Great job to lab members Ben Shuman, Michael Rosenberg, Sasha Portnova, and Hwan Choi for presenting their work at this year’s American Society of Biomechanics this August. To view the program and read more about biomechanics research, click here.
Publications
H Choi, TL Wren, KM Steele (2016) “Gastrocnemius operating length with ankle foot orthoses in cerebral palsy.” Prosthetics & Orthotics International
Journal article in Prosthetics & Orthotics International:
How does the operating length of the gastrocnemius vary with different common AFOs in children with cerebral palsy?
Background: Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.
Objectives: This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.
Study design: Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.
Methods: We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.
Results: Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.
Conclusion: Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.
Clinical relevance: Determining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.
Choi, H. Evaluation of Gait and Muscle Function with Ankle Foot Orthoses. PhD Dissertation.
A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, University of Washington, 2016. To download and read in full, CLICK HERE. to access through the University of Washington’s ResearchWorks Archive.
Background: Many individuals with cerebral palsy (CP) and stroke are prescribed ankle foot orthoses
(AFOs) for use during daily life. AFOs have been shown to improve pathologic gait and walking
speed in CP and stroke by providing support and alignment. There are many different types of
AFOs available such as posterior leaf spring AFOs, rigid AFOs, and articulated AFOs. Further,
there are many parameters that can be customized or tuned for each type of AFO, such as
stiffness, heel height, shank to vertical angle, and foot plate length. However, how different types
of AFOs and the customization of specific parameters impact muscle function remains unclear.
Purpose: The goals of this dissertation were to evaluate how different types of AFOs and different
tuning parameters impact gait kinematics and muscle function. Of particular interest is the
gastrocnemius, a key muscle that crosses the knee and ankle joints and is commonly tight among
individuals with CP or stroke. Gastrocnemius operating length, defined as the total muscle and
tendon length during a functional activity, influences ankle and knee kinematics during gait.
Results/Discussion: This dissertation provides important evidence for how humans adapt to various AFO
properties and suggests important implications for the design and prescription of AFOs. This
work provides a quantitative evaluation of how AFOs impact musculotendon dynamics among
individuals with stroke (Aim 1) and cerebral palsy (Aim 2). The fabrication methods in Aim 3
creates a powerful and flexible research platform for evaluating AFO design, which may be
extended to fabrication of AFOs for daily use with further improvements in additive
manufacturing materials and methods. The final study (Aim 4), provides the first experimental
evidence combining ultrasound and musculoskeletal modeling to understand how muscle and
tendon length are impacted by AFO design. These evaluations provide guidance for future AFO
design and prescription that can not only augment human mobility for unimpaired individuals,
but also provide improve metrics for improving function and guiding rehabilitation for
individuals with neurologic impairments.
Michael MacConnell, Bradley Wachter, CJ Smith, and Sasha Portnova Present at the Undergraduate Research Symposium
Our undergraduate researchers presented in Mary Gates Hall today, presenting their research from 11am-1pm. Member of the community, faculty, and staff stopped by to hear about Bradley and CJ’s work developing an open-source proximal control orthosis, Sasha’s wrist-driven, wrist-hand orthosis, and Michael’s work on ankle foot orthoses as a rehabilitation tool. Great job, everyone!
CL Bennett, K Cen, KM Steele, DK Rosner, (2016) “An intimate laboratory? Prostheses as a tool for experimenting with identity and normalcy.” CHI Human Factors in Computing Systems, ACM
Peer-review paper at CHI Human Factors in Computing Systems Annual Conference:
Prostheses are more than just a tool to enhance function – they strongly influence perceptions of identity and normalcy.
Abstract: This paper is about the aspects of ability, selfhood, and normalcy embodied in people’s relationships with prostheses. Drawing on interviews with 14 individuals with upper-limb loss and diverse experiences with prostheses, we find people not only choose to use and not use prosthesis throughout their lives but also form close and complex relationships with them. The design of “assistive” technology often focuses on enhancing function; however, we found that prostheses played important roles in people’s development of identity and sense of normalcy. Even when a prosthesis failed functionally, such as was the case with 3D-printed prostheses created by an on-line open-source maker community (e-NABLE), we found people still praised the design and initiative because of the positive impacts on popular culture, identity, and community building. This work surfaces crucial questions about the role of design interventions in identity production, the promise of maker communities for accelerating innovation, and a broader definition of “assistive” technology.
View the video for more information on this work.