By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply their knowledge, in order to perform a range of procedures and clinical skills undertaken across a range of rehabilitation engineering functions including assistive technology, clinical gait analysis and medical engineering design responding to complexity and ambiguity using professional expertise as a Consultant Clinical Scientist. Clinical Scientist in HSST will be expected to reflect on the challenges of applying research to practice in relation to these procedures and suggest improvements, building on a critique of available evidence.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise and critically apply their expert knowledge with respect to rehabilitation engineering including:
- the basis of human biomechanics and the impact of disease on human movement and anatomy spanning the:
- musculoskeletal system.
- nervous system and the senses as systems to drive assistive technology.
- load, strength, failure and equilibrium performance of musculoskeletal structures.
- joints and joint movement.
- measurement of load and strain in the body.
- forces and movement in the body.
- principles of kinematics and kinetics; energy and power.
- fluid systems in the body.
- nervous system and the senses.
- cardiovascular and respiratory system.
- urinary system.
- skin and superficial soft tissues.
- application of engineering design principles to rehabilitation engineering.
- the measurement of human movement.
- physiological measurements and how they can be used to control aids for daily living.
- the practice of rehabilitation engineering.
- principles and application of imaging techniques.
- orthopaedic biomechanics and the requirements for orthopaedic implants.
- the range of biomaterials encountered in rehabilitation engineering design solutions and their biocompatibility.
- the development of innovative design solutions in aids for daily living.
- the characteristics of patients and patient groups likely to benefit from biomechanical assessment and assistive technology solutions.
- gait analysis and human movement.
- mobility and postural management.
- aspects and influence of disease on human motion and anatomy.
- practice of rehabilitation engineering for people with physical, sensory, communication, learning or neurological disabilities including:
- principles of patient assessment and rehabilitation plans
- sensory impairments and their treatment
- mobility and postural management
- orthotic and prosthetic devices.
- mobility aids.
- seating systems.
- augmentative and alternative communication.
- environmental controls, aids for daily living, smart homes, workplace adaptations.
- sensory and neurological implants.
- functional electrical stimulation.
- advances in rehabilitation engineering including:
- implantable and body-worn (bio)sensors.
- neural stimulation.
- biological cell manipulation.
- software for rehabilitation engineering.
- finite element analysis.
- current social, political and legislative contexts, the service user perspective and ethical issues.
- evidence-based assistive technologies.
- innovation and design of custom aids for daily living for clients with a complex range of disabilities.
- effects of disease and age on musculoskeletal system.
- engineering requirements of orthopaedic implants.
- mechanical load requirements.
- standards for production and testing.
- approaches to biocompatibility and constraints in respect of implants.
- common orthopaedic implants.
Technical and clinical skills
- By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and effective implementation of the following technical skills within the field of Assistive Technology (aids for daily living; electronic assistive technology (EAT); functional electrical stimulation (FES); postural management; prosthetics and orthotics (P&O) and wheelchairs), Clinical Gait Analysis and Medical Engineering Design and will:
- perform physical and functional patient assessment appropriate for an AT prescription. It is expected that the Clinical Scientist in HSST will have exposure to the majority of the modalities listed above but focus specifically on between one and three.
- define and develop the interface between the patient and (a) the test/measurement equipment and/or (b) the prescribed AT equipment, discussing the possible adverse consequences in terms of safety, performance, comfort and aesthetic appearance.
- prescribe appropriate AT interventions in close collaboration with patients, carers and clinical colleagues and to measure and assess their outcome.
- design and modify devices appropriately to suit patients’ needs.
- teach patients and carers in the safe and effective use of equipment provided.
Clinical Gait Analysis
- prepare the system for gait analysis including calibration and quality assurance checks, as appropriate for use.
By the end of this the module Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:
- assess, provide, report, document and measure clinical and patient outcome across a range of ATs, in people with a range of pathologies, ages and presentations including:
- the clinical assessment for and the provision of an aid for daily living.
- the clinical assessment for and the provision of an EAT system, to include two or more components (e.g. environmental control unit and complex wheelchair controls).
- the clinical assessment for and the provision of a FES system.
- posture management and the writing of a clinical report, including recommendations and rationale which may include wheelchair seating, static seating and/or bed positioning, as applicable.
- the provision of appropriate posture management equipment.
- a wheelchair assessment and clinical report, including recommendations and rationale which may include manual and/or powered wheelchairs, as applicable
- the provision of a wheelchair and any associated equipment.
- monitor the progress of the range of patients described above from the initial consultation, through investigations and/or assessments and/or manufacturing processes, to follow-up appointments talking to each patient to gain their insight.
- critically reflect on current practice in assistive technology and consider how you will use your experience to improve clinical practice to benefit patients.
- discuss the impact of assistive technology with a range of patients and critically reflect on the effect of assistive technology interventions on their lifestyle and the role of the healthcare scientist in the process.
- critically appraise the process of referral, diagnosis, treatment and/or provision of assistive technology equipment and the role of the multiprofessional team following attendance at a range of patient consultations in different healthcare settings.
- identify areas of current assistive technology practice that could be improved, in partnership with the clinical team and patients, and design and evaluate a suitable intervention based on a critical review of evidence to improve practice.
Clinical Gait Analysis
- take a clinical history from patients as part of clinical gait analysis liaising with the referring clinician as appropriate.
- analyse this history to confirm the clinical question(s) to be addressed.
- select the most appropriate gait assessment tools.
- perform physical and clinical examinations of patients referred for clinical gait analysis.
- collect, process and analyse clinical gait data for a range of clinical presentations.
- interpret and report the results of clinical gait analysis including options of kinematic, kinetic and/or visual assessment and reflecting the limitations of the techniques.
- make treatment recommendations.
- participate and contribute to multidisciplinary discussions.
- identify areas of clinical gait analysis that could be improved, in partnership with the clinical team and the patients, and design and evaluate a suitable intervention based on a critical review of evidence to improve practice.
Medical Device customisation and modification/design
- identify the need for equipment modification to meet the needs of patients reviewed in a range of out-patient clinics.
- determine the details of the required modifications in discussion with the referring clinician and the patient.
- perform the required modifications, demonstrating an adherence to the relevant legislation
- evaluate the effectiveness of the modification, in terms of patient satisfaction, functionality and cost effectiveness.
- critically reflect on the impact of at least two pieces of equipment on the patient/clinical environment and identify aspects that should be improved.
- identify an area of medical engineering design that could be improved, in partnership with the clinical team and the patients, and design and evaluate a suitable intervention based on a critical review of evidence to improve practice.
- reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:
- present complex ideas in simple terms in both oral and written formats.
- consistently operate within their sphere of personal competence and level of authority.
- manage personal workload and objectives to achieve quality of care.
- actively seek accurate and validated information from all available sources.
- select and apply appropriate analysis or assessment techniques and tools.
- evaluate a wide range of data to assist with judgements and decision making.
- conduct a suitable range of diagnostic, investigative or monitoring procedures with due care for the safety of self and others.
- take restorative action within quality control/assurance requirements to address threats of performance deterioration.
- work in partnership with colleagues, other professionals, patients and their carers to maximise patient care.