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INNOVATION FOR INDEPENDENCE
ISSUE 97 JUNE/JULY 2014 £6.95
‘Intelligent’ liner could ease pain for thousands By Nicola Hyde A NEW device is being developed that could help to relieve the pain and discomfort experienced by thousands of amputees as a result of poorly fitting replacement lower limbs. Researchers are developing a prototype of the world’s first prosthetic ‘intelligent’ liner with integrated pressure sensors, which could be available to NHS patients in as little as three years. The sensors for the device, invented by Dr Liudi Jiang and a team at the University of Southampton, measure the pressure and pulling forces at the interface between a patient's stump and socket of their prosthesis. Dr Liudi Jiang said: “Socket fit is the single biggest factor determining whether prosthesis will be successful for a patient. If we had a simple way to accurately measure the load at the socket-stump interface and determine the best possible fit for that limb, it would
completely transform the socket fit experience for amputees. “We’re hoping that the development of the intelligent liner will be the first step leading to the ‘holy grail’ in prosthetics – a fully automatic, selfadjusting smart socket interface for amputees.” There are 50,000 lower-limb amputees in the UK, most of whom use artificial limbs that are attached to the residual limb through a socket. No two stumps are exactly the same shape and size and even an individual's stump can change shape over the course of a single day. The intelligent liner will allow clinicians to quickly and accurately assess and optimise socket fit at the outset. The wireless interface will also monitor changes to socket fit over time, alerting patients of the need to adjust their socket or activities to prevent ulcers from forming. Scientists believe the technology
could also form the basis for other intelligent materials, like shoe insoles to prevent diabetic foot ulcers, or mattresses and wheelchairs that protect against pressure sores in immobile or elderly patients. The Southampton team will work with Chas A Blatchford & Sons Ltd,to fine-tune the design and develop the sensor into a range of thin prosthetic liners to fit sockets of any shape and size. Dr David Moser, head of research, said: “This is a tremendously exciting project which has the potential to transform socket technology as a whole in lower limb prosthetics. We anticipate that from the development of this technology we will reach a new level of understanding and uncover the as yet unclear ‘dynamic’ qualities of limb loading and socket fit. This step is crucial for the development of the next generation of socket technology products and future artificial limb controls.”
Dad Darren Pugh has become the first UK civilian to be fitted with a technologically advanced prostheses that was originally developed for injured soldiers returning from Afghanistan. Full story, Page 8
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Implant ‘restores connection from brain to muscles’ SCIENTISTS have developed an implant that could cure paralysis that could be available to the industry within five years. Newcastle University researchers have shown that by connecting the brain and spinal cord of a macaque monkey to a computer they could stimulate the nerves and restore function to a temporarily paralysed hand. There is currently no cure for upper limb paralysis, where there has been damage to the nerves which send messages to the muscles from the brain, such as happens after a stroke or spinal injury. But scientists at Wellcome Trustfunded researchers at Newcastle University say their discovery opens up the possibility of new treatments which could help stroke victims or those with spinal cord injuries regain some movement in their arms and hands.
The team trained the primates to grasp and pull a spring-loaded handle. The monkeys were then temporarily paralysed, using a drug that wore off after about two hours. During that time the monkey had no movement in their hand and was unable to grasp, even though most of the brain was functioning normally. But when the stimulation circuit was switched on the monkey was able to control its own arm and pull the handle.
restore that connection, to allow the signal telling the hand to move to reach the spinal cord. By exploiting surviving neural networks below the injury, we can activate natural actions like grasping using just a few stimulation sites. This is the first time that anyone has done that.”
The work is published in the journal Frontiers in Neuroscience.
Dr Jackson added: “I think within five years we could have an implant which is ready for people. And what is exciting about this technology is that it would not just be useful for people with spinal injuries but also people who have suffered from a stroke and have impaired movement due to that. There are some technical challenges which we have to overcome, as there is with any new technology, but we are making good progress.”
Dr Andrew Jackson, Research Fellow at Newcastle University and Dr Jonas Zimmermann, now at Brown University, Providence, Rhode Island, USA, led the research. He said: “When someone has a damaged motor cortex or spinal cord the problem is that the signal from the brain to the muscles isn’t getting through. What we have done here is
The next stage will be to further develop the technology to eventually have a small implant for use in patients that can then form the link between the brain and the muscles.
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Reflecting on mirror therapy NEWS
By Nicola Hyde MIRROR therapy is being used to help upper limb motor recovery in patients with acquired brain injuries at a rehabilition centre in Briston.
It is related to motor imagery, bilateral upper limb training and movement observation.
The occupational therapy team at The Huntercombe Group’s specialist Brain Injury Rehabilitation Centre at Frenchay are exploring the use of mirror therapy to aid motor recovery in patients who are suffering from hemi-paresis (loss of control and weakness). A trial use of mirror therapy, with a 20-year-old man who had sustained a traumatic brain injury, demonstrated an improvement in distal upper limb function. The Chedoke arm and hand inventory was used as an outcome measure, and results showed a reduction in the level of assistance required. The subject also demonstrated an increase in the spontaneous use of his affected upper limb during assessment which has enabled him to participate in further treatment options. Other benefits experienced included an increase in ‘ownership’ and reduction in the neglect of the affected upper limb.
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1994 Ramachandran suggested that visual feedback may also help recovery of arm and leg function post stroke.
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Mirror therapy creates an illusion that the patient is once again able to use the extremity, giving positive feedback and reward.
Donna Wilding, lead occupational therapist, said: “In the stroke population, evidence suggests that Mirror Therapy is especially beneficial for those without detectable motor function of the distal upper limb. “However, to date, there is little evidence for its use within the acquired brain injury population, due to the global cognitive and perceptual impairments that our patient group often present with, exclude them from research studies. “We therefore set out to explore whether the therapy would be suitable for our patients who may
experience cognitive impairments, for example, attention deficits or communication difficulties. The initial outcome is very encouraging, leading us to extend our studies to other patients who might potentially benefit.” Mirror therapy stems from studies in the 1990’s by Ramachandran, of phantom limb pain (PLP). Ramachandran suggested that phantom limb pain may be due to changes in the brain rather than peripheral nerves. He created the mirror box and noticed remarkable changes in amputees with PLP. In
The patient sits at a table and the mirror is placed in the saggital plane (a vertical plane which passes from front of the person to rear, effectively dividing the body into right and left halves.) The hemiplegic arm is placed out of view. The reflective part of the mirror shows the non-affected arm. The patient is asked to perform exercises with both extremities focusing on the reflection of their non-affected arm. The patient views the reflection as if it were the hemiplegic side. Motor imagery and movement execution are driven by the same mechanisms linked into the Pre-Motor Cortex and Motor Cortex that plan and drive movements.
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Richie Lovett
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Picture: Peter Crumpton
Richie on crest of a wave after getting all-clear A PROFESSIONAL surfer who had pioneering prosthetic treatment is now back in the water having made a full recovery. Richie Lovett was diagnosed with a cancerous tumour in his femur or thigh bone at the peak of his career – and he launched an international search to find the experts who could offer him the best care. The search led him from Australia to the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute and the care of surgical oncologist Earl Warren Brien, MD. Richie said: “As a professional athlete, I was blindsided by the news that I had cancer. I realised very quickly that cancer would have a profound effect on my life. I knew I needed an experienced oncologist to tackle this disease, so I began an international search to find the very best options and care.” Brien, director of Musculoskeletal Tumor Service at the Orthopaedic Oncology Programme in the CedarsSinai Orthopaedic Center, is an expert in treating bone cancer and has pioneered many of the most groundbreaking surgical procedures in orthopedic oncology. Brien diagnosed Lovett with a tumour called clear cell chondrosarcoma, an uncommon form of bone
Richie Lovett
cancer that rarely responds to chemotherapy or radiation. Instead of therapeutic treatments, Lovett would undergo a state-of-the-art surgery to give him the best chance at surfing again. The surgical technique, described recently in the journal Orthopedics, required Brien to remove Lovett's tumour and damaged bone in its entirety, replace it with a prosthetic and then reconnect his hip and surrounding muscle to the prosthetic implant. This innovative approach provides the greatest range of movement possible. Brien said: “With standard procedures, healing can be slow and patients often need multiple followup surgical procedures. But when damaged bone is removed and replaced with a metal prosthesis, patients may get back to their daily activities more quickly and easily. “The surgical approach Richie received is unique due to the prosthetic. The prosthesis is made of a combination of cobalt-chrome and titanium and has a three-piece head that allows for more range of motion and greater stability. This technique gave Richie, and patients like him, a faster recovery, more predictable outcomes and better overall quality of life.”
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Pictures courtesy of Eammon Deane
‘I think losing my leg has even made me more determined’ By Nicola Hyde A MAN who lost his left leg in a road accident just five years ago has burst back onto the sporting scene by winning national titles from ablebodied competitors. Jozef Meltelka, 27, from Oxford was a professional tennis coach before his accident in 2009 and says losing his leg has made him more detemined to succeed in sport. He said: “Growing up in Slovakia, I was always out skiing, cycling, playing tennis. So, after my accident, I was determined to get back to
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enjoying these activities. I think losing my leg has even made me more determined.” Jozef has been fitted with some specialist prosthetic limbs that have allowed him to return to winning. Thanks to his drive and positive attitude, along with some specialist prosthetic limbs, Jozef has returned to the ski slopes of Europe (competing in the Slovakian Paralympic ski team) and has smashed his way onto the cycling scene, not only in Paracycling competition, but also winning
National races. At his first World Championship Paracycling event in Mexico, he won three medals (one gold and two silver), as well as a world record. These successes followed national wins against non-adaptive athletes, in races up to 200kms. Jozef added: “I love racing in mainstream races. Sometimes I don’t think that they can quite believe that a guy with one leg is challenging them. But it’s all good experience for my Paralympic aspirations. “Hopefully, if I continue to develop, I
can challenge for medals at the Paralympics, which will be incredible.” Prosthetist Jamie Gillepsie, who looks after his prosthetic requirements at Pace Rehabilitation’s clinic in Chesham, says Jozef is always pushing the boundaries. He added: “To be competing at this level is quite remarkable. Jozef certainly keeps us on our toes.” Jozef’s other ambition – besides competing in the Paralympics in Rio in 2016 – is to compete in the Tour De France.
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Revolutionary prostheses gives young dad new confidence By Nicola Hyde A YOUNG dad has become the first UK civilian to be fitted with a technologically advanced prostheses that was originally developed for injured soldiers returning from Afghanistan. Darren Pugh, 37, was been fitted with the revolutionary Ottobock Genium X3 – which has a microprocessor-controlled knee, is waterproof and completely submersible – by Dorset Orthopaedic. Darren became a through knee amputee, after a motorcycle accident in 2007 and with a todder son wanted to be as active as he could be. He said: “I now have much more confidence to rush forward and pick up my baby boy as it gives me greater stability. I have more trust in the prosthesis supporting me. It is nice to be able to keep up with my son and run after him when he tries to run away as toddlers do.” Originally fitted with the standard Genium, Darren was worried about getting it wet or dirty. But the X3 uses intelligent technology that isn’t only water proof but allows him to walk normally without having to worry about his environment. The Genium X3 microprocessor reads and records the user’s movement as
data at a 100 times a second. It converts that data into adjustments that control the hydraulics, which regulate the movement of the prosthesis, depending on what the user is doing such as walking, running or walking down stairs. Darren added: “I want to be able to go on day-to-day walks with my family to the beach, rivers and streams without having to worry about my prosthesis. With the new leg I will be able to follow my son into water without even thinking about it. “I also like to keep active. As well as going to the gym regularly, I plan to take up other sports like kayaking, which is something I didn’t think about before my amputation. But now I’m really keen to try it again to prove to myself I can still do it and set myself a challenge. I couldn’t really think about kayaking again if I didn’t have this.” Dorset Orthopaedic prosthetist, Matthew Hughes, said: “We have always been slightly limited before, as you have to be so careful with a microprocessor knee, but now it is so much more durable and useable. “It is like the SAS of the prosthetic leg world. It will be a revolution for a lot of patients and it is very exciting for me to be fitting the first civilian unit in the UK.”
“I now have much more confidence to rush forward and pick up my baby boy as it gives me greater stability. I have more trust in the prosthesis supporting me. It is nice to be able to keep up with my son and run after him when he tries to run away as toddlers do.” 8
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Animal learning used in knee research A NEW research paper from the University of Bath uses learning from the knee joints of horses and cows to better understand human knee weakness. The paper, published in flagship science journal Naturwissenschaften, demonstrates a powerful new tool that could give medics a better understanding of osteoarthritis in the knees of humans. Professor Richie Gill, author of the paper from the University’s Department of Mechanical Engineering, said: “For human knees, a common failure is osteoarthritis, which is the result of degradation of cartilage within the knee joint. The cartilage is needed to provide a low-friction, self-lubricating surface that can bear loads and permit movement. When this breaks down, the sufferer will experience pain and a loss of movement.” There is good understanding in medicine about the biochemistry and genetics of the materials that make up cartilage, but relatively little is known about how they contribute to the bulk properties of cartilage and
how they work in a joint. Professor Gill added: “Understanding the mechanical properties of cartilage within the knee isn’t trivial. Traditionally, to do this you’d need to surgically remove significant amounts of cartilage from the knee, and this would require the use of cumbersome equipment. There is a clear need to develop a simple technique that will allow the testing of small tissue samples.” The research team at Bath has developed such a technique, using it to compare the knees of horses and cows. The insights into horse and cow knees were made possible by the use of a novel analytical measuring technique based on the shearing of small biopsy samples, called ‘Dynamic Shear Analysis’. Professor Gill said: “Dynamic Shear Analysis, or DSA, can give us detailed measurements of the behaviour of a material. We have been able to use this method to test the collagen network that makes up cartilage.” The research team chose the knees of horses and cows for comparison in order to test that their method
worked as expected. It is already known that there are correlations between the lifestyle of an animal and the form and function of its knees. Professor Gill said: “Our method enabled us to study the makeup of cartilage in the knees of cows and horses, rather than just knee morphology – how the knee joint is formed. Overall we saw highly significant differences between the cartilage of horses and cows. Horse cartilage is thicker, compresses less and has a greater resistance to deformation - it almost certainly developed this way to allow for the speeds at which horses travel, and increased pressure on the knee joint. “Our observations have implications for the study of human knee cartilage and its diseases. Evolutionary pressures in human knees may have increased our knee range of motion, but not driven significant change in cartilage material properties. The technique of DSA could offer a new, powerful means to understand osteoarthritis and classify knee joint failures.”
‘Rehabilitation road to recovery’ A CONFERENCE that focussed on the rehabilitation road to recovery was held for the Royal College of Physicians in London. The event focused on the patient and how to achieve successful rehabilitation outcomes for catastrophically injured individuals through collaborative working. Below-the-knee amputee Bobby Griffin presented his own rehabilitation journey, following his road traffic accident in 2008 and subsequent elective leg amputation. Pace clinicians Toby Carlsson and Carolyn Hirons then presented the benefits of a multi-disciplinary team approach to successful rehabilitation and introduced five different prosthetic users who demonstrated their prosthetic provision. A spokesman said: “The entrance by one of the users, above-the-knee mountain biker Glenn Johnstone, certainly surprised and impressed the audience as he cycled down the stairs into the auditorium.” There was also talk from through shoulder amputee Andy Garthwaite, one of the first patients in the world to receive the ground-breaking TMR (Targeted Muscle Reinnervation) surgery, where the nerves from his amputated side are re-positioned into his chest, enabling him to intuitively move this prosthetic arm through thought alone.
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How Colin found a way to protect his ankle ... A PARACYLIST says a custom-made carbon orthotic brace made for him by a company in Leeds has revolutionised the way he competes and led him to another World Championship medal.
compromising my power on the bike. I had a design for a brace in mind, but it would require some tricky custom carbon fibre work and someone with the vision to bring it to life.”
Colin Lynch, a paracycling rider for the Irish National Team, has a custom-made carbon orthotic brace made by Crispin Orthotics.
Colin approached Crispin Orthotics in Leeds with his idea – managing director Mark Thaxter is a keen cyclist himself and understood what needed to be done.
Colin lost one leg below the knee and has almost complete muscle loss on the opposite leg from a spinal cord injury when he was 20. He said: “I have been racing an International Paralympic cyclist for the last four years now and the long hours on the bike are starting to take their toll on my body. “When pedalling the bike, all the force from my leg is driven through the ankle – which locks out at the bottom of each pedal stroke. Over time it places a huge amount of stress on the joint and has made me prone to injury. “I went looking for a solution to the problem – something that would protect the ankle without 10
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He set about fabricating a custom brace that would strap onto Colin’s lower leg to support his body weight, fixing his foot and ankle into a stable position. It fits inside a cycling shoe and does not interfere with his pedal stroke. Colin added: “The technician on the project, Simon Barnett, made a prototype of the brace from plastic to check the fit. I was able to strap on the brace and hop onto a stationary bike to test it to see how it felt. Fortunately, very few changes were needed at this stage. “The next step was to copy the prototype into full carbon fibre. In addition to the brace itself, there is a carbon backplate and it is held
“I went looking for a solution to the problem – something that would protect the ankle without compromising my power on the bike. I had a design for a brace in mind, but it would require some tricky custom carbon fibre work and someone with the vision to bring it to life.” together with snowboard straps on one side and fasteners from cycling shoes on the other. The fasteners from the cycling shoes allow the brace to be progressively tightened (or loosened) at any time during a ride. “The last step was to fit some padding to the inside to protect the skin from the carbon. The placement of the padding had to be precise as to spread the force being exerted through the brace without damaging the skin. This was a trial and error process of adding and subtracting padding from various areas until the right balance was found.” Colin says it meant that he managed a ride that was six hours long without having any pain.
In April, he took the brace to the Paracycling Track World Championships in Mexico and broke the World Record in the Individual Pursuit event, and secured a Silver Medal. He added: “Modern orthotics isn’t about off-the-shelf solutions any more (if it ever was). It’s the people that are willing to take a chance, think differently and be creative that can make the biggest difference. “I will now be able to not only extend my cycling career, but in all likelihood, protect my vulnerable ankle from further damage. “And with a bit of luck, win a few more medals along the way.”
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Arm system gets go-ahead for sale in US A TECHNOLOGICALLY advanced prosthesis that is controlled by the body’s own electrical signals has made it through testing and has been approved for commercial sale in America. The FDA has approved the Deka Arm System, developed by Deka Research and Development Corporation, which uses electromyogram electrodes to pick up electrical signals from muscle contractions where the prosthesis is attached, or from a wireless controller operated by foot movements. It learns to convert these signals into the arm movement intended by the user. The arm is not surgically implanted but fitted via a customised plastic or carbon-fibre socket that attaches the prosthetic to the residual limb. Users can learn to perform some tasks within hours, and most are fully trained within weeks, learning fine control of the device either through direct muscle motions of their
residual arm, through the foot attachment, or a combination of the two. Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health, said: “This innovative prosthesis provides a new option for people with certain kinds of arm amputations. The DEKA Arm System may allow some people to perform more complex tasks than they can with current prostheses in a way that more closely resembles the natural motion of the arm.” A clinical study of 36 participants showed how the arm performed in common household and self-care tasks. Almost 90 per cent of study participants were able to perform activities that they were not able to perform with their current prosthesis. The DEKA Arm System can be configured for people with limb loss occurring at the shoulder joint, midupper arm, or mid-lower arm.
Circuit board ‘can mimic the brain’ By Nicola Hyde SCIENTISTS have created a circuit board modelled on the human brain that they believe could help control prosthetic limbs for paralysed people. The Neurogrid – developed at Stanford – can mimic the brain on the power it takes to run a tablet computer. Kwabena Boahen, associate professor of bioengineering at Stanford, and his team have developed Neurogrid, a circuit board consisting of 16 customdesigned ‘Neurocore’ chips. Together these 16 chips can simulate one million neurons and billions of synaptic connections. Now, work is being done to lower costs of creating a Nuerogrid and create software that would allow engineers to use it to control robots and even prosthetic limbs. Boahen is working with other Stanford scientists to develop prosthetic limbs for paralysed people that would be controlled by a Neurocore-like chip.
He said: “Right now, you have to know how the brain works to programme one of these. We want to create a neurocompiler so that you would not need to know anything about synapses and neurons to able to use one of these." A chip as fast and efficient as the human brain could drive prosthetic limbs with the speed and complexity of our own actions – but without being tethered to a power source. Krishna Shenoy, an electrical engineering professor at Stanford and Boahen's neighbour at the interdisciplinary Bio-X center, is developing ways of reading brain signals to understand movement. Boahen envisions a Neurocore-like chip that could be implanted in a paralysed person’s brain, interpreting those intended movements and translating them to commands for prosthetic limbs without overheating the brain. A small prosthetic arm in Boahen's lab is controlled by Neurogrid to execute movement commands in real time.
Company introduces new technology into process A COMPANY that manufactures custom orthotic insoles has launched a new technology into the way it designs and manufactures its products. Delcam is now using Additive Manufacturing (AM) after it first considered it in 2010, working with Adrian Bowyer of Bath University using a RepRap device to print custom PLA insoles. More recently, the healthcare team has been able to transfer surface data from Delcam's orthotics solution software, OrthoMODEL, into ArtCAM, Delcam's artistic CADCAM package. A spokesman said: “By combining the 12
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functionality of these two software packages, Delcam has been able to generate and print a series of concept designs which demonstrate some of the possibilities for AM in the production of orthotics. “The process started by creating the orthotic designs within OrthoMODEL and then importing them into ArtCAM where additional product features were added. These included structural ribs for strength, high resolution 3D reliefs for aesthetics, and textures and aeration holes for potential clinical benefits.” Delcam showed its use of AM at its stand at OT World in Germany last month.
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Toyota-made robots used in research study A PAIR of robots manufactured by Toyota are being used in a clinical research study into how they can be used in rehabilitation by helping patients walk and keep their balance. The Walk Training Assist and Balance Training Assist robots are part of the Toyota Partner Robot Series that was first announced in 2011 in collaboration with the Fujita Health University Hospital in Toyoake, Japan. The modification process has streamlined the robots’ functions, focusing on motor learning theory and easier attachment to the user. The robot can be attached to a paralysed leg to help the user walk and stand and helps patients regain control of their balance, linking their body movements to a video game display. Toyota wants to make its robots commercially available in the near future, and will be supplying its clinical research models, for a fee, to 20 medical facilities from this autumn. The Walk Training Assist Robot provides support from the early stages of rehabilitation so that people suffering lower limb paralysis
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can train to walk normally. Attached to a paralysed leg, this robot helps the user swing the leg forwards, while helping straighten the knee and supporting the user’s weight. The leg mount has a lifting mechanism which reduces the weight burden of the robot on the user.
Making a beeline for funds
The level of robot assistance can be varied, according to the degree of rehabilitation required.
A BRITISH soldier is leading a team of fund-raisers on a unique fund-raising challenge that will see them aim to get from Land’s End to John O’Groats – by making a beeline for the finish in a straight line. BLESMA member and London Paralympian Nick Beighton, 32, pictured above, is part of a team of four taking on the challenge that has already raised almost £7,000 for charity with funds still coming in. Nick, from Shropshire, is currently serving as a Captain in the Royal Engineers, and lost both his legs above the knee while serving in Helmand Province, Afghanistan in October 2009. Having gone through rehabilitation at Headley Court, Nick began training full-time as a Trunk and Arms rower for the London 2012
The Balance Training Assist Robot supports people unable to maintain balance in an enjoyable rehabilitation process that uses a video game-style presentation. It uses the same inverted two-wheel technology that is also featured on Toyota’s Winglet personal transport assistance robot. The user’s forward/back and left/right body movements are linked to a character in the video game. Tennis, skiing and rodeo game modes are available, helping train the user in shifting their centre of gravity in different directions while keeping their balance.
Paralympic Games, finishing fourth in his event with partner Sam Scowen. Nick said: “Taking on Beeline Britain after the high of the London Paralympic Games gave me a new challenge to focus on. “BLESMA have given me a lot of support since my injuries, so I suggested we chose them as the beneficiaries as I am very keen to raise as much money and awareness for them as possible. “The fact that Land’s End to John O’Groats has never been done in a straight line before makes the challenge unique and I am excited to see how it unfolds.” BLESMA – The Limbless Veterans is the national charity for all limbless service men and women, their widows and dependants.
Praise for dynamic and innovative BAPO stands THE UK’s largest dedicated event for prosthetics and orthotics saw scores of delegates enjoy a packed seminar programme and join in debates. The 2014 Bapo Conference included everything from a debate on TUPE with an expert panel outlining how they can help members with legal issues to a series of prosthetic and orthotic programmes. The DeNovo keynote Keith Smith gave an overview into the treatment of paediatric scoliosis and his presentation provoked lively debate from the floor. OETT keynote Rory O’Connor provided delegates with an update on how rehabilitation pathways are set up within the healthcare system while Faye Dearden gave an insight into the mechanisms of FES. Dr Murphy’s talk on accessibility of gait analysis software and video gait analysis used in an everyday clinic was a must for clinicians. Peter Slijkhuis and Hayley Ginn, our Ossur keynotes provided an impressive insight into the rehabilitation pathway for amputees and Sam Shotton conducted a thoroughly intuitive presentation on
phantom limb pain. The prosthetic programme continued with Nick Hillsdon MBE giving a fascinating account of his time at Queen Mary’s Hospital, Roehampton. Following the theme of upper limb prosthetics, Melissa Jacobs spoke on the application of an Assessment tool of Capacity for Myoelectric Control (ACMC) while Nathan Babiker provided an insightful interactive session on the management of expectations and goals within the rehabilitation setting. Martin Twiste updated delegates on limbless statistics and Fergus Jepson concluded the prosthetic programme with an update on the VPP (Veteran’s Prosthetic Panel). The Technician programme saw Phil Buttery open the morning session with a talk on his trip to Uganda with the UPP charity. Keith Miller gave a technical appreciation of contracture correction devices, Dave Buchanan talked on the importance of KAFO alignment and Adrian Stenson presented on the training needs in prosthetics and orthotics.
Tim Cooney provided a technical explanation of carbon composites used in P&O with Steve Hutchins bringing the programme to a close with an in-depth look at rocker soles before the Technicians joined the Algeo orthotictechnicians.com Show & Tell event in the bar. Sunday workshop attendees were treated to an upper limb prosthetic consultation panel with Brian McLaughlin and Alison Goodwin while Orthotists enjoyed the opportunity to further their knowledge on KAFO prescription with a presentation from Dave Buchanan and another from Chris Cody on the evidence and funding streams for stance phase control KAFO’s. A BAPO spokesman said: “Companies once again went to great lengths to create dynamic, innovative stands to showcase their products. “Visitors to the exhibition very much enjoyed the efforts of exhibiting companies and in particular the array of games, food and alcohol made available at many of the stands. “BAPO appreciate the considerable contribution the exhibitors make to
Jonathan Bull (Chair of BAPO) and Mags Miller (Former Chair of BAPO)
our event and appreciate that many of the events/prizes would not be possible without the continued support of our Exhibitors, sponsors and delegates and we would like to take this opportunity to thank all those who helped make the event such a success.” ASSISTIVE TECHNOLOGIES I JUNE/JULY 2014
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Jamie stars in ‘The Limbless Mountaineer’ NEWS
A MAN who almost died after being stranded in the Alps has featured on a Channel 5 documentary after taking on The Matterhorn – even though he’s a quadruple amputee. Jamie Andrews starred in ‘The Limbless Mountaineer’ and was filmed while he embarked on the epic challenge that had always been his lifetime ambition. He said: “To anyone the Matterhorn is an iconic mountain, a symbol of the Alps. However it is a huge challenge to attempt the climb, even today it is still a serious mountain for climbers to scale. “There is no easy way up or down the mountain but it has always been in my thoughts as a challenge
Backing for Northern Ireland campaign A CAMPAIGN to allow independent prescribing by physiotherapists and podiatrists in Northern Ireland has been backed by the CSP. The Chartered Society of Physiotherapy and the College of Podiatry hosted a conference at the University of Ulster outlining the benefits of physiotherapists and podiatrists being able to independently prescribe medicines to their patients. It is hoped that legislation to enable independent prescribing by physiotherapists and podiatrists will soon be introduced in Northern Ireland, as it has or is about to, elsewhere in the UK. The additional prescribing responsibility can greatly improve care for patients, as suitably trained physiotherapists can prescribe a range of medicines relevant to their area of practice without needing a signature from a doctor. The ability to prescribe medicines means faster and quicker access to treatment for patients and makes more efficient use of health service resources. Professor Karen Middleton, CSP Chief Executive, was instrumental in developing prescribing rights for physiotherapists and podiatrists across the UK. She said: “Physiotherapists and podiatrists being able to independently prescribe – for the first time anywhere in the world – will remove bureaucracy, free up time for doctors and save money for the health service.” 14
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to attempt. Since the accident I did think that it would be out of the question but my attitude is always ‘never say never’.” Fifteen years ago Jamie and his climbing partner, Jamie Fisher, were stranded during a climb in the Alps. One of the most dangerous helicopter rescues ever carried out was done to save him after he had spent five days in the cold without food or water. Jamie was rushed to hospital with hypothermia and frostbite - which led to the amputation of his hands and feet - but tragically his friend had frozen to death by the time the helicopter arrived. He said: “The Matterhorn is a serious mountain for any
mountaineer. The challenge for me was that although it isn’t extremely steep rock, it is constantly difficult and serious, and you are constantly looking for sure footing. There are no easy sections and no let-up in the ascent.” Jamie has a range of adapted prosthetics, as seen in the documentary, including one he uses to throw snowballs. “I like to keep things as simple as possible and this applies to my prosthesis. I use the Össur Vari-Flex every day and also for climbing, I know its limits and how it functions so there will be no surprises on the climb. As I don’t have to worry about the cold I wear trail shoes rather than heavier
climbing boots.” Although on this occasion the summit of the mountain was just out of reach, the challenge has not deterred Jamie from future climbs. Not least returning to The Matterhorn to complete the ascent. “Not being able to reach the summit was disappointing but we purposely packed light and there was no way we could stay on the mountain or have enough time to reach the summit and descend safely. “I’d love to have another go at reaching the summit of the Matterhorn. Another challenge is to climb El Capitan in Yosemite National Park, California.”
Prosthetic opens up new world for Helen A WOMAN who was given a prosthetic running leg from a charity after being refused one on the NHS for over three years has appeared on national TV talking about her sporting achievements. Helen Chapman, 46, from Essex, collected her Ossur Cheetah blade from Pace Rehabilitation’s clinic in Chesham in mid-March. It was funded by charity Arctic ONE and saw her able to take part in the London Marathon where she smashed her personal best time by an hour – then she appeared on ITV’s This Morning with Pace physiotherapist Joanna Breslin the day after. Helen said: “To finally have a prosthesis that allows me to run has opened up a whole new world for me. “It’s been absolutely crazy. I spent three years being denied a running prosthesis by my NHS centre. “Then a charity called Arctic ONE stepped in and helped fund my ‘blade’ from Pace. “Since then I’ve been able to do so much more and help others along the way.” She has participated in Limbpower’s ‘Learn to Run’ events, has been classified for Paralympic athletics and was a mentor at the Amputee Games in Stoke Mandeville. Helen wore a Limbless Association running vest for the London Marathon but admits it was a challenging race. She added: “The first nineteen miles
Pictures courtesy of Pace Rehabilitation
felt good, but then my stump started to swell and cramp up, so I had ease right up. “But the crowd was amazing and I determinedly ran up The Mall to cross the line in a time of 5 hours 30 minutes. Although I was disappointed not to run the whole distance and was in discomfort, I was absolutely chuffed to beat my personal best time, by an hour.” Helen is now in training for a Duathlon which is being organised by Arctic ONE. She said: “I want to show my appreciation to them and to Pace for the support they have given me. Hopefully we can encourage more people with disabilities to get into sporting activities.”
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sponsors podiatry In this special column, exclusively for Assistive Technologies magazine, Barbara Young – the chief executive of Diabetes UK – talks about preventing unnecessary amputations.
How to spot a foot attack ... SINCE Diabetes UK launched its Putting Feet First campaign there has been more focus than ever by Clinical Commissioning Groups (CCGs) on diabetes-related amputation. Decision makers are recognising that, as up to 80 per cent of amputations are preventable with the correct management, they can play an important role in reducing the rate. The campaign has encouraged more hospitals than ever before to have a multi-disciplinary foot care team (MDfT) and we are continuing to campaign for more teams to be in place. Unfortunately, more than 6,000 leg, foot, or toe amputations are still being carried out each year on people with diabetes. This is more than 100 amputations a week. If current rates continue, the number of amputations will rise to more than 7,000 in 2015/16 in England. Amputation rates currently vary widely from one area to another and we want to support CCGs to offer an integrated care approach to drive down incidence and variation. The starting point is making sure patients get a good quality annual foot check. Currently 15 per cent of people with diabetes are not getting this crucial check and this figure has not improved in recent years. It is essential that there are enough people who have been trained to deliver the foot checks – whether that is in a primary or secondary setting. Patients also need to be reminded about the importance of the foot check by all healthcare professionals, in order to encourage
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better uptake. Patients also need to understand the implications of their risk status, know how to look after and check their own feet on a daily basis, and realise the importance of urgently seeking medical attention in the event of any problems. Healthcare professionals have an important role to play in educating their patients in this way. People with diabetes who have acute foot problems – a “foot attack” – often do not get assessed and treated quickly enough by a member of the multidisciplinary foot care team, which NICE recommends should happen. That is why we’ve produced a new booklet – free to order at our online shop – aimed at people with diabetes who are at high risk of a foot attack. Called ‘How To Spot a Foot Attack’ and based on the integrated footcare pathway, it gives people with diabetes the vital information they need to access help fast. It also includes a card, which can be kept in a wallet, where the person can write the emergency contact numbers of their GP, multidisciplinary foot care team and podiatry/footcare services.
Barbara Young, chief executive of Diabetes UK
person is also feeling unwell. Booklets have been sent to every GP surgery in England and Northern Ireland and you can order your own copies at https://shop.diabetes.org.uk/go/redcard-foot-booklet If an integrated footcare system is in
place, with access to specialist care available as quickly as possible and patients have a better understanding of what they need to do, then potentially thousands of amputations could be prevented. Spare a few minutes to order the booklet and discuss it with patients. Your action could make all the difference.
A person is at high risk of a foot attack if they have a previous history of foot ulcers or previous amputation, or two or more of the following: neuropathy/loss of sensation, peripheral vascular disease/poor circulation, deformity (e.g. bunion, claw foot). A foot attack is when the foot is red, warm or swollen or if there is a break in the skin or any discharge and it is especially important the person seeks urgent medical attention if the ASSISTIVE TECHNOLOGIES I JUNE/JULY 2014
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sponsors podiatry
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Drop foot management – what are the latest innovations? by Dr Salim Ghoussayni, Ottobock Neurorehabilitation Business Development Director
Solutions for the clinician treating drop foot patients FOR many patients who suffer from upper motor neuron lesions, e.g. stroke, the damage to the central nervous system can result in a drop foot. Besides Functional Electrical Stimulation (FES), current treatment options for such cases are primarily physiotherapy and the use of an ankle-foot orthosis (AFO). Additionally, medical therapy (such as baclofen and botulinum toxin) and surgery are sometimes used. Ottobock is now also able to offer a full range of solution for clinicians treating patients with drop foot. The range extends from off-the-shelf orthotics, through external FES devices to implantable neurostimulation systems. The WalkOn range of carbon fibre AFOs are designed to address the specific needs of each patient and a variety of conditions and degrees of
paralysis in the lower limb can be treated. The primary feature of the WalkOn orthoses is that they are dynamic – a particular benefit for patients with permanent dorsiflexor weakness. The latest product to join the range, the WalkOn Reaction, is a lightweight, low profile AFO. Due to its unique anatomical design and quality carbon fibre prepreg material, the WalkOn Reaction allows users to walk naturally and in addition to supporting dorsiflexion, employs ground reaction forces to influence the knee and ankle joint.
rehabilitation phase and gait retraining. With its unique cuff design and the possibility to stimulate additional muscles through a second stimulation channel provides unique advantages for versatile application and additional therapy options (e.g. support at the hip and knee).
The MyGait system is the latest addition to external FES devices. It is a cuff-based system, triggered with a wireless heel switch and adjusted through a wireless remote control, making it suited for independent use by patients. The introduction of the MyGait system has also enabled clinicians to use FES during the
With the surgically implanted electrode, an optimal electrode position is achieved, eliminating the need for daily placement of external electrodes, yet maintaining a consistent foot and ankle movement. This also eliminates the small risk of skin and soft tissue irritation due to surface electrodes. Additional
The partly implantable ActiGait system operates through a number of components: an implanted stimulator and cuff electrode, an external control unit, antenna and wireless heel switch.
benefits are better sensation and comfort, improved ease of use and cosmetic appearance. The ActiGait system has recently benefited from a redesign of all external components with focus on improved user comfort and usability. Combined with the first evidence from patients continuing to successfully use the system 10 years post-implantation, ActiGait is a durable and effective long term solution for people living with drop foot. FES is suitable for patients with drop foot caused by central neurological injury (e.g. stroke, MS, TBI, and in some incomplete SCI cases) and is backed by interventional procedural guidance from NICE (IPG278). For cases caused by peripheral nerve injury, other treatment and management options are necessary.
Orthosis aiming to help stroke sufferers A NEW low profile ankle support orthosis has been introduced to the market that will aim to help stroke and muscular dystrophy sufferers.
fibre prepreg material and allows users to walk naturally, whether on a level pavement or tackling steep terrain while hiking.
The splint from Ottobock offers improved walking speed and stability for weak dorsiflexion and is designed to help lift and support slight to severe drop foot.
John Young, lead Orthotist at the Ledbrook Clinic, said: “I give all my patients the opportunity to try the different types of AFO’s which are on the market. I have found that the WalkOn Reaction is the best carbon fibre AFO. To quote one of my patients: ‘I feel as if this AFO is
The WalkOn Reaction Ankle-Foot Orthosis (AFO) is made from carbon
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springing my foot up’.” In addition to supporting dorsiflexion, it employs ground reaction forces to influence the knee and ankle joint. The energy return supports toe-off and heel strike, thus reducing compensatory movements such as hip hike. At the same time, it prevents uncontrolled foot contact and foot slap during heel strike.
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sponsors podiatry Podiatry services in Greater Glasgow and Clyde were transformed when the clinical decision was made to add Algeos Diaped Dopplers. This case study, by David Wylie, podiatry services manager, explains why.
Podiatry team benefits from Doppler test OUR podiatry department provides care for around 75,000 patients, delivering over 220,000 treatments each year. A team of 200 clinicians delivers patient services from 75 clinical locations across the area. The podiatry department only had a small number of Dopplers available to staff working in multi-disciplinary acute teams, whilst staff working in community clinics just had limited access to Dopplers to assist them in vascular assessments. A Doppler is used to identify reduced blood pressure at the ankle. This assessment might be the first indication that a patient is at risk of cardiovascular disease. I wanted to ensure that our whole team of staff had the equipment they required to confidently assess vascular risk. By providing Dopplers for community
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podiatrists, they were able to identify patients without palpable pulses but with adequate perfusion to allow them to be managed in a lower-risk category. The Algeos Diaped Flux-200 Vascular Doppler is a handheld, portable device, which is ideal for use in either our hospital or communitybased clinics. All patients within the service will have access to a Doppler test whenever they need one. Plus, there are more appropriate onward referral to vascular services for community podiatrists. The podiatry team has benefitted as it now has the equipment it required to deliver quality patient care in the community. There is now more effective use of time and resources, which enables the team to make more confident clinical decisions.
‘The podiatry team has benefitted as it now has the equipment it required to deliver quality patient care in the community.There is now more effective use of time and resources, which enables the team to make more confident clinical decisions’
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Latest version of fracture brace launched
Brace increases patient comfort
medi UK are delighted to announce the launch of the latest version of their Humeral Fracture Brace. Available in 3 sizes and left/right versions the medi Humeral Fracture Brace has been widely used across the UK. Newly improved strapping configurations, enhanced padding and wrist support configuration ensures a comfortable fit for patients, providing an improvement in compliance during healing and rehabilitation. The lateral strap panel provides a low profile covering that protects patients clothing and enables clothes to be worn over the brace comfortably
medi uk are delighted to announce the launch of the new M4s Comfort 4-point rigid knee brace. The M4s Comfort is the product of over 10 years’ experience in the development of functional knee braces. We have combined our expertise, unique product features and quality workmanship for increased patient comfort and therefore compliance. The Physioglide joint mimics the roll and glide of the knee and therefore ensures a secure fit with little migration. Now even flatter it can be worn discreetly under clothing. The flexion / extension wedges can
and without fear of velcros rubbing or catching. The scalloped axilla section of the brace in conjunction with the different breathable materials used in the manufacture also ensures that the patient remains as comfortable and cool as possible. For more information or for a demonstration, please contact us: medi UK Limited, Plough Lane, Hereford, HR4 0EL | Tel. 01432 373400 | enquiries@mediuk.co.uk | www.mediuk.co.uk | shop.mediuk.co.uk
be changed quickly and easily with built in tweezers with no need for screws. Lightweight but sturdy D-Rings are hinged and rotate to selfalign with the straps, and the frame is flared at the calf to ensure an optimal fit. For more information or for a demonstration, please contact us: medi UK Limited, Plough Lane, Hereford, HR4 0EL | Tel. 01432 373400 | enquiries@mediuk.co.uk | www.mediuk.co.uk | shop.mediuk.co.uk
Naidex boasts biggest speaker programme in 40-year history across the UK, including health care professionals, the trade plus end users and their families.
TV personality Alex Brooker and Britain’s Got Talent semi finalists Strictly Wheels opened this year’s Naidex show that was held last month.
Matthew Tingey, event director, said: “I was incredibly moved to see the thousands of people flocking to Naidex National, seeking the latest products and thinking to support
The event boasted the biggest speaker programme in the show’s 40-year history with visitors from
Product helps amputees to walk on sand ... A NEW product has been developed that aids amputees in walking on sand without their prosethtics. Above knee amputee Jerry Vasilatos has developed the SandPad for beach-goers like himself. He came up with the idea after a holiday to Greece when – despite the fact that he wanted to swim in the ocean – he had trouble getting across long stretches of beach on crutches without his prosthesis because the crutch tips kept sinking in to the sand. He said: “I could imagine what I needed, right down to the shape and how it would attach to a crutch, but I was shocked to discover no one manufactured this simple device that would enable me greater mobility at the beach... what I described as a sand pad." Jerry devloped a durable, flexible rubber crutch pad that could easily attach to conventional crutches and canes. The SandPad provides a wider base of stability than normal tips for those using crutches or canes on beaches or other sandy terrain. The pad's circular design supports a user's weight allowing them to walk easily across beaches without sinking into the sand. Its scientific design utilizing four support ribs and a flexible rubber elastomer make it both lightweight and stable for the user. 18
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independent living for people with disabilities.
Morgan demonstrating their exoskeleton.
“Forty years since the show launched, the drive to enable people to help themselves and the huge range of products on show from our exhibitors was stronger than ever.”
Canary, which supplies elderly people and their carers with a security solution to enable people to live in their homes for longer, launched their business at the show.
Football star Ian Taylor, the ex-Aston Villa player who is now an ambassador for the club, came to talk about the sports programmes his club offers people with disabilities. The Community Wellbeing Choir, made up of mental health service users and staff, opened the last day on the perfect note with a series of beautiful and inspirational songs.
Among more than 100 speakers was Claire Lomas, who walked the London Marathon in an exoskeleton. In an inspirational keynote speech on the second day she spoke of her experience following a horse riding accident, which left her paralysed from the chest down.
The show featured fledgling companies that are pushing the boundaries of technology. The REX Bionics stand featured Sophie
She is also fundraising for the Nicholl Spinal Injury Foundation, which is looking for a cure for paralysis. Naidex National returns to the NEC, Birmingham next year from 28 to 30 April.
Fashion house opens in San Francisco A FASHION house that has been created to offer custom ornamentations for prosthetic legs has launched in San Francisco this month. UNYQ is a direct-to-consumer ecommerce site that invites amputees to design 3D printed custom fairings and other ornamentations for their prosthetic legs.
Eythor Bender, UNYQ’s cofounder and CEO, said: “We design for the whole person and address their wants and needs as opposed to simply appending technical functionality.
Twenty limited-edition collections serve as a starting point for amputees to realize their own ideas and personal style.
“Amputees don’t have to make fashion compromises anymore, and we can scale our craftsmanship without depending on individual skills to deliver consistently high end design that is beautifully made and to each customer’s specifications.
UNYQ’s designers then work with them to create one-of-a-kind pieces.
The company has studios in San Francisco, California and Seville, Spain.
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