PROSTHETICS EDUCATION SPOTLIGHT

Interviewee: Courtney Frengopoulos, MSc MD, University of Western Ontario, Department of Health Sciences

Article: Rehabilitation outcomes after major lower limb amputation in the oldest old: a systematic review Katherine Fuller, Michael W.C. Payne, Ricardo Viana, Susan W. Hunter
University of Western Ontario, Faculty of Health Sciences
McMaster University, Michael G. DeGroote School of Medicine
Department of Physical Medicine & Rehabilitation, Parkwood Institute
University of Western Ontario, Department of Physical Medicine & Rehabilitation
University of Western Ontario, Schulich School of Medicine & Dentistry
University of Western Ontario, School of Physical Medicine


Key Takeaways

  • Paucity of research investigating rehab outcomes in the oldest old age group (aged 80+) so there is a need for more research to be done involving this age group so that practitioners can better serve this population
  • Some challenges associated with prosthetic rehabilitation in the oldest old including higher mortality rate and associated comorbidities
  • People in this age group can be successful prosthetic users, so age alone should not disqualify someone from having an assessment by an amputee rehabilitation program


Please tell us about your lab, your team, and your research interests
While I am no longer a student at the University of Western Ontario, I was introduced to the lab during my undergraduate degree and have had the opportunity to collaborate with them on research for many years and am still fortunate enough to do so. The lab that conducted this study is based at the University of Western Ontario in London, Ontario. There are three researchers that are associated with the lab – Dr. Susan Hunter, Dr, Michael Payne, and Dr. Ricardo Viana. Dr. Susan Hunter is a professor of Department of Health Sciences, works in the physiotherapy department, and is affiliated with the Schulich School of Medicine & Dentistry. Drs. Michael Payne & Ricardo Viana physiatrists at the Parkwood Institute in London, Ontario. Together, these three individuals are key researchers at the Gray Centre for Mobility and Activity at the Parkwood Research Institute. Much of their research examines how to improve outcomes for people with limb loss or people with congenital limb differences. They focus specifically on mobility outcomes, gait abnormalities and falls, and some research has also been done on the cognitive ability of older adults in this population. The lab takes on undergraduate and graduate students for shorter time periods who help contribute to research.


What are you working on right now that you are most excited about?
I am currently working on a chart audit of older adults who have come through the prosthetic rehabilitation program at the McMaster University Amputee Rehab Group. We are examining the demographics of this population to get a more complete picture of this age group within the amputee population. A secondary goal of the audit is to compare the outcomes among more discrete groups of individuals in the older adult population. We know that age plays a role in functional outcomes, so we are currently trying to determine if there is a difference in outcome based on age among older adults living with an amputation. A master’s student in London affiliated with the aforementioned research group is also currently conducting a similar study although her research will focus on all adults over the age of 18. The results of this research will provide researchers and healthcare practitioners with a better understanding of what the population looks like so that they can be better served.


What are next steps based on your research? How can we integrate your findings into clinical practice?
Those in the oldest old can also be a difficult population to care for, due to comorbidities, interruptions to care, social factors, and cognitive impairments, but that should not disqualify them from receiving prosthetic care. Our research shows that people in the oldest old age group can be successful in their prosthetic rehabilitation, so clinicians should ask themselves how they can help them be successful when providing care to someone in this age group.
Another finding of this study is that more research is needed for this population. Our review concluded that a more holistic view of rehabilitation outcomes is needed in research as much of the published literature focused only on functional or physical outcomes which did not provide much information on the person as a whole or on how they were able to integrate into their community. A possible future multi-site perspective study could examine several outcomes such as quality of life, return to community, mental health, and social support within the oldest old population. Ideally, this study will look at three groups of individuals: those who were successful in their prosthetic rehabilitation process, those who were not, and those who were
deemed unfit to receive prosthetic care after their amputation. Understanding the differences between these groups can help us better identify barriers to care and may help improve their experience through their healthcare journey.

ORTHOTICS EDUCATION SPOTLIGHT

Interviewee: Megan Balsdon, MSc., P.Eng., SoleScience Inc.

Article: Custom-made foot orthoses with and without heel plugs and their effect on plantar pressures during treadmill walking
Megan E.R. Balsdon, Colin E. Dombroski
SoleScience Inc., Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, Canada
Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada Corresponding a


Key Takeaways

  • Heel plugs in orthotics significantly decreased average plantar pressure, peak plantar pressure, and pressure contact area in the hindfoot compared to orthotics without heel plugs
  • The reduction in hindfoot pressure corresponded to an increase in midfoot pressure
  • Reduction in hindfoot pressure is critical in treating certain pathologies of the foot, such as plantar fasciitis


Please tell us about your lab, your team, and your research interests
This study was conducted by Sole Science Inc., a pedorthics company based in London, ON. They have nine clinics throughout Ontario, however the clinic in London is the only one that conducts research. I am the research coordinator, and I work alongside the principal investigator and owner of Sole Science, Dr. Colin Dombroski, as well as some of the technicians to conduct research. Dr. Dombroski is an adjunct professor at the University of Western Ontario which allows us to collaborate and conduct research under that umbrella as well.
Our research focus is on quantifying the effect of orthotic interventions and examining if it aligns with the anecdotal feedback we are given from clients, which is how this current study came about. We also try to keep abreast of new technologies coming out in the orthotics field, such as 3D printing. With all of our research though our aim is to still provide our clients appropriate care and effective custom orthotic devices.


What are you working on right now that you are most excited about?
One of the conclusions of this study was that research needed to be conducted with participants with plantar heel pain, so we recently conducted a cross-over study with members of this population. Two sets of foot orthoses were given to participants in random order (one pair with and one pair without heel plugs) and each pair was worn for four weeks. Plantar pressure was measured for each pair at the end of the wear period, and a Foot Function Index and comfort assessment was also taken for each pair of orthoses. The results of this study are currently being written for publication and will be presented at the upcoming Pedorthic Association of Canada Symposium in April 2023.
We are also currently working on comparing different scanning methods (i.e. mobile apps vs. Laser scanners) for shape capturing feet and fabricating subsequent devices. Through this research we are hoping to get a better understanding of the quality of the scans obtained through different methods and determine any adjustments that would need to be made to the scans to produce orthoses of similar quality to those fabricated from the scans generated in the clinic using laser scanners.


What are next steps based on your research? How can we integrate your findings into clinical practice?
Looking forward with this research again I’ll be presenting the findings at the upcoming symposium and I am in the process of writing up the publication for the follow-up study that was conducted with a pathological population. For clinicians working with those with plantar fasciitis and plantar heel pain I hope that they take these findings into their practice so that they can design and fabricate the best foot orthoses for their patients. Working with those who have severe pain that may affect their daily function often requires custom and outside the box solutions, so the findings from this study provide clinicians with another option to incorporate into their treatment planning to improve their quality of life.

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Interviewee: Jan Andrysek, Ph.D., PEng, Associate Professor, Institute of Biomaterial and Biomedical Engineering, University of Toronto, Senior Scientist at the Bloorview Research Institute and Lead of the PROPEL Lab, Holland Bloorview Kids Rehabilitation Hospital

Article: Understanding the adoption of digital workflows in orthotic & prosthetic practice from practitioner perspective: a qualitative descriptive study
Calvin C Ngan, Harry Sivasambu, Kerri Kelland, Sandra Ramdial, Jan Andrysek
Holland Bloorview Kids Rehabilitation Hospital
University of Toronto


Key Takeaways

  • Digital technology is becoming more prevalent in the P&O field, however there are still challenges to fully implementing the technology into clinical practice
  • Three key themes of challenges: technological advancement and scientific evidence; marketplace, economic, and operational factors; mindset shift of embracing digital technology practice
  • Goals of the study were to gain a more in-depth understanding of these challenges from the perspective of practicing professionals and bring awareness to some of the gaps inthe technology and its implementation


Please tell us about your lab, your team, and your research interests
Our team at the PROPEL Lab (Paediatrics, Rehabilitation, Orthotics, Prosthetics, Engineering, Locomotion) is based in the Bloorview Research Institute. Our research lab is comprised of about a dozen students, researchers, and engineers. Our research interests primarily focus on P&O, and the use of technology to enable and improve the lives of children and adults with physical disabilities. We are fortunate to be based out of a hospital, and to work closely with P&O clinicians, technicians and clients on our hospital’s mission to enable the most meaningful and healthy futures for all children, youth and families through cutting-edge treatment, technology, and ground-breaking research. The digital workflow was a good example of this as the team comprised of three individuals from the clinical team and four from the research team.


What are you working on right now that you are most excited about?
The digital technology project is currently most closely related to clinical practice in the hospital, so it has the greatest potential to have the most immediate impact to change and improve the lives of our clients.
In addition to our digital technology projects, we are excited about our work focused on biofeedback and gait training systems, specifically on developing wearable technology to help with the rehabilitation process. Several of our students are researching strategies and approaches on how we can help improve the gait of children and adults using lower limb prostheses. Several other students are also working on upper limb applications, focusing on providing sensory feedback for upper limb prosthetic control. Both of the upper and lower limb feedback research are investigating novel ways of improving physical function.


What are next steps based on your research? How can we integrate your findings into clinical practice?
The devices that we think the digital technology can have the greatest and most immediate impact on are transradial sockets and ankle-foot orthoses (AFO) in terms of being able to provide and improve the methods by which the devices are fabricated. The transradial projects are currently focusing on the socket design, with the goal of eventually being able to provide an entire device. For the AFO project, our lab has teamed up with a local clinic as part of a master’s project to try to advance this research. With all of this research underway, we are trying to not only implement these methods into our own and our partner’s clinics, but we are focused on disseminating our knowledge and information with others in the P&O field. We have been actively sharing our research through
conference presentations, journal publications and medial to make it accessible to other professionals, and as a way of engaging with others that share a similar mission and goals.

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Interviewee: Katia Turcot, Ph.D., Associate Professor, Faculty of Medicine, Department of Kinesiology, Université Laval
Article: Balance control deficits in individuals with a transtibial amputation with and without visual input
Gabriel Moisan, Ludovic Miramand, Hanneh Younesian, Katia Turcot
Université Laval, Faculty of Medicine, Department of Kinesiology
Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)

Key Takeaways

  • Amputees displayed an asymmetrical loading pattern during quiet standing tasks with greater loads on their sound side compared to their affected side
  • Visual input is critical for maintaining balance in transtibial amputees
  • When vision was deprived, balance was significantly affected in amputees compared to when vision was normal


Please tell us about your lab, your team, and your research interests
Our team is interested in the lower limb amputee population, and we have many objectives we wish to accomplish with our research. Firstly, we would like to better understand the body motion strategy developed by lower limb amputees to help them maintain their functional level during activities of daily living and also understand any coping strategies that they may have for pain they may experience in adjacent joints. Secondly, the team would like to develop new biomechanical indicators that can help improve follow-up with clinicians. An example of the applicability of this research would be to help improve the way a prosthesis is prescribed or adjusted at an appointment. Lastly, we would like to research ways to prevent the development of secondary joint diseases in the lower limb amputee population, such as osteoarthritis or back pain.


What are you working on right now that you are most excited about?
We are currently working on many projects. One of the goals of our research is for it to be
transferrable from the lab to more ecological settings in which an amputee may find themselves. For example, one of our projects is studying the joint distribution during functional tasks, such as a sit to stand and exploring what the impact of different devices is on the task and if the joint moments change throughout the task. Another project is examining how amputees navigate stairs, and the impact of aids, such as ramps, how they are being used, and what strategies are being used to navigate these environments, and how these strategies can help prevent the development of secondary pathologies.
In addition to research done exclusively within our lab, we also work in collaboration with
industry partners. We are currently working with Ethnocare, a Quebec-based start-up, to help validate their technology. They have developed a thin sleeve worn over a prosthetic liner that has an integrated adjustment system to help control volume changes in the residual limb throughout the day. This is accomplished through a series of pneumatic cells embedded in the sleeve, and the objective of the sleeve is to replace the need for prosthetic socks. Finally, the project that we are most excited about is another collaborative project where we are hoping to provide all lower limb amputees with access to the motion lab as we believe that this will help clinicians better adjust and align prostheses. Right now, we are in the process of obtaining funding to make this a reality so that clinicians can access the lab when working with their clients.


What are next steps based on your research? How can we integrate your findings into
clinical practice?
Our main goal is to develop biomechanical indicators that clinicians can use in their daily practice when working with clients. With these biomechanical indicators we hope to provide more objectivity to tests clinicians may conduct with their clients. We are working with our system and more portable systems, such as inertial sensors, simultaneously, and the goal is to instrument the tests to help better quantify the outcomes. For example, in a 6 minute walk test the sensors can provide information regarding how gait changes over the duration of the test, biomechanical differences between transtibial and transfemoral amputees, or if spatiotemporal parameters degrade over the test. All of our research is very collaborative, and we involve many other healthcare professional including physiatrists, physiotherapists, and prosthetists.