1 20 187 https://staging.drfop.org/files/original/c3460a2dab08b833441c25bf7385221d.pdf 07ff006625669bcbaab152e35ddbab6e 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/1982_02_007.pdf Text Any textual data included in the document <h2>Letter To The Editor: A Return To Research?</h2> <h5>A. Bennett Wilson, Jr. </h5> Thirty-seven years ago, with funds from the United States Government, the National Academy of Sciences initiated a research and development program in artificial limbs because amputees in Army and Navy hospitals expressed quite vociferously their dissatisfaction with the artificial limbs provided at that time, and because there had never been, in this country, any concerted scientific effort to solve the problems of amputees. Although the research program, funded until the late 1950's largely by the Veterans Administration, was not looked upon with favor by many prosthetists during its early stages, with the help of a few of the more progressive prosthetists and orthopaedic surgeons sufficient progress was made by 1952 to warrant the initiation of a formal education project at the University of California at Los Angeles, which set the pattern for the present education program in prosthetics and orthotics. The Department of Health, Education, and Welfare, about 1955, joined the VA in supporting research, development, evaluation, and education; orthotics was added to the mission in the late 50's; and progress continued to the point that by the early 70's nearly every aspect of prosthetics had been replaced by newer techniques and devices, and work in orthotics was progressing rapidly. Although it was, and is, recognized by many that further, continuing research was needed, the government agencies have all but abandoned research and development in prosthetics and orthotics, and as a result very few improvements have been introduced to the practice of prosthetics and orthotics during the last few years. This unfortunate situation has been brought about because of a number of factors: the decision by the National Academy of Sciences to withdraw from the program; reorganization by the VA in 1973 that resulted in transferring research and development responsibility from the Prosthetic and Sensory Aids Service to general medical research, and to conduct most of the research and development in VA hospitals; and an unbelievable proliferation in all government agencies of "red tape" required in awarding contracts and grants. During these 37 years, the prosthetics and orthotics profession has become healthy and strong, in part because the research and development program has provided a teachable body of knowledge and an education program that has produced a group of practitioners who are capable of communicating effectively among themselves and with other groups. Given this set of circumstances, it seems reasonable that the prosthetists and orthotists in this country should consider taking responsibility for research, development, and evaluation, and relieve the government of most of the responsibility it has assumed in this area for the last 37 years. Certainly a program administered by AAOP-AOPA could be more efficient and more effective than one administered by the government. One way to finance this undertaking is to include in the price of each new prosthesis and orthosis an appropriate percentage of the price to be set aside for the research program. This sum would, of course, be a legitimate business expense. The coordination and "clearing-house" functions would reside in the National Office, and R&D would be carried out in appropriate facilities and institutions. If properly managed such a program would have many obvious advantages, not the least of which would be improved patient care. Page Number(s) 7 - 7 Year 1982 Volume 6 Issue 2 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 Letter To The Editor: A Return To Research? Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. https://staging.drfop.org/files/original/51f5adc7b73ba20f64f5b1072208d97e.pdf 22b566ecc169422c3f86252d9a20be5e https://staging.drfop.org/files/original/3af9a5ff106766a98f790a31724a2a1f.jpg f6e27c5ae43c78cb08a394d78fa3b275 https://staging.drfop.org/files/original/2aff81bed2e3b007be1b8792137c5788.jpg 28e771b1094c0b1209ef81372fd82ce6 https://staging.drfop.org/files/original/41beee5399a82e0e40acfda675701aad.jpg f1003cc7f042f683207455f6a189e513 https://staging.drfop.org/files/original/90ef2a1233e04d701819d9715038383f.jpg 4d02c130bcdd0706cf18f7b6fc0dd0be https://staging.drfop.org/files/original/634d5ee7cc369045d31e39da291ee0d3.jpg d7e48a87b19caa8b90142027b54ae166 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/1978_01_001.pdf Text Any textual data included in the document <h2>Externally Powered Upper-Limb Prostheses</h2> <h5>A. Bennett Wilson, Jr. </h5> The earliest reference to externally powered upper-limb prostheses seems to be in connection with experiments that took place in Germany about 1918 in which electromagnets were used to close the fingers of an artificial hand <a></a>. The next reported effort apparently is the research and development program proposed and carried out by Alderson <a></a> on electrically powered arm systems during 1946-1952 with support from International Business Machines, Inc. and the Veterans Administration. Initial results of the Alderson-IBM project (Fig. 1) were quite impressive with respect to operation, but an extensive evaluation at UCLA in 1951 revealed that a disproportionate amount of mental effort by the wearer was required for use of the various systems<a></a>. As a result of the findings of the UCLA study, and because only a limited amount of money was available for work in artificial limbs, the Advisory Committee on Artificial Limbs (later the Committee on Prosthetics Research and Development) of the National Academy of Sciences recommended that development of actuators be delayed until sufficient research could be carried out concerning the control problem so as to provide means for control of the prosthesis without conscious thought by the wearer. <a href="/files/original/3af9a5ff106766a98f790a31724a2a1f.jpg">Fig. 1</a>. An early model of the Alderson-IBM Electric Arm. A project was initiated at UCLA about 1953 to explore various control methods. Among the various studies conducted at UCLA was an evaluation of the so-called Vaduz hand (Fig. 2)<a></a>, a design that originated in Lichtenstein which used bulging of the residual muscles in a forearm stump to provide control of an electrically actuated artificial hand. Some rather positive findings were overshadowed by the poor quality of the one unit that was available at the time, and perhaps by the introduction by Russia in 1958 of a "thought control" electric arm<a></a>. The Russian device actually consisted of an electric hand controlled by myoelectric signals from the residual forearm agonists and antagonists of a below-elbow amputee. <a href="/files/original/2aff81bed2e3b007be1b8792137c5788.jpg">Fig. 2</a>. The "Valduz" hand and control system. The "Thalidomide tragedy"<a></a> in 1958-1962 prompted England and Canada to secure manufacturing rights to the Russian design, but fabrication and distribution was not successful in either country. The "Thalidomide tragedy" also encouraged work at the University of Heidelberg in the development of pneumatically powered artificial arm systems<a></a>, and an agreement was obtained by Kessler and Kiessling<a></a> for continuation of this work in the U.S. (Fig. 3). This project was carried out between 1960 and 1969. Again the problem of control was the primary reason for discontinuing the work. <a href="/files/original/41beee5399a82e0e40acfda675701aad.jpg">Fig. 3</a>. On the pneumatic above-elbow systems developed by Kiessting at the American Institute for Prosthetic Research. Because of the Thalidomide tragedy, Sweden<a></a> also launched a modest program in development of externally powered upper-limb prostheses about 1960. Work in this area has been carried out continuously since, but with no commercially available devices resulting, as far as is known at this time. The Russian design caused an Austrian group, Viennatone, and the Otto Bock Company in Germany to develop and market about 1962 similar devices. A few years later Hannes Schmidl began fitting externally powered artificial arms on a relatively large scale at the INAIL Center, Budrio, Italy and continues to do so to the present time<a></a>. Pneumatic models were used initially, but all designs used now are electric. Simpson<a></a>, at the Princess Margaret Rose Hospital, Edinburgh, Scotland uses routinely pneumatic prostheses for a group of "Thalidomide" children, but his design is not widely available elsewhere. In 1960 while on Sabbatical study at the University of Southern California Tomovic from the Institute Pupin, Belgrade, suggested the use of electromechanical pressure sensitive systems to aid in solution to the control problem by introducing closed-loop feedback systems<a></a>. A number of prototypes (Fig. 4) were designed and fabricated upon the return of Tomovic to Yugoslavia. Results of evaluation were also overshadowed by poor workmanship and engineering, and work on this was abandoned about 1968. <a href="/files/original/90ef2a1233e04d701819d9715038383f.jpg">Fig. 4.</a> The "Belgrade" hand and control system. McLaurin, while at Northwestern University, designed the so-called Michigan feeding arm about 1960 which used a linkage to coordinate motions about the elbow and the wrist to make it possible for young bilateral children amputees to feed themselves<a></a>. This device met with considerable success in the clinical setting, but never became a commercial success. McLaurin continued work in electrical arms for children at the Ontario Crippled Childrens Centre, Toronto, between 1963 and 1975. Although he was able to persuade the Variety Club to develop a facility for manufacturing, at cost, some of the products of research as a philanthropic endeavor, to date only an electric elbow has been made available, but because of the low volume the cost is extremely high in spite of subsidization. In the late sixties a number of efforts in the U.S. were directed toward the development of electric elbows. By 1969 three designs were considered ready for clinical evaluation, the "Boston" elbow developed by M.I.T. and Liberty Mutual Insurance Co., the AMBRL elbow, developed by the Army Medical Biomedical Research Laboratory, and a design by Rancho Los Amigos Hospital. The clinical evaluation program was organized and coordinated by CPRD in 1969-70<a></a>. Of 20 subjects in the study only 3 elected to retain the electric device. Two of these subjects had physical problems that made operation of the body powered prosthesis more difficult than would have been the case otherwise. Out of this experience came a revised set of design criteria and objectives. In addition to all of these efforts, research and development programs in externally powered artificial arms have been carried out in the U.S. at Temple University - Moss Rehabilitation Hospital <a></a>, Northwestern University (Fig. 5)<a></a>, Veterans Administration Prosthetic Center, Duke University, Rancho Los Amigos Hospital, University of California at Los Angeles, the University of Colorado, and Johns Hopkins University<a></a>. <a href="/files/original/634d5ee7cc369045d31e39da291ee0d3.jpg">Fig. 5</a>. The self-contained and self-suspended below-elbow system using myoelectric controls developed at Northwestern University. Sweden, Great Britain, Italy, Germany, Russia, and others have continued to support research and development in this field. Yet today it is very difficult to obtain an electric or pneumatic arm in the United States, other than the electrically operated hands that are suitable for below-elbow patients. We will be pleased to hear the opinions of readers of the NEWSLETTER concerning the reasons for this. A. Bennett Wilson, Jr. March 16, 1978 References: <ol> <li>Alderson, Samuel W., The electric arm, (Chapter 13 in Klop-steg and Wilson's "Human Limbs and Their Substitutes," McGraw-Hill, 1954, reprinted by Hafner Press, 1969).</li> <li>Battye, C.K., A. Nightingale, and J. Whillis, "The use of myoelectric currents in the operation of prostheses," J. Bone Joint Surg., 37-B, 506, Aug. 1955.</li> <li>Berger, N., and CR. Huppert, The use of electrical and mechanical muscular forces for the control of an electrical prosthesis, Amer. J. Occup. Ther., 6:110-14, 1952.</li> <li>Childress, D.S., et al., Myoelectric immediate postsurgical procedure: A concept for fitting the upper-extremity amputee, Artif. Limbs, Vol. 13, No. 2, Autumn, 1969.</li> <li>Committee on Prosthetics Research and Development, Externally powered prosthetic elbows - a clinical evaluation, Report E-4 National Academy of Sciences, 1970.</li> <li>Committee on Prosthetics Research and Development, The application of external power in prosthetics and orthotics, National Academy of Sciences, Publication 874, 1961.</li> <li>Committee on Prosthetics Research and Development, The control of external power in upper-extremity rehabilitation, National Academy of Sciences, Publication 1352, 1966.</li> <li>Dankmeyer, Charles H., Sr., Charles H. Dankmeyer, Jr., and Martin P. Massey, An externally powered modular system for upper-limb prosthesis, Orth, and Pros., 26:3, Sept. 1972.</li> <li>Frantz, CH., An evolution in the care of the child amputee, Artif. Limbs, Vol. 10, No. 1, Spring 1966.</li> <li>Kadefors, R., et al., Stryning av armprotes med myosignaler, Electronic 3:42-49, 1967.</li> <li>Kessler, H.H., and Kiessling, E.A., Pneumatic arm prosthesis, Am J. Nursing, 65:6: June 1965</li> <li>Kobrinski, A.E., Bolkhovit-in, S.V., Voskoboinikova, L.M., Ioffe, D.M., Polyan, E.P., Popov, B.P., Slavutski, Y.L., Sysin, A.Y., and Yakobson, Y.S.: Problems of bioelectric control in automatic and remote control. Proceedings of the First International Congress of the International Federation of Automatic Control, Moscow, 1960, London, Butterworth & Co. (Publishers) Ltd., 1961, Vol. 2, p. 619.</li> <li>Marquardt, E., Heidelberg pneumatic arm prosthesis, J. Bone and Joint Surgery, 47-B:3:425-434, August 1965.</li> <li>Rakic, M., Practical design of a hand prosthesis with sensory elements, Proceedings of the Interna-, tional Symposium of the Application of Automatic Control in Prosthetics Design, 103-119, August 27-31, 1962, Belgrade, Yugoslavia.</li> <li>Reiter, R., Eine neue electro-kuntshand, Grenzgeb. Med., 4, 133, 1948.</li> <li>Schlesinger, G., Der Mechanische aufbau der kunst-chanische aufbau der kunstlichen glieder, in Ersatzglieder und Arbeitshilfen, Borchartd, M., et al., Eds., J. Springer, Berlin, 1919.</li> <li>Schmeisser, Gerhard, Wood-row Seamone, and C. Howard Hoshall, Early clinical experience with the Johns Hopkins externally powered modular system for upper-limb prostheses, Orth, and Pros. 26:3, Sept. 1972.</li> <li>Schmidl, Hannes, The I.N.A.I.L. experience fitting upper-limb dysmelia patients with myoelectric control, Bull Pros. Res. 10-27, Spring 1977.</li> <li>Scott, R.N., Myo-electric control, Science J., 2-7, March 1966.</li> <li>Simpson, D.C., An experimental design for a powered prosthesis for children, Health, Scottish Home and Health Department Bulletin, 22:4:75-78, October 1964.</li> <li>Tomovic, R., and G. Boni, An adaptive artificial hand, IRE Transactions on Automatic Control, 3-10, April 1962.</li> <li>Wirta, R.W., Taylor, D.R., and Finley, F.R., Engineering principles in the control of external power by myoelectric signals. Archives of Physical Medicine, 49:294-296, 1968.</li> </ol> Page Number(s) 1 - 4 Year 1978 Volume 2 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-5.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 Externally Powered Upper-Limb Prostheses Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. https://staging.drfop.org/files/original/09fe10baa626726ecfda342c957103aa.pdf d19f909aad10c8d77d23f58e47708607 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/1980_02_007.pdf Text Any textual data included in the document <h2>Editorial: To Fill a Void</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a></h5> I believe that everyone familiar with the recent history of prosthetics and orthotics will agree that the results of the research program in artificial limbs initiated in 1945 by the National Academy of Sciences at the insistence of the Surgeon General of the Army has been very beneficial to amputees and to the prosthetists that serve them. Patients requiring orthopaedic bracing and orthotists have also benefited from this program, which has been supported from the beginning by the Veterans Administration and since about 1956 by the Department of Health, Education & Welfare. Yet for the first five years, or so, of the program, prosthetists and orthotists, not knowing how it would affect their "business," were quite wary of the government-supported research and development teams, and it was not an easy matter to induce practicing private prosthetists to attend the first series of formal education programs offered by the government at UCLA in 1953, even when their attendance was heavily subsidized. Today, the prosthetics and orthotics education programs are considered by all to be essential to the maintenance of a healthy prosthetics and orthotics service, and students pay substantial tuitions to obtain an education in this field. In recent years the AAOP has come forth with continuing education programs that are being improved steadily, and I am sure the younger practitioners probably find it difficult to imagine a world without formal education programs in prosthetics and orthotics. Although the original purpose of the educational programs was to introduce the results of research to practitioners as soon as possible, the government agencies, for reasons known only to the bureaucrats involved, have in recent years essentially abandoned support of research in prosthetics and orthotics. A review of the latest issue of the Bulletin of Prosthetics Research (BPR #10-32) which contains progress reports on all of the research and development efforts in prosthetics and orthotics supported by the VA and DHEW, indicates that less than a quarter of the projects devoted to "Rehabilitation Engineering" relate to prosthetics and orthotics. The percentage in terms of fiscal support is probably even less. This circumstance is reflected also in the source of manuscripts submitted to "Orthotics and Prosthetics." In the past, most of the articles were submitted by workers involved in government-supported research programs. Today, the majority of articles are being received from private practitioners. Perhaps this is as it should be, even though medical research is heavily subsidized, and maybe the prosthetics and orthotics profession has grown to the point where it can assume the leadership in the research, development, evaluation, and education needed if it is to continue to provide the increasingly better services expected of professional groups. In addition to the role of the AAOP in providing opportunities for continuing education, an encouraging signal seems to be coming recently through many of the manuscripts submitted to "O & P" in which practicing prosthetists and orthotists describe their own innovations. However, almost without exception, the authors include only their own experiences with patients, and it never fails to occur to me, as editor, what a pity it is that there exists no group to which these excellent ideas can be submitted for a non-biased evaluation conducted under typical clinical conditions, and thus, be channelled with confidence into the formal educational programs. Even if the federal bureaucrats feel that research and development in prosthetics and orthotics is not important or glamorous enough for support, perhaps AAOP could persuade them that it would be in the public interest to support, at least partially, a clinical evaluation program to be conducted by the Academy. I am confident that Academy members will gladly cooperate by fitting patients on a controlled, experimental basis, and, thus, the government will need to support only staff, travel expenses, and in some instances the cost of materials and devices in connection with this much needed function. If such a project is proposed, I recommend strongly that the universities and colleges offering educational programs in prosthetics and orthotics be given the opportunity to participate, for, in that way, any recommendation that a device or technique be added to their respective programs will come as no surprise, and therefore be accepted more readily. *A. Bennett Wilson, Jr. Director, Rehab. Engineering Program, University of Texas Health Science Center at Dallas; Editor, O &P Journal Page Number(s) 7 - 7 Year 1980 Volume 4 Issue 2 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 Editorial: To Fill a Void Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * https://staging.drfop.org/files/original/22f2bcc00fd13d3ee3dbba5a01cf9dfd.pdf f5dcb905e27a0297a27464a85893dcbb https://staging.drfop.org/files/original/739b1a9158b00278582d96d76ac19145.jpg 925b8b94e9c4b16ea14a5b8e612748f3 https://staging.drfop.org/files/original/c03ea9b706c703a0c23b955ca07c7da5.jpg 6114438d0c7b0f11b4f55fa8ed817d8b https://staging.drfop.org/files/original/13144e1ac56398758d04b22fc4b25fc5.jpg 464fa1a98a48cb3d50fe5a79ca02b7ba https://staging.drfop.org/files/original/d621137e255ef9d7c7e242e2122776f2.jpg 3a8ed62b5588399a696c3c1e1529768f https://staging.drfop.org/files/original/360efe6c756b05e84d50d65ed85add45.jpg cb981259d0b15353cd7336e14fd68c8c https://staging.drfop.org/files/original/8d2cd187f502495317c736775b95b3b1.jpg 7fe8a40aa682646a3bc9513370614734 https://staging.drfop.org/files/original/12aab77dddaf713fca6201a3a944eb99.jpg 89aa7327ec6c0d36aaacad28471c6ea0 https://staging.drfop.org/files/original/743a4583056a4ffceb44d54938b38c0f.jpg c26243f82589c6280ee0cb1f38b09bd7 https://staging.drfop.org/files/original/7bde68b6fc67e46a86f42233817d383a.jpg 8f117df5f4cf67539777c80e85427227 https://staging.drfop.org/files/original/2c4626ebe0deef97dca3a79434d65014.jpg 1774df62ca57088bb04d63e5bfb1501e 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/1987_02_082.pdf Text Any textual data included in the document <h2>Wheelchairs for Paraplegic Patients</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a></h5> The best current estimates of the incidence and prevalence of spinal cord injury in the U.S. is 30-32 and 900 cases per million of population respectively.<a></a> About half of these cases are paraplegic. Added to this are paraplegics due to spina bifida, a few polio cases, etc. By definition, paraplegics have to rely on one or more assistive devices if mobility is to be achieved. Only a small segment of the paraplegic population make use of lower-limb orthoses, and even those who do have orthoses, and use them, need a wheelchair as well, in order to make the most of their available energy. For the very few who can "walk" enough not to feel the need for a wheelchair in work and activities of daily living, wheelchairs permit participation in athletic activities that would otherwise be impossible. Wheelchairs can be classified as either "manual" or "powered". The manual wheelchair is designed to be propelled by the occupant or by an attendant. Tests have shown that the energy cost of using a manual wheelchair for mobility on a smooth, level surface can be appreciably less than that of unimpaired persons walking on the same type of surface.<a></a> The conditions, of course, are reversed when uneven surfaces or ascending surfaces are encountered. The "powered" wheelchair is designed to be propelled by a battery-powered electric motor or motors. Originally conceived to be used by patients unable to propel themselves, powered chairs are sometimes indicated so that a paraplegic can make more effective use of his own energy. The basic manual wheelchair has two side-frames connected by a cross-bar that is pivoted about its intersection and a flexible seat and back to allow folding, two large driving wheels at the rear, and two caster wheels at the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg">Fig. 1</a>).<a></a> This is a configuration that has evolved over the years since the original patented design of Everest and Jennings<a></a> in 1936 for the folding mechanism, and represents a rather elegant compromise between maneuverability, stability, and portability. Many concerted attempts, especially in recent years, to develop better designs have not been very successful. The use of new materials has made it possible to produce significantly lighter wheelchairs, but the original configuration is basically the same. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg">Figure 1. The basic wheelchair-folding frame, 24-inch diameter wheels in the rear, 8-inch diameter casters in the front, flexible seat and back.</a> It must be remembered that a change in the design to emphasize one feature generally affects adversely one or more of the other features. An example is when the wheelbase of the basic chair is lengthened to provide more stability for the bilateral leg amputee; maneuverability is sacrificed. Designers of some of the "sports" chairs, in order to reduce weight, have eliminated the folding mechanism. Portability is achieved by connecting and disconnecting driving wheels for transport in an automobile. <h3>Prescription Considerations</h3> Variations of the basic chair are available for amputees, hemiplegics, and others, but the basic chair of proper dimensions is generally the most suitable for paraplegic patients. The range of dimensions of the basic wheelchairs available in the United States are shown in<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg"> Fig. 2.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg">Figure 2. Dimension ranges for the basic adult wheelchairs from major U.S. manufacturers.</a> Even when sensation is present, the hammock type seat is seldom used without cushions, which are needed to provide a better distribution of pressure over the thighs and buttocks for comfort, if for no other reason. Cushions and other seating systems affect the relationship between the user and the chair and, therefore, must be selected and taken into account before the final dimensions of the chair are determined. The importance of selecting the most appropriate chair and seat cushion cannot be over emphasized. The dimensions of the chair must distribute the forces of the body properly while also placing the user in a position, with respect to the driving wheels, to provide maximum efficiency during propulsion. <h3>Seat Width And Depth</h3> Selection of the proper seat width is important to comfort and stability. A seat that is too narrow is not only uncomfortable, but access to the chair is made difficult. Furthermore, the chances of pressure sores developing is increased. A seat that is too wide encourages the user to lean toward one side, thus promoting scoliosis and increased pressure over the buttocks on one side. In addition, a seat wider than is necessary makes propulsion more difficult. A seat that is too shallow reduces the area in contact with the buttocks and thighs and causes more pressure on the soft tissues in contact with the seat than is necessary or safe. Furthermore, the location of the footrests is changed so that the feet and legs are not supported properly, and the balance of the user can be affected. A seat that is too long can restrict circulation in the legs. <h3>Seat Height</h3> The height of the seat above the ground of the basic adult chair is 19 1/2 - 20 1/2 inches. Tall persons require a seat that is higher and deeper; short persons require a seat that is lower. Usually these requirements can be met by a stock chair; if not, properly dimensioned units can be had on special order. Obviously, the cushion or seating system to be used will affect the end result. <h3>Seat Type</h3> Seats available from wheelchair manufacturers are sling or hammock types, made of a flexible material, and solid seats which are generally removable (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg">Fig. 3</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg">Figure 3. Seat types-a. hammock or sling; b. solid.</a> The sling seats are, by far, the type most used. A solid seat installed to permit folding is available, or a removable solid wooden seat may be purchased or made. <h3>Backrest</h3> The backrest of the basic chair is made of a flexible material stretched between the two side frames which are fixed with respect to the seat. The backrest should be high enough to provide support without inhibiting motion, yet not so low that the scapulae can hang over the back of the chair and cause discomfort. <h3>Arms</h3> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg">Fig. 4</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg">Figure 4. The basic wheelchair with the most popular types of arms-removable full-length, removable desk-type, and removable, adjustable desk-type.</a> The lightest chairs have fixed arms or none at all. But an overriding factor in wheelchair prescription is transfer into and from the wheelchair, especially when the patient is unable to stand for a brief period. For this reason, most patients require chairs with arms that can be removed easily. Chair arms not only provide support for the patient's arms in a resting attitude, but also provide lateral support and a reaction point for the hands when the asensitive patient elevates his body at regular intervals to prevent restriction of circulation and thus pressure sores. Both removable and fixed arms are available in full-length and desk models; both of these styles are available with the height fixed or adjustable. The desk models are foreshortened to permit the user to get closer to a desk or table top. The removable desk arm is by far the most popular type. The full length models are indicated when the forepart is needed to support the arms of the user in rising from the chair, or when lordosis, obesity, or some other physical factor makes it necessary to use the front part of the arm for support. The standard removable desk model can be reversed to provide this feature. <h3>Wheels And Tires</h3> The basic chair has two 24 inch diameter rear wheels and two eight inch caster wheels in the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg">Fig. 5</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg">Figure 5. Basic wheelchair with standard 24-inch diameter wire-spoke wheel and two options: the cast magnesium wheel and a wheel with special built in hand rim.</a> The standard rear wheel for many years has been a wire spoke wheel, but wheels of cast metal alloy and wheels of cast plastic have been made available recently to overcome the maintenance problems inherent in the wire wheel design without adding more weight. Three types of tires are available in several widths and tread types. Pneumatic, semi-pneumatic, and solid tires are available (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg">Fig. 6</a>). The eight inch diameter wheel with solid rubber tires is standard on the basic chair, and is suitable for use on smooth surface and indoors. The semi-pneumatic and pneumatic tires provide shock absorption, and, thus, are more suitable for rough surfaces and outdoor use. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg">Figure 6. Basic wheelchair and optional casters available. Shown on the chair is the standard 8-inch diameter wheel with solid rubber tire. Next in order are: the 8-inch wheel with the semi-pneumatic tire; the 8-inch wheel with pneumatic tire; a 5-inch diameter wheel with solid rubber tire.</a> Pneumatic tires provide a more cushioned ride and their shock absorber action tends to prolong the life of a wheelchair when kept inflated properly. <h3>Handrims</h3> Handrims are attached to the driving wheels of wheelchairs to permit control without soiling the hands. The standard handrim is a circular steel tube. For users who have problems gripping the smooth surface of a metal ring, vinyl coated rings and a variety of knobs and projections can be added to the ring. <h3>Casters</h3> Casters make steering possible and are available in two diameters: eight inches and five inches. The five inch model is available only with solid tires, and is used on children's chairs and in special circumstances on adult chairs and basketball chairs, when more maneuverability is desired. <h3>Parking Locks</h3> Most users need some means of securing one or more wheels to keep the chair from rolling down inclines or to provide stability during transfer to and from the chair. Two types of parking locks are available from the large wheel (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg">Fig. 7</a>): toggle and lever. Selection depends upon user preference. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg">Figure 7. Two types of parking locks-left, toggle type; right, lever type. Variations of these two types of locks are available.</a> Pin type locks are also available. These retain a caster in the trail position and are used to prevent swiveling during lateral transfer. <h3>Cushions</h3> The vast majority of paraplegics require, and can use successfully, seat cushions that are mass produced and are widely available at reasonable prices. A great many designs of seat cushions are available. Some have been developed by trial and error, the designs being based on what has proven to be acceptable to the inventor or his customers; other designs have a more scientific basis, but because the exact cause of decubitus ulcers is not known, precise criteria for design of wheelchair seating have not been established.<a></a> Although each of the cushion designs available has advantages and disadvantages, most of which are not clearly defined, selection of seat cushions for individual cases is seldom simple or straightforward. Commercially available cushions may be divided roughly into five categories, including "miscellaneous" or "other", based on material and design (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg">Fig. 8</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg">Figure 8. Various types of seat cushions that are available.</a> <ol> <li> Foam </li> <li> Viscoelastic foam </li> <li> Gel </li> <li> Fluid </li> <li> Other </li> </ol> Foam Cushions Foam cushions generally use polyurethane or polyether foam, and are available in various configurations. The simplest are homogeneous rectangular blocks 2-4 inches thick; some are contoured; and others are composed of two or more layers of material of different densities, some of which may contain hollow spaces or cores in an attempt to distribute the load to specific areas. Viscoelastic Foam Cushions Viscoelastic foam is less resilient than ordinary foam. Gel Cushions Gel cushions consist of rather firm emulsion enclosed in a "non breathing" plastic casing. Fluid Flotation Cushions Water, air, or water-and-foam particles are used in a flexible, tailored plastic bag to provide distribution of forces. The overall effect varies with the amount of fluid introduced. Other Types Many other designs that combine several elements are available. Prominent among these are the ROHO, which uses a collection of air-filled tufts to distribute the loads and the VASIO (Veterans Administration Spinal Injury Orthosis), in which foams of two different densities are combined and contoured to meet the special needs of paraplegic patients. Each type and design has advantages and disadvantages, and, therefore, selection of the type most appropriate for individual patients is not easy. Until more is known, selection has to be made on a trial basis. <h3>Sports Chairs</h3> Since the introduction of wheelchair basketball shortly after World War II, a constant stream of modifications and refinements has been made to the basic wheelchair to meet the needs of wheelchair athletes. Development of the lightweight, high-performance, sports chair has led to racing among wheelchair users and has made playing tennis from wheelchairs practical and enjoyable. These chairs have also been found useful in non-competitive recreation, such as camping and mountain climbing. Much that has been learned in developing and using sports chairs has resulted in improved performance and quality of prescription wheelchairs, just as automobile racing has led to improvements in the family car. At the same time, many of the people who have been using conventional wheelchairs are now using sports chairs full-time. Like the basic prescription wheelchair, the sports chair (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg">Fig. 9</a>) has evolved through a series of refinements to where the general configurations of most chairs are strikingly similar. At least 20 manufacturers at this time offer one or more models. Most use 24 inch diameter wheels; some use 27 inch wheels. Weight varies from 16 to 38 pounds, due mainly to material selection and whether or not the chair can be folded. A number of designs incorporate provisions for folding; Others use wheels that can be disconnected (and connected) quickly without tools to make transportation easier. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg">Figure 9. Three types of sports chairs. The one shown at the top is limited primarily for use in racing. The other two are more versatile.</a> Nearly all use five inch diameter front castors, except one manufacturer that uses four inch wheels. Two make eight inch castors available as an option. Nearly all, if not all, have a feature that permits a choice of rear wheel axle position with respect to the frame (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg">Fig. 10</a>). Only a very few offer arm rests. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg">Figure 10. Schematic showing adjustability often found in sports chairs that permit an optimum relationship between position of the user and the wheels.</a> Many active wheelchair users prefer to use a sports type chair all the time, and in many instances options are offered that make regular use practical. Many models have adjustable features, and most manufacturers will provide a chair with dimensions to suit a given individual. A feature found on most sports chair, but not on other types, is the easy adjustability of wheelbase and seat height afforded by the positioning plate for the rear wheels. In many models, the position of the castor wheels can also be adjusted. Such adjustability, of course, permits the user to be seated in a position which puts the muscles in the upper limbs and shoulders in the optimum arrangements for maximum biomechanical efficiency. Because refinements and advances are being introduced so frequently, the periodical SPORTS 'N' SPOKES, published by the Paralyzed Veterans of America, has been devoting one issue each year to sports chairs and their specifications.<a></a> <h3>Summary</h3> Because of increased competition and refinements brought about by the sports chair movement, paraplegics now have available high quality wheelchairs. No single chair design is apt to meet all the needs of each individual, but careful thought and attention to detail in prescription preparation can result in a chair that meets most of the needs of the paraplegic. References: <ol> <li>Cochran, George Van B. and Vincent Palmieri, "Development of Test Methods for Evaluation of Wheelchair Cushions," Bulletin of Prosthetics Research, 10-22, 17:1:9-30, Spring 1980.</li> <li>Everest, H.A., et al., U.S. Patent No. 2,095.411, October 12, 1937.</li> <li>SPORTS 'N' SPOKES, 5201 N. 19th Avenue, Suite 111, Phoenix, Arizona 85015.</li> <li>Grimby, Gunnar, "On the Energy Cost of Achieving Mobility," Scand. J. Rehab. Med., Supplement 9, 1983, pp. 49-54.</li> <li>University of Alabama at Birmingham, Spinal Cord Injury Project, "Spinal Cord Injury - The Facts and Figures," 1986.</li> <li>Wilson, A. Bennett, Jr., Wheelchairs: A Prescription Aid, Rehabilitation Press, Charlottesville, VA, 1986.</li> </ol> *A. Bennett Wilson, Jr. A. Bennett Wilson, Jr. is an Associate Professor with the Department of Orthopedics and Rehabilitation at the University of Virginia, Charlotteville, Virginia 22908. Page Number(s) 82 - 90 Year 1987 Volume 11 Issue 2 Figure 2 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.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 Wheelchairs for Paraplegic Patients Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * https://staging.drfop.org/files/original/5e9f050c02d96432d8f104ec812ace8c.pdf da0d38d9a804a332fd9a3207062a9f1a https://staging.drfop.org/files/original/08e07425408bf41c87dc2c93b224fb5b.jpg 5c092b58ef2060d68e7424b84d6116a0 https://staging.drfop.org/files/original/e346dec2bedf92a857e59abd1ffd7248.jpg 7ee5ff43fa419c57bc4fd8cc6391d463 https://staging.drfop.org/files/original/f61adfb1b17552120e234743993ec28c.jpg ab766cfcc2786236a2c9260ce284e2f4 https://staging.drfop.org/files/original/273c55454cc1bf885d5d972065422824.jpg 2bd9f6a2c4b4d4dc4605e3164b28a1a4 https://staging.drfop.org/files/original/d7748887e1fa845160bc8a5ed9a0b605.jpg a6a917a2af2d7d7b9c2aaf4fe33859dc https://staging.drfop.org/files/original/66af61cdb008228dfacfa6384bb43a35.jpg 4526ad7811f6fb0b5ab5e82c5898c111 https://staging.drfop.org/files/original/ec901e8f405550f48f40e16d73cb2668.jpg f6a4b8e029d8a483756ef3093ef5b526 https://staging.drfop.org/files/original/4f6d845321f89277e90d05be3717d8c6.jpg 1b032cda8b3d4109ce6eb11f5a7f1bff https://staging.drfop.org/files/original/8f7da8912d661f332b7e1a1bf78d597d.jpg 674e1d743a9075daacadf8b4dc82e328 https://staging.drfop.org/files/original/259e168640efa7a9e4790687b54c8fe3.jpg f2644041c4e2f5558269baa90c20d8ca https://staging.drfop.org/files/original/0e7f28c6e5f7b709866175e5ccdf4771.jpg a9c7feb31eff0f0a1e47b133085f51fb https://staging.drfop.org/files/original/117acbf788a7d3c1a7c6e8475739c1ed.jpg 415a50b0631ed70cc4f1c6e34ead3306 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/1987_01_011.pdf Text Any textual data included in the document <h2>A Variable Volume Socket for Below-knee Prostheses</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a> C. Michael Schuch, C.P.O. <a style="text-decoration: none;">*</a> Robert O. Nitschke, C.P.O. <a style="text-decoration: none;">*</a></h5> The benefits concerning control of edema by fitting the lower limb amputee as soon as the stitches are removed are well documented,<a></a> yet for a number of reasons, mostly economic, the majority of new amputees are not treated in this manner. As a result, most patients present for their first prosthesis with an edematous residual limb that can be expected to shrink even when it has been wrapped properly with an elastic bandage or with a shrinker sock. Proper management of these patients has usually required the fabrication of several provisional sockets in successively smaller sizes until the soft tissues have reached a point where no further reduction is to be expected. Besides the expense involved in this procedure, a truly proper fit occurs only for a very short period after each new provisional socket is provided, a condition which is bound to have an effect on the activity of the newly fitted patient. Thus, a socket that can be adjusted to accommodate the gradual change in residual limb volume is desirable. <h3>History</h3> Attempts to provide adjustable socket volume are found more commonly at the above-knee level.<a></a> The Irons, et al.<a></a> socket design has evolved to become available as a non-custom fitted, prefabricated socket system, manufactured and distributed by Orthomedics<a></a> and United States Manufacturing Company.<a></a> To quote Mooney,<a></a> a co-author of the paper by Irons, et al.,<a></a> "For the above-knee stump, the design constraints are simpler in that the residual limb usually presents no significant bony contours and adequate soft tissue covers all bony elements. On this basis, the fabrication of a lightweight above knee prosthesis with an adjustable socket is a relatively simple problem." Referring again to the Irons, et al.<a></a> study, Dr. Mooney7 states that, "a significantly higher percentage of amputees became functional users due to the availability of the adjustable above-knee prosthesis than would have been expected by previous experience if they had waited for the maturation time to be considered for a conventional socket. The average time to fitting with a conventional socket in the past was about six months. In this group, using earlier fit of adjustable sockets, which were also lightweight, a higher percentage of patients became functional users." The only volume adjustable below-knee socket system reported on to date is by Mooney, et al.<a></a> from the University of Texas at Dallas, who report early gratifying results with use of this system. However, it is an off-the-shelf item, which inherently presents fitting problems. As opposed to the above-knee limb, the below-knee limb requires more exacting contours of fit due to prominent bony contours, and relatively less soft tissue. In addition, the below-knee amputee often presents with adherent scar tissue in the suture areas. For these reasons, most will agree that a custom fit is mandatory at the below-knee level. An interesting fact can be noted in all of the designs cited: ease of volume adjustments were concentrated in the proximal aspect of the socket as opposed to the distal aspect, where the greatest reduction in volume occurs. <h3>Goals And Design Criteria</h3> After reviewing existing designs in which the volume of the socket can be adjusted, and considering the use of materials and techniques now available, a set of criteria was established for a custom fitted variable volume below-knee socket as follows: 1) the socket would be custom fitted to the individual patient; 2) existing prosthetic molding, modification, and fabrication techniques would be used as appropriate; 3) the volume would be controlled equally or selectively between proximal and distal parts of the residual limb; 4) normal prosthetic cosmesis would be possible and practical; and 5) the finished prosthesis would be light, but durable. The original, primary purpose of the project was to design a socket for use as a preparatory prosthesis, and thus avoid the need for several socket changes before stabilization occurs. However, it appears that the design that has resulted may also be very appropriate for use over extended periods where fluctuation in limb volume is difficult to control, or where the shear stresses normally encountered with present day socket designs present a problem. Because of the two-piece design (<a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-01.jpg">Fig. 1</a> and <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-02.jpg">Fig. 2</a>), it is possible to don and doff the prosthesis without subjecting the skin of the residual limb to shearing forces, and thus should be considered when it is desirable to avoid shear on the limb. Additionally, the two-piece construction should add a measure of suspension if this element is considered in the individual design. <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-01.jpg">Figure 1. Exploded schematic view of the variable volume socket showing major components.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-02.jpg">Figure 2. Schematic showing relationship of the major components of the variable volume socket.</a> We are confident that the concept is valid and useful. What follows here is, we hope, sufficient information for an experienced prosthetist to try the concept. The materials and dimensions given are those that have been found to work in our still limited experience, but are by no means considered to be the best. Our original method for controlling volume, by use of two conventional hose clamps, is described here, because we have yet to locate a commercially available adjustment buckle that is suitable. We made some progress in designing a buckle especially for this purpose, but have not pursued the idea since the hose clamps can be made to work satisfactorily. However, there is probably a place for a more convenient method of controlling the circumferential dimensions. <h3>Casting And Modifying The Positive Model</h3> As stated in the design criteria, this socket system is intended to make use of existing prosthetic molding, modification, and fabrication techniques. We recommend use of the casting procedure described by Fillauer<a></a> in which an impression of the anterior portion of the limb is made first, using plaster splints to capture the bony definition before enclosing the remainder of the residual limb with plaster. Model modification should be carried out in normal function. We also recommend the use of a transparent diagnostic socket and algination procedure as described by Schuch and Lucy,<a></a> before proceeding with pouring the final positive model and fabrication of the socket. Fabrication of the Socket <ol> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-03.jpg">Step 1 </a> Place the positive model in a vise horizontally with the anterior section facing up. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-04.jpg">Step 2 & 3</a> Over the positive model, form a Pelite™ liner for the anterior half of the socket. After heating a proper size sheet of Pelite™, a piece of latex rubber can be used to form the Pelite™ around the cast model. </li> <li> Trim the Pelite™ liner so that it extends posteriorly slightly past the midline, dividing the anterior-posterior halves of the model. Skive all edges that will be inside the socket. Remove the Pelite™ liner from the cast in preparation for the next step. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-05.jpg">Steps 4 and 5</a> Rotate the model in the vise 180° so that the posterior surface is up. </li> <li> Using conventional drape molding techniques, vacuum form a piece of 1/8 inch polyethylene (or Surlyn®) around the model, posterior side up so the seam is on the anterior side. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-06.jpg">Step 6</a> Trim the polyethylene to form a posterior socket shell that extends anteriorly just past the midline and "underlaps" the Pelite™ anterior liner by about 3/8-1/2 inch. Again, skive all edges that will be inside the socket. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-07.jpg">Step 7</a> With the Pelite™ anterior liner and the polyethylene posterior shell in place on the model, pull a thin sheath of nylon over both to hold them in place. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-08.jpg">Step 8</a> On the posterior aspect of the model, glue a 1/4 inch diameter rope to form the cutout for the posterior volume control panel. Prepare for lamination in the usual manner. For use as a temporary design prosthesis, we use Otto Bock<a></a> modular endoskeletal components and laminate the 4R42 component (socket adaptor with pyramid and lamination anchor) directly into the socket. </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-09.jpg">Step 9</a> Before beginning the lamination procedure, cut two polyethylene strips 1/16 inch thick by 9/16 inch wide by the circumference, plus 1/2 inch of the cast model at the levels shown. The strips are placed in the lamination layup and are removed after the lamination sets up to form channels for the volume control straps. Layup for the lamination is as follows: <blockquote> 1 layer of 1/2 oz. dacron felt 1 nylon stockinette the 4R42 component (if used) I.P.O.S.<a></a> glass matting over the lamination anchors of the 4R42 component and over the medial, lateral, and posterior aspects of the layup 1 nylon stockinette; the two polyethylene strips cut earlier are placed at the appropriate levels; 1 nylon stockinette 2 nyglass stockinettes; laminate with 80:20 mixtures of acrylic resin </blockquote> </li> <li> <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-10.jpg">Steps 10, 11, and 12</a> When the laminate has set and cured, cut out the window over the rope and trim as shown. </li> <li> Using a pair of needle nose pliers, pull out the two polyethylene strips imbedded in the lamination. This leaves a clean, hidden track for guiding the pull of the control straps. </li> <li> Cut out an area about 1 1/2 inches along each control strap track in the anterior-lateral area of the socket, to allow for exposure of the adjustable part of the control strap. </li> <li> Make up control straps of 1/2 inch da-cron tape and two to three inches of the hose clamps. </li> <li> Put the socket system back on the cast model for determination of the initial volume setting. Insert the dacron straps through the tracks and speedy rivet the hose clamp section so that the hex head of the clamp is exposed in the slots cut in step 12 above (<a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-11.jpg">Fig. 3</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-11.jpg">Figure 3. Photograph of laminated outer socket prior to mounting on adjustable leg. A foam block is shown here but this practice has been superceded by use of the Otto Bock 4R42 component which is laminated into the distal end of the outer socket.</a></li> <li> Attach the pylon and foot and align in the conventional way (<a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-12.jpg">Fig. 4</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-12.jpg">Figure 4. Variable volume socket mounted on an adjustable leg.</a></li> </ol> <h3>Clinical Experience</h3> To date, seven variable volume below-knee sockets have been fitted on six carefully chosen amputees. Five of these patients were new amputees and the variable volume socket prosthesis was their first prosthesis. One of these five had an extremely edematous limb due to a recent infection, and required two successive variable volume sockets before being fitted with a definitive conventional P.T.B, prosthesis. The remaining patient was a young amputee, three years post-amputation, who was having difficulty maintaining consistency in limb volume. The variable volume socket proved to be very useful in managing this patient. Evaluation was basically simple and subjective. The clinic team discussed and recorded any problems that arose with the socket design and documented that atrophy was accommodated by the variable volume socket. In all cases, maintenance of socket fit was made possible by decreasing socket volume as atrophy of the residue limb took place. At no point was comfort compromised by a reduction of socket volume. In addition to the patients fitted at the University of Virginia; trial fittings were made by Mr. Nitschke in the courses of development at Leimkuehler, Inc. in Cleveland, Ohio, American Orthotic and Prosthetic Laboratory, Inc. of Columbus, Ohio, and Rochester Orthopedic Laboratories, Inc. in Rochester, NY where we were given much help and encouragement. In addition, Karl Fillauer, CPO of Fillauer Orthopedic, Inc. in Knoxville, Tennessee has fit two patients and Robert Gooch, CP and John Michael, CPO of Duke University have fit one patient, all of whom are currently being followed. <h3>Summary And Conclusion</h3> Rationale, design criteria, and fabrication techniques for an adjustable volume below-knee socket have been discussed and described. Successful fittings with the system have been noted. It is felt that this system can meet a need by providing new amputees with a durable, cosmetic, and reasonably long lasting preparatory prosthesis that accommodates the familiar problem of residual limb volume shrinkage. <h3>Acknowledgments</h3> This work was made possible by support from the Veterans Administration Rehabilitation Research and Development Service. We are also grateful for the help and encouragement provided by Messrs. Jon Leimkuehler, CPO, Peter Ockenfels, CPO, Karl Fillauer, CPO, Carlton Fillauer, CPO, Robert Klebba, Robert Gooch, CP, John Michael, CPO, and Dr. Frank Clippinger. References: <ol> <li>Brownsey, ZZ; Fillauer, ZZ: "Temporary Prosthesis with Adjustable Socket," Physical Therapy, 47:12:December, 1967, pp. 1129-1131</li> <li>Fernie, Geoff, R. and Pamela J. Holiday, "Volume Fluctuations in the Residual Limbs of Lower Limb Amputees," Archives of Physical Medicine and Rehabilitation, 63:4:April, 1982, pp. 162-165.</li> <li>Fillauer, Carlton, "A Patella-Tendon-Bearing Socket with a Detachable Media Brim," Orthotics and Prosthetics, 25:4:December 1971, pp. 25</li> <li>Irons, G., V. Mooney, S. Putnam, M. Quigley, "A Lightweight Above Knee Prosthesis With an Adjustable Socket, Orthotics and Prosthetics, 31:1:March 1977, pp. 3-15.</li> <li>Malone, J. et al, "Rehabilitation for Lower Extremity Amputation," Archives of Surgery, 116:1:January 1981, pp. 93-98.</li> <li>Malone, J. et al., "Therapeutic and Economic Impact of a Moderate Amputation Program," Annals of Surgery, 189:6:June 1979, pp. 798-802.</li> <li>Mooney, V., B. McClellan, D. Cummings, P. Smith, "Early Fitting of the Below Knee Amputee," Orthopedics, 8:2:February 1985, pp. 199-202.</li> <li><a href="cpo/1986_03_101.asp">Schuch, C. Michael, and Tony Lucy, "Experience with the Use of Alginate in Transparent Diagnostic Below-Knee Sockets," Clinical Prosthetics and Orthotics, 10:3:Summer 1986, pp. 101-104.</a></li> <li>Orthomedics, Inc., 2950 East Imperial Highway, Brea, California 92621.</li> <li>Otto Bock Orthopedic Industry, Inc., 4130 Highway 55, Minneapolis, Minnesota 55422.</li> <li>United States Manufacturing Company, 180 North San Gabriel Blvd., Pasadena, California 91107.</li> <li>I.P.O.S., U.S.A., 155 Portage Road, Lewiston, New York 14092.</li> </ol> *Robert O. Nitschke, C.P.O. Robert Nitschke is a consultant and lives in Rochester, NY. *C. Michael Schuch, C.P.O. Department of Orthopedics and Rehabilitation at the University of Virginia. *A. Bennett Wilson, Jr. Department of Orthopedics and Rehabilitation at the University of Virginia. <div style="width: 400px;"> </div> Page Number(s) 11 - 19 Year 1987 Volume 11 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-01.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 2 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-02.jpg Figure 3 STEP 1 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-03.jpg Figure 4 STEP 2 &3 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-04.jpg Figure 5 STEP 4&5 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-05.jpg Figure 6 STEP 6 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-06.jpg Figure 7 STEP 7 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-07.jpg Figure 8 STEP 8 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-08.jpg Figure 9 STEP 9 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-09.jpg Figure 10 STEP 10,11&12 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-10.jpg Figure 11 FIGURE 3 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-11.jpg Figure 12 FIGURE 4 http://www.oandplibrary.org/cpo/images/1987_01_011/1987_01_011-12.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 Variable Volume Socket for Below-knee Prostheses Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * C. Michael Schuch, C.P.O. * Robert O. Nitschke, C.P.O. * https://staging.drfop.org/files/original/c1dcd8002daf073f875a014ab93e6d77.pdf 9f6846fc84195173da86b474bf524650 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/1983_04_003.pdf Text Any textual data included in the document <h2>Hydraulics and Above-Knee Prosthetics</h2> <h5>A. Bennett Wilson, Jr., B.S.M.E. <a style="text-decoration: none;">*</a></h5> Some of the highlights in the history of the use of hydraulic systems in artificial legs might be useful in understanding the present status and influencing the future application of hydraulic principles in lower-limb prosthetics. One of the prime objectives of the designers of artificial legs for above-knee amputees is control of the knee joint, and, thus, the shank to provide the amputee with the means to stand and walk safely, efficiently, and gracefully. Sporadically since 1918, and possibly before, hydraulic principles were proposed as a means for locking or braking the knee to enhance safety, but none of these ideas seem to have reached a practical stage until after World War II. When the National Academy of Sciences (NAS) initiated a research program in limb prosthetics in 1945 at the request of the Surgeon General of the Army, surveys of amputees indicated that the above-knee amputees felt that their greatest need was a knee lock that would prevent stumbling. This "finding" prompted a number of designs in the United States that used hydraulic systems to provide knee locking or braking on demand. Concurrently, a team in Germany, Ulrich Henschke, a physician, and Hans Mauch, an engineer, developed a leg prototype that used a hydraulic lock activated by motion of the abdominal wall. After Dr. Henschke and Mr. Mauch moved to the United States at the invitation of the United States Air Force, they were encouraged by their host to continue development of their design, and they became active in the NAS Artificial Limb Program. During the 1940's, Mr. Jack Stewart, an AK amputee and inventor, devised, to meet his own needs, an above knee leg which used a hydraulic system to not only provide knee locking, but also to provide shock absorption at the heel, co-ordinated motion between knee and ankle joints, and adjustability of the height of the heel. Swing phase control was provided by hydraulic fluid being forced through a single orifice, a serendipitous sort of circumstance. About 1951, leaders in the research program came to the conclusion, based on data developed at the University of California, that perhaps, more important than control in the stance phase, is control during the swing phase. Mr. Mauch was requested to give high priority to the design of a mechanism that would provide control of the knee during swing phase so that the amputee could vary cadence without changing the friction control setting. At about the same time, it was recognized that the characteristics of a fluid flowing through an orifice had the possibility of providing automatically the change in resistance to knee flexion and extension needed to compensate for changes in the walking cadence. Using many of the same parts designed for the stance-control system as well as data provided by the University of California Biomechanics Laboratory concerning knee movements during swing phase, Mr. Mauch produced a unit with a number of orifices arranged to provide changes in resistance to rotation at the knee corresponding to the "normal." This design, known as the Model "B," after some years of testing and field use, was combined with the stance-control system to produce the Model "A," which when modified was marketed as the Henschke-Mauch S'n'S (Swing and Stance) knee unit. During the development of the Henchke-Mauch units several less complex hydraulic and pneumatic units were also developed by others and marketed commercially with some degree of success. During the early 1950's 18 units of the Stewart design known as the Stewart-Vickers Hydraulic Leg were evaluated by a team at New York University, who found good amputee acceptance, and recommended that the locking feature be eliminated since the cost could be reduced appreciably and the test subjects didn't seem to make use of that feature. This recommendation was followed by Mr. Stewart, who a short while later sold all rights to U.S. Manufacturing Co., who manufactured and marketed it as the Hydra-Cadence Leg. The Hydra-Cadence Leg has been a commercial success, but in spite of a great deal of experience, no one can be sure of the relative importance of its many features. The development of hydraulic mechanisms for artificial legs has been plagued by leakage and breakage, which is only natural in an effort that tries to arrive at the optimum compromise between cost, weight, and function. Whether or not this optimum has been achieved is not yet known. We do know, however, that active above-knee and hip-disarticulation amputees appreciate the swing-phase control function afforded by hydraulic mechanisms and that the present day costs are not prohibitive for a substantial number of amputees. No definitive studies have been made that would delineate the efforts of the various factors and features involved, singly or in combination. With the availability of 4-channel 24-hour physiological surveillance systems and other sophisticated instrumentation, such studies seem to be quite feasible now and certainly should be considered. For at least thirty years the need for voluntary control of the knee joint has been recognized, but until the advent of the microcomputer it was difficult to conceive of a practical method to accomplish this. When microcomputers became available, the first reaction of some designers was simply to add the microcomputer to present hydraulic systems, but these efforts failed most probably because the systems available were not designed for control by computer. At any rate, it would seem that the weight alone of present systems would make voluntary control impractical, and thus any project in this area should begin anew. At present, very little work seems to be going on in the area of voluntary control systems. Some work at the Massachusetts Institute of Technology has been reported for nearly a decade. More recently, the REC at Moss Rehabilitation Hospital started a project where pattern recognition techniques are used to obtain subconscious control of a knee mechanism by EMG signals about the hip joint, which shows a good deal of promise. Perhaps what we need most at this point is more information concerning the contribution of each variable, such as swing-phase control, stance-phase control, ankle action, weight, and weight distribution, singly and in combination, for designers of the next generation of above-knee legs. With the technology now available to us, this appears to be possible as well as practical. *A. Bennett Wilson, Jr., B.S.M.E. Assistant Director, Rehabilitation Research and Training Center Dept. of Orthopaedics and Rehabilitation University of Virginia Medical Center Charlottesville, Virginia 22908. <div style="width: 400px;"></div> Page Number(s) 3 - 4 Year 1983 Volume 7 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 Hydraulics and Above-Knee Prosthetics Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr., B.S.M.E. * https://staging.drfop.org/files/original/c4f7c87a6d3b45eaeeb780028322aac3.pdf 2f3019f3a58522e9c6c9ef279008e662 https://staging.drfop.org/files/original/e3fa45ed04f25031b0eae1b1ae3563f7.jpg 1d480fe476876e4ae28210d460878f00 https://staging.drfop.org/files/original/8d9753f4b6b5322d836534694564a736.jpg 18e2d169d78ebf6f59e41dce49306715 https://staging.drfop.org/files/original/ba2d5caaf2bb5a526891c65720e02f75.jpg 4c419b14d2f5c2e8b85e998eec950f1e https://staging.drfop.org/files/original/1bb426ed68464888794dcdf4a783cf53.jpg d1da7506184096c8d68116798a87facd https://staging.drfop.org/files/original/1c12f7dc0e21d73986874eddb77e705e.jpg 6f0727ef350636789bc9df62f3eccbf4 https://staging.drfop.org/files/original/00d157335a62ec44dbfdf98f9c624906.jpg f4e81019aca87bb8e609ca049e7db794 https://staging.drfop.org/files/original/5e53449d0db91f56ed12371c0939588b.jpg 38d62fb95c884d54aa066fc874713827 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/1987_02_101.pdf Text Any textual data included in the document <h2>The Cast Off Valve: An Improved Method for Removing and Retaining Above Knee Casts and Prosthetic Sockets</h2> <h5>Albert F. Rappoport, M.A., CP. <a style="text-decoration: none;">* </a></h5> <h3>Introduction</h3> The fabrication of a prosthesis continues to be a labor intensive process. The advent of prefabricated components, together with the use of central fabrication, has allowed many prosthe-tists to utilize their time more effectively. Time saving devices have always been welcomed by the prosthetic practitioner, especially when the quality of work is not compromised. Removal of an above-knee socket from a plaster model is a common procedure in most prosthetic facilities. There are several methods for removing the socket from the cast. These methods will be addressed later in the text and the problems of each discussed. The most improved method is the Cast Off Valve (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-1.jpg">Fig. 1</a>). The Cast Off Valve uses compressed air, linking it directly to the above-knee socket (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-2.jpg">Fig. 2</a>). The female coupling of the air hose is attached to the male connector of the Cast Off Valve (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-3.jpg">Fig. 3</a>). The Cast Off Valve is then threaded into the suction valve housing of the above-knee socket. This method saves manpower, time, and energy by allowing removal of the socket from the cast in a matter of seconds. It is also effective in the duplication of any definitive above-knee suction socket. The concept is credited in its design to Judd Lundt, B.S.A.E., Assistant Director at UCLA's Prosthetic Education Program. <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-1.jpg">Figure 1. The Cast Off Valve.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-2.jpg">Figure 2. Female couple of air hose to male connector on Cast Off Valve.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-3.jpg">Figure 3. Cast Off Valve attached to female air hose coupling.</a> <h3>Methods Of Removing Socket From Cast</h3> Several methods have been used, with varying degrees of success, in removing an above-knee socket from a plaster model. The oldest method involves breaking the plaster out of the socket with a cold chisel and hammer, or air chisel. This is a labor intensive process which is still practiced by many prosthetists (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-4.jpg">Fig. 4</a>). This process is not always necessary to facilitate the removal of a definitive socket. <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-4.jpg">Figure 4. Age old method of removing socket by breaking out plaster by hand.</a> <h3>Bivalving</h3> Many times, the prosthetist would like to save the plaster model for further modification or reference. One approach to saving the model is to bivalve the socket with a cast saw (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-5.jpg">Fig. 5</a>). Once the socket has been bivalved, the cast can be touched up with minor plastic additions and used again. After the socket is bivalved, it cannot be reused. This process is not only time consuming, but can be eliminated in many circumstances. <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-5.jpg">Figure 5. Bivalving socket to retain cast.</a> <h3>Compressed Air</h3> The use of compressed air is by far the most popular method. It saves labor, time, sockets, and casts. A newly formed check socket or laminated socket may be easily blown off using an air gun. The newly fabricated socket must be trimmed just proximal to the desired trim line. A hole must then be drilled at the distal end of the socket to correspond in size to the tip of the air gun (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-6.jpg">Fig. 6</a>). One person holds the air gun with compressed air in the hole at the distal end of the socket, while the other person gently taps, trying not to fracture the socket, at the proximal brim. This is continued until the air is forced through the socket and assists in forcing the socket off the cast. Some radical socket shapes may prevent the ease of this technique, in which case it may be helpful to attempt this procedure while the socket is still warm or to refer back to the previously mentioned methods. The compressed air technique is an effective way to remove the socket from the cast without damaging either one. Two drawbacks to this method are: 1) it requires two persons to remove the socket, and 2) it is possible for air to leak through the hole where the air gun is held at the socket's distal end. <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-6.jpg">Figure 6. Removing socket from cast using compressed air. This two-person operation requires one person to use air gun to direct air through hole in bottom of socket and second person to tap proximal socket. </a> <h3>Cast Off Valve</h3> The use of the Cast Off Valve can improve the effectiveness of the compressed air method (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-7.jpg">Fig. 7</a>). This improved technique can be employed whenever a valve housing is used in either a laminated socket or clear check socket. The Cast Off Valve is designed to fit the valve housing and link the air hose coupling directly to the socket. This approach allows a stronger air pressure to be obtained and little chance for air leakage. The use of this method requires only one person, freeing the hands of a second person who holds the air gun in the hole (<a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-6.jpg">Fig. 6</a>). First, the proximal brim of the socket should be trimmed with a cast saw. Once the Cast Off Valve is installed, the air hose can then be connected and the socket will blow off without any further effort. One may need to gently tap the proximal brim with a piece of wood dowling and hammer to assist the removal. (Note: certain radical socket shapes may prevent the use of this method.) In summary, the Cast Off Valve requires only one person to remove a socket from the cast with a minimum amount of effort, reduction of time and improved results over methods previously discussed. <a href="http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-7.jpg">Figure 7. The Cast Off Valve is threaded into valve housing and air hose is connected to blow socket off with minimum effort and maximum results.</a> <h3>Socket Duplication</h3> The Cast Off Valve also is excellent when an above-knee suction socket is to be duplicated from a definitive limb. No longer is an alginate impression or use of duplicating foam necessary. The patient's socket should be filled with plaster and a holding pipe inserted once the plaster has set. The valve housing must be cleared of any material so the Cast Off Valve can be inserted. The air hose coupling can then be hooked up and the socket is blown off in a matter of seconds. The socket is duplicated exactly in plaster and ready for lamination or check socket fabrication. <h3>Summary</h3> The Cast Off Valve has been well accepted and tested clinically with great success for the past two years by the staff at UCLA's Prosthetic Education Program and Prosthetic-Or-thotic Laboratory. The UCLA prosthetic staff has found this device to be valuable, in many cases, in removing an above-knee socket in both quadrilateral and CAT-CAM designs. This method allows the cast to remain undamaged for further reference and can be useful when duplicating a definitive socket. When working with an appropriately shaped cast, the Cast Off Valve allows the removal of the socket from the cast with improved results from the previously aforementioned methods. <h3>Acknowledgments</h3> This work is supported by VA Contract #633P-1667 Rehabilitation Research & Developmental Funds. Special thanks to Shirley M. Forsgren for the photography on this article and to Diane I. Lyons for preparation of the manuscript. Special thanks also to Dr. Ernest M. Burgress for his continued support in the research and development of advancing prosthetics. Thanks to Christopher Hoyt, CP, David Litig, CP, Mark Yamaka, CP, Richard Boryk, CPO, and Kenneth Neal, O/P Technician for their clinical evaluation of the cast-off valve at UCLA's Prosthetic-Orthotic Laboratory. *Albert F. Rappoport, M.A., CP. Albert F. Rappoport, M.A., CP., is Chief of Research Prosthetics with the Prosthetics Research Study, 1102 Columbia Street, Room 409, Seattle, Washington 98104, (206) 622-7717. He is formerly Senior Prosthetist-Orthotist at UCLA's Prosthetic-Orthotic Laboratory in Los Angeles, California. <div style="width: 400px;"></div> Page Number(s) 101 - 105 Year 1987 Volume 11 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-5.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-6.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 7 http://www.oandplibrary.org/cpo/images/1987_02_101/1987_02_101-7.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 Cast Off Valve: An Improved Method for Removing and Retaining Above Knee Casts and Prosthetic Sockets Creator An entity primarily responsible for making the resource Albert F. Rappoport, M.A., CP. * https://staging.drfop.org/files/original/bd8676bd2ae282b639f2399c6de321e3.pdf ffb53e28db8f2fc150a90906e09d5a19 https://staging.drfop.org/files/original/b5b98ec26d73edf01c22777a6f4f5372.jpg 2970dc2423a7e01f1bb92f8ceb1a1354 https://staging.drfop.org/files/original/bb57324218f589f3d313b6eacad77646.jpg 39967dc29d987500fb2008de8d00e469 https://staging.drfop.org/files/original/9f4e8fe4f15db8a5f8ba4d01ee1a70be.jpg 27a0ccb1ddc4f295ced948da5496ca58 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/1987_03_173.pdf Text Any textual data included in the document <h2>Below-Knee Waterproof Sports Prosthesis with Joints and Corset</h2> <h5>Alfred W. Lehneis, CP. <a style="text-decoration: none;">*</a></h5> This article is concerned with the development of a waterproof below-knee prosthesis with knee joints and corset, utilizing the supracondylar/suprapatellar (SC/SP) suspension socket. A case report is described below. The patient had a below-knee amputation due to traumatic injury with a resultant amputation length of the tibia of approximately 1" (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg">Fig. 1</a>). This patient currently wears a PTB type socket with leather thigh corset, polycen-tric joints and an SC/SP suspension socket, thus, no auxilliary suspension was necessary (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg">Fig. 2</a>). He was doing well with this design in all activities of daily living, but desired a waterproof prosthesis for boating. <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg">Figure 1. Length of tibia is approximately 1".</a> <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg">Figure 2. Patient currently wears a PTB type socket with a leather thigh corset.</a> In developing the waterproof design, the following components were utilized: Kingsley beachcomber foot, Otto Bock polycentric stainless steel knee joints, and a corset fabricated from 4mm Subortholen thermoplastic. Closures were 1" dacron straps with virgin nylon buckle closures used on scoliosis type body jackets. The fitting and fabrication of the prosthesis was as follows: the patient was casted (including the thigh) and the cast modified, using standard procedures for SC/SP suspension, an insert was fabricated from Pelite™, and the socket was fabricated with acrylic resin and carbon/glass reinforcements, especially at the side bar attachment sites. After fabrication of the socket, the socket was foamed up and set-up on a Staros-Gardner coupling and aligned atop the beachcomber foot. The bars were then attached directly to the socket (not over the foam build-up), and the area over the bars filled with fiberglass/resin putty. The thigh bars were contoured to the modified cast, over which the Subortholen thermoplastic had been molded and attached to the corset. The patient was then fitted and aligned in the usual manner, but while wearing topsider type boating shoes. After optimum alignment was achieved, the Staros/Gardener coupling was transferred out. This can be accomplished on a horizontal transfer device. The prosthesis was then shaped to the patient's tracing and measurements and reduced to accommodate the lamination thickness. The sole of the foot is then removed and a woman's nylon is pulled over the entire prosthesis, followed by the PVA sleeve. A lamination of one carbon-glass and two nylons without pigment is performed. After the lamination is set, the laminated shell is split longitudinally on the posterior aspect (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Fig. 3</a>), taken off the prosthesis, and taped back together to retain its shape. <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Figure 3. The laminated shell is split longitudinally on the posterior aspect.</a> The shaped portion of the prosthesis is cut to allow for a 3" ankle block and the socket is cut at the base. The foam between the ankle and socket is now eliminated (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Fig. 3</a>). The foam ankle block and the foam at the base of the socket can be sealed with a resin-silica mix to prevent water penetration. The laminated shell should be sealed with tape on the outside, and the seam should be sealed on the inside with Siegelharz. The socket and ankle block can then be bonded to the laminated shell. Once this is set, the outer shell should be sanded for a second lamination, and approximately 1" of the proximal socket and distal ankle block perimeter should be exposed (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Fig. 3</a>). The prosthesis is then filled with sand through the hole at the bottom of the ankle block. The hole is then sealed with play dough. Lay-up of the prosthesis consists of six alternating layers of nylon and nyglass. Two pieces of polypropylene with 120° arcs (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Fig. 3</a>) should be placed between the joints and the socket after the first two layers to allow attachment of the joint clevis after lamination. These pieces are removed after lamination. The foot drain hole is then reopened to release the sand. A second 1/2" hole should be drilled posterior and distal to the socket end to allow air to enter and escape the inner hollow of the leg. This allows water to enter and escape the foot drain hole and prevent bouyancy of the prosthesis. The thermoplastic corset is finished with a polyethylene tongue and dacron strap closures as described earlier. When assembling the prosthesis, bonding of the foot should be as recommended by Kingsley, Mfg. or using Devcon two-part epoxy. <h3>Acknowledgments</h3> The author gratefully acknowledges the technical contribution of Roger Losee, CO., and Robert Wilson, M.S., for the illustration in <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg">Fig. 3.</a> *Alfred W. Lehneis, CP. Alfred W. Lehneis, CP., is with Lehneis Orthotics and Prosthetics Associates in Roslyn, New York. Page Number(s) 173 - 175 Year 1987 Volume 11 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 3 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.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 Below-Knee Waterproof Sports Prosthesis with Joints and Corset Creator An entity primarily responsible for making the resource Alfred W. Lehneis, CP. * https://staging.drfop.org/files/original/ba789f483ace72e6c0f63c6846e6c081.pdf 519c0ffb1b60b8ec2558c4682b78c1b1 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/1985_04_005.pdf Text Any textual data included in the document <h2>Basic Changes in Lower Limb Prosthetics</h2> <h5>Alvin L. Muilenburg, C.P.O. </h5> After several years of very little change in above knee amputee fitting, we now have a C.P.O. issue with four papers on current advanced clinical practice in lower limb prosthetics. Some of these advances can be brought into use without too much difficulty while others require much more training and careful follow-up. The techniques that involve materials and fabrication are usually not too difficult to try, but changes in these techniques can give us problems that we didn't expectand require extra caution during initial use. Alterations of socket shape to adapt to more difficult amputations or congenital deficiencies is something where we also look for improvements. Papers that are written giving experience and suggestions on how to solve these problems give us help that is needed in our day to day fitting. This usually does not alter our basic method of alignment and cast model alterations. The discussions concerning basic changes in socket shape and alignment cause us much more concern by whatever name they may be given. There is a new way to fit an AK amputation, that is certain. I cannot question the results; patient acceptance has been proven. New information, however, does not always come easily. These new methods have been brought to the public view only through a considerable amount of publicity, which then stimulates us to get more information. Traditionally, information and results have been passed on from one prosthetist to the other; usually by visiting the developers and exchanging new ideas. Educational institutions have provided a valuable learning ground. U.C.L.A. had a one week course in March and a few seminars have been held elsewhere. However, many details on how to teach the new methods have created controversy. We must support our educational institutions and help them to determine what should be taught. I believe we need a working group of a few prosthetists who are already involved in the new methods to develop guidelines for teaching. Perhaps the Academy could organize this. Clinical evaluation programs have been discussed but communication between prosthetists involved seems to have adequately covered that area. I want to express my appreciation to the publishers in this issue for all the work that has been done. Having this information published enables us to sort it out and make better decisions on improving our own care of the AK amputees. Page Number(s) 5 - 5 Year 1985 Volume 9 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 Basic Changes in Lower Limb Prosthetics Creator An entity primarily responsible for making the resource Alvin L. Muilenburg, C.P.O. https://staging.drfop.org/files/original/596f5df1b45e5408aef2d2e48e214ce0.pdf 89788688822cc599a338f475aef91c26 https://staging.drfop.org/files/original/557b90124720a7da30c19930ed30060d.jpg 9d2990c77123a6377d72a6b73da5ddd1 https://staging.drfop.org/files/original/7f2ea2a39e9b4dc64c65b4067f43bef1.jpg 6533d942da6c283ee8488e49fbe0c9cd https://staging.drfop.org/files/original/ac090bbd79cd145e52cb323e58c729c5.jpg dc2fb43cee750c93112f0affc4206428 https://staging.drfop.org/files/original/ccee007808b1dde739c36d5b00a84e55.jpg ca28e413c0c22d65eae31d5c57c751e0 https://staging.drfop.org/files/original/42d540eb5f7d243a2ca53cb4bf06d76e.jpg b70baead32291e81c86a0750b9e4a4b3 https://staging.drfop.org/files/original/2ef9ffb0acc6dbf9ca7315d0af0b65e0.png 68b444d713762deb48fee990e6b67351 https://staging.drfop.org/files/original/d13990334d94f8492f71d5cfd1dbbd52.png d823f6dba920fa93bfa85d199b314ec6 https://staging.drfop.org/files/original/c715bcdfcce079d9e580963d051d2093.png bb37d520b9116d9fec4491ee5cbe2f09 https://staging.drfop.org/files/original/5bb4495a35e6ed75542b508319864f8c.png 86e9e1f85b2b7cf997340d8727376efe https://staging.drfop.org/files/original/05bf1a813e6795e969c67bfdf70beb0f.png a40d28845357c57383853d91eff35f12 https://staging.drfop.org/files/original/32b9476d17d9fdde664b335970aa3fe5.png a60199a7436285575bd5b6846f9edf04 https://staging.drfop.org/files/original/d09c868f1688a0ecaf1d9c45b742c1e6.png aea7141fd41b96043e2bf8c7e583b38d https://staging.drfop.org/files/original/453f7876178baebff0b7b7e77820263e.png 2215c16b82603b81bd349d1814c50193 https://staging.drfop.org/files/original/11dff246699d89e686eaade91a2ea9bb.png 3828c0ac5b26e697a16be78c5dd19ca0 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/1986_01_008.pdf Text Any textual data included in the document <h2>The Biomechanics of the Foot</h2> <h5>André Bähler <a style="text-decoration: none;">*</a></h5> "The human foot is one of nature's works of art and as such, it has not yet been fully recognized and explained. It will require a deal of scientific investigation before this structure is fully understood." These words of the old master of orthopaedics, Georg Hohmann, from his book "Fuss und Bein" are still applicable today. Thirty years later, the biomechanics of the foot have still not been completely explained, and there are many questions yet unanswered. The many, more or less articulated connections of the foot allow a variety of changes which make it difficult to understand the movement as a homogeneous process. Too many factors can only be qualified, but not quantified. Nor may we forget the reciprocal influence of the position of the foot, knee, and hip joints. Each change in the position of one of these joints automatically involves a change in the position of the other two joints. For example, in the upright position, the neck of the femur forms a posteriorly open angle of approximately 20 degrees. This is determined by the anatomical factors in relation to the frontal plane of the body. The direction of the axis of the hip joint corresponds fairly accurately to the connection inner-malleolus/ outer-malleolus, which have an exterior rotation of approximately 20 to 30 degrees in relation to the frontal plane. Consequently, there is a conformity between the ankle axis and the hip axis. In the upright position, the knee is practically locked due to the automatic rotation, so the position of this axis is of minor importance. When walking, the pelvis rotates approximately 20 degrees forward. As the lower leg also rotates inwardly in relation to the upper leg during flexion, the ankle axis rotates inwardly and the foot takes up a straight position in the swing phase. <h3>Characteristics Of The Foot</h3> The foot has the characteristics of a triple axial joint which allows it to assume any position. The three main axes of movement converge in the talus area (<a href="staging.drfop.org/files/original/557b90124720a7da30c19930ed30060d.jpg">Fig. 1</a>). Particularly during rotational movements to adapt the foot to an uneven surface, all the joints are involved to some extent; nevertheless, the ankle joint, although formed as a hinge joint, forms the main joint for locomotion. According to Kapandji, the foot can be compared architectonically to a vault, which is supported by three arches. Other authors criticize this vault-concept on the basis that it is too static. However, the vault-structure is very meaningful as an aid to analyzing the foot in general (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-02.jpg">Fig. 2</a>). The arrow shows the direction and position of the main weight, which is first taken by the calcaneus (A) and then transferred to the forefoot: inside on metatarsal I (B) and outside on metatarsal V (C). The front transversal vault can also be understood as a supporting construction: on the one side the two corner stones (metatarsal I and metatarsal V) and on the other side, the transverse vault (metatarsal II, III, and IV). This construction enables the forefoot to take a great amount of weight and at the same time allows the foot to adapt to uneven surfaces. Furthermore, it can be seen that when the feet are put together, the position of both cal-canei can be regarded as a vault structure. The position of the calcaneus together with a slight valgus position serves to stabilize the body, particularly during the walking motion of the leg (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-03.jpg">Fig. 3</a>). <h3>The Joints</h3> The joints themselves pose some problems. Let us take for example the development of the inclination of the trochlea of the talus, and the distal tibial epiphyseal cartilage to the longitudinal axis of the lower leg in the frontal plane as described by Lanz Wachsmuth. Left in the infant and right in a two year old (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-04.jpg">Fig. 4</a>), it can be seen that the axes of the ankle joint and the talocalcaneonavicular joint and that of the epiphyseal cartilage are developing. In the 12 year old, left, and in the adult, right, the axis becomes horizontal during normal growth process, stabilizing the support system of the foot (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-05.jpg">Fig. 5</a>). The changes in the various process-, movement-, and development-axes of the ankle during the development of the child are probably one reason for the controversial views over the biomechanics of the foot. Biomechanically we are interested in the joints, and in particular, those used when walking. The Ankle Joint The ankle joint (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-06.jpg">Fig. 6</a>) is of particular importance, because in at least one direction it secures a movement without which it would be impossible to walk. This joint could also be described as a hinge joint with a diagonal axis of rotation, which allows a movement of about 20 degrees up and down. This inclination of the ankle joint certainly contributes to stability when carrying weight and can only be fully understood when considered in connection with the talocalcaneonavicular joint. The Talo-Calcaneonavicular Joint The movement of the talocalcaneonavicular joint is decidedly more difficult to understand. Whereas the axis of the ankle joint can easily be defined, the axis of the talocalcaneonavicular joint is drawn obliquely from lateral posterior to medial anterior. It is surprising that both articular surfaces of the talocalcaneonavicular joint are congruent only in the mid-position. An incongruence develops between the two articular surfaces by both eversion and inversion. This incongruence cannot be maintained for long periods when carrying weight. The ankle joint and the talocalcaneonavicular joint must be regarded as a functional unit. The possible movements of these two joints can be compared to a spheroid joint which can be moved freely within its range of motion: flexion, supination, pronation, abduction and adduction which in some respects corresponds to a rotation. Chopart's Joint The talocalcaneonavicular joint, comprising the talus and the navicular, and the joint which is formed from the calcaneus and the cuboid, together all form a sort of working unit. These two joints comprise Chopart's joint which allows a rotational movement of the fore-foot. Lisfranc's Joint The Lisfranc joint is a collective joint where the three cuneiform bones and the cuboid bone on the one side, and the five metatarsal bones on the other side, are united to form an articular connection. The small deflectionary movement can be described as in an obliquely situated hinge exhibiting dorsal and plantarflexion. The Chopart and the Lisfranc joints are connected by taut ligaments so that there is hardly any friction between them. They serve primarily to give elasticity to the foot during pressure and allow it to adapt better to uneven surfaces. The Transversal Anterior Vault of the Foot From metatarsal I to metatarsal V, the metatarsal bones form an oblique arch (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-07.jpg">Fig. 7</a>). This arch tends to drop due to excessive pressure, which can partly be attributed to walking on level ground. This "even" walking, which always puts pressure on the same points of the foot, leads to over-exertion of the individual metatarsal heads. The Toe Joints The toe joints are limited spheroid joints. That is, they are capable of sideways movement within certain limits, but are primarily intended as hinge joints with movement upwards and downwards. <h3>The Ligaments</h3> It is known that the structure of the foot is held together with muscles and ligaments. These ligaments are so constructed as to be able to withstand the extreme pressures exerted on the foot (long jump and high jump). <h3>The Muscles</h3> Long and short muscles hold and move the foot. If one of the muscles gives way, it is immediately visible from the gait how important the interaction of each muscle group is for locomotion. However, descriptive anatomy is not the theme here and so a further discussion of this aspect must be omitted. <h3>The Mechanics Of Depression Of The Foot</h3> Experience has shown that not every valgus of the calcaneus results in an equivalent drop of the longitudinal vault. The talipes valgoplanus is a collective term for different inadequacies which arise when the foot is under pressure. These can be classified according to different characteristics: (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-08.jpg">Fig. 8</a>) <ol> <li> The pronation position of the calcaneus; </li> <li> Inward rotation of the ankle joint; </li> <li> A forward and inward drop of the talus; </li> <li> Abduction of the fore-foot; and </li> <li> Supination, i.e., a turning upwards of the first metatarsal. </li> </ol> These five basic characteristics of the talipes valgoplanus lead to a variety of outward manifestations, which must be taken into consideration when deciding on a course of action. This wide variety is one reason why the kinematics of the foot eludes an exact biomechanical and mathematical analysis. When pressure is applied in valgoplanus, the calcaneum gives way but the fore-foot remains flat on the ground, regardless of the extent of the flexion. Congenital and ischaemic valgoplanus are exceptions to this but they are not included in the discussion here (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-09.jpg">Fig. 9</a>). Between the calcaneus, rear-, and fore-foot there is a distortion or rotation. If pressure is removed from the foot, the calcaneus falls into a vertical position, but the fore-foot then rotates to the same degree. Consequently the position of the rear-foot relative to the fore-foot remains a constant deformity (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-10.jpg">Fig. 10</a>). What then is the role of the shoe in the standing position and swing-phase? In the standing position, more pressure is exerted medially on the rear part of the shoe (the counter and the heel), depending on the extent of the valgoplanus. However, the front of the shoe remains flat on the ground regardless of the extent of the deformity. In the swing-phase, the distortion between the fore- and rear-foot influences the alignment of the shoe. If the heel is too big or badly fitting, the fore-foot dictates the position of the shoe and as a result there is an unwanted deflection of the heel of the shoe from the heel of the foot. This means that the heel-strike is lateral and as pressure is exerted, it then turns inwards and adapts to the surface whereby it has returned to the original standing position. The distortion between the fore- and rear-foot, combined with an inadequate heel counter, produces a potential risk of injury. A stone on an inclined surface can easily lead to a strained joint (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-11.jpg">Fig. 11</a>). This phenomenon is particularly significant for sportsmen and joggers who train in open country. After suffering such strains, the fear of further injury can hinder training. <h3>Deformity Of The Fore-Foot (Talipes Transversoplanus)</h3> During growth, there is a slight biomechanical change in the lateral metatarsal arch. The first metatarsal rotates pronatorally and this leads to a greater arching in adults. Congenital ligament or tissue weakness can cause this lateral arch to flatten under pressure and so result in a broadening of the fore-foot. Here, the length of the various metatarsal bones compared to the different patterns of pressure exerted on the fore-foot is of significant importance. Depending on the type of foot, the first or second metatarsal will be under greater pressure depending on which is the longer of the two. Instability between the fore- and rear-foot can also result if the inclination between metatarsal one and metatarsal five is too great. This type of foot tends to tilt sideways during the propulsion process of walking. In the case of the high-arched foot, the angle between the metatarsal and the ground increases, resulting in a greater load to the individual metatarsal heads. <h3>The Shoe</h3> From a biomechanical point of view, the shoe plays a significant part in the process of walking and standing. The height of the heel as well as the thickness of the sole greatly influence the conveyance of the weight and consequently influence locomotion itself. This sphere of influence must be duly considered, particularly in cases of static deformity. A build-up of the shoe, i.e., constructing a rocker bottom must be compensated for at the heel, otherwise the relationship between the heel-height and sole-thickness in the front of the shoe will be disturbed, thus having a negative effect on the roll-over process (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-12.jpg">Fig. 12</a>). <h3>Cushion-Heel</h3> The attachment of a cushion-heel also changes the roll-over process in that it acts as a shock absorber at heel strike and at the same time increases the roll-over (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-13.jpg">Fig. 13</a>). <h3>Heel-To-Toe-Roll For The Whole Sole</h3> A heel-to-toe roll sole can be attached to the shoe to protect the ankle joint and Chopart's joint. Measured radially from the knee, this allows a complete roll of the foot (<a href="http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-14.jpg">Fig. 14</a>). <h3>The Use Of Insoles</h3> The insole and the shoe must form a unit with the level ground. Whether the foot is neutral, in pronation or supination, is of no significance. When insoles are made of solid material, their length and shape are important. It is of particular importance with handicapped patients that the insoles are kept somewhat longer in order to reduce the risk of tilting sideways. This pronatory support, especially in the forefoot region, gives the patient a feeling of security. The correction of the talipes valgus should be differentiated from the correction of the talipes varus. With talipes valgus, the rear of the foot should be supinated and the fore-foot pronated in order to achieve a rotation of the foot. With talipes varus, this is not possible. Here, the whole foot must be pronated, i.e., the rear- and fore-foot must be included in an homogenous correction. *André Bähler André Bähler is an Orthotist/Prosthetist from Zurich, Switzerland. References: <ol> <li>G. Hohmann, Fuss und Bein, ihre Erkrankungen und deren Behandlung, Verlag von J.F. Bergmann 1951.</li> <li>J. Lang, W. Wachsmuth, Praktische Anatomie, Bein und Statik, Springer-Verlag AG.</li> <li>I.A. Kapandji, The Physiology of the Joints, Churchill Livingstone.</li> </ol> Page Number(s) 8 - 14 Year 1986 Volume 10 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_01_008/1986_01_008-05.jpg Review Status Status of review after import from old O&P Library into Omeka platform. 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Title A name given to the resource The Biomechanics of the Foot Creator An entity primarily responsible for making the resource André Bähler * https://staging.drfop.org/files/original/366a1b6eaf8bdac3bf9bcd5f96e1e444.pdf c15a1b90ec331cb4018325209aeb65ef https://staging.drfop.org/files/original/b3dc33d12739a97901cabea5ed23bb64.jpg 8e66cf5f8e78aecdf2a5e3408530f798 https://staging.drfop.org/files/original/92afbcf437362864c05cee1d9fa423c2.jpg c0d649cd24f105d7e78a3eab0426d1cf https://staging.drfop.org/files/original/0f39a6e5637d2eeb1b906bc972b06ff7.jpg a90f1c11e95d0e45be2d704ef73f3783 https://staging.drfop.org/files/original/a3d1bce9c03ac1f72a552321aa0bc80e.jpg 5061311d76421aff2b48d025e41524ac https://staging.drfop.org/files/original/869a037a5d6fd31b16b0c2f6ccbfe210.jpg a90f1c11e95d0e45be2d704ef73f3783 https://staging.drfop.org/files/original/7fb21f3f118ac4cef50e01d0f5ea9dc4.jpg 6a18a10291eac44ee2e3b2f40d37a99c https://staging.drfop.org/files/original/104394cd613cd757fc34ae6b51dfc916.jpg 0cbd76a6321d43132c8d653b6a6537d5 https://staging.drfop.org/files/original/ae525dd9f2a300f6da5093b8e9111117.jpg 5018452d2616ca984b0b8fbc9ddf3f8e https://staging.drfop.org/files/original/b0b1518c7c3d7343a5f0d147218d622b.jpg 79e8f6d9e08cb4a44e6e7bbdb9e3957a https://staging.drfop.org/files/original/05e3f4224a7bf14e0a1994fa8f1bc64a.jpg 4c431528b25733c9af6035131de80b91 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/1984_02_004.pdf Text Any textual data included in the document <h2>The Technical Aspects of the Orthopaedic Treatment of the Knee after Sports Injuries</h2> <h5>Andre Bähler <a style="text-decoration: none;">*</a></h5> The last decades have shown a marked increase in the number of people, both young and old, participating in sporting activities. As a result of systematic education and schooling, it has become generally recognized that a certain amount of physical exercise is necessary for a healthy body. The mass media—radio, television, the press—as well as schools and private insurance companies, have systematically reported the advantages to be gained by participating in physical activities. Sports are no longer the prerogative of the young; there is no age limit for those engaged in sports in one form or another. Senior citizen keep-fit groups, jogging, and the like, have proven to many older people that age is not a justified reason to neglect physical fitness, and they have become aware that exercise is a means of showing the body the respect it deserves. However, this almost revolutionary attitude towards sports is not limited to amateurs, but has also brought changes into the world of top athletes. Today, the degree of involvement is greater than ever before, but so accordingly are the associated risks. Many forms of sports seem to have lost sight of the original ideal of sportsmanship. Enjoyment and leisure have been replaced by a deadly seriousness in attitude that only total dedication will bring the desired results. Not only in the competition itself, but in the long months and sometimes years of training prior to it, the body is stretched to its utmost. Success at any price is the motto of the day, and such an attitude consciously calculates and accepts casualties and losses as part of the "game." It has been proven that this type of approach to sports results in an increase in injuries, strain, and general wear, particularly in the joints of the lower limbs. Clearly, modern sports put the knee-joint under great pressure. Be it cycling, football, skiing or ice-hockey, the movement of the knee is of central importance, as changing techniques increase the pressure put on it. The large number of knee injuries are a cause of great concern to modern sports medicine. The top athletes in particular, are anxious to start training again as soon as possible after injury. Although the knee is capable of taking great strain, mobility is often restricted, either by external injuries, or because of wear within the joint itself. Immobilization of the joint after injury or surgery can damage the cartilage, hindering the assimilation of nutrients. The ligaments begin to lose their tensility, there is a loss of coordination between muscle groups, and muscles atrophy. Finally, immobilization of a limb also affects the whole organism, particularly circulation, respiration, and the digestive system, and last but not least, the psychological effect of immobilization should not be underestimated. Controlled movement of the knee-joint after ligament surgery has great advantages during rehabilitation: movement between 20-60 degrees does not strain the collateral or cruciate ligaments to any degree. The muscles are also activated within pre-controlled limits. In tests, Hettinger found that 20-30 percent of the maximum pressure was sufficient to retain normal muscle strength. However, in order to increase muscle strength, the pressure must be at least 40-50 percent, and this is not possible after surgery. Therefore, rehabilitation requires electro-stimulation. A pre-condition of functional treatment is the exact restoration of all the anatomical elements, (e.g. cruciate and collateral ligaments). <h3>Rehabilitation Phases</h3> Pre-operative Treatment When reconstructive surgery is required in the case of an old injury to the knee, the time before the operation should be used to improve and retain muscle strength, for coordination exercises, and to instruct and explain the postoperative treatment Post-operative Treatment Day 1: For the rest period, the leg should be held in a preoperative prepared plaster-splint with a flexion angle of 20-30 degrees. Day 5: A knee-orthosis with a 20-50 degree range of movement is fitted and a gentle swinging movement is allowed. The orthosis is also worn in the pool but the injured leg should not actually be used for swimming. Rehabilitation at this stage should also include controlled extension and flexion exercises between 20-60 degrees and isometric quadricep training. Fifth to sixth week: Flexion and extension exercises from 0-90 degrees should be practiced. For walking, the orthosis must be locked in extension with the swiss-lock. After eight weeks: The lock can be removed and the patient may be allowed to walk with free movement of the joint. The orthosis is usually worn for approximately one year. <h3>The Principles of Fixation and Correction with the Orthosis</h3> Both the upper and lower leg must be securely held all round. If necessary, support at the thigh is given on the same principle as a prosthetic support. If the upper and lower leg are kept straight, then it is best to use a physiological (polycentric, Ed.) knee-joint. However, if the securing bands of the orthosis are made of rubber or a similar material, then a simple single-axis knee-joint is sufficient. Besides the above mentioned points, the orthosis for post-operative rehabilitation after ligament reconstruction must also exhibit the following characteristics: <ol> <li> The program of correction or fixation must be exactly determined in advance. </li> <li> The upper and lower leg must be securely held in the orthosis. </li> <li> The construction of the joint must allow for varying ranges of mobility: <ol> <li> 20-50 degrees </li> <li> 0-90 degrees with the option of a locking device </li> <li> 0-120 degrees with free movement. </li> </ol> </li> </ol> <h3>Procedure to Relieve the Medial or Lateral Ligaments</h3> Principle: Triple-point correction (<a href="/files/original/b3dc33d12739a97901cabea5ed23bb64.jpg">Fig. 1</a>) <a href="/files/original/b3dc33d12739a97901cabea5ed23bb64.jpg">Figure 1</a>. Triple-point correction to relieve the medial or lateral ligaments.  The principle underlying the triple-point correction, forms the basis for efficient correction of genu varum or genu valgum. With young patients, it is possible to position the correcting pressure-pads exactly, but with older patients, because of the flaccid tissue, pressure must be applied over as large an area as possible, e.g., with splints which distribute the pressure equally. For technical as well as anatomical reasons, it is often not possible to apply pressure at the centre of the joint itself, therefore pressure must be applied above and below the joint, but as near to it as possible. If the splints do not fit securely, then the orthosis will twist inwards when bent and this results in a reduction of the correcting forces at extension. <h3>Procedure for Controlling the Posterior Drawer</h3> Principle: Posterior pressure on the proximal lower leg and anterior pressure on the distal upper leg (<a href="/files/original/92afbcf437362864c05cee1d9fa423c2.jpg">Fig. 2</a>) <a href="/files/original/92afbcf437362864c05cee1d9fa423c2.jpg">Figure 2</a>. Controlling the posterior drawer. There are two biomechanical procedures to choose from: <ol> <li> Fixation of the upper and lower leg with the orthosis on the basis of the triple-point method. With this method, the splints are fitted individually to the upper and lower leg and the correcting pressures are placed so that a posterior drawer is held firmly. </li> <li> Placing the correcting pressures in such a way that together with the knee-joint of the orthosis, they act as a lever. Here too, it is advantageous to distribute the pressure over as large a surface as possible (<a href="/files/original/0f39a6e5637d2eeb1b906bc972b06ff7.jpg">Fig. 3</a>). <a href="/files/original/0f39a6e5637d2eeb1b906bc972b06ff7.jpg">Figure 3.</a> An alternative approach</li> </ol> <h3>Procedure to Correct the Anterior Drawer</h3> Principle: Anterior pressure on the proximal lower leg and posterior pressure on the distal upper leg This involves, first, the fixation of the upper and lower leg with the orthosis on the basis of the triple-point principle (<a href="/files/original/a3d1bce9c03ac1f72a552321aa0bc80e.jpg">Fig. 4</a>), and second, placing the correcting pressure so that together with the knee-joint of the orthosis, they act as a lever. The greater the distance between the knee and the external counter-pressure, the better the corrective effect (<a href="/files/original/869a037a5d6fd31b16b0c2f6ccbfe210.jpg">Fig. 5</a>). <a href="/files/original/a3d1bce9c03ac1f72a552321aa0bc80e.jpg">Figure 4</a>. Fixation of the upper and lower leg.  <a href="/files/original/869a037a5d6fd31b16b0c2f6ccbfe210.jpg">Figure 5</a>. Increase the distance between the knee and the external counter-pressure <h3> Restricting Rotation</h3> The restriction of rotation depends on how well the orthosis fits the upper and lower leg. The efficiency of the orthosis in restricting rotation is determined less by the type of orthosis, than by the size and type of the surface area of support. In practice, the following points must be checked: <ol> <li> Any fixation of the knee-joint must conform to the principles of biomechanics. </li> <li> The orthosis and all bandages should cover the leg properly to ensure that the orthosis does not slip. </li> <li> The orthosis must fit so as not to hinder or limit muscle activity. </li> </ol> As we found that the orthotic devices available at present did not completely satisfy our needs, we devised a system of our own which we would now like to explain with the help of some photographs. <h3>Type I: Sport Orthosis for Old Injuries to the Knee, or for Instability of the Joint</h3> In order to keep the reduction in fitness to a minimum, the athlete aims to return to training as soon as possible. However, the knee is often not strong enough to cope with the high demands made upon it and needs some form of support, without however, limiting the range of movement. This orthosis guides the joint and eliminates the forward and backward drawer as well as movements to the side (<a href="/files/original/7fb21f3f118ac4cef50e01d0f5ea9dc4.jpg">Fig. 6</a>, <a href="/files/original/104394cd613cd757fc34ae6b51dfc916.jpg">Fig. 7</a>, <a href="/files/original/ae525dd9f2a300f6da5093b8e9111117.jpg">Fig. 8</a>). If necessary, it can also be fitted so as to restrict all extreme movements. The half-splints of the orthosis are made of the new Plexiglass XTO (natur) by the Röhm Company (Darmstadt 1). This material is much tougher than the well-known Plexidur. It is easy to form, and locks can be fitted to the joints without first having to be strengthened. In order to stop the splints from slipping, they are lined with a thin layer of foam-rubber. The best results are achieved when the orthosis is formed from a plaster model of the leg. <a href="/files/original/7fb21f3f118ac4cef50e01d0f5ea9dc4.jpg">Figure 6.</a> The sport orthosis eliminates forward and backward drawer.  <a href="/files/original/104394cd613cd757fc34ae6b51dfc916.jpg">Figure 7.</a> The orthosis can be fit to eliminate all extreme movements.  <a href="/files/original/ae525dd9f2a300f6da5093b8e9111117.jpg">Figure 8.</a> The half-splints are made of Plexiglass XTO. <h3>Type II: Orthosis for Operative Ligament Reconstruction, or Other Similar Serious Knee Injuries</h3> Basically the same orthosis is made as in Type I (<a href="/files/original/a3d1bce9c03ac1f72a552321aa0bc80e.jpg">Fig. 4</a>, <a href="/files/original/869a037a5d6fd31b16b0c2f6ccbfe210.jpg">Fig. 5</a>, <a href="/files/original/7fb21f3f118ac4cef50e01d0f5ea9dc4.jpg">Fig. 6</a>) but with the difference that a lock and positioning-screw are fixed to the outside of the splint (<a href="/files/original/b0b1518c7c3d7343a5f0d147218d622b.jpg">Fig. 9</a>, <a href="/files/original/05e3f4224a7bf14e0a1994fa8f1bc64a.jpg">Fig. 10</a>). As already mentioned, the positioning screw allows a movement between 20-60 degrees. After a while, this can be removed and the lock used to hold the leg in extension. <a href="/files/original/b0b1518c7c3d7343a5f0d147218d622b.jpg">Figure 9</a>. A lock and positioning screw are fixed to the outside of the splint. <a href="/files/original/05e3f4224a7bf14e0a1994fa8f1bc64a.jpg">Figure 10</a>. The positioning screw allows movement between 20-60 degrees.  Depending on the injury, the half-splints are placed either at the front or at the back of the upper and lower leg. Securing straps and pressure-pads increase the corrective effect. *Andre Bähler Andre Bähler is an Orthotist/Prosthetist from Zurich, Switzerland. <div style="width: 400px;"></div> Page Number(s) 4 - 7 Year 1984 Volume 8 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-02.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-05.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/1984_02_004/1984_02_004-06.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-03.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1984_02_004/1984_02_004-10.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 Technical Aspects of the Orthopaedic Treatment of the Knee after Sports Injuries Creator An entity primarily responsible for making the resource Andre Bähler * https://staging.drfop.org/files/original/b55c999f394c95f22da4376f0a7fd130.pdf 5101740961929f47b6d05aa1fc10398e 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/1980_01_002.pdf Text Any textual data included in the document <h2>Guest Editorial: Of Prosthetics And 1980</h2> <h5>Anthony Staros <a style="text-decoration: none;">*</a></h5> The survey of prosthetics components shown in this issue yields conclusions mostly related to above-knee amputees, as indicated in the text associated with Tables I and II. Fortunately more lower-limb amputations today are below-knee, so one really cannot tell much about trends in prosthetics practice from these data except to note that the SACH foot is indeed a success. This however should not make us complacent about this design, for we should never be happy with anything that we have in prosthetics. Our objective should always be constant improvement. As suggested, data are needed on below-knee fittings to give us a better impression of the state of lower-limb prosthetics today. Surveys of suppliers will show little; needed are data from the fitters of the country. Many of you know that the support of the VA Research Program of the University of California at Berkeley and San Francisco many years ago yielded the crucial bio-mechanical parameters in lower-limb amputee prosthetic service associated with fit and alignment. But never to be overlooked as very significant to service is the "tender loving care" and the training provided to the patient by the emphatic prosthetist. In any case, components although secondary are still important. But clearly recognized is the need to get the prosthesis properly interfaced and the amputee motivated. Perhaps a survey covering rotators might produce helpful data about how these have been used to reduce fitting problems by the diminution in shear stresses. The post-World War II education program has been primarily based on the teaching of the biomechanics and techniques of fit, those of alignment and to some extent but a lesser one, teaching about components. Even though these are of lesser importance, have we overlooked some essentials? <h3>On Prosthetic Knees.</h3> We really don't fault the survey, but recognize its limitations. It nevertheless does show that for above-knee knee joints at least there may be some lapses in the teaching of prosthetists, in the teaching of other members of the clinic team and most importantly, in orienting the administrators representing third party payers. Perhaps the low number of hydraulic knees (as a %) can be attributed to the larger percentage of amputees who are geriatric. But aren't these supposed to be mostly below-knee amputees these days? Not to be overlooked is the value of properly selected hydraulic knee mechanisms for certain cases. The selection of large numbers of "safety" knees is noted; but isn't it that clinic teams seem to get hooked on these, not trying others, or perhaps they have become disillusioned with price or maintenance burdens? Today, the safety knee is the unit of choice but we wonder whether even these are being used properly. For example, are they in fact being used to exploit the value of the stance phase characteristics in initiation of swing phase? Are the alignments such that one provides more "trigger" for initiation of knee flexion? The low numbers for polycentric knees bother us. If properly understood, some of the polycentric knee systems can be very beneficial in providing improved function to amputees with very short above-knee residual limbs and those with very weak hip musculature. How about their use in geriatrics? Are indeed the polycentrics really understood? Are those that are being used being fitted and aligned properly? Do clinicians really understand the real values of the polycentric systems? The system developed at the Orthopaedic Hospital, Copenhagen for example, can be used not only for end-bearing above-knee amputees but can also be applied for shorter amputation levels. The University of California at Berkeley is now developing other improvements in polycentric systems; we hope to see some of those soon presented through manufacturers. Unfortunately we sense that clinics tend to adopt particular "pet" knee mechanisms or pet prescriptions. We worry that for various reasons (valid?) the full range of knee mechanisms has not been given a complete trial. Our publications have tried to get the information across about the pros and cons of each system. Perhaps we have failed. For example, some of the rehabilitation achievements we have been able to make in our own clinic with the hydraulic knees are in fact extraordinary. Alongside the other important factors, the Mauch SNS in particular has been a boon to many of our above-knee amputees, particularly bilateral cases we have had from the Viet-Nam conflict and some Israeli cases from the October (Yom Kippur) War which were referred to us. <h3>A Case in Point</h3> One interesting case from Viet-Nam, a bilateral above-knee amputee, not only now sky dives but snow skis and disco dances on his above-knee prostheses, both with SNSs. This gentlemen has personal drive and motivation; he was an athlete before he was wounded, but now and this is important, he has been given the "tools" in those knee mechanisms: tools which can be used by him to achieve activity levels to which some of us nonamputees could aspire. Here, the SNS provided the wherewithal; matching these with the man's motivation and well-fitted sockets properly aligned, we were able to provide what can be considered a maximum degree of rehabilitation. This is not an isolated case. There have been many people fitted with the SNS and with others that are spin-offs of this design. We in the Veterans Administration put money into these developments, and we continue to purchase them because we have confidence in them. And our patients do. The problem is that others don't. Perhaps primary cost and maintenance experiences detract. But more so, other third party payers do not or cannot value these units as we do for our service-connected amputees who we believe deserve no less. <h3>How about Modular Systems?</h3> We are concerned about the low percentage of modular systems used. Less than one in four are shown. But these, in this survey, are directly linked to above-knee and higher amputations. Again, the geriatric amputee experiences and thus the more common below-knee amputation levels are not reflected. For these, modular or endoskeletal systems may be used most commonly, more than the rugged, heavier crustacean systems of wood and the like. We hope at least that more and more lightweight below-knee prostheses either using endoskeletal systems or polypropylene would be used to the benefit of this group of amputees. <h3>Finally, on Research and Development</h3> The component survey also doesn't really indicate anything about the needs for research and development. Inferred are some gaps in our link with the prosthetist and the clinic team mainly in the channels of information flow about all kinds of hardware. But one cannot draw too many conclusions. We are pleased to inform you that the National Amputation Foundation with the assistance of Dr. Jerome Siller of New York University has now nearly completed for the VA Prosthetics Center a nation-wide survey of 900 service-connected veteran amputees. Provided from this survey will be data about prosthetic, medical, surgical, employment and psychosocial experiences and statuses of veterans from all wars since and including World War II. We expect the investigators to give a report at the 1980 World Congress of ISPO to be held in Bologna, Italy. From this, we expect to have some significant directions for research and development. On this matter of research and development, it seems to us that as soon as you become extremely successful with a particular item you might look at it again to see what you can do to improve on it. Besides more durable SACH feet more functional types of foot-ankle systems seem needed. Are there ways, for example of achieving the same function with less complexity than presented in the current "universal" ankle joints? There appears to be no need to focus again on knee joint development; we would seriously worry about a further proliferation of new knee mechanisms. A few research groups are working on EMG control of valves on hydraulic knees, to produce voluntary control of knee function. This we can accept as long-range. You should also know that Federal support of research and development in prosthetics and orthotics (our own Center's deemphasis is an example) has been decreased to some extent. We do assist in evaluations; we do a little bit of development, primarily as a result of case presentations in our clinics, but we offer no great effort in prosthetics and orthotics development at this time; we have diverted scarce resources to attack the problems of the very severely handicapped: the spinal cord injured, the blind, the non-vocal, and the cumbersome complexities of the debilitated aged. So there'll be no mistake, know that we're still involved in prosthetics and orthotics, but we honestly believe that prosthetics and orthotics development has come a long way. We in the VA believe we have done much to contribute to this process, especially in funding projects around the country. We have also had our own laboratories involved. But now with a mature profession in place, these responsibilities can be carried primarily by the professional with the Government only assisting when necessary. The manufacturers as a group are certainly participating in development, evaluation, and even in training. Outstanding examples are several in the United States and those from Europe who have done an extremely good job in making the quality and function of components of high quality. And the competition among them has been welcomed by us. We think that the prosthetics (and orthotics) professional especially when it comes to process and device development is contributing enormously. Therefore the Government can turn its attention to that which the private sector cannot economically handle. But we always will be ready to help. *Anthony Staros Director, VA Prosthetics Center New York, N.Y. 10001 Page Number(s) 2 - 4 Year 1980 Volume 4 Issue 1 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 Guest Editorial: Of Prosthetics And 1980 Creator An entity primarily responsible for making the resource Anthony Staros * https://staging.drfop.org/files/original/9efbf424d1bfe2b5b84fe13f0d2fd516.pdf 0bcf1c41627ab178388a24b6e69db174 https://staging.drfop.org/files/original/9811319d59776c370a44ed906f991cfd.jpeg 00380d4a6a0059f69700b9ea0c517dc3 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/1981_04_001.pdf Text Any textual data included in the document <h2>Rehabilitation Engineering and Prosthetics/Orthotics</h2> <h5>Anthony Staros, MSME, PE <a style="text-decoration: none;">*</a></h5> The words "Rehabilitation Engineering" are now commonly used to mean a paramedical practice which in its job characteristics and their demands, in the basic technical background needed, in its high activity level, and in its human service slant, is an extrapolation of professional prosthetics and orthotics. Prosthetics and orthotics are in fact very significant components. Rehabilitation engineering is defined as that broad discipline having as its ultimate objective the application of technology to enhance life's quality for the disabled. It includes subsidiary goals in research, development and education. But one doesn't need to be an engineer to practice rehabilitation engineering! With the recent advances in technical aids, prosthetics and orthotics included, there has been increasing need for those who currently serve the disabled with technology to expand the range of their commitment requiring a persistent demand for more knowledge. At the same time, there are counterpressures:—the potentially harmful low rates of increase in the numbers of practitioners. Fewer people are trying to do more while also needing more information for what they do. The effects that Government budget restraints will produce in this situation are difficult to predict, but clearly seen is that the pressures will be greater, that there will be real need for increased efficiency in all parts of society and more so for us committed to the delivery of high quality service to the disabled: increased productivity and more knowledge are conjointly required. Much of what rehabilitation engineering means in real practice is the selection of devices, the making of special systems, or the design of environments, and then the delivery of these, customizing them even further when necessary, and applying them to assist the disabled. Demanded is the achievement of independence through function and/or access with both comfort and control maximized. Training of the client is essential. These efforts are effected in a precise and deliberate process with full understanding of the patterns of disability presented and a substantial awareness of the personal wishes of the disabled person being served (and his/her family). Rehabilitation engineering includes aids fitted directly to the client as in prosthetics and orthotics, tools such as communication devices, and adaptations to environment, to work sites, to the home, or to the vehicles used to reach one or the other or to those mobility devices operated within an environment. Some of the technical aids may be very simple in design; most of those which are custom-made require biomechanically sound, creative, and often inventive approaches. The simplest may require the most creativity. In the rehabilitation engineering applications process, in supporting the physician's role in prescription or in the selection of aids and then in their application, the knowledgeable and interested prosthetist, orthotist, and therapist (physical, occupational, speech) can play the key roles. Especially productive and cost effective is the involvement of the skilled technician, an essential member of the rehabilitation engineering team. The team concept is crucial in that the knowledge needed comes out of the sharing of training and experience—and the creativity sought can usually come from the synergism in the group, especially including the client. The actual "making" although involving all to various degrees becomes the special province of the technician, with the "fitting" itself being a product of the team. The required contribution to benefit the patient will be a scenario of analysis and synthesis, idea and response, search and research, give and take, and then plain work. That which is rehabilitation engineering has been performed for many years, before it became stylish to use this expression to represent a special technology. But there is now in place an acceleration in the development of new technology in products and processes, many so recent that they are not known to members of the rehabilitation team who received preparatory training or post-graduate courses years earlier. Even now the newer information needed is not obtained in structured formats. Pathways should be constructed for each member of the team to broaden his/her own discipline to include constantly updated knowledge about all technology necessary for his/her personal professional contribution to the rehabilitation engineering team. And not to be overlooked is that the payers for services need to be instructed on the cost benefits of rehabilitation engineering. We recommend that these professionals (the prosthetist, orthotist, and therapist) have their own societies' publications and conferences include the information about the advance in rehabilitation engineering. They should also participate in those societies which meld the team, the Rehabilitation Engineering Society of North America and the International Society for Prosthetics and Orthotics, thereby advancing the practice of rehabilitation engineering through contacts with the other team members. Special seminars need to be structured for the 3rd party payers. In the team, or even in the individual practices, the added knowledge about rehabilitation engineering aids can only benefit. If the prosthetist or orthotist fitting a patient with an upper-limb deficit relates his fitting in part to the vehicle controls the disabled person may need to use, shouldn't he or she be knowledgeable about such controls and their installation? Beyond that, shouldn't both (prosthesis or orthosis and control) be "installed" under such professional supervision? Yet still, in this decade of rapidly advancing technology and of certification of those who dispense it, ordinary automobile repair garages install hand controls for licensed vehicles for disabled drivers. Why not the orthotist or prosthetist overseeing his/her technician? There are often frustrating limits to the mobility which can be provided in lower limb orthotic or prosthetic care. Under what circumstances does one use a wheelchair as a supplement or as a last resort? How is it selected? In what way should it be modified if at all? What kind of buttock and trunk support are required? Here the prosthetist, the orthotist, and the therapist should be involved for aren't these the professionals who can be and should be closely associated with wheelchair prescription and modification? In a national workshop held in 1978, WHEELCHAIR I,<a style="text-decoration: none;">*</a> mention was repeatedly made about the need for a "wheelchairist", a person to be concerned exclusively with wheelchair prescription and fitting. If prosthetists, orthotists, and therapists are indeed responsible for other aids for mobility, why not then the wheelchair? Isn't a functioning rehabilitation engineering team the "wheelchairist" sought? From the clinic team setting or from the counselor's desk, the usual site for the final selection and customization of technical aids and then their application is not unlike a prosthetics/orthotics laboratory, there blessed with talented technician support. In a recent paper,<a style="text-decoration: none;">*</a> we recommended that the prosthetics/orthotics profession develop the practice of rehabilitation engineering: "Recommended is that prosthetics and orthotics, with their foundation in clinical technology, constitute the basis for the establishment and certification of a broadly based rehabilitation engineering capability in the United States. Indeed, it would be well for prosthetists and orthotists to start expanding their scope to include the other technical aids in rehabilitation engineering and in collaboration with other members of the rehabilitation team, especially the orthopedic surgeon, provide the means for a wider coverage in the delivery of technology to restore independence and function to many handicapped individuals who are not now receiving the full, broad spectrum services they deserve." <a href="/files/original/9811319d59776c370a44ed906f991cfd.jpeg">Figure 1</a> Is there then really need for the engineer, the graduate of a formal engineering curriculum to be the applier, the "clinical" practitioner of rehabilitation engineering? The rehabilitation engineer has a role: in design, development, research, and perhaps in management. The prosthetist, orthotist and therapist especially with technician support, as a team and as individuals can and should respond to the total technical needs of the patients presented to them; rehabilitation engineers should identify with the other (consulting) members of the medical-technical professional structure in the overall rehabilitation effort. To be called on only in the case of special, more complex problems, the engineer should be mostly involved in leading generalized design and development efforts, these to include others of the team as well. Total need, as the prosthetist, orthotist, and therapist well know, includes "tender loving care," this in the past demonstrated by the experiences of these professionals in analyzing then defining the problems of the disabled. For patients with the severer disabilities, those requiring broader rehabilitation engineering efforts, good practice requires more of such empathic yet deliberate reasoning to seek solutions: devices which yield function in a real sense and are more than just tolerated, used for their novelty, or accepted to please someone else. Seating, wheelchair designs, licensed vehicle modifications, electrical stimulation for pain relief or function, and home and job modifications are all parts of an armamentarium which spans the spectrum from modifications to the shoe to those to the motorcar, for mobility; from a mouth stick to a robotic system, for independent "prehensile" function; from a simple word-display board to synthetic speech, for communciation. Then, do we really need to cultivate large numbers of graduate engineers for rehabilitation engineering practices (other than for the employment of some smaller number in research and development)? Yes, if the prosthetist/ orthotist does not accept the alternative recommended: proper management of his/her practice integrating it with those of other team members and with the very significant role of their skilled technicians who become key constituents in that practice. Apparently some prosthetists and orthotists see an expanding future. The excellent document describing the professions of prosthetics and orthotics and recently published by the American Academy of Orthotists and Prosthetists<a style="text-decoration: none;">*</a> refers to the directions being taken by its professions, based for now on "bionics" referring specifically to automatic control of knee function and myoelectric control of powered upper-limb prostheses. These are presented as steps toward encompassing more and more technology, components of a rehabilitation engineering commitment. In fact the logo of this publication (shown here) presents the transition from orthotics and prosthetics to rehabilitation engineering over a natural pathway (or track) for growth. The essential initiatives now have to come from the current practitioners. In fact they could also abdicate their "clinical" role to the rehabilitation engineering equipment dealers! FootnoteThe Academy brochure can be ordered from the National Office for $1.25 each. Footnote Staros, A. and G. Rubin, The Orthopedic Surgeon and Rehabilitation Engineering in Orthopedics, March/April 1978, Volume 1/Number 2, Charles B. Slack, Inc., Thorofare, N.J. Footnote Moss Rehabilitation Hospital (REC) Wheelchair I; Report of a Workshop sponsored by RSA and VAPC, Dec. 6-8, 1977, Philadelphia, Pa. *Anthony Staros, MSME, PE Director, VA Rehabilitation Engineering Center New York, N.Y. <div style="width: 400px;"> </div> Page Number(s) 1 - 3 Year 1981 Volume 5 Issue 4 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/1981_04_001/1981_04_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 Rehabilitation Engineering and Prosthetics/Orthotics Creator An entity primarily responsible for making the resource Anthony Staros, MSME, PE * https://staging.drfop.org/files/original/7726a0b6d065fcfc2a69ee0f0fbdd82a.pdf aaecbd42a917de5b36eeb049f73ef608 https://staging.drfop.org/files/original/907b3b60ab891d2c062f4ceb5bb2af8d.jpg 31530cab1a56fffba73f07af39b2d077 https://staging.drfop.org/files/original/3a4e9c51a778e57578a9fabe571b7158.jpg c30f2899c6c3b59f9ad0d33d8b10c9bf 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/1986_02_090.pdf Text Any textual data included in the document <h2>Technical Note: The Soft Socket</h2> <h5>Arthur Forman, B.S., M.A. <a style="text-decoration: none;">*</a></h5> <h3>Introduction</h3> Oftentimes we are presented with an above-knee amputee who poses difficult problems for a successful prosthetic fitting. Some of these problems include advanced age, atrophy, trigger points, bony prominences, surgical implants, cardiopulmonary problems, short residual limbs, and other complications. Any one of these conditions might make for a difficult fitting, but any combination of these could contribute to an unsuccessful fitting, or a situation which precludes ambulation. It is my contention that given the current generally accepted practices and when presented with an involved patient as indicated above, we are doomed to failure, in terms of comfort and ambulation. Further, it is my contention that very often, although these patients may be confined to a wheelchair even after prosthetic fitting, it is of paramount importance that they be fitted as comfortably as possible. Although they have lost a limb, they may be just as motivated as any other patient and can suffer psychological stigma. Therefore, it is our duty as prosthetists to provide a prosthesis that will allow these patients to ambulate as much as possible, resulting in both psychological and physical benefits. <h3>Soft Socket Rationale</h3> As we all know, the quadrilateral above-knee socket was originally designed and fitted for World War II traumatic amputees. They were fairly young, usually with no other complications, good musculature, and in many cases of long length. Today we are faced with a high geriatric amputee population with conditions quite different than the World War II veteran. The quadrilateral above-knee socket design impinges directly on the neurovascular bundle in the area of the Scarpa's triangle. The posterior seat area bears directly on an anatomical area which is usually atrophied to the point of being uncomfortable. These features alone call into question the viability of the quadrilateral design when considering an involved patient as described previously. The soft socket design as described, owes its inception to the CATCAM design. The soft socket is almost an exact anatomical negative duplication of the residual limb without extreme scarpas impingement and without concentrated ischial weight bearing. It is lined with 1/2" thick Plastizote, or similar forgiving material that enhances soft tissue bearing, hence "soft socket." It is compatible with all existing above-knee components, far more cosmetic, aligned using current practices, and is fabricated only in a slightly different fashion. Also, it will allow the amputee to ambulate in a comfortable non-restrictive manner. <h3>Case Study</h3> A seventy-six year old man was presented for prosthetic fitting. He was a traumatic amputee who had lost his leg during the Korean War and was left with a four inch length femur. He had been wearing an exoskeletal system with an hydraulically controlled knee, conventional quadrilateral socket, hip joint, and pelvic belt. The prosthesis weighed approximately 13 pounds. The lateral wall of the socket was modified at mid-femoral length to impinge on the femoral shaft. The patient had recently undergone surgery to repair a fractured femoral head on the amputated side due to a fall. He had also recently developed emphysema and had lost a significant amount of weight. During weight bearing on the sound leg, he exhibited extreme fatigue and loss of breath. Despite these contraindications to prosthetic fitting, he expressed great motivation. I proceeded with the standard impression technique using the Berkeley brim. The patient experienced discomfort while suspended in the Berkeley brim. He indicated specific areas of discomfort including the ischial/gluteal area and the lateral femoral area. This continued despite angular adjustments to the brim. An impression was taken. Upon examination of the impression and after discussion with colleagues, it was decided that a conventional fitting would not work. After mulling over the situation, it was decided to hand wrap a new impression, while the patient laid on his sound side. This was done in a very particular way, encompassing the gluteals, and hand forming the medial and posterior wall. A very anatomic impression was obtained. Modification was minimal and consisted mainly of smoothing up and adding a layer of 1/2" Plastizote (<a href="http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-1.jpg">Fig. 1</a>) after lamination. The prosthesis weighed 7 1/2 pounds. This included a modular safety knee, extension assist, hip joint, pelvic belt, foam cover, foot, and shoe (<a href="http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-2.jpg">Fig. 2</a>). The patient has been wearing this prosthesis and is quite satisfied. <a href="http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-1.jpg">Figure 1.</a> The Berkeley brim above the AK prosthesis with hip joint and pelvic band. Note presence of Plastazote pad in the ischial seat area. <a href="http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-2.jpg">Figure 2.</a> The completed prosthesis. <h3> Conclusion</h3> It is my belief that we, as prosthetists, should approach our patients as individuals and if necessary, modify or completely discard commonly accepted techniques in order to successfully fit the uncommon patient. We should continue to examine our techniques in order to upgrade our profession and better serve the community. <h3>Acknowledgments</h3> Kevin S. Garrison, CP., Mahnke's Prosthetics-Orthotics, Inc., Fort Lauderale, Florida; Joseph Leal, C.P., Custom Prosthetics of Tucson, Arizona; John Sabolich, C.P.O., Sabolich, Inc., Oklahoma City; Thomas Guth, C.P., R.G.P. Orthopedic Appliance Co., Inc., San Diego, California; Ivan Long, C.P., Polycadence, Inc., Arvada, Colorado; Timothy B. Staats, C.P., Director of Prosthetics, education training programs, UCLA. *Arthur Forman, B.S., M.A. Arthur Forman, B.S., M.A., is a prosthetist formerly with Mahnkes Prosthetics and Orthotics, Inc., 1915 N.E. 45th Street, Fort Lauderdale, Florida 33308. Page Number(s) 90 - 92 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_090/1986_02_090-2.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 Technical Note: The Soft Socket Creator An entity primarily responsible for making the resource Arthur Forman, B.S., M.A. * https://staging.drfop.org/files/original/2a26fa46a936952d7346630a4fddeb3b.pdf 9bf1d7ad81311e350ca58227aa8ef3e4 https://staging.drfop.org/files/original/fd60ab108fc04d3ee3243e19fd78a73d.jpeg 12316de41cb85404fa07f030884d0bbd https://staging.drfop.org/files/original/b22d12eeac67c882c1a6ee06ab860780.jpg 5c959a25cd8c901d6983309deb9ae306 https://staging.drfop.org/files/original/7555fd7f9d24bef41fe4b95c8c319ccf.jpg aa82aa97958a91904276e94a5b918415 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/1983_03_005.pdf Text Any textual data included in the document <h2>Some Comments on Cervical Orthoses</h2> <h5>Augustus A. White, III, M.D. <a style="text-decoration: none;">*</a></h5> The following was received past the deadline for the Spring C.P.O., for which it was intended. Because of the interest in the subject it addresses, we are printing these comments here. Anyone wishing to respond to the points the author raises may do so through letters to the editor. Our thanks to Dr. White for submitting his editorial. The Editor <h3>Introduction</h3> A classic history on the development of orthopaedic appliances, including some interesting material on cervical orthoses, has been written by J. W. Edwards (1952). A reading of this work quickly illustrates that many orthotic devices bear a striking resemblance to components of medieval armor. Particularly prominent in cervical orthotics is the work of Hugh Owen Thomas. This ingenious, chain-smoking, nineteenth century inventor developed a number of useful orthopaedic appliances, and is credited with the basic design of the cervical brace used today and known as the Thomas cervical collar. <h3>Functions of Cervical Orthoses</h3> Any cervical orthosis is really a device designed to apply forces to the cervical spine in order to control it in some way. The goal of that control is usually support, rest, immobilization, protection, or correction. The application of the forces restrains the normal or abnormal patterns of movement or alignment of the cervical spine. When the goal is to rest the spine, the device must assist or substitute for stabilizing muscle action. For example, a cervical collar may be used to prevent extension into a range that is painful or irritating to the patient. In another instance, the purpose of the orthosis may be to protect the vital spinal cord or nerve roots. This would be required when the spine has been rendered unstable by tumor, disease, surgery, or injury. A cervical orthosis can also function simply as a reminder and psychological "support." When the patient moves, he or she is made aware of the brace and therefore voluntarily restricts motion. In addition, the orthosis may provide warmth and physical support that is reassuring to the patient. After the physician makes a diagnosis, and elects to treat a particular problem with a cervical orthosis, it is helpful to identify the specific mechanical functions that are to be achieved with the orthosis (see Table I). Is the goal to support (rest), immobilize (protect), or correct the spine? It is helpful for the clinician to go through the process of determining which of various motions of the spine must be controlled. Is it flexion, extension, lateral bending, axial rotation, or some combination of these? By thinking through these questions, a more rational and precise orthotics selection can be made. Table I. Systematic Analysis for the Selection of Orthoses <h3><img src="/files/original/fd60ab108fc04d3ee3243e19fd78a73d.jpeg" h3="" width="418" height="327" />Orthotics Evaluation Studies</h3> Before discussing examples of cervical orthotics, it is helpful to review briefly the experimental work upon which we base our clinical recommendations. In-vivo cineradiography studies by Hartman and colleagues evaluated the effectiveness of immobilization of various orthotic devices on the cervical spine (Hartman et al. 1975). These studies compared five different cervical orthoses (Findings are shown in Table II). The investigators concluded that the motion that was most difficult to restrain was that between the occiput and C2. Table II. Effectiveness of Cervical Spine Orthoses in Immobilization* <img src="/files/original/b22d12eeac67c882c1a6ee06ab860780.jpg" p="" width="568" height="192" /> An evaluation of cervical braces by Johnson and colleagues placed normal subjects in different orthotic devices Johnson et al. 1977). Photographs and radiographs were used to determine differences in range of motion with and without the subjects wearing various orthoses (Findings are shown in Table III). It was found that by increasing the vertical length and the rigidity of a given cervical orthoses, there is improvement in its ability to control motion. In general, it was found that controlling lateral bending and axial rotation is more difficult than controlling flexion/extension. The most effective conventional braces are able to restrict C1-C2 flexion extension by only 45% or normal. The halo apparatus restricts the motion by 75%. Table III. Efficiency of Cervical Braces in Immobilization* <img src="/files/original/7555fd7f9d24bef41fe4b95c8c319ccf.jpg" p="" width="422" height="254" /> In summarizing this experimental data, the following generalizations are valid. The soft collar does little in the way of immobilizing the cervical spine. The rigidity of the components at the chin and the occiput are the main elements in restricting motion. As one adds shoulder or thoracic fixation to the various conventional cervical collars, the immobilizing capacity of the orthosis is increased. When the added chest support is actually fixed to the thorax, the immobilizing efficiency is further improved. <h3>Clinical Review of Some Specific Cervical Orthoses</h3> To follow is a review of the major types of cervical orthoses. They are categorized on the basis of effectiveness of control. Thus, we have divided cervical orthotics into minimum, intermediate, and most effective control (Table III). Minimum Control: The basic Thomas collar and numerous variations of it are examples of minimum control orthoses. These collars vary in height, contour and rigidity. They may be worn either forwards or backwards to increase or decrease the amount of flexion/extension possible. Generally, they are to be worn so that the chin rest, which is a convexity in the collar that points downwards, is anterior. However, some patients find it more comfortable to reverse this position, and certainly in cases where one is more interested in restricting extension than flexion, a reversal of this position will block extension more effectively. In other words, if a high portion of the collar is worn posteriorly there is relatively less extension. Although these collars probably do little or nothing in the way of immobilizing the spine, they do provide warmth as well as psychological comfort and support. They can be helpful to the patient in the treatment of a broad variety of conditions including some whiplash injuries, minor sprains and strains, cervical spondylosis, and some stable postoperative surgical constructs. Intermediate Control: There are a number of orthotics that are appropriately classified in this group. The Philadelphia collar is a beefed-up version of a Thomas collar. It is more rigid, has an anterior and a posterior plastic reinforcement, a rigid chin support, and a significantly developed extension block posteriorly to support and restrict the occiput. In order to achieve a greater level of immobilization, some extension of the orthosis down into the shoulder and/or thorax is required. This lengthening of the orthosis provides a more effective anchoring, purchase, and immobilization. There are several braces that fit into this category, most notably the four-poster brace, the Duke brace, the Guilford brace, and the SOMI brace. The SOMI is the most effective immobilizer in this group. These orthoses are probably more effective in the standing and sitting positions. In the supine, prone, or side lying positions, relaxation and rotation of the shoulders and thorax minimize the effectiveness of these orthoses. We should also note that if we wish to prevent anterior displacement of C1 or C2 in a rheumatoid patient we cannot rely upon a soft cervical collar, a Philadelphia collar, a four-poster brace, or even a SOMI brace (Altoff and Goldie 1980). Most Effective Control: If there is a clinical problem involving significant loss of clinical stability, the cervical orthosis hould provide the maximum amount of immobilization, unloading of the spine, and protection. Major control is needed in all of the parameters of motion. Depending on the particular clinical situation, it may be more important to control some particular motion or combination of motions. One option in this situation is a significantly more rigid version of the Thomas collar. The Minerva cast incorporates the concepts of extending the brace down towards the thorax and immobilizing the chin and occiput. This cast extends from the forehead down to the pelvis. The goddess Minerva was born by popping from the head of Jupiter, fully armored. From this Roman myth the cast has taken its name. This device, although not used very much currently, can be useful, especially in the protection of irresponsible patients. It should be kept in mind, however, that even with a well-applied Minerva cast, a few degrees of cervical spine motion are possible. Most of the motion occurs at the occiput-C1 region. The cast has to be open enough to allow an adequate range of motion for the mouth so that the patient can talk and chew. This same range of motion allows for motion at the occiput-C1-C2 joint complex. Thus, when your patients are in a Minerva cast but can talk and chew, you must be aware that they can move C1-C2. In difficult clinical situations, where there is extensive disease or surgery, or an injury has rendered the cervical spine unstable, use of a halo apparatus should be considered. This device is fixed to the skull with pins and is attached either to an individually molded plaster jacket or to a prefabricated jacket which comes in several sizes. Experimental studies generally agree that this device is the most effective immobilizer of the cervical spine. One should be aware that use of this device carries the risk of several complications. These include: penetration of the skull by fixation pins, brain abscesses, abducens, glossopharangeal and facial nerve palsy, and the development of cervical spondylosis. Facial complications can be recognized during the first few days after application by requesting patients to smile, roll their eyes, and stick out their tongue. If the patient is unable to do any of these three activities, careful neurological evaluation is indicated. <h3>Resume</h3> A rational approach to the use of cervical orthotics may be taken by posing several questions. What is the clinical condition of the spine? What are the therapeutic goals to be achieved by the brace? Is the goal to protect the spine, or to rest it? In what way should the mechanics of the spine be changed to achieve that goal? What kinds of forces are necessary in order to achieve these therapeutic aims? In the cervical spine, the standby orthosis for minimal immobilization is the Thomas collar. If one needs a high level of control, then an intermediate zone orthosis, such as the Philadelphia collar or any variety of collars that involve thoracic attachments, can be employed. The SOMI brace is the most effective in this intermediate group. If the therapeutic goal is to obtain maximum control and immobilization of the cervical spine, a halo apparatus with an individually molded plaster jacket is required. One should be aware that this apparatus carries the liability of exposure to complications. These complications can be minimized by diligent care techniques and follow-up evaluation. References: <ol> <li>Altoff, B. and Goldie, I.F.: Cervical collars in rheumatoid atlauto-axial subluxation. A radiographic comparison. Annals of the Rheumatic Diseases 39: 485, 1980.</li> <li>Edward, J.W.: Orthopaedic Appliances Atlas. Vol. I, Ann Arbor, Michigan, American Academy of Orthopaedic Surgeons, 1952.</li> <li>Hartman, J.T., Palumbo, F., and Hill, B.J.: Cineradiography of the braced normal cervical spine. Clinical Orthopaedics 109: 97, 1975.</li> <li>Johnson, R.M. et al.: Cervical orthoses. A study comparing their effectiveness in restricting the cervical motion in normal subjects. Journal of Bone and Joint Surgery 59A: 332, 1977.</li> <li>O'Brien, J.P.: The halo-pelvic apparatus. A clinical, bio-engineering and anatomical study. Acta Orthopaedica Scandinavica 163 (supplement), 1975.</li> <li>Victor, D.I., Bresnan, M.J., and Keller, R.B.: Brain abscess complicating the use of halo traction. Journal of Bone and Joint Surgery 55A: 635, 1973.</li> <li>White, A.A. and Panjabi, M.M.: Clinical Biomechanics of the Spine, Philadelphia, J.B. Lippin-cott, 1978.</li> </ol> *Augustus A. White, III, M.D. The Department of Orthopaedic Surgery Beth Israel Hospital and Harvard Medical School, and the Charles A. Dana Research Institute, Beth Israel Hospital, Boston, Massachusetts <div style="width: 400px;"></div> Page Number(s) 5 - 7 Year 1983 Volume 7 Issue 3 Figure 2 TABLE II http://www.oandplibrary.org/cpo/images/1983_03_005/1983_03_005-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 3 TABLE III http://www.oandplibrary.org/cpo/images/1983_03_005/1983_03_005-3.jpg Figure 1 TABLE I http://www.oandplibrary.org/cpo/images/1983_03_005/1983_03_005-1.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 Some Comments on Cervical Orthoses Creator An entity primarily responsible for making the resource Augustus A. White, III, M.D. * https://staging.drfop.org/files/original/4c1c2659ace14b6587c3c801d470aa96.pdf dbc48fb2203d6c75e5adce812a9b03de https://staging.drfop.org/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg 4c4de5849811d644713ec7230d7d0f02 https://staging.drfop.org/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg 131fef1ae751f64e310d683f6e52c098 https://staging.drfop.org/files/original/27a2d16cac19d4fe68e3aead92053f88.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/1978_04_005.pdf Text Any textual data included in the document <h2>Vacuum Forming</h2> <h5>Ben Wilson </h5> In an article I wrote in 1974 on vacuum forming of sheet plastics<a></a> I erred in stating that the first reference to vacuum forming of sheet plastics in orthotics and prosthetics was a paper by Gordon Yates in 1968<a></a>. I should have remembered that Dana Street presented this concept in Volume 1 of the Orthopedic Appliances Atlas<a></a> for the fabrication of cervical orthoses. This is certainly an excellent example of how long it takes to get a technological development from the idea stage to fairly widespread application. <a href="/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg">Fig. 1</a> Vacuum-forming a shank for a below-knee prosthesis using the hand-drape. In the time since my article was published in "Orthotics and Prosthetics" vacuum forming of sheet plastics has been used more and more by private practitioners in both orthotics and prosthetics. Although the educational programs, with a few exceptions, seem to have been very slow in teaching vacuum forming techniques, use of the technique seems to be expanding, owing in part to the several workshops sponsored by the American Academy of Orthotists and Prosthetists. Every process and system has its limitations, and we all recognize that each design in orthotics and prosthetics represents a compromise, but as time goes on the gaps that engender compromise are narrowed as experience is gained. Although the "Orthotics and Prosthetics Clinic Newsletter" has discussed several aspects of vacuum forming in the relatively recent past, in view of what seems to be a rapidly expanding program it seems appropriate that another survey be made concerning the uses of and problems encountered by the private practitioners. A questionnaire on this subject is included in this issue. It will be appreciated greatly if each recipient will complete the enclosed form and add any comments he or she feels that will be helpful in improving service to patients. <a href="/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg">Fig. 2</a>. Vacuum-forming thigh section of knee-ankle-foot prosthesis using automatic machinery. <a href="/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg">Fig. 3.</a> Vacuum-forming a below-knee socket with use of a platen and form for holding plastic sheet. <h3>References:</h3> <ol> <li>"Vacuum-Forming of Plastics in Prosthetics and Orthotics," A. Bennett Wilson, Jr., Orthotics and Prosthetics, Vol. 28, No. 1, March 1974.</li> <li>"A Method for the Provision of Lighweight Aesthetic Orthopedic Appliances," Gordon Yates, Orthopaedics, 1:2:153-162, 1968.</li> <li>"Plastic Braces," Dana M. Street; pp. 90-95 in Orthopaedic Appliances Atlas, Edwards Brothers, Ann Arbor, Michigan, 195.</li> </ol> <h3>Additional Bibliography:</h3> <ol> <li> "Fabrication and Application of Transparent Polycarbonate Sockets," Vert Mooney, M.D., Roy Snelson, Orthotics and Prosthetics, Vol. 26, No. 1, March 1972. </li> <li> "Fabrication of Vacuum-Formed Sockets for Limb Prostheses," Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 3, September 1973. </li> <li> "Report of Workshop on Below-Knee and Above-Knee Prostheses," Hector Kay, June D. Newman, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "The Use of Check Sockets in Lower-Limb Prosthetics," Samuel Hammontree, Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "A Thermoplastic Structural and Alignment System for Below-Knee Prostheses," Hans Richard Lehneis, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Development of a Thermoplastic Below-Knee Prosthesis With Quick Disconnect Feature," Charles H. Pritham, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Vacuum-Formed Sockets in Prosthetics Education," Bernard C. Simons, Alan V. Dralle, Orthotics and Prosthetics, Vol. 29, No. 2, June 1975. </li> <li> "Ultralight Prostheses for Below-Knee Amputees," A. Bennett Wilson Jr., Melvin L. Stills, Orthotics and Prosthetics, Vol. 30, No. 1, March 1976. </li> <li> "Use of Thermoplastic Components in Temporary Prostheses," Charles H. Pritham, Ivan E. Letner, David Knighton, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Applications of Transparent Sockets," S.I. Reger, I.E. Letner, CH. H. Pritham, M.D. Schell, and W.G. Stamp, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Above-Knee Polypropylene Pelvic Joint and Band," Erich Fischer, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "A Lightweight Above-Knee Prosthesis with an Adjustable Socket," George Irons, Vert Mooney, Sandra Putnam, Michael Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Welding Plastics," Neil R. Donaldson, Michael J. Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Functional Partial-Foot Prosthesis," Gustav Rubin, Michael Danisi, Bulletin of Prosthetics Research, BPR 10-16, Fall 1977. </li> <li><a href="http://www.acpoc.org/library/1972_06_003.asp"></a> <a href="http://www.acpoc.org/library/1972_06_003.asp">"A Functional Chopart Prosthesis," Gustav Rubin, Michael Danisi, Inter-Clinic Information Bulletin, Vol. 11, No. 6, March 1972.</a> <a href="http://www.acpoc.org/library/1972_06_003.asp"></a></li> <li><a href="http://www.acpoc.org/library/1972_10_009.asp"></a> <a href="http://www.acpoc.org/library/1972_10_009.asp">"Vacuum-Forming Techniques & Materials in Prosthetics & Orthotics," Alex Artamonov, Inter-Clinic Information Bulletin, Vol. 11, No. 10, July 1972.</a> <a href="http://www.acpoc.org/library/1972_10_009.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"A Foot Amputation Orthosis-Prosthesis," H.J. Ruben-stein, G.J. Sweeney, P. Strong, G. Durrett, Inter-Clinic Information Bulletin, Vol. 14, No. 4, April 1975.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"Partial Foot Amputation-A Case Study," Charles H. Pritham, Newsletter. . . Prosthetics and Orthotics Clinics, Vol. 1, No. 3, Summer 1977.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li> Manual for an Ultralight Below-Knee Prosthesis, A. Bennett Wilson, Jr., Charles H. Pritham, Melvin L. Stills, Rehabilitation Engineering Center, Moss Rehabilitation Hospital-Temple University-Drexel University (1977). </li> <li> The Rancho Ultralight Below-Knee Prosthesis, Michael Quigley, George Irons, Neal Donaldson, Rehabilitation Engineering Center, Rancho Los Amigos Hospital County of Los Angeles, University of Southern California (1977). </li> </ol> Page Number(s) 5 - 6 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-3.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 Vacuum Forming Creator An entity primarily responsible for making the resource Ben Wilson https://staging.drfop.org/files/original/ea5cb965d7cc12d8d6b0c436964b44d9.pdf e5e3dd0a8d1c47e6d18a93f0e7dde31d https://staging.drfop.org/files/original/eb8ca65bd9a979fad277a91a57b0e631.jpeg 43dae3e86044e9e9337edfa12f8d523c https://staging.drfop.org/files/original/b99d31ef707acfb4cb39459306f929ae.jpg 1f0a63be299196ddf613145c782f8bb2 https://staging.drfop.org/files/original/fac91bdfc7e7039cf0393d7300667e49.jpg 4f4ff35f2fa8689775893928003e2f4d https://staging.drfop.org/files/original/17601e26a1ee85e6b6d571785e2d2278.jpg b0ffbc512dbf96e101590a70c9834f21 https://staging.drfop.org/files/original/3c565e3e3e82d1e16dd0bc2c8487a402.jpg edc1b0783e1722653e72676e255cecdc https://staging.drfop.org/files/original/f60360f716924225bb6b1b92e24d5971.jpg ccb584ca57daf2499edbf1d0c9c55314 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/1983_04_004.pdf Text Any textual data included in the document <h2>Physical Therapy and Hydraulic Knee Units</h2> <h5>Bernice Kegel R.P.T. <a style="text-decoration: none;">*</a></h5> Without a thorough understanding of the principles of operation and functional benefits engineered into the sophisticated hydraulic knee mechanisms, the therapist will be unable to help the amputee gain maximum benefits and use the system effectively. It is important that the prosthetist ascertain that the therapist knows what adjustability is incorporated into the prosthesis. Much of the adjustment will be done during dynamic alignment at the prosthetic facility, but modifications will need to be made as the patient gains confidence and his ambulation pattern improves. An understanding of the fundamental differences between hydraulic control and mechanical friction will help in training the amputee to take full advantage of the flexibility of hydraulic mechanisms. Amputees can walk over a wide range of cadences instead of being limited as with mechanical friction. There are two reasons for this. First, hydraulic friction increases with speed to balance the increase in kinetic energy of the prosthesis while mechanical friction remains essentially constant. The programmed hydraulic characteristics give little frictional resistance during initial extension and flexion but build to a peak at terminal flexion and extension. This helps to provide a natural appearing gait regardless of cadence. The stability of hydraulic systems permits alignment nearer the trigger point and thus results in less energy expenditure required for walking. If a patient has previously used a mechanical knee, he needs to be reminded that no exaggerated residual limb motion is necessary to gain adequate flexion and extension of his hydraulic prosthesis. For purposes of brevity, I will limit my discussion to gait training with one knee unit-the Mauch S-N-S (Fig. 1). The Mauch S-N-S knee unit can be set to provide 3 functions: <a href="/files/original/eb8ca65bd9a979fad277a91a57b0e631.jpeg">Figure 1</a>. Cutaway diagram of the Mauch Unit <ol> <li> Swing and Stance phase control. </li> <li> Swing phase control only. </li> <li> Manual knee lock. </li> </ol> A stirrup shaped lever near the top of the piston rod operates as a selector switch. When the lever is in the down position, swing and stance control are both operative. This would be the adjustment chosen for normal walking. The major advantage of stance control is that it offers the patient stumble recovery. If the prosthetic knee buckles, it will give way slowly enough that the patient should be able to regain his balance before falling. When training a patient with a conventional knee unit, he is taught to forcefully contract his hip extensors late in swing phase to accelerate the shank forward (with resulting terminal impact) to ensure extension of the knee at heel strike. Amputees wearing fluid-controlled mechanisms need not do this. The amputee should be instructed to swing his thigh forward, decelerate it, and end the movement with the residual limb pointing to the point on the ground where the heel should strike. The shank, aided by the built-in extension bias will swing forward smoothly, and at heel strike will be in full extension. With the stance phase control engaged, the prosthetic knee will be stable in the initial portion of stance phase without forceful extension of the hip musculature being necessary. The feature makes gait training markedly easier. It is extremely important during the end of stance phase on the prosthetic side that the hip be ahead of the knee and weight on the ball of the foot. This hyperextension moment is necessary to disengage the stance phase control momentarily and allow the knee to bend freely in swing phase. If the amputee does not exert this hyperextension for 1/10th of a second, he might experience difficulty in flexing the knee to begin swing phase. When walking on soft ground, it is even more important to exert this hyperextension moment. The benefits of stance control are also used when walking down stairs and ramps in a step-over-step manner. This ability to walk down steps in a step-over-step manner rather than one step at a time or by jack-knifing is one of the key advantages of the Mauch knee unit. The patient needs to be taught to place his prosthetic heel on the lower step with the forefoot extending beyond the edge of the step (Fig. 2). He is then told to flex his hip forward while simultaneously putting weight on the prosthetic leg. This will cause a controlled bending of the prosthetic knee. As the prosthetic knee yields, the sound leg is brought forward and placed on the lower step. If the patient has to wait for the prosthetic knee to bend, then stance phase resistance is too high and should be reduced. This activity is probably the most difficult to teach an amputee, especially if he has used a conventional knee unit in the past. This same technique is used for going down ramps. When walking up steps and ramps the same techniques are used as in conventional training. <a href="/files/original/b99d31ef707acfb4cb39459306f929ae.jpg">Figure 2</a>. Correct placement of the prosthetic heel When sitting down in a chair, the patient can either use the weight bearing resistance of the S-N-S unit to control the rate of sitting, or release the stance phase control and use the sound leg to control sitting rate in the same fashion as with a conventional knee unit. How quickly the knee bends under weight is determined by the stance adjustment screw, which is turned with a 22mm Allen wrench (Fig. 3). The adjustment is extremely sensitive with a range of only 120 degrees. Slowest bending and maximum stability is obtained with a full clockwise adjustment. Most patients like to start with a high degree of stability. <a href="/files/original/fac91bdfc7e7039cf0393d7300667e49.jpg">Figure 3.</a> Allen wrench inserted into the stance adjustment screw To eliminate stance phase control the patient is told to stand with his prosthetic leg behind his sound leg. With weight on the toe of his prosthesis, he pulls the selector switch lever up (Fig. 4). This mode would be used for bicycling and other activities needing a free swinging leg. Swing resistance is adjusted by moving the serrated cap. The verticle black line under the serrated cap is the extension resistance marker. When the black line is all the way to the right (4 o'clock) extension resistance is lowest, and all the way to the left (8 o'clock) is the maximum setting. A good resistance for beginning walking would be at 5 o'clock (Fig. 5). <a href="/files/original/17601e26a1ee85e6b6d571785e2d2278.jpg">Figure 4</a>. Eliminating the stance phase control. <a href="/files/original/3c565e3e3e82d1e16dd0bc2c8487a402.jpg">Figure 5</a>. Good resistance settings for beginning walking. The same serrated cap that adjusts extension resistance also adjusts flexion resistance. When the "H" in the word HYDRAULIC is over the line marker (regardless of the position of the line marker), flexion resistance is lowest. "K" over the marker indicates maximum resistance. A good resistance for beginning walking is at the "D" position (as shown in Fig. 5). To engage the knee lock, the selector switch is pulled into up position with the knee flexed and bearing no weight (Fig. 6). The knee may now be extended from this flexed position, but increased flexion is not possible. <a href="/files/original/f60360f716924225bb6b1b92e24d5971.jpg">Figure 6</a>. Engaging the knee lock. A right-legged amputee might choose to lock the prosthetic knee while driving and pressing the pedal by a forward motion of the hip. For standing at work for any length of time or while standing on a bus, the amputee could be taught to lock his knee. The Mauch S-N-S units have also been successfully used by bilateral amputees. The two units are likely to be adjusted differently because different residual limb lengths call for different resistance settings. The patient should be taught that the hydraulic unit may require servicing every one to two years. He should also be told that small amounts of air in the hydraulic system are no reason for concern. An automatic selfbleeding feature will eliminate the air after he walks a few steps, or if he bends the knees several times before applying the prosthesis. The leg should be stored upright with the knee fully extended so that air does not enter the hydraulic spaces. References: <ol> <li>Kegel, B., Byers, J.L., "Amputee's Manual-Mauch S-N-S Knee." Medic Publishing Co., P.O. Box 1636, Bel-levue, WA 98009, 1977.</li> <li>Lewis, E.A., "Elements of Training with the Mauch S-N-S System for Above-Knee Amputees." Research and Development Division, Prosthetics and Sensory Aids Service, Veterans Administration, 252 Seventh Avenue, New York, New York 10001.</li> <li>Lewis, E.A. and Bernstock, W.M., "Clinical Application Study of the Henschke-Mauch Model A Swing and Stance Control System." Bulletin of Prosthetics Research Fall, 1968.</li> <li>Mauch, H.A., "Stance Control for Above-Knee Artificial Legs-Design Considerations in the S-N-S Knee." Bulletin of Prosthetics Research, Fall 1968.</li> <li>Knee Prostheses, Mauch Laboratories, Inc., 3035 Dryden Road, Dayton, Ohio 45439, January 1974.</li> <li>Murphy, E.F., "The Swing Phase of Walking with Above-Knee Prosthesis." Bulletin of Prosthetics Research, Spring 1964.</li> <li>Staros, A. and Murphy, E.F., "Properties of Fluid Flow Applied to Above Knee Prostheses." Bulletin of Prosthetics Research, Spring 1964.</li> </ol> *Bernice Kegel R.P.T. Seattle, Washington Page Number(s) 4 - 7 Year 1983 Volume 7 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1983_04_004/1983_04_004-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1983_04_004/1983_04_004-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1983_04_004/1983_04_004-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1983_04_004/1983_04_004-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1983_04_004/1983_04_004-5.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/1983_04_004/1983_04_004-6.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 Physical Therapy and Hydraulic Knee Units Creator An entity primarily responsible for making the resource Bernice Kegel R.P.T. * https://staging.drfop.org/files/original/14e71685d71f779f2e221b6ce3752c7b.pdf 7f5b513db755d91f0fee0e97ce868617 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/1980_01_005.pdf Text Any textual data included in the document <h2>Prosthetic Knee Mechanisms: A Guide for the Prosthetist</h2> <h5>Bert Goralnik, CP </h5> <h3>Introduction</h3> A function of the Veterans Administration Prosthetics Center (VAPC) is to assist VA Clinic Teams nationally in prescribing prosthetic devices, including, of course, prosthetic knees. Prescribing knee mechanisms, however, is a complex task because of the large variety available. Most often these devices differ not that much in function but in size, type of material used for the setup, and additional characteristics related more to assembly and installation processes than prescription rationales. All too often clinicians prescribe either limited numbers or certain types of knee mechanisms found to be reliable in the past. Another inhibitor may be a lack of specific information on the full range and variety of all available systems. The clinician rarely has an opportunity to compare the relative merits of one knee with another. In 1972, the Veterans Administration, through the Department of Medicine and Surgery, Washington, D.C., published a program Guide (M-2, part IX, G7) on "The Selection and Application of Prosthetic Knee Mechanisms." The guide was slightly modified and updated in 1976. A new Program Guide, reflecting developments of recent years and incorporating most commercially available knee mechanisms, will soon be published. This later Program Guide will provide a summary description of the various knee mechanisms thus far evaluated by the VAPC. It is intended to help maximize patient benefits. <h3>Description of Program Guide</h3> The Program Guide comprises six sections: Knee Function, Definitions, Classification, General Requirements, Prescription of Prosthetic Knee Mechanisms, and Catalog of Knee Mechanisms. <ol> <li> Knee Function: Here are described the normal function of the anatomical knee, specifically the relationships of its various parts during the gait cycle, and alignment stability as a key factor in prosthetic fitting. Discussion centers on the TKA line relative to the center of the knee in maintaining stability during the stance phase. Understanding these relationships and utilizing the special features of knee mechanisms for the patient's benefit is an asset for the prosthetist. The Clinic Team thereupon must strive to provide the patient with the specific knee mechanism whose features most closely match his individual needs. </li> <li> Definitions: Reference terms are given to describe the variety of knee functions. </li> <li> Classification: A chart classifying all types of commercially available knee mechanisms is provided. The chart shows functional criteria, specifically swing phase control and stance phase control. Additional topics in this section include extension aids, extension stops, mechanical locks, mechanical friction, and fluid resistance of hydraulic and pneumatic knees. </li> <li> General Requirements: This section consists of a checklist on knee mechanism requirements. </li> <li> Prescription: Prescription rationale is discussed, emphasizing the needs of the individual patient. Although the Program Guide concerns knee mechanisms, socket, shank, foot and suspension are also discussed to achieve the best type of prosthesis available. A chart shows the type of prosthesis best suited for different types of amputees. A classification chart of knee mechanisms is also included. To further assist the clinician, variations of basic prescriptions are given, i.e., for a short residual limb, a very long residual limb, and differences based on level of activity. </li> <li> Catalogue of Knee Mechanisms: this section, the heart of the Program Guide, lists most commercially available knee mechanisms. Illustrations furnished by the manufacturers are included. A chart lists type of knee mechanisms, materials, exact dimensions, and types of control offered. </li> </ol> <h3>Conclusions</h3> The new Program Guide on "The Selection and Application of Prosthetic Knee Mechanisms," will be available on or about June 1, 1980. It should prove to be of significance to all clinic teams. To obtain a copy of this publication, please write to the Veterans Administration Prosthetics Center, Attention: Mr. Bert Goralnik, 252 Seventh Avenue, New York, New York 10001. I wish to thank Mr. Max Nacht, Technical Writer/ Editor, VA Prosthetics Center, for his aid in preparing this article. Page Number(s) 5 - 6 Year 1980 Volume 4 Issue 1 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/. 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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/1987_03_131.pdf Text Any textual data included in the document <h2>Upper-Extremity Prosthetics: Considerations and Designs for Sports and Recreation</h2> <h5>Bob Radocy <a style="text-decoration: none;">*</a></h5> The population of upper-extremity amputees, including congenitally limb-deficient persons, in the United States and abroad is placing increased demand upon the profession for improved prosthetic designs and devices which will allow its members to participate competitively in sports and recreation activities.<a></a> Recreation trends indicate that these demands will most likely increase. Until recently, prosthetics did not directly address the needs of the sports-oriented amputee. Prosthetic designs focused on domestic and vocational needs and did not necessarily target the criteria necessary to perform in the vigorous environments of sports or recreation. Over the years, select prosthetists working with individual amputees have developed "one of a kind" sports devices for their patients. These devices sometimes proved adequate, but most were never made available commercially. Two commercially available sports terminal devices have been available for many years: the Baseball Glove Attachment and the Bowling Attachment.<a></a> Recently, other specialized prosthetic devices have become available to meet the sports-minded amputee's needs. These are the SUPER SPORTs,<a></a> Amputee Golf Grip,<a></a> and the Ski Hand.<a></a> Additionally, new variations in the designs of body-powered terminal devices are allowing amputees to participate in many sports activities without the need for specialized aids or radical modifications.<a></a> The measure of performance by the amputee in any activity, as always, depends upon proper limb design. Socket design, materials, alignment, and components all play a vital role in any amputee's ability to perform competitively. Another important factor is the amputee's physical condition. The prosthesis, no matter how well designed and constructed, cannot supplement atrophied muscle, limited range of motion, or inadequate strength. Sports prosthetics begins with the evaluation of the need and of the capacity of the amputee being served. A physical therapist and potentially a clinic physician will be important components in the rehabilitation of an amputee wishing to become active in sports and recreation. Exercise and conditioning with or without a prosthesis will be required as a preliminary step for an amputee who wishes to excel without injury in sports. Exercise can take multiple forms. Proven exercise techniques exist. Isometric, isotonic, and passive and active resistance all have specific goals and methods. Education is required so that the amputee is knowledgeable about how to proceed with an exercise program and to determine the objectives, i.e. is muscle hypertrophy (bulk) required for strength or is muscle endurance more appropriate? Additionally, how are flexibility and range of motion impacted? Preprosthetic exercise may be required or desired. Weight harnesses<a></a> (Figs. 1, 2, and 3) rather than strap or cuff weights are a better way to approach exercise without a prosthesis. A properly designed harness will prevent weight slippage during exercise and will enable many variations of upper-extremity conditioning (Figs. 4, 5, and 6). Figures 1, 2, and 3. Weight harnesses, rather than strap or cuff weights, are a better way to approach exercise without a prosthesis. Figures 4, 5, and 6. A properly designed harness will prevent slippage during exercise and will enable many variations of upper extremity conditioning. Bilateral exercise using a dumbbell on the non-affected side is important to maintain muscle balance and reduce spinal stress. A full length mirror aids the amputee in viewing him or herself in order to correct postural deficiencies or extraneous movements to optimize resistance exercise efforts. Certain weight machines also allow for non-prosthetic exercise, but exercise will be limited to specific muscle groups (Figs. 7, 8, 9, and 10). Complete upper-body conditioning will be most effectively accomplished while wearing a prosthesis. Furthermore, exercise while wearing a prosthesis will help condition the residual limb to the skin stresses and shears a prosthesis will create when under load. Modern exercise equipment systems, such as Nautilus, Hydra-Fitness, and Universal, are available virtually everywhere in YMCAs, community recreation centers, health and sports clubs. A planned program for the amputee can be structured by professional instructors to the amputee's goals. Free weights are another alternative or can complement a weight conditioning program with the convenience of low cost and home use. Equipped with a proper terminal device (Fig. 11), an arm amputee can safely handle dumbbells or barbells in weight training. Figures 7, 8, 9, (above) and 10 (right). Certain weight machines also allow for non-prosthetic exercise, but exercise will be limited to certain muscle groups. Figure 11. Amputee lifting dumbbell with a terminal device. Proper conditioning balanced by flexibility achieved through passive stretching, aerobics or any number of alternatives will result in the range of motion and strength an amputee will need for high performance in sports and recreation. A regular conditioning program will especially enhance the use of body-powered prostheses which require activation through body-controlled movements. Sound limb design, mentioned previously, is a major component in an amputee's performance potential. Lightweight yet strong prostheses are ideal, but strength should not be sacrificed just to achieve reduced weight. Socket design is dictated to a certain extent by stump configuration, but it is the author's belief that, if at all possible, a supra-condylar socket should be used.<a></a> Supra-condylar sockets with all their variations (Muenster, Bock, etc.) have evolved rapidly with advances in electromechanical limbs. A supra-condylar socket need not be unduly restrictive, and such a limb allows for less complicated harnessing. Carbon fiber and acrylic resins are two materials which lend well to the lightweight but high strength prosthetic objectives. Socket padding,<a></a> whether fully or partially lined, aids in protecting the condyles, olecranon, and distal residual limb end from trauma. If adequately reinforced, ISNY<a></a> style sockets may prove to be applicable for sports as well, but the published data on below-elbow applications is scarce. In addition to padding, the author recommends a heavy residual limb sock or two regular weight socks for most sports activities. Highly absorbent terry lined socks (designed for athletic footwear) are excellent. A polypropylene sock can be used effectively as a liner if heavy perspiration is a problem. An adjustable excursion harness,<a></a> such as the modified Northwestern (Fig. 9) which allows for excellent range of motion and terminal device control, can be applied, although other designs will work. Rapidly adjustable excursion is a plus for actuation of voluntary closing terminal device systems and in sports where gross motion of the arms is required, i.e. archery, golf, baseball, etc. Cable efficiency may also be targeted for consideration. Several experienced amputees known to the author wax the stainless steel cables before assembly into the cable housing. The wax is clean and reduces cable to cable housing friction, thus improving efficiency. Alignment of the prosthesis on the residual limb also requires consideration, depending upon the amputee's sports needs. Preextended, as opposed to pre flexed, socket designs have useful applications in sports. They allow for full elbow extension while limiting flexion only slightly and usually not unacceptably. Wrist alignment is also of consequence and affects the manner in which the prosthesis torques on the residual limb when load is applied. It is important to emphasize the need for prosthetists to be concerned with dynamic forces on the prosthesis. A mere static fitting with a check socket will not suffice because it doesn't accurately duplicate what will occur in the definitive prosthesis. A secondary fitting session with a foamed, but unlaminated, prosthesis donned and the chosen wrist unit and terminal device in place can determine the optimum alignment of the components. Changes can be made accordingly and retested so that the definitive prosthesis will fit correctly. Testing the prosthesis in this manner will also determine if undesirable trim lines exist in the socket or whether extended padding is required. A supra-condylar fit socket on short residual limbs can cantilever on the epicondyles and cut in proximal to the olecranon when the prosthesis is loaded distally making it impossible to carry any significant load (Fig. 12). Extending the trim line can direct pressures to the back of the humerus instead of into the joint. Figure 12. A supra-condylar fit socket with an undesirable trim line. Two other techniques which can aid in creating a more suitable sports prosthesis are external padding and suspension sleeves. Nylon covered neoprene rubber, such as a diver's wet suit material, is readily available and makes an excellent "stretch to fit" cover for a prosthesis (Fig. 13). Thicknesses from 3 mm to 1/4" are available. The material provides a good cushion for contact sports, helps reduce limb trauma during a fall, and the thicker materials have enough bouyancy to float a prosthesis. This technique has satisfied the requirements for a padded prosthesis in several school systems around the country. Figure 13. Nylon covered neoprene rubber, such as a diver's wet suit material, is readily available and makes an excellent "stretch to fit" cover for a prosthesis. Suspension sleeves can improve a supracondylar fit, especially when using a passive recreational device where the cable is absent or does not play a role in prosthetic suspension. Both latex and neoprene sleeves designed for below-knee amputees are available and can be modified for upper-extremity use simply by cutting them down in length (Fig. 14). The advantages of using a commercially available below-knee sleeve is that angulation for a joint is already built in. The author prefers neoprene due to its durability. Both cause increased perspiration within the socket. Designed properly, a neoprene prosthetic cover can function as a suspension sleeve as well. Figure 14. Both latex and neoprene sleeves designed for below-knee amputees are available and can be modified for upper extremity use. The remainder of this article will focus on modifications for specific sports and recreation to which the author has been exposed either directly or indirectly. In some cases, the solutions are simple; in others, performance dictates a more complex technical solution. Photographs and drawings have been used as often as possible rather than the written descriptions to illustrate a modification, device, or technique. Activities are dealt with alphabetically for convenience sake. <h3>Archery</h3> Modern archery equipment is easily adaptable to certain types of terminal devices. Fig. 15 illustrates how a bow riser (handle) can be wrapped with consecutive layers of rubber, foam, and bicycle inner tube to create a durable, functional bow grip.<a></a> A chuck or pin can be used to jam the thumb of the terminal device closed around the riser or the amputee can just "hold on" as illustrated by Fig. 16.<a></a> Performance capabilities are exemplified by the amputee archer in this photo. He is a skilled hunter who has harvested three deer in a four year period. Figure 15. A bow riser (handle) can be modified to create a functional bow grip. Figure 16. An amputee can simply hold on to the bow as shown. <h3>Basketball, Soccer, Volleyball, and Football</h3> Until recently, aids for amputees in ball-sports were limited to padded hooks, cosmetic hands, and custom one-of-a-kind terminal devices. Although these devices were useful, they rarely provided the type of high performance characteristics the sports-minded amputee required to compete successfully. One possible answer or solution is now available. The SUPER SPORTs devices, sized for all ages, are designed specifically for ball-sports and other rigorous recreations in which hand/wrist flexion/extension is needed. Additionally, they absorb shock as well as store and release externally applied energy (Figs. 17, 18, and 19). SUPER SPORTs are passive, not cable activated, but are helpful in catching and ball control when used in opposition to an anatomical hand or another device. SUPER SPORTs combined with padded arm covers create a safe, effective prosthesis for sports, such as football, basketball, and soccer in which interpersonal contact is inevitable. Figures 17, 18 and 19. The SUPER SPORTs devices sized for all ages, designed specifically for ball sports and other rigorous recreations in which hand/wrist flexion/extension is needed. <h3>Bicycling, Tricycling, and Motorcycling</h3> Bicycling or tricycling has proven to be an aggravation for amputees equipped with conventional style hooks. Lack of adequate gripping strength and finger shapes have hampered performance. Presently, however, children and adults equipped with newer style voluntary closing terminal devices (Figs. 20 and 21) can control two or three wheeled cycles as well as their two-handed peers. No modifications are required except when hand brakes are present. Front and rear brakes can be actuated from a single hand lever. Brake pressure must be regulated so that braking forces are always applied to the rear wheel first for safe handling. Your local bicycle shop can usually solve hand brake complications. Figures 20 and 21. Children and adults equipped with newer style voluntary closing devices can control two or three wheeled cycles as well as their two handed peers. Special adapters have been designed for or by individuals interested in competitive bicycle racing (Fig. 22).<a></a> The prototype illustrated is simple and is designed for safety to "quick disconnect" or "break away" at certain levels of force. Figure 22. Special adapter for use in bicycle racing. Motorcycling is a natural extension of bicycling. Again, hand brakes and, in this case, a clutch hand lever complicate the situation. Unilateral amputees missing their left hands can shift and clutch with one hand with practice. Brakes again can be combined. A single foot lever is practical for driving dual master cylinders for hydraulic brakes. The rear wheel braking must occur first however. A local motorcycle mechanic or custom motorcycle shop can provide ideas or adaptations and modifications to standard equipment. <h3>Canoeing and Kayaking</h3> The author's experience with conventional terminal devices proved frustrating during these types of recreation. Split hook finger shapes did not adequately adapt to a paddle or oar. Lack of prehension inhibited the bilateral arm function required for these activities. Locking type terminal devices should never be used in water sports activities. Figs. 23 and 24 illustrate how new technology and minor modifications to paddles can overcome problems in canoeing. Figures 23 and 24. New technology and minor modifications to paddles can overcome problems in canoeing. Kayaking (Fig. 25) with a double-bladed paddle requires only coordination and practice. Rubber rings on the paddle which are used to keep water off the central shaft work equally well in preventing terminal device slippage. Figure 25. Kayaking with a double-bladed paddle requires only coordination and practice. Gross arm movements, such as paddling or rowing, inherently activate voluntary closing devices and keep them closed. Rowing using an oar and oar lock can be enhanced by adding a stop or flange to the oar handle to prevent the terminal device from inadvertently pulling off during a power stroke. <h3>Dance/Floor Exercise and Gymnastics/Tumbling</h3> Activities, such as dance, tumbling and floor exercise gymnastics, have been treated similarly to ball sports in the past due to a lack of specialized terminal devices that were readily available. Padded hooks, cosmetic hands and some custom pedestal style terminal devices have been applied to attempt to satisfy the amputees' needs for balanced bilateral function. Fig. 26 illustrates how the SUPER SPORT terminal devices can be applied to satisfy these specialized recreation niches. Figure 26. SUPER SPORT terminal devices can be applied to satisfy specialized recreation niches. <h3>Fishing</h3> Fishing is a sport and pastime everyone has access to and should be able to enjoy. Amputees using split hooks who wish to have improved control of reels might want to consider the Ampo Fisher I<a></a> which adapts to their prosthesis and reel (Fig. 27). Figure 27. Amputees using split hooks may want to consider the Ampo Fisher I which adapts to their prosthesis and reel. Another alternative for the high level amputee is the Royal Bee Electric Retrieve Fishing Reel system (Fig. 28).<a></a> Figure 28. The Royal Bee Electric Retrieve Fishing Reel systems. Amputees equipped with voluntary closing terminal devices do not require many modifications to fish. A handle modified with some rubber inner tube or tape is usually all that is required to operate a spinning or bait casting reel, due to the improved prehension of these types of terminal devices (Figs. 29 and 30). Figures 29 and 30. A handle modified with some rubber inner tube or tape is usually all that is required to operate a spinning or bait casting reel. Casting with a prosthesis is awkward due to lack of wrist flexibility. Amputees usually control the pole with their natural hand then switch hands to reel or reel with the terminal device. Most reels are available in left and right handed models to suit various physical conditions. Fly fishing poses more of a challenge due to the two-handed dexterity required in handling the fly line. One alternative is the Fly Fishing Reel for Amputees<a></a> (Figs. 31 and 32). This system has been used successfully, although the author feels there is still a need for improved alternatives. Figures 31 and 32. The Fly Fishing Reel for Amputees. Automatic fly reels have been experimented with unsuccessfully due to the difficulties involved in "pulling out line" to wind up the return spring in these reels. Additionally, it was discovered that the spring force was only sufficient to pull in slack line, not with line under drag or a fish engaged. <h3>Golf</h3> Due to its popularity, golf has rules (USGA 14-3/15) regarding artificial limbs established by U.S. Golfing Association for tournament play. Variations in golf aids have evolved over the years primarily as individual designs to suit specific amputee's needs. Recently, however, a device called the Amputee Golf Grip (AGG)<a></a> has been introduced. The AGG is a standardized manufactured product which meets the USGA requirements (Figs. 33 and 34). The device is somewhat similar to the Robin-Aids Golfing device<a></a> (Figs. 35 and 36). Both devices utilize a flexible member to attach to the prosthesis and do not require club modification. They allow for complete wrist/club flexion and extension. The Amputee Golf Grip also allows for unrestricted rotation. Figures 33 and 34. The Amputee Golf Grip is a standardized manufactured product which meets the USGA requirements. Figures 35 and 36. The Robin-Aids golfing device. Other attempts to produce a functional aid should also be noted. One custom device is designed to have clubs attach directly to the prosthesis (Fig. 37).<a></a> Similarly, another model, the Atkins Golf Aid,<a></a> also attaches into the end of the club, but uses a ball-socket swivel. The swivel allows for a limited degree of wrist/ club, flexion/extension, and complete rotation. Figure 37. A custom device designed to have clubs attach directly to the prosthesis. The author has tried several devices and prefers those that do not require club modification and which provide for total flexion/extension/rotation at the wrist/club interface. This allows for a complete back swing and smooth follow through capability. It is important to note that certain of these designs function more easily with one hand than another and must be played cross-handed for opposite side amputations. <h3>Guns/Hunting</h3> Almost any amputee can redevelop the skills necessary to handle a firearm safely with some simple gun modification. In many cases, a standard military sling can prove useful for handling a rifle. Another technique is to add a ring to a forearm sling mount which can then be grasped or engaged with a terminal device. Improved control can be created by adding a custom pistol grip to the forearm of the rifle or shotgun (Figs. 38 and 39). This modification will even allow for the safe operation of pump style shotguns or rifles. Consult with your local gunsmith for help in this regard as he has the knowledge and the tools to perform the modifications correctly. Figures 38 (above) and 39 (left). Improved control can be created by adding a custom pistol grip to the forearm of the rifle or shotgun. Terminal devices can be used to trigger guns as illustrated in Fig. 40, but practice is obviously important. Figure 40. Terminal devices can be used to trigger guns, but practice is obviously important. Other modifications/aids like the Blevin's gun yoke (Fig. 41) illustrate what inexpensive devices amputees have designed for themselves to regain access to a favorite recreation. Figure 41. The Blevin's gun yoke illustrates what inexpensive devices amputees have designed for themselves. Persons with higher level amputations, multiple leg/arm amputations, strokes, or paralysis resulting in para or quadreplegia can also participate in shooting and hunting. Many states have now legalized hunting from parked vehicles to aid severely disabled sportsmen. Additionally, devices such as the SR-7721 (Fig. 42) or home-made Para-Quad Shooting System<a></a> (Fig. 43) offer capabilities not easily accessed in the past. Figure 42. The SR-77. Figure 43. The Para-Quad shooting system. One final design illustrates how an over and under shotgun can be modified to shoot one handed (Fig. 44). Figure 44. An over and under shotgun modified to shoot one-handed. <h3>Hockey</h3> A terminal device for hockey<a></a> (Fig. 45) developed in Canada is an ingenious aid for the hockey enthusiast. It is composed of an adjustable tension ball socket which fits with an adaptor onto the end of a hockey stick. The design allows for the stick to pivot under external force and quick release/flex during a fall. The original model pictured was custom designed for the young hockey player, but if modified with stronger materials, it would be applicable to adults as well. Figure 45. A terminal device for hockey developed in Canada. <h3>Mountaineering</h3> Mountaineering is a less accessible, less popular sport for most of the population, but it does attract enthusiasts and disabled persons. Figs. 46 and 47 illustrate the author during a technical climbing training session. Voluntary closing devices, because of their ability to grasp rope and control gripping force, have proved useful to mountaineering. Instruction and guidance by professional climbing instructors is a must, and "safety first" procedures are always dictated. Figures 46 and 47. The author during a technical climbing training session. <h3>Music</h3> Information and devices to aid amputees playing instruments is scarce. Recently, however, information on a new guitar prosthesis was published in Canada<a></a> (Fig. 48). Dan Roy, the guitarist, in conjunction with specialist Armand Viau have developed a prosthesis which allows Roy to use his shoulder to strum the guitar. The arm is lighter than a conventional prosthesis and can hold a guitar pick. Figure 48. A new prosthesis which enables guitarists to strum their instrument using their shoulders. Figures Figs. 49 and 50 illustrate how some newer terminal devices, such as the ADEPT,<a></a> have proved to be viable solutions for children wishing to "play" musician. Figures 49 and 50. Newer terminal devices, such as the ADEPT, have proved to be viable solutions for children wishing to "play" musician. <h3>Photography</h3> Custom photography and camera adapters have been fabricated for years. Now a device called the Amp-u-Pod<a></a> (Fig. 51) is a standardized, manufactured product which has proved to be an extremely effective aid for the amputee photographer. Designed to replace the amputee's regular terminal device, the Amp-u-Pod mounts directly to the prosthesis and adapts to any 35mm, movie, or video camera equipped to receive a tripod. Figure 51. The Amp-u-Pod has proven to be extremely effective for amputee photographers. <h3>Sailing</h3> Amputees are less restricted in this recreation, but handling rope lines and other types of sailing gear can place demands on the sailor to have two-handed capabilities. Fig. 52<a></a> illustrates a triple amputee who found a GRIP<a></a> terminal device to be one of his best assets for sailing. Figure 52. A GRIP terminal device used for sailing. <h3>Snow Skiing</h3> Amputees have experimented with a number of ways to attach a ski pole to a prosthesis with little functional success. The Ski Hand<a></a> (Fig. 53) is the first standardized manufactured terminal device designed specifically for skiing. Available in varying sizes, the amputee force fits the Ski Hand over a ski pole after removing the standard hand grip. The Ski Hand proved worthwhile for cross-country skiing where upper-body strength is required for propulsion. During downhill skiing, the author found the device of less advantage due to the shallow angle to which the pole enters the hand. The pole basket had a tendency to drag in the snow and was therefore more difficult to control. Novice skiers, however, will find the Ski Hand useful because it enhances maintaining balance and getting up after a tumble. Figure 53. The Ski Hand. <h3>Swimming</h3> Swimming for many upper-limb amputees requires no aid whatsoever. However, for those individuals who wish to perform better or compete in the water, several devices have evolved as custom, one-of-a-kind solutions. The Viau-Whiteside Swimming Attachment<a></a> (Fig. 54) and the P.O.S.O.S./Tablada Swimming Hand Prosthesis<a></a> (Figs. 55 and 56) are two with which the author is most familiar, although others may exist. Figure 54. The Viau-Whiteside swimming attachment. Figures 55 and 56. The P.O.S.O.S./Tablada Swimming Hand Prosthesis. The Tablada hand is flat rather than curved to prevent submarining of the prosthesis during pre-stroke arm extension (Australian Crawl) in order to generate greater stroke volume. Additionally, note that the Tablada system uses a prosthesis which is close to actual anatomical arm length, whereas the Viau system has a shortened forearm section. Both utilize a pre-flexed, rigid elbow design. The Viau arm was designed primarily for back stroke swimming and may therefore account for the curved terminal device shape which would not hamper this style of swimming. The author is also aware of the use of SUPER SPORT devices for swimming, especially for children unaccustomed to the water. Pistoning of the prosthesis can be one of the most common occurrences during swimming. A suspension sleeve can aid in eliminating this action. An additional consideration related to swimming and skin or scuba diving is that the prosthesis is not as buoyant as the body and can seem heavier than normal in water and sometimes will impair performance. <h3>Water-Skiing</h3> Water-skiing can be an extremely dangerous recreation if not approached with caution. The author suggests the following rules of good judgment if water-skiing is on an amputee's wish list of recreational pursuits. First, don't ever lock onto a ski rope handle with any terminal device or use a terminal device which requires a cable and harness system. Second, use a ski rope equipped with a single handle. Third, wear a self-suspending, condylar socket that can be twisted free of under stress. A suspension sleeve will aid support but not impair release of the socket due to the flexibility of the material. Fourth, have a neoprene arm cover for the prosthesis which will float the arm in the water if it comes off. Fifth, always wear an approved floatation vest. The Water Ski Hook<a></a> (Fig. 57) is a simple solution to water skiing that has proved safe when set up and used properly. The Ski Hook should be mounted on the prosthesis in a canted position and tightened into place so that it cannot rotate freely. The shallow hook design provides support, yet will twist off a ski rope handle. Should a fall occur where twisting off is impaired, the supra-condylar socket can be "torqued off" the arm and save the amputee's shoulder from potential trauma. Figure 57. The Water Ski Hand is a simple solution to waterskiing problems. Another solution to prevent injury is to have the tow rope attached to the boat with a quick release, or equipped with a second handle (for small children only) and always manned by an observer/handler. Should the amputee skier go down, the observer can release the rope instantly, preventing injury. The Ski Seat<a></a> (Fig. 58) and E-Ski<a></a> illustrated in Fig. 59 are viable answers for the high level bilateral amputee and the paraplegic or quadraplegic who wishes to enjoy the thrill of skiing. The sled is custom constructed and has two skis. The E-Ski, a newer device, has only one ski and a cage seat. Figure 58. The Ski Seat. Figure 59. The E-Ski. <h3>Wind Surfing</h3> Wind surfing is a relatively new recreation which combines aspects of sailing, surfing, and hang gliding. Load coordination and balance compounded by the need to grasp, maneuver, and rapidly let go of a cylindrical boom as well as uphaul a rope with mast and sail in tow are some of the obstacles the amputee windsurfer faces. A prototype voluntary closing wind surfing terminal device is illustrated in Figs. 60 and 61. Other considerations should include special adjustable harnesses and cable systems for ocean or cold water sailing. Salt accumulation can foul cable function and negate terminal device operation. Wet suits, due to their tight elastic fit, will also interfere with cable function if the cable is worn inside the suit. The harness and cable system must be designed to fit on the outside of the wet suit for unrestricted terminal device operation. Leather on the prosthesis or harness should be avoided, as well as hardware which corrodes. Performance wind surfing is a physically and mentally demanding sport, and the amputee needs to be cautious and prepared to participate safely. Figures 60 (above) and 61 (right). A prototype voluntary closing wind surfing terminal device. <h3>Summary</h3> The varied demands of sports and recreation create a multitude of factors which impact the design, construction, and use of a sports prosthesis. Physical fitness and conditioning, prosthetic design and materials, harness styles, and terminal devices all have roles in determining whether an amputee can engage in a sports activity successfully and safely. New improved prosthetic devices and designs will continue to evolve to meet these varying demands. Communication between professionals is important in order to share information on the improvements which are made. Designs for high performance limbs and devices for sports and recreation may well pave the way for improved prosthetic technology as a whole. An open mind, a fresh outlook, an understanding attitude, as well as the patience and willingness to experiment and develop, will inevitably lead to a brighter future for the disabled in sports and recreation. References: <ol> <li>Chadderton, O.C., C.A.E., "Survey: Consumer Interests," The Fragment, Winter, 1986, Vol. 151, pp. 29-31.</li> <li>Robinson, W.D., B. Pflanz, B. Watkins, and A. Viau "Recreational Limbs AMPUTATION III," The War Amputations of Canada, April, 1986, pp. 19-33.</li> <li><a href="poi/1986_03_129.asp">Mensch, G. and P.E. Ellis, "Running Patterns of Transfemoral Amputees: A Clinical Analysis," Prosthetics and Orthotics International, 1986, Vol. 10, pp. 129-134.</a></li> <li>Products and trade names of Hosmer-Dorrance Corporation, Campbell, California.</li> <li>Products and tradenames of T.R.S., Inc. of Boulder, Colorado.</li> <li>Product and tradename of Recreational Prosthetics, Inc., North Dakota.</li> <li>Radocy, R., "Sports Designs for Upper Extremity Amputees," a symposium presentation at the National Sports Prosthetics and Orthotics Symposium, U.C.L.A. Prosthetics/Orthotics Education Program, October, 1985.</li> <li>"Bow Modifications Serve Amputees," Archery World, February, 1987, p. 22.</li> <li>Weight harnesses designed and tested by Bob Radocy, T.R.S., Boulder, Colorado {not commercially available}.</li> <li>Radocy, B. and Randall D. Brown, "Technical Note: An Alternative Design for a High Performance Below-Elbow Prosthesis," Orthotics and Prosthetics, 1986, Vol. 40, No. 3, pp. 43-47.</li> <li>Billock, John N., "Northwestern University Supracondylar Suspension Technique for Below-Elbow Amputations," Orthotics and Prosthetics, December, 1972, Vol. 26, No. 4, pp. 16-23.</li> <li>Berger, N., et al, "The Application of ISNY Principles to the Below-Elbow Prosthesis," Orthotics and Prosthetics, Winter, 1985/86, Vol. 39, No. 4, pp. 10-20.</li> <li>Radocy, Bob, "The Rapid Adjust Prosthetic Harness," Orthotics and Prosthetics, 1983, Vol. 37, No. 1, pp. 55-56.</li> <li>Courtesy of Bill White, bilateral amputee using two GRIP terminal devices, Waterford, Pennsylvania.</li> <li>Courtesy of Kent Barber & Bill Dalke, Prototype bicycle aid not commercially available. Inquiries to T.R.S. of Boulder, Colorado.</li> <li>Courtesy of Bassamatic, Inc. of Canton, Ohio.</li> <li>Courtesy of Royal Bee Corporation, Pawhuskas, Oklahoma.</li> <li>Courtesy of Robin-Aids Prosthetics of Vallejo, California.</li> <li>Courtesy of The War Amputations of Canada, Ottawa, Ontario.</li> <li>Tradename and product of Innovation Research Corporation, Milwaukie, Oregon.</li> <li>Courtesy of SR-77 Enterprises, Inc. of Chadron, Nebraska.</li> <li>Courtesy of R.F. Meyer's photograph of R. Wityczak, a triple amputee.</li> <li>Courtesy of Carmen Tablada, CP., Professional Orthopedic Systems of Sacramento, California.</li> <li>Ski Seat, Mission Bay Aquatic Center of San Diego, California.</li> <li>E-Ski, Courtesy of E.S.C.I. of Gretna, Louisiana.</li> <li>Courtesy of the Rehabilitation Centre for Children, Winnipeg, Manitoba, Canada.</li> </ol> *Bob Radocy Bob Radocy is President, TRS, Inc. 1280 28th St., Suite 3, Boulder, CO. 80303-1797 <div style="width: 400px;"></div> Page Number(s) 131 - 153 Year 1987 Volume 11 Issue 3 Figure 2 FIGURES 4,5,&6 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-02.jpg Figure 3 FIGURES 7,8,9,& 10 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-03.jpg Figure 4 FIGURE 11 ttp://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-04.jpg Figure 6 FIGURE 13 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-06.jpg Figure 7 FIGURE 14 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Needs Revision-See Trello Figure 8 FIGURE 15 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-08.jpg Figure 1 FIGURES 1,2,& 3 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-01.jpg Figure 5 FIGURE 12 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-05.jpg Figure 9 FIGURE 16 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-09.jpg Figure 10 FIGURE 17,18,19 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-10.jpg Figure 11 FIGURE 20 & 21 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-11.jpg Figure 12 FIGURE 22 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-12.jpg Figure 13 FIGURE 23 & 24 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-13.jpg Figure 14 FIGURE 25 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-14.jpg Figure 15 FIGURE 26 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-15.jpg Figure 16 FIGURE 27 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-16.jpg Figure 17 FIGURE 28 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-17.jpg Figure 18 FIGURE 29 & 30 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-18.jpg Figure 19 FIGURE 31 & 32 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-19.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 Upper-Extremity Prosthetics: Considerations and Designs for Sports and Recreation Creator An entity primarily responsible for making the resource Bob Radocy * https://staging.drfop.org/files/original/d73a255fee4b364de1484751b0070bc2.pdf f4268f1f8160ca988e58b8d68c70e4d7 https://staging.drfop.org/files/original/9cd3809f346695203e049ecda06076b9.jpg 4a70f8736bfa8404d75ca3f32d5a0525 https://staging.drfop.org/files/original/fe34c6884c1d4f9cd65bd37a903a8070.jpg b70af2800e997203f2319c46296de5b7 https://staging.drfop.org/files/original/30a3a403da09b29c8a7c41ae21ae5364.jpg 8449acd023022b2f713fc97fc94bb381 https://staging.drfop.org/files/original/a6edecd2ad6203347d70e896ca018d83.jpg 9ce2a9f49884881e3a6ed64718708be7 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/1986_02_082.pdf Text Any textual data included in the document <h2>Voluntary Closing Control: A Successful New Design Approach to an Old Concept</h2> <h5>Bob Radocy, M.S.T.R. <a style="text-decoration: none;">*</a></h5> The arrival in early 1980 of the "Prehensile Hand,"<a></a> a new design and concept for terminal devices, sparked a revitalized interest in body power and voluntary closing control. Voluntary closing control and terminal devices are not new to prosthetics, but little interest in this system and technology has existed since the 1950's. Retrospectively, voluntary closing control never achieved dramatic success nor did it have any permanent, positive influence on the direction of upper-extremity prosthetic development until recently, meaning 1980-1985. The acceptance and success of the "GRIP,"<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg">Fig. 1</a>) and more recently the children's "ADEPT"<a></a> terminal devices, are strong indicators that voluntary closing control is an extremely viable concept. Furthermore, it confirms previous opinions that poor performance characteristics, reliability factors, and the inappropriate design criteria of early volunteer closing control systems and terminal devices<a></a> were responsible for the demise of voluntary closing systems and correspondingly for the dominance of voluntary "opening" control systems and terminal devices in the profession today. <a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg">Figure 1. (Top to bottom) GRIP I, GRIP II, ADEPT B, ADEPT C, and ADEPT I.</a> This is not to say that voluntary closing devices and systems were not put to excellent use by certain amputees, but that they failed to appeal to the majority of the upper-extremity limb deficient population, i.e. the traumatic or congenitally limb deficient below-elbow unilateral amputee. The standard voluntary opening split hook has continued to be the primary body-powered prescription, while experience now strongly illustrates that correctly designed voluntary closing terminal devices offer superior performance to the limb deficient. Training is no more difficult with voluntary closing; gripping force range is expanded and directly proportional to output, reflex grasping actions are improved, muscles of the affected limb and shoulder are utilized continuously and more effectively, and "feedback" sensations (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.jpg">Fig. 2</a>) are produced inherently<a style="text-decoration: none;">*</a> and are more easily assimilated, thereby enhancing control, than in voluntary opening systems. The mere fact that children three to six years of age have accepted the concept and have either learned with or converted to voluntary closing control and achieved good to excellent performance should open the minds of even the most conservative in our profession as to the value of the voluntary closing control prescription. Recently, we have seen and heard a great deal about the success of myoelectric devices for children and how a child's performance is improved with myoelectric systems as compared to "body-powered" systems.<a></a> Unfortunately, body power in these comparisons refers only to the voluntary opening split hook systems, and not to voluntary closing systems. It is my firm belief that, if given proper training, limb deficient children will perform as well or better with voluntary closing body powered systems than with myoelectric systems. Furthermore, considering the cost and reliability of externally powered limbs, voluntary closing body powered terminal devices should be prescribed as the primary complements to external powered units, rather than voluntary opening split hook systems. The logic for this assertion is simple. First, muscles of the torso and limb are used more actively with the voluntary closing system, and healthy, strong muscles can only enhance externally powered control and utilization. Second, the new designs in voluntary closing terminal devices offer an opposed thumb and finger gripping configuration, similar to powered hands, enabling the user to incorporate already "learned" patterns of gripping behavior, rather than having to constantly switch patterns of grasp to accommodate "split hook" prehension. Third, children with voluntary closing systems can achieve gripping prehension which equals or exceeds their anatomical capabilities, while voluntary opening systems remain inferior in this area. Comparable prehension bilaterally can only encourage bilateral function and increase prosthetic usage, two primary goals in prosthetic rehabilitation. The success of voluntary closing systems can be related to the design rationale and criteria of the 80's systems. Rationale and criteria are as follows: <ol> <li> Utilize an accepted natural prehension configuration. Previous studies indicate that cylindrical, palmar, and lateral are the most often used gripping patterns.<a></a> Opposed thumb and forefinger prehension satisfies these patterns. </li> <li> Design gripping shapes and surfaces to allow for a wide variety of holding tasks. Complementary curved gripping surfaces enhance cylindrical control and are especially important due to the vast numbers of curved object surfaces we handle daily (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-3.jpg">Fig. 3</a>). Additionally, a "clevis" tip configuration imitates the three point chuck of the thumb, index and long finger, important for utensil and implement control (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.jpg">Fig. 4</a>). </li> <li> Emphasize a simple, anesthetic, easily maintained, reliable design that can be understood and accepted by the user- a design with positive psychological connotations, reflecting the capability of the user. </li> <li> Incorporate passive support and suspension capacity (internal hook or bump) for carrying objects with handles or for supporting body weight while climbing or hanging. </li> <li> Require continuous control for grasping and holding to discourage muscle atrophy, enhance muscle development and allow for rapid reflexive grasping. Continuous control also creates an uninterrupted flow of pressure feedback information required for performance handling of objects. </li> <li> Select materials suitable for individualized age groups, rather than a single material for all models. Consider both the needs and the characteristics required for each population and design the model accordingly for each targeted group. </li> <li> Consider weight as a factor, but balance the need for light weight against the strength requirements for the terminal device. Also consider the tolerance the need for light weight against cause variation in age and corresponding tolerances vary. </li> <li> Redesign models as necessary to better answer the needs of the population they serve. </li> </ol> Exclusive of these criteria, a variety of factors exist which have aided the reintroduction of voluntary closing systems and which will increase the use of these systems in the future. Compatibility, harnessing, prosthesis design, proper rehabilitation and weight conditioning are all important if good to excellent prosthetic use is to be achieved. Voluntary closing terminal devices are compatible with all standard prosthetic components. Minor cable modifications or adjustments are usually required to optimize the user's energy output. Unlike previous voluntary closing designs, the user is harnessed under "controlled tension" rather than into a "no tension" system. Accordingly the thumb of the terminal device is not fully open, but pulled partially closed when the arms are relaxed at the user's sides. This tension harnessing allows for improved control of objects, during initial training, and while objects are manipulated close to the medial line of the body. Harnessing should be as simple as possible. A modified Northwestern #9 when possible is excellent, utilizing a ring and "rapid adjust" type buckle.<a></a> This harness system will enhance range of motion control at the shoulder, improve object manipulation overhead, and enable quick excursion adjustments. Prosthesis design should lean towards self suspending (supracondylar) sockets to minimize harnessing. Modified Muenster, Otto Bock, and similar designs can be employed depending on the limb's morphology. New designs such as ISNY or similar flexible sockets may also prove valuable. New patients should be educated in range of motion and pre-prosthetic exercise techniques.<a></a> This is especially important for traumatic limb loss and in instances where complete rehabilitation was lacking and the shoulder girdle and upper limb-musculature is weak and atrophied. Similar atrophication can occur due to disuse of the prosthesis or lack of vigorous bilateral use. Initially, muscle soreness at the shoulder may be experienced by the converting amputee, or the new amputee undergoing rehabilitation. This early soreness is a positive sign of muscle rejuvenation and should be regarded as improved health. However, long term muscle aggravation and soreness may be an indicator that the prosthetic system is not operating optimally. Prior to prosthetic fitting and after initial rehabilitation with the new voluntary closing prosthesis, weight training can be encouraged. Pre-prosthetic training can be accomplished by a knowledgeable therapist and should include a range of motion exercises, dynamic tension, and active bilateral resistance exercises using cuff weights, specialized training equipment, or a simple weight harness in conjunction with dumbbells. Post-prosthetically, the voluntary closing terminal device is capable of handling adjustable resistive weight equipment or free weights, although the former are easier to use, safer, and enable rapid, satisfactory results. An emphasis on strength and endurance conditioning rather than muscle building is suggested due to the needs for adequate range of motion in prosthetic control. This dictates lower resistance loads with more repetitions of exercises. Special applications for voluntary closing systems have also arisen in recent years. Brown<a></a> has achieved excellent success in patients with partial hand amputations. The success, I believe, is due to the common sense simplicity of the prosthesis and harness design, and the utility of the terminal device, which allows prehension in excess of 100 lbs. This amount of gripping force enables the partial hand amputee to be functionally bilateral in a manual working environment. Other terminal devices applied to the case of partial hand amputation cannot offer all the advantages of the new voluntary closing systems. Obviously, the partial hand prosthetic user will not wear the prosthesis all the time, but it is an effective functional tool for many occupations. The increased potential may enable the partial hand amputee to maintain an existing vocation rather than consider retraining for an entirely new occupation. In summary, the new voluntary closing systems offer a great deal of potential for the upper-extremity limb deficient of all ages. They can offer superior performance compared to any other systems, body powered or externally powered, and complement the externally powered prescription, when cosmesis is the primary consideration and function considered only of secondary importance. Voluntary closing systems are not a cure-all for the upper limb deficient individual, and the system is not applicable to everyone, even though all types and levels of amputees including bilaterals have used the technology successfully (excluding shoulder disarticulates). Success also has a lot to do with the attitude of the amputee and the capability of the rehabilitation team, including the prosthetist. Voluntary closing systems will continue to increase in popularity because the technology is reliable, improves performance, and more closely imitates the natural system. The voluntary closing systems will also continue to improve as more innovative research and development in better "total" body powered and hybrid body powered/external powered prosthetic technology evolves. References: <ol> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Klopsteg, Paul E. and Philip Wilson, Human Limbs and Their Substitutes. Hafner Publishing Company; New York. 1964. Reprint of 1954 Edition by McGraw Hill Company.</li> <li>Weaver, S.A. and L.R. Lange, "Myoelectric Prostheses versus Body Powered Prostheses with Unilateral, Congenital, Adolescent, Below-Elbow Amputees," American Orthotic and Prosthetic Association National Assembly Scientific Presentation on October 16, 1985.</li> <li>Mann, R.W., "Evaluation of Energy and Power Requirements for Externally Powered Upper-Extremity Prosthetic and Orthotic Devices," American Society of Mechanical Engineers. Publication No. 62-WA-121, 1962.</li> <li>Radocy, Bob, "The Rapid Adjust Prosthetic Harness," Technical Note, Orthotics and Prosthetics, Volume 37, No. 1, pp. 55-56, 1983.</li> <li>Bates, Marion D. and J.C. Honet, "Isometric Exercises for the Upper-Extremity Stump," Physical Therapy, Volume 44, No. 12, pp. 1093-94, December 1964.</li> <li>Deaver, G.G. and E.H. Daniel, "The Rehabilitation of the Amputee," Archives of Physical Medicine, Volume 30, No. 10, p. 638, October 1949.</li> <li>Gullickson, G. Jr., "Exercises for Amputees," Therapeutic Exercise, 2nd Edition. Sidney Licht, Editor, pp. 581-640.</li> <li>Klopsteg, D.E. and P.D. Wilson, Human Limbs and Their Substitutes, Hafner Publishing Co., pp. 739-756, 1968.</li> <li>Reilly, G.V., "Preprosthetic Exercises for Upper Extremity Amputees," The Physical Therapy Review, Volume 31, No. 5, pp. 183-188, May 1951.</li> <li>Olivett, Bonnie L., "Management and Prosthetic Training of the Adult Amputee," Rehabilitation of the Hand, 2nd Edition, C.V. Mosby, 1984.</li> <li>Brown, Russell D., "An Alternative Approach to Fitting Partial Hand Amputees," Orthotics and Prosthetics, Volume 38, No. 1, pp. 64- 67, Spring 1984.</li> <li>Radocy, Bob and Ronald E. Dick, "A Terminal Question," Orthotics and Prosthetics, Volume 35, No. 1, pp. 1-6, March 1981.</li> </ol> *Bob Radocy, M.S.T.R. Bob Radocy, M.S.T.R. is President of Therapeutic Recreation Systems (TRS), Inc. 1280 28th Street. Suite 3, Boulder, Colorado 80303-1797. Footnote A major objective of externally powered systems is to develop a reliable 'feedback' system for improved prehension control. Voluntary closing, body-powered systems offer the feedback system inherent in the design. Page Number(s) 82 - 86 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.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/1986_02_082/1986_02_082-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.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 Voluntary Closing Control: A Successful New Design Approach to an Old Concept Creator An entity primarily responsible for making the resource Bob Radocy, M.S.T.R. *