Literatura académica sobre el tema "Custom orthosis"
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Artículos de revistas sobre el tema "Custom orthosis"
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Lee, Winson CC, Toshiki Kobayashi, Barton TS Choy y Aaron KL Leung. "Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements". Prosthetics and Orthotics International 36, n.º 2 (21 de febrero de 2012): 190–95. http://dx.doi.org/10.1177/0309364611435500.
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Background: A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. Objectives: To test the above hypothesis by comparing it to three other available orthoses. Study Design: Repeated measures. Methods: Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. Results: The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact ( p = 0.006) and the peak inversion angle ( p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. Conclusions: The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Clinical relevance Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.
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Abbasi, Faezeh, Mahmood bahramizadeh y Mohammad Hadadi. "Comparison of the effect of foot orthoses on Star Excursion Balance Test performance in patients with chronic ankle instability". Prosthetics and Orthotics International 43, n.º 1 (13 de agosto de 2018): 6–11. http://dx.doi.org/10.1177/0309364618792718.
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Background: Chronic ankle instability as a prevalent consequence of ankle sprain causes various impairments such as balance and postural control deficits. Foot orthoses are one of the common interventions for rehabilitation of patients with chronic ankle instability. Objectives: To investigate the effect of custom-molded foot orthoses with textured surfaces on dynamic balance of chronic ankle instability patients and to compare their effects with other types of foot orthoses. Study design: This is a repeated measure design. Methods: A total of 30 participants were recruited based on the guideline introduced by the International Ankle Consortium. The effect of prefabricated, custom-molded, and custom-molded with textured surface foot orthoses was evaluated on dynamic balance by the Star Excursion Balance Test. Normalized reach distances in anteromedial, medial, and posteromedial directions of the test were computed to be used for statistical analysis. Results: The foot orthoses increased reach distances compared to the no-orthosis conditions in all three directions. The custom-molded with textured surface foot orthosis has significant differences compared with prefabricated foot orthosis ( p = 0.001) in all measured directions and with custom-molded foot orthosis ( p < 0.01) in medial and posteromedial directions. Conclusion: Foot orthoses improve reach distances in patients with chronic ankle instability. Custom-molded with textured surface foot orthosis has a more pronounced effect compared with other foot orthoses. Clinical relevance The custom-molded foot orthosis with textured surface could be an effective device to improve dynamic balance in chronic ankle instability (CAI) patients. It may be considered as an efficient intervention to reduce ankle sprain recurrence in these individuals, although further research should be conducted.
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Balsdon, Megan, Colin Dombroski, Kristen Bushey y Thomas R. Jenkyn. "Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: A biplane fluoroscopy study". Prosthetics and Orthotics International 43, n.º 3 (14 de febrero de 2019): 331–38. http://dx.doi.org/10.1177/0309364619825607.
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Background: Foot orthoses have proven to be effective for conservative management of various pathologies. Pathologies of the lower limb can be caused by abnormal biomechanics such as irregular foot structure and alignment, leading to inadequate support. Objectives: To compare biomechanical effects of different foot orthoses on the medial longitudinal arch during dynamic gait using skeletal kinematics. Study design: This study follows a prospective, cross-sectional study design. Methods: The medial longitudinal arch angle was measured for 12 participants among three groups: pes planus, pes cavus and normal arch. Five conditions were compared: three orthotic devices (hard custom foot orthosis, soft custom foot orthosis and off-the-shelf Barefoot Science©), barefoot and shod. An innovative method, markerless fluoroscopic radiostereometric analysis, was used to measure the medial longitudinal arch angle. Results: Mean medial longitudinal arch angles for both custom foot orthosis conditions were significantly different from the barefoot and shod conditions ( p < 0.05). There was no significant difference between the off-the-shelf device and the barefoot or shod conditions ( p > 0.05). In addition, the differences between hard and soft custom foot orthoses were not statistically significant. All foot types showed a medial longitudinal arch angle decrease with both the hard and soft custom foot orthoses. Conclusion: These results suggest that custom foot orthoses can reduce motion of the medial longitudinal arch for a range of foot types during dynamic gait. Level of evidence: Therapeutic study, Level 2. Clinical relevance Custom foot orthoses support and alter the position of the foot during weightbearing. The goal is to eliminate compensation of the foot for a structural deformity or malalignment and redistribute abnormal plantar pressures. By optimizing the position of the foot, the medial longitudinal arch (MLA) will also change and quantifying this change is of interest to clinicians.
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Raijmakers, Bart, Roelofine A. Berendsen-de Gooijer, Hilde E. Ploeger, Fieke S. Koopman, Frans Nollet y Merel-Anne Brehm. "Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey". Journal of Rehabilitation Medicine 54 (14 de febrero de 2022): jrm00261. http://dx.doi.org/10.2340/jrm.v53.1122.
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Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.Design: Cross-sectional survey study.Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors. LAY ABSTRACTKnee-ankle-foot orthoses for knee instability are commonly prescribed in polio survivors to enhance safe ambulation. This survey investigated the use of knee-ankle-foot orthoses in daily life and differences in factors of usability between users and discontinued users. Seventy-six percent of polio survivors used their custom-made knee-ankle-foot orthosis in daily life. Important usability factors that were related to continued use of knee-ankle-foot orthoses were low perceived walking ability status without orthosis, previous orthosis experience, high perceived effectiveness and satisfaction when standing and walking with a knee-ankle-foot orthoses. When prescribing a custom-made knee-ankle-foot orthoses it is important to consider these factors and discuss goals of use and expected benefits of the knee-ankle-foot orthoses with the patient, especially in relation to perceived walking limitations and activities in daily life.
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Mlakar, Maja, Nerrolyn Ramstrand, Helena Burger y Gaj Vidmar. "Effect of custom-made and prefabricated orthoses on grip strength in persons with carpal tunnel syndrome". Prosthetics and Orthotics International 38, n.º 3 (24 de junio de 2013): 193–98. http://dx.doi.org/10.1177/0309364613490440.
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Background: Based on the literature, patients with carpal tunnel syndrome are suggested to wear a custom-made wrist orthosis immobilizing the wrist in a neutral position. Many prefabricated orthoses are available on the market, but the majority of those do not assure neutral wrist position. Objectives: We hypothesized that the use of orthosis affects grip strength in persons with carpal tunnel syndrome in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses. Study design: Experimental. Methods: Comparisons of grip strength for three types of grips (cylindrical, lateral, and pinch) were made across orthosis types (custom-made, prefabricated with wrist in 20° of flexion, and none) on the affected side immediately after fitting, as well as between affected side without orthosis and nonaffected side. Results: Orthosis type did not significantly affect grip strength ( p = 0.661). Cylindrical grip was by far the strongest, followed by lateral and pinch grips ( p < 0.050). The grips of the affected side were weaker than those of the nonaffected side ( p = 0.002). Conclusions: In persons with carpal tunnel syndrome, neither prefabricated orthoses with 20° wrist extension nor custom-made wrist orthoses with neutral wrist position influenced grip strength of the affected hand. Compared to the nonaffected side, the grips of the affected side were weaker. Clinical relevance The findings from this study can be used to guide application of orthoses to patients with carpal tunnel syndrome.
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Pataradool, Kawee y Chayanin Lertmahandpueti. "A proximal interphalangeal joint custom-made orthosis in trigger finger: Functional outcome". Hand Therapy 26, n.º 3 (22 de mayo de 2021): 85–90. http://dx.doi.org/10.1177/17589983211018717.
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Introduction Trigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger. Methods This study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at the dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis. Results There were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference −29.0 (95%CI −34.5 to −23.4); p < 0.001), SST (mean difference −1.4 (95%CI −1.8 to −1.0); p < 0.001) and VAS (mean difference −3.4 (95%CI −4.3 to −2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Conclusions Despite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.
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Young, Joshua y Sally Jackson. "Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination: A case report". Prosthetics and Orthotics International 43, n.º 4 (4 de junio de 2019): 453–58. http://dx.doi.org/10.1177/0309364619852239.
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Background: Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis–footwear combination on the acquisition of walking in a single subject with cerebral palsy. Case Description and Methods: This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. Findings and Outcomes: The subject developed the ability to stand and walk using an ankle-foot orthosis–footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis–footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. Conclusion: An ankle-foot orthosis–footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Clinical relevance Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.
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Ghoseiri, Kamiar, Galavij Ghoseiri, Ahlam Bavi y Rojin Ghoseiri. "Face-protective orthosis in sport-related injuries". Prosthetics and Orthotics International 37, n.º 4 (9 de noviembre de 2012): 329–31. http://dx.doi.org/10.1177/0309364612463929.
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Background and aim: Sport is associated with risk of injury and re-injury. A rehabilitative sport-related orthosis could protect the injured site and help in the earlier return of athlete to the match. This technical note aims to describe a potential high-prescribed face orthosis to protect/prevent a sport-related injury. Technique: Face-protective orthosis should be custom molded from negative impression of the injured athlete’s face. It is lightweight and structured as a one-piece rigid plastic shell that is secured in place with three elastic straps. Due to the diverse patterns of craniomaxillofacial injuries, the shape, length, trimline, and characteristics of face-protective orthoses could be different. Discussion: Face-protective orthoses could have prophylactic or rehabilitative roles according to task and prescription reason. Although the main action of the facial orthoses should be protection, the design of the face-protective orthosis should be improved both functionality and aesthetically to promote its use by athletes. Clinical relevance The craniomaxillofacial injuries have potential to be treated by custom-molded face-protective orthoses. These orthoses could have prophylactic or rehabilitative roles based on their prescription purpose. These orthoses could cause earlier return of athletes to sports matches.
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Lee, Justin J., Siraj Z. Shaikh y Alice Chu. "398 The Feasibility of Designing and Using a 3-D Printed Dynamic Upper Extremity Orthosis (DUEO) with Children with Cerebral Palsy and Severe Upper Extremity Involvement". Journal of Clinical and Translational Science 6, s1 (abril de 2022): 75. http://dx.doi.org/10.1017/cts.2022.226.
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OBJECTIVES/GOALS: To evaluate whether a low cost, functional dynamic 3-D printed upper extremity (UE) orthosis could be designed, fabricated and used by children with cerebral palsy (CP) with severe unilateral UE involvement and the ability of common standardized instruments to assess its effectiveness. METHODS/STUDY POPULATION: Five patients, ages 13-17 years, with CP and unilateral UE involvement, MACS levels III-IV, were enrolled. Custom forearm thumb opponens orthosis and dynamic upper extremity orthosis (DUEO) were designed and fabricated by a multidisciplinary team for use during 8 one-hour occupational therapy sessions targeting bimanual UE training. Pre- and post-assessments included Assisting Hand Assessment(AHA), Melbourne-2(MA-2), Pediatric Motor Activity Log-Revised(PMAL-R), and PedsQL Measurement Model for the Pediatric Quality of Life Inventory: CP Module(Peds-QL). RESULTS/ANTICIPATED RESULTS: The 3D printed orthotic device is custom fit to the patient based on scans of their arm and is designed with a tensioning system that allows for functional usage of the arm. It incorporates a rigid polymer to provide support and flexible material for comfort where appropriate. Overall, higher post-treatment scores were found for the majority of participants using the custom orthotic. Four made minimal clinically important differences (MCID) in the AHA. Three met MCID scores in subtests of MA-2 (two positive and one negative). Patient-reported outcome improvements were found for PMAL-R for four, but only one met MCID and at least three reported improvements in more than one domain of PedsQL. DISCUSSION/SIGNIFICANCE: Children with CP may often present with UE impairment, yet current therapeutic orthoses only target the progression of contractures and are still limited by cost and discomfort. Our team designed and fabricated a functional, low cost, 3D printed orthosis that showed significant gains in UE function.
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Williamson, Patrick, Aron Lechtig, Philip Hanna, Stephen Okajima, Peter Biggane, Michael Nasr, David Zurakowski, Naven Duggal y Ara Nazarian. "Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses". Foot & Ankle International 39, n.º 8 (26 de abril de 2018): 994–1000. http://dx.doi.org/10.1177/1071100718770659.
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Background: Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Methods: Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. Results: The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. Conclusion: The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. Clinical Relevance: The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.
Tesis sobre el tema "Custom orthosis"
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Paterson, Abby. "Digitisation of the splinting process : exploration and evaluation of a computer aided design approach to support additive manufacture". Thesis, Loughborough University, 2013. https://dspace.lboro.ac.uk/2134/13021.
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Upper extremity splinting is a popular treatment method for a range of conditions, such as rheumatoid arthritis. The intent of this treatment approach is multifaceted, but fundamentally, the provision of tools to enable and encourage patients to carry out everyday activities and to improve their quality of life is paramount. However, the aesthetic and functional limitations of wrist immobilisation splints demonstrate various weaknesses in terms of wear duration and frequency. Patient compliance is often compromised due to a number of factors, including the perceived stigma associated with assistive devices. Additive Manufacturing (AM) has proved its worth in a number of applications relating to the design of assistive devices; builds of complex, bespoke fitting geometries make AM an ideal fabrication method for upper extremity splints. However, recent advances in system technology to enable multi-material builds have been limited in this field, and a distinct need for a specialised three-dimensional (3D) Computer Aided Design (CAD) software approach is required to allow therapists to design splints for AM. Furthermore, the intent to keep practising therapists at the forefront of splint prescription is of utmost importance. This research proposes a digitised splinting approach, specifically through development of a 3D CAD software strategy to allow therapists to capture their design intent without compromising creativity. Furthermore, the approach proposes the exploration of AM build capabilities by allowing the integration of more creative features, such as aesthetically pleasing lattice structures for increased skin ventilation. The approach also proposes the integration of multiple materials to replicate and improve upon current splint design and fabrication practises. The approach therefore explores an exciting new paradigm for upper extremity splinting, the driving characteristics of which have not been proposed before as a collective medium. This research describes the feasibility of capturing therapists design intent in a 3D CAD virtual environment, whilst capturing therapists opinions of the approach with suggestions for future research and development. Results concluded that therapists were excited by the proposed transition in AM splinting, but that significant development is required elsewhere to establish a supporting infrastructure in order to make the approach a viable option in future upper extremity splinting.
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Jumani, Muhammad Saleh. "Cost modelling of rapid manufacturing based mass customisation system for fabrication of custom foot orthoses". Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/2193.
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Solid freeform fabrication (SFF) or Additive manufacturing (AM) techniques have emerged in recent years as advanced manufacturing techniques. These techniques have demonstrated advantages particularly in situations where the demands for unique geometrical structured customer-specific products are high and the time to market is very short. Applications of these techniques in the medical sector in combination with the latest medical digital imaging technologies are growing quickly. The techniques have inherent advantages of compatibility with the output information of medical digitising techniques. Foot orthoses are medical devices used as shoe inserts in the treatment of foot disorders, injuries and diseases such as diabetes, rheumatoid arthritis, congenital defects and other foot related injuries. Currently custom foot orthoses are fabricated through manufacturing techniques which involve costly and based on lengthy trial and error manufacturing process. These techniques have limitations in terms of fabricating required geometries and incorporating complex design features in the custom-made orthoses. The novelty of this research is to explore the commercial scale application of rapid manufacturing techniques and to assess a rapid manufacturing based design and fabrication system for production of custom foot orthoses. The developed system is aimed at delivering the custom made orthoses at mass scale with improved fit, consistency, accuracy and increased product quality. The traditional design and fabrication process for production of custom foot orthoses was investigated and modelled with IDEF0 modelling methodology. The developed IDEF0 model was re-modelled and then the rapid manufacturing approach was integrated in the design and fabrication process. The main functions of foot geometry capture, orthoses design and manufacture of orthoses were modelled and evaluated individually with respect to time and cost and quality of the final product. Different well-established rapid manufacturing techniques were integrated in the current design and fabrication process. The results showed that the techniques have significant impacts on the overall design and fabrication process in terms of increased process efficiency, low lead-time, increased productivity and improved quality of the final product. An orthosis model was fabricated on an experimental basis using different well established rapid manufacturing techniques. The techniques were separately investigated and analysed in terms of orthoses fabrication cost and build time. The cost and lead-time in different techniques were modelled, analysed and evaluated for evaluation of commercial scale applications. The analysis and evaluation of the cost and lead-time modelled for different rapid manufacturing techniques showed that selective laser sintering technique is the better option for integrating the technique in fabrication of custom foot orthoses and that it has the potential to compete with conventional techniques.
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Miguel, Olivier. "A Low-Cost Custom Knee Brace Via Smartphone Photogrammetry". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/38746.
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This thesis provided the foundational work for a low-cost three-dimensional (3D) printed custom knee brace. Specifically, the objective was to research, develop and implement a novel workflow aimed to be easy to use and available to anyone who has access to a smartphone camera and 3D printing services. The developed workflow was used to manufacture two prototypes which proved valuable in the design iterations. As a result, an improved hinge was designed which has increased mechanical strength. Additionally, a smartphone photogrammetry validation study was included which provided preliminary results on the accuracy and precision. This novel measurement method has the potential to require little training and could be disseminated through video instructions posted online. The intention is to enable the patient to collect their own “3D scan” with the help of a friend or family member, effectively removing the need to book an appointment simply for collecting custom measurements. Lastly, it would allow the clinician to focus all their time on clinically relevant design tasks such as checking alignment, fit and comfort, which could all potentially be improved by adopting such digital methods. The ultimate vision for this work is to enable manufacturing of better custom knee braces at a reduce cost which are easily accessible for low-income populations.
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Servi, Michaela. "RE&AM-based methods and tools for biomedical engineering". Doctoral thesis, 2020. http://hdl.handle.net/2158/1188798.
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In line with recent approaches to personalized medicine, where 3D technologies are rapidly becoming a new concept of treatment based on the ability to model patient-specific devices, this work aims to analyze the life cycle of a customized device in order to achieve a related systematic production, in the effort to provide tools that can be introduced into clinical practice and used directly by hospital staff. In this context, tools for arm acquisition and modeling of custom orthoses have been developed, as well as tools for monitoring and treatment of thoracic malformations.
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Trinidad, Lieselle E. "Engineering Analysis Of Custom Foot Orthotics". 2008. https://scholarworks.umass.edu/theses/213.
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This thesis presents an engineering approach to the modeling and analysis of custom foot orthotics. Although orthotics are widely used and accepted as devices for the prevention of and recovery from injuries, the design process continues to be based on empirical means. There have been many clinical studies investigating the various effects that the orthotics can have on the kinematics and kinetics of human locomotion. The results from these studies are not always consistent, primarily due to subject variability and experimental nature of the design. Alternatively, a better understanding of the therapeutic effects of custom foot orthotics, as well as designing for optimal performance, can be achieved through simulation-based engineering modeling and analysis studies. Such an approach will pave the way to clarify some of the ambiguous findings found in the clinical studies-based literature. Towards this goal, this research presents a methodical process for the replication of the orthotics’ complex three-dimensional geometry and for the construction of finite element analysis models using estimated nonlinear material properties.
As part of this research, laser scanning techniques are used to capture the objects’ details and geometry through generation of point cloud surface images by taking multiple scans from all angles. Material testing and Mooney-Rivlin equations were used to construct the hyperelastic nonlinear material properties. Using the mid-stance phase of gait for loading conditions, the ANSYS finite element package was utilized to run analyses on three different load classifications and the corresponding maximum stresses and deflection results were generated.
The results indicate that the simulated models can augment and validate the use of empirical tables for designing custom foot orthotics. They can also provide the basis for the optimal design thicknesses of custom foot orthotics based on an end-users’ weight and activities. From a practical perspective, they can also be useful in further exploring different orthotics, loading conditions, material properties, as well as the effectiveness of orthotics for different foot and lower extremity deformities.
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Faria, Ana Sofia Teixeira de Jesus. "Additive Manufacturing of Custom-Fit Orthoses for the Upper Limb". Master's thesis, 2017. https://repositorio-aberto.up.pt/handle/10216/103720.
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Faria, Ana Sofia Teixeira de Jesus. "Additive Manufacturing of Custom-Fit Orthoses for the Upper Limb". Dissertação, 2017. https://repositorio-aberto.up.pt/handle/10216/103720.
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Trinidad, Lieselle E. "Engineering modeling, analysis and optimal design of custom foot orthotic". 2011. https://scholarworks.umass.edu/dissertations/AAI3482668.
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This research details a procedure for the systematic design of custom foot orthotics based on simulation models and their validation through experimental and clinical studies. These models may ultimately be able to replace the use of empirical tables for designing custom foot orthotics and enable optimal design thicknesses based on the body weight and activities of end-users. Similarly, they may facilitate effortless simulation of various orthotic and loading conditions, changes in material properties, and foot deformities by simply altering model parameters. Finally, these models and the corresponding results may also form the basis for subsequent design of a new generation of custom foot orthotics. Two studies were carried out, the first involving a methodical approach to development of engineering analysis models using the FEA technique. Subsequently, for model verification and validation purposes, detailed investigations were executed through experimental and clinical studies. The results were within 15% difference for the experimental studies and 26% for the clinical studies, and most of the probability values were greater than α = 0.05 accepting our null hypothesis that the FEA model data versus clinical trial data are not significantly different. The accuracy of the FEA model was further enhanced when the uniform loading condition was replaced with a more realistic pressure distribution of 70% of the weight in the heel and the rest in the front portion of the orthotic. This alteration brought the values down to within 22% difference of the clinical studies, with the P-values once again showed no significant difference between the modified FEA model and the clinical studies for most of the scenarios. The second study dealt with the development of surrogate models from FEA results, which can then be used in lieu of the computationally intensive FEA-based analysis models in the engineering design of CFO. Four techniques were studied, including the second-order polynomial response surface, Kriging, non-parametric regression and neural networking. All four techniques were found to be computationally efficient with an average of over 200% savings in time, and the Kriging technique was found to be the most accurate with an average % difference of below 0.30 for each of the loading conditions (light, medium and heavy). The two studies clearly indicate that engineering modeling, analysis and design using FEA techniques coupled with surrogate modeling methods offer a consistent, accurate and reliable alternative to empirical clinical studies. This powerful alternative simulation-based design framework can be a viable and valuable tool in the custom design of orthotics based on an individual’s unique needs and foot characteristics. With these capabilities, the CFO prescriber would be able to design and develop the best-fit CFO with the optimal design characteristics for each individual customer without relying upon extensive and expensive trial and error ad hoc approaches. Such a model could also facilitate the inspection of robustness of resulting designs, as well as enable visual inspection of the impact of even small changes on the overall performance of the CFO. By adding the results from these studies to the CFO community, the prescription process may become more efficient and therefore more affordable and accessible to all populations and groups.
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Trinidad, Lieselle Enid. "Engineering Modeling, Analysis and Optimal Design of Custom Foot Orthotic". 2011. https://scholarworks.umass.edu/open_access_dissertations/498.
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This research details a procedure for the systematic design of custom foot orthotics based on simulation models and their validation through experimental and clinical studies. These models may ultimately be able to replace the use of empirical tables for designing custom foot orthotics and enable optimal design thicknesses based on the body weight and activities of end-users. Similarly, they may facilitate effortless simulation of various orthotic and loading conditions, changes in material properties, and foot deformities by simply altering model parameters. Finally, these models and the corresponding results may also form the basis for subsequent design of a new generation of custom foot orthotics. Two studies were carried out, the first involving a methodical approach to development of engineering analysis models using the FEA technique. Subsequently, for model verification and validation purposes, detailed investigations were executed through experimental and clinical studies. The results were within 15% difference for the experimental studies and 26% for the clinical studies, and most of the probability values were greater than α= 0.05 accepting our null hypothesis that the FEA model data versus clinical trial data are not significantly different. The accuracy of the FEA model was further enhanced when the uniform loading condition was replaced with a more realistic pressure distribution of 70% of the weight in the heel and the rest in the front portion of the orthotic. This alteration brought the values down to within 22% difference of the clinical studies, with the P-values once again showed no significant difference between the modified FEA model and the clinical studies for most of the scenarios. The second study dealt with the development of surrogate models from FEA results, which can then be used in lieu of the computationally intensive FEA-based analysis models in the engineering design of CFO. Four techniques were studied, including the second-order polynomial response surface, Kriging, non-parametric regression and neural networking. All four techniques were found to be computationally efficient with an average of over 200% savings in time, and the Kriging technique was found to be the most accurate with an average % difference of below 0.30 for each of the loading conditions (light, medium and heavy). The two studies clearly indicate that engineering modeling, analysis and design using FEA techniques coupled with surrogate modeling methods offer a consistent, accurate and reliable alternative to empirical clinical studies. This powerful alternative simulation-based design framework can be a viable and valuable tool in the custom design of orthotics based on an individual's unique needs and foot characteristics. With these capabilities, the CFO prescriber would be able to design and develop the best-fit CFO with the optimal design characteristics for each individual customer without relying upon extensive and expensive trial and error ad hoc approaches. Such a model could also facilitate the inspection of robustness of resulting designs, as well as enable visual inspection of the impact of even small changes on the overall performance of the CFO. By adding the results from these studies to the CFO community, the prescription process may become more efficient and therefore more affordable and accessible to all populations and groups.
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Tsai, Yen-Yi y 蔡燕怡. "The Dynamic Effects of Custom-Made Spinal Orthoses on Females with Adolescent Idiopathic Scoliosis". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/82457570771207969409.
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碩士國立臺灣大學
醫學工程學研究所
99
Background. Few studies have discussed the dynamic effects of spinal orthotic intervention on patients with adolescent idiopathic scoliosis (AIS), nor have they investigated the motion adaptation on them. Objectives. The objectives of this study is three-fold: 1) To evaluate dynamic and static balance between AIS patients and normal subjects; 2) to investigate the dynamic and static balance effects of spinal orthotic intervention in the AIS patients during investigative periods of immediate in-brace wearing and after four-month in-brace treatment; 3) to evaluate the motion adaptation after four-month brace treatment in the AIS patients. Design. A prospective cohort study was performed for this investigation. Participants. Fifteen adolescent females with AIS with Cobb angle of 20 to 50 degrees and fifteen age-matched healthy females participated in this study. Interventions. The intervention treatment for the females with AIS was a custom-made total contact thoracolumbar spinal orthosis. Methods. The gait kinematic data and the standing centre of pressure (COP) data were collected. For each AIS patient, data were collected for the following four conditions—pre-brace, immediate in-brace, after four-month of brace treatment data without the brace, and after four-month of brace treatment data in the brace. Normal iv subjects acted as the control and participated in gait analysis just one time. Main outcome measures. The dynamic variables of temporal-distance parameters, walking smoothness with harmonic ratios, and torsional offset of central segments during gait were calculated. The static variables included COP sway, postural orientation and head decompensation in static standing were also calculated for all subjects and conditions. Results. The walking smoothness measured by harmonic ratios was reduced in AIS patients compared with healthy teenagers, especially in the vertical direction on the head (p=.001), trunk (p=.001) and pelvis (p=.005) as well as the antero-posterior direction on the segments of the head on pelvis (p=.025) and the trunk on pelvis (p=.01). For the four-month effect of bracing, bracing negatively affected the smoothness in the medio-lateral direction on the head (p=.001), in the global reference, but the smoothness was not changed on the body reference in AIS patients. Moreover, the effect of bracing restricted the pelvis motion during gait in the frontal plane causing the limited motion on the trunk on pelvis. For the four-month motion adaptation, brace treatment promoted the walking rhythm and smoothness in the vertical direction on the segment of the head on pelvis (p=.026), but decreased in the medio-lateral direction on the head (p=.018). Conclusion. AIS patients before the brace treatment exhibited significantly poor v walking symmetry compared with age-matched girls. AIS patients had abnormal segmental offset during gait and abnormal segmental orientation in standing posture. Bracing stiffened the range of motion on the body but did not disturb walking rhythm in on the body reference in the four-month brace intervention. Brace treatment yielded motion adaptation for walking rhythm in the body reference in the four-month brace intervention.
Libros sobre el tema "Custom orthosis"
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Dixon, Sharon y Sophie Roberts. Orthotics. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199533909.003.0017.
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An orthotic is a custom-made insole which fits inside a shoe with the purpose of changing the way in which the foot functions during both standing and dynamic gait. There are many theories regarding the influence of these devices on the foot and lower limb. It is widely accepted that the fundamental principle is that an orthotic encourages a change in the movement pattern of the foot, aiming to alleviate stress to musculoskeletal structures, and produce changes in muscle firing patterns. An example of how an orthotic works is when one is used to change the functioning position of the medial longitudinal arch of the foot by altering the orientation of the calcaneus and potentially reducing the demand on the tibialis posterior tendon....
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Seligman, Deborah A. R. Treating heel pain in adults: A randomized clinical trial of hard versus modified soft custom orthotics and heel pads. 2006.
Buscar texto completoCapítulos de libros sobre el tema "Custom orthosis"
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Hasan, Falah, Qasim Murtaza, Faisal Hasan, Abid Ali Khan y Mohd Parvez. "Vibration Analysis of Custom Ankle Foot Orthosis (AFO) for Drop Foot Patient". En Design Science and Innovation, 177–85. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-2229-8_19.
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Hasan, Falah, Qasim Murtaza, Mehul Varshney y Faisal Hasan. "Design and Analysis of a Custom Ankle Foot Orthosis (AFO) with Foot Drop Patient". En Design Science and Innovation, 187–97. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-2229-8_20.
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Sharma, Neha, Dennis Welker, Shuaishuai Cao, Barbara von Netzer, Philipp Honigmann y Florian Thieringer. "An Interactive, Fully Digital Design Workflow for a Custom 3D Printed Facial Protection Orthosis (Face Mask)". En Industrializing Additive Manufacturing, 26–36. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-54334-1_3.
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Scherer, Paul R. "Custom Foot Orthoses". En Athletic Footwear and Orthoses in Sports Medicine, 113–18. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-0-387-76416-0_12.
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Toso, H., D. P. Campos, H. V. P. Martins, R. Wenke, M. Salatiel, J. A. P. Setti y G. Balbinotti. "Design and Performance Evaluation of a Custom 3D Printed Thumb Orthosis to Reduce Occupational Risk in an Automotive Assembly Line". En XXVII Brazilian Congress on Biomedical Engineering, 1269–75. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-70601-2_190.
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Scherer, Paul R. "Custom Foot Orthoses Prescription for the Athlete". En Athletic Footwear and Orthoses in Sports Medicine, 137–43. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-52136-7_12.
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Nunan, Patrick y Shawn Walls. "Special Olympics: Custom Foot Orthoses for Athletes with Genetic Disorders". En Athletic Footwear and Orthoses in Sports Medicine, 441–52. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-52136-7_34.
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Sponchiado, Riccardo, Francesca Uccheddu, Luca Grigolato, Pierandrea Dal Fabbro y Gianpaolo Savio. "A Design Method for Custom Functionally Graded Lattice Orthoses". En Advances on Mechanics, Design Engineering and Manufacturing IV, 265–75. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-15928-2_23.
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Kaufmann, Martin W. y Patrice M. Mich. "Custom External Coaptation as a Pain Management Tool: Veterinary Orthotics and Prosthetics". En Pain Management in Veterinary Practice, 155–60. Chichester, UK: John Wiley & Sons, Ltd, 2014. http://dx.doi.org/10.1002/9781118999196.ch13.
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Kumar, Ravi y Saroj Kumar Sarangi. "Design, Applications, and Challenges of 3D-Printed Custom Orthotics Aids: A Review". En Lecture Notes on Multidisciplinary Industrial Engineering, 313–28. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-73495-4_22.
Texto completoActas de conferencias sobre el tema "Custom orthosis"
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Chu, Tai-Ming. "Experimental Study of a Stress Change in Ankle-Foot Orthoses due to a Weight Change". En ASME 1998 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1998. http://dx.doi.org/10.1115/imece1998-0156.
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Abstract An Ankle-Foot Orthosis (AFO) is a device that prescribed to assist patient during recovering of lost functions, and at the same time, to protect the ankle-foot from further injuries when patients are in motion. Currently, polypropylene is the most popular thermoplastic for all kinds of custom-made orthoses. It has the characteristics of low weight, high strength, high fatigue resistance and excellent molding capabilities. However, there are too many pre-manufacturing parameters such as the thickness and curvatures required that makes the quality control impossible. Supan and Hovorka (1995) studied the thermoplastic Ankle-Foot Orthoses adjustments/replacements in young cerebral palsy and spina bifida patients. Six types of thermoplastic AFOs were tested. They found that neuromusculoskeletal functional status appears to determine the AFO design and its replacement. Chu, et al., (1997) developed an experimental method that studied the stress changes in the AFO due to AFO geometry changes. The goal of this project is to quantify the stress changes associated with a series of body weights and motion change; thus, to determine if the resulting stresses are of such magnitude as to potentially result in fractures and destruction of the AFOs.
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Abu-Hasaballah, Khamis S., Michael D. Nowak y Paul D. Cooper. "Enhanced Solid Ankle-Foot Orthosis Design: Real-Time Contact Pressures Evaluation and Finite Element Analysis". En ASME 1997 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1997. http://dx.doi.org/10.1115/imece1997-0340.
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Abstract Adult neuropathic diabetic patients with acquired foot deformities such as flat foot and Charcot feet often develop plantar foot ulceration, leading to extended hospital procedures. These ulcerations are attributed to elevated plantar contact pressures (Ctercteko, 1981). A recent preventative means is to fit the patient with a custom made ankle-foot-orthosis (AFO) designed to reduce these pressures. Although effective, AFOs have poor patient compliance due to their high weight.
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Jeewantha, Janitha, Chris Emmanuel, Madhubhashitha Herath, Mainul Islam y Jayantha Epaarachchi. "Development and Characterization of Shape Memory Polymers for Non-Invasive Biomedical Applications". En ASME 2021 Conference on Smart Materials, Adaptive Structures and Intelligent Systems. American Society of Mechanical Engineers, 2021. http://dx.doi.org/10.1115/smasis2021-66024.
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Abstract This paper details a shape memory polymer (SMP) synthesis and characterization process has been undertaken to develop a bio-medical material for fabricating non-invasive custom prosthetic components and orthosis devices. The glass transition temperature of a one-way SMP epoxy is tailored for external biomedical applications since human skin is sensitive to high temperature (> 45°C). The key shape memory properties of shape fixity ratio, shape recovery ratio and shape retention properties were comprehensively analyzed, and thermomechanical properties were verified. SMPs can be customized for the purpose; thus, SMP prosthetic and orthosis devices will be ideal for first aid and emergency treatments until proper medical attention is received. Finally, brief details of an SMP bone immobilization casting method are provided to explain the application further.
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Kim, Sangjoon J., Junghoon Park, Wonseok Shin, Dong Yeon Lee y Jung Kim. "Proof-of-concept of a Pneumatic Ankle Foot Orthosis Powered by a Custom Compressor for Drop Foot Correction". En 2020 IEEE International Conference on Robotics and Automation (ICRA). IEEE, 2020. http://dx.doi.org/10.1109/icra40945.2020.9196817.
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Mo, Yaru, Zeeshan Qaiser y Shane Johnson. "Design and Development of a Reconfigurable and Adjustable Compliance System for the Measurement of Orthotic Properties". En ASME 2021 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2021. http://dx.doi.org/10.1115/imece2021-70326.
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Abstract Custom foot orthoses (CFOs) are effective in the prevention and treatment of lower extremity injuries (LEIs). However, the current design methodologies of CFOs are not efficient due to the limited consideration of soft tissue impedance, orthotic properties and subjective feedback during the measurement. A new design methodology of CFOs is required to determine the desired orthotic properties including geometry and impedance, which satisfy pressure/load distribution, subjective comfort and reduce iterations. A measurement device which provides an Interface with Tunable Ergonomic properties using a Reconfigurable Framework with Adjustable Compliant Elements (INTERFACE) is developed. The INTERFACE system provides locally adjustable geometry and stiffness for the support of Medial Longitudinal Arch (MLA) by applying a mechanism with six degrees of freedom and three Tunable Stiffness Mechanisms (TSMs). Therefore, the Rapid Evaluate and Adjust Device (READ) Methodology can be implemented by adjusting the interface properties based on the pressure/load and subjective evaluation. The prototype of the INTERFACE system was fabricated to conduct the validation test on 10 subjects, in which the interface pressure/load distribution and subjective feedback in different combinations of geometry and stiffness were recorded. The plantar pressure/load increased with stiffness and geometrical height, and the significance has been demonstrated by a correlation analysis. Subjective comfort can be achieved with different combinations of geometry and stiffness. The proposed INTERFACE system can be employed to conduct the plantar measurement to obtain the desired orthotic properties which satisfy objective and subjective requirements.
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Fite, Richard, Adrian A. Polliack, Samuel Landsberger, Donald R. McNeal y Vicente Vargas. "The Utilization of Ambient-Stored Pre-Preg Carbon Composite Material With a New Fabrication Technique for the Development of Ankle-Foot Braces". En ASME 1998 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1998. http://dx.doi.org/10.1115/imece1998-0155.
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Abstract A novel, room temperature-stored carbon-graphite cloth has been utilized to produce a variety of ankle-foot orthoses (AFO). It was discovered that the curing process of the composite could be altered, and the AFO could be partially cured under vacuum. After removal of the composite AFO from the mold, the material maintains its shape and allows the orthotist to hand-modify it further. Following this, the brace is returned to the oven for final curing. This advance in the fabrication process may allow for the manufacture and distribution of modular AFOs in the partially cured state without need of refrigeration. They could then be custom-shaped by hand to fit the patient. This material is post-formable by heat with no delamination. Mechanical testing of the carbon cloth is in progress along with evaluation of the brace by able-bodied subjects. Failure mode investigation is also underway and attention is now directed to safety issues. Results of some of these findings are presented.
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de Souza, Mauren Abreu, Cristiane Schmitz, Marcelo Marega Pinhel, Joao A. Palma Setti y Percy Nohama. "Proposal of custom made wrist orthoses based on 3D modelling and 3D printing". En 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). IEEE, 2017. http://dx.doi.org/10.1109/embc.2017.8037682.
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Rizza, Robert, XueCheng Liu, William Clarke y Channing Tassone. "A Custom Contoured Surgical Pillow to Reduce Soring". En 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3342.
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Commercial donut pillows are used during lengthy surgical operations. With the patient anesthetized, the multiple pressure points on the head and wrinkling of the skin cut off blood circulation in the face, which leads to facial decubitus ulcers [1]. Cellular type materials such as foam, which are used in these pillows, are very effective in reducing pressure points by transferring pressure into shear forces [2]. In a similar way to surgical pillows, these materials are used to reduce foot pain due to plantar pressure in foot orthotics [3]. However, these same shear forces lead to wrinkling of the skin which generates sores. These shear forces are related to shear stress in the pillow. Pressure normal to the pillow surface is related to normal stress in the pillow, which also leads to soring. Thus, the optimal pillow design, which reduces sores due to pressure points and wrinkling, would be characterized by the design where optimal values of the normal and shear stress are obtained [2]. In a previous study [2], a surgical pillow design was developed which implemented foam wedges. The angle these foam wedges made with the transverse plane was determined to be the angle that gave minimal values of the normal and shear stresses. Thus this new pillow design reduced pressure sores as well as sores due to wrinkling of the skin. The use of foam wedges has some fundamental disadvantages. Chief among these disadvantages is that the wedges have planar surfaces which do not match the curvature of the human body well. This tends to make the wedges uncomfortable and ineffective. In addition, the manufacturing of small wedges which then have to be connected to the main pillow structure is cumbersome and inefficient. In this study, a new pillow design was developed which is based on the contour of the patient’s body to generate supportive surfaces that not only match the patient’s shape exactly but which minimizes normal and shear stresses.
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Reina-Bueno, M., P. V. Munuera-Martínez, C. Vázquez-Bautista, S. Pérez-García y C. Rosende-Bautista. "THU0733-HPR Effect of custom-made foot orthoses versus placebo in patients with rheumatoid arthritis: randomised clinical trial". En Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3421.
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Parkinson, Matthew B. y Jane E. Huggins. "A Method for the Rapid Prototyping of Custom Contoured Cushions". En ASME 2001 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2001. http://dx.doi.org/10.1115/imece2001/bed-23097.
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Abstract Decubitous ulcers (“pressure sores”) are a significant concern for people using wheelchairs. In fact, results published by the University of Kansas [1] indicate that over half of those using wheelchairs will develop a pressure sore at some point. This susceptibility is due to the conditions under which these ulcers develop: shear stress and pressure work together to cut off the blood supply to the surface tissue, which subsequently dies. Heat and moisture can increase the likelihood of this necrosis and the rate at which it occurs. Although sores can develop quickly (onset can occur in as few as fifteen minutes), they may take months to heal. Appropriate seat cushion selection helps to mitigate the causative factors [2]. In particular, custom-contoured cushions (CCC) can offer dramatic improvements. Research has shown that CCC’s offer the best distribution of pressure and reduction of shear stress, reducing these factors by as much as 80% [3]. CCC’s are not commonly used, however, because the cost and time involved in design, manufacture, and delivery are prohibitive. The obstacles of cost, time, and inconvenience, can be overcome by applying mass-customization and rapid-prototyping principles to the process used to create CCC’s. This involves automating the basic steps of the process: creating an electronic representation of the seating surface and machining that surface using a computer-controlled (CNC) mill. Similar systems have been put in place to automate a variety of processes, from the creation of custom orthotics for footwear to the design and creation of impeller wheels [4]. Such a system would be capable of producing a suitable custom-contoured cushion in minutes or hours rather than weeks or months.