26 July 2022
American paediatric specialist visits LOC to gain more understanding of OSKAR and lower limb orthotic management of cerebral palsy patients.
This month LOC was very pleased to welcome Teresa Pierce, a pediatric physical therapist from the USA. Having previously attended Elaine Owen’s gait courses, Teresa was keen to see at first-hand the application of her concepts. Here is her ‘report’ on her visit.
“Greetings! I am excited to share about my recent visit to the London Orthotic Consultancy (LOC). I sent a Facebook message to the LOC in Spring 2022 to inquire about visiting the facility to observe their approach to lower extremity orthotic management of children with cerebral palsy. I am a pediatric physical therapist from the U.S. with an interest in studying accommodative orthotics as part of my PhD dissertation. After attending Elaine Owen’s gait courses in 2018 and 2021, I have been applying the concepts of her OSKAR (Optimal Segment Kinematics and Alignment Approach to Rehabilitation) methods in the clinic and wanted to learn more about it in person. A plan was made for me to spend a day observing at the LOC during an upcoming visit to London.
Upon arrival at the LOC, I toured the facility with George Coles, senior orthotist, and met many of the other orthotists. The clinic director and lead orthotist, Sam Walmsley and I discussed current orthotic research, particularly a study Elaine authored in which she found that ankle dorsiflexion in children with spasticity actually increased over time after wearing heeled orthotics. I related my research interest in exploring the effects of accommodative orthotics and discussed possible collaborations. The most meaningful aspect of the visit was observing a real patient visit. The visit was a true example of collaboration involving the pediatric patient, a family member, George, the orthotic specialist, Elaine Owen, and the physical therapist, who has been seeing the patient for many years. George set up a video call with Elaine, who attends patient visits remotely from Wales. The iPad was placed at a specified point in the room to allow Elaine to view the gait passes virtually. Comfortable speed, slow speed, and fast speed gait were observed and recorded via coronal and sagittal cameras interfaced with the computerized force plate system. The physical therapist eventually joined the video call with Elaine and was able to view the last few gait passes in real-time.
One other goal for scheduling the visit to the LOC was to connect with Elaine Owen to gain more insight into her innovative approach to orthotic intervention as a potential dissertation topic. I accomplished that goal and found the visit both informative and intriguing. Informative, in that I was able to learn about new products and equipment, and how to integrate components of gait analysis and physical examination with technology. The observation was intriguing because of LOC’s ability to use virtual technology so effectively, authentically collaborate with all team members, and schedule adequate time for a thorough patient visit. The opportunity to spend time at the LOC was truly inspiring. Elaine Owen’s approach to optimizing gait kinematics is ground-breaking and evidence-based. Future research is needed to continue exploring the benefits of fabricating orthotics to accommodate limited lower leg range of motion and spasticity. In her courses, Elaine challenged us to understand gait mechanics and the importance of hip/knee extension in preventing deformity and minimizing muscle co-contraction in children with spasticity. The patient visit exemplified this concept along with a collaborative team approach to maximize function and achieve desired outcomes. I am grateful to LOC for coordinating this visit and London is very fortunate to have such outstanding clinicians and resources available to families.”
Board-Certified Pediatric Clinical Specialist
Assistant Professor, Department of Physical Therapy, Philadelphia College of Osteopathic Medicine, Georgia Campus, USA
PhD student, Texas Woman’s University, Dallas, Texas, USA
Contact:
[email protected]
If you have a child who has cerebral palsy or any other neurological condition, you may find that LOC’s evidence-based approach helps to optimize their gait pattern. For more information or to arrange a consultation please contact us. LOC's team of experienced clinicians have the advantage of access to our Gait Lab facilities in Kingston and Salford. Click here for a free initial video consultation.
An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.
The length of time that one needs to wear an AFO very much depends on the condition being treated. If it is a long-term condition like cerebral palsy or post-polio syndrome it is likely to be years as the condition cannot be cured. Your orthotist will advise you.
A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.
So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.
A GRAFO is used to control instabilities in the lower limb by maintaining proper alignment of limbs and controlling their motion. It reaches around to the front of the knee extending down to the ankle. It works by altering a patient’s limb presentation to displace load and impact as well as offering further control to the knee.
The cost of an AFO is dependent on the type of AFO that has been prescribed and the material that it has been made with. Carbon fibre will be more expensive than metal or plastic for example. LOC’s bespoke AFOs cost can be found on our Orthotic Prices page.
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.
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.
If you are worried about your chest shape, or your child’s chest shape, then get in touch for a free Skype consultation with one of our pectus specialists who can assess their chest and discuss treatment options. We are always happy to communicate with local GPs, thoracic surgeons and consultants if a patient approaches us for bracing treatment after considering other options.
