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Hitting the road to a better quality of life

Advances in technology are helping to open up the world like never before for people who rely on mobility assistance, as NR Times discovers.

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The use of Bluetooth, LED lights and phone charging points are no longer the sole domain of the executive car – these are the types of technology being installed into state-of-the-art mobility aids, to help people who rely on them to explore  the world.

Major breakthroughs in accessibility in recent years have seen power wheelchairs, manual wheelchairs, power assists and seating and positioning products developed to help empower users, giving them  freedom to travel and discover new places and experiences.

In addition to mobility and wellbeing, lifestyle is now a key feature in the development of new products going  to the market, with modern technology helping to redefine the traditional view  of wheelchairs.

One leading manufacturer in this field is Permobil, a company which has been at the forefront of redefining the sector, with the introduction of its Active Height and Active Reach innovations to help the user achieve new goals.

“We are constantly striving to find ways to contribute to our user’s quality of life.

“As well as our power wheelchair products, we want to communicate the possibilities that the combination of manual wheelchairs with power assist devices offer to users, extending their mobility, increasing function and opening up possibilities for excursions and travel,” says Gordon Cunningham, who leads Permobil’s  UK operation.

Permobil, which began life in Sweden over 50 years ago and has grown into a global leader in its field, is certainly using technology to maximum effect.

The clinical need for good seating and positioning, alongside the necessity to create maximum comfort, has seen the development of practical functions like its Active Height – a seat elevator to allow users to achieve better vantage points – and Active Reach, which tilts the seat forward and raises it, helping to extend reach.

Both have been hailed as breakthroughs  in independence.

The F5 Corpus VS offers the possibility to stand and even to drive at slow speed while standing, and its SmartDrive power assist for manual wheelchairs enables users to go up hills and ramps through actions controlled by a Bluetooth wristband.

The discreet unit is compact and lightweight and clips onto the back of the wheelchair. Whenever energy levels are low or a challenging obstacle is reached, users simply tap their device and the SmartDrive takes over.

It has a range of around 20km and weighs just under 6 kgs. Another useful addition is the company’s Connect Me system – currently on trial in some EU countries and coming to the UK soon. The wheelchair is equipped with a GPS device with a SIM card module connected to an app.

It enables users to contact a service hub for possible faults to be diagnosed remotely. Good seating and positioning is an important aspect of the Permobil philosophy, not only from a clinical point of view, but also to provide maximum  comfort by being highly adjustable to individual needs.

As the body moves and changes over the course of a day, month or year, the cushion adapts to ensure a user is always  optimally seated.

A nice feature from a travel perspective is that you can transfer your ROHO cushion to an airplane, train or bus seat, helping you to maintain your comfort and leaving you to enjoy the journey.

“It’s vital that our products are adaptable for the user – not the other way around. User centric design that focuses on first and foremost functionality, comfort, quality of life. If you are comfortable and mobile, then you can get a lot more done during the day,” says Cunningham.

Add to that the likes of the LED lights, puncture free tyres, on-chair phone charging ports and holders for phones and tablets, which are increasingly becoming standard features, and the appeal of manual and power assisted wheelchairs has never been greater.

For more information on Permobil products, visit www.permobil.com or contact info@permobil.co.uk.

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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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Tech

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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