Transcript feasibility case study on the use of dynamic elastomeric fabric

FEASIBILITY CASE STUDY ON THE USE OF
DYNAMIC ELASTOMERIC FABRIC
ORTHOSES IN CMT
Sarah Brown
Paediatric Neuromuscular Physiotherapist
Royal Hospital for Children, Glasgow
25th April 2016
Introduction
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Why research?​
Why this study in this patient group?​
Who is involved?​
What are we doing?​
What do we hope to find out?​
Why research?
• There has been a surge in neuromuscular research in recent
years.​
• It can be challenging to conduct research in a limited
population that is classed as a rare disease (an incidence of
less that 5:10,000, WHO, 2012).​
• A large enough sample population is required to produce
clinically valid results.​
• Limitations in funding and staffing.​
• There is a lack of evidence for many of the interventions for
this patient group and in this evidence based climate we
need to work towards finding this information to improve
our knowledge and impact patient care.
Aim
• To investigate the difference
between an ankle foot orthosis
(AFO) and dynamic elastomeric
fabric orthosis (DEFO) on gait and
fatigue in a young person with
Charcot Marie Tooth (CMT).
Why this patient group?
• CMT is a genetic condition affecting the motor and sensory
peripheral nerves. Damage to either the axon or myelin sheath
results in weaker conduction of the electrical signals between the
brain and muscles and causes muscle weakness and altered
sensation (MDUK, 2014).
• CMT commonly affects the peroneal nerve resulting in weakness
of tibialis anterior, extensor digitorum and hallucis brevis
and peroneus brevis and longus.
• Ankle dorsiflexion and eversion weakness causes "foot
drop" which can result in significant gait abnormalities, increased
falls risk and foot posture abnormalities.
Why this patient group?
• This symptom of CMT is commonly managed by rigid
AFOs to help to maintain a neutral ankle position and
aid toe clearance when walking.
• Some of our patients have reported difficulties with
their rigid AFOs such as:
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discomfort and pressure pain
reduced proprioceptive feedback
increased trips and falls
functional limitations such as difficulty managing stairs,
rising from a chair and cycling due to the restricted
dorsiflexion range of movement.
Why this patient group?
• In CMT, the muscles of the trunk and lower limbs are
weaker so balance is already affected, but the
reduced proprioceptive feedback further challenges
balance.
• A rigid AFO may be posturally correct, but it actually
inhibits the normal function of the muscles of the
lower leg which compromises muscle strength.
• In addition, the fixed position of the foot can cause
increased muscle fatigue as the other muscles of the
lower leg are mechanically disadvantaged.
Why this patient group?
• There is an increasing use of lycra in patients with
neurological conditions to help to aid posture, joint position,
facilitate movement and manage tone.
• There is limited availability of evidence in the CMT patient
group, particularly in paediatrics and more specifically with
relation to foot drop.
• With the increasing need for evidence-based justification for
the use of treatment modalities we have a duty to this
patient group to use our position in this specialist service to
further inform clinical practice.
Who is involved in the study?
• Principal Investigator: Sarah Brown, Specialist
Paediatric Neuromuscular Physiotherapist, RHC,
Glasgow
• Marina DiMarco, Principal Neuromuscular
Physiotherapist, West of Scotland
• Dr Iain Horrocks, Consultant Paediatric Neurologist,
RHC, Glasgow
• Matthew Banger, Research Asscociate, Department of
Biomedical Engineering, Strathclyde University
• Patricia McCotter, Orthotist, DM Orthotics
Study Aim
• To investigate the difference between an
AFO and DEFO on gait and fatigue in a
young person with CMT.
Process
• IRAS form and ethics process
• Select a paediatric patient with CMT who is an existing AFO
wearer.
• Gain consent
• Initial physio assessment including joint ROM, muscle strength and
a modified North Star assessment.
• Baseline visit - Gait assessment on the force plate and on the
treadmill in normal footwear and initial fatigue questionnaire.
Process (cont.)
• Review one week later for gait assessment in AFOs.
• DEFO fitting one week later and patient to wear for 6
weeks to get used to them.
• Gait assessment with DEFOs, repeat fatigue
questionnaire and physio assessment.
• Review one week later for gait analysis in normal
footwear to see if there is any carry over effects from
the DEFO use.
Other possibilities…
• ? Addition of a fatigue diary for patient to
complete throughout the study.
• ? Additional objective outcome measures
such as the 6 minute walk test or similar
What do we hope to find?
• We aim to examine the potential differences, if any,
in:
– Fatigue levels
– Gait pattern
– Muscle Strength
– Ankle ROM
Conclusion
• There is a need for research into this patient group
and if we want to explore the use of new
treatments and devices we need to be part of the
process of finding evidence to support it.
• Single case studies are becoming increasingly
important in informing preliminary research,
particularly in conditions with small sample sizes.
• This is a feasibility study with a single patient, but
the hope is to widen the study to increase the
sample size in both the paediatric and adult
populations.
Any questions?
[email protected]