09 November 2020
LOC’s Director and Lead Orthotist, Sam Walmsley, has been invited to join world-renowned and key NHS speakers at the CMSUK virtual conference in November 2020. He will share his experiences of working with an orthotic framework for treating children with lower limb neurological conditions, called OSKAR (Optimal Segmental Kinematic Alignment approach to Rehabilitation). Here, Sam explains what OSKAR involves and the positive impact it’s having on his patients.
Usually, when I say OSKAR to people, they think I’m talking about the Hollywood film awards! But in my world, OSKAR represents a different gold standard - not for acting, but for orthotic care for children with lower limb neurological conditions, such as cerebral palsy and spina bifida.
OSKAR is a framework originally developed by Elaine Owen MBE MSc SRP MCSP, in cooperation with our team at LOC. Elaine is a world-renowned physiotherapist whose work has challenged conventional wisdom and rewritten textbooks. We have worked with her for many years and have seen extraordinary results in many of our patients. As a result, we set up our first OSKAR clinic at our Kingston-upon-Thames clinic in 2015 and have since set up a second at the University of Salford in Manchester. Usually, we operate a clinic from the gait laboratory in the university’s teaching hospital. During Covid-19, though, we have temporarily moved orthotic treatment to our Manchester Clinic.
So, what exactly is OSKAR and how does it work? In simple terms, it’s a comprehensive treatment plan tailored to the individual’s goals and requirements. It starts with a patient assessment in our video vector Gait Laboratory. Here, we assess a child’s gait and walking patterns by filming their movement and taking lots of digital photographs. We do that both barefoot and using any existing orthotics to get a complete picture of an individual’s range of movement. We’ll also look at the bone and joint alignment, muscle strength and stability.
We then use the International Classification of Functioning, Disability and Health (ICF) guidelines as a framework to measure and assess a patient’s musculoskeletal progress against specific, agreed goals. So, for example, parents might be looking to help their child stand independently, or move around nursery safely, or even play football with their friends. Combining our Gait Laboratory data with these goals allows us to create a customised orthotic treatment plan. And, because we document everything, we have a clinical baseline from which to work and assess progress over time.
The centrepiece of the treatment plan is an orthotic prescription that we manufacture on-site. Our manufacturing tools can create precise orthotics using evidence-based work that Elaine has conducted on computer algorithms that have established good patterns of walking.
Once the new orthotics are made, we then conduct a fitting. This involves a ‘tuning up’ process where we bring the patient back into the Gait Laboratory to reassess their movement in their splints, tweak the prescription if necessary and keep repeating that process until everyone is happy that the child is comfortable and that the orthotics fit their shoes.
Shoes are incredibly important in this process! Often, patients come to us wearing orthotics made elsewhere that are causing discomfort because they haven’t been tuned to the shoe. It doesn’t have to be a special shoe, either. It could be a trainer from Sports Direct. But the important point is that we develop the orthotic with that shoe in mind to ensure maximum comfort. This also means that parents don’t have to worry about anything other than their child’s progress.
Working with LOC and Elaine has been a great experience – they really take the time to look at your child and understand their individual challenges and needs. For parents who are in the same position that we were, I would say do your research – see what clinics are available near you and what the costs are, but my feeling is it’s worth every penny.
After 10 years of daily physiotherapy and swimming, not to mention SDR, hamstring and tendon lengthening, we have finally achieved independent walking – it was a mother’s day gift that would take some beating.
LOC’s video vector technology measures exactly where Austin’s weight is being distributed, how his hips are moving and how his legs are moving. It’s those insights that have made his new AFOs so effective. Even within a few days, LOC’s splints have had more impact on his independence of movement than anything else we have done.
Since his new orthoses, his change has been remarkable. He is more mobile and can walk independently. Jason is now walking indoors and outdoors and is unrestricted. He is now properly enjoying the summer sunshine for the first time in a few years with no complaints of pain.
It has been a breath of fresh air – LOC’s ability to accommodate Sophie’s circumstances and manufacture her orthotics so quickly has taken a huge amount of potential stress away. Alan talks to Sophie as well - she looks forward to seeing him. He has even been able to fulfil her request to have her SMOs decorated with unicorns! It makes her feel special and much happier about wearing them.
I can now go a mile without having to stop, so it is a lot better and I’m walking in a regular pattern now. The orthotic fits perfectly because LOC took proper mouldings and photographs; they were very thorough.
Amelia was always looking for something to hold on to, now she runs around. Sam really puts in that extra effort to make the clients happy. I’d recommend LOC because they have all the equipment and extremely professional staff who have been trained by world-renowned physiotherapist Elaine Owen.
Lilac just flits about now. Every day she's getting stronger and our expectation now. We are absolutely with The London Orthotics Consultancy for the long haul now. We’ve found a business that can provide what we need and who we trust, and it’s the trust that's the most important thing to us.
My left knee hyperextends and Sam felt he could improve that condition with a different design of brace and also improve my gait with some other adjustments. The brace was such a success that I used it solely after receiving it. I am most thankful to Sam and his colleagues for their dedication to my case and their prompt assistance, which changed a potential disaster into a great tourist visit.
Multidisciplinary teams in business will sit down together and discuss a project with all parties concerned, each adding their particular expertise and insight. This is what it is like at London Orthotic Consultancy (LOC) but on a more personal level: Teamwork is evident. The camaraderie and mutual respect are undeniable. The attention to the smallest achievement is uplifting.
The orthotics help support my foot. Not only that, they have endured daily use, training for the Marathon des Sables, the race itself and they are still going! I am amazed that they survived the MDS and they are still being used today.
Most of our OSKAR clients require follow up appointments, although how frequently we need to see them depends on a range of factors, such as age and range of movement. The good thing about OSKAR, though, is that it is an entire treatment plan. That means everything is agreed upfront. The cost of return visits and further tweaking of the splints or shoe repairs are all included within the plan, so there are no surprises for the child’s parents along the way.
It’s in those follow-up reviews that we can really start to help a child hit their goals. We work with them and their parents to move through stages – for instance, how can we help them progress from standing to stepping, to walking? Usually, after about a year, we’ll review everything against the original goals and decide whether a new treatment plan is needed.
Whilst orthotics are key in all of this, it’s OSKAR’s focus on alignment and rehabilitation, using those orthotics, that are at the heart of the framework’s success. We know from experience that if we can improve a person’s gait pattern then we can also help them improve their range of movement. This, in turn, can help with the development of bones and joints, all of which is crucial for children facing conditions like cerebral palsy, which affect muscle tone.
What’s more, we have evidence that we’re going to be sharing at the CMSUK virtual conference that shows you can increase a child’s muscular length with the correct orthotics. In many instances, this means that we can help to reduce the number of other – often invasive – interventions, such as Botox injections and surgery.
We are seeing incredible results using the OSKAR method in both our clinics. We have helped children walk who hadn’t otherwise been able to in their standard splints; some are even walking earlier than expected. And the earlier we can start to work with a child, the more positive an impact we are likely to have in the long term.
Sam will be speaking at the CMSUK virtual conference on the 11th of November 2020. Delegates can register here and view the seminar programme here.
We have the following facilities and amenities at our Kingston Upon Thames location:
We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.
We have the following facilities and amenities at our Cambridge location:
For more information about The Beechwood Complementary Medical Practice, please visit The Beechwood Practice.
We have the following facilities and amenities at our Bristol location:
For more information, visit Litfield House Medical Centre.
We have the following facilities and amenities at our Romford location:
For more information about The Colin Dove Practice, please visti The Colin Dove Practice
LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.
It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.
Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton.
508 Blackburn Rd,
For more information, please visit The Good Health Centre
Clothing worn is dependent on which clinic you are attending. You will be sent a letter detailing what clothing to wear along with all other details prior to any appointment at the clinic.