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Raatebooklet2003

CONFERENCE
PROGRAMME
Birmingham Botanical Gardens
Welcome and Introduction………………. 2 Plenary Sessions………………………… 3 Beginners Sessions……………………. 3 First Day Programme……………………. 4 Second Day Programme………………. 5 Abstracts for General Sessions………… 6 This is the third year for RAATE and, despite the rather late start in planning, we have an exciting programme again. There have been many conferences on assistive technology during this last year, but RAATE is the original and, we believe, still the best interdiscipli-nary conference for the whole spectrum of assistive technology. It has been good to see publication of some of the best papers from RAATE2001 appear at last in the special edition of Technology & Disability (Volume 14 no. 4, 2002). Three papers were eventually accepted from RAATE2002. The same offer is open again to presenters this year. If you think you have a presentation that can be turned into a paper for Technol-ogy & Disability we can guide it on its way (although it will still be subject to the normal peer review process, of course). This year has given rise to more important debates. The National Occupational Standards rumble on and are about to be tested in practice; Paul Richardson will be filling us in during Session S13. No one quite knows what the impact of “Agenda for Change” will be; Keith Ison will be presenting a view from a major London teaching hospital in Session S10. Statutory registration of clinical technologists grows closer and there is a renewed interest in conducting appropriate education and training for the field; we have arranged for a num-ber of course organisers to set out their approaches during the lunch-time sessions. User involvement remains a central concern to all our services; Keren Down of FAST and Julie Fernandez will be leading a discussion in Session S1, which also includes more news about the AT Forum – which can now boast government support for its federation of all UK organisations that are stakeholders in AT provision. Check the programme out and choose what to attend with care. Give yourself time for the exhibition and networking – coffee is available most of the time. Finally, please remember to complete your feedback form so that we can plan to meet your needs next year. If you need an attendance certificate, we can provide it at the registration desk on receipt of your completed feedback form. We wish you a most enjoyable and use-ful meeting. Alan Turner-Smith and the organising committee: Colin Clayton, Moira Mitchell, Donna Cowan and Gary Derwent RAATE 2003
Gill Grimshaw, Warwick University Two beginners sessions will cover basic information and are aimed at people with little or no ex-perience in that area. They are intended to allow people who work primarily in another area of EAT to broaden their knowledge. Jane Bache & Gary Derwent, Royal Hospital for Neuro-disability Beginners Guide to Environmental Control Alan Woodcock, Rehab Engineering, Kings College Hospital RAATE 2003
DAY ONE PROGRAMME—MONDAY 10th NOVEMBER
Plenary:
Welcome and Opening
S1 User and Specialist Services
S2 Wheelchair Service Issues
(a) Building a partnership with users—Keren (a) Whizz-Kidz / DoH Wheelchair Training Project: An Evaluation of the second ‘Keep (b) RCP-IPEM Working Party on Specialist Ser- on moving’ Scheme—Sarah Jefkins, Whizz- (b) Wheelchair Service Mapping Project—Aisling Devlin, emPOWER (c)Them and Us: The relationship between wheelchair services and speech Therapy—Dave Rogerson, Hull Royal Infirmary 12.45 -2pm Lunch, exhibition and lunchtime presentations
S3
(a) Courses for AT and rehabilitation engineering: UniS / Biomedical Engineering—David Ewans
& George Marinakis
(b) Courses for AT and rehabilitation engineering: CoRE Certificate—Douglas Cartwright
(c)SRS Lite—Jurek Sikorski, SRS Technology Ltd
S4 Beginners
S5 AT in the Home
S6 Prosthetics and Orthotics
Guide to Com-
(a) Upper Limb Orthoses for Patients with puter Access
Brachial Plexus Lesions—Krishna Patel, Sal- (b) Sound Advice on the Isle of (b) Clinical Gait Analysis in Rehabilitation— Royal Hospital for Wight—Joyce Love RNID (c)AT for Older Peoples Public (c)Audit or Risk Assessment of Non-Housing—Donna Cowan, approved Artificial Lower Limb Builds—Colin (d) Custom-made attachments for a commer-cial pilot: A case study—James Regan, Otto Bock and Dominic Feely, Sussex Rehab Centre S7 Beginners
S8 Biomechanics and Sys-
S9 Mobility
(a) Effect of Powered Mobility for Non-driving Environmental
Children—Sarah Vines, Kings College Hospi- (b) The SCAD Assistive Mobility System— (c)Measurement of Mobility in Wheelchair Users—Susan Wilson & Malcolm Granat, Hospital Profiling Bed Fea-tures—Helen Pain, DEAC, Southampton RAATE 2003
DAY TWO PROGRAMME—TUESDAY 11th NOVEMBER
Health Technology Assessment
Gill Grimshaw, Warwick University

S10 AT in Society
S11 AT Devices
(a) SARA stands for Self Assessment Rapid (a) Eye Blinks for Control (Case Study) - Neil Gregory et al, West Midlands Rehab Centre (b) Implementing Telecare—David Wardle and (b) Controlling a Computer with head Move-Dick Currie, FAST ment—so whats new? Mark Saville, ACE Ox- (c) Agenda for Change—Keith Ison, Guys and ford St Thomas’ Hospital (c) Novel Control for a Patient with Motor Neurone Disease—Neil Gregory et al, West Midlands Rehab Centre Lunch, Exhibition and Lunchtime Presentations
S12
(a) Courses for AT and rehabilitation engineering: MSc in Clinical Engineering—Len Nokes,
Cardiff
(b) Courses for AT and rehabilitation engineering:MSc in Assistive Technology—Ruth Mayago-
tia-Hill, CoRE, Kings College London
S13 Competencies for AT Specialists
S14 Are you sitting comfortably?
(a) Clinical Competency in Assessing for EC (a) Guidelines for Wheelchair Stability—Alan and AAC—Neil Gregory et al, West Midlands (b) Wheelchair Tilt Safety Alarm System— (b) National Occupational Standards, Into prac- Hamed Ezzatizadeh et al, University of Surrey tice—Paul Richardson, Kings College Hospital (c) A Potty Seat for Children with Brittle Bone S16 Update on Standards and a chance to tell (a) Case Studies of EAT on a Ventilator Unit— (a) Update on Wheelchair and seating stan- (b) Case Study—provision of an integrated sys- dards—Alan Lynch, Chairman ISO Committee (b) What do you want from MHRA? Interactive A New Concept in Robotic Assistance : The User View—Clive Thursfield, ACT, west Mid-lands Rehab Centre RAATE 2003
Session 1: User and Specialist Services
Building a partnership with users
RCP-IPEM Working Party on
Specialist Services
The principle of the ICES initiative (Integrating There is no abstract for this sessions as it will be Community Equipment Services) is to create a ra- interactive and encourage participation from the tional relationship between social services and audience in exploring issues regarding the relation- healthcare in the supply of assistive technology. ships between service users and service providers. This principle, and the energy and vision with which the initiative is being pursued are commend- able. However questions remain about how clients with more specialised needs are best supported within this new framework. A hub and spoke model has been proposed, but interpreted in different This session will provide an update on the pro- ways according to the perspective of the interested gress and goals of the AT Forum and will allow an parties. Simply categorising equipment into, for ex- opportunity for discussion of the issues involved. ample basic technology, complex technology, and bespoke technology does not help a Service meet complex needs. The Institute for Physics and Engineering in Medi-cine (IPEM) is the professional body principally re-sponsible for the clinical engineers and technolo-gists in rehabilitation engineering. The Royal Col-lege of Physicians and IPEM have set up a work-ing party on specialist equipment services for inde-pendent living to examine these matters and rec-ommend suitable models for provision. This presentation will present some of the issues in the provision of assistive technology, report on some of the findings of the working party, and seek the views of the audience. Dr Alan Turner-Smith Centre of Rehabilitation Engineering King's College Hospital London RAATE 2003
Monday, 11.15am to 12.45pm
RAATE 2003
Session 2: Wheelchair Service Issues
Whizz-Kidz / Department of Health Wheelchair
Wheelchair Service Mapping Project
Training Project : An evaluation of the second
Keep on Moving scheme
The Wheelchair Service Mapping Project was launched in July 2002 and scheduled for comple- In 2001 national children’s charity, Whizz-Kidz, tion in July 2004. The project is funded by a Sec- was awarded a three year Department of Health tion 64 Grant from the Department of Health and is Section 64 grant to develop a national, standard- managed by emPOWER. emPOWER is the chari- ised wheelchair training programme. Since June ties consortium of Users of Prosthetics, Orthotics, 2002 four pilot wheelchair training schemes, Wheelchairs and Electronic Assistive Technology named Keep on Moving, have been run. The main and campaigns for a “national look” based on indi- aims of the training scheme are to help disabled 2.Develop confidence to use their wheel chairs in a 1. Gather evidence about the NHS Wheelchair 3. Increase their social interactions and autonomy. 2. Identify Best Practice within the Wheelchair These main aims were derived as a result of previ- ous research that has shown disabled children and young people are less likely to have active social The project pictures eligibility criteria, referral, as- lives, nor take part in out of school activities, clubs sessment and service user involvement throughout or sports, and are more likely to stay within the England. A Steering Group composed of profes- home environment (Hirst & Baldwin, 1994). The sionals and wheelchair users from various areas paper will give an overview of the London scheme involved with the NHS Wheelchair Service is moni- run in April and May 2003 (the second pilot). It will examine how the project was set up with local part- ners, and cover issues relating to participant re- The project is working alongside other initiatives cruitment and the involvement of experienced adult that the Government is funding with the Modernisa- wheelchair users. It will also present the findings of tion Agency. There is regular flow of information the evaluation of the scheme. The scheme was between emPOWER's project and collaborative evaluated in the main by questionnaires to partici- work that is already being conducted by the Mod- pants, their parents and volunteer helpers. Specific ernisation Agency, also aimed at spreading best wheelchair skill improvement was measured by analysing video recordings of participants at the beginning and end of the scheme. Participatory A Questionnaire was mailed to all NHS Wheelchair techniques were also employed to ensure all par- Services in England at the end of February, ticipants were included in the evaluation. responses to which are intended to paint as clear a picture as possible of the current service, identify Conclusion: Overall, the evaluation results have
good practice and areas that need improvement as been extremely positive, especially those based on well as any work that is needed to clarify existing self-assessment. All parents felt that their child’s wheelchair skills and confidence had improved. One parent explained “she’s quicker in her chair Aisling Devlin
and learnt that a wheelchair can do more for her in Wheelchair Service Mapping Project Manager her life.”. Pre and post scheme comparisons also show that participants’ perceive that their skills and confidence have improved. The paper will end by examining the main learning outcomes and looking
at how Keep on Moving can be sustained.
References: Hirst M & Baldwin S (1994). Unequal
opportunities, growing up disabled. London:
HMSO.
Sarah Jefkins, Project Manager
Whizz-Kidz, 1 Warwick Row, London SW1E 5ER
RAATE 2003
Monday, 11.15am to 12.45pm
Them and Us: The relationship between Wheel-
chair services and Speech Therapy

I have worked as an RE in the local Wheelchair
Service for 11 years before escaping to now cover
Technical Aids which includes support for Speech
Therapy, Environmental Controls and computer
access.
I propose to contrast the past “them and us” atti-
tude between these service with the present pa-
tient centred co-operation.
The Past: Wheelchair Service staff found mount-
ing blocks attached chairs on change over, or in
the way of repairs to brakes etc. Speech Therapy
staff found that chairs changed without warning,
sometimes losing mounting blocks or no longer be-
ing able to mount equipment. Both sides worried
about stability and transport issues.
Now: Most of the time we discuss changes of
wheelchairs and how the transfer of brackets will
take place. Most of the time we let each other
know what is to be fitted to who’s equipment and
when. We have a few integrated access systems,
but the process is not easy. Joint assessments are
arranged for complex cases. We worry about sta-
bility and transport issues together.
The Future: We are making efforts to change the
“most of the time” into “all of the time” but avoiding
the excessive use of forms and yet more paper.
We would like to make the integrated systems
more common and less painful. We would like to
worry less about stability and transport issues.
David Rogerson I Eng, IIPEM
Rehabilitation Engineer
Tulley Medical Physics Building
Hull Royal Infirmary
Anlaby Road
Hull
HU3 2JZ
tel 01482 675928
David.Rogerson@hey.nhs.uk
RAATE 2003
Session 3: Lunchtime Presentations
Courses for AT and Rehabilitation Engineering
CoRE Certificate in
University of Surrey / Biomedical Engineering
Rehabilitation Engineering
The King’s College Undergraduate Certificate in The University of Surrey MSc in Biomedical Engi- Rehabilitation Engineering is an in-service qualifi- neering was founded in 1964, and is fully accred- cation for rehabilitation engineers that provides a ited by the Institute of Physics and Engineering in suitable educational programme for the Institute of Medicine for its National Health Service clinical en- Physics and Engineering in Medicine (IPEM) Clini- cal Technologist Training Scheme. Subject areas The Masters Course is offered on a full time or part covered by the course include professional engi- time basis. It is divided into 3 main components; neering, functional anatomy and physiology, reha- the core modules covered in the autumn semester, bilitation engineering in the NHS, posture and mo- the specialist modules covered in the spring se- bility and electronic assistive technology. The core modules cover fundamental material in Most of the teaching on the intensive residential anatomy and physiology, instrumentation, fluids, modules is by leading practitioners and experts in biomechanics, biomaterials, statistics and research the various sub-disciplines, and this together with techniques. The specialist modules cover applied the small class sizes helps to promote a very lively topics in safety, physiological measurement, bio- materials, microengineering, orthopaedic biome- chanics, gait analysis and human movement, and The course comprises three one-week residential rehabilitation engineering. Assistive technology units, a one-week clinical placement, and a signifi- topics, such as functional electrical stimulation, cant distance learning element which includes a prosthetics, orthotics, wheelchairs and seating, are workplace project, library assignment and work- covered during the rehabilitation engineering two- sheets. Distance learning elements complement in- week intensive module. The taught element of the service training and work commitments, and are course gives approximately 400 hours direct teach- designed to encourage students to explore the ing time. Project work begins towards the end of subject beyond their immediate job role and organ- the autumn semester, and there is an extensive, isational structure. The distance learning assign- full time period, following the main examinations ments are assessed and there is also a final ex- The course is run annually and may be completed The MSc course is organised and directed by the in one year, or over a two-year period if the clinical Centre for Biomedical Engineering, and sup-
placement and workplace project are deferred to ported by staff throughout the University, in particu- lar the School of Engineering and the European Institute of Health and Medical Sciences. The Centre was one of the first in Britain to offer ad- vanced level education in Biomedical Engineering. Our activities remain focused on postgraduate re- search and teaching involving over 30 people. The
main research activities of the Centre for Biomedi-
cal Engineering can be divided into 5 areas: Hu-
man Movement and Gait Analysis, Functional Elec-
trical Stimulation, Microengineering, Osseointegra-
tion, Blood Flow and Vascular Grafts. Most MSc
projects therefore follow the activities in these ar-
eas, with a number being directly related to work in
our Clinical Biomedical Engineering Centre at
Queen Mary’s Hospital, Roehampton.
For further information, please contact:
Dr David Ewins, Centre for Biomedical Engineer-
ing, Duke of Kent Building, University of Surrey,
Guildford, Surrey GU2 7TE
Tel 01483 689670, fax 01483 689395, URL www.
bmesurrey.org, email d.ewins@surrey.ac.uk
RAATE 2003
Monday, 12.45pm to 2.00pm
The SRS Lite
SRS has a record of introducing new products de-veloped in response to what customers have asked for. In 2003 so far SRS has introduced a mobile telephone through collaboration with Mo-torola and a range of intercoms in collaboration with Videx. Customers also asked SRS to develop a remote controller with fewer functions than the SRS 100 that is easy to use, simple to install and above all is inexpensive. Having spoken to many of its custom-ers SRS designed a totally new personal environ-mental controller' that meets these requirements and is, in its own right, an attractive product. The product is the SRS Lite a compact, lightweight and stylish device that provides remote control of a wide range of home appliances including lights, doors, TV, video, curtains, and telephone. The SRS Lite is programmable up to 65 functions and 25 telephone numbers. It communicates by IR and radio (433 MHz) so there is no need to add devices to extend capability as with other controllers and unlike other controllers it has a built in social alarm trigger (1 73MHz) that allows users to call for help. The SRS Lite has direct selection of functions as well as single or dual switch scanning access unlike many controllers that only provide scanning access. It also has voice announcement through a built in speaker alternatively it can be used with an earpiece. SRS Lite is due to go on sale from the autumn of 2003. Jurek Sikorski SRS RAATE 2003
Session 5: AT in the Home
EAT at Home: a simple recipe?
Sound advice on the Isle of Wight
The Sound Advice Project has been running on the Current practice for Electronic Assistive Technol- Isle of Wight for 12 years as a Royal National Insti- ogy (EAT) implementation in relation to home sys- tute for Deaf People service, working closely with tems, tends to be patchy and a fairly hit and miss affair often due to lack of a co-ordinated structure. There are no standard specifications from which Its aim is to provide information and demonstra- designers can draw inspiration and specifier’s can tions of Environmental Equipment for deaf and specify accurately to ensure end users have their hard of hearing people of whom we estimate there needs accurately met. As a consequence, home are around 20,000 on the Island. Professionals installations of networked systems to support peo- make the assessment for service but trained volun- ple fail on a number of levels, through not being dependable, not being generalisable and often in- accurately specified/installed. Currently there is Many people with hearing problems find areas of little dissemination of systems that have been daily living extremely difficult. Problems can arise proved to work that can be adapted to specific us- in family situations when one member starts to lose ers or used as template systems. This paper at- hearing and equipment can help with things like tempts to resolve some of these omissions by de- scribing the work undertaken on a project (DIRC: www.dirc.org.uk and www.smartthinking.ukideas.
Clients can be assessed at home or at the Sound com) in designing appropriate, dependable EAT for Advice office. The project has been very success- residents with autistic behaviours. In many ways ful and has now seen over 4000 clients, many of this is one of the most difficult groups of people to whom come back time and time again for help and design for as individual communication patterns are limited. Therefore the designers must rely on a number of tools to achieve a satisfactory and accu- A Lottery Award in 1999 enabled the scope of the rate design specification. Moreover, the design of socio-technical systems for people with autism and behaviour that challenges others is required to be 1. Basic hearing aid maintenance – espe- consistent and meet the needs of current and fu- ture residents. The technology provided must be 2. Support for new hearing aid wearers by an quiet, seamless, futureproofed and effective to support both residents and carers. We try to show 3. Basic communication skills training for that simple design criteria can be used to enable and empower carers as well as residents within 4. Provision of portable loop systems to en- community living accommodations and we intend able hard of hearing people to take a full to demonstrate that good building design can be complimented by good technology design to assist residents and/or carers. The two aspects are inte- A second lottery award was received in 2003 to grally entwined and are required to co-exist. This continue the work and add the following tasks: means that architects, social care workers, design- ers, installers of technology and housing providers 1. Identify the ethnic community on the Island all have important parts to play in the design proc- ess and no part can be excluded if successful de- signs are to be ensured. We therefore advocate a 2. Work with young people to help prevent We also introduce the notion of ensuring a depend- 3. Establish a network of local call in centres able network and the notion of dependability into socio-technical systems design. In this, our inten- tion is to adapt classical computer science notions of dependability criteria to the socio-technical appli- The lottery funding has enhanced the service pro- cations inherent in domestic settings. We con- vided to Island inhabitants and we consider it is a clude that a readaption of classical dependability model that could be tried elsewhere. The service is theory can be applicable, useful and usable within currently the only one of its kind in the UK. The work the volunteers do cannot be overstated. The project could not run without them. There are RAATE 2003
Monday, 2.00pm to 3.45pm
around 35 working volunteers who undertake such tasks as: Equipment fitting in clients’ homes e.g. TV listen-ers, doorbells, phones etc. Supporting elderly and vulnerable people in the use of equipment Support for new hearing aid wearers Office support Attending meetings Hearing aid maintenance Manning exhibition stands This year a successful bid was made to take over the Social Services contract to assess and supply equipment We are a recognised provider under the ‘Supporting People’ scheme, which came into force in April 2003 (possibly the only one in the UK pro-viding hearing aid support). Joyce Love Project Manager AT for Older Peoples Public Housing
Abstract not available at time of going to print. RAATE 2003
Session 6: Prosthetics and Orthotics
Design of upper limb orthosis for patients with
Clinical Gait Analysis in Rehabilitation
brachial plexus lesions
K. Patel, S. Rithalia, L. Kenney & G. Heath Introduction: Crystal Palace Rehabilitation
This abstract describes work at the University of Centre is one of the few clinical facilities which Salford addressing the limitations with current or- routinely use Clinical Gait Analysis as part of the thotic approaches for patients with brachial plexus Rehabilitation Management of their Patients. lesions. Upper limb orthoses are used by this pa- Since the gait facility was opened in 1997 some tient group to assist or supplement lost upper limb 5378 sets of clinical measurements have been conducted on various groups of patients. Anecdotal evidence suggests that patients are dis- Objectives: This work is an ongoing study to
satisfied with the amount of functional gain pro- build up a major data base of hard scientific meas- vided by current BPL orthoses and therefore this urements of the performance of patients with vari- study aims to review these design limitations. The ous locomotor dysfunction such that histories of work began with a literature review focussing on performance can be immediately interrogated to the nature and extent of the problems with present compare and contrast with subsequent outcomes. day orthoses. This has been followed by a design This enables the Clinicians to assess the effective- review, based on the use of an approach known as ness of the current management of their patients. the House of Quality model. The House of Quality is a Quality Function Deployment tool, used by de- Techniques: The Gait Laboratory is housed in
signers to prioritise user needs and to convert the Physiotherapy Gym at crystal palace and con- them into engineering deliverables. In our case, sists of a Bertec embedded force plate with Aver- these engineering deliverables will be technical pro+5.17 Visual vector overlay and Pro-Vec5_0 features an improved orthosis should possess in software, Panasonic split screen Video recorder order to meet the user needs. This approach has together with Two Camera Mac Reflex Qualisys already been applied successfully to the design of Kinematics system. Rigorous protocols are always other rehabilitation aids, including a powered pros- adhered to so that comparisons between different runs and indeed different patients can be achieved, taking into account the individual capabilities of The input to the House of Quality model has been gathered through 2 postal questionnaire surveys, amongst patients using BPL orthoses and their cli- Measurements: Clinical measurements have
nicians, throughout the UK. This work will form a been recorded to date on patients ranging in age basis for the development of a design specification from 3.4 to 97 years. These are full data measure- for an improved upper limb orthoses for brachial ments (OV4) enabling subsequent interrogation and analysis to be conducted. In addition Scroll Vector Overlays (SVO) have also been recorded to enable Clinicians to visualise the ground reaction vectors on the video recording and these will be Results: Outcome measures indicate that virtu-
ally all the patients have benefited from the analy- ses. Indeed I would assert that for the more com- plex cases with multiple deficiencies or several concurrent disabilities, clinical gait analyses are the only ways of optimising their management. Conclusions: Several studies will be presented
to illustrate the benefits of Clinical gait analysis re-
sulting in immediate corrective action for cost ef-
fective management.
Dr Denis R W May, Clinical Scientist,
Crystal Palace Rehabilitation Centre.
King’s College Hospital NHS Trust
Medical Services Care Group
Rehabilitation Centre Bowley Close
Farquhar Road London SE19 1SZ
RAATE 2003
Monday, 2.00pm to 3.45pm
Audit of Risk Assessment Of Non-Approved
The development of custom made attachments
Artificial Lower Limb Builds
for a commercial pilot—a case study.
C. Dance, R. Batchelor, D. Feely, T. Pond, D. May, In May ’99, a 31 year old male pilot transferred to Introduction: The “Inter-Regional Prosthetic Audit the Sussex Rehabilitation Centre. He had suffered Group” is the joint initiative of 8 Limb Fitting Cen- traumatic loss of his left arm, at upper third transra- tres around London (Luton & Dunstable, Stanmore, dial level, in an air accident in Australia during Harold Wood, Charing Cross, Roehampton, Crys- 1989. He moved to the UK and secured employ- tal Palace, Gillingham and Brighton). The 8 centres ment piloting a Dash 8, carrying up to 50 passen- meet 4 times a year to agree new audit projects gers on short haul routes. Initially, he required an and review the results of those in progress. These attachment for his prosthesis that would enable are multi-professional meetings involving all staff. him to ‘co-pilot’ the aircraft with Civil Aviation Au- In June 2002 it was agreed to audit whether Risk thority approval. Subsequently, two more custom- made attachments were developed to enable him to ‘captain’ the plane. Their development is de- scribed. The three devices are demonstrated on Method: A designated auditor at each of the 8 cen- tres was tasked with auditing 60 medical files. New lower limb prescriptions prescribed between June Hook Fitting: To operate the “co-pilot’s” throttle lev- 1998 and October 2002 were checked and if a non-approved limb build had been issued, the presence or absence of a risk assessment was re- Clamp fitting: To grip the “captain’s” control yoke to corded. The quality of the risk assessment was not Steering Tiller Fitting: To steer the aircraft on the Results: Seven Centres finally participated in the audit. A total number of 474 risk assessments had been raised in the 4 ½ year period. 15% of the is- The user is believed to be the only commercial pi- sued new limbs during the period were non- lot with an upper limb deficiency in the UK. approved builds. 30% of the non-approved builds Throughout, there was close liaison between the had not had a risk assessment carried out. Of the CAA, the pilot and his employer and the rehabilita- 422 approved builds originally prescribed, 23 were tion centre. Each device was proof tested to check subsequently changed to non-approved and of it could sustain the loads to be exerted. The CAA these, only 30% had a filed risk assessment. assessed their use in a simulator then in flight tri- als. Inspection and servicing procedures were Conclusions: Audit findings indicated a wide varia- agreed to ensure the devices remained service- tion of compliance with the Medical Device Regula- able. Documentation was generated to meet the tions. P&T companies should be encouraged to requirements of the CAA and Medical Devices Di- share risk assessment information between cen- rective. This included risk assessments, handover tres. Other interesting data was noted: a significant number of patients had not been weighed, there was a significant variation between centres in the proportion of non-approved builds prescribed and there is undoubtedly room for improvement in terms of traceability of componentry. The changed requirements of the NHS Controls Assurance Stan- dards with respect to Risk Management indicate that further audit in this area will be advisable. Kings College Hospital NHS Trust Rehabilitation Centre Bowley Close London, SE19 1SZ Email: colin.dance@redmc.freeserve.co.uk Fax No: 020 7346 5276 Tel No: 020 7346 5275 RAATE 2003
Session 8: Biomechanics and Systems
Biomechanics of Stair Climbing
they may be reducing the impact while descending C. Galvan-Duque, R. Mayagoitia and F Wakil to avoid pain. The area under the lateral curve may be increased with age or after head injury, reflect- INTRODUCTION. Stair climbing is an essential ac-
ing an increase in the balancing effort. Cycle time tivity of daily living. It requires a fair amount of duration in combination of the vertical acceleration muscle force and coordination to accomplish can be used as a tool for balance control assess- safely. It is often associated with falls in the elderly ment for population with a psychomotor disability but it also has cardiovascular benefits. Assessing or elderly people. Asymmetry in left and right ca- performance during this task has proved particu- dence will be present after stroke. Further perform- larly difficult since the usual biomechanical assess- ance parameters such as trunk inclination can be ment tools of camera systems and force platforms tested in future studies. A deeper inclination will cannot be adapted easily to use in and around help to reduce the lever arm length between the flights of stairs. Therefore a system based on centre of mass and the front foot increasing the body-worn sensors has been developed and tested mechanical advantage the same muscle contrac- tion can generate to help lift a person in stair as- cent. A backwards inclination can also be used to METHODS. A commercial sensor combining accel-
increase the length of the resistance arm to aid in erometers and gyroscopes oriented in all three or- lowering against gravity in descent. This is a strat- thogonal directions was placed at the small of the egy often seen in older people. The system is port- back (Xsens MT9, Xsens Technologies B.V.). This able, easy to use, low cost and the results are easy place is approximately level with the centre of to interpret. It allows an assessment of stair climb- mass of the body when standing and was chosen to represent the overall movement of the person. Ten young healthy subjects were tested ascending REFERENCES. McFadyen B, Winter DA. An Inte-
and descending a flight of 13 steps. Only the mid- grated Biomechanical Analysis of Normal Stair As- dle eight steps were used in the analysis. The data cent and Descent, Journal of Biomechanics, from the accelerometers was corrected for the ac- celeration of gravity due to the sensor’s varying in- clination. From the vertical accelerometer signal Mayagoitia RE, Waarsing JH, Sánchez-Pineda A, peak to peak amplitudes were obtained as they are Veltink PH. Walking Balance Study Using a Triaxial associated with joint loading. From the lateral ac- Accelerometer, Measuring Behaviour’98, Gronin- celerometer signals the area under the curve was obtained as it is associated with balancing effort. In the anterior-posterior direction the cycle time dura- tion was obtained as timing differences between left and right legs as well as between ascent and RESULTS. Clear landmarks related to specific
events during stair climbing were found in the sig-
nals, allowing a division of the task into stages. A
new biomechanical model of the task was created.
Descending heel strike peak accelerations were
significantly larger than ascending ones. This was
expected as the acceleration of gravity is added to
that due to movement while descending. The area
under the medial-lateral curve while descending
was significantly larger than while ascending. This
was expected as there is more risk of falling during
descent and therefore more balancing movements
are made. The cycle time duration going down was
significantly shorter than while going up. This was
expected as more momentum must be generated
to ascend.
DISCUSSION. Some examples of the diagnostic
value of the performance parameters follow. The
differences in peak vertical loading while ascend-
ing and descending may be of special interest
when assessing people with lower limb arthritis as
RAATE 2003
Monday, 4.15pm to 5.45pm
I-Match: A software based system to allow
The use and oversight of hospital profiling bed
matching of an optimum interface to a User of
features
Assistive Technology.
Profiling bed frames reduce manual handling and Many people with disabilities rely upon assistive may assist skin pressure care. Many hospitals buy technology for independence. In many cases, the or lease these beds in large numbers, but little is potential of a particular piece of technology is re- known about how the beds are selected or their stricted by the difficulties of user operation. i.e. the impairments which lead to the recommendation of a device prevent its very operation because of the Eleven NHS Trusts, selected to represent different difficulties of interfacing with the user. I-Match is a types and sizes of NHS Trust geographically 3 year EU FP5 project which concentrates on the spread across the UK, were visited as part of a development of techniques to optimise the selec- study funded by the Medicines and Healthcare tion of an interface for a user by measuring both products Regulatory Agency, an executive agency the functional characteristics of the device (e.g. of the Department of Health. At each Trust, semi- joystick, switch, mouse etc) and the upper limb structured interviews were conducted with one or skills of the user. The project includes consultation more staff that had been involved with the procure- with users and providers to understand their suc- ment, management or use of profiling beds. The cess with assistive technologies and their unmet interview schedule included reflection on the profil- demands. A key activity is to define and measure ing bed features identified as important at the time physical and functional characteristics of available of acquisition, and an evaluation of the utility and interfaces; the resulting data is put into a publicly usage of these features in practice. A ward with available database for use by providers and users. profiling beds was then visited, and staff asked for A second activity is to measure the hand and arm skills of users. This involves development of simu- lations of devices to be controlled (e.g. powered Many Trusts reported that despite their careful wheelchairs, rehabilitation robots, computers). It market research either a feature had been omitted will be possible to operate this system with any that consequent experience showed to be valu- type of interface (including a haptic device). Using able, for example auto-regression, or a stipulated a set of exercises and tests, it allows quantification feature proved to be little needed on the wards. of the abilities of users and, therefore, choice of the Some key features seemed to be little used by staff optimum interface. The use of a haptic interface even after training, such as the knee break. with the system allows the identification of user skills in response to more sophisticated force feed- The data showed that to establish accurate re- quirements, field trials in relevant settings are im- portant; to equip staff to fully utilize the bed fea- tures, training is vital; and to ensure staff incorpo- rate the beds' advantages into their daily practice, RAATE 2003
Session 9: Mobility Monday, 4.15pm to 5.45pm
The SCAD Assistive Mobility System.
Measurement of Mobility in Wheelchair Users
The SCAD system is being used in special schools Mobility levels following a spinal cord injury are and rehab centres around the country and was first greatly reduced and a wheelchair is often used for created in 1996. The presentation will chart the mobility. Additionally, the SCI (spinal cord injured) development of the SCAD and how it has been ap- person may be uprightly mobile although still use plied to a variety of powered wheelchairs. The their wheelchair as a faster and more convenient conditions in which the system is expected to oper- ate will be discussed highlighting some of the prac- tical issues with this compact robust system and There are no standard evaluation tools to measure suitability for its operating environment. the mobility levels in the SCI population because of the variety of modes of mobility. The activPAL™ The level of automated guidance and the appropri- (PAL Technologies Ltd) is a small lightweight activ- ate support to assist the learner has been reflected ity monitor that has been validated for quantifying in the design of the system. The talk will highlight upright activities. It measures the frequency, inten- some of the continuing issues concerning the bal- sity and duration of the sitting, standing and step- ance between assertive control and subtle assis- tance and the possible side effect’s on child devel- The aim of this study was to demonstrate that by using a wheelchair sensor in addition to the ac- The development of the system has evolved to in- tivPAL™ the free-living activity of both wheelchair clude proportional joystick control function The dependent and partial walking SCI patients could system is currently being trailed with an older population who may not require the system as a learning tool, instead a supportive and labour sav- Free-living activity was monitored in 18 SCI sub- jects who used a variety of mobility methods. Ac- tivity levels were recorded for wheelchair depend- ent patients, both manual and powered, patients Some of the later systems are providing opportuni- who used both a wheelchair and upright locomo- ties for the driver to select assistive driver support. tion for mobility, and a patient who was mobile The driver does not have to feel that the system has been imposed on them for reasons low driving competence, however they have the choice of sys- We found a significant difference in the total activ- tem engagement for their own energy conserva- ity levels in partial walkers between the daytime and evening. It was also found that moving in a wheelchair, standing and stepping were all signifi- Other related issues including considering the con- straints imposed by the system on driver explora- tion and the balance between the barrier margins We describe a powerful new technique for deter- mining the total free-living mobility of the spinal cord injured patient, be they wheelchair dependent, partial walker or independent of wheelchair use. Glasgow G4 0NW m.h.granat@strath.ac.uk t: 0141 548 3032 f: 0141 552 6098 Effect of powered mobility for
non-driving children
Abstract not available at time of going to print RAATE 2003
Session 10: AT in Society Tuesday, 10.45am to 12.00noon
SARA stands for
Agenda for Change
Self-Assessment-Rapid-Access.
The modernisation agenda in the NHS, driven by A Department of Health Project, funded under the changing patient demands, developing technology ICES programme, to set up and evaluate the use and shortages of skilled staff, requires a rethink of of an IT based self assessment for the provision traditional demarcations and roles. As part of this and purchase or loan of basic equipment to help drive, the NHS is in the process of implementing a older and disabled people remain more independ- new system for setting the terms and conditions of its employees - Agenda for Change. As the title implies, the new system comes with the intention of simplifying current arrangements and making flexible working and new roles easier to introduce. · to evaluate the use of an IT based self as- It also integrates the idea of structured career and sessment made available in retail stores personal development, through the Knowledge and Skills Framework. Details of the new system are · to evaluate if people would purchase the available on the Department of Health website (http://www.doh.gov.uk/agendaforchange). · to signpost people to more specialist retail- Agenda for Change is being introduced by 12 Early ers including mail order where appropriate Implementer sites. This talk will describe briefly · to signpost people to their local Commu- how far implementation has progressed at the larg- nity Equipment Store where they might be est acute hospital Trust, and will identify issues that need to be considered by other engineering and physics groups thinking about how to intro- The pilot is expected to take place in four sites: · In Derbyshire there are discussions to see if the self assessment system can be used to link the rural library service and possibly a library building based service with ac-cess to equipment. · In the other three areas, Gateshead, Man- chester and Sandwell, the Community Equipment Service will have PC terminals but there may also be retailers in the area who will provide terminals, and stock equipment for sale. There are a number of high street retailers who have expressed an interest in developing the ser-vice for the pilot and contact is also being made with mail order providers. The IT self assessment software, will be accessed by touch screen, user friendly and disabled person’s accessible, kiosks. It is intended that the pilot will begin to operate in September 2003, actively running for three months. Following evaluation using both collected hard data and user satisfaction surveys, an evalua-tion report will be produced for the Department of Health by March 2004. Ian Salt Director ICES Room 261 Gateway House Implementing Telecare
Abstract not available at time of going to print RAATE 2003
Session 11: AT Devices
Case Study in Eye Blinks for Control
Controlling a computer with head movement –
N. Gregory, C. Thursfield, O. Gorodnichy so what’s new?
This is a case study of a man, Ron, who had a brain-stem stroke and is limited to only being able For decades it has been possible to use head to eye blink. Various technologies have failed in the past to help Ron communicate using a high- ‘headpointers’ to control computers and some tech method. Recent advances in facial recognition communication aids, but now there’s now a real and the feasibility of using a non-expensive web- choice in the headpointer market as new technolo- cam to capture images has led to the development gies like webcam-based software challenge the of software that can enable Ron to access AAC reliability of long-established headset-based regu- lars. This presentation gives an overview of the technology behind a number of different systems We have tried eye blink systems and EMG sys- such as the HeadMaster, SmartNav and Camera- tems without success. This led us to use the vi- Mouse in an attempt to inform the AT user and pro- sion-based perceptual technology developed at fessional of the capabilities and pitfalls of each par- NRC-CNRC, which is claimed to have the most re- liable eye blink detector to date. This detector rec- ognises Ron’s eye blinks using an off-the-shelf The presentation will look at the tilt-switch, infra- webcam in front of Ron’s face. This makes it possi- red, ultrasonic, gyroscopic and webcam technolo- ble for Ron to send commands to a computer by gies that are behind the current crop of products. It will also touch on the software features required for effective mouse-clicking with headpointer control – In this case study, we detail Ron’s case giving an ie cursor speed control, jitter control and dwell- up-to-date picture of the technological develop- ments and the plans for implementation of the Neil GREGORY – Clinical Engineer, ACT Dr. Clive THURSFIELD – Consultant Clinical Sci- Dr. Dmitry O. GORODNICHY - Computational OX3 7DR Tel: 01865 759800 Email: saville@ace-centre.org.uk RAATE 2003
Tuesday, 10.45am to 12.00noon
Case Study: Novel Control for Patient with Mo-
tor Neurone Disease
This is a case study of a 19-year-old ventilated lady with Motor Neurone Disease. She now has very little physical movement, except some lip movement, eye movement and jaw clenching. ACT’s intervention was to enable this lady to ac-cess the Internet, email, face-to-face communica-tion and Environmental Control. The control was achieved by using an EMG switch connected to special software developed at ACT to control The Grid software. She is presently an accomplished user of the whole system. Her head positioning was and continues to be very difficult to accomplish and the challenges are de-scribed here. Neil GREGORY – Clinical Engineer, ACT Dr. Clive THURSFIELD – Consultant Clinical Sci-entist (Head of Service), ACT RAATE 2003
Session 12: Lunchtime Presentations — Tuesday, 12.00pm to 1.30pm
MSc Clinical Engineering - Cardiff School of
MSc in Assistive Technology
Engineering
Assistive technology (AT) is a system or piece of The MSc in Clinical Engineering is a joint venture equipment that addresses the gap between an in- between Cardiff University (CU) and the University dividual’s functional ability and the load imposed by his or her environment. The increasing demand for AT brings with it an expectation on the part of the It originated from a proposed MSc in Rehabilitation AT user that the professionals who supply or ad- Engineering but as it covered subjects relevant to vise them will be well informed, competent and Clinical Engineering, it was decided to broaden the have a clear understanding of all their different scope of the scheme and make it a postgraduate degree in Clinical Engineering. With accreditation from the Institute of Physics and Engineering in The need for an MSc in Assistive Technology has Medicine (IPEM), the course has been very suc- cessful in attracting candidates from various disci- plines within the Health Care Sector from the UK • The continuing growth of demand in the field of • The increasing sophistication of AT equipment The course, which has just seen its 3rd cohort of students successfully graduate, is run on a part- • The occupational standards now being intro- time basis involving a total of eight contact week- ends spread over an eighteen month period. Suc- • The repeated call for an integrated (multi/inter cessful completion of this Part I stage enables the disciplinary approach) to the provision of AT for student to enter a six-month project stage which is completed by the submission of a dissertation of In recognition of this need the EPSRC awarded the Centre of Rehabilitation Engineering a four-year The modular structure of the scheme enables a grant in 2000 to set up and deliver a masters pro- degree of flexibility of study. For example it is pos- gramme in assistive technology that is both aca- sible to undertake the entire degree scheme or se- demic and vocational in nature. Therefore, we are lect individual modules on a stand alone basis for committed to developing competent AT profession- Continuing Professional Development purposes. als who are equipped with the personal skills re- quired to be self-directed, autonomous learners The course is open to those individuals working in and the professional skills required to take a user- the Health Care sector. These include candidates centred, multidisciplinary approach to AT design, pursuing chartered status, Grade A trainees and healthcare professionals, with a general interest in CPD, who wish to broaden their knowledge of The masters programme aims to produce AT spe- Clinical Engineering. The course is open to non- graduates over 25 with relevant experience and opens up the prospect of postgraduate study for · Able to understand the potential and possibili- mature clinical engineers who otherwise may not have had the opportunity to obtain a postgraduate · Able to develop and apply assistive technolo- gies with an understanding of the needs and · Able to understand the competence, language and values of others in the rehabilitation team and become effective members of multidiscipli-nary groups · Able to apply research evidence to profes- This programme is for those who have a back-ground in the fields of physical science, engineer-ing, medicine, social work, therapy or education and wish to gain a qualification to practice as an AT specialist. Graduates with degrees but no rele-vant work experience in the field study alongside RAATE 2003
Session 13: Competencies for AT Specialists Tuesday, 1.30pm to 3.00pm
students who have diplomas or certificates and Clinical Competency in Assessing
relevant work experience. For the part time pro- for EC and AAC
gramme, students complete the MSc in two years, N. Gregory, P. Palmer, C. Thursfield being taught along side the full time students. All students also do three one-week placements each Access to Communication and Technology (ACT) in a specialist area to choose from: mobility and is a regional assessment service based in the manipulation, seating and positioning, sensory im- West Midlands Rehabilitation Centre (WMRC), Bir- pairment, alternative and augmentative communi- mingham, England. ACT assesses needs for Aug- mentative and Alternative Communication (AAC) and Environmental Control (EC). The ACT model Being a new MSc programme, it has been de- of EC assessment[1] involves assessment by ei- signed incorporating the latest best practice guide- ther an Occupational Therapist (OT) or a Clinical lines and benchmark statements of the Institute for Engineer (CE). Because of this interdisciplinary Learning and Teaching and the Quality Assurance model, ACT determined the need for a measure of Agency for Higher Education in aspects of content, competency that would be applicable to clinicians skills and competencies development, teaching working in the field regardless of professional delivery and assessments. Also, all teaching mate- background. This has been used as a training tool rials, including those available in electronic format, and in the future could be used as a tool of quality are fully accessible according to the Special Edu- assurance for supervisor, Head of Department and Initially three areas of competency were identified: Clinical, Technical and Process. This was later adapted to follow the assessment chronology as follows: Clinical Planning, Expectations, Assess-ment, Synthesis, Goal Setting, Actions, Evaluation and Resources. Each property of competence is associated with a dimension ranging from 0 (no knowledge) to 6 (working independently on specialised cases). Future validation will include reference to National Occupational Standards[1] and professional compe-tencies. Neil Gregory – Clinical Engineer, ACT Phil Palmer – Clinical Specialist Occupational Therapist, ACT Dr. Clive Thursfield - Consultant Clinical Scientist (Head of Service), ACT National Occupational Standards
BHTA Matters
Abstract not available at time of going to print RAATE 2003
Session 14: Are you sitting comfortably ?
MHRA Guidance on wheelchair stability
A wheelchair tilt safety alarm system
MHRA (Devices) continue to receive reports where Children and young adults with multiple and com- users and/or carers have been injured or have died plex disability often have a high need for assistive as a result of wheelchairs tipping in use. technology. The majority of them will be wheel- chair users and much assistive technology will Approximately 51% of stability related incidents re- need to be used in conjunction with the wheelchair. ported to MHRA were concerned with rearwards Wheelchairs are primarily designed to convey the stability. 39% involved forwards stability and 10% user from A to B, but not to fit all requirements for the user. An important requirement for a wheel- chair is its stability. Epidemiologists have acknowl- Some investigations show that there is a lack of edged that wheelchair incidents are a significant understanding of the potential effects of the use of problem and that the majority of serious wheelchair wheelchairs on slopes, ramps or uneven ground. users' injuries result from tipping or falling out of Others show a lack of understanding of reduced the chair. This highlights the limited stability of cur- stability due to the movement of the user or the ef- rent indoor/outdoor wheelchairs and importance of fects of the addition of accessories or other equip- designing a device to control its stability and keep With the ever expanding use of wheelchairs and Wheelchair tilt safety alarm system is designed as their accessories combined with other assistive a part of requirement for the degree of Master of technology such as communication aids, environ- Science in biomedical engineering in center for bio- mental controls, personal computers etc the poten- medical engineering, school of engineering, univer- tial for problems concerning the stability of wheel- The purpose of this project is to develop a device MHRA believes that the far ranging subject would to provide a real time monitoring of wheelchair tilt benefit from one guidance document covering all and to provide a warning to the user if safety could the issues involved. The intention is to give guid- ance to all concerned including users, purchasers, service providers, prescribers and it aims to high- This device in fact controls dynamic stability of a light areas of risk and provide guidance on reduc- wheelchair in all conditions and checks whether it ing or removing these risks whilst maintaining inde- pendent mobility for an individual wheelchair user. The presentation will give an overview of the sub- ject area and give details of the draft guidance RAATE 2003
Tuesday, 1.30pm to 3.00pm
A Potty Seat for children with
Brittle Bone disease
The handling of children with brittle bone disease is extremely difficult, since their bones can easily fracture if any bending is applied to them. If such children are to use a potty seat (or any similar chair) it is important that parents and other carers can safely handle the children onto and off of the seat. Initially a wooden potty seat was modified. Subsequently we have developed a potty seat which takes into account this difficulty. The back-rest folds flat, the leg support can be raised to a horizontal position and the armrests can be moved level with the seat allowing easy access for the carer or patient to move the child. An important as-pect of the project is that besides correct function, the device should be an attractive piece of equip-ment. Throughout the development, the prototype devices have been tested by an occupational therapist who works with the Brittle Bone Society with her clients. Development has now been com-pleted and a batch will soon be delivered to the Brittle Bone Society. Dr Michael Hillman, CEng Principal Engineer Bath Institute of Medical Engineering Royal United Hospital, BAth BA1 3NG RAATE 2003
Session 15: Integrated Systems
Case Studies of EAT on a Ventilator Unit
Case Study - Provision of an Integrated System
Compass, the EAT service at the Royal Hospital An integrated system is described as using the for Neuro-disability, works extensively with resi- same input for several applications (1). Despite dents of a long term ventilator dependent unit at technology changes, some of the same questions will have been asked for at least the last fifteen years of integrated system provision (1, 2 and 3): Residents at the unit use EAT for environmental control, computer access, powered mobility and 1) Does the same control site provide the most communication. Voice output communication aids efficient access to each of the assistive tech- are used infrequently as most residents are able to communicate verbally, however computer based 2) Is the client physically and cognitively able to single switch scanning is used for written commu- 3) Is the integrated system at least as safe and reliable compared to separate devices each A combination of more cost effective ‘off the shelf’ equipment and simple custom made solutions are 4) Is the solution acceptable to the client and car- sometimes used to achieve a limited amount of en- vironmental control while residents are on the wait- ing list for full environmental controls. These questions cannot be considered in isolation and as with most technical solutions, compromises The session will examine general issues surround- ing the use of EAT on the unit and will use several case studies to illustrate issues and decisions on This case study describes an integrated system integration of equipment and how the ventilator provided by our Clinical Engineering Service. It is a equipment itself impacts on the provision of EAT. combination of commercially available and custom The system has been working successfully for sev- eral months. The process has required assess- ment of the client’s needs, identification of possible solutions, use of commercially available equip- ment, design and manufacture of custom made equipment, configuration of communication aid software, configuration of environmental control software, configuration of wheelchair control sys- tem and training. 1. Assistive Technologies – Principles and Practice 2nd Edition. Cook and Hussey. Published by Mosby 2002. 2. A Week In The Life of Mary: The Impact of Mi-crotechnology on a Severely Handicapped Person. E.A. Dymond et al. Journal of Biomedical Engineering. 1988 Nov. Vol. 10 (6): 483-490. 3. Wheelchair Mounted Integrated Control Systems for Multiply Handicapped People. M.S. Hawley et al. J Biomedical Engineering. 1992 May. Vol. 14 (3): 193-198. Marcus Friday Barnsley DGH RAATE 2003
Tuesday, 3.30pm to 5.00pm
A New Concept in Robotic Assistance
The User View
Clive Thursfield

A new concept for a robotic aid for the disabled is
currently being developed by a European consor-
tium. The device, known as Flexibot, is a symmetri-
cal robot arm which moves around the home under
direct user control or by predetermined patterns to
carry out a variety of tasks. It moves by translating
between sockets that span the required work area,
including onto a powered wheelchair.
To determine the operating and design characteris-
tics of the Flexibot a two part user survey was car-
ried out with 90 potential users. The initial survey
determined the content of a simulation video which
was then used to solicit attitudes and principle re-
quirements of the users in the second phase.
This presentation will demonstrate the Flexibot us-
ing the video employed in the user survey and will
present the results of the survey.
Dr Clive Thursfield
Access to Communication and Technology
West Midlands Rehabilitation Centre
91 Oak Tree Lane
Selly Oak
Birmingham
B29 6NG
Tel +44 (0)121627 8235
E-Mail clivethursfield@southbirminghampct.nhs.uk
Website: http://www.bscht.org.uk/Services/rehab/
frarehab.htm
RAATE 2003
Session 16: Update on Standards — Tuesday, 3.30pm to 5.00pm
Update on Wheelchair and seating standards
Followed by question and answer session: What do you want from the MHRA (Devices) ?
The MHRA (Devices) aims to prevent adverse inci-dents happening and, where they have already happened, to prevent them happening again. No device should ever be considered 100% safe and constant effort is therefore required to reduce both the rate at which adverse incidents occur and the severity of the outcome. Reporting incidents to the Agency provides information that may be directly responsible for preventing similar incidents from happening again. During 2002 MHRA (Devices) received over 8,700 adverse incident reports covering all types of medi-cal devices. Although approx. 2,500 of these were reports concerned with the safety or quality of as-sistive technology devices such as wheelchairs, artificial limbs, aids for daily living, walking aids, orthoses etc., there still appears to be confusion about what should actually be reported. The variety and use of assistive technology is con-tinuing to increase and is not expected to decrease in the near future as the elderly population in-creases and improvements in healthcare continue to occur. With this background is it surprising to see that during the first 9 months of 2003 there was a reduction in the number of adverse incident reports received by MHRA (Devices). There may be problems with the existing reporting system or you may not be aware of the full role of MHRA or that MHRA is not actually doing what you want it to do. This interactive session is to give you the chance to raise anything that you want directly with repre-sentatives from MHRA. Alan Lynch MHRA RAATE 2003
The Organisers of RAATE 2003 would like to www.advance.me.uk

Source: http://www.raate.org.uk/2003/RAATEBOOKLET2003.pdf

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Contact Dermatitis 1985: 12 : 18-20 Disodium cromoglycate inhibits allergic patch test reactions HANS MEFFERT¹, GERD G. WISCHNEWSKY² AND WOLFGANG GÜNTHER¹¹ Department of Dermatology (Charité), Humboldt-University, 1040 Berlin, GDR² Department of Pharmacological Research, VEB Berlin-Chemie, 1199 Berlin, GDRDisodium cromoglycate was applied before patch testing in patients with co

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