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TODAY Issue 1 | Summer/Autumn | Assistive Technology

HELP AT HAND Giving busy healthcare professionals a helping hand with all the latest assistive tech, innovations and insights AT TODAY MOVING & HANDLING EXPERTISE | CPD SEMINARS | HEALTHCARE TECH & INNOVATIONS

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HANDCRAFTED FURNITURE C O M P L E T E LY T A I L O R M A D E T O F I T Y O U R E X A C T R E Q U I R E M E N T S

Manufacturers of bespoke rise and recline chairs and handcrafted adjustable beds for the mobility and healthcare market

Delivery in 7 - 10 days* For furniture offering comfort, independence and a higher standard of care, contact;

Tel: 0115 913 3572

email: info@riseandreclinehealthcare.co.uk www.riseandreclinehealthcare.co.uk *On a wide range of products


R

ise & Recline Ltd has been successfully servicing the needs of the mobility and healthcare industry since 2001 through a combination of superbly designed and crafted chairs, beds and accessories, with a rapid turnaround of orders and a dealer support service that is second to none. Our ethics centre around not just delivering a product but delivering an experience, from assessment straight through to delivery and after sales. Attention to detail, unsurpassed quality, superior service and fast 7-10 day delivery turnaround of bespoke furniture, that is unmatched in the marketplace. Rise & Recline Ltd has always believed in giving its customers the products that best suit their individual needs. This means listening closely to its customers to identify new market trends and, where applicable, responding quickly to develop new products that can be recommended to their customers with confidence. Through its state of the art facility in Long Eaton, Nottingham, Rise and Recline Ltd demonstrates its commitment to upholding the traditional virtues of British design and craftsmanship. This philosophy runs through every item it produces and is the reason Rise & Recline Ltd continues to set the highest standards in the industry. Employing multi-skilled staff, from the local and surrounding

areas, we pride ourselves in keeping British manufacturing thriving. Rise & Recline Ltd is proud to hold both the ISO 9001 and 14001 accreditations, for which it works hard to maintain. The whole business works towards this high standard on a continuous basis, improving efficiency, capacity and service. As a business we also hold the approval by Trading Standards to call ourselves a truly “bespoke” company, a classification not many companies hold. Besides belonging to the BHTA, we also belong to the BFM Association (British Furniture Manufacturers) and are members of the UK Centre of Quality Upholstery Manufacture. Our chairs also hold the Medical Devices Class 1 certification.

0115 9133572 • info@riseandreclinehealthcare.co.uk

www.riseandreclinehealthcare.co.uk R

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ISO 9001:2015

REGISTERED COMPANY Certificate No. CAP1134CA

ISO 14001:2015

REGISTERED COMPANY Certificate No. CAP1134EN

TRADE ASSOCIATION MEMBER

British Furniture Manufacturers


Environmental Control for empowering independence

Our mission is to provide independence for indviduals with limited mobility through assistive technology. We offer environmental control solutions throughout a client’s home, which can assist with everyday tasks from opening doors and closing the blinds, to answering the phone. Our services are tailored around individual user requirements, to ensure they feel safe and secure within their home environment.

evo+ An innovative iOS environmental control app for controlling appliances throughout the home via switch, touch, or mouse. GEWA Connect An Android environmental control app enabling clients to control their physical and virtual world. Control Omni A standalone environmental control device, with a built-in mobile phone for secure communication. Grid Pad High spec computer with multiple AAC functions, which can be controlled by innovative eye gaze technology.

For more information contact our friendly team Tel: 0113 207 0449 Email: assist@steepergroup.com


CONTENTS

FROM THE EDITOR Welcome to the first edition of the brand-new AT Today – the go-to magazine for healthcare professionals to keep up-to-date with the latest in assistive technology, healthcare research, CPD courses and events, product innovations and expert advice.

08 MOVING & HANDLING EXPERTISE

28 MUST-HAVE 52 CPD COURSES HEALTHCARE APPS 06 RESOURCE GUIDES

26 PRESSURE ULCER DEVICES

18 VIRTUAL REALITY

32 MOBILITY INNOVATIONS

20 GOVERNMENT ACCESSIBILITY 40 ASSISTIVE ROBOTS 22 DEMENTIA

42 LIMITED DEXTERITY

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@ATTODAY_MAG FACEBOOK.COM/ATTODAY LINKEDIN.COM/COMPANY/AT-TODAY AT Today is produced by BHTA Engage, 2-4 Meadow Close, Ise Valley Industrial Estate, Wellingborough, NN8 4BH • 01933 278 086 • newsroom@thiis.co.uk BHTA Engage Ltd. All rights reserved. No part of this publication may be reproduced or used in any way without the written permission of the publisher. The views expressed in this publication are not necessarily those of the publisher and although every effort has been made to ensure that the information is accurate, the publishers take no responsibility for errors or omissions.

During my time with AT Today, I have become immersed in the world of assistive technology and have seen just how much impact technology has on the healthcare sector. Whether it’s a simple, wearable monitoring device that allows carers to track a patient’s risk of falls or a cutting-edge robot that can be used at home to assist people with dementia, technological advancements are allowing people across the globe to live more fulfilling and independent lives. This first issue has a particular focus on moving and handling expertise, with insights from Promoting Independence’s Stuart Barrow on mindful moving and handling, and A1 Risk Solutions’ Deborah Harrison who explores moving and handling and dementia patients. The must-have healthcare apps section is filled with different tools that place an emphasis back onto self-care. From a clever smartphone app that connects visually impaired people to sighted volunteers to help them navigate different spaces, to an AAC app offering practical guidance for children with communication difficulties, these digital apps are assisting healthcare professionals and users alike. Don’t miss the events & training section, which highlights unmissable events and CPDaccredited courses which are taking place throughout the year. In 2020, we will be launching AT Today as a quarterly publication. If you would like to find out more or want to get involved, please get in touch with me at sarah.sarsby@bhtaengage.com. I hope you enjoy this new edition of AT Today and I look forward to seeing what healthcare advancements I’ll be writing about next time… Sarah Sarsby, Editor

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AT TODAY 5


RESOURCE GUIDES

GOOD READS

Helping to expand healthcare professionals’ knowledge, AT Today has picked its top three guides that professionals can access for free.

CLINICAL SEATING MATTERS Seating Matters has published the fifth edition of The Clinician’s Seating Handbook. Written and published by Martina Tierney, Occupational Therapist and Clinical Director of Seating Matters, ten years ago, the book has become essential reading for clinicians and therapists, being used in universities and clinical practices worldwide. This latest edition contains various useful updated advice and clinical research for healthcare professionals, including moving and handling pointers, pressure injury staging guidelines, and paediatric & bariatric assessment tips. www.seatingmatters.com

BATHROOMS AND INDEPENDENCE Geberit is highlighting some of the barriers to bathroom adaptations with its new resource guide for occupational therapists, local authorities and care providers. It demonstrates the vital role of the bathroom in helping people remain independent in their own home. The guide also presents some of the modern bathroom solutions which are helping to make a difference. Simon Thomas, National Sales Manager at AquaClean Care, said: “The key to supporting independence in the home is in education and collaboration, to help overcome as many barriers as possible and give people the best possible chance to remain in their lifelong residence.” www.geberit.co.uk 6 AT TODAY

POSTURE PROWESS Repose Furniture has launched a new posture guide in association with The OT Service, which, according to Repose, provides clinicians with a well-researched guide into what they need to know about seating assessments. Kate Sheehan, Director of The OT Service and Repose’s resident occupational therapist, commented: “We have worked with Repose to ensure the Guide provides a step by step analysis to support the clinician when assessing and recommending the correct seating solution to meet their clients’ needs which can often be complex.” The guide is illustrated to explain the advice being given and these are complemented by an assessment template. Also incorporated within the guide are several case studies which detail the patient’s condition and post assessment recommendations and further educate the reader on how posture can impact on everyday tasks, long-term health and wellbeing. www.reposefurniture.co.uk


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We know YOU know how important it is to keep your clients moving So WE would like to tell you about OUR range of walkers

Here at Uniscan we have been designing and making walkers in the UK since 1983 - that’s lots of people still moving around safely thanks to our product. There’s no way that 1, 2 or even 3 models will cover the needs of your clients. We have four - 4 leg models with seat heights ranging from 13” (330mm) to 27” (686mm), frame widths from 23” (585mm to 29” (737mm) and with our 2 types of braking system we believe that we have the most comprehensive range of walkers around today... and that’s without even talking about our 3 leg models or choice of 8 colours! If you need something a little different to help you meet a specific clients needs just give us a call or drop us an email and we will see what we can do.

Bariatric Walker If you have any clients that need a bariatric walker look no further! Here’s our Grand Glider Plus able to take a user weight of up to 40 Stone (254kg) with seat heights from 19” (483mm) to 25” (635mm) and still weighing only 16lbs (7.4kg).

USER WEIGHT UP TO

40 Stone (254kg) Contact us: (Quoting Ref: THIIS AD 24/05/19)

01268 419 288 | sales@uniscan-walkers.co.uk

www.uniscan-walkers.co.uk

tsi APPROVED CODE

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MOVING & HANDLING EXPERTISE

THE OT’S PERSPECTIVE:

The importance of mindful moving and handling First up, you’ve probably heard the term ‘moving and handling’ bandied around quite a lot but even though we use these terms a lot, we’re not always clear on what they mean.

Stuart Barrow of Promoting Independence is a member of the Royal College of Occupational Therapists and a recognised expert in the field of home adaptations. His experience is sought by manufacturers and service providers looking for an expert opinion. Stuart also runs the Occupational Therapy Adaptations Conference (OTAC).

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So, here’s the definition according to the regulations: “Any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or bodily force.” When we’re referring to moving and handling in the world of occupational therapy, we’re specifically talking about how to transport or support clients in moving from one place to another who otherwise would not be able to do so. Examples are: • Moving a client from their bed to a bath for washing purposes • Moving a client from downstairs to upstairs • Lifting a client from their bed to a wheelchair or other support device Clearly, as with every other element of occupational therapy, our focus is simple: to allow the client to have the best quality of life possible, in the safest way possible. ASSESSING MOVING & HANDLING NEEDS The key to doing the above is to be absolutely clear on what is necessary for the client and how to deliver it in the safest way possible – if you can correctly assess what is needed, you can serve your clients effectively, and work with a manufacturer, other clinicians or shop to then recommend the right equipment to meet the need. In order to improve your moving and handling assessment ability, it’s worth joining the National Back Exchange and attending their conference each year and sign up to the local group in your area. Equally, the Disabled Living Foundation’s Moving and Handling People Conferences happen in various locations throughout the year and are well worth attending.

OUR FOCUS IS SIMPLE: TO ALLOW THE CLIENT TO HAVE THE BEST QUALITY OF LIFE POSSIBLE, IN THE SAFEST WAY POSSIBLE

SINGLE-HANDED Over the last decade, there has been a big move towards single-handed care in the word of moving and handling, and from an economic view, it makes sense. Here’s why: A mobile hoist used by two carers to support a person with bed transfers to a commode four times a day may cost £700 for the hoist and £35.00 per call (x 4 calls a day), at a daily cost of £140 a day. That’s a lot of money. Plus, if one carer is running late, the call gets delayed, and during times when resource is stretched – like over Christmas for example – the requirement for two carers makes things a lot more challenging. On the flipside, a ceiling track hoist may cost £3,000 up front, but if it means that one carer can do the same job that would take two without the hoist, it’d take just 42 days for the cost of the hoist to be covered, releasing the second carer to help someone else. WHAT ABOUT UNEXPECTED MOVING & HANDLING? Should a fall occur, there needs to be an effective strategy for the carer that will allow them to raise the person up from the floor in a safe, dignified manner. A person who has fallen is usually distressed, upset and potentially injured. If injured, an ambulance should be called. If not, they may display behaviours that mean helping them could be a challenge. Transferring a person from the floor back to standing without equipment is difficult and not recommended. The minimum would be from the floor to a chair but even that should not be attempted if you don’t have a clear idea of how to do it. If the client is usually hoisted, a hoist that picks up from the floor may be needed or if a risk assessment has been carried out and the falls process written, a safe single-handed care technique from the floor with the correct provision of equipment, strategy, assessment and training can be applied.


The equipment will need to be simple and intuitive to use and the staff using it will need to know how to access it. As well as single-handed care equipment, you may also require access to a slide sheet to position the person away from any immediate hazards and allow room for the equipment to be used. WHAT ABOUT THE EQUIPMENT? A great deal of ambulance trusts now use the Mangar Health Elk or Camel which can easily be operated by one person regardless where the person

falls. The Mangar Camel is like the Elk, although it has a backrest support, making it suitable for more users than a Camel. The Camel is more suitable for larger or heavier clients. If you attend the Occupational Therapy Adaptations Conference (OTAC), you can attend seminars and speak to suppliers about your clients needs and arrange joint visits to aid your clinical reasoning when helping your clients.

LOOK AT THE BACK OF THE THIIS MAGAZINE AND CHECK OUT THE WEBSITE TOO

FURTHER RESOURCES I’d strongly recommend checking out www.otac.org.uk as we run seminars around Moving & Handling with Handicare and have two great training sessions for free at all 2019 events. Finally, look at the back of the THIIS Magazine and check out the website too (www.thiis.co.uk) for useful retailers and manufacturers, training on key products to learn more about them, and how to implement their use in your practice.

AT TODAY 9


MOVING & HANDLING EXPERTISE

REDUCING THE RISKS:

Moving & handling and dementia across health and social care The purpose of this article is to consider, when carrying out moving and handling training, the following: Should we include how to deal with distressed behaviour for the person with dementia? We will explore person-centred strategies to improve the experience for the person being handled.

Deborah Harrison is the founder of A1 Risk Solutions, an independent organisation that specialises in moving and handling, training risk assessment and consultancy. Deborah started as a nurse and furthered her post-graduate studies in moving and handling, ergonomics and vocational rehabilitation. Deborah has an active role on the ISO committee working on the international standards for hoists and slings.

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IS IT AN ISSUE FOR THE WORKFORCE? Moving and handling in the health and social care sector is recorded as the second largest reason for workplace injuries. It accounts for 24 percent of all reasons of employee injuries (HSE 2018). The HSE identified moving and handling and physical assault in the health and social care sector as being the second and third highest reasons for workplace injuries respectively (see image below). The HSE recommends that employers should work with their employees to create a safe workplace to reduce these risks (HSE, 2019). It also acknowledges that there is an under-reporting culture, therefore it is estimated that the figures are higher. The health and social care sector is

MOVING AND HANDLING IN THE HEALTH AND SOCIAL CARE SECTOR IS RECORDED AS THE SECOND LARGEST REASON FOR WORKPLACE INJURIES

the industry that sustains the largest proportion of injuries due to violence in the workplace (see image on opposite page) (Riddor, 2018). Many of these will involve a range of service users in their home and patients in a hospital or community care setting. One of the increasingly common client groups where physical assault occurs in the health and social care setting is those with dementia or learning disabilities. Therefore, if we can establish the cause of their distress, we will be able to reduce the amount of physical assaults in the workplace. WOULD A COMBINED APPROACH TO MOVING AND HANDLING TRAINING MAKE A DIFFERENCE FOR THE ORGANISATION THAT HAS A CLIENT GROUP WITH DEMENTIA? A workplace evaluation was carried out by Sturman (2018),w alongside a combined approach to moving and handling, to reduce the number of workplace injuries and work days lost. This demonstrated significant improvements across all areas when combining moving and handling and dementia training.


Combining trainng would also appeal to employers as a means of cost saving. A competency assessment approach to moving and handling training was found to significantly improve the postures and skills whilst reducing the errors of the students (Webb and Harrison, 2019). The use of video and safe systems of work to support moving and handling training was identified by Webb and Harrison as playing a significant factor in reducing risk and improving skill (Webb, Harrison and Szczepura, 2016). If we combine the moving and handling and dementia training with a competency model and use of an online system, will this improve the outcomes for the person with dementia? The issue of a growing elderly population is well documented, currently there are 850,000 people with dementia in the UK, with numbers predicted to rise to over 1 million by 2025. We need to have systems, equipment, training and strategies to effectively deal with this. WHAT IS DEMENTIA? Dementia is a word that describes a variety of symptoms that may include: an impairment of thinking; memory loss; difficulties with thinking, problem-solving or language; and, sometimes, changes in mood or behaviour. Dementia interferes with a person’s ability to do things which he or she previously was able to do. One of those important things is the deterioration in the person’s ability to mobilise. Dementia isn’t a natural part of ageing. It occurs when the brain is affected by a disease. There are many known causes of dementia, the most common types are Alzheimer’s disease and vascular dementia. WHAT ARE THE SYMPTOMS? In brief, everyone experiences dementia in their own way. There are some common symptoms:

memory loss, difficulty planning, communication, being confused about time and place, visual difficulties, mood changes and mobility. WHAT ARE SOME OF THE BEHAVIOURS WE MAY SEE WHEN SOMEONE IS DISTRESSED? We may see emotional outbursts, such as crying, shouting, shaking, mumbling, walking with purpose, rocking, restlessness, swearing, inappropriate sexual comments or hiding things. If you have ever cared for this client group, you can identify some of the physical behaviours, such as: pushing away, grabbing, hitting, pinching, pulling hair and throwing things. When we see these behaviours, we can feel the emotion radiating from the person (Evans, 2019).

IT IS THAT OLD CHESTNUT: IF WE DID NOT MEASURE IT, IT DID NOT HAPPEN

WHAT ARE SOME OF THE CAUSES AND TRIGGERS FOR DISTRESSED BEHAVIOURS? Different people react in different ways to different stimuli, our senses change

CASE STUDY Doris has advanced dementia; staff are struggling to move and handle her. They have been hoisting her to carry out her transfers using a hoist and sling. Doris has become increasingly agitated, especially during the transfer from the bed to the chair. Doris appears sensitive to noise; she has been hitting out at staff and shouting when they have tried to hoist her. There are normally two staff to carry out the transfer.

Consider: What are the causes of Doris’ behaviours and possible solutions?

as people age and as dementia develops. Some people develop sensory processing challenges with dementia, this can affect responses to stimulation. An example is hypersensitivity to noise and certain tones in the environment, leaving individuals unable to decipher different noises. They may have a decline in vestibular function, which could, for instance, make them feel dizzy and disorientated. They may have a visual disturbance; this can cause people to misunderstand or misinterpret something in their environment. A good example of this is the pattern of a carpet on the stairs. IS COMMUNICATION IMPORTANT? Person-centred communication strategies are vital, consider how you would feel if you could not communicate, if you could not tell someone that you did not like a smell or if something was too loud. Or how would you feel if someone took something from you and you did not understand why? Imagine if you were in agonising pain and unable to express it. TOUCH This is a powerful stimulus and is often a way we communicate with each other. Sometimes touch is wanted and welcomed, and sometimes it is not. We have to consider the person’s preferences in this area. ASSESSMENT TOOLS Assessment tools for distressed behaviour have been available and are still current today (OSHAH, 2009). We need to use tools to measure what is happening. It is that old chestnut: if we did not measure it, it AT TODAY 11


MOVING & HANDLING EXPERTISE did not happen and we have lost an opportunity to capture important data. The purpose of collecting and summarising data is to observe trends, develop person-centred strategies and solutions, and reduce the behaviours that are just as distressing for the person and the handler.

A BEHAVIOUR SUMMARY SHEET (OSHAH, 2009) When did the behaviour occur: day of the week or weekend and time of day What behaviours were observed Who was present? Where did the behaviours take place

CASE STUDY CONSIDERATIONS FOR DORIS

What happened prior to the behaviours?

1. If Doris is sensitive to noise, are the two care workers talking over her, vocally loud, banging about with other pieces of equipment?

What interventions were used?

2. Is Doris startled when they first appear, do they need to gradually wake her up? 3. Will Doris respond better with one carer? Can she be moved and handled easily with one carer with the right equipment and risk assessment?

What happened while the behaviour occurred? What was the outcome? Were there any follow up recommendations? Using a format similar to this will enable you to observe any potential trends. Consider: is it just happening at the weekend, a specific time of the day, a particular task, or with certain people? It can often be a long process of elimination. One of the tools you may consider is the about-me passport for the person with dementia, the tool will move with the person as they transition across services.

4. Is any of the equipment noisy? 5. Is any of the equipment noisy due to the environment, such as the floor covering? 6. Is it just the hoisting from the bed to the chair? Are the care staff taking the bed down and the hoist up at the same time? That would cause a vestibular disturbance with all of us. It is the same effect as sitting in the car and someone sets off at the side of you, it makes you feel as though you are rolling backwards.

7. How does Doris like to be touched? We do need to remember no one technique fits all. Consider your approach and communication styles, we will be covering this and other strategies in another article. www.a1risksolutions.co.uk 0161 327 2195

WE DO NEED TO REMEMBER NO ONE TECHNIQUE FITS ALL

CASE STUDY Patricia became anxious when being turned from side to side in bed and would become very anxious when the carers came into the room. Patricia wept, grabbing at the carers and pinching them whilst they were trying to turn her. The carers became increasingly firm with their hand holds whilst moving and handling her, this resulted in bruises and an escalation of Patricia’s behaviours. Patricia actively resisted being turned. Patricia started to demonstrate other behaviours that were unrelated to moving and handling.

Consider: What are the causes of Patricia’s behaviours and possible solutions?

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A simple and versatile solution for assisted standing and transfers The Oxford Switch from Joerns Healthcare is designed to help a person with reduced mobility, stand from a seated position and enable their onward transfer to another surface. The Switch also facilitates patient rehabilitation, actively encouraging the user to participate in the standing process, engaging core muscles and helping to improve strength and natural function.

Key Features n

Safe Working Load 180kg / 28st / 397Ibs

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Compact and easy to manoeuvre

n

Easy to transport and store

n

Simple service and maintenance routines

n

Height adjustable knee pad and optional padded covers

n

Optional Patient Handling Belt for assistive support

Contact Joerns Healthcare for further information:

(T) 0844 811 1158

(E) info@joerns.co.uk

! 9 EW01 N for 2

Switch


The effectiveness of a specialist pressure redistributing mattress in a Critical Care Environment as a preventative measure. Patient case studies on the use of Artemis dynamic mattress system.

Introduction A pressure ulcer is a localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear1. Pressure ulcers are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, poor posture, or deformity. Furthermore, critically ill patients have an increased risk of pressure ulcer development due to underlying disease, unstable condition and haemodynamic instability. The use of equipment such as seating or beds which are not specifically designed to provide pressure relief can also cause pressure ulcers2. Critically ill patients in the Intensive Care Unit (ICU) are at the greatest risk for pressure ulcer development as they are likely to be immobile; present with higher severity of illness; require mechanical ventilation, associated sedation, and pharmacological drugs; which could all potentially reduce peripheral circulation. Therefore, the identification of patients at the risk of pressure ulcer development in the ICU is essential3. EPUAP Clinical Practice guidelines 20144 recommend the use of an active support surface for individuals at higher risk of pressure ulcer development when frequent manual repositioning is not possible. Current guidance states that critically ill people, cared for in intensive care units (ICUs), are a unique subset of hospitalized individuals and represent the sickest patients in the health care system. The development of a pressure ulcer presents an additional comorbid threat for an already severely compromised person. Pressure ulcer rates in the critical care population, are reported as the highest among hospitalized individuals. This is attributed to the high level of disease/ illness burden; hemodynamic instability, poor tissue perfusion and oxygenation requiring the use of vasoactive medications; coagulopathy and the repeated confrontation with multiple, concomitant risk factors for pressure ulcer development experienced by this population. Pressure relieving devices vary in the materials they are made from and in their pressure relieving mechanisms. For example, constant low pressure (CLP) devices mould around the patient to distribute their weight over a larger area, while alternating pressure (AP) devices mechanically vary the pressure beneath patients so that the duration of pressure is reduced5.


Aims

Method

To identify the effectiveness of the ARTEMIS mattress on individual patients in an intensive care unit in contributing to maintaining skin integrity. The Artemis was the mattress of choice within the Critical Care Units within Calderdale and Huddersfield NHS Trust, as its advanced alternating therapy delivers effective pressure relief to those at risk of developing pressure ulcers. Advanced specialist mattresses can reduce peak pressures and support peripheral blood flow and are suitable for Critical Care environments.

The study was carried out within a 6 bedded ICU unit located within Calderdale hospital period with inpatients who were very high risk, immobile and prescribed a dynamic mattress for more than 3 days and had been admitted with intact skin. Nursing staff were asked to continue their standard pressure ulcer preventative practice as per Trust policy which included skin assessments and repositioning where possible. The clinical nurse advisor reviewed the patient records both during and at the end of the evaluation period against the agreed outcomes, these were measured as follows: reason for admission, length of stay, number of days on the mattress, pressure ulcer risk score, mobility, frequency of skin assessment and skin integrity on discharge from the unit, heel tissue integrity. A questionnaire and discussion with the staff would provide additional feedback on the mattress performance, ease of use and design features.

Many surfaces will fall into a specific category and are classified as either active or reactive. The Artemis being a more advanced surface, can be switched between three modes. In addition to offering the pressure relieving qualities of an active support surface the mattress; 1. Provides the option of prescribing CLP mode, which reduces the pressure exerted on the patient’s skin and subcutaneous tissue, allowing the patient to immerse into the support surface and become enveloped in the inflated air cells. 2. Provides the option of Pulsation mode, which creates tissue stimulus by alternately increasing and decreasing the cell pressure of the constant low pressure mode by 20% in each direction To promote comfort, whilst still providing pressure relief, the Artemis mattress optimises the system pressure to deliver the lowest possible interface pressure between the patient and the mattress, for any given patient weight. The control unit can identify the optimum pressure level for that weight of patient by decreasing to the lowest possible supportive pressure where the patient weight is at its heaviest (i.e. sacral area, legs). This fully automatic system reacts to the patient’s weight and adjusts if a change in weight or positioning is identified. To further support the critically ill patient additional design characteristics were to be evaluated; • AUTO SEAT MODE: The mattress design allows for it to be profiled in an upright position. Pressure will be increased when the patient is sitting in an upright position but depending on patient comfort and clinical judgement the comfort setting may need to be changed. When the backrest travels beyond an angle of 20° the screen on the control interface advises that the backrest has been raised. • LOW PATIENT WEIGHT: The mattress accommodates patients whose weight would be considered as particularly low (<40kg). It significantly reduces internal cell pressures to make it suitable for lower weight patients. • PULSATION: Creates tissue stimulus by alternately increasing and decreasing the cell pressure of the constant low pressure mode by 20% in each direction. • HEEL ZONE: 8 narrow heel cells. • MAX INFLATE: Inflates the cells to maximum pressure to provide a stable, static support surface. • COMFORT CONTROL: By selecting this function the softness / firmness of the mattress can be manually altered, dependent on the patient’s requirements.

Results This study demographics reflected the typical Critical Care Patient population as reported in the literature below. Reported prevalence rates of pressure ulcers in the ICU population vary substantially, ranging from 4% to 42%, while reported incidence rates range from 0.25% to 44.4%, with wide variations reported between countries6. Guideline recommendations for preventing pressure ulcers include methods for identification and risk assessment and preventive measures including skin assessment, nutrition, repositioning, and choosing appropriate support surfaces1,2. It has long been recognized that pressure ulcers are a major cause of morbidity, mortality, and health-care burden globally and that many pressure ulcers are avoidable7. There is evidence that critical care patients are mostly males and that a high proportion are elderly. Intensive Care National Audit and Research Centre (ICNARC) data show that 4.8% of admissions are in the age range 0–17, and that 46.5% of admissions are of people aged 65 years or over. The mean age of patients is 57.3 years. There is evidence that the greatest proportion of admissions to ICUs are for medical emergencies (41%) followed by planned admissions from elective surgery (25%) and emergency surgical admissions (18%). There are more recent data suggesting that the proportion of nonsurgical admissions to ICUs is increasing. The most common source of admission to intensive care is theatre or recovery in the same hospital (44.1%), followed by a ward in the same hospital (22.3%) and A&E in the same hospital (17.1%). One study reported that over 70% of admissions to ICUs were in the cardiovascular or respiratory categories6.


Artemis Study demographics were; • 6 patients admitted with intact skin were reviewed and evaluated for the purposes of the study. • All patients very high risk on the Waterlow scale. • All patients had complex needs which made repositioning difficult and met the agreed evaluation criteria. Patient 1 A 60-year-old female patient with small frame and weighing 50kg. She was admitted following a cardiac arrest – due to her unstable condition repositioning was difficult and minimum movement was achievable. A backrest height of 30 degrees was prescribed which utilised the seat inflate function of the mattress. Skin remained intact and the max inflate setting was also utilised by the staff to create a stable surface for care tasks.

33.33% females

66.66% males

Patient 2 A 71-year-old male who was admitted to the unit following a severe chest infection. The patient had multiple co-morbidities and was sedated and ventilated on admission. The patient had intact skin which remained intact on discharge from the Unit. Patient 3 A 73-year-old male patient was admitted following cardiac arrest – respiratory compromised due to COPD. Ventilated and immobile the patient was nursed as a preventative measure in alternating mode to ensure pressure relief to his skin was prescribed. His skin remained intact following one week being nursed on the mattress with 3 hourly repositioning carried out. Patient 4 A 59-year-old male weighing 72kg was nursed successfully on the mattress with 4 hourly repositioning schedule. The patient was sedated and ventilated following cardiac arrest. He has multiple co morbidities including diabetes and end stage renal failure. His skin remained intact. Patient 5 A 64-year-old male admitted to ICU with sepsis and other factors contributing to his high risk of developing tissue damage were respiratory problems due to smoking. The patient was successfully nursed on the mattress through the acute phase of his illness and gradually mobilised to discharge. His skin remained intact. Patient 6 A 72-year-old female patient admitted following cardiac arrest who was ventilated and intubated via tracheostomy. Was unable to be repositioned due to injuries sustained in a fall following the episode. Comfort setting were utilised to maintain an immersive surface whilst still achieving the required pressure relief to support and maintain skin integrity. Her skin remained intact.

See the Artemis From Drive DeVilbiss Sidhil video on YouTube

The average age of the patients was

54.5 100%

were admitted due to medical emergency

50%

due to cardiac arrest


Outcomes • No patient developed a pressure ulcer whilst being nursed on the Artemis mattress during this study. The potential for skin cell and tissue breakdown is reduced when using this specialist support surface. • Staff reported through questionnaires and discussion that COMFORT CONTROLS, MAX INFLATE were very useful and the SEAT INFLATE provided additional support and confidence when carrying out mobilisation. The HEEL ZONE was also valuable in providing additional support to the vulnerable heel areas of these critically ill patients. Although LOW WEIGHT was not utilised during this study a previous case study can be found for further reference. https://epostersonline.com/wounds2018/node/418

Discussion Further guidance can be developed to identify patients who could be prescribed Pulsation therapy mode in order to manage oedema.

This small study highlighted that the Drive DeVilbiss Artemis mattress provided a clinically effective support surface which contributes to the prevention of pressure ulcers in the critical care environment and meets the criteria as above to be a true alternating device. Though it is important to consider the impact of a combination of interventions namely regular skin assessments, re assessment of pressure ulcer risk, repositioning regimes and support surface selection, all of which contributed to the prevention of pressure ulcers. In the McInnes et al. systematic review,11,12 data from two studies comparing active support surfaces and standard mattresses were pooled. The results suggested that fewer pressure ulcers develop on active support surfaces as compared to standard hospital mattresses. A study by Richardson et al13 further highlighted a successful intervention was the change from foam and gel mattresses to alternating low pressure mattresses. Therefore, it is important to consider that one the preventative measures in relation to pressure ulcers in the critically ill patient, should include a technologically advanced alternating support surface such as the Artemis mattress.

Conclusion The guidance ‘The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care RCN 2005’8 states that Active (alternating) Pressure Redistributing Mattresses (APRM) deliver therapy by means of cyclical pressure redistribution; this serves to periodically off-load the tissue and restore blood flow. The goal of an APRM is to deliver true alternating pressure by producing an off-loading profile which mimics normal spontaneous movement: • 6–8 times every hour9 • Pressure as low as possible • Low pressure held for as long as possible to enable reperfusion of the tissue10

References: 1. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Prevention of Pressure Ulcers: Quick Reference Guide. Washington DC: NPUAP; 2009. 2. National Institute for Health and Care Excellence. Pressure Ulcers: Prevention and Management of Pressure Ulcers. NICE Clinical Guideline 179. Issued April, 2014. 3. Pressure ulcers in the adult Intensive Care Unit: A literature review of patient risk factors and risk assessment scales. Tayyib N, Coyer F, Lewis P.J Nurs Educ Pract 2013;3:11, 28-42. 4. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Pane and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. In: Haesler E, editor. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Perth, Australia: Cambridge Media; 2014. 5. Systematic reviews of wound care management: . Cullum N, Nelson EA, Sheldon T (2001) Health Technology Assessment 5:1–211. 6. Adult Critical Care Eugenia Cronin, Mick Nielsen, Martin Spollen and Nigel Edwards https://www.birmingham.ac.uk/documents/collegemds/haps/.../01hcnaseries3d2.pdf 7. Pressure Ulcers in the Aging Population: A Guide for Clinicians, Aging Medicine 1, D Berlowitz DOI 10.1007/978-1-62703-700-6_2, © Springer Science+Business Media New York 2014. 8. Royal College of Nursing Clinical Practise guidelines ‘The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care RCN 2005 https://www.rcn.org.uk/professionaldevelopment/publications/pub-002444 9. Body movements during night sleep and their relationship with sleep stages are further modified in very old subjects. Brain Res Bull, . Giganti F, Ficca G, Gori S, Salzarulo P 2008 Jan 31;75(1):66-9. 10. Wavelet-based spectrum analysis of sacral skin blood flow. Presented to the Rehabilitation Engineering and Assistive Technology Society of North America, June 25–27, 2005, Atlanta, GA. Jan YK, Brienza DM, Geyer MJ, Karg P 11. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. McInnes E, Bell-Syer SE, Dumville JC, Legood R, Cullum NA. 2008;4:CD001735. 12. Support surfaces for pressure ulcer prevention. Cochrane Database Of Systematic Reviews McInnes E, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Cullum N. 2011;4:CD001735. 13. Reducing the incidence of pressure ulcers in critical care units: a 4-year quality improvement Annette Richardson Joanna Peart Stephen E. Wright Iain J. McCullagh International Journal for Quality in Health Care, Volume 29, Issue 3, June 2017, Pages 433–439, https:// doi.org/10.1093/intqhc/mzx040

Contact us for more information Tel: 0845 0600 333 / 01274 475 000 | Fax: 0845 0600 334 Email: info@drivedevilbiss.co.uk | Web: www.drivedevilbiss.co.uk


VIRTUAL REALITY

A NEW HEALTHCARE REALITY Futuristic technology that is coming to patients now, virtual reality presents a computer-generated environment that is seemingly real through interacting with the world with specialist equipment, such as glasses with a screen inside or gloves fitted with sensors. The use of virtual reality in healthcare settings has become more and more prevalent, enabling for engaging rehabilitation or as a welcome distraction from an individual’s condition.

SENSOR-BASED STROKE SOLUTION

Designed by Kinestica, the Bimeo is a cutting-edge upper body rehab device aimed at replacing traditional stroke therapy methods. Using virtual reality gaming, the product is designed to encourage patients to continue with essential daily exercises by making the rehabilitation exercises entertaining, challenging and fun. These exercises are synchronised with the device through sensors, which capture objective data to provide the clinician with insight into the patient’s progress. The progress is monitored, and the treatment can be adjusted to maximise individual benefit and speed up recovery. Bimeo allows therapists to prescribe a wide variety of therapy options, such as bimanual and unimanual mode, and isolated arm joint mode. The various therapy modes require different therapeutic attachments which are changed via the quick release mechanism and a few clicks of the user interface. The Bimeo benefits both the patient and the therapist, as a single therapist can simultaneously assist multiple patients exercising with the Bimeo. www.kinestica.com

SMART ROOM, SMART HOUSE, SMART TECH A new space in the NHS has opened in Liverpool to test the latest digital technology to support patient care, including monitoring falls risk, heart rate and blood pressure. The ‘Livernerds Lab’ consists of two specialised areas: a ‘Smart Room’, which simulates a hospital room, and a ‘Smart House’, which simulates a patient’s home. Both spaces are specifically adapted and fitted with the latest digital equipment, including sensor technology, virtual reality and telehealth, all enabled by 5G connectivity. The lab brings together the pioneering work of the Royal Liverpool and Broadgreen University Hospitals NHS Trust’s Global Digital Exemplar (GDE) programme and Liverpool 5G Health and Social Care. The Lab has been selected to be part of the £3.5 million Liverpool 5G Health and Social Care pilot. This opportunity allows partners to work collaboratively to trial digital health technology before it is implemented in hospitals and patients’ homes.

A WELCOME DISTRACTION Lancashire-based St Catherine’s Hospice has helped a patient experience the sights and sounds he loves from his hospice bed. 58-year-old Phil Morris, who enjoyed snorkelling before he became ill, has been able to experience the sights and sounds of the sea again through the use of VR. Acting as a diversional therapy for patients, the VR equipment allows patients to enjoy different experiences from around the world during their time at the hospice. St Catherine’s has signed up to the DR:VR programme – The Virtual Reality Distraction 18 AT TODAY

THE VIRTUAL REALITY FILM, TOOK HIM UNDER THE SEA

Therapy Solution – for a one-year trial to assess the impact VR has on reducing its patients’ pain, stress and anxiety. Phil was the first patient at the hospice to use the new technology, who chose an underwater experience. The film, watched through VR goggles, took him under the sea where he could see a variety of fish and marine mammals.


GOVERNMENT ACCESSIBILITY

ACCESSIBILITY JUMPS UP THE GOVERNMENT AGENDA With Brexit having dominated news headlines for the past two years, some major changes aimed at creating more inclusive environment may have flown under the radar. As the topic of disability continues to gain more prominence in society and the media, paired with the UK’s ageing population, the need for more inclusive environments is more pressing than ever. In light of this, the Government has introduced new policies and investments, such as railway station accessibility upgrades and increased Access to Work funding, to help make the UK more inclusive.

CHANGING PLACES CHANGING SPACES The Ministry of Housing, Communities & Local Government, Caroline Dinenage MP and Rishi Sunak MP have put forward plans to increase the number of Changing Places facilities for disabled people across England. As it stands, building regulations guidance only recommends that Changing Places facilities are installed, but the Government is putting forward new proposals to ensure Changing Places toilets are a mandatory requirement in all new, large, publicly-accessible buildings and significant redevelopments in the future. Additionally, the Department of Health and Social Care has announced £2 million to install over 100 Changing Places toilets in NHS hospitals. The Government has also provided £70,000 for an online map of the UK that helps carers and disabled people locate Changing Places facilities.

BRIDGING THE DISABILITY EMPLOYMENT GAP The Department for Work and Pensions has revealed a number of new reforms to help disabled people get into employment, including increases to work allowances and to the Access to Work scheme. Under the new reform, people can now claim up to an extra £2,000 a year to help pay for additional support that may be required in the workplace through the UK Government’s Access to Work scheme, raising the maximum annual grant to £59,200. Access to Work is a scheme available to disabled people to fund adaptations and assistive technology at work to ensure someone with a disability is not substantially disadvantaged when doing their job. Alongside enhancing the Access to Work funding, the Government has boosted the amount disabled people can earn by an extra £1,000 per year before their Universal Credit work allowance starts to reduce.

STATION AMELIORATION 73 railway stations across the UK are set to benefit from a £300 million accessibility funding boost to support people with disabilities. Chosen stations will receive an accessible route into the station, as well as to and between every platform. The Department for Transport’s Access for All programme has already delivered an accessible, step-free route at more than 200 stations. All work at the stations is due to be completed by the end of March 2024.

(left) Liverpool Central Station 20 AT TODAY


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DEMENTIA

DEMENTIA DEVELOPMENTS There are currently around 850,000 people living with dementia in the UK, according to Alzheimer’s Research UK, and by 2025, this number is forecast to increase to one million. This section covers some of the latest developments that are helping combat the global issue of dementia, from sensory AI cushions, through to expert advice on the importance of keeping dementia patients hydrated.

SENSORY STIMULATION in 2017, the Inmu cushion – which stands for “interactive music” – was designed to help people with dementia feel relaxed. The innovative cushion works by incorporating artificial intelligence to create an interactive experience for users. Inmu translates touch and movement into soft vibrations, which are stimulating for clients. In the same way, depending on how the user moves the cushion, the sounds will mimic the user’s actions to create an interactive experience. There are currently two versions available – The inmuRELAX and the inmuDANCE. inmuRELAX provides soft sounds and vibrations for clients, which gives people a sense of closeness and safety. It helps people with dementia, unrest and stress. Whereas inmuDANCE features more upbeat sounds, which promotes happiness and pleasure. This is useful for cognitive and movement therapy, sensory stimulation and increasing arousal. www.inmutouch.com 22 AT TODAY


IPAD DETECTION TEST A five-minute online iPad test, which examines the speed and accuracy of a personâ&#x20AC;&#x2122;s thinking, could help healthcare professionals diagnose dementia earlier than before. South London and Maudsley NHS Trust is currently trialling the online exam, where people are shown 100 photos and have to determine whether or not there is an animal in the picture. Some photos have obvious animals, while others have hidden animals or no animals at all. If people are slow to respond or incorrectly identify the animals, it could be a sign their brain function is reduced â&#x20AC;&#x201C; potentially signposting towards dementia. Individuals are able to take the test at home, providing a quick and easy solution. Simultaneously, the test can help spot brain deterioration before any symptoms appear that a doctor may notice.


DEMENTIA

DEMENTIA & HYDRATION Repose Furniture & The OT Service’s Kate Sheehan have written an article highlighting the importance of keeping people with dementia hydrated and why people with dementia may find drinking fluids challenging. The human body needs water to function; to perform various and numerous physiological, including regulating the body’s temperature, removing waste from the body as well as and carrying out cell functions; and to survive. Hydration is crucial yet extremely challenging in an individual with dementia.

PEOPLE WITH ADVANCING DEMENTIA ARE INCREASINGLY VULNERABLE AS THEY MAY SIMPLY FORGET TO DRINK OR THEN FORGET THEY HAVE MADE THEMSELVES A DRINK OR WHERE THEY HAVE PUT IT

24 AT TODAY

DEHYDRATION Anybody can become dehydrated. In basic terms: “Dehydration means your body loses more fluids than you take in”. Risk factors for becoming dehydrated include the following and are often combined: • Older age • Residing in long-term care • Requiring assistance with foods and fluids • Incontinence • Cognitive impairment/ confusion • Impaired functional status and assistance required for feeding • Inadequate numbers or appropriately trained staff to assist • Depression • Multiple medications, particularly diuretics • Decreased thirst • Acute illness, diarrhoea and vomiting

THE SIGNALS THAT WOULD ORDINARILY INFORM THE BRAIN OF THIRST CAN BE ALTERED WITH DEMENTIA, REDUCING INITIATION TO DRINK IN THE FIRST PLACE

DEHYDRATION AND DEMENTIA The risk of dehydration is much higher with older people, rising even higher when the person also has dementia. People with advancing dementia are increasingly vulnerable as they may simply forget to drink or then forget they have made themselves a drink or where they have put it. Their memory cues may also prove unsuccessful; they may not recognise the cup or glass as something that may hold water or that they could drink from. The signals that would ordinarily inform the brain of thirst can be altered with dementia, reducing initiation to drink in the first place. Various medications can exacerbate dehydration, particularly diuretics and laxatives. Subsequently, many people then limit their fluid intake for fear of incontinence. Signs to look out for: • The person is warm to the touch • The person seems more confused than usual (this can be challenging to distinguish in later stages of dementia) • Lips appear dry and/or cracked • The skin is a lot drier than usual and may peel or shed • The person may complain of headaches • A person’s blood pressure is lower than usual • A person’s pulse is faster • The person’s urine appears darker and has a strong odour • Eyes can become sunken


Dehydration and malnutrition are often observed together and pose particular risk to those with dementia. Both have significant negative impacts upon health and wellbeing and are observed in the community and care settings as well as in hospital. Often not timely recognised or treated, the likeliness of hospital admission and ultimately mortality are increased with dehydration. Even with mild symptoms, cognitive function is further impaired and can affect mood

and motivation. Physically, individuals can become weak and dizzy and at increased risk of falls. Development of pressure sores and skin conditions, urinary tract infections and acute kidney injury are possible. In a wider sense, this then impacts greatly on the wider health economy with much higher demand on GP services and ultimately hospital admissions.

SO, WHAT CAN BE DONE TO IMPROVE HYDRATION FOR INDIVIDUALS WITH DEMENTIA? Making an event of having fluids can help. Why not organise an excuse for a drink together and raise some valuable funds too by visiting: www.dementiauk.org/support-us/ fundraise/time-for-a-cuppa/ Other options include: 1. Provide staff training regarding the importance of hydration 2. Provide a daily fluid intake goal for the individual 3. Make available the individualâ&#x20AC;&#x2122;s preferred fluids 4. Ensure fluids are available all the time 5. Ensure the drink is appealing visually as well as the taste 6. Ensure fluids are actually offered or given to the person regularly throughout the day 7. Use opportunities at specific points of the day such as routine appointments or activities. 8. Make available a variety of fluids, some hot and cold 9. Provide some assistance if required or suitable receptacles/drinking aids 10. Always give a full glass of fluid with any medications to be taken 11. Put up notes or reminders 12. Make the process easier and more visual â&#x20AC;&#x201C; put a jug of water and glass out 13. Include hydrating foods in diet For more information on the full range of bespoke seating solutions available from Repose, call 0844 7766001, email info@reposefurniture.co.uk or visit www. reposefurniture.co.uk

AT TODAY 25


PRESSURE ULCER DEVICES

PIONEERING PRESSURE PREVENTION Pressure ulcers are a problem that cost the NHS an alarming £1.4 million every day. These worrying statistics showcase the need to reduce the number of pressure incidences, both to ease the strain off caregivers and help patients. These innovative devices hope to prevent pressure ulcers and reduce the burden for clinicians and patients.

STOP THE PRESSURE The Flexi by Pure Air advanced crossover mattress from Hill-Rom UK and Select Medical aims to reduce the issue of pressure ulcers for clients and healthcare professionals. Flexi by Pure Air is suitable for patients that are at very high risk of developing a pressure ulcer. The uniquely constructed pressure-relieving mattress combines premium density Visco memory foam technology with the proven ‘figureeight cell’ designs. This system allows the cells to maintain their shape whilst avoiding ballooning, which may cause discomfort for the patient. The step-up, step-down surface is designed to deliver effective pressure redistribution and comfort in static, dynamic and constant low-pressure therapy modes, appropriate to varying needs. It can be used in an array of environments, including both hospitals and community care settings. www.hill-rom.co.uk/uk www.selectmedical.co.uk

DAMAGE CONTROL The SEM Scanner from medical device specialist BBI has been proven to result in an 86.2 percent reduction in hospital acquired pressure ulcers. A handheld, portable, skin tissue assessment device, the SEM Scanner measures sub-epidermal moisture, which is an invisible precursor to the development of incipient pressure damage. The scanner has been found, when used as an adjunct to current standard of care, to detect tissue damage on the sacrum and heels five days on average before it becomes visible on the skin’s surface. www.sem-scanner.com 26 AT TODAY

THE SEM SCANNER MEASURES SUBEPIDERMAL MOISTURE

RISE & RECLINER RELIEF MediSmart Technologies’ MicroCell Dynamic Recliner Chair Overlay strives to provide comfort and pressure ulcer relief for users in rise & recline chairs. A slim, alternating air mattress, the MicroCell Dynamic Recliner Chair Overlay features a ‘simpleto-use’ pump and can retro fit any recliner chair. The aim of the mattress is to reduce the risk of pressure ulcers in people who tend to use recliner chairs as beds for long periods of time. MediSmart Sales Director David Beavis commented: “Although I realise that it is not encouraged that patients use recliner chairs in a supine position as beds, the facts are that many do and therefore are not always on the appropriate support surface as they would have in a profiling bed. This has encouraged the need to manufacture such a comfortable system.” www.medismart.co.uk


S MART Wheelchairs Limited At SMART Wheelchairs we are able to meet and accommodate the needs of some of the most complex disabilities. Our aims and objectives are to provide as much independent access for all of our customers by using the latest technology and equipment available. Here at SMART we believe we’re best equipped to deal with your needs. From electric and manual wheelchairs, specialist seating systems that deal with a wide range of conditions to control systems that allow the user to control anything from a light switch to a PC or even a Sky TV Box. We realise that everybody is an individual and that is why all our chairs are tailored to you, the individual. Our aim is to provide each client with maximum comfort and functionality. You can rest assured that SMART will only recommend the right wheelchair or equipment that is best suited for our customer’s needs.

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HEALTHCARE APPS

MUST-HAVE HEALTHCARE APPS:

DIGITAL HEALTHCARE APP-RECIATION Not just a source of bringing fun tools to smartphones and tablets, like games or shopping, apps can also benefit healthcare professionals and their clients. The need for self-care is a priority in the healthcare sector, with endless reports discussing the pressures the NHS faces and how staff in health and social care are overworked and exhausted. This has led to an urgent need for digital innovations to help bring care back to the individual and free clinicians and carers to spend their time with the individuals who need the most support. The below apps allow patients and carers to manage health problems with ease, from managing back pain to helping researchers worldwide detect Alzheimer’s risk.

TOOL FOR FALLS A free interactive post-falls assessment tool is now available to download on both iOS and Android devices. The app – ISTUMBLE – has been launched to support carers to be able to assess fallen residents and to make the informed decisions whether they can lift the faller themselves safely and with the appropriate lifting equipment. It is part of an ongoing initiative to decrease the amount of unnecessary ambulance callouts to uninjured fallers and to safeguard the lives of residents living in care homes. Mangar Health worked closely with the Welsh Ambulance Service and the West Midlands Ambulance Service to launch the app. www.mangarhealth.com/uk/

ALZHEIMER’S ADVANCEMENTS A specially designed mobile phone game can detect people at risk of Alzheimer’s – according to new research from the University of East Anglia. Researchers studied gaming data from an app called Sea Hero Quest, which has been downloaded and played by more than 4.3 million people worldwide. The game, created by Deutsche Telekom in partnership with Alzheimer’s Research UK, University College London (UCL), the University of East Anglia and game developers Glitchers, has been designed to help researchers better understand dementia by seeing how the brain works in relation to spatial navigation. As players make their way through 28 AT TODAY

mazes of islands and icebergs, the research team are able to translate every 0.5 seconds of gameplay into scientific data. The team studied how people who are genetically pre-disposed to Alzheimer’s disease play the game compared to people who are not. The results show that people who are genetically at risk of developing Alzheimer’s disease can be distinguished from those who are not on specific levels of the Sea Hero Quest game. The findings are particularly important because a standard memory and thinking test could not distinguish between the risk and nonrisk groups. www.seaheroquest.com/site/en/

THE RESEARCH TEAM ARE ABLE TO TRANSLATE EVERY 0.5 SECONDS OF GAME PLAY INTO SCIENTIFIC DATA


BE MY EYES Be My Eyes is a global community that connects people who are blind or visually impaired with sighted volunteers or company representatives. On the app, volunteers assist visually impaired users through a live video connection and work together to tackle challenges and handle a wide range of tasks, giving users greater independence and removing the need to rely on family, friends or carers. The app brings together generosity, technology and human connection to help visually impaired people lead more independent lives. Be My Eyes is accessible in more than 150 countries worldwide and in over 180 languages. The app is free and available for download on both iOS and Android. www.bemyeyes.com

THE APP IS FREE AND AVAILABLE FOR DOWNLOAD ON BOTH IOS AND ANDROID

TAKING BACK CONTROL OF PAIN Swedish digital healthcare provider Min Doktor is pioneering a digital approach to back pain treatment with Kaia Health, a digital therapeutics company. Min Doktor physicians will prescribe the Kaia back pain app to patients suffering from repeat and/ or chronic back pain. Each patient will also be supported by Min Doktor physiotherapists. The Kaia app uses a multidisciplinary, mind-body digital approach to treat back pain, including education, physiotherapy and meditation. The treatment was

developed with physiotherapists, pain management physicians, orthopaedic surgeons and clinical psychologists. Using sophisticated AI, the app tailors treatment programmes for each user from over 120 exercises. Motion tracking technology ensures that the exercises are performed correctly via a smartphone, without the need for additional hardware. This empowers individuals to take control and self-manage their condition from the comfort of their home. The Kaia app can be downloaded via GooglePlay and AppStore. www.kaiahealth.com/?locale=en

AT TODAY 29


HEALTHCARE APPS

ENHANCED HEARING uSound is an app for smartphones that helps people with hearing impairments, available on Android and iOS devices. The app performs an estimate hearing test and the results are used to tailor sounds to the individual’s hearing. Although not designed to replace a hearing exam, uSound is an alternative device to help enhance people’s hearing. The personal amplification smart audio system, developed by hearing and sound professionals, can aid people in different scenarios, such as: listening to a lesson at school, participating in conversations, listening to a conference and listening to a film at home. Offering a customised experience, it is aimed at people with slight to moderate hearing impairment. www.usound.co/en

COMMUNICATION TRANSFORMATION Available on iPad, Avaz is a fullfeatured AAC app that has been developed for children who are non-verbal or who have difficulty speaking. The app offers practical guidance for parents and educators to help extend AAC beyond therapy and into homes and classrooms. It is childand caregiver-friendly, and helps therapists and educators to bring out the maximum potential in children. Boasting a wide range of features, Avaz keeps track of the child’s communication development to help measure progress; parents can print out their child’s vocabulary as a book; it teaches parents strategies to engage their child and speed up communication development, and much more. www.avazapp.com 30 AT TODAY

THE APP OFFERS PRACTICAL GUIDANCE FOR PARENTS AND EDUCATORS TO HELP EXTEND AAC BEYOND THERAPY AND INTO HOMES AND CLASSROOMS.


Essentials

One hoist To meet your every need The Mackworth Essentials 180 Mobile Hoist represents the greatest value mobile moving and handling hoist available to the market. With an impressive 180kg lifting capacity, powered leg opening and market leading Linak® actuators and motors, the Essentials 180 Mobile Hoist is ready for any environment. •

Quick and simple construction with tool-free assembly

Compact size with a small footprint and versatile lifting range, allows hoisting from the floor

Suitable for a variety of environments with robust, easy-to-clean powder coated steel frame

Comprehensive testing and quality construction to ensure years of reliable service

UK manufacture guarantees express delivery (typically within 48hrs)

Peace of mind with 3 year warranty

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MOBILITY INNOVATIONS

A GLIMPSE INTO THE FUTURE OF MOBILITY Innovations in the world of mobility are far and few between, with mobility products being criticised over the years for appearing too clinical, stigmatising and unattractive. However, these mobility innovations are aiming to transform people’s lives while remaining contemporary and stylish.

THE MOBILITY UNLIMITED CHALLENGE Launched by the Toyota Mobility Foundation in partnership with Nesta’s Challenge Prize Centre in 2017, the $4 million Mobility Unlimited Challenge aims to improve the lives of millions of people with lower-limb paralysis by bringing new innovation to the world of mobility. Five teams from the USA, Japan, Italy and the UK were announced to have reached the finals. Now the teams will use their half-million-dollar grants to develop their prototypes further in a bid to win the coveted $1 million prize in Tokyo in 2020. mobilityunlimited.org

THE EVOWALK Team: Evolution Devices (United States) A smart, wearable leg sleeve that helps people with partial lower limb paralysis regain mobility, the EvoWalk AI system uses sensors to predict the user’s walking motion. The device stimulates the right muscles at the right time to help individuals to walk better, with the personalised, timed muscle stimulation allowing users to contract their muscles as they walk. This contraction will not only assist users on a day-to-day basis, says Evolution Devices, but also rehabilitate the muscles and neural pathways over time.

MOBY Team: Italdesign (Italy) The mobility equivalent of a cycle share scheme, Moby is a mobility service created for users consisting of a series of wheel-on electric devices, located in urban hubs such as busy cities to make travelling easier and more accessible for people with lightweight, manual wheelchairs. Connected via an app, the platform will enable users to interact with other wheelchair users, the device itself, as well as other means of transport. 32 AT TODAY


QOLO (Quality of life with locomotion) Team: Team QOLO, University of Tsukuba (Japan) The QOLO Standing Device consists of a lightweight, mobile exoskeleton on wheels which uses passive actuators to allow users to sit or stand, effectively removing the ‘chair’ from ‘wheelchair’. Users operate the device with their upper body, enabling people to keep their hands free, whilst the device allows the user to travel in a standing position.

QUIX Team: IHMC & MYOLYN (United States)

PHOENIX AI ULTRALIGHT WHEELCHAIR Team: Phoenix Instant (United Kingdom) Designed by the creator of the original Carbon Black carbon-fibre wheelchair, Andrew Slorance’s latest innovation is a smart, ultra-lightweight, selfbalancing, intelligent wheelchair which eliminates painful vibrations for users.

Another exoskeleton that grabbed judges’ attention was the QUIX, featuring motors at the hips, knees and ankles, as well as additional actuators offering someone with lower-limb paralysis fast, stable and agile upright mobility. The team says the exoskeleton is able to provide the mobility, safety and independence that other exoskeletons are unable to via modular actuation, perception technology from autonomous vehicles and control algorithms for balancing autonomous humanoid robots. AT TODAY 33


MOBILITY INNOVATIONS

PIONEERING OCCUPATIONAL PERFORMANCE:

AN OT’S PERSPECTIVE ON THE FUTURISTIC TGA WHILL MODEL C POWERCHAIR HOW DOES TGA WHILL MODEL C IMPROVE MENTAL HEALTH AND WELL-BEING? They feel confident and more accepted as the appearance of the wheelchair is not clinical. It’s all about the ‘feel good factor’.

HOW IS THE TGA WHILL MODEL C ERGONOMIC? The controls on the WHILL Model C are akin to a computer mouse and so can be used with the palm of the hand – making manipulation easier for people with arthritic fingers or limited hand function. The WHILL Model C 34 AT TODAY

has a small footprint and can turn on its own axis, hence providing easier access. EXPLAIN HOW TGA WHILL MODEL C IMPROVES OCCUPATIONAL PERFORMANCE Owners have been more involved in activities outside of their home and improved their social interaction. It can be used for traveling by car, train or plane, making holidaying more accessible. WHILL improves a person’s self-esteem and selfconfidence leading to greater psychological benefits.

IT’S ALL ABOUT THE ‘FEEL GOOD FACTOR’

HOW CAN OTS JUSTIFY GRANT FUNDING TOWARDS TGA WHILL MODEL C? WHILL Model C has a contemporary design and helps owners remain positive and confident. Its looks are perceived as more in keeping with modern society and allows inconspicuous mobility in the outside world. WHAT TYPE OF USER IS TGA WHILL MODEL C MOST APPROPRIATE FOR? The TGA WHILL Model C is appropriate for those people who do not have complex postural needs


and require mobilisation over longer distances. WHY IS TGA WHILL MODEL C BETTER THAN OTHER POWERCHAIRS FROM A CLINICAL POINT OF VIEW? From a mental health perspective, the design and styling of this powered wheelchair provides users with greater self-confidence and self-worth. They feel they are using attractive equipment that fits into their lifestyle and is not embarrassing.

PLEASE SUMMARISE THE SUITABILITY OF TGA WHILL MODEL C FROM AN OT’S PERSPECTIVE The TGA WHILL Model C is a quality product that is ideal for semi-ambulant users who value product style and usability. This product resolves many barriers to independence through design that is viewed more positively resulting in greater inclusion within society. www.tgamobility.co.uk

THE TGA WHILL MODEL C IS A QUALITY PRODUCT THAT IS IDEAL FOR SEMIAMBULANT USERS WHO VALUE PRODUCT STYLE AND USABILITY

Ailsa Reston has been a qualified OT since 1986 and is co-owner of RKS Occupational Therapist Services in Cheshire. As part of her private practice, she assesses client needs, wants and risks, and hence prescribes appropriate mobility products for enhanced occupational performance. Ailsa has identified the innovative WHILL Model C Powerchair from TGA as a leading choice for improved mental and physical wellbeing. Its advanced styling, ergonomics and technology deliver a mobility solution that, from a healthcare professional’s point of view, strengthens confidence and selfesteem for users.

AT TODAY 35


MOBILITY INNOVATIONS

IS 90 DEGREES A RIGHT ANGLE? By Dr Barend ter Haar

Dr ter Haar has been involved in seating and mobility for over 30 years, including lecturing internationally, and developing international seating standards. He is aiming to address common misconceptions and myths in the world of posture and mobility to promote better practice. If you are interested in receiving further information on the topic, please contact barend@ beshealthcare.net

For the ideal seating set up, all joints should be at 90 degrees, just like in the text books, or should they? The answer is: “Usually no”. Look around you: how many people do you see sitting naturally and comfortable at 90-90-90 positions in symmetric positions? Unless you are a character from a Lego movie, your seat to back support angle at 90˚ will be very uncomfortable and difficult to maintain. Most of us need space, at least for our shoulder blades. At the pelvis, a neutral pelvis results in maximal gravitational pull through the ischial tuberosities. Work with the iShear device has shown that a ‘neutral pelvis’ exerts more shear on the seat surface than when at a 3˚ recline. For those wishing to control athetoid (involuntary, convoluted,

A GOOD SEATING SET UP ALLOWS THE OCCUPANT TO GET INTO THE BEST FUNCTIONAL POSITION FOR THEIR ACTIVITY

writhing) movements, an asymmetrical the sitting position, induced by turning the trunk, and hooking one arm around the back support, gives more control of the other arm. Foot supports requiring an angle of 90˚ or more at the knee, will often result in inducing a pelvic posterior tilt and spinal kyphosis (curbature), due to shortened hamstrings common in wheelchair users – so think where you place the foot support. You change the relative position of your head to your pelvis to your feet, depending on your activity (compare eating, with using a computer, with watching TV, with sitting on the toilet) – hence, a good seating set up allows the occupant to get into the best functional position for their activity, and it will seldom be 90-90-90.

RAMPING UP ACCESS Ford has creatively reinvented its car mat into a lightweight, portable ramp for disabled drivers to navigate previously inaccessible public spaces. The ‘Accessibility Mat’ provides a new function to an already existing car part, redesigning its Ecosport boot mat into a dual-purpose ramp which can be easily carried on the back of a wheelchair. The ramp/mat innovation incorporates an element of “smart” technology, with the Accessibility Map connecting to the wheelchair user’s smartphone via Bluetooth and a microprocessor embedded in the ramp. Each time the device is used by a wheelchair user, the Accessibility Mat gathers data on the location and highlights places where disabled access needs to be improved on an app and website, flagging to local authorities where action is required. 36 AT TODAY


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AskSARA answers who is using national prevention tool, and why

Janet Seward, Partnerships Manager at DLF, is a former chartered marketer who now leads the commercial projects at DLF, the national information, advice and training charity celebrating 50 years this year. Following a period of successfully developing the AskSARA programme, she has recently recruited a team of regionally based specialists to raise the charity’s profile and work in partnership with local organisations who themselves provide advice about aids and adaptations for daily living to the public. To contact the team please call DLF on 0207 289 6111 or email marketing@dlf.org. uk

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“If only my father/mother/granny/ brother/sister knew about that things would have been so much easier…” Variations on this phrase have been relayed thousands of times over DLF’s 50-year history. The lack of awareness of what adaptive equipment and technology is available and where it can be acquired was why DLF was established in 1969. It is also why DLF is still needed today. It is our aim to reach five million people, by 2022, with our impartial advice, information and training on equipment for daily living. DLF’s services are mainly online these days, although the telephone helpline remains a staple offering. The Hamiliton Index ring-binders that were a feature on every OT’s desk are now far more accessible online in the shape of DLF Data (by subscription), Living Made Easy and AskSARA (both for the public and free to access). Our knowledge base features over 10,000 products from 950+national suppliers and lists over 800 local retailers. Originally supported by the Department of Health in 2009, the DLF’s AskSARA online guided advice tool provides ‘self-assessment, rapid access’ (SARA) to help direct older and disabled people to impartial advice about suitable products to help with activities of daily life. Most importantly, it is anonymous and free - factors that DLF believes contribute to its popularity. The dynamic question streams and resulting advice in AskSARA are devised and revised by occupational therapists and the tool is regulated by The Information Standard https:// www.england.nhs.uk/tis/, which gives further assurance of quality.

SELFASSESSMENT, RAPID ACCESS

WHO’S USING ASKSARA, AND WHY? The AskSARA application is available nationally at https://asksara.dlf.org. uk/ and is also available through licensed versions which provide a more targeted local service. Licensees include around 30 local authorities who add further signposting and advice, directing users to useful resources within their local areas. The Welsh language AskSARA was launched last September and now covers over 25% of the population.

Waiting times for assessments are being stretched and can also differ widely across different localities and services. Councils report that when the tool is offered as a ‘front door’ service, it can help residents quickly find low level solutions for themselves that they are often happy to self-fund. This allows those with more complex needs to access formal assessments more quickly and efficiently. AskSARA’s user analytics can also provide useful pointers for future service development. DLF’s topics-based analysis is drawn from over 100,000 reports produced by users of AskSARA over a three-year period. Surveys have shown that over 45% of users are searching on behalf of someone else. Profiling data taken from Google Analytics provides the following profile


TOP 10 TOPIC AREAS, AS CHOSEN BY USERS OF ASKSARA (SOURCE: DLF)

of users for the year 2018: • Female. ......................................................... 65% • Over 65s........................................................ 20% • Over 55s........................................................ 40% • From England.......................................... 92% • New users.................................................. 88% So far, users have tended to be older women from England and the vast majority are using it for the first time. They select a topic, answer some OTauthored questions about their needs and the combination of answers they provide produces a clear and tailored advice-based report which discusses the types of products they might find useful. If the user then clicks on the product links, they’re taken to the product and supplier pages in Living Made Easy with over 10,000 products from 950+national suppliers and a list of over 800 local retailers. If the user’s answers suggest areas of greater complexity, they are given clear advice to seek a more formal professional consultation. DLF’s analysis examined which topics were most commonly accessed. With over 90 topics to choose from, many were grouped together in order to identify trends more clearly. A primary finding was that usage was widespread with the top five grouped categories accounting for 35% of reports, but they themselves include 44 separate topics. Strikingly, the most popular topics cover the essentials of daily living, underlining the importance of products being easily and quickly available to fulfil those needs before they escalate due to accident or neglect. As innovations and awareness of the value of telecare increase, it is likely we’ll see more people accessing advice about those areas. Currently, the usage of the tool centres on early generation solutions with ‘help in emergencies’ dominating attention within the category.

Rank

Topics

2015-16

2016-17

2017-18

1

Bathing, Bathroom, Bathroom safety & Showering, Taking a bath, Using a shower, Washing and bathing, Basin

3400

2686

3476

10%

2

Drinking, Eating, Eating and drinking, Preparing drinks, Preparing food, Preparing meals and drinks, Opening jars, tins, packages or bottles

2439

2203

2342

7%

3

Bedroom, Bedroom furnishings, Bedroom location, Beds, Getting into bed, Getting ready for bed, Getting up at night, Getting up in the morning, Sleeping, Whilst in bed

2424

1932

2253

7%

4

Toilet, Toileting, Going to the toilet, Getting to the toilet, Sitting and standing from the toilet, Using the toilet

1786

1457

1973

6%

5

Alarms sensors and doorbells, Doorbells, Alarm clocks and smoke alarms, Meters, Telecare and gas detectors, Telecare and smoke alarms, Telecare and temperature extreme alarms, Safety concerns and complaints, Security, Personal safety, Help in emergencies, Living alone

1971

1824

1680

5%

For further information, including access to all the findings from this analysis, please contact DLF at marketing@dlf.org.uk or phone 0207 289 6111.

Turning to the next most popular topics, one of DLF’s single most common product areas is medication management, a lower value but nevertheless critical area for maintaining optimum health and safety within the home. Rank

Topics

6

FUTURE DEVELOPMENTS Further development of the AskSARA platform is planned in 2019. New features will include moving to a ‘mobile-first’ design, recognising the growing importance of access from mobile devices. We will also take a fresh approach to the presentation of user reports and introduce new topics - including dementia-related equipment solutions.

2015-16

2016-17

2017-18

Stairlifts and through-floor lifts, Steps and stairs, Your stairs

1575

1516

1583

7

Medication management, Taking medication, Medical conditions

1686

1388

1482

8

Dressing, Clothing and footwear, Getting dressed and ready, Washing and dressing

1561

1291

1394

9

Chairs, Seating, Sitting and standing, Mobility

1139

1147

1104

10

Kitchen, Kitchen appliances, Kitchen cupboards, Kitchen lighting, Kitchen worktops and drawers, Safety in the kitchen

986

846

999

As the list progresses further, we start to see lifestyle-orientated desires, acknowledging people’s desire to maintain their leisure activities. The full list of topics is extensive and shows a range of practical concerns - a powerful reminder of the wideranging effects of ageing.

DLF has offices in Scotland and Wales and as part of Shaw Trust is registered as a charity in England and Wales 287785 and Scotland SCO39856

AT TODAY 39


ASSISTIVE ROBOTS

THE RISE OF CARE ROBOTS The use of assistive robots in care and domestic environments has seen a radical increase recently, helping individuals to remain independent in their own homes and relieving the pressure on carers. The three universities below have created robots that help make day-to-day tasks easier for disabled and elderly people, while boosting their independence at home.

FACILITATING FEEDING

ANIMAL COMPANIONS Researchers at the University of Sheffield are helping create intelligent assistive robots that can reduce anxiety in children and enable families to ‘visit’ their elderly or disabled relatives. One of the main focal points for the researchers is to develop animal-like companion robots that could help reduce anxiety in children in a hospital setting. The university will also be developing telepresence robots – video screens on wheels raised to head height that can be controlled remotely using a smartphone app. These robots will enable relatives and social workers to ‘visit’ elderly people more often, removing the barriers of distance.

AT HOME ASSISTANCE Researchers at the University of Washington have developed an innovative robotic device that helps people to eat, making the task easier for individuals who might otherwise require assistance from someone else. After identifying different foods on a plate, the robot can evaluate how to use a fork to pick up and deliver the desired food to a person’s mouth. The system attaches to a person’s wheelchair and feeds them whatever they want to eat. The robotic feeding device was developed after studying how volunteers used a fork to pick

40 AT TODAY

up different foods with different consistencies. The results showed that humans use different methods to pick up food, depending on its consistency. Therefore, the robot adjusts how much force, as well as the angle, it needs to use to pick up different kinds of food.

Researchers at Washington State University have unveiled a new robot that aims to help people living with dementia stay independent in their own homes. Called the Robot Activity Support System (RAS), it uses sensors embedded in the home to determine where its residents are, what they are doing and when they need assistance with daily tasks. RAS then navigates through rooms and around obstacles to find people, provides video instructions on how to carry out simple tasks and can lead its owner to objects like their medication or a snack in the kitchen.


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SMALL AIDS, BIG IMPACT For people with reduced dexterity, getting a hold on everyday items can prove a difficult task, particularly on objects that are small or fiddly. However, these clever aids are helping people grip items with ease, removing the need for assistance and increasing independence.

NEED A HAND? Designed by The Helping Hand Company, the Classic reacher range comes with an integral dressing post, handy magnetic tip and stick clip to secure to walker, rollator or frame. It allows clients to reach and grip items both big and small. The Gripcert claw enables a firm but gentle hold on slippery fabrics whilst remaining smooth against the skin when getting dressed. There is also the option of using the hooked trigger to help pull round clothing or to hang it up. For people on the go, there is also a folding option within the Classic range to ensure easy storage into shopping bags, suitcases or cars. www.hhadlessentials.co.uk

GET A GRIP! The Active Hands Company has released a new aid designed to make everyday fine-motor activities for gripping items easier. Called the Small Item Gripping Aid, the product comes in two parts; a neoprene glove and a Velcro-backed palm pad with clamp and aims to give users the independence to accomplish more. Items clamped in the palm pad can be placed into the glove at any angle, making a wide range of activities accessible and allowing those with reduced hand function to hold pens upright, a toothbrush sideways or a mascara wand at just the right tilt. The clamp mechanism can be easily opened and closed to switch between items. Alternatively, additional palm pads can be purchased, enabling users to pre-load commonly used items and simply switch between the palm pads without having to remove the glove each time. www.activehands.com 42 AT TODAY

USING KEYS WITH EASE Winner of the Design Council Spark Award and a ÂŁ65,000 investment from Versus Arthritis, the Keywing from Dext is helping millions with reduced dexterity to open doors. Keywing is a simple and innovative product that clips onto keys. Once in place, it creates a larger surface area and longer lever, making keys easier to hold, grasp and turn, and locks much easier to open. It launched in March 2019 on the Keywing website and on Amazon. www.thekeywing.com


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Apollo Dynamic Mattress Clinical Evaluation Large scale patient study on the appropriate use of Apollo dynamic mattress system and the impact of a ‘step down’ discharge decision tree on clinical practice. Authors: Linda Kemp-Sheridan, Tissue Viability CNS. MSc, PGCert Ed, NMP, BSc (Hons), RGN Sarah Westcott, RGN RSCN Product Support Specialist Drive DeVilbiss Healthcare Ltd

Introduction The Hillingdon Hospitals NHS Foundation Trust provides services from both Hillingdon Hospital and Mount Vernon Hospital. The Trust has a turnover of around £222million employs over 3,300 staff. They deliver healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving them a total catchment population of over 350,000 people. In line with the Trust Quality and Safety Improvement Strategy 20162021 to reduce the number of hospital acquired pressure ulcers through improved education and appropriate utilisation of specialist equipment, a programme of education was developed and the dynamic system Apollo by Drive DeVilbiss Healthcare was chosen in 2016 as the pressure relieving mattress of choice across the Trust sites. Greater demands are being placed on healthcare organisations to implement cost effective strategies for pressure ulcer prevention and it is important to understand which types of patients can benefit from different types of support surfaces1. Pressure ulcer prevention is therefore a high priority for patients admitted to hospital who are particularly vulnerable. Not only have the majority of patients sustained a fracture following a fall but many are elderly, have multiple comorbidities and many have a diagnosis of dementia. All of these factors increase the risk of pressure ulcer development2. The aim of pressure ulcer prevention strategies is to reduce either the magnitude or duration of pressure between the patient and his or her support surface or both3. Stepping down from dynamic mattresses onto static foam mattresses was not routine practice because of the patients’ sustained level of risk. A step down decision tree was implemented to encourage and provide clarity on support surface decision prior to discharge. The Tissue Viability Nurse Linda Kemp-Sheridan developed and introduced the ‘step down decision tree’ protocol to be implemented 48 hours prior to discharge with the aim of enhancing the patients longer term experience of support surface selection in the community setting4. The Apollo mattress system from Drive DeVilbiss Healthcare is a powered dynamic mattress that has additional manual comfort control settings to allow adjustment of internal cell pressures resulting in optimum pressure redistribution. The mattress has a 2:1 cycle of 10 minutes which provides pressure relief to the tissue by provide cyclic loading to the skin, so that each area of skin experiences pressure only intermittently. The Apollo alternating dynamic system features zoning with narrower cells in the heel section and this study aimed to identify pressure ulcer to heel outcomes in order to measure the effectiveness of this mattress feature in an acute setting.


Method

Discussion

The study was carried out to capture 100 patient’s data over a 16 week period with inpatients on elderly wards who were prescribed a dynamic mattress for more than 3 days. Clinical Areas included: Hillingdon Hospital Rehab including Neuro rehab, Orthopaedics and Care of The Elderly wards.

Developing clear protocols to assist ward staff to identify support surface requirements and options following discharge home engages staff that ‘Step down’ activities are a valuable and important part of discharge planning to consider the impact on mattress choices in the longer term community settings4.

Nursing staff were asked to continue their standard pressure ulcer preventative practice as per Trust policy which included skin assessments and repositioning according to level of risk.

Conclusion

The clinical nurse advisor reviewed the patient records both during and at the end of the evaluation period against the agreed outcomes, these were measured as follows: reason for admission, length of stay, number of days on the mattress, pressure ulcer risk score, mobility, frequency of skin assessment and skin integrity on discharge, heel tissue integrity.

Results 100 patient records were reviewed and evaluated • The average age of the patients was 83 with a range of between 33 and 97. • High number of patients admitted following a fall resulting in # hip fracture. • The average length of stay was 17 days with a range of between 3 and 56 days. • The majority of patients were at high risk of developing pressure ulcers with a range of between 13 and 25 on the Waterlow risk assessment scale. • Most had intact skin on admission which remained intact. • 15 patients had superficial tissue damage which in the majority of cases resolved. No patient developed a pressure ulcer during the study period whilst being nursed on the Apollo mattress, this met the criteria for heel damage assessment There was clear evidence that the education, promotion of and results from TVN ‘decision tree’ in implementing the 48 hour ‘step down’ and good practice in Safe Discharge Planning was adopted successfully by the clinical areas included in the study.

This study confirmed that the Drive DeVilbiss Apollo mattress provided a clinically effective support surface which met the evaluation outcomes and contributes to the minimisation and prevention of pressure ulcers in the clinical environment. It is important to consider the impact of a combination of interventions namely regular skin assessments, re assessment of pressure ulcer risk, reposition regimes and support surface selection, all of which contributed to the prevention of pressure ulcers. The Apollo alternating dynamic system use of zoning with narrower cells in the heel section may contribute to Pressure Ulcer heel outcomes and effectiveness. Results showed clinical effectiveness of Apollo mattress and evidence of low hospital acquired Pressure Ulcer rates across both sites for an 18 month period. The potential for skin cell and tissue breakdown is reduced when using this safe and cost effective support surface.

No patient developed a pressure ulcer during the study period whilst being nursed on the Apollo mattress.

Most had intact skin on admission which remained intact.

Contact us for more information Tel: 0845 0600 333 / 01274 475 000 | Fax: 0845 0600 334 Email: info@drivedevilbiss.co.uk | Web: www.drivedevilbiss.co.uk

References: 1. Support surfaces for pressure ulcer prevention - McInnes et al 3 September 2015 Editorial Group: Cochrane Wounds Group 2. An overview of co-morbidities and the development of pressure ulcers among older adults Efraim Jaul et al BMC Geriatr. 2018; 18: 305. 3. Iglesias C, Nixon J, Cranny G, Nelson EA, Hawkins K, Phillips A, et al. Pressure relieving support surfaces (PRESSURE) trial: costeffectiveness analysis. BMJ 2006;332(7555):1416. 4. Support surface selection for long term patients in the community. S Westcott L Welding JCN 2017, Vol 31, No 4


What needs to be considered when it comes to designing accessible kitchens? For elderly and disabled people, having an accessible living space is crucial, both for the physical and psychological benefits. It allows individuals to remain in their own homes, reduces the need for carers and – when it’s viable to do so – avoids paying steep care home costs. We spoke to Peter Davies at Ropox, one of the leading manufacturers and suppliers of independent living solutions for bathrooms and kitchens in both domestic and care environments, who shared his insights on what needs to be considered when it comes to accessible kitchens and the client.

EVERYONE HAS THEIR OWN IDEAS ON STYLE OF DOORS AND COLOUR AND JUST BECAUSE YOU HAPPEN TO SIT IN A WHEELCHAIR, THIS SHOULDN’T LIMIT YOUR CHOICE TO JUST A SMALL RANGE PETER DAVIES

46 AT TODAY

WHAT SHOULD PEOPLE CONSIDER WHEN DESIGNING AN ACCESSIBLE KITCHEN? Family home - It is vital to include the individual as they are likely to have very specific needs, such as right or left handed, limited hand movement, poor sight, and other strengths and weaknesses. If it is a family home, the whole family needs to be considered to ensure the kitchen enhancements for one person will not inconvenience the whole family, this can require more flexibility and possible compromises. Care home - If the installation is for a care home, the most flexible option may be needed to suit several different users with different levels of mobility. People undergoing rehabilitation – A training kitchen may be used for

PEOPLE HAVE OFTEN FOUND WAYS OF ‘MANAGING’ IN A POORLY DESIGNED KITCHEN

teaching specific skills, testing of abilities or of a layout with a view to using a kitchen at home. Extra space for training staff is often required. There are a huge numbe of acitivies performed in a kitchen, all of which need to be taken into consideration. These include: • Moving between work stations • Worktop food preparation • Cleaning vegetables at the sink • Washing up • Cooking at the hob • Using the oven • Accessing the fridge and freezer • Cleaning Listing and prioritising the importance of each of the above, and possibly even more activities, will help develop the design brief and ensure the final design meets all the needs of everyone involved. Individual wheelchair users will often need to carry out these activities at different heights. For example, cooking at the hob may be easier at lower heights than when washing up at the sink. WHAT COMMON MISTAKES DO PEOPLE MAKE WHEN DESIGNING AN ACCESSIBLE KITCHEN? People have often found ways of “managing” in a poorly designed kitchen and want to incorporate these movements in a new kitchen – afraid that a better design might not work for them.


For a wheelchair user, minimising movement and being able to slide pans between the hob and sink are crucial. Very often, people want an adjustable height sink and a hob and put them either side of a normal height fixed unit. This creates a stepped barrier between the hob and sink and can be quite dangerous. It’s also fairly common to forget to have preparation space between the hob and sink and this is where most time would be spent. WHEN PLANNING A KITCHEN, DO YOU WORK ALONGSIDE HEALTHCARE PROFESSIONALS? It’s always really important to work with the occupational therapist as well as listening carefully to the client. Often, the client can feel that everything is decided for them, so listening to their priorities and thoughts and involving them in the design is vital. HOW HAVE ACCESSIBLE KITCHENS EVOLVED OVER THE YEARS? At Ropox, we’ve been involved in making adjustable height frames to make kitchens flexible for nearly 50 years. Initially, the only total kitchen suppliers were specialist manufacturers of units which were relatively expensive, making the kitchens only practical for use in therapy/rehabilitation centres. We have simplified our systems over the years so that they can work with any standard kitchen

manufacturer’s units and worktops. This has meant that the costs of an adjustable height kitchen can be as low or as high as any customer buying a standard or really upmarket kitchen will face. Everyone has their own ideas on style of doors and colour and just because you happen to sit in a wheelchair, this shouldn’t limit your choice to just a small range. The contents of units should come to the user for easy access from a wheelchair. There has been a trend in standard kitchens to have more drawer units, pull out baskets and shelves and this has brought the prices down for these accessories. DO YOU THINK THAT INSTALLING AN ACCESSIBLE KITCHEN IN A PERSON’S HOME IS A BETTER OPTION THAN THAT PERSON MOVING INTO A CARE HOME? If someone can cook safely with a well-designed accessible kitchen, cooking can develop into a passionate hobby and a way of improving selfreliance, well-being and self-worth. It also allows the individual to do something for family and friends, rather than be on the receiving end of care all the time. Research has shown that people being able to live independently will

IT’S ALWAYS REALLY IMPORTANT TO WORK WITH THE OCCUPATIONAL THERAPIST AS WELL AS LISTENING CAREFULLY TO THE CLIENT.

live longer and spend less time in care homes – even the Government can see that this is a lower cost and a better outcome for everyone involved. LOOKING TO THE FUTURE, WHAT DO YOU THINK WE WILL SEE IN TERMS OF PRODUCT INNOVATION? We’ve got some really innovative ideas in our development pipeline. One of the biggest changes recently has been the changes made in the 2016 Doc M Building Regulations, relating to kitchens in new build wheelchair accessible dwellings. With much better room layouts and sizes than in the previous Doc M, this has a long-term positive effect on the accessible housing stock which, hopefully, will have a knock-on effect on refurbishments and adaptations. For more information on the full range of products available from Ropox or to book an assessment call 07831 401118, email pd@ropox.com or visit www.ropox.com

AT TODAY 47


EVENTS & TRAINING

EVENTS CALENDAR JUNE 12, 2019 Hallmark Hotel, Cambridge – OTAC (Occupational Therapy Adaptations Conference) www.otac.org.uk or 02921 900402 JUNE 14-15, 2019 RISE 4 Disability – Kent Event Centre, Maidstone www.rise4disability.com JUNE 17-18, 2019 COT Annual Conference – ICC Birmingham www.cotannualconference.org.uk JUNE 26-27, 2019 Health+Care – Excel London www.healthpluscare.co.uk

JULY 4, 2019 Kidz to Adultz Wales & West – Bristol www.kidzexhibitions.co.uk JULY 10, 2019 Hilton Hotel, Reading – OTAC www.otac.org.uk or 02921 900402 JULY 14, 2019 28th Disability Awareness Day – Walton Hall and Gardens in Warrington www.disabilityawarenessday.org.uk JULY 15-17, 2019 Posture & Mobility Group Conference – Telford International Centre, Shropshire www.pmguk.co.uk

AUGUST 7-8, 2019 DLF Moving & Handling People – De Vere Beaumont Estate, Windsor SL4 2JJ www.training. dlf.org.uk/moving-and-handlingpeople-south-2019 SEPTEMBER 11, 2019 Hilton Hotel, Southampton – OTAC www.otac.org.uk or 02921 900402 SEPTEMBER 18-21, 2019 REHACARE – Dussledorf, Germany www.rehacare.com OCTOBER 9-10, 2019 The Care & Dementia Show – NEC Birmingham www.caredementiashow.com

OCTOBER 22, 2019 Hilton Hotel, Newcastle – OTAC www.otac.org.uk or 02921 900402 NOVEMBER 6, 2019 The Spa Hotel, Kent – OTAC www.otac.org.uk or 02921 900402 NOVEMBER 27-28, 2019 The OT Show – NEC Birmingham www.theotshow.com DECEMBER 4, 2019 St David’s Hotel, Cardiff – OTAC www.otac.org.uk or 02921 900402

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Train the Trainer and Risk Assesors Qualification - Level 4 Award Occupational Therapists Care Agencies Care Homes NHS Local Authorities A1 Risk Solutions Ltd are a leading specialist in Moving and Handling Training, providing a range of qualification courses for Train the Trainer and Risk Assessors, all accredited by RoSPA. All training can be delivered ‘In-House’ designed and tailored to individual organisation needs or as ‘Open Public Courses’.

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EVENTS & TRAINING

WHAT TO LOOK OUT FOR AT THIS YEAR’S UNMISSABLE EVENTS OTAC (OCCUPATIONAL THERAPY ADAPTATIONS CONFERENCE) What is OTAC? OTAC is a day packed with the latest equipment and adaptation guidance you will require in your day-to-day practice. A free event with free parking and refreshments, OTAC provides you with CPD sessions; a chance to locate products for your clients; and expert run seminars, training and exhibitors who specialise in home adaptations and equipment for the disabled. OTAC also boasts a number of special guest seminars from: • Michael Mandelstam (legal trainer and consultant in health and social care) • Elizabeth Ainsworth (OT and Access Consultant, Australia) • Adam Ferry (OT, Speaker and Consultant, the OT Service, on behalf of Abacus) Who should attend? Occupational therapists (OTs), occupational therapy assistants and support staff, commissioners, people working within housing (surveyors, architects and technicians), occupational therapy students, housing associations, charities

DLF MOVING & HANDLING PEOPLE The Disabled Living Foundation Moving & Handling People is a CPDaccredited event focussing on positive solutions for practitioners and clients, and offering content and networking opportunities to keep your CPD fresh and up-to-date. The conference will include plenaries, seminars and workshops to give a range of learning options, which all delegates will have an opportunity to attend. There are also new opportunities for those interested in paediatrics to attend a workshop more relevant to their field. There will be a poster zone for new areas of research and techniques along with a separate space for new or bespoke equipment solutions in the field of moving and handling.

50 AT TODAY

involved in adaptations / funding equipment, manufacturers and retailers. Foundations Technical Roadshow Suitable for OTs, surveyors, technical officers, builders, architects, companies involved with adaptations, architect technicians and manufacturers, the Foundations Technical Roadshow offers a range of educational sessions. A must-attend session: The DFG Surgery event is open to all and will enable professionals to take problems and queries to the floor and let the room assist with their expertise across the region. What else is on? The below sessions are a must for all moving and handling therapists, from students through to experienced practitioners. • Handicare Moving and Handling Training and Workshop Sessions • Bed migration / Clients sliding down the bed • The small things

Foundations Technical Roa dshow Event Programm e

10:30am -12:30 pm

Foundations

Paul Smith, Foun dations An open forum for catch up on the Technical Officers to latest news on building and surveying, discuss good practice and talk to othe rs about burn ing issues. Includes a briefi ng on the tech nica implications of the DFG Review. l 10 MINUTE COM

FORT BREAK

Contour Sho wers

Richard Poole, Commerical Man and Mike Smi ager thies As part of the Foun we focus on how dations workshop level & easy acce showering can ss be easily achi eved in the bathroom to enab le people with needs to acce mobility ss safe, independ ent showering. Our presentation supp benefits of crea orts the ting level acce ss showering using wetroom floor formers and trays as well as shower key considera tions needed when specifying these solutions , we hope can help all Technica which l Officers & Specifiers in their day to day role. also be acquainti We will ng attendees with our latest easy acce ss, low profile shower tray which has unriv alled characte ristics for the bathroom adap tation sector. 10 MINUTE COM

Register your plac e

FORT BREAK

Geberit

Simon Thomas , Geberit Mera Care Ease of Installatio n & Service Main – tenance Discover just how easy the new Geberit Mera Care show er service with Simo toilet is to install and n Thomas. Simo has 18 years’ n, who worth of expe rience in the care industry will explain how to install, refurbish and adjust the new shower toilet from Geberit. He will focus on the details of how this new unit can technical and serviced without the need be installed to call out a Geberit tech nicia and money. Also n saving you both time explained will be the ease of registering for the as stan dard three year warranty whic h ensures peac e of mind for both you and the user. With over 40 year s’ shower toilet tech experience in developing nology, Geberit invested all their has wealth and expe offer somethin rtise to g new and inno vative. The new AquaClean Mera Care show is specifically desi er toilet gned to improve of life for those quality elderly and disa bled people who have diffi culty using a conv entional WC.

Event made poss

ible by:

2:30pm - 3:30p m

DFG Surgery

Paul Smith, Foun dations Stumped by the regulations or havin in agreeing wha g difficulty t’s reasonable and practical? Come along to the DFG Surgery, hosted by Paul Smith, Direc tor of Foundatio ns, and see if you can get the answers.

through www.o tac.org.uk alte rnatively

call us on + 44

(0)2921 900 402

Organised by:

#

OTAC19

DISABILITY AWARENESS DAY (DAD) An annual event, DAD is the world’s largest not-for-profit voluntary-led disability exhibition. Visitors to the free show can expect to find around 250 exhibitors, equipment suppliers, transport, holidays, leisure, employment, support groups and services, as well as a Sports Zone, an Arts Marquee, Centre Arena and family entertainment. The five main attractions at DAD are: EXHIBITION: Made up from organisations from the voluntary, statutory and business sectors, the exhibitors all work towards a common goal of promoting independence throughout life and work. SPORTS ZONE: The DAD Sports zone

offers chances for visitors to participate in scuba diving, wheelchair fencing, archery, golf, boxing, tennis, martial arts and more. ARTS: This consists of an exciting programme of performing arts in the Arts Marquee. THE MAIN ARENA: The Main Arena line up for 2018 included the Guide Dog Display Team, Vale Royal Falconry and the Warrington Pipe Bands. FOR THE CHILDREN: Children’s entertainment includes something for all abilities, with all the fun of the fair provided by Chadwick’s Family Fairground Rides.


Our aim is your mobility

Precision Rehab is one of the UK’s leading suppliers of bespoke powerchairs with a team that have over 25 years’ experience in assessment, sales & servicing The Precision Rehab team work closely with the client, their Occupational Therapist, family members and anyone else who may be involved in their day to day care to ensure the end product meets all their requirements. “Every powerchair we supply is bespoke as every client is unique and I have always held the belief that the chair should fit the person as opposed to the person fitting the chair” commented founder Matthew James.

leading seating manufacturers, supplementary suppliers and paint finishing company’s in the UK during the assessment and design process to ensure the end product meets all the requirements of the client. “Over the years we have worked with many people that have required extremely complex seating to the simple personal painted body covers to match everything from a nail varnish colour through to the correct shade of red for an ex fireman”.

To be able to meet and accommodate the needs of some of the most complex disabilities, Precision Rehab works with the

In addition to being the official supplier of the Paravan range of specialist powered wheelchairs for the UK and Ireland, Precision Rehab recently launched the groundbreaking ULTRA LS300 powerchair which has been designed by the original creators of the Balder Finesse. The minimum floor to seat height of just 300mm to 600mm is the lowest ever available

Gyro Glory

ULTRA LS300 powerchair

on a powerchair, using the Dahl docking system the user can also drive their vehicle from the LS300. Precision Rehab also supply other manufacturers’ wheelchairs including Quickie and UPnRIDE. Precision Rehab is always looking to embrace the latest technology and recently signed an agreement to be an official UK supplier for the Gyro Glory head control which has been designed to provide powerchair users with an easy to use, discreet headset from which they can control their chair and computer through head, cheek or eye movement, to offer even more specialist controls and mountings. The company has also added the MO-VIS controls to their list of suppliers and can now offer a wide range of specialist controls including the all new scoot attendant control.

To book a free assessment call 01256 300111, email info@precisionrehab.co.uk or visit www.precisionrehab.co.uk

AT TODAY 51


EVENTS & TRAINING

CPD COURSES CARE QUALITY CONSULTING Aiming to provide motivating training to the health and social care sector, Care Quality Consulting has a range of CPDaccredited courses on offer to healthcare professionals. Courses include Catheter Care, Dementia Champion, Diabetes Awareness, Managing Challenging Behaviour, Moving

& Handling Awareness, Pressure Area Care, Safeguarding Children, Falls Prevention and much more. To find out more about Care Quality Consulting’s range of courses, visit www. carequalityconsulting.com, call 03333 441 066 or email enquiries@ cqc-uk.com

ACTION ON HEARING LOSS Charity Action on Hearing Loss is providing a number of CPD courses to help healthcare professionals better understand and support those with hearing impairments. Its courses include Deaf Awareness, BSL at Work and Serving

Customers with Hearing Loss. To find out more about the CPD courses the charity has on offer, visit www.actiononhearingloss.org.uk, call 0333 240 5658 or email access. solutions@hearingloss.org.uk

STAFF TRAINING INSTITUTE OF PROFESSIONAL DEVELOPMENT The Staff Training Institute of Professional Development seeks to deliver bespoke, high-quality and cost-effective training solutions. Working with organisations and individuals, its goal is to aid thedevelopment of knowledge and skill sets to improve care delivery. It has two CPD-accredited courses on offer: Moving And Handling, and Infection Prevention And Control.

To discover more about these CPD courses, or any other courses on offer from the Staff Training Institute of Professional Development, visit www. stafftraining.me, email info@ stafftraining.me or call (028) 9562 2002

NATIONAL AUTISTIC SOCIETY (NAS) NAS Training and Consultancy has many years’ experience delivering tailored in-house training in autism to various organisations, local authorities, social services practitioners and professionals across the UK. Its CPD certified course range covers various topics, such as Autism, Sport & Physical Activity, Safeguarding Children on the Autism Spectrum, Autism in maturity, Sensory Considerations and many more. To find out more about the courses, visit the website www.autism.org.uk/ training 52 AT TODAY

IN LEARNING YOU WILL TEACH AND IN TEACHING YOU WILL LEARN

HANDICARE Handicare is a specialist in healthcare equipment to make everyday life easier for disabled and elderly people and to empower them to live an active life. The company provides solutions that help increase independence and are easy and safe to use for both healthcare professionals and family members. It has a variety of CPD courses

and workshops available, including Application, Assessment, & Use Of Hoisting/Lifting Slings, Single Carer Management and In Bed Management. To find out more about Handicare’s CPD workshops, visit www.handicare.co.uk, email enquiries@handicare.co.uk or call 01384 408700


SILVALEA Silvalea works collaboratively with medical specialists in paediatric, bariatric, elderly care, mobility rehabilitation and acute units in order to develop specific products which meet the demands of the medical care industry. Its CPD workshops include Amputee Sling Types Considerations and assessment, In-situ patient slings - how they are used and when to use them,

ACCOMPLISH Paediatric Slings - passive and active end-users, Understanding basic sling shapes and their application, and more. To learn more about Silvaleaâ&#x20AC;&#x2122;s CPD courses, visit www.silvalea. com or email global-training@ silvalea.com

accomplish is an independent provider of hospital, residential and supported living care. It has a huge range of CPD-certified courses on offer for healthcare professionals, including Pressure Care Awareness, An Introduction to Personality Disorders, Dementia Awareness, Epilepsy Awareness, Personality Disorder Awareness, Understanding the perspective of the people we support, and more. To find out more, visit www.accomplish-group. co.uk, call 0333 444 0075 or email info@accomplishgroup.co.uk

AT TODAY 53


LIGHTWEIGHT

PRESCRIPTION

POSITIONING

POWER

A COMPLETE RANGE MOBILITY SOLUTIONS KARMA MOBILITY LTD UNIT 6 TARGET PARK, REDDITCH, WORCESTERSHIRE B98 8YN T: 0845 630 3436 E: INFO@KARMAMOBILITY.CO.UK WWW.KARMAMOBILITY.CO.UK


T US R A RES ND O O FI NE ST LI ITY ON BIL O M

High performance ferrules for everyday adventures Flexyfoot – an ergonomically designed range of award winning walking aids with a flexible and shock-absorbing foot that securely grips almost any surface range of easy-to-fit ferrules, folding and telescopic • Complete sticks, crutches, hiking poles and accessories

• 50% more grip than standard ferrules • Help reduce trips and falls • Help reduce referred pain • ISO tested for grip and endurance • User tested for comfort Visit flexyfoot.com for more information

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AT Today 2019 Issue 1  

The first issue of AT Today keeps busy healthcare professionals all the latest news, updates, research and developments from the world of as...

AT Today 2019 Issue 1  

The first issue of AT Today keeps busy healthcare professionals all the latest news, updates, research and developments from the world of as...

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