Orthosis

NL Zaino, M Yamagami, DJ Gaebler-Spira, KM Steele, KF Bjornson, HA Feldner (2022) “‘That’s frustrating’: Perceptions of ankle foot orthosis provision, use, and needs among people with cerebral palsy and caregivers”

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Journal Article in Prosthetics and Orthotics International:

This research provides insights into the lived experiences of individuals with CP and their caregivers regarding the process of obtaining and using an AFO. Further opportunities exist to support function and participation of people with CP by streamlining AFO provision processes, creating educational materials, and improving AFO design for comfort and ease of use.

Aim: The study objective was to evaluate the lived experiences of individuals with CP and their caregivers regarding AFO access, use, and priorities. We examined experiences around the perceived purpose of AFOs, provision process, current barriers to use, and ideas for future AFO design.

Method: Secondary data analysis was performed on semistructured focus groups that included 68 individuals with CP and 74 caregivers. Of the focus group participants, 66 mentioned AFOs (16 individuals with CP and 50 caregivers). De-identified transcripts were analyzed using inductive coding, and the codes were consolidated into themes.

Results: Four themes emerged: 1) AFO provision is a confusing and lengthy process, 2) participants want more information during AFO provision, 3) AFOs are uncomfortable and difficult to use, and 4) AFOs can benefit mobility and independence. Caregivers and individuals with CP recommended ideas such as 3D printing orthoses and education for caregivers on design choices to improve AFO design and provision.

Interpretation: Individuals with CP and their caregivers found the AFO provision process frustrating but highlight that AFOs support mobility and participation. Further opportunities exist to support function and participation of people with CP by streamlining AFO provision processes, creating educational materials, and improving AFO design for comfort and ease of use.

RehabWeek/ISPO Canada Best Student Poster: Brandon Nguyen!

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Brandon Nguyen standing in front of his poster at RehabWeek wearing a dark blue shirt. His poster features images of the smartphone app and graphs.

Congrats to Brandon Nguyen who was awarded the Best Student Poster award by the International Society of Prosthetics & Orthotics Canada at RehabWeek in Toronto this past week! Brandon presented his work, “Accuracy and repeatability of using smartphone sensors for orthotic tuning.”

Check out his abstract and poster.

You can also download the HuskySTEPS app to try it out yourself.

The ISPO student award winners for 2019 rehab week, including four students with Brandon in the middle, and the two main conference award organizers.

This work, in collaboration with Nick Baicoianu and Darrin Howell, examined the accuracy of measuring shank-to-vertical angle during walking with a smartphone compared to traditional motion capture systems. Shank-to-vertical angle is a measure used by orthotists and therapists for AFO tuning and gait training. The short story – placing the smartphone on the front of the shank can measure shank-vertical-angle with errors less than two degrees compared to traditional motion capture systems, with high intra-rater and inter-rater repeatability across days.

Brandon dressed in his purple graduation regalia in front of the UW fountain

Brandon also recently finished his Doctorate of Physical Therapy (DPT) degree at the University of Washington – making him one of the rare engineer-therapists. In recognition of his efforts to combine academic scholarship with social awareness and concern, he was awarded the 2019 UW Graduate Medal.

Congratulations Brandon! We are so excited to see what you do next.

Claire Mitchell, Karley Benoff, and Makoto Eyre present at the Mary Gates Research Symposium

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On May 18th, Claire Mitchell, Karley Benoff, and Makoto Eyre presented their research at the Mary Gates Undergraduate Research Symposium. These three students worked on year-long projects and showcased their hard work during a campus-wide poster session.

Claire’s research focused on creating a website and server framework for clinicians and researchers across the country to use for calculating muscle synergies for motor control analysis. Muscle synergies are an incredibly complex and computationally expensive analysis of electromyography data but provide quantification of motor control and assist in therapy prescription for movement disorders.

Claire Mitchell, and undergraduate student in the Steele Lab, stands in front of her poster at Mary Gates Hall during the undergraduate research symposium. Claire is wearing a white and blue floral blouse. She is in the middle of describing her research project to four community members who have taken an interest in her research.

Makoto Eyre and Karley Benoff stand nearly back to back in front of their poster at Mary Gates Hall during the undergraduate research symposium. Makoto is facing to the left of the poster, and is wearing glasses, a white button up shirt and black slacks while conversing with members of the community outside of the images capture. Karley Benoff has shoulder length brown and blonde hair and is wearing a pink blouse while helping to fit a member of the community with her 3D-printed device at the elbow. Karley and the female community member are making sure the device's elbow joint is aligning well with the community member's elbow.

 

 

 

 

 

 

Karley and Mako’s research focused on designing and testing a 3D-printed elbow-driven orthosis for individuals with limited hand function. They drew inspiration from upper-extremity prosthetic devices and evaluated a voluntary close and voluntary open mechanism to assist an individual’s dominant limb.

Great work Karley, Mako, and Claire!

The interior courtyard of Mary Gates Hall has interior windows and a combination of new and old architectural elements. This is the location where hundreds of undergraduate presenters and community members discuss research accomplishments and next steps.

AA Portnova, G Mukherjee, KM Peters, A Yamane, KM Steele (2018) “Design of a 3D-printed, open-source wrist-driven orthosis for individuals with spinal cord injury.” PLOSOne

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Journal article in PLOSOne: In collaboration with the University of Washington Prosthetics and Orthotics Division, a user-centered design approach was used to improve the design and wearability of a passive, wrist-driven orthosis. To read the article in full, click HERE. To access the open-source print files, click HERE.

Orthotists in training assemble the 3D-printed parts of a new wrist-driven orthosis in the top image. The lower image showcases a user gripping a pen in his freshly donned orthosis.Background: Assistive technology, such as wrist-driven orthoses (WDOs), can be used by individuals with spinal cord injury to improve hand function. A lack of innovation and challenges in obtaining WDOs have limited their use. These orthoses can be heavy and uncomfortable for users and also time-consuming for orthotists to fabricate.

Purpose/Methods: The goal of this research was to design a WDO with user (N = 3) and orthotist (N = 6) feedback to improve the accessibility, customizability, and function of WDOs by harnessing advancements in 3D-printing.

Results: The 3D-printed WDO reduced hands-on assembly time to approximately 1.5 hours and the material costs to $15 compared to current fabrication methods. Varying improvements in users’ hand function were observed during functional tests, such as the Jebsen Taylor Hand Function Test. For example, one participant’s ability on the small object task improved by 29 seconds with the WDO, while another participant took 25 seconds longer to complete this task with the WDO. Two users had a significant increase in grasp strength with the WDO (13–122% increase), while the other participant was able to perform a pinching grasp for the first time.

The WDO designs are available open-source to increase accessibility and encourage future innovation.

H Choi, KM Peters, M MacConnell, K Ly, E Eckert, KM Steele (2017) “Impact of ankle foot orthosis stiffness on Achilles tendon and gastrocnemius function during unimpaired gait.” Journal of Biomechanics

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Journal article in Journal of Biomechanics:

How does the stiffness of an AFO impact the muscultendon dynamics of the gastrocnemius?

Abstract

Method combining ultrasound and musculoskeletal modeling to evaluate changes in muscle and tendon length.

Ankle foot orthoses (AFOs) are designed to improve gait for individuals with neuromuscular conditions and have also been used to reduce energy costs of walking for unimpaired individuals. AFOs influence joint motion and metabolic cost, but how they impact muscle function remains unclear. This study investigated the impact of different stiffness ankle foot orthoses (AFOs) on medial gastrocnemius muscle (MG) and Achilles tendon (AT) function during two different walking speeds. We performed gait analyses for eight unimpaired individuals. Each individual walked at slow and very slow speeds with a 3D printed AFO with no resistance (free hinge condition) and four levels of ankle dorsiflexion stiffness: 0.25 Nm / °, 1 Nm / °, 2 Nm / °, and 3.7 Nm / °. Motion capture, ultrasound, and musculoskeletal modeling were used to quantify MG and AT lengths with each AFO condition. Increasing AFO stiffness increased peak AFO dorsiflexion moment with decreased peak knee extension and peak ankle dorsiflexion angles. Overall musculotendon length and peak AT length decreased, while peak MG length increased with increasing AFO stiffness. Peak MG activity, length, and velocity significantly decreased with slower walking speed. This study provides experimental evidence of the impact of AFO stiffness and walking speed on joint kinematics and musculotendon function. These methods can provide insight to improve AFO designs and optimize musculotendon function for rehabilitation, performance, or other goals.