AOPA Clinical Feature: Knee Orthoses

Transcription

Gazette
the
THE NEWSLETTER OF THE AUSTRALIAN ORTHOTIC PROSTHETIC ASSOCIATION INC.
Volume 13 - Issue 2 / June 2013
AOPA Clinical Feature:
Knee Orthoses
New aoPa website launched
Update on disabilitycare australia
Get ready for the 2013 aoPa congress
eXecUtive rePorts
President’s report
office and Membership report
We are now less than 3-months away from AOPA’s 3rd National
Congress in Melbourne. The AOPA Congress represents one of
the highlight events of the calendar year for our membership.
Attendance at our two previous AOPA conferences in 2011 and 2012
has been outstanding, and I believe this demonstrates the interest
the membership has in enhancing their professional knowledge
and practice. It also attests to the efforts and planning of the team
responsible, and the efforts of those AOPA members presenting
at the conference. Our AOPA Congress Committee, led so capably
by Sally Cavenett, has prepared what will be our best program to
date. Together with an array of outstanding clinical presentations,
we are hoping to have representatives from both sides of Australian
politics, and from DisabilityCare Australia (NDIS) in attendance.
It has certainly been a fast-paced beginning to 2013. The National
Office has worked steadily with the National Council to deliver a
number of significant projects in this first half of the year.
Since the publication of the March gazette, AOPA has completed
a couple of major projects. In the first week of May the new
website and information platform went live on the internet. The
website team have worked diligently and creatively to deliver
a pleasing outcome, and I urge every member to log on and
browse the site (www.aopa.org.au). The new website will not only
provide an outstanding “external face” for the profession, but will
also ensure our administrative processes are much more efficient
and member services greatly enhanced.
The National Office is also pleased to announce the completion of
Stage One of the Competency Standards review. This project was
funded through the Department of Industry, Innovation, Science,
Research and Tertiary Education (DIISRTE). The completion of
Stage One has resulted in the 2013 Competency Standards
draft being produced. We are now ready for Stage Two, which
is currently in planning and development and will involve
consultation with the membership. Further detail is also provided
in this edition of the Gazette.
In mid-May Shane Grant, AOPA’s Project Officer, successfully
completed phase one of the DIISRTE funded Competency Standards
project on time and slightly under the $45,000 budget. The project
represents one of the core components of AOPA’s long-term
strategic plan, and enables detailed work to be further performed
on essential issues such as workforce planning & self regulation.
Hopefully this is the first of many grants AOPA will be awarded,
and we are pleased to have achieved this major milestone.
The National Office has also engaged in significant representation
and advocacy activities over the last 3 months. AOPA has
been represented at Minister’s meetings in Canberra, attended
DisabilityCare Australia and policy related meetings and been
consulted with regarding workforce levels and regulation. We
continue to work to represent the profession and advocate for the
services that our membership provide.
The DisabilityCare Australia (NDIS) trials commence on 1st July in
five locations across the country. AOPA hopes all members are
pleased to see the passing of legislation of the 0.5% surcharge
to fund DisabilityCare Australia, which cements the program’s
future. The DisabilityCare Australia program provides a tremendous
opportunity to “nationalise” treatment, and bring an end to the
inefficient “federated” models that have prevailed for generations.
The six launch sites will have varying scales of “trials” over the
coming 3-years, and I urge the membership to communicate closely
with the National AOPA Office to support the successful rollout and
inclusion of orthotic and prosthetic service provision.
AOPA is currently pursuing a broad range of initiatives, and
we look forward to outlining the tremendous progress our
Association has made at the upcoming 3rd National Congress.
I look forward to seeing a record number of AOPA members join
what will be an exceptional two days.
Yours respectfully,
Harvey Blackney
President, The AOPA Inc
The launch of the new AOPA website represents tireless hours
of volunteer work from National Councilors and in particular
Sarah Carter (website content volunteer). I would also like to
acknowledge the work of Sue Laksassi who has project managed
the major transition from the old database to our new system.
The new website and database has been an enormous success
and we thank the membership for the positive feedback. Please
read the website article in this edition for tips regarding your CPD
Tracker and website access.
As of the 28th May 2013, our membership numbers have risen
dramatically. Whilst we are experiencing a steady increase in number
generally, we have had significant growth in the last 3 months. We
are pleased to report that we have now reached a total membership
of over 350, with a total practicing membership of 273*.
Membership type
Number
Full time
Part time
Student
Leave of absence
Retired
Life
Total practicing members*
Total Members
235
38
43
20
9
7
273
352
* Based on ABS census
2006, AOPA members
represent 79% of the
profession.
Please continue to make your enquiries to the office via phone or
email admin@aopa.org.au. Should you have any suggestions or
feedback regarding your peak professional body, please do not
hesitate to contact us.
Leigh Clarke and Sue Laksassi
Executive Officer & Administration Officer, The AOPA Inc.
Gazette
the
The Gazette is produced in March, June, September and
December and is sent out to all AOPA members. Please
contact the editor if you would like any information
regarding advertising rates. The inclusion of advertising in
no way implies endorsement by the Association.
For further information on items in this Gazette
please contact:
Editor, AOPA Office,
PO Box 1219, Greythorn VIC 3104
Ph:
1300 668 194 / (03) 9816 4620
Fax:
(03) 9816 4305
E-Mail: admin@aopa.org.au
The Gazette / Volume 13 - Issue 2 / June 2013 / 3
Project Updates
Navigating the New AOPA Website
The newly released AOPA website has a significant number of
new resources and features, which we encourage you to explore
by visiting www.aopa.org.au. Here are some tips for you regarding
your Member Only access to the new AOPA website:
• You can renew your membership online and pay by direct deposit.
• When you renew, you will be required to answer a lot of
questions regarding your professional role. This will help us
with workforce data collection and also to provide targeted
information where possible.
• AOPA advocacy submissions are available under the public
tab “Publications”, but there are also some Member Only
submissions. You will only be able to see these if you are logged
in. Log in and check out how AOPA has represented you and
the profession to the West Australian Artificial Limb Scheme,
Enable NSW and the Department of Immigration.
• In the “Events” tab, you will find the State based CPD and
General Meeting events for 2013. AOPA Accredited Events
will also be listed here. Whilst official registration for AOPA
Accredited Events will occur externally with the event, you can
“Register” your intention to attend in this “Events” tab. This will
ensure that your CPD points will be automatically transferred
and logged in your record, and will enable you to track your
future planned activities in the My Events section of the
Member Centre.
• If you’re looking for all the important documents and CPD
Tracker – simply click on the Member Centre in the top right
hand corner of the home page and you are in your personal
Member Centre. Here you will find the CPD Tracker, all your
important membership documents and My Membership for all
your personal membership related details.
Competency Standards Project
Stage One Completion
Stage Two Development
On the 27 May, 2013, the first stage of the Competency
Standards project was completed. Stage One was highly
successful, with the Final Project report approved by DIISTRE,
the Government funding body. The main outcome of Stage One
was the development of draft minimum Competency Standards
for entry into the profession in Australia. AOPA would like to
thank our Project Officer, Shane Grant, and Expert Consultant, Dr
Susan Ash, for their commitment to this project and ensuring an
excellent outcome for the Association.
With the successful completion of Stage One of the Competency
Standards project, AOPA is very keen to continue moving
forward. We are now excited to begin the planning and funding
submission process for Stage Two of this review.
th
Our next step will be to disseminate the results of Stage One
more broadly. AOPA has demonstrated a valid, reliable, timely and
cost effective method for Competency Standard redevelopment
which will have far reaching potential. This project has received
ethics approval and we look forward to sharing the process and
outcome at the National Allied Health Conference in Brisbane and
with the membership at the AOPA Congress in August, 2013.
4 / June 2013 / Volume 13 - Issue 2 / The Gazette
Stage Two will involve the validation of the draft Competency
Standards with the profession nationally. AOPA would like to
thank Dr Emily Ridgewell and Dr Susan Ash for developing the
methodology for Stage Two, with an ethics application also
submitted for this part of the project. The validation phase of Stage
Two will involve the use of Delphi Surveys which will be distributed
to a large proportion of the membership nationally. These surveys
will seek to determine the level of agreement with the draft
Competency Standards developed in Stage One. There will be
numerous rounds of surveys, in which modifications will be made to
the draft Competency Standards based on the feedback from each
round. Successive rounds will seek agreement amongst participants
relating to the modifications made. It will certainly be an extensive
process and we look forward to working again with the funding
body, recruited staff and the membership to complete this project.
Project Updates
AOPA pursues application
to Medical Services Advisory
Committee (MSAC)
For many years, orthotic/prosthetic services have been omitted
from the Federally funded Medicare Benefits Schedule (MBS),
because funding for orthoses and prostheses has generally been
allocated through state-based equipment and limb schemes. Wait
lists, ceiling limits and funding structures vary depending on the
patient’s geographic location and in some cases, diagnosis.
Orthotist/prosthetists and their patients are well aware that more
than a device is provided by the practitioner as an allied health
service provider. While some funding bodies are recognising the
necessity of reimbursement for clinical time, others, including
DVA, maintain historical billing practices for orthotists, linking
payments only to the devices provided. The problems stemming
from this fundamental flaw in the historical approach to funding
of orthotic/prosthetic services are far reaching, and submissions
by AOPA to DVA, the Productivity Commission and the ACCC
regarding Private Health Insurers, have all drawn on lack of
recognition of clinical services as a common key issue amongst
funding bodies.
In an effort to achieve industry standard recognition for clinical
services, a new project will seek to achieve inclusion of a clinical
service to be provided by orthotist/prosthetists on the Medicare
Benefits Schedule. The processes and timeframes for the project
have been researched and the budget is being finalised. Work
continues into researching suitable lobbyists and necessary
deliverables for the project to succeed.
This project falls under AOPA’s aim to promote the profession at
a policy level, and National Council hopes to engage with key
advisory committees and decision-makers in seeking recognition
of clinical services on the MBS. Please note that opportunities
for individuals and commercial industry leaders to partner with
AOPA and mobilise this and other projects will become available
in coming months. Interested parties and AOPA members who
would like the opportunity to be involved or updated on progress,
are encouraged to register their interest with the Office by email
(admin@aopa.org.au) with the subject ‘MSAC Project’ by
31 July 2013.
Workforce Research
In 2012, AOPA began the exhaustive process of analysing the
workforce data collected through our membership from 2007
to 2012. AOPA membership is thought to represent 80% of the
profession nationally, and therefore the membership demographic
data will provide significant insight into the Australian profession.
Emily Ridgewell has worked on this project to extract and clean
the data from the previous database in preparation for analysis.
This project has received ethics approval from La Trobe University,
however we are currently waiting on the outcome of a federal
funding submission to proceed with the work. Our profession
is very small and susceptible to national policy and legislative
changes. AOPA hopes the Federal Minister for Health, The Hon
Tanya Plibersek, and the Parliamentary Secretary for Disabilities
and Carers, The Hon Amanda Rishworth, will recognise the
unique position of the profession and support workforce planning
through the funding of this small, finite project. Please do not
hesitate to contact the AOPA Office should you have any queries
regarding this project.
Whilst AOPA is able to provide basic membership data, the
Workforce Project will assist with the development of a clear
demographic profile and detailed trend analysis of the profession
from 2007 to 2012. Further to this, the new database system
enables the Association to collect more detailed data regarding
member’s areas of expertise, field of practice and public or private
employment. You will notice that you are required to provide this
information when you renew your membership via the Member
Centre. This information will ensure we have an even clearer
understanding of our workforce in years to come.
From simplistic data, we can however report that your peak
Association is on the move, with increasing membership numbers
and impact level. We have experienced 7% growth in the last year
and 52% growth in member numbers since 2005. It certainly is
exciting times. We look forward to providing members and key
policy makers with our detailed workforce statistics, including
trend analysis, in the later part of the year.
AOPA Membership numbers 2005 to 2013
AOPA’s New Look Gazette
AOPA is very pleased to present this Gazette to you and you may
notice its change in format and structure. The AOPA Gazette has
been a 16 page edition for some time now and had a focus on
updating the membership regarding national and state activities.
With the introduction of monthly eNews and the release of the
dynamic website, the Gazette has been in need of a makeover. This
edition showcases the new structure, which for June and December
editions will include a lengthy Clinical Feature section. It is our
intention that the Gazette will serve to update you on National
allied health and association news and projects broadly, whilst also
providing some clinical professional development. Timely updates
regarding projects, activities and news will now be provided in the
Member Only eNews, with past editions available in the Member
Only section of the website. The Gazette will now also function
as an advocacy tool, promoting the activities and successes of the
Association more broadly. It will remain a member only publication
in its hard format, however, past electronic editions (1 year or older)
will be available for download from the AOPA website. We hope
that you enjoy the revised structure and focus, and we encourage
feedback direct to the National Office.
Representation
EO represents AOPA and AHPA in
Minister’s meetings
In March 2013 the AOPA Executive Officer, Leigh Clarke, attended
a series of meetings in Canberra over two days to represent Allied
Health Professions Australia (AHPA) and their recently released
position papers. AHPA is the peak professional body representing
Allied Health nationally. AHPA has over 18 member organisations,
including AOPA, which are all allied health peak bodies. These
organisations come together as a group to address issues of mutual
interest in allied health. The EO attended the following meetings:
• The Hon Tanya Plibersek, Federal Minister for Health
• David Butt, Deputy Secretary with the Department of Health and
Ageing and the newly appointed Chief Allied Health Officer
• The Hon Warren Snowdon, Minister for Veterans Affairs and
Minister for Indigenous Health
• Senator Mitch Fifield, Shadow Minister for Disabilities, Carers
and the Voluntary Sector
• Representative of The Hon Mark Butler, Minister for Mental
Health and Ageing
• The Hon Peter Dutton, Shadow Minister for Health
These meetings were significant as they enabled both AHPA and
AOPA to detail issues and areas of concern relating to allied health
services and workforce. As a member of the APHA Disability
Working Group, Leigh Clarke presented AHPA’s position on
disability and NDIS, particularly focussing on the need to engage
with peak professional bodies. Follow up from these meetings
has been especially positive and AOPA looks forward to continued
engagement and representation at the federal level.
AOPA Registrar meets with Minister
for Disabilities
On the 18 June the AOPA Registrar, Jackie O’Connor, attended a
meeting with The Hon Amanda Rishworth, Parliamentary Secretary
for Disabilities, to discuss DisabilityCare Australia. This meeting
was also attended by representatives from Speech Pathology
Australia, Australian Psychological Society and Occupational
Therapy Australia. The Parliamentary Secretary also had key
representatives from FAHCSIA attend the meeting to answer and
discuss issues specific to the site launches.
th
There were 4 key messages delivered by the peak professional
bodies in attendance. These included the following:
• the importance of participants having access to high quality and
evidence based services delivered by appropriately qualified and
skilled practitioners;
• the risks associated with participant choice and control within
the scheme without appropriate support and resources;
• the role of authorised self regulation in the protection of
participants and delivery of high quality services; and,
• the importance of allied health being engaged across all areas
including assessments, governance, training and leadership and
the development of models of care.
AOPA continues to represent and advocate on behalf of the
profession and the consumers that access services. Our advocacy
success is evident through the increasing number of invitations to
provide comment, provide advice or meet with key policy makers
and Government representatives.
DisabilityCare Australia representation
The National Disability Insurance Scheme (NDIS) has been recently
renamed to DisabilityCare Australia in preparation for the launch
across 4 different areas in Australia. Whilst many of the sites are
focussing on early intervention and the paediatric population,
there will still be a number of our practitioners involved and
thousands of participants accessing orthotic and prosthetic care.
AOPA continues to engage with the NDIS Launch Transition
Agency and the NDIS Expert Working Groups regarding
issues pertinent to orthotists and prosthetists. The key issues
being discussed include the management of the prescriber/
supplier relationship, the potential administrative burden for
the profession within a self-directed funding model, workforce
capacity, accreditation and credentialing, and quality and safety
management for participants. In early June, AOPA continued
representation in this area, with meetings with Mary Hawkins,
Research and Engagement Manager of the NDIS Launch Transition
Agency, to discuss accreditation and credentialing issues. Further
details from this meeting are outlined in the DisabilityCare
Australia update in this issue.
Options for Accreditation/Credentialing
of Practitioners and Suppliers within
DisabilityCare Australia
In mid-2012, DisabilityCare Australia announced the recipients
of funding through the Practical Design Fund. One of the funded
projects was the Assistive Technology Suppliers Association (ATSA)
project to investigate and present options for accreditation and
credentialing of prescribers and suppliers within DisabilityCare
Australia. Leigh Clarke, the AOPA EO, was appointed to the Expert
Reference Group for this project as a representative of AHPA. This
project is now completed and the options paper will be publicly
released in the near future and also presented at the DisabilityCare
Australia conference at the end of June. As an Expert Reference
Group member, Leigh was able to raise the unique position of
orthotist/prosthetists as both the prescriber and supplier as well as
concern with the duplication of regulatory procedures with those of
peak professional bodies and registration agencies.
AOPA supports a regulation system which has the “right touch”,
without administrative burden and duplication of existing
mechanisms, whilst covering all allied health practitioners regardless
of the model of funding in which the consumer is enrolled. We
look forward to the release of this paper, which will summarise the
variances in credentialing procedures between states and funding
agencies and present options to DisabilityCare Australia.
Prosthetic and Orthotic Health Training
Package (Certificate III) Review
Over the last 6 months AOPA has been providing advice and
feedback to the Community Services & Health Industry Skills Council
(CS&HISC) regarding the Rehabilitation and Assistive Technology
and the Prosthetic and Orthotic Technology health training
packages. These are Vocational Education and Training (VET) sector
packages designed to meet the education needs of the orthotic/
prosthetic technician and rehabilitation technician workforce.
This Certificate III program (HLT32112) is currently not available
through any Registered Training Organisations (RTO) and has
not had an enrolment since 2007. The Technician workforce in
Australia represents a valuable resource, not just for the specialised
and unique skill set, but also in supporting the increase in
workforce capacity. The program currently consists of 28 units,
of which only 5 are specialised units to orthotics and prosthetics.
AOPA is being supported in this review with input from two
experienced practitioners. The review will consider whether the
current training package is meeting the technician workforce
education requirements in both its units and training mode. Public
consultation on this review is expected to occur in July, in which
formal feedback and submissions are encouraged. Should you
wish to review the Certificate III training package, please visit
http://training.gov.au/Training/Details/HLT32112. Please do not
hesitate to contact AOPA EO, Leigh Clarke, should you wish to
provide comment, feedback or assist in this review.
Member Biography
This month we’d like to introduce 2 of our AOPA student members – Luke Rycken and Elisa Helenius – who are
currently undertaking their 3rd year of a Masters of Clinical Prosthetics and Orthotics at La Trobe University. Luke
and Elisa are also our AOPA guest editors for this edition of the Gazette, and are responsible for the authorship
of our feature clinical article on knee orthoses. Luke and Elisa have done an outstanding job and we look
forward to hearing more from them in the future as their prospective prosthetic and orthotic careers unfold.
Elisa Helenius
Luke Rycken
What inspired you to
study prosthetics and
orthotics?
What inspired you to
study prosthetics and
orthotics?
I’ve always wanted to work in
a profession that would enable
me to help other individuals.
Prosthetics and orthotics was
a profession that would allow
me to assist people reach
their potential and improve
their quality of life. The
biomechanical and creative
aspect appealed to me, as I
was particularly interested in the application, creation, fit and
customization of various devices.
Toward the end of high school I
was just looking for something
that would allow me to follow
an interest in health and
engineering, think creatively and
help people in the most direct
way possible. Prosthetics and
orthotics seemed to be, and very
much is, a natural fit.
Which of your subjects do you most enjoy
studying and why?
After having studied so many foundational theoretical subjects for
the past few years it’s been really nice to develop some real-world
skills in our more practical classes over the last 2 years. Even our
research subjects have a strong emphasis on clinical practice, and
more than anything, many of us are just looking forward to finally
beginning our careers.
I enjoy the practical aspects of the course however I do like the
correlations made between the practical and evidence based
subjects. The research and evidence based subjects provide
background and understanding behind the use and development
of various devices, and the practical subjects apply the knowledge
gained and allow me to be creative to build and customize various
devices.
What do you like to do when you’re not
studying?
Which of your subjects do you most enjoy
studying and why?
What do you like to do when you’re not
studying?
I really enjoy music and have played guitar for a few years now.
How do you de-stress after exam time?
When I am not studying, I enjoy spending time with my friends
and family.
I’ve been applying some of the more technical skills from
the course toward building guitars – which is probably more
frustrating than studying for exams.
How do you de-stress after exam time?
Can you describe your dream job?
I tend to celebrate the end of the exams with my friends. Then
during the first week of the break I enjoy taking time for myself to
rest, recuperate and in particular catch up on missed sleep!
Can you describe your dream job?
Ideally I would love to work in paediatrics helping them achieve
their treatment goals.
Why did you join AOPA?
At the moment, I can’t think of anything better than working with
a diverse range of interesting patients and having the opportunity
to experiment with orthotic and prosthetic designs.
Why did you join AOPA?
Primarily because I believe that AOPA is essential for furthering
the credibility and standing of Prosthetics and Orthotics practice in
Australia.
I decided to join AOPA, as it is the peak professional body
representing orthotist and prosthetists and it provides valuable and
insightful information on the profession.
If you had a million dollars to put towards
research and development in prosthetics or
orthotics, what area would you focus on?
If you had a million dollars to put towards
research and development in prosthetics or
orthotics, what area would you focus on?
Personally, I would really like to conduct research into alternative
manufacturing techniques including CAD/CAM and 3D printing.
After studying clinical research this semester it seems most
pertinent to conduct studies evaluating the effectiveness of lowerlimb prosthetics and orthotics.
Due to the limited research associated with prosthetics and
orthotics, I think that it is important that more research is
undertaken in all aspects of the field. Through research, the
profession can continue to advance and develop, and foundations
and clinical reasoning can be established with clinicians able to
make more informed decisions based on current evidence.
Clinical Feature: Knee Orthoses
Guest Editor
Luke Rycken & Elisa Helenius
3rd year students, Master of Clinical Prosthetics & Orthotics
La Trobe University, Bundoora, Victoria
Introduction
The knee is the largest joint in the body and one of the most
common sites for injury 1,2. Whilst surgical methods and strength
training have previously been the most prevalent form of treatment,
knee bracing and orthotic management have become increasingly
routine 1, 3. Corollary to this increase, there has been substantial
growth in both the number and type of prefabricated braces used
in clinical practice and several categories have developed: the
prophylactic brace; the functional brace; the patellofemoral brace
and the unloading brace for osteoarthritis (OA) 1,2. Despite the
established use of knee bracing there is a limited range of evidence
suggesting their clinical and everyday applicability 1. This editorial
examines the evidence supporting the efficacy and use of each
brace within the context of the anatomy of the knee.
Anatomy
The knee joint consists of the lateral and medial femorotibial
articulations between the respective femoral and tibial condyles
and the femoropatellar articulation between the patella and
femur 4, 5. The knee is primarily a synovial hinge and allows flexion
and extension combined with rotation about a vertical axis 4.
These articulations are relatively incongruent and therefore the
articulations of the knee alone are consequently weak. As such
the stability of the knee primarily depends on the strength of
the muscles and tendons as well as ligaments that encapsulate
the knee 4, 5. The most important of these stabilising aspects
is the quadriceps femoris muscle; vastus lateralis and medialis.
An extended knee is considered most stable as a result of the
increased congruence of the articular surfaces and taut position
of the surrounding ligaments 4. These ligaments comprise two
categories; the extracapsular and intracapsular. The lateral
collateral ligament (LCL) and medial collateral ligament (MCL)
are within the extracapsular ligament category and respectively
prevent varus and valgus movements of the knee. The anterior
and posterior cruciate ligaments (ACL, PCL) of the knee prevent
displacement of the femur upon the tibia, limit posterior and
anterior rolling and prevent hyperextension of the knee4, 5.
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http://www.webmd.com/pain-management/knee-pain/picture-of-the-knee
A. [cid:CCC3F32E-0B43-441B-946B-92DB833805E3@gateway.2wire.net]
http://images2.wikia.nocookie.net/__cb20121202015613/orthopedia/images/5/52/Knee_Brace.png
B. [cid:1BB78CCC-B375-478A-A55E-07C78335610D@gateway.2wire.net]
http://www.breg.com/sites/default/files/product-gallery/COMPACT-X2K.png
Prophylactic Bracing
Prophylactic knee braces are designed
to support and protect the MCL against
valgus knee stresses and prevent re-injury
1,2,6
. Whilst the prophylactic brace may be
particularly successful in the prevention of
MCL injury, it substantially limits function 1.
The MCL connects the medial epicondyle
of the femur to the medial surface of
the tibia and is attached to the medial
meniscus. It is significantly weaker than
the LCL and is often torn or damaged with
the medial meniscus during the application
of a valgus force 4. As further tension
and stress is applied to the ligament, the
ACL and PCL can be damaged as a result of the rotational force
applied 2,6.
A
Prophylactic knee braces protect the MCL from valgus knee
stresses and prevent rotation 2. The device can consist of a single
lateral upright with single-axis, dual-axis, or polycentric hinges, or
bilateral uprights with polycentric hinges 2. The fit and conformity
of the device to improve brace-skin contact is essential. If the
device is not of the correct fit and size, it may potentially cause
further damage to the knee. Straps and regular tightening of
straps can ensure that the brace remains in the ideal position 1,2,6.
The literature supporting the use of Prophylactic Knee braces
is controversial 1,7. However, conclusive evidence suggests
that prophylactic knee braces are effective in preventing the
occurrence of MCL injuries, but not in reducing the severity 2.
Despite the restrictiveness of the device, the qualitative literature
demonstrates that individuals feel more stable whilst wearing the
brace and as a result many professional and amateur athletes use
these braces to aid in the prevention of a potential knee injury 1,6.
The prophylactic knee brace is therefore a suggested and effective
design in preventing MCL injury in susceptible patients.
Functional Bracing
B
The functional knee brace is primarily
designed to support the knee after
ACL injury and protect the ACL after
reconstructive surgery 1,2. It is also
commonly used to support injury of
the collateral ligaments 8. Functional
braces are intended to reduce the risk of
further injury and allow repair without
significantly affecting function 8. The ACL
prevents posterior displacement of the
femur on the tibia and hyperextension at
the knee joint 4. It is most often injured
during non-contact mechanisms that
involve the knee close to full extension
during sudden deceleration 9,10. Conversely, contact injuries of the
ACL often involve the valgus collapse of the knee 9. The collateral
ligaments primarily contribute to the stability of the knee during
standing and are commonly injured through valgus and varus
stresses whilst the knee is extended 4.
A typical functional knee brace is designed to replicate normal
motion and prevent the posterior displacement of the femur
on the tibia 2. The brace usually utilises double-hinged uprights
incorporating range-of-motion stops and fitted thigh and calf
cuffs.
D. [cid:59D1FEAF-BC26-48FB-A920-DAC6512D5898@gateway.2wire.net]
http://www.ossur.com/library/29877/proc/41/Unloader%20One%20with%20SmartDosing.jpg
Whilst evidence suggests that the functional brace significantly
reduces strain on the ACL under anterior loading and both
internal and external torque of the knee, there is less evidence
denoting the specific effect on the collateral ligaments 2. Despite
Content for clinical feature articles are provided by our advertisers & are not edited or endorsed by AOPA.
C. [cid:460E8965-A2E1-4CA7-91DB-28403CE1A88E@gateway.2wire.net]
http://www.breg.com/sites/default/files/product-gallery/Patella-stabilizer-knee.png
this lack of conclusive evidence it has been demonstrated that
functional knee braces decrease the risk of MCL injuries in an
athletic population, and provide greater resistance to valgus
stresses 11. Subjective measures of knee stability are reported as
being greatly improved in patients using functional knee braces
after ACL injuries 2. The available evidence demonstrates a strong
justification for the use of functional knee bracing for patients
with both ACL and collateral ligament injuries. However, several
studies have demonstrated a lack of evidence suggesting the use
of functional bracing after ACL reconstruction surgery 2. In two
comparative studies, researchers found no significant differences
in functional outcome, stability, range of motion, muscle strength
and pain with most of the braces used 12,13. This suggests that
successful ACL surgery does not require functional knee bracing.
Patellofemoral Bracing
C
Patellofemoral braces are commonly used
in the management of patellofemoral pain
syndrome that occurs in both active and
non-active individuals and is thought to
be a result of several mechanisms of injury
1,2,14,15
. Common mechanisms include:
direct trauma resulting in articular damage
and inflammation of the soft tissue;
overuse of the knee resulting in microtrauma and abnormal patellar tracking 1,2.
The current evidence regarding the efficacy of patellofemoral
braces is limited 2. In several studies patellofemoral bracing was
found to be only as effective as exercise programs, strapping
and no bracing 2. However, studies of the efficacy of the device
indicate improved patellar tracking and a reduction in lateral
forces and pain 1,2. The application of the device is also shown
to have a psychological effect on an individual, with those who
are confident whilst donning the device experiencing a decrease
in pain 2. Despite discrepancies in the literature, patellofemoral
braces are suggested as an appropriate treatment method
for patellofemoral pain syndrome. Currently, more evidence
is required to determine the most effective type of brace and
establish the appropriate use of patellofemoral bracing in
conjunction with strength training.
Unloading knee braces are used in
the treatment of osteoarthritis (OA) to
decrease pain, improve function and
slow the progression of the disease 2,16.
OA causes the breakdown of cartilage
at the articulations of joints and results
in significant swelling and pain 16. In the
knee OA may occur at either the medial
compartment due to a varus alignment,
the lateral compartment due to a valgus
alignment or within the entire knee 2,16.
Such a malalignment of the knee increases
both the risk and progression of OA and
the decline of function 16.
Evidence primarily exists only for the use of braces in treating
medial compartment OA and excludes OA of the lateral
compartment. As well as this, contradictions exist between the
interpretation of reviews of the available evidence. Despite these
limitations, there is strong evidence to suggest that unloading
braces will increase the ability of patients to walk longer distances
16
. Whilst it has been determined that braces are able to reduce
the moments about the knee by 13% and subsequent medial
compartment load by 11%, several low quality studies have
demonstrated a reduction in pain for patients with medial
compartment OA despite a lack of high quality evidence 2,16. As
such, the evidence recommends the use of unloading braces for
the treatment of medial compartment OA in promoting walking
distance, however further study is required to understand the
effect of braces on pain.
Conclusion
The patellofemoral brace is typically
designed to maintain patellar alignment
and prevent lateral displacement, thereby
reducing tracking and lateral displacement 1,2,15. The device
usually consists of an elastic material, such as neoprene, and may
include a lateral hinge and addition of straps or adjustable patellar
buttresses 1,2. There are often various sizes of prefabricated elastic
patellofemoral knee braces; it is essential that an individual has
the secure and the correct fit, so as to prevent movement of the
device 1,2.
Unloading Brace
The unloader brace is designed to provide a valgus moment for
medial compartment OA and conversely a varus moment for
lateral compartment OA2,16. The brace typically utilises a single
lateral or medial hinge and several straps to apply the required
varus or valgus force 2.
In summary, the increased use of knee bracing and orthotic
management of the knee is variably supported by limited research
within the literature. Whilst almost all types of braces may be
recommended by particular evidence to some extent, it is essential
that the informed clinician is able to critically assess this research.
In doing so, the actual effectiveness of any brace for each
individual patient may be addressed so as to promote the best
possible outcome.
References
1. Paluska, S. A., & Mckeag, D. B. (2000). Knee braces: Current evidence and clinical recommendations for
their use. American Family Physician, 61(2), 411-418. Retrieved from http://www.aafp.org/afp/2000/0115/
p411.html
2. Chew, K., Lew, H., Date, E., & Fredericson, M. (2007). Knee Braces: Current Evidence and Clinical
Recommendations for Their Use. American Journal of Physical Medicine & Rehabilitation, 86, 678-686. doi:
10.1097/PHM.0b013e318114e416
3. Gianotti, S. M., Marshall, S. W., Hume, P. A., & Bunt, L. (2009). Incidence of anterior cruciate ligament injury
and other knee ligament injuries: A national population-based study. Journal of Science and Medicine in
Sport, 12(6), 622-627. doi: 10.1016/j.jsams.2008.07.005
4. Moore, K. L., Dalley, A. F., & Agur, A. M. (2010). Lower Limb. In Clinically Orientated Anatomy (6th ed., pp.
518-520). Philadelphia, PA: Lippincott Williams & Wilkins
5. Blackburn, T. A., & Craig, E. (1980). Knee anatomy: A brief review. Physical Therapy Journal, 60(12), 15561560. Retrieved from http://ptjournal.apta.org/content/60/12/1556
6. Albright, J. P., Saterbak, A., & Stokes, J. (1995). Use of knee braces in sport. current recommendations.
Sports Medicine, 20(5), 281-301. doi: 10.2165/00007256-199520050-00001
7. Pietrosminone, B. G., Grindstaff, T. L., Linens, S. W., Uczekaj, E., & Hertel, J. (2008). A Systematic Review
of Prophylactic Braces in the Prevention of Knee Ligament Injuries in Collegiate Football Players. Journal of
Athletic Training, 43(4), 409-415. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474821/
8. Martin, T. J. (2001). Technical report: Knee brace use in the young athlete. AMERICAN ACADEMY OF
PEDIATRICS, 108(2), 503-507. doi: 10.1542/peds.108.2.503
9. Boden, B. P., Scott, D. G., Feagin, J. A., & Garrett, W. E. (2000). Mechanisms of anterior cruciate ligament
injury. Orthopedics, 23(6), 573-578. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10875418
10. S himokochi, Y., & Shultz, S. J. (2008). Mechanisms of noncontact anterior cruciate ligament injury. Journal
of Athletic Training, 43(4), 396-408. doi: 10.1136/bjsm.2007.037192
D
11. C
hen, L., Kim, P. D., Ahmad, C. S., & Levine, W. N. (2008). Medial collateral ligament injuries of the knee:
current treatment concepts. Current Reviews in Musculoskeletal Medicine, 1(2), 108-113. doi: 10.1007/
s12178-007-9016-x
12. H
arilainen, A., Sandelin, J., Vanhamem, I., & Kivinen, A. (1997). Knee brace after bone-tendon-bone
anterior cruciate ligament reconstruction. randomized, prospective study with 2-year follow-up. Knee
Surgery, Sports Traumatology, Arthroscopy, 5(1), 10-13. Retrieved from http://www.ncbi.nlm.nih.gov/
pubmed/9127847
13. R isberg, M. A., Holm, I., Steen, H., Eriksson, J., & Ekeland, A. (1997). The effect of knee bracing after
anterior cruciate ligament reconstruction a prospective, randomized study with two years’ follow-up.
The American Journal of SPorts Medicine, 27(1), 76-83. Retrieved from http://www.ncbi.nlm.nih.gov/
pubmed/9934423
14. L un, V. M., Wiley, J. L., Meeuwisse, W. H., & Yanagawa, T. L. (2005). Effectiveness of patellar bracing for
treatment of patellofemoral pain syndrome. Clinical Journal of Sports Medicine, 15(4), 235-240. Retrieved
from http://www.aafp.org/afp/2007/0115/p194
15. Powers, C. M., Doubleday, K. L., & Escudero, C. (2008). Influence of patellofemoral bracing on pain, knee
extensor torque, and gait function in females with patellofemoral pain. Physiotherapy Theory and Practice,
24(3), 143-150. doi:10.1080/09593980701665793
16. Brouwer, R. W., van Raaij, T. M., Jakma, T. T., Verhagen, A. P., Verhaar, J. A. N., & Bierma-Zeinstra, S. M.
A. (2009). Braces and orthoses for treating osteoarthritis of the knee (review). The Cochrane Library, (1),
1-33. doi: 10.1002/14651858.CD004020.pub2.
Knee Orthoses – The Next Generation
Mr Andrew Clarke, Director MAS Medical
Dr Aileen Ibuki, Orthotist, Melbourne Orthotics Pty/Ltd.
Introduction
In the 1980s and 90s, polyfarmer knee orthoses were a popular
choice for orthopaedic knee surgeons treating patients with common
knee pathologies. These days, there seems to have been a decline
in the orthopaedic referrals for such supports, perhaps due to cost,
conflicting evidence for their use and poor patient compliance.
The market is now flooded with Asian made neoprene knee
orthoses which are affordable and commercially available. Knee
surgeons often advise patients to trial such products as a “token”
effort to cheaply brace a knee for support and pain management.
But is a cheap commercially available knee orthosis comparable to
one that is specifically prescribed and fitted by an orthotist?
Current Literature
Basic knee orthoses are often made from neoprene and come in
various designs. There is mixed evidence in the literature regarding
the effectiveness of these knee orthoses in managing common
knee pathologies such as knee osteoarthritis and soft tissue injury,1-3
however, a recent review found evidence of improvement in pain
and function with neoprene knee sleeves and elastic bandaging.4
Neoprene Versus Knit
Although neoprene knee orthoses are affordable and widely
available, they often pose a number of issues with fitting and
comfort. Patients often report problems with the braces slipping,
retaining moisture, bunching behind the knee and not providing
adequate support around the joint. This is because neoprene
orthoses often lack an anatomical shape, are not breathable and
do not provide adequate elasticity in their fabric. The GenuTrain®
range of knee orthoses made by a German company called
Bauerfeind, are becoming more popular as prescribers and
patients realize that neoprene is not the only option. GenuTrain®
knee orthoses are knitted with a soft but durable elastic knitted
fabric that is breathable and moisture dissipating. The knitted
fabric offers a high level of elasticity and an anatomical shape.
There are 5 designs in the GenuTrain® range offering support and
targeted treatment for a number of specific knee pathologies.
Compression
An orthotist would not fit a compression stocking without being
sure of the compression class and accuracy of fit. This should be
no different when fitting a knee orthosis, however, it is unknown
what level of compression is applied by neoprene orthoses. When
correctly fitted, the GenuTrain® knee orthosis applies a class
two level of compression (23-32mmHg). The compression at
the distal and proximal edges is purposefully reduced to prevent
any tourniquet effect which is often observed in neoprene
orthoses that have been stitched around the edges. The class two
compression provides greater support around the knee, reduces
swelling and prevents the knee orthosis from slipping down the
leg. This results in greater comfort and patient compliance.
Compression provided by elastic knee bandages has been shown
to improve the total integration of the balance control system and
muscle coordination.5
Proprioception and Joint Stability
Innovative detail of the latest generation
of GenuTrain: two pads placed on the
Omega silicone ring exert pressure on the
infrapatellar fat pad (Hoffa’s fat pad)
beneath the patella. The moderate
compression relieves strain on the
patella, thus reducing pain.
joint proprioception, which provides natural stabilization to the
knee joint. Through circumferential compression and stimulation
of cutaneous afferents via the elastic knit, the proprioceptive
pathways become more active. Elastic compressive knee
bandaging has been shown to improve a subject’s proprioceptive
acuity following cruciate ligament injuries,6, 7 knee osteoarthritis8
and total knee joint replacement.8
Effects on pain and function
A study conducted on young army personnel who were split into
two groups (GenuTrain® vs control group) found a significant
reduction in anterior knee pain syndrome in the GenuTrain® group
compared with the control group over a period of eight weeks of
a vigorous physical training regimen.9
A study conducted on 21 subjects with knee pain due to knee
osteoarthritis found a 50% reduction in pain and a 75% improvement
in sense of knee joint stability when the GenuTrain® was worn.
Conclusion
The evidence suggests that compressive elastic knee orthoses
are superior to neoprene knee orthoses in the management of
common knee pathologies due to their anatomical fit, application
of compression, effectiveness in improving knee proprioception
and comfort. The GenuTrain® range of knee orthoses feature
characteristics that offer superior fit, comfort and support to
neoprene orthoses. Our clinical experience with the GenuTrain®
knee orthoses has proven positive for the clinician as well as
the patient. Orthopaedic surgeons are beginning to refer more
patients to our clinics for the GenuTrain® knee orthoses as they
also receive positive feedback from their patients.
References
1. Birmingham TB, Inglis JT, Kramer JF, Vandervoort AA. Effect of a neoprene sleeve on knee joint kinesthesis:
influence of different testing procedures. Medicine and Science in Sports and Exercise. 2000;32(2):304308.
2. Beynnon BD, Good L, Risberg MA. The effect of bracing on proprioception of knees with anterior cruciate
ligament injury. Journal of Orthopaedic Sports and Physical Therapy. 2002;32(1):11-15.
3. Chuang SH, Huang MH, Chen TW, et al. Effect of knee sleeve on static and dynamic balance in patients with
knee osteoarthritis. Kaohsiung Journal of Medicine and Science. 2007;23(8):405-411.
4. Raja K, Dewan N. Efficacy of knee braces and foot orthoses in conservative management of knee
osteoarthritis. American Journal of Physical Medicine and Rehabilitation. 2011;90(3):247-262.
5. Kuster MS, Grob K, Kuster M, Wood GA, Gachter A. The benefits of wearing a compression sleeve after ACL
reconstruction. Medicine and science in sports and exercise. 1999;31(3):368-371.
6. Jerosch J, Prymka M. Proprioception and joint stability. 1996;4:171-179.
7. Jerosch J, Prymka M. Knee joint proprioception in normal volunteers and patients with anterior cruciate
ligament tears, taking special account of the effect of a knee bandage. Archives of Orthopaedic Trauma
Surgery. 1996;115(3-4):162-166.
The GenuTrain® features a silicone patella ring and allows an
ideal anatomical adaptation to the knee joint. This improves
knee joint stability by improving muscular recruitment and knee
8. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. The
Journal of Bone and Joint Surgery. 1991;73-B(1):53-56.
9. BenGal S, Lowe L, Mann G, Finsterbush A, Matan Y. The role of the knee brace in the prevention of anterior
knee pain syndrome. American Journal of Sports Medicine. 1997;25(1):118-122.
Functional & Economic Efficacy of Unloader Knee Orthoses
Rod Cooper (CPO-AOPA)
Australian Orthotic Technologies
that braces are expensive!). Bracing was able to reduce costs and
increase quality of life, with the estimated decrease in sick leave
alone covering the costs of the brace.
Introduction
With an increasing OA patient population and improved evidence
for bracing intervention this is clearly a growth area for Orthotic
treatment.
Australia has an ageing population, with the percentage of the
population aged 65 years+ increasing from 8.3% to 14% in the
last 30 years (ABS, 2012). As the population ages, the incidence
of people with arthritis is increasing. Forecasting by Access
Economics suggests that by 2050, 7 million Australians will suffer
from some form of arthritis (ABS 2012).
Whilst osteoarthritis (OA) is not caused by ageing, the likelihood
of developing OA increases with age. It is a common cause
of disease among the elderly, but occurs even among young
and middle-aged people. Approximately 5% of the population
between 35 and 54 years of age has OA, while one of six adults
aged 60+ has had knee pain lasting more than three months.
(Löfvendahl et al, 2009).
Unloading knee braces offer a non invasive solution to
unicompartmental knee OA. The braces function by “unloading”
the affected joint compartment. Studies have demonstrated that
a well fitted brace can reduce load on the affected compartment
(Pollo et al, 2002). Despite their proven efficacy, the use of bracing
has been limited, possibly due to a lack of confidence by clinicians
in the functional outcomes of the brace and the monetary costs
associated with initial purchase.
Evidence
A recent study by Briggs et al (2012) was conducted to investigate
long term functional changes resulting from knee brace wear.
In the study 39 patients with unicompartmental knee OA
were supplied with an ‘Unloader One’ knee brace. Participants
completed questionnaires covering perceived pain, stiffness and
functional abilities at enrollment, 3 weeks, 6 weeks and 6 month
periods. Results showed significant reductions in knee pain and
stiffness, and improved functional ability at all reporting periods.
This correlated with improved physical quality of life scores.
Interestingly, results also showed a 35% decrease in the use
of prescription anti-inflammatories,
suggesting that patients were able
to increase their levels of activity and
reduce their use of medications as a
result of brace wear.
The authors concluded that “Braces
specifically designed to unload the
degenerative compartment of the
knee can be an effective treatment to
decrease pain and maintain activity
level to increase overall physical
health”.
A recent analysis by Cortez (2013)
examined the cost effectiveness of
Unloader knee bracing in Australia. The
author compared costs associated with
bracing, pharmaceuticals, sick leave and
surgery to determine the total costs
associated with knee OA management,
as well as the resultant impact upon
patient’s quality of life. The analysis
showed that over a five year period
there was a 40% reduction in costs for
patients receiving bracing compared
to those undergoing surgery (this is
a point worth mentioning to your
Surgical referrers next time they suggest
Tips for reducing skin irritation in an Unloader
Brace.
In our clinics (and the many others that we support) we have seen
issues with some patients developing skin irritations during the
early weeks of brace wear. In the majority of cases these seemed
to occur due to one (or a combination of); lack of “wear in”
period and/or lack of brace cleaning.
Acclimitisation: Common feedback from patients affected
by skin irritation suggested that as the brace was effective in
reducing OA knee pain they wanted to wear it as much as
possible and commenced full time use straight after fitting.
This can lead to skin irritation as the skin does not have time to
acclimitise to the new forces being applied by the brace. We now
recommend that patients only wear the brace for a maximum of
2-3 hours in the first week and increase wear by no more than 2
hours per week. Application of moisturizer to the skin after brace
wear can also assist skin conditioning.
Cleaning: Unloader One liners are made from Silicone with its
“tacky” nature assisting in brace suspension. Some patients report
having a reaction to the liner material. Silicone is an inert material
but if dirt builds up on the liner, friction between the liner and the
skin surface may result in irritation. Daily cleaning of the liner by
wiping with a damp cloth and regular removal of the liner from
the brace for washing are recommended to avoid this.
By implementing the above protocols we have been able to
substantially reduce the number of patients with skin irritation. We
revert to use of a Coolmax under sleeve if these protocols do not assist.
About the Unloader One
The ‘Unloader One’ evolved from the ‘G11’ unloading braces –
the inventors of the Dynamic Force system that unloads in knee
extension and loosens in flexion resulting in high patient compliance.
Users have the unloading force when they need it, but don’t have
the discomfort of strap pressure at other times. Weighing less than
500 grams and with Sensil Silicone liners for optimal suspension,
the Unloader One is the most effective, user-friendly brace on the
market. We are so confident of its ability to reduce pain and improve
function for unilateral OA knee sufferers that we offer a 30-day
patient satisfaction guarantee. Supply your patient with an Unloader
One and if they are not satisfied with its performance you can return
it for a full refund of the purchase price.
More information on Unloading knee braces is available at
www.aotech.com.au or phone 1300 123 AOT (268). Australian
Orthotic Technologies is the exclusive Australian Distributor of the
Ossur Unloader One knee brace as well as other OA knee options.
References
ABS ageing population data published 30/10/2012 http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2071.0
main+features752012-2013
Briggs KK, Matheny LM, Steadman JR. (2012) Improvement in quality of life with use of an Unloader knee
brace in active patients with OA: A prospective cohort study. J Knee Surg https://www.thieme-connect.com/
ejournals/abstract/10.1055/s-0032-1313748
Cortez H. (2013) Knee Bracing – a Health Economic Evaluation. Cost-Effective Analysis Australia. Available
from Ossur/AOT
Löfvendahl S, Lidgren L & Petersson I. (2009) Riktlinjer för sjukskrivning vid sjukdomar i röresleorganen –
en kunskapsöversikt. Lund : MORSE Minskad Ohälsa Rörelseorganens Sjukdomar Sydsverige, 2009. (MORSE
rapportserie 2009:1) (In Swedish, cited in Cortez 2013)
Pollo FE. et al. (2002) Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee.
Am J Sports Med, 30(3):414-421
Dynamic Bracing for ACL Deficient & Reconstructed Knees
Gary R. Bledsoe, L.O.
Chief Technology Officer Bledsoe Brace Systems
Introduction
ACL deficient (ACLD) knees and ACL reconstructed (ACLR) knees
both share common problems that many medical professionals
may not fully realize. The quadriceps contraction forces causing
symptoms in ACLD patients are still working against the ligament
graft in ACLR patients. While the reconstructed ligament
can prevent much of the motion that causes ACL deficiency
symptoms, unfortunately it does not reduce the forces which lead
to graft stretching and failure. Statistics reported for graft failure
in younger patients range from 1% to over 27%i with reported
laxity in up to 38% of allograft reconstructions.ii If the failure
statistics are further restricted to only those athletes that continue
playing high level sports following reconstruction, the failure
and laxity rates are alarming. While older bracing studies have
demonstrated reductions in anterior tibial translation from 28.8%
to 39.1% without stabilizing muscle contractions, and 69.8% to
84.9% with contractions by using functional braces, the data was
collected at 30° of knee flexion where the hamstrings can usually
control anterior tibial translation.iii The symptoms of ACLD knees
usually occur in a more extended position than in normal knees.iv
Problems of ACLD & ACLR Knees
The quadriceps muscle places considerable strain on the ACL from
45° flexion to full extension according to Renstrom,v who further
stated, “the hamstrings are not capable of masking the potentially
harmful quadriceps contraction on freshly repaired or reconstructed
ACLs unless the knee flexion angle exceeds 30°". Hirokawa showed
that translation in ACLD knees can occur at flexion angles of
more than 60°, but as hamstrings muscles were co-contracted,
tibial translation was reduced in all but the last 15° of extension.vi
Hamstrings co-contraction was ineffective in this range.
Recently, the presence of a primary ligamento-muscular reflex
between the ACL and the hamstrings muscle has been greatly
elucidated by researchers such as Solomonow and Sjolander.vii, viii,
ix
Electrical stimulation of the ACL produces a primary reflex in
the hamstrings muscles.x, xi However, the hamstrings latency is
twice as slow in ACLD knees as in normal knees.xii In rapid sport
maneuvers, this timing difference can produce symptoms in most
ACL deficient knees. The primary reflex arc does not appear to
return in ACL reconstructed knees.xiii
Four activities that ACLD patients have difficulty performing
include stopping, running downhill, landing from a jump, and
lateral maneuvers. All four actions involve open kinetic chain
extension of an ACLD knee where the tibia translates anteriorly
prior to foot strike. Andriacchi xiv (using a multi-camera motion
analysis system) and, later independently, Jackson xv (using his
unique ISLD - Instrumented Spatial Linkage Device), showed in
ACLD knees that the tibia translates anteriorly during extension in
the swing phase and is subluxed at foot strike.
Dynamic Knee Bracing
Dynamic knee braces use the muscles that cause tibial translation
as a source of power to work against this pathological movement.
In Dynamic ACL knee braces, some of the quadriceps extensor
force provides a progressively increasing force to push the tibia
posterior relative to the femur as the knee moves into terminal
extension. Force is reduced as the knee flexes back into the ready
position. As the knee extends to less than 30° flexion, the force rises
more quickly. The resulting force is sufficient to prevent the tibia
from subluxing prior to foot strike.vii As the knee joint is compressed
in the proper position, it gains much more stability.xvi This normal
tibial position enhances joint position sense and maintains a more
normal knee flexion angle.iv The rapid rise in strap force is often
enough to elicit a tonic reflex co-contraction in the hamstrings
which further stabilizes the knee and decreases hamstrings
latency. Additionally, after using dynamic braces for several
days the muscle re-learning that occurs provides “spontaneous
hamstrings coactivation” that is elevated
to prevent subluxation even if the brace is
removed.vii
Benefits of Dynamic Braces
Dynamic braces help to eliminate ACLD
symptoms by preventing tibial translation before
foot strike, thereby stopping the remaining
elements in the chain of events that lead to
symptoms. Without tibial translation, there is no
subsequent pivot shift or joint reduction. This stops the giving way
episodes, quadriceps inhibition, and other symptoms.
Existing literature seems to share a consensus that limiting tibial
translation is the most important element to successfully preventing
further damage to articular cartilage and the menisci. Since tibial
translation is effectively controlled using dynamic ACL braces
it is reasonable to assume that this will reduce or limit further
damage to these structures. One of the key uses of such braces
is on individuals who cannot undergo reconstruction, such as
adolescents, where potential risk to growth plates exists if an ACL
reconstruction is performed too early. Dynamic bracing is also
of great use in preventing further injury to non-surgically treated
adults that can perform daily activities without symptoms, but
occasional weekend sports produces some symptoms which are
easily handled with a Dynamic brace
When ACLR patients perform the same four maneuvers (involving
open kinetic chain extension) that cause symptoms in ACLD
knees, a high degree of stress is placed on the reconstructed
ligament graft. One of the functions of the original ACL is a
neuro-sensory role that not only elicits a primary hamstrings
reflex to protect the ACL, but also inhibits the quadriceps from
applying too much force that might damage the ACL under
certain circumstances.ix, x Both the hamstrings protective reflex,
and the quadriceps inhibition reflex are absent or reduced in
ACL reconstructed knees. Subjecting the knee ligaments to even
mild cyclic loading can cause “ligament creep”, laxity, and some
neuromuscular disorder.xvii, xviii This may be why we see progressive
stretching and failure in such a high percentage of ligament
grafts in the 2 to 5 year period. Dynamic braces can apply a force
which reduces the strain on the reconstructed ligament helping to
protect it from subsequent stretching.vii
Conclusion
Bracing has been shown to significantly reduce the risk and
incidence of re-injury to ACL injured athletes in certain sports.xix
Dynamic braces add an additional dimension to this protection.
These braces are an effective tool to eliminate symptoms of ACL
deficiency and to help protect ACL reconstructed knees. While
extensive research articles support this as an effective alternative
for patients, it can also be demonstrated very effectively on
symptomatic ACLD knees and on ACLR knees that might still have
residual problems such as quadriceps inhibition, poor proprioception,
or a sensation of instability. The difference in performance level and
the decrease of or the lack of symptoms clearly demonstrates the
principles outlined in the research, and the benefit to patients.
References
i Van Eck CF, et al. The Journal of Arthroscopic and Related Surgery. Volume 27, Issue 5, Supplement ,
Pages e62-e63, May2011
ii Sun K, et al. Arthroscopy. Sep 2011;27(9):1195-202.
iii Wojtys EM, et al. Am J Sports Med. 1996 Jul-Aug;24(4):539-46
iv Rudolph KS, et al. Journal of Electromyography and Kinesiology 8 (1998)349–362
v Renstrom P, et al. Am J Sport Med 1986;14:83–7.
vi Hirokawa S, et al. Am J Sport Med 1992;20:299–306.
vii Solomonow M. Journal of Electromyography and Kinesiology 16 (2006)549–567
viii Sjolander P. A sensory role for the cruciate ligaments. Dissertation, Umea University, Umea, Sweden; 1989
ix Solomonow M, et al. Scand J Med Sci Sport 2001;11:64–80.
x Dyhre-Poulsen P, et al. J Appl Physiol. 2000;89:2191–5.
xi Krogsgaard MR, et al. Journal of Electromyography and Kinesiology 12 (2002)177–182
xii Beard DJ, et al. J Orthop Res 1994;12:219–28.
xiii Krogsgaard MR, et al. Journal of Electromyography and Kinesiology 21 (2011)82–86
xiv Andriacchi TP, et al. J Biomech. 2005; 38 (2): 293-8
xv Jackson R, et al. Orthopaedic Research Society, 46th Annual Meeting, Orlando, FL / March 12-15, 2000
xvi Fonseca ST, et al. Journal of Electromyography and Kinesiology 14 (2004)239–247
xvii Sbriccoli P, et al. Am J Sport Med 2005;33:543–51.
xviii Chu D, et al. Clinical Biomechanics 18 (2003) 222–230
xix Sterett WI, et al. Am J Sports Med. 2006 Oct;34(10):1581-5.
DisabilityCare Australia
In March 2013, the National Disability Insurance Scheme (NDIS)
was renamed to DisabilityCare Australia. The name was reportedly
chosen based on consultations with people with a disability, their
families and carers, peak organisations and the general public.
The name change has been met with resistance from some
sectors, however it continues to represent the overarching aim of
providing a national approach to the provision of equipment and
services to people with disabilities.
Launch Sites
From 1 July 2013, DisabilityCare Australia will launch in South
Australia, Tasmania, the Barwon area of Victoria and the Hunter
area in New South Wales. The 2013 launch will involve 6 sites
within the 4 areas and will be working on a gradual transition
of integrating people from existing schemes to the new scheme.
Launch sites will also have a specific focus. For example, South
Australia will only be providing services to children (birth to 5
years) and Tasmania will be servicing young people (aged 15 to
24 years). The ACT and the Barkly region in the Northern Territory
will launch in July 2014. We would be very interested to hear
from any members located in launch sites who are able to provide
feedback to the National Office over the next 6 to 12 months.
Please direct your contact to the AOPA Executive Officer, Leigh
Clarke (exec@aopa.org.au).
Provider Registration
In order to provide services to participants of DisabilityCare
Australia, service providers will need to be registered with
DisabilityCare Australia.
Providers of services will be able to register with DisabilityCare
Australia using the Provider Portal on the website. At this stage, ONLY
providers in the launch sites are encouraged to register. Please do not
register if you are outside the launch site, as it will cause confusion
regarding the availability of service providers. DisabilityCare Australia
works within a self-directed funding model, so if a participant seeks
services from a provider who is not registered, then the provider
simply needs to register online at that time.
Participant Intake
As the launch date nears, there will also be a need for participants
to become enrolled within the scheme. Initially, DisabilityCare
Australia will have a wide gateway with which to introduce
people into the scheme. This process will be based on a person’s
enrolment in current programs that are considered within
appropriate scope. People will be able to use the online MyAccess
Checker to get an indication of the access available within the
scheme. The intake of new participants not currently within
another scheme will be more gradual across the launch sites.
A Changing Paradigm
The introduction of DisabilityCare Australia will represent one of
the biggest changes in orthotic and prosthetic service provision
in Australia in recent times. The traditional roles of “prescriber”,
“supplier” and “patient” will be shifting, along with the
changing terminology. Participants will have significant choice and
control over services and the professional role will shift towards
supporting client-centered care. Launch site representatives of
DisabilityCare Australia have suggested that all the allied health
professions will need to consider their position as the “experts”
and “prescribers” of assistive technology. It is important to
understand that in this new model, the role will be to facilitate
discussions, coach and support participants to exercise “choice
and control” and make informed decisions regarding their
equipment and services.
You can subscribe to receive email updates from DisabilityCare Australia
by filling out a form on the NDIS website (www.ndis.gov.au).
2013 aoPa coNGress
congress program
day 1
Time
Theme
8:30
8:45
8:55
9:00
9:30
10:00
10:15
10:30
11:00
Registration
11:15
Prosthetic
11:30
Prosthetic
11:45
12:00
12:15
12:30
Orthotics
Orthotic
Exhibitor
Lunch
1:30
Prosthetic
1:45
Prosthetic
2:00
Prosthetic
2:15
2:30
2:45
3:00
3:30
3:45
4:00
4:15
4:30
4:45
5:15
6:30
9:30
Prosthetic
Prosthetic
Exhibitor
Afternoon Tea
O&P
Orthotic
Prosthetic
Rehab
Welcome
AOPA
AOPA
AOPA
Exhibitor
Morning Tea
Orthotics
Exhibitor
Topics
Presenter
Harvey Blackney: AOPA President
Opening address - Federal Minister
Panel discussion - DisabilityCare Australia
AOPA - The Role of Competency Standards in Self-Regulation
OTTO BOCK
The Effectiveness of Ischial Bearing Knee Ankle Foot Orthoses in Weight Relieving the Lower Limb
Removable Rigid Dressings reduce the time from amputation to start of prosthetic management:
a systematic review and meta analysis.
Effectiveness of TSB compared to SSB socket design on health outcomes of adults with transtibial amputation: A systematic review.
Gait Pattern: AFO tuning in Cerebral Palsy
Gait Pattern: AFO tuning in Cerebral Palsy
ORTHOPAEDIC TECHNIQUES
Phil Parish: Fibular hemimelia with complete terminal deficiency to knee disarticulation with
femoral osteotomy: one patients journey
Brendan Burkett: Biomechanics of osseointegration
Dr Al Muderis: The Osseointegration Group of Australia Accelerated Protocol (OGAAP) for
rehabilitation of amputees
Stefan Laux: Prosthetic considerations following lower limb osseointegration: a recent cohort
To Be Confirmed
ORTHOTIC PROSTHETIC CENTRE
Go to the country! -Mobile orthotic service for regional and remote care
Experiences with CAD-CAM central fabrication
Saddle Casting – An alternative trans-femoral socket fabrication method
Good Vibrations -the design and development of a novel gaming controller
for children with cerebral palsy who have impaired tactile sensation
ORTHOPAEDIC APPLIANCES P/L
AOPA AGM
Social function on Pool-deck
Finish
Honor Murdoch
Dr Irina Churilov
Sally Cavenett
Jill Rodda
Jill Rodda
Orthotic AP Session
Orthotic AP Session
Orthotic AP Session
Orthotic AP Session
Orthotic AP Session
Orthotic AP Session
Tamra Enbom
Denise Nathan
Scott Elliott
David Hobbs
David Hobbs
day 2
Time
Theme
Topics
Presenter
9:00
Prosthetic
David Butler
9:15
Prosthetic
9:30
Prosthetic
9:45
10:00
10:15
10:30
11:00
11:15
Prosthetic
O&P
Exhibitor
Morning Tea
Lower-limb prosthetic alignment transfer
Hip Disarticulation Case Study: The prosthetic journey from 7E7 & 3R60 to Helix hip-joint &
Genium knee.
Prosthetic treatment for a complex, traumatic trans-tibial amputee; focusing on rehabilitation
and triathlon goals
London 2012 paralympics: the prosthetic perspective
Participating in FK Norway’s Staff Exchange Program
OSSUR
11:30
Orthotic
11:45
12:00
12:15
12:30
1:30
Orthotic
Orthotic
Exhibitor
Lunch
Orthotic
1:45
Orthotic
2:00
Orthotic
2:15
Orthotic
2:30
2:45
3:00
3:30
3:45
4:00
Orthotic
Exhibitor
Afternoon Tea
O&P
O&P
O&P
4:15
O&P
4:30
O&P
4:45
5:00
Exhibitor
O&P
Orthotic
NCPO STUDENT POSTER SESSION
Management of Charcot Neuroarthropathy at Northern Health
Can tuning Total Contact Casts influence the healing time of diabetic ulcers? A pilot study to
determine the effect of sagittal plane alignment on forefoot plantar pressures
Dynamic bracing for ACLD and ACLR knee's
Dynamic bracing for ACLD and ACLR knee's
DJO GLOBAL
Michael Storey
Monique Van Den
Boom
Cameron Ward
Louise Puli
Andrew Steel
Anthony Francis
Gary Bledsoe
Gary Bledsoe
Tim Jarrot: "Please provide an antiflexion brace"
Alison Knuckey: The Orthotist/Prosthetist’s role in heel pressure management in Australian
hospitals
Darren Pereira: Oregon Orthotic System - AFO tuning using advance fibre technology - A case study
Darren Pereira: Knee Ankle Foot Orthoses for polio clients - You can’t change them or can you?
- A case study
Tamra Enbom: "E-records: so easy, so why not?"
AUSTRALIAN ORTHOTIC TECHNOLOGIES
Prosthetic AP Session
Work related musculoskeletal disorders in P&O: Focus group findings
The GAP - from Uni to work: expectations and reality
Increasing clinical capacity in professional placements
Development and validation of draft competency standards for entry level Orthotist/Prosthetists
in Australia
Short term P&O volunteering in Ecuador & Haiti with a comparison in the patient demographic
& management options.
REIS ORTHOPAEDICS & SURGICAL SERVICES
AOPA: looking to the future
Congess Close
Sarah Anderson
Meleita Finnigan
Stephanie Barnard
Shane Grant
Daniel Moore
Harvey Blackney
Presentation times are subject to change, all updates made via Congress App available for free download Eventmobi.com/aopa2013
2013 aoPa coNGress
Venue: Rydges on Swanston
701 Swanston Street, Carlton
Date: Fri 23rd, Sat 24th August 2013
• Clinical presentations
• O&P Exhibitor Hall
• Product presentations
• O&P Advanced Practise sessions
• Association Update
• Student poster presentations
• Onsite social evening
Congress Opening Address
The convening committee is very pleased to announce an
informative and unique opening for the 2013 AOPA National
Congress. We will be welcoming a member of Parliament to
provide an opening address and we will be joined by Senator
Mitch Fifield, Shadow Minister for Disabilities, Carers and the
Voluntary Sector, for the entire opening session. Following the
opening address, congress delegates will be treated to an open
panel discussion specifically focusing on the structure of the new
national disability scheme and the launch of the DisabilityCare
Australia sites across Australia.
Mr Fifield will be joined by representatives of DisabilityCare
Australia and AOPA members practicing within DisabilityCare
launch sites. There will be an opportunity for AOPA members
to ask questions of the Ministers, DisabilityCare Australia
representatives and practitioners with launch experience. There
will be much to learn about the future of disability services from
the experts and policy makers within this sector.
AOPA looks forward to providing the membership with this
unique learning opportunity, including the building of awareness
of the orthotic and prosthetic profession amongst DisabilityCare
Australia representatives and federal Ministers.
Program Content
The 2013 AOPA Congress will incorporate two Advanced Practice
Sessions, which will be aimed at developing the knowledge of
experienced clinicians in a very specific area.
In response to the 2012 AOPA congress survey results, the
Orthotic Advanced Practice session will focus on AFO tuning.
Friday’s podium presentation by Jill Rodda, Physiotherapist at
the Royal Children’s Hospital is intended to set the scene for the
Orthotic Advanced Practice Session which will follow after lunch.
Jill is the recent recipient of a Churchill Fellowship which
supported her overseas investigations into how best to implement
AFO tuning into practice in Australia. Jill’s presentation aims to
discuss the requirements of a successful multidisciplinary approach
to AFO tuning in relation to clinic set-up and staffing, as well as
appropriate outcome measures to evaluate the benefits of the
practice both where a gait lab is and is not available for use.
AOPA
CONGRESS
August 23-24
Melbourne
2D
EVEAY
NT
“Innovations
Clinical
Trends
”
and
FATOIOR
NS
L
L
T
CPRAESEN
N
E
P
O
The Orthotic Advanced Practice session is titled "AFO tuning
- the evidence, clinical application and benefits". Two
Orthotists, Emily Ridgewell and Daniel Baldwin will present within
this session on the history of AFO tuning principles, the current
evidence within the literature, including Emily's recent PhD results
and the clinical application of this theory to orthotic management
utilising clinically appropriate video footage. Darren Pereira will
facilitate a discussion with the presenters and the audience to
further examine these principles and their application.
The Prosthetic Advanced Practice is titled “Assisting an active
lifestyle – prescription and manufacturing of recreational
and sports prostheses”. This session involves three experienced
Prosthetist’s sharing their knowledge of how best to assist active
amputee patients, from the social participant with one government
funded prosthesis to the elite athlete with extensive funding, with
prescription options and recommendations. Monique Van Den
Boom will focus on Running with a prosthesis, Andrew Vearing
on Swimming and Cameron Ward on Cycling. The aim of this
session is to share their knowledge, tips and tricks in these generally
infrequently visited areas, to allow you to assist your patients as best
you can without needing to conduct extensive research alone.
Both Advanced Practice sessions will be a beneficial learning
experience for clinicians of various levels and provide for collegial
discussion in these interesting areas of practice. These sessions will
run concurrently with podium presentations and on separate days,
to allow dual-stream practitioners to attend both sessions if desired.
Social Opportunities
AOPA have chosen to provide current La Trobe University P&O
students with the opportunity to present their work in a poster
session at the 2013 Congress. Following numerous changes to the
curriculum with the introduction of the Master’s degree, this is a
wonderful opportunity for students to demonstrate the high level
of investigative clinical based work being conducted within their
studies. The eight posters as selected by NCPO and produced by
students will be on display for all to engage with potential future
employees and colleagues throughout the Congress. Students will
be available to discuss their poster content during morning tea on
Saturday. Otto Bock have sponsored this session with a wonderful
prize of participation within one of their Otto Bock Academy
courses for the author of the most outstanding poster.
Program content will be continually updated and can be accessed
by downloading AOPA App Eventmobi.com/aopa2013.
We look forward to seeing you there!
associatioN NeWs
Update on state activities
Winter is coming… but the cooler weather has
not dampened the hard working efforts of aoPa
members around the Nation.
New South Wales
It’s been a busy quarter for the NSW membership. An AOPA
general meeting and CPD event was held in June with some great
presentations organised by David Gurr, including guest speaker
Dr. Munjed Al Muderis who presented on the Osseo-integration
surgery technique for amputees. This was followed by a short
presentation by Life Time Care and Support (LTCS) outlining the
changes they have introduced in regards to prosthetic and orthotic
funding for their clients. NSW has received updated reports from
Enable NSW indicating that the new prosthetic contracts that
resulted from the recent tender are progressing well, with some
amputee clinics going through a transition period over the next
few months to ensure minimal disruption to consumers. Some of
the NSW membership will also be involved in the launch of the
NDIS in the Hunter region on July 1st. This is sure to be an exciting
time for our service providers, with DisabilityCare Australia
supporting consumers with a permanent profound or significant
disability under the age of 65 years, which will encompass both
prosthetic and orthotic services.
Victoria
The Victorian membership enjoyed a recent CPD event on
‘Orthopaedic and Orthotic management of Lisfranc injuries’
presented by Andrew Oppy and Paul Retschko. The State
Committee is still in discussion about involvement with a potential
Mental Health First Aid course of which more information will
be available in the coming months. It is with much regret that
Tim Burke will be finishing his role as the State Section President
at the end of the financial year. Paul Retschko has also finished
as the State Treasurer, however Paul will continue on as a State
Committee member. Thanks to Tim and Paul for all their hard
work and ongoing commitment to AOPA. Members should begin
to consider nominations for committee roles before the Victorian
State AGM which will be held in September.
Queensland
Queensland is currently in a state of turmoil with the recent
departure of two valuable members of the State Section
committee. Sarah Carter (State Representative on National
Council) and Bree King (State Secretary) have both recently
left the sunny delights of Queensland and moved interstate to
Victoria and South Australia respectively. Sarah and Bree were
very involved in organising AOPA activities and will be sorely
missed. We wish them both the very best in their new roles.
The Queensland membership was invited to attend a June CPD
event on ‘Utilising Stance Control Technology’ presented by Rod
Scherger. In other news, current Queensland Government cut
backs have had noticeable effects on the core business of the
public prosthetics and orthotics departments. Changes in the
departments have had to be instigated to adhere to new budget
targets. It is unsure how this will affect the public sector in the
long-term or flow on to the private organisations. Otherwise, it’s
business as usual.
Western Australia
It’s been a busy time over in the West with ongoing plans for
the opening of 2 new public hospitals. The Royal Perth P&O
department will be moving to the brand new State Rehabilitation
Centre at Fiona Stanley Hospital, and The Princess Margaret
Hospital for Children will be moving to the new site at the Queen
Elizabeth II Medical Centre, which is onsite with Sir Charles
Gairdner Public Hospital and Hollywood Private Hospital. Both
of the prosthetics and orthotics departments affected should
be relocated to their new homes between early 2014 and late
2015, so no doubt the schedule will not be slowing! The 3
private prosthetic providers in WA have also recently submitted
their Tenders for the WA public prosthetic services for the second
time in 12 months after last years failed tender process. The WA
membership has had lots of opportunities for CPD recently with a
June event on Halo Management presented via videoconference
by Karly Wheeler of the orthotics department at the Alfred
Hospital, Melbourne. In May, many members attended a seminar
and full day workshop presented by Scott Elliott on ‘Transfemoral
Saddle Casting’. This 2-day event was presented by Ossur and
hosted by TLC Unlimbited, with positive feedback from all who
attended, especially the volunteer patient who stayed to observe
the plaster modification procedure and was gobsmacked when
Scotty started getting violent with the draw knife on her plaster
cast! Lastly, WA is very sad to be losing State President Helke
Melville to the dark side with her recent return to Melbourne. We
thank Helke for all her efforts over the last couple of years and
wish her well in her next adventure, however we urge her to keep
an eye on the Perth weather reports and hope it won’t be long
until she decides to return!
South Australia
Firstly, we’d like to send out big congratulations to previous SA
resident, AOPA member Rebecca Bowes and her husband on the
arrival of their daughter over in the UK. The SA team met in June
for a meeting and CPD event which featured two stimulating
presentations from members. Firstly, Jessica Angus presented
on the ‘surgical and prosthetic treatment of client’s with PFFD’,
followed by Hannah Keane presenting on ‘dealing with tone
in spinal injury patients’. SA would like to welcome new P&O
recruits Adam Gill, Claire Jessup and Louise Baxter to their new
clinical roles within the state. A reminder to members that the SA
section will be holding the state AGM in September. Nominations
are required for the state roles of President/NC Representative,
Vice President/Secretary and CPD Coordinator. All members are
encouraged to consider these roles and to fill out a nomination
form prior to the AGM.
Association Events
Upcoming Events
Please explore the Events module of the AOPA website for further details regarding these events. You can register your intention to
attend national, state and accredited CPD events to ensure your points are allocated automatically. You can also track your registered
CPD activity in the My Events section of the Member Centre.
Did you know that in August and September you could achieve 28 CPD points for the 2013/14 year, simply by attending the AOPA
National Congress and AGM, along with your state AGM and CPD event?
Event
Date of Event
CPD Points
Venue
Contact or details
Otto Bock:
Manufacturing a
Running prosthesis
with 3S80 system kit
15-16th July,
2013
18
Otto Bock,
Sydney
Aideen.curran@ottobock.com
Otto Bock:
Innovative Materials
for Orthopaedic
Technology
22-23rd July,
2013
12
Otto Bock,
Sydney
Otto Bock: Modern
Application techniques
in Custom Silicone
Products
25-26th July,
2013
14
Otto Bock,
Sydney
16
Otto Bock,
Sydney
Otto Bock:
Manufacturing TT
Prosthesis with
Harmony
2-4 Sept, 2013
Otto Bock: MyoBock®
Below Elbow
5-6th August,
2013
14
Otto Bock,
Sydney
Otto Bock:
Advanced principles
of Transfemoral
Prosthetics
12-14th
August, 2013
15
Otto Bock,
Sydney
AOPA National
Congress
23rd-24th
August, 2013
25
Rydges on
Swanston,
Melbourne
http://www.aopa.org.au/events/category/
national-events
1
Rydges on
Swanston,
Melbourne
http://www.aopa.org.au/events/category/
national-events
29-31st July,
2013
5:15pm
AOPA National AGM
23 August,
2013
rd
Otto Bock: Practical
Materials Seminar:
Advanced laminations
26-27th August,
2013
12
Otto Bock,
Sydney
AOPA Queensland:
AGM
4th September,
2013
1
Goodwill
Orthopaedics
sjcarter6@gmail.com
AOPA New South
Wales: AGM & CPD
Event
4th September,
2013
2
TBC
MStorey@apcprosthetics.com.au
AOPA Western
Australia: AGM & CPD
Event
4th September,
2013
2
Princess
Margaret
Hospital
bcahill@oandpsolutions.com.au
AOPA Victoria: AGM &
CPD Event
10th September,
2013
2
St Vincent’s
Hospital
Diana.Poole@svhm.org.au
AOPA South Australia:
AGM & CPD Event
10th September,
2013
2
W&CH
b.howley@prostek.com.au
r.sutherland@prostek.com.au
Your Association
National Council
The AOPA National Council consists of Office
Bearers and State Representatives. The Office
Bearers (except Registrar) are voted in by the
membership at the National Annual General
Meeting (AGM). All Office Bearer positions
are two-year terms and half of them become
available each year. The State Representatives
are elected at the State AGMs each year. These
positions are held for a one-year term.
National Committees
AOPA is well supported through volunteer efforts
on a number of committees. However, extra
support is always needed and most welcome,
please do not hesitate to contact the National
Office should you wish to be involved or
make a suggestion. The following committees
are currently driving the key activities of the
Association.
Position
Name
Contact
President
Harvey Blackney
hblackney@ossur.com
Vice-President
Paul Sprague
paul.sprague@health.wa.gov.au
Vice-President
Sarah Anderson
sarah.anderson@latrobe.edu.au
Secretary
Hannah Furlong
hannah.furlong@mh.org.au
Treasurer
Colin Aburn
c.aburn@cgmc.org.au
Registrar
Jackie O’Connor
jackie_oc@hotmail.com
SA Representative
Bridie Howley
b.howley@prostek.com.au
WA Representative
Brendan Cahill
bcahill@oandpsolutions.com.au
QLD Representative
Sarah Carter
sjcarter6@gmail.com
NSW Representative
Michael Storey
MStorey@apcprosthetics.com.au
VIC Representative
Gabriella Salemme
gsalemme@optusnet.com.au
TAS Representative
Ella Nicolson
ella.nicolson@dhhs.tas.gov.au
Committee
Purpose
CPD Management
Committee
Annual review and management of the CPD program
including points, categories, weighting and the annual audit.
CPD Accreditation
Committee
Annual review of the CPD accreditation process and review of
accreditation applications and point allocations.
Congress
Committee
Development and convening of the AOPA 2 day congress.
Strategic Education Development of the 3 year Strategic Education plan for the
Committee
delivery of CPD events and activities to members.
Chaired by the Treasurer, this committee develops the
annual budget, ensures adherence with external reporting
Finance Committee
requirements, reports the financials to the National Council
and develops and presents the annual financial report.
Certification
Committee
Chaired by the Registrar, this committee processes
membership applications in accordance with the AOPA Rules
and Statement of Purpose and internal procedures.
Gazette Committee
Development of the 4 editions of the Gazette, including
content management, editing, layout and design.
Announcements
AOPA Annual General Meeting
Student Volunteers
In 2013 the AOPA Annual General Meeting will be held as a
face-to-face event at the National Congress. The AGM will be
on Friday the 23rd August at 5:15pm. The AGM will involve the
presentation of Office Bearer reports, finances and the election
of Office Bearers. All members will receive the required AGM
communication in the coming months, including a call for
nominations and the 2012/13 Annual Report. We encourage
all members with a keen interest in Association activities and
governance to consider nominating for vacant Office Bearer
positions for the 2013/14 year.
The AOPA National Office is very pleased to welcome student
volunteers Jarrod, Jonathan, Luke and Elisa. Jarrod and Jonathan
will be supporting the Office over the coming months with
Gazette distribution and Congress preparations. Luke and Elisa
have assisted the Association through the development of our
very first Guest Editor article as part of the Gazette clinical feature.
AOPA welcomes all volunteer efforts, including committee
participation, administration support and special project
assistance. Thanks again to our new volunteers.
NCPO Students Raise Money As “Team Limbs”
In May 2013, the AOPA National Council approved new Terms of
Reference for the Strategic Education Committee. AOPA is very
grateful for the assistance provided by Richard Dyson-Holland and
we would like to acknowledge all his hard work in developing
these Terms of Reference documents. This Committee will focus
on the development of a long term continuing education plan for
the Association for the benefit of members. Particular attention
will be paid to educational events and activities which meet a
diverse range of member needs and will be delivered in a variety
of accessible formats. Please contact the Office and register your
interest if you would like to be involved.
More than 26,000 people will take part in The Age Run
Melbourne on Sunday 21st July, 2013. An expected $1.75 million
will be raised for charity. Among the entrants will be a group of
20 Orthotic and Prosthetic students from La Trobe University who,
along with family and friends, will take part in the half marathon
to raise funds for Limbs 4 Life.
“Team Limbs” organiser and participant, Stephanie Ford, has once
again rallied a team of Orthotic and Prosthetic students from La
Trobe University to participate in the day. Stephanie and her team
are looking for sponsors for this year’s event. If you are interested
in being involved please contact Melissa at Limbs 4 Life, or donate
directly to http://runmelbourne.everydayhero.com.au/limbs4life_5
Strategic Education Committee Re-formed

AOPA Clinical Feature: Knee Orthoses

Transcription

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