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OBJECTIVE: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA). DESIGN: Randomized, controlled single-blind trial. SETTING: The rheumatology outpatient clinic of the University. PARTICIPANTS: Sixty participants diagnosed with trapeziometacarpal OA. INTERVENTIONS: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night. MAIN OUTCOMES MEASURES: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function. RESULTS: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006). CONCLUSIONS: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients.

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Knee rehabilitation therapy after trauma or neuromotor diseases is fundamental to restore the joint functions as best as possible, exoskeleton robots being an important resource in this context, since they optimize therapy by applying tailored forces to assist or resist movements, contributing to improved patient outcomes and treatment efficiency. One of the points that must be taken into account when using robots in rehabilitation is their interaction with the patient, which must be safe for both and guarantee the effectiveness of the treatment. Therefore, the objective of this study was to assess the interaction between humans and an exoskeleton during the execution of knee flexion-extension movements under various configurations of robot assistance and resistance. The evaluation encompassed considerations of myoelectric activity, muscle recruitment, robot torque, and performed movement. To achieve this, an experimental protocol was implemented, involving an individual wearing the exoskeleton and executing knee flexion-extension motions while seated, with the robot configured in five distinct modes: passive (P), assistance on flexion (FA), assistance on extension (EA), assistance on flexion and extension (CA), and resistance on flexion and extension (CR). Results revealed distinctive patterns of movement and muscle recruitment for each mode, highlighting the complex interplay between human and robot; for example, the largest RMS tracking errors were for the EA mode (13.72 degrees) while the smallest for the CR mode (4.47 degrees), a non-obvious result; in addition, myoelectric activity was demonstrated to be greater for the completely assisted mode than without the robot (the maximum activation levels for the vastus medialis and vastus lateralis muscles were more than double those when the user had assistance from the robot). Tracking errors, muscle activations, and torque values varied across modes, emphasizing the need for careful consideration in configuring exoskeleton assistance and resistance to ensure effective and safe rehabilitation. Understanding these human-robot interactions is essential for developing precise rehabilitation programs, optimizing treatment effectiveness, and enhancing patient safety.

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Background: People with diabetes and diabetic peripheral neuropathy (DPN) often develop calluses due to toe misalignment and increased plantar pressure. Untreated, these issues can progress into ulcers, making early intervention crucial. This trial protocol aims to evaluate the efficacy and safety of customized silicone digital orthoses in preventing ulcers, pre-ulcerative lesions, and peak pressure during gait in people with DPN. Methods: In this superiority randomized controlled parallel trial with single-blind assessment, 60 participants will be allocated to the control group (CG) or the intervention group (IG). The CG will receive specialized nurse-administered foot care, including callus removal, nail care guidance, and self-care education. The IG will receive the same care plus a customized silicone orthosis for toe realignment for 6 months. Assessments will occur at baseline and 3 and 6 months for the primary outcomes (pre-ulcerative lesions and ulcer incidence) and secondary outcomes (pressure distribution, foot function and health, quality of life, safety, and comfort). Two-way ANOVAs (p < .05) will assess group, time, and group by time effects following an intention-to-treat approach. Conclusion: Although recommended for foot ulcer prevention, custom silicone orthosis adoption remains limited due to the low certainty of evidence. This trial seeks to provide more consistent evidence for the use of toe orthoses in preventing callus and ulcer formation for individuals with DPN. Trial registry: ClinicalTrials.gov (NCT05683106) "Effects of Customized Silicone Digital Orthoses in People with Diabetic Neuropathy" (registered on December 20, 2022).

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INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated through telemonitoring. OBJECTIVE: This study aimed to monitor the foot's flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot's flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.

INTRODUÇÃO: A intervenção precoce é essencial para o correto crescimento do pé torto congênito postural (PTC), mas pouco se sabe sobre sua contribuição para essa deformidade quando os pacientes são avaliados por meio de telemonitoramento. OBJETIVO: Este estudo teve como objetivo acompanhar, por telemonitoramento, a flexibilidade do pé de recém-nascidos com diagnóstico de PTC durante os primeiros meses de vida. MÉTODOS: Foi realizado um estudo descritivo longitudinal com recém-nascidos a termo, diagnosticados com PTC em pelo menos um pé, apresentando escore de Pirani ≥ 0,5. Foram excluídos recém-nascidos com outras malformações. Os recém-nascidos foram avaliados nas primeiras horas de vida e 30 dias após a alta hospitalar. Durante este período os pais foram incentivados a mobilizar os pés diariamente e manter a posição por meio de órtese ou bandagem. O telemonitoramento ocorreu semanalmente, e a flexibilidade dos pés foi classificada pelo escore de Pirani. RESULTADOS: Foram incluídos neste estudo treze recém-nascidos (dezoito pés), sete descontinuaram o estudo por faltas nas tentativas de contato e seis foram telemonitorados por 30 dias. A maioria dos RN era do sexo feminino (69%), nasceram com 39 semanas (± 1,18) e 3.346,54g (± 306,51). Um nasceu de parto normal e oito (61%) tinham histórico familiar de PTC. Inicialmente, a pontuação de Pirani variou de 1 a 3. Após 30 dias de telemonitoramento, três pés evoluíram para 0 e quatro pontuaram entre 0,5 e 1. CONCLUSÃO: Este estudo mostra uma melhora importante na flexibilidade do pé de recém-nascidos com diagnóstico de PTC, avaliados por telemonitoramento. O telemonitoramento pode ser um recurso adicional para assistência ao recém-nascido com PTC.

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Background: The occurrence of bone fractures is increasing worldwide, mainly due to the health problems that follow the aging population. The use of additive manufacturing and electrical stimulators can be applied for bioactive achievements in bone healing. However, such technologies are difficult to be transferred to medical practice. This work aims to develop an orthosis with a combined magnetic field (CFM) electrostimulator that demonstrates concepts and design aspects that facilitate its use in a real scenario. Methods: A 3D-printed orthosis made of two meshes was manufactured using PLA for outer mechanical stabilization mesh and TPU for inner fixation mesh to avoid mobilization. A CFM stimulator of reduced dimension controlled by a mobile application was coupled onto the orthosis. The design concepts were evaluated by health professionals and their resistance to chemical agents commonly used in daily activities were tested. Their thermal, chemical and electrical properties were also characterized. Results: No degradation was observed after exposure to chemical agents. The CMF achieved proper intensity (20-40 µT). The thermal analysis indicated its appropriate use for being modelled during clinical assessment. Conclusion: An orthosis with a coupled electrostimulator that works with a combined magnetic field and is controlled by mobile application was developed, and it has advantageous characteristics when compared to traditional techniques for application in real medical environments.

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Stroke disease leads to a partial or complete disability affecting muscle strength and functional mobility. Early rehabilitation sessions might induce neuroplasticity and restore the affected function or structure of the patients. Robotic rehabilitation minimizes the burden on therapists by providing repetitive and regularly monitored therapies. Commercial exoskeletons have been found to assist hip and knee motion. For instance, unilateral exoskeletons have the potential to become an effective training system for patients with hemiparesis. However, these robotic devices leave the ankle joint unassisted, essential in gait for body propulsion and weight-bearing. This article evaluates the effects of the robotic ankle orthosis T-FLEX during cooperative assistance with the AGoRA unilateral lower-limb exoskeleton (hip and knee actuation). This study involves nine subjects, measuring muscle activity and gait parameters such as stance and swing times. The results showed a reduction in muscle activity in the Biceps Femoris of 50%, Lateral Gastrocnemius of 59% and Tibialis Anterior of 35% when adding T-FLEX to the AGoRA unilateral lower-limb exoskeleton. No differences were found in gait parameters. Nevertheless, stability is preserved when comparing the two legs. Future works should focus on evaluating the devices in ground tests in healthy subjects and pathological patients.

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Injuries in the elbow area, such as lateral and medial epicondylitis, are the leading causes of consultation with health specialists. Therefore, this research proposes the mechatronic design of an orthosis with a graphic interface that supports professionals in the rehabilitation of the elbow joint through the execution of flexion-extension and pronation-supination movements. For the development of the rehabilitation prototype, mechatronic design, co-design, and IDEF0 methodologies are used, performing activities such as actuator characterization, simulations, and modeling, among others. Through the execution of a case study in a real environment, the device was validated, where the results suggest a functional and workable prototype that supports the treatment of pathologies in the elbow area through the execution of the mentioned movements, supposing that this is a low-cost alternative with elements to improve, such as the industrial design and new functionalities. The developed proposal shows potential as an economical product that health professionals can use. However, some limitations related to the design and functionalities in the application domain were identified.

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SUMMARY OBJECTIVE: Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). METHODS: Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. RESULTS: The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants' distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splint. The mean of the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was "0" for all participants. There was a difference between the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. CONCLUSION: According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints.

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Robotic-assisted systems have gained significant traction in post-stroke therapies to support rehabilitation, since these systems can provide high-intensity and high-frequency treatment while allowing accurate motion-control over the patient's progress. In this paper, we tackle how to provide active support through a robotic-assisted exoskeleton by developing a novel closed-loop architecture that continually measures electromyographic signals (EMG), in order to adjust the assistance given by the exoskeleton. We used EMG signals acquired from four patients with post-stroke hand impairments for training machine learning models used to characterize muscle effort by classifying three muscular condition levels based on contraction strength, co-activation, and muscular activation measurements. The proposed closed-loop system takes into account the EMG muscle effort to modulate the exoskeleton velocity during the rehabilitation therapy. Experimental results indicate the maximum variation on velocity was 0.7 mm/s, while the proposed control system effectively modulated the movements of the exoskeleton based on the EMG readings, keeping a reference tracking error <5%.

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Introduction: The field of brain-machine interfaces (BMI) for upper limb (UL) orthoses is growing exponentially due to improvements in motor performance, quality of life, and functionality of people with neurological diseases. Considering this, we planned a systematic review to investigate the effects of BMI-controlled UL orthoses for rehabilitation of patients with neurological disorders. Methods: This systematic review and meta-analysis protocol was elaborated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P 2015) and Cochrane Handbook for Systematic Reviews of Interventions. A search will be conducted on Pubmed, IEEE Xplore Digital Library, Medline, and Web of Science databases without language and year restrictions, and Patents Scope, Patentlens, and Google Patents websites in English, Spanish, French, German, and Portuguese between 2011 and 2021. Two independent reviewers will include randomized controlled trials and quasi-experimental studies using BMI-controlled active UL orthoses to improve human movement. Studies must contain participants aged >18 years, diagnosed with neurological disorders, and with impaired UL movement. Three independent reviewers will conduct the same procedure for patents. Evidence quality and risk of bias will be evaluated following the Cochrane collaboration by two review authors. Meta-analysis will be conducted in case of homogeneity between groups. Otherwise, a narrative synthesis will be performed. Data will be inserted into a table containing physical description, UL orthoses control system, and effect of BMI-controlled orthoses. Discussion: BMI-controlled orthoses can assist individuals in several routine activities and provide functional independence and sense of overcoming limitations imposed by the underlying disease. These benefits will also be associated with orthoses descriptions, safety, portability, adverse events, and tools used to assess UL motor performance in patients with neurological disorders. PROSPERO Registration Number: CRD42020182195.

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Introduction: Adaptive algorithms for controlling orthosis emerged to overcome significant problems with automatic biosignal classification and personalized rehabilitation. Smart orthoses are evolving fast and need a better human-machine interaction performance since biosignals, feedback, and motor control dynamically change and must be adaptive. This manuscript outlines a scoping review protocol to systematically review the smart upper limb (UL) orthoses based on adaptive algorithms and feasibility tests. Materials and Methods: This protocol was developed based on the York framework. A field-specific structure was defined to achieve each phase. Eleven scientific databases (PubMed, Web of Science, SciELO, Koreamed, Jstage, AMED, CENTRAL, PEDro, IEEE, Scopus, and Arxiv) and five patent databases (Patentscope, Patentlens, Google Patents, Kripis, J-platpat) were searched. The developed framework will extract data (i.e., orthosis description, adaptive algorithms, tools used in the usability test, and benefits to the general population) from the selected studies using a rigorous approach. Data will be described quantitatively using frequency and trend analysis methods. Heterogeneity between the included studies will be assessed using the Chi-test and I-statistic. The risk of bias will be summarized using the latest Prediction Model Study Risk of Bias Assessment Tool. Discussion: This review will identify, map, and synthesize the advances about the description of adaptive algorithms for control strategies of smart UL orthosis using data extracted from patents and articles.

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Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which impede the independence to execute different Activities of Daily Living (ADLs). From the fundamental role of the ankle in walking, Powered Ankle-Foot Orthoses (PAFOs) have been developed to enhance the users' gait patterns, and hence their quality of life. Ten patients who suffered a stroke used the actuation system of the T-FLEX exoskeleton triggered by an inertial sensor on the foot tip. The VICONmotion capture system recorded the users' kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. The biomechanical assessment exhibited changes in the lower joints' range of motion for 70% of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30% of the paretic limbs and 40% of the non-paretic, where the tendency was to decrease. The spatiotemporal parameters did not show significant variations between modalities, although users' cadence had a decrease of 70% of the volunteers. Lastly, the satisfaction with the device was positive, the comfort being the most user-selected aspect. This article presents the assessment of the T-FLEX actuation system in people who suffered a stroke. Biomechanical results show improvement in the ankle kinematics and variations in the other joints. In general terms, GDI does not exhibit significant increases, and the Movement Analysis Profile (MAP) registers alterations for the assisted gait with the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients, including a stage of training.

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INTRODUCTION: Scoliosis is a frequent deformity in children with cerebral palsy (CP), it is progressive and negatively affects functional capacity. The management of scoliosis in curves from 45º is surgical management and is aimed at solving the problem of the spine. In telethon, orthotic management is used in moderate and severe curves with thoraco-lumbo sacral orthosis (TLSO). In this regard, the present study sought to compare the evolution of scoliosis in patients treated with TLSO for 12 months with the natural history of scoliosis. MATERIALS (OR PATIENTS) AND METHODS: Study of two dynamic cohorts of patients with a diagnosis of CP, scoliosis greater than 20° and indication for TLSO between January 2017 and December 2019 at the Teletón Institute (IT) Santiago. The scoliotic curve was evaluated for one year using the Cobb method and the median time elapsed due to the presence of an ad-verse event (change in TLSO). RESULTS: Statistically significant differences were identified in the scoliotic curve between the baseline measurement and the first control, and between the first control and the last. There were no demographic or clinical variables significantly associated with variations in the scoliotic curve. A significant difference was identified between the survival curves of those who presented an adverse event and those who did not. CONCLUSIONS: The TLSO stopped the progression of the scoliotic curve after 12 months of use. The lack of comparable cases made it impossible to compare the results obtained with the natural history of scoliosis described in the available theoretical background.

INTRODUCCIÓN: La escoliosis es una deformidad frecuente en niños con parálisis cerebral (PC), es progresiva y afecta negativamente la capacidad funcional. El manejo de la escoliosis en curvas desde los 45º es de manejo quirúrgico y está orientado a resolver el problema de la columna. En teletón se utiliza manejo ortésico en curvas moderadas y graves con ortesis toraco-lumbo sacra (TLSO). Al respecto, el presente estudio buscó comparar la evolución de la escoliosis en pacientes con tratamiento de TLSO durante 12 meses con la historia natural de la escoliosis. MATERIALES (O PACIENTES) Y MÉTODOS: Estudio de dos cohortes dinámicas de pacientes con diagnóstico de PC, escoliosis mayor a 20° e indicación de TLSO entre enero de 2017 y diciembre de 2019en el Instituto Teletón (IT) Santiago. Durante un año se evaluó la curva escoliótica mediante método Cobb y tiempo mediano transcurrido por presencia de evento adverso (cambio de TLSO). RESULTADOS: Se identificaron diferencias estadísticamente significativas en la curva escoliótica entre la medición basal y el primer control, y entre el primer control y el último. No hubo variables demográficas o clínicas asociadas significativamente a las variaciones de la curva escoliótica. Se identificó una diferencia significativa entre las curvas de sobrevivencia de quienes presentaron un evento adverso y aquellos que no. CONCLUSIONES: El TLSO detuvo la progresión de la curva escoliótica tras 12 meses de uso. La falta de casos comparables impidió contrastar los resultados obtenidos con la historia natural de la escoliosis descrita en el antecedente teórico disponible.

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Introducción Los exoesqueletos robóticos son una nueva alternativa para complementar los procesos de rehabilitación funcional de la muñeca, facilitando la terapia de movilización pasiva temprana posterior a eventos traumáticos locales, con el propósito de mantener o restaurar el arco articular mientras cicatrizan los tejidos o consolidan las fracturas. El objetivo del estudio es presentar los resultados de la terapia de movilización temprana de forma pasiva mediante ortesis robóticas de muñeca. Materiales y Métodos Se seleccionaron cuatro pacientes con fracturas de radio distal, quienes fueron tratados quirúrgicamente con reducción abierta de la fractura más osteosíntesis con sistema de placa de bloqueo volar, fisioterapia convencional y movilización temprana con la órtesis robótica PRO-Wix; además, se hizo seguimiento clínico de la funcionalidad (escala DASH), del dolor (escala EVA), de los arcos de movilidad articular (goniómetro), de la adherencia y los potenciales eventos adversos. Resultados todos los pacientes se reintegraron a sus actividades de la vida diaria luego de tres semanas de rehabilitación, se registró recuperación del arco de movilidad articular, disminución de la intensidad del dolor, recuperación funcional, adecuada adherencia y no se presentaron eventos adversos. Discusión conservar al máximo la anatomía articular en la intervención quirúrgica especializada es la base para iniciar la rehabilitación temprana, y permitirá que el paciente tolere la movilización pasiva con órtesis robóticas.

Background Robotic exoskeletons are a new alternative to complement the functional rehabilitation processes of the wrist, facilitating early passive mobilization therapy after local traumatic events, with the purpose of maintaining or restoring joint range of motion while the tissues heal. The aim of the study is to present the results of early mobilization therapy in a passive robotic wrist orthosis. Methods Four patients with distal radius fractures were selected, treated surgically with open reduction and internal fixation of distal radius fracture with volar plate locking system. Conventional physiotherapy and early mobilization with the PRO-Wix robotic orthosis was performed. Clinical monitoring of functionality (DASH scale), pain (VAS scale), joint mobility arches (goniometer), adherence and potential adverse events were carried out. Results all patients returned to their daily living activities after three weeks of rehabilitation. Recovery of normal wrist joint range of motion was achieved; decreased in pain intensity, functional recovery, adequate adherence to rehabilitation protocol and adverse events were also recorded. Discussion preserving the joint anatomy as much as possible in specialized surgical intervention is the basis for starting early rehabilitation, and allowing the patient to tolerate passive mobilization with robotic orthoses. Further studies including a wide number of patients have to be conducted.

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This work presents the design, implementation, and evaluation of a P300-based brain-machine interface (BMI) developed to control a robotic hand-orthosis. The purpose of this system is to assist patients with amyotrophic lateral sclerosis (ALS) who cannot open and close their hands by themselves. The user of this interface can select one of six targets, which represent the flexion-extension of one finger independently or the movement of the five fingers simultaneously. We tested offline and online our BMI on eighteen healthy subjects (HS) and eight ALS patients. In the offline test, we used the calibration data of each participant recorded in the experimental sessions to estimate the accuracy of the BMI to classify correctly single epochs as target or non-target trials. On average, the system accuracy was 78.7% for target epochs and 85.7% for non-target trials. Additionally, we observed significant P300 responses in the calibration recordings of all the participants, including the ALS patients. For the BMI online test, each subject performed from 6 to 36 attempts of target selections using the interface. In this case, around 46% of the participants obtained 100% of accuracy, and the average online accuracy was 89.83%. The maximum information transfer rate (ITR) observed in the experiments was 52.83 bit/min, whereas that the average ITR was 18.13 bit/min. The contributions of this work are the following. First, we report the development and evaluation of a mind-controlled robotic hand-orthosis for patients with ALS. To our knowledge, this BMI is one of the first P300-based assistive robotic devices with multiple targets evaluated on people with ALS. Second, we provide a database with calibration data and online EEG recordings obtained in the evaluation of our BMI. This data is useful to develop and compare other BMI systems and test the processing pipelines of similar applications.

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Resumen: Introducción: El pie caído es una condición que suele manejarse con ortesis cortas, normalmente fabricadas en polipropileno. Se ha descrito también su tratamiento con ortesis de silicón, poco estudiadas pero que parecen mejorar el patrón cinemático de la marcha y, dada su comodidad, ser más aceptadas por los pacientes. Nuestro estudio describe cuáles son las características cinemáticas de la marcha y la satisfacción referida por los pacientes al usar una ortesis tobillo pie de silicón y compara dicho patrón con el no uso de la ortesis en casos con pie caído. Material y métodos: Estudio seudoexperimental descriptivo en pacientes con pie caído desde el año 2010 al 2012, en el que se evaluaron las variables cinemáticas del patrón de marcha a partir de laboratorios de marcha y además de la satisfacción de los sujetos con las ortesis de silicón y con el no uso de las mismas. Resultados: Cinco casos con pie caído fueron objeto del estudio. El análisis de marcha de los pacientes que usaron la ortesis constató una mejora de la posición del tobillo en el contacto inicial, en la velocidad promedio de marcha y en la longitud del paso, así como un aumento de la cadencia. Sin embargo, en términos de comodidad en comparación con el no uso de la ortesis, el resultado fue exiguo. Conclusiones: Las ortesis tobillo pie de silicón mejoran la posición del tobillo en el contacto inicial, así como los parámetros temporoespaciales de la marcha.

Abstract: Introduction: The Drop foot is a condition that is usually handled with short orthosis, usually made of polypropylene. It has also been described as being treated with silicon orthosis, little studied but which seem to improve the kinematic pattern of gait and, given its comfort, be more accepted by patients. Our study describes the kinematic characteristics of gait and patient satisfaction when using a silicon foot ankle orthosis, and compares this pattern to the non-use of the orthosis, in patients with a drop foot. Material and methods: Pseudo-experimental descriptive study in patients with dropped feet from 2010 to 2012, in which the kinematic variables of the gait pattern were evaluated from gait laboratories and in addition to the satisfaction of subjects with silicon orthosis and non-use of them. Results: Five patients with a drop foot were the subject of the study. Gait analysis of patients using the orthosis found an improvement in ankle position at initial contact, average walking speed and step length, as well as increased cadence. However, in terms of comfort compared to the non-use of the orthosis, the result was meager. Conclusions: Silicon foot ankle orthosis improve the position of the ankle in the initial contact, as well as the temporo-spatial parameters of the gait.

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The objective of this review was to identify the main types of insoles described in the literature that are used to treat musculoskeletal alterations of lower limbs and to analyze the existence of previous evaluation for the prescription of these insoles. To this end, two researchers, independently and blindly, searched the PubMed, SciELO, Bireme, MEDLINE, Lilacs, PEDro, Cochrane Library and Web of Science databases between June and July of 2018, from the free combination of the following descriptors: insoles, foot orthoses, foot, orthoses, musculoskeletal diseases and clinical trial. We included randomized or non-randomized clinical trials in which at least one intervention group used insoles and individuals with some type of musculoskeletal disorder had been sampled. Of the 227 documents identified in date bases, 20 were included in this review. In general, it is suggested to carry out more studies with more precise methods and that include evaluation before the prescription. This is a systematic review of clinical trials registered in PROSPERO (International Prospective Register of Systematic Reviews) under the protocol no. CRD42018099534e.

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ABSTRACT Introduction: Diabetes mellitus is a chronic disease that is characterized by causing damage to the peripheral nervous system, generating sensory and motor changes. Objective: This study aims at analyzing the impact of the use of different orthotic insoles on the gait of diabetic female rats. Methods: Twenty-six female Wistar rats were randomly divided into the Control and Diabetic groups. The mechanical sensitivity test was performed manually on the surface of the animals' hind paws using the von Frey test. The functional evaluation was carried out on an adapted platform where the animals were stimulated to walk in order to capture images of the ventral region for measurements of the right and left hind paws. After the images were collected they were processed using Kinovea software version 0.8.27 to assess: stride distance, time, speed and acceleration. Results: There was a reduction in the weight of the animals in the Diabetic Group (p = 0.0018), associated with hyperglycemia (p = <0.0001), and a decrease in mechanical sensitivity as compared to the Control Group (p = 0.0372). Gait analysis showed a reduction in stride speed (p = 0.0482) and acceleration (p = 0.0149), with the silicone orthosis in the Diabetic Group. Conclusions: The silicone orthosis demonstrated a reduction in stride speed and acceleration, without compromising the other variables in the diabetic rats. The other insoles showed no functional difference between groups. Even though the animals showed a change in sensitivity at the end of 28 days of DM induction, this time does not appear to have been able to develop extensive changes in the rats' gait function. Level of evidence II; Therapeutic studies - Investigating the Results of Treatment.

RESUMO Introdução: O diabetes mellitus é uma doença crônica que se caracteriza por causar danos no sistema nervoso periférico, gerando alterações sensitivas e motoras. Objetivos: O presente trabalho tem como objetivo analisar o impacto do uso de diferentes órteses do tipo palmilha sobre a marcha de ratas diabéticas. Métodos: Vinte e seis ratas Wistar foram divididas randomicamente nos grupos Controle e Diabético. O teste de sensibilidade mecânica foi realizado manualmente na superfície da pata traseira dos animais com o teste de von Frey. A avaliação funcional foi feita em plataforma adaptada, na qual as ratas foram estimuladas a deambular, a fim de captar imagens da região ventral para medições das patas traseiras direita e esquerda. Depois da coleta, as imagens foram processadas no software Kinovea versão 0.8.27 para avaliar distância, tempo, velocidade e aceleração de um passo. Resultados: Observou-se redução do peso dos animais no Grupo Diabético (p = 0,0018), associado à hiperglicemia (p = <0,0001) e diminuição da sensibilidade mecânica em comparação com o Grupo Controle (p = 0,0372). Na análise da marcha, verificou-se redução da velocidade (p = 0,0482) e aceleração de um passo (p = 0,0149) com a órtese de silicone no Grupo Diabético. Conclusões: A órtese de silicone demonstrou redução da velocidade e da aceleração do passo, sem comprometimento das demais variáveis nas ratas diabéticas. As demais palmilhas não demonstraram diferença funcional entre os grupos. Ainda que os animais tenham apresentado alteração de sensibilidade, ao final de 28 dias de indução do DM, esse tempo parece não ter sido capaz de desenvolver alterações amplas na função da marcha das ratas. Nível de evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: La diabetes mellitus es una enfermedad crónica que se caracteriza por causar daños al sistema nervioso periférico, generando alteraciones sensitivas y motoras. Objetivos: El presente trabajo tiene como objetivo analizar el impacto del uso de diferentes ortesis, del tipo plantilla sobre la marcha de ratas diabéticas. Métodos: Veintiséis ratas Wistar fueron divididas aleatoriamente en los grupos Control y Diabético. El test de sensibilidad mecánica fue realizado manualmente en la superficie de la pata trasera de los animales con el test de von Frey. La evaluación funcional fue hecha en plataforma adaptada, en la que se estimuló a las ratas a deambular, a fin de capturar imágenes de la región ventral para mediciones de las patas traseras derecha e izquierda. Después de la colecta, las imágenes se procesaron en el software Kinovea versión 0.8.27, para evaluar distancia, tiempo, velocidad y aceleración de un paso. Resultados: Se observó una reducción del peso de los animales en el Grupo Diabético (p = 0,0018), asociado a la hiperglucemia (p = <0,0001), y disminución en la sensibilidad mecánica en comparación con el Grupo Control (p = 0,0372). En el análisis de la marcha, se verificó reducción de la velocidad (p = 0,0482) y una aceleración de un paso (p = 0,0149), con la ortesis de silicona en el Grupo Diabético. Conclusiones: La ortesis de silicona demostró reducción de la velocidad y de la aceleración del paso, sin compromiso de las demás variables en las ratas diabéticas. Las demás plantillas no demostraron diferencia funcional entre los grupos. Aunque los animales hayan presentado alteración de la sensibilidad, al final de 28 días de inducción de DM, ese tiempo parece no haber sido capaz de desarrollar alteraciones amplias en la función de la marcha de las ratas. Nivel de evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

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Resumen Introducción: El labio y paladar hendido son malformaciones craneofaciales que se presentan en 1:1000 nacidos vivos en Colombia. Realizar un moldeado nasoalveolar previo a la cirugía favorece el reposicionamiento de los cartílagos nasales deformados y de los procesos alveolares. Objetivo: Dar a conocer a los profesionales la importancia de realizar moldeado nasoalveolar en un paciente con labio y paladar hendido antes de la intervención quirúrgica. Materiales y métodos: En la clínica odontológica de la Universidad del Sinú de Montería (Córdoba, Colombia), se atendió una paciente de 17 días de nacida que presentaba labio y paladar hendido completo unilateral izquierdo severo. Luego de diligenciar la historia clínica odontológica, se realizó placa de órtesis, que se cambió cada 15 días y se hizo el retoque del "tutor" cada 8 días. Resultados: La placa de órtesis permitió un moldeado naso alveolar, con el progreso en la alimentación y mejoras en el contorneado de los tejidos nasales, que mejoró la preparación para la operación de la hendidura a los 8 meses de edad. Conclusiones: La importancia del moldeado nasoalveolar en casos como el presentado, es propiciar mejores condiciones físicas, favoreciendo la ingesta de alimentos y beneficiando la apariencia física.

Abstract Introduction: Cleft lip and palate is a craniofacial birth defect that accounts for 1:1000 live birhts in Colombia. Performing nasoalveolar molding before surgery facilitates the reshaping of deformed nasal cartilage and alveolar processes. Objective: To make professionals aware of the importance of performing nasoalveolar molding in a patient with cleft lip and palate before surgical intervention. Materials and methods: A 17-day-old infant with a full left unilateral cleft lip and palate was treated at the dental clinic of the University of Sinú, Montería (Córdoba, Colombia). Once the dental clinical history was recorded, an orthosis plate was made. The plate was changed every 15 days and the molding appliance was repositioned every 8 days. Results: The orthosis plate promoted nasoalveolar molding, which facilitated feeding and improved the shape of nasal tissues. Consequently, this early intervention improved the preparation for the surgery of the cleft when the child reached 8 months of age. Conclusions: Nasoalveolar molding in patients with full cleft lip and palate is important to promote better physical conditions, which favor food intake and benefit their physical appearance.

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BACKGROUND: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.

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