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Amputation Rehabilitation Research At Imperial College

As I listened to Dr. Emily Mayhew, Historian in Residence, Department of Bioengineering at Imperial College speaking on Front Row about the new Wounded Exhibition at the Science Museum, I was reminded that I first encountered Emily on BBC Radio 4 when she was talking about the research on the lifelong cost and commitment to military amputees.

That led me to invite Emily to be the key note speaker at our Complex Trauma & Amputation Rehabilitation for Service Personnel Conference in March last year.

I am also a huge fan of Emily’s book “Wounded – from Battlefield to Blighty 1914-18”, which traces the journeys made by casualties of that war from battlefield to a hospital in Britain, something we all remembered recently in connection with the Centenary of the Somme.

I was therefore delighted when Emily invited me to a Rehabilitation Research Seminar at Imperial earlier this year. Emily started the day with a session on past and future histories of rehabilitation. Rehabilitation was originally called Orthopaedics and largely involved industrial accidents to children. Sir Robert Jones pioneered the specialism in the First World War, and following conscription in 1916, there was an acknowledgement by the medical profession that a large number of soldiers were going to be killed or injured. Massive bed capacity was needed for those who were injured and 20,000 specialist beds were established during 1917, including the Flagship Centre at Shepherd’s Bush. We were shown wonderful cinematic pictures of the wounded, with soldiers helping to build their own prosthetics, but this speciality, which involved the Consultants for the first time taking part in the post-surgery phase, was not universally welcomed and was seen as encroaching on the role of the General Surgeon. Indeed it is a theme of Emily’s key note speech to us that we lost much of the expertise from dealing with amputation in the First World War and must not do so again in connection with the recent conflict in Afghanistan.

Major Peter Le Feuvre MBE then spoke about Rehabilitation, Innovation and Approaches at Headley Court during the conflict. Amputees could expect cycles of surgery; it was not a continuous seamless journey from surgery through rehabilitation. This speaker emphasised the importance of a multi-disciplinary approach and, in echoes of another theme of our conference, recognised that it is difficult to rehabilitate if the patient is in pain. DMRC Headley Court has established groups in complex trauma, lower limbs, spines and other areas, and these help the individual to thrive.

This speaker addressed the inevitable tension between the Plastic Surgeons wanting to keep the stump still and the Physiotherapist wanting to move it about, and this was explored in issues of wound management.

In the audience we had Captain Dave Henson who graduated with merit in a Master’s Degree in Biomedical Engineering at Imperial in 2014. Dave was Team Captain of the British Armed Forces Team at the Invictus Games in 2014 and continues his interest in prosthetic research. He spoke about the disconnect of leaving army life but feeling separate from civilian life and how he carved out a new path for himself. Dave as a double-amputee ran the best T42 200 metre time in the world this year on the second day of the Invictus Games in Orlando and he also went on to win a bronze medal at the Rio Paralympics in the Men’s 200 T24.

Gillian Conway, Senior Prosthetist at Blachfords, spoke of prosthetic challenges and common problems, including the importance of continuity and knowing the patient and socket. Expectation of what could be achieved at Headley Court changed over time, and that experience has been shared with the NHS, although set up and resources would seem to me to be rather different.

Dr. Hannah Jarvis, the Higher Scientific Advisor at Headley Court, gave a fascinating talk on the Gait Laboratory, raising the importance of data, and exploding some myths about how amputees walk. There is a common perception that they walk more slowly with shorter stride length and asymmetry in step length and stance time.

Three groups of different types of amputees and a fourth control group took part in the studies, which showed that amputees walked faster and with a more even stride. This in turn fed back to the importance of rehabilitation and prosthetics in achieving a highly efficient gait pattern. Variation amongst the different types of amputation was small – the amputees were getting the same rehabilitation advice and working together.

Hannah told how, when at Salford University, she was informed that the most serious of the amputee groups would never walk and would be in wheelchairs. Someone then described a fire alarm at Headley Court during which they found themselves walking alongside these amputees, none of whom were in wheelchairs.

Matt Hopkins, a PhD student at the Centre, finished with a session on smart sockets for blast rehabilitation, showing us laser scanning and 3D printing, a socket filled with sensors and information coming to a smart phone.

I sat next to Vikki Hawkins of the Science Museum, who recommended a book on another important aspect of conflict – “Broken Men – Shell Shock, Treatment and Recovery in Britain 1914-30” by Fiona Reid. In turn, I would heartily recommend the Wounded Exhibition to all our readers.

Autumn 2016 (PDF)

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