The effect of AFO stiffness on the knee joint during the heel strike phase of gait in stroke patients

Madeline Singer, Toshiki Kobayahi, Lucas Lincoln, Michael Orendurff and K. Bo Foreman

Stroke patients suffering from foot drop are often prescribed ankle-foot orthoses (AFOs) to improve foot clearance during gait. However, excessive restriction of plantarflexion (PF) during the heel strike phase of gait has been shown to cause biomechanical changes at the knee joint. This pilot study aimed to determine how increasing the PF stiffness of an AFO affects knee joint kinematics and kinetics during heel strike in hemiplegic stroke patients with varying levels of active ankle range of motion. We hypothesized that increased PF resistance would cause an increase in anterior tibial rotation at heel strike with resulting increases in knee flexion angle and knee extension moment. To test this hypothesis, 5 stroke patients with foot drop were clinically evaluated, instrumented with reflective markers, and fitted with a spring modified AFO (Orthocare Innovations). A compression spring in the posterior aspect of the AFO was changed to increase the external dorsiflexion torque from 0.3 Nm/deg (Spring 1) to 2.0 Nm/deg (Spring 2). Kinematic and kinetic data were collected during walking on an instrumented treadmill (Bertec) in a motion analysis lab. Five steps with each spring were examined. Two patients exhibited an increase in knee flexion angle and knee extension moment with the stiffer spring. Clinical findings revealed that these 2 patients had minimal active PF while the other 3 patients had full active PF. From these initial results, we cautiously conclude that stroke patients with decreased active PF cannot overcome excessive PF resistance during the heel strike phase of gait, and as a result exhibit compensation strategies at the knee joint. These results will be used to create a more objective method for the prescription of AFOs in hopes to improve the long-term quality of life for stroke patients.

http://www.fasebj.org/content/28/1_Supplement/919.12.short

Foot orthoses for adults with flexible pes planus: a systematic review

Helen A Banwell, Shylie Mackintosh and Dominic Thewlis

Abstract

Background: Foot orthoses are widely used in the management of flexible pes planus, yet the evidence to support this intervention has not been clearly defined. This systematic review aimed to critically appraise the evidence for

the use of foot orthoses for flexible pes planus in adults.

Methods: Electronic databases (Medline, CINAHL, Cochrane, Web of science, SportDiscus, Embase) were systematically searched in June 2013 for randomised controlled, controlled clinical and repeated measure trials

where participants had identified flexible pes planus using a validated and reliable measure of pes planus and the intervention was a rigid or semi-rigid orthoses with the comparison being a no-orthoses (shoes alone or flat

non-posted insert) condition. Outcomes of interest were foot pain, rearfoot kinematics, foot kinetics and physical function.

Results: Of the 2,211 articles identified by the searches, 13 studies met the inclusion criteria; two were randomised controlled trials, one was a controlled trial and 10 were repeated measure studies. Across the included studies, 59

relevant outcome measures were reported with 17 calculated as statistically significant large or medium effects observed with use of foot orthoses compared to the no orthoses condition (SMD range 1.13 to −4.11).

Conclusions: No high level evidence supported the use of foot orthoses for flexible pes planus. There is good to moderate level evidence that foot orthoses improve physical function (medial-lateral sway in standing (level II) and

energy cost during walking (level III)). There is low level evidence (level IV) that foot orthoses improve pain, reduce rearfoot eversion, alter loading and impact forces; and reduce rearfoot inversion and eversion moments in flexible

pes planus. Well-designed randomised controlled trials that include appropriate sample sizes, clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult

flexible pes planus.

Source http://www.jfootankleres.com/content/pdf/1757-1146-7-23.pdf

Three simple clinical tests to accurately predict falls in people with Parkinson's disease

Serene S. Paul BAppSc(Phty)(Hons), Colleen G. Canning PhD1, Catherine Sherrington PhD, Stephen R. Lord PhD, DSc3, Jacqueline C. T. Close MD, Victor S. C. Fung PhD, FRACP

ABSTRACT

Falls are a major cause of morbidity in Parkinson's disease (PD). The objective of this study was to identify predictors of falls in PD and develop a simple prediction tool that would be useful in routine patient care. Potential predictor variables (falls history, disease severity, cognition, leg muscle strength, balance, mobility, freezing of gait [FOG], and fear of falling) were collected for 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using monthly falls diaries. In total, 125 participants (59%) fell during follow-up. A model that included a history of falls, FOG, impaired postural sway, gait speed, sit-to-stand, standing balance with narrow base of support, and coordinated stability had high discrimination in identifying fallers (area under the receiver-operating characteristic curve [AUC], 0.83; 95% confidence interval [CI], 0.77–0.88). A clinical tool that incorporated 3 predictors easily determined in a clinical setting (falling in the previous year: odds ratio [OR], 5.80; 95% CI, 3.00–11.22; FOG in the past month: OR, 2.39; 95% CI, 1.19–4.80; and self-selected gait speed < 1.1 meters per second: OR, 1.86; 95% CI, 0.96–3.58) had similar discrimination (AUC, 0.80; 95% CI, 0.73–0.86) to the more complex model (P = 0.14 for comparison of AUCs). The absolute probability of falling in the next 6 months for people with low, medium, and high risk using the simple, 3-test tool was 17%, 51%, and 85%, respectively. In people who have PD without significant cognitive impairment, falls can be predicted with a high degree of accuracy using a simple, 3-test clinical tool. This tool enables individualized quantification of the risk of falling. 

http://onlinelibrary.wiley.com/doi/10.1002/mds.25404/abstract;jsessionid=C8E52F1FD78D8397FBBD8E6C41B2C0CB.d04t04

Heart of England NHS Foundation Trust Job Advert - Band 6 Senior Orthotist

Please click here to view the Job Advertisement

BAPO Bulletin 26 March 2014

Conference

The Conference this year was a huge success; we hope you all enjoyed it. We are already looking forward to next years conference and if you didn’t get a chance during the weekend to fill our a feedback sheet for what you would like to see in 2015 please email your feedback to the secretariat.

AHP Informatics - Telehealth, Telecare & Telemedicine

BAPO is assisting with some work by the National AHP Informatics Strategic Taskforce (NAHPIST) to look into how information is collected, managed and shared to support the delivery of healthcare and promote health.

We would really like your assistance in this matter so we can find out about current practices and establish your current knowledge, attitudes towards and understanding of Informatics, Telehealth, Telecare and Telemedicine.

This information will help greatly with the planning, training and communication of these key areas in order to enhance and drive patient care across this diverse professional group. 

It will take approx 10 minutes to complete and, apart from indicating which AHP group you are from, it is completely anonymous.

The survey will close at the end of March.

https://www.surveymonkey.com/s/NAHPISTFEB14

Career Structure Documents

The Prosthetics and Orthotics Career Framework is now complete and if you didn’t have a chance to see it at the conference it is available for download on the BAPO website

Prescription Charge Increase in England

The government are increasing prescription charges in England. Current price for a single dispensed prescription has been increased to £8.05 this year and will increase to £8.25 next year.  There are also new charges for fabric supports and wigs:

 

Wigs and Fabrics
Surgical brassiere	27.05
Abdominal or spinal support	40.85
Stock modacrylic wig	66.70
Partial human hair wig	176.65
Full bespoke human hair wig	258.35

 

 

AHPs and Information Technology

Following the link sent out in our previous bulletin, only 2.25% of Prosthetists and Orthotists have responded to the questionnaire on AHPs and the use of IT.  Here is that link again if you missed it:  https://www.surveymonkey.com/s/NAHPISTFEB14

Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial

Marco Monticone, Emilia Ambrosini, Daniele Cazzaniga, Barbara Rocca, Simona Ferrante

Abstract

Purpose

To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°).

Methods

This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure.

Results

There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group.

Conclusions

The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.

http://link.springer.com/article/10.1007/s00586-014-3241-y

Secretariat Opening Hours

To allow Association staff to attend conference 2014 the Secretariat will close at 5pm on Wednesday 12 March and will re-open on Monday 24 March at 8.45am.  Please direct any queries to enquiries@bapo.com

Trulife Job Advert - Orthotist, London

Please follow the link to view the job advertisement: Trulife Job Advert

Conference 2014

Less than two weeks to go till Conference! There is still time to get tickets for both the Weekend event and the Saturday Evening with guest speaker Dennis Taylor; just book online or speak to the

secretariat.

 

BAPO Bulletin March 2014

Conference

As you may know the organising and finalising of the conference which is happening at The Point, Lancashire cricket ground is now well underway. We look forward to seeing many of you there, and would like to thank both the Conference Committee and the Secretariat for helping to organise this; if you haven’t got your tickets yet there is still time to register online or by phoning the Secretariat. We are looking forward to celebrating BAPO’s 20th Anniversary throughout the weekend, looking at what BAPO has done and what BAPO is currently doing.

Professional Affairs

The Professional Affairs committee are currently working on some commissioning documents that will be championed by Linda Hindle, AHP lead at public health England. This will be a series of documents with case studies, which will advise commissioners allowing them to understand the role of Prosthetists and Orthotists and how they can help deliver suitable care in practice.  These documents will be publically available online.

AHP Informatics - Telehealth, Telecare & Telemedicine

BAPO is assisting with some work by the National AHP Informatics Strategic Taskforce (NAHPIST) to look into how information is collected, managed and shared to support the delivery of healthcare and promote health.

We would really like your assistance in this matter so we can find out about current practices and establish your current knowledge, attitudes towards and understanding of Informatics, Telehealth, Telecare and Telemedicine.

This information will help greatly with the planning, training and communication of these key areas in order to enhance and drive patient care across this diverse professional group. 

It will take approx 10 minutes to complete and, apart from indicating which AHP group you are from, it is completely anonymous.

The survey will close at the end of March.

https://www.surveymonkey.com/s/NAHPISTFEB14

Career Structure Documents

 

The Prosthetics and Orthotics Career Framework is now complete and available on the BAPO website.   Andrew Nicol worked on behalf of North West Education England and Salford University to produce these framework documents.  He will be available throughout the conference to talk about this work.  BAPO were one of the key stakeholders in producing these documents.

Saturday Night Ticket - BAPO Conference 2014 - **now available to buy online or by contacting the BAPO Secretariat**

KAFO - Stance Phase Control and Lower Limb Solutions

This course aims to:

Give an overview of conventional and non-conventional KAFO designs, trimlines and material choices.

Give an overview of stance phase control with the information on how to apply this clinically.

If you are interested in this course, please click below link for further details:

KAFO - Stance Phase Control and Lower Limb Solutions

BAPO Conference & Exhibition 2014

Have you seen the BAPO conference programme yet?
Take a look there are some fantastic speakers lined up including Andrew Andrews on the Friday with a mock court scene And Keynote Speakers Rory O'Connor; Peter Slijkhuis and Hayley Ginn on the Saturday. There are many other exciting speakers to listen to and of course you have got to see the exhibition.
And don't worry Its not to late to register if you've not yet done so.

Executive Committee Elections

Dear Member,

Executive Committee Elections

There are a number of seats available at this years’ AGM. Do you know someone who is motivated and has enthusiastic drive for their profession, if so please nominate them for election onto the EC where they may have the opportunity to influence their profession and its position within current affairs.

Further information is available from the BAPO Secretariat or to nominate please complete the attached Nomination form and return it to the address below:

BAPO Secretariat
Sir James Clark Building
Abbey Mill Business Centre
Paisley
Renfrewshire
PA1 1TJ

Nomination Form 2014

BAPO Conference

Only 5 weeks to go to the BAPO conference. Have you got your tickets yet? If not there is still time Register Now!

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

Kevin Deschamps, Giovanni Arnoldo Matricali, Philip Roosen, Kaat Desloovere, Herman Bruyninckx, Pieter Spaepen, Frank Nobels, Jos Tits, Mieke Flour, Filip Staes

Abstract

Background

The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics.

Methodology/Principal Findings

Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters.

Conclusion/s Significance

There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot.

Source: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0079924

BAPO CONFERENCE

Remember to book your tickets for this years BAPO conference. If you haven't done it yet you can Register Here.
And nominations for Technician of the Year are still open if you know someone who has gone the extra mile, or deserves recognition for an excellent piece of work. Nomination Forms available here.

New Council for the Health and Care Professions Council appointed

HCPC News release

Thursday 9 January 2014

New Council for the Health and Care Professions Council appointed

The Health and Care Professions Council (HCPC) is pleased to announce the appointment of its new Council.  There are twelve members in total, all of whom have taken office in January 2014.  This is in line with the government recommendation that all regulatory bodies should be overseen by smaller, more 'board like' Councils.

Each Council member has been appointed for the skills they will bring, including a strong mix of governance, management and financial abilities.  The new Council has also been drawn from the professions we regulate as well as lay backgrounds to bring a diverse mix of experience and knowledge. The full list of appointees, including biographies, is set out below.

Chair of the HCPC, Anna van der Gaag, commented:

"The last few years has seen tremendous growth and change for the HCPC.  I am pleased that we have recruited a Council with such a strong mix of skills, ability and experience drawn from all parts of the UK.  This is particularly important for us as we continue working with our stakeholders in order to ensure we carry out our primary purpose of public protection effectively.  I very much look forward to continuing this work with the restructured Council."

Chief Executive and Registrar of the HCPC, Marc Seale, commented;

"I very much welcome the newly appointed Council members and am looking forward to working with them to ensure the highest standards of public protection. Council members play a fundamental governance role in setting the strategy and policy and ensuring HCPC fulfils its statutory duty. They also ensure we maintain efficient regulatory processes and that the standards we set continue to be fit for purpose."

New Short Course - Saturday 12th April 2014 - Staffordshire University

Imaging Interpretation of the Foot and Ankle with a focus on Diabetic Foot

 

This course aims to:

Provide basic imaging (X-Ray) interpreting skills to allow Allied Health Professionals to be able to distinguish the differences between a normal foot and an abnormal foot and how one can use this information for treatment planning.

If you are interested on this course, please click below link for further details:
Imaging Interpretation of the Foot and Ankle with a focus on Diabetic Foot