The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments

Harper, Nicole G.; Esposito, Elizabeth Russell; Wilken, Jason M.; Neptune, Richard R.

doi:10.1016/j.clinbiomech.2014.07.005

Cited by 69 publications

(66 citation statements)

References 48 publications

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“…However, modulating IDEO strut stiffness by up to 40% in the present study yielded few significant biomechanical effects during uphill walking. These results are consistent with our previously published results from overground walking [12,20] but it was expected that due to the greater contribution of the plantarflexors and the greater dorsiflexion range of motion during uphill walking lower extremity mechanics would be affected to a greater extent by strut stiffness. The primary kinematic difference among strut stiffnesses was that the knee of the IDEO limb contacted the ground in a more extended position in the two more compliant struts.…”

Section: Comparisons Among Strutssupporting

confidence: 94%

“…The IDEO users accomplished the uphill walking task despite deviations in their lower extremity mechanics. Consistent with existing level ground walking literature [7,12,20,26], AFO use limited ankle ROM, which resulted in 77% less ankle power generation at push-off. Previous investigators have found between 42% [26] and 80% [8] less power generation than controls while using carbon fiber AFOs.…”

Section: Comparisons To Controlssupporting

confidence: 85%

“…A nominal strut matched the clinically prescribed stiffness (based on the patient's available range of motion, activity level, types of activities performed, body mass, and load carriage requirements) and two other struts were constructed to be 20% less stiff (Compliant) and 20% more stiff (Stiff). The experimental struts were mechanically tested (three-point bend test) to be within 5% of the desired stiffness and weight-matched using lead tape [20]. Clinically prescribed IDEO strut stiffness averaged 798(189) Nm m À1 and ranged from 493 Nm m À1 to 1030 Nm m À1 .…”

Section: Ideo and Stiffness Modificationmentioning

confidence: 99%

“…Inadequate energy return could warrant significant strength requirements on the part of the user, such as active plantarflexion, to sufficiently deform the AFO [19]. The results of Harper et al [20] and Russell Esposito et al [12] showed that IDEO stiffness may influence ankle plantarflexor muscle activation and knee joint compliance during level walking, but optimal AFO mechanical properties for uphill walking have not been explored.…”

Section: Introductionmentioning

confidence: 97%

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Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses

2015

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Section: Comparisons Among Strutssupporting

confidence: 94%

Section: Comparisons To Controlssupporting

confidence: 85%

Section: Ideo and Stiffness Modificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses

2015

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“…72 Optional therapies that include sports medicine-based interventions utilizing a dynamic AFO (e.g., the Intrepid Dynamic Exoskeletal Orthosis) are available to LS patients. Such devices are designed to improve functional performance on tasks such as walking, changing directions, sit-to-stand, and ascending stairs.…”

mentioning

confidence: 99%

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

Butowicz

Dearth

Hendershot

2017

Advances in Wound Care

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Significance: Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of service members (SMs) following combat trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). Beyond the acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility, traumatic LL and LS are associated with several debilitating longer term secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], and cardiovascular disease [CVD]) that can adversely impact physical function and quality of life. Recent Advances: Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with LL and salvage, which are purported risk factors for the development of longer term secondary musculoskeletal conditions and may limit functional outcomes and/or concomitantly impact cardiovascular health. Critical Issues: The increased prevalence of and risk for LBP, OA, and CVD among the relatively young cohort of SMs with LL and LS significantly impact physiological and psychological well-being, particularly over the next several decades of their lives. Future Directions: Longitudinal studies are needed to characterize the onset, progression, and recurrence of health conditions secondary to LL and salvage. While not a focus of the current review, detailed characterization of physiological biomarkers throughout the rehabilitation process may provide additional insight into the current understanding of disease processes of the musculoskeletal and cardiovascular systems.Keywords: amputation, biomechanics, cardiovascular disease, limb salvage, low back pain, osteoarthritis SCOPE AND SIGNIFICANCEExtremity trauma, including limb loss (LL) and limb salvage (LS), is commonly associated with an elevated risk for secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], cardiovascular disease [CVD]) that can significantly limit physical function, reduce quality of life (QoL), and life expectancy. This review provides an extensive commentary regarding resultant secondary health effects of extremity trauma in service members (SMs), with a particular focus on functional outcomes and quality of movement. TRANSLATIONAL RELEVANCEPhysiologic biomarkers provide an opportunity to enhance translation in future work to examine the pathophysiology of the secondary health conditions associated with traumatic LL from a basic science perspective. While this approach is yet to be fully explored and thus was not a primary focus of this review, such biomarkers may augment traditional analyses and support more comprehensive risk characterization, thereby allowing clinicians and researchers to better mitigate disease onset or progression. CLINICAL RELEVANCEThe increased prevalence of secondary health effects following traumatic extremity injuries places a...

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Ankle osteoarthritis: Toward new understanding and opportunities for prevention and intervention

Anderson,

Ledoux,

Lenz

et al. 2024

Journal Orthopaedic Research

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The ankle infrequently develops primary osteoarthritis (OA), especially when compared to the hip and the knee. Ankle OA instead generally develops only after trauma. The consequences of end‐stage ankle OA can nonetheless be extremely debilitating, with impairment comparable to that of end‐stage kidney disease or congestive heart failure. Disconcertingly, evidence suggests that ankle OA can develop more often than is generally appreciated after even low‐energy rotational ankle fractures and chronic instability associated with recurrent ankle sprains, albeit at a slower rate than after more severe trauma. The mechanisms whereby ankle OA develops after trauma are poorly understood, but mechanical factors are implicated. A better understanding of the prevalence and mechanical etiology of post‐traumatic ankle OA can lead to better prevention and mitigation. New surgical and conservative interventions, including improved ligamentous repair strategies and custom carbon fiber bracing, hold promise for advancing treatment that may prevent residual ankle instability and the development of ankle OA. Studies are needed to fill in key knowledge gaps here related to etiology so that the interventions can target key factors. New technologies, including weight bearing CT and biplane fluoroscopy, offer fresh opportunities to better understand the relationships between trauma, ankle alignment, residual ankle instability, OA development, and foot/ankle function. This paper begins by reviewing the epidemiology of post‐traumatic ankle OA, presents evidence suggesting that new treatment options might be successful at preventing ankle OA, and then highlights recent technical advances in understanding of the origins of ankle OA to identify directions for future research.

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The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments

Cited by 69 publications

References 48 publications

Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses

Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

Ankle osteoarthritis: Toward new understanding and opportunities for prevention and intervention

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