3 20 371 https://staging.drfop.org/files/original/2af5e4a68353a2eed24a09786fdea090.pdf 90e8b0a379e8b9a8e9201fa5eefad784 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1956_02_001.pdf Year 1956 Volume 3 Issue 2 Page Number(s) 1 - 3 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1956_02_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1956_02_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Artificial Limbs - Their Human Owners</h2> <h5>David Shakow, Ph.D. <a style="text-decoration:none;">*</a><br /></h5> <p>In all areas of medicine and engineering where psychological factors are important, consideration of matters of the mind comes late. Physical problems are so obvious, urgent, and definable-mental problems so frequently cryptic, postponable, and unclear. But it usually develops that, soon after some control has been achieved over the immediate physical problems, the psychological problems obtrude themselves and call persistently for solution. Thus, in the field of amputations and artificial limbs, the primary effort has to date been directed quite naturally toward the achievement of physical restoration of function. Proportionately little thought has been directed toward the understanding and handling of the psychological problems which, in the amputee, the markedly altered adjustment situation creates. Although mechanics and the biomechanics of the amputee have many important identical principles, there is a whole area of needed activity of a quite different order.</p> <p>The psychological problems of the amputee are, of course, not merely problems of the physically disabled person himself. The new situations that are created with loss of limb are clearly social-psychological in character-situations where not only the manifold attitudes of the patient, both implicit and explicit, toward the loss and the replacement are important but also where the attitudes of family and associates toward him and his difficulty are equally significant. Hence, any full psychological study of the problem of physical handicap must involve three aspects: the attitudes of the disabled person toward the changes created in him by his new situation, as it affects his previous concepts of himself and the image he has of his body; the attitudes of others, especially significant others, toward his differentness; and, finally, the interaction of these two in the social context in which it occurs.</p> <p>In a recent evaluation of studies in this general area, Roger Barker and associates deplore the inadequacy and rarity of satisfactory investigations. Whatever the importance of adjustment problems, not only in the amputee but in all persons suffering a misfortune, it is only when problems become prominent and when social obligations are keenly felt that there appears a readiness to pay attention to what appear on the surface to be secondary aspects of problems. Just such a situation arose during World War II, when disabled veterans were returning from the battlefields in great numbers but when, although much thought was being given to physical rehabilitation, little had been done to face the problems associated with psychological readjustment.</p> <p>In response to this need, there was established at Stanford University on February 1, 1945, a study group to inquire into the social-emotional relationships between injured and noninjured people. Conducted partially under contract between Stanford and the wartime Office of Scientific Research and Development (recommended by the Committee on Medical Research), partially under a contract between the University and the Army Medical Research and Development Board of the Office of the Surgeon General, War Department, the work continued until April 1, 1948. By far the majority of the handicapped subjects studied were amputees.</p> <p>Despite the technical significance of the final report of the project, only a few mimeographed copies were distributed. It is only now-more than eight years later-that the results are seeing the light of print. Because it recognizes the basic nature of the contribution and its significance in the presentation of important problems in the psychology of handicap, the Prosthetics Research Board of the National Academy of Sciences-National Research Council has seen fit to devote an entire issue of ARTIFICIAL LIMBS to the reproduction of a single, exceptional monograph otherwise long since obscure and inaccessible. From one point of view, the departure reflects a considerable advance in the field of limb prosthetics-an acceptance of the importance of psychics as well as of the long-recognized importance of mechanics. For this major step forward, the Prosthetics Research Board merits the thanks of all.</p> <p>With regard to the unusual content of the monograph itself, a few remarks are in order. Barker and associates point out, for example, that physically deviant persons appear not to be a homogeneous group psychologically and that "so far as the somatopsychological relation is concerned there is no direct univocal link between physique and behavior." They state further that "lawful somatopsychological relations between physique and behavior are mediated by the psychological situation " These affirmations are especially pertinent to the report we are here studying. Indeed, the present material should properly be viewed in the context of these generalizations about the field as a whole. Although many questions are raised, and although many "I-wish-they-had's" remain unfulfilled, it is important to recognize the pioneering character of the study, the complexity of the field, and the reasons for the absence of more objective data and for the limited statistical treatment of the material. We should be grateful for the broad attack on the area, the commonsenseness and humanness of the molar approach used, its consistent emphasis on the total person, and the attempt to tackle the problems broadly in the context of a general theory of loss and maladjustment.</p> <p>We should perhaps not pass by the opportunity of calling attention to a few additional topics of especial interest that are dealt with in the monograph. For one thing, there is the emphasis on the emotional aspects of physical handicap rather than on the intellectual and the attempt to deal systematically with such difficult, though apparently commonplace, topics as misfortune and sympathy, seen from both the standpoint of the stricken person and of the outsider.</p> <p>There is, too, an important discussion on some of the methodological problems, particularly the place of measurement and the interview as a tool, in the present status of psychological study in the field. The presentation is made more effective by the liberal quotations from interviews and the inclusion of records of actual interviews in the appendices.</p> <p>The authors would, to be sure, be the last persons to claim any definitiveness for their study. Its major contribution lies in opening up questions and delineating areas clamoring for further psychological investigation both by more precise methods and with greater intensity. The authors' own attitudes in this respect may be gathered from the fact that they conclude the body of the monograph with a chapter headed Direction of Further Research.</p> <p>It is to be hoped that the recognition given at this time by the Prosthetics Research Board to this area of study will be the stimulus that the field needs for the multiplication of studies on this important aspect of the adjustment of the disabled person and of the noninjured people with whom he comes in contact.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>David Shakow, Ph.D. </b></td></tr><tr><td class="clsTextSmall">Chief, Laboratory of Psychology, National Institute of Mental Health, National Institutes of Health, Bethesda, Md.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> 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 Artificial Limbs - Their Human Owners Creator An entity primarily responsible for making the resource David Shakow, Ph.D. * https://staging.drfop.org/files/original/708fa372e3aa806c06ea2cec87c6d54d.pdf 9a1fac5f9d62e7f6b1c6180a01f964f8 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1954_01_001.pdf Year 1954 Volume 1 Issue 1 Page Number(s) 1 - 3 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1954_01_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1954_01_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Artificial Limbs-Today and Tomorrow</h2> <h5>F. S. Strong, Jr. <a style="text-decoration:none;">*</a><br /></h5> <p>Ours is an age of scientific research and development in almost every field of human interest. Some work to make man live longer, to make him more comfortable, more mobile, more informed. Some devise ways to maim or destroy him. This report and others to follow will tell the story of those who strive to replace what war, accident, or disease have removed, or what nature simply failed to provide. This is concerned with what modern science and engineering skill can do today-and what may be expected in the future-for the person in need of a substitute for normally standard equipment-an artificial limb for a missing arm or leg.</p> <p>From the dawn of history men have contrived replacements for lost extremities, particularly the lower. The loss of an arm, while causing inconvenience, has not resulted generally in serious handicap. But without a leg, a man becomes immobilized. Thus, over the years there has come about a considerable development until today some of the better types of artificial legs afford reasonably satisfactory service, always provided they are well fitted and aligned by qualified prosthetists. The same has not been true of upper-extremity devices. And so when young men returned from World War II with missing limbs, while the lower-extremity amputee could expect a replacement of some merit, the man who needed an arm was definitely in trouble. As a matter of fact, the entire field of artificial limbs needed serious attention to bring amputee service more in line with the scientific and engineering progress which has become synonymous with America in the modern world.</p> <p>To meet this need, not only for the benefit of veteran amputees, but also to help all similarly handicapped individuals everywhere, a program was established at the end of the war under the sponsorship of the Armed Services and the Veterans Administration and was later implemented on a permanent basis by the Eightieth Congress through Public Law 729. This act authorizes the expenditure of $1,000,000 annually "to aid in the development of improved prosthetic appliances ..." and designates the Veterans Administration as the appropriate agency for the administration of the funds thus made available.</p> <p>The activities encompassed within the framework of these endeavors have come to be known as the Artificial Limb Program. And since the field, though serving less than a million persons, of whom only some 27,000 are veterans, involves the cooperation of several scientific disciplines as well as various organizations both civil and military, a special structure had to be contrived for successful operation. This was done through a contract between the Veterans Administration and the National Academy of Sciences, by means of which an Advisory Committee on Artificial Limbs of the National Research Council has been established for general supervision and coordination, and through other contracts between the Veterans Administration and various educational and industrial organizations for research and development. In addition the Surgeons-General of the Army, Navy, and Air Force, and the Chief Medical Director of the Veterans Administration, have made available the services of certain laboratories and personnel in further support of the over-all program. While in the early stages of this undertaking, it was necessary to proceed generally on a broad front in order to explore and define the complete problem so that at one time as many as sixteen contracts were in force, at present the number has been reduced to three only, and an operational structure has been evolved through which a long-range plan can be followed with reasonable hope of success</p> <p>The word "prosthetics" has been found a convenient term to define the general field of amputee service. Since the problems of replacement in the lower extremity are quite different from those in the upper, the field is divided into two parts. Lower-extremity research and development are centered at the University of California, Berkeley Campus, while upper-extremity studies are similarly covered at the University of California at Los Angeles, all under a contract between the Veterans Administration and the University. Assisting in lower extremities is the Oakland Naval Hospital Artificial Limb Department while the Army Prosthetics Research Laboratory at Walter Reed Army Medical Center cooperates in the development of artificial arms and terminal devices Finally, through a contract with New York University, and with the cooperation of the VA Prosthetic Testing and Development Laboratory in New York well-defined methods of testing and field application assure that devices and techniques developed under the program are, before acceptance, in fact useful improvements in amputee rehabilitation.</p> <p>For general technical guidance in these two branches, standing committees, in lower- and upper-extremity prosthetics respectively, have been constituted, each composed of specialists in the fields of medicine, engineering, prosthetics, and the like, and each under the chairmanship of the leader of the appropriate University of California research project. These groups meet annually, or more frequently if necessary, to review progress, define requirements, and recommend action to the Advisory Committee on Artificial Limbs, to the artificial-limb industry, or to others interested in amputee rehabilitation problems. In addition smaller research and development panels have been appointed from these technical committees to supervise current activities between meetings of the larger groups. In this work, definite transition procedures have been adopted for orderly progress from the inception of ideas for improved devices and techniques to their final application in the limbshop or rehabilitation clinic.</p> <p>By these methods the results of some eight years of research and development are now being channeled as directly as practicable to the service of amputees, rather than indirectly merely through the issuance of reports or through publication in scientific journals. In order that physicians, prosthetists, rehabilitation specialists, insurance carriers, and other interested individuals and organizations may be informed of advances in this field as promptly as possible, this series of reports is being undertaken. While the Advisory Committee on Artificial Limbs has previously issued monthly progress reports on a limited basis to those immediately concerned, and although the various contractors and governmental laboratories associated with the program have contributed reports and other data on specific subjects, this will be the first organized attempt to disseminate timely information to a broad list of individuals and institutions interested in the rehabilitation of the amputee. This is being done in furtherance of the intent of the Congress which, in Public Law 729, authorizes the Administrator of Veterans' Affairs "to make available the results of his investigations to private or public institutions or agencies and to individuals in order that the unique investigative materials and research data in the possession of the Government may result in improved prosthetic appliances for all disabled persons."</p> <p>In offering these reports to the reader who has not been in a position to follow recent progress in this field as unfolded through the Artificial Limb Program it can be stated that the views and information to be set forth in this and Subsequent issues are the result of long and objective study by specialists in the various branches of science and engineering involved. These findings, therefore, can be accepted with considerable confidence as indications not only of the present state of the art but also as to future trends And where these findings may appear at variance with previous traditional concepts or the writings of earlier authorities, it can be said simply that the field of prosthetics is even today largely uncharted and untraversed-that it is a field where the marvels of modern science and engineering have yet to leave their mark.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>F. S. Strong, Jr. </b></td></tr><tr><td class="clsTextSmall">Executive Director, Advisory Committee on Artificial Limbs, National Research Council.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> 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 Artificial Limbs-Today and Tomorrow Creator An entity primarily responsible for making the resource F. S. Strong, Jr. * 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 Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. Contact Name/Title Kathy Barr Kruger State/Province GA Countries Served USA Email kkruger54@gmail.com Organization Type Including ID and tax status Donor Directed Charitable Trust Not-for-profit Type Granting Organization Services Provided Financial Assistance through GRANTS for Prosthetic Fitting, Education, Funding, Prosthetic Fabrication Historic Information Although the Barr Foundation was dissolved in 2015, there is still a charitable trust present to capture funds intended to support prosthetic care throughout the globe facilitated by other humanitarian organizations. 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 Barr Foundation 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.&nbsp;</h5> <p>After several years of very little change in above knee amputee fitting, we now have a <i>C.P.O.</i> 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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> Page Number(s) 5 - 5 Year 1985 Volume 9 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Basic Changes in Lower Limb Prosthetics Creator An entity primarily responsible for making the resource Alvin L. Muilenburg, C.P.O.  https://staging.drfop.org/files/original/cdc95b02cc47b6ac5a555a1046cadadf.pdf 34ed2a18f8f3439ef880701f80f81b2e https://staging.drfop.org/files/original/ce7a2b7ad0810f0b02370d41250efccc.jpg 3a4c39847e4ec3b9bf8261686abda3a1 https://staging.drfop.org/files/original/634cb539af8eab5253faddc40f6e9d0b.jpg 37149e5deb28bbdda74066f00fe6e09d https://staging.drfop.org/files/original/ea53ec98f51b6dce71f7a77727448ef3.jpg c7ecfa8c1488b9d239aaf61306016d21 https://staging.drfop.org/files/original/679f4b61888358a86e8bf53ae8458619.jpg a163b30fed74ee555cf603bcc30ef8cd https://staging.drfop.org/files/original/9ba53dc99c34b34ebbcf6445256aaa41.jpg 3bf51c3620d99120850d76f06e54d498 https://staging.drfop.org/files/original/b9ce20332f3ef2c5febd1df36e326169.jpg a27393f6213633786a241d9f9c92ce4f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/cpo/pdf/1986_02_093.pdf Text Any textual data included in the document <h2>Below-Knee Prosthesis with Total Flexible Socket (T.F.S.): A Preliminary Report</h2> <h5>John Sabolich, B.S., C.P.O.&nbsp;<a style="text-decoration: none;">*</a><br />Thomas Guth, CP.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Recent efforts in Oklahoma City, and San Diego have borne fruit to a promising new way to fit below-knee amputees. The basic design consists of a thin walled thermo-plastic socket secured in a frame by nylon strapping tape so that most of the socket is left exposed and unsupported (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg"><b>Fig. 1</b></a>). This design, named the Total Flexible Socket (T.F.S.), was conceived out of necessity with a few patients that were so difficult to fit that even aggressive techniques such as multiple transparent diagnostic sockets, alginate injections, total surface bearing modifications, and silicone gel inserts failed to provide a measure of comfort acceptable to them. It was felt that a more unconventional method would have to be implemented. Currently, this technique is being used with most of the geriatric population seen, and with time and experience it is being applied to an ever increasing proportion of the total below-knee amputee population served. Forty or more of these sockets have been fitted over the past five months to patients ranging in age from ten to 89 years with results that were beyond initial expectations. Patient reaction has been extremely positive. Plans are to submit an up-dated article when over 100 documented fittings with the described technique have been accomplished.</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg">Figure 1. Medial and lateral views of T.F.S. in an exoskeletal version. Suspension sleeve and cosmetic hose rolled down for clear view of socket secured in place with band of fiberglass tape.</a></strong><br /> <p>The idea for the T.F.S. design was prompted during the course of fitting a patient with a flexible diagnostic test socket. The patient was comfortable in this socket even when bearing his full weight on a padded fitting stool. Subsequently, when a full socket receptacle for the test socket was laminated and it was rigidly contained, this comfort was lost. The patient still complained of pressure even when holes were cut out over bony prominences.</p> <p>Finally, when the maximum amount of material was cut away and the former socket receptacle was reduced simply to a means of attaching the socket to the rest of the prosthesis, thus allowing the socket to return to its former measure of flexibility, comfort was regained.</p> <p>Several interesting phenomenons were noted:</p> <ol> <li> <p>Since the T.F.S. design is totally flexible, allowing ML as well as AP expansion and retraction, the socket finds and seeks its own level of pressure distribution. If the AP is too tight, it automatically expands, causing the ML to tighten up, wrapping around the tibial flare and the fibula. This, of course, is not true when a receptacle is only opened up over bony areas allowing no reciprocal ML-AP displacement and minimal flexibility, even over bony areas. With the T.F.S., if the ML is too tight, then the AP automatically tightens as the ML loosens, and vice-versa if the AP is too tight (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg"><b>Fig. 2</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg"><strong>Figure 2. Transverse view of a socket cross section showing, in an exaggerated fashion, the reciprocal AP-ML displacement.</strong></a></li> <li> <p>The AP-ML "Milking" action seems to have a positive effect on circulation since the residual limb seems palpably warmer when a T.F.S. is removed, as compared to when a rigid socket is used. In the case of flexible sockets thinner than 3/32 inches thick, the entire socket moves with the residual limb, seeming to expand and contract due to the open nature of the frame. This phenomenon can be felt better than seen by holding the socket as the patient alternately places weight on the prosthesis and removes it, especially after the socket warms up to body temperature. This dynamic socket movement and improved circulation could be very significant for the geriatric P. V.D. patient. This action also seems to enhance atmospheric suspension: when the patient removes weight, the socket collapses and grips the residual limb like the familiar childhood toy, a Chinese fingertrap.</p> </li> <li> <p>Atmospheric Suspension (A.S.) assorted methods of achieving suction suspension for the below-knee amputee have been tried for years, with varying degrees of success. The main reason behind this effort is the desire to solve the number one problem of the below-knee amputee, that of skin shearing and pistoning between the residual limb and socket. Another major problem has been that of the patient wanting a lighter weight, more responsive prosthesis. With the T.F.S.A.S. combination, most patients have been responding favorably with such comments as "It feels like my own leg!" and "It feels like part of me!" With atmospheric suspension, the patient no longer needs to wear a suspension sleeve to maintain full suction. The Total Flexible Socket holds suction better than a rigid socket because the socket can move and conform to the changing contours of the residual limb, through all phases of gait and sitting. A loose elastic knee cage is recommended to enhance proximal brim seal during knee flexion past 90°. For sports prostheses, use of a rubberized sleeve of choice is recommended. Cosmesis is also enhanced since the patient no longer has the extra bulk of socks or inserts increasing calf circumference. It's a little too early to tell, but it is felt that atmospheric suspension may well become the standard below-knee fitting technique for all types of patients.</p> </li> <li> <p>Use of a cuff suspension strap is improved since the cuff and socket brim can contour in about the patella (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg"><b>Fig. 3</b></a>). Use of a suspension sleeve with the T.F.S. is also possible, and if anything, enhances the function of a T.F.S. since the suspension sleeve supports the socket brim and soft tissues, holding the two in close conformity through the full range of knee motion.</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg"><strong>Figure 3.</strong></a></li> <li> <p>Flexibility allows greater containment posteriorally in the popliteal region. The posterior wall can be higher since it flexes away during sitting. Little posterior flare is needed. In fact, this area could be rolled in slightly, similar to how the cubital fold is contained in myoelectric below-elbow arms (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg"><b>Fig. 4</b></a>). If the practitioner desires, the socket can be made flexible all the way down to the distal tibia. This is accomplished by building a thick distal end pad (with or without an insert) inside the socket, or an extension on the exterior of the socket which extends the trimline of the frame distally, allowing total flexibility in the distal regions of socket.</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg"><strong>Figure 4. Lateral view of T.F.S. showing suggested modified contour.</strong></a></li> <li> <p>The ML measurement of the knee becomes wider as the knee flexes. This can be demonstrated by placing an ML gauge on the knee and watching the gauge as one puts the knee through its range of motion. The T.F.S. design allows for this dynamic variance.</p> </li> </ol> <p>Last but not least, overall hygiene and circulation seem to be dramatically improved. Especially impressive is the absence of red marks on the skin following doffing of the T.F.S. There are none of the usual red marks left by conventional sockets. Patients who had to have many reliefs before in their rigid sockets now require none.</p> <p>Since several prosthetists have been fitting these sockets successfully, using various modification techniques, it has been concluded that it is irrelevant which particular modification technique is used. Results from all modification techniques have been improved utilizing the Total Flexible Socket. The use of negative modifications only is recommended. One simply does not need to add positive build-ups to the model since the reciprocal AP-ML displacement dynamically accommodates the patient's anatomy. The bony areas are accommodated automatically (most of the time) as the patient ambulates. It is, of course, most exact to use multiple transparent diagnostic sockets, alignate, or oil injection procedures (as well as other means) to obtain the best fit possible.</p> <p>The flexible socket seems to work so well that it is tempting to skip the check socket stage. Do not succumb to this temptation, or you will never know just how comfortable the socket can be once you get the patient fairly comfortable in the rigid transparent socket and clone it to the T.F.S.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg"><b>Diagram</b></a></p> <br /> <p>After the hard socket is fit, it is necessary to remove an additional 1/4" to 3/8" of plaster from the positive model around the superior brim, close to the patella, to allow a flexible clamping action about the proximal brim. Use of this extra modification can not be emphasized enough for final comfort and stability. An intimate fit must be maintained around the proximal brim with the T.F.S. design. No other additions or modifications are necessary.</p> <p>If a liner or insert is used, it is fabricated over the positive model with a thick distal end pad to provide extra distance distally. This extra length is necessary if one desires to make the distal tibia area flexible since the frame can be trimmed more distal, even past the end of the distal tibia. Alternately, as mentioned, an extension can be added to the socket following vacuum forming.</p> <p>One can use any of four materials for the flexible part of the socket: The first is Surlyn,® which is preferred in most cases. This material can be molded fairly thin, and yet it provides excellent structural strength and integrity. Surlyn® stock material of 1/8"-3/16" thick is used (depending on the degree of flexibility) for vacuum forming. A final thickness of about 1/16" or less is adequate. It is not necessary for this socket to be extremely flexible, as with a fenestrated socket, since the majority of the socket is open and flexible in all directions with two adjacent sides being able to move relative to the frame.</p> <p>The second material is polyethylene, which is more flexible and sometimes more desirable for children or geriatrics who are somewhat inactive. The third is Streifylast, which is a material that is being utilized more and more lately since it has a high level of flexibility while maintaining its structural integrity, and is especially resistant to tearing and breakage. A fourth material called Polyethylene Plus® (available through Maramed) seems to be superior even to Streifylast and has an extremely good tear resistance.</p> <p>Once the socket is vacuum formed, a fiberglass nylon polyester frame is fabricated. Carbon fiber and acrylic resin can be used, if one desires greater strength and less weight, but is not necessary in most cases. The thickness of this frame depends on the activity level of the patient, but usually ranges in thickness from 1/16" to 1/8".</p> <p>As in<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg"> <b>Fig. 5</b></a><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg"><b></b></a>, there are two basic frame designs: one for geriatrics, and one for active or sports oriented patients. The geriatric type extends proximally to the medial tibial flare and is cut away everywhere else except around the distal end pad (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg"><b>Fig. 6</b></a>). The sports type frame for younger patients comes more proximal pos-teriorally, lending more strength. It maintains total AP-ML flexibility since it still has only two sides adjacent to each other. As long as one does not place a third wall on the frame, reciprocal AP-ML flexibility is preserved and provides for automatic pressure distribution. It must be emphasized that these are only guidelines and the actual trimlines of the frame are variable and modified as the patient's needs dictate.<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg"><strong>Figure 5. Four views of the T.F.S. showing sports and geriatric trimlines and distal end pad or buildup. Distal buildup is especially useful when it is desired to cut the anterior trimline below the distal tibia.</strong></a></p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg"><strong>Figure 6. T.F.S. showing geriatric trimline. Ultralite construction.</strong></a><br /> <p>The flexible socket can be attached to the rest of the prosthesis by using two or three bands of nylon fiber tape wrapped circumferen-tially about the frame and socket to provide strength, while not affecting flexibility. If one desires even more strength, pressure sensitive tape can be wrapped over the nylon tape or even over the whole frame and socket. The socket can be riveted or fastened with Chicago screws in addition to the tape, for additional security.</p> <p>The final finishing of the prosthesis is relatively simple. If an endoskeletal approach is used, the soft foam cover hides the socket frame interface as well as the nylon strapping tape and results in a very cosmetic prosthesis (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg"><b>Fig. 7</b></a>). The T.F.S. prosthesis finishes especially well as an endoskeletal since it feels more life-like all the way up the prosthesis. If one desires an exoskeletal finish, one can easily use polyurethane foam for shape, laminate the outer covering, remove the flexible socket, and grind the foam away from around the frame and cosmetic shell as desired. This leaves a void or hollow of about 1/8" (all that is necessary) between the flexible socket and cosmetic shell. Alternately, the prosthesis can be shaped and finished about the socket in the same fashion as an endoskeletal prosthesis. The proximal external contours can then be established with a soft fairing of PE-LITE® or Plastazote glued to the flexible socket and frame.</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg"><strong>Figure 7. T.F.S. with soft cosmetic covering.</strong></a><br /> <p>Fabrication of an Atmospheric Suspension Socket is the same as for any T.F.S., except for the placement of either an expulsion valve or a small suction valve on a 45° angle at the distal posterior of the total flexible socket (<a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg"><b>Fig. 8</b></a>).</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg">Figure 8. T.F.S.-A.S. showing placement of valve distally</a>.</strong><br /> <p>Modification on the other hand, is a little different than a non-atmospheric suspension T.F.S. The socket must be a little snugger to accommodate total self-suspension. After achieving the "perfect skin fit" with a clear diagnostic socket and the alginating procedures, the model is poured and modified the same as any T.F.S. by slightly tightening it about the patella area. The technician then takes the modified model and laminates a two layer cotton rigid socket over it, which is rolled or slushed twice with promoted liquid polyester resin to tighten all areas of the socket equally. This socket, with reduced internal dimensions, is then poured with plaster of Paris and the T.F.S. socket is subsequently vacuum formed over the resulting positive model. It is felt that this extra tightening is necessary to compensate for the fact that a rigid diagnostic socket cannot be donned as easily as a T.F.S. of equal or greater tightness.</p> <p>In conclusion, a new concept for the fabrication of a below-knee prosthesis has been described, as well as the preliminary results of fitting some 40 patients for up to five months. It is sincerely hoped that other prosthetists will find it as beneficial to their patients as it has been found to be in both Oklahoma City and San Diego.</p> <h3>Acknowledgments</h3> <p>We would like to thank one of our own prosthetists, Bill Etheridge in Oklahoma City for forcing John out of conventional thinking so we could aggressively research this interesting phenomenon.</p> <p>We would like to thank Mary Healy, San Diego, for her help in Atmospheric Suspension Technique.</p> <p>We also wish to thank Alan Finnieston, CPO for materials research and for finding an appropriate tear resistant thermoplastic.</p> <b><b>Thomas Guth, CP.<br /></b></b><em>Thomas Guth, CP is Secretary Treasurer at RGP Orthopedic Appliance Company, 6147 University Avenue, San Diego, California 92115.</em><b><b><br /><br /></b></b><b>John Sabolich, B.S., C.P.O.</b><br /><em>John Sabolich, B.S., CPO is with Sabolich, Inc. at 1017 N.W. 10th Street in Oklahoma City, Oklahoma 73106.</em> Page Number(s) 93 - 99 Year 1986 Volume 2 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1986_02_093/1986_02_093-09.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Below-Knee Prosthesis with Total Flexible Socket (T.F.S.): A Preliminary Report Creator An entity primarily responsible for making the resource John Sabolich, B.S., C.P.O. * Thomas Guth, CP. * https://staging.drfop.org/files/original/bd8676bd2ae282b639f2399c6de321e3.pdf ffb53e28db8f2fc150a90906e09d5a19 https://staging.drfop.org/files/original/b5b98ec26d73edf01c22777a6f4f5372.jpg 2970dc2423a7e01f1bb92f8ceb1a1354 https://staging.drfop.org/files/original/bb57324218f589f3d313b6eacad77646.jpg 39967dc29d987500fb2008de8d00e469 https://staging.drfop.org/files/original/9f4e8fe4f15db8a5f8ba4d01ee1a70be.jpg 27a0ccb1ddc4f295ced948da5496ca58 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_03_173.pdf Text Any textual data included in the document <h2>Below-Knee Waterproof Sports Prosthesis with Joints and Corset</h2> <h5>Alfred W. Lehneis, CP.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>This article is concerned with the development of a waterproof below-knee prosthesis with knee joints and corset, utilizing the supracondylar/suprapatellar (SC/SP) suspension socket. A case report is described below.</p> <p>The patient had a below-knee amputation due to traumatic injury with a resultant amputation length of the tibia of approximately 1" (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg"><b>Fig. 1</b></a>). This patient currently wears a PTB type socket with leather thigh corset, polycen-tric joints and an SC/SP suspension socket, thus, no auxilliary suspension was necessary (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg"><b>Fig. 2</b></a>). He was doing well with this design in all activities of daily living, but desired a waterproof prosthesis for boating.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg"><strong>Figure 1. Length of tibia is approximately 1".</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg"><strong>Figure 2. Patient currently wears a PTB type socket with a leather thigh corset.</strong></a><br /> <p>In developing the waterproof design, the following components were utilized: Kingsley beachcomber foot, Otto Bock polycentric stainless steel knee joints, and a corset fabricated from 4mm Subortholen thermoplastic. Closures were 1" dacron straps with virgin nylon buckle closures used on scoliosis type body jackets.</p> <p>The fitting and fabrication of the prosthesis was as follows: the patient was casted (including the thigh) and the cast modified, using standard procedures for SC/SP suspension, an insert was fabricated from Pelite™, and the socket was fabricated with acrylic resin and carbon/glass reinforcements, especially at the side bar attachment sites.</p> <p>After fabrication of the socket, the socket was foamed up and set-up on a Staros-Gardner coupling and aligned atop the beachcomber foot. The bars were then attached directly to the socket (not over the foam build-up), and the area over the bars filled with fiberglass/resin putty. The thigh bars were contoured to the modified cast, over which the Subortholen thermoplastic had been molded and attached to the corset. The patient was then fitted and aligned in the usual manner, but while wearing topsider type boating shoes.</p> <p>After optimum alignment was achieved, the Staros/Gardener coupling was transferred out. This can be accomplished on a horizontal transfer device. The prosthesis was then shaped to the patient's tracing and measurements and reduced to accommodate the lamination thickness. The sole of the foot is then removed and a woman's nylon is pulled over the entire prosthesis, followed by the PVA sleeve. A lamination of one carbon-glass and two nylons without pigment is performed. After the lamination is set, the laminated shell is split longitudinally on the posterior aspect (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><b>Fig. 3</b></a>), taken off the prosthesis, and taped back together to retain its shape.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><strong>Figure 3. The laminated shell is split longitudinally on the posterior aspect.</strong></a><br /> <p>The shaped portion of the prosthesis is cut to allow for a 3" ankle block and the socket is cut at the base. The foam between the ankle and socket is now eliminated (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><b>Fig. 3</b></a>). The foam ankle block and the foam at the base of the socket can be sealed with a resin-silica mix to prevent water penetration.</p> <p>The laminated shell should be sealed with tape on the outside, and the seam should be sealed on the inside with Siegelharz. The socket and ankle block can then be bonded to the laminated shell. Once this is set, the outer shell should be sanded for a second lamination, and approximately 1" of the proximal socket and distal ankle block perimeter should be exposed (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><b>Fig. 3</b></a>).</p> <p>The prosthesis is then filled with sand through the hole at the bottom of the ankle block. The hole is then sealed with play dough. Lay-up of the prosthesis consists of six alternating layers of nylon and nyglass. Two pieces of polypropylene with 120° arcs (<a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><b>Fig. 3</b></a>) should be placed between the joints and the socket after the first two layers to allow attachment of the joint clevis after lamination. These pieces are removed after lamination. The foot drain hole is then reopened to release the sand. A second 1/2" hole should be drilled posterior and distal to the socket end to allow air to enter and escape the inner hollow of the leg. This allows water to enter and escape the foot drain hole and prevent bouyancy of the prosthesis.</p> <p>The thermoplastic corset is finished with a polyethylene tongue and dacron strap closures as described earlier. When assembling the prosthesis, bonding of the foot should be as recommended by Kingsley, Mfg. or using Devcon two-part epoxy.</p> <h3>Acknowledgments</h3> <p>The author gratefully acknowledges the technical contribution of Roger Losee, CO., and Robert Wilson, M.S., for the illustration in <a href="http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg"><b>Fig. 3</b>.</a></p> <p><em><b>*Alfred W. Lehneis, CP. </b> Alfred W. Lehneis, CP., is with Lehneis Orthotics and Prosthetics Associates in Roslyn, New York.</em></p> Page Number(s) 173 - 175 Year 1987 Volume 11 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 3 http://www.oandplibrary.org/cpo/images/1987_03_173/1987_03_173-3.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Below-Knee Waterproof Sports Prosthesis with Joints and Corset Creator An entity primarily responsible for making the resource Alfred W. Lehneis, CP. * https://staging.drfop.org/files/original/bd46617c235c4772e936e7d1a60ba734.pdf 579389d66872bebcf4e498a65ae678ea https://staging.drfop.org/files/original/455ecf115629123392857fe8469670c3.jpg 83423844a564fec85ce56c817a3f5ec7 https://staging.drfop.org/files/original/741a3625b8142c75ec6b345c5bfffc5d.jpg 03abbdb99e38076f14d95a0e59f913a2 https://staging.drfop.org/files/original/1138499b4a4ed059bcd0c8b24e6f8680.jpg 710defbe06f6ae092234a49207f4415e https://staging.drfop.org/files/original/0c94fac2ea4e7c0aacd0c52cbcb94002.jpg 95ae51859297d017d7d6e2924646f528 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_006.pdf Text Any textual data included in the document <h2>Beyond the Quadrilateral</h2> <h5>Hans Richard Lehneis, Ph.D., C.P.O.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Earlier this year I had the pleasure to be invited to the Academy Midwest Chapter Symposium entitled, "AK Design Principles: Beyond the Quadrilateral." I found the latter half of the title so intriguing and expressive of contemporary thinking and rethinking in AK socket prosthetics that I chose it as the title of this commentary. I hope that the organizers of the Chicago Symposium do not mind my borrowing this title.</p> <p>One of the earliest and major break throughs in AK socket design in this century was the concept of ischial weight bearing. At first glance this appears to be a sound approach and certainly one that has improved general comfort over other sockets. If, however, one analyzes that concept more closely, i.e., biomechanically, it becomes clear that ischial weight bearing is not a reality through all phases of gait. It must be appreciated that the socket and, thus, the prosthesis as a whole during walking is controlled by movement emanating from the center of rotation of the residual hip joint. At heel strike, when the hip is flexed, the distance from the ischial tuberosity to the ischial seat of the socket increases with the angle of hip flexion (<a href="http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-1.jpg"><b>Fig. 1</b></a>). Obviously, at this point in the gait cycle, there cannot be any ischial weight bearing. Yet, the need to support weight is greater than at any other point during locomotion. Body weight, plus the force of impact must be transmitted. How is this possible without direct skeletal support?</p> <p>I believe that, by what in German is called "verspannung" of the musculature, a stable interface is achieved. This is a phenomenon which every AK amputee must learn to prevent the prosthetic knee from buckling.</p> <p>Unlike normal locomotion in which there is phasic interaction of the musculature to produce controlled hip and knee flexion (eccentric contraction), the AK amputee must learn out-of-phase contraction of the hip musculature, i.e., the hip joint must produce an extension moment prior to heel strike so that the knee joint is in full extension at heel strike. Such muscular activity causes "verspannung," an increase in cross sectional volume, which in turn increases the tangential forces in the socket to equal the vertical forces generated at this point in the gait cycle.</p> <p>While it is clear that reasonably comfortable ischial weight bearing is indeed possible in the midstance phase, ischial weight bearing cannot be comfortably maintained at heel off. When the hip joint is extended, the perpendicular distance between the axis of rotation of the hip and the ischial seat of the socket is less than in the mid-stance phase (<a href="http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-2.jpg"><b>Fig. 2</b></a>), yet the distance from the hip joint to the ischium remains constant throughout all phases. Thus, hip extension causes increasing pressure on the ischial tuberosity, which now becomes the fulcrum about which the prosthesis tends to rotate. This results in the stump being pulled out of the socket, gapping of the anterior brim, elevation of the body on the involved side, and discomfort. Clinically, prosthetists have relieved this problem by increasing the radius of the anterior portion of the ischial seat. This maneuver allows the socket and seat to move posterior to the ischium as the hip is extended.</p> <p>Personally, I have always advocated that the ischial seat is sloped forward and downward such that it is tangent to a radius from the hip joint to the ischium (<a href="http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-3.jpg"><b>Fig. 3</b></a>). This not only increases comfort at heel strike, since it reduces the sharpness of the anterior portion of the ischial seat, but at heel off, it allows the ischial tuberosity to be inside the socket and pressure to be transferred to the much larger part of the ischium and gluteus maximus. Placing the ischial tuberosity on the anterior portion of the ischial seat also results in greater comfort, since it reduces skin tension in that area.</p> <p>While one might argue that placing the ischial tuberosity squarely on the seat was a necessity with open-end sockets; it is amazing that this theory continued to persist past the advent of total contact sockets. Under certain conditions, Pascal's law may be applied to total contact sockets, i.e., a hydrostatic condition exists which would eliminate the need for ischial weight bearing. In other words, the quadrilateral shape of AK sockets has remained unchanged despite the fact that total contact has resulted in a different application of the laws of physics which makes ischial weight bearing less important than originally conceived.</p> <p>Practitioners familiar with the fitting of prostheses to patients with Proximal Femoral Focal Deficiency (PFFD) know that the quadrilateral socket is inappropriate for these patients. A more appropriate socket shape resembles that of a flower pot in which the ischium is contained within the socket. In addition, the largest patient population for which the quadrilateral shape must be revised is the geriatric AK amputee. These patients, as a rule, become amputees due to Peripheral Vascular Disease (PVD), often compounded by diabetes. They usually present diminished sensation, reduced muscle tone, poor skin quality, and sometimes senility. Generally, they suffer from great discomfort when fitted with a prosthesis. Although most of this can be ascribed to the problems presented, it appears that some of this discomfort is due to the quadrilateral socket shape, particularly when the patient is provided with a manual knee lock. Unlike amputees who are fitted with an open knee and who must, and are able to, contract the residual muscles prior to heel strike, the geriatric amputee with a manual knee lock simply steps on the prosthesis. This simulates the effect of stepping on a rake (<a href="http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-4.jpg"><b>Fig. 4</b></a>). As a result, the tissue below the ischium is compressed (poor muscle tone), resulting in excessive skin tension, anterior proximal gapping of the socket, and the ischium to be far posterior to the socket.</p> <p>In summary, it seems to me that in light of the change in patient population (overwhelmingly geriatrics) with all the physical problems they present, one should, indeed, think beyond the quadrilateral. One should also note that with the advent of total contact, the concept of ischial weight bearing needs to be re-visited and re-assessed. Designs such as CAT-CAM and work supported by the Veterans Administration at the Rusk Institute of Rehabilitation Medicine hold promise to go beyond the quadrilateral to improve patient comfort.</p> <h3>Acknowledgments</h3> <p>This is to acknowledge that certain concepts presented in this paper are based on, <i>Schnur</i>, J., DAS KUNSTBEIN- Messen und Bauen. Kothen-Anhalt: Buchdruckekel Hans Greiner.</p> <p>I am also grateful to Robert Wilson, M.S., research scientist, designer and medical illustrator, Orthotics &amp; Prosthetics Research for the illustrations in this text.</p> <em><b>*Hans Richard Lehneis, Ph.D., C.P.O. </b> Hans Richard Lehneis, Ph.D., C.P.O., is with the Rusk Institute of Rehabilitation Medicine, 400 East 34th Street, New York, New York 10016.<br /><br /><br /></em> Page Number(s) 6 - 8 Year 1985 Volume 9 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1985_04_006/1985_04_006-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. 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Title A name given to the resource Beyond the Quadrilateral Creator An entity primarily responsible for making the resource Hans Richard Lehneis, Ph.D., C.P.O. * https://staging.drfop.org/files/original/7821ac6162abe595c2139897f396fecc.pdf 0bcce967fcfd627030a029c02594ff9c https://staging.drfop.org/files/original/a66e029293ca734565f6b91200071432.jpg e0ab811142f0169b690b4e8859ef14b6 https://staging.drfop.org/files/original/345a8f6d88787fb5569177c99ca4d7f7.jpg d29c0ac6eb59475dc22409206e69c298 https://staging.drfop.org/files/original/12ca9adaacb8c06c5eb20427ab64f46d.jpg 8363fe5120fc99ac33a0eb179ae273ed https://staging.drfop.org/files/original/e9d94ea851ebdbb5e0a81ae9d61b845f.jpg a108f96e990025c40ff36607bc770296 https://staging.drfop.org/files/original/27ad3e7aadc5e665c134b448e33340c5.jpg ce9577ae574f7e521bf0a6dee646d735 https://staging.drfop.org/files/original/5bc094ab41ace0120e8ba8896408edb8.jpg 8d8a73eceb72ffa43d8d319a3dfd8f8d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1979_03_005.pdf Text Any textual data included in the document <h2>Bilateral Knee Disarticulation, Immediate Post-Surgical Fitting: An Unusual Case Study</h2> <h5>William Susman&nbsp;</h5> <p>There are certain specific indications for utilizing immediate Post-Surgical Fitting (IPSF) in the postoperative management of the amputee. Clinical observations have substantiated that the constant even pressure provided by the immediate application of a rigid dressing to the residual limb helps control edema, supports circulation, and immobilizes tissue, subsequently minimizing the inflammatory process within the traumatized tissues, promoting wound healing, aiding good shaping of the limb and decreasing intrinsic pain and phantom sensations.</p> <p>The attachment of a pylon and prosthetic foot to the rigid dressing either immediately after the residual limb is wrapped or within a short post-operative period has been shown to enhance the positive effects of the rigid dressing and provide additional functional and psychological benefits. The gentle compression of residual limb tissue provided by closely monitored weight-bearing promotes wound healing by further decreasing edema. Ambulation resumes with a prosthesis sooner than with more conventional post-operative management approaches. Hospital stay is shortened, resulting in a more rapid return to previous personal, social and vocational activities. The amputee experiences an almost immediate resumption of function and although he or she will most likely undergo mourning for the lost limb, the actual commencement of rehabilitation is also experienced. In addition, the patient may be told pre-surgically the sequence of post-operative events so that the immediate introduction of functional prosthetic restoration can be hopefully, although cautiously, anticipated.</p> <p>It is readily acknowledged that IPSF is not appropriate for all circumstances. Cooperation among the rehabilitation team members from prosthetics, physical therapy, surgery, physiatry, and nursing, and a shared understanding of the technical aspects and goals of treatment, as well as individual proficiency in treatment procedures are necessary. The patient's understanding of the treatment approach and a willingness to adhere to treatment protocol are also essential. Lowered standards in any one of these areas may lead to injury of residual limb tissue, pressure sores, wound infection, hematoma, or necrosis and ultimately failure of the procedure and a real physical and psychological set-back for the patient. In addition, such complications are more difficult to perceive since the wound cannot be directly observed without disruption of the rigid dressing.</p> <h3>Patient History</h3> <p>With the above general review of the clinical advantages and precautions of IPSF in mind, it may be illustrative to present a case which is representative of these aspects of this treatment approach and yet extraordinary in view of the history and personal motivation for seeking treatment. The patient was a 28 year old woman who had contracted anterior poliomyelitis at the age of 16 months. She presented with stunted lower limbs, and muscle power at both hips was below functional levels except for the ability of the Sartorious muscle to withstand moderate resistance bilaterally. The knees and ankles were essentially flaccid. Sensation throughout the lower limbs was within normal limits. No contractures were evident and upper body strength was above normal.</p> <p>The patient wore bilateral, conventional KAFO's with knee locks and both ankles set in plantarflexion. Her feet rested on approximately nine-inch cork lifts set inside the calf sections of tall leather boots. (See <a href="/files/original/a66e029293ca734565f6b91200071432.jpg"><b>Fig. 1</b></a>) The patient related that as an adolescent she increased the lift height periodically to compensate for the lack of normal lower limb growth. She displayed excellent balance and body awareness, ambulated and climbed stairs and curbs independently with axillary crutches, and was able to negotiate sitting and rising from most types of seating. She led an active life as a college instructor and graduate student.</p> <p>The patient had a history of multiple surgical procedures during her teen-age years including a spinal fusion for scoliosis, subtalar arthrodeses, transplantation of hamstring tendons to the quadriceps mechanisms, and Achille's tendon releases bilaterally. She also had a history of left patella and right tibial fractures because of falls.</p> <p>The patient had been interested in seeking elective amputation of her legs for some time. Her chief reasons were of both a physical and a psychological nature. Pain in her feet resulting from the prolonged standing teaching required, and concern over the vulnerability of her legs to fractures from falling were related. Nevertheless, her foremost concern was for her appearance. Due to the devices she used to provide height and function she always felt compelled to wear floor-length dresses and was unable to interchange footwear (see <a href="/files/original/a66e029293ca734565f6b91200071432.jpg"><b>Fig. 1</b></a> &amp; <a href="/files/original/345a8f6d88787fb5569177c99ca4d7f7.jpg"><b>Fig. 2</b></a>). She wanted greater freedom in dress and to be able to have her legs seen without embarrassment over their appearance. She also found the braces and boots cumbersome and loose on her legs. Therefore, the patient came to the clinic seeking amputation primarily for reasons of cos-mesis and self-image.</p> <h3>Pre-Surgical Management</h3> <p>The rehabilitation team's decision to recommend bilateral knee disarticulation amputations was based upon the less traumatic nature of the surgical procedure, the good weight-bearing tolerance that has been demonstrated at this level, and another factor unique to this case. Due to the diminished growth of the patient's femurs, knee disarticulations would leave the amputation level proportional in length to long above-knee amputations. This level would provide a long lever arm for prosthetic control, yet not disturb anthropometric placement of the prosthetic knee and, consequently, proportional thigh and shank length.</p> <p>The IPSF approach was selected due to the patient's psychosocial background and to avoid the abrupt prolonged change in function that can result from bilateral surgery. With IPSF the patient would have a shorter period of disruption of her social and vocational success and her proud independence in activities of daily living. It would limit her experience as a wheelchair-dependent individual since two-legged function would never be completely interrupted.</p> <p>To determine whether or not knee disarticulation prostheses would provide function comparable to her presenting situation, temporary prostheses were fabricated to simulate post-surgical restoration. Plaster quadrilateral sockets with polyvinyl chloride (PVC) thermoplastic pylons, SACH feet and shoes were used. A cut-out in the posterior wall of each socket allowed the patient's shanks to protrude in the flexed-knee position, thus mimicking knee-disarticulation amputations (see <a href="/files/original/12ca9adaacb8c06c5eb20427ab64f46d.jpg"><b>Fig. 3</b></a>). A full functional evaluation showed no deficit in the patient's function from that previously demonstrated. Her ambulation pattern remained unchanged.</p> <p>From a psychological standpoint the patient was instructed to seek psychiatric consultation to closely examine her motivations for electing this treatment and to investigate her feelings regarding the possible failure of adequate functional prosthetic restoration. In addition, the patient discussed at length with team members the pros and cons of her decision and the possible sequela of amputation surgery such as wound-healing difficulty, residual limb pain, phantom sensations, less than optimal function, and prosthetic maintenance.</p> <h3>Post-Surgical Management</h3> <p>After closure of the amputation wounds and placement of drains, stump socks were applied over the surgical dressings on both limbs. A distal pad was held in place while a plaster wrap of each residual limb was done. Each plaster socket was hand-molded to provide a quadrilateral shape and ischial seat. Supracondylar purchase and belts over the iliac crests provided suspension. Pylons were not added at this time since the PVC tubing to be used requires heating before application.</p> <p>On post-operative day (POD) #2 the surgical drains were removed. On POD #5, PVC pylons and SACH feet with shoes were applied. To control and monitor the degree of weight-bearing, a tilt table and two scales were used (see <a href="/files/original/e9d94ea851ebdbb5e0a81ae9d61b845f.jpg"><b>Fig. 4</b></a>). Two five minute-periods at ten pounds of weight-bearing were allowed initially. On POD #6 the patient was seen twice during the day and stood on scales in the parallel bars (see <a href="/files/original/27ad3e7aadc5e665c134b448e33340c5.jpg"><b>Fig. 5</b></a>). Two daily sessions were continued and weight-bearing was increased to 20 pounds on the right limb and 15 pounds on the left, being limited due to pain. Throughout this period the patient complained of phantom sensations and residual limb pain which increased markedly at night. The first cast change was done on POD #12 at which time the stitches were removed. The following day the patient began ambulation in the parallel bars with weight-bearing to tolerance. On POD #15 the patient was given a walker for bedside use and on the following day was able to ambulate independently outside the parallel bars with axillary crutches and a four-point gait, testimony to her longstanding adaptation to her physical deficits and her determination to succeed. At this time the patient was transferred from the acute care setting to an inpatient rehabilitation bed.</p> <p>Four weeks after surgery the patient was casted for her definitive prostheses. At five weeks she was fitted with the sockets and locked knees and returned to the parallel bars for ambulation training. During the sixth week, first one and then both prostheses had safety knees added. By the ninth post-operative week the patient had returned to the use of crutches and had received training in elevation activities and ambulation on different terrains.</p> <p>The prostheses were delivered at the end of the ninth post-operative week and consisted of quadrilateral total contact sockets with semi-suction and supracondylar suspension. Windows were not cut in the sockets for donning but rather a soft insert was fabricated which was compressed during donning and re-expanded within the socket to grip the femoral condyles. The patient rejected the use of any suspension belts as uncosmetic. Otto-Bock's modular endoskeletal safety knees and components, and SACH feet were used. (See <a href="/files/original/5bc094ab41ace0120e8ba8896408edb8.jpg"><b>Fig. 6</b></a>).</p> <h3>Follow-Up</h3> <p>The patient returned to her former daily interests and activities and maintained her ambulatory status. Having worn the prostheses for approximately a year and a half she returned for re-evaluation. Changes in residual limb shape due to shrinkage necessitated the fabrication of a second pair of prostheses which she currently uses.</p> <h3>Summary</h3> <p>This case well illustrates the advantages and appropriate application of the IPSF approach to amputee management. The patient was able to have both limbs amputated at once and yet hasten the rehabilitation process. The physical debilitation and psychological shock associated with such a radical intervention was minimized by her youth, determination, and cooperation with the rehabilitation team. A deeply felt desire to improve her quality of life was satisfied with minimal disruption of what was an already successful life style in the face of life-long physical difficulties.</p> Page Number(s) 5 - 7 Year 1979 Volume 3 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1979_03_005/1979_03_005-6.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Bilateral Knee Disarticulation, Immediate Post-Surgical Fitting: An Unusual Case Study Creator An entity primarily responsible for making the resource William Susman  https://staging.drfop.org/files/original/892fdbb362b8e10138add9644e5ab5c1.pdf bea506cbf5df4cebb34bc4911c8becb0 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1954_03_001.pdf Year 1954 Volume 1 Issue 3 Page Number(s) 1 - 3 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1954_03_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1954_03_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Bioengineering- Blueprint for Progress</h2> <h5>Augustus Thorndike M.D. <a style="text-decoration:none;">*</a><br /></h5> <p>The limbs of man move in space and time, in response to systems of internal and external forces, and in accordance with the laws of mechanics. To restore to any satisfactory extent the functions lost through amputation of an extremity therefore requires intimate knowledge not only of the structure, form, and behavior of the normal limb but also of the techniques available for producing complex motions in substitute devices activated by residual sources of body power. Since adequate replacement of a natural limb with an artificial one requires successful integration of the human mechanism with a toollike device, the biomechanical features of the stump and the physical characteristics of the prosthesis must be wedded as nearly as possible into a single, functional entity.</p> <p>Two-sided as this problem would now obviously appear, it is only in comparatively recent years that the medical sciences of surgery, anatomy, and physiology and the physical one of engineering have been brought together in a unified attack upon the whole problem of amputee rehabilitation. Until recently, surgeons, with few exceptions, had little or no understanding of engineering problems. And heretofore the design and construction of artificial limbs has been conducted mostly by artisans who, however ingenious they may have proved to be, were mostly without formal education in engineering or anatomy. Besides this, except in isolated instances the two worked separately and alone. All of which no doubt accounts for the fact that, as late as World War II, the available artificial limbs fell far short of the standards of accomplishment attained in other fields of research and invention.</p> <p>In the research program coordinated by the Advisory Committee on Artificial Limbs, National Research Council, there have been brought together in harmonious working relationship the individual skills of surgeon and engineer in a sort of mutual bioengineering to produce truly functional artificial limbs. As a result, there has been in the field of prosthetics perhaps more progress during the past decade than in all the preceding 2000 years of limb-making.</p> <p>Because the lower limb is more essential to human activity than is the arm, and also doubtless because the basic functions of the leg are easier to replace than are those of the arm, progress in artificial arms and hands has from the earliest times always lagged far behind developments in artificial legs. This circumstance was reflected in the fact that, when the Artificial Limb Program was established in 1945, much more had already been accomplished in replacements for the lower extremity than in those for the upper. And consequently developments in the ACAL program to date have been most noticeable in upper-extremity prosthetics, despite extensive engineering studies of normal and amputee locomotion and refinements in the techniques of lower-extremity fit and alignment.</p> <p>In any case, the development of prosthetics had necessarily to follow the pattern of developments in surgery, and conversely the surgeon's philosophy with regard to "sites of election" and other matters was necessarily dictated by the character and availability of such prostheses as there were. Since the science of amputation surgery and the art of limbmaking proceed as one, the standards and practices in one field dictate standards and practices in the other, and vice versa. That each of these has now been brought to understand more fully the problems of the other may be looked upon as a major achievement in the art of prosthetics.</p> <p>In the following pages of this issue of Artificial Limbs is to be found substantial evidence that the engineering profession, working with the amputation surgeon, has provided new thoughts, new ideas, and new approaches to the problem of providing adequate functional replacements for the limbless. In the whole Artificial Limb Program there exists no better example of cooperation toward progress than is demonstrated here. In the first of two articles, a surgeon and an engineer collaborate in describing the latest devices and techniques arising from systematic research and the influence which these developments ought rightly to exert upon the philosophy of modern amputation surgery. In the second, an engineer outlines the methodology required in investigation of the normal limbs and in the design of useful replacements. Only through such teamwork in biomechanics can truly great advances in the field of prosthetics be expected. The development of the thirty Veterans Administration and other civilian orthopedic and prosthetic appliance clinic teams has resulted in the better distribution of new knowledge toward improved fitting and alignment of artificial legs and in the design and construction of improved artificial arms.</p> <p>The program of research coordinated by the Advisory Committee on Artificial Limbs involves the participation of government, university, and industrial laboratories. The Veterans Administration, the Army, and the Navy provide the necessary funds for the operation of their own establishments, while the VA provides the contractual authority with the funds necessary for work in the universities and in industrial laboratories. Out of this cooperative effort there have come within recent years improved functional prostheses for almost every level of amputation, particularly for those special amputee cases heretofore considered unsuited for an artificial limb. With the mutual cooperation of surgeon and engineer, there has resulted a cross-fertilization of ideas and a new set of modalities in the rehabilitation of amputees.</p> <p> Nevertheless, the presently available devices, though anthropomorphoid in form, are far from anthropomorphoid in function. Unfortunately, no artificial limb, however elaborate, can ever serve as an ideal substitute for a natural member unless it incorporates some of the features of sensory and muscular control characteristic of the limb it replaces. Therein lies the challenge of the future- to devise mechanisms which not only simulate the motions and the functions of normal limbs but which also provide appropriate feedback of information such as occurs in natural arms and legs. In our present state of knowledge, the ultimate goal of the limb designer is still a long way off. Further progress depends largely upon the continued cooperation of surgeon and engineer, of prosthetist and therapist, and of the amputee himself.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Augustus Thorndike M.D. </b></td></tr><tr><td class="clsTextSmall">Acting Director, Prosthetic and Sensory Aids Service, U.S. Veterans Administration, Washington 25, D.C.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> 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 Bioengineering- Blueprint for Progress Creator An entity primarily responsible for making the resource Augustus Thorndike M.D. * https://staging.drfop.org/files/original/5d0ee93720e3cc29afeb69569f942ec3.pdf ec7d305e66c4b1672edc65546d744f4a https://staging.drfop.org/files/original/7e69b86f4f3e01170fb59ef73e47cd16.jpg 153b782803915d8c141c800756b99b14 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_02_001.pdf Text Any textual data included in the document <h2>Biomechanical Considerations in the Orthotic Management of the Knee</h2> <h5>Victor H. Frankel, M.D., Ph.D.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>The challenges facing the contemporary orthotist are akin to the interminable task of Sisyphus, the Greek mythic figure who was condemned to pushing a huge rock up an endless hill. Unlike Sisyphus, however, the orthotist has made and continues to make significant strides in the rational design and fabrication of prostheses and orthotic devices. Over the past decade major contributions to solving the anatomical and functional problems associated with joint replacement prostheses and orthoses have directly resulted from the growing interaction between orthopaedic surgery and biomechanics. The result of this increased interaction has been improved diagnosis and treatment of musculoskeletal disorders with prostheses and orthotic devices. The knee is certainly one of the joints that has greatly benefited from these biomechanical developments.</p> <p>Biomechanics enables the scientist to accurately describe and quantify surface joint motion of the knee and to analyze the complex forces imposed on the knee. Biomechanics also brings the motion of and the forces acting on the knee into sharp focus by analyzing the mechanical properties of the static and dynamic structures surrounding the knee: muscles, bones, ligaments, cartilage, and tendons. The biomechanical analysis of motion and force in the knee joint can be widely and successfully applied in orthotic management of the knee.</p> <p>The human knee is the largest and perhaps the most complex joint in the body. It is a two-joint structure composed of the tibiofemoral joint and the patellofemoral joint. Both joints sustain high forces and, located between the body's two longest lever arms, are particularly susceptible to injury. The knee transmits loads, participates in motion, aids in conservation of momentum, and provides a force couple for activities involving the leg.</p> <p>Although motion in the knee occurs simultaneously in three planes, the motion in one plane is so great that it accounts for most knee motion. Similarly, muscle forces on the knee are produced by several muscles, but a single muscle group (according to the activity) produces a force so large that it accounts for most of the muscle force acting on the knee. Thus, biomechanical analysis can be basically limited to motion in one plane and to the force produced by a single muscle group, and yet can still give an understanding of knee motion and an estimation of the magnitude of the main forces acting on the knee.</p> <p>To analyze motion in any joint, one must use kinematics, the branch of mechanics that deals with motion of a body without reference to force or mass. To analyze the forces imposed on a joint one must use both kinematic and kinetic data. Kinetics is the branch of mechanics which analyzes the motion of a body under the influence of given forces.</p> <h3>Kinematics</h3> <p>Kinematic data define the range of motion and describe the surface joint motion in three planes: frontal (coronal or longitudinal), sagittal, and transverse (horizontal).</p> <p>The range of motion can be measured in any joint and in any plane. Gross measurements can be made by goniometry, but more specific measurements must be made with more precise methods such as electrogoniometry, roentgenography, or photographic techniques using skeletal pins. <a></a></p> <p>The range of knee joint motion needed for performing various physical activities can be determined from kinematic analysis. A full range of knee motion is needed for performing the more vigorous activities of daily life in a normal manner. Moreover, any restriction of knee motion will be compensated for by increased motion in other joints.</p> <p>The values obtained in several studies indicate that full extension and at least 117 degrees of flexion are necessary for carrying out the activities of daily life in a normal manner (<b>Table I</b>).<a></a></p> <strong>Table I. Range of Tibiofemoral Joint Motion in the Sagittal Plane During Common Activities</strong> <img src="/files/original/7e69b86f4f3e01170fb59ef73e47cd16.jpg" h3="" width="415" height="337" /><br /> <h3>Surface Joint Motion</h3> <p>Surface joint motion, the motion between the articulating surfaces of a joint, can also be described for any joint in the sagittal and frontal planes, but not the transverse plane. The method used is called the instant center technique. This technique allows a description of the relative uniplanar motion of two adjacent segments of a body and the direction of displacement of the contact points between these segments. The instant center for motion of a planar joint can be obtained by the method of Reuleaux (1876).<a></a></p> <p>Clinically, a pathway of the instant center for a joint can be plotted by taking successive roentgenograms of the joint in different positions (usually ten degrees apart) throughout the range of motion in one plane, and applying the Reuleaux method for locating the instant center for each interval of motion. After the instant center pathway has been determined, the surface joint motion can be described. In a normal knee, the instant center pathway for the tibiofemoral joint is semicircular.</p> <p>Especially pertinent to orthotic management is data concerning knees with internal derangements. If the knee is extended and flexed about a displaced instant center, the tibiofemoral joint surfaces do not slide tangentially throughout the range of motion, but become either distracted or compressed. Such a knee is analogous to trying to close a door with a bent hinge. If the knee is continually forced to move about a displaced instant center, it will gradually adjust to this situation by either stretching the ligaments and supporting structures of the joint or by exerting abnormally high pressure on the articular surfaces.</p> <p>Such internal derangements of the tibiofemoral joint may interfere with the so-called screw-home mechanism, which is a combined motion of knee extension and external rotation of the tibia. The tibiofemoral joint is not a simple hinge joint, but has a spiral, or helicoid, motion. The spiral motion of the tibia about the femur during flexion and extension results from the anatomical configuration of the medial femoral condyle; in a normal knee this condyle is approximately 1.7cm longer than the lateral femoral condyle. As the tibia slides on the femur from the fully flexed to the fully extended position, it descends and then ascends the curves of the medial femoral condyle and simultaneously rotates externally. This motion is reversed as the tibia moves back into the fully flexed position. The screw-home mechanism gives more stability to the knee in any position than would be possible if the tibiofemoral joint were a simple hinge joint.</p> <p>The Helfet test, a simple clinical test, is used to determine if external rotation of the tibia occurs during knee extension, thus showing whether the screw-home mechanism is intact.<a></a></p> <p>In a deranged knee it may happen that no external rotation of the tibia occurs during extension. Because of the altered surface motion, the tibiofemoral joint will be abnormally compressed if the knee is forced into extension, and the joint surfaces may be damaged.</p> <h3>Kinetics</h3> <p>Kinetic data, based on static and dynamic analysis, are used to analyze the forces acting on a joint. The medical scientist can use kinetic analysis to determine the size of the forces imposed on the knee by muscles, body weight, connective tissues, or external loads in either static or dynamic situations. In particular regard to orthotic management, however, situations and movements which produce excessively high forces can be identified.</p> <p>In static analysis, the three main coplanar forces acting on a body in equilibrium are identified as: (1) the ground reaction force (equal to body weight), (2) the tensile force exerted by the quadriceps muscle through the patellar tendon, and (3) the joint reaction force acting on the tibial plateau. Since most of our activities are dynamic, however, an analysis of the forces acting on the knee during motion-dynamic analysis-must be applied to given situations. In addition to the three coplanar forces of static analysis, the medical scientist must also take into account the acceleration of the body part (the amount of torque needed to accelerate a body, for which anthropometric data-tables are used).<a></a> An orthotist might use dynamic analysis, for example, to calculate the joint reaction, muscle, or ligament forces on the tibiofemoral joint at a particular instant in time during walking, or at a particular instant in time (with a stroboscopic film) while kicking a football.</p> <p>Other biomechanical considerations in the orthotic management of the knee involve the two important functions of the patella: (1) it aids knee extension by lengthening the lever arm on the quadriceps, and (2) it allows a better distribution of stresses on the femur by increasing the area of contact between the patellar tendon and the femur. In a patellectomized knee, for example, the quadriceps muscle, now with a shorter lever arm, must produce even more force than normal to achieve the required torque about the knee during the last 45 degrees of extension. Full, active extension of a patellectomized knee may require as much as 30 percent more quadriceps force than normally required.<a></a></p> <p>During most dynamic activities, the greater the knee flexion, the higher all the muscle forces acting on the patellofemoral joint. Forces increase proportionately with knee flexion, for example, from walking to stair climbing to knee bends. Patients with patellofemoral joint derangements experience increased pain when performing activities requiring knee flexion, and orthotic management could be greatly aided by knowledge of such predictive biomechanical factors as knee flexion, and the muscle and joint reaction forces for specific situations.</p> <p>Biomechanical analysis can yield invaluable, practical data for the orthotic management of the knee. A continuing, close interaction among orthopaedic surgeons, bio-engineers, and orthotists will insure the applied efficacy of such data.</p> <p><b>References:</b></p> <ol> <li><a href="http://www.oandplibrary.org/al/1964_01_044.asp">Drillis, R., Contini, R., and Blustein, M.: "Body segment parameters: A survey of measurement techniques," <i>Artificial Limbs</i>, 8:44, 1964.</a></li> <li>Frankel, V.H., and Nordin, M.: <i>Basic Biomechanics of the Skeletal System</i>. Philadelphia, Lea &amp; Febiger, 1980.</li> <li>Helfet, A.J. : "Anatomy and mechanics of movement of the knee joint," <i>Disorders of the Knee</i>, edited by A. Helfet, Philadelphia, J.B. Lippincott, 1974.</li> <li>Kaufer, H. : "Mechanical function of the patella," <i>Journal of Bone &amp; Joint Surgery</i>, 53A:1551, 1971.</li> <li>Kettelkamp, D.B., Johnson, R.J., Smidt, G.L., Chao, E.Y.S., and Walker, M.: "An electrogoniometric study of knee motion in normal gait, <i>Journal of Bone &amp; Joint Surgery</i>, 52A:775, 1970.</li> <li>Laubenthal, K.N., Smidt, G.L., and Kettelkamp, D.B. : "A quantitative analysis of knee motion during activities of daily living," <i>Physical Therapy</i>, 52:34, 1972.</li> <li>Murray, M.P., Drought, A.B., and Kory, R.C.: "Walking patterns of normal men," <i>Journal of Bone &amp; Joint Surgery</i>, 46A:335, 1964.</li> <li>Perry, J., Norwood, L., and House, K.: "Knee posture and biceps and semimembranosis muscle action in running and cutting (an EMG study), "<i>Transactions of the 23rd Annual Meeting</i>, Orthopaedic Research Society, 2:258, 1977.</li> <li>Reuleaux, F.: <i>The Kinematics of Machinery: Outline of a Theory of Machines</i>. London, Macmillan, 1976.</li> </ol> <div style="width: 400px;"><em><b>*Victor H. Frankel, M.D., Ph.D. </b> Director of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17 Street, New York, New York 10003, and, Professor of Orthopaedic Surgery, Mt. Sinai School of Medicine, New York, N.Y.<br /><br /><br /></em></div> <div style="width: 400px;"></div> Page Number(s) 1 - 3 Year 1984 Volume 8 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1984_02_001/1984_02_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Biomechanical Considerations in the Orthotic Management of the Knee Creator An entity primarily responsible for making the resource Victor H. Frankel, M.D., Ph.D. * https://staging.drfop.org/files/original/28274e1bdc8b1f42b700c9e81f28597f.pdf c98bd0663a677efb5cc36261b7c4cb7f https://staging.drfop.org/files/original/b6970149668330ce776434d9198152e3.jpeg 731206ce838388691e18855abcf7eb68 https://staging.drfop.org/files/original/a0bf70a49a9e3db596969c11b0c2c69c.jpg 23969c8fa88696d9a5addf89f363da7e https://staging.drfop.org/files/original/8a915c80bd9484bb8ab1b9a594fe6c66.jpg 7494d39a35704017937591467700f667 https://staging.drfop.org/files/original/f5da1243900128485bea8bd5f391499b.jpg beeee6ab4ded6b95b152fb192d126b8d https://staging.drfop.org/files/original/9ecbbc7b6c0294a18f4bb82b168db309.jpg a3cccb644afd639c1fbbc7860f03f802 https://staging.drfop.org/files/original/628b6e300a318be54667478bf7d69ef8.jpg 0ed7a62e1104b47e6adf43049a770bb2 https://staging.drfop.org/files/original/324715b55eb49ed8d385db9eef8fde73.jpg ef08536eda1fad5db1231816539fca86 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_02_009.pdf Text Any textual data included in the document <h2>Bivalved Spinal Orthoses for the Structurally Unstable Spine</h2> <h5>H.R. Lehneis, Ph.D., CPO&nbsp;<a style="text-decoration: none;">*</a><br />Roger Chin, CPO&nbsp;<a style="text-decoration: none;">*</a><br />Donald Fornuff, CP&nbsp;<a style="text-decoration: none;">*</a></h5> <p>With the advent of plastics, particularly thermoplastics, and plastics technology, plastic molded spinal orthoses are increasingly used in the orthotics management of the structurally unstable spine for nearly all levels of involvement. Depending on the risk factor involved, they may be used in lieu of surgery, i.e. when the patient is not a candidate to undergo surgery for various physiological reasons, or they may be used in the post-surgical management of the structurally unstable spine. Because of the ability of modern plastics to be intimately contoured to the body, they provide for far safer orthotics management, particulary of the cervical spinal region, than conventional orthoses. Often they are a preferred substitute over casts since these bivalved orthoses can be readily removed, either fully or partially, for hygienic reasons and the orthosis can be kept clean much more easily than a cast.</p> <h3>Orthotics Designs</h3> <p>Two types of bivalved spinal orthoses are described below:</p> <ol> <li> <p>Cervico-thoracic orthosis (CTO) with forehead band.</p> </li> <li> <p>Thoraco-lumbo-sacral orthosis (TLSO).</p> </li> </ol> <p>With slight modifications, various combinations of the above can be designed. The area of injury or surgery usually determines the height and design of the orthosis. The contours of the orthosis aid in maintaining the proper position on the patient. Overlapping edges avoid pinching and allow for some weight gain or loss.</p> <p>The bivalved opening allows for fast removal in case of cardiac or respiratory problems, situations in which access has to be almost immediate. It is also a comfort to the patient, while lying in bed, that either half of the orthosis can easily be removed for short periods of time to give some relief from pressure and for ventilation.</p> <p><i>CTO with forehead band (<a href="/files/original/b6970149668330ce776434d9198152e3.jpeg"><b>Fig. 1</b></a>)</i></p> <p>The cervical region is the most flexible of the spine. Rotation, flexion/extension, and lateral bending are difficult to control using just a cervical orthosis. Stabilization of the thoracic spine is necessary in order to provide the base, or foundation, for control of the cervical spine and head.</p> <p>It is extremely important to appreciate that without proper head control the cervical spine cannot be properly stabilized. Thus, the orthosis must extend posteriorly to cover the occipital area (<a href="/files/original/a0bf70a49a9e3db596969c11b0c2c69c.jpg"><b>Fig. 2</b></a>), and anteriorly around the forehead, as well as the mandibular area (<a href="/files/original/8a915c80bd9484bb8ab1b9a594fe6c66.jpg"><b>Fig. 3</b></a>). Inferiorly, it should be noted that the orthosis covers the entire rib cage, including the floating ribs (<a href="/files/original/f5da1243900128485bea8bd5f391499b.jpg"><b>Fig. 4</b></a>).</p> <p><i>Thoraco-Lumbo-Sacral Orthosis (<a href="/files/original/9ecbbc7b6c0294a18f4bb82b168db309.jpg"><b>Fig. 5</b></a>)</i></p> <p>Orthotics design for structural instability of the thoracic and lumbar spine requires the formation of a sound base inferiorly. In general, this is identical to the trimline used in the Milwaukee brace, or other orthoses for scoliosis. The superior trimlines depend on the level of involvement, but extend from at least the level of the xyphoid process to the inferior border of the clavicle (<a href="/files/original/628b6e300a318be54667478bf7d69ef8.jpg"><b>Fig. 6</b></a>). The lateral Velcro® closures are of the cross-diagonal type described earlier by Ekus<a style="text-decoration: none;">*</a> to minimize relative vertical displacement between the bivalved sections.</p> <h3>Indications</h3> <p>The orthoses described are indicated either in lieu of surgery if the patient is not a surgical candidate for any physiologic reason, or post-surgically to maintain the desired position of the spine, instead of a plaster cast.</p> <p>Medical indications are:</p> <ol> <li> <p>Fracture and fracture-dislocations, including the odontoid process.</p> </li> <li> <p>Ligamentous rupture or laxity with resultant instability of the spine.</p> </li> <li> <p>Neoplastic disorders with concomitant degeneration of the vertebrae.</p> </li> </ol> <p>Physical indications are:</p> <ol> <li> <p>Lightweight.</p> </li> <li> <p>Hygiene, i.e. ability to clean the orthosis.</p> </li> <li> <p>Removability of either portion of the orthosis for patient hygiene and ventilation.</p> </li> </ol> <h3>Casting Technique</h3> <p>The casting method requires a Stryker frame. It is essential for accurate casting, and is the safest method for the patient. Body movement is limited to transfer in the supine position from bed to frame and back to bed, if the patient is not already in a Stryker frame and in skeletal traction. The patient can be turned from a supine to a prone position by turning the frame, which has been locked to prevent body movement. This method has proven to be the fastest, simplest, and cleanest.</p> <p>With the patient on the Stryker frame in the supine position, bony prominences and areas of relief are marked with an indelible pencil. The patient's anterior half is covered with a separative jelly (K-Y®, petrolatum), except the hair, which is covered with stockinette for casting for the CTO. Approximately 8-10 layers of plaster splints are applied in alternating vertical and horizontal layers to give the anterior shell added strength. With the patient in the supine position, abdominal pressure (which supports the spinal column internally) is built in at the time of casting.</p> <p>When the anterior half has hardened sufficiently to support the body without distortion, the patient is turned to the prone position. Again, bony prominences and areas of relief are marked with an indelible pencil on the posterior side which is then covered with a separative jelly. Approximately 4-6 layers of plaster splints are applied in alternating horizontal and vertical layers. The posterior half does not have to be as strong as the anterior half, as the patient will not be lying in it as in the anterior half. All casts are bi-valved with approximately 5 cm. overlap of the posterior half on the anterior half. A separative jelly is spread over the anterior areas to be covered by the posterior overlap. When the posterior half has hardened sufficiently to be removed, the sections will part easily because of the separative jelly under the overlap. They are then put back together with the overlap providing the key for proper position of the anterior and posterior halfs.</p> <p>The cast is then filled and modified. All bony prominences or areas of relief are built up approximately 2 to 3 cm. while in the soft tissue areas, e.g., abdomen, plaster is removed.</p> <h3>Fabrication</h3> <p>While any thermoplastic sheet material may be used for molding the orthosis, at this institution Subortholen® is preferred. It is a high strength polyethylene which is not only thermoplastic, but can be cold-formed as well. When heated, it can be drape-molded quite easily, and in a cold state, can be hammered similar to light alloy sheet material (e.g., hammered thin to form a hinge or channeled for rigidity or relief). Subortholen® is available in thicknesses of 1 to 6 mm.</p> <p>Sheets are cut to the size needed and placed in an oven heated to 150-160 degrees centigrade (350°F). The material is ready for molding when the sheet has lost its pink color and is almost translucent (<a href="/files/original/324715b55eb49ed8d385db9eef8fde73.jpg"><b>Fig. 7</b></a>, right). When molding Subortholen®, a half hour oven dry cast or driest possible cast is recommended. The cast should be covered with stockinette to prevent moisture contact to the Subortholen® which, if not done, may cause rapid cooling, bubbling, and an uneven finish on the surface.</p> <p>The posterior half is molded first to extend approximately 5 cm. beyond the lateral midlines. When cooled, the posterior half is removed and cut to the desired trim lines and placed back on the cast. The anterior half is then molded to overlap the posterior half by approximately 5 cm. After the anterior half is cut to the desired trim lines, the orthosis is ready for fitting.</p> <h3>Special Fitting Considerations</h3> <p>Cervico-Thoracic Orthosis with Forehead Band :</p> <ol> <li> <p>Inferior trim line of forehead band should be approximately 1 cm. above the eyebrows.</p> </li> <li> <p>Circumferential pressure adjustability of head band is accomplished by means of a Velcro® strap.</p> </li> <li> <p>Mandibular pressure can be controlled by tightness of forehead band.</p> </li> <li> <p>Inferior trim lines need not extend below rib cage, as not to restrict lateral and posterior/anterior motion.</p> </li> <li> <p>Posterior/superior trim line should extend 3-4 cm. above the apex of the occiput.</p> </li> </ol> <p>Thoraco-Lumbo-Sacral Orthosis:</p> <ol> <li> <p>The orthosis must be keyed in the soft tissue area between the rib cage and iliac crests to prevent vertical displacement of the orthosis.</p> </li> <li> <p>The anterior inferior aspect must be trimmed to avoid sitting problems and pressure on the pubis. The posterior inferior trimline should allow sitting without the orthosis being pushed up from contact with the chair.</p> </li> <li> <p>Depending on the level of involvement, the anterior superior trimline should extend from a point somewhere between the xyphoid process to a level that follows the course of the inferior border of the clavicles.</p> </li> </ol> <div style="width: 400px;"><strong>Footnote</strong> Ekus L., CO, Cross-Diagonal Closure of Pelvic and Spinal Appliances. Newsletter—Prosthetics and Orthotics Clinic, Vol. 5, No. 1, 2/1981 —Winter/Spring Issue<em><b><br /><br />*Donald Fornuff, CP </b> Institute of Rehabilitation Medicine New York University Medical Center New York, NY</em><br /><em><b><br />*Roger Chin, CPO </b> Institute of Rehabilitation Medicine New York University Medical Center New York, NY</em><br /><em><b><br />*H.R. Lehneis, Ph.D., CPO </b> Institute of Rehabilitation Medicine New York University Medical Center New York, NY<br /><br /></em></div> Page Number(s) 9 - 11 Year 1983 Volume 7 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-5.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-6.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 7 http://www.oandplibrary.org/cpo/images/1983_02_009/1983_02_009-7.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Bivalved Spinal Orthoses for the Structurally Unstable Spine Creator An entity primarily responsible for making the resource H.R. Lehneis, Ph.D., CPO * Roger Chin, CPO * Donald Fornuff, CP * https://staging.drfop.org/files/original/1a6a1f184c2cd633f78c0e51e7fd583d.pdf 888106633767347702e5270333805508 https://staging.drfop.org/files/original/8171860100ffe17960ae92f1c1b7a8d0.jpg 0c7928d738cf860db28f518883959e4d https://staging.drfop.org/files/original/8a08a028e48debbdf4ee986f98699a5c.jpg 4a00b22dd3dfd62390f8ba4f63b18825 https://staging.drfop.org/files/original/08ca4555f259d231e98499d7c73c6745.jpg bed855e369a3efebf3dbb45a39dc26d3 https://staging.drfop.org/files/original/5d9726a0d70d25e282e5ce3cb6acc7c3.jpg 84b68d902457336b3a79c6063c74c0ee https://staging.drfop.org/files/original/561c6de9e48cf18c7f2151422e231efe.jpg d97ac2700c75061656d8e1361d5ead59 https://staging.drfop.org/files/original/3877690c34824efa8115956d3b0a2228.jpg ca94e33e0cc3b346a85cae372f9efa31 https://staging.drfop.org/files/original/214655cdfbc70a1417706fd03bf6a90c.jpg c097b37a2e6e301bf9f8d22a385ac217 https://staging.drfop.org/files/original/d43be2a407eb388121e5a356fea5944f.jpg 9f50cc9d64f58612267042301517bfb0 https://staging.drfop.org/files/original/12b1d25199058a29e26176c2409e0d03.jpg 4950e3238e3bba891356e29d6431a8cb https://staging.drfop.org/files/original/3394cf2dce7b6e4720919e2650d7edfc.jpg 28bddd80061034f8d909eee6b3640a40 https://staging.drfop.org/files/original/e058338cad5520af44befe2f6a5065b2.jpg 07c48836d80a04cfe671b99f8b536819 https://staging.drfop.org/files/original/08d3f28bce0cc2b654faee759fbf43df.jpg 092fc66c6603e929370979286f089b62 https://staging.drfop.org/files/original/5f840ffc2fa022f39d93f212174b17d0.jpg 31e3d1cd5d444f17ff180e1a8d0f4ddf https://staging.drfop.org/files/original/16c6c01bce1b985df06b3717a4a4ea62.jpg 24c528bc31b56db4151f81170510c7ee https://staging.drfop.org/files/original/4030c50d9472b0af3537174082a6c112.jpg 6858cd0a306c0b542ec75507d11cd306 https://staging.drfop.org/files/original/4a43c2820bac145818f45fcb14291807.jpg 511c75d1f2c73f882f969ad6ee91b696 https://staging.drfop.org/files/original/14cff0d7ef503eb8545491831195dc8b.jpg c86204cca3a3d38e040653e3c6af86ee https://staging.drfop.org/files/original/a8e82dc65e5d99d52bd3f5ee18dc4085.jpg 92e551a7865e62369eedec664217bdd1 https://staging.drfop.org/files/original/0740cc4fe2fb2fc64ac5b4869573d026.jpg d0e7bf7ba9a78049c80e1b8560127ec3 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1972_01_001.pdf Year 1972 Volume 16 Issue 1 Page Number(s) 1 - 19 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1972_01_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1972_01_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Body Segment Parameters, Part II</h2> <h5>Renato Contini <a style="text-decoration:none;">*</a><br /></h5> <p>The performance of human (animal) activity requires the expenditure of energy. During the contraction of the muscles involved in this activity, chemical energy is converted first into mechanical energy, then into work and heat. Some of this chemical energy is required for maintenance of body functions. In movement, however, much of the mechanical energy is required to overcome friction and tissue displacement at the joints, gravity, inertial forces, air and water resistance—all of which oppose the action desired.</p> <p>Biomechanics is the science that is concerned with such effects. In order to understand better the biomechanics of movement, it is necessary to know certain characteristics of the segments involved. Among these characteristics are the mass of the segments, their centers of mass, and their mass moments of inertia. The characteristics (body parameters) themselves are not readily obtained on living subjects.</p> <p>It was the purpose of two studies conducted at the New York University School of Engineering and Science to obtain some of these body parameters. The first of these studies, <a></a> completed in 1966, was conducted on normal, healthy American males in the age range of 20-40 years. The second study, <a></a> completed in 1970, was conducted on a random selection of adults, young males and females 20-30 years of age, some females in the 40-50 age bracket, and a number of amputees and hemiplegics, male and female, in all age ranges.</p> <p>A history, survey of measurement techniques, and data developed over the years was given in "Body Segment Parameters: A Survey of Measurement Techniques," which appeared in <i>Artificial Limbs, </i>Spring 1964. <a></a> Also, a condensation of four of the most important monographs in this field ("Center of Gravity of the Human Body" by W. Braune and O. Fischer; "Theoretical Fundamentals for a Mechanics of Living Bodies" by O. Fischer; "The Human Motor" by J. Amar; and "Space Requirements of the Seated Operator" by W. T. Dempster) has been prepared by Krogman and Johnston <a></a> under the sponsorship of the United States Air Force.</p> <h3>Methods</h3> <p>Most studies undertaken previously used cadavers, but in a few studies, including those at New York University, living subjects were used. Although some available measuring techniques for compiling the data are similar for live subjects and for cadavers, other techniques must obviously differ. In general, the techniques covered here are for living subjects; thus, all techniques used on dissected cadavers are not included. When living subjects are used, particularly the elderly and those suffering with some affliction or disability, any technique utilized must be at the convenience of the subject. Some subjects cannot comfortably assume the necessary postures during the measurement processes, while for some others the procedures are physically impossible. As a result, not all measurements can be taken on all subjects, but, because of the various techniques available, most of the desired data can be obtained.</p> <p>The techniques are only briefly presented here because more adequate descriptions are available in other references.</p> <h4>Volume Determination</h4> <p>The body and all of its segments are irregular solids. The volume of an irregular solid may be obtained or approximated in a number of ways: by mensuration, immersion, or photogrammetry. Only the first two were used in both studies.</p> <p><i>Mensuration</i></p> <p>A relatively good approximation of body-segment volume can be obtained by using circumferential measurements at certain selected stations on the segment and the linear dimensions between any two consecutive circumferential measurements. If all these measurements are known for the full length of the segment, then an approximate volume can be determined. Accuracy will increase with the increased number of such measurements. This technique assumes that any two successive cross sections of the member are parallel and essentially similar geometrically. In that event, the volume contained within the two cross sections may be expressed as: <b>Equation 1</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 1. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>It is obviously impossible to obtain cross-sectional areas on the body segments of living subjects. If it is assumed, however, that the cross sections of the limbs are elliptical, it is possible to establish a relationship between the cross-sectional area and the perimeter at any chosen level. For any segmental portion between two levels, the volume may now be expressed as: <b>Equation 2</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 2. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>For a total limb divided into n segments, each <i>h </i>distance apart: <b>Equation 3</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 3. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The derivation of this equation is given in reference. <a></a></p> <p><i>Immersion</i></p> <p>In this method, the segment whose volume is to be determined is immersed in water. Incremental volumes are taken of the segment whose total volume then is the sum of these increments. For these studies, four tanks were specially designed: an arm tank, a hand tank, a leg tank, and a foot tank. Each tank was constructed of Plexiglas, the first three cylindrical in cross section, and the last, rectangular.</p> <p>The limb or body segment was completely immersed in the tank. Water was permitted to drain off in controlled increments, each representing a known change in cylinder height. Drained water was collected and measured. The difference in volume between that collected and that obtainable without the body segment in place (the actual volume of the tank for that increment) represents the volume of the body segment contained within the height increment. Whenever possible, these increments were 2.0 cm apart, but, if subjects with limited physical tolerance had minimal cross-sectional variation, the increments were increased to every 4.0 cm apart.</p> <p><i>Photogrammetry</i></p> <p>Two types of photogrammetric techniques are available-mono and stereo. In the former, lines or colored shadows are projected on the subject in such fashion as to produce a contour map on the particular segment of interest. The areas contained within these contours may be measured with a planimeter, and the same general equation for determining the volume as given previously may be used. Again, the sum of all the incremental volumes of the segment represents its total volume.</p> <p>In stereophotogrammetry, two cameras are used side by side to create an illusion of depth when the two photographs are juxtaposed. The resulting picture is treated as an aerial photograph of terrain upon which contour levels are applied. These then are treated as in monophoto-grammetry.</p> <h4>Density Determination</h4> <p>To obtain the overall body density of living subjects is extremely difficult. To obtain the density of individual segments on living subjects is virtually impossible. There are ways, however, to obtain fairly accurate values. The problems involved will not be discussed here; some of them are described in the two referenced reports. <a></a></p> <p><i>Empirical (Whole Body)</i></p> <p>Whole-body volume may be approximated in several ways. The mass may be obtained by weighing accurately. The density is the ratio of mass to volume. For lean bodies, the density is higher than for fat bodies. One provisional formula for determining density, developed by Dupertuis in 1950, <a></a> makes use of Sheldon's somatotyping system <a></a> and introduces the first component (x) of the system into the equation:<br /><i>d(ensity) =</i> 1.094 - 0.0119x</p> <p>A second equation developed by the Biomechanics Group at NYU, using data developed by Behnke, <a></a> is based on the height <i>(H) </i>in inches, and weight <i>(W) </i>in pounds of the individual (<b>Fig. 1</b> and <b>Fig. 2</b>): <b>Equation 4</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 4. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Anthropometric (Whole Body)</i></p> <p>Many studies have established the reasonably close relationship between body fat and certain skin-fold thicknesses. <a></a> The equations used for the NYU study were those developed by Pascale. <a></a></p> <p>The first depends on the measurement of the skin-fold thickness at the triceps:</p> <p><i>d(ensity) </i>= 1.0923 - 0.0202(S_t) x 10^-1</p> <p>The second depends on the measurement of the skin-fold thickness at the scapula:</p> <p><i>d</i> = 1.0896 - 0.0179(S_s) x 10^-1</p> <p><i>Mensuration (Whole Body)</i></p> <p>Skerlj in 1954 <i>(13) </i>developed a method for determining whole-body volume. He measured 10 circumferential dimensions and 6 linear dimensions (<b>Fig. 3</b>). From these he developed a formula that gives an approximate value for whole-body volume.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 3. Linear measurements: measurements for body-volume determination (after Skerlj). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The NYU group presented <a></a> a modified equation using the Skerlj notation and included some correction factors derived by applying the equation to five subjects for whom the volume of the various body segments was known. The modified formula is: <b>Equation 5</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 5. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>With the volume so determined, the mass may be obtained by direct weighing and the overall (whole body) density may be obtained: <i>d(ensity) = M(ass) /V(olume)</i></p> <p><i>Empirical (Body Segments)</i></p> <p>Until recently, very little work has been done to establish segment densities. Harless <a></a> conducted some studies with cadavers, as did Dempster. <a></a> At NYU, in the first of the two studies, the mass of certain body segments was established by the reaction-board method, which is described below.</p> <p>Based on these studies, two graphs were developed that relate whole-body density to body-segment density (<b>Fig. 4</b> and <b>Fig. 5</b>). These are approximations only, since no exact data are available.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 4. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 5. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Mass Determination</h4> <p>In studies conducted with cadavers, weight and eventually mass are obtained directly by accurate weighing techniques applied to the total segment or to its increments. In studies with live subjects, this cannot be done. The reaction-board method may be used.</p> <p><i>Reaction-Board Method</i></p> <p>This method is dependent on the validity of two assumptions. The first is that the center of mass can be established if the center of volume is known. This is true only if the density of the segment is constant along its entire length. The studies conducted by the Aerospace Medical Research Laboratory showed that the density is not constant along the segment and the variation in density is not the same for all segments.</p> <p>The second assumption is that the rotation of a segment occurs about a single axis. If this were so, in the movement of a segment the centers of mass of all other body segments would remain fixed relative to the center of rotation. Since no body joint is uniaxial, and since the muscle masses shift in the course of any movement, this also is not quite correct.</p> <p>Nonetheless, the method has been used (<b>Fig. 6</b>). For the purpose, a board or platform is supported on two knife edges- one on a fixed base, the other on the platform of a weighing scale. The subject is. placed on the board in a position that can be maintained or reproduced if necessary. A reading is taken on the scale. The subject is then asked to flex the segment of interest (forearm, arm, etc.) through a given angle-usually 45 deg., 90 deg., or 135 deg. A new reading is taken. The mass of the segment can then be determined substituting the appropriate readings in the formula: <b>Equation 6</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 6. Determination of the arm mass (reaction-board method). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 6. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Empirical</i></p> <p>For body segments the mass may be determined if the volume and density have been established. The mass, of course, is the product of the volume of the segment and the density of the segment. <i>M_s = V_sd_s</i></p> <h4>Center-of-mass Determination</h4> <p>The center of mass of the whole body may be determined readily by several methods since the mass is readily obtainable. The center of mass of a body segment on a live individual is not easily obtained, but may be approximated by one of several techniques.</p> <p><i>Volumetric Approximation</i></p> <p>A number of researchers, the NYU group included, have assumed that the density along the segment is constant and thus have concluded that the center of mass is coincident with the center of volume. Under this assumption, the center of volume, hence the center of mass, is found in the following way:</p> <p>A base line is established, usually the proximal joint of the segment. This segment is divided into a number of increments for which the volume is obtained by one of several methods (<i>V1, V2, V3</i>,..., <i>Vn). </i>The distance to the center of volume is measured from the base line (<i>d1, d2, d3, . . ., dn</i>).</p> <p>The center of volume is determined by dividing the sum of the products of each volume times its distance from the base line, by the sum of the volumes. <b>Equation 7</b>, <b>Equation 8</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 7. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 8. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Reaction-Board Method</i></p> <p>With cadavers, segments, or with plaster models of body segments, the center of mass may be obtained by use of the reaction board, previously described.</p> <p>Of these techniques, the one using the cadaver segment and the reaction board is the most accurate; the true center will vary in this technique only by the change that has occurred in the body tissues after death. Use of the plaster-of-paris cast creates the same error as that obtained by use of the volumetric technique; i.e., the error is introduced because it is assumed that the density along the segment is constant, whereas the density in any segment usually increases from the proximal to the distal end. This occurs because the ratio of bone to muscle and fat increases distally.</p> <h4>Segment Mass Moment Of Inertia</h4> <p>The motions of body segments are essentially rotatory, and linear movement is the result of a number of coordinated rotatory motions. The motion is assumed to occur about a fixed axis that is perpendicular to the plane in which the motion occurs. It is assumed that frictional and inertial forces occur in the plane of rotation. Rotation can be caused by a force at some distance from the axis of rotation, or by a force couple. In rotation, an inertial force resists angular acceleration which acts at the center of mass resulting in an inertial moment. This mass moment of inertia depends on the size, shape, and mass distribution of the body.</p> <p>The mass moment of inertia may be determined in several ways.</p> <p><i>Empirical</i></p> <p>The mass moment of inertia of a body with respect to a given axis of rotation is the sum of the products of the mass increments <i>mi </i>(into which the total mass may be divided) by the square of their respective distances from the particular axis of rotation: <b>Equation 9</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 9. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Quick Release</i></p> <p>If a force <i>(F) </i>is applied to a segment at some distance <i>(d) </i>from the axis of rotation of the segment, it will be imparted at an angular acceleration (a) in accordance with the equation: <i>Fd = Ia</i></p> <p>Because of this relationship, it is possible to determine the mass moment of inertia (<i>I</i>) experimentally by this quick-release method.</p> <p>In this method, the body segment of interest is arranged so that it may be free to swing about the proximal joint, which in turn is restrained from motion. At some distance (<i>d</i>) from the axis of rotation, a cable is attached to the segment such that it will prevent rotation in one direction. The other end of the cable is attached to a spring restraint, which in turn is attached to a force-measuring device. The subject is instructed to pull against the spring with a force <i>(F), </i>which is recorded. The cable is cut suddenly and the segment accelerates with an acceleration <i>(a) </i>that is appropriately recorded. By substitution of the known values <i>F, d, a, </i>the mass moment of inertia <i>(I) </i>can be obtained. <i>I</i> = Fd/<i>a</i></p> <p><i>Pendulum</i></p> <p>The period of a pendulum is related to the mass moment of inertia of the pendulum. For a simple pendulum, i.e., one where the mass is concentrated at some distance from the center of oscillation, the relationship is expressed by the equation: <b>Equation 10</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 10. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>This method utilizes plaster casts of body segments or the severed cadaver segments. The segment or its counterpart is suspended at one point near the end of the segment. It is permitted to swing through an arc of limited magnitude. The period of oscillation is obtained by some appropriate instrumentation. The values that are obtained are substituted in the above equation.</p> <h3>Results</h3> <p>Results are given for tests conducted both in the first and second series of experiments. In the first series of tests, data were collected on 12 male subjects in the age range of 20-40 years. In the second series of tests, data were collected on 9 male subjects in the age range of 20-30 years, 5 female subjects ages 17-20 years, and 3 female subjects ages 40-50 years, all without disabilities. Data were also recorded on 19 additional subjects with either hemiplegia or an amputation. In the second series of tests, not all data were recorded for every subject. The following tables contain the most valid data acquired.</p> <h4>VOLUMES</h4> <p><b>Table 1</b> contains the volume of body segments recorded during the first series of tests. There is only one major difference between the two series on males. In the first series, the value for volume of the upper arm—and hence the value for the whole arm—included the shoulder cap, i.e., the volume from the axilla to the acromion process. In the second series (<b>Table 2</b>), the values of volumes for the upper and whole arm are only up to the axilla. On the basis of the mean values for the upper arm in the two series, the volume of the shoulder cap is approximately 36% of the whole upper arm.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 1. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 2. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>In the second series of tests, a limited number of shoulder caps were cut off from the plaster-of-paris arms at the level of the axilla. Their dimensions, circumference at the axilla (c), and height to the acromion process <i>(h) </i>were taken. The volumes were obtained by immersion.</p> <p>An approximate equation for determining the volume of the shoulder cap was then established: <i>Volume </i>(shoulder cap) = 0.0526 <i>hc</i>²</p> <p>This equation is approximate to + 20% of the true value.</p> <p>In all other respects, the two series of tests give comparable results. The differences in mean values are of the order of 1%-10%. Considering the limited numbers of subjects, 12 and 8 in the respective samples, the differences are not serious, and the mean values are useful in general computations. Of interest in the second series of tests is the close relationship between mean values for right-hand and left-hand volumes. The variation between means in most instances is less than the variation between the volume of right and left segments in any subject.</p> <p><b>Table 3</b> indicates similar values for female subjects. There was greater inter-subject variation in this population than in that for the males. In view of this, and because there was such a limited number of subjects both in the younger and older age groups, the values for the two groups were combined. Even so, these mean values may be less accurate than those for the male population. They are presented, however, because few other similar data are available.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 3. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The body-segment volume may be expressed as a ratio or percentage of the whole-body volume. If it is desired to estimate body-segment volume, it is better to do so on the basis of the segment volume as a percentage of whole-body volume. This probably will give a more accurate result than using an average value for the volume of body segment.</p> <p><b>Table 4</b> gives such values for the first series of males. <b>Table 5</b> gives similar values for the second series of males, and <b>Table 6</b> gives these values for females.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 4. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 5. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 6. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Densities</h4> <p>As mentioned previously, it is very difficult to determine densities accurately. In <b>Table 7</b>, the densities have been determined by the equations shown in the section III-B for males first series. The densities for both males and females, second series, have been determined by dividing the mass (weight) by the volumes derived by using the NYU and Skerlj formulas and by using Pascale's equations A and B and skin-fold thicknesses.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 7. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Center Of Volume</h4> <p>In the absence of satisfactory techniques for determining the center of mass, it has been assumed to be coincident with the center of volume. <b>Table 8</b> shows the location of mass centers (volume centers) obtained by various researchers. Some studies conducted on cadavers are probably more truly mass centers. Others, conducted on live subjects, are probably the centers of volume.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 8. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Table 9</b> has been prepared to provide information as to the location of the center of volume of the various body segments, measured from the proximal joint. Again, it should be noted that the values for the upper arm are measured from the axilla. In both <b>Table 8</b> and <b>Table 9</b>, the value indicated is in percent of the segment length.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 9. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>A study was conducted on seven above-knee amputees. There was considerable variation in the length and contour of the stumps, although all of them could be described as modified truncated cones. The average distance from the crotch, measured downward and expressed as a percentage of the total stump length, was 32.1%, with an upper limit of 44.0% and a lower limit of 23.0%. The standard deviation was + 6.4%.</p> <h4>Radius Of Gyration</h4> <p>The radius of gyration (p) is a distance measured from the true center of mass to a point within the mass at which, if all the mass were concentrated, its effect in rotatory movements would be similar to the effect of the mass as it is actually distributed. For geometrically similar shapes, the radius of gyration along a particular axis may be expressed as a percentage of the length of that shape along that axis.</p> <p>It has been assumed that every body segment-arm, leg, upper arm, forearm- for one subject is geometrically similar to that of any other subject. If it were so, then the radius of gyration expressed in percentage of the length <i>(p/L) </i>should be relatively constant. It was found to be so, with minor variations. The values of <i>p/L </i>for the various body segments obtained by previous researchers and in the first NYU study are given in <b>Table 10</b>. Values for the second NYU study are given in <b>Table 11</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 10. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 11. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Table 12</b> has been included as a guide against which the computed values of <i>p </i>may be compared. This table indicates the average values of <i>p </i>(the radius of gyration) for the populations included in the second series of NYU studies; not all values were determined for each category, and the table reflects this. The results were computed on the basis of tests and measurements were made as previously described.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 12. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Discussion</h3> <p>The data may be used in a number of ways. Consideration must be given to the nature of the problem for which a solution is sought and the accuracy desired. If a situation exists where a prosthesis or orthosis is desired for a specified individual, it would be best to obtain data directly on the individual. In such a case, judgment should be made as to which of the various techniques available would be adapted best to the set of conditions present, i.e., the condition of the subject, the skills of available personnel, and the facilities available.</p> <p>When extreme accuracy is not required, or in cases when the problem is confined to a class of individuals, or the solution may have a general application, the data may be used in various ways, with differing degrees of accuracy. In successively decreasing order of accuracy, the following maybe done:</p> <ol> <li>Obtain the weight and height of the subject and length and circumferences of the segments under consideration; use tables and graphs judiciously and, where several sets of data are available, use the most appropriate.</li><li>Obtain weight and height of the subject only and use tables as suggested.</li><li>Obtain weight and height of subject and use average data only. Data may be used for determining the length of a segment, its volume, mass, center of volume, center of mass, radius of gyration, and moment of inertia.</li></ol> <h4>Sample Computation</h4> <p>To determine the mass moment of inertia of the upper arm, forearm, and hand for a male patient (possibly for application of an externally powered orthosis), only the height and weight of the subject need be known.</p> <p><i>Procedure</i></p> <p>If the subject weights 190 pounds and is 73 inches in height:</p> <ol> <li>On graph (<b>Fig. 1</b>), join the weight in pounds (190) to the height in inches (73) by a straight line. At the intercept of this line with line c a value for c, approximately 12.8, is obtained.</li><li>On graph (<b>Fig. 2</b>), locate c = 12.8, proceed vertically upward to intersect solid black line, then proceed horizontally from this point to determine the value of whole-body density <i>d: d = </i>66.8 pounds per cubic foot</li><li>On graph (<b>Fig. 4</b>), proceed as in, <a></a> from <i>d = </i>66.8 vertically downward to intersect lines of segment densities:<br /><i>d, </i>upper arm = 68.1 lb/ft^3<br /><i>d, </i>forearm = 70.7 lb/ft³<br /><i>d, </i>hand = 72.2 lb/ft³</li><li>Given the weight of 190 pounds and whole-body density of 66.8 pounds per cubic foot, we may compute whole-body volume: 190/66.8 = 2.85 cubic feet</li><li><b>Table 4</b> gives values of volume for body segments in percentage of whole-body volume:<br />volume, upper arm = 3.495 x 0.01 x 2.85 = 0.0995 ft^3<br />volume, forearm = 1.70 x 0.01 x 2.85 = 0.0485 ft³ volume, hand = 0.566 x 0.01 x 2.85 = 0.0161 ft³</li><li>Multiplying the volumes of the segments by their respective densities, the mass (or weights) of the segments are obtained:<br /><i>m (w), </i>upper arm = 0.0995 x 68.1 = 6.78 lb<br /><i>m (w), </i>forearm = 0.0485 x 70.7 = 3.43<br />lb <i>m (w), </i>hand = 0.0161 x 72.2 = 1.16 lb</li><li>To obtain the approximate lengths of the body segments when they have not been measured, <b>Fig. 7</b> and <b>Fig. 8</b> may be used. The mean lengths expressed in terms of body height are 0.189<i>H</i>, 0.145<i>H</i> and 0.128<i>H</i> for the upper arm, forearm, and hand respectively. The lengths then are:<br /><i>Lv </i>= 0.189 x 73 = 13.8 in.<br />L<i>f </i>= 0.145 x 73 = 10.6 in.<br />L<i>h</i> = 0.128 x 73 = 9.35 in.</li><li>Having obtained the lengths of the segments, the location of the center of volume (mass) can be determined using values given in <b>Table 8</b> and <b>Table 9</b>: <br />c, upper arm = 0.461 x 13.8 = 6.37 in.<br />c, forearm and hand = 0.420 (10.6 + 9.35) = 8.38 in.</li><li>The radius of gyration (p) for the segments may be obtained using the values in <b>Table 10</b> or <b>Table 11</b>:<br /><i>p, </i>upper arm = 0.268 x 13.8 = 3.70 in.<br /><i>p, </i>forearm and hand - 0.263 x (10.6 + 9.35) = 5.25 in.</li><li>The moment of inertia about its proximal axis of rotation is expressed by the equation: Ij = m(p^2 + c^2)</li></ol> <p><b>Fig. 7</b> and <b>Fig. 8</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 7. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 8. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The moment of inertia of the upper arm about the shoulder: <b>Equation 11</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 11. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The moment of inertia of the forearm about the elbow: <b>Equation 12</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 12. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>If the moment of inertia of the forearm and hand about the shoulder joint is desired, then the equation is: <b>Equation 13</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 13. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Fig. 9</b>, <b>Fig. 10</b>, <b>Fig. 11</b>, <b>Fig. 12</b>, and <b>Fig. 13</b> have been included to facilitate any computations, to ease conversion from metric to British systems of measurement, and for graphically determining the moments of inertia.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 9. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 10. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 11. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 12. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 13. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Acknowledgment</h3> <p>Appreciation is expressed to Dr. Rudolfs Drillis and Messrs. Darrell Hill, Howard Gage, Maurice Bluestein, Albert Yatkauskas, and George Vadell for their contributions to this research project, and to Mrs. Mary Klaus for the preparation of the reports.</p> <p><b>References:</b></p> <ol> <li>Behnke, A. R., Jr., B. G. Feen, and W. C. Welham, The specific gravity of healthy men; body weight devided by volume as index of obesity, J.A.M.A. 118:495-498, Feb. 14, 1942.</li> <li>Brozek, J., J. K. Kihlberg, H. L. Taylor, et al., Skinfold distributions in middle-aged American men: a contribution to norms of leanness-fatness, Ann. N.Y. Acad. Sci. 110:492-502, Sept. 26, 1963.</li> <li>Contini, Renato, Body Segment Parameters (Pathological), Tech. Rept. 1584.03, New York Univ. School of Engineering and Science, June 1970.</li> <li>Dempster, W. T., Space Requirements of the Seated Operator, U.S. Air Force WADC Tech. Rept. 55-159, Wright-Patterson Air Force Base, Ohio, July 1955.</li> <li>Dempster, W. T, The anthropometry of body action, Ann. N.Y. Acad. Sci. 63:559-585, 1956.</li> <li>Drillis, Rudolfs, and Renato Contini, Body Segment Parameters, Tech. Rept. 116.03, New York Univ. School of Engineering and Science, Sept. 1966.</li> <li>Drillis, Rudolfs, Renato Contini, and Maurice Bluestein, Body segment parameters-a survey of measurement techniques, Artif. Limbs 8:1: 44-66, Spring 1964.</li> <li>Dupertuis, C. W., and J. M. Tanner, The pose of the subject for photogrammetric anthropometry, with especial reference to somatotyping, Amer. J. Phys. Anthrop. 8:1:27-47, March 1950.</li> <li>Harless, E., The static moments of human limbs, Treatises of the Math.-Phys. Class of the Royal Academy of Science of Bavaria 8:69-96, 257-294, 1860.</li> <li>Krogman, Wilton Marion, and Francis E. Johnston, Human Mechanics: Four Monographs Abridged, U.S. Air Force Systems Command Tech. Rept. AMRL-TDR-63-123, Univ. Pennsylvania Graduate School of Medicine, Philadelphia, December 1963.</li> <li>Pascale, L. R., M. I. Grossman, H. S. Sloane, and T. Frankel, Correlations between thickness of skinfolds and body density in 88 soldiers, Hum. Biol. 28:165-176, May 1956.</li> <li>Sheldon, W. H., C. W. Dupertuis, and C. McDermott, Atlas of Men: A Guide for Somatotyping the Adult Male at All Ages, Harper, New York, 1954.</li> <li>Skerlj, B., Volume, density and mass distribution of the human body by means of simple an-thropometrical means, Bulletin Scient., Conseil Acad. RPFV, hub. 2:11, 1954.</li> </ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>2.</b> </td><td class="clsTextSmall">Brozek, J., J. K. Kihlberg, H. L. Taylor, et al., Skinfold distributions in middle-aged American men: a contribution to norms of leanness-fatness, Ann. N.Y. Acad. Sci. 110:492-502, Sept. 26, 1963.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>References</b></td></tr><tr><td class="clsTextSmall"><b>4.</b> </td><td class="clsTextSmall">Dempster, W. T., Space Requirements of the Seated Operator, U.S. Air Force WADC Tech. Rept. 55-159, Wright-Patterson Air Force Base, Ohio, July 1955.</td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Dempster, W. T, The anthropometry of body action, Ann. N.Y. Acad. Sci. 63:559-585, 1956.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>9.</b> </td><td class="clsTextSmall">Harless, E., The static moments of human limbs, Treatises of the Math.-Phys. Class of the Royal Academy of Science of Bavaria 8:69-96, 257-294, 1860.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Contini, Renato, Body Segment Parameters (Pathological), Tech. Rept. 1584.03, New York Univ. School of Engineering and Science, June 1970.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>11.</b> </td><td class="clsTextSmall">Pascale, L. R., M. I. Grossman, H. S. Sloane, and T. Frankel, Correlations between thickness of skinfolds and body density in 88 soldiers, Hum. Biol. 28:165-176, May 1956.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>2.</b> </td><td class="clsTextSmall">Brozek, J., J. K. Kihlberg, H. L. Taylor, et al., Skinfold distributions in middle-aged American men: a contribution to norms of leanness-fatness, Ann. N.Y. Acad. Sci. 110:492-502, Sept. 26, 1963.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>1.</b> </td><td class="clsTextSmall">Behnke, A. R., Jr., B. G. Feen, and W. C. Welham, The specific gravity of healthy men; body weight devided by volume as index of obesity, J.A.M.A. 118:495-498, Feb. 14, 1942.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>12.</b> </td><td class="clsTextSmall">Sheldon, W. H., C. W. Dupertuis, and C. McDermott, Atlas of Men: A Guide for Somatotyping the Adult Male at All Ages, Harper, New York, 1954.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>8.</b> </td><td class="clsTextSmall">Dupertuis, C. W., and J. M. Tanner, The pose of the subject for photogrammetric anthropometry, with especial reference to somatotyping, Amer. J. Phys. Anthrop. 8:1:27-47, March 1950.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>References</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Contini, Renato, Body Segment Parameters (Pathological), Tech. Rept. 1584.03, New York Univ. School of Engineering and Science, June 1970.</td></tr><tr><td class="clsTextSmall"><b>6.</b> </td><td class="clsTextSmall">Drillis, Rudolfs, and Renato Contini, Body Segment Parameters, Tech. Rept. 116.03, New York Univ. School of Engineering and Science, Sept. 1966.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Contini, Renato, Body Segment Parameters (Pathological), Tech. Rept. 1584.03, New York Univ. School of Engineering and Science, June 1970.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>10.</b> </td><td class="clsTextSmall">Krogman, Wilton Marion, and Francis E. Johnston, Human Mechanics: Four Monographs Abridged, U.S. Air Force Systems Command Tech. Rept. AMRL-TDR-63-123, Univ. Pennsylvania Graduate School of Medicine, Philadelphia, December 1963.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>7.</b> </td><td class="clsTextSmall">Drillis, Rudolfs, Renato Contini, and Maurice Bluestein, Body segment parameters-a survey of measurement techniques, Artif. Limbs 8:1: 44-66, Spring 1964.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Contini, Renato, Body Segment Parameters (Pathological), Tech. Rept. 1584.03, New York Univ. School of Engineering and Science, June 1970.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>6.</b> </td><td class="clsTextSmall">Drillis, Rudolfs, and Renato Contini, Body Segment Parameters, Tech. Rept. 116.03, New York Univ. School of Engineering and Science, Sept. 1966.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Renato Contini </b></td></tr><tr><td class="clsTextSmall">Prosthetic-Orthotic Education Program, UCLA, Los Angeles, Calif.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-01.jpg Figure 2 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-02.jpg Figure 3 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-03.jpg Figure 4 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-05.jpg Figure 5 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-06.jpg Figure 6 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-04.jpg Figure 7 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-08.jpg Figure 8 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-07.jpg Figure 9 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-10.jpg Figure 10 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-11.jpg Figure 11 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-14.jpg Figure 12 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-09.jpg Figure 13 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-12.jpg Figure 14 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-13.jpg Figure 15 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-15.jpg Figure 16 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-16.jpg Figure 17 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-17.jpg Figure 18 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-18.jpg Figure 19 http://www.oandplibrary.org/al/images/1972_01_001/1972_01_001-19.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Body Segment Parameters, Part II Creator An entity primarily responsible for making the resource Renato Contini * https://staging.drfop.org/files/original/2110d586443d4b19b7fc9536683bc8db.pdf b96a92130c9eedff024e88641dc2063c https://staging.drfop.org/files/original/fb9ebe60dff913d9135a2935bdf2deda.jpg d13d55f144121d2cfb8b9d4b730617e3 https://staging.drfop.org/files/original/ed52127592e5a7556ac833dfac1e096e.jpg 09b1f0c571cdcf62a95b58b49c7de006 https://staging.drfop.org/files/original/7b8faeb9f25f51fe5128b4495503c950.jpg 99db08c49eea3368263b0db1627f47c4 https://staging.drfop.org/files/original/30dace90d04426eb54982c1e6db41b48.jpg 1ed343a6460af0febbb1795bc6c12e7e https://staging.drfop.org/files/original/f9b5fe8693775eed4668606286075472.jpg a15b89b39232a09a39e2b982223cb10c https://staging.drfop.org/files/original/3b8587872e5cd2828bb2963b8d88dbc6.jpg 0de0585464dffd0d381b1074931ae52c https://staging.drfop.org/files/original/ed4b52ce5ac75f7406ab601d3bcedf30.jpg 587647562e5551eb1a9ab4f918a8d05b https://staging.drfop.org/files/original/9d684744fe2af745dd567f69072abe94.jpg 6a8c37f94d45cf2102a83e1ba04ba532 https://staging.drfop.org/files/original/f47f13f4f517be2c68e4885132255a73.jpg 7a973ac6c580a0cd23a1aad0da06345e https://staging.drfop.org/files/original/ee934e7d6260f4fe6b2d0b475480c0c7.jpg 6a87da86f9c77268e89c2920e54290a7 https://staging.drfop.org/files/original/9eb67fe346807f23eb9721e730181cf6.jpg 3d6338336fa57f8e45e0c104c8e44f29 https://staging.drfop.org/files/original/d03ce299f5faed1b04bd1cb5d511348a.jpg 30c15358ad729c1d1b4c7c63b57d6e8f https://staging.drfop.org/files/original/f40a73ddf7abbe1bc363584464f188a0.jpg 8d3a34e6604c20c0b27728cfb136b495 https://staging.drfop.org/files/original/5c007bf3a01c041d44b41f637e3b98dd.jpg a3fad156c8637c58e8b2c697edb9aa86 https://staging.drfop.org/files/original/bbd4c7da3293e56cd493f889704a4ed4.jpg 40069e7ae5876d1e96e3a89a733cbb52 https://staging.drfop.org/files/original/36c833299af80c7d07ced66aa833331a.jpg 34987d61eca54e9e03b1ed422ae2ff44 https://staging.drfop.org/files/original/a1b4f107929b70c2c1e7b1bd1d4e4dcf.jpg 2f4d617a5b5753ac4821f7d6b284cd9b https://staging.drfop.org/files/original/840c46b44786ace3aff7daeaa6ff78f5.jpg 7e7806eb8e3e875d3fd8986e218f9c24 https://staging.drfop.org/files/original/6cda4b12ad5be268580aae44a30a5534.jpg b09bb8952a15ec26af4db027bbfc3382 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1964_01_044.pdf Year 1964 Volume 8 Issue 1 Page Number(s) 44 - 66 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1964_01_044.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1964_01_044.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Body Segment Parameters: A Survey of Measurement Techniques</h2> <h5>Rudolfs Drillis, Ph. D. <a style="text-decoration:none;">*</a><br />Renato Contini, B.S. <a style="text-decoration:none;">*</a><br />Maurice Bluestein, M.M.E. <a style="text-decoration:none;">*</a><br /></h5> <p>Human motor activity is determined by the response of the subject to constantly changing external and internal stimuli. The motor response has a definite pattern which can be analyzed on the basis of temporal, kinematic and kinetic factors.</p> <p>Temporal factors are those related to time: cadence (tempo) or the number of movements per unit time (minute or second), the variability of successive durations of motion, and temporal pattern. The temporal pattern of each movement consists of two or more phases. The relative duration of these phases and their interrelationships are indicative characteristics of the movement under consideration. For example, in walking, two basic time phases may be noted, the stance phase when the leg is in contact with the ground and the swing phase. The ratio of swing-phase time to stance-phase time is one of the basic characteristics of gait.</p> <p>The kinematic analysis of movement can be accomplished by studying the linear and angular displacements of the entire body, the joints (neck, shoulder, elbow, wrist, hip, knee, ankle) and the segments (head, upper arm, forearm, hand, thigh, shank, foot). For the purpose of investigation, the most important kinematic characteristics are: the paths of motion, linear and angular displacement curves, amplitudes or ranges of motion, the instantaneous and average velocities and their directions, and finally the linear and angular accelerations of the body segments under investigation. Information on these criteria can be obtained readily from objective (optical or electrical) recordings of the movements of a subject.</p> <p>The kinetic analysis is concerned with the influence of different forces and moments acting on the body or a body segment during the performance of a given activity. To determine these forces and moments, accurate data on the mass (weight), location of mass centers (centers of gravity), and the mass moments of inertia of the subject's body segments are required.</p> <p>At present there are limited data on body segment parameters, especially those for American subjects. Such data available are based on studies made on a limited number of dissected male cadavers. This cannot be regarded as a representative sample for our normal population with its wide range of age and difference of body build. There are no data available on female subjects in the United States.</p> <p>A precise knowledge of these body segment parameters has many applications, such as in the design of work activities or the improvement of athletic performances. It has particular value in understanding orthopedic and prosthetic problems. It would result in a better design of braces and prosthetic devices and more reliable methods for their adjustment. From these data it would also be possible to develop more precise and effective procedures for the evaluation of braces and artificial limbs. These procedures would replace the use of subjective ratings on performance by an amputee or a disabled person.</p> <p>The information on body segment parameters obtained by simple clinical methods can be very useful in general medical practice. It would provide a tool for the determination of:</p> <ol> <li>body segment growth and decay in normal and abnormal conditions</li><li>body segment density changes in normal and pathological cases;</li><li>body mass distribution asymmetry;</li><li>more precise body composition (fat, bones, muscles).</li></ol> <p>The aim of this article is to give a brief review of the methods used by different investigators for the determination of body segment parameters. Since some of the first treatises and papers are no longer available, we include some tables and figures which summarize the data obtained by some of the earlier researchers.</p> <p>Early Efforts</p> <p>Since ancient times there has existed an intense curiosity about the mass distribution of the human body and the relative proportions of its various segments. Those professions which had to select or classify subjects of varying body build were particularly interested in the problem. In spite of individual differences between particular subjects there are many characteristics which are common to all normal human beings. Thus the lower extremities are longer and heavier than the upper extremities, the upper arm is larger than the forearm, the thigh is larger than the shank, and other similar relationships.</p> <p>Historically this interest was first directed to the length relationships between the body segments. To characterize these relationships certain rules and canons were promulgated. Each canon has its own standard unit of measure or module. Sometimes the dimension of a body segment or component parts of a body segment were used as modules and occasionally the module was based on some abstract deduction.</p> <p>The oldest known module is the distance measured between the floor (sole) and the ankle joint. This module was used in Egypt some time around the period 3000 b.c. On this basis, the height of the human figure was set equal to 21.25 units. Several centuries later in Egypt a new module, the length of the middle finger, was introduced. In this instance body height was set equal to 19 units. This standard was in use up until the time of Cleopatra.(<b>Fig. 1</b>)</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. Egyptian middle finger canon. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>In the fifth century B.C., Polyclitus, a Greek sculptor, introduced as a module the width of the palm at the base of the fingers. He established the height of the body from the sole of the foot to the top of the head as 20 units, and on this basis the face was 1/10 of the total body height, the head 1/8, and the head and neck together 1/6 of the total body height. In the first century B.C., Vitruvius, a Roman architect, in his research on body proportions found that body height was equal to the arm spread-the distance between the tips of the middle fingers with arms outstretched. The horizontal lines tangent to the apex of the head and the sole of the foot and the two vertical lines at the finger tips formed the "square of the ancients." This square was adopted by Leonardo da Vinci. He later modified the square by changing the position of the extremities and scribing a circle around the human figure.</p> <p>Diirer (1470-1528) and Zeising (1810-1876) based their canons on mathematical abstracts which were not in accordance with any actual relationships.</p> <p>At the beginning of the twentieth century, Kollmann tried to introduce a decimal standard by dividing the body height into ten equal parts. Each of these in turn could be subdivided into ten subunits. According to this standard, the head height is equal to 13 of these smaller units: seated height, 52-53; leg length, 47; and the whole arm, 44 units.(<b>Fig. 2</b>)</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. Kollmann's decimal canon </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Previous Studies in Body Parameters</p> <p>Starting with the early investigators, the idea has prevailed that volumetric methods are best for determining relationships between body segments. There were basically two methods which were used for the determination of the volume of the body segments: (1) body segment immersion, and (2) segment zone measurement or component method. In these methods it is assumed that the density or specific gravity of any one body segment is homogeneous along its length. Hence the mass of the segment can be found by multiplying its volume by its density.</p> <p>Immersion Method</p> <p>Harless in Germany first used the immersion method. In 1858 he published a text book on <i>Plastic Anatomy, </i>and in 1860 a treatise, <i>The Static Moments of the Human Body Limbs. </i>In his investigations, Harless dissected five male cadavers and three female cadavers. For his final report, however, he used only the data gathered on two of the subjects.</p> <p>The immersion method involves determining how much water is displaced by the submerged segment. Previous researchers, including Harless, have relied on the measurement of the overflow of a water tank to find the volume of water displaced.</p> <p>Harless started his studies with the determination of the absolute and relative lengths of the body and its segments. The absolute lengths were measured in centimeters. For determining the relative lengths, Harless used the hand as a standard unit. The standard hand measurement was equal to the distance from the wrist joint to the tip of the middle finger of the right hand. Later Harless also used the total height of the body as a relative unit of length. In the more recent studies on body parameters, this unit is accepted as the basis for the proportions of the various segment lengths. The results of Harless' studies are shown in <b>Table 1</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 1. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>For obtaining the absolute weights of the body segments, Harless used the gram as the standard. As a unit for relative weights, he first decided to use the weight of the right hand, but later established as his unit the one thousandth part of the total body weight. His results are given in <b>Table 2</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 2. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>In a very careful way Harless determined the volume and density (specific gravity) of the body segments. The results of these measurements are presented in <b>Table 3</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 3. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>To determine the location of mass centers (centers of gravity), Harless used a well-balanced board on which the segment was moved until it was in balance. The line coincident with the fulcrum axis of the board was marked on the segment and its distance from proximal and distal joints determined. The location of the mass center was then expressed as a ratio assuming the segment length to be equal to one. Harless also tried to determine the location of segment mass center from the apex of the head by assuming that the body height is equal to 1,000. The data for one subject are shown in <b>Table 4</b>. From the table, the asymmetry of the subject becomes evident.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 4. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>To visualize the mass distribution of the human body, Harless constructed the model shown in <b>Fig. 3</b>. The linear dimensions of the links of the model are proportional to the segment lengths; the volumes of the spheres are proportional to segment masses. The centers of the spheres indicate the location of mass centers (centers of gravity) of the segments.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 3. Body mass distribution (After E. Harless). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Modified models of the mass distribution of the human body and mass center location of the segments have been made by several other investigators. It is unfortunate that up to now a unified and universally accepted subdivision of the human body into segments does not exist.</p> <p>In 1884, C. Meeh investigated the body segment volumes of ten living subjects (8 males and 2 females), ranging in age from 12 to 56 years. In order to approximate the mass of the segments, he determined the specific gravity of the whole body. This was measured during quiet respiration and was found to vary between 0.946 and 1.071 and showed no definite variation with age. The segment subdivision used by Meeh is shown in <b>Fig. 4</b> and the results of the segment volume measurements are presented in <b>Table 5</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 4. Body Segments (After C. Meeh). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 5. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>C. Spivak, in 1915, in the United States, measured the volumes of various segments and the whole body for 15 males. He found that the value of specific gravity of the whole body ranged from 0.916 to 1.049.</p> <p>D. Zook, in 1930, made a thorough study of how body segment volume changes with age. In making this study, he used the immersion method for determining segment volumes. These were expressed in per cent of whole body volume. His sample consisted of youngsters between the ages of 5 and 19 years. His immersion technique was unique, but his claim that it permitted the direct determination of the specific gravity of any particular body segment does not seem to have been established. Some of his results are shown in <b>Fig. 5</b> and <b>Fig. 6</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 5. Mean head volume change with age (After D. Zook). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 6. Mean leg volume change with age (After D. Zook and others). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>In the period from 1952 to 1954, W. Dempster at the University of Michigan made a very thorough study of human body segment measurements. His investigations were based on values obtained on eight cadavers. Besides volumes, he obtained values for mass, density, location of mass center, and mass moments of inertia. The immersion method was used to determine volume. However, these data have limited application since all of Dempster's subjects were over 50 years of age (52-83) and their average weight was only 131.4 lb. The immersion method was used in Russia by Ivanitzkiy (1956) and Salzgeber (1949).</p> <p>The immersion technique can be applied for the determination of the total segment volume or any portion thereof in a step-by-step sequence. It can be applied as well on living subjects as on cadavers. In this respect it is a useful technique.</p> <p>There is some evidence that for most practical purposes the density may be considered constant along the full length of a segment. According to O. Salzgeber (1949), this problem was studied by N. Bernstein in the 1930's before he started his extensive investigations on body segment parameters. By dividing the extremities of a frozen cadaver into zones of 2 cm. height, it was established that the volume centers and mass centers of the extremities were practically coincident. It would seem therefore that the density along the segment was fairly constant for the case studied. Accepting this, it follows that the extremity mass, center of mass, and mass moment of inertia may be determined from the volume data obtained by immersion. However, it should be noted that for the whole body, according to an investigation by Ivanitzkiy (1956), the mass center does not coincide with the volume center, due to the smaller density of the trunk.</p> <h4>Computational Methods</h4> <p>Harless was the first to introduce computational methods as alternatives to the immersion method for determining body volume and mass. He suggested that this would be better for specific trunk segments since no definite marks or anatomical limits need be applied.</p> <p>He considered the upper part of the trunk down to the iliac crest as the frustum of a right circular cone. The volume (<i>V1) </i>is then determined by the formula:<b>Eq. 1</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 1. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>He assumed that the volume of the lower (abdomino-pelvic) part of the trunk (<i>V2</i>) can be approximated as a body between two parallel, nonsimilar elliptical bases with a distance <i>h </i>between them. The volume <i>V2 </i>is determined by the formula:<b>Eq. 2</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 2. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>On the basis of dimensions taken on one subject, using these formulas he arrived at a value for <i>V1 </i>of 21,000 cm cubed and 5,769 cm subed for <i>V2. </i>Using a value of 1.066 gr/cm cubed as the appropriate specific gravity of these parts, the total trunk weight was computed to be 28.515 kg. The actual weight of the trunk was determined (by weighing) to be 29.608 kg. The computed weight thus differed from the actual weight by 1.093 kg, or 3.69 per cent.</p> <p>Several subsequent investigators used this method subdividing the body into segments of equal height. For increased accuracy these zones should be as small as practically possible -a height of 2 cm is the practical lower limit. The zone markings are measured starting usually from the proximal joint of the body segment. The circumference of the zone is measured and it is assumed that the cross-section is circular. The volume may be computed and on the basis of accepted specific gravity values the mass may be found. From these values one may compute the center of mass and mass moment of inertia.</p> <p>Amar (1914) in order to compute the mass moment of inertia of various body segments made a number of assumptions. He assumed the trunk to be a cylinder, and that the extremities have the form of a frustum of a cone. The mass moment of inertia for the trunk about a lateral axis through the neck is determined from the formula:<b>Eq. 3</b><br /> and for the extremities by the formula:<b>Eq. 4</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 3. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 4. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Weinbach (1938) proposed a modified zone method based on two assumptions: (1) that any cross-section of a human body segment is elliptical, and (2) that the specific gravity of the human body is uniform in all its segments and equal to 1.000 gr/cm cubed. The area <i>(A) </i>at any cross section is expressed by the equation:<b>Eq. 5</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 5. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Plotting a graph showing how the equidistant cross-sectional areas change relative to their location from the proximal joint, it is possible to determine the total volume of the segment and hence its mass and location of center of mass. The mass moment of inertia (/) may be obtained by summing the products of the distances from the proximal joint to the zone center squared <i>(r squred) </i>and the corresponding zone mass:<b>Eq. 6</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 6. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Unfortunately both of Weinbach's assumptions are questionable since the cross sections of human body segments are not elliptical and the specific gravities of the different segments are not equal to 1.000 gr/cm cubed nor is density truly uniform in all segments.</p> <p>Bashkirew (1958) determined the specific gravity of the human body for the Russian population to be 1.044 gr/cm cubed with a standard deviation of ±0.0131 gr/cm cubed and the limits from 0.978 minimum to 1.109 maximum. Boyd (1933) determined further that specific gravity generally increases with age. Dempster (1955) showed that Weinbach's method was good for determining the volume of the head, neck, and trunk but not good for other body parts.</p> <p>It is evident that the determination of body segment parameters, based on the assumption that the segments can be represented by geometric solids, should not be used when great accuracy is desired. This method is useful only when an approximate value is adequate.</p> <p>Fischer introduced another approximate method of determining human body parameters by computation known as the "coefficient method." According to this procedure, it is assumed that fixed relations exist between body weight, segment length, and the segment parameters which we intend to find. There are three such relationships or ratios expressed as coefficients. For the body segment mass, the coefficient is identified as <i>C1</i> and represents the ratio of the segment mass to the total body mass. The second coefficient <i>C2 </i>is the ratio of the distance of the mass center from the proximal joint to the total length of the segment. The third coefficient <i>C3</i> is the ratio of the radius of gyration of the segment about the medio-lateral centroidal axis to the total segment length. Thus to determine the mass of a given segment for a new subject, it would be sufficient to multiply his total body mass by coefficient <i>C1 </i>corresponding segment mass. Similarly the location of mass center and radius of gyration can be determined by multiplying the segment length by the coefficients <i>C2 </i>and <i>C3</i> respectively.</p> <p><b>Table 6</b> compares the values of coefficient <i>C1</i>obtained by different investigators.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 6. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Table 6</b> shows that the differences between the coefficients obtained by different investigators for particular segment masses are great. The difference is highest for the trunk and head mass where the coefficients vary from 49.68 to 56.50 per cent of body mass. Next highest difference is in the thigh coefficients from 19.30 to 24.43 per cent of body mass. Since the number of subjects used in the studies, with the exception of that of Bernstein, is small and no anthropological information on body build is given, it is difficult to draw any definite conclusions about the scientific and practical value of these coefficients for body segment mass determination.</p> <p>As already mentioned, the data obtained by Harless are based on two decapitated male cadavers, and since the blood had been removed some errors are possible. The data of Meeh are based on volume measurements of eight living subjects. The large coefficient for the trunk is influenced by the assumption that all body segments have the same average density, where actually it is less for the trunk.</p> <p>Braune and Fischer (1889) made a very careful study of several cadavers. Their coefficients are based on data taken on three male cadavers whose weight and height were close to the data for the average German soldier. The relative masses (coefficients) of the segments were expressed in thousandths of the whole body mass. The positions of the mass center and radius of gyration (for determination of the segment mass moments of inertia) were expressed as proportional parts of the segment's total length. Fischer's coefficients have been accepted and used in most subsequent investigations to date.</p> <p>N. Bernstein and his co-workers (1936) at the Russian All-Union Institute of Experimental Medicine in Moscow carried out an extensive investigation on body segment parameters of living subjects. The study took care of anthropological typology of body build. The results of this investigation were published in a monograph, <i>Determination of Location of the Centers of Gravity and Mass (weight) of the Limbs of the Living Human Body </i>(in Russian). At present the monograph is not available in the United States. Excerpts of this investigation, which cover 76 male and 76 female subjects, 12 to 75 years old, were published by N. Bernstein in 1935 in his chapters on movement in the book, <i>Physiology of Work </i>(in Russian), by G. P. Konradi, A. D. Slonim, and V. C. Farfel.</p> <p><b>Table 7</b> shows data for the comparison of segment masses of living male and female subjects as established by Bernstein's investigation. The data are self-explanatory.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 7. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Determination of Mass Center Location</h4> <p>In the biomechanical analysis of movements it is necessary to know the location of the segment mass center which represents the point of application of the resultant force of gravity acting on the segment. The mass center location of a segment system such as an arm or a leg or the whole body determines the characteristics of the motion.</p> <p><b>Table 8</b> shows the relative location of the mass center for different segments. It is evident that the assumption that mass center of all segments is located 45 per cent from the proximal and 55 per cent from the distal end of the segment is not valid. Since the mass distribution of the body is related to body build it seems that the mass center location also depends on it.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 8. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Bernstein claims that he was able to locate the mass centers with an accuracy of ±1 mm. Hence the data of <b>Table 9</b> represent the result of very careful measurements. An analysis of these data shows that there is no definite trend of the coefficients differing with age or sex. The variance of the coefficients is very high and reaches nine per cent as maximum. Thus the use of the same coefficients for subjects with a wide range of body build is highly questionable.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Table 9. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Fig. 7</b> and <b>Fig. 8</b> represent, in modification, Fischer's schemes for the indication of the mass center location of the extremities. The letters of the alphabet indicate the location levels of the mass centers on the human figure. The corresponding cross sections through the segments are shown separately. The letters designate the following:</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 7. Location of mass centers of the upper extremity (Redrawn from O. Fischer). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 8. Location of mass centers of the lower extremity (Redrawn from O. Fischer). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>A</i>-mass center of upper arm</p> <p><i>B</i>-mass center of whole arm</p> <p>C-mass center of forearm</p> <p><i>D</i>-mass center of forearm and hand</p> <p><i>E</i>-mass center of hand</p> <p><i>F</i>-mass center of thigh</p> <p><i>G</i>-mass center of whole leg</p> <p><i>H</i>-mass center of shank</p> <p><i>I</i>-mass center of shank and foot <i>J</i>-mass center of foot</p> <p>The location of mass centers with respect to the proximal and distal joints as determined by W. Dempster (1955) is shown in <b>Fig. 9</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 9. Location of mass centers of body segments (After W. Dempster). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>It is easy to find the equations for the determination of the coordinates of the mass center when the coordinates of the segment's proximal and distal joints are given.</p> <p>By using Fischer's coefficients for mass center of a particular segment the following formulas were developed:</p> <p>Coordinates of mass center of the:</p> <p>a. forearm:</p> <p><i>x = </i>0.42<i>xd</i> + 0.58<i>xp</i></p> <p><i>y = 0.42yd + </i>0.58<i>yp</i></p> <p>where <i>xd</i>, <i>yd </i>are coordinates of the distal (wrist) joint and <i>xp</i>, <i>yp </i>are coordinates of the proximal (elbow) joint.</p> <p>b. upper arm:</p> <p><i>x = </i>0.47<i>xd</i> + 0.53<i>xp</i> y <i>= </i>0.47<i>yd</i> + 0.53<i>xp</i></p> <p>where <i>xd, yd </i>are coordinates of the elbow joint and <i>xp, yp </i>are coordinates of the shoulder joint.</p> <p>c. shank:</p> <p><i>x = </i>0.42<i>dx</i> + 0.58<i>xpy = </i>0.42<i>yd</i> + 0.58<i>yp</i>where <i>xd, yd </i>are coordinates of the ankle</p> <p>joint and <i>xp, yp </i>are coordinates of</p> <p>the knee joint.</p> <p>d. thigh:</p> <p><i>x = </i>0.44<i>xd</i> + 0.56<i>xp</i> <i>y = </i>0.44<i>yd</i> + 0.56<i>yp</i></p> <p>where <i>xd, yd </i>are coordinates of the knee joint and <i>xp</i>, <i>yp </i>are coordinates of the hip joint.</p> <p>For the case of three-dimensional recordings of motion, similar equations for <i>z </i>are used. The coordinates of the mass center of trunk <i>(t) </i>are:</p> <p><i>xt = </i>0.235 <i>(xfr + xfl) + </i>0.265 <i>(xbr + xbl), </i>with similar equations for the <i>yt </i>and <i>zt</i> coordinates.</p> <p>Here <i>xfr </i>is the coordinate of the right hip and <i>xfl </i>is the coordinate of the left hip, and <i>xbr </i>is the coordinate of the right shoulder and <i>xbl </i>is the coordinate of the left shoulder.</p> <p>In the same manner the equations for segment systems are developed:</p> <p>a. entire arm:</p> <p>mass center <i>x </i>coordinate given by: <i>xac </i>= 0.130 <i>xgm + </i>0.148 <i>xm </i>+ 0.448 <i>xa + </i>0.27 <i>xb</i>, where</p> <p><i>xac</i>-entire arm mass center <i>x </i>coordinate <i>xgm</i>-mass center of the hand <i>xm</i>-wrist joint <i>xa</i>-elbow joint <i>xb</i>-shoulder joint</p> <p>Similar equations for <i>y </i>and <i>z </i>coordinates are used:</p> <p>b. entire leg:</p> <p>mass center <i>x </i>coordinate given by: <i>xlc = </i>0.096 <i>xgp</i>+ 0.119 <i>xp + </i>0.437 <i>xs + </i>0.348 <i>xf , </i>where</p> <p><i>xlc</i>-entire leg mass center <i>x </i>coordinate <i>xgp</i>-mass center of foot <i>xp</i>-ankle joint <i>xs</i>-knee joint <i>xf</i>-hip joint</p> <p>Similar equations are developed by the <i>y </i>and <i>z</i> coordinates.</p> <p>By analogy the formulas for coordinates determining the location of the mass center of the entire body in two or three dimensions can be developed.</p> <p>As regards the coefficient <i>C3, </i>it is known that the mass moment of inertia (<i>I</i>) is proportional to the segment's mass and to the square of the segment's radius of gyration <i>(p). </i>Fischer found that the radius of gyration for rotation about the axis through the mass center and perpendicular to the longitudinal axis of the segment can be established by multiplying the segment's length <i>(l) </i>by the coefficient <i>C3</i> = 0.3. Hence the mass moment of inertia with respect to the mass center is <i>Ig</i> = <i>mpp </i>= <i>m(0.3l)(0.31) </i>= <i>0.09ml squred.</i></p> <p>For the rotation of the segment about its longitudinal axis, Fischer found the coefficient <i>C4</i> = 0.35, so that the radius of gyration <i>p = </i>0.35 <i>d, </i>where <i>d </i>is the diameter of the segment.</p> <p>Since for living subjects the segment rotates about the proximal or distal joint and not the mass center, the mass moment of inertia that we are interested in is greater than <i>Ig </i>by the term <i>mee, </i>where <i>e </i>is the distance of mass center from the joint. It follows that the mass moment of inertia for segment rotation about the joint is equal to <i>Ij = mpp + mee = m(pp </i>+ <i>ee).</i></p> <h4>New York University Studies</h4> <p>At present the Biomechanics group of the Research Division of the School of Engineering and Science, New York University, is engaged in the determination of volume, mass, center of mass, and mass moment of inertia of living body segments. The methods employed will now be discussed. Some of these techniques are extensions of the methods used by previous researchers; others are procedures introduced by New York University.</p> <h4>Determination of Volume</h4> <p>The two methods being investigated by New York University to determine segment volumes are (1) immersion and (2) mono- and stereo-photogrammetry.</p> <p><i>Imersion Method</i></p> <p>The Biomechanics group at New York University uses water displacement as the basis for segment volume determination. However, the procedure differs from that used by previous researchers in that the subject does not submerge his segment into a full tank of water and have the overflow measured. Instead his segment is placed initially in an empty tank which is subsequently filled with water. In this way, the subject is more comfortable during the test, and the segment remains stationary to ensure the proper results.</p> <p>A variety of tanks for the various segments- hand, arm, foot, and leg-has been fabricated. It is desirable that the tank into which the segment is to be immersed be adequate for the extreme limits which may be encountered and yet not so large as to impair the accuracy of the experiments. A typical setup is shown in <b>Fig. 10</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 10. Determination of the arm volume. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The arm is suspended into the lower tank and set in a fixed position for the duration of the test. The tank is then filled to successive predetermined levels at two-centimeter increments from the supply tank of water above. At each level, readings are taken of the height of the water in each tank, using the meter sticks shown. The volume occupied by water between any two levels is found by taking the difference between heights of water levels and applying suitable area factors. Thus to find the volume of the forearm the displacement volume is found for the wrist to elbow levels in the lower tank and between the corresponding levels in the upper tank. The difference between these two volumes is the desired forearm volume.</p> <p>To find the center of volume obtain volumes in the same manner of consecutive two-centimeter sections of the limb. Assuming the volume center of each section as one centimeter from each face, sum the products of section volume and section moment arm about the desired axis of rotation. The net volume center for the body segment is then this sum divided by the total volume of the segment. In a similar fashion, using the appropriate combination of tanks, we find the volumes of other segments, hand, foot, and leg. The use of an immersion tank to find hand volume is shown in <b>Fig. 11</b>. The data on volume and volume centers can also be used along with density as a check against methods of obtaining mass and center of mass.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 11. Determination of the hand volume. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Photogrammetry Method</i></p> <p>In order to find the volume of an irregularly shaped body part such as the head or face a photographic method may be employed. Such a procedure, called photogrammetry, allows not only the volume to be found, but a visual picture of the surface irregularity to be recorded as well. The two types of this technique are mono- and stereophotogrammetry. The principles are the same for each, except that in the latter procedure two cameras are used side by side to give the illusion of depth when the two photographs are juxtaposed. The segment of interest is photographed and the resulting picture is treated as an aerial photograph of terrain upon which contour levels are applied. The portions of the body part between successive contour levels form segments whose volumes can be found by use of a polar planim-eter on the photograph as described by Wild (1954). By summing the segmental volumes, the total body segment volume can be found. A controlled experiment by Pierson (1959) using a basketball verified the accuracy of such a procedure. Hertzberg, Dupertuis, and Emanuel (1957) applied the technique to the measurement of the living with great success. The reliability of the photographic technique was proven by Tanner and Weiner (1949). For a more detailed discussion of the photogram-metric method, refer to the paper by Contini, Drillis, and Bluestein (1963).</p> <p><i>Method of Reaction Change</i></p> <p>In searching for a method which will determine the segment mass of a living subject with sufficient accuracy, the principle of moments or of the lever has been utilized. The use of this method was suggested by Hebestreit in a letter to Steinhausen (1926). This procedure was later used by Drillis (1959) of New York University. Essentially it consists of the determination of reaction forces of a board while the subject lies at rest on it. The board is supported by a fixed base at one end <i>(A</i>) and a very sensitive weighing scale at the other end <i>(B). </i>The location of the segment center of mass can be found by the methods described elsewhere in this paper. The segment mass is <i>m, </i>the mass of the rest of the body is <i>M. </i>The reaction force (measured on the scale) due to the board only should be subtracted from the reaction force due to the subject and board. First the reaction force <i>(S0) </i>is determined when the segment (say the arm) is in the horizontal position and rests alongside the body; second, the reaction force <i>(S) </i>is determined when the segment is flexed vertically to 90 deg. with the horizontal. The distance between the board support points <i>A </i>and <i>B </i>is constant and equal to <i>D. </i>The distance <i>(d) </i>of the segment mass center from the proximal joint is known and the distance <i>b </i>from the proximal joint to support axis <i>A </i>can be measured. From the data it is possible to write the corresponding moment equations about <i>A. </i>The solution of these equations gives the magnitude of the segment's mass as: <b>Eq. 7</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 7. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>To check the test results, the segment is placed in a middle position, approximately at an angle that is 45 deg. to the horizontal, in which it is held by a special adjustable supporting frame shown at the right in <b>Fig. 13</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 13. Reaction board with supporting frame. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The magnitude of the segment mass in this case will be determined by the formula:<b>Eq. 8</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 8. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>By replacing the sensitive scale with an electrical pressure cell or using one force plate, it is also possible to record the changing reaction forces. If the subsequent positions of the whole arm or forearm in flexion are optically fixed as in Stick Diagrams, the corresponding changing reaction forces can be recorded by electrical oscillograph.<b>Fig. 12</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 12. Determination of the arm mass (reaction board method). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>It is assumed that in flexion the elbow ioint has only one degree of freedom, <i>i.e., </i>it is uniaxial; hence the mass determination of forearm and hand is comparatively simple. The shoulder joint has several degrees of freedom and for each arm position the center of rotation changes its location so that the successive loci describe a path of the instantaneous centers. If the displacement <i>(e) </i>of the instantaneous center in the horizontal direction is known from the Slick Diagram, the magnitude of the segment mass will be: <b>Eq. 9</b>(<b>Fig. 14</b> and <b>Fig. 15</b>)</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 9. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 14. Stick diagram of forearm flexion. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 15. Stick diagram of arm flexion. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Quick Release Method</i></p> <p>This technique for the determination of segment moments of inertia is based on Newton's Law for rotation. This law states that the torque acting on a body is proportional to its angular acceleration, the proportionality constant being the mass moment of inertia. Thus if the body segment, say the arm, can be made to move at a known acceleration by a torque which can be evaluated by applying a known force at a given distance, its moment of inertia could be determined. Such a procedure is the basis for the so-called "quick release" method. To determine the mass moment of inertia of a body segment, the limb is placed so that its proximal joint does not move. At a known distance from the proximal joint at the distal end of the limb, a band with an attached cord or cable is fixed. The subject pulls the cord against a restraint of known force, such as a spring whose force can be found by measuring <i>its deflection. </i>The activating torque about the proximal joint is thus proportional to the force and the distance between the joint and the band (moment arm). The acceleration of the limb is produced by sharply cutting the cord or cable. This instantaneous acceleration may be measured by optical or electrical means and the mass moment of inertia about the proximal joint determined.</p> <p>This technique is illustrated in <b>Fig. 16</b>. The subject rotates his forearm about the elbow, thereby pulling against the spring shown at the right through a cord wrapped around a pulley. The mechanism on the platform to the right contains the cutter mechanism with an engagement switch which activates the circuit of the two accelerometers mounted on the subject's forearm. The potentiometer at the base of the spring records the force by measuring the spring's deflection. The accelerometers in tandem give the angular acceleration of the forearm and hand at the instant of cutting. A scale is used to determine the moment arm of the force. This method is further discussed by Drillis (1959).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 16. Quick release method. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Compound Pendulum Method</i></p> <p>This technique for finding both mass moment of inertia of the segment and center of mass may be used in one of two ways: (1) considering the segment as a compound pendulum and oscillating it about the proximal joint, and (2) making a casting of plaster of Paris or dental stone and swinging this casting about a fixed point.</p> <p>Using the first method, it is necessary to find the moment of inertia, the effective point of suspension of the segment, and the mass center; thus, there are three unknown quantities.</p> <p>A study by Nubar (1960) showed that these unknowns may be obtained if it is assumed that the restraining moment generated by the individual is negligible. In order to simplify the calculations, any damping moment (resulting from the skin and the ligaments at the joint) is also neglected. The segment is then allowed to oscillate, and its period, or time for a complete cycle, is measured for three cases: (1) body segment alone, (2) segment with a known weight fixed to it at a known point, (3) segment with another known weight fixed at that point. Knowing these three periods and the masses, one can find the effective point of suspension, the center of mass, and the mass moment of inertia from the three equations of motion. If the damping moment at the joint is not negligible, it may be included in the problem as a viscous moment. The above procedure is then extended by the measurement of the decrement in the succeeding oscillations.</p> <p>In the second procedure, the casting is oscillated about the fixed suspension point. The moment of inertia of the casting is found from the measurement of the period. The mass center can also be determined by oscillating the segment casting consecutively about two suspension points. This method is described in detail by Drillis <i>el al. </i>(1963). Since the weight of both the actual segment and cast replica can be found, the measured period can be corrected on the basis of the relative weights to represent the desired parameter (mass center or mass moment of inertia) of the actual segment. The setup for the determination of the period of oscillation is shown in <b>Fig. 17</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 17. Compound pendulum method. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The photograph in <b>Fig. 17</b> has been double-exposed to illustrate the plane of oscillation.</p> <p><i>Torsional Pendulum Method</i></p> <p>The torsional pendulum may be used to obtain moments of inertia of body segments and of the entire body. The pendulum is merely a platform upon which the subject is placed. Together they oscillate about a vertical axis. The platform is restrained by a torsion bar fastened to the platform at one end and to the ground at the other. Knowing the physical constants of the pendulum, <i>i.e., </i>of the supporting platform and of the spring or torsion bar, the measurement of the period gives the mass moment of inertia of the whole body. The principle of the torsional pendulum is illustrated schematically in <b>Fig. 18</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 18. Torsional pendulum method. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Fig. 19</b> and <b>Fig. 20</b> describe the setup in use. There are two platforms available: a larger one for studying the supine subject and a smaller one for obtaining data on the erect or crouching subject. In this way, the moments of inertia for both mutually perpendicular axes of the body can be found.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 19. Body dimensions on torsion table. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 20. Mass moment of inertia determination (squatting position). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><b>Fig. 19</b> shows a schematic top view of the subject lying supine on the large table. Recording the period of oscillation gives the mass moment of inertia of the body about the sagittal axis for the body position indicated. Figure 20 is a side view of the small table used for the standing and crouching positions. This view shows the torsion bar in the lower center of the picture encased in the supporting structure.</p> <p>This method can also be used to find mass moments of inertia of body segments. Nubar (1962) describes the necessary procedure and equations. Basically it entails holding the rest of the body in the same position while oscillating the system for two different positions of the segment in question. Knowing the location of the segment in each of these positions, together with the periods of oscillation of the pendulum, the segment moment of inertia with respect to the mediolateral centroidal axis may be found. This technique is illustrated by the schematic Figure 19 for the case of the arm. The extended position is shown; the period would then be obtained for the case where the arm is placed down at the subject's side.</p> <p>Both the mass and center of mass of the arm can be determined using the large torsion table. The table and supine subject are rotated for three arm positions-arms at sides, arms outstretched, and arms overhead-and respective total moments of inertia are found from the three periods of oscillation. Assuming that the position of the longitudinal axis of the arm can be defined, <i>i.e., </i>the axis upon which the mass center lies can be clearly positioned, the following equations may be applied:<b>Eq. 10</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Equation 10. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>where <i>I1, I2, I3 </i>are the total moments of inertia of table, supports, and subject, found from the periods of oscillation, for the subject with arms at sides, outstretched, and overhead, respectively.</p> <p><i>h </i>is the distance from middle fingertip when arms are at the sides to the tip when arms are overhead.</p> <p><i>l</i> is the total arm length (fingertip to shoulder joint).</p> <p><i>g </i>is the distance from middle fingertip to the lateral center line of the table when the arms are at the sides.</p> <p><i>p </i>is the distance from middle fingertip to the lateral center line when the arms are outstretched.</p> <p><i>s</i> is the distance between the longitudinal center line of the table and the longitudinal axis of the arm when the arms are at the sides.</p> <p><i>d </i>is the distance between the mass center of the arm and the shoulder joint.</p> <p>In this case, the subject is placed so that his total body mass center coincides with the table's fixed point of rotation and there are no initial imbalances. The explanation of the above symbols may be clarified by reference to <b>Fig. 19</b>.</p> <p><i>Difficulties in Obtaining Proper Data</i></p> <p>In the commonplace technical area, where it has been necessary to evaluate the volume, mass, center of mass, etc., of an inanimate object, this object is usually one of fixed dimensions; that is, there is no involuntary movement of parts. The living human organism, on the other hand, is totally different in that none of its properties is constant for any significant period of time. There are differences in standing erect and in lying down, in inhaling and in exhaling, in closing and in opening the hand. It is necessary, therefore, to develop a procedure of measurement which can contend with these changes, and to evaluate data with particular reference to a specified orientation of the body.</p> <p>One ever-present problem in dealing with the body is the location of joints. When a segment changes its attitude with respect to adjacent segments (such as the flexion of the elbow), the joint center or center of rotation shifts its position as well. Thus, in obtaining measurements on body segments, it is necessary to specify exactly what the boundaries are. As yet there is no generally accepted method of dividing the body into segments.</p> <p>When an attempt is made to delineate the boundary between segments for purposes of experimental measurement, one cannot avoid the method of placing a mark on the subject at the joint. This mark will have to serve as the segment boundary throughout the experiment. Unfortunately an error is introduced here when the elasticity of the skin causes the mark to shift as the subject moves. This shift does not correspond to a shift in the actual joint.</p> <p>In an analysis of a particular body segment involving movement of the segment, such as the quick release, reaction, and torsional pendulum methods which have been described, one must take care to ensure that only the segment moves. Usually this involves both physical and mental preparations on the part of the subject.</p> <p>Finally, the greatest error in obtaining results on body parameters is due to variations in body build. As can be seen from the previous data brought forth, different researchers using identical techniques have gotten quite dissimilar data on the same body segment due to the use of subjects with greatly varying body types.</p> <p>In an effort to resolve this conflict, the Biomechanics group at New York University is endeavoring to relate their data on body segment parameters to a standard system of body typology.</p> <p><i>Anthropometric Studies</i></p> <p>In order to develop a means of classifying the subjects according to body build, the method of somatotyping is utilized. Here the body build is designated according to relative amounts of "endomorphy, ectomorphy, and mesomorphy" as described by W. H. Sheldon <i>et al. </i>(1940, 1954) in the classic works in the field. In order to determine the subject's somatotype, photographs are taken of three views: front, side, and back. These are illustrated in <b>Fig. 21</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 21. Photographs for somatotyping. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The Biomechanics group of New York University has obtained the services of an authority in the field, Dr. C. W. Dupertuis, to establish the somatotype of the subjects. The photographs also will be used to obtain certain body measurements.</p> <p>The aim of the study is to develop relationships between body parameters and body build or important anthropometric dimensions so that a pattern will be established enabling body parameters to be accurately found for all body types.</p> <p>If sufficient subjects are measured it should be possible to obtain a set of parameter coefficients which take into consideration the effect of the particular body type. When these coefficients are applied to some set of easily measurable body dimensions on any new subject, the appropriate body parameters could easily be determined.</p> <p>It is planned to prepare tables of these body parameter coefficients (when their validity has been established) for some future edition of <i>Artificial Limbs.</i></p> <p><b>References:</b></p> <ol> <li>Amar, J., <i>Le moteur humain, </i>Paris, 1914.</li> <li>Bashkirew, P. N., <i>Human specific gravity in the light of its practical importance to anthropology and medicine </i>(in Russian). Soviet Anthropology, 2 (2): 95-102, Moscow, 1958.</li> <li>Bernstein, N. A., O. A. Salzgeber, P. P. Pavlenko,and N. A. Gurvich, <i>Determination of location of the centers of gravity and mass of the limbs of the living human body </i>(in Russian), All-Union Institute of Experimental Medicine, Moscow, 1936.</li> <li>Boyd, E., <i>The specific gravity of the human body,</i> Human Biology, 5: 646-672, 1933</li> <li>Braune, W., and O. Fischer, <i>The center of gravity of the human body as related to the equipment of the German infantryman </i>(in German), Treat. of the Math.-Phys. Class of the Royal Acad. of Sc. of Saxony, 26: 1889.</li> <li>Contini, R., R. Drillis, and M. Bluestein, <i>Determination of body segment parameters, </i>Human Factors, 5 (5): 1963.</li> <li>Dempster, W. T., <i>Space requirements of the seated operator, </i>USAF, WADC, Tech. Rep. 55-159, Wright-Patterson Air Force Base, Ohio, 1955.</li> <li>Drillis, R., <i>The use of gliding cyclograms in the biomechanical analysis of movement, </i>Human Factors, 1 (2): 1959.</li> <li>Du Bois, J., and W. R. Santschi, <i>The determination of the moment of inertia of the living human organism, </i>paper read at the International Congress on Human Factors in Electronics, Institute of Radio Engineers, Long Beach, Calif., May 1962.</li> <li>Fischer, O., <i>Theoretical fundamentals of the mechanics of living bodies </i>(in German), Berlin, 1906.</li> <li>Harless, E., <i>Textbook of plastic anatomy, Part III </i>(in German), Stuttgart, 1858.</li> <li>Harless, E., <i>The static moments of human limbs </i>(in German), Treatises of the Math.-Phys. Class of the Royal Acad. of Sc. of Bavaria, 8: 69-96 and 257-294, 1860.</li> <li>Hertzberg, H. T., C. W. Dupertuis, and I. Emanuel, <i>Stereophotogrammetry as an anthropometric tool,</i> Photogrammetric Engineering, 24: 942-947, 1957.</li> <li>Ivanitzkiy, M. F., <i>Human anatomy </i>(in Russian); Part I, 3rd ed., Moscow, 1956.</li> <li>Meeh, C, <i>Volummessungen des menschlichen Korpers und seiner einzelner Teile in der verg-chiedenen Altersstufen, </i>Ztschr. fur Biologie, 13: 125-147, 1895.</li> <li>Nubar, Y., <i>Determination of characteristics of the compound pendulum by observing oscillations, </i>unpublished report, Research Division, College of Engineering, New York University, 1960.</li> <li>Nubar, Y., <i>Rotating platform method of determining moments of inertia of body segments, </i>unpublished report, Research Division, College of Engineering, New York University, 1962.</li> <li>Pierson, W. F., <i>The validity of stereophotogram-metry in volume determination, </i>Photogrammetric Engineering, 25: 83-85, 1959.</li> <li>Salzgeber, O. A., <i>Method of determination masses and location of mass centers of stumps </i>(in Russian), Transact. Scient. Researc Inst. of Prosthetics in Moscow, 3: Moscow, 1949.</li> <li>Sheldon, W. H., S. S. Stevens, and W. B. Tucker,<i>The varieties of human physique, </i>New York, 1940.</li> <li>Sheldon, W. H., C. W. Dupertuis, and C. McDermott, <i>Atlas of men, </i>New York, 1954.</li> <li>Steinhausen, W., <i>Mechanik d. menschlichen Korpers,</i>in Handbuch d. Normalen n. pathologischen Physiologie, 14: 1926-1927.</li> <li>Tanner, J. M., and J. S. Weiner, <i>The reliability of the photogrammetric method of anthropometry, with a description of a miniature camera technique, </i>Am. J. Phys. Anthrop., 7: 145-186, 1949.</li> <li>Weinbach, A. P., <i>Contour maps, center of gravity,moment of inertia, and surface area of the human body, </i>Human Biology, 10 (3): 356-371, 1938.</li> <li>Wild, T., <i>Simplified volume measurement with the polar planimeter, </i>Surveying and Mapping, 14: 218-222, 1954.</li> <li>Zook, D. E., <i>The physical growth of boys, </i>Am. J. Dis. Children, 1930.</li> <li>Zook, D. E., <i>A new method of studying physical growth, </i>Junior-Senior High-School Clearing House, 5: 1932.</li> </ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Maurice Bluestein, M.M.E. </b></td></tr><tr><td class="clsTextSmall">Assistant Research Scientist, Research Division, School of Engineering and Science, New York University, New York City.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Renato Contini, B.S. </b></td></tr><tr><td class="clsTextSmall">Senior Research Scientist, Research Division, School of Engineering and Science, New York University, New York City.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Rudolfs Drillis, Ph. D. </b></td></tr><tr><td class="clsTextSmall">Senior Research Scientist, Research Division, School of Engineering and Science, New York University, New York City.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-1.jpg Figure 2 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-2.jpg Figure 3 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-3.jpg Figure 4 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-4.jpg Figure 5 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-5.jpg Figure 6 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-6.jpg Figure 7 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-7.jpg Figure 8 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-9.jpg Figure 9 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-8.jpg Figure 10 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-10.jpg Figure 11 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-11.jpg Figure 12 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-12.jpg Figure 13 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-13.jpg Figure 14 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-14.jpg Figure 15 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-15.jpg Figure 16 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-16.jpg Figure 17 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-17.jpg Figure 18 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-18.jpg Figure 19 http://www.oandplibrary.org/al/images/1964_01_044/tmp267-19.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Body Segment Parameters: A Survey of Measurement Techniques Creator An entity primarily responsible for making the resource Rudolfs Drillis, Ph. D. * Renato Contini, B.S. * Maurice Bluestein, M.M.E. * Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Text Any textual data included in the document <h2>Building A Positive Self Image In Patients</h2> <h5>Mary Point Novotny, RN., MS.&nbsp;<a style="text-decoration: none;">*</a></h5> <p><i>"Poems are made by fools like me, but only God can make a tree. "</i></p> <p>Momentary reflection on this literary work brings into perspective the complex task of rebuilding the image of one who has lost a limb. It is a task which requires not merely the professional and technical abilities of the prosthetist, but also a personal concern for the self image of the patient.</p> <p>Body image is the constantly changing mental picture one has of his individual, body appearance. It develops through reflected perceptions about one's body and sensations originating from internal and external stimuli as the individual adapts to a kaleidoscopic variety of living activities. All too frequently body image is overlooked in the rehabilitation plans for a patient with chronic disease, disability, or surgical intervention, because physical diagnosis and mechanical advances have become paramount in our fast-paced acute care settings. The concept is so basic, it is not hard to see why it is overlooked; yet, if one begins to examine the personal effect of alterations, such as mastectomy, amputation, colostomy or stroke, we can begin to identify with the grief, anxiety and fear accompanying the loss of a body part and the ensuing alteration in functional ability.</p> <p>Research of Schilder and others has shown that since body image is primarily a psychological entity, alterations in it are extremely subjective experiences which vary in intensity, dependent on the unique characteristics of each individual, in three distinct categories. These sources of self image include:</p> <ol> <li> <p>Past experiences which are gradually built up through the years from physiologic, psychologic, and social components, organized and integrated by the central nervous system.</p> </li> <li> <p>Social interactions which include the reaction of significant others and of society to the person's body, as well as his own interpretation of that reaction.</p> </li> <li> <p>Current sensations, such as perceptions of physical appearance, alterations incurred, and images, attitudes and emotions regarding the body.</p> </li> </ol> <p>Because these components are subject to constant revision, the body image of any individual is constantly changing. Survival of a healthy self image is determined by the amount of flexibility available to adapt to new situations and one's ability to realize that the image he projects to others is the one others see.</p> <p>The loss or absence of a limb, therefore, has varying consequences dependent on the individual and his stage in the life cycle. Studies have shown that an individual is capable of incorporating a firmly-attached object, such as a prosthesis, cane, etc., into his self image. This seems to be particularly evident with congenitals fitted very early in life, before developing unilateral coordination and functional abilities. Of the acquired amputees, early fitting and functional use of the prosthesis also increases the chances of reconstructing a complete image of one's self. A juvenile amputee, up to 3 years old, is not able to consciously deal with "loss," and congenitals, up to 6 years old, generally do not perceive themselves as "different." Yet amputation in later years results in the patient undergoing the process of grief, which includes feelings ranging from denial, anger and hopelessness, to reorganization and adaptation.</p> <p>Schilder places a positive emphasis on the necessity for communication of these feelings. He believes we constantly construct, dissolve, and reconstruct our own body image as well as the body images of others. He points out that the tendency to destroy a previous body image is essential to acceptance of a new, altered image.</p> <p>This appears to be a critical area in successful care of any patient. Because most amputees and their families have limited, if any, exposure to others with similar problems, their greatest fears are of the unknown. Will amputation ruin my personal life? End my career? Leave my child handicapped and dependent? With little factual information in the areas of prosthetics and a body image distortion that has not been reconciled, the patient frequently arrives at the professional door seeking an opportunity to communicate his fears and frustrations to an individual who will, hopefully, aid in the design of a prosthesis and promise for the future. While personal style and approach vary with the needs of individual patients, certain factors should be considered in dealing with an amputee: personality type, expectations, stage of adjustment, support system, and medical conditions.</p> <p>Recent amputees, for example, would benefit from an opportunity to see and touch a prosthesis, with a complete explanation of the stages of fitting and fabrication to limb completion. Be open and honest with patients, keeping in mind that cosmesis may be a priority for some while function and durability are essential for others. While no prosthesis will ever replicate human functioning, once you determine what a patient expects to achieve through prosthetic usage, you can then fulfill his needs and likewise increase his acceptance of an artificial limb.</p> <p>Parents of a congenital amputee frequently need much more support than the child who can learn to lead a "normal" life if allowed to develop and achieve, unhampered by "concerned" adults who would treat him "special/different."</p> <p>Meeting with another amputee who has mastered life with a prosthesis can have a very positive effect on the older child or adult who is attempting to re-adjust his self image. Family members or significant others should be encouraged to be present at such meetings, as the fear of new amputees is generally in direct proportion to the acceptance reaction of those whose opinion he values most. Seeing is believing!, and once normal functioning in everyday living is explained, there will be less chance of the amputee being treated as a "handicapped" individual, which he is not.</p> <p>Lastly, bear in mind that you are a very important person in the eyes of your patient. This is because you are now the professional most heavily relied on for advice, support and adjustment in the initial period of building a new self image. So grin and bear those minor repairs, etc., keeping in mind that a well-worn prosthesis is your best measure of success. Function and form go hand-in-hand in establishing a sense of completeness in self image.</p> <p>While you may not have the power of our creator, you can surely have a part in the final design of his creations.</p> <p><b>References:</b></p> <ol> <li>Fishman, Sidney, "Behavioral and Psychological Reactions of Juvenile Amputees." Reprinted from <i>Limb Development and Deformity: Problems of Evaluation and Rehabilitation</i>, Charles C. Thomas, Publisher, 400-407.</li> <li>La Fleur, Jean and Novotny, Mary, "A Study of Human Figure Drawings by Amputee Children and Verbalization of their General Adjustment," Masters' thesis, De Paul University, 1978.</li> <li>Schilder, Paul, <i>The Image and Appearance of the Human Body</i>, International Universities Press, Inc., New York, 1950.</li> <li>Schilder, Paul "Symposium on the Concept of Body-Image," Nursing Clinics of North America, VII (December, 1972).</li> </ol> <em><b>*Mary Point Novotny, RN., MS. <br /></b>Nurse-educator for health professionals; Consultant, University of Illinois at the Medical Center, Amputee Clinic, Chicago, Illinois; has lectured across the country on body image alterations and the role of professionals in assisting patients with adjustment.</em> Page Number(s) 1 - 2 Year 1979 Volume 3 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Building A Positive Self Image In Patients Creator An entity primarily responsible for making the resource Mary Point Novotny, RN., MS. * https://staging.drfop.org/files/original/69040961fa14eb3de1832ed0d1d448a5.pdf df098d8f74c3d28303ceedffbfd1dcaf DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1957_02_001.pdf Year 1957 Volume 4 Issue 2 Page Number(s) 1 - 3 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1957_02_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1957_02_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Canadian Candidate</h2> <h5>C. A. BELL, B.A.Sc, O.B.E., M.C <a style="text-decoration:none;">*</a><br /></h5> <p>Throughout the 200-odd years since its inception, the surgical procedure known as disarticulation of the hip has been fraught with danger and disappointment both medically and prosthetically. On few persons has the operation been performed, and fewer still have survived for any gratifying period. Because hip disarticulation is so severe a measure, and because in recent years it has for the most part been carried out only in the attempt to forestall fatal disease, the level of medical success thus far attained has been disturbing. Because the hip-disarticulation amputee presents such a difficult problem in anatomical deficiency, his successful rehabilitation prosthetically has proved particularly evasive.</p> <p>Although even in modern times postoperative mortality from residual systemic disease has remained alarmingly high, recent advances in surgical techniques and in medicine as a whole have done much to encourage hip disarticulation where it might not otherwise have been attempted. This circumstance, together with a growing tendency toward the use of radical amputation surgery as a curative measure in cases of malignancy, has been responsible for an increasing incidence of hip-disarticulation amputees. Meanwhile, the problem of providing a reasonably satisfactory substitute for a lower extremity amputated at hip level has over a long period of years continued to be most difficult for the limbmaker and most exasperating for the patient.</p> <p>To satisfy functional requirements in amputations at or about the hip, the prosthetist has not only to furnish a limb with three simulated anatomical joints, all of which have to be stabilized in the stance phase of walking, but he must do so with only the torso and associated structures as a source of activation and control. In the absence of an adequate thigh stump, reliable management of an articulated lower-extremity prosthesis calls for the use of various locks, or equivalent, and for the coordinated action of pelvis, trunk, and remaining sound leg. The saving grace in this situation is that weight-bearing can still be provided on one of Nature's chosen seats of election, the ischium.</p> <p>The hip-disarticulation prosthesis to which this issue of <i>Artificial Limbs</i> is devoted is the culmination of many years of practical work, later combined with present-day methods of organized research and the application of new materials. Canada has had much experience in the provision of orthopedic and prosthetic appliances in the aftercare of her veterans. Early in 1916, the government of the day was confronted with the matter of supply for members and ex-members of the Canadian Expeditionary Force. After thorough investigation, it was found that existing facilities were extremely limited and unable to cope with the problem. Further, although standardization of appliances was deemed essential to provide ready maintenance or renewal accessible to the veteran's place of residence over the breadth of the country, no such standardization existed throughout the Dominion. Government proprietorship was considered the best means for keeping in touch with latest developments in prosthetics from other countries and also seemed to offer the most expeditious way of initiating a domestic program of experimental work that would be productive of results in keeping with the policy of standardization.</p> <p>The agency thus established, which today is known as the Prosthetic Services Branch of the Department of Veterans Affairs, now consists of some twelve operating centres and six visiting facilities situated in or adjacent to Departmental hospitals in the principal Canadian cities from coast to coast. The largest centre, located at Sunnybrook Hospital in Toronto, serves as the central manufacturing facility for the production of standard parts and stores for supply to all other centres. Here also is located a research section technically staffed for the investigation of new designs, materials, and techniques. Situated close to the medical and production facilities, and with patient personnel from the largest veteran area, this unit provides ample opportunity for field-testing and final approval for manufacture in other District facilities across the country. It was here that Colin McLaurin and James Foort were inducted into the field of prosthetics research and here also that, early in 1954, McLaurin brought into production the hip-disarticulation leg now generally known as the "Canadian type."</p> <p>To produce an improved prosthesis for the hip-disarticulation case was already one of the problems confronting the design section organized in 1916. At that time, the choice of willow setups, wood or leather sockets, and heavy joints did not provide for a light limb or for good control. Later, in 1926, the Department adopted the J. E. Hanger English metal limb, which included a design known as the "tilting-table leg." This limb, although of lightweight construction and representing a decided improvement over former designs, did not eliminate locks, and, moreover, the location of the hip joint directly under the ischial seat created, when the wearer sat, a pelvic tilt that was tiresome over any lengthy period. Further design work was carried out after World War II using a lateral hip joint and folding-latch mechanism. But this device, while solving the "tilt" problem, necessitated heavy construction and gave little improvement in control. Because of this discouraging state of affairs, many hip-disarticulation and short-stump above-knee amputees had long preferred crutch ambulation rather than bother with the best prosthesis available.</p> <p>The current design of the Canadian-type hip-disarticulation prosthesis was evolved by McLaurin after some three years of work in which the scope of investigation was broadened to explore more features than the height of the joint under the seat. Included were a mechanical design of the hip joint to promote walking with a free hip, an alignment that provides stability through all phases of the walking cycle, and, finally, a new concept of a plastic socket-waistband. This all-plastic member embraces the pelvis and incorporates a rather rigid band which encircles the waist. When well fitted, it provides comfortable weight-bearing, a suspension that requires only the tightening of the front restraining strap, and a degree of control which permits the amputee to move the limb freely and confidently.</p> <p>Performance on the new device by a test amputee exceeded all expectations, despite the fact that in addition to an amputation at the right hip he had suffered amputation of the right arm above the elbow. Shortly after trials, he reported his ability to walk forty city blocks with less effort than he had formerly expended in two blocks with the old-style metal limb. The ease of donning and removing the new leg with the simple yet secure suspension was impressive. Further field-testing on a larger number of hip-level amputees justified the acceptance of the design as a standard of production, and by September of 1954, through instruction and training of District fitters, it was made available on a Dominionwide basis. Some thirty-two cases have been fitted to date, and twenty-five of these have been classified as successful.</p> <p>Following the results attained at Sunnybrook, the Prosthetics Research Group at the University of California at Berkeley undertook to assess the new device and to work out improved procedures for construction and fitting, and in the spring of 1956 the Committee on Prosthetics Research and Development of the Prosthetics Research Board approved the issuance of the Canadian-type hip-disarticulation prosthesis to veteran beneficiaries throughout the United States. Here, then, is a Canadian candidate for utilization by clinic teams everywhere in dealing successfully with one of the most troublesome prosthetic problems of all.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>C. A. BELL, B.A.Sc, O.B.E., M.C </b></td></tr><tr><td class="clsTextSmall">Director of Prosthetic Services, Department of Veterans Affairs, Ottawa, Canada.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> 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 Canadian Candidate Creator An entity primarily responsible for making the resource C. A. BELL, B.A.Sc, O.B.E., M.C * https://staging.drfop.org/files/original/0e21aacbf72bba2c34917b934ad97048.pdf 094d56220c0c63d9f7e92de77da375d2 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_002.pdf Text Any textual data included in the document <h2>Canons of Ethical Conduct and the Law</h2> <h5>John H. Harman&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Since its inception in 1947, the American Board for Certification in Orthotics and Prosthetics, Inc. has developed, perpetuated, and enforced a relatively straightforward and uncomplex set of rules for conduct in the profession of orthotics and prosthetics. Specifically, these rules are known as the Canons of Ethical Conduct and come under the jurisdiction of the Character and Fitness Committee, a permanent committee of the Board of Directors of ABC.</p> <p>The impact of the Canons has been progressively larger as time has passed. In particular, as certification in the field of orthotics and prosthetics has become more and more important, the loss of suspension from such certification due to violations of the Canons of Ethical Conduct has become much more important.</p> <p>Of course, canons of ethical conduct are nothing new. They have been around for hundreds of years. Virtually every profession that exists has some form of ethical code which is designed to bring a minimum level of moral conduct to bear upon the members of that profession. Of course, the nature and character of such codes differ vastly but their purpose is always important. Even insurers recognize that self-regulation through codes of ethical conduct reduces the claims experience of insurance companies with regard to malpractice and product liability insurance. Thus, the impact in the field of insurance is significant. Belonging to an organization which engages in self-regulation through a code of ethics is a basis and factor to be considered by the insurance company in setting rates for insurance.</p> <p>Orthotics and prosthetics is a unique profession. It has evolved from that of being more of an industry producing products to that which now is a technology of products bounded by professional services which are an integral part thereof. Thus, the Canons of Ethical Conduct for ABC, which are its self-regulating guide, parallel the canons of other professions, such as law and medicine, in a somewhat simpler form.</p> <p>Throughout most of this century, self-regulation was accepted and encouraged as a fundamental aspect of professionalism. Indeed, professional self-regulation was long regarded as necessary to set high standards and to protect the public from the unscrupulous or incompetent. Even the Supreme Court of the United States has stated that the ethics of a profession are but the consensus of expert opinion of the necessity of such standards. Indeed, for the first three quarters of the twentieth century, there was not one decision by the courts involving matters which questioned self-regulation in the professions.</p> <p>However, in the last decade, self-regulatory efforts have come under sharp and increasing attack. In various cases, the courts have held that various aspects of codes of ethical conduct violated fundamental antitrust laws and related legal principles. Prices set by ethical codes in minimum fee schedules have been stricken. Prohibitions against competitive bidding have been abolished. Likewise, prohibitions against advertising and solicitation have been eliminated.</p> <p>Further, the courts have held that associations which engage in standards-setting may be liable for improprieties promulgated in relation to such standards that affect competition.</p> <p>Self-regulation is particularly important in the professions because, to the extent that market forces do not function as effectively as in ordinary commerce, self-regulation can offer a degree of consumer protection that otherwise would be provided by competition.</p> <p>The premise, and thus the promise, of professional self-regulation is that it will raise the quality or lower the cost of services in areas in which lay persons, because of a lack of sophisticated training, are not particularly able to achieve these goals.</p> <p>However, the system has not functioned as envisioned. Professions have failed to one degree or another to effectively eliminate from their midst those who have abused their position. Professional discipline has become more and more the problem of state agencies and not the professions themselves.</p> <p>Worse still, those who were supposed to regulate themselves in the public interest sometimes chose to regulate themselves in their own interest. Finally, as social values evolved, some self-regulatory positions that had been adopted to protect the public came to be perceived as being selfishly motivated. Restrictions on professional advertising, for example, were imposed out of a conviction that any possible informative value would be outweighed by the potential for deception.</p> <p>As generally happens, the law has come to reflect the changes in society's attitudes. Where self-regulation once was uncritically accepted, the change in the prevailing view led to the placement of limits on the process.</p> <p>This is not to say that because of the application of antitrust laws and the active development by the courts in the last ten years of various theories which have nullified certain aspects of codes of conduct, such ethical codes are no longer valuable and should be abolished. Quite the contrary is true.</p> <p>Codes of ethical conduct contain basic fundamental ingredients and have applications which are important to self-regulation by the professions. However, those codes must conform to the judicial guidelines laid down involving restrictions and limitations on their content, application, and enforcement.</p> <p>It is still extremely important for the professions to regulate themselves and, indeed, their failure to do so may well be looked upon as equally as serious an impropriety as an over-zealous effort in self-regulation.</p> <em><b>*John H. Harman </b> Legal Counsel, American Board for Certification in Orthotics and Prosthetics, Inc. Coggins, Harman, Lackey and Lowe, P.A. Silver Spring, Maryland<br /><br /></em> Page Number(s) 2 - 2 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 Canons of Ethical Conduct and the Law Creator An entity primarily responsible for making the resource John H. Harman * https://staging.drfop.org/files/original/4699d64d3df5994ef8f7e1b85cd99959.pdf b3917f4e00ca2ab8d8c25b3f49862b6e https://staging.drfop.org/files/original/e5ce76adfd45dd6f57b618d54dde10ad.jpg 73269599a0739d162dabc155d43ed468 https://staging.drfop.org/files/original/743b5e834a6bd64136a8729f21c07d13.jpg 94ba2e4204849d17989659f400598a78 https://staging.drfop.org/files/original/36ae3ca908bc73b7f24e244440dda104.jpg f928a27eaaee312841c942cf30496ae1 https://staging.drfop.org/files/original/b65a0390d93c0160d55cc411ff05f1d9.jpg a2f12631b5934dca4d2cffbe177994eb https://staging.drfop.org/files/original/a366ac4453ec47ff2c58896dcaaeed9f.jpg 4d4b69bb9323ba6d1e82d72ee69e7b11 https://staging.drfop.org/files/original/404e9dfeeaf0ddf28ee6cc9724a164be.jpg b7cf2d1829b06c77f60ad53a56ea1532 https://staging.drfop.org/files/original/1b6b21650828332a841575640ebd49c2.jpg b97764b21b3f5e2eb36440de368b7a9e https://staging.drfop.org/files/original/69921ae973886707c7f19d0b0ad8d958.jpg 11567fa8743e3ca28c329197914c2b13 https://staging.drfop.org/files/original/cb3f332ee038c22ea975988c0684ce58.jpg 069149801aa269a87db508949da51d8f https://staging.drfop.org/files/original/924b2334c44029327c1b7924cb3fe7ac.jpg ffebb08a2dd20782db4a706e97eb0c18 https://staging.drfop.org/files/original/667fb5c153d80c36866d27fd5fd55700.jpg 6682288306bc4940fe68f83b9b600f51 https://staging.drfop.org/files/original/f078c25d734e44df7cc68fc2991aaa1e.jpg a46a3f90736de24584111c8e3b4dd414 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1969_01_027.pdf Year 1969 Volume 13 Issue 1 Page Number(s) 27 - 36 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1969_01_027.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1969_01_027.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Causes of Death in a Series of 4738 Finnish War Amputees</h2> <h5>Georg Bakalim <a style="text-decoration:none;">*</a><br /></h5> <p>The loss of a limb and its replacement by a prosthesis create conditions deviating from the normal. Walking is always more difficult. Loon <a></a> found that the energy consumption of amputees increases with the level of amputation. In the case of an above-knee amputation the effort of walking is greater than in a be-low-knee amputation and, in cases of hemipelvectomy and disarticulation of the hip, energy requirements are still greater. In the same investigation, it was found that walking with crutches, without a prosthesis, requires more energy than walking with a prosthesis. In addition, it appeared that in the presence of disturbances in the stump that affect walking, the consumption of energy increases. A poorly fitted prosthesis has the same effect. During walking, the center of gravity should shift smoothly, not in a jerky way that makes it more difficult to maintain balance. Almost all amputees experience excessive sweating not only of the stump but in general. The tightly fitted socket and the thigh corset used in connection with the old, conventional type of below-knee prosthesis are contributory causes of sweating.</p> <p>Owing to the loss of the weight and accompanying movements of the amputated limb, upper-extremity amputees find it more difficult to keep their balance in walking after amputation. Similarly, the strain on the remaining upper limb in lifting and carrying is greater than before. The increased consumption of energy taxes the circulation and the heart. In this connection, no further attention will be paid to the secondary changes in the weight-bearing structures, particularly the joints and spine, that result from the altered static conditions due to the loss of a limb <a></a>.</p> <p>The health of amputees has been the subject of many previous studies, <i>e.g., </i>those of Rausche, <a></a> Schneider, <a></a> Schulze, <a></a> and Bodechtel <a></a>. Meyer-ingh, Stefani, and Cimbal <a></a> reported a higher rate of hypertension in obese amputees than in amputees of average weight. In an electrocardiographic investigation of 1033 amputees, performed by the same authors, no differences were observed as compared with a normal series. Likewise, in a series of 1128 amputees obesity was not more frequent than in a corresponding group of the general population. <a></a> Loos <a></a> reported similar findings in a series of 647 cases. Solonen, Rinne, Viikeri, and Karvinen <a></a> observed no noteworthy increase in cardiac and vascular diseases in amputees.</p> <p>The purpose of this study was to find out whether death from degenerative cardiac and vascular diseases is more common among amputees than in the general population. At the same time tuberculosis, cancer, accidents, suicide, and miscellaneous causes of death were surveyed from the same standpoint.</p> <h3>Material</h3> <p>The series consists of 4782 war amputees. Data was collected from the files of the State Insurance Department. Finger, hand, toe, and foot amputations have been omitted since these cause no major problems. Before the end of 1944, <i>i.e., </i>during the war, 44 amputees died. These cases are also considered in this study. The age distribution in this group was the same as in the remaining 4738 cases which have been followed up from 1945 till the end of 1965. The causes of death were obtained from the death certificates. During the last 10 years a steadily increasing number of cases have been examined postmortem. In case of a casualty, or when the cause of death is unknown, autopsy is invariably performed. As a rule, the autopsy records contain more than one diagnosis, but in this study only the main diagnoses have been utilized. Although many of the second diagnoses might have been of interest, taking them into account would have implied considerable technical problems and would have rendered the statistical treatment more difficult. Since 1945, 643 subjects have died. During the period 1940-1965 the total mortality was thus 687/4782 (14.4 per cent). The number of mortalities during each year is shown in <b>Fig. 1</b>. A steady rise is seen from 1960 onward. This increased mortality is not surprising, considering that more than 20 years have elapsed since the war and the mean age of the war veterans is about 50. However, this curve alone permits no conclusions to be drawn. In order to form an opinion concerning the mortality of the war amputees, the figures have to be compared to the death rates for the corresponding age groups of the general population.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. Annual mortality of war amputees in 1940-1965. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Age And Occupation</h4> <p>For the main causes of death the distribution of the dead war amputees by 5-year age groups is given in <b>Table 1</b>. Mostly, the age groups 40-50 years show the highest mortality. However, for conclusions to be drawn concerning the health of the group under review, comparable data for a "normal" group is required. The occupations of the dead, differentiated mainly on the basis of training, are given in <b>Table 2</b>. In this connection the main interest attaches to the proportion of heavy laborers.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Farmers (177) and unskilled workers (230) constitute the largest groups. Heavy labor is represented by 72.6 per cent, light occupations by 27.4 per cent. The handicraftsmen number 74 (10.8 per cent). There are as many as 31 shoemakers, which is accounted for by the fact that training for this occupation was offered after the war.</p> <h4>Level Of Amputation</h4> <p>The level of amputation appears in <b>Table 3</b>. Finger, hand, toe, and foot amputations were not included in this series because the trouble caused by them is considered to be so slight that it cannot lead to vascular disease. Two amputees in the present series had Chopart stumps, one had a Pirogoff stump, and in six cases disarticulation of the wrist had been performed. The ratio of above-knee to be-low-knee amputations is 1:2.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Method of Comparison</h3> <p>The age distribution of the series followed up, exclusive of those who died before 1945, and the percentage figures for the corresponding age groups of the general Finnish male population are shown in <b>Table 4</b>. As may be seen in the table, the age distribution of the amputees differs widely from the age distribution of the general Finnish male population as obtained from the Statistical Yearbook of Finland. <a></a> For this reason, the death rates for the general Finnish male population could not be used as such for comparison with the mortality rate of amputees. It was necessary therefore to construct an equivalent, theoretical population with an age distribution corresponding to that of the amputees. The data required was obtained in part directly from the Statistical Yearbook, and in part by calculation based on the death rates for men and women and the sex ratio, or for the earlier years, on the total mortality and the age distribution of the dead, as indicated in the Statistical Yearbook. In the comparisons, it was deemed most appropriate to consider only the period from 1945 till the end of 1964. The amputees who died before 1945 numbered 44, and 71 died in 1965. When these 115 cases were subtracted from the total number of dead in the present series (687), 572 cases remained for the comparative analysis of mortality.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Mortality</h4> <p>As mentioned above, the total mortality for the period under review was 687/ 4782 (14.4 per cent). The causes of death are listed in detail in <b>Table 5</b>. The distribution according to the cause of death has been given in summary form in <b>Table 1</b>. Degenerative vascular diseases of the central nervous system and degenerative cardiac and vascular diseases have the same etiology but each forms a separate entity, and the Statistical Yearbook of Finland provides figures for comparison precisely on this basis. In addition, death rates were available for pulmonary tuberculosis, malignant diseases, accidents, and suicide, other causes falling into a miscellaneous group consisting of cases for which no comparative figures were found in the Statistical Yearbook. Many cases of poisoning and drowning were recorded under accidents. Alcohol abuse was a major etiological factor. It was sometimes difficult to decide whether the cause of death was an accident or suicide.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Comparison of Mortality of the Amputees and the General Population</h3> <p>In what follows, the total mortality is analyzed first and then the mortality in the various groups listed above is analyzed, except for the miscellaneous group for which no comparable data was available.</p> <h4>Total Mortality</h4> <p>On comparing the total number of deaths during the period January 1, 1945, to December 31, 1964, <i>i.e., </i>572, to the mortality of the general Finnish male population, the age distribution was taken into account in two different ways. In both methods, consideration was given to the fact that during the period under review the subjects passed into age groups with a lower expectation of life.</p> <p><i>Method I</i></p> <p>For each 5-year age group of amputees in <b>Table 4</b> (age distribution at the beginning of 1945), the expected losses for the 5-year periods 1945-1949, etc., until the beginning of 1965, were calculated on the basis of the expectations of life indicated in the Statistical Yearbook of Finland, that figure being used which pertains to the mean age of the age group during the period in question. To exemplify, for those who were aged 20-24 years at the beginning of 1945, the expectation of life at 25 years was considered as the relevant figure for the period 1945-1949, since the youngest in the group had survived for 20-24 years and the oldest for 24-29 years. Correspondingly, the expectation of life at 30 years was applied to the period 1950-1955, etc. The 5-year losses were calculated on the basis of the total number of survivors. In <b>Fig. 2</b>, the cumulative curve for the calculated losses from the level of 1945 is compared to the cumulative curve for the actual losses.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. Cumulative death rates-calculated for 5-year periods compared to cumulative expected death rates. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The recorded death rates for the <i>5-year age groups </i>are slightly lower than the expected figures, but the difference is statistically insignificant. The same obtains to the death rates as expressed by <i>5-year periods </i>(<b>Table 6</b>). The differences between the recorded and the expected figures are of the order of 10 per cent. The greatest differences relate to the periods 1950-1954 and 1955-1959, while for the periods 1945-1949 and 1960-1964, the recorded figures fall below the expected ones by about 2 per cent only.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Method II</i></p> <p>In the Statistical Yearbook of Finland, the number of survivors among 100,000 men of the same age is indicated. On the basis of these figures, the numbers of expected survivors in all age classes represented in this series at the beginning of 1945 were calculated for the end of the age periods 20-24 years, 25-29 years, etc., and the expected death rates in the various age groups were expressed as percentages. The expected total mortality by the end of 1964, <i>i.e., </i>549, is in very good agreement with the actual figure of 572. All the 687 deaths considered, the percentile distribution between the age groups corresponds fairly well to the expected distribution (<b>Table 7</b>, <b>Fig. 3</b>).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 3. Death rates for the different age groups compared to the expected death rates. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>If the causes of death are disregarded, it may be stated that the mortality in the present series corresponds very closely to the mortality in the corresponding general population. This obtains to the figures for the various 5-year periods and the total mortality as well as to the figures for the age groups. There seems to be a tendency toward a lower mortality for amputees than in the general population, and, with regard to the age at death, it appears that among the amputees there may be a trend toward a lower age, though only by one or two years at the most.</p> <h4>Degenerative Egenerative Vascular Diseases of the Central Nervous System</h4> <p>The mortality in degenerative vascular diseases of the central nervous system was 64/687 (9.3 per cent). Traumatic cerebral hemorrhages of course do not belong to this group. Comparable data relating to the general population was obtained from the Statistical Yearbook of Finland, and expected figures were calculated for the period 1945-1964 in the same way with respect to the total mortality. The expected number of deaths in this group of disease was 37.4. The actual number (64) was 71.2 per cent higher. In the age groups 25-44 years the actual number of deaths was 130.9 per cent higher than the expected number; in the age groups 45-64 years it was 49.6 per cent higher; and in the age groups 65-74 it was 42.6 per cent higher (<b>Table 8</b>). No consistent trend is discernible with regard to the age at death.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Degenerative Cardiac And Vascular Diseases</h4> <p>This group includes cardiac infarction, pulmonary infarction, peripheral embolism, myodegeneration, cardiac insufficiency, and arteriosclerosis. The mortality in this group was 219/687 (31.9 per cent). The expected number of deaths in the general population was 134.3. The actual mortality was 63.1 per cent higher. As regards the different age groups, the actual mortality was 193.2 per cent higher than the expected in the group aged 25-44 years at death, 38.9 per cent higher in the group aged 45-64 years, and 28.6 per cent higher in the group aged 65-74 years (<b>Table 8</b>). One hundred and four amputees (47.5 per cent) died at an age of 45-54 years, 51 (23.3 per cent) at an age of 35-44 years, and 44 (20.1 per cent) at 55-64 years. The remaining 20 deaths (9.1 per cent) were evenly distributed between the age groups 25-34 and 65-84 years (<b>Table 1</b>).</p> <h4>Pulmonary Tuberculosis</h4> <p>The mortality in pulmonary tuberculosis was 70/687 (10.2 per cent). The actual mortality was found to be 24.9 per cent lower than the expected mortality (93.2 cases). In the group under 24 years of age the mortality was 172.7 per cent higher than the expected, while in the age groups 25-44 and 45-64 the actual mortality was 10.5 and 70.9 per cent lower, respectively, than the expected (<b>Table 8</b>).</p> <h4>Malignant Diseases</h4> <p>The mortality in malignant disease was 96/687 (14.0 per cent). The mortality was 19.6 per cent lower than the expected. In the age group 45-64 years the mortality was 21.1 per cent lower, and in the age group 65-74 it was also 21.1 per cent lower than the expected mortality. The frequency of malignant disease in different organs appears in <b>Table 5</b>. In none of the present cases was the disease a result of the amputation (<b>Table 8</b>).</p> <h4>Accidents</h4> <p>Accidents were the cause of death in 72/687 cases (10.5 per cent). The actual figures were in all age groups lower than the expected. In the age group under 24, the recorded number of deaths was 78.3 per cent lower than the expected mortality; in the group 25-44 years it was 36.2 per cent lower; in the group 45-64 years it was 24.1 per cent lower. The actual total mortality was 34.2 per cent lower than the expected. This group includes 17 (2.5 per cent) traffic accidents, but these could not be separately analyzed, because traffic accidents are not treated as a separate group in the Statistical Yearbook (<b>Table 8</b>).</p> <p>It thus appears that the mortality from accidents was markedly lower among the amputees than in the general population. It might have been expected that amputees would be more accident-prone both at work and in the traffic, owing to their poorer mobility. The small proportion of traffic accidents among the total number of cases is also striking. Obviously, the amputees move about less than the general population, work at less dangerous places, and are, perhaps, employed to a lesser extent owing to their reduced working capacity.</p> <h4>Suicides</h4> <p>Since about 80 per cent of the suicides are committed by men, it seemed reasonable to use this age distribution as a basis when the expected mortality was calculated in the same way as for the other causes of death. The actual figures for the periods 1955-1959 and 1960-1964 are 68.1 and 36.0 per cent higher than the expected figures. The total number of suicides (63) for the period 1945-1964 is 37.3 per cent greater than the expected number. The greatest difference is noted for the period 1945-1949, the recorded frequency of suicides being 3.6 times higher (260.0 per cent) than the expected (<b>Table 8</b>). By contrast, the figure for 1950-1954 is 73.4 per cent lower than the expected mortality. If these two 5-year groups are added together the difference by which the actual frequency of suicides exceeds the expected has changed to a decrease (-13.8 per cent).</p> <p>It appears that among amputees under 25 years of age, suicides were 300.0 per cent higher, and in the age group 25-44 years 53.8 per cent higher than was to be expected on the basis of the statistics for the general population. By contrast, the number of suicides committed by amputees aged 65-74 years was within 0.2 per cent of the expected figure. The total actual number of suicides exceeds the expected figure by a difference of 37.3 per cent (<b>Table 8</b>).</p> <p>In addition, the rate of suicides among the dead amputees with the same occupation has been calculated. In this respect there is no major difference between heavy labor and other occupations. Technicians have the lowest rate of suicide, those with unknown occupations the highest. With regard to the former, it may be pointed out that their occupation is highly suitable for amputees, while the latter group includes subjects without regular employment, who lived in poor social conditions.</p> <p>The possible relationship between the rate of suicides and the level and site of the amputation is analyzed in <b>Table 9</b>. Among lower-limb amputees the frequency of suicide was twice the frequency among upper-limb amputees. However, when the whole series is taken into account, the difference is not very great, the number of lower-limb amputees being double the number of upper-limb amputees.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The methods of suicide appear in <b>Table 5</b>. Alcohol abuse was known to have played a part in 11 cases, and 6 subjects had used barbiturates in addition. This group of 63 consists of only sure cases of suicide. In the group of accidents, at least a slight suspicion of suicide was present in many cases.</p> <h3>Summary and Discussion</h3> <p>In a series of 4782 war amputees, the total mortality was 687 (14.4 per cent). The period covered by the present study is from 1945 till the end of 1965. In 1960, the mortality of the war amputees began to rise abruptly, and was one of the causes for undertaking this study. This mortality was compared to the mortality in the general Finnish male population. A theoretical, equivalent male population was constructed on the basis of data obtained from the Statistical Yearbook of Finland.</p> <p>When the causes of death were not differentiated, the mortality of the amputees was found to be in good agreement with the mortality of the general population. This obtains to both the whole series and the different 5-year periods. There was even a tendency towards slightly lower figures for the amputees.</p> <p>On the other hand, when the causes of death were differentiated, certain features of interest emerged. The recorded death rates were higher than the expected figures with regard to degenerative diseases of the central nervous system ( + 71.2 per cent), degenerative cardiac and vascular diseases ( + 63.1 per cent), and suicide (+37.3 per cent). These were the causes of death in half the cases. One-fourth of the deaths were due to pulmonary tuberculosis or malignant disease. In both these groups the actual death rate was lower than the expected ( - 24.9 per cent and - 19.6 per cent). In the age group under 25, the mortality in pulmonary tuberculosis was 2.7 times higher than in the corresponding group of the general population, but in all other age groups it was lower than the expected death rate. The number of deaths due to accidents (72) fell below the expected mortality by 34.2 per cent. Obviously, amputees move about considerably less than the general population, and they are less exposed to accidents owing to their limited working capacity.</p> <p>In order to give a general survey of the findings, the main causes of death are listed in <b>Table 8</b>. In addition to the number of deaths, the mortality in each group is expressed as a percentage. Likewise, the expected mortality is given both in absolute figures and as percentages, and the differences between the actual and expected figures are indicated in percentages. In this connection, it has been assumed that the total expected mortality is the same as the actual mortality, as was also suggested by the analysis of the total mortality carried out at the beginning of this study. The amputees seem to be more afflicted with fatal degenerative diseases of the central nervous system and fatal degenerative cardiac and vascular diseases, and suicides seem to be more common among them, as compared with the general population. On the other hand, the mortality from pulmonary tuberculosis, accidents, and a large group of miscellaneous diseases <i>(e.g., </i>various diseases of the lungs and abdominal disorders), was lower among the amputees than in the general population.</p> <p>It may be assumed that the higher frequency of suicides among the amputees is due in part to psychological causes connected with the loss of a limb. Also, a postwar depression may have become more pronounced with the lapse of time. Economic problems and poor social conditions may be regarded as contributory causes.</p> <p>In the care of amputees, the factors of importance are: a satisfactory prosthesis, good condition of the stump, rehabilitation, suitable employment, and judiciously administered subvention. The question arises as to whether all that could have been done for the war amputees was done. Perhaps something had been neglected that could have prolonged the lives in some cases.</p> <p><b>References:</b></p> <ol> <li>Bodechtel, G., <i>Klinik des veget</i>. Nervensystems, Verh. Deutsch. Ges. Inn. Med., 57: 1948.</li> <li>Loon, H. E., <i>Biological and biomechanical principles in amputation surgery</i>, Prosthetics international, Copenhagen, 1960.</li> <li>Loos, H. M., <i>Klinische und statistiche Ergebnesse des Blutdruckuerhaltens bei Amputierten</i>, Medizinische, 29:1050, 1957.</li> <li>Meyeringh, H., and H. Stefani, <i>Besteht nach einer Amputation des Oberschenkels eine Neigung zur Adipositas und zur Hyperextension</i>? Deutsch. Med. Wschr., 81:10, 1956.</li> <li>Meyeringh, H., H. Stefani, and G. Cimbal, <i>Herz und Amputation: Eine klinische EKG Studie</i>, Deutsch. Med. Wschr., 85:9, 1960.</li> <li>Rausche, C, <i>Uber den Zusammenhang zwischen Amputation und arteriellem Hochdruck</i>, Med. Klin., 35:1418, 1939.</li> <li>Schneider, K. W., according to G. Schletter, in A. W. Fischer, R. Herget, and G. Molineus, <i>Das artzliche Gutachten im Versicherungs-wesen</i>, Johann Ambrosius Barth, Munchen, 1955.</li> <li>Schulze, K., according to G. Schletter, in A. W. Fischer, R. Herget, and G. Molineus, <i>Das drtzliche Gutachten im Versicherungswesen</i>, Johann Ambrosius Barth, Munchen, 1955.</li> <li>Solonen, K. A., H. J. Rinne, M. Viikeri, and E. Karvinen, <i>Late sequelae of amputation: The health of Finnish war veterans</i>. Ann. Chir. Gynaec. Fenn., Supplementum 138, 1965.</li> <li>Statistical Yearbook of Finland, 1945-1965, Central statistical office.</li> </ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>10.</b> </td><td class="clsTextSmall">Statistical Yearbook of Finland, 1945-1965, Central statistical office.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>9.</b> </td><td class="clsTextSmall">Solonen, K. A., H. J. Rinne, M. Viikeri, and E. Karvinen, Late sequelae of amputation: The health of Finnish war veterans. Ann. Chir. Gynaec. Fenn., Supplementum 138, 1965.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Loos, H. M., Klinische und statistiche Ergebnesse des Blutdruckuerhaltens bei Amputierten, Medizinische, 29:1050, 1957.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Meyeringh, H., H. Stefani, and G. Cimbal, Herz und Amputation: Eine klinische EKG Studie, Deutsch. Med. Wschr., 85:9, 1960.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Meyeringh, H., H. Stefani, and G. Cimbal, Herz und Amputation: Eine klinische EKG Studie, Deutsch. Med. Wschr., 85:9, 1960.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>1.</b> </td><td class="clsTextSmall">Bodechtel, G., Klinik des veget. Nervensystems, Verh. Deutsch. Ges. Inn. Med., 57: 1948.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>8.</b> </td><td class="clsTextSmall">Schulze, K., according to G. Schletter, in A. W. Fischer, R. Herget, and G. Molineus, Das drtzliche Gutachten im Versicherungswesen, Johann Ambrosius Barth, Munchen, 1955.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>7.</b> </td><td class="clsTextSmall">Schneider, K. W., according to G. Schletter, in A. W. Fischer, R. Herget, and G. Molineus, Das artzliche Gutachten im Versicherungs-wesen, Johann Ambrosius Barth, Munchen, 1955.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>6.</b> </td><td class="clsTextSmall">Rausche, C, Uber den Zusammenhang zwischen Amputation und arteriellem Hochdruck, Med. Klin., 35:1418, 1939.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>9.</b> </td><td class="clsTextSmall">Solonen, K. A., H. J. Rinne, M. Viikeri, and E. Karvinen, Late sequelae of amputation: The health of Finnish war veterans. Ann. Chir. Gynaec. Fenn., Supplementum 138, 1965.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>2.</b> </td><td class="clsTextSmall">Loon, H. E., Biological and biomechanical principles in amputation surgery, Prosthetics international, Copenhagen, 1960.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Georg Bakalim </b></td></tr><tr><td class="clsTextSmall">State Supervisor of Prosthetic Services, Ministry of Social Affairs, Helsinki, Finland.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1969_01_027/spring69-21.jpg Figure 2 http://www.oandplibrary.org/al/images/1969_01_027/spring69-22.jpg Figure 3 http://www.oandplibrary.org/al/images/1969_01_027/spring69-23.jpg Figure 4 http://www.oandplibrary.org/al/images/1969_01_027/spring69-24.jpg Figure 5 http://www.oandplibrary.org/al/images/1969_01_027/spring69-25.jpg Figure 6 http://www.oandplibrary.org/al/images/1969_01_027/spring69-26.jpg Figure 7 http://www.oandplibrary.org/al/images/1969_01_027/spring69-27.jpg Figure 8 http://www.oandplibrary.org/al/images/1969_01_027/spring69-28.jpg Figure 9 http://www.oandplibrary.org/al/images/1969_01_027/spring69-29.jpg Figure 10 http://www.oandplibrary.org/al/images/1969_01_027/spring69-30.jpg Figure 11 http://www.oandplibrary.org/al/images/1969_01_027/spring69-31.jpg Figure 12 http://www.oandplibrary.org/al/images/1969_01_027/spring69-32.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 Causes of Death in a Series of 4738 Finnish War Amputees Creator An entity primarily responsible for making the resource Georg Bakalim * https://staging.drfop.org/files/original/69e82431a397885067840fb6bbdf7480.jpg 52d97f0792155a612a44e2ce8256fe13 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 Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.camo.org Contact Name/Title Kathryn Tschiegg - Director Address 322 Westwood Avenue City Orrville State/Province Ohio Countries Served USA Regions: Central AmericaCountries: HondurasSpecific cities, regions, or groups of people: Western HondurasAge Group: Adults, ChildrenFees Charged: Sometimes Postal Code 44667 Phone 330-683-5956 Fax 330-683-9978 Email camo@camo.org Organization Type Including ID and tax status Non-Profit Tax ID 34-1740695 Not-for-profit Type 501C-3 Services Provided Prosthetic Fitting, Orthotic Fitting, Medical Equipment / Supplies, Education, Funding, Prosthetic Fabrication, Orthotic Fabrication, Medical / Surgical Care, Rehabilitation / TrainingThere is a facility/physical building for patient care at the specified location. Accomodations for volunteers near or at the specified location. Need I Financial Assistance Need II Materials, Components, and Equipment Need III Materials, Components, and Equipment: New, Disassembled, Equipment, Used, Medical Supplies Additional Info & Comments In order to fulfill demand, CAMO is always in need of prosthetic and orthotic components, financial assistance and co-polymer plastic. 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 Central American Medical Outreach, Inc. https://staging.drfop.org/files/original/dca562c934e6c03968ea74fbd3ff1f31.pdf 573718b9201606fcbfbf62993cef40b0 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_02_001.pdf Text Any textual data included in the document <h2>Cervical Orthoses</h2> <h5>Charles H. Pritham, CPO&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Orthoses are fit for the control of motion about a joint or joints. By extension, cervical orthoses are fit to control motion of the cervical spine. Such orthoses are provided to patients for a wide variety of conditions ranging from the merely inconvenient on one end of the spectrum to the life threatening at the other end. In response to this need, a plethora of devices have been described; a review of the literature and of manufacturers' catalogs will reveal a positive galaxy of orthoses, all described as being of great efficacy and many differing from others in matters of only minor detail. What seems to be lacking is any systematic and quantitative assessment of the various orthoses' merits and a rational scheme for their use. While it may be overstating the case, it seems that most individuals in various parts of the country rely on two rules of three: selecting from the panoply available three orthoses graded as minimally, moderately, and maximally immobilizing; and fit in terms of small, medium, and large. Which orthoses are selected is shaped by local preference, training, and experience among other factors.</p> <p>In contrast to other areas of orthotics, the topic of cervical orthotics can be described as a stepchild or plain shoe. Since the end of World War II, other areas of orthotics have been radically reshaped (lower limb orthotics and spinal orthotics for scoliosis and kyphosis) by the application of new knowledge, new technology, and new philosophies of treatment. Upper limb orthotics occupies the middle ground: it's not that the effort has not been made, just that the results have been less than totally successful.</p> <p>It would, of course, be fallacious to suggest that no effort at all has been made to elucidate in some rational fashion the prescription of cervical orthoses. James D. Harris, D.O., in his review of cervical orthoses in Orthotics Etcetera, 2nd Ed. <a></a> cites a variety of references which used such means of measuring cervical motion as goniometry, cineradiography, and still radiography to assess the immobilizing affects of various orthoses. He further used these references and descriptions of effectiveness in his comparisons of a variety of orthoses. Rollin M. Johnson and his coworkers <a></a> used their original studies for a similar purpose. The impression remains, however, that while useful work has been done, the effects of it have been relatively small scale, and much remains to be done. This point of view is endorsed by the results of a workshop panel convened in 1977 <a></a>. It would seem that there exists a genuine need for research to be conducted comparing the efficacy of various orthoses with an eye towards developing a rational basis for prescription and for the results to be widely disseminated.</p> <p>The contrary point of view can, of course, be argued. Those instances that are truly life threatening are relatively few, usually promptly recognized, and are best managed aggressively with immobilization, confinement to bed and even surgery. For the rest, cervical orthoses are generally prescribed for episodic and short term relief of pain. Even if prescribed with an orthosis that does not perfectly match the need, patients limit their activities in response to pain and if necessary a new orthosis can be prescribed. Under the circumstances a basic measure of common sense illuminated by experience will serve to assess the competing claims of similar orthoses and match a particular orthosis with a particular situation.</p> <p>It would also be fallacious to argue that no improvements in technology have been made. While such developments as the Philadelphia Collar and the S.O.M.I. can be cited, the foremost example is the Halo. Originally a specialized device applied in specialized centers for relatively few indications, it has, in the guise of the Halo-vest, come to be widely used in instances where maximal immobilization and possibly distraction are needed. While intimidating in appearance and implications, the evidence is that the technique is readily mastered, and that the device is well tolerated by patients. However, the possibility of such complications as pin-site infections, penetration of the skull, and loosening do exist. As a result of these reasons and the generally felt need for something less drastic, if equally effective, calls have been made for a non-invasive halo <a></a>.</p> <p>In response, Wilson, Hadjipavlou, and Berretta <a></a> described "A New Non-Invasive Halo Orthosis ..." in 1978. Fundamentally, this is a S.O.M.I. orthosis modified by the substitution of a low temperature thermoplastic skull-cap for the occipital piece. The authors cited experience treating 20 cases of unstable fractures and cineradiographic studies to support their contention that "this orthosis is almost the treatment of choice whenever rigid immobilization of the cervical spine is indicated."</p> <p>In a similar vein, Rubin, Dixon, and Bernkopf <a></a> described in 1978 another modification of the S.O.M.I. In this device the mandibular piece was removed and two pads pressing in under the zygomatic arches where substituted. In addition, a "cranial vertex pad" rigidly fixed to the occipital pad and flexibly connected to the zygomatic pads was added. The authors showed radiographic and photographic evidence of near rigid immobilization of the cervical spine of one subject. However, they cautioned that the device was intended for relatively brief use, specifically for the removal of trauma patients to a hospital by trained paramedics, and they further speculated as to the unknown effects of long-term pressure on the zygomatic arches.</p> <p>Interestingly enough, both Harris <a></a> and Rubin, et al <a></a> refer to a device described by Boldrey in 1945. It is described as a rigid cap encompassing the posterior and lateral aspects of the skull with a forehead strap and sub-zygomatic pads. It was connected by a posterior steel upright to padded thoracic and lumbar bands with over the shoulder extensions and straps.</p> <p>None of these variations are commercially available. One further point needs to be considered: Harris <a></a> cites evidence of Hartman, et. al. that the Guilford Orthosis is 90-95% effective in restricting motion. Therefore, does the need for a non-invasive halo really exist?</p> <p>In any event, it is apparent that the subject of cervical orthotics is one that has received scant attention. What is not so apparent is whether or not such attention is vitally needed.</p> <p><b>References:</b></p> <ol> <li>Harris, James D., "Cervical Orthoses," <i>Orthotics Etcetera 2nd Ed.</i>, edited by James B. Redford, M.D., Williams and Wilkins, Baltimore, MD, 1980, pp. 100-122.</li> <li>Johnson, R.M.,; Hart, D.L.; Simmons, E.F.; Ramsby, G.R.; and Southwick, W.O., "Cervical Orthoses, A Study Comparing Their Effectiveness in Restricting Cervical Motion in Normal Subjects," <i>JBJS</i>, Vol. 59-A, No. 3, April 1977, pp. 332-339.</li> <li>Johnson, R.M.; Owen, J.R.; Hart, D.L.; and Callahan, R.A., "Cervical Orthoses: a Guide to their Selection and Use," <i>Clinical Orthopaedics and Related Research</i>, No. 154, Jan.-Feb. 1981, pp. 34-35.</li> <li>Edmonson, A.S.; et al., "Report-Panel on Spinal Orthotics" <i>Orthotics and Prosthetics</i>, Vol. 31, No. 4, pp. 67-71, Dec. 1977.</li> <li>Wilson, C.L.; Hadjipavlou, A.G.; and Berretta, G., "A New Non-Invasive Halo Orthosis for Immobilization of the Cervical Spine," <i>Orthotics and Prosthetics</i>, Vol. 32, No. 1, March 1978, pp. 16-19.</li> <li>Rubin, G.; Dixon, M.; and Bernknopf, J., "An Occipito-Zygomatic Cervical Orthosis Designed for Emergency Use-A Preliminary Report," <i>Bulletin of Prosthetics Research</i>, BPR 10-29, Spring 1978, pp. 50-64.</li> </ol> <div style="width: 400px;"><em><b>*Charles H. Pritham, CPO </b> Durr-Fillauer Medical, Inc., Orthopedic Division, Chattanooga, TN. Editor, Clinical Prosthetics and Orthotics-C.P.O</em></div> <div style="width: 400px;"><br /><br /></div> Page Number(s) 1 - 2 Year 1983 Volume 7 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 Cervical Orthoses Creator An entity primarily responsible for making the resource Charles H. Pritham, CPO * https://staging.drfop.org/files/original/2740ce76b24d219b3639249da803f0f6.jpg 72d6b8beda7396d8d0a61e1150e61c01 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 Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.childrenoftheamericas.org Contact Name/Title Rosemary Vance - Director Address 537 Arcadia Park City Lexington State/Province Kentucky Countries Served USA Regions: Central AmericaCountries: GuatemalaSpecific cities, regions, or groups of people: San Juan, Sacapetequez, Flores, Jalapa, Port Barrios, Huehuetenango and Guatemala City.Age Group: Adults, ChildrenFees Charged: No Postal Code 40503 Phone 859-338-5543 Fax (859) 257-8933 Email green71957@aol.com Organization Type Including ID and tax status Non-profit Not-for-profit Type 501C-3 Services Provided Prosthetic Fitting, Orthotic Fitting, Medical Equipment / Supplies, Education, Funding, Prosthetic Fabrication, Orthotic Fabrication, Medical / Surgical Care, Rehabilitation / TrainingThere is a facility/physical building for patient care at the specified location. Accomodations for volunteers near or at the specified location. Need I Financial Assistance Need II Volunteers: Prosthetists, Orthotists, Lay Persons, Physicians, Nurses, Therapists Need III Materials, Components, and Equipment: New, Equipment, Medical Supplies 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 Children of the Americas