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.