Conference reports

“REHABILITATION ENGINEERING: PROBLEMS OF COMMUNICATION AND MOBILITY”

Southampton, 9-11 April 1979

The 9th Conference in the series of Recent advances in Bio-Medical Engineering was devoted to specific aspects of Rehabilitation and on the first two days the organisers endeavoured to a arrange co-ordinated presentations and discussions on the problems of the hearing impaired and the speech impaired. Hearing was discussed on the first day, the programme being arranged and chaired by Dr. A.R.D. Thornton of the M.R.C. Institute of Hearing Research at the Department of Otolaryngology at the Royal South Hants Hospital.

The morning session was devoted to review papers which covered historical development leading to the present state of the art in various aspects of the field of audiology. Mr. Worgan laid the founda- tions in his review of the anatomy and physiology of the hearing system. He went on to detail the current method of surgical repair of outer and middle ear disorders. Dr. Brooks reviewed the methods by which the outer and middle ear disorders may be diagnosed and described the subjective tests used to detect disorders of the inner ear or hearing organ. Having looked at the problems involved and their diagnosis, Mr. Martin described the range of hearing aids and other rehabilitation equipment available to the hearing impaired. It would appear that, in this field, there is much more that could be done by the proper application of existing tech- nology. Professor Cooper described the complex parameters involved in prescribing and fitting a hearing aid to the individual patient, including several important non-auditory considerations.

Professor Evans reviewed the progress made in artificial auditory stimulation which involves the implantation of an‘electronic hearing organ’ which would directly stimulate the auditory nerve fibres in those patients who have a total hearing loss due to a deficit of the hearing organ. In this area, more research and quantitative evaluation of results is needed but, in the long term, it seems hopeful that the many existing problems will be overcome.

In the afternoon, research papers provided inform- ation about important areas which have been relatively neglected. Mr. Lawton described electro- acoustic modification to improve the performance of standard NHS hearing aids and Dr. Markides presented data comparing the performance, cost etc. of different types of classroom hearing aids. Mr. Shulberg showed data on the use of free-field audiometry as a comparative system for evaluating and fitting hearing aids. Mr. McCormick outlined some new findings about lipreading ability, made possible by detailed analyses and the use of video-tape facilities. There seems to be no sicgnilicant difference in the ability

to lipread equivalent live and video-tape present- ations. During a general discussion on future trends, the possible application of electrophysiological diag- nostic development to rehabilitation was discussed by Miss Saunders. Dr. Bloom detailed various ways in which speech reception could be studied and aided by the application of signal processing tech- niques. Mr. Rice and Mr. Shipley considered priorities for future hearing aid research and trends in the rehabilitation and assistance of the hearing-impaired. The programme for the second day made the transition from the problems of hearing to speech impairment. The chairman, Keith Copeland, used slides to illustrate some of the control and comm- unication devices which had been developed to assist the speech impaired and severly disabled. Referring to the initiation of the original device, he paid tribute to the dedication of a few indivi- duals, the support of a charitable trust and the enthusiastic collaboration of the Department of Health. This combination had at the time ensured rapid development of this type of biomedical tech- nology. Each succeeding generation of electrical and electronic technology was utilised for the medical field. We were now in the third genera- tion of devices to assist the severley disabled, and we must assess carefully how complicated these devices needed to be. The papers presented all reported new and original work beginning with a communication by Mr. A.C. Downton who with Dr A.F. Newell of Southampton University has developed a Palantype Transcript system whereby a speech may be presented on a plasma display panel in phonetic format whilst it is taking place by utilising the Palantype shorthand typewriter. The system was illustrated by a film and a further extension of the system is under development to display phonetic sub-titles on television sets via the ‘Ceefax’ and ‘Oracle’ systems. ‘Micro-Ed’ aptly described a microprocessor cased communication system for handicapped children developed at the University of Surrey by Mr. A.G. Cartwright. The system lends itself to alteration and adaptation to meet changing requirements. Mr. D.R. Ollington of Malden Electronics described and demonstrated a small communicator for the speech impaired; in size and style similar to a pocket calculator. He asked guidance from the audience as to its future development. The next presentation was truly multi-disciplinary involving a speaker from industry, a general prac- titioner, a speech therapist and electronics eng- ineers. In introducing ‘SPLINK’ - an abbreviation for Speech Link, Mr. John Piper said that the instrument had been initiated in August 1977 as a

J. Biomed. Engng. 1979, Vol. 1, October 303

Conference reports

result of the dedication of Dr. Grey Hamilton to his many patients who had suffered strokes with a resultant loss of speech. The transducer between the hand and the display system is a keyboard of 32 rows by 32 columns upon which are marked: words, suffixes, prefixes, phrases and commands. The keys are linked via a micro-processor to a display - an ordinary television receiver. The voca- bulary has been derived from a number of sources. Mr. Reed and Dr. Copping of Bristol University gave details of the electronic system and abilities of the instrument. Ms. Pam Enderly from Frenchay Hospital, Bristol reported on the evaluation trials of the system which had been used for periods of two weeks in their homes by ten people whose ages ranged from 6 to 63 years. These people and their relatives had had no difficulty in using the system.

A paper, given by Mr. J.M. Low of Aberdeen Uni- versity described a ‘body-worn delayed Auditory Feedback Fluency Aid for Stammerers’. The principle of delayed auditory feedback had been recognised for twenty years as a technique for improving fluency but instruments had only been available in desk top form. The speaker described a light weight instrument connected to a tie-pin microphone and two standard magnetic earpieces which had pre-set adjustments of acoustic gain up to 24 dB SPL and delays over the range 50 mS to 300 mS.

The final session of the day, organised by Mr. Nigel Ring of Chailey Heritage was devoted to a ‘Round

the Table’ discussion on Technical Aids for Non- Verbal Communication.

The third day of the conference comprised a morning session only at which some problems of mobility were discussed. In opening the session Dr. J.C. Robertson of Salisbury General Infirmary illustrated dramatically with numerous slides the importance of movement of patients - whatever they are doing - in order to alleviate pressure sores. Mobility he said meant good ergonomics and good ergonomics cost money. The lecture illus- trated that good patient management could prevent an enormous amount of suffering and sub- sequent expensive plastic surgery.

Mr. Eric Booth of Queen Mary College, London then described research work which had been undertaken in collaboration with industry to develop special mobility aids for children and films illustrated these devices in use. Two of the aids were also exhibited.

The morning’s session and the conference con- cluded with a discussion session opened by Mr. Nigel Ring in which he described with the aid of slides and a film special mobility aids for children. This discussion seminar and that on communica- tion aids the previous day were made the more effective by the active participation of some disabled people themselves.

Roger Thornton and Keith Copebnd

SECOND SYMPOSIUM ON METHODS AND MATERIALS FOR FRACTURE FIXATION

Stoke-on-Trent, 11 May 1979

This symposium held in the Medical Institute at Stoke-on-Trent was the second one of the series and was attended by some sixty people. It was organised jointly by the Biological Engineering Society, the Bio-Medical Engineering Unit of the North Staffordshire Polytechnic and the Ortho- paedic Department of the North Staffordshire Hospital Centre at Stoke-on-Trent. Nine speakers presented papers which dealt with operative and conservative methods of treatment applied to trochanteric and lower femoral fractures and there were also papers dealing with mechanical and materials aspects.

Mr. Phoenix, the Head of the Bio-Medical Engin- eering Unit, dealt with ‘Classification and Mecha- nisms of Femoral Fractures’, in particular the stress patterns in the different regions of the femur related to the types of injury observed. Using sheets of paper as modeis he illustrated the effect of crack propagation under the action of different modes of stress and was able to show the effect of grain boundaries as crack stoppers. The first

clinical paper was given by Mr. D. Bracey, Ortho- paedic Department, Stoke-on-Trent, who spoke about ‘Nailplate Fixation of Trochanteric Fracture. From a review of the literature he concluded that the way in which these plates were used was more important than the characteristics of the individual plates. The local preference was for the one-piece nailplate rather than the multi-component device. In a review of eighty-six cases, breakage of the device appeared to be the least of the problems and was only experienced in one out of this total num- ber. Migration of the nail appeared to be the great- est problem, with 13% showing penetration of the femoral head. In suitable fractures, reconstruction of the medial side of the femur was of primary importance and the use of telescopic nails appeared to offer some possible advantages. The Sarmiento technique of osteotomy was presented as a possible method for converting an unstable fracture into a stable one. However, if this technique is used, training of the surgeon is of absolutely vital impor- tance. It became apparent as a result of this review that that treatment of these fractures is not as simple as is sometimes supposed.

304 J. Biomed. Engng. 1979, Vol. 1, October