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Ankle Foot Orthosis Designs for Patient with Peroneal Nerve Damage: the Comparison of Three Devices for Their Effectiveness in Rehabilitation

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Ankle Foot Orthosis Designs for Patient with Peroneal Nerve Damage: the Comparison of Three Devices for Their Effectiveness in Rehabilitation ANKLE FOOT ORTHOSIS DESIGNS FOR PATIENT WITH PERONEAL NERVE DAMAGE: THE COMPARISON OF THREE DEVICES FOR THEIR EFFECTIVENESS IN REHABILITATION by HUAN HUAN CAI B.M.E., Mercer University, 2018 A Thesis Submitted to the Graduate Faculty of Mercer University School of Engineering in Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE IN ENGINEERING MACON, GA 2018 ANKLE FOOT ORTHOSIS DESIGNS FOR PATIENT WITH PERONEAL NERVE DAMAGE: THE COMPARISON OF THREE DEVICES FOR THEIR EFFECTIVENESS IN REHABILITATION by HUAN HUAN CAI Approved by: Date Dr. Ha Van Vo, Advisor Date Dr. Edward O’Brien, Committee Member Date Dr. Laura Moody, Committee Member Date Dr. Laura Lackey, Dean, School of Engineering TABLE OF CONTENTS LIST OF TABLES ………………………………………………………………… VI LIST OF FIGURES ………………………………………………………….……. IX ACKNOWLEDGEMENTS ……………………………………………………….. XV ABSTRACT ………………………………………………………………………. XVI CHAPTER 1. INTRODUCTION ……………………………………………………. 1 Purpose……………….....................................................................…… 2 About the Patient……………………………………………….…….…2 Anatomical Terminologies…………………………………………...… 4 Directional terms…………………………………………………… 4 Planes…………………………………………………………….… 5 Movements………………………………………………….……… 6 Human Walking Gait Cycle……………………………………………. 8 Ankle Foot Orthoses…………………………………………………… 14 2. ANATOMY OF THE LOWER EXTREMITIES ……………………... 16 Biomechanics…………………………………………...……………… 16 Skeletal System………………………………………………………… 19 Muscular System……………………………………………..………… 29 Peroneal Nerve…………………………………………………………. 37 3. METHODS AND MATERIALS ……………………………………… 40 Casting………………………………………………………….……… 41 Plaster Mold………………………………………………….………… 45 Plastic Molds…………………………………………………………… 50 III IV TABLE OF CONTENTS (Continued) CHAPTER (Continued) AFO Fabrication………………….………………….………………… 56 AFO 3 Fabrication………………….………………….……….……… 64 4. DESIGNS ……………………………………………………………... 71 Rigid AFO Design………………….………………………….….…… 71 Mobile AFO Design …………………………………………...….…... 73 Dorsiflexion Assistance AFO Design……………………….………… 74 5. TESTING PLANS ……………………………………………………. 76 Elastic Modulus Test ...………………….………..…………………… 76 Pulling Test ............................................................................................. 77 2D Kinematic Test……………………………………………………... 79 Longevity Test…..................................................................................... 82 Survey………………………………………………………….............. 83 6. TESTING RESULTS …………………………………………………. 84 Elastic Modulus Test…………………….……….…….……………… 84 Pulling Test……………………..………..………..…………………… 87 2D Kinematic Test…………………….……….……...…..…………… 89 Longevity Test……………………..………..………….……………… 92 Survey……………………..………..………………………………..… 92 7. AFO GAIT ANALYSES ……………………………………………... 94 Free Body Diagrams…………………………………………………… 95 Duration Analysis……………………………………………………… 107 ROM Analysis………………………………………………………..... 112 Cadence……………………………………………………………….... 115 Sagittal Plane Gait Motion……………………………………………... 117 8. NON-AFO ANALYSES …………………………………….……….. 121 Duration Analysis………………………………………………….…... 121 ROM Analysis………………………………………………………..... 126 V TABLE OF CONTENTS (Continued) CHAPTER (Continued) Cadence………………………………………………...……….……... 127 Sagittal Plant Gait Motion……………………………………………... 130 9. DISCUSSION …………………………………………………………. 134 Testing Results……………………………….………………………... 134 Duration Analysis……………………………………………….……... 134 ROM Analysis…………………………………………………………. 136 Cadence ………………………………………………………………... 137 Sagittal Plane Gait Motion……………………………………………... 138 Conclusion …………………………………………………………..… 139 Future Works........................................................................................... 140 REFERENCES…………………………………………………………………….. 142 APPENDICES A. IRB APPROVAL FORM ……………………………………………..…... 146 B. PATIENT CONSENT FORM ……………………………………….……. 147 C. CITI PROGRAM TRAINING COMPLETION …………………………... 149 D. PATIENT SURVEY FORM AND FEEDBACKS………………………... 150 E. 2D KINEMATIC DATA……………........................................................... 152 AFO 1 Data ……………………………………………………………..…. 152 AFO 2 Data ………………………………………………………………... 155 AFO 3 Data ………………………………………………………………... 158 N Data ……………………………………………………………………... 161 F. CADENCE CALCULATIONS………………………………………….... 164 G. RESISTANCE DETERMINATION DATA……………………….…….... 167 H. MORE ABOUT 2D GAIT MOTION FROM STREIFENEDER, INC….... 168 LIST OF TABLES Table 1.1: Gait phases, the functions and the recruited muscles. ..................................... 10 Table 6.1: Dimensions and data for E calculation ............................................................ 87 Table 6.2: Pulling test data................................................................................................ 88 Table 6.3: Sagittal plane ankle measurements .................................................................. 91 Table 6.4 Cadence and velocity. ....................................................................................... 91 Table 7.1: AFO 1 duration data ...................................................................................... 107 Table 7.2: AFO 2 duration data. ..................................................................................... 109 Table 7.3: AFO 3 duration data ...................................................................................... 111 Table 7.4: AFO 1 sagittal plane pre and post ROM change ........................................... 113 Table 7.5: AFO 2 sagittal plane pre and post ROM change ........................................... 114 Table 7.6: AFO 3 sagittal plane pre and post ROM change ........................................... 114 Table 7.7: Cadence, velocity, and PE data...................................................................... 116 Table 7.8a: Joint angles across the sagittal plane, AFO 1 .............................................. 118 Table 7.8b: Joint angles across the sagittal plane, AFO 2. ............................................. 119 Table 7.8c: Joint angles across the sagittal plane, AFO 3. ............................................. 120 Table 8.1: Gait phase duration in a single gait cycle at different N phases. ................... 123 Table 8.2: Normal sagittal plane ROM measurements ................................................... 127 Table 8.3: Cadence and velocity data of the devices at each N phases. ......................... 128 VI VII Table 8.4. Joint angles across the sagittal plane.. ........................................................... 131 Table 8.5: Degree difference between left and right ankle of the N phases. .................. 132 Table 8.6: Sum of all left ankle measurements in in sagittal plane data. ........................ 133 Table 9.1a: The mobility and dorsiflexion degree change after wearing the AFOs. ...................................................................................... 136 Table 9.1b: Ankle symmetricity and joint mobility data. ............................................... 137 Table 9.2: The comparison for the symmetricity and the dorsiflexors’ strength ............ 139 Table E1: Joint ROM, frontal plane ................................................................................ 152 Table E2: Dynamic angle change from IC to MST, frontal plane .................................. 152 Table E3: Joint ROM, sagittal plane. .............................................................................. 153 Table E4: Joint angles in IC, MST, and MSW. .............................................................. 153 Table E5: Joint angle in different gait phases along sagittal plane. ................................ 154 Table E6: Joint ROM along frontal plane ....................................................................... 155 Table E7: Dynamic angle change from IC to MST, frontal plane .................................. 155 Table E8: Joint ROM along sagittal plane. ..................................................................... 156 Table E9: Joint angles in IC, MST, and MSW phase of frontal plane. .......................... 156 Table E10: Joint angle in different gait phases along sagittal plane. .............................. 157 Table E11: ROM of joints along frontal plane ............................................................... 158 Table E12: Dynamic angle change from IC to MST, frontal plane ................................ 158 Table E13: ROM of joints along sagittal plane. ............................................................. 159 Table E14: Joint angles in IC, MST, and MSW phase of frontal plane. ........................ 159 VIII Table E15: Joint angle in different gait phases along sagittal plane. .............................. 160 Table E16: Joint ROM, frontal plane .............................................................................. 161 Table E17: Dynamic angle change from IC to MST, frontal plane ................................ 161 Table E18: Joint ROM, sagittal plane. ............................................................................ 161 Table E19: Joint angles in IC, MST, and MSW phase of frontal plane. ........................ 162 Table E20: Joint angle in different gait phases along sagittal plane. .............................. 163 Table F1: AFO 1 cadence calculations ........................................................................... 164 Table F2: AFO 2 cadence calculations ........................................................................... 164 Table F3: AFO 3 cadence calculations for heavy resistance .......................................... 165 Table F4: AFO 3 cadence calculations for medium
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