assistive technologies february/march 2015

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Innovation for independance



    By Olivia TaylorA COLORADO man recently became thefirst bilateral shoulder-level amputee towear and simultaneously control two ofJohns Hopkins University Applied PhysicsLaboratories modular prosthetic limbs.

    Les Baugh, who lost both arms in anelectrical accident 40 years ago, was ableto operate the system by simply thinkingabout moving his limbs, performing avariety of tasks during a short trainingperiod. Before putting the limb systemthrough the paces, Les had to undergo asurgery at Johns Hopkins Hospital known astargeted muscle reinnervation.

    Johns Hopkins Trauma Surgeon Albert Chi,M.D explained: Its a relatively newsurgical procedure that reassigns nervesthat once controlled the arm and the hand.

    By reassigning existing nerves, we canmake it possible for people who have hadupper-arm amputations to control theirprosthetic devices by merely thinking aboutthe action they want to perform.

    After recovery, Les visited the Laboratory fortraining on the use of the ModularProsthetic Limbs.

    First, he worked with researchers on thepattern recognition system, and by the time

    the socket was finished, Les said he wasmore than ready to get started.

    When he was fitted with the socket, andthe prosthetic limbs were attached, he said:I just went into a whole different world.

    He moved several objects, including anempty cup from a counter-shelf height to ahigher shelf, a task that required him tocoordinate the control of eight separatemotions to complete.

    APLs Courtney Moran, a prosthetistworking with Les, added: This tasksimulated activities that may commonly befaced in a day-to-day environment athome.

    This was significant because this is notpossible with currently available prostheses.He was able to do this with only 10 days oftraining, which demonstrates the intuitivenature of the control.

    The next step is to send Les home with apair of limb systems so that he can see howthey integrate with his everyday life, andhes looking forward to that day. Maybefor once Ill be able to put change in thepop machine and get pop out of it, hesaid. Hes looking forward to doing simplethings that most people dont think of. Andits re-available to me.

    Amputee makeshistory with twoprosthetic limbs

    British disabled skier Heather Mills is attempting to break the GuineessWorld Record for speed skating wearing a prosthetic leg that hasbeen a year in development. Heather who lost her leg in a collisionwith a motorbike in 1993 only started her professional sportingcareer in 2011 when she was approached by the head of the SlovenianMasters while on a skiing holiday in Austria. She has a host of medalsunder her belt and now has a permanent position with the Britishdisability skiing team but shes now in training to become the fastestdisabled female speed skier in the world.

    Full story, Page 8

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    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.

    Microprocessor-controlled legputs Jims life back on trackBy Nicola Hyde

    A MAN who lost his leg after it wascrushed in a forklift has spokenabout the challenges of getting theright prosthetic that worked for him.

    Jim Bruce, from Glasgow, was a keengym-goer, football supporter andgardener, but a freak acccident in1995 saw him injure his knee andshin so badly that he had to beamputated above the knee despitethe fact that his foot was uninjured.

    He said: When they told me theywere going to amputate my leg, itfelt strange but didnt really hit meuntil afterwards. It was only after theamputation that it dawned upon methat this would change my lifeforever. I was in hospital for threemonths which gave me time toreflect and then it was another sevenweeks until I got my first NHS leg.

    The amputation had a huge impacton my day-to-day life. It left meunable to do the small things I didnteven realise that I would miss, likeusing a step ladder and doing DIY.

    Jims first NHS leg used a hydraulicsystem which he found very tiringand often stumbled and fell. Later on

    in life, Jim found out about the C-Leg microprocessor knee fromOttobock from his active involvementin the amputee patient communityand was given the opportunity to tryit at the University of Strathclyde in


    He said: I was lucky to be able totry it out and I was immediatelyimpressed and knew it wouldimprove my lifestyle significantly andlet me get back to some of theactivities I enjoyed prior to myamputation.

    I can be active again; Im back atthe gym and have a bluetoothremote control that lets me changethe settings to use the treadmill orthe rowing machine. Im also havinggait training which is helping mebuild up speed and pace andimprove my walking pattern.

    Jim now volunteers on theprosthetics course at the Universityof Strathclyde. He regularlyparticipates to help aspiringprosthetists learn.

    Jim added: I really hope that in thefuture the NHS will be able toprovide microprocessor knees. It hashelped me to continue the activelifestyle I led before my injury, and Ibelieve that if a patient had a C-Legas their first leg it would help greatlywith healing and lead to fasterrecovery times.

    Jim Bruce with his C-Leg microprocessorknee from Ottobock

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    Is your orthotics service meetingyour customers requirements?By Simon Dickinson,clinical director, TalarMade

    I HAVE always found it interesting toask any clinician working in the NHSwho their customers are?

    The immediate answers are alwayspatients, but are patients really thecustomers of the NHS?

    The Oxford English dictionarysdefinition of a customer is a personwho buys goods or services from ashop or business.

    The obvious question therefore is, dopatients buy goods and services fromthe NHS? Although the NHS isfunded by taxation, the transfer ofcash to the providers of NHS servicesis not paid directly by patients(although a contribution may bemade by prescription charge in somecircumstances). So if patients arepotentially consumers of NHS serviceswho are the customers?

    Ultimately any customer has the rightto decide whether to buy yourservices or not. Therefore thecustomers of NHS orthotic servicesmust ultimately be commissionersand finance/procurementmanagers/directors in the NHS.

    These people essentially hire servicesand people (NHS or contracted) to

    deliver the care required for theirconsumers (i.e. patients).

    Over the last year I have been askedto do some work for theParliamentary and Health ServiceOmbudsman. This organisation is thefinal step in the NHS complaintssystem and is independent of theNHS. One of the questions posed tome by the Ombudsman was specificto timescales relating to orthoticservice delivery.

    As a result I investigated nationalguidelines relating to orthoticprovision timescales. I was morethan surprised by the result.

    The only timescale target that existsnationally that is applicable toorthotic services relates to the 18-week RTT (Referral to Treatment)target that 95 per cent of all patientsin England should receive their firstdefinitive treatment within 18 weeksof being referred by their GP.

    This treatment could be delivered byany professional on the patientsjourney through NHS consultant ledservices.

    Stopping the clock for orthoticservices is achieved at the first fittingof the orthosis or by a decision notto treat.

    In my previous role I was more thanaware of this target but I wasincredibly saddened to discover thatthere is no national servicespecification for orthotic services inEngland.

    Further investigation led me to

    discover that local orthotic servicespecification documents existed.Dialogue with the BAPO chairmanconfirmed this was the case andBAPO are trying to influence this.

    Therefore orthotic services are in therather bizarre position that itscustomers, i.e. commissioners, haveno national framework forcommissioning orthotic services todeliver and monitor consistency intimely access and treatment.

    Could this possibly mean thereforethat commissioners are uncertain ofexactly what they are commissioningregarding orthotic services? What iscertain is there are currently noquality standards for orthotic servicesnationally except the 18-week RTTtarget.

    Fortunately patient groups like theOrthotics Campaign are nowengaging with the NHS andcommissioners to inform them ofwhat patients want.

    Neil Churchill, director of patientexperience for the NHS, has graspedthe nettle and his listening event inSalford on March 2 will hopefullybecome the start of a brighter andmore consistent future for orthoticsservices, its customers and itsconsumers.

    Simon Dickinson

    A SPORTS medicine consultant hasbe