This videos provides an introduction to the kinds of access methods and technologies available to those using AAC. Whilst the videos are for the most part aimed at those with a diagnosis of Motor Neurone Disease, all access methods and technologies featured are available to those referred to BCAS. Choices will be made during an initial assessment as to what kind of technology is appropriate.

In order to enable communication, a number of different software packages are available to choose from. A software package is loaded onto a device and is used to create sentences. All of the programs allow a person using a communication device to turn text to speech, personalise keyboard homepages, and build up speech histories – facilitating faster communication. For the purposes of this video, the Communicator 5 package will be focused on. However, alternative software packages are also available, a few of which will be introduced at the end of this clip.

Charitable Support Organisations:

• Action Duchenne
• Association of Glycogen Storage Disease (POMPE)
• British Polio Association
• CMT UK (Charcot-Marie-Tooth Disease)
• Duchenne Family Support Group
• Duchenne UK
• FSH-MD Support Group UK
• GAIN (Guillain-Barré & Associated Inflammatory Neuropathies)
• Myaware (Myasthenia Gravis)
• Myositis UK
• Myotonic Dystrophy Support Group
• Myotubular Trust
• Spinal Muscular Atrophy (SMA) UK
• Together for Short Lives
• Transition (information for patients who are transitioning to adult services)

 

GMC Number: 6053698

Year & location of first qualification: 2002, Imperial College, London

Specialty: Trauma & Orthopaedics

Clinical interests: Spinal surgery including trauma, deformity, tumours and degenerative pathology (cervical, thoracic and lumbar).

Secretary: Linda Eyles

Telephone number: 0117 414 1620

Mr Priyan Landham is a fellowship trained Spine Surgeon. 

He qualified from Imperial College, London in 2002 and completed his orthopaedic training in Bristol.  He has undertaken adult and paediatric spine fellowships in Bristol, Auckland City Hospital and Starship Children’s Hospital in New Zealand.

He is a member of the British Orthopaedic Association, British Association of Spine Surgeons & North American Spine Society.

You may have been provided with a knee-ankle-foot orthosis, or KAFO, which has been designed to meet your individual needs.

KAFOs are provided to compensate for muscle weakness, paralysis or skeletal problems which cause lower limb instability. The KAFO aims to make standing and walking easier by:

• Controlling joint instability
• Preventing excessive joint motion
• Improving joint alignment
• Reducing joint pain

KAFOs are complex devices so their designs vary to suit each individual.

There are two main types:
1. Metal KAFO with side steels which insert into the heel of your shoe with leather thigh section and calf band.
2. Plastic KAFO with moulded thigh and calf sections which fit inside your shoe, connected by metal side bars.

Using a KAFO puts a large demand on your body and may cause premature wear and tear in your joints.

You should continue to be mindful of your surroundings as the risk of falls remains when using your KAFO.

Wear time

You should gradually increase the wear time with your KAFO. This allows your skin to adjust to the supportive pressures which the KAFO applies. Begin by using your KAFO in a safe, indoor environment.

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

Footwear

When selecting shoes to wear with your KAFO, 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 KAFO.

Skin care

It is advised to wear long socks or tights with your KAFO to reduce any friction applied to your skin.

Each time you remove your KAFO you should check your skin for any signs of marking or redness. If red marks persist for longer than 30mins or if the skin breaks down or blisters, discontinue use of the KAFO 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 KAFO.

Caring for your KAFO

You can clean your KAFO with a damp cloth and dry with a towel. Do not dry over sources of heat as this may deform the plastic.

Check the KAFO material regularly for any cracks or signs of wear and tear.

Each time you use your KAFO, check the joints and rivets for wear and tear.

Do not attempt repairs yourself, contact the Orthotics department for review.

Straps and padding will wear with use so you can arrange repairs with the Orthotics department.

Putting your KAFO on

You can put your KAFO on when sitting or lying down.

Ensure all straps on your KAFO and footwear are fastened securely.

If your KAFO has knee joint locks, be sure to lock these before bearing weight through the KAFO. You should hear a ‘click’ when you straighten your leg to lock the joints but you should also check these manually.

You may have been provided with an ankle-foot orthosis, or AFO, which has been selected to meet your individual needs.

The AFO aims to make standing and walking easier by:

• Controlling foot and ankle position
• Accommodating a fixed joint position
• Compensating for muscle weakness
• Reducing pain

The AFO is intended to be used solely by you. As the device is directly influencing your joint positions, it may feel strange or uncomfortable when you begin to you use it. This should ease as you gradually wear in the AFO.

The AFO is designed to work with a shoe so you should not wear the AFO without footwear.

Wear time

You should gradually increase the wear time with your AFO to allow your skin to adjust to the corrective pressures being applied.

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

Footwear

When selecting shoes to wear with your AFO, 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 AFO.

Skin care

It is advised to wear a sock with your AFO to reduce any friction applied to your skin.

Each time you remove your AFO you should check your skin 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 AFO 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 an AFO.

Caring for your AFO

You can clean your AFO with a damp cloth and dry with a towel. Do not dry over sources of heat as this may deform the plastic.

Check the AFO material regularly for any cracks or signs of wear and tear.

Repairs can be made to the AFO, such as strap and padding replacements.

If your AFO has ankle joints, be sure to check the integrity of the joints and screws each time you use the AFO.

Do not attempt repairs yourself, contact the Orthotics department for review.

It is likely that you have suffered a recent spinal injury or had recent spinal surgery and require a support to protect your spinal column during the rehabilitation process.

Your spinal orthosis (neck brace or back brace) has been selected to meet your individual needs.

The spinal orthosis aims to protect your spine by:

• Controlling joint instability
• Preventing excessive joint motion
• Improving joint alignment
• Reducing joint pain

Spinal orthoses can be complex devices so their designs vary to suit each individual and the level of the spine which requires stabilisation.

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.

Important
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.

Your spinal orthosis should be a secure fit in order to function correctly and as a result may feel uncomfortable. If your spinal orthosis causes pain then seek advice from the Orthotics department.

Skin Care

If you have been supplied with a back brace, it is advised to wear a layer of clothing between your skin and the device. A single layer of thin cotton clothing will help to wick away moisture from your skin, minimizing heat build-up and maintaining hygiene.

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.

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.

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. If your spinal orthosis has removable padding, this can be machinewashed as required.

Check the device material regularly for any cracks or signs of wear and tear.

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.

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.