Avril McCarthy's presentation presentation to the 2014 Academy for Healthcare Science Congress

1. Healthcare science in action – how scientific and technological
innovations are supporting service personnel on their return from combat
Avril McCarthy, Lead Clinical Scientist & MedTech Lead for D4D
Technology Innovations from “Devices for Dignity” (D4D)
Healthcare Technology Co-operative (HTC)
HTCs: “National resources embedded in the NHS, intended to accelerate new treatments
and technologies into practice to improve healthcare quality and well-being for patients.”

2. Outline
• Overview of Devices for Dignity (D4D)
• Relevance of D4D to Injured Combatants
• Challenges / opportunities for Healthcare Science

3. Mick Brennan, ex Royal Signals from Doncaster, Sochi 2014
To deliver innovative
healthcare technologies
that preserve dignity and
promote independence
for people of all ages living
with long term conditions
D4D Mission:
Clinicians
Academia
Businesses
Patient
focus
Patients and
Public

4. Relevance of D4D to Injured Combatants
• D4D focuses on functional limitations that impact
dignity & independence irrespective of cause –
holistic approach
• Dignity: core value of Geneva Convention
– human dignity of all individuals must be respected
at all times
• 4.8M veterans in UK ( estimate)
– 2.9M > 65yrs
– 52% of veterans have a long-term illness, disability
or infirmity (compared to 35% for non-veterans)
Paralysed ex-serviceman “Terry” using
an environmental control system to
open his front door remotely

5. Urinary Continence Management (UCM)
Major reason for loss of self-esteem/social isolation
2nd most common reason for need for institutional care
Renal Technologies (RT)
0.05% of population on dialysis but 2% of NHS budget
14% of older population with CKD
Assistive and Rehabilitative Technologies (ART)
11 million people in the UK with disabilities
Three areas of focus (Themes):

6. Functional Limitations & Causes
Stroke
Traumatic Brain Injury
Loss of
Mobility
Limb deficiencies
from amputation
Impaired:
Swallowing
Speech
Cognition /
memory
Impaired
muscle
control
Meningitis
Trauma
Incontinence
Spinal Cord Injury
Diabetes
Impaired Senses

7. Functional Limitations & Causes
Stroke
Traumatic Brain Injury
Loss of
Mobility
Limb deficiencies
from amputation
Impaired:
Swallowing
Speech
Cognition /
memory
Impaired
muscle
control
Meningitis
Trauma
Incontinence
Spinal Cord Injury
Diabetes
Impaired Senses

8. Functional Limitations & Causes
Stroke
Traumatic Brain Injury
Loss of
Mobility
Limb deficiencies
from amputation
Impaired:
Swallowing
Speech
Cognition /
memory
Impaired
muscle
control
Meningitis
Trauma
Incontinence
Spinal Cord Injury
Diabetes
Impaired Senses

9. D4D Project Portfolio
22 MedTech Projects:
• ART: Postural support, mobility aids,
swallowing, communication aids
• RT: Monitoring & self-management
technologies
• UCM: Catheter design, treatments for
incontinence, early diagnosis of
urinary infections
And importantly - we are open to
suggestions for new unmet needs
Example D4D Technologies

10. Banter, Bevvies & Bathrooms…
Communication difficulties – no banter 
– Giving or restoring a voice to those who
have lost their own – common in TBI
1. Improved communication aids in ICU for
those mechanically ventilated , willing
but unable to speak
2. Improved text-to-speech prediction app
with choice of voices
3. Self-directed speech therapy for
retraining vocal muscles
• NIHR i4i Project about to start
Ben Parkinson with his voice output aid – he
then progressed so donated it to a Veteran
who’d had a stroke

11. Banter, Bevvies & Bathrooms…
Swallowing difficulties
 TBI dysphagia incidence: 38%-65%
– High risk of aspiration pneumonia
 Electrical stimulation (ES) therapy
– Stimulation + exercise to improve swallow
function
– Randomised pilot trial: 1mth+ post-stroke
• 75% ES with significantly improved swallow v
57% on normal treatment (control)
• Significant improvement in ES QoL (SwalQol)
– Fully powered trial in planning
  Nutrition
in a bag


12. Banter, Bevvies & Bathrooms…
• Working on new urinary catheters to
reduce trauma, catheter-associated
infections & aid usability
• Diagnose, treat & manage
incontinence e.g. peripheral tibial
nerve stimulation for OAB
– >50% incidence post coma following TBI
• Development of aids for activities of
daily living e.g. showering/toileting
Ultra-lightweight folding shower chair for travel

13. 2204 UK military trauma patients 2003-10: Trauma Types
• Traumatic Brain Injury (TBI)
– In 2010, as high as 60% at DMRC with TBI
• Pelvi-perineal injuries
– Pelvic fracture: 261 (12%)
– Perineal injury: 118 (5.4%)
– Perineal with Pelvic fracture: 63 (2.9%)
• Only 27% survived
• Lower limb amputation >240
– + Pelvi-perineal injury = “Signature injury”
of Afghanistan conflict
• High likelihood (70%) of incontinence
post direct injuries (pelvi-perineal) or
60% with indirect (TBI) injuries
– High physical & psychological impact
Image source: Colonel John Etherington, DMRC
Colostomy
Bowel damage
Pelvic fracture
Finger
& upper
limb
tendon
damage
Traumatic Brain Injury (TBI)

14. Rehabilitation Challenges: Prosthetic
• Number / Complexity of other injuries
– e.g. Donning & doffing prosthetics one-
handed or with missing digits
– Spasticity related to TBI/SCI
– Sensory loss
• Complex stump/socket interface
– Achieving a stable fit
– Risk of further injuries if a poor fit
(pressure ulcers etc )
– Heterotopic ossification (uncontrolled
remodelling)
• Upper limb devices
– > degrees of freedom needed so more
challenging control problem
Genium X3 “bionic” waterproof, above
knee lower limb prosthesis (left) in action
Heterotopic ossification

15. New Rehabilitation Technology Opportunities
• Other wearable technologies
– Lower limb exo-skeleton for spinal cord
injury (SCI), stroke, TBI
– New materials – “soft robotics” to
integrate more easily into daily living –
EPSRC research collaboration in planning
– Upper limb assist devices for those with
neurological weakness
Ekso Bionics lower limb exoskeleton – Ian’s first
time upright & walking in 3 years following SCI

17. Evolving challenges for Healthcare Science (& Society)
Conflicts have led to accelerated advances in
emergency medicine / rehab that also
benefit non-military patients.
• However, leads to  number / complexity /
severity of now survivable injuries
• Resulting in long-term support challenges
– Requiring a comprehensive integrated
approach (including psychological)
• Including planning for long-term care of ageing
survivors
– Those with life-changing injuries will also begin
to experience age-related conditions

18. We should view the survivors’ experiences as a
valuable resource & invite them to help co-develop
medical technologies for the future
Opportunities for Healthcare Science (& Society)
D4D Innovation Model

19. 8 NIHR HTCs: Direct/indirect relevance to combatants
NIHR HTC Name Host NHS Trust Research Theme/s
Brain Injury
Cambridge
University Hospitals
Acquired & developmental brain injury across acute care pathway
Cardiovascular
Guy’s and St
Thomas’
Atherosclerosis, Arrhythmias, Heart failure & structural heart disease
Colorectal Therapies
Leeds Teaching
Hospitals
Minimally invasive therapies for colorectal disease
Devices for Dignity
Sheffield Teaching
Hospitals
Urinary incontinence management, renal technologies, assistive &
rehabilitative technologies
Enteric Barts Health
Stoma complications, neuromodulation for faecal incontinence, novel
diagnostics for chronic GI disease, improved GI surgery
MindTech Nottinghamshire Mental Health and neuro-developmental disorders
Trauma Management
University Hospitals
of Birmingham
Trauma: Immediate Care, Secondary Care, Regeneration,
Rehabilitation
WoundTec
Bradford Teaching
Hospitals
Wound management

20. Lest we forget…
“Treat your men/women as you would your own
beloved sons/daughters.
And they will follow you into the deepest valley.”
Sun Tzu, c 510BC, “The Art of War”,
Submit an unmet need: www.devicesfordignity.org.uk