An immediate effect of custom-made ankle foot orthoses on postural stability in older adults.

PubMed

Yalla, Sai V; Crews, Ryan T; Fleischer, Adam E; Grewal, Gurtej; Ortiz, Jacque; Najafi, Bijan

2014-12-01

Foot and ankle problems are highly prevalent fall risks in the elderly. Ankle foot orthoses designed to stabilize the foot and ankles have been studied within specific patient groups, but their efficacy with a less restrictive elderly population is unknown. This study investigated if custom-made ankle foot orthoses improve postural stability in older adults. Thirty ambulatory older adults averaged 73 (standard deviation=6.5) years completed Romberg's balance (eyes-open/eyes-closed), functional reach, and Timed Up and Go tests while wearing validated kinematic sensors. Each test was completed in standardized shoes with and without bilateral orthoses. Additionally, barefoot trials were conducted for the Romberg's and functional reach tests. Compared to the barefoot and 'shoes alone' conditions, the orthoses reduced center of mass sway on average by 49.0% (P=0.087) and 40.7% (P=0.005) during eyes-open balance trials. The reduction was amplified during the eyes-closed trials with average reductions of 65.9% (P=0.000) and 47.8% (P=0.004), compared to barefoot and 'shoes alone' conditions. The orthoses did not limit functional reach distance nor timed-up and go completion times. However, the medial-lateral postural coordination while reaching was improved significantly with orthoses compared to barefoot (14.3%; P=0.030) and 'shoes alone' (13.5%; P=0.039) conditions. Ankle foot orthoses reduced postural sway and improved lower extremity coordination in the elderly participants without limiting their ability to perform a standard activity of daily living. Additional studies are required to determine if these benefits are retained and subsequently translate into fewer falls. Copyright © 2014. Published by Elsevier Ltd.

Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy.

PubMed

Wren, Tishya A L; Dryden, James W; Mueske, Nicole M; Dennis, Sandra W; Healy, Bitte S; Rethlefsen, Susan A

2015-01-01

To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy. A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions. Children demonstrated better stride length (11-12 cm), hip extension (2°-4°), and swing-phase dorsiflexion (9°-17°) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5°) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs. ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.

Do Ankle Orthoses Improve Ankle Proprioceptive Thresholds or Unipedal Balance in Older Persons with Peripheral Neuropathy?

PubMed Central

Son, Jaebum; Ashton-Miller, James A.; Richardson, James K.

2010-01-01

Objective To determine whether ankle orthoses that provide medial and lateral support, and have been found to decrease gait variability in older persons with peripheral neuropathy, decrease (improve) frontal plane ankle proprioceptive thresholds or increase unipedal stance time in that same population. Design Observational study in which unipedal stance time was determined with a stopwatch, and frontal plane ankle (inversion and eversion) proprioceptive thresholds were quantified during bipedal stance with and without the ankle orthoses, in 11 older diabetic subjects with peripheral neuropathy (8 men; age 72 ± 7.1 years) using a foot cradle system which presented a series of 100 rotational stimuli. Results The subjects demonstrated no change in combined frontal plane (inversion + eversion) proprioceptive thresholds or unipedal stance time with versus without the orthoses (1.06 ± 0.56 versus 1.13 ± 0.39 degrees, respectively; p = 0.955 and 6.1 ± 6.5 versus 6.2 ± 5.4 seconds, respectively; p = 0.922). Conclusion Ankle orthoses which provide medial-lateral support do not appear to change ankle inversion/eversion proprioceptive thresholds or unipedal stance time in older persons with diabetic peripheral neuropathy. Previously identified improvements in gait variability using orthoses in this population are therefore likely related to an orthotically-induced stiffening of the ankle rather than a change in ankle afferent function. PMID:20407302

Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630

PubMed Central

Kulig, Kornelia; Pomrantz, Amy B; Burnfield, Judith M; Reischl, Stephen F; Mais-Requejo, Susan; Thordarson, David B; Smith, Ronald W

2006-01-01

Background Posterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction. Methods/design This paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD. Discussion We have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available. PMID:16756656

A scoping review of applications and outcomes of traction orthoses and constructs for the management of intra-articular fractures and fracture dislocations in the hand.

PubMed

Packham, Tara L; Ball, Pamela D; MacDermid, Joy C; Bain, James R; DalCin, Arianna

2016-01-01

Intra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. To conduct a scoping review of traction constructs for the management of intra-articular hand fractures. We conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. Our search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. The current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. Scoping review. N/A. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Effect of spinal orthoses and postural taping on balance, gait and quality of life in older people with thoracic hyperkyphosis: protocol for a systematic review and meta-analysis.

PubMed

Aboutorabi, Atefeh; Arazpour, Mokhtar; Ahmadi Bani, Monireh; Keshtkar, Abbas Ali

2018-01-31

Thoracic hyperkyphosis is one of the most common spinal disorders in older people, creating impairment, postural instability, gait disorders and a reduced quality of life. The use of spinal orthoses and/or postural taping may be feasible conservative interventions, but their efficacy is uncertain. The aim of this review is therefore to investigate the effectiveness of spinal orthoses and taping on the balance and gait of older people with hyperkyphosis. We will include randomised controlled trials and clinical trial studies which assess the efficacy of spinal orthoses and taping using the WHO International Classification of Functioning, Disability and Health (ICF) outcome measures in older people with hyperkyphosis of the thoracic spine. A search will be performed in PubMed, SCOPUS, ISI Web of Knowledge, CENTRAL, EMBASE, CINAHL, AMED, PEDro, REHAB DATA and RECAL databases with no restriction of language. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using modified Down and Black checklists. Publication bias and data synthesis will be assessed by funnel plots, Begg's and Egger's tests, and plots using STATA software V.12.1 version. No ethical issues are predicted. These findings will be published in a peer reviewed journal and presented at national and international conferences. CRD42016045880. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

New design for a rotatory joint actuator made with shape memory alloy contractile wire

NASA Astrophysics Data System (ADS)

Wang, Guoping; Shahinpoor, Mohsen

1996-05-01

A design approach for a rotatory joint actuator using a contractile shape memory alloy (SMA) wire is presented and an example design is followed. In this example, the output torque of the actuator is 18 Newton-meters, and its angular range is 30 degrees. Compared with a SMA spring type actuating component, a SMA wire type actuating component uses less SMA material and uses less electrical energy when it is electrically powered. On the other hand, a SMA wire type actuating component must have a large SMA wire length to produce a required amount of angular rotation of the joint. When pulleys are used to arrange a lengthy SMA wire in a small space, the friction between pulleys and pins is introduced and the performance of the joint actuator is degenerated to some degree. The investigated joint actuator provides a good chance for developing powered orthoses with SMA actuators for disabled individuals. It can relieve the weight concern with hydraulic and motor-powered orthoses and the safety concern with motor-powered orthoses. When electrically powered, a SMA actuator has the disadvantage of low energy efficiency.

Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis.

PubMed

Rasenberg, Nadine; Riel, Henrik; Rathleff, Michael S; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke

2018-03-19

Plantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this. To investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions. Systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017. Randomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP. Twenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI -0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI -0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI -0.15 to 0.22)). For the majority of other interventions, no significant differences were found. Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP. CRD42015029659. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial.

PubMed

Bonacci, Jason; Hall, Michelle; Saunders, Natalie; Vicenzino, Bill

2018-05-01

To determine the feasibility of a clinical trial that compares a 6-week, physiotherapist-guided gait retraining program with a foot orthoses intervention in runners with patellofemoral pain. Pilot randomised controlled trial. Runners aged 18-40 years with clinically diagnosed patellofemoral pain were randomly allocated to either a 6-week gait retraining intervention of increasing cadence and use of a minimalist shoe or prefabricated foot orthoses. Outcomes at baseline and 12-weeks included recruitment, retention, adherence, adverse events, global improvement, anterior knee pain scale, worst and average pain on a 100mm visual analogue scale. Of the 16 randomised participants, two withdrew prior to commencing treatment due to non-trial related matters (n=1 from each group) and 14 completed the pilot trial. Minor calf muscle soreness was reported by 3 participants in the gait retraining group while no adverse events were reported in the foot orthoses group. There were no deviations from the treatment protocols. There was a large between-group difference favouring gait retraining at 12-weeks in the anterior knee pain scale and the worst pain in the past week, which was reflected in the number needed-to-treat of 2. This study supports the feasibility of a trial comparing gait retraining with foot orthoses and provides point estimates of effect that informs the design and planning of a larger clinical trial. It appears that a 6-week gait retraining program has a clinically meaningful effect on runners with patellofemoral pain when compared to an evidence-based treatment of foot orthoses. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements.

PubMed

Lee, Winson C C; Kobayashi, Toshiki; Choy, Barton T S; Leung, Aaron K L

2012-06-01

A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. To test the above hypothesis by comparing it to three other available orthoses. Repeated measures. Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

Spinal Orthoses: The Crucial Role of Comfort on Compliance of Wearing - Monocentric Prospective Pilot Study of Randomized Cross-Over Design.

PubMed

Herget, G W; Patermann, S; Strohm, P C; Zwingmann, J; Eichelberger, P; Südkamp, N P; Hirschmüller, A

2017-01-01

PURPOSE OF THE STUDY Various spine disorders are regularly treated by orthoses, and success of treatment depends on wearing these devices. In this study we examined the compliance, wear comfort, subjective stabilization and side effects associated with spinal orthoses using an individualized questionnaire and the Compact Short Form-12 Health Survey (SF-12). MATERIAL AND METHODS In this prospective pilot study of randomized cross-over design, twelve healthy volunteers with a mean age of 31.2 years wore three different types of orthoses, each for one week: A hyperextension brace (HB), a custom-made semirigid orthosis (SO) and a custom-made rigid orthosis (RO). The daily duration of wearing the orthosis was defined as primary endpoint; contentment was measured using an individualized questionnaire and the standardized SF-12. RESULTS In the study population calculated probability of wearing the HB and RO was between 0.2 und 38.5% (95% confidence interval). No volunteer wore the SO orthosis for the predefined time. The SO and RO each displayed high subjective stabilization, while the RO was more often associated with side effects like skin pressure marks than the SO. The need for rework due to discomfort was mainly necessary with the RO. We observed no substantial differences in feeling compression and sweating. Noteworthy, eight of 12 subjects complained of uncomfortable sternal pressure due to the upper pad of the HB. The SF-12: scores ranged from 52.1 to 48.6 on the physical (PCS), and from 53.7 to 50.8 on the mental component score (MCS), demonstrating an influence on QoL. DISCUSSION AND CONCLUSIONS The design as well as the orthosis itself influence the compliance of wearing and exert a moderate negative, but acceptable impact on QoL. The SO appeared to correlate with the best overall compromise between comfort and subjective stabilization. Further investigations are necessary in patients with spinal diseases, for whom the effect of orthosis wearing may surpass the potential discomfort. Key words: thoracolumbar spine, orthoses, SF-12 - Quality of Life - QoL, comfort, compliance.

The Immediate Effect of Foot Orthoses on Subtalar Joint Mechanics and Energetics.

PubMed

Maharaj, Jayishni N; Cresswell, Andrew G; Lichtwark, Glen A

2018-03-05

Foot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function. Eighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only. During early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1 - 12 %), supination moments (3 - 21 %) and energy absorption (5 - 12 %) at the STJ, but had no effect on STJ pronation displacement. The changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear as the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses.

Can orthoses and navicular drop affect foot motion patterns during running?

PubMed

Eslami, Mansour; Ferber, Reed

2013-07-01

The purpose of this study was to examine the influence of semi-rigid foot orthoses on forefoot-rearfoot joint coupling patterns in individuals with different navicular drop measures during heel-toe running. Ten trials were collected from twenty-three male subjects who ran slowly shod at 170 steps per minute (2.23m/s) with a semi-rigid orthoses and without. Forefoot-rearfoot coupling motions were assessed using a vector coding technique during four intervals across the first 50% of stance. Subjects were divided into two groups based on navicular drop measures. A three way ANOVA was performed to examine the interaction and main effects of stance interval, orthoses condition and navicular drop (p<0.05). There were no interaction effects among stance interval, orthoses condition, or navicular drop (p=0.14) whereas an interaction effect of orthoses condition and stance interval was observed (p=0.01; effect size=0.74). Forefoot-rearfoot coupling motion in the no-orthoses condition increased from heel-strike to foot-flat phase at a rate faster than the orthoses condition (p=0.02). Foot orthoses significantly decrease the forefoot-rearfoot joint coupling angle by reducing forefoot frontal plane motion relative to the rearfoot. Navicular drop measures did not influence joint coupling relationships between the forefoot and rearfoot during the first 50% of stance regardless of orthotic condition. Copyright © 2012 Sports Medicine Australia. All rights reserved.

The Use of Night Orthoses in Cerebral Palsy Treatment: Sleep Disturbance in Children and Parental Burden or Not?

ERIC Educational Resources Information Center

Mol, E. M.; Monbaliu, E.; Ven, M.; Vergote, M.; Prinzie, P.

2012-01-01

In this study, we investigated whether (1) children with cerebral palsy (CP) using night orthoses experience more sleep disturbance than those not using night orthoses, (2) parental personality is related to the experienced parental burden of night orthoses, and (3) parental sense of competence in the parenting role mediates the relation between…

Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.

PubMed

Schasfoort, Fabienne; Dallmeijer, Annet; Pangalila, Robert; Catsman, Coriene; Stam, Henk; Becher, Jules; Steyerberg, Ewout; Polinder, Suzanne; Bussmann, Johannes

2018-01-10

Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. Children with spastic cerebral palsy, age range 4-12 years, cerebral palsy-severity Gross Motor Function Classification System levels I-III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross motor function, activity levels or health-related quality-of-life in this cerebral palsy age- and severity-subgroup.

A proof-of-concept study for measuring gait speed, steadiness, and dynamic balance under various footwear conditions outside of the gait laboratory.

PubMed

Wrobel, James S; Edgar, Sarah; Cozzetto, Dana; Maskill, James; Peterson, Paul; Najafi, Bijan

2010-01-01

This pilot study examined the effect of custom and prefabricated foot orthoses on self-selected walking speed, walking speed variability, and dynamic balance in the mediolateral direction. The gait of four healthy participants was analyzed with a body-worn sensor system across a distance of at least 30 m outside of the gait laboratory. Participants walked at their habitual speed in four conditions: barefoot, regular shoes, prefabricated foot orthoses, and custom foot orthoses. In the custom foot orthoses condition, gait speed was improved on average 13.5% over the barefoot condition and 9.8% over the regular shoe condition. The mediolateral range of motion of center of mass was reduced 55% and 56% compared with the shoes alone and prefabricated foot orthoses conditions, respectively. This may suggest better gait efficiency and lower energy cost with custom foot orthoses. This tendency remained after normalizing center of mass by gait speed, suggesting that irrespective of gait speed, custom foot orthoses improve center of mass motion in the mediolateral direction compared with other footwear conditions. Gait intercycle variability, measured by intercycle coefficient of variation of gait speed, was decreased on average by 25% and 19% compared with the barefoot and shoes-alone conditions, respectively. The decrease in gait unsteadiness after wearing custom foot orthoses may suggest improved proprioception from the increased contact area of custom foot orthoses versus the barefoot condition. These findings may open new avenues for objective assessment of the impact of prescribed footwear on dynamic balance and spatiotemporal parameters of gait and assess gait adaptation after use of custom foot orthoses.

What to measure when determining orthotic needs in children with Down syndrome: a pilot study.

PubMed

Looper, Julia; Benjamin, Danielle; Nolan, Mindy; Schumm, Laura

2012-01-01

To compare the effects of off-the-shelf foot orthoses and supramalleolar orthoses on the gait of children with Down syndrome (DS), and establish criteria for determining orthoses prescription for a child with DS. We assessed the gait of 6 children (aged 4-7 years) with DS using the GAITRite system, and obtained height, weight, leg length, hypermobility, calcaneal eversion, navicular drop, and tibial torsion measurements. Supramalleolar orthoses lead to a longer cycle time than foot orthoses (P = .05) and barefoot walking (P = .03) and a lower cadence than barefoot walking (P = .04). Significant strong correlations with gait parameters were obtained for height, leg length, and hypermobility. Biomechanical measurements showed no significant correlations with gait parameters. The role of physical examination data, including anthropometric and biomechanical measurements in the prescription of orthoses requires further investigation.

Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study.

PubMed

Halstead, Jill; Chapman, Graham J; Gray, Janine C; Grainger, Andrew J; Brown, Sarah; Wilkins, Richard A; Roddy, Edward; Helliwell, Philip S; Keenan, Anne-Maree; Redmond, Anthony C

2016-04-01

This randomised feasibility study aimed to examine the clinical and biomechanical effects of functional foot orthoses (FFOs) in the treatment of midfoot osteoarthritis (OA) and the feasibility of conducting a full randomised controlled trial. Participants with painful, radiographically confirmed midfoot OA were recruited and randomised to receive either FFOs or a sham control orthosis. Feasibility measures included recruitment and attrition rates, practicality of blinding and adherence rates. Clinical outcome measures were: change from baseline to 12 weeks for severity of pain (numerical rating scale), foot function (Manchester Foot Pain and Disability Index) and patient global impression of change scale. To investigate the biomechanical effect of foot orthoses, in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks. Of the 119 participants screened, 37 were randomised and 33 completed the study (FFO = 18, sham = 15). Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group. Both groups reported improvements in pain, function and global impression of change; the FFO group reporting greater improvements compared to the sham group. The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group. The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses. This feasibility study provides useful clinical, biomechanical and statistical information for the design and implementation of a definitive randomised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA.

Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

PubMed Central

Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yun, Hyun-Ju; Jeong, Tae-Ho

2015-01-01

Objective To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. Method A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. Result Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses. Conclusion Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot. PMID:26798604

Influence of foot orthosis customisation on perceived comfort during running.

PubMed

Lucas-Cuevas, A G; Pérez-Soriano, P; Priego-Quesada, J I; Llana-Belloch, S

2014-01-01

Although running is associated with many health benefits, it also exposes the body to greater risk of injury. Foot orthoses are an effective strategy to prevent such injuries. Comfort is an essential element in orthosis design since any discomfort alters the runner's biomechanics, compromising performance and increasing the risk of injury. The present study analyses the perceived comfort of three types of orthoses: custom-made, prefabricated and original running shoe insoles. Nine comfort variables for each insole were assessed in a sample of 40 runners. Custom-made and prefabricated insoles were both perceived as significantly more comfortable than the original insoles. The differences were clinically relevant and were potentially causes of modifications in running gait. Although the prefabricated insoles were rated slightly higher than the custom-made insoles, the differences were not statistically significant. This study shows that prefabricated insoles constitute a reasonable alternative to custom-made insoles in terms of comfort. The perceived level of comfort of footwear is considered to be a protective measure of the potential risk of running injuries. We here compared runners' perception of comfort of custom-made and prefabricated orthoses while running. We found that even though custom-made orthoses are closely matched to each individual's foot, such customisation does not necessarily imply greater comfort.

A decision-making tool to prescribe knee orthoses in daily practice for patients with osteoarthritis.

PubMed

Coudeyre, Emmanuel; Nguyen, Christelle; Chabaud, Aurore; Pereira, Bruno; Beaudreuil, Johann; Coudreuse, Jean-Marie; Deat, Philippe; Sailhan, Frédéric; Lorenzo, Alain; Rannou, François

2018-03-01

To develop a decision-making tool (DMT) to facilitate the prescription of knee orthoses for patients with osteoarthritis (OA) in daily practice. A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA. A first DMT draft was presented to the task force in a 1-day meeting in January 2016. The first version of the DMT was criticized and discussed regarding everyday practice issues. Every step was discussed and amended until consensus agreement was achieved within the task force. Then 4 successive consultation rounds occurred by electronic communication, first with primary- and secondary-care physicians, then with international experts. All corrections and suggestions by each member were shared with the rest of the task force and included to reach final consensus. The final version was validated by the steering committee. The definition and indication of several types of knee orthoses (sleeve, patello-femoral, hinged or unicompartmental offloading braces) were detailed. Orthoses may be proposed in addition to first-line non-pharmacological treatment if patient acceptance is considered good. At every step, a specific clinical assessment is needed. Based on the latest high-level evidence, practice guidelines, and an expert panel, a DMT to facilitate daily practice prescription of knee orthoses for OA patients was designed. An evaluation of DMT implementation in a wide range of health professionals is still needed. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

Foot orthoses for the management of low back pain: a qualitative approach capturing the patient’s perspective

PubMed Central

2013-01-01

Background The onset of non specific low back pain is associated with heavy lifting, age, female gender, and poor general health, with psychological factors being predictors of it becoming chronic. Additionally, it is thought that altered lower limb biomechanics are a contributory factor, with foot orthoses increasingly being considered as an appropriate intervention by physiotherapists and podiatrists. However, research into the effect of foot orthoses is inconclusive, primarily focusing on the biomechanical effect and not the symptomatic relief from the patient’s perspective. The aim of this study was to explore the breadth of patients’ experiences of being provided with foot orthoses and to evaluate any changes in their back pain following this experience. Method Following ethical approval, participants (n = 25) with non-specific low back pain associated with altered lower limb biomechanics were provided with customised foot orthoses. At 16 weeks after being provided with the foot orthoses, conversational style interviews were carried out with each patient. An interpretivistic phenomenological approach was adopted for the data collection and analysis. Results For these participants, foot orthoses appeared to be effective. However, the main influence on this outcome was the consultation process and a patient focussed approach. The consultation was an opportunity for fostering mutual understanding, with verbal and visual explanation reassuring the patient and this influenced the patient’s beliefs, their engagement with the foot orthoses (physical) and their experience of low back pain (psychological). Conclusion Clinicians need to adopt ‘psychologically informed practice’ in relation to the provision of foot orthoses. Likewise, researchers should consider all the influencing factors found in this study, both in relation to their study protocol and the outcomes they plan to measure. PMID:23651579

Is there any relationship between orthotic usage and functional activities in children with neuromuscular disorders?

PubMed

Alemdaroğlu, İpek; Gür, Gozde; Bek, Nilgün; Yilmaz, Öznur T; Yakut, Yavuz; Uygur, Fatma; Karaduman, Ayşe

2014-02-01

Contractures of Achilles tendons and gastrocnemius muscle deteriorate the performance in daily living activities of patients with neuromuscular diseases. Ankle-foot orthoses help to prevent the progression of deformities and to obtain optimal position of the joints to support standing and walking. To investigate the relationship between orthotic usage and functional activities in pediatric patients with different neuromuscular diseases. Retrospective study. A total of 127 subjects' physical assessment forms were analyzed. Functional level, type of orthoses, falling frequencies, ankle joint range of motion, and timed performance tests were examined in two consecutive dates with an interval of 3 months. A total of 91 patients were using orthoses while 36 patients were not within assessment dates. A total of 64 of 91 (70.3%) patients were diagnosed with Duchenne muscular dystrophy. A total of 81 (89.0%) subjects were using plastic ankle-foot orthoses for positioning at nights and 10 (11%) were using different types of the orthoses (knee-ankle-foot orthoses, dynamic ankle-foot orthoses, and so on) for gait in the study group. Night ankle-foot orthoses were not found to be effective directly on functional performance in children with neuromuscular diseases, although they protect ankle from contractures and may help to correct gait and balance. This retrospective study shows that the positive effects of using an ankle-foot orthosis at night are not reflected in the functional performance of children with neuromuscular diseases. This may be due to the progressive deteriorating nature of the disease.

Design and development of anthropometric device for the standardization of sizes of knee-ankle-foot orthoses.

PubMed

Dwivedi, M; Shetty, K D; Nath, L Narendra

2009-01-01

An anthropometric device (AD) was designed and developed to collect data on foot and knee of locomotor disabled people. The aim was to standardize the sizes of knee-ankle-foot orthoses (KAFOs) in a standard modular form so that they can be mass produced to cater for fitting to a large number of locomotor disabled people. The anthropometric data collected on large numbers of locomotor disabled people were processed, with the help of a computer programme, to arrive at standard sizes for three modules, i.e. a foot plate (seven sizes), knee pieces (six sizes) and a lateral upright in a universal size. These modules were produced by plastic injection moulding and compression moulding processes using glass-reinforced polypropylene. KAFOs were assembled and fitted to locomotor disabled people. Feedback obtained was encouraging and this vindicated the concept, design and utility of the AD.

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

PubMed Central

Vicenzino, Bill; Collins, Natalie; Crossley, Kay; Beller, Elaine; Darnell, Ross; McPoil, Thomas

2008-01-01

Background Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy. Methods/design A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries. Discussion The randomised clinical trial will utilise high-quality methodologies in accordance with CONSORT guidelines, in order to contribute to the limited knowledge base regarding the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome, and provide practitioners with high-quality evidence upon which to base clinical decisions. Trial registration Australian Clinical Trials Registry ACTRN012605000463673 ClinicalTrials.gov NCT00118521 PMID:18304317

The effect of ankle-foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia.

PubMed

Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

2014-04-01

One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. Repeated measures study design. Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.

Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet.

PubMed

Bishop, Christopher; Arnold, John B; May, Thomas

2016-04-01

There is a paucity of evidence on the biomechanical effects of foot taping and foot orthoses in realistic conditions. This study aimed to determine the immediate effect and relationships between changes in multisegment foot biomechanics with foot taping and customized foot orthoses in adults with flat-arched feet. Multisegment foot biomechanics were measured in 18 adults with flat-arched feet (age 25.1 ± 2.8 yr; height 1.73 ± .13 m, body mass 70.3 ± 15.7 kg) during walking in four conditions in random order: neutral athletic shoe, neutral shoe with tape (low-Dye method and modified method) and neutral shoe with customized foot orthoses. In-shoe foot biomechanics were compared between conditions using a purpose developed foot model with three-dimensional kinematic analysis and inverse dynamics. Foot orthoses significantly delayed peak eversion compared to the neutral shoe (44% stance vs 39%, P = 0.002). Deformation across the midfoot and medial longitudinal arch was reduced with both the low-Dye taping (2.4°, P < 0.001) and modified taping technique (5.5°, P < 0.001). All interventions increased peak dorsiflexion of the first metatarsophalangeal joint (1.4°-3.2°, P < 0.001-0.023). Biomechanical responses to taping significantly predicted corresponding changes to foot orthoses (R2 = 0.08-0.52, P = 0.006 to <0.001). Foot orthoses more effectively altered timing of hindfoot motion whereas taping was superior in supporting the midfoot and medial longitudinal arch. The biomechanical response to taping was significantly related to the subsequent change observed with the use of foot orthoses.

The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome.

PubMed

Barton, C J; Menz, H B; Crossley, K M

2011-03-01

Patellofemoral pain syndrome (PFPS) often results in reduced functional performance. There is growing evidence for the use of foot orthoses to treat this multifactorial condition. In this study, the immediate effects of foot orthoses on functional performance and the association of foot posture and footwear with improvements in function were evaluated. Fifty-two individuals with PFPS (18-35 years) were prescribed prefabricated foot orthoses (Vasyli Pro; Vasyli International, Labrador, Australia). Functional outcome measures evaluated included the change in (1) pain and (2) ease of a single-leg squat on a five-point Likert scale, and change in the number of (3) pain-free step downs and (4) single-leg rises from sitting. The association of foot posture using the Foot Posture Index, navicular drop and calcaneal angle relative to subtalar joint neutral; and the footwear motion control properties scale score with improved function were evaluated using Spearman's ρ statistics. Prefabricated foot orthoses produced significant improvements (p<0.05) for all functional outcome measures. A more pronated foot type and poorer footwear motion control properties were found to be associated with reduced pain during the single-leg squat and improvements in the number of pain-free single-leg rises from sitting when wearing foot orthoses. In addition, a more pronated foot type was also found to be associated with improved ease of completing a single-leg squat when wearing foot orthoses. Prefabricated foot orthoses provide immediate improvements in functional performance, and these improvements are associated with a more pronated foot type and poorer footwear motion control properties.

Duplication methods for replacement of broken orthoses.

PubMed

Bradbury, R L; Gastwirth, B W; O'Connor, K J; Bloom, J

1988-04-01

The methods presented for replacement of broken orthoses have proved very effective (Fig. 9). In more than 5 years of employing such duplication techniques, we have found patient satisfaction in the product to be commensurate with that for their originally prescribed devices. The techniques presented are not the only methods by which orthoses can be duplicated. We recognize that the clinician should refabricate the same orthosis only when the cause of breakage has been determined to be material fatigue or stress. Should the patient's weight, foot structure, or activities have changed, new orthoses should be fabricated with those factors in mind.

Powered lower limb orthoses for gait rehabilitation

PubMed Central

Ferris, Daniel P.; Sawicki, Gregory S.; Domingo, Antoinette

2006-01-01

Bodyweight supported treadmill training has become a prominent gait rehabilitation method in leading rehabilitation centers. This type of locomotor training has many functional benefits but the labor costs are considerable. To reduce therapist effort, several groups have developed large robotic devices for assisting treadmill stepping. A complementary approach that has not been adequately explored is to use powered lower limb orthoses for locomotor training. Recent advances in robotic technology have made lightweight powered orthoses feasible and practical. An advantage to using powered orthoses as rehabilitation aids is they allow practice starting, turning, stopping, and avoiding obstacles during overground walking. PMID:16568153

[Survey of carbon fiber reinforced plastic orthoses and occupational and medical problems based on a questionnaire administered to companies involved in the manufacture of prosthetics and orthotics].

PubMed

Kaneshiro, Yuko; Furuta, Nami; Makino, Kenichiro; Wada, Futoshi; Hachisuka, Kenji

2011-09-01

We surveyed carbon fiber reinforced plastic orthoses (carbon orthoses) and their associated occupational and medical problems based on a questionnaire sent to 310 companies which were members of the Japan Orthotics and Prosthetics Association. Of all the companies, 232 responded: 77 of the 232 companies dealt with ready-made carbon orthoses, 52 dealt with fabricated custom-made orthoses, and 155 did not dealt with carbon orthoses. Although the total number of custom-made carbon ortheses in Japan was 829/ 5 years, there was a difference by region, and one company fabricated only 12 (per 5 years) custom-made carbon orthoses on average. The advantages of the carbon orthosis were the fact that it was "light weight", "well-fitted", had a "good appearance", and "excellent durability", while the disadvantages were that it was "expensive", "high cost of production", of "black color", and required a "longer time for completion", and "higher fabrication techniques". From the standpoint of industrial medicine, "scattering of fine fragments of carbon fibers", "itching on the skin" and "health hazards" were indicated in companies that manufacture the orthosis. In order to make the carbon orthosis more popular, it is necessary to develop a new carbon material that is easier to fabricate at a lower cost, to improve the fabrication technique, and to resolve the occupational and medical problems.

The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain.

PubMed

Lack, Simon; Barton, Christian; Woledge, Roger; Laupheimer, Markus; Morrissey, Dylan

2014-11-01

Evidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step-up task, and (iii) associated clinical measures. Hip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n=20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, foot posture index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion. Reduced hip adduction (0.82°, P=0.01), knee internal rotation (0.46°, P=0.03), and decreased gluteus medius peak amplitude (0.9mV, P=0.043) were observed after ground contact in the 'with orthoses' condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r=-0.51, P=0.02) whilst higher Kujala scores correlated with earlier gluteus medius onset (r=0.52, P=0.02). Although small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful. Copyright © 2014. Published by Elsevier Ltd.

Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis.

PubMed

Fong, Daniel Tik-Pui; Pang, Kai-Yip; Chung, Mandy Man-Ling; Hung, Aaron See-Long; Chan, Kai-Ming

2012-12-01

It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. Recently, there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis. The aim of this study was to evaluate and compare the immediate therapeutic effects of individually prescribed rocker sole shoes and custom-made foot orthoses, and a combined prescription of them on plantar fasciitis. This was a cross-over study. Fifteen patients with unilateral plantar fasciitis were recruited; they were from both genders and aged between 40 and 65. Subjects performed walking trials which consisted of one 'unshod' condition and four 'shod' conditions while wearing baseline shoes, rocker shoes, baseline shoes with foot orthotics, and rocker shoes with foot orthotics. The study outcome measures were the immediate heel pain intensity levels as reflected by visual analog scale pain ratings and the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system. The results showed that a combination of rocker shoes and foot orthoses produced a significantly lower visual analog scale pain score (9.7 mm) than rocker shoes (30.9 mm) and foot orthoses (29.5 mm). With regard to baseline shoes, it also significantly reduced the greatest amount of medial heel peak pressure (-33.58%) without overloading other plantar regions when compared to rocker shoes (-7.99%) and foot orthoses (-28.82%). The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis.

PubMed

Jafarnezhadgero, Amir Ali; Shad, Morteza Madadi; Majlesi, Mahdi

2017-06-01

Foot orthoses are often used to correct altered gait patterns. The purpose of this study was to investigate how foot orthoses can modify the magnitude of three dimensional moments of ankle, knee, and hip joints during a stride of gait in children with flexible flat feet. Bilateral gait data were collected from fourteen male children (age 10.2±1.4 years) suffering from flat feet syndrome. In order to obtain the kinematics data, a Vicon system with six cameras (100Hz) was used and two Kistler force plates (1000Hz) to record the kinetics data under each leg. Arc support foot orthoses were used as an intervention. Paired-sample T-test was used for within-group comparisons (α=0.05). The results of data analysis showed that foot orthoses can decrease the ankle evertor moment, knee and hip abductor moments and hip flexor moment in dominant lower limb. In non-dominant lower limb, using the orthoses can decrease evertor and internal rotator moments at the ankle, flexor and internal rotator moments at the knee and extensor moment at the hip, while it can increase dorsiflexor moment at the ankle. The findings imply that effects of orthoses on three dimensional moments differ in dominant and non-dominant lower limbs. Furthermore, results demonstrated that dominant and non-dominant lower limbs would also show different responses to the same intervention. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of custom-made and prefabricated orthoses on grip strength in persons with carpal tunnel syndrome.

PubMed

Mlakar, Maja; Ramstrand, Nerrolyn; Burger, Helena; Vidmar, Gaj

2014-06-01

Based on the literature, patients with carpal tunnel syndrome are suggested to wear a custom-made wrist orthosis immobilizing the wrist in a neutral position. Many prefabricated orthoses are available on the market, but the majority of those do not assure neutral wrist position. We hypothesized that the use of orthosis affects grip strength in persons with carpal tunnel syndrome in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses. Experimental. Comparisons of grip strength for three types of grips (cylindrical, lateral, and pinch) were made across orthosis types (custom-made, prefabricated with wrist in 20° of flexion, and none) on the affected side immediately after fitting, as well as between affected side without orthosis and nonaffected side. Orthosis type did not significantly affect grip strength (p = 0.661). Cylindrical grip was by far the strongest, followed by lateral and pinch grips (p < 0.050). The grips of the affected side were weaker than those of the nonaffected side (p = 0.002). In persons with carpal tunnel syndrome, neither prefabricated orthoses with 20° wrist extension nor custom-made wrist orthoses with neutral wrist position influenced grip strength of the affected hand. Compared to the nonaffected side, the grips of the affected side were weaker. The findings from this study can be used to guide application of orthoses to patients with carpal tunnel syndrome. © The International Society for Prosthetics and Orthotics 2013.

Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial

PubMed Central

2014-01-01

Background Osteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis. Methods Eighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613001245785 PMID:24629181

Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis

PubMed Central

Pröbsting, Eva; Kannenberg, Andreas; Zacharias, Britta

2016-01-01

Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p = .001), paretic limb health (p = .04), sounds (p = .02), and well-being (p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety. PMID:27151648

A single-blinded, randomized, parallel group superiority trial investigating the effects of footwear and custom foot orthoses versus footwear alone in individuals with patellofemoral joint osteoarthritis: a phase II pilot trial protocol.

PubMed

Wyndow, Narelle; Crossley, Kay M; Vicenzino, Bill; Tucker, Kylie; Collins, Natalie J

2017-01-01

Patellofemoral joint osteoarthritis is a common condition, yet information regarding conservative management is lacking. Foot orthoses are an effective intervention for improving pain and function in younger individuals with patellofemoral pain and may be effective in those with patellofemoral osteoarthritis. This pilot study will seek to establish the feasibility of a phase III randomised controlled trial to investigate whether foot orthoses worn in prescribed motion controlled footwear are superior to prescribed motion control footwear alone in the management of patellofemoral osteoarthritis. This phase II pilot clinical trial is designed as a randomized, single-blind, parallel group, two arm, superiority trial. The trial will recruit 44 participants from Queensland and Tasmania, Australia. Volunteers aged 40 years and over must have clinical symptoms and radiographic evidence of patellofemoral osteoarthritis to be eligible for inclusion. Those eligible will be randomized to receive either foot orthoses and prescribed motion control shoes, or prescribed motion control shoes alone, to be worn for a period of 4 months. The feasibility of a phase III clinical trial will be evaluated by assessing factors such as recruitment rate, number of eligible participants, participant compliance with the study protocol, adverse events, and drop-out rate. A secondary aim of the study will be to determine completion rates and calculate effect sizes for patient reported outcome measures such as knee-related symptoms, function, quality of life, kinesiophobia, self-efficacy, general and mental health, and physical activity at 2 and 4 months. Primary outcomes will be reported descriptively while effect sizes and 95% confidence intervals will be calculated for the secondary outcome measures. Data will be analysed using an intention-to-treat principle. The results of this pilot trial will help determine the feasibility of a phase III clinical trial investigating whether foot orthoses plus motion control footwear are superior to motion control footwear alone in individuals with patellofemoral osteoarthritis. A Phase III clinical trial will help guide footwear and foot orthoses recommendations in the clinical management of this disorder. Retrospectively registered with the Australian New Zealand Clinical Trials Registry: ACTRN12615000002583. Date registered: 07/01/15.

The scientific basis for the use of biomechanical foot orthoses in the treatment of lower limb sports injuries--a review of the literature.

PubMed Central

Kilmartin, T E; Wallace, W A

1994-01-01

While it is documented that many overuse injuries of the lower limb can be relieved with the use of biomechanical foot orthoses, what remains unclear is how an orthosis can produce this effect. A review of the literature indicates that biomechanical orthoses will reduce rearfoot movement, but the effect on knee function is negligible and the clinical significance of excessive rearfoot movement is yet to be proven. While many athletes may potentially benefit from the use of biomechanical orthoses, further research is necessary to justify and, if indicated, promote the use of biomechanical foot arthoses by athletes suffering from overuse injuries. PMID:8000817

Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appraisal and commentary.

PubMed

Richter, Randy R; Austin, Tricia M; Reinking, Mark F

2011-01-01

Collins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot Ankle Int. 2007;28(3):396-412. Among patients with or at risk for musculoskeletal overuse conditions, (1) do foot orthoses provide clinically meaningful improvements, and (2) are foot orthoses cost-effective? Studies published through September 28, 2005, were identified by using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Physiotherapy Evidence Database (PEDro), PubMed, SPORTDiscus, Biological Abstracts, Web of Science, Allied Health and Complementary Medicine Database, and the full Cochrane Library. The authors did not provide the search strategy used. Reference lists of included randomized controlled trials (RCTs) and identified systematic reviews were searched by hand. Studies were included if (1) they were RCTs that included the use of foot orthoses (either custom or prefabricated) in 1 of the intervention groups, (2) the clinical problem was an overuse condition as defined by the American College of Foot and Ankle Orthopedics and Medicine guidelines for which foot orthoses were recommended, and (3) at least 1 clinically relevant outcome was measured for a minimum of 1 week. Limits were not placed on year of publication, status of publication, or language. The journal, authors, and author affiliations of included RCTs were masked from 2 of the reviewers who independently assessed the included RCTs for methodologic quality using a modified PEDro scale plus 3 additional items (justification of sample size, use of outcome measures with known validity and reliability, and reporting of adverse or side effects). Disagreements on methodologic quality were resolved with consensus or by a third reviewer. The effect sizes for the included RCTs were represented by relative risk (RR) for dichotomous outcomes and standardized mean difference (SMD) for continuous data. Confidence intervals (CIs) were reported for RR and SMD. Study data were extracted directly from each of the included studies. If provided, data from intention-to-treat analysis were extracted. Study authors were contacted when insufficient data were reported. A meta-analysis (random-effects model) was conducted using Review Manager (version 4.2; The Nordic Cochrane Centre, Copenhagen, Denmark). The search identified 3192 potentially relevant studies. Full articles were retrieved for 327 studies. Twenty-two of the 327 studies met the inclusion criteria. Because the authors of 1 study used the same methods to report on 2 populations, a total of 23 RCTs were included in the systematic review. Prevention of lower limb overuse conditions with the use of foot orthoses was reported in 8 RCTs (7 studies). The effect of foot orthoses in the treatment of lower limb overuse conditions was reported in 15 RCTs. Of the 23 RCTs, the cost-effectiveness of foot orthoses was reported in 2 and the adverse effects of foot orthoses were reported in 8. Across the prevention RCTs, data were available for analysis for a range of 47 to 417 participants with 8 to 16 weeks of follow-up. Based on 4 RCTs in which the researchers examined prevention of lower limb overuse conditions with foot orthoses versus control in military personnel, the RR was 1.49 (95% CI  =  1.07, 2.08). A clinically beneficial effect size was set a priori at 1.5 or greater for the foot-orthoses group or at 0.7 or less for the comparison group. Based on 2 RCTs reported in 1 study of the use of custom versus prefabricated foot orthoses for prevention of lower limb overuse conditions, no significant difference in risk was found (RR  =  1.14, 95% CI  =  0.90, 1.44). In their calculating and reporting of RR, the authors do not appear to have followed convention. Across the treatment RCTs, data were available for analysis for a range of 18 to 133 participants with 8 to 52 weeks of follow-up. The authors of the treatment RCTs reported a variety of outcome measures. Two of these, patient-perceived treatment effect (PPE) and pain on the visual analog scale (VAS), were used to calculate an overall treatment effect (PPE as RR and VAS as SMD). Based on 2 RCTs examining foot orthoses versus control, no significant difference in PPE was found (RR  =  1.01, 95% CI  =  0.61, 1.68). Based on 2 RCTs in which custom versus prefabricated foot orthoses were examined, no significant difference in PPE was found (RR  =  0.88, 95% CI  =  0.42, 1.81). The VAS data reported in the text appear to contradict the VAS data reported in Figure 2 for foot orthoses versus control for the treatment of lower limb overuse conditions. Specifically, the lower limit of the CI in the text was negative (-0.28) and in Figure 2 was positive. Because of this apparent contradiction, we did not interpret these data. Authors of 2 RCTs reported cost-effectiveness, but the data could not be pooled. Adverse events were reported in 8 of the 22 studies. The most common adverse effect reported was discomfort, which was the main reason for discontinuing foot-orthoses use in 2 studies. The evidence supports the use of foot orthoses to prevent a first occurrence of lower limb overuse conditions and shows no difference between custom and prefabricated foot orthoses. The evidence was insufficient to recommend foot orthoses (custom or prefabricated) for the treatment of lower limb overuse conditions.

Do ankle orthoses improve ankle proprioceptive thresholds or unipedal balance in older persons with peripheral neuropathy?

PubMed

Son, Jaebum; Ashton-Miller, James A; Richardson, James K

2010-05-01

To determine whether ankle orthoses that provide medial and lateral support, and have been found to decrease gait variability in older persons with peripheral neuropathy, decrease (improve) frontal plane ankle proprioceptive thresholds or increase unipedal stance time in that same population. Observational study in which unipedal stance time was determined with a stopwatch, and frontal plane ankle (inversion and eversion) proprioceptive thresholds were quantified during bipedal stance using a foot cradle system and a series of 100 rotational stimuli, in 11 older neuropathic subjects (8 men; age 72 +/- 7.1 yr) with and without ankle orthoses. The subjects demonstrated no change in combined frontal plane (inversion + eversion) proprioceptive thresholds or unipedal stance time with vs. without the orthoses (1.06 +/- 0.56 vs. 1.13 +/- 0.39 degrees, respectively; P = 0.955 and 6.1 +/- 6.5 vs. 6.2 +/- 5.4 secs, respectively; P = 0.922). Ankle orthoses that provide medial-lateral support do not seem to change ankle inversion/eversion proprioceptive thresholds or unipedal stance time in older persons with diabetic peripheral neuropathy. Previously identified improvements in gait variability using orthoses in this population are therefore likely related to an orthotically induced stiffening of the ankle rather than a change in ankle afferent function.

Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome.

PubMed

Boldt, Andrew R; Willson, John D; Barrios, Joaquin A; Kernozek, Thomas W

2013-02-01

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

Ankle foot orthoses for people with Charcot Marie Tooth disease--views of users and orthotists on important aspects of use.

PubMed

Phillips, Margaret; Radford, Kathryn; Wills, Adrian

2011-01-01

To explore important aspects of the benefits, important characteristics, barriers to use and disadvantages of using ankle foot orthoses (AFOs) as seen by people with Charcot Marie Tooth disease (CMT) and the orthotists who will fit and supply them. This qualitative study used the nominal group technique and individual semi-structured interviews, according to participant preference and ability to travel. Propositions were put to 15 participants (eight females) with CMT regarding benefits, disadvantages, barriers to use and important characteristics of ankle foot orthoses AFOs and regarding benefits and disadvantages to seven orthotists. Priorities in these areas were ranked and a thematic analysis of the free text was made separately by two observers and a joint decision made of final themes. Fifteen people (eight females) with CMT and seven orthotists participated. Users' themes concerned functional mobility walking, pain/discomfort, choice of AFOs and associated footwear, custom made design, use in practical situations and support for foot and ankle. They noted that AFOs improved walking, but practical aspects of use and provision, as well as consideration of cosmetic aspects, were frequently problematic. Orthotists had similar themes, but with a difference in emphasis, that included prevention of future complications, education regarding device limitations and craftsmanship as a further theme. Users understood the potential benefits of AFOs and could identify disadvantages which might be remedied, but were frustrated by the difficulties in translating this into practice. Further refinement of current orthoses and delivery of orthotic services may assist in addressing these issues. © 2011 Informa UK, Ltd.

Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial.

PubMed

Rome, K; Clark, H; Gray, J; McMeekin, P; Plant, M; Dixon, J

2017-05-01

Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis (RA). Data relating to the cost-effectiveness of foot orthoses in people with RA are limited. The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA. A single-blind randomized controlled trial was undertaken to compare custom-made foot orthoses (CMFOs) and simple insoles (SIs) in 41 people with established RA. The Foot Function Index (FFI) was used to measure foot pain, disability, and functional limitation. Costs were estimated from the perspective of the UK National Health Service (NHS), societal (patient and family) perspective, and secondary care resource use in terms of the intervention and staff time. Effects were assessed in terms of health gain expressed as quality-adjusted life years (QALYs). At baseline, 20 participants received a CMFO and 21 participants received an SI. After 16 weeks foot pain improved in both the CMFOs (p = 0.000) and the SIs (p < 0.01). However, disability scores improved for CMFOs (p < 0.001) but not for SIs (p = 0.40). The cost-effectiveness results demonstrated no difference in cost between the arms (CMFOs: £159.10; SIs: £79.10; p = 0.35), with the CMFOs being less effective in terms of cost per QALY gain (p < 0.001). In people with established RA, semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles. From a cost-effectiveness perspective, the customized foot orthoses were far more expensive to manufacture, with no significant cost per QALY gain.

Efficacy of low-level laser therapy associated to orthoses for patients with carpal tunnel syndrome: A randomized single-blinded controlled trial.

PubMed

Barbosa, Rafael Inácio; Fonseca, Marisa de Cássia Registro; Rodrigues, Eula Katucha da Silva; Tamanini, Guilherme; Marcolino, Alexandre Marcio; Mazzer, Nilton; Guirro, Rinaldo Roberto de Jesus; MacDermid, Joy

2016-08-10

Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS). 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength. Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms. LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.

Biomechanical Effects of Prefabricated Foot Orthoses and Rocker‐Sole Footwear in Individuals With First Metatarsophalangeal Joint Osteoarthritis

PubMed Central

Auhl, Maria; Tan, Jade M.; Levinger, Pazit; Roddy, Edward; Munteanu, Shannon E.

2016-01-01

Objective To evaluate the effects of prefabricated foot orthoses and rocker‐sole footwear on spatiotemporal parameters, hip and knee kinematics, and plantar pressures in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods. A total of 102 people with first MTP joint OA were randomly allocated to receive prefabricated foot orthoses or rocker‐sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in‐shoe plantar pressure measurement system. Results Spatiotemporal/kinematic and plantar pressure data were available from 88 and 87 participants, respectively. The orthoses had minimal effect on spatiotemporal or kinematic parameters, while the rocker‐sole footwear resulted in reduced cadence, percentage of the gait cycle spent in stance phase, and sagittal plane hip range of motion. The orthoses increased peak pressure under the midfoot and lesser toes. Both interventions significantly reduced peak pressure under the first MTP joint, and the rocker‐sole shoes also reduced peak pressure under the second through fifth MTP joints and heel. When the effects of the orthoses and rocker‐sole shoes were directly compared, there was no difference in peak pressure under the hallux, first MTP joint, or heel; however, the rocker‐sole shoes exhibited lower peak pressure under the lesser toes, second through fifth MTP joints, and midfoot. Conclusion Prefabricated foot orthoses and rocker‐sole footwear are effective at reducing peak pressure under the first MTP joint in people with first MTP joint OA, but achieve this through different mechanisms. Further research is required to determine whether these biomechanical changes result in improvements in symptoms. PMID:26640157

Does footwear type impact the number of steps required to reach gait steady state?: an innovative look at the impact of foot orthoses on gait initiation.

PubMed

Najafi, Bijan; Miller, Daniel; Jarrett, Beth D; Wrobel, James S

2010-05-01

Many studies have attempted to better elucidate the effect of foot orthoses on gait dynamics. To our knowledge, most previous studies exclude the first few steps of gait and begin analysis at steady state walking. These unanalyzed steps of gait may contain important information about the dynamic and complex processes required to achieve equilibrium for a given gait velocity. The purpose of this study was to quantify gait initiation and determine how many steps were required to reach steady state walking under three footwear conditions: barefoot, habitual shoes, and habitual shoes with a prefabricated foot orthoses. Fifteen healthy subjects walked 50m at habitual speed in each condition. Wearing habitual shoes with the prefabricated orthoses enabled subjects to reach steady state walking in fewer steps (3.5 steps+/-2.0) compared to the barefoot condition (5.2 steps+/-3.0; p=0.02) as well as compared to the habitual shoes condition (4.7 steps+/-1.6; p=0.05). Interestingly, the subjects' dynamic medial-lateral balance was significantly improved (22%, p<0.05) by using foot orthoses compared to other footwear conditions. These findings suggest that foot orthoses may help individuals reach steady state more quickly and with a better dynamic balance in the medial-lateral direction, independent of foot type. The findings of this pilot study may open new avenues for objectively assessing the impact of prescription footwear on dynamic balance and spatio-temporal parameters of gait. Further work to better assess the impact of foot orthoses on gait initiation in patients suffering from gait and instability pathologies may be warranted. Copyright 2010 Elsevier B.V. All rights reserved.

Orthoses: Not the Sole Solution for Running Ailments.

ERIC Educational Resources Information Center

Murphy, Patrick

1986-01-01

Orthotic devices are an important element of treatment for biomechanically disadvantaged runners, but alignment problems are multifaceted and require multifaceted solutions. Appropriate uses of orthoses are discussed. (MT)

The effectiveness of orthoses in the conservative management of thumb CMC joint osteoarthritis: An analysis of functional pinch strength.

PubMed

Grenier, Marie-Lyne; Mendonca, Rochelle; Dalley, Peter

2016-01-01

The study was a retrospective cohort analysis for a 19-month period from May 2013 to December 2014. Although the use of orthoses has long been a staple of conservative treatment measures for individuals with osteoarthritis of the thumb carpometacarpal (CMC) joint, there remains little evidence exploring its effectiveness in improving functional outcomes for this client population. The purpose of this study was to assess the effectiveness of 3 frequently used orthoses in improving the functional pinch strength of adults with a diagnosis of thumb CMC joint osteoarthritis. A retrospective cohort analysis was conducted to determine whether pinch strength improved after orthotic fabrication, and fitting in patients referred to a hand therapy clinic. Patients who received a Colditz design orthosis had a mean increase of 2.64 lb with regard to functional pinch strength after orthotic fabrication and fitting. Patients who received a Comfort Cool orthosis (North Coast Medical, Morgan Hill, CA) had a mean increase of 2.47 lb, whereas patients who received a Thumb Spica orthosis had a mean increase of 3.25 lb. There was no evidence of any statistically significant difference in the average improvements in pinch strength between the Colditz design orthosis and the Comfort Cool orthosis. Results from this study demonstrate that orthosis wear consistently increases the functional pinch strength of individuals with thumb CMC joint osteoarthritis. Large-scale multisite research studies comparing various orthotic designs are necessary to help therapists determine best practice interventions for the conservative management of thumb CMC joint osteoarthritis. 2(c). Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Gait COP trajectory of left side hip-dislocation and scoliotic patient using ankle-foot orthoses

NASA Astrophysics Data System (ADS)

Chong, Albert K.; Alrikabi, Redha; Milburn, Peter

2017-07-01

Plantar pressure-sensing mats and insole plantar sensor pads are ideal low-cost alternatives to force plates for capturing plantar COP excursion during gait. The acquired COP traces, in the form of pedobarographic images are favored by many clinicians and allied health professionals for evaluation of foot loading and balance in relation to foot biomechanics, foot injury, foot deformation, and foot ulceration. Researchers have recommended the use of COP trace for the biomechanical study of the deformed foot and lower-limb to improve orthosis design and testing. A correctly designed orthoses improves mobility and reduces pain in the foot, lower limb and lower spine region during gait. The research was carried out to evaluate the performance of two types of orthosis, namely: a custom-molded orthosis and an over-the-counter molded orthosis to determine the quality of gait of an adult scoliotic patient. COP trace patterns were compared with those of a healthy adult and showed the design of the custom-molded orthosis resulted in an improved quality of movements and provided enhanced stability for the deformed left foot during gait.

Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain.

PubMed

Kogler, G F; Solomonidis, S E; Paul, J P

1996-07-01

OBJECTIVE: The purpose of this investigation was to quantify the longitudinal arch support properties of several types of foot orthosis. DESIGN: An in vitro method that simulated 'static stance' was used to determine arch support capabilities, with plantar aponeurosis strain implemented as the performance measure. BACKGROUND: A longitudinal arch support mechanism of an orthosis resists depression of the foot's arches by transferring a portion of the load to the medial structures of the foot. Since the plantar aponeurosis is in tension when the foot is loaded, a quantifiable decrease in strain should occur with an adequate orthotic arch control mechanism. METHODS: A differential variable reluctance transducer was surgically implanted in the plantar aponeurosis of cadaveric donor limb feet (n = 7). Each specimen was mounted in an electromechanical test machine which applied a load of up to 900 N axially to the tibia. The test schedule was divided into seven test conditions: specimen barefoot; specimen with shoe and specimen with shoe and five different orthoses. RESULTS: The University of California Biomechanics Laboratory Shoe Insert and two other foot orthoses significantly decreased the strain in the plantar aponeurosis compared to the barefoot control and were considered effective arch supports (P < 0.05). The functional foot orthosis, stock orthosis, and test shoe did not effectively reduce plantar aponeurosis strain. Significant variations of time required to achieve the specified load levels were recorded among the test conditions, indicating the relative cushioning properties of the shoe/orthosis systems. CONCLUSIONS: The patterns of plantar aponeurosis strain observed in cadaveric tests suggest that certain types of orthoses are more effective than others in the support of the foot's longitudinal arches. It is suggested that to support the longitudinal arches of the foot effectively the medial surface contours of the orthosis must stabilize the apical bony structure of the foot's arch. RELEVANCE: Reducing tension in the plantar aponeurosis is an important treatment objective for orthotic management of plantar fasciitis. Therefore it is of great clinical interest to know whether the longitudinal arch support mechanism of specific foot orthoses have benefits with respect to the loading of the plantar aponeurosis.

Comparison of the immediate efficacy of the Spinomed® back orthosis and posture training support on walking ability in elderly people with thoracic kyphosis.

PubMed

Namdar, Nategh; Arazpour, Mokhtar; Ahmadi Bani, Monireh

2017-12-21

The effect of spinal orthoses, including the Spinomed ® and posture training support (PTS) in improving balance and reducing falls in older people has been previously evaluated. However, there is little evidence available regarding their effect on the walking ability of older individuals with thoracic hyperkyphosis. This study was therefore designed to compare the immediate effect of the Spinomed ® orthosis and PTS on specific gait parameters in this patient group. A total of 34 older volunteer subjects with thoracic hyperkyphosis participated in this study and were randomly allocated into two groups, to either walk with the Spinomed ® orthosis in situ or the PTS. The elderly mobility scale test (EMS), two-minute walk test (2-MWT), and 10-meter walk test (10-MWT) were used to evaluate their walking performance, the distance walked and their walking speed respectively. There were no significant differences in the mean age, body mass index (BMI), kyphosis angle, EMS, 2-MWT, and 10-MWT between the groups at baseline. All parameters were uniform amongst the two groups. The Spinomed ® orthosis and PTS both had a positive and significant effect on the EMS score, the 2-MWT, and the 10-MWT. No significant difference was detected between two the types of orthoses in terms of the EMS score, the 2-MWT, or the 10-MWT. The Spinomed ® and PTS were both effective in improving all the primary outcome measures, with similar improvements demonstrated by both orthoses. Implications for rehabilitations In this category, one of the approaches to treat the elderly with hyperkyphosis is the use of spinal orthoses such as Spinomed ® orthosis and posture training support (PTS). The results showed that the anti-kyphosis orthosis including Spinomed ® and PTS played effective roles in the elderly with hyperkyphosis to improve their walking function. According to the current study results, there was no significant difference between the efficacies of these orthoses in the mentioned parameters.

Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report.

PubMed

McKee, Pat; Nguyen, Cecilia

2007-01-01

Radial nerve injury is a relatively common occurrence and recovery depends on the level of injury and extent of connective tissue damage. Orthoses (splints) are often provided to compensate for lost motor power. This article chronicles the recovery, over 27 months, of a 76-year-old woman who sustained a high radial nerve injury of her dominant arm during surgery for total shoulder replacement (Delta Reverse). Customized, low-profile dynamic splints, unlike any previously published design, were developed to address her goals for functional independence and the biological needs of the tissues. Dynamic power was provided to the wrist, fingers, and thumb by elastic cords and thin, flexible thermoplastic, without the need of an outrigger, thus avoiding the need for wire bending and cutting. At the outset, the splint was forearm-based and when wrist extension power was recovered, a hand-based splint was designed. Eventually, a circumferential hand-based thumb-stabilizing splint fulfilled most of the remaining orthotic requirements.

Outcome of orthoses intervention in the rheumatoid foot.

PubMed

Kavlak, Yasemin; Uygur, Fatma; Korkmaz, Cengiz; Bek, Nilgün

2003-06-01

This study was carried out to determine the effect of foot orthoses on pain, gait, and energy expenditure in patients with rheumatoid arthritis. Eighteen patients were evaluated for these parameters. Each patient was given a foot insert or shoe modification suitable for his or her foot deformity. Following 3 months of orthosis use, a significant difference was found in regards to pain (p < .05), step length and stride length (p < .05), and physiological cost index (p < .05). The results suggest that foot orthoses are an important feature in the rehabilitation of the rheumatoid foot.

Prostheses and orthoses in the collections of the Auschwitz-Birkenau State Museum.

PubMed

Przeździak, Bogumił; Lutomirski, Adam; Kulczyk, Maria

2011-01-01

The authors described 424 orthopaedic appliances left by the prisoners of the Nazi Concentration Camp in Oświęcim. A collection of prostheses and orthoses, which is currently a part of the Auschwitz-Birkenau State Museum's exhibition, is extraordinary as it illustrates the fate of innocent, crippled people, who were incarcerated and murdered. Another point of value of the collection is its technical aspect, as it provides a clear picture of construction of prostheses and orthoses at the beginning of the 20th century.

An anterior ankle-foot orthosis improves walking economy in Charcot-Marie-Tooth type 1A patients.

PubMed

Menotti, Federica; Laudani, Luca; Damiani, Antonello; Mignogna, Teresa; Macaluso, Andrea

2014-10-01

Ankle-foot orthoses are commonly prescribed in Charcot-Marie-Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop. This study aimed at assessing the effect of an anterior ankle-foot orthosis on walking economy in a group of Charcot-Marie-Tooth type 1A patients. Within-group comparisons. 7 Charcot-Marie-Tooth type 1A patients (four women and three men; 37 ± 11 years; age range = 22-53 years) were asked to walk on a circuit at their self-selected speeds ('slow', 'comfortable' and 'fast') in two walking conditions: (1) with shoes only and (2) with Taloelast(®) anterior elastic ankle-foot orthoses. Speed of walking and metabolic cost of walking energy cost per unit of distance were assessed at the three self-selected speeds of walking for both walking conditions. Speed of walking at the three self-selected speeds did not differ between shoes only and anterior elastic ankle-foot orthoses, whereas walking energy cost per unit of distance at comfortable speed was lower in patients using anterior elastic ankle-foot orthoses with respect to shoes only (2.39 ± 0.22 vs 2.70 ± 0.19 J kg(-1) m(-1); P < 0.05). In Charcot-Marie-Tooth type 1A patients, the use of anterior elastic ankle-foot orthoses improved walking economy by reducing the energy cost of walking per unit of distance, thus reflecting a lower level of metabolic effort and improved mechanical efficiency in comparison with shoes only. From a practical perspective, Charcot-Marie-Tooth type 1A patients with anterior elastic ankle-foot orthoses can walk for a longer duration with a lower level of physical effort. Improvements in walking economy due to ankle-foot orthoses are likely a consequence of the reduction in steppage gait. © The International Society for Prosthetics and Orthotics 2013.

Overcorrection during treatment of pectus deformities with DCC orthoses: experience in 17 cases

PubMed Central

Haje, D. P.

2006-01-01

Treatment of pectus carinatum and pectus excavatum with dynamic chest compressor (DCC) orthoses have been reported by Haje and others. The goal of this study was to demonstrate that overcorrection during orthotic treatment of children and adolescents with pectus deformities can occur and requires medical attention. Of 3,028 children and adolescents with pectus deformities, observed between 1977 and October 2005, 1,824 were prescribed treatment with DCC orthoses and, after a few months of treatment, some overcorrection was noted in 30 patients. Of the patients who received orthoses, 738 had a minimum follow-up of 1 year and 17 of these, 2 with pectus excavatum and 15 with pectus carinatum, presented overcorrection and were studied. The dynamic remodeling method (DCC orthoses + exercises) was applied. The procedures, adopted according to each patient’s needs, were: decreasing the time of orthosis wear and/or the tightening of the screws, introducing a second orthosis, and improving the prescribed exercises and/or encouraging the patient to perform them more intensively. The therapy was successful in all patients, and the result was maintained in one case of pectus excavatum followed up until adulthood. It was concluded that overcorrection during DCC orthosis wear can occur and that careful medical follow-up is necessary if this complication is to be successfully reversed. PMID:16474937

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

PubMed

Dessery, Yoann; Belzile, Étienne; Turmel, Sylvie; Corbeil, Philippe

2017-08-01

There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. To verify if such effects occur in participants with medial knee osteoarthritis. Randomized single-blinded study. Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

Effectiveness of Foot Orthoses Versus Rocker‐Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis: Randomized Trial

PubMed Central

Auhl, Maria; Tan, Jade M.; Levinger, Pazit; Roddy, Edward; Munteanu, Shannon E.

2016-01-01

Objective To compare the effectiveness of prefabricated foot orthoses to rocker‐sole footwear in reducing foot pain in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods Participants (n = 102) with first MTP joint OA were randomly allocated to receive individualized, prefabricated foot orthoses or rocker‐sole footwear. The primary outcome measure was the pain subscale on the Foot Health Status Questionnaire (FHSQ) at 12 weeks. Secondary outcome measures included the function, footwear, and general foot health subscales of the FHSQ; the Foot Function Index; severity of pain and stiffness at the first MTP joint; perception of global improvement; general health status; use of rescue medication and co‐interventions to relieve pain; physical activity; and the frequency of self‐reported adverse events. Results The FHSQ pain subscale scores improved in both groups, but no statistically significant difference between the groups was observed (adjusted mean difference 2.05 points, 95% confidence interval [95% CI] −3.61, 7.71; P = 0.477). However, the footwear group exhibited lower adherence (mean ± SD total hours worn 287 ± 193 versus 448 ± 234; P < 0.001), were less likely to report global improvement in symptoms (39% versus 62%; relative risk [RR] 0.63, 95% CI 0.41, 0.99; P = 0.043), and were more likely to experience adverse events (39% versus 16%; RR 2.47, 95% CI 1.12, 5.44; P = 0.024) compared to the orthoses group. Conclusion Prefabricated foot orthoses and rocker‐sole footwear are similarly effective at reducing foot pain in people with first MTP joint OA. However, prefabricated foot orthoses may be the intervention of choice due to greater adherence and fewer associated adverse events. PMID:26638878

Do cervical collars and cervicothoracic orthoses effectively stabilize the injured cervical spine? A biomechanical investigation.

PubMed

Ivancic, Paul C

2013-06-01

In vitro biomechanical study. Our objective was to determine the effectiveness of cervical collars and cervicothoracic orthoses for stabilizing clinically relevant, experimentally produced cervical spine injuries. Most previous in vitro studies of cervical orthoses used a simplified injury model with all ligaments transected at a single spinal level, which differs from real-life neck injuries. Human volunteer studies are limited to measuring only sagittal motions or 3-dimensional motions only of the head or 1 or 2 spinal levels. Three-plane flexibility tests were performed to evaluate 2 cervical collars (Vista Collar and Vista Multipost Collar) and 2 cervicothoracic orthoses (Vista TS and Vista TS4) using a skull-neck-thorax model with 8 injured cervical spine specimens (manufacturer of orthoses: Aspen Medical Products Inc, Irvine, CA). The injuries consisted of flexion-compression at the lower cervical spine and extension-compression at superior spinal levels. Pair-wise repeated measures analysis of variance (P < 0.05) and Bonferroni post hoc tests determined significant differences in average range of motions of the head relative to the base, C7 or T1, among experimental conditions. RESULTS.: All orthoses significantly reduced unrestricted head/base flexion and extension. The orthoses allowed between 8.4% and 25.8% of unrestricted head/base motion in flexion/extension, 57.8% to 75.5% in axial rotation, and 53.8% to 73.7% in lateral bending. The average percentages of unrestricted motion allowed by the Vista Collar, Vista Multipost Collar, Vista TS, and Vista TS4 were: 14.0, 9.7, 6.1, and 4.7, respectively, for middle cervical spine extension and 13.2, 11.8, 3.3, and 0.4, respectively, for lower cervical spine flexion. Successive increases in immobilization were observed from Vista Collar to Vista Multipost Collar, Vista TS, and Vista TS4 in extension at the injured middle cervical spine and in flexion at the injured lower cervical spine. Our results may assist clinicians in selecting the most appropriate orthosis based upon patient-specific cervical spine injuries.

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses - Customised v Off-the-Shelf in Rheumatoid Arthritis].

PubMed

Gallagher, Kellie S; Godwin, Jon; Hendry, Gordon J; Steultjens, Martijn; Woodburn, Jim

2018-01-01

Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months. This is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken. Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future. ISRCTN13654421. Registered 09 February 2016.

Hand therapist management of the lateral epicondylosis: a survey of expert opinion and practice patterns.

PubMed

MacDermid, Joy C; Wojkowski, Sarah; Kargus, Cristin; Marley, Meghan; Stevenson, Emily

2010-01-01

Lateral epicondylosis (LE) is a common condition. Knowledge on practice patterns underlies identification of knowledge to practice gaps. The purpose was to determine the practice patterns and beliefs of hand therapists in managing LE. The study design used was a descriptive survey. A survey of Certified Hand Therapists and members of the American Society of Hand Therapists was conducted (n=693). Questions were framed around frequency and perceived effectiveness of interventions, examination techniques, outcome measures, and prognostic factors. More than 80% of therapists use education/activity modification, home exercise, LE orthoses, and stretching for both the acute and chronic LE. Therapists perceive education, orthoses and home exercise are the most effective for acute cases, whereas in chronic cases, orthoses dropped to ninth in ranked perceived effectiveness. Grip strength (80%) and numeric pain rating (71%) were the most commonly used outcome measures. Most (>70%) therapists perceived occupation and duration of symptoms are prognostic in terms of resolution of symptoms, whereas compliance with exercise (78%) and work factors are important for return to work. Therapists rely on impairment measures to evaluate hand therapy outcomes in patients with LE. Hand therapists are aligned with a number of recommendations from the available systematic reviews, although the use of outcome measures and optimal definition of education and exercise exhibit evidence to practice gaps. Level 5. Copyright (c) 2010 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Walking and wheelchair energetics in persons with paraplegia.

PubMed

Cerny, D; Waters, R; Hislop, H; Perry, J

1980-09-01

The energetics of walking with orthoses and wheelchair propulsion at free velocity were tested in 10 adults with low-level spinal cord injuries. Eight were subjects who customarily used wheelchairs as their primary mode of locomotion; the other two used orthoses and had discontinued use of their wheelchairs. All required bilateral knee-ankle-foot orthoses to walk. A third habitual walker also was tested during walking only. Patients walked or propelled their wheelchairs around a 60.5-meter outdoor cement track. Heart rate, respiratory rate, and step frequency were recorded and transmitted by radiotelemetry. Expired air was collected for gas analysis in a polyethylene bag during the activity after a three-minute warm-up. During wheelchair propulsion all subjects demonstrated physiological responses within normal limits. Walking was significantly more difficult to perform than wheelchair propulsion (p < .005). Subjects who customarily used orthoses walked at a mean velocity of 59 +/- 5 m/min; those who primarily used wheelchairs had a mean walking velocity of 22 +/- 13 m/min. Oxygen uptake per minute was similar for both groups. These data suggest that the wheelchair will be the primary mode of locomotion for persons with spinal cord injury who need two knee-ankle-foot orthoses to walk, unless they are willing to work under anaerobic conditions and can walk at a velocity of 54 m/min or better.

Asymmetry quantification from reflectance images of orthotic patients using structural similarity metrics

NASA Astrophysics Data System (ADS)

Boucher, Marc-Antoine; Watts, Nicolas; Gremillet, Frederic; Legare, Philippe; Kadoury, Samuel

2018-02-01

Pathologies like plantar fasciitis, a common soft tissue disorder of the foot, is frequently associated with older age, high BMI and little exercise. Like other pathologies associated with the foot, the knee or hip, foot orthoses can help the patient's posture and recent techniques allow the creation of personalized foot orthoses based on 3D foot model that are fitted with high accuracy to the foot surface. In order to assess the efficacy of the personalized orthoses on the patient's pose and balance, depth images with reflectance camera filters are acquired in order to evaluate the posture of the patient before and after the use of the orthoses. Images are analysed by clinicians to assess the region asymmetry and posture changes. However, this remains a subjective evaluation and a quantifiable measurement is required to follow patient progression. In this paper, we present a novel tool to assess and quantify the asymmetry of body regions using a color-based structural similarity metric calculated from paired regions. This provides a quantitative measure to evaluate the effect of the personalized orthoses on the patient. A user-friendly interface allows the user to select an area of the body and automatically generate a symmetry axis, along with a measure of asymmetry measuring reflectance variations from the skin. The tool was validated on 30 patients, demonstrating an 83% agreement rate compare to clinical observations.

Use of orthoses and orthopaedic technical devices in proximal spinal muscular atrophy. Results of survey in 194 SMA patients.

PubMed

Fujak, Albert; Kopschina, Carsten; Forst, Raimund; Mueller, Lutz Arne; Forst, Jürgen

2011-01-01

The purpose of this study is to determine the use of orthopaedic and assistive devices for Spinal muscular atrophy (SMA) patients, following a survey of 194 patients. The use of wheelchairs, corsets and orthoses was evaluated in 194 SMA patients whose mean age was 12.6 (SD 7.2, 0.7-41.1). There were 14 patients with SMA type Ib (age range 1.7-36.9), 133 with type II (age range 0.7-37.7), 42 with type IIIa (age range 3.2-41.1) and 5 with type IIIb (age range 8.0-20.0). One hundred and sixteen patients (60%) had powered and 29 patients (15%) manual wheelchairs. Nineteen patients (10%) used long leg orthoses. Ten patients (5%) used swivel walkers and 26 (13%) had standing frames. Twenty-six patients (13%) received lower leg orthoses because of foot deformities. Eight patients (4%) used night splints for the lower limbs. One hundred and fifteen patients (59%) were fitted with corsets because of progressive scoliosis. This is the first study about the provision of orthopaedic and assistive devices in a large group of SMA patients. Following the results of this survey we can optimise the strategy of providing orthoses and assistive devices for SMA patients and better adapt them to the patient's individual needs.

Analysis of stiffness reduction in varying curvature ankle foot orthoses.

PubMed

Braund, Matt; Kroontje, David; Brooks, James; Self, Brian; Aaron, Gregory; Bearden, Keith

2005-01-01

Ankle foot orthoses (AFO) are often used for patients who cannot generate a strong enough extension moment at the knee to allow functional gait. Orthotists often cut out portions of the AFO around the malleoli in order to improve comfort. There has been some question as to how this affects the stress distribution around the orthosis, the fatigue performance of the device, and the AFOs stiffness. To examine this, three orthoses were constructed with differing curvatures cut out of the malleolar regions. Photoelastic coatings were placed on the most stiff and least stiff orthoses, and the stress distributions while wearing the device were examined. A fixture was created to test the orthosis, and the stress distribution while loaded in the fixture closely matched the distribution with actual wear. These orthoses were then tested in fatigue for 500,000 cycles at 5 Hz in displacement control. Initial displacements were set to provide maximum loads of 45 lbs. The displacement settings for the stiffest orthosis were 0.4 to 0.6 inches of deflection; the load decreased from 44 lbs to 28 lbs after the final cycle. The least stiff displacement varied from 1.3 to 1.5 inches, and the load value changed from 46 lbs to 35 lbs. The data will be useful in guiding orthotists in building AFOs, particularly when shaving portions of the AFO for comfort. Excessive shaving may seriously degrade the performance of the device, especially after longer life cycles.

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review.

PubMed

Daryabor, Alieh; Arazpour, Mokhtar; Samadian, Mohammad; Veiskarami, Masoumeh; Ahmadi Bani, Monireh

2017-05-01

Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS. This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations. Literature review. According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria. People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis. Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention. Implications for Rehabilitations Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications. Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition. Spinal orthoses do not decline excessive energy expenditure to walk versus without it.

A functional comparison of conventional knee-ankle-foot orthoses and a microprocessor-controlled leg orthosis system based on biomechanical parameters.

PubMed

Schmalz, Thomas; Pröbsting, Eva; Auberger, Roland; Siewert, Gordon

2016-04-01

The microprocessor-controlled leg orthosis C-Brace enables patients with paretic or paralysed lower limb muscles to use dampened knee flexion under weight-bearing and speed-adapted control of the swing phase. The objective of the present study was to investigate the new technical functions of the C-Brace orthosis, based on biomechanical parameters. The study enrolled six patients. The C-Brace orthosis is compared with conventional leg orthoses (four stance control orthoses, two locked knee-ankle-foot orthoses) using biomechanical parameters of level walking, descending ramps and descending stairs. Ground reaction forces, joint moments and kinematic parameters were measured for level walking as well as ascending and descending ramps and stairs. With the C-Brace, a nearly natural stance phase knee flexion was measured during level walking (mean value 11° ± 5.6°). The maximum swing phase knee flexion angle of the C-Brace approached the normal value of 65° more closely than the stance control orthoses (66° ± 8.5° vs 74° ± 6.4°). No significant differences in the joint moments were found between the C-Brace and stance control orthosis conditions. In contrast to the conventional orthoses, all patients were able to ambulate ramps and stairs using a step-over-step technique with C-Brace (flexion angle 64.6° ± 8.2° and 70.5° ± 12.4°). The results show that the functions of the C-Brace for situation-dependent knee flexion under weight bearing have been used by patients with a high level of confidence. The functional benefits of the C-Brace in comparison with the conventional orthotic mechanisms could be demonstrated most clearly for descending ramps and stairs. The C-Brace orthosis is able to combine improved orthotic function with sustained orthotic safety. © The International Society for Prosthetics and Orthotics 2014.

Effectiveness of Foot Orthoses Versus Rocker-Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis: Randomized Trial.

PubMed

Menz, Hylton B; Auhl, Maria; Tan, Jade M; Levinger, Pazit; Roddy, Edward; Munteanu, Shannon E

2016-05-01

To compare the effectiveness of prefabricated foot orthoses to rocker-sole footwear in reducing foot pain in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Participants (n = 102) with first MTP joint OA were randomly allocated to receive individualized, prefabricated foot orthoses or rocker-sole footwear. The primary outcome measure was the pain subscale on the Foot Health Status Questionnaire (FHSQ) at 12 weeks. Secondary outcome measures included the function, footwear, and general foot health subscales of the FHSQ; the Foot Function Index; severity of pain and stiffness at the first MTP joint; perception of global improvement; general health status; use of rescue medication and co-interventions to relieve pain; physical activity; and the frequency of self-reported adverse events. The FHSQ pain subscale scores improved in both groups, but no statistically significant difference between the groups was observed (adjusted mean difference 2.05 points, 95% confidence interval [95% CI] -3.61, 7.71; P = 0.477). However, the footwear group exhibited lower adherence (mean ± SD total hours worn 287 ± 193 versus 448 ± 234; P < 0.001), were less likely to report global improvement in symptoms (39% versus 62%; relative risk [RR] 0.63, 95% CI 0.41, 0.99; P = 0.043), and were more likely to experience adverse events (39% versus 16%; RR 2.47, 95% CI 1.12, 5.44; P = 0.024) compared to the orthoses group. Prefabricated foot orthoses and rocker-sole footwear are similarly effective at reducing foot pain in people with first MTP joint OA. However, prefabricated foot orthoses may be the intervention of choice due to greater adherence and fewer associated adverse events. © 2016 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

Design of a 3D-printed, open-source wrist-driven orthosis for individuals with spinal cord injury

PubMed Central

Mukherjee, Gaurav; Peters, Keshia M.; Yamane, Ann; Steele, Katherine M.

2018-01-01

Assistive technology, such as wrist-driven orthoses (WDOs), can be used by individuals with spinal cord injury to improve hand function. A lack of innovation and challenges in obtaining WDOs have limited their use. These orthoses can be heavy and uncomfortable for users and also time-consuming for orthotists to fabricate. The goal of this research was to design a WDO with user (N = 3) and orthotist (N = 6) feedback to improve the accessibility, customizability, and function of WDOs by harnessing advancements in 3D-printing. The 3D-printed WDO reduced hands-on assembly time to approximately 1.5 hours and the material costs to $15 compared to current fabrication methods. Varying improvements in users' hand function were observed during functional tests, such as the Jebsen Taylor Hand Function Test. For example, one participant's ability on the small object task improved by 29 seconds with the WDO, while another participant took 25 seconds longer to complete this task with the WDO. Two users had a significant increase in grasp strength with the WDO (13–122% increase), while the other participant was able to perform a pinching grasp for the first time. The WDO designs are available open-source to increase accessibility and encourage future innovation. PMID:29470557

Concept and Design of a 3D Printed Support to Assist Hand Scanning for the Realization of Customized Orthosis.

PubMed

Baronio, Gabriele; Volonghi, Paola; Signoroni, Alberto

2017-01-01

In the rehabilitation field, the use of additive manufacturing techniques to realize customized orthoses is increasingly widespread. Obtaining a 3D model for the 3D printing phase can be done following different methodologies. We consider the creation of personalized upper limb orthoses, also including fingers, starting from the acquisition of the hand geometry through accurate 3D scanning. However, hand scanning procedure presents differences between healthy subjects and patients affected by pathologies that compromise upper limb functionality. In this work, we present the concept and design of a 3D printed support to assist hand scanning of such patients. The device, realized with FDM additive manufacturing techniques in ABS material, allows palmar acquisitions, and its design and test are motivated by the following needs: (1) immobilizing the hand of patients during the palmar scanning to reduce involuntary movements affecting the scanning quality and (2) keeping hands open and in a correct position, especially to contrast the high degree of hypertonicity of spastic subjects. The resulting device can be used indifferently for the right and the left hand; it is provided in four-dimensional sizes and may be also suitable as a palmar support for the acquisition of the dorsal side of the hand.

Concept and Design of a 3D Printed Support to Assist Hand Scanning for the Realization of Customized Orthosis

PubMed Central

Volonghi, Paola

2017-01-01

In the rehabilitation field, the use of additive manufacturing techniques to realize customized orthoses is increasingly widespread. Obtaining a 3D model for the 3D printing phase can be done following different methodologies. We consider the creation of personalized upper limb orthoses, also including fingers, starting from the acquisition of the hand geometry through accurate 3D scanning. However, hand scanning procedure presents differences between healthy subjects and patients affected by pathologies that compromise upper limb functionality. In this work, we present the concept and design of a 3D printed support to assist hand scanning of such patients. The device, realized with FDM additive manufacturing techniques in ABS material, allows palmar acquisitions, and its design and test are motivated by the following needs: (1) immobilizing the hand of patients during the palmar scanning to reduce involuntary movements affecting the scanning quality and (2) keeping hands open and in a correct position, especially to contrast the high degree of hypertonicity of spastic subjects. The resulting device can be used indifferently for the right and the left hand; it is provided in four-dimensional sizes and may be also suitable as a palmar support for the acquisition of the dorsal side of the hand. PMID:29234219

Inflammatory arthritis. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee.

PubMed

Küçükdeveci, A A; Oral, A; Ilıeva, E M; Varela, E; Valero, R; Berteanu, M; Chrıstodoulou, N

2013-08-01

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. Inflammatory arthritis is a major cause of disability with an important economic burden in society. The goals in the management of inflammatory arthritis are to control pain and disease activity, prevent joint damage, protect and enhance function and improve quality of life. This paper aims to define the role of PRM physicians in people with inflammatory arthritis. PRM interventions imply non-pharmacological treatments which include patient education for joint protection, energy conservation and self-management techniques, exercise therapy, physical modalities, orthoses/assistive devices and balneotherapy. Therapeutic patient education and exercises are the cornerstones of therapy with strong evidence of their effectiveness to improve function. Physical modalities are primarily used to decrease pain and stiffness whereas orthoses/assistive devices are usually prescribed to enhance activities and participation. PRM physicians have distinct roles in the management of people with inflammatory arthritis such that they effectively organise and supervise the PRM program in the context of interdisciplinary team work. Their role starts with a comprehensive assessment of patient's functioning based on the International Classification of Functioning Disability and Health (ICF) as the framework. In the light of this assessment, appropriate PRM interventions individualised for the patient are administered. Future research and actions regarding the role of PRM in inflammatory arthritis should target access to care, updates on the use and effectiveness of physical modalities, orthoses/assistive devices, and standardization of therapeutic patient education programs.

Orthoses for osteoarthritis: A narrative review.

PubMed

Beaudreuil, Johann

2017-04-01

Orthoses for osteoarthritis represent splints, taping, sleeves, unloading knee braces and insoles. This review of the effectiveness of these orthoses involved a search for articles published up to 2015 in MEDLINE via PubMed, with a focus on Osteoarthritis Research Society International, American College of Rheumatology and European League Against Rheumatology international recommendations. Evidence for splinting effectiveness in patients with thumb-base osteoarthritis is now provided. Splints for thumb-base osteoarthritis decrease pain and functional disability. Weaker evidence was found for knee bracing, including taping, sleeves and unloading braces. Low rate of observance and safety results should be considered before using current unloading knee braces for knee osteoarthritis. For insoles, data remain controversial. Orthoses for interphalangeal or hip osteoarthritis have not been investigated in a randomized trial. Regardless, if indicated in daily clinical practice, bracing must be checked by a healthcare professional to insure the suitability of the device. Patients using bracing must be educated. Patient education should include knowledge of the aims and modalities of the treatment as well as knowledge of potential side effects. Patients should be encouraged to contact the therapist if adjustment is needed, with poor tolerance or with questions about the device. Copyright © 2016. Published by Elsevier Masson SAS.

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis.

PubMed

O'Connor, Joanne; McCaughan, Dorothy; McDaid, Catriona; Booth, Alison; Fayter, Debra; Rodriguez-Lopez, Roccio; Bowers, Roy; Dyson, Lisa; Iglesias, Cynthia P; Lalor, Simon; O'Connor, Rory J; Phillips, Margaret; Ramdharry, Gita

2016-07-01

Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review - a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis - in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553. Various types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users. The population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs. Future work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery. This study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228. The National Institute for Health Research Health Technology Assessment programme.

Effects of foot orthoses on patients with chronic ankle instability.

PubMed

Richie, Douglas H

2007-01-01

Chronic instability of the ankle can be the result of mechanical and functional deficits. An acute ankle sprain can cause mechanical and functional instability, which may or may not respond to standard rehabilitation programs. Chronic instability results when there is persistent joint laxity of the ankle or when one or more components of neuromuscular control of the ankle are compromised. A loss of balance or postural control seems to be the most consistent finding among athletes with chronic instability of the ankle. Recent research in patients with acute and chronic ankle instability has revealed positive effects of foot orthoses on postural control. This article reviews the current research relevant to the use of foot orthoses in patients with chronic ankle instability and clarifies the suggested benefits and the shortcomings of these investigations.

Comparative analysis and quantitative evaluation of ankle-foot orthoses for foot drop in chronic hemiparetic patients.

PubMed

Zollo, L; Zaccheddu, N; Ciancio, A L; Morrone, M; Bravi, M; Santacaterina, F; Laineri Milazzo, M; Guglielmelli, E; Sterzi, S

2015-04-01

Ankle-foot-orthoses (AFOs) are frequently prescribed for hemiparetic patients to compensate for the foot drop syndrome. However, there is not a systematic study either on the effectiveness of AFOs in the gait recovery process or pointing out the therapeutic differences among the various types of AFOs available on the market. To perform a comparative evaluation of solid and dynamic Ankle-Foot-Orthoses (AFOs) on hemiparetic patients affected by foot drop syndrome by means of spatio-temporal, kinematic and electromyographic indicators. Crossover design with randomization for the interventions. A rehabilitation center for adults with neurologic disorders. Ten chronic hemiparetic patients with foot drop syndrome met inclusion criteria and volunteered to participate. Biomechanical gait analysis was carried out on hemiparetic subjects with foot drop syndrome under 3 conditions with randomized sequences: 1) without AFO; 2) wearing a solid AFO; 3) wearing a dynamic AFO. Significant changes in spatio-temporal, kinematic and electromyographic features of gait were investigated. Gait analysis outcomes showed that there were no significant differences among the solid and the dynamic AFO on the spatio-temporal parameters. Both AFOs led to a reduction of the range of motion of the ankle dorsi-plantar-flexion during stance with respect to the ambulation without AFO. They also had the effect of reducing the asymmetry between the paretic and the contralateral limb in terms of ankle angle at initial contact and hip flexion. The solid AFO generally led to an increase of the co-contraction of the couples of muscles involved in the gait. The proposed set of indicators showed that the AFOs were capable of limiting the effect of the foot-drop in hemiparetic patients and balancing the two limbs. Main differences between the two orthoses were related to muscular activity, being the level of co-contraction of the two couples of analysed muscles typically lower when the dynamic AFO was worn and closer to a normal pattern. A more extensive use of the proposed indicators in the clinical practice is expected in order to enable the definition of clinical guidelines for the prescription of the two devices.

Orthotic intervention in forefoot and rearfoot strike running patterns.

PubMed

Stackhouse, Carrie Laughton; Davis, Irene McClay; Hamill, Joseph

2004-01-01

To compare the differential effect of custom orthoses on the lower extremity mechanics of a forefoot and rearfoot strike pattern. Fifteen subjects ran with both a forefoot and a rearfoot strike pattern with and without orthoses. Lower extremity kinematic and kinetic variables were compared between strike pattern and orthotic conditions. Foot orthoses have been shown to be effective in controlling excessive rearfoot motion in rearfoot strikers. The effect of orthotic intervention on rearfoot motion in forefoot strikers has not been previously reported. Five trials were collected for each condition. Peak rearfoot eversion, eversion excursion, eversion velocity, peak inversion moment, and inversion work were compared between conditions. Kinematic variables in the sagittal plane of the rearfoot and in the frontal and sagittal plane of the knee were also determined. Increased rearfoot excursions and velocities and decreased peak eversion were noted in the forefoot strike pattern compared to the rearfoot strike pattern. Orthotic intervention, however,did not significantly change rearfoot motion in either strike pattern. Reductions in internal rotation and abduction of the knee were noted with orthotic intervention. Foot orthoses do not differentially effect rearfoot motion of a rearfoot strike and a forefoot strike running pattern. Orthotic intervention has a larger and more systematic effect on rearfoot kinetics compared to rearfoot kinematics.

Two case reports-Use of relative motion orthoses to manage extensor tendon zones III and IV and sagittal band injuries in adjacent fingers.

PubMed

Hirth, Melissa J; Howell, Julianne W; O'Brien, Lisa

Case report. Injuries to adjacent fingers with differing extensor tendon (ET) zones and/or sagittal band pose a challenge to therapists as no treatment guidelines exist. This report highlights how the relative motion flexion/extension (RMF/RME) concepts were combined into one orthosis to manage a zone IV ET repair (RME) and a zone III central slip repair (RMF) in adjacent fingers (Case 1); and how a single RME orthosis was adapted to limit proximal interphalangeal joint motion to manage multi-level ET zone III-IV injuries and a sagittal band repair in adjacent fingers (case 2). Adapted relative motion orthoses allowed early active motion and graded exercises based on clinical reasoning and evidence. Outcomes were standard TAM% and Miller's criteria. 'Excellent' and 'good' outcomes were achieved by twelve weeks post surgery. Both cases returned to unrestricted work at 6 and 7 weeks. Neither reported functional deficits at discharge. Outcomes in 2 cases involving multiple digit injuries exceeded those previously reported for ET zone III-IV repairs. Relative motion orthoses can be adapted and applied to multi-finger injuries, eliminating the need for multiple, bulky or functionally-limiting orthoses. 4. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

A comparison of the clinical effectiveness of spinal orthoses manufactured using the conventional manual method and CAD/CAM method in the management of AIS.

PubMed

Wong, M S; Cheng, C Y; Ng, B K W; Lam, T P; Chiu, S W

2006-01-01

Spinal orthoses are commonly prescribed to patients with moderate AIS for prevention of further deterioration. In a conventional manufacturing method, plaster bandages are used to get patient's body contour and plaster cast is rectified manually. With the introduction of CAD/CAM system, a series of automated processes from body scanning to digital rectification and milling of positive model can be performed in a fast and accurate fashion. This project is to study the impact of CAD/CAM method as compared with the conventional method. In assessing the 147 recruited subjects fitted with spinal orthoses (43 subjects using conventional method and 104 subjects using CAD/CAM method), significant decreases (p<0.05) were found in the Cobb angles when comparing the pre-intervention data with that of the first year of intervention. Regarding the learning curve, Orthotists are getting more competent with the CAD/CAM technique in four years time. The mean productivity of the CAD/CAM method is 2.75 times higher than that of the conventional method. The CAD/CAM method could achieve similar clinical outcomes and with its high efficiency, could be considered as substitute for conventional methods in fabricating spinal orthoses for patients with AIS.

Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape.

PubMed

Telfer, Scott; Gibson, Kellie S; Hennessy, Kym; Steultjens, Martijn P; Woodburn, Jim

2012-05-01

To determine, for a number of techniques used to obtain foot shape based around plaster casting, foam box impressions, and 3-dimensional scanning, (1) the effect the technique has on the overall reproducibility of custom foot orthoses (FOs) in terms of inter- and intracaster reliability and (2) the reproducibility of FO design by using computer-aided design (CAD) software in terms of inter- and intra-CAD operator reliability for all these techniques. Cross-sectional study. University laboratory. Convenience sample of individuals (N=22) with noncavus foot types. Not applicable. Parameters of the FO design (length, width at forefoot, width at rearfoot, and peak medial arch height), the forefoot to rearfoot angle of the foot shape, and overall volume match between device designs. For intra- and intercaster reliability of the different methods of obtaining the foot shape, all methods fell below the reproducibility quality threshold for the medial arch height of the device, and volume matching was <80% for all methods. The more experienced CAD operator was able to achieve excellent reliability (intraclass correlation coefficients >0.75) for all variables with the exception of forefoot to rearfoot angle, with overall volume matches of >87% of the devices. None of the techniques for obtaining foot shape met all the criteria for excellent reproducibility, with the peak arch height being particularly variable. Additional variability is added at the CAD stage of the FO design process, although with adequate operator experience good to excellent reproducibility may be achieved at this stage. Taking only basic linear or angular measurement parameters from the device may fail to fully capture the variability in FO design. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of different designs of ankle-foot orthoses on gait in patients with stroke: A systematic review.

PubMed

Daryabor, Aliyeh; Arazpour, Mokhtar; Aminian, Gholamreza

2018-05-01

Ankle foot orthoses (AFOs) are used to improve the gait of patients with stroke. The current review aimed at evaluating the efficacy of different designs of AFOs and comparison between them on the gait parameters of individuals with hemiplegic stroke. The search strategy was based on the population intervention comparison outcome (PICO) method. A search was performed in PubMed, ISI Web of Knowledge, Scopus, Science Direct, and Google Scholar databases. A total of 27 articles were found for the final evaluation. All types of AFOs had positive effects on ankle kinematic in the first rocker and swing phases, but not on knee kinematics in the swing phase, hip kinematics or the third rocker function. All trials, except two, assessed immediate or short-term effects only. The articulated passive AFO compared with the non-articulated passive AFO had better effects on some aspects of the gait of patients with hemiplegia following stroke, more investigations are needed in this regard though. An ankle-foot orthosis can immediately improve the dropped foot in the stance and swing phases. The effects of long-term usage and comparison among the different types of AFOs need to be evaluated. Copyright © 2018 Elsevier B.V. All rights reserved.

Pes planus: radiographic changes with foot orthoses and shoes.

PubMed

Penneau, K; Lutter, L D; Winter, R D

1982-03-01

Radiographic evaluation of 10 children with bilateral pes planus was performed. Radiographs taken barefoot, with a Thomas heel, with an over-the-counter insert, with two specially molded plastic foot orthoses were used. No significant change was seen after the donning of these appliances in their comparison to barefoot evaluation. The conclusion is that there was not a significant change radiographically of these feet by the utilization of any of the appliances.

Effects of foot orthoses on Achilles tendon load in recreational runners.

PubMed

Sinclair, J; Isherwood, J; Taylor, P J

2014-09-01

Achilles tendon pathology is a frequently occurring musculoskeletal disorder in runners. Foot orthoses have been shown to reduce the symptoms of pain in runners but their mechanical effects are still not well understood. This study aimed to examine differences in Achilles tendon load when running with and without orthotic intervention. Twelve male runners ran at 4.0 m·s(-1). Ankle joint moments and Achilles tendon forces were compared when running with and without orthotics. The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics. In addition to providing insight into the mechanical effects of orthotics in runners, the current investigation suggests that via reductions in Achilles tendon load, foot orthoses may serve to reduce the incidence of chronic Achilles tendon pathologies in runners. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida: A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework.

PubMed

Ivanyi, Barbara; Schoenmakers, Marja; van Veen, Natasja; Maathuis, Karel; Nollet, Frans; Nederhand, Marc

2015-12-01

To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance. To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida. Systematic literature review. A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework. Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle-foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance. Some data support the efficacy of using ankle-foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated. This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment on gait parameters, walking capacity, and walking performance. © The International Society for Prosthetics and Orthotics 2014.

The impacts of hinged and solid ankle-foot orthoses on standing and walking in children with spastic diplegia.

PubMed

Dalvand, Hamid; Dehghan, Leila; Feizi, Awat; Hosseini, Seyed Ali; Amirsalari, Susan

2013-01-01

The purpose of this study was to examine the impacts of hinged and solid anklefoot orthoses (AFOs) on standing and walking abilities in children with spastic diplegia. In a quasi-experimental design, 30 children with spastic diplegia, aged 4-6 years were recruited. They were matched in terms of age, IQ, and level of GMFCS E&R. Children were randomly assigned into 3 groups: a hinged AFO group (n=10) plus occupational therapy (OT), a solid AFO group (n=10) plus OT, a control group who used only OT for three months. Gross motor abilities were measured using Gross Motor Measure Function (GMFM). We obtained statistically significant differences in the values between baseline and after treatment in all groups. The groups were also significantly different in total GMFM after intervention. Furthermore, there were differences between hinged AFOs and solid AFOs groups, and between hinged AFOs and control groups. We concluded that gross motor function was improved in all groups; however, hinged AFOs group appears to improve the gross motor function better than solid AFOs and control groups.

The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet.

PubMed

Sheykhi-Dolagh, Roghaye; Saeedi, Hassan; Farahmand, Behshid; Kamyab, Mojtaba; Kamali, Mohammad; Gholizadeh, Hossein; Derayatifar, Amir A; Curran, Sarah

2015-06-01

Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. A quasi-experimental study. The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility. © The International Society for Prosthetics and Orthotics 2014.

Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis.

PubMed

Pröbsting, Eva; Kannenberg, Andreas; Zacharias, Britta

2017-02-01

There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation ( p = .001), paretic limb health ( p = .04), sounds ( p = .02), and well-being ( p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.

Test apparatus for the measurement of the flexibility of ankle-foot orthoses in planes other than the loaded plane.

PubMed

Klasson, B; Convery, P; Raschke, S

1998-04-01

Previous publications have reported on the flexibility of ankle-foot orthoses (AFO) only in the same plane as the applied load. This paper reports on a test apparatus developed to detect the flexibility of an AFO in 5 degrees of freedom when subjected to a plantar/dorsiflexion moment, a medial/lateral moment or a torque. A moment applied to an AFO in one plane induces angulation and translation in all planes.

Effects of customized foot orthoses on manufacturing workers in the metal industry.

PubMed

García-Hernández, César; Huertas-Talón, José-Luis; Sánchez-Álvarez, Eduardo J; Marín-Zurdo, Javier

2016-01-01

This 8-week study evaluates the effects of customized foot orthoses on work-related musculoskeletal disorders (WMSDs) of metal industry workers. These WMSDs were evaluated applying the Nordic musculoskeletal questionnaire (NMQ) at three different times (start, 4th week and 8th week) and additional questions were also formulated to obtain information about adaptation, fatigue, comfort and possible improvements. According to the NMQ results, statistical significance was found in the improvements after 4 weeks (p < 0.05 in two areas, p < 0.01 in three areas, p < 0.001 in two areas and no significance in the other two) and after 8 weeks (p < 0.01 in three areas, p < 0.001 in four areas and no significance in the other two). The additional questions indicated fatigue reduction (both in general and in lower extremity), comfort level increase (after the adaptation period) and good acceptance, according to workers' answers, suggesting customized orthoses can be effective in reducing and preventing WMSDs in several body regions.

Modelling of human walking to optimise the function of ankle-foot orthosis in Guillan-Barré patients with drop foot.

PubMed

Jamshidi, N; Rostami, M; Najarian, S; Menhaj, M B; Saadatnia, M; Firooz, S

2009-04-01

This paper deals with the dynamic modelling of human walking. The main focus of this research was to optimise the function of the orthosis in patients with neuropathic feet, based on the kinematics data from different categories of neuropathic patients. The patient's body on the sagittal plane was modelled for calculating the torques generated in joints. The kinematics data required for mathematical modelling of the patients were obtained from the films of patients captured by high speed camera, and then the films were analysed through a motion analysis software. An inverse dynamic model was used for estimating the spring coefficient. In our dynamic model, the role of muscles was substituted by adding a spring-damper between the shank and ankle that could compensate for their weakness by designing ankle-foot orthoses based on the kinematics data obtained from the patients. The torque generated in the ankle was varied by changing the spring constant. Therefore, it was possible to decrease the torque generated in muscles which could lead to the design of more comfortable and efficient orthoses. In this research, unlike previous research activities, instead of studying the abnormal gait or modelling the ankle-foot orthosis separately, the function of the ankle-foot orthosis on the abnormal gait has been quantitatively improved through a correction of the torque.

When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists

PubMed Central

Uden, Hayley; Kumar, Saravana; Banwell, Helen A.

2018-01-01

Background Flexible pes planus (flat feet) in children is a common reason parents and caregivers seek health professionals consult and a frequent reason podiatrists prescribe foot orthoses. Yet no universal agreement exists on the diagnosis of this condition, or when and how foot orthoses should be prescribed. The aim of this study was to garner consensus and agreement among podiatrists on the use of FOs for paediatric flexible pes planus. Methods A three round Delphi consensus survey was undertaken with 15 podiatry experts from Australia, New Zealand and the United Kingdom. Round One gathered consensus on the diagnosis and intervention into paediatric pes planus with specific questions on types of FOs and prescription variables used. Round Two and Three were based on answers from Round One and gathered agreement (rationale for choices) on a five point Likert scale. 70% of respondents had to agree to a statement for it to be accepted as consensus or agreement. Results Consensus and agreement was achieved for 83 statements directing the diagnosis of pes planus (using FPI-6 and/or rearfoot measures), common signs and symptoms (e.g., pain, fatigue, abnormal gait and other functional concerns) that direct when to intervene into paediatric flexible pes planus. Prefabricated orthoses were the preferred intervention where adequate control is gained with their use. When customised orthoses are prescribed, a vertical [heel] cast pour (71.4%) and minimal arch fill (76.9%) are the prescription variables of choice, plus or minus additional variables (i.e., medial heel (Kirby) skive, the use of a University of California Biomechanical Laboratory device or a medial flange) dependent on level of disorder and plane of excessive motion. Conclusions This study identified consensus and agreement on a series of diagnosis methods and interventions for the paediatric flexible pes planus. A clinical protocol was developed from the resultant consensus statements which provides clinicians with a series of evidenced-informed statements to better guide them on when, how and why FOs are used specific to this population. PMID:29682429

Hardness and posting of foot orthoses modify plantar contact area, plantar pressure, and perceived comfort when cycling.

PubMed

Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2018-07-01

To evaluate the effects of hardness and posting of orthoses on plantar profile and perceived comfort and support during cycling. A repeated measures study with randomised order of orthoses, hardness, and posting conditions. Twenty-three cyclists cycled at a cadence of 90rpm and a perceived exertion rating of twelve. Contoured soft and hard orthoses with or without a medial forefoot or lateral forefoot post were evaluated. Plantar contact area, mean pressure and peak pressure were measured for nine plantar regions using the pedar ® -X system and represented as a percentage of the total (CA%, MP%, and PP% respectively). Perceived comfort and support was rated on a visual analogue scale. The softer orthosis significantly increased CA% (p=0.014) across the midfoot and heel with a decrease in the toe region and forefoot. MP% (p=0.034) and PP% (p=0.012) were significantly increased at the mid and lateral forefoot with reductions in MP% at the midfoot and in PP% at the hallux and toes. Forefoot posting significantly increased CA% (p=0.018) at the toes and forefoot and decreased it at the heel. PP% was significantly altered (p=0.013) based on posting position. Lateral forefoot posting significantly decreased heel comfort (p=0.036). When cycling, a soft, contoured orthosis increased contact across the midfoot and heel, modulating forefoot and midfoot plantar pressures but not altering comfort or support. Forefoot postings significantly modified contact areas and plantar pressures and reduced comfort at the heel. Copyright © 2017. Published by Elsevier Ltd.

The Effectiveness of Low-Dye Taping in Reducing Pain Associated With Plantar Fasciitis.

PubMed

Verbruggen, Laura A; Thompson, Melissa M; Durall, Chris J

2018-01-01

Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. Initial treatment of plantar fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf stretching, ultrasound, foot orthoses, and taping. However, while custom foot orthoses are a common treatment method for plantar fasciitis, there is often a waiting period of a few weeks for them to be manufactured and delivered. Therefore, taping of the foot is often used as a temporary treatment to alleviate pain during the initial waiting period. Furthermore, taping may also be used as an alternative to foot orthoses for patients who may not tolerate the plantar pressures of an orthotic or for tight-fitting footwear that may not accommodate insoles. Specifically, the low-Dye taping (LDT) technique is one of the most frequently used methods, and recent literature has suggested that it may improve pain outcomes. Therefore, this critically appraised topic was conducted to determine the extent to which current evidence supports the use of LDT to reduce pain in patients with plantar fasciitis.

Clinical uses of in-shoe pressure analysis in podiatric sports medicine.

PubMed

Williams, Bruce E; Yakel, James D

2007-01-01

Athletic injuries of the foot and lower extremity are commonly treated with custom foot orthoses. These devices usually provide immediate relief of the athlete's pain and dysfunction. Occasionally, however, they do not help, or even increase the patient's discomfort. We discuss a method of using in-shoe pressure-measurement systems to analyze the athletic patient's foot and lower-extremity function before and after treatment with custom foot orthoses, with a focus on sagittal plane biomechanics. Case histories are presented of athletes whose gait pathologies were identified and treated successfully using an in-shoe pressure-measurement system.

A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet.

PubMed

Evans, A M; Rome, K

2011-03-01

The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks. As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment. The available prevalence estimates are all limited by variable sampling, assessment measures and age groups and hence result in disparate findings (0.6-77.9%). Consistently, flat foot has been found to normally reduce with age. The normal findings of flat foot versus children's age estimates that approximately 45% of preschool children, and 15% of older children (average age 10 years) have flat feet. Few flexible flat feet have been found to be symptomatic. Joint hypermobility and increased weight or obesity may increase flat foot prevalence, independently of age. Most attempts at classification of flat foot morphology include the arch, heel position and foot flexibility. Usual assessment methods are footprint measures, X-rays and visual (scaled) observations. There is no standardized framework from which to evaluate the pediatric flat foot. The pediatric flat foot is often unnecessarily treated, being ill-defined and of uncertain prognosis. Contemporary management of the pediatric flat foot is directed algorithmically within this review, according to pain, age, flexibility; considering gender, weight, and joint hypermobility. When foot orthoses are indicated, inexpensive generic appliances will usually suffice. Customised foot orthoses should be reserved for children with foot pain and arthritis, for unusual morphology, or unresponsive cases. Surgery is rarely indicated for pediatric flat foot (unless rigid) and only at the failure of thorough conservative management. The assessment of the pediatric flatfoot needs to be considered with reference to the epidemiological findings, where there is consensus that pediatric flexible flat foot reduces with age and that most children are asymptomatic. Globally, there is need for a standard by which the pediatric flat foot is assessed classified and managed. Until then, assessment should utilize the available evidence-based management model, the p-FFP Future research needs to evaluate the pediatric flat foot from representative samples, of healthy and known disease-group children prospectively, and using validated assessment instruments. The preliminary findings of the benefits of foot exercises, and discrete investigation into the effects of shoes and footwear use are also warranted.

Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial.

PubMed

Nikamp, Corien Dm; Buurke, Jaap H; van der Palen, Job; Hermens, Hermie J; Rietman, Johan S

2017-06-01

(1) To study the effects of providing ankle-foot orthoses in subjects with (sub)acute stroke; and (2) to study whether the point in time at which an ankle-foot orthosis is provided post-stroke (early or delayed) influences these effects. Randomized controlled trial. Rehabilitation centre. Unilateral hemiparetic stroke subjects with indication for use of an ankle-foot orthosis and maximal six weeks post-stroke. Subjects were randomly assigned to: early provision (at inclusion; Week 1) or delayed provision (eight weeks later; Week 9). 10-metre walk test, 6-minute walk test, Timed Up and Go Test, stairs test, Functional Ambulation Categories, Berg Balance Scale, Rivermead Mobility Index and Barthel Index; assessed in Weeks 1, 3, 9 and 11. A total of 33 subjects were randomized (16 early, 17 delayed). Positive effects of ankle-foot orthoses were found two weeks after provision, both when provided early (significant effects on all outcomes) or delayed (Berg Balance Scale p = 0.011, Functional Ambulation Categories p = 0.008, 6-minute walk test p = 0.005, Timed Up and Go Test p = 0.028). Comparing effects after early and delayed provision showed that early provision resulted in increased levels of improvement on Berg Balance Scale (+5.1 points, p = 0.002), Barthel Index (+1.9 points, p = 0.002) and non-significant improvements on 10-metre walk test (+0.14 m/s, p = 0.093) and Timed Up and Go Test (-5.4 seconds, p = 0.087), compared with delayed provision. We found positive effects of providing ankle-foot orthoses in (sub)acute stroke subjects that had not used these orthoses before.

Passive-dynamic ankle-foot orthosis replicates soleus but not gastrocnemius muscle function during stance in gait: Insights for orthosis prescription.

PubMed

Arch, Elisa S; Stanhope, Steven J; Higginson, Jill S

2016-10-01

Passive-dynamic ankle-foot orthosis characteristics, including bending stiffness, should be customized for individuals. However, while conventions for customizing passive-dynamic ankle-foot orthosis characteristics are often described and implemented in clinical practice, there is little evidence to explain their biomechanical rationale. To develop and combine a model of a customized passive-dynamic ankle-foot orthosis with a healthy musculoskeletal model and use simulation tools to explore the influence of passive-dynamic ankle-foot orthosis bending stiffness on plantar flexor function during gait. Dual case study. The customized passive-dynamic ankle-foot orthosis characteristics were integrated into a healthy musculoskeletal model available in OpenSim. Quasi-static forward dynamic simulations tracked experimental gait data under several passive-dynamic ankle-foot orthosis conditions. Predicted muscle activations were calculated through a computed muscle control optimization scheme. Simulations predicted that the passive-dynamic ankle-foot orthoses substituted for soleus but not gastrocnemius function. Induced acceleration analyses revealed the passive-dynamic ankle-foot orthosis acts like a uniarticular plantar flexor by inducing knee extension accelerations, which are counterproductive to natural knee kinematics in early midstance. These passive-dynamic ankle-foot orthoses can provide plantar flexion moments during mid and late stance to supplement insufficient plantar flexor strength. However, the passive-dynamic ankle-foot orthoses negatively influenced knee kinematics in early midstance. Identifying the role of passive-dynamic ankle-foot orthosis stiffness during gait provides biomechanical rationale for how to customize passive-dynamic ankle-foot orthoses for patients. Furthermore, these findings can be used in the future as the basis for developing objective prescription models to help drive the customization of passive-dynamic ankle-foot orthosis characteristics. © The International Society for Prosthetics and Orthotics 2015.

Design of active orthoses for a robotic gait rehabilitation system

NASA Astrophysics Data System (ADS)

Villa-Parra, A. C.; Broche, L.; Delisle-Rodríguez, D.; Sagaró, R.; Bastos, T.; Frizera-Neto, A.

2015-09-01

An active orthosis (AO) is a robotic device that assists both human gait and rehabilitation therapy. This work proposes portable AOs, one for the knee joint and another for the ankle joint. Both AOs will be used to complete a robotic system that improves gait rehabilitation. The requirements for actuator selection, the biomechanical considerations during the AO design, the finite element method, and a control approach based on electroencephalographic and surface electromyographic signals are reviewed. This work contributes to the design of AOs for users with foot drop and knee flexion impairment. However, the potential of the proposed AOs to be part of a robotic gait rehabilitation system that improves the quality of life of stroke survivors requires further investigation.

A Hybrid FPGA-Based System for EEG- and EMG-Based Online Movement Prediction.

PubMed

Wöhrle, Hendrik; Tabie, Marc; Kim, Su Kyoung; Kirchner, Frank; Kirchner, Elsa Andrea

2017-07-03

A current trend in the development of assistive devices for rehabilitation, for example exoskeletons or active orthoses, is to utilize physiological data to enhance their functionality and usability, for example by predicting the patient's upcoming movements using electroencephalography (EEG) or electromyography (EMG). However, these modalities have different temporal properties and classification accuracies, which results in specific advantages and disadvantages. To use physiological data analysis in rehabilitation devices, the processing should be performed in real-time, guarantee close to natural movement onset support, provide high mobility, and should be performed by miniaturized systems that can be embedded into the rehabilitation device. We present a novel Field Programmable Gate Array (FPGA) -based system for real-time movement prediction using physiological data. Its parallel processing capabilities allows the combination of movement predictions based on EEG and EMG and additionally a P300 detection, which is likely evoked by instructions of the therapist. The system is evaluated in an offline and an online study with twelve healthy subjects in total. We show that it provides a high computational performance and significantly lower power consumption in comparison to a standard PC. Furthermore, despite the usage of fixed-point computations, the proposed system achieves a classification accuracy similar to systems with double precision floating-point precision.

A Hybrid FPGA-Based System for EEG- and EMG-Based Online Movement Prediction

PubMed Central

Wöhrle, Hendrik; Tabie, Marc; Kim, Su Kyoung; Kirchner, Frank; Kirchner, Elsa Andrea

2017-01-01

A current trend in the development of assistive devices for rehabilitation, for example exoskeletons or active orthoses, is to utilize physiological data to enhance their functionality and usability, for example by predicting the patient’s upcoming movements using electroencephalography (EEG) or electromyography (EMG). However, these modalities have different temporal properties and classification accuracies, which results in specific advantages and disadvantages. To use physiological data analysis in rehabilitation devices, the processing should be performed in real-time, guarantee close to natural movement onset support, provide high mobility, and should be performed by miniaturized systems that can be embedded into the rehabilitation device. We present a novel Field Programmable Gate Array (FPGA) -based system for real-time movement prediction using physiological data. Its parallel processing capabilities allows the combination of movement predictions based on EEG and EMG and additionally a P300 detection, which is likely evoked by instructions of the therapist. The system is evaluated in an offline and an online study with twelve healthy subjects in total. We show that it provides a high computational performance and significantly lower power consumption in comparison to a standard PC. Furthermore, despite the usage of fixed-point computations, the proposed system achieves a classification accuracy similar to systems with double precision floating-point precision. PMID:28671632

Effect of carbon-composite knee-ankle-foot orthoses on walking efficiency and gait in former polio patients.

PubMed

Brehm, Merel-Anne; Beelen, Anita; Doorenbosch, Caroline A M; Harlaar, Jaap; Nollet, Frans

2007-10-01

To investigate the effects of total-contact fitted carbon-composite knee-ankle-foot orthoses (KAFOs) on energy cost of walking in patients with former polio who normally wear a conventional leather/metal KAFO or plastic/metal KAFO. A prospective uncontrolled study with a multiple baseline and follow-up design. Follow-up measurements continued until 26 weeks after intervention. Twenty adults with polio residuals (mean age 55 years). Each participant received a new carbon-composite KAFO, fitted according to a total-contact principle, which resulted in a rigid, lightweight and well-fitting KAFO. Energy cost of walking, walking speed, biomechanics of gait, physical functioning and patient satisfaction. The energy cost decreased significantly, by 8%, compared with the original KAFO. Furthermore, the incremention energy cost during walking with the carbon-composite KAFO was reduced by 18% towards normative values. An improvement in knee flexion, forward excursion of the centre of pressure, peak ankle moment, and timing of peak ankle power were significantly associated with the decrease in energy cost. Walking speed and physical functioning remained unchanged. In patients with former polio, carbon-composite KAFOs are superior to conventional leather/metal and plastic/metal KAFOs with respect to improving walking efficiency and gait, and are therefore important in reducing overuse and maintaining functional abilities in polio survivors.

Role of ankle foot orthoses in functional stability of individuals with stroke.

PubMed

Rao, N; Aruin, A S

2016-10-01

Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p < 0.05). The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke. Implications for Rehabilitation Functional stability is impaired in individuals with stroke. Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control. Individuals with stroke improved their functional stability while they were provided with AFOs. Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

Quantifying anti-gravity torques in the design of a powered exoskeleton.

PubMed

Ragonesi, Daniel; Agrawal, Sunil; Sample, Whitney; Rahman, Tariq

2011-01-01

Designing an upper extremity exoskeleton for people with arm weakness requires knowledge of the passive and active residual force capabilities of users. This paper experimentally measures the passive gravitational torques of 3 groups of subjects: able-bodied adults, able bodied children, and children with neurological disabilities. The experiment involves moving the arm to various positions in the sagittal plane and measuring the gravitational force at the wrist. This force is then converted to static gravitational torques at the elbow and shoulder. Data are compared between look-up table data based on anthropometry and empirical data. Results show that the look-up torques deviate from experimentally measured torques as the arm reaches up and down. This experiment informs designers of Upper Limb orthoses on the contribution of passive human joint torques.

National profile of foot orthotic provision in the United Kingdom, part 2: podiatrist, orthotist and physiotherapy practices.

PubMed

Nester, C J; Graham, A; Martinez-Santos, A; Williams, A E; McAdam, J; Newton, V; Sweeney, D; Walker, D

2018-01-01

A national survey recently provided the first description of foot orthotic provision in the United Kingdom. This article aims to profile and compare the foot orthoses practice of podiatrists, orthotists and physiotherapists within the current provision. Quantitative data were collected from podiatrists, orthotists and physiotherapists via an online questionnaire. The topics, questions and answers were developed through a series of pilot phases. The professions were targeted through electronic and printed materials advertising the survey. Data were captured over a 10 month period in 2016. Differences between professions were investigated using Chi squared and Fischer's exact tests, and regression analysis was used to predict the likelihood of each aspect of practice in each of the three professions. Responses from 357 podiatrists, 93 orthotists and 49 physiotherapists were included in the analysis. The results reveal statistically significant differences in employment and clinical arrangements, the clinical populations treated, and the nature and volume of foot orthoses caseload. Podiatrists, orthotists and physiotherapists provide foot orthoses to important clinical populations in both a prevention and treatment capacity. Their working context, scope of practice and mix of clinical caseload differs significantly, although there are areas of overlap. Addressing variations in practice could align this collective workforce to national allied health policy.

Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial.

PubMed

James, Alicia M; Williams, Cylie M; Haines, Terry P

2016-10-01

Calcaneal apophysitis, is a relatively common cause of heel pain in children. Very few randomised studies have evaluated treatment options. This trial compared the effectiveness of currently employed treatment options for the relief of pain and disability associated with calcaneal apophysitis. Factorial 2×2 randomised comparative effectiveness trial with 1, 2, 6 and 12-month follow-up. Participants were recruited from the caseload of podiatrists at Monash health and Peninsula Health. Children aged 8-14 years with clinically diagnosed calcaneal apophysitis. Treatment factor 1: two different types of in-shoe orthoses: a heel raise or prefabricated orthoses. Treatment factor 2: footwear replacement or no footwear replacement. Our primary outcome was functional disability, the secondary outcomes were pain and ankle dorsiflexion range. A total of 133 children and their parents responded to the recruitment advertisement, 124 participated in the trial.At the 1 and 2-month follow-up points, there was a main effect of the shoe insert (heel raise) in only the physical domain for the Oxford ankle foot questionnaire (p=0.04). At the 6 and 12-month follow-up points, there was no main effect or interaction effect for any outcome measure. This trial indicates at the 2-month time point there is a relative advantage in the use of heel raises over prefabricated orthoses for the treatment for calcaneal apophysitis. At 12 months there was no relative advantage to any one of the investigated treatment choices over another. Therefore, if a physical impact is experienced for greater than 2 months, the selection of treatment choice may defer to clinical judgement, cost-minimisation and or patient preference. ACTRN12609000696291. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia.

PubMed

Ferrari, Adriano; Maoret, Anna Rosa; Muzzini, Simonetta; Alboresi, Silvia; Lombardi, Francesco; Sgandurra, Giuseppina; Paolicelli, Paola Bruna; Sicola, Elisa; Cioni, Giovanni

2014-10-01

The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p=.025) and functional goals achievement (GAS) was also slightly better in the same group (p=.033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessment of a virtual functional prototyping process for the rapid manufacture of passive-dynamic ankle-foot orthoses.

PubMed

Schrank, Elisa S; Hitch, Lester; Wallace, Kevin; Moore, Richard; Stanhope, Steven J

2013-10-01

Passive-dynamic ankle-foot orthosis (PD-AFO) bending stiffness is a key functional characteristic for achieving enhanced gait function. However, current orthosis customization methods inhibit objective premanufacture tuning of the PD-AFO bending stiffness, making optimization of orthosis function challenging. We have developed a novel virtual functional prototyping (VFP) process, which harnesses the strengths of computer aided design (CAD) model parameterization and finite element analysis, to quantitatively tune and predict the functional characteristics of a PD-AFO, which is rapidly manufactured via fused deposition modeling (FDM). The purpose of this study was to assess the VFP process for PD-AFO bending stiffness. A PD-AFO CAD model was customized for a healthy subject and tuned to four bending stiffness values via VFP. Two sets of each tuned model were fabricated via FDM using medical-grade polycarbonate (PC-ISO). Dimensional accuracy of the fabricated orthoses was excellent (average 0.51 ± 0.39 mm). Manufacturing precision ranged from 0.0 to 0.74 Nm/deg (average 0.30 ± 0.36 Nm/deg). Bending stiffness prediction accuracy was within 1 Nm/deg using the manufacturer provided PC-ISO elastic modulus (average 0.48 ± 0.35 Nm/deg). Using an experimentally derived PC-ISO elastic modulus improved the optimized bending stiffness prediction accuracy (average 0.29 ± 0.57 Nm/deg). Robustness of the derived modulus was tested by carrying out the VFP process for a disparate subject, tuning the PD-AFO model to five bending stiffness values. For this disparate subject, bending stiffness prediction accuracy was strong (average 0.20 ± 0.14 Nm/deg). Overall, the VFP process had excellent dimensional accuracy, good manufacturing precision, and strong prediction accuracy with the derived modulus. Implementing VFP as part of our PD-AFO customization and manufacturing framework, which also includes fit customization, provides a novel and powerful method to predictably tune and precisely manufacture orthoses with objectively customized fit and functional characteristics.

Estimating the Mechanical Behavior of the Knee Joint during Crouch Gait: Implications for Real-Time Motor Control of Robotic Knee Orthoses

PubMed Central

Damiano, Diane L.; Bulea, Thomas C.

2016-01-01

Individuals with cerebral palsy frequently exhibit crouch gait, a pathological walking pattern characterized by excessive knee flexion. Knowledge of the knee joint moment during crouch gait is necessary for the design and control of assistive devices used for treatment. Our goal was to 1) develop statistical models to estimate knee joint moment extrema and dynamic stiffness during crouch gait, and 2) use the models to estimate the instantaneous joint moment during weight-acceptance. We retrospectively computed knee moments from 10 children with crouch gait and used stepwise linear regression to develop statistical models describing the knee moment features. The models explained at least 90% of the response value variability: peak moment in early (99%) and late (90%) stance, and dynamic stiffness of weight-acceptance flexion (94%) and extension (98%). We estimated knee extensor moment profiles from the predicted dynamic stiffness and instantaneous knee angle. This approach captured the timing and shape of the computed moment (root-mean-squared error: 2.64 Nm); including the predicted early-stance peak moment as a correction factor improved model performance (root-mean-squared error: 1.37 Nm). Our strategy provides a practical, accurate method to estimate the knee moment during crouch gait, and could be used for real-time, adaptive control of robotic orthoses. PMID:27101612

[Orthoses and assistive devices in rheumatology : Prevention of disability, support of residual function].

PubMed

Fikentscher, T; Springorum, H R; Grifka, J; Götz, J

2017-04-01

Due to the frequent presence of comorbidities in patients suffering from rheumatism with increased perioperative risk factors, conservative treatment is often needed. Besides pharmacological treatment, physiotherapy and occupational therapy, a variety of orthoses are available depending on the individual indications. They can be used to stabilize or support joints, limit the range of motion, prevent unphysiological movements or provide relief for affected limbs. In order to choose the right kind of orthosis, the physician should know the underlying cause of disease. Furthermore, for patients with rheumatism many devices are available for daily living that use ergonomic handles or improved leverage effects to compensate for the often severe limitations and to improve the quality of life.

Mechanism and Design Analysis of Articulated Ankle Foot Orthoses for Drop-Foot

PubMed Central

Choudhury, Imtiaz Ahmed; Mamat, Azuddin Bin

2014-01-01

Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of AFO must ensure compactness, light weight, low noise, and high efficiency. These entailments present significant engineering challenges to develop a new design with wide consumer adoption. PMID:24892102

The effect of tuning ankle foot orthoses-footwear combination on the gait parameters of children with cerebral palsy.

PubMed

Eddison, Nicola; Chockalingam, Nachiappan

2013-04-01

There are a wide variety of ankle foot orthoses used in clinical practice which are characterised by their design, the material used and the stiffness of that material. Changing any of these three components will alter the effect of the ankle foot orthosis on gait. The purpose of this article is to provide an overview on the available research on ankle foot orthosis-footwear combination tuning on the gait characteristics of children with cerebral palsy through a structured review. Literature review. A thorough search of previous studies published in English was conducted within all major databases using relevant phrases without any limits for the dates. These searches were then supplemented by tracking all key references from the appropriate articles identified including hand searching of published books where relevant. To date, there are 947 papers in the literature pertaining to the study of ankle foot orthosis. Of these, 153 investigated the use of ankle foot orthosis for children with cerebral palsy. All the studies included in this review were of a within-subjects design and the evidence levels were generally low. The overall results suggested that ankle foot orthosis-footwear combination tuning has the potential to improve the kinematics and kinetics of gait in children with cerebral palsy. However, the review highlights a lack of well-designed and adequately powered studies. Clinical relevance While the research described in this article indicates an improvement in the gait of children with cerebral palsy following tuning of their ankle foot orthosis-footwear combination, there is still a paucity of research with quantitative data on the effects of kinematics and kinetics of ankle foot orthosis-footwear combination tuning, comparing untuned ankle foot orthosis-footwear combinations with tuned ankle foot orthosis-footwear combination. Furthermore, current research does not identify the effect of tuning on energy efficiency.

The current status of rehabilitation engineering

NASA Technical Reports Server (NTRS)

Reswick, J. B.

1974-01-01

Mechanical and electrical engineering devices for paralytic patient care are discussed as they are applied to medical problems. These include means of preventing bedsores, mobility aids, upper extremity orthoses, and electrical stimulation.

Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

PubMed

Imms, Christine; Wallen, Margaret; Elliott, Catherine; Hoare, Brian; Randall, Melinda; Greaves, Susan; Adair, Brooke; Bradshaw, Elizabeth; Carter, Rob; Orsini, Francesca; Shih, Sophy T F; Reddihough, Dinah

2016-05-27

Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs. ANZ Clinical Trials Registry: U1111-1164-0572 .

Provision of assistive technology devices among people with ALS in Germany: a platform-case management approach.

PubMed

Funke, Andreas; Spittel, Susanne; Grehl, Torsten; Grosskreutz, Julian; Kettemann, Dagmar; Petri, Susanne; Weyen, Ute; Weydt, Patrick; Dorst, Johannes; Ludolph, Albert C; Baum, Petra; Oberstadt, Moritz; Jordan, Berit; Hermann, Andreas; Wolf, Joachim; Boentert, Matthias; Walter, Bertram; Gajewski, Nadine; Maier, André; Münch, Christoph; Meyer, Thomas

2018-01-30

The procurement of assistive technology devices (ATD) is an essential component of managed care in ALS. The objective was to analyze the standards of care for ATD and to identify challenges in the provision process. A cohort study design was used. We investigated the provision of 11,364 ATD in 1494 patients with ALS at 12 ALS centers in Germany over four years. Participants were patients that entered a case management program for ATD including systematic assessment of ATD on a digital management platform. Wheelchairs (requested in 65% of patients), orthoses (52%), bathroom adaptations (49%), and communication devices (46%) were the most needed ATD. There was a wide range in the number of indicated ATD per patient: 1 to 4 ATD per patient in 45% of patients, 5 to 20 ATD in 48%, and >20 ATD in 7% of patients. Seventy percent of all requested ATD were effectively delivered. However, an alarming failure rate during procurement was found in ATD that are crucial for ALS patients such as powered wheelchairs (52%), communication devices (39%), or orthoses (21%). Leading causes for not providing ATD were the refusal by health insurances, the decision by patients, and the death of the patient before delivery of the device. The need for ATD was highly prevalent among ALS patients. Failed or protracted provision posed substantial barriers to ATD procurement. Targeted national strategies and the incorporation of ATD indication criteria in international ALS treatment guidelines are urgently needed to overcome these barriers.

Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners.

PubMed

Mündermann, Anne; Nigg, Benno M; Humble, R Neil; Stefanyshyn, Darren J

2003-10-01

The purpose of this study was to determine the relationship between differences in comfort and changes in lower extremity kinematic and kinetic variables and muscle activity in response to foot orthoses. Twenty-one recreational runners volunteered for this study. Three orthotic conditions (posting, custom-molding, and posting and custom-molding) were compared with a control (flat) insert. Lower extremity kinematic, kinetic, and EMG data were collected for 108 trials per subject and condition in nine sessions per subject for overground running at 4 m.s-1. Comfort for all orthotic conditions was assessed in each session using a visual analog scale. The statistical tests used included repeated measures ANOVA, linear regression analysis, and discriminant analysis (alpha = 0.05). Comfort ratings were significantly different between orthotic conditions and the control condition ([lower, upper] confidence limits; posting: [-3.1, -0.8]; molding: [0.4, 3.4]; and posting and molding: [-1.1, 1.9]); 34.9% of differences in comfort were explained by changes in 15 kinematic, kinetic, and EMG variables. The 15 kinematic, kinetic, and EMG variables that partially explained differences in comfort classified 75.0% of cases correctly to the corresponding orthotic condition. In general, comfort is an important and relevant feature of foot orthoses. Evaluations of foot orthoses using comfort do not only reflect subjective perceptions but also differences in functional biomechanical variables. Future research should focus on defining the relationship between comfort and biomechanical variables for material modifications of footwear, different modes of locomotion, and the general population.

Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis.

PubMed

Herzenberg, John E; Burghardt, Rolf D

2014-03-01

Metatarsus adductus is a common pediatric foot deformity related to intrauterine molding. It is usually a mild deformity that responds well to simple observation or minimal treatment with a home program of stretching. Resistant cases may need a more aggressive approach such as serial casting or special bracing to avoid the need for surgical intervention. We compared clinical outcomes using serial casting with orthoses for resistant metatarsus adductus. We prospectively treated 27 infants (43 feet) between the ages 3 and 9 months who failed home stretching treatment. Patients were randomized to either serial plaster casting or Bebax orthoses. Footprints and simulated weight-bearing anteroposterior and lateral view radiographs were made at entry and follow-up. There was no statistical difference between casting and Bebax for the following parameters: age at study entry, length of treatment, number of clinic visits, follow-up, and follow-up maintenance treatments. Both groups showed improvement in footprint and radiographic measurements post-treatment, without worsening of heel valgus. The Bebax group had greater improvement in the footprint heel bisector measurement than the casting group. The Bebax treatment requires more active parental cooperation. A simulated cost analysis of materials and office visit charges, however, revealed that Bebax treatment was significantly less expensive, about half the cost of casting. Because of the cost savings and virtually identical clinical results, we recommend the Bebax orthosis for resistant metatarsus in pre-walking infants with parents who are compliant. Other considerations include specific insurance plans, which may pay for casts but not orthoses.

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study.

PubMed

Mojaver, Ali; Arazpour, Mokhtar; Aminian, Gholamreza; Ahmadi Bani, Monireh; Bahramizadeh, Mahmood; Sharifi, Guive; Sherafatvaziri, Arash

2017-10-01

Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait. The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs. Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters. Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence. A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced. The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.

Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness.

PubMed

Reed, Heath; Langley, Joe; Stanton, Andy; Heron, Nicola; Clarke, Zoe; Judge, Simon; McCarthy, Avril; Squire, Gill; Quinn, Ann; Wells, Oliver; Tindale, Wendy; Baxter, Susan; Shaw, Pamela J; McDermott, Christopher J

2014-01-01

This paper presents the Head-Up project, that aims to provide innovative head support to help improve posture, relieve pain and aid communication for people living with progressive neck muscle weakness. The initial focus is motor neurone disease. The case study illustrates collaborative, interdisciplinary research and new product development underpinned by participatory design. The study was initiated by a 2-day stakeholder workshop followed by early proof-of-concept modelling and patient need evidence building. The work subsequently led to a successful NIHR i4i application funding a 24-month iterative design process, patenting, CE marking and clinical evaluation. The evaluation has informed amendments to the proposed design refered to here as the Sheffield Support Snood (SSS). The outcome positively demonstrates use and performance improvements over current neck orthoses and the process of multidisciplinary and user engagement has created a sense of ownership by MND participants, who have since acted as advocates for the product.

Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.

PubMed

Larsen, Kristian; Weidich, Flemming; Leboeuf-Yde, Charlotte

2002-06-01

Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented. To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible. Prospective, randomized, controlled intervention trial. One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment. Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated. Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems. Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups. This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.

Instantaneous centers of rotation in dorsi/plantar flexion movements of posterior-type plastic ankle-foot orthoses.

PubMed

Sumiya, T; Suzuki, Y; Kasahara, T; Ogata, H

1997-07-01

Hingeless plastic ankle-foot orthoses (PAFOs) achieve ankle motion by flexing about the ankle joint. Instantaneous centers of rotation (ICRs) in dorsi- and plantarflexion movements, used as a measure of PAFO axes of movement, were measured to evaluate their fit to ankle motion. Thirty different PAFOs were fabricated and their stiffness modified in three stages. They were dorsi- and plantarflexed 16 degrees at 2 degrees-intervals using an original device. Displacement of two marks on the lateral calf-cuff were traced photographically, and ICRs were determined by plotting intersections of vertical bisectors for each displacement. The ICRs converged on the junction between the calf shell and the shoe insert. They deviated posteriorly from the anatomical ankle axis and caused the calf-cuff to move up-down during dorsi- and plantarflexion movements. However, this poor fit of the PAFO to ankle motion can be sufficiently compensated for by fastening straps more loosely.

How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study.

PubMed

Desloovere, Kaat; Molenaers, Guy; Van Gestel, Leen; Huenaerts, Catherine; Van Campenhout, Anja; Callewaert, Barbara; Van de Walle, Patricia; Seyler, J

2006-10-01

Several studies indicated that walking with an ankle foot orthosis (AFO) impaired third rocker. The purpose of this study was to evaluate the effects of two types of orthoses, with similar goal settings, on gait, in a homogeneous group of children, using both barefoot and shoe walking as control conditions. Fifteen children with hemiplegia, aged between 4 and 10 years, received two types of individually tuned AFOs: common posterior leaf-spring (PLS) and Dual Carbon Fiber Spring AFO (CFO) (with carbon fibre at the dorsal part of the orthosis). Both orthoses were expected to prevent plantar flexion, thus improving first rocker, allowing dorsiflexion to improve second rocker, absorbing energy during second rocker, and returning it during the third rocker. The effect of the AFOs was studied using objective gait analysis, including 3D kinematics, and kinetics in four conditions: barefoot, shoes without AFO, and PLS and CFO combined with shoes. Several gait parameters significantly changed in shoe walking compared to barefoot walking (cadence, ankle ROM and velocity, knee shock absorption, and knee angle in swing). The CFO produced a significantly larger ankle ROM and ankle velocity during push-off, and an increased plantar flexion moment and power generation at pre-swing compared to the PLS (<0.01). The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking (velocity, step length, first and second ankle rocker, sagittal knee and hip ROM). However, compared to shoes, not all improvements were statistically significant.

Chondromalacia.

ERIC Educational Resources Information Center

Connors, G. Patrick

Chondromalacia is the degeneration of the hyaline cartilage on the under surface of the kneecap. Its causes include patella maltracking (the kneecap does not glide properly over the joint), posttraumatic condition, and chronic overuse. The treatment can be a controlled rehabilitation program, various bracing techniques, foot orthoses, or, in…

Toward A National Biodefense Strategy: Challenges and Opportunities

DTIC Science & Technology

2003-04-01

Clostridium perfringens • Glanders ( Burkholderia mallei ) •Melioidosis ( Burkholderia pseudomallei) •Psittacosis (Chlamydia psittaci) •Q fever (Coxiella...its interests, orthose of friends and allies with biological weapons (BW). The last century wit- nessed the purported use of glanders by the Germans

Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.

PubMed

Spink, Martin J; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R; Menz, Hylton B

2011-08-26

Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

Gait analysis in a patient with severe Charcot-Marie-Tooth disease: a case study with a new orthotic device for footdrop.

PubMed

Vinci, Paolo; Paoloni, M; Ioppolo, F; Gargiulo, P; Santilli, V

2010-09-01

Management of footdrop in severe Charcot-Marie-Tooth (CMT) patients is a challenge owing to the combination of quadriceps muscle weakness, distal muscular atrophy, sensory impairment and poor soft tissue resistance to the placement of an orthotic device. We present a case study of a patient who gradually became unable to use his ankle-foot orthoses because they hampered the compensative movements required to stabilize his knees passively and caused pain. The aim of this report is to describe orthotic management in such a severe CMT case and to present a new orthotic device that we devised for the footdrop in this patient. We provided him with 3 different footdrop devices, each of which was highly elastic to allow knee hyperextension, and left him free to decide which one to use: 1) the silicone-ankle-foot orthoses were rapidly discarded because of pain; 2) the Codivilla support was not used because of discomfort and poor aesthetic appearance; 3) a new device, called the "Soft Footdrop Insert" (SFI), consisting of a sheet of Veolform, a reticulated polyolephinic foam, stuck to the counter of midcalf boots, was found to be effective, comfortable, pain-free and aesthetically acceptable, and was consequently used the vast majority of the time. At a 3-year follow-up, an instrumental gait analysis, in which ordinary shoes were compared with the Codivilla support and the SFI, revealed that both the Codivilla support and the SFI controlled footdrop more effectively than ordinary shoes and increased swing and mean velocity; in addition, the SFI yielded the best gait performances. We think that a soft, invisible device, such as the SFI, may satisfy the needs of CMT patients and improve compliance with orthoses-wearing for footdrop.

Contoured in-shoe foot orthoses increase mid-foot plantar contact area when compared with a flat insert during cycling.

PubMed

Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2013-01-01

To determine the effect of contouring of an in-shoe foot orthosis on plantar contact area and surface pressure, as well as perceived comfort and support at the foot-orthosis interface during stationary cycling. A randomised, repeated measures control study. Twelve cyclists performed steady-state seated cycling at a cadence of 90 rpm using a contoured orthosis and a flat insert of similar hardness. Contact area (CA) and plantar mean pressure (PP) were measured using the PEDAR® system, determined for seven discrete plantar regions and represented as the percentage of the total CA and PP respectively (CA% and PP%). Perceived comfort and support were rated using a visual analogue scale (VAS). The contoured orthosis produced a significantly greater CA% at the medial midfoot (p=0.001) and lateral midfoot (p=0.009) with a standardised mean difference (SMD) of 1.3 and 0.9 respectively. The contoured orthosis also produced a significantly greater PP% at the hallux (p=0.003) compared to the flat insert with a SMD of 1.1. There was a small non-significant effect (SMD<0.4) for the perceived comfort measures between conditions, but perceived support was significantly greater at the arch (p=0.000) and heel (p=0.013) with the contoured orthoses (SMD of 1.5 and 0.9, respectively). Contoured orthoses influenced the plantar surface of the foot by increasing contact area as well as a perception of greater support at the midfoot while increasing relative pressure through the hallux when compared to a flat insert during stationary cycling. No difference in perceived comfort was noted. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.

PubMed

Collis, Julie; Collocott, Shirley; Hing, Wayne; Kelly, Edel

2013-07-01

To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture. We conducted a single-center, randomized, controlled trial to investigate the effect of night extension orthoses on finger range of motion and hand function for 3 months following surgical release of Dupuytren contracture. We also wanted to determine how well finger extension was maintained in the total sample. We randomized 56 patients to receive a night extension orthosis plus hand therapy (n = 26) or hand therapy alone (n = 30). The primary outcome was total active extension of the operated fingers (°). Secondary outcomes were total active flexion of the operated fingers (°), active distal palmar crease (cm), grip strength (kg), and self-reported hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire (0-100 scale). There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes. Between the first postoperative measure and 3 months after surgery, 62% of little fingers had maintained or improved total active extension. The use of a night extension orthosis in combination with standard hand therapy has no greater effect on maintaining finger extension than hand therapy alone in the 3 months following surgical release of Dupuytren contracture. Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery. Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study.

PubMed

Tenten-Diepenmaat, Marloes; Dekker, Joost; Steenbergen, Menno; Huybrechts, Elleke; Roorda, Leo D; van Schaardenburg, Dirkjan; Bus, Sicco A; van der Leeden, Marike

2016-03-01

Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility. Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol. Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed. Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required. Copyright © 2016. Published by Elsevier B.V.

Characteristics of patients with rheumatoid arthritis presenting for physiotherapy management: a multicentre study.

PubMed

Kennedy, Norelee; Keogan, Fiona; Fitzpatrick, Martina; Cussen, Grainne; Wallace, Lorraine

2007-03-01

To describe the characteristics of patients with rheumatoid arthritis (RA) attending for physiotherapy management in Ireland. Managers of physiotherapy departments in the 53 hospitals in Ireland were invited to participate in a multi-centre observational study over a 6-month period. Data on patients with RA the day of presentation for physiotherapy management were recorded. These data related to patient demographic details, disease management, aids and appliances, splint and orthoses usage and occupational issues. The Health Assessment Questionnaire was also recorded for each patient. A total of 273 patients from eight physiotherapy departments participated in the survey (n = 199; 73% female). Mean age of the participants was 59.3 (SD 12.5) years with mean disease duration of 13.8 (SD 10.6) years. The majority of the patients were inpatients (n = 170, 62%). Sixty-eight per cent of patients had attended for previous physiotherapy treatment and 98% were under current rheumatologist care. Biologic therapies were prescribed to 11% of patients. Use of splint and foot orthoses was high with 133 patients (49%) wearing splints and 75 (31%) wearing foot orthoses. The majority of patients had moderate (n = 119, 44%) or severe (n = 94, 35%) disability as per Health Assessment Questionnaire (HAQ) score. Mean HAQ score was 1.5, with HAQ scores showing increasing disability with increasing age, disease duration and erythrocyte sedimentation rate (ESR) levels. Patients with RA attending for physiotherapy management present with varied profiles. This study provides valuable information on the characteristics of patients with RA attending for physiotherapy management which will contribute to physiotherapy service planning and delivery and will optimize patient care.

Molded foot orthosis after great toe or medial ray amputations in diabetic feet.

PubMed

Due, T M; Jacobs, R L

1985-12-01

Necrosis of the tip of the next lateral remaining toe has been found to be a late complication of great toe and medial ray amputations in diabetic feet. The use of custom-molded insert foot orthoses helps avoid this complication.

Foot osteoarthritis: latest evidence and developments

PubMed Central

Roddy, Edward; Menz, Hylton B.

2018-01-01

Foot osteoarthritis (OA) is a common problem in older adults yet is under-researched compared to knee or hand OA. Most existing studies focus on the first metatarsophalangeal joint, with evidence relating to midfoot OA being particularly sparse. Symptomatic radiographic foot OA affects 17% of adults aged 50 years and over. The first metatarsophalangeal joint is most commonly affected, followed by the second cuneometatarsal and talonavicular joints. Epidemiological studies suggest the existence of distinct first metatarsophalangeal joint and polyarticular phenotypes, which have differing clinical and risk factor profiles. There are few randomized controlled trials in foot OA. Existing trials provide some evidence of the effectiveness for pain relief of physical therapy, rocker-sole shoes, foot orthoses and surgical interventions in first metatarsophalangeal joint OA and prefabricated orthoses in midfoot OA. Prospective epidemiological studies and randomized trials are needed to establish the incidence, progression and prognosis of foot OA and determine the effectiveness of both commonly used and more novel interventions. PMID:29619094

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability.

PubMed

Hadadi, Mohammad; Ebrahimi, Ismaeil; Mousavi, Mohammad Ebrahim; Aminian, Gholamreza; Esteki, Ali; Rahgozar, Mehdi

2017-02-01

Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients. The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients. Cross-sectional study. An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform. The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support. The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

Young children with cerebral palsy: families self-reported equipment needs and out-of-pocket expenditure.

PubMed

Bourke-Taylor, H; Cotter, C; Stephan, R

2014-09-01

Costs to families raising a child with cerebral palsy and complex needs are direct and indirect. This study investigated the self-reported real-life costs, equipment needs, and associated characteristics of children who had the highest equipment and care needs. The purposive sample (n = 29) were families with a child with cerebral palsy: gross motor function levels 5 (n = 20), level 4 (n = 5), level 3 (n = 4); complex communication needs (n = 21); medical needs (n = 14); hearing impairment (n = 5) and visual impairment (n = 9). Participants completed a specifically designed survey that included the Assistance to Participate Scale. Equipment and technology purchases were recorded in the areas of positioning, mobility, transport, home modifications, communication, splinting and orthoses, self-care, technology, communication devices, medical, adapted toys/leisure items and privately hired babysitters/carers. Descriptive and inferential statistics were used to analyse the data. Families had purchased up to 25 items within the areas described. The highest median number of items were recorded for positioning (15 items), mobility devices (9 items) and adapted toys/leisure items (9 items). Median costs were highest for home modifications (AUD$23000), transport (AUD$15000), splints and orthoses (AUD$3145), paid carers (AUD$3080), equipment for toileting/dressing/bathing (AUD$2900) and technical/medical items ($2380). Children who needed more parental assistance to participate in play and recreation also required significantly more equipment overall for positioning, communication, self-care and toys/leisure. The equipment needs of young children with complex disability are extensive and out-of-pocket expenses and parental time to support participation in play/recreation excessive. Substantial financial support to offset costs are crucial to better support families in this life situation. © 2013 John Wiley & Sons Ltd.

The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations

PubMed Central

2010-01-01

Background The effects of lumbosacral orthoses (LSOs) on neuromuscular control of the trunk are not known. There is a concern that wearing LSOs for a long period may adversely alter muscle control, making individuals more susceptible to injury if they discontinue wearing the LSOs. The purpose of this study was to document neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO. Methods Fourteen subjects wore LSOs 3 hrs a day for 3 weeks. Trunk muscle activity prior to and following a quick force release (trunk perturbation) was measured with EMG in 3 sessions on days 0, 7, and 21. A longitudinal, repeated-measures, factorial design was used. Muscle reflex response to trunk perturbations, spine compression force, as well as effective trunk stiffness and damping were dependent variables. The LSO, direction of perturbation, and testing session were the independent variables. Results The LSO significantly (P < 0.001) increased the effective trunk stiffness by 160 Nm/rad (27%) across all directions and testing sessions. The number of antagonist muscles that responded with an onset activity was significantly reduced after 7 days of wearing the LSO, but this difference disappeared on day 21 and is likely not clinically relevant. The average number of agonist muscles switching off following the quick force release was significantly greater with the LSO, compared to without the LSO (P = 0.003). Conclusions The LSO increased trunk stiffness and resulted in a greater number of agonist muscles shutting-off in response to a quick force release. However, these effects did not result in detrimental changes to the neuromuscular function of trunk muscles after 3 weeks of wearing a LSO 3 hours a day by healthy subjects. PMID:20609255

Effects of two types of foot orthoses on lower limb muscle activity before and after a one-month period of wear.

PubMed

Moisan, Gabriel; Cantin, Vincent

2016-05-01

The purpose of this study was to quantify the effects of two types of foot orthoses (FOs) on muscle activity during walking. Twenty-one healthy participants were recruited to walk on a five-meter walkway with a control condition (no FOs) and two experimental conditions (FOs and FOs with lateral bar). The experimental protocol was performed before and after a one-month period of wear for each experimental condition. Electromyographic signals were recorded for six muscles (gluteus medius, vastus lateralis, medial gastrocnemius, lateral gastrocnemius, peroneus longus and tibialis anterior). Mean muscle activity was analyzed during the contact, the combined midstance/terminal stance and the pre-swing phases of gait. Peak amplitude and time to peak amplitude were quantified during the stance phase. Unacceptable level of variability was observed between the testing sessions. Therefore, no comparisons were performed to compare the effects of the experimental conditions between testing sessions. After a one-month period of wear, FOs with lateral bar decreased peak amplitude and mean activity of the peroneus longus muscle during the combined midstance/terminal stance phase and FOs decreased peak amplitude and mean activity of the tibialis anterior muscle during the contact phase compared to a control condition. In conclusion, repeated-test design should be used with caution when assessing the muscular adaptation to the wear of FOs for a certain period of time. More studies are needed to determine if the decreased activity of the peroneus longus muscle could be of benefit to treat pathologies such as peroneal tendinopathy or lateral ankle instability. Copyright © 2016 Elsevier B.V. All rights reserved.

Day vs. day-night use of ankle-foot orthoses in young children with spastic diplegia: a randomized controlled study.

PubMed

Zhao, Xiaoke; Xiao, Nong; Li, Hongying; Du, Senjie

2013-10-01

The aim of this study was to compare the effectiveness of treatment with hinged ankle-foot orthoses (AFOs) during the day vs. during both the day and the night in young ambulant children with spastic diplegia. In this prospective randomized controlled trial, 112 ambulatory children (70 boys and 42 girls; mean age, 2 yrs 6.93 mos; range, 1 yr 1 mo to 4 yrs 0 mo) with spastic diplegia participated. Forty-eight were classified at level I of the Gross Motor Function Classification System; the remaining 64 were at level II. Using stratified randomization, all children were assigned to either the day AFO-wearing group (n = 56, wearing AFOs all day) or the day-night AFO-wearing group (n = 56, wearing AFOs all day and all night). The two groups underwent conventional rehabilitative treatments five times a week for 8 wks. The primary outcomes measured were passive ankle dorsiflexion angle and sections D and E of the 66-item Gross Motor Function Measure; the root mean square of surface electromyography in the ventral and dorsal lower limb muscles was compared in a subgroup (ten from each group). Seven children did not complete the full intervention: three in the day AFO-wearing group and four in the day-night AFO-wearing group. Significant baseline-postintervention improvements were found for passive ankle dorsiflexion angle and the 66-item Gross Motor Function Measure in both groups (P < 0.05). On the basis of the score changes, there was no significant difference between these two groups with respect to passive ankle dorsiflexion angle; however, the improvements in the 66-item Gross Motor Function Measure were significantly better in the day AFO-wearing group (P < 0.01). A significant root mean square decrease in gastrocnemius (P < 0.05) was present after the intervention in the day AFO-wearing group, whereas the muscles affected in the day-night AFO-wearing group were the gastrocnemius (P < 0.05) and the tibialis anterior (P < 0.001). The results demonstrate that the daytime use of AFOs was more effective in improving Gross Motor Function Measure scores than the day-night use. In addition, the prolonged wearing of AFOs may influence muscle activity, which should be monitored in the clinic.

Design and experimental evaluation of a lightweight, high-torque and compliant actuator for an active ankle foot orthosis.

PubMed

Moltedo, Marta; Bacek, Tomislav; Langlois, Kevin; Junius, Karen; Vanderborght, Bram; Lefeber, Dirk

2017-07-01

The human ankle joint plays a crucial role during walking. At the push-off phase the ankle plantarflexors generate the highest torque among the lower limb joints during this activity. The potential of the ankle plantarflexors is affected by numerous pathologies and injuries, which cause a decrease in the ability of the subject to achieve a natural gait pattern. Active orthoses have shown to have potential in assisting these subjects. The design of such robots is very challenging due to the contrasting design requirements of wearability (light weight and compact) and high torques capacity. This paper presents the development of a high-torque ankle actuator to assist the ankle joint in both dorsiflexion and plantarflexion. The compliant actuator is a spindle-driven MACCEPA (Mechanically Adjustable Compliance and Controllable Equilibrium Position Actuator). The design of the actuator was made to keep its weight as low as possible, while being able to provide high torques. As a result of this novel design, the actuator weighs 1.18kg. Some static characterization tests were perfomed on the actuator and their results are shown in the paper.

Parametric design of pressure-relieving foot orthosis using statistics-based finite element method.

PubMed

Cheung, Jason Tak-Man; Zhang, Ming

2008-04-01

Custom-molded foot orthoses are frequently prescribed in routine clinical practice to prevent or treat plantar ulcers in diabetes by reducing the peak plantar pressure. However, the design and fabrication of foot orthosis vary among clinical practitioners and manufacturers. Moreover, little information about the parametric effect of different combinations of design factors is available. As an alternative to the experimental approach, therefore, computational models of the foot and footwear can provide efficient evaluations of different combinations of structural and material design factors on plantar pressure distribution. In this study, a combined finite element and Taguchi method was used to identify the sensitivity of five design factors (arch type, insole and midsole thickness, insole and midsole stiffness) of foot orthosis on peak plantar pressure relief. From the FE predictions, the custom-molded shape was found to be the most important design factor in reducing peak plantar pressure. Besides the use of an arch-conforming foot orthosis, the insole stiffness was found to be the second most important factor for peak pressure reduction. Other design factors, such as insole thickness, midsole stiffness and midsole thickness, contributed to less important roles in peak pressure reduction in the given order. The statistics-based FE method was found to be an effective approach in evaluating and optimizing the design of foot orthosis.

Design and validation of a high-order weighted-frequency fourier linear combiner-based Kalman filter for parkinsonian tremor estimation.

PubMed

Zhou, Y; Jenkins, M E; Naish, M D; Trejos, A L

2016-08-01

The design of a tremor estimator is an important part of designing mechanical tremor suppression orthoses. A number of tremor estimators have been developed and applied with the assumption that tremor is a mono-frequency signal. However, recent experimental studies have shown that Parkinsonian tremor consists of multiple frequencies, and that the second and third harmonics make a large contribution to the tremor. Thus, the current estimators may have limited performance on estimation of the tremor harmonics. In this paper, a high-order tremor estimation algorithm is proposed and compared with its lower-order counterpart and a widely used estimator, the Weighted-frequency Fourier Linear Combiner (WFLC), using 18 Parkinsonian tremor data sets. The results show that the proposed estimator has better performance than its lower-order counterpart and the WFLC. The percentage estimation accuracy of the proposed estimator is 85±2.9%, an average improvement of 13% over the lower-order counterpart. The proposed algorithm holds promise for use in wearable tremor suppression devices.

State-of-the-art robotic devices for ankle rehabilitation: Mechanism and control review.

PubMed

Hussain, Shahid; Jamwal, Prashant K; Ghayesh, Mergen H

2017-12-01

There is an increasing research interest in exploring use of robotic devices for the physical therapy of patients suffering from stroke and spinal cord injuries. Rehabilitation of patients suffering from ankle joint dysfunctions such as drop foot is vital and therefore has called for the development of newer robotic devices. Several robotic orthoses and parallel ankle robots have been developed during the last two decades to augment the conventional ankle physical therapy of patients. A comprehensive review of these robotic ankle rehabilitation devices is presented in this article. Recent developments in the mechanism design, actuation and control are discussed. The study encompasses robotic devices for treadmill and over-ground training as well as platform-based parallel ankle robots. Control strategies for these robotic devices are deliberated in detail with an emphasis on the assist-as-needed training strategies. Experimental evaluations of the mechanism designs and various control strategies of these robotic ankle rehabilitation devices are also presented.

Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people

PubMed Central

2011-01-01

Background Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. Methods The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Results Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Conclusions Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392. PMID:21871080

The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update

PubMed Central

Uden, Hayley; Banwell, Helen A.; Kumar, Saravana

2018-01-01

Background Flexible pes planus (flat feet) in children is a common presenting condition in clinical practice due to concerns amongst parents and caregivers. While Foot Orthoses (FOs) are a popular intervention, their effectiveness remains unclear. Thus, the aim of this systematic review was to update the current evidence base for the effectiveness of FOs for paediatric flexible pes planus. Methods A systematic search of electronic databases (Cochrane, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus and PEDro) was conducted from January 2011 to July 2017. Studies of children (0–18 years) diagnosed with flexible pes planus and intervention to be any type of Foot Orthoses (FOs) were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. McMaster critical review form for quantitative studies, was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken. Results Out of 606 articles identified, 11 studies (three RCTs; two case-controls; five case-series and one single case study) met the inclusion criteria. A diverse range of pre-fabricated and customised FOs were utilised and effectiveness measured through a plethora of outcomes. Summarised findings from the heterogeneous evidence base indicated that FOs may have a positive impact across a range of outcomes including pain, foot posture, gait, function and structural and kinetic measures. Despite these consistent positive outcomes reported in several studies, the current evidence base lacks clarity and uniformity in terms of diagnostic criteria, interventions delivered and outcomes measured for paediatric flexible pes planus. Conclusion There continues to remain uncertainty on the effectiveness of FOs for paediatric flexible pes planus. Despite a number of methodological limitations, FOs show potential as a treatment method for children with flexible pes planus. PROSPERO registration number CRD42017057310. PMID:29451921

Gait characteristics of post-poliomyelitis patients: standardization of quantitative data reporting.

PubMed

Portnoy, S; Schwartz, I

2013-10-01

To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data. Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects (n=16), PPS patients walking with shoes with/without an ankle-foot-orthosis (n=11), PPS patients walking with knee-ankle-foot-orthosis (n=5), and PPS patients walking with a walker/crutches (n=10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot. Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids. The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Splint: the efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial.

PubMed

Maas, Josina C; Dallmeijer, Annet J; Huijing, Peter A; Brunstrom-Hernandez, Janice E; van Kampen, Petra J; Jaspers, Richard T; Becher, Jules G

2012-03-26

Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP). Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range of motion is important in order to reduce secondary activity limitations and joint deformities. Sustained muscle stretch, imposed by orthotic management in rest, might be an effective method of preventing a decrease in range of motion. However, no controlled study has been performed. A single blind randomised controlled trial will be performed in 66 children with spastic CP, divided over three groups with each 22 participants. Two groups will be treated for 1 year with orthoses to prevent a decrease in range of motion in the ankle (either with static or dynamic knee-ankle-foot-orthoses) and a third group will be included as a control group and will receive usual care (physical therapy, manual stretching). Measurements will be performed at baseline and at 3, 6, 9 and 12 months after treatment allocation. The primary outcome measure will be ankle dorsiflexion at full knee extension, measured with a custom designed hand held dynamometer. Secondary outcome measures will be i) ankle and knee flexion during gait and ii) gross motor function. Furthermore, to gain more insight in the working mechanism of the orthotic management in rest, morphological parameters like achilles tendon length, muscle belly length, muscle fascicle length, muscle physiological cross sectional area length and fascicle pennation angle will be measured in a subgroup of 18 participants using a 3D imaging technique. This randomised controlled trial will provide more insight into the efficacy of orthotic management in rest and the working mechanisms behind this treatment. The results of this study could lead to improved treatments. Nederlands Trial Register NTR2091.

Proposal of custom made wrist orthoses based on 3D modelling and 3D printing.

PubMed

Abreu de Souza, Mauren; Schmitz, Cristiane; Marega Pinhel, Marcelo; Palma Setti, Joao A; Nohama, Percy

2017-07-01

Accessibility to three-dimensional (3D) technologies, such as 3D scanning systems and additive manufacturing (like 3D printers), allows a variety of 3D applications. For medical applications in particular, these modalities are gaining a lot of attention enabling several opportunities for healthcare applications. The literature brings several cases applying both technologies, but none of them focus on the spreading of how this technology could benefit the health segment. This paper proposes a new methodology, which employs both 3D modelling and 3D printing for building orthoses, which could better fit the demands of different patients. Additionally, there is an opportunity for sharing expertise, as it represents a trendy in terms of the maker-movement. Therefore, as a result of the proposed approach, we present a case study based on a volunteer who needs an immobilization orthosis, which was built for exemplification of the whole process. This proposal also employs freely available 3D models and software, having a strong social impact. As a result, it enables the implementation and effective usability for a variety of built to fit solutions, hitching useful and smarter technologies for the healthcare sector.

Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis.

PubMed

Zhang, Zhiwang; Wang, Lin; Hu, Kaijun; Liu, Yu

2017-12-01

BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.

Angular-velocity control approach for stance-control orthoses.

PubMed

Lemaire, Edward D; Goudreau, Louis; Yakimovich, Terris; Kofman, Jonathan

2009-10-01

Currently, stance-control knee orthoses require external control mechanisms to control knee flexion during stance and allow free knee motion during the swing phase of gait. A new angular-velocity control approach that uses a rotary-hydraulic device to resist knee flexion when the knee angular velocity passes a preset threshold is presented. This angular-velocity approach for orthotic stance control is based on the premise that knee-flexion angular velocity during a knee-collapse event, such as a stumble or fall, is greater than that during walking. The new hydraulic knee-flexion control device does not require an external control mechanism to switch from free motion to stance control mode. Functional test results demonstrated that the hydraulic angular-velocity activated knee joint provided free knee motion during walking, engaged upon knee collapse, and supported body weight while the end-user recovered to a safe body position. The joint was tested to 51.6 Nm in single loading tests and passed 200,000 repeated loading cycles with a peak load of 88 Nm per cycle. The hydraulic, angular velocity activation approach has potential to improve safety and security for people with lower extremity weakness or when recovering from joint trauma.

Vertebral body clinico-morphological features following percutaneous vertebroplasty versus the conservatory approach.

PubMed

Constantin, Cristian; Albulescu, Dana Maria; Diţă, Daniel Răzvan; Georgescu, Claudia Valentina; Deaconu, Andrei Constantin

2018-01-01

Most percutaneous vertebroplasty procedures are being performed in order to relieve pain in patients with severe osteoporosis and associated stable fractures of one or more vertebral bodies. In addition, vertebroplasty is also recommended for patients suffering from post-traumatic symptoms associated with vertebral fractures, patients with large angiomas positioned inside the vertebral body, with an increased risk for collapse fracture and also patients presenting with pain associated with vertebral body metastatic disease. On another aspect, it is possible that in isolated cases, an orthopedic surgeon confronted with a vertebra plana presentation will recommend bone cement injection into the vertebral bodies adjacent to the fractured one, in order to have a better and more robust substrate for placement of screws or other fixation devices. The aim of our study is to compare results attained by the Department of Interventional Radiology, in performing this procedure, with results attained by following the classical orthopedic treatment procedure, involving non-operative treatment, using medication and bracing varying from simple extension orthoses in order to limit spinal flexion, light bracing for contiguous fractures, presenting either angulation or compression, and for severe cases standard thoracolumbosacral orthoses (TLSOs).

The effect of gait velocity on calcaneal balance at heel strike; Implications for orthotic prescription in injury prevention.

PubMed

Shanthikumar, Shivanthan; Low, Zi; Falvey, Eanna; McCrory, Paul; Franklyn-Miller, Andy

2010-01-01

Exercise related lower limb injuries (ERLLI), are common in the recreational and competitive sporting population. Although ERLLI are thought to be multi-factorial in aetiology, one of the critical predisposing factors is known to gait abnormality. There is little published evidence comparing walking and running gait in the same subjects, and no evidence on the effect of gait velocity on calcaneal pronation, even though this may have implications for orthotic prescription and injury prevention. In this study, the walking and running gait of 50 physically active subjects was assessed using pressure plate analysis. The results show that rearfoot pronation occurs on foot contact in both running and walking gait, and that there is significantly more rearfoot pronation in walking gait (p<0.01). The difference in the magnitude of rearfoot pronation affected foot orthoses prescription. A 63% fall in computerized correction suggested by RSscan D3D software prescription was seen, based on running vs. walking gait. The findings of this study suggest that in the athletic population orthoses prescription should be based on dynamic assessment of running gait. Crown Copyright 2009. Published by Elsevier B.V. All rights reserved.

Double-Acting Sleeve Muscle Actuator for Bio-Robotic Systems.

PubMed

Zheng, Hao; Shen, Xiangrong

2013-11-25

This paper presents a new type of muscle-like actuator, namely double-acting (DA) sleeve muscle actuator, which is suitable for the actuation of biologically-inspired and biomedical robotic systems, especially those serving human-assistance purposes (prostheses, orthoses, etc .). Developed based on the traditional pneumatic muscle actuator, the new DA sleeve muscle incorporates a unique insert at the center. With the insert occupying the central portion of the internal volume, this new actuator enjoys multiple advantages relative to the traditional pneumatic muscle, including a consistent increase of force capacity over the entire range of motion, and a significant decrease of energy consumption in operation. Furthermore, the insert encompasses an additional chamber, which generates an extension force when pressurized. As such, this new actuator provides a unique bi-directional actuation capability, and, thus, has a potential to significantly simplify the design of a muscle actuator-powered robotic system. To demonstrate this new actuator concept, a prototype has been designed and fabricated, and experiments conducted on this prototype demonstrated the enhanced force capacity and the unique bi-directional actuation capability.

Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial.

PubMed

Turner, Deborah E; Helliwell, Philip S; Woodburn, James

2007-11-06

Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA) related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT) to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Patients with a definite diagnosis of RA, stable drug management 3 months prior to entry, and a current history of foot problems (pain, deformity, stiffness, skin or nail lesions, or footwear problems) were recruited from a hospital outpatient rheumatology clinic and randomised to receive 12 months of podiatry treatment or no care. The primary outcome was change in foot health status using the impairment/footwear (LFISIF) and activity limitation/participation restriction (LFISAP) subscales of the Leeds Foot Impact Scale. Disease Activity Score (DAS), Health Assessment Questionnaire (HAQ) score and walking speed (m/s) were also recorded. Of the 80 patients identified, 64 patients were eligible to participate in the pilot and 34 were recruited. 16 patients were randomised to receive podiatry led foot care and 18 received no care. Against a backdrop of stable disease (DAS and HAQ scores), there was a statistically significant between group difference in the change in foot health status for foot impairment (LFISIF) but not activity/participation (LFISAP) or function (walking speed) over 12 months. In the podiatry arm, 1 patient declined treatment following randomisation (did not want additional hospital visits) and 3 self-withdrew (lost to follow-up). Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions (n = 3), foot orthoses (n = 9), footwear referral to the orthotist (n = 5), and ultrasound guided intra-articular steroid injection (n = 1). In this exploratory trial patients were difficult to recruit (stable drug management and co-morbid disease) and retain (lack of benefit/additional treatment burden) but overall the intervention was safe (no adverse reactions). Twelve months of podiatry care maintained but did not improve foot health status. These observations are important for the design and implementation of a definitive randomised controlled trial. ISRCTN: 01982076.

The Development of an Accelerometer System for Measuring Pelvic Motion During Walking.

DTIC Science & Technology

1979-01-01

9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT, PROJECT, T ASK AFIT STUDENT AT: University of Oxford CONTROLLING OFFICE NAME AND...bones, joints or muscles and physiotherapy to improve the functioning of impaired lower limbs. When irreparable damage occurs, the normal locomotor system...restoring near normal functioning of the locomotor system. Any improvement in surgical procedures, physiotherapy techniques, orthoses or prostheses

Acceptability and Potential Effectiveness of a Foot Drop Stimulator in Children and Adolescents with Cerebral Palsy

ERIC Educational Resources Information Center

Prosser, Laura A.; Curatalo, Lindsey A.; Alter, Katharine E.; Damiano, Diane L.

2012-01-01

Aim: Ankle-foot orthoses are the standard of care for foot drop in cerebral palsy (CP), but may overly constrain ankle movement and limit function in those with mild CP. Functional electrical stimulation (FES) may be a less restrictive and more effective alternative, but has rarely been used in CP. The primary objective of this study was to…

Impact of child and family characteristics on cerebral palsy treatment.

PubMed

Rackauskaite, Gija; Uldall, Peter W; Bech, Bodil H; Østergaard, John R

2015-10-01

The aim of the study was to describe the relationship between the child's and family's characteristics and the most common treatment modalities in a national population-based sample of 8- to 15-year-old children with cerebral palsy. A cross-sectional study, based on the Danish Cerebral Palsy Registry. The parents of 462 children answered a questionnaire about their child's treatment and the family's characteristics (living with a single parent, having siblings, living in a city, parental education level). Descriptive and logistic regression analyses were performed for every treatment modality, stratified by Gross Motor Function Classification System (GMFCS) level. An IQ below 85 was associated with weekly therapy in GMFCS level I (adjusted odds ratio [ORadj ] 2.5 [CI 1.1-5.7]) and the use of oral spasmolytics in GMFCS levels III to V (ORadj 3.1 [CI 1.3-7.4]). Older children in GMFCS levels III to V used daily orthoses less frequently (ORadj 0.7 [CI 0.6-0.9] per year). Of all of the family characteristics studied, only the parents' education level had significant associations with more than one treatment modality. A child's cognitive function showed an impact on treatment of the motor impairment in children 8 to 15 years of age with cerebral palsy. Parental education level may influence the choice of treatment. © 2015 Mac Keith Press.

Embracing additive manufacture: implications for foot and ankle orthosis design

PubMed Central

2012-01-01

Background The design of foot and ankle orthoses is currently limited by the methods used to fabricate the devices, particularly in terms of geometric freedom and potential to include innovative new features. Additive manufacturing (AM) technologies, where objects are constructed via a series of sub-millimetre layers of a substrate material, may present the opportunity to overcome these limitations and allow novel devices to be produced that are highly personalised for the individual, both in terms of fit and functionality. Two novel devices, a foot orthosis (FO) designed to include adjustable elements to relieve pressure at the metatarsal heads, and an ankle foot orthosis (AFO) designed to have adjustable stiffness levels in the sagittal plane, were developed and fabricated using AM. The devices were then tested on a healthy participant to determine if the intended biomechanical modes of action were achieved. Results The adjustable, pressure relieving FO was found to be able to significantly reduce pressure under the targeted metatarsal heads. The AFO was shown to have distinct effects on ankle kinematics which could be varied by adjusting the stiffness level of the device. Conclusions The results presented here demonstrate the potential design freedom made available by AM, and suggest that it may allow novel personalised orthotic devices to be produced which are beyond the current state of the art. PMID:22642941

Engineering and Design: Rock Mass Classification Data Requirements for Rippability

DTIC Science & Technology

1983-06-30

Engineering and Design ROCK MASS CLASSIFICATION DATA REQUIREMENTS FOR RIPPABILITY Distribution Restriction Statement Approved for public release...and Design: Rock Mass Classification Data Requirements for Rippability Contract Number Grant Number Program Element Number Author(s) Project...Technical Letter 1110-2-282 Engineering and Design ROCK MASS CLASSIFICATION DATA REQUIREMENTS FOR RIPPABILITY 1“ -“ This ETL contains information on data

Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence.

PubMed

Harlaar, Jaap; Brehm, Merel; Becher, Jules G; Bregman, Daan J J; Buurke, Jaap; Holtkamp, Fred; De Groot, Vincent; Nollet, Frans

2010-09-01

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

Influence of Botulinum Toxin Therapy on Postural Control and Lower Limb Intersegmental Coordination in Children with Spastic Cerebral Palsy

PubMed Central

Degelaen, Marc; de Borre, Ludo; Kerckhofs, Eric; de Meirleir, Linda; Buyl, Ronald; Cheron, Guy; Dan, Bernard

2013-01-01

Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental) coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3–12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO) before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition) and in the frontal plane (AFO condition). Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia) but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy) is needed in order to learn new motor strategies. PMID:23344454

Mechanical and biomechanical analysis of a linear piston design for angular-velocity-based orthotic control.

PubMed

Lemaire, Edward D; Samadi, Reza; Goudreau, Louis; Kofman, Jonathan

2013-01-01

A linear piston hydraulic angular-velocity-based control knee joint was designed for people with knee-extensor weakness to engage knee-flexion resistance when knee-flexion angular velocity reaches a preset threshold, such as during a stumble, but to otherwise allow free knee motion. During mechanical testing at the lowest angular-velocity threshold, the device engaged within 2 degrees knee flexion and resisted moment loads of over 150 Nm. The device completed 400,000 loading cycles without mechanical failure or wear that would affect function. Gait patterns of nondisabled participants were similar to normal at walking speeds that produced below-threshold knee angular velocities. Fast walking speeds, employed purposely to attain the angular-velocity threshold and cause knee-flexion resistance, reduced maximum knee flexion by approximately 25 degrees but did not lead to unsafe gait patterns in foot ground clearance during swing. In knee collapse tests, the device successfully engaged knee-flexion resistance and stopped knee flexion with peak knee moments of up to 235.6 Nm. The outcomes from this study support the potential for the linear piston hydraulic knee joint in knee and knee-ankle-foot orthoses for people with lower-limb weakness.

14 CFR 21.93 - Classification of changes in type design.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Classification of changes in type design... TRANSPORTATION AIRCRAFT CERTIFICATION PROCEDURES FOR PRODUCTS AND PARTS Changes to Type Certificates § 21.93 Classification of changes in type design. (a) In addition to changes in type design specified in paragraph (b) of...

The effect of migration of instantaneous centre of knee orthosis rotation during gait - in vivo displacement measurements in two experimental variants.

PubMed

Bogucki, Artur J

2014-01-01

The knee joint is a bicondylar hinge two-level joint with six degrees of freedom. The location of the functional axis of flexion-extension motion is still a subject of research and discussions. During the swing phase, the femoral condyles do not have direct contact with the tibial articular surfaces and the intra-articular space narrows with increasing weight bearing. The geometry of knee movements is determined by the shape of articular surfaces. A digital recording of the gait of a healthy volunteer was analysed. In the first experimental variant, the subject was wearing a knee orthosis controlling flexion and extension with a hinge-type single-axis joint. In the second variant, the examination involved a hinge-type double-axis orthosis. Statistical analysis involved mathematically calculated values of displacement P. Scatter graphs with a fourth-order polynomial trend line with a confidence interval of 0.95 due to noise were prepared for each experimental variant. In Variant 1, the average displacement was 15.1 mm, the number of tests was 43, standard deviation was 8.761, and the confidence interval was 2.2. The maximum value of displacement was 30.9 mm and the minimum value was 0.7 mm. In Variant 2, the average displacement was 13.4 mm, the number of tests was 44, standard deviation was 7.275, and the confidence interval was 1.8. The maximum value of displacement was 30.2 mm and the minimum value was 3.4 mm. An analysis of moving averages for both experimental variants revealed that displacement trends for both types of orthosis were compatible from the mid-stance to the mid-swing phase. 1. The method employed in the experiment allows for determining the alignment between the axis of the knee joint and that of shin and thigh orthoses. 2. Migration of the single and double-axis orthoses during the gait cycle exceeded 3 cm. 3. During weight bearing, the double-axis orthosis was positioned more correctly. 4. The study results may be helpful in designing new hinge-type knee joints.

Vector quantizer designs for joint compression and terrain categorization of multispectral imagery

NASA Technical Reports Server (NTRS)

Gorman, John D.; Lyons, Daniel F.

1994-01-01

Two vector quantizer designs for compression of multispectral imagery and their impact on terrain categorization performance are evaluated. The mean-squared error (MSE) and classification performance of the two quantizers are compared, and it is shown that a simple two-stage design minimizing MSE subject to a constraint on classification performance has a significantly better classification performance than a standard MSE-based tree-structured vector quantizer followed by maximum likelihood classification. This improvement in classification performance is obtained with minimal loss in MSE performance. The results show that it is advantageous to tailor compression algorithm designs to the required data exploitation tasks. Applications of joint compression/classification include compression for the archival or transmission of Landsat imagery that is later used for land utility surveys and/or radiometric analysis.

49 CFR 1248.100 - Commodity classification designated.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 9 2011-10-01 2011-10-01 false Commodity classification designated. 1248.100... STATISTICS Commodity Code § 1248.100 Commodity classification designated. Commencing with reports for the..., reports of commodity statistics required to be made to the Board, shall be based on the commodity codes...

Robotics, assistive technology, and occupational therapy management to improve upper limb function in pediatric neuromuscular diseases.

PubMed

Rahman, Tariq; Basante, Joseph; Alexander, Michael

2012-08-01

This article presents an overview of occupational therapy assessments and treatment options for individuals with neuromuscular disabilities, with a particular focus on children with neuromuscular disorders. The discussion includes descriptions of standard treatments, commercial adaptive equipment, and homemade adaptive solutions. The state of the art in therapeutic and assistive robots and orthoses for the upper and lower extremity is also provided. Copyright © 2012. Published by Elsevier Inc.

Hallux valgus (bunions)

PubMed Central

2014-01-01

Introduction Hallux valgus (bunions) are prominent and often inflamed metatarsal heads and overlying bursae. They are associated with valgus deviation of the great toe which moves towards the second toe. Hallux valgus is found in at least 2% of children aged 9 to 10 years, and almost half of adults, with greater prevalence in women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of conservative treatments for hallux valgus (bunions)? What are the effects of osteotomy for hallux valgus (bunions)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: chevron osteotomy plus adductor tenotomy; distal metatarsal osteotomy; minimally invasive surgery (percutaneous distal metatarsal osteotomy, SERI [Simple, Effective, Rapid, Inexpensive] distal metatarsal osteotomy); phalangeal (Akin) osteotomy plus distal chevron osteotomy; proximal osteotomy; night splints; and orthoses (including antipronatory orthoses in children).

Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO).

PubMed

Yatsuya, Kanan; Hirano, Satoshi; Saitoh, Eiichi; Tanabe, Shigeo; Tanaka, Hirotaka; Eguchi, Masayuki; Katoh, Masaki; Shimizu, Yasuhiro; Uno, Akito; Kagaya, Hitoshi

2018-01-01

To compare the energy efficiency of Wearable Power-Assist Locomotor (WPAL) with conventional knee-ankle-foot orthoses (MSH-KAFO) such as Hip and Ankle Linked Orthosis (HALO) or Primewalk. Cross over case-series. Chubu Rosai Hospital, Aichi, Japan, which is affiliated with the Japan Organization of Occupational Health and Safety. Six patients were trained with MSH-KAFO (either HALO or Primewalk) and WPAL. They underwent 6-minute walk tests with each orthosis. Energy efficiency was estimated using physiological cost index (PCI) as well as heart rate (HR) and modified Borg score. Trial energy efficiency with MSH-KAFO was compared with WPAL to assess if differences in PCI became greater between MSH-KAFO and WPAL as time goes on during the 6-minute walk. Spearman correlation coefficient of time (range: 0.5-6.0 minutes) with the difference was calculated. The same statistical procedures were repeated for HR and modified Borg score. Greater energy efficiency, representing a lower gait demand, was observed in trials with WPAL compared with MSH-KAFO (Spearman correlation coefficients for PCI, HR and modified Borg were 0.93, 0.90 and 0.97, respectively, all P < 0.0001). WPAL is a practical and energy efficient type of robotics that may be used by patients with paraplegia.

Custom-made foot orthoses: an analysis of prescription characteristics from an Australian commercial orthotic laboratory.

PubMed

Menz, Hylton B; Allan, Jamie J; Bonanno, Daniel R; Landorf, Karl B; Murley, George S

2017-01-01

Foot orthoses are widely used in the prevention and treatment of foot disorders. The aim of this study was to describe characteristics of custom-made foot orthosis prescriptions from a Australian podiatric orthotic laboratory. One thousand consecutive foot orthosis prescription forms were obtained from a commercial prescription foot orthosis laboratory located in Melbourne, Victoria, Australia (Footwork Podiatric Laboratory). Each item from the prescription form was documented in relation to orthosis type, cast correction, arch fill technique, cast modifications, shell material, shell modifications and cover material. Cluster analysis and discriminant function analysis were applied to identify patterns in the prescription data. Prescriptions were obtained from 178 clinical practices across Australia and Hong Kong, with patients ranging in age from 5 to 92 years. Three broad categories ('clusters') were observed that were indicative of increasing 'control' of rearfoot pronation. A combination of five variables (rearfoot cast correction, cover shape, orthosis type, forefoot cast correction and plantar fascial accommodation) was able to identify these clusters with an accuracy of 70%. Significant differences between clusters were observed in relation to age and sex of the patient and the geographic location of the prescribing clinician. Foot orthosis prescriptions are complex, but can be broadly classified into three categories. Selection of these prescription subtypes appears to be influenced by both patient factors (age and sex) and clinician factors (clinic location).

A work study of the CAD/CAM method and conventional manual method in the fabrication of spinal orthoses for patients with adolescent idiopathic scoliosis.

PubMed

Wong, M S; Cheng, J C Y; Wong, M W; So, S F

2005-04-01

A study was conducted to compare the CAD/CAM method with the conventional manual method in fabrication of spinal orthoses for patients with adolescent idiopathic scoliosis. Ten subjects were recruited for this study. Efficiency analyses of the two methods were performed from cast filling/ digitization process to completion of cast/image rectification. The dimensional changes of the casts/ models rectified by the two cast rectification methods were also investigated. The results demonstrated that the CAD/CAM method was faster than the conventional manual method in the studied processes. The mean rectification time of the CAD/CAM method was shorter than that of the conventional manual method by 108.3 min (63.5%). This indicated that the CAD/CAM method took about 1/3 of the time of the conventional manual to finish cast rectification. In the comparison of cast/image dimensional differences between the conventional manual method and the CAD/CAM method, five major dimensions in each of the five rectified regions namely the axilla, thoracic, lumbar, abdominal and pelvic regions were involved. There were no significant dimensional differences (p < 0.05) in 19 out of the 25 studied dimensions. This study demonstrated that the CAD/CAM system could save the time in the rectification process and offer a relatively high resemblance in cast rectification as compared with the conventional manual method.

Reverse Shoulder Arthroplasty Prosthesis Design Classification System.

PubMed

Routman, Howard D; Flurin, Pierre-Henri; Wright, Thomas W; Zuckerman, Joseph D; Hamilton, Matthew A; Roche, Christopher P

2015-12-01

Multiple different reverse total shoulder arthroplasty (rTSA) prosthesis designs are available in the global marketplace for surgeons to perform this growing procedure. Subtle differences in rTSA prosthesis design parameters have been shown to have significant biomechanical impact and clinical consequences. We propose an rTSA prosthesis design classification system to objectively identify and categorize different designs based upon their specific glenoid and humeral prosthetic characteristics for the purpose of standardizing nomenclature that will help the orthopaedic surgeon determine which combination of design configurations best suit a given clinical scenario. The impact of each prosthesis classification type on shoulder muscle length and deltoid wrapping are also described to illustrate how each prosthesis classification type impacts these biomechanical parameters.

Designing a Classification System for Internet Offenders: Doing Cognitive Distortions

ERIC Educational Resources Information Center

Hundersmarck, Steven F.; Durkin, Keith F.; Delong, Ronald L.

2007-01-01

Televised features such as NBC's "To Catch a Predator" have highlighted the growing problem posed by Internet sexual predators. This paper reports on the authors' attempts in designing a classification system for Internet offenders. The classification system was designed based on existing theory, understanding the nature of Internet offenders and…

Issues in impedance selection and input devices for multijoint powered orthotics.

PubMed

Lemay, M A; Hogan, N; van Dorsten, J W

1998-03-01

We investigated the applicability of impedance controllers to robotic orthoses for arm movements. We had tetraplegics turn a crank using their paralyzed arm propelled by a planar robot manipulandum. The robot was under impedance control, and chin motion served as command source. Stiffness varied between 50, 100, or 200 N/m and damping varied between 5 or 15 N/m/s. Results indicated that a low stiffness and high viscosity provided better directional control of the tangential force exerted on the crank.

The Effects of Fabrication Techniques and Storage Methods on the Dimensional Stability of Removable Acrylic Resin Orthoses.

DTIC Science & Technology

1987-05-01

Bruxism : a report and a case report. J. Dent. Med., 9:189-199, 1954. 138. Super, S: A modified occlusal splint for segmental osteotomy fixation. J. Oral...minimize linear dimensional change prior to the clinical use of a removable acrylic resin orthosis. . .. . . . . TABLE OF CONTENTS Title...distortion and clinical use of an orthosis having a precise and accurate fit. V % N II. LITERATURE REVIEW A. Terminology The therapeutic use of interocclusal

10 CFR 1045.17 - Classification levels.

Code of Federal Regulations, 2014 CFR

2014-01-01

... classification include detailed technical descriptions of critical features of a nuclear explosive design that... classification include designs for specific weapon components (not revealing critical features), key features of uranium enrichment technologies, or specifications of weapon materials. (3) Confidential. The Director of...

10 CFR 1045.17 - Classification levels.

Code of Federal Regulations, 2013 CFR

2013-01-01

... classification include detailed technical descriptions of critical features of a nuclear explosive design that... classification include designs for specific weapon components (not revealing critical features), key features of uranium enrichment technologies, or specifications of weapon materials. (3) Confidential. The Director of...

10 CFR 1045.17 - Classification levels.

Code of Federal Regulations, 2011 CFR

2011-01-01

... classification include detailed technical descriptions of critical features of a nuclear explosive design that... classification include designs for specific weapon components (not revealing critical features), key features of uranium enrichment technologies, or specifications of weapon materials. (3) Confidential. The Director of...

10 CFR 1045.17 - Classification levels.

Code of Federal Regulations, 2012 CFR

2012-01-01

... classification include detailed technical descriptions of critical features of a nuclear explosive design that... classification include designs for specific weapon components (not revealing critical features), key features of uranium enrichment technologies, or specifications of weapon materials. (3) Confidential. The Director of...

A standard set of upper extremity tasks for evaluating rehabilitation interventions for individuals with complete arm paralysis

PubMed Central

Cornwell, Andrew S.; Liao, James Y.; Bryden, Anne M.; Kirsch, Robert F.

2013-01-01

We have developed a set of upper extremity functional tasks to guide the design and test the performance of rehabilitation technologies that restore arm motion in people with high tetraplegia. Our goal was to develop a short set of tasks that would be representative of a much larger set of activities of daily living while also being feasible for a unilateral user of an implanted Functional Electrical Stimulation (FES) system. To compile this list of tasks, we reviewed existing clinical outcome measures related to arm and hand function, and were further informed by surveys of patient desires. We ultimately selected a set of five tasks that captured the most common components of movement seen in these tasks, making them highly relevant for assessing FES-restored unilateral arm function in individuals with high cervical spinal cord injury (SCI). The tasks are intended to be used when setting design specifications and for evaluation and standardization of rehabilitation technologies under development. While not unique, this set of tasks will provide a common basis for comparing different interventions (e.g., FES, powered orthoses, robotic assistants) and testing different user command interfaces (e.g., sip-and-puff, head joysticks, brain-computer interfaces). PMID:22773199

OBJECTIVE METEOROLOGICAL CLASSIFICATION SCHEME DESIGNED TO ELUCIDATE OZONE'S DEPENDENCE ON METEOROLOGY

EPA Science Inventory

This paper utilizes a two-stage clustering approach as part of an objective classification scheme designed to elucidate 03's dependence on meteorology. hen applied to ten years (1981-1990) of meteorological data for Birmingham, Alabama, the classification scheme identified seven ...

A new podiatry service for patients with arthritis.

PubMed

Rome, Keith; Erikson, Kathryn; Ng, Anthony; Gow, Peter J; Sahid, Hazra; Williams, Anita E

2013-03-01

The aims of this study were to identify the impact of a new podiatric rheumatology service on reducing foot pain, impairment and disability in patients with foot problems associated with rheumatic disease, and to report on patient satisfaction with the service. A retrospective study of 245 patients with rheumatic disease at Counties Manukau DHB was conducted. Foot pain, impairment and disability were measured using a self-reporting patient outcome measure, the Foot Function Index. A range of podiatric interventions were reported. A self-administered, postal patient satisfaction questionnaire was sent to 148 patients. Over two-thirds of patients were observed with hallux valgus (bunions). The results demonstrate a significant reduction in foot pain (p<0.001) from initial visit to second visit (18% reduction in pain). A significant decrease in foot disability (p=0.04) was found from initial visit to second visit. No significant differences were seen with foot impairment (p=0.78). A variety of intervention measures were used with 24% of patients being prescribed foot orthoses and 28% of patients given footwear advice. The patient satisfaction survey found 84% of patients reported they were satisfied with the new service and 80% of patients reported that the service helped with their foot problems. The current service meets the needs of patients who suffer from rheumatological foot conditions such as rheumatoid arthritis and gout. The need for good foot education, provision of foot orthoses and advice on footwear are crucial to reduce the burden on patients with rheumatological foot conditions.

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work.

PubMed

Bregman, D J J; Harlaar, J; Meskers, C G M; de Groot, V

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the AFO in late stance will support ankle push-off, and reduce the energy cost of walking. In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3D kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics of the AFO were measured separately, and used to calculate the contribution of the AFO to the ankle kinetics. We found a significant decrease of 9.8% in energy cost of walking when walking with the AFO. With the AFO, the range of motion of the ankle was reduced by 12.3°, and the net work around the ankle was reduced by 29%. The total net work in the affected leg remained unchanged. The AFO accounted for 60% of the positive ankle work, which reduced the total amount of work performed by the leg by 11.1% when walking with the AFO. The decrease in energy cost when walking with a spring-like energy-storing AFO in central neurological patients is not induced by an augmented net ankle push-off, but by the AFO partially taking over ankle work. Copyright © 2011 Elsevier B.V. All rights reserved.

Railroad Classification Yard Technology Manual. Volume I : Yard Design Methods

DOT National Transportation Integrated Search

1981-02-01

This volume documents the procedures and methods associated with the design of railroad classification yards. Subjects include: site location, economic analysis, yard capacity analysis, design of flat yards, overall configuration of hump yards, hump ...

Therapy challenges for athletes: splinting options.

PubMed

Russell, Carrie R

2015-01-01

Therapists treating athletes with hand and wrist injuries may be involved in all stages of recovery, from the acute phase to return to sport. This article gives case examples of how creative use of custom and commercially available orthoses, splints, tape, and braces can augment various stages of recovery. Understanding the specific demands of the sport and respect for the standards of care are imperative to fabricating or fitting an athlete with the best device or customization of the athlete's own equipment for a safe return to sport. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparative Demonstration and Evaluation of Classification Technologies: Closed Castner Range, Fort Bliss, Texas

DTIC Science & Technology

2017-01-23

of classification technologies for Munitions Response (MR). This demonstration was designed to evaluate advanced classification methodology at the...advanced electromagnetic induction sensors and static, cued surveys to classify anomalies as either targets of interest (TOI) or non -TOI. Static data...17  5.1  Conceptual Experimental Design

Strength Analysis on Ship Ladder Using Finite Element Method

NASA Astrophysics Data System (ADS)

Budianto; Wahyudi, M. T.; Dinata, U.; Ruddianto; Eko P., M. M.

2018-01-01

In designing the ship’s structure, it should refer to the rules in accordance with applicable classification standards. In this case, designing Ladder (Staircase) on a Ferry Ship which is set up, it must be reviewed based on the loads during ship operations, either during sailing or at port operations. The classification rules in ship design refer to the calculation of the structure components described in Classification calculation method and can be analysed using the Finite Element Method. Classification Regulations used in the design of Ferry Ships used BKI (Bureau of Classification Indonesia). So the rules for the provision of material composition in the mechanical properties of the material should refer to the classification of the used vessel. The analysis in this structure used program structure packages based on Finite Element Method. By using structural analysis on Ladder (Ladder), it obtained strength and simulation structure that can withstand load 140 kg both in static condition, dynamic, and impact. Therefore, the result of the analysis included values of safety factors in the ship is to keep the structure safe but the strength of the structure is not excessive.

7 CFR 51.2836 - Size classifications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Size classifications. 51.2836 Section 51.2836...) Size Classifications § 51.2836 Size classifications. The size of onions may be specified in accordance with one of the following classifications. Size designation Minimum diameter Inches Millimeters Maximum...

7 CFR 51.2836 - Size classifications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Size classifications. 51.2836 Section 51.2836...-Granex-Grano and Creole Types) Size Classifications § 51.2836 Size classifications. The size of onions may be specified in accordance with one of the following classifications. Size designation Minimum...

7 CFR 51.2836 - Size classifications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Size classifications. 51.2836 Section 51.2836...-Granex-Grano and Creole Types) Size Classifications § 51.2836 Size classifications. The size of onions may be specified in accordance with one of the following classifications. Size designation Minimum...

7 CFR 51.2836 - Size classifications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Size classifications. 51.2836 Section 51.2836...) Size Classifications § 51.2836 Size classifications. The size of onions may be specified in accordance with one of the following classifications. Size designation Minimum diameter Inches Millimeters Maximum...

7 CFR 51.2836 - Size classifications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Size classifications. 51.2836 Section 51.2836...) Size Classifications § 51.2836 Size classifications. The size of onions may be specified in accordance with one of the following classifications. Size designation Minimum diameter Inches Millimeters Maximum...

22 CFR 9.5 - Original classification authority.

Code of Federal Regulations, 2010 CFR

2010-04-01

... classification authority. (a) Authority for original classification of information as Top Secret may be exercised... Notice dated May 26, 2000. (b) Authority for original classification of information as Secret or..., 2000. In the absence of the Secret or Confidential classification authority, the person designated to...

Railroad classification yard design methodology study Elkhart Yard Rehabilitation : a case study

DOT National Transportation Integrated Search

1980-02-01

This interim report documents the application of a railroad classification : yard design methodology to CONRAIL's Elkhart Yard Rehabilitation. This : case study effort represents Phase 2 of a larger effort to develop a yard : design methodology, and ...

PLAY HANDS PROTECTIVE GLOVES: TECHNICAL NOTE ON DESIGN AND CONCEPT.

PubMed

Houston-Hicks, Michele; Lura, Derek J; Highsmith, M Jason

2016-09-01

Cerebral Palsy (CP) is the leading cause of childhood motor disability, with a global incidence of 1.6 to 2.5/1,000 live births. Approximately 23% of children with CP are dependent upon assistive technologies. Some children with developmental disabilities have self-injurious behaviors such as finger biting but also have therapeutic needs. The purpose of this technical note is to describe design considerations for a protective glove and finger covering that maintains finger dexterity for children who exhibit finger and hand chewing (dermatophagia) and require therapeutic range of motion and may benefit from sensory stimulation resulting from constant contact between glove and skin. Protecting Little and Adolescent Youth (PLAY) Hands are protective gloves for children with developmental disorders such as CP who injure themselves by biting their hands due to pain or sensory issues. PLAY Hands will be cosmetically appealing gloves that provide therapeutic warmth, tactile sensory feedback, range of motion for donning/ doffing, and protection to maximize function and quality of life for families of children with developmental disorders. The technology is either a per-finger protective orthosis or an entire glove solution designed from durable 3D-printed biodegradable/bioabsorbable materials such as thermoplastics. PLAY Hands represent a series of protective hand wear interventions in the areas of self-mutilating behavior, kinematics, and sensation. They will be made available in a range of protective iterations from single- or multi-digit finger orthoses to a basic glove design to a more structurally robust and protective iteration. To improve the quality of life for patients and caregivers, they are conceptualized to be cosmetically appealing, protective, and therapeutic.

Quantifying anti-gravity torques for the design of a powered exoskeleton.

PubMed

Ragonesi, Daniel; Agrawal, Sunil K; Sample, Whitney; Rahman, Tariq

2013-03-01

Designing an upper extremity exoskeleton for people with arm weakness requires knowledge of the joint torques due to gravity and joint stiffness, as well as, active residual force capabilities of users. The objective of this research paper is to describe the characteristics of the upper limb of children with upper limb impairment. This paper describes the experimental measurements of the torque on the upper limb due to gravity and joint stiffness of three groups of subjects: able-bodied adults, able-bodied children, and children with neuromuscular disabilities. The experiment involves moving the arm to various positions in the sagittal plane and measuring the resultant force at the forearm. This force is then converted to torques at the elbow and shoulder. These data are compared to a two-link lumped mass model based on anthropomorphic data. Results show that the torques based on anthropometry deviate from experimentally measured torques as the arm goes through the range. Subjects with disabilities also maximally pushed and pulled against the force sensor to measure maximum strength as a function of arm orientation. For all subjects, the maximum voluntary applied torque at the shoulder and elbow in the sagittal plane was found to be lower than gravity torques throughout the disabled subjects' range of motion. This experiment informs designers of upper limb orthoses on the contribution of passive human joint torques due to gravity and joint stiffness and the strength capability of targeted users.

Database Design Methodology and Database Management System for Computer-Aided Structural Design Optimization.

DTIC Science & Technology

1984-12-01

52242 Prepared for the AIR FORCE OFFICE OF SCIENTIFIC RESEARCH Under Grant No. AFOSR 82-0322 December 1984 ~ " ’w Unclassified SECURITY CLASSIFICATION4...OF THIS PAGE REPORT DOCUMENTATION PAGE is REPORT SECURITY CLASSIFICATION lb. RESTRICTIVE MARKINGS Unclassified None 20 SECURITY CLASSIFICATION...designer .and computer- are 20 DIiRIBUTION/AVAILABI LIT Y 0P ABSTR4ACT 21 ABSTRACT SECURITY CLASSIFICA1ONr UNCLASSIFIED/UNLIMITED SAME AS APT OTIC USERS

9 CFR 146.7 - Terminology and classification; general.

Code of Federal Regulations, 2011 CFR

2011-01-01

... General Provisions § 146.7 Terminology and classification; general. The official classification terms defined in §§ 146.8 and 146.9 and the various designs illustrative of the official classifications... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Terminology and classification...

22 CFR 9.5 - Original classification authority.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., 2000. In the absence of the Secret or Confidential classification authority, the person designated to... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Original classification authority. 9.5 Section... classification authority. (a) Authority for original classification of information as Top Secret may be exercised...

22 CFR 9.5 - Original classification authority.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., 2000. In the absence of the Secret or Confidential classification authority, the person designated to... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Original classification authority. 9.5 Section... classification authority. (a) Authority for original classification of information as Top Secret may be exercised...

22 CFR 9.5 - Original classification authority.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., 2000. In the absence of the Secret or Confidential classification authority, the person designated to... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Original classification authority. 9.5 Section... classification authority. (a) Authority for original classification of information as Top Secret may be exercised...

Does Maximizing Information at the Cut Score Always Maximize Classification Accuracy and Consistency?

ERIC Educational Resources Information Center

Wyse, Adam E.; Babcock, Ben

2016-01-01

A common suggestion made in the psychometric literature for fixed-length classification tests is that one should design tests so that they have maximum information at the cut score. Designing tests in this way is believed to maximize the classification accuracy and consistency of the assessment. This article uses simulated examples to illustrate…

Design of a hybrid model for cardiac arrhythmia classification based on Daubechies wavelet transform.

PubMed

Rajagopal, Rekha; Ranganathan, Vidhyapriya

2018-06-05

Automation in cardiac arrhythmia classification helps medical professionals make accurate decisions about the patient's health. The aim of this work was to design a hybrid classification model to classify cardiac arrhythmias. The design phase of the classification model comprises the following stages: preprocessing of the cardiac signal by eliminating detail coefficients that contain noise, feature extraction through Daubechies wavelet transform, and arrhythmia classification using a collaborative decision from the K nearest neighbor classifier (KNN) and a support vector machine (SVM). The proposed model is able to classify 5 arrhythmia classes as per the ANSI/AAMI EC57: 1998 classification standard. Level 1 of the proposed model involves classification using the KNN and the classifier is trained with examples from all classes. Level 2 involves classification using an SVM and is trained specifically to classify overlapped classes. The final classification of a test heartbeat pertaining to a particular class is done using the proposed KNN/SVM hybrid model. The experimental results demonstrated that the average sensitivity of the proposed model was 92.56%, the average specificity 99.35%, the average positive predictive value 98.13%, the average F-score 94.5%, and the average accuracy 99.78%. The results obtained using the proposed model were compared with the results of discriminant, tree, and KNN classifiers. The proposed model is able to achieve a high classification accuracy.

Railroad classification yard design methodology study : East Deerfield Yard, a case study

DOT National Transportation Integrated Search

1980-02-01

This interim report documents the application of a railroad classification yard design methodology to Boston and Maine's East Deerfield Yard Rehabiliation. This case study effort represents Phase 2 of a larger effort to develop a yard design methodol...

32 CFR 2700.12 - Criteria for and level of original classification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... classification are authorized—“Top Secret,” “Secret,” “Confidential.” No other classification designation is... classification. 2700.12 Section 2700.12 National Defense Other Regulations Relating to National Defense OFFICE FOR MICRONESIAN STATUS NEGOTIATIONS SECURITY INFORMATION REGULATIONS Original Classification § 2700.12...

32 CFR 2700.12 - Criteria for and level of original classification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... classification are authorized—“Top Secret,” “Secret,” “Confidential.” No other classification designation is... classification. 2700.12 Section 2700.12 National Defense Other Regulations Relating to National Defense OFFICE FOR MICRONESIAN STATUS NEGOTIATIONS SECURITY INFORMATION REGULATIONS Original Classification § 2700.12...

32 CFR 2700.12 - Criteria for and level of original classification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... classification are authorized—“Top Secret,” “Secret,” “Confidential.” No other classification designation is... classification. 2700.12 Section 2700.12 National Defense Other Regulations Relating to National Defense OFFICE FOR MICRONESIAN STATUS NEGOTIATIONS SECURITY INFORMATION REGULATIONS Original Classification § 2700.12...

The Effects of Q-Matrix Design on Classification Accuracy in the Log-Linear Cognitive Diagnosis Model.

PubMed

Madison, Matthew J; Bradshaw, Laine P

2015-06-01

Diagnostic classification models are psychometric models that aim to classify examinees according to their mastery or non-mastery of specified latent characteristics. These models are well-suited for providing diagnostic feedback on educational assessments because of their practical efficiency and increased reliability when compared with other multidimensional measurement models. A priori specifications of which latent characteristics or attributes are measured by each item are a core element of the diagnostic assessment design. This item-attribute alignment, expressed in a Q-matrix, precedes and supports any inference resulting from the application of the diagnostic classification model. This study investigates the effects of Q-matrix design on classification accuracy for the log-linear cognitive diagnosis model. Results indicate that classification accuracy, reliability, and convergence rates improve when the Q-matrix contains isolated information from each measured attribute.

Tone-Inhibiting Insoles Enhance the Reciprocal Inhibition of Ankle Plantarflexors of Subjects With Hemiparesis After Stroke: An Electromyographic Study.

PubMed

Takahashi, Nobushige; Takahashi, Hidetoshi; Takahashi, Osamu; Ushijima, Ryosuke; Umebayashi, Rie; Nishikawa, Junji; Okajima, Yasutomo

2018-02-01

Spasticity is a common sequela of upper motor neuron pathology, such as cerebrovascular diseases and cerebral palsy. Intervention for spasticity of the ankle plantarflexors in physical therapy may include tone-inhibiting casting and/or orthoses for the ankle and foot. However, the physiological mechanism of tone reduction by such orthoses remains unclarified. To investigate the electrophysiologic effects of tone-inhibiting insoles in stroke subjects with hemiparesis by measuring changes in reciprocal Ia inhibition (RI) in the ankle plantarflexor. An interventional before-after study. Acute stroke unit or ambulatory rehabilitation clinic of a university hospital in Japan. Ten subjects (47-84 years) with hemiparesis and 10 healthy male control subjects (31-59 years) were recruited. RI of the spastic soleus in response to the electrical stimulation of the deep peroneal nerve was evaluated by stimulus-locked averaging of rectified electromyography (EMG) of the soleus while subjects were standing. The magnitude of RI, defined as the ratio of the lowest to the baseline amplitude of the rectified EMG at approximately 40 milliseconds after stimulation, was measured while subjects were standing with and without the tone-inhibiting insole on the hemiparesis side. Enhancement of EMG reduction with the tone-inhibiting insole was significant (P < .05) in the subjects with hemiparesis, whereas no significant changes were found in controls. Tone-inhibiting insoles enhanced RI of the soleus in subjects after stroke, which might enhance standing stability by reducing unfavorable ankle plantarflexion tone. III. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Ankle foot orthosis-footwear combination tuning: an investigation into common clinical practice in the United Kingdom.

PubMed

Eddison, Nicola; Chockalingam, Nachiappan; Osborne, Stephen

2015-04-01

Ankle foot orthoses are used to treat a wide variety of gait pathologies. Ankle foot orthosis-footwear combination tuning should be routine clinical practice when prescribing an ankle foot orthosis. Current research suggests that failure to tune ankle foot orthosis-footwear combinations can lead to immediate detrimental effect on function, and in the longer term, it may actually contribute to deterioration. The purpose of this preliminary study was to identify the current level of knowledge clinicians have in the United Kingdom regarding ankle foot orthosis-footwear combination tuning and to investigate common clinical practice regarding ankle foot orthosis-footwear combination tuning among UK orthotists. Cross-sectional survey. A prospective study employing a multi-item questionnaire was sent out to registered orthotists and uploaded on to the official website of British Association of Prosthetists and Orthotists to be accessed by their members. A total of 41 completed questionnaires were received. The results demonstrate that only 50% of participants use ankle foot orthosis-footwear combination tuning as standard clinical practice. The most prevalent factors preventing participants from carrying out ankle foot orthosis-footwear combination tuning are a lack of access to three-dimensional gait analysis equipment (37%) and a lack of time available in their clinics (27%). Although, ankle foot orthosis-footwear combination tuning has been identified as an essential aspect of the prescription of ankle foot orthoses, the results of this study show a lack of understanding of the key principles behind ankle foot orthosis-footwear combination tuning. © The International Society for Prosthetics and Orthotics 2014.

14 CFR Sec. 19-4 - Service classes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... integral part of services performed pursuant to published flight schedules. The following classifications... Classifications Sec. 19-4 Service classes. The statistical classifications are designed to reflect the operating...

14 CFR Sec. 19-4 - Service classes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... integral part of services performed pursuant to published flight schedules. The following classifications... Classifications Sec. 19-4 Service classes. The statistical classifications are designed to reflect the operating...

5 CFR 1312.4 - Classified designations.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Top Secret. This classification shall be applied only to information the unauthorized disclosure of... original classification authority is able to identify or describe. (2) Secret. This classification shall be...

Estimation of Quasi-Stiffness of the Human Knee in the Stance Phase of Walking

PubMed Central

Shamaei, Kamran; Sawicki, Gregory S.; Dollar, Aaron M.

2013-01-01

Biomechanical data characterizing the quasi-stiffness of lower-limb joints during human locomotion is limited. Understanding joint stiffness is critical for evaluating gait function and designing devices such as prostheses and orthoses intended to emulate biological properties of human legs. The knee joint moment-angle relationship is approximately linear in the flexion and extension stages of stance, exhibiting nearly constant stiffnesses, known as the quasi-stiffnesses of each stage. Using a generalized inverse dynamics analysis approach, we identify the key independent variables needed to predict knee quasi-stiffness during walking, including gait speed, knee excursion, and subject height and weight. Then, based on the identified key variables, we used experimental walking data for 136 conditions (speeds of 0.75–2.63 m/s) across 14 subjects to obtain best fit linear regressions for a set of general models, which were further simplified for the optimal gait speed. We found R2 > 86% for the most general models of knee quasi-stiffnesses for the flexion and extension stages of stance. With only subject height and weight, we could predict knee quasi-stiffness for preferred walking speed with average error of 9% with only one outlier. These results provide a useful framework and foundation for selecting subject-specific stiffness for prosthetic and exoskeletal devices designed to emulate biological knee function during walking. PMID:23533662

Development of a patient-specific anatomical foot model from structured light scan data.

PubMed

Lochner, Samuel J; Huissoon, Jan P; Bedi, Sanjeev S

2014-01-01

The use of anatomically accurate finite element (FE) models of the human foot in research studies has increased rapidly in recent years. Uses for FE foot models include advancing knowledge of orthotic design, shoe design, ankle-foot orthoses, pathomechanics, locomotion, plantar pressure, tissue mechanics, plantar fasciitis, joint stress and surgical interventions. Similar applications but for clinical use on a per-patient basis would also be on the rise if it were not for the high costs associated with developing patient-specific anatomical foot models. High costs arise primarily from the expense and challenges of acquiring anatomical data via magnetic resonance imaging (MRI) or computed tomography (CT) and reconstructing the three-dimensional models. The proposed solution morphs detailed anatomy from skin surface geometry and anatomical landmarks of a generic foot model (developed from CT or MRI) to surface geometry and anatomical landmarks acquired from an inexpensive structured light scan of a foot. The method yields a patient-specific anatomical foot model at a fraction of the cost of standard methods. Average error for bone surfaces was 2.53 mm for the six experiments completed. Highest accuracy occurred in the mid-foot and lowest in the forefoot due to the small, irregular bones of the toes. The method must be validated in the intended application to determine if the resulting errors are acceptable.

Six-Minute Walk Test Performance in Persons With Multiple Sclerosis While Using Passive or Powered Ankle-Foot Orthoses.

PubMed

Boes, Morgan K; Bollaert, Rachel E; Kesler, Richard M; Learmonth, Yvonne C; Islam, Mazharul; Petrucci, Matthew N; Motl, Robert W; Hsiao-Wecksler, Elizabeth T

2018-03-01

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS). Short-term intervention. University research laboratory. Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO. Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb. Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions. Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions. The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success.

PubMed

Ikeda, Andrea J; Grabowski, Alena M; Lindsley, Alida; Sadeghi-Demneh, Ebrahim; Reisinger, Kim D

2014-08-01

Literature Review We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two. © The International Society for Prosthetics and Orthotics 2013.

Pseudoelastic Nitinol-Based Device for Relaxation of Spastic Elbow in Stroke Patients

NASA Astrophysics Data System (ADS)

Viscuso, S.; Pittaccio, S.; Caimmi, M.; Gasperini, G.; Pirovano, S.; Villa, E.; Besseghini, S.; Molteni, F.

2009-08-01

A compliant brace (EDGES) promoting spastic elbow relaxation was designed to investigate the potentialities of pseudoelastic NiTi in orthotics. By exploiting its peculiar characteristics, EDGES could improve elbow posture without constraining movements and thus avoiding any pain to the patient. A commercial Ni50.7-Ti49.3 alloy heat treated at 400 °C 1 h + WQ was selected for this application. A prototype of EDGES was assembled with two thermoplastic shells connected by polycentric hinges. Four 2-mm-diameter NiTi bars were encastred in the upper-arm shell and let slide along tubular fixtures on the forearm. Specially designed bending tests demonstrated suitable moment-angle characteristics. Two post-stroke subjects (aged 62 and 64, mild elbow flexors spasticity) wore EDGES for 1 week, at least 10 h a day. No additional treatment was applied during this period or the following week. A great improvement (20° ± 5°) of the resting position was observed in both patients as early as 3 h after starting the treatment. Acceptability was very good. A slight decrease in spasticity was also observed in both subjects. All the effects disappeared 1 week after discontinuation. EDGES appears to be a good alternative to traditional orthoses in terms of acceptability and effectiveness in improving posture, especially whenever short-term splinting is planned.

Classification of male lower torso for underwear design

NASA Astrophysics Data System (ADS)

Cheng, Z.; Kuzmichev, V. E.

2017-10-01

By means of scanning technology we have got new information about the morphology of male bodies and have redistricted the classification of men’s underwear by adopting one to consumer demands. To build the new classification in accordance with male body characteristic factors of lower torso, we make the method of underwear designing which allow to get the accurate and convenience for consumers products.

14 CFR 1203.412 - Classification guides.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of the classification designations (i.e., Top Secret, Secret or Confidential) apply to the identified... writing by an official with original Top Secret classification authority; the identity of the official...

The postoperative COFAS end-stage ankle arthritis classification system: interobserver and intraobserver reliability.

PubMed

Krause, Fabian G; Di Silvestro, Matthew; Penner, Murray J; Wing, Kevin J; Glazebrook, Mark A; Daniels, Timothy R; Lau, Johnny T C; Younger, Alastair S E

2012-02-01

End-stage ankle arthritis is operatively treated with numerous designs of total ankle replacement and different techniques for ankle fusion. For superior comparison of these procedures, outcome research requires a classification system to stratify patients appropriately. A postoperative 4-type classification system was designed by 6 fellowship-trained foot and ankle surgeons. Four surgeons reviewed blinded patient profiles and radiographs on 2 occasions to determine the interobserver and intraobserver reliability of the classification. Excellent interobserver reliability (κ = .89) and intraobserver reproducibility (κ = .87) were demonstrated for the postoperative classification system. In conclusion, the postoperative Canadian Orthopaedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system appears to be a valid tool to evaluate the outcome of patients operated for end-stage ankle arthritis.

14 CFR 1203.701 - Classification.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Classification. 1203.701 Section 1203.701... Government Information § 1203.701 Classification. (a) Foreign government information that is classified by a foreign entity shall either retain its original classification designation or be marked with a United...

14 CFR 1203.701 - Classification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Classification. 1203.701 Section 1203.701... Government Information § 1203.701 Classification. (a) Foreign government information that is classified by a foreign entity shall either retain its original classification designation or be marked with a United...

Estimating Classification Consistency and Accuracy for Cognitive Diagnostic Assessment

ERIC Educational Resources Information Center

Cui, Ying; Gierl, Mark J.; Chang, Hua-Hua

2012-01-01

This article introduces procedures for the computation and asymptotic statistical inference for classification consistency and accuracy indices specifically designed for cognitive diagnostic assessments. The new classification indices can be used as important indicators of the reliability and validity of classification results produced by…

14 CFR 1203.701 - Classification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Classification. 1203.701 Section 1203.701... Government Information § 1203.701 Classification. (a) Foreign government information that is classified by a foreign entity shall either retain its original classification designation or be marked with a United...

A Powered Lower Limb Orthosis for Providing Legged Mobility in Paraplegic Individuals.

PubMed

Quintero, Hugo A; Farris, Ryan J; Hartigan, Clare; Clesson, Ismari; Goldfarb, Michael

2011-01-01

This paper presents preliminary results on the development of a powered lower limb orthosis intended to provide legged mobility (with the use of a stability aid, such as forearm crutches) to paraplegic individuals. The orthosis contains electric motors at both hip and both knee joints, which in conjunction with ankle-foot orthoses, provides appropriate joint kinematics for legged locomotion. The paper describes the orthosis and the nature of the controller that enables the SCI patient to command the device, and presents data from preliminary trials that indicate the efficacy of the orthosis and controller in providing legged mobility.

Active chainmail fabrics for soft robotic applications

NASA Astrophysics Data System (ADS)

Ransley, Mark; Smitham, Peter; Miodownik, Mark

2017-08-01

This paper introduces a novel type of smart textile with electronically responsive flexibility. The chainmail inspired fabric is modelled parametrically and simulated via a rigid body physics framework with an embedded model of temperature controlled actuation. Our model assumes that individual fabric linkages are rigid and deform only through their own actuation, thereby decoupling flexibility from stiffness. A physical prototype of the active fabric is constructed and it is shown that flexibility can be significantly controlled through actuator strains of ≤10%. Applications of these materials to soft-robotics such as dynamically reconfigurable orthoses and splints are discussed.

Effects of a recreational ice skating program on the functional mobility of a child with cerebral palsy.

PubMed

Walsh, Sharon Fleming; Scharf, Michael G

2014-04-01

The purpose of this study was to describe the effects of an ice skating program on the ambulation, strength, posture and balance of a child with cerebral palsy (CP). The subject was a five-year-old female with a diagnosis of CP and a Gross Motor Classification System level of III. The subject was a slow and labored household ambulator on level surfaces with bilateral forearm crutches and bilateral ankle foot orthoses. She was unable to transfer to and from the floor to stand independently, stand unsupported or take steps independently. Until the initiation of this study she was receiving physical therapy services 2×/week. For the purpose of this study she participated in a 1 h/week local ice skating program for people with disabilities for a period of four months. The subject displayed clinically significant improvements in functional mobility including: improved standing posture; independent transfer to and from the floor to stand; maintenance of independent standing for 3 min; independent walking for 10 feet; increased ability to isolate extremity musculature; increased strength; improved Gross Motor Function Measure-88 scores and increased endurance. A subsequent testing session four months after the ice skating program had ended displayed declines but not to pre-intervention levels in muscle strength; ability to transfer to and from the floor to stand; functional mobility and standing balance. The results appear to suggest that the participation in an ice skating program clinically improved this child's functional mobility. Further research needs to be done with regard to physical recreational programs and the benefit they can have on the function of children with activity limitations.

Optimal design of a bank of spatio-temporal filters for EEG signal classification.

PubMed

Higashi, Hiroshi; Tanaka, Toshihisa

2011-01-01

The spatial weights for electrodes called common spatial pattern (CSP) are known to be effective in EEG signal classification for motor imagery based brain computer interfaces (MI-BCI). To achieve accurate classification in CSP, the frequency filter should be properly designed. To this end, several methods for designing the filter have been proposed. However, the existing methods cannot consider plural brain activities described with different frequency bands and different spatial patterns such as activities of mu and beta rhythms. In order to efficiently extract these brain activities, we propose a method to design plural filters and spatial weights which extract desired brain activity. The proposed method designs finite impulse response (FIR) filters and the associated spatial weights by optimization of an objective function which is a natural extension of CSP. Moreover, we show by a classification experiment that the bank of FIR filters which are designed by introducing an orthogonality into the objective function can extract good discriminative features. Moreover, the experiment result suggests that the proposed method can automatically detect and extract brain activities related to motor imagery.

5 CFR 1312.4 - Classified designations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... describe. (3) Confidential. This classification shall be applied only to information the unauthorized... 1312.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CLASSIFICATION, DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Classification and...

5 CFR 1312.4 - Classified designations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... describe. (3) Confidential. This classification shall be applied only to information the unauthorized... 1312.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CLASSIFICATION, DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Classification and...

5 CFR 1312.4 - Classified designations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... describe. (3) Confidential. This classification shall be applied only to information the unauthorized... 1312.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CLASSIFICATION, DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Classification and...

Review article: A systematic review of emergency department incident classification frameworks.

PubMed

Murray, Matthew; McCarthy, Sally

2018-06-01

As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

14 CFR 298.3 - Classification.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Classification. 298.3 Section 298.3... REGULATIONS EXEMPTIONS FOR AIR TAXI AND COMMUTER AIR CARRIER OPERATIONS General § 298.3 Classification. (a) There is hereby established a classification of air carriers, designated as “air taxi operators,” which...

14 CFR 298.3 - Classification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Classification. 298.3 Section 298.3... REGULATIONS EXEMPTIONS FOR AIR TAXI AND COMMUTER AIR CARRIER OPERATIONS General § 298.3 Classification. (a) There is hereby established a classification of air carriers, designated as “air taxi operators,” which...

14 CFR 298.3 - Classification.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Classification. 298.3 Section 298.3... REGULATIONS EXEMPTIONS FOR AIR TAXI AND COMMUTER AIR CARRIER OPERATIONS General § 298.3 Classification. (a) There is hereby established a classification of air carriers, designated as “air taxi operators,” which...

14 CFR 298.3 - Classification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Classification. 298.3 Section 298.3... REGULATIONS EXEMPTIONS FOR AIR TAXI AND COMMUTER AIR CARRIER OPERATIONS General § 298.3 Classification. (a) There is hereby established a classification of air carriers, designated as “air taxi operators,” which...

14 CFR 298.3 - Classification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Classification. 298.3 Section 298.3... REGULATIONS EXEMPTIONS FOR AIR TAXI AND COMMUTER AIR CARRIER OPERATIONS General § 298.3 Classification. (a) There is hereby established a classification of air carriers, designated as “air taxi operators,” which...

If It Doesn't Work, Why Do We Still Do It? The Continuing Use of Subtalar Joint Neutral Theory in the Face of Overpowering Critical Research.

PubMed

Harradine, Paul; Gates, Lucy; Bowen, Catherine

2018-03-01

The use of subtalar joint neutral (STJN) in the assessment and treatment of foot-related musculoskeletal symptomology is common in daily practice and still widely taught. The main pioneer of this theory was Dr Merton L. Root, and it has been labeled with a variety of names: "the foot morphology theory," "the subtalar joint neutral theory," or simply "Rootian theory" or "Root model." The theory's core concepts still underpin a common approach to musculoskeletal assessment of the foot, as well as the consequent design of foot orthoses. The available literature continues to point to Dr Root's theory as the most prevalently utilized. Concurrently, the worth of this theory has been challenged due to its poor reliability and limited external validity. This Viewpoint reviews the main clinical areas of the STJN theory, and concludes with a possible explanation and concerns for its ongoing use. To support our view, we will discuss (1) historical inaccuracies, (2) challenges with reliability, and (3) concerns with validity. J Orthop Sports Phys Ther 2018;48(3):130-132. doi:10.2519/jospt.2018.0604.

Gait mode recognition and control for a portable-powered ankle-foot orthosis.

PubMed

David Li, Yifan; Hsiao-Wecksler, Elizabeth T

2013-06-01

Ankle foot orthoses (AFOs) are widely used as assistive/rehabilitation devices to correct the gait of people with lower leg neuromuscular dysfunction and muscle weakness. We have developed a portable powered ankle-foot orthosis (PPAFO), which uses a pneumatic bi-directional rotary actuator powered by compressed CO2 to provide untethered dorsiflexor and plantarflexor assistance at the ankle joint. Since portability is a key to the success of the PPAFO as an assist device, it is critical to recognize and control for gait modes (i.e. level walking, stair ascent/descent). While manual mode switching is implemented in most powered orthotic/prosthetic device control algorithms, we propose an automatic gait mode recognition scheme by tracking the 3D position of the PPAFO from an inertial measurement unit (IMU). The control scheme was designed to match the torque profile of physiological gait data during different gait modes. Experimental results indicate that, with an optimized threshold, the controller was able to identify the position, orientation and gait mode in real time, and properly control the actuation. It was also illustrated that during stair descent, a mode-specific actuation control scheme could better restore gait kinematic and kinetic patterns, compared to using the level ground controller.

[Technological advances in neurorehabilitation].

PubMed

Gutiérrez-Martínez, Josefina; Núñez-Gaona, Marco Antonio; Carrillo-Mora, Paul

2014-07-01

Neurological rehabilitation arose as formal method in the 60's, for the therapeutic treatment of patients with stroke or spinal cord injury, which develop severe sequelae that affect their motor and sensory abilities. Although the Central Nervous System has plasticity mechanisms for spontaneous recovery, a high percentage of patients should receive specialized therapies to regain motor function, such as Constraint Induced Movement Therapy or Upright physical Therapy. The neurorehabilitation has undergone drastic changes over the last two decades due to the incorporation of computer and robotic electronic devices, designed to produce positive changes in cortical excitability of the cerebral hemisphere damaged and so to improve neuroplasticity. Among equipment, we can mention those for electrotherapy devices, apparatus for transcranial magnetic stimulation, the robotic lower limb orthoses, robot for upper limb training, systems for functional electrical stimulation, neuroprosthesis and brain computer interfaces. These devices have caused controversy because of its application and benefits reported in the literature. The aim of Neurorehabilitation technologies is to take advantage of the functional neuromuscular structures preserved, and they compensate or re-learn the functions that previously made the damaged areas. The purpose of this article is to mention some clinical applications and benefits that these technologies offer to patients with neuronal injury.

Effect of Shoes on Stiffness and Energy Efficiency of Ankle-Foot Orthosis: Bench Testing Analysis.

PubMed

Kobayashi, Toshiki; Gao, Fan; LeCursi, Nicholas; Foreman, K Bo; Orendurff, Michael S

2017-12-01

Understanding the mechanical properties of ankle-foot orthoses (AFOs) is important to maximize their benefit for those with movement disorders during gait. Though mechanical properties such as stiffness and/or energy efficiency of AFOs have been extensively studied, it remains unknown how and to what extent shoes influence their properties. The aim of this study was to investigate the effect of shoes on stiffness and energy efficiency of an AFO using a custom mechanical testing device. Stiffness and energy efficiency of the AFO were measured in the plantar flexion and dorsiflexion range, respectively, under AFO-alone and AFO-Shoe combination conditions. The results of this study demonstrated that the stiffness of the AFO-Shoe combination was significantly decreased compared to the AFO-alone condition, but no significant differences were found in energy efficiency. From the results, we recommend that shoes used with AFOs should be carefully selected not only based on their effect on alignment of the lower limb, but also their effects on overall mechanical properties of the AFO-Shoe combination. Further study is needed to clarify the effects of differences in shoe designs on AFO-Shoe combination mechanical properties.

The effect of moderate running on foot posture index and plantar pressure distribution in male recreational runners.

PubMed

Escamilla-Martínez, Elena; Martínez-Nova, Alfonso; Gómez-Martín, Beatriz; Sánchez-Rodríguez, Raquel; Fernández-Seguín, Lourdes María

2013-01-01

Fatigue due to running has been shown to contribute to changes in plantar pressure distribution. However, little is known about changes in foot posture after running. We sought to compare the foot posture index before and after moderate exercise and to relate any changes to plantar pressure patterns. A baropodometric evaluation was made, using the FootScan platform (RSscan International, Olen, Belgium), of 30 men who were regular runners and their foot posture was examined using the Foot Posture Index before and after a 60-min continuous run at a moderate pace (3.3 m/sec). Foot posture showed a tendency toward pronation after the 60-min run, gaining 2 points in the foot posture index. The total support and medial heel contact areas increased, as did pressures under the second metatarsal head and medial heel. Continuous running at a moderate speed (3.3 m/sec) induced changes in heel strike related to enhanced pronation posture, indicative of greater stress on that zone after physical activity. This observation may help us understand the functioning of the foot, prevent injuries, and design effective plantar orthoses in sport.

28 CFR 570.35 - Transfer furlough eligibility requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... facility based on the inmate's security designation and custody classification at the time of transfer. (d... security designation and custody classification at the time of transfer. ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Transfer furlough eligibility...

28 CFR 570.35 - Transfer furlough eligibility requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... facility based on the inmate's security designation and custody classification at the time of transfer. (d... security designation and custody classification at the time of transfer. ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Transfer furlough eligibility...

28 CFR 570.35 - Transfer furlough eligibility requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... facility based on the inmate's security designation and custody classification at the time of transfer. (d... security designation and custody classification at the time of transfer. ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Transfer furlough eligibility...

28 CFR 570.35 - Transfer furlough eligibility requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... facility based on the inmate's security designation and custody classification at the time of transfer. (d... security designation and custody classification at the time of transfer. ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Transfer furlough eligibility...

The effect of ankle foot orthosis stiffness on the energy cost of walking: a simulation study.

PubMed

Bregman, D J J; van der Krogt, M M; de Groot, V; Harlaar, J; Wisse, M; Collins, S H

2011-11-01

In stroke and multiple sclerosis patients, gait is frequently hampered by a reduced ability to push-off with the ankle caused by weakness of the plantar-flexor muscles. To enhance ankle push-off and to decrease the high energy cost of walking, spring-like carbon-composite Ankle Foot Orthoses are frequently prescribed. However, it is unknown what Ankle Foot Orthoses stiffness should be used to obtain the most efficient gait. The aim of this simulation study was to gain insights into the effect of variation in Ankle Foot Orthosis stiffness on the amount of energy stored in the Ankle Foot Orthosis and the energy cost of walking. We developed a two-dimensional forward-dynamic walking model with a passive spring at the ankle representing the Ankle Foot Orthosis and two constant torques at the hip for propulsion. We varied Ankle Foot Orthosis stiffness while keeping speed and step length constant. We found an optimal stiffness, at which the energy delivered at the hip joint was minimal. Energy cost decreased with increasing energy storage in the ankle foot orthosis, but the most efficient gait did not occur with maximal energy storage. With maximum storage, push-off occurred too late to reduce the impact of the contralateral leg with the floor. Maximum return prior to foot strike was also suboptimal, as push-off occurred too early and its effects were subsequently counteracted by gravity. The optimal Ankle Foot Orthosis stiffness resulted in significant push-off timed just prior to foot strike and led to greater ankle plantar-flexion velocity just before contralateral foot strike. Our results suggest that patient energy cost might be reduced by the proper choice of Ankle Foot Orthosis stiffness. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pressure-relieving properties of various shoe inserts in older people with plantar heel pain.

PubMed

Bonanno, Daniel R; Landorf, Karl B; Menz, Hylton B

2011-03-01

Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain. Copyright © 2010 Elsevier B.V. All rights reserved.

Orthosis-Shaped Sandals Are as Efficacious as In-Shoe Orthoses and Better than Flat Sandals for Plantar Heel Pain: A Randomized Control Trial.

PubMed

Vicenzino, Bill; McPoil, Thomas G; Stephenson, Aoife; Paul, Sanjoy K

2015-01-01

To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis. 150 volunteers aged 50 (SD: 12) years with plantar heel pain (>4 weeks) were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49), flat flip-flops (n = 50) or over the counter, pre-fabricated full-length foot orthotics (n = 51). Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better), 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS) on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty). Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation. Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest. The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flip-flop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert. Physicians can have confidence in supporting a patient's decision to wear contoured sandals or in-shoe orthoses as one of the first and simple strategies to manage their heel pain. The Australian New Zealand Clinical Trials Registry ACTRN12612000463875.

The efficacy of nonsurgical interventions for pediatric flexible flat foot: a critical review.

PubMed

Jane MacKenzie, Angela; Rome, Keith; Evans, Angela Margaret

2012-12-01

The pediatric flat foot frequently presents as a common parental concern in the health care setting. Foot orthoses are often used, yet benefits are uncertain and disputed, having been variably investigated. A recent Cochrane review cites limited evidence for nonsurgical interventions. This critical and structured review evaluates the effect of pediatric foot orthoses from assessment of the current literature. A systematic search of the following electronic databases: Medline, CINAHL, AMED, and SPORTDiscus, using an array of search terms. A further search was also performed on relevant reference listings. Inclusion criteria were peer-reviewed journal articles, publication date from 1970 onwards, in the English language. Exclusion criteria were surgery interventions, adult subjects, rigid flat foot, articles based on opinion. A structured Quality Index was used to evaluate the research quality of articles. Three reviewers independently assessed the studies with disputes resolved by majority consensus. Studies were then grouped according to the outcome measures used. Thirteen articles, from an initial 429, met the criteria for quality evaluation. The mean Quality Index score was 35% (range: 13% to 81%), indicative of generally poor and varying methodological quality. The low quality of the studies negates definitive conclusions. Only 3/13 quality evaluations scored > 50%; hence, evidence for efficacy of nonsurgical interventions for flexible pediatric flat feet is very limited. Future research needs validated foot type assessment, applicable outcome measures for the intervention, the use of control groups, allowance for independent effects of footwear, age range comparisons, larger samples, and prospective, longer follow-up. There is very limited evidence for the efficacy of nonsurgical interventions for children with flexible flat feet. Clinicians need to consider the lack of good-quality evidence in their decision-making for the management of pediatric flat foot.

Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

PubMed

Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

2015-04-01

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p < 0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00). A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

A three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses.

PubMed

Fatone, Stefania; Johnson, William Brett; Tucker, Kerice

2016-04-01

Misalignment of an articulated ankle-foot orthosis joint axis with the anatomic joint axis may lead to discomfort, alterations in gait, and tissue damage. Theoretical, two-dimensional models describe the consequences of misalignments, but cannot capture the three-dimensional behavior of ankle-foot orthosis use. The purpose of this project was to develop a model to describe the effects of ankle-foot orthosis ankle joint misalignment in three dimensions. Computational simulation. Three-dimensional scans of a leg and ankle-foot orthosis were incorporated into a link segment model where the ankle-foot orthosis joint axis could be misaligned with the anatomic ankle joint axis. The leg/ankle-foot orthosis interface was modeled as a network of nodes connected by springs to estimate interface pressure. Motion between the leg and ankle-foot orthosis was calculated as the ankle joint moved through a gait cycle. While the three-dimensional model corroborated predictions of the previously published two-dimensional model that misalignments in the anterior -posterior direction would result in greater relative motion compared to misalignments in the proximal -distal direction, it provided greater insight showing that misalignments have asymmetrical effects. The three-dimensional model has been incorporated into a freely available computer program to assist others in understanding the consequences of joint misalignments. Models and simulations can be used to gain insight into functioning of systems of interest. We have developed a three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses. The model has been incorporated into a freely available computer program to assist understanding of trainees and others interested in orthotics. © The International Society for Prosthetics and Orthotics 2014.

Risk factors for lower limb injuries during initial naval training: a prospective study.

PubMed

Bonanno, Daniel R; Munteanu, S E; Murley, G S; Landorf, K B; Menz, H B

2018-04-06

This study aimed to identify risk factors associated with the development of common lower limb injuries during initial defence training in naval recruits who were enrolled in a randomised trial. Three-hundred and six naval recruits were randomly allocated flat insoles (n=153) or foot orthoses (n=153) while undertaking 11 weeks of initial training. Participant characteristics (including anthropometrics, general health, physical activity, fitness and foot characteristics) were collected at the baseline assessment and injuries were documented prospectively. Injury was defined as the combined incidence of participants with medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain throughout the 11 weeks of training. A discriminant function analysis was used to explore the ability of baseline measures to predict injury. Overall, 67 (21.9%) participants developed an injury. Discriminant function analysis revealed that participants who sustained an injury were slightly younger (mean 21.4±SD 4.1 vs 22.5±5.0 years) and were less likely to be allocated to the foot orthosis group (40% vs 53%) compared with those who remained uninjured. The accuracy of these baseline variables to predict injury was moderate (78.1%). Lower limb injury was not accurately predicted from health questionnaires, fitness results and clinical assessments in naval recruits undertaking initial defence training. However, although not reaching statistical significance, the use of foot orthoses may be protective against common lower limb injuries. ACTRN12615000024549; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Australian Diabetes Foot Network: practical guideline on the provision of footwear for people with diabetes

PubMed Central

2013-01-01

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system. PMID:23442978

Immediate effect of a functional wrist orthosis for children with cerebral palsy or brain injury: A randomized controlled trial.

PubMed

Jackman, Michelle; Novak, Iona; Lannin, Natasha; Galea, Claire

2017-10-28

Two-group randomized controlled trial. Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence. The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury. A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group. After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], -0.954; P = .348; and 95% confidence interval, -12.380 to 4.513). In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a 'typical' position, may not lead to an immediate improvement in hand function. Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. Copyright © 2017 Hanley & Belfus. All rights reserved.

Australian Diabetes Foot Network: practical guideline on the provision of footwear for people with diabetes.

PubMed

Bergin, Shan M; Nube, Vanessa L; Alford, Jan B; Allard, Bernard P; Gurr, Joel M; Holland, Emma L; Horsley, Mark W; Kamp, Maarten C; Lazzarini, Peter A; Sinha, Ashim K; Warnock, Jason T; Wraight, Paul R

2013-02-26

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.

Surgical versus accommodative treatment for Charcot arthropathy of the midfoot.

PubMed

Pinzur, Michael

2004-08-01

The treatment of Charcot foot arthropathy is one of the most controversial issues facing orthopaedic foot and ankle surgeons. Although current orthopaedic textbooks are in almost universal agreement that treatment should be nonoperative, accommodating the deformity with orthotic methods, most peer-reviewed clinical studies recommend early surgical correction of the deformity. In a university health system orthopaedic foot and ankle clinic with a special interest in diabetic foot disorders, a moderate approach evolved for management of this difficult patient population. Patients with Charcot arthropathy and plantigrade feet were treated with accommodative orthotic methods. Those with nonplantigrade feet were treated with surgical correction of the deformity, followed by long-term management with commercial therapeutic footwear. The desired outcome for both groups was long-term management with standard, commercially available, therapeutic depth-inlay shoes and custom-fabricated accommodative foot orthoses. During a 6-year period, 198 patients (201 feet) were treated for diabetes-associated Charcot foot arthropathy. The location of the deformity was in the midfoot in 147 feet, in the ankle in 50, and in the forefoot in four. At a minimum 1-year follow-up, 87 of the 147 feet with midfoot disease (59.2%) achieved the desired endpoint without surgical intervention. Sixty (40.8%) required surgery. Corrective osteotomy with or without arthrodesis was attempted in 42, while debridement or simple exostectomy was attempted in 18 feet. Three patients had initial amputation (one partial foot amputation, one Syme ankle disarticulation, and one transtibial amputation), and five had amputation (two Syme ankle disarticulations and three transtibial amputations) after attempted salvage failed. Using a simple treatment protocol with the desired endpoint being long-term management with commercially available, therapeutic footwear and custom foot orthoses, more than half of patients with Charcot arthropathy at the midfoot level can be successfully managed without surgery.

Modeling initial contact dynamics during ambulation with dynamic simulation.

PubMed

Meyer, Andrew R; Wang, Mei; Smith, Peter A; Harris, Gerald F

2007-04-01

Ankle-foot orthoses are frequently used interventions to correct pathological gait. Their effects on the kinematics and kinetics of the proximal joints are of great interest when prescribing ankle-foot orthoses to specific patient groups. Mathematical Dynamic Model (MADYMO) is developed to simulate motor vehicle crash situations and analyze tissue injuries of the occupants based multibody dynamic theories. Joint kinetics output from an inverse model were perturbed and input to the forward model to examine the effects of changes in the internal sagittal ankle moment on knee and hip kinematics following heel strike. Increasing the internal ankle moment (augmentation, equivalent to gastroc-soleus contraction) produced less pronounced changes in kinematic results at the hip, knee and ankle than decreasing the moment (attenuation, equivalent to gastroc-soleus relaxation). Altering the internal ankle moment produced two distinctly different kinematic curve morphologies at the hip. Decreased internal ankle moments increased hip flexion, peaking at roughly 8% of the gait cycle. Increasing internal ankle moments decreased hip flexion to a lesser degree, and approached normal at the same point in the gait cycle. Increasing the internal ankle moment produced relatively small, well-behaved extension-biased kinematic results at the knee. Decreasing the internal ankle moment produced more substantial changes in knee kinematics towards flexion that increased with perturbation magnitude. Curve morphologies were similar to those at the hip. Immediately following heel strike, kinematic results at the ankle showed movement in the direction of the internal moment perturbation. Increased internal moments resulted in kinematic patterns that rapidly approach normal after initial differences. When the internal ankle moment was decreased, differences from normal were much greater and did not rapidly decrease. This study shows that MADYMO can be successfully applied to accomplish forward dynamic simulations, given kinetic inputs. Future applications include predicting muscle forces and decomposing external kinetics.

The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses.

PubMed

Kerkum, Yvette L; Houdijk, Han; Brehm, Merel-Anne; Buizer, Annemieke I; Kessels, Manon L C; Sterk, Arjan; van den Noort, Josien C; Harlaar, Jaap

2015-09-01

The effectiveness of an Ankle-Foot Orthosis footwear combination (AFO-FC) may be partly dependent on the alignment of the ground reaction force with respect to lower limb joint rotation centers, reflected by joint angles and moments. Adjusting (i.e. tuning) the AFO-FC's properties could affect this alignment, which may be guided by monitoring the Shank-to-Vertical-Angle. This study aimed to investigate whether the Shank-to-Vertical-Angle during walking responds to variations in heel height and footplate stiffness, and if this would reflect changes in joint angles and net moments in healthy adults. Ten subjects walked on an instrumented treadmill and performed six trials while walking with bilateral rigid Ankle-Foot Orthoses. The AFO-FC heel height was increased, aiming to impose a Shank-to-Vertical-Angle of 5°, 11° and 20°, and combined with a flexible or stiff footplate. For each trial, the Shank-to-Vertical-Angle, joint flexion-extension angles and net joint moments of the right leg at midstance were averaged over 25 gait cycles. The Shank-to-Vertical-Angle significantly increased with increasing heel height (p<0.001), resulting in an increase in knee flexion angle and internal knee extensor moment (p<0.001). The stiff footplate reduced the effect of heel height on the internal knee extensor moment (p=0.030), while the internal ankle plantar flexion moment increased (p=0.035). Effects of heel height and footplate stiffness on the hip joint were limited. Our results support the potential to use the Shank-to-Vertical-Angle as a parameter to evaluate AFO-FC tuning, as it is responsive to changes in heel height and reflects concomitant changes in the lower limb angles and moments. Copyright © 2015 Elsevier B.V. All rights reserved.

Electromyography-controlled exoskeletal upper-limb-powered orthosis for exercise training after stroke.

PubMed

Stein, Joel; Narendran, Kailas; McBean, John; Krebs, Kathryn; Hughes, Richard

2007-04-01

Robot-assisted exercise shows promise as a means of providing exercise therapy for weakness that results from stroke or other neurological conditions. Exoskeletal or "wearable" robots can, in principle, provide therapeutic exercise and/or function as powered orthoses to help compensate for chronic weakness. We describe a novel electromyography (EMG)-controlled exoskeletal robotic brace for the elbow (the active joint brace) and the results of a pilot study conducted using this brace for exercise training in individuals with chronic hemiparesis after stroke. Eight stroke survivors with severe chronic hemiparesis were enrolled in this pilot study. One subject withdrew from the study because of scheduling conflicts. A second subject was unable to participate in the training protocol because of insufficient surface EMG activity to control the active joint brace. The six remaining subjects each underwent 18 hrs of exercise training using the device for a period of 6 wks. Outcome measures included the upper-extremity component of the Fugl-Meyer scale and the modified Ashworth scale of muscle hypertonicity. Analysis revealed that the mean upper-extremity component of the Fugl-Meyer scale increased from 15.5 (SD 3.88) to 19 (SD 3.95) (P = 0.04) at the conclusion of training for the six subjects who completed training. Combined (summated) modified Ashworth scale for the elbow flexors and extensors improved from 4.67 (+/-1.2 SD) to 2.33 (+/-0.653 SD) (P = 0.009) and improved for the entire upper limb as well. All subjects tolerated the device, and no complications occurred. EMG-controlled powered elbow orthoses can be successfully controlled by severely impaired hemiparetic stroke survivors. This technique shows promise as a new modality for assisted exercise training after stroke.

Development and evaluation of a study design typology for human research.

PubMed

Carini, Simona; Pollock, Brad H; Lehmann, Harold P; Bakken, Suzanne; Barbour, Edward M; Gabriel, Davera; Hagler, Herbert K; Harper, Caryn R; Mollah, Shamim A; Nahm, Meredith; Nguyen, Hien H; Scheuermann, Richard H; Sim, Ida

2009-11-14

A systematic classification of study designs would be useful for researchers, systematic reviewers, readers, and research administrators, among others. As part of the Human Studies Database Project, we developed the Study Design Typology to standardize the classification of study designs in human research. We then performed a multiple observer masked evaluation of active research protocols in four institutions according to a standardized protocol. Thirty-five protocols were classified by three reviewers each into one of nine high-level study designs for interventional and observational research (e.g., N-of-1, Parallel Group, Case Crossover). Rater classification agreement was moderately high for the 35 protocols (Fleiss' kappa = 0.442) and higher still for the 23 quantitative studies (Fleiss' kappa = 0.463). We conclude that our typology shows initial promise for reliably distinguishing study design types for quantitative human research.

C-fuzzy variable-branch decision tree with storage and classification error rate constraints

NASA Astrophysics Data System (ADS)

Yang, Shiueng-Bien

2009-10-01

The C-fuzzy decision tree (CFDT), which is based on the fuzzy C-means algorithm, has recently been proposed. The CFDT is grown by selecting the nodes to be split according to its classification error rate. However, the CFDT design does not consider the classification time taken to classify the input vector. Thus, the CFDT can be improved. We propose a new C-fuzzy variable-branch decision tree (CFVBDT) with storage and classification error rate constraints. The design of the CFVBDT consists of two phases-growing and pruning. The CFVBDT is grown by selecting the nodes to be split according to the classification error rate and the classification time in the decision tree. Additionally, the pruning method selects the nodes to prune based on the storage requirement and the classification time of the CFVBDT. Furthermore, the number of branches of each internal node is variable in the CFVBDT. Experimental results indicate that the proposed CFVBDT outperforms the CFDT and other methods.

32 CFR 2001.12 - Duration of classification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... classification authority shall follow the sequence listed in paragraphs (a)(1)(i), (ii), and (iii) of this... to the sequence in paragraph (a)(1) of this section are as follows: (i) If an original classification... and shall be designated with the following marking, “50X1-HUM;” or (ii) If an original classification...

32 CFR 2001.12 - Duration of classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... classification authority shall follow the sequence listed in paragraphs (a)(1)(i), (ii), and (iii) of this... to the sequence in paragraph (a)(1) of this section are as follows: (i) If an original classification... and shall be designated with the following marking, “50X1-HUM;” or (ii) If an original classification...

Optical Neural Classification Of Binary Patterns

NASA Astrophysics Data System (ADS)

Gustafson, Steven C.; Little, Gordon R.

1988-05-01

Binary pattern classification that may be implemented using optical hardware and neural network algorithms is considered. Pattern classification problems that have no concise description (as in classifying handwritten characters) or no concise computation (as in NP-complete problems) are expected to be particularly amenable to this approach. For example, optical processors that efficiently classify binary patterns in accordance with their Boolean function complexity might be designed. As a candidate for such a design, an optical neural network model is discussed that is designed for binary pattern classification and that consists of an optical resonator with a dynamic multiplex-recorded reflection hologram and a phase conjugate mirror with thresholding and gain. In this model, learning or training examples of binary patterns may be recorded on the hologram such that one bit in each pattern marks the pattern class. Any input pattern, including one with an unknown class or marker bit, will be modified by a large number of parallel interactions with the reflection hologram and nonlinear mirror. After perhaps several seconds and 100 billion interactions, a steady-state pattern may develop with a marker bit that represents a minimum-Boolean-complexity classification of the input pattern. Computer simulations are presented that illustrate progress in understanding the behavior of this model and in developing a processor design that could have commanding and enduring performance advantages compared to current pattern classification techniques.

Partial Least Squares with Structured Output for Modelling the Metabolomics Data Obtained from Complex Experimental Designs: A Study into the Y-Block Coding.

PubMed

Xu, Yun; Muhamadali, Howbeer; Sayqal, Ali; Dixon, Neil; Goodacre, Royston

2016-10-28

Partial least squares (PLS) is one of the most commonly used supervised modelling approaches for analysing multivariate metabolomics data. PLS is typically employed as either a regression model (PLS-R) or a classification model (PLS-DA). However, in metabolomics studies it is common to investigate multiple, potentially interacting, factors simultaneously following a specific experimental design. Such data often cannot be considered as a "pure" regression or a classification problem. Nevertheless, these data have often still been treated as a regression or classification problem and this could lead to ambiguous results. In this study, we investigated the feasibility of designing a hybrid target matrix Y that better reflects the experimental design than simple regression or binary class membership coding commonly used in PLS modelling. The new design of Y coding was based on the same principle used by structural modelling in machine learning techniques. Two real metabolomics datasets were used as examples to illustrate how the new Y coding can improve the interpretability of the PLS model compared to classic regression/classification coding.

14 CFR 1203.800 - Delegations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... paragraph (b)(3) of the section are authorized to declassify top Secret security classification assignments... which NASA has original classification authority. (b) Designated officials—(1) TOP SECRET Classification... this section. (3) Declassification Authority, Top Secret Assignments over 25 years Old. (i) Agency...

Termination Criteria for Computerized Classification Testing

ERIC Educational Resources Information Center

Thompson, Nathan A.

2011-01-01

Computerized classification testing (CCT) is an approach to designing tests with intelligent algorithms, similar to adaptive testing, but specifically designed for the purpose of classifying examinees into categories such as "pass" and "fail." Like adaptive testing for point estimation of ability, the key component is the…

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial

PubMed Central

Spink, Martin J; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R

2011-01-01

Objective To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Design Parallel group randomised controlled trial. Setting University health sciences clinic in Melbourne, Australia. Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months’ follow-up. Interventions Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Main outcome measures Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Results Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). Conclusions A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392. PMID:21680622

Field sampling and data analysis methods for development of ecological land classifications: an application on the Manistee National Forest.

Treesearch

George E. Host; Carl W. Ramm; Eunice A. Padley; Kurt S. Pregitzer; James B. Hart; David T. Cleland

1992-01-01

Presents technical documentation for development of an Ecological Classification System for the Manistee National Forest in northwest Lower Michigan, and suggests procedures applicable to other ecological land classification projects. Includes discussion of sampling design, field data collection, data summarization and analyses, development of classification units,...

77 FR 30087 - Air Quality Designations for the 2008 Ozone National Ambient Air Quality Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-21

...This rule establishes initial air quality designations for most areas in the United States, including areas of Indian country, for the 2008 primary and secondary national ambient air quality standards (NAAQS) for ozone. The designations for several counties in Illinois, Indiana, and Wisconsin that the EPA is considering for inclusion in the Chicago nonattainment area will be designated in a subsequent action, no later than May 31, 2012. Areas designated as nonattainment are also being classified by operation of law according to the severity of their air quality problems. The classification categories are Marginal, Moderate, Serious, Severe, and Extreme. The EPA is establishing the air quality thresholds that define the classifications in a separate rule that the EPA is signing and publishing in the Federal Register on the same schedule as these designations. In accordance with that separate rule, six nonattainment areas in California are being reclassified to a higher classification.

Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review.

PubMed

Takasaki, Hiroshi; Okuyama, Kousuke; Rosedale, Richard

2017-02-01

Mechanical Diagnosis and Therapy (MDT) is used in the treatment of extremity problems. Classifying clinical problems is one method of providing effective treatment to a target population. Classification reliability is a key factor to determine the precise clinical problem and to direct an appropriate intervention. To explore inter-examiner reliability of the MDT classification for extremity problems in three reliability designs: 1) vignette reliability using surveys with patient vignettes, 2) concurrent reliability, where multiple assessors decide a classification by observing someone's assessment, 3) successive reliability, where multiple assessors independently assess the same patient at different times. Systematic review with data synthesis in a quantitative format. Agreement of MDT subgroups was examined using the Kappa value, with the operational definition of acceptable reliability set at ≥ 0.6. The level of evidence was determined considering the methodological quality of the studies. Six studies were included and all studies met the criteria for high quality. Kappa values for the vignette reliability design (five studies) were ≥ 0.7. There was data from two cohorts in one study for the concurrent reliability design and the Kappa values ranged from 0.45 to 1.0. Kappa values for the successive reliability design (data from three cohorts in one study) were < 0.6. The current review found strong evidence of acceptable inter-examiner reliability of MDT classification for extremity problems in the vignette reliability design, limited evidence of acceptable reliability in the concurrent reliability design and unacceptable reliability in the successive reliability design. Copyright © 2017 Elsevier Ltd. All rights reserved.

From landscape to domain: Soils role in landscape classifications

USDA-ARS?s Scientific Manuscript database

Soil landscape classifications are designed to divide landscapes into units with significance for the provisioning and regulating of ecosystem services and the development of conservation plans for natural resources. More specifically, such classifications serve as the basis for stratifying manageme...

A Powered Lower Limb Orthosis for Providing Legged Mobility in Paraplegic Individuals

PubMed Central

Quintero, Hugo A.; Farris, Ryan J.; Hartigan, Clare; Clesson, Ismari; Goldfarb, Michael

2012-01-01

This paper presents preliminary results on the development of a powered lower limb orthosis intended to provide legged mobility (with the use of a stability aid, such as forearm crutches) to paraplegic individuals. The orthosis contains electric motors at both hip and both knee joints, which in conjunction with ankle-foot orthoses, provides appropriate joint kinematics for legged locomotion. The paper describes the orthosis and the nature of the controller that enables the SCI patient to command the device, and presents data from preliminary trials that indicate the efficacy of the orthosis and controller in providing legged mobility. PMID:22707874

An Annotated Bibliography on Operator Mental Workload Assessment

DTIC Science & Technology

1980-03-26

The descriptors associated with each citation designate the general workload classification, the specific workload classification, tue type of...systems, with all of their advanced sen3ors and avionics, must be compatible with the capabilities and limitations of the aircrew. During the design ...constructs or models was included only if mental workload was at least potentially assessable from the constructs or models. C. Experimental design . A

49 CFR 1248.100 - Commodity classification designated.

Code of Federal Regulations, 2010 CFR

2010-10-01

... STATISTICS Commodity Code § 1248.100 Commodity classification designated. Commencing with reports for the..., reports of commodity statistics required to be made to the Board, shall be based on the commodity codes... Statistics, 1963, issued by the Bureau of the Budget, and on additional codes 411 through 462 shown in § 1248...

Differences in forest area classification based on tree tally from variable- and fixed-radius plots

Treesearch

David Azuma; Vicente J. Monleon

2011-01-01

In forest inventory, it is not enough to formulate a definition; it is also necessary to define the "measurement procedure." In the classification of forestland by dominant cover type, the measurement design (the plot) can affect the outcome of the classification. We present results of a simulation study comparing classification of the dominant cover type...

A cautionary note on the use of the Analysis of Covariance (ANCOVA) in classification designs with and without within-subject factors

PubMed Central

Schneider, Bruce A.; Avivi-Reich, Meital; Mozuraitis, Mindaugas

2015-01-01

A number of statistical textbooks recommend using an analysis of covariance (ANCOVA) to control for the effects of extraneous factors that might influence the dependent measure of interest. However, it is not generally recognized that serious problems of interpretation can arise when the design contains comparisons of participants sampled from different populations (classification designs). Designs that include a comparison of younger and older adults, or a comparison of musicians and non-musicians are examples of classification designs. In such cases, estimates of differences among groups can be contaminated by differences in the covariate population means across groups. A second problem of interpretation will arise if the experimenter fails to center the covariate measures (subtracting the mean covariate score from each covariate score) whenever the design contains within-subject factors. Unless the covariate measures on the participants are centered, estimates of within-subject factors are distorted, and significant increases in Type I error rates, and/or losses in power can occur when evaluating the effects of within-subject factors. This paper: (1) alerts potential users of ANCOVA of the need to center the covariate measures when the design contains within-subject factors, and (2) indicates how they can avoid biases when one cannot assume that the expected value of the covariate measure is the same for all of the groups in a classification design. PMID:25954230

Reduction from cost-sensitive ordinal ranking to weighted binary classification.

PubMed

Lin, Hsuan-Tien; Li, Ling

2012-05-01

We present a reduction framework from ordinal ranking to binary classification. The framework consists of three steps: extracting extended examples from the original examples, learning a binary classifier on the extended examples with any binary classification algorithm, and constructing a ranker from the binary classifier. Based on the framework, we show that a weighted 0/1 loss of the binary classifier upper-bounds the mislabeling cost of the ranker, both error-wise and regret-wise. Our framework allows not only the design of good ordinal ranking algorithms based on well-tuned binary classification approaches, but also the derivation of new generalization bounds for ordinal ranking from known bounds for binary classification. In addition, our framework unifies many existing ordinal ranking algorithms, such as perceptron ranking and support vector ordinal regression. When compared empirically on benchmark data sets, some of our newly designed algorithms enjoy advantages in terms of both training speed and generalization performance over existing algorithms. In addition, the newly designed algorithms lead to better cost-sensitive ordinal ranking performance, as well as improved listwise ranking performance.

Predictive control of intersegmental tarsal movements in an insect.

PubMed

Costalago-Meruelo, Alicia; Simpson, David M; Veres, Sandor M; Newland, Philip L

2017-08-01

In many animals intersegmental reflexes are important for postural and movement control but are still poorly undesrtood. Mathematical methods can be used to model the responses to stimulation, and thus go beyond a simple description of responses to specific inputs. Here we analyse an intersegmental reflex of the foot (tarsus) of the locust hind leg, which raises the tarsus when the tibia is flexed and depresses it when the tibia is extended. A novel method is described to measure and quantify the intersegmental responses of the tarsus to a stimulus to the femoro-tibial chordotonal organ. An Artificial Neural Network, the Time Delay Neural Network, was applied to understand the properties and dynamics of the reflex responses. The aim of this study was twofold: first to develop an accurate method to record and analyse the movement of an appendage and second, to apply methods to model the responses using Artificial Neural Networks. The results show that Artificial Neural Networks provide accurate predictions of tarsal movement when trained with an average reflex response to Gaussian White Noise stimulation compared to linear models. Furthermore, the Artificial Neural Network model can predict the individual responses of each animal and responses to others inputs such as a sinusoid. A detailed understanding of such a reflex response could be included in the design of orthoses or functional electrical stimulation treatments to improve walking in patients with neurological disorders as well as the bio/inspired design of robots.

Designing and Implementation of River Classification Assistant Management System

NASA Astrophysics Data System (ADS)

Zhao, Yinjun; Jiang, Wenyuan; Yang, Rujun; Yang, Nan; Liu, Haiyan

2018-03-01

In an earlier publication, we proposed a new Decision Classifier (DCF) for Chinese river classification based on their structures. To expand, enhance and promote the application of the DCF, we build a computer system to support river classification named River Classification Assistant Management System. Based on ArcEngine and ArcServer platform, this system implements many functions such as data management, extraction of river network, river classification, and results publication under combining Client / Server with Browser / Server framework.

VizieR Online Data Catalog: LAMOST-Kepler MKCLASS spectral classification (Gray+, 2016)

NASA Astrophysics Data System (ADS)

Gray, R. O.; Corbally, C. J.; De Cat, P.; Fu, J. N.; Ren, A. B.; Shi, J. R.; Luo, A. L.; Zhang, H. T.; Wu, Y.; Cao, Z.; Li, G.; Zhang, Y.; Hou, Y.; Wang, Y.

2016-07-01

The data for the LAMOST-Kepler project are supplied by the Large Sky Area Multi Object Fiber Spectroscopic Telescope (LAMOST, also known as the Guo Shou Jing Telescope). This unique astronomical instrument is located at the Xinglong observatory in China, and combines a large aperture (4 m) telescope with a 5° circular field of view (Wang et al. 1996ApOpt..35.5155W). Our role in this project is to supply accurate two-dimensional spectral types for the observed targets. The large number of spectra obtained for this project (101086) makes traditional visual classification techniques impractical, so we have utilized the MKCLASS code to perform these classifications. The MKCLASS code (Gray & Corbally 2014AJ....147...80G, v1.07 http://www.appstate.edu/~grayro/mkclass/), an expert system designed to classify blue-violet spectra on the MK Classification system, was employed to produce the spectral classifications reported in this paper. MKCLASS was designed to reproduce the steps skilled human classifiers employ in the classification process. (2 data files).

How well do the rosgen classification and associated "natural channel design" methods integrate and quantify fluvial processes and channel response?

USGS Publications Warehouse

Simon, A.; Doyle, M.; Kondolf, M.; Shields, F.D.; Rhoads, B.; Grant, G.; Fitzpatrick, F.; Juracek, K.; McPhillips, M.; MacBroom, J.

2005-01-01

Over the past 10 years the Rosgen classification system and its associated methods of "natural channel design" have become synonymous (to many without prior knowledge of the field) with the term "stream restoration" and the science of fluvial geomorphology. Since the mid 1990s, this classification approach has become widely, and perhaps dominantly adopted by governmental agencies, particularly those funding restoration projects. For example, in a request for proposals for the restoration of Trout Creek in Montana, the Natural Resources Conservation Service required "experience in the use and application of a stream classification system and its implementation." Similarly, classification systems have been used in evaluation guides for riparian areas and U.S. Forest Service management plans. Most notably, many highly trained geomorphologists and hydraulic engineers are often held suspect, or even thought incorrect, if their approach does not include reference to or application of a classification system. This, combined with the para-professional training provided by some involved in "natural channel design" empower individuals and groups with limited backgrounds in stream and watershed sciences to engineer wholesale re-patterning of stream reaches using 50-year old technology that was never intended for engineering design. At Level I, the Rosgen classification system consists of eight or nine major stream types, based on hydraulic-geometry relations and four other measures of channel shape to distinguish the dimensions of alluvial stream channels as a function of the bankfull stage. Six classes of the particle size of the boundary sediments are used to further sub-divide each of the major stream types, resulting in 48 or 54 stream types. Aside from the difficulty in identifying bankfull stage, particularly in incising channels, and the issue of sampling from two distinct populations (beds and banks) to classify the boundary sediments, the classification provides a consistent and reproducible means for practitioners to describe channel morphology although difficulties have been encountered in lower-gradient stream systems. Use of the scheme to communicate between users or as a conceptual model, however, has not justified its use for engineering design or for predicting river behavior; its use for designing mitigation projects, therefore, seems beyond its technical scope. Copyright ASCE 2005.

Discrete Event Simulation for the Analysis of Artillery Fired Projectiles from Shore

DTIC Science & Technology

2017-06-01

a designed experiment indicate artillery systems provide commanders a limited area denial capability, and should be employed where naval forces are... Design 15. NUMBER OF PAGES 85 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY CLASSIFICATION OF THIS PAGE Unclassified 19...to deny freedom of navigation (area denial) and stop an amphibious naval convoy (anti-access). Results from a designed experiment indicate artillery

Corps of Engineers Hydraulic Design Criteria. Volume I

DTIC Science & Technology

1977-01-01

DESIGN CRITERIA CLASSIFICATION INDEX S000-GENERAL 000 Physical Constants 001 Fluid Properties 010 Open Channel Flow 020 Free Overflow 030 Pressure Flow...Dissipation 113 Erosion below Spillways 120 Chute Spillways 121 Approach Channel 122 Ogee Crests 123 Spillay Chutes S ii124 Spillway Stilling Basins 125...Spillvay Exit Channel Revised 5-59 .. . j1.I.i edCORPS OF ENGINEERS HYDRAULIC DESIGN CRITERIA CLASSIFICATION INDEX (Continued) %. IO0-SPILLWAYS

Testing a tool for the classification of study designs in systematic reviews of interventions and exposures showed moderate reliability and low accuracy.

PubMed

Hartling, Lisa; Bond, Kenneth; Santaguida, P Lina; Viswanathan, Meera; Dryden, Donna M

2011-08-01

To develop and test a study design classification tool. We contacted relevant organizations and individuals to identify tools used to classify study designs and ranked these using predefined criteria. The highest ranked tool was a design algorithm developed, but no longer advocated, by the Cochrane Non-Randomized Studies Methods Group; this was modified to include additional study designs and decision points. We developed a reference classification for 30 studies; 6 testers applied the tool to these studies. Interrater reliability (Fleiss' κ) and accuracy against the reference classification were assessed. The tool was further revised and retested. Initial reliability was fair among the testers (κ=0.26) and the reference standard raters κ=0.33). Testing after revisions showed improved reliability (κ=0.45, moderate agreement) with improved, but still low, accuracy. The most common disagreements were whether the study design was experimental (5 of 15 studies), and whether there was a comparison of any kind (4 of 15 studies). Agreement was higher among testers who had completed graduate level training versus those who had not. The moderate reliability and low accuracy may be because of lack of clarity and comprehensiveness of the tool, inadequate reporting of the studies, and variability in tester characteristics. The results may not be generalizable to all published studies, as the test studies were selected because they had posed challenges for previous reviewers with respect to their design classification. Application of such a tool should be accompanied by training, pilot testing, and context-specific decision rules. Copyright © 2011 Elsevier Inc. All rights reserved.

46 CFR 108.109 - Classification society standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Classification society standards. 108.109 Section 108.109 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT General § 108.109 Classification society standards. (a) Any person who desires to...

46 CFR 108.109 - Classification society standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Classification society standards. 108.109 Section 108.109 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT General § 108.109 Classification society standards. (a) Any person who desires to...

46 CFR 108.109 - Classification society standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Classification society standards. 108.109 Section 108.109 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT General § 108.109 Classification society standards. (a) Any person who desires to...

46 CFR 108.109 - Classification society standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Classification society standards. 108.109 Section 108.109 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT General § 108.109 Classification society standards. (a) Any person who desires to...

46 CFR 108.109 - Classification society standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Classification society standards. 108.109 Section 108.109 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT General § 108.109 Classification society standards. (a) Any person who desires to...

Evaluation of change detection techniques for monitoring coastal zone environments

NASA Technical Reports Server (NTRS)

Weismiller, R. A. (Principal Investigator); Kristof, S. J.; Scholz, D. K.; Anuta, P. E.; Momin, S. M.

1977-01-01

The author has identified the following significant results. Four change detection techniques were designed and implemented for evaluation: (1) post classification comparison change detection, (2) delta data change detection, (3) spectral/temporal change classification, and (4) layered spectral/temporal change classification. The post classification comparison technique reliably identified areas of change and was used as the standard for qualitatively evaluating the other three techniques. The layered spectral/temporal change classification and the delta data change detection results generally agreed with the post classification comparison technique results; however, many small areas of change were not identified. Major discrepancies existed between the post classification comparison and spectral/temporal change detection results.

75 FR 33169 - Dental Devices: Classification of Dental Amalgam, Reclassification of Dental Mercury, Designation...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

.... FDA-2008-N-0163] (formerly Docket No. 2001N-0067) RIN 0910-AG21 Dental Devices: Classification of Dental Amalgam, Reclassification of Dental Mercury, Designation of Special Controls for Dental Amalgam... the Federal Register of August 4, 2009 (74 FR 38686) which classified dental amalgam as a class II...

An automated approach to the design of decision tree classifiers

NASA Technical Reports Server (NTRS)

Argentiero, P.; Chin, P.; Beaudet, P.

1980-01-01

The classification of large dimensional data sets arising from the merging of remote sensing data with more traditional forms of ancillary data is considered. Decision tree classification, a popular approach to the problem, is characterized by the property that samples are subjected to a sequence of decision rules before they are assigned to a unique class. An automated technique for effective decision tree design which relies only on apriori statistics is presented. This procedure utilizes a set of two dimensional canonical transforms and Bayes table look-up decision rules. An optimal design at each node is derived based on the associated decision table. A procedure for computing the global probability of correct classfication is also provided. An example is given in which class statistics obtained from an actual LANDSAT scene are used as input to the program. The resulting decision tree design has an associated probability of correct classification of .76 compared to the theoretically optimum .79 probability of correct classification associated with a full dimensional Bayes classifier. Recommendations for future research are included.

New tools for evaluating LQAS survey designs

PubMed Central

2014-01-01

Lot Quality Assurance Sampling (LQAS) surveys have become increasingly popular in global health care applications. Incorporating Bayesian ideas into LQAS survey design, such as using reasonable prior beliefs about the distribution of an indicator, can improve the selection of design parameters and decision rules. In this paper, a joint frequentist and Bayesian framework is proposed for evaluating LQAS classification accuracy and informing survey design parameters. Simple software tools are provided for calculating the positive and negative predictive value of a design with respect to an underlying coverage distribution and the selected design parameters. These tools are illustrated using a data example from two consecutive LQAS surveys measuring Oral Rehydration Solution (ORS) preparation. Using the survey tools, the dependence of classification accuracy on benchmark selection and the width of the ‘grey region’ are clarified in the context of ORS preparation across seven supervision areas. Following the completion of an LQAS survey, estimation of the distribution of coverage across areas facilitates quantifying classification accuracy and can help guide intervention decisions. PMID:24528928

New tools for evaluating LQAS survey designs.

PubMed

Hund, Lauren

2014-02-15

Lot Quality Assurance Sampling (LQAS) surveys have become increasingly popular in global health care applications. Incorporating Bayesian ideas into LQAS survey design, such as using reasonable prior beliefs about the distribution of an indicator, can improve the selection of design parameters and decision rules. In this paper, a joint frequentist and Bayesian framework is proposed for evaluating LQAS classification accuracy and informing survey design parameters. Simple software tools are provided for calculating the positive and negative predictive value of a design with respect to an underlying coverage distribution and the selected design parameters. These tools are illustrated using a data example from two consecutive LQAS surveys measuring Oral Rehydration Solution (ORS) preparation. Using the survey tools, the dependence of classification accuracy on benchmark selection and the width of the 'grey region' are clarified in the context of ORS preparation across seven supervision areas. Following the completion of an LQAS survey, estimation of the distribution of coverage across areas facilitates quantifying classification accuracy and can help guide intervention decisions.

Library Classification 2020

ERIC Educational Resources Information Center

Harris, Christopher

2013-01-01

In this article the author explores how a new library classification system might be designed using some aspects of the Dewey Decimal Classification (DDC) and ideas from other systems to create something that works for school libraries in the year 2020. By examining what works well with the Dewey Decimal System, what features should be carried…

The Alaska vegetation classification.

Treesearch

L.A. Viereck; C.T. Dyrness; A.R. Batten; K.J. Wenzlick

1992-01-01

The Alaska vegetation classification presented here is a comprehensive, statewide system that has been under development since 1976. The classification is based, as much as possible, on the characteristics of the vegetation itself and is designed to categorize existing vegetation, not potential vegetation. A hierarchical system with five levels of resolution is used...

Estimation of Quasi-Stiffness and Propulsive Work of the Human Ankle in the Stance Phase of Walking

PubMed Central

Shamaei, Kamran; Sawicki, Gregory S.; Dollar, Aaron M.

2013-01-01

Characterizing the quasi-stiffness and work of lower extremity joints is critical for evaluating human locomotion and designing assistive devices such as prostheses and orthoses intended to emulate the biological behavior of human legs. This work aims to establish statistical models that allow us to predict the ankle quasi-stiffness and net mechanical work for adults walking on level ground. During the stance phase of walking, the ankle joint propels the body through three distinctive phases of nearly constant stiffness known as the quasi-stiffness of each phase. Using a generic equation for the ankle moment obtained through an inverse dynamics analysis, we identify key independent parameters needed to predict ankle quasi-stiffness and propulsive work and also the functional form of each correlation. These parameters include gait speed, ankle excursion, and subject height and weight. Based on the identified form of the correlation and key variables, we applied linear regression on experimental walking data for 216 gait trials across 26 subjects (speeds from 0.75–2.63 m/s) to obtain statistical models of varying complexity. The most general forms of the statistical models include all the key parameters and have an R2 of 75% to 81% in the prediction of the ankle quasi-stiffnesses and propulsive work. The most specific models include only subject height and weight and could predict the ankle quasi-stiffnesses and work for optimal walking speed with average error of 13% to 30%. We discuss how these models provide a useful framework and foundation for designing subject- and gait-specific prosthetic and exoskeletal devices designed to emulate biological ankle function during level ground walking. PMID:23555839

Geomorphic Classification and Assessment of Channel Dynamics in the Missouri National Recreational River, South Dakota and Nebraska

USGS Publications Warehouse

Elliott, Caroline M.; Jacobson, Robert B.

2006-01-01

A multiscale geomorphic classification was established for the 39-mile, 59-mile, and adjacent segments of the Missouri National Recreational River administered by the National Park Service in South Dakota and Nebraska. The objective of the classification was to define naturally occurring clusters of geomorphic characteristics that would be indicative of discrete sets of geomorphic processes, with the intent that such a classification would be useful in river-management and rehabilitation decisions. The statistical classification was based on geomorphic characteristics of the river collected from 1999 orthophotography and the persistence of classified units was evaluated by comparison with similar datasets for 2003 and 2004 and by evaluating variation of bank erosion rates by geomorphic class. Changes in channel location and form were also explored using imagery and maps from 1993-2004, 1941 and 1894. The multivariate classification identified a hierarchy of naturally occurring clusters of reach-scale geomorphic characteristics. The simplest level of the hierarchy divides the river from segments into discrete reaches characterized by single and multithread channels and additional hierarchical levels established 4-part and 10-part classifications. The classification system presents a physical framework that can be applied to prioritization and design of bank stabilization projects, design of habitat rehabilitation projects, and stratification of monitoring and assessment sampling programs.

Spectral-spatial classification of hyperspectral imagery with cooperative game

NASA Astrophysics Data System (ADS)

Zhao, Ji; Zhong, Yanfei; Jia, Tianyi; Wang, Xinyu; Xu, Yao; Shu, Hong; Zhang, Liangpei

2018-01-01

Spectral-spatial classification is known to be an effective way to improve classification performance by integrating spectral information and spatial cues for hyperspectral imagery. In this paper, a game-theoretic spectral-spatial classification algorithm (GTA) using a conditional random field (CRF) model is presented, in which CRF is used to model the image considering the spatial contextual information, and a cooperative game is designed to obtain the labels. The algorithm establishes a one-to-one correspondence between image classification and game theory. The pixels of the image are considered as the players, and the labels are considered as the strategies in a game. Similar to the idea of soft classification, the uncertainty is considered to build the expected energy model in the first step. The local expected energy can be quickly calculated, based on a mixed strategy for the pixels, to establish the foundation for a cooperative game. Coalitions can then be formed by the designed merge rule based on the local expected energy, so that a majority game can be performed to make a coalition decision to obtain the label of each pixel. The experimental results on three hyperspectral data sets demonstrate the effectiveness of the proposed classification algorithm.

Classification of Computer-Aided Design-Computer-Aided Manufacturing Applications for the Reconstruction of Cranio-Maxillo-Facial Defects.

PubMed

Wauters, Lauri D J; Miguel-Moragas, Joan San; Mommaerts, Maurice Y

2015-11-01

To gain insight into the methodology of different computer-aided design-computer-aided manufacturing (CAD-CAM) applications for the reconstruction of cranio-maxillo-facial (CMF) defects. We reviewed and analyzed the available literature pertaining to CAD-CAM for use in CMF reconstruction. We proposed a classification system of the techniques of implant and cutting, drilling, and/or guiding template design and manufacturing. The system consisted of 4 classes (I-IV). These classes combine techniques used for both the implant and template to most accurately describe the methodology used. Our classification system can be widely applied. It should facilitate communication and immediate understanding of the methodology of CAD-CAM applications for the reconstruction of CMF defects.

9 CFR 78.41 - State/area classification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE INTERSTATE TRANSPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS BRUCELLOSIS Designation of Brucellosis Areas § 78.41 State/area classification. (a) Class Free. Alabama, Alaska, Arizona...

9 CFR 78.41 - State/area classification.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE INTERSTATE TRANSPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS BRUCELLOSIS Designation of Brucellosis Areas § 78.41 State/area classification. (a) Class Free. Alabama, Alaska, Arizona...

9 CFR 78.41 - State/area classification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE INTERSTATE TRANSPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS BRUCELLOSIS Designation of Brucellosis Areas § 78.41 State/area classification. (a) Class Free. Alabama, Alaska, Arizona...

An Automatic User-Adapted Physical Activity Classification Method Using Smartphones.

PubMed

Li, Pengfei; Wang, Yu; Tian, Yu; Zhou, Tian-Shu; Li, Jing-Song

2017-03-01

In recent years, an increasing number of people have become concerned about their health. Most chronic diseases are related to lifestyle, and daily activity records can be used as an important indicator of health. Specifically, using advanced technology to automatically monitor actual activities can effectively prevent and manage chronic diseases. The data used in this paper were obtained from acceleration sensors and gyroscopes integrated in smartphones. We designed an efficient Adaboost-Stump running on a smartphone to classify five common activities: cycling, running, sitting, standing, and walking and achieved a satisfactory classification accuracy of 98%. We designed an online learning method, and the classification model requires continuous training with actual data. The parameters in the model then become increasingly fitted to the specific user, which allows the classification accuracy to reach 95% under different use environments. In addition, this paper also utilized the OpenCL framework to design the program in parallel. This process can enhance the computing efficiency approximately ninefold.

Treatment of Medial Tibial Stress Syndrome With Radial Soundwave Therapy in Elite Athletes: Current Evidence, Report on Two Cases, and Proposed Treatment Regimen.

PubMed

Saxena, Amol; Fullem, Brian; Gerdesmeyer, Ludger

Two case reports of high-level athletes with medial tibial stress syndrome (MTSS), 1 an Olympian with an actual stress fracture, are presented. Successful treatment included radial soundwave therapy, pneumatic leg braces, relative rest using an antigravity treadmill, and temporary foot orthoses. Radial soundwave therapy has a high level of evidence for treatment of MTSS. We also present recent evidence of the value of vitamin D assessment. Both patients had a successful outcome with minimal downtime. Finally, a suggested treatment regimen for MTSS is presented. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of multidensity orthotic materials used in footwear for patients with diabetes.

PubMed

Foto, J G; Birke, J A

1998-12-01

Selected combinations of multidensity orthotic materials were tested under simulated walking conditions found in the forefoot of diabetic patients. Materials were compared for therapeutic effectiveness by their stress/strain properties and dynamic compression set. Results showed that all of the multidensity materials experienced losses in performance throughout the testing period of 100,000 cycles, with the greatest losses occurring within the first 10,000 cycles. Of the materials tested, Poron + Plastazote #2 and Spenco + Microcel Puff Lite had the highest dynamic material strain and the lowest dynamic compression set over 100,000 cycles. In comparison, these are better multidensity combinations than the others tested to use as therapeutic orthoses in footwear for diabetic patients.

Prostheses and orthoses for the foot and ankle.

PubMed

Rubin, G; Cohen, E

1988-07-01

The general nature and function of the AFO has been presented. These devices encompass the foot and leg crossing the ankle joint. They may insert into the shoe or attach to the shoe. The more recent AFOs are made of polypropylene and were formerly composed of steel. The indications for an AFO are for a basically ambulatory patient with problems walking, including various pathologic gaits especially drop-foot and spastic equinus. Other primary indications include ankle arthritis, Charcot foot, fractures, and post-surgery. Given the basic employment of AFOs to treat problems directly related to the foot, it is hoped that this introduction has stimulated practitioners to begin using this essential tool as an integral component of their practice.

New Prostheses and Orthoses Step Up their Game: Motorized Knees, Robotic Hands, and Exosuits Mark Advances in Rehabilitation Technology.

PubMed

Allen, Summer

2016-01-01

Forty years ago, Les Baugh lost both of his arms in an electrical accident. With bilateral shoulder-level amputations, his options for prosthetic arms were limited. That changed two years ago, when Baugh underwent a surgical procedure at Johns Hopkins Hospital in Baltimore that allowed him to control state-of-the-art robotic arms using nerves that had been rerouted to his chest. Within ten days of training, he was able to control both arms simultaneously and move a cup from a lower shelf to a higher shelf-a task that previously had been impossible-just by thinking about how he wanted to move his arm.

Therapeutic orthosis and electrical stimulation for upper extremity hemiplegia after stroke: a review of effectiveness based on evidence.

PubMed

Aoyagi, Yoichiro; Tsubahara, Akio

2004-01-01

Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.

The Carnegie Classification of Institutions of Higher Education. 2000 Edition. A Technical Report.

ERIC Educational Resources Information Center

Carnegie Foundation for the Advancement of Teaching, Menlo Park, CA.

The Carnegie Classification of Institutions of Higher Education is the framework in which institutional diversity in United States higher education is commonly described. Developed in 1971, the Classification was designed to support research in higher education by identifying categories of colleges and universities that would be homogeneous with…

Variance estimates and confidence intervals for the Kappa measure of classification accuracy

Treesearch

M. A. Kalkhan; R. M. Reich; R. L. Czaplewski

1997-01-01

The Kappa statistic is frequently used to characterize the results of an accuracy assessment used to evaluate land use and land cover classifications obtained by remotely sensed data. This statistic allows comparisons of alternative sampling designs, classification algorithms, photo-interpreters, and so forth. In order to make these comparisons, it is...

Comparative Analysis of RF Emission Based Fingerprinting Techniques for ZigBee Device Classification

DTIC Science & Technology

quantify the differences invarious RF fingerprinting techniques via comparative analysis of MDA/ML classification results. The findings herein demonstrate...correct classification rates followed by COR-DNA and then RF-DNA in most test cases and especially in low Eb/N0 ranges, where ZigBee is designed to operate.

Cognitive Development and Reading: The Relation of Reading-Specific Multiple Classification Skill to Reading Comprehension in Elementary School Children.

ERIC Educational Resources Information Center

Cartwright, Kelly B.

2002-01-01

A reading-specific multiple classification task was designed that required children to classify printed words along phonological and semantic dimensions simultaneously. Reading-specific multiple classification skill made a unique contribution to children's reading comprehension over contributions made by age, domain-general multiple classification…

Linear Classification of Dairy Cattle. Slide Script.

ERIC Educational Resources Information Center

Sipiorski, James; Spike, Peter

This slide script, part of a series of slide scripts designed for use in vocational agriculture classes, deals with principles of the linear classification of dairy cattle. Included in the guide are narrations for use with 63 slides, which illustrate the following areas that are considered in the linear classification system: stature, strength,…

Optimizing spectral CT parameters for material classification tasks

NASA Astrophysics Data System (ADS)

Rigie, D. S.; La Rivière, P. J.

2016-06-01

In this work, we propose a framework for optimizing spectral CT imaging parameters and hardware design with regard to material classification tasks. Compared with conventional CT, many more parameters must be considered when designing spectral CT systems and protocols. These choices will impact material classification performance in a non-obvious, task-dependent way with direct implications for radiation dose reduction. In light of this, we adapt Hotelling Observer formalisms typically applied to signal detection tasks to the spectral CT, material-classification problem. The result is a rapidly computable metric that makes it possible to sweep out many system configurations, generating parameter optimization curves (POC’s) that can be used to select optimal settings. The proposed model avoids restrictive assumptions about the basis-material decomposition (e.g. linearity) and incorporates signal uncertainty with a stochastic object model. This technique is demonstrated on dual-kVp and photon-counting systems for two different, clinically motivated material classification tasks (kidney stone classification and plaque removal). We show that the POC’s predicted with the proposed analytic model agree well with those derived from computationally intensive numerical simulation studies.

Optimizing Spectral CT Parameters for Material Classification Tasks

PubMed Central

Rigie, D. S.; La Rivière, P. J.

2017-01-01

In this work, we propose a framework for optimizing spectral CT imaging parameters and hardware design with regard to material classification tasks. Compared with conventional CT, many more parameters must be considered when designing spectral CT systems and protocols. These choices will impact material classification performance in a non-obvious, task-dependent way with direct implications for radiation dose reduction. In light of this, we adapt Hotelling Observer formalisms typically applied to signal detection tasks to the spectral CT, material-classification problem. The result is a rapidly computable metric that makes it possible to sweep out many system configurations, generating parameter optimization curves (POC’s) that can be used to select optimal settings. The proposed model avoids restrictive assumptions about the basis-material decomposition (e.g. linearity) and incorporates signal uncertainty with a stochastic object model. This technique is demonstrated on dual-kVp and photon-counting systems for two different, clinically motivated material classification tasks (kidney stone classification and plaque removal). We show that the POC’s predicted with the proposed analytic model agree well with those derived from computationally intensive numerical simulation studies. PMID:27227430

77 FR 37346 - Export Control Reform Transition Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... review the appropriate Export Control Classification Number (ECCN) to determine the classification of their item. Licensees who are unsure of the proper ECCN designation may request a Commodity...

Taxonomy of asteroids. [according to polarimetric, spectrophotometric, radiometric, and UBV photometric data

NASA Technical Reports Server (NTRS)

Bowell, E.; Chapman, C. R.; Gradie, J. C.; Zellner, B.; Morrison, D.

1978-01-01

A taxonomic system for asteroids is discussed which is based on seven directly observable parameters from polarimetry, spectrophotometry, radiometry, and UBV photometry. The classification scheme is entirely empirical and independent of specific mineralogical interpretations. Five broad classes (designated C, S, M, E, and R), as well as an 'unclassifiable' designation, are defined on the basis of observational data for 523 asteroids. Computer-generated type classifications and derived diameters are given for the 523 asteroids, and the application of the classification procedure is illustrated. Of the 523 asteroids classified, 190 are identified as C objects, 141 as S type, 13 as type M, three as type E, three as type R, 55 as unclassifiable, and 118 as ambiguous. The present taxonomic system is compared with several other asteroid classification systems.

Balanced VS Imbalanced Training Data: Classifying Rapideye Data with Support Vector Machines

NASA Astrophysics Data System (ADS)

Ustuner, M.; Sanli, F. B.; Abdikan, S.

2016-06-01

The accuracy of supervised image classification is highly dependent upon several factors such as the design of training set (sample selection, composition, purity and size), resolution of input imagery and landscape heterogeneity. The design of training set is still a challenging issue since the sensitivity of classifier algorithm at learning stage is different for the same dataset. In this paper, the classification of RapidEye imagery with balanced and imbalanced training data for mapping the crop types was addressed. Classification with imbalanced training data may result in low accuracy in some scenarios. Support Vector Machines (SVM), Maximum Likelihood (ML) and Artificial Neural Network (ANN) classifications were implemented here to classify the data. For evaluating the influence of the balanced and imbalanced training data on image classification algorithms, three different training datasets were created. Two different balanced datasets which have 70 and 100 pixels for each class of interest and one imbalanced dataset in which each class has different number of pixels were used in classification stage. Results demonstrate that ML and NN classifications are affected by imbalanced training data in resulting a reduction in accuracy (from 90.94% to 85.94% for ML and from 91.56% to 88.44% for NN) while SVM is not affected significantly (from 94.38% to 94.69%) and slightly improved. Our results highlighted that SVM is proven to be a very robust, consistent and effective classifier as it can perform very well under balanced and imbalanced training data situations. Furthermore, the training stage should be precisely and carefully designed for the need of adopted classifier.

Effects of sample survey design on the accuracy of classification tree models in species distribution models

Treesearch

Thomas C. Edwards; D. Richard Cutler; Niklaus E. Zimmermann; Linda Geiser; Gretchen G. Moisen

2006-01-01

We evaluated the effects of probabilistic (hereafter DESIGN) and non-probabilistic (PURPOSIVE) sample surveys on resultant classification tree models for predicting the presence of four lichen species in the Pacific Northwest, USA. Models derived from both survey forms were assessed using an independent data set (EVALUATION). Measures of accuracy as gauged by...

A Classification Model and an Open E-Learning System Based on Intuitionistic Fuzzy Sets for Instructional Design Concepts

ERIC Educational Resources Information Center

Güyer, Tolga; Aydogdu, Seyhmus

2016-01-01

This study suggests a classification model and an e-learning system based on this model for all instructional theories, approaches, models, strategies, methods, and technics being used in the process of instructional design that constitutes a direct or indirect resource for educational technology based on the theory of intuitionistic fuzzy sets…

On validation of the rain climatic zone designations for Nigeria

NASA Astrophysics Data System (ADS)

Obiyemi, O. O.; Ibiyemi, T. S.; Ojo, J. S.

2017-07-01

In this paper, validation of rain climatic zone classifications for Nigeria is presented based on global radio-climatic models by the International Telecommunication Union-Radiocommunication (ITU-R) and Crane. Rain rate estimates deduced from several ground-based measurements and those earlier estimated from the precipitation index on the Tropical Rain Measurement Mission (TRMM) were employed for the validation exercise. Although earlier classifications indicated that Nigeria falls into zones P, Q, N, and K for the ITU-R designations, and zones E and H for Crane's climatic zone designations, the results however confirmed that the rain climatic zones across Nigeria can only be classified into four, namely P, Q, M, and N for the ITU-R designations, while the designations by Crane exhibited only three zones, namely E, G, and H. The ITU-R classification was found to be more suitable for planning microwave and millimeter wave links across Nigeria. The research outcomes are vital in boosting the confidence level of system designers in using the ITU-R designations as presented in the map developed for the rain zone designations for estimating the attenuation induced by rain along satellite and terrestrial microwave links over Nigeria.

Multiple category-lot quality assurance sampling: a new classification system with application to schistosomiasis control.

PubMed

Olives, Casey; Valadez, Joseph J; Brooker, Simon J; Pagano, Marcello

2012-01-01

Originally a binary classifier, Lot Quality Assurance Sampling (LQAS) has proven to be a useful tool for classification of the prevalence of Schistosoma mansoni into multiple categories (≤10%, >10 and <50%, ≥50%), and semi-curtailed sampling has been shown to effectively reduce the number of observations needed to reach a decision. To date the statistical underpinnings for Multiple Category-LQAS (MC-LQAS) have not received full treatment. We explore the analytical properties of MC-LQAS, and validate its use for the classification of S. mansoni prevalence in multiple settings in East Africa. We outline MC-LQAS design principles and formulae for operating characteristic curves. In addition, we derive the average sample number for MC-LQAS when utilizing semi-curtailed sampling and introduce curtailed sampling in this setting. We also assess the performance of MC-LQAS designs with maximum sample sizes of n=15 and n=25 via a weighted kappa-statistic using S. mansoni data collected in 388 schools from four studies in East Africa. Overall performance of MC-LQAS classification was high (kappa-statistic of 0.87). In three of the studies, the kappa-statistic for a design with n=15 was greater than 0.75. In the fourth study, where these designs performed poorly (kappa-statistic less than 0.50), the majority of observations fell in regions where potential error is known to be high. Employment of semi-curtailed and curtailed sampling further reduced the sample size by as many as 0.5 and 3.5 observations per school, respectively, without increasing classification error. This work provides the needed analytics to understand the properties of MC-LQAS for assessing the prevalance of S. mansoni and shows that in most settings a sample size of 15 children provides a reliable classification of schools.

Neural architecture design based on extreme learning machine.

PubMed

Bueno-Crespo, Andrés; García-Laencina, Pedro J; Sancho-Gómez, José-Luis

2013-12-01

Selection of the optimal neural architecture to solve a pattern classification problem entails to choose the relevant input units, the number of hidden neurons and its corresponding interconnection weights. This problem has been widely studied in many research works but their solutions usually involve excessive computational cost in most of the problems and they do not provide a unique solution. This paper proposes a new technique to efficiently design the MultiLayer Perceptron (MLP) architecture for classification using the Extreme Learning Machine (ELM) algorithm. The proposed method provides a high generalization capability and a unique solution for the architecture design. Moreover, the selected final network only retains those input connections that are relevant for the classification task. Experimental results show these advantages. Copyright © 2013 Elsevier Ltd. All rights reserved.

Angle classification revisited 2: a modified Angle classification.

PubMed

Katz, M I

1992-09-01

Edward Angle, in his classification of malocclusions, appears to have made Class I a range of abnormality, not a point of ideal occlusion. Current goals of orthodontic treatment, however, strive for the designation "Class I occlusion" to be synonymous with the point of ideal intermeshing and not a broad range. If contemporary orthodontists are to continue to use Class I as a goal, then it is appropriate that Dr. Angle's century-old classification, be modified to be more precise.

Comparing Linear Discriminant Function with Logistic Regression for the Two-Group Classification Problem.

ERIC Educational Resources Information Center

Fan, Xitao; Wang, Lin

The Monte Carlo study compared the performance of predictive discriminant analysis (PDA) and that of logistic regression (LR) for the two-group classification problem. Prior probabilities were used for classification, but the cost of misclassification was assumed to be equal. The study used a fully crossed three-factor experimental design (with…

A review of classification algorithms for EEG-based brain-computer interfaces.

PubMed

Lotte, F; Congedo, M; Lécuyer, A; Lamarche, F; Arnaldi, B

2007-06-01

In this paper we review classification algorithms used to design brain-computer interface (BCI) systems based on electroencephalography (EEG). We briefly present the commonly employed algorithms and describe their critical properties. Based on the literature, we compare them in terms of performance and provide guidelines to choose the suitable classification algorithm(s) for a specific BCI.

Pattern Recognition of Momentary Mental Workload Based on Multi-Channel Electrophysiological Data and Ensemble Convolutional Neural Networks.

PubMed

Zhang, Jianhua; Li, Sunan; Wang, Rubin

2017-01-01

In this paper, we deal with the Mental Workload (MWL) classification problem based on the measured physiological data. First we discussed the optimal depth (i.e., the number of hidden layers) and parameter optimization algorithms for the Convolutional Neural Networks (CNN). The base CNNs designed were tested according to five classification performance indices, namely Accuracy, Precision, F-measure, G-mean, and required training time. Then we developed an Ensemble Convolutional Neural Network (ECNN) to enhance the accuracy and robustness of the individual CNN model. For the ECNN design, three model aggregation approaches (weighted averaging, majority voting and stacking) were examined and a resampling strategy was used to enhance the diversity of individual CNN models. The results of MWL classification performance comparison indicated that the proposed ECNN framework can effectively improve MWL classification performance and is featured by entirely automatic feature extraction and MWL classification, when compared with traditional machine learning methods.

Orthosis-Shaped Sandals Are as Efficacious as In-Shoe Orthoses and Better than Flat Sandals for Plantar Heel Pain: A Randomized Control Trial

PubMed Central

Vicenzino, Bill; McPoil, Thomas G.; Stephenson, Aoife; Paul, Sanjoy K.

2015-01-01

Objective To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis. Method 150 volunteers aged 50 (SD: 12) years with plantar heel pain (>4 weeks) were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49), flat flip-flops (n = 50) or over the counter, pre-fabricated full-length foot orthotics (n = 51). Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better), 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS) on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty). Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation. Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest. Results The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flip-flop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert. Conclusions and Relevance Physicians can have confidence in supporting a patient's decision to wear contoured sandals or in-shoe orthoses as one of the first and simple strategies to manage their heel pain. Trial Registration The Australian New Zealand Clinical Trials Registry ACTRN12612000463875 PMID:26669302

A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing.

PubMed

Nikamp, Corien D M; Hobbelink, Marte S H; van der Palen, Job; Hermens, Hermie J; Rietman, Johan S; Buurke, Jaap H

2017-06-01

Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (-3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and -6.1° (7.8) vs 2.6° (3.5), respectively), all p<0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p≤0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p=0.026), stride duration (-0.08s, p=0.015) and single support duration (+1.0%, p=0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. NTR1930. Copyright © 2017 Elsevier B.V. All rights reserved.

The influence of thermoplastic thoraco lumbo sacral orthoses on standing balance in subjects with idiopathic scoliosis.

PubMed

Khanal, Minoo; Arazpour, Mokhtar; Bahramizadeh, Mahmood; Samadian, Mohammad; Hutchins, Stephen W; Kashani, Reza Vahab; Mardani, Mohammad A; Tari, Hossein Vahid; Aboutorabi, Atefeh; Curran, Sarah; Sadeghi, Heidar

2016-08-01

Idiopathic scoliosis patients have postural equilibrium problems. The objective of this study was to assess postural control in subjects with idiopathic scoliosis following a 4-month intervention in an unbraced position. Quasi-experimental. Eight healthy girls and eight girls with idiopathic scoliosis took part. A Kistler force platform was used with a frequency of 100 Hz for recording data. The center of pressure was recorded in different positions out of brace for scoliosis and healthy subjects. Test conditions were single limb and double limb stance, with eyes open and closed, and foam and rigid surfaces. The data reflected a weak balance of idiopathic scoliosis subjects compared to healthy subjects. After 1 and 4 months of wearing the brace, center of pressure and center of gravity sway increased in the majority of the tests, although there were no significant differences in any of the test conditions (p > 0.05). While the center of pressure sway in medio-lateral direction decreased after 4 months of wearing a brace, in other variables center of pressure and center of gravity sway increased. Idiopathic scoliosis patients have weak balance in comparison to healthy subjects. In addition, following a period of 4 months of wearing a brace, balance parameters in the scoliosis subjects did not improve. The results show that we need more follow-up of orthoses wearing in idiopathic scoliosis subjects and suggest more studies at least 1-year follow-up to identify the efficiency of brace wear on balance. Scoliosis can alter postural stability and balance performance during quiet standing. Spinal deformity can alter a subject's ability to compensate for postural changes and cause gait deviations. This study investigated balance differences between the healthy and idiopathic scoliosis patients and the results of thoraco lumbo sacral orthosis brace wear. It might provide some new insight into the conservative treatment of idiopathic scoliosis patients for clinicians and researchers. © The International Society for Prosthetics and Orthotics 2015.

Post-Polio Syndrome and Risk Factors in Korean Polio Survivors: A Baseline Survey by Telephone Interview

PubMed Central

Bang, Hyun; Suh, Jee Hyun; Lee, Seung Yeol; Kim, Keewon; Yang, Eun Joo; Jung, Se Hee; Jang, Soong-Nang; Han, Soo Jeong; Kim, Wan-Ho; Oh, Min-Gyun; Kim, Jeong-Hwan; Lee, Sam-Gyu

2014-01-01

Objective To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. Methods The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). Results Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. Conclusion We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS. PMID:25379493

Effect of ankle-foot orthoses on gait, balance and gross motor function in children with cerebral palsy: a systematic review and meta-analysis.

PubMed

Lintanf, Mael; Bourseul, Jean-Sébastien; Houx, Laetitia; Lempereur, Mathieu; Brochard, Sylvain; Pons, Christelle

2018-04-01

To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score ≥ 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), and decreased cadence (SMD = -0.72, P < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD = 0.57, P < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001) and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in stance (SMD = -0.72, P < 0.001) in children with equinus gait. In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.

[New International Classification of Chronic Pancreatitis (M-ANNHEIM multifactor classification system, 2007): principles, merits, and demerits].

PubMed

Tsimmerman, Ia S

2008-01-01

The new International Classification of Chronic Pancreatitis (designated as M-ANNHEIM) proposed by a group of German specialists in late 2007 is reviewed. All its sections are subjected to analysis (risk group categories, clinical stages and phases, variants of clinical course, diagnostic criteria for "established" and "suspected" pancreatitis, instrumental methods and functional tests used in the diagnosis, evaluation of the severity of the disease using a scoring system, stages of elimination of pain syndrome). The new classification is compared with the earlier classification proposed by the author. Its merits and demerits are discussed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honorio, J.; Goldstein, R.; Honorio, J.

We propose a simple, well grounded classification technique which is suited for group classification on brain fMRI data sets that have high dimensionality, small number of subjects, high noise level, high subject variability, imperfect registration and capture subtle cognitive effects. We propose threshold-split region as a new feature selection method and majority voteas the classification technique. Our method does not require a predefined set of regions of interest. We use average acros ssessions, only one feature perexperimental condition, feature independence assumption, and simple classifiers. The seeming counter-intuitive approach of using a simple design is supported by signal processing and statisticalmore » theory. Experimental results in two block design data sets that capture brain function under distinct monetary rewards for cocaine addicted and control subjects, show that our method exhibits increased generalization accuracy compared to commonly used feature selection and classification techniques.« less

A Classification of Designated Logic Systems

DTIC Science & Technology

1988-02-01

Introduction to Logic. New York: Macmillan Publishing, 1972. Grimaldi , Ralph P . Discrete and Combinatorial Mathematics. Reading: Addison-Wesley...sound basis for understanding non-classical logic systems. I would like to thank the Air Force Institute of Technology for funding this research. vi p ...6 p ILLUSTRATIONS Figure Page 1. Two Classifications of Designated Logic Systems 13 2. Two Partitions of Two-valued Logic Systems 14 3. Two

Ankle-foot orthosis bending axis influences running mechanics.

PubMed

Russell Esposito, Elizabeth; Ranz, Ellyn C; Schmidtbauer, Kelly A; Neptune, Richard R; Wilken, Jason M

2017-07-01

Passive-dynamic ankle-foot orthoses (AFOs) are commonly prescribed to improve locomotion for people with lower limb musculoskeletal weakness. The clinical prescription and design process are typically qualitative and based on observational assessment and experience. Prior work examining the effect of AFO design characteristics generally excludes higher impact activities such as running, providing clinicians and researchers limited information to guide the development of objective prescription guidelines. The proximal location of the bending axis may directly influence energy storage and return and resulting running mechanics. The purpose of this study was to determine if the location of an AFO's bending axis influences running mechanics. Marker and force data were recorded as 12 participants with lower extremity weakness ran overground while wearing a passive-dynamic AFO with posterior struts manufactured with central (middle) and off-centered (high and low) bending axes. Lower extremity joint angles, moments, powers, and ground reaction forces were calculated and compared between limbs and across bending axis conditions. Bending axis produced relatively small but significant changes. Ankle range of motion increased as the bending axis shifted distally (p<0.003). Peak ankle power absorption was greater in the low axis than high (p=0.013), and peak power generation was greater in the low condition than middle or high conditions (p<0.009). Half of the participants preferred the middle bending axis, four preferred low and two preferred high. Overall, if greater ankle range of motion is tolerated, a low bending axis provides power and propulsive benefits during running, although individual preference and physical ability should also be considered. Published by Elsevier B.V.

Neuromuscular adaptations to training, injury and passive interventions: implications for running economy.

PubMed

Bonacci, Jason; Chapman, Andrew; Blanch, Peter; Vicenzino, Bill

2009-01-01

Performance in endurance sports such as running, cycling and triathlon has long been investigated from a physiological perspective. A strong relationship between running economy and distance running performance is well established in the literature. From this established base, improvements in running economy have traditionally been achieved through endurance training. More recently, research has demonstrated short-term resistance and plyometric training has resulted in enhanced running economy. This improvement in running economy has been hypothesized to be a result of enhanced neuromuscular characteristics such as improved muscle power development and more efficient use of stored elastic energy during running. Changes in indirect measures of neuromuscular control (i.e. stance phase contact times, maximal forward jumps) have been used to support this hypothesis. These results suggest that neuromuscular adaptations in response to training (i.e. neuromuscular learning effects) are an important contributor to enhancements in running economy. However, there is no direct evidence to suggest that these adaptations translate into more efficient muscle recruitment patterns during running. Optimization of training and run performance may be facilitated through direct investigation of muscle recruitment patterns before and after training interventions. There is emerging evidence that demonstrates neuromuscular adaptations during running and cycling vary with training status. Highly trained runners and cyclists display more refined patterns of muscle recruitment than their novice counterparts. In contrast, interference with motor learning and neuromuscular adaptation may occur as a result of ongoing multidiscipline training (e.g. triathlon). In the sport of triathlon, impairments in running economy are frequently observed after cycling. This impairment is related mainly to physiological stress, but an alteration in lower limb muscle coordination during running after cycling has also been observed. Muscle activity during running after cycling has yet to be fully investigated, and to date, the effect of alterations in muscle coordination on running economy is largely unknown. Stretching, which is another mode of training, may induce acute neuromuscular effects but does not appear to alter running economy. There are also factors other than training structure that may influence running economy and neuromuscular adaptations. For example, passive interventions such as shoes and in-shoe orthoses, as well as the presence of musculoskeletal injury, may be considered important modulators of neuromuscular control and run performance. Alterations in muscle activity and running economy have been reported with different shoes and in-shoe orthoses; however, these changes appear to be subject-specific and non-systematic. Musculoskeletal injury has been associated with modifications in lower limb neuromuscular control, which may persist well after an athlete has returned to activity. The influence of changes in neuromuscular control as a result of injury on running economy has yet to be examined thoroughly, and should be considered in future experimental design and training analysis.

Benchmarking protein classification algorithms via supervised cross-validation.

PubMed

Kertész-Farkas, Attila; Dhir, Somdutta; Sonego, Paolo; Pacurar, Mircea; Netoteia, Sergiu; Nijveen, Harm; Kuzniar, Arnold; Leunissen, Jack A M; Kocsor, András; Pongor, Sándor

2008-04-24

Development and testing of protein classification algorithms are hampered by the fact that the protein universe is characterized by groups vastly different in the number of members, in average protein size, similarity within group, etc. Datasets based on traditional cross-validation (k-fold, leave-one-out, etc.) may not give reliable estimates on how an algorithm will generalize to novel, distantly related subtypes of the known protein classes. Supervised cross-validation, i.e., selection of test and train sets according to the known subtypes within a database has been successfully used earlier in conjunction with the SCOP database. Our goal was to extend this principle to other databases and to design standardized benchmark datasets for protein classification. Hierarchical classification trees of protein categories provide a simple and general framework for designing supervised cross-validation strategies for protein classification. Benchmark datasets can be designed at various levels of the concept hierarchy using a simple graph-theoretic distance. A combination of supervised and random sampling was selected to construct reduced size model datasets, suitable for algorithm comparison. Over 3000 new classification tasks were added to our recently established protein classification benchmark collection that currently includes protein sequence (including protein domains and entire proteins), protein structure and reading frame DNA sequence data. We carried out an extensive evaluation based on various machine-learning algorithms such as nearest neighbor, support vector machines, artificial neural networks, random forests and logistic regression, used in conjunction with comparison algorithms, BLAST, Smith-Waterman, Needleman-Wunsch, as well as 3D comparison methods DALI and PRIDE. The resulting datasets provide lower, and in our opinion more realistic estimates of the classifier performance than do random cross-validation schemes. A combination of supervised and random sampling was used to construct model datasets, suitable for algorithm comparison.

Effects of Classification Exposure upon Numerical Achievement of Educable Mentally Retarded Children.

ERIC Educational Resources Information Center

Funk, Kerri L.; Tseng, M. S.

Two groups of 32 educable mentally retarded children (ages 7 to 14 years) were compared as to their arithmetic and classification performances attributable to the presence or absence of a 4 1/2 week exposure to classification tasks. The randomized block pretest-posttest design was used. The experimental group and the control group were matched on…

The Impact of Model Misspecification on Parameter Estimation and Item-Fit Assessment in Log-Linear Diagnostic Classification Models

ERIC Educational Resources Information Center

Kunina-Habenicht, Olga; Rupp, Andre A.; Wilhelm, Oliver

2012-01-01

Using a complex simulation study we investigated parameter recovery, classification accuracy, and performance of two item-fit statistics for correct and misspecified diagnostic classification models within a log-linear modeling framework. The basic manipulated test design factors included the number of respondents (1,000 vs. 10,000), attributes (3…

IFLA General Conference, 1992. Division of Bibliographic Control: Section on Classification and Indexing; Section on Cataloguing. Papers.

ERIC Educational Resources Information Center

International Federation of Library Associations and Institutions, London (England).

Five papers from the sessions of the International Federation of Library Associations and Institutions 1992 conference on classification, indexing, and cataloging are presented. Three papers deal with knowledge classification as it relates to database design, as it is practiced in India, and in a worldwide context. The remaining two papers focus…

Design of partially supervised classifiers for multispectral image data

NASA Technical Reports Server (NTRS)

Jeon, Byeungwoo; Landgrebe, David

1993-01-01

A partially supervised classification problem is addressed, especially when the class definition and corresponding training samples are provided a priori only for just one particular class. In practical applications of pattern classification techniques, a frequently observed characteristic is the heavy, often nearly impossible requirements on representative prior statistical class characteristics of all classes in a given data set. Considering the effort in both time and man-power required to have a well-defined, exhaustive list of classes with a corresponding representative set of training samples, this 'partially' supervised capability would be very desirable, assuming adequate classifier performance can be obtained. Two different classification algorithms are developed to achieve simplicity in classifier design by reducing the requirement of prior statistical information without sacrificing significant classifying capability. The first one is based on optimal significance testing, where the optimal acceptance probability is estimated directly from the data set. In the second approach, the partially supervised classification is considered as a problem of unsupervised clustering with initially one known cluster or class. A weighted unsupervised clustering procedure is developed to automatically define other classes and estimate their class statistics. The operational simplicity thus realized should make these partially supervised classification schemes very viable tools in pattern classification.

Agent Collaborative Target Localization and Classification in Wireless Sensor Networks

PubMed Central

Wang, Xue; Bi, Dao-wei; Ding, Liang; Wang, Sheng

2007-01-01

Wireless sensor networks (WSNs) are autonomous networks that have been frequently deployed to collaboratively perform target localization and classification tasks. Their autonomous and collaborative features resemble the characteristics of agents. Such similarities inspire the development of heterogeneous agent architecture for WSN in this paper. The proposed agent architecture views WSN as multi-agent systems and mobile agents are employed to reduce in-network communication. According to the architecture, an energy based acoustic localization algorithm is proposed. In localization, estimate of target location is obtained by steepest descent search. The search algorithm adapts to measurement environments by dynamically adjusting its termination condition. With the agent architecture, target classification is accomplished by distributed support vector machine (SVM). Mobile agents are employed for feature extraction and distributed SVM learning to reduce communication load. Desirable learning performance is guaranteed by combining support vectors and convex hull vectors. Fusion algorithms are designed to merge SVM classification decisions made from various modalities. Real world experiments with MICAz sensor nodes are conducted for vehicle localization and classification. Experimental results show the proposed agent architecture remarkably facilitates WSN designs and algorithm implementation. The localization and classification algorithms also prove to be accurate and energy efficient.

Validating the performance of vehicle classification stations : executive summary report.

DOT National Transportation Integrated Search

2012-05-01

Vehicle classification data are used in many transportation applications, including: pavement design, : environmental impact studies, traffic control, and traffic safety. Typical of most developed countries, every : state in the US maintains a networ...

Mining vehicle classifications from the Columbus Metropolitan Freeway Management System.

DOT National Transportation Integrated Search

2015-01-01

Vehicle classification data are used in many transportation applications, including: pavement design, : environmental impact studies, traffic control, and traffic safety. Ohio has over 200 permanent count stations, : supplemented by many more short-t...

Correlation of the Rock Mass Rating (RMR) System with the Unified Soil Classification System (USCS): Introduction of the Weak Rock Mass Rating System (W-RMR)

NASA Astrophysics Data System (ADS)

Warren, Sean N.; Kallu, Raj R.; Barnard, Chase K.

2016-11-01

Underground gold mines in Nevada are exploiting increasingly deeper ore bodies comprised of weak to very weak rock masses. The Rock Mass Rating (RMR) classification system is widely used at underground gold mines in Nevada and is applicable in fair to good-quality rock masses, but is difficult to apply and loses reliability in very weak rock mass to soil-like material. Because very weak rock masses are transition materials that border engineering rock mass and soil classification systems, soil classification may sometimes be easier and more appropriate to provide insight into material behavior and properties. The Unified Soil Classification System (USCS) is the most likely choice for the classification of very weak rock mass to soil-like material because of its accepted use in tunnel engineering projects and its ability to predict soil-like material behavior underground. A correlation between the RMR and USCS systems was developed by comparing underground geotechnical RMR mapping to laboratory testing of bulk samples from the same locations, thereby assigning a numeric RMR value to the USCS classification that can be used in spreadsheet calculations and geostatistical analyses. The geotechnical classification system presented in this paper including a USCS-RMR correlation, RMR rating equations, and the Geo-Pick Strike Index is collectively introduced as the Weak Rock Mass Rating System (W-RMR). It is the authors' hope that this system will aid in the classification of weak rock masses and more usable design tools based on the RMR system. More broadly, the RMR-USCS correlation and the W-RMR system help define the transition between engineering soil and rock mass classification systems and may provide insight for geotechnical design in very weak rock masses.

A new adaptive L1-norm for optimal descriptor selection of high-dimensional QSAR classification model for anti-hepatitis C virus activity of thiourea derivatives.

PubMed

Algamal, Z Y; Lee, M H

2017-01-01

A high-dimensional quantitative structure-activity relationship (QSAR) classification model typically contains a large number of irrelevant and redundant descriptors. In this paper, a new design of descriptor selection for the QSAR classification model estimation method is proposed by adding a new weight inside L1-norm. The experimental results of classifying the anti-hepatitis C virus activity of thiourea derivatives demonstrate that the proposed descriptor selection method in the QSAR classification model performs effectively and competitively compared with other existing penalized methods in terms of classification performance on both the training and the testing datasets. Moreover, it is noteworthy that the results obtained in terms of stability test and applicability domain provide a robust QSAR classification model. It is evident from the results that the developed QSAR classification model could conceivably be employed for further high-dimensional QSAR classification studies.

Mining vehicle classifications from the Columbus Metropolitan Freeway Management System : [summary].

DOT National Transportation Integrated Search

2015-01-01

Vehicle classification data are used in many transportation applications, including: pavement design, : environmental impact studies, traffic control, and traffic safety. Ohio has over 200 permanent count : stations, supplemented by many more short-t...

76 FR 68767 - Draft Guidance for Industry and Food and Drug Administration Staff; De Novo Classification...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

... and Radiological Health (CDRH) guidance documents is available at http://www.fda.gov/MedicalDevices... ``De Novo Classification Process (Evaluation of Automatic Class III Designation)'' from CDRH you may...

The study of vehicle classification equipment with solutions to improve accuracy in Oklahoma.

DOT National Transportation Integrated Search

2014-12-01

The accuracy of vehicle counting and classification data is vital for appropriate future highway and road : design, including determining pavement characteristics, eliminating traffic jams, and improving safety. : Organizations relying on vehicle cla...

49 CFR 806.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... designated. One of the following classifications will be shown: (1) Top secret means information, the... expected to cause serious damage to national security. (3) Confidential means information, the unauthorized... an event which would eliminate the need for continued classification. ...

49 CFR 806.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... designated. One of the following classifications will be shown: (1) Top secret means information, the... expected to cause serious damage to national security. (3) Confidential means information, the unauthorized... an event which would eliminate the need for continued classification. ...

49 CFR 806.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... designated. One of the following classifications will be shown: (1) Top secret means information, the... expected to cause serious damage to national security. (3) Confidential means information, the unauthorized... an event which would eliminate the need for continued classification. ...

49 CFR 806.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... designated. One of the following classifications will be shown: (1) Top secret means information, the... expected to cause serious damage to national security. (3) Confidential means information, the unauthorized... an event which would eliminate the need for continued classification. ...

Non-linear molecular pattern classification using molecular beacons with multiple targets.

PubMed

Lee, In-Hee; Lee, Seung Hwan; Park, Tai Hyun; Zhang, Byoung-Tak

2013-12-01

In vitro pattern classification has been highlighted as an important future application of DNA computing. Previous work has demonstrated the feasibility of linear classifiers using DNA-based molecular computing. However, complex tasks require non-linear classification capability. Here we design a molecular beacon that can interact with multiple targets and experimentally shows that its fluorescent signals form a complex radial-basis function, enabling it to be used as a building block for non-linear molecular classification in vitro. The proposed method was successfully applied to solving artificial and real-world classification problems: XOR and microRNA expression patterns. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Bellevue Classification System: nursing's voice upon the library shelves*†

PubMed Central

Mages, Keith C

2011-01-01

This article examines the inspiration, construction, and meaning of the Bellevue Classification System (BCS), created during the 1930s for use in the Bellevue School of Nursing Library. Nursing instructor Ann Doyle, with assistance from librarian Mary Casamajor, designed the BCS after consulting with library leaders and examining leading contemporary classification systems, including the Dewey Decimal Classification and Library of Congress, Ballard, and National Health Library classification systems. A close textual reading of the classes, subclasses, and subdivisions of these classification systems against those of the resulting BCS, reveals Doyle's belief that the BCS was created not only to organize the literature, but also to promote the burgeoning intellectualism and professionalism of early twentieth-century American nursing. PMID:21243054

Computer classification of remotely sensed multispectral image data by extraction and classification of homogeneous objects

NASA Technical Reports Server (NTRS)

Kettig, R. L.

1975-01-01

A method of classification of digitized multispectral images is developed and experimentally evaluated on actual earth resources data collected by aircraft and satellite. The method is designed to exploit the characteristic dependence between adjacent states of nature that is neglected by the more conventional simple-symmetric decision rule. Thus contextual information is incorporated into the classification scheme. The principle reason for doing this is to improve the accuracy of the classification. For general types of dependence this would generally require more computation per resolution element than the simple-symmetric classifier. But when the dependence occurs in the form of redundance, the elements can be classified collectively, in groups, therby reducing the number of classifications required.

The Effects of Individual Disengagement on Insurgency Campaigns

DTIC Science & Technology

2010-12-01

PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY CLASSIFICATION OF THIS PAGE Unclassified 19. SECURITY CLASSIFICATION...and A. Kieser, 1981, “Development of Organizations over Time,” In Handbook of Organizational Design, edited by P. C. Nystrom and W. H. Starbuck , New...Hills: Sage Publications, 1981. William H. Starbuck , Arent Greve, and Bo Hedberg, Responding to Crises, Stockholm: Arbetslivscentrum, 1979. 36 D

Characteristics of a global classification system for perinatal deaths: a Delphi consensus study.

PubMed

Wojcieszek, Aleena M; Reinebrant, Hanna E; Leisher, Susannah Hopkins; Allanson, Emma; Coory, Michael; Erwich, Jan Jaap; Frøen, J Frederik; Gardosi, Jason; Gordijn, Sanne; Gulmezoglu, Metin; Heazell, Alexander E P; Korteweg, Fleurisca J; McClure, Elizabeth; Pattinson, Robert; Silver, Robert M; Smith, Gordon; Teoh, Zheyi; Tunçalp, Özge; Flenady, Vicki

2016-08-15

Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system. A group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three. The panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system. This study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.

Automatic sleep stage classification of single-channel EEG by using complex-valued convolutional neural network.

PubMed

Zhang, Junming; Wu, Yan

2018-03-28

Many systems are developed for automatic sleep stage classification. However, nearly all models are based on handcrafted features. Because of the large feature space, there are so many features that feature selection should be used. Meanwhile, designing handcrafted features is a difficult and time-consuming task because the feature designing needs domain knowledge of experienced experts. Results vary when different sets of features are chosen to identify sleep stages. Additionally, many features that we may be unaware of exist. However, these features may be important for sleep stage classification. Therefore, a new sleep stage classification system, which is based on the complex-valued convolutional neural network (CCNN), is proposed in this study. Unlike the existing sleep stage methods, our method can automatically extract features from raw electroencephalography data and then classify sleep stage based on the learned features. Additionally, we also prove that the decision boundaries for the real and imaginary parts of a complex-valued convolutional neuron intersect orthogonally. The classification performances of handcrafted features are compared with those of learned features via CCNN. Experimental results show that the proposed method is comparable to the existing methods. CCNN obtains a better classification performance and considerably faster convergence speed than convolutional neural network. Experimental results also show that the proposed method is a useful decision-support tool for automatic sleep stage classification.

Creating a better picture of chronic pain: improving pain pictogram designs through systematic evaluation of user responses

PubMed Central

Stones, Catherine; Knapp, Peter; Closs, S Jose

2016-01-01

This article discusses the challenges of visually representing pain qualities in pictogram design. An existing set of 12 pictograms designed for people with literacy problems was evaluated to understand more about misunderstandings of pictogram interpretation. Two sets of university students from different disciplines were asked to interpret the pictograms, and a novel classification system was developed to categorise answer types, as ‘location’, ‘affective’, temporal’ or ‘literal’. Several design recommendations are made as a result that will help improve the design of pain pictograms as a whole as well as guide designers of related pictogram work. We demonstrate how, through the robust classification of incorrect responses, it is possible to extract useful comprehension error patterns to inform future design. PMID:27867507

Privacy-Preserving Evaluation of Generalization Error and Its Application to Model and Attribute Selection

NASA Astrophysics Data System (ADS)

Sakuma, Jun; Wright, Rebecca N.

Privacy-preserving classification is the task of learning or training a classifier on the union of privately distributed datasets without sharing the datasets. The emphasis of existing studies in privacy-preserving classification has primarily been put on the design of privacy-preserving versions of particular data mining algorithms, However, in classification problems, preprocessing and postprocessing— such as model selection or attribute selection—play a prominent role in achieving higher classification accuracy. In this paper, we show generalization error of classifiers in privacy-preserving classification can be securely evaluated without sharing prediction results. Our main technical contribution is a new generalized Hamming distance protocol that is universally applicable to preprocessing and postprocessing of various privacy-preserving classification problems, such as model selection in support vector machine and attribute selection in naive Bayes classification.

Optimizing study design for interobserver reliability: IUGA-ICS classification of complications of prostheses and graft insertion.

PubMed

Haylen, Bernard T; Lee, Joseph; Maher, Chris; Deprest, Jan; Freeman, Robert

2014-06-01

Results of interobserver reliability studies for the International Urogynecological Association-International Continence Society (IUGA-ICS) Complication Classification coding can be greatly influenced by study design factors such as participant instruction, motivation, and test-question clarity. We attempted to optimize these factors. After a 15-min instructional lecture with eight clinical case examples (including images) and with classification/coding charts available, those clinicians attending an IUGA Surgical Complications workshop were presented with eight similar-style test cases over 10 min and asked to code them using the Category, Time and Site classification. Answers were compared to predetermined correct codes obtained by five instigators of the IUGA-ICS prostheses and grafts complications classification. Prelecture and postquiz participant confidence levels using a five-step Likert scale were assessed. Complete sets of answers to the questions (24 codings) were provided by 34 respondents, only three of whom reported prior use of the charts. Average score [n (%)] out of eight, as well as median score (range) for each coding category were: (i) Category: 7.3 (91 %); 7 (4-8); (ii) Time: 7.8 (98 %); 7 (6-8); (iii) Site: 7.2 (90 %); 7 (5-8). Overall, the equivalent calculations (out of 24) were 22.3 (93 %) and 22 (18-24). Mean prelecture confidence was 1.37 (out of 5), rising to 3.85 postquiz. Urogynecologists had the highest correlation with correct coding, followed closely by fellows and general gynecologists. Optimizing training and study design can lead to excellent results for interobserver reliability of the IUGA-ICS Complication Classification coding, with increased participant confidence in complication-coding ability.

Levels of Evidence in Cosmetic Surgery: Analysis and Recommendations Using a New CLEAR Classification

PubMed Central

2013-01-01

Background: The Level of Evidence rating was introduced in 2011 to grade the quality of publications. This system evaluates study design but does not assess several other quality indicators. This study introduces a new “Cosmetic Level of Evidence And Recommendation” (CLEAR) classification that includes additional methodological criteria and compares this new classification with the existing system. Methods: All rated publications in the Cosmetic Section of Plastic and Reconstructive Surgery, July 2011 through June 2013, were evaluated. The published Level of Evidence rating (1–5) and criteria relevant to study design and methodology for each study were tabulated. A new CLEAR rating was assigned to each article, including a recommendation grade (A–D). The published Level of Evidence rating (1–5) was compared with the recommendation grade determined using the CLEAR classification. Results: Among the 87 cosmetic articles, 48 studies (55%) were designated as level 4. Three articles were assigned a level 1, but they contained deficiencies sufficient to undermine the conclusions. The correlation between the published Level of Evidence classification (1–5) and CLEAR Grade (A–D) was weak (ρ = 0.11, not significant). Only 41 studies (48%) evaluated consecutive patients or consecutive patients meeting inclusion criteria. Conclusions: The CLEAR classification considers methodological factors in evaluating study reliability. A prospective study among consecutive patients meeting eligibility criteria, with a reported inclusion rate, the use of contemporaneous controls when indicated, and consideration of confounders is a realistic goal. Such measures are likely to improve study quality. PMID:25289261

Low-cost real-time automatic wheel classification system

NASA Astrophysics Data System (ADS)

Shabestari, Behrouz N.; Miller, John W. V.; Wedding, Victoria

1992-11-01

This paper describes the design and implementation of a low-cost machine vision system for identifying various types of automotive wheels which are manufactured in several styles and sizes. In this application, a variety of wheels travel on a conveyor in random order through a number of processing steps. One of these processes requires the identification of the wheel type which was performed manually by an operator. A vision system was designed to provide the required identification. The system consisted of an annular illumination source, a CCD TV camera, frame grabber, and 386-compatible computer. Statistical pattern recognition techniques were used to provide robust classification as well as a simple means for adding new wheel designs to the system. Maintenance of the system can be performed by plant personnel with minimal training. The basic steps for identification include image acquisition, segmentation of the regions of interest, extraction of selected features, and classification. The vision system has been installed in a plant and has proven to be extremely effective. The system properly identifies the wheels correctly up to 30 wheels per minute regardless of rotational orientation in the camera's field of view. Correct classification can even be achieved if a portion of the wheel is blocked off from the camera. Significant cost savings have been achieved by a reduction in scrap associated with incorrect manual classification as well as a reduction of labor in a tedious task.

New York State Thruway Authority automatic vehicle classification (AVC) : research report.

DOT National Transportation Integrated Search

2008-03-31

In December 2007, the N.Y.S. Thruway Authority (Thruway) concluded a Federal : funded research effort to study technology and develop a design for retrofitting : devices required in implementing a fully automated vehicle classification system i...

Incidental Learning and Recall in Children.

ERIC Educational Resources Information Center

Fox, Robert A.; And Others

Incidental learning research with mentally retarded children has produced findings inconsistent with those reported for the intellectually normal population. This study was designed to further investigate the efficacy of incidental semantic classification instructions relative to taxonomic classification instructions or superficial color…

Cluster designs to assess the prevalence of acute malnutrition by lot quality assurance sampling: a validation study by computer simulation.

PubMed

Olives, Casey; Pagano, Marcello; Deitchler, Megan; Hedt, Bethany L; Egge, Kari; Valadez, Joseph J

2009-04-01

Traditional lot quality assurance sampling (LQAS) methods require simple random sampling to guarantee valid results. However, cluster sampling has been proposed to reduce the number of random starting points. This study uses simulations to examine the classification error of two such designs, a 67x3 (67 clusters of three observations) and a 33x6 (33 clusters of six observations) sampling scheme to assess the prevalence of global acute malnutrition (GAM). Further, we explore the use of a 67x3 sequential sampling scheme for LQAS classification of GAM prevalence. Results indicate that, for independent clusters with moderate intracluster correlation for the GAM outcome, the three sampling designs maintain approximate validity for LQAS analysis. Sequential sampling can substantially reduce the average sample size that is required for data collection. The presence of intercluster correlation can impact dramatically the classification error that is associated with LQAS analysis.

Classification of self-assembling protein nanoparticle architectures for applications in vaccine design

NASA Astrophysics Data System (ADS)

Indelicato, G.; Burkhard, P.; Twarock, R.

2017-04-01

We introduce here a mathematical procedure for the structural classification of a specific class of self-assembling protein nanoparticles (SAPNs) that are used as a platform for repetitive antigen display systems. These SAPNs have distinctive geometries as a consequence of the fact that their peptide building blocks are formed from two linked coiled coils that are designed to assemble into trimeric and pentameric clusters. This allows a mathematical description of particle architectures in terms of bipartite (3,5)-regular graphs. Exploiting the relation with fullerene graphs, we provide a complete atlas of SAPN morphologies. The classification enables a detailed understanding of the spectrum of possible particle geometries that can arise in the self-assembly process. Moreover, it provides a toolkit for a systematic exploitation of SAPNs in bioengineering in the context of vaccine design, predicting the density of B-cell epitopes on the SAPN surface, which is critical for a strong humoral immune response.

Spectral-spatial classification of hyperspectral image using three-dimensional convolution network

NASA Astrophysics Data System (ADS)

Liu, Bing; Yu, Xuchu; Zhang, Pengqiang; Tan, Xiong; Wang, Ruirui; Zhi, Lu

2018-01-01

Recently, hyperspectral image (HSI) classification has become a focus of research. However, the complex structure of an HSI makes feature extraction difficult to achieve. Most current methods build classifiers based on complex handcrafted features computed from the raw inputs. The design of an improved 3-D convolutional neural network (3D-CNN) model for HSI classification is described. This model extracts features from both the spectral and spatial dimensions through the application of 3-D convolutions, thereby capturing the important discrimination information encoded in multiple adjacent bands. The designed model views the HSI cube data altogether without relying on any pre- or postprocessing. In addition, the model is trained in an end-to-end fashion without any handcrafted features. The designed model was applied to three widely used HSI datasets. The experimental results demonstrate that the 3D-CNN-based method outperforms conventional methods even with limited labeled training samples.

Multiple Category-Lot Quality Assurance Sampling: A New Classification System with Application to Schistosomiasis Control

PubMed Central

Olives, Casey; Valadez, Joseph J.; Brooker, Simon J.; Pagano, Marcello

2012-01-01

Background Originally a binary classifier, Lot Quality Assurance Sampling (LQAS) has proven to be a useful tool for classification of the prevalence of Schistosoma mansoni into multiple categories (≤10%, >10 and <50%, ≥50%), and semi-curtailed sampling has been shown to effectively reduce the number of observations needed to reach a decision. To date the statistical underpinnings for Multiple Category-LQAS (MC-LQAS) have not received full treatment. We explore the analytical properties of MC-LQAS, and validate its use for the classification of S. mansoni prevalence in multiple settings in East Africa. Methodology We outline MC-LQAS design principles and formulae for operating characteristic curves. In addition, we derive the average sample number for MC-LQAS when utilizing semi-curtailed sampling and introduce curtailed sampling in this setting. We also assess the performance of MC-LQAS designs with maximum sample sizes of n = 15 and n = 25 via a weighted kappa-statistic using S. mansoni data collected in 388 schools from four studies in East Africa. Principle Findings Overall performance of MC-LQAS classification was high (kappa-statistic of 0.87). In three of the studies, the kappa-statistic for a design with n = 15 was greater than 0.75. In the fourth study, where these designs performed poorly (kappa-statistic less than 0.50), the majority of observations fell in regions where potential error is known to be high. Employment of semi-curtailed and curtailed sampling further reduced the sample size by as many as 0.5 and 3.5 observations per school, respectively, without increasing classification error. Conclusion/Significance This work provides the needed analytics to understand the properties of MC-LQAS for assessing the prevalance of S. mansoni and shows that in most settings a sample size of 15 children provides a reliable classification of schools. PMID:22970333

77 FR 55482 - Public Workshop on Marine Technology and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-10

... provide a unique opportunity for classification societies, industry groups, standards development... email at [email protected] . You may also contact Lieutenant Commander Ken Hettler, Office of Design and... provides a unique opportunity for classification societies, industry groups, standards development...

Bayes-LQAS: classifying the prevalence of global acute malnutrition

PubMed Central

2010-01-01

Lot Quality Assurance Sampling (LQAS) applications in health have generally relied on frequentist interpretations for statistical validity. Yet health professionals often seek statements about the probability distribution of unknown parameters to answer questions of interest. The frequentist paradigm does not pretend to yield such information, although a Bayesian formulation might. This is the source of an error made in a recent paper published in this journal. Many applications lend themselves to a Bayesian treatment, and would benefit from such considerations in their design. We discuss Bayes-LQAS (B-LQAS), which allows for incorporation of prior information into the LQAS classification procedure, and thus shows how to correct the aforementioned error. Further, we pay special attention to the formulation of Bayes Operating Characteristic Curves and the use of prior information to improve survey designs. As a motivating example, we discuss the classification of Global Acute Malnutrition prevalence and draw parallels between the Bayes and classical classifications schemes. We also illustrate the impact of informative and non-informative priors on the survey design. Results indicate that using a Bayesian approach allows the incorporation of expert information and/or historical data and is thus potentially a valuable tool for making accurate and precise classifications. PMID:20534159

Bayes-LQAS: classifying the prevalence of global acute malnutrition.

PubMed

Olives, Casey; Pagano, Marcello

2010-06-09

Lot Quality Assurance Sampling (LQAS) applications in health have generally relied on frequentist interpretations for statistical validity. Yet health professionals often seek statements about the probability distribution of unknown parameters to answer questions of interest. The frequentist paradigm does not pretend to yield such information, although a Bayesian formulation might. This is the source of an error made in a recent paper published in this journal. Many applications lend themselves to a Bayesian treatment, and would benefit from such considerations in their design. We discuss Bayes-LQAS (B-LQAS), which allows for incorporation of prior information into the LQAS classification procedure, and thus shows how to correct the aforementioned error. Further, we pay special attention to the formulation of Bayes Operating Characteristic Curves and the use of prior information to improve survey designs. As a motivating example, we discuss the classification of Global Acute Malnutrition prevalence and draw parallels between the Bayes and classical classifications schemes. We also illustrate the impact of informative and non-informative priors on the survey design. Results indicate that using a Bayesian approach allows the incorporation of expert information and/or historical data and is thus potentially a valuable tool for making accurate and precise classifications.

Fully Convolutional Networks for Ground Classification from LIDAR Point Clouds

NASA Astrophysics Data System (ADS)

Rizaldy, A.; Persello, C.; Gevaert, C. M.; Oude Elberink, S. J.

2018-05-01

Deep Learning has been massively used for image classification in recent years. The use of deep learning for ground classification from LIDAR point clouds has also been recently studied. However, point clouds need to be converted into an image in order to use Convolutional Neural Networks (CNNs). In state-of-the-art techniques, this conversion is slow because each point is converted into a separate image. This approach leads to highly redundant computation during conversion and classification. The goal of this study is to design a more efficient data conversion and ground classification. This goal is achieved by first converting the whole point cloud into a single image. The classification is then performed by a Fully Convolutional Network (FCN), a modified version of CNN designed for pixel-wise image classification. The proposed method is significantly faster than state-of-the-art techniques. On the ISPRS Filter Test dataset, it is 78 times faster for conversion and 16 times faster for classification. Our experimental analysis on the same dataset shows that the proposed method results in 5.22 % of total error, 4.10 % of type I error, and 15.07 % of type II error. Compared to the previous CNN-based technique and LAStools software, the proposed method reduces the total error and type I error (while type II error is slightly higher). The method was also tested on a very high point density LIDAR point clouds resulting in 4.02 % of total error, 2.15 % of type I error and 6.14 % of type II error.

The Australian National Sub-Acute and Non-Acute Patient casemix classification.

PubMed

Eagar, K

1999-01-01

The Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) Version 1 casemix classification was completed in 1997. AN-SNAP is designed for the classification of sub-acute and non-acute care provided in both inpatient and ambulatory settings and is intended to be useful for both funding and clinical management purposes. The National Sub-Acute and Non-Acute Casemix Classification study has produced the first version of a national classification of sub-acute and non-acute care. Ongoing refinement (leading to Version 2) will be possible through further analysis of the existing data set in combination with analysis of the results of a carefully planned and phased implementation.

A heuristic multi-criteria classification approach incorporating data quality information for choropleth mapping

PubMed Central

Sun, Min; Wong, David; Kronenfeld, Barry

2016-01-01

Despite conceptual and technology advancements in cartography over the decades, choropleth map design and classification fail to address a fundamental issue: estimates that are statistically indifferent may be assigned to different classes on maps or vice versa. Recently, the class separability concept was introduced as a map classification criterion to evaluate the likelihood that estimates in two classes are statistical different. Unfortunately, choropleth maps created according to the separability criterion usually have highly unbalanced classes. To produce reasonably separable but more balanced classes, we propose a heuristic classification approach to consider not just the class separability criterion but also other classification criteria such as evenness and intra-class variability. A geovisual-analytic package was developed to support the heuristic mapping process to evaluate the trade-off between relevant criteria and to select the most preferable classification. Class break values can be adjusted to improve the performance of a classification. PMID:28286426

[Designer drugs in Finland].

PubMed

Tacke, Ulrich; den Hollander, Bjørnar; Simojoki, Kaarlo; Korpi, Esa R; Pihlainen, Katja; Alho, Hannu

2011-01-01

Designer drugs are synthetic psychotropic drugs which are marketed as "legal drugs". Their emergence, rapid spreading and unpredictable effects have challenged the health and substance abuse care. The slow process of classification of an abusable drug has provided too many possibilities for spreading the designer drugs. Once a certain substance receives an illegal drugs classification, dealers and users usually move to another, slightly different molecule that is still legal. In Finland, the Narcotics Act has been amended to the effect that the addition of a new substance to the illegal drug list does not require an amendment to the law.

The clubfoot over the centuries.

PubMed

Sanzarello, Ilaria; Nanni, Matteo; Faldini, Cesare

2017-03-01

The aim of this paper is to review all treatment methods of the clubfoot over the years through the documentation present in the literature and art with the aim of better understanding the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. The initial part of this paper traces the most representative iconographic representations of clubfoot in history to describe how his presence was witnessed since ancient times. Hippocrates, the father of medicine, was the first to present written references about treatment methods of clubfoot. After the dark period of the Middle Ages, during the Renaissance, there were more detailed studies on the disease, with the creation of the first orthopedic orthotics, designed to correct the deformity with the help of famous names in medicine's history. In the XVIII century, as we witness the birth of orthopedics as a distinct discipline in medicine, more and more brilliant minds developed complex orthoses and footwear with the aim of obtaining a proper correction of the deformity. In the last part of the paper, there is a description of the main surgical techniques developed over the years until the return to conservative treatment methods such as the Ponseti method, internationally recognized as the gold standard of treatment, despite the presence of some unresolved issues such as the possible recurrence of the disease.

Control of constraint forces and trajectories in a rich sensory and actuation environment.

PubMed

Hemami, Hooshang; Dariush, Behzad

2010-12-01

A simple control strategy is proposed and applied to a class of non-linear systems that have abundant sensory and actuation channels as in living systems. The main objective is the independent control of constrained trajectories of motion, and control of the corresponding constraint forces. The peripheral controller is a proportional, derivative and integral (PID) controller. A central controller produces, via pattern generators, reference signals that are the desired constrained position and velocity trajectories, and the desired constraint forces. The basic tenet of the this hybrid control strategy is the use of two mechanisms: 1. linear state and force feedback, and 2. non-linear constraint velocity feedback - sliding mode feedback. The first mechanism can be envisioned as a high gain feedback systems. The high gain attribute imitates the agonist-antagonist co-activation in natural systems. The strategy is applied to the control of the force and trajectory of a two-segment thigh-leg planar biped leg with a mass-less foot cranking a pedal that is analogous to a bicycle pedal. Five computational experiments are presented to show the effectiveness of the strategy and the performance of the controller. The findings of this paper are applicable to the design of orthoses and prostheses to supplement functional electrical stimulation for support purposes in the spinally injured cases. Copyright © 2010 Elsevier Inc. All rights reserved.

Classification, Properties, and Management of Aridisols.

ERIC Educational Resources Information Center

Mack, C. B.; And Others

1990-01-01

Described is a slide set which is designed to illustrate the entire range of soils found in the arid regions of the earth's surface. Information on physical and chemical soil properties, soil classification, and related soil management considerations for agricultural development are included. (CW)

40 CFR 51.350 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... population is allowed as long as an equal number of non-urban residents of the MSA containing the subject... monoxide (CO) nonattainment areas, depending upon population and nonattainment classification or design value. (a) Nonattainment area classification and population criteria. (1) States or areas within an...

40 CFR 51.350 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... population is allowed as long as an equal number of non-urban residents of the MSA containing the subject... monoxide (CO) nonattainment areas, depending upon population and nonattainment classification or design value. (a) Nonattainment area classification and population criteria. (1) States or areas within an...

40 CFR 51.350 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... population is allowed as long as an equal number of non-urban residents of the MSA containing the subject... monoxide (CO) nonattainment areas, depending upon population and nonattainment classification or design value. (a) Nonattainment area classification and population criteria. (1) States or areas within an...

40 CFR 51.350 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... population is allowed as long as an equal number of non-urban residents of the MSA containing the subject... monoxide (CO) nonattainment areas, depending upon population and nonattainment classification or design value. (a) Nonattainment area classification and population criteria. (1) States or areas within an...

Cripto-1 in Mammary Gland Development and Carcinogenesis

DTIC Science & Technology

2000-12-01

Task 4). T.O. 2 We have designed and tested a hammerhead ribozyme [21, 22] that recognizes nucleotides 12-28 of the murine CR-I mRNA and cuts after the...Growth Factors, Ribozymes 23 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION 19. SECURITY CLASSIFICATION 20. LIMITATION OF...Underexpression of CR-1 will decrease tumorigenicity of highly or moderately tumorigenic cell lines. (T.O. 2) 4. Efficient delivery of a ribozyme or

Regression-Based Approach For Feature Selection In Classification Issues. Application To Breast Cancer Detection And Recurrence

NASA Astrophysics Data System (ADS)

Belciug, Smaranda; Serbanescu, Mircea-Sebastian

2015-09-01

Feature selection is considered a key factor in classifications/decision problems. It is currently used in designing intelligent decision systems to choose the best features which allow the best performance. This paper proposes a regression-based approach to select the most important predictors to significantly increase the classification performance. Application to breast cancer detection and recurrence using publically available datasets proved the efficiency of this technique.

Crowdsourcing as a novel technique for retinal fundus photography classification: analysis of images in the EPIC Norfolk cohort on behalf of the UK Biobank Eye and Vision Consortium.

PubMed

Mitry, Danny; Peto, Tunde; Hayat, Shabina; Morgan, James E; Khaw, Kay-Tee; Foster, Paul J

2013-01-01

Crowdsourcing is the process of outsourcing numerous tasks to many untrained individuals. Our aim was to assess the performance and repeatability of crowdsourcing for the classification of retinal fundus photography. One hundred retinal fundus photograph images with pre-determined disease criteria were selected by experts from a large cohort study. After reading brief instructions and an example classification, we requested that knowledge workers (KWs) from a crowdsourcing platform classified each image as normal or abnormal with grades of severity. Each image was classified 20 times by different KWs. Four study designs were examined to assess the effect of varying incentive and KW experience in classification accuracy. All study designs were conducted twice to examine repeatability. Performance was assessed by comparing the sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Without restriction on eligible participants, two thousand classifications of 100 images were received in under 24 hours at minimal cost. In trial 1 all study designs had an AUC (95%CI) of 0.701(0.680-0.721) or greater for classification of normal/abnormal. In trial 1, the highest AUC (95%CI) for normal/abnormal classification was 0.757 (0.738-0.776) for KWs with moderate experience. Comparable results were observed in trial 2. In trial 1, between 64-86% of any abnormal image was correctly classified by over half of all KWs. In trial 2, this ranged between 74-97%. Sensitivity was ≥ 96% for normal versus severely abnormal detections across all trials. Sensitivity for normal versus mildly abnormal varied between 61-79% across trials. With minimal training, crowdsourcing represents an accurate, rapid and cost-effective method of retinal image analysis which demonstrates good repeatability. Larger studies with more comprehensive participant training are needed to explore the utility of this compelling technique in large scale medical image analysis.

Design of neural networks for classification of remotely sensed imagery

NASA Technical Reports Server (NTRS)

Chettri, Samir R.; Cromp, Robert F.; Birmingham, Mark

1992-01-01

Classification accuracies of a backpropagation neural network are discussed and compared with a maximum likelihood classifier (MLC) with multivariate normal class models. We have found that, because of its nonparametric nature, the neural network outperforms the MLC in this area. In addition, we discuss techniques for constructing optimal neural nets on parallel hardware like the MasPar MP-1 currently at GSFC. Other important discussions are centered around training and classification times of the two methods, and sensitivity to the training data. Finally, we discuss future work in the area of classification and neural nets.

What Images Reveal: a Comparative Study of Science Images between Australian and Taiwanese Junior High School Textbooks

NASA Astrophysics Data System (ADS)

Ge, Yun-Ping; Unsworth, Len; Wang, Kuo-Hua; Chang, Huey-Por

2017-07-01

From a social semiotic perspective, image designs in science textbooks are inevitably influenced by the sociocultural context in which the books are produced. The learning environments of Australia and Taiwan vary greatly. Drawing on social semiotics and cognitive science, this study compares classificational images in Australian and Taiwanese junior high school science textbooks. Classificational images are important kinds of images, which can represent taxonomic relations among objects as reported by Kress and van Leeuwen (Reading images: the grammar of visual design, 2006). An analysis of the images from sample chapters in Australian and Taiwanese high school science textbooks showed that the majority of the Taiwanese images are covert taxonomies, which represent hierarchical relations implicitly. In contrast, Australian classificational images included diversified designs, but particularly types with a tree structure which depicted overt taxonomies, explicitly representing hierarchical super-ordinate and subordinate relations. Many of the Taiwanese images are reminiscent of the specimen images in eighteenth century science texts representing "what truly is", while more Australian images emphasize structural objectivity. Moreover, Australian images support cognitive functions which facilitate reading comprehension. The relationships between image designs and learning environments are discussed and implications for textbook research and design are addressed.

Effects of sample survey design on the accuracy of classification tree models in species distribution models

USGS Publications Warehouse

Edwards, T.C.; Cutler, D.R.; Zimmermann, N.E.; Geiser, L.; Moisen, Gretchen G.

2006-01-01

We evaluated the effects of probabilistic (hereafter DESIGN) and non-probabilistic (PURPOSIVE) sample surveys on resultant classification tree models for predicting the presence of four lichen species in the Pacific Northwest, USA. Models derived from both survey forms were assessed using an independent data set (EVALUATION). Measures of accuracy as gauged by resubstitution rates were similar for each lichen species irrespective of the underlying sample survey form. Cross-validation estimates of prediction accuracies were lower than resubstitution accuracies for all species and both design types, and in all cases were closer to the true prediction accuracies based on the EVALUATION data set. We argue that greater emphasis should be placed on calculating and reporting cross-validation accuracy rates rather than simple resubstitution accuracy rates. Evaluation of the DESIGN and PURPOSIVE tree models on the EVALUATION data set shows significantly lower prediction accuracy for the PURPOSIVE tree models relative to the DESIGN models, indicating that non-probabilistic sample surveys may generate models with limited predictive capability. These differences were consistent across all four lichen species, with 11 of the 12 possible species and sample survey type comparisons having significantly lower accuracy rates. Some differences in accuracy were as large as 50%. The classification tree structures also differed considerably both among and within the modelled species, depending on the sample survey form. Overlap in the predictor variables selected by the DESIGN and PURPOSIVE tree models ranged from only 20% to 38%, indicating the classification trees fit the two evaluated survey forms on different sets of predictor variables. The magnitude of these differences in predictor variables throws doubt on ecological interpretation derived from prediction models based on non-probabilistic sample surveys. ?? 2006 Elsevier B.V. All rights reserved.

Developing Methods Using ToxCast Data for the Classification and Prioritization of Antimicrobials and Inerts

EPA Science Inventory

Improved chemical risk management and increased efficiency of chemical prioritization, classification and assessment are major goals within EPA. Towards achieving these goals, EPA's ToxCast™ research program has been designed to rapidly screen hundreds to thousands of chemicals' ...

44 CFR 8.2 - Original classification authority.

Code of Federal Regulations, 2012 CFR

2012-10-01

... information originally as TOP SECRET, as designated by the President in the Federal Register, Vol 47, No. 91...)(2), E.O. 12356, the following positions have been delegated ORIGINAL TOP SECRET CLASSIFICATION... Preparedness Directorate (3) Director, Office of Security (c) The positions delegated original Top Secret...

44 CFR 8.2 - Original classification authority.

Code of Federal Regulations, 2010 CFR

2010-10-01

... information originally as TOP SECRET, as designated by the President in the Federal Register, Vol 47, No. 91...)(2), E.O. 12356, the following positions have been delegated ORIGINAL TOP SECRET CLASSIFICATION... Preparedness Directorate (3) Director, Office of Security (c) The positions delegated original Top Secret...

10 CFR 1045.17 - Classification levels.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Top Secret. The Director of Classification shall classify RD information Top Secret if it is vital to... exceptionally grave damage to the national security. Examples of RD information that warrant Top Secret... comprehensive to warrant designation as Top Secret. Examples of RD information that warrant Secret...

Electronic Sleep Stage Classifiers: A Survey and VLSI Design Methodology.

PubMed

Kassiri, Hossein; Chemparathy, Aditi; Salam, M Tariqus; Boyce, Richard; Adamantidis, Antoine; Genov, Roman

2017-02-01

First, existing sleep stage classifier sensors and algorithms are reviewed and compared in terms of classification accuracy, level of automation, implementation complexity, invasiveness, and targeted application. Next, the implementation of a miniature microsystem for low-latency automatic sleep stage classification in rodents is presented. The classification algorithm uses one EMG (electromyogram) and two EEG (electroencephalogram) signals as inputs in order to detect REM (rapid eye movement) sleep, and is optimized for low complexity and low power consumption. It is implemented in an on-board low-power FPGA connected to a multi-channel neural recording IC, to achieve low-latency (order of 1 ms or less) classification. Off-line experimental results using pre-recorded signals from nine mice show REM detection sensitivity and specificity of 81.69% and 93.86%, respectively, with the maximum latency of 39 [Formula: see text]. The device is designed to be used in a non-disruptive closed-loop REM sleep suppression microsystem, for future studies of the effects of REM sleep deprivation on memory consolidation.

Integrated Internet based tools for learning and evaluating the International Classification of Nursing Practice.

PubMed

Alecu, C S; Jitaru, E; Moisil, I

2000-01-01

This paper presents some tools designed and implemented for learning-related purposes; these tools can be downloaded or run on the TeleNurse web site. Among other facilities, TeleNurse web site is hosting now the version 1.2 of SysTerN (terminology system for nursing) which can be downloaded on request and also the "Evaluation of Translation" form which has been designed in order to improve the Romanian translation of the ICNP (the International Classification of Nursing Practice). SysTerN has been developed using the framework of the TeleNurse ID--ENTITY Telematics for Health EU project. This version is using the beta version of ICNP containing Phenomena and Actions classification. This classification is intended to facilitate documentation of nursing practice, by providing a terminology or vocabulary for use in the description of the nursing process. The TeleNurse site is bilingual, Romanian-English, in order to enlarge the discussion forum with members from other CEE (or Non-CEE) countries.

Wing Classification in the Virtual Research Center

NASA Technical Reports Server (NTRS)

Campbell, William H.

1999-01-01

The Virtual Research Center (VRC) is a Web site that hosts a database of documents organized to allow teams of scientists and engineers to store and maintain documents. A number of other workgroup-related capabilities are provided. My tasks as a NASA/ASEE Summer Faculty Fellow included developing a scheme for classifying the workgroups using the VRC using the various Divisions within NASA Enterprises. To this end I developed a plan to use several CGI Perl scripts to gather classification information from the leaders of the workgroups, and to display all the workgroups within a specified classification. I designed, implemented, and partially tested scripts which can be used to do the classification. I was also asked to consider directions for future development of the VRC. I think that the VRC can use XML to advantage. XML is a markup language with designer tags that can be used to build meaning into documents. An investigation as to how CORBA, an object-oriented object request broker included with JDK 1.2, might be used also seems justified.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

PubMed

Sadeghi-Demneh, Ebrahim; Forghany, Saeed; Onmanee, Pornsuree; Trinler, Ursula; Dillon, Michael P; Baker, Richard

2017-06-20

Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

The influence of passive-dynamic ankle-foot orthosis bending axis location on gait performance in individuals with lower-limb impairments.

PubMed

Ranz, Ellyn C; Russell Esposito, Elizabeth; Wilken, Jason M; Neptune, Richard R

2016-08-01

Passive-dynamic ankle-foot orthoses are commonly prescribed to augment impaired ankle muscle function, however their design and prescription are largely qualitative. One design includes a footplate and cuff, and flexible strut connecting the two. During gait, deflection occurs along the strut, with the greatest deflection at a central bending axis. The vertical location of the axis can affect lower extremity biomechanics. The goal of this study was to investigate the influence of bending axis location on gait performance. For thirteen participants with unilateral ankle muscle weakness, an additive manufacturing framework was used to fabricate passive-dynamic ankle-foot orthosis struts with central and off-center bending axes. Participants walked overground while electromyographic, kinetic and kinematic data were collected for three different bending axes: proximal (high), central (middle) and distal (low), and the participants indicated their order of bending axis preference after testing. Gait measures and preference effect sizes were examined during six regions of the gait cycle. A few differences between bending axes were observed: in the first double-leg support peak plantarflexion angle, peak dorsiflexion moment and positive hip work, in the early single-leg support peak knee extension moment and positive ankle and knee work, and in the late single-leg support gastrocnemius activity and vertical ground reaction force impulse. In addition, preference was strongly related to various gait measures. Despite the observed statistical differences, altering bending axis location did not produce large and consistent changes in gait performance. Thus, individual preference and comfort may be more important factors guiding prescription. Copyright © 2016 Elsevier Ltd. All rights reserved.

Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers.

PubMed

Matthews, M; Rathleff, M S; Claus, A; McPoil, T; Nee, R; Crossley, K; Vicenzino, B

2017-12-01

Patellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an individual. A systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis); or (2) modified patient outcome from a specific treatment (treatment effect modifiers). 6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality. The 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting sample size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses. Current evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Area-Time Complexity of Sorting.

DTIC Science & Technology

1984-12-01

suggests a classification of keys into short (k < logn), long (k > 2 logn), and of medium length. Optimal or near-optimal designs of VLSI sorters are...suggests a classification of keys into short (k 4 logn ), long (k > 21ogn ), and of medium length. Optimal or near-optimal designs of VLSI sorters are...ARCHITECTURES 79 5.1 Introduction 79 5.2 Parallel Algorithms for Sorting 80 . 5.3 Parallel Architectures 88 6 OPTIMAL VLSI SORTERS FOR KEYS OF LENGTH k - logn

EMG finger movement classification based on ANFIS

NASA Astrophysics Data System (ADS)

Caesarendra, W.; Tjahjowidodo, T.; Nico, Y.; Wahyudati, S.; Nurhasanah, L.

2018-04-01

An increase number of people suffering from stroke has impact to the rapid development of finger hand exoskeleton to enable an automatic physical therapy. Prior to the development of finger exoskeleton, a research topic yet important i.e. machine learning of finger gestures classification is conducted. This paper presents a study on EMG signal classification of 5 finger gestures as a preliminary study toward the finger exoskeleton design and development in Indonesia. The EMG signals of 5 finger gestures were acquired using Myo EMG sensor. The EMG signal features were extracted and reduced using PCA. The ANFIS based learning is used to classify reduced features of 5 finger gestures. The result shows that the classification of finger gestures is less than the classification of 7 hand gestures.

A Design Study for Quick Strike Reconnaissance/Reconnaissance Reporting Facility

DTIC Science & Technology

1976-06-01

Engineer: Ronald B. Haynes (IRRO) Copies available in DDC . ’*■ KEY WORDS (Conllnut on ranfM »id* (/ n*c»«ary and Idmnllly by block number... CLASSIFICATION OF THIS PAGE (("),.„ D.I, Bm.rvd) 40 60% mmmmm tu ’~mmmmmmmm~~-’ rfÜk UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGEfWun...include the following: Systems time and date Operators name Project/mission identification Classification Organisation. (3) Station Release

Automated database-guided expert-supervised orientation for immunophenotypic diagnosis and classification of acute leukemia

PubMed Central

Lhermitte, L; Mejstrikova, E; van der Sluijs-Gelling, A J; Grigore, G E; Sedek, L; Bras, A E; Gaipa, G; Sobral da Costa, E; Novakova, M; Sonneveld, E; Buracchi, C; de Sá Bacelar, T; te Marvelde, J G; Trinquand, A; Asnafi, V; Szczepanski, T; Matarraz, S; Lopez, A; Vidriales, B; Bulsa, J; Hrusak, O; Kalina, T; Lecrevisse, Q; Martin Ayuso, M; Brüggemann, M; Verde, J; Fernandez, P; Burgos, L; Paiva, B; Pedreira, C E; van Dongen, J J M; Orfao, A; van der Velden, V H J

2018-01-01

Precise classification of acute leukemia (AL) is crucial for adequate treatment. EuroFlow has previously designed an AL orientation tube (ALOT) to guide towards the relevant classification panel (T-cell acute lymphoblastic leukemia (T-ALL), B-cell precursor (BCP)-ALL and/or acute myeloid leukemia (AML)) and final diagnosis. Now we built a reference database with 656 typical AL samples (145 T-ALL, 377 BCP-ALL, 134 AML), processed and analyzed via standardized protocols. Using principal component analysis (PCA)-based plots and automated classification algorithms for direct comparison of single-cells from individual patients against the database, another 783 cases were subsequently evaluated. Depending on the database-guided results, patients were categorized as: (i) typical T, B or Myeloid without or; (ii) with a transitional component to another lineage; (iii) atypical; or (iv) mixed-lineage. Using this automated algorithm, in 781/783 cases (99.7%) the right panel was selected, and data comparable to the final WHO-diagnosis was already provided in >93% of cases (85% T-ALL, 97% BCP-ALL, 95% AML and 87% mixed-phenotype AL patients), even without data on the full-characterization panels. Our results show that database-guided analysis facilitates standardized interpretation of ALOT results and allows accurate selection of the relevant classification panels, hence providing a solid basis for designing future WHO AL classifications. PMID:29089646

Implicit structured sequence learning: an fMRI study of the structural mere-exposure effect

PubMed Central

Folia, Vasiliki; Petersson, Karl Magnus

2014-01-01

In this event-related fMRI study we investigated the effect of 5 days of implicit acquisition on preference classification by means of an artificial grammar learning (AGL) paradigm based on the structural mere-exposure effect and preference classification using a simple right-linear unification grammar. This allowed us to investigate implicit AGL in a proper learning design by including baseline measurements prior to grammar exposure. After 5 days of implicit acquisition, the fMRI results showed activations in a network of brain regions including the inferior frontal (centered on BA 44/45) and the medial prefrontal regions (centered on BA 8/32). Importantly, and central to this study, the inclusion of a naive preference fMRI baseline measurement allowed us to conclude that these fMRI findings were the intrinsic outcomes of the learning process itself and not a reflection of a preexisting functionality recruited during classification, independent of acquisition. Support for the implicit nature of the knowledge utilized during preference classification on day 5 come from the fact that the basal ganglia, associated with implicit procedural learning, were activated during classification, while the medial temporal lobe system, associated with explicit declarative memory, was consistently deactivated. Thus, preference classification in combination with structural mere-exposure can be used to investigate structural sequence processing (syntax) in unsupervised AGL paradigms with proper learning designs. PMID:24550865

Implicit structured sequence learning: an fMRI study of the structural mere-exposure effect.

PubMed

Folia, Vasiliki; Petersson, Karl Magnus

2014-01-01

In this event-related fMRI study we investigated the effect of 5 days of implicit acquisition on preference classification by means of an artificial grammar learning (AGL) paradigm based on the structural mere-exposure effect and preference classification using a simple right-linear unification grammar. This allowed us to investigate implicit AGL in a proper learning design by including baseline measurements prior to grammar exposure. After 5 days of implicit acquisition, the fMRI results showed activations in a network of brain regions including the inferior frontal (centered on BA 44/45) and the medial prefrontal regions (centered on BA 8/32). Importantly, and central to this study, the inclusion of a naive preference fMRI baseline measurement allowed us to conclude that these fMRI findings were the intrinsic outcomes of the learning process itself and not a reflection of a preexisting functionality recruited during classification, independent of acquisition. Support for the implicit nature of the knowledge utilized during preference classification on day 5 come from the fact that the basal ganglia, associated with implicit procedural learning, were activated during classification, while the medial temporal lobe system, associated with explicit declarative memory, was consistently deactivated. Thus, preference classification in combination with structural mere-exposure can be used to investigate structural sequence processing (syntax) in unsupervised AGL paradigms with proper learning designs.

Strength in Numbers: Using Big Data to Simplify Sentiment Classification.

PubMed

Filippas, Apostolos; Lappas, Theodoros

2017-09-01

Sentiment classification, the task of assigning a positive or negative label to a text segment, is a key component of mainstream applications such as reputation monitoring, sentiment summarization, and item recommendation. Even though the performance of sentiment classification methods has steadily improved over time, their ever-increasing complexity renders them comprehensible by only a shrinking minority of expert practitioners. For all others, such highly complex methods are black-box predictors that are hard to tune and even harder to justify to decision makers. Motivated by these shortcomings, we introduce BigCounter: a new algorithm for sentiment classification that substitutes algorithmic complexity with Big Data. Our algorithm combines standard data structures with statistical testing to deliver accurate and interpretable predictions. It is also parameter free and suitable for use virtually "out of the box," which makes it appealing for organizations wanting to leverage their troves of unstructured data without incurring the significant expense of creating in-house teams of data scientists. Finally, BigCounter's efficient and parallelizable design makes it applicable to very large data sets. We apply our method on such data sets toward a study on the limits of Big Data for sentiment classification. Our study finds that, after a certain point, predictive performance tends to converge and additional data have little benefit. Our algorithmic design and findings provide the foundations for future research on the data-over-computation paradigm for classification problems.

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

9 CFR 78.40 - Designation of States/areas.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrator may approve the division of a State into two brucellosis classification areas upon finding that... State has defined the intrastate boundary by county lines or by recognizable geographic features, such... classification requested. The Administrator may amend § 78.43 to reclassify States as validated brucellosis-free...

7 CFR 160.1 - Definitions of general terms.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Analysis. Any examination by physical, chemical, or sensory methods. (m) Classification. Designation as to... Administrator has sufficient and proper interest in the analysis, classification, grading, or sale of naval... provisions of the act and the provisions in this part to show the results of any examination, analysis...

New Course Design: Classification Schemes and Information Architecture.

ERIC Educational Resources Information Center

Weinberg, Bella Hass

2002-01-01

Describes a course developed at St. John's University (New York) in the Division of Library and Information Science that relates traditional classification schemes to information architecture and Web sites. Highlights include functional aspects of information architecture, that is, the way content is structured; assignments; student reactions; and…

Soil Classification and Treatment.

ERIC Educational Resources Information Center

Clemson Univ., SC. Vocational Education Media Center.

This instructional unit was designed to enable students, primarily at the secondary level, to (1) classify soils according to current capability classifications of the Soil Conservation Service, (2) select treatments needed for a given soil class according to current recommendations provided by the Soil Conservation Service, and (3) interpret a…

New controller for functional electrical stimulation systems.

PubMed

Fisekovic, N; Popovic, D B

2001-07-01

A novel, self-contained controller for functional electrical stimulation systems has been designed. The development was motivated by the need to have a general purpose, easy to use controller capable of stimulating many muscle groups, thus restoring complex motor functions (e.g. standing, walking, reaching, and grasping). The designed controller can regulate the frequency, pulse duration, and charge balance on up to 16 channels, and execute pre-programmed and sensory-driven control operations. The controller supports up to eight analog and six digital sensors, and comprises a memory block for including history of the sensory data (time series). Five independent timers provide the basis for the multi-modal and multi-level control of movement. The PC compatible interface is realised via an IR serial communication channel. The PC based software is user friendly and fully menu driven. This paper also presents a case study where the controller was implemented to restore walking in a paraplegic subject. The assistive system comprised the novel controller, the power and output stages of an eight-channel FES system (IEEE Trans Rehabil Eng, TRE-2 (1994) 234), ankle-foot orthoses, and a rolling walker. Stimulation was applied with surface electrodes positioned over the motoneurons that innervate muscles responsible for the hip and knee flexion and extension. The sensory system included goniometers at knee and hip joints, force-sensing resistors built in the shoe insoles, and digital accelerometers at the hips. A rule-based control algorithm was generated following a two-step procedure: (1) simulation and (2) machine learning as described in earlier studies (IEEE Trans Rehab Eng, TRE-7 (1999) 69). The paraplegic subject walked faster, and with less physiological effort, when automatic control was applied as compared to hand-control. This case study, as well as a previous one for assisting grasping (The design and testing of a new programmable electronic stimulator. N. Fisekovic, MS thesis. University of Belgrade, Belgrade, 2000) indicate that the novel control unit is effectively applicable to FES systems.

Bath salts and synthetic cathinones: An emerging designer drug phenomenon

PubMed Central

German, Christopher L.; Fleckenstein, Annette E.; Hanson, Glen R.

2014-01-01

The synthetic cathinones are an emerging class of designer drugs abused for psychostimulant and hallucinogenic effects similar to cocaine, methylenedioxymethamphetamine (MDMA), or other amphetamines. Abuse of synthetic cathinones, frequently included in products sold as ‘bath salts’, became prevalent in early 2009, leading to legislative classification throughout Europe in 2010 and schedule I classification within the United States in 2011. Recent pre-clinical and clinical studies indicate dysregulation of central monoamine systems are a principal mechanism of synthetic cathinone action and presumably underlie the behavioral effects and abuse liability associated with these drugs. This review provides insight into the development of synthetic cathinones as substances of abuse, current patterns of their abuse, known mechanisms of their action and toxicology, and the benefits and drawbacks of their classification. PMID:23911668

Information processing systems, reasoning modules, and reasoning system design methods

DOEpatents

Hohimer, Ryan E.; Greitzer, Frank L.; Hampton, Shawn D.

2016-08-23

Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.

Information processing systems, reasoning modules, and reasoning system design methods

DOEpatents

Hohimer, Ryan E.; Greitzer, Frank L.; Hampton, Shawn D.

2015-08-18

Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.

Information processing systems, reasoning modules, and reasoning system design methods

DOEpatents

Hohimer, Ryan E; Greitzer, Frank L; Hampton, Shawn D

2014-03-04

Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.

Cluster designs to assess the prevalence of acute malnutrition by lot quality assurance sampling: a validation study by computer simulation

PubMed Central

Olives, Casey; Pagano, Marcello; Deitchler, Megan; Hedt, Bethany L; Egge, Kari; Valadez, Joseph J

2009-01-01

Traditional lot quality assurance sampling (LQAS) methods require simple random sampling to guarantee valid results. However, cluster sampling has been proposed to reduce the number of random starting points. This study uses simulations to examine the classification error of two such designs, a 67×3 (67 clusters of three observations) and a 33×6 (33 clusters of six observations) sampling scheme to assess the prevalence of global acute malnutrition (GAM). Further, we explore the use of a 67×3 sequential sampling scheme for LQAS classification of GAM prevalence. Results indicate that, for independent clusters with moderate intracluster correlation for the GAM outcome, the three sampling designs maintain approximate validity for LQAS analysis. Sequential sampling can substantially reduce the average sample size that is required for data collection. The presence of intercluster correlation can impact dramatically the classification error that is associated with LQAS analysis. PMID:20011037

An automated approach to the design of decision tree classifiers

NASA Technical Reports Server (NTRS)

Argentiero, P.; Chin, R.; Beaudet, P.

1982-01-01

An automated technique is presented for designing effective decision tree classifiers predicated only on a priori class statistics. The procedure relies on linear feature extractions and Bayes table look-up decision rules. Associated error matrices are computed and utilized to provide an optimal design of the decision tree at each so-called 'node'. A by-product of this procedure is a simple algorithm for computing the global probability of correct classification assuming the statistical independence of the decision rules. Attention is given to a more precise definition of decision tree classification, the mathematical details on the technique for automated decision tree design, and an example of a simple application of the procedure using class statistics acquired from an actual Landsat scene.

46 CFR 2.45-25 - Application for approval.

Code of Federal Regulations, 2012 CFR

2012-10-01

...), Office of Design and Engineering Standards, 2100 Second Street SW. Stop 7126, Washington DC 20593-7126... society complies with § 2.45-15; (3) Contain a list of the vessels surveyed by the classification society... vessels the classification society surveys for each of the previous 3 calendar years, including initial...

Teaching/Learning Methods and Students' Classification of Food Items

ERIC Educational Resources Information Center

Hamilton-Ekeke, Joy-Telu; Thomas, Malcolm

2011-01-01

Purpose: This study aims to investigate the effectiveness of a teaching method (TLS (Teaching/Learning Sequence)) based on a social constructivist paradigm on students' conceptualisation of classification of food. Design/methodology/approach: The study compared the TLS model developed by the researcher based on the social constructivist paradigm…

Effects of Stress Typicality during Speeded Grammatical Classification

ERIC Educational Resources Information Center

Arciuli, Joanne; Cupples, Linda

2003-01-01

The experiments reported here were designed to investigate the influence of stress typicality during speeded grammatical classification of disyllabic English words by native and non-native speakers. Trochaic nouns and iambic verbs were considered to be typically stressed, whereas iambic nouns and trochaic verbs were considered to be atypically…

Exploring Biological Classification: The Unique Organism Project

ERIC Educational Resources Information Center

Haines, Sarah; Richman, Laila; Hartley, Renee; Schmid, Rachel

2017-01-01

The unique organism project was designed as a culminating assessment for a biological classification unit in a middle school setting. Students developed a model to represent their unique organism. Using the model, students were required to demonstrate how their unique organism interacts with its environment, and how its internal and external…

19 CFR 19.1 - Classes of customs warehouses.

Code of Federal Regulations, 2011 CFR

2011-04-01

... customs warehouses. (a) Classifications. Customs warehouses shall be designated according to the following classifications: (1) Class 1. Premises that may be owned or leased by the Government, when the exigencies of the... class 11 warehouse, following an application under § 19.2. So far as such warehouses are used for the...

19 CFR 19.1 - Classes of customs warehouses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... customs warehouses. (a) Classifications. Customs warehouses shall be designated according to the following classifications: (1) Class 1. Premises that may be owned or leased by the Government, when the exigencies of the... class 11 warehouse, following an application under § 19.2. So far as such warehouses are used for the...

A vegetation classification system for use in California: its conceptual basis

Treesearch

Timothy E. Paysen; Jeanine A. Derby; C. Eugene Conrad

1982-01-01

A taxonomic Vegetation Classification System proposed for use in California is designed to simplify interdisciplinary communication about vegetation. The system structure is an aggregative plant community hierarchy at four levels of precision--the Association, Series, Subformation, and Formation. A flexible Phase category links specific resource management concerns to...

Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers.

PubMed

Gross, Douglas P; Zhang, Jing; Steenstra, Ivan; Barnsley, Susan; Haws, Calvin; Amell, Tyler; McIntosh, Greg; Cooper, Juliette; Zaiane, Osmar

2013-12-01

To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. Population-based historical cohort design. Data were extracted from a Canadian provincial workers' compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. The population included 8,611 unique claimants. Subjects were predominantly employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.

Autonomous self-configuration of artificial neural networks for data classification or system control

NASA Astrophysics Data System (ADS)

Fink, Wolfgang

2009-05-01

Artificial neural networks (ANNs) are powerful methods for the classification of multi-dimensional data as well as for the control of dynamic systems. In general terms, ANNs consist of neurons that are, e.g., arranged in layers and interconnected by real-valued or binary neural couplings or weights. ANNs try mimicking the processing taking place in biological brains. The classification and generalization capabilities of ANNs are given by the interconnection architecture and the coupling strengths. To perform a certain classification or control task with a particular ANN architecture (i.e., number of neurons, number of layers, etc.), the inter-neuron couplings and their accordant coupling strengths must be determined (1) either by a priori design (i.e., manually) or (2) using training algorithms such as error back-propagation. The more complex the classification or control task, the less obvious it is how to determine an a priori design of an ANN, and, as a consequence, the architecture choice becomes somewhat arbitrary. Furthermore, rather than being able to determine for a given architecture directly the corresponding coupling strengths necessary to perform the classification or control task, these have to be obtained/learned through training of the ANN on test data. We report on the use of a Stochastic Optimization Framework (SOF; Fink, SPIE 2008) for the autonomous self-configuration of Artificial Neural Networks (i.e., the determination of number of hidden layers, number of neurons per hidden layer, interconnections between neurons, and respective coupling strengths) for performing classification or control tasks. This may provide an approach towards cognizant and self-adapting computing architectures and systems.

Practice patterns when treating patients with low back pain: a survey of physical therapists.

PubMed

Davies, Claire; Nitz, Arthur J; Mattacola, Carl G; Kitzman, Patrick; Howell, Dana; Viele, Kert; Baxter, David; Brockopp, Dorothy

2014-08-01

Low back pain (LBP), is a common musculoskeletal problem, affecting 75-85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

Implementing Legacy-C Algorithms in FPGA Co-Processors for Performance Accelerated Smart Payloads

NASA Technical Reports Server (NTRS)

Pingree, Paula J.; Scharenbroich, Lucas J.; Werne, Thomas A.; Hartzell, Christine

2008-01-01

Accurate, on-board classification of instrument data is used to increase science return by autonomously identifying regions of interest for priority transmission or generating summary products to conserve transmission bandwidth. Due to on-board processing constraints, such classification has been limited to using the simplest functions on a small subset of the full instrument data. FPGA co-processor designs for SVM1 classifiers will lead to significant improvement in on-board classification capability and accuracy.

HARD PAN I Test Series Test and Instrumentation Plans. Volume I. Test Plan

DTIC Science & Technology

1975-12-01

t.jw .y..,,^.,^,. Ä!»,,«-* :,,; .trwev* ’ UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGt ’Wh&n Data Entered) J?)REPORT DOCUMENTATION PAGE...to facility-l—> DO ,: FORM A’J 73 1473 EDITION OF 1 NOV 65 15 OBSOLETE UNCLASSIFIED fNW SECURITY CLASSIFICATION OF THIS PAGE (Wfien Data Entered...y^o ... — ppiiw’.^y.-.j-w... v»t \\ UNCLASSIFIED iCURITY CLASSIFICATION CF THIS PAGEfWlon Data Entered) design, modification, and hardness

Design and Implementation of a Mobile Phone Locator Using Software Defined Radio

DTIC Science & Technology

2007-09-01

time difference of  arrival 15. NUMBER OF  PAGES  116 16. PRICE CODE 17. SECURITY  CLASSIFICATION  OF  REPORT Unclassified 18. SECURITY  CLASSIFICATION  OF...THIS  PAGE Unclassified 19. SECURITY  CLASSIFICATION  OF  ABSTRACT Unclassified 20. LIMITATION OF  ABSTRACT UU NSN 7540­01­280­5500 Standard Form 298...relatively inexpensive device called the Universal Software Radio Peripheral (USRP). The USRP consists of a motherboard which performs the analog-to

Diabetic Foot Australia guideline on footwear for people with diabetes.

PubMed

van Netten, Jaap J; Lazzarini, Peter A; Armstrong, David G; Bus, Sicco A; Fitridge, Robert; Harding, Keith; Kinnear, Ewan; Malone, Matthew; Menz, Hylton B; Perrin, Byron M; Postema, Klaas; Prentice, Jenny; Schott, Karl-Heinz; Wraight, Paul R

2018-01-01

The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. We reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate- or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.

INTERVENTION AT THE FOOT-SHOE-PEDAL INTERFACE IN COMPETITIVE CYCLISTS

PubMed Central

Vicenzino, Bill; Sisto, Sue Ann

2016-01-01

ABSTRACT Background Competitive cyclists are susceptible to injury from the highly repetitive nature of pedaling during training and racing. Deviation from an optimal movement pattern is often cited as a factor contributing to tissue stress with specific concern for excessive frontal plane knee motion. Wedges and orthoses are increasingly used at the foot-shoe-pedal-interface (FSPI) in cycling shoes to alter the kinematics of the lower limb while cycling. Determination of the effect of FSPI alteration on cycling kinematics may offer a simple, inexpensive tool to reduce anterior knee pain in recreational and competitive cyclists. There have been a limited number of experimental studies examining the effect of this intervention in cyclists, and there is little agreement upon which FSPI interventions can prevent or treat knee injury. The purpose of this review is to provide a broader review of the literature than has been performed to date, and to critically examine the literature examining the evidence for FSPI intervention in competitive cyclists. Methods Current literature examining the kinematic response to intervention at the FSPI while cycling was reviewed. A multi-database search was performed in PubMed, EBSCO, Scopus, CINAHL and SPORTdiscus. Eleven articles were reviewed, and a risk of bias assessment performed according to guidelines developed by the Cochrane Bias Methods Group. Papers with a low risk of bias were selected for review, but two papers with higher risk of bias were included as there were few high quality studies available on this topic. Results Seven of the eleven papers had low bias in sequence generation i.e. random allocation to the test condition, only one paper had blinding to group allocation, all papers had detailed but non-standardized methodology, and incomplete data reporting, but were generally free of other bias sources. Conclusions Wedges and orthoses at the FSPI alter kinematics of the lower limb while cycling, although conclusions about their efficacy and response to long-term use are limited. Further high quality experimental studies are needed examining cyclists using standardized methodology and products currently used to alter SPFI function. Level of Evidence 3 PMID:27525187

The influence of early or delayed provision of ankle-foot orthoses on pelvis, hip and knee kinematics in patients with sub-acute stroke: A randomized controlled trial.

PubMed

Nikamp, Corien D M; van der Palen, Job; Hermens, Hermie J; Rietman, Johan S; Buurke, Jaap H

2018-06-01

Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics. 1) To compare the effect of AFO-provision at two different points in time (early versus delayed) on frontal pelvis and hip, and sagittal hip and knee kinematics in patients with sub-acute stroke. Effects were assessed after 26 weeks; 2) To study whether possible changes in kinematics or walking speed during the 26-weeks follow-up period differed between both groups. An explorative randomized controlled trial was performed, including unilateral hemiparetic patients maximal six weeks post-stroke with indication for AFO-use. Subjects were randomly assigned to AFO-provision early (at inclusion) or delayed (eight weeks later). 3D gait-analysis with and without AFO was performed in randomized order. Measurements were performed in study-week 1, 9, 17 and 26. Twenty-six subjects (15 early, 11 delayed) were analyzed. After 26 weeks, no differences in kinematics were found between both groups for any of the joint angles, both for the without and with AFO-condition. Changes in kinematics during the 26-weeks follow-up period did not differ between both groups for any of the joint angles during walking without AFO. Significant differences in changes in walking speed during the 26-weeks follow-up were found (p = 0.034), corresponding to the first eight weeks after AFO-provision. Results indicate that early or delayed AFO-use post-stroke does not influence pelvis, hip and knee movements after 26 weeks, despite that AFO-use properly corrected drop-foot. AFOs should be provided to improve drop-foot post-stroke, but not with the intention to influence development of compensatory patterns around pelvis and hip. Copyright © 2018 Elsevier B.V. All rights reserved.

Orthopaedic Disorders in Myotonic Dystrophy Type 1: descriptive clinical study of 21 patients

PubMed Central

2013-01-01

Background Myotonic Dystrophy Type 1 (DM1) is the most common form of hereditary myopathy presenting in adults. This autosomal-dominant systemic disorder is caused by a CTG repeat, demonstrating various symptoms. A mild, classic and congenital form can be distinguished. Often the quality of life is reduced by orthopaedic problems, such as muscle weakness, contractures, foot or spinal deformities, which limit patients’ mobility. The aim of our study was to gather information about the orthopaedic impairments in patients with DM1 in order to improve the medical care of patients, affected by this rare disease. Methods A retrospective clinical study was carried out including 21 patients (11 male and 10 female), all diagnosed with DM1 by genetic testing. All patients were seen during our special consultations for neuromuscular diseases, during which patients were interviewed and examined. We also reviewed surgery reports of our hospitalized patients. Results We observed several orthopaedic impairments: spinal deformities (scoliosis, hyperkyphosis, rigid spine), contractures (of the upper extremities and the lower extremities), foot deformities (equinus deformity, club foot, pes cavus, pes planovalgus, pes cavovarus, claw toes) and fractures. Five patients were affected by pulmonary diseases (obstructive airway diseases, restrictive lung dysfunctions). Twelve patients were affected by cardiac disorders (congenital heart defects, valvular heart defects, conduction disturbances, pulmonary hypertension, cardiomyopathy). Our patients received conservative therapy (physiotherapy, logopaedic therapy, ergotherapy) and we prescribed orthopaedic technical devices (orthopaedic custom-made shoes, insoles, lower and upper leg orthoses, wheelchair, Rehab Buggy). We performed surgery for spinal and foot deformities: the scoliosis of one patient was stabilized and seven patients underwent surgery for correction of foot deformities. Conclusions An orthopaedic involvement in DM1 patients should not be underestimated. The most common orthopaedic impairments are contractures, foot deformities and spinal deformities. Contractures are typically located distally in the lower extremities, but can also occur in the hip or shoulder joints. Foot deformities could be treated with orthopaedic custom-made shoes, orthoses or insoles. Surgery is indicated for severe foot deformities or contractures. PMID:24289806

Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.

PubMed

Keren, O; Reznik, J; Groswasser, Z

2001-07-01

Patients surviving severe traumatic brain injury (TBI) often suffer from residual impairments in motor control, communication skills, cognition and social behaviour. These distinctly hamper their capability to return to their 'pre-trauma' activity. Comprehensive and integrated rehabilitation programmes initiate, during the acute phase, a prolonged treatment process which starts at the most sophisticated medical systems. There is no clear end point for the treatment of these patients, since the recovery process and the rehabilitation activity may continue for years, even after patients return home to live with their families. The inherent inability to make a firm early prediction regarding outcome of patients and the late appearance of additional symptoms stress the need for a comprehensive close long-term follow-up. The following presentation concerns the description of the treatment strategy and long-term improvement of a 22-year-old male who suffered from very severe TBI. On admission to the emergency room, he was in the decerebrated position and his Glasgow Coma Scale (GCS) was at the lowest (3). The focus of this presentation is on the recovery of motor function. The initial motor disabilities included weakness in all four limbs, in particular left hemiplegia, and right hemiparesis with severe bilateral ataxic elements and a marked tremor of the right arm. Range of motion was limited in hips, and he suffered from stiff trunk and neck. Goals of physiotherapy were directed towards improving range of motion (ROM) and active movement. Casting, use of orthoses, biofeedback, hydrotherapy, hippotherapy, medication and nerve blocks for reducing spasticity were timely applied during the process. The motor improvement in this very severe TBI patient who is now over 3 years post-injury still continues and has a functional meaning. He has succeeded in being able to stand up by himself from a chair and is able to walk unaided and without orthoses for very short distances--up to five steps. He is able to drink soup without assistance and play a few notes on the piano. Marked cognitive improvement occurred as well. It is concluded that motor improvement may be evident over long periods of time and various timely interventions may assist in the process.

Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence.

PubMed

Seah, Richard; Mani-Babu, Sivanadian

2011-01-01

To summarize the best available evidence in the last decade for managing ankle sprains in the community, data were collected using MEDLINE database from January 2000 to December 2009. Terms utilized: 'ankle injury primary care' (102 articles were found), 'ankle sprain primary care' (34 articles), 'ankle guidelines primary care' (25 articles), 'ankle pathways primary care' (2 articles), 'ankle sprain community' (18 articles), 'ankle sprain general practice' (22 articles), 'Cochrane review ankle' (58 articles). Of these, only 33 satisfied the inclusion criteria. The search terms identified many of the same studies. Two independent reviewers reviewed the articles. The study results and generated conclusions were extracted, discussed and finally agreed on. Ankle sprains occur commonly but their management is not always readily agreed. The Ottawa Ankle Rules are ubiquitous in the clinical pathway and can be reliably applied by emergency care physicians, primary care physicians and triage nurses. For mild-to-moderate ankle sprains, functional treatment options (which can consist of elastic bandaging, soft casting, taping or orthoses with associated coordination training) were found to be statistically better than immobilization for multiple outcome measures. For severe ankle sprains, a short period of immobilization in a below-knee cast or pneumatic brace results in a quicker recovery than tubular compression bandage alone. Lace-up supports are a more effective functional treatment than elastic bandaging and result in less persistent swelling in the short term when compared with semi-rigid ankle supports, elastic bandaging and tape. Semi-rigid orthoses and pneumatic braces provide beneficial ankle support and may prevent subsequent sprains during high-risk sporting activity. Supervised rehabilitation training in combination with conventional treatment for acute lateral ankle sprains can be beneficial, although some of the studies reviewed gave conflicting outcomes. Therapeutic hyaluronic acid injections in the ankle are a relatively novel non-surgical treatment but may have a role in expediting return to sport after ankle sprain. There is a role for surgical intervention in severe acute and chronic ankle injuries, but the evidence is limited.

Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey.

PubMed

Carlesso, Lisa C; Macdermid, Joy C; Gross, Anita R; Walton, David M; Santaguida, P Lina

2014-03-24

Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. To describe the utilization of interventions in patients with neck pain by clinicians. A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and 'other' interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics). This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective.

Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey

PubMed Central

2014-01-01

Background Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. Aim To describe the utilization of interventions in patients with neck pain by clinicians. Methods A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. Results The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and ‘other’ interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics). Conclusions This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective. PMID:24661461

Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.

PubMed

Bertozzi, Lucia; Valdes, Kristin; Vanti, Carla; Negrini, Stefano; Pillastrini, Paolo; Villafañe, Jorge Hugo

2015-01-01

The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score > 6). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short-term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA. Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA. Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results. Very few of the included studies showed a clinically significant effect size in favor of treatment.

Deep learning application: rubbish classification with aid of an android device

NASA Astrophysics Data System (ADS)

Liu, Sijiang; Jiang, Bo; Zhan, Jie

2017-06-01

Deep learning is a very hot topic currently in pattern recognition and artificial intelligence researches. Aiming at the practical problem that people usually don't know correct classifications some rubbish should belong to, based on the powerful image classification ability of the deep learning method, we have designed a prototype system to help users to classify kinds of rubbish. Firstly the CaffeNet Model was adopted for our classification network training on the ImageNet dataset, and the trained network was deployed on a web server. Secondly an android app was developed for users to capture images of unclassified rubbish, upload images to the web server for analyzing backstage and retrieve the feedback, so that users can obtain the classification guide by an android device conveniently. Tests on our prototype system of rubbish classification show that: an image of one single type of rubbish with origin shape can be better used to judge its classification, while an image containing kinds of rubbish or rubbish with changed shape may fail to help users to decide rubbish's classification. However, the system still shows promising auxiliary function for rubbish classification if the network training strategy can be optimized further.

On the Implementation of a Land Cover Classification System for SAR Images Using Khoros

NASA Technical Reports Server (NTRS)

Medina Revera, Edwin J.; Espinosa, Ramon Vasquez

1997-01-01

The Synthetic Aperture Radar (SAR) sensor is widely used to record data about the ground under all atmospheric conditions. The SAR acquired images have very good resolution which necessitates the development of a classification system that process the SAR images to extract useful information for different applications. In this work, a complete system for the land cover classification was designed and programmed using the Khoros, a data flow visual language environment, taking full advantages of the polymorphic data services that it provides. Image analysis was applied to SAR images to improve and automate the processes of recognition and classification of the different regions like mountains and lakes. Both unsupervised and supervised classification utilities were used. The unsupervised classification routines included the use of several Classification/Clustering algorithms like the K-means, ISO2, Weighted Minimum Distance, and the Localized Receptive Field (LRF) training/classifier. Different texture analysis approaches such as Invariant Moments, Fractal Dimension and Second Order statistics were implemented for supervised classification of the images. The results and conclusions for SAR image classification using the various unsupervised and supervised procedures are presented based on their accuracy and performance.

A Taxonomy of Introductory Physics Concepts.

NASA Astrophysics Data System (ADS)

Mokaya, Fridah; Savkar, Amit; Valente, Diego

We have designed and implemented a hierarchical taxonomic classification of physics concepts for our introductory physics for engineers course sequence taught at the University of Connecticut. This classification can be used to provide a mechanism to measure student progress in learning at the level of individual concepts or clusters of concepts, and also as part of a tool to measure effectiveness of teaching pedagogy. We examine our pre- and post-test FCI results broken down by topics using Hestenes et al.'s taxonomy classification for the FCI, and compare these results with those found using our own taxonomy classification. In addition, we expand this taxonomic classification to measure performance in our other course exams, investigating possible correlations in results achieved across different assessments at the individual topic level. UCONN CLAS(College of Liberal Arts and Science).

Classification of subsurface objects using singular values derived from signal frames

DOEpatents

Chambers, David H; Paglieroni, David W

2014-05-06

The classification system represents a detected object with a feature vector derived from the return signals acquired by an array of N transceivers operating in multistatic mode. The classification system generates the feature vector by transforming the real-valued return signals into complex-valued spectra, using, for example, a Fast Fourier Transform. The classification system then generates a feature vector of singular values for each user-designated spectral sub-band by applying a singular value decomposition (SVD) to the N.times.N square complex-valued matrix formed from sub-band samples associated with all possible transmitter-receiver pairs. The resulting feature vector of singular values may be transformed into a feature vector of singular value likelihoods and then subjected to a multi-category linear or neural network classifier for object classification.

Weakly supervised classification in high energy physics

DOE PAGES

Dery, Lucio Mwinmaarong; Nachman, Benjamin; Rubbo, Francesco; ...

2017-05-01

As machine learning algorithms become increasingly sophisticated to exploit subtle features of the data, they often become more dependent on simulations. Here, this paper presents a new approach called weakly supervised classification in which class proportions are the only input into the machine learning algorithm. Using one of the most challenging binary classification tasks in high energy physics $-$ quark versus gluon tagging $-$ we show that weakly supervised classification can match the performance of fully supervised algorithms. Furthermore, by design, the new algorithm is insensitive to any mis-modeling of discriminating features in the data by the simulation. Weakly supervisedmore » classification is a general procedure that can be applied to a wide variety of learning problems to boost performance and robustness when detailed simulations are not reliable or not available.« less

Weakly supervised classification in high energy physics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dery, Lucio Mwinmaarong; Nachman, Benjamin; Rubbo, Francesco

As machine learning algorithms become increasingly sophisticated to exploit subtle features of the data, they often become more dependent on simulations. Here, this paper presents a new approach called weakly supervised classification in which class proportions are the only input into the machine learning algorithm. Using one of the most challenging binary classification tasks in high energy physics $-$ quark versus gluon tagging $-$ we show that weakly supervised classification can match the performance of fully supervised algorithms. Furthermore, by design, the new algorithm is insensitive to any mis-modeling of discriminating features in the data by the simulation. Weakly supervisedmore » classification is a general procedure that can be applied to a wide variety of learning problems to boost performance and robustness when detailed simulations are not reliable or not available.« less

Optimal two-phase sampling design for comparing accuracies of two binary classification rules.

PubMed

Xu, Huiping; Hui, Siu L; Grannis, Shaun

2014-02-10

In this paper, we consider the design for comparing the performance of two binary classification rules, for example, two record linkage algorithms or two screening tests. Statistical methods are well developed for comparing these accuracy measures when the gold standard is available for every unit in the sample, or in a two-phase study when the gold standard is ascertained only in the second phase in a subsample using a fixed sampling scheme. However, these methods do not attempt to optimize the sampling scheme to minimize the variance of the estimators of interest. In comparing the performance of two classification rules, the parameters of primary interest are the difference in sensitivities, specificities, and positive predictive values. We derived the analytic variance formulas for these parameter estimates and used them to obtain the optimal sampling design. The efficiency of the optimal sampling design is evaluated through an empirical investigation that compares the optimal sampling with simple random sampling and with proportional allocation. Results of the empirical study show that the optimal sampling design is similar for estimating the difference in sensitivities and in specificities, and both achieve a substantial amount of variance reduction with an over-sample of subjects with discordant results and under-sample of subjects with concordant results. A heuristic rule is recommended when there is no prior knowledge of individual sensitivities and specificities, or the prevalence of the true positive findings in the study population. The optimal sampling is applied to a real-world example in record linkage to evaluate the difference in classification accuracy of two matching algorithms. Copyright © 2013 John Wiley & Sons, Ltd.

Introducing a design exigency to promote student learning through assessment: A case study.

PubMed

Grealish, Laurie A; Shaw, Julie M

2018-02-01

Assessment technologies are often used to classify student and newly qualified nurse performance as 'pass' or 'fail', with little attention to how these decisions are achieved. Examining the design exigencies of classification technologies, such as performance assessment technologies, provides opportunities to explore flexibility and change in the process of using those technologies. Evaluate an established assessment technology for nursing performance as a classification system. A case study analysis that is focused on the assessment approach and a priori design exigencies of performance assessment technology, in this case the Australian Nursing Standards Assessment Tool 2016. Nurse assessors are required to draw upon their expertise to judge performance, but that judgement is described as a source of bias, creating confusion. The definition of satisfactory performance is 'ready to enter practice'. To pass, the performance on each criterion must be at least satisfactory, indicating to the student that no further improvement is required. The Australian Nursing Standards Assessment Tool 2016 does not have a third 'other' category, which is usually found in classification systems. Introducing a 'not yet competent' category and creating a two-part, mixed methods assessment process can improve the Australian Nursing Standards Assessment Tool 2016 assessment technology. Using a standards approach in the first part, judgement is valued and can generate learning opportunities across a program. Using a measurement approach in the second part, student performance can be 'not yet competent' but still meet criteria for year level performance and a graded pass. Subjecting the Australian Nursing Standards Assessment Tool 2016 assessment technology to analysis as a classification system provides opportunities for innovation in design. This design innovation has the potential to support students who move between programs and clinicians who assess students from different universities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Recommended Values of Meteorological Factors to Be Considered in the Design of Aircraft Ice-Prevention Equipment

NASA Technical Reports Server (NTRS)

Jones, Alun R; Lewis, William

1949-01-01

Meteorological conditions conducive to aircraft icing are arranged in four classifications: three are associated with cloud structure and the fourth with freezing rain. The range of possible meteorological factors for each classification is discussed and specific values recommended for consideration in the design of ice-prevention equipment for aircraft are selected and tabulated. The values selected are based upon a study of the available observational data and theoretical considerations where observations are lacking. Recommendations for future research in the field are presented.

Pattern classification using charge transfer devices

NASA Technical Reports Server (NTRS)

1980-01-01

The feasibility of using charge transfer devices in the classification of multispectral imagery was investigated by evaluating particular devices to determine their suitability in matrix multiplication subsystem of a pattern classifier and by designing a protype of such a system. Particular attention was given to analog-analog correlator devices which consist of two tapped delay lines, chip multipliers, and a summed output. The design for the classifier and a printed circuit layout for the analog boards were completed and the boards were fabricated. A test j:g for the board was built and checkout was begun.

Image processing and applications based on visualizing navigation service

NASA Astrophysics Data System (ADS)

Hwang, Chyi-Wen

2015-07-01

When facing the "overabundant" of semantic web information, in this paper, the researcher proposes the hierarchical classification and visualizing RIA (Rich Internet Application) navigation system: Concept Map (CM) + Semantic Structure (SS) + the Knowledge on Demand (KOD) service. The aim of the Multimedia processing and empirical applications testing, was to investigating the utility and usability of this visualizing navigation strategy in web communication design, into whether it enables the user to retrieve and construct their personal knowledge or not. Furthermore, based on the segment markets theory in the Marketing model, to propose a User Interface (UI) classification strategy and formulate a set of hypermedia design principles for further UI strategy and e-learning resources in semantic web communication. These research findings: (1) Irrespective of whether the simple declarative knowledge or the complex declarative knowledge model is used, the "CM + SS + KOD navigation system" has a better cognition effect than the "Non CM + SS + KOD navigation system". However, for the" No web design experience user", the navigation system does not have an obvious cognition effect. (2) The essential of classification in semantic web communication design: Different groups of user have a diversity of preference needs and different cognitive styles in the CM + SS + KOD navigation system.

Flexible and composite structures for premium pavements. Volume 2, Design manual

DOT National Transportation Integrated Search

1980-11-01

This design manual presents the results of a detailed study to identify and design flexible and composite pavement configurations which will perform as premium or "zero-maintenance" pavements. This manual includes identification and classification of...

Habitat classification modelling with incomplete data: Pushing the habitat envelope

Treesearch

Phoebe L. Zarnetske; Thomas C. Edwards; Gretchen G. Moisen

2007-01-01

Habitat classification models (HCMs) are invaluable tools for species conservation, land-use planning, reserve design, and metapopulation assessments, particularly at broad spatial scales. However, species occurrence data are often lacking and typically limited to presence points at broad scales. This lack of absence data precludes the use of many statistical...

A CMOS VLSI IC for Real-Time Opto-Electronic Two-Dimensional Histogram Generation

DTIC Science & Technology

1993-12-01

large scale integration) design; MAGIC ; CMOS; optics; image processing; 93 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATiON 19...1. Sun SPARCstation ............. .............. 6 2. Magic .................. ................... 6 a. Peg ................. .................. 7 b...38 v APPENDIX B. MAGIC CELL LAYOUTS .... ............ .. 39 APPENDIX C: SIMULATION DATA ....... ............. .. 56 A. FINITE STATE MACHINE

Relationships between World Health Organization "International Classification of Functioning, Disability and Health" Constructs and Participation in Adults with Severe Mental Illness

ERIC Educational Resources Information Center

Sánchez, Jennifer; Rosenthal, David A.; Chan, Fong; Brooks, Jessica; Bezyak, Jill L.

2016-01-01

Purpose: To examine the World Health Organization "International Classification of Functioning, Disability and Health" (ICF) constructs as correlates of community participation of people with severe mental illnesses (SMI). Methods: Quantitative descriptive research design using multiple regression and correlational techniques was used to…

Thematic mapper design parameter investigation

NASA Technical Reports Server (NTRS)

Colby, C. P., Jr.; Wheeler, S. G.

1978-01-01

This study simulated the multispectral data sets to be expected from three different Thematic Mapper configurations, and the ground processing of these data sets by three different resampling techniques. The simulated data sets were then evaluated by processing them for multispectral classification, and the Thematic Mapper configuration, and resampling technique which provided the best classification accuracy were identified.

Abnormal Uterine Bleeding: Current Classification and Clinical Management.

PubMed

Bacon, Janice L

2017-06-01

Abnormal uterine bleeding is now classified and categorized according to the International Federation of Gynecology and Obstetrics classification system: PALM-COEIN. This applies to nongravid women during their reproductive years and allows more clear designation of causes, thus aiding clinical care and future research. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effects of Q-Matrix Design on Classification Accuracy in the Log-Linear Cognitive Diagnosis Model

ERIC Educational Resources Information Center

Madison, Matthew J.; Bradshaw, Laine P.

2015-01-01

Diagnostic classification models are psychometric models that aim to classify examinees according to their mastery or non-mastery of specified latent characteristics. These models are well-suited for providing diagnostic feedback on educational assessments because of their practical efficiency and increased reliability when compared with other…

An Ontology to Support the Classification of Learning Material in an Organizational Learning Environment: An Evaluation

ERIC Educational Resources Information Center

Valaski, Joselaine; Reinehr, Sheila; Malucelli, Andreia

2017-01-01

Purpose: The purpose of this research was to evaluate whether ontology integrated in an organizational learning environment may support the automatic learning material classification in a specific knowledge area. Design/methodology/approach: An ontology for recommending learning material was integrated in the organizational learning environment…

AAAS: Automated Affirmative Action System. General Description, Phase 1.

ERIC Educational Resources Information Center

Institute for Services to Education, Inc., Washington, DC. TACTICS Management Information Systems Directorate.

This document describes phase 1 of the Automated Affirmative Action System (AAAS) of the Tuskegee Institute, which was designed to organize an inventory of any patterns of job classification and assignment identifiable by sex or minority group; any job classification or organizational unit where women and minorities are not employed or are…

New Approach to Analyzing Physics Problems: A Taxonomy of Introductory Physics Problems

ERIC Educational Resources Information Center

Teodorescu, Raluca E.; Bennhold, Cornelius; Feldman, Gerald; Medsker, Larry

2013-01-01

This paper describes research on a classification of physics problems in the context of introductory physics courses. This classification, called the Taxonomy of Introductory Physics Problems (TIPP), relates physics problems to the cognitive processes required to solve them. TIPP was created in order to design educational objectives, to develop…

A Classification Scheme for Adult Education. Education Libraries Bulletin, Supplement Twelve.

ERIC Educational Resources Information Center

Greaves, Monica A., Comp.

This classification scheme, based on the 'facet formula' theory of Ranganathan, is designed primarily for the library of the National Institute of Adult Education in London, England. Kinds of persons being educated (educands), methods and problems of education, specific countries, specific organizations, and forms in which the information is…

[The classification of ceramics according to its chemical nature and its method of production].

PubMed

Moureau, Thomas; Bouhy, Alice; Raepsaet, Nicolas; Vanheusden, Alain

2006-01-01

Nowadays, we find on the market a huge amount of design and manufactured system that allows the realisation of all-ceramics restorations, using different ceramics. The purpose of this article is suggesting a classification of mostly used ceramics and a few laboratory process used in our university.

The Use of the Mayo Clinic System for Differential Diagnosis of Dysarthria.

ERIC Educational Resources Information Center

Simmons, Katharine C.; Mayo, Robert

1997-01-01

A survey of 100 speech-language pathologists involved in the assessment and treatment of patients with dysarthria investigated their attitudes toward the Darley, Aronson, and Brown (DAB) method of classification. Results indicated that most clinicians, believing it helps in the design of a treatment protocol, used the DAB classification system.…

Identification and classification of similar looking food grains

NASA Astrophysics Data System (ADS)

Anami, B. S.; Biradar, Sunanda D.; Savakar, D. G.; Kulkarni, P. V.

2013-01-01

This paper describes the comparative study of Artificial Neural Network (ANN) and Support Vector Machine (SVM) classifiers by taking a case study of identification and classification of four pairs of similar looking food grains namely, Finger Millet, Mustard, Soyabean, Pigeon Pea, Aniseed, Cumin-seeds, Split Greengram and Split Blackgram. Algorithms are developed to acquire and process color images of these grains samples. The developed algorithms are used to extract 18 colors-Hue Saturation Value (HSV), and 42 wavelet based texture features. Back Propagation Neural Network (BPNN)-based classifier is designed using three feature sets namely color - HSV, wavelet-texture and their combined model. SVM model for color- HSV model is designed for the same set of samples. The classification accuracies ranging from 93% to 96% for color-HSV, ranging from 78% to 94% for wavelet texture model and from 92% to 97% for combined model are obtained for ANN based models. The classification accuracy ranging from 80% to 90% is obtained for color-HSV based SVM model. Training time required for the SVM based model is substantially lesser than ANN for the same set of images.

Deep multi-scale convolutional neural network for hyperspectral image classification

NASA Astrophysics Data System (ADS)

Zhang, Feng-zhe; Yang, Xia

2018-04-01

In this paper, we proposed a multi-scale convolutional neural network for hyperspectral image classification task. Firstly, compared with conventional convolution, we utilize multi-scale convolutions, which possess larger respective fields, to extract spectral features of hyperspectral image. We design a deep neural network with a multi-scale convolution layer which contains 3 different convolution kernel sizes. Secondly, to avoid overfitting of deep neural network, dropout is utilized, which randomly sleeps neurons, contributing to improve the classification accuracy a bit. In addition, new skills like ReLU in deep learning is utilized in this paper. We conduct experiments on University of Pavia and Salinas datasets, and obtained better classification accuracy compared with other methods.

[Orthotic management for patients with osteogenesis imperfecta].

PubMed

Alguacil Diego, I M; Molina Rueda, F; Gómez Conches, M

2011-02-01

Osteogenesis imperfecta (OI) is a disease caused by a genetic defect in the qualitative and quantitative synthesis of type I collagen. There is a wide variation in its clinical signs, characterized by bone fragility, resulting in a bone vulnerable to external and internal forces, determining the occurrence of frequent fractures with minimal or no trauma. The therapeutic objective is directed to improve the functional capacity of the child or adult concerned, adopting those compensatory strategies to optimise their independence. In this sense, the use of different orthoses and assistive technology are important for achieving these objectives. We reviewed the main contributions to this orthotic disease and the evolution of the different devices used in different databases over the last 25 years. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Critical review on non-operative management of adolescent idiopathic scoliosis.

PubMed

Wong, M S; Liu, W C

2003-12-01

There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.

14 CFR 21.319 - Design changes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Design changes. 21.319 Section 21.319... PROCEDURES FOR PRODUCTS AND PARTS Approval of Materials, Parts, Processes, and Appliances § 21.319 Design changes. Pt. 21, Subpt. K, Nt. (a) Classification of design changes. (1) A “minor change” to the design of...

Evidence for the Existing American Nurses Association-Recognized Standardized Nursing Terminologies: A Systematic Review

PubMed Central

Tastan, Sevinc; Linch, Graciele C. F.; Keenan, Gail M.; Stifter, Janet; McKinney, Dawn; Fahey, Linda; Dunn Lopez, Karen; Yao, Yingwei; Wilkie, Diana J.

2014-01-01

Objective To determine the state of the science for the five standardized nursing terminology sets in terms of level of evidence and study focus. Design Systematic Review. Data sources Keyword search of PubMed, CINAHL, and EMBASE databases from 1960s to March 19, 2012 revealed 1,257 publications. Review Methods From abstract review we removed duplicate articles, those not in English or with no identifiable standardized nursing terminology, and those with a low-level of evidence. From full text review of the remaining 312 articles, eight trained raters used a coding system to record standardized nursing terminology names, publication year, country, and study focus. Inter-rater reliability confirmed the level of evidence. We analyzed coded results. Results On average there were 4 studies per year between 1985 and 1995. The yearly number increased to 14 for the decade between 1996–2005, 21 between 2006–2010, and 25 in 2011. Investigators conducted the research in 27 countries. By evidence level for the 312 studies 72.4% were descriptive, 18.9% were observational, and 8.7% were intervention studies. Of the 312 reports, 72.1% focused on North American Nursing Diagnosis-International, Nursing Interventions Classification, Nursing Outcome Classification, or some combination of those three standardized nursing terminologies; 9.6% on Omaha System; 7.1% on International Classification for Nursing Practice; 1.6% on Clinical Care Classification/Home Health Care Classification; 1.6% on Perioperative Nursing Data Set; and 8.0% on two or more standardized nursing terminology sets. There were studies in all 10 foci categories including those focused on concept analysis/classification infrastructure (n = 43), the identification of the standardized nursing terminology concepts applicable to a health setting from registered nurses’ documentation (n = 54), mapping one terminology to another (n = 58), implementation of standardized nursing terminologies into electronic health records (n = 12), and secondary use of electronic health record data (n = 19). Conclusions Findings reveal that the number of standardized nursing terminology publications increased primarily since 2000 with most focusing on North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification. The majority of the studies were descriptive, qualitative, or correlational designs that provide a strong base for understanding the validity and reliability of the concepts underlying the standardized nursing terminologies. There is evidence supporting the successful integration and use in electronic health records for two standardized nursing terminology sets: (1) the North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification set; and (2) the Omaha System set. Researchers, however, should continue to strengthen standardized nursing terminology study designs to promote continuous improvement of the standardized nursing terminologies and use in clinical practice. PMID:24412062

The Changing Metropolitan Designation Process and Rural America

ERIC Educational Resources Information Center

Slifkin, Rebecca T.; Randolph, Randy; Ricketts, Thomas C.

2004-01-01

In June 2003, the Office of Management and Budget (OMB) released new county-based designations of Core Based Statistical Areas (CBSAs), replacing Metropolitan Statistical Area designations that were last revised in 1990. In this article, the new designations are briefly described, and counties that have changed classifications are identified.…

Development of high integrity, maximum durability concrete structures for LLW disposal facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, W.P.

1992-05-01

A number of disposal facilities for Low-Level Radioactive Wastes have been planned for the Savannah River Site. Design has been completed for disposal vaults for several waste classifications and construction is nearly complete or well underway on some facilities. Specific design criteria varies somewhat for each waste classification. All disposal units have been designed as below-grade concrete vaults, although the majority will be above ground for many years before being encapsulated with earth at final closure. Some classes of vaults have a minimum required service life of 100 years. All vaults utilize a unique blend of cement, blast furnace slagmore » and pozzolan. The design synthesizes the properties of the concrete mix with carefully planned design details and construction methodologies to (1) eliminate uncontrolled cracking; (2) minimize leakage potential; and (3) maximize durability. The first of these vaults will become operational in 1992. 9 refs.« less

Development of high integrity, maximum durability concrete structures for LLW disposal facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, W.P.

1992-01-01

A number of disposal facilities for Low-Level Radioactive Wastes have been planned for the Savannah River Site. Design has been completed for disposal vaults for several waste classifications and construction is nearly complete or well underway on some facilities. Specific design criteria varies somewhat for each waste classification. All disposal units have been designed as below-grade concrete vaults, although the majority will be above ground for many years before being encapsulated with earth at final closure. Some classes of vaults have a minimum required service life of 100 years. All vaults utilize a unique blend of cement, blast furnace slagmore » and pozzolan. The design synthesizes the properties of the concrete mix with carefully planned design details and construction methodologies to (1) eliminate uncontrolled cracking; (2) minimize leakage potential; and (3) maximize durability. The first of these vaults will become operational in 1992. 9 refs.« less

On Classification in the Study of Failure, and a Challenge to Classifiers

NASA Technical Reports Server (NTRS)

Wasson, Kimberly S.

2003-01-01

Classification schemes are abundant in the literature of failure. They serve a number of purposes, some more successfully than others. We examine several classification schemes constructed for various purposes relating to failure and its investigation, and discuss their values and limits. The analysis results in a continuum of uses for classification schemes, that suggests that the value of certain properties of these schemes is dependent on the goals a classification is designed to forward. The contrast in the value of different properties for different uses highlights a particular shortcoming: we argue that while humans are good at developing one kind of scheme: dynamic, flexible classifications used for exploratory purposes, we are not so good at developing another: static, rigid classifications used to trap and organize data for specific analytic goals. Our lack of strong foundation in developing valid instantiations of the latter impedes progress toward a number of investigative goals. This shortcoming and its consequences pose a challenge to researchers in the study of failure: to develop new methods for constructing and validating static classification schemes of demonstrable value in promoting the goals of investigations. We note current productive activity in this area, and outline foundations for more.