National Clinical Director Posts

AHPs are being encouraged to apply for National Clinical Director (NCD) posts.  The post holders will take the clinical lead in driving improvement in quality across all relevant domains of the NHS Outcomes Framework.  As part of that the NCD will be the architect of and responsible for successful design and delivery of a suite of commissioning tools to support system, professional and care pathway changes at a national and local level.  The NCD will work collaboratively with other NCDs to ensure there is coherent commissioning guidance across CCG and specialised commissioned services.   This is a great opportunity for Prosthetists and Orthotists to get involved in key roles that can influence services.   Roles are by secondment and include:

Informatics

Maternity and Children
Mental Health
Urgent Care
Stroke

Rehab and Recovery in the community
Trauma
Spinal
MSK

Integration and Frail elderly
Dementia
CVD
Diagnostics and Imaging
Obesity and Diabetes
Renal
Heart disease
Enhanced recovery and critical care

 

Application is through the NHS Jobs site.

BAPO Conference & Exhibition 2013 - Early Bird Ends 31 December 2012

BAPO CONFERENCE & EXHIBITION 2013 EARLY BIRD OFFER ENDS 31 DECEMBER 2012 Don't miss out on this fantastic Early Bird Discount!!  For further information go to www.bapo.com find us on Facebook http://www.facebook.com/BAPO.com BAPO Secretariat Sir James Clark Building , Abbey Mill Business Centre, Paisley, Renfrewshire, PA1 1TJ T: +44 (0) 0141 561 7217 F: +44 (0) 0141 561 7218 E: Enquiries@bapo.com W: http://www.bapo.com Find us on facebook:http://www.facebook.com/BAPO.com

Review of NHS critical infrastructure risk initiated

A review of critical infrastructure risk (CIR) has been initiated to support the commitments under the NHS Constitution for the NHS 'to provide services from a clean and safe environment that is fit for purpose based on national best practice'.  It may be risking regulatory requirements to ensure service users are protected against risks associated with 'unsafe and unsuitable premises'.

The review will build on existing practices, such as how backlog maintenance is currently determined, and ensure a system is put in place for the future that gets to the heart of the investment required to address risks that are critical.

NHS organisations are invited to participate in the Review of the NHS' recurrent reporting of a need for significant investment in maintenance of its facilities. This is to eliminate 'critical risks' to the safety of patients, visitors and staff; and the resilience of its services.

Creating change: Innovation health and wealth one year on

The report, "Creating change: Innovation health and wealth one year on" provides an update on the implementation of the NHS Chief Executive's report "Innovation health and wealth, accelerating adoption and diffusion in the NHS" published in December 2011.

The first report  set out delivery for spreading innovation quickly and at a scale throughout the NHS. 'Creating change' demonstrates the progress that is being made at a time of great change in the NHS. It highlights what more should be done to deliver the improvements needed to fully embrace and embed innovation in the NHS and improve outcomes and quality for patients and the NHS and drive growth for the UK.

Read Creating change: Innovation health and wealth one year on

New national model to tackle variation in specialist healthcare services

For the first time patients requiring specialised treatment can look forward to the same level and standards of care. The NHS Commissioning Board has published the new Operating Model for commissioning specialised services setting out how a single, national system will ensure patients are offered consistent, high quality services across the country. The number of patients requiring specialised services is small with services located in specialist centres in major towns and cities across England. Concentrating services to provide the same national standards of quality will ensure that specialist staff can be more easily recruited and the necessary levels of training maintained. The new Operating Model and associated Commissioning Intentions mark a clear move away from regional commissioning to a single national approach to both commissioning and contracting. By bringing together the current ten different systems for commissioning specialised services, it provides the opportunity to innovate and introduce new technologies to benefit patients and improve health outcomes in a systematic way. Underpinning the Operating Model are the Commissioning Intentions for 2013/14 ensuring for the first time that the delivery, quality and access for all prescribed specialised services is standard across the country. Ian Dalton, Chief Operating Officer and Deputy Chief Executive at the NHS Commissioning Board said, "This improved system will ensure national consistency in accessing services, reduce variation, and set clear quality standards leading to better health outcomes for patients. It will also allow us to start developing an outcomes framework for rare and specialised conditions, thus starting to move the focus of our discussions with providers from contract inputs to health outcomes. "This is a real opportunity to dramatically improve the way we provide services for people with rare and specialised conditions through having clearly articulated standards for services. "Our next step will be to shortly launch a public consultation on the first ever set of national service specifications and clinical policies for specialised services.  This will be the first time we have had clear national policy and sets our clear intention for the future" The new system will provide a clear focus on a range of rare conditions and low volume treatments ranging from medical genetics, kidney disorders and uncommon cancers to complex cardiac interventions, burn care and some specialised services for children. James Palmer, the new Clinical Director for Specialised Services at the NHS Commissioning Board said, "Strong clinical involvement has been central to the development of this approach. We are working closely in partnership with Clinical Commissioning Groups and colleagues on the frontline to ensure the whole patient pathway is as seamless and locally responsive as possible in meeting patients' needs." Specialised services accounts for approximately 10% of the total NHS budget and accounts for approximately £11.8 billion per annum. More information is available in the specialised commissioning resources area.

Latest NHS Commissioning Board CCG bulletin 27 November 2012

Latest CCG bulletin published by the NHS Commissioning Board.

The NHS Commissioning Board has published its latest bulletin for CCGs from Dame Barbara Hakin, national director for commissioning development. 

Contractual ‘duty of candour’ to drive a more open NHS culture

New rules to toughen transparency in NHS organisations and increase patient confidence have been announced by Health Minister Dr Dan Poulter following a public consultation. The government will create regulations that require the NHS Commissioning Board to include a contractual duty of openness in all commissioning contracts from April 2013.

This means that NHS organisations will be required to tell patients if their safety has been compromised, apologise, and ensure that lessons are learned to prevent them from being repeated. Although all NHS organisations are currently expected to be open about mistakes, there is no contractual duty to hold them to account when this does not happen.

Dr Dan Poulter said:

"The importance of an open culture cannot be underestimated. We expect that Robert Francis will make further recommendations on duty of candour when the Mid Staffordshire Inquiry has been published, and we are committed to taking whatever further action we think is needed as a result. But we cannot simply wait when there are things we can already do – creating this contractual duty of candour now ensures that NHS contracts for the next financial year will champion patients' rights to always have basic honesty from our NHS, as well as safe care."

The responses to the public consultation and the government's analysis of them have now been published, alongside the impact assessment and equalities analysis of the proposed contractual duty of candour.

• Implementing a 'Duty of Candour': A new contractual requirement on providers – Analysis of consultation responses

Source: http://www.dh.gov.uk/health/2012/12/duty-candour/

Relationship Between Tightness of the Posterior Muscles of the Lower Limb and Plantar Fasciitis

Yolanda Aranda Bolívar, Pedro V. Munuera Martínez, and Juan Polo Padillo

Abstract

Background: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity

was associated with plantar fasciitis.

Methods: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited.

Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion

(knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves,

sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive

powers.

Results: Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in

all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of

94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study.

Conclusion: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in

the unaffected participants.

Clinical Relevance: The results of this study suggest that therapists who are going to employ a stretching protocol for

treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs

could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from

an adequate tissue-specific plantar fascia-stretching protocol.

Level of Evidence: Level III, case control study.

Source: ftp://ftp.sagepub.com/FAI%20Figures/FAI459173.pdf

--

Jonathan 

Rocket-Powered Prosthetics Will Allow Us to Compete With Our Robot Masters

The world of prosthetics is reaching critical turning point. Though the goal in the field has always been to replicate and replace human limbs as accurately as possible, we're now able to see a future where mechanical enhancements may make people stronger and faster than when they were whole. There's no reason why prosthetic-wearers shouldn't be allowed to live as discrete super-human cyborgs, though. Researchers at the University of Alabama are trying to make their new rocket-powered ankle more discrete than those controversial prosthetic blades from a few years back.

Most prosthetic leg-wearers are forced to make a choice when picking an artificial limb: Either choose a light, inanimate object, or an extremely heavy model that features a motor and power supply able to simulate the action of taking a step. The designers behind the rocket-powered ankle are trying to make the best of both worlds, building a lightweight frame that can house something powerful enough to generate a natural-feeling walking motion.

The key to making a lighter self-propelled prothetic, it seems, is actually the fuel. The "rocket-ankle" uses a special liquid fuel called "monorepellant," which can be activated with only a very small amount of catalyst. The minimalistic fuel-type cuts out a lot of the mechanical elements that weigh down most active prosthetics. The ankle also uses a sleeve muscle actuator, an artificial muscle designed to allow for a more natural-feeling stride.

Of course, there are still problems. For starters, the ankle produces a fair amount of hot exhaust. The device also may or may not have a tendency to overheat, which I would assume can get pretty uncomfortable. According to the University, designers hope that the leg will be at least theoretically functional, if not actually in use, by 2016. More importantly, the designers say that, for better or worse, the ankle is being built to simulate human motion, and not turn people into cyborg super-heroes.

Source: http://www.geekosystem.com/rocket-powered-prosthetics/

Influence of malalignment on socket reaction moments during gait in amputees with transtibial prostheses

• David A. Boone
 
• Toshiki Kobayashi
, 
• Teri G. Chou
, 
• Adam K. Arabian
, 
• Kim L. Coleman
, 
• Michael S. Orendurff
, 
• Ming Zhang

Highlights

► Effect of malalignment on socket reaction moments in transtibial prostheses was investigated. ► Socket reaction moments were measured at the base of a socket using an instrumented prosthesis alignment component. ► Both coronal and sagittal malalignment significantly affected the socket reaction moments. ► Socket reaction moments could be biomechanical effects of prosthetic malalignment.

Abstract 

Alignment – the process and measured orientation of the prosthetic socket relative to the foot – is important for proper function of a transtibial prosthesis. Prosthetic alignment is performed by prosthetists using visual gait observation and amputees' feedback. The aim of this study was to investigate the effect of transtibial prosthesis malalignment on the moments measured at the base of the socket: the socket reaction moments. Eleven subjects with transtibial amputation were recruited from the community. An instrumented prosthesis alignment component was used to measure socket reaction moments during ambulation under 17 alignment conditions, including nominally aligned using conventional clinical methods, and angle perturbations of 3° and 6° (flexion, extension, abduction, and adduction) and translation perturbations of 5mm and 10mm (anterior, posterior, lateral, and medial) referenced from the nominal alignment. Coronal alignment perturbations caused systematic changes in the coronal socket reaction moments. All angle and translation perturbations revealed statistically significant differences on coronal socket reaction moments compared to the nominal alignment at 30% and 75% of stance phase (P<0.05). The effect of sagittal alignment perturbations on sagittal socket reaction moments was not as responsive as that of the coronal perturbations. The sagittal angle and translation perturbations of the socket led to statistically significant changes in minimum moment, maximum moment, and moments at 45% of stance phase in the sagittal plane. Therefore, malalignment affected the socket reaction moments in amputees with transtibial prostheses.

Source: http://www.gaitposture.com/article/S0966-6362(12)00374-8/abstract

BAPO CONFERENCE & EXHIBITION 2013 SPONSORSHIP INFORMATION Thanks to our sponsors BAPO are once again able to offer a full and varied programme of events at an incredible low price - Early Bird Discount £60 for Full Member (whole weekend) for full programme and prices please go to www.bapo.com http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/BLANK_DELEGATE_BOOKING_FORM_2013_Final_220812.pdf http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/Tech_Free_Place_Booking_Form.pdf find us on Facebook http://www.facebook.com/BAPO.com BAPO Secretariat Sir James Clark Building , Abbey Mill Business Centre, Paisley, Renfrewshire, PA1 1TJ T: +44 (0) 0141 561 7217 F: +44 (0) 0141 561 7218 E: Enquiries@bapo.com W: http://www.bapo.com Find us on facebook:http://www.facebook.com/BAPO.com

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The role of foot morphology on foot function in diabetic subjects with or without neuropathy

• Annamaria Guiotto^a, 1, , 
• Zimi Sawacha^a, 2, , 
• Gabriella Guarneri^b, 3, , 
• Giuseppe Cristoferi^b, 4, ,
• Angelo Avogaro^b, 5, , 
• Claudio Cobelli^a,

Abstract

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P < 0.05), decreased contact surface on the hindfoot (P < 0.03).

While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.

---

Highlights

► Simultaneous three-dimensional kinematics and pressure analysis of three foot's subsegments: hindfoot, midfoot, forefoot. ► Comparison between controls, diabetics non neuropathic and neuropathic subjects' foot biomechanics. ► Foot morphology contribution to altered biomechanics. ► Data were collected during gait on 60 subjects: 20 controls and 40 diabetics. ► Statistically significant alterations on neuropathic and diabetic subjects with different foot morphology and heel/hallux alignment.

Source: http://www.sciencedirect.com/science/article/pii/S0966636212003700

BAPO Conference & Exhibition 2013 Registration now open

BAPOnline NOW OPEN!
Register for Conference & Exhibition 2013 at www.bapo.com 
 

For for the very latest info on our Clinical Programme, Competitions and Social Programme look no further than latest NewsJigs:
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Fwd: NHS CB welcomes mandate from the Government

PRESS RELEASE

13 November 2012

WE WILL PUT PATIENTS AT THE HEART OF  A LIBERATED AND INNOVATIVE NHS, PLEDGE HEADS OF NEW NHS COMMISSIONING BOARD

The Chief Executive of the NHS Commissioning Board today (Tuesday) welcomed its mandate from the Government.

Sir David Nicholson described the mandate as "a major step on the road to the more liberated and innovative NHS that can be more responsive to its patients." 

The NHS Commissioning Board (NHS CB), which is independent of government, is currently preparing to take on its full responsibilities from 1 April 2013.

Sir David said: "Our aim and our passion is to deliver a better NHS on behalf of patients and the public.  We will do this by working side by side with local clinical leaders; by focussing relentlessly on the outcomes that the NHS delivers for people; and by freeing those on the frontline to transform services in line with the needs of local communities.

"The mandate enables us to do this.  It marks a major step on the road to the more liberated and innovative NHS that can be more responsive to its patients.

"Make no mistake, the NHS will find this a challenging and stretching ask - and it comes against the most challenging financial environment the NHS has ever experienced. But I believe the goals are achievable. 

"The mandate avoids the danger of excessively prescribing the actions of health professionals. We in the NHS Commissioning Board want to ensure power in the NHS sits with those who are closest to the patients. Our role will be to work closely with local clinical leaders and provide the support they need.  Our role is not to tell them what to do."

Sir David concluded: "I am under no illusions about the scale of the task.  There will be bumps in the road and we will have to learn from them. 

"But I have been greatly impressed with the enthusiasm and commitment shown by our new clinical leaders and I look forward to us continuing to work in partnership to do what's best for patients in the coming years.

"We have a once in a lifetime opportunity to do things differently.  We will succeed only by releasing the energy, ideas and commitment of front-line staff and organisations. The NHS Commissioning Board wholeheartedly embraces this challenge."

The Chair of the NHS Commissioning Board, Malcolm Grant, added: "The publication of the Government's mandate to the NHS Commissioning Board marks a vital milestone in the liberation of the NHS.

"It sets clear objectives for the NHS for the coming two years, couched in terms of outcomes for patients, and it recognises that the NHS CB and clinical commissioning groups (CCGs) must operate independently from day-to-day political control.

"The aim of the NHS CB is to secure greatest value to patients from the nation's investment in the NHS. We will oversee delivery against the mandate, and compliance with commissioners' broader legal duties. 

"And we will ensure maximum freedom for CCGs, so that local clinical leaders may respond more effectively to the needs of their local population. They willneed to innovate and transform local health services to meet the needs and wishes of patients, while assuring the delivery of improved outcomes.

"This is an exceptionally challenging yet exciting time for the NHS, and through the mandate the Government has laid the foundation for a locally responsive, clinically-led NHS, focused on improving outcomes for the people of England."

Pressure Ulcers: Prevention and management in primary and secondary care Guideline

Do you work with Children?  Do you have knowledge in treating pressure ulcers?  Why not share this knowledge and join NICE on a consensus panel.  BAPO is a registered stakeholder and you can help out as a BAPO member in offering help to support your professions treatment in this area.

The National Clinical Guideline Centre (NCGC) is now recruiting for members of a Delphi consensus panel to inform the areas regarding children in the guideline 'Pressure Ulcers: Prevention and management in primary and secondary care' guideline.  

The NCGC is currently developing guidance for the prevention and management of pressure ulcers for all who access NHS service. However, it is acknowledged that there are few randomised controlled trials or high quality cohort studies available for children (including neonates, infants, children and young people). It is recognised that, in areas such as this where there is no high quality evidence available, the use of formal consensus methods is appropriate. Therefore, to inform the development of the guideline, the guideline development group will use a modified Delphi consensus technique to agree statements relating to the prevention and management of pressure ulcers in children and young people, which will subsequently be developed into recommendations for inclusion in the guideline.

 

Below is a link to the advertisement, which includes information on the roles required for the panel and all the necessary details on how to apply. The deadline for applications is 5pm, 21^st November 2012.

 

http://www.nice.org.uk/getinvolved/joinnwc/MemberDelphiConsensusPanelPressureUlcers.jsp

Panel members will be expected to take part in two consensus surveys, via email. In addition, panel members will need to be able to deal in a timely manner with any relevant correspondence.

 

If you have any queries regarding these positions, please contact katie.jones@rcplondon.ac.uk.

'Autism gene discovered' by researchers - Health News -

"Genetic mutation discovered in people with autism," The Daily Telegraph reports.

The newspaper goes on to say that this mutation "cuts communication between brain cells to about one-tenth of normal levels" and offers "a likely explanation" for the cognitive and behavioural difficulties experienced by people with autism.
 
This headline is loosely based on recent research into the impact of a previously discovered genetic mutation on the ability of brain cells to transmit signals. The Telegraph speculated that misfiring signals could cause the symptoms of autism.

The study was conducted using rat brain cells, and did not involve people with autism directly.

The researchers described the detailed molecular processes that occur between brain cells when the level of a specific protein is changed. Previous research had discovered that mutations to the gene that controls this protein occurred in people with some types of autism. The authors found that varying the level of this protein affected other proteins responsible for communication between the rats' brain cells.

The research did not, however, examine the impact of this disrupted communication in people with autism, and should not be interpreted as offering "a likely explanation for their cognitive and behavioural difficulties" as reported by the Telegraph.

In addition, many experts think that autism may arise as the result of a combination of factors – not just genetics. Viewing autism as a purely genetic disease may well be an over-simplification.

Source: http://www.nhs.uk/news/2012/11November/Pages/Autism-gene-discovered-by-researchers.aspx

NHS Continuing Healthcare: Getting Ready for 2013

NHS continuing healthcare (NHS CHC), NHS funded nursing care and personal health budgets is an area of £2bn spend and covers health and social care needs for very vulnerable people.

CCGs will be legally responsible from 1 April 2013 for undertaking this assessment process which is prescribed by the Department of Health, underpinned by legislation and must be consistently applied throughout England.

NHS North of England has prepared a set of slides as part of an overall briefing pack for CCGs.  The slides set out:

• An overview and why this is an issue for CCGs and CCG responsibilities
• An outline of the policy context
• An outline of what CCGs will inherit (individuals can ask for their cases to be looked at back to 2004)
• Whether there will be any policy changes after 2013
• Key performance issues (consistency in access is key to NHS CHC)
• What CCGs need to be able to deliver on NHS CHC from April2013
• Links to commissioning support, the NHS CB and local authorities

The work needed now to be legally compliant for April 2013

The pack also lists NHS CHC leads in each of the SHA areas.

Healthy Living and Social Care theme launched as part of Red Tape Challenge

The Healthy Living and Social Care theme of the Red Tape Challenge launches today.

The 6-week long initiative invites healthcare professionals and the public to comment on regulations covering a range of areas including quality of care, mental health, the NHS,  public health and professional standards.

Since its launch in April 2011, the Red Tape Challenge has looked at regulations across government that have an impact on business, the voluntary sector or the public.

The Department for Business, Innovation and Skills is also launching its 'Focus on Enforcement' review, which is part of the government's commitment to regulate all businesses more efficiently.

Public Health Minister Anna Soubry said:

"This Challenge will give the public, healthcare workers and clinicians a vital opportunity to let us know how we can improve the way we regulate or how we can do things differently, whilst ensuring the public is protected.

"We will use the feedback they give us to plan how to get rid of requirements that are no longer needed, freeing up business from unnecessary red tape and giving health professionals more time to care for patients."

SERUM MELATONIN LEVELS IN ADOLESCENT IDIOPATHIC SCOLIOSIS PREDICTION AND PREVENTION FOR CURVE PROGRESSION PROSPECTIVE STUDY

M. Machida, J. Dubousset * , T. Yamada ** and J. Kimura **
Author Affiliations
Corresponding to: Masafumi MACHIDA, M.D., Department of Orthopaedic Surgery, National Hospital Oraganization, Murayama Medical Centre, 37-1, 2-chome, Gakuen, Musashimurayama-shi, Tokyo 208-0011, JAPAN., Fax: 81-42-564-2210, E-mail: masa85@oak.ocn.ne.jp.
Abstract
Objective: To clarify whether serum melatonin levels in adolescent idiopathic scoliosis correlate with curve progression, and whether the exogenous melatonin treatment is effective in patients with decreased levels of endogenous melatonin in adolescent idiopathic scoliosis.
Method: A total of 63 adolescents were studied; 38 with adolescent idiopathic scoliosis and 25 age matched control subjects. We divided the patients into stable (28 patients) and progressive (10 patients) groups based on the scoliotic curve measured radiographically at three to six month intervals. The level of melatonin was considered low if it fell below the mean – 2.0 standard deviation established in normal adolescents throughout the 24 hour period or nocturnal (0:00 –6:00 hour) integrated concentration. Oral melatonin replacement (3mg / before bedding) was administered in patients with decreased endogenous melatonin. The patients with low melatonin were treated with a brace, melatonin or both combined. During melatonin treatment, the level of melatonin was measured yearly for a period ranging from three to six years.
Results: In all subjects the melatonin levels showed diurnal variations; low during the day and high at night. Of 38 patients with adolescent idiopathic scoliosis, 22 patients had normal melatonin and 16 had low melatonin. Of 22 patients with a normal melatonin, 10 of 15 treated with brace and 6 of 7 untreated patients had stable scoliosis, and the remaining six had a progressive scoliosis. Of 16 patients with low melatonin, eight of nine treated only with melatonin, and four of seven treated with melatonin and brace had stable scoliosis. The remaining four had a progressive course. Of the 10 patients who had progressive scoliosis in normal and low levels of melatonin, nine had greater than 40 degrees of curve at the initial examination.
Conclusion: These findings suggest that transient melatonin deficiency may be associated with deterioration of scoliosis and that melatonin level may serve as a useful predictor for progression of spine curvature in patients with idiopathic scoliosis. Also, the results of this study suggest a possible role of melatonin supplement in the prevention of progressive scoliosis especially in mild cases showing less than a 40° curve.
http://www.bjjprocs.boneandjoint.org.uk/content/90-B/SUPP_III/430.4.abstract

Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear

Joaquin A. Barrios^1,*,  Robert J. Butler², Jeremy R. Crenshaw³,  Todd D. Royer⁴, Irene S. Davis⁵

^{Journal of Orthopaedic Research}

Abstract

The use of lateral foot wedging in the management of medial knee osteoarthritis is under scrutiny. Interestingly, there have been minimal efforts to evaluate biomechanical effectiveness with long-term use. Therefore, we aimed to evaluate dynamic knee loading (assessed using the knee adduction moment) and other secondary gait parameters in patients with medial knee osteoarthritis wearing lateral foot wedging at a baseline visit and after 1 year of wear. Three-dimensional gait data were captured in an intervention group of 19 patients with symptomatic medial knee osteoarthritis wearing their prescribed laterally wedged foot orthoses at 0 and 12 months. Wedge amounts were prescribed based on symptom response to a step-down test. A control group of 19 patients wearing prescribed neutral orthoses were also captured at 0 and 12 months. The gait of the intervention group wearing neutral orthoses was additionally captured. Walking speed and shoes were controlled. Analyses of variance were conducted to examine for group-by-time (between the groups in their prescribed orthoses) and condition-by-time (within the intervention group) interactions, main effects, and simple effects. We observed increased knee adduction moments and frontal plane motion over time in the control group but not the intervention group. Further, within the intervention group, the mechanical effectiveness of the lateral wedging did not decrease. In patients with medial knee osteoarthritis, the effects of lateral foot wedging on pathomechanics associated with medial knee osteoarthritis were favorable and sustained over time. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

Source: http://onlinelibrary.wiley.com/doi/10.1002/jor.22252/abstract;jsessionid=11D6D0EC8BA3D2DC260591269F806918.d01t03?systemMessage=Wiley+Online+Library+will+be+disrupted+on+27+October+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage=

The Effects of Wedged Footwear on Lower Limb Frontal-Plane Biomechanics During Running

Lewinson, Ryan T. BSc; Fukuchi, Claudiane A. BSc, PT; Worobets, Jay T. PhD; Stefanyshyn, Darren J. PhD, PEng

Clinical Journal of Sport Medicine:

POST AUTHOR CORRECTIONS, 25 October 2012

doi: 10.1097/JSM.0b013e31826b7c83

Original Research: PDF Only

Objective: Patellofemoral pain syndrome (PFPS), the most common running injury, has been associated with increased internal knee abduction angular impulses (KAAI). Wedged footwear can reduce these impulses during walking, but their effects during running are not well understood. The purpose of this study was to identify the effects of wedged footwear on KAAIs and describe the mechanism by which wedged footwear alters KAAIs during running.

Design: Controlled Laboratory Study.

Setting: Motion analysis laboratory.

Participants: Nine healthy male subjects.

Interventions: Participants ran at a speed of 4 m/s with 7 different footwear conditions (3-, 6-, and 9-mm lateral wedges; 3-, 6-, and 9-mm medial wedges; neutral).

Main Outcome Measures: Knee abduction angular impulses and 8 predictor variables were measured and compared by 1-way repeated-measures analysis of variance ([alpha] = 0.05) with Bonferroni-adjusted 2-tailed paired t tests for post hoc analysis ([alpha] = 0.002). Correlation ([alpha] = 0.05) was used to determine the relationship between the mediolateral center-of-pressure to ankle joint center (COP-AJC) lever arm length and KAAIs.

Results: Laterally wedged conditions produced significantly lower KAAIs (P = 0.001) than medial wedge conditions. Peak knee abduction moments decreased (P = 0.001), whereas ankle inversion moments (P = 0.041) and the COP-AJC lever arms increased (P < 0.001) as wedges progressed from medial to lateral. KAAIs were negatively correlated with COP-AJC lever arm length (r = -0.50, P < 0.001).

Conclusions: KAAIs are reduced with laterally wedged footwear because of lateral shifts in the center-of-pressure beneath the foot, which then increases ankle inversion moments and decreases peak knee abduction moments. Laterally wedged footwear may therefore offer greater relief to runners with PFPS than medially wedged footwear by reducing KAAIs.

Source: http://journals.lww.com/cjsportsmed/Abstract/publishahead/The_Effects_of_Wedged_Footwear_on_Lower_Limb.99855.aspx

Cheaper prosthetic finger prototype could be a blessing to many

10,000 miles will not stop Richard Van As of South Africa and Ivan Owen of Washington State from building an inexpensive prosthetic finger prototype that could one day help millions of amputees. Richard lost his arm last year in an accident. In spite of his condition, he did not lose hope and decided to search for prosthetics online that could help him. After a seemingly futile search, he eventually found one of Ivan's mechanical hand prop videos on YouTube.

Ivan, who has a keen interest in mechanical systems, started working on his prop as a personal project. Richard immediately sent Ivan an email and since then, both men have been trying to build a mechanical digit that could replace what finger amputees lost. Richard created a plastic replica of his hand for Ivan to use as a reference. Ivan went on to work on a prosthetic finger made up of a lever arm, a fingertip  a set of pulleys, and a grip pad. The current prototype that Richard is now using acts like a glove and is held by a hand mount.

Unlike other high-tech prosthetic fingers in the market, Richard and Ivan claims that their prototype is cheaper and is easier to build. Richard and Ivan will be giving away the design for free so that other people will also benefit from their work. You can check out the project here. "My vision for the future will be to take this knowledge and carry it as far and as fast as possible. Get the design and parts out there to as many people as possible so that we can do as much as we can to help fill this need," said Ivan Owen.

Source: http://www.ubergizmo.com/2012/10/cheaper-prosthetic-finger-prototype-could-be-a-blessing-to-many/