INNOVATION FOR INDEPENDENCE ISSUE 100 DECEMBER 2014/JANUARY 2015 £6.95

By Nicola HydeCLINICAL studies will start next year in apioneering project that uses cells from thenose to repair damaged nerves in the spinalcord and potentially ‘cure’ paralysis.

A state-of-the-art clean room to culturecells is currently being completed at theUCL Institute of Neurology which will leadthe research into use of OlfactoryEnsheathing Cells (OECs) to repair brachialplexus avulsion, an injury common inmotorcycle accidents when the nerve rootsare pulled out of the spinal cord and thearm is left paralysed.

The pioneering research from ProfessorGeoff Raisman was plunged into thespotlight last month when it appeared onBBC One's Panorama programme.

The patient, Darek Fidyka, was paralysedafter suffering stab wounds to the back in2010, leaving an 8mm gap in his spinalcord. Scientists used the OECs thatregenerate damaged cells in our nose tomake repairs to his spinal cord.

Professor Raisman first discovered OECs in1985 and in 1997 successfully showed thatthey could be used to treat spinal injuries inrats.

He has spent the past decade developingspinal repair techniques for patients.

He said: “It is immensely gratifying to seethat years of research have now led to thedevelopment of a safe technique fortransplanting cells into the spinal cord.

“I believe we stand on the threshold of ahistoric advance and that the continuationof our work will be of major benefit tomankind.

“I believe we have now opened the door toa treatment of spinal cord injury that willget patients out of wheel chairs.

“Our goal now is to develop this firstprocedure to a point where it can be rolledout as a worldwide general approach.”

For the experimental treatment, Darek firstunderwent brain surgery to remove one ofhis olfactory bulbs, it was placed in a cellculture for two weeks to produce OECs.

These were then injected into the spinalcord above and below the injury, and fourstrips of nerve tissue were taken from theankle and patched across the 8mm gap.These formed ‘bridges’ for the spinal nervefibres to grow across.

Three months after the surgery, Darek’s leftthigh muscle began to grow and after sixmonths he was starting to walk within therehabilitation centre with the help of aphysiotherapist and leg braces.

Studies to repairdamaged spinalcord set to start

A woman has modelled in a Marilyn Monroe inspired photo shoot –wearing a running blade encrusted with crystals. Belinda Gatlandwanted the shimmering prosthesis for a charity photo shoot.Prosthetist Bob Watts worked closely with GlamSticks to create theglamorous end result. Belinda modelled the crystal leg to re-enact oneof the most iconic images of the 20th Century; the infamous momentwhen Marilyn’s white dress blows up as she stands over a subwaygrate.

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Bid to fund simple deviceA CROWDFUNDING campaign hasbeen launched to help produce asimple device that will create awheelchair push-rim cover that willmake it more comfortable for usersto propel themselves.

The invention – called Grippoz – isthe brainchild of Paul Lawson fromAlyth, Perthshire, whose partnerDiana has been wheelchair-boundfor six years.

Paul made a prototype of hisinvention after seeing how pain andlack of grip frustrated Diana incompleting everyday tasks.

The plan is for the invention to gointo full production, with the push-rim covers made from colourful,durable silicone with antimicrobialelement.

The social enterprise that has beenset up to market the product will sellGrippoz online, with profits beingused to help other small businessesand new products in the area.

The initial funding needed for theinjection moulds is being raisedthrough the establishedcrowdfunding platform, Kickstarter.The campaign will run online until8th December and aims to raise atleast £22,500.

Diana said: “I always had to wait forPaul to come and push me along.

When I first went out with myGrippoz on, I realised I didn’t have towait for him and went off myselfinto the hospital for myappointment.”

Grippoz are made from injectedsilicone which offers users additionalprotection from germs and infection,and their robust design helps toprotect furniture from bumps andscrapes.

Paul and Diana want the benefits ofGrippoz to help others and arelicensing the product to a social

enterprise managed by GrowBiz.

Self-propulsion is a highly repetitivetask for wheelchair users, frequentlyresulting in musculoskeletaldisorders.

It is estimated that nearly 70 per centof manual wheelchair users willexperience upper extremity pain oroveruse injury at some point in theirlifetime.

If the campaign achieves its target of£22,500, it will then aim to raiseadditional funding to produceGrippoz for children’s wheelchairs.

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by Simon Dickinson, ClinicalDirector, TalarMade

DUE TO the financial constraintsplaced on the NHS and the need todo “more for less”, the strain onrehabilitation services has never beengreater.

Orthotics and Prosthetics, as clinicalservices have a very differentfinancial composition than manyother AHP services. In mostphysiotherapy services in England theratio of staff pay to consumables(non-pay) is heavily in favour of staffcosts with staff pay making uparound 80-90% of service deliverycosts.

In Orthotics the non-pay costs (costsof orthoses & consumables) farexceeds the pay costs (staff costs)with 60-70% of service delivery costsestimated to be non-pay costs.

An ageing population and increasingrates of people with diabetes doesadd extra strain onto orthoticservices, but there is another hiddenreason why I believe Orthotic servicesare under increasing pressure. Ourability as orthotists to help patientshas increased. As the practicalapplication of biomechanical theory

has become better understood in thehealthcare system, our skills andinput is increasingly being demandedby colleagues and patients.

As our clinical abilities haveexpanded, we have been asked tosee increasing numbers of patientswith very few occurrences of thefunding for our services beingincreased. This has been highlightedby the Orthotics Campaign, a patientgroup desperate for improvements inclinical services, reduced waitingtimes and improvements in the wayorthotic services are funded (visitwww.orthoticscampaign.org.uk formore information). This patientgroup are currently working with NeilChurchill, director of patientengagement at NHS England. Neilhas agreed to carry out an initialproject to collect Orthotics data fromproviders across England. The NHSQuality Observatory is in the processof pulling together this data on hisbehalf. In February 2015 Neil willpresent the data he has extractedfrom the Orthotics Providers at around table event. The output of thisevent will hopefully formulate a planto address the Orthotic needs in apopulation and how to monitor andaddress these needs.

The way orthotic services are fundedacross the UK varies significantly. Thevast majority of services are fundedon a block contract (fixed sum peryear). These services have not seenany inflationary increases in fundingfor many years. A small number ofservices however are funded on apatient by patient basis either bydirect reimbursement (all bills paid),single or combined tariff.

The inconsistency of how services arefunded and delivered is, I believe,the biggest challenge currently toour profession and Orthotic services.

Commissioners of orthotic servicesare often unaware of thecomplexities of the orthotic servicesthey are commissioning and theepidemiological variance in types oforthotic treatment given from oneprovider in a particular setting toanother.

BHTA, BAPO and NOMaG have beenworking together to try to formulatea national tariff structure forcommissioning orthotic services in anattempt to have some consistency inthe way services are funded. Thiswork has been difficult andprotracted but has highlighted hugevariance in the way services have

been provided and funded. Therehas also been inconsistent input fromall orthotic service providers (bothcommercial and NHS).

With the NHS currently demanding“more for less” I am uncertain that anational tariff for orthotics will orshould be accepted. Having acommissioning framework based ona tariff structure would be asignificant improvement but is notthe final solution. It is however astep in the right direction.

Simon Dickinson

Is a national tariff the solution tofunding Orthotic services in the NHS?

By Nicola Hyde

AN innovative bionic leg is set to help patients ofa leading physiotherapy and healthcare practicerecover from neurologic and orthopaedicconditions.

BWT, which operates physiotherapy and healthcarecentres across Dorset, secured £13,000 from assetfinance specialist Academy Leasing to purchasethe state-of-the-art rehabilitation equipment.

“The leg is a wearable device that candramatically improve balance, mobility and qualityof life,” said BWT Partner Linda Whike.

“Thanks to lease funding from Academy Leasingwe can now offer the very latest treatmentinnovation for patients – and provide a therapy that is currently unavailable from theNHS.”

The bionic leg can also help patients re-learnfunctional movements and is currently being usedby BWT to support the recovery of stroke victims.

BWT, which employs a team of 25physiotherapists, is now planning to invest in more of the bionic leg units from US company AlterG – famed for its Anti-GravityTreadmills.

“BWT boasts an impressive track record forpushing the boundaries of healthcare andrehabilitation,” added Academy Leasing ManagingDirector Michael Nolan.

“This latest investment will help the company laythe foundations for even greater success andpatient care.”

‘Bionic leg improves balance,mobility and quality of life’

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Stanford Chemical Engineering Professor Zhenan Bao points to a diagram of a rubber molecule, indicating the springy featureexploited by her team’s wireless pressure sensor. Credit: Stanford Engineering

SCIENTISTS are developing apressure-sensing technology thatcould lead to touch-sensitive skinfor prosthetic devices.

A team at Stanford have inventeda sensor that uses radio waves todetect subtle changes in pressurewhich has already been tested inlab mice with brain injuries.

But the underlying technology hassuch broad potential that it couldone day be used to create skin-likematerials that can sense pressure,leading to prosthetic devices withthe electronic equivalent of a senseof touch.

A nine-member research team ledby Chemical Engineering ProfessorZhenan Bao detailed two medicalapplications of this technology inNature Communications.

In one simple demonstration theyused this wireless pressure sensorto read a team member's pulsewithout touching him.

In a more complex application,they used this wireless device to

monitor the pressure inside theskull of a lab mouse, anachievement that could one daylead to better ways to treat humanbrain injuries.

Bao's wireless sensor is made byplacing a thin layer of speciallydesigned rubber between twostrips of copper. The copper stripsact like radio antennas. The rubberserves as an insulator.

The technology involves beamingradio waves at this simpleantenna-and-rubber sandwich.When the device comes underpressure, the copper antennassqueeze the rubber insulator andmove infinitesimally closertogether.

That tiny change in proximity altersthe electrical characteristics of thedevice. Radio waves reflected bythese antennas slow down interms of frequency. When pressureis relaxed, the copper antennasmove apart and the radio wavesaccelerate in frequency.

The engineers proved that this

effect was measurable, givingthem a way to gauge the pressureexerted on the device by trackingthe frequency of radio wavesinteracting with the device.

Former Stanford graduate studentsLisa Chen and Benjamin C-K Teedesigned and modelled the physicsbehind the device, and calibratedthe pressure sensor in simplelaboratory tests.

Alex Chortos, graduate student inthe department of materialsscience and engineering, made thewireless device more robust andre-usable.

Bao said: “The device we inventedhere is extremely easy tomanufacture and consumes noenergy until readings are beingmade.

"In the short term we hope to usedevices like this to track packagesand monitor health conditions. Inthe longer run we dream of usingthis technology to create touch-sensitive lining for prostheticdevices."

Touch-sensitive technologydeveloped by scientists

Rogue trader is jailed over mobility goods conA MAN who conned disabled andelderly customers out of their muchneeded mobility goods has beenjailed and fined.Rogue trader Scott Keeley, 26, ofSincil Mobility, was investigated byLincolnshire Trading Standardsfollowing a complaint by one of hiscustomers. He had sold the man a mobilityscooter as an ex-demonstrationwhen it was actually over seven yearsold. Registration documents from theDVLA had been faked and he hadtaken payment for insurance, despitenot arranging any.Mr Keeley also sold defective

scooters to other customers and ifanyone complained, he failed tooffer repairs or a replacement. Onone occasion a victim received acheque for a full refund ofapproximately £2,500, but itbounced.Mr Keeley also cheated residents byoffering to sell their mobility goodsin his shop on Sincil Street for anagreed price. These victims receivedno payment and never saw theiritems again.Then, when he realised his businesswas in trouble he contactedcustomers who were happy withtheir purchases and claimed theirvehicle needed a service. It is

believed these vehicles were sold toother customers, leaving his victimswithout the mobility scooters theydepended on and out of pocket.Rebecca Money, Senior TradingStandards Officer, said: “This wasclearly a very serious case as thetrader was intentionally targetingand exploiting elderly and vulnerableresidents. “Having worked closely with MrKeeley’s victims and seen the upsetand detriment they have endured,this is a welcome result. I hope thiswill be a warning to other mobilityaids businesses who may be temptedto take advantage of vulnerableconsumers.”

The British Healthcare TradesAssociation (BHTA) has condemnedfraudulent practice and said the firmwere not members. Ray Hodgkinson MBE, DirectorGeneral of the BHTA, said: “We needto stop rogue traders preying onvulnerable consumers. “Our members are alert for badpractice in their area and have oftenalso been able to assist consumerswho are victims, for example byhelping them replace equipmentfraudulently removed, such as ascooter.”Mr Keeley was also ordered to paycompensation to ten of his victimstotalling £5,734.99.

New reportsuggestslack of AHP dataA NEW report suggests there is alack of data on the contributionallied health professionals are makingto the quality of patient care. More than 64,000 AHPs work in theNHS in England outnumbering GPsand representing one of the largestproviders of outpatientappointments. Focus on: Allied Health Professionals,a QualityWatch report published bythe Nuffield Trust and the HealthFoundation, states that there shouldbe more focus on the contribution ofAHPs. It explores how best the quality ofcare can be measured, with keyrecommendations such as havingaccess to technologies for sharedcare records, recording a broaderrange of activity, more specificstudies on short term outcomes andfurther training in recording andusing comparable data.Chris Austin, Research andDevelopment officer at the Collegeof Occupational Therapists said:“There is a paucity of data thatdemonstrates what we already know– occupational therapists and otherallied health professionals aredelivering excellent care. There aresome exemplary research studies inthe report, illustrating thatoccupational therapy is improvingpatient outcomes in key areas suchas stroke. However, we need morestudies like these to becommissioned, we must startmeasuring quality of care. “We know that just 57 per cent ofoccupational therapists are usingdigital care records and only 70 percent have access to word processingand other office software at work. “I encourage occupational therapiststo bring this report to the attentionof their managers and discuss theirneeds for collecting quality data toimprove patient care.”

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Diamonds are agirl’s best friendA WOMAN has modelled in a MarilynMonroe inspired photo shoot –wearing a running blade encrustedwith crystals.

Belinda Gatland wanted theshimmering prosthesis for a charityphoto shoot. Prosthetist Bob Wattsworked closely with GlamSticksto create the glamorous end result.

Belinda modelled the crystal leg tore-enact one of the most iconicimages of the 20th Century; theinfamous moment when Marilyn’swhite dress blows up as she standsover a subway grate.

She said: “I feel a bit like Cinderellaas I am the only person in the worldwhom it fits. It is quite surreal aspeople come and take photographsof it, it is truly beautiful.”

Belinda had her left leg amputatedafter years of operations to try andcorrect damage that resulted from ahorse-riding injury.

Now, with a standard running bladefrom Dorset Orthopaedic she lives anactive life in Dubai and continues towork with horses as an Equine SportsMassage Therapist, keeping horses ingood physical health.

She added:“You go on ajourney whenyou have yourleg amputatedand at first youwant to hide it,but then after awhile itbecomes part ofyou and to memy blade is athing ofbeauty.”

Belinda wearsher day-to-dayprosthesis forwork but wearsa running bladewhen she iswearing a heel and likes to show itoff, even adding touches of bling andglam to her socket with ribbon andgems so it looks the part when she iswearing an evening gown.

“A prosthesis is an amazing piece ofinnovation, a work of art, and italmost becomes an accessory thatyou want to show off – and whynot? Why not have some fun withit?”

Belinda Gatland

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A STUDENT-led research group hasdeveloped a 3D-printed prosthetichand that can learn functionalalgorithms.

The team from the University ofIllinois have created one of the first3D-printed prosthetic hands withpattern recognition capability.

A machine-learning algorithmallows it to do more than justopen and close. It learns otherpositions of the hand for morefunctionality – and it costs $270compared to the averagemyoelectric prosthetic, whichretails for between $30,000-$40,000.

Team leader Aadeel Akhtar, anMD/PhD candidate in neurosciencefrom the College of Medicine atIllinois, said: “Using the machine-learning algorithm based off thesignals it picks up from themuscles, it can figure out which ofthese grips he is actually doing.

“The microcontroller with themachine-learning algorithm willthen replicate the grip he's tryingto make. Based on those signals, itsends commands to motor drivers,which churn the motor and makethe hand move.”

Although the EMG board that isbeing used for the currentprototype is the size of a standard

audio mixing board, it willeventually shrink to a size that canfit into the socket of a residuallimb.

Akhtar's team has created amathematical model of five actions– a hand at-rest, open-faced,closed (tool grip), a three-fingergrasp, and a fine pinch. The initialtraining takes about one to twominutes and involves a patientgoing through each one of thegestures.

In August 2014, Akhtar and MaryNguyen, a master's student inaerospace engineering, travelled toSouth America to put an open-source dexterous artificial hand tothe test on an Ecuadorian man.

“The goal of the trip was to get itto work with a patient," Akhtarsaid. “Although it took somedebugging, we were successful."

The hand itself takes about 30hours to print, then another twohours to assemble. All theelectronics that are necessary toconvert the neural signals intomovements are located within thehand.

The team is working on the thirditeration of their design in whichthe palm will be thinner and thefingers stronger.

They plan to return to Ecuador inearly January to leave it for apatient, and the group has evenbigger plans for future iterations ofthe device.

He added: “No commercialprosthetic device has any sort offeedback. We're going to putsensors in the fingers. Based onthe amount of force that thefingertips are detecting, we aregoing to send a proportionalamount of electrical current acrossyour skin to stimulate your sensory

nerves. By stimulating your sensorynerves in different ways withdifferent amounts of current, wecan make it feel like vibration,tingling, pain, or pressure.

"We did some initial experimentsin the lab and found that with onlysix minutes of training, users coulddistinguish between six differentgrips with 88 percent accuracywithout looking. With that kind ofresult, image how well someonecould operate it in even a week'stime."

The 3-D-printed prosthetic hand can be programmed to recognize a hand at-rest,open-faced, closed (tool grip), a three-finger grip, and fine pinch.

Student team creates one of first3D-printed prosthetic hands

Charity to getlottery shareA CHARITY that was set up to supportamputees has been told it will get ashare of a £2.1m lottery pot to helpincrease the numbers of disabled peopleplaying sport.Sport England announced the boost todisability sports funding with an awardfrom the National Lottery – andLimbPower will get a share of the cashto fund a three-year scheme to helpthem engage with, and increaseaccessibility to sport for amputees andambulant disabled.The cash – over £210,000 – will be spenton rebuilding the LimbPower website,running four new Introduction to Sportworkshops in or around limb centreseach year, creating toolkits to supportaccess to sport, and creating a Guide toSport. The charity will also beemploying a full-time Sports Officer.Kiera Roche, LimbPower founder, said:“This a really exciting time for us andthe charity’s development. We haveachieved a great deal in just four years,and with this funding we are now ableto really build upon the strongfoundations we have laid and put intoaction some of the plans we have beenworking on for some time.”

AN APP has been developed thatwill help prosthetists decide whichknee is best suited to individualpatients based on both mobility andactivities.

Ottobock has launched the KneeSelection online application whichanalyses amputees’ needs, daily lifeand activities to find the bestOttobock knee joint for theirindividual requirements.

The online app asks multiple choicequestions based on the mobility

grade of the amputee, the user’sweight class and what activitiesthey participate in regularly ineveryday life.

It then quickly determines whichprostheses would be most suitableand provides in-depth productdetails, including how effective eachis for achieving selected activitiesand a 360 degree video of eachknee.

Ken Hurst, Academy prosthetist,said: “We aim to provide advice and

support to our customers wheneverpossible, and as such havedeveloped this new online tool toguide clinical team members as tothe best knee joints for their clients.It will enable quick and easilyobtainable intelligence to aid thedecision-making process of a fitting.

“Ottobock have a range of kneejoints to suit a wide selection ofamputees from indoor walkers tothose who partake in an activelifestyle. This tool will quickly selectwhich are most appropriate.”

Onlineapp tohelpwithkneechoice

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By Nicola Hyde

A PROSTHETIC leg is celebratingits 15th anniversary with thenews that it has helped over40,000 amputees worldwidethanks to its popularmicroprocessor knee.

Ottobock’s C-Leg wasintroduced in 1999 and was theworld’s first computer-controlledlower limb prosthesis and sinceits launch has been developedwith more technology to makeit the leg it is today.

Louise Tait was the UK’s firstever C-Leg patient.

She became an above kneeamputee in 1987 and hadproblems finding a socket thatfit due to the shape of herstump. She is still using a C-Legover a decade later.

Louise said: “Finding a kneethat you trust builds confidenceso everyday activities becomemore natural.

“You use less time and energythinking about where you arestepping and more time just

getting on with life.

“To get the most out of it youneed to practice and it takestime and repetition buteventually you will be walkingwithout constantly thinkingabout each step and when thathappens, it's a marvellousfeeling.

“Even after 15 years I rememberhow brilliant the C-Leg felt thefirst time I tried it, how fluid themotion was and once I learnedto trust it.

“I can walk down slopes withconfidence and the kneedoesn’t give way or collapse.When I learned to walk step-over-step down stairs, it gaveme a feeling of realachievement.”

The C-Leg has on-board sensorsand microprocessors toanticipate and adapt to aperson's movement, itimmediately adjusts 50 timesper second to changes inwalking speed and direction,providing knee stability themoment it is needed.

This optimised stumble recoveryfeature means users are able towalk down ramps and stairsstep-over-step and manoeuvreon rough terrain with a greatlyreduced fear of falling.

Programmed via Bluetoothtechnology to match the uniquegait of their sound leg, a useralso has several different activitymodes available to them thatallow stances for biking,golfing, and are activated usinga remote control.

Phil Yates, Managing Director ofOttobock UK, said: “The C-Leghas been paramount tochanging the way thatamputees have been fit withprosthetic knees in the past 15years and has changed manypeople’s lives by providing morestability, more flexibility, and aknee that responds differently ina range of circumstances.

“Ottobock is also very gratefulto the talented Prosthetists anddedicated patients who havehelped the development of thetechnology across the years.”

Ottobock celebrates 15 years ofcomputer-controlled lower limb

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CARE today is shaped by guidelinesfor clinical effectiveness which areindexed to a large statisticalpopulation rather than anindividual - and this constitutes aproblem. Rehabilitation has alwaysbeen a demanding specialitybecause of the very individualchallenges each person presents.It’s hard for the NHS to provide anefficient system that can deliverintensive and highly personalisedrehabilitation services.

Sadly, restoring an individual’squality of life following acatastrophic injury or after theyexperience a neurological conditionsuch as a stroke is more oftenlimited by the resources, attitudes,beliefs, structures and processes ofour health and social services thanit is by any fundamental lack ofknowledge of how to implementhealthcare.

We often might know what to dobut lack of financial resource in thesystem acts as a barrier. Other

barriers exist too – the question is– how can these barriers besurmounted?

Some feel that technology is theanswer. Certainly with some ofthe technology now available forrehabilitation, we can rejoice thatthis has attracted greaterawareness and interest to an areathat has not been a well-resourcedarea of medicine in the past.Technology alone will not providethe answer though. It provides theleverage to bring about positiveimprovement but to exploit thispotential is not easy.

In a long academic career I learnedto look outside of our field for thetechnology that would be capableof changing the status quo. Wecan now see evidence, forexample, of technology developedfor military or car manufacturinguse appearing in rehabilitation.

The Ekso Bionics system, forexample, is a leading edge productthat emerged from an original

investment for military purposes.The result is an exciting productbut at a cost that would challengethe pockets of most people rightnow. The Tek RMD (Pictured) alsotaps into military roboticstechnology but aims to be a more“down to Earth” practical productthat is affordable right now.

Now technology brings energy andhope. We now need some “bigthinking” if we are to tackle someof the problems we face inbringing effective rehabilitation tomany more people. Google Xbelieves in going for the hugeproblems of life with a mantra of“10 times rather than 10%”. Thelogic of this is that when you try todo something just 10% better, youinevitably create a structure thatmaintains the status quo. If thepremise is to create something 10times better, it requires a differentmindset and some counter-intuitivethinking. Exciting times if we havethe courage.

By Derek Jones PhD MBA Director, Anatomical Concepts (UK) Ltd

Exciting times for rehabilitation ...

BBC’s Panorama programme showed us the first ever repair of the spinal cord in a human being and ithas prompted a global debate. The experts at Cyclone Mobility share their thoughts.

IN THE aftermath of the BBCPanorama programme there is someturmoil as to whether this is thebeginning of a new era or justanother publicity stunt to get themillions of 'normal' able bodiedpeople to realise that in a splitsecond spinal cord injury (SCI) couldget them.

So the jury's out and judgment is yetto be clinically delivered and printedmedia together with social media iswild with statements like ‘it wasunder his nose all the time’ and thisis the moment when we begin toreverse paralysis.

What is without question now is thatwe are truly getting closer than everto the actual possibility of one daySCI meaning exactly that Spinal CordInjury. It will one day no longer betaken for granted that SCI whethercomplete or incomplete willultimately lead to paralysis.

But and this is a big BUT! how longwill it be before we see that day andwhat does this mean for those whotoday are paralysed through SCI.Statements like this summarise a lotof people's thoughts:

“If the current study is not furtheringdevelopment of a therapy, it's justgee-whiz, wowie-zowie. We have to

fight for studies that furtherdevelopment of therapies -- thatmove the damn dial toward the endgoal."

What is absolutely true is thatpresently we cannot reverse paralysisfor the masses, but we can becauseof years of clinical trials make theoperational muscles in the bodyactually work. In 2005 RestorativeTherapies of Baltimore USA were thefirst people to clear FDA with an FEScycle that could be used in home orrehabilitation clinic.

The RT300 is cleared for use by allSCI victims to maintain muscle massand have their limbs move as if theircentral nervous system wasprocessing the information.

No media attention in the massescovered this however, even thoughthis is actually more important thanjust one person being miraculouslycured or robots taking control of ourambulatory movement and 'walking'us. This is more important because it

is actually triggering the bodies ownsystem to function and when thescientists make their miraculousbreakthrough it will be vitallyimportant that the body is ready totake opportunity.

If we breakdown the factors ofparalysis we can easily see that theend goal is not necessarily the mostimportant, first on the list bladder,then bowels followed closely bysexual function then for tetraplegicsthe ability to use hands, arms andfingers. But imagine the storyline'man able to pee' or 'first time hecould feed himself'.

What we need to remember is thatresearch is going on ALL the timebut to make serious in roads intoWHEN because we no longer talkabout IF, real scientists need oursupport.

Programmes such as the RoyalHolloway breaking down of scartissue are behind the veils of massmedia attention and getting on with

vital work.

What we do understand from yearsof research is that fundamentally ifwe don't give the muscles in ourbody a job to do they will forget todo that job and maybe just maybethey will find something else to do.

Reality is sometimes a harshreflection which is left to amazingcharities like BackUp, SIA and Aspireto deal with, and deal with itremarkably they do with mentoring,daily living skills training, familysupport, counselling, housing, peer development, politicalcampaigning and welfare support toname just a few of their combinedsupport.

I personally have accepted life satdown however I would be lying if Itold that I had given up on everseeing the ‘cure’ in my lifetime. Inow believe I will see it but notbenefit from it, and if I can be partof that process that cures paralysiswhether it is partial cure to getpeople breathing independently,toileting freely or the whole packagebig dream then I'll be happy.

Today we are part of that wholeprocess with Exoskeletons, FEStherapy and psychological support,tomorrow who knows.

Fact or fiction?“If the current study is not furthering development of atherapy, it's just gee-whiz,wowie-zowie.We have to fight for studies that further development of therapies –that move the damn dial toward the end goal."

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While the patient is wearing the TVSBrace, the knee will be re-aligned toits original gait and long term usewill stop the knee from sagging to amore extreme position preventingthe need for a surgical solution.

The TVS has helping relieve arthriticknee pain to over 25,000 patients inthe UK alone for over 40 years.

Varus (bow-legged) and Valgus(knock-kneed) deformation support.

Helps relieve arthritic knee pain.

NHS approved and clinically provenfor over 35 years.

Easily attached and removed inseconds.

Ultra lightweight (200grams/8oz).

Greatly increase stability and securityfor the wearer.

Comfortable to wear andunobtrusive (can be worn underclothes).

Suitable for both legs.

Children’s size available.

For more information call 02380 643402,email sales@stclare-engineering.co.uk or

visit www.tvskneebrace.co.uk

TVS Brace ‘the kneesupport you can rely on’ LOOKING for specialist

seating options for childrenwith complex postures?Specialised Orthotic Serviceshas the answer.Better known as SOS,Specialised Orthotic Servicesare one of the UK’s leadingproviders of special seating,mobility and positioningproducts. SOS works closelywith NHS WheelchairServices, OTs andphysiotherapists to offerclinical services, advice andassessments nationwide.The company offers a comprehensiverange of special seating, thesuccessful Mojo wheelbase range ofmobility products and the Poziformrange of harnessing and positioningequipment, SOS has a wealth ofexperience in dealing with complexpostural problems. This includes theaward winning P Pod Bean Seat,Equipoise Straddle Seat and NessiePositioning Aid.The P Pod gives clients an alternativeseating option for the home without

compromising on levels of support.The standard or custom moulded topcombined with a unique beanbagbase offers unrivalled comfortwithout the wheelchair.Nessie and Equipoise help aidposture development, a comfortablealternative to 90/90 correctiveseating systems.

Contact SOS today or visit their websitefor more information. Specialised OrthoticServices Ltd Unit 127-128 Fauld Industrial

Park, Fauld Lane, Tutbury, Staffordshire,DE13 9HS Call: 01283 812860 Email:

enquiries@specialorthotic.com

Award-winning paediatric productsfrom Specialised Orthotic Services

NEW! Children’s TherapeuticFootwear

Superior comfortable, stability andsupport.

Stability footwear is ideal for childrenwho need extra support duringwalking as the shoes help to improvestability of the foot.

Features and benefits:

Velcro and lace styles help childrendevelop independent dressing skills.

Low opening style easy to takeon/off.

Light weight rubber soles help withmore energy efficient gait

Fully breathable lining reduces skinirritation.

Padded collars ensure a comfortablefit.

Extra padding around heel stiffenersimprove comfort.

Extended stiffeners on both medial &lateral sides provide improvedstability of the foot.

Adaptable sole provides enhancedfunction.

Leather uppers are durable andbreathable.

Comes with anatomically shapedfootbeds.

The footwear range is available insizes 4-6.5 and various width fittings.

RSLSteeper provides a wide range ofrehabilitation products and orthoticclinical services in the UK.

Contact us today for further information atorthotics@rslsteeper.com Please visit

www.rslsteeper.com/products/orthotics

Ideal for children ...

Whizz-Kids’ bossRuth is namedin top fiftyTHE WOMAN behind nationalchildren’s charity Whizz-Kidz hasbeen named as one of the top 50innovators in healthcare nationwide.

Chief Executive Ruth Owen OBE, hasbeen celebrated in the Health ServiceJournal’s (HSJ) 2014 ‘most innovativepeople in healthcare’ list, run inpartnership with Bird & Bird.

The charity has influencedgovernment policy through constantinnovation – the ‘Child in a Chair ina Day’ initiative is credited by theNHS as a beacon of good practiceand means that in 80 per cent ofroutine cases, a child goes home intheir wheelchair on the day of theirassessment.

The charity also launched aninnovative smartphone app last year,designed to offer a faster and moreefficient service for disabled childrenand families seeking mobilityequipment and access to otherservices.

Ruth said: “I’m very honoured to beamong such inspirational innovatorsand leaders – all of whom are on thislist for their tenacity anddetermination to get things done,

and make a real difference to thelives of the people they serve.

“All credit should really go to theWhizz-Kidz team of staff, volunteersand partners who work so hard toprovide equipment and services, raisefunds, and campaign so effectively tohelp disabled kids get the good startthey deserve and go on to fulfil theirpotential in life.”

Ruth Owen OBE

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sponsors kidsDorset Orthopaedic treat clients of all ages and are highly experienced in theprosthetic care of children from all over the UK with a variety of congenital oracquired limb loss. A fifth of their clients are under 21 and require an on-going,changing level of care as they grow up. Managing Director David Hills reports.

CHILDREN can often present with anumber of complex challenges,sometimes with all four limbsmissing.

Changes can take place in the spaceof less than a year and we ensure weare always available to change oradapt limbs to suit size and heightchanges, activities and requirementsat various periods in a child's life.

We also undertake research anddevelopment to produce ‘childspecific’ products such as theEasyfitTM Junior, which is essential ifwe are to meet their needs.

In addition to exceptional caremanagement, Dorset Orthopaedichas invested into the research anddevelopment of ultra-lightweightcomposite materials and soft shoresilicones to further support children’srequirements.

Their clinics throughout the UK, from Glasgow to the South coast,have provided numerous childrenwith specialised sports blades and P.E. prostheses, water activity limbs and every-dayprosthetics.

Their team of upper limb specialistsalso fit and supply custom designed electronic, body operatedand cosmetic arms, including specialadaptations to assist with playingsports and other activities.

The EasyfitTM Junior is a costeffective and durable cosmetic coverdesigned specifically for children.Developed around the award-winning adult version, the EasyfitTMJunior can be ordered and fittedthrough any NHS or private clinic,helping kids to live ‘life withoutlimits’.

Specialist prostheticcare for children

Fundraising beginsfor young meningitisvictim HarmonieFUNDRAISING is underway for ababy from Bath who has had to haveher arms and legs amputated aftersuffering meningitis.Harmonie-Rose Allen, from Bath, wasdiagnosed with what doctor’slabelled one of the worst cases ofmeningitis they had seen and wasgiven just a ten per cent chance ofsurvival.But the 11-month-old battledthrough – but doctors need toamputate both her arms above theelbow and both her legs above theknee to save her.She’s undergoing her third operationthis month and now the communityis rallying round to help raise moneyto pay for prothetic limbs for her. Company Goldgenie Global has alsostepped in to run an ebay auction fora gold Iphone 6 to boost thefundraising.Laban Roomes, CEO, said: “We werevery moved when we read aboutHarmonie’s situation in The Metro. “Meningitis is such a cruel disease

and it is an awful thing for such ayoung child to lose her limbs to it. Toensure a suitable living environmentand the best prostheses possible,Harmonie has an expensive roadahead and we wanted to dosomething to help straight away. Wehope that donating a 24ct. GoldiPhone 6 to an online auction willnot only raise funds towards thisworthy cause but also raiseawareness about the Hope forHarmonie campaign.”Anyone wanting to make a donationhere for Harmonie-Rose can do sohere:http://www.justgiving.com/hope4harmonie where amost £30,000 of the£250,000 target has been raised.The cash for charity Tree of Hope isfor Harmonie-Rose’s futurerehabilitation and will include hydrotherapy, physiotherapy and goodquality prosthetic limbs.Any surplus will go to the generalfunds of Tree of Hope to assist othersick children.

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RESEARCHERS investigating clinicalimplications of ill-fitting orthoseshave shown that dermal contactwith an ill-fitted cervical brace cancause skin lesions and affect patientcompliance. Thus leading to theadditional increased cost of thenhaving to nurse pressure sores. For those patients who are at risk ofoccipital breakdown, due toextended periods lying supine Aspenhave specifically developed theVista® ICU Back PanelInspired by the needs of ICU nurses,the Vista ICU Back Panel isconstructed of dual density foamthat eliminates bed sheer duringpatient movement and repositioning.The first level of foam cradles thepatient’s head for maximum pressure

distribution, while the second firmerlayer provides an added support andstructure. Like all Aspen collar pads, the VistaICU Back Panel is cotton-lined towick moisture away from patient’sskin whilst providing same superiormotion restriction as the standardVista Back Panel.

For further information please contactCustomer Services 01254 268788

Research-led products

A PARALYSED man has manage towalk and deliver the speech at hisdaughter’s wedding standing upthanks to a robotic suit beingdeveloped in the UK.

Irving Caplan was paralysed in abiking accident in 2012 and wasworried he would have to give hisfather of-the-bride speech sittingdown.

But thanks to a £100,000 devicefrom Rex Bionics – he was able towalk across the venue to address theguests.

The exoskeleton suit has legs thatcontain 29 computer processorswhich communicate 3,000

messages a second to each other.

The motors can carry a personweighing up to 15 stone have beenused by 50 people, clocking up4,000 hours of walking.

They are currently estimated atcosting £97,000 but the company isaiming to get the price down to£40,000.

The exo skeletons are currently beingtested by the US military inrehabilitation centres for woundedservicemen.

Developers are also researching usingbrain control to help users mobilisein the device making it truly the onlyhands free exoskeleton.

Robotic speech allowsIrving to walk atdaughter’s wedding

RESEARCHERS have beenawarded grant funding todevelop an adaptive interfacewhich fits between a prostheticand the limb to improve fit andcomfort.

UT Arlington scientists areworking on a wearable interfaceto make prosthetics morecomfortable after being awardeda $744,300 grant from theDepartment of Defense PeerReviewed Orthapaedic ResearchProgramme.

Haiying Huang, professor in theMechanical and AerospaceEngineering Department, andMuthu Wijesundara, principalresearch scientist at UTArlington's Research Institute, arecollaborating on the project. Theinterface will resemble aninflatable bubble wrap that willbe embedded with sensors.

Huang is an expert in sensortechnology. She said four types ofsensors will be used with theinterface to monitor the fitting ofthe prosthetic device. The sensorswill measure vertical movementof the limb relative to the socketwall, the pressure on the limb,the changes in the circumferenceof the residual limb during theday, and the water content in thetissue.

She said: “Eventually, we want tobuild the socket that can adjustautomatically to the patient. Inorder to do that, we need thesensors to tell us when and howto adjust the socket. We plan todesign a warning system first,then the sensor data will teach ushow to adjust the interfaceautomatically.”

Prosthetic users frequentlyexperience discomfort, blisteringand ulcers between their

prosthetics and their residuallimbs. The limb's volume changesthroughout the day - anunavoidable fluctuation whichchanges how the limb andprosthetic socket fit together.

At the moment, many prostheticusers manually adjust the fittingbetween the prosthetics and theirlimbs by adding or removingsocks.

Wijesundara – who specializes inmedical devices for applications intissue regeneration, woundhealing, and prostheticdevices/interfaces – said theywant an adaptable interface thatcan improve comfort and the fitregardless of the residual limbconditions and improve thequality of the life for the user.

He said: “We want everything toadjust depending on whether theperson is walking, running orsimply sitting down.

“This interface technology can beapplied to various prostheticdevices and exoskeletonapplications.”

The researchers believe it couldtake three to five years to startclinical applications of the device.

The bubble actuator pictured is what the UT Arlington research team isdesigning and building.

Researchers wingrant funding foradaptive interfacedevelopment

Haiying Huang, professor ofMechanical & Aerospace Engineering.

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sponsors podiatry

Views soughton proposednew standards

Youngerdiabetics atmore risk ofamputationBy Nicola Hyde

SHOCK statistics have revealed thatyounger diabetes patients are morelikely to face amputations as they get fewer vital checks.

The latest National Diabetes Auditreveals that diabetes patients underthe age of 40 are receiving fewervital checks and hitting treatmenttargets less often than older agegroups.

Diabetes UK says the figure shouldbe a wake up call to the NHSas if younger people are missingtheir checks and failing to reachtheir treatment targets, this isputting them at increased risk ofamputation.

A spokesman said: “Put simply,younger people who developdiabetes end up living longer withthe condition.

“Surely they should be receivingjust as good careº as those who areolder.

“After all, if they get the help andsupport they need throughout theirlives then they are far less likely todevelop the serious complicationswhich make up 80 per cent of theNHS’s current budget spend ondiabetes. We hear from many peoplewith diabetes in their 30s and 40swho tell us that patchy care and lackof structured education when they were younger has alreadyresulted in life-changingcomplications.

“Things need to change for the nextgeneration but the figures tell us thatthis just is not happening.Alarmingly, it appears things are notgetting better for young people; theyare actually getting worse.”

By Nicola Hyde

A CONSULTATION is underway aboutthe proposed new standards forpodiatric surgery.

The Health and Care ProfessionsCouncil is seeking the views ofstakeholders on proposed standardsfor podiatric surgery which outlinesthe knowledge, skills andunderstanding necessary for safe and effective podiatric surgerypractice.

Once agreed, the HCPC will use thestandards to approve and monitorpost-registration education andtraining programmes.

The HCPC will in the future annotate(mark) the register to indicatepodiatrists who have successfullycompleted an approved programme.

By providing information to thepublic about who is qualified inpodiatric surgery, this annotation willhelp support informed choices.

Podiatrists complete additionaltraining lasting a number of years inorder to practise podiatric surgeryand must already be registered withthe HCPC.

Therefore, podiatrists practicingpodiatric surgery will also still need

to meet the standards of proficiencyfor podiatrists, the standards ofconduct, performance and ethics,and standards for continuingprofessional development.

Director of Policy and Standards forthe College of Podiatry MichaelGuthrie said: “We have carefullyconsidered feedback from ourstakeholders about our approach toannotating the register for podiatristspractising podiatric surgery.

“We believe that annotation willimprove public protection as we willbe able to set separate standards andcreate an independent, robustframework for safe and effectivepractise of podiatric surgery.

“When we drafted these standards,we drew on our existing standards ofeducation and training as well as

documents and frameworksdeveloped by different organisations.

“We also held a consultation eventwith key stakeholders in the field ofpodiatric surgery and are grateful toall those who have contributed tothe process so far.”

The consultation will run until 16January 2015 and will be ofparticular interest to podiatrists whopractise podiatric surgery, educationproviders, employers, professionalbodies and service users.

The HCPC will analyse the responsesonce the consultation closes, publish the comments received andexplain the decisions made as aresult.

The HCPC plans to publish theapproved standards in June 2015.

“We believe that annotation will improve public protection as we will be able to set separate standards and create an independent,robust framework for safe and effective practise ofpodiatric surgery.

15 21/11/14 12:03 Page 1

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