ISPO Course: Joint event between ISPO Sweden and ISPO Norway

30 August 2023

Copy of Message from the Past President

Creating opportunities for collaborative research in prosthetics and orthotics

ISPO Course – The joint event was organised by the ISPO National Members countries within the North Sea Group and was attended by 60 participants from 5 countries (Sweden, Norway, UK, Germany, and the Netherlands). David Rusaw, the president of ISPO Sweden, presented the conference aim, and Rune Nilsen, the president of ISPO Norway, welcomed this joint initiative.

As a sign of appreciation, every presenter received a certificate of a donation to Doctors without Borders.

The one-day conference ended with a discussion on how to implement study results in daily practice, support CPOs staying in practice, offer them the possibilities of conducting studies, explore patients’ priorities, and focus on relatives/patients’ perspectives.

The participants were given the opportunity to give feedback on the conference format, and the majority of participants concluded that a smaller conference like this yields better outcomes and facilitates easier networking.

David Rusaw concluded the conference and announced that Norway would host a similar meeting in the future.

The Programme and the Abstracts can be found here: Creating opportunities for collaborative research in prosthetics and orthotics: ISPO2023 (


Read more about the speakers and their projects below:

Linn Reed-Schwanborg, CPO from Sophies Minde
Rehabilitation of persons with lower limb amputation; A retrospective cohort Analysis and a qualitative study focusing on multidisciplinary long-term follow-up.

The author discussed the pathway of amputees at Oslo University Hospital, highlighting the lack of available data on amputations in Norway. However, there is extensive data on mobility progress after discharge, which the author intends to focus on. The author plans to conduct interviews at five hospitals to examine the facilitators and barriers of outpatient clinics. They mentioned SwedeAmp as a reference, particularly for the elderly population. This raises concerns about studies primarily focusing on younger individuals and their applicability to the patient group. The author also faced challenges in recruiting Certified Prosthetist-Orthotists for their studies and wishes to explore the reasons behind this further.

Cathrine Widehammar OT, Faculty of Medicine and Health, Örebro University
Swedish translation and cultural adaptation of the Prosthetic Upper Extremity Functional Index-2

This postdoctoral project collaborates with a team from Holland Bloorview Hospital in Canada. It focuses on a questionnaire regarding upper extremity function. This updated version includes new questions about tablet or smartphone usage. The Canadian version was translated into Swedish, with cultural adjustments made for differences in children’s interests between Sweden and Canada. A pilot test was conducted with ten families, and interviews lasted 15 to 40 minutes. The results have not been summarized yet, but preliminary findings suggest that some children found it too long (20 minutes). However, it was determined that the child’s participation is essential.

Lis Sjöberg OT, School of Health Sciences, Örebro University
Parents’ role in treatment decision for children with congenital limb reduction deficiency – experiences of information, knowledge, and support.

Children with congenital limb reduction deficiencies in their upper and/or lower limbs were included in this study. As indicated in the title, this project aimed to examine the role of parents in decision-making based on Swedish legislation, which requires cooperation with parents in determining treatments. Two studies have already been published on this topic. The findings revealed that parents who were provided with comprehensive information and advice generally had a more positive outlook compared to those who received limited information.

Helen Lindner OT, Örebro University
The development of a standardized method protocol to characterize compensatory movements during upper limb prosthesis use – an initial literature review phase

The author and her team examined compensatory movements in relation to conventional myo hands versus multi-grip hands. Their main focus was on the compensatory movement of the shoulder on the prosthetic side. It became evident that the multi-grip hand necessitated significantly less compensatory movement and could produce a comparable movement pattern to that of the non-prosthetic side. In addition, they are conducting a literature review on the functional patterns exhibited by prosthetic hands currently available on the market, as well as the methods used to test their functionality.

Tobias Goihl, NTNU/TOV Trondheim
Ankle Foot Orthoses for walking children with CP Clinical practice and implementation of evidence Preliminary results from a national survey

A national survey on implementing evidence-based practice in orthotics supply for cerebral palsy patients was conducted in Norway. The author noted that while we excel in biomechanics, our understanding of patient preferences is lacking. Currently, there are no evidence-based guidelines in the country. The author surveyed five clinics and invited all 80 orthotists working with children with cerebral palsy to participate in an online survey. Forty-three orthotists (54%) responded. Among the findings, 60% of orthotists stated that a short gastrocnemius is not a reason to choose a solid ankle-foot orthosis (AFO). This highlights a gap between research and practice in Norway, emphasizing the need to adapt research to the local context.

Mohammad Sobuh CPO, Jönköping University
A new concept of solid ankle foot orthosis for subtalar joint malalignment management

This presentation focuses on the new design of a solid AFO and how it could improve the medial and lateral stability of the sub-talar joint. The ongoing study includes nine patients with an average age of 20 years, all of whom have flexible hindfoot. The focus was on applying pressure to the medial side of the calcaneus and measuring it in a static position. This was done using a special orthosis with various support placements. The study found that medial and lateral support affect the angle of the calcaneus differently.

Åsa Eliasson CPO, Karolinska institute
Use of orthoses and prostheses, functional exercise capacity and satisfaction with the devices in children with congenital lower limb deficiencies

The aim was to document the usage of prosthetic/orthotic devices and the frequency of their use in patients aged 5-18. A 6-minute walking test was conducted, and OPUS questions were used to assess the satisfaction of the children with their devices. Twenty-four children participated in the study, with 12 using a prosthesis and 12 using an orthosis. The children had different diagnoses and varying levels of disabilities. No statistical differences were found between the two groups, except for when analysing a specific part of the OPUS items. It was observed that more children in the prosthetic user group expressed dissatisfaction with wear and tear on clothes/shoes.

Erik Prinsen PT, Roessingh Research and Development, Enschede the Netherlands; University of Twente, Enschede, NL
Early provision of ankle-foot orthoses in the rehabilitation after stroke: from science into daily clinical practice

This study focuses on the provision of an AFO use for stroke patients. The question was whether to start early to use AFO or not. Pros and cons are known from the field, but evidence is lacking. Subjects (N=33) were randomized to AFO-provision early (at inclusion) or delayed (+8 weeks). Longitudinal effects were assessed during 26 weeks: – functional outcomes, measured every other week using clinical tests – gait kinematics and muscle activation patterns; measured in week 1/9/17/26 using 3D gait analysis (Vicon) and surface EMG – falls, measured every week using a diary.

The finding showed that it does not show any difference in the long term, but the function during the period was better in those who received AFO earlier. In-depth analysis showed that most early group falls (63.6) occurred without wearing AFOs, mainly during transfers/standing, in subjects without independent walking ability, and with low levels of balance (Berg Balance Scale more than 45 points).

A plan was made to implement the study’s recommendation, which positively benefited the whole process when treating stroke patients.

Keynote speaker Ulla Hellstrand Tang CPO, Dept. of Prosthetics & Orthotics, Sahlgrenska
Implementation, is it simple or complex?

The author mentioned Greenhalgh and Papoutsi’s study on complexity in health services research. The author discussed the development of a D-foot screening system and identified the complexities in healthcare innovations. These complexities relate to the broader system, the organization, its visions, rules (or lack thereof), and the framework supporting innovation implementation. Identifying and defining complexity doesn’t solve the issues, but it improves opportunities for innovation implementation.

Susanne Seidinger, Market Access, Ottobock
The Kenevo microprocessor-controlled prosthetic knee compared with non–microprocessor-controlled knees in individuals older than 65 years in Sweden: A cost-effectiveness and budget-impact analysis

This article was awarded with  the Forcheimer Prize at the ISPO World Conference in Mexico. It focuses on a study that compares the cost-effectiveness of the Kenevo/MPK with non-microprocessor-controlled knees (NMPKs) in individuals over 65 who have undergone transfemoral amputation/knee disarticulation. The study concludes that MPKs are preferable to mechanical knee joints.

Roland Zügner PT, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy
Relation between the kinematic gait profile score and daily activity data in individuals with amputation above the knee

Gait with a transfemoral or knee-disarticulation prosthesis can cause asymmetrical walking patterns. The kinematic gait profile score (GPS) is a clinical index that measures overall gait issues. Further research is needed to understand the impact of asymmetrical gait on daily activities for prosthetic users.

Typically, gait observations are done in a lab. This study compared lab analysis with an activity monitor attached to the prosthesis to record everyday activity. The results showed that a more symmetrical gait pattern was related to increased daily prosthetic steps, highlighting the importance of proper rehabilitation training. Self-reported mobility did not show a correlation with gait symmetry.

Vegar Hjermundrud PT, Oslo Metropolitan University
Effect four weeks of inpatient comprehensive prosthetic rehabilitation on functional outcome measures in different groups of prosthetic users

This study examined the impact of inpatient exercise rehabilitation on prosthetic mobility, function, and ambulation in people with lower limb loss. Experienced (EXP, n=20) and new prosthetic users (NEW, n=18) participated in a 4-week rehabilitation intervention, while a control group of experienced users (CON, n=19) received no intervention. Tests were conducted before and after the intervention, with ambulatory activity recorded using a step-monitoring device.

The 4-week rehabilitation intervention significantly improved mobility, prosthetic function, and ambulation activity for new users, but had less of an effect on experienced users. New prosthetic users (NEW) showed considerable functional improvement at the end of the intervention.

Terje Gjøvaag, Associate Professor at Oslo Metropolitan University
Effects of four weeks of comprehensive inpatient rehabilitation on health- related quality of life in Experienced and new lower limb prosthetic users

This study was part of a previous study conducted by Vegar Hjermundruds. The author pointed out that mobility is the primary factor affecting health-related quality of life in individuals with lower limb loss. However, impairments and limitations can persist long after completing the initial rehabilitation. Therefore, it is essential to examine whether the effects of rehabilitation are similar for individuals with a previous history of rehabilitation and those receiving their first rehabilitation.

This study investigated how 4 weeks of inpatient rehabilitation affected health-related quality of life in new (NEW, n=24, 7 females) and experienced prosthetic users (EXP, n=21, 7 females). Overall, the EXP group showed little change in the global health score or the mobility dimension of the EQ-5D-5L. The control group (CON), which matched the characteristics of the EXP group, did not receive the intervention and showed no significant changes. However, the NEW group showed significant improvements in both the global health score and the mobility dimension. These results indicate that experienced and new prosthetic users may require different approaches to prosthetic rehabilitation.

Marie Eriksson and Åsa Bartonek, Department of Women’s and Children’s Health, Karolinska Institute
Ambulation in adults with myelomeningocele after active orthotic treatment during childhood

In the early 1990s, Karolinska University Hospital initiated intensified orthotic management for children with myelomeningocele (MMC) in order to support their potential motor function and address muscle paresis. The purpose of this study was to retrospectively evaluate the use of orthoses for ambulatory function and explore the participants’ satisfaction with orthoses from an adult perspective.

Among the participants, 63% still had some degree of ambulatory function, with the majority using orthoses. In the N-a group, standing orthoses and AFOs for sitting were used. The high frequency of orthosis use and consistent satisfaction across all ambulation groups highlight the importance of early planning and follow-up of orthosis treatment to maintain mobility into adulthood. Our results also underscore the significance of closely assessing each individual’s condition.

Andreas Hahn, Otto Bock Healthcare Products
Microprocessor Stance and Swing Control Orthosis for patients dependent on a knee-ankle-foot-orthosis for walking: A randomized, controlled crossover trial.

Locked knee-ankle-foot orthoses (KAFOs) are considered the standard of care for patients with paresis of the knee-stabilizing muscles. Posterior offset KAFOs and stance control orthoses (SCO) have improved functionality with free swing but work safely on level ground only. The C-Brace microprocessor stance and swing control orthosis (MP-SSCO) makes the proven benefits of microprocessor-controlled prosthetic knees, including stumble recovery, available to patients dependent on a KAFO.

The improvements in balance, falls, fall risk, function, and mobility can be attributed to the stumble recovery and controlled knee flexion during weight-bearing with the C-Brace. These device features and functions positively impact the quality of life of users with increased fall risk compared to standard KAFOs and SCOs. The C-Brace represents a viable orthotic option for KAFO and SCO users with increased fall risk and reduced mobility.