You may have been provided with a spinal orthosis which has been designed to meet your individual needs. These are otherwise known as back supports or back braces.

Spinal orthoses are provided to compensate for muscle weakness, paralysis or skeletal problems which cause spinal instability by aiming to:

• Control joint instability
• Prevent excessive joint motion
• Improve joint alignment
• Reduce joint pain

Spinal orthoses can be complex devices so their designs vary to suit each individual.

There are three main types:
1. Rigid devices with plastic or metal sections or supports.
2. Fabric devices.
3. A combination of rigid and fabric sections.

 

Spinal supports use abdominal compression to stabilise and protect the spine therefore need to be a secure fit. As a result, your spinal orthosis may be uncomfortable to wear in the initial stages.

If your spinal orthosis has been supplied to you as a direct result of a recent spinal injury then you should have been given an indication of HOW LONG FOR and WHEN you should wear the brace. This information should be given to you by a doctor or physiotherapist. Please make sure that you are aware of this information.

However, if your spinal orthosis has been supplied for any other reason then you should gradually increase the wear time with your device. This allows your skin to adjust to the supportive pressures which the device applies. Begin by using your spinal orthosis in a safe, indoor environment.

If your spinal orthosis becomes uncomfortable or painful then seek advice from the Orthotics department.

Skin care

It is advised to wear a layer of clothing between your skin and the device. A single layer of thin cotton clothing is recommended as this will help to wick away moisture from your skin. This will help to keep the skin and the device hygienic and minimize heat build-up. Unless you have been instructed by a doctor NOT to remove the device you should check your skin for any signs of marking or redness each time you remove it. If red marks persist for longer than 30mins or if the skin breaks down or blisters, discontinue use of the spinal orthosis and seek a review with your Orthotist. It is particularly important to check your skin daily if you have reduced sensation.

There is always a risk of pressure and rubbing when wearing a spinal orthosis.

Each time you use your device, check the straps and connections for wear and tear. Do not attempt repairs yourself. Contact the Orthotics department for review.u can arrange repairs with the Orthotics department.

Caring for your device

You can clean your spinal orthosis with a damp cloth and dry with a towel. Do not dry over sources of heat as this may deform the plastic. Check the device material regularly for any cracks or signs of wear and tear.

Putting on your spinal orthosis

Unless you have been recommended NOT to remove the device it is generally possible to put your spinal orthosis on when standing, sitting or lying down. However, you will probably find it easier to position and fasten the device when lying down. This will allow you to use both hands to fasten the straps and other fastenings. Ensure all straps on your spinal orthosis are fastened securely.

If you have been provided with a functional foot orthosis (FFO), or insole, it will have been designed to meet your individual needs.

The FFO is designed to influence your joint mechanics by:

• Preventing excessive joint motion
• Correcting a joint position
• Evenly distributing pressures
• Accommodating foot shape

FFOs aim to reduce pain and allow you to maintain an active lifestyle by addressing your specific symptoms.

As FFOs directly influence your biomechanics, they may feel strange and mild discomfort can be common following initial use. This should ease as you gradually wear in your insoles.

Wear time

You should gradually increase the wear time with your FFOs to allow your skin to adjust to the pressures applied to it. Please speak to your Orthotist for your recommended guidelines.

If your FFOs become uncomfortable, discontinue use. If the pain persists then seek advice from the Orthotics department.

Footwear

When selecting shoes to wear with your FFOs, look for the following features:

• Enclosed heel and toe
• Secure lace or velcro fastening
• Removable insole
• Heel height recommended by your Orthotist

It is important to select supportive shoes which are comfortable to maximise the benefits of the insoles.

Skin care

It is important to check your skin regularly for any signs of marking or redness. If red marks persist for longer than 30mins or if
the skin breaks down, discontinue use of the FFOs and seek a review with your Orthotist.

It is particularly important to check your skin daily if you have reduced sensation.

Caring for your FFO

You can clean your FFOs with a damp cloth. Do not dry over a heat source as this may deform the shape of the material.
FFOs will become worn with use and their longevity varies between individuals. If your symptoms recur or the insoles become
uncomfortable, this may indicate you require a new pair.

If you have been provided with orthotic footwear, it will have been designed to meet your individual needs.

Your footwear, and insoles, aim to support and protect your feet by:

• Reducing the risk of skin breakdown
• Distributing pressures evenly over your feet
• Providing cushioning
• Accommodating foot shape

Wear time

It is important that you wear your new footwear and insoles in gradually. The Orthotist will recommend a wearing in regime that best suits you. If you are unsure, please speak to your Orthotist.

Wearing your footwear

You should always wear socks or stockings with your footwear. This helps to wick away moisture from your skin and reduce friction between your skin and the shoe.

When putting your footwear on:

• Check there are no foreign bodies (e.g. stones, coins) inside your shoe
• Ensure there are no wrinkles in your socks
• Locate your heel securely against the back of your shoe
• Fasten the laces/velcro securely

Skin care

Each time you remove your footwear, check your skin for any signs of rubbing or skin breakdown. This is especially important if you have poor sensation.

If you notice any redness on your skin which persists for longer than 30minutes after removing your footwear, contact the Orthotics department for a review. There is always a risk that your footwear will rub and mark skin.

Caring for your footwear

It is your responsibility to ensure your footwear is kept in good repair.

Leather
Clean with a damp cloth, taking care not to soak the leather. Allow to air dry before applying wax/polish to improve the waterproofing properties of the leather and keep it soft.

Nubuk/Suede
Clean with a damp cloth. Once dry, apply a nubuck/suede spray.

Neoprene
Clean with a damp cloth when removing dirt or stains.

Footwear repairs

The heels and soles of your shoes will wear with use. Repairs can be arranged with your local cobbler to maintain the safety and longevity of your footwear. If your footwear has any sole adaptions, it is advised to arrange repairs with the Orthotics department. Footwear should be clean when brought to the department for repair. Heavily soiled footwear will be returned for cleaning.

Review

If this is your first pair of Orthotic footwear, your Orthotist may arrange a review to discuss your progress.

If your footwear becomes uncomfortable, or any issues arise, you should contact the department for review.

Sometimes there will be choices to be made about your care and we encourage you to be a partner in your healthcare.

When patients work with healthcare professionals to make decisions on their health care plan and treatment, this is called shared decision making.

Before your appointment

It can be helpful to write a list of questions that you would like answered and have these with you during your appointment, along with a pen and paper to write things down.

During your appointment

If you are asked to make a choice about your care, you may have lots of questions. The following three questions can be a good place to start:

• What are my choices?
• How do I get information and support to help me make a decision that is right for me?
• What are the pros and cons of each option for me?

 

Attention allows the brain to effectively sift through the vast quantities of sensory and cognitive information it continuously receives and can be considered to optimise cognitive processing. Attention can be divided into three anatomical networks: alerting, orienting and executive. Each of these represents a distinct process, and they work independently but also interact.

Attentional fluctuations are one of the cardinal features of Dementia with Lewy bodies and also feature prominently in Parkinson’s disease. Current medical treatments for memory and thinking problems in dementia are in the form of attention boosters. Interestingly it is not known whether caffeine, the most widely taken stimulant, ingested by 90% of adults on a daily basis, has any direct, beneficial effect in Parkinson’s disease or dementia. In this study we examine whether caffeine improves specific subtypes of attention in patients with Dementia with Lewy bodies, Parkinson’s disease and healthy individuals.

How does the trial work?

We will randomly allocate you either caffeinated or decaffeinated coffee and then ask you to complete computerised tests of attention and a 20 metre timed walk. You would need to be able to attend 4 times over a 9 day period and will have to stop drinking tea/coffee for 1 week (we will give you a supply of decaffeinated tea/coffee to drink instead!).

Participants

We are recruiting 3 groups for this study:

• people with Dementia with Lewy bodies
• people with Parkinson's Disease
• healthy older adults (without any other neurological conditions).

If you wish to take part in the study, please contact us. 

Swelling (Oedema)

Swelling of your residual limb (stump) will occur after amputation but this will gradually reduce and your leg may continue to shrink for many months.

Swelling may be kept under control by elevating your stump and the use of a compression sock (shrinker).

A member of the clinical team will advise you how and when to wear your compression sock.

Phantom Limb Sensation

Phantom limb sensation is an extremely common occurrence. It can be a painful or non painful feeling where the limb is not present.

Although the body has lost a limb, the brain still has the old geography (map) wired in and therefore it still transmits pain signals.

If you are experiencing phantom limb sensations, please discuss this with the clinical team.

The staff who look after you:

Nurse Specialist - provides wound care, general advice on issues such as diabetes and pain management, including phantom limb pain. She is also able to prescribe medications in relation to pain and infections associated with your amputation.

Physiotherapist - provides the treatment for local patients and coordinates the provision of physiotherapy if you live outside the local area.

Occupational Therapist - teaches upper limb patients to use their artificial arm, and advises patients on how to achieve as much independence in the activities of daily living, such as washing, dressing and cooking. They will also advise both upper and lower limb patients on wheelchairs, driving, return to work and leisure activities.

Podiatrist - assesses and advises you on how to look after your remaining foot.

Counsellor - talks with patients and family members either before or after their amputation. They can help with the many
difficult emotions and feelings which often occur around the time of amputation or if a child is born with a disability.

Prosthetist - prescribes your prosthesis (artificial limb) and provides all ongoing care.

A team of specialist technicians make all the artificial limbs on site and also carry out any ongoing repairs.

Reach
Reach is a friendly, caring place for children and young people with upper limb differences and their families.  They give support and information to inspire and build confidence.  There are local branch networks throughout the UK and Ireland that provide support and an opportunity for children and parents to meet. Connecting families is a vital part of Reach’s work and the bonds this creates is priceless.  Whether it’s at our family weekend, branch meetings or on a Facebook forum, they help members to build relationships that last a lifetime. For more information visit www.reach.org.uk or telephone 0845 1306 225.

Steps
Steps are a national charity supporting children and adults affected by a lower limb condition such as clubfoot or a hip condition. For more information visit www.steps-charity.org.uk or telephone 01925 750271.

Meningitis Now (formerly Meningitis Trust)
Meningitis Now were the first meningitis patient group in the world, founders of the meningitis movement and the only charity dedicated to fighting meningitis in the UK. For more information visit www.meningitisnow.org or telephone 0808 8010388

Blesma
Blesma exists to guarantee that our limbless veterans are not failed, forgotten or left to fend for themselves. For more information visit www.blesma.org

Limbpower
Limb Power was launched in November 2009 to engage amputees and individuals with limb impairments in physical activity, sport and the arts to improve quality of life and to aid lifelong rehabilitation. For more information visit www.limbpower.com

The British Association of Prosthetists and Orthotists (BAPO)
For more information visit www.bapo.com

Changing faces
Changing Faces supports and represents people who have conditions or injuries which affect their appearance. For more information visit www.changingfaces.org.uk or telephone 0207 391 9270.

Sports Activities

Deloitte Parasport
Deloitte Parasport is designed to inspire, inform and signpost disabled people and those interested in disability sport to high quality opportunities. For more information visit www.parasport.org.uk  and use the search tool to find local clubs.

Bristish Atheletics
For more information visit www.britishathletics.org.uk and click 'Grassroots’ tab and select ‘disability athletics’ to find out more about competitive athletics.

These are core exercises that can be completed following a below-knee or above-knee amputation.

If you are unsure what to do, please do not attempt the exercises, but contact your Physiotherapist for advice.

Try aiming to do up to 10 of each exercise, up to twice a day. If you experience any pain or discomfort stop doing the exercises and seek advice from a Physiotherapist.

If you require exercises for a different level of amputation, please ask a Physiotherapist.

P.I.R.P.A.G. (Physiotherapy Inter Regional Prosthetic Audit Group) - Physiotherapy Exercises following Transfermoral (above knee) Amputation 

P.I.R.P.A.G. (Physiotherapy Inter Regional Prosthetic Audit Group) Physiotherapy Exercises following Transtibial (below knee) Amputation