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Effect of the Benefoot walker on plantar pressure during walking in apparently healthy people
S76
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
Discussion and conclusions: The robotic assisted therapy could be a beneficial treatment in the gait rehabilitation for children with diagnosis of hemiplegia (CP), GMFCS I and II. Those children improved their gait, probably, because were strengthened the ankle dorsal flexion muscles, reeducation motor engram was performed or improved their proprioception. Further reading [1] Borggraefe I, Schaefer JS, Klauber M. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with Cerebral Palsy.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.160 P61 Six minute walk distance in children with cerebral palsy and in typically developing children Fitzgerald 1 ,
Hickey 2 ,
Diarmaid Claire Damien Kiernan 1 , Eamonn Delahunt 2 , Michael Walsh 1 , Timothy O’Brien 1 1 Central Remedial Clinic, Gait Laboratory, Dublin, Ireland 2 University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
Introduction: The six minute walk test is used in children with cerebral palsy to quantify functional ability [1] and as an outcome measure to assess changes in ambulatory status over time or prior to and following specific treatment interventions. The aim of this research was to assess six-minute walking distance (6MWD) in children with cerebral palsy (CP) and in typically developing (TD) children. Patients/materials and methods: 6MWD values for children with CP were taken from a database of patients referred to a gait analysis laboratory. TD children aged 4–17 were assessed prospectively using the same standardised protocol that was used to assess participants with CP. For analysis, participants with CP were subcategorised based on topographical diagnostic subtype (hemiplegic or diplegic) and Gross Motor Function Classification System (GMFCS) level. Results: Mean 6MWD was 535 m (SD = 9.2) for TD participants (n = 73) and 382 m (SD = 8.7) for participants with CP (n = 129). Results of a pair-wise comparison showed significant differences between 6MWD values of TD participants and across CP participants of all subcategories. Differences were seen across subcategories of CP participants with hemiplegic participants of GMFCS level I performing the longest distances (mean = 430 m, SD = 12.6) and diplegic participants of GMFCS level III performing significantly shorter distances (mean = 427 m, SD = 13) than any other subcategory. Discussion and conclusions: A range of normative values for TD children and children with CP (GMFCS I-III) was established using a standardised protocol that can be used to quantify functional capacities of children with CP. Reference [1] Maher CA, Williams MT, Olds TS. The six-minute walk test for children with cerebral palsy. International Journal of Rehabilitation Research 2008;31(June (2)):185–8.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.161
P63 Effect of the Benefoot walker on plantar pressure during walking in apparently healthy people Ambreen Chohan 1 , Kwadwo O. Appiah-Kubi 2 , Robert Van Deursen 3 , Dhaher Alanzi 4 1 School of Sport, Tourism & the Outdoors, University of Central Lancashire, Allied Health Research Unit, Preston, United Kingdom 2 School of Allied Health Sciences, College of Health Sciences, University of Ghana, Physiotherapy, Accra, Ghana 3 School of Healthcare Studies, Cardiff University, Physiotherapy, Cardiff, United Kingdom 4 King Faisal Specialist Hospital, Physiotherapy, Riyadh, Kingdom of Saudi Arabia
Introduction: The development of diabetic foot ulcers is associated with excessive plantar pressure. The central goal of any treatment regime designed to heal these ulcers is the effective reduction of this excessive pressure. The use of an orthosis such as the Benefoot walker (BW) is a preferred non-surgical method for plantar pressure reduction. This study therefore investigated the difference in plantar pressure between the BW, compared to a control shoe (CS) during gait in apparently healthy people. Patients/materials and methods: Twenty-one apparently healthy volunteers (8 males, 13 females; mean age 49.7 + 7.0 years) participated in the study. The mean height and weight of the participants was 1.67 + 0.1 m and 75.9 + 18.2 kg respectively. A consecutive sampling technique was used to recruit participants via local social groups, institutions and societies. Participants had no history of neurological, respiratory, musculoskeletal back or lower limb pathology, or any low back pain in the 12 months preceding the study. A crossover design was employed to study the differences between the BW and CS. Participants were asked to walk 10 m in a pair of CS and then in a left CS with the BW on the right foot. The pedar-x (Novel gmbh, Germany) in-shoe pressure measurement system was used to measure plantar pressures at six sites (the heel, mid-foot, lateral metatarsal, medial metatarsal, hallux and the small toes) using insoles inside the footwear during testing. Descriptive statistics were used to analyse demographic data. Within subject analysis of mean peak plantar pressures (MPPPs) was compared between the CS and the BW, using the paired student t-test (SPSS v.17). The significance level was set to p ≤ 0.05. Results: The MPPP of the CS trial yielded similar results for both feet, for all respective plantar sites (p > 0.05). The BW however significantly reduced overall plantar pressure (p = 0.002) when compared to a CS on the same side. With the exception of the heel, the remaining five plantar pressure sites analysed showed that the plantar pressures in the right CS were higher than when walking with the BW on the right (p < 0.05). The most reduced plantar pressures occurred at the medial metatarsals (129.38 + 67.93 kPa; p < 0.05), followed by the hallux (128.58 + 135.32 kPa; p < 0.001) and lateral metatarsals (122.14 + 53.35 kPa; p < 0.001), with the midfoot (7.89 + 44.29 kPa; p = 0.424) being the least. Discussion and conclusions: Compared to the CS, the BW reduced mean plantar pressure by 18.9% when comparing the same side. The BW was effective in reducing plantar pressure significantly at all plantar sites except for the heel and mid-foot. The inability of the walker to reduce sufficient heel pressure would indicate that clinicians should be cautious when prescribing such orthoses to those with higher plantar pressures in this area. Further studies are required using neuropathic patients to determine the clinical benefits of the BW.
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
S77
Further reading
Further reading
[1] Ha Van G, Siney H, Hartmann-Heurtier, et al. Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers. Diabetes Care 2003;26:2848–52. [2] Van Schie CH, Rowell S, Knowles A, Boulton AJ. The effect of the Scotchcast boot and the Aircast device on foot pressures of the contralateral foot. Wounds 2003;15(9):289–93.
[1] Prätorius B, Milani TL. Kinder-Koordinationstests Diss 2007. [2] Bosch K, Gerß J, Rosenbaum D. Development of healthy children’s feet – nine year results of longitudinal investigation of plantar loading patterns. Gait & Posture 2010.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.162
P67
P65
A clinical trial of the wearable robot suit (HAL)
Pedobarographic results in children with insole treatment
Tatsuo Kobayashi 1 , Ryosuke Sanpei 1 , Kenichi Kaida 2 , Masanori Fujita 3
Susanne Lebek 1 , David Wohlrab 1 , Matti Panian 2 , Natalia Gutteck 1 , Karl-Stefan Delank 1
1 National Defense Medical College, Rehabilitation Medicine, Tokorozawa, Japan 2 National Defense Medical College, Neurology, Tokorozawa, Japan 3 National Defense Medical College Research, Environmental Medicine, Tokorozawa, Japan
1 University of Halle, Orthopaedic Department, Halle, Germany 2 Orthopaedic Department, University, Gait Laboratory, Halle, Germany
Introduction: So called proprioceptive insoles are supposed to improve the foot shape as well as to modulate plantar surface sensibility thereby influencing posture and coordination. We evaluated the pedobarographic results of 5 to 12 year old children to prove this effect and the usefulness of pedobarography in children. Patients/materials and methods: We assessed 15 children (6 girls, 9 boys) with a mean age of 8.4 years (SD 2.2 years), who wore proprioceptive insoles (insole group) prescribed by their physician for at least one year (mean 3.2 years, 1–6 years). Their pedobarographic results as well as their results of some coordination tests [1] were compared to an age- and BMI- matched group (control group) of 30 children (16 girls, 14 boys; mean age 8.4 years, SD 1.9 years). The mean BMI was 17.9 kg/m2 (SD 3.4). The pedobarography was performed with the Emed System, Novel, Germany. SPSS was used for statistical analysis (Mann Whitney Test, p < 0.05). Results: There were found no statistical differences (Table 1). Discussion and conclusions: An effect on the arch index or the coordination caused by special proprioceptive insoles could not be found in our controlled study. It cannot be determined whether the children in the insole group improved and showed normal results caused by wearing the insoles. We think that pedobarography is a useful tool to evaluate children’s feet dynamically in order to get more knowledge about the natural history of feet development [2] thereby aiming at the optimal time for conservative and surgical interventions.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.164
Introduction: The Hybrid Assistive Limb (HAL) developed as a wearable robot suit for the handicapped is a hopeful welfare instrument in Japan, which is threatened to be an ultra-aging society in the near future. The present report is about the volunteers with disfunction of lower limbs, who have tried out HAL. Patients/materials and methods: The volunteers are three patients with disfunction of lower limbs; the first is with traumatic incomplete lumbar spinal cord injury, the second with incomplete paraplegia after surgery for dissecting aneurysm, the last with Kennedy Alter Sung disease. Each patient had standing and walking training twice a week, 10 times in all, wearing HAL. Their joint movability, muscle strength, time of 10-m walk, and Time Up and Go test (TUG) results before and after the trial have been evaluated. Results: The first volunteer with traumatic incomplete lumbar spinal cord injury can walk on two Lofstrand crutches and a long leg brace. After the trial, his time of 10-m walk reduced from 10.2 s to 7.5 s and his TUG result from 13.4 s to 8.8 s. The assist of a short leg brace was needed because HAL does not have corrective function for pes equinovarus contracture. The second with incomplete paraplegia after surgery for dissecting aneurysm is incapable of standing or walking. HAL has enabled him to stand and walk on two side canes, though no improvement has been found in his joint movability, muscle strength, and activity function. The last with Kennedy Alter Sung disease has difficulty in rising from a chair, but can walk on T-cane. By wearing HAL, he became able to rise from a chair and to walk without T-cane. Both the second and the last patients needed someone’s assistance to keep his balance in standing and walking.
Table 1 Results of the coordination tests, the posturograms and the arch indices. n
Coordination velocity
Coordination precision
Arch index
n
Posturogram (in cm2 )
Insole group
15 30
2.3 (SD 2.9) 1.3 (SD 2.2) 0.518
0.19 (SD 0.065) 0.20 (SD 0.067) 0.847
12
Control group
37.4 (SD 16.4) 42.6 (SD 16.2) 0.252
55.4 (SD 53) 28.4 (SD 24.6) 0.068
p
14
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
Discussion and conclusions: The robotic assisted therapy could be a beneficial treatment in the gait rehabilitation for children with diagnosis of hemiplegia (CP), GMFCS I and II. Those children improved their gait, probably, because were strengthened the ankle dorsal flexion muscles, reeducation motor engram was performed or improved their proprioception. Further reading [1] Borggraefe I, Schaefer JS, Klauber M. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with Cerebral Palsy.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.160 P61 Six minute walk distance in children with cerebral palsy and in typically developing children Fitzgerald 1 ,
Hickey 2 ,
Diarmaid Claire Damien Kiernan 1 , Eamonn Delahunt 2 , Michael Walsh 1 , Timothy O’Brien 1 1 Central Remedial Clinic, Gait Laboratory, Dublin, Ireland 2 University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
Introduction: The six minute walk test is used in children with cerebral palsy to quantify functional ability [1] and as an outcome measure to assess changes in ambulatory status over time or prior to and following specific treatment interventions. The aim of this research was to assess six-minute walking distance (6MWD) in children with cerebral palsy (CP) and in typically developing (TD) children. Patients/materials and methods: 6MWD values for children with CP were taken from a database of patients referred to a gait analysis laboratory. TD children aged 4–17 were assessed prospectively using the same standardised protocol that was used to assess participants with CP. For analysis, participants with CP were subcategorised based on topographical diagnostic subtype (hemiplegic or diplegic) and Gross Motor Function Classification System (GMFCS) level. Results: Mean 6MWD was 535 m (SD = 9.2) for TD participants (n = 73) and 382 m (SD = 8.7) for participants with CP (n = 129). Results of a pair-wise comparison showed significant differences between 6MWD values of TD participants and across CP participants of all subcategories. Differences were seen across subcategories of CP participants with hemiplegic participants of GMFCS level I performing the longest distances (mean = 430 m, SD = 12.6) and diplegic participants of GMFCS level III performing significantly shorter distances (mean = 427 m, SD = 13) than any other subcategory. Discussion and conclusions: A range of normative values for TD children and children with CP (GMFCS I-III) was established using a standardised protocol that can be used to quantify functional capacities of children with CP. Reference [1] Maher CA, Williams MT, Olds TS. The six-minute walk test for children with cerebral palsy. International Journal of Rehabilitation Research 2008;31(June (2)):185–8.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.161
P63 Effect of the Benefoot walker on plantar pressure during walking in apparently healthy people Ambreen Chohan 1 , Kwadwo O. Appiah-Kubi 2 , Robert Van Deursen 3 , Dhaher Alanzi 4 1 School of Sport, Tourism & the Outdoors, University of Central Lancashire, Allied Health Research Unit, Preston, United Kingdom 2 School of Allied Health Sciences, College of Health Sciences, University of Ghana, Physiotherapy, Accra, Ghana 3 School of Healthcare Studies, Cardiff University, Physiotherapy, Cardiff, United Kingdom 4 King Faisal Specialist Hospital, Physiotherapy, Riyadh, Kingdom of Saudi Arabia
Introduction: The development of diabetic foot ulcers is associated with excessive plantar pressure. The central goal of any treatment regime designed to heal these ulcers is the effective reduction of this excessive pressure. The use of an orthosis such as the Benefoot walker (BW) is a preferred non-surgical method for plantar pressure reduction. This study therefore investigated the difference in plantar pressure between the BW, compared to a control shoe (CS) during gait in apparently healthy people. Patients/materials and methods: Twenty-one apparently healthy volunteers (8 males, 13 females; mean age 49.7 + 7.0 years) participated in the study. The mean height and weight of the participants was 1.67 + 0.1 m and 75.9 + 18.2 kg respectively. A consecutive sampling technique was used to recruit participants via local social groups, institutions and societies. Participants had no history of neurological, respiratory, musculoskeletal back or lower limb pathology, or any low back pain in the 12 months preceding the study. A crossover design was employed to study the differences between the BW and CS. Participants were asked to walk 10 m in a pair of CS and then in a left CS with the BW on the right foot. The pedar-x (Novel gmbh, Germany) in-shoe pressure measurement system was used to measure plantar pressures at six sites (the heel, mid-foot, lateral metatarsal, medial metatarsal, hallux and the small toes) using insoles inside the footwear during testing. Descriptive statistics were used to analyse demographic data. Within subject analysis of mean peak plantar pressures (MPPPs) was compared between the CS and the BW, using the paired student t-test (SPSS v.17). The significance level was set to p ≤ 0.05. Results: The MPPP of the CS trial yielded similar results for both feet, for all respective plantar sites (p > 0.05). The BW however significantly reduced overall plantar pressure (p = 0.002) when compared to a CS on the same side. With the exception of the heel, the remaining five plantar pressure sites analysed showed that the plantar pressures in the right CS were higher than when walking with the BW on the right (p < 0.05). The most reduced plantar pressures occurred at the medial metatarsals (129.38 + 67.93 kPa; p < 0.05), followed by the hallux (128.58 + 135.32 kPa; p < 0.001) and lateral metatarsals (122.14 + 53.35 kPa; p < 0.001), with the midfoot (7.89 + 44.29 kPa; p = 0.424) being the least. Discussion and conclusions: Compared to the CS, the BW reduced mean plantar pressure by 18.9% when comparing the same side. The BW was effective in reducing plantar pressure significantly at all plantar sites except for the heel and mid-foot. The inability of the walker to reduce sufficient heel pressure would indicate that clinicians should be cautious when prescribing such orthoses to those with higher plantar pressures in this area. Further studies are required using neuropathic patients to determine the clinical benefits of the BW.
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
S77
Further reading
Further reading
[1] Ha Van G, Siney H, Hartmann-Heurtier, et al. Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers. Diabetes Care 2003;26:2848–52. [2] Van Schie CH, Rowell S, Knowles A, Boulton AJ. The effect of the Scotchcast boot and the Aircast device on foot pressures of the contralateral foot. Wounds 2003;15(9):289–93.
[1] Prätorius B, Milani TL. Kinder-Koordinationstests Diss 2007. [2] Bosch K, Gerß J, Rosenbaum D. Development of healthy children’s feet – nine year results of longitudinal investigation of plantar loading patterns. Gait & Posture 2010.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.162
P67
P65
A clinical trial of the wearable robot suit (HAL)
Pedobarographic results in children with insole treatment
Tatsuo Kobayashi 1 , Ryosuke Sanpei 1 , Kenichi Kaida 2 , Masanori Fujita 3
Susanne Lebek 1 , David Wohlrab 1 , Matti Panian 2 , Natalia Gutteck 1 , Karl-Stefan Delank 1
1 National Defense Medical College, Rehabilitation Medicine, Tokorozawa, Japan 2 National Defense Medical College, Neurology, Tokorozawa, Japan 3 National Defense Medical College Research, Environmental Medicine, Tokorozawa, Japan
1 University of Halle, Orthopaedic Department, Halle, Germany 2 Orthopaedic Department, University, Gait Laboratory, Halle, Germany
Introduction: So called proprioceptive insoles are supposed to improve the foot shape as well as to modulate plantar surface sensibility thereby influencing posture and coordination. We evaluated the pedobarographic results of 5 to 12 year old children to prove this effect and the usefulness of pedobarography in children. Patients/materials and methods: We assessed 15 children (6 girls, 9 boys) with a mean age of 8.4 years (SD 2.2 years), who wore proprioceptive insoles (insole group) prescribed by their physician for at least one year (mean 3.2 years, 1–6 years). Their pedobarographic results as well as their results of some coordination tests [1] were compared to an age- and BMI- matched group (control group) of 30 children (16 girls, 14 boys; mean age 8.4 years, SD 1.9 years). The mean BMI was 17.9 kg/m2 (SD 3.4). The pedobarography was performed with the Emed System, Novel, Germany. SPSS was used for statistical analysis (Mann Whitney Test, p < 0.05). Results: There were found no statistical differences (Table 1). Discussion and conclusions: An effect on the arch index or the coordination caused by special proprioceptive insoles could not be found in our controlled study. It cannot be determined whether the children in the insole group improved and showed normal results caused by wearing the insoles. We think that pedobarography is a useful tool to evaluate children’s feet dynamically in order to get more knowledge about the natural history of feet development [2] thereby aiming at the optimal time for conservative and surgical interventions.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.164
Introduction: The Hybrid Assistive Limb (HAL) developed as a wearable robot suit for the handicapped is a hopeful welfare instrument in Japan, which is threatened to be an ultra-aging society in the near future. The present report is about the volunteers with disfunction of lower limbs, who have tried out HAL. Patients/materials and methods: The volunteers are three patients with disfunction of lower limbs; the first is with traumatic incomplete lumbar spinal cord injury, the second with incomplete paraplegia after surgery for dissecting aneurysm, the last with Kennedy Alter Sung disease. Each patient had standing and walking training twice a week, 10 times in all, wearing HAL. Their joint movability, muscle strength, time of 10-m walk, and Time Up and Go test (TUG) results before and after the trial have been evaluated. Results: The first volunteer with traumatic incomplete lumbar spinal cord injury can walk on two Lofstrand crutches and a long leg brace. After the trial, his time of 10-m walk reduced from 10.2 s to 7.5 s and his TUG result from 13.4 s to 8.8 s. The assist of a short leg brace was needed because HAL does not have corrective function for pes equinovarus contracture. The second with incomplete paraplegia after surgery for dissecting aneurysm is incapable of standing or walking. HAL has enabled him to stand and walk on two side canes, though no improvement has been found in his joint movability, muscle strength, and activity function. The last with Kennedy Alter Sung disease has difficulty in rising from a chair, but can walk on T-cane. By wearing HAL, he became able to rise from a chair and to walk without T-cane. Both the second and the last patients needed someone’s assistance to keep his balance in standing and walking.
Table 1 Results of the coordination tests, the posturograms and the arch indices. n
Coordination velocity
Coordination precision
Arch index
n
Posturogram (in cm2 )
Insole group
15 30
2.3 (SD 2.9) 1.3 (SD 2.2) 0.518
0.19 (SD 0.065) 0.20 (SD 0.067) 0.847
12
Control group
37.4 (SD 16.4) 42.6 (SD 16.2) 0.252
55.4 (SD 53) 28.4 (SD 24.6) 0.068
p
14