Archive for June, 2015

[Dissertation] The Braincon Platform Software – A Closed-Loop Brain-Computer Interface Software for Research and Medical Applications – Full Text PDF

Abstract

Brain-Computer Interfaces (BCIs) provide an auspicious opportunity for restoring movement to severely paralyzed persons, enabling communication with locked-in patients or improving efficacy in stroke rehabilitation. Therefore, this area of research has received great in interest in recent years and many research studies yielded excellent results. However, BCIs did not make the transition from research to clinical application and everyday home use.

A medical BCI needs to provide the means for recording neural activity in a stable and safe manner over several years while requiring minimal preparation time for everyday use. In addition, a medical BCI has to be safe for patients and users and needs to be certified as a medical device for use with human patients. These latter two regulatory and safety requirements cause an enormous increase of effort during development and testing.

The goal of Braincon is to be a general-purpose medical BCI (i.e., applicable to a wide range of research and medical indications) while reducing the effort for testing and regulatory compliance. Braincon consists of an implant for recording of neuronal signals and for electrical stimulation of brain areas and a software that processes neural data at run-time to control the implant’s electrical stimulation functionality.

This thesis focuses on the software component of Braincon (i.e., the Braincon Platform Software) and proposes a general, flexible and verifiable BCI software architecture with a filter pipeline for lowlatency multi-threaded processing of neuronal signals. In addition, a guide on the juristic and regulatory environment for the development of medical software is given together with a description of the test strategy and test tools employed for a regulatorily compliant verification of the Braincon Platform Software. The computational load and latency (i.e., the time that a BCI system needs to react to user input) are measured for different filter pipeline implementations, for different numbers of threads and for typical feature extraction and decoding algorithms from the BCI domain.

Results show that BCIs in general can benefit from the proposed parallelization: firstly, by reducing the latency and secondly, by increasing the amount of recording channels and signal features that can be used for decoding beyond the amount which can be handled by a single thread. The proposed software architecture was successfully employed in a human BCI study to show its capability for online decoding of neuronal signals. Furthermore, Braincon was put to the test in an in vivo sheep study. Results show that the neuronal signals recorded by Braincon are comparable to the signals recorded by a commercially available, non-implantable recording device. One sheep was chronically implanted, yielding successful verification of Braincon’s in vivo measurement and stimulation capabilities.

In conclusion, the Braincon Platform Software is a flexible and powerful tool for BCI research and has the potential to promote the development of BCI-based treatments for human patients with minimal regulatory effort.

Full Text PDF

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[ARTICLE] “Kinect-ing” With Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation – Full Text PDF

Microsoft’s Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals.

This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource.

Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice.

Full Text PDF

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[ARTICLE] A Comparison of Primed Low-Frequency Repetitive Transcranial Magnetic Stimulation Treatments In Chronic Stroke

Abstract

Background: Preceding low-frequency repetitive transcranial magnetic stimulation (rTMS) with a bout of high-frequency rTMS called priming potentiates the after-effects of the former in healthy adults. The utility of primed rTMS in stroke remains under-explored despite its theoretical benefits in enhancing cortical excitability and motor function.

Objective: To ascertain the efficacy of priming in chronic stroke by comparing changes in cortical excitability and paretic hand function following three types of primed low-frequency rTMS treatments.

Methods: Eleven individuals with chronic stroke participated in this repeated-measures study receiving three treatments to the contralesional primary motor cortex in randomized order: 6 Hz primed 1 Hz rTMS, 1 Hz primed 1 Hz rTMS, and sham 6 Hz primed active 1 Hz rTMS. Within- and between-treatment differences from baseline in cortical excitability and paretic hand function from baseline were analyzed using mixed effects linear models.

Results: 6 Hz primed 1 Hz rTMS produced significant within-treatment differences from baseline in ipsilesional cortical silent period (CSP) duration and short-interval intracortical inhibition. Compared to 1 Hz priming and sham 6 Hz priming of 1 Hz rTMS, active 6 Hz priming generated significantly greater decreases in ipsilesional CSP duration. These heightened effects were not observed for intracortical facilitation or interhemispheric inhibition excitability measures.

Conclusion: Our findings demonstrate the efficacy of 6 Hz primed 1 Hz rTMS in probing homeostatic plasticity mechanisms in the stroke brain as best demonstrated by differences CSP duration and SICI from baseline. Though 6 Hz priming did not universally enhance cortical excitability across measures, our findings pose important implications in non-invasive brain stimulation application in stroke rehabilitation.

via A Comparison of Primed Low-Frequency Repetitive Transcranial Magnetic Stimulation Treatments In Chronic Stroke.

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[WEB SITE] Changing a Common Belief About Brain Injury

As a scientist, I am impassioned to share research findings that upend conventionally-held wisdom about the brain – modifying viewpoints that are obsolete, wrong, and disabling.

The journal Neuropsychological Rehabilitation has just published the results of a study conducted by our interdisciplinary team of experts at the Center for BrainHealth at The University of Texas at Dallas. The study found that strategy-based cognitive training significantly improves the cognitive performance, psychological and neural health of those who have experienced a traumatic brain injury (TBI), long after the initial injury.

These findings should permanently put to rest the view, once commonly held among scientists and the medical community, that the brain can only recover lost functions for a period of one year following injury. Unfortunately, insurance companies still base their coverage policies on this outdated assumption. What’s worse, many of those afflicted with TBI may be tempted to give up on their recovery based on what we now know to be false.

The latest findings are sure to bring much-needed hope to the 5.3 million Americans living with TBI and their family members. TBI continues to be a leading cause of death and disability, and is a particular risk for our service members; more than 327,000 have been diagnosed with TBI since 2000. Whether caused by the blast of a bomb, or sustained in a car accident, a fall, or playing sports, such injuries–even those considered mild–can have consequences that last an entire lifetime.

Those who have sustained traumatic brain injuries often experience persistent cognitive difficulties, including poor ability to focus on the task at hand, to make decisions, or to anticipate consequences. They may feel overwhelmed or paralyzed when faced with too much information or the need to generate solutions to problems. They may also suffer from psychological difficulties, such as depression and post-traumatic stress disorder, which further hinder their participation in and enjoyment of daily activities.

Fortunately, as our study and other research reveals, the brain–even an injured brain–has tremendous power to grow, change, rewire and repair itself throughout life. We are also learning the rewiring of a brain depends on the degree to which it is challenged. If a person with a brain injury is trained using predominantly low-level thinking tasks, those are the connections that will be rebuilt.

Until now, most TBI treatment protocols have focused on restoring basic mental functions, such as memory or attention. The belief has been training should occur from the bottom up to help those with TBI rebuild their skills and mental capacity. Typically these training regimens ignore higher level thinking skills controlled by frontal lobe networks, such as decision-making, planning and judgment.

Through this study, we sought to test the hypothesis that a strategy-based cognitive training regimen focusing on higher-level thinking skills would be a more effective way to repair the brain after injury than a training that taught important facts about the brain and how it operates. Using a program we developed that focuses on improving higher-level thinking skills, we set out to determine whether this training could improve brain health and cognitive function in adults with TBI. Specifically, we wanted to find out if the training could help an individual make gains toward achieving his or her personal best.

We examined 60 individuals, both veterans and civilians, between the ages of 19 and 65 who had sustained one or more traumatic brain injuries. More than two-thirds of study participants were injured a decade or more ago, well beyond the one-year period previously thought to be the limit of brain recovery.

Study participants who received strategy-based cognitive training saw significant improvement in memory and the ability to think abstractly. They reported a 60% reduction in depressive symptoms as well as an almost 40% reduction in symptoms related to post traumatic stress disorder. Blood flow to the frontal lobe region of the brain–the area responsible for memory, attention, decision-making and problem-solving–also increased significantly following the strategy-based training. And participants continued to realize cognitive, psychological and brain blood flow benefits three to four months after training, suggesting their health continued to improve even after the training ended.

The implications of these research findings are enormous. No longer can we falsely assume that brain injury survivors can recover only for a certain period or that they are destined to regain only a limited number of skills. The potential for improvement is far greater than previously believed possible. With the right interventions, TBI survivors can continue to make progress repairing their brain’s health and their lives for many years. That knowledge should significantly change the way we think about–and address–this enormous public health challenge.

via Changing a Common Belief About Brain Injury | Sandra Bond Chapman, Ph.D..

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[BOOK] Medical books online: Physiotherapy book online

Medical books online is a website for doctors,nurses,medical students to give review about medical book its contains, about its author and its usefulness. Physiotherapy book online Practical guide to hemiplegia treatment book review Hemiplegia, a lot of unremarkably referred to as a stroke, isn’t simply a medical specialty or a contractor condition, however one with a psychosocial impact on the patient’s life. A sensible Guide to paralysis Treatment addresses the therapy management of paralysis specializing in the broader wants of the patient. This book is split into varied topics starting from basic anatomy and physiology of the human brain and development of the systema nervosum, to clinical diagnosing, symptomology, and therefore the management of paralysis complications. The necessities of rehabilitation medication and approach to treatment area unit lined intimately. For fast reference, varied exercises and treatment techniques area unit divided into lying, sitting and standing positions. Chapters on orofacial rehabilitation, perception, orthotics and management of complications offer a home care programme for paralysis patients. fifty five pictures and illustrations enhance the data provided during this comprehensive guide to paralysis treatment. Key Points

  • Clear format for fast reference and sensible use
  • Chapters embody basic anatomy of human brain and systema nervosum through to symptoms and rehabilitation
  • 55 pictures, illustrations and tables.

via medical books online: Physiotherapy book online.

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[WEB SITE] 5 Things Every TBI Survivor Wants You to Understand

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March is National Brain Injury Awareness Month, and as promised, I am writing a series of blogs to help educate others and bring awareness to traumatic brain injuries (TBI).

1. Our brains no longer work the same.

We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

2. We suffer a great deal of fatigue.

We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

I love doing things others do, however my body does not appreciate the strain and causes me to ‘pay the price,’ which is something that others don’t see.  I like to describe that my cognitive/physical energy is like a change jar. Everything I do costs a little something out of the jar.  If I keep taking money out of the jar, without depositing anything back into the jar, eventually I run out of energy. I just don’t know when this will happen.  Sometimes it’s from an activity that seemed very simple, but was more work then I intended. For me, like others with TBIs, I’m not always aware of it until after I’ve done too much.

Continue —>  5 Things Every TBI Survivor Wants You to Understand | Amy Zellmer.

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[WEB SITE] Intense Therapy Helps Restore Arm Function Long After Stroke: Study

Participants had been severely impaired for a year or more

Intense Therapy Helps Restore Arm Function Long After Stroke: StudyTUESDAY, June 23, 2015 (HealthDay News) — Intensive physical therapy helps restore arm function in people who have survived a severe stroke, a new study finds.

University of Florida researchers followed 39 patients who underwent intense physical therapy for the arms five hours a day, five days a week, for 12 weeks.

For the study, the team “enrolled people who had a stroke a year or more prior to their study participation, and who were still severely impaired,” lead researcher Janis Daly, a professor of neurology in the College of Medicine, said in a university news release.

“The magnitude of recovery we observed in our study is higher than any other studies that have been published so far, which supports the promise of longer treatment and more intensive treatment after stroke, even for those who are more severely impaired,” she added.

Three rehabilitation methods were used. One was motor learning rehabilitation, in which patients concentrate on performing a movement as deliberately as possible and constantly repeat the movement.

Another method was electrical stimulation rehabilitation, in which electrodes stimulate the muscles on the forearm and cause the hand to lift. The third method was robotics-assisted rehabilitation, in which robotics software assists with arm movement.

One group of patients did five hours a day of motor learning alone, while the other patients did motor learning for 3.5 hours and either electrical stimulation or robotic-assisted therapy for 1.5 hours.

On average, patients in all three groups doubled or nearly doubled the ability to use their stroke-affected arm, according to the study.

“The recovery was meaningful to patients in terms of physical function. Each person’s recovery was somewhat unique,” said Daly, who is also director of the National Veterans Affairs Brain Rehabilitation Research Center of Excellence in Gainesville.

“Some had dramatic recovery, some had less,” Daly explained. “Some were able to perform functional tasks that they weren’t able to do before; some recovered the ability to move their arm so they could actually place the arm for functional tasks, for example into the sleeve of a sweater.”

A larger study is needed to confirm the findings, Daly noted.

The study was published in the June issue of the Archives of Physical Medicine and Rehabilitation.

When the researchers calculated the salaries of the therapists and the cost of rehab equipment, they estimated that treatment for each patient cost between $4,500 and $5,600.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about stroke rehabilitation.

SOURCE: University of Florida, news release, June 12, 2015

via Intense Therapy Helps Restore Arm Function Long After Stroke: Study.

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[WEB SITE] SureStep: A Revolutionary Bracing Concept

AFO Mechanics

surestep-2SureStep manufactures a variety of products but is primarily known for the SMO (Supra malleolar orthosis) and pediatric AFOs (ankle foot orthosis). The SureStep SMO is meant for patients up to 80 pounds with hypotonic presentations. The purpose is to control the side to side movements of the ankle. The trim lines can be extended longer laterally or medially depending on whether the patient is pronating or supinating. As patients grow older there is a device called the Big Shot that accommodate children and adults weighing over 80 pounds. What makes the SureStep SMO so unique is the dynamic function that the brace allows. It uses compression to create alignment, unique trim-lines to allow freedom of motion where needed, and made from a material that travels together along with the foot.

Controling the Tri-Planar Deformities

This works under compression to maintain stability through midline. In young patients with CMT they can possibly present with a more over pronated foot position because of the low muscle tone (hypotonia) prior to developing a high arch foot presentation. This can been seen in CMT patients who have some symptoms of the disease but have not developed a high arch otherwise known as pes cavus foot. The SMO holds the heel in vertical alignment, giving stability in a coronal plane (side to side) position. An SMO is not necessarily for a patient who has weaknesses pushing up or down the ankle, just poor side-to-side movement.

Improving Stability During Gait

The device is designed to allow for motion to still occur from in and out of the midline position but limits the extremes that the foot would go to, in other words the extreme rolling inward our outward of the ankle. The goal is to improve balance and stability, or limit orthopedic injury. This helps limit out toeing or in toeing as well by improving the position to foot is landing on the ground. Having improved alignment may also utilize remaining strength for dorsiflexion or plantarflexion because the line of pull that these muscles are in has improved line of progression.

Fitting the Device

The trim-lines of the SureStep SMO are designed to be either longer on the lateral border for pronation or medial border for patient who supinate excessively and the orthotist should make the appropriate selection based on the patient’s mechanics. These trim-lines are critical to the successful outcome of this device. Although the SureStep SMO is primarily designed for a younger population as children get older or adults who still have need for such a device the same mechanism of function can be accomplished using the BigShot SMO manufactured by SureStep.

Continue —>  SureStep: A Revolutionary Bracing Concept | Lower Extremity Review Magazine.

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[WEB SITE] Kinetic Research: Carbon Fiber Orthopedic Braces

AFO Mechanics

Composite material advances over the past 10 years have improved the design creativity and possibility for clinical orthotists worldwide. In the past, an ankle orthosis required a completely solid and fully encompassing design in order to attain the mechanical control, durability and ultimately the function needed for corrective ankle varus bracing. These devices were essentially plastic shells that created a solid/static environment which was safer than not using a brace at all, but they were also highly problematic with patients complaining of pressure points and a clunky gait. Today we can simulate more natural gait patterns while completely avoiding pressure points.

Controlling the Tri-Planar Deformities

Custom ValgaNoodle AFO with Pre-Tibial Shell - Model: NPVKinetic Research offers a variety of ankle braces, each with its own character and effect to meet the needs of the user, from the most basic needs to the most complex. For folks that have foot/ankle weakness but have good alignment of their ankle, we offer the Noodle line of AFOs. These are the most dynamic and least restrictive designs for controlling drop foot. When the user has a tight heel cord with mild supination or ankle varus, they become a candidate for a PLS design. When the user has more significant ankle varus he/she becomes a candidate for the ValgaNoodle AFO. The ValgaNoodle offers the highest degree of lateral control that we can provide. It’s important to have a team approach when choosing the type of AFO that will work best for your individual needs, and there is always a trade off between control and mobility. The team is made up of the patient, the orthotist and the physician/therapist, and all have to be involved for the best results. The objective is to “put on as little as possible, but get the job done”.

Improving Stability During Gait

The ValgaNoodle is made specifically for varus control. It’s a highly custom AFO, meaning. That it is not assembled using pre-made components. The creation of a ValgaNoodle begins with a highly skilled orthotist who will evaluate and cast for the device. That attending orthotist will manipulate and control the patient’s foot while he is casting, keeping the ankle in the best position possible to maximize the effect of the finished ValgaNoodle. Evaluations and observations made by the clinical orthotist are then incorporated into a design formulation that will work best for the individual patient. The design details are then determined based on the level of control vs free movement that is needed to maximize the performance of the user. One of the objectives is to keep the ValgaNoodle lightweight and as simple to use as possible. The orthotist will select the device based on the severity of the case, as well as the users lifestyle, activities and footwear.

Fitting the Device

The one common mechanical concept for the ValgaNoodle variations of AFOs is, that they will all have a single medial strut with a floating lateral “reverse T” cuff.

Design options for the footplate:

  • Flat, in which we match the bottom of the shoe. When we make it in this format, it will usually have a custom foam removable arch support. It offers the least control but because it’s flat, we can make it flexible.
  • Contoured. This is similar to a UCBL footplate. Our technicians will adjust the cast taken by your orthotist to increase lateral control in a compact way for easy shoe selection.
  • Contoured with high control. This system goes higher than the UCBL, encompassing the dorsum of the foot, and has a special 3-point strapping system to provide maximum control.

Design options for the strut:

  1. Solid ankle, the highest level of control, removing the user’s ability to dorsi/plantar flex.
  2. Dynamic, which allows dorsi/plantar flexion, but with reduced lateral control.

Design options for the cuff:

  1. Posterior, for a normal or hyperextended knee.
  2. Anterior, generally used for knee extension weakness. Easier to don, but limited to low top shoes.

Continue —> Kinetic Research: Carbon Fiber Orthopedic Braces | Lower Extremity Review Magazine.

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[WEB SITE] Allard USA: Get Back Up Today! | Lower Extremity Review Magazine

What is the treatment for foot drop?

The most common treatment is an ankle-foot orthosis (AFO) which provides support to the ankle and foot. The AFO helps control foot drop and ankle instability by providing a better sense of balance. Often times, individuals are fit with a custom molded plastic AFO, however, there are other orthotic options available that provide superior function and performance.

The goal of orthotic treatment options is to help you maximize your mobility and independence. Chances are your most important need is to be able to walk better, without assistance and for longer periods of time without getting exhausted. Hundreds of thousands of people with foot drop have experienced a mobility rebirth thanks to the stability and dynamic assistance provided when wearing ToeOFF®, a unique patented carbon fiber composite AFO.

What is ToeOFF and how does it work?

Allard ToeOFF FantasyThe ToeOFF product line is made of ultra-light weight materials including carbon fiber, fiberglass and Kevlar®. The light weight is especially important to those individuals affected with neuro-muscular deficits from CMT. ToeOFF provides a natural biomechanical response similar to the movement of your own muscles. The footplate and “open heel” design are major contributors to the function of the ToeOFF. When your heel strikes the ground, energy passes down the side of the AFO to create a dynamic response that reflects the energy to the footplate to prevent “foot slap” and lift up the forefoot, much like the spring of a swimming pool diving board. The design and materials allow for enough strength to control the position of your foot as you swing your leg, making walking easier with less energy consumption. Unlike a custom molded plastic AFO that covers and immobilizes the ankle, the ToeOFFs open heel design allows your heel to move freely as it normally would, allowing proper biomechanics to occur in the foot.

What are the benefits of ToeOFF?

ToeOFF provides a stable, fluid, propulsive and symmetrical walking pattern. ToeOFF can improve your quality of life by:

  • Restoring balance and improving stamina – ToeOFFs strong and durable design allows you to move on uneven surfaces and climb stairs or ramps more confidently and independently, without stumbling or falling. Studies have shown that ToeOFF users can walk further in ToeOFF than in conventional molded plastic AFOs.
  • Decreasing risk of muscle atrophy – A recent study revealed that plastic AFOs can lead to ankle immobilization which resulted in calf muscle atrophy.
  • Fits well into good support shoes without having to increase shoe size – The thin and lightweight carbon fiber design ensures that you can wear your AFO inside any standard shoe that provides good support – without increasing your shoe size!
  • Providing function with fashion – Ask your orthotist about our Fantasy line that offers ToeOFF in ivory, purple, black or dark blue, or the removable SoftSHELL covers that are offered in beige or dark brown.

How do I obtain a ToeOFF?

ToeOFF Products require a prescription from your physician and must be fit by a certified orthotist who will go through an eight-step customization process. The ToeOFF product line offers a variety of AFOs with graded stability to accommodate for different individual’s needs, sizes, and stabilizing properties. While the ToeOFF products are state-of-the-art in both materials and design, not every individual may be a candidate for ToeOFF.   Allard USA offers a 30 day “Try It – You’ll Like It” Patient Satisfaction Guarantee for you to “test” that the ToeOFF will work for you. Talk to your physician about specifying “Allard ToeOFF – no substitutions” on the prescription and specifically ask for Allard ToeOFF with your Orthotist – this will ensure that you are offered the unique patented design of the ToeOFF. ToeOFF products are covered by Medicare and most insurance companies.

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Continue —> Allard USA: Get Back Up Today! | Lower Extremity Review Magazine.

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