This study aims to identify kinematic differences between children with Ponseti treated clubfoot and age-mat- ched healthy controls during gait, using the Oxford Foot Model. This pilot is part of a large project comparing gait kinematics between children with Ponseti treated clubfoot with and without relapse and healthy controls. Final results could identify relevant gait parameters which will allow for early detection of a relapse clubfoot.
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A clubfoot is characterized by a three-dimensional deformity with an equinus, varus, cavus and adduction component. Nowadays the Ponseti method is the preferred treatment for clubfeet, aiming to achieve a normal appearing, functional and painless foot. The reoccurrence of clubfoot components in treated clubfeet, a relapse, is a known problem in clubfoot patients. 3Dgait analysis can be used in assessment of foot function and residual deviations in gait or possible relapses. Gait analysis is frequently used to analyse differences in gait between clubfoot and healthy controls. However, the usage of multisegment foot models is, although of importance considering the characteristics of the clubfoot, rare. In order to capture the full multi-planar and multi-joint nature of a clubfoot, it is highly important to implement multi-segment foot models in gait analysis. In order to improve treatment of individual relapse clubfoot kinematics differences in clinical relevant functional outcomes should be known.
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Background Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot. Research question The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls. Methods A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane. Results The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot. Significance Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.
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Objective: The aim of this study was to obtain insight in specific elements influencing the use, non-use, satisfaction, and dissatisfaction of ankle foot orthoses (AFOs) and the presence of underexposed problems with respect to AFOs. Methods: A questionnaire was composed to obtain information from AFO users to investigate the variables associated with satisfaction and the relation between these variables. A specific feature of this study was the systematic analysis of the remarks made by the respondents about their AFO. Quantitative data analyses were used for analysing the satisfaction and qualitative analyses were used analysing the remarks of the respondents. A total of 211 users completed the questionnaire. Results: Our survey showed that 1 out of 15 AFOs were not used at all. About three quarters of the AFO users were satisfied and about one quarter was dissatisfied. Females and users living alone reported relatively high levels of dissatisfaction, especially in the field of dimensions, comfort, weight, safety and effectiveness. Dissatisfaction with respect to off-the-shelf AFOs for the item durability was higher than that for custom-made AFOs. In the delivery and maintenance process the items ‘maintenance’, ‘professionalism’ and ‘delivery follow-up’ were judged to be unsatisfactory. A large number of comments were made by the respondents to improve the device or process, mainly by the satisfied AFO users. These comments show that even satisfied users experience many problems and that a lot of problems of AFO users are ‘underexposed’. Conclusion: To improve user satisfaction, the user practice has to be identified as an important sub-process of the whole orthopaedic chain especially in the diagnosis and prescription, delivery tuning and maintenance, and evaluation phase.
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Background Objective gait analysis that fully captures the multi-segmental foot movement of a clubfoot may help in early identification of a relapse clubfoot. Unfortunately, this type of objective measure is still lacking in a clinical setting and it is unknown how it relates to clinical assessment. Research question The aim of this study was to identify differences in total gait and foot deviations between clubfoot patients with and without a relapse clubfoot and to evaluate their relationship with clinical status. Methods In this study, Ponseti-treated idiopathic clubfoot patients were included and divided into clubfoot patients with and without a relapse. Objective gait analysis was done resulting in total gait and foot scores and clinical assessment was performed using the Clubfoot Assessment Protocol (CAP). Additionally, a new clubfoot specific foot score, the clubFoot Deviation Index (cFDI*), was calculated to better capture foot kinematics of clubfoot patients. Results Clubfoot patients with a relapse show lower total gait quality (GDI*) and lower clinical status defined by the CAP than clubfoot patients without a relapse. Abnormal cFDI* was found in relapse patients, reflected by differences in corresponding variable scores. Moderate relationships were found for the subdomains of the CAP and total gait and foot quality in all clubfoot patients. Significance A new total foot score was introduced in this study, which was more relevant for the clubfoot population. The use of this new foot score (cFDI*) besides the GDI*, is recommended to identify gait and foot motion deviations. Along with clinical assessment, this will give an overview of the overall status of the complex, multi-segmental aspects of a (relapsed) clubfoot. The relationships found in this study suggest that clinical assessment might be indicative of a deviation in total gait and foot pattern, therefore hinting towards personalised screening for better treatment decision making.
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The World Health Organization (WHO) strives to assist and inspire cities to become more “age-friendly”, and the fundamentals are included in the Global Age-Friendly Cities Guide. An age-friendly city enables residents to grow older actively within their families, neighbourhoods and civil society, and o ers extensive opportunities for the participation of older people in the community. Over the decades, technology has become essential for contemporary and future societies, and even more imperative as the decades move on, given we are nearly in our third decade of the twenty-first century. Yet, technology is not explicitly considered in the 8-domain model by the WHO, which describes an age-friendly city. This paper discusses the gaps in the WHO’s age-friendly cities model in the field of technology and provides insights and recommendations for expansion of the model for application in the context of countries with a high human development index that wish to be fully age-friendly. This work is distinctive because of the proposed new age-friendly framework, and the work presented in this paper contributes to the fields of gerontology, geography urban and development, computer science, and gerontechnology. Original article at MDPI; DOI: https://doi.org/10.3390/ijerph16193525 (This article belongs to the Special Issue Quality of Life: The Interplay between Human Behaviour, Technology and the Environment)
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Purpose – Older people with dementia (OPD) have specific housing and technology-related needs, for which various design principles exist. A model for designing environments and its constituting items for people with dementia that has a firm foundation in neurology may help guide designers in making design choices. The paper aims to discuss these issues. Design/methodology/approach – A general design model is presented consisting of three principles for OPD, namely designing for ageing people; designing for a favourable state and designing for beautiful moments. The neurosciences as a whole give shape to an eminent framework explaining the behaviour of OPD. One of the objectives of this paper is to translate the design principles into design specifications and to show that these specifications can be translated in a design. Findings – Philosophical concepts are introduced which are required to understand design for OPD. Four case studies from Dutch nursing homes are presented that show how the theory of modal aspects of the philosopher Dooyeweerd can be used to map design specifications in a systematic way. Research limitations/implications – These examples of design solutions illustrate the applicability of the model developed in this article. It emphasises the importance of the environment for supporting the daily life of OPD. Originality/value – There is a need for a design model for OPD. The environment and technology should initiate positive behaviours and meaningful experiences. In this paper, a general model for the designing of environments for OPD was developed that has a firm foundation in neurology and behavioural sciences. This model consists of six distinct steps and each step can be investigated empirically. In other words, this model may lay the foundation for an evidence-based design. Original article at Emerald: https://doi.org/10.1108/JET-11-2017-0043 For this paper Joost van Hoof received the Highly Recommended Award from Emerald Publishing Ltd. in October 2019: https://www.emeraldgrouppublishing.com/authors/literati/awards.htm?year=2019
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Control methods are applied worldwide to reduce predation on livestock by European red foxes (Vulpes vulpes). Lethal methods can inflict suffering; however, moral debate about their use is lacking. Non-lethal methods can also inflict suffering and can unintentionally lead to death, and yet both the welfare consequences and ethical perspectives regarding their use are rarely discussed. The aim of this study was to investigate the animal welfare consequences, the level of humaneness, the ethical considerations and the moral implications of the global use of fox control methods according to Tom Regan’s animal rights view and Peter Singer’s utilitarian view. According to Regan, foxes ought not to be controlled by either lethal or potentially harmful non-lethal methods because this violates the right of foxes not to be harmed or killed. According to Singer, if an action maximises happiness or the satisfaction of preferences over unhappiness or suffering, then the action is justified. Therefore, if and only if the use of fox control methods can prevent suffering and death in livestock in a manner that outweighs comparable suffering and death in foxes is one morally obligated t
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Background: Currently, the Ponseti method is the gold standard for treatment of clubfeet. For long-term func- tional evaluation of this method, gait analysis can be performed. Previous studies have assessed gait differences between Ponseti treated clubfeet and healthy controls. Research question/purpose: The aims of this systematic review were to compare the gait kinetics of Ponseti treated clubfeet with healthy controls and to compare the gait kinetics between clubfoot patients treated with the Ponseti method or surgically. Methods: A systematic search was performed in Embase, Medline Ovid, Web of Science, Scopus, Cochrane, Cinahl ebsco, and Google scholar, for studies reporting on gait kinetics in children with clubfeet treated with the Ponseti method. Studies were excluded if they only used EMG or pedobarography. Data were extracted and a risk of bias was assessed. Meta-analyses and qualitative analyses were performed. Results: Nine studies were included, of which five were included in the meta-analyses. The meta-analyses showed that ankle plantarflexor moment (95% CI -0.25 to -0.19) and ankle power (95% CI -0.89 to -0.60, were significantly lower in the Ponseti treated clubfeet compared to the healthy controls. No significant difference was found in ankle dorsiflexor and plantarflexor moment, and ankle power between clubfeet treated with surgery compared to the Ponseti method. Significance: Differences in gait kinetics are present when comparing Ponseti treated clubfeet with healthy controls. However, there is no significant difference between surgically and Ponseti treated clubfeet. These results give more insight in the possibilities of improving the gait pattern of patients treated for clubfeet.
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Objective: This exploratory study investigated to what extent gait characteristics and clinical physical therapy assessments predict falls in chronic stroke survivors. Design: Prospective study. Subjects: Chronic fall-prone and non-fall-prone stroke survivors. Methods: Steady-state gait characteristics were collected from 40 participants while walking on a treadmill with motion capture of spatio-temporal, variability, and stability measures. An accelerometer was used to collect daily-life gait characteristics during 7 days. Six physical and psychological assessments were administered. Fall events were determined using a “fall calendar” and monthly phone calls over a 6-month period. After data reduction through principal component analysis, the predictive capacity of each method was determined by logistic regression. Results: Thirty-eight percent of the participants were classified as fallers. Laboratory-based and daily-life gait characteristics predicted falls acceptably well, with an area under the curve of, 0.73 and 0.72, respectively, while fall predictions from clinical assessments were limited (0.64). Conclusion: Independent of the type of gait assessment, qualitative gait characteristics are better fall predictors than clinical assessments. Clinicians should therefore consider gait analyses as an alternative for identifying fall-prone stroke survivors.
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