Case Studies and Testimonials of OETT Support
1. OETT Keynote Speaker BAPO Conference & Exhibition 2013
Our OETT keynote speaker for BAPO 2013 was Professor William Jeffcoate who presented on "Diabetes - the ticking bomb" to a standing room only audience of predominately Orthotists as well as other AHP's, Prosthetists, technicians and therapist colleagues Professor Jeffcoate, a consultant endocrinologist whose passion is the creation of evidence to underpin clinical practice, presented on the management of the Charcot foot; this has been the major interest and subject of four major foot ulcer trials. The trials were undertaken by his specialised service for the management of the foot in diabetes that has produced over 80 peer reviewed publications. Presently he is chair/co-chair of systematic review working parties for the international Working Group on the Diabetic Foot on infection and on treatment to improve healing. In 2010-12 he has been lead of the working party to develop an audit tool for foot care in routine clinical practice.
His presentation was a resounding success with a balance of education and entertainment from one of the UK's most eminent speakers on Diabetes that encompassed OETT principles to advance orthotic education.
2. OETT Technician Training Day BAPO Conference & Exhibition 2013
The 2013 OETT sponsored BAPO Conference parallel Technician training programme was exceedingly well supported and a resounding success.
Contributions were received from eminent presenters e.g. Dr Stephen Hutchins, Andy Dewsbury and Marsh Gibson as well as some new contributors namely; Blake Jackson, Rob Bradbury Mark Corrigan and Lee Willan.
Presentations covered future technician training, new materials and manufacturing techniques as well as updates of more established orthoses for the newer generation present. All this was shared in an open and generous dialogue which enabled all attendees to learn, contribute and greatly enjoy this event.
3. Nick Gallogly (Orthotist - Royal Berkshire Foundation Trust, Reading)
I am currently undertaking a Masters in Clinical Biomechanics at Staffordshire University. The decision to undertake this was not an easy one both from a financial and time point of view.
I put forward my application for funding help to the OETT board and received the full allocation. Working a full time job within the NHS and studying for an MSc is no easy task but the personal and professional rewards out-weight the long nights and weekends sat in front of the computer.
As I trawl through all the research in my travels, one element becomes very apparent, the lack of Orthotists doing research and adding to our practice. I do believe that this is a trend that will change, it has to if we, as Orthotists are going to be seen as influential members in the management of conditions and not facilitators in order for the other professionals to get what they want.
I hear in the back of my head people saying to me “what are you studying for, I still see Orthotists that can’t do footwear correctly”. The simple truth is that if we don’t, we will, if we are not already, be left behind.
So I encourage you all to pick up a new piece of research today, analyse it, and use it as a method to prove or disprove treatments. Look at others ways for you to expand your knowledge base and moved up the clinical ladder. One thing you can be sure of is that the OETT will be there, ready and waiting for your application to help in any way they can.
My aim is to add to my profession, for a fellow professional to read my research (the title changes from week to week) and use or not use it in their treatment regimes. At the very least it should spark conversation and discussions.
I would not be doing this MSc if I didn’t have the backing from the OETT, the costs are too great. I cannot thank the Board enough for their help
4. Jim Ashworth-Beaumont - OETT helps make dreams come true !
Since graduation in 2000 I had retained my focus and primary interest on nurturing team approaches in community and acute teams, as the gold standard to providing rehabilitation from neurological injury. I have been privileged to work alongside expert Orthotist, AHP and medical colleagues at the Royal National Orthopaedic Hospital NHS Trust where we aim to provide the highest standards of integrated rehabilitative care for spinal cord injury survivors who encompass the widest possible spectrum of abilities and goals.
I had long pondered the fundamental factors underlying motor learning - the lasting (or plastic) changes in behaviour and underlying neurophysiology which underpin therapy – the lasting skills improvements and adaptive short-term variations which allow us to meet goals in a dynamic environment. In the spring of 2007 I sent a proposal to OETT, setting out the aims and objectives which would be satisfied by undertaking an MSc in Neurorehabilitation at Brunel University. This course is aimed at specialist AHPs and medical professionals who seek a deeper understanding of the field and are considering embarking on neurorehab-focused research or evidence-based service delivery as part of their future career.
My NHS Trust supported me superbly in both spirit and study leave, but OETT was most generous in supporting me through this 2 year part-time taught course with 2/3 of the course funding. So I graduated in 2009, having met my personal learning objectives and having been exposed to a mind-boggling range of quantitative and qualitative themes along the way! My dissertation focused on the effect of non-invasive brain stimulation twinned with voluntary activity and FES on brain plasticity (cortical stimulation having the potential as a novel class of orthotic device to boost brain performance and skills learning), which earned me a Distinction.
I’m now embarked on a full-time PhD in Health Studies looking at brain plasticity and motor learning, and the effect of brain stimulation to enhance rehabilitation from tetraplegia following spinal cord injury. Though I was lucky to have been awarded a PhD Research Scholarship from Brunel, and continue working part-time at the RNOH, without the continuing help from OETT in the form of a 50% grant for travel expenses I simply would not be able to continue my career journey.
5. Paul Charlton - Senior Orthotist, Peacocks Medical Group, Newcastle-Upon-Tyne
The two challenges to learning and professional development of an individual are time and resources. I have been most fortunate in that the time offered by my employer has been complimented by financial support from OETT.
This has developed my orthotic knowledge and understanding by allowing me to attend short courses in several areas including functional foot orthoses and diabetes.
My special interest in adult neurology has been enhanced by learning the associated skill of application of functional electrical stimulation at the approved course at Salisbury. My breadth of knowledge and understanding was further broadened by attending a physiotherapy “Bobath” course on posture and balance.
My interest in gait anomalies and links with ORLAU and our local gait laboratory in Newcastle where enhanced by completing the Strathclyde University Postgraduate certificate in clinical gait analysis.
More recently I have been involved in both my London orthotic interest group and the ISPO consensus conference on orthotic management of stroke. Both of these involvements made me aware of the importance of supporting our work with good quality research and evidence. To this end I was fortunate to be funded to extend my Post Graduate certificate to a Master of Science degree. This both gave me an understanding of research quality and how to perform it well and to carry out a piece of in depth research.
My research embodied my learning of clinical gait analysis and stroke as I investigated the effect of rigid AFOs on knee alignment and muscle recruitment in the early recovery of stroke. This was considered to large a project for a MSc and consequently I co-opted a fellow student to carry out the muscle recruitment study. We hope to publish our findings in a peer reviewed journal later in 2006.
I am delighted to have this opportunity to thank the OETT for the support in my career development and would encourage all orthotists and their employers to take advantage of this superb support and opportunities offered.
6. Students from the National Centre of Training & Education in Prosthetics & Orthotics, Glasgow - Field Trip to Texas
Late June and early July 2006 saw 16 students from the National Centre of Training and Education in Prosthetics and Orthotics, Glasgow, descend upon the major cities of Texas, USA, in a bid to gain new knowledge and perhaps expand upon the current curriculum the University offers. This trip was funded not only by extensive fund raising on the student’s part, but by generous donations from various benefactors, the Orthotic Education and Training Trust being one of the keenest supporters.
The first port of call was the University of Texas South-western, Dallas, where students were introduced to the Otto Bock CAD-CAM system and tibial fracture bracing concepts.
The Otto Bock CAD-CAM system can be used by both prosthetists and orthotists to scan limb segment and using the programme software virtually rectify the model if need be. The main indication of this system, in the realm of Orthotics, is to gain accurate images of significant foot deformities, useful in the creation of bespoke footwear. A reintroduction to the familiar, but as students not yet practised, discipline of tibial fracture bracing was welcomed by all. Whilst the principles remained the same, it became evident fracture bracing is used more in the US as a cosmetic equivalent to the UK favoured casting.
Whilst still in Dallas, the students visited the Texas Scottish Rite Hospital for Sick Children, a centre dedicated to the rehabilitation of children free of charge. Kevin Felton kicked off proceedings by providing an overview of lower limb orthotics used at the Scottish Rite Hospital. Whilst familiar with many of the designs and notions Kevin suggested, the Ponseti brace, used in the treatment of club foot, was a new concept to the students. The Ponseti or Foot Abduction Bar orthosis, which maintains the child’s feet in an abducted position about shoulder width apart, is used after the Ponseti method of serial casting. Don Katz, a prominent figure in the field of scoliosis bracing, spoke extensively on his findings from a recent study he conducted regarding patient compliance with spinal braces. By inserting a flat plate temperature recorder into the anterior of the jacket, and explaining to the patients it was merely a design feature, any increase in temperature could be noted and recognised as the patient wearing the brace, and vice versa when the temperature dropped. Shockingly, when patients were asked to wear a brace between 16 and 23 hours, only 40% were recorded as having been worn. Of this 40%, 62% were deemed poorly compliant.
In general he noted, unsurprisingly, that patients with poor compliance showed curve progression. He also noted those with Risser sign 2 displayed no relationship between wear time and curve progression. Whilst touring the in-house fabrication centre at the hospital, a novel device for children with lower limb paralysis was spotted. Eloquently referred to as a “bucket”, the sledge shaped seat provided an enclosed platform to the bottom of which ice blades could be attached, thus allowing the child to partake in all manners of ice rink events, using their hands for propulsion. This unique design shows the lengths the hospital staff will stretch to ensure a child is not disadvantaged in any aspect of live.
After a whistle-stop tour of Austin (to see 5.2 million bats fly from under Congress Bridge) and San Antonio (to sample margaritas on the River Walk) and a short lay over at NASA (to ensure engineering standards were up top scratch), the students found themselves in Houston. Through our travels across the Lone Star State, many of the students were astonished at the sheer volume of orthoses on display and walking around the streets. Perhaps through some form of public education Texans seem more aware of the existence and uses of orthotics and in doing so not only lift any stigma surrounding the wear of them but also almost endorse the exhibition of them.
After some Independence Day Celebrations, Dynamic O&P, a company run by Tom Dibello, a former president of the American Academy of Orthotists and Prosthetists, was the scene of further education.
Doug Sammons began the day by discussing the orthotic interventions for patients suffering from post-polio syndrome. He noted up to 27% of patients now wear an orthosis on the previously unaffected limb thus highlighting the importance of a thorough clinical exam of both limbs when caring for polio patients.
Tom Dibello continued proceedings, talking about the pharmacological and orthotic management of lower limb spasticity. Tom noted the effectiveness of using Botox injections in conjunction with serial casing to reduce a contracture. As the students have not been exposed to spastic muscles with Botox treatment, Tom’s information regarding its peak effects (4 days after) and the optimum time for casting for an orthosis (2 weeks after) were of great use.
The appropriate orthotic treatment for thoracolumbar spinal fractures was addressed by Miguel Gomez, who denounced the 3-point force system for such uses. Miguel noted such force patterns could cause shear over the fracture site, putting the patient in more discomfort, and that by using bending moments such shear forces can be avoided.
A topic not considered in the UK was broached by Stacey Linton, that of omphaloceles - herniation of the umbilical cord. This abdominal wall disorder presents as a clear sack on the anterior of the torso, and can contain vital organs. They generally recede over time. The main orthotic aim is to protect the omphalocele, particularly during transit, and to prevent rupture. A cast is taken of the child in its car seat, across the frontal plane, and rectified such that it provides ample room for the omphalocele and is able to clip neatly onto the car seat. (See figure 2 – an omphalocele protector cast)
Another area not commonly practised in the UK, but recently introduced at Yorkhill Hospital, Glasgow, is the use of cranial helmets. Phil Stevens discussed the differences between two problems leading to cranial abnormalities. The first is craniosynostosis, a premature fusion of the fontamels present on the infant skull. Surgery is the only treatment for this disorder.
The second is positional plagiocephaly, whereby the preferred position an infant adopts provides a force that distorts the shape of the head. Whilst, if caught early, this can be corrected by encouraging the child into an opposite position, severely distorted craniums may require a helmet. The basic principle of providing an opposing force for areas of protrusion and excavations to encourage expansion of the skull in the desired direction makes the helmets very effective in correcting skull shapes.
The final day of clinical visits saw the students take tours of two facilities, both noted for excellence in rehabilitation.
Whilst at the Texas Institute For Rehabilitation and Research(TIRR), students were able to watch orthotic patients during physiotherapy sessions. Most impressive was the dedication of the centre in rehabilitating spinal cord injury patients. TIRR works with the idea of keeping paralysed limbs active in a bid to restore function by utilising four physiotherapists to manipulate the paralysed limbs such that they simulate normal gait on a treadmill.
The final clinical visit was at Shriners Hospital, another hospital dedicated to providing free healthcare for children. At this centre an impressive gait analysis lab is on site, and every child is analysed to ensure not only the correct prescription is sought, but also that said prescription is providing the best gait possible. The tour concluded with a brief talk from one of the technicians of the in house workshop. He provided insight to the numbers of each orthotic device being issued, and the varying designs of each mechanism.
All of the students involved with the trip thoroughly enjoyed it and felt that they gained some invaluable knowledge and experience, some which may not have been available in our current curriculum. Indeed, as one of these students I cannot express enough thanks for supporters of this trip, particularly the OETT. Without its generosity this trip would almost definitely have been shorter and less extensive. If this was the case many interesting gems of information
7. Chris Morris - Principal Orthotist, Nuffield Orthopaedic Centre NHS Trust, Oxford
I have benefited considerably from the OETT throughout my career as an orthotist. Firstly the Trust helped to establish the diploma course from which I graduated from in 1988. Since then my postgraduate training and development has also been supported by the Trust.
The costs of attending BAPO and other short courses over the years have been generously reimbursed retrospectively for tuition fees, travel and where necessary accommodation. When I wished to study part time for a Masters degree I made an application to the OETT several months in advance. My application was approved and the funding enabled me to achieve an MSc in Evidence-based Health Care in 2000.
Having decided to study for a DPhil, I was in the process of applying to the OETT again when I was awarded a scholarship as part of a studentship from the University of Oxford. Although I was not in need of help for tuition fees in Oxford the Trust has enabled me to participate in health research methodology courses at the London School of Hygiene and Tropical Medicine and at McMaster University in Canada.
Whilst I was the BAPO short course co-ordinator, I made contact with the Trustees to look for ways of integrating the aims of the Association and OETT to develop postgraduate training of orthotists. I was invited to become a Trustee in 2001 and with the other Trustees have looked for new ways to progress professional development now advertised on this website. I encourage any orthotists with an interest in formal postgraduate study to apply for help from the OETT and to realise your educational ambitions.
My tips for making a successful application are to be well organised and particularly:
1) Apply well in advance of when you want to start, and to demonstrate initiative and enthusiasm in your application.
2) Provide as much information about what you wish to do as you can, include any relevant course promotional material and website addresses.
3) Make a coherent case for why this educational opportunity will help you to further your career in orthotics.
4) Think through and detail clearly all the costs involved.
5) Think of alternative sources of funding, such as your employer, and mention in your application what contribution they are willing to provide.
6) If you need more than the 50% of funding that the OETT usually provides then make a persuasive case.
Remember: the Trustees want to help you but they are duty-bound to only authorise funding for appropriate cases; therefore make your application as clear as possible and you will have more chance of success.
8. Jonathan Tebbutt (Orthotist, Trulife)
I have spent the last few years undertaking an Msc in Clinical Gait Analysis at the University of Stafford. With the help of OETT funding, it has eased the financial worry and helped me concentrate on the studies in hand. Whilst working in a challenging and demanding role within a busy Orthotic team here in South Wales.
So far I have completed several modules in sports biomechanics, origins and principles of injury, tissue stress, musculoskeletal diagnosis and applied diagnostic imaging to name a few. This has helped me grow in my clinical and professional practice and helped me think outside the box when presented with complex patients. Deepening my understanding of certain mechanisms of injury has made problem solving easier within clinic. It has also helped me grow in confidence as a clinician and to question practices and theories in a healthy and inquisitive way to establish whether evidence is sound or not.
I will now endeavour to complete the final dissertation year of my Msc, although not an easy undertaking, it has been extremely worthwhile expanding my clinical understanding and development.
9. Sarah Wilson (Prosthetist/ Orthotist - Addenbrookes Hospital Cambridge)
I am currently involved in the diabetic foot clinic where I work and see many diabetic patients in my prosthetic clinics. I wanted to further develop my knowledge in this area so that I could improve the service I provide. I decided to undertake a MSc Diabetes as a distance learning course. My Company allow me study leave to attend the week blocks and the OETT contribute to the funding of my modules. I have now completed the first of my three years and already I have broadened my knowledge of diabetes. Studying with people involved in various aspects of diabetes care from all over the world allows me to gain from their experience but also pass on information about our profession. I have found myself reflecting on my own practice and been able to get involved in the development of the clinic using the information I have gained. I am also able to pass on my knowledge to the students and colleagues in my department by presenting some of my papers written throughout the year. I look forward to next year when I will be looking into management of the diabetic clinics and preparing to do my own research.