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Improvement of Ankle Joint Stability in Foot Drop Patients During Walking by 3D Printed Ankle Foot Orthoses

by Dr. Harish Banga (Author) Parveen Kalra (Author) Rajesh Kumar (Author)

Elaboration 2018 6 Pages

Medicine - Anatomy, Physiology, Cytology

Excerpt

Abstract

Lower leg foot orthoses are orthotic gadgets that help the decrease leg joint and are suitable for a few pathologies, typically those that improve the foot drop circumstance, which is resulting from a lower leg joint insufficiency. In the existing paintings, a custom designed model of decrease leg foot orthosis applied as a part of the human frame has been created. Additive Manufacturing structures has been utilized to create the lower leg foot orthosis (Selective Laser Sintering Technology). Kinematic estimations had been received in a stride lab from foot drop sufferers, with and with out three-D plastic printed lower leg foot orthoses on unmarried toes. The consequences got proven that with the orthoses, the lower leg joint conduct is sort of a instantly torsional spring, with out a hysteresis. With an goal to check the sufficiency of the AFO, Clinical GAIT Analysis of Foot Drop Patients has been performed. Customized 3-d printed Ankle Foot orthosis has been established to present higher GAIT cycle execution . The consequences of this look at indicated that development of gait in foot drop sufferers with 3-d published ankle foot orthosis that's measured via Clinical Gait evaluation.

Keywords: Ankle foot orthosis (AFO); Gait analysis; Foot Drop; Human biomechanics; 3D Printing

1. Introduction

Foot drop is a misleadingly legitimate name for a possibly com-plicated issue. It can be portrayed as a major deficiency of lower leg and toe dorsiflexion. The foot and reduction leg dorsif-lexors include the tibialis most indispensable, the extensor hallucis longus (EHL), and the extensor digitorum longus (EDL) as appeared in Figure 1(Abboud, R. J 2002). These muscles enable the body to lift the foot in the midst of swing level and control plantarflexion of the foot on heel strike.

The exam is organized to develop new orthoses to help the as often as feasible watched stroll variations from the norm pertaining to the human decrease leg foot complex using CAD showing. PC showing is a viewpoint approach for perfect plan of prosthesis and orthoses. Utilizing CAD geometry numerous exams may be made without loosing of material and fundamental define factors can be changed (Slavyana Milusheva et al 2011).

Dynamic KAFOs are developed to control every stance and swing stages. But those currently available are inconvenient to use and feature complex manipulate systems. This research is directed at the usage of superelastic alloys to expand a biologically inspired dy-namic knee actuator that may be hooked up on a traditional passive KAFO( S.M. Milusheva et al 2012).

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Figure 1: Foot Drop Disease& Anatomy of ankle nerve system

Anatomy

Strands from the dorsal branches of the ventral rami of L4-S1 are found in the peroneal nerve(H Banga et al 2017). These are coor-dinated with the tibial nerve to symbolize the sciatic nerve as affirmed in Figure 1. The sciatic nerve leaves the pelvic gap at the additional basic sciatic foramen, just beneath typical stood out from the piriformis. It bifurcates to plot the peroneal and tibial nerves each inside the distal 1/3 of the thigh or at the mid-thigh degree. The peroneal nerve explores the lower back edge of the fibular neck to the essential compartment of the lower leg, limiting into shallow and expansive branches(Whittle, M 2007). The shallow office is going among the 2 pioneers of the peronei and proceeds down the lessening leg to lie among the peroneal ligament and the parallel edge of the gastrocnemius. At that point It branches to the abatement leg anterolaterally to supply sensation to the dorsum of the foot (see the Figure 1).

2. Literature Review

The investigations including three-dimensional development examination of stride parameters and additionally measures of assembling methods. The papers recognized were assessed in view of the accompanying incorporation criteria 1) Design for foot drop/stroke patients and 2) Manufacturing procedures of lower leg foot orthoses and 3 ) clinical trial populace utilizing AFO's.

2.1 Ankle Foot Orthoses Design

(Ranky et al 2009) have definite headways in non-meddling three-dimensional inspecting that have made it possible to get automated models of free-form surfaces ordinary of the human body. Joined with quick prototyping (RP) methodology, these progressions can change singular restorative devices by streamlining creation and giving a quantitative plans to screen constant physiology. A novel system designing was delivered to utilize 3D photogrammetric checking as the patient specific shape data information, and particular laser sintering (SLS) as the patient-specific RP outline yield ideally suited for restorative orthoses where shape fit and comfort are imperative.

(Talaty et al 2010) have revealed a formed lower leg foot orthosis (MAFO's) a fundamental device to help strolling capacity and therefore freedom to a substantial number of individuals with broadly fluctuating pathologies. The quantity of MAFO choices and the procedure, by which they are directed.

2.2 Ankle Foot Orthoses Manufacturing Techniques

A (Chu TM et al 1995)Parametric examinations uncovered that the version turned into sensitive to the flexible moduli of the AFO and of the delicate tissue, but changed into fairly coldhearted to the tendon firmness. The effects affirmed the concept that top issues within the orthosis show up inside the mend and neck regions of the orthosis.

The enormous outcomes of the anterior AFO in lengthy-time period he-miplegic patients have been on lateral weight moving and weight bearing via affected leg after weight shifted to the affected side. Postural sway, postural symmetry, and anterior-posterior weight moving have been now not drastically affected(Chen CL et al 1999).

Comprehensive Clinical Approach is an revolutionary and com-prehensive new text that offers important records about modern-day orthoses to manual the pupil and clinician in prescribing and utilising those home equipment in neuromuscular, musculoskeletal, and integumentary rehabilitation (Edelstein, J. E. & Bruckner, J 2002).

(Steven J. Esses et al 2001)describe the manufacturing of bodily fashions from CT records the usage of speedy prototyping and gift their clinical application. MDCT data acquisition of isotropic voxels and modern postprocessing techniques offer superb detail for clinicians and radiologists.

(De Burgh, J. 2003) In The Human Body, discover what hu-mans are manufactured from and the way the body works. In this captivating and complete guide to human anatomy, the whole thing you'll ever want to know about the workings of your frame is presented in full colour element.The e book is structured from the pinnacle to the toe, and is damaged down into nine sections: head, neck, thorax, top limbs, stomach, reproductive machine, pelvis, decrease limbsand whole bodysystems.

(Fan Gao et al 2009)take a look at is to expand a motorized device to quantitatively look at the AFO alignment and mechanical houses. The motorized device includes a servo motor and an inline gear box with a 25:1 equipment ratio. A thermoplastic arti-culated AFO with TamarackTM dorsiflexion help flexure joint changed into investigated within the look at.

(Cook, D., Gervasi et al 2010) research founds that there are nevertheless scientific, financial and technological limitations for full-scale usage of AM in an administration framework for custom orthoses and prostheses.

(Constantinos Mavroidis et al 2011) The quickly prototyped orthoses manufactured in this investigation gave solid match of the sub-ject's life systems contrasted with a pre-assembled AFO while store vering tantamount capacity (i.e. mechanical impact on the biomechanics of walk).

(Woodburn et al 2013) have enhanced the fit resistance of customized lower leg and foot orthoses by 20%. This was accomplished by assessing and choosing a 3D checking procedure to give advanced models of surface life systems and moving all orthotic outlines from mortar throws, layouts and diagrams to computerized plan arrangements and furthermore coordinating co-made computerized configuration, customized plan streamlining and advanced manufac-turing to give finish geometrical outline opportunity. (Sha-maei et al 2014) have been represented on this paper, we favoring the mechanical blueprint, supervise set of rules, and deliberate assessment of a semi standoffish pleasing position control knee-bring down leg foot orthosis. The orthosis realizes a spring in parallel with the knee joint in the midst of the position segment of the progression and licenses extricated upset in the midst of the swing segment (Van Swigchem, R 2014). The plan is excited by strategies for the minute mindset examination of the knee joint revealing that the knee trademark approximates that of a straight torsional spring in the position territory of the gait(Winter, D. A 2009).The latest composition demonstrates that the supposition of using assorted procedures for gathering orthotic contraptions is commonsense. A couple of examinations tried to show how the condition of the orthotic devices can be adjusted to save weight, upgrade useful properties, be more fitting and patient changed.

2.3 Clinical Trials of Ankle Foot Orthoses

(Milusheva et al 2005) have said lower leg foot orthoses utilized particularly if there should be an occurrence of handicap of Neurological starting (cerebral paralysis, stroke, spinal rope harm) or musculoskeletal starting (injury, maturing). The look at is situated to grow new orthoses to help the oftentimes found walk variations from the norm bearing on the human lower leg foot complex the use of CAD displaying. (Mavroidis et al 2005) have said pre-assembled orthotic contraptions presently intended to fit as a fiddle a significant number sufferers and thusly they don't offer individualized solace and feature(Alexander M. A 2011). Custom-coordinate orthoses are better than pre-assembled orthotic gadgets from both of the above-expressed points of view. Be that as it may, growing a custom-coordinate orthosis is a cumbersome and time top to bottom manual framework completed through gifted orthotists (Branko Brackx et al 2012).

(Silva, P et al 2009)suggests AFO solidness can supplant lost lower leg muscle work and give useful additions. In the investigation, two patients who had encountered stroke wore a latent unique AFO intended to be worn without a shoe, with twisting firmness customized for their level of plantar flexor shortage. At the gauge visit, 3D milestones on every patient's lower leg were digitized and used to redo their AFO's fit.

3. Methodology

This process of 3D scanning CAD designing with a reasonable quality of image in terms of its resolution and the production of an AFO in 3D printing technology (H k Banga et al 2016). . Based on the observed result, the project purpose is feasible but further refinement of the process is necessary at this stage. It has been concluded that using a 3D laser scanner can provide a high quality of image of scanning for the AFO (Boehler, W. & Marbs, A 2004). The CAD design tools has been suitably used to reduce the size of the original, large scan, the mesh in order to make 5 mm thickness final AFO design, and the extrusion from the scan by sketching on CATIA V and Delmia Solid Works design software the complete process (South, B. J et al 2009) . The scanning of Foot Drop Patient's Leg has been carried out as shown in Figure 2.

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Figure 2:3D Scanning of Foot Drop Patients

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Figure 3a: Comparison of Ankle Torque occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

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Figure 3b: Comparison of Ankle Torque occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

The value of material deformation with minimum Load of 400 Newton at calf height 34 cm in Carbon Fiber is highest then other material but the Nylon Poly Amide is greater value than poly propylene in all thickness of ankle foot orthosis and much closer to the value of carbon fiber.

The AFO Deformation Calf Height 34 cm at minimum Constant Load of 400 Newton having different curves for Carbon Fiber, Nylon Poly Amide and Polypropylene material. The curve for Nylon Poly amide having thickness 5 mm is closer to the value carbon-fiber of thickness 5 mm. The poly propylene material is least value in comparison of other materials. GAIT Analysis of Foot Drop Patients has been carried out & GAIT Analysis with Old & New Ankle Foot Orthosis in PGIMER Chandigarh has been studied.

The comparison of Ankle Torque with and without 3D printed ankle foot orthosis is shown in Figure 3a and 3b. the torque improvement in deformed foot and correct is improved by 3D printed ankle foot orthosis.

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Figure 4a: Comparison of Ankle Power occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

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Figure 4b: Comparison of Ankle Power occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

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Figure 5a: Comparison of Ankle Forces produced in old designed and 3D printed ankle foot orthosis during GAIT Analysis

Abbildung in dieser Leseprobe nicht enthaltenFigure 5b: Comparison of Ankle Forces produced in old designed and 3D printed ankle foot orthosis during GAIT Analysis

The interaction of movement, standing security, and vitality protection brings about a complex and consistently changing relationship among the different appendage fragments as the body propels over the supporting foot and the toe is lifted to clear the ground(Yue Wei Ai et al 2012). Each joint plays out a delegate example of movement. Amid position the postural changes are actuated inactively by the impact of body weight. Swing-stage movement relies upon muscle activity (Waters, R. L 1975).

Lower leg edge shifted in two phases of plantar flexion and dorsiflexion are knowledgeable about every step cycle as appeared in Figure 4a & 4b with old AFO and with new AFO (Toshiki Kobayashi 2011). At the beginning of position the lower leg has a 90-degree position. As the rear area is stacked, the foot drops into 10 degrees of plantar flexion. At that point the activity turns around and step by step achieves 10 degrees of dorsiflexion (Sungjae, H et al 2006). As of now plantar flexion is continued and achieves 20 degrees before the finish of position, in spite of the fact that the last bend of movement happens in the twofold position time frame when the appendage is in effect quickly emptied. With toe-off the foot is immediately raised to unbiased dorsiflexion and kept up in this position all through swing (Vasconselos, C. A 2012).

Ankle plantarflexors power had been studied due to the fact those muscle tendon unit are fundamental electricity producers for the duration of taking walks . The majority of this electricity is produced in a burst-like fashion throughout the Push-off phase of strolling,which takes place at some stage in kind of 45–sixty five% of the stride cycle, straight away before the foot lifts off the floor (Tortora, G. J. & Derrickson, B. H,2008) . Push-off helps boost up the leg into swing and redirect/accelerate the body’s center-of-mass, which can probably lessen collisional energy losses after contralateral foot touch and thereby facilitate low-priced gait. Misestimating ankle or foot kinetics should have an effect on our understanding i.e wherein strength is generated/absorbed within the frame throughout human gait, which has implications on musculoskeletal simulations that depend (at once or circuitously) on empirical kinetics estimates, and on assistive devices (e.g., foot prostheses) which are regularly designed to imitate biological characteristic (Tai-Ming Chu, And Narender P. Reddy 1995). For example, overestimating organic ankle strength should result in powered prostheses .The ankle energy finished by way of antique AFO and new AFO is shown graphically in Figure 5a & 5b respectively.

Figure 6a & 6b confirmed that horizontal floor response pressure acted as generating dorsiflexion torque in the course of the first half of of the stance phase and as producing plantar flexion torque at some stage in the second one half of. Therefore, the ankle joint torque from the simulated calculation underestimated the dorsiflexion torque clearly after heel touch and the plantar flexion torque at push-off.

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Figure 6a: Comparison of Ankle Angle occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

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Figure 6b: Comparison of Ankle Angle occurred in old designed and 3D printed ankle foot orthosis during GAIT Analysis

4. Results

It has been found that 3D laser scanner can provide a high quality of scanning images for the AFO fabrication. The CAD design tools were used to reduce the size of the original, large scan, model and further quality meshing in for the final AFO design. Optimized design and product of the AFO device has been made in terms of functionality, aesthetics, rigidity and cost. 3-D human portable scanner (Artec Eva) has been used to get accurate dimensions of Foot drop Patients. Digital report of each affected person permits for anticipation of iterative design adjustments. New design of AFO is produced with the aid of 3-d printing Technology (SLS) which saves time and cost. By the use of 3D printing (SLS) era, a new material Nylon-Poly Amide (sort of Plastic) AFO has been manufactured. Selective Laser Sintering (SLS) three dimensional printing having the principle gain is that the fabricated prototypes are porous (generally 60% of the density of molded components), for this reason impairing their power and floor end. It also help to beautify ordinary probability distribution of plantar loading, which is fundamental importance to reduce lower extremity ache all through taking walks.

5. Conclusion

Future works of the design of Artec Eva Studio 12 Professional will focus on optimization of the computerized design process. Improvement of image-processing for the 3D scanned data will be researched so as to simplify current processes. The mechanical structure of compliant finger joint will be further developed, and algorithms of parameter optimization will be developed. The thumb joint will be designed and tested. More materials and embedded sensors could be tested and optimized. Software interface will be developed. In the future, the AFOs with sensor can provide accuracy indicate that when do they need to replace the AFOs. Future works on the development of the AFO test-bed will focus on the design of the clamp elements so as to provide quantitative body weight during the gait. Actual human gait cycle data and ankle stiffness could be implemented into the control system so as to verify the functional analysis of the AFO. Further study of the energy return in gait will be analysis in this AFO test bed.

Declaration of conflicting interests

No potential conflicts of interest with respect to the research, authorship, and publication of this article as declared by Author(s).

Funding

The author(s) received no financial support for the research, authorship, and publication of this article

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Pages
6
Year
2018
ISBN (eBook)
9783668809710
Language
English
Catalog Number
v442423
Grade
10.0
Tags
improvement ankle joint stability foot drop patients during walking printed orthoses

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Title: Improvement of Ankle Joint Stability in Foot Drop Patients During Walking by 3D Printed Ankle Foot Orthoses