1 20 371 https://staging.drfop.org/files/original/4dd6d94c1daa2cb68cd4f392331932db.pdf 259046e83e06f18b250ccc9220f4934a https://staging.drfop.org/files/original/2d3c637c51e5be4ea4a9b4f22c646846.jpg 11fee075823dd0fa5b865a8e747525dc https://staging.drfop.org/files/original/71f334ea18c694ea04b3d9b1f08a2253.jpg f7ec0a39eb5bbe47b310aa1f57a3d155 https://staging.drfop.org/files/original/6a0443994001a210b073e6923907b80a.jpg f8dcbc9d4224aa5e9cbb3f44145131fb https://staging.drfop.org/files/original/9263685d4481876c0d4e9272dd4ebeea.jpg d0d533d69cdfefbd4d631caee28aa13c https://staging.drfop.org/files/original/98f2d20450ad3768fbb296aef6b3bf20.jpg 74771fdcfdd89388647e71b2b29d843c https://staging.drfop.org/files/original/c55b28bda436388da75e3eee453c6c75.jpg 722fd6cb26bbb613bcdda96faad136a5 https://staging.drfop.org/files/original/46575d89fa490b67fd583a23dbb0eba1.jpg 1d6a709393590127cca18e095b03d7c1 https://staging.drfop.org/files/original/03efb5bd9a7aa0a4e0c7536b11d81944.jpg b8ab156ee418e2e7f14c6f781ad91ddc https://staging.drfop.org/files/original/9b3dd80c9f94cac1f8d03173ac09fa29.jpg 2cc8730d37d1046df4e01ae577b08e1a DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1966_01_024.pdf Year 1966 Volume 2 Issue 1 Page Number(s) 24 - 35 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/1966_01_024.pdf"></a></td> <td></td> <td><a href="al/pdf/1966_01_024.pdf">View as PDF</a></td> </tr> <tr> <td>with original layout</td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Nomenclature for Congenital Skeletal Limb Deficiencies, a Revision of the Frantz and O'Rahilly Classification</h2> <h5></h5>  Report of the Consultants to the Subcommittee on Child Prosthetics - Problems of the Committee on Prosthetics Research and Development: Cameron B. Hall, M.D., Los Angeles, Calif. Claude N. Lambert, M.D., Chicago, Ill. Ronan O'Rahilly, M.D., St. Louis, Mo. Chester A. Swinyard, M.D., Ph.D., New York, N.Y. Prepared by Robert L. Burtch, M.A.,<a style="text-decoration:none;">*</a> Research Scientist, Prosthetic and Orthotic Studies, New York University Post-Graduate Medical School, under the supervision of Sidney Fishman, Ph.D., Project Director, and Hector W. Kay, M.Ed.,<a style="text-decoration:none;">*</a> Associate Project Director, Prosthetic and Orthotic Studies, New York University Post-Graduate Medical School. At the request of the Subcommittee on Child Prosthetics Problems of the Committee on Prosthetics Research and Development, Child Prosthetic Studies, New York University, initiated a study of congenital skeletal limb deficiencies during March 1963<a></a>. The primary purpose of this initial effort was to determine the adequacy of the classification nomenclature for congenital skeletal limb deficiencies proposed by Drs. Charles H. Frantz and Ronan O'Rahilly<a></a> and of a description-classification form developed by NYU Child Prosthetic Studies. The results of the evaluation<a></a> indicated that 471 of 577 limbs (85 per cent) were classifiable within the framework of the Frantz-O'Rahilly system. In the light of these generally favorable results, the Subcommittee on Child Prosthetics Problems appointed a group of consultants (Drs. Cameron B. Hall, Claude N. Lambert, Ronan O'Rahilly, and Chester A. Swinyard) to consider possible ways and means by which the Frantz-O'Rahilly plan might be modified to provide an even more comprehensive system for classifying limb deficiencies. In the course of several joint meetings of the consultants and the NYU staff, a revised system was developed. The revised system generally follows the basic principles proposed by Drs. Frantz and O'Rahilly, in that: first, it is based on a description of absent skeletal parts; second, deficiencies are classified under the two basic headings, Terminal and Intercalary, with subgroups of Transverse and Longitudinal under each of these headings. However, the use of anatomical terms has been extended significantly and is included in the classification of all deficiencies. Thus the use of such clinical descriptive terms as hemimelia, peromelia, ectromelia, phocomelia, dysmelia, etc., has been eliminated. Only two basic descriptive  terms are now proposed: Amelia, or complete absence of a free limb, and meromelia, or partial absence of a free limb. The latter term is a derivative of the Greek meros (part or partial) and melos (limb). The use of the revised nomenclature adheres to procedures set forth in the Standard Nomenclature of Diseases and Operations <a></a>. The classification of a given deficiency, therefore, proceeds from the general to the specific, citing absent skeletal elements for definitive identification. For example, Meromelia: Terminal Longitudinal; Metacarpal: I, II, III describes a terminal longitudinal deficiency of the hand involving absence of digital rays I, II, and III. To provide a basis for possible international consideration, the anatomical terminology utilized in this system is consistent with Nomina Anatomica.<a></a> Since x-rays and the resulting classification may be expected to change depending on the degree of maturation (for example, tarsals and carpals), cases where ossification is continuing must be reclassified periodically. The material related to the revised classification system is presented in five parts: <blockquote> <ol> <li>A definition of the terms and symbols employed.</li><li>Two charts (II. a. and II. b.) adapted from articles by Dr. Hall et al. <a></a> and Dr. O'Rahilly<a></a> to facilitate understanding of the basic principles involved.</li><li>A detailed, illustrated description of the classification plan.</li><li>A description-classification form used for recording purposes.</li><li>Instructions for use of the description-classification form.</li></ol> </blockquote> <ol> <li>TERMS AND SYMBOLS <ul> <li>TERMS <ul> <li>Amelia - Complete absence of a free limb (exclusive of girdle).</li> <li>Meromelia - Partial absence of a free limb (exclu- sive of girdle).</li> <li>Terminal - Absence of all skeletal elements distal Deficiency to the proximal limit of the defi- ciency, along the designated axis (longitudinal or transverse).</li> <li>Intercalary Deficiency - Absence of middle part(s) lying between a proximal-distal series of limb components; elements proximal to and distal to the absent part(s) are present.</li> <li>Transverse - Absence extending across the width of the limb.</li> <li>Longitudinal - Absence extending parallel with the long axis of the limb (forearm and/or hand, or leg and/or foot), either pre-axial, postaxial, or (as in the hand or foot) central in nature.</li> <li>Pre-axial Absence of the portion of the fore- arm and/or hand, or leg and/or foot on the thumb or the great-toe side of the limb (radial or tibial portion).</li> <li>Postaxial - Absence of the portion of the fore- arm and/or hand, or leg and/or foot on the side of the limb opposite the thumb or the great toe (ulnar or fibular portion).</li> <li>Central - Absence of one or more of the intermediate digital rays (for example, Ray III).</li> <li>Rudimentary - A remnant of an osseous element. If the remnant is identifiable (for example, the humerus), the term "rudimentary humerus" would be applicable. If the remnant cannot be identified, the symbol "X" (unknown) would be cited (for example, "rudimentary X").</li> <li>Ray - A digit.</li> </ul></li> <li>SYMBOLS <ul> <li>I - Intercalary.</li> <li>T - Terminal.</li> <li>- - Transverse.</li> <li>/ - Longitudinal</li> <li>Pre - Pre-axial.</li> <li>Post - Postaxial.</li> <li>? - Questionable identity of element cited (for example, radius ?).</li> <li>X - Unknown (unidentifiable).</li> <li>:I, II, III, IV, or V - Digital ray(s) involved, starting from pre-axial to postaxial side of limb.</li> </ul></li> <li>SKELETAL ELEMENTS Capital letters are used to identify skeletal elements that are completely absent; small (lower case) letters are used to identify skeletal elements that are partially absent. If the word identifying the skeletal element is written out, the first letter of the word is capitalized when the element is completely absent (for example, Humeral), and in lower case when only partially absent (for example, humeral). <ul> <li>HU or hu - Humeral.</li> <li>U or u - Ulnar.</li> <li>R or r - Radial.</li> <li>CA or ca - Carpal.</li> <li>TI or ti - Tibial.</li> <li>FI or fi - Fibular.</li> <li>TA or ta - Tarsal.</li> <li>MT or mt - Metatarsal.</li>  <li>MC or mc - Metacarpal.</li> <li>PH or ph - Phalangeal.</li> <li>FE or fe - Femoral.</li> <li>PP or pp - Phalanx Proximal.</li> <li>PM or pm - Phalanx Middle.</li> <li>PD or pd - Phalanx Distal.</li> </ul></li> <li>SKELETAL SEGMENTS <ul> <li>P - Proximal third of element cited.</li> <li>M - Middle third of element cited.</li> <li>D - Distal third of element cited.</li> <li>The symbols P, M, and D are used to indicate thirds of the skeletal elements cited, which may be completely or partially absent. Utilization of the three symbols requires the following clarification:</li> </ul></li> <li>TERMINAL TRANSVERSE (T-) DEFICIENCIES <ul> <li>P - absence of part of the proximal third of the skeletal element cited and everything distal to it.</li> <li>M - absence of all or part of the middle third of the skeletal element cited and everything distal to it.</li> <li>D - absence of all or part of the distal third of the skeletal element cited and everything distal to it.</li> </ul></li> <li>TERMINAL LONGITUDINAL (T/) DEFICIENCIES <ul> <li>P - absence of part of the proximal third of the skeletal element cited and everything distal to it parallel with the same axis. </li> <li>M - absence of all or part of the middle third of the skeletal element cited and everything distal to it parallel with the same axis. </li> <li>D - absence of all or part of the distal third of the skeletal element cited and everything distal to it parallel with the same axis.</li> </ul></li> <li>INTERCALARY TRANSVERSE (I-) DEFICIENCIES AND LONGITUDINAL (I/) DEFICIENCIES <ul> <li>P - absence of all or part of the proximal third of the skeletal element cited.</li> <li>M - absence of all or part of the middle third of the skeletal element cited.</li> <li>D - absence of all or part of the distal third of the skeletal element cited.</li> </ul></li> </ul></li><li> <ol> <li>BASIC SCHEMA FOR CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES - Fig. 1 presents a basic schema for the classification of congenital skeletal limb deficiencies which has been adapted from one originally presented by Dr. Cameron B. Hall et al. .<a></a></li><li>BASIC SCHEMA FOR CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES - Fig. 2 presents a basic schema for the classification of congenital skeletal limb deficiencies which has been adapted from one originally presented by Dr. Ronan O'Rahilly.<a></a></li></ol> </li><li>CLASSIFICATION NOMENCLATURE <ol> <li>Terminal Transverse (T-) Deficiencies ( Fig. 3 and Fig. 4)</li><li>Amelia - complete absence of a free limb (exclusive of girdle). (For example, Amelia: T-; Upper Right.)</li><li>Meromelia - partial absence of a free limb (exclusive of girdle). <ol> <li>Humeral or Femoral (P, M, or D) - Partial absence of the humerus or femur and all distal elements.(For example, Meromelia: T-; humeral D (distal third above-elbow-type stump).)</li><li>Radio-Ulnar or Tibio-Fibular <ol> <li>Complete absence of the Radius and Ulna or Tibia and Fibula, and all distal elements. (For example, Meromelia: T-; Radio-Ulnar (elbow-disarticulation-type stump).)</li><li>Partial absence of the radius and ulna or tibia and fibula, and all distal elements. Use P, M, or D, as appropriate.(For example, Meromelia: T-; radio-ulnar M (short below-elbow-type stump).)</li><li>Complete absence of one of the forearm or leg elements, and all distal elements. (For example, Meromelia: T-; Radius (wrist-disarticulation-type stump).)</li></ol> </li><li>Carpal or Tarsalol - Complete absence of all hand or foot elements. (For example, Meromelia: T-; Tarsal (ankle-disarticulation-type stump).)</li><li>Carpal or Tarsal, Distal - Absence of the distal row of carpals or tarsals, and all other hand or foot elements distal to this level.(For example, Meromelia: T-; carpal, Distal (mid-carpal-type stump).) <ol> <li>Carpal or tarsal, Pre- or Postaxial - Absence of either the pre- or postaxial carpal or tarsal bones, and all other hand or foot elements. (For example, Meromelia: T-; carpal, Pre-axial (carpal-metacarpal-type stump).)</li><li>Metacarpal or Metatarsal <ol> <li>Absence of all metacarpals or metatarsals and all hand or foot elements distal to this level. (For example, Meromelia: T-; Metatarsal (tarsal-metatarsal-type stump).)</li><li>Absence of a portion of metacarpals or metatarsals and all hand or foot elements distal to this level. Use P, M, or D to indicate absent segment(s) of each metacarpal or metatarsal. (For example, Meromelia: T-; metacarpal: I D, II D, III D, IV M, V M (trans-meta-carpal-type stump).)</li></ol> </li><li>Phalangeal <ol> <li>Absence of all phalanges from all five digits. (For example, Meromelia: T-; Phalangeal, Upper Right (metacarpo-phalangeal-type stump).)</li><li>Complete or partial absence of one or more phalanges from all five digits (but not all phalanges from all five digits).(For example, Meromelia: T-; phalangeal, Upper Right: I, II; III PM, IV PM, D; V PD (trans-phalangeal-type stump).)</li></ol> </li></ol> </li><li>Terminal Longitudinal (T/) Deficiencies (Fig. 5) <ol> <li>Major Long Bones <ol> <li>Complete absence of one of the forearm or leg elements and of the corresponding portion of the hand or foot. The skeleto-anatomical terms Radial (R), Ulnar (U), Tibial (TI), or Fibular (FI) are used to indicate the absent long bone. In order to provide greater precision, the identifying number of each absent ray is included in the nomenclature. (For example, Meromelia: T/; Radial: I, II.) If all but one unidentifiable ray or rudimentary  ray is absent, the symbol "X" (unknown) or term "rudimentary X" is used.</li><li>Partial absence of one of the forearm or leg elements and absence of the corresponding portion of the hand or foot. P, M, or D is used to indicate the absent segment (s) of the long bone. Lower case letters are used, and the absent ray(s) is cited. (For example, Meromelia: T/; fibular M: IV, V.)</li></ol> </li><li>Carpal or tarsal, Pre- or Postaxial - Absence of either the pre- or postaxial carpal or tarsal bones, and corresponding digital rays.(For example, Meromelia: T/; carpal, Pre-axial: I, II.)</li><li>Metacarpal or metatarsal (P, M, or D) <ol> <li>Absence of all phalanges of one to four digits and complete or partial absence of their respective metacarpals or metatarsals.(For example, Meromelia: T/; metacarpal: I, II, III, V.)</li><li>In the case of partial absence of a specific metacarpal or metatarsal, P, M, or D is used to indicate the absent segment (s).(For example, Meromelia: T/; metatarsal: I, II; III D; V M.)</li></ol> </li><li>Phalangeal Absence of all or part of one or more phalanges from one to four digits.(For example, Meromelia: T/; phalangeal, Upper Right: I, II, III.)</li></ol> </li><li>Intercalary Transverse (I-) Deficiencies (Fig. 6 and Fig. 7) A minimum of at least two digital rays (two metacarpals or metatarsals and their associated phalanges) must be present to permit classification as an Intercalary Transverse (I-) deficiency of the major long bones. In such cases, the hand or foot deficiencies (if any) are classified separately. Where there are fewer than two complete digital rays, the deficiency is classified as Terminal Transverse (T-), with a description of the distal digital elements that are absent (for example, "all but one ray absent"). <ol> <li>Major Long Bones <ol> <li>Humeral, Radio-Ulnar; or Femoral, Tibio-Fibular - Complete absence of all three major long bones in the limb with hand or foot elements attached directly to the trunk. (For example, Meromelia: I-; Humeral, Radio-Ulnar.)Concomitant hand or foot deficiencies are classified independently of the major long bone deficit. (For example, Meromelia: I-; Humeral, Radio-Ulnar; plus T/; metacarpal: I, II, V.)</li><li>Humeral or Femoral - Complete or partial absence of the long bone cited. (For example, Meromelia: I-; Humeral.)  If a partial absence exists, P, M, or D is added to indicate the absent segment (s) of the bone cited.(For example, Meromelia: I-; humeral M, D.)</li><li>Radio-Ulnar or Tibio-Fibular - Complete or partial absence of the long bone cited.(For example, Meromelia: I-; Radio-Ulnar.)If a partial absence exists, P, M, or D is used to indicate the absent segment (s) of each bone.(For example, Meromelia: I-; tibio-fibular P, M.)</li><li>Humeral, radio-ulnar; or femoral, tibio-fibular - Partial absence of all three major long bones in the upper or lower limb. P, M, or D is used to indicate the absent segment (s) of each long bone.(For example, Meromelia: I-; humeral D; radio-ulnar M, D.)</li></ol> </li><li>Carpal or Tarsal - Complete absence of the carpal or tarsal bones, with proximal and distal skeletal elements present.(For example, Meromelia: I-; Carpal.)</li><li>Metacarpal or Metatarsal - Complete absence of the metacarpals or metatarsals, with proximal and distal skeletal elements present. (For example, Meromelia: I-; Metacarpal.)</li><li>Phalangeal - Absence of all or part of the proximal and/or middle phalanx from all five digits. (For example, Meromelia: I-; phalangeal, Lower Right: I PP; II PP; III PM; IV PM; V PP.)</li></ol> </li><li>Intercalary Longitudinal (I/) Deficiencies (Fig. 8) <ol> <li>Major Long Bones <ol> <li>Complete absence of one of the forearm (R or U) or leg (TI or FI) elements with hand or foot elements intact along the same axis as the deficient long bone. (For example, Meromelia: I/; Fibular.)</li><li>Similar to above except that only part of the long bone cited is absent. P, M, or D is used to indicate the absent segment(s).(For example, Meromelia: I/; radial P, M.)</li></ol> </li><li>Carpal or tarsal, Pre- or Postaxial - Absence of either the pre- or postaxial carpal or tarsal bones with all other hand or foot elements present. (For example, Meromelia: I/; tarsal, Pre-axial.)</li><li>Metacarpal or metatarsal - Absence of all or part of one to four metacarpals or metatarsals.(For example, Meromelia: I/; metatarsal: I, II.) If only part of a metacarpal or metatarsal is absent, P, M, or D is used to indicate the absent segment(s) of the involved ray.(For example, Meromelia: I/; metatarsal: I D; II M, D.)</li><li>Phalangeal - Absence of all or part of the proximal and/or middle phalanx of from one to four digits. (For example, Meromelia: I/; phalangeal, Upper Left: I PP; II PM; IV PP.)</li></ol> </li></ol> </li><li>DESCRIPTION-CLASSIFICATION FORM Fig. 9 presents the description-classification form developed by NYU Child Prosthetic Studies for recording congenital skeletal limb deficiencies.</li><li>CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES The following instructions were developed by NYU Child Prosthetic Studies to accompany the description-classification form: <ol> <li>Fill in the identification items at the top of the page.</li><li>Indicate in the space provided the presence or history of congenital visceral, soft-tissue or skeletal anomalies other than those of the limbs; that is, cardiac, pulmonary, gastrointestinal (esophageal and/or duodenal atresia, imperforated anus, etc.); genito-urinary, for example, cryptorchidism; cleft palate, hare lip, congenital and/or structural scoliosis, spina bifida, etc.</li><li>Using a black pencil or pen, shade in all absent skeletal elements or parts of elements. If an anomaly has been converted to an amputation, describe and classify the original anomaly. Care should be taken to retain the approximate length and girth proportions when shading in partial elements. Using a red pencil or pen, also indicate on the appropriate limb the approximate site and date of the surgical conversion (s).</li><li>In cases where prosthetic restoration is appropriate, indicate the analogous functional level of amputation for prosthetic purposes (for example, short above-elbow, short below-elbow, long above-knee, etc.) in the space provided. Consult Upper and Lower Extremity Manual(s) for functional amputation levels.</li><li>Indicate next to the appropriate skeletal part on the diagram any of the following conditions that exist. Also, include any unlisted conditions present, as well as any additional information that will enhance the completeness of the description. <ul> <li>Synostosis - Contracture</li> <li>Hypoplasia - Pseudoarthrosis</li> <li>Bifurcation</li> <li>Valgus - Dislocation</li> <li>Varus - Subluxation</li> <li>Syndactylism - Supernumerary digit(s)</li> <li>Torsion - Soft-tissue nubbin(s)</li> </ul></li><li>After completing the description of each affectedlimb, insert in the appropriate space the appropriate classification nomenclature.</li></ol> </li></ol> </li></ol> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 1. Basic schema adapted from Dr. Cameron B. Hall et al. (5). </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 2. Basic schema adapted from Dr. Ronan O'Rahilly (6). The term "meromelia," denoting partial absence of a free limb, is applicable to all examples in the schema with the exception of the transverse deficiency of the complete limb which has been denoted as "amelia." </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 3. Terminal transverse (T-) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 4. Terminal transverse (T-) deficiencies (continued). The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 5. Terminal longitudinal (T/) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 6. Intercalary transverse (I-) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 7. Intercalary transverse (I-) deficiencies (continued). The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 8. Intercalary longitudinal (I/) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> Fig. 9. Description-classification form for recording congenital skeletal limb deficiencies. </td> </tr> </tbody></table> </td> </tr> </tbody></table> References: <ol> <li>Burtch, Robert L., A study of congenital skeletal limbdeficiencies, Inter-Clinic Information Bulletin, May 1963, pp. 1-6.</li> <li>Burtch, Robert L., The classification of congenitallimb deficiencies: A preliminary report, Inter-Clinic Information Bulletin, October 1963, pp. 4-9.</li> <li>Excerpta Medica Foundation (Amsterdam, London,ilan, New York), Nomina anatomica, 2nd ed., 1961.</li> <li>Frantz, C. H., and Ronan O'Rahilly, Congenitalskeletal limb deficiencies, J. Bone & Joint Surg., Boston, 43A:1202-1224, December 1961.</li> <li>Hall, C. B., M. B. Brooks, and J. F. Dennis, Congenital skeletal deficiencies of the extremities, J.A.M.A., Chicago, 181:590-599, August 1962.</li> <li>O'Rahilly, Ronan, Morphological patterns in limbdeficiencies and duplications, Am. J. Anat., Philadelphia, 89:155-187, September 1951.</li> <li>Thompson, Edward T., ed., Standard nomenclatureof diseases and operations, McGraw-Hill, New York, 1961.</li> </ol> <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;">Reference</td></tr><tr><td class="clsTextSmall">6. </td><td class="clsTextSmall">O'Rahilly, Ronan, Morphological patterns in limbdeficiencies and duplications, Am. J. Anat., Philadelphia, 89:155-187, September 1951.</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;">Reference</td></tr><tr><td class="clsTextSmall">5. </td><td class="clsTextSmall">Hall, C. B., M. B. Brooks, and J. F. Dennis, Congenital skeletal deficiencies of the extremities, J.A.M.A., Chicago, 181:590-599, August 1962.</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;">Reference</td></tr><tr><td class="clsTextSmall">6. </td><td class="clsTextSmall">O'Rahilly, Ronan, Morphological patterns in limbdeficiencies and duplications, Am. J. Anat., Philadelphia, 89:155-187, September 1951.</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;">Reference</td></tr><tr><td class="clsTextSmall">5. </td><td class="clsTextSmall">Hall, C. B., M. B. Brooks, and J. F. Dennis, Congenital skeletal deficiencies of the extremities, J.A.M.A., Chicago, 181:590-599, August 1962.</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;">Reference</td></tr><tr><td class="clsTextSmall">3. </td><td class="clsTextSmall">Excerpta Medica Foundation (Amsterdam, London,ilan, New York), Nomina anatomica, 2nd ed., 1961.</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;">Reference</td></tr><tr><td class="clsTextSmall">7. </td><td class="clsTextSmall">Thompson, Edward T., ed., Standard nomenclatureof diseases and operations, McGraw-Hill, New York, 1961.</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;">Reference</td></tr><tr><td class="clsTextSmall">2. </td><td class="clsTextSmall">Burtch, Robert L., The classification of congenitallimb deficiencies: A preliminary report, Inter-Clinic Information Bulletin, October 1963, pp. 4-9.</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;">Reference</td></tr><tr><td class="clsTextSmall">4. </td><td class="clsTextSmall">Frantz, C. H., and Ronan O'Rahilly, Congenitalskeletal limb deficiencies, J. Bone &Joint Surg., Boston, 43A:1202-1224, December 1961.</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;">Reference</td></tr><tr><td class="clsTextSmall">1. </td><td class="clsTextSmall">Burtch, Robert L., A study of congenital skeletal limbdeficiencies, Inter-Clinic Information Bulletin, May 1963, pp. 1-6.</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;">Footnote</td></tr><tr><td class="clsTextSmall">Since April 1, 1965, Mr. Kay has been serving as Assistant Executive Director, Committee on Prosthetics Research and Development, National Academy of Sciences—National Research Council, 2101 Constitution Ave., N.W., Washington, D. C. 20418.</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;">Footnote</td></tr><tr><td class="clsTextSmall">Since September 1, 1965, Mr. Burtch has been serving as Coordinator of the Physical Medicine and Rehabilitation Service, Maimonides Hospital—Coney Island Division, Ocean and Shore Parkways, Brooklyn, N.Y. 11235.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-001.jpg Figure 2 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-002.jpg Figure 3 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-003.jpg Figure 4 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-004.jpg Figure 5 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-005.jpg Figure 6 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-006.jpg Figure 7 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-007.jpg Figure 8 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-008.jpg Figure 9 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-009.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 Nomenclature for Congenital Skeletal Limb Deficiencies, a Revision of the Frantz and O'Rahilly Classification https://staging.drfop.org/files/original/a962e11e32431a447a3ce708cbc2efbd.pdf e6d793879e49c2715fac7901c9ab48ab DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1965_02_034.pdf Year 1965 Volume 9 Issue 2 Page Number(s) 34 - 43 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/1965_02_034.pdf"></a></td> <td></td> <td><a href="al/pdf/1965_02_034.pdf">View as PDF</a></td> </tr> <tr> <td>with original layout</td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Review of Visual Aids for Prosthetics and Orthotics</h2> <h5></h5> <h4>Prosthetics (General)</h4> "A Day in the Life of the Amputee," Hosmer-Dorrance, 1955, 26 min., color, silent, 16 mm. Summary: Presents a bilateral upper-extremity amputee as he performs a number of activities related to self-care, work, and recreation. These include fishing, bowling, gardening, dressing, eating, playing pool, driving a car, and lighting a cigarette. Evaluation: A technically well-executed film of a man who has acquired unusual skill in the use of the prostheses. It is recommended for upper-extremity amputees and for professional groups who wish to become familiar with the potential accomplishments of this type of amputee. Essentially, its purpose appears to be to encourage upper-extremity amputees to use prostheses and to develop maximal skill in their use. Distributor: A. J. Hosmer Corporation, P. O. Box 37, Campbell, Calif. 95008. "A Triple Amputee Steps Out," U.S. Veterans Administration, 1964, 25 min., color, sound, 16 mm. Summary: Shows the rehabilitation of a male adult with an above-knee amputation on one side, a below-knee amputation on the other, and a unilateral above-elbow amputation. The patient also suffers from heart and kidney complications that add to the difficulty of rehabilitation. Preprosthetic exercises and balancing activities are followed by ambulation with stubbies and, finally, with permanent prostheses and crutches. Evaluation: The level of rehabilitation for this severely involved patient appears unrealistic; and, although he finally ambulates, the gait is labored and unsteady. Use of the upper-extremity prosthesis, which would seem a more useful activity for this patient, is not discussed. This film has little place in paramedical teaching and would be of interest only to note the accomplishments of this unusual and highly motivated amputee. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D.C. 20420. "Diary of a Sergeant," U.S. War Department, 1945, 22 min., black and white, sound, 16 mm. Summary: The story of a soldier (Harold Russell) who, having lost both arms during World War II, wages a determined and successful fight to achieve success in the use of artificial limbs and to establish himself as a useful member of society. Evaluation: An excellent film for its era. It has lost much of its value, however, through the passage of time and today is primarily of historical interest. It deals with the emotional trauma involved in loss of arms and portrays the courage required by an amputee to achieve his rehabilitation goals. For these reasons, the film may still serve a purpose when used to motivate discouraged upper-extremity amputees or when shown to groups concerned with the emotional impact caused by crippling disease or injury. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D.C. 20420. "Dynamic Exercises for Lower-Extremity Amputees," U.S. Veterans Administration, 1959, 10 min., color, sound, 16 mm. Summary: Reviews normal gait and the relationships of body segments during walking. Following the physician's examination of the above-knee stump, the amputee patient demonstrates a series of dynamic exercises to develop balance, coordination, and strength. These exercises are part of a physical-therapy program that prepares the amputee to meet daily functional demands. Several amputee gaits are demonstrated. Evaluation: This is a large order for a ten-minute film, particularly since it goes beyond the scope of the title. The exercises per se are excellent, but the rate at which they are presented limits the use of the film as a teaching device. A patient-to-patient type of teaching contributes to some worthwhile scenes. The film is considered useful for those who are previously oriented in the techniques of dynamic exercises and who are experienced in working with amputees. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D.C. 20420. "Gait Analysis," Northwestern University Medical School, 1961, 27 min., color, sound, 16 mm. <a style="text-decoration:none;">*</a> Summary: Demonstrates the most common gait defects that may be seen in an above-knee amputee, including circumduction, abduction, vaulting, medial and lateral whips, instability of the knee, long prosthetic step, and others. The defects are shown on a subject wearing an adjustable above-knee prosthesis and are described in detail, then discussed as to possible causes, considering the amputee, the stump, and the prosthesis. Demonstrates a normal gait so that comparison between normal and abnormal gait can be made. The narration is conducted by a physician, a prosthetist, and a physical therapist, all faculty members of the Prosthetic-Orthotic Education Program at Northwestern University Medical School. A pocket-size folder that summarizes the material presented has been prepared for use as a handout at showings. Evaluation: This is a valuable teaching film. Ample time is allowed for the viewer to observe each gait deviation, making it possible for him to correlate the movie sequence with the material presented in the booklet that accompanies the film. Recommended for all medical groups concerned with the management of the lower-extremity amputee, including physicians, physical and occupational therapists, nurses, and prosthetists, at both the student and the graduate levels. The amputee patient would also benefit from seeing this film. Distributor: American Academy of Orthopaedic Surgeons, 29 East Madison St., Chicago, Ill. 60602. Rental Fee: $3.00. "New Geriatric Prostheses Adaptable to Bilateral Amputees," Waterbury Hospital, Waterbury, Conn., 1964, 10 min., color, silent, 16 mm. Summary: Describes an above-knee prosthesis designed for use by the geriatric patient and points out the advantages of certain modifications over the more conventional "temporary" prosthesis. Demonstrates the use of these prostheses as fitted to a bilateral amputee, a 64-year-old woman. Evaluation: This film would be of interest only to those who are dealing with the problems of prescribing, designing, or fabricating prostheses for the geriatric patient. The graphic description of the prosthesis is well presented. Distributor: Dr. Sung J. Liao, Director, Department of Physical Medicine and Rehabilitation, Waterbury Hospital, Waterbury, Conn. "New Legs," National Council for Care of Cripples, South Africa, 1960, 18 min., color, sound, 16 mm. Summary: Presents the case history of a young railway plate-layer who suffered an accident that ultimately resulted in a bilateral hip disarticulation. He is fitted with a pair of prostheses that incorporate double-action hip joints. Following a training program, he is shown walking with prostheses and crutches and participating in many physical activities with and without the prostheses. Evaluation: The purpose of this film is to encourage people living in South Africa to support rehabilitation through the purchase of Easter Seal stamps. Perhaps this accounts for the optimistic tone of this technically excellent picture. The amputee is unusually cheerful, physically agile, and well motivated, and his well-planned rehabilitation program is highly successful. This film might be of interest to the patient and family. For paramedical groups it is of interest only to show the potential achievement of one amputee with a bilateral hip disarticulation. Distributor: Film Library, International Society for Rehabilitation of the Disabled, 219 East 44th St., New York, N. Y. 10017. Rental Fee: $10.00. (No rental fee for members in good standing with the International Society.) "Normal Human Locomotion," University of California at Los Angeles, 1965, 3 hr., black and white, sound, 16 mm. Summary: This seven-reel film reproduces a classroom lecture as presented by Cameron B. Hall, M.D., in the UCLA courses in lower-extremity prosthetics. In his presentation, Dr. Hall graphically describes the normal pattern of human locomotion and explains it in terms of pertinent basic principles, including determinants of gait and mechanical forces. The film is printed at a contrast level that permits it to be shown in a partially lighted room, thereby allowing viewers to write on the illustrated lesson sheets provided with the film. Evaluation: The film is of special value. It encompasses a difficult subject on the basis of research from voluminous literature, and it is organized in a clear, concise, and understandable manner. No attempt is made to achieve a technically perfect film; it comes "as is" from the classroom. Dr. Hall's teaching methods, which include skillful execution of illustrations, a keen sense of timing, and--most important-a sequential, organized presentation of materials, combine to make this film an excellent teaching device for both students and instructors. The film is highly recommended for any professional person engaged in gait training or concerned with any aspect of human locomotion. Its use in undergraduate programs will vary according to the teaching talents of the faculty members and the curriculum content. If the length precludes showing it in one session, it can be shown in two or three sessions. It is recommended that instructors review the film in order to strengthen their own teaching methods and to determine in what way it can supplement or reinforce instruction in their own particular situation. Distributor: American Academy of Orthopaedic Surgeons, 29 East Madison St., Chicago, Ill. 60602. Rental Fee: $3.00. (The film may be retained by the borrower for a maximum time of two weeks. Requests for the film should indicate the number of lesson sheets desired.) "One Step at a Time," Rehabilitation Institute of Montreal, 1963, 15 min., black and white. sound, 16 mm. Summary: Portrays a unilateral above-knee amputee who is first seen walking with crutches but without an artificial limb. After considerable introspection, this young male decides to be prosthetically fitted. As the story unfolds, it depicts his reaction to the various steps in the rehabilitation program. The three key people responsible for the program-the physician, the physical therapist, and the prosthetist-are presented, and their roles are briefly explained. The prosthetist plays the major role in this film. Evaluation: The close-ups, the music, and the general tone of this picture are designed to show the emotional impact on the amputee of the various situations that evolve during the rehabilitation process. The movie is photographically artistic and technically good. Its use to professional people is limited, however, because of the superficial manner in which the material is handled. It appears to be directed toward the layman and especially toward the unfitted amputee. Distributor: National Film Board of Canada, 690 Fifth Ave., New York, N. Y. 10019. Purchase Cost: $75.00. (Available for review if viewer is interested in purchasing the film.) "Physical Therapy Management of a Bilateral Lower-Extremity Amputee," U.S. Army, (PMF 5382), 1964, 32 min., color, sound, 16 mm. Summary: Illustrates the progression of physical-therapy procedures in the management of the amputee, following the program from the day preprosthetic stump exercises are initiated until the time skillful use of the prostheses is achieved and the amputee-a military officer-is returned to duty as an instructor. The various procedures include bandaging of the above-knee and below-knee stump, joint measurement, stump exercises, stump hygiene, care of the suction socket, body-strengthening and balancing exercises, gait training and analysis, and advanced functional activities. Also, briefly presented are the principles involved in fitting two types of prostheses, the suction socket and the patellar-tendon-bearing socket. Evaluation: The film is technically superior and professionally sound. Of particular interest and worthy of mention are the well-presented progression of exercises, the clear graphic descriptions, the inclusion of training with the patellar-tendon-bearing prosthesis, and the portrayal of the exacting self-discipline required by the patient. Although the rehabilitation team is acknowledged, the film is presented entirely from the physical therapist's point of view. Because of the extensive amount of material in this film, its primary value lies in an orientation to a good physical-therapy program rather than its use in teaching skills. It is recommended for viewing by physical therapists and students, and also by any of the allied medical professions who have an interest in the management of the amputee. New amputees would also appreciate this preview of the treatment program. Distributor: Requests for Army Medical Service motion pictures should be directed to the Commanding General, Attn.: Audio-Visual Communication Center, of the Army Area in which the requesting individual or institution is located, as follows: First U.S. Army, Governors Island, N. Y. (includes Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont); Second U.S. Army, Fort George Meade, Md. (includes Delaware, Kentucky, Maryland, Ohio, Pennsylvania, Virginia, and West Virginia); Third U.S. Army, Atlanta, Ga. (includes Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee); Fourth U.S. Army, Fort Sam Houston, Tex. (includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas); Fifth U.S. Army, 1660 East Hyde Park Blvd., Chicago, Ill. (includes Colorado, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin, and Wyoming); Sixth U.S. Army, Presidio of San Francisco, Calif. (includes Arizona, California, Idaho, Montana, Nevada, Oregon, Utah, and Washington). "Some Biomechanical Methods for Evaluating Activities," VA Prosthetics Center, 1956, 18 min., color, magnetic sound {requires special projector), 16 mm. Summary: Shows some of the biomechanical methods used in the laboratory to measure the effectiveness with which both normal and handicapped people can perform various activities. Various photographic, mechanical, and electrical techniques are demonstrated. Evaluation: This interesting film deals with research methodology and is, therefore, of interest primarily to individuals engaged or interested in research. Distributor: Research and Development Division, Prosthetic and Sensory Aids Service, Veterans Administration, 252 Seventh Ave., New York, N. Y. 10001. "Suction Socket Artificial Limb," U. S. Veterans Administration, 1951, 24 min., color, sound, 16 mm. Summary: Describes the suction-socket prosthesis in terms of the anatomical principles involved in its fabrication and fitting. Presents the indications and contraindications for its prescription, emphasizing the importance of the emotional maturity of the patient. Demonstrates briefly gait abnormalities and training. Also illustrates check-out procedures. Evaluation: Although made in 1951, this excellent film is valuable in its presentation of a type of above-knee prosthesis that continues to be widely used. This film is of greatest value to physicians, prosthetists, and physical therapists, both staff and students. As background information, it could be useful for anyone concerned with the management of the above-knee amputee. Distributor: Research and Development Division, Prosthetic and Sensory Aids Service, Veterans Administration, 252 Seventh Ave., New York, N. Y. 10001. "The Urban Maes Amputation for Peripheral Vascular Disease," U. S. Veterans Administration, 1956, 14 min., color, sound, 16 mm. Summary: Demonstrates the Urban Maes operative technique of below-knee amputation in a patient with disease of compromised circulations. Shows the healed stump and joint range of motion some weeks later. Also presented are several other patients whose treatment management is similar. Several views of stumps are shown, and the patients are seen ambulating on a temporary pylon as well as on the permanent prosthesis. Evaluation: Primarily of value to physicians. Because of its relative simplicity, however, the film would be a good selection to illustrate a well-defined surgical procedure to individuals who have not observed actual surgery. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D.C. 20420. "Total Rehabilitation of a Bilateral High Upper-Extremity Amputee" U. S. Veterans Administration, 1959, 30 min., color, sound, 16 mm. Summary: Stresses the roles of all members of the rehabilitation team in the management of this amputee. Illustrates the team approach in establishment of the program-examination and supervision by the physician; preprosthetic preparation of the stump and an exercise program by the physical therapist; prosthetic training by the occupational therapist; and vocational guidance by the counselor. Most of the time in this film is devoted to occupational therapy, and the amputee is shown in several learning situations involving functional activities. Evaluation: The scenes that show how the patient encounters difficulty in performing normally simple chores and how the patient and the therapist work together to find an efficient method of performance are well presented. Although the film does not attempt to present a step-by-step prosthetic training program, the omission of any reference to solving toilet problems, a real concern with this type of amputee, is unfortunate. The team approach is somewhat overemphasized in the film, particularly insofar as the meetings are concerned. This film has teaching value for occupational therapy students and for occupational therapists who have had limited experience in working with patients with upper-extremity amputations. It may also be useful as an orientation for any paramedical group whose members are concerned with the management of the high upper-extremity amputee. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D. C, 20420. "Upper-Extremity Prosthetics," U. S. Veterans Administration, 1952, 23 min., color, sound, 16 mm. Summary: Presents two veterans, both of whom are upper-extremity amputees. One wears his prosthesis successfully; the other keeps his device in his desk. The film explains the dynamics leading to this difference. The successful patient is portrayed as the recipient of services offered in a well-planned amputee management program. The absence of such a program, together with other deterrent factors, is presented as the cause for the second patient's rejection of his original prosthesis. A program designed to correct his reluctance to wear the prosthesis is outlined. Evaluation: This film succeeds in achieving its objectives, as it clearly demonstrates the importance of good technical and psychological management of the amputee patient. It is not recommended as a teaching film, for it is lacking in its portrayal of the ideal training program. It is recommended as a general type film for paramedical groups and for patients who might be resistant to the intensive effort needed to obtain maximal use of the prosthesis. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D. C. 20420. "Upper-Extremity Prosthetic Principles," U. S. Veterans Administration, 1955, 29 min., color, sound, 16 mm. Summary: Demonstrates several interesting activities that were part of a research program aimed at improving upper-extremity prosthetic devices. Of special interest are the demonstration of normal movements of the human hand in a variety of grasping and gripping activities, an analysis of lost movements at various levels of upper-extremity amputation, and the types of upper-extremity prostheses appropriate for specific levels of amputation. Evaluation: As far as paramedical groups are concerned, this film is of interest to those who would like to be better informed about the development of prosthetic devices. It could be used to illustrate components of prostheses when these are not available, although it should be remembered that only those prosthetic devices in use prior to 1955 are included. Distributor: Central Office Film Library, Veterans Administration, Vermont Ave. and H St., N.W., Washington, D. C. 20420. <h3>Child Prosthetics</h3> "Adaptation of Children to Prosthetic Limbs," Michigan Crippled Children Commission, 1960, 20 min., color, optical and magnetic sound, 16 mm. Summary: Presents five children, including upper- and lower-extremity amputees, each of whom demonstrates a wide range of physical activities while wearing his prosthesis. The disability of the child and the indicated prosthetic fitting are also presented. Evaluation: This film demonstrates well how the artificial limb becomes an integral part of the body image at an early age. The remarkable skill and agility with which these children perform various physical activities are impressive. Some scenes are unnecessarily prolonged and repetitious. The technical quality of the film is not good, and prosthetically it is primarily of historical interest. Of possible interest to parents in demonstrating potential achievement. Distributor: Michigan Crippled Children Commission, The Area Child Amputee Program, 920 Cherry St., S.E., Grand Rapids, Mich. 49506. "Child Upper-Extremity Amputee," University of Michigan Medical Center, 1964, 19 min., color, sound, 16 mm. Summary: Presents ten child amputees and portrays their accomplishments in use of an upper-extremity prosthesis at specified ages, covering a span of several years in some instances. The x-rays of the involved extremities are shown, and a pictorial description of the amputation or limb deficiency is given. In cases of congenital amputees, diagnoses are given in terms of roentgenographical appearance. The type of prosthesis prescribed for each child and the changes necessitated by his growth and development are shown. Evaluation: A well-presented, informative film that graphically portrays the accomplishments that may be expected of the child amputee who has the advantage of an early treatment program. It points out clearly the disadvantage to the child when prosthetic fitting is delayed. An orientation film of a specialized nature, it should be of interest to any professional person involved in the care of the child amputee. Parents of child amputees could also benefit by seeing this film. It is recommended for public health nurses who are in a position to refer the young amputee to the amputee clinic. Distributor: Audio-Visual Education Center, University of Michigan, Frieze Building, 720 East Huron St., Ann Arbor, Mich. 48104. "Child Prosthetics Project: A Report," University of California at Los A ngeles, 1958, 22 min., color, sound, 16 mm. Summary: Explains the role of each member of a large prosthetics team, which includes the family physician, pediatrician, orthopaedic surgeon, social worker, psychologist, engineer, prosthetist, physical therapist, occupational therapist, and project administrator. Portrays proceedings of a prosthetics conference, during which the patient and parent are presented. The contributions of the social worker, the psychologist, and the engineer are emphasized. At the conclusion of the film, it is explained that one of the principal purposes of the team is to collect research data with a view toward improving training and prosthetic devices and procedures. Evaluation: At the time the film was made, it undoubtedly served the purpose of showing the UCLA program as well as presenting the concepts of the prosthetics team and the early fitting of the child amputee. Although it might be of some value in demonstrating a research approach, its outdated quality relegates it, for the most part, to the category of "historical interest." Distributor: Paul L. Brand and Son, 2153 K St., N.W., Washington, D. C. 20001. Rental Fee: S7.60 plus shipping charges. "Early Development of Ambulation-Unilateral Below-Knee Amputee," University of California at Los Angeles, 1965, 18 min., black and white, sound, 16 mm. Summary: Depicts the progress of the child amputee from the time he attempts to stand until he walks independently with the prosthesis, which has become an integral part of his body image. Shown are the changing patterns of rhythm, the gradual narrowing of the base of support, and the increasing stability as motor-kinesthetic development takes place and the child participates in increasingly complex skills and play activities. Evaluation: Presents well the concept of early fitting, as the child is shown wearing and using the prothesis as effectively as a normal leg. The film should be shown in conjunction with Infant to School-Age Child - Unilateral Below-Elbow Amputee. Distributors: Child Amputee Prosthetics Project, UCLA Rehabilitation Center, 1000 Veteran Ave., Los Angeles, Calif. 90024. Also available for loan from the crippled children's services in all 50 states and in the District of Columbia, the Virgin Islands, Puerto Rico, and Guam through funds supplied by the Children's Bureau, Department of Health, Education, and Welfare. "Infant to School-Age Child - Unilateral Below-Elbow Amputee," University of California at Los Angeles, 1964, 10 min., black and white, sound, 16 mm. Summary: Presents the various stages in the motor-kinesthetic development of the child and relates them to the specific times at which the child amputee is ready for initial prosthetic fitting as well as for increasingly complex devices. As skills and physical activities develop in response to demands of daily living, devices are provided that are appropriate to the level of function. The cooperation of the parents in the teaching process is stressed. Evaluation: The concept of fitting the child amputee with the appropriate device at a specific time in his motor-kinesthetic development is well presented. The film has value, not only in demonstrating the progress of the child amputee, but also in teaching the basic principles of growth and development in the young child. Although the film is specialized in nature, it is recommended for undergraduate students in paramedical fields to present the principles of growth and development. It is highly recommended for professional groups working with child amputees. It should be shown in conjunction with the film Early Development of Ambulation-Unilateral Below-Knee Amputee. Distributor: Child Amputee Prosthetics Project, UCLA Rehabilitation Center, 1000 Veteran Ave., Los Angeles, Calif. 90024. Also available for loan from the crippled children's services in all 50 states and in the District of Columbia, the Virgin Islands, Puerto Rico, and Guam through funds supplied by the Children's Bureau, Department of Health, Education, and Welfare. "Juvenile Amputee with Congenital Skeletal Limb Deficiencies," Tulane University School of Medicine, 1964, 20 min., color, sound, 16 mm. Summary: Presents ten patients treated at a child-amputee clinic. As each case is presented, the limb deficiency is described on the screen in the terminology of the recently developed roentgenographic classification. The deficiency is further described by x-ray plates and by pictures of the child before surgical procedures. Scenes filmed at a later date show the patient wearing and using a prosthesis fitted to the surgically revised limb. The history of the child is outlined rather fully and, in some instances, the history is pictorially depicted at intervals over a number of years. Evaluation: This film would be helpful in reinforcing use of the classification of limb deficiencies as developed by O'Rahilly and Frantz. The results obtained in fitting severely involved children are impressive. The information presented is too extensive for the time allotted, making it difficult to stay with the narrator and detracting from the technical quality of the film. This film is recommended for professional groups interested in orientation to this particular type of patient and program. It could also benefit parents of the congenital child amputee. Distributor: American Academy of Orthopaedic Surgeons, 29 East Madison St., Chicago, Ill. 60602. Rental Fee: S3.00. "Lower-Extremity Amputees - Toddlers," Michigan Crippled Children Commission, 1957, 22 min., color, magnetic sound {requires special projector), 16 mm. Summary: Presents briefly the motor development of the child as it relates to the upright position and ambulatory progress. Describes anomalies and stumps, both pictorially and roentgenographically. Discusses the prosthetic fitting and the child's ambulatory program. Changes in gait patterns over a number of years are demonstrated. Evaluation: The development of the gait pattern over the years is especially interesting. Because of advances in design, fabrication, and the fitting of prostheses since the film was made, it has outlived its period of optimal value. Distributor: Michigan Crippled Children Commission, The Area Child Amputee Program, 920 Cherry St., S.E., Grand Rapids, Mich. 49506. "Prosthetic Training of the Very Young Child Amputee - Upper Extremity,'" Michigan Crippled Children Commission, 1959, 20 min., color, optical and magnetic sound, 16 mm. Summary: Demonstrates the training technique used in teaching three upper-extremity child amputees to use their prostheses. It shows a child-sized APRL hand that was in the experimental stage at that time. Evaluation: This film shows good beginning training technique, outlining three different areas of training-basic body-control motions, development of prosthetic control, and functional prosthetic use. The training situations shift abruptly, causing the film to lose continuity. Technically, it is not a high-quality film. Occupational therapists might find this film of value because some of the techniques of training are still acceptable, although the prostheses are outdated. Distributor: Michigan Crippled Children Commission, The Area Child Amputee Program, 920 Cherry St., S.E., Grand Rapids, Mich. 49506. "Upper-Extremity Amputees - Toddlers," Michigan Crippled Children Commission, 1956, 22 min., color, magnetic sound (requires special projector), 16 mm. Summary: Presents type, diagnosis, and prosthetic fitting of several upper-extremity child amputees. Demonstrates the performance of skills and activities while wearing the prosthesis. Evaluation: This film, made at the Mary Free Bed Guild Children's Hospital in Grand Rapids during the earlier years of the child-amputee program, serves to demonstrate how readily children adapt to early prosthetic fitting. Advancements in the prosthetic field, however, cause the film to be outdated. It should be noted that the sound, which is magnetic, is cut off for about the last ten minutes. Distributor: Michigan Crippled Children Commission, The Area Child Amputee Program, 920 Cherry St., S.E., Grand Rapids, Mich. 49506. <h3>Orthotics</h3> "Assistive Devices for the Physically Handicapped," National Foundation for Infantile Paralysis, 1951, 12 min., sound, color, 16 mm. Summary: Illustrates many assistive devices and their use by postpoliomyelitis patients. The devices include mouth sticks, overhead slings, feeders of various types, automatic page turners, hydraulic lifts, and several others. Evaluation: This very comprehensive film is useful to show the kinds of devices used to increase the functional capacity of the post-poliomyelitis patient with severe residual paralysis. Credit is due those whose ingenuity resulted in the improvised equipment demonstrated here. While the film is photographically excellent, its content in terms of emphasis on certain devices, such as the mouth stick, is questionable. The film, made prior to the poliomyelitis vaccines, is necessarily outdated in some aspects, but the devices shown would still be of interest to personnel working with the severely disabled. Distributor: Film Library, International Society for Rehabilitation of the Disabled, 219 East 44th St., New York, N. Y. 10017. Rental Fee: $10.00. (No rental fee for members in good standing with the International Society.) "Kinetics and Orthotics for Function," Institute of Physical Medicine and Rehabilitation, New York University Medical Center, 1963, 25 min., black and white, sound, 16 mm. Summary: Presents the basic principles in the selection and the use of orthotic devices to achieve as normal function as possible in the presence of upper-extremity weaknesses. The basic normal motions of the upper extremity in the performance of several everyday activities are carefully depicted. The subject, a quadriplegic patient, is introduced as he is undergoing a manual muscle test. The test, which reveals severe weakness in the musculature of the upper extremities, also serves as a basis for determining the degree and nature of the mechanical assistance required to supplement the existing strength. Periodic evaluations are made; and, as strength increases, the appliances are adjusted or replaced. Finally, the amount of assistance is reduced to the minimum required by the patient, who is shown performing a number of activities. Before discharge from the hospital, the patient is equipped with a flexor-hinge hand and is planning to return to his former occupation. Evaluation: An excellent analytical presentation of the prescription and use of orthotic devices for severely involved upper-extremity patients. Outstanding in this picture is its adherence to the practice of sound teaching principles. As each new step is presented, the principle underlying the selection of orthotic devices is applied and illustrated. The analysis of normal motion serves as a basic approach to the problem. The film gives a feeling for the long time involved and is realistically hopeful in terms of patient accomplishment. This film is highly recommended for all paramedical groups; for occupational therapists it is of value in teaching specific techniques of training. Distributor: Film Library, New York University Medical Center, 342 East 26th St., New York, N. Y. 10016. Rental Fee: $5.00. "Spinal Cord Injury" Rancho Los Amigos Hospital, 1961, 25 min., color, sound, 16 mm. Summary: Depicts eight levels of spinal-cord injury and demonstrates the degree of independence that the average patient can attain after injury. Independence is accomplished through a program of maximum strengthening of the remaining active muscles, combined with appropriate assistive devices, such as short leg braces, long leg braces, overhead slings, artificial muscles, special splints, crutches, hydraulic lifts, etc., and training. Evaluation: This well-organized film discusses clearly and precisely each level of injury in terms of specific pertinent information, such as key muscle groups involved, functional loss, and orthotic devices. It points out that the prognosis of the patient is not constant with the level of injury, but is based on demonstrable muscle function. Limitations are carefully noted, and goals are realistic. The film is highly recommended for any professional person working with the paraplegic or quadriplegic patient and for inclusion in the undergraduate curriculum for therapists and nurses. Patient and family would benefit from seeing this film, provided they have accepted a realistic attitude toward rehabilitation. Distributor: American Academy of Orthopaedic Surgeons, 29 East Madison St., Chicago, Ill. 60602. Rental Fee: $3.00. "The Heather Hand," U. S. Veterans Administration, 1960, 10 min., color, silent, 16 mm. Summary: Describes a light-weight, wrist-extension, hydraulic orthosis. Shows the patient putting it on himself and performing several activities. Evaluation: Although this film illustrates the device very well and graphically demonstrates its function, it is of practically no value for paramedical groups because it is not accompanied by any explanation, either written or auditory. Distributor: Research and Development Division, Prosthetic and Sensory Aids Service, Veterans Administration, 252 Seventh Ave., New York, N. Y. 10001. <h3>Amputation Surgery and Fabrication of Prostheses</h3> The compilers of this review did not consider themselves qualified to evaluate films on amputation surgery or the fabrication of prostheses. Titles of films on surgery may be found in the Film Reference Guide for Medicine and Allied Sciences, U. S. Department of Health, Education, and Welfare, Public Health Service, Communicable Disease Center, Atlanta, Ga. 30333. For those interested, the following films on the fabrication of prostheses are listed. Available from the Research and Development Division, Prosthetic and Sensory Aids Service, Veterans Administration, 252 Seventh Ave., New York, N. Y. 10001: Above-Knee Prosthetics-Stump Casting with the Use of a Casting Stand; Below-Knee Prosthetics-Stump Casting with the Use of a Casting Stand; Fabrication Technique for Medial Opening, Polyester Nylon, Syme Prosthesis; Plastic Finishing of an Above-Knee Socket; The Total-Contact, Soft-End, Plastic Laminate Above-Knee Socket. Available from Hydra-Cadence, Inc., 623 South Central Ave., P. O. Box 110, Glendale, Calif.: Hydra-Cadence, Reel 1; Hydra-Cadence, Reel 2. <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;">Footnote</td></tr><tr><td class="clsTextSmall">Enhancing the value of this film and intended to be used in conjunction with it are 16 loop films, each of which depicts one gait deviation. These loops are 7 ft. in length and can be rerun an indefinite number of times on standard projectors. The set may be purchased for $25.00. When the film is ordered, a check in this amount should be made payable to the distributor: Ideal Picture Co., 417 North State St., Chicago, Ill. 60610.</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 Review of Visual Aids for Prosthetics and Orthotics https://staging.drfop.org/files/original/646807426d786878263060044f860bb5.pdf a91cea6354ddf7b14de92ba2bb2c720d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_04_001.pdf Text Any textual data included in the document <h2>Partial Foot Amputation</h2> <h3>Results of the Questionnaire Survey</h3> There were fifteen replies by mail to the questionnaire on management of patients with partial foot amputation that appeared in the Summer 1977 issue of the NEWSLETTER. Ten came from prosthetists, one from a physical therapist, and four from physicians. The answers and remarks from all but one prosthetist are given below. One prosthetist, Lewis Meitzer of Miami, Florida, took the time and trouble to write a very thoughtful letter which is printed in full after the tabulation of the questionnaires. Prepared by the American Academy of Orthotists and Prosthetists, 1444 N Street, N.W., Washington, D.C. 20005. Editor: A. Bennett Wilson, Jr., B.S. M.E.; Editorial Board: Joseph M. Cestaro, C.P.O., Charles H. Epps, Jr., M.D., Robert B. Peterson, R.P.T. <ol> <li> Do you feel that patients with partial foot amputations require prostheses that extend higher than the distal third of the tibia? <ul> <li> Certified Prosthetists <ol> <li> No. Ankle high only. </li> <li> The prosthesis should not be higher than maleoli. </li> <li> Yes. </li> <li> Very seldom </li> <li> Especially true for active people. Low activity people without deformities seem to function well with the least amount of appliance. </li> <li> Not in all cases, for example, we're using C. Fillauer's AC & PLIC socket w/posterior (6) split for a great percentage of our partial foot amputees. </li> <li> No. </li> <li> I basically avoid terminating a prosthesis on the lower tibia. Often a shoe insert with the filler works fine. If a rigid ant. is used, I definitely do not stop at any point on the tibia. </li> <li> Transmetatarsal or longer - No. All others - Yes. </li> </ol> </li> <li> M.D.'S <ol> <li> If hand users. </li> <li> Yes. </li> <li> No. </li> <li> If full, pain free, weight bearing is possible on the remaining part of the foot - No. If not, then weight needs to be taken higher. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you feel that most patients who receive partial foot amputations would function better with a Syme's amputation? <ul> <li> Certified Prosthetists <ol> <li> No. </li> <li> No, as long as the plantar surface can tolerate weight bearing, a partial foot is better than Syme's. </li> <li> No. </li> <li> No. </li> <li> Again active people and children who can possible avoid bone spurs and eventually develop an endbearing cosmetic BK. Surgery is important. Good padding over bones is very beneficial. </li> <li> Yes, the large majority would increase their function and be relatively pain-free. </li> <li> No. </li> <li> No. I have seen too many patients function beautifully with partial foot and only a toe filler. </li> <li> For P.V.D. patients a Symes amputation usually has a better chance to heal and the prosthetic fitting is better. For traumatic amputations as much length should be preserved to increase weight bearing surface and lever arm. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes, but not all. </li> <li> Not necessarily. </li> <li> Yes, at least psychologically. </li> <li> No. A Syme's is much more radical than is often necessary and will not necessarily result in better function. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you agree with the author's list of advantages and disadvantages of this amputation? <ul> <li> Certified Prosthetists <ol> <li> Some. </li> <li> - </li> <li> Yes. </li> <li> Yes. </li> <li> I feel amputation sites for children should take bony overgrowth and foreshortening into account, i.e., disarticulation rather than partial foot types. </li> <li> Not in its entirety, but generally speaking, yes. </li> <li> Yes. </li> <li> Some of them. </li> <li> Yes we do, however, prosthetic breakdown will still occur regardless which type is fitted. </li> </ol> </li> <li> M.D.'S <ol> <li> No. They are not the indication for the procedure. </li> <li> ? </li> <li> Yes. </li> <li> Partially. </li> </ol> </li> <li> P.T. <ol> <li> Yes. </li> </ol> </li> </ul> </li> <li> Do you feel that the sole or shank of the shoes or prosthesis should be rigid or flexible? <ul> <li> Certified Prosthetists <ol> <li> Flexible. </li> <li> Flexible, to provide easy roll over the often tender distal anterior foot. </li> <li> Rigid to metatarsal break, flexible distal from this point. </li> <li> Rigid except for toe flexibility. </li> <li> The sole should extend the toe break past the end of the amputation, rigid slightly past this point. </li> <li> We think in terms of the SACH foot function using rigid soft tissue support w/flexible forefoot. </li> <li> Flexible. </li> <li> Depends on patient's gait, toe off phase especially. Generally rigid to the ball of the shoe and flexible in the toe area. </li> <li> Usually, a rigid shoe and/or prosthetic foot functions better. However, we do have success using a modified Winnipeg Symes Prosthesis, which is partially flexible. </li> </ol> </li> <li> M.D.'S <ol> <li> Rigid. </li> <li> Rigid. </li> <li> Do not know. </li> <li> It depends largely on the level of amputation, the shoe control which is achieved and the residual ankle function. In general it needs to be rigid proximal to the metatarsal heads and capable of flexing to about 15° under the metatarsal heads when loaded. Sometimes, e.g. when the metatarsal heads are painful or in a very proximal level amputation, it needs to be rigid throughout and with a rocker base. If there is adequate ankle function, and reasonable shoe control on the residual foot, the prosthesis should flex at the ankle too. </li> </ol> </li> <li> P.T. <ol> <li> Rigid. </li> </ol> </li> </ul> </li> <li> Please comment if you have experience with the "ankle-foot orthosis" type of treatment mentioned here and described by Fillauer. <ul> <li> Certified Prosthetists <ol> <li> I have been using the same basic idea for several years with good success. </li> <li> I have used this on one patient and he was quite pleased. </li> <li> - </li> <li> No experience. </li> <li> No experience. I added another approach to my repertoire. </li> <li> No experience. </li> <li> Yes. </li> <li> I have used the AFO with a toe filler attached a few times recently and am very satisfied with the results. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes, only very limited. </li> <li> Yes, occasionally useful. </li> <li> No. </li> <li> - </li> <li> No experience. </li> </ol> </li> <li> P.T. <ol> <li> No experience. </li> </ol> </li> </ul> </li> <li> Would you be willing to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations? <ul> <li> Certified Prosthetists <ol> <li> Yes. </li> <li> Yes. </li> <li> Yes. </li> <li> Yes. </li> <li> Yes, although my experience is limited (which is probably the situation 90% of the time). A ready reference such as this may help us all solve the unique problems each of these amputees present. </li> <li> Enthusiastically. </li> <li> Yes. </li> <li> At present I have nothing new to contribute. </li> <li> Yes, we would. </li> </ol> </li> <li> M.D.'S <ol> <li> Yes. </li> <li> No. </li> <li> Do not feel qualified to do so. </li> <li> Yes. </li> </ol> </li> <li> P.T. <ol> <li> No, not enough experience. </li> </ol> </li> </ul> </li> </ol> <h3>Conclusions</h3> It can be seen that although there is a wide variation of opinion about partial foot amputations and prostheses, more than half of the practitioners feel that partial foot amputations can provide better function than the Syme's. Nearly all of the respondents would be glad to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations. Mr. Meltzer's letter, which follows, seems to sum up the state of the art and is reproduced here in full. September 27, 1977 Newsletter Questionnaire AAOP 1444 N Street, N.W. Washington, D.C. 20005 The following are the answers to your questions as per your request from the Newsletter Questionnaire, copy enclosed. NAME: Lewis N. Meltzer, C.P.O. <ol> <li> Do you feel that patients with partial foot amputations require prostheses that extend higher than the distal third of the tibia? <blockquote> It has been my experience that patients with partial foot amputations occasionally cannot tolerate the Fillauer type orthosis. Yet, for cosmetic purposes, they prefer it rather than something extending above the shoe. I have fitted a few and only succeeded with one. This is after extended trials by myself and the patient. Yet, the two who were not satisfied, preferred to wear nothing and have been lost to follow up. Several years ago I worked with polypropylene or similar AFO's with toe fillers and steel shanks in the shoe, and those seemed to work satisfactorily. I think that Mr. Pritham's idea merits trials. My only concern is cosmetic acceptance when compared to the Fillauer type. </blockquote> </li> <li> Do you feel that most patients who receive partial foot amputations would function better with a Syme's amputation? <blockquote> This seems like an ambiguous question which I feel I can only answer by saying it would depend on the individual. At the same time, all else being equal, partial foot amputation would be my choice were I to need that type of amputation as I could more easily walk without a prosthesis either around the house or at night. </blockquote> </li> <li> Do you agree with the author's list of advantages and disadvantages of this amputation? <blockquote> Yes. </blockquote> </li> <li> Do you feel that the sole or shank of the shoes or prosthesis should be rigid or flexible? <blockquote> Here, again, this would depend on the patient as I have seen patients desiring no prosthesis. </blockquote> </li> <li> Please comment if you have experience with the "ankle-foot orthosis" type of treatment mentioned here and described by Fillauer. <blockquote> The Fillauer method I have tried has included a section of Silastic R.T.V. in the anterior distal socket for comfort and total contact. This is laminated over the cast rather than after the prosthesis is made. With this, I still have had only one satisfied patient. The other two required several attempts at fitting and yet the patients were not satisfied. </blockquote> </li> <li> Would you be willing to contribute to an "atlas" or "catalog" of methods for providing prostheses for partial foot amputations? <blockquote> I would be willing, if I felt I had something specific to offer as an alternative, but I have not found it to date. </blockquote> </li> </ol> Sincerely, Lewis N. Meltzer, C.P.O. Page Number(s) 1 - 3 Year 1977 Volume 1 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Partial Foot Amputation https://staging.drfop.org/files/original/30c31f3ab0a1bb7bf6b2fed3d44ab98e.pdf 1b4c13b6fe4572542d88a4b6b1765e21 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_03_001.pdf Text Any textual data included in the document <h2>"The Geriatric Amputees" - Results of the Questionnaire</h2> There were twenty-three replies by mail to the questionnaire on management of lower-limb geriatric amputees that appeared in the Spring 1977 issue of the NEWSLETTER. Ten were signed by prosthetists, five came from M.D.'s and two from therapists. The remarks included on the six unsigned forms appear to have come from prosthetists. The raw results, question-by-question, are shown below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? PROSTHETISTS <blockquote> AK yes: 15, No: 1 BK yes: 14, No: 2 </blockquote> Comments made by the prosthetists: <ul> <li> They cannot be made too light. </li> <li> We use endoskeletal AK set ups and light feet as often as possible to reduce weight. </li> <li> Yes. Unless "conventional" prostheses are already very light. BK's should weigh between 1 1/2 - 3 lbs. and AK's from 4 1/2 — 6 1/2 lbs. Decreases energy consumption, eases suspension. Soon, however, new materials and techniques should allow all prostheses to weigh about the same. Major difference for geriatrics is not weight but socket comfort and cost. </li> <li> A major complaint from the geriatric patient is the weight of the prosthesis. </li> <li> In most cases conventional prostheses are prescribed and the geriatric patient has trouble with them usually because of the weight. But age and strength are the difference. </li> <li> This is debatable, each case should be considered individually. I feel that most geriatric males would prefer a conventional prothesis. </li> <li> As much weight as you can knock off the better. The old story of the leg being so light that in a strong wind it is hard to control, just a tale. </li> <li> Whenever possible, a light-weight prosthesis is desirable for geriatric patients. </li> <li> Patients' resources less and need for strength not important, </li> <li> I do not feel that this is a very major issue as far as function is concerned. Most patients complain about weight early but those who do function do not continue these complaints, </li> <li> It is generally desirable that prostheses be as light as possible. </li> <li> Light limbs seem to be tolerated much more than the heavy limb. </li> <li> An attempt is always made to maintain lightness in all prostheses, however, especially AK geriatrics who are fighting quite a lever arm in regard to weight. </li> <li> The decrease in energy out-put during ambulation is very important for the geriatric amputee. Decrease in weight decreases energy out-put which in turn decreases the stress on the cardiovascular system. </li> <li> Even where a geriatric has not experienced an amputation, there is loss of muscular strength. This is the primary-reason for a lighter prosthesis. </li> </ul> PHYSICIANS AK Yes: 5, No: 1 BK Yes: 4, No: 2 <ul> <li> If the geriatric amputee is unable to manage the conventional prosthesis, making a lighter limb increases his difficulties when walking in a high wind or deep snow. In these cases I fit the geriatric amputee with an articulated peg leg invariably with a successful result. </li> <li> Initially they do quite well, however, a lighter, especially AK prosthesis would help. </li> <li> I think all prostheses should weigh less, particularly for geriatrics. The prosthetists should go to extra lengths to thin out the shell of exoskeletal limbs as thin as possible and consistent with durability. This is just not done enough with the shins of AK and BK prostheses. </li> <li> If there is sensory loss, a heavier prosthesis for sensory feedback may be necessary. </li> </ul> THERAPISTS <ul> <li> One therapist felt that both the AK and BK prosthesis should weigh less than the conventional and commented that "Patients seem to prefer an extremely lightweight prosthesis." The other therapist did not check any of the boxes but wrote in "Individualized Adjustment" and commented that "A neurophysiological functional evaluation should determine if the patient responds better to heavier or lighter sensory bombardment." </li> </ul> DISCUSSION The great majority of clinicians seem to feel that lower-limb prostheses that weigh less than those generally available are desirable for the older patient. </li> <li> What type of knee do you generally use for above-knee cases? PROSTHETISTS <table style="border-style: none; width: 338px; margin-left: auto; margin-right: auto;" height="120"> <tbody> <tr> <td>Manual lock</td> <td>6</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>10</td> </tr> <tr> <td>Other (please specify)</td> <td>11</td> </tr> </tbody> </table> Prosthetists' comments were as follows: Manual Lock: <ul> <li> Treatment for the dysvascular amputee should always be separated from geriatric amputees with other causes for amputation at Rancho, well over 90 percent of amputations are secondary to vascular problems. Manual lock knees have cut down PT time by two weeks, and, combined with an adjustable socket, have made it possible to convert nearly all of our dysvascular AK's into prosthesis wearers and more importantly, they use them. </li> <li> At our clinic either the adjustable AK "Rancho design" or conventional AK have locking knees. </li> <li> We have not been pleased with the various "safety" knees. The only really useful one is the SHS — we do not use it for geriatric patients, but it's the best. </li> <li> Balsa Lock knee, wherever possible, light weight foot with soft heel. Polypropylene joint and band (where stump is long) </li> </ul> Weight-Bearing (Safety-Knee): <ul> <li> The friction lock type of knee will work for 80% of the AK's. </li> <li> The weight-bearing knee seems to be the most easily managed by elderly amputees. </li> <li> Manual lock knees only when safety knee is inadequate. </li> <li> I prefer endoskeletal. </li> <li> About 90% of our geriatric patients are fitted with friction locking knees and 10% are fitted with manual locks. </li> <li> Aside from poorer musculature, the evidence of less proprioception illustrates that the AK geriatric has difficulty knowing where his knee and foot are. Only in extreme severe muscular weakness is a manual lock prescribed. </li> </ul> Manual lock & Weight-bearing (Safety) Knee: Varies with patient need. All three types marked: <ul> <li> Depends on needs of the patient and his ability to control the knee with his own efforts, as well as his expected level of performance. </li> </ul> Other: <ul> <li> Constant friction knee for the elderly. Not much maintenance problem. Variable gait is not an important factor. Mauch S-N-S for the younger amputee. </li> </ul> None Marked: <ul> <li> My approach is to evaluate each person individually. Our primary knee is the Bock Safety knee, relying primarily upon alignment stability and fast plantar flexion of S/A foot. I use Kolman only when absolutely necessary due to noise problems. </li> </ul> PHYSICIANS <table style="border-style: none; width: 390px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock</td> <td>2</td> </tr> <tr> <td>Weight-bearing (Safety Knee)</td> <td>3</td> </tr> <tr> <td>Other (please specify)</td> <td>0</td> </tr> </tbody> </table> The physicians comments were as follows: Manual Lock: <ul> <li> Bock Geriatric. Most often. Weight-bearing (Safety) knee, seldom. Often knee lock with option to give constant friction if open, as a trial. </li> <li> Safety is very important. There is more energy required to operate a safety knee (Bock). I reserve it for the younger amputee. </li> </ul> Weight-Bearing Safety Knee: <ul> <li> We need a manual lock that is sturdier than the Bock geriatric knee. Ideally someone should manufacture a lock that could be placed on the outside of the prosthesis so that if patient finally confident enough with free knee after practice he could remove it. </li> <li> I usually use the Otto Bock Safety knee which stands use by the geriatric amputee well. However, have run into breakdown problems with this knee in my younger patients. </li> </ul> THERAPISTS The comments from the two therapists were: <ul> <li> Knee usually depends on patient's functional demands, equipment cost, prosthetist convenience in non-standard set-ups in that order. </li> <li> My training is deficient in the prosthesis — but excellent in observation of physiological response. </li> </ul> DISCUSSION Opinion on use of manual lock versus the weight-bearing (Safety) knee is slightly in favor of the weight-bearing (Safety) knee. Certainly the weight-bearing units provide more function and better appearance when they can be used. It is gratifying to find that so many prosthetists and physicians are being successful with the more functional units. </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? PROSTHETISTS Yes: 7 No: 8 No experience: 1 <ul> <li> No, Have not used them for 5 years — patients would not wear them after six months. </li> <li> No. We have used them, however, the cases were to prove to the patient the difficult task it is to master bilateral AK prostheses. The stubbie is a substitute but not a good one. </li> <li> No. Much trouble and expense for very little benefit. Most should not be fit at all. If fit, shorten slightly but include knee joints for sitting purposes. Stubbies cause problems in wheelchairs, look horrible and do not convert non-users of prostheses into users. </li> <li> No. In most cases the bilateral AK patient has had extensive vascular surgery and scars in abdomen and scarpas are too much of a problem. </li> <li> No. Most would rather sit in a wheelchair. </li> <li> No. We have not had the occasion to use them. Geriatric amputees, with therapy, are able to use light-weight prostheses with weight bearing knees. </li> <li> No. We've tried stubbies in a few cases where we thought the patient could eventually go to regular legs. A better idea is pylons — you can adjust them. No one uses stubbies permanently — a wheelchair is much more functional. </li> <li> No. Stubbies make patients look like "freaks", they think. Patients are more functional in wheelchairs. </li> <li> Yes. Only if there is a good P.T. program. </li> <li> Yes. To permit A.D.L. in the home — We have 2 cases of short A.K.'s who did so well they demanded full length prostheses and did fair. </li> <li> Yes. As temporaries to define the patient's functional potential both to him and to the clinic team. </li> <li> Yes. If bilateral amputation occurs simultaneously. </li> <li> Yes. It is a way to allow an individual independence and mobility without the problems of knee control. </li> <li> Yes. There are amputees that can walk with stubbies and not walk with bilateral A/K prostheses therefore it is desirable in obtaining an accurate assessment of prosthetic potential. </li> <li> Yes. Bilateral stubbies offer safety that no AK with knees can offer. The CG is closer to the earth, and there is less weight to be manipulated. I would recommend stubbies for the desirable active AK. </li> <li> No opinion. I have no experience in this area. </li> </ul> PHYSICIANS Three physicians were opposed to the use of stubbies and two felt that their use is indicated. The physician's comments were: <ul> <li> No. Stubbies are unsightly ugly things, besides (they) cost as much as prostheses. I very seldom prescribe bilateral AK prostheses to geriatric patients. The few knees I did, the prosthesis ended up in the closet. However, an occasional patient may do well, however, when the prostheses are made several inches shorter than patient's original height. Each patient is pretested with pylons. </li> <li> No. I do not believe in fitting bilateral AK's with vascular disease. If young and vigorous and traumatic — and candidate for limited walking with bilateral AK prostheses — should be fitted with full length. </li> <li> No. Not in the geriatric, but useful in young adults. </li> <li> Yes. Useful around the house if patient wants them. Cosmesis bad. Useful for training. </li> <li> Yes. I regard this as an essential if the bilateral amputee is to learn to walk satisfactorily. </li> </ul> THERAPISTS Both therapists felt that use of stubbies is desirable. Their comments were: <ul> <li> Yes. Stubbies are desirable to demonstrate to most patients that the amount of energy expended is usually not worth the effort, from a functional point of view. </li> <li> Yes. Any reasonably balanced device helps maintain balance and muscle strength. Prevention of disuse atrophy. </li> </ul> DISCUSSION The respondents were almost equally divided on the issue of stubbies, and without exception each respondent offered a comment. The comments seem to indicate that in spite of drawbacks stubbies can be used successfully in certain settings, and that a careful, thorough evaluation of this procedure is needed. </li> <li> In your opinion, is immediate postsurgical fitting of prostheses desirable for geriatric cases? PROSTHETISTS Eleven prosthetists felt that immediate postsurgical fitting is indicated for geriatric patients; five felt that the procedure was contraindicated, while one felt that it would probably be useful if orthopaedic surgeons performed the amputations. Their comments are as follows: <ul> <li> Yes. We only recommend a rigid dressing. Only after wound healing has been ascertained do we apply a pylon. </li> <li> Yes. If there is a good P.T. program; otherwise only the rigid dressing should be used. </li> <li> Yes. This treatment doesn't allow the geratric amputee to become comfortable in a wheelchair thus losing strength and endurance. </li> <li> Yes. The PT Department starts working with the patient within 24 hours and the chances are (that) contractures and depression won't occur. </li> <li> Yes. BK's only. AK's too much trouble for benefit accrued. </li> <li> Yes. Immediate fitting is good for everyone. But its hard to do — hard to supervise, takes a lot of effort so its not done. </li> <li> Yes. For below-knee patients who have the ability to coordinate the post surgical dressing and pylon. </li> <li> Yes. I feel immediate post surgical fittings minimize loss of strength which is very critical in the geriatric cases. </li> <li> Yes. I.P.S. fittings are desirable for any amputee, aside from trauma cases. The less muscle tone the geriatric loses the better his chances are of becoming a successful prosthetic candidate with I.P.S.F. This is possible. </li> <li> No. The results I have witnessed have been mostly unfavorable. Perhaps if the orthopedic surgeons did more of the amputations it would be more advisable. </li> <li> No. Rigid dressings for BK's should be used for 10-14 days then a temporary prosthesis for 2-4 weeks. Immediate post-surgical fittings encourage too much activity and it is too hard to control the stress the patient is placing on the wound. </li> <li> No. We never use immediate postsurgical fitting. Stumps should be healed before shrinkage is attempted. After stump is healed, we use laminated plastic sockets on temporary units for definitive shrinking. </li> <li> No. Low tolerance. </li> <li> (Nothing marked) It depends on the patient's prior medical history. We would not recommend it for diabetic patients. </li> </ul> PHYSICIANS Two physicians felt that immediate postsurgical fitting had a place in management of geriatric patients; two felt otherwise; and one had no experience on which to base an opinion. Their comments were: <ul> <li> Yes, If you have full team approach including nurses who fully understand principle. Otherwise early temporary fitting with good control of stump edema may be second best alternative. Two months is still a long delay. </li> <li> Yes. I do not feel that a differentiation need be made unless there are other conflicting medical factors, e.g. heart disease. </li> <li> No. But I prefer rigid dressings with early fitting when wound is fully healed. </li> <li> No. No benefits except psychological, and many dangers. Use of cast is OK in many cases, but adding prosthesis courts disaster. </li> <li> (Nothing marked) I cannot express an opinion since in our institution immediate post surgical fitting is not being done at all. </li> </ul> THERAPISTS Both therapists felt that immediate post surgical fitting is useful. Their comments were: <ul> <li> Yes, . . . but please see abstract of article to be published in American Journal of Surgery {which will be publishing in a future issue. Ed.). I feel that very few people now are using the prosthesis on an immediate basis, but our prospective study well documents the value of the rigid dressing in the postoperative care of the BK amputee. </li> <li> Yes. Normal physiology maintained at maximum potential. </li> </ul> DISCUSSION The replies to this question indicate that the use of a rigid dressing is used widely and that immediate postsurgical fitting is used more than is generally expected. Perhaps the reports on the study at Iowa will encourage others to adopt these advanced techniques. Other clinics with experience should publish results of their clinical program. </li> <li> In your opinion what is needed to improve the function of geriatric amputees? All of the respondents commented on this question. Their comments were as follows: PROSTHETISTS <ul> <li> The lightest prosthesis with the safety factor at the knee system (being) the main factor. </li> <li> A better method of suspending the AK prosthesis. Total suction does not work, rigid pelvic belt is a fair substitute, but (is) heavy. Something better is needed. </li> <li> Vascular surgery is often indicated but compounds our fitting problems. After several surgical procedures — physiologically and psychologically the patients require more professional service — let us all hope that more orthopedists would become more involved in amputation surgery. </li> <li> An adjustable BK socket that is permanent. It can be fit(ted) instead of a "temporary" and will adjust throughout the "maturing" process. (It) will save time, as patient can adjust it and since a temporary is not needed, it will save dollars. Most physicians are looking for a cheap geriatric prosthesis, although they will state "light duty" or "lightweight" or "sitting prosthesis." </li> <li> I believe the prosthetic components that we have now are all we need: However the P.T. program needs to be reevaluated. </li> <li> Better pre-op and initial post-op care. </li> <li> This is where the total team is so very necessary. Pre-surgical consultation, pre-prosthetic care and post prosthetic training and followup. Outpatient care for the amputee is practically overlooked by the doctors and the subsidizing agencies, the insurance companies, Medicare and Medicaid. The patient can only receive adequate care as an inpatient. Usually his funding is exhausted by the time he is ready for prosthetic fitting. </li> <li> A lightweight single axis foot. More training for surgeons (general and vascular) to give the patient a chance for a BK, when the problem is in the toes or ankle; also teach them how to bevel and round the tibia. </li> <li> Articles such as this help spread information that geriatric patients can utilize a prosthesis. Motivation is an important factor. Two days ago we fitted a 91-year-old man with a prosthesis and his initial attempts have been excellent. </li> <li> Lighter prostheses, greater emphasis on use of temporaries in early phase of rehabilitation. </li> <li> Quicker fabrication and more adjustable prostheses. We use Polysar sockets and pylons. We can make adjustments easily and get (out) the prosthesis quickly. </li> <li> The limiting factors in geriatric amputees are motivation, coordination, and endurance. The therapist has the best chance to do something about these things. </li> <li> Patient compliance and patience with the amputee. </li> <li> Better post-surgical physical therapy. Some method to decrease the long periods of inactivity and confinement to a bed prior to amputation. </li> </ul> Follow-up programs. <ol> <li> Successful therapy program (before and after fitting) </li> <li> A competent prosthetist — follow-up necessary </li> <li> A sound instillation of confidence to the geriatric </li> <li> A good exoskeletal safety knee (needs) to be developed. </li> </ol> PHYSICIANS <ul> <li> Enthusiastic team work and total care of the patient to include medical, socioeconomic and vocational aspects. </li> <li> Immediate referral to a rehabilitation department to teach necessary conditioning exercise, range of motion exercise to prevent contracture and stump conditioning. </li> <li> More interest and concern of plight of elderly person with vascular disease by surgeons in particular, but also by physicians in general. And I don't mean simply interest in the pathophysicology and surgical approaches to arteriosclerosis. </li> <li> Improved sensory feedback </li> <li> Improved training procedures </li> <li> Improved knowledge of what the patient really needs </li> </ul> THERAPISTS My concern is the bracing needed for C.V.A.'s. Our suggestion to our Medical Chief of Staff is to invite your representative to hold a seminar in our hospital. Generally we need to sell the success of fitting the geriatric AK from the standpoint of requiring less in terms of third-party paid institutionalization or purchased services. An AK patient on a walker is much easier to deal with than a one-legged wheelchair-bound patient. In short, we need to emphasize the 4 successes of 10 attempts, and demonstrate this success in a cost-effective manner. This is the only language cost conscious bureaucrats will understand. Additionally, many patients report positive attributes of independence in gait, so they "don't have to depend on or bother their family or friends." At the same time, we need to strive to improve our care package so as to raise the percentage of AK's who become independent with their prostheses. </li> </ol> SUPPLEMENTARY DATA To augment the data provided by the 23 questionnaires returned through the mail, prosthetists attending the instructional course in molded plastics sponsored by the American Academy of Orthotists and Prosthetists and held in Kansas City, Missouri, July 15-16, 1977, were asked to fill out the questionnaire. Forty-one did so. The results are given below: <ol> <li> Should the prosthesis weigh less than conventional prostheses? AK Yes: 41 No: 0 No mark: 0 BK Yes: 39 No: 0 No mark: 2 </li> <li> What type of knee lock do you generally use for above-knee cases? <table style="border-style: none; width: 402px; margin-left: auto; margin-right: auto;" height="116"> <tbody> <tr> <td>Manual lock:</td> <td>15</td> </tr> <tr> <td>Weight-bearing (Safety Knee):</td> <td>22</td> </tr> <tr> <td>Other:</td> <td>3</td> </tr> <tr> <td>No mark:</td> <td>5</td> </tr> </tbody> </table> (Four people marked two places. Most of the 5 not marked made some kind of comment.) </li> <li> In your opinion is the use of stubbies for bilateral AK cases desirable? <table style="border-style: none; width: 401px; margin-left: auto; margin-right: auto;" height="123"> <tbody> <tr> <td style="text-align: left;">Yes:</td> <td style="text-align: left;">21</td> </tr> <tr style="text-align: left;"> <td>No:</td> <td>19</td> </tr> <tr style="text-align: left;"> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> (One person checked both yes and no.) </li> <li> In your opinion is immediate postsurgical fitting of prostheses desirable for geriatric cases? <table style="border-style: none; width: 400px; margin-left: auto; margin-right: auto;" height="121"> <tbody> <tr> <td>Yes:</td> <td>25</td> </tr> <tr> <td>No:</td> <td>14</td> </tr> <tr> <td>No mark:</td> <td>2</td> </tr> </tbody> </table> </li> <li> In your opinion what is needed to improve the function of geriatric amputees? <ul> <li> Improved knees and feet of lighter weight. </li> <li> In hospital prosthetic facilities so therapists and prosthetists could give combined and closer supervision to walking training, etc. </li> <li> Suspension in geriatrics seems to cause weight and cosmetic problems. </li> <li> A good pre-prosthetic program, a qualified P.T. and a well fitting lightweight prosthesis. </li> <li> Proper post surgical supervision and gait training with prosthesis. Lighter prosthesis that is more comfortable. </li> <li> A good sound Rehabilitation program: 1. Good Amputation; 2. Good prosthesis; 3. Good P.T. </li> <li> Simple donning procedures — less weight, uncomplicated mechanics to understand. </li> <li> Closer observation and good rehabilitation work after surgery so the patient will have the best chance possible of becoming self-sufficient. </li> <li> Reduced weight/energy consumption. </li> <li> Getting them in better physical condition prior to prosthetic fitting. </li> <li> Better physical therapy and PT follow-up. </li> <li> Better materials other than plaster, transparent materials perhaps, lighter weight, orthoplast possibly. </li> <li> More the patients can do for themselves, less care needed by other people. </li> <li> Feather weight prostheses, and 2) team approach management. </li> <li> You can put a safety knee and a two way ankle. </li> <li> (I don't know) I have been fitting AK prosthesis for only a year therefore the above information may not be of value due to my personal lack of experience. </li> <li> Lighter materials. </li> <li> Better communication between the doctor, therapist, prosthetist and patient. </li> <li> Most patients need one person, as overseer, who can control his rehab program, — a coordinator. </li> <li> Immediate post-operative fitting. </li> <li> Lighter prosthesis. </li> <li> Increased physical therapy, —early as possible. </li> <li> More lighter and durable prosthesis and exercise. </li> <li> Exercise. </li> <li> Lighter weight and a more positive attitude about age and life in the future. </li> <li> Proper instruction in wrapping, exercise, etc. </li> </ul> </li> </ol> DISCUSSION The supplementary data agrees remarkably well with that received through the mail, and only reinforces any conclusions that can be reached from the information supplied by the original 23 respondents. It seems that geriatric patients are receiving considerable attention throughout the country and while the results are good considerable refinement in devices and techniques will be welcomed. Reduction in weight of artificial legs for all levels of amputation through the lower limb seems to be indicated, and improved knee control units are needed by above-knee (and hip-disarticulation) cases. The use of stubbies certainly needs clarification, probably through a well-ordered study. Page Number(s) 1 - 5 Year 1977 Volume 1 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "The Geriatric Amputees" - Results of the Questionnaire https://staging.drfop.org/files/original/d586b041111b65540684d82a6e22f061.pdf e776f2fafbdbd45711ced14b11af8203 https://staging.drfop.org/files/original/a6c4aeadeff6b0f8ec45aad1761417bc.jpg 0335be700fe81e4e50cc3fa690fb418f https://staging.drfop.org/files/original/9621cce0bb9d571026c1d68d6c3bfdea.jpg e4ea4687449f451e36041c2e86b31857 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_02_001.pdf Text Any textual data included in the document <h2>Plastics in Lower-Limb Orthotics</h2> Our October 1976 Issue of the Newsletter discussed "Plastics in Lower-Limb Orthotics" and requested information from our readers as to their experiences and preferences. The following is the results of the questionnaire on this subject. <a href="/files/original/a6c4aeadeff6b0f8ec45aad1761417bc.jpg">Fig. 1: Fitting the Molded Plastic AFO.</a> <h3>Results of the Questionnaire and a Discussion of the Results</h3> <ol> <ol> <li> Does your clinic use custom made orthoses formed from sheet thermoplastic material? <blockquote> YES - 71 NO - 2 </blockquote> One of the respondents who answered "NO" is an institution that treats only amputees. The other "NO" came from an orthotics facility in New England who gave as the reason "We use Ortholene blanks and laminated AFO's." </li> <li> If the answer is "Yes" please name the materials used and show opposite the types of appliances made from the particular material. The responses to this question are shown in this Table. </li> </ol> </ol> <img src="https://staging.drfop.org/files/original/9621cce0bb9d571026c1d68d6c3bfdea.jpg" /> <ol> <li> Do you use preformed "off-the-shelf" AFO's? Thirty-one used preformed or "off-the-shelf" AFO's. Thirty-six who also used molded AFO's did not use "off-the-shelf" AFO's. Most of the respondents who used the preformed AFO's stipulated that the use was limited to initial trials or to those relatively few patients that could be fitted adequately. Those that refused to use the preformed unit felt that the better results obtained by custom molding was worth any extra effort necessary. </li> <li> Please give the reasons for the answer you gave to question "3". Some typical responses were: <blockquote> "They (preformed) will work on some patients....." "Use (preformed) on easy to fit patients or those not needing the extra support." "If the doctor specifically prescribes (preformed), or if the patient insists after explaining the advantages and disadvantages." "I use preformed AFO's for pes equinus only. I use custom made for all other orthotic treatment." "Because (preformed are) no good; have to reheat and mold to have work properly, so may as well start from scratch and make your own." "Fitting difficulties - sizes do not fit many patients who are edematous, atrophied, or need support." "They don't fit." "Doctors prefer custom-made." </blockquote> </li> <li> If you provide molded plastic orthoses, what type of equipment do you use in fabrication? The answers given were not always clear but it appears that: <blockquote> 35 used a vacuum machine of one type or another 19 used hand drape with vacuum 14 used hand drape without vacuum 8 used central fabrication </blockquote> Some facilities used more than one method, thus accounting for a total greater than the number of respondents that use custom formed orthoses. About the only conclusion that can be drawn from these figures is that vacuum machines are probably worth the investment. </li> <li> Please give your opinions about the usefulness of sheet thermoplastics in orthotics. Nearly every respondent answered this question in some detail. Most cited lightness and cosmetic benefits. Some typical comments: <blockquote> "We feel that this is the biggest advance in orthotics in the last few years, providing the patient with a lightweight, hygienic, orthotic system." "We feel that molded AFO's are far superior to conventional braces in every respect. Most of our orthoses are constructed using the materials and the patients and their physicians are most pleased." "I am able to obtain excellent fit and control with plastics that would not be possible with a leather-metal orthosis. Also, it is lighter and more cosmetic." "We find it has great adaptations to orthotics, with unlimited applications." "It's the only way." "These orthoses are useful for cosmesis, function, and light weight." "Unlimited potential, but discretion advised." "I feel we have uncovered a new dimension to orthotics and look forward to further developments in the future." "Enables orthotists to apply new ideas toward orthotics." </blockquote> </li> <li> Have you experienced problems with the quality of the sheet plastic material? If the answer is "Yes", please explain. Twenty five respondents indicated that they had experienced problems with the quality of sheet plastic, while 32 said that they have had no problems. Alan Finnieston of Miami, Florida, who has had a lot of experience in the use of the sheet plastics offers the following observations: <blockquote> "In answer to your question #7, we have had many difficulties with the quality of thermoplastic sheet material of various types. For example: Polypropylene, polyethylene, ABS, styrene, and polycarbonate to only mention a few. We have been involved with thermoplastics and the vacuum-forming field for approximately ten years. Orthotics and prosthetics cannot justify, by virtue of their volume, specific formulations of material to specifications. As an example, most Orthotists or Prosthetists are buying polypropylene on a local level through a distributor. The distributor has no means of controlling what material or formulation of polypropylene he is receiving. Polypropylene is available in homopolymer, copolymer, random or block, plus many variations of grades; extrusion, injection and film, with a multitude of modifiers which can vary specifications of the base material. One then must seek out the reputable extruder with high-quality equipment and technology. This eliminates the problem of the re-ground materials of unknown formulations plus regulation of the extrusion prices." </blockquote> </li> <li> Are special courses needed to provide orthotists and other members of the clinic team with training in the prescription, fabrication and fitting of molded plastic lower-limb orthoses? Please explain. Of the 73 respondents, only 2 said that they felt that special courses for orthotists and other members of the clinic team were not needed. One of these provided only "hard corsets" and "arch supports"; the other stated "No, not in lower limb orthotics, because the basic rationale is unchanged as is the function." An institution that provided only "hand splints" said "Registered occupational therapists who are trained in splinting in their academic and clinical education fabricate all splints in the clinic." One clinic and one orthotics facility both of which provided molded AFO's answered with a question mark, and another clinic did not respond to this question. However, the remaining 67 respondents felt quite strongly that special courses are needed if orthotists and other members of the clinic team are to make maximum use of the advantages afforded by sheet thermoplastics. The vast majority felt that all members of the clinic team should be offered training, but a few felt that formal training should be restricted to orthotists. Some of the responses are: <blockquote> "Yes, any further education is valuable to the entire team." "Yes - exchange of ideas would be very useful particularly concerning fabrication. I have been making vacuum formed molded orthoses for 2-1/2 years and I still find it useful to exchange ideas with others who do it; to get the bugs out." "Yes. It would be most help to attend a course in KAFO's." "Definitely. Many problems can be circumvented with previous training." "Yes, I believe this would be very helpful. I think this could be done in the curriculum of the schools already teaching Orthotics and Prosthetics. Seminars are helpful but only touch upon the surface. I think this area has already been covered in the last 5 years and needs more advance hands-on courses and experiences by physicians, therapists, orthotists and prosthetists." "Yes. So many doctors still want to use old methods." "Orthotists only should have courses, and then show the latest uses and methods. I feel that he should be the one to explain the advantages to the other team members." "I think courses stressing cast modification, preparation, hand layup, and fitting problems would be helpful to the whole team. Personally, I have seen all the vacuum layup films I can stand." </blockquote> </li> </ol> <h3>Overall Conclusions</h3> Thus, it seems obvious that sheet thermoplastics have a great potential in all aspects of orthotics and that appropriate education programs are needed and wanted. Alan Finnieston included in his reply an announcement that his firm intends to offer "a series of instructional programs on the correct use of plastics in contemporary orthotic practice" and suggests that those interested in attending contact him at 1901 N.W. 17th Avenue, Miami, Fla. 33125. The results of this survey have been forwarded to the formal education programs in this country and abroad with the hope that the faculties will be stimulated to initiate programs in this area. Page Number(s) 1 - 4 Year 1977 Volume 1 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 1 http://www.oandplibrary.org/cpo/images/1977_02_001/1977_02_001-1.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Plastics in Lower-Limb Orthotics https://staging.drfop.org/files/original/ee61dd08d73b1cad17151d32ba21665a.pdf 00de1488d4f6818f709108234fc1fd5a https://staging.drfop.org/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg 51ba0ecca6e54631dcd919a2c26a692f https://staging.drfop.org/files/original/1ea58d09d331e165282d3da5cc9f227d.jpg bf16b3b914da6223c95f0a83bf29956b https://staging.drfop.org/files/original/4fd62f8f90674af658c40281e2d37b8a.jpg f7926bbf8fc79875b7a3224beafaffed Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_01_002.pdf Text Any textual data included in the document <h2>Plastics in Lower-Limb Orthotics</h2> Polypropylene has been in use for lower-limb orthoses in various parts of the U.S. and Canada for more than 5 years. Although polypropylene itself was introduced and used in orthotics slightly before vacuum forming was introduced, most of the fabricators have used this technique in fabrication. Some AFO designs are being offered "off-the-shelf" in a series of sizes. Some suppliers stress that the purpose of these prefabricated units is to determine if the patient will benefit from a custom made device or devices. A partial bibliography on the use of plastics in orthotics is included on this page. We invite readers of the Newsletter to give us the benefit of their experiences with respect to both custom-made designs and off-the-shelf units by filling out the questionnaire on page 3 and returning it to AAOP, 1444 N Street, N.W., Washington, D.C. 20005. You are asked to be as complete as possible in the information you give so that meaningful conclusion can be obtained. If additional space is needed please use a blank piece of paper and attach it to the original. <a href="/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg">Fig. 1</a>, <a href="/files/original/1ea58d09d331e165282d3da5cc9f227d.jpg">Fig. 2</a>, <a href="/files/original/4fd62f8f90674af658c40281e2d37b8a.jpg">Fig. 3</a> References: <ol> <li>Artamonov, Alex, Vacuum forming of sheet plastics, ISPO Bulletin, No. 4, October 1972</li> <li>Casson, Jerry, Advanced designs of plastic lower-limb orthoses, Orth. and Pros. 26:3, September 1972</li> <li>Cohen, Samuel, and Warren Frisina, Polypropylene spiral ankle-foot orthosis, Orth. and Pros., 29:2, June 1975</li> <li>Demopoulos, James T. and Johne E. Eschen, Experience with plastic patellar-tendon-bearing orthoses, Orth, and Pros. 28:4, December 1974</li> <li>Dixon, Malcolm, and Robert Palumbo, Polypropylene knee orthosis with suprapatellar latex strap, Orth, and Pros., 29:3 September, 1975</li> <li>Engen, Thorkild J., The TIRR poly-propylene orthoses, Orth. and Pros. 26:4 December 1974</li> <li>Glancy, John and Richard E. Lindseth, "The polypropylene solid-ankle orthosis," Orth and Pros. 26:1, March 1972</li> <li>La Torre, Richard R., Michael Richards, and Sooklall Ramcharran, Ischial-thigh-knee-ankle orthosis, Orth, and Pros. 27:4, December 1973</li> <li>Lehneis, H. R., New concepts in lower-extremity orthotics, Med. Clin, of NA.A. 53:3:585-592, May 1969</li> <li>Lehneis, Hans Richard, Warren Frisina, Herbert W. Marx, and Tamara T. Sowell, Bioengineering design and development of lower-extremity orthotic devices, Bull. Pros. Res., BPR 10-20, Fall 1973</li> <li>Lehneis, Hans Richard, Plastic spiral ankle-foot orthoses, Orth, and Pros. 28:2, June 1974</li> <li>Marx, Herbert W., Lower-limb orthotic designs for the spastic hemiplegic patient, Orth, and Pros. 28:2, June 1974</li> <li>Rice, Edward, A new design for the drop-foot polypropylene orthosis, ISPO Bulletin No. 12, October 1974</li> <li>Rubin, Gustav, and Michael Danisi, A knee-stabilizing ankle-foot orthosis with adjustable spring-loaded ankle, Orth, and Pros. 29:3, September 1975</li> <li>Rubin, Gustav and Michael Danisi, A "slip" cuff for ankle-foot orthoses-a piston-action absorbing polypropylene orthotic cuff, Orth, and Pros. 28:1, March 1974</li> <li>Simons, Bernard C, Robert H. Jebsen, and Louis E. Wildman, Plastic short leg brace fabrication, Orth, and Pros. 21:3, September 1967</li> <li>Rubin, Gustav, and Robert L. Palumbo, A polypropylene knee-ankle orthosis, ISPO Bulletin No. 8, October 1973</li> <li>Sarno, J. E., and H. R. Lehneis, Prescription considerations for plastic below-knee orthoses, Arch. Phys. Med. and Rehab., 52:11:503-510, November 1971</li> <li>Stills, Melvin, Thermoformed ankle-foot orthoses, Orth, and Pros. 29:4, December 1975</li> <li>Stills, Melvin, Vacuum-formed orthoses for fracture of the tibia, Orth, and Pros., 30:2 June 1976</li> <li>Titus, Bert R., A patellar-tendon-bearing orthosis, Orth, and Pros. 29:1, March 1975</li> <li>Wilson, A. Bennett, Jr., Vacuum forming of plastics in prosthetics and orthotics, Orth. and Pros. 28:1, March 1974</li> </ol> Page Number(s) 2 - 2 Year 1977 Volume 1 Issue 1 Figure 1 https://staging.drfop.org/files/original/30c5fecef8a972c9d044dc4d99f003e8.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1977_01_002/1977_01_002-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 3 http://www.oandplibrary.org/cpo/images/1977_01_002/1977_01_002-3.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Plastics in Lower-Limb Orthotics https://staging.drfop.org/files/original/9e60ebed5692df9e5fe07e6d4cd87a96.pdf 77971953d21518efcd4221380ba3b8a3 https://staging.drfop.org/files/original/c2545799ce5601d736f2cd4f1463a521.jpg 16fbd70081beef02a934947a081b6280 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1977_01_001.pdf Text Any textual data included in the document <h2>Introduction</h2> In December of 1969 the Committee on Prosthetic-Orthotic Education of the National Academy of Sciences initiated publication of "NEWSLETTER .... AMPUTEE CLINICS" in an effort to disseminate timely information to amputee clinic teams throughout the country and to provide a vehicle for the interchange of information among clinicians responsible for the care of amputees. The Newsletter met with immediate success and was published every two months until 1975 when policy changes at the National Academy of Sciences precluded publication of the Newsletter .... Amputee Clinics. The final issue, Vol. VIII No. 1 has been published with a date of July 1976 after a hiatus of nearly a year. Because so many members of the American Academy of Orthotists and Prosthetists and their colleagues on the clinic teams that they work with have voiced regret that the forum provided by the Newsletter, no longer exists the Board of AAOP, after a study, determined that the majority of the membership were in favor of assuming responsibility for continuation of this type of publication. Therefore, the board of the AAOP has made the decision to proceed on the basis of four issues per year, initially, and to expand the coverage to include orthotics. It was hoped that an announcement concerning the plans of the AAOP would be made in the final edition published by the NAS, but since such could not be effected this abbreviated edition is being sent to those who in the past have received the "Newsletter-Amputee Clinics" to determine the size of the circulation that can be expected. Our editor for the new publication will be Mr. A. Bennett Wilson, Jr. who helped formulate the original newsletter while in his previous position as Executive Director of CPRD. Mr. Wilson is now acting Director of Training at the Krusen Research Center of the Moss Rehabilitation Hospital in Philadelphia, Pa. The editorial board will be headed by Charles H. Epps, Jr., M.D. of Washington, D.C. Dr. Epps is chief of the Juvenile Amputee Clinic at D.C. General Hospital. Mr. Robert B. Peterson, R.P.T., Supervising Physical Therapist for Hospital Services, Maryland Department of Health and Mental Hygiene and the undersigned will also reside on the board. This group plans to seek technical consultation with representatives of the Veterans Administration Prosthetic Center and the Rehabilitation Services Administration of Health, Education and Welfare on all applicable subject matter. We would also like to thank Mr. Anthony Staros, Director of the Veterans Administration Prosthetic Center for his assistance and guidance in planning this new publication. To begin, four issues per year are contemplated. The initial subscription rate will be $8.00 per year. Each issue will contain short articles on both Prosthetics and Orthotics. AAOP members will receive their copies as a service to members. Prices will be adjusted to reflect costs without profit to the AAOP. A subscription order blank is included in this issue for the use of those who are not members of AAOP. Your participation will help us in assuring the long term success of this publication. <a href="/files/original/c2545799ce5601d736f2cd4f1463a521.jpg">Joseph M. Cestaro: AAOP President</a> Page Number(s) 1 - 1 Year 1977 Volume 1 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1977_01_001/1977_01_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Introduction Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Review Status Status of review after import from old O&P Library into Omeka platform. Not Performed https://staging.drfop.org/files/original/13d59df7eaa0bb5ef10ecff3a8fa4fd9.pdf 0247ed6219932127b8f05567d483ea5a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1983_03_003.pdf Text Any textual data included in the document <h2>Analysis of the Results From the Questionnaire on Metal vs. Plastic Orthoses</h2> By May 1st, fifty-four (54) responses had been received, considerably more than usual. Fifty-two (52) respondees were certified personnel, one was a physician, and one was an unspecified "other." Interestingly enough, the individual listing himself as other was by far the most negative in his comments. The results were as follow: <ol> <li> Percentage of plastic vs. metal orthoses prescribed: <ul> <li> 100% plastic—17% </li> <li> 75% plastic, 25% metal—61% of the time </li> <li> 25% plastic, 75% metal—13% </li> <li> 100% metal—2% </li> </ul> </li> <li> Percentage of staff trained in plastic: <ul> <li> 100%—74% of respondees </li> <li> 75%—9% </li> <li> 50%—9% </li> <li> 25 %—7% </li> </ul> </li> <li> Most significant advantages: <ul> <li> lightweight—43% </li> <li> cosmesis—28% </li> <li> versatility—26% </li> <li> correction increased—17% </li> <li> other—11% </li> <li> total contact—9% </li> </ul> Many individuals checked more than one. </li> <li> Most significant disadvantage, most commonly indicated factors (actual numbers): <ol> <li> Inability to adjust dorsiflexion/plantarflexion—20 </li> <li> Fluctuating edema—7 </li> <li> Fitting a proper shoe and heel height—5 </li> </ol> </li> <li> Durability of plastic and hybrid orthoses vs. metal orthoses: <ul> <li> more durable, less maintenance—40% equal—30% </li> <li> less durable, more maintenance—22% </li> </ul> </li> <li> Do you agree with Mr. Shurr's arguments for the use of traditional metal upright orthoses? <ul> <li> yes—69% </li> <li> no—30% </li> </ul> </li> <li> Do you share Mr. Shurr's skepticism regarding prefabricated plastic AFO's? <ul> <li> Yes—83% </li> <li> No—13% </li> </ul> </li> </ol> This seems to be one issue about which considerable unanimity exists within the profession. Questions one and two seem to indicate that plastic plays a major role in the practice of many orthotists and that most of them are versed in its usage. The response to question 5 indicates that most practitioners are not experiencing significant problems with durability, probably as good an indication of good fabricating technique as any. In looking at questions 3, 4, 6 and 7, it appears that most respondents understand the role of plastic in orthotics and its advantages and disadvantages. In light of this unanimity of opinion it is interesting that the question of plastic vs. metal should excite enough interest to spark so large a response, particularly as plastic orthoses have now been in use for over ten years. It may be that orthotists still confront the need to defend plastic orthoses and justify their use. Contrarily it may be that enough individuals have enough experience with plastic that they feel comfortable responding to the issue. Additional responses: The following samples are chosen somewhat at random as examples of differing opinions: Comments on question 4: <ol> <li> It is my firm belief that the fixation of any joint will have the result of severe atrophy and eventual fusing of the joint. The long term results of the use of the (non-jointed) plastic AFO are not known. Putting it simply: What's the use of working toward recovery of use of an extremity (and that return gradually takes place) when the 'treatment' by an orthotic device has created other problems that the degree of recovery is not able to overcome? </li> <li> I feel there has been an overemphasis on plastic AFO/prefab AFO used by R.P.T.'s which have a limited application, and may be used with some success on geriatric patients in convalescent areas. They do make damned good night splints and that's about all. If used on hilly terrain or streets the patient usually ends up on his butt or smashes his face. </li> <li> How anyone could argue the cause for plastic AFO's is unreal. Any amount of comparisons with the traditional AFO reveals less durability and limited function. Seven out of 10 patients have disabilities necessitating metal over plastic, numerous modifications [to plastic] are a must, and medial lateral support is nil. In my experience, I have found that very mild cases necessitate the use of a plastic AFO when drop-foot (only) is the reason for bracing. Instability in the M-L plane is often accompanied by drop-foot, thus ruling out the plastic AFO. </li> <li> I feel that the plastic AFO is definitely a more desirable type of orthosis for all the reasons mentioned in question #3. However, not every patient is a candidate for a plastic AFO, especially if the patient has edema or needs adjustability at the ankle. </li> <li> Most students coming out of schools at this time only know how to make plastic AFO's and are not proficient or comfortable in making conventional orthoses. These "students" who usually possess degrees never spend sufficient time working in the lab to become bench technicians and most, when handed a pair of bending irons, are in jeopardy of hurting themselves. </li> <li> I agree with Mr. Shurr, but only from the standpoint of a therapist. Adjustment of plastic AFO's requires more than just a general knowledge of thermoplastics. During patient rehabilitation, minor changes in the degree of dorsi or plantar flexions that the orthosis is set in can make a drastic change in patient function. In clinical settings, this should always be done by the orthotist. However, physicial therapists working with patients wearing AFO's may not have accessibility to an orthotist whenever they want to "experiment" with different ankle settings. I can therefore understand Mr. Shurr's interim preference. This is, however, no comparison between the superiority of plastic systems over metal. Orthotists should be involved with any change made to their patients orthotic system. </li> </ol> In response to question 6: Therapist adjustment syndrome (TAS) is not a valid RX criterion. General Comments: Far more important than durability is the ability to provide superior fit alignment and function. Improperly fitting plastic orthoses, by their very nature, are far more obvious and as a result more nearly considered unacceptable than the traditional Brace—which by its very nature masks improper fit and alignment and of course results in improper braces being worn. In 1980, we introduced a policy of providing all necessary repairs and adjustments without additional cost for the life of any plastic orthosis. This policy specifically excludes traditional metal/leather braces. Page Number(s) 3 - 4 Year 1983 Volume 7 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Analysis of the Results From the Questionnaire on Metal vs. Plastic Orthoses https://staging.drfop.org/files/original/a4e24d04daaec423ee9b4e3a36bda7ea.pdf 1c53d4c491f0f059b170578f088b4157 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_006.pdf Text Any textual data included in the document <h2>Questionnaire: Extra-Ambulatory Prostheses</h2> The following analysis and comments were drawn from responses to a recent questionnaire on extra-ambulatory prostheses. The article, "Extra-Ambulatory Activities and Amputee/' by Drew A. Hittenberger, CP, appeared in the Autumn, 1982 issue of C.P.O. (Vol. 6, No. 4). As of January 25, 1983, five responses had been received to the questionnaire on extra-ambulatory prostheses. This is a very low response and of course no valid conclusions can be drawn from it. In response to question number one, "How many extra-ambulatory prostheses have you made?," four responses said six-15 and one said 16-25. On question number two, "What percent of your patients are involved in some form of physical exercise?," the average response was nine percent with a high of 20%, a low of five percent and one who said he had never thought to ask. When asked, "What percent of your patients ask you about extra-ambulatory prosthetics?," the average response was 11% with a low of two percent and a high of 25%. The respondees were asked to list, in order of occurrence, extra-ambulatory activities in which their patients participate. There were four mentions of swimming, although one was not the first activity listed; there was also one mention of scuba diving. Snow skiing was mentioned three times and water skiing once. Running and racquetball (a running sport) were both mentioned once, as were hunting, fishing, weight-lifting, and horseback riding. The respondees were asked what percentage of patients used their prosthesis for more than just daily activities and the average response was seven percent, with a high of ten percent, a low of five percent, and one who didn't know. As to how many of their patients had one prosthesis for daily activities and one for extra-ambulatory activities, the respondees on the average said four percent, with a low of one percent, to a high of ten percent. All the respondents said that they informed their patients of handicapped sports organizations. One said he had a directory posted, and another said that there were no such organizations in his area. Three of the respondents said that they were not satisfied with the level of prosthetics and its role in extra-ambulatory activities. One said yes, and the fifth said yes, but with reservations. Reasons given for amputees not being more involved were: <ul> <li> lack of interest </li> <li> not involved before amputation </li> <li> non-positive social conditioning </li> <li> fear of injury </li> <li> ignorance </li> <li> embarrassment </li> <li> rejection </li> <li> poor post-operative management </li> </ul> All five said that they would like to attend a seminar on the topic. Several additional comments were received and are listed below. In addition, Carl A. Caspers, CPO, of Minneapolis, Minnesota took the time to write a long, thoughtful letter in response. Parts of it are quoted below. Additional comments: <ol> <li> "Yes—we need better research on different designs of prostheses for different functional activities." </li> <li> "Technical reports detailing alignment and fabrication for these specialized devices [are needed]. I have had to research, design, and devise techniques to create extra-ambulatory prostheses. Also preprinted bulletins with photographs for the patients would offer greater understanding and perhaps desire for these devices." </li> </ol> Mr. Caspers writes, in part: "This letter is in response to Drew Hittenberger's article on extra-ambulatory activities and the amputee in the Autumn issue of Clinical Prosthetics & Orthotics—CPO. I was very pleased to see this article covering this subject as this has been a sadly neglected area for a long time. "Mr. Hittenberger brings up some very good questions regarding the rehabilitation team's capability of maximizing the patient's activity level and more importantly the resultant poor postoperative care and management of the amputee. The vast [majority] are suffering from diabetes or other vascular complications. Obviously, the level of activity and the requirements for these people are going to be considerably less strenuous than those of a younger amputee. I think the problem goes back one step further and does not start with the post-operative care but in the operative management of the amputee. To date, the physician's main concern has been with the medical needs of the patient at that time and very little thought is given to the patient's functional needs after amputation. Such things as myodesis procedures, tibia-fibula stabilization, and lengths of lever arms are all crucial in the long-range function of an amputee. . . . "In the area of limitation, I think Mr. Hittenberger covered this very well. There is an economic limitation that needs to be covered here also. The rehabilitation team's knowledge of extra-ambulatory activities and its awareness of the many extra-ambulatory prosthetic devices is somewhat limited. This thereby creates an economic factor that many amputees are unable to deal with. As has been well documented in the field of prosthetics, there is a need for extra-ambulatory devices and these should be considered in the total rehabilitation, physically, psychologically, and economically. "In the areas of prosthetic design, I think there are a number of things to provide [the patient] the capability of participating competitively or recreationally in extra-ambulatory activities. A sound pain-free residual limb is essential for good function in these areas. A good understanding of bio-mechanics as applied to the amputee is essential for the prosthetist to provide a well designed prosthetic device . . . "In this day and age we have available to us a very sophisticated armamentarium of component parts and space-age type materials that lend themselves extremely well to prosthetic device fabrication, particularly in the specialized limbs geared toward specific physical activities. "In recent times there has been much use of things such as rotational absorbers, Greissinger feet, and multi-axis type ankle joint foot complexes. All of these types of items offer capability to the amputee but should not be applied in a general fashion. There are many activities where a rotator or multi-axis type foot complex is extremely detrimental to the function-ability of an amputee. Any sport which requires rapid directional changes would be a good example where these items should not be used. A person making quick and rapid adjustments in dynamic balance requires immediate response from the floor through floor reaction with his foot. This cannot be accomplished adequately with such items. "In conclusion, I feel that extra-ambulatory activities of the amputee and the resultant prosthetic devices that may be required for his successful participation in these activities is a relatively untouched area. A great deal of input is needed, both from the amputees in this country and the individual prosthetic practitioner, along with the physician and rehabilitation team members. I, myself, have been an amputee for 23 years and have been involved in numerous competitive and recreational activities and sports. I have found there are many areas in which I can participate in a non-handicapped world, and can be very competitive either on a one to one basis or as a team member. I have found this to be extremely fulfilling for myself and feel this is one of the ultimate goals that any amputee would strive to achieve." As regards the question of torque absorbers and use of the more sophisticated ankle foot complexes, Mr. Caspers raises a very interesting question. Certainly many prosthetists hold decided views on the topic and it would be interesting to receive Letters to the Editor on the matter. The Editor Page Number(s) 6 - 7 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 Questionnaire: Extra-Ambulatory Prostheses https://staging.drfop.org/files/original/9df687fab2e971e5bdb448b8747dc9eb.pdf 78bf41dbabb6870890e75cc378aa3af1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_01_004.pdf Text Any textual data included in the document <h2>"Should Functional Ambulation Be a Goal for Paraplegic Persons." - Readers' Comments</h2> The <a href="cpo/1977_04_004.asp">above article</a>, which appeared in the last issue of the Newsletter elicited a great number of responses from physicians, orthotists-prosthetists, therapists, and counselors. More than 90 percent of our respondents agreed with Michael Quigley's position that the majority of paraplegic patients should be fitted with lower-limb orthoses despite the fact that use of such orthoses is extremely inefficient. The major reason for providing these orthoses to patients is to either have the patient prove to himself that he will not be able to walk in a normal manner again, or to make sure that every patient has a chance to walk, inasmuch as few patients are able to use orthoses even for transfer purposes or upright mobility. The following comments represent a consensus from our respondents: <h3>Indications For Fitting Paraplegics With Orthoses:</h3> Most respondents agreed that the T10 lesion level seemed to be on the border between a functional ambulator and a non-ambulator. One or-thotist-prosthetist responded that in his area the L1 level is used, as this is the most proximal innervation of the major hip flexors and hip hikers. Margaret Henry, R.P.T., of the Mt. Wilson Center in Maryland stated that the patient must first have abdominal muscles present and have a desire to walk. He is then fitted with trial braces and must be able to complete 200 lattisimus dorsi push-ups before he is fitted with his own braces. This exercise is used to determine if the patient would have the strength and endurance to ambulate functionally. Another therapist stated, "I enjoyed the article and comply with author. However the reasoning behind Cerney's conclusions or Hus-sey's conclusions are faulty. Their conclusions are valid only on the type of braces their patients had and type of training. Study should be qualified!" A rather interesting letter was sent in by Howard V. Mooney, CP. of Burlington, Massachusetts. Mr. Mooney stated that he had no experience with paraplegics but mentioned similar experiences with bilateral, above knee amputations. Mr. Mooney stated "I learned early in the profession that to some there is no such word as 'fail.' " He states that it is his policy to describe the facts and the pitfalls of walking on two above-knee prostheses but if the patient still wants to continue he gives them all the help and encouragement possible. <h3>What Orthotic Designs Do You Recommend For Paraplegic Patients?</h3> The most commonly mentioned design of orthosis is the Scott-Craig KAFO. The respondents preferred this because of the simplicity of design, the lack of a pelvic band, ease of donning, and control of ankle motion. Those readers that did not use the Scott-Craig system preferred plastic molded knee-ankle-foot orthoses or light-weight designs. No one recommended the use of a pelvic band. All respondents were quick to point out the indications for orthoses for children and polio patients differed from that for adult traumatic paraplegic patients. John Glancy, C.O., University of Indiana, Indianapolis feels that rehabilitation practitioners are making a mistake when they assume that present designs of orthoses begin to provide the mechanical aid paraplegics require. Mr. Glancy feels that patient's motivation towards walking is generally poor because they have to work with such inadequate orthotic systems. Mr. Glancy is presently working on a system that uses elastic material as a source of external power and sees this as a possible solution to the problem. <h3>Is It Practical To Expect Ambulation With LSHKAFO's (Bilateral Long Leg Braces With Night Spinal Attachments)?</h3> A resounding "no!" was given by all to this question. One respondent stated that this type of orthosis is too cumbersome and hard to don and that if the patient is so severely involved that he needs this measure of stabilization he undoubtedly lacks adequate muscular and respiratory reserve to ambulate any distance and is better off with a wheelchair. Mr. Robert Penny, C.O. of the Shelby State Community College and Leo Betzelberger, R.P.T. of the VA Spinal Cord Injury Center, Memphis, Tennessee stated that we have had 3000 (conservative) spinal-cord-injury patients as of 1948 and gradually abandoned LASKAFO's as they were just thrown in the closet. We found patients could ambulate up to T10 with KAFO's in parallel bars. Daily living at home negates KAFO's too. We do try to keep them in metal KAFO's for dorsiflexion and ankle protection. Probably the most interesting response on this question came from Frank W. Clippinger, M.D., Duke University Medical Center, Durham, North Carolina. Dr. Clippinger stated "from a purely practical standpoint anyone in their right mind won't bother with this. By locking the trunk to the thighs and the legs to the feet is not standing in the true sense. It is lying down vertically. I think this treats the therapist, orthotist and the doctor but not the patient. The same function can be accomplished using a coffin instead of braces as is perfectly evident in the Egyptian section of any museum." In summary, the vast majority of all respondents felt it was important to give paraplegic persons the chance to stand and ambulate for the many reasons stated above. The term "motivation" ranked very high on everyone's list as one of the major indications for providing orthoses to paraplegic persons. For this reason I think it is proper to finish this synopsis of our readers comments with another quote from Howard Mooney, CP., "Never underestimate the potential of anyone with unlimited motivation." Page Number(s) 4 - 5 Year 1978 Volume 2 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Text Copy Edit Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "Should Functional Ambulation Be a Goal for Paraplegic Persons." - Readers' Comments https://staging.drfop.org/files/original/1e1744490ce5197c6fbbd672bbe0ec51.pdf ae3011da56cde88195a6545638e8ac74 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_04_010.pdf Text Any textual data included in the document <h2>Follow-up on Endoskeletal Article and Questionnaire: The Manufacturers Reply</h2> Summarized results of the survey concerning endoskeletal prostheses appeared in the Summer, 1982 issue of C.P.O. (Vol. 6, No. 3). These compiled results were circulated among the manufacturers of endoskeletal prosthetic systems. The following responses were received. In regards to the "g" response in the additional comments section, [questioning whether the cost is justified] I will submit the following: Endoskeletal prosthetics is a poor excuse to charge more money, only when it is the excuse that it is being charged to the patient. I can also understand being afraid of the dollar sign where it prevails as fiscal remuneration for an excuse, rather than the patient's welfare. Endoskeletal prosthetics have consistently proven themselves a useful tool in developing value in the patients themselves, and in the patient's rehabilitation accomplishments . Michael T. Wilson, CPO Medical Center Prosthetics, Inc. Manufacturers must keep many things in mind when designing and building a modular system: weight vs. strength, added features vs. weight and strength, and cost to manufacture vs. simplicity. Research and development expenses are subsidized only by sales profits. A good example is that tooling for one simple item may run $80,000, while sales and volume of manufacture does not warrant this expense. In summary, manufacturers do have handicaps. In reviewing question number ten—what changes would you like to see?—we find 19 answers were provided. Eighteen of the 19 have been researched, and four of these are available now. The others will continue to be researched and will be available in the future. The field of prosthetics has come a long way in the past 20 years; let us look at what is available now in manufactured parts as to what was available in 1962. We at United States Manufacturing Company believe there will be even more improvements in the next 20 years compared to the last 20. Dan J. Edwards Sales Director United States Manufacturing Co. Otto Bock, along with several other manufacturers of endoskeletal prosthetic systems, was presented with the survey results from the Winter Issue of C.P.O. and was asked for a response. While the total number of endoskeletal prostheses indicated as having been delivered to patients was significant, we must offer our opinion that the total of 27 returned questionnaires is a rather poor response and certainly does not represent a consensus upon which to base any conclusions. Each manufacturer is individually aware of how many endoskeletal units it produces and sells each year, which gives a general idea of market acceptance. Our experience has been that our endoskeletal units sold continue to increase in significant quantities year after year and this trend has shown no sign of reversing. This in itself is an indication to us that endoskeletal systems have attained a definite place in the armamentarium of components available for prosthetic patient management. A great number of people seem to support the belief that endoskeletal prostheses were designed to replace exoskeletal prostheses. It is certainly not our company philosophy that one is intended to replace the other. Both types of systems have their advantages and disadvantages and it ultimately should depend on the professional decision of the prosthetist as to which system will best fit the needs of each individual patient. Perhaps many of the complaints about endoskeletal systems are due to improper patient selection criteria rather than deficiencies in the systems themselves. Another source of trouble with endoskeletal systems is the improper application of fabrication techniques. Recognizing this possibility—and being one of the first manufacturers to offer a complete multiple option endoskeletal system for the lower extremity—we developed a seminar program for instruction in these new techniques. In addition, we have developed Technical Information Bulletins, slide programs and presentations for various technical meetings. Despite these efforts on our part, the sheer numbers of prosthetists in this country and their diverse geographical locations make it nearly impossible to personally instruct every one, even if we could increase the size and frequency of our seminars. Basically, we are able to trace many of the problems to not following technical recommendations. In many cases the problems have been cleared up rather quickly by following instructions. The prosthetist has the choice of using any of several manufacturers' systems, each with its own unique features. If alignment capability in the definitive prosthesis is desired, an IPOS or OTTO BOCK System can be used. If it is felt that this permanent adjustability is detrimental, the USMC or AFP Systems can be used instead. When the Otto Bock foam cover is too difficult or time consuming to shape, or lacking in durability, there are other alternatives. These include the foam-in-place technique offered by Medical Center Prosthetics, and the option of a prefabricated cover. Choices also exist for the prosthetic skin, such as our nylon stocking, USMC's newly developed cover, or a covering of the paint-on variety. The foregoing statements are not meant to give the impression that Otto Bock is insensitive to the needs of the prosthetist or, more importantly, to the desires of patients they serve. We recognize fully the need for improvement of endoskeletal systems. The covers need to be more durable and easier to fabricate. The structural and functional components need to be made lighter and more sophisticated. Unfortunately, many of these things are easier said than done, but our research department is constantly striving to develop new and better systems. We very much appreciate the opportunity to comment on this survey and would encourage a much greater response to such surveys in the future. This type of feedback on a much larger scale could be very helpful to all manufacturers. Along this line, we are wondering what suggestions might be offered for quickly disseminating information on new products or techniques so everyone interested could become qualified to use them for maximum benefit to the patient. If anyone has some workable ideas for accomplishing this objective, we are certain all concerned would benefit greatly. Jack Hendrickson, CP Otto Bock <h3>More Endoskeletal Responses Added to Questionnaire Results</h3> Two questionnaire responses were received too late to be included in the compiled results published in the Summer C.P.O. One individual reported that 75% of definitive prostheses fit were of endoskeletal construction and the other reported fitting 150 endoskeletal prostheses (actual numbers, not a percentage). Their responses to questions two through nine were very much in line with the majority of others received. Their written responses are included below: <ol> <li> What changes would you like to see made? First respondee: <ol> <li> improved covers </li> <li> hydraulic knees </li> </ol> Second respondee: <ol> <li> Lighter in weight </li> <li> Improvements in the visual, tactile, and sound aspects of prostheses </li> <li> Longer lasting cosmetic covers, internally and externally </li> <li> For H.D./H.P. prostheses, better sitting ability </li> <li> Standardization of tube sizes and connectors to facilitate "intermarriage" of components </li> <li> More instructional courses by prosthetics/orthotics schools or manufacturers to deal with "practical every-day" problems </li> </ol> </li> <li> Additional comments: First Respondee: The ability to make either major or even subtle changes in a definitive prosthesis, months or even years after initial fitting, has always appealed to me. The more I use the Bock system the more confident I become of it and I find myself fitting a higher percentage [75% last year, Ed.] . . . every year. I find the poor durability of the cover a minor trade off . . . most of my patients agree. I practice in Montana, so you can guess my patients do not always give their prostheses the easiest use. I am a firm believer in the concept. Second respondee: Our first choice of components for any amputee (re: level of amputation, sex, job or environmental factors) is the endoskeletal prosthesis. My first reason for this is ease of maintenance/replacement of components. This single factor keeps patients coming back knowing they can get things "fixed" quickly. In our present rush society this factor cannot be overlooked. Cosmesis is becoming a more important factor every day, regardless of the patient's sex or age. For too long, we have, as professionals, trained our patients to think: 'functional restoration is your main objective.' Having been involved with many patients who are "prosthetic failures," I have learned a few very important lessons as to why they are on crutches, in wheelchairs, or have empty armsleeves. Consumers in general, today, are more educated and interested in knowing their options. The prosthetist has the responsibility to inform his patient as clearly and completely as possible concerning what is available. He may end up referring the patient to a colleague if he does not have the necessary skills to satisfy his client. A satisfied, happy patient is not a side benefit to our existence. It is a must. Through publications such as this one and many others around the world, we have an obligation to keep up-to-date on new developments as well as contributing our findings in return. It is not necessarily always true that something we are having success with is known to most colleagues. Try and publish articles with photographs and you will be surprised at the response. </li> </ol> Page Number(s) 10 - 11 Year 1982 Volume 6 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 Follow-up on Endoskeletal Article and Questionnaire: The Manufacturers Reply https://staging.drfop.org/files/original/a6792a109f39ee50864e3cdc534b4712.pdf 9841f910ceaf33e1e3f1cc6914edbe70 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_03_008.pdf Text Any textual data included in the document <h2>Survey Results</h2> Below are the summarized results of two questionnaires that appeared in recent issues of this publication. These results are important tools for observing, recording, and predicting trends within the Academy and the profession. Your responses are greatly appreciated, and we ask that you encourage your colleagues to send us their thoughts by answering the questionnaire in this issue (see p. 3), and those in future issues. <h3>Scoliosis Orthoses</h3> From the Summer, 1981 Issue, Vol. 5, No. 3 A total of six responses have been received. Two respondents were institutional facilities and the rest were private. The six reported fitting a total of about 757 patients last year, an average of about 126 per facility. The maximum was 400 patients and the minimum was 8. Not too surprisingly, the maximum was an institutional facility (Newington Children's Hospital). The most commonly prescribed orthosis was the Boston System, and among four of the respondents it accounted for the majority of orthoses fit. One individual reported that the Boston System accounted for 100% of orthoses he fit for scoliosis (actual number, 13); however, two of these orthoses had been modified by the addition of a super structure, and 3 with anterior uprights. Only one respondent reported using more than 50% conventional Milwaukees (60%) and this individual, practicing in the Southwest, stated that all had leather girdles as plastic girdles were too hot. He also reported using 35% Orthomedics SOS Systems, the only mention of this style orthosis in the survey. Interestingly enough, one respondent reported that 36% of his scoliosis practice was comprised of Raney Flexion Jackets prescribed by a neurosurgeon for treatment of scoliosis and as positioning devices. Only one respondent, Richard D. Koch, CO of University Hospital, Ann Arbor, Michigan, reported using a preponderance (90-95%) of custom molded TLSO Body Jackets and Low Profile Orthoses combined (actual numbers fit 120-125). The rest of his scoliosis practice was comprised of conventional Milwaukee braces. Mr. Koch comments: "Through school clinics and early screening for scoliosis the range of curves have reduced in degree of their severity. Consequently, we find that TLSO Body Jackets and Low Profiles are in wider use than CTLSO's." Newington Children's Hospital, mentioned earlier, reported using 75% Boston Systems and 25% custom molded TLSO's primarily for treatment of non-idiopathic scoliosis secondarily to paralytic diseases. <h3>Results of the Survey Concerning Endoskeletal Prostheses</h3> From the Winter, 1982 Issue, Vol. 6, No. 1 As of March 25, 1982: 27 responses <ol> <li>How many definitive endoskeletal prostheses does your facility fit a year?</li> </ol> <ol> <li style="list-style-type: none;"> <ul> <li> Total of 1,814 fit, an average of 67 per respondee </li> <li> Maximum of 380 </li> <li> Minimum of 0, second lowest 5 </li> </ul> </li> <li> Indicate the percentages of the type fit. While it is difficult to give precise figures, roughly speaking the same trend prevailed for all respond-ees. About 95-100% of Below-Knee prostheses fit were exoskeletal and 95-100% of Hip Disar-ticulation/Hemipelvectomy prostheses were endoskeletal. Above-Knee prostheses occupied some middle ground with many respondents reporting fitting more than 50% endoskeletal Above-Knee prostheses. Only four respondents reported fitting as many as 50% endoskeletal Below-Knee prostheses. These four tended to be among the most frequent users of endoskeletal prostheses reporting 380, 170, 75, and 50 respectively. </li> <li> Which Endoskeletal Prosthetic System was used most frequently? <ul> <li> Otto Bock 20 </li> <li> AFP 2 </li> <li> Both Otto Bock and AFP 2 </li> <li> Both Otto Bock and USMC 2 IPOS 1 </li> </ul> </li> <li> Do you consider endoskeletal prosthetic systems light enough? <ul> <li> 11 said yes </li> <li> 14 said no </li> <li> 1 said yes to AK's and no to BK's </li> <li> 1 said yes to AFP and USMC and no to Otto Bock </li> </ul> </li> <li> Do you consider them reliable enough? <ul> <li> 19 said yes, one of whom qualified his response by saying for adults and geriatrics only </li> <li> 7 said no </li> <li> 1 said yes and no </li> </ul> </li> <li> Are cosmetic covers and skins adequate? <ul> <li> 23 said no </li> <li> 3 said yes, one qualified his answer by saying only the AFP system </li> <li> 1 said yes and no </li> </ul> </li> <li> Do you consider it necessary to have full capability to modify alignment in definitive endoskeletal prostheses? <ul> <li> 11 said yes, one stating that the need for making changes in alignment as the patient's condition changed was an indication for prescribing an endoskeletal prostheses. One specified the use in temporary prostheses. </li> <li> 1 stated that he considered it desirable early in the patient's progress and unnecessary late </li> <li> 14 said no, one of whom indicated that he used the AFP system exclusively and revised 380 of them </li> <li> 1 ambiguous </li> </ul> </li> <li> How often do you make changes in alignment? <ul> <li> 7 said never </li> <li> 17 said occasionally, one of whom stated that he occasionally made changes early in the patient's progress and never in more advanced instances. </li> <li> 3 said frequently. One was the individual in #7 who identified the need for alignment changes as an indication for prescribing an endoskeletal prosthesis. </li> </ul> </li> <li> Would you consider it satisfactory to trade alignment modification capability for lightness and durability? <ul> <li> 22 said yes, one of whom qualified his position by saying not at the expense of the ability to interchange components. </li> <li> 5 said no </li> </ul> </li> <li> 10. What changes would you like to see made? <ol> <li> 11 specified improved cosmetic covers </li> <li> 4 specifically recommended a more durable cover at the knee, or a way to reinforce or prevent impingement at the knee. </li> <li> 3 recommended more work on hydraulic and pneumatic knee control units, one of whom mentioned a hydraulic foot. </li> <li> 2 mentioned a more secure system of maintaining alignment. </li> <li> 2 mentioned waterproof skin for covers One each: </li> <li> lighter safety knee </li> <li> improved strengh </li> <li> easier to operate and more cosmetic knee lock </li> <li> interchangeability of knee units without necessity of altering pylon tube length. </li> <li> easier and better attachment of cover to foot and socket for improved cosmesis, yet allowing removal for adjustment of alignment. </li> <li> reduction in weight of single-axis feet and ankles </li> <li> modular, removable, hip joint and pelvic belt m. more versatile socket for geriatrics to accommodate weight fluctuation and vascular problems </li> <li> incorporation of cable systems in upper extremity prostheses. </li> <li> durable covers easily donned by the layman </li> <li> easier access to the adjustment screws on top of the foot of the Otto Bock system. </li> <li> Covers such as those used on Hydra-Cadence, but they must look better and last longer. Preferably in assorted sizes." </li> <li> noise reduction (spring squeaks) </li> <li> system for small girls </li> </ol> </li> <li> Additional comments: <ol> <li> "The Otto Bock System was the best of both worlds (lightweight and adjustable) until the alloys and tubing were changed for increased strength. A main selling point of the endoskeletal systems has always been improved cosmesis. This may be true for standing and during the first few months post-delivery. However, the common foam cover system deteriorates relatively rapidly-cuts, tears, folds, and compression of the foam remain common problems. Therefore, I feel the foam covers need refinement." </li> <li> "I want full adjustability while aligning. After alignment on definitive prostheses the adjustability doesn't have much value." </li> <li> "In regard to question #7. Depending on patient indications two systems would be desirable; one fully adjustable in terms of alignment, the other lighter and more reliable." </li> <li> "Most endoskeletal prostheses are for AK female amputees." </li> <li> "In reference to question #4 and #5 above, of course they could be more reliable and lighterweight if they could redesign the system (Otto Bock, Ed's note). As it is, they are doing the best they can with what they have to work with (design)." </li> <li> "It is a good unit but needs improvement." </li> <li> "Endoskeletal is a poor excuse to charge more money. Shell replacement is too costly too soon. I'm afraid the dollar sign prevails and not the patient's welfare." </li> <li> "For below-knee amputees, I do not feel an endoskeletal system is any advantage. For the young, active above-knee amputee, the foam cover is not durable enough. For the hip disarticulation of any age, it is usually preferred, except in special cases." </li> <li> "The endoskeletal system should only be used in those cases where lightness is desired and where changes in alignment are anticipated." </li> </ol> </li> </ol> <h3>Questionnaire Summary Comments</h3> The article on endoskeletal prostheses provoked an astonishing and gratifying response, something of a record in size, in the recent history of this publication. A surprising total number of prostheses are reported fit, and endoskeletal prostheses occupy a significant total in many individuals' overall practice. In assessing the results of this survey, it would do well to bear in mind, however, that according to the statistics, we are primarily talking about prostheses for the higher levels (Above-Knee, Hip Disarticulation, and Hemipelvectomy) fabricated with Otto Bock components. This fact is particularly interesting when considered in light of the fact that below-knee amputees are undoubtedly far more common in most practices. Despite the numbers fit, it is apparent that the re-spondees were less than totally satisfied with the components available. While somewhat ambivalent about weight, and in general satisfied as to reliability, they were almost unanimous in judging cosmetic covers inadequate. Taking questions 7, 8, and 9 together, it would seem that most of the prosthetists replying would feel comfortable using an endoskeletal system that did not have full indwelling alignment capability if it were clearly superior in other aspects. This is noted in light of the proponderent use of Otto Bock endoskeletal components. The written comments and suggestions for change are presented, with few exceptions, in toto to provide more than simple statistics, and some inkling of the thoughts of the respondees. Taken in conjunction with the rest of the survey, they should provide food for thought to all and stimulus to action for designers and manufacturers. Page Number(s) 8 - 10 Year 1982 Volume 6 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 Survey Results https://staging.drfop.org/files/original/61a2fb11b7da32710eee905515de8f06.jpg c2347a862234afea56e70c8f32f049be Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. 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Player html for embedded player to stream video content <iframe width="480" height="270" src="//www.youtube.com/embed/DemNEFRGceA" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe> Imported Thumbnail If a thumbnail images was imported for an embedded video, its id is recorded here and the thumbnail is hidden on pages displaying the embedded video itself. https://i.ytimg.com/vi/DemNEFRGceA/default.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 CIR Sand Casting System - Extended Version Description An account of the resource Demonstrated by Yeongchi Wu, MD; Co-Editing: Josh Waller; Editing and Technical Assistance: Kate Jackson. A full demonstration of the CIR Sand Casting System. The process offers a low-cost, high-quality alternative to traditional prosthetic fabrication methods. The contents of this presentation/publication were developed under a grant from the Department of Education, National Institute on Disability and Rehabilitation Research grant number H133E980031. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. Date A point or period of time associated with an event in the lifecycle of the resource 2009-02-26T22:16:00Z Source A related resource from which the described resource is derived http://youtu.be/DemNEFRGceA Rights Information about rights held in and over the resource <a href="https://www.youtube.com/static?template=terms">Standard YouTube License</a> Publisher An entity responsible for making the resource available CIRNetwork published via YouTube.com amputation amputee arm bottle care casting center fabrication for health international land landmine leg limb lower medical mine plastic prosthesis reha rehabilitation sand soda upper william kennedy smith 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 Videos Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Imported Thumbnail If a thumbnail images was imported for an embedded video, its id is recorded here and the thumbnail is hidden on pages displaying the embedded video itself. https://i.vimeocdn.com/video/1093528281-08fa835c991033c250d4bbc81d340cbbfc2e59e16deb27d9d79e833299264d2f-d_1920x1080 Player html for embedded player to stream video content <iframe src="https://player.vimeo.com/video/500999363?h=7c0c0a4b15&badge=0&autopause=0&player_id=0&app_id=183091" width="1440" height="1080" frameborder="0" allow="autoplay; fullscreen; picture-in-picture" allowfullscreen title="1976 Fitzsimons Army Medical Center Exhibit"></iframe> Duration Length of time involved (seconds, minutes, hours, days, class periods, etc.) 435 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 1976 Fitzsimons Army Medical Center Exhibit Description An account of the resource Recreated from transcripts by Jim Scanlon, PT. Narration by Charles King, CP. This video was generated as part of the Digital Resource Foundation in Orthotics & Prosthetics. https://drfop.org Date A point or period of time associated with an event in the lifecycle of the resource 2021-01-15T20:08:47+00:00 Source A related resource from which the described resource is derived https://vimeo.com/500999363 Publisher An entity responsible for making the resource available Chris Robinson (https://vimeo.com/user103795237) https://staging.drfop.org/files/original/2b79f849d94307f25efd601945ef0c54.png 04f0b384d26021ca2807e73eaa2033ff 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 <a href="http://rompglobal.org">http://rompglobal.org</a> Countries Served Guatemala, Ecuador, United States Organization Type Including ID and tax status 501c3 Contact Name/Title Lauren Panasewicz Director of Development Mission ROMP’s mission is to provide high-quality prosthetic care for underserved people, improving mobility and independence. Tax ID 20-2603927 Address 1474 S Acoma St City Denver State/Province CO Postal Code 80223 Phone (303) 946-7124 Email info@rompglobal.org Services Provided ROMP operates two full time clinics in Guatemala and Ecuador and partners with clinics in the US to provide sustainable care at a low cost to patients. ROMP also operates a US Assistance Program (USAP) that provides access-limited people with amputation in the United States with an affordable, quality option for prosthetic care. Need I Volunteers Need II Donations Additional Info & Comments ROMP Guatemala L Calle, 25-62, Zona 15 Colonia Vista Hermosa 2 Guatemala City, Guatemala Abierto: Lunes a Viernes 9HR - 17HR 502-3049-9471 guatemala@rompglobal.org ROMP Ecuador Madrid y Lugo 24-185, La Floresta, Quito, Pichincha, Ecuador La Floresta, Quito Pichincha, Ecuador Abierto: Lunes a Viernes 9HR - 17HR 593 98 494 3141 ecuador@rompglobal.org LinkedIN Page/Profile https://www.linkedin.com/company/range-of-motion-project/ Facebook Page https://www.facebook.com/ROMPglobal 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 Range of Motion Project Description An account of the resource Prosthetic limbs and orthotic braces are not simply medical devices, but instruments of personal empowerment. 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 https://www.3d4e.org/freehand Contact Name/Title Madelina Pratt - Director Address 3670 Trousdale Pkwy City Los Angeles State/Province California Countries Served USA Postal Code 90089 Email 3d4e.freehand@gmail.com Services Provided Prosthetic Fitting, Medical Equipment / Supplies, Adaptive Mission Printing customizable 3D- printed prosthetic hands free of charge for children in need in the Los Angeles area Additional Info & Comments "The prostheses that we assemble are all based on digital 3D model files created by Enabling the Future, an organization dedicated to promoting the usage and distribution of 3D printed prostheses. If you would like to learn more about them, their website can be found at http://enablingthefuture.org/. " Facebook Page https://www.facebook.com/usc3d4e/ 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 USC Project Freehand Description An account of the resource Freehand is a project within USC 3D4E, whose mission is printing customizable 3D- printed prosthetic hands free of charge for children in need in the Los Angeles area. 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.americares.org Contact Name/Title HELP HOTLINE M-F: 9AM-5PM (EST) 1-203-658-9500 Address 88 Hamilton Ave. City Stamford State/Province Connecticut Countries Served USA, Latin America & the Caribbean, Africa & the Middle East, Asia & Eurasia Postal Code 06902 Phone 1-203-658-9500 Fax 203-972-0116 Email info@americares.org Organization Type Including ID and tax status Non-profit501 (C) (3) tax-exempt organization, and all donations are tax deductible to the extent provided by law Not-for-profit Type 501C-3 Services Provided Medical Equipment / Supplies, Funding, Medical / Surgical Care, Rehabilitation / Training Need I Financial Assistance Mission Americares supports local health centers, helping providers meet the needs of their patients and communities—in times of disaster and every day. Need II Americares accepts donations of medicine and medical supplies from manufacturers and distributors. Americares does not accept products donations from individuals. LinkedIN Page/Profile https://www.linkedin.com/company/americares Facebook Page https://www.facebook.com/americares/ 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 AmeriCares Description An account of the resource Americares is a health-focused relief and development organization that saves lives and improves health for people affected by poverty or disaster.