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Assistive tech drive moves up a gear

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Political pugilism gave way to a rare outbreak of unity at Westminster recently. An event, in the palatial quarters of Speaker John Bercow, officially celebrated the birth of the All-Party Parliamentary Group for Assistive Technology (APPG AT).

APPGs bring cross-party members together to pursue a particular interest. While they have no official status in Parliament, they can be a catalyst for positive change.

This APPG was initiated by the ACE Centre, which offers augmentative and alternative communication services. Anna Reeves, who runs the charity and was a driving force behind the APPG, says: “We’re focusing on the wider range of people that could benefit from assistive technology, which is rapidly evolving all the time.

“It’s touched a nerve with politicians because they are getting their constituents coming to them expressing frustrations about not having access to the right support that could be life-changing for them.”

Assistive technology (AT) is used by people with a range of conditions, including autism, vision and hearing problems, mobility impairment, learning and cognitive disabilities and manual dexterity difficulties.

Its ongoing advancement offers vast potential; but also presents a number of problems deserving of the APPG’s attention. Among them is the inconsistent provision of access and support across the country.

In 2014, a £15m-a-year injection of funding via NHS England was announced, supporting the provision of equitable services and equipment to children and adults unable to communicate verbally. The establishment of augmentative and alternative communication (AAC) services has made “a massive difference” according to Reeves – but inequalities remain.

“Support is no longer patchy for people with complex needs who require technology to support their verbal communication – for example, those in the latter stages of motor neurone disease or with cerebral palsy with very complex levels of disability. They can all access equitable services and provision across the country, which is fantastic.

“But there are still lots of people who are
not eligible for those services. If they have 
a less complex level of need they might not necessarily get the same level of support or access to the technology. There is also work to be done in terms of giving people who need it, access to a wider range of technology,
including computer access at home and access to mobile phone technology, which can be hugely liberating.”

Environmental control systems, which support independent living by enabling tasks like operating curtains, TVs and the front door, should also be more easily accessible,
says Reeves.

“There has been an explosion of AT that could make a difference to thousands of people’s lives. However, the benefits of the technology are far wider reaching than just helping people with little or no speech or with complex physical disabilities.

“For example, people in hospital may need such technology temporarily to communicate with the outside world. It can also support children in education, help people with disabilities gain employment and improve independent living. We need a political spotlight to ensure AT is embedded into policy, legislation and funding streams.”

If technology is to help secure jobs for people previously excluded from the workplace, one glaring error must be addressed, says Reeves.

“It seems obvious to me that if you give somebody technology to enable them to
show evidence of their potential and their capabilities, then they are more likely to be
able to compete on an even playing field in a recruitment situation.

“But as it stands, people can’t get support for the assistive equipment they need to do the job, until they’ve got the job. Surely you need the equipment to be able to prove you can do the job to get it. The system seems back to front.”

Amid cuts to disability benefits and the introduction of tougher eligibility tests in recent years, there may well be an appetite within the APPG to tackle this issue. Certainly early signs suggest AT’s link with employability is near the top of the group’s agenda.

As MP Seema Malhotra (pictured) put it at the APPG launch: “If we are to have a truly equal society then we have to make sure the issue of disability is as much on the agenda of education and the workplace as we have seen with gender
and race.”

According to the Resolution Foundation think-tank, 49% of disabled people aged 16–64 were in work last year, compared with 81% of non-disabled people. The disability employment gap—the difference between the employment rates of disabled and non- disabled people – therefore stood at 32 percentage points. Utilising technology to close this gap could have significant economic benefits to the nation; but wouldn’t the sheer cost of the technology be a major barrier in these days of austerity?

“The cost of the technology itself is a bit of a red herring,” says Reeves.
“With the obvious reduction of benefits and the increased taxes from getting more people into work, the cost is relatively low, although we need better research and evidence around that topic.”

Reeves sees training implications associated with AT as a bigger barrier than cost issues. “Clearer funding streams for technology would certainly help but I think significant investment is needed in terms of people’s time to develop skills and knowledge of the technologies.”

A lack of the knowledge needed to recommend and support AT usage is particularly evident in schools.

“We go to schools all the time and see equipment that could be life-changing for some children, but the staff don’t know how to use it, so it gets shoved to the back of a cupboard.

“It’s not as straightforward as the schools not having enough money.
The equipment is already there in many instances but is not necessarily used as well as it should be. There have been lots of cuts
to services supporting schools at a local authority level and schools have become more independent and in control of their own budgets.

“I think there is a risk that children with special educational needs and disabilities may not
be prioritised for the provision they need. But also, the expertise isn’t available to the schools about what technology is out there, and what a difference it could make to certain children.”

Reeves would like to see more training opportunities offered to a range of professionals about AT. Teachers, speech and language professionals, occupational therapists, school technicians, support staff working with adults in care and special educational needs co-ordinators would all benefit,
she says.

Such courses are often poorly attended and not prioritised by time-starved professionals and their bosses, however. It is hoped the APPG will help to switch more
professionals onto the value of AT and generate more demand for
AT-related training.

Reeves also recognises the need for clearer and more detailed evidence about the power of AT.

“There needs to be more research into this area and we need a better understanding of what AT can do to support people. We need to know how many people need it, what that costs and what difference it makes.
We haven’t got the research to answer
those basic questions. We’d like to get more academic institutions involved, although it’s quite difficult to identify funding streams where this could fit in.”

Funding to support innovation and new product development in AT is similarly strained. Often AT products have been spawned from technology used in more commercially-driven markets.

“Investors are usually looking to develop technology with a wide range of benefits, not just for people with disabilities, as
the funding is just not there to develop
it. Eye-gaze technology is used a lot in supermarkets to understand where customers are looking on the shelves,
for example. At the same time, it can be life-changing for people with no other movement than their eyes.”

Research and development will no doubt be one of many discussion points for the APPG once its work takes shape.

Follow the group’s progress online at policyconnect.org.uk.

Who’s who

The APPG AT is chaired by Labour and Co-operative Party MP Seema Malhotra, who represents Feltham and Heston.

She is also a member of the Parliamentary Select Committee on Exiting the European Union. She recently served as Shadow Chief Secretary to the Treasury and continues to keep an interest in economic affairs, productivity, how growth and prosperity can be shared and youth educational achievement.

The group is co-chaired by Lord Holmes of Richmond, MBE, one of Britain’s greatest Paralympians, amassing nine gold, five silver and one bronze medal across four games, including a record haul of six golds in Barcelona in 1992.

His fellow co-chairs are Lord Low of Dalston CBE – a lifelong campaigner for the rights of blind and disabled people – and Conservative MP Matt Warman, who represents Boston and Skegness.

Other parliamentarians in the APPG include MPs John Cryer, Neil Coyle, Barry Sheerman and Bill Esterton. Universities, technology firms and charities are among several organisations supporting the group.

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Tech

Revolutionary neurorehab app begins national roll-out

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A tech platform credited with revolutionising rehabilitation for the neuro sector goes live today as the first step in its national roll-out. 

Neuro ProActive has been created to enable a fully multi-disciplinary approach to rehabilitation, covering both inpatient and community care and involving patients and their families in the process.

The app – which supports the spectrum of neurological conditions, from brain injury to stroke, dementia and Long COVID – enables greater cohesion between therapists through its end-to-end message and video calling encryption, which allows remote services and patient monitoring to be done via one single platform. 

Neuro ProActive – the successor to the award-winning Stroke Active – has been in development for more than three years and goes live at UCLH Queen Square today. It will be used in its Upper Limb Neurorehabilitation Programme. 

The app is set to launch into six NHS Trusts initially, with national and international expansion planned in the near future.

Professor Nick Ward, clinical lead on the Upper Limb Programme, has been a key advisor to Ian Pearce on the development of both Stroke Active and Neuro ProActive. 

Ian, whose father had a stroke in 2017, was inspired to develop a platform to increase co-ordination in care to help families like his. 

Whilst having no background in healthcare or tech development, Ian created Stroke Active – which was named Innovation of the Year Award at the 2019 European Neuro Convention, in recognition of the role it played in revolutionising communication between stroke professionals and promoting patient self-management – and has since created Neuro ProActive.

Working with healthcare software developers L2S2, Neuro ProActive has been created as an entirely separate platform which has been built from scratch to be entirely fit for purpose for the whole neuro sector.

“After three years of consultations with patients, families and AHPs, it’s great to see Neuro ProActive deployed at UCLH,” says Ian. 

“Nick and his team were involved in the platform’s development from an early stage. The feedback we’re now getting from therapy teams all over the UK is extremely positive. 

“The pandemic has severely curtailed the provision of rehab services and Neuro ProActive helps NHS Trusts adhere to NICE guidelines on patient care in a post-COVID world.”

Speaking to NR Times about its role in neuro care, Ian says: “Frequently, there is a gap between inpatient and outpatient – early supported discharge too often is just early discharge, you hear stories of people waiting six weeks before their therapy starts, which makes things so much more difficult further down the line.

“But by using the platform, we have enabled patients to connect with their community rehab team. We work across all six disciplines – neurophysio, speech and language therapy, occupational therapy, diet, arts and neuropsychology – and the whole MDT can contribute to the dashboard in real time.

“Enabling patients to have the ability to self-manage, while also including family members in the rehabilitation process, is so important. Through using the app, everyone can be involved in the process. Each patient has their own message board too, so can instantly get in touch with their team.”

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How the C-Brace is opening up a new world of possibilities

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The C-Brace is big news in the progression of Orthotic treatment for neurological conditions. The integration of microprocessor technology into a carbon fibre Knee Ankle Foot Orthosis (KAFO’s) opens up a whole new world of possibilities and mobility for patients dependent on full leg support to stand and walk.

As standard, KAFO users are supplied with locked knee KAFOs. This is where the knee is locked in a straight position throughout their gait cycle, but manually unlocked to allow the user to sit down with their knee flexed. The use of a locked KAFO brings about stability of the knee for users with reduced lower leg muscles strength, when walking on level ground.

However, it also results in the development of multiple gait compensations for the user to progress through the gait cycle with a locked knee. Compensations include; hip hitching on the contralateral side, circumduction during swing phase, and vaulting of the contralateral ankle.

Gait can therefore be slower, require more metabolic energy and increase mechanical stress on the sound leg. Walking on slopes and stairs with a locked knee joint is very difficult and often situations avoided by KAFO users.

An alternative option to the locked KAFO is a Stance Control Orthosis (SCO). In a similar way to the locked KAFO, the knee joint is locked straight during stance phase, but unlocks at terminal stance to allow the knee to flex through swing phase, providing a more natural gait pattern and reduction in compensatory motions to achieve ground clearance.

SCOs require considerable confidence from the user, a consistent step length and are again limited on slopes, stairs and uneven ground. In order to prevent accidental disengagement of the knee lock on challenging surfaces, the user often manually locks the SCO.

Where the C-Brace comes into its own is the significant control available in both stance and swing phase of gait. The system provides stability for the foot and ankle, and stabilises the knee in the sagittal plane with the hydraulic unit replicating the eccentric and isometric muscle contraction of the quadriceps and hamstrings.

It controls both the stance and swing phases of gait with microprocessor sensor technology that can adapt to everyday situations in real time. The technology normalises gait by allowing controlled knee flexion during weight bearing, giving patients the ability to safely navigate quick stops, walk on uneven terrain, and descend slopes, curbs and stairs step over step.

The C-Brace calculates the orientation and movement of the system in space in three dimensions, using this information to control the flexion and extension valves of a hydraulic unit that provide varying levels of resistance to knee flexion. In turn, this allows for physiological knee flexion during loading response, absorbing the shock of weight transfer during heel strike.

In a locked KAFO or SCO, that shock is directly transferred to the pelvis and lumbar spine. Additionally, the C-Brace provides microprocessor swing control that adapts to the varying walking speeds of the patient. It does not require consistent step lengths to function as SCOs do.

Variable step length means a patient can increase or decrease walking speed and length of steps based on the instantaneous activity/mobility needs, making walking safer in unfamiliar or dangerous scenarios like crossing roads.

The C-Brace is also able to provide assistance descending stairs and slopes, allowing step-over-step gait, mimicking the contraction of the quadriceps for lowering the body down a stair or slope. The C-Brace considerably reduces stress to the sound limb in unilateral users, and allows bilateral users to descend stairs and slopes and ambulate on uneven terrain.

Additional features of the C-Brace include:

Stumble recovery: The microprocessor swing control of the C-Brace provides a stumble recovery feature that activates high knee flexion resistance during swing phase extension, in preparation for stance phase, allowing the patient to fully load their orthosis and stabilise the body in case of a stumble.

Intuitive Stance Function: This feature allows the patient to stand in a safe and relaxed manner with a flexed knee without the threat of knee collapse, and automatically switches back in to ambulation mode, turning off the blocked knee flexion when the patient moves. This feature allows the patient to unload the sound leg and rest while securely standing on level or non-level surfaces.

Sitting/Kneeling Function: The C-Brace assists the patient when sitting down and standing up from a chair by providing resistance to flexion or extension.

This adds an extra degree of safety and reduces stress to the upper extremities and the sound limb. The microprocessor automatically detects when the patient begins to sit down, adjusting the hydraulic resistance against bending during the transition to sitting.

Allowing the patient to sit in a controlled manner and at a controlled rate. When standing up from a seated position, the C-Brace blocks knee flexion as soon as the knee reaches a flexion angle of 45° or less, allowing the patient to reposition the foot and load the orthosis, for improved leverage to stand. The kneeling down function allows the patient to kneel down safely with controlled flexion of the knee joint, supported by increased flexion resistance.

Activity specific modes/Freeze mode: The C-Brace is programmable for activity specific needs of the patient in addition to ambulation. For instance, resistance can be reduced to a minimum for cycling, or a flexed knee joint position can be fixed for activities such as Yoga. The user, on their personal C-brace App, can control these modes.

So how can you know if the C-Brace might be right for your patient? The first stage is a thorough assessment, considering both the indications and contraindications of the system.

Indications:

  • Flaccid Paralysis or partial paresis of the lower limb
  • Quadriceps deficiency leading to poor knee control during stance phase

The patient may present with regular ‘giving way’ of the knee, reporting stumbles or falls when walking on flat, graduated or uneven surfaces. The C-Brace may be appropriate for a number of neurological conditions, including but not limited to:

  • Spinal cord injury between L1 and L5
  • Polio
  • Multiple sclerosis
  • Neuromuscular disease
  • Muscular atrophy or Traumatic paresis

Essential requirements for the use of the C-Brace:

  • The user must be able to stabilise their trunk and stand without support.
  • The muscles strength of the hip extensors and flexors must allow the controlled swing of the affected leg, or this must be possible through compensatory hip/trunk movement.

Contraindications of the C-Brace:

  • Swing phase initiation is not possible
  • Insufficient trunk stability
  • Severe spasticity
  • Knee or hip flexion contracture of more than 10°
  • Non correctable genu varus/valgus greater than 10°
  • Body weight less than 40Kg or greater than 125Kg
  • Height <140cm
  • Leg length discrepancy >15cm
  • Fluctuating Oedema or severe skin irritation that precludes the use of an orthosis

The C-Brace Dynamic Test Orthosis (DTO) is a trial orthosis, which features the C-Brace joint unit. The DTO can be set up to each individual user and programmed to their individual gait requirements, allowing users to test the function of the orthosis within the clinical setting.

The DTO can also provide valuable evidence to the function and benefits of the C-Brace for payers. The DTO can be trialled with support from the Ottobock Orthotic Academy Clinician or through Ottobock’s clinical partner Dorset Orthopaedic.

For more information about the C-Brace contact Ottobock or Dorset Orthopaedic through their website enquiry pages: www.ottobock.co.uk or www.dorset-ortho.com.

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Recruiter supports medtech business growth

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A startup recruitment business is supporting the development of life-changing inventions in the neuro sector by sourcing the high-level talent to drive their ventures forward. 

Hanison Green has established a niche as the only recruiter dedicated to neuromodulation and in its first eight months of trading has already helped globally-significant, early-stage businesses including ONWARD, the Swiss-based venture which hopes to launch devices within the next four years to enable paralysed people to regain the ability to move and walk. 

With a specialism in supporting startups within neuromodulation, Hanison Green is working globally from its London base, with a primary focus of supporting companies in the US and Europe. 

Founded by Lindsay Hartland, formerly a partner in global recruitment business SThree with over 18 years’ experience of permanent STEM leadership recruiting, he decided to form Hanison Green during the pandemic with a mission to ‘do recruitment differently’. 

And the business is quickly building its reputation in neuromodulation through bringing in key new figures to leadership teams at strategically important times, maximising their chances of long-term success. 

For Lindsay, while establishing a business in a new and unknown sector mid-pandemic was admittedly a risk, it’s one he was eager to take. 

“If you’d have asked me eight months ago what neuromodulation was, I would have looked at you blankly, I didn’t know – but I’m a fast learner and we are already very well-connected in this exciting space of medtech” he says. 

“I’ve always been really into tech and I’ve recruited in the STEM field for years, and medtech is seeing such huge and rapid development. 

“It’s an area which has so much meaning to so many people. I’ve never worked in an industry space where people care so much about the end result, and I find this hugely inspiring.

“My dad had a car crash many years ago, and while he has recovered, he has constant back problems – I’ve found out that neuromodulation could be a treatment that could help. 

“This technology can be genuinely life-changing, and it’s still so new that we’re only now starting to understand the possibilities. The potential is limitless.”

In addition to its specialism, Hanison Green’s approach is one that also makes it stand out from the crowd. Keen not to be regarded as a ‘typical recruiter’, its proactive approach is seeing them solve the recruitment problems businesses face, often before they have realised it themselves. 

“We have a very pinpointed approach, we aim to be incredibly relevant to the company we approach and are very strategic,” says Lindsay. 

“When I approached ONWARD, I had already researched their work and saw they were several years away from commercialisation, and also noticed they didn’t have a strategic commercial leader in place as yet. Anticipating that this was something likely to be under consideration, I approached them with someone I knew could help them prepare for market. 

“It’s normal for CEOs to wear many hats within the business they are leading, particularly within a startup environment, but that takes them away from what that should be doing. 

“We realise that and through our strategic approach, we can anticipate a leader they will be needing to guide them through their next stages of growth, and we provide that talent proactively.” 

Lindsay’s highly strategic approach also extends to sourcing the candidates for these businesses.

“Generally, the talent we find is headhunted – very, very rarely are they on jobs boards, or engaged with other recruiters. Our goal is to work with the best talent, irrespective of whether they are actively on the market or not,” he says. 

“I’ll tend to look for someone who has been with the same company for around four to eight years, with several promotions achieved during this time. It shows loyalty, that they’re serious about their career and are good at what they do. For me, this profile already tells me they are likely a great candidate.

“Recruitment is often seen as a numbers game, and admittedly doesn’t have a great reputation. It’s seen as an area where the recruiter throws hundreds of CVs out there in the hope something sticks, where candidates are farmed out all over the marketplace – but we want to be known for our relevance, and for the calibre of the talent we represent.” 

A new and dynamic business, Hanison Green was set up during the pandemic at a time when Lindsay had the opportunity to think about the future for his family, and to see where the journey of setting up his own business would take him. 

And for Lindsay, he’s happy to let that journey continue, and be guided by the opportunities and the marketplace. 

“I’ve come from a corporate world where it’s all about business planning, growth, profit, all kinds of stuff like that. Everything is mapped out and fixed, and everything has to get signed-off – but I’m now really excited about the unknown,” he says. 

“We’re occupying a great space in the market and will continue to build that further. We will not deviate from neuromodulation but beyond that, I don’t really have a plan for the future. 

“I’m back to frontline, hands-on recruitment, which I had been out of for some years through being a partner, and I think in my older age too and having kids, I felt the need to become a role model to them, and to put my experience to better use.

“To work in something as big as this, where the end result is saving and improving the quality of people’s lives, is very meaningful indeed.” 

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