Clinical Specialties - AOPA

Volume 1 / Issue 2 / December 2016www.aopa.org.au

THE

AOPA

DISCOVER THE ORTHOTIC & PROSTHETIC PROFESSION

Clinical Specialties Advancing P&O

Case Studies & Practical Guides

How you can promote Prosthetics and Orthotics

NEW RESOURCE:

SUPPORTING PRIVATE PRACTICE

For further information on items in this Review please contact:

Editor, AOPA Offi ce,PO Box 1219, Greythorn VIC 3104Ph: 1300 668 194 / (03) 9816 4620Fax: (03) 9816 4305 E-Mail: [email protected]

The AOPA Review is produced in June and December and is sent out to all AOPA members. Please contact the editor if you would like any information regarding advertising rates. The inclusion of advertising in no way implies endorsement by the Association.

THE

AOPA

THE AOPA REVIEW

WelcomeAfter the success of the fi rst edition of your new-look Review, the Editorial Committee, National Offi ce and AOPA Board are thrilled to present the December edition.

The theme for this edition is ‘Clinical Specialties in Prosthetics and Orthotics’. Inside you’ll fi nd the new AOPA Clinical Specialty Resource that promotes the amazing diversity of roles orthotist/prosthetists perform, as well as feature articles that provide an insight into the vital work AOPA members conduct each day. Read more about how you can use this new range of tools to promote the profession and advance P&O on page 7.

Discover more about a range of clinical topics including Cheneau bracing, plantar fasciitis management and developmental dysplasia of the hip in a range of case studies, clinical notes and research articles. Then fi nd out how to start-up your own private practice with the release of the AOPA Private Practice Resource that provides practical and easy-to-follow points to consider when developing a new business. Read about how you can support your clients with a new range of tools, from Limbs 4 Life, available for those living with limb-loss.

Catch up on P&O education with an introduction to the University of Sunshine Coast program and hear more about the Rio 2016 Paralympics from a team of Australian P&O’s. Finally, read about the workshops and presentations that you may have missed at the 2016 AOPA Congress.

We want to hear from you!Help us make The AOPA Review become the leading source of information relating to the orthotic/prosthetic profession in Australia. Help us showcase the valuable contribution our profession makes to the Australian healthcare system and highlight the unique skill sets of our practitioners. Get in touch if you’d like to submit an article for publication. Suggested articles include:

• Feature articles on clinical topics• Case studies• Research articles• Exploration of issues that impact our profession in

Australia• Introductions to new orthotic/prosthetic technologies• Member reviews of new technologies• Overviews of education events• Contributions from other allied health professionals

and related disciplines

We encourage you to submit articles or content by contacting any member of the Editorial Committee or the National Offi ce. We also encourage you to suggest ideas or tell us what you’d like to see published in upcoming editions. This is your member magazine and we want to provide high quality content that is valuable to you.

Guidelines for submitting articles are available on the AOPA website: http://www.aopa.org.au/publications/the-aopa-review

Earn extra CPD pointsYou can now gain some extra CPD points just by reading The Review. A brief online quiz will be available to complete for each edition. Make sure you keep an eye out for one of our upcoming member emails which will contain details of how to complete this quiz. Simply follow the links and correctly answer the quiz questions to earn valuable CPD points!

Thank you to each of our contributors to the second edition of The Review. We hope you enjoy reading it and fi nd each of the articles as interesting and informative as we did!

The AOPA Editorial Committee

CHAIR’S REPORT

Yours respectfully,

Harvey BlackneyChair, AOPA Board of Directors

Since the mid-year and the fi rst publication of our new review magazine, much activity has occurred. In line with our strategic plans and evolution over the past 5 years, our association continues its transition from a focus on internal infrastructure development, to external directed activities. Our aim to engage with end-users and external policy agencies continues to gather momentum and deliver outcomes. In line with our strategic plan, we continue to work on internal projects and the past 6-months has seen us strengthen our self-regulation platform.

Our offi ce team continue to foster cooperation and work diligently with consumer groups, along with external government and funding agencies, to improve end user access to our services. We have been making solid progress and our aim is to have the opportunity to deliver the appropriate and required services to those members of the Australian community requiring prosthetic & orthotic intervention. Those services are to be outcome focused and evidence based, and deliver value to consumer and funder alike. Work continues with the private health insurance association, Medicare, NDIS, and multiple state-based agencies. In particular, our offi ce team continue to work closely with senior NDIS to support the roll-out of the program.

We have just concluded our sixth and most successful Congress. The Congress saw in excess of 340 delegates in attendance, exceeding our prior record attendance of just under 300. Sarah Anderson and her dedicated and hard-working convening team, delivered an outstanding three days of learning and social activities, ably supported by our AOPA offi ce group. Our Congress continues to grow in quality and scale, and it has now established itself as THE event in the Australian P&O calendar for orthotist/prosthetists and our medical and allied health peers. The number of international delegates, exhibitors, presenters and keynote speakers continues to grow, and we look forward to further progress next year by proudly announcing the 2017 Congress will be heading to the Melbourne tennis center.

The transformation of our governance platform continues, and we are delighted to welcome Melanie Dooley to the board. Melanie brings an outstanding and much needed fi nancial capability to the board and our association, and will play a vital role in planning and overseeing our fi nancial activities. We now have a full complement of board members with three “non-industry” or independent directors, and seven directors who are members of the P&O profession. We also welcome Luke Rycken to the offi ce team, who is assuming the roles of Jackie O’Connor in the advocacy portfolio, and Ella Nicholson in the communications portfolio. Whilst Ella will return next year following maternity leave, we say farewell to Jackie and thank her sincerely for

the outstanding and tireless work she has performed over the past years. Our association and profession would not be as well placed without Jackie’s quality contribution.

We hope you enjoy the second edition of the Review. The AOPA board and offi ce team have received numerous positive comments from members in response to the fi rst edition, following the change to the regularity, quality, format and size of the publication. We are delighted to deliver our second edition, focusing on Clinical Specialties in Orthotics and Prosthetics. The Review will continue to represent a central and foundational vehicle in our aim to communicate, educate & inform. We hope the publication meets the memberships needs following our member survey performed early in 2016.

Every 4 years sees the running of the Paralympic games, and we have recently seen the completion of the 2016 event in Brazil. The increasing visibility of the Paralympic games continues to build awareness of the orthotic & prosthetic profession in Australia. Outstanding results achieved by many of our athlete’s, and the media’s desire to highlight athlete’s remarkable journeys, have provided many opportunities for the public to greater understand the contribution our members make.

It has been a big year for our profession, and we are seeing major shifts in regulatory and funding platforms across the country. We continue to aim to support and guide the progression of our profession and the quality and accessibility of our services. On behalf of the board, I wish our membership a safe festive season, and look forward to a further year of progress in 2017.

4 / December 2016 / Volume 1 - Issue 2 / The AOPA Review

The AOPA Review / Volume 1 - Issue 2 / December 2016 / 5

THOUGHTS FROM THE NATIONAL OFFICE

Hello members,

I hope you are enjoying the fi nal moments of 2016 which I know has been a highly successful year for the Association, the profession and individual members. This year seems to have disappeared quicker than normal, which possibly indicates how busy the National Offi ce has been. The Offi ce spends many months focused on the National Congress, supporting the convener and convening committee and developing workshops, forums and resources for launch. The 2016 Congress was our most successful event yet with record numbers of delegates, sponsors and exhibitors and additional events. Of note was the highly success Best Business Practice in your Practice workshop and the Leveraging Clinical Capacity Forum. These events were developed by the National Offi ce team and aimed to challenge our thinking and support the growth and development of private practice in Australia. Coinciding with these events was the launch of the AOPA Private Practice Resource Guide. This is now available for members to download from the website and offers extensive support for small and large private practices in areas such as insurance, establishing referral networks and promoting your business. Please do not hesitate to provide feedback on this resource and we hope that you fi nd it valuable.

I am also pleased to announce the beginning of AOPA’s fi rst public promotion activity. For the last few years there has been signifi cant time spent strengthening the Association’s regulatory role such as the development of competency standards, implementation of English language and recency of practice requirements and the launch of course accreditation. The Association is now able to confi dently represent the membership and make clear statements about the certifi cation process and standards to which our members are held. Therefore, it is now time to begin a campaign to raise awareness of the depth and breadth of clinical services delivered to the Australian community by the O&P profession. AOPA has developed a suite of fact sheets depicting several the clinical specialty areas for the profession. These are available on the AOPA website and we encourage you to download and print them for your facilities, placing your clinic details in the space provided on the second page.

We expect there will be a total of 20 fact sheets available for your use and accessible to the public. To support the release of these and our public education agenda we have also launched the AOPA Facebook page. AOPA is now pleased to provide a public social media resource where we share information on the profession for the public. This represents a substantial step for the Association, demonstrating that our regulatory development work is largely complete and our future ability to have proactive, public messages to deliver on behalf of our membership. This edition of The Review provides a snap shot of the clinical

Leigh ClarkeExecutive Offi cer, AOPA

specialties and we encourage you to join us on social media via Facebook, Twitter and LinkedIn to disseminate the message as widely as possible.

As a membership association one of the important measures of our growth and success is membership numbers and external engagement. The increased engagement with students, technicians and consumers at the AOPA congress is pleasing and indicates that people fi nd connecting with the Association valuable. Our total membership numbers are also telling and at the end of the 2016 renewal period, we are pleased to report total member numbers of 446 which has increased from 420 in April 2016. We welcome many new members and students to the Association and encourage you to contact the National Offi ce for assistance or support to access resources at any time.

In November, the National Board met to review strategic progress against the 2015-17 Strategic Plan. It has been a highly successful year for the Association with achievements in numerous areas including: membership growth, delivery of education events, development of member resources, advocacy and engagement with state and federal funding agencies, roll out of regulatory processes including course accreditation and assessment of competence and the development of key relationships with external stakeholders. I hope our members are experiencing an increase in benefi ts and representation and welcome feedback on areas of importance to you.

Thank you for your support in 2016. Best wishes to you and your family for Christmas and the holiday season and I look forward to delivering further outcomes in 2017.


CLINICAL SPECIALTIES

AOPA launches new promotional resource: Clinical Specialty Fact Sheetsp y

AOPA is incredibly excited to launch the fi rst series of clinical specialty fact sheets. The fact sheets are a new set of resources and tools to increase the recognition of orthotist/prosthetists amongst the community and promote the extensive range of clinical services provided by the profession.

The fact sheets highlight specifi c areas of clinical practice and illustrate the expertise of orthotist/prosthetists in clear language that is both easy to understand and share amongst the community.

AOPA encourages members to share each of the fact sheets with your personal and professional networks, to spread the word about the amazing and vital work that you perform every day, as well as the work of your fellow P&O’s.

What are the Fact Sheets?The fact sheets are double-sided information leafl ets that provide practical information on specifi c areas of interest to consumers. Each fact sheet provides an overview of a specifi c condition and clearly illustrates the service provided by orthotist/ prosthetists. Space is

provided on each fact sheet to affi x practice details and information is provided to enable consumers to easily locate a certifi ed orthotist/prosthetist. A full-size fact sheet can be found over the page.

AOPA has worked with experts in each specialty area to examine available evidence and current practices. The fact sheets explain this information in language appropriate for potential orthotic and prosthetic consumers and provides a small summary with key points.

Every fact sheet explains what an orthotist/prosthetist is and their role in supporting clients. Emphasis has been placed on ensuring that orthotist/prosthetists are correctly portrayed as highly-trained professionals that are the primary experts in managing each condition.

“Every fact sheet explains what an orthotist/prosthetist is and their role

in supporting clients.”


CLINICAL SPECIALTIES

How can I use these to promote P&O?AOPA encourages you to share, display and distribute the fact sheets amongst your personal and professional networks. Suggestions to do this include:

• Provide printed copies in your practice and to clients that may fi nd the information useful.

• Add the fact sheets to your practice website and social media accounts, including Facebook, Twitter and LinkedIn.

• Share the fact sheets on your personal Facebook accounts, to increase awareness of the orthotic/prosthetic profession amongst the community.

• Distribute the fact sheets to colleagues as a useful reference for a particular area of practice.

“increase the profi le of orthotist/prosthetists by joining in the

conversation and contributing to the promotion of P&O.”

Current Clinical SpecialtiesThe fi rst seven clinical specialty areas were selected in conjunction with AOPA members to exemplify the support Orthotist/Prosthetists provide to the Australian community. The fi rst seven fact sheets include:

• Scoliosis and Kyphosis

• Diabetes Related Foot Disease

• Sports and Recreational Prostheses

• Paediatric Orthotic Management

• Foot Orthoses

• Upper Limb Prostheses

• Plagiocepahly

Future Fact SheetsAOPA is currently working with a range of experts to develop the next series of fact sheets, which will be published on the AOPA website. If you would like to help develop further fact sheets, please contact the AOPA Offi ce. AOPA is in particular need of high-resolution images that can be used in future fact sheets. If you are able to provide images, please get in touch.

AOPA is proud of the thorough and consultative method of developing the Clinical Specialty Fact Sheets and would like to sincerely thank all of the members that provided advice, resources and content. AOPA members have been fundamental in developing these resources, that would not have been produced without their invaluable support. Thank you to everyone involved.

Fact sheets in development include:

• Acute Spinal Injury

• Burns Management

• Management of Neuromuscular Conditions

• Sports Injury

• Post-amputation Rehabilitation

• Osseointegration

t sheets in development include:


What is an orthosis?An orthosis (pl. orthoses) is an externally applied device that is designed and fitted to the body. Orthoses (historically known as splints or braces) are described by the body part they encompass. An orthosis may be used to correct body alignment, support function, minimise discomfort or pain, protect a body part after injury or surgery, re-distribute pressure, correct deformity or assist in rehabilitation.

Orthoses in paediatrics – who needs them?Orthoses play an important role in supporting development and therapeutic intervention across a range of pathologies in the paediatric population – from hip orthoses to encourage hip development in newborn babies, to spinal orthoses to reduce abnormal spinal curves in adolescents with scoliosis or kyphosis.

Hip orthoses for babies with developmental dysplasia of the hip (DDH) What is DDH?Developmental dysplasia (or dislocation) of the hip (DDH) is an abnormal development of the hip joint. The ball at the top of the thighbone (the femoral head) is not stable within the socket (the acetabulum). The ligaments which hold the joint together may also be stretched and loose. DDH can occur in one or both hip joints.

How do hip orthoses help?Babies with DDH can be successfully treated with hip abduction orthoses. There are different types of hip abduction orthoses – a pavlik harness, a ‘Denis Browne’ brace, a ‘Rhino’ brace. Though varied in design, these hip orthoses all hold the hip joint in the most stable position – with the thigh ‘up and out’ - so that the ligaments tighten and the hip joint develops normally. An orthotist works with a multidisciplinary team and the family to determine the hip abduction orthosis design that best meets the hip position requirements of the individual baby.

Clinical specialties in orthotics and prosthetics

Orthoses in paediatrics: supporting development and therapeutic intervention in babies, children and young people

Image Courtesy of Orthokids

Cranial orthoses for babies with positional plagiocephaly and brachycephalyWhat is positional plagiocephaly and brachycephaly? Positional (or deformational) plagiocephaly (pron. play-gee-o-kef-a-lee) and brachycephaly (pron. brak-ee-kef-a-lee) are types of cranial deformity – meaning a misshapen head. Plagiocephaly occurs when there is flattening on one side of the head, causing asymmetry. Brachycephaly occurs when there is flattening of the back of the head. Plagiocephaly and brachycephaly are common cranio-facial conditions that occur most often when babies spend prolonged periods lying with their head in the same position.

How do cranial orthoses help?Cranial orthoses are a treatment option for babies with more severe deformity, where counter positioning is not possible or has not improved head shape, and who also have good head control. A cranial orthosis is a custom-made helmet fabricated with a hard plastic shell and foam lining. An orthotist designs the helmet to redirect skull growth by fitting closely to the head but leaving room for growth in the flattened area. Refer to the Plagiocephaly and Brachycephaly Clinical Specialty Fact Sheet for further information.

Foot abduction orthoses for children with Congenital Talipes Equinovarus What is Congenital Talipes Equinovarus?Congenital Talipes Equinovarus (or CTEV or congenital clubfoot) is the most common congenital deformity affecting 1 in 1000 live births. In CTEV, the foot is twisted, pointing inward and downward.

Denis Browne Brace

Image Courtesy of Orthokids

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Cranial Remodelling Helmet


Orthotists – supporting the Australian communityHow do foot abduction orthoses help?The foot abduction orthosis is also known as ‘boots and bar’. It is part of the gold standard treatment for treating CTEV as part of the Ponseti method. This method begins with manipulation and casting to stretch the foot into a corrected position, then often a small operation is performed to lengthen the Achilles tendon (a tenotomy), and finally, wearing of special boots, connected by a bar (the foot abduction orthosis) to keep the feet in their corrected position and avoid relapse. An orthotist works as part of a multidisciplinary team in the selection and fitting of foot abduction orthoses to support therapy and surgical interventions.

Ankle-foot orthoses for children with cerebral palsyWhat is cerebral palsy?Cerebral palsy (or CP) is a neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is still developing — before birth, during birth, or immediately after birth. Cerebral Palsy primarily affects body movement and muscle coordination. Cerebral palsy is the most common childhood physical disability in Australia.

How do ankle-foot orthoses help?The most common type of orthosis used to help children with cerebral palsy is the ankle-foot-orthosis (or AFO). AFOs are custom-made and encompass the foot, ankle and lower leg. The design and purpose of the AFO is different according to each person’s unique needs and goals, which often includes supporting or correcting abnormal limb positioning, preventing deformity, providing a stable base for sitting and standing, and facilitating a safer and more efficient walking pattern. AFOs are also used by children who have other conditions such as spina bifida, developmental delay or CTEV. Orthotists work with the client, family and members of the multidisciplinary team to determine the most appropriate AFO to help each child meet their personal goals.

Spinal orthoses for adolescents with scoliosis and kyphosisWhat is spinal deformity?Spinal deformity is an abnormal curvature of the vertebral column. Two common spinal deformities are Adolescent Idiopathic Scoliosis (AIS) - a sideway curvature of the spine with rotation resulting in a rib hump; and Scheurman’s kyphosis – an increased forward curve of the thoracic (upper) spine presenting as rounded shoulder.

How do spinal orthoses help?Spinal orthoses provide corrective forces on the spine to promote symmetrical spinal alignment in adolescents who have moderate structural curves (scoliosis 25-45° or kyphosis 55-80°) and who are still growing. Spinal orthoses effectively prevent curve progression in AIS and reduce kyphotic curves in people with Scheurmann’s disease. Orthotists combine knowledge of complex anatomy and biomechanics to design and fabricate an orthosis (made out of rigid plastic) that incorporates the necessary forces to correct spinal alignment. Refer to the Spinal Clinical Specialty Fact Sheet for further detail.

Who provides orthoses?An orthotist (pron. or-tho-tist) is a tertiary qualified Allied Health Practitioner who is trained to assess and treat the physical and functional limitations of people, using orthoses. Orthotists are responsible for paediatric orthotic management including DDH, plagiocephaly, CTEV, cerebral palsy, scoliosis and kyphosis. Orthotists combine clinical and biomechanical expertise with their knowledge of current evidence, materials and product developments to support children with developmental and mobility impairments to meet their personal goals.

How do I access an orthotist?If your child requires orthotic management for one of these – or any other – condition, your GP or medical specialist will refer you to an orthotist. Certified Orthotist/Prosthetists ‘cOP-AOPA’ can also be located using the ‘Find a practitioner’ search function on the AOPA website (www.aopa.org.au).

Disclaimer – This fact sheet does not replace clinical advice. If you require orthotic services AOPA recommend speaking to your practitioner. This fact sheet was developed based on interpretation of current evidence as of August 2016. References available on request.

Orthotic management in paediatrics:

orthotic intervention – including those with Developmental Dysplasia of the Hip (DDH), deformational plagiocephaly, Congenital Talipes Equionovarus (CTEV or clubfoot), cerebral palsy, scoliosis and kyphosis

and support functional goals such as sitting, standing and walking

children and young people by providing comprehensive and evidence based orthotic care and interventions

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PROMOTING THE PROFESSION

AOPA Joins Facebook

AOPA is incredibly excited to launch an association Facebook page to engage with the community and promote the profession. Whilst AOPA has maintained a presence on both LinkedIn and Twitter, Facebook is the most effective platform to communicate with the community and increase the profi le of orthotist/prosthetists nationally.

To achieve this, AOPA will be promoting resources that concern the community and sharing articles and links when the profession is featured in the media. Recently, AOPA engaged with companies on Facebook after they featured orthoses in advertisements, and shared and promoted an article regarding changes to prosthetic funding in South Australia. In continuing to do this, the profession can raise the profi le of orthotist/prosthetists and ensure that we are clearly linked to the services we provide. Every time the profession is featured in the media presents an opportunity to further engage with the community and increase the awareness of orthotic and prosthetic services.

Throughout 2017 AOPA will also be utilising Facebook to promote the profession by featuring a particular clinical specialty every two weeks. In doing this, AOPA hopes to promote the services orthotist/prosthetists provide that may be less well-known or commonly associated with other professions. To support this, AOPA would be incredibly grateful if you could share, post and like each promotional post on the AOPA Facebook page.

Every AOPA member has the potential to increase the profi le of orthotist/ prosthetists by joining in the conversation and contributing to the promotion of P&O. Each time you write a personal post or share an AOPA post on Facebook you expose the orthotic/prosthetic profession to hundreds of additional consumers and people in the community. Join the AOPA Facebook page today to begin supporting the future of P&O in Australia.

Find AOPA on Facebook here: www.facebook.com/AOPAnews/

To support and promote the profession AOPA has developed an association Facebook page: www.facebook.com/AOPAnews/


Wesley Pryor Senior Technical Adviser at the Nossal Institute for Global Health

An International P&O CareerWes Pryor recently spoke at the AOPA and Ottobock Student Event. AOPA are pleased to provide his perspective on prosthetics and orthotics internationally.

INTERNATIONAL P&O PERSPECTIVES

Thanks to AOPA and its members for their extraordinary commitment to strengthening P&O in Australia. It's a real privilege to share some thoughts about the international dimension of our sector. Healthcare and technology are changing quickly. As P&O professionals, we must think of ourselves as being critical parts of that puzzle. I am always a bit embarrassed to be talking to P&Os about their profession, but am very glad to be able to continue learn from them and imagine how we might work together. I always wanted to be a P&O, plaster on-shoes, carbon fi bre, ovens, all of it. But I never got around to it.

With that in mind, AOPA has asked me to share a few thoughts about my career.

I am at least the proudest P&O there is, but I haven't had a typical career. Most of the time, I'm at a desk. Sometimes that desk is in other countries, but it’s a desk anyway. I started out at 15, compelled by the landmine legacy. Confl ict in Cambodia for the most part had ended, but the landmine legacy was still in the news. Somehow that news made it to Western Victoria. So I studied P&O and completed a clinical placement in Cambodia.

I wound up doing an evaluation of an aid project after the 2001 earthquake in western India and then ended up completing short term evaluation work in Iraqi Kurdistan. It opened my eyes to the changing policy environment, and the daily challenges of people living in and around confl ict. I applied for a few other jobs in health agencies, thinking there might be something for a P&O to do. I failed miserably in these attempts, but some of the people on those panels are now great mentors and have helped bring assistive technology and allied health into discussions about inclusion, rights and development.

In 2007 I began advising on P&O for Handicap International, who work across disability in development and emergency, in partnership with local agencies rather than providing services directly. In that role I lead teams, evaluated what works, and designed new programs. I did this for nearly 10 years, in about 15 countries. I now work in rehabilitation in global health. I have awesome colleagues, all with the same key things in mind: equity in health, and rights for people with disabilities. This means working with people with disabilities and policy makers to ensure disability inclusion is taken seriously in development practice. We also work to

strengthen rehabilitation and to address the unmet need for assistive products, which for many people are essential determinants of equitable participation in development.

Still, I truly envy those who get to work with people every day. As Australian P&Os we have peers working around the world in extremely complex scenarios, making a massive difference in peoples’ lives. I think they demonstrate the idea of P&O in international health much more than my work.

Improving access to services and basic rights for all is obviously a complex challenge and rehabilitation and allied health are not always a neat fi t. But, the situation is getting better. Decent rehab is absolutely on the development agenda. Your work, as a P&O, is highly valued and P&O's are rightly seen as essential professionals with unique skills that are necessary if the need for assistive technology is to be met. Advocating for what we do is still important, but we must now capture good evidence and practice detailing what works in improving access to services, and seek to strengthen them further. For me, the challenge is still mostly about connecting people to services that already exist, and to ensure those services are appropriate, fair, and meet the needs of the ever-growing number of consumers. These goals are exactly what AOPA and its members are all about. The next phase of strengthening and extending rehabilitation in general and P&O specifi cally will involve industry, educators, researchers and consumers working together. Professional associations are situated better than anyone to make those connections.


Felicity Williams (cOP-AOPA) & Wayne Borgelt (cOP-AOPA) Sydney Children’s Hospital

A comparison of a Boston TLSO and a Cheneau TLSO with Rigo principles in a patient with Adolescent Idiopathic Scoliosis

Figure 1. a) Pre-treatment x-ray, December 2012. b) Initial in-brace x-ray, May 2013. c) Curve progression in fi rst brace, March 2014.

Patient X, a 10.5 year old female presented to our department in February 2013 for treatment of her scoliosis. X-rays showed a 25˚ right thoracic curve and a 35˚ left lumbar curve at initial presentation (fi gure 1a). A cast was taken and she was fi t with a custom made Boston-style TLSO in March 2013 (fi gure 1b). As per our standard procedure a standing AP radiograph was taken six weeks after the initial fi tting. This showed good correction of the thoracic (25˚ to 12˚, 50% correction) and lumbar curves (35˚ to 20˚, 42% correction). Additional loading pads were applied at this time in an attempt to increase correction in the lumbar curve but additional x-rays were not taken.

X was a diligent brace wearer who would only allow her Dad to fasten the brace as Mum couldn’t fasten the straps tight enough for her liking. Despite her diligence, a radiograph in March 2014 showed that the lumbar curve had progressed to 30˚ in brace. A cast was taken and a new custom Boston-style TLSO was fi t in April 2014. Although multiple modifi cations were made at the time of fi tting the best in-brace correction obtainable was only 24˚ (31% correction). At this time it was decided to recast and fabricate a Cheneau TLSO with Rigo principles in an attempt to gain better correction of the lumbar curve.

The Cheneau TLSO utilises a system of very specifi c and detailed criteria to classify curves that directly relates to brace manufacture. There are both clinical and radiological criteria used to classify the curve pattern with four main classifi cations and nine substyles. Each of these provides a unique brace specifi c ‘blueprint’. A table showing these criteria can be found in Table 1.

CASE STUDY


CASE STUDY

Figure 3. a) X-ray in Cheneau TLSO May 2015. b) X-ray at end of treatment July 2016.

Figure 2. a) Out of brace x-ray April 2014 showing the transition point and central sacral line b) Radiological criteria for an E2 type brace c) E2 brace ‘blueprint’ (Adapted from Rigo, Villagrasa & Gallo, 2010).

REFERENCESLandauer, F; Wimmer, C; Behensky, H. (2003). Estimating the fi nal outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Ped Rehab, 6(3-4), pp. 201-207.Rigo, M; Villagrasa, M; Gallo, D. (2010). A specifi c scoliosis classifi cation correlating with brace treatment: description and reliability. Scoliosis 5:1. Negrini et al. (2012). 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 7:3.

Therefore, when we decided to make X a Cheneau style TLSO, we obtained an out of brace x-ray so she could be radiologically classifi ed (fi gure 2a). Radiologically X was borderline between B2 and E2 types, however clinically she met the E2 criteria as there was no rotation present in a forward bend test indicating that the thoracic curve had become a compensatory postural curve (rotation was present in the thoracic curve on initial presentation). Where there are discrepancies between clinical and radiological criteria the clinical classifi cation tends to take precedence. Therefore, an E2 type TLSO was fabricated and fi t in May 2014.

X-rays in her E2 Cheneau TLSO showed excellent in-brace correction of the lumbar curve (down to 8˚, 77% correction) and a negligible thoracic curve (fi gure 3a). A new Cheneau E2 was fi t in December 2015 with excellent correction once again obtained (10˚, 71% correction).

In July 2016 bracing was discontinued as a bone age x-ray showed that X was skeletally mature. An out of brace x-ray performed at this time showed that the lumbar curve was 23˚ (fi gure 3b).

It has been reported that patients with good compliance and greater than 40% correction are likely to have a stable reduction in Cobb angle at skeletal maturity (Landauer, Wimmer and Behensky, 2003). Although X initially had good correction of her lumbar curve (42%) in the Boston brace, at a 12 month follow up her curve had progressed in brace. If we had continued in the Boston brace her outcome was likely to have been poor. By changing to the Cheneau brace we achieved over 70% correction and a stable curve at skeletal maturity of 23˚ equating to a 12˚ reduction of her initial Cobb angle. With the primary aim of bracing being to simply prevent curve progression (Negrini et al. 2011), a reduction of Cobb angle at the end of treatment was an excellent outcome.


CASE STUDY

Table 1 – Cheneau Classifi cations. Adapted from Rigo, Villagrasa and Gallo, 2010.


Tricia Malowney Consultant and AOPA External Director

Introducing a Consumer AdvocateAOPA would like to introduce Tricia Malowney, AOPA Board member, disability and equality advocate, and P&O consumer.

BOARD INTRODUCTION

Tricia Malowney contracted polio at four months, using callipers until she was 16, at which time her surgeon told her that they were no longer required, a decision she now considers totally inappropriate. At age 36, Tricia developed post-polio syndrome, and at 46 retired from a management position as a policy and research offi cer, and educator with Victoria Police. Tricia now uses a stance control KAFO and crutches as mobility aids, and is always keen to espouse the benefi ts of good quality orthoses and the work of prosthetist/orthotists.

A key focus of Tricia's work is centred around improving access to services for people with disabilities, with an emphasis on access to justice and health as well as ending violence against women with disabilities. Tricia now works as a consultant, which enables her to contribute to inclusive practices through policy review, facilitation and development and by providing advice to the disability and mainstream sectors, including AOPA.

Tricia is a past President of the Victorian Disability Services Board and has roles on a range of disability and mainstream boards and committees, in addition to AOPA, including the Chair of Independent Disability Services Board and Director at Scope. Tricia is also a member of the Coroner's Systemic Review of Family Violence Deaths Reference Group and the Eastern Region Family Violence Partnership Executive Committee.

Tricia has previously been Deputy Chair of the Victorian Disability Advisory Council and was the inaugural chair of Women with Disabilities Victoria and the Royal Women’s Hospital Disability Reference Group, inaugural Co-chair of the Victorian Equal Opportunity and Human Rights Commission Disability Reference Group and had a ministerial appointment as the community representative on the Road Based Public Transport Advisory Council. She has served on both the Board of Women's Health Victoria and the Board of Women's Health East. Tricia was also the recipient of the inaugural Brenda Gabe Award by Women with Disabilities Victoria in November 2013, that included a scholarship to attend the Pacifi c Rim Disability Conference in Hawaii and present a paper on disability and leadership. An Ethel Temby research grant further enabled her to travel to Ireland in 2015 and look at their national disability strategy, particularly as it pertains to access to mainstream

services such as health, justice and employment, and bring the learnings back to the Victorian State Disability Plan and the National Disability Strategy.

Tricia's is passionate about the NDIS and was a campaigner for its introduction, and now campaigns for its implementation. However, she also believes that we also need to implement the National Disability Strategy and the State Disability Plan and the Information Linkages and Capacity Building component of the NDIS, previously ‘Tier 2’. Recognising the compounding nature of disadvantage, Tricia is committed to ensuring that a disability lens is applied to the development of mainstream policies and procedures, and that a gender lens is applied to the disability sector.

“We have access to an amazing range of prosthetic componentry and the possible outcomes for each client

are far greater.”


CLINICAL TOPICS

Barry Leech (cOP-AOPA)

Lower Limb Prostheses Through the Years: An Experience

In February 1964, I was seeking employment as an apprentice electrician at the Royal Alexandria Hospital for Children in Camperdown NSW. By misadventure I chose a traineeship as a Surgical Appliance Technician within the ‘Splint’ Department - and thus began my 52-year (and counting) career in orthotics and prosthetics.

So what has changed in lower limb prostheses? When I started out as a prosthetist, you were expected to complete every job you were given from start to fi nish. Unlike today, much of the componentry was made within the facility. The skills required to manufacture a limb included metalwork, woodwork, plastics manipulation, welding, fi tting and machining, leatherwork and technical drawing. Records were kept only to document time and date of appointment and the components that were used. In fact, the client would commonly collect their prosthesis from the offi ce counter and only return if there were problems.

Wooden prostheses required the prosthetist to take measurements and templates as a guide to carve a socket from a wooden block. The shaft milling machine (that we still use today) was fi tted with an exposed cutting blade which would hollow out the socket to a wall thickness of around 5mm. Aluminium prostheses required high-level panel beating skills and competence in using specialist machines to shape the prosthesis. Leather work skills were also required to mould and stitch the socket interface and mechanical skills to affi x the ankle and knee joints. Aligning the prostheses consumed a lot of time and the use of cumbersome jigs. 30 hours of labour was not uncommon from start to fi nish with an additional 6 hours of sanding and painting often required. It was very dirty, labour intensive work and required profi ciency in hand skills. Ultimately, these prostheses were works of art and occasionally you didn't want to hand them over to the client to be worn!

Today, orthotist/prosthetists begin their careers by completing university studies and then practice as allied health professionals in an evidence-based system. We have extensive procedures and guidelines to ensure all recommendations are followed and the best client outcomes are achieved. We must also utilise continuing education to stay abreast of advancing technologies and evidence.

For the majority, we utilise materials that technology has made available to us including carbon fi bre, plastics and laminates. However, we still provide the occasional wooden prosthesis as it still has its place for

some clients. We have access to an amazing range of prosthetic componentry (almost too many choices) and the possible outcomes for each client are far greater. The mechanical and biomechanical effi ciency, cosmetic options and comfort far exceeds that which was once available.

Osseointegration also provides signifi cant opportunities. Regardless of componentry prescribed, osseointegration reduces interface issues, eliminates socket fi tting problems and may provide improvements in gait symmetry, proprioception, sensory feedback and client satisfaction. When asked if any of our osseointegration clients would go back to a socket interface, the answer is always a resounding no! Osseointegration comes with a greater risk of infection and currently no real understanding of implant sustainability. Alignment and


“…the one thing that has remained unchanged is the responsibility of a prosthetist to provide the most appropriate limb for the client”

CLINICAL TOPICS

componentry selection are crucial to the success of osseointegration for shock absorption, torsional force and terminal impact.

Through the evolving years in lower limb prostheses, the one thing that has remained unchanged is the responsibility of a prosthetist to provide the most appropriate limb for the client as an individual.

So have lower-limb prostheses changed dramatically over the years considering the fi rst prosthesis was a ‘peg-leg?’ No…they have just become better!

I would like to acknowledge and thank the limb and splint makers of the past. The limbless, returned serviceman unendowed with the academic learning, nor the technology available to us today. They set in place the qualities of care and desire to achieve the highest

level of fi t, comfort and performance we should all aspire to. These are the very same people who bridged the gap between orthotists and prosthetists which eventually formed AOPA.


Paul Retschko B.P.O. (Hons.) cOP-AOPA

Custom Foot Orthosis Technique for Plantar Fasciitis

Figure 1. Manipulation of the cast to create varus or valgus stabilisation of the hind foot. Source Kirby, K.A.

CLINICAL NOTE

IntroductionPlantar Fasciitis is a painful foot condition with a reported incidence of 10% of the population1 of whom 80% will experience resolution of symptoms within 1 year irrespective of the chosen therapy2. The reported risk factors for plantar fasciitis are broad, spanning the sedentary, obese patients to active athletes; the pes cavus foot to the hypermobile pes planovalgus foot.3

Recently nomenclature has been expanded to plantar fasciosis, including a degenerative fascial disease as opposed to a sole infl ammatory focus. Despite this, the recommended treatments remain heel cord stretching exercises with soft heel inserts, physical therapy, cortisone injection (despite links with increased incidence of rupture7), extra corporeal shockwave therapy (ESWT), night splints, intrinsic toe fl exor strengthening exercises and in-shoe orthoses and inserts.3 For recalcitrant cases that fail conservative management, endoscopic release of the plantar fascia may be performed, often with gastrocnemius lengthening. Published studies on the results of the aforementioned treatments vary greatly, however the objectives remain to reduce patient pain, increase functional capacity and reduce disease duration.

A study by Walther et al (2013) into the effi cacy of 3 simple orthoses demonstrated signifi cant benefi ts in pain scores with customised versions of the tested orthoses. The desirable properties of the orthoses were to reduce maximum pressure at heel strike, stabilisation of the hind foot and support of the medial longitudinal arch (MLA) to decrease plantar fascia strain.2

Examining the array of foot orthoses provided by other clinicians (including all allied health disciplines) demonstrates little change in the orthotic technique used for other foot conditions. Often little or no attempt

has been made to reduce heel strike transients, control hind foot mechanics or support the MLA, let alone all at once. Following is an explanation of how our practice prescribes, designs and manufactures foot orthoses for the plantar fasciitis affl icted foot.

Biomechanical Assessment and CastingFull patient assessment is performed with attention paid to defi ning the degree of varus or valgus hind foot posting. This aids in achieving ‘stabilisation of the hindfoot’. Put simply, this is the magnitude of the skive, wedge or post applied to the heel in order to balance the plantar weight bearing surface of the calcaneum in subtalar neutral. (Figure 1). The easiest way to de-stress the plantar fascia is to invert the hind foot and plantar fl ex the fi rst ray.4

At this stage, the magnitude of any gastrocnemius contracture() is recorded. A heel raise is often required as gastrocnemius contracture creates internal rotation of the mid foot at mid to late stance phase which increases fascial tension. In a small number of cases, especially with cavoid posture, forefoot alignment may reveal that a valgus forefoot post may be necessary. This can relieve tension in the lateral portion of the fascia or can be used to counterbalance the varus hind foot post if lateral stability is problematic.5

A foam box impression is used for casting. Prior to embedding the foot, transfer paint is applied along the course of the prominent portions of the plantar fascia and used to defi ne the margins of the pain around the insertion of the fascia onto the calcaneal tuberosity. Orthotic pressure along the medial slip of an infl amed fascia is a classic cause of patient-orthotic intolerance; devices have often had the MLA lowered extensively when all that was required was a fascial groove. Loss of the MLA height then compromises heel decompression, mechanical control and a reduction in tension of the fascia. The foot is embedded whilst the patient is


Figure 2 Left: Posterior view displaying hind foot to forefoot relationship and PF insertional relief modifi cation, (ideally a more rounded heel cup would be included-modifi ed for demonstration), Right: Plantar view demonstrating metatarsal build up, medial slip modifi cation, MLA profi le and insertion of PF build up.

BIBLIOGRAPHY1. Grecco, M.V., Brech, G.C., Greve, J.M.D. One-year treatment follow-up of plantar fasciitis: radial

shockwaves vs. conventional physiotherapy. Clinics. 2013;68(8): 1089-1095.2. Walther, M., Kratschmer, B., Verschl, J., Volkering, C., Altenberger, S., Kriegelstein, S., Hilgers, M. Effect

of different orthotic concepts as fi rst line treatment of plantar fasciitis. Foot and Ankle surgery 2013; 19:103-107

3. Schwartz, E.N., Su, J. Plantar fasciitis: A concise review. The Permanente Journal 2014 Winter 18(1) e105-e107

4. Kirby, K.A., Foot and Lower Extremity Biomechanics: A ten year collection of precision intricast newsletters. 1997;Precision Intricast Inc. Payton Arizona

5. Hunter, S., Dolan, M.G., Davis, J.M. Foot Orthotics in therapy and sport. 1995; Human Kinetics, Champaign IL

6. Retschko, P.H., Wood, M. and Bach,T.M. The effect of casting technique on shock absorption foot orthoses. Prosthetics Orthotics Australia 1995 Dec. 38-44.

7. Rolf. C., Guntner, P., Ericsater, J., Turan., I. Plantar fascia Rupture: Diagnosis and treatment. The Journal of Foot and Ankle Surgery 1997; 36(2): 112-114

CLINICAL NOTE

seated, thereby allowing the position and posture of the foot to be manipulated. Through use of the windlass mechanism, subtalar neutral should be achieved during casting. Full weight bearing impressions result in maximum fl attening of the MLA and compromised results as the fascia is lengthened. Maintenance of a rounded heel and cupping of the subcalcaneal fat pad also improves shock absorption at heel strike.6

Modifi cationsWhen modifying the positive casts, I add 5mm to the metatarsal head region as this creates universal loading of the MLA tissues by the orthosis. Consequentially, care must be taken to ensure that the lateral longitudinal arch is not excessive in height. The marked areas of the plantar fascia and insertion are built up by approximately 6 mm. (Figure 2) The heel section should maintain approximately 60% contact with the foot, this is necessary for the hind foot posting to be effective and for patient comfort.

The MLA profi le is levelled horizontal to the ground from the base of the plantar fascia. This allows the profi le of the fi nished orthotic to be accurately manipulated in small increments where a curved surface is diffi cult to alter. It also helps reduce some of the bulk of the device.

ManufactureThe objective of the orthosis is to decompress the sensitive regions of the foot and create a soft landing for these regions if loaded. Areas of the foot capable of tolerating pressure are used to control frontal plane motion and redistribute force from those sensitive areas. A 2mm layer of 200-250 density material is vacuum formed over the cast. 2-3 mm thick super soft material is then adhered over the heel and fascia relief. The fi ll density is judged on patient weight and perceived activity level; i.e. for a

70kg person a layer of 6mm 300 then 6mm of 400 density is used ensuring heel raises are incorporated. These devices are typically bulky; the heel raise and aggressive MLA support dictate this.

Patients are encouraged to break the devices in by using for two hours twice daily for 3-4 days and then expand as tolerated. Typically, patients are in suffi cient discomfort such that deep shoes such as runners or lace up walkers are tolerated for the healing period. An initial period of 3 months of full time use is described, depending on recovery rates, this can be prolonged.

Review and AdjustReviews are performed two weeks’ post fi tting to alleviate common orthotic issues, then at six weeks to monitor pain and functional capacity. Notes are compared from pre and post fi tting reviews and walking standing tolerance durations compared.

Common problems experienced in the initial orthotic period are excessive lateral longitudinal arch and or mid foot height, excessive bulk of device and incongruity between location of pain and orthotic relief. These problems are readily adjusted for. It may be necessary to re-mark the most sensitive areas of the foot and have the patient stand on the device to double check that offl oading occurs. Modifi cation to the depth and with of the heel relief and or channel is often required. I will again review the patient two and six weeks’ post fi tting. Should insuffi cient progress be made the program may be augmented with a course of ESWT, review of gastrocnemius stretching exercises and on occasion use of a night splint.

I hope this enhances your management of a common and painful foot condition.

RESEARCH NOTE

Claire SkewesOrthotic and Prosthetic Student, La Trobe University

Comparison of the Pavlik Harness and Von Rosen Splint for the Orthotic Management of Neonatal Developmental Dysplasia of the Hip

IntroductionDevelopmental dysplasia of the hip (DDH) is the abnormal development or dislocation of the hip at birth, comprising a spectrum of abnormalities ranging from slightly dysplastic to completely dislocated hips (Agarwal & Gupta, 2012). Risk factors include female gender, being fi rstborn, a positive family history of DDH, oligohydramnios, and breech position (De Hundt et al., 2012). Untreated DDH is responsible for chronic pain, gait abnormalities, abnormal joint development, and juvenile osteoarthritis (Alsaleem et al., 2014). These consequences of DDH account for 30% of all total hip replacements in people under the age of 60 years (Agarwal & Gupta, 2012).

Incidence & Classifi cationThe reported incidence of developmental DDH ranges from 0.5 to 35 per 1000 live births (De Hundt et al., 2012). Age at diagnosis contributes to this variation, given that it can drop from 5.5 to 0.5 per 1000 live births in the same cohort after just two weeks of age (Alsaleem et al., 2014). This is due to the majority of newborn DDH cases spontaneously normalising within the fi rst two months of life (Agarwal & Gupta, 2012). Although no universal classifi cation system exists (Bin et al., 2014), the most commonly used is Graf’s classifi cation system which relies on the use of ultrasound and measurements of hip angles to determine normality of development (Graf, 1984).

DiagnosisDelayed diagnosis and subsequent intervention are synonymous with worsened outcomes and increased need for surgery (Aiello, 1989). It is well documented that an early diagnosis within the fi rst 2 weeks of life, and prompt conservative treatment before three months of age, are crucial to a good functional outcome (Agarwal & Gupta, 2012). A number of screening and diagnostic methods exist (Paton & Choudry, 2016), however ultrasound and the Ortolani and Barlow manoeuvres are of greatest relevance to the orthotic management of DDH.

“Untreated DDH is responsible for chronic pain, gait abnormalities, abnormal joint development, and

juvenile osteoarthritis.”

Figure 1. Flexion and abduction used in the Ortolani test to relocate a posteriorly dislocated hip at birth (Gelfer & Kennedy, 2008)

Figure 2. Flexion and adduction applied in the Barlow manoeuvre to dislocate an unstable hip (Gelfer & Kennedy, 2008)



Ortolani and Barlow Manoeuvres The purpose of the Ortolani test (Figure 1) is to relocate a dislocated hip using fl exion and abduction, while a positive Barlow test (Figure 2) will dislocate an unstable hip under applied fl exion and adduction (Agarwal & Gupta, 2012). Ultrasound is also used as confi rmation of positive Ortolani or Barlow hips (Aiello, 1989).

Treatment Commencement and Avascular NecrosisPrompt orthotic intervention before the age of three months is the gold standard (Agarwal & Gupta, 2012).

Every form of hip orthosis carries the risk of avascular necrosis (AVN) (Barkin et al., 2000) and evidence suggests extreme forceful hip abduction of 90˚ in the orthoses is causative (Gregosiewicz & Wosko, 1988). Avascular necrosis (AVN) is an iatrogenic disruption to the growth plate and secondary epiphysis when perfusion to the femoral head is compromised (Kitoh et al., 2009).

A ‘safe-zone’ of hip abduction (Figure 3) allowed in orthoses, has greatly reduced AVN risk (Dodenhoff, 1997).

“Delayed diagnosis and subsequent intervention are synonymous with worsened outcomes and increased

need for surgery.”

“Th e Pavlik harness has gained worldwide acceptance as the

‘gold standard’ of conservatively managing DDH.”

Figure 3. Safe Zone for abduction bracing of DDH: the angle between potential dislocation and maximum abduction.

Figure 4. Pavlik Harness (Grill et al., 1988)Two straps run from bilateral foot stirrups, over the shoulders, to the contralateral feet. Proper positioning of the hips is over 90˚ of fl exion, and within the safe zone of abduction. The child should be able to adduct their hips to within 3-5cm of the midline.

REDISLOCATION -- SAFE

ZONE

- MAXIMUMABDUCTION

Orthotic Treatment OptionsOrthoses for DDH utilise hip fl exion and abduction to dynamically reposition the femoral head into the acetabulum, thereby encouraging normal development to occur (Bin et al., 2014). Devices such as the Frejka Pillow, Craig splint and hip spica casts are available clinically, however there is minimal, inconclusive evidence for these (Eberle, 2003). The two most widely available orthoses are the Pavlik harness and Von Rosen splint.

Pavlik HarnessThe dynamic fl exion-abduction orthosis known as the Pavlik harness (Figure 4) has gained worldwide acceptance as the ‘gold standard’ of conservatively managing DDH (Agarwal & Gupta, 2012). The Pavlik harness is not without the risk of complications however, as seen in Table 2.

RESEARCH NOTERESEARCH NOTE


REFERENCESAgarwal, A., & Gupta, N. (2012). Risk factors and diagnosis of developmental dysplasia of hip in children. Journal of Clinical Orthopaedics and Trauma, 3(1), 10–14.

Aiello, D. H. (1989). Congenital Dysplasia of the Hip. AORN Journal, 49(6), 1566–1606.

Alsaleem, M., Set, K. K., & Saadeh, L. (2014). Developmental Dysplasia of Hip: A Review. Clinical Pediatrics.

Barkin, S. Z., Kondo, K. L., & Barkin, R. M. (2000). Avascular Necrosis of the Hip: A Complication Following Treatment of Congenital Dysplasia of the Hip. Clinical Pediatrics, 39, 307–310.

Bin, K., Laville, J.-M., & Salmeron, F. (2014). Developmental dysplasia of the hip in neonates: Evolution of acetabular dysplasia after hip stabilization by brief Pavlik harness treatment. Orthopaedics & Traumatology: Surgery & Research, 100(4), 357–361.

De Hundt, M., Vlemmix, F., Bais, J. M. J., Hutton, E. K., De Groot, C. J., Mol, B. W. J., & Kok, M. (2012). Risk factors for developmental dysplasia of the hip: A meta-analysis. European Journal of Obstetrics Gynecology and Reproductive Biology, 165(1), 8–17.

Dodenhoff, R. M. (1997). Role of ultrasound and harness treatment in the management of developmental dysplasia of the hip. Annals of the Royal College of Surgeons of England, 79(2), 157–158.

Eberle, C. F. (2003). Plastazote abduction orthosis in the management of neonatal hip instability. Journal of Pediatric Orthopedics, 23(5), 607–616.

Gelfer, P., & Kennedy, K. a. (2008). Developmental Dysplasia of the Hip. Journal of Pediatric Health Care, 22(5), 318–322.

Gregosiewicz, A., & Wosko, I. (1988). Risk Factors of Avascular Necrosis in the Treatment of Congenital Dislocation of the Hip. Journal of Pediatric Orthopaedics, 8(1), 17–19.

Grill, F., Bensahel, H., Canadell, J., Dungl, P., Matasovic, T., & Vizkelety, T. (1988). The Pavlik harness in the treatment of congenital dislocating hip: report on a multicenter study of the European Paediatric Orthopaedic Society. Journal of Pediatric Orthopedics, 8(1), 1–8.

Hansson, G. (1988). Congenital Dislocation of the Hip Joint- Problems in Diagnosis and Treatment. Current Orthopaedics, 2, 104–111.

Kitoh, H., Kawasumi, M., & Ishiguro, N. (2009). Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. Journal of Pediatric Orthopedics, 29(6), 552–557.

Paton, R. W. (2005). Management of neonatal hip instability and dysplasia. Early Human Development, 81(10), 807–813.

Ramsey, P. L., Lasser, S., & MacEwen, G. D. (1976). Congenital Dislocation of the Hip: Use of the Pavlik Harness in the Child during the First Six Months of Life. The Journal of Bone and Joint Surgery, 58(7), 1000–1004.

Viere, R. G., Birch, J. G., Herring, J. A., Roach, J. W., & Johnston, C. E. (1990). Use of the Pavlik Harness in Congenital Dislocation of the Hip: An Analysis of Failures of Treatment. The Journal of Bone and Joint Surgery, 72(2), 238–244.

Wenger, D., Samuelsson, H., Düppe, H., & Tiderius, C. J. (2016). Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head. Acta Orthopaedica, 87(2), 169–175.

Von Rosen SplintThe Von Rosen splint (Figure 5) is rigid and was developed specifi cally for early treatment from the fi rst week of DDH (Wenger et al., 2016). It has received signifi cantly less attention in the literature than the Pavlik harness.

Table 2.Possible Complications for the Pavlik Harness and Von Rosen Splint

Figure 5. Von Rosen Splint (Hansson, 1988)Foam covered metal, moulded to fi t around the shoulders and hips, allowing free fl exion and abduction 30˚ beyond the limits of the splint (90-110˚ fl exion and 60-70˚ abduction).

Adapted from Aiello (1989), Alsaleem et al. (2014), Dodenhoff (1997)

Comparison of Pavlik Harness and Von Rosen SplintConsidering the discrepancies in study design with regard to treatment duration, follow-up ages and initial severity, no solid recommendation can be made regarding orthosis superiority (Cooper, et al., 2014). One possible means of comparing the Pavlik harness and Von Rosen splint is to contrast the occurrence of AVN between studies (see Table 4). This idea stems from the strong correlation between improper positioning and AVN. When either orthosis is carefully monitored

to remain within the abduction limit, the occurrence of AVN is 0-2% (Agarwal & Gupta, 2012), leading to the possibility that higher instances of AVN may be associated with improper fi tting; as opposed to treatment choice.

To support this idea, there is disconcertingly no mention of an orthotist in the literature. Because evidence suggests the Von Rosen splint is simpler to fi t it is suggested that a qualifi ed orthotist correctly fi tting the orthoses may have mitigated complications seen in Pavlik harness treatment. Parental noncompliance or tampering with the orthosis, resulting in subsequent incorrect fi t, has also been associated with the failure of the Pavlik harness (Viere, et al., 1990).

RecommendationIt is the tentative conclusion that the best chance of reducing neonatal DDH without complications is the Von Rosen splint, however this is based only on its lower incidence of AVN (<1%) than the Pavlik harness (8.23%) in the literature. In clinical practice however, a correctly fi tted and monitored Pavlik harness should have a risk of 1% AVN (Paton, 2005).

Limitations to recommending either brace include minimal research of the Von Rosen splint, and no study where a qualifi ed orthotist was fi tting orthoses. Parental compliance can be a confounding factor, mitigated only by education.

Complications Reported

Pavlik Harness Von Rosen Splint

- AVN

- Femoral nerve palsy

- Pes Cavus foot

- Inferior dislocation

- Medial knee instability

- Iliotibial band contracture

- Pressure sores or rash

- AVN

- Pressure sores or rash under thigh piece

RESEARCH NOTE


GRANT RECIPIENT

Nick AitkenOrthotic and Prosthetic Student, La Trobe University

Bill Reed Memorial Grant

I was grateful to be selected as recipient of the Bill Reed memorial grant. I would like to thank AOPA for its ongoing commitment in celebrating the memory of Bill Reed and supporting students during their studies.

This grant has helped me to attend my fi nal block of clinical placement in Alice Springs. Attending a placement in a remote location has allowed me to experience a diverse range of complex cases that I would otherwise have not been exposed to. Whilst Alice Springs and the surrounding area is one of the most beautiful places I have visited it is extremely isolated with a catchment area of 830,000 square kilometres. A combination of distance, socio-economic disadvantage and diverse cultural differences has broadened my view on complex patient management not only from a P & O perspective but also in highlighting the importance of taking a holistic approach to patient care. This has helped me to realise the importance of multidisciplinary collaboration and the need to look at long-term care plans in order to achieve the best outcomes for a diverse range of isolated or otherwise vulnerable patient groups. Alice Springs and the surrounding areas have six times the national average in regards to amputation and one of the highest rates of diabetes anywhere in the world. This has helped highlight the need for creative thinking in implementing constructive and culturally appropriate interventions to educate at risk groups and the need for strong preventative strategies to help reduce the incidence of diabetes and its related complications.

One of the highlights of my placement was travelling to Tenant Creek to attend an outreach clinic where we were able to meet patients from remote locations who were unable to or were reluctant to travel to Alice Springs.

Thank you again to AOPA for helping me to travel to Alice Springs and attend what was a fantastic placement.


RIO PARALYMPICS

Jessica Grant (cOP-AOPA, BP&O)

Rio 2016: A prosthetists experience

“Watching the Aussie team stride through fi lled us all with pride and anticipation for the days

to follow.”

A very lucky group of Australian prosthetists had the opportunity to travel to Rio De Janeiro in early September for the 2016 Paralympic Games - and I was one of them. I joined David Lee-Gow (ProMotion Prosthetics), Andrew Vearing (Orthotic Prosthetic Solutions), Stuart Crampton (Brisbane Prosthetics and Orthotics), Steve Cox (Prostek), Greg Strachan (Ottobock) and Thomas Much (Ottobock) on a whirlwind, week-long adventure to South America.

From the moment we touched down in Rio (with our Zika virus protection kits in tow), the Brazilian people made us feel welcome, safe and ready for a great week of events.

First on the program was the Opening Ceremony at the Maracana Stadium. The atmosphere of the 78,000 strong crowd was incredible and really hard to describe. The roar and cheer as the Brazilian team entered the stadium was deafening. Watching the Aussie team stride through, lead by Brad Ness, fi lled us all with pride and anticipation for the days to follow.

The next day we went off to visit the Ottobock Prosthetic and Orthotic workshop within the Athlete’s Village. Walking through the village was such a surreal experience. Athletes of all abilities from every country were rolling, cycling, hopping, jogging, sprinting or just walking around getting themselves race-ready. The workshop itself, even being temporary, would make a few workshops around Australia green with envy. It was completely kitted out with everything you could possibly need to repair, maintain, fi t or modify prostheses, orthoses and wheelchairs. The sheer volume of wheelchair tyres, the boxes of liners, feet, WD40 and duck-tape was incredible. It was set up like a proper clinic in that the client (athlete) would come in, register and then discuss their problems with the prosthetist or technician. The prosthetist or technician would then do anything necessary to make the athlete comfortable and return them to the highest level of function at no cost. Not only did Ottobock have the main workshop within the village, but also smaller workshops set up at all of the venues for on-the-spot repairs as necessary.

The next few days were full of events. We had special ‘all-access’ passes which allowed us into any venue at


RIO PARALYMPICS

any time in some pretty spectacular seating. A few of us had clients competing which was exciting for the whole group. We tried to get to every venue and see as many events as possible. A personal highlight of mine was watching Vanessa Low from Germany smash the world record in the T42 long jump.

We did get one day to play tourist and take in some of the spectacular sights that Rio has to offer. Christ the Redeemer, who was covered in fog for the most part, showed his face for about 10 seconds and provided the obligatory ‘selfi e’. Sugar-loaf Mountain and Copacabana beach were also fantastic and to complete the day we were treated to a Brazilian banquet which basically involved kilos and kilos of BBQ - delicious!

We left Rio on the 5th day of competition and the success of the Aussie team and Brazil as the host nation continued. Congrats to all involved with our Para team and ‘Obrigado’ to Rio. Here’s to Tokyo in 2020.

“Congrats to all involved with our Para team and ‘Obrigado’

to Rio.”

THE NDIS

Stronger Together: Policy and Advocacy

NDIS P&O Assessment Templates Release


On the 13th of November the NDIS released the Prosthetics and Orthotics Assessment Template. The template is a non-mandatory form designed to enable providers to communicate uniformly with the NDIS and determine if a service will support a participant’s goals. The NDIS has recognised that nationally there is signifi cant variation in reporting requirements and documentation. The form provides space for reporting:

• Participant and Assessor Details

• Participant Goals

• Evaluation and Assessment

• Exploration of Options & Recommended Option

• Specifi cation of Recommended Solution (Including time, components and costs)

Whilst this template is not mandatory the NDIS has encouraged providers to use the form and have suggested that key aspects of the form be considered when evaluating AT options. It is also expected that State and Territory programs will incorporate parts of the template within their own documents.

The ‘AT General Prosthetics and Orthotics Template’ can be found at: https://www.ndis.gov.au/providers/market-information-useful-links under the Assistive Technology section.

Provide FeedbackThe NDIS has requested feedback from providers and stakeholders regarding the length of the form and how they may relate to the specifi c services you provide at: [email protected]

AOPA encourages members to read the form and consider how it may be used and how you expect it may affect your practice. AOPA also welcomes feedback and will be providing a detailed submission to the NDIS. Please direct any feedback to [email protected]

AOPA would like to encourage you to contact the offi ce at [email protected] or by phone to raise any issues you may be experiencing with the NDIS, public, compensable or private health schemes. Recent concerns raised by the members include:

• Insuffi cient reasoning provided for rejected service requests

• Diffi culty registering as a provider

• Inappropriate practices

• Communication and planning diffi culties

Concerns you believe are isolated may actually be occurring nationally. By collating member concerns AOPA are able to more easily identify issues and address these on behalf of the profession as quickly as possible.

p

rovide Feedback


AOPA RESOURCES

Louise PuliAOPA Professional Standards Offi cer

Supporting Private Practice

“Th e success of orthotic/prosthetic private practices will continue to be built upon with the delivery high quality clinical care and strong

relationships with consumers and referrers.”

Supporting existing private practice, and the growth of the private sector in orthotics and prosthetics is part of AOPA’s ongoing work.

Demand for private services is expected to increase in the coming years in-line with the trend for increasing chronic diseases and increasing life expectancy in Australia. This increasing need of orthotic/prosthetic practitioners will not likely be met through the public health sector, placing a greater demand for private practices.

The success of orthotic/prosthetic private practices will continue to be built upon with the delivery high quality clinical care and strong relationships with consumers and referrers.

What is classifi ed as Private Practice? Private practice can be defi ned as the treatment of clients by private arrangement. A private patient is defi ned by a client who gives, or is given an undertaking to pay charges for their services.

There are many reasons why clients may decide to access a private orthotic/prosthetic practice. Key considerations include patient choice and a perception of a high level of personalised care in private practice. For example, private patients may choose the practice they visit based on the geographical location close to their home, also because they may be able to choose the practitioner they see and are likely to be seen by the same practitioner throughout their treatment.

In addition, there may be peace of mind that treatment will be available without a long waiting list.

AOPA recently facilitated a ‘Best Business Practice’ Workshop with Maida Learning.


AOPA RESOURCES

These resources are available on the AOPA website in the member section, and can be used as an online resource, or can be printed to be used within your practice.

Private practice ResourceAre you thinking of going into Private Practice? Or are you overwhelmed at the idea due to the many considerations that need to be made?

AOPA’s new Private Practice Resource takes the reader through a series of considerations that should be made prior to setting up a private practice, and links them to appropriate external sources. The resource may also be used by those currently in private practice wishing to update their policies, or access up to date resources.

Of course, this resource does not replace the need of engaging with appropriate external agencies independently including accounts.

The Private Practice Resource is available on the AOPA Website under ‘Member Resources’.

“Are you thinking of going into Private Practice? Or are you

overwhelmed at the idea due to the many considerations that

need to be made?”

Who can undertake private orthotic/prosthetic practice?It is AOPA’s position that all orthotic/prosthetic practitioners working in private practice hold current AOPA Certifi cation. This ensures that practitioners are appropriately qualifi ed, subject to the suit of professional standards provided by AOPA and are recent continuing to meet continual professional development (CPD) requirements.

AOPA Private Practice ResourceAOPA is pleased to be launching the AOPA Private Practice Resource. This new member resource provides general information and links to external resources about the things that should be considered when setting up and managing a private practice in orthotics and prosthetics in Australia. We acknowledge the important contribution of the Private Practice Reference Group, who have generously contributed their time and expertise to this project.

This resource adds to AOPA’s other private practice support documents which include:

• Quotation guidance documents,

• Clinical justifi cation guidance and examples,

• Outcome measures resources.

• Privacy policies,

• GST guidance

• Funding specifi c resources such as the NDIS series of fact sheets that have been launched to assist with the promotion of your business and the scope of your services.

“AOPA is pleased to be launching the AOPA Private Practice

Resource.”

vate orthotic/h d k i h

These reso rces are a ailable on the AOPA

ent s

recent

Melissa NoonanLimbs 4 Life CEO

Release of Limbs 4 Life Health-Literacy Resources

“Th ese resources have been developed to fulfi l gaps in information for amputees and their families.”

Limbs 4 Life is excited to announce the release of a range of new health-literacy resources. These resources have been developed to fulfi l gaps in information for amputees and their families. To ensure that the literacy and information that Limbs 4 Life provides is correct and in line with current treatment and rehabilitation plans, Limbs 4 Life seeks resource development guidance and oversight from the members of our National Health and Wellbeing Advisory Group. The Group is made up of amputee specifi c healthcare providers, with representation from all states and territories, along with consumers and care-givers.

Fact SheetsTo meet on-going demand for information and to support our early invention Peer Support Program, Limbs 4 Life sought feedback from healthcare providers and consumers alike regarding the gaps in information provision.

This resulted in the development of eleven Fact Sheets covering an array of topics including:

• Understanding the healthcare system

• Returning home following a lower limb amputation

• Returning home following an upper limb amputation

• Regaining your independence

• What to expect following an amputation

• Post-traumatic stress disorder (PTSD)

• How to set goals following an amputation

You can view and download all of the Fact Sheets on the Limbs 4 Life website. Limbs 4 Life have also made the Fact Sheets available in hardcopy format. Additional Fact Sheets will be added to the series in 2017.

RESOURCES


RESOURCES


“Th e pocket cards are a great way of having brief information on hand

at all times.”

Pocket CardsA series of fi ve pocket-sized cards were specifi cally created to be included in the Limbs 4 Life ‘First Response Kits.’ These were developed by Limbs 4 Life and reviewed by allied health care professionals. The pocket cards cover fi ve key topics including:

• Hygiene

• Skin care

• Foot care

• Prosthetics

• Safety

The pocket cards are small enough to carry in a bag or wallet and contain some key tips for promoting good health and general wellbeing outcomes. The pocket cards are a great way of having brief information on hand at all times.

The Practical Guide for Amputees Now in its fi fth print-run, The Practical Guide for Amputees is a 54 page resource for people facing amputation. This publication provides people facing amputation with the unique insight into their journey ahead. It outlines what to expect following an amputation, the processes of hospital and rehabilitation, insights into the stages of a prosthetic fi tting, funding, assistive devices, returning home and managing on-going health complications which relate to amputations.

Copies of these resources can be downloaded via the Limbs 4 Life website at: www.limbs4life.org.au/peer-support.html or email [email protected] to receive hard copies.

For more information call: 1300 78 2231


CONGRESS

The 2016 Congress Wrap Up

The 2016 Congress began early with more than 40 delegates heading to Deakin University in Geelong to explore innovations in advanced materials. Attendees were given an insight into carbon manufacturing at the Nexus research facility as well as 3D printing at the Centre for Advanced Design.

Back in Melbourne, a full day of workshops were held at Mantra Bell City. In the Total Contact Casting 101 workshop, delegates were able to develop practical skills in appropriately applying total contact casts for clients with high risk feet whilst OAPL partnered with Blatchford to provide certifi cation for the LiNX transfemoral prosthesis. VORUM, who displayed a working 3D printer throughout the Congress, provided strategies to adopt CAD/CAM and Össur provided

an introduction to their new prosthetic and orthotic solutions.

AOPA partnered with Maida Learning to examine the essentials required to operate an effective private practice. Through practical tips attendees were able to consider essential business planning, marketing techniques and fi nancial strategies. To download a summary of the Business Practice workshop, visit the presentations section of your online member resource. In the Working in the NDIS workshop, Natasha Layton enabled participants to consider informed participant decision making, an essential aspect of the NDIS. Through providing an insight into the need for patient-centred care, delegates were encouraged to engage with clients as informed and empowered participants.

The second day of the Congress began with an address from the Hon. Ken Wyatt, Assistant Minister for Health and Aged Care who spoke about the importance of the orthotic and prosthetic profession in caring for the community. Dr. Japp van Netten then spoke about the high-risk foot and client communication in a clinical setting. Through a series of exercises and instructional videos, Dr. Netten emphasised the importance of actively engaging with clients and addressing each of their concerns in a responsive and considerate manner.

The morning sessions provided an opportunity for delegates to consider innovations in high risk foot management and advancing prosthetic practice. Katrina McGrath, spoke about the establishment of a diabetic foot clinic within the Samoan NHS to provide diabetes and foot care education, wound care and orthotic offl oading. Gavin Burchall, from The Alfred Hospital, then outlined an analysis of weight bearing total contact casts demonstrating their effectiveness for the treatment of acute diabetic foot problems and Charcot resolution rates comparable to other studies. Michael Storey and

The 2016 AOPA Congress was the most successful to date with over 340 delegates and more than 65 interactive sessions, presentations and social events. Catch up on the key sessions you may have missed in our Congress wrap-up.

Total contact casts at the TCC 101 workshop.

Hands-on experience in the TCC 101 Workshop.


CONGRESS

Continuing this theme, Peter Hawes from the Sydney Children’s Hospital presented a custom clinical service data management system to aid stock management and client services. Simon Lalor, from the Royal Children’s Hospital then summarised research demonstrating the reliability of the Edinburgh Visual Gait Scale in evaluating AFO use in adults with post-stroke hemiplegia. Sophie Fleming, a maxillofacial prosthetist at Northern Prosthetics, then presented a case study series and history of maxillofacial prosthetics.

The fi nal afternoon of sessions ended with a focus on 3D printing in orthotics and prosthetics. Luke Lorenzin outlined Artifi cial Limbs and Appliances’ approach to integrating additive 3D printing into practice, including a collaboration with the University of Queensland to fi t a 3D printed prosthetic hand. Ken Shaw, a Director of Orthokids, then detailed an investigation of 3D printing and presented a concise summary of the current viability and future possibilities of the technology, which was awarded the best presentation prize of the Congress.

David Thomas, from APC Prosthetics, presented two unique case studies evaluating sub-ischial transfemoral socket designs that emphasised increased range of motion, safety and comfort. Mahboobeh Mehdikhani, PhD student at The University of Melbourne, presented research examining muscle forces in partial foot amputees during walking which allowed the development and presentation of a musculoskeletal model for partial foot amputees.

AOPA then hosted Dr. Lloyd Walker, Director of Assistive Technology at the NDIS, and Wendy Hubbard, Chief Allied Health Offi cer at SWEP, to discuss the NDIS and its interface with state based funding schemes. The fi rst day of afternoon sessions examined gait analysis and training, including a presentation, by Ellyse Marum, of a video gait analysis system implemented at the Royal Children’s Hospital for less than $1,000. Cara Negri, Director of PnO Data Solutions, then emphasised the reliability of the Edinburgh Visual Gait Score and Prosthetic Observational Gait Score and presented pilot studies that demonstrated an increase in inter-rater and intra-rater reliability of these measures when utilising video analysis.

Friday night played host to the Congress dinner, with a special performance highlighting some of the quirks of the orthotic and prosthetic industry, by John Chaplin-Fleming, previously from the Scared Weird Little Guys.

Professor Bronwyn Fox launched the fi nal day with a keynote introducing Swinburne’s ‘Factory of the Future’ and discussed the application of new technologies to orthotics and prosthetics. Following this, Michelle Wymer, Paul Prusakowski and Professor Susan Nancarrow joined the AOPA Clinical Capacity forum to discuss the challenges facing the profession. The panel suggested an uptake in advanced manufacturing technologies, an increase in clinical effi ciency through adoption of new processes and new methods of interacting with consumers and clients.

Assistant Minister for Health and Aged Care the Hon. Ken Wyatt is introduced to Hal Grix, AOPA life member.

Delegates at Dr. Jaap Van Netten’s keynote address.

CONGRESS

Stephen Tindale, Princess Margaret Hospital for Children / Orthotic Prosthetic Solutions (cOP-AOPA),

Congress: A members experience

AOPA’s 2016 Congress was a great three days. As a young member attending my 2nd AOPA Congress I was impressed by all of the speakers and would like to thank them for their time and effort. For any student members or other members who haven’t been before, I would strongly suggest attending next year - the Congress is a great way to get to know people inside the industry and to increase your knowledge.

Day one at Deakin in Geelong was a glance into the future of P&O manufacturing. Learning about the gold standard practices for using and manufacturing carbon and getting to see the machinery that is used to create it was insightful. Attendees were also shown the manufacture of Carbon fi bre rims for V8 race cars that are stress tested and tuned at the Nexus centre. The stress placed on the rim was documented and graphed enabling the device to be as light and stiff as required. Testing P&O devices in this way would enable the use of carbon in a more effective manner.

3D printing was the other focus of the day, with Deakin utilising a wide range of printers, including plastic and titanium printers. Baum Cycles have 3D printed titanium parts with Deakin’s engineering team enabling shapes to be created that would otherwise be impossible to mould by hand. This creates a lighter, stronger and more aerodynamic product.

The next two days were more P&O specifi c and one of my favourite presentations was by Nathan Collins’ on

the development of a tool to report AFO stiffness and methods to tune stiffness in an AFO. With the increased use of carbon fi bre in AFOs and an increased demand for customisation, this presentation could help steer the orthotic industry into creating an interim AFO. He discovered that an optimal stiffness can be measured for an AFO. Prescribing an optimised level of stiffness for each device will enable improved function in clients and help shift the way we prescribe and manufacture AFOs.

The presentation from keynote speaker Paul Prusakowski about outcome driven, goal orientated patient centred care and documentation was impressive. With funding bodies increasingly asking for more data proving that your prescription is relevant and necessary, Paul has added Outcomes Measures and Goals to the acronym SOAP to create SOOGAP. Regularly using this method will increase professional standards and improve patient centred care.

The fi nal presentation about ditching the plaster room is something every clinician would like to implement. As technology expands and the cost of production drops these products will become more readily available to the P&O industry. Given the interest in the 3D printer in the exhibitor area it seems that everyone would like to invest in one.

The AOPA congress for 2017 looks to be the biggest one yet and I’m looking forward to hearing more about it.

The Carbon Nexus Research Facility.


CONGRESS


The AOPA and Ottobock Student Event

“students were encouraged to explore the potential trajectory of their own future careers and begin building their own professional network.”

Claire SkewesOrthotist/Prosthetist Student, La Trobe University

The orthotic/prosthetic profession is a diverse community offering a variety of interesting career opportunities, and the 2016 AOPA and Ottobock Student Event highlighted this perfectly with the theme ‘Evolving Careers in Orthotics and Prosthetics.’ Through listening to guest speakers then participating in the networking career fair, students were encouraged to explore the potential trajectory of their own future careers and begin building their own professional network. Fifteen experts all with unique and inspiring career histories were invited to share their knowledge and three of these were our guest presenters for the night; Greg Strachan, Jackie O’Connor and Wes Pryor.

Greg Strachan is the manager of Ottobock’s Prosthetics Business Unit which incorporates the Ottobock Academy and Technical Service teams. Beginning as an employee for a private practice, Greg soon felt drawn to the management aspects of business, worked his way up to the manager’s role and completed a Masters of Business Administration. This drive and enhanced knowledge of business allowed Greg to pair his passion for clinical interactions with administration and management strategies. One of Greg’s themes was a prosthetist with clean shoes, where his message to students was that you can be a great clinician outside of the plaster room, by helping drive the industry and educating other clinicians.

Jackie O’Connor then presented on her diverse career involving many roles in Australia and overseas, and her current studies, undertaking a Master of Health Service Management. She emphasised that her variety of clinical and management skills, which led to her being one of the key voices for the orthotic/prosthetic profession, were not obtained in one clinical setting. Jackie encouraged students thinking about their future to not focus on pursuing one particular role or company, but to appreciate what specialised skills can be learned in each of their future jobs, and use them to grow their clinical knowledge.

Wes Pryor began his career trained in prosthetics and orthotics, but now is Senior Technical Adviser in Disability and Rehabilitation at the Nossal Institute for Global Health at the University of Melbourne. He was previously involved in coordinating approximately 15 orthotic/prosthetic rehab services in 10 countries,

and has been advisor to agencies including WHO, DFAT, HelpAGE, UNICEF and CBM. Wes advocates for rehabilitation as a critical part of emergency response, and was involved in the 2015 Nepal earthquake disaster response, where rehabilitation was essential for secondary prevention, providing assistive devices and accessing other essential services. He inspired students as future orthotist/prosthetists to contemplate how their learned knowledge could be applied to the bigger humanitarian picture in roles they may not have originally considered.

Following the three inspiring presentations, the career fair involved seating the 15 invited experts at individual tables where students were encouraged to approach them with an introduction and targeted career questions. Information on each expert was provided to students before the night; allowing us to prepare questions for particular experts who could provide insight on aspects of our future careers. Little did we know that while we were picking the experts’ brains they were on the lookout for which students made the utmost effort to network, and at the end of the night two lucky fourth year students, Oliver Scott and Kayla Osinski, were awarded for their initiatives with a free Ottobock Academy course of their choosing. As students we found this opportunity to network in an informal setting right before the congress invaluable, and are immensely thankful to AOPA and Ottobock for organising the student event.

Look out for the AOPA Student Event in 2017!

Wes Pryor presenting at the AOPA and Ottobock Student Event.


CONGRESS

Consumer Event

Technician EventAt the 2016 Congress, AOPA hosted the fi rst Technician Event, ‘Techniques and Technologies: Advances in Technical Practice’. The event offered the fi rst ever opportunity for technicians and practitioners to come together and examine clinical and technical advancements, as well as new materials, manufacturing methods and products.

Brett Nicholas, from Sydney Children’s Hospital, provided two informative sessions. The fi rst on the application of hobbyist electronics platforms, including the Raspberry Pi and Arduino, to clinical work and research. Brett then spoke about the potential of utilising computer simulation to study the potential of advanced materials in prosthetic and orthotic manufacture.

Justine Madden, from the Royal Children’s Hospital, then discussed occupational health and safety in the prosthetics and orthotics workshop. Ottobock and Ossur also presented information on their latest

products and materials before an informal networking session that enabled participants to share information, techniques and ideas.

Thank you to all of our presenters and participants and look out for the AOPA Technician Event in 2017.

“presenters emphasised the importance of clients taking a leading role in their own goal

setting and ongoing orthotic and prosthetic experience.”

AOPA developed the fi rst Orthotic and Prosthetic Consumer Event to engage with consumers of P&O services and provide an insight into the role of orthotist/prosthetists. The event provided an introduction to clinical terminology, practitioner training and emphasised a consumer’s ability to exert choice and control of their own treatment.

Limbs 4 Life’s Melissa Noonan spoke to participants about becoming an ‘informed participant’ and provided helpful advice about interacting with practitioners and self-advocating for consumer rights. Gary Newton then presented his experiences as a current NDIS participant and provided an insight into the current benefi ts and shortfalls of the NDIS from the perspective of a consumer. Each of our consumer presenters emphasised the importance of clients taking a leading role in their own goal setting and ongoing orthotic and prosthetic experience.

At the conclusion of the presentations, a guided tour of the exhibitor area was provided and attendees were able to discuss their unique challenges and successes. Feedback from consumers and attendees was overwhelmingly positive and AOPA would like to thank each of our contributors and presenters.

AOPA provided an overview of the standards and codes that orthotist/prosthetists abide by and the methods that may be used to handle complaints. Darren Pereira, from Neuromuscular Orthotics, detailed the latest orthotic technologies and explained some of the challenging aspects of clinical practice. Nathaniel Kenyon, from Ottobock, then explained the intricacies of orthotic and prosthetic manufacturing whilst detailing the complex terms that may be used by an orthotist/prosthetist to enable consumers to better engage with health professionals.

:

s

i tt puter

Indigenous Allied Health Australia

ALLIED ASSOCIATIONS


Indigenous Allied Health Australia (IAHA) is a member based national organisation that originated in 2009 to bring together and collectively support Aboriginal and Torres Strait Islander allied health professionals and students within over 26 allied health professions, including prosthetics and orthotics. Aboriginal and Torres Strait Islander health professionals play a vital role in addressing the health and wellbeing of Australia’s First Peoples. In order to close the gap in health outcomes, more Aboriginal and Torres Strait Islander people must be encouraged to consider, pursue and succeed in allied health careers.

It is estimated that less than 1% of Australia’s 120,000 allied health professionals are Aboriginal or Torres Strait Islander peoples. IAHA provides targeted networking, development and support for Aboriginal and Torres Strait Islander allied health professionals and students, whilst focusing on building and sustaining a strong and inclusive allied health workforce. IAHA seeks to do this by supporting Aboriginal and Torres Strait Islander peoples in promoting allied health careers and facilitating further education and leadership development of allied health professionals.

IAHA also advocates for Aboriginal and Torres Strait Islander peoples to have health equity through improved

access to culturally responsive allied health care. It is imperative that allied health professionals recognise the importance of culturally appropriate services in achieving optimal health and wellbeing. This is an essential step to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.

IAHA welcomes all Aboriginal, Torres Strait Islander and non-Indigenous individual health professionals to join for free, in order to promote the health and wellbeing of Aboriginal and Torres Strait Islander peoples and promote allied health professions across Australia. You can do this by:

• Contributing to national discussions around issues that are important to the health and wellbeing of Aboriginal and Torres Strait Islander peoples

• Actively pursue strong relationships and networks across diverse Aboriginal or Torres Strait Islander cultures, professions and geographic locations

• Actively promote allied health careers in your local area

• Nominate people for a National Indigenous Allied Health Award to celebrate their achievements

Visit the IAHA website at www.iaha.com.au for more information and resources.

Ben Lucas, BS in Biomedical Engineering, MS in Prosthetics & Orthotics, (cOP-AOPA)[email protected]

The importance of development of clinical and technical skills in students

“Early exposure to clinical and technical skills that focus purely on

the motor development requirements of the skill allow students to later to

develop rationale for a task.”

“He who would learn to fl y one day must fi rst learn to stand and walk and run and climb and dance; one cannot fl y into fl ying.”

- Friedrich Nietzche

Her face showed a mixture of confusion and embarrassment as we worked through developing a ‘comprehensive treatment plan’ for her client-model. After she described the indications and contraindications of the various suspension methods, she sheepishly looked at me and shrugged her shoulders, “But why I would ever need to do anything besides a cuff strap. I don’t understand why any of this makes a difference or what I’m even trying to accomplish.”

Previous to this, I knew the breadth of the fi eld typically overwhelmed students who developed a very surface level understanding. However, this interaction surprised me and I started to fi nd out why this occurred. This course in particular was the fi rst introduction to the basic concepts and terminology related to prosthetics and amputations, with students


EDUCATION


EDUCATION

within a week working with client-models. The students were guided through the evaluation and casting, but the expectation was to apply what they just learned to justify what they were doing. So even by the end of the semester, this student felt that she neither knew what to do, how to do it, or what could be done, let alone rationale for her actions. She could only provide textbook knowledge, but could not relate it to the specifi c client needs or beyond generalisations. Hers is not an isolated experience as students typically fail to feel comfortable with the technical, clinical, or theoretical aspects individually, let alone in combination as they are often taught.

Exploring my own practise, I realised that the clinical application of concepts involves tacit, or innate, knowledge and skills and that these skills are the combination of more individualised skills and knowledge. More importantly, the combination of these is also a skill, creating a cycle of conscience incompetence and competence throughout learning. Mere exposure to most aspects of the profession develops a shallow understanding of what it means to ‘practise’ prosthetics and orthotics. Students continually

struggle to connect the common threads of practise and typically view them as isolated silos to be mastered individually.

Since then, I try to incorporate four main principles in my teaching: repetition of skills, explicit connection of principles, de-emphasis of ‘device-based’ knowledge in favour of transferrable skills/concepts, and eliminating the ‘success’ of a project as the objective to guide development of problem-solving through students own errors and ‘failures’. Early exposure to clinical and technical skills that focus purely on the motor development requirements of the skill allow students to later to develop rationale for a task. Repetition with early explicit guidance in fundamental skills provides means for student’s to apply their learning in increasingly complex and chaotic means, removing the ‘training wheels’ so to speak. Students naturally start to critically reason when they feel competent with the basic psychomotor skills involved in clinical and technical aspects.

Student’s that are pushed just beyond their natural comfort zone while learning are poised to learn faster and more than when they are overwhelmed or bored by unconnected or mindless tasks, creating graduates that understand more how they can improve with experience.

“Students naturally start to critically reason when they feel competent with the basic psychomotor skills involved in clinical and technical

aspects.” “Creating graduates that understand more how they can

improve with experience.”


CONNECT WITH AOPA

The 2017 Congress

AOPA’s 40th Anniversary

The 2017 AOPA Congress is set to be even more impressive than 2016. Join us at the Melbourne Park Function Centre on Batman Avenue for three days from the 5th to the 7th of October. Places will be limited, so get in early to avoid missing out.

Interested in presenting? Recently completed research or have an interesting case study?

Get in contact with AOPA at [email protected] to register your interest in presenting at the 2017 Congress.

December 5th marked the conclusion of AOPA’s celebration of its 40th anniversary. AOPA would like to thank all of its members, benefactors and contributors for helping mark the progress both the profession and association has made over the preceding forty years.

The year provided an opportunity to refl ect, which began with the AOPA40 video, which you can still watch here: http://youtu.be/Gr-7QkXKfyE. Looking forward, the outlook for the profession and Association is incredibly positive and we’re excited to share another 40 years with members and the Australian community.

40 YEARS

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CONNECT WITH AOPA

Whether you’re an AOPA member, an allied health practitioner, a product supplier, a user of orthotic/prosthetic services or simply someone who is interested in our profession, we want to make sure you have the opportunity to connect with us and, most importantly, with each other! We encourage you to share your experiences, seek advice from your colleagues, discuss new ideas and explore everything AOPA has to offer. You can fi nd us on social media and join the online orthotic/prosthetic conversation through the following channels:

Looking for a way to strengthen your brand and company image? Connect with us to deliver targeted messages direct to the orthotic/prosthetic community and allow your company to demonstrate your ongoing support of the orthotic/prosthetic profession. By doing so, you will be helping AOPA to deliver valuable services to our members, ensuring

excellence in standards of practice, strengthening the O&P profi le and reducing barriers to growth of the profession.

For specifi c details on these exciting opportunities, head to our website and download our full Advertising & Partnership Prospectus: http://www.aopa.org.au/about-us/connect-with-aopa

Alternatively, contact the National Offi ce for more information: [email protected]

LinkedInDon’t have a profi le set up on LinkedIn? What are you waiting for!

LinkedIn is an online professional networking service where you can connect with colleagues from all around the world. Create your LinkedIn profi le and share your work experiences, skill sets and areas of interest with other like-minded professionals.

Facebook Like the Australian Orthotic Prosthetic Association Facebook page to promote the profession and share the vital work of orthotist/prosthetists amongst the community.

AOPA will be posting a range of promotional topics, including the Clinical Specialty Resources, throughout 2017. Be sure to share these on Facebook to increase the profi le of P&O in Australia.

www.facebook.com/AOPAnews/

TwitterSign up to Twitter and follow @AOPA_News for regular tweets on all things #OandP. Help represent your profession and increase engagement and interaction with other

professional associations, related organisations and government bodies to extend the power and reach of our messages. twitter.com/aopa_news

Follow AOPA’s public company page for important Association news and announcements: https://www.linkedin.com/company/australian-orthotic- prosthetic-association

Join AOPA’s member only group to stay connected to the profession, association and your colleagues: www.linkedin.com/groups/6950694

AOPA Advertising & Partnership Opportunities

h d l d dy to strengthen your brand

• Place an advert in the Review: Advertise in the 2017 editions of the Review which will be distributed to 500 orthotist/prosthetists, education subscribers and related industry partners.

• Promote your educational events: AOPA strongly supports the delivery of high-quality Continuing Professional Development activities to our members.

• Fill your employment vacancies: reach the highest number of orthotist/prosthetists by advertising on our Employment Opportunities page, the most commonly accessed area of the AOPA website.

• Partner with us: receive a range of promotional benefi ts and discounts by joining AOPA as a Benefactor. Your support allows AOPA to progress a number of signifi cant projects on behalf of the membership and the profession.


Documents

Clinical Specialties - AOPA