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Ingenuity, new tech create newest orthoses
Monday October 1, 2012
The Kickstart is a kinetic orthosis that provides walking assistance, improves stability and can aid in physical therapy.

(Photo courtesy of Cadence Biomedical)


The first step toward making the Kickstart kinetic orthosis was biomechanics expert Ton van den Bogert’s research into why horses are so efficient when walking and running. The Kickstart is designed to help people with weakness in their lower extremities, especially in the hip flexor muscles. Van den Bogert, who worked at the Cleveland Clinic Foundation at the time, discovered tendons were the key, said Brian Glaister, president and CEO of Cadence Biomedical, which produces Kickstart.

"When a horse starts to take a step, these long tendons stretch like springs and they store lots of energy," he said. "At the end of the step, all that energy comes back and it helps push the horse forward, and it helps lift its leg and swing it through for the next step."

The conservation of energy keeps the horse’s muscles from having to work as hard, Glaister said. The Kickstart, which was released in September, can help a person with stroke, incomplete spinal cord injury or traumatic brain injury, Lou Gehrig’s disease, multiple sclerosis or muscular dystrophy. People need moderate quadricep strength and the ability to initiate a step to use Kickstart, he said.

Anecdotally, he said they are seeing users gain strength and endurance. Glaister cites a patient who had a SCI and had been in therapy for six years. "You need to take thousands of steps a day to rewire your nervous system," he said, and the patient could take only a few steps at a time. "His therapy included walking in a therapeutic pool and being held in a harness over a treadmill while his therapist would move his legs." The patient began using the Kickstart on both legs, and now his therapy is over-ground walking and stepping over obstacles, Glaister said.

For him, the best part is helping people who are stuck in their therapy. "We have gotten some really tough patients over that hump," he said.

Spine support

Among its orthotic and prosthetic offerings, Ottobock’s Spine Line includes 15 bracing options to address pain from stress or strain, traumatic injuries causing ligament sprain or stable vertebral fractures, said Kelly Clark, CO, clinical specialist, custom orthotics. He added the line was developed to be user-friendly. "The pulley system on our thoracic through sacral spine products give the highest level of support with the least effort on the patient’s part," Clark said. "There is no twisting and turning to tighten them."

Finding the fit

The PreStride is the newest addition to Becker Orthopedics’ Stride family of stance control devices, said C. Rudolph Becker, vice president of marketing and IT for the company. The family-run business was started in 1933 and like most of the market, historically made KAFOs with locked joints, he said.

"In general, PTs never liked to really see our old, traditional type of bracing where we locked up somebody’s leg where it couldn’t flex because they felt the patient had no chance of regaining any muscle return," Becker said.

The Stride knee joints allow the knee to flex when needed during a step and then lock at heel strike to add stability, he said. The PreStride KAFO is adjustable for heights from 5-feet-2-inches to 6-feet-2-inches for assessment or rehab and works with all of the Stride knee joints so a PT can determine what is best for each patient, Becker said. The PT then can order the patient a definitive custom orthosis, he said. It also can be used as a locked KAFO to stabilize acute patients first starting therapy. "As they start to get a little return in their muscles and get a little more confident with it, [a PT] could start to introduce a little bit of movement at the knee with the stance control knee joints," he said.

The KAFO addresses isolated quadricep weakness, TBI, MS, SCI, stroke, polio or postsurgery femoral nerve issues. The GX-assist can be added to improve leg extension.

Aiding arms

The Myomo mPower 1000 is an upper limb orthosis that strictly uses biofeedback, said Micheal Quzor, marketing director for Cambridge, Mass.-based Myomo Inc.

Quzor said the device has sensor on the biceps and triceps, that pick up the EMG signal from the person’s brain telling the muscles to move the arm. The mPower amplifies the signal, and its motor aids in movement, he said.

"It allows someone who has weak muscle signals or weak muscles to move their arm again," said Cindy Lee, OTR/L, lead clinical support specialist for Myomo. Lee said the mPower is designed for patients with central nervous system impairments, such as TBI, ALS, MS, CP and stroke, but they need to initiate movement.

It weighs less than 2 pounds and can be adjusted based on arm size, Quzor said. The orthosis can connect to a tablet via Bluetooth so therapists can store data from sessions.

"It’s beneficial with people who are trying to improve their range of motion or as a way to manage their tone in a clinical setting," Lee said. The mPower is easy to apply to functional activity and to take home, she said, which is helpful for patients who have a limited number of visits. "It helps facilitate repetitive task practice, so patients are able to get the proper dosage," she said. •

Bonnie Benton is a copy editor.

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Monday October 1, 2012
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