Our latest report provides standardised terminology for “therapeutic footwear” and will improve treatment for children with walking difficulties across the globe

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Our recent paper has established recognised terms, definitions, design characteristics and prescription criteria for off-the-shelf stability footwear for the first time.

Numerous terms have been used in the literature concerning clinical footwear interventions, including orthopaedic shoes, rehabilitative boots, modified shoes, supportive shoes and special shoes. There is also no standardised set of agreed outcome measures, both physical and psychosocial, to ascertain the effectiveness of this footwear.

A group of multinational professionals, from clinicians to those involved in the footwear industry, were recruited to take part in an online survey and to provide further insights through a series of open-ended questions.

“Therapeutic footwear” was the agreed term to represent children’s footwear interventions, with grouping and subgrouping of therapeutic footwear being dependent on their intended clinical outcomes: accommodative, corrective or functional. Design characteristics of off-the-shelf footwear were also grouped under three themes: stability, ergonomics and aesthetics.

This is believed to have many benefits including:

  • A common understanding of therapeutic footwear terminology to facilitate communication between clinicians, researchers and manufacturers.
  • Research-informed evidence for selection of appropriate off-the-shelf stability therapeutic footwear based on identified design characteristics.
  • Research-informed evidence for dispensing off-the-shelf stability therapeutic footwear to patients.
  • Standardised outcome measures for clinical assessment of the effectiveness of off-the-shelf stability therapeutic footwear interventions.

This study has achieved an expert consensus where none previously existed, which is important from both a manufacturing and clinical perspective. This is a huge step forward which we hope will lead to quicker, more personalised and more effective treatment for children with mobility issues.

Read the full paper published in BMJ Open – Defining and grouping children’s therapeutic footwear and criteria for their prescription: an international expert Delphi consensus study

Our latest paper provides a “step-change”!

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Our latest paper titled “A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living” published in Royal Society Open Science has attracted a substanital attention from the industry and the clinicians. 

We have developed a novel concept to assess plantar laoding using 3D-printed, tuneable structures. This will help clinicians better understand the cause of foot ulcer development in patients with diabetes and lead to improved clincal outcomes.

Dr Chatzistergos, who led the study, said: “Our work has demonstrated a method to reliably detect overloading using a low-cost non-electronic technique. We have used a 3D-printed thin-wall structure that changes its properties when repeatedly loaded above or below a tuneable threshold. We believe that this is a step change from current practice.”

https://www.eurekalert.org/pub_releases/2021-06/su-nra060921.php 

 

Our work on Scoliosis recognised at a prestigious international conference (#IRSSD2021)

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This year, Children’s Wisconsin and their academic partners, The Medical College of Wisconsin, were the hosts for the 2021 International Research Society for Spinal Disorders conference.

The Society was founded in 1992 with the tenet to integrate basic science with clinical care to benefit patients from across around the world. IRSSD conferences provide interaction between clinicians and researchers with interests in spinal biomechanics, imaging and measurement, genetics aetiopathogenesis, growth and metabolism, innovations in conservative and surgical therapies, and quality of life and functional outcomes, to mention just some of the areas of activity.

The pandemic de-railed the physical conference with just short of 200 attendees spent a fascinating, insightful, and very well run virtual event in late January. Professor Nachi Chockalingam, Dr Rob Needham, and Professor Tom Shannon presented work and opinion within a symposium entitled Gait and Posture Analysis in Scoliosis-Implications for Clinical Practice, with Dr Ram Haddas from the Texas Back Institute. After the presentations, Nachi hosted a very lively and interesting questions session.

 

 

 

 

 

Nachi, Tom and Nikola Jevtić from the Scolio Centar, Novi Sad, Serbia presented our work in Cosmetic changes in patients following a Schroth Exercise Regime: a two year follow-up. The primary objective of our longitudinal study has been to investigate the relationship between scoliosis spinal deformity measures, clinic reports, images, curve classifications, and back shape data with the goal to develop, test and validate some new cosmetic deformity metrics. Our work is starting to show encouraging results, and we were hugely honoured to be awarded one of the two poster prizes.

This exciting work continues in Serbia and Bulgaria with donated equipment now also installed in Banja Luka, Bosnia and Herzegovina to expand the research efforts in that country as well.

 

 

Visualising Coordination Patterns during human movement

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Here’s an introduction and highlights of our work

  • Proposed coordination pattern classification can offer an interpretation of the CA that provides either in-phase or anti-phase coordination information, along with an understanding of the direction of segmental rotations and the segment that is the dominant mover at each point in time.

Introduction to Vector Coding

  • The traditional approach of reporting time-series data from vector coding can be problematic when overlaying multiple trials on the same illustration.
  • The use of colour mapping and profiling techniques highlighted differences in coordination pattern and coordination variability data across several participants that questions the interpretation and relevance of reporting group data.

Coordinatiion Mapping

  • Colour mapping and profiling techniques are ideal reporting methods to compliment prospective multiple single-subject design studies and to classify commonalities and differences in patterns of coordination and patterns of control between individuals or trials.
  • The data visualisation approaches in the current study may provide further insight on overuse injuries, exercise prescription and rehabilitation interventions.
  • Our approach can have important implications in demonstrating gait coordination data in an easily comprehensible fashion by clinicians and scientists alike.

Key References

Needham, R., Naemi, R. and Chockalingam, N., 2014. Quantifying lumbar–pelvis coordination during gait using a modified vector coding technique. Journal of biomechanics47(5), pp.1020-1026. https://doi.org/10.1016/j.jbiomech.2013.12.032

Needham, R.A., Naemi, R. and Chockalingam, N., 2015. A new coordination pattern classification to assess gait kinematics when utilising a modified vector coding technique. Journal of biomechanics48(12), pp.3506-3511. https://doi.org/10.1016/j.jbiomech.2015.07.023

Needham, R.A., Naemi, R., Hamill, J. and Chockalingam, N., 2020. Analysing patterns of coordination and patterns of control using novel data visualisation techniques in vector coding. The Foot, p.101678.  https://doi.org/10.1016/j.foot.2020.101678

Our latest work shows that children with Cerebral Palsy have more energy to play and be physically active for longer!

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Our research shows that the appropriate design and tailoring of splints can reduce the energy used by children with CP while increasing their speed and distance, compared with a splint which is not fine-tuned. This is something which could have a significant impact on their quality of life.

During the study, the researchers analysed the walking pattern of children with cerebral palsy at our gait laboratory and participants were assessed while barefoot and with both non-tuned and tuned splints.

Children wearing the fine-tuned splints showed improvements in several areas including hip and pelvic function and knee extension, while a non-tuned splint potentially showed a decrease in hip function.

The full research findings, which were published in the June edition of the Foot Journal, are available below:

Postcode Lottery for NHS Orthotics Patients

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Our latest paper published in the BMJ Open highlight large variances in appointment times, waiting times, product entitlements for patients, and product lead times across various NHS trusts.

Although some geographical areas provide shorter waiting times and wider access to assistive devices, other areas have very long waiting time which means that the service, particularly to the paediatric population is meaningless.

The NHS trusts seemed to be able to answer questions that reflect quantity of service above quality of service. However, the combination of the number of Trusts who declined to reply to the FOI request and those who replied with limited information, hindered the ability of this study to collate the data received to provide a fuller national picture of the Orthotic Service provision.

Although this paper confirms that many of the issues reported in previous reports on Orthotic Service provision are still evident, the result show that there have been some improvements.

Read the full paper here: https://bmjopen.bmj.com/content/9/10/e028186

Press Release: https://www.staffs.ac.uk/news/2019/10/postcode-lottery-for-nhs-orthotics-patients

My experiences at Staffordshire University and #StaffsBiomech

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Christopher Aitkins

The decision of where to study for a master’s degree was a difficult one. There seemed to be an endless choice of institutions, with a multitude of differing delivery models. I was working as a podiatrist and an undergraduate lecturer, I had both teaching and clinical commitments which I couldn’t escape for long periods and the idea of a purely online course seemed tempting; however, deep down I knew that work and life pressures would likely mean my studies may take a back seat. The MSc Clinical Podiatric Biomechanics course seemed ideal, the teaching was blended taught sessions on a weekend, so my day job didn’t need to suffer and there was online support available. This was a bonus as I live in the North East of England and the idea of popping in for a quick tutorial wasn’t possible.

The course was delivered by excellent teaching staff, people who were not only passionate about the subjects they specialised in, but were the authors of the current literature which I had been reading to develop my own clinical practice. In all honesty I was a little star struck, when I met some of them. I was determined not ask a “stupid question”, however, every tutor made me feel at ease and provide a safe and supportive environment which meant there were no “stupid questions”. The discussions that formed were insightful and helpful, led by the tutor guiding us to through the subject. This learning experience is one I have never encountered before and is one I try to model within any teaching sessions I deliver.

The support continued throughout my time studying with Staffordshire University, all my tutors were on hand with a quick reply to an email or to arrange a time for a telephone call which, they managed to fit around my working schedule. This support never wavered even when I started my dissertation. I had excellent guidance from day one; I had opportunity to spend time discussing with my supervisor my research idea, developing my methodology and setting a realistic time frame. At my first meeting my wife was 6 months pregnant with our 1st child. My tutor helped me set a timetable and deadlines which were achievable. Without this I feel, I would have made this process almost impossible for myself and possibly not finished at all. Balancing the demands to complete a research project, write a thesis and live with a new born was challenging. But my tutor had an excellent skill to allow me the space to progress and work, but check in exactly when I needed a boost, some encouragement or just the opportunity to share where I was up to. I completed my project and received a good grade; I was so proud of my achievement through whole duration of my study and felt I had completed a well-rounded piece of research. I have to admit I was surprised when my tutor suggested that I should publish my research. I had never published in a scientific journal, “that’s the sort of thing experts do” I thought. However, as I reflected, I realised that my research was worthy of publication. I had no idea where to start, but my tutors came to my rescue again providing me with the same level of support I had before ( For people who are interested in reading our work, please follow this link).

I am so glad I chose to study with Staffordshire University and the teaching team on MSc Clinical Biomechanics course. I have not only gained a qualification, but published researched, developed a professional network that are always happy to share and discuss learning and most importantly I have developed as clinician. It has not only helped my practice and patients but the experience has allowed me to grow as a professional.

Branthwaite, H., Aitkins, C., Lindley, S. and Chockalingam, N., 2019. Surface Electromyography of the foot: a protocol for sensor placement. The Foot. https://doi.org/10.1016/j.foot.2019.07.001

 

Calling for Early career Researchers in India interested in Diabetes and Assistive Devices

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The Centre for Biomechanics and Rehabilitation Technologies at Staffordshire University, UK is looking to establish a network of like-minded early career researchers in India interested in the area of rehabilitation and/or mobility assistive devices (e.g. footwear, orthoses, prostheses, wheelchairs) for people with diabetes. The goal of this network will be to establish national collaboration between early career researchers within India and international collaboration with Indian institutions and Staffordshire University.Centre for Biomechanics and Rehabilitation Technologies

Ideally you should:

· Have a PhD related to the area of rehabilitation or mobility assistive devices for people with diabete
· Be employed at an Indian University or Research based Institution.
· Be an early career researcher who is currently within their first five years of academic or other research-related employment.
· Ideally with a good range of internationally peer reviewed journal publications.
· Below the age of 40 years.

If you are interested please email Dr. Aoife Healy (a.healy(at)staffs.ac.uk) with a short resume including a list of publications or provide a link to your ResearchGate/Google Scholar profile by Monday 22nd July 2019.

Explanatory model for diabetic foot ulcers

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First paper from the collaborative work between Dr Zulfiqarali G. Abbas and colleagues from the Muhimbili University of Health and Allied Sciences and Abbas Medical Centre in Dar es Salaam, Tanzania  and Professor Nachi Chockalingam and colleagues at Staffordshire University has just been published in the Journal of Diabetes and its Complications.

This particular work is part of a wide ranging research focusing on Diabetic foot and its complications and is led by Professor Roozbeh Naemi at Staffordshire. This research was aimed at identifying various parameters that will help explaining the presence of foot ulceration in patients with diabetes.

The work examined the biomechanical, neurological, and vascular parameters along with other demographics and life style risk factors that could explain the presence of foot ulcer in 1270 patients with diabetes. Although the data focused on patients in Tanzania, the results has  a global implication. 

The results of this study showed that the participants with ulcerated foot exhibit distinct characteristics in some of the foot related clinical observations. Swollen foot, limited ankle mobility, and peripheral sensory neuropathy were significant characteristics of patients with diabetic foot ulcer. In addition, the explanatory model outlined within this research clearly shows that only one out of three patients with ulcerated foot showed common characteristics that are typically considered as contributing factor to ulceration.

 

Can a combination of lifestyle and clinical characteristics explain the presence of foot ulcer in patients with diabetes?
Available Online 01 March 2019
Roozbeh Naemi, Nachiappan Chockalingam, Janet K. Lutale, Zulfiqarali G. Abbas

Foot orthoses: Is the practitioner really important?

One of our classic papers looked at the influence of practitioners and their skills in prescribing foot orthosis which are commonly prescribed and used in treating numerous lower limb problems.

Over the years several studies have reported positive effects and most clinical practitioners would confirm those findings. However, the exact mechanisms in which these orthoses work are not fully understood.

Our results suggest that the type and amount of effects observed is greatly influenced by the practitioners. From a scientific perspective, this indicates that great caution should be taken when studying and reporting the effects of custom foot orthoses (CFO). Had only one practitioner been used for studying CFO effects on kinematics, altogether different conclusions could have been drawn based on a single pair of CFO.

We recommend that future research on foot orthoses should focus on their long-term effect through longitudinal studies. Nevertheless, based on the reported data, it seems improbable that two different devices could yield the exact same results.

Most CFO will induce some systematic changes during gait. Furthermore, this study demonstrated that inter-practitioner variability is a major factor in orthotic intervention in treating a single patient and for a specific pathology. Based on the findings, it is strongly recommended to use caution when drawing general conclusions from research studies using CFO as it has been showed that the practitioner himself or herself will have a great influence on the treatment outcome. In addition, comparing studies on CFO where different practitioners were involved should be done with great caution as the conclusion could vastly differ.

Reference:

Chevalier, T.L. and Chockalingam, N., 2012. Effects of foot orthoses: how important is the practitioner?. Gait & posture35(3), pp.383-388.

https://www.sciencedirect.com/science/article/pii/S0966636211007600?via%3Dihub