Mirror Therapy May Reduce Phantom Limb Pain
Looking in the mirror may be good for more than straightening your tie. A new study suggests that phantom limb pain, which 90 percent of amputees experience, can be lessened by a technique called mirror therapy. The study was reported in a letter in the New England Journal of Medicine’s November 22, 2007 issue.

According to the Web site WedMD.com, the study incorporated 18 patients, who each felt phantom pain from an amputated foot. The patients were split into three groups of six. Those in the mirror group watched a reflection of their intact feet in a mirror while mentally moving their phantom amputated limbs.

The second group performed movements with their intact limbs and mentally moved their amputated limbs while the mirror was covered by an opaque sheet. The third group performed only a mental visualization, with their eyes closed, of moving their amputated limb.

The patients practiced their particular exercises for 15 minutes a day for four weeks, also keeping track of the number and duration of episodes of phantom limb pain, and the intensity of the pain they felt.

All of the patients in the mirror group reported a drop in all three aspects of their phantom limb pain. Only one patient in the covered mirror group did, while three of them reported worsening pain. Of the patients in the visualization group, two reported a positive difference, and four reported a change for the worse.

Phantom limb pain also decreased in eight of nine patients who switched to mirror therapy from one of the other groups after the first four weeks.

The researchers involved were affiliated with Walter Reed Army Medical Center in Washington, D.C., Malcolm Randall Veterans Affairs Medical Center in Gainesville, Fl., and Uniformed Services University of the Health Sciences in Bethesda, Md.

The researchers suggest in their letter that the pain relief gained from mirror therapy may be due to activation of mirror neurons in the hemisphere of the brain opposite from the side of the body with the amputation. These neurons fire when a person performs an action or observes another person performing an action. The mechanics of this phenomenon are not fully understood, but the researchers believe that mirror therapy could help amputees substantially reduce their phantom limb pain.

For more information, visit http://content.nejm.org.

Brain2Robot Could Help Paralyzed Patients
The Fraunhofer Institute for Computer Architecture and Software Technology (FIRST) in Berlin is working on a robotic-limb control system based on the eye movements of the user.

According to the Institute’s Web site, the Brain2Robot program would allow paralyzed individuals to have the direction of their gaze monitored by a special pair of eyeglasses. Another tracker would determine the direction of the head. Using these two forms of feedback, the software component of the device would direct the robotic arm to move and grasp.

The movement of the robotic arm is triggered by a signal from a brain-computer interface. The interface uses an EEG to measure brain signals, which are then analyzed by the computer to identify patterns of thought which correspond with moving a limb in a particular direction.

The FIRST system puts the bulk of the learning responsibility on the computer, which uses algorithms to analyze data and allows the patient to learn to use the system in a simple 30-minute session. The patient learns to look in a particular direction as a signal to the computer that it intends a particular movement.

FIRST hopes to make the Brain2Robot system available for medical applications including prosthetic control systems and robotics mounted on wheelchairs.

The program is funded by a Marie Curie Excellence Grant from the EU 6th Research Framework Programme.

For more information, visit www.first.fraunhofer.de.

Piezoelectricity Could Spark Prosthetic Advances
According to an article in Science Daily, a University of Houston research team is working on using piezoelectricity, the ability of some materials to generate an electrical charge when placed under stress, to enhance the flexibility and strength of prosthetic limbs.

Piezoelectrics may sound technical, but it’s involved in everyday things such as how a lighter works and how airbags deploy.

For example, an engineered piezoelectric strip in a soldier’s boot would generate electricity with every step of the walking motion, since exerting force on the strip would bend it and generate electricity that could power devices that soldiers carry.

Man-made piezoelectrics could conceivably be harnessed to build prostheses that provide better energy return and natural movement, since current prosthetic limbs face challenges in range and movement when using two types of naturally occurring piezoelectrics, ceramic and polymer.

“Ceramic piezoelectrics are very hard and brittle, and don’t allow for a lot of movement,” says Pradeep Sharma, the mechanical engineering professor who leads the UH team.  “They take a lot of electrical energy for a lot of motion. Polymers are better for large forces of motion, but don’t have a lot of strength. We wanted to combine the best qualities of the two types of piezoelectrics.”

Sharma is creating piezoelectrics from man-made materials that have no natural piezoelectric properties.
 
A $1.22 million grant from the National Science Foundation will fund the testing phase of the project.

For more information, visit www.sciencedaily.com.

China in Need of Lower-Cost, Higher-Quality Prostheses
China’s trade surplus with the western world is established. However, China does not produce prosthetic limbs in anything like the quantities in which it produces many other goods. Further, the prosthetic limbs China does produce are of quality too poor to make an appreciable difference in the lives of its more than 2 million amputees, according to China Daily.

Most of the 600 factories which produce prostheses or components are producing simple parts which are then used by foreign manufacturers. There are also many fewer prosthetics experts in China than in other countries––less than one-quarter of those in Japan, the United States, or Germany.

Some affluent Chinese, or those with national hero status, are able to purchase Western-made prostheses, but only products from Germany, Great Britain, or France are available to them. The cost of these imported prostheses is beyond the reach of the average Chinese consumer.

Lacking government backing, most disabled Chinese have no way to obtain quality prostheses. Advocates for China’s O&P industry are counting on the Paralympic Games being held this summer in Beijing to increase awareness of China’s disabled population and potentially encourage those empowered to find solutions to do so.

For more information, visit www.chinadaily.com.cn.

Simbex LLC Honored by Time
Simbex LLC, of Lebanon, N.H., had two products recognized by Timemagazine on its list of “Best Inventions of 2007.” The HIT System™, which alerts athletes to potential brain injury, and the PowerFoot One™ powered prosthetic ankle were included on the list of major product innovations of 2007. Simbex is a research and product development company specializing in biomechanical feedback systems.

The HIT (Head Impact Telemetry) System, which Simbex has developed for a number of applications, was recognized specifically for the product Revolution IQ HITS™. The technology can record,  measure and analyze head impacts during football practices and games. The system is now available to the general public.

For the PowerFoot One, a powered ankle prosthesis for lower-limb amputees, Simbex joined forces with Hugh Herr, Ph.D. of the MIT Media Lab. (For more information on Dr. Herr, see the November 2007 issue of the O&P Almanac.) A prototype was developed with funding from the U.S. Army.

Simbex founder and president Richard Greenwald heads the team, which has been awarded a Phase II contract to develop the product commercially. Dr. Herr’s company, iWalk, is expected to launch the product commercially in 2008.

For more information, visit www.simbex.com.

OPAF Receives Second USTA Tennis and Education Foundation Grant
OPAF’s First Volley tennis clinic has won the United States Tennis Association (USTA) Adaptive Tennis National Community Service Award for 2008. The award will be presented at the USTA Community Tennis Development Workshop in Las Vegas in February.

OPAF also received a $20,000 grant from the USTA Tennis and Education Foundation. This is the second year in a row that First Volley has received a grant from this division of the USTA.

“We are so honored to have been selected again,” said Robin Burton, executive director of OPAF. “These funds will allow First Volley attendees to learn or re-learn tennis skills and get them involved in an active lifestyle again.”

The grant funds will be used for eight First Volley clinics across the country for amputees and individuals with other physical challenges who wish to try their tennis skills with certified professional instructors. Participants ages 5-80 can come to First Volley clinics with little to no tennis experience and play league tennis with able-bodied players. Wheelchair players are welcome as well.

In 2007, OPAF hosted a total of 12 First Volley clinics.

For more information, visit www.opfund.org.

LCodeSearch.Com Proves Popular Since Launch
During the first four months from its launch at the National Assembly September 17, 2007 through January 11, 2008, the Web site LCodeSearch.com has received 4,968 visits, including 2,193 unique visitors. AOPA’s online resource for coding recommendations has drawn viewers from the United States, Canada, Germany, Puerto Rico and India, among others.

Most viewers—71 percent—logged on to LCodeSearch.com directly, which may suggest the O&P field at large is aware of this new tool from AOPA and is eager to see it for themselves. Search engines referred another 19 percent who were looking for L code information on sites such as Google or Yahoo.

Various pages of the site were accessed 35,469 times, with 19,130 unique views. Traffic to the site peaked on October 15, a month after launch, when 111 viewers logged on.

To see the site for yourself, visit www.lcodesearch.com.

People in the News

Brian Gustin, CP, 2008 president-elect of AOPA, has joined the executive team of BridgePoint Medical LLC. He will also assume the responsibility of chief clinical officer over all of the company’s orthotic and prosthetic facilities.

Todd Salley joined College Park Industries in January 2007 as the manager of the North Central territory. College Park recently divided their Northeast territory into North Central and North Atlantic regions to provide more personal attention to its customers. Salley previously worked with a company that filmed the first O&P Extremity Games.

In August 2007, Dan DeFillipi joined the company as North Atlantic Territory manager. DeFillipi has been a technical sales professional for over 20 years.
 
Elizabeth Mansfield was elected president of OPAF for fiscal year 2008. Vice president will be Dennis K. Williams, CP, and Robert C. Manfredi, Sr., CPO, C.Ped. will serve as treasurer.

Tammy Schulte, CO, joined the clinical staff of the Waldorf, Md. office of OrPro Prosthetics and Orthotics in late 2007. OrPro is based in Irvine, Calif.

Devendra Raj Mehta won the Tech Museum of Innovation’s 2007 Tech Museum Award in the Equality category for his work with the Jaipur Foot. The lifelike, inexpensive prosthesis was first invented in 1968 and has been refined and improved over the years. The project has grown from providing 50 limbs between 1968 and 1975 to treating 70,000 patients in 2006 and 2007.

In Memoriam

Keith Elliott, a technician at Next Step Orthotics & Prosthetics in Manchester, N.H., died November 24, 2007 at his home in Greenfield, N.H. He was 51.

Elliott was born in Memphis in 1956 and earned an associate’s degree from Keene State College. He served in the Navy from 1974-76 and later joined the Merchant Marine, serving on the Great Lakes and around the world. Elliott was a member of the Seafarers Union and loved the sea and ships, as well as sports.

An above-the-knee amputee, Elliott lost his leg 20 years ago in a motorcycle accident, and in 2004 decided to enter the prosthetic field.

“He was a great friend and employee,” says Peter Couture, CP, and president of Next Step O&P. “He was the type of person that would give you the shirt off his back.”

Theron Hogue, BOCP, of Scott Sabolich Prosthetics in Oklahoma City, died on December 12, 2007. He was 31. Born in Sacramento, Calif., Hogue grew up in the Oklahoma City area. Hogue was known in the medical
community for making the top three fastest and most lightweight prosthetic legs used in the 2004 Special Olympics. In his spare time, he enjoyed fishing, golfing and traveling.

He is survived by his daughter, Makynzie, and numerous family members and friends.

Businesses in the News

The Amputee Coalition of America (ACA) celebrated the grand opening of its new, more spacious national headquarters in Knoxville, Tenn. in November 2007. The ACA also received a four-year renewal of funds from the Centers for Disease Control (CDC).

Arizona AFO has joined with Susan G. Komen for the Cure to raise awareness for breast cancer. Arizona AFO will offer special pink ankle braces to its clients in 2008, donating $50 to the charity for each pink brace ordered. Arizona AFO has pledged a minimum $10,000 donation total.

Cascade Orthopedic Supply has donated approximately $60,000 in O&P materials to the Range of Motion Project (ROMP), a 501(c)3 nonprofit organization headquartered in Chicago. The donation will be used for ROMP’s clinics in Ecuador and Guatemala, which serve the disabled poor who would otherwise not have access to prosthetics.

Cleveland BioLabs founding partner Cleveland Clinic has received a $1 million Department of Defense grant to study protectans CBLB502 and CBLB612 for tourniquet and other battlefield uses. This research will be used to find treatments for injuries where blood flow is stopped and then restored after a prolonged period of time.

Hanger Orthopedic Group Inc. has announced the acquisition of three businesses: Orthopedic Services in Nashville, Tenn., Specialized Prosthetic & Orthotic Technologies in Salt Lake City and MHC Prosthetics LLC, with four offices in Maryland.

The Michigan Orthotics & Prosthetics Association (MOPA) will hold its annual continuing education meeting June 5-6, 2008 in Kalamazoo, Mich. at the Radisson Plaza Hotel. Workshops will be held June 5, with lecture presentations on June 6. For more information on speakers and submitting papers, e-mail mopainfo@mopa.info. For exhibition opportunities, e-mail exhibitor@mopa.info.

Mix Match Shoes was founded by Nancy Archambeau to provide amputees or individuals with different-size feet the opportunity to buy shoes in different sizes, or only one shoe, rather than a matched pair that don’t meet their needs. For more information, visit the Web site at www.mixmatchshoes.com or call (888) 726-9420.

The Social Security Administration has announced a number of improvements in its service and outreach to wounded veterans and their families. Among these initiatives are expedited processing of disability claims for those who became disabled while on active military duty; a user-friendly Web site, www.socialsecurity.gov/woundedwarriors; an agreement with the VA to provide medical records electronically to Social Security; assignment of liaisons to work with VA’s Transition Patient Advocates; and extensive training for disability claims examiners on identifying traumatic brain injury.