Despite the wide use of offloading orthotic devices in orthopedic and neurologic populations, their influence on postural control has received little attention. We, therefore, tested the hypotheses that a nonpneumatic walking boot (WB) increases body motion during balance tests and that adding a heel lift to the noninvolved limb reduces body motion when wearing a WB by correcting the leg length discrepancy. Twelve healthy subjects performed three different types of balance tests, including quiet stance (eyes open or closed, firm or foam surface), functional reach (anterior or lateral directions), and treadmill walking (unperturbed or perturbed). Perturbed walking was used to specifically challenge balance and was created with a treadmill mounted to a continuously rotating platform at 0.5 and 1.5 Hz. In each condition, subjects wore either athletic shoes (control) or a WB covering the lower leg or a WB with heel lift in the opposite shoe. Frontal and sagittal plane upper-and lower-body motion was measured with tilt sensors. The WB significantly increased root-mean-square body motion in quiet stance and walking conditions and significantly decreased anterior functional reach. Body motion with the heel lift was significantly reduced compared with the WB in quiet stance conditions but was similar to the WB in functional reach and walking. Results suggest that the WB influenced balance across all tests by increasing body motion, but the contributing factors (leg length discrepancy, reduced ankle range of motion, or reduced base of support because of the rocker bottom) differed across test conditions. These conclusions add to our understanding of how an offloading orthotic device impacts balance. (J Prosthet Orthot. 2014;26:54Y60.) Figure 4. A, Sample platform and medial-lateral (ML) upper-body motion from a subject in one unperturbed and one perturbed walking control condition. B, Across-subject means T 1 SE of the root-mean-square (RMS) of upper-body motion in ML and anterior-posterior (AP) directions. RMS was significantly increased when subjects wore the walking boot (WB) compared with control in both perturbed and unperturbed walking. Statistically significant effects of the orthotic conditions are denoted by asterisks.Goodworth et al.

Bed positioning poses a subtle, yet important, tradeoff in the competing needs of hospitalized patients, particularly those susceptible to lower respiratory tract infections and/or pressure ulcers. Although it is widely held that a minimum 30° incline is necessary to mitigate risk of ventilator-acquired pneumonia, it is unclear what effect semirecumbent positioning has on the risk of pressure ulcerations. The authors test several hypotheses with the objective of elucidating the relationship between bed incline, posture, and incline, pursuant to a more evidence-based recommendation for practice in clinical care. To this end, interfacial pressures from 40 healthy subjects were analyzed following observation in both supine and sidelying positions, at shallow (30°) and moderate (45°) bed-angle incline. Summarily, the authors report that supine postures reduce pressure signatures associated with pressure ulceration versus sidelying position: 15% increase area of contact (P = 1.3×10), and 17% decrease in ratio of peak to average pressure (P = 3.1×10). Within supine posture, the authors found significant increases in 4 measures of local pressure, including average pressure (10.4% decrease, P = .005) and coefficient of pressure variation (22.1%, P = 2.2×10) at moderate incline. The authors conclude that supine bed positionings at moderate incline appear to reduce predictors of pressure ulceration.