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Plantar pressure measurements to evaluate ankle foot orthoses in hemiplegic stroke patients: A pilot study
Abstracts / Clinical Biomechanics 23 (2008) 662–720
The baropodometrie allows qualitative and quantitative measures to examine the subject. This utilisation is with regard to the evolution and functional deficits (Autrusson et al., 2003). Several studies demonstrated the effect resulting from stimulation of the plantar surface (Gaillet et al., 2004; Guldemond et al., 2006; Janin, 2002; Janin et al., 2005; Kavounoudias et al., 2001). In clinical practice, orthotic devices are used to modify the plantar relief and did one’s work with great care for disease (Schabat et al., 2004). The aim of this study was to quantify the variation of pressure after plantar arch stimulation. Materials Thirteen healthy subjects with right dominant leg (leg preferred for kicking a ball) were selected without disturbance in plantar support. The variation was recorded by a stabilometric platform mixing with baropodometric platform (Fusyo, 2. Medicapteur). The selected orthotic device is a plantar arch support with a thickness of 3 mm and 60 scores (Podiser Atlantic). The medial position of CoP and pressure was collected. The haptic sensation of affordance was obtained by a questionnaire (Stoffregen et al., 1999).
703
References Autrusson et al., 2003. Encyclopaedia Medico Chirurgical, 27–150. Gaillet et al., 2004. Clinical Biomechanics 19, 1066–1069. Guldemond et al., 2006. Journal of American Podiatric Medical Association 96-1, 9–18. Janin, 2002. Cine´siologie 203, 13–14. Janin et al., 2005. Gait and Posture 21, 1.S79. Kavounoudias et al., 2001. Journal of Physiology 532–533, 869–878. Schabat et al., 2004. European Spine Journal 14, 546–550. Stoffregen et al., 1999. Experimental Journal Psychology 25-1, 120–136. doi:10.1016/j.clinbiomech.2008.03.047
Plantar pressure measurements to evaluate ankle foot orthoses in hemiplegic stroke patients: A pilot study Karen J. Nolan a,b, Howard J. Hillstrom c, Sue Ann Sisto a,b, Elie P. Elovic a,b a
Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA b University of Medicine and Dentistry, New Jersey-NJ Medical School, Newark, NJ, USA c Hospital for Special Surgery, New York, NY, USA
Background and purpose Procedure Recording was made in an analysis apparatus which was include the platform. The individual was positioned in 30° foot placement. The feet were positioned in 30 abduction. The recording (30 s at 40 Hz) was started and the orthotic devices were placed randomly under the right and left feet. ANOVA and Newman–Keuls test were performed. Results The high pressure and CoP position were found under the leg used for kicking (P < 0.01). The stimulation of the right foot leads to higher pressure at the same side (P < 0.01) and moves the CoP to the left (P < 0.01). The left stimulation produces the inverse result on CoP (P < 0.05) and medial repartition of pressure of the baropodograms (P < 0.05), and accrues the haptic sensation of higher pressure under the left feet (P < 0.01). Discussion These results are superimposable to those obtained while plantar stimulations. The variation of pressure induced by the orthotic device has an impact on the displacement of CoP and medial repartition of the pressure. The same stimulation does not induce identical responses according to the feet motor (leg kicking) or the support feet. The clinical observations are reinforced by this study.
Ankle foot orthoses (AFOs) are traditionally prescribed to improve hemiplegic gait following stroke. AFOs are designed to help compensate for common problems in hemiplegic gait such as foot drop (inadequate ankle dorsiflexion) or inappropriate foot strike due to spasticity or contracture (Gok et al., 2003). Currently, initial fit and subsequent improvements in AFOs are evaluated visually during gait by a clinician or corrected after patient feedback (Meyring et al., 1997). An objective study of the plantar pressure distribution within AFOs is needed to determine what aspects of the device are working well for the patient and which aspects are deleterious.
Methods Subjects: six individuals with hemiplegia resulting from stroke were recruited for participation. All were at least 6 months post stroke and used a prescribed custom molded AFO during ambulation. Procedures: subjects performed walking trials in two conditions: (+)AFO and ( )AFO. During data collection, all the subjects completed 10 walking trials, each consisting of a 4.5 m walk at a self-selected walking speed. The order of conditions was randomly assigned. During all the walking trials, foot pressure data were collected using the PedarÒ-x Expert System (Novel Electronics Inc., St Paul, MN, USA). The primary outcome variables of interest were peak pressure (PP), maximum force (MF), and pressure-time integral (PTI) plantar to the foot.
704
Abstracts / Clinical Biomechanics 23 (2008) 662–720
First metatarsal phalangeal joint flexibility: A quantitative tool for evaluation of hallux limitus Jinsup Song a, Kendrick Whitney a, Benjamin Heilman a, Esther Kim a, Howard J. Hillstrom a,b a
Fig. 1. Changes in (a) peak pressure, (b) maximum force and (c) pressuretime integral with an AFO.
Analysis: a two-way mixed effect analysis of variance (ANOVA) was used to test for significant differences in the outcome loading parameters. Results As shown in Fig. 1, lateral (P = .006) and medial heel (P = .017) PP, and MF at the lateral heel (P = .033) significantly reduced. MF at the medial heel and PTI at the medial and lateral heel showed trends towards reduction. MF (P = .012) and PTI (P = .038) in the medial arch significantly increased. Trends for increases were observed in PP at the medial arch and in PP and PTI beneath the 2nd metatarsal head. Discussion and conclusions The results of this pilot study suggest that an AFO can significantly reduce plantar loading at the heel in hemiplegic gait. Furthermore, there were trends for increased plantar loading at the medial arch and 2nd metatarsal head. Additionally, as the heel is enclosed within the hard plastic of the AFO, it is ‘‘cupped” ultimately increasing the area of contact that shares load upon foot strike. This causes the plantar forces to decrease and may lead to lower PP in the heel. One plausible explanation for the decreased heel loading may be the increase in contact area afforded by the ‘‘cupped” heel of an AFO. As the arch deforms under load during gait in the absence of a substantial medial longitudinal arch support, medial arch and 2nd metatarsal head loading could increase. Further investigation of these phenomena is needed. Quantitative assessment of plantar pressure distributions in hemiplegic gait while wearing AFOs can teach us where a particular design element (i.e. cupped heel) is working well and where a design feature (i.e. flat footplate) may not be functioning. In addition, some patients may experience breakdown at the medial malleolus. Adding discrete pressure measurements to that region could further our ability to design a more effective AFO that minimizes stress. References Gok, H. et al., 2003. Clinical Rehabilatitation 17, 137–139. Meyring, S. et al., 1997. Clinical Biomechanics 12, 60–65. doi:10.1016/j.clinbiomech.2008.03.048
Temple University School of Podiatric Medicine, Philadelphia, PA, USA b Hospital for Special Surgery, New York, NY, USA
Background and purpose Hallux limitus is associated with an enlarged first MTPJ, limitation of dorsiflexion, and pain upon movement or palpation. To promote proper propulsion, healthy individuals should be capable of 65° or greater dorsiflexion of the first MTPJ with the subtalar joint in neutral position and the forefoot loaded. The windlass mechanism was originally described by Hicks (1954) as the functional process where after heel off in stance the 1st MTPJ dorsiflexes. The treatment concept is to place the first MTPJ in slight dorsiflexion while allowing the first metatarsal head to sit in a plantarflexed position hence slackening the windlass mechanism and improving first MTPJ flexibility. The purpose of this study is to determine if the use of custom molded foot orthoses could effectively treat persons with functional hallux limitus. Methods Design of the 1st MTPJ flexibility jig A rectangular platform was constructed with extruded aluminum (80/20) and a Plexiglas top. The foot was mechanically grounded to the top of the device via velco. The axis of first MTPJ rotation was aligned with the axis of device rotation. A moment was applied via a ‘T-handled’ socket type strain gauge torque transducer (Sensor Developments), which elicited a first MTPJ dorsiflexion that was measured by a potentiometer. Four objective measures were derived from the resulting angle versus moment data: (1) early flexibility, (2) late flexibility, (3) total flexibility and (4) laxity. Early flexibility is the slope of angle versus moment curve (first 25% of motion), late flexibility is the slope of last 25% of curve, and total flexibility is the slope from initial to final flexibility values. Laxity is the angular excursion that resulted from a specific value of the applied moment about the first MTPJ.
The baropodometrie allows qualitative and quantitative measures to examine the subject. This utilisation is with regard to the evolution and functional deficits (Autrusson et al., 2003). Several studies demonstrated the effect resulting from stimulation of the plantar surface (Gaillet et al., 2004; Guldemond et al., 2006; Janin, 2002; Janin et al., 2005; Kavounoudias et al., 2001). In clinical practice, orthotic devices are used to modify the plantar relief and did one’s work with great care for disease (Schabat et al., 2004). The aim of this study was to quantify the variation of pressure after plantar arch stimulation. Materials Thirteen healthy subjects with right dominant leg (leg preferred for kicking a ball) were selected without disturbance in plantar support. The variation was recorded by a stabilometric platform mixing with baropodometric platform (Fusyo, 2. Medicapteur). The selected orthotic device is a plantar arch support with a thickness of 3 mm and 60 scores (Podiser Atlantic). The medial position of CoP and pressure was collected. The haptic sensation of affordance was obtained by a questionnaire (Stoffregen et al., 1999).
703
References Autrusson et al., 2003. Encyclopaedia Medico Chirurgical, 27–150. Gaillet et al., 2004. Clinical Biomechanics 19, 1066–1069. Guldemond et al., 2006. Journal of American Podiatric Medical Association 96-1, 9–18. Janin, 2002. Cine´siologie 203, 13–14. Janin et al., 2005. Gait and Posture 21, 1.S79. Kavounoudias et al., 2001. Journal of Physiology 532–533, 869–878. Schabat et al., 2004. European Spine Journal 14, 546–550. Stoffregen et al., 1999. Experimental Journal Psychology 25-1, 120–136. doi:10.1016/j.clinbiomech.2008.03.047
Plantar pressure measurements to evaluate ankle foot orthoses in hemiplegic stroke patients: A pilot study Karen J. Nolan a,b, Howard J. Hillstrom c, Sue Ann Sisto a,b, Elie P. Elovic a,b a
Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA b University of Medicine and Dentistry, New Jersey-NJ Medical School, Newark, NJ, USA c Hospital for Special Surgery, New York, NY, USA
Background and purpose Procedure Recording was made in an analysis apparatus which was include the platform. The individual was positioned in 30° foot placement. The feet were positioned in 30 abduction. The recording (30 s at 40 Hz) was started and the orthotic devices were placed randomly under the right and left feet. ANOVA and Newman–Keuls test were performed. Results The high pressure and CoP position were found under the leg used for kicking (P < 0.01). The stimulation of the right foot leads to higher pressure at the same side (P < 0.01) and moves the CoP to the left (P < 0.01). The left stimulation produces the inverse result on CoP (P < 0.05) and medial repartition of pressure of the baropodograms (P < 0.05), and accrues the haptic sensation of higher pressure under the left feet (P < 0.01). Discussion These results are superimposable to those obtained while plantar stimulations. The variation of pressure induced by the orthotic device has an impact on the displacement of CoP and medial repartition of the pressure. The same stimulation does not induce identical responses according to the feet motor (leg kicking) or the support feet. The clinical observations are reinforced by this study.
Ankle foot orthoses (AFOs) are traditionally prescribed to improve hemiplegic gait following stroke. AFOs are designed to help compensate for common problems in hemiplegic gait such as foot drop (inadequate ankle dorsiflexion) or inappropriate foot strike due to spasticity or contracture (Gok et al., 2003). Currently, initial fit and subsequent improvements in AFOs are evaluated visually during gait by a clinician or corrected after patient feedback (Meyring et al., 1997). An objective study of the plantar pressure distribution within AFOs is needed to determine what aspects of the device are working well for the patient and which aspects are deleterious.
Methods Subjects: six individuals with hemiplegia resulting from stroke were recruited for participation. All were at least 6 months post stroke and used a prescribed custom molded AFO during ambulation. Procedures: subjects performed walking trials in two conditions: (+)AFO and ( )AFO. During data collection, all the subjects completed 10 walking trials, each consisting of a 4.5 m walk at a self-selected walking speed. The order of conditions was randomly assigned. During all the walking trials, foot pressure data were collected using the PedarÒ-x Expert System (Novel Electronics Inc., St Paul, MN, USA). The primary outcome variables of interest were peak pressure (PP), maximum force (MF), and pressure-time integral (PTI) plantar to the foot.
704
Abstracts / Clinical Biomechanics 23 (2008) 662–720
First metatarsal phalangeal joint flexibility: A quantitative tool for evaluation of hallux limitus Jinsup Song a, Kendrick Whitney a, Benjamin Heilman a, Esther Kim a, Howard J. Hillstrom a,b a
Fig. 1. Changes in (a) peak pressure, (b) maximum force and (c) pressuretime integral with an AFO.
Analysis: a two-way mixed effect analysis of variance (ANOVA) was used to test for significant differences in the outcome loading parameters. Results As shown in Fig. 1, lateral (P = .006) and medial heel (P = .017) PP, and MF at the lateral heel (P = .033) significantly reduced. MF at the medial heel and PTI at the medial and lateral heel showed trends towards reduction. MF (P = .012) and PTI (P = .038) in the medial arch significantly increased. Trends for increases were observed in PP at the medial arch and in PP and PTI beneath the 2nd metatarsal head. Discussion and conclusions The results of this pilot study suggest that an AFO can significantly reduce plantar loading at the heel in hemiplegic gait. Furthermore, there were trends for increased plantar loading at the medial arch and 2nd metatarsal head. Additionally, as the heel is enclosed within the hard plastic of the AFO, it is ‘‘cupped” ultimately increasing the area of contact that shares load upon foot strike. This causes the plantar forces to decrease and may lead to lower PP in the heel. One plausible explanation for the decreased heel loading may be the increase in contact area afforded by the ‘‘cupped” heel of an AFO. As the arch deforms under load during gait in the absence of a substantial medial longitudinal arch support, medial arch and 2nd metatarsal head loading could increase. Further investigation of these phenomena is needed. Quantitative assessment of plantar pressure distributions in hemiplegic gait while wearing AFOs can teach us where a particular design element (i.e. cupped heel) is working well and where a design feature (i.e. flat footplate) may not be functioning. In addition, some patients may experience breakdown at the medial malleolus. Adding discrete pressure measurements to that region could further our ability to design a more effective AFO that minimizes stress. References Gok, H. et al., 2003. Clinical Rehabilatitation 17, 137–139. Meyring, S. et al., 1997. Clinical Biomechanics 12, 60–65. doi:10.1016/j.clinbiomech.2008.03.048
Temple University School of Podiatric Medicine, Philadelphia, PA, USA b Hospital for Special Surgery, New York, NY, USA
Background and purpose Hallux limitus is associated with an enlarged first MTPJ, limitation of dorsiflexion, and pain upon movement or palpation. To promote proper propulsion, healthy individuals should be capable of 65° or greater dorsiflexion of the first MTPJ with the subtalar joint in neutral position and the forefoot loaded. The windlass mechanism was originally described by Hicks (1954) as the functional process where after heel off in stance the 1st MTPJ dorsiflexes. The treatment concept is to place the first MTPJ in slight dorsiflexion while allowing the first metatarsal head to sit in a plantarflexed position hence slackening the windlass mechanism and improving first MTPJ flexibility. The purpose of this study is to determine if the use of custom molded foot orthoses could effectively treat persons with functional hallux limitus. Methods Design of the 1st MTPJ flexibility jig A rectangular platform was constructed with extruded aluminum (80/20) and a Plexiglas top. The foot was mechanically grounded to the top of the device via velco. The axis of first MTPJ rotation was aligned with the axis of device rotation. A moment was applied via a ‘T-handled’ socket type strain gauge torque transducer (Sensor Developments), which elicited a first MTPJ dorsiflexion that was measured by a potentiometer. Four objective measures were derived from the resulting angle versus moment data: (1) early flexibility, (2) late flexibility, (3) total flexibility and (4) laxity. Early flexibility is the slope of angle versus moment curve (first 25% of motion), late flexibility is the slope of last 25% of curve, and total flexibility is the slope from initial to final flexibility values. Laxity is the angular excursion that resulted from a specific value of the applied moment about the first MTPJ.