June 2014 www.ossur.com
PARTNER SOLUTIONS DIABETES a worldwide epidemic
GREAT SOLUTION with new Rebound速 Diabetic Walker
IMPRESSION OF OT WORLD 2014, LEIPZIG NEW: SYMBIONIC LEG速 3 added to the Bionic range
PEDIATRIC SOLUTIONS For every child
Cheetah® Xplore Junior
Iceross® Junior Dermo® and Stabilo
WWW.OSSUR.COM © Össur, 06. 2014
Total Knee® 1100
TEL. +31 (0) 499 462 848 FAX +31 (0) 499 462 841 firstname.lastname@example.org
ust before this Partner Solutions document was sent to the printer’s, I have written this preamble to you. And what a pleasure it is to speak to you now in an even more personal note.
can convey in this magazine, but with a short explanation of the new Iceross® Seal-In TF liner and SYMBIONIC LEG® 3 and a few photographs I will still try. There is no fair that provides so many new items as this one.........
I met many of you in Leipzig during OT World 2014 where, besides showing new solutions for your users, we paid a lot of attention to the social aspect. I think that I speak on behalf of all my colleagues when I say that I have a feeling of accomplishment regarding the visit to this fair. There is much more to share than I
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: Michelle Smits Contributed to this issue: Simone Faessen Steve Russell Roy Janssen Froukje Aben (ZIN tekst & redactie) Final editing: Yvonne van der Rijt © Copyright Össur All rights reserved.
TABLE OF CONTENTS 4
Diabetes and Foot Ulcers
Product in the spotlight Innovator X® Post-Op Elbow Brace
Be active again with Össur
Rebound® Diabetic Walker
OT World 2014, Leipzig
PROPRIO FOOT®: from the perspective of user Annemiek
PROPRIO FOOT® Clinically proven
Össur Academy East Europe
FUNCTIONAL HEALING™ Where mobility means recovery Our research and development efforts have led us to further raise the bar in an effort to improve the healing process after an injury. We call it FUNCTIONAL HEALING FUNCTIONAL HEALING from Össur represents our most advanced Injury Solutions’ products to date.
INDICATION-BASED PROTOCOLS Each Functional Healing product is designed to fit into an existing treatment protocol for a specific indication.
Backed by a solid 40 years of biomechanical experience, Functional Healing products incorporate PROPRIETARY TECHNOLOGIES and are specially designed to supplement current treatment options. They are developed for use in specific INDICATION BASED PROTOCOLS, and boast CLINICAL VALIDATION in form of proven clinically relevant outcomes.
PROPRIETARY TECHNOLOGY Functional Healing products contain patented Össur technology based on over four decades of specialized biomechanics expertise.
A Functional Healing label is our seal of approval for more effective, less painful healing, accompanied by improved mobility. Only carefully selected Össur products achieve the Functional Healing seal of approval. Biomechanics and orthopaedic solutions are the core of our expertise. They are part of Össur’s DNA and inherent in our entire range of cutting edge Functional Healing products.
CLINICALVALIDATION Each Functional Healing solution is backed up by proven clinically-relevant outcomes such as in-house testing, customer trials, clinical studies or existing clinical references.
THE BENEFITS OF FUNCTIONAL HEALING MAINTAINING FUNCTIONALITY Designed to harvest the healing power of mobility while minimizing the effect on daily living.
PROMOTING HEALING Designed to optimize and promote effective healing while maintaining mobility.
OPTIMIZING THE END RESULT Promoting healing with the aim of full recovery and minimal residual effect on functionality.
WHAT IS DIABETES?
iabetes is a chronic disease of sugar management leading to high blood sugar. There are different types of diabetes1: Type 1 diabetes - insulin dependent diabetes, IDDM • 5-10% of all diabetes • Little or no insulin production requiring daily injections of insulin to survive • Autoimmune destruction of the islet (insulin producing) cells of the pancreas - causes unknown • Majority have presented by the age of twenty with peak incidences around the age of 5 and 14
Type 2 diabetes - non insulin dependent diabetes, NIDDM or adult type diabetes • 90-95 % of all diabetes • Relative insulin deficiency with resistance of tissues to insulin • Obesity, western type diet and sedentary lifestyle are the main causes. • Weight loss, health diet and exercising are the mainstay of treatment with specific medication (tablets). May need insulin injections. • Majority present around middle age even though its incidence has been increasing among older children and adolescence.
Pre Diabetes • Higher glucose levels than normal but not high enough to be classified as diabetes. • Does not always lead to diabetes, only 1/3 of patients develop type II diabetes. HOW COMMON IS DIABETES? Worldwide it is estimated that 347 million people suffer from diabetes. 8.3% of the U.S. population (25.8 million people) suffers from diabetes. An estimated $245 billion are spent every year in U.S. for diabetes health care related costs. 2,3 Diabetes is the fastest growing health problem. Between 1990 and 2010 years lived with disability due to diabetes rose 67%, from 12.4 million to 20.8 million globally, the highest increase of top ranking health problems.
COMPLICATIONS OF DIABETES
iabetes can lead to many complications, such as heart disease and stroke and amputation.
Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for getting a stroke is 2 to 4 times higher among people with diabetes. Figures show that in 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65+ years. Stroke was noted on 16% of diabetesrelated death certificates. More than 60% of non-traumatic lower-limb amputations occur in people with diabetes. In 2006, about 65,700 non-traumatic lowerlimb amputations were performed in people with diabetes. 5 Other complications are high blood pressure, blindness, kidney disease, nervous system disease and foot ulcers. Up to 25% of those with diabetes will develop a foot ulcer.6 DIABETIC FOOT ULCERS As we have seen, foot ulcers are one of the complications when patients suffer from diabetes.Foot ulcers developat points of pressure and friction on the feetof people with diabetes. It is the major complication of diabetes mellitus, and major component of the diabetic foot. It is also the most common complication in diabetics leading to hospitalization and amputation. Foot ulcers occur in up to 25% of all patients with diabetes and precede 84% of all lower leg amputations.7
Locations of the ulcers coincide with the areas of moderate to high pressure and shearing forces(94%). Contact pressure on the plantar
• Over half of all foot ulcers get infected, requiring hospitalisation and 20% of infections results in amputation.15
surface generates local internal forces, stress and deformation of the subsurface tissues resulting in ulcer formation.8
• More than half of people with osteomyelitis of the heel will undergo high level amputation.16 • Every 30 seconds, a limb is lost due to diabetes.17 • After amputation because of diabetes, 50% will have had their other limb amputated within 2 years.18 • After amputation because of diabetes, the 5 year survival rate ranges from 41%-70%.19
LOCATION OF FOOT ULCERS: • Dorsal / interdigital toes • Plantar toes • Plantar forefoot / midfoot • Plantar hindfoot • Heel • Dorsal / lateral aspect foot SOME FACTS AND FIGURES ABOUT FOOT ULCERS • The prevalence of foot ulcers ranges from 4% to 10%among persons diagnosed with diabetes mellitus.10 • This translates to an annual populationbased (among diabetic patients) incidence of 1.0% to 4.1% and the lifetime incidence may be as high as 25%.10 • 66% 5-year recurrence rate for people with healed diabetic foot ulcers,with 12% leading to amputation.11 • 40% greater 10 year mortality than in diabetics without foot ulcers.12 • One third of patients seeking care for ischemic wounds die unhealed.13 • All lower extremity amputations because of diabetes are preceded by a foot ulcer. • Diabetes contributes to 80% of the 120.000 non-traumatic amputations performed yearly in the U.S. 14
TREATMENT OF FOOT ULCERS
here are three main treatment factors: wound care, offloading and long term management.
Offloading the foot ulcers can be realized by casting techniques, surgery, footware and some other offloading techniques e.g. bedrest, crutches, wheelchairs, walkers or dressings. Frequently used methods of offloading are Total Contact Cast and Removable Cast Walker. When we compare Total Contact Cast with Removable Cast Walkers, we can draw some conclusions: • Removable cast walkers reduces peak plantar pressure as effectively as TCC andbetter than other offloading devices.20 • When making a removable cast walker irremovable by applying a compliance strap,the healing percentages and healing time improves.21
• Irremovable walkers perform as well as or outperform TCC in all aspects of wound healing. 22 • Major advantages of irremovable cast walkers over TCC are lower costs, faster placement, faster removal times, ease of application.22 • Evidence was found to support the use of TCC and other non-removable modalitiesfor treatment of neuropathic plantar ulcers.23 * FOR THE REFERENCES IN THIS ARTICLE REFER YOU TO WWW.OSSUR.COM/EMEA/B2B.
THE DATA A COMPARISON OF FIBERGLASS CASTS AND PNEUMATIC WALKERS IMMOBILIZATION STUDY DONE BY ÖSSUR MEDICAL OFFICE
The results of this study indicate that pneumatic high top walkers immobilize the ankles range of motion in the sagittal plane, as well as, fiberglass casts. The cast ROM 9.45º (SD 4.69) was similar to that found by Kadakia et al*, 8.4º (SD 4.3), who performed the same study with different high top walkers. However the high top walkers in our study restricted ROM to 9.59º-11.82º compared to 10.7º- 15.4º in the study by Kadakia. In contrast to our study the difference between cast and walkers in the Kadakia study was significant. This difference could be explained by the different types of walkers used. At the same time the walkers allow wound inspection, adjustable compression, and improved ambulation in a breathable, lighter weight support system. The cast and braces immobilize significantly more than the bare foot. * Kadakia A, Espinosa N, Smerek J, White K, Myerson M, Jeng C. Radiographic comparison of sagittal plane stability between cast and boots. Foot & Ankle International. 2008Apr29(4):421-6.
REBOUND DIABETIC WALKER ®
Effective, safe and compliant support of foot ulcer treatment Offloading has proven to be a key factor in foot ulcer treatment and e ntails reducing pressure of the plantar area in general and the u lcer site in particular. The Rebound Diabetic Walker is uniquely designed for e ffective treatment of plantar foot ulcers, with easy access and re-fitting during wound care, while improving the patient's mobility during the healing process. The Rebound Diabetic Walker has major advantages over diabetic shoes and shoe inserts in its healing effectiveness and over t otal contact casting due to its ease of use, speed of a pplication and low cost.*
*For the references we refer you to the product brochure of Rebound Diabetic Walker
EASY PNEUMATIC SYSTEM FOR SAFETY AND COMFORT The pneumatic system equipped in the Rebound Diabetic Walker ensures fixation of the foot while allowing for customized comfortable fit. To secure blood flow to the foot, the inflatable bladder in the Rebound Diabetic Walker includes a patented pressure relief valve, conforming pressure in the bladder below the diastolic blood pressure.
IMMOBILIZATION AND PROTECTION The Rebound Diabetic Walkerâ€™s hard outer shell minimizes shear forces by immobilizing the foot and ankle at 90 degrees while providing protection. Furthermore a toe protection bumper keeps the toes safe. On the distal and proximal edges the Rebound Diabetic Walker incorporatesflexible Flex EdgeÂŽ overmold which prevents pressure points. The Flex Edge at the top of the walker can easily be trimmed and cut downwards allowing for an increased opening at the top, providing a snug fit for anyone.
INCREASED PATIENT COMPLIANCE As the effectiveness in healing foot ulcerations using a walker increases when compliance is enhanced,5 the Rebound Diabetic Walker includes patented tamper evident strapping for compliance monitoring.
EVEN PRESSURE DISTRIBUTION The effective Rebound Diabetic Walker tri-laminate insole consists of removable independent hexagonal pieces that work collectively to adjust and react to forces under the plantar surface of the foot. The removable pieces are on the underside of the insole, offloading the ulcer, while the Plastazote top cover, next to the skin, evenly distributes the pressure. To ensure even distribution of pressure and minimize the risk of developing new foot ulcers the insole is heat-moldable.
EASY FITTING CHECK WITH POSITIONING PORTALS Positioning Portals allow the clinician to check the fit of the walker at the heel bottom, in order to ensure appropriate positioning of the foot in the walker.
NATURAL GAIT The rocker bottom outsole of the Rebound Diabetic Walker is designed for a smooth roll over and enables a close-to-natural gait cycle.
OT WORLD 2014 What is presented in Leipzig, doesn’t stay in Leipzig….
ssur has been in Leipzig last month at one of the largest industry tradeshows called OT World. Held every 2 years, OT World attracts over 12.000 visitors from more than 80 countries. We have been meeting with customers and conveying our theme of INNOVATIVE SOLUTIONS | SHARED SUCCESS.
New and exciting products such as the Rebound® Cartilage, RHEO KNEE® 3, SYMBIONIC LEG® 3 and Iceross Seal-In® X TF, along with established products like theUnloader One®, have gotten extremely positive feedback from the market, and customers and employees alike have been motivated by the dynamic atmosphere at the Össur booth. Information about the Rebound® Diabetic Walker from the OA & Injury Solutions package was already provided earlier in this Partner Solutions. Other new orthoses will be extensively introduced to you later. However, should you not have been able to visit us at the fair we do not want you to miss out on the newest prosthetic products. On the next page you can find a summary of these new products. If you wish to receive more information, please feel free to contact your Össur representative.
Iceross Seal-In X TF ®
Iceross® Seal-In X TF features the latest advancement in Seal-In technology, where Seal Ring placement is already left to the practitioner and patient to decide. The liner and ring can be selected individually to match patient’s stump size, ring placement and pre-compression preference. FEATURES:
The 2-tone cover lasts up to 5 times longer than previous Durable 2-tone Iceross Liner Cover Iceross TF covers. Liner conforms to residual limb shape rather than force limb Thinner distal end with a flexible into liner shape. Easier to work out air pockets when donning. cover closure Improved proprioception and feel for the prosthesis. Increased length
Iceross Seal-In X TF is 4cm longer than current predecessors.
Controlled stretch in cover
Improved proximal support without being excessively stiff.
Double Durometer silicone
Protect the sensitive skin and still give the required support to contain soft tissue.
Unity for Flex-Foot Balance ®
Unity® is now available for the low active patients where Flex-Foot Balance is appropriate. There are no known contraindications for Unity® related to activity levels. Applicable User Population: • Transtibial amputees • Body Weight according to foot kit recommendation (max 136kg) • ICEROSS® Seal-In V™ candidates Unity™ should not be used as a remedy for already wide sockets or to counteract discomfort in existing sockets. Cavities and too wide sockets can cause pain and/or serious injury. Unity® for Flex-Foot Balance is available in the following configurations: • Preassembled with a Flex-Foot Balance • Retrofit kit
SYMBIONIC LEG™3 In the previous Partner Solutions we already presented the new RHEO KNEE 3. In order to bring all the benefits of previous product upgrades of that knee to SYMBIONIC LEG, the knee unit in the current SYMBIONIC LEG will be replaced with the RHEO KNEE 3 (including extension lock – more info on page 22). The resulting new product inherits all the features and benefits from RHEO KNEE 3 and is called SYMBIONIC LEG 3. • New knee actuator, designed to provide higher torque and resistance for more stability and safety • Redesigned extension assist mechanism for an even smoother swing phase • Kinematic sensor, supporting stability in stance • Extension lock to lock the knee in full extension and increase safety and comfort under specific circumstances • Increased battery capacity to extend use time • Easier set-up.
Inspired by the upcoming World Cup? Form Fit® Ankle Brace is a stirrup ankle brace that offers soft ankle support when playing football, among other things. The softgood is made of a breathable mesh Aerospace overmolded with a semi-rigid plastic exoskeleton. When applied, the contoured plastic provides the medial/ lateral support of a stirrup brace and the softgood applies the compression of a lace-up support. In addition, the softgood aeromesh is highly breathable, increasing comfort and greatly improving the hygiene of the product. The Form Fit Ankle has multiple applications in both clinical and athletic environments (sprains and strains, post cast, support for weak ankles, sprain prevention, etc.) Qualities and advantages of Form Fit Ankle Brace • The advanced ankle design provides the compression and comfort of an orthosis but offers 20 -35% more protection than traditional soft orthoses. • The speed laced design provides the option of a quick lace-up of the orthosis • The optional heel lock by means of figure-8 strap offers constant fixationunlike tape that stretches over time. • Loop for simple adjustment of the figure-8 when putting on the brace and for quick adjustment while wearing. • Loops for simple adjustment of the tongue when putting on the brace.
IN THE SPOTLIGHT ®
INNOVATOR X POST-OP ELBOW BRACE
enefiting from our proven, patented technologies, Innovator X, with extending struts, can help improve patient outcomes. With superior comfort, clean aesthetics and the most user-friendly hinge in post-op bracing, Innovator X is designed to increase patient satisfaction and compliance.
FEATURES AND BENEFITS
• Easy-to-use Innovator hinge • Slide-to-Size™ struts lead to a more customised fit • Sensil® silicone padding on the strapping system reduces slipping and malleable aluminium cuffs allow for customisation • Patented Form Fit® 3-dimensional padding and lycra lining provide superior comfort and compliance • Comfort pad at the neck and shoulder • Flexion range can be quickly adjusted to 0, 10, 20, 30, 45, 60, 75, 90, 105 and 120. Extension range can be adjusted to 0, 10, 20, 30, 45, 60, 75 and 90. • Optional anti-supination/pronation arm bar kit is available
INNOVATOR X IS USED FOR:
• Post elbow surgery: elbow reconstruction, ligament and tendon repairs, surgical repair of a fracture and biceps repair • Stable fractures • Mild to severe soft tissue injuries
BE ACTIVE AGAIN WITH ÖSSUR Össur Ambassador Ernst van Dyk wins men’s wheelchair race at Boston Marathon
rnst Van Dyk returned to the winner’s circle for a record 10th time in the push rim wheelchair division of the Boston Marathon – but first since 2010 – leading from start to finish on Monday in 1 hour, 20 minutes, 36 seconds.
When not competing, Ernst van Dyk uses the Vari Flex® XC Rotate.
Team Össur athletes Jody Cundy and Richard Whitehead had weekends to remember.
yclist Jody won gold at the Para-cycling Track World Championships in Mexico, breaking his own world record in the process. Competing in the C4 Kilo on Saturday 12th April, Jody won the race by almost four seconds with a time of 1.01.466. You can see an interview with Jody and fellow gold medalist Dame Sarah Storey here. The following day saw Richard Whitehead complete yet another marathon! Following his incredible 40 marathons in 40 days challenge last year Richard decided to take part in this years London marathon, delighting the crowds as he made his way past the historic sights of London.
Team Össur Athlete Richard Brown Breaks New World Record
alnut, CA – Team Össur athlete Richard Browne set a new men’s T44 200m World Record on Friday April 18, 2014 at Mount SAC Relays. With a blazing time of 21.91, Browne became the first single below-knee amputee to run under 22 seconds.
In two short years since running on the Cheetah Xtreme, Browne has set 3 world records in the 60m, 100m, and 200m. Browne’s next major competition will be the IPC Grand Prix Series in Phoenix, Arizona on May 10th. Team Össur athletes Blake Leeper, Jerome Singleton, and April Holmes and Össur Ambassador Jeff Skiba all showed strong performances at Mount SAC Relays.
Because the world is not flat
PROPRIO FOOT is the adaptive prosthesis for low to moderately active below-knee amputees. Using a motorpowered ankle it mimics natural foot motion, allowing different types of terrain to be traversed in a natural and secure way.
•Increases ground clearance, reduces the risk of trips and falls and enhances safety and gait quality. •Enables users to focus on their surroundings, instead of the walking terrain, offering a high degree of ground compliance, on all kinds of surfaces. •Reduces strain on knees, hips and back. •Enhances stability, efficiency and comfort on inclines, declines and stairs. •Maintains symmetry and alignment while changing shoes.
A high precision linear actuator receives commands in the form of signals via a control board, which contain precise instructions concerning when and how fast to move to achieve the best possible response to any situation.
Powered ankle flexion during swing phase for consistent toe clearance and optimal ground adaptation.
Fixed ankle position in stance maximizes the energy storage and return and provides stability in every step.
Automatic alignment up to 5cm heel height which allows the user to wear different shoes without interfearing with alignment.
Full length toe lever with split toe
Dynamic foot module with EVO technology stores and releases energy from heel strike to toe off to promote natural gait.
INTERVIEW With our PROPRIO FOOT user Annemiek Janssen ®
nnemiek Janssen (48) is married to Peter and they have a son, 20-year-old Luuk. She works four days a week: two days at a physiotherapy practice and two days a week at a practice with two veterinarians. ‘So it’s the best of both worlds; working with people as well as animals.’
Annemiek explains why she has been amputated. ‘I was born with a congenital defect of my left hand and my right leg. My right lower leg had not developed; I had no foot, but the stump did have five toes strangely enough. That part was also much shorter than my left leg and from the age of two onwards, I have actually learned to walk with an artificial leg. So you can say I’m a pro with regard to walking on prostheses.’ In November 2008, Annemiek underwent surgery at a hospital in Eindhoven. After her amputation, she felt that her problems were solved: ‘Give me a prosthesis and I’ll just start walking again, I thought. After all, I had been used to walk on prostheses for more than 40 years already, but things turned out differently. After ten prostheses, my prosthesist told me: ‘I actually don’t really know what to do with you, so I’ll give you the telephone number of a clinical specialist at Össur’. I called him, made an appointment and suddenly everything changed. The foot was placed under my prosthesis, I stood up and started to walk and thought: wow, this is unbelievable! At one point, the clinical specialist said I should try to walk up the stairs and to walk on uneven terrain. We then went outside and walked on the grass. These were all things that were simply difficult for me in the beginning, because my foot did not adapt.’ ‘LET’S WALK AROUND FOR A BIT’ Annemiek had been an enthusiastic equestrian for thirty years. In 2006, when she developed problems with her stump, she stopped. She no longer had the energy and was in pain. ‘After my amputation two years later and with this foot, I have been able to take up my hobby again!’ ‘I used to walk the dog for only a very short distance. Now, the dog jumps into the car and we go to the woods. We go on long walks. I no longer have to consider: is it best to go back? No, let’s just keep going!’ In the first two weeks after Annemiek was fitted with
her PROPRIO FOOT, she did a lot of things in a very short space of time. For example, she went to the theatre again. For, as Annemiek says, the foot can do that too. ‘It has a relax mode and when you sit down, it relaxes; it adjusts to the situation you are in, which is very relaxing. There is no more muscle tension on the stump. You have no more contact with your prosthesis, which feels really good.’ Another very important point, especially for women, is walking on shoes with a certain heel height. This was never an option for Annemiek because her prosthetic feet were set to a single heel height and she had to make do with that pair of shoes, or she was forced to buy shoes with the same heel height. ‘Now, it is finally a completely different story, as you can put the shoe you wish to wear underneath it, adjust the foot and it will automatically adjust to the relevant heel height. It does not feel unpleasant, it does not hurt, walking is natural and that is a beautiful thing to experience.’ ‘THE WORLD LOOKS VERY DIFFERENT’ Annemiek is clearly pleased with PROPRIO FOOT. With her old prostheses, she used to only look down. Wherever she went, she was always paying attention if, for example, the pavement was level. She only looked where she had to walk. With PROPRIO FOOT, she walks upright, looking around. ‘The world looks very different. PROPRIO FOOT has given me so much. I have been able to take up my life again and I can do things again I couldn’t do for years. I am no longer in pain and my stump looks very nice. I walk nicely and with a natural gait which feels really good and gives you confidence. It has worked for me so I hope it will work for others as well.’
CLINICAL EVIDENCE Clinically proven: PROPRIO FOOT
he renewed PROPRIO FOOT with its intelligent terrain-adaptation and active, natural ankle-movement offers a safe, adjusted and natural walking pattern….. ... after all, the world is not flat.
neutral position of conventional prosthetic feet causes difficulties for lower leg amputees when they have to go up a slope – Wolf et al, 20093 – Falling when climbing or descending stairs often leads to injuries for older prosthetic users – Grabiner et al, 19934).
In this article, we will look at the everyday challenges of a lower leg prosthesis user and we will learn how the new PROPRIO FOOT can provide a solution. Going up-hill, walking on uneven terrain and climbing or descending stairs are part of the daily challenges of a lower leg amputee. A known fact is the limited ability of conventional prosthetic feet to adapt to a variety of surfaces. (Conventional prosthetic feet cannot adapt to specific conditions, such as
PROPRIO FOOT recognizes the changes in terrain and automatically adjusts the angle of the foot. Active control of the ankle joint allows for customized dorsiflexion during the swing phase, a smooth and secure adjustment on slopes and stability during the support phase. These properties offer significant advantages for daily use, such as easily stepping over obstacles and entering uneven terrain. These
climbing stairs or slopes - Alimusaj et al, 20081. There are important dorsiflexion limitations in the designs of mechanical ankle-foot systems for prostheses - Powers et al, 19942).
advantages are described in different studies: - Dorsiflexion during the swing phase results in a more efficient and physiological gait pattern (Powers et al, 19942).
- Better alignment leads to a reduced impact load on the contralateral leg (Pinzur et al, 19955). - Dorsiflexion during walking increases user confidence and helps preventing injuries (Grabiner et al, 19934).
Abnormalities in gait, the danger of tripping and/or falling, increased energy consumption and reduced activity levels are often associated with walking with a prosthesis. (The fixed
Toe clearance during level ground
Additional ankle flexion during swing phase
Distance of the tip of the toe from ground (height/mm) 120 Degrees, ankle angle (sagittal plane)
80 10° 60 Degrees
40 -10° 20 Plantarflexion
Stance -20 0
Swing % Gait cycle
Swing % Gait Cycle
PROPRIO FOOT proactive dorsiflexion turned ON during level ground walking
PROPRIO FOOT proactive dorsiflexion turned OFF during level ground walking
Figure 1: Clearly shows how PROPRIO FOOT adjusts with a dorsiflexion of 15 to 20 mm during the swing phase.
PROPRIO FOOT proactive dorsiflexion turned ON during level ground walking
PROPRIO FOOT proactive dorsiflexion turned OFF during level ground walking
Figure 2 shows the amplitude of movement to dorsiflexion, also during the swing phase.
GLOBE-TROTTER AND TEAM PLAYER Tomas Bury, Sales Manager East-Europe
ALWAYS ON THE ROAD TO ACHIEVE THE BEST FOR END USERS
omas Bury is the face of Össur in Eastern Europe. The Czech born took up the sales gauntlet energetically and actively set about building up long-term relationships with customers. Making distributors willing to commit only works if you show your face often enough and you are there for them when they need you, which means that he spends a large proportion of his time travelling around the region. He does not mind being on the road at all because he is still learning things from all the different people and cultures he encounters every day. As the Sales Manager for Eastern Europe, Tomas creates the ideal conditions for ‘his’ distribution partners to enable them to use or sell Össur products in their daily operations. His work territory mainly consists of the Czech Republic, Poland and Russia, but he also regularly visits customers in other East European countries. He organises, for example, seminars for customers at the Össur Academy Eastern Europe in the Czech Republic, he is a sought after guest at conferences and works together with a number of organisations to draw attention to Össur’s portfolio in all the countries in his work territory. STRONG PARTNERSHIP In doing his work, Tomas has a good feeling about partnering mainly Dutch colleagues. Össur’s international character is in any case a bonus for him. He really likes the contact with people of widely ranging nationalities. And yes, the Dutch planning and organising approach is different and more strict, but all the same it has been extremely useful. On the other hand,
‘the Dutch’ have discovered that you have to be able to respond quickly to unforeseen circums-
times, but also during the Partner Event that was held last year in Volendam. The next
tances and changes that are an inherent aspect of working in so many different countries. This has produced a win-win situation in which the teamwork is improving all the time.
Partner Event in Zaandam is already in his agenda.
FLEXIBEL TO ADAPT Collecting information and putting Össur on the map is highly demanding on his ability to improvise and his flexibility. The market is constantly changing and, because you are active in so many countries, you have to be able to adapt to the local situation. Every country has its own regulations, which also means that Össur has to develop a separate strategy and planning for each one. The sales manager’s job entails making products accessible to an increasingly larger group of end users. To be able to do this, forging good relationships with distributors and customers is essential. It makes Tomas’ work challenging. There are plenty of opportunities for responding to specific developments, new things to learn and different work methods to discover. But is it all fun and games? Not at all, a sales manager also has a ‘normal’ day at the office once in a while to do the paperwork - not particularly exciting compared to the days he spends travelling, but nevertheless necessary, especially for the future. Tomas is building up a file in his territory by collecting and adding information to customer databases that he and his colleagues can utilise now and in the future. A GREAT JOB One trip that is noted as standard in his agenda is the visit to the head office in Eindhoven once every six weeks. He enjoys being in The Netherlands. The people are generally friendly and open. This is something he noticed in Amsterdam, which he has been to several
As far as Tomas is concerned, he has a great job. Constantly learning new things is simultaneously challenging, special and enjoyable. Travelling to a wide range of countries and meeting very different people means that his work is never dull. But what does Tomas think is the best part of his job? The moment when he realises that everything he has put in motion comes together and that he is a link in the chain that helps bring about positive change in the lives of so many people.
WE PRESENT ÖSSUR ACADEMY EAST EUROPE
ssur, as a leader in technological innovation and education, is proud to introduce an Össur Academy East Europe,training and education centre in Czech republic, located in Frýdek-Místek. Since its formation in the year 2007, the Össur Academy East Europe, has demonstrated a proven commitment to improving the quality education of prosthetic and orthopaedic knowledge among professionals, prosthetic/orthotic users and their families. Using a foundation based on scientific evidence, the Össur Academy East Europe provides a
mulidisciplinary team approach to the support of medical and rehabilitation systems for the attendants from Middle and East Europe. Regional centre Össur Academy East Europe has organized during his tenure two dozen of seminars and training events for professionals not only from the Czech and Slovak Republic, but also for colleagues from Poland, Russia, Hungary, Bulgaria, Romania, Slovenia, Bosnia & Hercegovina, Croatia and Turkey. Support provided by the Össur Academy East Europe among colleagues is aimed at encouraging continual professional development and clinical competence. Support is also extended to providing awareness of current clinical options with ustification to representatives of governmental reimbursement systems, prosthetic/orthotic users and their families. The Össur Academy East Europe is confident to offer support as a result of established relationships and partnerships with leading universities, educational facilities and rehabilitation teams. A combination of academic and practical multidisciplinary education programs are offered and delivered by a core team of international presenters and consultants.
In 2014 Össur Academy East Europe enters in the eighth year of its existence. As usual, this year it would like to offer three specialized workshops - two focused on prosthetic products and one the orthotic Össur products. In the March seminar we focussed on Unity Vacuum System. The next seminars will take place in September and November: SEPTEMBER 2014 - REBOUND® DIABETIC WALKER AND PRESENTATION OF THE OSSUR NEW LAUNCHED ORTHOTICS PRODUCTS
NOVEMBER 2014 – PRESENTATION OF THE IMPROVED BIONIC KNEE RHEO KNEE® 3 Also Össur Academy East Europe can offer on demand following education programs: • Anatomy & Physiology • Gait analysis • General biomechanics • Prosthetic biomechanics (lower limb) • Clinical assessment & evaluation • Post-operative management of residual limbs • Residual limb volume management • Prosthetic socket design and biomechanics • Transtibial and Transfemoral casting techniques • General CAD/CAM • Prosthetic physiotherapy and gait re-education • High activity and sports prostheses • Clinical support for existing Össur product lines • Bionic range of products • Iceross Silicone liners • Flex Foot • Prosthetic Knees • Knee Orthoses • Cervical Orthoses
EQUIPMENT OF THE TRAINING CENTRE: The Össur Academy regional facility in Eastern Europe is well equipped for advanced education and training of multidisciplinary rehabilitation teams in the field of orthotics and prosthetics. The high tech facility is equipped to host both academic and practical educational programs using the following:
SEMINARS AND LECTURES: Seminar room to accommodate up to 40 participants, interactive SMARTboard, wireless voting system, projector, audio/video system,
3D digital presenter, DV camcorder, PC educational stations, Refreshment area PRACTICAL TRAINING: Gait training ramps – walkway, slope & stairs Motion analyzing system KineView Assessment couches Treadmill, exercise cycle In addition, a well equipped and fitted O&P workshop is available including autoclave technology and R&D mechanical testing equipment. CONTACT DETAILS: Össur Academy East Europe Dr. Jánského 3238 738 01 Frýdek – Místek Czech Republic Tel: + 420 558 663 215 e-mail: email@example.com
PRODUCT UPDATES EXTENSION LOCK FOR RHEO KNEE®3
From May 2014 onwards, the RHEO KNEE 3 product offering includes a manual Extension Lock as a standard product feature. The most important user needs are safety and stability, specifically for the lower active user. In order to further increase user safety and stability, RHEO KNEE 3 has been upgraded with a manually operated extension lock feature. When engaged, it locks the knee mechanically in full extension. This offers important additional safety and stability benefits for the user, contributing to further fulfillment of the user needs: • While standing for longer periods of time, RHEO KNEE 3 can be locked in an extended position to increase stability, to conserve battery power and to avoid unwanted flexion of the knee • While walking on slippery surfaces, RHEO KNEE 3 can be locked to increase safety • When the battery is depleted, the user will be able to bear weight and walk on the RHEO KNEE 3 with a fully extended leg.
CHANGED INFLATION SYSTEM FOR REBOUND® AIR WALKER • Upgrade of pump and release valve inner components to improve air flow and release from bladders. • Smoothed / rounded posts on top of pump to help prevent tearing of the pump rubber cover and pressure points on the patient’s leg. • Lengthened and rounded post on release valve improves ease of use. • The new bladder design features a new location for the connecting air channel to help eliminate the potential pin holing that may have restricted air flow within the bladder on previous design. The connecting air channel is now at the top of the bladder, rather than on the heel area. • New routing of the tube/bladder connection will not require any twisting allowing the tube to travel freely within the liner reducing the chance of kinking.This new design allows a long enough tube to live within the liner to allow appropriate fit of the dorsal shell even in cases where there is a lot of swelling and/or bandages. • Bladder is now stitched, not glued, onto the liner allowing increased flexibility to adjust to the anatomy leading to improved comfort. • New smooth (non-star) tube provides more efficient air fill and release. Also, the low top walker now has a shortened tube.
UNLOADER ONE ®
Clinically proven to reduce pain and increase activity One of the most common causes of knee pain is osteoarthritis, a disease that causes a gradual breakdown of the cartilage in the joints. The Unloader One is a safe and simple treatment for the symptoms associated with osteoarthritis of the knee. Unlike many other knee-pain treatment options, this innovative knee brace has been clinically proven to decrease knee pain, reduce the use of pain medication and improve knee fuction.
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SUMMER IS COMING…
Agenda* 4 – 6 June 2014 15th EFORT Congress London, United Kingdom
During the coming summer period we will also be available for you. Our Inside Sales department can be reached at: +31 (0)499 462 840 email@example.com Össur already wishes you pleasant summer months and a nice summer holiday!
20 June 2014 4rd ISPO Czech Republic Conference Olomouc, Czech Republic 17 – 21 September 2014 XL conference Polish society of orthopaedics and traumatology Wroclaw, Poland 1 – 3 October 2014 EUROSPINE 2014 Lyon, France 8 – 11 October 2014 Rehacare Düsseldorf, Germany 22 – 24 October 2014 Medikos Serbia 2015 16 – 18 April 2015 2015 ICJR World Arthroplasty Congress CME Paris, France 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.
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