1 20 187 https://staging.drfop.org/files/original/1bc3249b9871bf77d6deaebeec0f9573.pdf 062b6087654766cc1458acca6e7a8016 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/cpo/pdf/1984_04_028.pdf Text Any textual data included in the document <h2>Technical Note: Rigid A.F.O. - Another Choice</h2> <h5>Robert E. Doran, C.P.O. <a style="text-decoration: none;">*</a></h5> When an orthotic prescription calls for an ankle/foot orthosis to provide rigid ankle/foot stabilization, the two basic choices have been (1) a double bar metal orthosis or (2) a thick and/or reinforced thermoplastic orthosis. We are all familiar with the advantages and disadvantages each has to offer. It was this author's goal to design a rigid A.F.O. that would combine the advantages of both. The features of such an orthosis should include light-weight construction; provide rigid ankle stabilization; provide adjustable plantar and dorsiflexion in order to dynamically align the orthosis; fit inside the shoe; be cosmetically acceptable; be easily donned; and maintain alignment while changing heel heights. With the above in mind, the following orthosis was designed. The orthosis consists of "pre-preg" (the resin is impregnated in the matrix in an uncatalyzed form prior to lay-up, generally at the factory. Once the desired lay-up is achieved, the structure is exposed to a catalyzing agent so that it hardens), carbon-fiber and fiberglass fabric. Epoxy and polyester resin have been used as bonding agents and the orthosis is formed over a plaster model of the patient's leg. Such pressure applying agents as vacuum bags and pressure wraps have been used. The carbon fiber and fiberglass fabric are properly oriented to resist the stresses imposed upon the orthosis and comprise a structure that provides a high strength to weight ratio. The orthosis has a foot section which begins on the plantar aspect of the foot and extends proximally on the medial and lateral sides of the leg. The "uprights" are connected by adjustable velcro-closing calf straps. Plantar and dorsiflexion adjustments are independently achieved by adjusting the anterior and posterior velcro-closing calf straps. In some cases, donning is simplified by removing the posterior strap, thus allowing for a posterior entry of the foot and leg into the orthosis and shoe. Over the past eighteen months, nine patients with diagnoses that include low level paraplegic, C.V.A., and neuromuscular disease have been fitted with the graphite composite A.F.O. as a successful alternative to "traditional" orthoses. Orthotists now have another choice when designing a rigid ankle foot orthosis for their patients. The graphite composite A.F.O. combines some of the advantages of the standard metal and thermoplastic constructed A.F.O. Robert E. Doran, C.P.O. Thousand Oaks Prosthetic Orthotics, 253 Lombard Street, Suite C, Thousand Oaks, California 91360. <div style="width: 400px;"></div> Page Number(s) 28 - 28 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Technical Note: Rigid A.F.O. - Another Choice Creator An entity primarily responsible for making the resource Robert E. Doran, C.P.O. * https://staging.drfop.org/files/original/b3bb30209b6e347e141d9887fbe0dd84.pdf 8fe2d7fe613164fa18efa52b86f36da9 https://staging.drfop.org/files/original/5bc93a35ec2adce600c9b2fec1513009.jpg 0fe31995eb047f4d749816ffeec36e4c https://staging.drfop.org/files/original/570eebfc4bc5a5450dc2cee53a1356dd.jpg a27208224d59514e3a6eaab581dc3c90 https://staging.drfop.org/files/original/4af954f59f49c76eabdab685dc5eab40.jpg 319799db788cc6ab393c7443e79399a0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/cpo/pdf/1984_04_026.pdf Text Any textual data included in the document <h2>Orthotic Pelvis Control in Spina Bifida</h2> <h5>H.R. Lehneis, Ph.D., C.P.O. </h5> Control of the pelvis has been typically problematic in high level spina bifida patients due to the imbalance of motor power around the hip joint. This can be readily appreciated when one considers the differential innervation particularly of the hip flexors versus the hip extensors (Table 1). Note that the hip flexors are at least partially innervated at the L2 and L3 level, whereas the hip extensors are innervated below the L3 level. Such imbalance at the L2 and L3 level of involvement is the cause of lordosis so often seen in these patients, which is often aggravated by hip flexion contractures. Control of the pelvis and thus lordosis has been difficult with conventional designs. Table 1. Innervation of the Lower Limb <img src="/files/original/5bc93a35ec2adce600c9b2fec1513009.jpg" p="" width="469" height="684" /> In analyzing the force system required to prevent hip flexion and thus lordosis, it becomes clear that the rigid portion of the pelvic band needs to be reversed from the conventional location (<a href="/files/original/570eebfc4bc5a5450dc2cee53a1356dd.jpg">Fig. 1</a>). It should be noted that this consists of a plastic molded Subortholen panel which extends superiorly to the level of the xyphoid process. The uprights of the hip joints are attached to this panel. An anteriorly directed force is provided by a leather hammock covering the buttocks (<a href="/files/original/4af954f59f49c76eabdab685dc5eab40.jpg">Fig. 2</a>). Straps attached on each of the four corners of the hammock run through D rings, attached equi-distant above and below the orthotic hip joint center. This system has worked quite effectively in controlling lordosis since first initiated approximately five years ago. In cases where the patient presents a relatively severe hip flexion contracture, the hip joint uprights are attached to the panel by means of a single pivot placed approximately 5 cm. below the lateral trim line of the panel. By gradually tightening the straps of the buttock pad, some correction can often be achieved. The pivot allows the anterior panel to adapt to the changing angulation as correction is attempted. It should also be noted that in our practice, patients up to the age of approximately six years old are provided with solid ankles and knees since their legs are still short enough to sit through hip flexion without obstructing much of the space in front of the chair. The purpose of this is to provide the patient with maximum stability and lightweight orthoses. As the patient gains upper limb strength and mobility, knee joints with drop locks are added, usually of the lateral single bar type. Double bars are only used when the patient is relatively heavy and when there is a torsional problem in the orthosis. The ankle-foot portion of the orthosis remains of the solid ankle type to provide the largest possible base of support over which the patient's center of gravity can be maintained with a greater degree of latitude than is possible if orthotic ankle joints were to be used. <h3>Acknowledgment</h3> The assistance of Barry Gosthnian, CPO in developing the system described is gratefully acknowledged. Page Number(s) 26 - 28 Year 1984 Volume 8 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1984_04_026/1984_04_026-3.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_04_026/1984_04_026-1.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_04_026/1984_04_026-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Orthotic Pelvis Control in Spina Bifida Creator An entity primarily responsible for making the resource H.R. Lehneis, Ph.D., C.P.O. https://staging.drfop.org/files/original/465b011652d5a340194157a65a7ec6cc.pdf 058afa0a050515ba9cadcbbbe5bbdcbc https://staging.drfop.org/files/original/1117b4f8d56a347cb37a8fec48fb1ba1.jpg fb35416caeea9a249029aa892a41fa14 https://staging.drfop.org/files/original/f48d51f3218c758f4338e50f0b689234.jpg fabaf7cea0b1796ff8316615aabb3e95 https://staging.drfop.org/files/original/812c173d343ffad067c6c208af011518.jpg e1dad0e0174b7d66a96d04ede66f5469 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/cpo/pdf/1984_04_024.pdf Text Any textual data included in the document <h2>Rochester Parapodium</h2> <h5>Edwin Kinnen, Ph.D. <a style="text-decoration: none;">*</a> Martha Gram, P.T. <a style="text-decoration: none;">*</a> Kenneth V. Jackman, Ph.D. <a style="text-decoration: none;">*</a> Franklin V. Peale, M.D., P.C. <a style="text-decoration: none;">*</a> P.W. Haake, M.D. <a style="text-decoration: none;">*</a> Gerald A. Tindali, C.P.O. <a style="text-decoration: none;">*</a> James A. Brown, O.P.A. <a style="text-decoration: none;">*</a></h5> The Biomechanics Team at the University of Rochester Medical Center has been developing and testing design modifications to the Toronto parapodium since 1975. Early in 1983, these design modifications had stabilized, and prototypes of the new design were offered to medical centers and orthopedic laboratories in the United States and Canada. The Rochester parapodium has now been fitted to over 80 young children of ages 17 months to 14 years. Most of these children have flaccid paralysis due to spina bifida or spinal injury from L5 to T12. The Rochester parapodium differs from the Toronto design in the hip and knee hinge and locking mechanisms. The hip joints unlock together with a single lever release and lock automatically on extension. The hip joints unlock with a forward motion and have no lateral projections, which allows ease in releasing hip lock in a confined space such as a wheelchair. The knee joints also unlock independent of the hip joints with a second single lever release and lock automatically on extension with the aid of an extension assist bar. <a href="/files/original/1117b4f8d56a347cb37a8fec48fb1ba1.jpg">Figure 1</a>: The hip joints unlock independent of the knee joints. Without lateral projections, rolling is easier for the child who applies the orthosis sitting or in the supine position on floor, then rolls to prone position in order to elevate to a standing posture. This separated locking and unlocking action has simplified many everyday activities for the paraplegic child. With increased control, the child can become independent in sitting and standing from a chair with arms. He can also bend over to pick up objects from the floor with hips flexed and knees locked. These are important functions for a preschooler exploring his or her surroundings and participating in peer group activities. <a href="/files/original/f48d51f3218c758f4338e50f0b689234.jpg">Figure 2</a>: Both joints unlock with a pull of a lanyard. Previously, children wearing the parapodium had to get up from a prone position on the floor by pulling to standing with fully extended knee and hip joints. Now a child can use jackknife-like movements to stand. These movements appear to require much less energy and open the activity to children with higher levels of paralysis. The lateral supports have also been redesigned for the Rochester parapodium, using bar stock instead of tubular sections. These flat lateral supports facilitate rolling, a very important movement for a child who is independent in dressing and changing positions. The new side bar design, a more rigid construction, also improves the child's momentum during swivel walking. With polypropylene added to the bottom of the base, many children can learn to swivel-walk at functional speeds, with hands free. <a href="/files/original/812c173d343ffad067c6c208af011518.jpg">Figure 3</a>: A child can bend over to pick up objects with hips flexed and knees locked. The activities now possible with the new design allow the paraplegic child to function at home and in school with relatively little need for adult supervision or assistance. Partial support for this work has been provided by the J.M. McDonald Foundation, Cortland, New York. James A. Brown, O.P.A. Rochester Orthopedic Laboratories, Inc., 1654 Monroe Avenue, Rochester, New York 14618. <div style="width: 400px;"> Gerald A. Tindali, C.P.O. Rochester Orthopedic Laboratories, Inc., 1654 Monroe Avenue, Rochester, New York 14618.</div> <div style="width: 400px;"></div> <div style="width: 400px;"> P.W. Haake, M.D. 220 Alexander Street, Rochester, New York 14610</div> <div style="width: 400px;"> Franklin V. Peale, M.D., P.C. 220 Alexander Street, Rochester, New York 14610.</div> <div style="width: 400px;"> Kenneth V. Jackman, Ph.D. Associate Professor of Pediatric Orthopedics, University of Rochester, Rochester, New York 14642. </div> <div style="width: 400px;">Martha Gram, P.T. Dept. of Pediatrics, University of Rochester, Rochester, New York 14627.</div> <div style="width: 400px;"> Edwin Kinnen, Ph.D. Dept. of Electrical Engn, University of Rochester, Rochester, New York 14627. </div> Page Number(s) 24 - 25 Year 1984 Volume 8 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1984_04_024/1984_04_024-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_04_024/1984_04_024-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_04_024/1984_04_024-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Rochester Parapodium Creator An entity primarily responsible for making the resource Edwin Kinnen, Ph.D. * Martha Gram, P.T. * Kenneth V. Jackman, Ph.D. * Franklin V. Peale, M.D., P.C. * P.W. Haake, M.D. * Gerald A. Tindali, C.P.O. * James A. Brown, O.P.A. * https://staging.drfop.org/files/original/cdc95b02cc47b6ac5a555a1046cadadf.pdf 34ed2a18f8f3439ef880701f80f81b2e https://staging.drfop.org/files/original/ce7a2b7ad0810f0b02370d41250efccc.jpg 3a4c39847e4ec3b9bf8261686abda3a1 https://staging.drfop.org/files/original/634cb539af8eab5253faddc40f6e9d0b.jpg 37149e5deb28bbdda74066f00fe6e09d https://staging.drfop.org/files/original/ea53ec98f51b6dce71f7a77727448ef3.jpg c7ecfa8c1488b9d239aaf61306016d21 https://staging.drfop.org/files/original/679f4b61888358a86e8bf53ae8458619.jpg a163b30fed74ee555cf603bcc30ef8cd https://staging.drfop.org/files/original/9ba53dc99c34b34ebbcf6445256aaa41.jpg 3bf51c3620d99120850d76f06e54d498 https://staging.drfop.org/files/original/b9ce20332f3ef2c5febd1df36e326169.jpg a27393f6213633786a241d9f9c92ce4f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/cpo/pdf/1986_02_093.pdf Text Any textual data included in the document <h2>Below-Knee Prosthesis with Total Flexible Socket (T.F.S.): A Preliminary Report</h2> <h5>John Sabolich, B.S., C.P.O. <a style="text-decoration: none;">*</a> Thomas Guth, CP. <a style="text-decoration: none;">*</a></h5> Recent efforts in Oklahoma City, and San Diego have borne fruit to a promising new way to fit below-knee amputees. The basic design consists of a thin walled thermo-plastic socket secured in a frame by nylon strapping tape so that most of the socket is left exposed and unsupported (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg">Fig. 1</a>). This design, named the Total Flexible Socket (T.F.S.), was conceived out of necessity with a few patients that were so difficult to fit that even aggressive techniques such as multiple transparent diagnostic sockets, alginate injections, total surface bearing modifications, and silicone gel inserts failed to provide a measure of comfort acceptable to them. It was felt that a more unconventional method would have to be implemented. Currently, this technique is being used with most of the geriatric population seen, and with time and experience it is being applied to an ever increasing proportion of the total below-knee amputee population served. Forty or more of these sockets have been fitted over the past five months to patients ranging in age from ten to 89 years with results that were beyond initial expectations. Patient reaction has been extremely positive. Plans are to submit an up-dated article when over 100 documented fittings with the described technique have been accomplished. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg">Figure 1. Medial and lateral views of T.F.S. in an exoskeletal version. Suspension sleeve and cosmetic hose rolled down for clear view of socket secured in place with band of fiberglass tape.</a> The idea for the T.F.S. design was prompted during the course of fitting a patient with a flexible diagnostic test socket. The patient was comfortable in this socket even when bearing his full weight on a padded fitting stool. Subsequently, when a full socket receptacle for the test socket was laminated and it was rigidly contained, this comfort was lost. The patient still complained of pressure even when holes were cut out over bony prominences. Finally, when the maximum amount of material was cut away and the former socket receptacle was reduced simply to a means of attaching the socket to the rest of the prosthesis, thus allowing the socket to return to its former measure of flexibility, comfort was regained. Several interesting phenomenons were noted: <ol> <li> Since the T.F.S. design is totally flexible, allowing ML as well as AP expansion and retraction, the socket finds and seeks its own level of pressure distribution. If the AP is too tight, it automatically expands, causing the ML to tighten up, wrapping around the tibial flare and the fibula. This, of course, is not true when a receptacle is only opened up over bony areas allowing no reciprocal ML-AP displacement and minimal flexibility, even over bony areas. With the T.F.S., if the ML is too tight, then the AP automatically tightens as the ML loosens, and vice-versa if the AP is too tight (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg">Fig. 2</a>). <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg">Figure 2. Transverse view of a socket cross section showing, in an exaggerated fashion, the reciprocal AP-ML displacement.</a></li> <li> The AP-ML "Milking" action seems to have a positive effect on circulation since the residual limb seems palpably warmer when a T.F.S. is removed, as compared to when a rigid socket is used. In the case of flexible sockets thinner than 3/32 inches thick, the entire socket moves with the residual limb, seeming to expand and contract due to the open nature of the frame. This phenomenon can be felt better than seen by holding the socket as the patient alternately places weight on the prosthesis and removes it, especially after the socket warms up to body temperature. This dynamic socket movement and improved circulation could be very significant for the geriatric P. V.D. patient. This action also seems to enhance atmospheric suspension: when the patient removes weight, the socket collapses and grips the residual limb like the familiar childhood toy, a Chinese fingertrap. </li> <li> Atmospheric Suspension (A.S.) assorted methods of achieving suction suspension for the below-knee amputee have been tried for years, with varying degrees of success. The main reason behind this effort is the desire to solve the number one problem of the below-knee amputee, that of skin shearing and pistoning between the residual limb and socket. Another major problem has been that of the patient wanting a lighter weight, more responsive prosthesis. With the T.F.S.A.S. combination, most patients have been responding favorably with such comments as "It feels like my own leg!" and "It feels like part of me!" With atmospheric suspension, the patient no longer needs to wear a suspension sleeve to maintain full suction. The Total Flexible Socket holds suction better than a rigid socket because the socket can move and conform to the changing contours of the residual limb, through all phases of gait and sitting. A loose elastic knee cage is recommended to enhance proximal brim seal during knee flexion past 90°. For sports prostheses, use of a rubberized sleeve of choice is recommended. Cosmesis is also enhanced since the patient no longer has the extra bulk of socks or inserts increasing calf circumference. It's a little too early to tell, but it is felt that atmospheric suspension may well become the standard below-knee fitting technique for all types of patients. </li> <li> Use of a cuff suspension strap is improved since the cuff and socket brim can contour in about the patella (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg">Fig. 3</a>). Use of a suspension sleeve with the T.F.S. is also possible, and if anything, enhances the function of a T.F.S. since the suspension sleeve supports the socket brim and soft tissues, holding the two in close conformity through the full range of knee motion. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg">Figure 3.</a></li> <li> Flexibility allows greater containment posteriorally in the popliteal region. The posterior wall can be higher since it flexes away during sitting. Little posterior flare is needed. In fact, this area could be rolled in slightly, similar to how the cubital fold is contained in myoelectric below-elbow arms (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg">Fig. 4</a>). If the practitioner desires, the socket can be made flexible all the way down to the distal tibia. This is accomplished by building a thick distal end pad (with or without an insert) inside the socket, or an extension on the exterior of the socket which extends the trimline of the frame distally, allowing total flexibility in the distal regions of socket. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg">Figure 4. Lateral view of T.F.S. showing suggested modified contour.</a></li> <li> The ML measurement of the knee becomes wider as the knee flexes. This can be demonstrated by placing an ML gauge on the knee and watching the gauge as one puts the knee through its range of motion. The T.F.S. design allows for this dynamic variance. </li> </ol> Last but not least, overall hygiene and circulation seem to be dramatically improved. Especially impressive is the absence of red marks on the skin following doffing of the T.F.S. There are none of the usual red marks left by conventional sockets. Patients who had to have many reliefs before in their rigid sockets now require none. Since several prosthetists have been fitting these sockets successfully, using various modification techniques, it has been concluded that it is irrelevant which particular modification technique is used. Results from all modification techniques have been improved utilizing the Total Flexible Socket. The use of negative modifications only is recommended. One simply does not need to add positive build-ups to the model since the reciprocal AP-ML displacement dynamically accommodates the patient's anatomy. The bony areas are accommodated automatically (most of the time) as the patient ambulates. It is, of course, most exact to use multiple transparent diagnostic sockets, alignate, or oil injection procedures (as well as other means) to obtain the best fit possible. The flexible socket seems to work so well that it is tempting to skip the check socket stage. Do not succumb to this temptation, or you will never know just how comfortable the socket can be once you get the patient fairly comfortable in the rigid transparent socket and clone it to the T.F.S. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg">Diagram</a> After the hard socket is fit, it is necessary to remove an additional 1/4" to 3/8" of plaster from the positive model around the superior brim, close to the patella, to allow a flexible clamping action about the proximal brim. Use of this extra modification can not be emphasized enough for final comfort and stability. An intimate fit must be maintained around the proximal brim with the T.F.S. design. No other additions or modifications are necessary. If a liner or insert is used, it is fabricated over the positive model with a thick distal end pad to provide extra distance distally. This extra length is necessary if one desires to make the distal tibia area flexible since the frame can be trimmed more distal, even past the end of the distal tibia. Alternately, as mentioned, an extension can be added to the socket following vacuum forming. One can use any of four materials for the flexible part of the socket: The first is Surlyn,® which is preferred in most cases. This material can be molded fairly thin, and yet it provides excellent structural strength and integrity. Surlyn® stock material of 1/8"-3/16" thick is used (depending on the degree of flexibility) for vacuum forming. A final thickness of about 1/16" or less is adequate. It is not necessary for this socket to be extremely flexible, as with a fenestrated socket, since the majority of the socket is open and flexible in all directions with two adjacent sides being able to move relative to the frame. The second material is polyethylene, which is more flexible and sometimes more desirable for children or geriatrics who are somewhat inactive. The third is Streifylast, which is a material that is being utilized more and more lately since it has a high level of flexibility while maintaining its structural integrity, and is especially resistant to tearing and breakage. A fourth material called Polyethylene Plus® (available through Maramed) seems to be superior even to Streifylast and has an extremely good tear resistance. Once the socket is vacuum formed, a fiberglass nylon polyester frame is fabricated. Carbon fiber and acrylic resin can be used, if one desires greater strength and less weight, but is not necessary in most cases. The thickness of this frame depends on the activity level of the patient, but usually ranges in thickness from 1/16" to 1/8". As in<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg"> Fig. 5</a><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg"></a>, there are two basic frame designs: one for geriatrics, and one for active or sports oriented patients. The geriatric type extends proximally to the medial tibial flare and is cut away everywhere else except around the distal end pad (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg">Fig. 6</a>). The sports type frame for younger patients comes more proximal pos-teriorally, lending more strength. It maintains total AP-ML flexibility since it still has only two sides adjacent to each other. As long as one does not place a third wall on the frame, reciprocal AP-ML flexibility is preserved and provides for automatic pressure distribution. It must be emphasized that these are only guidelines and the actual trimlines of the frame are variable and modified as the patient's needs dictate. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg">Figure 5. Four views of the T.F.S. showing sports and geriatric trimlines and distal end pad or buildup. Distal buildup is especially useful when it is desired to cut the anterior trimline below the distal tibia.</a> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg">Figure 6. T.F.S. showing geriatric trimline. Ultralite construction.</a> The flexible socket can be attached to the rest of the prosthesis by using two or three bands of nylon fiber tape wrapped circumferen-tially about the frame and socket to provide strength, while not affecting flexibility. If one desires even more strength, pressure sensitive tape can be wrapped over the nylon tape or even over the whole frame and socket. The socket can be riveted or fastened with Chicago screws in addition to the tape, for additional security. The final finishing of the prosthesis is relatively simple. If an endoskeletal approach is used, the soft foam cover hides the socket frame interface as well as the nylon strapping tape and results in a very cosmetic prosthesis (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg">Fig. 7</a>). The T.F.S. prosthesis finishes especially well as an endoskeletal since it feels more life-like all the way up the prosthesis. If one desires an exoskeletal finish, one can easily use polyurethane foam for shape, laminate the outer covering, remove the flexible socket, and grind the foam away from around the frame and cosmetic shell as desired. This leaves a void or hollow of about 1/8" (all that is necessary) between the flexible socket and cosmetic shell. Alternately, the prosthesis can be shaped and finished about the socket in the same fashion as an endoskeletal prosthesis. The proximal external contours can then be established with a soft fairing of PE-LITE® or Plastazote glued to the flexible socket and frame. <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg">Figure 7. T.F.S. with soft cosmetic covering.</a> Fabrication of an Atmospheric Suspension Socket is the same as for any T.F.S., except for the placement of either an expulsion valve or a small suction valve on a 45° angle at the distal posterior of the total flexible socket (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg">Fig. 8</a>). <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg">Figure 8. T.F.S.-A.S. showing placement of valve distally</a>. Modification on the other hand, is a little different than a non-atmospheric suspension T.F.S. The socket must be a little snugger to accommodate total self-suspension. After achieving the "perfect skin fit" with a clear diagnostic socket and the alginating procedures, the model is poured and modified the same as any T.F.S. by slightly tightening it about the patella area. The technician then takes the modified model and laminates a two layer cotton rigid socket over it, which is rolled or slushed twice with promoted liquid polyester resin to tighten all areas of the socket equally. This socket, with reduced internal dimensions, is then poured with plaster of Paris and the T.F.S. socket is subsequently vacuum formed over the resulting positive model. It is felt that this extra tightening is necessary to compensate for the fact that a rigid diagnostic socket cannot be donned as easily as a T.F.S. of equal or greater tightness. In conclusion, a new concept for the fabrication of a below-knee prosthesis has been described, as well as the preliminary results of fitting some 40 patients for up to five months. It is sincerely hoped that other prosthetists will find it as beneficial to their patients as it has been found to be in both Oklahoma City and San Diego. <h3>Acknowledgments</h3> We would like to thank one of our own prosthetists, Bill Etheridge in Oklahoma City for forcing John out of conventional thinking so we could aggressively research this interesting phenomenon. We would like to thank Mary Healy, San Diego, for her help in Atmospheric Suspension Technique. We also wish to thank Alan Finnieston, CPO for materials research and for finding an appropriate tear resistant thermoplastic. Thomas Guth, CP. Thomas Guth, CP is Secretary Treasurer at RGP Orthopedic Appliance Company, 6147 University Avenue, San Diego, California 92115. John Sabolich, B.S., C.P.O. John Sabolich, B.S., CPO is with Sabolich, Inc. at 1017 N.W. 10th Street in Oklahoma City, Oklahoma 73106. Page Number(s) 93 - 99 Year 1986 Volume 2 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Below-Knee Prosthesis with Total Flexible Socket (T.F.S.): A Preliminary Report Creator An entity primarily responsible for making the resource John Sabolich, B.S., C.P.O. * Thomas Guth, CP. * https://staging.drfop.org/files/original/45936845c560d4d5eebd237d926562f2.pdf 0ea2670a224e26f8a1b36cd756e5f496 https://staging.drfop.org/files/original/1e3bdc3b8dc622982e576909d90687d7.jpg 4c4de5849811d644713ec7230d7d0f02 https://staging.drfop.org/files/original/abf3a4d5ce92c8133b359340480b34ab.jpg 0ceb64af346708b11b688bc9aec46035 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_04_004.pdf Text Any textual data included in the document <h2>Should Functional Ambulation be A Goal for Paraplegic Persons?</h2> <h5>Michael J. Quigley, C.P.O. <a style="text-decoration: none;">*</a></h5> The goal of functional ambulation for paraplegic persons is a subject of long debate in virtually all rehabilitation settings. Such factors as lesion level, motivation, attitude of the clinic team, age, body build and occupation are important determinants when orthoses are prescribed for ambulatory purposes. Despite the various orthotic designs available, and the philosophies that accompany each design, the majority of paraplegic persons will either reject their orthoses or not have them prescribed. Personal experiences and published reports indicate that when a thoracic level lesion is present, only about two percent of patients fitted will reach the level of household ambulation. There are many reasons for this, the main one being the excessive energy expenditure needed to ambulate in an orthosis. The donning procedure for most orthoses is difficult and time consuming, and once the orthoses are on the patient they often interfere with transfer activities. In addition, crutches are needed for stability while standing and ambulating, which limits the use of the hands and arms. Other problems with standing and ambulation for paraplegic patients are the lack of bladder control while standing and obviously abnormal walking pattern. In this brief article, I will review some of the more pertinent articles on this subject, and then present my opinion concerning the provision of lower-limb orthoses for paraplegic persons. The history of the orthotic treatment of paraplegia does not go back much further than World War II, since previous to that time about 90 percent of the spinal-cord-injured persons died from genitourinary infections. The development of antibiotics to combat these infections reversed the fatality rate shortly after World War II. The physiological benefits of standing persons with paraplegia were first mentioned by Abramson <a></a> in 1948, who stated that an hour of standing each day will prevent osteoporosis in the lower limbs and helps to prevent urinary calculi and genitourinary infections. In 1964, Rusk, stated that "circulation and nutrition, as well as morale, are also aided by keeping the patient in the upright position for several hours each day". Rusk also recommended that the tenth thoracic vertebra be used as a landmark when prescribing orthoses; lesions at or superior to this level are usually given double-bar long leg-braces with a pelvic band and Knight spinal attachment (current terminology is LSHKAFO, or lumbo-sacral-hip-knee-ankle foot orthosis); lesions inferior to T10 level are prescribed the same orthoses without the spinal attachment, and lesions inferior to L1 are fitted without a pelvic band. Hahn <a></a> and Scott <a></a> from Craig Rehabilitation Hospital in Denver, Edberg <a></a> from Rancho Los Amigos Hospital in Downey, and Warren et al., <a></a> from the University of Washington, do not advocate the use of the pelvic band on paraplegic patients. Edberg feels that the pelvic band must apply excessive pressure against the skin to be effective, that it causes difficulty in donning the orthosis, limits flexibility and adds excessive weight. Hahn and Scott state that the two most important considerations for orthotic design for paraplegics are ease of donning and control of ankle dorsiflexion, hence the so-called Craig-Scott design KAFO (Fig. 2) has no pelvic band, only one thigh band, and a fixed but adjustable ankle joint. Hussey and Stauffer <a></a> studied the ambulatory function of 164 spinal-cord-injured patients at Rancho Los Amigos Hospital and stated that "no patient achieved any form of functional ambulation without pelvic control<a style="text-decoration: none;">*</a> and there appeared to be no effective method of bracing patients to overcome this deficit". The nerve supply for the pelvic control muscles is affected by a thoracic lesion. Rosman and Spira <a></a> reported similar problems in ambulating patients with thoracic lesions. In a study of 35 patients with lesions from the T1 to T11 level who were fitted with orthoses for ambulation, only one patient was ambulating out of the hospital, and five used the orthosis for standing only. The report concluded "that there is an essential difference between the 'occupation' of walking in the 'non-pressured' rehabilitation environment and walking when faced with the problems of everyday life". It further concludes that "some disabled persons with unusual strength, willpower, and motivation for walking will successfully overcome the difficulty, effort, and social strain involved in the continuous use of braces", but that "most will eventually relinquish these goals because the effort proves too great". Pneumatic orthoses (Fig. 1) were developed and first used in the United States, amid great fanfare, in 1973. Three major evaluations by Silber <a></a>, at New York's Bird S. Coler Hospital, Ragnarsson et. al., <a></a> at the Institute of Rehabilitation Medicine, New York University, and by the Committee on Prosthetics Research and Development, National Academy of Sciences <a></a> on a total of 62 paraplegic persons indicate that the orthoses were lighter than metal designs and required less energy for ambulation but severe mechanical limitations, such as donning and inflation problems, outweigh these advantages when the orthoses are used outside of an institutional setting. A study by Cerney, at Rancho Los Amigos Hospital, comparing energy costs for eight paraplegics walking versus using a wheelchair concluded "The average velocity for paraplegic walking was less than half of normal while oxygen uptake per minute was increased by 50 percent. These two factors combine to create an oxygen uptake per meter than is increased six times". Similar data for the same patients using wheelchairs, again compared to normal individuals, showed "only a two to six percent increase in the physiological factors and a ten percent decrease in velocity". Despite the poor track record I have documented, ambulation is still considered a goal for paraplegic patients in most rehabilitation settings. Obviously, the patient will fail to reach this goal in most cases, so why do most of us expend our energies in this area? I feel there are benefits to be gained by providing ambulation training. For one, nearly all new paraplegic persons believe they will walk again, and it is virtually impossible to convince them otherwise. These patients feel that they are being deprived of their chance for complete rehabilitation if they are never given the opportunity to try to walk. Psychologically, they must prove it to themselves. After these patients are convinced that walking is impractical, they will concentrate more heavily on becoming wheelchair-independent. A physician I worked with in Chicago told the story of an obese, bilateral above-knee amputee who wanted to be fitted with prostheses so he could walk again. They physician refused to prescribe a prostheses as he knew that the patient could never use them, and told the patient he would not be able to walk again. The patient immediately suffered a nervous breakdown in the clinic and required hospitalization. From that day on, the physician prescribed prostheses for patients with similar problems so they could convince themselves of the impracticality of ambulation and, more important, have a longer period of time to accept reality. A small percentage of patients do ambulate in orthoses (Fig. 3), especially those patients with pelvic or hip control or sensation. It is impossible to predict successful ambulators, and patients should be given a chance to succeed. Obviously, patients who lack motivation, are very obese, or who lack strength and endurance will never succeed and should be dissuaded from trying to ambulate. In this article I have attempted to back up my personal experiences with information from published reports, and then to justify why most paraplegics are given ambulation training despite the poor prognosis. We would appreciate your thoughts on this subject and therefore encourage you to complete the attached questionnaire. References: <ol> <li>Abramson, S. A., Bone disturbances in injuries to spinal cord and caude equina (paraplegia). J. Bone and Joint Surg. 30-A:982-987, October 1948.</li> <li>Edberg, E., Bracing patients with traumatic paraplegia. Phys. Ther. 47:9:818-823, September 1967.</li> <li>Hahn, Harry, Personal communication, March 1975.</li> <li>Hofstra, Peter C, The clinical engineer and the spinal-cord-injured person. Bull. Pros. Res. 10-22:37-40, Fall 1974.</li> <li>Hussey, Robert W., and E. Shannon Stauf-fer, Spinal-cord injury: requirements for ambulation. Arch. Phys. Med. Rehab. 54:12:544-547, December 1973.</li> <li>Ragnarsson, K. T., G. Heiner Sell, Margaret McGarrity, and Reuven Ofir, Pneumatic orthosis for paraplegic patients: functional evaluation and prescription considerations. Arch. Phys. Med. Rehab. 56:11:479-483, November 1975.</li> <li>Rosman, N., and E. Spira, Paraplegic use of walking braces: a survey. Arch. Phys. Med. Rehab. 55:7:310-314, July 1974.</li> <li>Rusk, Howard A., Rehabilitation Medicine, Second Edition. C. V. Mosby Co., St. Louis, Missouri, p. 503, 1964.</li> <li>Scott, Bruce A., Engineering principles and fabrication techniques for the Scott-Craig long leg brace for paraplegics. Orth. and Pros. 25:4:14-19, December 1971.</li> <li>Silber, Maurycy, Tae-Soo Chung, George Varghese, Catherine Hinterbuchner, Milton Bailey, and Nancy Hirvy, Pneumatic orthosis: pilot study. Arch. Phys. Med. Rehab. 56:1:27-32, January 1975.</li> <li>Warren, C. G., J. F. Lehmann, and B. J. DeLateur, Use of the pelvic band in orthotics for adult paraplegic patients. Arch. Phys. Med. Rehab. 56:5:221-223, May 1975.</li> <li>Cerney, Kay, R.P.T., Walking and wheelchair energetics in spinal cord injury.</li> <li>National Academy of Sciences, Evaluation of the ortho-walk type B pneumatic orthosis on thirty-seven paraplegic patients. Washington, D.C., 1976, pp. 1-5.</li> </ol> Footnote The Term 'pelvic control' used here refers to the ability of the abdominals to move the pelvis when body weight is on the crutches. <div style="width: 400px;"> *Michael J. Quigley, C.P.O. Rehabilitation Engineering Center, Rancho Los Amigos Hospital, Downey, California.</div> Page Number(s) 4 - 6 Year 1977 Volume 1 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1977_04_004/1978_04_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1977_04_004/1978_04_005-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Needs Revision- See Trello Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Should Functional Ambulation be A Goal for Paraplegic Persons? Creator An entity primarily responsible for making the resource Michael J. Quigley, C.P.O. * https://staging.drfop.org/files/original/646807426d786878263060044f860bb5.pdf a91cea6354ddf7b14de92ba2bb2c720d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_04_001.pdf Text Any textual data included in the document <h2>Partial Foot Amputation</h2> <h3>Results of the Questionnaire Survey</h3> There were fifteen replies by mail to the questionnaire on management of patients with partial foot amputation that appeared in the Summer 1977 issue of the NEWSLETTER. Ten came from prosthetists, one from a physical therapist, and four from physicians. The answers and remarks from all but one prosthetist are given below. One prosthetist, Lewis Meitzer of Miami, Florida, took the time and trouble to write a very thoughtful letter which is printed in full after the tabulation of the questionnaires. Prepared by the American Academy of Orthotists and Prosthetists, 1444 N Street, N.W., Washington, D.C. 20005. Editor: A. Bennett Wilson, Jr., B.S. M.E.; Editorial Board: Joseph M. Cestaro, C.P.O., Charles H. Epps, Jr., M.D., Robert B. Peterson, R.P.T. <ol> <li> Do you feel that patients with partial foot amputations require prostheses that extend higher than the distal third of the tibia? <ul> <li> Certified Prosthetists <ol> <li> No. Ankle high only. </li> <li> The prosthesis should not be higher than maleoli. </li> <li> Yes. </li> <li> Very seldom </li> <li> Especially true for active people. Low activity people without deformities seem to function well with the least amount of appliance. </li> <li> Not in all cases, for example, we're using C. Fillauer's AC & PLIC socket w/posterior (6) split for a great percentage of our partial foot amputees. </li> <li> No. </li> <li> I basically avoid terminating a prosthesis on the lower tibia. Often a shoe insert with the filler works fine. If a rigid ant. is used, I definitely do not stop at any point on the tibia. </li> <li> Transmetatarsal or longer - No. All others - Yes. </li> </ol> </li> <li> M.D.'S <ol> <li> If hand users. </li> <li> Yes. </li> <li> No. </li> <li> If full, pain free, weight bearing is possible on the remaining part of the foot - No. If not, then weight needs to be taken higher. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you feel that most patients who receive partial foot amputations would function better with a Syme's amputation? <ul> <li> Certified Prosthetists <ol> <li> No. </li> <li> No, as long as the plantar surface can tolerate weight bearing, a partial foot is better than Syme's. </li> <li> No. </li> <li> No. </li> <li> Again active people and children who can possible avoid bone spurs and eventually develop an endbearing cosmetic BK. Surgery is important. Good padding over bones is very beneficial. </li> <li> Yes, the large majority would increase their function and be relatively pain-free. </li> <li> No. </li> <li> No. I have seen too many patients function beautifully with partial foot and only a toe filler. </li> <li> For P.V.D. patients a Symes amputation usually has a better chance to heal and the prosthetic fitting is better. For traumatic amputations as much length should be preserved to increase weight bearing surface and lever arm. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes, but not all. </li> <li> Not necessarily. </li> <li> Yes, at least psychologically. </li> <li> No. A Syme's is much more radical than is often necessary and will not necessarily result in better function. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you agree with the author's list of advantages and disadvantages of this amputation? <ul> <li> Certified Prosthetists <ol> <li> Some. </li> <li> - </li> <li> Yes. </li> <li> Yes. </li> <li> I feel amputation sites for children should take bony overgrowth and foreshortening into account, i.e., disarticulation rather than partial foot types. </li> <li> Not in its entirety, but generally speaking, yes. </li> <li> Yes. </li> <li> Some of them. </li> <li> Yes we do, however, prosthetic breakdown will still occur regardless which type is fitted. </li> </ol> </li> <li> M.D.'S <ol> <li> No. They are not the indication for the procedure. </li> <li> ? </li> <li> Yes. </li> <li> Partially. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you feel that the sole or shank of the shoes or prosthesis should be rigid or flexible? <ul> <li> Certified Prosthetists <ol> <li> Flexible. </li> <li> Flexible, to provide easy roll over the often tender distal anterior foot. </li> <li> Rigid to metatarsal break, flexible distal from this point. </li> <li> Rigid except for toe flexibility. </li> <li> The sole should extend the toe break past the end of the amputation, rigid slightly past this point. </li> <li> We think in terms of the SACH foot function using rigid soft tissue support w/flexible forefoot. </li> <li> Flexible. </li> <li> Depends on patient's gait, toe off phase especially. Generally rigid to the ball of the shoe and flexible in the toe area. </li> <li> Usually, a rigid shoe and/or prosthetic foot functions better. However, we do have success using a modified Winnipeg Symes Prosthesis, which is partially flexible. </li> </ol> </li> <li> M.D.'S <ol> <li> Rigid. </li> <li> Rigid. </li> <li> Do not know. </li> <li> It depends largely on the level of amputation, the shoe control which is achieved and the residual ankle function. In general it needs to be rigid proximal to the metatarsal heads and capable of flexing to about 15° under the metatarsal heads when loaded. Sometimes, e.g. when the metatarsal heads are painful or in a very proximal level amputation, it needs to be rigid throughout and with a rocker base. If there is adequate ankle function, and reasonable shoe control on the residual foot, the prosthesis should flex at the ankle too. </li> </ol> </li> <li> P.T. <ol> <li> Rigid. </li> </ol> </li> </ul> </li> <li> Please comment if you have experience with the "ankle-foot orthosis" type of treatment mentioned here and described by Fillauer. <ul> <li> Certified Prosthetists <ol> <li> I have been using the same basic idea for several years with good success. </li> <li> I have used this on one patient and he was quite pleased. </li> <li> - </li> <li> No experience. </li> <li> No experience. I added another approach to my repertoire. </li> <li> No experience. </li> <li> Yes. </li> <li> I have used the AFO with a toe filler attached a few times recently and am very satisfied with the results. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes, only very limited. </li> <li> Yes, occasionally useful. </li> <li> No. </li> <li> - </li> <li> No experience. </li> </ol> </li> <li> P.T. <ol> <li> No experience. </li> </ol> </li> </ul> </li> <li> Would you be willing to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations? <ul> <li> Certified Prosthetists <ol> <li> Yes. </li> <li> Yes. </li> <li> Yes. </li> <li> Yes. </li> <li> Yes, although my experience is limited (which is probably the situation 90% of the time). A ready reference such as this may help us all solve the unique problems each of these amputees present. </li> <li> Enthusiastically. </li> <li> Yes. </li> <li> At present I have nothing new to contribute. </li> <li> Yes, we would. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes. </li> <li> No. </li> <li> Do not feel qualified to do so. </li> <li> Yes. </li> </ol> </li> <li> P.T. <ol> <li> No, not enough experience. </li> </ol> </li> </ul> </li> </ol> <h3>Conclusions</h3> It can be seen that although there is a wide variation of opinion about partial foot amputations and prostheses, more than half of the practitioners feel that partial foot amputations can provide better function than the Syme's. Nearly all of the respondents would be glad to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations. Mr. Meltzer's letter, which follows, seems to sum up the state of the art and is reproduced here in full. September 27, 1977 Newsletter Questionnaire AAOP 1444 N Street, N.W. Washington, D.C. 20005 The following are the answers to your questions as per your request from the Newsletter Questionnaire, copy enclosed. NAME: Lewis N. Meltzer, C.P.O. <ol> <li> Do you feel that patients with partial foot amputations require prostheses that extend higher than the distal third of the tibia? <blockquote> It has been my experience that patients with partial foot amputations occasionally cannot tolerate the Fillauer type orthosis. Yet, for cosmetic purposes, they prefer it rather than something extending above the shoe. I have fitted a few and only succeeded with one. This is after extended trials by myself and the patient. Yet, the two who were not satisfied, preferred to wear nothing and have been lost to follow up. Several years ago I worked with polypropylene or similar AFO's with toe fillers and steel shanks in the shoe, and those seemed to work satisfactorily. I think that Mr. Pritham's idea merits trials. My only concern is cosmetic acceptance when compared to the Fillauer type. </blockquote> </li> <li> Do you feel that most patients who receive partial foot amputations would function better with a Syme's amputation? <blockquote> This seems like an ambiguous question which I feel I can only answer by saying it would depend on the individual. At the same time, all else being equal, partial foot amputation would be my choice were I to need that type of amputation as I could more easily walk without a prosthesis either around the house or at night. </blockquote> </li> <li> Do you agree with the author's list of advantages and disadvantages of this amputation? <blockquote> Yes. </blockquote> </li> <li> Do you feel that the sole or shank of the shoes or prosthesis should be rigid or flexible? <blockquote> Here, again, this would depend on the patient as I have seen patients desiring no prosthesis. </blockquote> </li> <li> Please comment if you have experience with the "ankle-foot orthosis" type of treatment mentioned here and described by Fillauer. <blockquote> The Fillauer method I have tried has included a section of Silastic R.T.V. in the anterior distal socket for comfort and total contact. This is laminated over the cast rather than after the prosthesis is made. With this, I still have had only one satisfied patient. The other two required several attempts at fitting and yet the patients were not satisfied. </blockquote> </li> <li> Would you be willing to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations? <blockquote> I would be willing, if I felt I had something specific to offer as an alternative, but I have not found it to date. </blockquote> </li> </ol> Sincerely, Lewis N. Meltzer, C.P.O. Page Number(s) 1 - 3 Year 1977 Volume 1 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Partial Foot Amputation https://staging.drfop.org/files/original/f4a0dba11dbd83d1386ccb0e624bc090.pdf cdd8923abdae6f28e1a9d8d1fe8755c4 https://staging.drfop.org/files/original/681863a98ef8c1b69d476ca775d584e5.jpeg ae65dd03b074faa805393f2bb2cca1eb https://staging.drfop.org/files/original/b3f368a835f52e8d59db880235d53694.jpg 64a7ad3c59294b4014476742e34ee741 https://staging.drfop.org/files/original/bd5404308943c819bbb4f8cf4312b7c3.jpg 40b7c14dc32d98e7f4de52e02a7bd7aa https://staging.drfop.org/files/original/8377ac015b32853159b839d4e215bde5.jpg ebb48fe686c96a27f8944c39a7ea1994 https://staging.drfop.org/files/original/568455a545a488a7582cc67a53f4e0ff.jpg 39633f73e9a88bef0976b0d0d921dcb5 https://staging.drfop.org/files/original/bba2f04183e22d65f8b82db57ebb81de.jpg 56a7734fbe443f9e90a5a81715258054 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_03_005.pdf Text Any textual data included in the document <h2>Partial Foot Amputation - A Case Study</h2> <h5>Charles H. Pritham C.P.O. <a style="text-decoration: none;">*</a></h5> Traditionally amputations through the foot have been held in poor repute for a variety of reasons<a></a>, chief among them being the equinus deformity that can result from an imbalance between the intact triceps surae and the severed anterior muscles. In addition, the poor quality of socket fit that often occurs with older styles of fabrication can be cited as a contributing factor for the low esteem in which tarsal and mid-tarsal amputations are held. In recent years there has been an ever increasing emphasis on more distal level of amputation for peripheral vascular disease and the advantages to be accrued. Thus, today, below-knee amputations and disarticulations at the knee have supplanted to a large measure above-knee amputations. In a similar fashion Syme's and partial foot amputations are being performed by some <a></a> to ensure the patients the advantages of full limb length, distal end-bearing, retention of proprioception, and a long lever arm. The trend has gained impetus from such improved methods of predicting successful amputation levels as Xenon Radiography, and differential pulse ratios to predict accurately stump viability <a></a> as well as such improved methods of surgical technique as fixation of the pretibial muscles for Chopart and Lisfranc amputations, heel pad fixation for the Syme's, and the use of rigid dressings for all levels of amputation <a></a>. It, thus, seems correct to conclude that an increasing number of partial foot amputations for vascular insufficiency will be seen by prosthetists in the years to come. The challenge to the prosthetist, therefore, is to maximize the advantages cited by using the best products of the latest available technology. One example of this can be found in the use of a modified plastic ankle-foot orthosis with a toe filler distal to the stump in those cases where stump length is adequate to ensure proper control and fit of the shoe <a></a>. Numerous variations of the basic theme exist, and are well known. Karl Fillauer has reported recently on his experience with a prosthesis that totally encompasses the stump below the malleoli and permits free motion of the ankle <a></a>. To the extent of the author's knowledge, neither of these designs have ever been subjected to formal evaluation and while experience has been gained by many prosthetists with the first design, little is known objectively about the latter. Both designs appear to work well in selected cases, but neither design appears to provide for the broadest possible distribution of pressure (or in the case of a modified AFO, the most accurate distribution) to protect the fragile, sensitive, and often partially anesthetic skin over the dorsal surface of the remainder of the foot <a></a>. The purpose of this paper is to discuss one possible solution to this problem. <h3>Case Report</h3> W.M. is a 62-year-old male Caucasian, who sustained a right Chopart amputation in 1972, secondary to peripheral vascular disease and necrosis of the forefoot (Fig. 1). He was subsequently fitted with a prosthesis which he wore until April 1977 (Fig. 2). The prosthesis was fabricated of polyester lamination with a posterior opening and metal reinforcing elements. Because of subsequent failure an additional steel armature was added externally, and the weight of the unit when seen by us had crept to 5 lb. 4 oz. Over the years sufficient change had taken place in contour of the stump so that W.M. was experiencing pain on the distal-lateral and anterior aspects of the stump, and he walked slowly with the use of a cane. Our initial attempt to fit the patient was made with a molded ankle-foot orthosis with a toe filler, but the patient obtained no relief from the pain, and the situation was re-evaluated. <a href="/files/original/681863a98ef8c1b69d476ca775d584e5.jpeg">Fig. 1.</a> W.M.'s Chopart Amputation <a href="/files/original/b3f368a835f52e8d59db880235d53694.jpg">Fig. 2.</a> W.M.'s "Conventional" prosthesis After due deliberation, the patient was cast in the weight-bearing position, tracings were taken of both feet and vertical reference lines drawn (Fig. 3). With the tracing as a guide, a proper sized SACH foot was selected for the forefoot extension to the positive model of the stump, overwhich a polyethelene form of the heel and sole could be vacuum molded. The positive model of the stump was positioned inside the polyethelene form and the tracing and reference lines were used as guides to establish proper alignment. After plaster had been poured in the form and blended into the stump model, 1/4-in. thick polypropylene was vacuum formed about the extended model and subsequently modified to establish an AFO-type of socket with maximum rigidity about the ankle and anterior lever arm. A Plastizote interface was molded to the anterior aspect of the stump model and mated to a toe filler shaped from SACH-foot heel-cushion stock. <a href="/files/original/bd5404308943c819bbb4f8cf4312b7c3.jpg">Fig. 3</a>. Outline of feet during weight-bearing to provide references for fabrication and alignment of the molded prosthesis. The semi-completed prosthesis was fitted to the patient so that adequacy of fit and alignment could be checked. Ambulation by the patient revealed that he still experienced some pain, which was relieved by using adhesive tape to strap the shin firmly into the prosthesis and thus distribute the pressure over a broader area. While the patient was standing, strapped in the prosthesis, splints were used to cast the limb for an anterior shell that would match properly with the posterior element. Polyethelene was vacuum formed over the model to form an anterior shell that was lined with Plastizote. The two elements were then fitted to the patient and fastened proximally with "PTB-type" buttons in a fashion identical to the tibial fracture orthosis reported by Stills <a></a>. The finished prosthesis (Fig. 4, Fig. 5, Fig. 6) weighed 18 ounces and fitted more loosely in the shoe than the older prosthesis. The patient reported total comfort in the prosthesis during walking and considered the vastly decreased weight an important advantage. <a href="/files/original/8377ac015b32853159b839d4e215bde5.jpg">Fig. 4.</a> The molded prosthesis on the patient. <a href="/files/original/568455a545a488a7582cc67a53f4e0ff.jpg">Fig. 5</a>. Lateral view of the molded prosthesis. <a href="/files/original/bba2f04183e22d65f8b82db57ebb81de.jpg">Fig. 6.</a> Three-quarter anterior view of the molded prosthesis. References: <ol> <li>Alidredge, R. FF, and E. F. Murphy, The influence of new developments on amputation surgery. In: Human Limbs and their Substitutes. New York, McGraw Hill Co., Inc. 1954.</li> <li>Anderson, M. H., J. J. Bray, and C. A. Hennessey, The construction and fitting of lower-extremity prostheses. In: Orthopaedic Appliances Atlas. Ann Arbor, ). W. Edwards, 1960.</li> <li>Bingham, J. The surgery for partial foot amputations. In: Prosthetic and Orthotic Practice. London, Edward Arnold Ltd., 1970.</li> <li>Condie, D. N. Biomechanics of the partial foot amputation. In: Prosthetic and Orthotic Practice. London, Edward Arnold Ltd., 1970,</li> <li>El-Sharkaw, A., H. Abdel-Farrar, H. El-Hadidi, and M. Abdel-Hafez, A reconsideration of tarsal amputations with a new approach to the problem of equinus deformity. In: Proceedings of the International Conference, Cairo and Alexandria, Egypt, May 1- 1 1, 1972. Sponsored by Social and Rehabilitation Service, DHEW, USA and International Society-tor Prosthetics and Orthotics.</li> <li>Eillauer, K. A prosthesis tor foot amputation near the tarsal-metatarsal junction. Orthotics and Prosthetics 30 (3): 9-11, September 1976.</li> <li>Rubenstein, H. J., G. J. Sweeney, P. Strong, and C. Durrett, A foot amputation orthosis-prosthesis. Inter-Clinic Information Bulletin 14(4), April 1975.</li> <li>Rubin, G., and M. Daniso, Functional partial foot prosthesis. Bulletin of Prosthetic Research 10-16: 149-152, Fall 1971.</li> <li>Rubin, C, and M. Daniso, A functional Chopart prosthesis. Inter-clinic Information Bulletin 11(6), March 1972.</li> <li>Stills, M. Vacuum-formed orthoses for fracture of the tibia. Orthotics and Prosthetics 30(2): 43-55, June 1976.</li> <li>Wagner, W. Instructional Course in Amputation Surgery and Post-Op Care. ISPO World Congress. New York, May 1977</li> </ol> *Charles H. Pritham C.P.O. Staff Prosthetist, Rehabilitation Engineering Center, Moss Rehabilitation Hospital, 12th St. &Tabor Rri., Phila., Pa. 19141 Page Number(s) 5 - 7 Year 1977 Volume 1 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1977_03_005/1977_03_005-6.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Partial Foot Amputation - A Case Study Creator An entity primarily responsible for making the resource Charles H. Pritham C.P.O. * https://staging.drfop.org/files/original/30c31f3ab0a1bb7bf6b2fed3d44ab98e.pdf 1b4c13b6fe4572542d88a4b6b1765e21 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_03_001.pdf Text Any textual data included in the document <h2>"The Geriatric Amputees" - Results of the Questionnaire</h2> There were twenty-three replies by mail to the questionnaire on management of lower-limb geriatric amputees that appeared in the Spring 1977 issue of the NEWSLETTER. Ten were signed by prosthetists, five came from M.D.'s and two from therapists. The remarks included on the six unsigned forms appear to have come from prosthetists. The raw results, question-by-question, are shown below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? PROSTHETISTS <blockquote> AK yes: 15, No: 1 BK yes: 14, No: 2 </blockquote> Comments made by the prosthetists: <ul> <li> They cannot be made too light. </li> <li> We use endoskeletal AK set ups and light feet as often as possible to reduce weight. </li> <li> Yes. Unless "conventional" prostheses are already very light. BK's should weigh between 1 1/2 - 3 lbs. and AK's from 4 1/2 — 6 1/2 lbs. Decreases energy consumption, eases suspension. Soon, however, new materials and techniques should allow all prostheses to weigh about the same. Major difference for geriatrics is not weight but socket comfort and cost. </li> <li> A major complaint from the geriatric patient is the weight of the prosthesis. </li> <li> In most cases conventional prostheses are prescribed and the geriatric patient has trouble with them usually because of the weight. But age and strength are the difference. </li> <li> This is debatable, each case should be considered individually. I feel that most geriatric males would prefer a conventional prothesis. </li> <li> As much weight as you can knock off the better. The old story of the leg being so light that in a strong wind it is hard to control, just a tale. </li> <li> Whenever possible, a light-weight prosthesis is desirable for geriatric patients. </li> <li> Patients' resources less and need for strength not important, </li> <li> I do not feel that this is a very major issue as far as function is concerned. Most patients complain about weight early but those who do function do not continue these complaints, </li> <li> It is generally desirable that prostheses be as light as possible. </li> <li> Light limbs seem to be tolerated much more than the heavy limb. </li> <li> An attempt is always made to maintain lightness in all prostheses, however, especially AK geriatrics who are fighting quite a lever arm in regard to weight. </li> <li> The decrease in energy out-put during ambulation is very important for the geriatric amputee. Decrease in weight decreases energy out-put which in turn decreases the stress on the cardiovascular system. </li> <li> Even where a geriatric has not experienced an amputation, there is loss of muscular strength. This is the primary-reason for a lighter prosthesis. </li> </ul> PHYSICIANS AK Yes: 5, No: 1 BK Yes: 4, No: 2 <ul> <li> If the geriatric amputee is unable to manage the conventional prosthesis, making a lighter limb increases his difficulties when walking in a high wind or deep snow. In these cases I fit the geriatric amputee with an articulated peg leg invariably with a successful result. </li> <li> Initially they do quite well, however, a lighter, especially AK prosthesis would help. </li> <li> I think all prostheses should weigh less, particularly for geriatrics. The prosthetists should go to extra lengths to thin out the shell of exoskeletal limbs as thin as possible and consistent with durability. This is just not done enough with the shins of AK and BK prostheses. </li> <li> If there is sensory loss, a heavier prosthesis for sensory feedback may be necessary. </li> </ul> THERAPISTS <ul> <li> One therapist felt that both the AK and BK prosthesis should weigh less than the conventional and commented that "Patients seem to prefer an extremely lightweight prosthesis." The other therapist did not check any of the boxes but wrote in "Individualized Adjustment" and commented that "A neurophysiological functional evaluation should determine if the patient responds better to heavier or lighter sensory bombardment." </li> </ul> DISCUSSION The great majority of clinicians seem to feel that lower-limb prostheses that weigh less than those generally available are desirable for the older patient. </li> <li> What type of knee do you generally use for above-knee cases? PROSTHETISTS <table style="border-style: none; width: 338px; margin-left: auto; margin-right: auto;" height="120"> <tbody> <tr> <td>Manual lock</td> <td>6</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>10</td> </tr> <tr> <td>Other (please specify)</td> <td>11</td> </tr> </tbody> </table> Prosthetists' comments were as follows: Manual Lock: <ul> <li> Treatment for the dysvascular amputee should always be separated from geriatric amputees with other causes for amputation at Rancho, well over 90 percent of amputations are secondary to vascular problems. Manual lock knees have cut down PT time by two weeks, and, combined with an adjustable socket, have made it possible to convert nearly all of our dysvascular AK's into prosthesis wearers and more importantly, they use them. </li> <li> At our clinic either the adjustable AK "Rancho design" or conventional AK have locking knees. </li> <li> We have not been pleased with the various "safety" knees. The only really useful one is the SHS — we do not use it for geriatric patients, but it's the best. </li> <li> Balsa Lock knee, wherever possible, light weight foot with soft heel. Polypropylene joint and band (where stump is long) </li> </ul> Weight-Bearing (Safety-Knee): <ul> <li> The friction lock type of knee will work for 80% of the AK's. </li> <li> The weight-bearing knee seems to be the most easily managed by elderly amputees. </li> <li> Manual lock knees only when safety knee is inadequate. </li> <li> I prefer endoskeletal. </li> <li> About 90% of our geriatric patients are fitted with friction locking knees and 10% are fitted with manual locks. </li> <li> Aside from poorer musculature, the evidence of less proprioception illustrates that the AK geriatric has difficulty knowing where his knee and foot are. Only in extreme severe muscular weakness is a manual lock prescribed. </li> </ul> Manual lock & Weight-bearing (Safety) Knee: Varies with patient need. All three types marked: <ul> <li> Depends on needs of the patient and his ability to control the knee with his own efforts, as well as his expected level of performance. </li> </ul> Other: <ul> <li> Constant friction knee for the elderly. Not much maintenance problem. Variable gait is not an important factor. Mauch S-N-S for the younger amputee. </li> </ul> None Marked: <ul> <li> My approach is to evaluate each person individually. Our primary knee is the Bock Safety knee, relying primarily upon alignment stability and fast plantar flexion of S/A foot. I use Kolman only when absolutely necessary due to noise problems. </li> </ul> PHYSICIANS <table style="border-style: none; width: 390px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock</td> <td>2</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>3</td> </tr> <tr> <td>Other (please specify)</td> <td>0</td> </tr> </tbody> </table> The physicians comments were as follows: Manual Lock: <ul> <li> Bock Geriatric. Most often. Weight-bearing (Safety) knee, seldom. Often knee lock with option to give constant friction if open, as a trial. </li> <li> Safety is very important. There is more energy required to operate a safety knee (Bock). I reserve it for the younger amputee. </li> </ul> Weight-Bearing Safety Knee: <ul> <li> We need a manual lock that is sturdier than the Bock geriatric knee. Ideally someone should manufacture a lock that could be placed on the outside of the prosthesis so that if patient finally confident enough with free knee after practice he could remove it. </li> <li> I usually use the Otto Bock Safety knee which stands use by the geriatric amputee well. However, have run into breakdown problems with this knee in my younger patients. </li> </ul> THERAPISTS The comments from the two therapists were: <ul> <li> Knee usually depends on patient's functional demands, equipment cost, prosthetist convenience in non-standard set-ups in that order. </li> <li> My training is deficient in the prosthesis — but excellent in observation of physiological response. </li> </ul> DISCUSSION Opinion on use of manual lock versus the weight-bearing (Safety) knee is slightly in favor of the weight-bearing (Safety) knee. Certainly the weight-bearing units provide more function and better appearance when they can be used. It is gratifying to find that so many prosthetists and physicians are being successful with the more functional units. </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? PROSTHETISTS Yes: 7 No: 8 No experience: 1 <ul> <li> No, Have not used them for 5 years — patients would not wear them after six months. </li> <li> No. We have used them, however, the cases were to prove to the patient the difficult task it is to master bilateral AK prostheses. The stubbie is a substitute but not a good one. </li> <li> No. Much trouble and expense for very little benefit. Most should not be fit at all. If fit, shorten slightly but include knee joints for sitting purposes. Stubbies cause problems in wheelchairs, look horrible and do not convert non-users of prostheses into users. </li> <li> No. In most cases the bilateral AK patient has had extensive vascular surgery and scars in abdomen and scarpas are too much of a problem. </li> <li> No. Most would rather sit in a wheelchair. </li> <li> No. We have not had the occasion to use them. Geriatric amputees, with therapy, are able to use light-weight prostheses with weight bearing knees. </li> <li> No. We've tried stubbies in a few cases where we thought the patient could eventually go to regular legs. A better idea is pylons — you can adjust them. No one uses stubbies permanently — a wheelchair is much more functional. </li> <li> No. Stubbies make patients look like "freaks", they think. Patients are more functional in wheelchairs. </li> <li> Yes. Only if there is a good P.T. program. </li> <li> Yes. To permit A.D.L. in the home — We have 2 cases of short A.K.'s who did so well they demanded full length prostheses and did fair. </li> <li> Yes. As temporaries to define the patient's functional potential both to him and to the clinic team. </li> <li> Yes. If bilateral amputation occurs simultaneously. </li> <li> Yes. It is a way to allow an individual independence and mobility without the problems of knee control. </li> <li> Yes. There are amputees that can walk with stubbies and not walk with bilateral A/K prostheses therefore it is desirable in obtaining an accurate assessment of prosthetic potential. </li> <li> Yes. Bilateral stubbies offer safety that no AK with knees can offer. The CG is closer to the earth, and there is less weight to be manipulated. I would recommend stubbies for the desirable active AK. </li> <li> No opinion. I have no experience in this area. </li> </ul> PHYSICIANS Three physicians were opposed to the use of stubbies and two felt that their use is indicated. The physician's comments were: <ul> <li> No. Stubbies are unsightly ugly things, besides (they) cost as much as prostheses. I very seldom prescribe bilateral AK prostheses to geriatric patients. The few knees I did, the prosthesis ended up in the closet. However, an occasional patient may do well, however, when the prostheses are made several inches shorter than patient's original height. Each patient is pretested with pylons. </li> <li> No. I do not believe in fitting bilateral AK's with vascular disease. If young and vigorous and traumatic — and candidate for limited walking with bilateral AK prostheses — should be fitted with full length. </li> <li> No. Not in the geriatric, but useful in young adults. </li> <li> Yes. Useful around the house if patient wants them. Cosmesis bad. Useful for training. </li> <li> Yes. I regard this as an essential if the bilateral amputee is to learn to walk satisfactorily. </li> </ul> THERAPISTS Both therapists felt that use of stubbies is desirable. Their comments were: <ul> <li> Yes. Stubbies are desirable to demonstrate to most patients that the amount of energy expended is usually not worth the effort, from a functional point of view. </li> <li> Yes. Any reasonably balanced device helps maintain balance and muscle strength. Prevention of disuse atrophy. </li> </ul> DISCUSSION The respondents were almost equally divided on the issue of stubbies, and without exception each respondent offered a comment. The comments seem to indicate that in spite of drawbacks stubbies can be used successfully in certain settings, and that a careful, thorough evaluation of this procedure is needed. </li> <li> In your opinion, is immediate postsurgical fitting of prostheses desirable for geriatric cases? PROSTHETISTS Eleven prosthetists felt that immediate postsurgical fitting is indicated for geriatric patients; five felt that the procedure was contraindicated, while one felt that it would probably be useful if orthopaedic surgeons performed the amputations. Their comments are as follows: <ul> <li> Yes. We only recommend a rigid dressing. Only after wound healing has been ascertained do we apply a pylon. </li> <li> Yes. If there is a good P.T. program; otherwise only the rigid dressing should be used. </li> <li> Yes. This treatment doesn't allow the geratric amputee to become comfortable in a wheelchair thus losing strength and endurance. </li> <li> Yes. The PT Department starts working with the patient within 24 hours and the chances are (that) contractures and depression won't occur. </li> <li> Yes. BK's only. AK's too much trouble for benefit accrued. </li> <li> Yes. Immediate fitting is good for everyone. But its hard to do — hard to supervise, takes a lot of effort so its not done. </li> <li> Yes. For below-knee patients who have the ability to coordinate the post surgical dressing and pylon. </li> <li> Yes. I feel immediate post surgical fittings minimize loss of strength which is very critical in the geriatric cases. </li> <li> Yes. I.P.S. fittings are desirable for any amputee, aside from trauma cases. The less muscle tone the geriatric loses the better his chances are of becoming a successful prosthetic candidate with I.P.S.F. This is possible. </li> <li> No. The results I have witnessed have been mostly unfavorable. Perhaps if the orthopedic surgeons did more of the amputations it would be more advisable. </li> <li> No. Rigid dressings for BK's should be used for 10-14 days then a temporary prosthesis for 2-4 weeks. Immediate post-surgical fittings encourage too much activity and it is too hard to control the stress the patient is placing on the wound. </li> <li> No. We never use immediate postsurgical fitting. Stumps should be healed before shrinkage is attempted. After stump is healed, we use laminated plastic sockets on temporary units for definitive shrinking. </li> <li> No. Low tolerance. </li> <li> (Nothing marked) It depends on the patient's prior medical history. We would not recommend it for diabetic patients. </li> </ul> PHYSICIANS Two physicians felt that immediate postsurgical fitting had a place in management of geriatric patients; two felt otherwise; and one had no experience on which to base an opinion. Their comments were: <ul> <li> Yes, If you have full team approach including nurses who fully understand principle. Otherwise early temporary fitting with good control of stump edema may be second best alternative. Two months is still a long delay. </li> <li> Yes. I do not feel that a differentiation need be made unless there are other conflicting medical factors, e.g. heart disease. </li> <li> No. But I prefer rigid dressings with early fitting when wound is fully healed. </li> <li> No. No benefits except psychological, and many dangers. Use of cast is OK in many cases, but adding prosthesis courts disaster. </li> <li> (Nothing marked) I cannot express an opinion since in our institution immediate post surgical fitting is not being done at all. </li> </ul> THERAPISTS Both therapists felt that immediate post surgical fitting is useful. Their comments were: <ul> <li> Yes, . . . but please see abstract of article to be published in American Journal of Surgery {which will be publishing in a future issue. Ed.). I feel that very few people now are using the prosthesis on an immediate basis, but our prospective study well documents the value of the rigid dressing in the postoperative care of the BK amputee. </li> <li> Yes. Normal physiology maintained at maximum potential. </li> </ul> DISCUSSION The replies to this question indicate that the use of a rigid dressing is used widely and that immediate postsurgical fitting is used more than is generally expected. Perhaps the reports on the study at Iowa will encourage others to adopt these advanced techniques. Other clinics with experience should publish results of their clinical program. </li> <li> In your opinion what is needed to improve the function of geriatric amputees? All of the respondents commented on this question. Their comments were as follows: PROSTHETISTS <ul> <li> The lightest prosthesis with the safety factor at the knee system (being) the main factor. </li> <li> A better method of suspending the AK prosthesis. Total suction does not work, rigid pelvic belt is a fair substitute, but (is) heavy. Something better is needed. </li> <li> Vascular surgery is often indicated but compounds our fitting problems. After several surgical procedures — physiologically and psychologically the patients require more professional service — let us all hope that more orthopedists would become more involved in amputation surgery. </li> <li> An adjustable BK socket that is permanent. It can be fit(ted) instead of a "temporary" and will adjust throughout the "maturing" process. (It) will save time, as patient can adjust it and since a temporary is not needed, it will save dollars. Most physicians are looking for a cheap geriatric prosthesis, although they will state "light duty" or "lightweight" or "sitting prosthesis." </li> <li> I believe the prosthetic components that we have now are all we need: However the P.T. program needs to be reevaluated. </li> <li> Better pre-op and initial post-op care. </li> <li> This is where the total team is so very necessary. Pre-surgical consultation, pre-prosthetic care and post prosthetic training and followup. Outpatient care for the amputee is practically overlooked by the doctors and the subsidizing agencies, the insurance companies, Medicare and Medicaid. The patient can only receive adequate care as an inpatient. Usually his funding is exhausted by the time he is ready for prosthetic fitting. </li> <li> A lightweight single axis foot. More training for surgeons (general and vascular) to give the patient a chance for a BK, when the problem is in the toes or ankle; also teach them how to bevel and round the tibia. </li> <li> Articles such as this help spread information that geriatric patients can utilize a prosthesis. Motivation is an important factor. Two days ago we fitted a 91-year-old man with a prosthesis and his initial attempts have been excellent. </li> <li> Lighter prostheses, greater emphasis on use of temporaries in early phase of rehabilitation. </li> <li> Quicker fabrication and more adjustable prostheses. We use Polysar sockets and pylons. We can make adjustments easily and get (out) the prosthesis quickly. </li> <li> The limiting factors in geriatric amputees are motivation, coordination, and endurance. The therapist has the best chance to do something about these things. </li> <li> Patient compliance and patience with the amputee. </li> <li> Better post-surgical physical therapy. Some method to decrease the long periods of inactivity and confinement to a bed prior to amputation. </li> </ul> Follow-up programs. <ol> <li> Successful therapy program (before and after fitting) </li> <li> A competent prosthetist — follow-up necessary </li> <li> A sound instillation of confidence to the geriatric </li> <li> A good exoskeletal safety knee (needs) to be developed. </li> </ol> PHYSICIANS <ul> <li> Enthusiastic team work and total care of the patient to include medical, socioeconomic and vocational aspects. </li> <li> Immediate referral to a rehabilitation department to teach necessary conditioning exercise, range of motion exercise to prevent contracture and stump conditioning. </li> <li> More interest and concern of plight of elderly person with vascular disease by surgeons in particular, but also by physicians in general. And I don't mean simply interest in the pathophysicology and surgical approaches to arteriosclerosis. </li> <li> Improved sensory feedback </li> <li> Improved training procedures </li> <li> Improved knowledge of what the patient really needs </li> </ul> THERAPISTS My concern is the bracing needed for C.V.A.'s. Our suggestion to our Medical Chief of Staff is to invite your representative to hold a seminar in our hospital. Generally we need to sell the success of fitting the geriatric AK from the standpoint of requiring less in terms of third-party paid institutionalization or purchased services. An AK patient on a walker is much easier to deal with than a one-legged wheelchair-bound patient. In short, we need to emphasize the 4 successes of 10 attempts, and demonstrate this success in a cost-effective manner. This is the only language cost conscious bureaucrats will understand. Additionally, many patients report positive attributes of independence in gait, so they "don't have to depend on or bother their family or friends." At the same time, we need to strive to improve our care package so as to raise the percentage of AK's who become independent with their prostheses. </li> </ol> SUPPLEMENTARY DATA To augment the data provided by the 23 questionnaires returned through the mail, prosthetists attending the instructional course in molded plastics sponsored by the American Academy of Orthotists and Prosthetists and held in Kansas City, Missouri, July 15-16, 1977, were asked to fill out the questionnaire. Forty-one did so. The results are given below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? AK Yes: 41 No: 0 No mark: 0 BK Yes: 39 No: 0 No mark: 2 </li> <li> What type of knee lock do you generally use for above-knee cases? <table style="border-style: none; width: 402px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock:</td> <td>15</td> </tr> <tr> <td>Weight-bearing (Safety Knee):</td> <td>22</td> </tr> <tr> <td>Other:</td> <td>3</td> </tr> <tr> <td>No mark:</td> <td>5</td> </tr> </tbody> </table> (Four people marked two places. Most of the 5 not marked made some kind of comment.) </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? <table style="border-style: none; width: 401px; margin-left: auto; margin-right: auto;" height="123"> <tbody> <tr> <td style="text-align: left;">Yes:</td> <td style="text-align: left;">21</td> </tr> <tr style="text-align: left;"> <td>No:</td> <td>19</td> </tr> <tr style="text-align: left;"> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> (One person checked both yes and no.) </li> <li> In your opinion is immediate postsurgical fitting of prostheses desirable for geriatric cases? <table style="border-style: none; width: 400px; margin-left: auto; margin-right: auto;" height="121"> <tbody> <tr> <td>Yes:</td> <td>25</td> </tr> <tr> <td>No:</td> <td>14</td> </tr> <tr> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> </li> <li> In your opinion what is needed to improve the function of geriatric amputees? <ul> <li> Improved knees and feet of lighter weight. </li> <li> In hospital prosthetic facilities so therapists and prosthetists could give combined and closer supervision to walking training, etc. </li> <li> Suspension in geriatrics seems to cause weight and cosmetic problems. </li> <li> A good pre-prosthetic program, a qualified P.T. and a well fitting lightweight prosthesis. </li> <li> Proper post surgical supervision and gait training with prosthesis. Lighter prosthesis that is more comfortable. </li> <li> A good sound Rehabilitation program: 1. Good Amputation; 2. Good prosthesis; 3. Good P.T. </li> <li> Simple donning procedures — less weight, uncomplicated mechanics to understand. </li> <li> Closer observation and good rehabilitation work after surgery so the patient will have the best chance possible of becoming self-sufficient. </li> <li> Reduced weight/energy consumption. </li> <li> Getting them in better physical condition prior to prosthetic fitting. </li> <li> Better physical therapy and PT follow-up. </li> <li> Better materials other than plaster, transparent materials perhaps, lighter weight, orthoplast possibly. </li> <li> More the patients can do for themselves, less care needed by other people. </li> <li> Feather weight prostheses, and 2) team approach management. </li> <li> You can put a safety knee and a two way ankle. </li> <li> (I don't know) I have been fitting AK prosthesis for only a year therefore the above information may not be of value due to my personal lack of experience. </li> <li> Lighter materials. </li> <li> Better communication between the doctor, therapist, prosthetist and patient. </li> <li> Most patients need one person, as overseer, who can control his rehab program, — a coordinator. </li> <li> Immediate post-operative fitting. </li> <li> Lighter prosthesis. </li> <li> Increased physical therapy, —early as possible. </li> <li> More lighter and durable prosthesis and exercise. </li> <li> Exercise. </li> <li> Lighter weight and a more positive attitude about age and life in the future. </li> <li> Proper instruction in wrapping, exercise, etc. </li> </ul> </li> </ol> DISCUSSION The supplementary data agrees remarkably well with that received through the mail, and only reinforces any conclusions that can be reached from the information supplied by the original 23 respondents. It seems that geriatric patients are receiving considerable attention throughout the country and while the results are good considerable refinement in devices and techniques will be welcomed. Reduction in weight of artificial legs for all levels of amputation through the lower limb seems to be indicated, and improved knee control units are needed by above-knee (and hip-disarticulation) cases. The use of stubbies certainly needs clarification, probably through a well-ordered study. Page Number(s) 1 - 5 Year 1977 Volume 1 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "The Geriatric Amputees" - Results of the Questionnaire https://staging.drfop.org/files/original/9e338894b1f207843da22d94280a118d.pdf 3393a872a919021256b2ab1ef2371b05 https://staging.drfop.org/files/original/4fee943f810bcedb55cf94bac3f60253.jpeg 0b6369b919b0a4c5d421fce6886e6d5e https://staging.drfop.org/files/original/6396c81100371bfe9d8ac940075631cb.jpg 023518571192ab6721498d9b4a8f7662 https://staging.drfop.org/files/original/0d2768cace046397bbf7d7040508d863.jpg 07e13ce84947e5b2f1732d2de5338794 https://staging.drfop.org/files/original/d83594653570ca96f690044f2b1d657d.jpg 8bc03b7ee87b349b287b877e8a698bc0 https://staging.drfop.org/files/original/8a3452f59a563b52f53eb6f67c8a4be4.jpg 470315d686168817996c70c6a4928ce9 https://staging.drfop.org/files/original/1f8be944e589b7eac3c9645bca1a26e8.jpg 59b8b275e0cb6ce51b166ec3ae492e31 https://staging.drfop.org/files/original/aec7299a96361a338ddc5dacbcdf4e28.jpeg cf51d6d972c19f2beaaeced91b298b2e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_02_004.pdf Text Any textual data included in the document <h2>The Geriatric Amputee</h2> <h5>Florence T. Leist, P.T.  <a href="/files/original/4fee943f810bcedb55cf94bac3f60253.jpeg">Fig 1: Florence Leist</a></h5> Presented at the Annual Meeting of the American Physical Therapy Association of Md., Inc., November 13, 1976. The purpose of this presentation is to challenge each of you to become an advocate for the geriatric amputee, and to evaluate his potential on factors other than his age. To dispel the theory of a person being too old to use a prosthesis I would like to share a couple of real situations. We had a dear 77-year-old man receive his prosthesis at our clinic at Deer's Head in the spring. Last summer I met his grandson, and when I asked him how his grandfather was, he replied, "oh, he's fine now that he has his new leg. He's even courting a girl friend." Then there is the 85-year-old woman who received a new prosthesis and yet another new one at the age of 87 to enable her to continue caring for and babysitting her great grandchildren. This afternoon I would like to talk first about factors to be considered in the management of the geriatric lower-limb amputee, and then present some statistics gathered from a review of the amputees who received their prostheses through the clinic at Deer's Head Center during its first two years of operation. The management of the amputee can be divided into three phases: <ol> <li> Post amputation and/or pre-prosthetic training. </li> <li> Prescription. </li> <li> Post prosthetic training. </li> </ol> One of the problems we had in the management of the geriatric amputee was the scarcity of information provided by the referring physician. We sometimes got little more information than that the patient had had an amputation - not even a mention of whether it was an AK or BK, or whether it was on the right or the left. To help overcome this situation we developed a questionnaire to develop not only the necessary basic history, but, more importantly, information such as cardiac status and the condition of the remaining lower limb. We also included the question "is he able to increase exertion 50 per cent more than is required for normal walking or wheelchair use." We used the reference "On energy requirements for prosthesis use of geriatric amputee" to establish that question (Peizer, E. On the energy requirements for prosthesis use by geriatric amputees, in "The Geriatric Amputee," Committee on Prosthetics, Research and Development, National Academy of Sciences, 1961). <h3>Depression</h3> In the pre-prosthetic period there are many apsects to consider. From our first contact with the geriatric amputee we usually get a definite feeling about his general mental status. We often find that he is depressed: his self-image has been shattered; he is suddenly unable to walk, work, or even get out of the house; he is faced with a great fear of the future. "What," he asks, "is going to happen to me and my family?" To help him cope with these many frightening problems, the social worker, who we feel is an important member of the team, can be of value from the beginning by helping him face reality, helping solve some of his problems, and by giving him added encouragement. <h3>Range of Joint Motion</h3> Loss of range of motion is more rapid in the geriatric patient because of loss of tissue elasticity. Management is to institute bed positioning and range of motion exercises and encourage freedom of movement as soon as possible. Our goal to have not more than 10 deg. of flexion contracture in hip and knee. Stretching exercises must be carried out if contractures have developed, but one must remember that the older patient tolerates stretching poorly. <h3>Muscle Strength</h3> There is a generalized decrease in strength with age which is compounded by the effects of surgery and forced inactivity. Management is through general strengthening exercise, but the cardiac status and other systems must be considered in planning the exercise program. Usually we must accept less than what is considered as ideal strength. The goal is that the patient be able to support himself by a walkerette or crutches. Often times the geriatric amputee has poor balance and is fearful of falling. He has to be encouraged to try walking with crutches or walkerette and must be well guarded to prevent failing. Ideally our highest pre-prosthetic goal is independence in walking with crutches, however, as we are more concerned with safety and realize the older person does not have the agility and balance of a younger person, walking independently with a walkerette is acceptable. Our chief concern is the safety of the patient and his ability to function. We emphasize the specific stump exercises for extension and abduction of the hip for the AK and the quadriceps for the BK. <h3>Shaping the Stump</h3> In the older amputee generalized soft tissue atrophy is already present and stump wrapping should be monitored carefully. The patient and his family usually lack a clear understanding for the need of stump wrapping, so clear explanations and instructions should be given to insure proper shaping of the stump. <h3>Length of Time Before Prescription</h3> We usually find that most new amputees are presented at our Prosthetic Clinic about 2 months post amputation. Sometimes it is more than that and once in a while less. If it has been 2 months or longer, usually there has been adequate time for reduction of contractures, an increase in strength, proper shaping of the stump, and for learning to walk with assistive devices. If the time is shorter and the patient is able to handle himself on crutches or walkerette but still lacks range of motion or has not stabilized in the shrinking process, we usually go ahead and present him at clinic. The physician in charge of the clinic at DHC has at times given a provisional prescription, stating that when the contracture has been reduced or shrinkage has stabilized the prosthetist may proceed with fabrication of the prosthesis. The team approach is used at the clinic at DHC. The team consists of the physician in charge, the prosthetist, the physical therapist, the occupational therapist, the social worker, counselors from the Division of Vocational Rehabilitation, the patient, and his family, whenever possible. <h3>Prescription for the Geriatric Amputee</h3> Usually, when a patient has worn a prosthesis previously, a prescription for a duplication of the present prosthesis is made, i.e., when a person has a plug socket or a thigh corset, it is duplicated as closely as possible. For a new amputee, we try to prescribe components to meet the criteria which we developed during our evaluation. <h3>Sockets</h3> Quadrilateral sockets with partial suction and valve, usually fitted with a heavy cotton sock, is the design of choice unless there is extensive soft tissue atrophy, when a 5-ply woolen sock is used. <h3>Suspension</h3> A hip joint with pelvic band gives greater security. Suction is generally not prescribed for the geriatric patient because he does not have the muscle strength or tone to use it. At times a "Silesian bandage," or belt, is prescribed, but the patient often has difficulty with internal rotation of the prosthesis when he pulls the "bandage" tight. We recently had to change a "Silesian bandage" to hip joint and pelvic band for a woman. <h3>Knee</h3> Maximum stability at heel strike is necessary for the geriatric patient. The manually locked knee joint provides this stability in ambulation. It does result in gait deviations, but safety with the geriatric patient is our chief concern. It is better to have gait deviations than no gait at all. To help overcome partially the need to circumduct or vault the prosthesis is generally made 1/2 to 1-in. shorter than the contralateral leg. Another knee component that is prescribed sometimes is the BOCK safety knee which provides stability through friction upon weight-bearing. <h3>Foot Components</h3> When a locked knee is used a single-axis foot is desirable because it permits the entire plantar surface of the foot to make contact with the floor early in the stance phase. With a person who is not a vigorous walker, such as an older person is apt to be, an extra soft heel bumper is indicated. When a SACH foot is used with an articulated knee an extra soft heel cushion is desirable. <h3>Post-Prosthetic Training</h3> Post-prosthetic training for a geriatric amputee should be considerably different from that for a young vigorous person. Balance, strength, agility, and endurance will all be reduced greatly and we must proceed more slowly. Goal setting will vary greatly from individual to individual - from limited use in the home to general activities of daily living, to return to work, from walking with no assistive device, to walking with cane or canes, crutches, or walkerette. We must set realistic goals for the geriatric amputee. Many of these people have not been active for a long period before amputation, and they will probably not regain vigorous strength and agility. But if we can return them to the life style to which they were accustomed then I think we have reached our goal. As I have said several times before, we are concerned with safety. While we would like to have a perfect gait, without any assistive device, we settle for safe gait with an assistive device. But when a 75-year-old man can climb on and run a tractor on the farm, what difference does it really make if he uses a cane? Or, if a 75-year-old woman is taking care of herself, staying by herself most of the day and performing household chores, is it so awful she uses a walkerette? Last year we conducted a review of the patients who received a prosthesis through our clinic during the first 2 years of its existence. The purpose of this was to ascertain whether or not the clinic was meeting the needs of the patient; i.e., were we prescribing the proper kind of prosthesis for the individual? And, we felt, this would be partially determined by the use the patient made of his prosthesis. All patients had had their prosthesis for at least a year. We interviewed each of these 24 patients on the day of the clinic, having them complete a questionnaire. Level of amputation, age group, and cause of amputation are given in Table 1. Five of these questions with the result are given in Table 2, Table 3, Table 4, Table 5, and Table 6. Table 1. Classification of Patients <img src="/files/original/6396c81100371bfe9d8ac940075631cb.jpg" alt="Italian Trulli" width="368" height="158" /> Table 2. I Wear My Artificial Limb: <img src="/files/original/0d2768cace046397bbf7d7040508d863.jpg" br="" width="580" height="179" /> Table 3. When I Wear My Limb It Is On: <img src="/files/original/d83594653570ca96f690044f2b1d657d.jpg" br="" width="602" height="134" /> Table 4. When My Limb Is On I Can: <img src="/files/original/8a3452f59a563b52f53eb6f67c8a4be4.jpg" br="" width="565" height="224" /> Table 5. When I Walk I Use: <img src="/files/original/1f8be944e589b7eac3c9645bca1a26e8.jpg" br="" width="571" height="127" /> Table 6. I Need Someone To Assist Me When I Walk: <img src="/files/original/aec7299a96361a338ddc5dacbcdf4e28.jpeg" br="" width="566" height="74" /> It was apparent to us from these statistics that we evidently were meeting the needs of the patients and that the amputees over 60 years of age function about on the same level of those under 60. References: <ol> <li>Burgess, Ernest M., Robert L. Romano, and Joseph H. Zettl, The management of lower-extremity amputations, Prosthetic and Sensory Aids Service, Veterans Administration, TR 10-6, August 1969.</li> </ol> Page Number(s) 4 - 7 Year 1977 Volume 1 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-5.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-6.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Text Copy Edit Figure 7 http://www.oandplibrary.org/cpo/images/1977_02_004/1977_02_004-7.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Geriatric Amputee Creator An entity primarily responsible for making the resource Florence T. Leist, P.T. https://staging.drfop.org/files/original/d586b041111b65540684d82a6e22f061.pdf e776f2fafbdbd45711ced14b11af8203 https://staging.drfop.org/files/original/a6c4aeadeff6b0f8ec45aad1761417bc.jpg 0335be700fe81e4e50cc3fa690fb418f https://staging.drfop.org/files/original/9621cce0bb9d571026c1d68d6c3bfdea.jpg e4ea4687449f451e36041c2e86b31857 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_02_001.pdf Text Any textual data included in the document <h2>Plastics in Lower-Limb Orthotics</h2> Our October 1976 Issue of the Newsletter discussed "Plastics in Lower-Limb Orthotics" and requested information from our readers as to their experiences and preferences. The following is the results of the questionnaire on this subject. <a href="/files/original/a6c4aeadeff6b0f8ec45aad1761417bc.jpg">Fig. 1: Fitting the Molded Plastic AFO.</a> <h3>Results of the Questionnaire and a Discussion of the Results</h3> <ol> <ol> <li> Does your clinic use custom made orthoses formed from sheet thermoplastic material? <blockquote> YES - 71 NO - 2 </blockquote> One of the respondents who answered "NO" is an institution that treats only amputees. The other "NO" came from an orthotics facility in New England who gave as the reason "We use Ortholene blanks and laminated AFO's." </li> <li> If the answer is "Yes" please name the materials used and show opposite the types of appliances made from the particular material. The responses to this question are shown in this Table. </li> </ol> </ol> <img src="https://staging.drfop.org/files/original/9621cce0bb9d571026c1d68d6c3bfdea.jpg" /> <ol> <li> Do you use preformed "off-the-shelf" AFO's? Thirty-one used preformed or "off-the-shelf" AFO's. Thirty-six who also used molded AFO's did not use "off-the-shelf" AFO's. Most of the respondents who used the preformed AFO's stipulated that the use was limited to initial trials or to those relatively few patients that could be fitted adequately. Those that refused to use the preformed unit felt that the better results obtained by custom molding was worth any extra effort necessary. </li> <li> Please give the reasons for the answer you gave to question "3". Some typical responses were: <blockquote> "They (preformed) will work on some patients....." "Use (preformed) on easy to fit patients or those not needing the extra support." "If the doctor specifically prescribes (preformed), or if the patient insists after explaining the advantages and disadvantages." "I use preformed AFO's for pes equinus only. I use custom made for all other orthotic treatment." "Because (preformed are) no good; have to reheat and mold to have work properly, so may as well start from scratch and make your own." "Fitting difficulties - sizes do not fit many patients who are edematous, atrophied, or need support." "They don't fit." "Doctors prefer custom-made." </blockquote> </li> <li> If you provide molded plastic orthoses, what type of equipment do you use in fabrication? The answers given were not always clear but it appears that: <blockquote> 35 used a vacuum machine of one type or another 19 used hand drape with vacuum 14 used hand drape without vacuum 8 used central fabrication </blockquote> Some facilities used more than one method, thus accounting for a total greater than the number of respondents that use custom formed orthoses. About the only conclusion that can be drawn from these figures is that vacuum machines are probably worth the investment. </li> <li> Please give your opinions about the usefulness of sheet thermoplastics in orthotics. Nearly every respondent answered this question in some detail. Most cited lightness and cosmetic benefits. Some typical comments: <blockquote> "We feel that this is the biggest advance in orthotics in the last few years, providing the patient with a lightweight, hygienic, orthotic system." "We feel that molded AFO's are far superior to conventional braces in every respect. Most of our orthoses are constructed using the materials and the patients and their physicians are most pleased." "I am able to obtain excellent fit and control with plastics that would not be possible with a leather-metal orthosis. Also, it is lighter and more cosmetic." "We find it has great adaptations to orthotics, with unlimited applications." "It's the only way." "These orthoses are useful for cosmesis, function, and light weight." "Unlimited potential, but discretion advised." "I feel we have uncovered a new dimension to orthotics and look forward to further developments in the future." "Enables orthotists to apply new ideas toward orthotics." </blockquote> </li> <li> Have you experienced problems with the quality of the sheet plastic material? If the answer is "Yes", please explain. Twenty five respondents indicated that they had experienced problems with the quality of sheet plastic, while 32 said that they have had no problems. Alan Finnieston of Miami, Florida, who has had a lot of experience in the use of the sheet plastics offers the following observations: <blockquote> "In answer to your question #7, we have had many difficulties with the quality of thermoplastic sheet material of various types. For example: Polypropylene, polyethylene, ABS, styrene, and polycarbonate to only mention a few. We have been involved with thermoplastics and the vacuum-forming field for approximately ten years. Orthotics and prosthetics cannot justify, by virtue of their volume, specific formulations of material to specifications. As an example, most Orthotists or Prosthetists are buying polypropylene on a local level through a distributor. The distributor has no means of controlling what material or formulation of polypropylene he is receiving. Polypropylene is available in homopolymer, copolymer, random or block, plus many variations of grades; extrusion, injection and film, with a multitude of modifiers which can vary specifications of the base material. One then must seek out the reputable extruder with high-quality equipment and technology. This eliminates the problem of the re-ground materials of unknown formulations plus regulation of the extrusion prices." </blockquote> </li> <li> Are special courses needed to provide orthotists and other members of the clinic team with training in the prescription, fabrication and fitting of molded plastic lower-limb orthoses? Please explain. Of the 73 respondents, only 2 said that they felt that special courses for orthotists and other members of the clinic team were not needed. One of these provided only "hard corsets" and "arch supports"; the other stated "No, not in lower limb orthotics, because the basic rationale is unchanged as is the function." An institution that provided only "hand splints" said "Registered occupational therapists who are trained in splinting in their academic and clinical education fabricate all splints in the clinic." One clinic and one orthotics facility both of which provided molded AFO's answered with a question mark, and another clinic did not respond to this question. However, the remaining 67 respondents felt quite strongly that special courses are needed if orthotists and other members of the clinic team are to make maximum use of the advantages afforded by sheet thermoplastics. The vast majority felt that all members of the clinic team should be offered training, but a few felt that formal training should be restricted to orthotists. Some of the responses are: <blockquote> "Yes, any further education is valuable to the entire team." "Yes - exchange of ideas would be very useful particularly concerning fabrication. I have been making vacuum formed molded orthoses for 2-1/2 years and I still find it useful to exchange ideas with others who do it; to get the bugs out." "Yes. It would be most help to attend a course in KAFO's." "Definitely. Many problems can be circumvented with previous training." "Yes, I believe this would be very helpful. I think this could be done in the curriculum of the schools already teaching Orthotics and Prosthetics. Seminars are helpful but only touch upon the surface. I think this area has already been covered in the last 5 years and needs more advance hands-on courses and experiences by physicians, therapists, orthotists and prosthetists." "Yes. So many doctors still want to use old methods." "Orthotists only should have courses, and then show the latest uses and methods. I feel that he should be the one to explain the advantages to the other team members." "I think courses stressing cast modification, preparation, hand layup, and fitting problems would be helpful to the whole team. Personally, I have seen all the vacuum layup films I can stand." </blockquote> </li> </ol> <h3>Overall Conclusions</h3> Thus, it seems obvious that sheet thermoplastics have a great potential in all aspects of orthotics and that appropriate education programs are needed and wanted. Alan Finnieston included in his reply an announcement that his firm intends to offer "a series of instructional programs on the correct use of plastics in contemporary orthotic practice" and suggests that those interested in attending contact him at 1901 N.W. 17th Avenue, Miami, Fla. 33125. The results of this survey have been forwarded to the formal education programs in this country and abroad with the hope that the faculties will be stimulated to initiate programs in this area. Page Number(s) 1 - 4 Year 1977 Volume 1 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 1 http://www.oandplibrary.org/cpo/images/1977_02_001/1977_02_001-1.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Plastics in Lower-Limb Orthotics https://staging.drfop.org/files/original/ee61dd08d73b1cad17151d32ba21665a.pdf 00de1488d4f6818f709108234fc1fd5a https://staging.drfop.org/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg 51ba0ecca6e54631dcd919a2c26a692f https://staging.drfop.org/files/original/1ea58d09d331e165282d3da5cc9f227d.jpg bf16b3b914da6223c95f0a83bf29956b https://staging.drfop.org/files/original/4fd62f8f90674af658c40281e2d37b8a.jpg f7926bbf8fc79875b7a3224beafaffed Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_01_002.pdf Text Any textual data included in the document <h2>Plastics in Lower-Limb Orthotics</h2> Polypropylene has been in use for lower-limb orthoses in various parts of the U.S. and Canada for more than 5 years. Although polypropylene itself was introduced and used in orthotics slightly before vacuum forming was introduced, most of the fabricators have used this technique in fabrication. Some AFO designs are being offered "off-the-shelf" in a series of sizes. Some suppliers stress that the purpose of these prefabricated units is to determine if the patient will benefit from a custom made device or devices. A partial bibliography on the use of plastics in orthotics is included on this page. We invite readers of the Newsletter to give us the benefit of their experiences with respect to both custom-made designs and off-the-shelf units by filling out the questionnaire on page 3 and returning it to AAOP, 1444 N Street, N.W., Washington, D.C. 20005. You are asked to be as complete as possible in the information you give so that meaningful conclusion can be obtained. If additional space is needed please use a blank piece of paper and attach it to the original. <a href="/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg">Fig. 1</a>, <a href="/files/original/1ea58d09d331e165282d3da5cc9f227d.jpg">Fig. 2</a>, <a href="/files/original/4fd62f8f90674af658c40281e2d37b8a.jpg">Fig. 3</a> References: <ol> <li>Artamonov, Alex, Vacuum forming of sheet plastics, ISPO Bulletin, No. 4, October 1972</li> <li>Casson, Jerry, Advanced designs of plastic lower-limb orthoses, Orth. and Pros. 26:3, September 1972</li> <li>Cohen, Samuel, and Warren Frisina, Polypropylene spiral ankle-foot orthosis, Orth. and Pros., 29:2, June 1975</li> <li>Demopoulos, James T. and Johne E. Eschen, Experience with plastic patellar-tendon-bearing orthoses, Orth, and Pros. 28:4, December 1974</li> <li>Dixon, Malcolm, and Robert Palumbo, Polypropylene knee orthosis with suprapatellar latex strap, Orth, and Pros., 29:3 September, 1975</li> <li>Engen, Thorkild J., The TIRR poly-propylene orthoses, Orth. and Pros. 26:4 December 1974</li> <li>Glancy, John and Richard E. Lindseth, "The polypropylene solid-ankle orthosis," Orth and Pros. 26:1, March 1972</li> <li>La Torre, Richard R., Michael Richards, and Sooklall Ramcharran, Ischial-thigh-knee-ankle orthosis, Orth, and Pros. 27:4, December 1973</li> <li>Lehneis, H. R., New concepts in lower-extremity orthotics, Med. Clin, of NA.A. 53:3:585-592, May 1969</li> <li>Lehneis, Hans Richard, Warren Frisina, Herbert W. Marx, and Tamara T. Sowell, Bioengineering design and development of lower-extremity orthotic devices, Bull. Pros. Res., BPR 10-20, Fall 1973</li> <li>Lehneis, Hans Richard, Plastic spiral ankle-foot orthoses, Orth, and Pros. 28:2, June 1974</li> <li>Marx, Herbert W., Lower-limb orthotic designs for the spastic hemiplegic patient, Orth, and Pros. 28:2, June 1974</li> <li>Rice, Edward, A new design for the drop-foot polypropylene orthosis, ISPO Bulletin No. 12, October 1974</li> <li>Rubin, Gustav, and Michael Danisi, A knee-stabilizing ankle-foot orthosis with adjustable spring-loaded ankle, Orth, and Pros. 29:3, September 1975</li> <li>Rubin, Gustav and Michael Danisi, A "slip" cuff for ankle-foot orthoses-a piston-action absorbing polypropylene orthotic cuff, Orth, and Pros. 28:1, March 1974</li> <li>Simons, Bernard C, Robert H. Jebsen, and Louis E. Wildman, Plastic short leg brace fabrication, Orth, and Pros. 21:3, September 1967</li> <li>Rubin, Gustav, and Robert L. Palumbo, A polypropylene knee-ankle orthosis, ISPO Bulletin No. 8, October 1973</li> <li>Sarno, J. E., and H. R. Lehneis, Prescription considerations for plastic below-knee orthoses, Arch. Phys. Med. and Rehab., 52:11:503-510, November 1971</li> <li>Stills, Melvin, Thermoformed ankle-foot orthoses, Orth, and Pros. 29:4, December 1975</li> <li>Stills, Melvin, Vacuum-formed orthoses for fracture of the tibia, Orth, and Pros., 30:2 June 1976</li> <li>Titus, Bert R., A patellar-tendon-bearing orthosis, Orth, and Pros. 29:1, March 1975</li> <li>Wilson, A. Bennett, Jr., Vacuum forming of plastics in prosthetics and orthotics, Orth. and Pros. 28:1, March 1974</li> </ol> Page Number(s) 2 - 2 Year 1977 Volume 1 Issue 1 Figure 1 https://staging.drfop.org/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1977_01_002/1977_01_002-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 3 http://www.oandplibrary.org/cpo/images/1977_01_002/1977_01_002-3.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Plastics in Lower-Limb Orthotics https://staging.drfop.org/files/original/9e60ebed5692df9e5fe07e6d4cd87a96.pdf 77971953d21518efcd4221380ba3b8a3 https://staging.drfop.org/files/original/c2545799ce5601d736f2cd4f1463a521.jpg 16fbd70081beef02a934947a081b6280 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_01_001.pdf Text Any textual data included in the document <h2>Introduction</h2> In December of 1969 the Committee on Prosthetic-Orthotic Education of the National Academy of Sciences initiated publication of "NEWSLETTER .... AMPUTEE CLINICS" in an effort to disseminate timely information to amputee clinic teams throughout the country and to provide a vehicle for the interchange of information among clinicians responsible for the care of amputees. The Newsletter met with immediate success and was published every two months until 1975 when policy changes at the National Academy of Sciences precluded publication of the Newsletter .... Amputee Clinics. The final issue, Vol. VIII No. 1 has been published with a date of July 1976 after a hiatus of nearly a year. Because so many members of the American Academy of Orthotists and Prosthetists and their colleagues on the clinic teams that they work with have voiced regret that the forum provided by the Newsletter, no longer exists the Board of AAOP, after a study, determined that the majority of the membership were in favor of assuming responsibility for continuation of this type of publication. Therefore, the board of the AAOP has made the decision to proceed on the basis of four issues per year, initially, and to expand the coverage to include orthotics. It was hoped that an announcement concerning the plans of the AAOP would be made in the final edition published by the NAS, but since such could not be effected this abbreviated edition is being sent to those who in the past have received the "Newsletter-Amputee Clinics" to determine the size of the circulation that can be expected. Our editor for the new publication will be Mr. A. Bennett Wilson, Jr. who helped formulate the original newsletter while in his previous position as Executive Director of CPRD. Mr. Wilson is now acting Director of Training at the Krusen Research Center of the Moss Rehabilitation Hospital in Philadelphia, Pa. The editorial board will be headed by Charles H. Epps, Jr., M.D. of Washington, D.C. Dr. Epps is chief of the Juvenile Amputee Clinic at D.C. General Hospital. Mr. Robert B. Peterson, R.P.T., Supervising Physical Therapist for Hospital Services, Maryland Department of Health and Mental Hygiene and the undersigned will also reside on the board. This group plans to seek technical consultation with representatives of the Veterans Administration Prosthetic Center and the Rehabilitation Services Administration of Health, Education and Welfare on all applicable subject matter. We would also like to thank Mr. Anthony Staros, Director of the Veterans Administration Prosthetic Center for his assistance and guidance in planning this new publication. To begin, four issues per year are contemplated. The initial subscription rate will be $8.00 per year. Each issue will contain short articles on both Prosthetics and Orthotics. AAOP members will receive their copies as a service to members. Prices will be adjusted to reflect costs without profit to the AAOP. A subscription order blank is included in this issue for the use of those who are not members of AAOP. Your participation will help us in assuring the long term success of this publication. <a href="/files/original/c2545799ce5601d736f2cd4f1463a521.jpg">Joseph M. Cestaro: AAOP President</a> Page Number(s) 1 - 1 Year 1977 Volume 1 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1977_01_001/1977_01_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Introduction https://staging.drfop.org/files/original/557e23aa1d087b7c2f923c835fba0ffc.pdf ad1cf6296e80bdb87d62d1953933265f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_04_004.pdf Text Any textual data included in the document <h2>Phantom Limb Pain</h2> <h5>Gustav Rubin, M.D., FACS <a style="text-decoration: none;">*</a></h5> This article is reprinted with authors permission from the Feb. 1979 issue of "The Amp." Doctor Rubin discusses Phantom Limb Pain on a basic and objective level that is easily understandable, especially to the amputee. This column was prompted by a letter from John Riegel, N.S.O., of Cleveland, Ohio. Let me expand on some of the points he wanted discussed. First: A definition of terms. Phantom Sensation is the feeling that the absent limb is still there but not necessarily painful. Phantom pain is the same feeling but the absent limb (or part of it) is painful. Almost every amputee experiences phantom sensation but statistically only five to ten percent have varying degrees of phantom pain. Second: Some of my medical colleagues still think that this type of pain is imagined by the amputee. It is not. It is a very real pain and can sometimes be so severe and continuous as to be disabling. However, in the great majority of instances it is intermittent, although it may last for days (and nights) at a time. Third: The cause and cure are unknown, just as the cause and cure of the common cold, and even cancer, are unknown. We have difficulty satisfactorily treating such ordinary conditions as chronic arthritis and severe flat feet, so the difficulty in adequately treating phantom limb pain should not be surprising. Fourth: The Cause. There are many theories about the cause. None is completely explanatory. As a working basis, the theory most acceptable to me is based on the fact that there is an area in the central nervous system which is a sort of way-station for messages on the way to our consciousness where they can be interpreted, in this specific case, as pain. Signals can either go up from the absent limb, or down from the conscious part of the brain (cortex) and affect the way-station. Sometimes if an amputee talks about or thinks about phantom pain he will trigger an episode. The signals that go up can be described as either "excitatory" or "inhibitory." These terms require no explanation. The inhibitory effect is partly maintained by messages from the skin. If a leg is amputated then a large part of the inhibitory messages that would ordinarily come from the skin of that part will be absent. The excitation messages will dominate and pain could be experienced. A way of thinking about the effect of inhibitory messages from the skin could be exemplified by the instance of the person who bumps his shin and then rubs the skin over a broad area to relieve the pain. He sends skin inhibitory messages to the brain to relieve the pain. Fifth: Treatments. Many different methods of treatment have been used. It is a simple fact that, when there are many ways to treat a condition, not one of them is much good. If there was one good way that would be the method used. Treatments attempted have ranged from the use of a freezing spray, to injections of novocaine, either locally or into the lower spine, cutting the nerves to the stump, cutting the roots of the nerves near the spinal cord, cutting the nerve pathways in the spinal cord itself, and even cutting out parts of the brain. Drugs, acupuncture, biofeedback, hypnosis, electrically stimulated implants around the nerve or in relation to the spinal cord; and even reamputation have been employed as methods of treatment. The most recent, and, at this writing, the most popular approach has been the use of transcutaneous electrical nerve stimulation (TNS or TENS). In contrast to many of the other previously mentioned methods it is harmless to the amputee. It is not destructive. Sometimes wrapping the stump tightly with an Ace bandage or percussing the stump will help. Putting the leg back on will often help. As one amputee said he wraps the stump and just "lies there and curses." If the pain in unrelieved by simple, non-destructive, non-damaging techniques, the amputee should be referred to one of the highly specialized pain centers. There are now many of these throughout the country. *Gustav Rubin, M.D., FACS V.A. Prosthetics Center <div style="width: 400px;"></div> Page Number(s) 4 - 5 Year 1979 Volume 3 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Phantom Limb Pain Creator An entity primarily responsible for making the resource Gustav Rubin, M.D., FACS * https://staging.drfop.org/files/original/52f7d266c544d7b057ce3f61ff421222.jpeg c442d8b15660c8c79d4df71065ad319d https://staging.drfop.org/files/original/cecb22a00897ba34f840608eed75219c.jpeg 1dad83a740d94fdf8668227e6d78ec45 https://staging.drfop.org/files/original/4840e49061168dd070be6b5f910136d0.jpg bc55027014a65d697e997b2b937c2821 https://staging.drfop.org/files/original/23866a9c822d0eb399417ae71c53afde.jpg de5956ea11e10351dd0edbc4eb3964c7 https://staging.drfop.org/files/original/9654f5f19860f0e88b033d410589d261.jpg 32b34b3e40ced6807f3639dbaa1dc46a https://staging.drfop.org/files/original/208783458811d4c978eb476b9ddc2a62.jpg 1c8a4fce56522125a18f83d04e40f32b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Text Any textual data included in the document <h2>A Solution For Split-Size Shoes</h2> <h5>Eugenio Lamberty <a style="text-decoration: none;">*</a> John Milani <a style="text-decoration: none;">*</a></h5> Despite the almost daily occurrence of new concepts and improvements in Orthotics, many problems remain to be solved. A significant number of these problems result from congenital factors or acquired diseases during childhood. The severely deformed leg and foot have been of major concern, particularly when the deformed foot has been significantly shorter in length than the sound foot (<a href="/files/original/52f7d266c544d7b057ce3f61ff421222.jpeg">Fig. 1</a>). In some cases the feet may vary in shoe size by as much as three or four sizes (<a href="/files/original/cecb22a00897ba34f840608eed75219c.jpeg">Fig. 2</a>). This becomes quite expensive for the patient, who must either purchase two pairs of shoes to fit each foot properly or custom-made shoes. To reduce this financial burden and yet greatly improve cosmesis, a method of fabrication had to be found whereby the patient would be required to purchase only one pair of ordinary shoes that would be the size of the normal foot. A shoe filler (<a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg">Fig. 3</a>), conceived, designed and developed by the authors through the Veterans Administration Prosthetics Center, has solved this problem. This device is placed in the shoe (<a href="/files/original/23866a9c822d0eb399417ae71c53afde.jpg">Fig. 4</a>) to take up the excess space of the shortened foot. Then the shoe insert portion of the orthosis is placed into the filler and shoe (<a href="/files/original/9654f5f19860f0e88b033d410589d261.jpg">Fig. 5</a>). This results in a highly-cosmetic arrangement (<a href="/files/original/208783458811d4c978eb476b9ddc2a62.jpg">Fig. 6</a>) that is also financially beneficial to the patient. <h3>Method of Fabrication</h3> To construct the shoe filler, proceed as follows: <ol> <li> Secure a SACH foot that will fit the size shoe to be worn by the patient. Ensure that the plantar surface of the SACH foot is flat, to prevent the shoe insert portion of the orthosis from rocking. An immediate post-op foot can be used. </li> <li> Vacuum mold the SACH foot with 1/4-inch low density polyethylene. Polyethylene is ideal since it provides good strength and flexibility. </li> <li> When the plastic has cooled, remove it from the SACH foot and initially trim it so that it does not protrude beyond the borders of the shoe. Refer to <a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg">Fig. 3</a>. </li> <li> Use standard methods and techniques to fabricate the orthosis. </li> <li> Place the orthosis on the patient. Then place the orthosis on the patient into the shoe and shoe filler while ensuring that the shoe filler does not hinder this process. </li> <li> Further trim the shoe filler along its medial and lateral sides, behind what would normally be the metatarsal heads of the sound foot. This allows the normal toe break of the shoe to function properly and thereby ensure unrestricted motions of the ankle and foot. </li> </ol> <h3>Notes</h3> To prevent the orthosis from slipping forward in the filler, the filler should curve around slightly, onto the dorsum of the foot. Refer to<a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg"> Fig. 3</a>. This trim, together with a properly laced shoe or a shoe laced with micro straps, should provide the required counterforce to prevent the orthosis from slipping forward in the filler. It is further noted that one patient, who had worn the new orthotic system for one month, required foam padding that was placed anteriorly into the filler to prevent the orthosis from slipping. <h3>Summary</h3> The design and development of a shoe filler when bracing the shortened foot is cosmetically appealing and financially beneficial to the patient who is consequently required to purchase only a single pair of ordinary shoes. In addition, fabricating the filler is a relatively simple procedure for the orthotist. <h3>Acknowledgements</h3> The authors would like to express their appreciation to Max Nacht, Technical Writer-Editor, VAPC, for his cooperation and assistance in preparing this article; and to Charles Berman and Anthony Morales, Photographers, VAPC, for their fine photographic work. <div style="width: 400px;">John Milani Orthotist-Prosthetist, Veterans Administration Prosthetics Center, 252 Seventh Avenue, New York, NY 10001 *Eugenio Lamberty Orthotist. Veterans Administration Prosthetics Center, 252 Seventh Avenue, New York, NY 10001</div> <div style="width: 400px;"></div> Page Number(s) 3 - 4 Year 1979 Volume 3 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-4.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 5 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-5.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-6.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Solution For Split-Size Shoes Creator An entity primarily responsible for making the resource Eugenio Lamberty * John Milani * Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Text Any textual data included in the document <h2>Building A Positive Self Image In Patients</h2> <h5>Mary Point Novotny, RN., MS. <a style="text-decoration: none;">*</a></h5> "Poems are made by fools like me, but only God can make a tree. " Momentary reflection on this literary work brings into perspective the complex task of rebuilding the image of one who has lost a limb. It is a task which requires not merely the professional and technical abilities of the prosthetist, but also a personal concern for the self image of the patient. Body image is the constantly changing mental picture one has of his individual, body appearance. It develops through reflected perceptions about one's body and sensations originating from internal and external stimuli as the individual adapts to a kaleidoscopic variety of living activities. All too frequently body image is overlooked in the rehabilitation plans for a patient with chronic disease, disability, or surgical intervention, because physical diagnosis and mechanical advances have become paramount in our fast-paced acute care settings. The concept is so basic, it is not hard to see why it is overlooked; yet, if one begins to examine the personal effect of alterations, such as mastectomy, amputation, colostomy or stroke, we can begin to identify with the grief, anxiety and fear accompanying the loss of a body part and the ensuing alteration in functional ability. Research of Schilder and others has shown that since body image is primarily a psychological entity, alterations in it are extremely subjective experiences which vary in intensity, dependent on the unique characteristics of each individual, in three distinct categories. These sources of self image include: <ol> <li> Past experiences which are gradually built up through the years from physiologic, psychologic, and social components, organized and integrated by the central nervous system. </li> <li> Social interactions which include the reaction of significant others and of society to the person's body, as well as his own interpretation of that reaction. </li> <li> Current sensations, such as perceptions of physical appearance, alterations incurred, and images, attitudes and emotions regarding the body. </li> </ol> Because these components are subject to constant revision, the body image of any individual is constantly changing. Survival of a healthy self image is determined by the amount of flexibility available to adapt to new situations and one's ability to realize that the image he projects to others is the one others see. The loss or absence of a limb, therefore, has varying consequences dependent on the individual and his stage in the life cycle. Studies have shown that an individual is capable of incorporating a firmly-attached object, such as a prosthesis, cane, etc., into his self image. This seems to be particularly evident with congenitals fitted very early in life, before developing unilateral coordination and functional abilities. Of the acquired amputees, early fitting and functional use of the prosthesis also increases the chances of reconstructing a complete image of one's self. A juvenile amputee, up to 3 years old, is not able to consciously deal with "loss," and congenitals, up to 6 years old, generally do not perceive themselves as "different." Yet amputation in later years results in the patient undergoing the process of grief, which includes feelings ranging from denial, anger and hopelessness, to reorganization and adaptation. Schilder places a positive emphasis on the necessity for communication of these feelings. He believes we constantly construct, dissolve, and reconstruct our own body image as well as the body images of others. He points out that the tendency to destroy a previous body image is essential to acceptance of a new, altered image. This appears to be a critical area in successful care of any patient. Because most amputees and their families have limited, if any, exposure to others with similar problems, their greatest fears are of the unknown. Will amputation ruin my personal life? End my career? Leave my child handicapped and dependent? With little factual information in the areas of prosthetics and a body image distortion that has not been reconciled, the patient frequently arrives at the professional door seeking an opportunity to communicate his fears and frustrations to an individual who will, hopefully, aid in the design of a prosthesis and promise for the future. While personal style and approach vary with the needs of individual patients, certain factors should be considered in dealing with an amputee: personality type, expectations, stage of adjustment, support system, and medical conditions. Recent amputees, for example, would benefit from an opportunity to see and touch a prosthesis, with a complete explanation of the stages of fitting and fabrication to limb completion. Be open and honest with patients, keeping in mind that cosmesis may be a priority for some while function and durability are essential for others. While no prosthesis will ever replicate human functioning, once you determine what a patient expects to achieve through prosthetic usage, you can then fulfill his needs and likewise increase his acceptance of an artificial limb. Parents of a congenital amputee frequently need much more support than the child who can learn to lead a "normal" life if allowed to develop and achieve, unhampered by "concerned" adults who would treat him "special/different." Meeting with another amputee who has mastered life with a prosthesis can have a very positive effect on the older child or adult who is attempting to re-adjust his self image. Family members or significant others should be encouraged to be present at such meetings, as the fear of new amputees is generally in direct proportion to the acceptance reaction of those whose opinion he values most. Seeing is believing!, and once normal functioning in everyday living is explained, there will be less chance of the amputee being treated as a "handicapped" individual, which he is not. Lastly, bear in mind that you are a very important person in the eyes of your patient. This is because you are now the professional most heavily relied on for advice, support and adjustment in the initial period of building a new self image. So grin and bear those minor repairs, etc., keeping in mind that a well-worn prosthesis is your best measure of success. Function and form go hand-in-hand in establishing a sense of completeness in self image. While you may not have the power of our creator, you can surely have a part in the final design of his creations. References: <ol> <li>Fishman, Sidney, "Behavioral and Psychological Reactions of Juvenile Amputees." Reprinted from Limb Development and Deformity: Problems of Evaluation and Rehabilitation, Charles C. Thomas, Publisher, 400-407.</li> <li>La Fleur, Jean and Novotny, Mary, "A Study of Human Figure Drawings by Amputee Children and Verbalization of their General Adjustment," Masters' thesis, De Paul University, 1978.</li> <li>Schilder, Paul, The Image and Appearance of the Human Body, International Universities Press, Inc., New York, 1950.</li> <li>Schilder, Paul "Symposium on the Concept of Body-Image," Nursing Clinics of North America, VII (December, 1972).</li> </ol> *Mary Point Novotny, RN., MS. Nurse-educator for health professionals; Consultant, University of Illinois at the Medical Center, Amputee Clinic, Chicago, Illinois; has lectured across the country on body image alterations and the role of professionals in assisting patients with adjustment. Page Number(s) 1 - 2 Year 1979 Volume 3 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Building A Positive Self Image In Patients Creator An entity primarily responsible for making the resource Mary Point Novotny, RN., MS. * https://staging.drfop.org/files/original/7821ac6162abe595c2139897f396fecc.pdf 0bcce967fcfd627030a029c02594ff9c https://staging.drfop.org/files/original/a66e029293ca734565f6b91200071432.jpg e0ab811142f0169b690b4e8859ef14b6 https://staging.drfop.org/files/original/345a8f6d88787fb5569177c99ca4d7f7.jpg d29c0ac6eb59475dc22409206e69c298 https://staging.drfop.org/files/original/12ca9adaacb8c06c5eb20427ab64f46d.jpg 8363fe5120fc99ac33a0eb179ae273ed https://staging.drfop.org/files/original/e9d94ea851ebdbb5e0a81ae9d61b845f.jpg a108f96e990025c40ff36607bc770296 https://staging.drfop.org/files/original/27ad3e7aadc5e665c134b448e33340c5.jpg ce9577ae574f7e521bf0a6dee646d735 https://staging.drfop.org/files/original/5bc094ab41ace0120e8ba8896408edb8.jpg 8d8a73eceb72ffa43d8d319a3dfd8f8d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_03_005.pdf Text Any textual data included in the document <h2>Bilateral Knee Disarticulation, Immediate Post-Surgical Fitting: An Unusual Case Study</h2> <h5>William Susman </h5> There are certain specific indications for utilizing immediate Post-Surgical Fitting (IPSF) in the postoperative management of the amputee. Clinical observations have substantiated that the constant even pressure provided by the immediate application of a rigid dressing to the residual limb helps control edema, supports circulation, and immobilizes tissue, subsequently minimizing the inflammatory process within the traumatized tissues, promoting wound healing, aiding good shaping of the limb and decreasing intrinsic pain and phantom sensations. The attachment of a pylon and prosthetic foot to the rigid dressing either immediately after the residual limb is wrapped or within a short post-operative period has been shown to enhance the positive effects of the rigid dressing and provide additional functional and psychological benefits. The gentle compression of residual limb tissue provided by closely monitored weight-bearing promotes wound healing by further decreasing edema. Ambulation resumes with a prosthesis sooner than with more conventional post-operative management approaches. Hospital stay is shortened, resulting in a more rapid return to previous personal, social and vocational activities. The amputee experiences an almost immediate resumption of function and although he or she will most likely undergo mourning for the lost limb, the actual commencement of rehabilitation is also experienced. In addition, the patient may be told pre-surgically the sequence of post-operative events so that the immediate introduction of functional prosthetic restoration can be hopefully, although cautiously, anticipated. It is readily acknowledged that IPSF is not appropriate for all circumstances. Cooperation among the rehabilitation team members from prosthetics, physical therapy, surgery, physiatry, and nursing, and a shared understanding of the technical aspects and goals of treatment, as well as individual proficiency in treatment procedures are necessary. The patient's understanding of the treatment approach and a willingness to adhere to treatment protocol are also essential. Lowered standards in any one of these areas may lead to injury of residual limb tissue, pressure sores, wound infection, hematoma, or necrosis and ultimately failure of the procedure and a real physical and psychological set-back for the patient. In addition, such complications are more difficult to perceive since the wound cannot be directly observed without disruption of the rigid dressing. <h3>Patient History</h3> With the above general review of the clinical advantages and precautions of IPSF in mind, it may be illustrative to present a case which is representative of these aspects of this treatment approach and yet extraordinary in view of the history and personal motivation for seeking treatment. The patient was a 28 year old woman who had contracted anterior poliomyelitis at the age of 16 months. She presented with stunted lower limbs, and muscle power at both hips was below functional levels except for the ability of the Sartorious muscle to withstand moderate resistance bilaterally. The knees and ankles were essentially flaccid. Sensation throughout the lower limbs was within normal limits. No contractures were evident and upper body strength was above normal. The patient wore bilateral, conventional KAFO's with knee locks and both ankles set in plantarflexion. Her feet rested on approximately nine-inch cork lifts set inside the calf sections of tall leather boots. (See <a href="/files/original/a66e029293ca734565f6b91200071432.jpg">Fig. 1</a>) The patient related that as an adolescent she increased the lift height periodically to compensate for the lack of normal lower limb growth. She displayed excellent balance and body awareness, ambulated and climbed stairs and curbs independently with axillary crutches, and was able to negotiate sitting and rising from most types of seating. She led an active life as a college instructor and graduate student. The patient had a history of multiple surgical procedures during her teen-age years including a spinal fusion for scoliosis, subtalar arthrodeses, transplantation of hamstring tendons to the quadriceps mechanisms, and Achille's tendon releases bilaterally. She also had a history of left patella and right tibial fractures because of falls. The patient had been interested in seeking elective amputation of her legs for some time. Her chief reasons were of both a physical and a psychological nature. Pain in her feet resulting from the prolonged standing teaching required, and concern over the vulnerability of her legs to fractures from falling were related. Nevertheless, her foremost concern was for her appearance. Due to the devices she used to provide height and function she always felt compelled to wear floor-length dresses and was unable to interchange footwear (see <a href="/files/original/a66e029293ca734565f6b91200071432.jpg">Fig. 1</a> & <a href="/files/original/345a8f6d88787fb5569177c99ca4d7f7.jpg">Fig. 2</a>). She wanted greater freedom in dress and to be able to have her legs seen without embarrassment over their appearance. She also found the braces and boots cumbersome and loose on her legs. Therefore, the patient came to the clinic seeking amputation primarily for reasons of cos-mesis and self-image. <h3>Pre-Surgical Management</h3> The rehabilitation team's decision to recommend bilateral knee disarticulation amputations was based upon the less traumatic nature of the surgical procedure, the good weight-bearing tolerance that has been demonstrated at this level, and another factor unique to this case. Due to the diminished growth of the patient's femurs, knee disarticulations would leave the amputation level proportional in length to long above-knee amputations. This level would provide a long lever arm for prosthetic control, yet not disturb anthropometric placement of the prosthetic knee and, consequently, proportional thigh and shank length. The IPSF approach was selected due to the patient's psychosocial background and to avoid the abrupt prolonged change in function that can result from bilateral surgery. With IPSF the patient would have a shorter period of disruption of her social and vocational success and her proud independence in activities of daily living. It would limit her experience as a wheelchair-dependent individual since two-legged function would never be completely interrupted. To determine whether or not knee disarticulation prostheses would provide function comparable to her presenting situation, temporary prostheses were fabricated to simulate post-surgical restoration. Plaster quadrilateral sockets with polyvinyl chloride (PVC) thermoplastic pylons, SACH feet and shoes were used. A cut-out in the posterior wall of each socket allowed the patient's shanks to protrude in the flexed-knee position, thus mimicking knee-disarticulation amputations (see <a href="/files/original/12ca9adaacb8c06c5eb20427ab64f46d.jpg">Fig. 3</a>). A full functional evaluation showed no deficit in the patient's function from that previously demonstrated. Her ambulation pattern remained unchanged. From a psychological standpoint the patient was instructed to seek psychiatric consultation to closely examine her motivations for electing this treatment and to investigate her feelings regarding the possible failure of adequate functional prosthetic restoration. In addition, the patient discussed at length with team members the pros and cons of her decision and the possible sequela of amputation surgery such as wound-healing difficulty, residual limb pain, phantom sensations, less than optimal function, and prosthetic maintenance. <h3>Post-Surgical Management</h3> After closure of the amputation wounds and placement of drains, stump socks were applied over the surgical dressings on both limbs. A distal pad was held in place while a plaster wrap of each residual limb was done. Each plaster socket was hand-molded to provide a quadrilateral shape and ischial seat. Supracondylar purchase and belts over the iliac crests provided suspension. Pylons were not added at this time since the PVC tubing to be used requires heating before application. On post-operative day (POD) #2 the surgical drains were removed. On POD #5, PVC pylons and SACH feet with shoes were applied. To control and monitor the degree of weight-bearing, a tilt table and two scales were used (see <a href="/files/original/e9d94ea851ebdbb5e0a81ae9d61b845f.jpg">Fig. 4</a>). Two five minute-periods at ten pounds of weight-bearing were allowed initially. On POD #6 the patient was seen twice during the day and stood on scales in the parallel bars (see <a href="/files/original/27ad3e7aadc5e665c134b448e33340c5.jpg">Fig. 5</a>). Two daily sessions were continued and weight-bearing was increased to 20 pounds on the right limb and 15 pounds on the left, being limited due to pain. Throughout this period the patient complained of phantom sensations and residual limb pain which increased markedly at night. The first cast change was done on POD #12 at which time the stitches were removed. The following day the patient began ambulation in the parallel bars with weight-bearing to tolerance. On POD #15 the patient was given a walker for bedside use and on the following day was able to ambulate independently outside the parallel bars with axillary crutches and a four-point gait, testimony to her longstanding adaptation to her physical deficits and her determination to succeed. At this time the patient was transferred from the acute care setting to an inpatient rehabilitation bed. Four weeks after surgery the patient was casted for her definitive prostheses. At five weeks she was fitted with the sockets and locked knees and returned to the parallel bars for ambulation training. During the sixth week, first one and then both prostheses had safety knees added. By the ninth post-operative week the patient had returned to the use of crutches and had received training in elevation activities and ambulation on different terrains. The prostheses were delivered at the end of the ninth post-operative week and consisted of quadrilateral total contact sockets with semi-suction and supracondylar suspension. Windows were not cut in the sockets for donning but rather a soft insert was fabricated which was compressed during donning and re-expanded within the socket to grip the femoral condyles. The patient rejected the use of any suspension belts as uncosmetic. Otto-Bock's modular endoskeletal safety knees and components, and SACH feet were used. (See <a href="/files/original/5bc094ab41ace0120e8ba8896408edb8.jpg">Fig. 6</a>). <h3>Follow-Up</h3> The patient returned to her former daily interests and activities and maintained her ambulatory status. Having worn the prostheses for approximately a year and a half she returned for re-evaluation. Changes in residual limb shape due to shrinkage necessitated the fabrication of a second pair of prostheses which she currently uses. <h3>Summary</h3> This case well illustrates the advantages and appropriate application of the IPSF approach to amputee management. The patient was able to have both limbs amputated at once and yet hasten the rehabilitation process. The physical debilitation and psychological shock associated with such a radical intervention was minimized by her youth, determination, and cooperation with the rehabilitation team. A deeply felt desire to improve her quality of life was satisfied with minimal disruption of what was an already successful life style in the face of life-long physical difficulties. Page Number(s) 5 - 7 Year 1979 Volume 3 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-6.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Bilateral Knee Disarticulation, Immediate Post-Surgical Fitting: An Unusual Case Study Creator An entity primarily responsible for making the resource William Susman https://staging.drfop.org/files/original/8bb8e9e8755bb707d94843a7f67c3c83.pdf 2d1e1c9eb5739153c629b229aba1573c https://staging.drfop.org/files/original/0aa3c65a77880b3f215c6a379f41ebdf.jpeg 4e53ce2cb0da74c0306d918dbcbf3600 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_03_003.pdf Text Any textual data included in the document <h2>Comment</h2> <h5>Lawrence W. Friedman, M.D. <a style="text-decoration: none;">*</a></h5> <a href="/files/original/0aa3c65a77880b3f215c6a379f41ebdf.jpeg">Photo</a>: Lawrence W. Friedmann, M.D. Dear Sir: I have just been reading <a href="https://staging.drfop.org/items/show/179433">Volume II, Number 4, 1978</a> of the NEWSLETTER. While I have a lot to say on immediate postsurgical fittings, whose major problem I fear is the inaccurate name since very few people really fit a prosthesis immediately post-surgically, I think that the part of the NEWSLETTER that deserves the most comment is the reprint of the article "<a href="https://staging.drfop.org/items/show/179433">Prostheses, Pain and Sequelae of Amputation as Seen by the Amputee</a>" from Prosthetics and Orthotics International. There appears to me to be little doubt that the complaints of the amputees are accurate. There is not only poor fitting and poor fabrication, but a tremendous absence of knowledge on what is correct on the part of the medical profession, the amputees, and, unfortunately, sometimes even the prosthetists. We must recognize the fact that many doctors "prescribe" an artificial limb with instructions to the prosthetist to "give the patient a prosthesis" or, if they want to be very accurate, "give the patient an above-knee prosthesis". This leaves the entire prescription, fabrication and sometimes training of the amputee on the prosthesis to the prosthetist, who does the best he can, but is not adequately trained to take over the entire responsibility for the care of the patient. It is the exact equivalent of a doctor "prescribing" a medication for a patient and saying "give heart medicine". Most of the doctors doing amputation have little or no interest in the aftercare of the amputee once the wound is healed. For that reason, the amputee is required to be responsible for his own care and must seek out amputee clinics in which adequate prescription, checkout and training can be given to assure that adequate prosthetic fabrication has been achieved. The average general or vascular surgeon cannot be assumed to have been able to keep up with the latest in prosthetic components, fitting and training. While research is important, we are not, at the present, delivering the standard of care which we could have delivered twenty-five years ago had every amputee the access to an amputee clinic team. It is obvious that the amputees questioned are suggesting checkout procedures, such as x-rays, to measure the accuracy of prosthetic fit which have been available to us and have been used for decades. Unfortunately, it is the "consumer" who determines what is produced in the market place. In my view, the amputees must band together and insist on getting adequate service. When they do so, the competitive market place will give them what they need. In some areas, there is a problem because there are very few prosthetists and the amputee is, to some extent, at the mercy at that individual. With modern transportation however, any dissatisfied amputee should be able to get to a knowledgeable amputee team for adequate care. I know that there are many problems. In a neighboring state I know that the orthopedic surgeons have inhibited any competitor from coming into the state to challenge what everyone admits is an inadequate prosthetist-orthotist because they like that individual as a person, even though they know that the devices produced are grossly inadequate. While this is beneficial to the individual prosthetist-orthotist, it is to the detriment of his patients. Part of the problem is that each amputee is concerned with his own welfare, and when his needs are satisfied to a tolerable level, he tends not to band together with his fellows for their common good. This decreases their effectiveness in demanding optimal care. Rehabilitation is a process in which a patient is made responsible for his own well-being. In this regard, we may have made amputees feel so independent that they have lost sight of the power of communal action. Perhaps the NEWSLETTER format should be duplicated for the amputees as well as for those of us serving the amputees, so that the amputee himself could know what is going on and what devices and techniques are available to him should he need them. Certainly a list of the formal clinics and services would be of help. While there is much discussion of the advantages and disadvantages of different socket designs and other prosthetic components, it appears to me that these are, to some extent, academic discussions, since even the plug fit socket can be made comfortable for the majority of above-knee amputees, provided it is properly fabricated for the individual. What is needed is to improve the state of prosthetic delivery, even more than the state of the prosthetic art. The situation in prosthetics is the same as the situaiton in general medicine, in which in many places in this country what has been known in the medical literature is not getting to the individual patient. As far as upper extremity amputees go, the professor is much more satisfied with the appearance of the cosmetic hand cover than are the amputees themselves. I believe that I have the opportunity in this region to see." some of the most cosmetic hand covers available. They are, despite all our efforts, still inadequate and rejected by the great majority of amputees. As far as myo-electric hands are concerned, all of my patients want them. Most of them use them for a period of a few months and then discard them, except for rare use as a cosmetic hand, since they are so poorly functional as well as delicate. I believe it is important to prescribe one, if the patient demands a myo-electric hand, because he will never be satisfied of its mediocre function, until he has the opportunity to try it. I think the professor needs to be aware of many of its limitations. We, perhaps, get carried away too often by our favoritism for our own development. I believe further discussion on this point would be of help to the amputee community and also to the medical community in its broader sense, to give us a proper perspective of where our problems are. Best wishes for a happy and productive year. Lawrence W. Friedmann, M.D. <div style="width: 400px;"></div> Lawrence W. Friedman, M.D. Chairman of the Department of Rehabilitation Medicine at the Nassau County , Medical Center in East Meadow, New York. Page Number(s) 3 - 4 Year 1979 Volume 3 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete. Figure 1 http://www.oandplibrary.org/cpo/images/1979_03_003/1979_03_003-1.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Comment Creator An entity primarily responsible for making the resource Lawrence W. Friedman, M.D. * https://staging.drfop.org/files/original/54dae95f148a182054379dab02968d3b.pdf 8910c8603388bad0090b5916a7fc8ef7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_03_002.pdf Text Any textual data included in the document <h2>Guest Editorial: Thoughts On The Amputee Clinic Team</h2> <h5>Newton C. McCollough, III, M.D. </h5> The Amputee Clinic team as we know it today, evolved during World War II when the Surgeon General of the Army established a number of Amputee Centers within Army Hospitals to upgrade the management of these patients. Impetus to this multidisciplinary approach was given by the Veterans Administration in 1948 when suction suspension was introduced for the above knee amputee and a protocol was developed establishing the Amputee Clinic Team which initially comprised the physician, the prosthetist and the therapist. Since that time as a more holistic approach to disability developed the team has been enlarged in most clinics to include the occupational therapist, social worker and vocational specialists among other disciplines. The clinic team approach is comprehensive and unquestionably has resulted in superior management of patients with limb loss over the past thirty years. However, recently questions have been raised regarding the efficiency of such a clinic and whether or not a more streamlined approach is desirable from the standpoint of the logistical management of relatively large numbers of patients. The impersonal nature of such a clinic has also been impugned in recent years, and some have felt that the patient may actually be intimidated by such a host of professional personnel. Several years ago, at the University of Miami, a compromise approach to amputee management was undertaken. All new patients and patients with identifiable medical problems (including skin breakdown) were seen in the traditional setting with the physician as the amputee team leader in clinic. Routine follow-up visits and problems which were purely prosthetic in nature were seen in "prosthetic clinic" by the prosthetist and therapist with a prosthetist as the team leader or clinic chief. Other clinic personnel including physicians were available for these clinics but were not necessarily in attendance. This approach was far more efficient in terms of man hours and in many ways more practical than imposing the traditional approach upon all patients at every clinic visit. Two major drawbacks to this system of care slowly became apparent and currently we have resumed the traditional approach to all patients. The first difficulty encountered was that many routine prosthetic visits were also accompanied by concurrent medical problems which could not be identified before the patient was actually seen. Of course, the patient could be referred to the next "full team clinic" but this resulted in undue delay of treatment. Psychological or vocational problems though less frequent were also concurrent in some patients. Secondly, in a major teaching hospital, the education of residents, interns and students suffered from this approach. The critical analysis of prosthetic problems in relation to alignment, gait, suspension, etc. was lost upon students in the absence of interchange between prosthetist, physician and therapist. Additionally, innovative techniques in prosthetic management not infrequently result from discussions involving the prosthetist and physician and the presence of all team members in clinic greatly enhances this aspect of the amputee program. In conclusion, I now feel that the multidisciplinary clinic team approach is sound and has no equal in the educational sphere. Spinoffs from the dialogue created may enhance prosthetic research and thus ultimately patient care. Efficiency in this sytem is less than ideal, but the benefits are greater in the long run. Suitable precautions must be taken to avoid "depersonalization" of the amputee in the multi-disciplinary environment and it is encumbent upon each team member to insure that the clinic experience is a rewarding one for the patient. Page Number(s) 2 - 3 Year 1979 Volume 3 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guest Editorial: Thoughts On The Amputee Clinic Team Creator An entity primarily responsible for making the resource Newton C. McCollough, III, M.D. https://staging.drfop.org/files/original/bfcefefb32a201912fdc868f0f0cc04e.pdf 0148ecdd9b99d82897c6b1c95fb4d6cd Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_03_001.pdf Text Any textual data included in the document <h2>To Check Out Or Not To? That Is The Question</h2> <h5>Kurt Marschall, CP </h5> It is now over twenty-five years since the introduction of intensive short-term courses in prosthetics and orthotics at New York University, Northwestern, and the University of California at Los Angeles. These condensed courses have benefitted every practitioner, not only in his practical approach to patient management, but also in his inter-relationship with his peers through a unified and common language that we call "nomenclature." In countless cases, these formal educational courses have served as a springboard to successful completion of the certification examination. It was the Veterans Administration which at that time took the primary responsibility of disseminating and funding prosthetic research programs. Their Clinic Team approach became very popular, leading to the simultaneous education of physicians, therapists and prosthetists/orthotists. Undoubtedly, this close relationship of the three disciplines, working together for one common goal, namely, the rehabilitation of the disabled, has narrowed a gap that formerly was all too visible. I feel it has also helped to lift the field of prosthetics and orthotics out of the dark age, out of its sole "craftsmanship concept" into the more comprehensive classification of "professionalism"—all in all, an appropriate tribute that was long overdue. Every prosthetist/orthotist, having successfully completed these short-term courses, came out a better person, a better clinician. The physician and therapist, by the same token, gained insight into our field as never before. Now all three disciplines in their deliberations at clinic meetings spoke at the same level through a unified language, and intelligent solutions were arrived at by understanding the underlying problems. A by-product of this progressive and noteworthy approach was the respect the prosthetic/orthotic practitioner gained from the medical and paramedical professions, once his continued striving for excellence in performance and elevation of standards was realized by them. This respect, however, was not attained very easily. In our quest for sharing the knowledge and insight into our field with the physician and therapist, we also committed a monumental mistake—making them experts in the fitting, alignment and fabrication of every prosthetic/orthotic device there is. Without realizing it at the time, we gave into their hands a powerful tool, even further, a most powerful weapon —the check-out sheet!!! There, in black and white, we developed a questionnaire telling them exactly how to pick a device apart, piece by piece, making them the sole, omnipotent judge of whether to pass or fail it. By setting up this systematic method of examining our devices we have admitted that one cannot trust our professional judgment or technical expertise. I know of no other group in the health care profession that has so mindlessly relinquished its professional prerogatives and intricate understanding of a subject to another discipline, with certainly less knowledge of the particular subject, for its scrutiny. Even today, after 25 years of continuous upgrading, we sheepishly subject ourselves to this procedure. This permits even a therapist fresh out of school, but equipped with a check-out sheet, to suddenly become powerful and to be feared for his or her "judgment" when check-out day rolls around. Countless man-hours and precious components and materials have been wasted when physician and therapist could not see eye-to-eye with the prosthetist/orthotist on alignment, fitting and finishing procedures. A device often had to be altered, sometimes even done over entirely, for rather trivial reasons, not to mention the immense damage inflicted on the patient-prosthetist/orthotist relationship when these so-called "problems" were hashed out in the open, for everyone to hear, rather than in a more private setting. There is no doubt in my mind that the level of education and the competence of every prosthetist/orthotist has risen tremendously in the last two and one-half decades, especially for one who takes advantage of the continued education process. He is a better person than he was 25 years ago, and his knowledge of the subject, "Prosthetics and Orthotics," is vastly greater than that of a physician or therapist. He is a professional who will, without complaint, work his way around a poorly-amputated limb that may not be to his liking for fitting purposes and come up with a functional prosthetic device without asking the surgeon for a revision. He will produce an adequate prosthetic device despite flexion contractures and edema, due to insufficient exercise and lack of proper stump-wrapping. Nobody denies the need for a check-out after a prosthetic/orthotic device has been completed. But yesterday's check-out sheet should be scrapped in its entirety —the sooner the better—and replaced with one consisting of only three questions: <ol> <li>Is the prosthesis/orthosis as prescribed?</li> <li>Is the patient comfortable?</li> <li>Is the prosthesis/orthosis functional?</li> </ol> The above criteria should more than satisfy any physician or therapist. The decision as to pleasing cosmetic appearance, insofar as possible, should be left to the patient. The decision on whether or not accepted standards and principles have been met in the fitting, alignment and fabrication of the device, should be entirely that of the prosthetist/orthotist. The field of prosthetics and orthotics has come of age; so have its practitioners. The check-out sheet has not kept pace with changing times and should be abolished in its present form. Page Number(s) 1 - 2 Year 1979 Volume 3 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource To Check Out Or Not To? That Is The Question Creator An entity primarily responsible for making the resource Kurt Marschall, CP Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Review Status Status of review after import from old O&P Library into Omeka platform. Not Performed