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INNOVATION FOR INDEPENDENCE
ISSUE 102 APRIL/MAY 2015 £6.95
New research to tackle limb pain after amputation By Nicola Hyde A TRIAL is underway to evaluate a surgical method that could help treat chronic pain following on from limb amputation. Northwestern Medicine researchers are leading a new multi-centre clinical trial into targeted muscle reinnervation. Around a quarter of all amputees develop chronic pain in the remaining portion of their amputated limb, which can include phantom limb syndrome (pain that is perceived in the portion of the limb that is gone), and prevents many patients from using prostheses. Northwestern Medicine’s chief of plastic surgery and principal investigator for the study, Gregory A. Dumanian, MD, said: “The problem for amputees that experience chronic pain isn’t that the limb itself was removed. The problem is that the nerves used to control the amputated limb are incomplete, but also remain active, constantly sending signals to the brain. “These separated nerves cannot heal properly without the chance to connect to other nerve tissue, and end up creating painful growths called neuromas.” The current standard of care for a painful amputee neuroma is to remove the nerve growth and then place the nerve ending
into a nearby muscle for extra cushioning. While this treatment can reduce neuroma pain, it is not always successful and still leaves the nerve active and disconnected to inevitably create a new neuroma. The TMR therapy’s goal is to transfer a nerve that has been cut-off from the muscles it used to control and essentially plug it into a functioning muscle nearby. This is accomplished by removing the neuroma from the damaged nerve, and then surgically joining it with a healthy nerve that controls the existing target muscle. Joining these nerves together allows them to then grow into, or reinnervate, the target muscle and prevent the neuroma from reforming. “TMR is a completely new approach to treating neuroma induced pain for amputees,” said co-investigator Todd Kuiken, MD, PhD, a Northwestern Medicine physiatrist who is director of the Centre for Bionic Medicine at the Rehabilitation Institute of Chicago and professor of surgery at the Northwestern University Feinberg School of Medicine. “Instead of trying to treat a painful neuroma by burying it, this procedure provides damaged nerves with a new purpose.”
Fashion is being injected into the functional by a Canadian company who have designed a line of accessories that fits onto prosthetic limbs. The Alleles Design Studio – founded by McCauley Wanner (industrial designer) and Ryan Palibroda (art/architecture) – was founded at the end of 2013 to create a fresh approach for designing for those with a disability. A company spokesman said: “By taking a fashion approach to the prosthetic industry we have designed a new line of prosthetic accessories which has transformed prosthetics into a new stream of fashion and have shifted prosthetics into objects of healthy curiosity. The covers are designed in 3D on a computer before being fabricated by CNC – a process that uses a computer-controlled cutting machine.”
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Academics awarded cerebral palsy resistance training grant By Nicola Hyde ACADEMICS from Brunel's physiotherapy and biomechanics departments have been awarded ÂŁ250,000 to lead research into resistance training in young people with cerebral palsy.
Dr Jennifer Ryan will lead the study, which will include a randomised controlled trial of 60 young people
Editorial Judith Halkerston Email: jh@scriptmedia.co.uk
Group Editor
Dominic Musgrave Group Production Editor Email: dm@scriptmedia.co.uk Tel: 01226 734407 Nicola Hyde Reporter Email: news@scriptmedia.co.uk Tel: 01226 734715 Sales
Dr Jennifer Ryan, Dr Thomas Korff, Dr Cherry Kilbride and Professor Bill Baltzopoulos received the award from Action Medical Research for Children and the Chartered Society of Physiotherapy Charitable Trust. It will be used for a three-year study, firstly to evaluate how feasible and effective resistance training is for youngsters with the condition and secondly to determine how resistance training changes the mechanical structure of muscles and tendons in this population.
Contacts
Carole Rice
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Product Manager
Email: cr@scriptmedia.co.uk Tel: 01226 734412 Fax: 01226 734478 Tony Barry Sales and Marketing Director Email: tb@scriptmedia.co.uk Circulation circulation@scriptmedia.co.uk 24 hour hotline: 01226 734695
Cherry Kilbride and Jennifer Ryan. between the ages of 12 and 19.
team that received the award.
Dr Adam Shortland, a consultant clinical scientist from Guy's and St Thomas' NHS Foundation Trust, and Wendy Levin, a physiotherapist at the Royal Free London NHS Foundation Trust, are also on the
The project will look to involve adolescents with cerebral palsy from across London.
Design/Production Stewart Holt Studio Manager Email: sth@scriptmedia.co.uk Laura Blackburn Graphic Designer Email: lb@scriptmedia.co.uk
Anyone who might be interested should contact Dr Ryan on Jennifer.ryan@brunel.ac.uk
At Script Media, we try to get things right but occasionally, we make mistakes. If you have a complaint about a story featured in our magazine or on our website, please, in the first instance, contact us by email: dm@scriptmedia.co.uk We abide by the Editors’ Code of Practice as demanded by the Independent Press Standards Organisation. For details on the code and what to do should you be unsatisfied with the way we handle your complaint, please visit www.ipso.co.uk
Whilst every effort is made to ensure the accuracy of all contents, the publishers do not accept liability for any error, printed or otherwise, that may occur.
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Should all orthoses be paid for by the NHS? By Simon Dickinson THE financial strain on public services in England looks unlikely to change for a considerable period of time. All NHS trusts are being asked to continue to do more for less and savings required for 2015/16 are likely to be in excess of 7% across most trusts. The NHS continues to demand “more for less” and the strain on orthotic services finances are therefore under significant pressure like many other services. Whilst everyone works hard to try to meet these challenging targets patient demands for quality increase. This is further compounded by the development of new orthotic treatment options to further assist patients. Many of these new developments are more expensive (but significantly better for patients). So who decides what orthotic devices can be provided by the NHS, particularly in the current climate of shrinking budgets and increasing demand on services and an ageing population?
After spending considerable time researching this question it appears that this is a local decision. Some SLA’s (service level agreements) with orthotic service providers have clear instructions, but it appears the majority are vague and new devices can be prescribed.
significant criticism from health unions.
Some CCG’s have systems in place for individual funding requests for complex orthotic devices which are not normally provided within their SLA agreements.
Although South Warwickshire CCG ultimately have not made the decision to stop funding orthotic devices the fact that they considered it is alarming as is the huge variation in orthoses which can and cannot be provided by individual providers.
Some orthotic services have their own rules but again these are local and patients could easily find themselves in a “postcode lottery” for specific types of orthotic device. The orthotics section of NHS networks is conducting a survey on whether “your trust fund’s silicone ankle foot orthoses (SAFO’s)”. At the time of writing this editorial 83% of respondents state “No”, 17 state “yes” and there are no responses for the “yes but the patient has to apply for special funding”. In April 2014 the Guardian newspaper reported that South
On March 5 East Midlands Today reported that children requiring AFO’s from the community trust in Nottingham could no longer have transfers on their splints as they “couldn’t afford them”.
Simon Dickinson
Warwickshire CCG presented a tentative proposal to a public participation group suggesting patients could be asked to pay for some of their orthosis. The list of orthoses which could be purchased included ankle foot orthoses (AFO’s), wrist splints, trusses, spinal supports, hip braces, lumbar/sacral/abdominal supports, collars and helmets! The move was uncovered by the anti-cuts group False economy and received
Scientists developing prototype prosthetic ankle that can see SCIENTISTS are developing a prototype prosthetic ankle that doesn’t just have a natural gait - it could also have a vision system so it can analyse where it goes.
“Then the computer analyses the information from the camera and applies the correct angle and stiffness 4
Simon Dickinson is clinical director at TalarMade.
All change at BHTA THE TRADE association that represents the healthcare trades has appointed a new director general.
The BHTA has recently made some significant staff changes with a view to improving support to all sections. Greg Askew has recently been appointed as sales and relationship manager.
The key components are a low-cost camera and a computer-controlled actuator, which adjusts the ankle’s position through a system of cables.
“The camera can identify the profile of the ground, while the computer knows where the next footstep will be, based on how the user is moving the leg.
This will also hopefully include guidelines on which orthoses can be provided by trusts and also the possibility of which orthoses shouldn’t be provided by the NHS.
Tracey Lloyd took the helm of the British Healthcare Trades association on March 1 – Ray Hodgkinson remains a key advisor too in a newly created post of director of public affairs.
Mo Rastgaar – a Michigan Technological University mechanical engineer – and his team aim to give their robotic ankle something different: eyes.
He said: “We are developing an artificial vision system. The key components are a low-cost camera and a computer-controlled actuator, which adjusts the ankle’s position through a system of cables.
Hopefully the outputs and recommendations form the NHS England “Improving Orthotic Services” event in Salford on March 2 will move us towards a patient centred, outcome based national service specification.
This is a new position created to improve communication and develop relationships with new and existing member organisations. The robotic ankle being devloped at Michigan Technological University.
to the ankle, just as you would with your biological foot and ankle.” The ankle could adapt precisely, whether the user is climbing stairs or striding over a pothole. They are working on a more streamlined design for the actuator - it doesn’t have to be mounted on the prosthesis.
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Mo hopes that eventually the robotic ankle will find its way out of the lab and into the marketplace. The research is being partially supported by a five-year Faculty Early Career Development (CAREER) Award from the National Science Foundation (NSF), and a provisional patent has been issued for the technology.
Carol Noel has been appointed as executive assistant. Donna Eade has been appointed to be coordinator for Shopmobility now that it has now come under the management of the BHTA. Sally Edgington has also joined the Association as research and committee support officer.
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Inlays among new DeNovo products NEWS
DeNovo Healthcare is a dynamic and progressive patient centred company focused on providing some of the most innovative products from around the world to the UK healthcare market. As distributors for some of the best known and reputable suppliers in the world we have a lot to offer. New for 2015
Our new and highly competitively priced range of DeNovo Daily Orthotic inlays offer unique solutions for your inlay requirements. Initial reaction to these has been excellent. The slimline profile and wide range of options make these a good choice where space is an issue in footwear.
An innovative stroke rehabilitation programme has been launched in Wales that is aimed at using functional gym-based training to get clients more independent. Celtic Leisure has secured Health Board funding to launch the ARNI Stroke Rehabilitation Programme that helps patients with neurological Injury. The new service – funded thanks to an £8,000 grant – hopes to reduce the pressure on NHS resources by rehabilitating patients in a different way. The ARNI Institute has found recent prominence through its work in rehabilitating political broadcaster Andrew Marr following a severe stroke, and is now highly regarded as a rehabilitation programme with real results. David Francis, Wales’ only ARNI trained Instructor, has run an independent short term trial with clients before teaming with Celtic Leisure to launch the programme.
A handheld 3D scanning system for under £1,000 was a dream up until the introduction of our new scanning solution. Using our easy digital system, which is designed to offer a fast and reliable way of collecting data for the manufacture of all types of orthotic devices and footwear, give the practitioners the ability to capture accurate and detailed images which can be used to collect accurate measurements, create foam models
and store digital data which can be used to monitor clinical changes easily. Arriving soon is a new solution for managing ankles and feet. This new development will bring an exciting option to the clinic and more will be revealed soon so keep an eye on our website! Our successful Nimco Made4You footwear with children and adult ranges has now been enhanced with many exciting additions including children’s shoes with a new light weight flexible sole option from size 16 and new stylish adult footwear options. We are also introducing additional lasts which make this collection the most comprehensive to date. The Centri Dynamic Walk orthoses is manufactured with ultra-light weight thermo formable carbon fibre to give the clinician the option to make adjustments for better fit and relief of pressure that has not been an option with other carbon fibre materials. These orthoses are also available in mix and match, custom versions and made to cast. A full list of products available can be viewed at www.denovohealthcare.com
Advertiser’s announcement
Mobility Roadshow makes Donington Park return THE MOBILITY Roadshow will be held in June to showcase the latest developments in the latest independent lifestyle solutions from specialist manufacturers and expert providers. The event – which runs at Donington Park, Derbyshire, June 25 to 27 – will feature a selection of rehabilitation solutions and self-help products for consumers to compare. There is the unique opportunity to test drive the latest adapted and accessible cars around the historic Donington race circuit. Amongst the 2015 exhibitors, Trekinetic will be showcasing their modern, manual and power, allterrain alternatives to traditional wheelchairs. Their new and innovative ‘Hyperforma’ paediatric seat system enables a child to perfectly fit into a standard adult 16” seat. This clever ‘future-proof’ solution can be readjusted as the child grows, eliminating the cost to replace the whole wheelchair. Trekinetic’s all new, remote action telescopic locking footrest, that eliminates the need to bend forwards, will also be on display for the first time. Active Hands will be demonstrating 6
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their wide range of gripping aids at the Roadshow. These impressive designs enable users with limited hand function to hold tightly onto objects, such as gym equipment or adaptive bike/trike handlebars. Available in child to adult sizes, these clever devices can be put on independently and work by gently yet firmly, folding the users hand into a gripping shape. Sirus Automotive, specialists in the design and conversion of wheelchair accessible vehicles will be demonstrating the industry’s first ever self-lifting ramp system. This will be exhibited alongside a selection of its popular upfront passenger and drivefrom-wheelchair vehicles. From revolutionary wheelchairs and mobility scooters to advanced therapy exercise equipment, an exciting array of technological innovations, gismos and gadgets are available.
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University researchers get $1.4m for further bionic hand research NEWS
By Nicola Hyde
RESEARCHERS at the University of Utah have received a $1.4million grant to further develop an implantable neural interface that will allow an amputee to move an advanced prosthetic hand with just his or her thoughts. The Utah Slanted Electrode Array uses 100 electrodes that connect with nerves in an amputee’s arm to read signals from the brain telling the hand how to move. It then delivers meaningful sensations of touch and movement from a prosthetic hand back to the brain. Associate professor Gregory Clark said: “Imagine wiretapping into those nerves, which are like a hotline between the brain and the body. “We can pick up the nerve signals, translate them, and relay them to an artificial hand. “People wouldn’t have to do anything differently from what they’d already learned how to do their whole life with their real hand. “They’ll just think what they normally
think, and the prosthetic hand will move.”
Gregory hopes the Utah Slanted Electrode Array will give users of this advanced prosthetic hand over 20 types of hand and wrist movements by using electrical signals from remaining nerves and muscles. The Utah Slanted Electrode Array was first developed by University of Utah bioengineering professor emeritus Richard Normann and ultimately will communicate with the prosthetic limb wirelessly. The funding is part of DARPA’s Hand Proprioception and Touch Interfaces programme, which aims to create an artificial limb that is so realistic, it can provide a psychological benefit to the wearer. It will cover about 18 months of research and pay for testing on two human volunteers. DARPA programme manager Doug Weber added: “We have the opportunity to not only significantly improve an amputee’s ability to control a prosthetic limb, but to make a profound, positive
Associate professor Gregory Clark.
psychological impact. “Amputees view existing prostheses as if they were tools, like a wrench, used only to perform a specific job, so many people abandon their prostheses unless absolutely needed.
“We believe (the new prosthetic limb) will create a sensory experience so rich and vibrant that the user will want to wear his or her prosthesis full time and accept it as a natural extension of the body.”
Advertiser’s announcement
Portable Structure Sensor makes 3D scanning a reality 3D SCANNING has now become a reality for all orthotists, prosthetists and engineers involved in postural seating systems with the introduction of Structure Sensor. Relief Orthotics have fully embraced this technology and believe that this low cost scanner has revolutionised the way these services are being delivered. Structure Sensor is totally portable and has no wires, processing unit, PC, or laptop attached, only your iPad. The manufacturers claim accuracy levels of 0.15 per cent at a minimum range of 40cms and 1.1 per cent at a maximum range of 3.5metres, has 640x480 resolution, three to four hours of active sensing, a built in lithium polymer battery (doesn’t use iPad battery) and 1,000+ hours’ standby. It uses the Captevia App, (available to download free from the App store) to capture the image which would then be either imported into Rodin Neo 8
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software or emailed to your chosen central fabrication centre for processing. Once the image has been processed through Relief Orthotics’ central fabrication centre, the experienced technicians can assist via an online shared Netview session which allows the professional to view and discuss in real time all rectifications, trim lines and details of a finished product or for a carve only model created by our CAM should they prefer to manufacture their own device. Structure Sensor is supplied with an attachment for iPad or iPad mini and as no formal training is required you are up and running in a matter of minutes.
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Robot will help people with spinal cord injuries to walk SCIENTISTS have developed a robot that will help people with spinal cord injuries walk with a natural gait and relieve pressure on physiotherapists. The team - from the National University of Singapore’s (NUS) Faculty of Engineering - has invented a novel robotic walker that helps patients carry out therapy sessions to regain their leg movements and natural gait. The system also increases productivity of physiotherapists and improves the quality of rehabilitation sessions. Designed by a team of researchers led by Assistant Professor Yu Haoyong, the robotic walker is capable of supporting a patient’s weight while providing the right amount of force at the pelvis of the patient to help the patient walk with a natural gait. In addition, quantitative data can be collected during the therapy sessions so that doctors and physiotherapists can monitor the progress of the patient’s rehabilitation. The robotic walker comprises six modules: an omni-directional mobile platform; an active body weight support unit; a pelvic and trunk motion support unit; a suite of body sensors; a functional electrical stimulation unit; and an intuitive user control interface. The suite of body sensors measure the gait of the
patient so that the walker can provide the right amount of support to help the patient walk with a natural gait. The electrical stimulation unit can deliver targeted electrical current to stimulate the correct muscle at the correct timing to facilitate joint movement.
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The walker can also provide assistive force, resistive force, and disturbance force depending on the training requirements set by the therapists. In this way, patients can go through different training schemes that are often difficult to achieve manually. The patient interacts with the walker through a force sensor which detects the user intent. The intelligent control system uses this information as well as the gait information provided by the body sensors to control the movement of the walker. Asst Prof Yu said: “This robotic walker allows patients to practice their gait movements continuously to optimise their therapy. When patients repeat the movements in a natural setting, the routine can be imprinted into their brains which gradually learn to correct from the damage resulting from their medical conditions.” Besides improving the quality of rehabilitation sessions, the robotic walker will also relieve physiotherapists from the physical strain of assisting patients with the exercises. He said: “Our vision is for the robotic walker to be
Mun Kyung-Ryoul and Dr Yu Haoyong demonstrate the robotic walker. Photo credit: National University of Singapore installed at outpatient clinics and rehabilitation centres to benefit patients who need therapy sessions. There is also a possibility that patients can perform exercises in the comfort of their own homes.”
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In-shoe orthoses study given grant funding NEWS
A NEW study has been given grant funding to research the impact inshoe orthoses have for treatment of knee osteoarthritis.
Kelly Sotherton with Hugh Sheridan, CEO of ALG International Holdings.
Olympian Kelly opens suite OLYMPIAN Kelly Sotherton has opened a state-of-the-art medical technology centre in Birmingham.
and Podotech Elftman Matrix, a small, lightweight device that assesses lower limb activity.
The former heptathlete – who won a bronze medal at the 2004 Olympics – launched the £50,000 Algeos Innovation Suite at Birmingham Metropolitan College’s Matthew Boulton Campus.
The college’s students will use the equipment to support the consultations and treatment they provide to 2,500 patients each year at their 18-chair on-site private clinic.
The centre will house the latest technology for podiatry services and will be used by students as a key part of their training and practitioners. The innovation suite will include a range of technologies including Clearanail, a revolutionary product to combat fungal nail, OptoGait, an innovative gait analysis technology for movement analysis and functional assessment of patients,
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Andrew Cleaves, principal at Birmingham Metropolitan College, said: “This remarkable facility cements Birmingham’s position as the region’s hub for podiatry training, scholarly activity and professional development. “Students, practitioners and manufacturers will be able to showcase innovation and excellence in clinical decision making, resulting in more effective diagnostic and patient care outcomes.”
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Peter Barrance, PhD, of Kessler Foundation, was awarded a threeyear field-initiated grant by the National Institute on Disability and Rehabilitation Research. He will use weight-bearing MRI to study the effects of in-shoe orthoses in individuals with osteoarthritis of the knee. Dr Peter Barrance is the study’s principal investigator and Jeffrey Cole, MD, at Kessler Institute for Rehabilitation is the physician coinvestigator.
Forty-four participants with functional limitations caused by knee osteoarthritis will be recruited for this new study, which aims to refine the prescribing of in-shoe footwear modifications, using the weightbearing MRI technology developed under a previously funded NIDRR Field-Initiated Development program. “Our hypothesis,” said Dr. Barrance, “is that in-shoe footwear modifications, prescribed on a patient-specific basis with the benefit of weightbearing MRI, can be clinically effective in reducing the burden of pain and mobility limitation associated with knee osteoarthritis.” A new piece of kit that supports rehabilitation through games and music has been launched by assitive technology experts Filisia in cooperation with 60+ therapists, special needs educators, clients and families. The Monoma product is being sold for use for patients with occupational needs who face neuromuscular, sensory and cognitive challenges. It is a modular set of tactile and wireless units that are touch sensitive and contain LED lights. Therapists can select among musical games, memory exercises, coordination and reaction to stimuli exercises.
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Advertiser’s announcement
DM Orthotics mark 10th anniversary DM ORTHOTICS recently celebrated its 10th anniversary. The Cornwall based company designs and manufactures bespoke Lycra® orthoses used to aid the management of neurological conditions such as cerebral palsy multiple sclerosis, stroke and scoliosis.
Katy Duncan
It was created by orthotist Martin Matthews and has grown into an international market leader, serving over 20 countries as far as the United States, Australia and Japan.
A WOMAN who was left with debilitating pain after routine spinal surgery says a custom fitted leg brace has revolutionised her life.
Over this time, the company has made more than 100,000 individually tailored products, improving function and independence for thousands of people worldwide. Martin said: “It really is a great achievement. When I first started the company we had a team of 15 in manufacturing and office space of around 4,000 square feet. We have since moved to new premises employing over 60 people and are constantly growing.” Martin attests the company’s success largely to sticking to its original ethos of undertaking clinical research to
Brace transforms Katy’s life find practical solutions, while at the same time developing and innovating in order to stay ahead of an everchanging industry. DM Orthotics’ latest innovation is the DMO e-step®, which combines its highly successful Dorsiflex Sock with FES (Functional Electronic Stimulation) utilising patented technology to produce a hybrid product for improved management of Drop Foot, a condition which is often caused post stroke. This is an industry first and is set to lead the way for Drop Foot management.
Katy Duncan has suffered intense pain, muscle weakness in her legs, bladder and bowel complications and epilepsy for the last seven years. She has a rare condition known as Cauda Equina Syndrome (CES), a serious neurological condition in which damage to the spine causes acute loss of function of spinal nerve roots. The condition, which was caused when routine spinal surgery went wrong, has no cure. She said: “I’ve suffered with CES for seven years. The first few years I was either bed or wheelchair-bound with long periods in hospital. I relied on
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strong opiate pain killers which left me with additional side effects. “I’ve never been one for giving up though and with the help of the wonderful NHS teams in North Wales, I was fitted with a KneeAnkle-Foot-Orthosis (KAFO) system. “Not only can I now walk, but I’ve seen a dramatic reduction in pain and have been able to come off some of the heavy pain killers I was relying on.” Katy’s CES caused a bilateral foot drop but she says the KAFO systems have ankle and foot plates to steady her lower legs and feet. They are custom made for her by NHS Wales and manufactured by orthotic specialists Ottobock. They are made of light carbon fibre.
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Photo credit: The Lancet
Austrian men undergo world first ‘bionic reconstruction’ technique By Nicola Hyde THREE Austrian men have become the first in the world to undergo a new technique called “bionic reconstruction”, enabling them to use a robotic prosthetic hand controlled by their mind, according to new research published in The Lancet. All three men suffered for many years with brachial plexus injuries and poor hand function as a result of motor vehicle and climbing accidents. The new technique was developed by Professor Oskar Aszmann, Director of the Christian Doppler Laboratory for Restoration of Extremity Function at the Medical University of Vienna, together with engineers from the Department of Neurorehabilitation Engineering of the University Medical Center Goettingen. It combines selective nerve and muscle transfers, elective amputation, and replacement with an advanced
robotic prosthesis (using sensors that respond to electrical impulses in the muscles). Following comprehensive rehabilitation, the technique restored a high level of function, in all three recipients, aiding in activities of daily living. Professor Aszmann said: “In effect, brachial plexus avulsion injuries represent an inner amputation, irreversibly separating the hand from neural control. “Existing surgical techniques for such injuries are crude and ineffective and result in poor hand function. “The scientific advance here was that we were able to create and extract new neural signals via nerve transfers amplified by muscle transplantation. These signals were then decoded and translated into solid mechatronic hand function.” Before amputation, all three patients spent an average of nine months
undergoing cognitive training, firstly to activate the muscles, and then to use the electrical signals to control a virtual hand. Once they had mastered the virtual environment, they practiced using a hybrid hand – a prosthetic hand attached to a splint-like device fixed to their non-functioning hand. Three months after amputation, robotic prostheses gave all three recipients substantially better functional movement in their hands, improved quality of life, and less pain. For the first time since their accidents all three men were able to accomplish various everyday tasks such as picking up a ball, pouring water from a jug, using a key, cutting food with a knife, or using two hands to undo buttons. Professor Aszmann added: “So far, bionic reconstruction has only been done in our centre in Vienna.
“However, there are no technical or surgical limitations that would prevent this procedure from being done in centres with similar expertise and resources.” Professor Simon Kay who carried out the UK’s first hand transplant, and Daniel Wilks from Leeds Teaching Hospitals NHS Trust, Leeds,said: “The present findings – and others – are encouraging, because this approach provides additional neural inputs into prosthetic systems that otherwise would not exist. “However, the final verdict will depend on long-term outcomes, which should include assessment of in what circumstances and for what proportion of their day patients wear and use their prostheses. “Compliance declines with time for all prostheses, and motorised prostheses are heavy, need power, and are often noisy, as well as demanding skilled repair when damaged.”
Staff absent with muscle and joint injuries costs NHS millions SHOCKING research has revealed that NHS hospitals are losing millions of pounds each year due to staff being absent from work with muscle and joint injuries. More than 60 per cent of staff working in Acute Hospital Trusts take sick leave every year, averaging just over 20 days absence each. 12
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But that figure rises to almost 23.5 days per head for those suffering from musculoskeletal disorders (MSDs) meaning that hospitals across the country lose an average of almost 14,000 staff days per year due to staff having conditions such as bad backs, sore necks or stiff joints.
research – say faster access to physiotherapy could help to significantly reduce sickness absence.
Physio Med – which carried out the
“But when these employees are
MD Phil Clayton said: “Many of the roles are physically demanding and therefore the prevalence of muscular and joint injuries can, understandably, be high.
absent from work it can have a severe knock-on effect on the delivery of NHS services to the public.” Physio Med says it works with a number of NHS trusts to allow fast access to physiotherapy services – one Trust has recorded 58 per cent reduction in days lost in the employees.
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Technology to allow amputees to ‘feel’ being developed The product being worked on by researchers at Nottingham Trent University.
Knitting technology could help wounded soldiers RESEARCHERS are working on a product that will help prevent ulcers for amputees as part of an arrangement with the Ministry of Defence. Scientists at Nottingham Trent University are looking to improve the comfort of injured military personnel by preventing ulcers and stopping the uncomfortable build-up of perspiration between an amputee’s residual limb and the prosthesis. The Advanced Textile Research Group at the university has used 3D knitting technology to produce seamless and breathable sleeves, worn between the residual limb and the artificial limb, which prevent sweat from being trapped in the prosthesis. Seamlessness is also important, as seams in a sleeve can cause discomfort and pressure necrosis – damage to skin tissue caused by
sustained pressure. Professor Tilak Dias said: “The first phase of work has been completed, demonstrating the potential for sleeves knitted with smart yarns, which have the required grip, longitudinal stiffness and transverse flexibility, which can be customised for each individual amputee. Further research will be required to optimise parameters prior to commercialisation.” Professor Dias’ research team received nearly £66,500 from the Defence Science and Technology Laboratory under a Centre for Defence Enterprise contract to develop the concept and prove its worth to the Ministry of Defence. The University’s team will work closely with personnel from the Defence Medical Rehabilitation Centre at Headley Court to begin user trials.
RESEARCHERS are hoping to be testing a device that allows amputees to ‘feel’ a prosthetic arm on patients living at home within four years. Rehabilitation experts at the University of Pittsburgh School of Medicine hope to one day give people with an arm amputation a prosthetic limb that not only moves like a natural one, but feels like it, too. They expect such sensation will improve dexterous control of the device and give users greater intuition about what they are doing with their prosthetic. Robert Gaunt, assistant professor, Department of Physical Medicine and Rehabilitation, Pitt School of Medicine and a multidisciplinary research team from Pitt, West Virginia University and Ripple LLC will begin developing the technology with the aim of being able to test it in patients’ homes within four years. Dr Gaunt said: “Advanced prosthetic limbs that behave like the hand and arm they are replacing have been an unrealised promise for many years largely because until recently, the technologies to really accomplish this goal simply haven’t been available. “To make the most of these new
capabilities, we have to integrate the prosthetic into the remaining neural circuitry so the patient can use it like a regular hand that, for example, can pick up a pen, gently hold an egg or turn a stuck doorknob.” In the 18-month, first phase of the project, the team will recruit five volunteers to try to demonstrate that stimulation of the sensory portion of the spinal cord nerves, which would normally innervate the hand and forearm, can cause the amputee to feel distinct sensations of touch and joint movement in the ‘phantom’ hand and wrist. They also plan to insert fine-wire electrodes into the forearm muscles of able-bodied volunteers to collect and interpret muscle signals to guide movement of a virtual prosthetic hand to control hand opening and closing, as well as thumb movement. Eventually, the team aims to devise a fully implantable system for home use. Funding for the research was made possible by an award from the BRAIN Initiative, a White House programme launched to revolutionise understanding of the brain and accelerate the development of new technologies.
‘Unfussy’ brain finds ways of coping with loss of a hand, new study finds PEOPLE born without one hand, who are still able to use both limbs well in otherwise two-handed tasks, are likely to show brain activity which resembles that of people with two hands, an Oxford University study has found. Lead author Dr Tamar Makin, from the Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), said: “The brain doesn't care if you are born with only one hand. The brain is not fussy about whether there is a hand at the end of the arm, a prosthetic or a "stump" – so long as it is used in a similar way.” The team's results might indicate ways in which new amputees may be able to regain near-normal function, through therapy which potentially takes advantage of the brain resources normally used by the missing hand. A previous study from Dr Makin's group shows that people born without a hand tended to use the 10
remaining part of the arm in their daily life. When moving that arm, they showed activation in a brain area corresponding to the missing hand. In contrast, people who were born with a hand and lost it later in life tended to favour their intact hand much more. For them, moving the opposite, intact hand tended to activate the brain area corresponding to the missing hand. These differing patterns of brain activation suggest that the body part which is used more to compensate for the absence of the hand takes over the brain area which would otherwise have been used to move the missing hand.
handed tasks nearly as well as ablebodied people (such as putting on socks or using a knife and fork) have brains that are nearly indistinguishable from those of ablebodied people. The study involved 38 participants (14 born with one arm, 24 with two) who were asked to rest quietly in a MRI scanner while the researchers tracked their brain activity. The scientists looked at how brain activity on one side of the brain correlated with the corresponding activity on the other side of the brain. They found that there was a symmetrical pattern of activity in those with two hands.
The new study, published in the journal eLife, shows that the extent different people compensate for a missing hand has an even greater effect on the brain.
Those with a missing hand, as a group, were more likely to have an asymmetrical pattern of brain activity, because of differences in brain areas linked to the missing hand versus the intact hand.
So much so that people with a missing hand who can do two-
However, the more people used the stump in everyday life, the more
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2015
symmetrical the pattern of their brain activation. The few people with a missing hand who functioned nearly as well as two-handed people showed brain activity that was almost indistinguishable from those with two hands. Study co-author Dr David Henderson Slater, consultant at the Nuffield Orthopaedic Centre in Oxford, said: “We have always known that some people adapt to the loss of a limb very soon, and start to make changes in the way they use other parts of their body to compensate for not having a hand. It is encouraging to see that there is hope for improvement even after devastating injuries, and to understand better what is going on inside the brain to make these behavioural adaptations. “We may be able to incorporate this knowledge into the therapy we offer to new amputees.”
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Advances in prosthetics lift amputees’ quality of life to whole new level RECENT years have seen some amazing advances in the prosthetics field, lifting the quality of life of amputees to a whole new level. Össur are fortunate to have a large global research and development team and specialists with innovative mind-sets that continuously push the boundaries to create the best products and services in the fields of Prosthetics, Osteoarthritis and Injury Solutions. Össur’s bionic technology platform has been developed since 2004 and has redefined the capabilities of modern prosthesis. Drawing from the knowledge and experience of disciplines such as mechanical, software and electronic engineers, top clinical professionals and industrial designers are able to create intelligent devices that behave like human limbs. Össur bionic products include the RHEO KNEE® which is a microprocessor swing and stance knee joint which uses artificial intelligence. The RHEO KNEE® adapts automatically to individual walking styles and different environments. It is the only microprocessor knee on the market that fully satisfies the needs of both low K3 users who place a premium on stand stability and high K3 users who desire a more responsive knee for a dynamic walking experience. The plug and play design also ensures a straightforward experience for prosthetists and
users alike. Össur’s proven Bionic technology has been further developed for the third generation of RHEO KNEE® and new updates will be launched in the near future. Also included in Össur’s bionic range is POWER KNEE®, designed to restore power to lost muscles and give greater symmetry of movement. It allows users to cover greater distances and negotiate more terrains with less energy cost.
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It is similar to the RHEO KNEE® in using sensor technology and microprocessors but it also has gyroscopic sensor technology, acting as a motion sensor. It always knows where in ‘space’ the joint is and the angle of tilt, making it easier for the user to benefit from appropriate power assisted function. The PROPRIO FOOT® was the first intelligent ankle/foot module. It thinks for itself, responds to changing terrains, aligns itself and helps amputees to sit and stand up more easily and naturally. Össur also brought to the market the unique SYMBIONIC LEG®, the world’s first complete bionic leg. Össur are constantly evolving, pioneering the latest advances in technology to deliver its mission of improving people’s mobility. This involves listening to feedback from our clinicians and users and continuously testing and working to make even better products.
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PODIATRY
sponsors podiatry
Ground-breaking 3D technology to print insoles in under an hour PIONEERING 3D technology that can print a pair of insoles in an hour was unveiled at the recent BAPO conference in Manchester. The revolutionary new technology allows custom-made and more supportive insoles to be created six times faster than anything else on the market. The technology, developed by Aortha, could help millions of people with foot conditions. Aortha is the orthotics and prosthetics brand owned by Liverpool-headquartered ALG International Holdings which also includes the medical products distributor Algeos. Hugh Sheridan, CEO of ALG International Holdings, said: “Opticians can make lenses in an
hour for their customers. Now Aortha OrthaPrint and Aortha OrthaFlex can provide orthotists and podiatrists with the ability to print a pair of insoles in an hour. “The technology transforms the speed with which custom-made, multi-density insoles can be produced. “This advance fits with the ALG mission to develop and bring to market life-changing products that not only change the way people
move, but also the way they feel.” The OrthaPrint with OrthaFlex special material for 3D Printing can build an insole with an enhanced degree of precision. The material’s elasticity enables it to print at high speed. This new manufacturing technology builds up layers of plastic which are just millimetres thick until a 3D object is created. The breakthrough has a number of other benefits including financial and
energy savings and the ability to recycle plastic materials if mistakes are made. ALG distributes its products to more than 70 countries through its offices in the UK, Australia, United States and United Arab Emirates. It is continually investing in the research and development of existing and new products in O&P, podiatry and physiotherapy through its experienced team of medical professionals and clinicians.
UK’s first Podiatry Hive conference is a success A CONFERENCE aimed at helping podiatrists in the UK to grow their practices has been hailed a success. The Business Reset Conference was organised by business mentors Podiatry Hive in conjunction with leading medical products distributor Algeos.
Australian podiatrist, experienced business mentor Jonathon Heath and Michelle Weddell, Algeos’s head of education and herself an experienced podiatrist.
The conference was a sell-out with 45 podiatrists from around the UK attending the two-day event in London.
Michelle said: “Our partnership with Podiatry Hive fits neatly with our desire to educate by providing podiatrists in the UK with business support to help them develop their practices, enhance the services they offer and become more profitable.”
Algeos is partnering with Podiatry Hive to promote the service which has already proved a huge success in Australia.
Troy believes there is a lack of knowledge in the UK about podiatrists and the services they provide.
The conference ran a number of different sessions looking at key issues including practice management, self-management, marketing, product selling, HR, business planning and goal-setting.
He added: “Our vision is to help podiatrists regain control of their lives. We want to empower them to operate successful businesses and allow them the time to mentor the next generation of podiatrists, while educating the wider community about what podiatry offers.”
The sessions were led by Podiatry Hive’s Troy Parsons, a leading
Kettering to host Foot Health FOOT Health 2015 is the largest UK independent educational event for health care professionals involved in treating lower limb conditions. Delegates can follow a varied programme of workshops and presentations delivered by experts in their chosen field. This year it will take place on 9th and 10th June at the Kettering 16
Conference Centre. To support the educational programme there is a large trade exhibition where delegates can look at the latest product innovations. The event provides a wonderful opportunity for health care professionals and suppliers to network and update their knowledge and skills.
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2015
Medi to launch UCS at Foot Health event MEDI is pleased to present UCS at the Foot Health in Kettering.
UCS is a sterile, pre-moistened cloth which is easy to use in the interdigital spaces, as well as gently cleaning and debriding foot ulcers and the surrounding skin. It can also be used for treating dry skin associated with heel fissures. It is a unique, convenient and safe way for cleaning the peri-lesional area and preparing the diabetic foot or leg ulcer for healing – effectively debriding the wound. For your free sample, while stocks
last, visit us at the stand in Kettering and register for your free place at the UCS training sessions. AH from Hereford said: “So easy to use. No need to worry about lotions, straight forward, saved time and reduced manual handling.” UCS is available on FP10/GP10 prescription for £32.50 for a box of 10. Enquiries: If you require any further information on this product or any of the medi range, please do not hesitate to contact your local medi representative or head office on 01432 373500.
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sponsors podiatry The first cohort of graduate podiatrists who aim to add to their expertise with a specialist course on forensics have begun their study. Assistive Technologies hears from world leader professor Wesley Vernon.
University’s post-graduate forensic podiatry degree is a world first THE University of Huddersfield is offering the world’s first postgraduate degree in forensic podiatry a field that is increasingly used by crime scene investigators.
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It helps train people to get valuable identification evidence from footprints, from the wear and tear on shoes and boots plus the subtle differences in people’s walking patterns. The University of Huddersfield’s Professor Wesley Vernon – who leads the course – is one of the world’s leading forensic podiatrists and one of a small number of experts in the field who are registered by the National Crime Agency in the UK. He is regularly consulted by investigators in Europe, Australia and the USA and has lectured on this subject in China, Australasia and the US. He said: “In the mid-1990s I was getting maybe one or two cases a year. Now I am getting requests for assistance most weeks, so it has increased quite dramatically.” He defines forensic podiatry as ‘the use of a podiatrist’s knowledge principally for the purposes of identification of humans’. The discipline has four broad areas. They include the use of podiatrists’ records for identification, the analysis of bare footprints at the scenes of crime and examination of the “wear features” of shoes. “There might be shoeprints at the scene of crime. The police have a
Professor Wesley Vernon, one of the world’s leading forensic podiatrists, is leading the course at Huddersfield University.
suspect and can match the shoes to the crime scene, but the suspect might say ‘yes I know you got that shoe from my house, but it’s not mine’,” said Professor Vernon. “DNA often fails or may not be helpful in these circumstances, but we can use the wear features of shoes to assist in the process of identification.” The fourth area is known as Forensic Gait Analysis, which now accounts for as much as 90 per cent of Professor Vernon’s investigative work. It requires a podiatrist to examine footage – perhaps from a security camera – in order to analyse the walking pattern of a suspect who might otherwise be unidentifiable, if
he or she is wearing a hood for example. By comparing it with film – possibly acquired covertly by the police – in which the identity of the subject is incontrovertible, an expert can assist in the identification of the perpetrator. “The skill is to combine both an experience and a science-based approach,” said Professor Vernon, who has carried out footprint and footwear analysis in some complex murder cases. His early ambition, while at school in the 1970s, was to become a pathologist, and he even landed work experience in a mortuary. But
he went on to study podiatry and while doing so he began to realise that many aspects of a podiatrist’s work could be useful in the field of human identification. “I started doing research studies of value to forensic podiatry. People took notice and the case work started.” In addition to his University of Huddersfield post, Professor Vernon is Head of Podiatry Services at Sheffield Teaching Hospitals NHS Foundation Trust, although he estimates that 60 per cent of his time is devoted to forensic work and teaching.
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NEWS
Plymouth NHS Trust trials new self-referral system
HAPTIX project leader Sat Pannu.
Photo credit: Julie Russell/LLNL
PLYMOUTH’S NHS Trust is pioneering a new self-referral system that allows patients to access the Musculoskeletal Physiotherapy Service, without the patient having to visit their GP.
decrease this number so we can offer those unwanted appointments to other patients on our waiting list.”
After a successful pilot with three local GP practices, the option will be rolled out across the whole Plymouth health community this month.
From November 2014, the option was rolled out to Plympton and Ivybridge areas, followed by the Cumberland area in February 2015.
Nicki Martin, Director of Therapy Services said: “The patient satisfaction with self-referral is high, as it encourages patient engagement with their treatment plus it allows a patient to state exactly what their symptoms are and how it is affecting them.
The self-referral option will be opening up to the rest of the community, with effect from April 1.
The total number of patients who have used this pathway to date is 658.
Musculoskeletal problems include neck pain, back pain, muscle strains, ligament strains and arthritis, all of which are appropriate for this service. It is necessary to understand that Self-Referral is not a fast track access to the Physiotherapy Service, these referrals will be categorised on the same basis as the current referrals from GPs and other sources. But the self-referral route will save patients the time of having to wait and attend a GP appointment before referral.
Bionic implant will allow amputees to do movements of Robotic glove could a human hand “We hope ownership from patients will decrease the number of appointments currently being lost when patients fail to attend their booked appointment, without letting the department know. “Currently, nearly 400 appointments each month are lost due to patient non-attendance. We would like to
By Nicola Hyde
A BIONIC implant that will allow amputees to perform movements of a human hand and experience pressure, touch and texture is being developed by scientists.
help stroke sufferers
“Its neural system intends to recreate a range of functions, including a real feeling of touch when holding another person’s hand.”
EXPERTS have created a robotic glove that could help stroke sufferers to get more independence.
The American Defense Advanced Research Projects Agency(DARPA) selected Lawrence Livermore National Laboratory (LLNL) to join a collaborative research team that intends to build the world’s first neural system to enable naturalistic feeling and movements in prosthetic hands.
It works by a series of neural interface systems that measure and decode motor signals recorded in peripheral nerves and muscles in the forearm by using tiny electrodes. Eventually, the bionic hand would be able to perform movements of a human hand and experience pressure, touch and texture.
Known as Hand Proprioception and Touch Interfaces (HAPTIX), the programme aims to give amputees dexterous control over advanced prosthetic devices that substitute for amputated hands.
The ultimate goal is to create a fully implantable device that is safe, reliable, effective and approved for human use.
It is hoped that - by giving patients the psychological benefit of having natural sensation in their prosthetic hands - it will lead to a reduction of “phantom limb” pain, a sensation some amputees can feel despite the removal of a limb. Lawrence Livermore’s Neural Tech Group and their collaborators (Case Western Reserve University and the Louis Stokes Cleveland Veterans Administration Medical Center) intend to develop neural interface systems that measure and decode motor signals recorded in peripheral nerves and muscles in the forearm by using tiny electrodes. Project leader Sat Pannu said: “The HAPTIX project intends to achieve a 18
phenomenal breakthrough in prosthetics never thought possible.
Pannu and his team of engineers are developing wireless electronic smart packages that record and stimulate the peripheral nervous system to control movement and sensation in a patient’s prosthetic hand. Smart packages intend to be designed to miniaturize electronics normally the size of a third of a mobile phone into a package the size of a watch battery. The electronics would be made of ceramics and titanium, biocompatible materials that would seal the package tightly, preventing components from leaking into nerves or human tissue from entering the package. Pannu added: “The packages have to be really small, so they don’t put any weight or pressure on the nerves. We don’t want to damage the nerves.”
ASSISTIVE TECHNOLOGIES I APRIL/MAY 2015
Researchers at the University of Hertfordshire have developed the prototype which stroke sufferers can use in their own home to support rehabilitation. It is specifically aimed at targeting the impairments left in the chronic stages of stroke – when patients are not likely to still be receiving treatments. The glove – which has been in development for three years – helps patients do repetitive movements and exercises for the hand and wrist. It records performance and sends to a therapist so treatment can be tailored remotely. Dr Farshid Amirabdollahian, an expert in rehabilitation robotics and assistive technologies, co-ordinated the SCRIPT (Supervised Care and Rehabilitation Involving Personal Telerobotics) programme. Dr Amirabdollahian said: “Our goal was to make motivating therapies available to people to practise at home using this system, hoping that they have a vested interest to practise and will do so. “We tried this system with 30 patients and found that patients indeed practised at home, on average around 100 minutes each week, and some showed clinical improvements in their hand and arm function.’
The glove device on Mr Alfredo Cesario from San Raffaele, Italy.
The overall aim of the project was to provide an educational, motivational and engaging interaction, making a more positive therapy session for the patient, while providing feedback to them and their health care professionals. The team is now considering a follow-up project to improve recovery outcomes, while also searching for funding to turn this prototype into a product for home rehabilitation. The team have passed the proof-ofconcept stage and are now looking at getting the glove into production.
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Eye-controlled chair wins competition
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A WHEELCHAIR controlled by the user’s eye movement has scooped the top prize at a Dragons’ Den style design competition. Care provider Blackwood held a Student Design Competition for ideas that aim to improve standards of living for those with physical or mental disabilities. Designs from across the globe were presented in person and over the internet to a panel of judges, with Kirubin Pillay taking home the coveted top prize. The Oxford University Biomedical Engineering student will now receive invaluable backing from Blackwood and its partners in a bid to make his creative design into a working reality that could offer a life changing transport facility for many people with severe physical disabilities. The design is based on a typical electric wheelchair – an electric module has been added to the frame which communicates with the current wheelchair electronics and this, in turn, is also connected to a commercial eye-tracker and laptop that is mounted on the back of the chair. The laptop uses a ‘smart’ algorithm, and receives eye gaze positions from the eye tracker, which is then communicated as a position to the wheelchair. The eye-tracker is then mounted on the wheelchair in the front, just below the user’s eyes –
allowing the user to intuitively direct its movements. Kirubin said: “I wanted to get involved as I knew my device had great potential to be extremely useful for people who really need it. “The student design award provided an opportunity to receive constructive feedback on the device’s commercial merits as well as provide an opportunity to present the system. “The advice and guidance I will now receive will mean there is a far greater chance of this becoming a reality and making it a successful product.” Competitors located as far away as America pitched via Skype to land the top prize. Volunteer judges from various care, private and public sector organisations provided contestants with direct feedback on the day and critique over the live stream feed.
Jiraffe launches revamped white Multistander frame The Multistander is a versatile product that provides Supine, Prone and Upright positioning all in one product for children from as young as nine months to six years old.
We visit all our customers a number of times throughout the year and these meetings tend to be very product focused.
Cocktails started the Friday night off, allowing for lots of networking amongst the delegates.
We also provide a number of educational seminars throughout the year, which encompass an intense day of lectures and workshops.
Saturday, in keeping with the ‘British’ theme we provided a selection of locally produced foods. Beagle wishes to say a BIG thank you to all those who made BAPO 2015 a success.
So, this year we took the decision to create a real social aspect around the
Jobskin re-launch Orthowrap range JOBSKIN are delighted to announce the re-launch of the Orthowrap range of garments.
Garments are available in traditional beige with the addition of most items now being available in black with a range of trims as desired to jazz up these traditional garments for sportswear and other activities.
The easy to clean polyurethane boards contain an antimicrobial agent that helps keep it hygienic – ideal for busy families and making it easy for re-issue for schools.
There is also a new basic head support that provides greater support
stand. We wanted to say a big ‘thank you’ to all loyal customers for their continuous support and a big ‘hello’ to all new customers.
We also have a range of garments suitable for support during pregnancy.
It now comes in a new, fresh, white frame option and a range of six colours for the support boards.
The Multistander from Jiraffe is simple to use, and now comes with an adjustable footplate and an improved knee support bracket too.
BEAGLE Orthopaedic attended the recent BAPO, and the show had a buzz about it from beginning to end.
The range includes bracing to support hands, wrists, legs, ankles back and abdomen.
JIRAFFE has launched the revamped Multistander by Jenx for 2015.
The new white frame makes it easy to spot spills and clean before they become hazardous, whilst the compact footprint means it fits in even the smallest of family homes.
Beagle Orthopaedic at BAPO
to children using the stander in Supine. The Multistander is simply adjusted for growth and positioning and has a range of accessories to meet varying complex postural needs. And later this summer Jiraffe is launching the Multisander 2 (ages six to 12 years), providing both longevity and value for money Telephone 0114 285 3376 or visit www.jiraffe.org.uk
The materials used are of the highest quality breathable fabric for wearer comfort with easy to secure Velcro strapping for patients with poor manual dexterity. Garments are available in a range of sizes and many include removable steels for added comfort and support. Please contact our customer service team should you have any questions or request a new catalogue Tel: 0115 973 4300 or email orders@jobskin.co.uk www.jobskin.co.uk
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