INNOVATION FOR INDEPENDENCE
ISSUE 130 DECEMBER/JANUARY 2019/20 £6.95
Insole helps reduce diabetic-related foot ulcers re-emerging AN early warning system powered by a smart shoe insole can help prevent the reemergence of diabetes-related 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 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 study involved 90 diabetic patients with diabetic neuropathy in the UK and was funded by Diabetes UK and Orpyx Medical Technologies.
A Welsh company that designs and manufactures prosthetic leg covers is expanding rapidly. LIMB-art, which was established by former Paralympian Mark Williams, has just become an accredited supplier to the NHS. It is the first time that prosthetic leg covers have been available to people on the NHS. Full story on page 2.
NEWS
CONFERENCE
DO YOU, OR SOMEONE YOU KNOW, WEAR OR WORK WITH:
Prostheses- artificial limbs and/or Orthoses- devices which support, protect or
improve function, such as footwear, insoles, braces and supports?
The British Association of Prosthetists and Orthotists (BAPO) is excited to invite you to our Annual Conference. Developers and suppliers of P&O devices will be present, giving you a unique opportunity to ask questions and meet charities involved in the field. You’ll also have full access to our clinical programme. Already announced in our orthotic programme, we have Angus Harper sharing his experience with Guillian Barre Syndrome. Talks focusing on improving clinical skills include Emily Greenan and James McVicar discussing how to adapt clinical testing for patients with autism, Monica Smith demonstrating how to perform a fast and simple APBI assessment, and Katie Kinch and Laura Wiggins presenting on CPIPs. We also have Adam Horrocks highlighting the importance of material choices, and Katie Prosser who will discuss job satisfaction. As for our prosthetic programme, we have Professor Gary Berke joining us from America to talk about contact detection in myoelectric prostheses. Looking at revolutionising the industry, we have Prosfit joining us to talk about the future of prosthetic provision. Jessica Herrick will be presenting the Hero Arm, with Ivan Phelan illustrating the benefits of using Virtual Reality in myoelectric training. We also have Dr Mike Dillon describing the use of shared decision making in dysvascular patients. We are also pleased to have a range of individuals helping us to improve the quality of our patient interaction. Professor Pamela Gallagher will present her research into managing expectations of assistive technology. Mitchell Graham will be presenting on how to improve communication using BSL, with Susie Fraser focusing on Dementia. We are also very pleased to have partnered up with LimbPower who will be hosting a family sports event on Saturday; an excellent opportunity for those who want to get involved with sports rehabilitation, and a Diabetic Foot Conference, which will run alongside our own over the weekend, focussing on the multi-disciplinary approach to management of the diabetic foot and renowned Podiatric Surgeon, Dr David Armstrong is attending as a keynote speaker. We hope to see you there!
RICOH Arena, Coventry, Fri 24th & Sat 25th April 2020 Contact conference@bapo.com for further details 2
ASSISTIVE TECHNOLOGIES I DECEMBER/JANUARY 2019/20
Mark Williams receives his Wales StartUp Award.
Firm expands rapidly after becoming NHS accredited supplier A WELSH company that designs and manufactures prosthetic leg covers is expanding rapidly. LIMB-art, which was established by former Paralympian Mark Williams, has just become an accredited supplier to the NHS. It is the first time that prosthetic leg covers have been available to people on the NHS. Lancashire Teaching Hospitals NHS Foundation Trust in Preston and Kent and Medway NHS and Social Care Partnership Trust are the first two Trusts to prescribe the innovative covers. To keep pace with the rapid growth of the company, Mark is opening new offices and a distribution facility. He is also looking to start selling his products overseas and break in to America in 2020.
confidence and allow them to show their personality because the brand offer a whole range of colours and designs. One of its ambassadors is Darren Greenfield, currently the World’s Strongest Disabled Man and a LIMBart fan. Mark, who has received support from Business Wales’ Accelerated Growth Programme, added: “This is an incredibly exciting time for the business. Becoming an accredited supplier to the NHS is hugely important and we’re delighted that we’ve already supplied a dozen people with our leg covers in the past few weeks. “Although prostheses have come on in leaps and bounds functionally, until now how they look has generally been overlooked.
The Denbighshire company is also working on a number of new limb cover designs including one made with electronic paint which lights up because, as Mark says, “We don’t our customers to blend in!”
“We don’t want prosthetic wearers to hide away or be self-conscious. We want to be known worldwide for making the coolest prosthetic leg covers so people who wear them feel they can stand out and stand proud.
LIMB-art recently won Manufacturing Start-Up of the Year in Wales StartUp Awards, which celebrates the best new businesses in Wales.
“When you wear a cool looking cover, it breaks down barriers and cuts out awkward stares. I’ve lost count of the number of times I’ve been stopped in the street and been told my leg looks amazing.”
The company is on a mission to give prosthetic legs a better shape – traditionally offered on the NHS and which resemble ‘poles’ – as well as allowing the wearer to express their personality. LIMB-art’s covers are a completely customisable accessory, lightweight and easy to fit and they are suitable for all users of above and below knee prostheses. The covers not only give the wearer a full leg shape and restore balance to their silhouette, they also boost their
Mark, 47, was 10 when he was cycling home from school and was involved in a road traffic accident in Pen y Maes, Rhyl, North Wales. He lost his leg as a result of the accident. The accident transformed him from a shy boy, who couldn’t swim, into a super-confident athlete winning medals in the pool. This included competing and winning medals at The Paralympics and World Championship in swimming.
A BIONIC hand can be made to measure in 10 hours and can grip using a moveable thumb.
Designers and engineers from WMG, University of Warwick and UK industry, have been able to entirely 3D print the device with embedded electrical circuitry to seamlessly connect sensors and actuators. The IMPACT project, led by Iterate Design and Innovation Ltd, in collaboration with WMG, University of Warwick, C Enterprise (UK) Ltd and Printed Electronics Ltd, was made possible thanks to a grant of nearly £900,000 from Innovate UK, with the aim of developing a 3D printing technology with the ability to print plastic products with integrated electrical circuitry, a capability which they have demonstrated in a bionic hand. The IMPACT hand has taken inspiration from a similar developed by Ambionic’s Ben Ryan, whose son had his forearm amputated after birth, and who decided to make him a new one.
The IMPACT team has taken this design further by embedding the electrical circuitry linking the motion controlling muscle sensors with the motors and battery into the structure of the bionic hand, thus providing a durable and aesthetic solution.
Printed Electronics Ltd developed the technology for printing the electrical circuitry within the 3D Printing process and C Enterprise (UK) Ltd developed the multi-axis, multimaterial 3D printer that enables the hand to be realised in 3D.
Engineers at WMG, University of Warwick have tested the durability of the printed electrical circuitry to understand how well they will endure the bending and flexing that they might experience in use.
Dr Greg Gibbons from WMG University of Warwick said: “WMG is delighted to be a partner in the IMPACT project, helping to deliver this innovative and revolutionary technology, which is undoubtedly helping put UK PLC at the forefront of 3D printing research and development globally.”
They also developed a website so people can interact with the manufacturers to order a 3D printed hand, allowing them to insert the measurements of their arm, and select what colour they want their hand to be, providing them with a tailored and personalised product. 10 hours later the hand will be printed with the sensors inbuilt ready for use. Within the project, Iterate Design and Innovation Ltd developed the design of the hand, including the integration of the electrical circuitry and sensors.
Gethin Roberts, project lead and MD of Iterate Design + Innovation, added: “The project has resulted in the creation of an exciting new technology that has the ability to print electro-mechanical parts and assemblies, which weren’t previously possible. Through laying down conductive ink tracks within polymer structures means that parts produced are fully functional straight off the machine bed; offering huge productivity benefits.”
At Script Media, we try to get things right but occasionally, we make mistakes. If you have a complaint about a story featured in our magazine or on our website, please, in the first instance, contact us by email: dm@scriptmedia.co.uk We abide by the Editors’ Code of Practice as demanded by the Independent Press Standards Organisation. For details on the code and what to do should you be unsatisfied with the way we handle your complaint, please visit www.ipso.co.uk
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NEWS
Hand with moveable thumb can be made in 10 hours
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NEWS
Advertiser’s announcement
Let go and fly… AS an avid runner for years, Cheryl Hile and her husband have loved to travel the world and run marathons. But in October 2006, she was diagnosed with Multiple Sclerosis (MS) and everything changed. The symptoms, including debilitating fatigue, muscle spasticity, neuropathic pain, and specifically foot drop, quickly halted her ability to run. “I had not been able to run for almost a year due to drop foot that began six months after my diagnosis,” Cheryl said. “During a race, I started tripping and falling, and finished the run with bloody knees. Soon after, I learned
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the falling was due to foot drop.” Despite the advice of Cheryl’s neurologist to “lower her expectations,” she was determined to run again. For more than 10 years, Cheryl has worn an AFO, which has helped her complete many marathons. However, she still struggled with most of the brace options on the market. In 2018, Cheryl decided it was time to move on and try a new AFO model with different composite materials. She met the Thuasne team and they worked together on a custom AFO designed for her needs.
ASSISTIVE TECHNOLOGIES I DECEMBER/JANUARY 2019/20
Ultimately, that brace inspired the SpryStep® Flex. The carbon fibre materials are lighter and more flexible and decrease the amount of discomfort Cheryl feels while running long distances. Despite having a disease that stops people from moving, Cheryl continues to charge forward. In 2017 she set a record of becoming the first person with MS to run seven marathons on seven continents in 12 months. In October, 2018 Cheryl reached her second goal; to gather the biggest group of people with MS to participate in the Detroit Marathon!
Cheryl has a mission to reach people with MS and encourage them to either start an exercise program or keep pushing forward with their current sport. Cheryl Hile is an inspiration to us all and a wonderful reminder of how our Thuasne products help improve lives! Cheryl often tells herself to trust the AFO while running, to let go and fly… Watch Cheryl by searching “Cheryl Hile SpryStep” on YouTube To book a demonstration of SpryStep call 01295 257422 or email orders@thuasne.co.uk www.thuasne.co.uk
NEWS
Wheelchair users scale mountain on student-designed handcycle A UNIQUE handcycle designed and built by graduates of the University of Southampton has reached the summit of Ethiopia’s tallest mountain. The Wild Wheelchairs Project expedition endured an epic journey over rough terrain and through torrential rain with quadruple amputee Alex Lewis and Ethiopian wheelchair user, Emebet Allie Deress, successfully scaling the 4,550 metres of Ras Dashen in the northern Armara region of the country. Amongst those from the University supporting the expedition were Dr David Marshall, aerospace engineering graduate and manager of the University’s wind tunnels, and Tom Parker, mechanical engineering graduate and a member of the original design team from Southampton. Both travelled to Ethiopia for the entire journey, making adaptions en route to improve the performance of the handcycles as they made their ascent. Southampton’s Dr Clint Styles and a number of the School of Engineering technical support staff helped to test the cycle with Alex in the UK before the expedition set off for Ethiopia. The Wild Wheelchairs Project hopes to raise money to finance the construction of wheelchair manufacturing facilities in Ethiopia,
which will transform the lives of hundreds of disabled people living in the eastern African nation. During an arduous journey over several days, Alex and Emebet successfully powered their way through driving rain and mud over roads that were, at times, severely eroded. This was a particular challenge for the pair. Alex had both of his arms and both of his legs amputated, as well as undergoing extensive skin grafts and facial reconstruction, after contracting strep A toxic shock syndrome, septicaemia and necrotising fasciitis in 2013. Emebet, now 19, was hit by a car at the age of three and lost both her legs from the knee down. She now plays wheelchair basketball, races tricycles and is also keen to take on the challenge. At one stage, the pair managed to drive their handcycles past a bus stuck in the mud. A few days later, the support team had to carry the handcycles across a river ford in kneehigh water. The team’s Land Rover also had to intervene as the handcycles encountered steep gradients, towing it up and over hills at times, including the pass at Bwahit Peak, at an elevation of 4,200m.
The expedition has also featured many poignant moments. On market day in the village of Cheru Leba, the team attracted a great deal of attention with Alex shaking many people’s hands and on the way out of town before being met by a local man using a wheelchair who came out into the street. During a later visit to a small settlement that had sprung up by a road construction camp, scores of children followed the expedition for several kilometres as it set off along the eastern side of a widening gorge. The designers of the handcycle – Christopher Charalambous, Gayan Kahatota Lyanage, Guillaume Henry, Junaid Mahomed, Jin The and Tom Parker - embarked on the challenging task for their fourth year Group Design Project, the culmination of their Mechanical Engineering (MEng) studies at the University of Southampton. The group advanced the project with supervisors Professor Andrew Cruden and Dr Lindsay-Marie Armstrong. The project was honoured in the Engineering Impact Awards’ Student Design Showcase at the National Instruments Week 2019 conference in Austin, Texas. Their original design was unveiled during the University’s annual Design Show in June 2018 with extensive
testing continuing over subsequent months. Christopher Charambolous secured a summer internship in 2018 to continue working on the project once the original University assignment was concluded. “Alex’s team told us about the difficult conditions in Ethiopia, it’s a very mountainous area and the roads are bad,” said Christopher prior to the recent expedition. “We are using solar power to help him tackle the climb and all the materials have to be light yet robust enough to cope with the terrain. “Safety is all-important too. Alex has to clip himself into the handcycle to make sure he’s safe while he’s using it and that was a difficult mechanism to design and test.” “Limited mobility is something that affects millions of people globally,” he concluded. “To be able to work with individuals who want to make a positive difference through emerging technologies, in this case a seriously cool hand cycle, is a privilege as it has an end-user in mind. “Through briefing, design, testing and the subsequent attempt to cycle up Ras Dashen we will be able to highlight the University but also show that anything is possible when you put a collective of enthusiastic minds to it.”
The app that is improving therapy for stroke survivors
A MOBILE phone app is improving care for stroke survivors and helping health staff make evidence-based decisions ‘on-the-go’ to speed up recovery – according to new research from the University of East Anglia.
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Health Sciences worked with the community neuro-rehabilitation team at Cambridgeshire and Peterborough NHS Foundation Trust to test the app.
The ViaTherapy phone app is designed to help health staff find the best treatment options for people to regain arm function when recovering from a stroke.
Results from the project show that ViaTherapy could enhance and improve therapy services for stroke survivors, by increasing access to evidence on the best interventions for quick and effective treatment.
Researchers from UEA’s School of
Dr Nicola Hancock, from UEA’s
ASSISTIVE TECHNOLOGIES I DECEMBER/JANUARY 2019/20
School of Health Sciences, said: “This was, from the outset, a truly collaborative project between UEA and the CPFT community rehabilitation team, demonstrating the impact of working together on quality improvement initiatives. “The app addresses an important challenge - how busy clinical therapists can rapidly access best available evidence on arm rehabilitation after stroke.
“In our project, clinicians found the app easy to use and supportive of their decision-making around treatments, helping to build their confidence in using evidence-based practice. Some even commented that they had increased the intensity of the therapy they offered because of using the app. “We are excited to pursue future quality improvement and coproduction partnerships with the team,” she added.
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The OA Spiral combines unloading in the tibiofemoral joint with realignment in the patellofemoral joint. Tibiofemoral: The OA Spiral uses a three-point leverage system and a non-elastic strap to pull the knee out of varus or valgus and decrease pain.* 3 Point Leverage - Medial or Lateral Unloading
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*** Callaghan, M. et al. “Beneficial effects of a brace for patellofemoral OA: results of a randomised trial” Osteoarthritis and Cartilage vol. 21 (2013): S23
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NEWS 8
ASSISTIVE TECHNOLOGIES I OCTOBER/NOVEMBER 2019
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Many more styles available for each risk category To request a copy of the latest PODartis catalogue, please call 01254 503333 or email admin@reedmedical.co.uk
Providing free treatments to musicians NEWS
MUSICIANS across the UK are being given fast and free access to physiotherapy treatment, via their professional body, the Incorporated Society of Musicians and the ISM Members’ Fund. The ISM’s sister charity the ISM Members’ Fund has embarked on a pilot project with award winning physiotherapy provider Physio Med after research amongst its 10,000 members revealed that musculoskeletal injuries and conditions are one of the three biggest issues facing professional musicians.
The majority of ISM members work on a freelance basis, so anything that prevents them from working can have a significant impact on their lives. The organisation – which represents anyone earning a living from music, including performers, composers, songwriters, music teachers and sound engineers – supports its members primarily with legal services, insurances, professional development, campaigns and more. The ISM Members’ Fund has supported its members and their
dependents in times of need since 1917.
As part of this support the ISM Members’ Fund is now moving towards providing specific specialist services which will help musicians remain fit and healthy while working in the sector. In a survey, members reported that mental health, MSK conditions and hearing impairment were the three biggest medical challenges they faced that prevented them from working. The ISM Members’ Fund has already introduced a counselling service and is now offering access to Physio Med’s blended service, to enable members who have suffered an MSK injury to access its fast-track physiotherapy provision. Access to physiotherapy via GP referral currently stands at more than 14 weeks, which can result in injuries and conditions becoming chronic. ISM members will now be able to access Physio Med’s innovative and award winning PAL (Physiotherapy Advice Line) service, which provides a blended approach of fast-track
telephone triage, remote multimedia self-management and face-to-face treatment and advice. Musicians referred to Physio Med via ISM will receive a call back within four hours to ensure they are appropriate to access the service.
An initial telephone assessment with a senior chartered physiotherapist then takes place within a maximum of 72 hours and the member receives either a tailored exercise programme to enable them to self-manage their condition or is referred for up to three face-to-face treatments at a local clinic of their choice within Physio Med’s approved UK-wide network of physiotherapy clinics. Deborah Annetts, chief executive of the Incorporated Society of Musicians, said: “Responding to the ever-changing nature and needs of the music sector is of paramount importance to the ISM, and over the past year, the ISM Members’ Fund, the ISM’s sister charity, has developed and expanded the range of specialist support we offer to members for their health and wellbeing. “The freelance and self-employed
nature of musicians means that suffering an injury or MSK condition which prevents their ability to work can have a devastating impact on their wellbeing.
“Providing fast access to physiotherapy to help them get back on their feet is vital, which is why we are pleased to launch our new physiotherapy service. “This is first time this kind of innovative service has been offered on this scale in the music sector and we hope it is transformative for our members suffering from any kind of injury or MSK condition.” Those who self-manage receive a review with a physiotherapist after 10 working days to assess their progress. Physio Med MD, Phil Clayton, added: “MSK injuries can happen to anyone and musicians are no different. “Any job which involves sitting in the same position for a length of time or holding something – such as an instrument – in a particular position can be a challenge physically so we are looking forward to providing practical support to ISM’s members.”
Limb raise supports needs Accessible housing design: of patient and practitioner put pleasure over procedure ACCORDING to guidance published by RIBA, a well-designed bathroom is often the key to dignity and independence. The guidance – ‘Age Friendly Housing’ – says “hospital-style bathrooms have made bathing [personal hygiene] a procedure rather than a pleasure for older and disabled people but safety and practicality no longer need to come at the expense of style”. It cites as exemplar of well-designed accessible bathrooms the inclusion of fixtures such as wash and dry toilets. Closomat is the leading brand of wash dry toilets, also known as shower toilets, smart toilets or automatic toilets, which combine integrated douching and drying 10
within the WC so there is no need to manually wipe. Its latest models, the wall-hung Asana and floor-mounted Palma Vita, reflect several of the features and benefits referenced in the age-friendly housing guidance. They deliver contemporary styling with the best performance in douching and drying. The Asana features a low level soft ambient light, facilitating its location in the dark/ at night. The Palma Vita is unique in that it can be accessorised, initially and retrospectively, to suit the individual’s changing needs. Enquiries: Call 0161 969 1199 or email info@clos-o-mat.com
ASSISTIVE TECHNOLOGIES I DECEMBER/JANUARY 2019/20
SPECTRUM Healthcare (UK) Ltd has announced the launch of its new ergonomically designed limb support the ErgoRaiser™, a sister product to the highly successful ErgoKneeler™.
Moulded in antimicrobial polyethylene and polyurethane, the smooth lines and open design of the ErgoRaiser™ ensure all areas are accessible for efficient and effective cleaning.
The ErgoRaiser is a modular limb support designed to address the postural and comfort needs of both patient/client and practitioner.
The multi-positional, easy to clean support pad eliminates the ongoing expense and environmental impact of disposable slings, making the ErgoRaiser™ both economical and eco-friendly.
It is easy to use, has superior infection control properties and low maintenance costs. With its versatile range of elevations and angles of support, the unique ErgoRaiser™ can provide comfortable support for a limb from either floor level or from raised surfaces such as a plinth, bed or table. The sturdy construction can also assist the practitioner in having both hands free to carry out the required health/ care procedure.
Weighing 2kg, the ErgoRaiser™ has integral handles to enable easy moving and handling in all situations. The top module and pad may be stowed within the lower module to aid portability and storage. An optional shoulder strap is also available. Enquiries: Visit www.spectrumhealthcare. co.uk/products/ergoraiser or call 01793 762928
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