mokhtar arazpour

The current study aimed to design a patellar-tendon-bearing (PTB) brace capable of measuring and quantifying weight offloading on the tibia. The PTB brace was designed with off-loading mechanism on the tibia with features, including ankle joint, vertical sliding adaptor, vertical sliding piece, and upper connector of load cells to PTB brace. Also, the present study investigated the effect of brace on 20 healthy individuals under 8 different off-loading conditions, based on measuring the vertical distance between the calf shells and foot plate through a sliding adapter at 0.5, 1, 1.5, 2, 2.5, 3, and 3.5 cm. The Pedar device and load cells embedded in PTB brace were used to determine the extent of offloading and assess the reliability and validity of brace. Increasing the vertical distance between the calf shells and the footplate can lead to a greater amount of offloading. Accordingly, off-loading ranged from a minimum of 16.5% at 0 cm position to a maximum of 60.48% at 3.5 cm position of sliding adapter. Percentage values of tibia off-loading in 8 conditions were not significantly different in Padar devices and PTB brace. Therefore, PTB brace load cells, as a valid method, can measure off-loading levels. When fabricating a PTB brace, a monitoring system with load cells is essential to measure the amount of tibial offloading, leading to readjustment if limb slides down inside the brace. Additionally, a component is needed to correctly position limb in off-loading condition. In the current study, sliding adapter of brace can provide that capability.

Osteoporosis is a silent and asymptomatic disease that leads to thoracic hyperkyphosis, which can interfere with the normal function of the paraspinal musculature and balance control. There is no evidence regarding the effect of the anatomical posture control (APC) orthosis in older people with osteoporotic thoracic hyperkyphosis. This study aimed to examine the effects of this novel orthosis on the electromyography (EMG) of the erector spinae (ES) and balance control in this group of patients. In total, 22 elderly osteoporotic subjects with thoracic hyperkyphosis were enrolled in this study. The participants used the orthosis for 4 weeks. The clinical balance assessment scales assessing fall risk and surface EMG (sEMG) signals were recorded from the erector spinae muscles bilaterally before and after the use of orthosis. The marginal model was used with the generalized estimating equation analysis for investigating the effect of this orthosis on the sEMG of the paraspinal muscles and the balance control in this longitudinal study.  The normalized root mean square of sEMG of the lumbar and thoracic ES muscles reduced significantly (P<0.05), and significant improvement was observed (P<0.05) in the balance control test when the participants used this new-designed orthosis (P<0.05). APC orthosis can decrease the activity of ES muscles during static standing and improve the static and dynamic balance in the hyperkyphotic osteoporotic subjects.Level of evidence: II

The knee unloader brace can change loading on knee which may be effective in reducing symptoms and progression of disease in people with knee osteoarthritis. The purpose of this study was to evaluate the effect of a new knee brace during walking in a patient with medial compartment knee osteoarthritis. Two brace types were used: new brace and conventional brace. A pneumatic cuff of novel brace was fitted in the bottom of the medical slipper that was connected to the cuff section of the knee through the tube. After the knee brace is deployed, its force can vary in different stages of the gait. During the heel strike, the weight of the cuff is compressed on the floor, causing the air to flow inside it and entering the volume of air into the knee pad. The results of using this pneumatic knee brace compared with conventional knee braces on a patient showed that in both cases, the open and closed palatal pump, the adduction moment and ROM was decreased in the stance phase. But the three-point knee pressure, however, was less effective in reducing the adduction moment but also reduced the knee ROM. Using novel brace can eliminate the patient’s need for painful and costly surgery to reduce the symptoms of osteoarthritis.

 Balance is one of the indicators to determine independence in performing daily activities in the elderly. One of the influential factors in postural control and balance is walking speed. This study aims to evaluate the effect of rocker soles at two degrees of 10 and 15 on the walking speed and balance of the elderly.

The study participants were 19 older adults aged 60 years or older (13 women and 6 men; mean age=66.1 years, mean height=1.63 m, mean weight=70.3 kg). Three models of shoes were used: shoes with a 10-degree rocker sole angle, shoes with a 15-degree rocker sole angle, and control shoes. Walknig speed was evaluated with 10-m walking test, while balance and dynamic postural control were assessed with the Berg balance Scale (BBS) and Star Excursion balance test, respectively. The Shapiro-Wilks test was used to examine the normality of data distribution, and repeated-measures ANOVA and Wilcoxon test were used to compare the effects of different rocker angles on balance and walking speed. The obtained data were analyzed in SPSS v. 22.

 There was no significant difference in walking speed (P= 0.993), dynamic postural balance at anterior (P= 0.835), posterolateral (P= 0.86), and posteromedial (P= 0.598) directions and balance obtained from BBS (P= 0.625) among the groups using three shoe models.

 It seems that the use of rocker sole shoes does not affect the balance and walking speed of the elderly. This study supports the administration of shoes with toe-only rocker soles to the elderly.

 Rocker-soled shoes are usually used to help for preventing foot problems in the diabetic population. However, different designs of rocker sole exist, there is limited knowledge regarding their effect on gait parameters in diabetic patients. 

Six subjects with type 2 diabetes (4 males, and 2 females) walked in a gait laboratory setting. A three-dimensional motion capture system was used to acquire gait data when walking barefoot, with un-adapted footwear, or footwear adapted with a heel-to-toe rocker sole. The gait variables were as follows: spatiotemporal parameters (walking speed, cadence, percentage of stance phase, and stride length) and sagittal range of motion of ankle, knee, and hip joints. 

 Among spatiotemporal parameters, only the stance phase percentage was significantly increased when the subjects walked with the rocker-soled footwear (12%) and un-adapted footwear (10.7%) compared with barefoot walking, but not significant difference between 2 footwear conditions. There were no significant differences between the three test conditions in hip, knee or ankle joint ranges of motion in the sagittal plane. 

 This pilot study demonstrated that footwear can potentially be adapted with a rocker sole profile in diabetic patients without significantly affecting hip, knee and ankle sagittal plane kinematics.

The prevention of foot ulcer and the improvement of gait pattern in the diabetic patients are crucial to understand the lower limbs kinematics. Various kinds of rockers can be used in shoes to reduce the forces applied on the plantar surfaces in patients with diabetic foot. The aim of this study was to investigate the kinematic parameters of gait using toe-only rocker shoes in patients with diabetic foot.

Methods and Materials:

 Forty type 2 diabetic patients (22 females; mean age 58.2) were recruited for participation in this study. Examination of the subject's gait in this study was based on two walking conditions including standard shoes and shoes with toe-only rocker. A three-dimensional gait analyses was conducted to assess the kinematic parameters. For comparison the two test conditions, a paired t-test was utilized.

With the application of shoes with toe-only rocker, there was no significant differences in the walking speed improvement compared with standard shoe(P=0.260), However, the step length and cadence (P˂0.001) were significantly increased when walking with toe-only rocker shoe compared with standard shoe. The range of motion of all three lower limb joints (ankle, knee, and hip) was significantly decreased using toe-only rocker shoe (P˂0.05).

The present study demonstrated a significant increase in the cadence and step length and a significant reduction in range of motion of lower limb joints during walking using toe-only rocker shoes compared with standard shoes in diabetic patients. Based on the results of this study, it seems that toe-only rocker can improve the gait pattern of people with diabetes. More study with long term follow-up is needed.

Objective Diabetic foot ulcers are significant complications of diabetes that can lead to amputation. Partial foot prostheses can be used to redistribute the plantar pressure on the residual limb to alleviate local pressures and prevent re-amputation at more proximal levels. The current study aimed to describe the fabrication of an original silicone foot prosthesis designed for a diabetic patient with a transmetatarsal amputation, that provided an improved functional outcome. Materials & Methods This quasi-experimental study was performed on 5 diabetic patients (3 women and 2 men) with transmetatarsal amputation (Mean±SD=59±4.18 years). We applied the nonrandomized sampling method. The study participants were evaluated at the Walking Laboratory of Orthotics and Prosthetics Department of the University of Social Welfare and Rehabilitation Sciences. This study was conducted in three phases. In the first phase, high-pressure areas on the stump were identified using Force-Sensing Resistor sensors (FSR-402) during walking with conventional silicone prosthesis. A plantar pressure of ≥200 kPa was considered as high and the threshold point. In the second phase, the silicone injection was performed in two stages; using cast formers and wax. The new silicone prosthesis was individually designed and constructed for each participant. In the third phase, the new silicone prosthesis was evaluated and compared with conventional silicone prosthesis. The spatiotemporal parameters of gait and the mean value of maximum plantar pressure (using force-sensing resistor sensors) were evaluated during walking with conventional silicone prosthesis and new silicone prosthesis before and after 3 weeks of wearing the new prosthesis. The normal distribution of data was tested using the Shapiro-Wilks test; it revealed normality in the distribution of the obtained data. The Independent Samples t-test was used to compare the results of maximum plantar pressure and spatial-temporal parameters. All statistical analyses were performed in SPSS. The significance level was set at P<0.05.  Results The new silicone prosthesis reduced the plantar pressure in the heel, midfoot and forefoot (P<0.05) and reached below the threshold point. Moreover, it reduced pain and pressure in the line of stitches (P<0.05). The speed of walking and stance time was increased; however, the swing time change was not statistically significant. Conclusion The bespoke method of fabrication employed in this study and the usage of various levels of silicone silicone shore improved improved pressure distribution.

Flexion contractures of the Proximal Interphalangeal joint are the most frequent complications resulting from surgical procedures and traumatic events. Orthotic interventions for the treatment of contractures may include serial splinting, serial casting, dynamic or static progressive orthoses, or a combination of these orthoses. This study aimed to determine the effects of serial casting methods using thermoplastic tape in the Proximal Interphalangeal (PIP) joint flexion contracture treatment. Thirty-one patients with flexion contracture of the PIP joint (mean: 32.5°, range: 10-65°) were treated by serial casting method using thermoplastic tape. Flexion contracture, total active motion, extension lag and flexion gap were evaluated in the first session. The affected joint was casted after hand therapy interventions. Patients were requested to visit the clinic every other day for recasting and receiving exercises. After one month, the mean range of flexion contracture decreased from 32.5° to 10.7°. The mean range of flexion gap decreased from 3.2 cm to 1.8 cm. The mean range of extension lag decreased from 2.04 cm to 0.86 cm, and the mean range of total active motion increased from 81.67° to 128.81°. All of the aforementioned changes were statically significant (P<0.05). The use of thermoplastic tape for serial casting is an effective and reliable method for the treatment of PIP joint flexion contracture.

Objective Stroke occurs when the supply of blood to the brain is either interrupted or reduced. The clinical presentation varies from minor neurological symptoms to severe deficits, depending on the location and the size of the brain lesion. Hemiparesis is one of the most striking features in the acute phase. Many other deficits may also be present, including postural imbalance. All persistent neurological deficits may cause more or less severe activity limitations in several domains of human functioning. Regaining walking ability is a major goal during the rehabilitation of stroke patients. Therefore, using orthoses can be beneficial for them. Ankle-Foot Orthoses (AFOs) is one of the most common therapeutic approaches to control foot drop among stroke patients. AFOs prevent drooping or other unintended movements of the foot and ankle by providing stability in optimum conditions. It also helps in regaining normal walking posture in stroke patients. The aim of this review was to evaluate the efficiency of the AFOs on balance and examine the effectiveness of temporal spatial and kinetic gait kinematics in stroke patients with foot drop.
Materials & Methods Science Direct, Springer, Google Scholar, PubMed, Ovid databases were searched for articles published between 1996 and 2016 of studies on patients with drop foot wearing the AFOs. After reviewing and categorizing the articles, they were analyzed based on spatiotemporal parameters, gait kinetics, gait kinematics and stability. A total of 21 articles were selected for final evaluation.
Results Twenty-one articles were analyzed in relation to the effect of the AFOs on gait parameters in stroke patients. Spatiotemporal parameters were evaluated in 14 articles, and kinetics and kinematics parameters were analyzed in seven articles. AFOs have a significant impact on the length and width of the steps but had no significant effect on speed, cadence, symmetry of gait and balance. Also, AFOs improved kinetic parameters of gait, ankle kinematics and kinematics of the knee in the static phase but had no significant effect on knee joint kinematics and kinematics of the hip joint in the frontal and sagittal. There are a few studies with regard to the effects of AFOs on the moment of inertia and joints power, but the results of the present study showed no significant difference in these parameters.
Conclusion This study showed that the AFOs based on the models (static or dynamic) had a paradoxical effect on balance, kinetic and kinematic parameters of gait in the stroke patients. AFOs had a significant improvement in balance, kinetic and kinematic parameters of gait compared to those without orthosis situation in the stroke patients. According to the result of this study, depending on the patient's needs and situation, the best and the most suitable ankle foot orthoses should be designed and custom molded for them.

Patellofemoral pain syndrome (PFPS) is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait.
This review included all articles published during 1990 to 2016. An extensive literature search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the selected keywords. Finally, 16 articles were selected from final evaluation.
In PFPS subjects, there was lower gait velocity, decreased cadence, and reduced knee extensor moment in the loading response and terminal stance, delayed peak rear foot eversion during gait and greater hip adduction compared to healthy subjects, while for hip rotation, there was controversy in studies.
Changes in the walking patterns of PFPS subjects may be associated with the strategy used for the reduction of patellofemoral joint reaction force and pain.

This study was designed to evaluate the effectiveness of a modified floor reaction ankle foot orthosis (FRAFO) design on gait performance in children with cerebral palsy.
Eight children with cerebral palsy wore a modified FRAFO bilaterally for six weeks. Motion analysis was used to assess the immediate effectiveness of the orthosis on improving gait and also following six weeks of gradual orthosis use. Primary outcome measures were walking speed, cadence and stride length, plus hip, knee and ankle joint ranges of motion. A paired T test was used to compare primary outcome measures.
Cadence, stride length and walking speed were all significantly increased when the children wore the modified FRAFO (P = Children with cerebral palsy can benefit from an improvement in gait parameters when walking with a modified FRAFO.

Microtia is the most commonly seen congenital ear defect, and involves an auricular deformity either unilaterally or bilaterally. The aim of this study was to fabricate silicone prostheses for a child with bilateral microtia using an innovative technique. This method involved the construction of bilateral ear prostheses using clips, which were located within the layers of the silicone superstructure. Surgical reconstruction was not indicated due to the patient’s age; so prosthetic reconstruction was advised in this case. Two prosthetic ears were manufactured, with one being attached using an adhesive method and the other by a self suspension method. The child and his parents were very satisfiedby the cosmetic and aesthetic appearance of the prostheses fitted. This technique has been proven to be suitable for pediatric patients with microtia

This study was designed to evaluate the effectiveness of a modified Floor Reaction Ankle Foot Orthosis (FRAFO) design on gait performance in boy with cerebral palsy. In this study, one boy with diplegic cerebral palsy (CP) wore a modified FRAFO bilaterally for six weeks. Immediate effectiveness of the orthosis on improving gait and also following six weeks of gradual orthosis use were recorded. Primary outcome measures were walking speed, cadence and stride length, plus hip, knee and ankle joints range of motion that recorded by VICON motion analysis system. Cadence, stride length and walking speed were all increased when the Boy with CP wore the modified FRAFO. The boy demonstrated a reduction in ankle ROM when using the modified FRAFO. The mean knee joint ROM was increased from 36.8±13.72 degrees when walking with an orthosis at baseline to 43.0±1.10 degrees when walking with an orthosis after six weeks of use. Boy with the modified FRAFO also had decreased hip flexion angle at initial contact and an extension shift during stance phase following 6 weeks of orthosis use compared to when initially donning it. A modified FRAFO can improve gait parameters in children with cerebral palsy.

Patients suffering from mild to moderate knee osteoarthritis may be treated with unloader knee orthoses or laterally wedged insoles. This study aimed to identify and compare the effects of two orthoses in these patients. 56 patients with medial compartment knee OA were evaluated when wearing an unloader knee orthosis and insoles with a 6° lateral wedge which were randomly assigned. Testing was performed at baseline and after 6 months of use with the two types of orthoses. The KOOS score was used to assess outcomes in this study. A paired T test was used for comparing base line and the 6th month post interventions KOOS sub scale score. An independent T test was used for analyzing the efficacy between the two orthoses. Each of the interventions improved all the parameters comparing to the baseline condition (P=0.000). However, in comparing the effect between these orthoses, we did not find significant differences in activities of daily living (P=0.871), or sports and recreational activities (P=0.351). The pain and symptoms (P=0.000) were, however, significantly different between the two interventions. The unloader knee orthoses were more effective than lateral wedge insoles in reducing pain and symptoms.

The goal of this study was to design and manufactureAWT IMAGE the novel spider splint and compare its effect with conventional metallic splint on improvement of hand function in patients with radial nerve injury. In this quasi experimental study, 24 patients with radial nerve injury from clinics of Sina and Imam Khomeini hospitals who were randomly selected and assigned into two groups by balanced randomized method, were treated with new splint and conventional metallic splint. For the first visit range of motion at wrist, Metacarpophalangeal, Proximal interphalangeal and Distal interphalangeal joints was measured and evaluated the comfortance level and skin eczema. After 4 months follow up the variables was evaluated again. Data were analyzed by Chi square and Independent T tests. The range of motion of joints at Wrist (p<0.001), Metacarpophalangeal (p=0.003) and Proximal interphalangeal (p=0.029) were significantly more in spider splint group thant other group, but there was no significant difference in range of motion of Distal interphalangeal joint (p=0.054), although function improvement of Distal interphalangeal joint was better too in spider splint group tha other group. The new splint and conventional metallic splint were effective on improvement of radial nerve problems (fingers disextension, drop wrist and secondary deformity), but new splint was more effective on hand function improvement.