VI Nordic P&O Congress in Iceland - Part Four
Bengt Soderberg CPO
Readers of this Corner may remember that Bengt Soderberg is one of the authors of an excellent text on the P&O management of partial foot amputations. [ www.sol.nu/book1.pdf - PDF Format ] He is well respected internationally as a savvy clinician, and has been actively investigating the application of instrumented gait studies to the management of prosthetic and orthotic patients for the past decade. He uses Computerized Gait Analysis [CGA] routinely at his facilities in Sweden and Poland, and this presentation was to share some of his observations.
The Swedish facility was established in 1994 at the University Hospital in Helsingbord, and includes 6 Vicon cameras, a Kistler force plate, COSMED energy consumption equipment, and the Active PAL step counter apparatus. In 2002, Bengt's lab conducted more than 70 gait studies, primarily to evaluate patients but also for research, sport performance, and commercial purposes. This undoubtedly makes him the most experienced CPO in the world in the practical use of gait lab data.
Bengt is firmly convinced that CGA is the future for the field, and that it will drop in cost so rapidly in the next few years that it can become a routine tool in major P&O facilities around the world. He reviewed the available literature on the application of gait lab data to P&O questions, and although the body of work is rather limited, the support for objective measurement is very impressive.
Bengt presents his gait lab evaluation results in a very understandable format, which is contained in a self-running CD-ROM that the referral source receives. He demonstrated some of these capabilities during his talk, including the following information:
- Real time digital video in all three planes
- Real time skeletal animations in all three based on kinematic marker movements
- Real time ground reaction force data, which can be superimposed on either #1 or #2 above.
- Graphed data display for motion and moments at all lower limb joints.
- Clinical summary and interpretation of results [one half-page ONLY]
- Additional questions raised by the study that remain open
This seems to be very useful work, since one of the barriers to the practical use of gait lab data has been the difficulty in presenting it to clinicians in a readily understandable manner. For more information, go to www.sol.nu , where the entire presentation should be posted for downloading.
Joellen McPhan CPO
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I first met Joellen on the way to the reception at the sculpture museum, and learned that she was a recent graduate from the P&O program at LaTrobe University in Melbourne. She was just about to conclude a "job exchange" with a CPO from Ossur Kristinsson's facility in Reykjavik, who swapped jobs and apartments with her for one year.
She presented a well-crafted paper that summarized her experience with a multidisciplinary approach to enabling amputee athletes to excel in Paralympic competition. The remarkable showing of the Aussie athletes at the Sydney games was due in large part to a close collaboration between the coaches at the Australian Institute for Sports and the prosthetists and the Advanced Prosthetic Center in the same city.
Similar to the traditional clinic team, this group added the athletic coach to work alongside the PT, CP, and amputee. Since the focus was on systematic preparation to excel in competition, compliance with a six-month preparatory physical therapy regime was a prerequisite to fitting with a sports-specific prosthesis that was optimized for a specific event.
Joellen emphasized the interconnection between coaching to improve the athlete's ability, leading to greater muscular strength after training, which in turn requires modifications to the alignment and adjustment of the prosthetic limb. She also reviewed the major prosthetic design considerations regarding weight bearing, suspension, and static alignment principles. She has written a monograph titled Preparing Amputee Athletes: The Australian Approach that was part of her Senior project at LaTrobe with more detailed information on this topic.
The entire publication can be downloaded as a PDF file from www.fos.com.au/foscomau/db/632107532080093876.pdf - PDF Format . This is an excellent example of how an undergraduate project can make a meaningful contribution to the field, since Joellen devoted the time to systematically collecting and recording this information.
