Prosthetics service for veterans launched

A NATIONAL prosthetics service has been launched for veteran military amputees.

The service will provide amputees with advanced prosthetics designed to function as much like a natural limb as possible. It will also act as a dedicated point of access to services including limb fitting and rehabilitation.

It is estimated there are about 66 military amputees in Scotland, and ministers yesterday met one of them, Steven Richardson from East Lothian.

He lost both legs and some fingers on both hands after he stood on an explosive device during a tour in the Nad-e-Ali district of Afghanistan in 2010.

Health secretary Alex Neil said: "It is only right our veterans, who have risked their lives for this country, receive world-class services through our NHS.

"Scotland is already leading the way in prosthetic care and this new specialist service is a fantastic example of the NHS using innovative technologies to deliver 21st-century healthcare."

The service has been launched by the Scottish Government following recommendations in a report by Dr Andrew Murrison on NHS prosthetics for veterans, particularly those from recent conflicts in Iraq and Afghanistan.

The UK government asked Dr Murrison, a Tory MP, to review prosthetic services after concerns were raised by some charities the NHS may not provide services to the same standard as the Defence Medical Service provided by the Ministry of Defence.

Ian Waller, of the British Limbless Ex-Service Men's Association, said: "We are encouraged by the clear message this sends to our members in Scotland; that their needs have been recognised, considered and are being addressed."

Source: http://www.scotsman.com/news/health/prosthetics-service-for-veterans-launched-1-2976943

Cost Benefit Analysis of Knee Prostheses

A study is being conducted at Imperial College Business School. The purpose of this study is to analyse the costs and benefits of different types of leg prostheses used by clients in the UK.

The survey is directed to patients who have undergone UNILATERAL ABOVE-KNEE AMPUTATION (only in one leg).

The RESULTS of this study will help provide evidence-based research to support the campaign for more funding to be made available for microprocessor knees in the UK.

The survey can be completed in 10-15 minutes and can be found on the following link https://iclbusiness.eu.qualtrics.com/SE/?SID=SV_7QdSoPKMkQkHqhD

Your response will be confidential. You will be assigned a participant number and only these numbers will appear in subsequent analyses of the data.

If you do not wish to answer a particular question please leave it blank and you can withdraw from the study at anytime.

By completing the survey, you acknowledge that you have read this information and agree to participate in this research.

An Introduction to Podiatric Medicine for Healthcare Professionals Saturday 21st September 2013

For further information on the 'An Introduction to Podiatric Medicine for Healthcare Professionals' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 24th August 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

NHS e-Referral Service vision - making paperless referrals a reality

What might an NHS e-Referral Service look like in the future?

The needs of patients and professionals will be foremost in designing the new service, which will include support for enhanced functionality and usability for delivering some or all of the following:

Improved integration and usability

Referral management support

Any to any referrals

Linked appointments

Follow-up appointments

Self referrals

Enhanced reporting capability

Electronic communications

http://systems.hscic.gov.uk/ers

Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes

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

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013 Staffordshire University

Please click for Further Information on the 'Pysiotherapy to Complement Orthotic Treatment' BAPO Short Course.

HCPC launches consultation on guidance for professional indemnity cover and registration

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

Gene Associated With Adolescent-Onset Scoliosis Identified

Researchers at the RIKEN Center for Integrative Medical Sciences in Japan have identified a gene associated with adolescent idiopathic scoliosis (AIS). This is the first time that any gene or specific cause has been linked to this form of scoliosis which affects adolescents. Scoliosis is a skeletal disease that causes the spine to become deformed: the spine of an individual suffering from scoliosis may look like the shape of an "S" or a "C" when viewed on an X-ray. AIS, as the name suggests, is a form of scoliosis that has its onset in adolescence, usually during the puberty growth period. Although the condition is called idiopathic because its cause is unknown, scientists have suspected that genetics may play a part in causing AIS. In their study, published in Nature Genetics, the team from RIKEN sought to uncover genetic risk factors for AIS by studying the genomes over 1,800 patients who suffer from AIS and almost 26,000 unaffected individuals in the Japanese population.

From their genome-wide analysis, the researchers identified variants of a gene, GPR126, that were

significantly associated with a higher risk for developing AIS. The team subsequently confirmed

that GPR126 is also linked to AIS susceptibility in the Han Chinese and Caucasian populations.

Experiments further showed that the GPR126 gene product, which is known to play a role in human

height and trunk length, promotes growth and bone tissue formation in spine development. These findings suggest that genetic alterations in GPR126 may affect both AIS susceptibility and height by causing abnormal spinal development and growth. 

The article can be found at: Kou et al. (2013) Genetic Variants In GPR126 Are Associated With Adolescent Idiopathic Scoliosis.

http://www.asianscientist.com/health-medicine/gene-adolescent-onset-scoliosis-identified-2013/

The Department of Health has announced a £4m fund to improve the way diseases are diagnosed.

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 .....

Specialised health services clinical reference groups: Patient and carer member recruitment – second wave

Specialised health services clinical reference groups: Patient and carer member recruitment – second wave 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 INTERNAL MEDICINE A5 Morbid Obesity Surgery A13 Specialised Rheumatology TRAUMA D10 Specialised Orthopaedic Services D14 Complex Spinal Surgery D15  Major Trauma WOMEN AND CHILDREN E4 Paediatric Cancer Services E12 Fetal Medicine E7 Paediatric Intensive Care E13  Multi System Disorder

Dose–response effects of customised foot orthoses on lower limb kinematics and kinetics in pronated foot type

S Telfer, M Abbott, MM Steultjens, J Woodburn - Journal of Biomechanics, 2013

Abstract 

Despite the widespread use of customised foot orthoses (FOs) for the pronated foot type there is a lack of reliable information on the dose–response effect on lower limb mechanics. This study investigated these effects in subjects with normal and pronated foot types. Customised FOs were administered to 12 participants with symptomatic pronated foot type and 12 age and gender matched controls. A computer-aided design (CAD) software was used to design nine FOs per participant with dose incrementally changed by varying only the rearfoot post angle. This was done in 2° increments from 6° lateral to 10° medial posting. A 3D printing method was used to manufacture the FOs. Quantification of the dose–response effect was performed using three-dimensional gait analyses for selected rearfoot and knee kinematics and kinetics. Under these experimental conditions, significant and linear effects of posting were seen for the peak (p<0.001) and mean (p<0.001) rearfoot eversions, peak (p=0.003) and mean (p<0.001) ankle eversion moments and peak (p=0.017) and mean (p=0.005) knee adduction moment variables. Group effects were observed for the peak (p=0.007) and mean (p=0.007) forefoot abduction and for the peak (p=0.007) knee adduction moment. A significant interaction between posting and group was seen for internal tibial rotation (p=0.004). These data indicate that a dose–response effect, with a linear trend for both the rearfoot and knee, exists for customised FOs used to treat pronated foot type.

http://www.jbiomech.com/article/S0021-9290(13)00166-8/abstract

The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: A systematic review

A Healy, R Naemi, N Chockalingam - Journal of Diabetes and its Complications

Abstract 

Aim

Footwear interventions are used within clinical practice in an effort to reduce ulcerations however the effectiveness of these interventions is unclear. The aim of this paper was to conduct a systematic review which examined the effectiveness of footwear as an intervention for prevention of diabetic foot ulcers or the reduction of biomechanical risk factors for ulceration and to discuss the quality and interpret the findings of research to date.

Methods

The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with 12 articles identified for review.

Results

The majority of these studies were cross sectional and examined the effect of different footwear conditions on plantar pressure measurements. Factors which influenced study findings such as participant selection, measurement and analysis techniques, footwear design and compliance are discussed and recommendations for future studies are provided.

Conclusions

No research to date has examined the effectiveness of footwear in preventing ulceration. Conflicting findings are reported on the effective of footwear interventions to prevent reulceration. While the use of rocker sole footwear and custom orthoses in plantar pressure reduction are supported in cross sectional studies, longitudinal studies are required to confirm their benefit.

http://www.jdcjournal.com/article/S1056-8727(13)00056-1/abstract

Scoliosis—treatment indications according to current evidence

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

Foot Drop Stimulation Versus Ankle Foot Orthosis After Stroke - 30-Week Outcomes

Patricia M. Kluding, PhD, 

Kari Dunning, PhD, 

Michael W. O'Dell, MD,

Samuel S. Wu, PhD, 

Jivan Ginosian, MS, 

Jody Feld, DPT and

Keith McBride, DPT

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.

http://stroke.ahajournals.org/content/early/2013/05/02/STROKEAHA.111.000334.abstract

A pilot study to assess the effectiveness of orthotic insoles on the reduction of plantar soft tissue strain

• Musab Ibrahim
, 
• Rana El Hilaly
, 
• Mona Taher
, 
• Ahmed Morsy

Clinical Biomechanics

Abstract 

Background

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.

Methods

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.

Findings

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.

Interpretation

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

Brain implant points to advanced prosthetics

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.'

Read more: http://www.theengineer.co.uk/medical-and-healthcare/news/brain-implant-points-to-advanced-prosthetics/1015825.article#ixzz2OAFn0BWE

Drainpipe prosthetics in war torn Syria

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.

Source: http://www.itv.com/news/central/topic/prosthetics/

Effect of different orthotic concepts as first line treatment of plantar fasciitis

• Markus Walther, MD, PhD^a, , , , 
• Bernd Kratschmer, MD^b, 
• Joachim Verschl, MD^b, 
• Christoph Volkering, MD^a, 
• Sebastian Altenberger, MD^a, 
• Stefanie Kriegelstein, MD^a, 
• Marc Hilgers, MD, PhD^c

• ^a Department of Foot and Ankle Surgery, Schoen Klinik Munich Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany¹
• ^b Outpatient Clinic for Orthopedic and Trauma Surgery, Altstadtring 6, 91161 Hilpoltstein, Germany
• ^c Florida Orthopaedics Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA

• http://dx.doi.org/10.1016/j.fas.2012.12.008, 

Abstract

Background

Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.

Methods

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.

Results

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).

Conclusions

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.

http://www.sciencedirect.com/science/article/pii/S1268773113000209

Prosthetics study to improve mobility of amputees

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

NHS Change Day – a single day of collective action to demonstrate how small changes can have a big impact

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.