March 2014www.ossur.com

PARTNER SOLUTIONS

RHEO KNEE® 3 user Tim “I always believed I could ride my bike again”

NEW PEDIATRIC SOLUTIONS… And a lot more Flex-Foot® background information

MIAMI LUMBAR® POSTEO – Highlight of Össur’s spinal range

Miami Lumbar® Posteo

Stabilisation, offloading and pain relief

WWW.OSSUR.COM TEL +31 (0) 499 462 840TEL +31 (0) 499 462 841info-europe@ossur.com

Advantages of an osteoporosis orthosis:• Alleviation of pain• Offloading• Increase in mobility• Reduction of the risk of a fall• Ease of use• Increase in quality of life

With this first edition of Partner

Solutions for this year, spring is

already in the air. And we are off

to a quick start with a number of new chal-

lenges. There are many new opportunities for

us all this year.

The first challenge was to introduce the new

Össur brand. We thought it was time for a

fresh, new look that presented the Össur brand

more clearly. You can read more about this in

this issue of Partner Solutions. The magazines

design has been given a new look, while retai-

ning the familiar Össur appeal.

4 News from the Head Office

5 Product in the spotlightFoot-Up®

6 RHEO KNEE® 3Stability and dynamicsInterview with user Tim

10Flex-Foot®

Main Flex-Foot features described

14Interview with Icelandic Flex-Foot® production specialist Magnús

16 Flex-Foot® Junior Solutions

18 Össur’s Spinal Range

19 Osteoporosis solution:Miami Lumbar® Posteo

22 Össurin action

24 Product Updates & Discontinuations

26 Agenda

In terms of content, the magazine is still cha-

racterised by a combination of interviews, pro-

duct information, scientific background infor-

mation and news about activities and events.

You can read in this edition for example an

interview with Tim, one of the first users of

RHEO KNEE 3. Besides a lot of background

information about our Flex-Foot range and the

new Junior Solutions, you will get a refresh of

Össur’s spinal range.

Yours sincerely,

Yvonne van der Rijt

Marketing Manager

PS is a production of Össur and is

published 4 times a year.

Redaction:

Yvonne van der Rijt

Design:

Marta Tripp

Contributed to this issue:

Simone Faessen

Steve Russell

Peter Slijkhuis

Froukje Aben (ZIN tekst & redactie)

Final editing:

Yvonne van der Rijt

© Copyright Össur All rights reserved.

Dear relation,

TABLE OF CONTENTS

Colophon:

3

ÖSSUR STRATEGY 2014

CHANGE IN ÖSSUR BRAND STRUCTURE

You might have read in the first Partner

Solutions about the brand restructur-

ing that Össur was going through. In

the past months we have been planning this

new brand structure within Össur.

The goal is to ensure the Össur brand structure

reflects our strategy of providing indication

based solutions to our customers. Findings are

based on research conducted with employees

and customers.

The result was a restructuring of the Össur

brand architecture along with an update to our

logo. We will no longer speak about Braces and

Supports, but about Össur OA Solutions and

Össur Injury Solutions.

IMPLEMENTATION

The implementation of it has started already.

The first changes presented to you are the new

OA & Injury Solutions product catalogue 2014

(instead of Bracing and Supports catalogue)

and the new logo you can see on on the cover

of this magazine. We will not change every-

thing overnight. Our “old“ logo will continue

to coexist with the new version for quite some

time (on products, signage and other existing

material).

In case you want to use Össur brand elements

in your marketing tools, please contact our

Marketing Manager for support: Yvonne van

der Rijt [yvdrijt@ossur.com].

4

Foot-Up®

Foot-Up is an AFO (ankle foot orthosis) prescribed in case of dropfoot. Dropfoot means

that, during the swing phase, the forefoot drops down due to muscle weakness on the

front of the lower leg. The cause of this weakness include peroneal nerve damage or paresis

due to circulatory problems in the brain. The orthosis is used to prevent the forefoot’s falling

downward, to promote heel strike, to stabilise the ankle during the support phase and to facilitate

toe clearance at the end of the support phase.

COMFORTABLE

The ankle strap is flexible and can be adjusted

to the anatomy of the lower leg and ankle. It

is made of multiple layers and is breathable.

This decreases the likelihood of sweating and

increases wearer comfort.

DYNAMIC

Foot-Up’s dynamic character is evident in the

gait. Walking with a dynamic AFO such as the

Foot-Up not only provides ankle stability, but

also provides a smooth transition during the

support phase. This improves speed and step

length while walking.

SIMPLE

Foot-Up is easy for users to don. Many users

also say it is easy to walk with Foot-Up.

DID YOU KNOW?

• Foot-Up is Össur’s 7th-best-selling product?

• A 2007 study of VU University (Faculty of

Human Movement Sciences) revealed that

walking with Foot-Up scored better in the

areas of ease-of-use and comfort than wal-

king without an AFO? And that users are

provided more comfort by Foot-Up than by

plastic AFOs?

• Foot-Up can be worn not only in lace-up

shoes, but also in sandals, loafers and boots,

thanks to the Shoeless bandage?

• Foot-Up is also available in skin-tone colour,

making it less noticeable to wear?

IN THE SPOTLIGHT

5

6

7

Interview with our RHEO KNEE® 3 user Tim

Tim Klinker is one of the faces of our

RHEO KNEE 3 campaign. He is 41 years

old and lives in Germany. He has a

degree in electronics and is currently doing a

degree in science with an internship in psycho-

therapy. Tim has many hobbies like reading,

writing, playing a lot of darts and his favourite

hobby is to ride the bicycle. Tim had his left

leg amputated two years ago. So let’s ask him

how he learned riding his bike again.

? After your amputation, did you believe you

would ever be able to ride your bike again?

Of course, I believed that I could ride my bike

again. You only have to believe in yourself and

what you can accomplish if you try.

?What did you learn during your rehabilita-

tion phase?

They taught me, how to balance my body defi-

ciencies and to carry on with all the exercises.

? Now you know what it is to be an

amputee, what can you say about the

needs of an amputee?

To have an amputation is a big step in life, but

after 40 years with a stiff leg that was begin-

ning to affect my movements, it was time to

do something about it.

? What solutions a prosthesis should give in

your opinion?

After my amputation I found how free I could

be in my movements in daily life. For example

in my hobbies. So mobility, that’s what I think

a prosthesis should give me.

? Could you ever think that you would be at

the mobility level where you are at the

moment?

Yes I thought about the mobility I could

achieve, but I was surprised how mobile I

could be again.

First I had a knee that was probably not ideal

for me but with time I got a reliable knee that

helped me to become more free and dynamic

but also gave me safety. I m now using the

RHEO KNEE 3 and it combines both without

a doubt.

8

The product catalogues for OA &

Injury Solutions and Prosthetics 2014

are available on stock.

The prosthetic catalogue is updated

with all the latest changes. We added

for example Unity™ for LP Vari-

Flex® and PROPRIO FOOT® and we

implemented the SYMBIONIC® LEG

Protector.

The OA & Injury Solutions catalogue

looks a bit different due to the new

brand structure we’ve implemented

The catalogue is divided in Össur OA

Solutions and Injury Solutions.

The product catalogues are

digitally available on:

www.ossur.com/emea/b2b

and are updated every quarter.

Catalogues 2014

9

FLEX-FOOT®

RHEO KNEE 3 is compatible with more Össur feet then before....

There are approximately one million

amputees worldwide. Most have had

to undergo lower limb amputations

because of poor blood circulation in the legs

and feet, brought on by either trauma or dis-

ease. All of them are individual people with

individual lifestyles, needs and aspirations.

Therefore their requirements for a prosthetic

device differ too.

Össur recognises this huge variation and takes

various factors such as personal mobility and

body weight into account in the development of

the Flex-Foot range, a collection of foot modu-

les designed with this individuality in mind. The

Flex-Foot product line consists of carbon fibre

feet, designed for optimum performance and

suitable for all ages and activity levels.

While the needs of children, active adults and

older people vary, all our customers demand

high quality products that imitate the function

of the human body as closely as possible and

that respond to their unique needs.

Van Phillips, the inventor and himself also

a user of Flex-Foot, describes his first expe-

riences with prosthetic feet that led him to

search for a better solution to satisfy his requi-

rements. “The feet were light but had no flexi-

bility. Some had a degree of ankle movement,

but no method of storing energy.” These two

attributes, flexibility with energy storage, led

Phillips to select carbon fibre as the perfect

material for a prosthetic foot. His innovation

was to revolutionise the lives of prosthesis

users around the world.

SHOCK ABSORBTION

As Perry et al. 5* indicated, prostheses for

the transtibial amputee have to provide better

ankle flexibility and have to imitate the dynamic

characteristics of a normal joint between the

foot and the leg when setting the foot down.

The prosthesis used has to provide terrain

adaptation or the initial contact in the early

stance phase. In the context of loading res-

ponse, an active heel has to absorb the shocks

and store the energy generated by the initial

contact as the amputee transfers his body

weight onto the prosthetic foot in the early

stance phase. In addition, it has to support

the initial tilting motion for inducing forward

progression in the ankle and has to control the

forward progression of the tibial portion for a

fluid roll-over of the foot in this initial phase.

The importance of this characteristic is demon-

strable in terms of the protection that this pro-

vides the vascular or diabetic amputee with

sensitive skin. Although the extent to which

this prevents skin necrosis and skin damage is

unknown, this preventive effect is likely.

RANGE OF MOTION (ROM)/FLEXIBILITY

The vertical forces that are generated upon heel

strike are stored and translated into a linear

motion described as tibial progression, from

the moment of initial contact to mid-stance,

and from forward progression to toe-off - equi-

valent to a range of motion in the joint of a

non-amputee of between 15 and 20 degrees.

This flexible, controlled motion enables the

patient not only to limit the body’s active for-

ward acceleration that has to take place in order

to proceed from early stance to mid-stance,

but also to make the stride length equal to

that of the healthy limb and to decrease energy

consumption. At the same time, the tibial pro-

gression promotes forward progression in the

opposing limb during the swing phase, which

results in more controlled placement of the

foot when completing the step and as small as

shock as possible upon putting the foot down.

This characteristic has been studied by several

researchers and, according to Hafner et al. 6*,

the Flex-Foot systematically offers the greatest

range of motion of the joint. The same study

reveals that the use of the Flex-Foot decreases

the forces exerted on the residual limb and

on the other leg, which indicates that the foot

prosthesis not only absorbs forces exerted

on the prosthetic side, but also on the side of

the healthy leg.

10

FLEX-FOOT®

RHEO KNEE 3 is compatible with more Össur feet then before....

ROLL-OVER AND DISPLACEMENT OF THE

CENTRE OF GRAVITY

The full-length toe lever is the same length as

the healthy foot for a smoother, more com-

fortable and more natural gait. The range of

motion and flexibility of the joint, as indicated

above, are well-known characteristics of the

foot, but the objective of the full-length toe

lever is to enable patients to support themsel-

ves just as long on the prosthesis as they do

on their healthy leg. For persons with normal

anatomical characteristics, the unique action

of the foot’s muscles and joints ensures a natu-

ral gait and the stability required at the end of

stance. In patients with a prosthesis, the toe

lever stabilises the knee over the entire stride

length and it supports every displacement of

the body’s centre of gravity. In instances of a

short toe lever (e.g., with an SACH foot with

flexible ends), the foot’s roll-over is cut off

abruptly, shortening the stance phase of the

prosthesis and the swing phase of the healthy

leg. This has serious consequences for the

healthy side: this side becomes damaged or,

for diabetic and vascular amputees, even runs

the risk of having to be amputated as well. It

has been demonstrated that the impact on

the other leg is decreased by a combination of

sufficiently extensive range of motion of the

joint, controlled tibial progression and a full-

length toe lever. The hypothesis has also been

posed that a reduction in the forces exerted on

the healthy leg may completely prevent damage

to this leg. The efficacy of roll-over and the

displacement of the body’s centre of gravity

when using the Flex-Foot are discussed in the

study by Lehmann et al. 7*

FLEX-FOOT®

Re-Flex® Rotate

Flex-Foot Assure®

Talux®

Vari-Flex®

Vari-Flex® XC

11

ENERGY RETURN

The energy return from ESAR (Energy Storing

And Returning) feet takes place in two steps.

During the first step, after the initial contact,

the force exerted on the heel of the foot pros-

thesis results in the opening up of the J-shaped

tube (if applicable). The energy is then stored

for use during the first phase of the tibial pro-

gression. Once the J-shaped tube has ope-

ned, the returned energy initiates the forward

progression so that the patient can proceed

from the initial contact to mid-stance. This

decreases the muscle activity that the patient

has to provide. Just before the toe-off, energy

is released once again in the second step of

active forward progression up to the moment

of the toe-off. This is also influenced by the full-

length toe lever. This phase of energy return

plays a key role because it supports dynamic

swing initiation. The general energy return

is known to decrease the effort required to

walk at various levels. These effects have been

researched and proven in various studies -

e.g., Macfarlane et al. 8*, which showed that

torso motions were smoother and more regular

when using Flex-Foot, allowing transfemoral

amputees to walk more efficiently.

EVO™ – ENERGY VECTOR OPTIMIZING

Although results with Flex-Foot have been

satisfactory, we were and are still looking for

improvements, which are users would des-

cribe as beneficial and which we could quantify

using adapted analysis tools. The objective,

for the development of the EVO feature, today

present in the Vari-Flex EVO, was to mimic

the natural roll-over of the physiologic foot,

using the COP displacement during roll-over

as reference. Vector Optimization, Energy

Vector Optimization to be precise, stands for

the optimization of the movement pattern of

the COP. The feature is the result of a change in

the design of the foot cover. Foot covers have

never been considered of high functional value.

By matching the inside of the foot cover with

the arch shape of a Vari-Flex, we obtain what

we like to call EVO. Matching the outside of the

footshell to fit a shoe completes the concept by

making a solid interface between shoe/ground

and the foot module. The interface between

foot module and ground is the “make or break”

factor for function, comfort and stability. The

objective is to mimic the natural roll-over of the

physiologic foot, using the COP displacement

during roll-over as reference.

ROTATION

For the amputee, portions of this kinetic chain

are replaced with the prosthesis. Whatever

torque was applied to the biological structu-

res that were removed, are now applied to the

prosthesis and its interface with the stump.

An intact leg is free to rotate in the transverse

plane as described above, or to transmit the

transverse rotation into motion in other planes;

however, with the exception of the prosthetic

foot rotating in the shoe, few lower limb pros-

theses allow for transverse rotation.

Constrained rotation can increase stump

shear stresses and, for some amputees, may

be sufficiently uncomfortable to require an

altered gait. Given that discomfort and injury

due to shear forces between the stump and

the prosthetic socket are major complaints

of amputees, it is important to minimise the

shear forces in all planes of the socket/lining

with respect to the stump. The addition of a

torsion adapter in a prosthesis will be of impor-

tance to address secondary complaints. The

higher the level of amputation is, the higher

the necessity of rotating elements, even for

low active amputees. In case of high active

prosthetic users, rotation should be combined

with optimalisation of shock-absorption. The

installation of a torsion adapter in a lower-limb

prosthesis is therefore recommended.

1. Bob Gailey, 2008, Secondary conditions related to prosthetic users and ten steps to reduce the risk of injury, In motion, July/August, Vol 18, issue 5

2. Christiane Gauthier-Gagnon et al. Predisposing Factors Related to Prosthetic Use by People with a Transtibial and Transfemoral Amputation, JPO 1998; Vol 10, Num 4, p 99.

3. Robert Gailey, Predictive outcome measures vs functional outcome measures in the lower limb amputee, JPO 2006; Vol 18, Num 1S, p 51

4. Johannesson et al. From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population. Prosthetics and orthotics international 2004, 28, 9-21.

5. Perry J et al. Prosthetic weight acceptance mechanics in transtibial amputees wearing the Single Axis, Seattle Lite foot, and Flex-Foot. IEEE Trans Rehabil Eng. 1997;5(4):283-289.

6. Brian J. Hafner, PhD, Overview of Outcome Measures for the Assessment of Prosthetic Foot and Ankle Components, JPO 2006; Vol 18, Num 1S, p 105.

7. Lehmann JF et al. Comprehensive analysis of energy storing prosthetic feet: Flex-Foot and Seattle Foot Versus Standard SACH foot. Arch Phys Med Rehabil 1993; 74:1225–1231.

8. Pamela MacFarlane et al. Transfemoral amputee physiological requirements: Comparisons between SACH foot and Flex-Foot. Journal of prosthetics and orthotics 1997, Vol. 9, Num. 4.

9. Esquenazi et al. Rehabilitation After Amputation, Journal of American Podiatric Med. Assoc. 91(1): 13-22, 2001.

THE DATA

12

13

Earlier in this Partner Solutions we

described how the idea of Flex-Foot was

founded, what the main features of Flex-

Foot feet are and which developments this

product has gone through in the past years. In

this interview with Magnús we try to answer

questions that we get very often from CPO’s.

Magnus works as supervisor at the Flex-Foot

production department of Össur in Iceland.

All Flex-Foot feet are produced in Reykjavík,

Iceland.

? What are the main changes that have

occurred from the first versions?

The main changes are a few bolts and nuts,

finetuning of shapes and lay-up to maintain

durability, and greatly enhanced manufacturing

process, where automation plays increasingly

big part.

? Can you tell us a bit more about the

production proces?

Flex-Feet are laminated of carbon fiber/epoxy

pre-impregnated material which are combined

under extremely strict quality procedures and

with unique machinery.

Categories are controlled by the amount and

placement of carbon material(thickness). An

automated process takes care to compile that

with great precision.

? Össur is constantly searching for

innovative ideas and ways to bring those

innovations to the market. Can you explain

us a little bit more about the development of

a new product within Össur?

A product idea is taken into one end of a so-

called new product development process. If it

turns out to be viable, it results in a product.

How long it the process from the decision of

making the product till having it available for

the patient takes differs quite a bit depending

on the complexity, testing and logistics around

the new product. Anything between 10 and 30

months can be considered normal.

Besides the development of new products we

also improve existing products.

Two factors decide on an upgrade: If there is

a quality weakness which can be fixed with an

upgrade, that’s one good reason. If we see

an opportunity to make the product easier to

apply or better for the patient, that’s a very

good reason as well.

? What is the testing procedure for a

Flex-Foot?

Every carbon component is stiffness tested

before the foot is assembled to make sure that

it corresponds to an exact activity and impact

level. All products are tested in machines to

verify safety. Depending on previous experi-

ence with similar solutions, we either do or

do not conduct user tests.

? CPO’s ask us sometimes the question

‘Why does my patient feel his Flex-Foot is

stiff?’. What could be the answer according

to you?

Choosing the right category of your Flex-Foot

is crucial for optimal functionality. Weight and

impact on the foot are the main factors to take

into account when deciding on the category.

Selection-tables are presented to choose the

right category according to the weight of the

user. Please take into account the different

activities the user will execute/perform with the

prosthesis. In this case impact on the foot will

be more important than the activity itself. For

example, the impact on the foot working on a

construction-site will be different compared to

the impact on the foot of someone sitting by a

desk when working. (Other example: playing

tennis vs cycling). Choosing a category too

high will cause the foot to be too stiff. Flex-

Foot can be tested in the home-environment,

so please make sure the user is provided with

correct type of foot.

MAGNÚS ÖRN HALLDÓRSSON

“If we see an opportunity to make the product easier to apply or better for the patient, that’s a very good reason to improve an existing product.”

- Magnús Örn Halldórsson

Picture: Production of the Flex-Foot - Carbon fibre cutting

14

MAGNÚS ÖRN HALLDÓRSSON

Wrong bench-alignment of the prosthesis will

influence the lever arm of the foot. A too long

lever arm, for example aligning the socket too

far posterior (sagittal plane), will increase the

stiffness of the foot. This results into torque-

and shearforces between the skin and the

socket and can lead to damaging of the skin-

and bonestructure of the residual limb. Please

use the prescriptions of bench-alignment as

indicated in the Technical Manuals to provide

optimal functionality.

The full length toe lever of the Flex-Foot mat-

ches the length of the sound foot, giving a

smoother, more natural gait. It ensures the

amputee to spend equal time on the prosthetic

limb because of increase of stance phase, this

because of support of the prosthesis by the

rigid toes of the foot. For this reason, wrong

size selection will increase the lever arm of

the foot and increase the feeling of stiffness.

Because of the great diversity of Flex-Feet (dif-

ferent types of feet for different types of users),

the amputee can have an “almost” custom-

made design of foot, providing an excellent

option for an optimal functionality.

? Customers want to know how long a

Flex-Foot lasts. Is that a question you can

answer?

This is a difficult question to answer because

different factors are of influence when consi-

dering usage. Every prototype is tested for a

time-period of 36 months (2.000.000 cycles).

This means we know we can and will guarantee

proper functioning of the foot for this period.

(Note: Please note that there are some designs

of feet with different periods of warranty. Check

warranty specifications in your catalogue.) A

second influencing factor is the amount of

loading on the foot, which will depend on the

activity and the impact. The higher the amount

of loading, the shorter the time of the foot

will last.

? Sometimes CPO’s tell that their users

complain of noise in the Flex-Foot. What

could be causing this?

This can be dirt and debris inside the foot

cover. Also the absence of a Flex-Foot Sock is

common cause for noise.

? We also get questions on a regular base

about using prosthetis in the water. Can

users take a shower with a Flex-Foot for

example?

Flex-Foot are not designed to use in a shower-

prostheses. On the other hand, using titanium

parts which are protected against corrosion,

could give the user the benefit to use the pros-

thesis in not-salted water if the other parts of

the prosthesis are designed to use within water.

Using the prosthesis on the beach should be

no problem, as long as the user makes sure

the prosthesis is cleaned properly when leaving

the beach, so no sand can cause no problems.

15

16

KIDS ARE MORE ACTIVE THAN ADULTS

It’s no secret that kids move more than adults.

They have more energy, they play more, and,

while many adults don’t run as a part of normal

daily activity, most children do.

This is why we added not one, not two, but

three new dynamic foot options to our pediatric

product line, including a running foot for kids

with longer residual limbs and a hybrid wal-

king/running foot, the Cheetah® Xplore Junior.

Children may dream of playing with friends,

competing in sports or walking the family dog

and Össur wants to support them every step

of the way.

Cheetah® Xplore Junior

A custom-built, hybrid carbon fiber foot

designed to function as both an eve-

ryday and sports foot.

For kids that require the flexibility of an eve-

ryday walking foot and a running foot in a sin-

gle prosthesis, Cheetah Xplore Junior is the

answer. Cheetah Xplore couples the proven

performance of our Cheetah sprinting foot with

a heel for everyday walking/standing.

Vari-Flex® Junior

Vari-Flex Junior provides an exclusive

combination of comfort and dynamics.

It is specially made for children who

require the additional energy response.

Vari-Flex Junior is lightweight, easy to assemble

and has a slender profile which makes it easy to

cosmetically cover. It ensures the highest levels

of user confidence and security. Promoting a

natural gait with less fatigue and strain on the

lower back and sound side, it is the ideal foot

for any activity.

Cheetah® Junior

Custom-built, high-performance carbon

fiber foot designed primarily for sport-

ing activities.

This is the optimal run and play foot for both

transtibial and transfemoral users. It attaches

posterior to the socket, making it agile, strong

and a proven performer for children who want

to practice sports.

FULL LENGTH TOE LEVER

PROPORTIONALRESPONSE

ACTIVE TIBIAL PROGRESSION

CARBON-X®

ACTIVE HEEL

SANDAL TOE

FULL LENGTH TOE LEVER

PROPORTIONALRESPONSE

ACTIVE TIBIAL PROGRESSION

CARBON-X®

ACTIVE HEEL

PROPORTIONALRESPONSE

ACTIVE TIBIAL PROGRESSION

17

CERVICALTHORACIC

LUMBAROCCIPUT

C1

C3C5

T2T7

T9L1

L5

SACRUM

“We recognise that our customers want

access to a complete spinal range, one

that offers motion restriction, comfort

and compliance, as well as innovative features

that enhance clinical use. Össur’s focus has

been on optimising patient outcomes, using

our advanced design and materials technolo-

gies to make our products easier to use and

less stock intensive.”

When someone suffers a spinal injury, which

may carry with it the risk of permanent para-

lysis, even the most skilled clinician faces a

complex and challenging set of treatment

protocols.

Össur’s spinal range currently includes six dif-

ferent products and a number of accessories

to ensure outstanding treatment options for

every stage of the care pathway. These out-

come-focused products have been developed

in consultation with leading clinicians and their

patients and offer a number of advantages:

• Motion restriction, pain relief and the protec-

tion of injured ligaments/muscles.

• Size adjustable and modular systems that

help to reduce stock levels.

• User-friendly design and enhanced patient

comfort and compliance.

ÖSSUR’S SPINAL RANGE

MIAMI LUMBAR® TLSOA secure, comfortable orthoses allowing step-down treatment of thoracic or multi-level injuries.

MIAMI JTO®

A thoracic extension for the ambulatory needs of cervical and high-thoracic injured patients. (For use in conjunction with the Miami J.)

MIAMI LUMBAR®

The easy-to-use modular system for post-op immobilisation, pain relief and protection of injured ligaments/muscles in the lumbar region.

MIAMI J®

The popular and proven cervical collar available in a range of phenotype size options.

MIAMI J® ADVANCEDThe highly effective cervical collar offering phenotype size adjustability and a tracheotomy friendly design.

RESOLVE® HALOThe renowned MRI-safe halo for traumatic fractures/chronic disorders requiring traction.

MIAMI LUMBAR® POSTEOFunctional relief of vertebral fracture pain, with an innovative approach to ease of use and consistent donning.

18

According to the World Health

Organisation osteoporosis is amongst

the top ten most significant diseases

in the world. Osteoporosis is the condition of

reduced bone density which leads to bones

having less load-bearing capacity and increased

bone fragility. In advanced stages of the disease

someone can sustain fractures of the spine or

of the neck of the femur even on slight impact

or following light falls. According to the

International Osteoporosis Foundation, every

30 seconds someone in the European Union

has a fracture as a result of osteoporosis. Annual

direct medical costs to treat 2.3 million osteo-

porosis fractures in Europe and in the United

States of America come up to 27.000 million

USD. Every third woman and every fifth man

over 50 sustains a bone fracture which is attrib-

utable to osteoporosis.

ADVANTAGES OF AN OSTEOPOROSIS

ORTHOSIS

• Alleviation of pain

• Offloading

• Increase in mobility

• Reduction of the risk of a fall

• Ease of use

• Increase in quality of life

MIAMI LUMBAR® POSTEO

The Miami Lumbar Posteo offers functional

support for vertebral compression fractures and

provides the patient with early mobilisation. The

orthosis provides thoracic extension and lumbar

compression. This postural correction and the

active relief of the vertebra produces effective

alleviation of pain.

INDICATIONS

• Back pain caused by stable vertebral compres-

sion fractures (VCF)

• Post-operative immobilisation

OSTEOPOROSIS

19

The aim of the study was to assess if partici-

pants using the Miami Lumbar Posteo experi-

ence a significant reduction in back pain and/

or a significant improvement in function over

a 6 week period, compared with subjects not

using a brace.

A secondary goal was to evaluate if the effects

of the Miami Lumbar Posteo spinal brace dif-

fer from the effects of the Spinomed® (medi)

brace.

METHODS

A randomized controlled trial, approved by the National Bioethics Committee in Iceland. Subjects with confirmed vertebral compression fracture(s)

and chronic pain were randomized by drawing into 3 groups: Miami Lumbar Posteo brace, Spinomed brace (medi) or no brace (control group).

MIAMI LUMBAR®

POSTEO

Osteoporosis Spinal Brace Study

USERSATISFACTION

Comfort, ease of use etc. were assessed using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0)1,2.

In general, users were more satisfied on the scale of 1-5 with the Miami Lumbar Posteo brace.

N SIZ

E

WEI

GH

T

EA

SE O

F A

DJU

STM

ENT

DU

RA

BIL

ITY

EA

SE O

F U

SE

CO

MFO

RT

USE

FULN

ESS

MIAMI LUMBAR POSTEO 10 3.5 5 4.4 4.8 4.2 4 4.1

SPINOMED (MEDI) 7 3.4 4.4 3.4 4 4.1 3.4 3.7

REFERENCES

1 Demers L, Weiss-Lambrou R, Ska RB. The Quebec user evaluation of satisfaction with assistive technology (QUEST 2.0): an overview and recent progress. Technology

and Disability 2002;14:101-105.2

2 Demers L, Monette M, Lapierre Y Arnold DL, Wolfson C. Reliability, validity and applicability of the Quebec user evaluation of satisfaction with assistive technology

(QUEST 2.0) for adults with multiple sclerosis. Disability and Rehabilitation 2002;24(1-3):21-30.

THE DATA

THE DATA

Back pain was estimated by a visual analogue scale (VAS) and was sig-

nificantly reduced in subjects using either brace. A reduction of 2.0 or

more points on the VAS scale is considered a meaningful improvement.

Functional limitation, estimated by the Rolland Morris score, was sig-

nificantly reduced in subjects using either brace. A 5 point reduction

on the RM scale is considered a clinical improvement in function.

ESTIMATED MARGINAL MEANS OF PAIN

MEA

N S

CO

RE

ON

TH

E P

AIN

SC

ALE

baseline 1 week 3 weeks 6 weeks

no brace - control group spinomed (medi) miami lumbar posteo

ESTIMATED MARGINAL MEANS OF ROLAND MORRIS SCALE

MEA

N S

CO

RE

ON

TH

E FU

NC

TIO

NA

L LI

MIT

ATIO

N S

CA

LE

baseline 1 week 3 weeks 6 weeks

no brace - control group spinomed (medi) miami lumbar posteo

The exercises described below may not

be appropriate for every patient with

osteoporosis. Please consult a clinician

for a personalized training program.

CARDIOVASCULAR

• Walking and running up to 20 minutes, low to

high impact aerobic exercises.

BALANCE

• Good leg strength and balance to reduce risk

for falling. Stand on one leg for some time

without dropping the contralateral (opposite)

side of the pelvis. (Figure 1).

STEPS

• Short forward lunge. Stand on one leg while

maintaining balance, then take a short step

forward and put your weight on the front leg.

Firmly push off with the front leg to return to

starting position. Avoid changing position of

spine during the exercise. (Figure 2).

BACK MUSCLES

• Sit or stand with the spine aligned against a

wall, lift both arms over head and take deep

breaths before taking your arms down again.

Repeat 5-10 times, 2-5 times daily. (Figure 3)

• Lying prone (on stomach) with good support

of pillows under your chest and stomach, arms

in overhead position. Lift your arms from sup-

port/ floor by pulling shoulder blades together.

Try to keep the muscles in the lumbar/lower

back and abdominal wall relaxed. Repeat 5-10

times, 2-5 daily. (Figure 4)

ABDOMINAL MUSCLES

• We do not recommend any strengthening exer-

cises, only relaxation of the abdominal wall.

In a quadruped position resting forearms on

a table, relax abdominal muscles and breath

slowly. (Figure 5)

• Stretching: Stand in a corner, one foot in front

of the other with each arm on separate walls

at shoulder height. The stretch should be felt

in your chest, anterior shoulders and upper

arms. (Figure 6)

LEG MUSCLES

• Rest arms on the backrest of a stable chair.

With feet little apart and bend at the hips and

knees as far as possible without lifting your

heels from floor. (Figure 7)

2

3

7

5 6

1

4

MIAMI LUMBAR®

POSTEO

Exercises for individuals with osteoporosis

21

RICHARD BROWNE JR. JOINS TEAM ÖSSUR

Össur is pleased to announce that

World-Record holder and Paralympian

Richard Browne, Jr. is the latest elite

athlete to join Team Össur.

Richard holds World Records in both the 60m

(6.99) and 100m (10.75) races in the T-44 cate-

gory. Although relatively new to the competitive

arena, he has already distinguished himself by

competing as a member of the Gold Medal-

winning, World Record-setting U.S. 4x100

relay team at the 2013 IPC Worlds. He also

won Silver Medals in the 100m at the 2013

IPC World Championships and at the 2012

London Paralympic Games. Richard uses the

Össur Cheetah Xtreme®, which is ideally desig-

ned for short distance sprinting. He also stu-

died Physics at Morehouse College in Atlanta,

Georgia. We look forward to cheering Richard

on at his upcoming races at the IAAF Indoor

British Athletics GP in Birmingham, England;

the 5 Nations Match in Glasgow, Scotland; and

the Meeting de Mondeville in France.

AN ASPIRING JOURNEY IN MYANMAR

The 7th ASEAN Para Games were suc-

cessfully held in Myanmar at Wunna

Theikdi Stadium from the 14th to the

20th of January. This venue is the largest sta-

dium in Myanmar and was crowded with spec-

tators for this country’s milestone event. The

Para Games featured over 1000 athletes from

eleven countries in Southeast Asia (ASEAN),

competing in twelve sports, with Myanmar’s

own team being second in participation with

around 269 athletes.

Össur Asia was approached by the International

Red Cross association and the Myanmar

Paralympic Committee (MPC) to support

their athletes and with the help of the MPC,

Össur selected a total of 10 athletes (6 men

and 4 women) to assist with training, technical

support and products. One of Össur Asia’s

very own CPOs, Charles Wang spent countless

hours working with the team in the weeks lea-

ding up to the main event. It is important to

note that prior to Össur’s involvement, almost

all of the athletes in Myanmar’s team were

using very basic componentry (SACH feet,

Single-axis knees, no liners etc.) In the end,

the Myanmar team won 6 gold, 4 silver and

7 bronze medals. Truly a great achievement

and Össur Asia was proud to have been a part

of this event.

22

23

FOOT COVERS

The foot covers from Össur are known for the technology which is called EVO. EVO stands for

Energy Vector Optimization and intends to provide a more natural way of walking to the patient.

The foot covers have been specifically designed to be used in combination with the best pros-

thetic feet in the market, „Flex-Foot “ with EVO. Össur has now improved her EVO foot covers.

The new foot covers have a more anatomically correct shape and more natural looks.

MORE ANATOMICALLY CORRECT SHAPE

• Opening width reduced

• Ankle shape improved

• Lowered dorsum

• Reduced width metatarsal section

MORE NATURAL LOOKS

• Smooth surface texture

• Toe details improved

• Consistent quality and durability

NEW VALVE SETTINGS - TOTAL KNEE® 2000 & 2100

In order to clarify the valve settings of Total Knee 2000 and Total Knee 2100, we have changed

the following:

• A becomes F [flexion]

• C becomes E [extension]

• B becomes H [heel rise] it will be indicated as optional and will be covered by a sticker.

Also a yellow sticker has been added on the back link as a visual reminder that the socket should

not touch the upper half of the back link.

COLOR SWATCHES

New color swatches are available, with the 12 standard colors, showing the matt color on 1 side

and the glossy color on the other side. These swatches can be used for the CTi braces, Unloader

XT and Extreme braces, and of from early next year the Unloader One Custom brace will also

be available in custom paint options.

IMPROVED PATELLA CUP FOR CTI

CTi brace can be ordered with a patella cup, a protective cup that keeps the patella safe. User

feedback has led us to develop an improved patella cup, that fits in perfectly with the recent

improvements of the CTi brace. This new patella cup can be fitted on both new and old CTi

braces, in custom and OTS versions.

FEATURES AND BENEFITS OF THE NEW PATELLA CUP:

• Self-tracking design to stay positioned in front of the knee

• Thigh and patella shell to increase the thigh coverage

• Simple 5 point attachment system which fit both the CTi OTS and the CTi Custom

• Additional foam pad for improved cushioning

• Nylon laminate on patella cup and gear guards for increased durability and wear resistance

• Matte black finish which matches the aesthetics of the new CTi

ACCESSORY: OLD ITEM NUMBER: NEW ITEM NUMBER:

MX Kit Small B-705130072 B-711140002

MX Kit Medium B-705130073 B-711140003

MX Kit Large B-705130074 B-711140004

MX Kit X-Large did not exist before B-711140005

Gear Guards 22101 B-705000003

Patella Cup B-711130000 B-711130011

PRODUCT UPDATES

24

SURE-FLEX (JANUARY 2014)

Replacement products are Flex-Foot Assure or Balance Foot J, depending on the user profile.

Discontinued item numbers:

SFP0xyyz (BR) (xx=22-28; y=1-6, z= L or R)

SFX0xyyz (BR) (xx=22-28; y=1-6, z= L or R)

REHAB DROP LOCK (FEBRUARY 2014)

Discontinued item numbers:

B-233500000 Air Light R

B-233600000 Air Light L

B-234500000 Full Foam R

B-234600000 Full Foam L

B-236000000 Universal Air Light

B-235000000 Universal Full Foam

FROG SPLINTS (JUNE 2014)

Discontinued item numbers:

71963 Frog Splints Pad Sm 12Pk

71965 Frog Splints Pad Md 12Pk

71967 Frog Splints Pad Lg 12Pk

DISCONTINUATIONS

Note the dates of OT World 2014 in your

agenda: 13-16 May 2014!

You will have 4 days (Tuesday to Friday) at

the Trade Show, during which you will be

able to visit the Össur booth.

A sneak preview about what Össur is going

to present:

OA & INJURY SOLUTIONS

- Unloader One

- Rebound Cartilage

PROSTHETICS

- Unity

- Bionics

- Bionic Service Concept

In case you are planning to visit Leipzig for

OT World 2014, please think about arranging

your accomodation in time.

OT World 2014 – visit us in Leipzig

25

PLANNER, MULTI-TASKER AND WALKING ENCYCLOPAEDIA

Seizing all the opportunities the market

has to offer together with distributors.

If Marketing Manager B2B Yvonne van

der Rijt could sum up her ambitions in a single

sentence it would be this. Meet this versatile

professional, who not only sits at her desk

writing plans, but is also a multi-tasker, trou-

bleshooter, walking encyclopaedia and the

initiator of this magazine.

After completing her studies in communication

sciences, Yvonne started her career as a marke-

ting assistant with Somas in 2005. After a year,

she was promoted to Marketing Manager of the

Braces and Supports Division. She first became

acquainted with the international market when

she also became responsible for the Somas

International Division. After the company was

taken over by Össur, she fulfilled a similar posi-

tion, but her portfolio was expanded to include

Prosthetics as well as Braces and Supports.

Meanwhile, Össur’s business-to-business

department grew and, when a vacancy opened

up for a full-time marketing manager in 2013,

it did not take long for Yvonne to be appoin-

ted. Although her four immediate colleagues

travel all over the world, Yvonne’s main base

is still the office in Son en Breugel, where she

works on long-term plans, but is always ready

to undertake ad hoc action when necessary.

NOT DIFFICULT, BUT ENJOYABLE

The more intensive contact with customers

makes this job enjoyable for her to do. She

does not regard the cultural differences she

encounters as troublesome, but more as a huge

challenge. You cannot, for example, roll out a

marketing plan that works well in Turkey in

Poland and expect the same result. The market

requirements and the approach are vastly dif-

ferent. Yvonne has made a game out of working

out the best strategy for a country together

with the respective distributor. She uses all the

information she obtains from colleagues and

customers to release communication materi-

als in the right way, at the proper moment and

through the most appropriate channel. Despite

the occasional fortunately visible success, her

job is sometimes difficult because the results

are hard to quantify.

FROM HARDCOPY TO DIGITAL

Anyone who has been in the same line of work

for nearly ten years will notice the changes.

Yvonne has, for example, seen a clear shift away

from hardcopy to digital marketing tools. This

has been a global development that Össur has

thankfully effectively anticipated. With depart-

ments like ‘mobile solutions’ and a web team

to fall back on, Yvonne can also use on-line

tools and social media in the marketing mix

she presents to her customers.

INVESTMENTS IN KNOWLEDGE

‘Innovative’ is a word that is frequently used

and abused at the moment, but Yvonne believes

that Össur certainly deserves to be called by

this name. The sales figures for her own orga-

nisation obviously count, but the investments

that have been made in building up and trans-

ferring knowledge are also worth a great deal.

Yvonne recently organised, for example, a three-

day partner event in Volendam, during which

a vast amount of information was exchanged

by speed dating. An important outcome for the

Marketing Manager B2B is that customers want

more involvement in advance. This means they

can set translators to work and sort out all the

customs paperwork at an early stage. Yvonne

thinks it is a good thing this question came up.

It serves to emphasise what she feels every day.

Sending out the right flows of information at

the proper moment is an important criterion

in her profession for ensuring that products

are optimally placed on the market with the

correct amount of support.

Yvonne van der Rijt, Marketing Manager B2B

26

Changes, errors and typing errors are reserved

2 – 5 April 2014

WCO-IOF-ESCEO SEVILLE

2014: World Congress on

Osteoporosis, Osteoarthritis and

Musculoskeletal Diseases CME

Seville, Spain

10 – 11 April 2014

Anatomy and Surgical Exposures

in Orthopaedics Course

Oswestry, United Kingdom

11 – 12 April 2014

2nd International Congress on

Cartilage Repair of the Ankle

Prague, Czech Republic

8 – 9 May 2014

Lumbar Degenerative Disorders

Prague, Czech Republic

8 – 11 May 2014

10th Central European Orthopaedic

Congress (CEOC) & congress

of the Croatian Orthopedic and

Traumatology Association (COTA)

Split, Croatia

13 – 16 May 2014

OT World 2014

Leipzig, Germany

17 – 20 May 2014

ECTS 2014

Prague, the Czech Republic

14 – 17 May 2014

16th ESSKA Congress

Amsterdam, The Netherlands

26 – 28 May 2014

Iraq Medicare

Erbil International Fair Ground

Kurdistan Region – Iraq

4 – 6 June 2014

15th EFORT Congress

London, United Kingdom

17 – 21 September 2014

XL conference Polish society of

orthopaedics and traumatology

Wroclaw, PL

1 – 3 October 2014

EUROSPINE 2014

Lyon, France

8 – 11 October 2014

Rehacare

Düsseldorf, Germany

22 – 24 October 2014

Medikos

Serbia

2015

16 – 18 April 2015

2015 ICJR World Arthroplasty

Congress CME

Paris, France

27 – 30 May 2015

16th EFORT Congress

Prague, Czech Republic

2 – 4 September 2015

EUROSPINE 2015

Copenhagen, Denmark

* This agenda is an overview of

conferences and exhibitions Össur

wants to notify you about. It is not

intended to be complete and for

information we direct you to the

organizations of these events.

Agenda*

© ÖSSUR, 03. 2014

Össur Europe BVEkkersrijt 4106-4114PO Box 1205690 AC Son en BreugelThe Netherlands

TEL +31 (0) 499 462 840FAX +31 (0) 499 462 841 info-europe@ossur.com

WWW.OSSUR.COM

27

UNITY™

Sleeveless vacuum

No sleeve required

Greater mobility and user acceptance

15-22 inHg Vacuum

Effective volume stabilization

Simple design

Quick and easy to achieve/release vacuum

Independent pump

Foot function uncompromised

Light weight

Complete system weighs only 130g

WWW.OSSUR.COM TEL +31 (0) 499 462 840TEL +31 (0) 499 462 841info-europe@ossur.com