified: the Intrepid Dynamic Exoskeletal Orthosis, ToeOff, WalkOn, Neuro Swing, and Chignon. The devices have unique designs and are associated with specific populations. The Intrepid Dynamic Exoskeletal Orthosis was used in individuals with lower-limb trauma, the Neuro Swing and ToeOff in individuals with neurological disorders, the Chignon in individuals with hemiplegia and stroke, and the WalkOn in people with hemiplegia and cerebral palsy. Each device produced favorable outcomes in their respective populations of interest, such as increased walking speed, reduced pain, or improved balance.
CONCLUSIONS
The mechanical characteristics and designs of carbon fiber AFOs improve outcomes in the populations in which they are most studied. Future literature should diligently report patient population, device used, and fitting procedures.
Topics: Humans; Foot Orthoses; Ankle; Carbon Fiber; Hemiplegia; Walking Speed; Gait
PubMed: 36779973
DOI: 10.1097/PXR.0000000000000217 -
Disability and Rehabilitation Sep 2022The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and...
PURPOSE
The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and understand their insights for the future.
MATERIALS AND METHODS
A narrative exploration study design, employing a phenomenological approach was used. Semi-structured interviews were conducted with three female and two male prosthetic and orthotic users from Australia and the United Kingdom. Interviews were analysed, coded and key themes and sub-themes identified.
RESULTS
Three themes were identified. The Maximising Opportunity theme linked sub-themes of recreation and pushing boundaries. The Health Care Network theme included sub-themes of communication, peer support and building a team. The final theme, Changes over time, included sub-themes of disability perception, advice and advancements over time.
CONCLUSION
Prosthetic and orthotic users identified that there had been vast changes in disability perception, disability rights, and their role in the health care system, along with the variety of technology and materials available. Key findings were that prosthetic and orthotic users want to be listened to, considered central to the health care team, and had a deep understanding of their own health care needs.Implications for rehabilitationProsthesis and orthosis users want to be listened to and considered central within the health care team.Attending medical and allied health teams must recognise that prosthesis and orthosis users have a fundamental understanding of their own health care needs.Themes, whilst potentially generalisable, are derived from specific individuals and may particularly relate to these individuals.
Topics: Artificial Limbs; Australia; Delivery of Health Care; Disabled Persons; Female; Humans; Male; Orthotic Devices; Qualitative Research
PubMed: 34088248
DOI: 10.1080/09638288.2021.1928777 -
American Journal of Physical Medicine &... Oct 2021The aim of this study was to explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and...
OBJECTIVE
The aim of this study was to explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and used by individuals with spinal cord injury (SCI) from a developing country.
DESIGN
This was a cross-sectional study.
PARTICIPANTS
A total of 163 participants with SCI from several rural communities in a developing country participated in the study from June 2018 to August 2019.
METHODS
The participants were interviewed and assessed for their SCI characteristics and the external devices (i.e., mobility devices, ambulatory aides, and orthotics) they possessed and used in their daily living.
RESULTS
Most participants (85%), who lived in rural communities with a family income of less than $3167 per year, possessed external devices (one to five types), and 80% of all participants actually used the devices (one to three types) in their daily living. Most participants with motor-complete SCI used a single device, especially a manual wheelchair, whereas those with mild lesion severity used multiple devices for their daily activities, particularly a standard walker.
CONCLUSION
Owing to budget and environmental constraints, the external devices used by individuals with SCI from a developing country are different from those reported in a developed country. The findings provide particular insights into the management of external devices for these individuals of a developing country.
Topics: Adult; Cross-Sectional Studies; Developing Countries; Humans; Middle Aged; Orthotic Devices; Self-Help Devices; Spinal Cord Injuries
PubMed: 33394593
DOI: 10.1097/PHM.0000000000001676 -
Soft Robotics Apr 2022This work demonstrates the first 3D printed wearable motor-sensory module prototype designed for facial rehabilitation, focusing on facial paralysis. The novelty of the...
This work demonstrates the first 3D printed wearable motor-sensory module prototype designed for facial rehabilitation, focusing on facial paralysis. The novelty of the work lies in the fast fabrication of the first fully soft working prototype, including feedback control, with a focus on the methodology for individual customization. Facial paralysis results from a variety of conditions, and more wearable and modular technologies are needed to address the complexity of facial movement rehabilitation. Smiling muscles are especially important for both expression and eating, and so this work focuses on this motion as an example of how the module can be applied to mimic and support needed muscle movement. A generalized actuator-sensor pair with a feedback control system is created to translate signals from smiling on the healthy side of the face (notably temporal and zygomatic branch) to actuation on the paralyzed side of the face for augmented physiotherapy. Fabric and a sensor fluid are integrated during the silicone printing process to create a multicomponent wearable that is ready to use with minimal postprocessing. The actuators' force and vertical contraction results under a 0.98 and 1.96 N load meet the 1-7 N requirements needed for smiling. It is a challenge to measure soft surface-based force and contraction ratio consistently; therefore, a novel modular surface is designed to simulate the interaction of skin and bone using 3D printed hard plastic (bone) and a silicone sheet (skin). The actuator is tested on top of four different repeatable and standardized surface morphologies, and results reveal that the actuator force application will vary based on topography and hardness of the facial surface. Demonstration of the complete system on the face while collecting sensor and pressure data serves as a proof-of-concept and motivates potential applications in rapid customization of highly specialized soft wearable orthotics, prosthetics, and rehabilitation devices. This unique actuator-sensor combination can have additional applications for wearables due to the (1) customizability, (2) closed-loop control, and (3) unique "grounding" test platform.
Topics: Facial Paralysis; Humans; Orthotic Devices; Printing, Three-Dimensional; Silicones; Textiles
PubMed: 34191624
DOI: 10.1089/soro.2020.0010 -
Disability and Rehabilitation Apr 2020To evaluate the access to human rights of persons with disabilities who use prosthetic and orthotic assistive devices, and to compare groups of participants in terms of...
To evaluate the access to human rights of persons with disabilities who use prosthetic and orthotic assistive devices, and to compare groups of participants in terms of gender, residential area, income, and type and level of assistive device. The addressed areas were rights to: health, a standard of living adequate for health, education, marry and establish a family, vote, and work. Questionnaires were used to collect self-reported data from 139 lower-limb prosthetic and orthotic users in Sierra Leone. About half of the participants considered their overall physical health good, while 37% said their mental health was bad. Most said they lacked access to medical care. About half of the participants had regular access to safe drinking water. Most had reasonable housing and 60% could read and write. Half of the participants were married and 70% had children. Almost all reported that they could vote if desired and about half were working. There is still a need for improved access to medical care when needed for persons with lower limb physical disability in Sierra Leone. Better access to food and clean water are also necessary to facilitate a standard of living adequate for health, to realize the health rights of persons with disabilities.Implications for rehabilitationIn Sierra Leone, persons with disabilities need a source of regular income to access basic needs, including clean water, access to food, medical care, and medications which should be considered in addition to providing rehabilitation services.To facilitate implementation of the Convention on the Rights of Persons with Disabilities, Sierra Leone's health system needs to be strengthened: an increased number of healthcare staff should be educated, knowledge of disability should be improved in the general public to reduce negative attitudes toward persons with disabilities, persons with disabilities should be included in mainstream health services, and national development policies should target sustainable development goals to a greater extent than during the millennium development goal era.
Topics: Child; Disabled Persons; Health Services Accessibility; Human Rights; Humans; Orthotic Devices; Self-Help Devices; Sierra Leone
PubMed: 30616394
DOI: 10.1080/09638288.2018.1515267 -
The American Journal of Sports Medicine May 2022Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural...
BACKGROUND
Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural features of the foot may increase fracture risk in some individuals, emphasizing the need for intervention strategies to prevent fracture. Although orthotic devices have shown promise in reducing fractures of the fifth metatarsal bone, the effect of orthosis on fifth metatarsal strains is not well understood.
PURPOSE
To quantify the effects of different foot orthotic constructs on principal tensile strains in the proximal fifth metatarsal bone during cadaveric simulations of level walking. An additional purpose was to investigate the relationships between structural features of the foot and corresponding strains on the fifth metatarsal bone during level walking.
STUDY DESIGN
Controlled laboratory study.
METHODS
A total of 10 midtibial cadaveric specimens were attached to a 6 degrees of freedom robotic gait simulator. Strain gauges were placed at the metaphyseal-diaphyseal junction (zone II) and the proximal diaphysis (zone III) during level walking simulations using 11 different foot orthotic configurations. Images of each specimen were used to measure structural features of the foot in an axially loaded position. The peak tensile strains were measured and reported relative to the sneaker-only condition for each orthotic condition and orthotic-specific association between structural features and principal strains of both zones.
RESULTS
In total, 2 of the 11 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone II. Further, 6 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone III. Increased zone II principal strain incurred during level walking in the sneaker-only condition showed a significant association with increases in the Meary's angle. Changes in zone III principal strain relative to the sneaker-only condition were significantly associated with increases in the Meary's angle and fourth-fifth intermetatarsal angle.
CONCLUSION
The use of orthotic devices reduced principal strain relative to the condition of a sneaker without any orthosis in zone II and zone III. The ability to reduce strain relative to the sneaker-only condition in zone III was indicated by increasing values of the Meary's angle and levels of the fourth-fifth intermetatarsal angle.
CLINICAL RELEVANCE
Clinicians can use characteristics of foot structure to determine the proper foot orthosis to potentially reduce stress fracture risk in high-risk individuals.
Topics: Cadaver; Fractures, Bone; Fractures, Stress; Humans; Metatarsal Bones; Orthotic Devices; Walking
PubMed: 35302902
DOI: 10.1177/03635465221079652 -
The Surgical Clinics of North America Aug 2020Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for... (Review)
Review
Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.
Topics: Ankle Injuries; Ankle Joint; Braces; Chronic Disease; Debridement; Equipment Design; Foot; Foot Injuries; Humans; Orthotic Devices; Osteomyelitis; Soft Tissue Injuries; Surgical Flaps; Tendinopathy; Wound Healing; Wounds and Injuries
PubMed: 32681871
DOI: 10.1016/j.suc.2020.05.003