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BACKGROUND: Wearable lower extremity exoskeletons can provide walking assistance for the physical rehabilitation of paralyzed individuals. However, most of the existing exoskeletons require crutches to maintain balance, thus a self-balancing type is needed to improve applicability. OBJECTIVE: The purpose of this work is to study the kinematic characteristics of a novel lower extremity exoskeleton for crutch-less walking rehabilitation, and evaluate the movement performance through practical experiments. METHODS: Based on the human lower limb structure and movement characteristics, a fully actuated 10 degrees-of-freedom (DoF) lower extremity exoskeleton was proposed. The kinematic characteristics of the exoskeleton were analyzed by the D-H method and geometric method, and the model validity was verified through simulations and experiments. RESULTS: The closed-form solutions for both forward and inverse kinematics models were obtained. The consistent results of theoretical calculation and numerical simulation have shown the accuracy of the established models. The practical experiments regarding six trials have demonstrated the movement performance of the proposed exoskeleton, including sit, stance, leg extension/flexion, and left/right swing. CONCLUSIONS: The kinematic characteristics of the proposed 10-DoF lower extremity exoskeleton are similar to the human lower limb, and it could meet the motion demands of crutch-less walking rehabilitation.

Background Instead of using axillary crutches, using a hands-free crutch (HFC) has been associated with higher functional outcome scores. However, hip and back pain have been reported as side effects. Purpose/Hypothesis The purpose of this study was to compare range of motion and joint reaction forces at the hip and low back between HFC walking, normal walking, and standard crutch walking. It was hypothesized that hip joint reaction forces and low back joint reaction forces would be higher with HFC walking compared with normal walking and axillary crutch walking. Study Design Controlled Laboratory Study Methods Using 3D motion analysis and force plates, kinematics and ground reaction forces were measured in 12 healthy subjects during gait, crutch ambulation and HFC walking. Gait speed, hip and trunk range of motion, and hip and low back reaction forces, were compared using repeated-measures ANOVA. Results Gait speed during HFC ambulation was reduced 33% compared to crutch ambulation (P Conclusion Hip joint reaction forces during HFC walking did not exceed those during gait or axillary crutch ambulation. However, a reduction in hip motion using the HFC was associated with increases in trunk motion and low-back loading. These could be a cause for reports of low-back pain accompanying HFC usage. Level of Evidence Level 3

A patient who unexpectedly sustains a lower leg injury often uses crutches for walking, to both assist the patient and prevent further injury until a full recovery is made. In this study, a novel crutch walk training system was developed; a head-mounted display (HMD) was introduced to present a virtual obstacle for trainees using crutches. Through repetitions of the training, it was expected that the trainees would improve their overall body stability. Healthy subjects participated in experimental training exercises using the developed training system. As a result, the participants acquired the skill of walking well with crutches without losing their body balance significantly, even in the event of facing a virtual obstacle, during the five training sessions.

Background: Different fractures of the proximal femur are managed using different techniques depending on baseline functional status, patient’s age, fracture stability, injury mechanism, morphologic features, and/or fracture location. One such fracture is Subtrochanteric fractures of femur seen below lesser trochanter extending 5cm distally in femur shaft.Objectives: The present study was conducted to assess the functional outcomes of proximal femoral fractures in adult males managed using Long Proximal femoral nails.Methods: The present prospective clinical study was conducted on 150 subjects managed for Subtrochanteric fractures of femur who were managed surgically using Long Proximal femoral nails. After treatment, the subjects were evaluated at 4 weeks, 6 weeks, and 3 months using suitable radiographs and Harris Hip Score, and the results were formulated.Results: 16% (n=24) subjects had no pain, whereas, severe pain was seen in 8% (n=12) subjects. Concerning stair climbing, 32.66% (n=49) subjects were able to climb stair without help and 3% (n=4) subjects were not able to climb stair. 96.66% (n=145) subjects were able to sit comfortably post-surgery. 36.66% (n=55) subjects were able to walk easily and 14% (n=21) subjects could walk only indoors. 36% (n=54) subjects needed no support post-surgery, 58% (n=87) needed canes, and 6% (n=9) needed crutch support. No limping, slight limping, and moderate limping was seen in 34% (n=51), 40.66% (n=61), and 25.33% (n=38) subjects respectively. The functional results for the present study were excellent, good, fair, poor, and not known in 26% (n=39), 46% (n=69), 17.33% (n=26), 6.66% (n=10), and 4% (n=6) study subjects respectivelyConclusion: The present study concludes that subtrochanteric femur fractures are effectively managed using the long proximal femoral nail as a reliable implantation method with minimum soft-tissue damage and high bone-union rates. Various biochemical and biological advantages are associated with intramedullary fixation, however, this management strategy is technically demanding and requires patience and learning.

Background: Osteoarthritis (OA) of the knee is a degenerative, non-inflammatory joint condition marked by articular cartilage disintegration and the growth of new bone (osteophytes) at the joint surfaces and borders. It impairs one’s ability to function and makes one disabled. It is the most common rheumatic disease. Because the Knee is a weight-bearing joint and a crutch joint, it is the most usually afflicted joint by Osteoarthritis. Materials and Methods: A Correlational study was conducted to find out the correlation between Knee Society Score (KSS) and Oxford Knee Score (OKS) on 142 Osteoarthritis Knees. Purposive sampling was used to collect data from the Orthopaedics OPD at AIIMS Jodhpur from October to December 2018. Results: On evaluation, the mean age of the patients was 60.191.01. Bilateral Knee Osteoarthritis affected about 42% of the patients. Approximately half of the patients were obese. Only 34% of patients had compliance in physiotherapy. Analgesics and massage treatment are used by about 76% of the patients to relieve knee pain. In the Knee Society Score, the majority of the patients (82.4%) had a bad knee condition, with a mean score of 49.071.06. In OKS, about half of the patients (46.5%) had Moderate to Severe Knee Osteoarthritis, with a mean score of 22.697.09. The correlation coefficient between the Knee Society Score and the Oxford Knee Score is 0.660. As a consequence of the analysis, both scales have almost the same outcome, indicating that they are moderately associated. The Knee Society Score is highly associated with occupation and physiotherapy, whereas the Oxford Knee Score is significantly related to the patients’ age alone. Conclusion: According to the study, there is a moderate correlation between the Knee Society Score (KSS) and the Oxford Knee Score (OKS). These scores should be included during the diagnosis of Knee Osteoarthritis for improved patient care. Keywords: Correlation, Knee, Knee Society Score

Background The aim of this study was to evaluate the influence of antirheumatic drug treatment on knee function of stiff knee patients after total knee arthroplasty (TKA). Methods Twenty-seven patients (44 knees) of active RA (rheumatoid arthritis) or AS (ankylosing spondylitis) with stiff knees were included in this study. And they were divided into two groups according to continue antirheumatic drug treatment or not after TKA: the therapeutic group (16 patients, 27 knees) and the controlled group (11 patients, 17 knees). The outcomes were assessed by Knee Society Score (KSS), Visual Analogue Scale (VAS), range of motion (ROM) (at week 6, month 6, year 1, and year 2), “Forgotten Joint” Scale (FJS), with or without crutch, satisfaction, and revision (at year 2). The knee prosthetic loosening was evaluated by the followed X-ray at each following time. Results The mean follow-up time was 51 months (34–69 months). The KSS was higher at week 6 after TKA in the therapeutic group (p < 0.05); however, the functional scores of KSS at month 6, year 1, and year 2 in the controlled group were more points improved. The therapeutic patients preferred the knee more at month 6, year 1, and year 2. The differences of KSS clinical scores (at month 6, year 1, and year 2), VAS, ROM, Crutch and FJS between the two groups were not statistically significant (p > 0.05). Conclusion For patients with stiff knees, the sequential antirheumatic drug treatment after TKA had no obvious effect on postoperative KSS, but can improve the satisfaction. Level of evidence Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence.

In order to resolve some of the disadvantages of conventional crutch designs, as well as some of the existing crutch-substitute devices, available on the market, a novel Exo-Limb crutch design is presented. The Exo-limb is a hands-free crutch meant to enhance and replace standard underarm crutches and other competitive products during injury rehabilitation. The focus of this research has been on creating a cost-effective passive device that mimics humans natural walking gait using purely mechanical components. Prior to the design, human natural treadmill walking was monitored by a 3D Motion Capture System and a reference end¢‚¬€œfoot trajectory with a ¢‚¬Ëœteardrop shape¢‚¬„¢ was acquired. Considering the design objectives, natural human walking and comfort, and other factors such as load capacity and weight of the device, the final design was determined. In order to satisfy the design objectives a kinematic synthesis, previously developed by one of the co-authors, is applied to test if the end¢‚¬€œfoot trajectory of the designed crutch substitute smoothly follows the desired reference, ¢‚¬Ëœteardrop shape¢‚¬„¢ in the vicinity of two specified task points, heel strike and toe off. A prototype of the final design was fabricated and its performance was tested by 2 mph treadmill walking. The research and developments made in this project with regard to mimicking the natural walking gait are important contributions that find applications in different areas, such as military, robotic locomotion, injury recovery and physical therapy.

Objective We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. Design Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale and self-reported functional independence scale. Participants The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 years, 53% were female, 52% lived alone and were functionally independent with the use of assistive technology. Results We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. Conclusions Age is associated with psychosocial outcomes for assistive device users and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

Background Heel ulcers in patients with peripheral neuropathy and diabetes pose a significant challenge to treating physicians. Infection spreading to the os calcis is associated with a poor prognosis. There is no consensus on which method of surgical treatments results in better outcomes. The aim of this study was to assess patients’ survival, rate of ulcer healing following surgical treatment, along with limb salvage rate, time taken for healing, ulcer recurrence and patients’ functional outcome after healing. Methods We studied 29 patients (20 men, 9 women) presenting with diabetic neuropathic heel ulcers (30 feet) and no critical limb ischemia, were managed surgically in our unit and followed-up for a minimum of 12 months. We assessed their clinical and functional outcomes within a mean follow-up period of 28 months (12–83). Results 11 out of 29 patients died (38%) with mean duration of post op survival being 31months (range 4–70). 14 ulcers (50%) healed fully within a mean of 360 days (131–1676). Limb salvage was achieved in 29 feet (97%). Only 5 out of 17 patients with diabetic nephropathy (p value 0.016) and 9 out of 24 ulcers with calcaneal osteomyelitis (p value 0.044) achieved full ulcer healing. Ulcer recurrence rate was 36% (5/14) within 12 months of achieving ulcer healing. Six patients were able to return to independent walking in surgical shoes while 11 patients were mobilising using either a crutch or frame. Conclusion While excellent limb salvage can be anticipated from the outcome of surgically managed infected heel ulcers in patients with diabetes, complete healing can still be slow and unpredictable. Significant medical co-morbidities in these patients make them vulnerable to medium-term post-operative complication and survival.

Various exoskeleton robots are being developed according to users’ conditions. Lower limb exoskeleton robots have attracted much attention for performing walking motions, a basic exercise for paralyzed patients. In this study, the walking environment of an exoskeleton robot wearer who walks using a crutch is identified as the foot position of the crutch support point and the support leg; therefore, the upcoming foothold location is calculated and sets as a control target. Rather than using preset pedestrian patterns, pedestrian patterns that can match the environment are created using the dynamic movement primitives machine learning technology. We evaluated the exoskeleton robot through an experiment with a healthy 29-year-old male. The experimental results showed that the exoskeleton robot was able to demonstrate the adaptive strides according to the wearer’s intention.

We may be suddenly forced to use crutches when having injuries to our legs, and, at that time, are often unfamiliar with the use of the crutches. To prevent secondary accidents that are caused by the lack of the patient’s knowledge of using crutches, the authors proposed a training device with pendulum-mechanism that may have a trainee suffer a falling by providing an external torque to the trainee’s body. It is expected to present a sense to be falling and to perturb the crutch walking motion by swinging a motor-driven pendulum weight. Thus, patients will acquire an ability to cope with falling by the use of the proposed system. In this paper, it was clarified that the pendulum device was effective for tilting the crutch moreover with any weight masses through experiments. In addition, it is also confirmed that it succeeds in perturbing the walking motion of the participants.

Resection of malignant bone tumors in the posterior ilium may result in pelvic ring disruption. Preserving the pelvic ring and keeping an adequate surgical margin is ideal, but is challenging, especially when the tumor extends to the sacroiliac joint. The current report proposes a line from the lateral point of the second sacral dorsal foramen to the anterior surface of sacral ala (S2‐sacral ala line), and cutting from the line to the ilium over the sciatic notch and to the sacral wing using thread saws. This preserves the cortex at the sciatic notch and the distal sacroiliac joint. Two posterior iliac tumors extending to the sacroiliac joint, a metastatic melanoma in a 75‐year‐old male, and an osteosarcoma in a 56‐year‐old male were resected. The resections were performed along the S2‐sacral ala line, and consequently lumbo‐sacro‐pelvic fusions were performed. Both patients were able to walk with one crutch. Indications for the method using the S2‐sacral ala line for iliac tumors may be limited. However, the method can increase pelvic ring preservation in cases with posterior iliac malignant bone tumors., Preserving the pelvic ring at the sciatic notch during resection of a malignant bone tumor (brown) at the posterior ilium, with a resection line (red dotted line) and S2‐sacral ala points (green dot) of the lateral point of the second sacral dorsal foramen (S2 point: left illustration) and the anterior surface of sacral ala (sacral ala point: right illustration).

The proximal femur is the most frequent operative site for metastasis, but there is no consensus between internal fixation and hip replacement. The present multicenter retrospective observational study sought: (1) to compare early clinical results between internal fixation and hip replacement for proximal femoral metastasis (PFM), and (2) to assess events affecting survival.The study hypothesis was that internal fixation and hip replacement give comparable clinical results, operative site complications rates and survival.The series comprised 309 cases, 10 of which were bilateral, in 182 females and 117 males, with a mean age of 67.2±11.5 years and 62.5±13.2 years, respectively. Primaries were mainly breast (118; 38.2%), lung (85; 25.5%) or kidney (40; 12.9%). PFM was revelatory in 114 cases (36.9%). There was visceral involvement in 142 patients (46%), multiple peripheral bone involvement in 212 (68.6%), and spinal involvement in 134 (43.4%). There were 124 pathologic fractures (40%), 51 of which were revelatory. Metastases were cervicocephalic in 135 cases (43.7%), metaphyseal in 166 (53.7%) and both in 8 (2.6%). PFM was osteolytic in 90% of cases, managed by hip replacement in 161 cases and internal fixation in 148 (12 screwed plates, 136 nails). Seventy-seven patients had postoperative radiation therapy.After hip replacement (n=144), walking was normal in 35 cases (24.3%), impaired but unassisted in 53 (36.8%), with 1 forearm crutch in 24 (16.6%), 2 crutches or a frame in 26 (18%), and impossible in 6 (4.1%). After nailing (n=125), results were respectively 38 (30.4%), 47 (37.6%), 15 (12%), 18 (14.4) and 7 (5.6%). Recovery of normal walking capacity did not significantly differ according to technique (p=0.162); nor did pain or function. Recovery of normal walking capacity was better after preventive surgery (p0.001). Perioperative complications comprised: 10 cases of severe blood loss, 7 pulmonary embolisms, 6 digestive hemorrhages, and 5 lung infections. Secondarily, there were 11 infections (7 after hip replacement, 2 after nailing, 2 after plate fixation), 7 progressive osteolyses and 5 fractures. Complications rates were significantly higher with plate fixation, with no difference between nailing and hip replacement. Survival did not significantly differ between hip replacement (12 months [95% CI: 7-19]), nailing (7 months [95% CI: 6-11]) and plate fixation (16 months [95% CI: 6-not calculable]).Clinical results and survival were comparable between hip replacement and nailing, confirming the study hypothesis, in agreement with the literature. Each technique has its indications. Patients with severely impaired walking capacity benefited greatly from surgery. The importance of preventive surgery was highlighted.IV, retrospective study.

Background Mobility aids are commonly prescribed to offload an injured lower extremity. Device selection may impact stance foot loading patterns and foot health in clinical populations at risk of foot ulceration. Research questions Two questions motivated this study: How does device selection influence peak plantar and regional (rearfoot, mid foot and forefoot) foot forces on the stance foot? Does device selection influence peak, cumulative, and regional plantar forces within a 200 m walking trial? Methods Twenty-one older adults walked 200 m at self-selected pace in four randomized conditions for this prospective crossover study. Participants used a walker, crutches, wheeled knee walker (WKW), and no assistive device (control condition). Plantar forces were measured using a wireless in-shoe system (Loadsol, Novel Inc., St. Paul, MN). Repeated measures analyses of variance were used to determine differences in peak and cumulative total and regional forces among walking conditions. Paired sample t-tests compared forces during first and last 30 s epochs of each condition to determine device influence over time. Results The WKW reduced peak net forces by 0.29 and 0.35 bodyweight (BW) when compared to the walker or control condition with similar trends in all foot regions. Crutch use had similar peak forces as control. There were no differences in the number of steps taken within devices comparing first and last epochs. Crutches had a 0.04 and 0.07 BW increase in peak net and forefoot forces during the last epoch. Walker use had 66.44 BW lower cumulative forefoot forces in the last epoch. Significance Crutches had similar stance foot loading as normal walking while a walker lowered forefoot forces at the expense of increased steps. A WKW may be the best choice to ‘protect’ tissues in the stance foot from exposure to peak and cumulative forces in the forefoot region.

Bone-anchored attachment of amputation limb prostheses is increasingly becoming a clinically accepted alternative to conventional socket suspension. The direct transfer of loads demands that the percutaneous implant system and the residual bone withstand all forces and moments transferred from the prosthesis. This study presents load measurements recorded at the bone-anchored attachment in 20 individuals with unilateral transfemoral amputation performing the everyday ambulatory activities: level ground walking, stairs ascent/descent and slope ascent/descent. Mean peak values for the sample populations across activities ranged from 498–684 N for the resultant force, 26.5–39.8 Nm for the bending moment, and 3.1–5.5 Nm for the longitudinal moment. Significant differences with respect to level walking were found for the resultant force during stairs ascent, (higher, p = 0.002), and stairs descent, (lower, p = 0.005). Using a crutch reduced the peak resultant forces and the peak bending moments with averages ranging from 5.5–12.6 % and 13.2–15.6 %, respectively. Large inter-participant variations were observed and no single activity resulted in consistently higher loading of the bone-anchored attachment across the participants. Results from this study can guide future development of percutaneous osseointegrated implant systems for limb prostheses and their rehabilitation protocols.

Rosai–Dorfman disease (RDD) with spinal cord involvement is a rare clinical entity. We report a case of RDD with paravertebral and intraspinal epidural involvement in a 24-year-old male Bangladeshi patient who presented with progressive bilateral lower limb weakness for 20 days duration associated with spasticity and muscle spasm. MRI demonstrated an enhancing paravertebral soft tissue lesion extending from C7 through T4 with intraspinal epidural extension encasing the spinal cord with focal cord oedema. Histopathology of the paraspinal-epidural lesion reported a finding consistent with RDD. The patient was initiated on high-dose steroids. Follow up after 2 months demonstrated symptomatic improvement as the patient was able to move on the crutch and repeated MRI showed lesion regression. Keywords: Rosai–Dorfman disease, Tuberculosis, Lymphoma, Spinal cord

This work provides quantitative data related to the use of Lofstrand crutches, these data are the strengthapplied on the armrest to the contact surface, the angle of the crutch relative to its axis of origin.Modular sensors of magnetometer, gyroscope and accelerometer were used. The results presented are: the dynamic force variation in the order of 0 kgf to 50 kgf was measured by the Force Sensing Resistor (FSR) sensor indicating the convergence of the data with the theoretical reference. Another innovative contribution of this work is the geoprocessing during the walk of the user. Finally, the purpose of the system is to explore the use of the Canadian crutch for the walking response and consequent storage of the users data, providing a mapping for user walk.

Cesarean births are serious and costly surgical procedures that can be lifesaving in emergencies, but are becoming more preferable to vaginal births globally due to their comparative predictability and relative quickness. For example, a mother I spoke with had a two and a half day delivery, while a cesarean birth only takes around two hours. Cesarean births are predictable in that a doctor is in control of what is happening, instead of complimenting the natural process and rhythm of the laboring mother. This makes cesarean births preferable for many doctors and for some mothers as well. Ideally, the rate of cesarean sections would be 10-15 percent of all births, according to the World Health Organization, but in Mexico, nearly half of all births are cesarean births (Freyermuth, Munos, and del Pilar Ochoa 2017; WHO 2015). This paper shows how macro-level structures impact the type of birth a mother on Isla Mujeres wishes to have, assuming she is aware of such resources. Data comes from formal interviews with doctors and immigrants on Isla Mujeres, informal interviews with Mexican women living on Isla Mujeres, surveys, and participation observation at the Community Hospital.

This study focuses on whether a mentor can facilitate the development of entrepreneurial self-efficacy particularly with regard to opportunity recognition (ESE-OR) for novice entrepreneurs and whether their level of learning goal orientation (LGO) has a moderating effect. Based on a sample of 219 mentees and a longitudinal follow-up for 106 of these respondents, the results show that mentoring supports the development of ESE-OR, but only for low LGO mentees. Furthermore, the effect of mentoring on ESE-OR for low LGO mentees is ephemeral as it decreases once the relationship ends. This suggests the need for long-term support in order to maintain their ESE-OR high throughout the entrepreneurial endeavour. At the opposite end, high-LGO mentees see their ESE-OR slightly decline in an intense mentoring relationship suggesting that mentoring helps to adjust ESE-OR to a more appropriate level for novice entrepreneurs.

Introduction and hypothesis Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal. Methods The featured patient is a 31-year-old woman unable to walk after transobturator sling implantation 2 years before. She reported left thigh pain immediately after surgery that was not responsive to postoperative medication. Six months later, suburethral portion excision was performed but no pain relief was obtained. She was unable to walk, and needed a wheelchair. Electromyography showed axonal injury of the left obturator nerve. After providing proper informed consent, the patient was admitted for combined transvaginal and transcutaneous transobturator tape arm removal. Results The featured procedure was completed in 120 min and blood loss was

Lower-limb exoskeletons are a promising option to increase the mobility of persons with leg impairments in a near future. However, it is still challenging for them to ensure the necessary stability and agility to face obstacles, particularly the variety that makes the urban environment. That is why most of the lower-limb exoskeletons must be used with crutches: the stability and agility features are deferred to the patient. Clinical experience shows that the use of crutches not only leads to shoulder pain and exhaustion, but also fully occupies the hands for daily tasks. In November 2020, Wandercraft presented Atalante Evolution, the first self-stabilized and crutch-less exoskeleton, to the powered exoskeleton race of the Cybathlon 2020 Global Edition. The Cybathlon aims at promoting research and development in the field of powered assistive technology to the public, contrary to the Paralympics where only participants with unpowered assistive technology are allowed. The race is designed to represent the challenges that a person could face every day in their environment: climbing stairs, walking through rough terrain, or descending ramps. Atalante Evolution is a 12 degree-of-freedom exoskeleton capable of moving dynamically with a complete paraplegic person. The challenge of this competition is to generate and execute new dynamic motions in a short time, to achieve different tasks. In this paper, an overview of Atalante Evolution system and of our framework for dynamic trajectory generation based on the direct collocation method will be presented. Next, the flexibility and efficiency of the dynamic motion generation framework are demonstrated by our tools developed for generating the important variety of stable motions required by the competition. A smartphone application has been developed to allow the pilot to choose between different modes and to control the motion direction according to the real situation to reach a destination. The advanced mechatronic design and the active cooperation of the pilot with the device will also be highlighted. As a result, Atalante Evolution allowed the pilot to complete four out of six obstacles, without crutches. Our developments lead to stable dynamic movements of the exoskeleton, hands-free walking, more natural stand-up and turning moves, and consequently a better physical condition of the pilot after the race compared to the challengers. The versatility and good results of these developments give hope that exoskeletons will soon be able to evolve in challenging everyday-life environments, allowing patients to live a normal life in complete autonomy.

Pierre Auguste Cot's painting, "Mireille giving alms at the door of Saint-Trophime," depicts a wealthy lady giving alms to a crippled beggar boy. The beautiful painting portrays the striking contrast between the rich and the poor. The painting also draws attention to the crude crutch the boy was using. This type of crutch was used over the centuries; improvements in the design of the axillary crutch occurred only in the 20th century.

Introduction and importance: Pelvic osteosarcoma is quite rare and is a challenging task for orthopedic surgeons. This aim of this study is to present the first case report using customized 3D-printed prosthesis in Vietnam. Case presentation 57-year-old male was diagnosed with pelvic osteosarcoma. After neoadjuvant chemotherapy, we did limb-salvage surgery after partial pelvic resection. He had to undergo another surgery due to an infection complication that exposed part of the prosthesis. At 6 months follow-up, the patient's overall status was stable. VAS score when moving is 2/10. He can walk with one crutch. Patient is still being followed up and treated. Clinincal discussion Management of pelvic osteosarcoma remains a challenging task for orthopedic surgeons. Advancements in customized 3D-printed prosthesis have been applied in treatment of pelvic osteosarcoma. Despite the complications, the results are promising. We believe that this is a new and innovative route in surgery of pelvic osteosarcoma. Conclusion Using customized 3D-printed prosthesis is a good way for management of pelvic osteosarcoma., Highlight • Osteosarcoma of pelvis is not common, account for 4–10% of all bone cancer. • Pelvis connect the lower limb with body by hip joint and support the intraabdominal organ. • It is very difficult to preserve the pelvis after wide resection. • Custom made 3D printed implant give us a chance to restore the pelvis anatomically and functionally.

In recent years, interest in monitoring Physical Activity (PA) has increased due to its positive effect on health. New technological devices have been proposed for this purpose, mainly focused on sports, which include Machine Learning algorithms to identify the type of PA being performed. However, PA monitoring can also provide data useful for assessing the recovery process of people with impaired lower-limbs. In this work, a Machine-Learning based Physical Activity classifier design procedure is proposed, which makes use of the data provided by a Sensorized Tip that can be adapted to different Assistive Devices for Walking (ADW) such as canes or crutches. The procedure is based on three main stages: 1) defining a wide set of potential features to perform the classification; 2) optimizing the number of features by a Random-Forest approach, detecting the most relevant ones to classify five relevant activities (walking at a normal pace, walking fast, standing still, going up stairs and going down stairs); 3) training the ML-based classifiers considering the optimized feature set. A comparative analysis is carried out to evaluate the proposed procedure, using three ML-based classifier (Support Vector Machines, K-Nearest Neighbour and Artificial Neural Networks), demonstrating that the proposed approach can provide very high success rates if proper feature selection is carried out. This work presents four relevant contributions to the PA monitoring area: 1) the approach is focused on people that require ADW, which are not considered in other approaches; 2) an analysis of the features to characterize gait in people that require ADW is carried out; 3) a design procedure to optimize the number of features using a Random-Forest approach is used, avoiding a typical “brute force” procedure; and 4) a comparative analysis is carried out to demonstrate the validity of the approach.

Study design Case report. Objective Describe the clinical and radiological outcomes of a patient with a piezo-type mechanosensitive ion channel component 2 (PIEZO2)-deficient arthrogryposis receiving surgery for severe kyphoscoliosis. Summary of background data Spinal deformity is a characteristic feature of arthrogryposis due to PIEZO2 gene deficiency, for which surgical correction is indicated when the deformity is progressive to avoid neurological deficits and respiratory impairment. However, there exist few reports on the surgical treatment of spinal deformity in PIEZO2-deficient arthrogryposis, and no therapeutic standards have been established. Methods We retrospectively reviewed a case of proximal junctional kyphosis after posterior spinal fusion for severe kyphoscoliosis in PIEZO2-deficient arthrogryposis. Results The patient was a 13-year-old girl with PIEZO2-deficient arthrogryposis who underwent posterior spinal fusion with an all-pedicle screw construct from T2 to L2 for a preoperative main thoracic curve Cobb angle of 78° and thoracic kyphotic angle of 83°. Postoperative Cobb angle of the main thoracic curve and thoracic kyphotic angle were improved at 11° and 34°, respectively. Although revision surgery was required for neurological deficits from proximal junctional kyphosis, she could walk with a crutch and improvements in clinical questionnaire scores were noted at 2 years and 3 months after surgery. Conclusion Based on the present case, posterior spinal fusion represents a good treatment option for severe spinal deformity in PIEZO2-deficient arthrogryposis. Careful consideration of fusion level is needed to prevent proximal junctional kyphosis. Level of evidence 5.

In Sophocles’ Oedipus Coloneus, after laying hands on Antigone and Ismene, Creon ridicules Oedipus by saying these words (OC 848–9):οὔκουν ποτ’ ἐκ τούτοιν γε μὴ σκήπτροιν ἔτιὁδοιπορήσῃς.Then you shall never more walk with the aid of these two props!It is possible that Creon is here alluding to Oedipus’ actual appearance throughout the play. As far as we know, Oedipus comes on stage with no walking stick, and uses Antigone and Ismene as a crutch while walking. Creon's comparing Oedipus’ daughters to a crutch, however, is also metaphorical. Such a metaphor is quite common in some modern languages (for example in Italian, ‘bastone della vecchiaia’, or in French, ‘bâton de vieillesse’), but was known by ancient Greek poetry as well. In Euripides’ Hecuba, for instance, Hecuba depicts her daughter Polyxena as her crutch (281 βάκτρον).

OBJECTIVE The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type. DESIGN This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction. RESULTS The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0-1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01). CONCLUSIONS Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.

Background:Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT).Aim:Evaluate aFB effects on load control during gait by a self-controlled case series trial.Methods:A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved.Results:Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p= 0.001). The FB did not influence gait speed or fatigue (p> 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives.Conclusion:aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.

In this paper, we succinctly present the hardware properties and capabilities of the lower body exoskeleton Co-Ex, which was developed to attain self-balancing and crutch-free walking support for those experiencing ambulatory difficulties in general. To provide full 3-D walking support while containing the number of required actuators, it includes 4 active joints per leg. Custom-built series elastic actuators enable the torque sensing and controllability at each joint, enhancing the robot’s physical interaction capabilities. While limiting the number of active joints minimizes the weight and energy requirements, the underactuated leg configuration increased the computational load. The preliminary squatting experiments revealed that Co-Ex may provide crutch-free 3-D movement support.