The National Center for Training and Education in Prosthetics and Orthotics is based in the University of Strathclyde, Glasgow, with associated facilities in rehabilitation centers and hospitals in the area. It operates in association with the Bioengineering Unit and is administered by the university on behalf of the Scottish Home and Health Department and the Scottish Health Service.
The functions of the Center are to:
- provide professional training for prosthetists/orthotists;
- provide courses to maintain and extend the professional competence of practicing prosthetists and orthotists in relation to advances in established techniques, new techniques, and associated developments;
- offer postgraduate training to doctors, staff of professions involved with rehabilitation, and administrators involved in prosthetics and orthotics;
- train future instructors in prosthetics and orthotics; and
- enhance and maintain an awareness of current research and its clinical applications.
To this end, the National Center offers a four-year honors degree course leading to the award of Bachelor of Science in Prosthetics and Orthotics, and provides short courses to maintain and extend the professional competence of those involved in rehabilitation. Typically, these courses are intended to give the members of the clinic team an overview of the basic concepts and modern practices in prosthetics and orthotics.
Feedback from the short course participants indicated that some people would like to understand the biomechanical implications of prosthetic and orthotic fittings and movement analysis in greater depth than is possible to teach in a short course program. Fulfilling this need would require courses that covered the basic background mechanics and biomechanics before progressing to the application of those biomechanical principles to prosthetic and orthotic devices, and to clinical gait analysis. Such courses would take more time than is available in a typical short course program, as the participants would have to complete many exercises to become familiar with the basic biomechanical principles.
Therefore, courses in Lower Limb Prosthetic Biomechanics, Postgraduate Diploma in Lower Limb Orthotic Biomechanics, and Postgraduate Diploma in Clinical Gait Analysis were developed and introduced. They were intended to enable participants to explore biomechanics using distance learning techniques.
Teaching by the use of distance learning or open learning techniques was pioneered in the United Kingdom by the Open University, which was brought into existence by the grant of its Royal Charter in April 1969. Since then, it has become a popular form of education because distance learning allows candidates to learn at their own pace and at times that fit best into their own daily routines. It also forces the educators to examine their teaching resources and to ensure that the material they send to students is in a format that is easily understood and well explained.
POSTGRADUATE DIPLOMA COURSES 1991–2000
The Postgraduate Diploma courses were designed for professional personnel involved in rehabilitation in such fields as prosthetics, orthotics, therapy, rehabilitation surgery, bioengineering, etc. Candidates were required to possess an acceptable academic or professional qualification in one of these fields. The courses were of 12 months’ duration (24 month maximum), and the participants received a comprehensive study package approximately every four weeks. Each package contained the study material, a listing of references to relevant research publications, and self-assessment exercises. These packages were designed to guide the candidate through the material to be learned using text, illustrations, sample calculations, and exercises. In some instances, activities involving commonly available equipment were suggested. Tutors were available for direct contact by telephone, letter, fax, and E-mail if required.
All three courses contained some new knowledge but endeavored to present standard knowledge in a coherent format for those with little background in the mechanical and biomechanical subjects covered. The two residential periods, when the students attended the National Center for laboratory/demonstration and tutorial sessions, were essential features of the courses. The residential periods were intended to expand upon the course work that had already been covered in the teaching packages. At the end of each of these two five-day periods, there was a three-hour examination. Successful completion of a course depended on obtaining an adequate mark in each of these examinations.
The Postgraduate Diploma course in Lower Limb Prosthetic Biomechanics was first offered in 1991. This course was intended to give the candidates an understanding of the forces generated during walking with lower limb prostheses, the effects of these forces on both the patient and the prostheses, and how malalignment and poor socket fit influence the magnitude of these forces. The mechanical requirements of prosthetic feet and knee mechanisms were considered. Sixty-nine rehabilitation specialists registered for this course, 37 of whom were prosthetists/orthotists, 22 therapists, 7 medical, and 3 of another profession allied to rehabilitation (Table 1).
The Postgraduate Diploma course in Lower Limb Orthotic Biomechanics was introduced in 1992. This course was intended to give the candidates an understanding of the force systems required to meet the differing prescription aims of orthotic fitting, the magnitude of the forces generated during walking with lower limb orthoses, the effects of these forces on both the patient and the orthosis, and how malalignment and poor fit influence such forces. Sixty-eight rehabilitation specialists registered for this course, 39 of whom were prosthetists/orthotists, 22 therapists, 6 medical, and 1 other (Table 1).
The Postgraduate Diploma course in Clinical Gait Analysis was the third course to be offered in 1994. This course was intended to give the candidates an appreciation of the methods and levels of accuracy of those gait assessment techniques that are currently available. These techniques range from the simple to the sophisticated (or the inexpensive to the costly), and the advantages and limitations of each are explored. The interpretation of the data and the relevance to clinically observed conditions were discussed. Fifty-four rehabilitation specialists registered for this course, 13 of whom were prosthetists/orthotists, 21 therapists, 15 medical, and 5 others (Table 1).
FEEDBACK FROM COURSE PARTICIPANTS
Feedback from the participants indicated that the courses provided a useful review and/or revision of the subject matter, especially for the prosthetists/orthotists. The courses covered material that the participants expected and that they required in their daily working activities. None of the participants felt that anything of any importance had been omitted, and all indicated that the courses had matched their requirements and perceived needs. When questioned about the time spent on each study package, the participants’ estimates varied from 2 to 60 hours. This large variation depended on their background and familiarity with the subject matter covered by a particular package. Participants reported that the courses had given them a better understanding of the aims and objectives of prosthetic/orthotic fitting and gait analysis, and improved their ability to communicate effectively with other professionals, especially those in their own clinic teams.
A total of 162 people successfully completed the courses (Table 2). This high pass rate reflects the fact that the participants were a well-motivated group of mature students who had made a positive decision to register for the course.
The international interest in these courses was an aspect we had not anticipated. Of the total of 191 registrants, 112 were people who reside outside the United Kingdom (Table 3). Registrations were received from Australia, Brazil, Canada, Cambodia, Ireland, Finland, Germany, Gibraltar, Greece, Hong Kong, India, Israel, Kingdom of Saudi Arabia, Malaysia, Netherlands, Nigeria, Norway, Pakistan, Panama, Switzerland, Tanzania, Trinidad and Tobago, and the United States.
For such participants, the cost of attending the Center for the two residential periods in terms of travel, accommodation, and subsistence expenses far outweighs the cost of registration for the course. These costs have inhibited people in developing countries from registering for the program. The National Center is currently examining ways in which these costs can be reduced by conducting the residential weeks in appropriate establishments around the globe.
The National Center has found that these courses also provided a useful mechanism for assessing unconventional applicants for higher degree study, that is, applicants who have not achieved the usual first degree but are competent prosthetists or orthotists.
After successfully completing one course, some participants registered for a second and even a third course. Five participants acquired the confidence to register for a full time master’s degree at the National Center or other higher education establishments. One participant recently completed his doctorate at the National Center.
POSTGRADUATE COURSES IN REHABILITATION STUDIES
In 1999, the Faculty of Engineering conducted a review of all the postgraduate courses that it offered with a view to bringing a uniformity of structure across the faculty. The decision was taken that all departments were to offer courses with similar formats. All courses that had been available up to that date were to be discontinued and new, modular courses developed. This review prompted us to consider extending and developing our postgraduate program.
Therefore, in September 2000 the National Center discontinued the Postgraduate Diploma Courses and introduced a new suite of Postgraduate Courses in Rehabilitation Studies leading to the award of either a Master of Science degree, Postgraduate Diploma, or Postgraduate Certificate. These courses are modular and intended for off-campus delivery. They are offered by open learning to allow participants to study at their own pace, in their own homes, at times convenient to them.
Registrants select courses from the range of instructional modules available. Their choice is limited by their initial qualifications. Each module has a credit value (Table 4), and students accumulate credits as they progress through the course. All the modules include course work, class work, tutorials, and self-directed learning with the appropriate academic support. Candidates are assessed on the work contained within each module, normally by both course work assignments and written examinations. Such examinations normally take place at the end of each of the instructional modules and at the conclusion of the residential periods held in the National Center.
These courses have been designed for professionals already involved in prosthetics, orthotics, therapy, surgery, or associated disciplines. The National Center intends the courses to appeal to people with different amounts of professional experience. Therefore, the range of modules that is currently available includes overviews of the service for those who are recent entrants to the field of rehabilitation as well as management and accountancy studies for those who are rising in the management hierarchy of their employment (refer to the Modular Course Descriptors at the end of this article). Other modules may be introduced at some stage in the future as the courses develop and needs are identified.
It is anticipated that some candidates may wish to dip their toes in the waters of postgraduate education and initially register on the Postgraduate Certificate or the Diploma course. At a later stage, they may wish to forgo that award and upgrade their registration to a Master of Science. Such cases will be dealt with sympathetically.
POSTGRADUATE CERTIFICATE IN REHABILITATION STUDIES
Candidates who obtain a minimum of 60 Strathclyde Masters, SM, credits from a selection of the instructional modules will be awarded a Postgraduate Certificate. In this case, candidates will normally be required to complete the course within a minimum of 12 months and a maximum of 24 months from the date of first registration.
POSTGRADUATE DIPLOMA IN REHABILITATION STUDIES
Candidates who obtain a minimum of 120 SM credits will be awarded a Postgraduate Diploma in Rehabilitation Studies. In this case, candidates will normally be required to complete the course within a minimum of 24 months and a maximum of 36 months from the date of first registration.
MASTER OF SCIENCE IN REHABILITATION STUDIES
Candidates studying for the MSc in Rehabilitation Studies will undertake a research project and submit a written dissertation. The project may be carried out at the candidate’s place of employment. A minimum of 180 SM credits must be obtained for the award of the master’s degree, of which 120 SM credits will be obtained from taught modules and 60 SM credits from the project. An oral examination may also be required. Candidates will normally be required to complete the course, including submission of the dissertation, within a minimum of 36 months and a maximum of 60 months from the date of first registration. Candidates will be encouraged to use home video cameras to record all aspects of the project, in particular: patient assessments, fittings, and tests. Any videos taken will be viewed and discussed during tutorial sessions and be available to the external examiner.
All candidates will be expected to communicate with the National Center by E-mail, and it is intended that the Internet will eventually be used to deliver the educational packages to participants.
In this, the first year in which the courses have been available, we have 2 Certificate registrations, 3 Diploma registrations, and 14 MSc registrations. The international appeal is still evident with 14 of the 19 candidates living outside the United Kingdom.
More details about the course are available on the web site at http://www.nctepo.co.uk.
In conclusion, I can report that the National Center is providing courses that meet a real need for knowledge and that can reach participants wherever they live, especially those in developing countries.