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Student Papers

Alignment Magazine 2016

The following are student research projects from British Columbia Institute of Technology and George Brown College that each program is excited to share with the P & O community across Canada.

With thanks to project coordinators Caroline Soo, B.Sc. (Kinesiology), M.Sc., Research Coordinator, Prosthetics and Orthotics School of Health Science, British Columbia Institute of Technology, and Gordon Ruder, CO(c), B.Sc., M.Sc., Coordinator, Prosthetic & Orthotic Programs, George Brown College.

Table of Contents

  1. Effects of dynamic AFOs after chemo-denervation and serial casting in adults with acquired brain injury: a feasibility study
  2. Outcome Measures for Lower Extremity Orthotic Treatment
  3. An Investigation of Inertial Effects on a Trans-tibial Amputee
  4. Using 3D Printing to Design a New Cranial Remodeling Orthosis
  5. Pre- and Post-assessment of a Prosthetic and Orthotic Treatment: a health-related quality of life questionnaire using the Orthotics Prosthetics Users’ Survey (OPUS)
  6. Prosthetic Outcome Measures for a Smart Device Application
  7. Are plant-based fibres an acceptable alternative to fibreglass in the fabrication of prosthetic sockets?
  8. Pilot Study: A Quantitative Analysis of Peak Pressures Experienced During Walking and Running Gait in an Unstable and a Stable Mid-foot While Wearing Supramalleolar, Dynamic Mid-foot Control, and Dynamic Foot Orthosis.
  9. Are there beneficial elements to non-surgical intervention of paediatric in-toeing in terms of temporal parameters, and balance?
  10. Management of Partial Foot Amputations
  11. Will the new Ossur Iceross Seal-In X adjustable liner allow higher socket comfort and product satisfaction among trans-tibial prosthesis users?
  12. Clinical Perceptions on the use of a Digital Outcome Measures Tool in Prosthetics and Orthotics

Effects of dynamic AFOs after chemo-denervation and serial casting in adults with acquired brain injury: a feasibility study

A common treatment for spastic equinus deformities in people with acquired brain injury is chemodenervation, sometimes followed by serial casting. There is anecdotal evidence to suggest the use of dynamic resting ankle-foot orthoses (AFO) as a novel adjunct therapy to these treatments.

Objectives of Research

While implementing the International Classification of Functioning, Disability and Health framework, this study will evaluate the effectiveness of dynamic resting AFOs as an adjunct treatment for spastic equinus deformities. However, the primary aim is to examine the feasibility of the described methodology in a clinical setting.

About the Authors

Malena Rapaport, B.Kin., (BCIT), is a graduate of the Faculty of Kinesiology at the University of Toronto. She is currently comleting her Masters in Rehabilitation Science at McMaster University while doing her Prosthetics Residency at Barber Prosthetics.

Amanda Bremmer, earned a B.Sc, from Simon Fraser University in Biomedical Physiology and Kinesiology and is currently completing her M.Sc. from McMaster University in Rehabilitation Sciences.

Outcome Measures for Lower Extremity Orthotic Treatment

Outcome measures (OMs) are standardized tools used to evaluate, discriminate, and/or predict attributes of interest in an individual or group (Finch et al., 2002). The incorporation of these tools into clinical practice facilitates the development of evidence-based practice and aids in the justification of treatment. OMs can aid in communicating to the patient, multidisciplinary team members, and third parties the need for a particular prescription and provide evidence regarding the effectiveness and progression of treatment. Rehabilitation disciplines such as physiotherapy, occupational therapy, and nursing have developed standardized practice guidelines for patient care and management in which OMs are becoming a commonlyused tool (Canadian Association of Occupational Therapists, 2015; Canadian Nurses Association, 2015; Canadian Physiotherapy Association, 2012). In current orthotic practice, OMs are not implemented on a regular basis. This is due to a lack of resources and limited ease of accessibility to the few resources that exist which diminishes the ability of an orthotist in justifying treatment methods.

Objectives of Research

The purpose of this paper is to initiate the development of an orthotic outcome measure database by identifying OMs that can be applied to lower extremity orthotic treatment in clinical practice. Suitable OMs will be identified through a comprehensive review of publicly available OM databases. This paper aims to eliminate some of the uncertainty in choosing an appropriate OM and reduce barriers of implementation in clinical orthotic practice.

About the Authors

Christine Tschirhart, B.Sc.,is a second-year student in Clinical Methods in Prosthetics and Orthotics at George Brown College and co-enrolled in the Masters of Rehabilitation Science program at McMaster University. Christine will do her Orthotic Residency at Orthopedic Bracing Solutions Inc.

Anne Whitney is a second-year student in the Clinical Methods in Prosthetics and Orthotics program at GBC. She graduated from McGill University in 2009 with a B.Sc. in Kinesiology. She will undertake her Orthotic Residency at Boundless Biomechanical Bracing

An Investigation of Inertial Effects on a Trans-tibial Amputee

Prosthetists have an increasing level of control over distribution of mass within the prosthesis. Currently, there is little research available quantifying the clinical effects of varied mass distribution. The clinical impacts of prosthetic mass distribution are not well known; currently, mass distribution is not considered during the fabrication of prosthetic devices.

Objectives of Research

The aim of this pilot study was to investigate whether inertial effects have a significant impact on quadricep and hamstring activation during swing phase. Positive results would suggest that mass distribution may play a significant role during gait, and should be studied further and optimized during fabrication of prosthetic devices.

About the Authors

Roopa Somayaji, B.Sc.,graduated from the University of Alberta with an undergraduate degree in Mechanical Engineering. She is currently enrolled in the Masters of Rehabilitation Science program at McMaster University.

Gillian Archibold, B.Sc.,graduated with distinction from the University of Saskatchewan with an undergraduate degree in Kinesiology. She is a certified personal trainer with CSEP and is working towards completing the BCIT P&O program.

Using 3D Printing to Design a New Cranial Remodeling Orthosis

Cranial Remodeling Orthosis (CRO) currently have several limitations including time to fabricate, temperature, weight and cost. 3D printing is a manufacturing technique that has the potential to address these limitations but has yet to be clinically evaluated. 3D printing can be used as an alternative manufacturing process for the fabrication of a CRO. This technology also has the potential to change the design of a CRO and improve associated clinical outcomes.

Objectives of Research

To introduce new design criteria and to demonstrate the viability of using a new manufacturing technique to fabricate a CRO, the first stage of this work is to prove the feasibility of using 3D printing to duplicate the fit and function of orthoses that are currently provided. The second stage is to apply new design criteria that could potentially address the identified limitations. This will be accomplished by utilizing the advantages of additive manufacturing vs. traditional thermoforming.

About the Authors

Jeff Wright, (BCIT), is a graduate of the University of Calgary’s Exercise and Health Physiology program. He is currently enrolled in the Rehabilitation Science program at McMaster University and intends on pursuing a residency in orthotics.

Shane Bates, B.Kin., (BCIT), is a graduate of the University of British Columbia’s School of Kinesiology. He is currently completing his Masters of Rehabilitation Science at McMaster University.

Pre- and Post-assessment of a Prosthetic and Orthotic Treatment: a health-related quality of life questionnaire using the Orthotics Prosthetics Users’ Survey (OPUS)

There is a dearth of longitudinal studies about patients’ health-related quality of life (HRQOL) in P&O. Filling this gap in research can support the validity and reliability of treatment plans for patients, payers and professionals. If there is an increase in HRQOL over time, there may be an indication that care from a prosthetist or orthotist will decrease a patients’ dependence on the healthcare system. Additionally, by quantifying HRQOL it could contribute to developing patient-centred care among P&O professionals.

Objectives of Research

Drawing on the International Classification of Functioning (ICF) framework, this study aims to assess a patients’ HRQOL prior to receiving an orthotic/prosthetic device and after receiving their specific device.

About the Authors

Julia Rayner, CAT(c), C.Ac., (BCIT), is a graduate of the University of Winnipeg’s Athletic Therapy program and the College of Acupuncture and Therapeutics. She is currently finishing her Masters of Rehabilitation Science at McMaster University while completing her Orthotics Residency at Winnipeg Prosthetics and Orthotics

Amber Major, B.Kin, is a graduate of the University of the Fraser Valley. She is currently completing her Masters of Rehabilitation Science at McMaster University. She is excited to work with colleagues and patients to enhance the P&O profession.

Prosthetic Outcome Measures for a Smart Device Application

As the field of prosthetics and orthotics continues to advance, “the need for having reliable evidence available to distinguish and validate our client service is paramount” (Pardoe, 2014). The goals of prosthetic treatment are to improve functionality and quality of life for individuals with limb loss. These goals require outcome measures (OMs) specifically designed to quantify them (Heinemann, 2003). This means practitioners must assess outcomes related to body structure and function, activity level and ability to carry out tasks, participation in life situations, and overall quality of life (Wright, 2013). Despite the availability of OMs to assess these qualities (Condie, 2006), several barriers limit their use in clinical practice. The first challenge is finding and interpreting research to select appropriate OMs for patients (Resnik & Borgia 2011). It is critical to select quality OMs that have strong validity and reliability for the specific population of interest (Condie, 2006). Several mobile applications (apps) have been developed and utilized for individual outcome measures to combat these barriers. No smart-device app exists which contains multiple prosthetic outcome measures, and links directly to pre-existing electronic medical records software.

Objectives of Research

The purpose of this project is to compile an updated list of outcome measures suitable for prosthetic practice to minimize the barrier of appropriate outcome measure selection. From this list, suitable outcome measures will be strategically selected for use in an OMs smart-device application.

About the Author

Mitchell Visser earned a B.Sc. in Biology from StFX University. In his second year of the Clinical Methods in Prosthetics and Orthotics program at GBC, he is also completing the Masters of Rehabilitation Science program at McMaster University. He will begin his Prosthetic Residency at Atlantic Prosthetics Inc.

Are plant-based fibres an acceptable alternative to fibreglass in the fabrication of prosthetic sockets?

In 2013 the World Health Organization stated that only 5-15% of persons in need of assistive health products have access to them. Prosthetic and orthotic (P&O) devices are among these products. The recent United Nations climate change agreement reinforces an international concern to reduce carbon footprints (United Nations, 2015). It is understood from this that there is a need for more P&O materials that are sustainable but also produce a lesser environmental impact than conventional options. Within the conventional materials, fibreglass is considered moderate strength (Phillips, 2005) and is consistently noted as suitable within industry standards in regards to tensile strength (Campbell et al.; Che Me et al., 2012; Phillips, 2005). Despite the apparent suitability of fibreglass for use in prosthetics there are aspects of the material, such as health hazards and environmental impacts, that can pose challenges/issues in certain settings.

Objectives of Research

The objective of this paper is to identify sustainable alternatives to conventional materials, specifically fibreglass, for use in the lamination of prosthetic sockets. Plant-based fibres will be identified and compared to synthetic fibres to determine their viability through the following measures: mechanical properties, environmental effects, health hazards, and overall feasibility.

About the Author

Tania Gripper Chabot, RTP(c), has been working in the field for nine years. She returned from teaching at the Philippine School of Prosthetics and Orthotics to further her education by completing the Clinical Methods in Prosthetics and Orthotics program at George Brown College. Tania will join the team at the Ottawa Rehabilitation Hospital to pursue a residency in Prosthetics.

Pilot Study: A Quantitative Analysis of Peak Pressures Experienced During Walking and Running Gait in an Unstable and a Stable Mid-foot While Wearing Supramalleolar, Dynamic Mid-foot Control, and Dynamic Foot Orthosis.

This study will be analyzing and comparing peak pressures at the heel, big toe, head of the first metatarsal, and medial arch during walking and running. Pressures will be measured while shod as a control condition and while wearing a Supra-Malleolar Orthosis (SMO), Dynamic Mid-foot Control Orthosis (DMC), and a Dynamic Foot Orthosis (Dyno) using F-scan.

Objectives of Research

To determine the peak pressures in each of the SMO, DMC and Dyno orthoses in a patient with a mobile mid-foot and a patient with a stable, but not rigid, midfoot, the stability of the mid-foot will be captured in barefoot conditions weight-bearing and non-weight-bearing, using picture analysis and markers on the first MTP, navicular and centre of calcaneus to quantify. A full range of motion analysis of the rays, oblique axis, as well as subtalar joint motion will be taken and recorded to further quantify the collapsibility. Pressures will be measured at the heel, big toe, head of the first metatarsal, and medial arch to determine which device yields the lowest peak pressures in self-selected walking and running speeds. This is important in determining the impact of these devices on those with an unstable and stable mid-foot.

About the Authors

Heather Mackenzie completed her B.Sc. (Kinesiology) at McMaster University in 2013. She then completed one year of the George Brown College prosthetic and orthotic technical program before entering the clinical program where she is now in her second year. She is looking forward to her next step in becoming a certified orthotist in the residency program.

Shaughn Reilly, B.Sc., graduated from McMaster University with an undergraduate degree in Kinesiology. He is currently finishing his second year of the Clinical Methods in Prosthetics and Orthotics program at George Brown College and will be starting his Orthotic Residency at Valley Orthocare Ltd. in Surrey, British Columbia.

Are there beneficial elements to non-surgical intervention of paediatric in-toeing in terms of temporal parameters, and balance?

In-toeing is a common deviation within the paediatric population and a major cause of concern for parents (Li, Leong, 1999). The foot progression angle (relationship of the line of progression of the foot compared to the direction of walking) will indicate if in-toeing is occurring. The normal range of foot progression angle within young children is -3 to 20 degrees. A negative value below -5 or more is deemed excessive in-toeing in a child (Walls, Sehgal, 2012). The adverse effects of untreated in-toeing may include frequent tripping, pain, and patella instability (Uden, Kumar 2012). This negative foot progression angle can be caused by various deformities such as femoral anteversion, tibial torsion, metatarsus adductus, or muscle imbalance (Li, Leong, 1999). The cause of the negative foot progression angle should be determined in order to provide the most beneficial treatment. The cause can be determined by various tests such as the Ryder’s test, foot-thigh angle, transmalleolar axis angle, and heel bisection line. Although physical examination should be sufficient in assessing the cause, use of X-rays, fluoroscopy or CT scans can be used to determine the cause of the in-toeing (Li, Leong, 1999). There are various methods both surgically and non-surgically to address in-toeing (Uden, Kumar, 2012). Some of the non-surgical options include Twister straps, Twister cables, Gait plates, and Theratogs. Surgical options include casting and/or osteotomies (Li, Leong, 1999). In the current literature, there is controversy within the non-surgical options (Mohamad, 2013). Some of the literature states that the use of derotation orthotics do not provide any benefit to the in-toeing individual (Li, Leong 1999). Other works have seen an improvement in temporal parameters and gait when utilizing non-derotation orthotics (Mohamad, 2014). A literary review of the most current studies and papers is required to answer the underlying question: Are there beneficial elements to non-surgical intervention of paediatric in-toeing in terms of temporal parameters, and balance?

Objectives of Research

Orthotic management of this deviation is used in facilities today. There seems to be little knowledge of the effects of the correction beyond a visual assessment and gait analysis. The purpose of this research article is to assess a compilation of case studies and research papers in search of quantitative evidence of the benefits or harm of these various interventions. This will provide education on the orthotic management used, and its effectiveness in clinical practice.

About the Author

Devin Sims is currently a second-year student in the Clinical Methods of Prosthetics and Orthotics program. He graduated from the P&O technical program at George Brown College in 2013 and has spent time volunteering at Sri Lanka School of Prosthetics and Orthotics. Moving forward, Devin hopes to become dual certified and begin volunteering abroad again.

Management of Partial Foot Amputations

Partial foot amputation (PFA) is a surgical treatment involving the resection of part or all of the foot distal to the ankle, while retaining at least part of the plantar weight-bearing surface of the foot. PFA is indicated for many disease processes as well as traumatic causes. PFA is the most common amputation surgery performed in industrialized countries, with an incidence of approximately two per 1,000 individuals (Dillon, 2010). Improvements in revascularization techniques and an emphasis on limb salvage have led to an increased proportion of amputations being performed distal to the ankle (Dillingham, Pezzin, Mackenzie, 2002; Dillon, Kohler, & Peeva, 2014). Little data is available regarding the incidence of PFA in the Canadian population, although incidence is likely similar to other industrialized nations. The goal of the current study is to create a focus group of Canadian pedorthists, prosthetists, and orthotists to describe the number of individuals with PFA treated by Canadian practitioners, and the types of treatment they provide.

Objectives of Research

The objective of the current study is to describe the current body of knowledge on the prevalence and treatment options for individuals with partial foot amputations through a comprehensive literature review, as well as discussion with a focus group of orthotists, prosthetists, and pedorthists. Following the descriptive analysis of the available information on prevalence of partial foot amputations and options for partial foot care, a survey will be disseminated to Canadian orthotists, prosthetists, and pedorthists to gather data on practitioners’ experiences

About the Author

Meagan Gerein is in her final year of the Clinical Methods program at George Brown College. She graduated from McMaster University with a degree in Arts & Science. Meagan will begin her Orthotics Residency at B.D. Mitchell Prosthetics and Orthotics.

Will the new Ossur Iceross Seal-In X adjustable liner allow higher socket comfort and product satisfaction among trans-tibial prosthesis users?

As the Seal-In liner acts as an interface between the skin and socket of the prosthesis, it can be a viable suspension option for amputees. Until the recent release of the Iceross TT Seal-In X, manufacturers determine the seal-in level. Ossur’s new Seal-In X liner allows patients to self-select the level with an adjustable Seal-In ring. Limited research is available about this liner. Our quantitative and qualitative research investigates how adjustability contributes to patient comfort and product satisfaction.

Objectives of Research

To investigate how adjustability of the Seal-In liner will affect pistoning, knee flexion, patient comfort, and overall satisfaction.

About the Authors

Christine Richardson, B.Kin., C.E.P., (BCIT), is a graduate of the University of Regina with a Bachelors of Kinesiology majoring in Human Kinetics and Adapted Movement Science. She also completed her Certified Exercise Physiologist (C.E.P.) exam though the Canadian Society of Exercise Physiology. She is currently finishing her Masters of Rehabilitation Science at McMaster University while doing her Prosthetics Residency at Winnipeg P&O.

Patrick Smith, B.PEd, CAT(c), RT (Orthopaed), (BCIT), is a graduate of Mount Royal College and the University of Manitoba. He is a certified Athletic Therapist and a registered Orthopaedic Technologist and is currently doing his residency at Winnipeg P&O in orthotics.

Clinical Perceptions on the use of a Digital Outcome Measures Tool in Prosthetics and Orthotics

Outcome measures in prosthetics and orthotics can be used to objectively measure treatment outcomes. However, clinicians have been reluctant to implement these measures in practice as they are often time-consuming, difficult to analyze, and procedures have not been standardized. The development of an easyto-use digital outcome measures tool for prosthetists and orthotists could assist in quantifying patient satisfaction and functional outcomes. This may help to ensure optimal care is provided to the patient. Digital data collection could also allow for large amounts of accessible data to be compiled and used to conduct high quality research in this small field.

Objectives of Research

By analyzing questionnaire and focus group responses, this study explores clinical perceptions on the implementation of a digital outcome measures tool.

About the Authors

Anna Kruithof, B.Sc., (BCIT), is a graduate of the University of Victoria with a degree in Psychology.

Jasmine Slomp, B.Sc., (BCIT), is a graduate of the University of Lethbridge with a degree in Kinesiology. She is currently completing her Masters in Rehabilitation Science through McMaster University