Specialist Commissioning & ISPO Activities – an Update

Laura Burgess Clinical Specialist Physiotherapist

ISPO Executive Board Member 2013-5 Member of Clinical Reference Group for

Complex Disability Equipment

• Chair: Professor Rajiv Hanspal • Commissioner- Carolyn Young • Clinical Members: Lal Landham Margaret Hannon Uditya Jayatunga Alan Woodcock Henry Lumley Stephen Kirker Clive Thursfield Jai Kulkarni Laura Burgess Alison Hadfield Kanther Selvarajaha Mark Hawley David Henderson-Slater. Graham Marsh

Affiliated Organisations: ISPO, RCS&LT, BHTA & DMRC Patient/Carers – x 4

Members – CRG for Complex Disability Equipment

Impairment Measures: McGill Pain Scores which are well recognised for description of pain Numeral Rating Score or Visual Analogue Score for Pain Socket Comfort Score Stump Descriptors (e.g. ISO) Mobility Disability/Activity Measures: Special Interest Group in Amputee Medicine Mobility (SIGAM) Grades Locomotor Capabilities Index 5 (LCI-5) Timed Walking Tests Timed Up and Go Video recording of gait while performing tasks relevant to goals Canadian Occupational Performance Measure (COPM) Participation: Assessment of mutually agreed personalised care plans EuroQol - 5D, Trinity Amputation and Prosthetic Scales (TAPES) Emotional: Hospital Anxiety and Depression Scale (HADS) or General Health Questionnaire (SF-12 Health Survey)

OUTCOME MEASURES – Prosthetics Service Specification 2014

Prosthetic Policies…

• Microprocessor Knees

• Multi-articulating Hands

• High grade Silicone Cosmesis

Microprocessor Knee Policy

Definition- A Microprocessor Knee: An artificial knee joint which includes a battery-powered, built-in, programmable computer that continuously controls both swing and stance phase based on real time data of the user’s gait.

MPK components covered by this policy are:

• Orion Knee (Endolite)

• The Rheo Knee (Ossur)

• The C-leg (Ottobock)

• Plie Knee (Freedom Innovations)

Patient Selection

Full Clinical Assessment

Goal Setting

Trial

Outcome Measures

Provision

Reviews

Microprocessor Knee Policy Activity level: Unilateral amputee K3 or K4 – patient is an active walker with a free knee Bilateral amputee K2, patient is able to walk with a free knee.

Mobility level: SIGAM D or above

Amputation level: Unilateral Trans-femoral Hip disarticulation Knee disarticulation Bilateral lower limb amputee (A major amputation on the contralateral side at or higher than mid-foot level, or functional loss on the contralateral side as per definition)

Patient must demonstrate: Commitment to rehabilitation Adequate strength and balance Requirement of MPK as the main day to day prosthesis Cognitive reasoning Sufficient cardiovascular abilities

Microprocessor Knee Policy 7.2.1 Unilateral Amputees (K3 level, SIGAM D) • user should have a comfortable, well-fitting, well-aligned prosthesis , non-MPK , be able to

walk out doors with a free knee. In this case an MPK would be indicated if the patient presented with: • Clinical presentation of unstable gait evidenced as history of frequent falls, stumbles or near misses • When the risk of injury from a fall is very high due to a co-existing medical condition 7.2.2 Bilateral Transfemoral / Knee Disarticulation Amputees (K2 or above, SIGAM D) Prescription of MPKs to this patient group is limited to prosthetic users who are able to independently mobilise with Stubbies ; have sufficient balance and muscle control to progress on to achieve independent mobility with full length articulating prostheses during rehabilitation. 7.2.3 Bone Anchored Prosthesis Techniques • MPK is indicated when a non-MPK would not allow the patient to mobilise at their full

potential, or when an MPK is essential to avoid potential fractures around the implant as a result of a fall.

7.3 Contra-indications

Current Position

July 2014 - September 2014

January-March 2015

27th October 2014

? April 2015

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Structure

International Committee

Executive

Board

Elects

ISPO Office/

Staff

Directs

Committees (Standing & ad hoc) International Consultants

Task Officers

Appoints

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Executive Board

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ISPO is Global…

• 60 Member Societies worldwide

• 3,416 Members

• In 107 countries

Vision…

ISPO contributes to a world where all persons have equal opportunity for full participation in society.

International Perspective…

• 354 million people (0.5%) of the world’s population are estimated to need prosthetic and orthotic devices – currently we are only meeting 5-15% of current need…

• 1 in 10 can access Assistive Technology

** 15% of the worlds population

living with a disability

United Nations High-Level Meeting on Disability & Development

23 September 2013

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Collaborations and Partnerships

ISPO is an international advisory body interacting with other international and national agencies.

ISPO is in:

• special consultative status with the Economic and Social Council of the United Nations

• special collaborative status with USAID

• official relations with the World Health Organization

• special collaborative status with many international organisations including the International Committee of the Red Cross

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Exchange – Events – Courses

Short Courses, Workshops and Consultative Meetings

Format: 3 to 5 days, forum for updated information

on a specific topic

Latest: Management of Stroke, Philippines (2012);

Management of Cerebral Palsy, Lao PR (2012);

Amputation Surgery and Prosthetics, Russia (2012);

Management of Stroke, Sri Lanka (2013);

Management of Cerebral Palsy, Afghanistan (2013)

Consensus Conferences

Format: Literature survey, presentations by recognized experts, syndicate discussions, plenary discussions, consensus statement, final report

Latest: Consensus Conference on Recent Developments in Healthcare for Cerebral Palsy, Oxford, UK (2008)

ISPO Consensus Procedure on Lower Limb Amputation – 2014/5 ongoing…

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Learn – Education - Certification

In collaboration with the World Health Organization (WHO), ISPO has developed criteria for education and training of:

Category I Professionals Prosthetist/Orthotist, Orthopedic Engineer (or equivalent)

Category II Professionals Orthopedic Technologist (or equivalent)

Category I : Prosthetist-Orthotist

Category II : Orthopaedic Technologist

Category III : Prosthetic/Orthotic Technician

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Standards & Guidelines:

WHO/ISPO Guidelines & ISPO Information Packages.

Education Committee Update

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ISPO Grant Supported Activities

(US Agency for International Development)

Grant awarded by the Leahy War Victims Fund supporting the rehabilitation of people with physical

disability in developing countries

– Scholarships for professional training

– Impact assessments of Category I and II training

– Publication of a new guideline for prosthetic and orthotic services

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Access to the worldwide

ISPO community

Highest level of international expertise & keep abreast of latest developments in the field

Contribute by supporting

ISPO’s various training activities

Quality training

Participating in debates and congresses

BENEFITS...

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Membership Benefits

ISPO members benefit from:

• A free subscription to Prosthetics and Orthotics International (POI), the leading international scientific publication in the field of prosthetics and orthotics

• Reduced registration fees at ISPO events: ISPO world congresses, national congresses, workshops, seminars and other professional activities

• Receiving ISPO’s eUpdates every two months

• Enjoy ISPO’s refreshed website and access to ISPO exclusive online services

• Complimentary access to selected articles of the American Academy Journal of Prosthetics and Orthotics

• Voting rights and eligibility to serve on ISPO committees and taskforces

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Exchange –Events – World Congresses

World Congresses

Format: Invited and free paper presentations, instructional courses, specialists forum, symposia, poster sessions, industry exhibition, product showcases

1974 Montreux, France 1998 Amsterdam, Netherlands

1977 New York City, NY, USA 2001 Glasgow, UK

1980 Bologna, Italy 2004 Hong Kong

1983 London, UK 2007 Vancouver, Canada

1986 Copenhagen, Denmark 2010 Leipzig, Germany

1989 Kobe, Japan 2013 Hyderabad, India

1992 Chicago, IL, USA 2015 Lyon, France

1995 Melbourne, Australia 2017 Cape Town, South Africa

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Exchange –Events – World Congresses

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