Advanced Arm Dynamics

ISPO 13th Congress in Leipzig, Germany

“It's a conference on steroids.” -John Miguelez, CP, FAAOP, president and senior clinical director, Advanced Arm Dynamics, Redondo Beach, California

Leipzig brings O&P to the World Stage

From the O&P EDGE, July 2010

Dancers, performance artists, music, and multilevel product display booths complete with bars, cafe tables, and mini-theaters set the tone for the combined meeting of the International Society of Prosthetics and Orthotics (ISPO) 13thWorld Congress and the ORTHOpADIE + REHA-TECHNIK 2010 International Trade Show, held from May 10-15 in Leipzig, Germany.

But when Miguelez summed up his experience at the record-setting event, he was referring to more than the electric atmosphere created by exhibit hall booths the size of a small city block. He was also referring to the palpable energy created by the global exchange of ideas. The combined meeting "gives you the opportunity to spend the day visiting the exhibit hall and listening to presenters, and then in the evening go out in a group and ... share your clinical experience with people from all over the globe;' Miguelez said. "That's so invigorating. It's a really unique opportunity to extend past the borders of the United States and open yourself up to new approaches, techniques and technologies.” 

'Most Successful’ World Congress Ever

Building on the theme, "Research and Innovation for Human Technology;' the ISPO World Congress brought together 630 speakers from 55 countries. Presentations covered the latest developments and research results in the fields of orthotics, prosthetics, orthopedic technology, orthopedic footwear technology, and compression treatment, and drew in approximately 2,600 visitors. Sessions focusing on neuroprosthetics were well received, with one in five participants saying they were strongly interested in the subject. 

"It was our most successful Congress ever;' said Dan Blocka, immediate past-president of ISPO. "In some keynote presentations, all seats were taken.”

The l3th World Congress also marked the end of Blocka’s three-year term as ISPO president. During the closing ceremonies, Blocka officially handed over the baton to incoming president Ian Geertsen, MD, a specialist in physical medicine and rehabilitation (PM&R) at the Center for Rehabilitation, Groningen, Netherlands. Exhibitors seized on the global marketing opportunity presented in Leipzig.

More than 550 exhibitors from 45 countries filled 40,000 square meters of exhibition area, presenting mobility aids in the fields of prosthetics and orthotics technology, orthopedic and rehabilitation technology, orthopedic footwear technology, medical foot care, and compression therapy. ORTHOpADIE + REHA-TECHNIK drew in 21,200 visitors from 108 nations, according to Area Manager Klaus Ernst.

More than 50 new products were launched at the trade fair, including the world premier of the SacroLoc lower-back orthosis by Bauerfeind AG, Zeulenroda-Triebes, Germany; the world premier of the  PowerKnee by Ossur, Reykjavik, Iceland; the world premier of the bebionic myoelectric hand system by RSLSTEEPER, Rochester, Kent, England; the European premier of the Pro Digits partial hand system by Touch Bionics, Livingston, Scotland; and the world premier of the Genium lower-limb bionic prosthetic system and the Michelangelo Hand, both by Otto Bock HealthCare, Duderstadt, Germany.

"This was the best ORTHOpADIE + REHA-TECHNIK we have ever seen;' said Hans Georg Nader, CEO of Otto Bock HealthCare. "Combining the ISPO Congress and Trade Fair is a model for the future. The world comes together in Leipzig.”

“Regardless of what discipline a clinician specializes in-upperlimb, lower-limb, orthotics, prosthetics, or pedorthics, “Miguelez said, "The World Congress is an incredible, unparalleled educational opportunity. The World congress offers a unique opportunity for clinicians to exchange ideas with other experts from around the world.”

The next ORTHOpADIE + REHA-TECHNIK International Trade Show will be held in Leipzig May 16-19, 2012. ISPO will hold its 14thWorld Congress February 4-7, 2013, in Hyderabad, India.

30th Annual Texas History Day

Advanced Arm Dynamics (AAD), an upper extremity prosthetics provider, recently played a role in the 30^th Annual Texas History Day Contest; albeit, one behind the scenes.  When the business was approached by a group of 8^th graders from a Texas middle school who were creating a play on the history of innovation in prosthetics to perform as their submission for the contest, the AAD team was more than happy to help. They worked with the students over a period of months, which included showing them various prosthesis and how they work, introducing them to patients, providing a tour of the facilities and lab, and even lending them four prosthetic arms to use when performing their play. 

After first winning their school and the Dallas Fort-Worth regional competitions, the students were among the 1,000 students out of 45,000 who were allowed to compete at the state-level this past weekend at the 30^th Annual Texas History Day Contest, the official affiliate of the National History Program, which was held at the Texas State History Museum in Austin. The students received 4^th place out of the 45,000 state competitors.

The theme of this year’s Texas History Day was “Innovation in History.” For their submissions, students in 6^th through 12^th grade had a choice of submitting performances, Web sites, historical papers, documentaries or exhibits in accordance with the theme.

  PHOTO CAPTION (Left to Right): Rebecca Gold, Shelby Johnson, Amy Lytle, Corinne Kowald

 

About Texas History Day

Texas History Day, the official Texas affiliate of the National History Day program, is a yearlong education program that culminates in an annual state-level history fair for students in grades six through twelve. It provides an opportunity for students to develop their knowledge of history and their critical thinking, analytical reading and writing, presentation, media design, and public performance skills through creative and original papers, performances, documentaries, web sites or exhibits.  The Texas State Historical Association coordinates the Texas competition, which involves over 45,000 young Texans statewide. The 2010 event was co-hosted by the Bob Bullock Texas State History Museum and The University of Texas at Austin College of Education. Over 1,000 students participate in the state level History Day contest with approximately 60 students representing Texas at National History Day each year in Washington, D.C.

The Artificial Hand That Can 'Feel'

London, England (CNN) -- Researchers are working on a breakthrough in artificial limb technology -- a prosthetic hand that can actually feel.

The SmartHand project is funded by the European Union and is a collaboration between researchers from across the continent. It has produced a prototype motorized prosthetic hand that researchers say gives unprecedented sensory feedback.

Fredrik Sebelius, of Lund University, in Sweden, is one of those working on the project. He told CNN that the SmartHand is able to exploit the fact that many amputees experience what he terms a "phantom hand."

"If you push the skin on an amputee's forearm, they feel like you are pushing on their phantom fingers," Sebelius told CNN.

When an amputee imagines moving a "phantom hand," signals are sent down nerve fibres in the remaining part of the amputated arm to activate muscles that would have moved the fingers.

Myolelectric signals from those muscles are recorded by electrodes applied to the forearm and then transmitted to motors in the artificial hand.

It's a technique that has been used in prosthetic limbs for decades, but Sebelius says the SmartHand gives much more control than other systems.

It also allows sensory information to be detected and transmitted from several sensors in each prosthetic finger, meaning users can actually "feel" objects they hold in the SmartHand.

"The big difference between our system and others is the sensory feedback", Sebelius told CNN.

"Sensors in the prosthesis pick up tactile information, which is relayed to actuators on the arm that pass on the sensory feedback, and this hasn't been done before,"

Sebelius gives the example of a pressure sensor on the artificial index finger sending a signal to forearm. By targeting the area of the forearm that activates the part of the brain associated with the index finger, the signal from the finger is "felt" by the brain.

He says the prosthesis could be commercially available within two years, but that the current technology is only suitable for amputations below the elbow. Upper arm amputees don't have enough muscles associated with hand movement to control the SmartHand.

Martin Twiste, senior lecturer of prosthetics and orthotics at the University of Salford, in England, told CNN that he did not know of any commercially available prosthetic hands that gave this kind of sensory feedback.

But he said the challenge with relaying sensory information from a prosthetic hand is sending the signals to the right place.

"Any sensory information from the prosthetic hand has to be fed back to the residuum (remainder of the amputated arm) and then to the brain," he told CNN. "The difficulty is where do you feed it back to?"

"If you have several electrodes on the residuum it's very difficult to place the electrodes accurately enough for the amputee to distinguish, say, the index finger from the middle finger."

One potential solution for upper arm amputees being explored by U.S. firm Deka Research and Development is to control an artificial arm using foot pedals.

Another method uses "Targeted Muscle Reinnervation," a technique developed by Dr Todd Kuiken at the Rehabilitation Institute of Chicago. This involves transferring the remaining nerves from an amputated limb to other muscles -- for example the pectoral muscle in the chest.

That means that when someone thinks about moving their amputated hand, they activate the muscle in their chest, and the myolelectric signals from that muscle can be used to control a prosthetic hand.

Researchers from the Johns Hopkins University Applied Physics Laboratory have developed a prototype prosthetic limb that uses this technique as part of a U.S. Defense Advanced Research Projects Agency-sponsored project.

But another solution is to directly attach electrodes to nerve bundles in the remaining part of the amputated arm, recording signals from the nerves, rather than from muscles.

Some of the SmartHand researchers have been working on this technology and Sebelius says developing this kind of "neural interface" is the long-term goal of the project.

Although neural interfaces have been trialled in animals, Sebelius says there are a number of problems that have to be overcome before the technology can be made commercially available for humans.

"The neural interface has to be implanted in the body, which brings problems of biocompatibility," Sebelius told CNN.

"A common problem is for the interface to be rejected by the body, then you get a lot of tissue forming around the interface and it doesn't function correctly."

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Smarthand

The Smarthand contains 40 sensors that are activated when pressed against an object.

They stimulate nerves in the arm to activate the appropriate part of the brain, allowing patients to feel objects they are holding.

Sensory feedback has always been the Holy Grail for scientists developing prosthetic limbs.

"It's a feeling I have not had in a long time," said Robin af Ekenstam, the first amputee to try the hand.

"When I grab something tightly I can feel it in the fingertips. It's strange since I don't have them any more! It's amazing."

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Prosthetic limbs get a sense of touch

The bionic man, leaping over walls and running faster than a speeding bullet, is a character in a futuristic movie.

But a man with touch-sensitive prosthetic limbs could soon be reality.

A University of New Brunswick-based start-up company is using nanotechnology to develop skin for prosthetic limbs that has pressure sensors, giving people born with congenital defects or amputated limbs a sense of touch.

"Our technology is based on carbon nanotubes," said Kumaran Thillainadarajah, at the helm of the start-up and a fourth-year undergraduate student in computer engineering.

"About 100,000 of these - an entire forest of nanotubes - would fit onto the head of a needle," he said. "They are a hundred times stronger than steel and at the same time they are flexible and more importantly pressure-sensitive."

Smart Skin's invention could change the world for millions of people using prosthetic arms or legs and has grabbed the attention of the New Brunswick Innovation Foundation.

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Targeted Muscle Reinnervation

VOICE ONE:

You are listening to the VOA Special English program SCIENCE IN THE NEWS. With Barbara Klein, I’m Bob Doughty in Washington.

Scientific progress improves the lives of people around the world every day. One of the latest developments is a new kind of surgery. It holds promise to greatly improve the abilities of people who have lost both arms. The operation could help double arm amputees move their manufactured arms with greater ease and control.

Arm amputees commonly use devices joined to their shoulders to operate man-made arms or wrists. These devices use rope-like material to carry movement from the shoulder to the prosthetic arm. Yet, the movement is limited, and requires the person to tighten muscles in the back or arms.

VOICE TWO:

Now, researchers with the Rehabilitation Institute of Chicago are working on another method called TMR, or targeted muscle reinnervation. It uses the remaining nerves of arm amputees that would otherwise be lost because of injuries.

TMR surgically connects the remaining nerves to chest muscles. Electric devices are then placed near those muscles. The idea is to activate the remaining arm nerves to make electrical signals to operate prosthetic devices.

To move an arm, the brain sends a message that causes the chest muscles to tighten. An electrical signal is then sent to the prosthetic arm, telling it to move. The process takes place without any more effort than in a person without prosthetics.

READ MORE

What Guitar Hero Can Do For You.

"...researchers at John Hopkins University have cranked the volume on the concept to 11. By modifying the controller for Guitar Hero III: Legends of Rock to interface with cutting edge prosthetic technology, they've made it possible for amputees to shred their way through the game with surprising accuracy.

The research is part of a project being sponsored by the U.S. Defense Advanced Research Projects Agency, and the true goal is not to nail a high score in the music game. Rather, the aim is to eventually perfect an extremely realistic prosthetic limb that mimics a real arm - including finger movement. Several prototypes have already been developed thorough the project.

Calibrating the mechanical limbs to correctly recognize and respond properly to electrical signals in an amputee's residual muscles is an exhausting and draining process. By using Guitar Hero, the researchers are able to speed up the tedious calibration process and make it more fun for volunteers. The highest recorded score among the experiment subjects was 70 percent..."

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The "Luke Arm" Featured on ABC World News Tonight - This Friday, August 1, 2008

The Luke Arm allows five-finger movement, flection extension of the wrist and 230-degree rotation of the wrist. There is full range of motion in the elbow and shoulder.

The fully functioning robotic arm was being developed by DEKA through a $18.1 million contract from the Pentagon to provide better artificial limbs for U.S. soldiers who have lost limbs in combat.

The high-tech development outfit designed the arm under a U.S. Department of Defense Advance Research Project — or DARPA — contract, whose "Revolutionizing Prosthetics Program" is focused on delivering a prosthetic for clinical trials that functions almost identically to a natural limb, with the ultimate goal being to have such a device controlled by brain signals.

Watch ABC World News Tonight on Friday, August 1, 2008.

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AAD Founder Responds to DARPA Funding for Advanced Prostheses

DARPA Revolutionizes Prosthetics: How and Why?

By Judith Philipps Otto

Times change. Perceptions change.

Once upon a time, not so long ago, only a relatively small ratio of the population had experienced limb loss or amputation, and only a few dedicated manufacturers and individuals with limited resources focused on research and development of new prosthetic solutions...READ MORE

John Miguelez, CP, FAAOP, points out that funding DARPA-developed high-tech prostheses might not be as difficult as we think.

"Ten years ago, when the C-Leg� first appeared, people feared that it was way too expensive for a knee system, and insurance companies wouldn't pay for it," Miguelez says. "It may not be the standard knee being fit today, but it's certainly mainstream, and a lot of patients have access to it."

Making a case for reimbursement for high-dollar high-tech items is not difficult, Miguelez believes. "As long as that emerging technology is medically necessary, and we can document that it will have a positive impact on the patient's medical outcomes, insurance companies are, to a certain extent, required to fund the treatment. It's really all in the approach."

As the provider of upper-extremity prosthetic services for Walter Reed Army Medical Center (WRAMC), Washington DC, Miguelez is involved in the beta testing of new DARPA-developed technology designed to benefit recovering amputee soldiers. "It's a very aggressive plan that has developed a new upper-extremity prosthetic system and new controls in just four years," Miguelez says. "Although some really impressive new technology has appeared over the last ten years, we have never seen it evolve to this degree this quickly."

Miguelez describes another DoD benefit in the making. He is one of several prominent experts nationwide who have been commissioned to write specialized chapters for a book titled Care of the Combat Amputee -which should be available in early 2008.

"This is something else that has not happened historically-a gathering of experts sharing their knowledge and experience for the benefit of our prosthetic patients."

Welcome to AAD's Brand New Blog

Advanced Arm Dynamics is the nation’s leading provider of upper-extremity prostheses working with thousands of patients across the world. Our Centers of Excellence offer a comprehensive approach to patient care, providing advanced technology to improve prosthetic function and comfort, psychological counseling and insurance assistance services. In addition, our patient-to-patient mentoring program offers patients the choice to receive support and guidance from peers during and following their rehabilitation. Advanced Arm Dynamics brings industry experience combined with compassion and a commitment to enhance the lives of upper-extremity amputees. In partnership with patients, their family members and caregivers – Advanced Arm Dynamics makes “life within reach” for upper-extremity patients worldwide.