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Sensors (Basel, Switzerland) Dec 2023Lower limb exoskeletons and orthoses have been increasingly used to assist the user during gait rehabilitation through torque transmission and motor stability. However,...
Lower limb exoskeletons and orthoses have been increasingly used to assist the user during gait rehabilitation through torque transmission and motor stability. However, the physical human-robot interface (HRi) has not been properly addressed. Current orthoses lead to spurious forces at the HRi that cause adverse effects and high abandonment rates. This study aims to assess and compare, in a holistic approach, human-robot joint misalignment and gait kinematics in three fixation designs of ankle-foot orthoses (AFOs). These are AFOs with a frontal shin guard (F-AFO), lateral shin guard (L-AFO), and the ankle modulus of the H2 exoskeleton (H2-AFO). An experimental protocol was implemented to assess misalignment, fixation displacement, pressure interactions, user-perceived comfort, and gait kinematics during walking with the three AFOs. The F-AFO showed reduced vertical misalignment (peak of 1.37 ± 0.90 cm, -value < 0.05), interactions (median pressures of 0.39-3.12 kPa), and higher user-perceived comfort (-value < 0.05) when compared to H2-AFO (peak misalignment of 2.95 ± 0.64 and pressures ranging from 3.19 to 19.78 kPa). F-AFO also improves the L-AFO in pressure (median pressures ranging from 8.64 to 10.83 kPa) and comfort (-value < 0.05). All AFOs significantly modified hip joint angle regarding control gait (-value < 0.01), while the H2-AFO also affected knee joint angle (-value < 0.01) and gait spatiotemporal parameters (-value < 0.05). Overall, findings indicate that an AFO with a frontal shin guard and a sports shoe is effective at reducing misalignment and pressure at the HRI, increasing comfort with slight changes in gait kinematics.
Topics: Humans; Biomechanical Phenomena; Ankle; Foot Orthoses; Robotics; Gait
PubMed: 38203110
DOI: 10.3390/s24010246 -
Human Resources For Health Jan 2024Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always...
BACKGROUND
Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision.
METHODS
To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022.
RESULTS
The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they "definitely" planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation's (WHO) recommendation.
CONCLUSIONS
The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.
Topics: Humans; Medicine; Allied Health Personnel; England; Health Facilities; Workforce
PubMed: 38191415
DOI: 10.1186/s12960-023-00882-w -
BMC Oral Health Jan 2024Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including...
BACKGROUND
Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism.
METHODS
The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically.
RESULTS
Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually.
CONCLUSIONS
This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.
Topics: Humans; Occlusal Splints; Sleep Bruxism; Sleep
PubMed: 38182999
DOI: 10.1186/s12903-023-03782-6 -
Sleep & Breathing = Schlaf & Atmung Jun 2024The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients... (Meta-Analysis)
Meta-Analysis
UNLABELLED
The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day.
MATERIALS AND METHOD
A systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model.
RESULTS
MAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I = 75%; z = - 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at - 0.06 (- 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I = 84%%; z = - 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of - 0.99 (- 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001).
CONCLUSIONS
Only systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.
Topics: Humans; Blood Pressure; Circadian Rhythm; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive
PubMed: 38180683
DOI: 10.1007/s11325-023-02984-0 -
Diabetes Research and Clinical Practice Jan 2024Rocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to...
INTRODUCTION
Rocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to inconsistent effectiveness. If foot structure changes over time, high PP-locations also change. To address this, individualized algorithm based 3D-printed rockers and self-adjusting pressure-reducing insoles are applied.
METHODS
PP across seven foot regions was analyzed in 21 persons with DM and LOPS. Regions with PP < 200 kPa were considered not at risk (RnoR); regions with PP ≥ 200 kPa at risk (RaR). The aim was to offload RaR, while remaining PP < 200 kPa in RnoR.
RESULTS
Individualized rockers and self-adjusting insoles combined successfully reduce PP < 200 kPa (on average 24 % - 48 %) in all feet with toes, central and lateral forefoot identified as RaR. Same intervention reduces PP in 68 % of the feet with medial forefoot identified as RaR. With the heel as RaR, no intervention reduces PP successfully in all feet.
CONCLUSIONS
Individualized 3D-printed rockers combined with self-adjusting insoles reduce PP (< 200 kPa) in toes, central and lateral forefoot, but not in heels. Alternative insoles with medial arch support, heel cup and compliant midsole materials might enhance success rate across entire foot.
Topics: Humans; Shoes; Equipment Design; Diabetes Mellitus; Foot; Foot Orthoses; Sensation; Walking
PubMed: 38154536
DOI: 10.1016/j.diabres.2023.111077 -
Scientific Reports Dec 2023Plantar taping has been used in clinical settings as a short-term conservative treatment for plantar heel pain and related pathologies. The rise of at-home taping... (Randomized Controlled Trial)
Randomized Controlled Trial
Plantar taping has been used in clinical settings as a short-term conservative treatment for plantar heel pain and related pathologies. The rise of at-home taping methods may offer patients more independence, but effectiveness has not been established. The purpose of this study was to evaluate the effects of plantar taping on foot mechanics during gait. We hypothesized that material compliance would drive mechanical effectiveness, with longitudinally inelastic tape reducing medial longitudinal arch (MLA) motion and anterior/posterior (A/P) plantar tissue spreading forces, and laterally inelastic tape reducing medial/lateral (M/L) tissue spreading. We also hypothesized that these effects would be influenced by foot structure. Fifteen healthy participants were tested in a randomized cross-over study design. Barefoot (BF) plus four taping methods were evaluated, including two inelastic tapes (Low-Dye, LD, and FasciaDerm, FD) along with longitudinally elastic kinesiology tape (KT) and a novel laterally elastic kinesiology tape (FAST, FS). Participants' arch height and flexibility were measured followed by instrumented gait analysis with a multi-segment foot model. Ankle eversion and MLA drop/rise were calculated from rearfoot and forefoot reference frames, while plantar tissue spreading was calculated from shear stresses. ANOVAs with Holm pairwise tests evaluated tape effects while correlations connected arch structure and taping effectiveness (α = 0.05). The three longitudinally inelastic tapes (LD, FD, FS) reduced MLA drop by 11-15% compared with KT and BF. In late stance, these tapes also inhibited MLA rise (LD by 29%, FD and FS by 10-15%). FS and FD reduced A/P spreading forces, while FD reduced M/L spreading forces compared with all other conditions. Arch height had a moderately strong correlation (r = -0.67) with the difference in MLA drop between BF and FS. At-home plantar taping can affect the mechanical function of the foot, but tape elasticity direction matters. Longitudinally elastic kinesiology tape has little effect on mechanics, while inelastic tapes control MLA drop but also restrict MLA rise in late stance. Lateral elasticity does not limit tissue spreading and may increase comfort without sacrificing MLA control. At-home taping has the potential to broaden conservative treatment of plantar heel pain, flat foot deformity, and related pathologies, but additional studies are needed to connect mechanics with symptom relief.
Topics: Humans; Athletic Tape; Elasticity; Foot; Gait; Pain; Cross-Over Studies
PubMed: 38129639
DOI: 10.1038/s41598-023-50169-2 -
The Journal of Knee Surgery Jul 2024It is unclear if bracing is necessary after isolated medial patellofemoral ligament reconstruction (MPFLr) for recurrent patellar instability. We hypothesize that...
It is unclear if bracing is necessary after isolated medial patellofemoral ligament reconstruction (MPFLr) for recurrent patellar instability. We hypothesize that patients who did not use a brace will have similar outcomes to those who were braced postoperatively. A retrospective review of patients who underwent isolated MPFLr from January 2015 to September 2020 at a single institution was performed. Those with less than 6 weeks of follow-up were excluded. The braced group was provided a hinged-knee brace postoperatively until the return of quadriceps function, which was determined by the treating physical therapist (brace, "B"; no brace, "NB"). Time to straight leg raise (SLR) without lag, recurrent instability, and total re-operations were determined. Univariate analysis and logistic regression were used to evaluate outcomes (statistical significance, < 0.05). Overall, 229 isolated MPFLr were included (B: 165 knees, 146 patients; NB: 64 knees, 58 patients). Baseline demographics were similar (all > 0.05). Median time to SLR without lag was shorter in the NB group (41 days [interquartile range [IQR]: 20-47] vs. 44 days [IQR: 35.5-88.3], = 0.01), while return to sport times were equivalent (B: 155 days [IQR: 127.3-193.8] vs. NB: 145 days [IQR: 124-162], = 0.31). Recurrent instability rates were not significantly different (B: 12 knees [7.27%] vs. NB: 1 knee [1.56%], = 0.09), but the re-operation rate was higher in the brace group (20 knees [12.1%] vs. 0 [0%], = 0.001). Regression analysis identified brace use (odds ratio [OR]: 19.63, 95% confidence interval [CI]: 1.43-269.40, = 0.026) and female patients (OR: 2.79, 95% CI: 1.01-7.34, = 0.049) to be associated with needing reoperation. Recurrent instability rates and return to sport times were similar between patients who did or did not use a hinged knee brace after isolated MPFLr. Re-operation rates were higher in the braced group. Retrospective Comparative Study, Level III.
Topics: Humans; Braces; Retrospective Studies; Female; Male; Joint Instability; Adult; Patellofemoral Joint; Young Adult; Adolescent; Postoperative Care; Recurrence; Plastic Surgery Procedures
PubMed: 38113911
DOI: 10.1055/a-2232-4856 -
Scientific Reports Dec 2023Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the... (Randomized Controlled Trial)
Randomized Controlled Trial
Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial.
Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen's d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen's d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen's d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann-Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.
Topics: Humans; Occlusal Splints; Quality of Life; Treatment Outcome; Temporomandibular Joint Disorders; Chronic Pain
PubMed: 38110552
DOI: 10.1038/s41598-023-49911-7 -
Complementary Therapies in Medicine Mar 2024Taxi drivers experience chronic neck pain owing to their posture while driving. The aim of this study was to investigate the effect of self-stretching exercises with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Taxi drivers experience chronic neck pain owing to their posture while driving. The aim of this study was to investigate the effect of self-stretching exercises with kinesio taping on pain, stress, pressure pain threshold (PPT), disability, cervical range of motion (CROM) in this population.
DESIGN
A single-blind, randomized controlled trial SETTING: Forty-three taxi drivers with nonspecific chronic nonspecific neck pain were randomly assigned to experimental (n = 22) and control (n = 21) groups.
METHODS
In the experimental group, self-stretching exercises were performed 3 times a day, 5 days per week, for 4 weeks, with kinesio taping applied while driving. In the control group, only kinesio taping was applied while driving for 4 weeks. Pain intensity, stress intensity, PPT, neck disability, and CROM were assessed pre-intervention, post-intervention, and at 4 weeks post-intervention.
RESULTS
Significant time and group interactions were observed in pain intensity at rest (p = 0.048) and while driving (p = 0.001). In the experimental group, the Pre - Post - Follow-up mean (95% CI) was 4.41 (4.14 to 4.68) - 3.82 (3.57 to 4.07) - 3.78 (3.55 to 3.99). In the control group, the Pre - Post - Follow-up mean (95% CI) was 4.29 (4.01 to 4.56) - 3.86 (3.60 to 4.11) - 4.05 (3.82 to 4.27) for pain at rest. In the experimental group, the Pre - Post - Follow-up mean (95% CI) was 4.91 (4.63 to 5.19) - 4.00 (3.76 to 4.24) - 3.69 (3.69 to 4.22), while in the control group, the Pre - Post - Follow-up mean (95% CI) was 4.81 (4.53 to 5.09) - 4.38 (4.13 to 4.63) - 4.57 (4.30 to 4.85) for pain while driving. PPT on the right (p = 0.029) and left (p < 0.001) sides, and neck disability (p = 0.001) also showed significant time and group interactions. NDI was not clinically significant based on the minimum clinically important difference. All CROM showed significant time and group interactions (flexion, p = 0.008; right lateral flexion, p = 0.009; left lateral flexion, p = 0.004; right rotation, p = 0.001; left rotation, p = 0.001), except for extension.
CONCLUSION
This study showed that self-stretching exercises with kinesio taping provided benefits over kinesio taping alone on pain intensity, PPT, disability, and CROM in taxi drivers with nonspecific chronic neck pain.
CLINICAL TRIAL REGISTRATION
This study registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) on September 22, 2020 (KCT0005406).
Topics: Humans; Neck Pain; Single-Blind Method; Athletic Tape; Exercise Therapy; Chronic Pain; Range of Motion, Articular
PubMed: 38104730
DOI: 10.1016/j.ctim.2023.103010 -
Journal of Orthopaedic Surgery and... Dec 2023To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive... (Review)
Review
OBJECTIVES
To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive effect of spinal flexibility on bracing outcomes.
METHODS
A broad literature search was performed in the PubMed, Web of Science, EMBASE, CINAHL, Scopus, and Cochrane Library databases to obtain relevant information about spinal flexibility and bracing outcomes. All literature was retrieved by October 14, 2023. The inclusion and exclusion criteria were meticulously determined. The quality of each included study and the level of evidence were evaluated by the Quality in Prognosis Studies (QUIPS) method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively.
RESULTS
After screening 1863 articles retrieved from databases, a total of 14 studies with 2261 subjects were eligible for the final analysis in this review. Overall, nine methods of flexibility assessment were identified, including supine radiographs, supine lateral bending radiographs, lateral bending radiographs but without clear positions, hanging radiographs, fulcrum bending physical method, and ultrasound imaging in the positions of supine, prone, sitting with side bending and prone with side bending. In addition, five studies demonstrated that flexibility had a strong correlation with in-brace correction, and eleven studies illustrated that spinal flexibility was a predictive factor of the bracing outcomes of initial in-brace Cobb angle, initial in-brace correction rate, curve progression, and curve regression. The results of GRADE demonstrated a moderate-evidence rating for the predictive value of spinal flexibility.
CONCLUSION
Supine radiography was the most prevalent method for measuring spinal flexibility at the pre-brace stage. Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes.
Topics: Adolescent; Humans; Braces; Prognosis; Radiography; Scoliosis; Spine
PubMed: 38082366
DOI: 10.1186/s13018-023-04430-z