A gathering was hosted by the WHO Assistive Technology team in Geneva on March 28th and 29th, with the objective of evaluating the process, results, and distribution of the WHO rapid Assistive Technology Assessment (rATA) survey, as well as devising strategies to enhance this significant means of collecting data.
The rATA survey is designed to gather information from households at a population level, which includes assessing self-reported requirements, obstacles and demand related to assistive technology. This survey was conducted worldwide between 2019 and 2021 in 35 countries and contributed to the WHO-UNICEF Global Report on Assistive Technology, which was released in May 2022.
At the meeting, 28 stakeholders hailing from 18 different countries were assembled, all of whom were involved in the creation, delivery, and interpretation of rATA data. The participants shared their individual experiences and insights gained from collecting rATA data and collectively identified key measures to enhance the questionnaire’s effectiveness, streamline rATA implementation, offer more robust support for country implementation, fortify data management and analysis, and broaden the dissemination of rATA results.
To inform evidence-based policies and programs, measure progress in improving access to quality assistive products and services, and guarantee equal access to assistive technology for those in need, it is essential to invest in effective and efficient assistive technology data collection. Stakeholder representatives attending the meeting identified key measures to enhance the rATA questionnaire’s effectiveness and ensure equitable access to assistive technology for all. The outcome of this meeting will guide further development of rATA through the GATE Global Network on Measuring Access to Assistive Technology.
We are undertaking research to gather information on the prosthetic and orthotic workforce in the UK. The study aims to capture a wide variety of demographic and work-related information about the UK prosthetic and orthotic workforce. Currently, workforce data for people working within the prosthetics and orthotics profession is incomplete resulting in an unknown national workforce picture, which prevents accurate service planning and projection requirements. The project has been funded by Health Education England through the British Association of Prosthetists and Orthotists (BAPO). The findings of the study have the potential to influence future service planning.
Who do we want to complete the survey?
We want to gather information on all individuals working within the prosthetic and orthotic profession which includes:
• Prosthetists/Orthotists
• Prosthetic/Orthotic technician
• Prosthetic/Orthotic support worker
• Prosthetic/Orthotic student/apprentice
Survey update
The survey has now been running for 4 weeks but we need your help to get more responses, from all professions across the UK. We know that there are 1,124 registered Prosthetists/Orthotists in the UK today and so far, we have only had responses from 30% of this population.
We have a low response from technicians, support workers, students, and apprentices.
We have a low response from Northern Ireland, Wales, and Scotland.
To complete the survey, click here or scan the QR code:
There is a chance to win a £100 retail voucher, the survey closes 18/11/22.
International Society for Prosthetics and Orthotics (ISPO) organises biennial World Congresses. This is ISPO’s flagship conference and is a unique forum where the global community of professionals involved in the care of persons in need of prosthetic, orthotic, mobility and assistive devices comes together to learn about the latest scientific and clinical advances, products, innovative technologies, designs and materials in P&O care provision with the global health services.
The next world congress in 2023 is titled “Art and the Science” and will be held in Guadalajara, Mexico.
Four renowned international professionals Rosielena Jované, Sophie de Oliveira Barata, Professor Stefania Fatone and Professor Nachiappan Chockalingam will present keynote lectures around the congress theme The Art and the Science.
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.
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
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
The COVID-19 pandemic saw an unprecedented expansion of telehealth with a shift to remote patient consultations across the allied health professions.
Our study published in BMJ Open has examined current guidelines for the 14 Allied Health Professionals (AHPs) in the UK reveals a clear need to solve the disparities in the level of guidance for remote consultations between professions.
While telehealth can be considered an efficient and safe way to deliver consultations, in practice there are barriers which can lead to unintended consequences; these include technological constraints such as inadequate internet bandwidth, lack of skills among users, patient confidentiality, privacy as well as data security issues.
Additionally, concerns have been raised about the risk of patient harm resulting from the lack of diagnostic and therapeutic quality of services delivered through telehealth, as this can lead to highly infectious and life-threatening conditions being missed.
The study revealed that most telehealth guidelines were designed to quickly respond to the need for remote patient consultations during the Covid-19 pandemic and recommends that available guidelines should be reviewed to ensure they meet the long-term needs of patient consultations.
Very few guidelines were specifically designed for certain clinical populations, which acknowledged that telehealth consultations need to be adapted to meet individual needs. It was also found that most guidelines were specifically designed for occupational therapists, physiotherapists and speech and language therapists, leaving the other AHP groups with very few or inadequate guidelines.
Everyone has a right to certain products and devices that can help them function in everyday life. This is the stance of the World Health Organisation (WHO), which has published a list of the most important of these devices. It includes things like walking aids, wheelchairs and braille displays.
But assistive technologies, as they are called, are difficult to access in many parts of Africa. This is a huge problem because the prevalence of disabilities on the continent is estimated at 15.6%. With a population of more than one billion, the number of people in need of at least one assistive product in Africa stands at over 200 million, and that figure is projected to double by 2050.
The WHO estimates that only about 15% to 25% of those in need of assistive technology products in Africa currently have access to them.
Our research sought to find out why and to offer solutions to this problem.
Human rights
Assistive technologies are functional, adaptive, and rehabilitative devices. Not only does the WHO support a global commitment to making them more easily available, the United Nations also regards them as a basic human right. This is because some people need them in order to exercise their rights.
Without access to the assistive technology they need, people can face exclusion and are at risk of poverty. They may also be perceived as a burden to their families and society. The positive impact of assistive technology products goes far beyond improving the health and well-being of users. There are also the socio-economic benefits of reducing direct health costs and having a more productive labour force, indirectly stimulating economic growth.
The 2006 UN Convention on the Rights of Persons with Disabilities and its optional protocol was negotiated quickly and well supported by member states. It was also the first human rights convention to be open for signature by regional integration organisations. But its implementation has been shaky, particularly in Africa.
We believe this is best explained by the idea of economic and political institutional voids. These are basically gaps in political and economic systems, trade policies and markets. An absence of specialised intermediaries, regulatory systems and contract enforcing mechanisms creates higher transaction costs for doing business or even entering markets.
Seeing the problem in this way also helps to show how to solve it and achieve fair access to assistive technologies.
Institutional voids
First, there is little production of assistive technologies in Africa because the parts are generally expensive to make. Many indigenous producers use crude and unstandardised materials.
Second, assistive technologies that are not produced locally are expensive to import. There are no unified tariff structures for them within the continent. This means that costs vary widely from country to country. Often, when assistive technologies do get imported despite high tariffs, they might need to be adapted for the local environment. This increases the costs even further.
Third, assistive technologies are mostly excluded from health financing and insurance schemes on the continent. They are not often included in central medical store catalogues.
Fourth, there aren’t enough people at all levels of the health system with the required knowledge and skills to provide assistive technology services and products.
Fifth, and most crucially, there is no unified governance framework for assistive technologies on the continent. And there’s a widespread lack of awareness about why they are needed and how they can improve the lives of people who need them.
Most African countries do not have national assistive technology policies or programmes. As a result, access to assistive products is difficult and many are left behind.
Solutions
African governments need to provide leadership, coordination and resources to plan and implement policies that increase access to assistive technologies.
Acting on the WHO African regional framework is a good place to start. The framework has modest aims. For instance, it calls for 40% of African member states to have assessed their assistive technology situation and developed a national strategy to improve access by 2024. This will help 40% of the population in Africa that needs assistive products to get them without suffering financial hardship.
The African Union can learn from the European Union. The European Parliamentary Research Service has commissioned and published an in-depth report of assistive technologies. The report covers economic, political and socio-ethical perspectives and it tries to implement the declarations that assistive technologies are a basic human right. Such a focused and thorough evaluation is missing in Africa.
To produce technologies on the continent, the African Union should develop a market strategy. The current market is one where the players are left to fend for themselves, and so face high operating costs. These costs ultimately make assistive technologies expensive.
Producers should also embrace frugal innovation – the process of reducing the complexity and cost of an item and its production, usually by removing nonessential features.
Qualified personnel are another part of the solution.
Finally, but maybe most importantly, there is a need for a structured enquiry to highlight the gaps in economic, political, scientific, and clinical knowledge for assistive technology development and deployment in Africa – and a unified approach to solving the problems.
This would help millions of people in Africa to achieve their basic rights such as access to education, freedom to live, and the right to work.
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.”
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 inCosmetic 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.
@ThePO_dcast is set up to discuss points of interest from across the world of prosthetics and orthotics. The latest podcast features our Dr Nicola Eddison discussing Tuning vs. Biomechanical Optimisation!
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.
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.
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.
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.
to expand the research efforts in that country as well.
