Life after Amputation: Physiotherapy to Improve Rehabilitation, Quality of Life and Patient Care- USA, Sweden and UK

Beck Hefferon, Physiotherapist, Sir Charles Gairdner Hospital, Churchill Fellow 2016

• The Winston Churchill Memorial Trusts are 3 independent

but related living memorials to Sir Winston Churchill

• Founded: 1 February 1965, : UK, Aus, NZ

• Motto:With opportunities comes responsibility

• Focus:World peace and mutual understanding through

projects requiring 4 to 8 weeks international travel

• ~ 100 Annual Awards (Aus)

• Benefit to Australians through expansion of knowledge and

commitment to sharing.

2 million Americans living with limb loss

UK - 20 amputations per dayIn Australia an

amputation every 2 hours

Numbers forecast to double by

2050Major Causes: (1) Diabetes; (2) Global

Conflict

Significant advances in rehabilitation overseas

▪Lack of progression

▪Changing national healthcare framework

▪Perth’s Isolation

▪The Internet & social media

▪Technology not yet in Australia

▪Diabesity Epidemic

▪Travel - across 3 nations

▪Visit - 8 centres of excellence

▪Connect - with leading clinicians & researchers

▪Learn – advancements in 4 key areas

▪Report can be found here:

▪ https://www.churchilltrust.com.au/fellows/?page=2

Best practice MDT care

Protocols - MDT & physio - OI (OPRA system)

Neuromotus Programme - Phantom Limb pain -

Advances in prosthetics

Performance Optimization Warrior

Enhanced Rehabilitation

▪How different places approach MDT care

▪How healthcare systems differ

▪Barriers and enablers

▪Different MDT tools used

▪Evaluation and Research

▪What might we learn and implement

▪Centre for the Intrepid -San Antonio

▪PACE Rehabilitation

▪Queen Mary’s Hospital, Roehampton

Physio and prosthetic collaboration

Embrace technology in clinical and admin care

Patient Expectations &

Goals

Closed Structure MDT

Uniform pathway for continuity of

care

Open access &

Collaborative research

Seamless Multidisciplinary

Care

EVALUATES

• Factors pre and post amputation

• Prosthetic fitting, componentry and rehab

• Functional and mobility outcomes

ANALYSIS

• Beyond capacity of inpatient records

• Therapy treatment frequency and methods

• Highlights variances in patient care

DATA

• Quality improvements throughout continuum of care

• Cost analysis at regional and national levels

• Prosthetic prescription and fitting

▪ Interdisciplinary practice

▪Clinical Pathways, New OMs- BLART, EQOL 5D

▪Early Mobility Aids: PPAM/ Femurett

▪Partial weight & pressure plate feedback systems

▪ (esp for OI)

▪Technologies:

▪ Virtual reality environments

▪ Smart technologies

▪ Team communication

Professor Per-Ingvar Brånemark discovered bone can

integrate with titanium components.in the 1950s

Professor Rickard Brånemark treated the first OPRA patient in

Sweden in 1990.

▪Sahlgrenska University -Sweden

▪UCSF

▪Chalmers University –Sweden

▪PACE Rehabilitation - UK

▪St Mary’s, Roehampton-NHS

▪C.A.R.E: Centre for Advanced Reconstruction of Extremities ▪ 20yrs of research

▪UCSF- USA 1st FDA approved implant▪ MDT pathway/protocols

▪Template for all OI Physio Rehab globally

▪Exercise prescription & progression

▪Outcome Measures

▪OPRA patient perspectives

▪UCSF

▪CFI

▪University of Miami

▪University of Texas

▪Ottobock - Austin

▪Fillauer – Stockholm

▪Blatchford - London

▪Casting technologies- Direct /Modular sockets

▪Socket Designs

▪3D printing

▪Bionics

▪OI Prosthetics

▪Research

▪FORE (Miami)

▪ ‘Reload’ music programme

▪https://youtu.be/8AykROuuCXw

▪ ‘Smart’ insoles

▪University of Texas

▪Gait deviations and SLR printing

▪CFI- CAREN

▪Virtual Realities retrain frontline skills

▪ Inform Surgery

▪Blatchford UK

▪ ‘Smart’ sockets

▪Chalmers University of Technology- Gothenburg

▪Biomechatronics & Neurorehabilitation Laboratory

▪CFI- San Antonio

▪UK: Advanced scope of practice

For physios- various NHS sites

http://integrum.se/wp-

content/uploads/2016/

11/Neuromotus_Video.

mp4?_=1

▪MDT pathway for OI patients through the public system

▪ Introduce OPRA procedure

▪MDT Collaborative and interactive strategies

▪SCGH trial of database of amputees

▪ Extend to registry if successful

▪OI physiotherapy protocol

▪Neuromotus pilot study

▪Using elements from SWEDEAMP, NHS protocols and CFI POWER programme: SCGH Amputee Database QI submitted for 3mth trial

▪Osseointegration programme, MDT treatment pathway and Physio guidelines being developed

▪Strategies to maximise shared prosthetic, physio and patient clinical care

▪Neuromotus programme- awtg latest software from Sweden- plans to collaborate with teams at The Alfred and Epworth Hospital

▪New technologies…?!

https://www.churchilltrust.com.au/fellows/?page=2

▪ https://youtu.be/kI0ejhlq4tk

▪ https://youtu.be/0NKdZvxwaBc

▪ https://youtu.be/inh4rE6-ADo