Search Results (28)

Background: Elastic ankle straps are frequently used to improve ankle stability; however, they often fail to provide adequate support due to material limitations. Therefore, this study aimed to investigate the effects of an ankle stabilization strap applied using a bandaging technique on ankle range of motion, balance, and spatiotemporal gait parameters in patients with chronic stroke. Methods: Twenty-eight patients with chronic stroke were randomly assigned to either an ankle stabilization strap with bandaging technique (ASB, n = 14) group or an ankle–foot orthosis (AFO, n = 14) group. Both groups participated in treadmill gait training for 10 min per day, five days per week, for four weeks. Outcome measures included ankle dorsiflexion range of motion, total center of pressure displacement, timed up and go test, gait speed, and step length. A mixed-design analysis of variance was used for statistical analysis. Results: All outcome variables showed significant group-by-time interaction effects, and the ASB group exhibited significant within-group improvements after the intervention (p < 0.05). Conclusions: The ankle stabilization strap applied using a bandaging technique effectively improved ankle mobility, balance, and gait in patients with chronic stroke, suggesting its potential as a useful intervention in stroke rehabilitation. Full article

Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness for mitigating the risk of ankle sprains due to excessive subtalar inversion during high-impact activities, such as landing from a free fall. Methods: We employed biomechanical simulations to assess the influence of translational stiffness on subtalar inversion control, given that inversion angles exceeding 25 degrees are strongly correlated with injury risk. Simulations were conducted using a musculoskeletal model with and without a passive AFO; the stiffness varied in three anatomical directions. A Design of Experiments (DoE) approach was utilized to capture nonlinear interactions among stiffness parameters. Results: The results indicated that increased translational stiffness significantly reduced inversion angles to safer levels, though direction–dependent effects were noted. Based on these insights, we developed a 4D visualization tool that integrates simulation data with an interactive color–coded interface to depict ”safe design” zones for various AFO stiffness configurations. This tool supports clinicians in selecting stiffness values that optimize both safety and functional performance. Conclusions: The proposed framework enhances clinical decision-making and engineering processes by enabling more accurate and individualized AFO designs. Full article

Background/Objectives: This study focuses on the motion planning and control of an active ankle–foot orthosis (AFO) that leverages biomechanical insights to mitigate footdrop, a deficit that prevents safe toe clearance during walking. Methods: To adapt the motion of the device to the user’s walking speed, a geometric model was used, together with real-time measurement of the user’s gait cycle. A geometric speed-adaptive model also scales a trapezoidal ankle-velocity profile in real time using the detected gait cycle. The algorithm was tested at three different walking speeds, with a prototype of the AFO worn by a test subject. Results: At walking speeds of 0.44 and 0.61 m/s, reduced tibialis anterior (TA) muscle activity was confirmed by electromyography (EMG) signal measurement during the stance phase of assisted gait. When the AFO was in assistance mode after toe-off (initial and mid-swing phase), it provided an average of 48% of the estimated required power to make up for the deliberate inactivity of the TA muscle. Conclusions: Kinematic analysis of the motion capture data showed that sufficient foot clearance was achieved at all three speeds of the test. No adverse effects or discomfort were reported during the experiment. Future studies should examine the device in populations with footdrop and include a comprehensive evaluation of safety. Full article

Background/Objectives: “Hermes” is an ankle–foot orthosis (AFO) with negative stiffness designed to mechanically compensate the symptomatic increase in plantarflexion (PF) torque (i.e., ankle joint torque resistance to dorsiflexion, DF) in patients with spastic paresis. Methods: The effectiveness of “Hermes” was evaluated in twelve patients with chronic unilateral spastic paresis after stroke. Using a robotic ankle manipulator, stiffness at the ankle joint was assessed across three conditions: ankle without Hermes ($A$), ankle with Hermes applying no torque compensation ($A+H_{0\mathrm{\%}}$), and ankle with Hermes tuned to compensate 100% of the patients’ ankle joint stiffness ($A+H_{100\mathrm{\%}}$). Results: A significant reduction in PF torque was found with Hermes applying compensation ($A+H_{100\mathrm{\%}}$) compared to the conditions without Hermes ($A$) and with Hermes applying no compensation ($A+H_{0\mathrm{\%}}$). Furthermore, a significant reduction in positive dorsiflexion work was found with Hermes applying compensation ($A+H_{100\mathrm{\%}}$) compared to the condition with Hermes applying no compensation ($A+H_{0\mathrm{\%}}$). Hermes did not significantly contribute to additional PF torque or positive work when applying no compensation ($A+H_{0\mathrm{\%}}$). Conclusions: The reductions in PF torque achieved with Hermes are comparable to those seen with repeated ankle stretching programs and ankle robot training. Thus, Hermes is expected to assist voluntary dorsiflexion and improve walking in patients with spastic paresis. Full article

Many stroke patients develop ankle deformities due to neurological or non-neurological factors, resulting in abnormal gait patterns. While Ankle-Foot Orthoses (AFOs) are commonly used to address these issues, few are specifically designed for ankle varus. The Elastic Neutral Ankle-Foot Orthosis (EN-AFO) was developed for this purpose. This study aimed to analyze changes in kinematic and kinetic gait data in stroke patients with ankle varus, comparing those walking with and without EN-AFO in both AFO and No-AFO groups. Initially, 30 stroke patients with ankle varus were screened; after exclusions, 17 were included in the final analysis. In the No-AFO group, EN-AFO significantly improved maximal ankle inversion on the affected side during the swing phase (from 4.63 ± 13.26 to 10.56 ± 11.40, p = 0.025). Similarly, in the AFO group, EN-AFO led to a significant improvement in maximal ankle inversion on the less-affected side during the swing phase (from 7.95 ± 10.11 to 12.01 ± 8.64, p = 0.021). Additionally, ground reaction forces on the affected side of the AFO group significantly increased at both the forefoot (from 182.76 ± 61.45 to 211.55 ± 70.57, p = 0.038) and hindfoot (from 210.67 ± 107.88 to 231.85 ± 105.38, p = 0.038) with EN-AFO. Conversely, maximal and minimal thoracic axial rotation on the affected side improved significantly in the No-AFO group compared to the AFO group with EN-AFO, during both the stance and swing phases (stance phase: max improvement from −1.13 ± 1.80 to 4.83 ± 8.05, min improvement from −1.06 ± 2.45 to 5.89 ± 7.56; swing phase: max improvement from −1.33 ± 2.13 to 5.49 ± 7.82, min improvement from −1.24 ± 2.43 to 5.95 ± 7.12; max p = 0.034, min p = 0.016 during stance; max p = 0.027, min p = 0.012 during swing). Furthermore, both maximal and minimal thoracic axial rotation on the less-affected side during the swing phase improved significantly in the No-AFO group (max improvement from −2.09 ± 4.18 to 6.04 ± 6.90, min improvement from −0.47 ± 2.13 to 8.18 ± 10.45; max p = 0.027, min p = 0.012) compared with the AFO group. These findings suggest that EN-AFO may effectively improve gait in stroke patients with ankle varus in the No-AFO group. Full article

Background/Objectives: This paper proposes a method for managing gait imbalances by integrating the Internet of Things (IoT) and machine learning technologies. Ankle–foot orthosis (AFO) devices are crucial medical braces that align the lower leg, ankle, and foot, offering essential support for individuals with gait imbalances by assisting weak or paralyzed muscles. This research aims to revolutionize medical orthotics through IoT and machine learning, providing a sophisticated solution for managing gait issues and enhancing patient care with personalized, data-driven insights. Methods: The smart ankle–foot orthosis (AFO) is equipped with a surface electromyography (sEMG) sensor to measure muscle activity and an Inertial Measurement Unit (IMU) sensor to monitor gait movements. Data from these sensors are transmitted to the cloud via fog computing for analysis, aiming to identify distinct walking phases, whether normal or aberrant. This involves preprocessing the data and analyzing it using various machine learning methods, such as Random Forest, Decision Tree, Support Vector Machine (SVM), Artificial Neural Network (ANN), Long Short-Term Memory (LSTM), and Transformer models. Results: The Transformer model demonstrates exceptional performance in classifying walking phases based on sensor data, achieving an accuracy of 98.97%. With this preprocessed data, the model can accurately predict and measure improvements in patients’ walking patterns, highlighting its effectiveness in distinguishing between normal and aberrant phases during gait analysis. Conclusions: These predictive capabilities enable tailored recommendations regarding the duration and intensity of ankle–foot orthosis (AFO) usage based on individual recovery needs. The analysis results are sent to the physician’s device for validation and regular monitoring. Upon approval, the comprehensive report is made accessible to the patient, ensuring continuous progress tracking and timely adjustments to the treatment plan. Full article

Conventional passive ankle foot orthoses (AFOs) have not seen substantial advances or functional improvements for decades, failing to meet the demands of many stakeholders, especially the pediatric population with neurological disorders. Our objective is to develop the first comfortable and unobtrusive powered AFO for children with cerebral palsy (CP), the DE-AFO. CP is the most diagnosed neuromotor disorder in the pediatric population. The standard of care for ankle control dysfunction associated with CP, however, is an unmechanized, bulky, and uncomfortable L-shaped conventional AFO. These passive orthoses constrain the ankle’s motion and often cause muscle disuse atrophy, skin damage, and adverse neural adaptations. While powered orthoses could enhance natural ankle motion, their reliance on bulky, noisy, and rigid actuators like DC motors limits their acceptability. Our innovation, the DE-AFO, emerged from insights gathered during customer discovery interviews with 185 stakeholders within the AFO ecosystem as part of the NSF I-Corps program. The DE-AFO is a biomimetic robot that employs artificial muscles made from an electro-active polymer called dielectric elastomers (DEs) to assist ankle movements in the sagittal planes. It incorporates a gait phase detection controller to synchronize the artificial muscles with natural gait cycles, mimicking the function of natural ankle muscles. This device is the first of its kind to utilize lightweight, compact, soft, and silent artificial muscles that contract longitudinally, addressing traditional actuated AFOs’ limitations by enhancing the orthosis’s natural feel, comfort, and acceptability. In this paper, we outline our design approach and describe the three main components of the DE-AFO: the artificial muscle technology, the finite state machine (the gait phase detection system), and its mechanical structure. To verify the feasibility of our design, we theoretically calculated if DE-AFO can provide the necessary ankle moment assistance for children with CP—aligning with moments observed in typically developing children. To this end, we calculated the ankle moment deficit in a child with CP when compared with the normative moment of seven typically developing children. Our results demonstrated that the DE-AFO can provide meaningful ankle moment assistance, providing up to 69% and 100% of the required assistive force during the pre-swing phase and swing period of gait, respectively. Full article

Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6–11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill −5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy. Full article

Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle–foot orthosis (AFO) and knee–ankle–foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains. Full article

Ankle–foot orthoses (AFOs) constitute medical instruments designed for patients exhibiting pathological gait patterns, notably stemming from conditions such as stroke, with the primary objective of providing support and facilitating rehabilitation. The present research endeavors to conduct a comprehensive review of extant scholarly literature focusing on mathematical techniques employed for the examination of AFO models. The overarching aim is to gain deeper insights into the biomechanical intricacies underlying these ankle–foot orthosis models from a mathematical perspective, while concurrently aiming to advance novel models within the domain. Utilizing a specified set of keywords and their configurations, a systematic search was conducted across notable academic databases, including ISI Web of Knowledge, Google Scholar, Scopus, and PubMed. Subsequently, a total of 23 articles were meticulously selected for in-depth review. These scholarly contributions collectively shed light on the utilization of nonlinear optimization techniques within the context of ankle–foot orthoses (AFOs), specifically within the framework of fully Cartesian coordinates, encompassing both kinematic and dynamic dimensions. Furthermore, an exploration of a two-degree-of-freedom AFO design tailored for robotic rehabilitation, which takes into account the interplay between foot and orthosis models, is delineated. Notably, the review article underscores the incorporation of shape memory alloy (SMA) elements in AFOs and overviews the constitutive elastic, viscoelastic, and hyperelastic models. This comprehensive synthesis of research findings stands to provide valuable insights for orthotists and engineers, enabling them to gain a mathematical understanding of the biomechanical principles underpinning AFO models and fostering the development of innovative AFO designs. Full article

Background: Clubfoot is a congenital deformity that can affect one or both of a newborn’s lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot. Full article

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. Full article

Hemiplegia is a form of disability that affects one side of the body and has a prevalence of 0.5–0.7 per 1000 live births. It has consequences not only at the medical level but also on psychological, cognitive, and social aspects, and it prevents children from social participation, especially in sports settings. The studies demonstrating the social impact of sports on the hemiplegic population and, in particular, children, are limited. In addition, previous evaluations of healthcare sports initiatives in the hemiplegic population are not available, and traditional methods of evaluation, which are mostly focused on economic outcomes, are not applicable. Thus, this article employs the social return on investment (SROI) methodology, which is able to determine the socio-economic impacts of an initiative, to evaluate the impact of an innovative ankle–foot orthosis (AFO) for hemiplegic children that was created to promote the possibility of “sports for all”. The model was designed with the involvement of stakeholders in all the phases and with mixed methods to assess the input, outcomes, and impact indicators. The final SROI, computed for a time horizon of three years and with a focus on the Lombardy Region, was equal to 3.265:1. Based on this result, the initiative turned out to be worthy of investment. Full article

This study aims to evaluate the immediate effect of a robotic ankle–foot orthosis developed in previous studies on a foot drop patient. The difference with previous research on AFO evaluation is that this research used a setting based on the patient’s request. The robotic AFO locked the foot position on zero radians during the foot flat until the push-off but generates dorsiflexion with a constant velocity in the swing phase to clear the foot drop. A kinematic and spatiotemporal parameter was observed using the sensors available on the robotic AFO. The robotic successfully assisted the foot drop (positive ankle position of 21.77 degrees during the swing phase and initial contact) with good repeatability (σ² = 0.001). An interview has also conducted to investigate the qualitative response of the patient. The interview result reveals not only the usefulness of the robotic AFO in assisting the foot drop but also some improvement notes for future studies. For instance, the necessary improvement of weight and balance and employing ankle velocity references for controlling the walking gait throughout the whole gait cycle. Full article

Many studies focus on the torque-to-dimension ratio when designing magnetorheological brakes (MRB), especially for ankle foot orthosis (AFO) devices. Vane MRB is one type of MRB with a limited angle of motion that is naturally suitable to be applied to AFO. However, very few implement quality function deployment (QFD) when making MRB, whereas QFD is an essential factor in making product designs. In this study, a tiny vane-type MR brake (TVMRB) was successfully made using the QFD method. Torque characteristics are determined by analysis of magnetic flux density, theoretically, by 3D simulation, and by using Ansys Maxwell experimentally. For consideration, the analysis was carried out with fluid gap variations (0.5 mm, 0.75 mm, and 1 mm) and current variations (0.5–2 A with 0.5 A increments). As a result, ignoring the leakage of MR fluid (MRF), at a constant rotation of 10 rpm, the smallest torque of 6.14 Nm was obtained at the fluid gap variation of 1 mm and input current of 0.5 A, whereas the largest torque was 46.71 Nm at the fluid gap variation of 0.5 mm and input current of 2 A. Apart from torque, this article will also discuss other brake performances in the form of operational range and power consumption. Finally, the structure of the TVMRB design is compared with other designs presented in the House of Quality (HOQ). Full article