Recent developments in healthcare for cerebral palsy

Recent developments in the conceptualisation of disability (1), definition and classification of cerebral palsy (CP), treatment goals, and research on the effectiveness of interventions require synthesis for AHPs in clinical practice. A multidisciplinary consensus conference which included an international group of 24 clinicians and researchers was convened by the International Society for Prosthetics and Orthotics to consider research and contemporary thinking on the management of CP

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Development of a best practice statement on the use of ankle-foot orthoses following stroke in Scotland

A National Health Service Quality Improvement Scotland (NHS QIS) scoping exercise in 2007 identified the use of ankle-foot orthoses (AFOs) following stroke as a clinical improvement priority, leading to the development of a best practice statement (BPS) on AFO use after stroke. This paper outlines the development process of the BPS which is available from NHS QIS. The authors were involved in the development of the BPS as part of a working group that included practitioners from the fields of orthotics, physiotherapy, stroke nursing and bioengineering, and staff of NHS QIS and a patient representative. In consultation with an NHS QIS health services researcher, the authors undertook a systematic literature review to evidence where possible the recommendations made in the BPS. Where evidence was unavailable, consensus was reached by the expert working group. As the BPS was designed for the non-specialist and non-orthotic practitioner the authors also developed educational resources which were included within the BPS to aid the understanding of the principles underpinning orthotic design and prescription. The BPS has been widely distributed throughout the health service in Scotland and is available electronically at no cost via the NHS QIS website. At part of an ongoing evaluation of the impact of the BPS on the quality of orthotic provision, NHS QIS has invited feedback regarding successes and challenges to implementation

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial

Objective: To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. Design: Multicentre, powered, non-blinded, randomized trial. Setting: Seven Multiple Sclerosis outpatient centres across Scotland. Subjects: Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop. Interventions: Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42). Outcome measures: Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions. Results: Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care. Conclusion: AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty

The immediate effects of fitting and tuning solid ankle–foot orthoses in early stroke rehabilitation

Background: Ankle-foot orthoses are known to have a generally positive effect on gait in stroke, however the specifc type of AFO and the time point at which it is provided are highly variable in the currently available literature. Objective: The objective was to determine the immediate spatiotemporal and kinematic effect of custom-made solid ankle–foot orthoses in early stroke rehabilitation, compared to shod walking. Methods: Five male and three female participants were recruited to the study (n = 8), with a mean age of 57 (16) years who were 3.5 (3) weeks post-stroke. Each received a custom-made solid ankle–foot orthosis to a predefined set of design criteria and tuned using heel wedges to control the shank inclination angle during shod walking. Repeated spatiotemporal and three-dimensional gait measures were taken pre- and immediately post-intervention. Study design: A pre–post-test experimental study. Results: With the solid ankle–foot orthosis, walking velocity increased from 0.22 (0.2) to 0.36 (0.3) m/s (p < 0.05), overall average step length increased from 0.28 (0.1) to 0.37 (0.1) m (p < 0.05), cadence increased from 45 (19) to 56 (19) steps/min (p < 0.05) and step length symmetry ratio increased from 0.65 (0.2) to 0.74 (0.2) (not significant). No clear changes were observed in the joint kinematics of the hip and knee. Conclusion: In our small group of early stroke patients who were fitted with a solid ankle–foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only. Clinical relevance This study provides evidence about the immediate effects of custom solid ankle–foot orthoses on gait of early stroke survivors. Ankle–foot orthosis design specifications are fully described for replication. This study suggests that observing global segment orientation may be more useful than joint angles when fitting and tuning ankle–foot orthoses for optimal ankle–foot orthosis/footwear alignmen

Contraception Choice and Compliance Among Mothers with Opioid Addiction: Identifying Barriers to Care

West Virginia leads the nation in substance abuse deaths per capita. This epidemic has given rise to a novel population of high risk, obstetrics patients with opiate abuse. Appropriate education, counseling, and implementation of contraception is of extreme importance among this population due to risks of unintended pregnancy. This study was a retrospective chart review to determine compliance and uptake of contraceptive methods by patients in a maternal buprenorphine maintenance program prior to and following implementation of standardized contraception education and Medicaid coverage of immediate postpartum long acting reversible contraceptives (LARC). Rates of planned contraception and rates of actual method initiation were compared between two groups representing two distinct time periods before and after intervention. Rates of high efficacy contraception options, especially LARC options, were noted to statistically significantly increase following dedicated education and Medicaid coverage. Patients receiving no contraception at all significantly decreased following these interventions. Patients desiring surgical sterilization continued to encounter barriers to care as the rate of actual sterilization to desired sterilization was still very low

Failure of effective contraception in opioid addicted mothers: a disparity in planned and actual usage

The ongoing opioid epidemic in West Virginia has given rise to a unique population of opioid-addicted obstetric patients. Appropriate education, counseling, and implementation of contraception is of extreme importance among this high risk patient population. This study was a retrospective chart review aimed at evaluating contraception choice and initiation rates among patients enrolled in a maternal buprenorphine maintenance program compared to non-opioid addicted patients. Rates of planned contraception initiation were compared between the two groups. Rates of actual contraception initiation were also compared. Contraceptive choices were then placed into one of three tiers based on efficacy, and rates of initiation of equivalent, less effective, or more effective methods of contraception were compared between the groups. Rates of compliance to planned contraceptive method were low for both groups and not statistically different between the two. Use of long acting reversible contraceptives was statistically higher among the control population. Compared to the control group, a significant number of women in the opioid group received less effective contraception than planned. This study shows that the high-risk population of opioid addicted patients did not receive high efficacy, long lasting contraception at the same rate as their non-opioid addicted peers

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people’s experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS. Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified. Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual’s ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed. Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term

Factors influencing the reliability of the universal goniometer in measurement of lower limb range of motion : a literature review

The universal goniometer (UG) is commonly used in clinical practice tomeasure lower-limb joint range ofmotion (ROM). Reliability of the UG is essential to ensure consistency of measurement between and within practitioners. Clinically, it is important to understand how reliability may be affected by various factors.  An electronic and manual literature search was conducted to determine the reliability of the UG. A variety of search terms were used to search between 1980 and July 2015. Articles sourced were graded according to the Scottish Intercollegiate Guideline Network guidelines. Articles reviewed included bothmeasurements of healthy subjects and those with different pathologies. Active and passive lowerlimb ROMs were studied, and intratester and intertester reliability were examined.  Twenty-one studies were included and fully reviewed. Most studies indicated that UG reliability was best when used to measure ROM in healthy subjects in comparison to patients. The limited number of studies measuring active motion compromised the ability to make comparisons with measuring of passive ROM. It was reported from the studies investigating both intratester and intertester reliability that intratester reliability was higher than intertester reliability. Reliability ofmeasurements varied depending on the joint measured. Tester training and standardization of the measurement procedure led to increased reliability, and there was a suggestion that involving two testers in the measurement procedure may have a beneficial effect. This literature review highlights variation in studymethodology used, which reduces the ability to directly compare studies. Clinicians should be aware of the variability of reliability of the UG and the effect of different factors when interpreting measurements taken with this instrument. Further research is required to investigate the effect different factors may have on the reliability of the UG and the possibility of using protocols and technology to increase reliability when measuring joint ROM

Direct enhancement of nitrogen-15 targets at high-field by fast ADAPT-SABRE

Signal Amplification by Reversible Exchange (SABRE) is an attractive nuclear spin hyperpolarization technique capable of huge sensitivity enhancement in nuclear magnetic resonance (NMR) detection. The resonance condition of SABRE hyperpolarization depends on coherent spin mixing, which can be achieved naturally at a low magnetic field. The optimum transfer field to spin-1/2 heteronuclei is technically demanding, as it requires field strengths weaker than the earth's magnetic field for efficient spin mixing. In this paper, we illustrate an approach to achieve strong 15N SABRE hyperpolarization at high magnetic field by a radio frequency (RF) driven coherent transfer mechanism based on alternate pulsing and delay to achieve polarization transfer. The presented scheme is found to be highly robust and much faster than existing related methods, producing ∼3 orders of magnitude 15N signal enhancement within 2 s of RF pulsing