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In Celebration of Prosthetists & Orthotists Day

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The British Association of Prosthetists & Orthotists are celebrating their 3rd P&O Day today. The day aims to raise the profiles of the two roles within the healthcare system and the public.

In support of this and to celebrate our exceptional Prosthetist and Orthotist expert witnesses, we are excited to share interview with Conor McDaid, Orthotist & Expert Witness and Ruth Nicholson, Prosthetist & Expert Witness, who talked to us about some of their observations, new innovations and challenges within their fields of expertise.

In your expert opinion, what are some of the key challenges currently facing clinicians within your field of specialism?

Conor; Prosthetics and Orthotics is such a niche field of healthcare and there is a need for more clinicians in this field. Recent estimates suggest that there is 1 Orthotist for 35,000 people in the UK. With an aging population, improved outcomes in orthotic clinical services and ever-growing focus on conservative management of conditions, there is a real pressure on providing quality clinical care due to time constraints and patient demand.

Ruth; Lack of experienced workshop staff to build limbs. When I started my career as a Prosthetist, I worked with a large team of technicians with a vast skills range using many different materials. The technical team spanned multiple generations so conventional and new variations of prosthesis could be made. Over the years many of these technicians have retired taking their experience with them. 

Is there a new or innovative approach to treatment in your field of specialism that you believe has significant potential to improve patient outcomes?

Conor; The use of 3d printing in P&O has made a phenomenal difference. Material science will play a huge role in the development of P&O over the next 20 years.

Ruth; Pattern recognition. Upper limb prosthetics is a small area, it's a rare site that is challenging and rewarding in equal measures. Achieving good control is paramount, for a trans humeral amputee who need to control an elbow, wrist and hand. Switching between each joint using standard surface electrodes can be complicated to master and makes simultaneous control unachievable. A pattern recognition system allows the client to calibrate multiple electrodes over a larger surface area. Muscle patterns are translated in to prosthetic movement which is much more intuitive and provides potential for simultaneous control rather than sequential. This has given amputees with a high level of loss access to electric components that they were not previously able to utilise.  

How do you see technology impacting your field of specialism in the future?

Conor; It is an exciting time to work in this field. Particularly with the introduction of app-based control of devices, new manufacturing and simplified CAD systems. The gait equipment that is readily available now, compared to 10/15 years ago makes it so much more accessible for the average clinic to provide real time outcomes for intervention.

Ruth; Implanted electrodes! Attached directly to the muscle body to preserve effort and for accurate control. This would be useful for both upper and lower limb amputees and could be linked to prosthetic joint control in the future. As an extension to this technology, it would be useful is some form of sensation is possible. I think that in the near future prosthetists will be working more closely with surgeons.  

As an expert in this field, what do you believe are the most important skills or qualities for clinicians to possess?

Conor; The single most important skill is understanding your patient. Looking at them as a person rather than a diagnosis and ensuring that your treatment plan fits in with who they are as a person. This is the single most important aspect of being a good clinician in this field. If you are asking someone to utilise an Orthosis or prosthesis, that will impact their mobility, it had better be one that they are willing to use or it will be sat in the cupboard and wont do anyone any good.

Ruth; A good ear, lateral thinking for effective problem solving. It doesn't have to be complicated. 

Is there a recent research study or clinical trial that has produced meaningful findings within your field of specialism? If so, what implications do you think these findings may have for clinicians moving forward?

Conor; I am particularly interested in research. I am a believer in evidence-based practice, but also understanding that absence of evidence is not evidence of absence. At this moment I think the use of the APOS devices is a really interesting way of managing osteoarthritic knees. I have had fairly good results so far and the evidence basis keeps getting better.

Ruth; I am following research by Paul Cederna and his team in Michigan for the above reasons

Finally, how has your work with Somek & Associates impacted on your clinical work?

Conor; As an expert witness I have an opportunity to assess clients in their own homes and this has given me a more in depth understanding of my patient group and the wider implications that injury can have on an individual and their family. Working with Somek has really helped me to understand the devastating consequences of injury, and just how far those consequences can reach for a person. It has also shown me just how much people are willing to invest to ensure someone who has suffered an injury has a chance to regain their pre-injury life. I am thoroughly enjoying my work and the variety of people I am meeting.

Ruth; It keeps me on the ball!


Conor qualified in 2011. You can read his profile summary here

Ruth qualified in 2010. Her profile summary is available here

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