Search Results (80)

Background: Prader–Willi syndrome (PWS) is a rare syndrome that presents in about 1 in 25,000 newborns. It is characterized by a typical phenotype that includes short stature, hypothyroidism and hypogonadism, cognitive and developmental delays, slow growth, obesity, and, in most patients, scoliosis. These patients generally have a life expectancy of less than 60 years, with respiratory distress being the leading cause of death; scoliosis is not the primary cause of these respiratory problems, but may contribute to their worsening. Therefore, accurately diagnosing and managing scoliosis is crucial for improving the life expectancy of PWS patients. Previous studies have shown a limited effectiveness of bracing due to a combination of factors, including generalized hypotonia, rapid early progression, poor brace compliance, and thus frequent progression to surgical intervention. Case presentation: This case report presents a 20-year follow-up of a female patient with PWS. Multiple clinical parameters were collected at every follow-up appointment. Throughout this extended observation and treatment period, the patient used two push-up braces of different rigidity, resulting in improvements in the thoracic and lumbar Cobb angle and the thoracic angle of trunk rotation. The treatment protocol was based on a shared decision with the parents and the patient. Conclusions: This case demonstrates how consistent and thorough follow-up can result in a successful, conservative treatment of a severe secondary scoliosis, thereby preventing the need for a major surgical procedure during growth. Full article

Ankle-foot orthoses (AFOs) are widely used to improve gait; nonetheless, it remains unclear how specific settings, particularly the dorsiflexion angle, affect gait kinematics in individuals with stroke. This study investigated the effect of different AFO dorsiflexion angles on gait kinematics in ambulatory adults with hemiparesis. Twenty-six individuals with post-stroke hemiparesis walked on a treadmill while wearing the same type of AFO at four ankle dorsiflexion angles: 0°, 5°, 10°, and 15°. Temporal-spatial variables, joint angles, and toe clearance and its components were quantified using three-dimensional analysis. The double-stance time before the paretic swing shortened significantly with increasing dorsiflexion angle, whereas the mean stride time and length did not significantly change. During the swing phase, increased AFO dorsiflexion was associated with reduced maximal knee flexion, in addition to its direct effect on ankle angles. The absolute toe clearance height was unaffected by the AFO settings; however, the contribution of ankle dorsiflexion to limb shortening increased stepwise from 0° to 15°, and the hip elevation and compensatory movement ratio declined. In conclusion, increasing the AFO dorsiflexion angle significantly altered gait kinematics, with distal ankle mechanics replacing inefficient hip compensation and reducing double-stance time. Full article

Background: Shoulder subluxation and pain are common complications of stroke that impair upper limb function. Objectives: This study conducted a systematic review and network meta-analysis to compare multiple therapeutic interventions for post-stroke shoulder subluxation, establishing an evidence-based hierarchy of treatment efficacy to optimize rehabilitation strategies and guide clinical practice. Methods: A comprehensive search was conducted using the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases until 8 August 2025. Randomized controlled trials evaluating treatments for shoulder subluxation, including neuromuscular electrical stimulation (NMES), Kinesio taping, corticosteroid injections, slings, repetitive peripheral magnetic stimulation, and electroacupuncture, were included. The follow-up duration in the included trials ranged from 1 to 12 weeks. Effect sizes were calculated using standardized mean differences with a random-effects model, and treatment rankings were determined using surface under the cumulative ranking curve (SUCRA). Results: Thirteen studies including 402 patients were analyzed. NMES was the most effective intervention for reducing subluxation distance (SUCRA: 84.9), while corticosteroid injections provided the greatest pain relief at rest (SUCRA: 73.6). Kinesio taping was most effective for functional recovery, as measured by the Fugl–Meyer Assessment (SUCRA: 98.5), and for pain relief during activity (SUCRA: 87.7). Conclusions: Our network meta-analysis suggests that different interventions are optimal for specific aspects of post-stroke shoulder impairment. NMES most effectively reduces subluxation distance, whereas corticosteroid injections are most effective for alleviating pain at rest. Kinesio taping appears superior for enhancing functional recovery and reducing pain during movement. These findings, based on short-term follow-up durations (1–12 weeks), provide an evidence-based ranking of interventions to support multimodal rehabilitation and inform clinical decision-making. The observed heterogeneity across studies underscores the need for standardized treatment protocols and rigorous long-term investigations. Full article

Orthoses are external devices designed to provide structural and functional support for disorders affecting the musculoskeletal or nervous systems. While these devices have a long history, recent technological advancements offer significant opportunities to enhance their therapeutic performance. This review examines three key innovations shaping the future of orthotic devices: additive manufacturing, auxetic metamaterials, and smart sensors. Additive manufacturing (AM), commonly known as 3D printing, is gaining prominence for its ability to create patient-specific solutions, improve design flexibility, and reduce production time. Despite these advantages, traditional fabrication methods remain dominant due to cost and regulatory challenges. Auxetic metamaterials, characterized by a negative Poisson’s ratio, allow an orthosis to dynamically conform to the patient’s anatomy and movements while maintaining stability and comfort. Thanks to synclastic deformation, auxetic structures reduce the formation of wrinkles during motion, improving body fit, and potentially enhancing comfort as well as adherence to orthosis usage recommendations. However, their integration into orthoses is still in the early stages, requiring further research and clinical validation. Finally, smart sensors have been extensively studied for the real-time monitoring of joint movement and rehabilitation progress, enabling personalized therapy and improved clinical outcomes. In conclusion, these emerging technologies—additive manufacturing, auxetic metamaterials, and smart sensors—hold great promise for next-generation orthotic devices, but widespread adoption will depend on addressing technical, economic, and practical limitations. Full article

Background and Objectives: Three-dimensional (3D) scanning is increasingly utilized in medical practice, from orthotics to surgical planning. However, traditional hand measurement techniques remain inconsistent and prone to human error and are often time-consuming. This research evaluates the practicality of a commercial 3D scanning method by comparing the accuracy of scans conducted by two user groups. Materials and Methods: This study evaluated the following two groups: an experimental group (n = 45) and a control group (n = 42). A total of 261 hand scans were captured using the Structure Sensor Pro 3D scanner for iPad (Structure, Boulder, CO, USA). The scans were then evaluated using Meshmixer software (version 3.5.474), analyzing key parameters, such as surface area, volume, number of vertices, and triangles, etc. Furthermore, a digital literacy test and a user experience survey were conducted to support a more comprehensive evaluation of participant performance within the study. Results: The experimental group outperformed the control group on all measured parameters, including surface area, volume, vertices, triangle, and gap count, with large effect sizes observed. User experience data revealed that participants in the experimental group rated the 3D scanner significantly higher across all dimensions, particularly in ease of use, excitement, supportiveness, and practicality. Conclusions: A short 15 min training session can promote scan reliability, demonstrating that even minimal instruction improves users’ proficiency in 3D scanning, fundamental for supporting clinical accuracy in diagnosis, surgical planning, and personalized device manufacturing Full article

Nowadays, Fused Filament Fabrication (FFF) 3D printing offers promising opportunities for the customized manufacturing of ankle–foot orthoses (AFOs) targeted towards rehabilitation purposes. Polypropylene (PP) represents an ideal candidate in orthotic applications due to its light weight and superior mechanical properties, offering an excellent balance between flexibility, chemical resistance, biocompatibility, and long-term durability. However, Additive Manufacturing (AM) of AFOs based on PP remains a major challenge due to its limited bed adhesion and high shrinkage, especially for making large parts such as AFOs. The primary innovation of the present study lies in the optimization of FFF 3D printing parameters for the fabrication of functional, patient-specific orthoses using PP, a material still underutilized in the AM of medical devices. Firstly, a thorough thermomechanical characterization was conducted, allowing the implementation of a (thermo-)elastic material model for the used PP filament. Thereafter, a Taguchi design of experiments (DOE) was established to study the influence of several printing parameters (extrusion temperature, printing speed, layer thickness, infill density, infill pattern, and part orientation) on the mechanical properties of 3D-printed specimens. Three-point bending tests were conducted to evaluate the strength and stiffness of the samples, while additional tensile tests were performed on the 3D-printed orthoses using a home-made innovative device to validate the optimal configurations. The results showed that the maximum flexural modulus of 3D-printed specimens was achieved when the printing speed was around 50 mm/s. The most significant parameter for mechanical performance and reduction in printing time was shown to be infill density, contributing 73.2% to maximum stress and 75.2% to Interlaminar Shear Strength (ILSS). Finally, the applicability of the finite element method (FEM) to simulate the FFF process-induced deflections, part distortion (warpage), and residual stresses in 3D-printed orthoses was investigated using a numerical simulation tool (Digimat-AM^®). The combination of Taguchi DOE with Digimat-AM for polypropylene AFOs highlighted that the 90° orientation appeared to be the most suitable configuration, as it minimizes deformation and von Mises stress, ensuring improved quality and robustness of the printed orthoses. The findings from this study contribute by providing a reliable method for printing PP parts with improved mechanical performance, thereby opening new opportunities for its use in medical-grade additive manufacturing. Full article

Background: Charcot-Marie-Tooth (CMT) disease is a hereditary motor and sensory neuropathy that affects foot morphology and gait patterns, potentially leading to abnormal plantar pressure distribution. This systematic review synthesizes the existing literature examining plantar pressure characteristics in CMT patients. Methods: A comprehensive search was conducted across PubMed, Scopus, and Web of Science databases. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Six studies comprising 146 patients were included. Four studies employed dynamic baropodometry, and two used in-shoe pressure sensors to evaluate the main plantar pressure parameters. The findings were consistent across different populations and devices, with a characteristic plantar-pressure profile of marked midfoot off-loading with peripheral overload at the forefoot and rearfoot, often accompanied by a lateralized center-of-pressure path and a prolonged pressure–time exposure. These alterations reflect both structural deformities and impaired neuromuscular control. Interventional studies demonstrated a load redistribution of pressure after corrective surgery, though residual lateral overload often persists. Conclusions: Plantar pressure mapping seems to be a valuable tool to identify high-pressure zones of the foot in order to personalize orthotic treatment planning, to objectively monitor disease progression, and to evaluate therapeutic efficacy. Further longitudinal studies with standardized protocols are needed to confirm these results. Full article

Orthotics are often used to support the metacarpophalangeal joint (MCPj) in horses recovering from soft tissue injury; however, their effect on the MCPj biomechanics remain largely underexplored. The MCPj moves primarily in the sagittal plane, flexing during the swing phase and extending during the stance phase. The suspensory ligament and flexor tendons act as biological springs resisting MCPj extension. Injuries to these structures are common and, although early mobilization promotes their healing, controlled loading may be beneficial during rehabilitation. This study aims to evaluate the efficacy of a semirigid orthotic in limiting the MCPj extension and the MCPj range of motion, and its influence on the MCPj kinematics. Twelve healthy horses were equipped with portable inertial sensors on the distal limb. The MCPj extension and the MCPj range of motion were assessed during walking and trotting without the orthotic (S0) and with the orthotic using two different support settings (S1 and S4). Data were evaluated for normality and homoscedasticity. A Student t-test was used to compare the MCPj angle pattern of the two forelimbs of each horse at the baseline. Data were analysed using one-way ANOVA to compare the mean values across conditions, followed by paired t-tests for post-hoc comparison (significance set at p < 0.05). The results showed significant reductions in both the MCPj extension and the MCPj range of motion, with the greatest restriction occurring at the highest support setting. These results suggest that the semirigid orthotic limits the MCPj movement in the sagittal plane and consequently the load on the suspensory ligament and flexor tendons. Therefore, this orthotic device is an effective tool during rehabilitation for forelimb tendon and ligament injuries. Full article

We developed an optoelectronic sensor capable of quantifying in-plane rotational and linear displacements between two parallel surfaces. The sensor utilizes a photo detector to capture the intensity of red (R), green (G), blue (B), and clear (C, broad visible spectrum) light reflected from a color gradient wheel on the opposing surface. Variations in reflected R, G, B and C light intensities, caused by displacements, were used to predict linear and rotational motion via a polynomial regression algorithm. To train and validate this model, we employed a custom-built positioning stage that produced controlled displacement and rotation while recording corresponding changes in light intensity. The reliability of the predicted linear and rotational displacement results was evaluated using two different color gradient wheels: a wheel with changing color hue, and another wheel with changing color hue and saturation. Benchtop experiments demonstrated high predictive accuracy, with coefficients of determination (R²) exceeding 0.94 for the hue-only wheel and 0.92 for the hue-and-saturation wheel. These results highlight the sensor’s potential for detecting shear displacement and rotation in footwear and wearable medical devices, such as orthotics and prostheses, enabling the detection of slippage, overfitting, or underfitting. This capability is particularly relevant to clinical conditions, including diabetic neuropathy, flat feet, and limb amputations. Full article

Background/Objectives: This review analyzes the effects of invasive and non-invasive methods of knee joint unloading on knee loading, employing a biomechanical model to evaluate their impact. Methods: PubMed, Web of Science, Cochrane, and Scopus were searched up to 15 May 2024 to identify eligible clinical studies evaluating Joint Space Width, Cartilage Thickness, the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score system, Gait velocity, Peak Knee Adduction Moment, time to return to sports and to work, ground reaction force, and the visual analogue scale pain score. A second search was conducted to select a biomechanical model that could be parametrized, including the modifications that each treatment would impose on the knee joint and was capable of estimate joint loading to compare the effectiveness of each method. Results: Analyzing 28 studies (1652 participants), including 16 randomized clinical trials, revealed significant improvements mainly when performing knee joint distraction surgery, increasing Joint Space Width even after removal, and high tibial osteotomy, which realigns the knee but does not reduce loading. Implantable shock absorbers are also an attractive option as they partially unload the knee but require further investigation. Non-invasive methods improve biomechanical indicators of knee joint loading; however, they lack quantitative analysis of cartilage volume or Joint Space Width. Conclusions: Current evidence indicates a clear advantage in knee joint unloading methods, emphasizing the importance of adapted therapy. However, more extensive research, particularly using non-invasive approaches, is required to further understand the underlying knee joint loading mechanisms and advance the state of the art. Full article

Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered a possible approach for this issue. Objective: to understand how foot type and foot orthotics may influence the electromyographic (EMG) activity of the TFL. Methods: A total of 41 healthy recreational runners (mean age 32.66 ± 3.51) were recruited for the present cross-sectional study, categorizing them as neutral (NEUg = 15), supinators (SUPg = 15), and pronators (PROg = 11) according to the foot postural index, over a period of 11 months. The EMG of the TFL was measured using a surface electromyograph device while they ran on a treadmill at a constant speed of 9 km/h for 3 min, randomly using supinating (SUP), pronating (PRO), or heel lift (TAL) insoles of 5 mm each one, compared to the baseline condition (SIN). The intraclass correlation coefficient (ICC) was performed to check the reproducibility of the tests, pairwise comparisons with Bonferroni adjustment were made, and to test the differences between measurements, the Friedman test was performed. Results: The Shapiro–Wilk test indicated a normal distribution of the sample (p > 0.05). Almost all obtained results showed a “perfect reproducibility” close to one; a significant statistical increase was observed in the mean EMG values from NEUg (87.58 ± 4.81 mV) to SUPg (97.17 ± 4.3 mV) (p < 0.05) during SIN+ basal condition. Additionally, there was a statistical reduction from SIN (87.58 ± 4.81 mV) vs. PRO (74.69 ± 3.77 mV) (p < 0.001) in NEUg and from SIN (97.17 ± 4.3 mV) vs. PRO (90.96 ± 4 mV) (p < 0.001) in SUPg. Conclusions: The SUPg exhibited increased activation of TFL fibers compared to the NEUg, likely due to the biomechanical demands associated with a supinated foot type. In contrast, the use of PRO appeared to promote relaxation of the TFL fibers by inducing internal rotation of the lower limb. Based on these preliminary results from a cross-sectional study in a healthy population, it is recommended to assess foot type when addressing ITBS and to consider the use of PRO as a complementary therapeutic strategy alongside conventional treatments. Full article

Background: This study compared performance-based function and self-report function in lower-limb prosthesis users. Methods: Twenty-two lower-limb prosthesis users (aged 52.1 ± 14.2) were administered the Orthotic Prosthetic User Survey (OPUS) Lower Extremity Functional Status (LEF), Satisfaction With Devices (SWD), alongside the Godin Leisure-Time Exercise Questionnaire (GLTQ), Timed Up and Go (TUG) test, two-minute walk test (2MWT), and six-minute walk test (6MWT). Body composition and standing postural sway displacement and velocity were also measured. Pearson’s Product Moment coefficients were used to assess relationships between the OPUS and other outcome variables. ANOVAs were used to identify differences in all outcome variables between lower unilateral (LU) and all other (AO) amputees. Results: There was a moderate correlation between LEF and center of pressure (CoP) path length with eyes open (r₍₁₉₎ = −0.43, p = 0.048) and eyes closed (r₍₁₉₎ = −0.43, p = 0.049). While the relationship between LEF and TUG was significant (r₍₂₀₎ = −0.49, p = 0.021), this was not so with SWD and TUG (r₍₂₀₎ = −0.17, p = 0.456). Both the 2MWT (r₍₂₀₎ = 0.48, p = 0.023) and 6MWT (r₍₂₀₎ = 0.47, p = 0.028) were moderately correlated with LEF. GLTQ was significantly correlated with LEF (r₍₂₀₎ = 0.70, p = 0.001). The LU group outperformed the AP group during the TUG and 6MWT (p < 0.05). LU group scored significantly higher on LEF compared to the AO group (p < 0.05). The reliability of LEF between the measurement on day 1 (54.3 ± 12.0) and day 2 (53.6 ± 12.8) was high (α = 0.94). Conclusions: This study provides an insight into associations of balance and self-reported function in lower limb prosthesis users. Future work can target rehabilitation strategies to address challenges faced by multiple limb prosthesis users. Full article

Athletic Tape is widely used as an immediate and cost-effective intervention for flexible flat feet, offering a practical alternative to orthotic devices and exercise therapies. This study aimed to compare the effects of low-dye and anti-pronation taping (elastic and inelastic) on ankle strength, gait parameters, and balance control in women with flexible flat feet. Thirty women were evaluated under four conditions: no taping, low-dye taping, elastic anti-pronation taping, and inelastic anti-pronation taping. Each condition was tested at 3-day intervals. Outcome measures included ankle muscle strength, step length, stride length, balance control ability assessed using the Romberg and limits of stability tests. Repeated-measures analysis of variance and post hoc least significant difference analyses were used to determine statistical significance. Additionally, effect sizes (η²) were calculated for the primary outcomes. Dorsiflexion strength significantly improved with elastic taping (p < 0.05). Step length increased with both elastic and inelastic taping, whereas stride length improved only with elastic taping. All taping methods significantly reduced the limits of stability compared with the no-taping condition (p < 0.05). Athletic Tape interventions, especially elastic anti-pronation taping, may reduce excessive foot pronation and improve ankle strength and gait performance in women with flexible flat feet. Full article

Background: Early-onset scoliosis (EOS) is a severe spinal deformity that can compromise thoracic development and pulmonary function if left untreated. While Mehta casting is widely used to manage deformity non-surgically in young children, its effects on spinal and thoracic growth remain underexplored. Methods: In this retrospective case series, 15 children with EOS underwent serial elongation–derotation–flexion (EDF) Mehta casting. Radiographic assessments were performed pre-treatment, post-casting, and at follow-up, including measurements of Cobb angle, rib–vertebral angle difference (RVAD), Th1–Th12 spinal length, coronal chest width (CCW), and space available for lung (SAL). Growth rates were estimated based on the duration of treatment. Correlation analyses were conducted to examine associations between baseline deformity and structural outcomes. Results: Serial casting reduced the mean Cobb angle by 22.2° and RVAD by 15.5°. During treatment, measurable increases were observed in Th1–Th12 length (mean: 2.93 cm), CCW (1.12 cm), SAL-L (2.60 cm), and SAL-R (2.98 cm). Estimated annual growth was significantly greater in children with lower initial Cobb and RVAD values. In contrast, total casting duration showed no consistent correlation with growth outcomes. Conclusions: Mehta casting is effective not only in correcting spinal deformity but also in supporting thoracic and axial growth in children with EOS. Early application in flexible, less severe curves may optimize structural outcomes and preserve thoracic development during early growth. Full article

Integrating bioinspired design and additive manufacturing into engineering education fosters innovation to meet the growing demand for accessible, personalized assistive technologies. This paper presents the outcomes of an international course, “3D Prosthetics and Orthotics”, offered to undergraduate students in the Biomimetic program at Westfälische Hochschule (Germany), in collaboration with the 3D Orthotics and Prosthetics Laboratory at the Federal University of São Paulo—UNIFESP (Brazil). The course combined theoretical and hands-on modules covering digital modeling (CAD), simulation (CAE), and fabrication (CAM), enabling students to develop bioinspired assistive devices through a Project-based learning approach. Working in interdisciplinary teams, students addressed real-world rehabilitation challenges by translating biological mechanisms into engineered solutions using additive manufacturing. Resulting prototypes included a hand prosthesis based on the Fin Ray effect, a modular finger prosthesis inspired by tendon–muscle antagonism, and a cervical orthosis designed based on stingray morphology. Each device was digitally modeled, mechanically analyzed, and physically fabricated using open-source and low-cost methods. This initiative illustrates how biomimetic mechanisms and design can be integrated into education to generate functional outcomes and socially impactful health technologies. Grounded in the Mao3D open-source methodology, this experience demonstrates the value of combining nature-inspired principles, digital fabrication, Design Thinking, and international collaboration to advance inclusive, low-cost innovations in assistive technology. Full article