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Sensomotoric in sports workshop

Discussion in 'Australia' started by Boots n all, Dec 21, 2015.

  1. Boots n all

    Boots n all Well-Known Member


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    Sensomotorics in Sports

    Lothar Jarling is an international authority on the use of Sensomotoric orthoses and will be here in Australia January 2016 as a consulting clinician to one of the worlds top tennis players, Lothar is also a consulting clinician to many elite sports people and teams in Europe.

    As a result of Lothar being here in Australia, he has made himself available for the 22nd of January to speak to us on the use of sensomotorics in sports and neurological conditions such as CP and CMT.

    This international speaker is not to be missed, Limited numbers available, bookings are essential.

    l have attached a PDF of some locally produced research for the use of sensomotoric insoles with clients with CMT.
     

    Attached Files:

  2. Boots n all

    Boots n all Well-Known Member

    The numbers of those wanting to attend have caused us to change the venue.
    Make sure you book soon.

    Crown Plaza Hotel 6:30 for a 7 PM start
    1-5 Spencer Street, Docklands, Vic 3008.

    We will have drinks and canapes available on arrival, remember books are essential.

    Parking Information:
    They are able to provide valet parking at a cost of $47.00* per vehicle, per day.
    Self park options are available, we recommend CarePark located on Siddeley Street.
    A self-park charge of $16.00* per vehicle per day / exit is available. The discounted parking ticket must be collected from our Concierge department prior to exiting the car park.

    I would recommend public transport
     
  3. Petcu Daniel

    Petcu Daniel Well-Known Member

    Quote from article : "Foot orthoses are conventionally designed around the mechanical principle of supporting the medial longitudinal arch to alter plantar pressure and skeletal alignment. However, there is evidence that sensorimotor alterations may also be an important factor.The ?sensorimotor orthotic? paradigm has been proposed whereby foot orthoses are designed on the principle of altering sensory input to the plantar surface of the foot thereby changing muscle activation patterns"

    As far as I've understood in the time spent on PA, the 'sensorimotor paradigm' is not well accepted in the podiatric community who has produced a definition of foot orthotics which is not based on 'supporting the medial longitudinal arch to alter plantar pressure and skeletal alignment'. Am I wrong ?
    Daniel
     
  4. Boots n all

    Boots n all Well-Known Member

    Who said these devices dont have a medial longitudinal arch on them?
     
  5. footpower

    footpower Active Member

    While sensomotoric orthoses are not widely accepted in the podiatry community, they maybe in future. Up until a few years only rigid foot orthoses were accepted widely in the podiatry community in Australia. That has changed, many podiatrists are now using EVA or other non-rigid material in their orthotic therapy. I therefore think that podiatrists are open to look at alternatives and are not limiting themselves.
    Sensomotoric foot orthoses are widely accepted in a number of EU countries, how is it in Rumania?
     
  6. Ian Drakard

    Ian Drakard Active Member

    Hi David

    The paper you attach appears to show little effect on emg values and therefore that the 'sensorimotor' insoles are actually working primarily by mechanical means.

    May be not the best paper to support a course on sensorimotor insoles? But fair play for not cherry picking :drinks
     
  7. Petcu Daniel

    Petcu Daniel Well-Known Member

    In my opinion Romania is at least 30 years back regarding foot biomechanics and foot orthotics. Suffice to say that we don't have podiatry or pedorthics schools and professions. This means that the information related to these fields comes mainly through marketing channels many times of poor quality. This is available for the sensorimotor insoles where there is on the market a franchise of an Italian company. I suppose a similar situation exists in the other East European countries. A step forward was made last year through the establishment of an Podiatry Association ( http://www.podiatrie.ro/ ) in relation with diabetic foot.
    I've participated last year at IVO Congress and I regret I couldn't met some people which I know from PA !

    Daniel
     
  8. Ian Drakard

    Ian Drakard Active Member

    Potentially any orthoses will have a sensory motor effect with change in muscle function, and so having a 'sensorimotor' orthoses may be as meaningless as the rigid 'functional' and soft 'accomodative' divide.

    The problem in a normal clinical setting is determining how much of an effect is direct mechanical from orthotic reaction force and how much is cns motor mediated.

    That said I would welcome thoughts as to how to optimise the sensory motor component of a prescription and where this might be put to good use.
     
  9. Ian, Google Duncan's reflex and tone reducing insoles. Tony Achilles and I got interested in this area some years ago. If memory serves Tony made some orthoses using the principles Duncan described for paediatric patients with C.P. Again if I remember correctly the effects of the insoles in reducing tone in the target muscles was short lived.
     
  10. footpower

    footpower Active Member

    The attached study shows: "Increased activity of the peroneus longus
    could be found in mid-stance with sensori-motor insoles. The change in muscle
    activation patterns was statistically significant at 17.51?4.30 % stance phase and
    reached its maximum at 29.67?4.51% with maximal values of 21.56?10.03%
    MVC (Dummy 16.09?7.06% MVC)." Trouble is the bulk of the paper is not in English.
    At the presentation, papers that are around will be discussed. Yes we will need more research that is no question, clinical case studies we have to discuss.
     

    Attached Files:

  11. I went back to the old podiatry mailbase archives (2000) and found a couple of references:

    Pratt, D, (1996) Paediatric foot orthoses The foot, vol. 6, pp. 99-111.
    Lohman, M Goldstien, H (1993) Alternative strategies in tone reducing AFO design Journal of prothetics and orthotics, vol. 5, no. 1
     
  12. Petcu Daniel

    Petcu Daniel Well-Known Member

    If the sensory input is altered through increasing of the local pressure then which level of pressure should be applied in which area of the plantar surface in order to modify a specific muscle's activation pattern? This is what I'm expecting to understand from "Intervention" section. Instead of this we have only one technical detail: 45 Shore A hardness. Why 45 and not 30 or 50? There is any relation between 'sensory input' map and Novel automask regions?

    Daniel
     
  13. Again many years ago when I was interested in this, I found some research on Hoffman reflex and stimulation of the sural nerve. If I recall correctly the stimulation of the sural nerve provoked a different neuromotor response depending upon the phase of gait at which it was stimulated.
     
  14. Petcu Daniel

    Petcu Daniel Well-Known Member

    If I well understand at the moment you are not interested in this theory. Can I ask why ?
    Thanks,
    Daniel
     
  15. Daniel, it's not that i'm not interested in this topic, more that my focus over the last decade or more has been refined down to trying to fathom out how foot orthoses exert their direct mechanical effects rather than their indirect neuro-physiological effects. Why was this? I can't really remember as it was about 15 or 16 years ago when I last really read in depth on the subject of neuro-physiological effects of foot orthoses. But it probably has something to do with my own interests and my sense that I have a better understanding of mechanics than I do of neuro-physiology. And there are only so many hours in the day...
     
  16. Here you go http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2230764/
     
  17. Petcu Daniel

    Petcu Daniel Well-Known Member

    One more question, please: why are you considering the neuro-physiological effect of foot orthoses to be 'indirect' and not a 'direct' one (which means that it could be obtained through technical prescription of the foot orthoses) ?
    Thanks,
    Daniel
     
  18. Kevin gives a nice example of direct versus an indirect neuromotor response in his October 2009 Newsletter in which the example of a foot orthosis designed to increase external supination moment with a medial heel skive and high medial longitudinal arch height is employed but results in increased foot pronation. The direct mechanical effect is the modification of reaction forces at the foot-orthosis interface resulting in increased external supination moment acting on the plantar foot. However, if the device creates too much external supination moment the body may respond via the CNS to fire the peroneals to prevent inversion injury and we observe an increase in late midstance pronation. So in this example the direct mechanical effect of the device is to increase external supination moment, however in the response to this, the orthoses indirectly resulted in increased pronation of the foot via a CNS mediated response. So it's the "via the CNS" bit which makes it indirect in my opinion.
     
  19. Petcu Daniel

    Petcu Daniel Well-Known Member

    But in this case the 'indirect' effect isn't caused by a CNS response to an overcorrection (too much increased supination moment) ? What about Nigg's 'preferred movement path' model as a reflection of a 'direct' neuromotor response covering both type of interventions: correction (desired) and overcorrection ( https://www.researchgate.net/public...'Preferred_movement_path'_and_'comfort_filter' ) ?
    Daniel
     
  20. Nigg's model still goes via the CNS. In essence it's a semantic discussion.
     
  21. Boots n all

    Boots n all Well-Known Member

    Re: Sensomotoric in sports workshop Melb & Sydney

    To meet the growing interest there is now the same event to be held in Sydney.

    In Sydney January 28. The Hilton Hotel, 488 George Street, Sydney.

    INVITATION
    Sensomotoric orthoses, sports and Lothar Jahrling
    In late January 2016 Lothar Jarling will be in Australia and l would like to extend an invitation to you for this workshop.
    Lothar Jarling is an international authority on the use and the inventor of Sensomotoric foot orthoses and will be here in Australia January 2016 as a consulting clinician to one of the world?s top tennis players, Lothar is also a consulting clinician to many elite sports people and teams in Europe. As a result of Lothar being here in Australia, he has made himself available for an evening in Melbourne and Sydney. He will speak to us on the use of sensomotorics in sports and neurological conditions such as CP. The other speaker of the evening will be Karl Schott discussing the CMT research project with Sydney University, case studies using sensomotoric orthoses in neurological cases. The program starts at 6:30PM with drinks and canapes. It ends at 9 PM.

    In Melbourne January 22
    The Crowne Plaza Hotel, 1-5 Spencer Street, Melbourne

    In Sydney January 28
    The Hilton Hotel, 488 George Street, Sydney. This international speaker is not to be missed, limited numbers available, bookings are essential.

    Bookings for Melbourne and Sydney booking through reception@footpower.com.au

    The event is sponsored by ShoeTech Pty. Ltd trading as footpower as part of our commitment to bring exciting new ideas to you.
     
  22. footpower

    footpower Active Member

    here some more research about sensomotoric orthoses or sensomotoric insoles (SMI)

    ?SMI showed significant decreased internal rotation of the proximal femur in terminal swing phase and loading response phase in patients with idiopathic in toeing and club feet?
    The Biomechanical Effect of the Sensomotor Insole on a Pediatric Intoeing Gait
    AkiyoshiMabuchi,1 Hiroshi Kitoh,1 Masato Inoue,2 Mitsuhiko Hayashi,3 Naoki Ishiguro,1 and Nobuharu Suzuki4
    International Scholarly Research Network ISRN Orthopedics Volume 2012, Article ID 396718, 5 pages
     
  23. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    If you look at the design of those orthotics, the effect could have all been mechanical: http://www.hindawi.com/journals/isrn/2012/396718/fig1/ and nothing to do with "sensory motor" issues.

    I went to a "sensorimotor orthotic" seminar yrs ago and the orthotics used had a great big lump under the sustenatculum tali --> all effects could easily have been mechanical
     
  24. footpower

    footpower Active Member

    yes a study we did with CMT and sensomotoric orthoses suggests a mechanical effect, see top of the post. Here is another study that showed a change in muscular activity:
    “Increased activity of the peroneus longus could be found in mid-stance with sensori-motor insoles”.
    Influence of a Sensorimotor Insole on the Activity of the Peroneus Longus Muscle during the Stance Phase
    Ludwig O, Quadflieg R, Koch M: Aktivit?t des M. peroneus longus in der Standphase. Dtsch Z Sportmed 64 (2013) 77-82.
     
  25. Boots n all

    Boots n all Well-Known Member

    l believe these are the papers Karl is quoting from
     

    Attached Files:

  26. Petcu Daniel

    Petcu Daniel Well-Known Member

    Still I don't understand from these articles how the sensomotor insole is designed to stimulate the proprioceptors of the sole. In my understanding this is not explained in the sections "Material and Methods". It is a huge difference, for example, in the way in which Kirby is explaining how medial skive is working to increase the supinatory moment around STJA compared with the way in which the "five exclusive bars, including medial and lateral heel bars, a retro bar, a toe bar, and a lateral wedge" is altering sensory input to the plantar surface of the foot.
    On the other hand there are evidences that foot orthoses has an effect on lower limb muscle activity. All of them are sensomotric ?


    Gait Posture. 2009 Feb;29(2):172-87. doi: 10.1016/j.gaitpost.2008.08.015. Epub 2008 Oct 14.

    Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review.
    Murley GS1, Landorf KB, Menz HB, Bird AR.
    Abstract
    The aim of this systematic review was to evaluate the literature pertaining to the effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running. A database search of Medline, CINAHL, Embase and SPORTDiscus without language restrictions revealed 504 citations for title and abstract review. Three articles were translated to English and a final 46 articles underwent a two-tiered quality assessment. First, all articles were scored for their reporting of electromyographic methodology using a set of standards adopted by the International Society of Electrophysiology and Kinesiology. Thirty-eight articles displayed adequate reporting of electromyographic methodology and qualified for detailed review including a second quality assessment using a modified version of the Quality Index. These included six studies investigating the effect of foot posture, 12 the effect of foot orthoses and 20 the effect of footwear on lower limb muscle activity during walking or running. Meta-analysis was not conducted due to heterogeneity between studies. Some evidence exists that: (i) pronated feet demonstrate greater electromyographic activation of invertor musculature and decreased activation of evertor musculature; (ii) foot orthoses increase activation of tibialis anterior and peroneus longus, and may alter low back muscle activity; and (iii) shoes with elevated heels alter lower limb and back muscle activation. Most studies reported statistically significant changes in electromyographic activation, although these findings were often not well supported when confidence intervals were calculated. Most important, however, is that there is a need for further research of more rigorous methodological quality, including greater consensus regarding standards for reporting of electromyographic parameters.
    http://www.ncbi.nlm.nih.gov/pubmed/18922696
     
  27. footpower

    footpower Active Member

    Orthoes seem to have both a mechanical effect as well as a neuromuscular or sensomotoric effect. Many orthoses aim at the mechanical model to explain their function while the sensomotoric has a different aim. The latter is clearly less understood and needs more research. That makes it more interesting to me and makes attending a presentation from Lothar Jahrling very exciting.
     
  28. Petcu Daniel

    Petcu Daniel Well-Known Member

    I've attended at the 2nd Seminar on foot pathology from Zaragoza when already I knew speakers'work ( http://www.congresospodologosaragon.com/en/ponentes-internacionales.html ) from their articles and debates from Podiatry Arena. This is why Podiatry Arena is invaluable !
    Daniel
     
  29. Petcu Daniel

    Petcu Daniel Well-Known Member


    Does the abstract below speaking about the same concept of foot orthotics ?

    Effects on posture by different neuromuscular afferent stimulations and proprioceptive insoles: Rasterstereographic evaluation

    Peter Dankerl1⇑
    Andrea Kerstin Keller2
    Lothar H?berle2,3
    Thomas Stumptner4
    Gregor Pfaff5
    Michael Uder1
    Raimund Forst6
    1Department of Radiology, University Hospital Erlangen, Erlangen, Germany
    2Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen, Germany
    3Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
    4Consultant for Orthopaedics, N?rnberg, Germany
    5Consultant for Orthopaedics, M?nchen, Germany
    6Department of Orthopaedic Surgery, University Hospital Erlangen, Erlangen, Germany
    Peter Dankerl, University Hospital Erlangen, Erlangen, 91054, Germany. Email: peter.dankerl@uk-erlangen.de


    Abstract


    Background: Proprioceptive neuromuscular stimulating insoles are increasingly applied in treating functional complaints, chronic pain, foot disorders and so on.
    Objectives: To evaluate rasterstereography as a tool in objectifying postural changes resulting from neuromuscular afferent stimulation and proprioceptive neuromuscular stimulating insoles and to compare the respective effects on posture.
    Study design: This is a prospective experimental study.
    Methods: A total of 27 healthy volunteers were consecutively exposed to six different varying intense neuromuscular afferent stimulating test conditions at three different times. One test condition featured proprioceptive neuromuscular stimulating insoles. In each test condition, a sequence of 12 rasterstereographic recordings of back shape was documented. Changes between six different test conditions and over time for 14 posture characterising parameters were investigated, for example, trunk inclination, pelvic torsion, lateral deviation of the spine?s amplitude or sagittal spinal curve.
    Results: Standard deviation of our rasterstereographic measurements (?2.67 mm) was better than in most comparable reference values. Different neuromuscular stimuli were found to provoke significant changes to various posture parameters, including trunk inclination, pelvic torsion and so on ( each p < 0.001, F-tests). Proprioceptive neuromuscular stimulating insoles induced significant changes for parameter lateral deviation of the spine?s amplitude (p = 0.03).
    Conclusion: Neuromuscular afferent stimulation and proprioceptive neuromuscular stimulating insoles induce postural changes, which can be detected reliably by rasterstereography.
    Clinical relevance We demonstrated that rasterstereography ? a radiation-free imaging modality ? enables visualisation and documentation of subtle postural changes induced by varying intense neuromuscular afferent stimulation and the application of proprioceptive neuromuscular stimulating insoles.

    http://poi.sagepub.com/content/40/3/369?etoc
     
  30. footpower

    footpower Active Member

    Thank you for letting me know about this research. The concept that we referred to in this workshop is based on the work of Lothar Jahrling. His work is listed in the literature list of both articles. Lothar Jahrling first presented on this concept and his work in 1996 at a conference.
    There is a connection as far as the concept is concerned for both articles and the workshop. However there is a difference in the foot orthoses individual material combination. It appears that both articles support the concept the workshop was about. I think another workshop is planned for 2017.
     
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