Sensory Foot Orthotics for balance and movement enhancement

We know that peripheral sensory inputs are important for controlling movement strategies in both cyclical and emergency tasks (e.g. during a trip). There are a wide range of clinical groups where sensory neuropathy affects the ability to perceive load and movement and thus movement control strategies operate whilst the tasks and limb segments are underspecified and are thus susceptible to poor movement outcomes. This leads to less regular movement patterns, greater risk of movement related accidents in people who are otherwise vulnerable/frail.



Prior work in the Salford group was funded by the Brian Injury Trust and involved working directly with people suffering from sensory impairments in the feet to understand their experiences of the sensory loss on their movements, footwear and confidence in walking/moving. This revealed a range of individual unmet needs but also a willingness to seek out sensory technologies that could compensate for their lost sensation. The literature also reveals the location and nature of sensory deficits, and work in the Salford group has identified some association between sensory loss and balance control. This included development and implementation of a foot specific assessment of sensory deficits (modified RASP). The Literature also reveals region specificity in the effects of sensory stimulation at the level of the foot, with different muscle groups and movement strategies affected by different patterns of stimulation.



Finally, a prototype vibrating insole platform has been developed with Salford Royal Hospital Trust Medial Physics department, as a means of demonstrating the ease of construction and use of sensory stimulation to the sole of the foot.



This PhD aims to:

Map lower limb and foot sensory deficits in specific populations

Develop and evaluate different modes (location, frequency, timing of) vibration on movement tasks in vulnerable older adults.

Conduct a clinical study of people living with an ambulatory stimulation system that augments their peripheral sensation

Work plan



Conduct PPI work to ensure end users inform research focus and design

Continue existing work using modified RASP to map nature and location of sensory deficits in older adults and stroke survivors. Studies on n = 50 in each group

Develop lab based stimulation system for use during ambulatory tasks

Investigate effects of sensory stimulation at sites of sensory loss and intact sensation in older adults and stroke survivors.

Implement lab based sensory stimulation system in feasibility trial for home use over 7 days

Conduct PPI to capture experiences during trial and roadmap to clinical devices (e.g. suitable for i4i funding)

The CDT students will help create solutions for amputees and people with debilitating conditions such as stroke and diabetes, reducing mortality and enabling them to live more satisfying, productive and fulfilling lives. These solutions, co-created with industry and people living with disabilities, will have direct economic and societal benefits. The principal beneficiaries are industry, P&O service delivery, people who need P&O devices, and society in general.
Industry
The novel methods, devices and processes co-created with users and industry will have a direct economic value to our industry partners (by the creation of IP, new products, and improved industry and academic links). Our CDT graduates will be the natural potential employees of our industry partners and for companies in the wider healthcare technology sector. This will help address the identified critical skills need and shortage leading to improvement in the UK's competitiveness in this rapidly developing and growing global market. The CDT outcomes will help UK businesses spread risk (because new developments are well founded) and more confidently enter new markets with highly skilled employees (CDT graduates).

P&O service delivery
Doctoral engineering graduates with clinical knowledge are needed to improve the deployment of advanced technologies in practice. Our main UK industry partner, Blatchford, stated: "As technology develops it will become easier for the end-user (the patient), but the providers (the clinicians) are going to need to have a higher level of engineering training, ideally to PhD level". The British Association of Prosthetists and Orthotists estimates that no more than ten practising P&O clinicians have a PhD in the UK. Long-term P&O clinical academic leadership will be substantially improved by the CDT supporting a select number of clinically qualified P&O professionals to gain doctorates.

Users
The innovation of devices, use of device and patient monitoring, and innovation approaches in LMIC should not only lead to improved care but also lower healthcare costs. Diabetes UK estimates that the total healthcare expenditure related to foot ulceration and amputation in diabetes was £1billion (2014-15), with 2/3 of this related to foot ulceration. Small innovations could lead to large cost savings if targeted at the right aspects of care (e.g. earlier adoption, and reducing device abandonment).
An ability to work is fundamental to a person's place in society and their sense of purpose and has a significant societal impact in all territories. This is perhaps greatest in LMIC where attitudes towards disability may still be maturing, and appropriate social care infrastructure is not always in place. In these cases, an ability to work is essential for survival.
Improved design approaches will impact on all users regardless of context, since the device solutions will better match local and individual user needs. Addressing issues related to prosthetic/orthotic device abandonment (e.g. cosmesis) and improved adherence should also lead to greater social participation. Improved device solutions will shift focus from what users "cannot do" to what they now "can do", and help progress attitudes towards acceptance of disability.
Societal
The majority of the global P&O users are of working age, and a key economic impact will be keeping users in work. The average age at amputation due to diabetes is just 52 in the USA but much younger in countries with less well-developed health care and trauma services (e.g. 38 in Iran). Diabetes UK reports that 35-50% of people are of working age at diagnosis and that there are around 70,000 foot ulcers in the UK, precursors to amputation. There is a similar concern for stroke survivors around a quarter of whom are of working age and are 2-3 times more likely to be out of work after eight years.