assistive technologies june/july 2015

INNOVATION FOR INDEPENDENCE ISSUE 103 JUNE/JULY 2015 £6.95

By Nicola HydeRESEARCHERS have developed a noveldevice that may allow individuals to feelhot, cold and the sense of touch through aprosthetic device.

A team of engineers and researchers atWashington University in St. Louis isworking to change that so those withupper limb prosthetics can feel hot andcold and the sense of touch through theirprosthetic hands.

Daniel Moran, PhD, professor of biomedicalengineering in the School of Engineering &Applied Science and of neurobiology hasreceived a three-year, nearly $1.9milliongrant from the Defense Advanced ResearchProjects Agency (DARPA) to test the devicethat would stimulate the nerves in theupper arm and forearm.

If it works, upper-limb amputees who usemotorised prosthetic devices would be ableto feel various sensations through theprosthetic, which would send sensorysignals to the brain.

Daniel, whose expertise is in motorneurophysiology and brain-computerinterfaces, and his team have developed anelectrode designed to stimulate sensorynerve cells in the ulnar and median nervesin the arms.

The ulnar nerve, one of three main nervesin the forearm, is the largest nerve in thebody unprotected by muscle or bone and isconnected to the ring finger and pinkiefinger on the hand.

It’s the nerve that is stimulated when a hitto the elbow triggers the “funny bone.”

The median nerve in the upper arm andshoulder is connected to the other fingerson the hand, so together, the two nervescontrol movement and sensations includingtouch, pressure, vibration, heat, cold andpain in all of the fingers.

People using arm prosthetics have to relyon their vision to use them properly, Moransaid.

To pick up a cup of coffee, they have to beable to see the cup, place the fingers of theprosthesis around it and lift it.

They are unable to feel whether the cup isin their hand, if the cup is hot or cold, or ifthey are about to drop it.

By enabling the ability to feel, users willhave more control over the prosthesis.

The team developed a macro-sieveperipheral nerve interface designed tostimulate regeneration of the ulnar andmedian nerves to transmit information backinto the central nervous system.

Device may allowprosthetic handsto feel sensations

Limbcare has been announced as a winner of the Queens Award forvoluntary service. The charity, which supports amputees and theirfamilies, was founded five years ago by quad amputee Ray EdwardsMBE (pictured above). As a quad amputee Ray is aware of theemotional and physical challenges facing new amputees and theirfamilies. He said: “Servicemen and women get great support from themilitary and the wonderful Help for Heroes if they have a limbamputated – but civilians have no such support. Limbcare helps to fillthat gap by offering, among other things, emotional support and advice.In particular Limbcare is there to let amputees and their families knowthey are not alone. For many amputees it’s the knowledge that someoneelse has ‘been there too’ which is the most important.”

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ContactsEditorialJudith Halkerston Group EditorEmail: [email protected]

Dominic Musgrave Group Production EditorEmail: [email protected]

Tel: 01226 734407Nicola Hyde ReporterEmail: [email protected]

Tel: 01226 734715Sales Carole Rice Product ManagerEmail: [email protected]: 01226 734412 Fax: 01226 734478

Tony Barry Sales and Marketing DirectorEmail: [email protected]

[email protected] hour hotline: 01226 734695

Design/Production Stewart Holt Studio ManagerEmail: [email protected] Firth Graphic DesignerEmail: [email protected]

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.

www.assistivetechnologies.co.uk

New limb helps Tom to becomeGB Paraclimbing team memberBy Nicola Hyde

A MAN who lost his leg after aworks accident is trying newactivities like rock climbing andbouldering thanks to his prostheticlimb.

Tom Perry, 35, from Great Ayton, isnow a member of the GBParaclimbing team.

He said: “Both of my legs werecrushed into a four inch gap by aneight tonne piece of machinery atwork.

“I was trapped for more than anhour, until the emergency serviceswere able to release me.”

“I remained conscious throughoutthe rescue. Thankfully thecontainment meant that I wasn’tlosing blood, which certainly helpedme to survive.”

Unfortunately, due to a severedartery, four days after the accidentTom’s right leg had to be amputated

above the knee, in addition to theinsertion of a condylar plate andscrews into his left leg.

“Prior to the accident I led a veryactive life, fell walking, climbing andI enjoyed my manual job, so I wasdevastated and was uncertain of myfuture.”

Pace prosthetist Howard Woolley andphysiotherapist Carolyn Hironsassessed Tom to see if improvementscould be made.

Carolyn said: “We felt thatsignificant improvements could bemade, primarily with the provision ofa prosthetic knee that would providestability and reliability, therebyimproving his confidence andultimate prosthetic use.

“We also gave consideration to asubsequent prosthesis that wouldbenefit him with his recreationalactivities.”

Tom was fitted with a Geniummicroprocessor knee.

At Script Media, we try to get things right but occasionally, we make mistakes. If you have a complaint about a story featured in ourmagazine or on our website, please, in the first instance, contact us by email: [email protected] We abide by the Editors’ Codeof Practice as demanded by the Independent Press Standards Organisation. For details on the code and what to do should you beunsatisfied with the way we handle your complaint, please visit www.ipso.co.uk

Tom Perry

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Five more years of austerity– more for considerably less?By Simon Dickinson

THE NHS in England is projected tohave overspent its budget by morethan £600m in 2014/15, an analysisby the Health Foundation has found,despite the service receiving an extra£900m in funding.

In its ‘Hospital finances andproductivity: in a critical condition?’report, the think-tank found thefinancial performance of NHSproviders in England has deterioratedsharply, moving from a net surplus of£582m in 2012/13 to a net deficit of£789m at the end of the thirdquarter of 2014/15.

With the surprise majority won bythe conservatives at the generalelection in May 2015 it is highly likelythat public services will be required to

make continuing efficiencies.

Even with the promise of anadditional £8billion for the NHS, I amincredibly sceptical that these fundswill filter down into rehabilitationservices let alone orthotic, prostheticor wheelchair budgets.

The cost improvement plans (CIP) formany NHS trusts for the 2015/16financial year appear to beincreasing, with some organisationsfacing a savings target of 11% thisyear. NHS staff have also hadnegligible increases in pay for wellover five years.

The challenge for NHS managers andcommissioners has never beengreater.

But how much further can costs becut and savings be made without

negatively impacting patient care orwaiting times?

Procurement departments from NHStrusts are all looking to save moneyin every way possible. Many haveeven written to suppliers asking forall prices to be frozen.

Some services, such as the fractureclinic at the Glasgow Royal Infirmary,have been looking at new ways ofworking to drive efficiency.

Their “Virtual fracture clinic” hasreduced fracture clinic attendances byover 50% and combined with amove to orthotic braces instead oftraditional casts they have madefurther savings.

Despite all the hard work done toreduce costs, I fear it will not beenough. The NHS may have to

consider which services it funds andwhich treatments are and are notgoing to be funded.

� Simon Dickinson is clinical directorat TalarMade.

Simon Dickinson

Paralysed man moves robotic armusing thought alone in world first By Nicola Hyde

A MAN who was paralysed from theneck down after being shot can nowmove a robotic arm just by thinkingabout it.

Erik Sorto is the first person in theworld to have a neural prostheticdevice implanted in a region of thebrain where intentions are made,giving him the ability to perform afluid hand-shaking gesture, drink abeverage, and even play "rock,paper, scissors," using a robotic arm.

The clinical collaboration betweenCaltech, Keck Medicine of USC andRancho Los Amigos NationalRehabilitation Centre, want toimprove the versatility of movementthat a neuroprosthetic can offer topatients by recording signals from a

different brain region other than themotor cortex.

Principal investigator RichardAndersen said: “When you moveyour arm, you really don’t thinkabout which muscles to activate andthe details of the movement—suchas lift the arm, extend the arm, graspthe cup, close the hand around thecup, and so on. Instead, you thinkabout the goal of the movement, forexample, ‘I want to pick up that cupof water.’ So in this trial, we weresuccessfully able to decode theseactual intents, by asking the subjectto simply imagine the movement as awhole, rather than breaking it downinto a myriad of components.

“We expected that the signals fromthe PPC would be easier for patients

to use, ultimately making themovement process more fluid.”

The device was surgically implantedin Erik’s brain at Keck Hospital of USCin April 2013, and he has since beentraining with Caltech researchers andstaff at Rancho Los Amigos to controla computer cursor and a robotic armwith his mind. The researchers sawjust what they were hoping for:intuitive movement of the roboticarm.

Erik, a single father-of-two who hasbeen paralysed for over 10 years, wasthrilled with the quick results: “I wassurprised at how easy it was (tocontrol the robotic arm),” he said. "Iremember just having this out-of-body experience, and I wanted to justrun around and high-five everybody.”

Sorto has signed on to continueworking on the project for a thirdyear.

"This study has been very meaningfulto me,” added Erik. “As much as theproject needed me, I needed theproject. It gives me great pleasure tobe part of the solution for improvingparalysed patients’ lives. I jokearound with the guys that I want tobe able to drink my own beer—to beable to take a drink at my own pace,when I want to take a sip out of mybeer and to not have to asksomebody to give it to me.

“I really miss that independence. Ithink that if it were safe enough, Iwould really enjoy grooming myself—shaving, brushing my own teeth.That would be fantastic.”

Photo credit: Spencer Kellis and Christian Klaes, Caltech

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Ground-breakingnew roles createdin physiotherapydepartmentBy Nicola Hyde

BURTON’s Queen’s Hospital isbelieved to be one of the first in theUK to offer a new role forphysiotherapists, which has alsohelped it attract high calibre staffmembers who can deliver specialistcare for patients.

Three physiotherapists have joinedthe Queen’s Hospital team in theinnovative Fellowship Posts.

They will undergo 18 months offocused training under the guidanceof Extended Scope Practitioners(ESPs); highly skilled physiotherapistswho provide an expert level of careto patients with complex healthproblems.

The three new staff members haveleft posts in hospitals in Kettering,Nottinghamshire and Kent to moveto Burton because of the uniqueopportunity the posts offered.

Consultant physiotherapist EmmaSalt came up with the plan ofcreating a structured Fellowship Postwhere ambitious and well-motivatedband six physiotherapists could trainover an 18-month period to work atthe level of a Band 7 ESP.

Emma’s idea got the go-ahead andthe innovative recruitment approach– believed to be the first of its kind inthe UK in physiotherapy – received agreat reaction from jobseekers.

“We were delighted with the qualityand quantity of applications that theadvert attracted, and we chose threepeople to join our team in January,”said Emma.

The new recruits are Leena Lad, whohas moved from Kettering GeneralHospital, Fred Mainwaring, whopreviously worked for SherwoodForest Hospitals NHS FoundationTrust and Agostino Faletra whopreviously worked at SevenoaksHospital in Kent.

They will each spend six monthsspecialising in the upper quadrant(arms, neck, and shoulders), sixmonths specialising in the lowerquadrant (legs, pelvis, and lowerback) and also spend six monthsattached to the EmergencyDepartment.

By the end of each six month periodit is anticipated that they all have allthe skills experience and confidenceto work at a Band 7 ESP level in thatarea.

Leena said: “I was delighted when Isaw this job advertised. I’d neverseen anything like this before and itwas perfect for what I wanted to do.I was thrilled when I heard myinterview had been successful.”

Emma intends that the FellowshipPosts will continue on a rollingprogramme with new candidatesrecruited in 18 months’ time.

HUNDREDS of war amputees willcost the NHS over £288million overthe next 40 years according to a newstudy.

The study into aftercare costs forthose who lost limbs in IED attacks inAfghanistan was carried out byresearchers from the Royal BritishLegion Centre for Blast Injury Studiesat Imperial College London.

It reveals that policy makers need tobudget the sum to pay forprosthetics, trauma care and relatedtreatment.

Major DS Edwards of the RoyalCentre for Defence Medicine in theUK, spoke out in an article appearingin the journal Clinical Orthopaedicsand Related Research, published bySpringer.

He led a study into the scale andlong-term economic cost of militaryamputees following Britain'sinvolvement in Afghanistan between2003 and 2014.

It found that an extensive use ofimprovised explosive devices byinsurgent groups against the coalitionforces combined with better personalprotection equipment, improved earlymedical care, and rapid extraction ofthe injured, more service memberssurvived such attacks.

However, many now have to dealwith complex wounds such asmultiple amputations.

Edwards and his colleagues set out toquantify the extent and nature oftraumatic amputations suffered byBritish service staff from Afghanistan.This was done as a first effort toadequately start budgeting for thelong-term needs of the injured

beyond their years of service in thearmed forces.

They found that between 2003 and2014, 265 British soldiers sustained416 amputations. On average thesoldiers lost 1.6 limbs each. Of these,153 soldiers lost their whole leg,while the lower leg of 143 patientswas amputated. Including additionaltreatment cost and economic losses,the total cost or "disease burden"associated with these injuries couldbe higher than £288 million over thenext 40 years.

This translates to a lifetime cost ofaround £870,000 per single belowknee military amputee.

The report adds: “Over the nextdecades British military amputees willnot only suffer from the same chronichealth problems as that of thegeneral population, but also havespecific issues related to their injuries.

“This includes the use of prostheses.The authors believe these impactscan be modified by developing moreeffective and sustained medical andsocial support, post-militarydischarge, in order to encouragehealthier lifestyles and developpeople's skills and earning capacity.

"A long-term facility to budget forveterans' health care is necessary.Our estimates should be taken as thestart of a challenge to developsustained rehabilitation and recoveryfunding and provision."

* Reference: Edwards, D.S. et al(2015). What Is the Magnitude andLong-term Economic Cost of Care ofthe British Military AfghanistanAmputee Cohort? ClinicalOrthopaedics and Related Research.DOI 10.1007/s11999-015-4250-9

High healthcare costfor military amputeesrevealed in research

SCIENTISTS at Brunel UniversityLondon have developed a system forParkinson’s sufferers to counter twoof the most common and distressingsymptoms of the degenerativedisease.

Many patients are afflicted byfreezing of gait (FOG) wheresuddenly, in mid-stride, the musclesfreeze and they are left unable tomove forward or they simply fall over.

Previous research shows that givingvisual clues such as projecting linesahead on the floor “unfreezes” themuscles but current equipment hasto be worn.

But Dr Konstantinos Banitsas andPhD candidate Amin AminiMaghsoud Bigy have turnedMicrosoft’s Kinect computer gamescontroller into a system that can be

installed into a patient’s own home.

Linked to a ceiling mounted laser, theKinect can not only project promptlines when the software detects aFOG incident but if a patient falls,the system not only detects that butalso automatically triggers a videoconferencing call.

Dr Banitsas said: “All the othersystems require a patient to wearsensors and power packs where oursolution is unobtrusive and covers awhole room.

“By mounting the laser guide markeron the ceiling it can provide thevisual clues in any direction. And it isonly activated when a FOG incidentoccurs instead of having to be wornconstantly. The system has alreadypassed proof of concept stage andwe will shortly begin patient trials.”

Scientists develop system

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Lecturer helpsamputee chaseTeam GB dreamBy Nicola Hyde

A BOURNEMOUTH University lectureris helping a disabled cyclist to achievehis dream of representing Britain atthe Rio 2016 Paralympics.

Dr Bryce Dyer is designing aprosthetic leg for amputee CraigPreece, who is in with a chance ofmaking the Team GB cycling squadfor next year’s summer ParalympicGames, held in Rio de Janeiro.

Currently a member of the PodiumSquad, Craig is pushing himself to beready for Rio, where he wouldcompete in both road and trackevents, and is making gains intraining towards the cause. As abelow-the-leg amputee, a prostheticleg enables him to compete at thehighest levels.

Dr Dyer is working with both Preeceand prosthetists at PaceRehabilitation in designing the limbthat he will use to train and,hopefully, compete with next year inBrazil.

The leg itself is being createdfollowing testing that determined themost effective geometry to providemaximum power transfer.

The result of these tests led to Dyer

generating several prototype designsthat will now all be fabricated andevaluated aerodynamically in thefield.

The final result will see a set up thatis comfortable, efficient andhopefully provide Preece with acompetitive advantage.

Dr Dyer said: “A project like this istricky as you’re taking something thathas to replace a limb that has beenlost. It must be comfortable to useduring extremely high levels of effortbut has to perform well technicallytoo.

“I realised we could developsomething special but we’d need todo some further experimentation tofind out how to push its performanceon from what we did in the lastproject.

“We’re in the middle of that processnow – the athlete has a chance ofgetting into the Team GB squad so itis exciting for all of us involved.”

Craig Preece, a father of two, wasinjured by a roadside bomb whileserving as a soldier with the RoyalEngineers in Afghanistan in 2010 andwas bought his first racing bike byHelp for Heroes.

Bournemouth University lecturer Dr Bryce Dyer.

A SERIES of wheelchairs that arepopular in America are being broughtto the UK market by Leckey.

The products – Ki Mobility’s LittleWave, Focus, Catalyst 5 and Roguewheelchairs – feature everythingfrom a product for the youth marketto a tilt chair and lightweight foldingchair.

Martin Rennie, Mobility Sales

Manager at Leckey, said: “We arereally excited to have the opportunityto bring the Ki Mobility range ofwheelchairs to our customers in theUK.

“The Little Wave, Focus, Catalyst 5and Rogue offer the latest in designinnovation, helping make mobilityeasier for the user. We are confidentthat the response from the marketwill be extremely positive.”

Leckey brings wheelchairs to UK

Peter begins Ice Capworld record attemptAN AMPUTEE adventurer has set offfor a world record crossing of theGreenland Ice Cap.

Peter Bowker is leading the 65Degrees North expedition as theyset off on the world’s firstunsupported attempt by anamputee.

The mission covers 600km facingtemperatures as low as -37 degrees- the team will be forced to crossthe ice cap on skis pulling pulksweighing up to 80kg.

A former Queen’s DragoonGuardsman, Peter was injured by aroadside bomb while onattachment in Afghanistan.

He has learnt to ski especially forthe expedition and will wear anElite blade foot, from Blatchford,which will fit directly to his ski bootand perform well at sub-zerotemperatures.

Peter’s prosthetist Alan McDougallsaid: “Peter is incredibly committedand it’s been a pleasure to supporthim.

“The Elite blade is ideal for theconditions as it reduces shock and

provides energy return.

“The carbon fibre design islightweight and low maintenancewhich will be essential for Pete toconserve energy and minimisepotential repairs during the event.”

Peter added: “I am humbled by thesupport that has been generatedfor this mission.

“But it’s all about giving somethingback and all proceeds from themission will be going to Help forHeroes.”

The team are being supported byPrince Harry and actor anddocumentary filmmaker Ross Kemp.

Peter Bowker

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BEAGLE Orthopaedic houses a largedatabase of spinal models to suit avariety of patients.

From this extensive library we canmanufacture your CTLSO usingmeasures provided from a simplemeasurement chart, we then adaptthe relevant model to meet thespecification.

Each orthosis is fabricated to thepatient’s unique model and yourspecifications, ensuring the optimumfit, support and comfort.

CTLSO’s are available as; bi-valvedesign finished to completion (nointermediate fitting) with a variety of

liners such as cool foam, north foam33, evazote and lambs wool.

We can also provide a customisedcombination of products for highthoracic fractures / instabilities. Thechosen TLSO is then coupled withcomponents from the Aspen CTO, toprovide the stability required for yourpatient in the upper thoracic andcervical region.

This design offers a step-downreduction for on-going rehabilitationtherapy. Available in paediatric andadult sizes.

Enquiries: For further information call01254 268 788.

Spinal models available tosuit a variety of patients

PHYSIOTHERAPISTS are encouraginginnovative employers across the UKto take an active break and sign upfor one of the UK’s biggestworkplace health and wellbeingevents.

Registrations are open for Workoutat Work Day 2015, a free annualevent organised by the CharteredSociety of Physiotherapy toencourage employees to becomemore active in order to stay fit forwork.

Thousands of employees areexpected to team up withphysiotherapists for active workplace-based fitness events, ranging fromexercise classes and workstationassessments to lunchtime walks andteam games.

Prof Karen Middleton, chief executiveof the CSP, said full-time workerscould find it challenging to do atleast 30 minutes of moderate

intensity physical activity five times aweek, but it was in employers’ bestinterests to create an activeworkforce.

“Aside from the human cost, theprice of inactivity for employers canbe vast, with higher sickness absencecosts and lower productivity.Physiotherapists play a key role ingetting people back to work andkeeping them fit for work.

“The consequences of not doing socan be devastating, with manypeople suffering ill health andprolonged spells off work.

“It is in everybody’s interests to findways to tackle the enormous problemof inactivity in the UK and we wouldencourage people to takeresponsibility for their own health.”

Employers interested in registeringfor the day can sign up by visitingwww.csp.org.uk/workoutatwork.

Physios encourageemployers to signup to free event

‘Leg bank’ aims tochange Colombianamputees’ livesBy Nicola Hyde

A LEG bank which sets to providelife-changing prostheses to peoplewho can’t afford their own is beingdeveloped.

Academics from the University ofStrathclyde, and members of Dutch-based social enterprise organisationProPortion plan to establish a servicein Colombia offering high-qualityartificial legs to people who have lostlimbs, often through injuries fromlandmines.

A team led by Dr Arjan Buis, fromStrathclyde’s Department ofBiomedical Engineering, hasdeveloped innovative technology,known as Majicast, to manufacturelower limb prosthetic sockets whichfit prostheses securely to patients’residual limbs.

A spokesman said: “The Majicast iscurrently being optimised into amarket-ready product, with the helpof a design agency. We expect thatthis social enterprise venture can besuccessfully piloted in Colombia, thendeveloped for other parts of theworld.

“We have fantastic inventions butthe capacity and organisationalstructure to bring them to markets islacking; only then does an inventionbecome an innovation.”

Merel Rumping, Project Incubatorwith ProPortion, developed the ideafor the leg bank after hearing of asurgeon in Thailand who, frustratedby a lack of access to qualityprostheses, created his own fromplastic bottle caps. She was alsoinspired by the many amputeeswithout prostheses she saw duringher time working with street childrenand former child soldiers inColombia.

“Those who can pay for their travelexpenses have to wait up to two orthree months to have their prosthesismade; rehabilitation takes evenlonger. In this period they cannotwork, and they cannot take care oftheir families.”

The partners in the leg bank projectare currently seeking funding for theventure. They are in talks withpotential investors and intend tobegin a crowdfunding campaign.

Majicast has been designed to manufacture lower limb prosthetic sockets.

THE UK’S first ever stand-alone mass-participation sports event for peoplewith disabilities will be held inAugust.

Para Tri is the first in a wider series ofevents planned beyond 2015, whichwill include a Para Swim and a ParaRun/Push.

The series gives the 9.4 milliondisabled people in England alonemore opportunities to participate inthe burgeoning mass-participationmarket and is supported by OttobockUK.

Para Tri founder and ParalympianSophia Warner said: “There iscurrently a significant gap in the

market and we look forward todevelop our series from the verybeginning.

“Para Tri is the realisation of a long-held dream that was inspired bytaking part in many mass-participation events over the years.This is an exciting opportunity tomake sport as fun as I know it can befor everyone.”

Ottobock UK will provide technicalsupport for all Para Tri participants onthe day. It will be conducting variousrepairs to equipment throughoutsuch as wheelchairs and prostheticlimbs damaged in competition for anestimated 500 participants.

August date for first Para Tri

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Advantages of Dynamic KneeLigament Bracing technologyBy Chris Everett

ACL deficient and reconstructedknees share common problems thatmay not be recognised by manymedical professionals.

The quadriceps contraction forcesthat cause symptoms in an ACLDpatient are still at work against theligament graft in an ACLR patient.

These forces unfortunately can leadto graft stretching and failure. Thereare four activities that ACLD patientshave difficulty performing, these arestopping, walking/running downhill,landing from a jump and lateralmanoeuvres.

These all involve open kinetic chainextension where quadricepscontraction can sublux the tibia priorto foot strike. Static bracing, musclestrengthening, and other forms oftraining cannot completely eliminatethe symptoms of ACL deficiency.

Dynamic bracing maintains theproper relationship between thefemur and tibia as it goes through arange of motion. In the case ofDynamic ACL knee braces, thequadriceps extensor force is used to

provide a progressively increasingforce to push the tibia posteriorrelative to the femur as the kneemoves into extension. Force isreduced as the knee flexes back intothe ready position. As the kneeextends to less than 30 degreesflexion, the force rises more quickly,the resulting force is sufficient toprevent the tibia from subluxing priorto foot strike. As the knee joint iscompressed in the proper position, itgains more stability.

An added benefit of using dynamicbraces after several days is themuscle re-learning that occursproviding “spontaneous hamstringsco-activation” that is elevated toprevent subluxation even if the braceis removed.

Dynamic braces have several furtherbenefits:

1 – Eliminate ACLD Symptoms

ACL deficient patients using dynamicbraces could generate maximalvoluntary isokinetic extension effortthroughout the full range of motionwith significantly increasedquadriceps activation and without

any knee subluxation.

2 – Limit Further Damage

Limiting tibial translation is the mostimportant element to successfullypreventing further damage toarticular cartilage and the menisci.Since tibial translation is effectivelycontrolled using Dynamic ACL bracesit’s reasonable to assume that this will

reduce or limit further damage tothese structures.

3 – Protect ACL Reconstructions

When ACL reconstructed patientsperform the same manoeuvres thatcause symptoms in ACLD knees ahigh degree of stress is placed on thereconstructed ligament graft.

The original ACL has a neuro-sensoryrole that elicits a primary hamstringsreflex to protect the ACL, and inhibitsthe quadriceps from applying toomuch force that might damage theACL.

Both these reflexes are absent orreduced in ACL reconstructed knees.Dynamic braces can apply a force toreduce the strain on thereconstructed ligament helpingprotect it from subsequent stretching.

The benefits can be quickly proven byactual brace use on symptomaticknees. Bledsoe dynamic bracingtechnology is available in the UK viaPromedics Orthopaedic.

� For further details contact ChrisEverett, national bracing manager, on07768 833416 or by [email protected]

Chris Everett

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sponsors podiatry

University launchesUK’s first nationalorthotic surveyBy Nicola Hyde

THE first ever national survey oforthotic services in the UK isexpected to go live in July.

Professor Chris Nester and colleaguesat the University of Salford arelaunching the survey after focusgroups revealed just how variedapproaches to the use of footorthoses are.

The steering group was established inNovember 2014 and along with DrJane McAdam the team at Salfordare expecting to go live with a Bristolonline survey in July 2015.

Australian trained podiatrist Dr JaneMcAdam said: “The survey willprovide clinicians, managers,researchers, industry and charitableorganisations with perhaps the firstclear picture of which clinicians areproving which type of orthoses towhich patients and why, but alsoreveal how service structure andchanges in service provision areaffecting clinical orthotic decisionmaking.

“With so much change ongoing thisfeels like a perfect time to be doingthis important exercise”.

Indeed the problem of poor qualitydata on orthotic practice in the UKwas central to discussions led by NeilChurchill from NHS England at arecent meeting at Salford.

In March more than 50representatives of professionalbodies, NHS Trusts, industry andpatient organisations met to forge apathway towards new guidelines formore patient led commissioning oforthotic services.

Professor Nester runs the SalfordFOOTPRINT research programme andsays the survey is part of a deliberatestrategy to strengthen the impact oftheir research by exploring newdirections.

He added: “We are perhaps bestknown for our foot biomechanicsand orthotic biomechanics research,but we are striving to complementthese strengths with research andinnovations that are more directlyrelevant to practice.

“It would be wonderful to think thissurvey is the start of an exercise werepeat every five years, allowing theorthotic sector to build a clear pictureof changes in practice and the factorsdriving these changes.”

£20,000 research grant available

A UNIVERSITY of East Londonlecturer has been awarded more than£200,000 to help bring relief topeople suffering with arthritis.

Dr Kellie Gibson has received theresearch grant from the Dr SchollFoundation to lead an investigationinto the effectiveness ofprefabricated insoles which treatproblems associated with rheumatoidarthritis.

The disease affects an estimated645,000 people in the UK, most ofwhom will develop foot and ankleproblems. Standard treatment isthrough the use of foot insoles whichhelp to redistribute load from weight-bearing sites and correct the shape ofthe foot arch.

These specialist insoles aremanufactured using two differentapproaches. In the more traditionalone, the insole is customised to thepatient’s specifications. Thealternative is prefabricated versionswhich are cheaper to make andeasier to mass produce.

Research suggests that customisedversions result in a 25 per centreduction in pain and disabilitycompared with no treatment. Butlittle work has been done on theeffectiveness of the prefabricatedversions.

And that is where Kellie will

concentrate her efforts.

‘’This study will evaluate both theclinical and cost-effectiveness ofprefabricated insole in comparison tocustomised versions,” she said.“Currently, prefabricated ones arethe treatment of choice within mostNHS trusts, due to them costing asignificant amount less than thecustomised option.”

However, there is conflicting evidenceabout whether prefabricated versionsprovide the same long-term benefits.If they do not, and patients go on torequire more treatment, they couldend up being even more costly.

The study, which is being carried outin collaboration with researchers fromGlasgow Caledonian University, aimsto address this lack of knowledge onprefabricated insoles and provide theNHS with evidence on clinicaloutcomes, patient satisfaction andcost-effectiveness, by exploringpatient perceptions, and experiencesthrough a series of interviews andquestionnaires.

“With the ever-tightening pursestrings of the NHS and the limitedevidence base for insole treatment inrheumatoid arthritis patients withfoot impairment, this research shouldprovide vital evidence and thusguidance to inform clinical decisionmaking in future,” added Kellie.

Lecturer to lead newpodiatry research

PODIATRISTS are being encouragedto apply for a new research grant,which is worth £20,000, to supportinnovative studies.

The URGO Foundation is offering thefinancial support to any healthcareprofessional working in the fieldwhether they be a specialist, clinicianor part of a wider multidisciplinaryteam.

The grant will be awarded to theapplicant with the best originalproject relating to diabetic footulcers. There are a number of areasthe project is looking to investigatefurther, focusing on both preventionand management of the condition.

The deadline for submitting anapplication is 30th June 2015.

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Climbing high with DM Orthotics TOM Watts, 16, has been taking onthe world of extreme sports thanks tohis Lycra orthoses supplied by DMOrthotics.

Tom suffered a stroke at the age of11 which impaired the function andmovement down his left side,preventing him from continuing toenjoy contact sports such as rugby.

Now aided with DM Orthotics’Dorsiflex Sock and more recently theDMO Glove, Tom is taking onextreme sports like climbing andmountain biking.

Tom was determined to get activeagain and tried a number of rigidcarbon fibre splints for his footbefore his physiotherapistrecommended DM Orthotics’ Lycraversion.

Tom said: “I got through about threedifferent types of carbon fibre splints,but because I was so active, I keptbreaking them. They just didn’t last,or weren’t flexible enough to allowme to do the things I wanted to do.”

The Dorsiflex Sock works using anumber of strategically placed Lycrapanels which create forces to re-alignthe foot’s position, providing activedorsiflexion (lifting the foot up duringwalking and running).

Martin Matthews, managing directorat DM Orthotics, said: “The new

positioning stimulates the body’sneuro-sensory system and effectively,re-programmes the brain so that themuscles work in a new bio-mechanical state.

“There are a number of benefits tothis including increasedproprioception but most importantlyit encourages muscle movement andusage.”

Tom added: “The Dorsiflex Sock isgreat. Because it is made from Lycrait is really easy to put on. It’s so muchmore comfortable, nice and light anddoesn’t rub.

“I don’t have to keep changing itover either like I did with the carbonfibre splints. I can just put it on in themorning and leave it on all day.”

Tom has been able to take part in alot more activities that require a lot ofleg movement with the DorsiflexSock and joined the Club of ExtremeSports at his local leisure centre.

“I can do a lot more running usingthe sock, “ he added. “I go to anextreme sports club – I do wallclimbing, mountain biking androcketball. The Dorsiflex Sock hasdefinitely allowed me to do a lotmore of these things.”

And there are also other aestheticbenefits, something which isimportant.

“The other great thing is that youcan choose your own colours,” saidTom. “Mine looks like a regularsports sock, which is great in thesummer when people see it, theythink it’s just a sports sock – itdoesn’t draw the same sort ofattention as a rigid brace.”

Tom has just started his collegecourse following completion of hisGSCEs. He is pursuing an activeoutdoor career studying game

keeping and wildlife management.

DM Orthotics is a world leader in thedevelopment and manufacture ofbespoke Dynamic MovementOrthoses used to treat neurologicaland musculoskeletal conditions.

Their aim is improve function andencourage independence for theuser.

To find out more visitwww.dmorthotics.com

Tom tries his hand at wall climbing.

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BOA® Closure with NimcoFootwear – the idealsolution to encourageindependent footwear useDeNovo Healthcare is a dynamic andprogressive patient centred companyfocused on providing some of themost innovative products and servicesfrom around the world to the UKhealthcare market.

As distributors for some of the bestknown and reputable suppliers in theworld we have a lot to offer.

Our successful Nimco Made4Youchildren’s footwear range has nowbeen enhanced with the new excitingaddition of the BOA® closure system.

This system is an innovative methodof closing your footwear, which iseasier and stronger than both laceand Velcro options.

With a simple one-handed turn of adial, you can tighten your shoes upto the desired amount with a level ofprecision, which is not achievablewith other closure options.

Removing your Nimco shoes with aBOA® closure is as easy as pullingthe adjustment wheel outwards,which instantly releases the steel lace

mechanism.

The BOA® closure is available on thefront of the shoe for a standardopening or with a rear closure optionwhich releases and opens up theback of the shoe to provide a veryeasy way of putting on shoes overAFOs.

Being able to operate the BOA® onehanded, coupled with the easy to usemechanism not only enablesindependent footwear use, butencourages it by boosting wearerconfidence when the shoes arefastened correctly first time, everytime.

DeNovo Healthcare Ltd, 6a CheddarBusiness Park, Wedmore Road, Cheddar,Somerset, BS27 3EB. Call 01934 808416,email sales@ denovohealthcare.com orvisit www.denovohealthcare.com

High-tech language assessment pointsway to better future for disabled kids A NEW high tech computer-basedspeech and language assessment toolhelping professionals accuratelyrecord the levels of understanding ofchildren who have a physicaldisability could improve the outcomesof thousands of non-verbal children.

The Computerised AccessibleReceptive Language Assessmentsoftware has been designed inresponse to an audit which identifiedthat speech and language therapistsfound it difficult to get an accuratepicture of a child’s receptive languageusing current tests if the child had aphysical disability and couldn’t speakor point to pictures to show whatthey could understand.

The technology has been developedby the NIHR Devices for DignityHealthcare Technology Co-operative(D4D), a specialist centre based inSheffield, and Barnsley Hospital’sassistive technology team inpartnership with Jabbla, a Belgiantechnology company.

D4D is hosted by Sheffield TeachingHospitals NHS Foundation Trust andempowers patients to live more

dignified, independent lives.

Incorporating eye gaze tracking,mouse pointers and switch scanningoptions, the software is the firstassessment of its kind to combine allthese features into a single softwarepackage so that speech and languagetherapists can use these methods toaccurately record a child’s receptivelanguage level.

Children with physical disability oftenuse these methods for othercomputer programmes so byintegrating these options intoCARLA, the software aims to reducethe barriers these children face whenbeing assessed.

Simon Judge, joint communicationaid project lead for D4D and seniorclinical scientist from BarnsleyHospital’s assistive technology teamsaid: “We’re delighted to belaunching this new assessment. Upuntil now, when a child cannot pointto their answers, speech andlanguage assessment tools haverelied on the therapist’s interpretationof the child’s responses, but thissystem gives an objective record of

these responses as the child canmake their choices using eye gaze,head switches or mouse pointers.

“As a result of having a moreaccurate picture of these children’sability to understand language, thesoftware will make it easier forspeech and language therapists totarget their therapy at an appropriatelevel. This could make a significantdifference in terms of theireducational outcomes and ensuringthe appropriate language support is

put into place.”

The software, which has beendesigned for children with a physicaldisability, also has the potential tohelp children with sensory orattention difficulties and adults withcommunication disabilities such asthose with learning difficulties,dementia or aphasia.

It will initially be available for use byspeech and language therapists andteachers.

A screenshot from the CARLA software.

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Orthotix – the best kept secret in Wales?ORTHOTIX was established in 2004to provide ready-made orthoses tothe NHS supplementing the bespokeproduct already being supplied by itsholding company, Dacey Ltd.

Today Orthotix is the leading sportsand orthopaedic bracing businessbased in Wales supplying a diverserange of products to customersacross the UK and Ireland.

Originally set up in the South Walesvalley town of Merthyr Tydfil, thebusiness has expanded significantlysince its inception, adding furtheroffices and an additional warehouseto its site in the capital city, Cardiff.

The family run business uniquelybenefits from its close relationshipwith its sister company Ace Feet InMotion Ltd and its holding companyDacey Ltd, accumulating over 50years worth of experience in thehealthcare industry.

Through continued productdevelopment instigated by theHealthcare Professionals employedwithin its group of companies,Orthotix is able to offer innovativebest value products, with many nowbeing made at both of their ownmanufacturing facilities in Wales.

Popular items such as stock gaiters,abdominal supports, lumbosacralbelts, maternity supports, slings,cervical collars and limb de-rotationorthoses are just a handful of theproducts which are now fabricatedon site.

In addition to its own branded range,Orthotix has established tradepartnerships with two large Europeancompanies, Orliman and Pavis.

To date, these relationships havegiven rise to the introduction ofestablished external market leadingproducts to the UK marketplace.

This has enabled British and Irishcustomers to purchase the likes ofthe Boxia Drop Foot AFO and theWellness Line 100% Cotton HernialBriefs/Boxers, for the first time.

Due to the special workingrelationship between Orthotix andtheir trade partners there have beennumerous product collaborationswhere expertise from both companieshave been utilised to design anddevelop innovative products such asthe hugely successful soft shellhelmet, “Head Protex”.

This offers a comfortable and easy tofit stock solution that provides

suitable skull protection for childrenat risk from head injury. They areavailable in a bright pink, aqua orblack colour.

The latest exciting addition to theproduct portfolio is a collection oforthopaedic bracing designedspecifically for children.

The range branded as “Paediatrix”has been created for commonchildhood injuries and conditions,with functionality, comfort andaesthetics in mind.

Included in this range are the everpopular Feet In Motion FFO’s, and thebrand new Single/DoubleTibiofemoral De-rotation Orthoseswhich have been developed by theirteam of orthotists over the past 18months.

Going forward Orthotix will becompiling its new product cataloguefor release in January 2016,showcasing over 25 new products.

The business plans to continue itsexpansion with a new emphasis onretail and export.

� For any product or trade enquiriesplease contact Orthotix on 02920370 696 or [email protected]

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DreamaTM 24-hour positioning system– providing valuable rest for everyoneAT Jiraffe we believe that night-time positioning should be of thesame high quality as day timepositioning.

After all, we probably spendmore time in our sleepingposition than we do in anyother! That’s why as part of ourrange of postural supportproducts, we provide theDreamaTM by Jenx.

DreamaTM is a combinedpressure reducing mattress andpostural support system thatuses a variety of support pads tocontribute to better quality sleepor rest.

It can be used as both apreventative system or to reducethe risk of further posturaldeterioration and is thereforeappropriate for any age.DreamaTM can be used onprofiling beds too as it easilycontours thanks to its strong,flexible aluminium base.

It also provides good ventilationbetween the body and themattress, which not only reduces

heat-triggered spasms, butprovides greater comfort for theuser.

The pressure-reducing modularmattress is 15cms deep and ithas individual towelling coverswhich are soft and stretchy andcan be quickly removed if soiledand the cushions wiped clean.

Perhaps best of all though, is theunique Glide-LockTM system ofsupports, which can beconfigured exactly to the user’sneeds and can be adjustedquietly or the user’s positionchanged easily withoutdisturbing the user.

DreamaTM can also be set up

with the user in bed, so transferscan occur with some, all or nosupports in place, reducing theneed for lifting and the positionthen being adapted once theuser is on the bed.

DreamaTM is particularlybeneficial to those with thefollowing conditions: CerebralPalsy, Muscular Dystrophy, SpinalMuscular Atrophy,Arthrogryposis, RheumatoidArthritis, Post-trauma, Post-surgery, Spina Bifida and Scoliosisamongst others.

We’ll be showcasing our cot sizeDreamaTM on the Jiraffe stand atthis year’s Kidz South, Stand 308.

INTRODUCINGMemo children’sshoes, sandals, bootsand inserts with theunique MemoDiagnostic System.

Memo shoes are amedically registeredproduct, highlysupportive andhardwearing andhave been sold inEurope for over 25years and over sevenyears by Equip ToMove Ltd, UK distributor.

Memo shoes are available in a wide range oftrendy styles and colours and available from babysize two to adult size six and include a school shoerange. Memo shoes are very cost effective withmost ranges just £65 a pair. For NHS procurementwe can offer a discounted price.

We carry a large stock and can dispatch the sameday. We can bring a selection of our stock to youso your Orthotic team can see these lovely bootsand shoes.

Equip To Move Ltd 01525 718581

www.equiptomove.co.uk

[email protected]

CPPC House, 1 Kings Road, Flitwick Bedfordshire.

Introducing Memochildren’s footwear

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E was diagnosed with CongenitalMuscular Dystrophy at six weeks oldand at age seven years the effects ofa progressive neurological conditionwere taking their toll.

A diagnosis that we can do nothingabout but can we address what it isdoing to his body?

E has muscle weakness that is drivinghis body out of alignment andplacing him in the most complex ofpositions where constant pain is oneof his biggest issues.

He is unable to tolerate a TLSO (arigid brace) and so his mother soughtadvice about the Sensory DynamicOrthosis (a made to measure lycragarment).

Some passive correction in lyingsupine was achievable but when upagainst gravity this is lost.

He was provided with a day suit anda sleep suit because of his clinicalpresentation and five months laterthe SDO had made a difference.

� Improved alignment.

� No pain when wearing the suit.

� Improved upright posture.

� Improved upper limb function outof base of support.

� Improved volume and clarity ofspeech.

� E immediately states that it feelsgood and that he feels safe.

Little boy feels good afterwearing made-to-measureSensory Dynamic Orthosis

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Orthotics inspired by collagen masks canbe developed in hours, researchers claimFLEXIBLE orthotics that use theexperience of collagen masks can bedeveloped within hours, according toresearchers.

MHOX (mhoxdesign.com) and CRPGroup (crptechnology.com –windform.com) are aiming to create aframework that will allow for masscustomisation of orthoses, ratherthan the traditional size systems (XS,S, M, L, XL, XXL).

A software workflow has beendeveloped that takes a bodyscan ofthe patience and uses a set ofalgorithms aimed at fitting the deviceon the patient anatomy andarticulating its form to achievespecific, customised performance.

The bodyscan of the patient isperformed via infrared or structuredlight sensors. This phase wasdesigned to be fast, easilymanageable in medical environment,cheap in terms of hardwareresources.

The generation of a 3d model oforthosis allows the designer todifferentiate object's morphologyfrom patient to patient, managingspecific performance needs, whileadapting to personal anatomies. It ispossible to create devices withdifferent balances of stiffness andflexibility, allow certain movementswhile constraining others, integratean aesthetic value, implementmaterial properties totally new to this

objects, such as porosity and surfacearticulation.

A spokesman said: “3D printing andadditive manufacturing were used tocreate the orthosis. This technologycan enable the full customization ofthe medical device according topatient need. The material that CRPGroup used for this kind ofapplication is Windform GT that is apolyamide-based material reinforcedwith glass fibers.”

The software to scan and generatethe orthosis is designed to beadaptable to different body segmentsand performance needs.

The hand orthosis is intended to be adevice to aid rehabilitation after

surgical operation. It constrains anymovement of the hand. A surfaceporosity, variable in size anddistribution, allows the hand to stayventilated and washable.

The leg orthosis is a device forpatients with peroneal musclesdeficits and consequent troubles intheir gait cycle.

The 3d scan allows the object toembrace both the leg and the foot,directly integrating a plantar. Aspecific joint, centered on the ankle,whose geometric characteristics varyparametrically from patient topatient, employs the flexibility of thematerial to provide active supportand control in the gait cycle.

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assistive technologies june/july 2015

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