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Post by TimVS on Mar 3, 2008 9:18:08 GMT
Been thinking about this over the weekend. I would propose that "proper prescription" would be that which leads to a satisfactory outcome in the eyes of the practicioner and, hopefully, the patient. The latter is, I believe, down to the therapist properly educating the patient as regards expected outcomes, etc. I also have used none of the above. (Haven't even tried a Kirby Skive yet!) Despite the usual assessments, I usually post to what I see on the cast at the end of the day. Begs the question, perhaps I should just do that and save me time and the patient money! (I'm only partially joking!) I seem to have reasonably good outcomes; I'm casting my mind back to think about the causes of my "failures". Not many, thankfully, but mainly shoe fit, usually remedied by an adjustment or different device, and in one case a refund. I can think of one or two that may be incorrect prescription, but I can't be certain as there are so many other possible extrinsic factors leading to 'orthotic failure', IMHO. It would be nice to be good enough to hit 100%. Wonder if that's possible  |
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Post by robertisaacs on Mar 3, 2008 12:39:52 GMT
And here we go!  Its quite hard to argue on the basis of "what works". Its a catch 22. The problem, of course, is that this much depends on the practitioner and what type of patients they see. Here's fun. David, you mentioned that you DO feel that ROM / QOM is important. How would you justify that to a company (which might rhyme with Mole) who would say they have an equally high success rate based on no biometric readings at all? Or indeed if we are considering that the same prescription why not just send them to boots? There might be something to be said for the complex approach (which needs an acronym) in patients with more "gross" structuaral / functional variations as might be seen in the NHS? Regards Robert |
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Post by Admin on Mar 3, 2008 20:59:09 GMT
David, you mentioned that you DO feel that ROM / QOM is important. How would you justify that to a company (which might rhyme with Mole) who would say they have an equally high success rate based on no biometric readings at all? Or indeed if we are considering that the same prescription why not just send them to boots? There might be something to be said for the complex approach (which needs an acronym) in patients with more "gross" structuaral / functional variations as might be seen in the NHS? Hmmm... the BIRC approach - Biomechanics is ruddy complicated  . I think that the Company whose name rhymes with moles probably get a fair degree of success. In fact I saw a lady today who likes my devices (had them two weeks now) but also likes her "rhymes with moles" devices in her high-heeled boots. Same could be said for other OTC devices. IMO the two main problems with these devices is not that they are fitted with no regard to biometric data, but that they are over-prescribed, and poorly (if at all) followed-up. Regards, |
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Post by robertisaacs on Mar 3, 2008 21:23:03 GMT
Agreed. And this might have something to do with their degree of success. I used to work for a company which may or may not rhyme with roll (before i was a pod, summer holiday job). A lot of the people who went away with £75 of stainless steel insole really did not need them at all. And its amazing how good the success rate is if the alternative is for them to admit they've been talking into shelling out for a device they did'nt need!
I'm not saying thats how it is in PP, however there might be a difference in caseload. For EG my clinic this AM included a fixed and grossly enlarged pair of MTJs with fused STJs, a Quad CP with a massive peroneal spasm creating a HUGE pronation moment, a patient with a 4cm LLD following a severe juvenile fracture and an 18 month old toddler! I suspect none of these would have done well with a pre fab or a rigid neutral shell.
Regards
Robert
How about
Biomechanics of grading objectively functional feet?
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Post by blinda on Mar 3, 2008 22:32:21 GMT
BOG OFF, like it.
How about…Biomechanics Incorporates The Complex Hypothesis that assessments such as the jack’s tests, location of STJ axis, etc, have value both in diagnostics and in informing the most appropriate insole?
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Post by Admin on Mar 4, 2008 7:39:04 GMT
I go along with this (in both cases). Blinda, [glow=red,2,300]Bog off [/glow] is good (if I'd read Roberts post last night I would have missed that for sure!). I prefer the rather snappy [glow=red,2,300]BWFACP[/glow] myself. [glow=red,2,300]B[/glow]iomech [glow=red,2,300]w[/glow]hich [glow=red,2,300]f[/glow]ollows [glow=red,2,300]a[/glow] [glow=red,2,300]c[/glow]onvoluted [glow=red,2,300]p[/glow]aradigm. ;D. Thinking around this sensibly (as sensibly as I can at 7.45am) I believe that following a simple biomech protocol helps both teaching and learning in the first instance. Anyone who understands the concept that we walk on a flat surface which our feet have not grown accostomed to should find it relatively easy to work out what to do to correct biomech in symptomatic feet. Much biomech seems to be taught on the basis of treating a presenting condition, and I believe this is wrong. I'm thinking here of formulaic solutions, as in "this is the condition which you treat by...." This approach does not need any clear understanding of biomech, and in fact can often preclude any learning of the basics. Robert, I'm sure you are familiar with the staff member who can give a perfectly good textbook answer to a biomech problem, yet is totally incompetent when faced with a real person/foot. Regards, |
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Post by Admin on Mar 4, 2008 7:55:10 GMT
BOG OFF, like it. How about… Biomechanics Incorporates The Complex Hypothesis that assessments such as the jack’s tests, location of STJ axis, etc, have value both in diagnostics and in informing the most appropriate insole? ;D ;D ;D |
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Post by robertisaacs on Mar 4, 2008 12:31:47 GMT
I was with you there up until the last bit. If we are not treating the presenting condition what ARE we treating? Ah. Now that makes more sense. I fully agree that this approach is just dumb. It just a series of formulas. I also agree that this approach does not encourage people to keep learning. After all why bother if you have the "if A then B" approach. This is the antithesis of the "complex" approach. I like the acronyms BTW! Still think we can do better. To expand on Bel's Biomechanics Incorporates The Complex Hypothesis; Simplicity Limits Accurate Prescription Or how about Complex Reasoning Abstract Paradigm or maybe Biomechanics Undertaken Like Linear Science, Helping Intricate Treatments No comment (on an open forum Regards Robert |
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Post by Admin on Mar 5, 2008 12:08:14 GMT
Hi Robert, So do we agree that in order to understand biomech there must be a simple paradigm to follow? I offer the "flat earth" paradigm - but I'm not saying its the only one. It's just that its so simple and workable (which is why I like it ;D). Following on from that I see no reason why frills and fritteries such as skives, planal dominance and the like cannot be used as long as they give the operator confidence in what he or she does. I just don't see much research out there showing that they make a huge amount of difference to the normal everyday orthosis  . Re - acronymns for the complex approach - I wonder if Advanced, Reliable and Sequential Evaluation could be fitted in anywhere? Regards, |
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Post by davidsmith on Mar 7, 2008 19:02:53 GMT
Dear All With respect to the premise that we do not need complex evaluation protocols to produce effective orthoses, here are some pro complex evaluation arguments. I need to pass thru a door to enter another room. 1) Minimal evaluation, I shoulder charge the closed door which crashes open bursting the hinges and I enter the room with excellent result. I thoroughly evaluate the mechanics of the door, approach it gently and turn the handle, apply a force to the door at the opposite side to the hinges and proceed into the room with excellent result. Finesse!! 2) At my local garage there are two excellent mechanics. one, Ben, has just the bare minimum of tools in one small steel toolbox. Another, Fred, has a huge collection of premium SnapOn tools that are kept in an impressive SnapOn tool chest the size of a small minibus. They both fix cars all day everyday using the same basic range of tools from each set respectively - with excellent results. However every now and then Fred finds he has just the right tool for the job. Fred fids the job a breeze. Ben however finds it a right thingy and spends all day cursing and swearing but in the end gets excellent results (as far as the customer is concerened) Ben didn't earn any bonuses that day tho. 3) In Fred and Ben's world cars don't change but methods and tools do. 25 years later - Ben has always had good results so he carries on fixin cars in the same way with the same tools. Fred on the other hand has invested heavily in the latest tools and car repair and service research. He wizzes thru 5 times as many cars as Ben and has cut the cost of servicing to his customers. He has also discovered ways of fixing some parts that previously could only replaced. Fred can now offer repairs that Ben can't, Ben might go out of business soon. Sitting back and thinking 'this is good enough' isn't good enough, it doesn't advance you one step. Being simplistic will fix most people most of the time but not everyone all of the time - shouldn't this be our ultimate goal? FFO's won't fix everything that you are presented with, so how will you evaluate the patient that need something else using your simple tool box. I don't believe that in depth evaluation and the ability to do in depth evaluation camn be replaced or equaled by simplistic paradigm. But I would say that wouldn't I  Cheers Dave |
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Post by robertisaacs on Mar 7, 2008 20:12:11 GMT
What he said. Dave S. The biomechanist i want to be when i grow up Karma RObert |
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Post by blinda on Mar 7, 2008 20:21:07 GMT
i still have patients asking for "steel inserts like Dr Troll".
Like Dave`s analogies, I`m definately/defiantly leaning towards the red corner....hope the Express Holiday Inn has reinforced doors.
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Post by robertisaacs on Mar 7, 2008 21:16:24 GMT
I shall call you darth Vectorvus. Welcome to the dark side. ;D Regards Robert |
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Post by billliggins on Mar 8, 2008 0:22:40 GMT
From the point of view of a 'non-biomechanist' it always gets back to the old problem.
If we cannot define normalcy then it does not matter which paradigm you use, complex or simple for defining the abnormal. That is why I tend to lean towards Tim's view, if it works according to the patient and the practitioner then it's acceptable. Having said that, Robert will be calling me a traitor to the scientific cause. We must keep on researching in order to define the normal and thus discover the abnormal. We will then be able to treat the abnormal using rational and scientific methods.
All the best
Bill
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Post by Admin on Mar 8, 2008 7:54:53 GMT
From the point of view of a 'non-biomechanist' it always gets back to the old problem. If we cannot define normalcy then it does not matter which paradigm you use, complex or simple for defining the abnormal. That is why I tend to lean towards Tim's view, if it works according to the patient and the practitioner then it's acceptable. Having said that, Robert will be calling me a traitor to the scientific cause. We must keep on researching in order to define the normal and thus discover the abnormal. We will then be able to treat the abnormal using rational and scientific methods. Well said Bill! ;D When "normal" is finally defined using robust science and logic, I predict it will contain much more natural variation than previously thought. The list of "abnomal" on the other hand, will be much shorter than currently recognised, and will veer more towards those conditions which are currently widely regarded as "orthopaedic" (ie pes pancakus etc). Cheers, David |
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