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.
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.
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.
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.
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.
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.
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.
Traditionally, amputees have been offered one-size-fits-all prosthetics – functional but not particularly attractive. Now technology is blurring the line between medical devices and sculpture.
J Antonio Bernabeu, M Germani, M Mandolini… - Computer-Aided Design, 2013
... 2.3. Orienting and measuring the foot and the last. The InfoHorma (IH) software aims to extract standard measurements from the geometrical shapes of digitised 3D feet or last models after they have been aligned. ... 2.4. Modifying last geometry to ensure optimal foot–last fitting. ...
NHS services across the country are set to benefit from additional funding to improve prosthetic and rehabilitation services for ex-servicemen and women.
The government is making £11 million available over the next 2 years to ensure veterans are able to access a high level of prosthetic and rehabilitation care.
Nine NHS facilities across the country will receive a share of up to £6.7 million of the funding. They will be able to use this specifically to access the latest technology and provide the highest quality of prosthetic care for veteran amputees. The centres are:
Bristol: Disablement Services Centre, North Bristol NHS Trust
Leicester: Leicester Specialist Mobility Centre, provided by Blatchford Clinical Services on behalf of PCTs
Sheffield: Mobility and Specialised Rehabilitation Centre, Northern General Hospital
Carlisle: Disablement Services Centre, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust
Preston: Specialist Mobility & Rehabilitation Centre, Lancashire Teaching Hospitals NHS Foundation Trust
Stanmore: Stanmore Prosthetic Rehabilitation Unit, Royal National Orthopaedic Hospital Trust
Birmingham: West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust
Cambridge: Addenbrooke's Rehabilitation Clinic, Cambridge University Hospitals NHS Foundation Trust
Other services will benefit too, with a £1million fund to ensure that all prosthetics services across England improve. The remainder will go towards providing prosthetics.
Announcing the funding, Health Minister Dr Dan Poulter said:
"Ex-servicemen and women who have been injured in the line of duty deserve the very best possible care from the NHS. This is why we are making more funding available to improve veterans' prosthetic limb services – and £22 million in total between 2010 and 2015 to support veterans' physical and mental health.
"We want to ensure that our Armed Forces veterans have access to the very best healthcare services at specialist prosthetic and rehabilitation centres across the country. In time, these NHS centres will achieve the same high standards of care for veterans that are offered by Armed Forces rehabilitation centres, such as Headley Court."
Today's announcement is in response to recommendations made by Dr Andrew Murrison MP in a report, commissioned by the Prime Minister, about the provision of prosthetics for military amputees.
Dr Murrison recommended that a small number of multi-disciplinary centres should provide specialist prosthetic and rehabilitation services in England to ensure veterans have access to a similar, high quality of care to that which the Armed Forces provides.
Dr Jeff Lindsay, a Consultant in Amputee Rehabilitation at the West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust, said:
"Our aim is for ex-service men and women to maintain their level of independence, function and capabilities as they move from the military into civilian life.
"The additional funding will enable us to offer the highest possible standards of prosthetic provision and care for these brave men and women, as they leave the armed forces and their care is transferred to the NHS.
"Furthermore, the additional funding will help to enhance both the knowledge and skills of our expert staff and improve available facilities for the benefit all patients, both ex-servicemen and women and civilians alike."
The additional funding and improvements that this will bring will mean that civilian amputees will also be able to benefit from advanced care in centres across the NHS in England.
The NHS Commissioning Board will work with military charities and the NHS to finalise the amount each service will receive.
Due to technical difficulties please use the link below for further information on the 'Clinical Responsibility and the Healthcare Professional' BAPO short course.
Download the new NHSAcronym app to your iPhone or iPad so you have the definition of over 500 commonly used acronyms in the NHS at your fingertips. Just search 'NHSAcronym' in the iTunes app store.
The Stroke Association organises the Life After Stroke Awards to recognise the courage and determination of those people whose lives have been affected by stroke. The 2013 Life After Stroke Awards will be held on 26 June at The Dorchester, London.
This year sees the introduction of a new category – The Professional Excellence Award – you may like to nominate a colleague who has provided exceptional service in the provision of stroke care or prevention.
Nominations for the Life After Stroke Awards 2013 are open until 1 March 2013. Visit www.stroke.org.uk/lasato nominate now. If you would like to be sent a nomination form in the post please email lasa@stroke.org.uk.
The Stroke Association has announced that Apprentice star, Businesswoman and West Ham boss, Karren Brady, is the charity's first Life After Stroke Awards Patron. She said: "I am thrilled and delighted to be the first LASA Patron and am calling on everyone affected by stroke to nominate someone they know for these very special awards.
At the Annual General Meeting in Telford on 23 March 2013 the elections for Executive Committee members will take place.
Three members of the committee have or will stand down, namely: Nigel Jones, John Head and Suzanne Faulkner.One member wishes to stand for election, namely: Nicola Eddison.The following members will remain on the committee; Steve Mottram, Jonathan Bull, Pamela Coulton, Sandie Waddell, Ian Jones and Paul Charlton thus nominations are invited for four vacancies.
A nominee must be a fully paid up Full Member and their nomination must be proposed and seconded by two current Full Members of the Association.
Nominations should be signed by the nominee, proposer and seconder. A summary of no more than 100 words should be attached, indicating:
·who the nominee is
·what they have done for the profession
·why they wish to be elected
·and how they see the profession and the Association going in the next two years
This should be addressed to the Secretary at the BAPO Secretariat to arrive by Friday 8 February 2013 (extended deadline date).It would be appreciated if nominations could be sent in as soon as possible.
Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery
J. Dawson, I. Boller, H. Doll, G. Lavis, R. Sharp, P. Cooke, and C. Jenkinson J Bone Joint Surg Br 2012;94-B 215-221
Quote: The responsiveness of the Manchester–Oxford Foot Questionnaire (MOXFQ) was compared with foot/ankle-specific and generic outcome measures used to assess all surgery of the foot and ankle. We recruited 671 consecutive adult patients awaiting foot or ankle surgery, of whom 427 (63.6%) were female, with a mean age of 52.8 years (18 to 89). They independently completed the MOXFQ, Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires pre-operatively and at a mean of nine months (3.8 to 14.4) post-operatively. Foot/ankle surgeons assessed American Orthopaedic Foot and Ankle Society (AOFAS) scores corresponding to four foot/ankle regions. A transition item measured perceived changes in foot/ankle problems post-surgery. Of 628 eligible patients proceeding to surgery, 491 (78%) completed questionnaires and 262 (42%) received clinical assessments both pre- and post-operatively. The regions receiving surgery were: multiple/whole foot in eight (1.3%), ankle/hindfoot in 292 (46.5%), mid-foot in 21 (3.3%), hallux in 196 (31.2%), and lesser toes in 111 (17.7%). Foot/ankle-specific MOXFQ, AOFAS and EQ-5D domains produced larger effect sizes (> 0.8) than any SF-36 domains, suggesting superior responsiveness. In analyses that anchored change in scores and effect sizes to patients' responses to a transition item about their foot/ankle problems, the MOXFQ performed well. The SF-36 and EQ-5D performed poorly. Similar analyses, conducted within foot-region based sub-groups of patients, found that the responsiveness of the MOXFQ was good compared with the AOFAS.
This evidence supports the MOXFQ's suitability for assessing all foot and ankle surgery.
G. S. Murley, J. M. Tan, R. M. Edwards, J. De Luca, S. E. Munteanu, J. L. Cook
Scandinavian Journal of Medicine & Science in Sports
Abstract
The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty-one healthy participants (31 male, 30 female; aged 27.1 ± 8.8 years) underwent gray-scale musculoskeletal ultrasound examination to determine the anterior-posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat-arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait.
Approximately one in every 1,000 people in the UK is an amputee. Many lose their limbs as the result of tragic accidents or due to active military combat and for some amputees losing a limb is a loss of freedom.
Bryce Dyer (pictured) is part of a team of design engineers and clinicians studying prosthetics at BU’s Design Simulation Research Centre: “Many prosthetic limbs remain unused simply because they can be so uncomfortable over time,” he says.
Fitting a false limb is currently “a bit of a black art” says Dyer. Prosthetists traditionally require decades of experience to do their job successfully and are dependent upon the subjective feedback of patients, with no other method of measuring fit. Additionally, current technology does not allow for changes in volume – patients’ stumps may swell and contract. “It’s like having your feet change size on a daily basis and expecting your shoes to still fit comfortably,” says Dyer.
Led by Professor Siamak Noroozi, the BU team are turning an academic concept into a practical product that could lessen the misery of thousands of amputees.
They are creating a ‘smart socket’ – a lower-limb prosthetic which can adjust itself to fit the changing shape of the limb stump it connects with. The design team say the fit will be so comfortable that amputee servicemen may even be able to return to active combat.
Calling on combined expertise, BU’s School of Design, Engineering and Computing is using artificial intelligence to create a self-learning system that will measure interactions between socket and limb stump during the fitting and wear.
“It is very much at a research and development stage,” says Dyer. Currently the team are also attempting to miniaturise the technology to make it light and portable as well as incorporating wireless technology.
BU scientists have teamed with commercial partners at prosthetics and orthotics supplier Chas A Blatchford & Sons, who work with the Ministry of Defence Medical Rehabilitation Centre in Surrey, where injured soldiers are sent following service in Afghanistan and Iraq.
“One of the great things about this industrial partnership is that we will be able to get feedback from the very kind of people we are trying to help,” says Dyer.
With better fitting false limbs, medical costs will fall, say BU designers. Prosthetists will be able to get it right first time and will require less experience to be able to do their job properly. Being agile enough to return to active service is a huge bonus for the rising numbers of amputee soldiers. “It will get them back in the field rather than being retired early or restricted in what they can do,” says Dyer.
Understanding how elite sprinters perform with artificial limbs or “blades” and how different types of prostheses compare is central to another strand of Dyer’s research. “Paralympic running world records are still being set on a near annual basis – the sport hasn’t settled down yet. I’m looking at how individuals should be grouped together or separated – how to give the fairest possible race.”
As well as informing future Paralympic Committees, the research will apply to disability in sport in general. Should someone who’s lost both limbs compete against a runner missing just one limb, for example? And how should technology be categorised, when variations in quality of false limbs may create substantial differences among international athletes?
“Some 30 years ago, it was all about enabling disabled people to take part in sport,” says Dyer. “But now the quality of performances and the sums of money involved are so great, there’s much more at stake. We don’t want to restrict technology but we need to find a way to measure it.”
Ex-paratrooper Tom Neathway lost both legs and an arm in an explosion in Afghanistan but is tackling this grueling 5,000-mile race across South America.
This is the 34th edition of the race, which started in Lima on January 4 and ends in Chile on January 20.
There is the fund-raising side. Tom will be raising hopefully £1million for Help For Heroes and Tedworth House, one of the five recovery centres set up in partnership between the Ministry of Defence, Help for Heroes and the Royal British Legion.
A former pub landlord from West Yorkshire has become the first person in the UK to have a hand transplant.
Mark Cahill, who is 51, had been unable to use his right hand after it was affected by gout.
This procedure allowed very accurate restoration of nerve structures and is believed to be the first time this approach has been used, surgeons said.
Consultant plastic surgeon Professor Simon Kay, who led the surgical team, said: "This operation is the culmination of a great deal of planning and preparation over the last two years by a team including plastic surgery, transplant medicine and surgery, immunology, psychology, rehabilitation medicine, pharmacy and many other disciplines.
"The team was on standby from the end of November awaiting a suitable donor limb, and the call came just after Christmas.
Doctors say he is making good progress after an eight-hour operation at Leeds General Infirmary.
It is still very early to assess how much control of the hand will be gained - so far he can wiggle his fingers, but has no sense of touch.
