- A comparison of gait with solid and hinged ankle-foot orthoses A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy "This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests."
- Comparison of a dynamic and a hinged ankle-foot orthosis Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy "We studied the effect of a dynamic ankle-foot orthosis (d-AFO) on gait in 12 hemiplegic cerebral palsy patients. Sagittal plane kinematic and kinetic data of walking with the d-AFO were compared with walking barefoot, walking in a hinged ankle-foot orthosis (h-AFO) with a plantarflexion block and normal values."
- Comparison of gait with and without AFO after lower limb surgery - (open access) Comparison of gait with and without ankle-foot orthoses after lower limb surgery in children with unilateral cerebral palsy "Purpose Children with spastic unilateral cerebral palsy (SUCP) frequently undergo lower limb surgery to improve gait. Postoperatively, ankle-foot orthoses (AFOs) are used to maintain the surgical corrections and provide adequate mechanical support. Our aim was to evaluate changes in gait and impacts of AFOs one-year postoperatively."
- Effect of foot orthoses on the kinematics and kinetics of normal walking gait "Despite their wide clinical application and success, our understanding of the biomechanical effects of foot orthoses is relatively limited. The aim of this study was to assess the effect of medially wedged and laterally wedged foot orthoses on the kinematics and joint moments of the rearfoot complex, knee, hip and pelvis and the ground reaction forces."
- Immediate effect of solid ankle foot orthosis versus ground reaction AFO Immediate effect of solid ankle foot orthosis versus ground reaction ankle foot orthosis on balance in children with spastic diplegia "Children with cerebral palsy usually demonstrate balance defect. Orthotic management may help in improving balance in these children. The aim of the study was to evaluate the immediate effect of solid ankle foot orthoses (AFOs) versus ground reaction ankle foot orthoses (GRAFOs) on balance in diplegic children."
- Impact of ankle-foot orthoses Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy "Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year postoperatively, many children are recommended continued use of ankle-foot orthoses. Our aims were to quantify the impact of ankle-foot orthoses on gait 1 year postoperatively and evaluate predictors for clinically important improvement."
- Prevalence of Balance Compromise in Commonly Treated Patient Populations "Balance compromise is frequently encountered among those patient populations commonly treated with ankle-foot orthoses. While this compromise can be measured and quantified using laboratory techniques and clinically accepted outcome measures, it also can be appreciated by considering such things as fall rates, associated injuries, balance confidence and activity limitation. The impact of these variables on the patient populations of stroke, acquired brain injury, incomplete spinal cord injury, multiple sclerosis, post-polio and peripheral neuropathy are briefly considered. An overview of the manuscripts included in the conference proceedings is presented."
- The Effect of Ankle-Foot Orthoses on Balance - A Systematic Review AAOP State-of-the-Science Evidence Report:
- A Review of the Literature Pertaining to KAFOs and HKAFOs for Ambulation "The purpose of this review is to evaluate the scientific literature regarding the clinical use of knee-ankle-foot orthoses (KAFOs) and hip-knee-ankle-foot orthoses (HKAFOs) for ambulation to establish what is known and what requires further research to optimize the application of these orthoses. A search of the literature was carried out using a number of computerized databases. Based on their abstracts, publications were included and ranked when they were written in English and evaluated some aspect of ambulation with [H]KAFOs (KAFO and HKAFO)."
- Ambulatory KAFOs: A Biomechanical Engineering Perspective "Individuals with proximal weakness of the lower extremity are often prescribed knee-ankle-foot orthoses (KAFOs), also known as long-leg braces, to compensate for severe weak-ness of the lower limb muscles. More than 1.5 million people in the United States have partial or complete paralysis of the extremities. Prevalence of paralysis increases with age (Figure 1), and it is not surprising that the mobility of individuals with neuromuscular disorders is one of the most common and complicated issues treated by rehabilitation professionals. Many of these individuals require assistive technology (AT) in the formof an orthosis to enhance mobility (Table 1). It is important to note that although there is a greater need for assistive technology as age increases (Figure 1), the use of AT actually decreases with age (Figure 2). This usage with age is due, in part, to consumer rejection of KAFO designs."
- Summary from the Academy's Seventh State-of-the-Science Conference on KAFO Summary from the Academy's Seventh State-of-the-Science Conference on Knee-Ankle-Foot Orthoses for Ambulation "This article summarizes the results from deliberations by an international multidisciplinary group of experts convened by the American Academy of Orthotists and Prosthetists to review the State-of-the-Science regarding use of custom-made knee-ankle-foot orthoses (KAFOs) to assist in ambulation. Based on a comprehensive review of peer-reviewed literature from the past decade, only four articles on this topic were identified as controlled trials, with only three investigating the use of KAFOs by clinical populations. The participants concluded that there is currently no substantive evidence at the highest level of scientific certainty regarding the use of KAFOs and hip-knee-ankle-foot orthoses (HKAFOs) for ambulation, but there are a number of core assumptions supported by expert opinion and peer-reviewed publications that can be considered clinical hypotheses about these orthoses."
- Appropriate Lower Limb Orthotics for Developing Countries ISPO/USAID/WHO Consensus Conference on Appropriate Lower Limb Orthotics for Developing Countries - Hanoi 3-8.04.2006
- Lower Extremity Telescopic Orthosis Lower Extremity Telescopic Orthosis for Immediate Fitting in Paraplegia
- A comparison of the C-Leg and the 3R60 Prosthetic Knee Joint "The C-leg is an advanced microprocessor-regulated prosthetic knee mechanism. Having a prosthetic knee that is monitored and regulated by a computer during the entire walking cycle (stance and swing phase) is thought to enhance function in a wide range of locomotion modes. It has been suggested that the C-leg improves the amputee’s ability to walk down ramps and descend stairs, and it provides stumble control (Stinus, 2000; Michael, 1999; Dietl, 1998; Zahedi et al., 1998). In this study, the C-leg is compared with the 3R60 joint, a multi-linkage passive knee joint."
- Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees "The effect of increased walking speed on temporal and loading asymmetry was investigated in highly active trans-femoral and trans-tibial amputees. With increasing walking speed, temporal gait variables reduced in duration, particularly on the prosthetic limb, while vertical ground reaction force (vGRF) increased in magnitude, particularly on the intact limb. Thus, temporal asymmetry reduced and loading asymmetry increased with walking speed. The greater force on the intact limb may reflect the method by which the amputees achieve greater temporal symmetry in order to walk fast, and could possibly account for greater instances of joint degeneration in the intact limb reported in the literature."
- Centre of pressure displacements in trans-femoral amputees during gait "The aim of this study was to describe and quantify centre of pressure (CoP) displacement during walking in 12 unilateral trans-femoral amputees who had worn a prosthesis for at least 10 years. All subjects wore the same type of prosthesis and seven healthy subjects acted as controls. The CoP was acquired by an F-scan system and the displacements along the longitudinal axis of the foot versus time were quantified."
- Gait analysis of transfemoral amputees: errors in inverse dynamics Gait analysis of transfemoral amputees: errors in inverse dynamics are substantial and depend on prosthetic design "Quantitative assessments of prostheses performances rely more and more frequently on gait analysis focusing on prosthetic knee joint forces and moments computed by inverse dynamics. However, this method is prone to errors, as demonstrated in comparison with direct measurements of these forces and moments. The magnitude of errors reported in the literature seems to vary depending on prosthetic components. Therefore, the purposes of this study were (A) to quantify and compare the magnitude of errors in knee joint forces and moments obtained with inverse dynamics and direct measurements on ten participants with transfemoral amputation during walking and (B) to investigate if these errors can be characterised for different prosthetic knees."
- Gait characteristics of persons with bilateral transtibial amputations "The gait characteristics of persons with unilateral transtibial amputations are fairly well documented in the literature. However, much less is known about the gait of persons with bilateral transtibial amputations. This study used quantitative gait analysis to investigate the gait characteristics of 19 persons with bilateral transtibial amputations. To reduce variability between subjects, we fitted all subjects with Seattle Lightfoot II feet 2 weeks before their gait analyses. The data indicated that subjects walked with symmetrical temporospatial, kinematic, and kinetic parameters."
- Hip and knee frontal plane moments in persons with unilateral, trans-tibial amputation "Persons with unilateral, lower-extremity amputation are at risk of developing osteoarthritis in their intact limb. Among persons without amputation, knee osteoarthritis disease severity has been linked to elevated frontal plane knee moments. Therefore, the purpose of this study was to examine knee and hip frontal plane moments in persons with unilateral, trans-tibial amputation. We hypothesized that knee and hip internal abduction moments are greater in the intact limb compared to the prosthetic side. Three-dimensional gait mechanics were measured bilaterally from 10 persons with unilateral, trans-tibial amputation during walking to calculate lower-extremity joint moments. The intact limb knee and hip peak internal abduction moments were 46% and 39% greater, respectively, than on the prosthetic side. The intact side knee and hip peak internal abduction moments were 17% and 6% greater, respectively, than normal. Larger moments suggest joint loading is of higher magnitude on the intact side, which may be predisposed to premature joint degeneration, particularly knee osteoarthritis."
- Kinematic and kinetic comparisons of transfemoral amputee gait Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees "The C-Leg (Otto Bock, Duderstadt, Germany) is a microprocessor-controlled prosthetic knee that may enhance amputee gait. This intrasubject randomized study compared the gait biomechanics of transfemoral amputees wearing the C-Leg with those wearing a common noncomputerized prosthesis, the Mauch SNS (Ossur, Reykjavik, Iceland)."
- Medial-lateral centre of mass displacement and base of support Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking "Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee."
- Rehabilitation After Amputation "The principles of amputee rehabilitation, from preamputation to reintegration into the work force and community, are reviewed. The authors discuss exercise techniques, training programs, and environmental modifications that have been found to be helpful in the rehabilitation of the amputee. The exercise programs presented here are divided into four main components: flexibility, muscle strength, cardiovascular training, and balance and gait. The programs include interventions by the physical, occupational, and recreational therapist under the supervision and guidance of a physician."
- The effect of footwear mass on the gait patterns of unilateral below-knee amputees "This study reports an investigation into the effect of shoe mass on the gait patterns of below-knee (BK) amputees. Ten established unilateral BK, patellar-tendon-bearing prosthesis wearers were assessed using a VICON system of gait analysis. Incremental masses of 50g (up to 200g) were added to the subjects' shoes and data captured as they walked along a 15m measurement field. Coefficients of symmetry of various parameters of the swing phase (knee frequency symmetry, swing time symmetry, maximum flexion to heel strike time symmetry) were measured and their correlation was tested with the patient's preferrerd shoe mass and also their own shoe mass, all expressed as a proportion of body mass."
- Use of Quantitative Gait Analysis for the Evaluation of Prosthetic Walking Performance "Prosthetists must be skilled in observational gait analysis to perform a rapid assessment of their client's gait in the clinic and make appropriate adjustments to the prosthesis to eliminate or reduce gait abnormalities. Quantitative gait evaluations are able to provide additional, objective information to supplement the clinical observation."
- An Advanced Approach Toward Improved Prosthetic Fittings David F.M. Conney, R.P.T., C.P.O., is a senior vicepresident at Beverly Hills Prosthetics and Orthotics, Inc.. Keith E. Vinnecour, C.P.O., is owner and president of Beverly Hills Prosthetics Orthotics, Inc., Beverly Hills, California.
- Evaluation of a Prosthetic Shank with Variable Inertial Properties Scott Tashman, M. Eng., Ramona Hicks, R.P.T., M.A., and David L. Jendrzejczyk, CP. are with the Kinesiology Department and Department of Orthotics and Prosthetics at Newington Children's Hospital, Newington, Connecticut, 06111.
- Gait Analysis in Prosthetics James R. Gage, M.D. and Ramona Hicks, R.P.T., M.A. are with the Kinesiology Laboratory at Newington Children's Hospital in Newington, Connecticut 06111.
- Kinematic and Kinetic Comparison of the Conventional and ISNY Above-Knee Socket David E. Krebs, M.A., P.T., Associate Research Scientist, Prosthetics and Orthotics New York University Post-Graduate Medical School, 317 East 34th Street, New York City, New York 10016. Scott Tashman, M.S., Biomedical Engineer, Motion Analysis Laboratory, Newington Children's Hospital, Newington, Connecticut 06111.
- The Application of Gait Analysis in Orthotics Robert S. Lin, C.P.O. is with the Department of Orthotics and Prosthetics at Newington Children's Hospital, Newington, CT 06111.
- Survey Form
- Evaluation Guide
- Questionnaire
- Guia de Avaliação e Questionário Tradução: Priscila Oréfice Pinheiro - Fisioterapeuta no Laboratório de Marcha Helena Pereira de Moraes, Associação de Assistência à Criança Deficiente (AACD - SP)
- Guia para el uso del cuestionario
- Cuestionario Tradução: Dra. Tania Suárez Parrado e Dr. Pascual Jovino Figueroa Rivero (LIB - UNICAMP)
- A Manual for the Rehabilitation of People with Limb Amputation (2004) World Health Organization, United States Department of Defense, MossRehab Amputee Rehabilitation Program and MossRehab Hospital
Órteses
AFO (ankle-foot orthoses)
The Effect of Ankle-Foot Orthoses on Balance - A Systematic Review "Ankle-foot orthoses (AFOs) are typically designed to limit the motion of the ankle joint in one or more planes. Given that balance may be compromised when joint range of motion is restricted, an understanding of the relative effects of AFOs on balance performance is clinically relevant. The aim of this systematic review was to evaluate existing evidence related to the effects of AFOs on static and dynamic balance. A search of appropriate medical databases was conducted, and 37 articles were found to satisfy predetermined inclusion criteria."
KAFO (knee-ankle-foot orthoses) and HKAFO (hip-knee-ankle-foot orthoses)
LETOR
LETOR: Lower Extremity Telescopic Orthosis LETOR was developed at the Rehabilitation Center in Konstancin in cooperation with the Institute of Biocybernetics and Biomedical Engineering, the Polish Academy of Sciences. Design proved to be appropriate in various environments and in different cultures.
Próteses/Prostheses
Clinical Prosthetics & Orthotics - 1985, Volume 9, Number 3
Gait Analysis, by Ronald F. Altman, C.P.O.
The following series of articles on Gait Analysis were based on a project which was supported by the Newington Children's Hospital Research Fund.The following series of articles all have to do with using gait analysis, in orthotics as well as prosthetics, to improve function. The Gage/Hicks study traces gait analysis in prosthetics from Inman forward, and the individual articles illustrate contemporary laboratory approaches to the objective assessment of gait.
Fundamental to optimal lower-extremity prosthetic/orthotic service is an analysis of the gait of the patient. To the extent the method of analysis fails to provide adequate objective or useful information about gait, it allows for the possibility and probability that a less than optimum fit and/or alignment configuration has been or will be achieved.
While gait analysis has long been an established procedure of varying objectivity in prosthetics, in orthotics the use of gait analysis has been rather ineffectual in assisting to optimize gait, a process which for the most part fails to go beyond a most rudimentary observation. This is due in part to the rudimentary functional characteristics of most orthoses.
Advances in our profession as well as technology and materials can and do result in more functional orthoses. If we are going to provide the optimal orthotic design configuration for any given patient, it is essential that we define gait characteristics more precisely and reliably.
Though not yet universally available, the increasing number of gait analysis facilities will soon benefit us all—patients and practitioners alike—as we gain access to the resulting information flow in formats readily usable by orthotists and prosthetists.
PEQ - Prosthesis Evaluation Questionnaire
Versão Original - EN
Versão em Português - BR
Versão em Espanhol - LA
The Rehabilitation of People with Amputations
This manual presents information for healthcare personnel who provide care for people with amputations, e.g., mid-level rehabilitation personnel, nurses and doctors and for people who have had amputations and for thier families. The content of the manual focuses on the activites a person with an amputation performs without a prosthesis (artificial limb), the basic components of a prosthesis for upper and lower limbs, and the basic training for use of the prosthesis. The manual gives information about training for self-care activities, but does not include training for household or work activities. It presents information about prostheses that is useful for the general health care personnel, as well as for people with amputations, but does not provide information on making or evaluating a prosthesis.
- Full text by Tanneke Schoppen
Thesis: "Functional outcome after a lower limb amputation" (NL)
The main aim of this thesis is to gain a better understanding of the influence of physical, mental, and social characteristics on the functional outcome of patients after a lower limb amputation. The main research questions answered in this thesis are:
- 1. Which physical, mental, and social characteristics after amputation predict the functional outcome for elderly lower limb amputee patients?
- 2. What is the relationship between impairments, activities, and participation for elderly amputee patients?
- 3. What is the employment status of amputee patients in the Netherlands?
- 4. Which factors are related to successful job reintegration and job satisfaction for working people with a lower limb amputation?