INNOVATION FOR INDEPENDENCE
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Researchers turning plastic water bottles into prosthetic limbs RESEARCHERS from Strathclyde are involved in a project to create artificial limb sockets from recycled plastic bottles. The initiative by De Montfort University in Leicester, has successfully manufactured the first-of-its-kind prosthetic limb socket. Project lead, engineer Dr K Kandan, found he could grind the plastic bottles down and use the granulated material to spin polyester yarns. This yarn can be knitted into a fabric and used to produce a strong yet lightweight material that can be moulded into prosthetic sockets. It has been trialled with two patients in India – one who had his leg amputated above the knee, and one who had his leg amputated below the knee. Now biomedical engineers from Strathclyde will help shape and develop the device to take part in a larger-scale study in India, so that the design can be adapted to meet patients’ individual circumstances. Strathclyde biomedical engineer and prosthetic expert, Dr Arjan Buis, said: “Prosthetic sockets are commonly made from different materials which are often composites, but De Monfort University have created a new kind of knitted recycled material. “They invited us to a workshop because they thought that they could use our prosthetic casting technology called Majicast to enhance
theirs. We had a common target group in India because we both work with the Bhagwan Mahaveer Viklang Sahayata Samiti in Jaipur, the world’s largest organisation for rehabilitating disabled people.
“What they have done is, irrespective of what the socket looks like or what it should do, is explore whether a recycled material can be used and can that then be formed into a shape that can carry a person, for instance.” The sockets are being tested in comparison with other materials, following the quality standards set by the International Organisation for Standardisation for prosthetic components. The cost of producing a prosthetic socket this way is just £5, comparable to what it would cost for a socket in India, but much less than the industry average of around £500 each in developed economies. Dr Buis added: “As well as using recycled material, the aim is to establish a research and knowledge base within up and coming economies and to enable us to have an impact in these places. If it’s recyclable it also means that it won’t just end up on a big heap of general waste and polluting oceans, so it has a long term ecological benefit.” Prosthetic experts from the Malaviya National Institute of Technology in Jaipur and the Universities of Salford and Southampton are also involved.
A gold medal-winning Paralympian has been honoured by the University of Wolverhampton for his sporting achievements Record-breaking Mickey Bushell MBE won gold at the London 2012 Paralympic Games. He received an Honorary Doctor of Sport at a graduation ceremony at the Grand Theatre recently. Mickey, who is from Telford, said: “I’m honoured to receive this award from Wolverhampton and I’d like to thank everyone involved in making it happen, it was a complete surprise.” Mickey is a record-breaking Paralympian, who won gold in his second Paralympic Games in London 2012. In recent years, while still competing, Mickey has branched out from sport and runs his company Project Emotion, which teaches others how to effectively communicate via body language and channel their emotions to their advantage.
AN early warning system powered by a smart shoe insole can help prevent the re-emergence of diabetesrelated foot ulcers which can lead to complications such as amputation, a study suggests. One of the challenges for the clinical profession is how to help patients with diabetes avoid developing reocurring foot ulcers on the sole of their feet: one in every fourth person with diabetes will get one in their lifetime and the danger is they fail to heal and become infected over time. Tragically, up to 30 per cent of patients with a diabetic foot ulcer may go on to require some form of lower limb amputation. Diabetic patients with peripheral neuropathy – nerve damage in the extremities – experience less sensitivity in their hands and feet and as such run a higher risk that in some common situations, such as walking, sitting or standing, their feet may experience higher than normal foot pressures, causing skin damage to the bottom of the foot and leading to an ulcer. Researchers at Manchester
Metropolitan University, The University of Manchester and Manchester Diabetes Centre tested the effectiveness of an intelligent shoe insole system that tracks pressures and provides instant feedback, prompting users to adjust their behaviour or stance to alleviate or offload the kind of pressure that can cause ulcers. The results of the study published in The Lancet Digital Health journal show the system reduced the reoccurrence of foot ulcers in patients by 71 per cent over the course of the 18 months of the project. Lead author on the paper, Dr Caroline Abbott, Research Fellow within the Research Centre for Musculoskeletal Science and Sports Medicine at Manchester Metropolitan University, said: “This is the first clinical trial to test if ‘smart’ or ‘intelligent’ insoles, worn during daily life over a long period of time, can prevent debilitating foot ulcers from recurring in ‘high-risk’ diabetic patients. “We realised that any active technology that alerts patients to their daily periods of harmful high foot
pressures would be a very powerful foot ulcer prevention strategy. “The benefits of the technology are that the patients are empowered to monitor their own risk themselves and better understand their own foot pressures and then actively offload pressures during harmful periods. “The patients with the best compliance and self-management were best protected against ulcers recurring. “This finding illustrates the concept of the effectiveness of patient empowerment through targeted technology.” The smart insole system tested by the Manchester Metropolitan team is called SurroSense Rx® and was developed by sensor-based advanced wound care product manufacturer Orpyx Medical Technologies Inc in Canada. The shoe inserts were fitted with eight sensors that continually monitored and measured pressure points around the sole of the foot during the wearer’s day to day activities.
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Walking speed may predict if and when young stroke survivors return to work A SIMPLE walking speed test may help predict whether young adult stroke survivors are ready to return to work, according to new research.
Dr Jarvis added: “There was a huge range in outcomes in our stroke population, highlighting the fact that some people recover quickly and can return to work, while others are so severely affected that they cannot go back to work.
There are 152,000 strokes each year in the UK – approximately one every five minutes – and around a quarter of those strike people under the age of 65.
“Walking speed is a really useful tool for clinicians to use to predict return to work. It’s simple, low cost and effective.
Figures suggest 44 per cent of victims may not be able to return to work, mostly due to challenges they experience with walking. In a study whose findings were published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association, a team of researchers led by Dr Hannah Jarvis, Research Associate in the Research Centre for Musculoskeletal Science and Sports Medicine at Manchester Metropolitan University, examined how walking speed related to readiness for reemployment. Dr Jarvis said: “Stroke affects motor control and motor function. “To return to work, you must be able to walk to your car, bus, office and meeting rooms. “If you can’t walk or you get tired easily, your ability to do your job is going to be seriously impacted.” Researchers analysed the relationship
“In addition, clinicians can use this measure to guide their patients during rehabilitation.
between walking speed and readiness to return to work after stroke. They compared mobility in 46 stroke survivors from across Wales – between the ages of 18 and 65 – to 15 people who had not had a stroke. Using a walking test, they measured how fast and far participants walked in three minutes. A benchmark measure was calculated that predicted readiness to return to work. The researchers found: n A walking speed of more than three feet per second was a critical threshold. Stroke survivors walking slower than this were significantly less
“For example, they can focus on increasing walking speed and maintaining quality of walking in order to give their patients a chance of going back to work.”
likely to return to work n Of the 23 per cent who returned to work, 90 per cent walked faster than the critical threshold. Those who returned to work walked almost six feet per second, compared to those who didn’t go back to work and only covered about two and a half feet per second n Young stroke survivors were less efficient at walking (known as metabolic cost of walking) than their healthy counterparts. This means that walking at a similar pace requires more effort and results in becoming tired more easily.
Recent figures suggest that there are more than 100,000 strokes in the UK each year and around a quarter of strokes happen in people of working age, with the average age of someone suffering a stroke decreasing in recent years. People of working age who have had a stroke are two to three times more likely to be unemployed eight years after their stroke. The Stroke Research Innovation and Education Fund Wales funded this project which is from the Welsh Government via the Stroke Implementation Group.
Smart camera technology is shown to help rehabilitation of adults with impairments RESEARCH presented by a team from City University at the European Society for Low Vision Rehabilitation conference in Manchester has shown that the wearable OrCam MyEye 2 smart camera device may be beneficial for adults with visual impairments and/or language impairments caused by stroke.
to make me feel more confident. “I also really liked that it is a totally secure device that doesn’t store any of your data, because that’s something that you can’t always be sure of with a smartphone app.” Lead researcher from City University’s Division of Optometry and Visual Sciences, Ahalya Subramanian, added “Our exploratory study found that smart camera technologies have potential to facilitate a range of reading activities for people with language and or visual impairments.
The OrCam MyEye 2 uses a smart camera, equipped with world-leading artificial intelligence technology, to instantly recognise printed or digital text, faces, or barcodes. The device is specifically designed to give people who are blind, visually impaired, or have reading difficulties more independence and improved quality of life. The device is wireless and attaches magnetically to any pair of glasses. The City University pilot study was set up to investigate the ability of smart camera technologies to act as a reading aid and improve quality of life and independence for people with acquired language and visual impairments. The OrCam MyEye 2 device was compared to a number of smartphone apps which offer some similar functionality. Participants attended one training session on how to use the OrCam MyEye 2 and then borrowed the device to use at home. 4
ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
“We are now seeking funding to pursue a larger study to explore this research area more fully.”
After two weeks of use, they provided feedback on the OrCam MyEye 2. Bernie Warren, who lost her sight due to complications from her type-1 diabetes, was one of the participants who assessed the OrCam. She said: “it was absolutely brilliant to take out and about with me, particularly going shopping or when I was travelling. “One of the scariest things about being visually impaired is feeling disorientated in unfamiliar places, so it was great to have the OrCam with me
The research was conducted by a joint team from the Division of Optometry and Visual Sciences and the Division of Language and Communication Science at City, University of London. There are two million people in the UK that live with sight loss, with that number expected to double by 2050 (RNIB). Almost half of blind and partially sighted people feel ‘moderately’ or ‘completely’ cut off from people and things around them. Low vision aids can be crucial for improving the confidence and independence of blind and visually impaired people whose sight cannot be improved by lenses or medical interventions.
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Interpod Orthotics and Injury Management and Prevention Some professionals say orthoses are used to treat an overuse injury, but others maintain they are used to manage an unprepared tissue injury. The difference is subtle on paper but very different in reality. Training load errors For athletes and those involved in regular activity, orthoses are used to treat a training load error. For example, a longdistance runner may train consistently 100K a week without injury. So high loads or volumes of training is not necessarily always a problem i.e. doing a lot of activity. Injury tends to occur when there’s a sudden spike or rapid increase in activity that the athlete is simply not used to (unprepared). Weekend warriors Exercise makes tissues weaker - it’s the rest after exercise, the recovery period, during which they get stronger. Weekend warriors that train at low volumes on a regular basis are more likely to get injured when they decide to run a 20K race having only ever completed 10Ks. The sudden increase in training and the tissues can’t cope and injury occurs. Reducing the likelihood of injury Orthotics fit into an athletes’ training program because they’ve been shown to decrease the loads placed upon the working tissues. They can reduce the likelihood of injury caused by a spike in training by helping to decrease the loads on the tissues for the average athlete. They can also allow the more experienced athletes to train more, to increase their volume, without getting an injury. In an article from the Foot and Lower Extremity Biomechanics II, Dr Kevin Kirby wrote “Foot orthoses work by altering the magnitudes, plantar locations and temporal pattern of ground reaction force (GRF) acting on the plantar foot by causing an orthosis reaction force (ORF). The goals of foot orthotic therapy are: 1.
2. 3.
Reduce the pathological loading forces acting on and within the structural components of the foot and lower extremity that are the cause of injury. Optimise gait biomechanics. Prevent additional injuries from occurring”.
The use of orthotics fits into a treatment regime when, despite all other methods to allow the tissues to recover, symptoms
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persist. Often patients don’t want to change their training by decreasing activity, stretching or strengthening muscles. Despite wearing the best training footwear, they either do too much too soon or just too much. Using orthotics can decrease the strain and loads on the tissues to a level where the athlete can still train pain-free.
How to Prescribe an Orthotic An assessment needs to be made to ensure a prescribed orthotic meets the needs of the patient. Interpod, an established Australian manufacturer of off-the-shelf orthotics designed and developed by podiatrists, suggest the following 4 steps: Step 1. Determine how much orthotic support the patient needs: • Use the keystone device to measure supination resistance. • Design features - such as rearfoot wedging, arch height and orthotic stiffness can be pictured above: keystone device prescribed. Step 2. Check the windlass mechanism: • Do jack’s test and check 1st met and 1st ray motion. • Design features - such as lateral pads, plantar fascial groove, 1st cut away, or rearfoot wedging can be prescribed. Step 3. Lunge test: • Decreased dorsiflexion can push the orthotic into the arch causing discomfort. • If soft tissue work fails then heel lifts can be used to immediately increase dorsiflexion. Step 4. Fit to foot and shoe: • Check patient footwear. • Sometimes the patient must be advised to wear a more supportive shoe to accommodate the orthotic. If the patient is unwilling to compromise a slimmer orthotic may be needed.
What is the Interpod Orthotic Library? By using the 4 steps above, you can select from the Interpod Orthotic Library, which is a custom range of premade orthotics, the best solution for your patient. The advantages of using the Interpod Orthotic Library over other orthotic manufacturing methods such as plaster casting, CAD CAM or 3D printing include: • • • •
Immediate fit, observation and patient review. Known levels of support - arch height, rearfoot and midfoot control. Shoe fit and comfort are immediately determined. Elimination of lab errors.
Short and medium term use of orthotics Orthotics can be used effectively in the short term to treat injuries because alternative treatment options such as increasing the ability of the tissues to take the load, or to find other ways to reduce the load, take time. Other treatment methods such as mechanobiology techniques - like eccentric loading exercises or changing running form - also take time. Long term use of orthotics If a patient will not comply with exercises needed to help adapt the tissues to the demands placed upon them, or where the repetitive loads on the tissues are too high then the long-term use of orthotics maybe necessary. Excessive repetitive loads can also be due to an individual’s biomechanics where high joint moments are a result of the individuals joint axis position. Excessive body weight can also be a contributing factor. The Interpod Orthotic Library is only available to practitioners To view the Interpod Orthotic Library visit www.algeos.com or call 0151 448 1228 to request an Interpod brochure.
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ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
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Research to explore how AI and voice technologies can help people with disabilities live independently A GROUP of Loughborough University academics have been awarded funding to examine how AI-voicebased technologies, such as the Amazon Echo, help people with disabilities live independently and explore how they may shape the future of social care.
researchers, designers, and policy professionals to use Social Action research methods.” Other researchers that will work with Dr Albert on the project include Loughborough University’s Professor Elizabeth Stokoe, Professor Thorsten Gruber, Dr Crispin Coombs, and Professor Donald Hislop, of the University of Aberdeen and previously of Loughborough University.
Project lead Dr Saul Albert, of the School of Social Sciences and Humanities, aims to submit the research findings as evidence for the various House of Commons and Lords groups that have health, social care and technology in their remit in the hope it will lead to positive changes. There is a crisis in social care for disabled people and care providers are turning to AI for high-tech ‘solutions’ – with robot carer seals and the humanoid robot Pepper having made headlines in recent years. However, current research focuses predominantly on medical or custom technological interventions rather than on disabled people’s productive adaptations of mainstream consumer technology to enhance their independence. The Loughborough project will use a ‘Social Action’ research methodology to explore how people with disabilities are using technology to deal with access issues they face in their daily lives. Social Action research involves research ‘participants’ – in this case disabled people and carers – in codesigning and steering the project from the outset. They will act as co-investigators, having a say at every stage of the data-gathering, analysis and dissemination phases of the research project. As well as getting an idea of how
The research will also be conducted in collaboration with Mark Harrison, of SocialAction.info – a social enterprise that specialises in Social Action research methodology.
tech is currently being used, the project will explore the wider opportunities that AI presents for the future of social care, for example, more efficient services, but also the risks, such as enabling further cuts to health and social care budgets. Findings will be shared with disabled people’s organizations, key academic outlets, as well as parliamentary groups on AI, disability, and social care. It is hoped this project will impact on current debates around AI in social care by developing a group of skilled participant-researchers and ongoing follow-up projects in this increasingly important area of policy and practice. Dr Albert said: “Disabled people are very adept at adapting consumer devices to deal with access issues. In the next few years, the big tech companies will put voice technologies in every home, so we want to use this opportunity to make sure access needs are considered. “From the perspective of the disability movement and Social Action research, with which our project is aligned,
many of the wacky ideas about robot carers sensationalise tech ‘solutions’ and ignore the more fundamental obstacles that disabled people face in society. “Similarly, health and care services often focus on how technology will ‘fix’ individual people’s impairments, rather than looking for relatively cheap and straightforward systemic adaptations to the environment that could provide greater accessibility for everyone. “Furthermore, given the constraints of funding in health and social care, and from our previous research talking to disabled people in the different policy environments across England, Wales and Scotland, most anticipate that these technologies will be used to drive efficiency, to reduce provision of personal assistants, and to justify further cuts to social care budgets.” He continued: “This project aims to explore how disabled people adapt new technologies and work with care services to manage in their daily lives and I hope it will encourage more
Mark added: “The crisis in social care is one of the big political and social policy issues of our time. Unfortunately, the debate often focusses on cost rather than quality of life. “Our research approach puts disabled and older people at the heart of the enquiry process. Because it is rooted in the real lives of people who use care services, we are confident there will be positive outcomes for participants. “By co-producing the research with experts, one aim is to enable people to empower themselves through the process. Another key aspect will be peer-topeer learning, connecting people who can share experiences and creating a community of AI users.” The team have been awarded funding by the British Academy to run this pilot project for one year. The pilot findings will then be used to develop a four-year project that is hoped to run from 2020-2024. The research group are asking technology users with disabilities to get in touch if they would like to be involved in shaping the project. Email s.b.albert@lboro.ac.uk to express your interest.
Company named most innovative in London ANDIAMO has been crowned the most innovative company in London beating well known tech brands like Deliveroo, Zopa, Revolut, Babylon, Monzo, DueDil and GoCardless, London based Andiamo has developed a cloud-based platform that designs and delivers a 3D printed orthotic using the latest AI and 3D printing technologies. The award follows the appointment of Hugh Sheridan as Andiamo’s chief commercial officer. Hugh is the former CEO of Algeos, the global orthotics company which he shaped to be one the largest orthotic and podiatry materials suppliers in EMEA and Australia. Hugh has been appointed to lead the company’s sales, marketing and education efforts as it rolls out its 8
technology delivery platform globally. Andiamo’s platform allows an orthotist to upload a scan with a prescription for a 3D printed AFO to be delivered that offers a first-time fit rate of more than 90 per cent. The platform’s AI creates devices that are 60 per cent lighter than polypropylene and offers prescription opportunities that are not possible with standard Polypropylene. Hugh said: “The Andiamo team has quietly taken five years to build a platform that is able to deliver some of the highest quality orthotics I’ve ever seen. “However, the real opportunity for our industry are the benefits of the devices that the platform and manufacturing technology, can deliver.
ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
“That brings huge clinical and commercial benefits. “Orthotic providers want to deliver the best possible orthotics and understand the promise of 3D printing.
to printed paediatric AFOs but the product roadmap includes orthotics, seating and prosthetics. CEO Naveed Parvez added: “We’re very proud to be named top tech company in London.
“The large investments in 3D printing infrastructure, the new material and engineering challenges to ensure these devices are safe, and upcoming regulatory changes mean that going alone can be high risk.
“Especially as London is becoming Europe’s tech hub. Orthotics and prosthetics is always viewed as medicine’s poor relation so it’s great that we have an orthotics company being recognised in this way.”
“Andiamo’s technology and knowhow removes these unknowns.”
“Bringing Hugh in as our CCO at this point is perfect timing as we start to deliver high quality, safe, low cost 3D printed orthotics to the industry.
Currently Andiamo has customers in UK and Scandinavia, but are establishing delivery points in Saudi Arabia, USA and across Europe over the next 12 months. The current product range is limited
“I’m very excited at how we can educate the benefits of Andiamo devices so all orthotists can benefit from happier patients and happier payers.”
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Allard UK Gait Symposium Introduction:
A consultant’s viewpoint:
angle were fundamental to this discussion.
In February of this year, Allard UK hosted a symposium, focused on the management of gait, using carbon fibre AFO’s for adult and paediatric pathologies.
The perspective of an orthopaedic surgeon relative to the challenges of surgery and the use of complimentary orthoses was of interest.
The mathematical calculations behind this determination were explained. Finally, the design of the wedge, in terms of its parameters was explained.
Allard have long felt the need for such an event to open debate for the benefit of patients and to educate healthcare professionals in the area of gait analysis and the treatment of drop foot. A number of experienced orthotic professionals with diverse interests were invited to share their particular insights and experiences. Various perspectives, treatment approaches and case studies were presented, culminating in an open forum discussion. This enabled current practice and methodology to be examined and provide a form of verbal consensus in the closing session.
Patient expectations and compliance through footwear design parameters and style were driving clinical goals. Measurement of outcomes in patients with childhood neuro muscular disorders, such as walking speed and the ability to achieve lifestyle goals were a major factor in enhancing life quality Patient assessment protocols: A detailed description of one particular patient assessment protocol was provided. This would subsequently drive the goals for physiotherapy, orthotic and orthopaedic interventions. The main determinants of integrated treatment were to optimise energy consumption, reduce pain, avoid overstretching and limit deformity. Perceptions of patient and parent expectations were also most important and the treatment regime should seek to minimise cost to the families. Self-image and compliance were also seen as drivers for the use of less visually obvious designs of orthosis. Several case studies were presented to illustrate the team’s rationale and support the theories discussed.
Design evolution and considerations:
A perspective on the use of Allard carbon fibre was outlined and the influence of Dr Stig Wilner and Karl Engdal, resulting in the awarding of a patent for the Toe Off in 1997.
Orthosis versus prothesis? The final presentation described the impact of orthotic prescription in paediatric partial foot amputation utilising carbon fibre ankle foot orthosis. This case study concluded that improvements in walking speed, community activity levels and physical function are achievable in changing children with bilateral forefoot amputations to orthosis. Summary: Following the presentations and taking into account some of the questions and observations made by the delegates a series of short questions were tendered by the chair to try to encapsulate the feeling of the meeting and therefore create simple verbal consensus.
Inter disciplinary understanding and communication was felt to be vitally important and was perceived as where some systems break down.
Design considerations for a dynamic, lightweight and footwear compatible device were discussed.
Delamination testing to establish the efficiency of designs, the importance of void testing, geometrical shaping and whether 3D printing will have a place in manufacture in the future were also topics that were raised during this session.
The next section encompassed several case presentations using Allard carbon AFOs in the treatment of paediatric cases, highlighting the change in gait parameters and the need for review at regular intervals and the collection of outcomes in driving change in philosophy of prescription criteria. The findings were broadly similar to those in a previous presentation.
Dependant on the needs of the pathologies presented, it was generally felt that the mobility of foot/ ankle joints should be maintained and the use of orthoses with a variety of ankle joint mechanisms or free foot control, such as the Toe Off range should be considered before fixing anatomical joints that would otherwise function normally.
In order to provide a context for the meeting, a historical perspective of innovation timelines relating to the advancement of material technologies, biomechanical understanding and where current best practice sits, was examined.
The main issues for success, and conversely, material failure of components including fatigue and cyclic load were also highlighted.
Paediatric experience:
What about shank angle? Another presentation was focused specifically on the challenge of understanding the engineering behind the determination of shank angle and the optimal use of wedging . Angular velocity, load management and reflecting on the significance of shank angle and the definition of a practical method of managing shank
It was expressed that orthotists should try to keep prescriptions simple and not overcomplicated and that the need to feel they have an intervention solution was not always the case, advice could be as valuable as a device. Did the delegates feel that cost could be a barrier to prescription, and therefore promoting dispensing rather than problem solving? On the whole the feeling was cost was not a constraint. Universities have a role in organising good practical research, and ethics and time for this to be granted often resulted in literature studies being conducted over hard practical evidence. Integrated pathways led by consensus leading to multicentre studies would also be useful in producing evidence. Data collection on outcome measures and the use of new technology such as 3D printing and production of customised laminates in conjunction with prosthetic technology were also seen as issues to be addressed. Conclusion: Communication and understanding of multidisciplinary roles was paramount in delivering quality of service, and therefor quality of life experience to the patients. Published evidence as well as clinical experiences such as this Allard symposium, demonstrated added value to Multidisciplinary working. The full Symposium summary document can be viewed at www.allarduk.co.uk
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Advertiser’s announcement
Chris and Denise Arthey have been able to continue their love of DIY and gardening after being fitted with the Blatchford Orion3 prosthetic limb.
Blatchford Orion3 – making mobility possible BLATCHFORD is a multi-award winning manufacturer of some of the world’s most advanced prosthetic technology, bespoke seating solutions and orthotic devices. It combines clinical expertise and pioneering innovation to redefine mobility. Their evidence based approach and commitment to continuously challenge possibilities, ensures their mobility solutions prioritise the wellbeing and longterm health of our users. The human leg performs an incredible number of complex functions that many people take for granted in their daily lives. Things like changing walking speed, avoiding a fall after tripping, walking down stairs, navigating slopes, coping with different surfaces or even just standing still. All of these movements rely on the knee and its adjacent muscles’ ability to adjust rapidly their resistance to the shifting weight of the body to maintain perfect balance. Blatchford has almost 130 years of innovation and expertise in lower limb prosthetic technology and its microprocessor-controlled knee (MPK) Orion3, comes closer to replicating nature than ever before. One couple whose lives have vastly changed since using Orion3 is Chris and Denise Arthey. In 2008, while touring South Texas on a motorcycle holiday, a drunk driver, who veered into their lane, hit Chris and Denise at 80mph.
However, after switching prosthetists, Chris and Denise were able to try Orion3 and immediately noticed a difference. Orion3 provides a range of features, including hydraulic resistance that constantly adapts, providing the wearer with intelligent support when moving in a variety of environments or when standing still.
Both suffered multiple and severe injuries, resulting in each of them losing their left legs above the knee, and leaving Chris in a coma for many days.
This meant Chris was able to work on their 100-year-old cottage capably and confidently, with Orion3 allowing him to climb ladders and get to hard-to-reach places.
Following the accident, Chris and Denise were originally fitted with older prosthetic knee technology.
Orion3 also has stumble recovery technology, ensuring that the knee remains stable should the user falter on uneven surfaces or slopes.
Both are very active, with Chris enjoying DIY and Denise an avid gardener.
Chris and Denise’s driveway has a gravel surface and gentle slope.
These tasks became more difficult due to the limitations of their prosthetics, taking more effort and affecting their confidence.
Thanks to the capabilities of Orion3 they can tackle this without hesitation, as the knee will always adapt to the terrain and ensure they are able to
walk seamlessly. Denise is able to volunteer in a school, navigating crowded classrooms, while also standing and singing in a choir without having her prosthetic limb limit her. She continues to take on the garden, confidently moving across varying terrain without the fear of falling over, kneeling to weed, with her knee helping to make tending the plants manageable again. Since Chris and Denise have had their Orion3 fitted, both say that they are able to live full and active lives and feel less like amputees in the process. Chris said: “We couldn’t recommend it highly enough to above the knee amputees keen to stay active.” To find out more about Blatchford’s range of MPK Packages contact your local Blatchford Training & Education Specialist: Northern England & Scotland Alastair Ward – 07736 890151 Midlands Kate Pearce – 07801 217219 Southern England & Wales Laura Ritchie – 07770 843282
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NEWS
Rehabilitation programme named in NHS Long Term Plan after saving £22million AN award-winning programme created by a Kingston University and St George’s, University of London professor to help people with chronic hip and knee pain has received national recognition – after cutting NHS waiting times and saving the service millions of pounds. The ESCAPE-pain rehabilitation programme – which is delivered in some 220 sites across the United Kingdom including community centres, leisure centres and schools – has treated more than 13,000 people to date, saving the NHS an estimated £22million by reducing the amount of healthcare needed by patients. The six-week scheme was designed for people with osteoarthritis – the most common form of arthritis – and aims to help them to understand their condition better, realise that exercise is a safe and effective selfmanagement strategy to reduce hip and knee pain and recognise the physical and psychosocial effects of joint pain. ESCAPE-pain, first piloted in centres across South London and North Kent, was launched by Mike Hurley, professor of rehabilitation sciences at Kingston University and St George’s,
University of London, to address the care of more than 8.5 million patients who suffer from chronic joint pain across the United Kingdom.
after the six weeks have ended.” Professor Hurley said participants have told him that, as a result of the programme, they have been able to get up and down stairs more easily, sleep better, do their own shopping, make new friends and play with their children and grandchildren.
Its success has seen it heralded in the 10-year long term plan by the NHS as a solution to cut waiting times in hospitals and GP surgeries and reduce waiting lists.
“A lot of these activities come naturally to most people, but it’s proof ESCAPE-pain is allowing participants to live normal lives again while also helping break down social isolation for those with osteoarthritis,” he concluded.
Professor Hurley said the ESCAPE programme helps participants overcome social anxiety and isolation – a symptom often suffered by patients. “The most important thing at the start of the process is to help people to understand their problem – then they are more likely to take your advice about doing physical activity and exercise, which is safe and beneficial despite being uncomfortable in the early stages of recovery,” he added. “We want to reduce people’s pain and the impact it has on their quality of life.” The programme, which has been endorsed by organisations including NHS England, Public Health England, and the charity Verus Arthritis, is taught in groups of 10 to 12 people
Mike Hurley, professor of rehabilitation sciences at Kingston University and St George’s, University of London.
and is also available online and through a smartphone app. “We wanted to make the scheme as easily accessible as possible, but the face-to-face classes are so effective because the groups start and finish the course together, learn from and develop each other and can spur their peers on,” he added. “I’ve seen first-hand the cohesive bond several groups have built while on the programme and some of them have actually gone on to maintain it
The ESCAPE-pain has collected several accolades including, the Royal Society of Public Health’s Health and Wellbeing Award and UK Active’s Specialist Training Programme of the Year Award. The next step is to get the scheme to hard-to-reach groups to ease the burden on the health and social care system. “We really want this programme to go to all parts of the UK so we can help our amazing National Health Service deal with the increasing population and the severe strain it is currently being put under.”
App set to make streets safer for the disabled, the elderly, and parents of young children A NEW app is tapping into the “gig economy” to empower members of the public to report parking infringements to their local councils, helping to ease traffic flow and prevent the blocking of pavements. The eFine app was developed by brother and sister Alex Mühlhölzl (COO) and Lisa Mühlhölzl (CEO) following Lisa’s experiences travelling to and from work in London. “I regularly got caught in a bus while traffic went from two way to one way due to an inconsiderately parked car on the narrow street,” she said. “When we first floated the idea to friends and coders looking to put a demo together, we got told stories of their friends in wheelchairs or pushing buggies and the impact cars on footpaths had on them, their safety and general accessibility and mobility. This is basically an app to let local residents take back their streets.” The eFine app uses proprietary code and patent pending technology to effectively turn a mobile phone into a CCTV camera, forming part of a distributed CCTV network. When you spot a parking infringement, you start the app, video it, and eFine takes care of the rest. 14
“The app lets a user know if they are in a partner council area before they record the infringement,” said Alex. “The data is not accessible by the user and is not stored on the user’s phone, it is sent to us and stored on an Azure system, meaning only the council associated with the infringement notice can see the video and decide if a fine should be issued. We can’t even see it.” The app users receive 25 per cent of the infringement notice when it is paid to the council – meaning that as well as helping keep traffic flowing and the roads safe, they get rewarded for their efforts. “The system offers councils the ability to take advantage of an emerging ‘gig economy’ and empowers local residents who often feel powerless when they have to deal with cars illegally parked on the curb or double yellow lines,” added Alex. “We do not deal with anything related to parking meters or timed parking areas.” “The council only pays on the infringement notices when they are paid, and they keep 50 per cent of the fine, which is significantly more than the majority of council’s
ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
earn from a fine after costs. We were amazed to find that a number of councils run this part of their operations at a loss.” While the app is aimed at anyone who spots parking infringements, Alex and Lisa anticipate that it will be especially appealing to the elderly, and people who are disabled and/or have young children. “Those that have a disability get impacted by people parking on the footpath, as do those pushing buggies or elderly on scooters who have to go into traffic to get around the illegally parked vehicle,” said Alex. “There is also the issue that some electric vehicles cannot charge because a combustion vehicle has parked in the charge point parking space.” The expectation is that the app will contribute much needed revenue for local councils, which can be put back into improvements to local roads and pathways – many of which have suffered from neglect due to reductions in allocated funding. “It addresses the need for better management of traffic flow, vehicle and pedestrian, without the huge costs that are incurred by councils
having to hire enforcement staff or outsourcing the service.” Alex and Lisa will also introduce other capabilities, so that members of the public can also use it to report other issues such as potholes. “We have a focus on traffic flow management, cars and pedestrians, and also pedestrian safety, and as such we are looking to prepare a template for councils that are looking to introduce pedestrian zones around schools without the financial burden of installing CCTV networks at the school,” concluded Alex. “We are also looking to support councils who are looking at the initiative of fining households for leaving rubbish or bins out for days or weeks. This rubbish is often scavenged by animals and creates an environmental problem and bins on the footpaths create pedestrian traffic issues for the disabled and those pushing buggies or trolleys and those on scooters.” The app is compatible with smart phones and tablets with internet access. Alex and Lisa expect it to transform enforcement infrastructure in the UK, making people less likely to park in ways that are anti-social and potentially dangerous.
Advertiser’s announcement
Toe Tec socks – German engineering for people with diabetes and problem feet completes the whole experience!” She said: “I started wearing them because foot care is a huge issue in Diabetes and it’s massively important to prevent damage that leads to so many amputations.
But the right pair of socks can provide untold virtues. Uncomfortable feet are distracting whether you’re sitting at a computer carrying out the daily grind, dragging the kids around the supermarket or trudging through the pain barrier on that particularly challenging hill halfway round your regular training run. As runners, the humble sock is something we don’t tend to devote much thought to. Far too many of us will grab at a cheap pair of ‘sport socks’ on the way home from a shopping trip to invest in those technically supreme shoes perfectly suited to our running style; that breathable training top or those temperature-controlled running tights. But the sexy garments that give you that professional touch, the ones that call out to you with their “buy-me-and-I’ll-change-your-life” fluorescent flashes won’t help you if your toes are swimming in sweat, your soles are chafing against an increasingly irritating material, and your mind is turning to that developing blister on your Achilles. Originally developed for the medical market, the Toe Tec sock was designed to help people with Diabetes to prevent complications in their soreprone feet. But top athletes are now enjoying their unique
MEDIUM RISK
“But they’re now the socks I wear for all my training,” she continued.
NEWS
SOCKS are so often given a raw deal… the butt of so many jokes about fashion faux pas and bad Christmas presents, the garment is the forgotten gem of the sporting world.
“They’re so smooth and comfortable and you don’t get that abrasion where you’re putting pressure on the same areas over and over again. My feet now feel as fresh at the end of a long session as they do at the start.” qualities that provide great benefit to runners. The revolutionary socks use a wrinkle free fabric that wicks moisture away from the skin keeping your foot at the optimum temperature. They provide extra protection for the heel and achilles to prevent chafing and eliminate friction in the toe area. Some of the styles even provide antibacterial qualities due to the fibres used in their manufacture. Welsh International athlete Mel Stephenson first came across the socks in her role as an ambassador for Diabetes UK. “It’s vitally important to wear the right socks,” she said. “These are like slippers, there’s no irritating seams that can really ruin a run… and if you put on a fresh pair when you finish to recover, it just
Melanie emphasis that when you’re diagnosed with diabetes, you could be forgiven for worrying solely about needles and focus solely on the constant issue of controlling your sugar level. But what about the lurking danger, one that must be monitored just as closely, the risk to your feet? The reduced sensation you experience when you have diabetes is particularly problematic on the feet, and it’s very easy to develop serious skin conditions such as ulcers and gangrene – conditions that lead to needless amputations. Reed Medical want to stop you being part of those statistics. Protecting your feet starts with your socks, and Reed Medical are providing that vital weapon. www.reedmedical.co.uk admin@reedmedical.co.uk
VERY HIGH RISK
HIGH RISK
Giotto
XDiab 14
Active 1 Ladies
Bottero 11
Deambulo X
Loss of protective sensation
• Therapeutic (*) perfect fitting shoes, without undue stress from upper.
reed medical
Giotto GV
Peripheral arterial disease or loss of protective sensation. Foot deformities but without history of foot ulceration and/or amputation. • Accommodate deformities and re-equilibriate the pressure peaks.
Peripheral arterial disease and/or loss of protective sensation. Foot deformities and history of foot ulceration or amputation. • Avoid ulceration. Accommodate deformities and equilibriate the pressure peaks.
To request a copy of the latest PODartis catalogue, please call 01254 503333 or email info@reedmedical.co.uk ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
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NEWS
Prosthetic tech startup gears up for launch BIOMEDICAL startup Adapttech has appointed Stuart Mead as chairman ahead of the company’s launch in the United States later this year. Adapttech’s unique technology for improving the fitting of lower limb prostheses has also been granted a decision as a Class I medical device by the United States Food and Drug Administration. The company’s INSIGHT system, which has already undergone successful user testing in Europe, is now being used in an outcome study at two prosthetic clinics in the United States ahead of its commercial launch later this year. Stuart is the former CEO of Touch Bionics, the company that created the world’s first bionic hand, and has been appointed for his insight and leadership in the prosthetics sector. Touch Bionics was acquired by prosthetics giant Össur in 2016. “Securing the FDA’s decision on INSIGHT is a key business milestone for Adapttech and we are now fully focused on launching in the US market this year,” he said. “Our technology is proven, we have the team in place to support it, and we are ready to transform the way
that prostheses are fitted.” “We are delighted to welcome Stuart to the Adapttech team,” added Peter Dines, COO and head of life sciences and biosciences at Adapttech’s lead investor, Mercia Asset Management. “As the company moves into its commercialisation phase, we wanted to find a business leader with specific expertise in the prosthetics sector, and there are very few people in the world who are as well-qualified as Stuart for this role.” INSIGHT combines laser scanning, wearable technology and a mobile app to make it faster and easier to correctly fit lower-limb prosthesis and monitor a patient’s entire rehabilitation process. n The laser scanner creates a 3D model of the socket in less than 90 seconds;
“When fitting a lower limb prosthesis, it can take weeks to achieve a final, properly-fit solution, with several appointments often required, which is inconvenient for the patient and clinician alike,” said Frederico Carpinteiro, founder, Adapttech. “Using INSIGHT, clinicians spend less time attending to patients with limb-socket problems; technicians spend less time fitting, assessing and refitting sockets; and patients spend less time visiting and re-visiting the clinic. “INSIGHT has the potential to help prosthetic facilities improve their patients’ lower limb functional mobility scores, which can help them access better prostheses from their healthcare provider.”
Torre Orthotics and Prosthetics in Pittsburgh, PA, and Prosthetics and Orthotic Associates in Middletown, NY. “We’re excited to be one of the first clinics in the United States to access this technology,” said Edward De La Torre, president, De La Torre Orthotics and Prosthetics. “By using INSIGHT in our fitting and evaluation process, we expect to see improved patient health, reduced pain levels, and increased patient activity by greatly improving the initial patient/prosthetist experience. “INSIGHT allows our prosthetists to more accurately fit the socket to the patient sooner, and who doesn’t appreciate that?”
n The wearable device uses sensors to gather real-time data between the residual limb and the socket to pinpoint exactly where issues are occurring;
The completed European study, conducted at the Centro de Medicina de Reabilitação de Alcoitão in Portugal, demonstrated that INSIGHT reduced the time taken for fitting and patient evaluation when fitting residual limb sockets.
“By integrating INSIGHT into our patient management system, we aim to reduce the amount of time prosthesis fitting and evaluation takes for the benefit of both our patients and medical operators,” added Thomas Passero, founder, Prosthetic and Orthotic Associates.
n The mobile app shows the clinician where issues are occurring in the 3D model, and also allows results to be registered and assessed at any time and in any place.
The US study is using clinically recognized tests and validated scales for health, function, satisfaction and pain level, and is running at two independent clinics: De La
“We hope that INSIGHT will help us improve patients’ AMPPRO K-level scores, opening up a new world of opportunity for access to more advanced prostheses.”
Games can be used to detect signs of cognitive decline NEW research led by the University of Kent shows that popular mobile phone games could provide a new tool to help doctors spot early signs of cognitive decline, some of which may indicate the onset of serious conditions like dementia.
individuals’ overall brain health.
Investigating the link between patterns of tap, swipe and rotational gestures during mobile game play and the users’ cognitive performance, the research shows that the speed, length and intensity of these motions correlates with brain function.
“This additional analysis reinforced the conclusions of our original research.
In particular, the performance of these gestures reveals key information about players’ visual search abilities, mental flexibility and inhibition of their responses. They all offer clues about the 16
Dr Ang, who is a senior lecturer in multimedia/digital systems, said: ‘We are very encouraged by the results of our study and have since collected data from patients who showed signs of brain damage.
Fruit Ninja over two separate periods, a fortnight apart. The three games selected were chosen because they are easy to learn, engaging for most players and involve intensive interactions using multiple gestures.
“We’re now working to design an algorithm which can carry out automatic monitoring of individuals’ cognitive performance while playing these games.’
Using the sensors built into the mobile phones to collect data, the team showed how users interacted with the games and illustrated a clear link between the subjects’ touch gestures, or taps and swipes, their rotational gestures and their levels of cognitive performance.
The research put 21 healthy participants through standard paperbased cognitive assessment tests, followed by 10-minute sessions of playing Tetris, Candy Crush Saga and
The study revealed the participants’ ability to perform visuo-spatial and visual search tasks, as well as testing their memory, mental flexibility and attention span.
ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
The research team concluded that off-the-shelf, popular mobile games can provide an effective measure of brain function to spot changes in motor abilities which are commonly seen in patients with Alzheimer’s Disease, stroke, traumatic brain injury, schizophrenia and obsessivecompulsive-disorder. Early detection of the signs of cognitive decline is crucial to effective treatment and prevention, as well as identification of individuals at risk of brain disease. Furthermore, the study provides evidence of the potential to use mobile gameplay to detect changes in cognitive performance among athletes who are exposed to traumatic brain injuries, such as boxers, rugby players and footballers.