Private clinic the London Orthotic Consultancy (LOC), founded in 2004, provides bespoke orthotic treatments for a wide range of adult and paediatric conditions.

It operates privately across the whole of the UK and abroad and also has a growing number of international clients.

Director Sam Walmsley explains: “We deal with complex physical problems and generally manufacture bespoke orthotics to address them. We have a unique setup for the UK in that we have 2D video vector gait labs and we do all our manufacturing on site.’’

LOC has two clinics with the gait labs, that specifically focus on the Optimal Segmental Kinematic Alignment approach to Rehabilitation (OSKAR) – one at its Kingston-upon-Thames headquarters and another at the University of Salford teaching hospital, a mile from Manchester city centre.

These are in addition to satellite clinics in London’s Harley Street, Bristol, Cambridge and Romford.

It operates the OSKAR clinics in partnership with Elaine Owen, a world renowned physiotherapist who was awarded an MBE in 2012 for services to children with disability.

She developed OSKAR as an orthotic method for treating children with lower limb neuromuscular conditions such as cerebral palsy and it is a method that has enjoyed considerable success.

The London Orthotic Consultancy’s gait lab in action.

“At its heart, it’s really all about trying to prevent some of the very disabling conditions that can happen with a condition like cerebral palsy, for example, and trying to prevent the natural history of the condition taking hold,’’ says Sam.

“Normally, somebody with cerebral palsy is going to develop contractures and pectal deformities. Perhaps, at some point, they’re going to walk, but maybe then they’re going to lose that ability later in life as they go through adolescence.

“OSKAR is all about trying to reduce the impact of cerebral palsy as they grow.

“It’s also about trying to reduce the other interventions that are then required, certainly the surgical interventions, but also things like Botox which are very commonly prescribed – it can reduce the incidence of using that as well.’’

The effects of cerebral palsy range in severity, usually in correlation to the degree of injury to the brain. The primary impairments are to muscle tone, motor functions, balance and posture, but the symptoms will vary from one child to another.

LOC worked with Elaine Owen, using the gait lab and developing the clinic and soon began to see improvements in the children they were treating, which led to a roll out of OSKAR across the UK and the opening of the Salford clinic.

Treatment begins with a detailed consultation at LOC, which is structured around the International Classification of Functioning (ICF) guidelines, which look at different areas, such as bone structures, muscles and joints.

But LOC then takes that further in a more comprehensive and holistic approach.

“We look at their function, their mental well- being, and all of those areas. So it’s not just saying ‘I want that joint to have more range of movement’. If you are going to fit them into something and that then compromises their participation in their school activities, then that’s an issue,’’ says Sam.

“We look at it in that framework and then we set goals around it. So a parent might say ‘my child is not standing yet and I want them to stand and that is my short-term goal and I want my medium-term goal to be that they are taking steps before they start school’.

“Or, at the moment, they might say that they are using a walking frame, but they want them to be able to start walking using sticks or to be able to walk independently.

“We might say ‘great, we feel we can do that’ but also we might also say they need some other treatment, for example if their posture is very bad or there’s an issue with the bones in their leg and we will then build some goals around those things as well.

“There may also be some subjective goals, such as they are not comfortable in their AFOs (Ankle Foot Orthosis) or they are not happy with some other aspect of their provision.’’

LOC then develops a prescription, takes measurements, fits the child with a splint and prescribed footwear. At the next appointment, after about a month, when they come back for a fitting, it then uses the gait lab to ensure that that prescription is optimal.

“Then we send them away for probably between one and two months,’’ he says.

Orthotics products are crafted on site at the London Orthotic Consultancy.

“After that we bring them back to review and measure them with the gait lab to make sure everything is still optimal against our milestones.

“We then measure them periodically against the goals we expect, so that everybody can see that the orthotics are delivering on the original goals.’’

Because LOC manufactures its own orthotics, it can promptly address any issues that patients might have.

“We always resolve any problems free of charge,’’ says Sam. “We have a manufacturing setup in-house, so it’s easy for us to make any adjustments or alterations.

“This might sound like a no-brainer, but often in an NHS department you go to see the orthotist and they will say: I’ve just got to send that away to Leeds or Brighton, so it may go away for three weeks, then you get an appointment three weeks later.

“So the fluidity and speed with which we can do problem solving is absolutely fundamental to the success of OSKAR as well. That is a key part in delivering a very good orthotic practice.’’

And are there any plans to extend this successful practice?

“We would like to continue developing the Manchester clinic and use it as a major hub in the UK with satellite clinics running off from that.

“From there, we would be looking at the next location to build upon in the UK, so that people can access us far more easily.’’