In the News
Neuro-Controlled Prosthesis Is
Promising
A new technique known as targeted muscle
re-enervation (TMR) has been able to make a prosthetic arm move as if it were a
real limb, according to a February article in The Lancet. TMR uses the residual
nerves from an amputated limb and transfers them onto alternative muscle groups
that are not functional since they are no longer attached to the missing arm.
Initial tests showed improved prosthesis function and the potential for the user
to feel “meaningful sensory feedback.”
Todd Kuiken, of the Neural Engineering Center for Artificial Limbs and the Rehabilitation Institute of Chicago, developed the technique along with colleagues, which was funded by the U.S. National Institutes of Health.
His tests were conducted on a female with a left arm amputation at the humeral neck. The ulnar, median, musculocutaneous and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. After the patient recovered, she was fitted with a new prosthesis using the TMR sites. Functional testing was conducted and sensation levels in the re-enervated skin were measured.
The tests showed positive results, with the patient describing the control of the new prosthesis as intuitive. “I just think about moving my hand or elbow and they move,” she said in the article.
The transfer of sensation was another goal of this technique, which the researchers say was successful. “When the patient was touched on her re-enervated chest skin she perceived the sensation to be in her missing hand,” said Kuiken. This should eventually lead to the patient feeling what she is touching with the artificial hand as if it were her own hand, say the researchers.
The researchers agree that long-term follow-up is needed to see how TMR sensation evolves. In the meantime, they are encouraged by an even more basic benefit of the device—actually wanting to wear it.
“My original prosthesis wasn’t worth wearing—this one is,” said the patient.
For more information, visit www.lancet.com.
Todd Kuiken, of the Neural Engineering Center for Artificial Limbs and the Rehabilitation Institute of Chicago, developed the technique along with colleagues, which was funded by the U.S. National Institutes of Health.
His tests were conducted on a female with a left arm amputation at the humeral neck. The ulnar, median, musculocutaneous and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. After the patient recovered, she was fitted with a new prosthesis using the TMR sites. Functional testing was conducted and sensation levels in the re-enervated skin were measured.
The tests showed positive results, with the patient describing the control of the new prosthesis as intuitive. “I just think about moving my hand or elbow and they move,” she said in the article.
The transfer of sensation was another goal of this technique, which the researchers say was successful. “When the patient was touched on her re-enervated chest skin she perceived the sensation to be in her missing hand,” said Kuiken. This should eventually lead to the patient feeling what she is touching with the artificial hand as if it were her own hand, say the researchers.
The researchers agree that long-term follow-up is needed to see how TMR sensation evolves. In the meantime, they are encouraged by an even more basic benefit of the device—actually wanting to wear it.
“My original prosthesis wasn’t worth wearing—this one is,” said the patient.
For more information, visit www.lancet.com.
Arkansas Obtains Licensure
Arkansas has become the twelfth state to require
licensure to practice orthotics, prosthetics and pedorthics. Arkansas’ Governor
Mike Beebe signed the act into law late February.
“Licensure makes it a requirement that practitioners be qualified to provide care,” said David Yates, CPO, FAAOP and member of the legislative committee. “It will raise the quality of care. It’s primarily a protection for the patient.”
The Arkansas State Orthotic & Prosthetic Association began an initiative five years ago after the board voted unanimously to pursue licensure. They drafted the bill with the help of ABC’s model licensure bill, according to Yates.
“We looked at every licensure law that exists and ours is a combination of the good points that we saw in several other states,” said Yates. One of these “good points” is the bill’s grandfathering clause, which Yates says was included to “not put anyone out of business.”
Because patients receiving O&P care in Arkansas are often treated by practitioners living in bordering states, the bill does not require a practitioner to reside in Arkansas in order to obtain licensure. The bill also includes a reciprocal component which allows practitioners from other states with similar licensure to obtain Arkansas’ licensure easily.
The Arkansas bill also requires that pedorthists hold licensure—a nod to both the significance of the profession as well as BCP’s recent incorporation into ABC.
The next step will be creating a board of directors consisting of both certified practitioners and the general public. The board will be responsible for developing the administrative documents and the timeframes for the licensure program.
“Licensure makes it a requirement that practitioners be qualified to provide care,” said David Yates, CPO, FAAOP and member of the legislative committee. “It will raise the quality of care. It’s primarily a protection for the patient.”
The Arkansas State Orthotic & Prosthetic Association began an initiative five years ago after the board voted unanimously to pursue licensure. They drafted the bill with the help of ABC’s model licensure bill, according to Yates.
“We looked at every licensure law that exists and ours is a combination of the good points that we saw in several other states,” said Yates. One of these “good points” is the bill’s grandfathering clause, which Yates says was included to “not put anyone out of business.”
Because patients receiving O&P care in Arkansas are often treated by practitioners living in bordering states, the bill does not require a practitioner to reside in Arkansas in order to obtain licensure. The bill also includes a reciprocal component which allows practitioners from other states with similar licensure to obtain Arkansas’ licensure easily.
The Arkansas bill also requires that pedorthists hold licensure—a nod to both the significance of the profession as well as BCP’s recent incorporation into ABC.
The next step will be creating a board of directors consisting of both certified practitioners and the general public. The board will be responsible for developing the administrative documents and the timeframes for the licensure program.
Fantastic Fish Findings
Tropical fish are the latest animal to be studied
in an attempt to improve prosthetic limbs. Researchers at John Hopkins
University in Baltimore have been monitoring the complex undulations of the
South American glass knifefish to see how the brain communicates with the rest
of the body. Their findings were published in the January 31 issue of the
Journal of Neuroscience.
“All animals, including humans, must continually make adjustments as they walk, run, fly or swim through the environment. These adjustments are based on feedback from thousands of sense organs all over the body,” said Noah Cowan, an assistant professor of mechanical engineering at John Hopkins.
“Understanding how the brain processes this overwhelming amount of information is crucial if we want to help people overcome pathologies.”
The team chose the glass knifefish because of its nearly transparent, blade-shaped body. Also, this type of fish emits weak electrical signals that help it “see” in the dark, say researchers. These signals make it easier to monitor the fish’s brain activity.
The fish were placed in small tubes that were inside larger tanks of water. The researchers then shifted the tubes forward and backward at varying frequencies and monitored how the fish compensated to stay inside the tube.
Cowan and the team believes that the fish’s brains are “tuned” to dealing with motion. “The fish were able to accelerate, brake and reverse directions based on a cascade of adjustments made through their sensory and nervous systems in the same way that a driver approaching a red light knows he has to apply the brakes ahead of time to avoid ending up in the middle of the intersection,” said Cowan.
Understanding this “cascade of adjustments” is what the researchers hope to one day “tune” into artificial systems like prostheses and robots so that they have more natural and fluid movements.
For more information, visit www.jhu.edu.
“All animals, including humans, must continually make adjustments as they walk, run, fly or swim through the environment. These adjustments are based on feedback from thousands of sense organs all over the body,” said Noah Cowan, an assistant professor of mechanical engineering at John Hopkins.
“Understanding how the brain processes this overwhelming amount of information is crucial if we want to help people overcome pathologies.”
The team chose the glass knifefish because of its nearly transparent, blade-shaped body. Also, this type of fish emits weak electrical signals that help it “see” in the dark, say researchers. These signals make it easier to monitor the fish’s brain activity.
The fish were placed in small tubes that were inside larger tanks of water. The researchers then shifted the tubes forward and backward at varying frequencies and monitored how the fish compensated to stay inside the tube.
Cowan and the team believes that the fish’s brains are “tuned” to dealing with motion. “The fish were able to accelerate, brake and reverse directions based on a cascade of adjustments made through their sensory and nervous systems in the same way that a driver approaching a red light knows he has to apply the brakes ahead of time to avoid ending up in the middle of the intersection,” said Cowan.
Understanding this “cascade of adjustments” is what the researchers hope to one day “tune” into artificial systems like prostheses and robots so that they have more natural and fluid movements.
For more information, visit www.jhu.edu.
Amputee Center Opens in San Antonio
A 65,000-square-foot, $50 million, state-of-the-art
rehabilitation center for war amputees has opened in San Antonio. The new
“Center for the Intrepid” will allow the U.S. Army to move its rehabilitation
program out of the Brooke Army Medical Center and into a separate facility that
includes a rock-climbing wall, wave pool and a 360-degree virtual reality sphere
to help amputees recover balance and other basic skills.
The center was built with private donations that represent “the largest single private contribution to our nation’s wounded warriors in the history of our country,” said Bill White, president of the Intrepid Fallen Heroes Fund and master of ceremonies at the center’s dedication ceremony. The ceremony was attended by more than 3,200 guests, including senators John McCain (R-Ariz.) and Hillary Rodham Clinton (D-N.Y.).
The center will provide traumatic amputee patients, burn patients requiring advanced rehabilitation and those requiring limb salvaging with techniques and training to help them regain their ability to live and work productively.
For more information, visit www.army.mil.
The center was built with private donations that represent “the largest single private contribution to our nation’s wounded warriors in the history of our country,” said Bill White, president of the Intrepid Fallen Heroes Fund and master of ceremonies at the center’s dedication ceremony. The ceremony was attended by more than 3,200 guests, including senators John McCain (R-Ariz.) and Hillary Rodham Clinton (D-N.Y.).
The center will provide traumatic amputee patients, burn patients requiring advanced rehabilitation and those requiring limb salvaging with techniques and training to help them regain their ability to live and work productively.
For more information, visit www.army.mil.
Vietnam Vets Needed
Researchers at Indiana University and Ohio State
University are looking to help Iraq and Afghanistan war amputees by turning to
amputees of the Vietnam War. By studying the long-term effects of traumatic
amputations, the group hopes to better anticipate the psychical and mental needs
of these recent war victims.
“The largest remaining group with a lifetime of experience is the [group of] Vietnam War amputees,” said Mark Sothmann. Sothmann and Stephen Wilson are the principal investigators of the project.
The project has already received the support of the Department of Defense, which has funded a center for the research called the Indiana-Ohio Center for Traumatic Amputation Rehabilitation Research.
Researchers are in the process of creating a secure registry of Vietnam veterans for the purpose of contacting them with survey and focus group opportunities.
For more information, visit www.vietnamwaramputee.org.
“The largest remaining group with a lifetime of experience is the [group of] Vietnam War amputees,” said Mark Sothmann. Sothmann and Stephen Wilson are the principal investigators of the project.
The project has already received the support of the Department of Defense, which has funded a center for the research called the Indiana-Ohio Center for Traumatic Amputation Rehabilitation Research.
Researchers are in the process of creating a secure registry of Vietnam veterans for the purpose of contacting them with survey and focus group opportunities.
For more information, visit www.vietnamwaramputee.org.
Native Americans Receive O&P Care
Native American citizens of the Muscogee (Creek)
Nation who have diabetes now have access to O&P care, thanks to a
partnership with the Oklahoma State University-Okmulgee’s O&P Clinical
Center.
“There are many Native Americans who have either lost a limb or are at risk of losing a limb due to diabetes,” said Jerry Wilson, chair of the OSU-Okmulgee’s health and environmental technologies division. More than 2,000 diabetic Creek Nation citizens live within the university’s immediate service area, according to Wilson.
More than $500,000 from the Creek Nation’s diabetes prevention program has been approved to supplement Medicare payments for the Native American patients.
For more information, visit www.osu-okmulgee.edu.
“There are many Native Americans who have either lost a limb or are at risk of losing a limb due to diabetes,” said Jerry Wilson, chair of the OSU-Okmulgee’s health and environmental technologies division. More than 2,000 diabetic Creek Nation citizens live within the university’s immediate service area, according to Wilson.
More than $500,000 from the Creek Nation’s diabetes prevention program has been approved to supplement Medicare payments for the Native American patients.
For more information, visit www.osu-okmulgee.edu.
Cranial Remolding Headbands Work
In February, the Journal of Craniofacial Surgery
published a study by Children’s Healthcare of Atlanta showing that infants with
asymmetric head shapes significantly benefited from treatment using cranial
remolding headbands. Of the 224 infants studied, 96 percent showed significant
improvement, according to a press release issued by Orthomerica.
Infants’ heads were measured with 3-D scanners and fitted with customized cranial remolding headbands. Each subject was followed for approximately four months and tested on 25 different variables. Additional scans were taken every two weeks to monitor cranial shape changes.
According to the report, 96.3 of the subjects improved “in every statistically significant variable.” Seventeen infants made up the control group and did not receive cranial remolding headbands. They only showed changes related to growth, say the researchers.
For more information, visit www.jcraniofacialsurgery.com.
Infants’ heads were measured with 3-D scanners and fitted with customized cranial remolding headbands. Each subject was followed for approximately four months and tested on 25 different variables. Additional scans were taken every two weeks to monitor cranial shape changes.
According to the report, 96.3 of the subjects improved “in every statistically significant variable.” Seventeen infants made up the control group and did not receive cranial remolding headbands. They only showed changes related to growth, say the researchers.
For more information, visit www.jcraniofacialsurgery.com.
Money Needed to Make it to Market
The developers of a motorized, body-mounted brace
that the O&P Almanac first reported in September 2006 are seeking additional
funding to bring their “powered-arm orthosis” to the market. The device—designed
to help people with muscular dystrophy perform simple physical tasks—won
Worcester Polytechnic Institute’s (WPI) first Kalenian Award. The $25,000 grant
helped the WPI researchers proceed toward commercial production.
}“The Kalenian Award helped put us in a business mindset. It really helped shape where this product was going,” said one of the device’s inventors, Steven P. Toddes, in an article in the Worcester Telegram & Gazette.
The process of bringing a product from the prototype stage through Food and Drug Administration (FDA) approval to commercial availability can be expensive and lengthy. Paul G. Silva, manager of River Valley Investors, was quoted in the article referring to a “vicious catch-22” when it comes to moving a product through the cycle: “If you have FDA approval, it’s very easy to get funding, and life becomes exponentially easier. But FDA trials cost huge amounts of money and many devices do not survive.”
Developers are seeking both venture capital and angel investments to proceed with clinical trials. Angel funds are usually groups of wealthy individuals who provide money to early-stage companies. The article notes that both streams of money have been strong over the past few years.
“We’re motivated by success and the desire to help people,” said graduate student Michael J. Scarsella, who has worked on the device since he was an undergraduate. “We think investors do buy into the idea of helping others.”
For more information, visit www.wpi.edu.
}“The Kalenian Award helped put us in a business mindset. It really helped shape where this product was going,” said one of the device’s inventors, Steven P. Toddes, in an article in the Worcester Telegram & Gazette.
The process of bringing a product from the prototype stage through Food and Drug Administration (FDA) approval to commercial availability can be expensive and lengthy. Paul G. Silva, manager of River Valley Investors, was quoted in the article referring to a “vicious catch-22” when it comes to moving a product through the cycle: “If you have FDA approval, it’s very easy to get funding, and life becomes exponentially easier. But FDA trials cost huge amounts of money and many devices do not survive.”
Developers are seeking both venture capital and angel investments to proceed with clinical trials. Angel funds are usually groups of wealthy individuals who provide money to early-stage companies. The article notes that both streams of money have been strong over the past few years.
“We’re motivated by success and the desire to help people,” said graduate student Michael J. Scarsella, who has worked on the device since he was an undergraduate. “We think investors do buy into the idea of helping others.”
For more information, visit www.wpi.edu.
Worrisome Conditions at Walter Reed
In February, The Washington Post published a series
of articles that highlighted allegations of decrepit conditions at Walter Reed
Army Medical Center, Washington, D.C.’s nearly 100-year-old military medical
facility that’s been used to treat wounded soldiers from every war since 1909.
Moldy rooms, roach and insect infestation, neglected mouse droppings and stained
carpets were just some of the conditions reported by the newspaper.
The article contrasted the conditions in some of the buildings with “the hospital’s spit-polished amputee unit, Ward 57.”
Soldiers also reported frustration with the “mountain of paperwork” that’s often required when entering and exiting the medical processing world. According to one article, 16 different information systems are used to process the forms, but few of them can communicate with each other. The Army has three personnel databases, and none of them can read each other’s files, nor can they interact with the separate pay system or the medical recordkeeping database. Sometimes there is no record of a soldier even serving in Iraq. And when forms go missing, patients must redo them—creating what the Post calls the “most common reason soldiers languish at Walter Reed longer than they should.”
In response, Secretary of Defense Robert Gates urged Army Secretary Francis J. Harvey to fire the officer in charge of Walter Reed, General George W. Weightman. The day after firing the general, Harvey was forced to resign after appointing another general also under scrutiny at Walter Reed. President Bush called the conditions at Walter Reed “unacceptable” and went on to appoint former Sen. Bob Dole and former Clinton cabinet member Donna Shalala to head an independent inquiry into military healthcare. According to the Post, many are confused as to how such conditions could have persisted when the president has visited the facility many times in the past five years.
For more information, visit www.washingtonpost.com.
The article contrasted the conditions in some of the buildings with “the hospital’s spit-polished amputee unit, Ward 57.”
Soldiers also reported frustration with the “mountain of paperwork” that’s often required when entering and exiting the medical processing world. According to one article, 16 different information systems are used to process the forms, but few of them can communicate with each other. The Army has three personnel databases, and none of them can read each other’s files, nor can they interact with the separate pay system or the medical recordkeeping database. Sometimes there is no record of a soldier even serving in Iraq. And when forms go missing, patients must redo them—creating what the Post calls the “most common reason soldiers languish at Walter Reed longer than they should.”
In response, Secretary of Defense Robert Gates urged Army Secretary Francis J. Harvey to fire the officer in charge of Walter Reed, General George W. Weightman. The day after firing the general, Harvey was forced to resign after appointing another general also under scrutiny at Walter Reed. President Bush called the conditions at Walter Reed “unacceptable” and went on to appoint former Sen. Bob Dole and former Clinton cabinet member Donna Shalala to head an independent inquiry into military healthcare. According to the Post, many are confused as to how such conditions could have persisted when the president has visited the facility many times in the past five years.
For more information, visit www.washingtonpost.com.
People in the News
Rick Smith, CO, has joined American Prosthetics
& Orthotics of Clive, Iowa. Previously, Smith was the manager at Hanger
Prosthetics and Orthotics in Lincoln, Neb.
Daniel Gurley is the new manager of regulatory
affairs at AOPA. He tracks, disseminates, and comments on regulatory and policy
changes within Medicare, Veterans Affairs, and the FDA. Daniel is available to
help AOPA members with HIPAA and quality standards issues. Previously, Daniel
was research manager for United BioSource Corporation of Bethesda, Md., a health
policy consulting firm. He can be reached at dgurley@AOPAnet.org or (571)
431-0876, ext. 212.
Scott Baranek, CP, of Michigan Orthopedic Services
has been elected to serve on the board of directors of the Board for
Orthotist/Prosthetist Certification (BOC).
Grayson Rosenberger, a 15-year-old from Nashville,
is the grand prize winner of the first Bubble Wrap® Competition for Young
Inventors. His invention—a cost-effective, cosmetic covering for prosthetic
limbs—won him a $10,000 savings bond.
Don Foley Jr. is the new owner of Cailor Fleming
Insurance of Youngstown, Ohio—an insurance provider for O&P. Don has been
with Cailor Fleming since 2001 as an account executive.
Michael Burton has stepped down from Comfort
Products of Croydon, Penn. to serve as director of sales and marketing at
Florida Brace Corporation. He will work out of a new home-based office in
Langhorne Penn.
Heather Mills is a contestant on ABC’s Dancing with
the Stars. The BK amputee and former wife of Paul McCartney is the first amputee
to appear on the show, which premiered in March.
Jeremy Blum, a 16-year-old from Armonk, N.Y., received a $2,000 grant from Mu Alpha Theta, a national math honor society, to help fund his project to develop superior prosthetic technology. Blum—who earns money on the side from a computer repair business he co-founded—is experimenting with force sensors mounted on the forearm and their ability to control the movements of a prosthetic hand.
$800 of the grant has been dedicated to prosthetic parts, while the remainder will be spent on travel expenses to meet with Blum’s mentor, Dr. Peter Kyberd of the University of New Brunswick in Canada.
Jeremy Blum, a 16-year-old from Armonk, N.Y., received a $2,000 grant from Mu Alpha Theta, a national math honor society, to help fund his project to develop superior prosthetic technology. Blum—who earns money on the side from a computer repair business he co-founded—is experimenting with force sensors mounted on the forearm and their ability to control the movements of a prosthetic hand.
$800 of the grant has been dedicated to prosthetic parts, while the remainder will be spent on travel expenses to meet with Blum’s mentor, Dr. Peter Kyberd of the University of New Brunswick in Canada.
Kyle Devlin has been certified as a First Volley™
instructor by the Orthotic & Prosthetic Assistance Fund (OPAF). Kyle joins
instructors Stan Backovsky and First Volley’s director of tennis Darren Kindred
for the adapted sports clinic.
Ossur Americas, based in Aliso Viejo, Calif., has
promoted three members of its prosthetic management team. Jeff Gilbert is the
new director of customer service for prosthetics; Tabi King is the new director
of marketing for prosthetics; and Mike Magill is the new director of prosthetic
management.
Ossur Orthopaedics has reorganized to create three
business units: sports medicine and extremity; trauma and spine; and podiatry
and retail. Leadership for these units will come from Tim Prior, director of
sports medicine and extremity; Melissa Browning Till, director of trauma and
spine; and Kelly Long, director of podiatry and retail.
Three additional support groups will assist the newly-created business units. Rob Thompson is director of distributor relations; Catarina M. Loewenadler is director of clinical partnership services; and Oddny Bjornsdottir, vice president of business development, is serving as interim director of marketing.
Dennis Clark, CPO, is the new president of Point Health Centers of America, based in Waterloo, Iowa. Dennis helped to launch the Orthotic & Prosthetic Group of America and has held leadership positions within ABC and the Academy.
In Memoriam
Anthony Barr, president of The Barr Foundation, died on March 5 at the age of 59. Barr lost a foot in a train accident in 1972. As part of his wok with The Barr Foundation, a nonprofit organization which provides prosthetic limbs for amputees who cannot otherwise afford them, the Barr Foundation Amputee Assistance Fund was created. The Fund pays for materials and fitting of a new prosthesis after financial need has been established by a prosthetist. Donations may be made to The Barr Foundation in Tony Barr’s memory.
Business in the News
ABC is seeking nominations for two director positions on its board of directors. Each position requires a four-year commitment and begins on Dec. 1. Nominees must be ABC-certified practitioners who have had past involvement with ABC programs. Applications must be received by June 1. For more information, contact Tom Derrick at
tderrick@abcop.org.
Three additional support groups will assist the newly-created business units. Rob Thompson is director of distributor relations; Catarina M. Loewenadler is director of clinical partnership services; and Oddny Bjornsdottir, vice president of business development, is serving as interim director of marketing.
Dennis Clark, CPO, is the new president of Point Health Centers of America, based in Waterloo, Iowa. Dennis helped to launch the Orthotic & Prosthetic Group of America and has held leadership positions within ABC and the Academy.
In Memoriam
Anthony Barr, president of The Barr Foundation, died on March 5 at the age of 59. Barr lost a foot in a train accident in 1972. As part of his wok with The Barr Foundation, a nonprofit organization which provides prosthetic limbs for amputees who cannot otherwise afford them, the Barr Foundation Amputee Assistance Fund was created. The Fund pays for materials and fitting of a new prosthesis after financial need has been established by a prosthetist. Donations may be made to The Barr Foundation in Tony Barr’s memory.
Business in the News
ABC is seeking nominations for two director positions on its board of directors. Each position requires a four-year commitment and begins on Dec. 1. Nominees must be ABC-certified practitioners who have had past involvement with ABC programs. Applications must be received by June 1. For more information, contact Tom Derrick at
tderrick@abcop.org.
In February, Hanger Orthopedic Group, based in
Bethesda, Md., announced an increase in net sales for 2006 by $20.6 million, or
3.6 percent, from $578.2 million to $598.8 million in the prior year.
The Illinois Society of Orthotists, Prosthetists
and Pedorthists has launched a new Web site, www.illinoisoandp.org,
that includes information on membership, political action, meetings and more.
Tornier, a developer of prosthetic devices based in
Eden Prairie, Minn., has acquired Nexa Orthopedics Inc., a San Diego-based
manufacturer of orthopedic implants, devices and biologics.
