March 2014 www.ossur.com
PARTNER SOLUTIONS RHEO KNEE 3 user Tim “I always believed I could ride my bike again” ®
NEW PEDIATRIC SOLUTIONS… And a lot more Flex-Foot background information ®
MIAMI LUMBAR POSTEO – Highlight of Össur’s spinal range ®
Miami Lumbar Posteo ®
Stabilisation, offloading and pain relief Advantages of an osteoporosis orthosis: • Alleviation of pain • Offloading • Increase in mobility • Reduction of the risk of a fall • Ease of use • Increase in quality of life
TEL +31 (0) 499 462 840 TEL +31 (0) 499 462 841 firstname.lastname@example.org
ith this first edition of Partner Solutions for this year, spring is already in the air. And we are off to a quick start with a number of new challenges. There are many new opportunities for us all this year. The first challenge was to introduce the new Össur brand. We thought it was time for a fresh, new look that presented the Össur brand more clearly. You can read more about this in this issue of Partner Solutions. The magazines design has been given a new look, while retaining the familiar Össur appeal.
Colophon: In terms of content, the magazine is still characterised by a combination of interviews, product information, scientific background information and news about activities and events. You can read in this edition for example an interview with Tim, one of the first users of RHEO KNEE 3. Besides a lot of background information about our Flex-Foot range and the new Junior Solutions, you will get a refresh of Össur’s spinal range. Yours sincerely, Yvonne van der Rijt Marketing Manager
PS is a production of Össur and is published 4 times a year. Redaction: Yvonne van der Rijt Design: Marta Tripp Contributed to this issue: Simone Faessen Steve Russell Peter Slijkhuis Froukje Aben (ZIN tekst & redactie) Final editing: Yvonne van der Rijt © Copyright Össur All rights reserved.
TABLE OF CONTENTS 4
News from the Head Office
Product in the spotlight Foot-Up®
RHEO KNEE® 3 Stability and dynamics Interview with user Tim
Main Flex-Foot features described
Miami Lumbar® Posteo
Interview with Icelandic Flex-Foot® production specialist Magnús
Flex-Foot® Junior Solutions
Össur’s Spinal Range
Product Updates & Discontinuations
ÖSSUR STRATEGY 2014
CHANGE IN ÖSSUR BRAND STRUCTURE
ou might have read in the first Partner Solutions about the brand restructuring that Össur was going through. In the past months we have been planning this new brand structure within Össur.
The result was a restructuring of the Össur brand architecture along with an update to our logo. We will no longer speak about Braces and Supports, but about Össur OA Solutions and Össur Injury Solutions.
of this magazine. We will not change everything overnight. Our “old“ logo will continue to coexist with the new version for quite some time (on products, signage and other existing material).
The goal is to ensure the Össur brand structure reflects our strategy of providing indication based solutions to our customers. Findings are based on research conducted with employees and customers.
IMPLEMENTATION The implementation of it has started already. The first changes presented to you are the new OA & Injury Solutions product catalogue 2014 (instead of Bracing and Supports catalogue) and the new logo you can see on on the cover
In case you want to use Össur brand elements in your marketing tools, please contact our Marketing Manager for support: Yvonne van der Rijt [email@example.com].
IN THE SPOTLIGHT Foot-Up
oot-Up is an AFO (ankle foot orthosis) prescribed in case of dropfoot. Dropfoot means that, during the swing phase, the forefoot drops down due to muscle weakness on the front of the lower leg. The cause of this weakness include peroneal nerve damage or paresis due to circulatory problems in the brain. The orthosis is used to prevent the forefoot’s falling downward, to promote heel strike, to stabilise the ankle during the support phase and to facilitate toe clearance at the end of the support phase.
COMFORTABLE The ankle strap is flexible and can be adjusted to the anatomy of the lower leg and ankle. It is made of multiple layers and is breathable. This decreases the likelihood of sweating and increases wearer comfort. DYNAMIC Foot-Up’s dynamic character is evident in the gait. Walking with a dynamic AFO such as the Foot-Up not only provides ankle stability, but also provides a smooth transition during the support phase. This improves speed and step length while walking.
SIMPLE Foot-Up is easy for users to don. Many users also say it is easy to walk with Foot-Up. DID YOU KNOW? • Foot-Up is Össur’s 7th-best-selling product? • A 2007 study of VU University (Faculty of Human Movement Sciences) revealed that walking with Foot-Up scored better in the areas of ease-of-use and comfort than walking without an AFO? And that users are provided more comfort by Foot-Up than by plastic AFOs? • Foot-Up can be worn not only in lace-up shoes, but also in sandals, loafers and boots, thanks to the Shoeless bandage? • Foot-Up is also available in skin-tone colour, making it less noticeable to wear?
Interview with our RHEO KNEE 3 user Tim ®
im Klinker is one of the faces of our RHEO KNEE 3 campaign. He is 41 years old and lives in Germany. He has a degree in electronics and is currently doing a degree in science with an internship in psychotherapy. Tim has many hobbies like reading, writing, playing a lot of darts and his favourite hobby is to ride the bicycle. Tim had his left leg amputated two years ago. So let’s ask him how he learned riding his bike again.
After your amputation, did you believe you would ever be able to ride your bike again? Of course, I believed that I could ride my bike again. You only have to believe in yourself and what you can accomplish if you try.
What did you learn during your rehabilitation phase? They taught me, how to balance my body deficiencies and to carry on with all the exercises.
Now you know what it is to be an amputee, what can you say about the needs of an amputee? To have an amputation is a big step in life, but after 40 years with a stiff leg that was beginning to affect my movements, it was time to do something about it.
What solutions a prosthesis should give in your opinion? After my amputation I found how free I could be in my movements in daily life. For example in my hobbies. So mobility, that’s what I think a prosthesis should give me.
Could you ever think that you would be at the mobility level where you are at the moment? Yes I thought about the mobility I could achieve, but I was surprised how mobile I could be again. First I had a knee that was probably not ideal for me but with time I got a reliable knee that helped me to become more free and dynamic but also gave me safety. I´m now using the RHEO KNEE 3 and it combines both without a doubt.
Catalogues 2014 The product catalogues for OA & Injury Solutions and Prosthetics 2014 are available on stock. The prosthetic catalogue is updated with all the latest changes. We added for example Unity™ for LP VariFlex® and PROPRIO FOOT® and we implemented the SYMBIONIC® LEG Protector. The OA & Injury Solutions catalogue looks a bit different due to the new brand structure we’ve implemented The catalogue is divided in Össur OA Solutions and Injury Solutions. The product catalogues are digitally available on: www.ossur.com/emea/b2b and are updated every quarter.
RHEO KNEE 3 is compatible with more Össur feet then before....
here are approximately one million amputees worldwide. Most have had to undergo lower limb amputations because of poor blood circulation in the legs and feet, brought on by either trauma or disease. All of them are individual people with individual lifestyles, needs and aspirations. Therefore their requirements for a prosthetic device differ too. Össur recognises this huge variation and takes various factors such as personal mobility and body weight into account in the development of the Flex-Foot range, a collection of foot modules designed with this individuality in mind. The Flex-Foot product line consists of carbon fibre feet, designed for optimum performance and suitable for all ages and activity levels. While the needs of children, active adults and older people vary, all our customers demand high quality products that imitate the function of the human body as closely as possible and that respond to their unique needs. Van Phillips, the inventor and himself also a user of Flex-Foot, describes his first experiences with prosthetic feet that led him to search for a better solution to satisfy his requirements. “The feet were light but had no flexibility. Some had a degree of ankle movement, but no method of storing energy.” These two
attributes, flexibility with energy storage, led Phillips to select carbon fibre as the perfect material for a prosthetic foot. His innovation was to revolutionise the lives of prosthesis users around the world. SHOCK ABSORBTION As Perry et al. 5* indicated, prostheses for the transtibial amputee have to provide better ankle flexibility and have to imitate the dynamic characteristics of a normal joint between the foot and the leg when setting the foot down. The prosthesis used has to provide terrain adaptation or the initial contact in the early stance phase. In the context of loading response, an active heel has to absorb the shocks and store the energy generated by the initial contact as the amputee transfers his body weight onto the prosthetic foot in the early stance phase. In addition, it has to support the initial tilting motion for inducing forward progression in the ankle and has to control the forward progression of the tibial portion for a fluid roll-over of the foot in this initial phase. The importance of this characteristic is demonstrable in terms of the protection that this provides the vascular or diabetic amputee with sensitive skin. Although the extent to which this prevents skin necrosis and skin damage is unknown, this preventive effect is likely.
RANGE OF MOTION (ROM)/FLEXIBILITY The vertical forces that are generated upon heel strike are stored and translated into a linear motion described as tibial progression, from the moment of initial contact to mid-stance, and from forward progression to toe-off - equivalent to a range of motion in the joint of a non-amputee of between 15 and 20 degrees. This flexible, controlled motion enables the patient not only to limit the body’s active forward acceleration that has to take place in order to proceed from early stance to mid-stance, but also to make the stride length equal to that of the healthy limb and to decrease energy consumption. At the same time, the tibial progression promotes forward progression in the opposing limb during the swing phase, which results in more controlled placement of the foot when completing the step and as small as shock as possible upon putting the foot down. This characteristic has been studied by several researchers and, according to Hafner et al. 6*, the Flex-Foot systematically offers the greatest range of motion of the joint. The same study reveals that the use of the Flex-Foot decreases the forces exerted on the residual limb and on the other leg, which indicates that the foot prosthesis not only absorbs forces exerted on the prosthetic side, but also on the side of the healthy leg.
FLEX-FOOT® Flex-Foot Assure® Talux® Vari-Flex® Vari-Flex® XC Re-Flex® Rotate
ROLL-OVER AND DISPLACEMENT OF THE CENTRE OF GRAVITY The full-length toe lever is the same length as the healthy foot for a smoother, more comfortable and more natural gait. The range of motion and flexibility of the joint, as indicated above, are well-known characteristics of the foot, but the objective of the full-length toe lever is to enable patients to support themselves just as long on the prosthesis as they do on their healthy leg. For persons with normal anatomical characteristics, the unique action of the foot’s muscles and joints ensures a natural gait and the stability required at the end of
stance. In patients with a prosthesis, the toe lever stabilises the knee over the entire stride length and it supports every displacement of the body’s centre of gravity. In instances of a short toe lever (e.g., with an SACH foot with flexible ends), the foot’s roll-over is cut off abruptly, shortening the stance phase of the prosthesis and the swing phase of the healthy leg. This has serious consequences for the healthy side: this side becomes damaged or, for diabetic and vascular amputees, even runs the risk of having to be amputated as well. It has been demonstrated that the impact on the other leg is decreased by a combination of
sufficiently extensive range of motion of the joint, controlled tibial progression and a fulllength toe lever. The hypothesis has also been posed that a reduction in the forces exerted on the healthy leg may completely prevent damage to this leg. The efficacy of roll-over and the displacement of the body’s centre of gravity when using the Flex-Foot are discussed in the study by Lehmann et al. 7*
ENERGY RETURN The energy return from ESAR (Energy Storing And Returning) feet takes place in two steps.
never been considered of high functional value. By matching the inside of the foot cover with the arch shape of a Vari-Flex, we obtain what
During the first step, after the initial contact, the force exerted on the heel of the foot prosthesis results in the opening up of the J-shaped tube (if applicable). The energy is then stored for use during the first phase of the tibial progression. Once the J-shaped tube has opened, the returned energy initiates the forward progression so that the patient can proceed from the initial contact to mid-stance. This decreases the muscle activity that the patient has to provide. Just before the toe-off, energy is released once again in the second step of active forward progression up to the moment of the toe-off. This is also influenced by the fulllength toe lever. This phase of energy return plays a key role because it supports dynamic swing initiation. The general energy return is known to decrease the effort required to walk at various levels. These effects have been researched and proven in various studies e.g., Macfarlane et al. 8*, which showed that torso motions were smoother and more regular when using Flex-Foot, allowing transfemoral amputees to walk more efficiently.
we like to call EVO. Matching the outside of the footshell to fit a shoe completes the concept by making a solid interface between shoe/ground and the foot module. The interface between foot module and ground is the “make or break” factor for function, comfort and stability. The objective is to mimic the natural roll-over of the physiologic foot, using the COP displacement during roll-over as reference.
EVO™ – ENERGY VECTOR OPTIMIZING Although results with Flex-Foot have been satisfactory, we were and are still looking for improvements, which are users would describe as beneficial and which we could quantify using adapted analysis tools. The objective, for the development of the EVO feature, today
ROTATION For the amputee, portions of this kinetic chain are replaced with the prosthesis. Whatever torque was applied to the biological structures that were removed, are now applied to the prosthesis and its interface with the stump. An intact leg is free to rotate in the transverse plane as described above, or to transmit the transverse rotation into motion in other planes; however, with the exception of the prosthetic foot rotating in the shoe, few lower limb prostheses allow for transverse rotation. Constrained rotation can increase stump shear stresses and, for some amputees, may be sufficiently uncomfortable to require an altered gait. Given that discomfort and injury due to shear forces between the stump and the prosthetic socket are major complaints of amputees, it is important to minimise the shear forces in all planes of the socket/lining with respect to the stump. The addition of a torsion adapter in a prosthesis will be of impor-
present in the Vari-Flex EVO, was to mimic the natural roll-over of the physiologic foot, using the COP displacement during roll-over as reference. Vector Optimization, Energy Vector Optimization to be precise, stands for the optimization of the movement pattern of the COP. The feature is the result of a change in the design of the foot cover. Foot covers have
tance to address secondary complaints. The higher the level of amputation is, the higher the necessity of rotating elements, even for low active amputees. In case of high active prosthetic users, rotation should be combined with optimalisation of shock-absorption. The installation of a torsion adapter in a lower-limb prosthesis is therefore recommended.
THE DATA 1. Bob Gailey, 2008, Secondary conditions related to prosthetic users and ten steps to reduce the risk of injury, In motion, July/ August, Vol 18, issue 5 2. Christiane Gauthier-Gagnon et al. Predisposing Factors Related to Prosthetic Use by People with a Transtibial and Transfemoral Amputation, JPO 1998; Vol 10, Num 4, p 99. 3. Robert Gailey, Predictive outcome measures vs functional outcome measures in the lower limb amputee, JPO 2006; Vol 18, Num 1S, p 51 4. Johannesson et al. From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population. Prosthetics and orthotics international 2004, 28, 9-21. 5. Perry J et al. Prosthetic weight acceptance mechanics in transtibial amputees wearing the Single Axis, Seattle Lite foot, and Flex-Foot. IEEE Trans Rehabil Eng. 1997;5(4):283-289. 6. Brian J. Hafner, PhD, Overview of Outcome Measures for the Assessment of Prosthetic Foot and Ankle Components, JPO 2006; Vol 18, Num 1S, p 105. 7. Lehmann JF et al. Comprehensive analysis of energy storing prosthetic feet: Flex-Foot and Seattle Foot Versus Standard SACH foot. Arch Phys Med Rehabil 1993; 74:1225–1231. 8. Pamela MacFarlane et al. Transfemoral amputee physiological requirements: Comparisons between SACH foot and FlexFoot. Journal of prosthetics and orthotics 1997, Vol. 9, Num. 4. 9. Esquenazi et al. Rehabilitation After Amputation, Journal of American Podiatric Med. Assoc. 91(1): 13-22, 2001.
MAGNÚS ÖRN HALLDÓRSSON “If we see an opportunity to make the product easier to apply or better for the patient, that’s a very good reason to improve an existing product.” - Magnús Örn Halldórsson 14
Picture: Production of the Flex-Foot - Carbon fibre cutting
arlier in this Partner Solutions we described how the idea of Flex-Foot was founded, what the main features of FlexFoot feet are and which developments this product has gone through in the past years. In this interview with Magnús we try to answer questions that we get very often from CPO’s. Magnus works as supervisor at the Flex-Foot production department of Össur in Iceland. All Flex-Foot feet are produced in Reykjavík, Iceland.
What are the main changes that have occurred from the first versions? The main changes are a few bolts and nuts, finetuning of shapes and lay-up to maintain durability, and greatly enhanced manufacturing process, where automation plays increasingly big part.
Can you tell us a bit more about the production proces? Flex-Feet are laminated of carbon fiber/epoxy pre-impregnated material which are combined under extremely strict quality procedures and with unique machinery. Categories are controlled by the amount and placement of carbon material(thickness). An automated process takes care to compile that with great precision.
Össur is constantly searching for innovative ideas and ways to bring those innovations to the market. Can you explain us a little bit more about the development of a new product within Össur? A product idea is taken into one end of a socalled new product development process. If it turns out to be viable, it results in a product. How long it the process from the decision of making the product till having it available for the patient takes differs quite a bit depending on the complexity, testing and logistics around the new product. Anything between 10 and 30 months can be considered normal. Besides the development of new products we also improve existing products. Two factors decide on an upgrade: If there is a quality weakness which can be fixed with an upgrade, that’s one good reason. If we see an opportunity to make the product easier to apply or better for the patient, that’s a very good reason as well.
What is the testing procedure for a Flex-Foot? Every carbon component is stiffness tested before the foot is assembled to make sure that it corresponds to an exact activity and impact
level. All products are tested in machines to verify safety. Depending on previous experience with similar solutions, we either do or do not conduct user tests.
CPO’s ask us sometimes the question ‘Why does my patient feel his Flex-Foot is stiff?’. What could be the answer according to you? Choosing the right category of your Flex-Foot is crucial for optimal functionality. Weight and impact on the foot are the main factors to take into account when deciding on the category. Selection-tables are presented to choose the right category according to the weight of the user. Please take into account the different activities the user will execute/perform with the prosthesis. In this case impact on the foot will be more important than the activity itself. For example, the impact on the foot working on a construction-site will be different compared to the impact on the foot of someone sitting by a desk when working. (Other example: playing tennis vs cycling). Choosing a category too high will cause the foot to be too stiff. FlexFoot can be tested in the home-environment, so please make sure the user is provided with correct type of foot.
Wrong bench-alignment of the prosthesis will influence the lever arm of the foot. A too long lever arm, for example aligning the socket too far posterior (sagittal plane), will increase the stiffness of the foot. This results into torqueand shearforces between the skin and the socket and can lead to damaging of the skinand bonestructure of the residual limb. Please use the prescriptions of bench-alignment as indicated in the Technical Manuals to provide optimal functionality. The full length toe lever of the Flex-Foot matches the length of the sound foot, giving a smoother, more natural gait. It ensures the amputee to spend equal time on the prosthetic limb because of increase of stance phase, this because of support of the prosthesis by the rigid toes of the foot. For this reason, wrong size selection will increase the lever arm of the foot and increase the feeling of stiffness. Because of the great diversity of Flex-Feet (different types of feet for different types of users), the amputee can have an “almost” custommade design of foot, providing an excellent option for an optimal functionality.
Customers want to know how long a Flex-Foot lasts. Is that a question you can answer? This is a difficult question to answer because different factors are of influence when considering usage. Every prototype is tested for a time-period of 36 months (2.000.000 cycles). This means we know we can and will guarantee proper functioning of the foot for this period. (Note: Please note that there are some designs of feet with different periods of warranty. Check warranty specifications in your catalogue.) A second influencing factor is the amount of loading on the foot, which will depend on the activity and the impact. The higher the amount of loading, the shorter the time of the foot will last.
Sometimes CPO’s tell that their users complain of noise in the Flex-Foot. What could be causing this? This can be dirt and debris inside the foot cover. Also the absence of a Flex-Foot Sock is common cause for noise.
We also get questions on a regular base about using prosthetis in the water. Can users take a shower with a Flex-Foot for example? Flex-Foot are not designed to use in a showerprostheses. On the other hand, using titanium parts which are protected against corrosion, could give the user the benefit to use the prosthesis in not-salted water if the other parts of the prosthesis are designed to use within water. Using the prosthesis on the beach should be no problem, as long as the user makes sure the prosthesis is cleaned properly when leaving the beach, so no sand can cause no problems.
KIDS ARE MORE ACTIVE THAN ADULTS It’s no secret that kids move more than adults. They have more energy, they play more, and, while many adults don’t run as a part of normal daily activity, most children do. This is why we added not one, not two, but three new dynamic foot options to our pediatric product line, including a running foot for kids with longer residual limbs and a hybrid walking/running foot, the Cheetah® Xplore Junior. Children may dream of playing with friends, competing in sports or walking the family dog and Össur wants to support them every step of the way.
Cheetah Xplore Junior Cheetah Junior
ari-Flex Junior provides an exclusive combination of comfort and dynamics. It is specially made for children who require the additional energy response. Vari-Flex Junior is lightweight, easy to assemble and has a slender profile which makes it easy to cosmetically cover. It ensures the highest levels of user confidence and security. Promoting a natural gait with less fatigue and strain on the lower back and sound side, it is the ideal foot for any activity.
custom-built, hybrid carbon fiber foot designed to function as both an everyday and sports foot.
For kids that require the flexibility of an everyday walking foot and a running foot in a single prosthesis, Cheetah Xplore Junior is the answer. Cheetah Xplore couples the proven performance of our Cheetah sprinting foot with a heel for everyday walking/standing.
FULL LENGTH TOE LEVER
FULL LENGTH TOE LEVER
ACTIVE TIBIAL PROGRESSION
CARBON-X® ACTIVE HEEL
ACTIVE TIBIAL PROGRESSION
CARBON-X® ACTIVE HEEL
ustom-built, high-performance carbon fiber foot designed primarily for sporting activities.
This is the optimal run and play foot for both transtibial and transfemoral users. It attaches posterior to the socket, making it agile, strong and a proven performer for children who want to practice sports.
ACTIVE TIBIAL PROGRESSION
ÖSSUR’S SPINAL RANGE
We recognise that our customers want access to a complete spinal range, one that offers motion restriction, comfort and compliance, as well as innovative features that enhance clinical use. Össur’s focus has been on optimising patient outcomes, using our advanced design and materials technologies to make our products easier to use and less stock intensive.”
When someone suffers a spinal injury, which may carry with it the risk of permanent paralysis, even the most skilled clinician faces a complex and challenging set of treatment protocols. Össur’s spinal range currently includes six different products and a number of accessories to ensure outstanding treatment options for every stage of the care pathway. These outcome-focused products have been developed
in consultation with leading clinicians and their patients and offer a number of advantages: • Motion restriction, pain relief and the protection of injured ligaments/muscles. • Size adjustable and modular systems that help to reduce stock levels. • User-friendly design and enhanced patient comfort and compliance.
RESOLVE® HALO The renowned MRI-safe halo for traumatic fractures/chronic disorders requiring traction.
MIAMI J® ADVANCED The highly effective cervical collar offering phenotype size adjustability and a tracheotomy friendly design.
MIAMI LUMBAR® TLSO A secure, comfortable orthoses allowing step-down treatment of thoracic or multi-level injuries.
MIAMI J® The popular and proven cervical collar available in a range of phenotype size options.
MIAMI LUMBAR® POSTEO Functional relief of vertebral fracture pain, with an innovative approach to ease of use and consistent donning.
MIAMI JTO® A thoracic extension for the ambulatory needs of cervical and highthoracic injured patients. (For use in conjunction with the Miami J.)
C3 CERVICAL C5 C1 THORACIC T2 OCCIPUT
MIAMI LUMBAR® The easy-to-use modular system for post-op immobilisation, pain relief and protection of injured ligaments/muscles in the lumbar region.
ccording to the World Health Organisation osteoporosis is amongst the top ten most significant diseases in the world. Osteoporosis is the condition of reduced bone density which leads to bones having less load-bearing capacity and increased bone fragility. In advanced stages of the disease someone can sustain fractures of the spine or of the neck of the femur even on slight impact or following light falls. According to the International Osteoporosis Foundation, every 30 seconds someone in the European Union has a fracture as a result of osteoporosis. Annual direct medical costs to treat 2.3 million osteoporosis fractures in Europe and in the United States of America come up to 27.000 million USD. Every third woman and every fifth man over 50 sustains a bone fracture which is attributable to osteoporosis. ADVANTAGES OF AN OSTEOPOROSIS ORTHOSIS • Alleviation of pain • Offloading • Increase in mobility • Reduction of the risk of a fall • Ease of use • Increase in quality of life MIAMI LUMBAR® POSTEO The Miami Lumbar Posteo offers functional support for vertebral compression fractures and provides the patient with early mobilisation. The orthosis provides thoracic extension and lumbar compression. This postural correction and the active relief of the vertebra produces effective alleviation of pain. INDICATIONS • Back pain caused by stable vertebral compression fractures (VCF) • Post-operative immobilisation
MIAMI LUMBAR POSTEO 速
Osteoporosis Spinal Brace Study The aim of the study was to assess if participants using the Miami Lumbar Posteo experience a significant reduction in back pain and/ or a significant improvement in function over a 6 week period, compared with subjects not using a brace.
A secondary goal was to evaluate if the effects of the Miami Lumbar Posteo spinal brace differ from the effects of the Spinomed速 (medi) brace.
METHODS A randomized controlled trial, approved by the National Bioethics Committee in Iceland. Subjects with confirmed vertebral compression fracture(s) and chronic pain were randomized by drawing into 3 groups: Miami Lumbar Posteo brace, Spinomed brace (medi) or no brace (control group).
EASE OF ADJUSTMENT
EASE OF USE
MIAMI LUMBAR POSTEO
Comfort, ease of use etc. were assessed using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0)1,2. In general, users were more satisfied on the scale of 1-5 with the Miami Lumbar Posteo brace. REFERENCES 1D emers L, Weiss-Lambrou R, Ska RB. The Quebec user evaluation of satisfaction with assistive technology (QUEST 2.0): an overview and recent progress. Technology and Disability 2002;14:101-105.2 2 D emers L, Monette M, Lapierre Y Arnold DL, Wolfson C. Reliability, validity and applicability of the Quebec user evaluation of satisfaction with assistive technology (QUEST 2.0) for adults with multiple sclerosis. Disability and Rehabilitation 2002;24(1-3):21-30.
THE DATA Back pain was estimated by a visual analogue scale (VAS) and was significantly reduced in subjects using either brace. A reduction of 2.0 or more points on the VAS scale is considered a meaningful improvement.
Functional limitation, estimated by the Rolland Morris score, was significantly reduced in subjects using either brace. A 5 point reduction on the RM scale is considered a clinical improvement in function. ESTIMATED MARGINAL MEANS OF ROLAND MORRIS SCALE
MEAN SCORE ON THE PAIN SCALE
MEAN SCORE ON THE FUNCTIONAL LIMITATION SCALE
ESTIMATED MARGINAL MEANS OF PAIN
baseline miami lumbar posteo
6 weeks no brace - control group
baseline miami lumbar posteo
6 weeks no brace - control group
MIAMI LUMBAR POSTEO ®
Exercises for individuals with osteoporosis
he exercises described below may not be appropriate for every patient with osteoporosis. Please consult a clinician for a personalized training program. CARDIOVASCULAR •W alking and running up to 20 minutes, low to high impact aerobic exercises. BALANCE • Good leg strength and balance to reduce risk for falling. Stand on one leg for some time without dropping the contralateral (opposite) side of the pelvis. (Figure 1).
STEPS • Short forward lunge. Stand on one leg while maintaining balance, then take a short step forward and put your weight on the front leg. Firmly push off with the front leg to return to starting position. Avoid changing position of spine during the exercise. (Figure 2). BACK MUSCLES • Sit or stand with the spine aligned against a wall, lift both arms over head and take deep breaths before taking your arms down again. Repeat 5-10 times, 2-5 times daily. (Figure 3)
• Lying prone (on stomach) with good support of pillows under your chest and stomach, arms in overhead position. Lift your arms from support/ floor by pulling shoulder blades together. Try to keep the muscles in the lumbar/lower back and abdominal wall relaxed. Repeat 5-10 times, 2-5 daily. (Figure 4) ABDOMINAL MUSCLES • We do not recommend any strengthening exercises, only relaxation of the abdominal wall. In a quadruped position resting forearms on a table, relax abdominal muscles and breath slowly. (Figure 5) • Stretching: Stand in a corner, one foot in front of the other with each arm on separate walls at shoulder height. The stretch should be felt in your chest, anterior shoulders and upper arms. (Figure 6) LEG MUSCLES • Rest arms on the backrest of a stable chair. With feet little apart and bend at the hips and knees as far as possible without lifting your heels from floor. (Figure 7) 7
RICHARD BROWNE JR. JOINS TEAM ÖSSUR
ssur is pleased to announce that World-Record holder and Paralympian Richard Browne, Jr. is the latest elite athlete to join Team Össur.
Richard holds World Records in both the 60m (6.99) and 100m (10.75) races in the T-44 category. Although relatively new to the competitive arena, he has already distinguished himself by competing as a member of the Gold Medalwinning, World Record-setting U.S. 4x100 relay team at the 2013 IPC Worlds. He also won Silver Medals in the 100m at the 2013 IPC World Championships and at the 2012 London Paralympic Games. Richard uses the Össur Cheetah Xtreme®, which is ideally designed for short distance sprinting. He also studied Physics at Morehouse College in Atlanta, Georgia. We look forward to cheering Richard on at his upcoming races at the IAAF Indoor British Athletics GP in Birmingham, England; the 5 Nations Match in Glasgow, Scotland; and the Meeting de Mondeville in France.
AN ASPIRING JOURNEY IN MYANMAR
he 7th ASEAN Para Games were successfully held in Myanmar at Wunna Theikdi Stadium from the 14th to the 20th of January. This venue is the largest stadium in Myanmar and was crowded with spectators for this country’s milestone event. The Para Games featured over 1000 athletes from eleven countries in Southeast Asia (ASEAN), competing in twelve sports, with Myanmar’s own team being second in participation with around 269 athletes.
Össur Asia was approached by the International Red Cross association and the Myanmar Paralympic Committee (MPC) to support their athletes and with the help of the MPC, Össur selected a total of 10 athletes (6 men and 4 women) to assist with training, technical support and products. One of Össur Asia’s very own CPOs, Charles Wang spent countless hours working with the team in the weeks leading up to the main event. It is important to note that prior to Össur’s involvement, almost
all of the athletes in Myanmar’s team were using very basic componentry (SACH feet, Single-axis knees, no liners etc.) In the end, the Myanmar team won 6 gold, 4 silver and 7 bronze medals. Truly a great achievement and Össur Asia was proud to have been a part of this event.
PRODUCT UPDATES FOOT COVERS The foot covers from Össur are known for the technology which is called EVO. EVO stands for Energy Vector Optimization and intends to provide a more natural way of walking to the patient. The foot covers have been specifically designed to be used in combination with the best prosthetic feet in the market, „Flex-Foot “ with EVO. Össur has now improved her EVO foot covers. The new foot covers have a more anatomically correct shape and more natural looks. MORE ANATOMICALLY CORRECT SHAPE • Opening width reduced • Ankle shape improved • Lowered dorsum • Reduced width metatarsal section
MORE NATURAL LOOKS • Smooth surface texture • Toe details improved • Consistent quality and durability
NEW VALVE SETTINGS - TOTAL KNEE 2000 & 2100 ®
In order to clarify the valve settings of Total Knee 2000 and Total Knee 2100, we have changed the following: • A becomes F [flexion] • C becomes E [extension] • B becomes H [heel rise] it will be indicated as optional and will be covered by a sticker. Also a yellow sticker has been added on the back link as a visual reminder that the socket should not touch the upper half of the back link.
COLOR SWATCHES New color swatches are available, with the 12 standard colors, showing the matt color on 1 side and the glossy color on the other side. These swatches can be used for the CTi braces, Unloader XT and Extreme braces, and of from early next year the Unloader One Custom brace will also be available in custom paint options.
IMPROVED PATELLA CUP FOR CTI CTi brace can be ordered with a patella cup, a protective cup that keeps the patella safe. User feedback has led us to develop an improved patella cup, that fits in perfectly with the recent improvements of the CTi brace. This new patella cup can be fitted on both new and old CTi braces, in custom and OTS versions. FEATURES AND BENEFITS OF THE NEW PATELLA CUP: • Self-tracking design to stay positioned in front of the knee • Thigh and patella shell to increase the thigh coverage • Simple 5 point attachment system which fit both the CTi OTS and the CTi Custom • Additional foam pad for improved cushioning • Nylon laminate on patella cup and gear guards for increased durability and wear resistance • Matte black finish which matches the aesthetics of the new CTi ACCESSORY:
OLD ITEM NUMBER:
NEW ITEM NUMBER:
MX Kit Small
MX Kit Medium
MX Kit Large
MX Kit X-Large
did not exist before
SURE-FLEX (JANUARY 2014)
Replacement products are Flex-Foot Assure or Balance Foot J, depending on the user profile. Discontinued item numbers: SFP0xyyz (BR) (xx=22-28; y=1-6, z= L or R) SFX0xyyz (BR) (xx=22-28; y=1-6, z= L or R)
REHAB DROP LOCK (FEBRUARY 2014) Discontinued item numbers: B-233500000 Air Light R B-233600000 Air Light L B-234500000 Full Foam R B-234600000 Full Foam L B-236000000 Universal Air Light B-235000000 Universal Full Foam
FROG SPLINTS (JUNE 2014) Discontinued item numbers: 71963 Frog Splints Pad Sm 12Pk 71965 Frog Splints Pad Md 12Pk 71967 Frog Splints Pad Lg 12Pk
OT World 2014 – visit us in Leipzig Note the dates of OT World 2014 in your agenda: 13-16 May 2014! You will have 4 days (Tuesday to Friday) at the Trade Show, during which you will be able to visit the Össur booth. A sneak preview about what Össur is going to present:
OA & INJURY SOLUTIONS - Unloader One - Rebound Cartilage PROSTHETICS - Unity - Bionics - Bionic Service Concept In case you are planning to visit Leipzig for OT World 2014, please think about arranging your accomodation in time.
PLANNER, MULTI-TASKER AND WALKING ENCYCLOPAEDIA Yvonne van der Rijt, Marketing Manager B2B
eizing all the opportunities the market has to offer together with distributors. If Marketing Manager B2B Yvonne van der Rijt could sum up her ambitions in a single sentence it would be this. Meet this versatile professional, who not only sits at her desk writing plans, but is also a multi-tasker, troubleshooter, walking encyclopaedia and the initiator of this magazine. After completing her studies in communication sciences, Yvonne started her career as a marketing assistant with Somas in 2005. After a year, she was promoted to Marketing Manager of the Braces and Supports Division. She first became acquainted with the international market when she also became responsible for the Somas International Division. After the company was taken over by Össur, she fulfilled a similar position, but her portfolio was expanded to include Prosthetics as well as Braces and Supports. Meanwhile, Össur’s business-to-business department grew and, when a vacancy opened up for a full-time marketing manager in 2013, it did not take long for Yvonne to be appointed. Although her four immediate colleagues travel all over the world, Yvonne’s main base is still the office in Son en Breugel, where she works on long-term plans, but is always ready to undertake ad hoc action when necessary. NOT DIFFICULT, BUT ENJOYABLE The more intensive contact with customers makes this job enjoyable for her to do. She does not regard the cultural differences she encounters as troublesome, but more as a huge challenge. You cannot, for example, roll out a marketing plan that works well in Turkey in Poland and expect the same result. The market requirements and the approach are vastly different. Yvonne has made a game out of working out the best strategy for a country together with the respective distributor. She uses all the
information she obtains from colleagues and customers to release communication materials in the right way, at the proper moment and through the most appropriate channel. Despite the occasional fortunately visible success, her job is sometimes difficult because the results are hard to quantify. FROM HARDCOPY TO DIGITAL Anyone who has been in the same line of work for nearly ten years will notice the changes. Yvonne has, for example, seen a clear shift away from hardcopy to digital marketing tools. This has been a global development that Össur has thankfully effectively anticipated. With departments like ‘mobile solutions’ and a web team to fall back on, Yvonne can also use on-line tools and social media in the marketing mix she presents to her customers. INVESTMENTS IN KNOWLEDGE ‘Innovative’ is a word that is frequently used and abused at the moment, but Yvonne believes that Össur certainly deserves to be called by this name. The sales figures for her own organisation obviously count, but the investments that have been made in building up and transferring knowledge are also worth a great deal. Yvonne recently organised, for example, a threeday partner event in Volendam, during which a vast amount of information was exchanged by speed dating. An important outcome for the Marketing Manager B2B is that customers want more involvement in advance. This means they can set translators to work and sort out all the customs paperwork at an early stage. Yvonne thinks it is a good thing this question came up. It serves to emphasise what she feels every day. Sending out the right flows of information at the proper moment is an important criterion in her profession for ensuring that products are optimally placed on the market with the correct amount of support.
Agenda* 2 – 5 April 2014 WCO-IOF-ESCEO SEVILLE 2014: World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases CME Seville, Spain 10 – 11 April 2014 Anatomy and Surgical Exposures in Orthopaedics Course Oswestry, United Kingdom
8 – 9 May 2014 Lumbar Degenerative Disorders Prague, Czech Republic
22 – 24 October 2014 Medikos Serbia
8 – 11 May 2014 10th Central European Orthopaedic Congress (CEOC) & congress of the Croatian Orthopedic and Traumatology Association (COTA) Split, Croatia
2015 16 – 18 April 2015 2015 ICJR World Arthroplasty Congress CME Paris, France
14 – 17 May 2014 16th ESSKA Congress Amsterdam, The Netherlands 26 – 28 May 2014 Iraq Medicare Erbil International Fair Ground Kurdistan Region – Iraq
Changes, errors and typing errors are reserved © ÖSSUR, 03. 2014
1 – 3 October 2014 EUROSPINE 2014 Lyon, France 8 – 11 October 2014 Rehacare Düsseldorf, Germany
17 – 20 May 2014 ECTS 2014 Prague, the Czech Republic
W W W.OSSUR.COM
17 – 21 September 2014 XL conference Polish society of orthopaedics and traumatology Wroclaw, PL
11 – 12 April 2014 2nd International Congress on Cartilage Repair of the Ankle Prague, Czech Republic
13 – 16 May 2014 OT World 2014 Leipzig, Germany
Össur Europe BV Ekkersrijt 4106-4114 PO Box 120 5690 AC Son en Breugel The Netherlands
4 – 6 June 2014 15th EFORT Congress London, United Kingdom
TEL +31 (0) 499 462 840 FAX +31 (0) 499 462 841 firstname.lastname@example.org
27 – 30 May 2015 16th EFORT Congress Prague, Czech Republic 2 – 4 September 2015 EUROSPINE 2015 Copenhagen, Denmark
* This agenda is an overview of conferences and exhibitions Össur wants to notify you about. It is not intended to be complete and for information we direct you to the organizations of these events.
Sleeveless vacuum No sleeve required Greater mobility and user acceptance
15-22 inHg Vacuum Effective volume stabilization
Simple design Quick and easy to achieve/release vacuum
Independent pump Foot function uncompromised
Light weight Complete system weighs only 130g
TEL +31 (0) 499 462 840 TEL +31 (0) 499 462 841 email@example.com