Author Archives: gbalasubramanian

Congratulations – Nicky !

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Nicola Eddison, one of the senior orthotists in the UK who recently completed her Ph.D at the Centre for Biomechanics and Rehabilitation Technologies writes on her experience:

I have worked in the NHS as the clinical lead for orthotics at the Royal Wolverhampton NHS Trust, for over a decade. My passion is paediatric orthotics, primarily the provision of ankle foot orthoses – footwear combinations (AFO-FCs) for children with neurological conditions.

I chose to undertake a Ph.D to increase my understanding of the biomechanics involved in AFO prescriptions and to investigate the effects of AFO optimisation (commonly termed AFO tuning) in an attempt to improve clinical outcomes and better inform the wider clinical community.

My research focused on the effect of biomechanically optimised AFO-FCs on the gait of children with cerebral palsy.

This research is first of its kind, to offer data in a case series analysis format on AFO-FC tuning, providing individual data rather than group means. For a practising clinician this is very important as each patient is different. I hope others will follow this model. In addition, my work is also the first piece of research which looked at the effects of AFO-FC tuning on energy expenditure and patient perception.

The project provides quantitative data to support the importance of biomechanically optimising AFO-FCs and as such, it contributes to the improvement of AFO prescriptions for children with cerebral palsy.

I thoroughly enjoyed conducting this research and have applied my research knowledge to practice. I intend to continue working with Professor Chockalingam and Dr Healy to help tackle issues relating to Orthotics and Assistive Technology.

As Nachi says, “research is addictive” and I want to continue to work on clinically relevant research questions which will have a substantial impact on people’s lives.

Publications from Nicky’s work:

Eddison N and Chockalingam N (2012): The effect of tuning ankle foot orthoses-footwear combination on the gait parameters of children with cerebral palsy. Prosthet Orthot Int published online 24. July 2012. https://doi.org/10.1177/0309364612450706

Eddison N and Chockalingam N (2014): Ankle foot orthosis- footwear combination tuning: An investigation into common clinical practice in the United Kingdom. Published online before print February 24, 2014 Prosthet Othot Int February 24, 2014. https://doi.org/10.1177/0309364613516486

Eddison N and Chockalingam N (2014): Response: Turning of rigid ankle-foot orthoses is essential. Prosthet Orthot Int, first published on April 1, 2014. https://doi.org/10.1177/0309364614525734

Eddison N, Mulholland M and Chockalingam N. Do research papers provide enough information on design and material used in Ankle Foot Orthoses (AFO) for children with cerebral palsy (CP)? : A systematic review. Journal of Children’s Orthopaedics, 2017; 1-9. https://doi.org/10.1302/1863-2548.11.160256

Eddison N, Healy A, Needham R and Chockalingam N. Shank – to – Vertical – Angle in AFOs: A comparison of static and dynamic assessment in a series of cases. Journal of Prosthetics and Orthotics . JPO Journal of Prosthetics and Orthotics · August 2017. doi: 10.1097/JPO.0000000000000141

Eddison N, Healy A, Needham R and Chockalingam N: Exploratory investigation into energy expenditure using tuned versus non-tuned ankle foot orthoses- footwear combinations in children with cerebral palsy. JPO Journal of Prosthetics and Orthotics. 2018. In Press.

Effectiveness and Cost-effectiveness of Prosthetic and Orthotic Interventions

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An Infographic on the Effectiveness and Cost-Effectiveness of Prosthetic and Orthotic Interventions

The International Society for Prosthetics and Orthotics (ISPO) in partnership with the WHO, and funded by the United States Agency for International Development (USAID), recently published Standards for Prosthetics and Orthotics Service Provision. These Standards were developed to encourage better access to prosthetics and orthotics services.

To support the development of these Standards we were commissioned by the ISPO, in partnership with WHO and USAID, to conduct a systematic review.

What was the context to the project?

It has been estimated that in excess of 100 million people across the world are in need of a prosthesis or orthosis. However, it is projected that only 1 in 10 people in need has access to prosthetic and orthotic devices. To date no one has completed an overall examination of research examining orthotic and prosthetic interventions across healthcare.

What was the aim of the project?

The aim of this project was to complete a systematic review of the research to date which has examined the effectiveness of prosthetic and orthotic interventions.

How was information gathered?

Searches across 14 databases were used to capture all research in this area.

What were the main findings?

A large volume of research has been conducted in this area, however, there was limited high quality prospective studies. 319 English language randomised controlled trials were identified with only 4 of these examining prosthetic interventions, the rest examined orthotic interventions.

At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high-quality research to allow strong conclusions on their effectiveness and cost-effectiveness.

Key statistics

  • The database searches resulted in a total of 28,958 articles.
  • 346 randomised controlled trials were identified, of which 323 were English language. Of the 323 English language RCTs, 319 examined orthotic interventions and 4 examined prosthetic interventions.
  • Orthotic interventions were categorised by the medical condition/injury with 68 categorises identified.
  • The most studies conditions were:
  • Osteoarthritis (30 studies)
  • Fractures (26)
  • Stroke (22)
  • Carpal tunnel syndrome (20)
  • Plantar fasciitis (18)
  • Anterior cruciate ligament (post-surgery) (16)
  • Diabetic foot (15)
  • Rheumatoid and juvenile idiopathic arthritis (13)
  • Ankle sprain (10)
  • Cerebral Palsy, Lateral Epicondylitis, Low back pain (8 studies each)

What are the implications of the findings?

This review highlighted the vast range of outcome measures utilised with few studies reporting on the same outcome measures. It was also evident that studies in general did not assess if the prosthetic or orthotic interventions allowed the users to participate in the activities of daily living in which they wished to perform, which is the major consideration for the user. There are many methodological issues within this area of research which need to be addressed to strengthen the quality of future research, which would then allow conclusive decisions to be made on the effectiveness and cost-effectiveness of these interventions.

Link to full article:

Healy A, Farmer S, Pandyan A, Chockalingam N (2018) A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS ONE 13(3): e0192094. https://doi.org/10.1371/journal.pone.0192094

Funding:

This work was supported by the International Society for Prosthetics and Orthotics (ISPO) (Sub-grant from ISPO’s Collaborative Agreement with USAID Rehabilitation of physically disabled people in developing countries – USAID cooperative agreement DFD-A-00-08-00309-00).

Life as a PhD student: An Indian Experience by Stylianos Fanourakis

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This is my very first blog and I would like to share a small part of my experience in India as a PhD student so far. I have observed a lot of similarities and obvious influences of western civilization on Indian lifestyle. It has been a month since I arrived in Tamil Nadu, which is located in the South of India. It is a unique place with its own distinctive language called Tamil in addition to the national language (Hindi). I have visited a few cities in Tamil Nadu and the major temples in those cities that are at least 2000 years old. It fascinates me to know that they remain intact even after the known history of wars, without any intention of the invaders to attack or destroy some of them. Those temples are also protected by UNESCO heritage committee and are indeed amazing.

India has a very interesting landscape, which is rich in flora and fauna. As an European, it is very interesting for me to see monkeys jumping around the place like stray animals. Personally, I have seen monkeys only in cages at the zoo but never at my doorstep like in here.

Indian food is tasty. However, it is difficult for me to adapt to a vegetarian lifestyle. Of course, there are options for non-vegetarians like me, but not so widely available in the place where I am staying.

I am currently at SASTRA university, where I have been invited to collaborate for several months during my PhD. I am impressed by the size of the campus, which is vivid with a lot of students. This may be due to the fact that I am used to divided campuses. In the UK and Greece, I have never seen a whole campus operating as a single entity. The campus is always alive and active with people working six days a week. Also, I found that unlike most countries, people in India including academic staff and students, work six days a week. However, I deem that human body requires more than just one day per week to rest and alleviate stress.

My project at SASTRA university is about developing an innovative device, like a fully automated weight-bearing ultrasound scanning machine. It is a complicated task and challenging to deal with , however, this fact makes it interesting. Absolutely, it will not be a common topic of research for a PhD program. I am working with two other PhD scholars from SASTRA university, Hari and Saru. Each one of us, have our own objective in order to achieve the ultimate goal, which is to construct a new fully automated weight-bearing ultrasound device.

My objective is to create a new approach to automated elastography by calculating a map of stiffness through the deformation of a stand-off material. The device will also include features such as automated segmentation of various types of tissues; independent of their mechanical properties or thickness. Finally, the ultrasound device will be able to identify if the sample tissue is healthy or pathologic by quantifying the homogeneity of textured features. Furthermore, the weight-bearing device is aimed to be implemented in everyday clinical practice. In summary, the project is expected to have beneficial outcomes and promising results.

From my experience, I can say that India has a lot of opportunities and prospects as a competitor to the global market. The cost of living in India is cheaper in comparison to many other countries; but, that does not mean the lack of quality. The current rate of renewals or updates in relation to the infrastructure and transportation are low. I would recommend that the public transportation services are improved and updated periodically. Also, eco-friendly vehicles with less air and noise pollution would be useful. Better waste management and recycling methods must be promoted. Additionally, implementing strategies that utilize the renewable energy sources like the solar panels, which takes advantage of the sunlight available throughout the year can be beneficial. Last but not the least, there is a need for investing more into health, safety and hygiene. If the above actions are taken, perhaps, India may soon be one of the upcoming powerful global players.