The British Association of Prosthetists and Orthotists (BAPO) was established to encourage high standards of prosthetic and orthotic practice. It is committed to Continued Professional Development and education to enhance standards of prosthetic and orthotic care. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and associate members to their employers, BAPO enjoys the support of a high majority of the profession as members.
J.D. Chapman, S. Preece, B. Braunstein, A. Höhne, C.J. Nester, P. Brueggemann, S. Hutchins
Abstract
Background
There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle.
Methods
A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed.
Findings
There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd–4th metatarsal regions (39%) but that lower rocker angles (<20°) and anterior apex positions (>60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°.
Interpretation
We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations.
http://www.clinbiomech.com/article/S0268-0033(13)00114-9/abstract
Please click for Further Information on the 'Pysiotherapy to Complement Orthotic Treatment' BAPO Short Course.
News release
The Health and Care Professions Council (HCPC) has today launched an eight week consultation to seek the views of stakeholders on guidance for registrants in relation to professional indemnity cover and registration.
The Government are proposing that all health professionals must hold professional indemnity cover as a condition of registration. This is subject to parliamentary approval and will apply to all of the professions regulated by the HCPC with the exception of social workers in England*. This is because these 15 professions are considered to be 'healthcare professions' under the terms of the European Directive 2011/24/EU on cross-border healthcare.
We anticipate that the majority of our registrants will already be able to meet these requirements as they will be indemnified either through their employer, a professional body, directly with an insurer or a combination of these. However, it is important that registrants ensure that they have cover in place that is appropriate for their practice.
Subject to the legislative timetable, cover must be in place by Friday 25 October 2013. From 1 April 2014 new applicants to the Register and those renewing their registration will be required to complete a professional declaration. Failure to hold appropriate cover will mean an individual will not have their registration renewed or, in the case of new applicants, will not be registered by us.
Louise Hart, Director of Council and Committee Services commented;
"It is important that professionals are aware of their responsibilities to have appropriate indemnity cover and to take steps to ensure they meet this new requirement of registration.
"The draft guidance we have produced outlines what professionals need to know about their responsibilities and provides detailed information about professional indemnity, how they can meet this requirement and how the HCPC will check that cover is in place.
"We are now seeking views on this draft guidance and would welcome feedback from professionals on our Register as well as employers and other stakeholders who may be affected by this new requirement."
The consultation will run from 10 June 2013 until 2 August 2013 and can be found on the following link https://www.research.net/s/consultationonguidanceforPIIrequirement
This money will fund research that looks at the way a number of different diseases are diagnosed, so patients can access the best available treatments more quickly.
The National Institute for Health Research (NIHR) will share the funding across four NHS organisations in London, Leeds, Newcastle and Oxford. These places will become national centres of expertise called NIHR diagnostic evidence co-operatives.
These centres will promote research into medical tests used to diagnose things like cancer, liver and respiratory diseases, so patients across the NHS can benefit from advances in technology. More .....
| NHS England has opened the second wave of recruitment for patient and carer members of its Clinical Reference Groups for 2013/14. For a full list of CRGs who are still recruiting members please follow the link below. CRGs are responsible for providing NHS England with clinical advice regarding specialised services, and for promoting equity of access to high quality services for all patients, regardless of where they live. CRGs are also at the forefront of the drive to spearhead innovation, working with clinical leaders, patients and suppliers to identify and promote best practice; scanning the horizon for new treatment approaches; and taking action to improve patient experience and outcomes in the NHS. This is an exciting time to join a CRG, as they take their place within the new commissioning structures of the NHS. The accompanying Guide to CRGs and Information Pack for Patients and Carers will provide you with more, detailed information about their work; where they sit within NHS England, and what it means to be a patient and carer member of a CRG. If you are interested in applying to be a patient or carer member, you will also find an application form which you can complete online. The closing date for applications for membership is midnight 13 June 2013. To find out more about becoming a patient or carer member of one of these groups, where you will find the list of CRGs we are still recruiting to, a Guide to CRGs, an Information Pack and application form. This opportunity is open to people 18 years and over. We are committed to ensuring that the work of CRGs is informed by the voice of children and young people; however, we are also aware that there are extra support needs for this group and that membership of the CRGs may not be the most appropriate approach to engaging with this section of the population. They are recruiting for the following CRG's
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HR Weiss, M Moramarco
Abstract
Introduction
Long-term follow-ups of untreated patients with adolescent idiopathic
scoliosis (AIS) indicate that the consequences of AIS over a lifetime are
minimal, sometimes moderate in more severe cases, however, never
life-threatening. In light of these findings, the historical indications
for treatment should be investigated according to current evidence.
Recent reviews have been investigated for their contribution to
evidence in the field of scoliosis treatment—especially the impact of
the results obtained on the historical modes of treatment.
From these findings, we may conclude that there is promising
evidence for the application of physiotherapy in the treatment of scoliosis in children or adolescents and for adults with curvatures exceeding 35°
Cobb. There is a stronger evidence for the application of (hard) braces
during growth. There is no evidence for spinal fusion surgery for AIS. The
use of surgery should be limited in patients with scoliosis of other origin. This critical review discusses the treatment methods for scoliosis.
Conclusion
There is some evidence for the use of physiotherapy as a treatment for
scoliosis. There is strong evidence for the use of hard braces during growth.
http://www.oapublishinglondon.com/images/article/pdf/1368523536.pdf
Abstract
Background and Purpose—Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ≤0.8 m/s.
Methods—Participants (n=197; 79 females and 118 males; 61.14±11.61 years of age; time after stroke 4.55±4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial.
Results—There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11–0.17 m/s for FDS and 0.12–0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group.
Conclusions—Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke.
Plantar ulcers pose a frequent serious complication in the neuropathic foot. Previous studies suggested that ulcer initiation occurs within the plantar soft tissue rather than on the plantar surface. This study investigated the effectiveness of different shaped silicone insoles on the reduction of both plantar soft tissue strain and pressure. The authors have found no previous experimental studies on the effectiveness of insole shape on reducing plantar soft tissue strain during standing.
A custom molded silicone insole which allowed passage of ultrasound to the plantar surface of the foot was prototyped for this study. Soft tissue strain was computed from soft tissue thickness measured using ultrasound in five conditions: unloaded, barefoot, wearing a prefabricated silicone insole, wearing the custom molded silicone insole alone then with a metatarsal pad. Plantar pressure was measured for the same conditions.
The custom molded insole was found to significantly reduce soft tissue strain and plantar pressure relative to both the barefoot condition and the prefabricated insole under the second and third metatarsal heads. The metatarsal pad was found to significantly reduce soft tissue strain but not significantly affect plantar pressure.
A custom molded silicone insole can effectively reduce both soft tissue strain and plantar pressure and is thus preferable to a prefabricated insole. It is suggested that quantifying the reduction of soft tissue strain is an essential design requirement for orthotic insoles since plantar pressure may not be a sufficient indicator of the effectiveness of an insole in preventing ulcer initiation.
Source: http://www.clinbiomech.com/article/S0268-0033(12)00222-7/abstract
A compact, self-contained sensor recorded and transmitted brain activity data wirelessly for more than a year in early stage animal tests, according to a study funded by the US National Institutes of Health.
In addition to allowing for more natural studies of brain activity in moving subjects, this implantable device is claimed to represent a potential major step toward cord-free control of advanced prosthetics that move with the power of thought. The report is in the April 2013 issue of the Journal of Neural Engineering.
For people who have sustained paralysis or limb amputation, rehabilitation can be slow and frustrating because they have to learn a new way of doing things that the rest of us do without actively thinking about it,' said Grace Peng, Ph.D., who oversees the Rehabilitation Engineering Program of the National Institute of Biomedical Imaging and Bioengineering (NIBIB), part of NIH. 'Brain-computer interfaces harness existing brain circuitry, which may offer a more intuitive rehab experience, and ultimately, a better quality of life for people who have already faced serious challenges.'
Mr Qurashi Credit: Dudley Group NHS Foundation Trust
A doctor from Dudley has returned from Syria where he has been fitting prosthetic limbs made from drainpipes to war victims.
Mr Qurashi, who works at Russells Hall Hospital, occupied a makeshift clinic and workshop helping men, women and children who lost limbs during the two-year war that has so far claimed thousands of lives.
A Turkish businessman has donated the drainpipes which are melted down at high heat in an oven and moulded against a plaster cast of the amputated leg. They are then fitted into place with metal pins and leather straps.
The artificial feet are made from recycled rubber.
, 
, , Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.
Prospective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort.
There was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p < 0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p < 0.05).
PO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.
Research by the University of Salford, University of Manchester and Blatchford's Endolite Technology Centre will help to enhance the mobility of people with above-knee amputations by improving the energy efficiency of prosthetic legs.
When walking with a single prosthetic leg, above-knee amputees typically use up to 60% more energy than people who are able-bodied, causing fatigue and a 40% slower walking speed. These difficulties can hinder an amputee's mobility and, as a result, affect their quality of life.
The energy storage and return capabilities of prosthetic legs are crucial to improving an amputee's gait and mobility, but most prostheses only store and return significant energy below the knee and in an uncontrolled way.
To overcome these problems the team of engineers and prosthetists will explore the potential for using hydraulic technology to harvest and store energy from the parts of the prosthesis that absorb power, and then return that energy to the parts that do useful propulsive work.
The results will be used to develop new prosthetic leg designs which have increased functionality and require less energy from the amputee.
http://www.salford.ac.uk/home-page/news/2013/prosthetics-study-to-improve-mobility-of-amputees
On the 13 March 2013 NHS Change Day will bring together the individual creativity, energy and innovative thinking of thousands of NHS staff from across clinical and non-clinical areas of work, in a single day of collective action to improve care for patients, their families and their carers. Change Day is an NHS grassroots initiative devised and driven by new young and emergent clinical and managerial leaders from primary and secondary care across the NHS in England, who want to make this call to action the single largest simultaneous improvement event in the NHS. It is an ambitious programme of activities aimed at galvanising and engaging the frontline in the process of improvement through individuals and teams pledging to make a change in their practice which will improve patient experience and/or clinical outcomes by spreading and adopting best practice and championing innovation. This will be a country wide event covering the whole of the UK and will coincide with Healthcare Innovation Expo at Excel in the same day. The idea of NHS Change Day is create a mass movement of people working in the NHS demonstrating the difference they can make - by one simple act – and proving that large scale improvement is possible in the NHS. The aim is for 65,000 people to take part, 65 being the number of years the NHS has been in existence. Those who wish to take part can go to the NHS Change Day website at http://www.changemodel.nhs.uk/changeday and make their pledge online, join in the discussions on the forum and become part of the growing list of active supporters and organisations taking part on the day.
A consultation is launched on legislation that would mean all regulated healthcare professionals have to hold indemnity or insurance to practise.
The consultation will run from 22 February to 17 May 2013 on draft regulations on the requirement for all regulated healthcare professionals to hold an insurance or indemnity arrangement as a condition of their registration with the relevant regulatory body.
The vast majority of healthcare professionals are already covered by their employer's arrangements. In the first instance, it will be for each individual healthcare professional to assure themselves that they are covered by an insurance or indemnity arrangement appropriate to their scope of practice.
Health Minister Dr Dan Poulter said:
"We believe all regulated healthcare professionals should hold insurance or indemnity to ensure the patients they treat are fully protected if things don't go according to plan.
"We are changing the law to make sure that this is the case. This will mean that in the rare cases where a patient suffers harm as a result of negligence, they are able to seek compensation.
"This should increase patient confidence and improve safety overall."
The department has asked some specific questions in the consultation document but please provide comments on any aspect of the consultation package.
There are a number of other provisions of the directive which have yet to be transposed into UK law and which will be consulted upon separately. The UK is required to be compliant with the directive from 25 October 2013. The department is undertaking the consultation on behalf of all UK health administrations.
Legislation in respect of the Pharmaceutical Society of Northern Ireland remains the responsibility of the Northern Ireland legislature and is subject to a separate consultation in Northern Ireland.
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