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Braced for a better quality of life

It’s 100 years since Otto Bock created an orthopaedic tech firm in Berlin to help soldiers wounded in WWI. Just as it did then, his company continues to pioneer new ways of improving mobility.

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Ottobock is big news in Germany. When the company celebrated its centenary earlier this year, German Chancellor Angela Merkel addressed 350 distinguished guests from politics, industry and academia at its Lower Saxony HQ.

On the world stage too, it is a dominant force, with a team of over 7,300 and an array of mobility-boosting products available across the globe.

The company exhibited at this year’s European Neuro Convention in Birmingham; and NR Times took the opportunity to explore its newest offerings.

Among them is latest version of C-Brace, billed as ‘the world’s only stance and swing phase controlled orthosis’. For users affected by partial or total paralysis of the knee extensors, this means being able to walk more naturally.

In neuro-rehab terms, this might be required for example, after stroke, brain injury or polio. In the past, paralysis orthoses were limited to locking and unlocking the knee joint, leading to abrupt movements – for example when sitting down.

The C-Brace, however, is able to respond rapidly and intelligently to the user’s immediate situation, including to tripping situations.

An integrated microprocessor controls the stance and swing phase of the leg, and therefore the entire gait cycle. The result is that users no longer need to pay attention to every step and can navigate stairs, uneven ground and slopes more naturally.

The new generation of C-Brace comes with a few useful additions. The sensor technology has been stepped up to make it more dynamic and sensitive than previous versions.

A clever introduction is the Cockpit smartphone app that enables users to adjust their joint and switch into different modes such as ‘cycling’. It is also supported by the Setup app, designed for the orthotist’s use.

An additional advancement is that it is smaller, so can be worn under clothing; it is also lighter, meaning less effort is needed to walk.

Jana Middlebrook (pictured above), Orthotic Academy clinician at Ottobock UK, says: “Everything we do is aimed at improving the patient’s life and reducing the impact their disability has on them. With other braces on the market, it can be easy to accidently unlock the knee, particularly on stairs or slopes.

“The C-Brace will lockout to prevent the patient from falling. This computer controlled brace enables the user to walk step over step and to have a controlled sit. Often if people have weakness in their quad muscles, they end up throwing themselves down when they sit. This prevents that.”

Also relatively new to Ottobock’s product portfolio, meanwhile, is the Bioness L300 Go. Created by Californian-based Bioness, this is a functional electrical stimulation (FES) system designed for patients with foot drop, for example in MS or after a stroke.

FES involves the application of small electrical charges to a muscle that has become paralysed or weakened, due to brain or spinal cord damage. The electrical charge stimulates the muscle to make its usual movement.

With foot drop, disruptions in the nerve pathways between the legs and the brain prevent the foot from being lifted to the correct angle when walking. FES can help to change this.

Ottobock has been the exclusive distributor of the new FES generation and a strategic partner of Bioness since September 2017. This latest product was introduced to the UK last year.

As well as electric stimulation, it provides support for instability of the knee and can be used for both children and adults. It is available as an independent lower leg system (L300 Go), a combined lower leg and thigh system (L300 Go and L300 Go Plus Upgrade) and as an independent thigh system that uses a foot sensor (L300 Go Plus Stand Alone).

Features include 3D motion detection, multichannel stimulation, Bluetooth programming and a user app for mobile devices.

Middlebrook says: “Importantly, it doesn’t have wires so the patient can just pop it on and off and it doesn’t require the fishing of electrodes, which is quite a complicated technique required to make sure the correct nerves are stimulated.

“The technology works on gyroscopes on three planes so, rather than just being able to walk in a straight line, users can walk diagonally and backwards, and it will still work to lift the foot clear of the ground. With the upgraded version, you can also control the knee.

“If there is a much higher level of weakness, you can stimulate the quads or the hamstring muscles to control knee hyperextension or knee flexion.”

L300 Go is supported by a ‘learning algorithm’ that adapts to changes in gait dynamics and deploys stimulation within 0.01 seconds. The device controls dorsiflexion (movement of the foot upwards) and inversion/eversion (tilting the sole of the foot inward and outward) with a single electrode pad – plus acceleration sensors which monitor movement patterns on three planes.

Other features include an optional foot sensor and remote control and an app that allows users to monitor their own therapy progress.

For more information on this and other Ottobock products visit: www.ottobock.co.uk.

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Tech

Using technology to help preserve independence

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With the creation of the Luscii remote monitoring platform, people with ongoing care needs can avoid the necessity for regular medical appointments, while clinicians can ensure they’re being looked after from afar. NR Times speaks to its founder Professor Daan Dohmen about Luscii’s role in the future of healthcare

 

From his early experience of working part-time in a nursing home came a realisation that patients could and should play a more active role in their care and health. 

“For me, that was a really important step in my vision to use technology to help regain people’s independence,” says Professor Dr Daan Dohmen. 

“The nursing home had all good intentions but took away the independence of people living there – they put them in the shower, they did everything. 

“There was one day that I took an 82-year-old lady from the nursing home to a grocery store one block away. We weren’t supposed to do that as there was a store in the nursing home, but I said ‘Let’s go together’ and took her there in a wheelchair. 

“She said to me ‘Daan, this was the nicest thing to happen to me in ten years’ – and that made me think even more about how we can use technology to provide freedom to people who may not have that.”

And from that realisation has grown Luscii, a platform which enables home monitoring for patients, allowing clinicians to keep check from afar without the need for them to come in to hospital.

Founded in the Netherlands, it is now used in seven countries across Europe and Africa, including in the NHS, Luscii – named in tribute to Florence Nightingale, derived from the Latin ‘luscinia’ – is enabling a new digital approach to healthcare. 

Powered by its Clinical Engine, the use of AI supports and alerts healthcare providers when intervention may be needed, and contact can be made immediately via message or video connection. 

Clinicians can monitor patients remotely via a dashboard, using Luscii’s concept of virtual wards to correlate data and alerts for multiple patients, and then responding with intervention whenever required. 

“For managers of Trusts and CCGs, they understand this can help increase capacity and help with waiting lists, but it is even more important from the patients’ perspective in unlocking the power for them to use the tools independently,” says Daan. 

“And for doctors and nurses, who we call our ‘medical developers’, they can build their own digital pathway with e-learning modules and algorithms for their patients.”

With the launch of Luscii in a pre-COVID-19 era, in 2018, the events of the past year have seen the platform take on an even more fundamental role in healthcare.

“COVID really pushed the concept of digital,” says Daan. 

“We’d seen a lot of doctors and nurses who were quite anxious about digital health, thinking is it clinically relevant, will it lead to ‘cold care’? Often if a patient said they wanted to try digital apps, the doctor would say ‘That’s nice, but I don’t think it’s for you’. 

“The past year has forced clinicians to try digital means, and suddenly they are finding out that this can be beneficial in certain situations. 

“Through our virtual wards, we were able to support the early discharge and triage of COVID patients – sometimes it was 11 days earlier when patients could go home.”

And its response to COVID, which saw it develop the Corona Check app – which enabled hundreds of thousands of people to submit health data daily from their homes, allowing healthcare providers to determine who may have COVID-19 and who needed most immediate care – has been acknowledged with the Prix Galien Excellence COVID-19 MedTech Award. 

“We got out the digital Lego box and built a COVID app – we now have 20million registrations on that platform,” he says. 

Born out of his previous business FocusCura, a healthtech which uses smart tools to promote the autonomy of vulnerable people, Luscii continues to grow, particularly in light of the new-found digital adoption within healthcare. 

Now in seven countries – five of which came in during COVID – with its native Netherlands and the UK being some of the earlier adopters. Currently, it is used in more than half of all Dutch hospitals and was pioneered in the NHS by the All Together Better alliance in Sunderland, supporting elderly patients with chronic illnesses at home. 

And it was among elderly people, inspired by his experience of the nursing home, that Luscii’s potential was initially realised. 

“A lot of elderly people with chronic diseases had to go to hospital all the time, they often had to arrange for a family member to take them there, then they would get to hospital only for ten minutes later to be back outside as they were fine and able to leave. The rest of the week they’d be too tired to do anything,” says Daan. 

“We came up with the idea of how to support people with chronic illnesses to have remote check-ups. This was at a time when iPads had just launched and video calls were happening. But what started as a project got bigger and bigger so we had to split off independently.”

And from its origins in supporting elderly people, the roll-out is now including a much wider area of healthcare, as its role in COVID has helped to demonstrate. 

“Once we have virtual wards, people can understand how they could be used in other areas,” says Daan, 

“It’s a personal dream of mine that doctors create these programmes and share between them. Through collaboration, it becomes bigger than a product – it is a movement.”

Going forward, with the potential for digital healthcare continuing to be realised, the ongoing international roll-out is set to continue for Luscii. 

“We are now in seven countries worldwide, four of which we haven’t been to physically, the roll-out has all been done virtually,” says Daan. 

“We have shown we can scale quickly so we can support more patients in more areas.” 

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Tech

Rehab tech business wins further recognition for innovation

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Rehabilitation technology developed by Fourier Intelligence has won yet more recognition for its globally-significant innovation. 

The ExoMotus M4, a lower limb exoskeleton, was awarded the Shanghai Design 100+ accolade. 

The exoskeleton, a gait and body weight system, is the first and only product of its kind on the market with its own body weight supporting system. 

The ExoMotus M4 will be launched into the Chinese market at the Shanghai GReAT 2021 annual summit at the end of July, and is expected to be unveiled in the international market in early 2022.

The latest recognition comes only shortly after Fourier Intelligence won four awards at the China International Medical Equipment (CMEF) Spring Expo, with two being given to its newly-revamped ArmMotusTM M2 Pro device.

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The Shanghai Design 100+ awards recognise and promote the influence of designers in Shanghai, and covers innovation from over 30 industries. 

Over 2.45million public online votes were cast in determining the winners, which were also determined through industry voices and key expert votes. 

The ExoMotus M4 lower limb rehabilitation robot was acknowledged for its ergonomic and user-friendly design, which can achieve gait functional training and multiple mode evaluations. 

The gait mechanical leg can provide the user with precise sensory input in the early stage of rehabilitation through repetitive walking and inhibit the formation of an abnormal gait pattern or learned non-use. 

Early gait training on the ground enhances plantar activation and biofeedback, and dynamic balance and symmetrical weight-bearing assessments can be performed before and after training, which provides a quantitative reference for measuring the outcome and progress of gait training with this futuristic assistive technology.

In addition to having multiple training modes and adjustable parameters, having the additional balance assessment and training modules are the three main characteristics of this lower limb rehabilitation robot that is designed to empower gait training. Through this feature, users can have personalised rehabilitation training.

Fourier Intelligence is recognised globally for its innovative and intelligent solutions that are based on independent research and development of core rehabilitation robot technology, providing medical institutions and patients with the world’s leading comprehensive advanced rehabilitation solutions. 

At present, the company has strategic partnerships with nearly 20 universities and research institutes around the world to jointly develop progressive rehabilitation technologies and promote the application of rehabilitation robotics at the international level. 

Some of these partner institutions include the Shirley Ryan Ability Lab in Chicago, KITE Research Institute at the Toronto Rehabilitation Institute – University Health Network, ETH Zürich in Switzerland, National Healthcare Group in Singapore, and the University of Melbourne. 

Fourier Intelligence has over 1,000 installations in hospitals and institutions with a global presence in more than 50 countries and regions around the world.

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‘Eye tracking technologies are vital life links for ALS patients’

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Eye tracking technology is proving to be a lifeline for people living with ALS, delivering vital communication assistance which helps to break isolation. Here, leading healthtech influencer and ambassador for health innovation Gil Bashe discusses the power of such intervention

 

The moment the flood of ice-cold water poured over my head, there was shock and silence; seconds afterward, my senses returned. I blurted out: “That’s cold!” Family nearby laughed, the moment passed, and the video of my ALS Ice Bucket Challenge was shared online. Mission accomplished, or so one might think. 

My state of frozen speechlessness was over in a moment, but for people diagnosed with ALS (amyotrophic lateral sclerosis also known as Lou Gehrig’s disease), that state doesn’t just last for a moment. It’s an ongoing, harsh and frightening reality that makes life more difficult and can actually shorten it. 

LOSS OF SPEECH SIGNALS LOSS OF CONNECTION

Verbal and physical communication connects us. It is essential to life. But impaired speech (dysarthria) is among the first symptoms evident with ALS. As the disease advances, degradation of the nerves that control lip, jaw, tongue and vocal cord movement causes reduction in muscle stimulation. Unused muscles grow weaker and weaker, to the point where 80 to 95 per cent of people with ALS cannot fulfill their communication needs using their voices alone. In time, most become silent, unable to speak at all, and it’s this loss that isolates ALS patients perhaps more than any other aspect of the disease.

New clinical research points to promising investigational therapies that may slow the progress of ALS. This is important, but patients struggling now lack the luxury of time. While they wait, there are other innovations that can make their lives better and ease their isolation, especially health tech that assists essential communication. But these technologies only work if patients can get access to them.

EYE-TRACKING TECHNOLOGY OFFERS PEOPLE WITH ALS THE ABILITY TO COMMUNICATE

Advancements in precision eye-tracking can enable many with ALS to tap into lifestyle-assistive technology options. As leg, arm and lip muscles become weaker, eye-tracking tech enables users with ALS and other neurodegenerative conditions to engage in daily tasks, including wheelchair operation, home automation and augmentative and alternative communication (AAC) with family, friends and health providers. 

One thing to keep in mind: for ALS patients, preserving communication is an essential part of care. If  patients can’t communicate with those around them – especially family, caregivers and doctors – they are lost. The ability to communicate and be understood improves and may lengthen life. Austin Nieto recounted how obtaining an AAC device broke through his father Augie’s crippling isolation. 

“With my dad’s mind unaffected, he basically became locked in his body, unable to communicate his thoughts, feelings, and basic needs,” shared Nieto. “My father was given a life expectancy of two to three years at the time of his diagnosis, and we are blessed that this year will be his sixteenth year with us since that day. I honestly believe this is a result of his EyeTech eye-tracking communication device.”

Artificial intelligence is making inroads into the field of augmentative communication.

Today’s AAC technology is easy to navigate, and the clinical “magic” is driven by the marriage of medicine and software. EyeTech technology uses machine learning and artificial intelligence to translate a user’s gaze into action, enhancing conversation and ability. While the technology’s control panel is a familiar, user-friendly tablet, its operating system draws from constant human interaction, cloud-based secure data and camera calibration. The more a user makes it part of their real-world situations, the faster the technology adapts to provide an intuitive and natural connection between users and those around them. EyeTech founder and chief science officer Robert Chappell says:

“Eye-tracking is uniquely capable of enriching lives and delivering a higher quality of life to people needing to access AAC technologies. Focusing on how the technology can be a facilitator of connection and not an arduous barrier for people with neurologic conditions is what is making innovators drive toward new software and software updates geared to advance the AAC and medical fields – it’s all about accessibility for people in need – accessible of use and reimbursement.”

ALS DIAGNOSIS SHOULD TRIGGER RAPID PAYER APPROVALS FOR SUPPORTIVE CARE

Accessibility is the rub. The urgent need to support or restore communication makes getting authorization for AAC devices among the most frustrating challenges people with ALS and their families face. Payers too often treat requests for communication technology as secondary to care. This is wrong: with ALS, communication IS care. 

The process is far from straightforward. People with ALS must first be evaluated by a speech language pathologist or other health professional to validate need based on cognition, speech quality and access ability. Then, device requests are sent to an AAC device manufacturer who must navigate the Medicare, Medicaid or private payer maze for reimbursement. Finally, the person with ALS must train to use the technology that will break their isolation and allow them to communicate again. Then they wait for approval to gain access. As their minutes and days tick away, they live in disease-imposed silence.

Service organizations like the Paralyzed Veterans of America (PVA) help U.S. veterans, who are twice as likely to develop ALS, navigate the Byzantine approval process. Others have to find their own path forward. Medicare often covers 80 per cent of device costs every five years, but ALS patients without supplemental Medicaid or private insurance need to pay out-of-pocket for copays. The average cost of a speech-generating device is $15,000, so people already devastated by ALS and the potential of being trapped in a silent world face the additional hurdles of income loss and mounting medical debt.

COMMUNICATION IS A LIFE LINK

For most with ALS, this is an unnecessary hardship, imposed by a system that appears to lack the humanity required to meet their most basic needs. Communication for people with ALS isn’t just a “nice- to-have” – it is an essential life link. While caregivers, providers and AAC innovators struggle through the approval and payment process and its roadblocks, people with ALS and other neurological conditions watch precious days, often weeks, slip by. 

Eye-tracking AAC technologies are proven; they support and sustain lives. There is little doubt of their ability to break the isolation of ALS patients and support those who live with other disabilities and neurological diseases like Parkinson’s and Alzheimer’s. The health system is fragmented with people with health urgencies needing to navigate its complexities. The technology works and makes a life-sustaining impact.  What will it take for the payer and approval system to heed the patient’s urgent call to action?

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