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    Orthopedic and Rehabilitation Engineering

    Designing a Multi-Planar Ankle Therapy Device to Restore Range of Motion and Improve Muscle Imbalances

    (L-450) Designing a Multi-Planar Ankle Therapy Device to Restore Range of Motion and Improve Muscle Imbalances

    Friday, October 13, 2023
    9:30 AM – 10:30 AM PDT
    Location: Exhibit Hall - Row L - Poster # 450
    Introduction:: Each year in the United States, there are over 2 million ligamentous ankle injuries which are generally treated through surgery [1]. While the surgeries do repair the damaged ligament, they may leave the patient with a lifelong decrease in range of motion (ROM) which will lead to inefficient gait and the failure to properly ambulate leading to an increased risk of repeat ankle, knee, hip, and spinal injuries or deformities over time. Most and current studies focus on the use of passive and active motion therapy postoperatively to restore this ROM; however, the primary goal of this research was to design, test, and build a Multi-Planar Ankle Therapy device to assist a physical therapist in performing passive motion therapy in both the sagittal and transverse planes of motion, seen in Figure 1.

    Materials and Methods:: The device was modeled and tested in simulation using Autodesk Inventor and manufactured through a combination of purchased FDM 3D printed, and machined aluminum and steel components. Three patients (n=3) with ligamentous ankle injuries and decreased ROM were subjected to testing using the Multi-Planar Ankle Therapy device. The initial ROM and muscle activity data was collected using a goniometer and PRO-vision 2D by Streifeneider Portable Gait Analysis System, Noxaron Myoresearch MR3.16 software, and an electromyography unit, respectively. The patients then were subjected to 30-minute passive motion therapy sessions weekly for three weeks utilizing the device. An example of this treatment can be seen in Figure 2. Final measurements were taken at the end of the third week, and the exported data was analyzed using Microsoft Excel and Noxaron MyoResearch MR3.16.

    Results, Conclusions, and Discussions::

    There were statistically significant increases in ROM for all three of the subjects in all four of the directions of motions bilaterally. Additionally, the muscle activation data showed a balancing of activation across the available data. However, due to the incomplete nature of the EMG data, these p-values may not accurately reflect the significance of the treatment. Figure 3 depicts the results from the ROM testing data for the motions of dorsiflexion, plantarflexion, adduction, and abduction of the ankle bilaterally. Table 1 is the tabular data for the EMG muscle activity of the Tibialis Anterior and Gastrocnemius bilaterally. Patient 2 was unable to complete final testing due to scheduled surgery and subsequently is not included in the paired T-test of the data. This data was incredibly encouraging for the safety and efficacy of the Multi-Planar Ankle Therapy Device.
    The final device is a completely mechanical device that can be adjusted to the anatomical measurements of an individual, facilitate the full range of motion in the sagittal and frontal planes using an external force, significantly improve ROM for an individual with ligamentous ankle injuries, and aid in balancing muscle activation bilaterally.  In the future, another IRB-approved clinical trial should be conducted with more subjects and for a longer period of time to ascertain if these results are consistent. Additionally, the Vastus Lateralis and the Semitendinosus may be added to the electromyography data collection to further investigate the restoration of balanced muscle activity after prolonged use of the device.



    Acknowledgements (Optional): :

    The authors would like to acknowledge the support of Dr. Ha Van Vo, Dr. Loren Sumner, and Dr. Scott Schultz for their assistance during the entire senior design process. We would also like to thank Mr. Mullis and the Mercer Fab Lab for their assistance in the fabrication and testing of the prototype.



    References (Optional): :

    [1] Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training, 54(6), 603–610. https://doi.org/10.4085/1062-6050-447-17


    [2] Figure 4. Basic ankle movements. (n.d.). ResearchGate. Retrieved September 5, 2022, from https://www.researchgate.net/figure/Basic-ankle-movements_fig4_262462393