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There is limited understanding of how well patients adhere to postoperative instructions following ankle surgery, particularly in outpatient settings regarding partial weight bearing (15–30 kg) and orthosis use. This study aims to assess orthosis compliance and load frequency over six weeks post-surgery using pressure-sensitive insoles, while also evaluating the effectiveness of continuous biofeedback. A total of 84 patients with isolated ankle fractures were enrolled. All participants were instructed to maintain partial weight bearing of 15–30 kg for six weeks with a lower leg orthosis equipped with insoles that continuously recorded daily step counts and maximum loads. In a prospective randomized design, the control group received no biofeedback, while the intervention group received audiovisual feedback whenever loads exceeded 20 kg. Adherence to the prescribed partial weight bearing and orthosis use was low in both groups, with only 10% of the control group wearing the orthosis by week three and overload occurring as early as week one. However, the implementation of biofeedback resulted in significant improvements in orthosis utilization (57.4% vs. 29.1%) and adherence to prescribed loading. The implementation of continuous biofeedback significantly enhanced adherence to prescribed loading and orthosis usage, highlighting its critical role in postoperative rehabilitation for ankle fractures.

Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed.

Purpose: The effectiveness of the customised solutions compared to the conventional ones and the emergence of advanced production technologies, such as Additive Manufacturing (AM) techniques, strengthened the trend towards an enhanced individualization of the clinical treatments. In the present research, the value of topological optimisation (TO) in the manufacturing process of tailor-made orthopaedic appliance (upper-limb orthosis) was analysed. Methodology: From the morphology of a patient’s arm, orthotic models were developed. Nonparametric optimization (Simulia Tosca) was performed, based on the Finite Element Analysis (FEA) program (Abaqus), and contributed to the development of TO orthotic models with diverse levels of volume reduction fraction. The modelling and manufacturing framework for customising orthotic solutions was evaluated with a discussion on the feasibility of lightweight and high-performance products, encompassing production time and cost. Pilot products were produced with a Material Extrusion (MEX) printer. Findings: TO proved to be a practical and valuable approach for the advanced customisation of orthopaedic devices, offering lightweight solutions able to withstand stresses also during patient rehabilitation and remission. From the rapid prototyping perspective, specific strategies must be adopted to prevent the escalation of production costs and time. Originality: The research delves into the overall benefit of implementing an advanced modelling technique within the context of manufacturing highly customised orthoses, analysing how TO activity impacts the rapid prototyping process. Beyond product evaluation, the analysis explores broader implications, including the assessment of feasibility and the development of strategies for integrating the approach into clinical workflows and hospital settings.

Case series. Pain and injury at the radial and ulnar aspects of the wrist due to overuse or trauma are commonly treated in hand therapy clinics. Describe two orthoses that allow targeted rest and recovery of involved anatomical structure(s) while preserving function of surrounding uninvolved structures in patients who have sustained overuse or traumatic injury at the radial or ulnar aspect of the wrist. Outline the fabrication of the Ulnar-Wrist Articulating Control Orthosis (U-WACO) and Radial-Wrist Articulating Control Orthosis (R-WACO) as well as presents case examples for each orthosis. The U-WACO and R-WACO designs may improve comfort, compliance, and functional ability to complete daily tasks while allowing targeted rest and recovery of involved anatomical structure(s) at the radial and ulnar aspects of the wrist due to overuse or trauma. Dynamic orthoses that allow for movement in one plane while restricting movement in another may overcome the shortcomings of some static orthotic designs. •Pain and injury at radial orulnar aspect of wrist due to overuse or trauma are common.•Static orthoses immobilizesboth involved and uninvolved joints.•WACO orthoses designed to restrict ulnar or radial deviation at the wrist.•WACO may allow targeted rest and recovery of involved anatomical structure(s).

So far, there have been no high-quality studies examining the efficacy of outpatient biofeedback devices in cases of prescribed partial weight-bearing, such as after surgery on the lower limbs. This study aimed to assess whether a biofeedback device is more effective than using a personal scale. Two groups of healthy individuals wearing an insole orthosis were trained to achieve partial loading in a three-point gait within a target zone of 15–30 kg during overground walking and going up and down stairs. The treatment group (20 women and 22 men) received continuous biofeedback, while the control group (26 women and 16 men) received no information. Findings were compared in a randomized controlled trial. Compliance with partial loading without biofeedback was poor; on level ground and stairs, only one in two steps fell within the target area, and overloading occurred on at least one in three steps. The treatment group reduced the percentage of steps taken in the overload zone to ≤8.4% (p < 0.001 across all three courses) and achieved more than two-thirds of their steps within the target zone (p < 0.001 on level ground, p = 0.008 upstairs, and p = 0.028 downstairs). In contrast, the control group did not demonstrate any significant differences in the target zone (p = 0.571 on level ground, p = 0.332 upstairs, and p = 0.392 downstairs). In terms of maintaining partial load, outpatient biofeedback systems outperform bathroom scales.

Background In the Ponseti treatment of idiopathic clubfoot, children are generally provided with a standard foot abduction orthosis (FAO). A significant proportion of these patients experience irresolvable problems with the FAO leading to therapeutic non-compliance and eventual relapse. Accordingly, these patients were equipped with a unilateral lower leg orthosis (LLO) developed in our institution. The goal of this retrospective study was to determine compliance with and the efficacy of the LLO as an alternative treatment measure. The minimum follow-up was 5 years. Results A total of 45 patients (75 ft) were retrospectively registered and included in the study. Compliance with the bracing protocol was 91% with the LLO and 46% with the FAO. The most common problems with the FAO were sleep disturbance (50%) and cutaneous problems (45%). Nine percent of patients experienced sleep disturbance, and no cutaneous problems occurred with the LLO. Thirteen percent of patients being treated with an FAO until the age of four (23 patients; 40 ft) underwent surgery because of relapse, defined by rigid recurrence of any of the components of a clubfoot. Fourteen percent of patients being treated with an LLO (22 patients; 35 ft), mostly following initial treatment with an FAO, experienced recurrence. Conclusion Changing from FAO to LLO at any point during treatment did not result in an increased rate of surgery and caused few problems.

Systematic review Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective. All studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence. Four authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses. All authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed. •Symptom reduction was noted by using an orthosis for 6-10 weeks continually.•Various orthosis may be used, limiting excursion by immobilizing MP, PIP, or DIP.•Use validated patient outcome measures and high level studies for best practice.

Background/Objectives: Deformational plagiocephaly (DP) is defined as an asymmetrical flattening of infants’ occipital skull. Helmet therapy is one of the treatments reported that can reduce skull deformity by guiding the growing direction of the head. However, its effectiveness remains insufficiently validated in the literature due to variability in treatment protocols and regimes. This study aims to evaluate the clinical outcomes of helmet therapy in infants with deformational plagiocephaly. Methods: This single-center retrospective study was conducted at a tertiary university hospital and included 30 consecutive infants (mean age 7.83 ± 2.51 months) who attended a pediatric orthopedic outpatient clinic between 2022 and 2025. Infants without craniosynostosis and with cranial vault asymmetry index (CVAI) ≥ 5% were prescribed a course of helmet therapy (mean duration 3.77 ± 2.37 months). The primary outcome was the change in CVAI. Results: The mean CVAI (%) significantly decreased from 7.57 ± 2.45 to 6.10 ± 2.63 (p = 0.002). The effect of helmet therapy was dose-dependent, with greater improvement observed in infants wearing the helmet for at least 6 h per day. Poor compliance and predominantly daytime helmet use were associated with less improvement. Increased sweating and mild skin redness were the most common reported adverse effects, but the skin redness can be relieved by proper donning of the helmet. Conclusions: Helmet therapy is effective for infants with plagiocephaly when initiated early and with high compliance of helmet use. Greater improvements were observed in infants using the helmet during sleeping. Further multi-center studies with a larger sample size and longer follow-up are recommended.

This article introduces a novel concept where advanced technologies have been leveraged to produce a modular walking orthosis (MOWA) within a completely digital process chain. All processes of this new supply chain are described step-by-step. The prescription and treatment of lower leg orthoses for individuals with paralysis or muscle weakness, particularly cerebral palsy (CP), are complex. A single case study indicates successful treatment with this new orthosis (MOWA). From the authors’ perspective, this innovative fitting concept is promising and will contribute to creating more efficient care within a multidisciplinary team.

We designed and manufactured a pneumatic-driven robotic passive gait training system (PRPGTS), providing the functions of body-weight support, postural support, and gait orthosis for patients who suffer from weakened lower limbs. The PRPGTS was designed as a soft-joint gait training rehabilitation system. The soft joints provide passive safety for patients. The PRPGTS features three subsystems: a pneumatic body weight support system, a pneumatic postural support system, and a pneumatic gait orthosis system. The dynamic behavior of these three subsystems are all involved in the PRPGTS, causing an extremely complicated dynamic behavior; therefore, this paper applies five individual interval type-2 fuzzy sliding controllers (IT2FSC) to compensate for the system uncertainties and disturbances in the PRGTS. The IT2FSCs can provide accurate and correct positional trajectories under passive safety protection. The feasibility of weight reduction and gait training with the PRPGTS using the IT2FSCs is demonstrated with a healthy person, and the experimental results show that the PRPGTS is stable and provides a high-trajectory tracking performance.