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INNOVATION FOR INDEPENDENCE
ISSUE 66 April/May 2009 £6.95
‘Robot’ could revolutionise prosthetics By Dominic Musgrave PROSTHETIC limbs could be revolutionised as scientists at a Scottish university have taken the first steps in developing a robot that has the ability to evolve in the same way as animals. Researchers at the Robert Gordon University in Aberdeen are using artificial intelligence to produce robots which are much more complex than are presently available. In particular, it offers the potential to make machines which can interact with their environment and perform useful tasks in difficult or dangerous circumstances – or even around the home. Chris Macleod, who is leading the research at RGU's School of Engineering, told Assistive Technologies that the work could be used to change the way prosthetic limbs are made in the future. He said: “The system we are using allows the robot to evolve in a similar way to how animals do. We begin with a simple system similar to an onion, and over time can build it up to become something a lot more complex. Using this idea we hope to be able to grow a system for a prosthetic limb that can take an arm,
for example, and control the individual joints such as the elbow and the wrist. As well as developing the robot's body and environment from simple to complex, the researchers are also developing its brain using an “artificial neural network”. Using this theory, Chris says they hope to train human brains to use their prosthetic limbs more effectively. He added: “Using an artificial model of the brain we hope to train the robot to recognise patterns, and this is something we feel could be useful for amputees. When putting this on a person with an artificial limb we could train their brain to identify nerve patterns that would enable them to control their joints and get the most from their prosthetic limb.” Chris says using this approach is different to any of the techniques that have been used to create any other prosthetic limbs currently available. He added: “The way prosthetic limbs are made at the moment has been around for a long time. Using our method means that we can learn from experiences to create something that would be completely different.”
A design student has come up with a ‘sexy’ range of prosthetic limbs which he says can turn a handicap into a fashion statement. Hans Alexander Huseklepp, from Norway, claims his designs called Immaculate could revolutionise the artificial limb market. He said: “Prosthetics have become highly
advanced from a technical point of view, but still follow the aesthetic path of imitating normal limbs. I want to show that giving prosthetics their own visual identity can not only contribute to prosthetic users feeling better about themselves, but also add functionality beyond that of a normal arm.”
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How magnets hold Matthew’s ear in place A MAN born with virtually no left ear has been fitted with a prosthetic one that looks just like the real thing.
Matthew, 25, told Assistive Technologies that it takes only a few seconds for him to put his prosthetic ear on in the morning and take it off when he showers or goes to bed. He said: “It doesn't fall off, and it's much more convenient than prosthetic ears that are attached with adhesive. "I'm extremely happy with it. It turned out better than I expected
This follows the award of a £2million grant from the National Institute for Health Research for a five year programme grant which will be spread around a number of universities and hospitals. Funding is initially for a three-year evaluation of existing services and
Tibion’s PowerKnee won the Silicon Valley/San Jose Business Journal emerging technology award (ETA) for medical devices.
Matthew Houdek’s ear before he was fitted with the prosthetic one
Contacts
and my mum almost cried when she saw it.”
down to the small blood vessels.
When Matthew was about four years old, a surgeon reconstructed a new ear from his rib cartilage. At first the ear was the right size, but it did not grow as he grew up.
Like many people with microtia, he was also born without an ear canal, a condition called congenital aural atresia.
Editorial Andrew Harrod Group Editor editorial@assistivetechnologies.co.uk
The prosthesis was made by facial prosthetist Gregory Gion. The flesh coloured silicone limb looks almost identical to his natural ear – right
Dr Marzo opened a new ear canal and lined it with a skin graft from Matthew's leg. He now has partial hearing in his left ear.
Scientists chosen to lead national trial CLINICAL scientists at Salisbury District Hospital have been chosen to lead a national trial on assistive technologies that help improve hand and arm rehabilitation following a stroke.
A WEARABLE bionic device for the leg which enhances rehabilitation and helps patients improve muscle strength has won a prestigious award in America.
“It is an honour to be recognised as an innovator in technology among medical device companies,” said Kern Bhugra, CEO and co-founder of Tibion. “With this technology, we have the potential to profoundly impact the lives of patients dealing with loss of muscle function due to surgery, stroke, or chronic diseases such as multiple sclerosis.”
Matthew Houdek was born with a deformity called microtia (small ear), a condition in which one or both outer ears are underdeveloped or absent which affects approximately one in 10,000 babies. Ear-nose-throat surgeon Dr. Sam Marzo at Loyola University Health System implanted three small metal screws in the side of his head. Each screw is fitted with a magnet, and magnetic attraction holds the prosthetic ear in place.
Award for device
technologies followed by a two-year clinical trial which is depending on an interim report. Professor Ian Swain, head of service for medical physics and chief investigator for the trial, said: “This is a really exciting project that will, for the first time, look at the effectiveness of all assistive technologies together. “The fact that Salisbury has been chosen to lead the trial highlights the significant experience that we have in this field and the expertise, innovation and creativity of our
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Dominic Musgrave Healthcare Editor Email: dm@whpl.net Tel: 01226 734407 Sales Ellen Sharpe Email: es@whpl.net Tel: 01226 734412
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Circulation circulation@wharncliffepublishing.co.uk 24 hour hotline: 01226 734695 Design/Production Judith Halkerston Group Deputy Editor Email: jhalkerston@whpl.net Stewart Holt Studio Manager Email: sth@whpl.net
staff.” The assistive technologies include a number of approaches including the use of robots to move the arm and leg, electrical impulses to activate muscles, toxins to reduce tightness in paralysed muscles and a variety of splints and supports that aid function. Previously, clinical scientists in Salisbury developed the revolutionary Odstock dropped foot stimulator, which has helped thousands of people walk more effectively following a stroke.
Sales and Marketing Director Tony Barry Email: tb@whpl.net Product manager Jackie Brook Email: jb@whpl.net Whilst every effort is made to ensure the accuracy of all contents, the publishers do not accept liability for any error, printed or otherwise, that may occur.
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ASSISTIVE TECHNOLOGIES I APRIL/MAY 2009
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Project leader sought for 3-year study
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By Dominic Musgrave THE search is on for someone to lead a study into developing an artificial muscle to give prosthetic limb users more natural movement.
Jim Landrum without the liner
Team develops new skin protection for amputees A NEW skin protection which provides amputees with a more comfortable fit along with a significant increase in their range of motion has been launched in America. The custom silicone skin protection eliminates the outside sleeve and creates an air tight seal. It was developed by a team of upper extremity specialists from Advanced Arm Dynamics including Chris Lake, Rob Dodson, Ryan Spill and Dan Conyers. Chris said: “We heard from our patients that the liners they were wearing under their prosthesis were uncomfortable and not very stable. So, as a team, we did a little testing and developed our own custom silicone skin protection specific for the upper
extremity amputee. “These liners are secure, and provide a stable suspension for the patient. Our patients have been very pleased with the fit and we continue to fine tune the process.” Jim Landrum, who was injured in a firework accident that claimed his left arm below the elbow, is one of the patients using the new skin protection. He said: “This liner seems like it is an attachment to my arm. It doesn’t hinder my movements like before and now I am able to reach up above my head, take off my hat and put my shirt on. It is so much more comfortable and the functionality is so much greater.”
Plymouth University has advertised a three-year PhD project to create the tissue using shape memory alloy wires that work like natural fibres based on a model of how the brain and muscles interact to produce movement. Professor of neuroscience Chris Harris said: “The idea is to build artificial muscles to believe they are real ones. It is a completely different way of doing things but we are going to try to replicate the fibres that muscles are made up of, because they are there for a reason. “If we succeed then we hope to create prosthetic muscles for limbs that look more like the real thing, and to train the brain to adapt to it.” The researchers will explore the properties of nickel-titanium memory alloy wires, which can be squeezed until they are very thin and used in parallel. Like muscles, they generate force when a current is applied, but
PATIENTS are no longer waiting until they are elderly before choosing to have a hip or knee replacement, it has been claimed.
Data collected between September 2008 and February 2009 showed that 56 per cent of patients were over 60, 27 per cent between the ages of 51 and 60, and 12 per cent aged between 41 and 50 years. Steven Young, one of the orthopaedic surgeons on the hip and knee network medical panel, said: “These findings are generally consistent with what I see in my surgery.
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He added: “To start with, we'll experiment with quite big, thick wires, around a millimetre in diameter, but I want to go down to much thinner than that. “I don't know how thin we can go – there are a lot of material questions we need to investigate: strength, conductivity, heat dissipation, how much force you can get out of them – there are a lot of unknowns.” The three-year, EPSRC-sponsored project starts in October and consists of three key phases: exploring the use of nickel-titanium wires, developing a controller that drives the wires with optimised signal-tonoise ratio, and detecting signals from the human brain to drive the artificial system. Chris added: “The advantage of our approach is the artificial muscles could be any size you like, just like human muscles. We have very small muscles in the eyes or ears and very big muscles in our legs. It's a tradeoff between the amount of force you want to generate and the accuracy you need.”
Hip and knee patients are getting younger A survey by the Hip and Knee Network has found that patients are generally getting younger and tend to describe themselves as 'quite active'.
Jim Landrum with the liner
in doing so generate the heat which causes contraction.
“It has become much more common to see relatively young people considering joint replacement surgery.
“As a result, patients’ priorities are changing and post operative expectations are also rising.” The survey, which was carried out on respondents who had previously been diagnosed with hip or knee problem, also found that 21 per cent of people had undergone hip or knee replacement surgery after experiencing pain for less than 12 months. However, 22 per cent admitted that they had endured more than eight years of pain before opting for surgery – a finding Steven said was “surprising”. He added: “There is no need for such a high proportion of patients to wait over eight years before resolving their joint pain. “Most operations take place 18 weeks between referral and surgery.”
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Nadya swims again with help from ‘mermaid’ prosthetic By Dominic Musgrave A DOUBLE amputee can swim again after the special effects company behind The Lord of the Rings films transformed her into a real-life mermaid. Nadya Vessey was born with a condition that meant her legs would never develop properly, but began swimming after she had her first leg amputated at seven. Despite having her other leg amputated at 16, she swam competitively in high school and now swims as often as she can. The New Zealander told Assistive Technologies that the first idea for the mermaid’s tail came from a friend who she went swimming with, but was something she considered seriously following a discussion with a boy several years ago. She said: “His 'why' questions could have gone on for a while, so to cut him short I asked him if he had heard of the little mermaid. He said 'yes' and I said 'I'm a mermaid'. “A few nights later, being somewhat bored, I googled Weta Workshops and found they had
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a prosthetics department On impulse I flicked them an email telling them I was a double amputee and asking if they could make me a mermaid’s tail. “To my surprise they answered immediately 'yes'. And it proceeded from there. It presented them with quite a challenge as it turns out, which is why it took almost three years to complete.” Every aspect of the tail has been custom-made to her body using a blend of 3D modelling and milling technology, combined with vac forming and a poly carbonate spine and tail fin. Nadya added:” It is not quick to get on, being like a wetsuit which takes some shimmying to get into. And I need a little assistance given that it is a firm fit. "I thought rather than just having it as a plaything, I would take it further. A prosthetic is a prosthetic, and your body has to be comfortable with it and you have to mentally make it part of yourself.” She said she is thinking of using the tail to help her complete the swimming section of a triathlon.
Nadya Vessey and her mermaid’s tail
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Researchers at a university in America have developed a new technique which may be able to help people with arm and hand amputations move their prosthetic limbs more naturally.
Patients can control prosthetic arms by putting their mind to it THE new procedure, which allows patients to control prosthetic arms simply by thinking about it, has been developed by the Center for Bionic Medicine at the Rehabilitation Institute of Chicago. Known as Targeted Muscle Reinnervation, they found that through a technique called patternrecognition control, researchers can harness more nervous system information from patients who have had the procedure and decode those signals to allow patients real-time, multiple-degree control of advanced prosthetic arms.
Director Todd Kuiken said: “The use of pattern-recognition control is an exciting advancement for patients with arm amputations. It will allow us to decode more neural information from the patients providing enhanced, more natural operation of their prostheses. “This neural interface, used in combination with DARPA's new sophisticated prosthetics, is creating better patient independence and supporting our vision to advance human ability.” One of the first people to have the procedure was 40-year-old
Amanda Kitts, who lost her left arm below the shoulder in a car accident in 2006. Surgeons rewired the nerves that once went to her left arm and hand, to skin and muscle in her remaining bicep muscle. A prosthetic arm was fitted over her residual limb, and electrodes conducted the signals to the arm so that when she thinks about moving her arm or hand, it moves. She said: “I was amazed at the level of hand function and how fast I was able to control the arm and hand. I was able to pick up a
penny off the table and could catch an object in motion like a checker that was rolling across the table. It's really amazing to be able to just think about it and have my prosthetic move so quick.” The research is part of a Journal of the American Medical Association study which assessed five upperarm amputees who have had the procedure and five people without amputations. All participants were instructed to perform various arm movements, and their abilities to control a virtual prosthetic arm were measured.
Spiders’ silk science could lead to improved knee injury treatment THE science behind spiders’ silk could improve treatment of knee injuries following a massive funding boost.
regenerative meniscal (knee cartilage) repair device, which uses a protein found in silk to repair damaged cartilage and bone tissue.
Tissue repair company Orthox Limited has received more than £1.6m from the Wellcome Trust to help it continue to develop a range of orthopaedic products for the repair of cartilage.
Based on a decade of research by Oxford University scientists, the absorbable implant takes over the function of the damaged tissue, removing the need for permanent plastic or metal prosthesis.
It will be used to fund the development of Orthox’s
Founder and CEO Dr Nick Skaer said: “This funding will enable us to
AN all terrain wheelchair which has been inspired by Formula One has gone on display at the Science Museum in London. The carbon fibre K2, the world’s first production ‘monocoque’ wheelchair, has been created by British engineering company Trekinetic using their experience of manufacturing parts for Formula One. It is one of by-products that will be on
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show as part of the ‘Fast Forward: 20 ways F1 is changing our world’, showing how manufacturers and researchers have found new ways to bring race track innovation and technology into our everyday lives. Its creator, Mike Spindle, said: “‘People may not realise that Formula One technology transfer is one area where Britain’s engineering talent still leads the world. The high-octane, high-pressure environment has led to many innovations that otherwise may not have been developed.”
initiate the roll-out of our pipeline of Spidrex® products, starting with the meniscal repair device. “In the future, we plan to develop further products for other serious orthopaedic problems, such as spinal disc repair and bone regeneration.” The company's prototype targets the meniscus, a crescent-shaped cartilage pad located where the major bones of the leg connect. It
works mainly as a stabilising tissue and is one of the most commonly injured parts of the knee, as well as the most difficult to repair. Damage to the meniscus can frequently result in osteoarthritis, and eventually a knee joint replacement is often required. Knee replacements now cost the NHS more each year than total hip replacements, estimated at nearly £1 billion by 2010.
Cash boost for stroke movement study RESEARCH into a technique that could help stroke patients regain movement has been given a financial boost by the Engineering and Physical Sciences Research Council. The study by scientists at Southampton University's School of Electronics and Computer Science aims to assess the feasibility of using Iterative Learning Control patterns to help stroke patients relearn movements.
the future and make the movements more functional. “As far as we know, up to now, nobody has tried using the technique to help people who have had a stroke to move again.” The technique uses electrodes attached to the skin to contract selective muscles.
Building on successful trials of five stroke patients in 2008, the £285,000 grant will extend work for two years, and will help develop a control theory that will back up future clinical trials.
The patient's movements are then measured and can be corrected by adjusting the intensity and timing of stimulation. Iterative Learning Control is an established technique in the automation robotics industry. However, this will be the first time that it is used to aid rehabilitation in a human.
Dr Chris Freeman said: “The grant will help us get the underlying theory needed to increase the number of muscles we're going to stimulate in
The aim is that through repetition, voluntary movement will be strengthened, reducing the need for artificial stimulation.
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A Finnish computer programmer who lost a finger in a motorbike crash has replaced it with a USB drive. Jerry Jalava built a prosthetic finger which contains a 2GB memory stick for storing photos, films and other files. The idea came to him when surgeons joked about a “finger drive” after his accident. Jerry peels back the prosthetic from its “nail” to show the flash drive. He said: “It is not attached permanently to my body so when I’m using the USB I just leave my finger inside the slot and pick it up when I’ve finished.”
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Dial for physiotherapy advice PEOPLE suffering from sprains, strains, muscle and joint problems in Scotland will soon be able to benefit from physiotherapy advice over the phone. NHS Lothian's physiotherapists are piloting a new physiotherapy phone advice service for
patients in north east Edinburgh from NHS 24's centre in South Queensferry. Clinical specialist physio Wendy Johnson said: “Giving people early access to advice means any problem can be dealt with early, thereby minimising its severity.”
Link between arm fractures and hip break By Dominic Musgrave ELDERLY women with upper arm fractures are five times more likely than the general population to experience a broken hip in the following 12 months, it has been claimed. A study, led by Jeremiah Clinton, an orthopaedic surgeon and associate professor of orthopaedics at the University of Washington in Seattle, found that understanding the risk could be key to preventing the fractures. He said: “There have been studies in the past showing a relationship between upper arm fractures and hip fractures, but we wanted to determine when that risk is greatest. “By recognising when that period of increased risk occurs, physicians have a window of opportunity to take steps that may possibly prevent a subsequent fracture.” “The older population is at a greater risk for fall-related fractures, due to the fact that their bones are generally more brittle than the younger population.” The research found that a number of reasons can cause and elderly patient to fall. The most common were: Effects of medications. Neurological disorders.
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Loss of an ability to maintain balance. Decreased reaction time. Jeremiah added: “One of the first steps a patient should take following a fall is to talk with their orthopaedist and other physicians to determine the cause. “Once the cause is more clearly understood, the proper steps can be taken to decrease a patient’s risk of having another fall and potentially future fractures.” Previous studies have indicated that 25 per cent of patients who experience hip fractures have a survival rate of less than a year, with another 25 per cent losing some level of their independence and potentially need to move to an assisted living facility. Jeremiah added: “When we look at the numbers, we can see that there is a huge increase in the population that maybe at risk for these types of fragility fractures. “And if we look only at the costs associated with treating hip fractures, we are talking about hundreds of millions, or probably billions, of dollars in health care costs. Much of those costs theoretically could be decreased if we knew when and how to intervene.”
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The celebrities who did it for Comic Relief
A cancer survivor with a prosthetic leg followed in the footsteps of nine celebrities and scaled the world’s highest free-standing mountain. Dominic Musgrave found out more.
Andy scales the heights for charity ANDY Ward was part of a team of 12 who climbed Kilimanjaro to raise money for Oxfordbased charity Urology Cancer Research and Education. He took the same route as stars including Chris Moyles and Cheryl Cole, who took part in the challenge to raise money for Comic Relief. And, despite going blind in one eye due to the high altitude and needing to be carried down on a stretcher because his leg was causing him so much pain, he still described the experience as ‘the best week of my life’. The builder and plumber, who raised more than £5,000 for the charity, told Assistive Technologies that he is already planning next year’s challenge. He said: “The walk to the top and back down again almost killed me, but there was no way I wasn’t going to reach the summit having got so far. “I am used to extreme weathers having been in the army for six years and working as a builder now, but nothing can prepare you for the extreme conditions that we faced on the mountain. “I loved it that much that I am now planning climbing to the base camp of Everest. I proved to a lot of people, including myself, that I can still achieve things despite having a prosthetic leg.” Andy lost his right leg below the knee following complications with testicular cancer three years
The team ahead of their climb
ago. The idea for the trip came about following a chance meeting with the doctor who amputated his leg. He added: “I was shopping with my family one Saturday when we bumped into Dr Andrew Protheroe. He asked me how my prosthetic leg was doing, and I said great. “I thought he was joking when he then asked if I would be fit to walk up Kilimanjaro, but the following week he sent me the details and six
months later there I was. “I went up there expecting to be broken, and I was because climbing 19,000ft is hardly a stroll in the park. I had to take a few pills along the way to cope with the pain, but after a lot of rest and recuperation I am better now. I wouldn’t describe the experience as enjoyable because of the pain, but I am so glad I did it.” The team hope to raise more than £18,000 for the charity.
Call for more action from employers on RSI THE Chartered Society of Physiotherapy is calling on the Government to encourage employers to do more to prevent and reduce repetitive strain injury among British workers. The call comes as the latest figures from the Health and Safety Executive show that 213,000 people in work had a musculoskeletal upper limb or neck disorder that was caused or made worse by work in 2007/08. 10
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The figures also show there has been little progress in tackling the problem of RSI in the last six years. Pauline Cole, CSP spokesperson and member of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics, said: “There is a clear opportunity for employers to do more to provide occupational health services both with regard to prevention of RSI and rehabilitation. The CSP is calling on the
Government to both encourage and enforce measures to address this with legislation, combined with incentives and best practice guidance. We may then, after the frustration of many years of no progress, begin to see some reduction in the rates of this almost completely preventable condition.“ Employers currently have a legal duty to prevent the occurrence of risks of injury or illness, which are reasonably foreseeable in relation to
their employees. However, the latest statistics suggest preventative action to reduce the risk of RSI is still lacking, causing many thousands of workers to develop this debilitating condition. RSI costs employers around £300m per year in lost working time, sick pay and administration. An estimated 2.8m working days were lost in 2007-08 due to RSI, with on average each person affected taking 13.3 days off sick.
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Elderly can still benefit from surgery NEWS
PEOPLE in their 80s can still benefit from knee replacement surgery, it has been claimed. A study by researchers at Singapore General Hospital found that elderly patients can achieve an improved quality of life thanks to the procedure, in which the damaged bone and cartilage is replaced with an artificial joint. The findings were presented at the annual meeting of the American academy of orthopaedic surgeons and suggest that knee replacement surgery can provide both physical and social benefits for patients in their 80s. Lead author Dr Edsel Arandia, an orthopaedic surgeon at Philippine orthopaedic centre and a fellow at Singapore General Hospital, said: “As patients are living longer, there is an upward trend in the demand for quality of life among the elderly population. “Overall, total knee arthroplasty in elderly patients resulted in significant gains in their quality of life, which was reflected in both health and social-related quality of life score dimensions.”
Research scientists in America have found that stroke patients can be rehabilitated using a hand-operated robotic device and MRI scanner. Dominic Musgrave found out more.
The scanner
Aria Tzika
Study hope for stroke patients THE findings of the first study to map the brain in order to track stroke rehabilitation were presented at the annual meeting of the Radiological Society of North America. Previously, it was believed that there was only a short window of three to six months following a stroke when rehabilitation could make an improvement. “We have shown that the brain has the ability to regain function through rehabilitative exercises following a stroke,” said Aria Tzika, director of the NMR surgical laboratory at Massachusetts General Hospital and Shriners Burn Institute and assistant professor in the department of surgery at Harvard Medical School in Boston.
“We have learned that the brain is malleable, even six months or more after a stroke, which is a longer period of time than previously thought.” As part of the study the researchers looked at five right-hand dominant patients who had had strokes at least six months previous that had affected the left side of the brain and, consequently, use of the right hand. The patients squeeze a special MRcompatible robotic device for an hour a day, three days per week for four weeks. Exams were performed before, during and upon completion of training, and after a non-training period to assess permanence of rehabilitation.
The results showed that rehabilitation using the training significantly increased activation in the cortex, the area in the brain that corresponds with hand use. “Our research is important because 65 per cent of people who have a stroke affecting hand use are still unable to incorporate the affected hand into their daily activities after six months,” Aria added. “These findings should give hope to people who have had strokes, their families and the rehabilitative specialists who treat them.” Approximately 700,000 strokes occur annually in America, where it is believed to be the third biggest killer.
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David steps down to concentrate on NHS role TOUCH Bionics’ founder David Gow has stepped down from the company to concentrate on his expanding role within NHS Lothian’s SMART Centre in Edinburgh. David was the original inventor of the concepts that resulted in the iLIMB hand, the world's first commercially available bionic hand. More recently he has worked as director of research and non executive director of the company. David said: “I have immensely enjoyed my time with Touch Bionics and look forward to even greater strides by the company in the field of upper limb prosthetics. “It was really in 2005, with funding from existing and new investors, including Archangel Informal Investments and the Scottish Coinvestment Fund, that we started the commercialisation of my ideas – it’s very rewarding to have over 500 users from all over the world wearing an i-LIMB hand.” In his expanding role within NHS Lothian, David will become head of SMART services and will be focusing
David Gow
his experience and efforts into managing strategic service change and modernisation of mobility, prosthetic and bioengineering services for the South East of Scotland. David set the course for the company that, in early 2003, was the first to be spun out from the Scottish National Health Service – becoming the first SHIL (Scottish Health Innovations Ltd) to receive significant funding.
David first began working on electronic arms, including shoulders, wrists and hands, in the 1980s. In 1993 his partial hand system received international publicity, and in 1998 major international profile was achieved through the fitting of the world’s first electrically powered shoulder. In 2000 further clinical fittings and publicity with partial hands was a catalyst for the decision to set up Touch Bionics.
New system activates the muscles NEW technology has been launched to help people who have suffered foot drop following either a stroke, spinal cord injury or disease process associated with disruption of the upper motor neuron system. Using sophisticated sensor technology and software, the WalkAide System analyses the unique movement of the leg and foot in the individual with foot drop. Based on that analysis, WalkAide then creates a unique stimulation pattern for walking and sends appropriate functional electrical stimulation (FES) to the common peroneal nerve as it passes near the head of the fibula. This stimulation activates the muscles that dorsiflex the foot at the appropriate time during the gait cycle, producing a much more natural, efficient, and safe pattern of walking. WalkAide is applied directly to the leg below the knee and can be worn under most clothing.
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Waiting times to be slashed
Team leader Sarah Mills in the new suite.
A NEW orthopaedic X-ray suite at the Royal Bolton Hospital is set to slash waiting times and bring other benefits for patients.
She added: “We’ve been looking forward to this for some time. The investment is going to bring real benefits for patient care.
The suite, which cost £900,000, includes two new digital X-ray machines which cost around £300k. It is being used for outpatients who have suspected fractures or who may be having hip or knee replacements.
“Having a dedicated orthopaedic X-ray suite, along with much faster digital imaging means outpatients will no longer have to wait behind patients from other departments, and their x-rays can be checked as soon as they have been taken.”
Radiology manager Catherine Walsh said the new suite was a very exciting development.
Currently around 30,000 orthopaedic outpatient X-rays a year are taken at the hospital.
New guidelines to reduce risks By Dominic Musgrave NEW guidelines have been issued to NHS and private hospitals to reduce risks for patients undergoing hip replacement surgery after fracturing their joint. Figures released by the National Patient Safety Agency (NPSA) have shown that the death rate following partial hip replacement for fracture treatment is ten times higher than following a planned hip replacement. The main reason for this is because the patients undergoing surgery after fracture are older, ill and are in need
of an emergency operation. The death rate is also significantly higher when surgery is delayed more than 48 hours. The NPSA is now calling on all hospitals to report all deaths and incidents to adopt best practice techniques in surgery and anaesthesia. Dr Kevin Cleary, medical director of the NPSA, said: “For certain patients the short term risks of using cement in orthopaedic surgery need to be balanced against the long term benefits.
“By asking staff to report all serious incidents to the NPSA, we hope to improve learning and make this common procedure even safer for patients.”
Orthopaedic Association, added: "Hip surgery is a very common procedure and when performed following hip fracture enhances the lives of many elderly patients.
Twenty-six patient deaths and six cases of severe harm were reported to the National Patient Safety Agency (NPSA) between October 2003 and October 2008 in patients having a partial or total hip replacement where bone cement was used. The majority related to older patients undergoing emergency hip fracture.
“It is generally considered safe and effective. However there are rare examples where patients have experienced severe harm or death immediately following these replacement operations.”
Clare Marx, president of the British
Approximately 60,000 total hip replacements and 60,000 repairs of hip fractures are carried out each year in the UK.
Hospital stay Rapid regime sees Len head for home times reduced
A NEW rapid rehabilitation regime has enabled a patient who had hip replacement to go home the following day.
THE average stay of amputees at the Royal Free Hospital has been reduced by almost two-thirds in the last three years, it has been revealed.
Building contractor Len Cater from Shrewsbury was able to walk pain free with crutches just four hours after having the operation as a result of the type of anaesthetic and pain relief used during and after the procedure.
Patients spent an average 46 days on the ward during 2008, down from 126 during 2005, thanks to an overhaul of the service.
The breakthrough development, which is already being used successfully in Australia and America, will result in significantly shortening the waiting times for patients requiring new hip joints.
Senior amputee physiotherapist Kate Primett said: “We looked closely at our objectives and what we were trying to achieve in the service.
Consultant orthopaedic surgeon, professor James Richardson, who carried out the surgery at the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, said: "Before surgery patients requiring a new hip are often in extreme pain. This development, which is largely down to multi-disciplinary teamwork, in particular anaesthetics and physiotherapy, is great news for patients, as they will get their new hip more quickly and will be able to recover sooner in the comfort of their own home."
“By developing a co-ordinated multi-disciplinary approach to care and increasing staffing levels to enable more intensive rehabilitation, we have been able to facilitate early discharges from hospital.” Kate puts the reduced stay down to the purchase of six amputee specific wheelchairs, which are correctly balanced and support the amputated limb. New gym facilities have also made it possible for all patients to take part in daily rehabilitation sessions away from the ward. Len Cater leaves hospital 14
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The new technique involves injecting large amounts of local anaesthetic directly into the site of the operation. The surgeon then places a small plastic tube in the operation site which is connected to a pump, which continues to provide local anaesthetic for the first 24 to 48 hours.
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Physical activity monitoring could save health service millions of pounds A PHYSICAL activity monitoring system which compares actual patient activity with researched norms for individual patient types could save the health service millions of pounds, it has been claimed. Developed by Yorkshire-based Activ4Life, the ProV3.8 system,which is the first of its kind, has been launched to support orthopaedic surgeons in their decision making processes. It could also save the NHS money by enabling better clinical decision making by monitoring the activity levels of hip and knee replacement patients for several months both pre and post operatively. CEO Ian Revie, said: “The visibility of patient activity and pain trends over time will help inform the patient, GP and surgeon of the optimal time for surgery. Moreover, potential problems in rehabilitation can be identified early and acted on.” It is estimated that the simple-to-use technology could save a medium
sized hospital up to £500,000 annually through better bed utilisation and a reduction in post operative appointments as well as offering similar savings in primary care. The activity monitor is discretely worn by the patient throughout the day under their clothes. At night it is placed into a small docking station and the patient is asked to record, on a level of 1 to 10, any pain they have experienced that day. Once in the docking station the data
is automatically transmitted to an Activ4Life server via an existing mobile phone network, where it is analysed against a researched activity profile assigned based on the patient's age, gender, BMI, operative state and activity levels. Regular reports are then sent to clinicians to assist them in the decision making process; information which can be accessed at any time from a secure website. Clinical trials in two UK hospitals are currently being held.
Stuart to tackle Kilimanjaro BRITAIN’S first military casualty in Afghanistan is planning to climb Kilimanjaro later this year for a charity which helps wounded soldiers. Stuart Trow, who lost a leg in 2001 after it was struck by three bullets and has worn a prosthetic limb since, wants to raise £10,000 for Help for Heroes. Following the incident the 32-yearold spent four weeks in hospital after his leg was amputated from the knee down, while his rehabilitation went on for months. He initially struggled with depression and his new leg, but he has beaten the blues and set his sights on Africa. Stuart said: “After seven years of rehab and recovery I want to help some of the other brave men and women who are facing life changing challenges after being injured in action. I’m slowly increasing the training depending on how I am with my leg, but it’s not so much the climbing, it’s dealing with the amputation. “It will be a tough physical challenge but it’s the least I can do to help our armed forces.” For more information or to sponsor Stuart, visit www.justgiving.com/heroclimb
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US researchers find key reaction to device metals
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By Dominic Musgrave
patient to undergo a second surgery.
RESEARCHERS in America have identified a key immunological defence reaction to the metals in joint replacement devices which can lead to loosening of the components and early failure.
According to Nadim, the loosening is often caused by localised inflammation, an immune reaction to tiny particles of debris from the components themselves as they rub against one another. No infection is involved.
The Rush University Medical Center study, funded by the National Institutes of Health, has won the annual William H. Harris, MD Award for scientific merit from the Orthopaedic Research Society.
Albert Thomson receives his award from Sadaqat Ali, a member of the RADAR leadership programme.
Albert wins disabled entrepreneur award AN ex-serviceman who lost his leg in action has won an award for simulating emergency scenes using amputees. Albert Thomson, who had one of his legs removed in 2003 after he was injured in Iraq, was named disabled entrepreneur of the year at Radar’s annual people of the year awards. After contemplating in hospital how he could turn the negative impact on his life into a positive he formed
Action Amps, where amputees carry out training simulations for the emergency services and military.
Associate professor and the study’s author, Nadim Hallab, said: “As soon as joint replacement devices are implanted, they begin to corrode and wear away, releasing particles and ions that ultimately signal danger to the body’s immune system.
There are two different types of inflammatory pathways: one that reacts to foreign bodies like bacteria and viruses, which cause an infection, and another that reacts to “sterile” or non-living danger signals, including ultraviolet light and oxidative stress.
“This is the first time that researchers have shown that debris and ions from implants trigger this dangersignaling pathway.”
He added: “When specialised cells of the immune system, called macrophages, encounter this metallic debris, they engulf it in sacs called lysosomes and try to get rid of the debris by digesting it with enzymes. But the particles damage the lysosomes, and the cells start screaming ‘danger.’”
Over 600,000 total joint replacements are performed in the United States each year. The vast majority are successful and last well over ten years. But in up to ten per cent of patients, the metal components loosen, requiring the
The researchers are hopeful that identification of the pathway that triggers inflammation without infection could lead to new and specific therapeutic strategies to avoid the early failure of joint replacements.
“Disabled people are probably better qualified to start and run their own business, having already overcome, or able to deal with their disability within their normal day-to-day living,” he said. “Starting a business may seem daunting, but when you are doing something that you really enjoy, it couldn’t be easier.”
New ice pack claims to help athletes recover more quickly AN ice pack which claims to help athletes recover quicker and more effectively from injury or surgery has been launched. The MORPHO Cryo-Matrix by North Yorkshire healthcare innovations company Salitas remains colder up to 12 times longer than conventional gel packs, is not wet or messy and is easy to prepare and apply. It can be programmed to stay at a constant 'cold' temperature (with a skin interface temperature in the ideal (7-12°C zone) for up to four hours, as opposed to the 20 minutes associated with conventional gel packs. It is made from a unique matrix structure that moulds to the 16
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patients' contours, even when they are moving; allowing patients to receive treatment whilst taking part in exercise, training schedules or physiotherapy programmes. Managing director Richard Wilson said: "It can be used by top athletes to aid the rehabilitation of acute sport injuries, ease the effects of arthritis, rheumatism and multiple sclerosis and help millions of patients recover from injuries faster." A study carried out in Belgium concluded that if patients use MORPHO regularly it can be more effective than standard pharmacological treatments such as paracetamol to relieve pain and improve joint mobility.
New website helps find disability aids and mobility products THE Stroke Association and Mobilis have joined forces to launch a new website to help people in need of disability aids and mobility products find suitable equipment. For every sale made through the website www.strokeshop.org.uk and an associated catalogue, the charity will receive an automatic donation. Account manager Monika Milne said: “The Stroke Association is pleased to be able to offer products that will provide greater
independence for stroke survivors, whether living at home, in care or still in hospital. These mobility products will provide extra reassurance for family, friends and carers of all people with disabilities.” Stroke is the leading cause of adult disability in this country, with an estimated 150,000 suffering each year, and there are around a million people reliant on others for everyday living, due to the consequences of stroke.
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Jo returns to action after ski accident By Dominic Musgrave A BRITISH skier who suffered a career-threatening accident has returned to action. When Jo Ryding crashed at high speed during a competition in Austria in 2007 she feared her career was over. But, almost two years later she has returned to the slopes, and now hopes to fulfill her dreams of making the Winter Olympics in 2014. Jo told Assistive Technologies that the accident, during a downhill race in Austria, left her with a badly broken knee. She said: “The femur bone had crushed the tibia, so I needed an operation. Following the initial operation, I was on crutches for fourand-a-half months before undergoing a second procedure in September. “I was told I’d be able to start training again after the second operation, but I tried and found I couldn’t. It was a huge blow, so I
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went back to the doctors to see what could be done.” Jo was treated by a surgeon in London who re-broke the knee and grew new bone. The treatment was successful, but it became clear that in addition to the bone injury, her knee had sustained ligament damage as well as some tendon and cartilage problems. Still unable to compete at the level she wanted to, Jo was referred to Technology in Motion from Össur for a CTi knee brace. She added: “The brace is really comfortable, and will support my knee where the damage is. It will also protect it from further damage, so I can ski with confidence. I will wear the brace every time I ski from now on. I just wish I’d worn one before.” “My ultimate goal is to compete in the 2014 Winter Olympics. I won’t be recovered in time for next year’s games, so I’m putting all my energy into when I know I will be fully fit.”
Margaret Bennett with colleagues at NHS Darlington
Physio Margaret puts her feet up A COMMUNITY physiotherapist is putting her feet up after more than three decades of getting people moving. Senior neurological physiotherapist at NHS Darlington, Margaret Bennett opted to work for the NHS because of her experience with her mother living with the effects of polio. She began her training in 1969 at the Royal Victoria Infirmary, Newcastle upon Tyne, qualifying in 1973. Following a year working in Denmark and travelling across Europe, Margaret returned to the North East to continue working in
physiotherapy at the Freeman Hospital in Newcastle. She then worked in a neurological rehabilitation unit in Middlesbrough, before taking up her current role in the community for the stroke and neurology team at Darlington. “I knew that I didn’t want to be a teacher or a secretary which were usually the only options open to women who wanted a career,” Margaret said. “I’d always had a real interest in physiotherapy after hearing how my mother had undergone treatment when she was younger, so I decided that was where my career path lay.”
Paralympian Marc gives inspirational presentation at BAPO exhibition PARALYMPIAN and sports commentator Marc Woods delivered the Ossur lecture at this year’s 15th annual BAPO exhibition. Marc, who won 12 swimming medals at five different Games, had his leg amputated because of cancer when he was 17. The day after he had his stitches out he went swimming, and after a year he was quicker with one leg than when he had two. He has now retired from competition after 17 years, winning a further 21 medals from either World or European Championship events. His inspirational presentation ‘The Path to Gold’ focused on the need for everyone to take personal responsibility to team cohesion, and through to organisational change. Also with a sporting theme was Sarah A. Deans and Sandra Sexton’s presentation entitled ‘The Need for
SPEEAD (Sporting Prosthetics for Everyday and Elite Athletes with a Disability)’. Sarah and Sandra are the lecturer and director respectively at the National Centre for Prosthetics and Orthotics at the University of Strathclyde. They said that preparation for the 2014 Commonwealth Games in Glasgow has highlighted a need to champion sport for people withlower limb deficiency and give those people who may not have participated the opportunity to get involved. Their talk discussed the aims and objectives of the recently created national SPEEAD network, which will focus on building professional expertise, increase research capacity and facilitate knowledge transfer in sporting prosthetics. The event took place at the Reebok Stadium, Bolton. ASSISTIVE TECHNOLOGIES I APRIL/MAY 2009
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World first for stem cell trial NEWS
A STEM cell trial currently being carried out at an Oswestry hospital is a world first. The randomised trial at the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust is looking at fixing lower limb bone fractures which wouldn’t otherwise heal. It has currently treated 25 of the required 40 patients for the trial to be assessed, with the testing only relating to where the stems cells are placed in the body. "To date the results of this work are extremely encouraging,” said consultant orthopaedic surgeon, professor James Richardson, who is leading this trial. “Whilst only 20 per cent of leg fractures do not heal after a 20 week period using traditional treatments, for those who are affected, this can have serious consequences for their life
style and ability to work.” He added: “Over 40 per cent of people in the UK will suffer a fracture during their lifetime, so the more that can be done to maximise full recovery in a short time period for every case, the better it is for the patient and for the economy as a whole.” When an appropriate candidate for this technique is identified, they are asked whether they would like to be part of the trial. If they agree and the funding is available from their primary care trust, the stem cells in the bone marrow are taken from the patient’s own body, along with 20 syringes of the patient’s blood to feed the cells. These are multiplied over a three week period in the stem cell laboratory at the hospital and then are re-implanted in the same patient’s body at the site of the
fracture. Using the stem cells to build extra bone enables the fracture to heal. It is a way of encouraging nature to do its job a little more quickly.
Professor James Richardson with Loraine Holland, who had the treatment.
Campaign to promote regulating health professionals THE Health Professions Council has launched a national campaign to promote its work in regulating key health professionals. It is specifically aimed at older people because of their frequent use of professions registered by the council, particularly physiotherapists, dieticians, occupational therapists, chiropodists and podiatrists. Through the campaign the council hopes to emphasise how, by using registered health professionals, people can be confident that the individual they are treated by is genuine and the care they receive meets national standards.
President Anna van der Gaag said: “We are keen to let older people know more about our work because that way they can feel certain that the health professional is who they say they are and the care they receive will meet national standards. “Not only do we regulate physiotherapists, dieticians, occupational therapists, chiropodists and podiatrists – as well as nine other professions – we are also able to act on the very rare occasion that a health professional does not meet our standards. We can take action which might include stopping them from practising.”
North Yorkshire patients benefit from improved physio access PATIENTS in parts of North Yorkshire are benefitting from improved access to physiotherapy services thanks to a new scheme introduced by the local NHS. North Yorkshire and York NHS Trust has released a short film which celebrates the success of musculoskeletal assessment clinics, which were first introduced in 2007 to improve access to specialised physiotherapy services. GPs are now able to make referrals to community assessment teams), which consist of specialist physiotherapists, podiatrists and clinicians who make swift judgements on what course of action is best for patients with these problems. “Before we launched this new way of working, GPs would normally have to
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make a referral to an orthopaedic consultant in a hospital which could take up to 13 weeks,” said Anne Alder, extended services manager for NHS North Yorkshire and York. “Now physiotherapy services have been streamlined so that a specialist team look at the patient’s needs and decide whether that patient can be referred directly to a clinic for immediate treatment rather than waiting to see a consultant. Our service is now more responsive to patients and enables them to be treated much quicker and often much closer to where they live.” The assessment clinics have been well received by patients in the Scarborough, Whitby and Ryedale area, and there are plans to develop the service across other parts of North Yorkshire.
Anna van der Gaag
Centres would save hundreds of lives – consultation FIVE hundred lives a year would be saved through the creation of specialist stroke and trauma centres in London, according to a consultation.
and hyper-acute centres.
Expert clinical care and the latest technology should be concentrated in a few super–centres which would treat the most serious and lifethreatening cases.
Stroke is the second biggest killer in London and the most common cause of disability – around 11,500 Londoners suffer a stroke each year, about one person every hour.
And they would be linked to a network of A&E, stroke units and mini-stroke centres across the capital dealing with less serious cases, rehabilitation and continued treatment.
The consultation, which is on part of Lord Darzi’s 10-year vision for the capital ‘Healthcare for London’, will look at the location and coverage of potential sites for eight specialist stroke and four major trauma centres.
Ann Radmore, chief executive of Wandsworth Teaching PCT, said: “All stroke patients and trauma patients in London will benefit from improved trauma centres
“The proposals will ensure investment, new services and world class quality for all Londoners.”
The findings of the will be considered by a joint committee of primary care trusts in the summer.
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Pressure care seminars to form part of Naidex A SERIES of pressure care seminars hosted by seating specialist Fiona Collins will form part of the annual Naidex exhibition. They will take place in the professional seminar theatre on all three days of the event, and will allow healthcare professionals and visitors to increase their knowledge and understanding of the principles of seating theory, as well as explore practical specialist seating solutions within a care environment. The seminars will present case studies to examine therapists’ accountability as well as cover topics including: dynamic seating for personal hygiene, seating
assessment, seating the bariatric patient and gaining funding for seating. Event Manager Liz Virgo said: “The pressure care seminars provide the perfect opportunity for anyone interested in this important issue to get the latest tips and advice from the specialists.” Healthcare professionals will also receive a certificate of attendance for inclusion in their CPD portfolio. As well as learning about pressure care management, visitors will also be able to test and compare the latest specialist seating products.
Fiona Collins
Anyone wishing to keep up to
Updates will be displayed on the
Four events for the price of one THE College of Occupational Therapists’ 33rd conference is this year offering four events for the price of one. The annual event, which is being held at the Brighton Centre from June 23-26, includes three specialist sections’ conferences, and professional development is the key aim. They are: HIV/AIDS, Oncology, Palliative Care
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Older People People with Learning Disabilities Professor Florence Clark, pioneer of lifestyle redesign, will address the opening plenary, sharing her Professor Mike Richards, national cancer director at the Department of Health, will discuss how cancer survivorship has presented new challenges and opportunities for occupational therapists.
date with the latest developments about the event can now do so using micro-blogging service Twitter.
Naidex profile page and delivered to other users following the event. Naidex takes place at the Birmingham NEC from April 28-30.
Hundreds attend Kidz in the Middle exhibition MORE than 1,400 people visited Disabled Living’s inaugural Kidz in the Middle exhibition in Coventry. Visitors were able to browse the most up-to-date equipment and products including wheelchairs, seating, bathing and information on support services.
To complement the exhibition was a programme of free seminars on topics previously requested by both parents and professionals. A conference ran alongside to address the complexities of handling and moving disabled children.
Danny Crates
Gold medallist Danny to open Mobility Roadshow PARALYMPIC gold medal runner Danny Crates, the GB flagbearer in Beijing, will open this year’s Mobility Roadshow at Kemble airfield near Cirencester.
They can also try wheelchair basketball, football and dancing in the sports arena, while the mouth and foot painting artists are holding free masterclasses.
Other sporting guests attending over the three days will include TV presenter Ade Adepitan and tennis gold medallist Peter Norfolk.
To register for free advance tickets visit www.mobilityroadshow.com and be in with a chance to win a P&O mini-cruise for two.
Visitors to the show can take a trial flight with the British Disabled Flying Association or the Kemble Flying School, experience the thrill of adapted go-karts, take a skid car or 4x4 off-road ride and aim high on the accessible climbing wall.
Opening from 10am each day, parking, entry and showguide are also free. There is a free shuttle bus from Swindon station and accessible accommodation details are available on the website. ASSISTIVE TECHNOLOGIES I APRIL/MAY 2009
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Knee injuries common when people go skiing and return as patients By Martin Haines It is that time of year again when many people go skiing and often return as patients, following a variety of different injuries, most commonly knee problems. In this feature I willl examine two different types of knee ailment: Meniscus and Anterior Cruciate Ligament (ACL) injuries, and discuss treatment options for each.
Meniscus Injuries
The meniscus is a crescent-shaped cartilage pad in the knee joint and it assists with stabilisation and shock absorption. Typically, when damaged it swells, weight bearing becomes difficult and, on occasion, the knee will lock due to the physical distortion of the meniscus and resultant muscle spasm. There are a number of occasions, however, when the meniscus can be traumatised over time and symptoms can be insidious; then, the patient will often describe an aching in the knee, as well as some discomfort on twisting and turning, even when simply walking around corners. This more insidious onset can occur without effusion and, depending upon which meniscus is damaged, the symptoms can be in the popliteal fossa or on the joint line.
Causes The meniscus is commonly damaged in field sports, during twisting and turning manoeuvres. However, skiers are prone to this too, by virtue of the twisting loads imposed at high velocity and the large levers they have on their feet, which exaggerate torque transmitted through the knee.
Treatment The often-quoted Rest, Ice, Compression and Elevation (R.I.C.E) regime is usually advised. Also, a compressive knee brace, which offers some degree of stability, can help to minimise the swelling and provide proprioceptive stimulation, to artificially stabilise the knee while it is vulnerable. Partial or non-weight bearing walking, using crutches, is often necessary in the short term. In time exercises to help reduce the effusion are important by virtue of the ‘muscle pumping action’, although too much exercise too soon will often aggravate the effusion. 20
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Therefore, a short range exercise, which is less likely to load the knee, yet still provides quadriceps work, is helpful. If the damage is either minimal or on the periphery of the meniscus where there is a good blood supply, which can facilitate healing, then these conservative measures can sometimes be sufficient to resolve the problem. In more severe cases, however, surgery is often indicated and it is worth the patient taking time to try and reduce the effusion and get the knee stronger prior to the operation, as this will help facilitate better and quicker post-op healing. During rehab, a more secure brace is usually required so that, although movement is encouraged, more stability is provided while the knee is vulnerable, yet starting to become active. When the patient moves into sport or higher levels of activity, a brace that provides some stability, but emphasises proprioceptive stimulation to encourage correct muscle firing sequences, is particularly valuable.
ACL Injuries Symptoms The main function of the ACL (anterior cruciate ligament) is to provide proprioceptive information to the brain, to facilitate the correct
degree of muscular control for stabilising the knee. The ACL is a hotbed of proprioceptor activity and signals from it and other structures ensure that the brain has sufficient sensory information to enable it to reflexly determine the correct amount of muscle stimulation, for providing mobility and stability in the knee; this also ensures the safe and efficient performance of leg movements. If the ACL is torn or damaged in any way, the proprioceptors switch off, which provides faulty information to the brain, making it impossible to correctly analyse the required amount of muscle control to safely and effectively move the knee. A patient with a torn or ruptured ACL will often say he or she heard a snap or tear in the knee and immediately knew that it ‘went’. Pain will typically be accompanied by an effusion and weight support will be difficult, with the patient unable to bear weight through the knee, as it feels weak or unstable.
Causes Typically in skiing, an ACL injury will be caused by an uncontrolled or unexpected movement, perhaps while going off piste or when skiing on moguls or ice. Often the patient will refer to ‘wiping-out’ during the incident.
Treatment Again, as with any acute traumatic
‘A patient with a torn or ruptured ACL will often say he or she heard a snap or tear in the knee and immediately knew that it ‘went’.’
injury, Rest, Ice, Compression and Elevation (R.I.C.E) can be useful. While there is swelling in the joint, a compressive knee brace can help to minimise the effusion and provide proprioceptive stimulation to help artificially stabilise the knee, while it is vulnerable. Partial or non-weight bearing walking, using crutches, may be necessary in the short term. It is also possible to re-educate the proprioceptors in the joint, through balance-type exercise with the eyes closed. This exercise requires a high degree of sensory information to confirm the status of the joint using the knee proprioceptors, without having the assistance of visual information from the eyes. There will be occasions when surgery is not required, depending upon the severity of the damage and the activity levels of the patient; in such cases, a progressive rehab programme relating to muscular performance and proprioceptive requirements of a correctly functioning knee can be prescribed and progressed over time. Should the knee require surgery, techniques are quite advanced these days and so it is a more viable option for patients. Post-operatively, a brace that provides compression as well as stability is required. Then, when rehab commences, the patient will require a secure brace that encourages movement, but also provides stability while the knee remains vulnerable. Participation in sport requires a different brace, in that it will need to provide some degree of stability, but must emphasise proprioceptive stimulation, in order to encourage the correct muscle firing sequences. Martin Haines is managing director of Mobilis Performance.
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Passing on the knowledge ... By Ruth Everard BEING a teenager is hard. How many times have you heard someone say "I wouldn't go through it again if you paid me" or said that yourself? Just as we think we have life figured out as a child, the transition to adulthood presents new and complex struggles. We have to navigate new opportunities for success or failure, we are asked to make our own decisions that will shape and define our future and we stop relying on the adults who have been looking after us. And to make it all the more complicated, our bodies change and so do the ways we relate to one another. This is no different for disabled teenagers – except that the responsibilities and challenges you must take on for yourself are greater. Added to those challenges are a complete switch in service provision and the need to learn skills that nobody around you will ever need. It really is enough to make you go screaming for cover. In our modern society of integration and independence, entering the world of adulthood remains daunting for a disabled
teenager. As much as teenagers hate to be told what to do, they need the help and advice of somebody who has been there before. It is this very need that is being addressed by a new charity, the Priority Trust. The trust's founder, Kieran Prior, is himself a wheelchair user and the Priority Trust aims to provide greater independence to young people in two very practical ways. It funds mobility equipment – arguably the key tool for setting out in the world – and it runs a blog with a number of contributors, all of whom are adults who have successfully navigated the minefield. Kieran himself, writes in his first entry: “We came up with the idea of using my life and career experience to show others what can be achieved and to open the issue of disability to a new audience.” Other bloggers have joined Kieran and between them will cover such subjects as work, housing, employing personal assistants, university and relationships. It aims to be interactive, so questions and discussion can prompt the bloggers to give particular information. You can view the blog at www.prioritytrust.org/blog/
University projects feature in exhibition PROJECTS developed at the university of Dundee featured in an exhibition of assistive technology that can enhance the lives of people. Rolf Black and Dr Annalu Waller from the university’s school of computing attended the opening of the ATcare design and development centre in London to demonstrate two projects that aim to help children with complex communication needs (CCN). The PhonicStick is a prototype joystick to improve the ability of children with CCN to generate speech through a computer, and is funded by Capability Scotland and the Nuffield Foundation. 'How was school today?' has developed software to enable CCN children reliant on speech-generating devices to tell others about their school day. Using sensor and other data, the software automatically generates novel
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The PhonicStick
stories about the child's day. The 12-month EPSRC funded feasibility study is a collaborative project with the University of Aberdeen, Capability Scotland and Communication Matters. Dr Arlene Astell from the University of St Andrews also demonstrated CIRCA, a research project carried out jointly with Dundee that has found a way to promote communication for elderly people with dementia. Annalu said: “The feedback on our projects was superb and at one point people were queuing three deep to see the PhonicStick and ‘How was school today?’. It was great to think that we had three out of the eight projects being demonstrated.” ASSISTIVE TECHNOLOGIES I APRIL/MAY 2009
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G&M ANNOUNCES NEW ASSESSMENT AND MANAGEMENT OF GAIT SEMINAR DATE
G&M WINS BEST STAND COMPETITION AT BAPO
G&M held two inspiring multi-disciplinary (podiatrists, physiotherapists and orthotists) seminars in 2008 covering many topics relating to the analysis and management of gait.
G&M was proud to take home the best stand competition prize, voted for by the delegates attending the BAPO 2009 exhibition at the Reebok Stadium in Bolton. Its stand was custom designed and housed a number of its new and existing products, and included an ice cream factory where delegates could make their own, including choosing flavours and adding their own sprinkles and sauces. Marketing manager Gemma Hirst said: “This year’s BAPO was an excellent exhibition for G&M, we generated a huge response to our new products and of course the ice cream machine went down a storm. “Anyone involved with exhibiting will know how much time and effort goes in to producing an interesting and customer enticing stand, so to walk away with the prize was an honour and we would like to thank everyone who took the time to vote for us.”
And, due to an overwhelming response, the company has announced the next seminar will be held on May 27 and 28 at the Ramada Jarvis Hotel in Solihull, Birmingham. G&M has also added an optional second day to their seminar entitled ‘New Opportunities in Postural Alignment: Carbon composite AFO and new theories for use of a VAHO’ covering treatment options for paediatric gait and looks at the use of products such as SWASH and KiddieGait, the latest addition to the ToeOff family of products. The seminar will cover many topics relating to the analysis and management of gait including practical patient demonstrations. Attendees can expect to gain knowledge of how the foot affects the whole chain all the way up to the pelvis and develop a great understanding of the importance of a functional foot. Contact: Telephone 0121 475 1101 or email marketing@gilbertmellish.co.uk
WALK ON WITH FIT KIT
HIPTRIC BRACE TO HELP PATIENTS
THE new Otto Bock Fit Kit is an ideal tool to enable you to trial the Walk On orthoses before making a definitive purchase.
THE Hiptric™ from Ossur is a post-operative brace designed to protect primary arthroplasty patients at risk of dislocation, hip revision patients, recurrent dislocations, inoperable hip abnormalities or for preventative use in everyday living.
The kit comprises of two sizes (36 and 41), both left and right, to enable you to fit patients for trial purposes.
The innovative design prevents hip dislocation postsurgically by dynamically applying an abduction force to the affected side and by limiting flexion and extension, movements which can trigger a dislocation.
The Walk On is designed solely for use on active patients with peroneal palsies and weakness of dorsi-flexion of the foot or paralysis. As a result of its anatomical design, and the use of carbon fibre compound material, the Walk On meets all requirements for higher walking speeds and load capacities. It supports dorsi-flexion of the foot and limits plantar-flexion in a passive, flexible manner. Gait analysis studies have shown that, compared to other carbon orthoses with frontal contact in the standing phase, the Walk On offers increased stability for the user. Contact: Telephone 0845 430 1231 or visit www.ottobock.co.uk
The unique sliding joint follows anatomical hip movement and provides an abduction force which increases as adduction increases, allowing for a natural gait when walking. Unlike a conventional orthosis, the Hiptric™ maintains a constant abduction force when the patient is sitting or ascending stairs. The low profile design offers improved comfort, cosmesis and patient compliance, whilst the modular system allows for an optimal user fit and a reduction in inventory stock levels. A completely new concept and product to the market, the Hiptric™ is backed by a clinical trial and research by Össur, and is proven to deliver excellent security, compliance and efficacy. Contact: Telephone 08450 065 065 or visit www.ossur.co.uk
NEW FOOT DROP SYSTEM HAS MANY BENEFITS THE NESS L300 Foot Drop System from Bioness is a non-invasive, advanced neuroprosthesis indicated for treatment of foot drop in patients with stroke, traumatic brain injury, Multiple Sclerosis, Cerebral Palsy, and incomplete spinal cord injury. Key benefits of the NESS L300 include: Facilitation of a more normal gait Muscle re-education Prevention/ retardation of disuse atrophy Maintenance/ increase of joint range of motion Increase in local blood circulation Unique gait sensor The NESS L300 also has a unique gait sensor that adjusts to accommodate uneven surfaces and changes in elevation to help patients walk safely and confidently, regardless of terrain. The NESS L300 Leg Cuff is a light-weight device that was designed to be comfortable to wear and easy for patients to put on without assistance. The electrodes are located within the custom fitted device; a clinician positions them prior to initial use and once they are in place, patients don't have to reposition them. Contact: Telephone 0800 411 8100 or visit www.bioness.com
22 ASSISTIVE TECHNOLOGIES I APRIL/MAY 2009
CASTING SAFETY STRIP SAFETY of your patient is paramount especially in these days of litigation. Cast removal has been a potentially dangerous process in the past when using knives or blades. It is the duty of the clinician to prevent the patient from being put at risk. The Casting Safety Strip is a specially made PVC channel that creates a space under the plaster for your plaster scissors, protecting the patient at all times. We can now offer our specially designed stainless steel plaster scissors for use with the Casting Safety Strip. Not only are they safe, they make plaster removal extremely easy. The Casting Safety Strip process is used in the teaching of student Prosthetists and Orthotists in the UK. Casting Safety Strip costs £15.90 per metre Special Cast scissors £19.00 per pair Prosthetist/orthotist starter kit £35.00 1 metre casting strip Special cast scissors Indelible pencil Chinagraph pencil Postage and packaging £5.00 M G Gillgan Ltd Enquiries: Telephone 0161 747 8728 or email mggilligan@hotmail.com
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