A day in the life of an Ilizarov Occupational Therapist Occupational therapy in the Limb Reconstruction s Service in the Belfast HSC Trust Occupational Therapy the Limb Reconstruction Service in the Belfast HSC Trust A day in the life of an Ilizarov Occupational Therapist Jillian Black Clinical Specialist Occupational Therapist Trauma Poly trauma Bone loss Specialist nurse Surgeon Occupational therapy in the Limb Reconstruction s Service in the Belfast HSC Trust OT Adult Child Physio ad Elective Deformity correction 4 months – 2+ years

Background 1WTE since 1998 Patient group – average age 45.5 (19-91) Ratio 2.6 males to 1 female MDT working – patients active engage in rehab Ilizarov philosophy – loading limb = good bone healing Contents Splinting: rationale, types and audit Functional skills: FIM/FAM audit Extended ADLs

Static progressive until achieve correct position, then static. Splinting Joint stiffness due to trauma, frame position, pain, difficulty weight bearing, frame adjustments Static progressive until achieve correct position, then static. Velcro foot splint Rodded foot splint Rodded foot splint audit 20 made Jan 2016- Sept 2017 16 achieved neutral in 1 week to 15 week More than half achieved neutral ankle in 4 weeks

Knee Splints Correct knee flexion deformities Thermoplastic and Ilizarov components Hinge set at passive end range Toe Splints /slings Maintain forefoot/ toe extension Foot within frame, e.g. foot correction, ankle arthrodesis

Functional skills - living with a frame Maximising independence – through functional assessment, rehab and equipment provision FIM/FAM completed at admission and discharge. FIM/FAM Audit 81 files reviewed (June 2016- June 2017) Type of frame 70 tibia 9 tibia and cross knee 1 bilateral tibia 1 precise nail Reason for frame 74 fractures 7 elective Mechanism of injury Number Fall 38 RTC 21 Sport/ activity 10 Stress fracture 2 Crush injury Assault 3 Deformity correction 5 Mechanism of injury Number Fall 38 RTC 21 Sport/ activity 10 Stress fracture 2 Crush injury Assault 3 Reason for frame Average admission score Average discharge score Percentage increase Elective 150.5 157.5 5   Trauma unspecified # 163 178 12.1 Schatzker# 135.4 164.8 34 -Pilon/distal tibia# 148 161.2 35.2 Segmental /compound# 160 171.2 9 Spiral# 30 198.6 5.6

FIMFIM/FAM results Areas of improvement Number of patients Bath transfer 33 Bed chair toilet transfer 20 Bathing Dressing lower 19 Community mobility 14 Car transfer 12 Walking Dressing upper 9 Stairs Grooming 8 Reason for frame Average admission score Average discharge score % increase Elective 150.5 157.5 5 Unspecified fracture 163 178 12.1 Schatzker fracture 135.4 164.8 34 Pilon fracture 148 161.2 35.2 Segmental fracture 160 171.2 9 Spiral fracture 188 198.6 5.6

Forewarned is forearmed Extended ADL – work, school, leisure, coping skill Maintain ‘normal’ routine and roles Find alternatives to maintain activity levels and achievement Structure, planning, goal setting, pacing “Managing the frame was easy, keeping my head right was more difficult” Forewarned is forearmed Patients views 100% were satisfied or very satisfied with all aspects of OT

and finally …! Ilizarov philosophy – load limb = good bone healing In a typical day an Ilizarov Occupational Therapist will splint to improve joint position functional skills and equipment increase independence and use of the limb good coping skills allow patient to take control of their own recovery Future plans formalise psychological screening scar management jillian.black@belfasttrust.hscni.net