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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