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

 

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

 

 

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.