Orthotic Analysis using the video vector system

Category:          Scheme best illustrating Technological Innovation

Name:                Helen Evans

Job Title:            Research Physiotherapist

Organisation:     Broxtowe and Hucknall PCT

Email:                 helen.evans@nottingham.ac.uk

Telephone:         0115 8404894 / 4880

Key team:          Helen Evans (Research Physio, Based In Nottingham University, Human Performance Lab), Karen Marshall (Paediatric Physiotherapist – Broxtowe and Hucknall PCT), Beverley Jackson, Ian Johns (Paediatric Physiotherapy Manager, Broxtowe and Hucknall PCT)

Title:                 Orthotic analysis using the video vector system.

Previously the method by which orthoses were assessed was rather subjective, relying predominantly on clinical observation, and therefore dependent to some extent on clinician experience. By using a more objective measurement and assessment tool, it was hoped that the process by which orthoses are prescribed and their benefits assessed, would be made more quantitative therefore allowing an objective clinical decision to be made. Furthermore it was hoped that the process would allow each orthotic prescription to be optimised (whether this be increased or decreased), allowing the children to gain the most benefit out of their orthoses, whilst still being able to assess the need for their use.

The predominant users of this assessment service are children with specific gait problems, referred by Community Paediatric Physiotherapists, thus these children benefit the most from the service. However, it is also anticipated that, through developing further orthotic and gait analysis skills, the physiotherapists would also benefit from participating in this assessment process. These benefits will then be passed onto the child through improved assessment skills and therefore more specific treatment planning. Following the installation of the equipment, a service protocol was agreed between the lab in which the equipment is based and the referrers to the service, allowing them to refer children they felt would benefit from this assessment service.

The service involves the collaboration of the Community Paediatric Physiotherapists along with the Research Physiotherapist working in the laboratory to set up the equipment, paperwork and service agreement, and is managed by the Research Physiotherapist. An in-service training session was organised by the Research Physiotherapist and one of the Community Paediatric Physiotherapists to highlight the benefits and organisation of the service to the other physiotherapists able to refer.  The benefits were determined via a mini-audit after 6 months of service provision to assess the effect of the service on orthotic provision in this client group.  This continual assessment of the outcomes of this service will be maintained.

The main challenge involved the technical set-up of the equipment within the lab, as the system is an in-house (rather than commercial) system. These were overcome through research, networking with other similar laboratories, and time spent investigating and testing the equipment once set up.

Although the service is still developing, we have found instances where children no longer require the orthotics they have required for years, which has obvious benefits for the child, as well as cost saving potential for the orthotic budget.  It also allows the child’s gait to be assessed in more detail than is usually possible in the clinical setting, providing further information for physiotherapy management, such as specificity in their exercise programme.  We plan to continue running the orthotic service, in order to optimise the management of these children.

Through contact from the Research Physiotherapist with other gait laboratories, two further labs have installed video vector systems using the same set-up as here, thereby allowing other centres to benefit from its potential within their field of work.  The service here also takes referrals from Consultants who have contact with the lab to assess their patients in a similar manner.  Continual feedback (via further in-service training) to the physiotherapists will allow the findings of this service to be fed back to the clinicians seeing these children, thus promoting the service and its potential, as well as updating their knowledge base within this field.