Classification System for Bespoke Thermoplastic Ankle Foot Orthoses

Featured


Everyone agrees that not all Ankle Foot Orthoses (AFOs) are the same and they do not treat the same pathologies. Also different designs have varying effects on biomechanical function. However, the terms used to describe the different types of AFOs have not been fully classified and defined. This has led to the use of varying descriptions and acronyms resulting in poorly designed research studies (1,2) and a misunderstanding of research outcomes. The lack of classification has also resulted in generalisation on the effects of AFOs from research studies which have not been clear on the design of the AFO used or the presenting pathology it was used for (2), with some studies describing the AFO as “a standard AFO”, for which there is no definition. Standardised terminology and definitions for AFOs are critical in clinical practice, without these, there may be serious negative consequences, with the potential to cause harm.

We have now developed and validated a new classification system for different designs of bespoke thermoplastic AFOs.

Figure 1: Bespoke thermoplastic AFO classification chart.

The proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care.

Read the full paper at:

https://www.sciencedirect.com/science/article/pii/S0958259222000219

References:

  1. Figueiredo EM, Ferreira GB, Maia Moreira RC, Kirkwood RN, Fetters L, Figueiredo E, Ferreira G, Moreira R, Kirkwood R FL. Efficacy of Ankle-Foot Orthoses on Gait of Children with Cerebral Palsy: Systematic Review of Literature. Pediatr Phys Ther. 2008;20(3):207-223. doi:10.1097/PEP.0b013e318181fb34
  2. Eddison N, Mulholland M, Chockalingam N. Do research papers provide enough information on design and material used in ankle foot orthoses for children with cerebral palsy? A systematic review. J Child Orthop. Published online July 3, 2017:1-9. doi:10.1302/1863-2548.11.160256

A practical tool for Footwear Assessment in clincs

Featured

Footwear advice created from footwear assessment is often anecdotal based on individual clinical experience and interest. There is often no structured way to evaluate the shoe worn to clinic and a generalised opinion on footwear choice is given.

Isolated assessment of footwear can provide a number of challenges for clinicians as wider footwear choices made by patients often do not reflect the shoes worn to appointments. This creates an unrealistic view for the clinician and inaccurate assumptions are often made when issuing advice.

To assist clinicians in assessing shoes we have developed a simple valid clinical footwear tool.

This tool has been designed to help clinicians quantify and measure a full range of footwear in one appointment. The footwear tool also provides a systematic view to assess the quality of fit and design of the shoe whilst channelling the clinician towards developing individual footwear advice for the patient. The tool is multifaceted and addresses a number of parameters associated with good fit and footwear choice.

Our validation of the tool shows that it is reliable to use in the clinic and can be applied to a number of styles of shoes. There is minimal equipment required to use the tool and completion of the assessment takes a short period of time.

For further details read our publication in JFAR:

https://link.springer.com/article/10.1186/s13047-022-00519-6https://link.springer.com/article/10.1186/s13047-022-00519-6

Please contact Dr Branthwaite or Professor Chockalingam to download the tool and the instructions for use

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

Featured

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

Featured

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!

Featured

 

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:

My experiences at Staffordshire University and #StaffsBiomech

Featured

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

Featured

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.

Congratulations – Nicky !

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

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

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.