The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study

Recently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis (AIS) patients. Previously, a Cochrane review suggested also producing studies according to the Scoliosis Research Society (SRS) criteria on the effectiveness of bracing for AIS.

Even if the SRS criteria propose a prospective design, until now only one out of 6 published studies was prospective. Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria for AIS conservative treatment. 

Methods: Study design/setting: prospective cohort study nested in a clinical database of all outpatients of a clinic specialized in scoliosis conservative treatment.Patient sample: seventy-three patients (60 females), age 12 years 10 months +/-17 months, 34.4+/-4.4 Cobb degrees, who satisfied SRS criteria were included out of 3,883 patients at first evaluation.Outcome measures: Cobb angle at the end of treatment according to SRS criteria : (unchanged; worsened 6[degree sign] or more, over 45[degree sign] and surgically treated, and rate of improvement of 6[degree sign] or more).Braces were prescribed for 18-23 hours/day according to curves magnitude and actual international guidelines.

Weaning was gradual after Risser 3. All patients performed exercises and were managed according to SOSORT criteria.

Results in all patients were analyzed according to intent-to-treat at the end of the treatment. Funding and Conflict of Interest: no. 

Results: Overall 46 patients (49.3%) improved.

Seven patients (9.6%) worsened, of which 1 patient progressed beyond 45[degree sign] and was fused. Referred compliance was assessed during a mean period of 3 years 4 months+/-20 months; the median adherence was 99.1% (range 22.2-109.2%).

Employing intent-to-treat analysis, there were failures in 11 patients (15.1%). At start, these patients had statistically significant low BMI and kyphosis, high thoracic rotation and higher Cobb angles.

Drop-outs showed reduced compliance and years of treatment; their average scoliosis at discontinuation was low: 22.7[degree sign] (range 16-35[degree sign]) at Risser 1.3 +/- 1. 

Conclusions: Bracing in patients with AIS who satisfy SRS criteria is effective. Combining bracing with exercise according to SOSORT criteria shows better results than the current literature.

Author: Stefano NegriniSabrina DonzelliMonia LusiniSalvatore MinnellaFabio Zaina
Credits/Source: BMC Musculoskeletal Disorders 2014, 15:263

http://7thspace.com/headlines/478452/the_effectiveness_of_combined_bracing_and_exercise_in_adolescent_idiopathic_scoliosis_based_on_srs_and_sosort_criteria_a_prospective_study.html

--

Jonathan

BAPO Bulletin September 2014

 

 

BAPO Bulletin September 2014

 BAPO Short Courses

 

Spaces available - book quickly to avoid disappointment

 

Paediatric Gait Analysis and Orthotic Management: A Segmental Kinematic Approach - Elaine Owen MSc SRP MCSP
16^th-17^th October, 2014, Venue- Mercure Goldthorn Hotel, Wolverhampton

The course explores a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders. The biomechanics of normal gait and standing, and the pathological gaits of disabling conditions will be extensively reviewed, with particular reference to orthotic management. Pre-gait analysis and orthotic management assessment will be demonstrated. The emphasis of patient cases will focus on cerebral palsy, myelomeningocoele and other neurological conditions. Participants will gain a knowledge of the aims of orthotic management and how to achieve them through: the biomechanics of ankle-foot orthoses, the influence of footwear, varieties of ‘AFO Footwear Combination’ design, tuning ‘AFO Footwear Combinations’ to optimise gait and extensive video examples.

 

Orthotic treatment of Neurological Conditions
Friday 14^th November, 2014, Venue- Peacocks Medical, Newcastle

Developed to support clinicians to consolidate and update their clinical knowledge with neurological conditions, this one day course is aimed at level 5/6 clinicians.  This course gives an intensive overview of orthotic treatment interventions and principles for a wide range of neurological conditions.  Common interventions to compliment orthotic treatment will be discussed along with the role of specialise orthotic skills such as FES.

World Obesity Survey 

This survey developed by the International Association for the Study of Obesity (Now World Obesity Clinical Care) aims to build a better understanding of how obesity is currently managed and to identify educational and other priorities to improve outcomes for people who are overweight or obese.  It takes 5-10 minutes to complete and is a good opportunity to raise awareness of the contribution of AHPs.  Please encourage relevant members to contribute.

http://staging.n24i.com/novosurvey/index.cfm?UnqRef=3CBCB2FF-C9E6-40B2-BCE7-F7DB51DD655D

Regional Meetings

BAPO have recently hosted some regional meetings in the North East of England on the 29th July and Scotland on the 12th August. Read the reports in the upcoming BAPOmag for more details. These are the first in a series of meetings, with plans for meetings in the south of England and Wales. Please look out for more details and how to get involved.

 

Allied Health Professionals Survey

Following the success of Making Every Contact Count (MECC) initiative in supporting people to lead healthier lives in NHS settings, the Royal Society for Public Health is working in partnership with Public Health England to explore the potential for Allied Health Professionals (AHPs) to engage in “healthy conversations” with their clients in order to improve the health and wellbeing of their patients and clients.

In collaboration with Allied Health Professional Bodies, we are keen to hear from AHPs to better understand the extent to which professionals already engage in healthy conversations with their patients or clients and some of the challenges they might face.

We would really appreciate it if you could spare five minutes to complete a short survey to help direct our research.

www.surveymonkey.com/s/AHPSurvey2014 

 Professional Indemnity

As you may be aware the government have now introduced legislation that
requires all HCPC registrants, apart from social workers in England, to
hold appropriate professional indemnity cover as a condition of
registration with the HCPC.

This will not affect the majority of registrants as they will already be
indemnified either through their employer, BAPO Indemnity Insurance, directly
with an insurer or a combination of these. It is, however important that
each HCPC registrant has the appropriate level of cover for their practice.

HCPC have published guidance for registrants, -Professional indemnity and your registration, which is available on their website here:

http://www.hcpc-uk.org/assets/documents/10004776Professionalindemnityandyourregistration.pdf

HCPC have also put together some Frequently Asked Questions which are
available here: http://www.hcpc-uk.org/registrants/indemnity/

 

Fundamental standards: improving quality and transparency in care

The government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, they will become law in April 2015.

The new measures are being introduced as part of the government’s response to the Francis Inquiry’s recommendations and are intended to help improve the quality of care and transparency of providers by insuring that those responsible for poor care can be held to account.

https://www.gov.uk/government/news/fundamental-standards-improving-quality-and-transparency-in-care

HCPC CPD audit process webinars

The HCPC will be running free CPD audit process webinars on Thursday 25

September 2014.

This online event will focus on the Health and Care Professions Council's
audit process and how this links to your HCPC registration and CPD and will
provide detailed information on how to put your CPD profile together

The presentation will last around 40 minutes, followed by the opportunity
to ask representatives from the HCPC questions about the audit (via the
webinar portal).

We will be running two sessions on 25 September 2014:

1pm - 2.30pm
4pm - 5.30pm

If you would like to register for these events, please click here

Further details about the webinar, including the link to join on the
day and how to send in questions, will be sent to those registered 1 week
before the event.

You can find further details on CPD and registration on our webpage -
http://www.hcpc-uk.org/registrants/renew/

BAPO Conference & Exhibition 2015 - Call for Papers

HSE West - Orthotist vacancies Ireland

For full details of this job advert please click here

Halo Medical - Experienced Orthotists

For full details of this job advert please click here

Lancashire Teaching Hospitals - Senior Prosthetist & Senior Orthotist Positions

For further information regarding the latest vacancies please follow the link below.

Lancashire Teaching Hospitals Vancancy

Orthotic Treatment of Neurological Conditions

This event aims to:

Review orthotic principles of managing different types of neurological conditions

Provide up to date knowledge on orthotic prescription and interventions available to complement orthotic treatment.

For further information on the BAPO short course please follow the link below:

Orthotic Treatment of Neurological Conditions

Guidance Framework for personalised care and population health

Resource to support nurses, midwives, health visitors and AHPs to access best evidence for practice and deliver their public health role.

Guidance can be found here:

https://www.gov.uk/government/publications/framework-for-personalised-care-and-population-health

The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review

Maryam Maleki, Mokhtar Arazpour, Mahmoud Joghtaei, Stephen W Hutchins, Atefeh Aboutorabi, Ali Pouyan

Background: Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented.

Objectives: The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients.

Study design: Literature review

Methods: According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria.

Results: The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee.

Conclusion: Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis.

Clinical relevance Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis.

Source: http://poi.sagepub.com/content/early/2014/08/23/0309364614547411.abstract

Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness

H.E. Ploeger, S.A. Bus, M.A. Brehm, F. Nollet

Abstract

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group.

Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6-minute walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires.

Compared with shoes-only, walking with DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p  < 0.05). Furthermore, walking energy cost was lower (-7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were significantly more satisfied, felt safer and less exhausted with the DR-AFO, compared to shoes-only (p  < 0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO.

In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.

Source: http://www.sciencedirect.com/science/article/pii/S0966636214005487

BAPO Conference & Exhibition 2015 - Save the date

Ottobock, Prosthetist x 2, Cleveland

For full details of job advert click here

Buchanan Orthotics, Orthotist, Glasgow

Click here to view job advertisement

Personalized Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot

Maria Luz González Fernández, Rosario Morales Lozano, Carmen Martínez Rincón, and David MartínezHernández

Background: We sought to assess the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and to determine reulceration rates before and after personalized conservative orthotic treatment.

Methods: A longitudinal prospective study was performed in 35 patients with Charcot's foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph. Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first-ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received.

Results: In a 1-year period, 70 feet received orthotic treatment, of which 41 were Charcot's feet. Ulceration rates before the study were 73.2% in feet with Charcot's and 31.0% in those without. After 1 year of wearing the customized orthoses, rates fell significantly to 9.8% in the Charcot feet and 0% in the feet without this condition.

Conclusions: Conservative customized orthotic treatment was effective at preventing ulcers and the complications that often lead these patients to surgery.

Source: http://www.japmaonline.org/doi/abs/10.7547/0003-0538-104.4.375

Paediatric Gait Analysis and Orthotic Management

This course explores a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders.

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

Paediatric Gait Analysis

Ottobock - Orthotist - Portsmouth

Click here to view the job advertisement. 

The Subtalar Joint Axis Palpation Technique Part 2: Reliability and Validity Results Using Cadaver Feet

Ken K. Van Alsenoy, Kristiaan D'Août, PhD, Evie E. Vereecke, Joris De Schepper, and Derek Santos

Background: Clinically locating the point of no rotation to determine the subtalar joint axis location by applying pressure on the plantar surface of the foot was described by Kirby in 1987 but was never validated. We sought to extend a previously validated mechanical model to cadaver feet and to examine the intratester and intertester reliability.

Methods: Four testers with different levels of experience determined the subtalar joint axis location and moved the subtalar joint through its range of motion, capturing the movement using kinematic analysis. The comparison of the spatial subtalar joint axis location as determined by palpation between and within testers determined the intertester and intratester reliability. The helical axis method was performed to validate the model.

Results: The intrarater reliability varied from a high of α = 0.96 to a low of α = 0.26 for the slope and was, in general, high (α = 0.78–0.95) for the intersection. The interrater reliability scored moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method.

Conclusions: The palpation technique as part of the subtalar joint axis location and rotational equilibrium theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence-based practice, this technique could be a standard tool in the examination of patients with lower-limb–related pathologic disorders.

Source: http://www.japmaonline.org/doi/abs/10.7547/0003-0538-104.4.365

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Hampshire Hospitals NHS Foundation Trust - Orthotist

For full details of vacancy please click here

Buchanan Orthotics - Orthotist Vacancy

For full advert details please click here 

#hellomynameis

As a healthcare professional you know so much about your patient. You know their name, their personal details, their health conditions, who they live with and much more. What do we as patients know about our healthcare professionals? The answer is often absolutely nothing, sometimes it seems not even their names. The balance of power is very one-sided in favour of the healthcare professional.

Getting to know people's names is part of building good working relationships with both patients and other colleagues. It is the first rung on the ladder to providing compassionate care and often getting the simple things right, means the more complex things will follow more easily and naturally.

Dr Kate Granger created the #hellomynameis campaign. If you support this idea please download a #hellomynameis name card from the BAPO website, add your name and send in a photograph of yourself toenquiries@bapo.comor post to the Secretariat. BAPO would like to create a collage of images that will be put onto YouTube to promote this campaign and our profession.

Please share with your fellow Prosthetists and Orthotists to see how many pledges we can get!

Orthotist Name Tag

Prosthetist Name Tag

Student Name Tag

OARSI guidelines for the non-surgical management of knee osteoarthritis

OARSI have published new guidelines for the non-surgical management of kneeosteoarthritis.  They recommend use of biomechanical interventions as directedby an appropriate specialist.
Full guidance can be downloaded here:
http://www.oarsi.org/sites/default/files/docs/2014/non_surgical_treatment_of_knee_oa_march_2014.pdf

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Dorset Orthopaedic - Orthotist - Hampshire

Click here to view Job Advert.

BAPO Bulletin July 2014

BAPO Bulletin July 2014

Outcome Measures
BAPO is doing some work on outcome measures. If you haven’t filled in the survey yet now is your chance, we need as many P&O professionals as possible to fill it in so please pass it on to those who may not be BAPO members. http://survey.bapo-online.com/index.php/944889/lang-en

Professional Indemnity
The government have now introduced the legislation requiring all AHP’s to have professional indemnity insurance. This will not affect the majority of registrants as they will already be indemnified either through their employer, BAPO Indemnity Insurance, directly with an insurer or a combination of these. It is, however, important that each HCPC registrant has the appropriate level of cover for their practice.

HCPC have published guidance for registrants, -Professional indemnity and your registration, which is available on their website here: http://www.hcpc-uk.org/assets/documents/10004776Professionalindemnityandyourregistration.pdf

HCPC have also put together some Frequently Asked Questions which are
available here: http://www.hcpc-uk.org/registrants/indemnity/

AHP Research Network
BAPO are part of the AHP research network and as such our profession can access and involve themselves in their activities. For those considering or already involved in research, the following may be of interest:
Clinical Academic Careers Capability Framework – May 2014
www.aukuh.org.uk/index.php/affiliate-groups/20-nmahps/128-clinical-academic-careers-pathway-capability-framework

Chief Allied Health Professions Officer Appointed
NHS England has announced the appointment of Suzanne Rastrick as Chief Allied Health Professions Officer. She will work alongside colleagues both within and outside of NHS England, as the Senior Adviser to the Department of Health on AHP matters, as well as representing England’s health professionals on the international stage

 

An Open NHS Culture
Sir Robert Francis is currently leading a review to drive up safety standards in the NHS and to protect staff who speak out in the public interest in order to create an open culture needed to ensure safe care for patients.

The link below gives more detail about this campaign and the new data which is available to the public regarding safety in hospitals. http://www.gov.uk/government/news/nhs-rated-on-open-and-honest-reporting-culture-in-world-leading-transparency-drive

The government has also produced some fundamental standards of care in response to this review which can be seen on the link below: https://www.gov.uk/government/news/fundamental-standards-improving-quality-and-transparency-in-care

 

 

Keep an eye on your inbox for more information on regional meetings and short courses. Coming soon!!!

BAPO Secretariat

Please note that the BAPO Secretariat will be closed for the holiday weekend from 5pm on Thursday 17 July and will re-open on Tuesday 22 July at 8.45am 

Heart of England NHS Foundation Trust - Clinical Specialist Orthotist

For job advert details please click here

Improving the design of the curved rocker shoe for people with diabetes

Jonathan D Chapman

PhD Thesis 2014

AbstractIntroductionFoot ulceration and re-ulceration are a serious problem in people with diabetes as the outcome can be lower limb amputation, reducing quality of life and increasing mortality. The pathogenesis of foot ulceration is multifactorial with neuropathy, alterations in foot structure, callus formation and increased plantar foot pressure. The most effective intervention for reducing plantar pressure is the curved rocker outsole. To date this design has been prescribed from clinical intuition rather than scientific evidence. Therefore the studies within this thesis aimed to improve our understanding of how to best to design, and also prescribe, a rocker sole.
MethodsEthical approval was obtained from the University of Salford and the NHS. Study 1 investigated the independent effect of varying the three outsole design features (apex angle, apex position and rocker angle) on plantar pressure in 24 people with diabetes and healthy participants. In-shoe pressure data was collected using Pedar-x and analysed using Matlab. Study 2 investigated the effect of varying apex position in combination with rocker angle, in 87 people with diabetes, and aimed to establish how many people would receive sufficient offloading when wearing a pre-defined rocker design. Study 3 investigated a new method of prescribing a rocker sole using artificial neural networks with an input of gait variables on 78 people with diabetes. Gait data was collected using Vicon and analysed using Visual-3D and Matlab.
ResultsThe results of Study 1 suggested that fixing apex angle at 95° would be a suitable compromise to offload the high risk areas (medial forefoot). It also suggested that apex position and rocker angle needed more investigation. Therefore, in Study 2 the combined effect of two rocker angles and four apex positions were investigated. Despite some inter- subject variability, this study showed that over 60% of participants received sufficient offloading when walking in a mean optimal design. Furthermore, over 60% of people received sufficient offloading with the smaller rocker angle of 15°. The results in Study 3showed there was low accuracy when predicting an individual optimal shoe using gait variables as inputs (34-49%).
ConclusionsThis project has shown it is possible to significantly reduce plantar pressures in people with diabetes with a well-designed rocker shoe (95° apex angle, individual apex position and 15° rocker angle). This finding paves the way for future clinical trials which could provide robust clinical evidence for the use of rocker shoes.
Source: http://usir.salford.ac.uk/31862/1/PhD_Thesis_Jonathan_D_Chapman_2014.pdf

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ProActive Prosthetic Job Advertisement - Prosthetist, Surrey

For further information on the current vacancy please click on the link below:

ProActive Prosthetic - Prosthetist, Surrey

Club Foot Appeal

Algeos are looking for your help to support a fantastic charity called the http://www.infantclubfootappeal.org

Algeos have helped the charity set up a fully functional O&P workshop which will enable the team to produce suitable O&P devices.

 

Our container of products leaves Liverpool for Zanzibar on Monday 28^th July. If anyone would like to make any generous donations we are in need of the following items.

Your help and support would be really appreciated and the people of Tanzania would be eternally grateful.

 

·         Paediatric & adult shoes / boots to treat clubfoot

·         Paediatric & adult insoles to treat clubfoot

·         Paediatric & adult shoes

·         Paediatric & adult insoles

·         Paediatric & adult AFO's

·         Nimco or similar style

·         Scoliosis brace

·         Foot supports

·         Leg braces

·         Skull guards

Please contact Algeos directly if you can help provide some of these items. Many thanks in advance, your support is very much appreciated and your generosity will make a huge difference.

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Blatchford - Orthotist - South West

Click here to view the job advertisement.

Ottobock - Prosthetist Vacancy

Click here to view vacancy

Blatchford - Orthotist - Carlisle

Click here to view the Job Advertisement.

The immediate effects of fitting and tuning solid ankle–foot orthoses in early stroke rehabilitation

Bruce Carse, Roy Bowers, Barry C Meadows, Philip Rowe

Abstract

Background: Ankle-foot orthoses are known to have a generally positive effect on gait in stroke, however the specifc type of AFO and the time point at which it is provided are highly variable in the currently available literature.

Objective: The objective was to determine the immediate spatiotemporal and kinematic effect of custom-made solid ankle–foot orthoses in early stroke rehabilitation, compared to shod walking.

Methods: Five male and three female participants were recruited to the study (n = 8), with a mean age of 57 (16) years who were 3.5 (3) weeks post-stroke. Each received a custom-made solid ankle–foot orthosis to a predefined set of design criteria and tuned using heel wedges to control the shank inclination angle during shod walking. Repeated spatiotemporal and three-dimensional gait measures were taken pre- and immediately post-intervention.

Study design: A pre–post-test experimental study.

Results: With the solid ankle–foot orthosis, walking velocity increased from 0.22 (0.2) to 0.36 (0.3) m/s (p < 0.05), overall average step length increased from 0.28 (0.1) to 0.37 (0.1) m (p < 0.05), cadence increased from 45 (19) to 56 (19) steps/min (p < 0.05) and step length symmetry ratio increased from 0.65 (0.2) to 0.74 (0.2) (not significant). No clear changes were observed in the joint kinematics of the hip and knee.

Conclusion: In our small group of early stroke patients who were fitted with a solid ankle–foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only.

Clinical relevance This study provides evidence about the immediate effects of custom solid ankle–foot orthoses on gait of early stroke survivors. Ankle–foot orthosis design specifications are fully described for replication. This study suggests that observing global segment orientation may be more useful than joint angles when fitting and tuning ankle–foot orthoses for optimal ankle–foot orthosis/footwear alignment.

Source: http://poi.sagepub.com/content/early/2014/06/16/0309364614538090.abstract

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Ottobock - Prosthetist (Maternity Cover) - Stoke on Trent

Click here to view the Job Advertisement. 

Dorset Orthopaedic - Experienced Prosthetist, Hampshire

Click here to view job advert details

Optimising the effects of rigid ankle foot orthoses on the gait of children with cerebral palsy (CP) – an exploratory trial

Kavi C. Jagadamma, kjagadamma@qmu.ac.uk Fiona J. Coutts, Thomas H. Mercer, Janet Herman, Jacqueline Yirrell, Lyndsay Forbes, and Marietta L. van der Linden

Disability and Rehabilitation: Assistive Technology

Vol. 0: 1-7

DOI: 10.3109/17483107.2014.908244

Abstract

Purpose: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO – Footwear Combination (AFO-FC) further affected gait. Methods: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions – barefoot, non-tuned AFO-FC and tuned AFO-FC. Results: In comparison to barefoot gait, walking with a non-tuned AFO-FC produced significant (p < 0.05) improvements in several key gait parameters. Compared to the non-tuned AFO-FC, on average a tuned AFO-FC produced a significant reduction in peak knee extension and knee ROM during gait. However, when examined as case studies, it was observed that the type of gait pattern demonstrated while wearing a non-tuned AFO-FC affected the outcomes of tuning. Conclusions: The findings of the current study indicate the potential benefits of using rigid AFO-FC with optimal AAAFO and tuning of AFO-FCs. This study emphasises the need for categorising children with CP based on their gait patterns when investigating the effects of interventions such as AFOs.Implications for Rehabilitation

	Rigid ankle foot orthoses (AFO) cast at an optimal angle to accommodate the length of gastrocnemius muscle may positively influence walking in children with Cerebral Palsy (CP).
	Tuning of the AFO-Footwear Combination (AFO-FC) has potential benefits to the walking of children with CP, depending on their gait abnormalities.
	When investigating the effects of interventions such as AFOs, it is important to categorise children with CP based on their gait abnormalities.

Keywords: AFO , ankle foot orthosis , cerebral palsy , gait , tuning

http://informahealthcare.com/doi/abs/10.3109/17483107.2014.908244

Foot drop in MS: Experiences of using functional electrical stimulation (FES) or orthotic devices

Summary

Foot drop is a symptom experienced by some people with multiple sclerosis. It is caused by a disruption in the nerve pathway to and from the brain, which results in an inability to lift the foot and toes properly when walking. To improve walking and reduce the risk of trips or falls, foot drop can be treated using two types of device. Functional electrical stimulation (FES) uses small electrical charges to force the foot into a more natural position for walking. An ankle-foot orthoses (AFO) is a device made of plastic or carbon fibre that holds the foot and ankle in a correct position during walking.

This study aimed to explore the experiences and satisfaction with FES and AFO in people with MS who had foot drop.

10 participants took part in the study and were split into two groups, the first group was made up of people using FES (six participants) and the second used AFO (four participants). The groups were questioned and encouraged to discuss their experiences of using the devices.

A similar number of positive and negative aspects were described for FES and AFO. In both groups the participants said that their device had reduced their fatigue, improved their gait (the pattern of walking), reduced trips and falls and increased their confidence. The negative aspects mentioned by both groups included the implications for shoes and clothing, for example users had found it difficult to concealtheir device under their clothes for social occasions.

In conclusion both groups considered that the benefits to them from wearing the device were more important and outweighed any problems.

This study highlights the importance of a health professional taking the individual's experiences and preferences into account, when selecting and prescribing a device to manage foot drop.

Source: http://www.mstrust.org.uk/research/updates/articles/update140520.jsp?utm_medium=email&utm_source=MS+Trust&utm_campaign=4174715_Research+update+140520+AGAIN&dm_i=157R,2HH8B,EDBPM9,91P2X,1#item01

Bulley C, Mercer TH, Hooper JE , et al.
Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis..
Disabil Rehabil Assist Technol. 2014 May 6. [Epub ahead of print]
abstract

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Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

Jan S. Ulbrecht, Timothy Hurley, David T. Mauger and Peter R. Cavanagh

Abstract

OBJECTIVE To assess the efficacy of in-shoe orthoses designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration.

RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion), or to study termination. Proportional hazards regression was used for analysis.

RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study.

CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses but they did not significantly reduce nonulcerative lesions.

Source: http://care.diabetesjournals.org/content/early/2014/04/18/dc13-2956.abstract

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

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

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

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

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

Helen A Banwell, Shylie Mackintosh and Dominic Thewlis

Abstract

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

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

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

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

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

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

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

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

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

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

flexible pes planus.

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

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

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

ABSTRACT

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

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

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