INNOVATION FOR INDEPENDENCE
ISSUE 120 APRIL/MAY 2018 £6.95
Team wins £900k for new artificial limbs project RESEARCHERS at the University of Southampton have won more than £900,000 in funding for a project to improve access to artificial limbs in lower and middle income countries. The three-year project will see two studies carried out in Cambodia, southeast Asia, with the aim of developing digital tools to improve access to prosthetic and orthotic services, train clinicians and ensure funding is spent more efficiently. About 100 million people worldwide need prosthetics (artificial limbs) or orthotic devices (braces and splints), but an estimated 80 to 90 per cent of those do not have access to P&O services because of a shortage of personnel, service units and health rehabilitation infrastructures. The higher incidence of traumatic amputations in LMICs (caused by accidents, conflict and landmines) means people with P&O needs are typically younger, with more physically active years ahead of them, than users in more economically developed countries, for whom most prosthetics technology has been developed. The project is one of 15 to receive a total of £16m in funding from the Engineering and Physical Sciences Research Council and the National Institute for Health Research through the Global Challenges Research Fund, a £1.5billion government fund to support technology that
addresses challenges faced by LMICs. University of Southampton mechanical engineer Dr Alex Dickinson, who is leading the project, said: “I’m delighted that we have won this vital backing. In LMICs there are still many more patients than the existing number of clinicians can possibly cope with, and there is an ever-growing population of people with P&O requirements. “In south-east Asian LMICs, it is estimated that three times the current number of clinicians is required to cater for the amputee population.” The project is a result of the Institute for Life Sciences’ FortisNet initiative, which brings together experts from different disciplines across the University. Dr Dickinson and his colleagues have spent three years building the project and the partnerships which will help it to deliver real-world impact. They will investigate: n Digital measurement tools to assess a user’s residual limb anatomy, biomechanics of gait, typical daily prosthetic limb use, and health status. n The architecture for a portable digital patient case note system: a robust and secure IT network for travelling prosthetists to visit provincial areas to provide evidence-based treatment for those in remote communities who cannot afford to travel.
One of Scotland’s best young athletes picked up her new wheelchair from Bromakin Wheelchairs in Loughborough. 22-year-old Samantha Kinghorn, also known as Sammi, from the Borders region of Scotland, has soared to the top of the para-sports world in recent years. Her stunning performances at the World Para Athletics Championships in 2017 resulted in her winning gold medals for both the 100m and 200m events. Along with the medals and world records, Sammi has been recognised with numerous honours including being the first para athlete to be crowned Scottish Sports Personality of the Year. Full story on page 4
NRS Healthcare has worked with Cambridgeshire and Peterborough Country Council to donate a range of their children’s mobility aids overseas, in order to help youngsters in some of the world’s poorest countries. After reviewing the stock in their Cambridgeshire warehouse, staff at NRS Healthcare found a number of older items that were no longer used such as seating for disabled children who need postural support, children’s mobility aids and children’s standing frames for physiotherapy. These items were donated to PhysioNet, a charity which ships physiotherapy and mobility equipment to needy organisations in developing countries worldwide, with the intention of enabling children in these countries to benefit from the equipment and live more independently. Councillor Simon Bywater, chairman of the Children and Young People Committee, said: “It is great we have this opportunity to donate this mobility equipment rather than it
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David Lacy (left), one of the occupational therapists at NRS Healthcare, making the donation to Ian Stockley, UK collections co-ordinator of PhysioNet.
being scrapped. “Not only are these unwanted items that have been sitting collecting dust in the warehouse going to a good home, they will also make such a difference to the lives of children with mobility issues in other countries.” The equipment will be safety checked before being shipped and distributed. David Lacy, an occupational therapist for NRS Healthcare, added: “Around 15 items are included in this initial shipment but we hope that this will
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be the start of an ongoing project. All the equipment is in fit, working order but is not currently being used.
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“In the developing countries that PhysioNet works with, this equipment is hard to come by and will bring significant benefits by helping children to take part in activities and join in with learning and playing. “We have been very careful in selecting the equipment that has been donated to make sure that the items are useful, configurable and can function without electrical power.”
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Equipment provider gives mobility aids to charity
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ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
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Patients benefit from donation A GRATEFUL family has donated a piece of equipment to Goole and District Hospital which will benefit those patients requiring rehabilitation.
NEWS
Ward 3 has been able to buy a piece of equipment – a turn stand – which therapists can use to help patients safely transfer from sitting to standing positions. The equipment has been donated in memory of Mike Earle who suffered a stroke in March and was cared for at the hospital before passing away in June.
New wheelchair for Paralympian Sammi Kinghorn ONE of Scotland’s best young athletes picked up her new wheelchair from Bromakin Wheelchairs in Loughborough. 22-year-old Samantha Kinghorn, also known as Sammi, from the Borders region of Scotland, has soared to the top of the para-sports world in recent years. Her stunning performances at the World Para Athletics Championships in 2017 resulted in her winning gold medals for both the 100m and 200m events. Along with the medals and world records, Sammi has been recognised with numerous honours including being the first para athlete to be crowned Scottish Sports Personality of the Year. Her success is down to many years of hard work and dedication to her training, supported by her close-knit family and her coach Ian Mirfin. In 2018, Sammi has set her sights on a new challenge; representing Scotland at the Commonwealth Games in Australia in April, in the marathon and the 1,500m. Along with the state-of-the-art wheelchair that she uses for racing, Sammi requires a high performing wheelchair for her busy everyday life, whether she’s going to training sessions, travelling around the world representing her country or spending time with her family and friends. Her new wheelchair, the Wolturnus W5 SL is a tailor-made, light, robust rigid wheelchair with a slim design which harnesses all energy for propulsion. The chair has welded on sideguards and includes the ILSA back option, a specially designed multi-adjustable back rest system for individual modification of the seating position. Sammi also received a Triride clip4
on handbike attachment. Designed in Italy, and provided by mobility equipment supplier Mobilitise in the UK, the versatile Triride attachment is a smart, efficient and convenient solution that turns a manual wheelchair into a motorised one using an easy-to-attach motor. Wolturnus wheelchairs are distributed in the UK by Ottobock. Robert Redgewell, retail business development manager at Ottobock UK, said: “Sammi is a trailblazer in every sense of the word; she leads the competition in her races and pushes every limit in sport and day-to-day life. ‘We couldn’t be happier to have Sammi continue to be an Ottobock ambassador and we’re confident that this new wheelchair will support her on her journey to even more success this year.” Bromakin has over 30 years of experience in the mobility industry, growing from a spare room business to a respected national supplier of powered mobility equipment and an international name in the field of street and sports wheelchairs. Bromakin product specialist, Rob Wickham, said: “We’re incredibly proud to be able to work with Sammi, who is such a dedicated and accomplished athlete. “Bromakin is very passionate about making sure people have the right equipment to help them be active, and we are confident that Sammi’s new wheelchair will provide all the support she needs as her exciting career continues to flourish. “The new chair will help her posture, and importantly it will look good when she attends awards ceremonies and appears on TV.”
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
His wife Jean Earle, daughter Sue and son Michael raised £500 after asking for donations at his funeral in aid of Ward 3.
Jean said: “We wanted to give something back to the ward for all the care they gave Mike and my family.
“Nothing was too much trouble. After spending nearly three months visiting the ward the staff became more like friends, and we still get hugs from them when we see them. “All of the staff on ward three were brilliant. They are a great team.” Senior physiotherapist Megan O’Hara added: “We would like to say a huge thank you to Mike’s family for their kind donation. “It will aid the rehabilitation of patients as they regain their strength following s stroke.”
Future medical students walk the walk as they visit podiatry clinic HIGH School students who want to study medicine got a first-hand look at the work of lower limb specialists when they visited the University of Northampton’s podiatry clinic. Year 8 and Year 12 students from Northampton Academy spent a day alongside fully qualified podiatrists and students from the University of Northampton podiatry course. The day involved sessions focusing on patient care, diagnosis and scanning. The students looked at and used some of the specialist, high-tech equipment used in the clinic, including ultrasound imaging and vascular and neurological assessments. They also had a full tour of the clinic, including the orthotics laboratory where insoles and support wear are made. The visit was such a success that the academy will be returning with a fresh crop of budding medical professionals within the next few weeks. Paul Fletcher, senior lecturer in podiatry at University of Northampton, said: “I have always been keen on involving school children with our podiatry clinic and these visits seem to be working
really well with some very positive comments from school children and their tutors. We’re looking forward to meeting more potential podiatry professionals over the coming weeks and months.” Elspeth Duncan, science teacher and Key Stage 3 co-ordinator at Northampton Academy, added: “This was an excellent and unique opportunity for the students to understand the vital role that podiatry plays in the community. “Pupils were enlightened to the huge variety of cases that podiatrists see, including sports players, children and even being able to perform surgery themselves. The pupils thoroughly enjoyed hands on tasks such as ultra-sounding each-others’ ankles and feet. I am looking forward to returning more keen pupils.” Future engagement work with the podiatry team include open evenings for local school for pupils to come in to the clinic for some ‘hands on’ feet workshops, arranged through the National Collaborative Outreach Programme. NCOP is a Higher Education Funding Council for England project aimed at raising applications to university from students in disadvantaged areas of the county.
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Physiotherapy student crosses world to do work experience WHEN deciding where to do work experience, University of East London student Nandu Pillai wanted something different.
with the staff and treatment.” Nandu feels that the opportunity to interact with students of different disciplines and nationalities was also very valuable.
So the Physiotherapy student spent his summer in Tanzania in East Africa.
He said, “At home, I naturally spend a lot of time with other physiotherapy students, so my trip to Dar meant I could have more time with medics, nurses and dentists.
Nandu, who is 22 and currently in the second year of his degree, knew that a period of work placement would enhance his learning and make him more employable after graduation.
“I was able to learn about their studies at home as well as what they were experiencing alongside me in Tanzania.
He liked the idea of going overseas, so he got in touch with Work the World – an organisation that organises placements for students and healthcare professionals around the world. Nandu said: “As a keen traveller, nothing appealed more than doing a placement in a country that I have never visited and is very different from home. “As I’ve never been to Africa before, I chose Dar es Salaam in Tanzania, which has one of Work the World’s longest-running programmes.” During his placement, Nandu spent time in orthopaedic outpatient physiotherapy and paediatrics units. He also made regular visits to the intensive care unit, the private wards, operating theatres and a cerebral palsy clinic. He also had the chance to visit both the neurological paediatric and orthopaedic paediatric wards.
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Nandu said the difference in equipment and resources compared to the UK was clear. He added:: “TENS electrodes and towels were used multiple times, ITU uniform was somewhat makeshift, and gloves were used sparingly. But the staff were still able to do an amazing job despite the challenges. “A pleasant surprise was how few appointments were missed per month in the department. Despite huge amounts of people waiting to be seen and patients having to travel very long distances, patients made the most of the healthcare available. “They never complained and were very compliant
“At the house (where the group stayed) we felt like family, and were able to share stories and experiences from the day. We were also able to travel parts of Tanzania together, and still remain friends now after we’ve all returned home.” Since his return to the UK, Nandu has gained a greater appreciation for the structure and resources of the National Health Service. He added: “The best piece of advice I could give someone considering a placement with Work the World is to throw yourself in. It’s been one of the most fulfilling and enjoyable experiences of my life. I feel that I will be a better physio in the future because of these experiences.” Once he graduates Nandu plans to gain a few more years of work experience, and then possibly return to academia to study for a Master’s degree.
NEWS Tommy Dengel wearing his favourite arm made by his dad Adam on his 3D printer.
Pictures: Shaun Colborn
Little Tommy goes 3D ... By Josh Timlin
A LITTLE boy who was born with no right hand has had his life transformed by his dad who created artificial limbs for him to use. Three-year-old Tommy Dengel, who was born with a short forearm due to amniotic band syndrome – a rare condition where stray bands of tissue wrap around the limbs and cut off blood flow - can now pick things up, shake hands and play with toys using his DIY arm. A charity, Team UnLimbited, provided the design and his dad, 29-year-old Adam, of Royston, bought a 3D printer and spent hours mastering the technique due to being unhappy with the basic NHS prosthetic. Each arm is made of plastic which is strung together with fishing wire and orthodontic elastic bands, before it’s strapped on to the youngster’s limb with velcro. Adam, who works at Sheffield Arena,
said he had no knowledge of making prosthetics but felt compelled to make his son’s life better.
“During early pregnancy, my wife Katie and I were given the devastating news that a complication had occurred and our baby was going to born missing a limb,” he added. “I’ll never forget the day we were sat having a normal baby scan, looking forward to seeing our beautiful baby again. The nurse paused and went quiet – I instinctively thought she was just concentrating trying to find a better angle. “A senior nurse came in, she looked concerned, they talked quietly and then she left. The nurse said she was very sorry and something was wrong with our baby. “That moment I’ve never felt pain quite like it. I didn’t know what to think, they explained that our baby we had tried for so long to have was going to be born disabled and missing
a limb and could have potentially more problems.
“Still crying and shook up we were ushered into a cramped little room, walking past the waiting room full of expectant parents who didn’t know where to look. “We were given a basic pamphlet of a generic limb difference which to be honest didn’t help one bit as it was dry and clinical. We were also given the option of abortion.” But Adam and Katie continued with the pregnancy and, with help from specialist charities along the way, Tommy is now happier than ever with six artificial arms to choose from. And the pair have set up their own charity – The LimbBo Foundation – which aims to help other parents and children going through the same thing. Adam added: “We have been absolutely blown away with the amount of people who have shared
Tommy’s story. It means so much, but we are doing this to help our son and other disabled children with limb differences lead a normal, happy life without fear of not being like other kids their age. “We have thought tirelessly of a way as parents we can help not only limb difference children but also parents and expectant parents. “The foundation’s first step will be to design and create heartfelt, considerate, informative, nonjudgmental, useful leaflets plastered with photos of superb kids like Tommy and how they’ve overcome adversity, made friends and live a happy life. “That’s what we needed, a hug and someone to say it’s going to be OK, not a medical journal. “We will aim to get a professional product that can be mass printed and positioned in hospitals throughout the UK.”
Sheffield medical experts travel to India to help children with rare bone conditions BONE experts from Sheffield Children’s Hospital travelled to India to give life-improving surgery to 40 children and provide advanced medical training to 85 medical staff.
The volunteer team spent six days in Bengaluru, Southern India, to help underprivileged children with bone conditions who wouldn’t otherwise be able to afford surgery.
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Hospital and physiotherapists from Barnsley Hospital.
in the fields of radiology, genetics, pathology and orthopaedics.
The medical and surgical staff from Sheffield Children’s – who are worldrenowned for their expertise – also went on to help develop a greater understanding of complex and rare conditions in the country’s medical community.
The training focused on skeletal and metabolic bone diseases – a category of rare genetic disorders that affect bones and joints and hinders children’s growth and development. Children with these conditions often have other orthopaedic complications and can have a degree of short stature.
As well as operating on 40 children, the team provided professional opinions on the needs of a further 25 children.
The Sheffield Children’s team helped 85 Indian medical staff gain a greater understanding of rare bone dysplasias and metabolic bone conditions.
This medical team included orthopaedic surgeons and theatre staff from Sheffield Children’s
The experts were part of The Skeletal Dysplasia Group UK and ran the four-day course for senior doctors
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
The Sheffield Children’s international team included: n Dr Paul Arundel, Consultant in Paediatric Metabolic Bone Disease. n James Fernandes, Consultant Paediatric Orthopaedic Surgeon.
n Dr Amaka Offiah, Reader in Paediatric Musculoskeletal Imaging at The University of Sheffield, Honorary Consultant Paediatric Radiologist at Sheffield Children’s, and chairperson of the Skeletal Dysplasia Group for Teaching & Research.
Dr Melita Irving, a Consultant Clinical Geneticist from London also played a key role in the training. Other partners included The Skeletal Dysplasia Group for Teaching and Research UK, St. John’s Medical College Hospital and St. John’s Centre for Children with Special Needs (Unit of Hope).
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New device could change lives of children born without arms A NEW device being developed at the University of Salford could help thousands of children across the world born without arms.
Researchers are creating a special unit to help youngsters with congenital conditions that mean they have to use myoelectric prosthesis – artificial hands controlled using the electronic signals generated by their own muscles. These prosthetics are only effective if an electrode is fixed in close contact with the skin, but as artificial limbs for children are deliberately built with some ‘growing room’ in them, the electrode is often too loose to work properly especially for the first few weeks after a new fitting. John Head, lecturer in prosthetics and orthotics at the University, who is leading the project, said: “Prosthetics for children are like children’s clothes.
“It’s an incredibly simple idea, but it could make a huge difference to these children’s lives.”
Because they grow so quickly, their prosthetic sockets – the interfaces which house the electrodes – only last a few months, before they become too tight and new ones have to be made. “Unfortunately, this means the child goes through a cycle in which the electrode is often too loose to work the hand effectively after a new socket fitting. “Once the socket tightens up over time, the electrode contact improves and the problem diminishes, only to begin again when a new socket fitting is needed. “This can be incredibly frustrating for the child and the parent and sadly some of them may give up trying to operate the prosthesis properly.” John believes a crude prototype device he has built could be the answer. The device should enable parents to adjust the electrode’s position until a visual cue, such as a green light, shows it has made optimum contact with the skin. The original prototype is too bulky to use but John has now received a
New designs featured in latest catalogue from Reed Medical
REED Medical is pleased to announce the release of Issue 8 of their Adult therapeutic footwear catalogue. Inside we offer new materials, a new last design and new styling reflecting today’s high street trends and colours. We now offer a diabetic specification in most designs which includes our unique “Superplush Lining and Safeseam® technology” The new NOVA LOW TOE last is designed to reduce pressure under the metatarsal heads by a reduction in toe spring. Ideal for the at risk foot. We offer more choice in our leisure footwear range with new trainer designs in performance stretch materials mimicking current styling. 10
We have increased the range available in our PODOWELL footwear that has proved so beneficial to trusts in reducing the costs of footwear provision. Options in the Lymph footwear range has been extended to include a choice of Lace or Velcro fastening in the LYMPH shoe. These can be purchased singularly, and we now offer modular manufacturing for this range. We also offer a full range of milled insoles ranging from EVA’s to Polypropylene, Polyurethane and Carbon Fibre, all with a wide choice of coverings. Please call 00 44 (0) 1254 503333 for your copy.
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
John Head demonstrating how to make a prosthetic with undergraduate student Archie Veale.
£43,810 grant from the Starworks Innovation Project, which works with the NHS National Institute for Health Research, to develop the device. His team will collaborate with the University of Southampton and work with engineers to create a much smaller working model.
John said: “It’s an incredibly simple idea, but it could make a huge difference to these children’s lives. “We’re going to use 3D printing to create something that can be tested on patients, and hopefully this is something that can eventually be manufactured on a much larger scale.”
Proud partnership ... DeNovo Healthcare is a dynamic and progressive company focused on providing some of the most innovative products and services from around the world to the UK healthcare market. As a patientoriented organisation, we pride ourselves in providing both healthcare professionals and patients the highest level of quality, service and choice possible. DeNovo Healthcare is proud to work together with Nimco Made4You, in order to supply patients with the most comfortable, fashionable yet affordable orthopaedic footwear, for both adults and children alike. Nimco Made4You produces footwear for the whole family! In our catalogues you will be able to find: 8 toddler’s styles, 30 children’s styles, 28 women’s styles and 17 men’s styles. All of our footwear is made using natural leathers, no pig skin is used and is also available in 28 different lasts. All footwear from our children’s and adult’s catalogues are completely made to order. This allows you to request additions to the last dimensions, change the pattern of the uppers, add additional closure
options such as medial zips and change material types and colours. All these additional options give you much more bespoke fit whilst maintaining a stock shoe price range. All of the Nimco range is fully adaptable and we offer a full range of adaptions from raises and floated soles to carbon sole strips and heel sockets. These adaptions are applied to your footwear at time of manufacture which increases the quality and reduces overall lead time when compared to modifications on finished shoes. DeNovo Healthcare together with Nimco can offer quick delivery times of 12 working days* or 8 working days* with our express manufacture option. All footwear is supplied with supportive stock inlays as standard. If fully bespoke inlays are required we offer a direct milled inlay range which is made to your exact specification and is manufactured at the same time as the footwear, protecting the overall lead time of your order. If you would like to see our full range of products, please visit our website on www.denovohealthcare.com. *terms and conditions apply.
Residents test digital health technologies NEWS
A BLOCK of retirement flats has become a test bed for internetconnected devices which could help improve the health of older people.
This first stage of the project is building the infrastructure, testing the new technologies and sharing the residents’ experiences with university academics, doctors and technology industry experts.
Tenants of Leach Court in Kemp Town, Brighton, have volunteered to trial digital technologies including smart medication dispensers, activity monitors, and falls detectors which are carried with them or are built into their homes.
The University of Brighton plans to explore the possibility of further technological development, in collaboration with commercial partners, based on the findings at Leach Court.
It is hoped the data will help the individual and also their families and their GPs. Specialists from the universities of Brighton and Sussex joined professionals from Brighton and Hove City Council, NHS Brighton and Hove Clinical Commissioning Group and Kent, and Surrey & Sussex Academic Health Science Network to explain the aims of the ‘Living Laboratory’ project to Leach Court residents. The project is being led by Dr Theo Fotis, Principal Lecturer in health sciences at the University of Brighton, who is working with Dr Anand Sundaralingam, Darzi Fellow at the University. Dr Fotis said the aim of the Living Laboratory was to “empower citizens to better manage their own health, at a time when restrictions on funding make it hard to provide the level of quality healthcare needed for an
Dr Theo Fotis and Leach Court resident Rachel Frost exploring the new technology.
ageing population”. He added: “The uniqueness of the project is that we are working in the community, with the community, and for the community to provide stakeholders with a tool to accelerate digital health innovation.” Dr Sundaralingam said at the meeting with tenants: “Digital technology for self-managed healthcare has already arrived, so we need to work out how to best use it. It is a real privilege to have all of the important people – the end-users and patients – in the room with us.
“A lot of barriers are often put up by professionals like us, but we need to actively encourage our end-users to be part of these decisions by using the technology to see what might have value and whether it has ‘patient importance’. “We are exploring a number of digital technologies including smart medication dispensers, activity monitors, and falls detectors which can not only be carried around, but also be built into the home. This is a whole-person approach to selfmanaged care rather than looking at specific conditions.”
The project fits with Ageing Society, one of the ‘4 Grand Challenges’ identified in the Government’s recent Industrial Strategy White Paper, which says: “We will harness the power of innovation to help meet the needs of an ageing society.” Dr Fotis said: “We will also be leveraging our digital health ecosystems to other teams at the University of Brighton who may want to explore additional aspects of healthy ageing.” The project came about through an initiative called Leading Places which saw Brighton and Hove City Council and the universities of Brighton and Sussex working together to draw on Brighton’s expertise in pharmacy, allied health, digital design and architecture. The project explored the development of strategies for selfmanaged care for older people.
Brace helps realign the knee to its original gait THE TVS knee brace is designed to hold a medially or laterally unstable knee from moving into a painful position of deformity while the knee is in extension and weight bearing.
While the patient is wearing the TVS Brace the knee will be realigned to its original gait and long term use will stop the knee from sagging to a more extreme position preventing the need for a surgical solution. The TVS has helped relieve arthritic knee pain to over 25,000 patients in the UK alone for over 40 years. n Varus (bow-legged) and Valgus (knock-kneed) deformation support. More than 21,000 experts from various disciplines and professions will come together to present and discuss the quality of treatment, innovations in technology at OTWorld, International Trade Show and World Congress from May 15 to 18.
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ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
n Helps relieve arthritic knee pain.
n NHS approved and clinically proven for over 40 years. n Easily attached and removed in seconds. n Ultra lightweight (200grams/8oz). n Greatly increase stability and security for the wearer. n Comfortable to wear and unobtrusive (can be worn under clothes). n Suitable for both legs. For more information call 02380 643402, email sales@stclare-engineering.co.uk or visit www.tvskneebrace.co.uk
A NEW £3million programme has been launched to support higher education in small, specialist healthcare disciplines that are experiencing difficulty in recruiting or retaining students.
The programme will also facilitate work-shadowing facilities specifically in orthoptics, and fund a co-ordinator to develop work placements and apprenticeships in prosthetics and orthotics.
The disciplines identified for support are prosthetics and orthotics, therapeutic radiography, podiatry, and orthoptics.
Ed Hughes, head of health and medicine at HEFCE, said: “HEFCE is very pleased to be able to provide a range of support for higher education in these small and specialist disciplines, which will help maintain the pipeline of healthcare professionals in these areas to meet the future needs of students, healthcare providers and patients.”
The HEFCE-funded Strategic Interventions in Health Education Disciplines programme starts this spring, and will enable a range of activities to help ensure the sustainability of higher education courses in these areas. The interventions include a national marketing and communications campaign to encourage students to apply, and employing outreach and communications officers to coordinate an outreach network and share best practice. There will also be a ‘challenge fund’ offering higher education providers with finance for innovative approaches to delivering or recruiting to their courses.
The College of Podiatry is a key partner in the programme, and will develop, deliver and manage the communications and marketing campaign and coordinate the outreach network. Chief executive, Steve Jamieson, added: “Raising awareness and building understanding of these vital health disciplines is critical if we are to continue to attract students and so ensure the future health skills mix required to meet the needs of patients.”
Chris Fielding from Newlife with Jiraffe’s Holly Jenkins.
NEWS
New support for higher education courses in specialist disciplines Firm partners with charity SPECIALIST equipment provider Jiraffe has made children’s disability charity Newlife its first charity of the year, with the two organisations working in partnership to improve the lives of children with disabilities. Sheffield-based Jiraffe is a family business that supplies innovative postural care products across the UK including seating, standing, sleeping, therapy, mobility and bathroom equipment. Newlife is the largest UK charity providing specialist equipment for disabled and terminally ill children. Many families rely on Newlife when equipment from statutory services is refused or there are delays in
provision. Jiraffe aims to raise £5,000 for Newlife ,with staff taking part in a programme of activities throughout the year. These range from in-house raffles and bake sales to innovative volunteering events where team members de-tag clothing donated from high street retailers. This enables Newlife to sell products at their stores throughout the UK, providing vital funds for the charity to support disabled children and their families. Jiraffe team members will take on the gruelling Yorkshire Warrior obstacle challenge at Ripley Castle, near Harrogate.
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Podiatry management in children By Vince Zevallos
NEWS
FOOT and lower limb conditions such as pes planus, gait malfunction, and tendon-ligament injuries are relatively common among children. The structural development of the lower limb during childhood, environmental factors such as obesity or excessive physical activity, and heritable disorders, are all key factors to consider during a comprehensive podiatric assessment, and are vital in preventing future lower limb pathologies. Increased weight gain in childhood has been linked to an increased risk of skeletal fractures, musculoskeletal pain, and misalignment conditions such as Blount’s disease and genu valgum [1, 2]. Furthermore, obesity and rapid physical development during childhood are key contributing factors to foot pathologies such as pes planus. Although obesity might not be directly causing pes planus and rather favoring a lowered longitudinal arch or a thicker midfoot plantar fat pad [3,4], there is evidence suggesting that obesity contributes to increased plantar pressure, altered foot biomechanics, and foot pain [5], therefore limiting the likely participation in physical activity programs and contributing to a sedentary lifestyle. The promotion of physical activity under appropriate parameters has beneficial effects to general health status and wellbeing. However, childhood growth and development may not be entirely compatible with intensive exercise regimes [6]. Although regular physical activity has been linked to decreased body fat, bone mineralisation, and improved
cardio-respiratory functions [7-9], excessive childhood physical activity also increases the risk of injury and alteration of physical development, particularly affecting tendons and ligaments at the ankle [10]. Genetic factors are also key determinants in the aetiology of paediatric lower limb injuries. EhlersDanlos Syndrome (EDS) is a heritable disorder caused by a collagen defect and characterised by joint hypermobility and high likelihood of dislocation and subluxation, skin hyperextensibility, and tissue fragility. Although EDS is not a very prevalent condition (1 / 5000 worldwide), there are thirteen subtypes based on specific mutations that alter the structure, production, or processing of collagen or proteins that interact with collagen [11]. Thus, EDS has a direct effect on ligamentous laxity at an early age, often leaving individuals coping with its complexities for many years before diagnosis. In fact, there are many undiagnosed young adults suffering with associated symptoms relating to a heritable connective tissue disorder pathology that would have benefited from expert assessment or review in their childhood. Therefore, common paediatric lower limb conditions such as pes planus, gait malfunctions, tendon-ligament injuries, and hypermobility, require a careful podiatric assessment focus on musculoskeletal components including weight bearing and nonweight bearing range, quality, and direction of motion. Treatment options usually include foot orthoses, stretching / strengthening exercises, and footwear evaluation at regular intervals during periods of growth and development.
The prescription, design, manufacture, and issuing of paediatric foot orthoses requires a careful selection of materials considering their physical properties and biocompatibility, from plastic homo-polymers or co-polymers (polypropylene or polyethylene) to foam materials or cellular rubbers, depending on the required flexibility, strength, comfort and durability. Polyethylene is a flexible, low stiff material with low breaking rate and does not shrink when exposed to heat. It will provide shock absorption and control to balance a misaligned foot, for example, abnormal pronation, supination, or instability. Foam materials or cellular rubbers manufactured with diverse types of sponge, latex foam, expanded rubber, and subclasses of open and closed cell polyurethanes, provide flexibility and comfort. Thus, the main aim of foot orthoses is to improve foot function and to reduce symptoms in a wide range of lower limb problems. To conclude, paediatric foot and lower limb conditions are likely to be influenced by structural development and external factors such as body weight gain and high level of physical activity. Signs and symptoms of lower limb discomfort and their effect on quality of function should not be ignored as an early podiatric intervention can lead to successful treatment options that could prevent potential adult lower limb complications. Vince Zevallos Herencia is Algeos Head of Education and Research and Development Podiatrist. He has worked within; Private Practice (MDT group), NHS PCT, Social enterprise (CIC), NHS Foundation Trust and now Industry. Vince has experience in health
promotion, completed training in DM, Theory of Podiatric Surgery and material science. He was able to put some of his experience into practice while managing a Podiatry team and an orthotic laboratory in Medway before going on to lead an MSK department. References 1. Chan G, Chen CT. Musculoskeletal effects of obesity. Curr Opin Pediatr. 2009; 21:65–70. [PubMed: 19242242] 2. Taylor ED, Theim KR, Mirch MC, Ghorbani S, Tanofsky-Kraff M, Adler-Wailes DC, et al. Orthopedic complications of overweight in children and adolescents. Pediatrics. 2006; 117:2167– 74. [PubMed: 16740861] 3. Mickle KJ, Steele JR, Munro BJ. The feet of overweight and obese young children: are they flat or fat? Obesity (Silver Spring). 2006; 14:1949–53. [PubMed: 17135610] 4. Adoracion Villarroya M, Manuel Esquivel J, Tomas C, Buenafe A, Moreno L. Foot structure in overweight and obese children. Int J Pediatr Obes. 2008; 3:39–45. [PubMed: 17852546] 5. Willems TM, De Clercq D, Delbaere K, Vanderstraeten G, De Cock A, Witvrouw E. A prospective study of gait related risk factors for exercise-related lower leg pain. Gait & posture. 2006; 23:91–8. [PubMed: 16311200] 6. Moreno JA, Moreno R, Cervelló E. El autoconcepto físico como predictor de la intención de ser físicamente activo. Psicol Y Salud 2007;17:261–7. 7. Pan Y, Pratt CA. Metabolic syndrome and its association with diet and physical activity in US adolescents. J Am Diet Assoc 2008;108:276–86. Discussion 286. 8. Fehily AM, Coles RJ, Evans WD, Elwood PC. Factors affecting bone density in young adults. Am J Clin Nutr 1992;56:579–86. 9. Loprinzi PD, Cardinal BJ, Loprinzi KL, Lee H. Benefits and environmental determinants of physical activity in children and adolescents. Obes Facts 2012;5:597– 610. 10. Angoorani H, Haratian Z, Mazaherinezhad A, Younespour S. Injuries in Iran futsal national teams: a comparative study of incidence and characteristics. Asian J Sports Med 2014;5. 11. Malfait et.al. The 2017 international classification of Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C (seminars in medical genetics) 2017: 175C, 8-26.
‘Stand Up for Legs’ campaign finds its feet LOWER leg and feet disorders are often overlooked by patients, carers and clinicians leading to thousands of people needlessly suffering simply because there is a lack of awareness.
The campaign will actively promote high quality lower leg and foot care via a national campaign which will focus on public awareness and raising the political profile of lower limb issues.
Now, a lecturer from the University of Huddersfield, together with a team of experts, has been awarded funding from the Urgo Foundation to launch a national campaign to ensure these ailments no longer go unnoticed. Leanne Atkin is lecturer in the University’s Institute of Skin Integrity and Infection Prevention. For the last six months she has been a part of a steering group – consisting of eight healthcare organisations – formulating their manifesto for a campaign entitled Your Legs Matter, urging patients and clinicians to “Stand Up for Legs”. “Leg ulcers are four times more prevalent than pressure ulcers,” said Leanne.“Yet there is a lack of 14
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2018
Leanne Atkin, lecturer and vascular nurse consultant.
awareness among the public of lower leg and foot conditions and the importance of seeking out the right advice and treatment. “Most leg and foot problems can be improved and indeed prevented given the right care, especially if addressed early.”
A public facing website is also in development and this will inform patients, carers, clinicians, educational institutes, commissioners and politicians about the importance of seeking appropriate help for these conditions early on. The campaign will officially launch at the Tissue Viability Society annual conference in April. Leanne’s research has also led to the creation of a leg algorithm published by Wounds UK in their Best Practice Statement for Holistic Management of Venous Leg Ulceration. By following the algorithm, anyone can successfully take care of a leg ulcer which in turn will positively impact
the NHS. She added: “If used correctly the number of nurses visits can reduce by half. It is cheaper and leads to a better outcome for the patient as they heal quicker and there is less nursing involvement.” As well as conducting her own valuable research into leg ulcers within the University’s Skin Institute alongside Professor Karen Ousey, Leanne still works in practice as a vascular nurse consultant for the MidYorks NHS Trust. Her methods and hard work were recently recognised by the National Institute for Clinical Excellence as she was recruited to be one of their clinical experts. In this role, she will review NICE’s peripheral artery disease guidelines and ensure their advice for experts looking after the disease continues to be the very best in clinical excellence.