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Mobility after stroke – what options exist?

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There are more than 100,000 new incidences of strokes in the UK each year – that is around one stroke every five minutes.

1.2 million people in the UK live with the after effects of stroke every day, making stroke one of the most resource-intensive indications faced by the NHS today, and a huge challenge for many years to come.

The NHS and social care costs of stroke are around £1.7 billion a year in England. Therefore, stroke inevitably demands medical and therapy solutions founded on sound scientific principles, such as those provided by Ottobock.

The National Institute for Health and Care Excellence (NICE) released the Stroke Rehabilitation in Adults [CG162] guidelines, in June 2013.

The guidelines advise the consideration of ankle–foot orthoses (AFOs) for people who have difficulty with swing-phase foot clearance after stroke (for example, tripping and falling) and/or stance-phase control (for example, knee and ankle collapse or knee hyper-extensions) that affects walking.

The treating orthotist will assess the ability of the person with stroke to put on the AFO or ensure they have the support needed to do so and the effectiveness of the AFO for the person with stroke, in terms of comfort, speed and ease of walking. 

For those recovering from a stroke, the right rehabilitation aids – be that orthosis or electrostimulation – depend on the nature of their impairments, as well as their daily activities. The solutions selected will be tailored to their changing requirements over the course of their rehabilitation.

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Hemiplegia – the loss of sensory and motor function on one side of the body – is often the greatest challenge faced by patients following their stroke. This occurs as a result of damage to the central nervous system. Stroke is a leading cause of disability in the UK – almost two thirds of stroke survivors leave hospital with a disability.

Mobility aids that are tailored to each stage of rehabilitation can substantially ease activities of daily living and promote mobility. Limb weakness is common after stroke and it is reported that over three quarters of stroke survivors report arm weakness, which can make it difficult for people to carry out daily living activities.

Functional Electrical Stimulation 

Functional Electrical Stimulation (FES) reactivates the nerves that are no longer controlled by the central nervous system. Bioness have developed the L300 Go and L100 Go lower leg FES devices. Unlike FES devices commonly supplied within the NHS which require a control box/pulse generator via long wires, or a heel switch, the L300 Go and L100 Go utilise wireless technology. The H200 wireless is also available as a upper limb solution.

The simple design makes it easy for users to don/doff, with the potential for single-handed application. The self-contained electric pulse generator (EPG) uses accelerometers and gyroscopes to provide 3D motion detection in all 3 kinematic planes and enables users to walk without the need for a heel switch, opening up freedom of choice for footwear and allowing the user to walk barefoot. The 3D motion detection and learning algorithm provides consistent stimulation, deployed in 0.01seconds and adapts to the users gait dynamics.

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Custom Made Orthoses

Our custom manufacturing unit at Ottobock Minworth specialise in hand crafted orthotics made to specification. The orthotist will design the orthosis depending on specific patient needs. Our experienced and award winning technicians ensure that each orthosis made is to the highest level of fit and comfort for your patient.

Ottobock Minworth blend cutting edge manufacturing techniques with traditional manufacturing skills to ensure the best possible outcomes for your orthotic device. A full range of AFOs, DAFOs, GRAFOs, and Stance control, Cosmetic and Convention KAFOs are available, complimented by Ottobock’s full range of world leading bars and joints.

Braces and Supports – Upper Extremity 

Limb weakness is common after stroke and it is reported that over three quarters of stroke survivors report arm weakness, which can make it difficult for people to carry out daily living activities.

The Omo Neurexa plus is a shoulder support that prevents or reduce subluxation, resists pathological movement patterns, has a forearm support to further offload the shoulder joint. The Clima Cool material also aids with sensory feedback.

The Omo Neurexa plus can also be used in conjunction with the Manu Neurexa plus, or the Manu Immobil Long – a wrist hand orthosis that stabilises and supports the wrist where the wrist or hand is paralysed. Together, these products make up the complete upper limb solution.

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Braces and Supports – Lower Extremity

Stock lower limb braces are designed to improve posture, mobility, walking speed and balance, as well as providing the end user with a greater sense of safety. 

The WalkOn Range are dynamic lower leg orthoses, suitable for indoor and outdoor use. The primary feature of the WalkOn orthoses is that they are dynamic – a particular benefit for patients with permanent dorsiflexor weakness. The range is made of glass fibre (Flex) and carbon fibre prepreg materials (Trimable, Reaction and ReactionPlus) which provide easy energy storage and return during the gait cycle. The ergonomic design of the WalkOn orthoses means they are discreet and inconspicuous to wear.

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Ottobock also offers a range of other lower limb braces for mild dorsiflexor weakness.

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Stance Control Orthoses (SCO)

Stance Control Orthoses, usually available through NHS funding, are for patients with partial paralysis or absent knee extensor power. In general they allow for free swing phase and stable stance phase. 

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If you would like to know more about any of these products please get in touch via orthoticsuk@ottobock.com or visit our website for more information: www.ottobock.co.uk.

MND

£1m dedicated to MND research through 7 in 7 Challenge

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A £1million fund has been created to lead new research into potential treatments for Motor Neurone Disease (MND) through the efforts of an iconic challenge by Kevin Sinfeld. 

Kevin, director of rugby at Leeds Rhinos, raised over £2million through his 7 in 7 Challenge, inspired by his former team-mate and close friend Rob Burrow. 

Rhinos legend Rob was diagnosed with MND in December 2019, and Kevin completed seven marathons in as many days to help boost badly-needed research into the condition. 

Now, with £500,000 of the money raised through the 7 in 7 Challenge ring fenced for research, that sum has been matched by medical research charity LifeArc. 

The move has created a £1million joint fund established by the MND Association and LifeArc, which will support research projects focused on developing new therapies or repurposing drugs already approved for use for other conditions.

“This is fantastic news and an amazing contribution from LifeArc,” says Kevin. 

“When we set out to complete the 7 in 7 Challenge we hoped to raise awareness and funds to support the MND community but it is so wonderful to see the inspiration it has given people and organisations, like LifeArc, so they too can support the need for more research.

“Our hope, like that of everyone affected by this brutal disease including Rob, is that this money will make a real difference and help find the breakthrough we all desperately want.”

Researchers are now able to apply for a share of the funding, with the criteria that they will be expected to conclude their project within three years and be target driving with set milestones and a credible delivery plan – including a clear route to reach MND patients.

Dr Brian Dickie, director of research development at the MND Association says: “We are so grateful to LifeArc for this generous contribution and are looking forward to working with them to identify projects which have a real chance of making a difference to our community in the coming years.”

Melanie Lee, LifeArc’s chief executive, emphasised that the focus of the new funding is on boosting research around potential treatment options based on the latest understanding of the disease.

“The ambition around stimulating the search for new treatments fits with LifeArc’s approach over the last 25 years to translate early science into health care treatments or diagnostics that can transform patients’ lives,” she says. 

“Our partnership with the MND Association is the latest in a series of strategic partnerships that maximise LifeArc’s expertise in translating strong discoveries from the lab into benefitting patients with conditions with few or no effective treatment options.”

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What causes a stroke?

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Ischemic and hemorrhagic are the two main types of stroke

Over 100,000 people in the UK suffer a stroke each year, with there currently being around 1.2 million survivors living in the country.

Many people note that despite how common strokes are they remain unaware of what the actual causes of a stroke are.

Depending on which of the two types develops, causes and outcomes can differ.

What both have in common is they restrict blood flow to the brain. This leads to a reduction in the brain’s oxygen levels, which can cause tissue damage.

Here, NR Times breaks down why a stroke may occur and what risk factors there are behind each different type.

What are the different types of stroke?

There are two main types of strokes: ischaemic and hemorrhagic.

Ischemic strokes make up nearly 90 percent of all cases and they materialise when an artery which provides blood and oxygen to the brain becomes blocked. 

A hemorrhagic stroke is much less common, but happens when an artery leading to the brain bursts and starts to leak blood around or in the brain.

Causes of an ischaemic stroke

The brain is only able to function properly when its arteries supply it with oxygen-rich blood, meaning any blockages can cause lasting damage.

With a lack of blood flow, the brain is unable to make enough energy to work. If this consists for more than a few minutes, brain cells will begin to die.

This is exactly what happens in an ischaemic stroke, but there are a range of reasons as to why these blockages develop.

One of the main causes is when the arteries around the head narrow, which makes it harder for the blood to pass through.

This can also lead to something called atherosclerosis, which is where substances in the blood (such as fat or cholesterol) stick to the sides of the arteries.

Blood can build up on these deposits, causing a further increase in pressure and a reduction to the brain’s oxygen supply.

There are a number of reasons for these blockages, with the most common ones being around a person’s lifestyle.

For example, smoking can increase the risk of a stroke by up to 50 percent.

This is because nicotine not only narrows the arteries, but it also makes the heart beat faster, causing an increase in blood pressure.

Excessive alcohol intake, obesity and high cholesterol levels are also all listed as major risk factors when it comes to ischaemic strokes.

Problems with the arteries around the heart can also lead to an ischaemic stroke.

Irregular heartbeats, heart attacks and other irregularities around this area can again limit the blood’s oxygen levels.

Causes of a hemorrhagic stroke

Hemorrhagic strokes are most common in people ages 45 to 70, but they affect a lot more younger people than an ischaemic stroke.

These are caused after the arteries around the brain burst and cause bleeding.

Depending on where the artery is can affect the outcome of the hemorrhagic stroke.

If the bleeding occurs within the brain, blood shooting out at high pressure can kill some cells.

Bleeding on the surface increases the pressure in the protective layer between the brain and the skull, potentially causing more cell loss.

This bleeding is normally caused by chronically high blood pressure. In many cases, the increased pressure can cause the arteries to expand and weaken, meaning a split in them is more likely to take place.

A rarer cause of hemorrhagic stroke is where the blood vessels around the brain are connected abnormally, causing further stress on the brain. These are congenital (present at birth) but the reason for their occurrence is currently unknown.

Again, the best way to reduce the risk of an hemorrhagic stroke is to make healthy lifestyle choices.

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NHS pilots video service for epilepsy diagnoses

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A new clinical video service which supports epilepsy diagnoses and management in the era of coronavirus and beyond has been launched in the UK.

vCreate Neuro allows registered patients and carers to share smartphone-recorded videos of potential seizures or unknown movements with their clinical team via a secure, NHS-trusted system.

The data and footage act as a visual aid to assist clinical teams with rapid precision diagnostics, creating a digitised clinical pathway that minimises the need for face-to-face clinic appointments and invasive tests.

The system is currently being piloted across Scotland and, following its initial success, across England including Great Ormond Street Hospital, Evelina London and Sheffield Children’s Hospital.

The system is available to families who are concerned that they, their child or loved one may be experiencing seizures or unexplained episodes including epilepsy.

Since May 2020, more than 2,000 families have shared over 5,000 videos with their clinical teams across the platform.

Dean MacLeod was referred to the service when her seven-year-old daughter, Olivia, began having unknown movements in May 2020.

Dean uploaded videos of Olivia during these episodes as Olivia’s seizures grew more frequent.

The videos were reviewed by Paediatric Neurology professionals at the Royal Hospital for Children, Glasgow, and, supported with telephone appointments, Olivia was diagnosed with a form of epilepsy and quickly started on treatment.

Speaking about her experience, Dean said: “I’ve found vCreate to be invaluable in Olivia’s journey since she started having seizures last summer.

“We live in a remote location on the Isle of Lewis, Scotland, and we have a very limited paediatric service on the Island. The service has made it easy to access the specialist clinical knowledge needed by sending recordings of various seizure events to the Paediatric Neurology team at Glasgow.

“Since the diagnosis, I have kept in regular contact with the clinical team through the platform, sending videos and typically receiving advice from a Consultant within 24 hours which is fantastic. Between the vCreate service and telephone discussions, our family have not needed to have face-to-face consultations which has been hugely beneficial during the pandemic.”

Professor. Sameer Zuberi, consultant paediatric neurologist at the Royal Hospital for Children, Glasgow, said: “vCreate Neuro has transformed how we use carer-recorded video in our service. We are diagnosing epilepsy more rapidly, preventing misdiagnosis and saving unnecessary investigations. Families feel in more control and better connected to the service.

During the Covid-19 pandemic, many people experiencing seizures and seizure-like episodes, including children, have been unable to see a clinician.

Create Neuro aims to help by empowering patients to use asynchronous video technology for self-management, reducing the need for physical appointments. 

Founder Ben Moore said: “We’re passionate about family-forward care, and worked closely with clinical teams, patients and carers to develop the vCreate Neuro service.

“The system aims to improve patient care, reduce the number of clinic investigations – and resulting costs to the NHS – and digitise the patient pathway. We want families to be in control of their healthcare journey and have a direct link to their clinical team despite the pandemic restrictions.”

The vCreate platform has been independently assessed and approved by Information Governance teams in over 100 UK NHS Trusts.

 Within the platform, a clinical database is available as a learning resource for clinicians to study seizure types, events, and other symptoms.

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