1 20 187 https://staging.drfop.org/files/original/9df687fab2e971e5bdb448b8747dc9eb.pdf 78bf41dbabb6870890e75cc378aa3af1 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_004.pdf Text Any textual data included in the document <h2>"Should Functional Ambulation Be a Goal for Paraplegic Persons." - Readers' Comments</h2> The <a href="cpo/1977_04_004.asp">above article</a>, which appeared in the last issue of the Newsletter elicited a great number of responses from physicians, orthotists-prosthetists, therapists, and counselors. More than 90 percent of our respondents agreed with Michael Quigley's position that the majority of paraplegic patients should be fitted with lower-limb orthoses despite the fact that use of such orthoses is extremely inefficient. The major reason for providing these orthoses to patients is to either have the patient prove to himself that he will not be able to walk in a normal manner again, or to make sure that every patient has a chance to walk, inasmuch as few patients are able to use orthoses even for transfer purposes or upright mobility. The following comments represent a consensus from our respondents: <h3>Indications For Fitting Paraplegics With Orthoses:</h3> Most respondents agreed that the T10 lesion level seemed to be on the border between a functional ambulator and a non-ambulator. One or-thotist-prosthetist responded that in his area the L1 level is used, as this is the most proximal innervation of the major hip flexors and hip hikers. Margaret Henry, R.P.T., of the Mt. Wilson Center in Maryland stated that the patient must first have abdominal muscles present and have a desire to walk. He is then fitted with trial braces and must be able to complete 200 lattisimus dorsi push-ups before he is fitted with his own braces. This exercise is used to determine if the patient would have the strength and endurance to ambulate functionally. Another therapist stated, "I enjoyed the article and comply with author. However the reasoning behind Cerney's conclusions or Hus-sey's conclusions are faulty. Their conclusions are valid only on the type of braces their patients had and type of training. Study should be qualified!" A rather interesting letter was sent in by Howard V. Mooney, CP. of Burlington, Massachusetts. Mr. Mooney stated that he had no experience with paraplegics but mentioned similar experiences with bilateral, above knee amputations. Mr. Mooney stated "I learned early in the profession that to some there is no such word as 'fail.' " He states that it is his policy to describe the facts and the pitfalls of walking on two above-knee prostheses but if the patient still wants to continue he gives them all the help and encouragement possible. <h3>What Orthotic Designs Do You Recommend For Paraplegic Patients?</h3> The most commonly mentioned design of orthosis is the Scott-Craig KAFO. The respondents preferred this because of the simplicity of design, the lack of a pelvic band, ease of donning, and control of ankle motion. Those readers that did not use the Scott-Craig system preferred plastic molded knee-ankle-foot orthoses or light-weight designs. No one recommended the use of a pelvic band. All respondents were quick to point out the indications for orthoses for children and polio patients differed from that for adult traumatic paraplegic patients. John Glancy, C.O., University of Indiana, Indianapolis feels that rehabilitation practitioners are making a mistake when they assume that present designs of orthoses begin to provide the mechanical aid paraplegics require. Mr. Glancy feels that patient's motivation towards walking is generally poor because they have to work with such inadequate orthotic systems. Mr. Glancy is presently working on a system that uses elastic material as a source of external power and sees this as a possible solution to the problem. <h3>Is It Practical To Expect Ambulation With LSHKAFO's (Bilateral Long Leg Braces With Night Spinal Attachments)?</h3> A resounding "no!" was given by all to this question. One respondent stated that this type of orthosis is too cumbersome and hard to don and that if the patient is so severely involved that he needs this measure of stabilization he undoubtedly lacks adequate muscular and respiratory reserve to ambulate any distance and is better off with a wheelchair. Mr. Robert Penny, C.O. of the Shelby State Community College and Leo Betzelberger, R.P.T. of the VA Spinal Cord Injury Center, Memphis, Tennessee stated that we have had 3000 (conservative) spinal-cord-injury patients as of 1948 and gradually abandoned LASKAFO's as they were just thrown in the closet. We found patients could ambulate up to T10 with KAFO's in parallel bars. Daily living at home negates KAFO's too. We do try to keep them in metal KAFO's for dorsiflexion and ankle protection. Probably the most interesting response on this question came from Frank W. Clippinger, M.D., Duke University Medical Center, Durham, North Carolina. Dr. Clippinger stated "from a purely practical standpoint anyone in their right mind won't bother with this. By locking the trunk to the thighs and the legs to the feet is not standing in the true sense. It is lying down vertically. I think this treats the therapist, orthotist and the doctor but not the patient. The same function can be accomplished using a coffin instead of braces as is perfectly evident in the Egyptian section of any museum." In summary, the vast majority of all respondents felt it was important to give paraplegic persons the chance to stand and ambulate for the many reasons stated above. The term "motivation" ranked very high on everyone's list as one of the major indications for providing orthoses to paraplegic persons. For this reason I think it is proper to finish this synopsis of our readers comments with another quote from Howard Mooney, CP., "Never underestimate the potential of anyone with unlimited motivation." Page Number(s) 4 - 5 Year 1978 Volume 2 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Text Copy Edit Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "Should Functional Ambulation Be a Goal for Paraplegic Persons." - Readers' Comments https://staging.drfop.org/files/original/30c31f3ab0a1bb7bf6b2fed3d44ab98e.pdf 1b4c13b6fe4572542d88a4b6b1765e21 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_03_001.pdf Text Any textual data included in the document <h2>"The Geriatric Amputees" - Results of the Questionnaire</h2> There were twenty-three replies by mail to the questionnaire on management of lower-limb geriatric amputees that appeared in the Spring 1977 issue of the NEWSLETTER. Ten were signed by prosthetists, five came from M.D.'s and two from therapists. The remarks included on the six unsigned forms appear to have come from prosthetists. The raw results, question-by-question, are shown below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? PROSTHETISTS <blockquote> AK yes: 15, No: 1 BK yes: 14, No: 2 </blockquote> Comments made by the prosthetists: <ul> <li> They cannot be made too light. </li> <li> We use endoskeletal AK set ups and light feet as often as possible to reduce weight. </li> <li> Yes. Unless "conventional" prostheses are already very light. BK's should weigh between 1 1/2 - 3 lbs. and AK's from 4 1/2 — 6 1/2 lbs. Decreases energy consumption, eases suspension. Soon, however, new materials and techniques should allow all prostheses to weigh about the same. Major difference for geriatrics is not weight but socket comfort and cost. </li> <li> A major complaint from the geriatric patient is the weight of the prosthesis. </li> <li> In most cases conventional prostheses are prescribed and the geriatric patient has trouble with them usually because of the weight. But age and strength are the difference. </li> <li> This is debatable, each case should be considered individually. I feel that most geriatric males would prefer a conventional prothesis. </li> <li> As much weight as you can knock off the better. The old story of the leg being so light that in a strong wind it is hard to control, just a tale. </li> <li> Whenever possible, a light-weight prosthesis is desirable for geriatric patients. </li> <li> Patients' resources less and need for strength not important, </li> <li> I do not feel that this is a very major issue as far as function is concerned. Most patients complain about weight early but those who do function do not continue these complaints, </li> <li> It is generally desirable that prostheses be as light as possible. </li> <li> Light limbs seem to be tolerated much more than the heavy limb. </li> <li> An attempt is always made to maintain lightness in all prostheses, however, especially AK geriatrics who are fighting quite a lever arm in regard to weight. </li> <li> The decrease in energy out-put during ambulation is very important for the geriatric amputee. Decrease in weight decreases energy out-put which in turn decreases the stress on the cardiovascular system. </li> <li> Even where a geriatric has not experienced an amputation, there is loss of muscular strength. This is the primary-reason for a lighter prosthesis. </li> </ul> PHYSICIANS AK Yes: 5, No: 1 BK Yes: 4, No: 2 <ul> <li> If the geriatric amputee is unable to manage the conventional prosthesis, making a lighter limb increases his difficulties when walking in a high wind or deep snow. In these cases I fit the geriatric amputee with an articulated peg leg invariably with a successful result. </li> <li> Initially they do quite well, however, a lighter, especially AK prosthesis would help. </li> <li> I think all prostheses should weigh less, particularly for geriatrics. The prosthetists should go to extra lengths to thin out the shell of exoskeletal limbs as thin as possible and consistent with durability. This is just not done enough with the shins of AK and BK prostheses. </li> <li> If there is sensory loss, a heavier prosthesis for sensory feedback may be necessary. </li> </ul> THERAPISTS <ul> <li> One therapist felt that both the AK and BK prosthesis should weigh less than the conventional and commented that "Patients seem to prefer an extremely lightweight prosthesis." The other therapist did not check any of the boxes but wrote in "Individualized Adjustment" and commented that "A neurophysiological functional evaluation should determine if the patient responds better to heavier or lighter sensory bombardment." </li> </ul> DISCUSSION The great majority of clinicians seem to feel that lower-limb prostheses that weigh less than those generally available are desirable for the older patient. </li> <li> What type of knee do you generally use for above-knee cases? PROSTHETISTS <table style="border-style: none; width: 338px; margin-left: auto; margin-right: auto;" height="120"> <tbody> <tr> <td>Manual lock</td> <td>6</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>10</td> </tr> <tr> <td>Other (please specify)</td> <td>11</td> </tr> </tbody> </table> Prosthetists' comments were as follows: Manual Lock: <ul> <li> Treatment for the dysvascular amputee should always be separated from geriatric amputees with other causes for amputation at Rancho, well over 90 percent of amputations are secondary to vascular problems. Manual lock knees have cut down PT time by two weeks, and, combined with an adjustable socket, have made it possible to convert nearly all of our dysvascular AK's into prosthesis wearers and more importantly, they use them. </li> <li> At our clinic either the adjustable AK "Rancho design" or conventional AK have locking knees. </li> <li> We have not been pleased with the various "safety" knees. The only really useful one is the SHS — we do not use it for geriatric patients, but it's the best. </li> <li> Balsa Lock knee, wherever possible, light weight foot with soft heel. Polypropylene joint and band (where stump is long) </li> </ul> Weight-Bearing (Safety-Knee): <ul> <li> The friction lock type of knee will work for 80% of the AK's. </li> <li> The weight-bearing knee seems to be the most easily managed by elderly amputees. </li> <li> Manual lock knees only when safety knee is inadequate. </li> <li> I prefer endoskeletal. </li> <li> About 90% of our geriatric patients are fitted with friction locking knees and 10% are fitted with manual locks. </li> <li> Aside from poorer musculature, the evidence of less proprioception illustrates that the AK geriatric has difficulty knowing where his knee and foot are. Only in extreme severe muscular weakness is a manual lock prescribed. </li> </ul> Manual lock & Weight-bearing (Safety) Knee: Varies with patient need. All three types marked: <ul> <li> Depends on needs of the patient and his ability to control the knee with his own efforts, as well as his expected level of performance. </li> </ul> Other: <ul> <li> Constant friction knee for the elderly. Not much maintenance problem. Variable gait is not an important factor. Mauch S-N-S for the younger amputee. </li> </ul> None Marked: <ul> <li> My approach is to evaluate each person individually. Our primary knee is the Bock Safety knee, relying primarily upon alignment stability and fast plantar flexion of S/A foot. I use Kolman only when absolutely necessary due to noise problems. </li> </ul> PHYSICIANS <table style="border-style: none; width: 390px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock</td> <td>2</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>3</td> </tr> <tr> <td>Other (please specify)</td> <td>0</td> </tr> </tbody> </table> The physicians comments were as follows: Manual Lock: <ul> <li> Bock Geriatric. Most often. Weight-bearing (Safety) knee, seldom. Often knee lock with option to give constant friction if open, as a trial. </li> <li> Safety is very important. There is more energy required to operate a safety knee (Bock). I reserve it for the younger amputee. </li> </ul> Weight-Bearing Safety Knee: <ul> <li> We need a manual lock that is sturdier than the Bock geriatric knee. Ideally someone should manufacture a lock that could be placed on the outside of the prosthesis so that if patient finally confident enough with free knee after practice he could remove it. </li> <li> I usually use the Otto Bock Safety knee which stands use by the geriatric amputee well. However, have run into breakdown problems with this knee in my younger patients. </li> </ul> THERAPISTS The comments from the two therapists were: <ul> <li> Knee usually depends on patient's functional demands, equipment cost, prosthetist convenience in non-standard set-ups in that order. </li> <li> My training is deficient in the prosthesis — but excellent in observation of physiological response. </li> </ul> DISCUSSION Opinion on use of manual lock versus the weight-bearing (Safety) knee is slightly in favor of the weight-bearing (Safety) knee. Certainly the weight-bearing units provide more function and better appearance when they can be used. It is gratifying to find that so many prosthetists and physicians are being successful with the more functional units. </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? PROSTHETISTS Yes: 7 No: 8 No experience: 1 <ul> <li> No, Have not used them for 5 years — patients would not wear them after six months. </li> <li> No. We have used them, however, the cases were to prove to the patient the difficult task it is to master bilateral AK prostheses. The stubbie is a substitute but not a good one. </li> <li> No. Much trouble and expense for very little benefit. Most should not be fit at all. If fit, shorten slightly but include knee joints for sitting purposes. Stubbies cause problems in wheelchairs, look horrible and do not convert non-users of prostheses into users. </li> <li> No. In most cases the bilateral AK patient has had extensive vascular surgery and scars in abdomen and scarpas are too much of a problem. </li> <li> No. Most would rather sit in a wheelchair. </li> <li> No. We have not had the occasion to use them. Geriatric amputees, with therapy, are able to use light-weight prostheses with weight bearing knees. </li> <li> No. We've tried stubbies in a few cases where we thought the patient could eventually go to regular legs. A better idea is pylons — you can adjust them. No one uses stubbies permanently — a wheelchair is much more functional. </li> <li> No. Stubbies make patients look like "freaks", they think. Patients are more functional in wheelchairs. </li> <li> Yes. Only if there is a good P.T. program. </li> <li> Yes. To permit A.D.L. in the home — We have 2 cases of short A.K.'s who did so well they demanded full length prostheses and did fair. </li> <li> Yes. As temporaries to define the patient's functional potential both to him and to the clinic team. </li> <li> Yes. If bilateral amputation occurs simultaneously. </li> <li> Yes. It is a way to allow an individual independence and mobility without the problems of knee control. </li> <li> Yes. There are amputees that can walk with stubbies and not walk with bilateral A/K prostheses therefore it is desirable in obtaining an accurate assessment of prosthetic potential. </li> <li> Yes. Bilateral stubbies offer safety that no AK with knees can offer. The CG is closer to the earth, and there is less weight to be manipulated. I would recommend stubbies for the desirable active AK. </li> <li> No opinion. I have no experience in this area. </li> </ul> PHYSICIANS Three physicians were opposed to the use of stubbies and two felt that their use is indicated. The physician's comments were: <ul> <li> No. Stubbies are unsightly ugly things, besides (they) cost as much as prostheses. I very seldom prescribe bilateral AK prostheses to geriatric patients. The few knees I did, the prosthesis ended up in the closet. However, an occasional patient may do well, however, when the prostheses are made several inches shorter than patient's original height. Each patient is pretested with pylons. </li> <li> No. I do not believe in fitting bilateral AK's with vascular disease. If young and vigorous and traumatic — and candidate for limited walking with bilateral AK prostheses — should be fitted with full length. </li> <li> No. Not in the geriatric, but useful in young adults. </li> <li> Yes. Useful around the house if patient wants them. Cosmesis bad. Useful for training. </li> <li> Yes. I regard this as an essential if the bilateral amputee is to learn to walk satisfactorily. </li> </ul> THERAPISTS Both therapists felt that use of stubbies is desirable. Their comments were: <ul> <li> Yes. Stubbies are desirable to demonstrate to most patients that the amount of energy expended is usually not worth the effort, from a functional point of view. </li> <li> Yes. Any reasonably balanced device helps maintain balance and muscle strength. Prevention of disuse atrophy. </li> </ul> DISCUSSION The respondents were almost equally divided on the issue of stubbies, and without exception each respondent offered a comment. The comments seem to indicate that in spite of drawbacks stubbies can be used successfully in certain settings, and that a careful, thorough evaluation of this procedure is needed. </li> <li> In your opinion, is immediate postsurgical fitting of prostheses desirable for geriatric cases? PROSTHETISTS Eleven prosthetists felt that immediate postsurgical fitting is indicated for geriatric patients; five felt that the procedure was contraindicated, while one felt that it would probably be useful if orthopaedic surgeons performed the amputations. Their comments are as follows: <ul> <li> Yes. We only recommend a rigid dressing. Only after wound healing has been ascertained do we apply a pylon. </li> <li> Yes. If there is a good P.T. program; otherwise only the rigid dressing should be used. </li> <li> Yes. This treatment doesn't allow the geratric amputee to become comfortable in a wheelchair thus losing strength and endurance. </li> <li> Yes. The PT Department starts working with the patient within 24 hours and the chances are (that) contractures and depression won't occur. </li> <li> Yes. BK's only. AK's too much trouble for benefit accrued. </li> <li> Yes. Immediate fitting is good for everyone. But its hard to do — hard to supervise, takes a lot of effort so its not done. </li> <li> Yes. For below-knee patients who have the ability to coordinate the post surgical dressing and pylon. </li> <li> Yes. I feel immediate post surgical fittings minimize loss of strength which is very critical in the geriatric cases. </li> <li> Yes. I.P.S. fittings are desirable for any amputee, aside from trauma cases. The less muscle tone the geriatric loses the better his chances are of becoming a successful prosthetic candidate with I.P.S.F. This is possible. </li> <li> No. The results I have witnessed have been mostly unfavorable. Perhaps if the orthopedic surgeons did more of the amputations it would be more advisable. </li> <li> No. Rigid dressings for BK's should be used for 10-14 days then a temporary prosthesis for 2-4 weeks. Immediate post-surgical fittings encourage too much activity and it is too hard to control the stress the patient is placing on the wound. </li> <li> No. We never use immediate postsurgical fitting. Stumps should be healed before shrinkage is attempted. After stump is healed, we use laminated plastic sockets on temporary units for definitive shrinking. </li> <li> No. Low tolerance. </li> <li> (Nothing marked) It depends on the patient's prior medical history. We would not recommend it for diabetic patients. </li> </ul> PHYSICIANS Two physicians felt that immediate postsurgical fitting had a place in management of geriatric patients; two felt otherwise; and one had no experience on which to base an opinion. Their comments were: <ul> <li> Yes, If you have full team approach including nurses who fully understand principle. Otherwise early temporary fitting with good control of stump edema may be second best alternative. Two months is still a long delay. </li> <li> Yes. I do not feel that a differentiation need be made unless there are other conflicting medical factors, e.g. heart disease. </li> <li> No. But I prefer rigid dressings with early fitting when wound is fully healed. </li> <li> No. No benefits except psychological, and many dangers. Use of cast is OK in many cases, but adding prosthesis courts disaster. </li> <li> (Nothing marked) I cannot express an opinion since in our institution immediate post surgical fitting is not being done at all. </li> </ul> THERAPISTS Both therapists felt that immediate post surgical fitting is useful. Their comments were: <ul> <li> Yes, . . . but please see abstract of article to be published in American Journal of Surgery {which will be publishing in a future issue. Ed.). I feel that very few people now are using the prosthesis on an immediate basis, but our prospective study well documents the value of the rigid dressing in the postoperative care of the BK amputee. </li> <li> Yes. Normal physiology maintained at maximum potential. </li> </ul> DISCUSSION The replies to this question indicate that the use of a rigid dressing is used widely and that immediate postsurgical fitting is used more than is generally expected. Perhaps the reports on the study at Iowa will encourage others to adopt these advanced techniques. Other clinics with experience should publish results of their clinical program. </li> <li> In your opinion what is needed to improve the function of geriatric amputees? All of the respondents commented on this question. Their comments were as follows: PROSTHETISTS <ul> <li> The lightest prosthesis with the safety factor at the knee system (being) the main factor. </li> <li> A better method of suspending the AK prosthesis. Total suction does not work, rigid pelvic belt is a fair substitute, but (is) heavy. Something better is needed. </li> <li> Vascular surgery is often indicated but compounds our fitting problems. After several surgical procedures — physiologically and psychologically the patients require more professional service — let us all hope that more orthopedists would become more involved in amputation surgery. </li> <li> An adjustable BK socket that is permanent. It can be fit(ted) instead of a "temporary" and will adjust throughout the "maturing" process. (It) will save time, as patient can adjust it and since a temporary is not needed, it will save dollars. Most physicians are looking for a cheap geriatric prosthesis, although they will state "light duty" or "lightweight" or "sitting prosthesis." </li> <li> I believe the prosthetic components that we have now are all we need: However the P.T. program needs to be reevaluated. </li> <li> Better pre-op and initial post-op care. </li> <li> This is where the total team is so very necessary. Pre-surgical consultation, pre-prosthetic care and post prosthetic training and followup. Outpatient care for the amputee is practically overlooked by the doctors and the subsidizing agencies, the insurance companies, Medicare and Medicaid. The patient can only receive adequate care as an inpatient. Usually his funding is exhausted by the time he is ready for prosthetic fitting. </li> <li> A lightweight single axis foot. More training for surgeons (general and vascular) to give the patient a chance for a BK, when the problem is in the toes or ankle; also teach them how to bevel and round the tibia. </li> <li> Articles such as this help spread information that geriatric patients can utilize a prosthesis. Motivation is an important factor. Two days ago we fitted a 91-year-old man with a prosthesis and his initial attempts have been excellent. </li> <li> Lighter prostheses, greater emphasis on use of temporaries in early phase of rehabilitation. </li> <li> Quicker fabrication and more adjustable prostheses. We use Polysar sockets and pylons. We can make adjustments easily and get (out) the prosthesis quickly. </li> <li> The limiting factors in geriatric amputees are motivation, coordination, and endurance. The therapist has the best chance to do something about these things. </li> <li> Patient compliance and patience with the amputee. </li> <li> Better post-surgical physical therapy. Some method to decrease the long periods of inactivity and confinement to a bed prior to amputation. </li> </ul> Follow-up programs. <ol> <li> Successful therapy program (before and after fitting) </li> <li> A competent prosthetist — follow-up necessary </li> <li> A sound instillation of confidence to the geriatric </li> <li> A good exoskeletal safety knee (needs) to be developed. </li> </ol> PHYSICIANS <ul> <li> Enthusiastic team work and total care of the patient to include medical, socioeconomic and vocational aspects. </li> <li> Immediate referral to a rehabilitation department to teach necessary conditioning exercise, range of motion exercise to prevent contracture and stump conditioning. </li> <li> More interest and concern of plight of elderly person with vascular disease by surgeons in particular, but also by physicians in general. And I don't mean simply interest in the pathophysicology and surgical approaches to arteriosclerosis. </li> <li> Improved sensory feedback </li> <li> Improved training procedures </li> <li> Improved knowledge of what the patient really needs </li> </ul> THERAPISTS My concern is the bracing needed for C.V.A.'s. Our suggestion to our Medical Chief of Staff is to invite your representative to hold a seminar in our hospital. Generally we need to sell the success of fitting the geriatric AK from the standpoint of requiring less in terms of third-party paid institutionalization or purchased services. An AK patient on a walker is much easier to deal with than a one-legged wheelchair-bound patient. In short, we need to emphasize the 4 successes of 10 attempts, and demonstrate this success in a cost-effective manner. This is the only language cost conscious bureaucrats will understand. Additionally, many patients report positive attributes of independence in gait, so they "don't have to depend on or bother their family or friends." At the same time, we need to strive to improve our care package so as to raise the percentage of AK's who become independent with their prostheses. </li> </ol> SUPPLEMENTARY DATA To augment the data provided by the 23 questionnaires returned through the mail, prosthetists attending the instructional course in molded plastics sponsored by the American Academy of Orthotists and Prosthetists and held in Kansas City, Missouri, July 15-16, 1977, were asked to fill out the questionnaire. Forty-one did so. The results are given below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? AK Yes: 41 No: 0 No mark: 0 BK Yes: 39 No: 0 No mark: 2 </li> <li> What type of knee lock do you generally use for above-knee cases? <table style="border-style: none; width: 402px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock:</td> <td>15</td> </tr> <tr> <td>Weight-bearing (Safety Knee):</td> <td>22</td> </tr> <tr> <td>Other:</td> <td>3</td> </tr> <tr> <td>No mark:</td> <td>5</td> </tr> </tbody> </table> (Four people marked two places. Most of the 5 not marked made some kind of comment.) </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? <table style="border-style: none; width: 401px; margin-left: auto; margin-right: auto;" height="123"> <tbody> <tr> <td style="text-align: left;">Yes:</td> <td style="text-align: left;">21</td> </tr> <tr style="text-align: left;"> <td>No:</td> <td>19</td> </tr> <tr style="text-align: left;"> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> (One person checked both yes and no.) </li> <li> In your opinion is immediate postsurgical fitting of prostheses desirable for geriatric cases? <table style="border-style: none; width: 400px; margin-left: auto; margin-right: auto;" height="121"> <tbody> <tr> <td>Yes:</td> <td>25</td> </tr> <tr> <td>No:</td> <td>14</td> </tr> <tr> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> </li> <li> In your opinion what is needed to improve the function of geriatric amputees? <ul> <li> Improved knees and feet of lighter weight. </li> <li> In hospital prosthetic facilities so therapists and prosthetists could give combined and closer supervision to walking training, etc. </li> <li> Suspension in geriatrics seems to cause weight and cosmetic problems. </li> <li> A good pre-prosthetic program, a qualified P.T. and a well fitting lightweight prosthesis. </li> <li> Proper post surgical supervision and gait training with prosthesis. Lighter prosthesis that is more comfortable. </li> <li> A good sound Rehabilitation program: 1. Good Amputation; 2. Good prosthesis; 3. Good P.T. </li> <li> Simple donning procedures — less weight, uncomplicated mechanics to understand. </li> <li> Closer observation and good rehabilitation work after surgery so the patient will have the best chance possible of becoming self-sufficient. </li> <li> Reduced weight/energy consumption. </li> <li> Getting them in better physical condition prior to prosthetic fitting. </li> <li> Better physical therapy and PT follow-up. </li> <li> Better materials other than plaster, transparent materials perhaps, lighter weight, orthoplast possibly. </li> <li> More the patients can do for themselves, less care needed by other people. </li> <li> Feather weight prostheses, and 2) team approach management. </li> <li> You can put a safety knee and a two way ankle. </li> <li> (I don't know) I have been fitting AK prosthesis for only a year therefore the above information may not be of value due to my personal lack of experience. </li> <li> Lighter materials. </li> <li> Better communication between the doctor, therapist, prosthetist and patient. </li> <li> Most patients need one person, as overseer, who can control his rehab program, — a coordinator. </li> <li> Immediate post-operative fitting. </li> <li> Lighter prosthesis. </li> <li> Increased physical therapy, —early as possible. </li> <li> More lighter and durable prosthesis and exercise. </li> <li> Exercise. </li> <li> Lighter weight and a more positive attitude about age and life in the future. </li> <li> Proper instruction in wrapping, exercise, etc. </li> </ul> </li> </ol> DISCUSSION The supplementary data agrees remarkably well with that received through the mail, and only reinforces any conclusions that can be reached from the information supplied by the original 23 respondents. It seems that geriatric patients are receiving considerable attention throughout the country and while the results are good considerable refinement in devices and techniques will be welcomed. Reduction in weight of artificial legs for all levels of amputation through the lower limb seems to be indicated, and improved knee control units are needed by above-knee (and hip-disarticulation) cases. The use of stubbies certainly needs clarification, probably through a well-ordered study. Page Number(s) 1 - 5 Year 1977 Volume 1 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "The Geriatric Amputees" - Results of the Questionnaire https://staging.drfop.org/files/original/3c4ac589e8903780aa0da08c35aaeb58.pdf c97b050714fb3e489b9de161df583e40 https://staging.drfop.org/files/original/e764f2e58593ada37005d3d671580fcc.jpg e1b3b3b57afea255233eea6635c36111 https://staging.drfop.org/files/original/8d7c38e3e14f7ff5264b9dc030615015.jpg 6fcb2c844c796a0566c819a3ec665430 https://staging.drfop.org/files/original/3f65a33756d243d9afabd2712fe9240b.jpg 7e2a8536aa8f9635302e070c9e7f99ca https://staging.drfop.org/files/original/c0094ee66e32340329fd3c14ab5fdbf2.jpg 95b1799693489eae13885500343e64d2 https://staging.drfop.org/files/original/11c6bea9e74d7b47e03c2f589c5f3dcc.jpg c17a38b68b4a2e9a28ba4bfc88b46ab0 https://staging.drfop.org/files/original/a9f74838bb3d260e38168c79e38c620a.jpg c910911d2c29aac18ef5344138533538 https://staging.drfop.org/files/original/6c3b995cb38a1514af6eaf680994ddd0.jpg 29990018762f14ec45b71e8106effaaf https://staging.drfop.org/files/original/4efea2cf8a0ab176b2e02167045bf2c0.jpg f505f6705bbc9e93d3772e72f9a5b118 https://staging.drfop.org/files/original/f88f0a978929d9669ad1e8001308498d.jpg 2ed82df089dc35c181a50d43ec37a98e https://staging.drfop.org/files/original/e1c24db93cdb2a299cab3af1da2f2dc9.jpg 560f2db154b03d37f12eb9b6d864e7d2 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_03_013.pdf Text Any textual data included in the document <h2>A Below-Knee Weight-Bearing Pressure-Formed Socket Technique</h2> <h5>Robert F. Hayes, CP. <a style="text-decoration: none;">*</a></h5> I'm pleased that the Academy has requested that I update and rewrite the Below-Knee Weight-Bearing, Pressure-Formed Socket Technique article I originally wrote in 1975. It's hard to believe that ten years have passed since the original publication of this paper. I haven't made any significant changes regarding the principles or application of this procedure, but let's go back to some of the reasons this concept was developed. <a href="/files/original/e764f2e58593ada37005d3d671580fcc.jpg">Fig. 1.</a> Place a sheet of plastic wrap, such as Saran, over the patient's stump to keep it clean and to ease removal of the cast. As I explained in the original article, my son was being fitted for ski boots and it occurred to me that we might make use of some of the techniques used by ski boot designers. The ski boot had an inflatable inner bladder. With the foot under weight-bearing, a conforming material similar to certain silicone compounds was injected into the bladder to give a perfect form-fitting in the attitude of weight-bearing. The incentive to apply this technique to limb prosthetics was reinforced while I was casting a below-knee patient who was a dentist. We exchanged thoughts on molds and changes when pressures are applied. Dentists take one mold for a cast which is filled with dental impression cream (similar to alginate). This is applied to the patient under pressure to give a more accurate impression, and then this is filled to form the definitive positive mold. The standard method of fitting a below-knee amputee involves taking a negative cast in a non-weight-bearing condition, forming a positive model, modifying it in size to present dimensions by removing material to create pressure, and applying material to relieve pressure on the stump as appropriate. A socket is then molded over this model with the hope that, with small adjustments, it will fit the patient. Wouldn't it be wiser to develop a socket under pressure that will adjust to and fit the patient, rather than fit the patient to the socket? In trying to answer this question, the procedure described here was developed. <a href="/files/original/8d7c38e3e14f7ff5264b9dc030615015.jpg">Fig. 2</a>. Apply cast sock and felt relief pads. <a href="/files/original/3f65a33756d243d9afabd2712fe9240b.jpg">Fig. 3.</a> Using Plaster-of-Paris, wrap the residual limb in the usual manner. <a href="/files/original/c0094ee66e32340329fd3c14ab5fdbf2.jpg">Fig. 4</a>. Remove the tube gauze and felt buildup from the negative cast. <a href="/files/original/11c6bea9e74d7b47e03c2f589c5f3dcc.jpg">Fig. 5.</a> Pour and modify the positive model. <a href="/files/original/a9f74838bb3d260e38168c79e38c620a.jpg">Fig. 6</a>. Build up the distal end of the positive model at least 1". <h3>The Procedure</h3> Measure the patient in the usual manner. Place a sheet of plastic wrap material, such as Saran, over the patient's stump to keep it clean of indelible pencil, and to make removal of the cast easy. If a wool sock is to be used, apply it, and then apply the plastic wrap. Apply a cast sock or tube gauze over the stump. Bond 1/4" felt over all pressure-sensitive areas: the crest of the tibia and the head of the fibula. Keep in mind that all areas being built up will be filled with alginate to give contact, yet minimizing pressure. There are some prosthetists who have adopted this technique and claim they apply direct pressure over the crest of the tibia. My experiences do not agree with that. In particular, since many of our patients are diabetic with very thin skin, extra caution should be taken to reduce pressure and especially friction over all bony prominences. Using elastic Plaster-of-Paris bandage 4" wide, wrap the stump in the usual manner, and reinforce with 3" or 4" wide regular plaster bandage. Remove the cast and remove the tube gauze and felt buildup from the negative cast. Pour the positive model, remove the negative cast, and modify in the usual manner, but do not touch areas that were covered with felt. Build up the distal end of the positive model at least 1". <a href="/files/original/6c3b995cb38a1514af6eaf680994ddd0.jpg">Fig. 7.</a> Set up the transparent check socket for dynamic alignment. <a href="/files/original/4efea2cf8a0ab176b2e02167045bf2c0.jpg">Fig. 8.</a> Pour the alginate and let it escape through the distal holes until the patient is lowered into the socket to the proper level at which time the holes are blocked. The alginate will then escape along the proximal brim of the socket. Make a check socket. This is a perfect application for vacuum-forming. Plaster bandages or laminates can, of course, be used. Drill two holes 1/4" in diameter in the distal end and rough up the inside surface of the socket. For the first fitting, apply the stump sock of choice, and place plastic "wrap" over the stump sock to act as a separator. An invaginated balloon will not work because it adheres to the alginate that is to be used later. Some prosthetists apply the check socket to the patient's bare stump (no socks) for visual inspection. It bothers me to think what happens to the fit of this socket when the prosthesis is finished from this exact mold and the patient applies the usual stump sock of 3-ply or 5-ply. When the check socket is applied on new patients, I recommend using a thin-fitting sock in anticipation of stump atrophy. On seasoned, well-shaped stumps, I use the same sock that the patient usually wears. When using inserts that tend to compress, i.e. Pelite®, you may use a 3-ply and, after several weeks of prosthetic use, the socket should accommodate a 5-ply sock. Of course, there are many factors to be considered, and this is the area where the prosthetist's knowledge and experience will play the major role as to how well his or her patient does. Mix about 1/2 pint of dental impression cream or alginate (which is more economical). Pour about 1/3 of the total amount in the distal part of the socket and, with a spatula, spread the rest around the remaining surface of the socket. It is necessary to work quickly at this point. Place the socket on a fitting stool adjusted for height. Use some sort of pad to prevent slipping and cover the drilled holes in the socket with your thumb and forefinger. Have the patient place his stump in the socket. Let the alginate escape through the distal holes until the patient is lowered into the socket to the proper level, at which time the holes are blocked. Alginate will now escape along the proximal brim of the socket. <a href="/files/original/f88f0a978929d9669ad1e8001308498d.jpg">Fig. 9.</a> The completed socket. <a href="/files/original/e1c24db93cdb2a299cab3af1da2f2dc9.jpg">Fig. 10</a>. The completed socket. As soon as the alginate has set up, remove the stump from the socket and immediately fill the socket with plaster. The rigid socket and alginate are removed by using a cast cutter. The mold resulting is a perfectly smooth, pressure-formed, positive mold that can be used in any method of fabrication desired. When this technique is used, patients can be fit with sockets without soft liners. Only a minimal amount of additional time is required. I feel that the technique allows better fitting of "problem" stumps and that it may be used as a routine procedure to advantage, especially in central fabrication systems. Vacuum-forming procedures recently introduced make this approach to fitting even more attractive. We have since switched to clear plastic check sockets for the obvious advantage of visual inspection and also the ability to adjust check socket pressure areas with a heat gun on some plastics. We also now fit the check socket on the adjustable leg, rather than the fitting stool. This better simulates the pressures exerted on the stump by the definitive prosthesis, since we all agree that socket alignment greatly affects the application of pressure. I know that this procedure has been used by many prosthetists in various parts of the country, and I have received many favorable comments about the benefits to the patient. This pleases me because this is the goal of the process. I'm sure that in the future new devices and innovations will continue to add to and improve this concept to even greater benefit of the patient. *Robert F. Hayes, CP.President of Hayes Prosthetics, Inc., 1309 Riverdale Street, West Springfield, Massachusetts 01089. Page Number(s) 13 - 16 Year 1985 Volume 9 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 8 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1985_03_013/1985_03_013-10.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 A Below-Knee Weight-Bearing Pressure-Formed Socket Technique Creator An entity primarily responsible for making the resource Robert F. Hayes, CP. * https://staging.drfop.org/files/original/55a3a7b173a4ea49841968b5b80df860.pdf 30ec3d14f98a7ba60ecf7428947253e5 https://staging.drfop.org/files/original/3fc21ceaa5b19ada556ba3270df45738.jpg 02bb4d6365ac241f87b6773edcb7e0c1 https://staging.drfop.org/files/original/8f618f54353873ee21984ffd68d8d05a.jpg c3e7d29a8e7b778ed3c74a7defb1e58b https://staging.drfop.org/files/original/44447ecd073a0cc7c351cea452163a32.jpg ee515bdf345c39774428067d5ecef159 https://staging.drfop.org/files/original/5b949cda2964dd9764e61908c066bc6f.jpg 760890658c08795998286568770b9a05 https://staging.drfop.org/files/original/12b48da7443410fc2c39aec2a208a4a8.jpg 517767050abb9972fcd7bb791f3c924c https://staging.drfop.org/files/original/c0bda2f49bcde7fbdb45d9aa932572f0.png da19301ad0fdfca7f5f640abb9c3b40b 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_01_009.pdf Text Any textual data included in the document <h2>A Case History: Clinical Indication for Flexible Above-Knee Prosthetic Socket</h2> <h5>Howard Adelglass, M.D. <a style="text-decoration: none;">*</a> Don Sung Chu, M.D. <a style="text-decoration: none;">*</a> H.R. Lehneis, Ph.D., CPO <a style="text-decoration: none;">*</a></h5> R.W. is a 62 year old male with a 32 year history of insulin dependent diabetes mellitus. He was in a normal state of good health until August, 1982 when he developed gangrene of the first three toes of his left foot. A left femoral popliteal bypass was performed unsuccessfully. He then underwent a left below-knee amputation which also was unsuccessful and, in October, 1982, a left above-knee amputation was done. In December, 1982, he was admitted to the Institute of Rehabilitation Medicine, NYU Medical Center(IRM-NYU) for a prosthetics rehabilitation program. At that time, his stump became infected and dehisced, requiring stump revision. In July, 1983, he was readmitted to IRM-NYU and started on gait training with an AK prosthesis with a semi-suction socket, hip joint and pelvic belt, polycentric knee joint (Lang) and SACH foot (<a href="/files/original/3fc21ceaa5b19ada556ba3270df45738.jpg">Fig. 1</a>). During the course of his rehabilitation training, he began complaining of pain at the distal stump. The socket was adjusted numerous times by alternately relieving painful areas distally and placing padding above these areas, but with little success. Subsequently, x-rays taken of the stump revealed a small amount of soft tissue calcification distally with a small spur at the posterior lateral side of the femur (<a href="/files/original/8f618f54353873ee21984ffd68d8d05a.jpg">Fig. 2</a>). The patient was started on anti-inflammatory agents which provided a moderate amount of pain relief. However, he still had difficulty ambulating secondary to stump pain. A lateral pad above the distal end was inserted into the prosthesis which relieved some of the pain. However, within a few days, the patient developed a skin breakdown in the left peroneal area, and an erythematous area on the distal stump. The patient was not allowed to wear his prosthesis for 2 1/2 weeks. During this time, a repeat stump x-ray showed a large spur in the posterior lateral side of the distal stump and more soft tissue calcifications on the anterior surface of the stump (<a href="/files/original/44447ecd073a0cc7c351cea452163a32.jpg">Fig. 3</a>). Consequently, a new socket was designed to give relief over the distal anterior and posterior stump in order to decrease the pain and improve ambulation. This socket consisted of a vacuum-molded ionomer (Surlyn®) flexible socket contained in plastic laminated socket. There were fenestrations put into the anterior (<a href="/files/original/5b949cda2964dd9764e61908c066bc6f.jpg">Fig. 4</a>) and posterior walls (<a href="/files/original/12b48da7443410fc2c39aec2a208a4a8.jpg">Fig. 5</a>) of the rigid outer socket, which afforded relief to the area of spur formation and soft tissue calcification. The flexible inner socket was chosen for several reasons : <ol> <li> Flexibility of the socket results in a more comfortable fit and reduces pressure concentration. </li> <li> Its transparency allows direct visualization of the stump, if skin breakdown is a problem, and to monitor pressure areas. </li> <li> It permits quicker heat dissipation because of reduction in socket wall thickness. </li> <li> The socket allows improved sensory feedback, especially while sitting, due to flexibility in fenestrated areas. </li> </ol> The patient tolerated the prosthesis well, however, he still had pain over the anterior distal stump. Thus, new x-rays of the patient were taken while he was wearing the prosthesis to determine if the fenestrations were, in fact, over the spur and the soft tissue calcifications. Because of the design of this socket, it was easy to determine that the fenestrations needed correction. The anterior cut out was then enlarged to better accommodate the soft tissue calcification (<a href="/files/original/c0bda2f49bcde7fbdb45d9aa932572f0.png">Fig. 6</a>). This afforded the patient the relief needed. He is presently ambulating independently with a straight cane and the above-knee prosthesis without any pain. In summary, this flexible socket technique allows improved accuracy in fitting not only routine cases, but is especially suited for problem cases as illustrated here. *H.R. Lehneis, Ph.D., CPO Institute of Rehabilitation Medicine, NYU Medical Center (IRM-NYU). *Don Sung Chu, M.D. Institute of Rehabilitation Medicine, NYU Medical Center (IRM-NYU). *Howard Adelglass, M.D. Institute of Rehabilitation Medicine, NYU Medical Center (IRM-NYU). <div style="width: 400px;"></div> Page Number(s) 9 - 11 Year 1984 Volume 8 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1984_01_009/1984_01_009-6.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_01_009/1984_01_009-1.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_01_009/1984_01_009-2.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1984_01_009/1984_01_009-4.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_01_009/1984_01_009-5.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1984_01_009/1984_01_009-3.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 A Case History: Clinical Indication for Flexible Above-Knee Prosthetic Socket Creator An entity primarily responsible for making the resource Howard Adelglass, M.D. * Don Sung Chu, M.D. * H.R. Lehneis, Ph.D., CPO * https://staging.drfop.org/files/original/4e183acf56bb242b877abe71bad0c82c.pdf 2d5fb2193aba4c56fe7e72e3aa738711 https://staging.drfop.org/files/original/f35dbf1ec5058164a5372c266853ed58.jpeg b93e3a485fb5fa30970f58cb3c3f97b4 https://staging.drfop.org/files/original/84f9510431f05aafdee61cf4a63a6e60.jpg 815e14879134606d06e3dec6ad49473c https://staging.drfop.org/files/original/2bf778e75bd7f9b6cdd9a04374f57fee.jpg 0ce17c62d2456956432115616f913c64 https://staging.drfop.org/files/original/bf19e271aafb1c9ff9bb542af0b93338.jpg d3e8c2de5e80c1498f33a82414e7bcb3 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_01_011.pdf Text Any textual data included in the document <h2>A Modified Hemipelvectomy Socket</h2> <h5>Peter A. Ockenfels, CPO <a style="text-decoration: none;">*</a></h5> This paper is to demonstrate a modified design for a hemipelvectomy type of prosthetic socket, which was designed for an endoskeletal system prosthesis. The patient, a 28-year old white male, while involved in the operation of heavy equipment in May of 1978, experienced severe crushing type injuries. The injuries required a hemipelvectomy amputation on the right side, and due to peroneal nerve injuries, the function of the left lower limb was limited. For the purpose of this paper, however, only the hemipelvectomy socket design, which is different and special due to the presence of a colostomy, which needed to be fitted into the prosthetic receptacle, will be discussed. The patient's first prosthesis was designed in the usual fashion with the colostomy inside the prosthetic socket. This restricted drainage into the colostomy device. The patient needed to remove his prosthetic socket during the day in order to relieve pressure and dispose of the accumulated waste. In considering the design of a new prosthesis, it was felt that an anterior or a lateral opening on the opposite side was inadequate and non-functional since the colostomy opening could not be maintained in one particular area at all times. Thus, a lateral opening was provided on the amputated side. A flexible tongue allows the socket to expand as the patient dons his prosthesis (<a href="/files/original/f35dbf1ec5058164a5372c266853ed58.jpeg">Fig. 1</a>). A single Velcro strap (<a href="/files/original/84f9510431f05aafdee61cf4a63a6e60.jpg">Fig. 2</a>) secures the prosthesis, and the colostomy opening is maintained in a permanent position while standing (<a href="/files/original/2bf778e75bd7f9b6cdd9a04374f57fee.jpg">Fig. 3</a>), as well as sitting (<a href="/files/original/bf19e271aafb1c9ff9bb542af0b93338.jpg">Fig. 4</a>). *Peter A. Ockenfels, CPO American Orthotic &Prosthetic Laboratory, Inc., Columbus, OH Page Number(s) 11 - 11 Year 1983 Volume 7 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1983_01_011/1983_01_011-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1983_01_011/1983_01_011-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1983_01_011/1983_01_011-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 4 http://www.oandplibrary.org/cpo/images/1983_01_011/1983_01_011-4.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 A Modified Hemipelvectomy Socket Creator An entity primarily responsible for making the resource Peter A. Ockenfels, CPO * https://staging.drfop.org/files/original/0fd16e6b909f7130aea2a750ca50a40a.pdf 853cb1beca60fbae264611089e78bb36 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_04_005.pdf Text Any textual data included in the document <h2>A Need for Information</h2> <h5>Kent Smith </h5> April 6, 1971. My wife and I were eagerly anticipating the birth of our second child. I accompanied her to the hospital in suburban Chicago. It had been a normal pregnancy, much like the pregnancy two years earlier when our daughter was born. Shortly after midnight the joyous moment arrived. The doctor came to the father's waiting room; he was not smiling. Our son was born with a birth defect known as spina bifida. As we look back on that moment, we've realized how much the birth of our son Stephen has affected our lives. As a news writer/producer for a major television station in Chicago, I had access to a great deal of information. I had been trained to ask the right question, investigate the story thoroughly, and report both sides equally. My wife had received her education in library science and enjoyed the research involved in establishing a library and developing good reference systems. Nowhere in our professional experience had either of us come across information on the birth defect spina bifida, nor were we to realize how difficult it would be to get the information that should be so readily available to new parents of a spina bifida child. Parents find themselves very vulnerable after having given birth to a child with spina bifida. The hospital and medical staff appeared intimidating. We knew little about birth defects in general and nothing about our own child's specific needs. We looked to the "experts" whom we hoped would help. Our first attempt to get information was through the local chapter of the March of Dimes. Their personnel were courteous, sympathetic to our needs, but could not answer specific questions on how other families were coping with a child with spina bifida. We tried to gain understanding on a variety of terms. How did it affect our Stephen? Were we unique with this problem? What was the outlook for our son's future? Those questions went unanswered, although we did receive some pages copied directly from a well-known book on birth defects. Good friends stood by us trying to provide a sympathetic ear. They couldn't answer questions, but wanted to do the best for our family, even encouraging us to look at places where our child could be placed and be raised in a loving atmosphere; then we could go on with our own lives. This only frustrated us, for we wanted to help our son, who—by some quirk of fate—had problems that we knew were serious but we didn't understand. He was part of our family and we wanted to provide him with the best medical care available. As parents, we had to depend on others for guidance. The most obvious person to turn to is the family physician. Clearly, new parents of a disabled child need information on the disability and its treatment, as well as the names of agencies and support groups available to assist the family unit. Other parents who have faced the same situation can share their knowledge and give comfort and assistance. My wife and I were steered to a support group of parents and adults with spina bifida. This group met every month at the hospital. Our physician had been working with this parent group. Although he could not share the parental experience of raising a handicapped child, he respected the support that was freely given by parents "sharing their experiences." From our point of view, it was the best medicine that he could provide. It gave us hope that our son might make advances similar to other children. Information is the key to knowledgeable parents raising their children with spina bifida. My wife and I became active in this parent support group to learn more about the birth defect. From those adults with spina bifida we learned some problems they had faced and how we could help our son. Our involvement with a national organization wasn't something we planned, it evolved. In 1979, I was asked to establish a central office to provide information to new parents and be a resource to chapters consisting of parents, adults, and professionals in many cities. Under a letter of agreement with my employer, the American Broadcasting Company, I took a year's leave of absence to establish the office. I've never gone back to ABC. The leadership of Spina Bifida Association of America (SBAA) comes from the active participation of adults with spina bifida and parents working together. When SBAA was formed as a volunteer group in 1972, the greatest need was to provide printed information written in lay language. Today, the Association has 11 booklets directed to educators, new parents, adults with spina bifida, and to children. As a journalist, I was able to work with the writers in developing a distribution system that now has over 50,000 pieces of literature circulated each year. One concern we have is the misinformation that others continue to tell new parents regarding the current treatment or the lack of potential of people born with the birth defect today. In 1979, the SBAA established a policy that encourages early evaluation and medical/surgical treatment of every infant with spina bifida, and recommends that the evaluation be performed by professionals experienced in that care and treatment. Improved medical treatment within the last 25 years minimizes the disabling effects of spina bifida. Recent statistics from major treatment centers in New York, Pittsburgh, Chicago, Seattle, and elsewhere indicate that approximately 90 percent of those infants born today with spina bifida can lead a competitive life with some adjustments for physical disabilities. The majority of infants who receive aggressive treatment early do not suffer mental retardation. Lack of bowel and bladder control can be dealt with and should not take the "opportunity for life" away from the child. Some amount of paralysis often occurs, but the degree of involvement varies widely and cannot be determined at birth. The SBAA also sponsors an Adoption Referral program which offers a viable alternative to parents who feel unprepared to raise a child with a disability. The program has placed 70 babies in loving homes and has a waiting list of parents willing to take infants with spina bifida. During these last five years I have met hundreds of parents with similar stories, all with a commitment to provide information to a new parent who, like each of us, needed someone or some group to answer questions. The adults with spina bifida hold challenging jobs, and in general make worthwhile contributions to society. They have devised innovative ways in which to overcome their disabilities. Each represents a realistic goal which our child born with this birth defect can hope to achieve. If you would like further information on Spina Bifida and our Association, please call 1-800-621-3141. Page Number(s) 5 - 6 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Need for Information Creator An entity primarily responsible for making the resource Kent Smith https://staging.drfop.org/files/original/934d9d58cdc431c9e0221d32ee8fe951.pdf 9ab98303a3e42383d5edd757b0da7d06 https://staging.drfop.org/files/original/9a0943f435a6d9fe4ed610d2caba0b86.jpg b20aa7224fab12563b41462c3dd6fe20 https://staging.drfop.org/files/original/ac1c440073b39ee145136d5d5c0f8990.jpg caadd7555cef407c05e9e41c66a61ecb 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_079.pdf Text Any textual data included in the document <h2>A New Look at the RGO Protocol</h2> <h5>Lou Ekus, C.P.O. <a style="text-decoration: none;">*</a> Linda McHugh, R.P.T. <a style="text-decoration: none;">* </a></h5> <h3>Introduction</h3> The L.S.U. Reciprocal Gait Orthosis (RGO) is an orthotic device that gives structural stability to the patient with lower trunk and lower limb paralysis while allowing, through a cable coupling system, reciprocal hip joint motion for ambulation. The device has been used at the Shriners Hospital in Springfield, Massachusetts since December, 1980. Our experience with the Reciprocal Gait Orthosis has led us to a simplified approach in the selection, fitting, and training of patients suitable for fitting with this device. <h3>Patient Distribution</h3> Sixteen fittings with the Reciprocal Gait Orthosis have been reviewed for this article. Seven of these children were under the age of four years at the time of their first fitting, with a total of 12 children under the age of eight at the time of first fitting. All 12 children were discharged from the hospital using the orthosis effectively. One child in this group later rejected the orthosis because he was able to ambulate with bilateral knee-ankle-foot orthoses and felt the Reciprocal Gait Orthosis was too much bracing. Out of this group, the remaining 11 children are currently community ambulators and wear the orthosis for most of the day. In addition to these 12 children, we have four young adults who are fit with the Reciprocal Gait Orthosis. Three of them were 13 years old at the initial fitting. Two of these children were discharged from the hospital using the orthosis effectively and are currently household ambulators. The last of the 13 year olds rejected the brace due to an extreme fear of the upright position. Our last fitting was done on a 21 year old male with severe hip and knee flexion contractures. This patient had a tremendous desire to ambulate and so the fitting was attempted. However, after numerous fittings and adjustments, the attempt was abandoned as a result of the severity of his contractures. <h3>Protocol</h3> Our first patient was fit with a reciprocator in December, 1980. Subsequently, 12 children were fit following the general guidelines established by Louisiana State University. In November, 1985, we developed our own written protocol. The protocol was extremely specific, outlining prerequisites before fitting with the Reciprocal Gait Orthosis. The protocol included such criteria as, 1) hip and knees free of flexion contractures greater than 20 degrees, 2) patient required to demonstrate independent mobility in a parapodium, and 3) parents required to admit children for training. After a review of our series up to that point, we realized that few of the patients actually met 100 percent of the criteria in our existing protocol, and yet our success rate was quite high. After a further review of the fittings was done, a revised protocol was written and instituted in June, 1986. Our new protocol for fitting with the Reciprocal Gait Orthosis is outlined below: <ol> <li> Parents and child will watch a video prepared by the hospital showing the fitting and training process for the Reciprocal Gait Orthosis. </li> <li> A team meeting will be held prior to admission with parents and child, physical therapist, orthotist, nurse, social service representative, and physician. At this meeting, goals are set for admission and parents are given the opportunity to ask any member of the team questions that they might have. The child's abilities will be discussed, including a) ability to stand and move in the parapodium, b) emotional and cognitive ability to tolerate training, c) upper extremity strength, and d) any existing joint contractures and their influence on fitting and training. </li> <li> Goals will be set, regarding a) cooperation for training, b) balance and confidence with movement, c) quality of mobility, d) independency in transfers, and e) donning and doffing of the orthosis. </li> </ol> Following fitting and dynamic alignment of the Reciprocal Gait Orthosis, gait training begins. It includes 1) momentary standing balance, 2) training on the parallel bars (patient instructed to "shift weight" and "push back"), 3) progression to a rollator walker when consistent orthotic control, good balance, and even stride length are demonstrated in parallel bars, and 4) progression to Loftstrand crutches when improved independence in balance is achieved and the patient is cognitively able to use them. Three weeks into training, a second team meeting is held. Each goal is addressed and the team determines the best way to continue training based on the reassessed goals. At discharge, the patient will 1) ambulate with the walker, 2) exhibit consistent control in step length, balance and stability, 3) exhibit good standing balance, and 4) be able to negotiate a ramp. <h3>Fitting Problems</h3> Without a doubt, the most consistent problem we've seen in fitting the Reciprocal Gait Orthosis is existing hip, knee, and ankle contractures. We have fit patients with significant contractures of these joints and have accommodated for the contractures in alignment by wedging the shoes (<a href="http://www.oandplibrary.org/cpo/images/1987_02_079/1987_02_079-1.jpg">Fig. 1</a> and <a href="http://www.oandplibrary.org/cpo/images/1987_02_079/1987_02_079-2.jpg">Fig. 2</a>). Our intention is to enable the child to exhibit effective ambulation and then to consider joint releases when possible. <a href="http://www.oandplibrary.org/cpo/images/1987_02_079/1987_02_079-1.jpg">Figure 1. Front view of patient showing extensive pre-existing contractures and shoe wedging to accommodate the contractures.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_079/1987_02_079-2.jpg">Figure 2. Lateral view.</a> We have seen, in a few cases, where it is difficult for the patient to comprehend that pushing back will advance the leg. To make this concept more easily understood in the early stages of training, the hip joints are flexed slightly more than usual to allow the patient to grasp this concept easily. This usually makes standing balance impossible. However, after a day or two, the orthosis can be extended and standing balance can be addressed. We found this to be an extremely useful tool in expediting the initial stages of training. <h3>Early Intervention</h3> Taking into consideration the importance of upper limb strength, preservation of range of motion, and weight control before fitting a patient with the reciprocating orthosis, it is easy to see the importance of early intervention in cases of congenital deficiency. Through our myelodysplasia clinic, we are able to follow the patients on an ongoing basis from birth to insure continuing follow up in these areas. It is also possible to insure the delivery of an infant Stander at the appropriate time. The clinic also gives us the opportunity to observe the child in the Stander or parapodium. Mobility in these devices is a good indication of motivation, balance, and the child's awareness of his body moving through space. The myelodysplasia clinic gives us an invaluable opportunity to insure that all of the prerequisites are being nurtured and that we can initiate a fitting with the Reciprocating Gait Orthosis at the appropriate time. <h3>Results</h3> Included in our series of 16 patients are 12 children who are community ambulators. In addition, two children are ambulatory in their household or for short distances, and two rejected the Reciprocal Gait Orthosis as their means of mobility. The age of initial fitting for these children spanned two years to 21 years, with children under the age of eight all being community ambulators. <h3>Conclusion</h3> Clearly, the results demonstrate the importance of both early intervention and early fitting with the Reciprocal Gait Orthosis. We hope that children with congenital paraplegia who initiate ambulation with a Reciprocal Gait Orthosis at an early age will continue to be ambulatory further into adult life than those who have used knee-ankle-foot orthoses in the past. In conclusion, we would like to propose the idea that, based on experience with our protocol, the fitting and training of a child using the Reciprocal Gait Orthosis is no more difficult than other bracing modalities and can be approached with the same ease. References: <ol> <li>Douglas, R., P. Larson, R. Ambrosia, and R. McCall, "The LSU Reciprocation-Gait Orthosis," Orthopedics, Vol. 6, No. 7, July, 1983, pp. 834-838.</li> <li>McCall, R., R. Douglas, and N. Rightor, "Surgical Treatment in Patients with Myelodysplasia Before Using the LSU Reciprocation Gait System," Orthopedics, Vol. 6, No. 7, July, 1983, pp. 843-848.</li> <li>Shanks, K., "LSU Reciprocating Gait Orthosis," Durr-Fillauer Medical, Inc.</li> <li><a href="http://www.acpoc.org/library/1985_03_046a.asp">Ekus, L., "Reciprocator Orthosis: A Protocol," ACPOC, April, 1985.</a></li> </ol> *Linda McHugh, R.P.T. Linda McHugh, R.P.T. is also with Shriners Hospital for Crippled Children. *Lou Ekus, C.P.O. Lou Ekus, C.P.O. is Director of Orthotics and Prosthetics at Shriners Hospital for Crippled Children, 516 Carew Street, Springfield, Massachusetts 01104. <div style="width: 400px;"></div> Page Number(s) 79 - 81 Year 1987 Volume 11 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_079/1987_02_079-1.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_02_079/1987_02_079-2.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 New Look at the RGO Protocol Creator An entity primarily responsible for making the resource Lou Ekus, C.P.O. * Linda McHugh, R.P.T. * https://staging.drfop.org/files/original/c056d5b5a2d5292f7ea7a2216c435354.pdf 14428dbbc64bb672eab6dba111374692 https://staging.drfop.org/files/original/039849a9bbceb9fb919ccc08ac599212.jpg 23bca0088192426d9167c9c7d9e9d44c https://staging.drfop.org/files/original/f197722dfcff2c0aac358b6fcc12d2eb.jpg 161a1c77318b8073974e27d61d273bc9 https://staging.drfop.org/files/original/1749053d5b5f32553d0c1fe1f894c64e.jpg 3380cde244b9b2f336392b04665d1732 https://staging.drfop.org/files/original/e0887c118d00cc471ff8de5bf88811f3.jpg d25c837f996f02af2fc5e6e1f15a76c5 https://staging.drfop.org/files/original/fb3a271a31f4d3f1d7d07493673581d3.jpg cc66ef1f8e51ec73b5b2f73b2cfb26a5 https://staging.drfop.org/files/original/a0cdfd4316a17eb6233a90ae1f54727d.jpg df6536c12852883e6140ab2bd6a2eb74 https://staging.drfop.org/files/original/37a2a6c5c5b3fa090ca1aa5f15a1c855.jpg e2c8a5972b78da0ae35e57c29ead0c0a https://staging.drfop.org/files/original/2d1dd36d6e47d7c89ef2024f8633baa2.jpg 5ff571b0dd18d2ce9ae71785e9716822 https://staging.drfop.org/files/original/d5ce24b019b33092116f6dab2dcb1ad8.jpg fa9b285cc6d96d43260008b1e6983207 https://staging.drfop.org/files/original/c4ef31384fca87b5d234cd3857247810.jpg 8f8fe63d422f492829cf8f7221eac5c9 https://staging.drfop.org/files/original/a16361aca619486a85231e5bf4f67da1.jpg bddcc94158c1706f18aaa77bf8cb0a7a 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/1988_01_019.pdf Text Any textual data included in the document <h2>A Partial Foot Prosthesis for the Transmetatarsal Level</h2> <h5>Jack N. Collins, C.P.O. <a style="text-decoration: none;">* </a></h5> <h3>Introduction</h3> Traditionally prosthetists and orthotists have faced the problem of partial foot amputations with the skills, materials, and observations gained from past experiences or from others in the field. The author is not aware of any extensive research in prosthetics for partial foot amputations. Attempts to provide a suitable prosthesis have ranged from a simple toe filler with arch support, to an ankle immobilizer at P.T.B, level, and lace-on fillers of many descriptions. In the author's observation, any prosthesis that goes above the ankle results in the buildup of unwanted forces. The late Charles Childs, C.P.O.,<a></a> made the greatest breakthrough in partial foot prostheses. I attended his seminar in late 1978 and was very impressed with the entire approach demonstrated, especially the cosmesis and fit at shoe level height. Unfortunately, after a few weeks wear, the rubber material used in the fabrication of the prosthesis did not retain its shape and support against the extreme forces exerted in walking. The forces developed on the short lever arm, the foot, in walking are greater than at any other level of amputation. These forces applied in walking and running are not confined to the plantar surface of the residual foot, but are transmitted in part to the entire surface of the prosthesis. In turn, some of these forces are applied to whatever footwear is worn. Thus, the footwear applies a resistant force to the prosthetic appliance, quite often to the detriment of the appliance and the residual foot. It must be stated at this point that the prosthesis about to be described has not been evaluated with foot amputations at the Lisfranc or Chopart level, but only on transmetatarsal level. And from our limited experience, developed over the past 7 to 8 years, a mid-trans-metatarsal amputation presents fewer problems in toe-off than amputations at a greater or lesser length. With this in mind, the evaluation, casting, and fabrication techniques used will be described. <h3>Evaluation, Casting and Fabrication</h3> Evaluation is made in routine manner, for amputation level, range of motion at ankle, contractures, cut bone covering, abrasions, callosities and sensitive areas. With patient seated in a chair, invaginate a casting balloon over the residual foot with a short piece of plastic tubing on the dorsum of the foot. Mark with indelible pencil all boney prominences, callosities and sensitive areas (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-01.jpg">Fig. 1</a>). Very carefully roll on a 4" roll of plaster in a manner to cover the entire foot to the inferior edge of the lateral malleoli and with a thickness sufficient to retain its shape on removal. While the plaster is still soft, have the patient place his foot on the floor, with the knee at 90°, foot in neutral position (not in valgus), and with the weight of the leg on the plaster. Make marks with indelible pencil on the cast at 90° across the plastic tube. With a cast saw cut down the tube to remove the cast. If care is taken in applying the plaster, you will have a very smooth and detailed cast on removal (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-02.jpg">Fig. 2</a>). <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-01.jpg">Figure 1. Foot ready for casting with casting balloon and plastic tubing in place.</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-02.jpg">Figure 2. Cast removed</a> Close the cast carefully with plaster wrap, apply the release agent, and pour the cast with mandrel in place about 45° to vertical. This makes it easier to apply P.V.A. and stockinette. Remove the plaster wrap from the model. Very little modification should be necessary. Add about 1/8" plaster buildup over the boney prominence at the distal end and over any callosities or other sensitive areas. It is not necessary to modify as in the U.C.B.L. Shoe Insert casting method. Using a Scarpas knife, remove about 3/16" to 1/4" plaster from the plantar surface 1/2" proximal to the metatarsal ends, the width of the metatarsals, and taper in the direction of the heel about 1" to 1 1/2" depending on the size of the foot. The anterior edge of cut should have a 5/16" radius (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-03.jpg">Fig. 3</a>). Dry or seal the model. <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-03.jpg">Figure 3. Modified positive model</a> Pull on one layer of nylon stockinette to allow for the patient's sock. Pull the P.V.A. over cast for vacuum. Tailor a piece of 1 oz. Dacron felt to cover the plantar surface. The felt should extend over the anterior distal end, laterally to cover the base of the 5th metatarsal, and medially to cover the scaphoid prominences. Sew one end each of four lengths of nylon stockinette and pull on the model with the Dacron felt in place. On heavier more active patients, one layer of woven glass reinforcement is added between the felt and stockinette. When pulling on the stockinette, take care not to pull out the stretch of the stockinette. The stretch needs to be retained in the silicone laminated areas to allow donning. Take two 4" P.V.A. sleeves and cut 12" long pieces from the small end of each to make feeder tubes. Apply a 6" moist P.V.A. sleeve to the model so as to give a smooth surface all over. Do not tie off the ends, but do dry with a heat gun. Use a tongue depressor to push the small end of one of the feeder tubes under the P.V.A sleeve at the heel of the model. The tube should be about 3/8" from the plantar surface of the heel. In the same manner, position the remaining feeder tube under the P.V.A. sleeve over the dorsum of the model. The tube should be about 3/8" from the proximal edge. Roll a 1" wide by 6" long piece of 1/16" thick polyethylene into a funnel and place in the open end of one of the tubes (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-04.jpg">Fig. 4</a>). Mix 80 grams of Dow Corning 382 silicone with 2 or 3 drops of appropriate color and catalyze as directed by Dow Corning, pour into the funnel and very carefully squeeze into the stockinette. On the dorsum of the foot, laminate the section the shoe lace will cover, or a little more area. Squeeze with your finger tips to get a thorough and even penetration working the Silastic, laterally, and distally down to, but not onto the plantar surface. Working with the fingers gives better penetration without spreading the resin to unwanted areas. After this has cured, repeat in the same manner posteriorally. The posterior portion should extend distally down the back of the heel to the sole and anteriorally along the proximal trimline for a width of 1" distal of the trimline so that it meets the posterior border of the anterior lamination medially and laterally (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-05.jpg">Fig. 5</a>). When the posterior portion has cured and both feeder tubes have been removed, tie off the pipe end of the 6" P.V.A. sleeve and pour in 150 grams of 4110 Laminae that has been catalyzed and pigmented. Saturate the remaining lamination and maintain it under a vacuum until cured. While the polyester is still warm, trim to the shoe top level and remove the prosthesis from model (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-06.jpg">Fig. 6A</a> and <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-07.jpg">Fig. 6B</a>). The prosthesis is now ready for fitting. <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-04.jpg">Figure 4. Completed layup with P.V.A. sleeve and feeder tubes in place</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-05.jpg">Figure 5. Initial phase of lamination. Dorsum and proximal border of socket have been laminated with Dow Corning 382 Silastic.</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-06.jpg">Figure 6A. Socket completed and removed from model, medial view</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-07.jpg">Figure 6B. Lateral view</a> In weight bearing, check for comfort, undue pressure, and position of the foot. More than likely it is in some valgus, as any foot amputated proximal to the head of the first metatarsal loses its medial support. With small wooden wedges, you can determine the amount of posting needed under the distal end of the first metatarsal to hold the foot in a neutral position. When this has been done, mix a small amount of thickened polyester and add it to the distal plantar surface of the first metatarsal area to establish the desired position. When comfort and fit have been achieved, the prosthesis is ready to be completed. Obtain a shoe from the patient for foot sizing. Take a plaster wrap of the distal portion of an appropriately sized S.A.C.H. foot. When the plaster on the S.A.C.H. foot has cured, remove it from the foot, and inspect the inside for smoothness. Fill any voids and smooth nicely. Dry the plaster and paint the inside with ambroid or celluloid. Spray the inside of the toe cast with silicone release agent. Rivet with two #12 copper rivets, all" long by 1 1/2" wide .0035 thick blued steel spring, that has been shaped to the contour of the inside surface of the shoe sole, to the plantar surface of the socket. Shear off the distal portion of the spring so it ends about 1" from the toe. Drill a hole for a #12 copper rivet and rivet on a small "U" shaped piece of leather to act as an anchor for the silicone toe piece (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-08.jpg">Fig. 7</a>). Drill 1/2" hole in the distal plantar surface of the toe cast. Wipe the anterior surface of the prosthesis with acetone. It must be clean. Fit the plaster shell over the spring and anterior portion of the prosthesis as far proximal as necessary to obtain proper foot length. Be sure the spring or leather anchor does not come in contact with the inside of the plaster mold. When properly positioned, solidly tape the plaster wrap to the prosthesis (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-09.jpg">Fig. 8</a> and <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-10.jpg">Fig. 9</a>). <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-08.jpg">Figure 7. Socket with toe spring and leather anchor rivetted in place</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-09.jpg">Figure 8. Socket and plaster toe mold</a> <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-10.jpg">Figure 9. Toe mold taped in place</a> Mix 65 grams of Dow Corning #382, 5 grams Dow Corning Q74290 Prosthetic Foam, and 2 or 3 drops of appropriate pigment. Catalyze and pour slowly into the 1/2" hole in the toe. Stand the assembly on the back of the heel, toe up, and support it in this position until foamed and cured. When the foam has cured, carefully use a thin instrument to pry the silicone toe gently loose from the plaster. It should come off with little effort. Depending on the smoothness of your plaster toe mold, the release agent used, and the foam mixture, the prosthesis should be very presentable (<a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-11.jpg">Fig. 10</a>). If it is rough and has air holes, sand it smooth and paint on a coat of Pigmented Dow Corning #382. <a href="http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-11.jpg">Figure 10. The completed prosthesis</a> <h3>Summary</h3> The rigid control of the residual foot, yet flexible entry and toe off, together with good patient acceptance, cosmesis, and wearibility makes this type prosthesis our choice in the prosthetic management of transmetatarsal amputations. We call this the C.O.S.I. Partial Foot Prosthesis (Collins Orthopedic Service, Inc.). <h3>Addendum</h3> It is the author's opinion that Lisfranc and Chopart level amputations could be approached in a similar manner by extending the distal support and point of toe off to a more normal position. However, this opinion is not based on personal experience with using the C.O.S.I. Partial Foot Prosthesis to fit these level amputations. This would require some thought and quite a bit more effort in the lamination procedure. References: <ol> <li>Childs, Charles, Pacific Orthotic and Prosthetic Services, 111 East First Street, Medford, Oregon 97535.</li> </ol> *Jack N. Collins, C.P.O. Jack N. Collins, C.P.O., is with Collins Orthopedic Service, Inc. 2875 Joyce Street, Fayetteville, Arkansas 72703. Page Number(s) 19 - 23 Year 1988 Volume 12 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-05.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 6 FIGURE 6A http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-06.jpg FIGURE 6B http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-07.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-08.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-09.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-10.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1988_01_019/1988_01_019-11.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 Partial Foot Prosthesis for the Transmetatarsal Level Creator An entity primarily responsible for making the resource Jack N. Collins, C.P.O. * https://staging.drfop.org/files/original/33ac5f83c3b345c7f45c737170f43aa0.pdf 7e4f270c0b93c37ded6218cb290d8afb 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_04_003.pdf Text Any textual data included in the document <h2>A Personal Experience</h2> <h5>Cynthia L. Cuchna <a style="text-decoration: none;">*</a></h5> Most people would say, "It would be terrible to be born with a birth defect." Well, I know firsthand that it really isn't so terrible. I have been blessed with family and friends who have not let me feel that my disability should get in the way of reaching my goals. My parents have never let me use my handicap as a way of getting out of responsibilities. I have the same responsibilities around the house as my sisters and if I don't take care of them I am equally disciplined just as my sisters would be if they didn't do their share of the work. I feel my oldest sister, Sherri, has helped me the most in believing that I am just as capable as anyone else in doing things for myself. If I would ask her to get me a book or a glass of water or something, Sherri would probably say something like, "Get it yourself, you aren't helpless!" I wouldn't want it any other way between us. People have asked me if I feel my sisters are allowed to go more places and do more things than me. I don't feel that I've missed out on any of the experiences my sisters have had. I go to football games, movies, go shopping, and go to the local disco just like my sisters. The only problem I have is that most of my friends live too far away from me to just "drop by" whenever they feel like it. My friends are my classmates from the high school I had to attend, which is outside my local school district and is the only school in the county capable of handling my special problems. We can't even call one another very often because it is long distance. Hospitals have been a vey important part of my life, since I was in and out of them quite frequently when I was young. I never really minded going into the hospital because the doctors and nurses were always nice and I knew they would take good care of me. Along with hospitals comes bills. Our family has never been eligible for financial aid because my parents always made "too much money." I know that at times it has been tough for my parents to make ends meet because I am such an "expensive kid." Sometimes I feel guilty about having my parents pay such big bills just because of me. I have been in braces ever since I was four years old. I know that they have helped me considerably, but I often have negative feelings about my braces. There was a time when I was unable to wear my braces due to pressure sores. I like being out of them because my clothes weren't torn by the locks on my braces and I liked getting dressed faster. I thought I looked prettier without all of that plastic and metal sticking out of my clothes. I am finally starting to realize that I look better in them because they make me straighter. I don't look like I'm a "pretzel" when I'm in them. I have greater mobility in them, which enables me to do things and go places that I couldn't in my wheelchair. Even though the negative feelings may resurface in the future, I plan on wearing my braces a lot more than I have for the past two years. When I go out to a movie or go shopping, sometimes people stare at me. This has never really bothered me. It just shows me that they are interested in my disability and are curious to see how my braces, crutches and/or wheelchair works. I especially like it when little children come up to me and ask, "What happened to you?" I am glad that children aren't afraid to ask questions. I wish that adults would open up and ask, because I would be more than willing to tell them about anything they would want to know. My plans for the future are to graduate from college with a degree in psychology. I think that I would like to be a school psychologist because I love children. I know that the road ahead will have some rough spots, but I know that I can make it with the love and support of my family behind me. *Cynthia L. Cuchna Cynthia Cuchna was born with spina bifida on March 21, 1966. Now she is 18 years old and is entering her first year of college. <div style="width: 400px;"></div> Page Number(s) 3 - 4 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Personal Experience Creator An entity primarily responsible for making the resource Cynthia L. Cuchna * https://staging.drfop.org/files/original/57984a195780837231c3d47547393acc.pdf 11789779a85e2b709280689bf0e71309 https://staging.drfop.org/files/original/229e5d0143847fe4a628fb14ddec46e4.jpg be7e746d002f06941f613b3ffcdfe220 https://staging.drfop.org/files/original/c42e1a9caf2711b34235fffd340b847a.jpg b9f313905f981a7b1b591b553ac76025 https://staging.drfop.org/files/original/65483353f040cfd3076c229f9103ba79.jpg f7f25aeeda8fcb9417fcb2a3f14480d5 https://staging.drfop.org/files/original/48332643526aa1b923893a54d16f1d14.jpg 6fdbc24c287659b506d32920ab794a07 https://staging.drfop.org/files/original/2bfcb2f521edd120186e036fda6d7d8f.jpg 6ecc7fab73b16908b5797aa5757d6bfd 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_066.pdf Text Any textual data included in the document <h2>A Physiologic Rationale for Orthotic Prescription in Paraplegia</h2> <h5>Robert L. Waters, M.D. <a style="text-decoration: none;">*</a> Leslie Miller, R.P.T. <a style="text-decoration: none;">* </a></h5> <h3>Introduction</h3> A difficult clinical decision to be made when treating a paraplegic patient is deciding if walking is a realistic goal, if orthoses should be prescribed, and what the functional outcome will be. It has been demonstrated that the energy expenditure for paraplegics, utilizing a crutch assisted swing-through gait pattern, is markedly elevated. Many patients have learned to walk with crutches and orthoses, but discontinued their use after discharge from a rehabilitation center.<a></a> Studies of other forms of bracing also reveal elevated energy expenditure.<a></a> In this review, we will describe the indications for prescribing ankle-foot orthoses and knee-ankle-foot orthoses. We will then outline the criteria used at Rancho Los Amigos Medical Center to determine whether or not a paraplegic is a candidate for ambulation. These criteria are based on the results of energy expenditure measurements of 150 patients with traumatic paraplegia.<a></a> Further investigation of the data collected revealed that the proprioception level or pattern seemed a reliable indicator of which patients would achieve ambulation, while muscle function seemed to determine the quality of their ambulation. These results have helped us to develop guidelines for projecting the functional outcome of ambulation of paraplegics. <h3>Orthotic Prescription</h3> The goal of orthotic management in paraplegia is to provide the external support necessary to compensate for the motor and sensory deficits. Joint range of motion, muscle strength, proprioception, sensation, and spasticity are evaluated when determining the orthotic prescription. Knee-Ankle-Foot Orthosis (KAFO) Quadriceps strength less than "Fair+" on manual muscle testing is the most common indication for a KAFO. The KAFO is locked at the knee while walking. Although some patients with less than "Fair+ " strength are able to ambulate a short distance without a locked knee (knee stabilization), knee instability usually occurs after a few steps. The exception is the patient with severe quadriceps spasticity which maintains the knee in extension, eliminating the need for external support. Another indication for a KAFO is impaired or absent knee proprioception. The lack of proprioception can result in knee instability even when the quadriceps strength is "Fair+" or greater, as the patient is unable to monitor joint position. If light touch sensation is present on the front of the thigh, a KAFO which allows knee flexion is usually sufficient to control the knee. The anterior stop of the knee mechanism limits extension at 180 degrees and the patient feels pressure from the anterior thigh cuff. In this regard, the brace serves as a transducer that converts proprioception (which is not perceived) into pressure (which is perceived). The final indication for extending bracing above the knee is a severe hyperextension thrust during stance. Paraplegics whose gait is characterized by a hyperextension thrust may develop ligamentous instability, due to attenuation of the posterior cruciate ligament and posterior knee capsule resulting in hyperextension deformity. Range of motion at the hip from 0 degrees of extension to 110 degrees of flexion should be present. In the absence of hip extensor muscles, full hip extension range is necessary to allow the patient to lean backwards and move the center of gravity of the trunk posterior to the hip joint (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-1.jpg">Fig. 1</a>). Hip flexion to 110 degrees, with the knee extended, enables the patient to come to standing with locked KAFO's and rise from the ground after a fall. Full knee extension is required for optimal fit. <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-1.jpg">Figure 1. Standing posture.</a> Ten degrees of dorsiflexion at the ankle is the minimum necessary for unassisted upright balance (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-1.jpg">Fig. 1</a>). Normal proprioception in at least one hip also facilitates unassisted standing. Inability to meet the joint range requirements described above commonly occurs and is most often due to spasticity or contracture. If satisfactory orthotic fit and posture cannot be achieved, a physical therapy regime that includes stretching exercises or serial casting is often successful when spasticity is mild and the deformity is not longstanding. When severe spasticity or deformity is present, or the deformity has been present for an extended time, the patient should be referred to an orthopedic surgeon. Good trunk strength is necessary to maintain an erect posture in the standing position without excessive weight bearing in the arms. High level paraplegics without adequate trunk strength must exert a strong upwards force by the arms throughout the entire gait cycle to prevent forward collapse and accomplish forward progression. This contributes to the high energy demand. (All swing-through gait candidates are required to perform 50 consecutive dips on parallel bars to insure they have sufficient upper extremity strength and endurance.) Ankle-Foot Orthosis (AFO) Quadriceps strength greater than "Fair" should be present to stabilize the knee if an AFO is prescribed. The patient must also have adequate hip flexion strength to swing the leg forward to achieve a reciprocal gait pattern. The indications for AFO are numerous and include any or all of the following: plantarflexion strength less than "Good," dorsiflexion strength less than "Fair," impaired ankle proprioception, and moderate to severe plantar-flexion spasticity. During normal walking, the plantarflexors are active during the stance phase of gait to prevent excessive forward advancement of the tibia. As a result of forward momentum, the knee passively extends as the body advances forward over the stabilized tibia, and the demand placed on the quadriceps is minimal. Customary manual muscle testing methods fail to place a sufficient load on the plantarflexors to evaluate the force required during gait. The strength required to provide ankle and knee stability is present in patients who can perform 15 to 20 toe raises on one leg. Failure to provide adequate orthotic stabilization of the ankle in patients with inadequate plantarflexion strength may result in ankle instability and knee instability, if the quadriceps and/or hip extension strength is also inadequate. Knee wobble can be a sign of impaired ankle proprioception and/or weakness. This can be eliminated by an AFO with a rigid ankle or anterior ankle stop, which provides distal stability and kinesthetic information via the calf cuff. An AFO may be utilized to hold the ankle in the neutral position when dorsiflexion strength is impaired or there is excessive plantarflexion spasticity. When spasticity is severe, it may not be possible to maintain the foot in neutral, and the patient should be referred to an orthopedic surgeon if non-operative measures prove inadequate. When the ankle is held in a rigid orthosis, ankle stability is gained during midstance. However, a forward thrust is imposed, forcing the knee into flexion at the moment of heel contact. (This knee flexion torque is generated because the rigidly immobilized ankle rotates forward about the point of heel contact.) During normal gait, this torque is avoided by ankle plantarflexion, minimizing the effect of the heel lever. There are two courses of action available to provide ankle stability during stance, while still maintaining knee stability at heel strike. If the patient has "Fair+ " or better ankle dorsiflexion strength and intact proprioception, we fit a metal AFO with a double adjustable ankle joint. A set screw in the anterior channel provides an adjustable stop that prevents excessive dorsiflexion. The posterior stop is left open to allow free ankle plantarflexion. Springs can be added posteriorly if dorsiflexion strength is less than "Fair+." The advantage gained is that restriction of motion during terminal stance is maintained while the normal plantarflexion motion during heel contact is preserved, avoiding the undesired knee flexion torque. If the patient has less than "Fair" dorsiflexors or absent proprioception at the ankle, then the ankle is locked and either metal or plastic is used. To avoid the excessive knee flexion torque when the AFO is locked, the heel of the shoe is undercut. This decreases the heel lever and, thus, the knee flexion torque. <h3>Orthosis Weight</h3> Weight is an important factor to some patients, as is the availability of joint motion of the orthotic system. Plastic, because of its potential to be lighter than metal, is sometimes preferable. For the patient with weak hip flexors, efforts to minimize weight are warranted since any extra weight at the end of the limb will make it more difficult to lift the foot and advance the leg. Lehneis, et al.<a></a> found that improving orthotic stability at the ankle reduces energy costs. It follows, then, that in any orthotic design, stability (control about a joint) should not be sacrificed merely to achieve lighter weight. <h3>Exercise Physiology</h3> It is necessary to understand several fundamental principles of exercise physiology to interpret the results of energy expenditure measurements in paraplegic patients.<a></a> The use of oxygen consumption is based on the fact that during sustained exercise, most of the ATP for muscle contraction is generated by aerobic metabolic pathways. After several minutes of exercising at a constant submaximal workload, the rate of oxygen consumption rises until it reaches a level sufficient to meet the metabolic demands of the exercising muscle. Measurement of the rate of oxygen consumption at this time reflects the energy cost of the activity and indicates the exercise intensity. The oxygen cost per meter walked determines the efficiency of ambulation. The principle fuels for aerobic metabolism are carbohydrates and fats. The oxidation of glucose can be summarized by the following equation: GLUCOSE + 36 ADP + 6 O2 --> 6 CO2 + 44 H2O + 36 ATP During exercise, the extent to which anaerobic pathways contribute to the production of energy depends upon the intensity of the effort. In mild to moderate exercise (approximately 50 percent of the maximal aerobic capacity for untrained individuals), the oxygen supplied to the tissue for the aerobic energy producing reactions is usually sufficient to meet energy requirements. During more strenuous exercise, anaerobic oxidation processes also occurs. The amount of energy that can be produced by anaerobic means is limited. Nineteen times more energy is produced by the aerobic oxidation than by anaerobic oxidation. Also, accumulation of lactate in muscle and blood leads to acidosis, limiting the extent to which intense exercise can be performed. From a practical standpoint, anaerobic oxidation provides an extra supply of energy for sudden bursts of strenuous effort, but these pathways cannot be routinely utilized for a prolonged time. In contrast, when exercise is performed below anaerobic threshold, an individual can sustain exercise for many hours without exhaustion. <h3>Maximal Aerobic Capacity</h3> The maximal aerobic capacity (VO2 max) is the single best indicator of physical work capacity and fitness. It measures the individual's maximum energy production capability. Generally, an individual is able to reach the VO2 maximum within two to three minutes of instituting strenuous exercise. Any disorder of the respiratory-cardiovascular muscle or metabolic systems that restricts the supply of oxygen to the muscle decreases the VO2 max. A physical conditioning program can increase aerobic capacity by several processes which include improving cardiac output, increasing the capacity of the muscle to extract oxygen from the blood, increasing the level of hemoglobin, and increasing the muscle mass. On the other hand, the maximal aerobic capacity can be reduced due to blood loss, paralysis, surgery, negative nitrogen balance, or bed rest.<a></a> The important clinical implication is that the paraplegic patient is usually severely deconditioned as a consequence of the injury. The prescription of orthoses and a walking program should not be initiated until the patient has sufficient strength and maximal aerobic capacity to meet the required energy demand. The deconditioned paraplegic patient will respond to a physical conditioning program just as an able bodied subject with respect to increased strength, endurance, and maximal aerobic capacity.<a></a> In able bodied subjects, the VO2 max also depends on the type of exercise. During lower limb exercise, the VO2 max is greater than the VO2 max for the upper limbs. Since paraplegic patients rely on the upper extremities to walk with the aid of crutches, their energy production capability is inherently limited. The problem in paraplegics is further compounded by the effects of the spinal injury. The upper extremity VO2 max for paraplegics is lower than for able bodied subjects, presumably due to the effects of paralysis and interruption of the autonomic neurological pathways which regulate blood flow and cause venous pooling in the lower extremities.<a></a> For the typical adult male paraplegic, we establish a VO2 max of 20 ml/kg-min during upper arm cranking as the minimal criteria acceptable for entering gait training if a swing-through crutch assisted gait pattern will be required. <h3>Energy Expenditure</h3> Wheeling Versus Normal Walking On a hard, level surface paraplegic wheelchair use is as efficient as normal walking. A comparison of the data in <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2</a> indicates that when propelling a chair around a 60.5 meter circular track, the speed was almost as fast as normal walking (72 versus 80 m/min).<a></a> The oxygen rate was approximately the same (11.5 versus 11.9 ml/kg/min) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a>), as was the oxygen cost (.16 versus .15 ml/kg/ min). The heart rate was higher in paraplegics using the wheelchair than in normal walking (123 versus 100 BPM) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>). As previously mentioned, this relates to the lower upper maximal aerobic capacity in paraplegics during arm exercise. From a clinical standpoint, it may be concluded that the wheelchair is a highly efficient means of transportation whose speed and energy requirements are comparable to that of normal walking. <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Figure 2. Average velocity in normal subjects and in patients using wheelchairs or orthoses.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Figure 3. Rate of oxygen consumption in normal subjects and in patients using wheelchairs or orthoses.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Figure 4. Heart rate in normal subjects and in patients using wheelchairs or orthoses.</a> Swing Through Gait Crutch walking with a swing-through gait requires the arms and shoulder girdle to lift the entire weight of the body and swing it forward with each step. The average speed in paraplegics trained to use a swing-through crutch assisted gait was 64 percent lower than normal walking (20 versus 80 m/min) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2</a>); the rate of oxygen consumption was 38 percent greater (16.5 versus 11.9 ml/kg/min) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a>); the oxygen cost was 560 percent greater (.84 versus .15 ml/kg/min); and the heart rate was increased 46 percent (145 versus 99 BPM) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>).<a></a> This rate of energy expenditure requires most of the aerobic capacity of the typical adult male paraplegic with a complete T12 lesion and is well above the anaerobic threshold. The extreme exertion required for a swing-through gait demands a greater intensity of physical effort than a normal individual customarily expends on sports activity such as recreational jogging. Consequently, it is not surprising that while the athletic paraplegic may be willing to expend this level of exertion for recreational purposes, he is unwilling to sustain these efforts for normal activities of daily living. Even those patients, who are physiologically capable of sustaining the intense physical effort of a swing-through gait for a sustained time period to travel longer distances, find tachypnea (rapid breathing), tachycardia (rapid heart rate), and hidrosis (sweating), unacceptable for routine activities of daily living. We believe that the highly motivated paraplegic who is willing to exercise strenuously should not be discouraged from walking, but a more realistic approach should be taken for the average patient. The average patient should be given walking training and bilateral knee-ankle-foot orthoses only if walking is necessary for psychological reasons, for purposes of exercise, or because of architectural barriers in the living environment. It should be clearly explained that the wheelchair should be considered as the primary means of mobility. We have tested three patients with "Fair+" hip flexors who used bilateral KAFO's and preferred a reciprocal gait pattern.<a></a> Interestingly, the effort expended by these patients was just as great as in swing-through gait (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2</a>, <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a>, and <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>). Energy Expenditure: Reciprocal Gait In a review of spinal cord injured patients, Hussey and Stauffer found that those patients who were able to walk in the community had pelvic control with at least "Fair" hip flexor strength and at least "Fair" extensor strength in one knee so that a maximum of one KAFO was required, enabling the patient to achieve a reciprocal gait pattern.<a></a> Having "Fair+" or greater quadriceps strength sufficient to stabilize one knee eliminates the need for one KAFO and enables the patient to walk with a crutch assisted reciprocal gait pattern at a rate of energy expenditure and heart rate that are significantly below that required for a swing-through gait pattern (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a> and <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>). Surprisingly, we found no difference in the speed and rate of energy expenditure in patients with one free knee or two free knees and requiring bracing only below the knee (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2</a> and <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a>). Nevertheless, paraplegics who have intact hip flexion and knee extension bilaterally require orthoses only below the knees, and those who use a reciprocal crutch assisted gait pattern are still severely impaired (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2,</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3,</a> and <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>). Compared to normal walking, the rate of oxygen expenditure is 20 percent greater (16.3 versus 11.9 ml/kg/min) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg">Fig. 3</a>), the heart rate 31 percent greater (131 versus 100 BPM) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg">Fig. 4</a>), and the speed 67 percent slower (80 versus 20 m/min) (<a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg">Fig. 2</a>).<a></a> The typical paraplegic who uses crutches and a reciprocal gait still exerts a force of 25 to 50 percent of total body weight on the crutches with each step, accounting for the increased rate of energy expenditure. The only spinal cord injured patients we have tested whose energy expenditure during walking does not exceed normal values are those patients with minimal involvement who have intact sacral function (in addition to lumbar function) and a sufficient hip abductor and extensor strength to maintain an erect posture without crutches. The average distances necessary to perform different daily living activities are listed in <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-5.jpg">Fig. 5</a> and were obtained from numerous measurements made in different types of urban areas in Los Angeles.<a></a> Since the average speed of walking in low lumbar paraplegics who used bilateral ankle-foot orthoses and a reciprocal crutch assisted gait pattern was only 26 m/min, it would take more than five minutes to travel 150 meters. Because five minutes of walking will require a strenuous effort, it is apparent why even the typical low lumbar paraplegic is a limited walker outside the home and is not able to routinely ambulate comfortably for activities which require walking a longer distance. In this regard, clinicians are justified in prescribing a wheelchair to any spinal injury patient who requires crutch assistance. The patients should be encouraged to use the wheelchair as necessary and be reassured that reliance on the wheelchair, when necessary, should not be considered a failure. <a href="http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-5.jpg">Figure 5. Average distances necessary to perform customary activities of daily living.</a> References: <ol> <li>Aastrand, P.O. and K. Rodahl, Textbook Work Physiology, Ed. 2, McGraw-Hill, Inc., New York, 1977.</li> <li>Cerny, K., R. Waters, H. Hislop and J. Perry, "Walking and Wheelchair Energetics in Persons with Paraplegia," Physical Therapy, 60:1133-1139, 1980.</li> <li>Clinkingbeard, J.R., J.W. Gersten, and D. Hoehn, "Energy Cost of Ambulation in the Traumatic Paraplegic," American Journal of Physical Medicine, 43:157-165, 1964.</li> <li>Gordon, E.E., "Physiological Approach to Ambulation in Paraplegia," JAMA, 161:686-688, 1956.</li> <li>Huang, C.T., A.B. McEachran, K.V. Kuhlemeier, M.J. DeVivo, and P.R. Fine, "Prescriptive Arm Ergometry to Optimize Muscular Endurance in Acutely Injured Paraplegic Patients," Arch. Phys. Med. Rehab., 64:578-582, 1983.</li> <li>Hussey, R.W. and E.S. Stauffer, "Spinal Cord Injury: Requirements for Ambulation," Arch. Phys. Med. Rehab., 54:544-547, 1973.</li> <li>Lehneis, H.R., E. Bergofsky, and W. Fresina, "Energy Expenditure with Advanced Lower Limb Orthoses and with Conventional Braces," Arch. Phys. Med. Rehab., 57:20, 1976.</li> <li>Lerner-Frankiel, M.B., S. Vargas, M. Brown, L. Krusell, and W. Schoneberger, "Functional Community Ambulation: What Are Your Criteria?" Clin. Man. in Phys. Ther., 6:12-15, 1986.</li> <li>Waters, R.L., H.J. Hislop, J. Perry, and D. Antonelli, "Energetics: Application to the Study and Management of Locomotor Disabilities," Orthop. Clin. North America, 9:351-377, 1978.</li> <li>Waters, R.L. and B.R. Lunsford, "The Energy Cost of Paraplegic Locomotion," Journal of Bone Joint Surgery, 67A: 1245-1250, 1985.</li> <li>Wolf, E. and A. Magora, "Orthostatic and Ergomet-ric Evaluation of Cord-injured Patients," Scandinavian Journal of Rehabilitation Medicine, 8:93-96, 1976.</li> </ol> *Leslie Miller, R.P.T. Leslie Miller, R.P.T. is a spinal cord injury clinical specialist at Rancho Los Amigos Medical Center. *Robert L. Waters, M.D. Robert L. Waters, M.D. is Chairman of the Department of Surgery at Rancho Los Amigos Medical Center, HB-121, 7601 E. Imperial Highway, Downey, California 90242. Page Number(s) 66 - 73 Year 1987 Volume 11 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-4.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 5 http://www.oandplibrary.org/cpo/images/1987_02_066/1987_02_066-5.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 Physiologic Rationale for Orthotic Prescription in Paraplegia Creator An entity primarily responsible for making the resource Robert L. Waters, M.D. * Leslie Miller, R.P.T. * https://staging.drfop.org/files/original/809ea89a32d4d8e36fa8e6385772fa3a.pdf 3ee99a2bf09bacedf1558f9b28f4ed07 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_02_001.pdf Text Any textual data included in the document <h2>A Proposal for Delivery of Externally Powered Upper-Limb Prostheses</h2> <h5>Michael J. Quigley, C.P.O. </h5> Prepared by the American Academy of Othotists and Prothetists, 1444 N St., N.W., Washington, D.C. 20005. Editor: A. Bennett Wilson, Jr., B.S. M.E.; Managing Editor: Brian A. Mastro, B.A.; Editorial Board: Joseph M. Cestaro, C.P.O., Charles H. Epps, Jr., M.D., Robert B. Peterson, R.P.T. There are about 322,000 amputees in the United States today. Of this number, approximately 9,000 people have upper-arm amputations and 16,000 have forearm amputations. Many arm amputees choose not to wear a prosthesis for three major reasons; 1) lack of sensory feedback, 2) poor function and 3) poor cosmesis. Unfortunately, the vast majority of physicians, therapists, and prosthetists seem to believe that new amputees should always be provided a hook first, and a hand later, if the hook is accepted. Nearly all patients, however, want a hand first and dread the thought of using a hook for obvious cosmetic and psychological reasons. In a great number of cases, the hook and prosthesis are rejected due to the undue amount of attention attracted to the wearer. Body powered mechanical hands are heavy, cumbersome, and far less functional than hooks. The same amount of harnessing and body power is required to control these hands as with the hooks. The cosmetic gloves that cover these hands are easily stained, torn, and discolored. The major indication for prosthetic hands has been for unilateral amputees who are engaged in light-duty work and are very conscious of cosmesis. The introduction of the VA- Northwestern University, Otto Bock, Variety Village, and other powered hands and elbows for prostheses should change the dismal attitude concerning prosthetic hands. These prostheses are extremely cosmetic, and require very little body motion and little or no harnessing to control the hand. The hand can be controlled easily whether the wearer is reaching for something over his head or behind him, which was previously very difficult. Powered prostheses are of greatest value for patients with high amputations, whether they are unilateral or bilateral. These patients are normally present complicated problems because they lack the muscle power and leverage to control mechanical prostheses, but they can easily control powered prostheses by myoelectric or switch controls. Powered prostheses have received a very cool reception in the United States due to a number of factors; the cost of the prostheses is high- four to five times that of conventional prostheses-and therefore many third-party payers refuse to pay for them. The prosthetist fitting an externally powered prosthesis must be well trained in order to evaluate myoelectric potentials and to properly fit and maintain the prosthesis. As most prosthetists have no background in electronics, more than a short orientation course is required. Even after thorough training is obtained, the prosthetist may only see two or three patients per year requiring these types of prostheses, and therefore much of the information will be forgotten. In many cases, components that were intended to be modular in concept and simply plugged in need to be reworked or redistribued around on the socket in order to accommodate a long or non-standard type of amputation. In a study conducted by the Veterans Administration 18 prosthetists were involved in an evaluation of powered prostheses. All prosthetists were given a one-to-two-week course by the VA on myoelectric prostheses and patients were referred to them through VA clinics for fittings. Despite all this education, prosthetist errors were responsible for more malfunctions than any other cause. Faced with all of the above facts plus the fact that the cosmetic glove is still a problem, most prosthetists chose not to handle externally powered prostheses. Further, since such a small percentage of the amputee population can be fitted with this type of prosthesis, most prosthetists find it impractical to invest the great amount of time and money for education and equipment before they can provide satisfactory service. It has been shown that in areas where prosthetists learned enough about powered prostheses to be able to properly fit and maintain them, the prostheses received wide acceptance. John Billock, C.P.O., in Warren, Ohio uses a number of different powered prosthesis systems, including hybrid models using components of different systems on severely disabled upper-limb amputees that are referred from all over the Midwest. William Sauter at Ontario Crippled Childrens Center has also proven the practicality of powered systems on adults and children. In each area, however, institutional support has been the determining factor. Mr. Billock's success was achieved after years of participation in the research program at Northwestern University and Mr. Sauter's work is done in a large Rehabilitation Center. Similarly, the Bock system is used in Minneapolis due to a great amount of support from the Germany-based Otto Bock Company to its United States headquarters in Minneapolis. The Otto Bock Company is presently offering a free one-week course on the basic below-elbow system, and plans future courses on advanced powered components. We are faced with the situation that powered upper-limb prostheses are presently available but are not used for the many reasons stated previously. How do we solve the service delivery problem, particularly for the more severely disabled upper-limb amputee? I suggest that specialized fitting centers are the best solution to the problem. Such centers can be privately owned or located in an institution. The advantage of this system is that the prosthetist would see enough patients to become truly expert in the area of powered prostheses, and could well afford the expense of taking all relevent courses or preceptorships and obtaining the necessary staff and equipment. I have visited one such center in Warren, Ohio, which is owned by John Billock, C.P.O. Mr. Billock and his staff at Warren Orthotics and Prosthetics Restoration Laboratory fit three to four powered upper-limb prostheses per month, including all levels of amputation. His staff includes a full time electrical engineer and an electronics technician. There are enough equipment and spare parts available so that essentially all maintenance is carried out on the scene, which avoids long delays when repairs are done elsewhere. Patient referrals are mostly from the Midwest and East Coast, although patients from the West Coast are not uncommon. One patient being seen during my visit had a right shoulder disarticulation and a left above-elbow amputation and was being fitted with powered hands, elbows and wrist rotators controlled by switches. Components from at least three manufacturers had to be made compatible in the ten-month long project. I feel that a total of four centers in the United States could adequately handle the patient load. The average prosthetist with a good understanding of powered prostheses will be able to treat most unilateral below-elbow patients, so referrals to a powered prosthesis center will usually be for more difficult cases. It will be important for private centers to be closely allied with a rehabilitation center, as these patients will require therapy, counseling, and other services while the prosthetic services are being performed. It seems obvious to me that powered prostheses will be more common than body powered designs within the next twenty years, and it is time now to establish an efficient service delivery system. Page Number(s) 1 - 2 Year 1978 Volume 2 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 A Proposal for Delivery of Externally Powered Upper-Limb Prostheses Creator An entity primarily responsible for making the resource Michael J. Quigley, C.P.O. https://staging.drfop.org/files/original/52f7d266c544d7b057ce3f61ff421222.jpeg c442d8b15660c8c79d4df71065ad319d https://staging.drfop.org/files/original/cecb22a00897ba34f840608eed75219c.jpeg 1dad83a740d94fdf8668227e6d78ec45 https://staging.drfop.org/files/original/4840e49061168dd070be6b5f910136d0.jpg bc55027014a65d697e997b2b937c2821 https://staging.drfop.org/files/original/23866a9c822d0eb399417ae71c53afde.jpg de5956ea11e10351dd0edbc4eb3964c7 https://staging.drfop.org/files/original/9654f5f19860f0e88b033d410589d261.jpg 32b34b3e40ced6807f3639dbaa1dc46a https://staging.drfop.org/files/original/208783458811d4c978eb476b9ddc2a62.jpg 1c8a4fce56522125a18f83d04e40f32b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Text Any textual data included in the document <h2>A Solution For Split-Size Shoes</h2> <h5>Eugenio Lamberty <a style="text-decoration: none;">*</a> John Milani <a style="text-decoration: none;">*</a></h5> Despite the almost daily occurrence of new concepts and improvements in Orthotics, many problems remain to be solved. A significant number of these problems result from congenital factors or acquired diseases during childhood. The severely deformed leg and foot have been of major concern, particularly when the deformed foot has been significantly shorter in length than the sound foot (<a href="/files/original/52f7d266c544d7b057ce3f61ff421222.jpeg">Fig. 1</a>). In some cases the feet may vary in shoe size by as much as three or four sizes (<a href="/files/original/cecb22a00897ba34f840608eed75219c.jpeg">Fig. 2</a>). This becomes quite expensive for the patient, who must either purchase two pairs of shoes to fit each foot properly or custom-made shoes. To reduce this financial burden and yet greatly improve cosmesis, a method of fabrication had to be found whereby the patient would be required to purchase only one pair of ordinary shoes that would be the size of the normal foot. A shoe filler (<a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg">Fig. 3</a>), conceived, designed and developed by the authors through the Veterans Administration Prosthetics Center, has solved this problem. This device is placed in the shoe (<a href="/files/original/23866a9c822d0eb399417ae71c53afde.jpg">Fig. 4</a>) to take up the excess space of the shortened foot. Then the shoe insert portion of the orthosis is placed into the filler and shoe (<a href="/files/original/9654f5f19860f0e88b033d410589d261.jpg">Fig. 5</a>). This results in a highly-cosmetic arrangement (<a href="/files/original/208783458811d4c978eb476b9ddc2a62.jpg">Fig. 6</a>) that is also financially beneficial to the patient. <h3>Method of Fabrication</h3> To construct the shoe filler, proceed as follows: <ol> <li> Secure a SACH foot that will fit the size shoe to be worn by the patient. Ensure that the plantar surface of the SACH foot is flat, to prevent the shoe insert portion of the orthosis from rocking. An immediate post-op foot can be used. </li> <li> Vacuum mold the SACH foot with 1/4-inch low density polyethylene. Polyethylene is ideal since it provides good strength and flexibility. </li> <li> When the plastic has cooled, remove it from the SACH foot and initially trim it so that it does not protrude beyond the borders of the shoe. Refer to <a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg">Fig. 3</a>. </li> <li> Use standard methods and techniques to fabricate the orthosis. </li> <li> Place the orthosis on the patient. Then place the orthosis on the patient into the shoe and shoe filler while ensuring that the shoe filler does not hinder this process. </li> <li> Further trim the shoe filler along its medial and lateral sides, behind what would normally be the metatarsal heads of the sound foot. This allows the normal toe break of the shoe to function properly and thereby ensure unrestricted motions of the ankle and foot. </li> </ol> <h3>Notes</h3> To prevent the orthosis from slipping forward in the filler, the filler should curve around slightly, onto the dorsum of the foot. Refer to<a href="/files/original/4840e49061168dd070be6b5f910136d0.jpg"> Fig. 3</a>. This trim, together with a properly laced shoe or a shoe laced with micro straps, should provide the required counterforce to prevent the orthosis from slipping forward in the filler. It is further noted that one patient, who had worn the new orthotic system for one month, required foam padding that was placed anteriorly into the filler to prevent the orthosis from slipping. <h3>Summary</h3> The design and development of a shoe filler when bracing the shortened foot is cosmetically appealing and financially beneficial to the patient who is consequently required to purchase only a single pair of ordinary shoes. In addition, fabricating the filler is a relatively simple procedure for the orthotist. <h3>Acknowledgements</h3> The authors would like to express their appreciation to Max Nacht, Technical Writer-Editor, VAPC, for his cooperation and assistance in preparing this article; and to Charles Berman and Anthony Morales, Photographers, VAPC, for their fine photographic work. <div style="width: 400px;">John Milani Orthotist-Prosthetist, Veterans Administration Prosthetics Center, 252 Seventh Avenue, New York, NY 10001 *Eugenio Lamberty Orthotist. Veterans Administration Prosthetics Center, 252 Seventh Avenue, New York, NY 10001</div> <div style="width: 400px;"></div> Page Number(s) 3 - 4 Year 1979 Volume 3 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-4.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 5 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-5.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1979_04_003/1979_04_003-6.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Solution For Split-Size Shoes Creator An entity primarily responsible for making the resource Eugenio Lamberty * John Milani * 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/83648b0b711c382f195cc6bdaa6ab376.pdf 0d93f48bc78669170b984704c62a93b6 https://staging.drfop.org/files/original/51ee9f592b7e05126ec1e1eeec2c8f87.jpg e2e5e9a0ff445f9d032735045a3720b6 https://staging.drfop.org/files/original/cd87e6b8e63780897953794d33b1a88f.jpg 611cb47da091fa4220b0a84a5621f946 https://staging.drfop.org/files/original/ee0b549a0ac2ac1213258d9a7cf6bde6.jpg 13dc19f7b6d5ad835d26c445b688647b https://staging.drfop.org/files/original/9268367df64346914dfcd44ac7f8e280.jpg dccae3622fdb0d507ef88c33387b8ecf https://staging.drfop.org/files/original/748805f5859f6d87f7e3d2763cbd306e.jpg 4dd495359ed8ab36487f3abc0abf6221 https://staging.drfop.org/files/original/46b2b805c5456f6a9b6763b29e69dd6e.jpg c6ddf3929559d51cb9a4c5ac217b757d 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_04_130.pdf Text Any textual data included in the document <h2>Adaptive Seating in Pediatrics</h2> <h5>Robert S. Lin, C.P.O. <a style="text-decoration: none;">*</a> Susan S. Lin, O.T.R. <a style="text-decoration: none;">*</a></h5> Adaptive seating represents one of the most complex areas of orthotic management. No other area of clinical practice requires the degree of knowledge and application of biomechanics, design engineering, tissue physiology, wheelchair design and the clinical manifestation of the many neuromuscular disorders involved. No other area of management effects as many aspects of the patient's life and treatment programs initiated by other professionals. Therefore, it is imperative to solicit input from all members of the multidisciplinary team (<a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-1.jpg">Fig. 1</a>). The orthotist, physician, physical therapist, occupational therapist, educator, speech pathologist, social worker, psychologist, and wheelchair vendor must all take part in the prescription formulation (<a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-2.jpg">Fig. 2</a>). Unfortunately, formal training for the aforementioned professionals provides very little, if any, information for the evaluation, assessment, and design of adaptive seating systems. <a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-1.jpg">Figure 1.</a> Input from all members of the rehabilitation team is solicited. <h3>Development</h3> To compound the difficulty of equipment provision, pediatrics offers additional complications that aren't as prevalent in management of the adult population. Because the child is still undergoing physical development and maturation, the clinical picture he/she presents is expected to change. Some of the changes are due to growth (longitudinal and/or circumferential), yet some are due to disease progression, developmental abnormalities, and psycho-social problems that result from an increasing awareness of the physically handicapping condition. The adaptive seating system must be able to accommodate growth, environmental, and clinical changes in the child. This is particularly important in view of the funding restrictions on equipment replacement set by state or private payment sources. <h3>Education</h3> Another very important consideration in positioning a child is the child's educational goals and limitations. Aside from the physical barriers that a school may present, safe transportation to and from the school in a bus or van must be achieved. Few wheelchair bases are compatible with the lock down mechanism used by local transportation systems. This basic mechanical problem can hamper the educational process even before it begins. Once the child is in the school environment, many subtle factors can influence the success and acceptance of the adaptive seating system. These factors include whether or not the child is mainstreamed or in a special education program; the physical design of the school such as elevators for multilevel institutions and overall wheelchair accessibility; whether the communication needs of the child are met in a group setting; desk height, which can profoundly effect actual integration; whether medical/nursing facilities are available; and the kinds of recreational provisions offered for physical education. <h3>Information Collection</h3> Because the breadth of information concerning the patient can be extensive, there must be a mechanism to facilitate the collection of this critical data. It is imperative that the primary treating professionals provide this input because of familiarity with the patient and pre-established goals. The following In-take form was developed by author Susan Lin, O.T.R. in an effort to provide a concise patient data collection sheet. While the completion of this form can be time consuming, we have found that access to this information is essential (<a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-3.jpg">Fig. 3</a>, <a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-4.jpg">Fig. 4</a>, <a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-5.jpg">Fig. 5</a>, and<a href="http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-6.jpg"> Fig. 6</a>). <h3>One Approach To Adaptive Equipment Provision</h3> In 1981, Newington Children's Hospital initiated its first formal Adaptive Equipment Clinic. The clinic is covered by seven members of the core team with three others forming the ancillary team. The core consists of a physician, orthotist, seating specialist, physical therapist, occupational therapist (who serves a dual function as the Adaptive Equipment Coordinator), speech pathologist, and social worker. The ancillary team is comprised of an educator, psychologist, and durable medical equipment vendor. The clinic is held one morning per week, divided into four one-hour appointments. Every third week of each month is reserved for a re-check clinic and follow-up care is provided every six months. The follow-up appointments are one half hour long, with eight patients checked in a morning. Prior to the first patient evaluation, the In-take forms for all new patients scheduled that day are reviewed and discussed. This enables us to establish a preliminary game plan as well as discuss certain confidential factors that may influence management. Formulation of the actual prescription occurs during the hour appointment, with various tasks assigned to appropriate team members to ensure follow-up of our recommendations. Over the past five years, the NCH Adaptive Equipment Clinic has provided an ideal forum for patient and equipment evaluation and prescription. The aforementioned protocol evolved slowly and has worked very well considering our resources, patient population, time and cost constraints. Those factors that have universal application are the need for a multidisciplinary approach, the need for follow-up appointments, and a sound understanding of seating principles. The recent emphasis on adaptive seating has finally enabled the orthotist to assist in management of the entire spectrum of patients, not just those who are candidates for ambulation. The appropriate seating system can be a therapeutic tool which enhances the quality of life and serves as an adjunct to other rehabilitation efforts. *Susan S. Lin, O.T.R. Susan Lin, O.T.R., is the Director of Occupational Therapy at Forestville Nursing Center and an Adaptive Equipment Consultant at Hudson Home Health Care. She was the primary developer of the Adaptive Equipment Clinic at Newington Children's Hospital and was the Hospital's first Adaptive Equipment Clinic Coordinator from 1981 to 1985. *Robert S. Lin, C.P.O. Robert Lin is the Clinical Coordinator of Orthotics at Newington Children's Hospital, 181 East Cedar Street, Newington, Connecticut 06111. Page Number(s) 130 - 136 Year 1986 Volume 10 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_04_130/1986_04_130-5.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/1986_04_130/1986_04_130-6.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 Adaptive Seating in Pediatrics Creator An entity primarily responsible for making the resource Robert S. Lin, C.P.O. * Susan S. Lin, O.T.R. * https://staging.drfop.org/files/original/b3a2c7a0584c7b41faa78f8463cf4268.pdf f252ffd28bf2d19a88c0995299dca5af 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_03_004.pdf Text Any textual data included in the document <h2>An Advanced Approach Toward Improved Prosthetic Fittings</h2> <h5>David F.M. Cooney, R.P.T., C.P.O. <a style="text-decoration: none;">*</a> Keith E. Vinnecour, C.P.O. <a style="text-decoration: none;">*</a></h5> The importance of amputation surgery and dedicated follow-up cannot be underestimated by those clinicians who deal with the amputee population. A prosthetist who receives a patient with a residual limb that is of the optimum configuration to receive a prosthesis and permits the lowest energy cost with maximum unilateral weight bearing comfort, is too often the exception. A concerted effort by all professionals involved—physicians, nurses, physical and occupational therapists, psychologists, social workers, and prosthetists—is required for truly successful rehabilitation. <h3>Delineation Of Level</h3> Successful primary healing in patients who have experienced a trauma related amputation is not as great a concern since the average age of this group is much younger than the dysvascular amputee. For the majority of patients who require prosthetic care due to vascular insufficiency, predictions for successful healing, and therefore level of amputation, is a critical consideration and of primary address here. The following discussion and techniques employed, however, can apply to all prosthetic fittings. In the dysvascular patient, the correct assessment of tissue viability and level of limb amputation is paramount to successful rehabilitation. Correct assessment also serves to reduce the length of the hospital stay and, therefore, costs. Patient morbidity and mortality are also reduced.<a></a> A number of methods are employed to determine amputation level. Absolute determinants include ischemia and necrosis. Skin temperatures, absence of hair, sensory deficits, and peripheral pulses are also clinical tools of relative, though unreliable, demarcation. A less direct way of determining level of amputation is the condition of the underlying tissues and skin bleeding during surgery.<a></a> Objectively defined methods are being used to more accurately determine surgical level. Doppler pressure measurements use systolic pressure differentials between the level of concern and brachial pressure. The literature cited offers relative values for prediction of successful healing,<a></a> but also points out the Doppler method's fallibility.<a></a> Two other non-invasive tests, segmental systolic pressure readings and pulse-volume recordings, can provide a reasonably valid prediction of primary wound healing, but should not be used as the sole indicators for amputation site.<a></a> Thermography has been used to estimate the optimal site of amputation. Infrared emissions from the involved extremity are displayed on a screen to show temperature differentials. One study claimed a 96 percent success rate with amputation levels recommended via thermography<a></a>. Skin blood flow by the Xenon-133 clearance techniques to predict primary healing levels in amputation surgery have shown positive results. A 100 percent primary amputation healing is claimed by these authors for surgeries where recommendations according to their standards were followed.<a></a> The choice of any of the above methods rests with the abilities of the institution. Though most non-invasive means are available throughout the medical community, invasive techniques using radioactive isotopes, like Xenon-133, require the availability of a nuclear medicine department. Clearly, not all facilities have this capability. Once the level of tissue viability and surgical healing have been determined, operative procedures commence. A residual limb offering optimal function should be a "well muscled, durable stump of effective length with a pliable skin cover that has adequate sensation." The means to this end requires careful attention to the handling of the bone, nerves, and soft tissues.<a></a> <h3>Surgery</h3> Subsequent to determining the amputation level is the actual surgical technique, which is an important adjunct to successful rehabilitation of the amputee. Handling of the bone requires close attention to the residual cortical shaping, and in standard practice it should be beveled to prevent sharp margins and potential socket problems.<a></a> The reaction of the bone to surgical handling of the periosteum is not fully understood, but when dealing with tissues that are compromised initially, one cannot fault a "kid-glove" approach to dissection and ligation. Delicate handling may avoid subsequent spurring along the bony margins.<a></a> It has generally been considered that fibular length should be less (approximately 2.0 cm.) than the length of the tibia.<a></a> The authors feel that fibular length should be equal to or no more than 5 mm. shorter than the cut tibia. It is felt that this improves prosthetic medio-lateral stability, provides greater distal bulk, and serves to prevent mature conical shaping and increase total tissue contact and weight-bearing. In the procedure described by Ertl,<a></a> the lengths of the two bones are equal. A bony bridge, or periosteal flap, is then created to afford an end bearing residual limb. This synostosis also prevents any relative motion of the two bones. The tibiofibular osteoplasty closes the open medullary canals and can recreate the normal conditions of direct weight bearing pressures and circulation in the long axis of the bone. This can help prevent degeneration in the joints proximal to the amputation.<a></a> It would seem that this procedure should warrant greater attention in appropriately selected patients (especially in light of the much improved fitting techniques now available). Establishing stabilization in the distal musculature at the selected site of amputation is important to provide a more physiologically effective residual limb. Where surgically feasible, the muscles should be sutured to each other as well as to the periosteum and/or bone without excessive tension or laxity. This allows for a well contoured and generally less prosthetically troublesome limb.<a></a> Nerve tissue should be handled meticulously to avoid residual problems once prosthetic wear is initiated. Each nerve should be individually dissected and have adequate traction applied. Severing of the nerve with traction maintained will cause it to retract far enough up into the soft tissue so as to be well protected and less threatened by weight bearing pressures.<a></a> Prosthetically crucial are the smaller sural and saphenous nerves, as they are sometimes neglected in lieu of the more major posterior tibial, deep and superficial peroneal nerves.<a></a> Redundancy of soft tissues should be avoided, but adequate coverage of the remaining structures is a must in order to provide a good limb for weight bearing. Closure of the wound should include careful suturing and handling of the already compromised tissues and care should be taken to avoid traction at the suture line so as to prevent contractures of the joint.<a></a> It has been shown again and again that immediate post-surgical fitting procedures can improve residual limb viability, reduce pain and edema, and prevent contractures.<a></a> Rigid dressings are common practice in immediate post-surgical fittings, but variations on this theme include the use of pneumatic devices that can also afford the advantages of their more rigid counterparts.<a></a> More tenuous situations that may not allow for early weight bearing and ambulation, secondary to healing problems, can be approached through the use of Una boot dressings<a></a> and an innovative removable rigid dressing technique.<a></a> Invariably, the independent and/or conjunctive use of any one of these methods can enhance the post-operative management of even the most difficult rehabilitation patient. By improving a patient's physical and mental status and by providing mobility through this approach, the clinical team can increase a patient's rehabilitation potential.<a></a> <h3>Prosthetic Evaluation</h3> Little has changed in the physical aspects of evaluation. Standard anthropometric measures are still used to provide an objective record for modifications and fabrication, and for comparative purposes related to future changes. Accurately determining the anatomical joint range of motion (both in the involved and uninvolved limb) and strength/stability can provide criteria for prescription and serve to mediate problems during fitting. One new tool in the evaluative process is Xeroradiography®. Xeroradiography® is a process that yields an x-ray image on an opaque background. The picture records are easier to store than their x-ray counterparts and provide a clear definition of both the bony anatomy and soft tissue. Evidence of bone spurring, vessel calcification, and presence of vascular surgery staples is readily observed. Measurements are also easy to glean. The use of this information in the treatment of the amputee is obvious and can significantly improve and objectify the prosthetist's skills and, ultimately, improve patient management.<a></a> <h3>Casting</h3> Adopting a "hands-on" technique in the quest of obtaining an anatomical replica of the residual limb should be the goal of the prosthetist. A careful volume study of the involved limb can serve to optimize the definitive results. The growing use of static and dynamic test sockets, and the information provided by them, has yielded a twist on the time tested practices utilized by many prosthetists. The technique of automatic build-ups over sensitive areas has been found to be less than necessary. Reversing this thought process to promote negative model modifications over areas of weight bearing can provide better total-contact, total-weight bearing sockets. Doing this in the molding process can reduce the amount of relatively educated guesswork necessary in cast modification by producing better initial cast molds. Methods which have been developed to aid in this pursuit include vacuum casting<a></a> or a three to four stage alginate casting technique.<a></a> Another method to improve fit from the initial casting is to work toward a more dynamic casting method. As the casting is predominantly done under non-weight bearing conditions, working toward more "dynamic" casting methods which equalize the weight bearing pressures is warranted consideration. Where an Ertl procedure has been performed, distal weight bearing casting is preferred to achieve maximum results. The same intent should be attempted with the non-Ertl distal end as well. Ultimately, the better the quality of the cast and the less initial modification guesswork, the better the test socket fitting. <h3>Test Socket</h3> Use of clear test sockets for improving fit is well documented in the literature cited. Though the technology for transparent test sockets has been available since the 1950's, the current practice of direct weight bearing modifications to the socket are relatively new.<a></a> During the initial static weight bearing period, areas of the residual limb are demarcated according to weight distribution and, therefore, load. This is evidenced by varying degrees of blanching or redness. The goal of a total tissue bearing socket is then pursued to decrease areas of excessive pressure (blanching) and to increase areas of inadequate loading (redness). This goal can be met through either static or dynamic test socket volume changes, or cast model modifications. Under weight bearing conditions, loose areas are marked by redness, and tension analysis is accomplished via "poking" the tissue through holes made in the socket. Various injectable materials (glycerine, alginate, pour-a-pad) are then added to equalize weight bearing pressures. Areas of excessive weight bearing, if not relieved by the weight borne by the newly injected materials, are either relieved in the socket or modified on the master mold. By achieving a careful stump-socket interface tension analysis as described, greater confidence in he ultimate result and an optimum fit is possible. Difficulty of fit dictates the number of check socket fittings. Unfortunately, fittings are also affected by the reimbursement source. The fact is undeniable, however, that a transition to the use of transparent test socket fittings can increase the level of prosthetic expertise and elevate the profession to a higher plateau of fitting success. <h3>Dynamics</h3> Advancements in prosthetic componentry and gait analysis techniques, when used in conjunction with improved evaluation tools and fitting methods, provides a greater arsenal for the prosthetist seeking to optimize his patient's abilities. An exciting variety of new techniques are surfacing throughout the country which not only render prosthetics more professionally demanding to the practitioner, but also challenging to the patient. Different socket styles and theoretical bends are adding to current thought and practice. The above-knee amputee now has a variety of alternatives in not only socket material and construction, but in functional design as well. The Swedish flexible socket offers a lighter weight, more "natural" feeling socket to the AK amputee. It also allows for greater transmission of heat via the polyethylene or Surlyn® material, and therefore a cooler feeling. The flexibility of the socket also encourages physiological muscle activity and provides sensory feedback through the thin material.<a></a> Contoured Adducted Trochanteric Controlled Alignment Method (CATCAM) is an exciting new above-knee socket design. Proponents claim it increases comfort secondary to total soft tissue weight bearing, because the ischial tuberosity is no longer on the "seat" of the conventional quadrilateral design, but contained within the socket. The CATCAM also allows for more natural muscle activity by virtue of both the flexible design (a la Swedish flexible socket) and inherent socket mechanics. By improving the socket's purchase on the femur, whereby the ischium, trochanter, and adductor longus tendon are in essence "locked-in," stabilization increases, which then decreases the Trendelenberg tendencies experienced by many above-knee amputees. By obtaining a definite position of adduction of the femur, one can take advantage of the muscle stretch of the gluteus medius and therefore increase pelvic control with unilateral weight bearing.<a></a> Ultralight weight components continue to be preferred in the above-knee prosthesis. The availability of titanium, carbon graphite, and higher density plastics in the manufacturing of the pylons, joints, and attachment plates allow for lighter weight limbs and, ultimately, decreased energy costs for the amputee. The below-knee amputee has a varied repertoire of options. A greater array of suspension methods—latex rubber, neoprene sleeves, total suction prostheses—are now available. The Flex-foot prosthesis<a></a> utilizes a sleeve suspension and is comprised of a carbon graphite and fiberglass pylon and a heel that is very strong, light weight, waterproof, and energy cost effective. The Flex-foot design provides "stored energy" upon weight bearing that "propels" the amputee forward, mimicking "normal" muscle activity in gait. This can also be used for the above-knee amputee. The Flex-foot is proving to be a great advance toward increasing the abilities of the athletic amputee and shows great promise for the elderly and less physically challenged. New liner materials have also provided alternatives for the below-knee amputee, with greater comfort as a result. Silicone gel and leather liners,<a></a> Ipocon gel,<a></a> and injection molded silicone gel liners<a></a> offer the amputee who has minimal tissue coverage and/or scarring the benefit of shock absorption and a "new skin" type feel. The active, athletic below-knee amputee also captures the benefit of the gel system and suffers less trauma as a result. Prosthetic feet, such as the Seattle<a></a> foot and S.A.F.E.<a></a> foot, appear to offer better gait characteristics and function, and also allow for increased activity by virtue of their functional, flexible designs. Ancillary methods of evaluating and improving gait performance are making their way into the more aggressive practices. John Sabolich, C.P.O.<a style="text-decoration: none;">*</a> in Oklahoma City has been utilizing a bio-feedback device with his above-knee patients in an attempt to re-educate the gluteus medius muscle during gait training. Utilizing the system in a dynamic fashion, i.e. patient ambulating with the electrodes over the targeted muscle, provides the patient audible feedback of muscle activity. Use of a video tape camera also provides patients with optimum benefits during the alignment and gait training period.<a></a> Careful analysis of the saggital and frontal views provides the practitioner with a better opportunity to critically analyze and improve his patient's gait. Improved problem-solving subsequent to delivery is also a benefit of this technique. The film serves as a learning tool for the new amputee and the practitioner, and also serves as a record of a patient's progress and delivery status for ironing out future fitting problems relative to gait induced complaints. The Computer Aided Design, Computer Aided Manufacturing (CADCAM) technique<a></a> is presently available for use in designing below-knee prosthetic sockets and will soon be available for design of above-knee prosthetic sockets as well. Measurements are taken from the residual limb and entered into the program. A screen display then allows for modifications to be made relative to the entered data and design scheme. Once the design is created, the information is transmitted to a computerized milling device that then carves out a model of the residual limb. From this model a socket is fabricated from polypropylene. In the future, "shape-sensing" will allow for modifications from the sensed data rather than the standard methodology. The ability to draw from the digitalized information of Computerized Axial Tomography (CATSCAN) or x-rays is also in the offing. This system is also an excellent, accurate record keeping tool. The potential to "sense" size and shape, store the information, recall, modify, or duplicate as desired is an enticing prospect. Further research is both warranted and forthcoming. <h3>Conclusion</h3> With the advent of better technology and methods, a concomitant increase in prosthetic professionalism occurs. Improved education must also follow. Industry-wide attention to continuing the trend will help prevent our field from lapsing into the mundane. The practice of this increased professionalism and improved techniques also commands a higher cost. Jan Stakosa, C.P.'s<a style="text-decoration: none;">*</a> method of using a wide variety of componentry per patient during the fitting and alignment phases in order to optimize function not only serves to improve the patient's quality of life, but carries with it an increased time commitment and cost. Due to this increased input and component variability, thorough education of the public and professionals per the costs involved is required. Ultimately, third party payers and the government will also have to be addressed. Until such time as these practices and advancements become standard, there will not be reimbursement for them.<a></a> How do you value human needs in a marketplace in which the trend is toward price reduction? The reality is that all these advances will increase the cost of prosthetic care. Prosthetists, the public, third party payers, and the government will need to be willing to improve the quality of life for this sector of the population, who deserve to be rehabilitated to the maximum and be allowed to perform as well as any able-bodied individual. It is our hope that the prosthetic industry will take up the challenge to advance the profession and invest the time in testing preferred methods and improvements. Equally important is the quest to participate in their creation. Through improved knowledge of the mechanics of amputation surgery and the variables of follow-up care, combined with mutual professional dialogue, we can better serve the amputee population. References: <ol> <li>Barnes, R.W.; Shanik, G.D.; and Slaymaker E.E., "An index of healing in below-knee amputation: Leg blood pressure by Doppler ultrasound," Surgery 79(1):13-20, 1976.</li> <li>Bonner, F.J. and Green, R.F., "Pneumatic airleg prosthesis: Report of 200 cases," Archives of Physical Medicine and Rehabilitation, 63:383-385, 1982.</li> <li>Burgess, E.M., "General principles of amputation surgery," Atlas of Limb Prosthetics: Surgical and Prosthetic Principles, St. Louis, MO, Mosby, Ch. 2, p.p. 14-18, 1981.</li> <li>Burgess, E.M., "Postoperative management," Atlas of Limb Prosthetics: Surgical and Prosthetic Principles, St. Louis, MO, Mosby, Ch. 3, p.p. 19-23, 1981.</li> <li>Burgess, E.; Hittenberger, D.; Forsgren, S.; and Lindh, D., "The Seattle foot," Orthotics and Prosthetics, 37(1):25-31, 1983.</li> <li>Campbell, J. and Childs, C, "The S.A.F.E. Foot," Orthotics and Prosthetics, 34(3):3-16, 1980.</li> <li>Cary, J.M. and Thompson, R.G., "Planning for optimum function in amputation surgery," Atlas of Limb Prosthetics: Surgical and Prosthetic Principles, St. Louis, MO, Mosby, p. 28, 1981.</li> <li>Ertl, J., "Uber amputationstumpfe," Chirurg., 20:218, 1949.</li> <li>Gibbons, G.W.; Wheelock Jr, F.C.; Hoar Jr, CS., et al, "Predicting success of forefoot amputations in diabetics by noninvasive testing," Archives of Surgery, 144:1034, September, 1979.</li> <li>Graves, J., "Selectively placed silicone gel socket liners," Orthotics and Prosthetics, 34(2):21-24, 1980.</li> <li>Hanak, R., "Fabrication procedures for the ISNY above-knee flexible socket (instruction manual)." Course at New York University, Post-Graduate Medical School, Prosthetics and Orthotics, January, 1984.</li> <li>Henderson, H.P. and Hackett, M.E.J., "The value of thermography in peripheral vascular disease," Angiology, 29:65-71, 1978.</li> <li>Hittenberger, D.A. and Carpenter, K.L., "A below knee vacuum casting technique," Orthotics and Prosthetics, 37(3): 15-23, 1983.</li> <li>Ipocon Silicon Liner Technical Manual. IPOS, Lune-berg, West Germany.</li> <li>Kerstein, M.D., "Utilization of an air splint after below-knee amputation," American Journal of Physical Medicine and Rehabilitation, 53(3): 119-126, 1974.</li> <li>Koniuk, W., Personal communication. San Francisco Prosthetic-Orthotic Service, Inc., San Francisco, 1985.</li> <li>La Noue, A.M., "More on Ertl tibiofibular synostosis," Newsletter . . . Amputee Clinics, (V)4:3-4, July, 1973.</li> <li>Leal, J., "The Flex-foot prosthesis" (instruction manual). Presented at UCLA Prosthetics Education Program, Advanced Below Knee Prosthetics Saturation Seminar, October, 1984.</li> <li>Loon, H.E., "Below-knee amputation surgery," Selected Articles from Artificial Limbs, January 1954 - Spring 1966. Huntington, NY, Krieger, p.p. 305-318, 1970.</li> <li>Malone, J.M.; Leal, J.M.; Moore, W.S.; et al., "The Gold Standard for amputation level selection: Xenon-133 clearance," Journal of Surgical Research, 30:449-455, 1981.</li> <li>Malone, J.M.; Moore, W.S.; Leal, J.M. and Childers, S.J., "Rehabilitation for lower-extremity amputation," Archives of Surgery, 116:93-98, January, 1981.</li> <li>Mehta, K.; Hobson II, R.W.; Jamil, Z; et al., "Fallibility of Doppler ankle pressure in predicting healing of transmetatarsal amputation," Journal of Surgical Research, 28:466, 1980.</li> <li>Mooney, V. and Snelson, R., "Fabrication and application of transparent polycarbonate sockets," Orthotics and Prosthetics, 26(1):1-13, 1972.</li> <li>Moore, W.S.; Henry, R.E.; Malone, J.M.; et al., "Prospective use of Xenon Xe 133 clearance for amputation level selection," Archives of Surgery, 116:86-88, January, 1981.</li> <li>Pike, A.C. and Black, L.K., "The orthoglas transparent test socket-an old idea, a new technology," Orthotics and Prosthetics, 36(4):40-43, 1982-83.</li> <li>Pollack Jr, S.B. and Ernst, C.B., "Use of Doppler pressure measurements in predicting success in amputation of the leg," American Journal of Surgery, 139:303, 1980.</li> <li>Reger, S.I.; Letner, I.E.; Pritham, CH.; et al., "Applications of transparent sockets," Orthotics and Prosthetics, 30(4):35-39, 1976.</li> <li>Sabolich, J. and Guth, T., "The C.A.T.C.A.M. above knee prosthesis pilot course" (instruction manual). Course at UCLA Prosthetic Education Program, March, 1985.</li> <li>Saunders, C.G., "Computer-aided socket design: A computer-aided design and manufacturing package for fitting below-knee amputees with sockets," Medical Engineering Resource Unit, Shaughnessy Hospital, Vancouver, BC, Canada, March, 1984.</li> <li>Saunders, C.G. and Fernie, G.R., "Automated prosthetic fitting." Proceedings of the 2nd International Conference on Rehabilitation Engineering, Ottawa, 1984.</li> <li>Schmitter, E.D., "Surgical principles and practice: Lower Extremity amputations." Lecture-Prosthetics and Orthotics Course for Physicians and Therapists. Provided by Prosthetic-Orthotic Education Program, School of Medicine, Department of Surgery (Orthopaedics). University of California, Los Angeles, April 5-9, 1982.</li> <li>Staats, T.B., "Advanced prosthetic techniques for below knee amputations," Orthopedics, 8(2):249-258, 1985.</li> <li>Stakosa, J.J., "Prosthetics for lower limb amputees," Vascular Surgery: Principles and Techniques, Norwalk, CT, Appleton-Century-Crofts, p.p. 1143-1162, 1984.</li> <li>Sterescu, L.E., "Semirigid (Una) dressing of amputations," Archives of Physical Medicine and Rehabilitation, 55:433-434, September, 1974.</li> <li>Varnau, D.; Vinnecour, K.E.; Luth, M.; and Cooney, D.F., "The enhancement of prosthetics through Xerora-diography," Orthotics and Prosthetics, 39( 1): 14-18, 1985.</li> <li>Whipple, L. and Stakosa, J., "The not so simple ABC's of high technology," Disabled USA, Washington, D.C., July, 1983.</li> <li>Wu, Y.; Keagy, R.D.; Krick, H.J.; et al., "An innovative removable rigid dressing technique for below-the-knee amputation," Journal of Bone and Joint Surgery, 61-A(5):724-729, 1979.</li> </ol> <div style="width: 400px;">Footnote Jan Stakosa, C.P. is Director of the Institute for the Advancement of Prosthetics, Lansing, Michigan. John Sabolich, C.P.O., is Vice-President of Sabolich Orthotics-Prosthetics Center, Oklahoma City, Oklahoma. </div> <div style="width: 400px;">*Keith E. Vinnecour, C.P.O. Keith E. Vinnecour, C.P.O., is owner and president of Beverly Hills Prosthetics Orthotics, Inc., Beverly Hills, California. *David F.M. Cooney, R.P.T., C.P.O. David F.M. Conney, R.P.T., C.P.O., is a senior vice-president at Beverly Hills Prosthetics and Orthotics, Inc. </div> Page Number(s) 4 - 9 Year 1985 Volume 9 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource An Advanced Approach Toward Improved Prosthetic Fittings Creator An entity primarily responsible for making the resource David F.M. Cooney, R.P.T., C.P.O. * Keith E. Vinnecour, C.P.O. * https://staging.drfop.org/files/original/b95e5342fe7eaaa21c950572d787fbda.pdf 22900e4b73ce0e89c1e8e6b35ce978e9 https://staging.drfop.org/files/original/69a206a2aa84ed680056a9fdc2139438.jpg d2cf4a108bb4637b1831508eed43a6bb https://staging.drfop.org/files/original/bbdcebf3e88af2b9c4154c6ab8600941.jpg 1742853ff042c4f63024eb1c3f70a128 https://staging.drfop.org/files/original/f6b252668fde0f741327f4ce578605b4.jpg d7e17f3201c463458fb90ab1fc6ed3c9 https://staging.drfop.org/files/original/072c8063021ab7603ec812365ca28462.jpg 844e15bf47ec63eb59e4d48548c2ffda https://staging.drfop.org/files/original/3f19c0d013a453a5a3aac4a18fd62be7.jpg 059db7ef417cd22394cde20c77c23ff8 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_03_115.pdf Text Any textual data included in the document <h2>An Alternative Technique for Fabricating Flexor Hinge Hand Orthoses Using Total Contact Molded Plastic Finger Pieces</h2> <h5>Greg Moore, R.T.O. <a style="text-decoration: none;">*</a></h5> The flexor hinge hand orthosis is one of the most demanding orthoses for the orthotist to fit properly. The slightest error can result in failure of the orthosis and loss of patient confidence in the orthotist. Presented here is a technique for fabricating the orthosis with increased fitting accuracy and reduction of patient-practitioner contact time. The procedures presented here have been accumulated from the measurement and fabrication techniques of various practitioners (see acknowledgments) and assimilated into this single technique. <h3>History</h3> The flexor hinge hand splint was originally based on the principle of the flexor hinge hand as described by Nickel, Perry, and Garrett in 1955.<a></a> In the years that followed, it was developed by them and their co-workers, using the principle of the modified three-jaw chuck, in which the index and middle fingers move together towards the thumb. This is accomplished by immobilizing the thumb in a position of opposition and placing the index and middle fingers in a position of semiflexion at the inter-phalangeal joints. To prevent slippage of the object grasped, the thumb pad must oppose the pads of the two fingers. The flexor hinge is that part of the orthosis which hinges at the MP joint and holds the index and middle fingers in a functional position. The range of motion is from a position of full extension of the MP joints to a point where the finger pads contact the thumb. The orthosis is operated in one direction by internal or external power under voluntary control, and returned to the starting position passively, usually by a spring or gravity. The orthosis was originally developed to restore upper extremity function of patients with poliomyelitis. As the incidence of poliomyelitis decreased, the orthosis was used with other patients with severe upper-extremity paralysis such as cervical spine injury, hemiplegia, and brachial plexus injury. The results of treatment in these patients indicated that it is the degree of functional loss rather than the diagnosis that is significant. To a large degree, management of upper-extremity paralysis is the same regardless of the cause.<a></a> <h3>Fabrication Technique</h3> After the patient has been assessed by the rehabilitation team and the orthotic design has been determined, the patient is seen by the orthotist. Appropriate measurements are taken and recorded for fabrication of the forearm and/or palmar pieces. Following this initial visit, the orthotist shapes and assembles the pieces according to the measurements, with special attention to accurate placement of the MP mounting plate for the flexor hinge finger piece. Temporary straps are also attached to the orthosis to eliminate migration of the orthosis during trial fitting. Other fabrication steps that can be completed at this time are the placement of temporary padding (if used) and the attachment of the adjustable actuating lever kit (Rancho style wrist-driven). The thumb post can be shaped, but should not be attached to the palmar piece until it has been properly fitted to the patient on the second visit. With the patient's second visit, the forearm and/or the palmar pieces should be fit to the patient and necessary adjustments made to provide for optimal fit and function. The thumb post is fit and attached to the palmar piece in the normal manner at this time. With this accomplished, the orthosis is placed on the patient's hand and secured with the temporary straps. The index and middle fingers are taped together at the distal phalanges using 1/4" masking tape, so as to keep the middle finger slightly longer than the index finger. A position of 35-40° of flexion at the MP joint, 30° of flexion at the proximal interphalangeal joint, and 5-10° of flexion of the distal interphalangeal joint is needed to position the fingers in opposition with the thumb.<a></a> When the positioning of the fingers has been accomplished to the satisfaction of the orthotist, the fingers and thumb are coated with a thin layer of petroleum jelly in preparation for casting. Four layers of 4" plaster bandage material are measured and cut so that the ends of the bandage extend over the ends of the fingers by 3/4" and at the other end over the proximal edge of the MP mounting plate by 3/4" (<a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-1.jpg">Fig. 1</a>). The plaster bandage is then dipped in water and with the fingers held in a position of opposition to the thumb, the plaster bandage is placed over the dorsal aspect of the fingers. The edge of the bandage extends distally so that the tip of the thumb is included in the impression. Proxi-mally, the bandage extends over the MP mounting plate so that an impression of this is included. The bandage should not cover the volar (palmar) side of the fingers. The bandage is rubbed into the fingers, tip of the thumb, and the MP mounting plate to obtain a clear impression, and the edges of the bandage should be folded back approximately 1/4" to reinforce the borders (<a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-2.jpg">Fig. 2</a>). After the bandage has hardened, it can be removed without the use of a cast saw by gently disengaging it from the MP mounting plate area and tilting it up over the fingers. <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-1.jpg">Figure 1.</a> Preparation for casting fingers. <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-2.jpg">Figure 2</a>. Cast impression incorporating MP joint plate and fingers. The proper length of the temporary straps should be marked and the fitted forearm and palmar pieces removed. The patient's hand can now be cleaned, and he/she can be scheduled for a final return visit. The impression is prepared for filling by enclosing it in plaster bandage and coating the inside with a thin layer of liquid soap. A small mandrel should be contoured to fit the inside of the impression, extending as far distally as the tips of the fingers to prevent fracturing of the positive model (a length of 1/2" O.D. aluminum tubing works well for this). The impression is filled with plaster of Paris and stripped, using great care not to fracture the positive model. The model will have good detail, showing the contours of the finger nails, skin lines, and MP mounting plate. The positive model is prepared for vacuum forming, using a length of nylon stocking as the interface for the 1/8" polyethylene. If Surlyn® is used, the Surlyn® is vacuum formed directly over the lightly smoothed impression without an interface. The clarity of Surlyn® facilitates visual assessment of pressure distribution when used with a sensation impaired hand. The plastic should be vacuum formed and not drape formed to insure an exact fit. Once the vacuum forming has been completed, the plastic piece can be removed by using a cast saw and carefully avoiding excessive damage to the impression. The finger piece is now ready to be trimmed using the following general guidelines. The distal border should be 1/8" distal to the proximal edge of the fingernails of the index and middle fingers. The proximal border should be trimmed to the proximal aspect of the proximal phalanges. In the coronal plane, the plastic piece is trimmed along the midline of the fingers. The plastic finger piece is then placed back on the positive impression and a stainless steel superstructure is fabricated using the MP mounting plate impression as the reference for the MP operating lever (<a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-3.jpg">Fig. 3</a>). This saves an enormous amount of time since the reference between the palmar piece and finger piece is part of the positive impression. A regular Jaeco style proximal finger piece is used for the proximal bar of the superstructure, and a 3/32" rod connects it to a distal stainless bar located at the middle of the middle phalange. Both of the bars are silver soldered to the 3/32" rod and simply bent to the contours of the plastic finger piece. <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-3.jpg">Figure 3</a>. Shows ease of aligning MP joint and finger pieces with MP joint included in the cast. The proximal finger piece is connected to the MP operating lever in the usual manner. A Velcro® closure can be attached to the distal superstructure bar on a stainless steel closure and can be fabricated using the bar as the dorsal half of the closure. With the finger piece completed and the remainder of the orthosis finished, the patient can be fitted and the orthosis delivered (<a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-4.jpg">Fig. 4</a> and <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-5.jpg">Fig. 5</a>). Patient training and minor adjustments are done following regular rehabilitation procedures. <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-4.jpg">Figure 4.</a> Complete orthosis wih polyethylene finger piece. <a href="http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-5.jpg">Figure 5.</a> Orthosis showing use of Surlyn® finger-piece for observation of the skin. <h3>Summary</h3> Fabrication of the intimate fitting flexor hinge component of the flexor hinge wrist hand orthosis can be tedious. The procedure detailed here can facilitate fabrication of a more accurately fitting flexor hinge. The use of a vacuum formed finger section assures a total contact fit resulting in fewer pressure problems on the fingers. The optional use of Surlyn® for fabrication of the plastic finger piece permits direct skin observation when deemed beneficial. <h3>Acknowledgments</h3> I would like to express my special thanks and admiration to Jack E. Greenfield, CO. at Rancho Los Amigos Hospital and David Bird, CO. at University of Michigan Hospitals for their willingness to share their experience and knowledge. References: <ol> <li>Nickel, V.L., Perry, J., and Garrett, A.L., "Development of Useful Function in the Severely Paralyzed Hand," Journal of Bone and Joint Surgery, 45:933, 1963.</li> <li>Rae, J.W., Jr.: Personal communication. Conference on Upper Extremity Devices, Rancho Los Amigos Hospital, Downey, California, May 15-16, 1957.</li> <li>Malick, M.H., and Meyer, C.M.H., "Manual on Management of the Quadriplegic Upper Extremity," Har-marville Rehabilitation Center, 1978, p. 39.</li> <li>Engel, W.H., Kmiotek, M.A., Hohf, J.P., French, J., Barnerias, M.J., and Sievens, A.A., "A Functional Splint for Grasp Driven by Wrist Extension." Archives of Physical Medicine & Rehabilitation, January, 1967, pp. 43-52.</li> <li>Bisgrove, J.G., "A New Functional Dynamic Wrist Extension-Finger Flexion Hand Splint-A preliminary report, Journal of Ass. Phys. Ment. Rehab., 8, September-October 1954, pp. 162-163.</li> <li>Redford, J.B., ed. Orthotics Etcetera. Baltimore, Md. Williams and Wilkins, 1980, pp. 238-248.</li> </ol> Greg Moore, R.T.O. At the time of writing, Greg Moore, R.T.O., was a student in the Long Term Orthotic Practitioner Program at 916 Vo-Tech. He may be reached at: c/o Bill Moore, 7366 S. Bannock Drive, Littleton, CO 80110. <div style="width: 400px;"> </div> Page Number(s) 115 - 118 Year 1986 Volume 10 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_03_115/1986_03_115-5.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 An Alternative Technique for Fabricating Flexor Hinge Hand Orthoses Using Total Contact Molded Plastic Finger Pieces Creator An entity primarily responsible for making the resource Greg Moore, R.T.O. * https://staging.drfop.org/files/original/fa104bc2df9d1eb8a2e3fcfe1be372dc.pdf 3cac7ed2272aa4b36cb461ab73d777af https://staging.drfop.org/files/original/03c6dab500bcc8abcf2064a69651e3fb.jpg 78f6ebbe4d49f0e3d87c4a2431800fec https://staging.drfop.org/files/original/ef57e986fd642949abac655e0ddfbb48.jpg f228ca3d4b1bb1b07a591f5647f82f55 https://staging.drfop.org/files/original/6f3713a26a2d78a1af84b3371b05ee26.jpg 4cbdb84cf8ff35a7778b82dbb1364778 https://staging.drfop.org/files/original/984d8d4e3f3b4d44a11796f074d966bc.jpg fd661aac55fb812af0850e8319a6494b https://staging.drfop.org/files/original/a0e1497de95803eedb7c9bae27189933.jpg 86578a267fce21bebb761d96df09ad56 https://staging.drfop.org/files/original/ac40bae7d01bf2c9df78320ef938a453.jpeg 121965bd03be3afd015cb87750d6b2f5 https://staging.drfop.org/files/original/6ac0309f920adb45f06a6d73b90dbb23.jpeg 822b8149c492fcc9a1b2e8791f80a98d https://staging.drfop.org/files/original/ad272a01fb6edf60c48e85a6111e0d64.jpeg 28953020850578f0557a831f57db00da 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_03_003.pdf Text Any textual data included in the document <h2>An Ankle-Foot Orthosis Providing Mediolateral Stabilization While Allowing Free Plantar and Dorsiflexion of the Foot</h2> <h5>Lucia Klemmt, CO  Fritz Klemmt </h5> The development of an ankle-foot orthosis (AFO) providing mediolateral stabilization while allowing free plantar and dorsiflexion of the foot was prompted by a patient (W. F.) seen some months ago, who was wearing a posterior solid ankle-foot orthosis (PSAFO). However, rather than providing ankle stability, it was ineffective and an irritant during stance. W. F. was unhappy with it, and discouraged. In evaluating his condition, he was found to have good plantar and dorsiflexion, but suffered from mediolateral ankle instability. He was shown a conventional AFO with a metal stirrup and metal uprights, demonstrating the mediolateral protection the orthosis provides, while allowing free motion at the ankle. The fact that it was less cosmetic than a plastic orthosis did not concern the patient, if it allowed him to walk normally again and not with a stiff ankle. But considering his physician's preference for plastic over a metal orthosis, with its advantages, e.g., free choice of shoes, better appearance, etc., it occurred to us to combine mediolateral protection of the ankle with free ankle plantarflexion and dorsiflexion in a plastic orthosis. This idea was realized by incorporating an ankle joint similar to that used in fracture bracing in a PSAFO (<a href="/files/original/03c6dab500bcc8abcf2064a69651e3fb.jpg">Fig. 1</a>). From a plaster mold of the patient's limb, a PSAFO was fabricated with an anterior section for added tibial support. The distal aspect of the calf section was trimmed to clear the Achilles tendon. The proximal edge of the footplate was trimmed so as to include the malleoli (<a href="/files/original/ef57e986fd642949abac655e0ddfbb48.jpg">Fig. 2</a>). A contoured bar was riveted to the lateral aspect of the posterior calf portion and joined with the footplate over the malleoli, creating a pivot point allowing, rotation necessary for flexion or extension (<a href="/files/original/6f3713a26a2d78a1af84b3371b05ee26.jpg">Fig. 3</a>). Two velcro straps provided an intimate fit around the limb. The patient was pleased with the function and support provided by this orthosis. The second patient fitted with this type of orthosis (R. R.) had a similar ankle problem. A slight change in the design was made. A separate ankle joint as with W. F.'s orthosis was not used. Rather, the proximal edges of the footplate were extended to the proximal aspect of the malleoli. The distal edges of the posterior calf section were then made to overlap the malleoli portions of the foot plate (<a href="/files/original/984d8d4e3f3b4d44a11796f074d966bc.jpg">Fig. 4a</a> and <a href="/files/original/a0e1497de95803eedb7c9bae27189933.jpg">Fig. 4b</a>). This joint system works smoothly and is more cosmetic, although it requires a little more work. R. R. was delighted with the orthosis since he can wear it with regular Oxfords or boots (<a href="/files/original/ac40bae7d01bf2c9df78320ef938a453.jpeg">Fig. 5</a> and <a href="/files/original/6ac0309f920adb45f06a6d73b90dbb23.jpeg">Fig. 6</a>). A third patient (P. B.) with a similar problem of ankle instability was fitted with the same type of orthosis made for R. R., but eliminating the anterior portion. This patient, too, was happy with the freedom of motion it allowed (<a href="/files/original/ad272a01fb6edf60c48e85a6111e0d64.jpeg">Fig. 7</a>). In these three cases, free plantar and dorsiflexion were allowed while mediolateral ankle stability was achieved. Though it involves extra work and time during fabrication of this type of ankle joint on a posterior solid ankle foot orthosis, the security of the ankle on weight bearing, the freedom of movement while walking, and the satisfaction of the patients wearing the orthosis are achievements justifying the extra effort and expense. Page Number(s) 3 - 5 Year 1980 Volume 4 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-3.jpg Figure 4 FIGURE 4A http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-4.jpg FIGURE 4B http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-5.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-6.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/1980_03_003/1980_03_003-7.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-8.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 An Ankle-Foot Orthosis Providing Mediolateral Stabilization While Allowing Free Plantar and Dorsiflexion of the Foot Creator An entity primarily responsible for making the resource Lucia Klemmt, CO Fritz Klemmt https://staging.drfop.org/files/original/13d59df7eaa0bb5ef10ecff3a8fa4fd9.pdf 0247ed6219932127b8f05567d483ea5a 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_003.pdf Text Any textual data included in the document <h2>Analysis of the Results From the Questionnaire on Metal vs. Plastic Orthoses</h2> By May 1st, fifty-four (54) responses had been received, considerably more than usual. Fifty-two (52) respondees were certified personnel, one was a physician, and one was an unspecified "other." Interestingly enough, the individual listing himself as other was by far the most negative in his comments. The results were as follow: <ol> <li> Percentage of plastic vs. metal orthoses prescribed: <ul> <li> 100% plastic—17% </li> <li> 75% plastic, 25% metal—61% of the time </li> <li> 25% plastic, 75% metal—13% </li> <li> 100% metal—2% </li> </ul> </li> <li> Percentage of staff trained in plastic: <ul> <li> 100%—74% of respondees </li> <li> 75%—9% </li> <li> 50%—9% </li> <li> 25 %—7% </li> </ul> </li> <li> Most significant advantages: <ul> <li> lightweight—43% </li> <li> cosmesis—28% </li> <li> versatility—26% </li> <li> correction increased—17% </li> <li> other—11% </li> <li> total contact—9% </li> </ul> Many individuals checked more than one. </li> <li> Most significant disadvantage, most commonly indicated factors (actual numbers): <ol> <li> Inability to adjust dorsiflexion/plantarflexion—20 </li> <li> Fluctuating edema—7 </li> <li> Fitting a proper shoe and heel height—5 </li> </ol> </li> <li> Durability of plastic and hybrid orthoses vs. metal orthoses: <ul> <li> more durable, less maintenance—40% equal—30% </li> <li> less durable, more maintenance—22% </li> </ul> </li> <li> Do you agree with Mr. Shurr's arguments for the use of traditional metal upright orthoses? <ul> <li> yes—69% </li> <li> no—30% </li> </ul> </li> <li> Do you share Mr. Shurr's skepticism regarding prefabricated plastic AFO's? <ul> <li> Yes—83% </li> <li> No—13% </li> </ul> </li> </ol> This seems to be one issue about which considerable unanimity exists within the profession. Questions one and two seem to indicate that plastic plays a major role in the practice of many orthotists and that most of them are versed in its usage. The response to question 5 indicates that most practitioners are not experiencing significant problems with durability, probably as good an indication of good fabricating technique as any. In looking at questions 3, 4, 6 and 7, it appears that most respondents understand the role of plastic in orthotics and its advantages and disadvantages. In light of this unanimity of opinion it is interesting that the question of plastic vs. metal should excite enough interest to spark so large a response, particularly as plastic orthoses have now been in use for over ten years. It may be that orthotists still confront the need to defend plastic orthoses and justify their use. Contrarily it may be that enough individuals have enough experience with plastic that they feel comfortable responding to the issue. Additional responses: The following samples are chosen somewhat at random as examples of differing opinions: Comments on question 4: <ol> <li> It is my firm belief that the fixation of any joint will have the result of severe atrophy and eventual fusing of the joint. The long term results of the use of the (non-jointed) plastic AFO are not known. Putting it simply: What's the use of working toward recovery of use of an extremity (and that return gradually takes place) when the 'treatment' by an orthotic device has created other problems that the degree of recovery is not able to overcome? </li> <li> I feel there has been an overemphasis on plastic AFO/prefab AFO used by R.P.T.'s which have a limited application, and may be used with some success on geriatric patients in convalescent areas. They do make damned good night splints and that's about all. If used on hilly terrain or streets the patient usually ends up on his butt or smashes his face. </li> <li> How anyone could argue the cause for plastic AFO's is unreal. Any amount of comparisons with the traditional AFO reveals less durability and limited function. Seven out of 10 patients have disabilities necessitating metal over plastic, numerous modifications [to plastic] are a must, and medial lateral support is nil. In my experience, I have found that very mild cases necessitate the use of a plastic AFO when drop-foot (only) is the reason for bracing. Instability in the M-L plane is often accompanied by drop-foot, thus ruling out the plastic AFO. </li> <li> I feel that the plastic AFO is definitely a more desirable type of orthosis for all the reasons mentioned in question #3. However, not every patient is a candidate for a plastic AFO, especially if the patient has edema or needs adjustability at the ankle. </li> <li> Most students coming out of schools at this time only know how to make plastic AFO's and are not proficient or comfortable in making conventional orthoses. These "students" who usually possess degrees never spend sufficient time working in the lab to become bench technicians and most, when handed a pair of bending irons, are in jeopardy of hurting themselves. </li> <li> I agree with Mr. Shurr, but only from the standpoint of a therapist. Adjustment of plastic AFO's requires more than just a general knowledge of thermoplastics. During patient rehabilitation, minor changes in the degree of dorsi or plantar flexions that the orthosis is set in can make a drastic change in patient function. In clinical settings, this should always be done by the orthotist. However, physicial therapists working with patients wearing AFO's may not have accessibility to an orthotist whenever they want to "experiment" with different ankle settings. I can therefore understand Mr. Shurr's interim preference. This is, however, no comparison between the superiority of plastic systems over metal. Orthotists should be involved with any change made to their patients orthotic system. </li> </ol> In response to question 6: Therapist adjustment syndrome (TAS) is not a valid RX criterion. General Comments: Far more important than durability is the ability to provide superior fit alignment and function. Improperly fitting plastic orthoses, by their very nature, are far more obvious and as a result more nearly considered unacceptable than the traditional Brace—which by its very nature masks improper fit and alignment and of course results in improper braces being worn. In 1980, we introduced a policy of providing all necessary repairs and adjustments without additional cost for the life of any plastic orthosis. This policy specifically excludes traditional metal/leather braces. Page Number(s) 3 - 4 Year 1983 Volume 7 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Analysis of the Results From the Questionnaire on Metal vs. Plastic Orthoses https://staging.drfop.org/files/original/b45df324d6e6eb3062561af4ba9ca31c.pdf fe6df163464ebb5485158fcdc77801d6 https://staging.drfop.org/files/original/42f3cf78c258ae2747437e3c837288cc.jpeg 2b66e681fb1e8c1d4ab08e11a80b7f95 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_01_001.pdf Text Any textual data included in the document <h2>Ankle Foot Orthoses: Metal vs. Plastic</h2> <h5>Joanne A. Klope Shamp, CPO <a style="text-decoration: none;">*</a></h5> Since the late 1960's, when Yates <a></a> and Lehneis <a></a> wrote the first articles pertaining to the use of plastics in orthotics, the debate has continued comparing conventional metal to thermoformed orthoses. But debate is no longer necessary as the well-informed clinic team finds that plastic orthotic systems have come of age and should be prescribed on a routine basis. The advantages of thermoformed orthoses are numerous, extending far beyond the obvious factors of improved cosmetic and weight considerations. These, however, have significant merit in themselves. American society is appearance-conscious and highly competitive, an atmosphere in which individuals with disabilities are finding their rightful place among the non-disabled. The influence that the appearance of a device has on the effective interrelationships at home and in the workplace cannot be ignored. Thermoplastic devices are form-fitting, fleshtone, hygienic, and noise-free, unlike the metal devices of yesterday, and assist the individual in breaking the stereotypes of disability set by society. Of particular importance to the patient is the ability to interchange shoes, as long as the heel height remains consistent. The devices' light weight means a decrease in energy expenditure and, in many cases, makes a marked difference in the patient's ability to perform hip and knee flexion adequate for a full day's activities. This also allows the patient to life the involved extremity for climbing stairs, getting into an automobile and other actions requiring flexibility. A recent study by Smith, Quigley, and Waters <a></a> concluded that the "lighter" polypropylene Ankle Foot Orthosis promotes more efficient advancement of the involved limb, allowing a greater percentage of the gait cycle to be devoted to the stance phase of gait." This accounted for the "more normal pattern of foot-floor contact at initial contact and at terminal stance" <a></a>, p. 54. Hygienic concerns are easily met with plastic orthoses that may be cleaned daily with soap and water, rubbing alcohol, or chemicals such as acetone. To incontinent children and adults this means an increased life for the orthosis, as well as cleanliness and an improved self-image. In the same manner that prosthetic practice was revolutionized by the concept of total contact, so too has orthotics experienced a renaissance. With the total contact features of thermoformed orthoses, increased force may be applied to the skeleton without discomfort and skin breakdown as the area receiving the force is multiplied. Prevention and correction of deformity is greatly enhanced as compared to the metal bands of conventional double upright orthoses with their small surface areas. The force-distributing properties of plastic orthoses are of particular benefit in the case of insensitive feet where decubitus ulcers must be aggressively prevented. The use of well-formed total contact orthoses may preclude the need for expensive custom shoes in these cases and allow healthy feet in affordable and attractive footwear. Although cosmesis, weight, hygiene, and total contact features are important assets of thermoformed orthotic systems, versatility is the major advantage to the prescribing physician and clinic team. Design potentials are unlimited and allow the customizing of the orthosis to the exact biomechanical needs of the patient, without excess bulk or "over-bracing." As von Werssowet stated ". . . a brace should be selected with the most simple design that will accomplish the purpose and mission" <a></a>, p. 364. At the knee and ankle joints, free motion and some degrees of limited motion are easily obtained with a total plastic orthotic system. When a specialized assist or stop is required, a hybrid system <a></a> utilizing metal joints within the plastic design may be more satisfactory in meeting the patient's needs. Where total immobilization is indicated, plastic orthoses may be fabricated with corrugations or carbon composite inserts <a></a> that afford rigidity. Ankle position may be altered to provide a stabilizing effect to the knee joint at midstance or to prevent recurvatum when posterior structures are compromised. <a href="/files/original/42f3cf78c258ae2747437e3c837288cc.jpeg">Fig. 1</a>: The controversy illustrated—metal double upright ankle-foot orthosis vs. plastic ankle foot orthosis. A striking advantage of plastic orthotic systems is their superior control at the ankle in the frontal plane. A result of both the total contact nature of the device, as well as the individuality of possible designs, this provides excellent control in cases presenting equi-novarus (hemiplegia secondary to CVA), clubfoot deformities, and other mediolateral instabilities. Varying the thickness of the plastic and the configuration of the trimlines creates an appropriate three point pressure system that will not require force application over boney prominences, as the ankle strap of a conventional double upright orthosis requires over the lateral malleolus. Plastic orthoses are beginning to play a role in work regarding inhibitive casting and the effect upon spasticity. Eberle, Jeffries, and Zachazewski <a></a> recently reported success with an inhibitive AFO, a concept that was not feasible with metal orthotics. Their report stated that "the technique of fabrication used for construction of a molded polypropylene AFO allows for all of the tone-inhibiting characteristics of casting ... to be built into the AFO. . . (including) hyperextension of the toes, pressure under the metatarsal heads, a stable ankle position, and deep tendon pressure along the tendo calcaneus" <a></a>, p. 454. The molded footplate offers excellent control as compared to conventional metal orthoses where "modification must be made to the shank of the shoe in cases of severe spasticity, lest it break at the anterior edge of the tongue and thus allow the foot to adopt a position of equinus" <a></a>, p. 1. The hydrostatic features of plastic fracture orthoses have, in many regions, radically changed the orthopaedic approach to fracture management. Their effective application has been well documented by Sarmiento <a></a> and others. Their light weight (6-10 oz.), excellent hygiene, and wear with street shoes <a></a>, allows the patient a safe and speedy return to a near-normal lifestyle that often includes employment, even in cases of delayed healing. Hybrid and total plastic systems are easily adjusted for volume change and progressive positional correction through the use of heat forming techniques. Longitudinal growth in children can be predicted and the appropriate length adjustability feature can be an integral part of the orthotic design. Some unique and exceptionally biomechanical designs have been made possible through the use of thermoplastics. The spiral and hemispiral AFO designs <a></a> employ the physical characteristics of the coiled configuration of plastic to store energy and serve as a functional assist to weakened dorsi- and plantar-flexor musculature, with little effect on knee stability. The prescription and use of thermoplastic orthotic systems is no longer confined to regions with specialized clinic teams. Although their use originated in the research of large medical centers in major cities, the private practice sector nationwide now has ten years experience in these management concepts. The professional literature of the prosthetic and orthotic profession abounds with information on all aspects of design rationale and fabrication techniques utilizing today's total plastic and hybrid systems. I challenge each of you to break through the stereotypes of your conventional metal orthotic prescription and management practices. The potentials of current thermoformed based orthotic design are limitless, and will provide the patient with an immeasurably improved functional outlook and self-image. References: <ol> <li>Yates, G. ,"A Method for Provision of Lightweight Aesthetic Orthopaedic Appliances," Orthopaedics: Oxford, 1:2, 153-162, 1968.</li> <li>Lehneis, H.R., Ph.D., CPO, "New Concepts in Lower Extremity Orthotics", Medical Clinics of North America, 53:3:3, pp.585-592, 1969.</li> <li>Lehneis, H.R., Frisina, W., Marx, H.W., "Bioengineering Design and Development of Lower Extremity Orthotic Devices. Final Report, Project #23-p-55029 2-03," Institute of Rehabilitation Medicine, New York University Medical Center, October, 1972.</li> <li>Smith, A.E., Quigley, M., Waters, R., "Kinematic Comparison of the BiCaal Orthosis and the Rigid Polypropylene Orthosis in Stroke Patients" Orthotics and Prosthetics, 36:2, pp.49-55,1982.</li> <li>von Werssowetz, O.F., "The Use and Abuse of Braces in Rehabilitation of Neuromuscular Disorders," Archives of Physical Medicine and Rehabilitation 35:1, pp. 363-368, 1954.</li> <li>Behsman, A.S., and Lossing, W.W., "A New Ankle-Foot Orthosis Combining the Advantages of Metal and Plastics," Orthotics and Prosthetics 33:1, pp. 3-10, 1979.</li> <li>Fillauer, C, "A New Ankle Foot Orthosis With a Moldable Carbon Composite Insert," Orthotics and Prosthetics, 35:3, pp. 13-16, 1981.</li> <li>Eberle, E.D., Jefferies, M., and Zachazewski, J.E., "Effect of Tone-Inhibiting Casts and Orthoses on Gait: A Case Report," Physical Therapy, 62:4, pp. 453-455, 1982.</li> <li>Rosenberger, R. and Pritham, C.H., "Instep Strap," Newsletter. . .Prosthetics and Orthotics Clinic, 3:1, pp. 1-3, 1979.</li> <li>Sarmiento, A., and Sinclair, W.F.,"Tibial and Femoral Fractures-Bracing Manegement," University of Miami School of Medicine, circa 1973.</li> <li>Stills, M., "Vacuum-Formed Orthoses for Fracture of the Tibia," Orthotics and Prosthetics, 3:2, pp. 43-55, 1976.</li> </ol> <div style="width: 400px;">*Joanne A. Klope Shamp, CPO Shamp Prosthetic Center, Inc. Norton, OH </div> Page Number(s) 1 - 3 Year 1983 Volume 7 Issue 1 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/1983_01_001/1983_01_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 Ankle Foot Orthoses: Metal vs. Plastic Creator An entity primarily responsible for making the resource Joanne A. Klope Shamp, CPO * 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.