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INNOVATION FOR INDEPENDENCE
ISSUE 80 August/September 11 £6.95
Wearers ‘could turn thoughts into motion’ By Dominic Musgrave ‘BRAIN cap’ technology and neural interface software being developed at an American university could enable its wearers to turn their thoughts into motion. University of Maryland associate professor of kinesiology Jose ‘Pepe’ L. Contreras-Vidal and his team have created the system that they claim could control computers, robotic prosthetic limbs or motorised wheelchairs. He said: “We are doing something that few previously thought was possible. We are on track to develop, test and make available to the public – within the next few years – a safe, reliable, non-invasive brain computer interface that can bring life-changing technology to millions of people whose ability to move has been diminished due to paralysis, stroke or other injury or illness. “We use EEG [electroencephalography] to non-invasively read brainwaves and translate them into movement commands for computers and other devices.” The potential of the brain cap technology has attracted grants from the National Science Foundation and National Institutes of Health, and a growing list of partners that includes the University of Maryland School of Medicine, the Veterans Affairs Maryland
Health Care System, the Johns Hopkins University Applied Physics Laboratory, Rice University and Walter Reed Army Medical Center's Integrated Department of Orthopaedics and Rehabilitation. The team has successfully used EEG brain signals to reconstruct the 3D movements of the ankle, knee and hip joints during human treadmill walking. In two earlier studies they showed similar results for 3D hand movement and that subjects wearing the brain cap could control a computer cursor with their thoughts. Jose added: “This data could help stroke victims in several ways. One is a prosthetic device, called an ‘anklebot’, or ankle robot, that stores data from a normal human gait and assists partially paralysed people. “People who are less mobile commonly suffer from other health issues such as obesity, diabetes or cardiovascular problems, so we want to get stroke survivors up and moving by whatever means possible. ‘By decoding the motion of a normal gait, we can then try and teach stroke victims to think in certain ways and match their own EEG signals with the normal signals. This could ‘retrain’ healthy areas of the brain in what is known as neuroplasticity.”
Rugby star James Haskell officially opened a new clinic in Hertfordshire. The England World Cup squad member cut the ribbon at Harpenden Physiotherapy and Osteopathy. The new clinic, which is run by Chris Eke and Nick Sinfield, will offer a wide range of treatments including physiotherapy, podiatry, sports massages, orthotics and acupuncture. Full story, Page 20
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Conference focuses on ground-breaking developments By Dominic Musgrave AN INTERNATIONAL conference has shed new light on pioneering scientific research that will give disabled people a better quality of life. More than 100 academics and senior researchers from 15 nations attended the event at the University of Ulster’s Magee campus to showcase the initiatives they are developing in computational intelligence, cognitive robotics, neural engineering and other ground-breaking blue sky scientific disciplines. The conference trained a fresh focus on international advances that are harnessing robotic science and the computer-aided power of brainwaves in ways that will improve healthcare and independence for people who are disabled. ISRC director professor Martin McGinnity said that while tremendous advances have been made by researchers in both brain computer interfaces and robotics technologies, there could be even greater potential if the two areas of research could be better integrated.
He added: “The conference examined some of the barriers currently impeding the integration of BCI and robotics technologies. “However, despite the potential for making life easier for people with physical disabilities, due to practical limitations there is still very little takeup of BCI systems for real-world use. Similarly in the AR field, highly promising prototype systems have shown that these can have enormous benefits in terms of helping disabled individuals in mobility, performing activities of daily living and undertaking rehabilitation exercises for recovery of paralysed limbs. “These systems include a range of devices involving smart wheelchair, tele-robotics, intelligent manipulators, and prosthetic and orthotic devices. But AR systems have yet to find widespread application.” Brain Vision UK Ltd, a distribution company based in London, and manufacturer Brain Products GmbH, a German-headquartered firm that is making the next generation of BCI systems, jointly sponsored the conference.
Charity bid to raise £1m A SPECIALIST cycle and tricycle provider hopes to raise £1m for charity with a ride from John O’Groats to Lands End next spring. Quest 88’s Ride Side by Side challenge will be spread over 12 days, and the money raised will be split between the Help for Heroes and Caudwell Children charities. David Vernon-Henshaw (joint managing director), Mark Leary (technical services engineer) and Tony Smart (design engineer) will each ride one of the tandems, and they will be accompanied by representatives from the three armed forces that have been injured while serving their country. David said it is hoped that various celebrities who work with both charities will also be joining the teams along the route. He added: “To have the opportunity to ride the length of the UK with such brave people while also raising money for two such great charities will be a fantastic experience. As part of the event, we will also be holding All Ability Cycling days in Glasgow, Manchester, Shrewsbury, Taunton and Plymouth. At each event, anybody with a disability will have the opportunity to use a Quest 88 tricycle and hopefully realise that cycling is still a possibility for them.”
Contacts Editorial Andrew Harrod Group Editor editorial@assistivetechnologies.co.uk Dominic Musgrave Healthcare Editor Email: dm@whpl.net Tel: 01226 734407 Christina Eccles Reporter Email: ce@whpl.net Tel: 01226 734463
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Games can motivate to learn NEWS
INTERACTIVE computer games have the potential to help young people with learning difficulties master everyday tasks and motivate them to learn, it has been claimed PhD researcher Rachael Folds, from Nottingham Trent University’s School of Education, has studied how repetitive use of interactive mimetic digital games, such as those on the Nintendo Wii and Xbox Kinect, could help to improve certain skills. The research was carried out with Loughborough College students who are undertaking specialist training programmes that assist in the transition from special schools into further education courses. The participants were aged 16-24 and have intellectual disabilities ranging from Down’s syndrome to Autism Spectrum Disorder. Rachael said: “The initial results from this small sample suggest that interactive games teach the students movements which they can improve upon and mimic in everyday life. “Although they were playing tennis and bowling in the trial, games
which teach them how to do things like bake a cake or change a tyre could potentially be very beneficial. “The students really enjoyed taking part in this project and found it a rewarding and enriching learning experience, they were very motivated to learn using this method. “The outcomes were certainly very interesting and I think this is an area which warrants further research so we can build on how we best teach children with special educational needs.” During the study the students undertook pre and post test ‘realworld’ activities. The first part of the project – tennis – involved 24 students hitting 10 forehand and backhand balls and serving 10 balls. They were then asked to carry out the same task on a Wii tennis game at regular intervals over five weeks.
After playing the computer games, the students repeated the real-world exercise and their results were compared.
The second stage – bowling – asked 18 students to knock down as many pins as possible with five balls and this was then replicated over five weeks on an Xbox Kinect bowling game.
During the five week Wii trial 75 per cent of the group experienced an increase in their computer game scores, and the final test showed that the students' real-life tennis skill level had improved by an average of
Michael Caines MBE will officially open a new exhibition at the Ashton Gate Stadium in Bristol in September. The Michelin star chef, who lost his right arm in a car accident, will be at the ‘One Life - Live It’ event organised by the Prosthetics, Orthotics Rehabilitation Technology – Education and Research (PORT-ER) charity for people living with limb impairment. The September 9 exhibition will run from 10am-4pm, and will feature sports, gadgets, health and beauty and medical devices. Entry is £5 in advance or £7 on the day, with under 16s going free.
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53 per cent. The second stage of the project showed more significant findings as 94 per cent got higher scores in week five than they did in the first week playing the computer game. The average increase in their bowling real world skills was 143 per cent after interacting with the game.
Clients invited to education day NUFFIELD Health welcomed existing clients from the corporate health and wellbeing world to a physiotherapy education day at their Cannon Street centre. The event was an opportunity for key decision makers to engage with the senior physiotherapy team, and view the platform from which Nuffield Health’s physiotherapy offering is delivered in the corporate environment. Cabella Lowe, professional head of physiotherapy at the company, said: “We have invested a lot into identifying and addressing muscularskeletal problems that arise in the workplace, by combining intelligence from occupational health professionals with our own evidencebased practice.
“Our robust clinical governance not only ensures the delivery of physiotherapy in line with the newest research, but has proven cost-cutting benefits for the employer.” Nuffield’s entire network is clinically governed by a central team of senior physiotherapists, meaning that all patients receive an individuallytailored package giving only the clinically appropriate amount of sessions. Attendees were given the opportunity to participate in a live diagnostic triage session and watch some of the most effective methods of treatment in action, including ultrasound, acupuncture and gym-based rehabilitation.
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Premiership player pledges to raise awareness of condition PREMIERSHIP footballer Rory Delap visited The Robert Jones and Agnes Hunt Sports Injury Clinic to raise awareness of ankylosing spondylitis.
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The Stoke City player, renowned for his long throws, pledged his support to the Back in Play campaign, to raise awareness of the symptoms of the chronic inflammatory condition that can cause severe pain and loss of mobility in the lower back. The FA cup finalist said Back in Play can help raise awareness of this relatively unknown condition and its symptoms, despite not being a sufferer himself. He added: “Most football fans will not have heard about AS, yet the stats show up to one in 200 young men will have it.
Rory Delap (centre) with occupational therapist John Ridgeway and physiotherapist Carwyn Davies
“It is understandable that some of the symptoms like lower back pain are often written off as a sports injury or bad posture, however there are some key subtleties, such as the pain getting better with exercise and painful red eyes, that can indicate AS.”
across the UK to mark World AS Day, with a series of local public awareness raising activities.
The campaign, supported by the the National Ankylosing Spondylitis Society and funded by Pfizer Limited, launched in May at The RJAH Oswestry and a number of other hospitals
“Due to a lack of awareness about AS and the gradual onset of symptoms this debilitating condition can often go undiagnosed for a number of years,” said consultant
The campaign uses football to communicate the common AS symptoms to the people most likely to suffer – men and women aged 18 to 40 years old.
rheumatologist Dr Atheer Al-Ansari. “By increasing awareness of the specific symptoms we are aiming to reduce the frequent confusion with common back pain and sports injuries and help patients suffering from the condition to get diagnosed and treated earlier.” Although there is no cure for AS, there are lifestyle and medical treatments available to help those diagnosed.
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Crutch amnesty launched THE Accident and Emergency department at Torbay Hospital has launched a ‘crutch amnesty’ for the summer holidays. More than 5,000 pairs of crutches are given out to patients every year, and an estimated 1,500 don't make it back to the hospital. With the average pair of crutches costing around £10 this means that the A&E department loses up to £15,000 in missing crutches every year. Matron Andy Mortimore said: “We completely understand that when people are back at home and getting well they may simply forget to return the crutches. However, this does present us with a big problem, both practically and financially, so we are holding this amnesty to encourage people to bring them in. “At this time of year people are often preparing for their holidays and we asking that when they are getting their bags and suitcases out that they check to see if they are storing anything they may have borrowed from us.”
Physio aiming to row a million metres to help Bel By Dominic Musgrave A SKIPTON physiotherapist has set himself the task of rowing a million metres in 60 days to raise more than £10,000 for the care of a paralysed girl. Skipton physiotherapist Mark Wilkinson aims to complete 50 halfmarathons on a Concept II rowing machine to raise money for The Being Bel Trust. The trust funds care and support for Bel Young – a nine-year-old who suffered a broken neck in a fall from a garden climbing frame at a friend’s house, leaving her tetraplegic. The nine-year-old spent months in the paediatric high-dependency unit at Leeds General Infirmary and needs specialist help and equipment to help her live independently. She relies on a ventilator to breathe. Mark said: “I’ve just started doing some work with Bel, and I was so taken by her bravery, confidence and outlook on life that I thought I would do something that would really help her needs. “She requires a lot of specialist equipment so I decided, rather
Mark Wilkinson
stupidly, that as a physio who is relatively fit I would do something on a machine that I hate because it is so hard. I also hoped it would create the most attention.
Mark, who has also been nominated as one of the Olympic torch bearers for the 2012 Games, is currently ranked number one on the machine this year.
“I trained for six months ahead of the challenge, and in that time probably did around two million metres. I’ve done most of the halfmarathons at Craven leisure centre, but have also done several exhibitions in local supermarkets and at local shows.
He added: “Bel’s equipment is going to need changing in a few years, but I am doing my bit to help make this time of her life as comfortable as possible.
“They have been putting me on a stand and people come and watch me suffer, which I don’t mind as long as they donate.”
“But I’m not doing this for fun and my body is slowly getting wrecked. I have a bad back and blistered hands and, after 30 minutes of rowing my fingers go numb. I’m also having to sit on a pillow because the seats aren’t the comfiest.”
Double qualification for medallist Oscar OSCAR Pistorius has qualified for the World Championships and the London 2012 Olympics after clocking 45.07 seconds for the 400 metres at a meeting in Italy. The South African double amputee, who runs with carbon fibre prosthetic running blades after being born without a fibula in both legs, achieved the 45.25secs ‘A’ standard qualifying time by winning a race in Lignano. The four-time Paralympic gold medallist dubbed “the fastest man on no legs”, finished well clear of the field as he smashed his personal best of 45.61. He will become the first amputee sprinter to compete at the World Championships, which get under way in Daegu, South Korea, on August 27, and the Olympics. 6
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£3m centre to probe arthritis and sport link
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By Dominic Musgrave A PIONEERING £3m national research centre has been launched to investigate the development of arthritis from sports and exercise injuries. Almost 3,000 members of the public have visited Arthritis Research UK’s ‘Taking the pain out of sport’ website to share their concerns about pain or injury connected to sport or exercise activity, and 40 per cent were worried about limited mobility and joint problems in future.
A prosthetic limb user has completed a 630-mile run from Somerset to Dorset in a bid to raise £10,000 for charity. Colin Edwards ran 10 miles a day on the South West coastal path for PORT-ER, a charity that he is trustee of, which supports people with limb deficiencies. He had a serious motorcycle accident when he was 19, although his leg was not amputated until he was in his 40s, which is when he took up running. He ended the challenge by completing the Torbay Half Marathon in a personal best time.
Medical director, professor Alan Silman, said: “There’s a growing body of evidence to suggest that sports injuries can have long term implications, causing conditions such as osteoarthritis, with little knowledge about how to prevent and manage this future risk. “The health benefits of being active cannot be underestimated, but as we work hard to encourage people to adopt a more active lifestyle, we need to ensure they’re doing everything they can to prevent future problems. “The new centre will, for the first time, co-ordinate the work of leading experts to undertake and share research into the risks
associated with specific sports and specific body types, and how best to reduce these risks and to participate in sport healthily.” The National Centre for Arthritis from Sports and Exercise will also look at how best to manage injuries when they do occur, reviewing recovery techniques and surgical and pharmacological interventions. The charity is looking to collaborate with various partners, while universities and clinical centres will be invited to tender, collaborating in their bids. An international panel of medical experts will judge the submissions, based on their levels of expertise, enthusiasm and infrastructure to deliver the plan. The experts involved in the centre will be gathered from a number of related disciplines, drawing on the expertise of sports and exercise medicine specialists, physiotherapists, rheumatologists, the research community and the NHS. Olympians spanning the generations are also supporting the campaign. Diver Edna Child and hockey player John Peake who competed in the 1948 Olympics, as well as Zac Purchase MBE, gold medallist rower in the 2008 games and British hopeful for London 2012.
New features introduced for revamped summer school DR Kevin A. Kirby, Craig Payne, Dr Simon K. Spooner and Trevor Prior were the speakers at the revamped Langer RX Biomechanics Summer School. The event had a more hands on format, with morning lectures and afternoons jam-packed with intimate workshops that allowed the delegates to work closer with the speakers and be more involved in their own learning experience. The following subject matter was covered: Biomechanics and treatment of juvenile flatfoot and adult acquired flat foot deformity. Patello/ Femoral syndrome; the foot or hip. The practical application of biomechanical theory for patient assessment. How Orthoses work. Biomechanics of Hallux Limitus – Rigidus. Pathology specific prescribing. 10 biomechanical functions of the plantar fascia. 8
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Kinetic Quantified Casting. One of the new features which was incorporated was ‘ask the stars’ – a light hearted and informal opportunity for the delegates to quiz the speakers on topics not related to the lectures. Next year’s event will be held on June 22 and 23 with a sports theme. Speakers already confirmed include Simon Barthold, Kevin Kirby, Paul Harradine, Nat Padhiar and Trevor Prior.
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Damage to the cruciate knee ligaments has cut short the careers of many sports stars, but treatment for the injury could be revolutionised by a new device which has just secured a top innovation award. Dominic Musgrave reports.
Mechanism aims to improve knee surgery success rate RESEARCHERS from the University of Aberdeen’s School of Engineering in partnership with Martyn Snow, a leading specialist in joints and cartilage at the Royal Orthopaedic Hospital, have developed a new fixation mechanism which could improve the success rate in cruciate knee ligament surgery. The team was funded by the NHS to study the rupture of the anterior cruciate ligament (ACL). The ACL is the main ligament in the middle of the knee which stabilises the knee joint, and the team has developed a device to replace the screws traditionally used in this type of surgery. ACL injuries are particularly common in sports people. Michael Owen famously ruptured his during the first few minutes of England’s World Cup match against Sweden in 2006, and Tiger Woods also had problems during the 2008 US Open. The new device, known as a GraftBolt® has been developed from the initial concept and
brought to market in just five years. As a result the team was awarded the 2011 PraxisUnico’s Collaborative Impact Award. Dr Bin Wang, who led the team at Aberdeen, said: “ACL injury affects around one in 3,500 people. It is commonly repaired using the patient’s own hamstring tendons to form a quadruple graft that is secured in the tibia – the shin bone – and femur – the upper leg bone. “The NHS performs around 11,000 ACL reconstructions per year, but the procedure is not universally successful, with failure rates of five to 25 per cent often resulting in further surgery and long term problems. The main cause of this is loss of graft fixation within the tibia in the early post-operative period. “GraftBolt® aims to improve the patient’s quality of life by successfully repairing their injury first time and improving the quality of bonding of the graft to the bone, which speeds up the healing of the graft implant and hence improves the patient’s
Michael Owen
rehabilitation. “The product has a higher ‘pullout strength’ than the main competing product and therefore improves healthcare provision by increasing the reliability of the ACL reconstruction leading to fewer hospital readmissions for ACL reconstruction failure, which could lead to a cost saving to the NHS and other healthcare providers.” The GraftBolt® is used in place of a traditional screw for securing damaged ligaments to the bone and has a superior performance, increasing the reliability of ACL
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reconstruction and reducing the need for follow-up procedures. Bin added: “An ACL revision operation in the NHS costs £3,000£3,500, and sometimes two operations are required. Thus, use of GraftBolt® could save up to £6,000 per ACL reconstruction prevented.” The intellectual property rights for the GraftBolt® are owned by the NHS and it is licensed to US orthopaedic device company Arthrex Inc, which has developed the device into a commercially viable product.
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Backing for call to help older people live well at home Pets as Therapy dog Mollie with stroke patient Mary Horler, owner Terry Farren and occupational therapist Nicci O’Neil.
Mollie raises a smile ... A DOG brought smiles to some of the sickest patients on the stroke ward at Good Hope Hospital in Sutton Coldfield. Mollie the husky and her owner Terry Farren have been visiting the stroke rehabilitation unit at the hospital for the last six weeks, and were an instant hit with patients and staff alike. With the Pets as Therapy scheme, pets are allowed onto the ward for patients to stroke and spend some quality time with. Occupational therapist from the stroke unit, Nicci O’Neill, said: “From a clinical point of view, this scheme is excellent
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for patients. Not only is time with a therapy dog therapeutic, aiding recovery and rehabilitation, it also gives a taste of home. “The animals also encourage interaction in patients who wouldn’t usually get involved in social activity, thus boosting their confidence. The scheme has the added bonus of encouraging the use of effected muscles and limbs in stroke patients as these are used instinctively to pet Mollie. This is especially important in a ward where patients tend to spend a couple of weeks here. Their eyes really light up when they hear Mollie is coming back.”
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THE College of Occupational Therapists has lent its to support to a report which calls on Government to take urgent action to enable older people to live well at home. The All Party Parliamentary Group on Housing and Care for Older People research follows an inquiry into the barriers faced by older people who want to stay in their own home, but are struggling to do so. Among the obstacles found were: Delays and duplication in assessments of what an individual needs. Insufficient funds for preventative home care, and inflexibility in administering personalised support. Shortages of Disabled Facilities Grants for home adaptations (and of occupational therapists to advise on them). Under-resourced – and relatively few – home improvement agencies and handyperson schemes to get things done for older home owners. Among the 17 recommendations it makes to government it recommends that the CoT should work with local statutory, voluntary and commercial housing, health and social care to produce joint good practice
guidelines and procedures. Chief executive Julia Scott said: “We are fully behind APPG’s call for urgent action to enable older people to live well at home and their recognition of occupational therapists’ role in this. “We are key to unlocking dependency on hospital services, residential or nursing care. We are experts at adapting the home, removing obstacles to independent living and working with older people to live life their way. “These are exactly the areas in which OTs have unique skills and expertise. It is vital the Government work with us at this crucial time in health and social care reform. Together we can provide a sustainable and cost effective solution to caring for older people so that they can stay where they most want to be, in their own home.” She called on the Government to invest more in occupational therapy to make significant long term savings by reducing the risk of falls and accidents, avoiding premature admissions to nursing or residential care and unnecessary, and costly, hospital admissions.
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Funding secured for research into osteoporosis A UNIVERSITY of Manchester scientist has won funding from a leading medical research charity to develop a more effective way of routinely detecting osteoporosis in the spine. Tim Cootes, professor of computer vision in the School of Cancer and Enabling Sciences, has been awarded £136,600 over two years from Arthritis Research UK. Working with professor Judith Adams at Manchester Royal Infirmary, he and his team aim to produce a new computer programme to detect fractured vertebrae in radiographs, which are commonly used to diagnose osteoporosis. Currently, up to 50 per cent of fractured vertebrae are missed, as identifying them requires considerable expertise. Tim added: “The tool will automatically measure the shape of each vertebra and indicate if they are damaged or unusual, so helping clinicians to detect vertebral fractures more
reliably and quickly. This will help to diagnose osteoporosis at an earlier stage, leading to earlier treatment and reducing the risk of future fractures.” Osteoporosis is a condition affecting the bones, causing them to weaken and fracture. Around three million people in the UK have the disease leading to more than 230,000 fractures as a result. However, lifestyle changes and drug treatments can significantly reduce the risk of fractures so early diagnosis is important. An early sign of the disease is fracture of the vertebrae, but because they often cause no discomfort they can go unnoticed by the patient. Tim added: “We’ve developed a computer system that can distinguish between normal and fractured vertebrae, and in this project we aim to improve the system further and to train it to work on the different types of x-ray images that are commonly used.”
The world’s first motorised prosthesis launched THE world’s first motorised prosthesis was launched at a ceremony at London’s Science Museum by Össur. Power Knee uses cutting edge bionic technology to respond instantly to the precise movements the amputee makes and reacts to motions of sitting, standing, climbing stairs and walking, and also prevents stumbles.
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A motor integrated in the knee provides power, replacing the function of muscles lost through trans-femoral amputation. This means that for the first time the amputee does not have to generate the entirety of the effort required to walk or negotiate steps. User David Jonsson, who gave a live demonstration at the launch, said: “A motorised knee is different from a passive knee, which just follows the motion of the body. “The motor gives you more control over the knee, it allows you to mimic the natural gait more easily and allows the user to use their body more like the way is intended to work, because they do not have to compensate for using a prosthesis and muscle loss.”
David Jonsson
The event also featured a technical briefing by Richard Hirons, clinical specialist at Össur UK and comment from leading prosthetist Toby Carlsson, of Pace Rehabilitation.
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Delegates try Orthotists attend Stance Control seminar hand at colour matching DORSET Orthopaedic opened its doors for the first of what will hopefully be many silicone partner conferences. Delegates attended from around the world and were treated to a tour of the firm’s Ringwood clinic and three silicone workshops, which gave the delegates a chance to try their hand at colour matching. One delegate said the two days allowed him to truly comprehend how complex the process is after placing an order. Professor Mark Waters from Technovent answered questions surrounding the uses and manufacture of silicone and give a presentation on the company and its association with Dorset Orthopaedic. This allowed the delegates to gain a better understanding of why they chose to use the material in the majority of its manufacturing.
Ramp gives physio boost for young PERSUADING toddlers and children between the ages of two and 10 to actively engage in physiotherapy to stretch their Achilles tendons and calf muscles is not easy. Use of this safe and child friendly CPro Direct’s Dorsi Ramp can be readily incorporated into routine activities, such as daily teeth cleaning, playing computer games or working at a desk to make physiotherapy far less of a chore. It can help children suffering from idiopathic toe walking conditions, clubfoot and cerebral palsy to improve dorsiflexion and mobility. Strong, stable, safe child friendly ramp with no moving parts. Reversible design and insert provides 10, 15 and 20 degree slopes. Moulding encourages correct foot placement. Compound slope angle ensures correct dorsiflexion.
T AND S Orthotics held its first Stance Control seminar at the Hilton Hotel in Croydon, Surrey. The event attracted a group of 25 enthusiastic orthotists from around the UK, and began with an Introduction to Stance Control presentation by Dr Jim Campbell, vice president of Becker Orthopedics. This was followed by Patient Assessment and KAFO Prescription Principles by Karyn Ros, senior lecturer at Strathclyde University, and Dr. Andreas Kannenberg, director of medical affairs for Otto Bock Germany, speaking about the evidence behind stance control The day was rounded off with a presentation by both David Buchanan from the Otto Bock Healthcare Academy and Dr. Jim Campbell on component selection for Stance Control.
Many individuals with neuromuscular and/ or musculoskeletal disorders exhibit knee instability because of paresis or paralysis of lower limb muscles (Polio and Post Polio Syndrome). These individuals cannot walk safely or efficiently and, until 20 years ago, patients with neuromuscular or musculoskeletal disorders or instability of the knee were provided with a cosmetic or conventional type knee ankle foot orthoses (KAFO). This type of orthosis aids stability for the patient when walking. Most of the KAFOs supplied would have had some form of locking knee joint (ring catch, bar or bail lock) which would provide the much needed stance stability for the patient. But the downside to this was that the individual would not be allowed any knee movement during swing phase,
meaning they would walk with a stiff leg. For these patients to walk, the individual would compensate by either circumducting or hiking up their leg, which could cause long term pain joint dysfunction, especially in the hips and lower back. Research has shown that a patient with a traditional KAFO with locked knee joints is less energy efficient against the Stance Control devices available today. Advancement in orthotic technology has led to the development of Stance Control knee joints. These orthoses are designed to allow free flexion of the knee during swing phase, while providing full stability in stance phase by automatically locking on initiation of the stance phase of gait. To read more visit www.assistivetechnologies.co.uk
‘Spin out’ company holds regular clinics multidisciplinary team.
LACERTA Rehabilitation is a ‘spin out’ company of the University of Salford and has developed a close working relationship with the Polio Fellowship, along with other specialist groups.
Patients undergo a full orthotic assessment before being advised as to the best way forward. We are happy to produce a full written report for the referrer outlining our prescription thoughts, realistic expectations and full costings before any decision to go ahead with the manufacture of orthotic equipment.
We hold regular clinics in our state of the art facilities at the University Department of Prosthetics and Orthotics. Specialising in spinal and lower limb orthotics, we receive a large number of referrals for Polio and Post Polio Syndrome patients. All new patients who are referred to our clinic are invited to attend an assessment, where we have a
Polio sufferers, together with other groups requiring complex orthotics, are very much affected by the weight of their brace. We therefore specialise in a wide variety of designs
utilising a range of modern materials and manufacturing techniques in order to produce strong effective bracing while minimising the weight involved. On occasions it is necessary for us to design a specific orthosis for a particular problem where previous attempts at providing one has not been successful. We are increasingly requested by case managers to also provide an assessment and report service, and to go on to manage their client’s orthotic treatment.
Guaranteed to fit first time BY simply providing Beagle Orthopaedic with two measurements (waist circumference and length of sternal notch to navel) we will take care of the rest, providing you with a brace that is guaranteed to fit first time. The Contour™ Brace will come pre-assembled, allowing you to apply it straight on to a patient, making minimal yet critical adjustments for it to become a perfect fit for each individual. The Contour™ LSO by Aspen is the latest technology for restricting motion in the lumbar spine. Utilising the Quikdraw™ with Rigid Anterior Panel (RAP) as the platform, the brace is effective and comfortable to increase patient compliance and shorten recovery time. The Contour™ LSO is modular
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What is Stance Control?
ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
with adjustable side and vertical panels, allowing you the practitioner to fit a wide variety of patients. Contour™ LSO is a multiple orthotic system designed with rehab in mind, and can eventually be stepped down to the proven QuikDraw™ lumbar support. The Contour™ LSO steps up to form the Aspen Contour™ TLSO which provides superior motion restriction for the thoracic and lumbar regions of the spine (up to T9). The compression of the QuikDraw™, rigidity of the Contour™ Back Panel and stability of the TLSO upgrade combine to provide the most comfortable, simple yet effective, brace available on the market today.
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A 10-year-old’s dreams of becoming a professional golfer has moved a step closer after he was fitted with a special bionic glove. Dominic Musgrave reports.
Leo gets in the swing LEO Millar has learned the game using just one hand after a birth defect left him without fingers on his right hand. But, following a visit to founder Bob Watts at Hampshire-based Dorset Orthopaedic, he can now drive a ball as far as most amateur golfers. Bob told Assistive Technologies the youngster first visited him to have something fitted that would enable him to go from being a brown belt at karate to a black belt. He added: “Leo’s family originally approached us because the NHS limb centre told them they weren’t prepared to make him a device to help him reach his goals in karate. “We did that and then his dad, who is a keen golfer, came back to us and asked if we could do anything to help Leo because although he can pitch and putt well using the one hand he cannot give it a good swing when he needs to. “To get the distance he really needed two hands so they presented the golf clubs to me and I looked at his residual limb and started to think about the position he needed to get into, to firstly address the ball and then complete the swing.”
Bob created a flexible glove that attaches to Leo’s right wrist and has a handle on the end of it that grips any golf club, allowing him to swing with two hands for the first time. The device has been given the allclear by the the game's governing body the Royal and Ancient. Bob added: “After a bit of tweaking, the prosthetic we decided on is made out of silicone and a cuff goes around his wrist and up his forearm, and he tightens it up with a velcro strap. There is a handle holder on the end of it that fits all golf club grips. The silicone allows the prosthetic to rotate through 90 degrees as Leo swings the club and allows him to rotate his hand. “Leo is a great lad who is really mature for his age. He comes across as someone who is very focussed and knows that if he wants to be the best at something he is going to have to practice hard.” Leading club manufacturer Callaway has offered to provide Leo with a set of custom made clubs, while TV presenter and fan of the sport Chris Evans is also believed to be interested in playing a round with him for a feature for The One Show.
Leo Millar
Youngster in esteemed company LEO joins a list of well-known people to have their limbs fitted by Bob Watts. Over the years he has been involved with the likes of Heather Mills, most recently for her appearances on Dancing on Ice, and American actress, Paralympian and model Aimee Mullins. Aimee, who was born with missing fibula bones and, as a result, had both of her legs amputated below the knee when she was a year old, has recently been named as an ambassador for L’Oreal, joining the likes of Cheryl Cole. Bob said: “We have fitted Aimee’s limbs for several years and she called in a few weeks ago because she wanted a pair that she could wear with flat shoes. “Her high heeled ones apply more pressure on the limbs. In the past we have had to create ones for her for Alexander McQueen’s fashion shows.” Bob is also currently working with world champion sailor Stephen Thomas.
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NEWS
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sponsors kids
Golden start for Danielle’s Paralympic campaign By Dominic Musgrave AMPUTEE Danielle Bradshaw’s bid to represent Great Britain at the Paralympics has got off to a promising start. The 11-year-old struck gold in her first 100m race against able-bodied athletes at the Sportcity stadium, in Manchester. Danielle, who chose to have her leg amputated at The Children’s Hospital in Sheffield last year to give her a chance of competing for Team GB at the 2016 Paralympic Games, recorded a time of 23.6 seconds at the sports day event. She said: “It was a great feeling to complete my first race and even better to win. I couldn’t believe it when I
crossed the finish line and realised I had won gold. It was brilliant to be up on the podium at such a big stadium and I hope it is the start of many more medals to come.” Danielle, from Newton Hyde, Greater Manchester, was born with Developmental Dysplasia of both hips and a congenital abnormality of her right knee, which left her reliant on a brace, crutches or a wheelchair. She had never before been able to play sport and, although doctors said they could try other treatments, chose to undergo major surgery at The Children’s Hospital to have her crippled right leg amputated to allow her to compete with a running blade.
Danielle Bradshaw
Support for major event PHYSIOTHERAPY students from Cardiff University’s School of Healthcare Studies have supported a major new multi-sport event for young people. Gemau Cymru brought together athletes from nine different competitive elements to celebrate and showcase the future of Wales’ sporting talent inspired by the 2012 Olympic and Paralympic Games. In total nine sports events held at seven different venues across Cardiff made up the games including: athletics, boccia, canoeing, gymnastics, swimming, girls’ football and multi disability football teams, netball, rugby sevens and triathlon. The Cardiff physiotherapy team included 70 student volunteers and some of the most experienced staff from the School of Healthcare Studies who have, in the past, worked with athletes in the Olympics and Commonwealth Games.
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Nich to take help to Afghan youngsters A PARAMEDIC will be taking his medical skills to a war torn country this autumn. Nich Woolf, a Welsh Ambulance Service paramedic, based at Chepstow ambulance station Is preparing to travel in October to North Afghanistan to help children who have limb disabilities or developmental dysplasia of the hip. He is taking on the trip in partnership with the former ITN reporter Sandy Gall’s Afghanistan Appeal, which since 1986 has provided physiotherapy, artificial limbs, walking aids, and for more than 70,000 patients affected by illness, war, and disease.
“The trip comes on the back of a previous visit by British medical staff who found an urgent need for instruments and basic anaesthetic supplies “This is what I am working hard to gather before I go out in October. I want to bring with me good, serviceable equipment and supplies to the hospitals in Northern Afghanistan.” Nich is a well-known face on the music festival circuit, especially Glastonbury, after setting up Festival Medical Services which raises money for medical causes.
Nich said: “I am travelling to Afghanistan to raise awareness of these conditions, as children in such a poor country with a disability are more vulnerable than youngsters in a developed country. “This is a really important trip as I want to help treat these patients with by using my clinical skills and by training professionals in the country in recognition and treatment. ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
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PODIATRY
sponsors podiatry
Award for foot care project A PROJECT which helps to keep patients mobile by ensuring they have routine foot care has received a top award. The scheme run by Cardiff and Vale University Health Board won the award for developing a flexible and sustainable work force at the annual NHS Wales awards ceremony. It trains staff, as well as Age Concern and residential and nursing home workers to provide patients with basic foot care and refer patients to the podiatry team. Theresa King, of the strategic and clinical lead podiatry team, said: “Good foot care matters especially to older people. As people are living longer we need to be pro-active in identifying health risks, and providing efficient and empathetic care. This project without doubt demonstrated that we listened and understood a basic need to help make a difference.” Around 168 people have attended the training programme so far.
Rugby star cuts ribbon at clinic AN ENGLAND rugby star has officially opened a new clinic in Hertfordshire. James Haskell, who currently plies his trade for Stade Francais and scored two tries for England in the opening Six Nations game against Wales last year, cut the ribbon at Harpenden Physiotherapy and Osteopathy. The new clinic, which is run by Chris Eke and Nick Sinfield, will offer a wide range of treatments including physiotherapy, podiatry, sports massages, orthotics and acupuncture. Chris, a former professional rugby player himself with Wasps, told Assistive Technologies that he has known James several years. He added: “I’ve always been involved with rugby and have treated many players over the years, including James, and I’m sure we will continue to see him when he returns from his world travels. “In these difficult financial times it’s not easy opening a business on the High Street so it’s great to have had such strong support from the local community and people like James. “Our aim is to provide individuals with an extremely high level of diagnosis, treatment and patient care,
James Haskell cuts the ribbon watched by Harpenden physiotherapy and osteopathy staff
and our rehabilitation centre is furnished with the latest advances in exercise and electrotherapy equipment to assist us in providing the best possible care.” The HPO Clinic is offering the opportunity for local back pain sufferers to take part in a clinical trial, free of charge. The purpose is to demonstrate how to successfully treat back pain for lasting long-term relief, and it involves a four-week programme of self management, activities for daily living advice and exercise.
The trials will be conducted by Nick, a leading expert in the management of back and neck pain who has recently published a book called ‘Now I Can Bend My Back’. He said: “The NHS is pushing more towards self management and the trial aims to show how using the book and personal health can work together. Using questionnaires and stats we want to gauge how people are going. If successful we hope to roll it out to the NHS and PCTs.” The trial is due to start in September.
‘Arthritis crisis’ looming? WOMEN who wear high heels or badly-fitting trainers could be putting themselves at risk of arthritis, it has been claimed. The Society of Chiropodists and Podiatrists said the UK could be facing an ‘arthritis crisis’ due to increasing levels of obesity and poor footwear. The most common form of the condition, osteoarthritis, causes pain and stiffness in the joints and affects at least eight million people in the UK. The condition is more common in women. A poll of 2,000 people for the Society of Chiropodists and Podiatrists found that a quarter of women wear high heels every day or “frequently”. But experts warned high heels can alter the body's posture and increase pressure on the foot, ankle and knee joints, increasing the risk of osteoarthritis. Professor Anthony Redmond, a podiatrist and arthritis researcher from The Society of Chiropodists and Podiatrists said: “Although you are more likely to develop arthritis as you get older, it can occur at any age and the good news is that there are simple things you can do to help prevent and treat arthritis. “Choosing the right footwear will help minimise the stress placed on the feet and joints during everyday 18
ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
activity and helps reduce the risk of injury and joint damage. “For daily wear, the recommendation is to opt for a round toed shoe with a heel height of no more than 2-3cm and with a shock absorbent sole to help minimise shock to the joints.” The poll also found that 77 per cent of both men and women do not wear shoes designed specifically for the sport they are doing. Anthony added: “When doing exercise, wearing trainers that are fitted and designed specifically for that form of exercise will both improve performance and protect from injury. Those who wear trainers that are not designed for sporting activity are placing themselves at real risk. With forces through the joints exceeding eight times the body weight during some sports, the importance of matching the right footwear to the activity cannot be overstated. “If you do experience frequent pain in your feet or ankles, don’t ignore it as something can always be done. Some forms of arthritis start first in the feet and early treatment is vital to achieving the best long term outcome.” The survey also found that while 65 per cent have suffered stiffness or pain in their lower body and feet, only half have sought help for their symptoms.
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SPORTS REHABILITATION
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New hydrotherapy pool gets runner Sharon back on track
Sharon Gayter is pictured with Steve Smelt in Teesside University's new hydrotherapy pool.
A NORTH East based long distance runner has returned to full fitness thanks to the efforts of her local university. Sharon Gayter turned to Teesside University for help following an operation to remove a large cyst from inside her ankle bone last September. The operation involved stem cell treatment and left her with a drastically weakened bone, which meant she could only cope with light stress. Desperate to reclaim her crown as Britain's number one long distance runner, she turned to the Teesside Sports Injury Centre, based at the University, for help. Sports injury staff from the University's sports therapy degree put together a recovery programme for Sharon, who studied on Teesside’s sport and
exercise master’s degree and does some part-time lecturing at the University in between her busy running schedule. This included using the new hydrotherapy swimming pool. Sharon said: “I needed to get back to running, but my ankle bone couldn’t support my weight – the underwater treadmill was a godsend. With the water absorbing 70-80 per cent of my body weight, I ran against an underwater jet stream three times a week for a month. “Underwater cameras helped monitor the impact on my legs. For one-to-one rehab, this is absolutely magnificent.” Sharon made her comeback in the Athens International Ultramarathon, and then went on to become the fastest ever British finisher when she competed in a 120km race in
Mat hoping for 2012 support role A WARWICKSHIRE physiotherapist has set his sights on gold next summer as he heads to the 2012 Paralympics as part of the support staff for the Great Britain blind football team. Senior physiotherapist at George Eliot Hospital in Nuneaton, Mat Jones, became involved with the team after being approached by the FA a couple of years back while managing a local club side. Ever since then he has been providing physio for the GB blind and cerebral palsy teams. Mat performs the same kinds of duties a physio would at any football match, as well as running clinics and providing emergency pitch
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side management. He told Assistive Technologies the job has taken him all over the world, with trips to Holland and Madrid coming up as part of the cerebral palsy World Cup and blind European Championships respectively. “I never really dreamed that I would ever walk out at an Olympic or Paralympics opening ceremony so it will be a very proud moment for me and I’m sure for my family as well,” Mat added. “We are currently ranked fourth in the world so we are definitely in with a shout of bringing home a medal; we’re aiming for gold.
ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
“The FA invest a lot in our professional development.The experience has helped me to modify my skills to cope with different situations. “Working so closely with the blind and visually impaired has also helped to greatly improve my communication skills. Over the last couple of years I have been constantly presented with new situations. It’s been a big challenge but very fulfilling.” Along with the rest of the team and staff, Mat will feature in a flyon-the-wall Channel 4 documentary focussing on the build up to the Paralympics which will be aired in the near future.
the Netherlands. She is now preparing for some of the world’s toughest endurance races over the summer, including The High – the world’s highest ‘ultra’ going up to 18,000ft in the Himalayas. Only one person has ever finished the 135 miles to date. Sharon also hopes to reclaim her British crown at the Commonwealth Mountain and Ultra Championships in North Wales in September – providing she suffers no further injuries. Teesside Sports Injury Centre was set up as a social venture five years ago by senior lecturer Steve Smelt, programme leader in sports therapy. He previously worked for both Middlesbrough and Sunderland football clubs.
First device of its kind launched CYCLONE Technologies launched the first device that enables Functional Electrical Stimulation therapy in an upright position at the Mobility Roadshow . Heralded as a revolution in FES for disability recovery and fitness, the RT600 is a major advance in encouraging the body to learn a full range of routine movements. Until now it has been available only seated at a cycling or rowing system. “We were delighted to be the first in the world to launch and extremely positive about its potential,” said Dave Hawkins, managing director of Cyclone Technologies Limited. “Initially we expect to install the system in clinical rehabilitation centres, but long term we hope that it could be feasible for personal use.”
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Football rehabilitation centre invests in world first ... By Dominic Musgrave A REHABILITATION centre dedicated to helping professional footballers overcome injuries and return to competition has invested in the world’s first elliptical bicycle, the ElliptiGO, to enhance its programme. Lilleshall National Sports Centre, in Shropshire, is funded by the Professional Footballers’ Association, and its main purpose is to help players overcome the type of lower limb injuries that are common to the game. Philip Newton, director and physiotherapist at Lilleshall, said: “Football is a high energy, fast-paced game that’s centred on speed and endurance. Combine that with sliding tackles, flicks and tricks and players are bound to pick up the odd niggle here and there. “We have always used exercise bikes and mountain bikes as part of our rehab programme, to improve lower limb endurance and overall fitness. “However, because the ElliptiGO requires you to balance and use your upper body to maintain posture, as well
as use a leg motion that is more akin to running, it means that the exercise is more functional and is well tolerated in conditions where pain with lower limb loading is an issue. Training with ElliptiGO recruits the same muscles as running, but with a lesser impact biomechanically, as the motion does not create pressure or abrasion on the joints. Phil added: “Players on the rehab programme have really bought into the ElliptiGO and enjoy using it as part of their wider training programme. “It’s a lot more dynamic than a regular bicycle, but then replicates a running workout while eliminating the pressure on knees and joints.” The ElliptiGO’s pedalling motion is specifically engineered to be closer to running than an elliptical trainer or stepper. The system includes a long stride length and steep recovery stroke that makes “running” on it feel like running outdoors. ElliptiGO riders can cruise along at speeds in excess of 25 miles an hour, as well as climb and descend steep hills utilising the range of gears provided.
SPORTS REHABILITATION
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ADVERTISER’S ACCOUNCEMENT
DJO Global’s product range can help with ACLR rehabilitation THE rehabilitation of Anterior Cruciate Ligament Reconstrction (ACLR) is dependent on the type of graft used and the concomitant trauma sustained at the time of injury. As with most rehabilitation no two ACLR patients will be the same, each presenting with their own challenges. That said there are some fundamental goals that need to be achieved to obtain the best short and long term results. These can be achieved more effectively if the patient’s rehabilitation commences before their reconstruction, generally referred to as ‘prehab’. The aims of prehab are to ensure FROM, minimise swelling, maximise strength and gait control (Shelbourne and Klotz, 2006). Post operatively, the goals are similar: To restore knee stability, ROM, strength and function through the kinetic chain. DJO Global has a range of products to help facilitate this process. Both pre and post operatively it is important to try to attain FROM. Swelling is a limiting factor, as well as inhibiting surrounding muscles, especially Vastus Medialis, therefore early emphasis should be placed on minimising the effects. Aircast’s
Cryocuff is a portable unit that a patient can use easily at home, after they have been educated on the importance of cooling, compression and elevation. While controlling swelling, patients should also be encouraged to maintain/restore FROM with non weight bearing exercises, such as heel slides for flexion and stretches for extension. For immediately post operative recovery, rehabilitation should commence with priority. Once again, Aircast’s Cryocuff can be used to minimise swelling and restore FROM. Following on from this, the Shelbourne Clinic (USA) recommend a period of one week’s total bed rest with the patient only allowed to get up for comfort breaks. To ensure ROM is worked on during this period, a Continued Passive Motion (CPM) machine is advised which can be used in conjunction with the Cryocuff unit. DJO Global has a range of CPM machines (Artromot K1, K2 and K4) that will fulfil this purpose. Of course, while it has been shown that this protocol is very effective in minimising effusion and restoring ROM, it can result in neural
inhibition and muscle atrophy, especially to the Quadriceps. It is therefore recommended that the early introduction of Cefar Compex, a neuro muscular electro stimulation (NMES) machine is advocated. Compex programmes, such as Capillarisation, can be commenced from around day two post op and, while this programme will not produce muscle contractions, it does encourage cellular activity of both nerve and muscle cells. Progression can be made to a Disuse Atrophy programme, as the patient can tolerate, which stimulates contractions of the Type I (slow twitch) fibres. DJO Global are currently running free Compex CPD workshops, presented by chartered physiotherapist Cliff Eaton, demonstrating how to maximise the use of a NMES device for both recovery and performance. Compex is the perfect companion for every physiotherapy clinic. For further details, or to book a workshop, contact Emma Cartwright on 01483 470237 or email ukinfo@djoglobal.com ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
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PRODUCTS
SYSTEM SUITABLE FOR ANYONE FACING A TOTAL KNEE REPLACEMENT BIONICARE is a revolutionary non-invasive treatment for uni, bi and tri-compartmental knee osteoarthritis. Suited for anyone facing a total knee replacement, young or non-operative patients. Bionicare provides a clinically proven and cost effective alternative to knee surgery without any of the associated risks. Bionicare is simple to use and imperceptive to the patient, with treatment delivered using a simple night-time wrap and/ or the OActive off-loading OA knee brace. The system delivers an electronic impulse directly to the knee and after treatment restores the health of the knee, bringing back a patient’s quality of life. Bionicare is cost-effective compared to knee surgery, low risk and backed by five studies, prescribed by over 4000 clinicians in the USA treating in excess of 80,000 patients with outstanding results. Enquiries: For further information and a product demonstration contact Gilbert and Mellish on 0121 475 1101 or email marketing@gilbert-mellish.co.uk
BEAGLE ADDS NEW BRACE TO ITS PORTFOLIO NEW from Beagle Orthopaedic’s Custom Fabrication Department is the Torticolls Orthosis. It is designed to offer patients with this distressing condition a long-term comfortable solution to integrate into their daily lives.
TALARMADE has added a unique addition to its Trio range designed to achieve return to normal function to the foot and protect the forefoot. By combining features which have previously only been available, in combination, via a custom made device, Talarmade has designed a product which offers genuine opportunity for effective control of damaging pronation forces, with reduction and offloading of forefoot pressures.
Enquiries: To find out more about Trio PR contact 01246 268456 or email info@talarmade.com
PRO-ACTION KNEE RANGE BRACE LAUNCHED NEW WHEELCHAIR THE Pro-Action ACL/PCL Knee Brace offers a four-leverage design for optimal stabilisation, providing a range of limitation stops and immobilisation at either 0? or 30? Features and benefits: •ROM Hinge with plug-in stops •Extension limitations at: 0?, 10?, 20?, 30?
Constructed from thermoformable plastics, which vary dependent upon their required function, the shoulder and head components are linked using an innovative hinge.
•Flexion limitations at: 0?, 30?, 45?, 60?, 90?
It uses multi-directional adjustment in the flexion/extension plane, rotational adjustment to ensure optimal stabilisation when correction is applied to the joint, and also allows the head component to be raised.
•Indications for use:
The orthosis is secured with a circumferential strap with ultra low profile buckle, and further optional fastenings to control the head movement can be supplied as required Enquiries: Visit www.spokz.co.uk or telephone 0845 2577496.
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TALARMADE ADDS TRIO PR TO RANGE
ASSISTIVE TECHNOLOGIES I AUGUST/SEPTEMBER 2011
•Hypoallergenic silicone grip straps for anti migration Concentric condyle pads •After meniscus resection •After meniscus reconstruction •After ligament reconstruction •Isolated or combined ligament instabilities of the knee joint Enquiries: Telephone 0161 2736789, fax 0161 2731400 or email info@benecaremedical.com
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