Modern Lower Extrimity Prostetics

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Modern Lower Extrimity Prostetics Janne Isokangas, CPO, Otto Bock Scandinavia Ab Otto Bock HealthCare

Otto Bock HealthCare

1919 Otto Bock Almost one hundred years ago the company was founded by its namesake, Otto Bock, who started to produce prostheses and orthopaedic aids for wounded soldiers from World War I. The company is still family-owned and today managed by his grandson, Professor Hans Georg Näder. With over 6 000 employees located in 49 markets worldwide and an annual turnover of 870 million EUR, Ottobock is a leading company in the orthopaedic industry. The global headquarters is today located in Duderstadt, Germany.

Ottobock Scandinavia Group What we provide Prosthetics Wheelchairs & Seating aids Orthotics MedicalCare Otto Bock HealthCare

Quality for life 4/28/2016 Otto Bock HealthCare

4/28/2016 Otto Bock HealthCare

Technical Solutions MOBIS The Ottobock Mobility System Otto Bock HealthCare

MOBIS The choice of the correct prosthesis components by the prosthetist is a decisive factor for a successful fitting. MOBIS is a further development of the Ottobock classification system introduced in 1994. It focuses on the person and his/her need for a better Quality of life. With the help of the MOBIS symbol, the prosthetist can immediately regognise the mobility grade and patient weight for which functional components such as prosthetic feet, knee joints and hip joints are recommended.

MOBIS MOBIS is based on 4 mobility grades MOBIS defines 4 weight classes MOBIS is easy to apply

The Ottobock Mobility System: Mobility Grades and Therapy Goals MOBIS 1 Indoor walker Therapy goal: Restoring the ability to stand and to walk indoors to a limited degree. MOBIS 2 Restricted outdoor walker Therapy goal: Restoring the patient's ability to stand and walk both indoors and outdoors.

The Ottobock Mobility System: Mobility Grades and Therapy Goals MOBIS 3 Unrestricted outdoor walker Therapy goal: Restoring the patient's ability to stand and to walk indoors and outdoors with only mild restrictions. MOBIS 4 Unrestricted outdoor walker with especially high requirements Therapy goal: Restoring the ability to stand, walk and move about both indoors and outdoors without any limitations.

MOBIS defines 4 weight classes: < 75 kg <100 kg <125 kg >150 kg

MOBIS Modular components

Knee Joints and MOBIS Functionality Security

Feet and MOBIS Functionality

Modern Technology Microprosessor-controlled knee joints C-Leg 4 Genium Genium X3 Kenevo Myoelectric upper limb prosthesis technology Michelangelo, Myo Bock System Microprocessor-controlled ankel Triton Smart Ankle Meridium Otto Bock HealthCare

C-Leg 4 / 3C98-3 Microprosessor-controlled knee joint Otto Bock HealthCare

Introduction Technology Bluetooth Battery Inertial Motion Unit (acceleration sensors and gyroscope) Electronics Hydraulics Servo electronics Charging plug

Introduction Technology New control concept for C-Leg 4 Detected parameters (sampling rate: 100 Hz) Knee angle + angular velocities Knee extension moment Inertial Motion Unit (IMU) Linear accelerations + velocities & distances Orientation of shank in space + angular velocities

Introduction Functional sequence of prosthetic control Input signals Processor C-Leg 4 Output signals Knee angle Knee moment Linear accelerations Shank inclination Angular velocities Servo motor Flexion valve Servo motor Extension valve

Introduction Characteristics Improved swing phase behavior Adaptive swing phase flexion control Very good support for slow and fast walking speeds Adapts flexion resistances to different walking speeds Adapts to changed parameters (e.g. shoe weight) The swing phase control regulates the maximum flexion even at different speeds with a very high accuracy!

Introduction Characteristics Improved swing phase behavior Real-time swing phase extension control Adapts extension resistances to different situations and walking speeds Adjustable basic resistance for swing extension during level walking Minimal resistance when walking stairs and ramps (reliable foot positioning)

Introduction Characteristics Broader range of ADL s Flexion possible no stable standing Stance Function activated Locked joint in flexion Intuitive Stance Function If the joint is at rest in a flexed position, it is instantaneously locked E.g. useful for standing on ramps

Introduction Characteristics Broader range of ADL s Sitting Function (low flexion and extension resistance) Weatherproof (IP67) 2 additional MyModes for specific activities

Introduction Characteristics Easier use for patient and CPO Cockpit Ottobock Cockpit app or optional remote control Switch modes Limited changes to adjustments Battery level indicator Status indicator User friendly dialog texts for service and error messages New posterior position for charging receptacle Additionally protected by a cover Adjustable signals (+ louder beeper)

Introduction Characteristics Improved outcomes for patient and CPO Safety Safe backwards walking Enhanced stumble recovery Easier stance release small steps, sand (real time control) Adjustable safety mode Exit strategy Additional improvements compared to old C-Leg Higher extension resistances possible for a more convenient stance extension movement (no hydraulic shortcut)

Introduction Characteristics Broader group of patients MOBIS 2 4 Patients with hip disarticulation or hemipelvectomy have to be fitted with the 7E7, 7E9 or 7E10 hip joint Maximum knee angle: 130 Up to 136 kg (300 pounds) of body weight Minimal installation height = 307 mm (using LoRider foot) Shorter users possible More functional feet possible

Components and Materials Documentation Data Safety Sheets Component Testing 5.000.000 steps = 3 years (avarage user) REACH? Registration, Evaluation, Authorisation and Restriction of Chemicals 2007 -> CE Marking Materials Cytotoxicity Testing (ISO 10993-5) Irritation- and sensitization testing (ISO 10993-10)

Future? Osseointegration

Future? (TMR) targeted muscle reinnervation

Official partner to Paralympics since 25 years Partner to the International Paralympic Committee since 2005 Official supplier of technical services for prosthetics, orthotics and wheelchairs for Paralympics Rio 2016 During London 2012 2080 repairs were made by 78 technicians (ca 10 680 h work) We had 13,7 tons of workshop equipment on set and over 15 000 spare parts Otto Bock HealthCare

Janne Isokangas CPO, Productspecialist janne.isokangas@ottobock.fi Otto Bock HealthCare

Quality for life 4/28/2016 Otto Bock HealthCare

Janne Isokangas CPO, Productspecialist janne.isokangas@ottobock.fi Otto Bock HealthCare