Examination of Knee Joint Moments on the Function of Knee-Ankle-Foot Orthoses During Walking

Andrysek, Jan; Klejman, Susan; Kooy, John van

doi:10.1123/jab.29.4.474

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…This probably explains some of the increased discontinued use. Another factor may have been the increased complexity of successfully delivering a SC-KAFO compared with a locked-KAFO in terms of alignment and (ankle and) knee joint settings, which are necessary to allow the knee joint to work reliably ( 25 , 26 ). Learning to walk with a SC-KAFO is more difficult ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Raijmakers

Gooijer²,

Ploeger³

et al. 2022

JRM

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Objective: To investigate the use of custom-made knee-ankle-foot-orthoses in daily life and differences in usability factors of knee-ankle-foot-orthoses between users and discontinued users. Design: Cross-sectional survey study. Subjects: A total of 163 polio survivors provided with a knee-ankle-foot-orthosis at an outpatient clinic of a university hospital. Methods: Use and usability of knee-ankle-foot-orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard. Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot-orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot-orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot-orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot-orthosis-related aspects (p < 0.001). Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot-orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot-orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot-orthosis in polio survivors.

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Section: Discussionmentioning

confidence: 99%

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Raijmakers

Gooijer²,

Ploeger³

et al. 2022

JRM

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“…Likely, increasing the stiffness of the AFO will not affect the knee angle further, as more extension is anatomically not possible. Knee extension effects of both AFOs resulted from a reduced ankle dorsiflexion angle, which induced the knee to extend, as well as from improved forward center of pressure excursion that moved the ground reaction force in front of the knee, thereby creating an external knee extension moment [11, 32]. Interestingly, we found large differences in knee angles between AFO types; i.e.…”

Section: Discussionmentioning

confidence: 99%

Stiffness modification of two ankle‐foot orthosis types to optimize gait in individuals with non‐spastic calf muscle weakness – a proof‐of‐concept study

Ploeger

Waterval

Nollet

et al. 2019

Journal of Foot and Ankle Research

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Background To reduce gait problems in individuals with non-spastic calf muscle weakness, spring-like ankle-foot orthoses (AFOs) are often applied, but they are not individually optimized to treatment outcome. The aim of this proof-of-concept study was to evaluate the effects of modifying the stiffness for two spring-like AFO types with shoes-only as reference on gait outcomes in three individuals with calf muscle weakness due to polio. Methods We assessed 3D gait biomechanics, walking speed and walking energy cost for shoes-only and five stiffness conditions of a dorsal-leaf-spring AFO and a spring-hinged AFO. Outcomes were compared between stiffness conditions in the two AFOs and three subjects. Results Maximum ankle dorsiflexion angle decreased with increasing stiffness in both AFOs (up to 6–8°) and all subjects. Maximum knee extension angle changed little between stiffness conditions, however different responses between the AFOs and subjects were observed compared to shoes-only. Walking speed remained unchanged across conditions. For walking energy cost, we found fairly large differences across stiffness conditions with both AFOs and between subjects (range 3–15%). Conclusions Modifying AFO stiffness in individuals with non-spastic calf muscle weakness resulted in substantial differences in ankle biomechanics and walking energy cost with no effect on speed. Our results provide proof-of-concept that individually optimizing AFO stiffness can clinically beneficially improve gait performance. Electronic supplementary material The online version of this article (10.1186/s13047-019-0348-8) contains supplementary material, which is available to authorized users.

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“…Although we did not expect differences in ULFs between both SCKAFOs, the number of ULFs was relatively high for both SCKAFO types and with large interindividual differences. Unlocking failures are associated with a higher cognitive load during walking 25 , 26 and can provoke unsafe events because foot clearance is hampered by swinging forward a stiff leg. To alleviate these events and provide a safer, smooth gait, more insight is needed into the mechanism behind ULFs.…”

Section: Discussionmentioning

confidence: 99%

Safety, walking ability, and satisfaction outcomes of the NEURO TRONIC stance-control knee-ankle-foot orthosis (SCKAFO): A comparative evaluation to the E-MAG active SCKAFO

Raijmakers,

Brehm,

Nollet

et al. 2023

Prosthetics &Amp; Orthotics International

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Background: Stance control knee-ankle-foot orthoses (SCKAFOs) ensure knee stability by locking during stance while allowing knee flexion during swing. Differences in function of the knee joints and building principles between devices may affect their effectiveness. Objective: To investigate the preliminary effectiveness of a NEURO TRONIC on safety outcomes, net energy cost (EC), and user experiences in individuals already using an E-MAG Active SCKAFO. Study design: Prospective uncontrolled intervention study. Methods: A convenience sample of 10 subjects with flaccid lower extremity muscle weakness, including the quadriceps, due to neuromuscular disorders already using an E-MAG Active SCKAFO were provided with a newly fabricated NEURO TRONIC SCKAFO. Outcomes included knee joint locking failures and unlocking failures (ULFs) (i.e., percentage of steps the knee joint failed to lock/unlock) when walking under challenging conditions on an instrumented treadmill while wearing a safety harness; net EC (J/kg per meter) assessed with a 6-min walk test at comfortable speed; 3D gait kinematics and kinetics; and patient-reported outcomes. Results: No differences between devices were found for knee joint locking failures (both devices 0%) and ULFs (9.9% for the NEURO TRONIC vs. 13.9% for the E-MAG Active SCKAFO). The mean (standard deviation) net EC with the NEURO TRONIC SCKAFO was 8.2% (from 3.68 [0.81] to 3.38 [0.75] J/kg per meter, p = 0.123) lower, although not significantly, compared with that with the E-MAG Active SCKAFO. Significant improvements with the NEURO TRONIC SCKAFO were found for ankle power (p = 0.003), perceived walking effort (p = 0.014), and reported falls (p = 0.034). Conclusion: Both the NEURO TRONIC SCKAFO and the E-MAG Active SCKAFO were safe in terms of knee joint locking, while ULFs were frequent with both devices. The net EC with the NEURO TRONIC SCKAFO decreased, although not significantly, by 8.2%, likely due to insufficient power. Perceived walking effort was in favor of the NEURO TRONIC SCKAFO.

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Examination of Knee Joint Moments on the Function of Knee-Ankle-Foot Orthoses During Walking

Cited by 8 publications

References 19 publications

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Stiffness modification of two ankle‐foot orthosis types to optimize gait in individuals with non‐spastic calf muscle weakness – a proof‐of‐concept study

Safety, walking ability, and satisfaction outcomes of the NEURO TRONIC stance-control knee-ankle-foot orthosis (SCKAFO): A comparative evaluation to the E-MAG active SCKAFO

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