Review
Biotechnology & Applied Microbiology
Julio S. Lora-Millan, Mahdi Nabipour, Edwin van Asseldonk, Cristina Bayon
Summary: Assistive ankle-foot orthoses (AAFOs) are powerful solutions for gait assistance or rehabilitation. This research analyzes the latest AAFO technologies and categorizes the different approaches into clusters based on their basis and working principles. It also reviews the purpose and experimental validation of the devices, providing insights into their technology readiness level. The reviewed designs, limitations, and future directions in this field are summarized and discussed.
FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY
(2023)
Article
Engineering, Biomedical
Sumiko Yamamoto, Naoyuki Motojima, Yosuke Kobayashi, Yuji Osada, Souji Tanaka, Aliyeh Daryabor
Summary: This study compared the effects of using an ankle-foot orthosis (AFO) with plantarflexion stiffness but without dorsiflexion resistance (AFO-OD) and a nonarticulated AFO on gait improvement in stroke patients. The results showed that the AFO-OD group exhibited greater improvement in ankle joint kinematics and kinetics compared to the nonarticulated AFO group. However, the results of peak power absorption varied greatly among patients.
JOURNAL OF NEUROENGINEERING AND REHABILITATION
(2022)
Article
Neurosciences
Yusuke Sekiguchi, Keita Honda, Dai Owaki, Shin-Ichi Izumi
Summary: Categorization based on quasi-joint stiffness (QJS) can help clinicians select appropriate ankle foot orthoses (AFOs) for patients after stroke. The study classified gait patterns based on ankle joint stiffness into three subgroups, with significant differences in the proportion of AFO, articulated AFO, and non-articulated AFO used among the subgroups.
Article
Chemistry, Analytical
Pedro Fonseca, Leandro Machado, Manoela Vieira Sousa, Ricardo Sebastiao, Filipa Sousa, Joana Figueiredo, Cristina P. Santos, Joao Paulo Vilas-Boas
Summary: The study found that using an ankle foot orthosis in passive mode at a constant speed does not significantly affect minimum foot clearance, but can alter gait linear and angular parameters.
Article
Biotechnology & Applied Microbiology
Guillermo Asin-Prieto, Silvana Mercante, Raul Rojas, Mariangeles Navas, Daiana Gomez, Melisa Toledo, Aitor Martinez-Exposito, Juan C. Moreno
Summary: This study investigated the effects of passive stretching, combined with active and resisted movement, accompanied by visual feedback, using a low-cost monoarticular robot (MEXO) in patients with stroke sequelae and spastic ankle. The results showed significant improvements in joint range, balance, and walking capacity.
FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY
(2022)
Review
Engineering, Biomedical
Hua Ling, Hui Guo, Hao Zhou, Xiao-Qian Chang, Zi-Yang Guo, Sumiko Yamamoto, Li-Fei Cai, Jun Zhao
Summary: This study investigated the effects of different types of ankle foot orthosis (AFO) on pelvic and thoracic movements in stroke patients during gait. The results showed that the use of AFO-OD improved pelvic and lower limb movements and had better gait performance compared to RAFO. However, the use of AFO resulted in in-phase rotation of the thoracic, indicating insufficient trunk control and dissociation movement. These findings have important implications for gait rehabilitation in stroke patients.
BIOMEDICAL ENGINEERING ONLINE
(2023)
Article
Sport Sciences
Perri A. Johnson Jr, Max R. Paquette, Denis J. Diangelo
Summary: This study compared tibial compressive force and ankle motion during walking between a dynamic ankle orthosis (DAO) and an orthopedic walking boot. The findings showed that the DAO moderately reduced tibial compressive force and Achilles tendon force, and allowed more sagittal ankle excursion during treadmill walking.
MEDICINE & SCIENCE IN SPORTS & EXERCISE
(2023)
Article
Engineering, Biomedical
N. F. J. Waterval, M. M. van der Krogt, K. Veerkamp, T. Geijtenbeek, J. Harlaar, F. Nollet, M. A. Brehm
Summary: Using predictive simulations, this study investigated the effects of plantarflexor weakness, passive plantarflexor stiffness, body mass, and walking speed on the optimal stiffness of a dorsal leaf AFO for reducing walking energy cost. The results showed that the severity of plantarflexor weakness had the greatest impact on the required AFO stiffness, while walking speed, passive muscle stiffness, and body mass had less influence.
JOURNAL OF NEUROENGINEERING AND REHABILITATION
(2023)
Article
Rehabilitation
Wyatt D. Ihmels, Kelly A. Ohm, Simisola Oludare, Jonathan Elrod, Elizabeth Russell Esposito
Summary: The study compared the metabolic demands of walking in individuals with lower limb injury with and without ankle-foot orthosis (AFO) use. The results showed that the use of AFO did not significantly affect the energetic demand in participants with a lower limb injury. Although the heart rate was higher compared to able-bodied controls, the perceived exertion was significantly lower. There were no significant differences between participants with a lower limb injury (with or without the AFO) and individuals with unilateral transtibial amputation (TTA).
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
(2022)
Article
Biotechnology & Applied Microbiology
Guillermo Asin-Prieto, Filipe Oliveira Barroso, Aitor Martinez-Exposito, Eloy Urendes, Jose Gonzalez-Vargas, Juan C. Moreno
Summary: This study aimed to improve ankle muscle function through the application of motorized ankle foot orthoses (MAFOs). Two different ankle disturbances were successfully tested and the adaptation of ankle muscles and co-activation of antagonists were assessed. The results showed that dorsiflexion torque enhanced tibialis anterior activation and plantarflexion torque increased gastrocnemius medialis activation. These novel disturbance approaches have potential applications in ankle rehabilitation.
FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY
(2023)
Article
Orthopedics
Jeffrey W. Hoffman, Rogerio C. Bitar, Nicholas Williams, Brett D. Steineman, Daniel R. Sturnick, Glenn W. Garrison, Constantine A. Demetracopoulos, Mark C. Drakos, Martin J. O'Malley
Summary: This study aimed to investigate the effects of different foot orthotic constructs on strains in the proximal fifth metatarsal bone and explore the relationships between structural features of the foot and corresponding strains. The results showed that the use of orthotic devices reduced the strains in the fifth metatarsal bone, and these strains were associated with certain foot structural features.
AMERICAN JOURNAL OF SPORTS MEDICINE
(2022)
Article
Biophysics
N. F. J. Waterval, M. A. Brehm, K. Veerkamp, T. Geijtenbeek, J. Harlaar, F. Nollet, M. M. van der Krogt
Summary: In order to maximize the effects of dorsal leaf ankle foot orthoses (AFOs) on gait in people with bilateral plantarflexor weakness, the AFO properties should be matched to the individual. This study investigated the interaction of AFO bending stiffness with neutral angle and footplate stiffness on gait function. The results showed that higher AFO bending stiffness and dorsiflexion of the neutral angle minimized energy cost of walking and normalized joint kinematics and kinetics.
JOURNAL OF BIOMECHANICS
(2023)
Article
Chemistry, Analytical
Paolo Capodaglio, Michele Gobbi, Lucia Donno, Andrea Fumagalli, Camillo Buratto, Manuela Galli, Veronica Cimolin
Summary: This retrospective study quantified the 3D knee and ankle joint kinematics and kinetics during walking in young individuals with different degrees of obesity, revealing significant differences in mechanical aspects at the knee and ankle joints compared to healthy-weight participants. These findings suggest a potential pathway by which obesity may increase the risk of osteoarthritis in healthy adults.
Article
Physics, Fluids & Plasmas
Daniel Renjewski, Susanne Lipfert, Michael Guenther
Summary: This article proposes a mathematical model that captures the dynamics of human foot during walking and analyzes the functional interplay of biomechanical contributors. It identifies the foot as the key functional element in walking and provides insights for gait therapy, assistive device development, and humanoid robot design and control.
Article
Multidisciplinary Sciences
Antonio Rodriguez-Fernandez, Joan Lobo-Prat, Rafael Tarrago, Diego Chaverri, Xavier Iglesias, Lluis Guirao-Cano, Josep M. Font-Llagunes
Summary: This study compared the effectiveness of a knee-powered lower limb exoskeleton against conventional knee-ankle-foot orthoses in individuals with spinal cord injury. The knee-powered exoskeleton showed improvement in gait kinematics but did not significantly enhance walking performance or reduce energy consumption in comparison to passive orthoses.
SCIENTIFIC REPORTS
(2022)
Article
Neurosciences
N. F. J. Waterval, M. A. Brehm, J. Harlaar, F. Nollet
Summary: Individuals with unilateral plantar flexor weakness exhibit higher impact forces on the contralateral leg compared to healthy subjects. Energy cost optimized dorsiflexion leaf AFOs can significantly reduce this force and improve impact symmetry in individuals with unilateral plantar flexor weakness.
Review
Orthopedics
J. Harlaar, E. M. Macri, M. Wesseling
Summary: Osteoarthritis (OA) is a complex disease with a partly understood etiology. Recent research advancements in biomechanics have brought us closer to designing targeted treatments for OA. Innovations in technology-based instruments, combined with machine learning models, have expanded the applicability of biomechanics. Combining biomechanics with imaging has improved precision and personalization. The combination of Musculoskeletal & Finite Element Models has yielded valid personalized cartilage loads. Mechanical outcomes are increasingly meaningful for informing and evaluating treatments, including predictive power from biomechanical models. Future research should focus on clinical workflows to incorporate precision biomechanics into large scale studies, ultimately leading to clinical tools for decision making and new therapies in OA.
OSTEOARTHRITIS AND CARTILAGE
(2022)
Article
Rehabilitation
Jana Tuijtelaars, Martine Jeukens-Visser, Frans Nollet, Merel-Anne Brehm
Summary: This study explored factors associated with walking adaptability and found that leg muscle weakness and reduced balance confidence are limiting factors for walking adaptability in polio survivors. The study also revealed that target-stepping performance is related to falling. These findings are important for fall prevention in polio survivors.
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
(2022)
Article
Engineering, Biomedical
N. F. J. Waterval, V. L. Meekes, M. T. Hooijmans, M. Froeling, R. T. Jaspers, J. Oudeman, A. J. Nederveen, M. A. Brehm, F. Nollet
Summary: This study investigated the changes in plantar flexor function during walking in individuals with neuromuscular diseases using diffusion tensor imaging and T2 imaging. The results showed a correlation between T2 relaxation time and plantar flexor strength, ankle moment, and power, while fractional anisotropy and mean diffusivity were only related to plantar flexor strength.
CLINICAL BIOMECHANICS
(2022)
Article
Neurosciences
Jana Tuijtelaars, Merel-Anne Brehm, Frans Nollet, Melvyn Roerdink
Summary: This study demonstrated the validity and reproducibility of the C-Mill walking-adaptability assessment in polio survivors. Adding walking-adaptability assessment, particularly the more challenging tests, to currently used clinical tests could improve fall-risk evaluation in this population.
Article
Chemistry, Analytical
Dylan den Hartog, Marjolein M. van der Krogt, Sven van der Burg, Ignazio Aleo, Johannes Gijsbers, Laura A. Bonouvrie, Jaap Harlaar, Annemieke Buizer, Helga Haberfehlner
Summary: Accurate measurement of the severity of dystonia is crucial for treatment. This study investigates the feasibility of using home-based measurements, such as smartphone-coupled sensors and machine learning, to assess and evaluate dystonia. The results show that individual models can automatically detect dystonia, providing frequent and objective assessments that enhance clinical care.
Letter
Physiology
Kirsten Veerkamp, Marjolein M. van der Krogt, Niels F. J. Waterval, Thomas Geijtenbeek, Henry P. J. Walsh, Jaap Harlaar, Annemieke I. Buizer, David G. Lloyd, Christopher P. Carty
EXPERIMENTAL PHYSIOLOGY
(2022)
Editorial Material
Cardiac & Cardiovascular Systems
Niels F. J. Waterval, Merel-Anne Brehm
INTERNATIONAL JOURNAL OF CARDIOLOGY
(2023)
Article
Multidisciplinary Sciences
Elza van Duijnhoven, Fieke S. Koopman, Hilde E. Ploeger, Frans Nollet, Merel-Anne Brehm
Summary: This study found that specialized care orthoses provided better treatment outcomes compared to usual care orthoses for adults with NMD. Guideline-based orthotic care within a multidisciplinary expertise setting could improve goal attainment and walking ability.
Review
Rehabilitation
Sander Oorschot, Merel-Anne Brehm, Joost Daams, Frans Nollet, Eric Lucas Voorn
Summary: This study summarized the evidence on the efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases (NMDs). The findings showed that aerobic exercise can improve aerobic capacity directly post-intervention, but the long-term efficacy remains unclear.
ANNALS OF PHYSICAL AND REHABILITATION MEDICINE
(2023)
Article
Clinical Neurology
Laura M. M. Oudenhoven, Marjolein M. M. Van Der Krogt, Sanne Ettema, Karin Roeleveld, Merel A. A. Brehm, Annemieke I. I. Buizer
Summary: This study aimed to investigate the effects of fatigue on kinematics, kinetics, and energy cost of walking in children with cerebral palsy. The results showed that kinematic deviations occurred in children with cerebral palsy during prolonged walking, while kinetics and energy cost of walking did not significantly change. Therefore, an individualized approach is recommended to study the effects of physical fatigue on gait in clinical practice.
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY
(2023)
Article
Engineering, Biomedical
Kirsten Veerkamp, Christopher P. Carty, Niels F. J. Waterval, Thomas Geijtenbeek, Annemieke I. Buizer, David G. Lloyd, Jaap Harlaar, Marjolein M. van der Krogt
Summary: Spasticity contributes to gait deviations in children with neuromusculoskeletal disorders. This study used predictive simulations to evaluate the pathophysiological mechanisms underlying these deviations. The analysis extracted distinct gait patterns, and the simulation framework predicted gait with velocity- or force-based hyperreflexia. The study found that velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, providing insights for targeted treatment.
JOURNAL OF APPLIED BIOMECHANICS
(2023)
Article
Biophysics
N. F. J. Waterval, M. A. Brehm, K. Veerkamp, T. Geijtenbeek, J. Harlaar, F. Nollet, M. M. van der Krogt
Summary: In order to maximize the effects of dorsal leaf ankle foot orthoses (AFOs) on gait in people with bilateral plantarflexor weakness, the AFO properties should be matched to the individual. This study investigated the interaction of AFO bending stiffness with neutral angle and footplate stiffness on gait function. The results showed that higher AFO bending stiffness and dorsiflexion of the neutral angle minimized energy cost of walking and normalized joint kinematics and kinetics.
JOURNAL OF BIOMECHANICS
(2023)
Article
Rehabilitation
Jana Tuijtelaars, Max Keller, Frans Nollet, Merel-Anne Brehm, Jaap van Dieen, Melvyn Roerdink
Summary: This study investigated the fatigue experienced by polio survivors during 6-min walking and how it influenced their normal and adaptive walking. The results showed that leg-muscle activation declined over time during adaptive walking and cardiorespiratory fatigue increased during all tests, especially in polio survivors. Furthermore, walking adaptability was further degraded by cardiorespiratory fatigue during narrow-beam walking in polio survivors. These findings suggest that fatigue might increase the risk of falls among polio survivors.
JOURNAL OF REHABILITATION MEDICINE
(2022)
Article
Rehabilitation
Bart Raijmakers, Roelofine A. Berendsen-De Gooijer, Hilde E. Ploeger, Fieke S. Koopman, Frans Nollet, Merel-Anne Brehm
Summary: This study investigated the use of custom-made knee-ankle-foot orthoses in daily life and the differences in usability factors between users and discontinued users among polio survivors. The majority of survivors used their knee-ankle-foot orthoses in daily life. Factors related to continued use include walking ability without orthosis, expectations of the orthosis, previous orthosis experience, and type of knee-ankle-foot orthosis provided.
JOURNAL OF REHABILITATION MEDICINE
(2022)