Innovative advances in medical paediatric orthotics shared at Primary Care and Public Health 2016

Orthotics and Physiotherapy Partnership in Pioneering Gait Laboratory set to transform prognosis for movement disorder patients in the UK

Innovative, clinician-led advances in orthotic techniques have the capacity to dramatically improve short term progress and long term outcomes for selective dorsal rhizotomy and scoliosis patients as well as patients with neurological disorders affecting movement. That’s the message that Dr Sam Walmsley BSc (Hons), Director and Lead Orthotist at London Orthotic Consultancy, brought to delegates at this year’s Primary Care and Public Health Conference on the 18^th May 2016.

Photograph of Aran in his family setting. Reproduced with the permission of London Orthotics Consultancy ©London Orthotic Consultancy 2016.

Drawing on empirical research and patient-led data, Walmsley discussed the success rates that are being achieved at LOC’s Gait Laboratory in partnership with internationally renowned physiotherapist Elaine Owen MBE (MSc SRP MCSP) – whose unique diagnostic insights are rewriting conventional opinion to optimise the effectiveness of AFO-Footwear Combination (AFOFC) treatments. Walmsley also addressed LOC’s innovative use of dynamic movement orthotics, citing case studies where the use of high quality lycra body suits is achieving encouraging long term results for scoliosis patients.

Post SDR Patients Taking First Steps Thanks to Gait Lab Insights

Aran, aged 10, is the latest patient to experience the impact of Elaine Owen’s gait analysis techniques, which are informing the application of AFOFC devices at LOC’s Kingston clinic. Diagnosed with diplegia cerebral palsy, Aran travelled to the USA in 2011 to undergo selective dorsal rhizotomy surgery to address spasticity, before beginning a course of rehabilitative orthotic treatment with LOC.

“Children who have undergone this surgery typically face an intensive rehabilitation programme and orthotics play a huge part in that process” Walmsley explains. “The conventional orthotic opinion at St Louis Children’s Hospital is that the post-operative patient should be allowed as much movement as possible by limiting medio-lateral movement whilst allowing movement in the sagittal plane with the application of hinge splints. However, in Aran’s case, we felt that he had the capacity to progress much more by introducing him to the Elaine Owen clinic.”

Elaine’s approach, which has been developed over a 40-year career and attracted widespread attention across the international orthotics community, focuses instead on controlling sagittal, coronal and frontal movement, with detailed attention to stance phase positioning. “Working closely with Elaine’s analysis, we developed a new, bespoke splint and AFOFC combination for Aran which ensured stringent control of these areas” says Walmsley. “The results have been remarkable. Within a week of fitting the devices, Aran was taking his first independent steps. After two months he is able to walk for five metres independently – a significant milestone that is giving us new insights into his achievable goals for the future.”

Scoliosis Lycra Suit – A Innovative Dynamic Scoliosis Management

Aran also presents with Scoliosis, which had been rapidly deteriorating. This has been addressed by the provision of an innovative lycra bodysuit. Dynamic movement orthosis is designed to apply a global compression to the joint and body segment that it is worn over. This compression acts to increase the client’s awareness of that part of the body, a process called proprioception. The suits are made from complex panels of Lycra that compress over specific muscle groups. In addition, elasticated panels add a biomechanical effect to specific areas of the suit. The elasticated panels allow LOC to gain control of postural problems, such as protracted shoulders, kyphotic posture or internally rotated limbs. With increased proprioception, the patient can often control that part of the body more effectively. With increased proprioception to the trunk, balance and posture can be significantly improved. Over the past two years, X-Rays have demonstrated definitive improvement for Aran’s scoliosis with this treatment – one of numerous positive results that LOC is generating in this area.

Economic, Social and Developmental Impacts

Walmsley believes that it is vital to share LOC’s experience of the success rates for these new orthotic advances with his fellow practitioners operating in primary and public healthcare. “We are constantly learning from these new techniques” he explains. “But I don’t think it’s exaggerating to say that the impact is already becoming clear to us. The benefits of early intervention to prevent invasive (and costly) surgery in later life must not be ignored. Not to mention the impact on the lives of patients and their families. By providing the right orthotic devices, informed by detailed gait analysis, we aim to improve strength and movement for patients who otherwise might not progress or may even deteriorate over time. We can impact on areas like the intensive physiotherapy that parents are often responsible for handling on a daily basis – we should not underestimate the physical and emotional strain this can cause. Aran is by no means the only patient we are seeing improve beyond our original expectations thanks to these advances. If we can achieve a much wider awareness in the medical profession of the potential of these treatments, then we have the capacity not only to improve lives, but to reduce strain on medical funding by ensuring that the right treatment has the right impact at the right time. These are exciting times for the orthotics profession, and we are delighted to be working with Elaine and her team to drive them forward.”