Professor Len Nokes

Biography

At present the Institute of Medical Engineering and Medical Physics comprises teaching and research staff from the Cardiff School of Engineering and the Department of Medical Physics and Clinical Engineering Heath hospital.

My main scholarly activity has been in the area of bioengineering. Recently however, using my sports medicine background, I have been developing my research interest in sports biomechanics. I also have an interest in orthopaedic and forensic engineering which is reflected in my higher degrees by research. I have co-authored 7 books. The book on the determination of the early post-mortem period has been cited in many illustrious trials, including the O.J. Simpson trial and is recognised as the definitive text in its subject area.

In 1991, in conjunction with Professor D R Towill, I received a grant of £215.4K to develop the role of electronics and computing in orthopaedics. This contributed towards the development of undergraduate and postgraduate courses in medical electronics and resulted in a textbook being published.

I have been successful in obtaining industrial funding from a number of orthopaedic companies to carry out original research, including the design and development of a new spinal implant. I have also obtained funding from industry for a fixed-term lecturer in orthopaedic and forensic engineering.

Successfully completed the Practical Leadership for University Management course at Cardiff University (2012). I was also voted by the students a Teaching of the Year award 2012-2013 and 2013-2014.

Orthopaedic Engineering

I have co-authored a number of papers with orthopaedic surgeons to analyse the clinical parameters associated with bone fracture healing. In addition to clinical studies to obtain data, a number of models were developed to predict how bone would heal with time. Work in this area led to me being commissioned to write reviews in the area of vibrations in orthopaedics. During my time in orthopaedic engineering I became increasingly aware of the need to provide orthopaedic surgeons with basic engineering theory. This resulted in the publication of two textbooks. The latter concerns the use of shape memory alloys in medicine which brings together the research carried out on the particular application of this novel material to the clinical field. In conjunction with the Orthopaedic Department UWCM I have developed an MSc in Orthopaedic Engineering which runs on a part-time basis for Orthopaedic surgeons which currently has seventy students.

A major problem of vibration techniques to measure in-vivo bone properties is the use of accelerometers placed on the skin to pick up the vibrating bone. To overcome this problem a novel Doppler probe was developed that eliminated the skin affects on vibration. No other paper has reported this approach to successfully overcome this problem. Further applications of this Doppler based technique were explored in a recently awarded PhD supervised by myself, ( E.Maylia 2003).

Research in the application of alternative medicine to the musculo-skeletal system is a relatively new field. In 1994 I was principal investigator in a clinical trial to establish the viability of reflexology in treating patients post-operatively after knee surgery. The trial was the first of its type to quantify outcomes from using alternative medicine techniques. To further investigate the potential benefits of alternative medicine, I gained a certificate in the practice of acupuncture (2002).

Forensic Engineering

My other major scholarly activities involve forensic engineering. To determine the time since death a method involving the use of temperature measurement is often used. Factors such as the amount of clothing on the corpse, the size and position of the corpse all affect the cooling curve, and hence the calculated time of death. In order to eliminate the effect of these variables, a number of new algorithms were developed.

Other methods developed to determine the post-mortem period have included measuring the rate of decay of the compound action potentials of nerves and the decay of C-fibre nerve conduction. A major area of interest is the use of measurement of the post-mortem electrical excitability of skeletal muscle to determine the post-mortem period. A phenomenon often seen in cooling curves of human corpses is the temperature plateau. Generally this plateau has to be taken into account when using temperature based algorithms to determine the post-mortem period. The cause of this plateau was the main focus of my investigations.

I was awarded a ROPA Grant of £45.8K in 1995 from the EPSRC to design and build the first ever dedicated microprocessor to determine the time of death using temperature and muscle contraction. Other areas of interest include the dating of human remains, the correlation of head injuries with the height of fall, and the biomechanics of judicial hanging. A new field in forensic engineering is the application of human motion analysis to investigate mechanisms of injury. This has led to a number of publications in this area. I currently sit on the editorial board of the Journal of Forensic Biomechanics.

Sports Biomechanics

I am currently the club doctor at Cardiff City FC Duties include management of sports injuries and everyday ailments eg asthma, bronchitis, hayfever, abdominal complaints, general infections etc. This involves prescribing of medication within the IOC Anti-doping Guidelines. I am in daily contact with other sports medicine specialists including orthopaedic surgeons, physiotherapists, dieticians, and radiologists. In addition to my Cardiff City Football Club duties, I am also consulted by other professional sports personnel, ranging from Rugby players to Olympic athletes.

In my capacity firstly as doctor to the Under 21 Welsh Football team, and then as medical officer for the senior Welsh team, I was required to attend to players on a 24 hour basis for days at a time. I was recognised for my experience in sports medicine by being elected onto the UEFA medical committee (2002-2004). I am now the medical representative on the UEFA Expert Panel on Artificial Turf.

In 2008 I was appointed a consultant to FIFA on biomechanics relating to injuries of footballers playing on artificial and natural turf. It is FIFA’s intention to develop a set of standards for football pitches in order to reduce the likely hood of injury. My role has been to develop the research programmes at various institutes across Europe to develop a player based testing procedure.

Due to the increasing professional nature of sports medicine I felt that I should obtain a formal qualification in this field hence my successful completion of the Diploma in Sports and Exercise Medicine, which is becoming a prerequisite for any doctor involved in professional sports medicine. In 2007 I was elected a Fellow of FSEM and in 2008 invited to be an examiner on their Diploma in Sports and Exercise Medicine.

On field emergencies can occur and I felt that it was appropriate to have the necessary skills to deal with these situations. I therefore completed the Certificate in Advanced Trauma and Life Support and Sports Trauma Management (Advanced Level) and recently the Advanced Resuscitation & Emergency Aid (AREA) course. In order to maintain update my trauma skills, I regularly attend clinical sessions at a local casualty department. I also attend related teaching sessions covering all aspects of trauma management which is also run by the local casualty /trauma department.

With a colleague Professor Colin Dent I established the part time MSc course in Orthopaedic Engineering. This scheme was exclusively aimed at Orthopaedic surgeons to teach them engineering principles applied to Orthopaedic practice. This included understanding the biomechanics of causation of injury and their prevention. A number of the students successfully completed dissertations in this field which has resulted in publications in peer reviewed journals and conferences.
I am actively involved in research in sports injuries with a particular interest in treatment modalities. This includes the use of cryotherapy to treat acute injuries and the catergorizing of haematomas using ultrasound. I have also been interested in the role of the fat pad (Kager’s) in the human heel and its significance in achilles tendon rupture. More recent areas of interest have involved motion analysis to compare the human interaction between different types of football pitches and also the use of actovegin and its role in treating soft tissue injuries. The latter involves a randomized clinical trial using professional footballers. I have published my actovegin work in a number of international sports medicine journals. All of these examples involve an understanding of functional anatomy and the potential mechanisms of injury which are inherent in sports medicine and rehabilitation.

CEDAR

Since 2010 I have been working closely with CEDAR who are an NHS-academic evaluation centre which supports decision making healthcare by providing information and recommendations on a number of areas including emerging health technologies, medical devices and diagnostic tests. The majority of CEDAR’s work is funded by the National Institute for Health Care Excellence (NICE). I have been successful in obtaining approximately £1M in research funding from NICE to help CEDAR in it’s evaluation programme

Professional memberships

• UEFA Medical Committee, Biomechanics Expert (2001 – 2004).
• UEFA Artificial Turf Panel, Biomechanics Consultant (2003 – 2008).
• Consultant to FIFA on biomechanics.
• Expert witness: numerous court cases involving engineering applied to medicine. Examples include implant failure, sports biomechanics, time of death of human corpses and biomechanics of judicial hanging (Rupe v Washington state, 1998).
• Foundation Fellow of Faculty of Sports and Exercise Medicine (FSEM)(UK).
• Member of the editorial board of the Journal of Forensic Biomechanics.
• Referee for a number of national and international journals; reviewer of grant applications for EPSRC and the Royal College of Surgeons (England).

Publications

Research theme: Health, Technology and the Digital World

Contracts

Supervised Students

Supervision

Past projects