Research & Development

There are thousands of biomechanical engineers, biomedical engineers, orthotists and industrial designers working in universities, private laboratories and workshops to explore new technology and refine existing concepts to improve the lives of those with disabilities.

Part of the motivation for those groups to spend resources on R & D is financial reward, but also the satisfaction of seeing new technology change lives for the better.

The process can be arduous and long to create reliable and effective technology suitable for commercial use. In Australia, there are requirements for registration with TGA on certain quality control measures.

Advancements in Technology

There are a number of technologies that are advancing Orthotic healthcare.

• 3D printing of devices - Has sped up manufacturing processes, allows for minuscule changes to design and consistency in the fitting of Orthoses.
   
• Specialised fabrication facilities - Australian Orthotists are collaborating with leading countries (notably, USA and Germany) to manufacture and ship speciality Orthoses in a timely manner.
   
• Integration of computer technology - The addition of technology to assistive devices and the continual size reduction of these components has allowed orthoses to be even more effective and provide truly life changing results in certain cases.

These advancements in technology are helping many Australians with a disability by increasing the capacity to rehabilitate, simulating muscle function, improve mobility and living safe, meaningful lives.

Advancements in Material

The original Orthotists and Prosthetists were armourers, so devices were made out of metal, leather and wood.

Thankfully, materials technology has developed to the point that carbon fibre, lightweight thermoplastics, as well as other traditional materials such as cotton and foam are available.

Orthotists leverage this advancement to make strong, slim, lightweight and more effective devices than ever before. The practicality and style of the device is very important to many patients, so these materials provide choice in terms of colours, shape and profile. These specifications can be adjusted to the individual.

One person might want a hot pink carbon fibre Ankle Foot Orthoses, and the next person might want theirs in black high temp thermoplastic, a good orthotist will accommodate and advocate for freedom of preference.

Advancements in material technology are giving both Orthotists and consumers plenty of options and choice.

Scanning & Shaping

There are progressive 3D scanners and CAD modelling software tools available for clinicians.

Certain scanners use light sensors/mesh technology to scan a limb and map the anatomy of the patient.

The file creates a 3D representation of the relevant anatomy on a computer. The representation can be modified, smoothed out or adjusted where necessary. The Orthoses can be prototyped using the CAD CAM software and then milled out in a workshop.

Historically, this task was performed with plaster and hand-measurements. The automated approach can be faster, cleaner and efficient. However, Orthotists suggest hand-work and plaster is sometimes still the best option.

Computer Controlled Orthoses: The C-Brace

The C-Brace is a lower-limb orthosis manufactured by Ottobock. It is potentially the most impressive technology to emerge from the industry to date.

The C-Brace is a unit integrated into a Knee Ankle Foot Orthosis. At its core is a computer-controlled unit which provides variable resistance at the knee. It can simulate the role of knee extensors in an isometric and eccentric contraction and deliver variable resistance to assist those with quads weakness.

It is responsive to scenarios such as sitting down, walking on stairs or ramps. It can be programmed while the patient is walking, so it is tuned to that patient until their gait is as natural as possible. The user can swap between profiles (i.e. walking/cycling modes).

There have been instances where the C-Brace has helped people go from dragging their limbs with minimal stability to being able to walk with a natural gait.

Data and Electronic Orthoses

Modern Orthoses have the ability to capture user data, such as:

• Number of steps per day
• Average walking speed
• Events such as locked knees or clearing obstacles

This data is currently used for product improvement purposes, however, can be expanded to provide biomechanical reporting to clinicians to quantify their patient’s status/improvements.

Functional Electrical Stimulation



What is an FES device?

There are orthoses that use electrical currents to assist their wearer, these are referred to as Functional Electrical Stimulation. An FES device will cause movement at a specific joint by stimulating a muscle at the right time.

The concept of FES is very old. People have known for centuries that electricity can stimulate muscles. However, only recently has the technology developed so that it can be integrated into a small, safe, reliable, wearable and functional device on the upper or lower limbs.

Technology

How FES Devices are Administered VIDEO

A typical FES device will be a housing with:

• A battery pack,
• Programming unit / CPU
• Sensors (i.e. switches, accelerometers and gyroscopes)

The device is programmed to consider the wearer’s natural walking pattern and understands when it needs to stimulate the muscle group required for walking, which is usually just after the foot leaves the ground (toe off) until the heel hits the ground (heel strike or initial contact).

How it works

Functional Electrical Stimulation FES device demonstration VIDEO

Once an FES device is calibrated to a person, it can sense where the body of the user is in space via different measuring tools, and when required, it will engage a low-level stimulation at an appropriate time on conductive pads that cause a muscle contraction that will initiate movement.

The stimulation could be described as a localised mild buzzing sensation and is experienced in one area, it is not a systemic kind of electrocution. As such, most patients are comfortable wearing an FES and become used to walking with FES assistance.

For example, enabling a patient to lift their ankle to avoid catching their foot while walking.

Outcomes



Electrical Orthoses can be beneficial and enable safer walking, better rehabilitation, long-term muscle maintenance, better bone health and potential neuro-plasticity in a patient as they rehabilitate.

Orthotists are now helping patients regain movements they weren't able to do voluntarily without the use of this technology.

Accessing Equipment in Australia

At times, there is equipment that is available that has not passed quality-control measures, which is potentially unsafe.

Consumers should consider products that are approved by the Therapeutic Goods Administration, Department of Health, Australia.

It is important to be guided by the relevant medical professional to access equipment. This article was contributed to by Orthotics Plus Melbourne, who are happy to answer any follow-up questions from the community.

Funding schemes that may be applicable are the NDIS, homecare packages, private health insurers and more.