Gazettethe THE NEWSLETTER OF THE AUSTRALIAN ORTHOTIC PROSTHETIC ASSOCIATION INC.

Volume 12 - Issue 4 / December 2012

Orthotic management of patients with Amyotrophic Lateral Sclerosis

In This Issue President’s Report 3 Office and Membership Report 3 2012 AOPA Planning Day 4 The AOPA 2013 Strategic & Operational Plan 5 Update on State Activities 7 Orthotic management of patients with Amyotrophic 8-9 Lateral Sclerosis Member Biography: Jackie O’Connor 9 Definition of allied health 12 Allied Health Professions Australia 13 AOPA Congress 2013 - Call for presentations 13 AOPA Executive & National Council 15 State Section Office Bearers 15

President’s Report Office and Membership Report

The AOPA National Council recently held the annual It has certainly been a busy and exciting year for the Association. As we strategic planning day in late October, and an enter this last quarter we are pushing to finalise a number of projects and overview of this event is outlined in this edition of the are also reflecting on the achievements of 2012. Membership renewals and gazette. The primary objective of the planning day is CPD reporting is a major task of the Association in the third quarter. The to consolidate the Associaion’s plans for 2013, whilst National Office is happy to report that all membership renewals, CPD logs providing us with an opportunity for review of past and CPD auditing has been completed and we are looking forward to an activities and achievements. Many achievements have improved and streamlined process next year with the implementation of a been made during Richard Dyson-Holland’s term of new website and database system. This will be a significant membership presidency and we thank him again for all his time and and office operational benefit that National Council and the Office intends to dedication to AOPA. roll out in the 2013/14 financial year.

Perhaps our most significant developmental leap under The National Annual General Meeting (AGM), Meeting of Special Resolution Richard’s leadership has been the establishment of (MSR) and CPD event was another highly successful event. We welcome our new national Office, and the appointment of a the new Board members to the National Council, including Harvey Blackney new Executive Officer and retainment of a valuable (President), Jackie O’Connor (Registrar) and Paul Sprague (Vice-President). Administrative Officer. This has provided AOPA with the Colin Aburn was also re-elected into the Treasurer position. Further to the requisite infrastructure platform and skill set to meet the AGM elections, we have also welcomed Sarah Anderson into the casual demands placed on a modern allied health association. vacancy Vice-President position. It is pleasing to see the number of high The recently increased annual membership fees have quality nominations for Office Bearer positions. Our newly elected Office been well supported by the membership and now Bearers have hit the ground running this year with a very productive planning provides our Association with the funding base required day held in late October, the details of which can be found over the page. to execute the key strategic plans AOPA has outlined. The National Office continues to represent the membership in a number Further to the creation of much needed organizational of consultations. We have provided another submission to the National infrastructure and capacity, Richard’s term as president Disability Insurance Scheme (NDIS) taskforce. This focused on the elements has also seen the running of two highly successful of individual assessment and long term planning and our submission can be annual Congresses, ably managed by Sally Cavenett found in the member essentials section of the website. A more significant and her team. The Congress has received outstanding consultation occurred in late September being the Australian Competition support from the membership and much positive and Consumer Commission (ACCC) report to the Senate regarding Private comment. AOPA has also delivered substantive Health Insurance. This is an annual inquiry, however unique to this year submissions and contributions to a broad range of was the specific focus on issues that reduce the extent of health cover initiatives including the NDIS, workforce development, and increase consumer’s out of pocket expenses, particularly focusing registration, Medicare funding, and many more. There on the discriminatory basis in which private health insurance companies is much being done by AOPA to advance the profession choose not to recognise some allied health providers. AOPA provided a and lay the foundation for a successful future. Whilst detailed submission which is available to view on the website and also reflecting on what has already been achieved, the provided representation at an invitation only meeting with the ACCC in late current Executive team and National Council are aware September. We look forward to hearing the outcome of the report after it there is still much to do to ensure the membership is has been received by the Senate in early 2013. fully informed and integrally involved in the future steps we take. Our current membership statistics are outlined in the table below. We are pleased to report relatively stable membership numbers overall, with Over the next 12 months we will see some further a slight decrease in full time members, but an equivalent increase in significant shifts in how the Association operates. To part-time members*. We have also heighten efficiency, the national Office will aim is to had a significant increase in student Members Number centralise administrative processes wherever possible, membership uptake, and we welcome and to ensure all efforts made by members in any student members Claire Jessup, Full time 228 capacity or location are translated into successful Heather Stewart, Jude Doherty, Udo Part time 37 outcomes. We hope to have the support of the Foerster, Sarah Bell, Thomas Garnier, Student 36 membership in these times of change. Emma Davis (BRM Grant Recipient), Leave of absence 21 Joseph Murray, Marc Spence, Alison Our profession faces tremendous challenges over the Schenk, Jessica Dunn, Claire Harms, Retired 9 next five years, and major shifts across all areas of Joshua Carey, and Kate Doodson to Life 7 health are forecast. Long-term structural changes are the Association. We would also like to Total practicing underway, and these changes will significantly impact 265 welcome full members Radhika Van members* how we are able to deliver services to our clients in the Rooyen, Claudia Doebrich, and Louise future. Both public and private sector groups will need Toose to the Association. Total Members 338 to embrace the new environment and creatively drive * Based on ABS census 2006, AOPA change. This period of transition provides opportunities members represent 79% of the profession for the profession that have not existed in the past. It will be an exciting period, and the executive urges all Please continue to make your enquiries to the Office via phone or email members to keep abreast of all activities undertaken by [email protected]. Should you have any suggestions or feedback the Association. regarding your professional association, please do not hesitate to contact us. Yours respectfully, Harvey Blackney Leigh Clarke and Sue Laksassi President, The AOPA Inc. Executive Officer and Administration Officer, The AOPA Inc. [email protected]

The Gazette / Volume 12 - Issue 4 / December 2012 / 3 2012 AOPA Planning Day

The AOPA held its annual planning day on Friday 26th October Another major undertaking 2012. The purpose of this meeting was to create a new strategic over the past 12 months has and operational plan for the AOPA to pursue in 2013. An been a review of the current extensive range of topics were covered and issues pertinent to AOPA CPD program. A new CPD the efficient and effective running of the Association discussed. committee was formed last year This report aims to focus on the progress of projects identified as and this team has been working most important to the majority of members. on clarifying existing discrepancies within the current CPD program as well as The meeting was attended by the current AOPA Executive developing more rigorous guidelines for processing applications Council, National Council state representatives (exception of for CPD event accreditations and applications from members for Peter Digance on behalf of Bridie Howley), our Executive Officer, special consideration or leave of absence. A document is also Administrative Officer and Richard Dyson-Holland as the outgoing being developed outlining the procedure for managing non- President. Details of our current Executive and National Council compliance of CPD. These new documents and guidelines are can be found on the final page of this Gazette. currently being finalised and will become available to members early next year. Planning Day commenced with a motivating welcome address from incoming President, Harvey Blackney. Our Executive Officer, A topic of great interest to many members is the ongoing Leigh Clarke, presented a review of outcomes against the 2012 struggle for Orthotist/Prosthetists to be nationally recognised by Strategic and Operational Plan. This review demonstrated how Medicare. The current lack of Medicare recognition has numerous much has been achieved in 2012 and the results of this review consequences for the profession including many challenges in can be found on the AOPA website. achieving funding and a lack of general parity with other Allied Health professionals. The AOPA considers the ongoing process Over the course of the day, proceedings included a presentation of lobbying for Orthotist/Prosthetist inclusion on the Medicare and discussion regarding the current structure of the Association, Benefits Schedule (MBS) to be a major task for 2013. Our alternative Association and Company Board models, benefits and Executive Officer had a recent face-to-face meeting with Bronwyn limitations and opportunities for optimising efficiency within our Taylor, Advisor to Health Minister Hon. Tanya Plibersek, with some current structure. The National Council has identified inefficiencies very positive outcomes, including a planned meeting early next within the current Association structure and will begin preparing year with the MBS Advisor and Bronwyn Taylor in Canberra. a case for restructure following further research. An informative re-education on the Association’s finances and how to accurately Other major topics discussed throughout the planning day read financial statements was also provided. Appropriate included: governance of not-for-profit associations is increasingly required, • the future structure of the Association and governance and AOPA is working hard to fully modernise our governance platforms; platform and ensure that all AOPA officer bearers are educated, engaged and informed. • organisational efficiencies and planned national changes for 2013; The AOPA regularly communicates and engages with members • Private Health Insurer status and strategies (including the in numerous formats, including state-based general meetings, current ACCC action); monthly eBlasts, the quarterly Gazette and uploads to the • state and national education strategies; website. Our review of communication techniques revealed that the most successful formats appeared to be the national AGM/ • International Health Practitioners and membership application CPD event, state-based general meetings, state-based CPD policies and procedures; events and positive member interactions with state National • AOPA finances and budgetary considerations; and Council representatives. A ‘State Communication procedure’ • 2013 Congress planning and status. is currently being developed by a team of South Australian members to aid in understanding the role of the state sections I am happy to say that this was the most productive and efficient and office bearers and aims to summarise the way in which state AOPA planning day that I have attended. Preparation was sections should function and communicate with the national thorough, attendees were well informed and participation and Office and members. This important document will streamline discussion was extensive, passionate and with direction. As a processes for the states and assist new office bearers to more result of this, the 2013 Strategic and Operational Plan has been seamlessly integrate into their new position. formulated and is outlined below.

Whilst all Association documents are available on the AOPA The current Executive and National Council welcomes any website, it appears members are not regularly logging on enquiries regarding milestones and achievements in 2012, and to access and utilise these resources. In January 2013 the the strategic and operational plans for 2013. We urge all AOPA Association will begin the process of website redevelopment and members to contact us at any time to discuss historical actions database implementation. This will provide us with a platform and our plans for 2013. for improved member communication of AOPA activities and easier access to relevant information for members. This major IT Rebecca Bowes investment will be finalised at the end of June 2013 and will result Secretary, The AOPA Inc. in a more streamlined communication tool for our membership and the general public. Of significant benefit to the membership will be the dramatically improved CPD Activity Logs, membership renewal processes and tools for social interaction and web based CPD.

4 / December 2012 / Volume 12 - Issue 4 / The Gazette The AOPA 2013 Strategic & Operational Plan

To promote the profession and its role at the policy level, the Goal 1 professional level and to the public. Objectives 1) Providing expert opinion regarding Prosthetics and Orthotics within State and Federal & TASKS funding schemes, such as; • the National Disability Insurance Scheme • State based equipment schemes • Insurance schemes • Private Health Insurance models

2) Ongoing development of the pathway to authorised Self Regulation in association with similar peak professional bodies, including; • Developing and refining self-regulation processes and procedures • Ensuring the Rules and Statement of Purpose reflect current self-regulation practice and Association growth requirements

3) Continued development of the Prosthetic and Orthotic workforce and recognition of the profession both domestically and internationally, including; • Collection, analysis and publication of workforce data, • Pursuing immigration recognition to promote skilled migration, • Re-categorisation of Orthotist/Prosthetists to be considered with and equivalent to other allied health professions, for example, within ANZSCO codes, Private Health Insurance Act and Medicare • Continuing the process of formalising the accreditation process to consider applications to the AOPA from potential members with overseas qualifications. • Pursuing the pathway through the Medical Services Advisory Committee for inclusion of a clinical service on the Medicare Benefits Schedule for the services of Orthotist/Prosthetists. • Continuing the consultation and submissions to funding bodies and government departments to pursue member and professional recognition and equality with other allied health professions. GOAL 2 To provide services to members. Objectives 1) Improve member engagement and communication, through; & TASKS • Streamlined communication strategy • Improved website usability, including the reformatting and updating of information • The use of varying communication mediums

2) Maintain and review the Continuing Professional Development processes; • Review the CPD process and determine any alterations that are required • Improve website functionality to support the ease of CPD reporting for members • Developing supporting Guidelines and Procedures to improve office efficiency in CPD management

3) Development of Education events for members; • Continue with AOPA Congress Events • Explore varying education formats to support CPD event access Nationally • Create a longer term plan for future CPD events and member education GOAL 3 To provide effective and sustainable administration. Objectives 1) Investigate more efficient organisational models for the Association. & TASKS 2) To create Operational Procedures and Policies to further operational clarity, transparency and sustainability of the AOPA National Office and the Association in general.

The Gazette / Volume 12 - Issue 4 / December 2012 / 5

Update on State Activities

The AOPA Executive and National Council are continually in need of and thankful for the support they receive from the local state committees. We encourage all members to engage regularly with their local office bearers in order to stay up to date on the numerous projects and activities that are being undertaken by National Council. In addition, AOPA are always looking for members to volunteer their time and expertise to assist with the progression of submissions and other specific projects to assist in meeting the 2013 strategic and operational goals.

The state sections have recently held their AGMs and elected new office bearers for the coming year. The AOPA would like to take this opportunity to thank all outgoing state office bearers for Victoria their hard work, dedication and support of the Association. Details Back in the east, the Victorian section recently held a very of current state office bearers are provided on the back page of interesting education session in conjunction with their AGM. this Gazette. Dr. Gerald Powell (Orthopaedic Surgeon, St. Vincent’s Hospital) presented on ‘Amputation and Limb Salvage for Musculoskeletal Around the nation we continue to see high quality CPD events Tumours’, followed by a presentation from Orthotist Andrea de being held to provide educational opportunities for members Rauch on ‘Orthotic Management Following Limb Salvage’. to enhance professional knowledge and promote stimulating discussions amongst colleagues. Tasmania New South Wales Tassie is still limited in AOPA based activity due to the very small AOPA member base, which means it does not meet the The NSW section recently held an event where Michael Storey requirements to become an official ‘state section’. However, presented a fascinating case study on the fitting of a hip- members still remain active in finding educational resources to disarticulation client with a microprocessor knee and innovative assist with meeting their individual CPD requirements. Member socket system. Michael was joined by Cameron Ward who John Semmens is presenting at the upcoming Tasmanian Arts provided the membership with an “insiders” view of the recent Health and Wellbeing State Conference exploring ‘Prosthetics 2012 Paralympic Games in London. and Orthotics – works of art and works of health’ – an interesting and innovative concept that aims to explore the links between Queensland individualised designs for artificial limbs and orthotic devices, and Further north, the Queensland membership had the opportunity the inclusive nature of allowing patients to be involved in decision to attend an educational session focusing on the prosthetic and making around their prosthetic and orthotic needs. orthotic management options for complicated foot pathologies. The Victorian state committee will be distributing a survey in David Sweet from Goodwill Orthopaedics presented an interesting January 2013 to all Victorian members to initiate discussion and case study discussing the prosthetic management of a symes- interest in developing a ‘Continuing Professional Education Plan’. level amputation utilising advanced silicone technology. This Member feedback from this survey will help to form a framework was followed by a presentation from John Coffey with a series around which educational sessions will be organised and of short case studies outlining x-ray findings from patient’s with structured. complicated foot conditions. This was a great opportunity for Queensland clinicians to be exposed to complex scans and The NSW section would like to update members on the progress encouraged discussions around appropriate management of the current tender for amputee services. This tender continues options. to be evaluated by the NSW Health selection panel and the Prosthetists of the state are highly anticipating the results. At this Western Australia point in time, the evaluation process has already taken almost three months. The lack of high level, evidence based early Over in the far west the skies remain blue and the sun continues amputee management established under a prior tender structure to shine. The West Australian section has planned a Christmas continues to restrict the functional outcomes of many of our new breakup and CPD event being presented by Ferg d’Ardis from prosthetic clients. Whilst currently stuck in a stasis, the NSW SiliconCoach, a valuable biomechanical video assessment tool profession eagerly awaits the opportunity to move ahead. specially designed for the P&O profession. On a more positive note, prosthetic and orthotic facilities South Australia throughout Australia will have recently had the opportunity to mentor 4th year La Trobe University students completing their final South Australian members have been exploring the ins and clinical placements. All reports suggest the quality of this year’s outs of management of Charcot feet. Their recent CPD session upcoming graduates to be exceptional. Most facilities will be ran in the format of a focus group where members were invited hoping to attract these new graduates to return to their state for to discuss the way in which Charcot feet are managed within establishment of their individual P&O careers, with many exciting member’s respective facilities, both from a multidisciplinary employment opportunities already existing around our states. approach and an individual clinician perspective. The goal of the focus group was to help design a standardised treatment protocol Announcements for dates of state general meetings and CPD to help with continuity of treatment aims and modalities. SA was events will continue to be advertised on the AOPA website also very fortunate to have guest presenter Aideen Curran from (www.aopa.org.au) under the member documents section. Otto Bock attend one of their recent CPD events to provide a valuable overview on custom silicone prostheses. Let’s keep up the great work!

The Gazette / Volume 12 - Issue 4 / December 2012 / 7 Orthotic management of patients with By Hannah Ozturk

AOPA student member Hannah Ozturk is a Graduate Entry Masters body death, progressing to reduced excitatory activation to student at La Trobe University who started third year in the combined the muscle fibres, culminating in their subsequent atrophy (Shaw, degree (Bachelor of Health Sciences / Masters in Clinical Prosthetics 2000). There is no cure for ALS, with patients surviving on average and Orthotics) in 2012. Hannah has previously completed a Bachelor 2-4 years. The condition is relatively rare with less than 600 new Degree with Honors in Mechanical Engineering and Science. cases diagnosed in Australia each year, and a current prevalence Following is an interesting piece of work Hannah submitted as part of approximately 1 in 15,000 Australians (Australian Bureau of of the new unit ‘‘Foot and Ankle Orthotics Evidence”. Statistics, 2009). Does the type of ankle foot orthosis worn by patients with Irrefutable diagnosis of ALS is challenging due to the absence of Amyotrophic Lateral Sclerosis in Stages I - III of disease a biological diagnostic marker (Dengler et al., 2005, Brooks et al., progression affect their gait performance? 2000). The El Escorial Criteria (Brooks et al., 2000) is the most widely used diagnostic tool, and uses medical history, gait, EMG, Summary MRI, nerve conduction velocities and the Babinski sign to acquire evidence of both upper and lower motor neuron degeneration and The window of ambulatory time for patients with Amyotrophic progressive spread of symptoms. Ancillary tests exclude other Lateral Sclerosis (ALS) is small, thus, the onus is on the orthotist diseases. If diagnosis is confirmed early and correctly, it can assist to accurately match the right orthosis to the patient’s progressively greatly with tailoring appropriate interventions to maintain quality of diminishing muscular strength. There is little evidence however, to life during disease progression (Andersen et al., 2005). assist clinicians to select AFO design features which maximise gait performance for ALS patients through each disease stage. This Individuals with ALS, similar to those with Huntington's and paper aims to synthesise relevant literature and ultimately provide Parkinson's disease, have been shown to have a less steady and a useful summary of AFO design features which maximise gait more rhythmically disorganised gait pattern (Hausdorff et al., 2000). performance during ALS disease Stages I - III. Results of evidence Specifically, stride duration is both longer and fluctuates to a greater search indicate that AFO choice does impact gait performance, in extent between strides than that of healthy individuals. As a result, self- particular study of shank progression during stance phase of gait selected walking speed of ALS patients is significantly lower than that is a particularly sensitive and systematic tool to help to individually of healthy individuals and steadily reduces with disease progression. tailor AFO selection to a very diverse ALS patient population. Eventually, unassisted ambulation is no longer possible, with 50% Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressing, of individuals requiring ankle foot orthotic (AFO) intervention at degenerative motor / neurological condition, most commonly approximately 45% of their disease progression to counteract manifesting between 50-70 years of age. In 90% of cases, it occurs foot-drop. At 75% of disease progression, three-quarters of sporadically, leaving patients with often as little as ~3-6 months ALS patients are no longer ambulant, with significant atrophy of of ambulation independence before requiring a wheelchair for quadriceps resulting in an inability of the muscles of the lower limb mobility. It has been demonstrated that patients who are actively to support body weight, and a wheelchair required for mobility ambulant during this time have reduced depressive symptoms (Bromberg et al., 2010). and increased cardiovascular health (Dal Bello-Haas et al., 2008). Degeneration of deep and superficial peroneal and tibial nerves Threats to independent ambulation include foot-drop and instability results in tri-planar muscle weakness around the foot and ankle. brought about by increasing tri-planar muscular weakness. Orthotic Ankle dorsiflexors are unable to clear the forefoot during swing, resulting intervention plays a vital role in prolonging independent gait in foot-drop and high risk of falls. As shown in Figure 1 below, reduced counteracting these deficits and ensuring safety and confidence plantarflexion capacity due to weakened superficial and deep posterior through increased gait performance. compartment muscles, cause uncontrolled shank progression, limiting

Of the five general classifications of Motor Neuron Disease, ALS 3rd and 4th rocker stages of gait (Owen, 2010), and contributes to the is the most common and affects both upper and lower motor above stride fluctuations. This, coupled with significantly decreased neurons, causing weakening and atrophy of muscles of the lower inversion and eversion strength, results in an ALS patient's reduced limb (Beresford, 1995). The aetiology of ALS is still unknown stabilising capability during quiet standing and stance phase of gait; with damage to neurofilaments via a combination of genetic and manifesting in loss of balance particularly when negotiating uneven biochemical factors hypothesised as the most likely pathogenesis terrain (Hillel et al., 1989). Without assistance, individuals with (Ng & Khan, 2011). Degeneration begins with motor neuron cell moderately advanced stages of ALS are unable to maintain centre of mass anterior to the knee joint or within their base of support. For those patients whose primary goal is to prolong ambulation, studies have shown that a physiotherapist and orthotist from a multidisciplinary team can work together to address foot drop and balance problems during gait (Ng & Khan, 2011, Gordon & Mitsumoto, 2007). However, treating foot-drop in ALS patients is challenging as muscular atrophy occurs at advanced and varying rates between limbs. Not only does body

Figure 1. Adapted from Owen, 2010. Owen’s clinical algorithm for the design and tuning of AFO’s provides a method for assessing ALS patient gait according to shank kinematics during stance phase of gait as tri-planar weakness progresses, and prescribing the AFO to optimise gait performance.

8 / December 2012 / Volume 12 - Issue 4 / The Gazette Amyotrophic Lateral Sclerosis

weight steadily decline, but the cross-sectional area of the patient’s In conclusion, rapid muscular shank reduces, leaving the AFO loose and increasingly ineffective. atrophy and subsequent tri- References: Andersen P.M., Borasio G.D., Dengler R., Hardiman O., As such the weight, flexibility and force application of the AFO, planar weakness of the lower Kollewe K., Leigh P.N., Pradat P.-F., et al. (2005). EFNS task and the distribution of these design parameters within the device limb in ALS patients affects gait force on management of amyotrophic lateral sclerosis: becomes increasingly influential on the patient’s gait performance as performance in a stage-wise Guidelines for diagnosing and clinical care of patients and relatives: An evidence-based review with good practice disease progresses. Thus, effectiveness of an AFO for ALS patients fashion and thus AFO prescription points. Journal of Neurology, 921–938. doi:http:// relies heavily on the orthotist's diligence in regularly assessing fit should be sensitive to precise dx.doi.org/10.1111/j.1468-1331.2005.01351.x and mechanical appropriateness. Modifications and re-tuning of the kinematics of the shank during Australian Bureau of Statistics. (2009). Australian Mortality AFO should be performed such that efficiency of mobility and safety stance phase of gait. A broad Rates for Motor Neuron Disease. General Record of Incidence of Mortality. Australian during gait can be optimised. review of the literature highlighted Institute of Health and Welfare. Beresford, S. (1995). several studies which either Motor Neurone Disease (Amyotrophic Lateral Sclerosis). A broader review of the literature identified four studies: Dal Bello- related particular gait symptoms London, United Kingdom: Chapman & Hall. Haas et al., 1998; Gordon & Mitsumoto, 2007; Hillel et al., 1989; & to AFO choice for improved gait Bromberg, M. B., Brownell, A. A., Forshew, D. A., & Swenson, M. (2010). A timeline for Owen, 2010, which when viewed together in Table 1 below provide performance, or, disease stage a comprehensive evidence summary to assist optimisation of gait predicting durable medical equipment needs and to gait performance. Together, interventions for amyotrophic lateral sclerosis patients, performance in Stages I-II of ALS. Owen's clinical algorithm (Figure when synthesised into tabular Amyotrophic Lateral Sclerosis, Informa Healthcare. 1) could be especially useful as it would allow clinicians to assess Amyotrophic Lateral Sclerosis, 11(1-2), 110–115. form, a helpful summary of ALS doi:10.3109/17482960902835970 shank kinematics in detail at any time during disease progression disease stages, indicators for gait Brooks, B., Miller, R., Swash, M., Munsat, T., & World and re-tune the AFO's accordingly. abnormalities and subsequent Federation of Neurology Research Group on Motor Neuron Diseases. (2000). El Escorial revisited: revised Synthesis of literature to evaluate AFO material characteristics AFO design choice for optimal criteria for the diagnosis of amyotrophic lateral sclerosis. provides useful evidence regarding stiffness, weight, thickness gait performance has been made. [Review]. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders, 1(5), 293–9. Retrieved from http:// and durability of AFOs and translates effectively to application for ovidsp.ovid.com/ovidweb.cgi? T=JS&CSC=Y&NEWS=N treating foot-drop and instability in ALS patients but are beyond the Hannah Ozturk &PAGE=fulltext&D=med4&AN=11464847 scope of this study so will not be discussed here (Kerr et al.,2011), [email protected] Dal Bello-Haas, V., Florence, J. M., & Krivickas, L. S. (2008). Therapeutic exercise for people with amyotrophic (Hachisuka et al., 2007) (Gordon & Mitsumoto, 2007). lateral sclerosis or motor neuron disease - The Cochrane Library - Dal Bello- Haas - Wiley Online Library. Retrieved May 11, 2012 . http://onlinelibrary.wiley.com/ doi/10.1002/14651858.CD005229.pub2/abstract Dal Bello-Haas, V., Kloos, A. D., & Mitsumoto, H. (1998). Physical Therapy for a Patient Through Six Stages of Amyotrophic Lateral Sclerosis. Physical Therapy, 78(12), 1312–1324. Retrieved via document delivery La Trobe University Library. Dengler, R., von Neuhoff, N., Bufler, J., Krampfl, K., Peschel, T., & Grosskreutz, J. (2005). Amyotrophic lateral sclerosis: new developments in diagnostic markers. Neuro- degenerative diseases, 2(3-4), 177–184. doi:10.1159/000089623 Gordon, P. H., & Mitsumoto, H. (2007). Symptomatic therapy and palliative aspects of clinical care. Handbook of Clinical Neurology, Motor Neuron Disorders and Related Diseases (1st ed., Vol. 82, pp. 389–424). Amsterdam, The Netherlands: Elsevier B.V. Hachisuka, K., Makino, K., Wada, F., Saeki, S., & Yoshimoto, N. (2007). Oxygen consumption, oxygen cost and physiological cost index in polio survivors: A comparison of walking without orthosis, with an ordinary or a carbon-fibre reinforced plastic knee-ankle-foot orthosis. Journal of Rehabilitation Medicine, 39(8), 646– 650. doi:10.2340/16501977-0105 Hausdorff, J., Lertratanakul, A., Cudkowicz, M., Peterson, A., Kaliton, D., & Goldberger, A. (2000). Dynamic markers of altered gait rhythm in amyotrophic lateral sclerosis. Journal of Applied Physiology, 88(6), 2045–53. Retrieved from http://www.jap.org. Hillel, A., Miller, R., Yorkston, K., McDonald, E., Norris, F., & Konikow, N. (1989). Amyotrophic lateral sclerosis severity scale. Neuroepidemiology, 8(3), 142–50. Retrieved via document delivery La Trobe University Library. Kerr, E., Moyes, K., Arnold, G., & Drew, T. (2011). Permanent Deformation of Posterior Leaf- Spring Ankle- Foot Orthoses: A Comparison of Different Materials. JPO Journal of Prosthetics and Orthotics, 23(3), 144–148. doi:10.1097/JPO.0b013e3182272941 Ng, L., & Khan, F. (2011). Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease - The Cochrane Library - Ng - Wiley Online Library. The Cochrane Collaboration, (12), 1–32. doi:10.1002/14651858.CD007425.pub2. Owen, E. (2010). The Importance of Being Earnest About Shank and Thigh Kinematics Especially When Using Ankle-Foot Orthoses. Prosthetics and Orthotics International, 34(3), 254–269. doi:10.3109/03093646 .2010.485597 Shaw, C. (2000). Clinical neurology and neurobiology. In D. Oliver, G. D. Borasio, & D. Walsh (Eds.), Palliative Care in Amyotrophic Lateral Sclerosis. New York, USA: Oxford University Press.

Table 1 Summary of ALS gait and muscular status according to disease stage and recommendations for AFO design for optimal gait performance.

The Gazette / Volume 12 - Issue 4 / December 2012 / 9

Member Biography: Jackie O’Connor

1. What made you interested in P&O as a career? Nerolyn Ford (now Ramstrand) at the University ‘open day’ when I was in Year 12. I was checking out all the Health Science options and I left the Podiatry lecture half way through when they were talking about cutting toe nails! Mum was concerned I hadn’t liked anything for the day and was hassling me about making a 4. As the newly elected Registrar, what will be your areas of decision… then we ran into Nerolyn who said, “Are you looking focus over the coming 12 months? for the P&O lecture?” I replied, “Maybe?” She showed me all Overseas member applications have been on hold and my first around the workshop and I was hooked! project is to process the outstanding applications and ensure 2. Tell us about your clinical background, where you’ve there are robust process changes put in place to allow these to worked and what roles you’ve undertaken? re-open. If recently submitted funding applications are approved, this project will expand to revisit the competency standards and in After graduating I moved to Adelaide and worked at the Royal the longer term develop an exam for overseas applicants who do Adelaide Hospital. Here I was exposed to a broad range of not clearly meet the defined AOPA eligibility criteria. Orthotic treatment areas, particularly acute spinal and ortho, with polio and ortho outpatients thrown in to keep me busy. I remained 5. What are your favourite things to do for your ‘down-time’? in SA but moved jobs to OPSA and learnt Prosthetic treatment Down-time… I’m struggling for that as I have recently under the guidance of Sally Cavenett. I also participated in clinical commenced a Masters degree in Health Services Management. research and kept up some orthotics. I do spoil myself with some fantastic holidays though. We travel I wanted to do the European travel thing so I moved to Dublin, anywhere that we haven’t been to before and I especially love Ireland, and worked for a private P&O company based at a hospital to experience different cultures and places where I am a definite with a caseload consisting of amputee interim and definitive minority. Our most recent trip was to Ethiopia, where we hiked prosthetic management and a range of orthotic outpatients. mountains, ate different food, drank a lot of cheap beer and had a Conducting country clinics to Cashel was my favourite part of the great time! My dream destination is Antartica, will have to wait and job because there was always good ol’ fashioned service with see if I ever get there. toast, jam and a pot of tea ready whenever I arrived! 6. What are you reading at the moment? On return to Melbourne, I focused on Prosthetics in my role at I like to read murder mysteries mostly, ‘The Girl with the Dragon Orthopaedic Techniques, then moved to St Vincent’s to work as a Tattoo’ series was great! I also enjoy Michael Connelly books, senior Prosthetist. I have more recently taken on the Management particularly ‘Blood Work’ and now I’m reading Jo Nesbo, a role within this facility. Norwegian author whose work has recently been translated and published in English. 3. What motivated you to get more involved with AOPA? My first two Managers, Allan Wicks and Sally Cavenett, are avid 7. What do you predict will be the next great opportunity for AOPA supporters and helped me to understand the benefits AOPA and our profession? of AOPA for the whole profession early in my career. I was also Our recently improved links with other Allied Health professions keen to meet as many people in the profession as I could and who are not within the National Registration Scheme are creating this was a great way to do it. Now, I’m motivated by the need to amazing opportunities for us to learn and develop faster than better promote the profession for the sake of my colleagues and we ever could on our own. Utilising this group through our any new graduates and so our patients can have the access to Executive Officer is our chance to become more recognised and funding and services they deserve. professional than we ever have been before.

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The Gazette / Volume 12 - Issue 4 / December 2012 / 11 Allied Health Professions Australia (AHPA): DefinitionDefinition of Alliedof allied Health health

The allied health workforce in Australia is comprised of allied health professionals and technicians, assistants and support workers who work with allied health professionals.

In this definition, Allied Health Professions Australia (AHPA) aims only to define the allied health professions and their professionals.

Background AHPA’s definition of ‘Allied Health Professions’ It is well accepted that the allied health sub-set of the Australian health professions AHPA uses and builds on Professions Australia’s does not include medical, nursing or dental definition of a profession with additional professionals. specifications.

In both the international and national domain An allied health profession is one that has: there is no universally accepted definition of „ a direct patient care role and may have allied health professions. Instead, a range application to broader public health of definitions is used in various sectors. A outcomes variety of professions are listed as allied health „ a national professional organisation with a professions by various government authorities code of ethics/conduct and clearly defined and departments, health service providers, membership requirements health funds and tertiary institutions. „ university health sciences courses (not Professions Australia has defined ‘a profession’ medical, dental or nursing) at AQF Level as: ‘a disciplined group of individuals who 7 or higher, accredited by their relevant adhere to ethical standards and who hold national accreditation body themselves out as, and are accepted by the „ clearly articulated national entry level public as possessing special knowledge and competency standards and assessment skills in a widely recognised body of learning procedures derived from research, education and training „ a professionally defined and a publicly at a high level, and who are prepared to apply recognised core scope of practice this knowledge and exercise these skills in the „ robust and enforceable regulatory interest of others. It is inherent in the definition mechanisms of a profession that a code of ethics governs the activities of each profession. Such codes require and has allied health professionals who: behaviour and practice beyond the personal „ are autonomous practitioners moral obligations of an individual. They define „ practise in an evidence-based paradigm and demand high standards of behaviour in using an internationally recognised body of respect to the services provided to the public knowledge to protect, restore and maintain and in dealing with professional colleagues. optimal physical, sensory, psychological, Further, these codes are enforced by the cognitive, social and cultural function profession and are acknowledged and accepted „ may utilise or supervise assistants, by the community’. technicians and support workers.

w:www.ahpa.com.au e:[email protected] p:03 8662 6620 Allied Health Professions Australia Being part of the third force in health By Lin Oke, Executive Officer, AHPA

As AOPA members may be aware, Leigh Clarke, our Executive n Highlighted the need for legislative backing for the self- Officer, is an active member of the Board of Directors of Allied Health regulating professions and remonstrated about the unintended Professions Australia (AHPA). The 15 Directors of AHPA each represent consequences of the National Registration and Accreditation different national professional associations and work together to Scheme advocate for and promote allied health in the national health arena, n Recruited a range of allied health practitioners to contribute providing unified and effective advice to government and key stake their ideas to the development of an allied health hub on the holders to improve the health and wellbeing of all Australians. CareSearch website (palliative care) Current AHPA membership represents the following professions: n Successfully nominated an allied health practitioner to join the Audiologists, Chiropractors, Dietitians, Exercise Physiologists, Standards Australia delegation to an international meeting with Occupational Therapists, Orthoptists, Orthotists/ Prosthetists, health informatics experts in Baltimore in September 2012 Osteopaths, Pharmacists, Podiatrists, Perfusionists, Psychologists, Social Workers, Sonographers and Speech AHPA is regularly invited to provide representation on important Pathologists. Collectively, these organisations with their members national committees and working parties. Most recently AHPA in public, private, urban, rural and regional services across representatives have joined the Medicare Compliance Working Australia, work together to provide an effective voice for over Party and two working parties of the Independent Hospital Pricing 55,000 allied health professionals in Australia. Authority – for mental health and for subacute services.

In recent months AHPA has: Might you be interested in sharing your knowledge and passion for your area of work by representing AHPA? We are looking for n Met with the allied health adviser to the Minister for Health allied health practitioners to contribute to: n Made representation to the Implementation Taskforce of the n An advisory group oversighting the development of teaching National Disability Insurance Scheme for appropriate input from resources for palliative care allied health practitioners n AHPA’s Rural and Remote Group n Spoken with the Transitional CEO, Australian Medicare Local n Alliance about facilitating Medicare Locals’ access to allied eHealth – electronic health records in public and private health health practitioners If you are interested, please email a brief Expression of Interest to n Rebuffed the AMA’s call for greater GP control of Medicare Lin Oke [email protected] Locals by calling for a team approach in governance as well as consumer care Call for presentations Venue: Rydges on Swanston 701 Swanston Street, Carlton Date: Fri 23rd, Sat 24th August 2013

August 23-24 Melbourne

• Thank you to all those who have expressed an interest in presenting at 2013 AOPA Congress. We now ask for all presenters to commence abstract submission. AOPA will forward an e-mail to all members and past Congress delegates, with an attached Abstract Proforma for submission to [email protected] for review and consideration. • This year we are pleased to introduce poster presentations for participation of NCPO students. Students are encouraged to consider presenting an interesting case study they have • Advanced Practise sessions will be co-ordinated around encountered during placement or clinical schools, or to the topics of 'paediatric and adolescent prosthetics', 'Acute showcase a project they have worked on as part of the Spinal orthotics', 'Recreational and Sports prostheses’, and curriculum. Eight posters will be accepted for display, with a 'AFO tuning'. The committee will focus on two of these prize sponsored by Otto Bock for the stand-out poster. for final delivery depending on availability of presenters and • AOPA wish to welcome on board our key sponsors for content. We welcome anyone with expertise or special the Congress event, Orthopaedic Techniques, OAPL, interest in these topic areas to contact Jackie O'Connor at Orthomedico, DJO Global, Otto Bock, Orthotic Prosthetic [email protected] Centre, Ossur, Orthotic Technical Services, and Reis Orthopaedics. A limited amount of exhibitor opportunities We look forward to meeting you in Melbourne in 2013. remain available. www.aopa.org.au

The Gazette / Volume 12 - Issue 4 / December 2012 / 13

AOPA Executive & State Section National Council Office Bearers

President Harvey Blackney Victoria Vice President Paul Sprague President Tim Burke Vice President Sarah Anderson Secretary Diana Poole Secretary Hannah Furlong Treasurer Paul Retschko Treasurer Colin Aburn Student Liaison Gabriella Salemme Registrar Jackie O’Connor Committee members Jessica Quayle, Michael Bond, Lauren Ljiljak VIC Representative Gabriella Salemme SA Representative Bridie Howley South Australia WA Representative Brendan Cahill President Bridie Howley QLD Representative Sarah Carter Vice President Robin Sutherland NSW Representative Michael Storey Treasurer Peter Digance TAS Representative (invited) Ella Nicolson CPD Co-ordinator Hannah Keane

Western Australia President Helke Melville (nee Thorpe) Vice President John Shehade Secretary Steve Carpenter Treasurer Andrew Vearing CPD Co-ordinator Rhiannon Assetta

Queensland President John Coffey Vice President Chris Wallace Secretary Brianna King Treasurer Shaun McKay Committee Members Patrick Shinners & Rod Goodrick

New South Wales President Michael Storey Secretary Joe Chapparro CPD Co-ordinator David Gurr

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The Gazette / Volume 12 - Issue 4 / December 2012 / 15