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INNOVATION FOR INDEPENDENCE
ISSUE 103 JUNE/JULY 2015 £6.95
Device may allow prosthetic hands to feel sensations By Nicola Hyde RESEARCHERS have developed a novel device that may allow individuals to feel hot, cold and the sense of touch through a prosthetic device.
The ulnar nerve, one of three main nerves in the forearm, is the largest nerve in the body unprotected by muscle or bone and is connected to the ring finger and pinkie finger on the hand.
A team of engineers and researchers at Washington University in St. Louis is working to change that so those with upper limb prosthetics can feel hot and cold and the sense of touch through their prosthetic hands.
It’s the nerve that is stimulated when a hit to the elbow triggers the “funny bone.”
Daniel Moran, PhD, professor of biomedical engineering in the School of Engineering & Applied Science and of neurobiology has received a three-year, nearly $1.9million grant from the Defense Advanced Research Projects Agency (DARPA) to test the device that would stimulate the nerves in the upper arm and forearm. If it works, upper-limb amputees who use motorised prosthetic devices would be able to feel various sensations through the prosthetic, which would send sensory signals to the brain. Daniel, whose expertise is in motor neurophysiology and brain-computer interfaces, and his team have developed an electrode designed to stimulate sensory nerve cells in the ulnar and median nerves in the arms.
The median nerve in the upper arm and shoulder is connected to the other fingers on the hand, so together, the two nerves control movement and sensations including touch, pressure, vibration, heat, cold and pain in all of the fingers. People using arm prosthetics have to rely on their vision to use them properly, Moran said. To pick up a cup of coffee, they have to be able to see the cup, place the fingers of the prosthesis around it and lift it. They are unable to feel whether the cup is in their hand, if the cup is hot or cold, or if they are about to drop it. By enabling the ability to feel, users will have more control over the prosthesis. The team developed a macro-sieve peripheral nerve interface designed to stimulate regeneration of the ulnar and median nerves to transmit information back into the central nervous system.
Limbcare has been announced as a winner of the Queens Award for voluntary service. The charity, which supports amputees and their families, was founded five years ago by quad amputee Ray Edwards MBE (pictured above). As a quad amputee Ray is aware of the emotional and physical challenges facing new amputees and their families. He said: “Servicemen and women get great support from the military and the wonderful Help for Heroes if they have a limb amputated – but civilians have no such support. Limbcare helps to fill that gap by offering, among other things, emotional support and advice. In particular Limbcare is there to let amputees and their families know they are not alone. For many amputees it’s the knowledge that someone else has ‘been there too’ which is the most important.”
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New limb helps Tom to become GB Paraclimbing team member By Nicola Hyde A MAN who lost his leg after a works accident is trying new activities like rock climbing and bouldering thanks to his prosthetic limb. Tom Perry, 35, from Great Ayton, is now a member of the GB Paraclimbing team. He said: “Both of my legs were crushed into a four inch gap by an eight tonne piece of machinery at work. “I was trapped for more than an hour, until the emergency services were able to release me.” “I remained conscious throughout the rescue. Thankfully the containment meant that I wasn’t losing blood, which certainly helped me to survive.” Unfortunately, due to a severed artery, four days after the accident Tom’s right leg had to be amputated
Editorial Judith Halkerston Email: jh@scriptmedia.co.uk
above the knee, in addition to the insertion of a condylar plate and screws into his left leg.
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“Prior to the accident I led a very active life, fell walking, climbing and I enjoyed my manual job, so I was devastated and was uncertain of my future.” Pace prosthetist Howard Woolley and physiotherapist Carolyn Hirons assessed Tom to see if improvements could be made.
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Carolyn said: “We felt that significant improvements could be made, primarily with the provision of a prosthetic knee that would provide stability and reliability, thereby improving his confidence and ultimate prosthetic use.
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“We also gave consideration to a subsequent prosthesis that would benefit him with his recreational activities.” Tom was fitted with a Genium microprocessor knee.
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Tom Perry
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Photo credit: Spencer Kellis and Christian Klaes, Caltech
Paralysed man moves robotic arm using thought alone in world first By Nicola Hyde A MAN who was paralysed from the neck down after being shot can now move a robotic arm just by thinking about it. Erik Sorto is the first person in the world to have a neural prosthetic device implanted in a region of the brain where intentions are made, giving him the ability to perform a fluid hand-shaking gesture, drink a beverage, and even play "rock, paper, scissors," using a robotic arm. The clinical collaboration between Caltech, Keck Medicine of USC and Rancho Los Amigos National Rehabilitation Centre, want to improve the versatility of movement that a neuroprosthetic can offer to patients by recording signals from a
different brain region other than the motor cortex.
to use, ultimately making the movement process more fluid.”
Principal investigator Richard Andersen said: “When you move your arm, you really don’t think about which muscles to activate and the details of the movement—such as lift the arm, extend the arm, grasp the cup, close the hand around the cup, and so on. Instead, you think about the goal of the movement, for example, ‘I want to pick up that cup of water.’ So in this trial, we were successfully able to decode these actual intents, by asking the subject to simply imagine the movement as a whole, rather than breaking it down into a myriad of components.
The device was surgically implanted in Erik’s brain at Keck Hospital of USC in April 2013, and he has since been training with Caltech researchers and staff at Rancho Los Amigos to control a computer cursor and a robotic arm with his mind. The researchers saw just what they were hoping for: intuitive movement of the robotic arm.
“We expected that the signals from the PPC would be easier for patients
Erik, a single father-of-two who has been paralysed for over 10 years, was thrilled with the quick results: “I was surprised at how easy it was (to control the robotic arm),” he said. "I remember just having this out-ofbody experience, and I wanted to just run around and high-five everybody.”
Sorto has signed on to continue working on the project for a third year. "This study has been very meaningful to me,” added Erik. “As much as the project needed me, I needed the project. It gives me great pleasure to be part of the solution for improving paralysed patients’ lives. I joke around with the guys that I want to be able to drink my own beer—to be able to take a drink at my own pace, when I want to take a sip out of my beer and to not have to ask somebody to give it to me. “I really miss that independence. I think that if it were safe enough, I would really enjoy grooming myself— shaving, brushing my own teeth. That would be fantastic.”
Five more years of austerity – more for considerably less? By Simon Dickinson
make continuing efficiencies.
THE NHS in England is projected to have overspent its budget by more than £600m in 2014/15, an analysis by the Health Foundation has found, despite the service receiving an extra £900m in funding.
Even with the promise of an additional £8billion for the NHS, I am incredibly sceptical that these funds will filter down into rehabilitation services let alone orthotic, prosthetic or wheelchair budgets.
In its ‘Hospital finances and productivity: in a critical condition?’ report, the think-tank found the financial performance of NHS providers in England has deteriorated sharply, moving from a net surplus of £582m in 2012/13 to a net deficit of £789m at the end of the third quarter of 2014/15.
The cost improvement plans (CIP) for many NHS trusts for the 2015/16 financial year appear to be increasing, with some organisations facing a savings target of 11% this year. NHS staff have also had negligible increases in pay for well over five years.
With the surprise majority won by the conservatives at the general election in May 2015 it is highly likely that public services will be required to 4
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
The challenge for NHS managers and commissioners has never been greater. But how much further can costs be cut and savings be made without
negatively impacting patient care or waiting times? Procurement departments from NHS trusts are all looking to save money in every way possible. Many have even written to suppliers asking for all prices to be frozen. Some services, such as the fracture clinic at the Glasgow Royal Infirmary, have been looking at new ways of working to drive efficiency. Their “Virtual fracture clinic” has reduced fracture clinic attendances by over 50% and combined with a move to orthotic braces instead of traditional casts they have made further savings. Despite all the hard work done to reduce costs, I fear it will not be enough. The NHS may have to
Simon Dickinson
consider which services it funds and which treatments are and are not going to be funded. Simon Dickinson is clinical director at TalarMade.
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High healthcare cost for military amputees revealed in research
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HUNDREDS of war amputees will cost the NHS over £288million over the next 40 years according to a new study. The study into aftercare costs for those who lost limbs in IED attacks in Afghanistan was carried out by researchers from the Royal British Legion Centre for Blast Injury Studies at Imperial College London. It reveals that policy makers need to budget the sum to pay for prosthetics, trauma care and related treatment.
Ground-breaking new roles created in physiotherapy department By Nicola Hyde BURTON’s Queen’s Hospital is believed to be one of the first in the UK to offer a new role for physiotherapists, which has also helped it attract high calibre staff members who can deliver specialist care for patients. Three physiotherapists have joined the Queen’s Hospital team in the innovative Fellowship Posts. They will undergo 18 months of focused training under the guidance of Extended Scope Practitioners (ESPs); highly skilled physiotherapists who provide an expert level of care to patients with complex health problems. The three new staff members have left posts in hospitals in Kettering, Nottinghamshire and Kent to move to Burton because of the unique opportunity the posts offered. Consultant physiotherapist Emma Salt came up with the plan of creating a structured Fellowship Post where ambitious and well-motivated band six physiotherapists could train over an 18-month period to work at the level of a Band 7 ESP. Emma’s idea got the go-ahead and the innovative recruitment approach – believed to be the first of its kind in the UK in physiotherapy – received a great reaction from jobseekers. 6
“We were delighted with the quality and quantity of applications that the advert attracted, and we chose three people to join our team in January,” said Emma. The new recruits are Leena Lad, who has moved from Kettering General Hospital, Fred Mainwaring, who previously worked for Sherwood Forest Hospitals NHS Foundation Trust and Agostino Faletra who previously worked at Sevenoaks Hospital in Kent. They will each spend six months specialising in the upper quadrant (arms, neck, and shoulders), six months specialising in the lower quadrant (legs, pelvis, and lower back) and also spend six months attached to the Emergency Department.
Major DS Edwards of the Royal Centre for Defence Medicine in the UK, spoke out in an article appearing in the journal Clinical Orthopaedics and Related Research, published by Springer. He led a study into the scale and long-term economic cost of military amputees following Britain's involvement in Afghanistan between 2003 and 2014. It found that an extensive use of improvised explosive devices by insurgent groups against the coalition forces combined with better personal protection equipment, improved early medical care, and rapid extraction of the injured, more service members survived such attacks.
This translates to a lifetime cost of around £870,000 per single below knee military amputee. The report adds: “Over the next decades British military amputees will not only suffer from the same chronic health problems as that of the general population, but also have specific issues related to their injuries. “This includes the use of prostheses. The authors believe these impacts can be modified by developing more effective and sustained medical and social support, post-military discharge, in order to encourage healthier lifestyles and develop people's skills and earning capacity.
However, many now have to deal with complex wounds such as multiple amputations. Edwards and his colleagues set out to quantify the extent and nature of traumatic amputations suffered by British service staff from Afghanistan. This was done as a first effort to adequately start budgeting for the long-term needs of the injured
* Reference: Edwards, D.S. et al (2015). What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort? Clinical Orthopaedics and Related Research. DOI 10.1007/s11999-015-4250-9
Scientists develop system SCIENTISTS at Brunel University London have developed a system for Parkinson’s sufferers to counter two of the most common and distressing symptoms of the degenerative disease. Many patients are afflicted by freezing of gait (FOG) where suddenly, in mid-stride, the muscles freeze and they are left unable to move forward or they simply fall over.
Leena said: “I was delighted when I saw this job advertised. I’d never seen anything like this before and it was perfect for what I wanted to do. I was thrilled when I heard my interview had been successful.”
Previous research shows that giving visual clues such as projecting lines ahead on the floor “unfreezes” the muscles but current equipment has to be worn.
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
They found that between 2003 and 2014, 265 British soldiers sustained 416 amputations. On average the soldiers lost 1.6 limbs each. Of these, 153 soldiers lost their whole leg, while the lower leg of 143 patients was amputated. Including additional treatment cost and economic losses, the total cost or "disease burden" associated with these injuries could be higher than £288 million over the next 40 years.
"A long-term facility to budget for veterans' health care is necessary. Our estimates should be taken as the start of a challenge to develop sustained rehabilitation and recovery funding and provision."
By the end of each six month period it is anticipated that they all have all the skills experience and confidence to work at a Band 7 ESP level in that area.
Emma intends that the Fellowship Posts will continue on a rolling programme with new candidates recruited in 18 months’ time.
beyond their years of service in the armed forces.
But Dr Konstantinos Banitsas and PhD candidate Amin Amini Maghsoud Bigy have turned Microsoft’s Kinect computer games controller into a system that can be
installed into a patient’s own home. Linked to a ceiling mounted laser, the Kinect can not only project prompt lines when the software detects a FOG incident but if a patient falls, the system not only detects that but also automatically triggers a video conferencing call. Dr Banitsas said: “All the other systems require a patient to wear sensors and power packs where our solution is unobtrusive and covers a whole room. “By mounting the laser guide marker on the ceiling it can provide the visual clues in any direction. And it is only activated when a FOG incident occurs instead of having to be worn constantly. The system has already passed proof of concept stage and we will shortly begin patient trials.”
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Peter begins Ice Cap world record attempt NEWS
AN AMPUTEE adventurer has set off for a world record crossing of the Greenland Ice Cap. Peter Bowker is leading the 65 Degrees North expedition as they set off on the world’s first unsupported attempt by an amputee. The mission covers 600km facing temperatures as low as -37 degrees - the team will be forced to cross the ice cap on skis pulling pulks weighing up to 80kg. A former Queen’s Dragoon Guardsman, Peter was injured by a roadside bomb while on attachment in Afghanistan. He has learnt to ski especially for the expedition and will wear an Elite blade foot, from Blatchford, which will fit directly to his ski boot and perform well at sub-zero temperatures. Peter’s prosthetist Alan McDougall said: “Peter is incredibly committed and it’s been a pleasure to support him. “The Elite blade is ideal for the conditions as it reduces shock and
Peter Bowker
Bournemouth University lecturer Dr Bryce Dyer.
provides energy return.
Lecturer helps amputee chase Team GB dream
“The carbon fibre design is lightweight and low maintenance which will be essential for Pete to conserve energy and minimise potential repairs during the event.” Peter added: “I am humbled by the support that has been generated for this mission. “But it’s all about giving something back and all proceeds from the mission will be going to Help for Heroes.” The team are being supported by Prince Harry and actor and documentary filmmaker Ross Kemp.
By Nicola Hyde
A BOURNEMOUTH University lecturer is helping a disabled cyclist to achieve his dream of representing Britain at the Rio 2016 Paralympics. Dr Bryce Dyer is designing a prosthetic leg for amputee Craig Preece, who is in with a chance of making the Team GB cycling squad for next year’s summer Paralympic Games, held in Rio de Janeiro. Currently a member of the Podium Squad, Craig is pushing himself to be ready for Rio, where he would compete in both road and track events, and is making gains in training towards the cause. As a below-the-leg amputee, a prosthetic leg enables him to compete at the highest levels. Dr Dyer is working with both Preece and prosthetists at Pace Rehabilitation in designing the limb that he will use to train and, hopefully, compete with next year in Brazil. The leg itself is being created following testing that determined the most effective geometry to provide maximum power transfer. The result of these tests led to Dyer
generating several prototype designs that will now all be fabricated and evaluated aerodynamically in the field. The final result will see a set up that is comfortable, efficient and hopefully provide Preece with a competitive advantage. Dr Dyer said: “A project like this is tricky as you’re taking something that has to replace a limb that has been lost. It must be comfortable to use during extremely high levels of effort but has to perform well technically too. “I realised we could develop something special but we’d need to do some further experimentation to find out how to push its performance on from what we did in the last project. “We’re in the middle of that process now – the athlete has a chance of getting into the Team GB squad so it is exciting for all of us involved.” Craig Preece, a father of two, was injured by a roadside bomb while serving as a soldier with the Royal Engineers in Afghanistan in 2010 and was bought his first racing bike by Help for Heroes.
Leckey brings wheelchairs to UK A SERIES of wheelchairs that are popular in America are being brought to the UK market by Leckey. The products – Ki Mobility’s Little Wave, Focus, Catalyst 5 and Rogue wheelchairs – feature everything from a product for the youth market to a tilt chair and lightweight folding chair. Martin Rennie, Mobility Sales 8
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
Manager at Leckey, said: “We are really excited to have the opportunity to bring the Ki Mobility range of wheelchairs to our customers in the UK. “The Little Wave, Focus, Catalyst 5 and Rogue offer the latest in design innovation, helping make mobility easier for the user. We are confident that the response from the market will be extremely positive.”
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Physios encourage employers to sign up to free event
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Majicast has been designed to manufacture lower limb prosthetic sockets.
‘Leg bank’ aims to change Colombian amputees’ lives By Nicola Hyde A LEG bank which sets to provide life-changing prostheses to people who can’t afford their own is being developed. Academics from the University of Strathclyde, and members of Dutchbased social enterprise organisation ProPortion plan to establish a service in Colombia offering high-quality artificial legs to people who have lost limbs, often through injuries from landmines. A team led by Dr Arjan Buis, from Strathclyde’s Department of Biomedical Engineering, has developed innovative technology, known as Majicast, to manufacture lower limb prosthetic sockets which fit prostheses securely to patients’ residual limbs. A spokesman said: “The Majicast is currently being optimised into a market-ready product, with the help of a design agency. We expect that this social enterprise venture can be successfully piloted in Colombia, then developed for other parts of the world.
“We have fantastic inventions but the capacity and organisational structure to bring them to markets is lacking; only then does an invention become an innovation.” Merel Rumping, Project Incubator with ProPortion, developed the idea for the leg bank after hearing of a surgeon in Thailand who, frustrated by a lack of access to quality prostheses, created his own from plastic bottle caps. She was also inspired by the many amputees without prostheses she saw during her time working with street children and former child soldiers in Colombia.
PHYSIOTHERAPISTS are encouraging innovative employers across the UK to take an active break and sign up for one of the UK’s biggest workplace health and wellbeing events. Registrations are open for Workout at Work Day 2015, a free annual event organised by the Chartered Society of Physiotherapy to encourage employees to become more active in order to stay fit for work. Thousands of employees are expected to team up with physiotherapists for active workplacebased fitness events, ranging from exercise classes and workstation assessments to lunchtime walks and team games. Prof Karen Middleton, chief executive of the CSP, said full-time workers could find it challenging to do at least 30 minutes of moderate
intensity physical activity five times a week, but it was in employers’ best interests to create an active workforce. “Aside from the human cost, the price of inactivity for employers can be vast, with higher sickness absence costs and lower productivity. Physiotherapists play a key role in getting people back to work and keeping them fit for work. “The consequences of not doing so can be devastating, with many people suffering ill health and prolonged spells off work. “It is in everybody’s interests to find ways to tackle the enormous problem of inactivity in the UK and we would encourage people to take responsibility for their own health.” Employers interested in registering for the day can sign up by visiting www.csp.org.uk/workoutatwork.
“Those who can pay for their travel expenses have to wait up to two or three months to have their prosthesis made; rehabilitation takes even longer. In this period they cannot work, and they cannot take care of their families.” The partners in the leg bank project are currently seeking funding for the venture. They are in talks with potential investors and intend to begin a crowdfunding campaign.
Spinal models available to August date for first Para Tri suit a variety of patients THE UK’S first ever stand-alone massparticipation sports event for people with disabilities will be held in August. Para Tri is the first in a wider series of events planned beyond 2015, which will include a Para Swim and a Para Run/Push. The series gives the 9.4 million disabled people in England alone more opportunities to participate in the burgeoning mass-participation market and is supported by Ottobock UK. Para Tri founder and Paralympian Sophia Warner said: “There is currently a significant gap in the 10
market and we look forward to develop our series from the very beginning.
“Para Tri is the realisation of a longheld dream that was inspired by taking part in many massparticipation events over the years. This is an exciting opportunity to make sport as fun as I know it can be for everyone.” Ottobock UK will provide technical support for all Para Tri participants on the day. It will be conducting various repairs to equipment throughout such as wheelchairs and prosthetic limbs damaged in competition for an estimated 500 participants.
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
BEAGLE Orthopaedic houses a large database of spinal models to suit a variety of patients. From this extensive library we can manufacture your CTLSO using measures provided from a simple measurement chart, we then adapt the relevant model to meet the specification. Each orthosis is fabricated to the patient’s unique model and your specifications, ensuring the optimum fit, support and comfort. CTLSO’s are available as; bi-valve design finished to completion (no intermediate fitting) with a variety of
liners such as cool foam, north foam 33, evazote and lambs wool. We can also provide a customised combination of products for high thoracic fractures / instabilities. The chosen TLSO is then coupled with components from the Aspen CTO, to provide the stability required for your patient in the upper thoracic and cervical region. This design offers a step-down reduction for on-going rehabilitation therapy. Available in paediatric and adult sizes. Enquiries: For further information call 01254 268 788.
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Advantages of Dynamic Knee Ligament Bracing technology By Chris Everett ACL deficient and reconstructed knees share common problems that may not be recognised by many medical professionals. The quadriceps contraction forces that cause symptoms in an ACLD patient are still at work against the ligament graft in an ACLR patient. These forces unfortunately can lead to graft stretching and failure. There are four activities that ACLD patients have difficulty performing, these are stopping, walking/running downhill, landing from a jump and lateral manoeuvres.
reduce or limit further damage to these structures.
provide a progressively increasing force to push the tibia posterior relative to the femur as the knee moves into extension. Force is reduced as the knee flexes back into the ready position. As the knee extends to less than 30 degrees flexion, the force rises more quickly, the resulting force is sufficient to prevent the tibia from subluxing prior to foot strike. As the knee joint is compressed in the proper position, it gains more stability. An added benefit of using dynamic braces after several days is the muscle re-learning that occurs providing “spontaneous hamstrings co-activation” that is elevated to prevent subluxation even if the brace is removed.
These all involve open kinetic chain extension where quadriceps contraction can sublux the tibia prior to foot strike. Static bracing, muscle strengthening, and other forms of training cannot completely eliminate the symptoms of ACL deficiency.
1 – Eliminate ACLD Symptoms
Dynamic bracing maintains the proper relationship between the femur and tibia as it goes through a range of motion. In the case of Dynamic ACL knee braces, the quadriceps extensor force is used to
ACL deficient patients using dynamic braces could generate maximal voluntary isokinetic extension effort throughout the full range of motion with significantly increased quadriceps activation and without
Dynamic braces have several further benefits:
3 – Protect ACL Reconstructions
When ACL reconstructed patients perform the same manoeuvres that cause symptoms in ACLD knees a high degree of stress is placed on the reconstructed ligament graft.
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The original ACL has a neuro-sensory role that elicits a primary hamstrings reflex to protect the ACL, and inhibits the quadriceps from applying too much force that might damage the ACL.
Chris Everett
any knee subluxation. 2 – Limit Further Damage
Limiting tibial translation is the most important element to successfully preventing further damage to articular cartilage and the menisci. Since tibial translation is effectively controlled using Dynamic ACL braces it’s reasonable to assume that this will
Both these reflexes are absent or reduced in ACL reconstructed knees. Dynamic braces can apply a force to reduce the strain on the reconstructed ligament helping protect it from subsequent stretching. The benefits can be quickly proven by actual brace use on symptomatic knees. Bledsoe dynamic bracing technology is available in the UK via Promedics Orthopaedic. For further details contact Chris Everett, national bracing manager, on 07768 833416 or by emailing chriseverett@promedics.co.uk
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sponsors podiatry
PODIATRY
Lecturer to lead new podiatry research A UNIVERSITY of East London lecturer has been awarded more than £200,000 to help bring relief to people suffering with arthritis.
University launches UK’s first national orthotic survey By Nicola Hyde THE first ever national survey of orthotic services in the UK is expected to go live in July. Professor Chris Nester and colleagues at the University of Salford are launching the survey after focus groups revealed just how varied approaches to the use of foot orthoses are. The steering group was established in November 2014 and along with Dr Jane McAdam the team at Salford are expecting to go live with a Bristol online survey in July 2015. Australian trained podiatrist Dr Jane McAdam said: “The survey will provide clinicians, managers, researchers, industry and charitable organisations with perhaps the first clear picture of which clinicians are proving which type of orthoses to which patients and why, but also reveal how service structure and changes in service provision are affecting clinical orthotic decision making. “With so much change ongoing this feels like a perfect time to be doing this important exercise”.
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Indeed the problem of poor quality data on orthotic practice in the UK was central to discussions led by Neil Churchill from NHS England at a recent meeting at Salford. In March more than 50 representatives of professional bodies, NHS Trusts, industry and patient organisations met to forge a pathway towards new guidelines for more patient led commissioning of orthotic services. Professor Nester runs the Salford FOOTPRINT research programme and says the survey is part of a deliberate strategy to strengthen the impact of their research by exploring new directions. He added: “We are perhaps best known for our foot biomechanics and orthotic biomechanics research, but we are striving to complement these strengths with research and innovations that are more directly relevant to practice. “It would be wonderful to think this survey is the start of an exercise we repeat every five years, allowing the orthotic sector to build a clear picture of changes in practice and the factors driving these changes.”
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Dr Kellie Gibson has received the research grant from the Dr Scholl Foundation to lead an investigation into the effectiveness of prefabricated insoles which treat problems associated with rheumatoid arthritis. The disease affects an estimated 645,000 people in the UK, most of whom will develop foot and ankle problems. Standard treatment is through the use of foot insoles which help to redistribute load from weightbearing sites and correct the shape of the foot arch. These specialist insoles are manufactured using two different approaches. In the more traditional one, the insole is customised to the patient’s specifications. The alternative is prefabricated versions which are cheaper to make and easier to mass produce. Research suggests that customised versions result in a 25 per cent reduction in pain and disability compared with no treatment. But little work has been done on the effectiveness of the prefabricated versions. And that is where Kellie will
concentrate her efforts. ‘’This study will evaluate both the clinical and cost-effectiveness of prefabricated insole in comparison to customised versions,” she said. “Currently, prefabricated ones are the treatment of choice within most NHS trusts, due to them costing a significant amount less than the customised option.” However, there is conflicting evidence about whether prefabricated versions provide the same long-term benefits. If they do not, and patients go on to require more treatment, they could end up being even more costly. The study, which is being carried out in collaboration with researchers from Glasgow Caledonian University, aims to address this lack of knowledge on prefabricated insoles and provide the NHS with evidence on clinical outcomes, patient satisfaction and cost-effectiveness, by exploring patient perceptions, and experiences through a series of interviews and questionnaires. “With the ever-tightening purse strings of the NHS and the limited evidence base for insole treatment in rheumatoid arthritis patients with foot impairment, this research should provide vital evidence and thus guidance to inform clinical decision making in future,” added Kellie.
£20,000 research grant available PODIATRISTS are being encouraged to apply for a new research grant, which is worth £20,000, to support innovative studies. The URGO Foundation is offering the financial support to any healthcare professional working in the field whether they be a specialist, clinician or part of a wider multidisciplinary team.
The grant will be awarded to the applicant with the best original project relating to diabetic foot ulcers. There are a number of areas the project is looking to investigate further, focusing on both prevention and management of the condition. The deadline for submitting an application is 30th June 2015.
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Climbing high with DM Orthotics TOM Watts, 16, has been taking on the world of extreme sports thanks to his Lycra orthoses supplied by DM Orthotics. Tom suffered a stroke at the age of 11 which impaired the function and movement down his left side, preventing him from continuing to enjoy contact sports such as rugby. Now aided with DM Orthotics’ Dorsiflex Sock and more recently the DMO Glove, Tom is taking on extreme sports like climbing and mountain biking. Tom was determined to get active again and tried a number of rigid carbon fibre splints for his foot before his physiotherapist recommended DM Orthotics’ Lycra version. Tom said: “I got through about three different types of carbon fibre splints, but because I was so active, I kept breaking them. They just didn’t last, or weren’t flexible enough to allow me to do the things I wanted to do.” The Dorsiflex Sock works using a number of strategically placed Lycra panels which create forces to re-align the foot’s position, providing active dorsiflexion (lifting the foot up during walking and running). Martin Matthews, managing director at DM Orthotics, said: “The new
positioning stimulates the body’s neuro-sensory system and effectively, re-programmes the brain so that the muscles work in a new biomechanical state. “There are a number of benefits to this including increased proprioception but most importantly it encourages muscle movement and usage.”
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Tom added: “The Dorsiflex Sock is great. Because it is made from Lycra it is really easy to put on. It’s so much more comfortable, nice and light and doesn’t rub. “I don’t have to keep changing it over either like I did with the carbon fibre splints. I can just put it on in the morning and leave it on all day.” Tom has been able to take part in a lot more activities that require a lot of leg movement with the Dorsiflex Sock and joined the Club of Extreme Sports at his local leisure centre. “I can do a lot more running using the sock, “ he added. “I go to an extreme sports club – I do wall climbing, mountain biking and rocketball. The Dorsiflex Sock has definitely allowed me to do a lot more of these things.” And there are also other aesthetic benefits, something which is important.
Tom tries his hand at wall climbing.
“The other great thing is that you can choose your own colours,” said Tom. “Mine looks like a regular sports sock, which is great in the summer when people see it, they think it’s just a sports sock – it doesn’t draw the same sort of attention as a rigid brace.” Tom has just started his college course following completion of his GSCEs. He is pursuing an active outdoor career studying game
keeping and wildlife management. DM Orthotics is a world leader in the development and manufacture of bespoke Dynamic Movement Orthoses used to treat neurological and musculoskeletal conditions. Their aim is improve function and encourage independence for the user. To find out more visit www.dmorthotics.com
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CHILDREN
sponsors children
High-tech language assessment points way to better future for disabled kids A NEW high tech computer-based speech and language assessment tool helping professionals accurately record the levels of understanding of children who have a physical disability could improve the outcomes of thousands of non-verbal children. The Computerised Accessible Receptive Language Assessment software has been designed in response to an audit which identified that speech and language therapists found it difficult to get an accurate picture of a child’s receptive language using current tests if the child had a physical disability and couldn’t speak or point to pictures to show what they could understand. The technology has been developed by the NIHR Devices for Dignity Healthcare Technology Co-operative (D4D), a specialist centre based in Sheffield, and Barnsley Hospital’s assistive technology team in partnership with Jabbla, a Belgian technology company. D4D is hosted by Sheffield Teaching Hospitals NHS Foundation Trust and empowers patients to live more
dignified, independent lives. Incorporating eye gaze tracking, mouse pointers and switch scanning options, the software is the first assessment of its kind to combine all these features into a single software package so that speech and language therapists can use these methods to accurately record a child’s receptive language level. Children with physical disability often use these methods for other computer programmes so by integrating these options into CARLA, the software aims to reduce the barriers these children face when being assessed. Simon Judge, joint communication aid project lead for D4D and senior clinical scientist from Barnsley Hospital’s assistive technology team said: “We’re delighted to be launching this new assessment. Up until now, when a child cannot point to their answers, speech and language assessment tools have relied on the therapist’s interpretation of the child’s responses, but this system gives an objective record of
A screenshot from the CARLA software.
these responses as the child can make their choices using eye gaze, head switches or mouse pointers. “As a result of having a more accurate picture of these children’s ability to understand language, the software will make it easier for speech and language therapists to target their therapy at an appropriate level. This could make a significant difference in terms of their educational outcomes and ensuring the appropriate language support is
put into place.” The software, which has been designed for children with a physical disability, also has the potential to help children with sensory or attention difficulties and adults with communication disabilities such as those with learning difficulties, dementia or aphasia. It will initially be available for use by speech and language therapists and teachers.
BOA® Closure with Nimco Footwear – the ideal solution to encourage independent footwear use DeNovo Healthcare is a dynamic and progressive patient centred company focused on providing some of the most innovative products and services 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. Our successful Nimco Made4You children’s footwear range has now been enhanced with the new exciting addition of the BOA® closure system. This system is an innovative method of closing your footwear, which is easier and stronger than both lace and Velcro options. With a simple one-handed turn of a dial, you can tighten your shoes up to the desired amount with a level of precision, which is not achievable with other closure options. Removing your Nimco shoes with a BOA® closure is as easy as pulling the adjustment wheel outwards, which instantly releases the steel lace 14
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
mechanism. The BOA® closure is available on the front of the shoe for a standard opening or with a rear closure option which releases and opens up the back of the shoe to provide a very easy way of putting on shoes over AFOs. Being able to operate the BOA® one handed, coupled with the easy to use mechanism not only enables independent footwear use, but encourages it by boosting wearer confidence when the shoes are fastened correctly first time, every time. DeNovo Healthcare Ltd, 6a Cheddar Business Park, Wedmore Road, Cheddar, Somerset, BS27 3EB. Call 01934 808416, email sales@ denovohealthcare.com or visit www.denovohealthcare.com
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Orthotix – the best kept secret in Wales? ORTHOTIX was established in 2004 to provide ready-made orthoses to the NHS supplementing the bespoke product already being supplied by its holding company, Dacey Ltd. Today Orthotix is the leading sports and orthopaedic bracing business based in Wales supplying a diverse range of products to customers across the UK and Ireland. Originally set up in the South Wales valley town of Merthyr Tydfil, the business has expanded significantly since its inception, adding further offices and an additional warehouse to its site in the capital city, Cardiff. The family run business uniquely benefits from its close relationship with its sister company Ace Feet In Motion Ltd and its holding company Dacey Ltd, accumulating over 50 years worth of experience in the healthcare industry. Through continued product development instigated by the Healthcare Professionals employed within its group of companies, Orthotix is able to offer innovative best value products, with many now being made at both of their own manufacturing facilities in Wales.
Popular items such as stock gaiters, abdominal supports, lumbosacral belts, maternity supports, slings, cervical collars and limb de-rotation orthoses are just a handful of the products which are now fabricated on site. In addition to its own branded range, Orthotix has established trade partnerships with two large European companies, Orliman and Pavis. To date, these relationships have given rise to the introduction of established external market leading products to the UK marketplace. This has enabled British and Irish customers to purchase the likes of the Boxia Drop Foot AFO and the Wellness Line 100% Cotton Hernial Briefs/Boxers, for the first time. Due to the special working relationship between Orthotix and their trade partners there have been numerous product collaborations where expertise from both companies have been utilised to design and develop innovative products such as the hugely successful soft shell helmet, “Head Protex”. This offers a comfortable and easy to fit stock solution that provides
suitable skull protection for children at risk from head injury. They are available in a bright pink, aqua or black colour. The latest exciting addition to the product portfolio is a collection of orthopaedic bracing designed specifically for children. The range branded as “Paediatrix” has been created for common childhood injuries and conditions, with functionality, comfort and aesthetics in mind.
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Included in this range are the ever popular Feet In Motion FFO’s, and the brand new Single/Double Tibiofemoral De-rotation Orthoses which have been developed by their team of orthotists over the past 18 months. Going forward Orthotix will be compiling its new product catalogue for release in January 2016, showcasing over 25 new products. The business plans to continue its expansion with a new emphasis on retail and export. For any product or trade enquiries please contact Orthotix on 02920 370 696 or email enquiries@orthotix.co.uk
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Introducing Memo children’s footwear INTRODUCING Memo children’s shoes, sandals, boots and inserts with the unique Memo Diagnostic System.
AT Jiraffe we believe that nighttime positioning should be of the same high quality as day time positioning.
Memo shoes are a medically registered product, highly supportive and hardwearing and have been sold in Europe for over 25 years and over seven years by Equip To Move Ltd, UK distributor.
After all, we probably spend more time in our sleeping position than we do in any other! That’s why as part of our range of postural support products, we provide the DreamaTM by Jenx.
Memo shoes are available in a wide range of trendy styles and colours and available from baby size two to adult size six and include a school shoe range. Memo shoes are very cost effective with most ranges just £65 a pair. For NHS procurement we can offer a discounted price. We carry a large stock and can dispatch the same day. We can bring a selection of our stock to you so your Orthotic team can see these lovely boots and shoes. Equip To Move Ltd 01525 718581 www.equiptomove.co.uk info@cppcltd.co.uk CPPC House, 1 Kings Road, Flitwick Bedfordshire.
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DreamaTM 24-hour positioning system – providing valuable rest for everyone
ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
DreamaTM is a combined pressure reducing mattress and postural support system that uses a variety of support pads to contribute to better quality sleep or rest. It can be used as both a preventative system or to reduce the risk of further postural deterioration and is therefore appropriate for any age. DreamaTM can be used on profiling beds too as it easily contours thanks to its strong, flexible aluminium base. It also provides good ventilation between the body and the mattress, which not only reduces
heat-triggered spasms, but provides greater comfort for the user. The pressure-reducing modular mattress is 15cms deep and it has individual towelling covers which are soft and stretchy and can be quickly removed if soiled and the cushions wiped clean. Perhaps best of all though, is the unique Glide-LockTM system of supports, which can be configured exactly to the user’s needs and can be adjusted quietly or the user’s position changed easily without disturbing the user. DreamaTM can also be set up
with the user in bed, so transfers can occur with some, all or no supports in place, reducing the need for lifting and the position then being adapted once the user is on the bed. DreamaTM is particularly beneficial to those with the following conditions: Cerebral Palsy, Muscular Dystrophy, Spinal Muscular Atrophy, Arthrogryposis, Rheumatoid Arthritis, Post-trauma, Postsurgery, Spina Bifida and Scoliosis amongst others. We’ll be showcasing our cot size DreamaTM on the Jiraffe stand at this year’s Kidz South, Stand 308.
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Little boy feels good after wearing made-to-measure Sensory Dynamic Orthosis E was diagnosed with Congenital Muscular Dystrophy at six weeks old and at age seven years the effects of a progressive neurological condition were taking their toll. A diagnosis that we can do nothing about but can we address what it is doing to his body? E has muscle weakness that is driving his body out of alignment and placing him in the most complex of positions where constant pain is one of his biggest issues. He is unable to tolerate a TLSO (a rigid brace) and so his mother sought advice about the Sensory Dynamic Orthosis (a made to measure lycra garment).
Some passive correction in lying supine was achievable but when up against gravity this is lost. He was provided with a day suit and a sleep suit because of his clinical presentation and five months later the SDO had made a difference. Improved alignment. No pain when wearing the suit. Improved upright posture. Improved upper limb function out of base of support. Improved volume and clarity of speech. E immediately states that it feels good and that he feels safe. ASSISTIVE TECHNOLOGIES I JUNE/JULY 2015
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Orthotics inspired by collagen masks can be developed in hours, researchers claim FLEXIBLE orthotics that use the experience of collagen masks can be developed within hours, according to researchers. MHOX (mhoxdesign.com) and CRP Group (crptechnology.com – windform.com) are aiming to create a framework that will allow for mass customisation of orthoses, rather than the traditional size systems (XS, S, M, L, XL, XXL). A software workflow has been developed that takes a bodyscan of the patience and uses a set of algorithms aimed at fitting the device on the patient anatomy and articulating its form to achieve specific, customised performance.
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The bodyscan of the patient is performed via infrared or structured light sensors. This phase was designed to be fast, easily manageable in medical environment, cheap in terms of hardware resources. The generation of a 3d model of orthosis allows the designer to differentiate object's morphology from patient to patient, managing specific performance needs, while adapting to personal anatomies. It is possible to create devices with different balances of stiffness and flexibility, allow certain movements while constraining others, integrate an aesthetic value, implement material properties totally new to this
objects, such as porosity and surface articulation. A spokesman said: “3D printing and additive manufacturing were used to create the orthosis. This technology can enable the full customization of the medical device according to patient need. The material that CRP Group used for this kind of application is Windform GT that is a polyamide-based material reinforced with glass fibers.� The software to scan and generate the orthosis is designed to be adaptable to different body segments and performance needs. The hand orthosis is intended to be a device to aid rehabilitation after
surgical operation. It constrains any movement of the hand. A surface porosity, variable in size and distribution, allows the hand to stay ventilated and washable. The leg orthosis is a device for patients with peroneal muscles deficits and consequent troubles in their gait cycle. The 3d scan allows the object to embrace both the leg and the foot, directly integrating a plantar. A specific joint, centered on the ankle, whose geometric characteristics vary parametrically from patient to patient, employs the flexibility of the material to provide active support and control in the gait cycle.
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