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Medal-winning paralysed cyclist aims to raise £1 million for spinal stimulation research

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A paraplegic cyclist has utilised the power of Functional Electrical Stimulation (FES) to pedal his way to second place at the annual Cybathlon. Now, he’s embarking on another journey to raise £1 million to fund research on spinal stimulation; a treatment method which aims to improve the recovery and function of people with paralysis.

Following a trampolining accident in 2011 at the age of 16, Johnny Beer (AKA BionicBeer), was paralysed from the chest down.

Almost ten years later, the 25-year-old has snatched the silver medal at the Cybathlon 2020 FES Bike Race. BionicBeer powered his bike using Functional Electrical Stimulation (FES), a method which contracts paralysed muscles using small electrical charges.

Electrodes are placed on the skin through which an electrical current is passed. This effectively replaces the nervous system stimulus that is lost when someone is paralysed.

This year, due to the COVID-19 pandemic, the Cybathlon race took place virtually with competitors racing 1,200 metres in stationary bikes connected to roller trainers. As Beer is unable to use his hands, he competed in a recumbent bike designed by BerkelBike and controlled the bike and level of electrical simulation using his chin.

Beer wasn’t alone in the competition and his success has been described as a team effort between himself and several companies. The applied science team at Mercedes F1 played an integral role in the development of the bike set up and the carbon fibre cycling boots which powered Beer to the runner-up position.

The involvement of the German automotive company originated from a chance encounter with Eric Blandin, Mercedes’ chief aerodynamicist, when Johnny was touring its factory.

“Eric was immediately interested and supportive,” says Johnny.  “Within days, he had spoken to the team’s Applied Science Division and assembled an interested group of amazing engineers to build carbon fibre boots, a heightened axle for larger wheels with custom made hubs, ceramic bearings and optional Camber adjustment.

“The team’s Applied Science engineers were always just an email away and I couldn’t have wished for a better team in my corner.”

Graham Miller, Director of Applied Science at Mercedes F1 says: “We are delighted and very proud to have been able to help Johnny on his route to success in the Cybathlon 2020.

“Our Applied Science Division was set up earlier this year to use our vast engineering knowledge and resources to help deliver innovative technical solutions to businesses and individuals.

“Working with Johnny has been both rewarding and a real technical challenge for our team, applying their F1 knowledge to new areas. His spirit, commitment and dedication to helping others are fantastic.”

Beer had previously won a silver medal at the 2016 edition of the Cybathlon event and won the Cyberbike 2018 time trials in France. His main rival this year was Mark Muhn, winner of the 2016 Cybathlon, who used surgically implanted electrodes as opposed to the adhesive electrodes used by BionicBeer.

Since winning the silver medal, Beer has turned his attention to spinal stimulation research with the goal of further improving his and others’ recovery. He is supporting Neurokinex, a specialist spinal cord injury rehabilitation facility and charity which has treated him since his injury.

Neurokinex also aided Beer in his physical preparation for the race, creating an FES leg weightlifting programme to help him make full use of the technology.

“Johnny is an incredible individual whose energy, enthusiasm and determination is unmatched,” says Harvey Sihota, founder and CEO of Neurokinex.  “Since the day we met, he has inspired others to share his vision to progress his dream of regaining mobility and independence.

“At Neurokinex we use electrical stimulation alongside many other ground-breaking therapies.  As well as our rehabilitation programmes, we are committed to researching next-generation therapies and solutions to treat spinal cord injury.

“People like Johnny are vital to that process and we are hugely grateful to him for giving so much of his time and energy to seek solutions for other people.”

Beer had his sights set on a place on the podium, however his primary motivation for competing was to raise funds for research into spinal stimulation and increase awareness about electrical stimulation and its potential for helping people regain movement and independence.

“While I love the competition and thrill of racing, my priority is to drive research for electrical stimulation by competing in Cybathlon 2020,” says Beers. “My dream is to recover from paralysis, and I want this to become reality so badly.

“Electrical stimulation has powered me to race at the highest level and its potential to provide practical recovery solutions for others cannot be ignored.

“As with so much in spinal cord injury rehab, the science is ahead of the money here. Lack of funding is getting in our way which is why I’m going all out to raise £1 million to make this possibility a reality.”

Odstock Medical Ltd (OML), a spin-out company from the Salisbury NHS Foundation Trust, specialises in FES technology. It works with patients with spinal cord injuries to help them stand, treat chronic pain and control spasticity. In an interview with Health Tech World, managing director of OML, Paul Taylor, spoke of the barriers to making FES a more widely used treatment.

“It’s a recommended treatment for the NHS but not everyone chooses to fund it,” says Taylor. “FES is generally used by a physiotherapist for controlling spasticity and controlling movement. However, because physiotherapists usually don’t have the budget for equipment, it doesn’t fit into the general funding model of the NHS.

“The published reasons for this are that there is insufficient evidence regarding the cost benefits of the technique. At the end of the day, CCGs are trying to save money, however many of the published evidence uses statements that are out of date.”

A recent randomised clinical trial at the Ayrshire General Hospital in Scotland found that FES was in fact more cost effective than the widely used alternative, ankle foot orthosis (AFO). It found that while AFOs were initially cheaper, the FES provided better improvements in overall quality of life.

The most successful use of FES in a clinical setting is for treating a condition called drop foot, a muscular weakness or paralysis commonly experienced by patients with neurological conditions such as stroke, MS and cerebral palsy.

The concept has existed since the 1960s but has failed to be adopted in clinical practice until recently. Even with access to the treatment is still limited.

Taylor says: “Currently you can’t live in one place and get immediate access to FES treatment. Unfortunately, you have to jump through a few hoops in many areas and in some areas it’s a complete no. There’s no consistency across the country.”

In addition to its applications for treating foot drop, FES has been shown to improve hand, arm and shoulder function in stroke patients by strengthening muscles around the shoulder. Although this may not bring back movement, but it can significantly reduce chronic pain. It can also be used for improving elbow movement and finger movement by reducing spasticity.

In recent years, OML has been finding innovative new applications for the technique. For example, Taylor says the company has discovered a way to treat constipation, a common problem amongst people with neurological issues. Some people report only making bowel movements every week, however after stimulating the abdominal muscles using FES, patients reported that their frequency of bowel movements increased to every one or two days.

The company’s latest project is a hand-grasping system for people with tetraplegia. The project is in its early stages but has the potential to allow paralysed patients to pick up and move objects.

Taylor explains: “It is like a long sleeve glove with electrodes on the inside and it is controlled by movements in the opposite shoulder. You can programme it to open the hand, close it around an object, and then open the hand again to drop the object.”

A growing body of published research and increased interest from patients such as Beer is driving the FES sector forward. Beer hopes his campaign will show more people the potential of the treatment and shine a light on the work of Neurokinex who “threw him a lifeline” after his injury.

“I cannot thank everyone enough for their support,” says Beer.  “The collaboration and belief among everyone has been incredible and I can only hope that such enthusiasm and foresight will continue after the race to back the Neurokinex Spinal Stimulation Research Programme.  That remains the ultimate goal with my performance at Cybathlon 2020 showing what can be done with electrical stimulation.”

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No higher risk of pregnancy complications in women with MS – study

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Women with multiple sclerosis (MS) may not be at a higher risk of pregnancy complications like gestational diabetes, emergency caesarean section or stillbirth than women who do not have the disease, new research has found.

However, the study did find that babies born to mothers with MS had a higher chance of being delivered by elective caesarean section (c-section) or induced delivery, and of being small for their age when compared to babies of women who did not have the disease.

“Women with multiple sclerosis may be understandably concerned about the risks of pregnancy,” says study author Professor Melinda Magyari, of the University of Copenhagen.

“While previous research has shown there is no higher risk of birth defects for babies born to women with MS, there are still a lot of unknowns around pregnancy and MS.

“We wanted to find out if women with MS are at risk for a variety of pregnancy complications.

“We found overall their pregnancies were just as healthy as those of the mothers without MS.”

The study involved 2,930 pregnant women with MS who were compared to 56,958 pregnant women without MS. All women gave birth between 1997 and 2016.

Researchers found no difference in risk of several pregnancy complications between women with MS and women without it.

No differences were found in risk of pre-eclampsia, gestational diabetes, placenta complications, emergency c-section, instrumental delivery, stillbirth, pre-term birth, congenital malformations or low Apgar score. Apgar score is a test of a newborn’s health, including measures like heart rate, reflexes and muscle tone immediately after birth.

Researchers did find that 401 of the 2,930 women with MS, or 14 per cent, had an elective c-section, compared to 4,402 of the 56, 958 women without MS, or eight per cent, who had an elective c-section.

After adjusting for other factors that could increase the likelihood of having an elective c-section, such as prior c-section and mother’s age, women with MS were 89 per cent more likely to have an elective c-section.

Researchers also found women with MS were 15 per cent more likely to have an induced delivery than women without the disease.

Also, women with MS were found to be 29 per cent more likely to have babies that were born small for their gestational age compared to women without MS.

Overall, 3.4 per cent of women with MS had babies small for their gestational age, compared to 2.8 per cent of women without MS.

“We think the reason more women with MS have babies by elective c-section or induced delivery may have to do with MS-related symptoms such as muscle weakness, spasticity or fatigue that might affect the birth,” Professor Magyari says.

“Any of these could make a mother more tired and lead to delivery complications that could prompt the clinician and woman to take extra precautions.”

Researchers also found that mothers with MS were 13 per cent less likely to give birth to babies with signs of being deprived of oxygen, or asphyxia.

Professor Magyari said the higher prevalence of elective c-sections among women with MS most likely explains the corresponding lower odds of asphyxia.

A limitation of the study is the lack of data on the mothers’ smoking, which could cause babies to be born small for their gestational age.

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Neuro physio

Community neurorehab gym continues to expand

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The West Berkshire Therapy Centre was established on the back of £145,000 worth of fundraising

A community therapy centre which enables neuro patients access to the physio-led exercise which can support their recovery continues to expand in response to demand for its services.

West Berkshire Therapy Centre was opened in 2014 to bridge the gap in existing community resources, and initially opened for 20 hours a week with ten items of equipment.

Since that time, the Thatcham centre has expanded into premises twice the size of its initial home, and now has 17 items of equipment which clients can access 35 hours each week.

While the centre has been forced to close during lockdown periods, the investment in its offering has continued, with a further £17,500 being spent to upgrade equipment.

In addition to its regular clientele of around 260 people, around 200 more will be referred to the centre from the Berkshire Long COVID Integrated Service, led by Dr Deepak Ravindran, who has worked closely with the centre for several years.

As well as the anecdotal evidence from clients who attest the positive effect West Berkshire Therapy Centre has, the centre’s work has been proven to improve client mobility by an average of ten per cent, psychological outlook by 15 per cent and weight loss by three per cent.

All clients are assessed by the centre’s physio before being prescribed an individual exercise programme. The centre prides itself on its client-centred approach and some of the equipment in the gym has been designed and built specifically in response to what clients said were important to them.

West Berkshire Therapy Centre was created by the West Berkshire Neurological Alliance, a group of 23 local neuro charities, which recognised the need for greater specialist provision for people living with neurological conditions in the area.

John Holt was instrumental to the creation of both the Alliance and the Centre. Having supported his wife in living with MS for over 40 years, he took the lead on ensuring greater provision and support was there for those who needed it.

“I’m not from a medical background, I’m a food technologist, and while I was chair of a trade association during my career, I was used to working with competitors and business enemies, that was just what happened for the greater good of us all,” he says.

“So I was rather shocked when I got involved with the local voluntary sector and found that wasn’t the case. I was very proactive in all of our charities working together as I know the importance of working as one alliance.

“People who were living with neurological conditions were often having to fend for themselves when it came to community rehab, and that’s why we wanted to create the West Berkshire Therapy Centre.”

Having been established on the back of £145,000 in fundraising, five years later the demand for its services was such it had to expand into larger premises and invest in more equipment.

The centre – which is funded by voluntary contributions for sessions and through fundraising – now has eight part-time staff and a core of volunteers to support clients with whatever rehabilitation issues they have.

While most clients have neurological conditions – including stroke, Parkinson’s, MS and Post-Polio Syndrome – the centre has broadened its reach to include large numbers of people with arthritis, heart and lung conditions, sight impairments as well as amputees.

“We’re completely pan-disability and will support anyone who needs us. Our clients talk to us and we listen and adapt,” says John.

“I think many clients come to us because we are a safe place for them and they’re among people who understand the challenges they face.

“It is very important that we talk about things openly. For example, we talk about how hard it is when you can’t get to the bathroom in time and you wet yourself.

“When you face issues like that, it can be the start of a spiral downhill, you might then stop going to work or stop leaving the house, but we share these kinds of things.

“By having this interaction, it becomes a place people aren’t afraid to open up.”

With the centre having been closed for much of the past year, John and the team are ready to welcome back regular and new clients, including the many who are recovering from Long COVID.

“Many of our clients won’t have exercised for several months, but we hear very often that people have waited 20 years for a centre like this, so a few months hasn’t been long in comparison,” says John.

“But we are very much looking forward to re-opening and supporting our clients in regaining any progress and fitness they may have lost. Hopefully we are on the right track now after three lockdowns and clients can come back to us regularly.

“Long COVID is a new condition for us, as it has only come into being in the past few months, but we are ready to support people with their symptoms and in them using exercise as part of their recovery.”

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Brain tech company secures funding to increase support post COVID-19

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CBS Health will help clinicians utilise more digital services

An online brain assessment platform has secured funding to enable its work in telehealth to continue to support people as the world emerges from the COVID-19 pandemic.

Cambridge Brain Sciences (CBS) is planning to expand its operation through a funding round from Canadian Shield Capital, a Toronto-based private equity investment firm, closely aligned to Hatch, a global engineering consultancy.

The investment will allow Candian-based CBS to further its work in digital health, especially around mental health, and respond to the need for accurate and reliable quantified measures of brain function and brain health – hailed as being essential to so many people who have suffered psychologically from the effects of COVID-19.

The funds will allow CBS to grow its sales and customer support teams rapidly, which will enable it to roll out its flagship product, CBS Health, further.

It will also enable it to expand on CBS Health features to help continue to refine and develop its cognitive care platform for healthcare professionals treating the growing mental health, brain injury and ageing patient populations.

The COVID-19 global pandemic has seen many healthcare practitioners to adopt platforms such as CBS Health to manage patients remotely.

As a result of lockdowns and ‘stay at home’ guidance, there has been exponential growth in patients seeking treatment for mental health conditions brought on, or exacerbated by, the pandemic, as well as individuals recovering from COVID-19 suffering with longer term neurological symptoms.

CBS Health has also grown as a result, and offers a web-based platform or integration which allows healthcare professionals to administer the CBS tasks standalone or alongside other established and validated complementary assessments (such as the PHQ-9, a standard scale for assessing the severity of depressive symptoms).

Assessments can be combined into a single session and administered in person or remotely via email—an option from which clinicians have benefitted greatly throughout the COVID-19 global pandemic.

The investment also contemplates further collaboration between CBS and Hatch, building upon an earlier successful pilot for a dedicated CBS platform to address corporate workplace mental health and safety at large scale industrial operations, construction sites and infrastructure projects.

“CBS is excited to be closing this round of financing which builds upon a long-term relationship with Canadian Shield and an earlier successful pilot with Hatch,” says Marc Lipton, president and CEO of Cambridge Brain Sciences.

“The funding will allow us to further accelerate the growth of our core CBS Health product especially amongst mental health practitioners, as well as to strategically explore, with Hatch, large corporate applications for workplace mental health and safety.”

“CBS brings many years of academic discipline and rigorous digital measurement of cognitive health, with applications in mental health, brain injury recovery, healthy ageing, and soon workplace safety,” says Andrew W. Dunn, managing partner at Canadian Shield Capital.

“The growing awareness of, and attention to, mental health conditions and CBS’ engaging and efficient approach gives it enormous runway.”

James Marzocca, global managing director for project delivery at Hatch, adds: “We see great potential to apply CBS testing as a non-invasive diagnostic to assess fitness for duty for individuals reporting to worksites where mental alertness is essential for their own safety and the safety of others.”

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