Orthotic Technology Forum 2014 – Netherlands

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Orthotics Technology Forum 2014 – The Netherlands

We are happy to announce that the 2014 European Orthotics Technology Forum (OTF) will take place in Eindhoven, The Netherlands at the Evoluon Centre on 18th September.

This event is focussed on existing and emerging technologies related to the orthotic insoles industry. Previous events attracted over 100 attendees from 13 different countries worldwide.

This year’s European event is being run alongside The Dutch Society of Podiatry (NVvP) Annual Congress which is an event for high level clinical discussion being held on 19th September. By bringing the two events together on consecutive days in the same venue, delegates have the unique opportunity to attend two days of presentations, discussions and hands on workshops covering both clinical and technological topics. See more about the NVvP conference.

Our guest speakers are leading the way in developing and using different types of technology, from hardware devices to help measure biomechanical features, pressure and anatomical form, CADCAM tools for plasterless manufacture, as well as new ideas for increasing productivity and reducing manufacturing costs.

As with past events we are expecting speakers and attendees to travel from around the world making this a unique global experience.

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Solved: Mystery of phantom limb pain

“Phantom limbs” have long been a mystery. Early theories saw them as proof of the immortal soul or part of the Freudian mourning process for the amputated limb. Nowadays, the standard explanation is that the ghostly appendages – which lurk painfully in place of amputated ones – result from confusion in the brain’s map of the body.

In a new study, Israeli and Albanian researchers have found the primary source of phantom limb syndrome in nerves near the spine – and managed to alleviate the associated pain. Their work proves that phantom limbs are not “imagined” in the brain, but “felt” in the body. A version of the procedure used in the study, which is to be published in the journal Pain in May, could soon improve quality of life for millions of amputees.

“In a way, the debate about the origin of phantom limb syndrome is a version of the ancient mind-body problem,” said professor Marshall Devor of the Hebrew University of Jerusalem’s Department of Cell and Developmental Biology and Center for Research on Pain, who led the study. “Our research resolves the problem, at least in this case. It’s the body.”

The ghost in the machine

Limbs have been getting lopped and blown off – whether from war, mishap or surgery – since antiquity, with some people always managing to survive. Ancient Egyptian mummies have been unearthed wearing prosthetics; and Roman general Marcus Sergius switched to fighting the Second Punic War left-handed after losing his right one (and replacing it with an iron prosthetic in the style of fictional knight Jaime Lannister of HBO series “Game of Thrones”).

There are an estimated 10 million amputees in the world. Pretty much all of them experience phantom limb syndrome – the perception of sensations in a limb that has been amputated – and up to 80 percent suffer from pain in the limb. Phantom limb pain, which can be shooting, stabbing, burning or electric shock-like, usually eases in frequency and intensity over time – but may never go away.

Skeptical of conventional brain-centric explanations of phantom limb syndrome, Devor and his colleagues set out to test another neurobiological theory: that phantom limb syndrome comes from the nerve fibers that used to run to the amputated limb. Guided by medical imaging, the researchers injected 31 leg amputees who suffered from phantom limb syndrome – 16 in Albania and 15 in Israel – with local anesthetic near where the nerves from their amputated legs enter the spinal cord in the lower back.

Within minutes, phantom limb sensation and pain was temporarily reduced or eliminated in all the amputees. Control injections had no effect; nor did numbing nerves in the stump in the few cases tested.

Body over mind

The results of the study establish that phantom limb syndrome primarily comes from the nervous system at or below the spine. If the sensations were coming from the brain, the injections would have had no effect. The most likely culprit is the dorsal root ganglion, a cluster of neurons that carries signals from the body to the spinal cord, from where they are transmitted to the brain.

The researchers say these neurons, which were the target of the study, probably begin terrorizing the brain with abnormal signals when the limb they innervate is amputated, causing the pain and other sensations characteristic of phantom limb syndrome. The anesthetic appears to block signals associated with the phantom limbs from reaching the brain.

As the ultimate organ of sensory perception, the brain plays a role in phantom limb syndrome, and may even originate some of the symptoms. For instance, the common sensation that a phantom limb is withdrawing, or “telescoping,” into the stump over time may be due to maladaptive plasticity – the shrinking of an area of the primary somatosensory cortex that once sensed the real limb. Where most scientists were wrong, it turns out, was in thinking this theory explains phantom limb syndrome and pain entirely.

“The dismantling of phantoms via the silencing of these ‘terror cells’ is in my mind a death blow to the brain theory of phantom pain and a call to industry to join forces with scientists to find new treatments for neuropathic pain,” said Dr. Haim-Moshe Adahan, who ran the Israeli trial at Chaim Sheba Medical Center at Tel Hashomer’s Pain Rehabilitation Unit and is working on a follow-up study to extend symptom relief using steroids.

Amputees have come so far that a sprinter who lost both his legs qualified for the last summer Olympics, Adahan notes. What hasn’t improved significantly is treatment for phantom limb pain, which he says continues to haunt Israeli soldiers and other amputees he treats. Thanks to the study, doctors may for the first time in thousands of year be able to “amputate” phantom limbs, offering relief to many.

Orthotics help local dog walk

Like most dog owners, Kris Dexter thinks her dog is pretty special.

But aside from the Golden Labrador’s great demeanor and beautiful coat, Missy has a bit more going on in her life.

“We call them her shoes,” Dexter said, holding up one of the custom orthotic leg braces Missy wears on her back legs. The braces, which look a bit like a walking cast a person would wear, were custom made for Missy. The dog has common calcaneal tendon degeneration in her hind legs.

“Her Achilles tendons are bad in her back legs,” Dexter said. “For most dogs that have this, only one leg is affected. Unfortunately, Missy has it in both of her hind legs.”

Missy has trouble standing and when she manages to get to all fours, she is not very steady. Walking is difficult for her, and Dexter said she can stumble and fall, something that keyed the family off that something was wrong with their furry friend.

“One day she just wasn’t walking right and I thought it was hip dysplasia, which is common in Labs,” Dexter said. “So I got her over to Dr. White right away.”

In 2012, Missy was diagnosed with her condition, along with the news surgery would not help her.

Dr. Dan White, of Animal Medical Center of Midland, is Missy’s primary veterinarian. When he saw the condition ravaging Missy’s legs, he referred her to the Michigan State University Veterinary Clinic. The staff at MSU told Dexter Missy was a good candidate for orthotics and from there, Dexter reached out to OrthoPets in Denver, Colo.

“Missy was Dr. White’s first orthotics patient,” Dexter said. Dr. White took the time to work with OrthoPets to properly cast Missy’s legs and get her ready for her new orthotics.

There was a learning curve for Missy at first, but she has certainly got the feel of her new shoes.

“When we first put them on, she stumbled a lot. I thought, ‘How are we ever going to do this?’” Dexter said. But it didn’t take Missy too long to adapt to her new augmentations and now the dog gets quite excited when asked, “Do you want to put your shoes on?”

OrthoPets, the designer and manufacturer of the devices worn by Missy, started in 2003 when Martin Kaufmann tried to find a way to help the pet of a family member avoid an amputation. With a background in human orthotics and prosthetics, Kaufmann designed a device for the animal with great success. Later, Kaufmann began to apply his talents to the world of animal medicine.

“All of our products are made right here in Denver, and we ship them all over the world,” said Silver Stebbins, certified veterinary technician and case manager for OrthoPets.

Stebbins said all of the devices are custom made, something that requires vets to cast molds of the limb that needs attention. She said the need for such devices continues to grow around the world, and the range of animals helped with the devices is increasing as well.

“Martin (Kaufmann) has made orthotics for a chimpanzee and even horses,” Stebbins said. “One of the coolest uses of a device was on a sandhill crane in Canada. It now has a prosthetic leg and is doing great.”

But there is more to helping an animal than just fitting it with a device.

“We definitely recommend rehabilitation with our products,” Stebbins said. “The devices are not magical. The animals need to do the work (exercise) to get the benefit of the device, just as a human being would need to be rehabilitated.”

Missy is in just such a program. Dr. Tari Kern of Pawsitive Steps Rehabilitation & Therapy for Pets in Rochester Hills (www.pawsitivestepsrehab.com) offers services to help ailing and aging pets.

“Missy is a great dog. She is just so happy to be up on her legs walking,” Kern said of her patient. Kern’s practice is unique in that it deals specifically with the rehabilitation of pets, and her facility is one of only three in the state that deals exclusively in that field. Through many different avenues of therapy, including acupuncture, massage, thermotherapy and hydrotherapy, Kern and her team do their best to bring injured or aging animals back to their full potentials. Missy has gone through acupuncture and hydrotherapy while in Dr. Kern’s care.

Kern said animals seem to roll right along with the punches life throws at them.

“With an animal, if they lose mobility, they don’t seem to mourn it,” Kern said. “They just adapt and find new ways to move or live.” It is this tactic that makes orthotics or other adaptive devices work so well for many animals.

Kern said one of the hardest parts of her job is finding out where an animal is hurting.

“They can’t tell you what is hurting, and they are the masters of hiding their discomfort,” she said. She went on to say that signs of injury or pain, like a favored limb or lack of normal physical behaviors, are good signs that a pet may be in pain.

Missy can walk just about anywhere with her orthotics, even in snow and in water. “She loves to go swimming,” Dexter said. Since she has become used to her orthotics, Missy goes on about three walks a day.

“We have a great neighborhood. She knows all the neighbors and they all have treats for her,” Dexter said with a laugh. “She is a very social girl.”

Neighbor Ed Stapish is always in his yard when Missy stops by for a visit.

“Did you know this dog can do arithmetic?” he asked. Stapish asked Missy if she can add two and two.

Missy barked four times.

“OK Missy, what is two divided by one,” he asked the dog, who stared at him intently, her head cocked to one side.

Missy barked twice.

“We are working on fractions next,” Stapish said as he tossed a treat to Missy. “She is one smart dog.”

When Dexter and her family are working or away, Missy is in the good hands of neighbor and surrogate mom Diane Stewart.

“Diane is Missy’s second mother,” Dexter said. “We could not make it without her.”

Like most pet owners, Dexter said the animal in her charge has become a member of the family, and they wanted Missy to be as happy and healthy as they could make her.

“She is the only dog in Midland that I know of that has orthotics,” Dexter said. “People have asked me if this is worth all of the trouble. These orthotics allow her to have quality of life, and that is what matters to me.”

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Algeos at Leipzig

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