AOPA Review: December 2022

Thanks for stopping by at #AOPA22!

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Orthotics

Welcome

The AOPA Office and AOPA Editorial Committee are pleased to deliver the December edition of the AOPA Review for 2022. The theme of this edition is Paediatric Orthotics and we are excited to showcase a series of orthotic case studies featuring paediatric clients. This edition is targeted at Orthotists following the release of the Paediatric Prosthetic edition in June. We are also pleased to share with you reflections from the recent 2022 AOPA Congress and other O&P updates and achievements.

This edition will be the final printed version of the AOPA Review as we move towards delivering a digital version. Though the printed magazine has been an important part of the AOPA education calendar, we look forward to the changes a virtual AOPA Review will bring. If you would like to be involved in the next edition of the AOPA Review, we encourage you to reach out to a member of the AOPA Review Editorial Committee.

Contribute to the Review

The Review is distributed to over 500 O&P practitioners, AOPA education subscribers and related industry partners. The Review provides an excellent platform and resource for members to celebrate our profession and the important role of orthotists/prosthetists.

The Editorial Committee invite content submissions from all members as a way of sharing the valuable contribution and unique set of skills the O&P profession contribute to the Australian healthcare system.

Suggested topics include:

• Feature articles on clinical topics, case studies or research

• Exploration of issues that impact our profession in Australia

• Introductions to new orthotic/prosthetic technologies

• Member reviews of new technologies

• Overviews of education events

• Contributions from other Allied Health and related disciplines

Contribute by contacting any member of the Editorial Committee or the National Office (admin@aopa.org.au). We also encourage you to suggest ideas of what you’d like to see in upcoming editions.

Reminder: Earn extra CPD Points

Remember that you can top up your CPD points just by reading the Review. Keep an eye on your email for a link to our Review online quiz, where you can earn valuable CPD points by answering correctly!

Finally, a huge thankyou to all our authors for sharing their time, insights and expertise with us – this publication would not be possible without your contributions.

With Special thanks to the 2022 AOPA Editorial Committee: Nawaal Ovais / Elizabeth Tori / Emily Hill

NEWS

Thoughts from the National Office 4

Chair’s Report 5

2022 AOPA Congress Reflections 8

Leigh’s farewell 18

Thank you Emily and Megg 21

START’s Farewell 22

The AOPA Review goes electronic 46

FEATURE: PAEdiATRic ORThOTicS

CADCam vs Plaster when learning modifications 29

3D Case Study 31

To helmet or not to helmet 32

Exploring Options for Paediatric KAFOs 34

Complex neurological spinal presentation 35

Don’t forget the Mob: a case study 38

AOPA MEMBERS

Life membership Barry Leech 15

The AOPA Board 16

O&P Clinical Supervision 24

Placement Reflections 25

Ambitions to remove barriers to O&P services 26

AOPA PROJEcTS

Advocacy and Policy Update 6

OPT Membership launch 13

AOPA23: Call for clinical content 41

CEP: National Benchmarks 42

For further information on items in The Review contact:

Editor, AOPA Office

The AOPA Review is produced in June 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.

P.O. Box 1132 Hartwell VIC 3124

T. 1300 668 194 / (03) 9816 4620 F. 03) 9816 4305

E. admin@aopa.org.au

THE AOPA

Thoughts from the National Office

Attempting to capture the activities of the preceding 6 months is a difficult task, and on reflection I am impressed by the volume and quality of work our small team is able to produce with limited resources.

Despite significant changes to the staff team in 2022 we have continued to make important connections, have many achievements to celebrate, and many people to thank.

Transitions

It would be remiss of me to begin my update without acknowledging the departure of Leigh Clarke, CEO, and Dr Emily Ridgewell, Manager of Research and Policy. The work undertaken by Leigh and Emily has transformed our Association and profession over the last 12 years. I extend my congratulations to Leigh on her appointment to CEO of the Victorian Healthcare Association and wish her all the very best.

I would like to thank the AOPA Board members, both current and recently resigned, for their foresight in implementing a succession plan for the CEO position. This forward planning has allowed Leigh and I to work closely together for almost 2 years to ensure our organisation is well-placed to manage this transition and move to our new phase of leadership.

Connections

It has been a busy start to my time as Acting CEO. Building and maintaining connections with and within our membership is a primary focus for me and in a short time I am pleased to have connected with many of our members, partners and key stakeholders, including our Corporate partners, education providers, the START Foundation and the New Zealand Orthotic Prosthetic Association (NZOPA). Important advocacy work continues to progress throughout the last half of the year, with Natasha and I connecting and meeting with the National Disability Insurance Agency (NDIA), Therapeutic Goods Administration (TGA), the International Society of Prosthetics and Orthotics (ISPO) and private health insurers regarding the Orthotic Prosthetic Services Schedule (OPPS).

“ during congress we shared the details of the first ever national benchmarks for the consumer Experience Program (cEP), detailing the experiences of O&P consumers across Australia.”

Celebrations

Firstly, it was an absolute pleasure to facilitate our profession coming together in October for the 2022 AOPA Congress. Thank you to Congress convenor Courtney Crighton for her very capable leadership of the Congress Committee in their delivery of our biggest (and I dare say, best), congress yet.

I am grateful to Leigh for so willingly sharing her knowledge, skills and experience with me over this time. Thank you also to AOPA staff team, Board, members and partners who have reached out to offer their support during this time. With this knowledge, preparation and support, I feel well prepared to provide stability to our community and progress our important activities during my time as Acting CEO.

The AOPA Board also experienced a time of transition in November as Rhiannon Assetta and Pete Kneebone completed their terms as Directors. Thank you, Rhiannon and Pete, for the significant contribution you have made to the organisation during your time on the Board. Welcome to our new Board Directors Andrew Vearing and Sam Palazzolo and welcome back to Directors continuing for subsequent terms, including our Chair, Dr Sarah Anderson. I look forward to working closely with you to shape the future of our organisation and profession.

During Congress we shared the details of the first ever national benchmarks for the Consumer Experience Program (CEP), detailing the experiences of O&P consumers across Australia. Thank you to those service providers who have embraced this Program, we look forward to working with you to ensure it is as user-friendly and valuable as possible into the future. Congress also saw the launch the Orthotic Prosthetic Technician (OPT) membership class.

We are thrilled to finally offer this membership, which will facilitate increased connection with our O&P profession and increase access to education for our OPT members. Thank you to Julia Hibma, AOPA Member Engagement Coordinator, for her capable coordination of these two significant activities.

Thank you

Finally, and most importantly, thank you to our members, partners and volunteers for your ongoing support throughout 2022. It is thanks to you that our Association continues to be the strong community it is today. I look forward to connecting and collaborating with as many of you as possible throughout 2023.

With warm wishes, Jessica

It is my pleasure to bring you this update from the AOPA National Office, in my capacity as Acting cEO.

chair’s Report

It certainly has been a busy end to 2022 with significant movement in the AOPA office team, a highly successful congress and the launch to a new membership class all delivered in the last six months.

Thank you Leigh

In October the Board was sad to announce the resignation of long standing AOPA CEO Leigh Clarke. Leigh has played a critical leadership role for AOPA and Australian O&P for over 11 years, contributing greatly to the organisations’ growth and success.

While the AOPA Board, staff and membership will miss Leigh’s leadership and passionate representation of the O&P profession, we congratulate her on an exciting appointment as the CEO of the Victorian Healthcare Association (VHA). The VHA is the peak body providing a unified voice for Victoria’s diverse public healthcare sector.

We thank Leigh for her commitment to AOPA and her leadership over a long period where the organisation has grown and changed and through those hard COVID-19 times that most of us are hoping are a distant memory. Leigh’s name has been synonymous with Australian O&P, and we can only begin to express the depth of our gratitude. We are excited to see what you do next Leigh, and wish you all the very best.

AOPA Office Team Changes

In the last six months, we have also farewelled Dr Emily Ridgewell and are preparing to say farewell to Megg Banks. Emily worked in various roles throughout her time at AOPA and stepped into a leadership role in 2020 as the Research and Policy Manager. Emily’s work has been instrumental in growing recognition of the O&P profession in Australia, with her publications influencing policy at the highest level. Some of Emily’s outstanding contributions have led to changes to the immigration status of orthotist/prosthetists, AOPA becoming recognised as a self-regulating health profession through NASRHP, and the development of the Private Health Insurance schedule. Megg joined the team in 2021 in the Pre-graduate Communications Officer role, and has become a reliable and vital member of the AOPA team. Megg has now completed her studies and is entering full time work.Thank you, Emily and Megg for your contributions to AOPA and we wish you all the best for your next steps.

Clinical Care Across the Lifespan

In October we gathered for AOPA’s 12th National Congress Clinical Care Across the Lifespan, which is our most successful Congress to date. It was great to see over 500 delegates join us across the three days with the new format program positively received. Congratulations to first time Congress Convenor Courtney Crichton and the Congress Committee for delivering such a successful event.

The new look program enabled for a greater reach with free paper sessions, sponsored workshops and panel discussions supporting and engaging and interactive program. Thank you to all involved in the program, we cannot deliver this event without your involvement.

We look forward to announcing details about the 2023 AOPA Congress in the new year.

AOPA Board

At the November 2022 AGM we saw long standing AOPA contributors Peter Kneebone and Rhiannon Assetta step down from their board commitments. I would like to thank them both for their outstanding contribution to the governance of AOPA. I would also like to welcome back Bec Bowes and welcome Andrew Veering and Sam Palazzolo to the board.

AOPA Projects

Over the last six months, a number of key milestones have been achieved in key AOPA projects. The first national benchmarks have been released for the Consumer Experience Program (CEP) giving a snapshot into the client groups Australian O&P services are providing. Congratulations to all involved in the CEP and for taking the step to improve consumer experience at your orthotic and prosthetic services.

The commencement of the Orthotic Prosthetic Technician following an extensive process to developing the membership class is a wonderful achievement and recognition of the vital role the technical workforce plays within O&P. Congratulations to Julia Hibma and the AOPA Office team for their work in developing this opportunity for important members of the O&P workforce. This new membership class will provide an opportunity to connect and unite OPTs with the intention of strengthening and growing the OPT workforce. I encourage businesses to support their technicians to get involved in this new membership group.

In closing, I would like to thank each and every one of our members for your support as we return to a semblance of normality after a difficult few years. I wish everyone a safe and restful festive season and new year, and am looking forward to connecting with you all again next year

Sarah Anderson, Chair, AOPA

As we enter a period of change, it is important to look back over the past 6 months and reflect on the achievements driven by AOPA for Australian O&Ps.

Advocacy and Policy Update

As AOPA returns to proactive advocacy work, we are reflecting on our data collection needs and methods. We look forward to implementing new ways to connect with the membership to hear their experiences.

Back to the future

As the Commonwealth, State, and Territory governments allow pandemic orders to lapse and/or cease, the provision of allied health service delivery returns to a ‘new’ normal. This has meant allied health advocacy and policy has started moving back to its original roots.

Pre-COVID, AOPA would dedicate time to respond to new policies (e.g. the introduction of a new schedule) and advocacy opportunities (e.g. TGA consultations), balancing this with proactive advocacy (e.g. the business case for an orthotic item under Medicare).

COVID-19 saw a massive shift in the advocacy and policy world, with almost all the focus on responsive activities. The ability for AOPA to place proactive advocacy to the side meant practitioners and service providers could receive the support they needed in a time of crisis.

collaborate with the goal to amplify the voice of the sector. This will influence how AOPA will advocate (e.g., co-sign submissions and letters).

The data we need to gather

The needs of orthotic/prosthetic consumers and the profession continue to grow. Although data on how practitioners utilise schemes and schedules has accumulated, AOPA’s collection of this data is not complete. For example, the Orthotist Schedule of Fees under the Department of Veterans Affairs (DVA) has been in place for almost four years. AOPA has data pertaining to practitioners’ experiences for the first year of its implementation.

“ cOVid-19 saw a massive shift in the advocacy and policy world, with almost all the focus on responsive activities.”

Over the past few months, AOPA has slowly started to shift back towards balancing proactive and responsive advocacy. However, we cannot just pick up where we left off. Significant changes in the political and service delivery spaces means that AOPA is needing to recalibrate and prioritise.

The changes that influence AOPA’s advocacy

The change in Federal Government has had many effects – there have been changes in contacts, prioritisation, and approach of Federally funded programs and activities. In particular, AOPA have noted a large focus on making the National Disability Insurance Scheme (NDIS) more accessible and streamlined. (e.g., a new focus of NDIS access and planning, the announcement of an allencompassing review of the scheme titled NDIS 2.0: A New Hope). This will influence the opportunities AOPA will take to advocate for improved NDIS processes.

AOPA have also noted a large shift in the primary care space. There is a strong call to review the way primary care is accessed and delivered. This has a significant impact on AOPA’s work to advocate for an orthotic item under the Medicare Benefits Scheme. This shift does not change AOPA’s focus to improve access to orthotic/ prosthetic services in primary health, but it does influence what mechanism AOPA will advocate for.

At the allied health level, there has been a large pull toward collaborating to drive workforce data, solutions, and allied health recognition. Allied health peak bodies are finding more ways to

We have also seen the introduction of new policies, such as the Mid-Cost Assistive Technology code under the NDIS. AOPA has received feedback from its NDIS Reference Group and service providers who reach out to the office, however, AOPA has not actively sought experiences on this code beyond these methods.

At present AOPA utilises the following methods to gather advocacy and policy feedback and experiences:

• Individual requests (mainly via email) for information, resources, and support from the membership

• Corporate and clinical partnership meetings (occurring 2-4 times per year)

• NDIS Reference Group

• Consumer Experience Program data

Our data-gathering opportunities

The membership has communicated a desire to engage in more opportunities to provide policy/funding body experiences and feedback.

With large consultations on the horizon, and AOPA’s desire to take part in more proactive advocacy, there is now a wonderful opportunity to develop and implement some advocacy and policy data collection strategies.

At an informal level, AOPA will utilise Facebook polls within the Community of Practice Facebook Group. These polls will be used as a ‘temperature check’ – a way to gauge if the general direction of our advocacy work is helpful.

At a more formal level, AOPA will be developing a plan to gather data and experiences on funding bodies, with an emphasis on

Natasha Korbut Clapp / Advocacy and Policy Officer, AOPA /

PHI Industry Experts and AOPA team members at #AOPA22. From Left to right Ryan Hutton (NIB), Leigh Clarke (AOPA), Jenny Martin (HICAPS), Natasha Korbut Clapp (AOPA) and Ben Harris (PHA).

In case you missed it…

Here is a brief summary of some of the advocacy and policy work AOPA has been focussing on over the past 6 months. For more detail, see the advocacy and policy briefings on the website.

Private Health Insurance

#AOPA22 was a wonderful opportunity to reflect on the 10-year journey of the Orthotic, Prosthetic, and Pedorthic Services (OPPS) Schedule. During a private health insurance (PHI) symposium, delegates had the opportunity to listen to how the Schedule was developed and researched over 10 years. The symposium also provided delegates with an opportunity to learn about the process of implementation.

After a Fund chooses to adopt the Schedule, the Fund must implement the Schedule. Implementation involves a series of tasks including internal policy reviews, alignment of codes, and internal communications. During the symposium, delegates had a chance to listen to PHI industry experts as they talked about their specific implementation roles.

AOPA continues to encourage Funds to adopt the Schedule. For those who have adopted the Schedule, we have been offering our assistance to help Funds implement the Schedule.

In addition to this work, AOPA has been working with HICAPS (Health Industry Claims and Payments Service) to ensure the Schedule can be utilised under its system. AOPA is also reviewing provider number options for the membership. We continue to provide support to the membership in the way of one-to-one support where requested, and the delivery of resources and factsheets. We look forward to Funds launching the OPPS Schedule in 2023.

the NDIS. This plan will include surveys for the membership, focus groups, and one-on-one interviews.

“ We have seen the introduction of new policies, such as the Mid-Cost Assistive Technology code under the NDIS. AOPA has received feedback from its NDIS Reference Group and service providers who reach out to the office.”

The outcome of both the informal and formal data collection will be an increased opportunity for the membership to provide AOPA with feedback, and an increase in the pool of examples and data AOPA can use in future consultations, submissions, and targeted advocacy.

Members are advised to keep an eye out for these opportunities in Advocacy and Policy Briefings, the Community of Practice Facebook group, and calls for participation in their inbox.

If you have any advocacy or policy related questions, or if you are interested in assisting AOPA in future consultations, resource building or advocacy, please email natasha.korbut@aopa.org.au

Therapeutic Goods Administration

AOPA has taken/taking part in one Therapeutic Goods Administration (TGA) consultation, and two consultations led by the International Medical Device Regulators Forum (IMDRF). All three consultations will influence how the TGA will regulate orthoses and prostheses in Australia.

In addition to these consultations, AOPA has also been working with the TGA’s Medical Device Branch. AOPA has revised some examples for their guidance document on the personalised medical device refinements. AOPA has also met with the Medical Device Branch to confirm current regulatory requirements and potential future requirements.

The TGA has a role to ensure medical devices meet a certain safety standard. AOPA remains confident our certification requirements compliment these TGA device standards. AOPA continues to advocate for a right-touch approach to the application and mechanisms of these standards.

National Disability Insurance Scheme

AOPA and the NDIA have been working together to enhance the practitioner-technical advisor communication pathway. AOPA together with Allied Health Specialist Consultants delivered a Policy Breakfast; Makingiteasierforyourorganisationtomeetsection 34 of the NDIS Act. AOPA has also reviewed the NDIS Assistive Technology (AT) AT template. Both of these activities aimed to reduce the required contact between a practitioner and a technical advisor.

The NDIA and AOPA are currently refining processes and communication between technical advisors and practitioners. Both organisations hope to find a communication method that encourages efficiency, standardisation, and best practice.

2022 AOPA Congress Reflections

What a fantastic 2022 AOPA congress! Our theme ‘clinical c are Through the Lifespan’ shone through in the many great presentations over the span of the event. We hope that everyone had an enjoyable and insightful three days!

A massive team effort was required from everyone involved, from the Congress Convening Committee, our exhibitors, sponsors, and presenters, to the AOPA Office and AOPA Board, together we delivered a program that brought a high calibre of content and connections over the three days.

We were so pleased to see over 500 delegates attend the event, making 2022 our largest face-to-face Congress ever! The strong show of support from the O&P community demonstrates the importance of the AOPA Congress as a tool to educate and connect the profession. Thank you all for your support.

It was wonderful for everyone to be able to connect with friends, old and new, and make the most of seeing our wonderful exhibitors in the exhibitor hall. A special thank you to our supersite exhibitors, Massons, OPC Health, Ossur and Ottobock, and to those who ran a sponsored workshop.

Our new look program was a hit, with the opening Keynote address delivered by Briana Baass, Victorian Chief Allied Health Officer. Briana shared her career journey with us and provided some insights and advice for career progression and leadership. We’d like to thank Briana for her time to speak with delegates. It was so great to see a fellow O&P advocating for allied health and O&P in her various roles.

Our deep dive panels were a great conversation starter, covering some tricky case studies, exploring 3D technology and examining ethics in O&P. This was a great new addition to our program, and we look forward to bringing you new and exciting topics to discuss in this form in 2023.

We’d like to thank SSS Prosthetics and Orthotics for supporting the best free paper presentation, awarded to Ellen Neville for her presentation on CTEV. Thank you to SSS Prosthetics and Orthotics for sponsoring the award which provides free Congress registration for Ellen next year.

I’d like to encourage anyone who is eager to be involved next year on a panel or in any other way outside the free paper sessions. We’d love to hear from you and hear your ideas, please reach out via email to express your interest.

“We were so pleased to see over 500 delegates attend the event, making 2022 our largest face-to-face Congress ever!”

We had great student and technician streams on day two of Congress. It was a wonderful opportunity to share and learn together in smaller groups! Equally, the student and technician Welcome Events were also very successful, and an enjoyable night was had by all who attended.

Thank you to all our presenters and panelists. The free paper presentations, deep dive discussions and workshops were all delivered to a high standard, and I hope you found them insightful. Also, a special thanks to our session chairs, without whom the program would not be able to run so smoothly and efficiently!

Similarly, it was wonderful to see everyone come together at our Welcome Event at the conclusion of day one. The room was buzzing with positive energy, laughter, and great conversations. In lieu of individual presenter gifts each year, AOPA donates to charity. This year, the Congress Committee made a meaningful and more personal donation to Jersey Day, using this opportunity to spread greater awareness about organ donation.

Courtney Crichton / Congress Convenor, AOPA / events@aopa.org.au

Rob Hodgson is an Australian O&P and at the time of Congress was awaiting a heart transplant. I’m now pleased to say that Rob had a successful heart transplant the day after our Congress closed. Jersey Day was inspired by the gift of life that Nathan Gremmo gave to six people when he became an organ donor at age 13 after he was critically injured in an accident.

Each year on Jersey Day schools and workplaces across Australia are encouraged to get involved and wear their favourite sporting jersey to begin the conversation with their family and friends about the importance of becoming an organ and tissue donor.

Jersey Day is all about raising awareness – there is no requirement to raise funds. Jersey Day is fun and free to get involved and by registering to become an organ and tissue donor you could be helping to save a life. If you’d like any more

information about how to get involved, you can find them on social media.

I’d like to express my thanks again to the AOPA team and say a special thank you to Ashleigh for her assistance and to Leigh for her mentorship and support. To my convening team, Meleita Finnigan, Emily Hill, Amy-Beth Yeo and Joshua De Stefanis.

Thank you so much for your assistance with the planning of our biggest Congress ever, and for helping across the three very busy days, you’ve been a wonderful team to work with. Josh will be stepping out of his role on the committee and will be missed.

If anyone is interested to join our team, I’d love to hear from you! Please reach out to learn more information.

Thanks again everyone for your support and see you in 2023!

AOPA 2022 Congress: Student Reflections

Final year students Rene and dakoda share their experiences attending the recent AOPA congress and their highlights attending the Student Stream and Welcome Event.

The student stream consisted of a day long program, enabling AOPA student members to have the ability to participate in interactive learning workshops and development across both technical and clinical aspects of O&P.

We began the morning with expert advice from Sally Cavenett on how to make the best first impression in a resume and interview, along with the do’s and don’ts of the job application process. This was followed by a panel discussion with recent graduates, who offered valuable insight into their new graduate experience. Both discussions provided imperative tips and tricks to help bolster your morale, pluck up the courage to chat to industry professionals and land your first graduate job.

After morning tea, we engaged in four highly interactive workshops across both prosthetics and orthotics: transfemoral socket designs with Michael Storey; clinical case studies and proactive clinical decision-making with the SSS O&P team; management of developmental dysplasia of the hip with OAPL; and acute spinal management with the Head to Foot Orthotics team. Each workshop was informative, educational and engaging, with some workshops requiring you to utilise critical thinking and others presenting us with the opportunity to fit our peers with a bulky TLSO brace.

The day’s final session focused on and explored careers and opportunities in O&P, contained within a panel discussion. The

panel contained a variety of industry leaders and senior clinicians who provided an influential discussion about their own unique career pathways. The afternoon outlined a multitude of ways that graduates may approach their graduate year in the workforce and reinforced that you do not always have to undertake a traditional clinical pathway.

For students questioning whether the student stream may be worth it, my answer to you would be absolutely. Whether it is your first year attending Congress, or you are a final-year student, the student stream offers and provides a fundamental learning opportunity for everyone. Thank you to everyone who was involved throughout the day!

AOPA 2022 Congress: Student Reflections

I attended the Student Welcome Event at the 2022 AOPA Congress as a final-year student from the University of the Sunshine Coast (USC). Being my second AOPA congress, and second welcome event I was aware of the networking opportunity I had in front of me. The Student Welcome event is an exciting opportunity for establishing connections within our small profession. Being a niche profession, I expect that one person will know someone, who knows everyone thus presenting itself as an invaluable chance to demonstrate myself and the prosthetist/orthotist I will be.

To begin the night, we heard from experienced clinician Jess Fox of Southern Prosthetics and Orthotics. She presented her clinical pathway which spans worldwide and provided insight into employment possibilities I thought were out of reach. Shortly after, Ashleigh Greig facilitated a speed networking event which consisted of 5 minutes per table. With roughly 4 students, and

2 professionals each, it was the perfect time for me to meet clinicians, experts and other graduating students. Conversations ranged from how we got into the industry, to upcoming graduate positions. In this short time, most discussions were cut short however made for the perfect conversation starters the following day. I also found myself making many friendships with the La Trobe University students as we discussed our placement experiences and job prospects. In addition to my USC classmates, I think these relationships will be invaluable in the years to come as we, the 2022 graduate cohort, will be navigating our professional careers at a similar rate

A big thank you to all the experts who attended the Student Welcome Event and shared their insights and experience. As a message to future students, this event is not to be missed as there is no other opportunity quite like this

Rene Bartolo / Final year student, La Trobe University

Dakoda Daniels / Final year student, University of the Sunshine Coast

2022 AOPA congress: Technician Stream and Welcome Event Reflection

in October, we came together to celebrate the launch of the new AOPA Orthotic Prosthetic Technician membership class and a full day of education and connection.

Momentum Health Technologies presented “Demystifying Silicon” with Maria Pfundstein from Streifeneder demonstrated techniques for working with HTV and RTV Silicones. We learned how manufacturing with silicones can revolutionise the fabrication process and how the right equipment and training can provide access to silicone in any workshop.

In the afternoon, Aaron Lederhose from PARTEC Training in Brisbane joined us to provide a full overview of their range of training options for OPTs.

The 2022 AOPA National Congress provided opportunity to come together and celebrate the launch of the Orthotic Prosthetic Technician (OPT) membership. There was a triumphant vibe in the air as a record number of OPTs gathered for a full day of education, networking, and enjoyable conversation.

The program included workshops from Ottobock, Massons Healthcare, and Momentum Health Technologies, a forum on building and upskilling the OPT workforce, and a fascinating deep dive into lamination standards. Keep reading to learn more about the new OPT membership!

The morning session consisted of a welcome by the AOPA Board Chair, Sarah Anderson, an introduction to the OPT membership, and insight into the NSW technician training pathway by Brett Nicholas from the Health Education & Training Institute (HETI)/ Sydney Children’s Hospital.

Massons Healthcare explored digital shape capture and the use of multi-axis robotic carvers and how this technology can optimise workflow and decrease costs. The team spoke about the advantages of working with foam models and new skills and techniques when thermoforming over foam models for prosthetic and orthotic devices.

Rhys Clenton of APC Prosthetics on the Central Coast of NSW presented the journey he and the APC team took when they set out to prove that the lamination techniques they were using were scientifically sound, by investigating the science behind lamination theory and the available evidence. It was great to see our first presentation from the field and we hope Rhys inspired more technicians to present at next year’s Congress.

Lastly, Ottobock provided an overview of the ‘OrthoLean’ concept. We learned how to achieve a more streamlined and efficient workspace, with improved safety & less waste. Participants learned strategies to convert wasted time into value-added time through simple and easily introduced approaches.

The technician stream was directly followed by the Technician Welcome Event, once again proudly supported by Ottobock. This event allowed continued discussion and further connection in a more relaxed atmosphere. We are very thankful to Ottobock for their ongoing support of this event.

We thank Massons Healthcare, Momentum Health Technologies, Brett Nicholas, Rhys Clenton, Aaron Lederhose, and Ottobock for the fabulous workshops and presentations. This event could not have happened without your ongoing support.

If you know an O&P technician who is working in Australia, please help us to spread the word about the new OPT membership and share this edition of the AOPA Review with them or to the membership section of the AOPA website to find out more

Julia Hibma / Member Engagement Coordinator, AOPA /

Hibma / Member Engagement Coordinator, AOPA / julia.hibma@aopa.org.au

AOPA launches new Orthotic Prosthetic Technician Membership!

Following consultation with O&P technicians and the community throughout 2022, we were thrilled to open our new membership class, which launched at the AOPA congress in October.

This new O&P Technician (OPTs) membership class will provide the opportunity to connect and unite OPTs with the intention of strengthening and growing the OPT workforce.

To ensure this membership met the needs of the OPT community, over the past year we have undertaken an in-depth consultation process with OPTs and the rest of the O&P community.

This included:

1) Formation of the AOPA OPT Membership Working Group

2) OPT Focus Group discussion at AOPA Congress (March 2022)

3) Workforce Planning workshop at AOPA Congress (March 2022)

4) ‘AOPAO&Ptechniciansurvey’ (July 2022)

5) ‘AOPAOPTmembershipproposalfeedbacksurvey’ (September 2022)

We were thrilled with the large number of OPTs that provided valuable feedback throughout this consultation, and in particular via the OPT survey. Over 50 OPTs responded to the survey, out of approximately 200 currently working in Australia.

From the consultation, three key themes emerged.

1. Education and training:

We learned that OPTs feel undervalued by the profession and healthcare system due to the absence of a recognised training program, limited CPD opportunities, undefined role definition, non-existent career pathways, a lack of training support from employers and industry, and in many cases, low salaries.

2. Recruitment & retention:

The feedback received during the consultation led to the design of AOPA’s OPT membership.

AOPA’s Orthotic Prosthetic Technician membership has launched, and we have already welcomed our first OPT members!

You might be wondering what this membership means and what the process is to become a member.

Whilst OPTs have played a key role in the delivery of O&P services in Australia for many years, they have not yet been fully realised as a formal workforce. They have been without a clear role definition, defined scope of practice, and standards, and as such, the value of this vital workforce is not well understood by policymakers.

When the value of a workforce is understood, career pathways become more defined, which brings employment opportunities, the development of robust training programs, and the retention of experienced staff. The introduction of the OPT membership represents the first step toward formalising this workforce and realising the subsequent benefits to this workforce. The flow-on effect of this has the potential to lead to a more satisfied OPT workforce, improved recruitment and retention, and ultimately increased workforce capacity.

“We are offering a special early adopter joining fee between now and June 30, 2023. We encourage OPTs to apply now to save over 30% on application and membership fees.”

What’s in it for OPTs?

The OPT membership provides access to a wide range of education and development opportunities as well as facilitates networking and connection across the wider O&P industry. A full list of OPT membership benefits can be found in the Membership section of the AOPA website.

We learned that early-mid career OPTs are struggling to upskill and progress in their career due to a lack of support, on-the-job training, external training, industry collaboration, and reported low salaries. It is for these reasons that many are leaving the profession.

Service Providers reported that they find recruitment problematic as there is no direct pool of applicants from a training pathway and need to recruit creatively, often from trade industries.

3. Connection & Networking: Most technicians reported that they felt disconnected from other technicians and the rest of the O&P profession, due to a lack of networking opportunities. Networking, connection, and mentoring are important to this group.

How do OPTs become OPT members?

We encourage OPTs to head to the Membership section on the AOPA website to learn more about the application process.

How can AOPA members help?

Spread the word! Show this article to your O&P tech colleagues and direct them to the Membership section of the AOPA website to find out more.

How can we help?

If you have any questions relating to the OPT membership, please don’t hesitate to reach out to AOPA’s Member Engagement Coordinator, Julia Hibma by emailing julia.hibma@aopa.org.au, or calling the National Office

Julia

Barry Leech awarded AOPA Life Membership

Barry Leech’s exemplary dedication to clients and the Australian O&P profession has been recognised with an AOPA Life Membership Award.

ensuring his continued professional development and mentoring enabled his registration renewal year after year.

Barry has promoted the training, education, and professional status of O&Ps with his contribution to student placement experiences. Barry has mentored many students, dating back to the Lincoln institute as well as students from La Trobe University and more recently the Sunshine Coast University.

Barry contributed to the profession by representing O&Ps and assisting the sportsmen and women at the Australian Institute of Sport as well as at the Sydney 2000 Paralympic Games. These are roles he was approached for and undertook on a voluntary basis, promoting honourable practice and attesting to his skill and expertise.

“ Barry has been a member of the Australian Orthotic and Prosthetic Association since its inception. he was at the very first meeting in Albury in the mid 70’s when the association was first discussed and formed.”

Barry has worked in both the public and private sectors of the O&P industry, domestically and internationally. He has attended and participated in AOPA Congresses over the years. He was one of the first clinicians to support osseointegration, holding state-based clinics within his facility. Barry is a collaborator. AOPA members from all over the country will attest to this. He has always been happy to discuss and assist other clinicians when called upon.

Barry Leech began his career in the O&P industry in Camperdown, NSW in 1964 at the age of just 15. He arrived at Sydney Children’s Hospital for a job interview in the maintenance department, and left there that day, instead as an apprentice brace fitter and maker.

He has worked and travelled throughout Australia – from Sydney Children’s Hospital, to Canberra Hospital, up to Darwin and owning and operating his own clinic on the Gold Coast. He ventured to Bangladesh and Cambodia mentoring fellow O&P clinicians and assisting people with limb loss to achieve their goals.

Barry has been a member of the Australian Orthotic and Prosthetic Association since its inception. He was at the very first meeting in Albury in the mid 70’s when the association was first discussed and formed. He fondly remembers the biggest discussion was whether to be named AOPA or APOA! He has been a member ever since,

Barry has been a big supporter of the O&P technicians program and was delighted to see the recognition of technicians throughout Australia come to fruition. Having learned his craft and skill “on the bench” as opposed to in the classroom, Barry has a deep appreciation for the skill and workmanship of the O&P technician workforce.

On a personal level, I had the pleasure of working alongside Barry at both his Cairns and Gold Coast facilities for over four years. I emphasise the word alongside, as although Barry was technically my boss and my superior, he never made me feel less than an equal. From the moment we met, Barry and I shared a love for our vocation - what better job is there? Barry has worked tirelessly for the amputee population of Australia, and particularly Queensland. He has improved the lives of countless clients over the past 58 years.

Barry recently sold his private facility and retired at the age of 73 and was awarded Life Membership at the 2022 AOPA Congress. On behalf of the broader AOPA community, I’d like to Congratulate Barry and wish him all the very best for his well-deserved retirement

Jessica

The AOPA Board

Following another successful online Annual General Meeting (AGM) in November we were pleased to elect new general directors. Thank you to our members who joined and support us in celebrating the achievements of the 2021/22 year.

Following the success of previous years, the AOPA AGM remained online this year. We were pleased to have over 70 members in attendance and would like to thanks everyone for taking the time to attend. It was a very successful meeting that allowed us to reflect upon the outcomes, challenges and activities AOPA has seen and been a part of during the 2021/22 financial year.

The 2021/22 financial year saw significant change to our Board composition. At the recent AGM we thanked outgoing Board members Pete Kneebone and Rhiannon Assetta, who have both been big contributors to the O&P profession during their time on the Board. We were pleased to also welcome Andrew Vearing and Sam Palazzolo as new general directors.

Dr Sarah Anderson

Sarah graduated with a Bachelor of Prosthetics and Orthotics from La Trobe University and worked clinically in South Australia and overseas. Sarah was the Head of the Prosthetics and Orthotics Program and then Director of Academic Partnerships for the School of Allied Health, Human Services and Sport at La Trobe University until mid2020. Sarah is now the Manager of Research and Evaluation at the Australian Health Practitioner Regulation Agency (AHPRA).

Sarah is currently the Board Chair of the Australian Orthotic and Prosthetic Association, Board Chair of Disability, Sport and Recreation, a Board Director of Scope and sits on the Victorian Workplace Incidents Consultative Committee.

Sarah was a previous AOPA Board director from 2012 – 2015 and 2018-2021 a Board director and Chair of the Clinical Governance Committee at a rural hospital in Victoria. Sarah is an Adjunct Senior Lecturer at La Trobe University.

Sarah has extensive corporate and clinical governance, strategic planning and finance training coupled with a broad understanding of health care, allied health, regulation, education, research and disability.

Tim Burke

Tim is currently employed in a teaching focused role at La Trobe University in the Discipline of Prosthetics & Orthotics, providing undergraduate education to O&P students. Prior to this, Tim worked for an extended period in the Victorian public

health care system at Alfred Health and Austin Health in both senior clinical and management positions. His clinical areas of interest and expertise include orthotic trauma management and diabetic foot disease management.

Tim has sat on the AOPA Ethics Committee, in addition to a variety of roles on committees within the public health care system at Alfred Health. Tim has enjoyed the last year serving on the AOPA Board and gaining an increased understanding of both the Association and the broader context of our peak professional body.

Tomie Pfeiffer

Tomie is a National Business Development Manager at Healthworks. She is a health professional with over 25 years of international experience in upper limb prosthetics, import distribution, sales, marketing, education, management positions in private enterprise for Marketing, Sales and business units.

Tomie can strategically view the industry and business from many different perspectives, providing a balanced, unbiased and impartial view. These contrasting areas of experience provide Tomie with the ability to enrich the strategic decisions made for the future of our members.

Tomie is passionate about prosthetics and increasing Australian Prosthetist engagement with the AOPA and looks forward to continuing to progress the profession for the benefit of our members and our clients.

Andrew Vearing

Andrew graduated from Latrobe University with a Bachelor of Prosthetics and Orthotics in 1996. Since that time, he has worked in public and private facilities in Melbourne, Sydney and Perth. Currently, Andrew is the General Manager and Senior practicing orthotist/prosthetist at Orthotic and Prosthetic Solutions (OPS) providing both prosthetic and orthotic clinical services in Perth Western Australia. As a co-director at OPS this role includes responsibility for initiatives to improve client service, staff morale, administration, and growth of OPS as a business. An additional focus has been the development of professional orthotist/ prosthetists within the clinic.

Andrew currently serves on the La Trobe University Prosthetics and Orthotics Course advisory committee and has served as AOPA WA state treasurer prior to closure of the AOPA State factions.

Given Andrew’s directorship role at OPS he brings a wealth of strategic skills, including short- and long-term goal setting, vision and mission development, analysis of the internal and external environment and alignment of activities to strategy.

Andrew welcomes the opportunity to contribute at a board level to our profession and is excited by the opportunity to bring his experience as a director and knowledge of AOPA’s 15 year transition and growth onto the AOPA board.

Rebecca Bowes

Rebecca works at APC Prosthetics in the Hunter branch and as a Consultant with Allied Health Specialist Consultants. She has gained a wealth of knowledge and experience in prosthetics and orthotics since her graduation in 2001 from La Trobe University. In addition, Rebecca has completed a Masters in Clinical Rehabilitation and a Graduate Certificate in Business Administration.

Rebecca is part of a Defence family, and as such has worked in public and private facilities in NSW, South Australia, Western Australia, Victoria and the ACT, gaining insight into the way different facilities operate and provide clinical care.

In addition to her current roles, Rebecca’s diverse employment history and clinical experience includes: Orthotics & Prosthetics South Australia (Senior Clinical Prosthetist/Orthotist, Orthotic Clinical Lead); APC Orthotics (Senior Orthotist), Orthotic & Prosthetic Solutions (Orthotist), ACT Health Prosthetic & Orthotic Service (Orthotist & Prosthetist), Orthopaedics Australia (Assistant Orthotist) and Maroondah Hospital (Plaster Technician).

Rebecca was previously on the AOPA National Council as Secretary and has been a director of AOPA since February 2020. Rebecca brings a knowledge of policy, governance and understanding of the diversity of the profession to her role on the Board.

Sam Palazzolo

Sam has been an ongoing member of AOPA since returning from the UK in 2019. Additionally, he still holds registration with HCPC, the UK regulatory body for allied health practitioners. Sam has been fortunate to work in both public and private sectors since graduation in 2011. Over this time, he has worked in a host a different roles including; clinical, managerial, sales and distribution positions.

Currently Sam holds a clinical management position with OAPL with a significant clinical load. His clinical areas of interest and expertise are transfemoral prosthetics and amputee mental health. Sam is enthusiastic about the industry, with a strong drive for

continuing to improve patient experiences and service delivery improvements. His varied experience of health service delivery in Victoria, Tasmania, NSW and internationally in the UK makes him well placed to understand the challenges faced by large cohorts of the AOPA membership base.

Diana Poole

Diana is currently General Manager at Orthotic Technical Services, a manufacturer and distributor of allied health products. The company’s size means the role is multifaceted and involves all aspects of business management. Previously Diana has worked in public health, in a variety of Victorian and overseas health services, most recently as Manager of the Prosthetic and Orthotic Department, St Vincent’s Hospital Melbourne. Her clinical specialty is lower limb orthotics.

Diana completed a Master of Business Administration at Deakin University in February 2020. The business focus of this qualification, coupled with experience in large organizations, has given Diana a wide perspective of issues affecting the P&O profession and how these intertwine in health/disability settings. Diana has thoroughly enjoyed serving on the AOPA Board for the last two years, gaining a deeper understanding of the association.

Jolene Morse

Jolene is a finance professional with extensive experience including regulatory engagement, frontline lending, audit, regulatory compliance, policy development and implementation, credit modelling, capital optimisation, risk appetite development, education, business risk performance and business transformation.

Jolene is passionate about risk, strategy and process improvement and how these elements can work together to create a competitive advantage and contribute to community prosperity.

Kathryn Munro

Kathryn’s professional career included delivering significant business restructuring projects with CSL Limited, evolving regional governance and financial reporting frameworks with McCormick Foods Australia and leading strategic information technology, financial investment and risk mitigation initiatives with Cheetham Salt Limited. As a Director Kathryn led governance, compliance, risk management and divestment activities.

Kathryn is a graduate of the Australian Institute of Company Directors and a member of the Australian Society of Certified Practising Accountants. Kathryn is proactively seeking to use her professional skills and experience to make a positive impact in the community. Contributing to the AOPA Board, and the profession provides her with a valuable opportunity to do so.

With thanks to the Australian O&P community

The 2nd of december 2022 marks the end of 12 years of AOPA leadership for AOPA’s inaugural CEO, Leigh Clarke. Here she reflects on the journey and extends thanks to the AOPA membership and colleagues for their unwavering support.

In January 2011 I was pleased to take the role of Executive Officer of AOPA – a 2 day per week part-time role, focused on membership renewals, communication and publication of the Gazette. The CEO role has significantly changed since that time, with primary responsibility for organisational management, advocacy to Government and funding agencies, and building collaborative relationships with external stakeholders as examples. It has been a wonderful journey for both myself and AOPA, inextricably intertwined, as the organisation grew in size and capacity. AOPA is now an organisation that represents 89% of the profession in Australia, has a staff team of 8 (4.5FTE), has a modern governance and organisational structure and is a known leader in O&P workforce development and self-regulation.

The shared wins

The growth of AOPA’s capacity has allowed the obtainment of important wins over time. These are shared wins for the organisation and the membership, and those I am most proud of include:

• Establishment of AOPA’s modern governance structure, including transition from an incorporated association to a company limited by guarantee.

• Development and implementation of the full suite of regulatory standards for the profession and stabilising AOPA’s certification program, including implementing a robust process for the competency assessment of International Health Practitioners (IHPs).

• Inclusion of orthotist/prosthetists on the Skilled Occupations List and appointment of AOPA as the Skills Assessing Authority for the purpose of IHP migration.

• Recognition of AOPA’s self-regulation including the certification program through obtainment of National Alliance of Self Regulating Health Professions (NASRHP) membership.

• Achievement of parity in orthotist/prosthetist hourly rate with other allied health providers under the NDIS, including a 17% rate increase.

• Establishment of service and fee schedules, including the recognition of clinical services under the Department of Veterans Affairs and Private Health Insurance.

• Provision of formal and informal supports to the membership during the challenges of the COVID-19 pandemic and the statebased lockdowns and restrictions on services.

• Achievement of operational stability including establishment of a staff team and professional office and financial stability including a 240% increase in membership and a 300% increase in annual turn-over.

With thanks

I have shared the wins with many colleagues, members and allied counterparts and am grateful for the opportunity to have collaborated. Whilst the destination, being the shared wins, and the journey, being the motivating and exciting work, have been highlights, it is the company that I have shared that is most memorable. As always, it is about the people, and I have so many to thank.

The AOPA team

I have had the pleasure of working with a number of iterations of the AOPA operations team over my time. I extend thanks also to

Leigh Clarke / Chief Executive Officer, AOPA / admin@aopa.org.au

the following fabulous contributors: Shane Grant, Jackie O’Connor, Ella Nicolson, Louise Puli, Luke Rycken, Pete Kneebone, Courtney Crichton, Shanelle Whitson, Beatrix White and Dr Emily Ridgewell.

I also extend heartfelt thanks to the current AOPA team that includes Jessica Landers, Sue Laksassi, Natasha Korbut Clapp, Ashleigh Greig, Julia Hibma and Megg Banks, whom I will miss very much. The membership and association have a lot to be proud of, but the #ATeam should be high on the list - we continue to attract the most passionate and most capable people into the operations team. I would specifically like to thank Sue who has been with me on the entirety of this AOPA journey, sharing 12 enjoyable years together watching the association grow and the profession change.

Finally, I would like to acknowledge Jessica Landers, AOPA’s deputy CEO, who is so very capable and has enabled me to feel comfortable (ish) with my resignation. Thank you to Jess for stepping into the acting role and making this transition as seamless as possible for myself, the staff team, Board and the membership.

The chairs and Board

I am grateful for the support of the Board over many years. The Board has provided me with both the guidance and the space, allowing AOPA to progress important pieces of work quickly. In particular I thank Harvey Blackney, who led me into this role and has provided mentorship and guidance over decades. Harvey has always been at the end of a call to provide leadership support as a I felt my way in this emerging role and I am very grateful.

I also extend thanks to Board Chairs Richard Dyson-Holland who I started the journey with, and Dr Sarah Anderson who I am now closing out with.

A special thank you however to Paul Sprague, who I have worked with for nearly a decade. We have shared a period of highs and lows, from extreme advocacy success in Canberra to extreme stress with COVID-19. Paul’s stewardship and support over this period have been so meaningful and impactful to me and I am so very grateful.

The volunteers and congress convenors

I am also thankful to all the volunteers I have worked with, specifically recent congress convenors Jessica Fox, Tim Muling and Courtney Crichton. Your service to AOPA is so important.

I have always felt so very lucky to have a core group of members and friends that I can reach out to, to test an idea, ask for support or help me solve a dilemma. Those on my “help” call up list know who you are. Thank you – I appreciate you always taking my phone calls.

The membership

Finally, a big thanks to the AOPA membership. I am so grateful for your confidence and support over many years. It is hard to explain how unique what we have as a profession is, and that it should be cherished. Other association CEOs and teams do not have the benefit of such a connected community, nor the trust and support of their membership. As I navigated my way over the years I have always felt that both AOPA and myself have had 500+ people cheering us on. This support and connectedness is so powerful and a key reason that the profession and organisation is positioned so well today.

Over the last 12 years, we have achieved many great things together and I hope that brings you as much joy as it brings me.

In closing, thank you to the AOPA membership and the wider O&P community for allowing me this very privileged opportunity to lead the profession and supporting me on both my own and AOPA’s growth journey.

I am very pleased to be leaving you in the hands of a very capable operations team and board.

Best wishes.

#OandP #ATeam

Thank you dr Emily Ridgewell

In August 2022 AOPA farewelled one of our longest-serving team members, dr Emily Ridgewell from the role of Research and Policy Manager.

Emily has contributed immensely to the growth and development of the organisation since 2013. Her first engagement with AOPA was in a volunteer capacity to develop our workforce data. This progressed to a contract role to complete the associated research. Through this piece of work, it became clear the value of Emily’s skill set in writing and communication and she was engaged formally in a Research Officer role in 2015. In 2020 it was our great pleasure to formalise the leadership that Emily provided to AOPA, through the development of AOPA’s leadership structure, including her appointment to the Research and Policy Manager role.

Over nearly 10 years, Emily’s contribution to AOPA and the Australian O&P profession has been instrumental. She has led publications (Ridgewell, et al, 2016; Ridgewell et al 2021) that have influenced policy at the highest level, such as the change to the immigration status for orthotist/prosthetists and the subsequent appointment of AOPA as the Assessing Authority for migration. She has also led AOPA’s work to establish self-regulation compliance with the NASRHP standards, including the development of many of our standards and leading the successful NASRHP application in 2021. In addition, she has provided research support and leadership to key advocacy and promotional activities, such as the development of the Private Health Insurance Schedule,

Thank you Megg

submissions to Government consultations and the development of the clinical specialties fact sheets. More recently Emily has led the roll out of the Consumer Experience Program of which she is the primary investigator and grant holder of the ISPO ANMS research grant, supported the successful application for two AOPA-COPL (US) grants to investigate telehealth in O&P, supported launch of the Provider Search Directory and led integration with the National Health Service Directory.

It is almost impossible to convey the full extent of Emily’s contributions to AOPA through snapshots of her key successes. Whilst we can pinpoint the “activities” and “outputs”, these fail the enormity of her contribution. There is very little that has passed through the AOPA office over her time that has not benefitted from her considered review and input. This extensive contribution has paved the way for AOPA’s success. It is Emily’s unwavering support, leadership, and commitment to the AOPA staff team that we have valued the most. We are so grateful to have had Emily as part of the leadership team over the preceding years, in particular for her support and guidance as we navigated many staff changes and the challenges of COVID-19. Emily is a thoughtful and patient leader who brings out the best in those around her.

It has been and pleasure and an honour to work alongside such a wonderful colleague and friend. Thank you, Emily

At the end of this year AOPA farewells Megg Banks from her communications Officer role as she enters full time work after completing her studies.

Since beginning in the Communications role at the start of 2021, Megg has become a vital and important member of the AOPA Office team. Over the last two years Megg has led the changes so positively seen across AOPA’s social media platforms and email communications.

As a result of Megg’s work to see our organisation more engaged across social media platforms, we have seen an increase in the number of followers across LinkedIn, Facebook, Twitter and Instagram. This increase in followers means more visibility for our profession and opportunities for connection with members, consumers, peak bodies and other stakeholders. Throughout her time at AOPA, Megg’s organisation, commitment and drive has helped AOPA launch new initiatives

and systems to further support AOPA members and staff. Her initiatives include the development of internal ‘how-to’ guides, monitoring and reviewing of communication engagement and implementing lessons learnt from these activities, and routine promotion of AOPA’s activities across all communication platforms. Megg began her role working from home, with the AOPA Office team not returning to the AOPA Office until March of 2021. This was then followed with yet another round of working from home due to COVID-19 restrictions. Megg will be missed, as will her thoughtfulness, dedication, and initiative.

Thankyou for all your work over the past couple of years Megg, you have left some big shoes to fill. Congratulations on your graduation and all the best as you enter full time work! We can’t wait to watch you grow and succeed

START’s Farewell

After 10 years of empowering amputees in life through sport, the team at START foundation has made the decision to wind up the organisation.

When START foundation was established in 2013 it filled a funding gap that enabled amputees to purchase sports prosthesis or adaptive sports equipment, to help achieve their sporting dreams.

The initial inspiration for START was Kerryn Harvey, who battled the odds to survive after a cycling accident resulted in her having a forequarter amputation (arm and shoulder). Prior to the accident, sport had always played a critical role in Kerryn’s life and getting assistance to have her bike modified so she could ride again was a catalyst to reclaiming and reframing her life. Through Kerryn’s personal experience, the concept of START foundation was created.

“iamsadthatSTARTissayingfarewellbutthankfulfor allithasachieved,andforthefriendshipsIhaveformed. Iwillbeforevergratefultohaverunforthefirsttimein mylife,andparticipateinthe“BridgetoBrisbane,both goalsIcouldnothavereachedwithoutthesupportof START foundation.”

Sara Shams, grant recipient (Prosthetist, Stuart crampton)

2013wasthebeginning of a whole new life journey.Gettingfitand successfullyreturningto thesportoftriathlonas aparatriathletegaveme the confidence and belief that i could continue livingahappyand fulfillinglife.”

Kerryn Harvey, Founding director

“i,alongwithmyfamily,willalways besogratefulandthankfulforthe opportunitiesSTARTgaveme.”

Jacob Mibus, grant recipient (Prosthetist, Phoebe Malone)

Since the NDIS was established in 2013, the funding gap to support amputees to purchase sports prostheses has slowly diminished. This was always START’s hope and vision. To arrive at a point where the NDIS will fund amputees for a sports prosthesis or adaptive technology to assist them to lead active and healthier lives, is to be applauded. This is now a time to celebrate the enormous achievements of START over the past decade.

Over 10 years START has funded 24 grant recipients. This has had an extraordinary impact on those individuals, their families, friends and the broader community. The START team has been continually motivated by the determination and commitment of our grant recipients. Not only have they achieved their sporting dreams, they have and continue to grow as individuals.

“Therunningblade igotthrough STARThastransformedmyrunning andhelpedmeconnectwitha wholenewcommunity.Besides completingtwohalfmarathons,it means icankeeppacewithfriends aswegoforsocialrunsandstay healthy. it’sbeenagamechanger asanamputee!Thanks,START.”

Zoe creelman, grant recipient (Prosthetist, Monique Van den Boon)

Michelle Jelleff / Founder, Director & Chair, START foundation / michelle@startfoundation.org.au

“Becominganamputeein

“

Integral to the success of START has been the amazing prosthetists across Australia who have supported our grant recipients and fitted them with sports prostheses or assisted with design and development of adaptive sports equipment. The professionalism, expertise and enthusiasm to ensure each grant recipient was able to optimise their sporting outcomes was clear right from the beginning. It has been a privilege to work with such a wonderful group of professionals who have always provided unwavering support.

IthoroughlyenjoyworkingwithElla.Shehassucha positiveattitudetolife;shetrainshardandhasfun doingit.Weworkedverycloselytogethertodesignthis prosthesistosuitElla’sspecificneeds;fromarmangles attheblocks,tocustomisingtheweightoftheprosthesis, toaesthetics–itwasareallyenjoyableproject.”

Paul dixon, Prosthetist

“

WhenIreceivedtheinauguralSTARTgrantin2017,I wasinaweofthebeliefandsupportIreceivedfromthe teamtochaseafterthegoals i’doutlinedformyselfand myfuture.5yearson,I’vehadtheprivilegeofbeingthe STARTambassador,representingthecharitythrough sportandlife,edgingclosertothedreams ispokeabout in2017.Toseethecountlessothergrantrecipientsand showthemwhatispossiblehasbeenahighlight i will cherish forever.”

Liam Twomey, START Ambassador

“

START ambassadors, Kelly Cartwright and Liam Twomey, have been a tremendous asset to START over the years, sharing their lived experience and providing encouragement to amputees to remain active and to chase sporting dreams. As elite athletes, Kelly and Liam understand the challenges faced with getting all facets of their preparation right for a particular race or event. Most importantly, they were able to convey to other amputees that sport was also about having fun and having the capability to live a healthy and active life.

Findinganadaptivesportaftermyamputationgaveme hopeandre-engagedthedesiretoliveandenjoylife.”

The START team would like to thank all those in the O&P profession who have been tireless in their support and commitment to START’s grant recipients and the parasport community. Together we united to strive for a world where an amputation is no barrier to participating in sport and achieving sporting dreams. We can all take solace in the fact that we have paved the way for this vision to be fully realised.

Our success has been an absolute reflection of the commitment of those who have continued to believe in START’s mission to empower amputees in life through sport

Jason Sauer, grant recipient

Kat O’Kelly-Kennedy, grant recipient (Prosthetist Ross Powrie)

Kelly Cartwright with Kerryn Harvey

O&P Clinical Supervision - Learning from other Allied health Professions

An AOPA Professional Enhancement Grant (PEG) supported my exploration into Clinical Supervision, hoping to improve the current process in O&P.

As an experienced orthotist/prosthetist (O&P), my Clinical Supervision (CS) has predominantly been ‘at point of care supervision’ – treating a client with a more experienced clinician with the aim of my skill development. As a Counsellor, regular CS is a requirement of registration with a strong focus on reflection and wellbeing. These contrasting experiences inspired me to deepen my understanding of CS in Allied Health.

I was fortunate to receive an AOPA PEG earlier this year which enabled me to attend the ‘RISE UP Supervision Training’ by Supervision Training Services. The following summarises my learnings from the 3-day training and allied health CS literature:

What is CS?

Clinical Supervision describes the process of an experienced professional (supervisor) supporting a less experienced professional (supervisee) with the objective of sharing knowledge and improving practice and client outcomes (Fitzpatrick, et al., 2012). As this definition is so non-specific, when initiating a supervision relationship, it is important to discuss the perceptions and expectations, so that a comprehensive CS agreement can be created (Martin, et al., 2014).

Who and where?

How to facilitate CS?

According to Kilminster and Jolly (2000), the supervision relationship is the most important factor in the effectiveness of supervision - more so than the supervision method chosen.

For a strong supervisor/supervisee relationship to occur, safety and trust must be established so the supervisor is able to challenge the supervisee to reflect more deeply on his/her practices (Mehr, et al., 2015). Developing trust and safety requires clearly defined boundaries and a willingness for self-disclosure experiences from both parties, particularly the supervisor, as this builds a bond which assists in role modelling, learning from failures, and reducing the supervisee’s fear of judgement (Corey et al., 2010).

“ For a strong supervisor/supervisee relationship to occur, safety and trust must be established.”

The Armstrong (2020) RISE UP model is a detailed guide for supervisors to assist in addressing all aspects of supervision. Not all aspects of the RISE UP model need to be addressed in each session, but it is expected that they are explored at some point, with the supervisee guiding what they need from each session.

Clinical Supervision is reported to be more effective for supervisees who have chosen their own preferred supervisor and it is recommended that the supervisor not be their Line Manager (Martin, et al., 2014). In addition, CS is more effective when conducted away from the workplace, as this increases the ability to reflect and discuss more confidential topics (Edwards, et al., 2005).

Why make time for CS?

CS results in improved quality of care, clinician governance, and professional practice, increased job satisfaction, and reduced stress (Dawson, et al., 2013). Supervisees who are unable to make time for CS, report higher levels of emotional exhaustion or ‘burnout’ (Edwards, et al., 2005). In Allied Health, CS typically occurs for just one hour per month, research shows that less frequency reduces effectiveness (Snowdon, et al., 2020).

In addition to formal CS sessions, supervision can occur informally such as ‘at point of care’ where a supervisor may assist a supervisee with the treatment of a client. However, it is important that this session be seen as ‘extra’ not ‘instead of’ formal CS meetings, thus ensuring that the supervisee benefits from all avenues of CS (Health and Human Services, Victorian Government, 2019).

The RISE UP supervision model includes: Review previous session/progress/case follow up. Information procedures, case planning administration. Support affirming, empowering, challenging, validation. Education resources, professional development. U (Self Care) wellbeing, time management, work relationships. Practice career development, goal setting.

Reflection

The CS practices applied in other Allied Health professions such as Counselling, can offer many insights which can assist our O&P community to build on the traditional ‘at point of care supervision’ approach applied to O&P CS. By selecting their own non-reporting supervisor and agreeing on a clear purpose and goals, the supervisee can build a safe and effective environment to be able to disclose challenges, improve professional practice and increase job satisfaction.

Resources

The Victorian Allied Health Clinical Supervision Framework provides online training modules and CS support tools and resources including CS agreements and Reflective practice record templates Victorian Allied Health Clinical Supervision Framework (2019)

A full list of references is available by contacting the author.

Andrea de Rauch / Orthotist, St Vincents Health Melbourne / andrea.derauch@svha.org.au

Humphreys / 4th Year Student, La Trobe University / will.humphreys12064@gmail.com

Reflection on Final Clinical Placements

Bill Reed Memorial Grant recipient, William humphreys, shares his appreciation for receiving the student grant and offers some reflections on his final prosthetics and orthotics clinical placements.

I would firstly like to express my gratitude and appreciation to AOPA for giving me this opportunity to contribute to the 2022 December Review edition and for the continual support offered to P&O students whilst completing their studies. I was extremely fortunate to receive the Bill Reed Memorial grant for 2022. This grant honours Bill’s immense contributions to the amputee community, particularly through the areas of Wollongong and Nowra which are very close to my hometown of Bowral, NSW.

Bill Reed is remembered as a colourful, empathetic, and prominent character in the NSW prosthetic and orthotic community. He entered the profession at age 17, working at AST Orthopaedics Pty Ltd in Sydney, and went on to make significant contributions to the industry throughout his career. This included opening, with colleague Barry Smithers, the first private practice to service clients in the South of NSW, Southern Prosthetics and Orthotics in Wollongong.

Bill also established Reed Prosthetics and Orthotics in 1991 further south in Nowra, and was awarded an OAM in 1999 for his dedication, service, and contribution to the amputee community. Bill lost a long-term battle with cancer in December 2007. He will always be fondly remembered for not only his work but his cheerful, friendly and positive approach to life.

I’m extremely grateful for my time spent with OAPL, as my clinical and technical knowledge of prosthetics improved significantly. I took a lot away from each member of the OAPL team, through their enthusiasm and dedication to providing patient-centred care to achieve the best possible outcomes for clients and applying the latest technology and research in practice.

For my final clinical placement, I was welcomed into the orthotics team at the Royal North Shore Hospital, Sydney. Throughout my placement I was exposed to a variety of in and out-patients, therefore gaining experience in both acute and rehabilitative orthotic management. The pathologies, injuries, patient characteristics, and orthotic areas of management were extremely diverse, broadening my clinical knowledge and skillset.

“ i would like to thank all of my fellow graduates from the class of 2022 and wish you all the very best for the future! it has been an absolute pleasure getting to know each one of you over the past 4 years.”

I’m so grateful for my time spent with the supportive and knowledgeable team at RNSH. I experienced first-hand the high level of organisation and teamwork required in this acute environment, heavy reliance on adapting in real-time and problem solving and working collaboratively for the multidisciplinary care of clients.

I’m extremely grateful to have received this grant in honour of Bill’s memory and I cannot thank enough the colleagues and friends of Bill from Appliance and Limb Centre Intl (ALC), and Reis Orthopedic and Surgical Services (REIS), who in conjunction with AOPA offer this grant to P&O students each year. Like many, to pursue a career in Prosthetics and Orthotics, I’ve had to relocate interstate to study at La Trobe University. The grant provided by AOPA has been incredibly beneficial in my final year of the degree to assist in travel expenses and costs associated with placements.

My clinical prosthetics placement was with the extremely supportive and friendly team at the private OAPL clinic in Flemington, Melbourne. During this placement I was largely exposed to long-term prosthetic users, assisting with, and conducting under supervision, consultations with a variety of patients of various amputation levels, goals, and prescriptions. Additionally, I attended clinic days servicing amputees at the Peninsula Health Rehabilitation Centre.

The acute setting was fast-paced with high volumes of patients, therefore requiring efficient assessment and problem-solving.

If I was to offer any advice to current students preparing for placement next year or in the future, I would say to back yourself and your knowledge. Gain as many clinical experiences as you can while on placement, step outside your comfort zone, and don’t be afraid to make mistakes. Constant learning and adapting is the nature of the industry, so making mistakes is inevitable and these moments are where the most growth occurs. Also, brush up on some recipes early if you’re not huge on baking.

I would like to thank all of my fellow graduates from the class of 2022 and wish you all the very best for the future! It has been an absolute pleasure getting to know each one of you over the past 4 years and I cannot wait to see all the amazing things each of you will achieve on the road ahead! A huge thank you must also go out to all of the teachers and support staff that we have had at La Trobe University throughout our study. Your constant support, hard work, and enthusiasm does not go overlooked and we can’t thank you enough!

Lastly, thank you again to AOPA for this opportunity and for selecting me as the recipient of the Bill Reed Memorial Grant for 2022

William

Ambitions to remove barriers to prosthetic and orthotic service access through culturally responsive service delivery

Mitch shares his experiences participating in the indigenous Allied health Australia (IAHA) Cultural Responsiveness Training and reflects on the benefits of introducing the training into clinical practice.

As a person raised in Australia’s dominant culture, it’s not often I’ve experienced any inhibitions in accessing the health services I need. The vast majority of services across Australia have been developed by people like me, are delivered by people like me, and unconsciously are targeted toward people like me, with similar value systems, language, and an understanding of age, family, and gender dynamics.

However, my lack of inhibition to seek supports is not shared by everyone. Aboriginal and Torres Strait Islander people are just one minority group who are commonly forced to shift between two cultures, introducing challenges to their experience in accessing health services, including prosthetics and orthotics. Use of appropriate verbal and non-verbal language, accommodation of traditional customs and philosophies on healing as well as opportunities to include appropriate family members in their health services are all important components of many First Nations’ cultures. These can easily be overlooked or misunderstood and discourage one from accessing the valuable health services they require.

Compared to non-indigenous Australians, Aboriginal and Torres Strait Islander people are at a heightened risk of major amputation by as much as forty times. It is important then that we as a profession always make efforts to allow for equitable access to

prosthetic services, inclusive of such an at-risk population. This necessitates our services to minimise any unintentional bias that favours those with a clear understanding and comfort in Australia’s dominant western culture.

With the support of AOPA’s Professional Enhancement Grant (PEG) and inspired by discussions with clients of both Aboriginal and Māori heritage, the team at Leading Edge Prosthetics have undertaken the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness Training. Facilitated entirely through an online platform, the course has given our team the tools to reflect upon what has shaped our own values within the dominant culture we all have been brought up through as well as any preconceived ideas concerning First Nations cultures. This helped us to better understand the approach of our service delivery and highlight any opportunities to allow for a more inclusive, culturally safe service. An accompanying education in the ongoing cultural practices and the historical experience of First Nations people then laid the foundations behind strategies which we have set out to further develop cultural safety throughout our services.

Upon completion of three levels of the training course, we were required to develop our own Cultural Responsiveness Action Plan. Rather than directing participants with explicit interventions, this exercise encouraged us to reflect further on what we as a company

Mitch Farrar / Senior Prosthetist, Leading Edge Prosthetics / mitch@edgeprosthetics.com

can do to support cultural safety specific to our service. We aim to roll out these strategies progressively, and continuously review our approach to refine their effectiveness.

Most importantly, it is essential to engage with First Nations’ people to better understand both their culture and how it can be best involved within our service delivery. This could include discussions with Aboriginal and Torres Strait Islander clients, Aboriginal and Torres Strait Islander liaison officers in hospital settings, or local Aboriginal Land Councils. Such continuous, ongoing discussions can also support a further understanding of events significant to First Nations people such as NAIDOC week and Reconciliation Day. Openly celebrating these events can highlight to clientele the acknowledgment and respect our service has for the cultures and history of First Nations people.

Specifically to our client-centred service, opportunities exist for us to incorporate cultural considerations into our assessments for those identified as Aboriginal or Torres Strait Islander. These include and are not limited to the use of culturally-appropriate language, or a concept known as code-mixing, as well as raising the possible need for cultural concepts through our assessment process such as kinship, family or community involvement, and connection to the land through a prosthesis. Identifying the specific heritage and associated needs of our clients to respective funding agencies also both pay due acknowledgment and highlights the value of cultural responsiveness when considering services to be funded.

Strategies such as these are small and not disruptive to our existing service. Nevertheless, they have the potential to allow Aboriginal and Torres Strait Islander people, as well as those from other minority groups, to feel safe to express their primary culture in a facility that would be traditionally characterised by western practices.

The uptake and quality of services are likely to improve, thereby supporting their capacity to achieve their personal goals. More broadly, it gives us the chance to contribute toward efforts in addressing health gaps between Indigenous and non-Indigenous Australians.

Leading Edge would like to thank AOPA for supporting us to participate in such a valuable program through their PEG. We would encourage all other AOPA members to consider the opportunities which the PEG can help to realise and specifically endorse any opportunity to address the unmet needs of our most vulnerable groups.

I would also like to pay respect to the elders and traditional custodians, past, present, and emerging, of the Yuggera and Turrbal countries, the lands on which Leading Edge Prosthetics is located. We acknowledge their continuing connection to the land, water, and cultural practices of this area and thank them for their support in working with us to improve our services

A full list of references is available by contacting the author.

CADCAM vs Plaster When Learning Cast Modifications

Learning cast modifications upon entering the work force is better supported with the use of cA dcAM. The inconsistency of plaster reduces how efficiently new clinicians learn to appropriately prescribe for their client.

Plaster and CADCAM are just tools for cast modifications

The fit, comfort and function of a cast modification relies on 2 key things:

1. The Prescription - what modifications need to be done to the cast to suit the client’s needs? (i.e. What is the appropriate % of volume reduction for this residuum’s tissue density or what is the ankle angle that will be comfortable and functional for the client’s ankle range/spasticity)

2. The Implementation - how accurately were those modifications completed? (i.e. Is the 4mm of build-up on this bony prominence actually 4mm?)

Plaster and CADCAM are the tools available to O&Ps to achieve the second stage: the implementation.

My experience since graduating

When I graduated from university, I started in an orthotic facility where they only used CADCAM to complete their cast modifications. Here I learned to prescribe orthotics using CADCAM as my tool for implementation.

the peak, if they’ve captured the entire prominence; and with a few clicks of the “undo” button, supervisors are able to show their juniors how they would have done it.

Using CADCAM, junior clinicians can learn to appropriately prescribe for their patients faster, because they have a more accurate and consistent tool for implementing their prescription. They can trust the tool they are using will consistently do what they tell it to. The same can never be said for plaster.

The inconsistency of plaster as a tool

A clinician’s plaster modifications on a good day, when they’re well-rested, caffeinated, and have all morning to do one cast, is inevitably going to be different from a bad day when they’re sore from the gym, it’s their third plaster cast and they have 10 minutes to complete it before their next patient.

“ cAdcAM enables new graduates to grasp the second concept, the implementation, more efficiently than plaster.”

There are methods clinicians can employ to increase the accuracy of plaster: adding a colourant to the plaster or using a nail to get the height at the peak of the build-up. But it is impossible to see through the plaster to get a full picture of the modifications being made, impossible to document every modification done, and impossible to be as precise as a computer.

I then moved to a dual practicing facility where they predominantly used plaster for their cast modifications but had a CADCAM system. Here I learned how to prescribe prosthetics using plaster as my implementation tool.

I’ve had the experience of transitioning from only using CADCAM to using plaster to modify my orthotic devices. And vice versa, I’ve had the experience of transitioning from only using plaster to using CADCAM to modify my prosthetic sockets.

CADCAM is the better tool

CADCAM enables new graduates to grasp the second concept, the implementation, more efficiently than plaster. The accuracy of CADCAM as a tool means junior clinicians can trust that their 4mm build-up was actually 4mm. This allows them more capacity to develop the clinical reasoning for their prescription, rather than questioning if they’ve accurately implemented their prescription.

The digital record of the original cast along with all the modifications enables supervisors to teach more effectively. Supervisors are able to overlap the original untouched cast with the final cast. They are able to check how their junior clinician has added that build-up - the contour of the build-up, the height at

The unreliability and inaccuracies of plaster means it takes junior clinicians a longer time to comprehend key concepts to appropriately prescribe for their client. When they have a bad fit, they have two variables to question instead of one. Was it their prescription that needed to be changed? Or did they not accurately implement their prescription? With CADCAM the answer would have been definitive.

The anxiety of learning with an inconsistent tool

Some clinicians have expressed they’ve been reluctant to transition to CADCAM because they can’t “feel” the leg and that they need to feel it with their hands and see it in front of them to get a good fit.

The inconsistency of plaster and the lack of data it provides means clinicians have to develop a keen sense of what the plaster cast physically feels like to assess if they’ve modified their cast as intended. The anxiety around losing the physical touch of a cast stems from using an inaccurate tool to implement their prescription.

The reluctance to learn a new tool could also be rooted in the anxiety clinicians experienced when they first learned how to modify casts. The time it took to learn using an unreliable tool, where mistakes were more difficult to correct, is a commitment many would not choose to make a second time.

Transitioning from plaster to CADCAM does not require the same time commitment. The difference is comparable to using a digital scale versus using measuring cups when baking. The recipe is the same - but the tool is more accurate.

A message for clinicians reluctant to take the leap

I want to reassure you. You’re not starting again. You have a wealth of clinical experience and you know what to prescribe. That was the hard part. Think of what that knowledge would accomplish when you transition to using a tool that will consistently implement your

prescription with the accuracy that could never be achieved in plaster.

For anyone struggling to take the first step, my tip for you is this: scan your untouched plaster positive, scan it again when you finished your modifications, over-lay the 2 scans and modify your untouched positive until you get to your finished cast.

It’ll let you practice scanning without the pressure of having the patient in front of you (if you’re live scanning). It’ll let you play around with the tools of the CADCAM system without the time pressure of having a finished product to fit. And it’ll let you test whether or not your 4mm build-up was actually 4mm.

CADCAM’s accuracy and its ability to document data makes it a better tool to learn and teach cast modifications of orthotic/ prosthetic devices

Lisa Dodds / Orthotist, AbilityMade / lisa@abilitymade.com

A case study: 3d Printed Flexible Strut AFO prescription

Delivering regional services can be challenging yet so very rewarding. With the help of digital workflow, the clinician can find the flexibility to modify and design devices outside of the workshop enviroment, switch on numerous manufacturing workflows including, but not limited to 3D printing, find greater efficiency of time to allow for travel and gain the same if not superior clinical outcomes as traditional manufacture.

Introduction

Jimmy (pseudonym) is a 12 year old male, who has been a long term orthoses user with varied success. Jimmy has a diagnosis of Cerebral Palsy and presents with a Gross Motor Function Classification System (GMFCS) level 3. Jimmy has been a long term orthoses user.

Assessment

Jimmy presented with a physiotherapist referral for new orthoses having gone through a recent growth spurt. Jimmy’s Physiotherapist and his parents had similar goals for him including reducing fatigue, reducing pain and improving his gait to be more biomechanically efficient. Another major concern for Jimmy’s parents was his readiness to transition to high school, and the increased endurance he will require for this transition.

When ambulating, Jimmy walks with a crouch gait, with minimal knee extension. He has bilateral 5 degree plantarflexion contractures (variable), significant spasticity at his knees, considerable valgus position at hindfoot/ankle. Jimmy walks unaided and will drop to the floor if he feels unsteady or in pain.

Jimmy is currently using bilateral supramalleolar orthosis (SMOs) with bilateral anterior shell carbon fibre ankle foot orthoses (AFOs). Though these have been going well, Jimmy’s parents often struggle to don these two devices and so often Jimmy just wears the SMOs. Having a device that is easily donned is another important goal with orthoses prescription.

The Edinburgh Visual Gait Score (EVGS) was completed with Jimmy’s current prescription with the following results: Bilateral SMAFO =22 Bilateral SMAFO/AFO= 16. With this information the family were encouraged to limit walking in SMO’s alone and most walking needed to be in the combination AFO/SMO.

Jimmy is a big lover of basketball and often plays both at lunchtime and on the sidelines of after school basketball. His basketball participation levels are a good indication of a positive outcome with orthoses and is therefore used as an outcome measure in Jimmy’s case.

Treatment Plan

Following assessment and discussion with Jimmy allied health team and his parents the following prescription was decided on: one pair of SMOs to be used around the home and for some of Jimmy’s hobbies (very limited) and one pair of AFOs with a flexible posterior strut, both made from 3D printed material. The flexible strut AFO is designed with a flexible toe plate and aims to have solid hindfoot control, some dynamic response allowing

approximately 0-15 incline of shank. The AFO was manufactured with a stabilising heel to accommodate for Jimmy’s plantarflexion contracture. The combination of heel pitch, flexible strut and stability heel has Jimmy set up at the perfect angle for therapy to work on stretching out the knees and hips.

The initial fit of the flexible strut AFO went well with the new AFOs much easier to don and fit into shoes. Though the fit of the devices was good with no signs of significant pressure, there was a couple of modifications required for the AFOs. It was observed in the fitting appointment that the toe plate is too rigid for Jimmy and had a negative biomechanical effect on Jimmy’s gait decreasing step length and reducing tibial progression. Once the toe plate was trimmed to a three quarter toe plate these issues were resolved.

Tools of the trade

Shape Acquisition: E Cast and Comb scanner- the need to get good control of the hindfoot was going to be compromised with live scanning.

Shape Modification: Canfit Vorum Solid device design and manufacture: Abilitymade Video capture and analysis: iPad, OnForm app and EVGS

Small tool kit: Robi cordless range

Ambiance: Google mini and Spotify

Outcome

Though the fit of the AFO was good and Jimmy was comfortable in the AFOs, there has been a slow wean in process with the AFOs as Jimmy is slow to adapt to change. The plan is to gradually increase these hours, allowing Jimmy to adapt at his own speed. His mother sent a video of Jimmy participating in his first basketball game this week instead of running on the sidelines, a proud moment for this orthotist!

The Edinburgh Visual Gait Score (EVGS) assessment was completed again with the Bilateral Flexistrut AFO with a result of 16. Though there was no difference to previous prescription EVGS score, this was before an intensive therapy block.

Outcome of easier donning was achieved and gaining a gig on the basketball team instead of the sidelines suggests the change of prescription is a winner

Figure 2: Mid/late stance

Figure 1: Initial contact

To helmet or not to helmet?

Introduction

Positional Plagiocephaly and Brachycephaly, also referred to as Flat Head Syndrome, is primarily cosmetic condition. The risk factors include muscular torticollis, back sleeping, delayed milestones, prematurity, uterus/labour position and multiple gestations. The risk of not intervening may affect the physical appearance of the client including head, ear and jaw asymmetry and may provoke social and psychological concerns. Researched intervention strategies include repositioning techniques, physical therapy and cranial helmeting (Congress of Neurological Surgeons, 2016; Graham et al., 2019). Plagiocephaly is measured by the Cranial Vault Asymmetry Index (CVAI) and Brachycephaly is measured by the Cephalic Index/Ratio (CI, CR). The ideal age to helmet is from 4-10 months due to rapid head growth (Congress of Neurological Surgeons, 2016), taking into account each individual client presentation. At NovitaTech, our service aims to provide support for families who have concerns relating to their child’s head shape and offer 3D scanning for assessment for clients from 3- 12 months of age and for monitoring and/or helmeting purposes for clients aged 4-10 months.

Before introducing this service in 2019, a rapid review was conducted by Novita’s Knowledge and Innovations department to determine the clinical effectiveness of cranial helmeting for positional flat head syndrome. It found cranial reshaping orthoses can be useful and effective, however acknowledged there is conflicting evidence as to the necessity of these. Research conducted by found 3D printed helmets were better tolerated, and had increased compliance compared to traditional manufacture, and thus facilitated better clinical outcomes. It was therefore decided that Novitatech would offer a 3D cranial scanning and helmeting service.

Clinical assessment

of his head, with minimal success. Initial observations included forehead bossing, asymmetrical ear positioning in both transverse and coronal planes and posterior one-sided flattening. The first scan indicated moderate Plagiocephaly with a CVAI of 7.90) and a normal CI (Children’s Healthcare of Atlanta, 2015).

“ Our service aims to provide support for families who have concerns relating to their child’s head shape and offer 3d scanning for assessment for clients from 3- 12 months of age and for monitoring and/ or helmeting purposes for clients aged 4-10 months.”

The guardian’s goal of accessing services was to encourage a more symmetrical head shape and improve ear alignment.

Helmet or Monitor?

Managing expectations and anxiety is an important part of our service delivery. Families express valid and real concerns about the cosmetic outcomes that may occur if they don’t intervene. The social and psychological effects could potentially be experienced by both the child and the parent (Congress of Neurological Surgeons, 2016). Simply providing support, patience and education can significantly reduce families’ anxiety and facilitate a positive clinical experience (Van Allen, Mott, McGrath & DeGrazia, 2020). This enables families to be better equipped to make the decision to monitor head shape or helmet.

Baby C came into our clinic at 7 months old (4.5 months adjusted) for a cranial assessment. He was born 10 weeks premature and spent his first 6 weeks of life in NICU. Due to his prolonged hospital stay he spent an increased amount of time on the back of his head, and also developed mild left side torticollis which had been resolved.

Upon initial assessment, Baby C’s guardian reported trialling repositioning techniques and pillows to reduce time on the flat spot

Clinical justification

NovitaTech utilise the Atlanta Children’s Severity Scale (Children’s Healthcare of Atlanta, 2015) as a guideline, in conjunction with individual evaluation, including risk factors and subjective assessments, to determine if a helmet is an appropriate intervention. The treating Orthotist provides decision making guidance, but as cranial head shape is primarily a cosmetic concern, the final decision to helmet is up to the parents or

Managing clients with Plagiocephaly and Brachycephaly: Using 3d scanning technology to educate and empower families to decide whether to helmet or not to helmet?

Allie Bisas / Liana Giacon / Orthotists, NovitaTech

Client outcomes

Baby C wore his helmet for four months and he and his guardian were compliant with wear time with no complications. Review appointments were conducted at the 1 month and 4 month mark. At 1 month, a CVAI of 5.49, mild, was measured and the family decided to continue wearing the helmet. At 4 months Baby C’s helmet no longer fit, and a final scan was obtained. His CVAI reduced to 2.68, classifying him in the normal category (Children’s Healthcare of Atlanta, 2015) and he had grown 28mm. Reduced forehead bossing, improved ear alignment and a more symmetrical head shape were observed, and this was confirmed by the results of the scan. His Guardian was very happy with the outcome and she had “no regrets”. This appointment marked that treatment had concluded.

guardians. Given Baby C’s CVAI and clinical presentation, the clinical recommendation was repositioning or a cranial helmet (Children’s Healthcare of Atlanta, 2015). As the family had already trialled repositioning techniques, had real concerns about the future cosmetic outcomes, and presented with multiple risk factors, the Orthotist supported the Guardian’s decision to helmet.

Treatment plan

NovitaTech Orthotists work collaboratively with Serkel® to design treatment plans and manufacture 3D print helmets. Baby C’s helmet was designed to redirect growth by applying a gentle pressure on his high spots (Q2, Q3) whilst allowing space for growth in his flat spots (Q1, Q4). Nine days after the initial scan, the helmet was fit. Minor initial adjustments were made to the right neck nape anchor point. No further adjustments were required during the treatment period.

To accurately capture Baby C’s growth, the helmet needed to be worn for 23 hours a day. The length of treatment was determined by the amount and speed of growth Baby C experienced.

Our primary goal providing these services is to empower families to access objective data, a thorough subjective assessment and education to make an informed healthcare decision. Many families access our services for monitoring or assessment only purposes, which offers peace of mind and awareness to the intervention options available to them.

NovitaTech’s orthotics team would like to thank those who contributed to the establishment of the Cranial Therapy Service and to the Serkel® team for their support and guidance

Exploring Options for Paediatric KAFOs

Trying to find the ideal prescription for a young client with fear of medical appointments has been challenging. However, some careful planning and a lot of patience have been a step in the right direction.

Introduction

Sadie (pseudonym) is an 8-year-old female with a diagnosis of Spina Bifida. She was seen at Interface Technology Orthotics and Prosthetics for an initial orthotic assessment in June 2022. Sadie has an extensive orthotic history, receiving her first orthoses as an infant. This orthotic history has primarily consisted of a left solid ankle foot orthosis (AFO) and right knee ankle foot orthosis (KAFO).

Assessment

Sadie was referred through her physiotherapist who had reached out seeking alternative AFO/KAFO technology to help improve Sadie’s gait biomechanics, particularly energy return when walking.

Prior to the assessment, Sadie’s physiotherapist and parents contacted Interface to provide some background in the hopes of improving her experience at the clinic. Sadie had experienced a significant amount of medical trauma as a young person. As a result of this, she was extremely anxious, apprehensive and fearful of all medical personnel.

The first hurdle when working with Sadie was her anxiety when being touched, making physical assessment extremely difficult. Sadie’s long-term physiotherapist reported that despite their good rapport it was difficult for her to capture accurate information from Sadie.

Most of the initial assessment was spent encouraging Sadie to stand, walk, play and explore the clinic. With time and positive reinforcement Sadie eventually consented to a brief range of motion test in exchange for sitting on the clinician’s wheely chair.

Sadie presented with reduced ankle range bilaterally. Significant knee hyperextension (over 40 degrees) was observed on her right with additional medial/lateral instability. Clear muscle strength was difficult to obtain, however Sadie was seen to have hip weakness, weak knee flexors and extensors (grade 3 bilaterally), reduced strength of muscles below the knee on her left (grade 3), and no active muscle control below the knee on her right (grade 0).

Gait observation was undertaken without gait aids or orthoses. Sadie was able to walk short distances unaided, however, was quite unstable and fatigued quickly. A right-side leg length discrepancy was apparent in gait in addition to high-level hyperextension. Significant medial/lateral instability and increased external rotation was also observed on her right.

Treatment Plan

Developing a treatment plan for Sadie was a lengthy process and extended beyond the initial appointment through ongoing

discussions with Sadie, her mum and her physiotherapist. As Sadie was a strong-willed young person but also quite anxious over medical treatments it was decided that changes to prescription should be done as a staged approach. This gave Sadie the opportunity to adjust to the change and would not require as many appointments. We decided to leave her AFO prescription unchanged, instead exploring alternatives to her current KAFO – ideally a device with high energy return that required minimal ongoing maintenance. We discussed various materials, componentry and configurations, and liaised with external providers for central fabrication options including 3D modelling examples.

The final prescription was a left side solid thermoplastic AFO and right side pre-preg carbon KAFO with posterior offset joints, provided through central fabrication at Thuasne UK. The decision was made to use an adult-size knee joint to improve strength and decrease maintenance needs of the device.

It was anticipated that the biggest barrier to device fabrication would be casting. It was decided that using a quick-setting soft cast would be best. Surprisingly, with the assistance of another clinician, positive reinforcement, and funny videos for distraction, casting for both devices took less than 20 minutes!

Outcome

After some initial hesitation from Sadie and assistance needed from clinic dog Chester, the KAFO and AFO were fit without issue. Sadie was able move comfortably and walk unaided through the clinic demonstrating good stability bilaterally, and improved control of right knee.

The transition to a new device has gone better than expected and has given us and her family the confidence to explore ongoing options to improve her gait and mobility. Additionally, from initial assessment to most recent review, there has been a significant change in Sadie’s demeanour. She has been silly and fun and happy to engage with clinical staff. Sadie helps staff don and doff her devices, has been more open to assessment and has even written notes about her KAFO for staff to review.

Overall, the experience has really exemplified how working clients with significant fear or trauma can take great level of patience and care. Taking the time required to work with Sadie has been immensely rewarding and seeing improvement to her disposition has been just as positive as improvements to her mobility. It has really shown how important relationship building is in providing effective, high-quality care

Elizabeth Tori / Orthotist, Interface Technology Orthotics and Prosthetics / elizabeth@interfacetechnology.com.au

A complex Neurological Spinal Presentation

Editorial Committee Member Emily Hill, interviewed Wayne Borgelt about his experiences working in scoliosis, and his key learnings working with this client group.

With over 13 years working in scoliosis, Wayne Borgelt has become a respected clinician in this clinical area. He has developed a scoliosis training program, endorsed by AOPA, ‘Scoliosis TLSO usingRigo-Cheneauprinciples’, providing training to multiple P&O facilities around Australia. In this article, Wayne shares his experiences and insights working with a complex neurological spinal presentation.

Ryan* is a 15-year-old male diagnosed with Charcot-Marie-Tooth (CMT). He was referred to the Orthotics Department through the Orthopaedic Clinic at the Sydney Children’s Hospital in Randwick and presented with scoliosis, probable Scheuermann’s kyphosis and pectus carinatum.

Subjective Assessment

Ryan lives at home with his parents and brother. He attends mainstream school five days a week and has some assistance from an education support worker.

Ryan’s CMT affects him globally. He presents as quite ataxic, lethargic, significantly reduced grip strength and has a relatively low BMI. He does not participate in extracurricular sport due to his ataxia and fatigue. At the age of 1, Ryan had cardiac surgery, resulting in sternal wiring which can be observed in his x-ray.

“ Wayne ultimately wants to see an in brace correction of around 50% correction of the curve with a bare minimum of 25%.”

Ryan attends regular Physiotherapy and Occupational Therapy one to two days a week. He has had

prior Orthotic intervention at another facility for his lower limbs and is currently wearing bilateral Dictus bands which he uses at school to help with foot drop as he fatigues towards the end of the day.

His kyphotic posture was raised by his mum as a concern which prompted his referral to Orthopaedics. On initial examination, he reported vague lower back pain and no concern with the cosmesis of his pectus carinatum.

Objective Assessment

The clinical examination demonstrated an overall kyphotic posture with a trunk shift to the left of 10mm and a deeper right waist. The forward bend test showed a left thoracolumbar prominence with 13 degrees rotation. In the sagittal plane, there was also a noticeable, localised thoracolumbar prominence at the apex of the kyphosis.

Overall, he was able to self-correct his posture when directed, however, there was a residual localised thoracolumbar prominence was not as easily correctable. His pectus carinatum was located over the lower 1/3 of the left sterno-costal margin.

Radiologically, Ryan had a left T10/11 thoracic scoliosis with a Cobb angle of 32 degrees and a kyphosis angle of 34 degrees with an apex at T11/12. His kyphosis was very localised to 3 vertebrae.

Wayne Borgelt / Senior Orthotist, The Sydney Children’s Hospital, Randwick / wayne.borgelt@health.nsw.gov.au

Figure 2: 2nd Brace (lateral view)

Figure 4: Brace (lateral view)

Figure 1: 2nd Brace (anterior view)

Figure 3: Brace (anterior view)

Purpose of Treatment

The primary purpose of bracing was to stabilise curve progression of the kyphosis. A normal thoracic kyphosis angle is 20-40 degrees. Although Ryan’s kyphotic angle is theoretically well within normal limits, it is not normal so close to the thoraco-lumbar junction and, more importantly, it is occurring over a very localised region. When the spinal cord is stretched around such an acute angle, it can cause neurological symptoms distally.

The second goal of bracing was to prevent progression of the scoliosis. Bracing for scoliosis is indicated when the Cobb angle is greater than 20 degrees. Curves greater than 45-50 degrees typically require surgical stabilisation. No scoliotic curve is normal.

Initially, it was not a goal to correct the pectus carinatum as Ryan indicated nil concerns with cosmesis. It was also decided not to attempt to correct it at this stage due to the contradiction between the force systems required to correct the scoliosis and kyphosis versus the pectus.

Treatment Plan

Taking principles from Cheneau bracing, an A1 style was chosen as the starting point. This brace consists of a broad thoraco-lumbar loading located over the right T9/10/11 ribs, a rotational counter force diagonally opposite, an anterior void area adjacent, a high axilla force at T6/7 on the left and a low pelvic force on the left with a cut-out over the left iliac crest.

It was decided to enclose the left-side of the pelvis, unlike the A1’s usual open pelvis design. This provided greater structural integrity to the brace and allowed for thinner plastic to be used to increase brace flexibility. This allowed for ease of donning and doffing, taking into consideration Ryan’s reduced grip strength. The closed pelvis design also aimed to allow for improved postural stability with his ataxia.

The anterior build-up, typical for a Cheneau brace is to provide space anteriorly so that there is room to correct the spine and facilitates the derotational breathing mechanics. It also allows for the brace to overlap anteriorly. It was necessary in this case to reduce the amount of build-up so that the overlap was eliminated. This was critical to ensure that the kyphosis bars were positioned reliably and were not affected by medio-lateral variations as the brace overlaps more or less. As a result of this, there was also less derotational aspects of the breathing mechanics incorporated into the brace, striking a delicate balance of compromising scoliosis correction to achieve a more successful kyphosis correction.

him to spread the bars further apart with less force. The kyphosis bars were also positioned in a neutral sagittal plane alignment. Having bars attached separately to the brace also allowed for ease of adjustment and optimisation of the kyphosis force, even with growth.

“ Wayne was initially apprehensive that the brace may affect Ryan’s balance due to the restriction of his proprioceptive postural adjustments.”

Rather than the two straps generally required for this style of brace, a third strap was added to allow for gradual adjustments in tightness when donning. This accommodation allowed Ryan to be more autonomous in tightening his brace with his reduced grip strength.

The brace was to be worn for 16-20 hours per day with encouraged physical activity outside of wear time. For Ryan, this involved continuing his Physiotherapy. He will be required to continue spinal bracing until his end of growth, which would be determined by the Orthopaedic team through height growth and a hand x-ray to determine bone age.

Placement of the kyphosis bars was important for functionality. The bars were positioned slightly more medial to aid with donning and doffing due to Ryan’s reduced grip strength. This allowed

The key design elements of Ryan’s brace were critical to the successful integration of the different forces required to control his spine. It was decided to use a scoliosis brace as the core design of Ryan’s brace as the loading forces are quite specific and their relationship to each other is critical. The design was then modified to accommodate the forces required to control the kyphosis and also the patient’s specific functional requirements.

Figure 5: In-brace X-ray Figure 6: Pre bracing X-ray

Clinical Outcomes

Ryan’s in-brace measures were as follows:

Scoliosis: 21 degrees (30% correction) Kyphosis: 26 degrees (<25% correction)

Ryan was well aligned in his brace globally and the overall shape and balance of his scoliosis and kyphosis looked promising.

There was evident stiffness at the thoraco-lumbar junction. This was not unexpected due to localised wedging of the vertebrae occurring both anteriorly and laterally, with the combination of scoliosis and kyphosis.

Ryan was very receptive and stoic in his approach to bracing. He was compliant with his wear time and was wearing the brace full time within three days. He was very autonomous with bracing and was able to donn, doff and tighten the brace independently, despite difficulties with grip strength.

Wayne reported that he was initially apprehensive about how the brace may affect Ryan’s balance with his ataxia, due to the restriction of his proprioceptive postural adjustments. Ryan adapted well to the brace and reported no impact on balance or falls since his commencement.

After one year of bracing, Ryan was remeasured for a new brace. He had grown 6.5cm over this time. Clinically there was a visible reduction in his thoraco-lumbar rotation from 13 degrees to 4 degrees.

His new brace will incorporate pectus loading by broadening and lengthening the kyphosis pad on the left to provide a compressive force. The bar will be positioned over the top of the pectus for adequate loading. The correction of Ryan’s pectus carinatum is less predictable due to stiffness of the chest wall from his previous cardiac surgery. Correction will also be more complex due to conflicting forces in correcting both pectus and scoliosis. This will require both an understanding of biomechanical principles and compromise.

Despite clinical complexity, Ryan responded very well to bracing. A successful outcome by the end of growth should leave him with a stable spine that should serve him well for the rest of his life.

Reflections

Having a thorough understanding of Cheneau principles allowed for greater outcomes with bracing. An anterior opening design was able to be adopted which allowed for successful posterior loading elements and less sensitivity to growth, as a broad loading area could be applied. It also allowed for ease of donning and doffing.

Figure 7: Pre bracing X-ray (sagittal) Figure 8: In-brace X-ray (sagittal)

Having an awareness around the importance of subjective assessment is also vital. For Ryan, his grip strength played a large role in brace design, as it was what affected him the most daily with his CMT. Maintaining independence through autonomous donning, doffing and tightening would play an important role in his compliance.

Upon reflection, Wayne noted that understanding and evaluating spinal flexibility and shape was vital for Ryan’s bracing. Pectus carinatum correction was omitted in Ryan’s initial brace mostly due to the complexity of understanding how both the scoliosis and kyphosis would interact with one another. There is also a fine balance between understanding how much load the spine can tolerate due to flexibility versus what the skin will allow.

With complex cases like Ryan’s, breaking elements of bracing down can often aid with understanding how the brace is going to or supposed to behave. Clinicians should continually analyse what they are doing, and not hesitate to discuss their ideas with colleagues

*Patient has been deidentified for patient confidentiality purposes

“ Understanding and evaluating spinal flexibility and shape was vital for Ryan’s bracing.”

don’t Forget the Mob: A case Study

Jemma Verghese works as an Orthotist at the Perth children’s hospital (P ch). in this article she shares her insights and experiences into working with an indigenous patient, living in a remote community in WA and undertaking surgery as the cOV id-19 pandemic hits.

Western Australia (WA) is sparse, and healthcare can be difficult to access for patients living rural and remotely, particularly for the indigenous community. If this difficulty wasn’t enough, let’s throw in a pandemic!

Pre-Operative Mary* is an eightyear-old female diagnosed with left spastic hemiplegic Cerebral Palsy (CP), GMFCS I. She lives in an indigenous community approx. 900km northeast from Perth, an eight and a half hour drive.

Mary was referred to the PCH Rehab mobility clinic at the start of 2020, this was her first medical engagement with PCH. In February 2020, Mary had botox of her left gastrocnemius and tibialis posterior. Her mum reported this made Mary’s leg feel looser however, it did not influence her gait. She then underwent serial casting in Geraldton, five and a half hours from her community. Post serial casting, the community physio provided an off the shelf AFO. Later, an outreach Orthotist cast and fit her with a custom fixed AFO however, she was unable to tolerate it. Her equinovarus foot positioning continued to worsen, significantly impacting her gait. It became evident that surgery may be required. Mary was seen by Orthopaedics at PCH where it was decided that foot and ankle surgery would procced. The multidisciplinary CP orthopaedic team discussed Mary’s case to plan her pre and post-surgical journey.

A multidisciplinary pre-surgery telehealth meeting then took place, using Mary’s school to set up the link. The meeting was attended by the Orthopaedic Consultant, the Orthopaedic Outpatient Clinical Nurse, Orthopaedic inpatient Clinical Nurse Coordinator, CP Mobility Service Coordinator, an Orthotist, Social Worker, Occupational Therapist and Physiotherapist. Both Mary and her family were provided with information around the procedure, post operative management and informed of the requirement of a left solid AFO post-surgery. Both Mary and her

family felt informed about the process and could see the benefit of utilising an AFO after surgery.

Surgery

Mary undertook surgery in May 2021. This involved a left split tibialis anterior tendon transfer, gastrocnemius lengthening and tibialis posterior lengthening. Post operatively, Mary went into a plaster of paris cast and was advised to be non-weightbearing for 6 weeks.

Post-Operative

During a cast change at four weeks, Jemma scanned Mary for her AFO. This was done using a SPECTRA scanner to reduce risk of infection with wound healing and minimise patient pain and discomfort. Mary would be prescribed a basic fixed AFO set at plantargrade.

At six weeks post-op, Mary was required to have her cast removed. Due to difficulty access funding for regional travel, Mary’s cast removal was delayed until week seven. Unfortunately, during that time, COVID had started ramping up in the state of WA. This meant an added layer of complexity to Mary’s case, as she was from a remote community. Mary’s mum was hesitant attending the appointment as she did not wish to put her family or her community at greater risk of spreading coronavirus. Jemma and the team at PCH worked to ensure Mary’s family and her community felt safe in attending the hospital through reassurance and education. Post cast removal, Mary was then fit with her new AFO. She was required to wear her AFO for 23 hours per day for the next three months.

Jemma Verghese / Orthotist, Perth Children’s Hospital / jemma.verghese@health.wa.gov.au

Figure 2: Post Surgery & AFO use (coronal view)

Figure 1: Pre Surgery (coronal view)

Figure 3: Pre Surgery (initial contact)

Figure 4: Pre Surgery (mid stance)

Six weeks post-surgery, Mary was now able to achieve plantargrade. She had neutral talocrural and subtalar joint alignment. Her forefoot was now in a neutral position, rather than adducted. Her AFO fit well and she experienced minimal pain with initial weightbearing. She was also very receptive to wearing the AFO and happy that the transfer matched her stylish outfit. Education was provided so that Mary and her family would be able to manage her AFO quite autonomously whilst back home in their community.

Mary ineligible for community physiotherapy however, Mary was eligible for the post intervention therapy service (PITS) which involves 10-12 rehabilitation sessions post orthopaedic surgery. With the remoteness of their home location taken into consideration, Jemma, alongside her multidisciplinary team at PCH, was able to coordinate her rehab to be undertaken closer to home. Mary and her family were able to attend eight of these rehab sessions.

At three months post-surgery, Mary was reviewed by the orthopaedic team at PCH. She was going extremely well. On observation, she had good initial contact with her heel when walking with her AFO. She reported less fatigue during that day at school with the use of her AFO and had been able to walk around a lot more with her friends without tiring.

Despite education being provided around footwear with the AFO, Mary had been spending a lot of time in the community not wearing shoes. In Mary’s community, walking barefoot around the community is very common. However, this had resulted in a very worn-out AFO sole. Jemma swiftly organised a quick turnaround for a new AFO within a week. An EVA base and tread were added to the new AFO and both Mary and her family were re-educated on the importance of wearing shoes with the AFO.

Mary and her family were required to extend their stay due to appointments at the hospital. During this time, both Social Work and Orthotics coordinated their efforts and provided a support letter for additional funding and accommodation. The extended stay conflicted with cultural events occurring within her community, and therefore the support letter was sent to her community, which enabled the family to stay in Perth for the required time.

Figure 7: Client Community Location

As of June 2022, Mary is mobilising well post-surgery. Her foot and ankle remain in a neutral position, and she is very compliant with her AFO. She does take time out of her AFO to partake in lower limb strengthening exercises, as prescribed by the orthopaedic consultant and physiotherapist. The orthopaedic team at PCH are very happy with her progress.

When Mary attends PCH for her review appointments, Jemma is always sure to block out time for a quick AFO turn around. This is flagged by Jemma with both the Orthotics team and coordinated with the CP Mobility Service Coordinator.

Reflections

Jemma states that upon reflection of her experience with Mary, she has become more organised and coordinated in her practice, particularly regarding pre and post operative interventions. Communication with the PCH teams, with patient’s families and communities has been vital to providing patient centred care.

This case highlighted for Jemma the importance of culturally appropriate education around orthotics, particular for those living in rural and remote indigenous communities. The PCH Orthotics Department has since developed an education sheet around AFO’s and the importance of footwear with AFOs. Currently, PCH are converting their information sheets to a ‘Keeping our Mob Healthy’ version. With this initiative, 120 information sheets have been rewritten and illustrated, by local Noongar and Saibai Islander artist Tyrown Waigana who has created over 450 unique illustrations.

In her work at PCH, Jemma has been lucky to have mandatory training around cultural sensitivity and competency. As WA has a large indigenous population, this is highly valued by healthcare workers at PCH. Since her involvement with Mary, Jemma has sought additional training around indigenous communities and culture. This has improved her ability to provide more wholistic patient centred care. She also reflects the importance of always keeping culture in mind and that ‘going with the flow’ as things change can be vital for cultural sensitivity and maintaining patient and community rapport.

*Patient has been deidentified for patient confidentiality purposes

Editorial Committee Member Emily Hill, interviewed Jemma about her experiences with this client her key learnings working with this client group

Figure 6: Post Surgery and AFO use (loading response)

Figure 5: Post Surgery and AFO use (initial contact)

THE ULTIMATE

FOR PROSTHETIC LIMBS

#AOPA23: call for clinical content

Planning is well underway for the 2023 AOPA congress.

Following the success of the clinical case study panel discussions at the most recent AOPA Congress, we are excited to extend the opportunity for case study submissions to all delegates.

Do you have an interesting case study to discuss? A client you could benefit from some assistance with? A unique and challenging client condition? We encourage you to submit your case study for discussion at next year’s AOPA Congress.

What do you need to submit?

In order to get a full picture of the client to be discussed the following must be submitted:

• Client history (diagnosis, family and support systems, relevant comorbidities, funding body, etc.)

• Objective assessment (gait analysis, muscle strength testing, range of motion, outcome measures, etc.)

• Client goals

• Gait video and client photos

• Current treatment plan (if established)

• Any other relevant information

We look forward to further exploring and sharing expert knowledge in the management of orthotic and prosthetic cases.

If you would like to be involved in these panel discussions, we encourage you to reach out to Courtney (events@aopa.org.au).

Call for Abstracts opening soon

AOPA is preparing to open call for abstracts for the #AOPA23 AOPA National Congress and invites you to start brainstorming your contributions to the largest O&P event in Australia. We look forward to showcasing the latest in clinical practice, developments in technology, and innovative ideas across both prosthetics and orthotics.

At #AOPA23 we would like to showcase a wide variety of exciting topics from every facet of the O&P profession. Whether you are a seasoned expert or an early career professional, the Congress is the ideal platform to share your research, clinical practice, design or service delivery.

Start your brainstorming and keep an eye on your emails, we look forward to calling for abstracts soon!

Courtney Crichton / Congress Convenor, AOPA / events@aopa.org.au

Ashleigh Greig / Events and Education Coordinator, AOPA / ashleigh.greig@aopa.org.au

First National Benchmarks and Annual Provider Reports released!

Following the first complete year of enrolment in the AOPA Consumer Experience Program, we released the ‘National Benchmark Report for Consumer Experience with Orthotic & Prosthetic services in Australia’ and Annual Provider Reports in October.

The purpose of the Benchmark Report is to present the National Benchmarks for consumer experience with O&P services in Australia, and to give readers information about who the consumers of O&P services were, and what services were provided.

The Consumer Experience Program (the Program) aims to support O&P consumers to make an informed choice when selecting an O&P provider by providing access to high-quality data about the experience of other consumers. The Program achieves this aim by taking a systematic and national approach to the collection, analysis, and reporting of consumer experience data.

This data is used to calculate the annual National Benchmarks and to quantify consumer experience across seven domains of healthcare known to be important to consumers: access, communication, feedback, participation, privacy, respect, and safety; and an overall score (Figure 1).

How many consumers completed the survey in 2021/22?

The table below (Table 1) describes survey response statistics according to the number and proportion of surveys distributed, opened, and completed.

National n (%)

Invited: Email 417 (100%)

Started: Email 117 (28%) Completed: Email 89 Invited: Text 66 (100%) Started: Text 23 (35%) Completed: Text 9 (14%) Invited: Total 479 (100%) Started: Total 140 (29%) Completed: Total 98 (20%)

Net Promotor Score 9.2

Table 1. Summary of survey response statistics.

The Survey response rate is the number of surveys completed as a proportion of those invited. Typical response rates for electronic surveys are around 20% and the response rates for the Program were 20% for 2021/22.

1:

How are the National Benchmarks calculated?

The Benchmarks are derived from individual survey data. These individual survey data are summarised to produce seven domain scores and an overall score representing the provider’s mean scores. These mean scores from each provider are then summarised to produce the National Benchmarks that include seven domain scores and an overall score that represents the mean scores for the nation.

The total number of completed surveys was 98, a small sample size for the first full year of the program. The data in this report should therefore be interpreted in light of the sample size (i.e., 98 survey responses), and the representativeness of the consumers who completed the survey, such as, are the consumers who completed the survey typical of those who would normally receive the service?

Whilst survey responses for the 2021/22 year are lower than we would have liked, fortunately, we have already observed an increase in surveys completed to date in the 2022/23 year.

Download the National Benchmarks by visiting https://www. aopa.org.au/publications/national-benchmarks-2021-22

Figure

The National Benchmarks for consumer experience with O&P services in Australia are measured across seven domains of healthcare known to be important to consumers, and an overall score.

2021/22 National Benchmarks at a glance

Figure 2. A snapshot of the National Benchmarks for 2021/22.

Figure 2 provides a snapshot of the National Benchmarks. The Benchmarks are calculated annually and include the survey data collected in the previous financial year.

National Benchmarks are measured on a 5-point scale where five (5) describes the most positive experience, and one describes the least.

All benchmark scores for 2021/22 are reasonably high, ranging between 4.5 and 4.8. The highest scores were in the domains of privacy and respect; the lowest scores were in the domains of access, feedback, and participation.

For a full breakdown of the dataset, we encourage you to visit the AOPA website and download the full Report.

What do the ratings against the national Benchmarks mean?

The National Benchmark for each of the seven domain scores and the overall score, describes the mean of all participating providers; thereby providing a measure of the ‘national average’.

Annually, each provider receives a score for each of the seven domains and an overall score. Each of these scores are then expressed relative to the National Benchmarks to determine the rating of: ‘exceeding’, ‘meeting’, or ‘working towards’ the National Benchmark (Figure 3). This data is presented within the Annual Provider Reports.

What is the Annual Provider Report?

The purpose of the Annual Provider Report is to give enrolled providers their annual service data including their scores and ratings against the National Benchmarks.

Providers with multiple service locations receive location-specific summary data; response statistics, consumer-, service-, and providerscores at each location, as well as summary data for the provider overall.

The Program also allows service providers to gather and analyse consumer feedback via the Program’s portal. Enrolled service providers also received their confidential report for 2021-22 in October. These two valuable resources assist providers to understand where to focus future improvement activities.

Check out the depth of information that enrolled providers receive in our exampleAnnualProviderReport and demo portal found by visiting the Resources tab in the Consumer Experience Program section of the AOPA website.”

How are the National Benchmarks made accessible?

The National Benchmarks are published annually on the AOPA website. To help consumers make an informed choice about which O&P provider will best meet their individual needs, providers are encouraged to publish their scores and National Benchmark ratings.

Whilst we acknowledge that survey responses for the 2021/22 year are lower than we would have initially hoped for, we look forward to continuing to work alongside enrolled providers, and partners, Cemplicity, to make improvements that will ultimately increase survey distribution numbers and responses, and therefore sample size and reliability.

We are very grateful to the service providers who took on the challenge of adopting our novel program, in the middle of the COVID-19 pandemic, and who continue to collaborate with us to ensure this program’s success for the overall benefit of O&P consumers.

I would like to acknowledge the work of Dr Emily Ridgewell who lead the development of the National Benchmark and Annual Provider Reports which have informed this article.

Figure 3: Providers receive a rating for each of the seven domains and overall score, that describes whether their score is above (‘Exceeding’), the same as (‘Meeting) or below (‘Working Towards’) the National Benchmark.

If you would like to learn more about the Program, please visit the AOPA website to access many resources. If you have any questions, please email cep@aopa.org.au

REBOUND® POST-OP BRACING

Easy to fit. Easy to use.

The Rebound Post-Op Knee & Rebound Post-Op Elbow are designed with two priorities in mind: ease of fitting for practitioners and ease of use for patients.

Simple and intuitive. Tool-free design makes fitting fast and easy, while the numbered strapping order and color-coded patient touch points simplify patient education and product use.

Total control. Use the OneTouch ™ hinge to quickly and easily set patient range-of-motion. Then, secure your range-of-motion settings in place with lockout clips to further reduce the risk of patient non-compliance.

Comfortable and secure. Rebound Post-Op Knee and Rebound PostOp Elbow have ergonomic paddles and contoured hinge struts that improve comfort and anatomical fit, as well as anti-migration features to help ensure secure suspension.

LIGHT WEIGHT

Expression of interest: AOPA committees

We are looking forward to calling for expressions of interests for a number of AOPA committees next year. Learn more about the different AOPA committees, and what they contribute to Australian O&P.

AOPA is a small peak professional body which is well-served by several important committees. AOPA provides opportunities to expand practitioners’ skill set, enhance governance knowledge, increase networking opportunities and take on leadership roles through participation in our committees. Voluntary committee membership provides an opportunity to extend knowledge and skills and work towards a future leadership role in the field of orthotics and prosthetics, and beyond.

Past committee members have been able to develop their project management, communication, organisation and writing skills, in addition to the enhancement of their professional network. Many members have gone on to contribute to AOPA further by joining other committees or through election to a Board role.

Editorial Committee

The AOPA Editorial Committee is responsible for the sourcing and editing content, and publication of the bi-annual magazine, The AOPA Review. The AOPA Review aims to be the leading source of information relating to the orthotic/prosthetic profession in Australia. It features articles on clinical topics, case studies, exploration of issues that impact the orthotic/prosthetic profession, introductions to new orthotic/prosthetic technologies, member reviews of new technologies, research articles, updates on AOPA advocacy activities, overviews of education events and contributions from other allied health professionals and related disciplines.

Student Engagement Committee

The role of the Student Engagement Committee is to ensure that AOPA is effectively listening and communicating with students in orthotic/prosthetic courses in Australia. This collaboration between the student body of La Trobe University and University of the Sunshine Coast aids AOPA in designing how and in what ways AOPA can engage and bring value to our student members.

National Education Delivery Committee

The National Education Delivery Committee (NEDC) is a Board committee, meaning it performs the activities delegated by the Board, in this case the development and delivery of education to the AOPA membership. More specifically the NEDC has the following primary purposes:

• The development and delivery of area and/or state based education including the facilitation of biannual education events;

• Collaboration in the development of area education to maximize resources and volunteer effort;

• Implementation of State/Territory education as part of an annual program; and

• Consideration of the diverse education needs of Members and development of innovative annual education programs

Congress Committee

The AOPA National Congress is a core component of AOPA’s education program and the flagship national event for O&P in Australia. Led by a Congress Convenor and supported by Secretariat staff, the Congress Committee undertakes many planning, operational and development tasks to ensure the congress is delivered to a high standard, on time and on budget. Committee members play an active role in making decisions and actioning those decisions.

Committee members are also responsible for setting the theme and tone of the event, including recommendations of keynote speakers, social function location and the event themes.

CPD Management Committee

The AOPA CPD Management committee works to ensure highquality learning opportunities for AOPA certified orthotist/ prosthetists through management of the Endorsed Education and Grants programs.

These programs aim to assist certified AOPA members to maintain, improve and broaden their knowledge, expertise, and competence, and develop personal and professional qualities required throughout their professional life.

If you are interested in learning more about these committees or other AOPA committees or special interest groups please reach out to the AOPA Office

Greig / Events and Education Coordinator, AOPA / ashleigh.greig@aopa.org.au

The AOPA Review goes electronic

Big changes are coming to the AOPA Review as we move towards delivering the biannual magazine in a virtual and interactive platform.

For the past 22 years, the AOPA Review, formally known as the Gazette, has been printed and posted to members, used as a regular source of information providing updates to the O&P profession. The AOPA Review has gone through many iterations throughout the years since first launching in 2000 and is a permanent record of how the Association has grown and changed over the years.

Initially, the Gazette was a newsletter, providing updates on CPD Log requirements, new members, and focused heavily on state-based updates, which reflected the structure of the Association at the time. In newsletter style, the Gazette was a way of updating the profession, delivered quarterly, and was brief as it didn’t include the clinical content we have learned to appreciate in the AOPA Review. The Gazette didn’t lack member contributions though, with nearly all content developed by volunteer members of AOPA, especially the State Representatives.

contribute their knowledge and findings to the AOPA Review and the Australian O&P profession.

Following the success of the repurposing and redesign, the AOPA Review had another redesign in 2018, giving the magazine a more modern look. This design has been the foundation of the Review for four years now, and will continue to heavily influence the move to a virtual platform. Thanks to all who have been involved in the publishing of the Review, editorial committee members, authors, advert suppliers, and all who have been part of the multiple redesigns!

“ in 2016, the purpose and look of the Gazette was revitalised, and the AOPA Review was created.”

What’s Next?

As planning for the next edition of the AOPA Review begins, a redesign and transition to a virtual platform will also take place. We look forward to the changes this platform brings, with more photos, videos, and other interactive possibilities with a virtual platform! For those who will miss the traditional printed version of the AOPA Review, PDF copies of your favourite articles will also be available for download.

In 2016, the purpose and look of the Gazette was revitalised, and the AOPA Review was created. The redesign was heavily influenced by feedback from AOPA members and the Editorial Committee, and facilitated the contribution of clinical content from Australian O&Ps in a new format. It is exciting looking back at this 2016 edition of the Review and seeing names that continue to regularly

Want to be involved?

AOPA is looking for members to be a part of the refresh of the AOPA Review and is looking for new ideas to include. If you would like to be involved in the next edition of the AOPA Review, we encourage you to reach out to the AOPA Office

Ashleigh

Connect with us and join the conversation!

There are so many ways to connect with AOPA and the O&P profession, whether you’re an AOPA member, an allied health practitioner, a product supplier, a user of orthotic/ prosthetic services or simply someone who is interested in our profession. Share your experiences, seek advice from your colleagues, discuss new ideas and explore everything AOPA has to offer. Find us on social media and join the online orthotic/ prosthetic conversation!

LinkedIn  linkedin.com/company/australian-orthotic-prosthetic-association

Member-only group: linkedin.com/groups/6950694

@Create your LinkedIn profile and share your work experiences, skill sets and interests with other like-minded professionals. Follow AOPA’s public company page for important official news and announcements, and join AOPA’s member only group to stay connected to the profession, association and your colleagues.

Twitter  twitter.com/aopa_news

SMS

Sign up to Twitter and follow @AOPA_News to stay updated on all things #OandP. Help represent your profession and increase engagement and interaction with other professional associations, related organisations and government bodies to extend the power and reach of our messages.

Facebook  www.facebook.com/AOPAnews  Member-only group: www.facebook.com/groups/519317918755136

Like the Australian Orthotic Prosthetic Association Facebook page to promote the profession and share the vital work of orthotist/prosthetists within the community. Join the private AOPA Community of Practice Facebook group for time-sensitive updates that affect the O&P profession, such as changes to COVID-19 restrictions and research opportunities. Instagram  www.instagram.com/aopa_news

Follow @AOPA_News on Instagram for regular updates from the National Office team, including the latest employment opportunities, event news and exciting announcements. Help promote the profession, engage with all things #OandP and share the important work of orthotist/prosthetists in Australia.

Strengthen your brand with AOPA Advertising & Partnership Opportunities

Deliver targeted messages direct to the orthotic/prosthetic community and demonstrate your ongoing support of the profession. Advertising and partnership allow AOPA to deliver valuable services to our members, ensuring excellence in standards of practice, strengthening the O&P profile and reducing barriers to growth of the profession.

Place an advert in the Review Reach over 500 orthotist/ prosthetists, education subscribers and related industry partners.

Want to know more?

Promote your educational events AOPA strongly supports the delivery of high-quality CPD activities to our members.

Fill your employment vacancies

Advertise on our Employment Opportunities page, the most frequently accessed area of the AOPA website.

Partner with us

Join AOPA as a Corporate Partner and receive a range of benefits and discounts. Your support allows AOPA to progress significant projects for the profession.

Head to our website and download the AOPA Advertising Prospectus and the Corporate Partnership Program at aopa.org.au/ about-us/connect-with-aopa or email admin@aopa.org.au