13 20 371 https://staging.drfop.org/files/original/4c1c2659ace14b6587c3c801d470aa96.pdf dbc48fb2203d6c75e5adce812a9b03de https://staging.drfop.org/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg 4c4de5849811d644713ec7230d7d0f02 https://staging.drfop.org/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg 131fef1ae751f64e310d683f6e52c098 https://staging.drfop.org/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg 0ceb64af346708b11b688bc9aec46035 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_005.pdf Text Any textual data included in the document <h2>Vacuum Forming</h2> <h5>Ben Wilson </h5> In an article I wrote in 1974 on vacuum forming of sheet plastics<a></a> I erred in stating that the first reference to vacuum forming of sheet plastics in orthotics and prosthetics was a paper by Gordon Yates in 1968<a></a>. I should have remembered that Dana Street presented this concept in Volume 1 of the Orthopedic Appliances Atlas<a></a> for the fabrication of cervical orthoses. This is certainly an excellent example of how long it takes to get a technological development from the idea stage to fairly widespread application. <a href="/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg">Fig. 1</a> Vacuum-forming a shank for a below-knee prosthesis using the hand-drape. In the time since my article was published in "Orthotics and Prosthetics" vacuum forming of sheet plastics has been used more and more by private practitioners in both orthotics and prosthetics. Although the educational programs, with a few exceptions, seem to have been very slow in teaching vacuum forming techniques, use of the technique seems to be expanding, owing in part to the several workshops sponsored by the American Academy of Orthotists and Prosthetists. Every process and system has its limitations, and we all recognize that each design in orthotics and prosthetics represents a compromise, but as time goes on the gaps that engender compromise are narrowed as experience is gained. Although the "Orthotics and Prosthetics Clinic Newsletter" has discussed several aspects of vacuum forming in the relatively recent past, in view of what seems to be a rapidly expanding program it seems appropriate that another survey be made concerning the uses of and problems encountered by the private practitioners. A questionnaire on this subject is included in this issue. It will be appreciated greatly if each recipient will complete the enclosed form and add any comments he or she feels that will be helpful in improving service to patients. <a href="/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg">Fig. 2</a>. Vacuum-forming thigh section of knee-ankle-foot prosthesis using automatic machinery. <a href="/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg">Fig. 3.</a> Vacuum-forming a below-knee socket with use of a platen and form for holding plastic sheet. <h3>References:</h3> <ol> <li>"Vacuum-Forming of Plastics in Prosthetics and Orthotics," A. Bennett Wilson, Jr., Orthotics and Prosthetics, Vol. 28, No. 1, March 1974.</li> <li>"A Method for the Provision of Lighweight Aesthetic Orthopedic Appliances," Gordon Yates, Orthopaedics, 1:2:153-162, 1968.</li> <li>"Plastic Braces," Dana M. Street; pp. 90-95 in Orthopaedic Appliances Atlas, Edwards Brothers, Ann Arbor, Michigan, 195.</li> </ol> <h3>Additional Bibliography:</h3> <ol> <li> "Fabrication and Application of Transparent Polycarbonate Sockets," Vert Mooney, M.D., Roy Snelson, Orthotics and Prosthetics, Vol. 26, No. 1, March 1972. </li> <li> "Fabrication of Vacuum-Formed Sockets for Limb Prostheses," Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 3, September 1973. </li> <li> "Report of Workshop on Below-Knee and Above-Knee Prostheses," Hector Kay, June D. Newman, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "The Use of Check Sockets in Lower-Limb Prosthetics," Samuel Hammontree, Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "A Thermoplastic Structural and Alignment System for Below-Knee Prostheses," Hans Richard Lehneis, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Development of a Thermoplastic Below-Knee Prosthesis With Quick Disconnect Feature," Charles H. Pritham, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Vacuum-Formed Sockets in Prosthetics Education," Bernard C. Simons, Alan V. Dralle, Orthotics and Prosthetics, Vol. 29, No. 2, June 1975. </li> <li> "Ultralight Prostheses for Below-Knee Amputees," A. Bennett Wilson Jr., Melvin L. Stills, Orthotics and Prosthetics, Vol. 30, No. 1, March 1976. </li> <li> "Use of Thermoplastic Components in Temporary Prostheses," Charles H. Pritham, Ivan E. Letner, David Knighton, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Applications of Transparent Sockets," S.I. Reger, I.E. Letner, CH. H. Pritham, M.D. Schell, and W.G. Stamp, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Above-Knee Polypropylene Pelvic Joint and Band," Erich Fischer, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "A Lightweight Above-Knee Prosthesis with an Adjustable Socket," George Irons, Vert Mooney, Sandra Putnam, Michael Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Welding Plastics," Neil R. Donaldson, Michael J. Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Functional Partial-Foot Prosthesis," Gustav Rubin, Michael Danisi, Bulletin of Prosthetics Research, BPR 10-16, Fall 1977. </li> <li><a href="http://www.acpoc.org/library/1972_06_003.asp"></a> <a href="http://www.acpoc.org/library/1972_06_003.asp">"A Functional Chopart Prosthesis," Gustav Rubin, Michael Danisi, Inter-Clinic Information Bulletin, Vol. 11, No. 6, March 1972.</a> <a href="http://www.acpoc.org/library/1972_06_003.asp"></a></li> <li><a href="http://www.acpoc.org/library/1972_10_009.asp"></a> <a href="http://www.acpoc.org/library/1972_10_009.asp">"Vacuum-Forming Techniques & Materials in Prosthetics & Orthotics," Alex Artamonov, Inter-Clinic Information Bulletin, Vol. 11, No. 10, July 1972.</a> <a href="http://www.acpoc.org/library/1972_10_009.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"A Foot Amputation Orthosis-Prosthesis," H.J. Ruben-stein, G.J. Sweeney, P. Strong, G. Durrett, Inter-Clinic Information Bulletin, Vol. 14, No. 4, April 1975.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"Partial Foot Amputation-A Case Study," Charles H. Pritham, Newsletter. . . Prosthetics and Orthotics Clinics, Vol. 1, No. 3, Summer 1977.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li> Manual for an Ultralight Below-Knee Prosthesis, A. Bennett Wilson, Jr., Charles H. Pritham, Melvin L. Stills, Rehabilitation Engineering Center, Moss Rehabilitation Hospital-Temple University-Drexel University (1977). </li> <li> The Rancho Ultralight Below-Knee Prosthesis, Michael Quigley, George Irons, Neal Donaldson, Rehabilitation Engineering Center, Rancho Los Amigos Hospital County of Los Angeles, University of Southern California (1977). </li> </ol> Page Number(s) 5 - 6 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Vacuum Forming Creator An entity primarily responsible for making the resource Ben Wilson https://staging.drfop.org/files/original/b6eb0984e5194084f16aa1bb9f96f8cf.pdf 9ceae6af2557c11b5e7c66bcaacd9215 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_003.pdf Text Any textual data included in the document <h2>Prostheses, Pain and Sequelae of Amputation, As Seen By the Amputee</h2> <h5>H. C. Chadderton </h5> <blockquote> Reprinted from Prosthetics and Orthotics International, Vol. 2, No. 1, 1978, by permission </blockquote> The War Amputations of Canada, Ottowa, Ontario <h3>Abstract</h3> Results of a survey of 19 organizations belonging to World Veterans Federation indicate that major complaints of amputees include; poor fitting, poor dissemination of knowledge to doctors and amputees regarding new prostheses, lack of opportunity for "input" from amputees at research level and inadequate measures to deal with phantom and stump pain. Suggested improvements by amputees; decrease in weight of prostheses, reduction in maintenance for swing and stance-phase control units, development of recreational prostheses, more frequent checks through use of X-ray and film techniques, particularly during the "break-in" of a new appliance. Older veterans showed increasing concern in regard to development of consequential disabilities arising from amputation; premature arthritic changes in spine and remaining limb, circulatory problems and gastro-intestinal problems due to ingestion of drugs to control pain. <h3>Introduction</h3> With the co-operation of the World Veterans Federation, information was requested from 19 veteran organizations in 14 countries. Replies were received of varying significance from all. The enquiries were based on a questionnaire, the basic elements of which were: Legs Weight of the prosthesis. SACH feet versus articulated feet. Wearing of rubber-soled shoes. Cosmetic appearance. Soft socket versus hard socket, below-knee. Plug socket versus quadrilateral socket, above-knee. Swing phase control units, above-knee. Modular versus standard limb. Arms Munster fitting versus harness. Myo-electric hands. Cosmesis—hands. Wearing of prosthesis, above-elbow. Adjustment Do you see yourself in your dreams as an amputee? Psychological effect of dismemberment. Sequelae (medical) of amputations. Recreational limbs. The replies to the questionnaire were, in the initial stages of review, sent to a computer firm for analysis. It was evident, however, that the response could not be measured in terms of "yes" or "no" and it was recommended that an attempt be made to obtain a "feeling" from the replies which might be useful. Therefore, this survey should not be considered as a fully accurate statement of response and the views herein must be seen in this light. Fitting It seems possible to draw a startling conclusion from the replies concerning comfort. It appears that many amputees were prepared to accept an uncomfortable fit as "part of the game". A significant number of amputees suggested that use should be made of X-ray and film techniques and of bio-mechanical devices in measuring the accuracy of a prosthetic fit. Information on new prostheses The amputees seemed to be overwhelmingly of the opinion that there was a lack of information on the part of medical doctors in this area. It was evident also that, with certain exceptions the amputees themselves were poorly informed on new prostheses. Understandably, a number of amputees commented that they knew far more about the new models of automobiles than about the new models of limbs. Input at the research level The respondees stated they were unaware of any concerted effort to obtain opinions from amputees concerning the types of research which should be done to improve prostheses. To be fair, some replies indicated that "amputee input" may be going on but they did not know about it. Significantly, however, they felt that there should be more liaison at the "user" level with the researchers. Pain Universally, phantom limb pain appeared to be a significant problem and the amputees felt that very little was being done to develop remedial measures. A review of the replies indicated that the usual advice was to take aspirin and a hot drink. Obviously this has not been effective and the amputee is looking for something more concrete. Many amputees complained also of stump pain, as separate from phantom limb pain, stating that massage, heat treatments and sometimes surgery had been successful in its elimination. Weight of prostheses There were two distinct "camps" in the replies, some 62 per cent wanted lighter prostheses but 12 percent stated some weight was essential and felt that good hardware should be used, despite additional weight. Feet No trend was evident on the question concerning SACH versus articulated feet. There was, however, a small but dedicated group of amputees who sincerely believed that an articulated foot was much superior. This group described the SACH foot as "too springy" or "unstable". Rubber-soled shoes By far the majority of leg amputees preferred rubber-soled shoes for stability and heel strike. Cosmetic appearance This did not appear to be a factor. However, the respondees were all war amputees whose average age would be 60 which is perhaps significant. Sockets By far the majority of below-knee amputees preferred a soft socket for reasons of comfort. The question on the plug versus quadrilateral socket for the above-knee amputee elicited the information that, for the most part, the quadrilateral socket users were well aware of the advantages, stating them as being "better circulation ", " more comfort", "easier standing", "taking the weight on the ischium", etc. Tragically, perhaps, many plug socket users were unaware of the difference between the two types. Controls The question concerning swing phase controls elicited a very high response, indicating that a large proportion of the amputees were not familiar with these devices. (We had not dared ask for information on stance phase controls as we were reasonably certain that the concept is not known to the majority of amputees.) It would seem, from the replies, that many more amputees would be prepared to try these devices if they knew of their existence! Modular versus exo-skeletal Here again the majority of the amputees replying (approximately 60 per cent) did not know the difference. There were, however, a dedicated group of modular users who recognized the advantages of alignment, light weight and cosmesis who were "sold" on modulars. Here again, a conclusion can perhaps be drawn regarding the necessity for the dissemination of more information. Munster versus harness fitting The answer was predictable. The below-elbow amputee is very partial to a light fitting for a passive hand. Alternatively, he seems to have a passionate love affair with his hooks and harness when he wants to do heavy work or engage in recreation. This was an area in which the amputee seemed to be fairly well satisfied, except as brought out below. Myo-electric hands There was a distinct feeling among World War II veterans that they had been passed over by the myo-electric stage. Many had apparently been told that they were too old to adjust to myo-electric fittings. The majority of the replies stated "yes" to the question of whether they would like an opportunity to be fitted with a myoelectric hand. Cosmesis The replies on cosmesis (or lack of it) for hands contained comments such as "disgusting" and "lack of sensitivity". Surprisingly, many hand amputees appeared to have no knowledge of the cosmetic skins and stated they were wearing either brown or black leather gloves over their passive hands. Wearing of prosthesis, above-elbow amputees The rejection rate was predictably high. Some farsighted individuals (amputated one side only) suggested that they should get used to wearing a prosthesis in the event that they developed medical difficulties in their other arm, arising from strokes, arthritis, etc. The second part of this question indicated there was little knowledge of lighter prostheses now available through the use of modular designs. Dreams The question on dreams was thrown in only for general interest. The respondees seem to divide 50-50 as to whether they visualize themselves as amputees in their dreams or not. Psychological effect Perhaps surprisingly, a large number of war amputees describe their feelings about the loss of their limb in terms of being "grief stricken", "lost my best friend", "embarrassed", etc. It should be remembered that this survey asked for truthful answers. Psychological effect is perhaps an area which we tend to ignore as it could be interpreted as indicating a lack of machismo, etc. The Adolph Meyer school of psychiatric thought may be of interest on this subject should any one wish to develop it further, that is, depression can follow from a physical disorder such as amputation. Sequelae Most of the replies indicated consequential disabilities. Leg amputees; bad backs, arthritis in the remaining leg and foot. Arm amputees; cervical pain, headaches. Both; gastro-intestinal problems which were believed due to ingestion of drugs as well as "inner tension" associated with the continuing discomfort of amputation. The respondees were careful to suggest they were not trying to prove their case, but felt that more study should be done upon the medical after effects and side effects of amputation. Recreational limbs This question resulted in possibly the most significant response. There were requests for special legs for swimming, golfing, skiing, tennis, rowing and motor sports. The arm amputees were almost frightening in their requests for the development of special prostheses for fishing, playing baseball, cricket (for holding bats), golf, tennis and rowing. <h3>Conclusion</h3> It must be said that the information presented in this paper was not the subject of any strict statistical treatment. In this sense this is not a "scientific paper". This highlights the problem of communication in this field between the consumer on the one hand and the professionals involved on the other. However, it is essential that such communication be fostered if energies and resources are to be channelled in the most fruitful direction. It is hoped that against this background the views contained herein will prove useful, highlighting as they do the opinions of a substantial number of patients. Page Number(s) 3 - 5 Year 1978 Volume 2 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 Prostheses, Pain and Sequelae of Amputation, As Seen By the Amputee Creator An entity primarily responsible for making the resource H. C. Chadderton https://staging.drfop.org/files/original/a16c64d7ccf859685483448cdaa30655.pdf 030e2ddd7f33ca508ab0109a9cb77990 https://staging.drfop.org/files/original/20971c1df6a94f651c41c24f4b2fa35b.jpg 2531dc6b54ab731bd857b99ad1648727 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_001.pdf Text Any textual data included in the document <h2>Up-Date on Immediate Post Surgical Fittings</h2> <h5>Robert F. Hayes, CP. </h5> I would like to express some thoughts regarding the use of the technique of immediate post-surgical fittings of prostheses for below-knee amputees. Nearly all of us certainly agree that there are definite advantages to the patient in the use of prosthesis immediately after amputation, especially in the case of the BK amputee. However, the I.P.S.F. technique is not being used as standard practice in many areas. Perhaps one of the reasons is the lack of continuing education courses dealing with immediate postsurgical procedures. When the concept of immediate postsurgical fitting was first introduced approximately fifteen years ago there was a heavy concentration to the point of saturation on the application of prostheses in the operating room. This was good, because it gave us all an opportunity to be educated in such a revolutionary technique of treatment. However, today, there are many people entering the field involving amputation and amputee care every year, surgeons and prosthetists and in most cases they have only a limited knowledge of the I.P.S.F. techniques. Obviously, and for good reason, most surgeons are reluctant to use a technique with which they themselves are not familiar. It then becomes the role of the prosthetist to educate and encourage the use of I.P.S.F. and, ideally, apply the concept himself. Another reason for lack of use of I.P.S.F. is the inconvenience created by scheduling between doctor, prosthetist, and operating room. Often hours of valuable time are wasted when things are not proceeding on schedule, which is the norm rather than the exception. Another reason why I.P.S.F. techniques are abandoned is that when a surgeon and prosthetist first attempt this technique, they sometimes use a patient whose probability of healing is marginal under the best of circumstances. And sometimes ambulation is attempted too early, causing stump breakdown. The result is a surgeon convinced that this technique is not for his patients. Still another factor that discourages use of the I.P.S.F. concept is the application of a poorly fitting weight-bearing cast by individuals not fully trained. There have been individuals who, after reading an article or hearing a thirty-minute lecture on I.P.S.F., attempted to apply a weightbearing cast. Some of the more skilled are able to do this, but most have problems. If a cast is intended to bear weight, it must fit well, have proper relief areas and distal padding to provide relief if the patient should atrophy and settle in the socket. It is my opinion that no weight-bearing cast at all is better than a poor application of one that is supposed to bear weight. Please note, I said "weightbearing cast" and not a rigid dressing, which is and should be more readily applied immediately after the operation and does not require the same precision as does the weight-bearing cast. This will be taken up later. Now that we have discussed some of the problems that may have discouraged the utilization of I.P.S.F.- and I'm sure there are many more- let's constructively consider a couple of approaches that seem to work well. Since the inception of I.P.S.F., most of us have changed our thinking for some very solid reasons. One of the primary problems arose in the attempt to have the patient weightbearing and often ambulating within forty-eight hours postoperatively. We have learned that, in most cases, this concept is a disadvantage rather than an advantage and can be the cause of stump breakdown. If we agree that early ambulation is not intended, we may apply an immediate rigid dressing with the appropriate snugfitting sterile stump sock. <a href="/files/original/20971c1df6a94f651c41c24f4b2fa35b.jpg">Fig 1:</a> Schematic lateral view of method first recommended in the U.S. for immediate past surgical fitting of below-knee prostheses. From "Immediate Postsurgical Prosthetics in the Management of Lower Extremity Amputees, Ernest M. Burgess, Joseph E. Traub, and A. Bennett Wilson, Jr., Veterans Administration, TR 10-5, April 1967. When the rigid dressing is not intended for weightbearing, most surgeons will make the application since they need not be concerned about felt pads for relief over pressure areas. The initial rigid dressing can be left on for approximately two weeks. During this time we have: <ol> <li> Protected the wound by <ol> <li> Keeping external contaminates out </li> <li> Preventing injury to the stump </li> <li> Protecting the posterior flap from undue pressure </li> </ol> </li> <li> Maintained the size of the stump, preventing edema, which alleviates pain </li> <li> Made the patient more comfortable and able to move about without fear of injury to the stump </li> <li> Prevented knee flextion contracture </li> <li> Greatly reduced complaints of phantom limb </li> </ol> After two weeks the initial rigid dressing is removed; or, in some cases, the surgeon will remove the sutures and wait for an additional week or two. At the end of the two-week postoperative period, the prosthetist is called in to apply an early post-surgical prosthesis usually with a plaster socket and a pylon with a SACH foot. In the fabrication of our plaster sockets, we strive to keep the plaster high up over the condyles to the mid thigh area. We find this is beneficial in eliminating knee flexion contractures and, most importantly, eliminating piston action within the socket, a very hazardous condition, especially in the early stages of fitting. I know attempts are made to trim plaster to a P.T.B, level for increased knee motion. The advantages of enclosing the knee offset the short time needed for patients to regain knee motion. I also use a waist belt and fork strap for added suspension. This temporary prosthesis is worn for approximately six weeks. The very thin patient may not need a cast change before the end of six weeks, but more muscular and fatty tissue will require cast changes according to the amount of atrophy. After the patient has been ambulating for approximately six weeks, the plaster socket is bi-valved and a negative mold is taken for the definitive prosthesis. The plaster socket is then put back on the patient and closed with plaster or tape. The plaster socket and pylon stay on the patient until delivery of the definitive prosthesis and removed as needed for fittings. When minor changes in stump size occur, stump socks may be added while using the plaster pylon prosthesis. To reduce some expense to the patient, the hospital can inventory several pylon assemblies suitable for temporary use. We also supply various sizes of used SACH feet that can be used temporarily. The patient is then charged only for the professional services of the prosthetist, thus saving the considerable expense of components. I hope that some of my comments may be of assistance to others who would like to employ more immediate postsurgical prosthetic care for patients, and hopefully stimulate others to respond with other approaches so that we may all benefit. I would like to acknowledge Dr. Elmer Franseen, from whom I have used references many times in this paper. Dr. Franseen is an Orthopedic Surgeon at Baystate Medical Center, Springfield, Mass. I am sad to say that Dr. Franseen is retiring this month, and I will miss working with this truly professional man. In the past fifteen years of working with Dr. Franseen, I have witnessed him employing I.P.S.F. on all of his B.K. amputees and only on rare occasions was a revision necessary. Page Number(s) 1 - 3 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_001/1978_04_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 Up-Date on Immediate Post Surgical Fittings Creator An entity primarily responsible for making the resource Robert F. Hayes, CP. https://staging.drfop.org/files/original/6f7e3f82472638ae5c7d6a8fe6502b0c.pdf aafc0735d891c3ca5b70c59e5b9e4dca https://staging.drfop.org/files/original/c8b4856c8000a6349f542a3fc1d9792b.jpg 155701ed19ed5a4cc064357783299d6f https://staging.drfop.org/files/original/f42bc1634981d3ce3923261609c448f0.jpg 86bbb24b5c5ea6d276b246de92acb3e4 https://staging.drfop.org/files/original/9e3ce64e754060714e02f7e869bb56c1.jpg bcc33ceb1a17e7d1665e8600710bf8c7 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_03_001.pdf Text Any textual data included in the document <h2>Externally-Powered Upper-Limb Prostheses: An American Dilemma</h2> <h5>Charles H. Epps, Jr., M.D. <a style="text-decoration: none;">*</a></h5> The discussion by A. Bennett Wilson, Jr., in Vol, 2, of the Prosthetic and Orthotic Clinic Newsletter is an excellent historical summary of the saga of externally powered upper-limb prostheses. Ben Wilson has brought to this forum an abundance of personal knowledge about the development of these devices that can only be known by one who has been intimately involved with the problem. I think it also raises the question, when one considers the present state of the art and the availability of American made components why more could not have been done and is not being done. As one who has been intimately involved in the treatment of patients with upper-limb deficiency for the past 17 years, I have experienced the frustrations that are unique to this area of medical delivery. In the Juvenile Amputee Clinic at the D,C. General Hospital, in Washington, D.C., we have cared for almost 300 children with one or more limb deficiencies, I remember, vividly, when I first began this work in 1961, telling parents that in five years we should have available for the child (bilateral upper amelia), a good set of externally powered arms. Much to my chagrin, five years later we were unable to deliver this needed service to a degree that satisfied the patient or the Clinic Team. After 17 years, there are still unfulfilled expectations. <a href="/files/original/c8b4856c8000a6349f542a3fc1d9792b.jpg">Fig. 1.</a> This male was born with bilateral upper amelia and lower complete phocomelia. After acquisition of sitting balance, he was fitted with a shoulder disarticulation type prosthesis with nudge control for elbow lock and unlock and with terminal device and forearm lift control by chest expansion. At age five, a Michigan Feeder Arm was applied, and his feeding time and ease of eating were enhanced. One then has to ask the question, why has there not been greater progress in the United States? Research money has been available, to a limited extent and powered arms have been developed. These events have been developed historically by Ben and will not be reported in any depth here. I would mention the Michigan Feeder Arm, which was a very useful arm for the purpose of eating, in the young age group. Once the child became older, there was no model available. The Michigan Electric Hook was developed out of a similar need and can be purchased commercially today. We are using, at the present time, a number of these in our clinic. The Coordinated Arm, developed at the Ontario Crippled Children's Center, and which succeeded the feeding arm, can be purchased from a Variety Village in Toronto, Canada, but the problem is that this unit is suitable only for the younger child. There is literally nothing as good as the Coordinated Arm available for the older child or adult. <a href="/files/original/f42bc1634981d3ce3923261609c448f0.jpg">Fig. 2.</a> A fourteen-year-old with partial transverse hemimelia fitted with a Otto Bock Myoelectric hand that is available in a kit as shown. The battery pack can be attached to the belt. The shirt covers the wire and the socket resulting in excellent cosmesis. Another approach we have utilized is the combination of the OCCC electric elbow with the Michigan electric hook, in what we have termed a "Hybrid" prosthesis. Today, our experience has been satisfactory, as we are able to combine both units to operate with a single electrical system, supplied by one battery. Even under these circumstances, it is very difficult to import the electric elbows from Canada. The cost is not inconsequential, when one considers that the purchase of both items will be close to $1,000 and then one has to consider the cost of fabrication. The net result is that unless one is extremely zealous, it is not possible to supply children with severe limb deficiencies with externally powered devices. When they are supplied, there are mechanical problems, electrical problems, and frequent repairs are necessary. The "down time" is considerable. For this reason, many clinicians and patients have been discouraged and have abandoned use of these devices. <a href="/files/original/9e3ce64e754060714e02f7e869bb56c1.jpg">Fig. 3</a>. This youngster with right upper phocomelia and left amelia was given an opposition post early. A standard left shoulder-disarticulation prosthesis provided little function. A hybrid system utilizing an OCCC electric elbow and a Michigan Electric Hook, provides greater function. Both units are powered by one battery pack. It is ironic that the greatest development has been made for the patient with the below elbow deficiency. The Otto Bock System is available in a number of sizes and provides excellent cosmesis and function. Our experience has been satisfactory with this device. The cost, however, is considerable and this may be one reason that this prosthesis has not been applied extensively in this Country, in spite of the fact that there are large numbers of children with below-elbow level deficiencies. It is also a fact that below-elbow patients function quite well with body powered equipment. In either case, American industry has not been at the forefront. The majority of commercially available devices today have been developed in Europe or Canada. I recently had the opportunity to visit Doctor Rolf Sorbye, in Orebro Sweden, who in collaboration with Systemteknik has developed an excellent below-elbow self-contained self-suspended prosthesis, using myeoelectric control. This device has been fitted to a number of children as young as 18 months and the results are extremely promising. Two prostheses are fabricated for each patient so that there is no "down time" when one prosthesis becomes inoperative and needs bench repairs. The cost per patient therefore, is approximately $6,000 for the pair of arms. There is under development, at the present time, in Sweden, another multi-functional hand (also for the below-elbow level), which will provide powered function for grasp, release, dorsi- and palmar flexion of the wrist, and supination and pronation of the forearm. The project is funded by a joint effort on the part of the Swedish Government and private industry. It is unfortunate that we have not been able to have a similar effort in this Country. Dr. Dudley Childress, at Northwestern University has developed an excellent self-contained, self-suspended below-elbow system, using myeoelectric control. The fact of the matter is that this and similar devices, developed in this Country, have not found a manufacturing outlet for disbursement. It is, therefore, a financial matter that in the face of limited demand the manufacturers cannot produce these items at a cost that will make it profitable. It seems to me, therefore, that this is an area, where the Government should intervene and subsidize this effort. There are numerous precedents throughout industry in this regard. The railroads, the airlines, and the shipbuilders have been subsidized. The renal dialysis program is one health area where Government is presently providing a subsidy. The precedent is there. There also needs to be an effective lobbying effort mounted, not only by the profession, but by the affected individuals, that is, patients and their parents. I believe that this is the essence of the problem. The technical "know how" is available but what is lacking is sufficient funding to make these devices in sufficient numbers so that they can become available to patients. It is fortunate that there are not a large number of patients. Ironically, were there large numbers of patients and a large demand, then the cost, of course, would be reduced. In the absence of this unfavorable manufacturing circumstance, subsidies must be given to industry so that the necessary devices can be produced and made available at reasonable cost. Another aspect of the problem, which is paradoxical, is that there has been so much effort put into the below-elbow level, where the need, as I see it, is not nearly as great as it is in the above-elbow and the shoulder-disarticulation levels. The patients with more proximal limb deficiencies are greatly in need of externally powered devices. Yet the powered devices that are available for the proximal cases, are not the most efficient. The available commercial items, even at great cost, are not representative of the best technology available in this country, today. This can be partially explained by the fact that the numbers of patients affected at the higher level are substantially less than those at the below-elbow level. It is also natural to work on problems where success is more readily obtained. The challenge is there at the shoulder-disarticulation level and the above-elbow level, where these patients desperately need more function. There is need in this country for a concerted effort to develop and provide powered arms for patients with the more proximal limb deficiencies. It is a blight on our record as a nation, with such sophisticated technology and industrial and productive capacity, that this area of human need has been so long unfulfilled. <h5>Charles H. Epps, Jr., M.D. Professor and Chief, Division of Orthopaedic Surgery, Howard University, Washington, D.C.</h5> Page Number(s) 1 - 3 Year 1978 Volume 2 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1978_03_001/1978_03_001-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_03_001/1978_03_001-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_03_001/1978_03_001-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Externally-Powered Upper-Limb Prostheses: An American Dilemma Creator An entity primarily responsible for making the resource Charles H. Epps, Jr., M.D. * https://staging.drfop.org/files/original/0eb0155fd4a6657c71f5a235373aa4bf.pdf a9eff5f0c0999d72953d88dc04f93154 https://staging.drfop.org/files/original/f158ce59a35747a9d9020e944269da53.jpg 757f7d66742eb5392ce4c317b6cb55db https://staging.drfop.org/files/original/67ca44d880b4aca5258caa2712db2aab.jpg 802b68c5445dacd6da77b74473d6a6c8 https://staging.drfop.org/files/original/4536555d7f66980c8ddffa5cb6fb6905.jpg 6662f3e43b363f5633707abfd523a5f6 https://staging.drfop.org/files/original/0c036efb96682517789da461a8caa5b1.jpg bd4bc6c6da7b8254b78d3a008146646b https://staging.drfop.org/files/original/4d1d11c52e9a10c1859a7c1aacce2376.jpg 0126ae23c2d2a6c7aa2f5ca6c0971c37 https://staging.drfop.org/files/original/55483c1f96ae1c766e8d18f2843826cc.jpeg 9355ee3a449698ab5e54d338aa49cdf3 https://staging.drfop.org/files/original/2c9444bd9873add9855c30b383b9b0ec.jpeg 7e7c6d801120cf56fba8c150439ee460 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_02_002.pdf Text Any textual data included in the document <h2>Concerning Suspension Alignment, and Control</h2> <h5>Charles H. Pritham, C.P.O. </h5> In the prescription of any prostheses consideration is naturally given to the proper means of suspending the prosthesis and maintaining it in place. In contrast, not as much concern seems to be given to this crucial matter in the prescription of an orthosis. Paradoxically, this relative state of neglect is undoubtedly due to the very success with which suspension has been incorporated in most conventional orthosos. To cite but one example, the shoe that inevitably must be used with any ambulatory AFO, KAFO, or HKAFO provides for suspension of the device as well as providing support to the ground. In recent years with the expansion of new technology in the area of prosthetics and orthotics there has developed a corresponding interest in new techniques to overcome shortcomings in conventional devices. In the process, however, new problems can arise as a result of the intertwining roles played by various components of the device under consideration, and it would therefore appear worthwhile to attempt to sort out these various roles with special emphasis on suspension in order to clarify the picture, and possibly, as a result, to suggest new and unique applications for the various suspension systems available. For clarity a brief glossary has been prepared, and is included at the conclusion of this article. <h3>Maintenance of Alignment</h3> For any prosthesis or orthosis to provide the maximum benefit possible, it must be held in proper position relative to the body segments concerned. The prevention of inappropriate motion can be classified broadly as maintenance of alignment by either suspension or stabilization depending upon the direction of the motion. As it is defined, suspension is concerned with the prevention of linear displacement along the longitudinal axis, and it will be seen that no discrimination is made as to whether the direction is distal or proximal. Thus, the perineal straps that may be attached to a spinal orthosis to prevent proximal displacement ("riding-up") are just as much a suspension aid as is a suprapatellar cuff suspension strap on a below-knee prosthesis. Considered in this light, the weightbearing component of any given device naturally prevents proximal displacement, and, thus, may be confused as a suspensory component. The distinction must be made on the basis of intended function. Weightbearing is a primary characteristic of a lower-limb prosthesis or a weightbearing orthosis without which it cannot function. Suspension is a secondary characteristic inasmuch as it is but one of a number of different components intended to ensure proper weight bearing and thus function of the device. It can be seen, therefore, that the intended role of a weightbearing component is quite a bit different than suspension. However, the use of this same component as a non-weightbearing device for purposes other than weightbearing is not inconceivable. It is possible, if not practical, to use PTB brims about the knees of a patient to prevent proximal displacement of a corset, and the use of quadrilateral sockets as anchor points <a></a> for the powering of upper-limb prostheses comes to mind. Stabilization, as it is defined, is concerned with the prevention of displacement about the various rotatory axes of the body rather than along the linear axes. Motion does take place undoubtedly includes some linear motion, either laterally or anterioposteriorly, but in the author's opinion the rotary displacement is inevitably the predominant component. How then is stabilization to be differentiated from control which, as it is defined, is also involved, in part, with the prevention of motion? Two separate but interrelated definitions of the word control are given. In both instances control is to be considered as a primary characteristic. In the first definition control refers to the regulation of motion in one portion of the body segment relative to another portion, while stabilization (a secondary characteristic) refers to the regulation of the device relative to the body segment. In the second definition control refers to volitional regulation of motion in the device by the patient; while stabilization holds the device in firm contact with the body segment in order to maximize the efficiency of this volitional regulation. In any event, it can be appreciated that any given component of a prosthetic or orthotic device may play multiple roles in the function of that device. A hip joint and pelvic band fitted to an above-knee prosthesis while providing suspension also provides stabilization against lateral and rotary motion. The same component is likely to be fitted to an HKAFO to control motion about the patient's hip, and is unlikely to be used for suspension or rotary stabilization of the HKAFO since both of these functions are provided effectively by the fit of the foot in the shoe. Supracondylar wedge suspension in a below-knee prosthesis also provides effective stabilization against lateral thrust, while a cuff suspension strap fitted to a below-knee prosthesis does not. A figure-8 harness (Fig. 1) fitted to an above-elbow prosthesis not only provides suspension, but also stabilization against lateral or rotary motion of the socket and control of the elbow and terminal device, while a butterfly harness and Bowden cable (Fig. 2) fitted to a shoulder-driven WHO provides only control of motion in the metacarpal-phalangeal joints of the index and ring finger and neither suspension nor stabilization. <a href="/files/original/f158ce59a35747a9d9020e944269da53.jpg" target="_blank" rel="noopener">Fig. 1.</a> One Version of the Figure-8 Harness for Above-Elbow Amputees <a href="https://staging.drfop.org/files/original/67ca44d880b4aca5258caa2712db2aab.jpg">Fig. 2.</a> The "Butterfly" Harness These are but a few of the many examples that could be cited in designing or prescribing a device for a given situation. Consideration must be given to the many intertwining roles played by the many available design elements and selection be made of those elements that perform the intended function with maximum benefits and a minimum of adverse side effects. A particularly troublesome example of this dilemma is to be found in the design of an orthosis to control knee motion without involving the ankle-foot complex, the traditional source of suspension and rotary stabilization of devices to regulate the knee. If supracondylar suspension is used as with the IRM supracondylar knee orthosis (<a href="https://staging.drfop.org/files/original/4536555d7f66980c8ddffa5cb6fb6905.jpg">Fig. 3</a>) or Iowa knee orthosis (to name but two examples of this class of orthosis) adequate suspension and stabilization may be gained initially from the critical fit about the knee, but the patient may not be able to tolerate it, and with compression of the soft tissues fit and, thus, suspension may be lost. The CARS-UBC knee orthosis (<a href="https://staging.drfop.org/files/original/0c036efb96682517789da461a8caa5b1.jpg">Fig. 4</a>) avoids these problems by using a waist belt and suspension strap. Waist belts, however, are not well tolerated by many patients, and considerable effort must be taken in fitting the device to achieve adequate rotary stabilization. <a href="https://staging.drfop.org/files/original/4536555d7f66980c8ddffa5cb6fb6905.jpg">Fig. 3</a>. IRM Supracondylar Knee Orthosis <a href="https://staging.drfop.org/files/original/0c036efb96682517789da461a8caa5b1.jpg">Fig. 4.</a> CARS-UBC Knee Orthosis In any given instance it is necessary to weigh the pros and cons of the applicable suspension components available, and select the one that best fits the needs of the patient. <h3>Classification of Suspension Types</h3> In most instances, suspension is secured by obtaining a purchase above a flaring bony prominence (epicondyle, adductor tubercle) or other body segment (buttocks, shoulder). This general principle is the same regardless of type of suspension. Suspension may be classified into two major groups and a third miscellaneous one (<a href="https://staging.drfop.org/files/original/4d1d11c52e9a10c1859a7c1aacce2376.jpg">Fig. 5</a>). <a href="https://staging.drfop.org/files/original/4d1d11c52e9a10c1859a7c1aacce2376.jpg">Fig 5.</a> A. Extrinsic Suspension: The means of suspension are not contained within the proper borders of a device, and must be gained by the addition of extraneous elements that pass beyond the borders of the device and may not be otherwise absolutely necessary for the function of the device. However, the extrinsic elements may also serve as means of stabilization or control. <ol> <li> Examples of extrinsic suspension are: <ol> <li> PTB cuff suspension strap </li> <li> Knee joints and thigh corset </li> <li> Waist belt </li> <li> Rubber suspension sleeve </li> <li> Hip joint and pelvic band </li> <li> Silesian belt f. Suspenders </li> <li> Perineal straps on a spinal orthosis </li> <li> Various harnesses used in upper-limb orthotics and prosthetics </li> </ol> </li> </ol> B. Intrinsic Suspension: Suspension is gained by means of some elements) contained within the proper borders of the device. The elements) may also serve as a means of stabilization. <ol> <li> Examples of intrinsic suspension are: <ol> <li> All self-suspending prostheses </li> <li> All orthoses with few exceptions A shoe is necessary for the proper function of lower-limb orthoses while a waist belt used on a KO is not absolutely necessary for the function of the KO as suspension can be accomplished by other means. Therefore, an AFO is a case of intrinsic suspension while a KO is not necessarily an example. </li> </ol> </li> <li> Types of intrinsic suspension can be broken down as follows: <ol> <li> Supracondylar: purchase is obtained above any of the various condyles or epicondyles of the body. </li> <li> Flaring body segments other than bony prominences: purchase is obtained above any of the flaring body segments not covered in Item 1, such as the buttocks or shoulders. </li> <li> Suction, or negative atmospheric pressure: In general, suction suspension is used with amputation stumps that exhibit a high soft-tissue-to-bone ratio with few prominent subcutaneous bony prominences such as above-knee or above-elbow stumps; however, suction suspension has been used with below-knee prostheses in Europe and there is a current resurgence of interest in it in America. </li> <li> Muscular grasp: This is the often greatly overlooked ancillary of suction suspension and other suspension types. Rudolf Poets <a></a> has described briefly the principle of an "undercut socket" he attributes to Dr. Oskar Hepp, and every clinician is familiar with the admonition to the patient that he should use his stump muscles to hold the above-knee prosthesis on. Many below-knee amputees have reported being able to hold their prosthesis on with muscular contractions, and Dr. Ernest Burgess is currently studying how to capitalize on this phenomenon. </li> <li> Compression of soft tissue and friction: This means of suspension serves for such lightweight, elastic, and readily conformable devices as a spinal corset or knee support and may be used in conjunction with other means of suspension. </li> </ol> </li> </ol> C. Other Miscellaneous: This serves as a catch-all division to contain those means that do not readily fit in the other divisions and are rarely used in prosthetics and orthotics. <ol> <li> Examples of the miscellaneous category are: <ol> <li> Medical grade adhesive used with rigid dressings, some cosmetic finger prostheses, facial restoration, and stoma appliances. </li> <li> Skeletal attachment. While under active consideration by some, this means of suspension is not currently in use. </li> </ol> </li> </ol> <h3>Selection Criteria</h3> As can be seen in Fig. 6 and Fig. 7, selection of an appropriate means of suspension for a specific device can often pose problems. A variety of factors must be considered, a few of which are listed here. <a href="https://staging.drfop.org/files/original/55483c1f96ae1c766e8d18f2843826cc.jpeg">Table I.</a> Suspension Methods versus Orthosis Level <img src="/files/original/55483c1f96ae1c766e8d18f2843826cc.jpeg" alt="Italian Trulli" /> <a href="https://staging.drfop.org/files/original/2c9444bd9873add9855c30b383b9b0ec.jpeg">Table II.</a> Suspension Techniques and Additional Auxiliary Function Possible. <img src="/files/original/2c9444bd9873add9855c30b383b9b0ec.jpeg" ul="" /> <ul> <li> Medical contraindications </li> <li> Donning difficulties </li> <li> Clinic team preferences </li> <li> Patient preferences </li> <li> Maintenance </li> <li> Fitting difficulties and problems maintaining proper fit. </li> <li> Necessary related functions (stabilization or control) provided by a specific suspension system. </li> <li> Aesthetics </li> </ul> In any event the essential matter is to balance the pros and cons of the various suspension systems available and select the one that offers the most advantages with the fewest disadvantages. The matter becomes even more important when the emphasis is shifted from routine clinical prescription to the design of one-of-a-kind applications for a specific patient's unique problems or in research and development of a new style device. <h3>Conclusion and Summary</h3> Suspension is inevitably related closely to a wide variety of interrelated factors, all of which are involved in the determination of proper fit. An attempt has been made to logically sort out the various factors and concentrate on suspension. Further, suspension has been broken down into various categories and some of the inherent difficulties in selecting between a number of suspension techniques relevant to a specific patient or prosthetic or orthotic device have been suggested. <h3>Glossary</h3> Orthosis: An externally applied device for the control of motion about the joints of a body segment. Prosthesis: (Artificial Limb)-an externally applied device to substitute for a missing body segment. Suspension: The method of maintaining a prosthesis or orthosis in proper place relative to the affected body segment and resisting linear displacement along the longitudinal axis. <ol> <li> Not weight-bearing </li> <li> Displacement due to: <ol> <li> gravity </li> <li> momentum </li> <li> "oozing" "creeping" (movement due to compression of a conical section) </li> </ol> </li> </ol> Weight-Bearing: The transmission of a person's mass (or weight) to the ground from a relatively distant body segment by means of a prosthesis or orthosis. Stabilization: The method of maintaining a prosthesis or orthosis in proper placement relative to the affected body segment and resisting angular or rotary displacement about one of the three axes. <ol> <li> Due to: <ol> <li> Moments created by the eccentric application of forces about the various axes or centers of rotation. </li> </ol> </li> </ol> Control: <ol> <li> Orthotic: The maintenance of a body segment in a desired position or positions by an orthosis (also called correction or corrective control). </li> <li> Orthotic or Prosthetic: The voluntary activation of a prosthesis or orthosis (or of an artificial articulation thereof) by means of the body segment enclosed in the device or by a signal generated by a remote body segment and transmitted to the device or articulation by means of a mechanical, hydraulic, pneumatic, or electric linkage (also called volitional control). </li> </ol> Alignment: The relationships that exist or are to be created between the components of a device or between the device as a whole and the affected body segment. Pistoning: The cyclical linear displacement that takes place along a body segment with the cyclic application and removal of a load and due to inadequate suspension. "Bell-Clappering" : Cyclical angular displacement in the A-P or M-L planes due to inadequate angular stabilization. Whipping: A specific form of rotary instability that occurs in AK Prostheses. Primary Characteristic: An absolutely essential property of a device if it is to carry out its intended function. Secondary Characteristic: A property of a device necessary to facilitate one of its primary characteristics but not itself absolutely necessary to achieve the intended function of the device. References: <ol> <li>Blakeslee, Burton (ed.), The limb-deficient child, University of California Press, 1963.</li> <li>Poets, Rudolfe, The fitting of the above-knee stump, Orth. and Pros., 28:1, March 1974.</li> </ol> Page Number(s) 2 - 6 Year 1978 Volume 2 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 TABLE I http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-6.jpg Figure 7 TABLE II http://www.oandplibrary.org/cpo/images/1978_02_002/1978_02_002-7.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Concerning Suspension Alignment, and Control Creator An entity primarily responsible for making the resource Charles H. Pritham, C.P.O. https://staging.drfop.org/files/original/809ea89a32d4d8e36fa8e6385772fa3a.pdf 3ee99a2bf09bacedf1558f9b28f4ed07 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_02_001.pdf Text Any textual data included in the document <h2>A Proposal for Delivery of Externally Powered Upper-Limb Prostheses</h2> <h5>Michael J. Quigley, C.P.O. </h5> Prepared by the American Academy of Othotists and Prothetists, 1444 N St., N.W., Washington, D.C. 20005. Editor: A. Bennett Wilson, Jr., B.S. M.E.; Managing Editor: Brian A. Mastro, B.A.; Editorial Board: Joseph M. Cestaro, C.P.O., Charles H. Epps, Jr., M.D., Robert B. Peterson, R.P.T. There are about 322,000 amputees in the United States today. Of this number, approximately 9,000 people have upper-arm amputations and 16,000 have forearm amputations. Many arm amputees choose not to wear a prosthesis for three major reasons; 1) lack of sensory feedback, 2) poor function and 3) poor cosmesis. Unfortunately, the vast majority of physicians, therapists, and prosthetists seem to believe that new amputees should always be provided a hook first, and a hand later, if the hook is accepted. Nearly all patients, however, want a hand first and dread the thought of using a hook for obvious cosmetic and psychological reasons. In a great number of cases, the hook and prosthesis are rejected due to the undue amount of attention attracted to the wearer. Body powered mechanical hands are heavy, cumbersome, and far less functional than hooks. The same amount of harnessing and body power is required to control these hands as with the hooks. The cosmetic gloves that cover these hands are easily stained, torn, and discolored. The major indication for prosthetic hands has been for unilateral amputees who are engaged in light-duty work and are very conscious of cosmesis. The introduction of the VA- Northwestern University, Otto Bock, Variety Village, and other powered hands and elbows for prostheses should change the dismal attitude concerning prosthetic hands. These prostheses are extremely cosmetic, and require very little body motion and little or no harnessing to control the hand. The hand can be controlled easily whether the wearer is reaching for something over his head or behind him, which was previously very difficult. Powered prostheses are of greatest value for patients with high amputations, whether they are unilateral or bilateral. These patients are normally present complicated problems because they lack the muscle power and leverage to control mechanical prostheses, but they can easily control powered prostheses by myoelectric or switch controls. Powered prostheses have received a very cool reception in the United States due to a number of factors; the cost of the prostheses is high- four to five times that of conventional prostheses-and therefore many third-party payers refuse to pay for them. The prosthetist fitting an externally powered prosthesis must be well trained in order to evaluate myoelectric potentials and to properly fit and maintain the prosthesis. As most prosthetists have no background in electronics, more than a short orientation course is required. Even after thorough training is obtained, the prosthetist may only see two or three patients per year requiring these types of prostheses, and therefore much of the information will be forgotten. In many cases, components that were intended to be modular in concept and simply plugged in need to be reworked or redistribued around on the socket in order to accommodate a long or non-standard type of amputation. In a study conducted by the Veterans Administration 18 prosthetists were involved in an evaluation of powered prostheses. All prosthetists were given a one-to-two-week course by the VA on myoelectric prostheses and patients were referred to them through VA clinics for fittings. Despite all this education, prosthetist errors were responsible for more malfunctions than any other cause. Faced with all of the above facts plus the fact that the cosmetic glove is still a problem, most prosthetists chose not to handle externally powered prostheses. Further, since such a small percentage of the amputee population can be fitted with this type of prosthesis, most prosthetists find it impractical to invest the great amount of time and money for education and equipment before they can provide satisfactory service. It has been shown that in areas where prosthetists learned enough about powered prostheses to be able to properly fit and maintain them, the prostheses received wide acceptance. John Billock, C.P.O., in Warren, Ohio uses a number of different powered prosthesis systems, including hybrid models using components of different systems on severely disabled upper-limb amputees that are referred from all over the Midwest. William Sauter at Ontario Crippled Childrens Center has also proven the practicality of powered systems on adults and children. In each area, however, institutional support has been the determining factor. Mr. Billock's success was achieved after years of participation in the research program at Northwestern University and Mr. Sauter's work is done in a large Rehabilitation Center. Similarly, the Bock system is used in Minneapolis due to a great amount of support from the Germany-based Otto Bock Company to its United States headquarters in Minneapolis. The Otto Bock Company is presently offering a free one-week course on the basic below-elbow system, and plans future courses on advanced powered components. We are faced with the situation that powered upper-limb prostheses are presently available but are not used for the many reasons stated previously. How do we solve the service delivery problem, particularly for the more severely disabled upper-limb amputee? I suggest that specialized fitting centers are the best solution to the problem. Such centers can be privately owned or located in an institution. The advantage of this system is that the prosthetist would see enough patients to become truly expert in the area of powered prostheses, and could well afford the expense of taking all relevent courses or preceptorships and obtaining the necessary staff and equipment. I have visited one such center in Warren, Ohio, which is owned by John Billock, C.P.O. Mr. Billock and his staff at Warren Orthotics and Prosthetics Restoration Laboratory fit three to four powered upper-limb prostheses per month, including all levels of amputation. His staff includes a full time electrical engineer and an electronics technician. There are enough equipment and spare parts available so that essentially all maintenance is carried out on the scene, which avoids long delays when repairs are done elsewhere. Patient referrals are mostly from the Midwest and East Coast, although patients from the West Coast are not uncommon. One patient being seen during my visit had a right shoulder disarticulation and a left above-elbow amputation and was being fitted with powered hands, elbows and wrist rotators controlled by switches. Components from at least three manufacturers had to be made compatible in the ten-month long project. I feel that a total of four centers in the United States could adequately handle the patient load. The average prosthetist with a good understanding of powered prostheses will be able to treat most unilateral below-elbow patients, so referrals to a powered prosthesis center will usually be for more difficult cases. It will be important for private centers to be closely allied with a rehabilitation center, as these patients will require therapy, counseling, and other services while the prosthetic services are being performed. It seems obvious to me that powered prostheses will be more common than body powered designs within the next twenty years, and it is time now to establish an efficient service delivery system. Page Number(s) 1 - 2 Year 1978 Volume 2 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Proposal for Delivery of Externally Powered Upper-Limb Prostheses Creator An entity primarily responsible for making the resource Michael J. Quigley, C.P.O. https://staging.drfop.org/files/original/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/51f5adc7b73ba20f64f5b1072208d97e.pdf 22b566ecc169422c3f86252d9a20be5e https://staging.drfop.org/files/original/3af9a5ff106766a98f790a31724a2a1f.jpg f6e27c5ae43c78cb08a394d78fa3b275 https://staging.drfop.org/files/original/2aff81bed2e3b007be1b8792137c5788.jpg 28e771b1094c0b1209ef81372fd82ce6 https://staging.drfop.org/files/original/41beee5399a82e0e40acfda675701aad.jpg f1003cc7f042f683207455f6a189e513 https://staging.drfop.org/files/original/90ef2a1233e04d701819d9715038383f.jpg 4d02c130bcdd0706cf18f7b6fc0dd0be https://staging.drfop.org/files/original/634d5ee7cc369045d31e39da291ee0d3.jpg d7e48a87b19caa8b90142027b54ae166 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_01_001.pdf Text Any textual data included in the document <h2>Externally Powered Upper-Limb Prostheses</h2> <h5>A. Bennett Wilson, Jr. </h5> The earliest reference to externally powered upper-limb prostheses seems to be in connection with experiments that took place in Germany about 1918 in which electromagnets were used to close the fingers of an artificial hand <a></a>. The next reported effort apparently is the research and development program proposed and carried out by Alderson <a></a> on electrically powered arm systems during 1946-1952 with support from International Business Machines, Inc. and the Veterans Administration. Initial results of the Alderson-IBM project (Fig. 1) were quite impressive with respect to operation, but an extensive evaluation at UCLA in 1951 revealed that a disproportionate amount of mental effort by the wearer was required for use of the various systems<a></a>. As a result of the findings of the UCLA study, and because only a limited amount of money was available for work in artificial limbs, the Advisory Committee on Artificial Limbs (later the Committee on Prosthetics Research and Development) of the National Academy of Sciences recommended that development of actuators be delayed until sufficient research could be carried out concerning the control problem so as to provide means for control of the prosthesis without conscious thought by the wearer. <a href="/files/original/3af9a5ff106766a98f790a31724a2a1f.jpg">Fig. 1</a>. An early model of the Alderson-IBM Electric Arm. A project was initiated at UCLA about 1953 to explore various control methods. Among the various studies conducted at UCLA was an evaluation of the so-called Vaduz hand (Fig. 2)<a></a>, a design that originated in Lichtenstein which used bulging of the residual muscles in a forearm stump to provide control of an electrically actuated artificial hand. Some rather positive findings were overshadowed by the poor quality of the one unit that was available at the time, and perhaps by the introduction by Russia in 1958 of a "thought control" electric arm<a></a>. The Russian device actually consisted of an electric hand controlled by myoelectric signals from the residual forearm agonists and antagonists of a below-elbow amputee. <a href="/files/original/2aff81bed2e3b007be1b8792137c5788.jpg">Fig. 2</a>. The "Valduz" hand and control system. The "Thalidomide tragedy"<a></a> in 1958-1962 prompted England and Canada to secure manufacturing rights to the Russian design, but fabrication and distribution was not successful in either country. The "Thalidomide tragedy" also encouraged work at the University of Heidelberg in the development of pneumatically powered artificial arm systems<a></a>, and an agreement was obtained by Kessler and Kiessling<a></a> for continuation of this work in the U.S. (Fig. 3). This project was carried out between 1960 and 1969. Again the problem of control was the primary reason for discontinuing the work. <a href="/files/original/41beee5399a82e0e40acfda675701aad.jpg">Fig. 3</a>. On the pneumatic above-elbow systems developed by Kiessting at the American Institute for Prosthetic Research. Because of the Thalidomide tragedy, Sweden<a></a> also launched a modest program in development of externally powered upper-limb prostheses about 1960. Work in this area has been carried out continuously since, but with no commercially available devices resulting, as far as is known at this time. The Russian design caused an Austrian group, Viennatone, and the Otto Bock Company in Germany to develop and market about 1962 similar devices. A few years later Hannes Schmidl began fitting externally powered artificial arms on a relatively large scale at the INAIL Center, Budrio, Italy and continues to do so to the present time<a></a>. Pneumatic models were used initially, but all designs used now are electric. Simpson<a></a>, at the Princess Margaret Rose Hospital, Edinburgh, Scotland uses routinely pneumatic prostheses for a group of "Thalidomide" children, but his design is not widely available elsewhere. In 1960 while on Sabbatical study at the University of Southern California Tomovic from the Institute Pupin, Belgrade, suggested the use of electromechanical pressure sensitive systems to aid in solution to the control problem by introducing closed-loop feedback systems<a></a>. A number of prototypes (Fig. 4) were designed and fabricated upon the return of Tomovic to Yugoslavia. Results of evaluation were also overshadowed by poor workmanship and engineering, and work on this was abandoned about 1968. <a href="/files/original/90ef2a1233e04d701819d9715038383f.jpg">Fig. 4.</a> The "Belgrade" hand and control system. McLaurin, while at Northwestern University, designed the so-called Michigan feeding arm about 1960 which used a linkage to coordinate motions about the elbow and the wrist to make it possible for young bilateral children amputees to feed themselves<a></a>. This device met with considerable success in the clinical setting, but never became a commercial success. McLaurin continued work in electrical arms for children at the Ontario Crippled Childrens Centre, Toronto, between 1963 and 1975. Although he was able to persuade the Variety Club to develop a facility for manufacturing, at cost, some of the products of research as a philanthropic endeavor, to date only an electric elbow has been made available, but because of the low volume the cost is extremely high in spite of subsidization. In the late sixties a number of efforts in the U.S. were directed toward the development of electric elbows. By 1969 three designs were considered ready for clinical evaluation, the "Boston" elbow developed by M.I.T. and Liberty Mutual Insurance Co., the AMBRL elbow, developed by the Army Medical Biomedical Research Laboratory, and a design by Rancho Los Amigos Hospital. The clinical evaluation program was organized and coordinated by CPRD in 1969-70<a></a>. Of 20 subjects in the study only 3 elected to retain the electric device. Two of these subjects had physical problems that made operation of the body powered prosthesis more difficult than would have been the case otherwise. Out of this experience came a revised set of design criteria and objectives. In addition to all of these efforts, research and development programs in externally powered artificial arms have been carried out in the U.S. at Temple University - Moss Rehabilitation Hospital <a></a>, Northwestern University (Fig. 5)<a></a>, Veterans Administration Prosthetic Center, Duke University, Rancho Los Amigos Hospital, University of California at Los Angeles, the University of Colorado, and Johns Hopkins University<a></a>. <a href="/files/original/634d5ee7cc369045d31e39da291ee0d3.jpg">Fig. 5</a>. The self-contained and self-suspended below-elbow system using myoelectric controls developed at Northwestern University. Sweden, Great Britain, Italy, Germany, Russia, and others have continued to support research and development in this field. Yet today it is very difficult to obtain an electric or pneumatic arm in the United States, other than the electrically operated hands that are suitable for below-elbow patients. We will be pleased to hear the opinions of readers of the NEWSLETTER concerning the reasons for this. A. Bennett Wilson, Jr. March 16, 1978 References: <ol> <li>Alderson, Samuel W., The electric arm, (Chapter 13 in Klop-steg and Wilson's "Human Limbs and Their Substitutes," McGraw-Hill, 1954, reprinted by Hafner Press, 1969).</li> <li>Battye, C.K., A. Nightingale, and J. Whillis, "The use of myoelectric currents in the operation of prostheses," J. Bone Joint Surg., 37-B, 506, Aug. 1955.</li> <li>Berger, N., and CR. Huppert, The use of electrical and mechanical muscular forces for the control of an electrical prosthesis, Amer. J. Occup. Ther., 6:110-14, 1952.</li> <li>Childress, D.S., et al., Myoelectric immediate postsurgical procedure: A concept for fitting the upper-extremity amputee, Artif. Limbs, Vol. 13, No. 2, Autumn, 1969.</li> <li>Committee on Prosthetics Research and Development, Externally powered prosthetic elbows - a clinical evaluation, Report E-4 National Academy of Sciences, 1970.</li> <li>Committee on Prosthetics Research and Development, The application of external power in prosthetics and orthotics, National Academy of Sciences, Publication 874, 1961.</li> <li>Committee on Prosthetics Research and Development, The control of external power in upper-extremity rehabilitation, National Academy of Sciences, Publication 1352, 1966.</li> <li>Dankmeyer, Charles H., Sr., Charles H. Dankmeyer, Jr., and Martin P. Massey, An externally powered modular system for upper-limb prosthesis, Orth, and Pros., 26:3, Sept. 1972.</li> <li>Frantz, CH., An evolution in the care of the child amputee, Artif. Limbs, Vol. 10, No. 1, Spring 1966.</li> <li>Kadefors, R., et al., Stryning av armprotes med myosignaler, Electronic 3:42-49, 1967.</li> <li>Kessler, H.H., and Kiessling, E.A., Pneumatic arm prosthesis, Am J. Nursing, 65:6: June 1965</li> <li>Kobrinski, A.E., Bolkhovit-in, S.V., Voskoboinikova, L.M., Ioffe, D.M., Polyan, E.P., Popov, B.P., Slavutski, Y.L., Sysin, A.Y., and Yakobson, Y.S.: Problems of bioelectric control in automatic and remote control. Proceedings of the First International Congress of the International Federation of Automatic Control, Moscow, 1960, London, Butterworth & Co. (Publishers) Ltd., 1961, Vol. 2, p. 619.</li> <li>Marquardt, E., Heidelberg pneumatic arm prosthesis, J. Bone and Joint Surgery, 47-B:3:425-434, August 1965.</li> <li>Rakic, M., Practical design of a hand prosthesis with sensory elements, Proceedings of the Interna-, tional Symposium of the Application of Automatic Control in Prosthetics Design, 103-119, August 27-31, 1962, Belgrade, Yugoslavia.</li> <li>Reiter, R., Eine neue electro-kuntshand, Grenzgeb. Med., 4, 133, 1948.</li> <li>Schlesinger, G., Der Mechanische aufbau der kunst-chanische aufbau der kunstlichen glieder, in Ersatzglieder und Arbeitshilfen, Borchartd, M., et al., Eds., J. Springer, Berlin, 1919.</li> <li>Schmeisser, Gerhard, Wood-row Seamone, and C. Howard Hoshall, Early clinical experience with the Johns Hopkins externally powered modular system for upper-limb prostheses, Orth, and Pros. 26:3, Sept. 1972.</li> <li>Schmidl, Hannes, The I.N.A.I.L. experience fitting upper-limb dysmelia patients with myoelectric control, Bull Pros. Res. 10-27, Spring 1977.</li> <li>Scott, R.N., Myo-electric control, Science J., 2-7, March 1966.</li> <li>Simpson, D.C., An experimental design for a powered prosthesis for children, Health, Scottish Home and Health Department Bulletin, 22:4:75-78, October 1964.</li> <li>Tomovic, R., and G. Boni, An adaptive artificial hand, IRE Transactions on Automatic Control, 3-10, April 1962.</li> <li>Wirta, R.W., Taylor, D.R., and Finley, F.R., Engineering principles in the control of external power by myoelectric signals. Archives of Physical Medicine, 49:294-296, 1968.</li> </ol> Page Number(s) 1 - 4 Year 1978 Volume 2 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1978_01_001/1978_01_001-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Externally Powered Upper-Limb Prostheses Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. https://staging.drfop.org/files/original/78bf6788488bdf97bc8b5683d42a6f70.pdf 28499b5aee932356ff3db57649d54f41 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_03_005.pdf Text Any textual data included in the document <h2>Editorial: The Driving Force in Rehabilitation</h2> <h5>William M. Susman, M.A., R.P.T. <a style="text-decoration: none;">*</a></h5> By design, and in daily clinical practice, rehabilitation is a multi-disciplinary effort. The patient is best served by professionals addressing the psychosocial and vocational aspects of disability as well as the various aspects of physical impairment in a specialized manner. The driving force behind the effective functioning of this approach is communication among the professionals comprising the rehabilitation team. This communication may occur within the structured format of professional publications, the formal yet often spontaneous settings of team clinics and rounds, or the many informal daily contacts between colleagues involved in the treatment of any one patient. Such communication enhances patient management in numerous ways. Consistent definitions and coordination of treatment approaches and goals can be achieved. Different perspectives regarding the same clinical situation can be shared, perspectives tempered by the different relationship each team member has with the patient, the expertise each member brings to the clinical problem, and the priority of concerns each establishes according to his or her functional role. Perhaps most importantly, the team is able to bring its collective clinical experience to bear upon the problem at hand. No one clinician, regardless of depth or breadth of experience, should fail to search out and use this collective experience for it can only serve to broaden the range of possible solutions. An excellent example of such an opportunity is provided in the lead article by Dr. Alexander in this issue of the Newsletter. This is not to say that executive decisions should not be made in the rehabilitation setting, but that if they are based upon the communicated experience and viewpoints of all team members, such decisions will not be autocratic. It should not be forgotten that the clinician also benefits from such communication. The most stimulating workplace is one in which a free exchange of ideas can take place without the fear that image or role is being threatened. In an imperfect world with personality differences and professional pressures, this can be hard to achieve, but must be actively sought. The stimulation of thought through this collective process also leads to clinical innovation and new research ideas and, ultimately, improvement in the professional's level of expertise and advancement of the state of the art of rehabilitation as a whole. Clinical professions involved in rehabilitation are currently undergoing rapid growth in knowledge base, upgrading of standards for entry into practice, and increasing professional responsibility. The fields of orthotics and prosthetics and physical therapy may be the best examples of these trends. It is imperative that no one clinical field, regardless of increased training, authority, or specialization becomes more isolated in clinical practice. Obviously, a given level of clinical skill cannot be replaced by input from another discipline, but the effective use of that skill can be channeled by communication within the clinic team towards better patient treatment, our foremost concern. *William M. Susman, M.A., R.P.T. Assistant Professor, Ithaca College, Division of Physical Therapy, Albert Einstein College of Medicine, Jacobi Hospital, Bronx, New York. <div style="width: 400px;"></div> Page Number(s) 5 - 6 Year 1980 Volume 4 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 Editorial: The Driving Force in Rehabilitation Creator An entity primarily responsible for making the resource William M. Susman, M.A., R.P.T. * https://staging.drfop.org/files/original/fa104bc2df9d1eb8a2e3fcfe1be372dc.pdf 3cac7ed2272aa4b36cb461ab73d777af https://staging.drfop.org/files/original/03c6dab500bcc8abcf2064a69651e3fb.jpg 78f6ebbe4d49f0e3d87c4a2431800fec https://staging.drfop.org/files/original/ef57e986fd642949abac655e0ddfbb48.jpg f228ca3d4b1bb1b07a591f5647f82f55 https://staging.drfop.org/files/original/6f3713a26a2d78a1af84b3371b05ee26.jpg 4cbdb84cf8ff35a7778b82dbb1364778 https://staging.drfop.org/files/original/984d8d4e3f3b4d44a11796f074d966bc.jpg fd661aac55fb812af0850e8319a6494b https://staging.drfop.org/files/original/a0e1497de95803eedb7c9bae27189933.jpg 86578a267fce21bebb761d96df09ad56 https://staging.drfop.org/files/original/ac40bae7d01bf2c9df78320ef938a453.jpeg 121965bd03be3afd015cb87750d6b2f5 https://staging.drfop.org/files/original/6ac0309f920adb45f06a6d73b90dbb23.jpeg 822b8149c492fcc9a1b2e8791f80a98d https://staging.drfop.org/files/original/ad272a01fb6edf60c48e85a6111e0d64.jpeg 28953020850578f0557a831f57db00da Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_03_003.pdf Text Any textual data included in the document <h2>An Ankle-Foot Orthosis Providing Mediolateral Stabilization While Allowing Free Plantar and Dorsiflexion of the Foot</h2> <h5>Lucia Klemmt, CO  Fritz Klemmt </h5> The development of an ankle-foot orthosis (AFO) providing mediolateral stabilization while allowing free plantar and dorsiflexion of the foot was prompted by a patient (W. F.) seen some months ago, who was wearing a posterior solid ankle-foot orthosis (PSAFO). However, rather than providing ankle stability, it was ineffective and an irritant during stance. W. F. was unhappy with it, and discouraged. In evaluating his condition, he was found to have good plantar and dorsiflexion, but suffered from mediolateral ankle instability. He was shown a conventional AFO with a metal stirrup and metal uprights, demonstrating the mediolateral protection the orthosis provides, while allowing free motion at the ankle. The fact that it was less cosmetic than a plastic orthosis did not concern the patient, if it allowed him to walk normally again and not with a stiff ankle. But considering his physician's preference for plastic over a metal orthosis, with its advantages, e.g., free choice of shoes, better appearance, etc., it occurred to us to combine mediolateral protection of the ankle with free ankle plantarflexion and dorsiflexion in a plastic orthosis. This idea was realized by incorporating an ankle joint similar to that used in fracture bracing in a PSAFO (<a href="/files/original/03c6dab500bcc8abcf2064a69651e3fb.jpg">Fig. 1</a>). From a plaster mold of the patient's limb, a PSAFO was fabricated with an anterior section for added tibial support. The distal aspect of the calf section was trimmed to clear the Achilles tendon. The proximal edge of the footplate was trimmed so as to include the malleoli (<a href="/files/original/ef57e986fd642949abac655e0ddfbb48.jpg">Fig. 2</a>). A contoured bar was riveted to the lateral aspect of the posterior calf portion and joined with the footplate over the malleoli, creating a pivot point allowing, rotation necessary for flexion or extension (<a href="/files/original/6f3713a26a2d78a1af84b3371b05ee26.jpg">Fig. 3</a>). Two velcro straps provided an intimate fit around the limb. The patient was pleased with the function and support provided by this orthosis. The second patient fitted with this type of orthosis (R. R.) had a similar ankle problem. A slight change in the design was made. A separate ankle joint as with W. F.'s orthosis was not used. Rather, the proximal edges of the footplate were extended to the proximal aspect of the malleoli. The distal edges of the posterior calf section were then made to overlap the malleoli portions of the foot plate (<a href="/files/original/984d8d4e3f3b4d44a11796f074d966bc.jpg">Fig. 4a</a> and <a href="/files/original/a0e1497de95803eedb7c9bae27189933.jpg">Fig. 4b</a>). This joint system works smoothly and is more cosmetic, although it requires a little more work. R. R. was delighted with the orthosis since he can wear it with regular Oxfords or boots (<a href="/files/original/ac40bae7d01bf2c9df78320ef938a453.jpeg">Fig. 5</a> and <a href="/files/original/6ac0309f920adb45f06a6d73b90dbb23.jpeg">Fig. 6</a>). A third patient (P. B.) with a similar problem of ankle instability was fitted with the same type of orthosis made for R. R., but eliminating the anterior portion. This patient, too, was happy with the freedom of motion it allowed (<a href="/files/original/ad272a01fb6edf60c48e85a6111e0d64.jpeg">Fig. 7</a>). In these three cases, free plantar and dorsiflexion were allowed while mediolateral ankle stability was achieved. Though it involves extra work and time during fabrication of this type of ankle joint on a posterior solid ankle foot orthosis, the security of the ankle on weight bearing, the freedom of movement while walking, and the satisfaction of the patients wearing the orthosis are achievements justifying the extra effort and expense. Page Number(s) 3 - 5 Year 1980 Volume 4 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-3.jpg Figure 4 FIGURE 4A http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-4.jpg FIGURE 4B http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-5.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-6.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-7.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1980_03_003/1980_03_003-8.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource An Ankle-Foot Orthosis Providing Mediolateral Stabilization While Allowing Free Plantar and Dorsiflexion of the Foot Creator An entity primarily responsible for making the resource Lucia Klemmt, CO Fritz Klemmt https://staging.drfop.org/files/original/c1b212e5569be3980845775e2e5a8a20.pdf b5411e7663896df2ca89672710d0c1cb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_03_001.pdf Text Any textual data included in the document <h2>Irreversible Contractures: An Impediment to Prosthetic Rehabilitation</h2> <h5>Justin Alexander, Ph.D. </h5> Prosthetic rehabilitation of patients with severe contractures of the remaining joints of the affected lower extremity has been generally viewed as being difficult due to biomechanical problems in fitting, increased energy costs of ambulation and poor cosmesis of the prosthesis. As a result, attempts are often made to "stretch out the contracture" with minimal success, or suggestions are made to the patient to remain in the wheelchair. Our experiences with a number of patients who presented with "irreversible" contractures, indicate that another choice may be available. In 1965(1) we reported our experience in the management of a 59 year old man who had undergone bilateral amputations (BK and AK). Following a herniorrhaphy, he developed occlusions of both iliac arteries and despite attempts to reconstruct the vascular supply, he developed gangrene necessitating the amputations. When he was examined by us, he presented with bilateral hip flexion contractures of about 60° and a knee flexion contracture on the BK side of 90°. In addition, there was limited mobility of the lumbar spine. Primarily because the patient refused our recommendation for wheelchair independence, pylons were constructed. For the left, a bent knee pylon was fabricated and for the right the device was built to hold the stump in about 50° hip flexion with weight bearing on the posterior thigh. Since the patient demonstrated that this solution was a realistic one, prosthetic devices incorporating the features of the pylons were made. When the patient was discharged, he was able to ambulate with the aid of Lofstrand crutches. The patient was re-examined periodically, and after about 2 years it was noted that the contractures had decreased to a point where he was able to wear a PTB prosthesis on the left and a conventionally aligned AK quadrilateral socket prosthesis on the right. Lippman(2) described his observations of a 72 year old man who lost his right leg as a result of trauma, complicated by a long history of arteriosclerosis obliterans. Because of a 40° hip flexion contracture, his prosthetic treatment followed the course outlined above. In our prosthetics clinic (Bronx Municipal Hospital Center), we have seen a number of patients who had undergone below knee amputations and presented with severe knee flexion-hip flexion contractures to a degree which precluded fitting with a standard PTB or condylar bearing prosthesis. We have frequently fitted them with bent knee pylons followed by a similar prosthetic device after they had demonstrated their ability to function with the temporary device. On follow-up we again noted reduction of the "irreversible" contractures to the point where a more conventionally aligned prosthesis could be prescribed. <h3>Discussion</h3> Delagi and co-workers(3) (1955) as well as Blau, et. al(4) (1951) reported their impressions of the benefits of ambulation with a temporary device. Both emphasized the stretching effect of early ambulation. In the devices described in this article, however, stretching has been purposely minimized because the contractures were believed to be "irreversible." Despite the lack of active stretching, the contractures were relieved to a considerable degree. Partridge and Duthie (1963) (5) reviewed the literature describing the effect of immobilization on acutely inflamed rheumatoid joints and cite Hunter (1835) "nothing can promote contraction(s) of a joint so much as motion before the disease is removed." Hunter's observations were confirmed by Thomas (1878), Duthie (1951, 1952) and Partridge and Duthie. Harris and Copp(6) (1962) immobilized acutely inflamed knee joints, keeping one completely immobilized and the other being exercised intermittently. They noted that when the fixed knee lost more than 15° of motion, the mobile knee also lost range, thereby suggesting that some factors other than immobility might be a contributing factor. In their opinion immobilization produced a decrease in muscle spasm, thus permitting restoration of motion. Fried (1969) (7) concurs "complete immobilization is not only not harmful but frequently beneficial, provided that splinting is done judiciously, especially when a joint is inflamed and painful." Under those conditions when patients are likely to dread motion, immobilization leads to decreased pain and inflammation and "it is not unusual for immobilization to result in increase in motion." It seems that those amputees who experience considerable pain pre-operatively or in the immediate post-operative period, might react with a response similar to that described above and when pain is relieved, inhibition, spasm or another mechanism is decreased and motion can be restored. In addition, it appears that the judgment of "irreversible contractures" may be applied too quickly. Patients are treated for a finite period of time and if during that period no appreciable change is observed, a decision must be made based on demonstrable facts. It can, therefore, be concluded that for some patients interim solutions as outlined may be appropriate and that the clinic staff must accept the responsibility for regular, periodic and long term follow-up of patients in order to facilitate accommodation to changes in the patient's condition. References: <ol> <li>Alexander, Justin and Herbison, Gerald, "Prosthetic Rehabilitation of a Patient With Bilateral Hip-Flexion Contractures: Report of a Case." Archives of Physical Medicine and Rehabilitation, Vol. 46, 708-711, October, 1965.</li> <li>Lippmann, Heinz I., "Rehabilitation of the Lower Extremity Amputee with Marked Flexion Contractures: Report of Two Cases." Archives of Physical Medicine and Rehabilitation, Vol. 48:3, 147-149, March, 1967.</li> <li>Delagi, Edward F., Abramson, Arthur S. and Tauber, Arthur N., "Use of Temporary Plaster Pylon in the Management of the Lower Extremity Amputee." Archives of Physical Medicine and Rehabilitation, Vol. 36: 784-786, December, 1955.</li> <li>Blau, Leslie, Phillips, Joseph J. and Rose, Donald M., "Value of the Pylon in Pre-prosthetic Management of the Lower Extremity Amputee." Archives of Physical Medicine and Rehabilitation, Vol. 32: 585-589, 1951.</li> <li>Partridge, R. E. H. and Duthie, J. J. R., "Controlled Trial of the Effect of Complete Immobilization of the Joints in Rheumatoid Arthritis." Ann. Rheum. Dis., 22: 91, 1963.</li> <li>Harris, R. and Copp, E. P., "Immobilization of the Knee Joint in Rheumatoid Arthritis." Ann. Rheum. Dis., 21: 353, 1962.</li> <li>Fried, David M., "Splints for Arthritis." Arthritis and Physical Medicine, S. Licht (edit.), 1969, pp 285-314.</li> </ol> Page Number(s) 1 - 2 Year 1980 Volume 4 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 Irreversible Contractures: An Impediment to Prosthetic Rehabilitation Creator An entity primarily responsible for making the resource Justin Alexander, Ph.D. https://staging.drfop.org/files/original/09fe10baa626726ecfda342c957103aa.pdf d19f909aad10c8d77d23f58e47708607 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_007.pdf Text Any textual data included in the document <h2>Editorial: To Fill a Void</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a></h5> I believe that everyone familiar with the recent history of prosthetics and orthotics will agree that the results of the research program in artificial limbs initiated in 1945 by the National Academy of Sciences at the insistence of the Surgeon General of the Army has been very beneficial to amputees and to the prosthetists that serve them. Patients requiring orthopaedic bracing and orthotists have also benefited from this program, which has been supported from the beginning by the Veterans Administration and since about 1956 by the Department of Health, Education & Welfare. Yet for the first five years, or so, of the program, prosthetists and orthotists, not knowing how it would affect their "business," were quite wary of the government-supported research and development teams, and it was not an easy matter to induce practicing private prosthetists to attend the first series of formal education programs offered by the government at UCLA in 1953, even when their attendance was heavily subsidized. Today, the prosthetics and orthotics education programs are considered by all to be essential to the maintenance of a healthy prosthetics and orthotics service, and students pay substantial tuitions to obtain an education in this field. In recent years the AAOP has come forth with continuing education programs that are being improved steadily, and I am sure the younger practitioners probably find it difficult to imagine a world without formal education programs in prosthetics and orthotics. Although the original purpose of the educational programs was to introduce the results of research to practitioners as soon as possible, the government agencies, for reasons known only to the bureaucrats involved, have in recent years essentially abandoned support of research in prosthetics and orthotics. A review of the latest issue of the Bulletin of Prosthetics Research (BPR #10-32) which contains progress reports on all of the research and development efforts in prosthetics and orthotics supported by the VA and DHEW, indicates that less than a quarter of the projects devoted to "Rehabilitation Engineering" relate to prosthetics and orthotics. The percentage in terms of fiscal support is probably even less. This circumstance is reflected also in the source of manuscripts submitted to "Orthotics and Prosthetics." In the past, most of the articles were submitted by workers involved in government-supported research programs. Today, the majority of articles are being received from private practitioners. Perhaps this is as it should be, even though medical research is heavily subsidized, and maybe the prosthetics and orthotics profession has grown to the point where it can assume the leadership in the research, development, evaluation, and education needed if it is to continue to provide the increasingly better services expected of professional groups. In addition to the role of the AAOP in providing opportunities for continuing education, an encouraging signal seems to be coming recently through many of the manuscripts submitted to "O & P" in which practicing prosthetists and orthotists describe their own innovations. However, almost without exception, the authors include only their own experiences with patients, and it never fails to occur to me, as editor, what a pity it is that there exists no group to which these excellent ideas can be submitted for a non-biased evaluation conducted under typical clinical conditions, and thus, be channelled with confidence into the formal educational programs. Even if the federal bureaucrats feel that research and development in prosthetics and orthotics is not important or glamorous enough for support, perhaps AAOP could persuade them that it would be in the public interest to support, at least partially, a clinical evaluation program to be conducted by the Academy. I am confident that Academy members will gladly cooperate by fitting patients on a controlled, experimental basis, and, thus, the government will need to support only staff, travel expenses, and in some instances the cost of materials and devices in connection with this much needed function. If such a project is proposed, I recommend strongly that the universities and colleges offering educational programs in prosthetics and orthotics be given the opportunity to participate, for, in that way, any recommendation that a device or technique be added to their respective programs will come as no surprise, and therefore be accepted more readily. *A. Bennett Wilson, Jr. Director, Rehab. Engineering Program, University of Texas Health Science Center at Dallas; Editor, O &P Journal Page Number(s) 7 - 7 Year 1980 Volume 4 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Editorial: To Fill a Void Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * https://staging.drfop.org/files/original/f84bb0c475ca9d030e23df9e4e80658d.pdf 94375248bcccdaeab873ef4e4c97c777 https://staging.drfop.org/files/original/6ec0d5b59e7d232d595707c15372a97c.jpg de00e861806273a4296343544b6bf106 https://staging.drfop.org/files/original/15c0eaaa0b4778e274016ee3e4f0eaef.jpg 2a616dc0bb2ebcf0e39110254f7214fe https://staging.drfop.org/files/original/5349fa590d8d8b526c3f243a7bd1bdd1.jpg f22b164a89f5fea857cfaad0f802eacc https://staging.drfop.org/files/original/cab9f2ad9f641a085d9079b6e82bbc7e.jpg 98f7040eb022de51e27dbc7ee91ab790 https://staging.drfop.org/files/original/544d0554c74d2d5950384e2e1dfd6aff.jpg 559149ef240dff1d7a44a72d9e261ebf https://staging.drfop.org/files/original/cbd70b676214f45b70d3cf9ff79514fd.jpeg 355eedf11c055b25646f742ec329eb73 https://staging.drfop.org/files/original/9872c7817353817cc6a62cc57c60d007.jpeg f54103ca4b7342b6319599df2a9f0aeb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_003.pdf Text Any textual data included in the document <h2>Plastic Ankle-Foot Orthoses: Indications and Functions</h2> <h5>H. Richard Lehneis, Ph.D., C.P.O. </h5> Prescription of plastic ankle-foot orthoses at the Institute of Rehabilitation Medicine, New York University Medical Center (IRM-NYUMC) has, over approximately the past 12 years, been based on the identification of a pathomechanical condition affecting the ankle-foot complex for the purpose of matching that condition with a bio-mechanical device (plastic ankle-foot orthosis). Over the years, this basic system has been improved to include modifying factors such as spasticity and sensory status.  Table I. <img src="/files/original/6ec0d5b59e7d232d595707c15372a97c.jpg" p="" /> Table II.<img src="/files/original/15c0eaaa0b4778e274016ee3e4f0eaef.jpg" nbsp="" represents="" an="" elaboration="" of="" the="" system="" in="" describing="" addition="" to="" indications="" bio-mechanical="" actions="" each="" ankle-foot="" orthosis="" as="" well="" contraindications="" afo="" s="" described="" is="" shown="" b="" /> Fig. 1, Fig. 2, Fig. 3, Fig. 4, and Fig. 5. <a href="/files/original/5349fa590d8d8b526c3f243a7bd1bdd1.jpg">Figure 1.</a> Posterior Leaf Spring Ankle Foot Orthosis. <a href="/files/original/cab9f2ad9f641a085d9079b6e82bbc7e.jpg">Figure 2</a>. Hemi Posterior Leaf Spring Ankle Foot Orthosis. <a href="/files/original/544d0554c74d2d5950384e2e1dfd6aff.jpg">Figure 3</a>. Spinal Ankle Foot Orthosis. <a href="/files/original/cbd70b676214f45b70d3cf9ff79514fd.jpeg">Figure 4</a>. Hemi Spiral Ankle Foot Orthosis. <a href="/files/original/9872c7817353817cc6a62cc57c60d007.jpeg">Figure 5</a>. Posterior Solid Ankle Foot Orthosis. Table I and Table II have been used successfully in the training of physicians, orthotists, therapists, and other health-related personnel. We hope that the readers of the Newsletter find these tables useful in their respective clinics to clarify indications and contraindications for the various AFO's. Page Number(s) 3 - 6 Year 1980 Volume 4 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-3.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-4.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-5.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-6.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-7.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 Plastic Ankle-Foot Orthoses: Indications and Functions Creator An entity primarily responsible for making the resource H. Richard Lehneis, Ph.D., C.P.O. https://staging.drfop.org/files/original/cb540e7ef43f29b8f2a54281780f08ca.pdf db1f8f57d64f091532e8e80aa08d9455 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_001.pdf Text Any textual data included in the document <h2>The Nature of Orthotics Practice</h2> <h5>Sidney Fishman, Ph.D. <a style="text-decoration: none;">*</a> Joan E. Edelstein, M.A. <a style="text-decoration: none;">*</a> Lynn Michaelson, B.S. <a style="text-decoration: none;">*</a></h5> How typical is YOUR orthotics practice? How extensively are plastic orthoses being utilized? How many KAFO wearers utilize a knee lock, and what kind? Examining the experience of a larger number of certified orthotists regarding these and other prescription issues is a logical way to gain perspective on contemporary orthotics management. Some time ago New York University Post-Graduate Medical School conducted a pilot survey of approximately sixty orthotists who were attending several short-term courses. While the sample was small and drawn largely from the Eastern seaboard, the completed questionnaires revealed a number of interesting trends regarding patient population, orthotic designs, and materials. Among the most important of the preliminary findings is the overwhelming predominance of lower limb orthotics (LLO) practice over spinal (SO) and upper limb (ULO) activities by a ratio of 5 to 1 to 1; the continued preference, although small, for metal rather than plastic materials, especially for LLO's. Lastly, middle aged adults with upper motor neuron disorders (stroke, etc.) constituted the largest single type of patients requiring services. <h3>Population</h3> Although orthotists reported that they treated substantial numbers of patients in all age brackets, about 55 % of the individuals fitted were between 18 and 60 years of age. Of the remaining 45% , the proportion of children below 18 years exceeded that of older adults (over 60) by a third. Patients presented a wide variety of disorders. Among LLO wearers, more than half had upper motor neuropathies; approximately 30 percent had skeletal disorders, and the remaining 20 percent had lower motor neuron diseases. In contrast, the greatest number of ULO's were worn by persons with lower motor neuron lesions (42%), while the remaining individuals wearing ULO's experienced upper motor neuron and skeletal disorders in nearly equal numbers. <h3>Materials</h3> The great majority (80%) of orthotists responding used both metals and plastics in their LLO practice, however 10 percent stated that plastics constituted the primary or sole material in all LLO's they made, while the remaining 10 percent used metals only. Overall, the ratio of usage of aluminum to plastic to steel was 5 to 4 to 1. <h3>Lower Limb Orthotic Designs</h3> Among the lower limb devices fabricated, 63 percent were AFO's while 37 percent were HKAFO's, KAFO's, and KO's. Forty-six percent were unilateral AFO's and 25 percent were KAFO's applied unilaterally; 17 percent of the LLO were AFO's fitted bilaterally. The solid stirrup was by far the most commonly used method of shoe attachment (42%), followed in turn by the split stirrup (20%), plastic shoe insert (18%), calipers (15%), and miscellaneous attachments (5%). About half of the LLO's prescribed permitted free or nearly free ankle motion of which 17 percent permitted free motion, and 37 percent utilized some form of motion assist, usually a coiled or wire spring. Approximately one-third of the ankle components limited motion in some way with 27 percent of such appliances utilizing stops, and 10 percent consisting of solid ankles. Such diverse components as dual action assists and double axis joints accounted for 11 percent of the orthotic ankles. In relation to specific AFO designs utilized, the most frequently identified were patellar tendon bearing, Denis Browne, posterior leaf spring (both Rancho polyethylene and TIRR polypropylene), VAPC shoe clasp and the NYU insert. As regards orthoses encompassing the knee and/or the hip, a single axis joint with drop lock, (with or without spring loading) accounted for nearly 70 percent of knee controls provided. Cam and plunger locks were very seldom used and only 13 percent of the orthoses had free knee joints, including single axis as well as offset and polycentric types. Regarding hip joints, the number of free single and double axis joints far exceeded that of any locking hip joints. Approximately half of the orthotists reported making fracture LLO's of one type or another. A third had fabricated both AK and BK fracture orthoses, while nearly 10 percent had made only BK fracture orthoses and 5 percent had fabricated AK designs exclusively. As for other specific KO and KAFO designs, orthotists constructed knee cages and trilateral Legg-Perthe's orthoses most commonly. <h3>Upper Limb Orthoses</h3> While as indicated, the survey focussed on LLO practice, several interesting facts concerning ULO management also emerged. The most frequently prescribed ULO was the opponens orthosis (70%), while 19 percent were provided with prehension orthoses with about 21 percent of this number being fitted bilaterally. External power was employed in only 3 percent of the fittings reported. Although these preliminary data indicate some interesting patterns there is no doubt that it is not possible, at the present time, to present a satisfactory overview of the nature of orthotics practice, with any degree of confidence. This fact presents particular problems for the educational institutions who are obliged to teach students those procedures and techniques which are most widely utilized by the practitioners. The same lack of information causes severe difficulties for potential researchers in relation to their ability to identify and undertake valuable and meaningful projects. Consequently there is a crying need for more comprehensive and reliable information than is presently available. We therefore propose to obtain such data from as many certified orthotics facilities in the country as possible. A revised questionnaire has been prepared which attempts to obtain the most important, precise information regarding lower limb orthotics practice. We request that each certified facility complete the questionnaire on pp. 8-10. It should take no more than 15-20 minutes. Return the completed form to Prosthetics and Orthotics, NYU Post-Graduate Medical School, 317 East 34th St., New York, NY 10016, by Sept. 15, 1980. Obviously only one questionnaire for each facility should be submitted, since any duplicate returns would tend to unbalance the information gathered. Lastly, in order to identify regional differences and to permit the possibility of follow-up contacts, we ask that each return be identified. In order to avoid any possible intrusion on confidential business statistics please note that all of the requested information is only in percentages of total practice. Following the necessary period of time to accumulate, tabulate and analyze the data, a report summarizing the results of the study will be published in a forthcoming issue of the Newsletter. At a later time similar surveys relating to spinal and upper limb practice will be undertaken. *Lynn Michaelson, B.S. New York University Post-Graduate Medical School *Joan E. Edelstein, M.A. New York University Post-Graduate Medical School *Sidney Fishman, Ph.D. New York University Post-Graduate Medical School <div style="width: 400px;"></div> Page Number(s) 1 - 2 Year 1980 Volume 4 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Nature of Orthotics Practice Creator An entity primarily responsible for making the resource Sidney Fishman, Ph.D. * Joan E. Edelstein, M.A. * Lynn Michaelson, B.S. * https://staging.drfop.org/files/original/14e71685d71f779f2e221b6ce3752c7b.pdf 7f5b513db755d91f0fee0e97ce868617 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_005.pdf Text Any textual data included in the document <h2>Prosthetic Knee Mechanisms: A Guide for the Prosthetist</h2> <h5>Bert Goralnik, CP </h5> <h3>Introduction</h3> A function of the Veterans Administration Prosthetics Center (VAPC) is to assist VA Clinic Teams nationally in prescribing prosthetic devices, including, of course, prosthetic knees. Prescribing knee mechanisms, however, is a complex task because of the large variety available. Most often these devices differ not that much in function but in size, type of material used for the setup, and additional characteristics related more to assembly and installation processes than prescription rationales. All too often clinicians prescribe either limited numbers or certain types of knee mechanisms found to be reliable in the past. Another inhibitor may be a lack of specific information on the full range and variety of all available systems. The clinician rarely has an opportunity to compare the relative merits of one knee with another. In 1972, the Veterans Administration, through the Department of Medicine and Surgery, Washington, D.C., published a program Guide (M-2, part IX, G7) on "The Selection and Application of Prosthetic Knee Mechanisms." The guide was slightly modified and updated in 1976. A new Program Guide, reflecting developments of recent years and incorporating most commercially available knee mechanisms, will soon be published. This later Program Guide will provide a summary description of the various knee mechanisms thus far evaluated by the VAPC. It is intended to help maximize patient benefits. <h3>Description of Program Guide</h3> The Program Guide comprises six sections: Knee Function, Definitions, Classification, General Requirements, Prescription of Prosthetic Knee Mechanisms, and Catalog of Knee Mechanisms. <ol> <li> Knee Function: Here are described the normal function of the anatomical knee, specifically the relationships of its various parts during the gait cycle, and alignment stability as a key factor in prosthetic fitting. Discussion centers on the TKA line relative to the center of the knee in maintaining stability during the stance phase. Understanding these relationships and utilizing the special features of knee mechanisms for the patient's benefit is an asset for the prosthetist. The Clinic Team thereupon must strive to provide the patient with the specific knee mechanism whose features most closely match his individual needs. </li> <li> Definitions: Reference terms are given to describe the variety of knee functions. </li> <li> Classification: A chart classifying all types of commercially available knee mechanisms is provided. The chart shows functional criteria, specifically swing phase control and stance phase control. Additional topics in this section include extension aids, extension stops, mechanical locks, mechanical friction, and fluid resistance of hydraulic and pneumatic knees. </li> <li> General Requirements: This section consists of a checklist on knee mechanism requirements. </li> <li> Prescription: Prescription rationale is discussed, emphasizing the needs of the individual patient. Although the Program Guide concerns knee mechanisms, socket, shank, foot and suspension are also discussed to achieve the best type of prosthesis available. A chart shows the type of prosthesis best suited for different types of amputees. A classification chart of knee mechanisms is also included. To further assist the clinician, variations of basic prescriptions are given, i.e., for a short residual limb, a very long residual limb, and differences based on level of activity. </li> <li> Catalogue of Knee Mechanisms: this section, the heart of the Program Guide, lists most commercially available knee mechanisms. Illustrations furnished by the manufacturers are included. A chart lists type of knee mechanisms, materials, exact dimensions, and types of control offered. </li> </ol> <h3>Conclusions</h3> The new Program Guide on "The Selection and Application of Prosthetic Knee Mechanisms," will be available on or about June 1, 1980. It should prove to be of significance to all clinic teams. To obtain a copy of this publication, please write to the Veterans Administration Prosthetics Center, Attention: Mr. Bert Goralnik, 252 Seventh Avenue, New York, New York 10001. I wish to thank Mr. Max Nacht, Technical Writer/ Editor, VA Prosthetics Center, for his aid in preparing this article. Page Number(s) 5 - 6 Year 1980 Volume 4 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosthetic Knee Mechanisms: A Guide for the Prosthetist Creator An entity primarily responsible for making the resource Bert Goralnik, CP https://staging.drfop.org/files/original/b55c999f394c95f22da4376f0a7fd130.pdf 5101740961929f47b6d05aa1fc10398e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_002.pdf Text Any textual data included in the document <h2>Guest Editorial: Of Prosthetics And 1980</h2> <h5>Anthony Staros <a style="text-decoration: none;">*</a></h5> The survey of prosthetics components shown in this issue yields conclusions mostly related to above-knee amputees, as indicated in the text associated with Tables I and II. Fortunately more lower-limb amputations today are below-knee, so one really cannot tell much about trends in prosthetics practice from these data except to note that the SACH foot is indeed a success. This however should not make us complacent about this design, for we should never be happy with anything that we have in prosthetics. Our objective should always be constant improvement. As suggested, data are needed on below-knee fittings to give us a better impression of the state of lower-limb prosthetics today. Surveys of suppliers will show little; needed are data from the fitters of the country. Many of you know that the support of the VA Research Program of the University of California at Berkeley and San Francisco many years ago yielded the crucial bio-mechanical parameters in lower-limb amputee prosthetic service associated with fit and alignment. But never to be overlooked as very significant to service is the "tender loving care" and the training provided to the patient by the emphatic prosthetist. In any case, components although secondary are still important. But clearly recognized is the need to get the prosthesis properly interfaced and the amputee motivated. Perhaps a survey covering rotators might produce helpful data about how these have been used to reduce fitting problems by the diminution in shear stresses. The post-World War II education program has been primarily based on the teaching of the biomechanics and techniques of fit, those of alignment and to some extent but a lesser one, teaching about components. Even though these are of lesser importance, have we overlooked some essentials? <h3>On Prosthetic Knees.</h3> We really don't fault the survey, but recognize its limitations. It nevertheless does show that for above-knee knee joints at least there may be some lapses in the teaching of prosthetists, in the teaching of other members of the clinic team and most importantly, in orienting the administrators representing third party payers. Perhaps the low number of hydraulic knees (as a %) can be attributed to the larger percentage of amputees who are geriatric. But aren't these supposed to be mostly below-knee amputees these days? Not to be overlooked is the value of properly selected hydraulic knee mechanisms for certain cases. The selection of large numbers of "safety" knees is noted; but isn't it that clinic teams seem to get hooked on these, not trying others, or perhaps they have become disillusioned with price or maintenance burdens? Today, the safety knee is the unit of choice but we wonder whether even these are being used properly. For example, are they in fact being used to exploit the value of the stance phase characteristics in initiation of swing phase? Are the alignments such that one provides more "trigger" for initiation of knee flexion? The low numbers for polycentric knees bother us. If properly understood, some of the polycentric knee systems can be very beneficial in providing improved function to amputees with very short above-knee residual limbs and those with very weak hip musculature. How about their use in geriatrics? Are indeed the polycentrics really understood? Are those that are being used being fitted and aligned properly? Do clinicians really understand the real values of the polycentric systems? The system developed at the Orthopaedic Hospital, Copenhagen for example, can be used not only for end-bearing above-knee amputees but can also be applied for shorter amputation levels. The University of California at Berkeley is now developing other improvements in polycentric systems; we hope to see some of those soon presented through manufacturers. Unfortunately we sense that clinics tend to adopt particular "pet" knee mechanisms or pet prescriptions. We worry that for various reasons (valid?) the full range of knee mechanisms has not been given a complete trial. Our publications have tried to get the information across about the pros and cons of each system. Perhaps we have failed. For example, some of the rehabilitation achievements we have been able to make in our own clinic with the hydraulic knees are in fact extraordinary. Alongside the other important factors, the Mauch SNS in particular has been a boon to many of our above-knee amputees, particularly bilateral cases we have had from the Viet-Nam conflict and some Israeli cases from the October (Yom Kippur) War which were referred to us. <h3>A Case in Point</h3> One interesting case from Viet-Nam, a bilateral above-knee amputee, not only now sky dives but snow skis and disco dances on his above-knee prostheses, both with SNSs. This gentlemen has personal drive and motivation; he was an athlete before he was wounded, but now and this is important, he has been given the "tools" in those knee mechanisms: tools which can be used by him to achieve activity levels to which some of us nonamputees could aspire. Here, the SNS provided the wherewithal; matching these with the man's motivation and well-fitted sockets properly aligned, we were able to provide what can be considered a maximum degree of rehabilitation. This is not an isolated case. There have been many people fitted with the SNS and with others that are spin-offs of this design. We in the Veterans Administration put money into these developments, and we continue to purchase them because we have confidence in them. And our patients do. The problem is that others don't. Perhaps primary cost and maintenance experiences detract. But more so, other third party payers do not or cannot value these units as we do for our service-connected amputees who we believe deserve no less. <h3>How about Modular Systems?</h3> We are concerned about the low percentage of modular systems used. Less than one in four are shown. But these, in this survey, are directly linked to above-knee and higher amputations. Again, the geriatric amputee experiences and thus the more common below-knee amputation levels are not reflected. For these, modular or endoskeletal systems may be used most commonly, more than the rugged, heavier crustacean systems of wood and the like. We hope at least that more and more lightweight below-knee prostheses either using endoskeletal systems or polypropylene would be used to the benefit of this group of amputees. <h3>Finally, on Research and Development</h3> The component survey also doesn't really indicate anything about the needs for research and development. Inferred are some gaps in our link with the prosthetist and the clinic team mainly in the channels of information flow about all kinds of hardware. But one cannot draw too many conclusions. We are pleased to inform you that the National Amputation Foundation with the assistance of Dr. Jerome Siller of New York University has now nearly completed for the VA Prosthetics Center a nation-wide survey of 900 service-connected veteran amputees. Provided from this survey will be data about prosthetic, medical, surgical, employment and psychosocial experiences and statuses of veterans from all wars since and including World War II. We expect the investigators to give a report at the 1980 World Congress of ISPO to be held in Bologna, Italy. From this, we expect to have some significant directions for research and development. On this matter of research and development, it seems to us that as soon as you become extremely successful with a particular item you might look at it again to see what you can do to improve on it. Besides more durable SACH feet more functional types of foot-ankle systems seem needed. Are there ways, for example of achieving the same function with less complexity than presented in the current "universal" ankle joints? There appears to be no need to focus again on knee joint development; we would seriously worry about a further proliferation of new knee mechanisms. A few research groups are working on EMG control of valves on hydraulic knees, to produce voluntary control of knee function. This we can accept as long-range. You should also know that Federal support of research and development in prosthetics and orthotics (our own Center's deemphasis is an example) has been decreased to some extent. We do assist in evaluations; we do a little bit of development, primarily as a result of case presentations in our clinics, but we offer no great effort in prosthetics and orthotics development at this time; we have diverted scarce resources to attack the problems of the very severely handicapped: the spinal cord injured, the blind, the non-vocal, and the cumbersome complexities of the debilitated aged. So there'll be no mistake, know that we're still involved in prosthetics and orthotics, but we honestly believe that prosthetics and orthotics development has come a long way. We in the VA believe we have done much to contribute to this process, especially in funding projects around the country. We have also had our own laboratories involved. But now with a mature profession in place, these responsibilities can be carried primarily by the professional with the Government only assisting when necessary. The manufacturers as a group are certainly participating in development, evaluation, and even in training. Outstanding examples are several in the United States and those from Europe who have done an extremely good job in making the quality and function of components of high quality. And the competition among them has been welcomed by us. We think that the prosthetics (and orthotics) professional especially when it comes to process and device development is contributing enormously. Therefore the Government can turn its attention to that which the private sector cannot economically handle. But we always will be ready to help. *Anthony Staros Director, VA Prosthetics Center New York, N.Y. 10001 Page Number(s) 2 - 4 Year 1980 Volume 4 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Needs Revision- See Trello Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guest Editorial: Of Prosthetics And 1980 Creator An entity primarily responsible for making the resource Anthony Staros * https://staging.drfop.org/files/original/eaf0a7b425c90dc8b9205c09b4cfeddd.pdf 15e97b748c74abe2a1ca3e141ad14231 https://staging.drfop.org/files/original/b4340fe7dc6294b06bd93a46a9eefcfb.jpg 106945255e1ae54dde98455ab0a3f13e https://staging.drfop.org/files/original/eb21a4e75152f4ff61417686c70f9188.jpg 2bfb40cb9fe53bb031b025e027a5cc4b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_001.pdf Text Any textual data included in the document <h2>Prosthetics Up-Date 1980: Foot and Knee Components</h2> <h5>H. Richard Lehneis, Ph.D., C.P.O. </h5> This paper is, in part, based on a lecture given by the author at the International Congress on Technical Orthopedics, 1979, in Nurenburg, Germany. The data relating to prosthetic foot and knee components was obtained from a survey of the relative sales volume of the various components by three of the largest U.S. distributors of prosthetics components from practically all manufacturers. The distributors cooperating in this were Knit Rite, Inc., Kansas City, Missouri; Northeast Paramedical Industries, New York, New York; and PEL Supply Company, Cleveland, Ohio. These firms were requested to provide the relative percentage of sales of the various foot (Table 1) and knee components (Table II), rather than the absolute volume of sales. The table on knee components includes conventional versus modular constructions. The average (mean) percentages  of the various prosthetic feet and knee components sold by the three firms are listed in the last columns of Tables I and II respectively. On the basis of these data, one may infer current prescription and fitting practices in the United States. An attempt to get similar data on below-knee and above-knee suspension systems, based on the percentage of sales of supracondylar cuff, BK side joints, hip joints, suction socket valves, and Silesian belts, appeared not valid after analysing the data collected because of the possibility of various combinations of suspension systems that may be prescribed and used. It is, therefore, hoped that readers of the Newsletter will return the questionnaire on Page 10 which addresses the subject of BK and AK sockets and suspension systems with due consideration of the various possibilities of combination of suspension systems. <h3>Discussion</h3> Referring to Table 1, there appears to be a vastly increased use of SACH feet versus other types of prosthetic feet. This may be interpreted in terms of the far greater frequency in recent years of BK versus AK amputations due to improved surgical techniques. Although, from the author's experience, it appears that SACH feet are used to an increasing extent and with great frequency in AK prostheses. <img src="/files/original/b4340fe7dc6294b06bd93a46a9eefcfb.jpg" br="" /> In Table II, one notes a surprisingly low use of hydraulic mechanisms. This may be interpreted in terms of the increase in the geriatric population who, in general, do not benefit as much as younger amputees from the hydraulic systems. Support for this interpretation may be viewed in the larger percentage of safety knees, and single-axis knees with manual knee locks used which total 66 % of all knee units sold.<img src="/files/original/eb21a4e75152f4ff61417686c70f9188.jpg" br="" width="440" height="525" /> Page Number(s) 1 - 2 Year 1980 Volume 4 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1980_01_001/1980_01_001-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_01_001/1980_01_001-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosthetics Up-Date 1980: Foot and Knee Components Creator An entity primarily responsible for making the resource H. Richard Lehneis, Ph.D., C.P.O. 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/b07addbca7cb05cba5493373ba37e4d5.pdf beaed1b03564c538ee3e1e8ec6019f68 https://staging.drfop.org/files/original/3315a246e37eef6187bbc4b8ea89f1ba.jpg 2cd16c71b05ac05e1bf1a8dec6934bc5 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_005.pdf Text Any textual data included in the document <h2>Editorial: Special Prostheses Enhance Rehabilitation</h2> <h5>Charles H. Epps, Jr., MD <a style="text-decoration: none;">*</a></h5> In the case of a child, conventional wisdom has held that success of prosthetic rehabilitation can be measured by the ability of the child to play, as play may be considered child's work. In the adult, ultimate success was evidenced by the patient's return to his former job or to some other gainful employment. Special acclaim and attention have been given to amputees like Pete Gray, who succeeded as a professional baseball player. Today another criterion can offer a more valid assessment of success. The ability of the patient, child or adult, to participate in life's activities is a better measure. This assessment should include sports and athletic activities, especially those activities formerly enjoyed in the case of an acquired amputee. Fortunately, today's prosthetic armamentarium includes special techniques, components and prostheses that make participation possible in a variety of activities. On the basis of the experience gained in treating more than 700 juvenile amputees, R.C. Hamilton<a></a> formulated the conclusions about their role in competitive sports as shown in Table I. Most amputees are not interested in competition, but desire to engage in recreational athletic activities. Table I. Suggested Areas of Athletic Participation by Unimembral and/or Uncomplicated Amputees <img src="/files/original/3315a246e37eef6187bbc4b8ea89f1ba.jpg" p="" width="399" height="473" /> Beginning in Europe in the late 1940's, skiing was one of the first sports to be "adopted" for amputees. In the United States there has been a great interest in this activity, as manifested by the formation of the National Amputee Ski Association. Special ski boots and outriggers have been developed. The unilateral below-knee amputee can ski with or without a prosthesis. The bilateral below-knee uses the four track technique with two prostheses, two skis and outriggers. The unilateral above-knee usually must ski on the intact leg using the three track technique. The bilateral above-knee can use short prostheses without knee mechanisms. Cross-country skiing is recommended solely for the below knee amputee. According to Bernice Kegel, the average amputee can learn to ski intermediate and expert slopes in one fourth the time an abled-bodied skier needs, and with a far greater degree of proficiency.<a></a> Swimming is an activity that can be enjoyed by amputees of all ages. If the swimmer is able to stay afloat safely without a prosthesis, opportunities are plentiful as swimming facilities are fairly common in our society. For the amputee who wishes to enjoy aquatic activities, several options are available: <ol> <li> Swimming without a prosthesis </li> <li> Peg legs for use on the beach and possibly swimming </li> <li> Sockets attached directly to swim fins </li> <li> The utility or beach prosthesis used to ambulate on the beach but not for swimming </li> <li> The swimming leg worn while in the water<a></a> </li> </ol> Water skiing is another activity that can be enjoyed by amputees. Wheelchair sports have been organized for amputees, also. A rather detailed classification of degrees of disability has been developed to maintain fairness in competition for men and women. Competition is now commonplace in wheelchair basketball, marathon races, bowling, field events, table tennis, and archery; there are even international events. Special prosthetic adaptations have been developed for the lower extremity amputee who is interested in participating in the following activities. <ol> <li> Golfing—a rotor in the shank<a></a> </li> <li> Flying—portable hand controls and a special SACH foot<a></a> </li> <li> Boating<a></a> </li> <li> Horseback riding<a></a> </li> </ol> In the upper extremity, special adaptations may be necessary for certain activities. The standard terminal device may be used for given activities, especially in the case of the unilateral amputee. For other activities the amputee may find it more convenient to remove the prosthesis completely. By and large the ability of the bilateral upper limb amputee is dependent upon the strength and mobility of the residual limbs. For the upper limb amputee, M.D. Robb<a></a> has grouped activities into those requiring closed or open skills. When the environment or activity is highly unpredictable and constantly changing, open skills are needed to adjust to and/or regulate the environment. Closed skills are those such as swimming, bowling, and golf activities which are performed in a comparatively stable environment. Among the recreational activities for which adaptive devices have been developed are: <ol> <li> Rein bar for horseback riding<a></a> </li> <li> Special terminal device for fishing<a></a> </li> <li> Terminal device for bowling<a></a> </li> <li> Fletcher-Motis adapter for archery<a></a> </li> <li> Universal joint terminal device for golf<a></a> </li> <li> Additional devices adapted for hockey,<a></a> skiing,<a></a> and driving<a></a> </li> <li> Baseball glove terminal device for the unilateral below elbow (this has always been a popular item among teenage boys in our clinic)<a></a> </li> </ol> Swimming can usually be accomplished without prostheses and special appliances. However, it may require minor adaptations of stroke techniques, kick modifications and a special breathing pattern.<a></a> It should be apparent even to the casual observer that there are benefits to be derived from the use of secondary prostheses or adaptive devices by amputees. The physiological benefits will flow to the cardiopulmonary system as the result of the physical activity. However, there is another even greater benefit—the psychological uplift—realized by the patient who achieves new heights of pleasure, pride, and increased self esteem by participation in physical recreation and/or competition. This aspect is so important to the total treatment and rehabilitation of the amputee patient that we must educate clinicians and third party carriers so that ordering such devices will become routine for all who have the ability and desire to use them. Furthermore, third party carriers should pay for them as routinely as the standard prostheses. In this manner we can give our patients the opportunity to participate in and enjoy life more fully—the essence of rehabilitation. References: <ol> <li>Hamilton, R.C.: The juvenile amputee in athletics. Inter-Clinic Info. Bull., 6(1):1, 1966.</li> <li>Kegel, Bernice: Prostheses and assistive devices for special activities. Chapter 29, Atlas of Limb Prosthetics, American Academy of Orthopaedic Surgeons, St. Louis, C.V. Mosby, 1981.</li> <li>Racette, W., and Beraken, J.W.: Clinical experience and functional considerations of axial rotators for the amputee. Orthot. Prosthet. 31(2): 29,1977.</li> <li>Hughes, H. N. and Helmuth, G.: A modified prosthetic foot for pilots. Orthot. Prosthet. 29(1): 33,1975.</li> <li>Robb, M.D.: The dynamics of motor skill acquisition. En-glewood Cliffs, N.J., Prentice-Hall, Inc., 1972.</li> <li>Larkins, C: Horsemanship for the physically handicapped. Inter-Clin. Info. Bull., 9(7): 4-11, 1970.</li> <li>Sabolich, L.J.: An adapted fishing rod for arm amputees. Inter-clin. Info. Bull., 12(2): 13-15,1972.</li> <li>Kay, H.W.; Lewis, S.L.; and Steward, W.A.: A bowling device for bilateral arm amputees. Inter-Clin. Info. Bull., 9(7): 13-16, 1970.</li> <li>Bender, L.F.: Prostheses and rehabilitation after arm amputation. Springfield, Illinois, Charles C. Thomas, 1974.</li> <li>Redford, J.B.: Prostheses for hockey-playing upper limb amputees. Inter-Clin. Info. Bull., 14(6): 11-15,1975</li> <li>Stanek, W.F.: Report of the juvenile amputee ski program. Inter-Clin. Info. Bull., 8(9): 1, 1969.</li> <li>Wuttke, W.: New German foot-control system enables armless persons to drive. Rehabilitation World, pp. 12-13. Winter 1978-79.</li> <li>Shearer, J.D.; Buckner, M.L.; and Bowker, J.H.: Prostheses and assistive devices for special activities. Chapter 16, Atlas of Limb Prosthetics, American Academy of Orthopaedic Surgeons, St. Louis, C.V. Mosby, 1981.</li> </ol> <div style="width: 400px;">*Charles H. Epps, Jr., MD Professor and Chief Division of Orthopaedic Surgery, Howard University Hospital, Washington, DC </div> <div style="width: 400px;"></div> Page Number(s) 5 - 6 Year 1982 Volume 6 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1982_04_005/1982_04_005-1.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 Editorial: Special Prostheses Enhance Rehabilitation Creator An entity primarily responsible for making the resource Charles H. Epps, Jr., MD * https://staging.drfop.org/files/original/b226593ad4d658ae5abd8ff8f834848b.pdf 36ae121273f428280cbbd01d4ed8ba0d https://staging.drfop.org/files/original/0aebfe07b23f1c1385e5e11dabd23ab4.jpg 7b1f6e7332d2d1940d9f2014e8d0a872 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_001.pdf Text Any textual data included in the document <h2>Extra-Ambulatory Activities and the Amputee</h2> <h5>Drew A. Hittenberger, CP <a style="text-decoration: none;">*</a></h5> Extra-ambulatory activities and their use in the treatment of amputated individuals have received considerable publicity. Initially motivated by a personal drive for physical accomplishment, many patients have discovered unsuspected levels of performance. It is this high level of performance, combined with the sense of personal accomplishment, that has captured the public's attention. The purpose of this article is to examine the need for physical exercise among amputees in hopes of making such activities the norm rather than the exception in rehabilitation and daily activities. To better understand the physical limitations imposed on the amputee and their effect on exercise, the following areas will be discussed: <ol> <li> Need for physical exercise among amputees. </li> <li> Areas of limitation. </li> <li> Factors in extra-ambulatory prosthetic design. </li> </ol> <h3>Need for Physical Exercise</h3> The level of physical activity a person attains naturally affects his quality of life. This motivates a general public concern for physical fitness. The physically handicapped are no exception. In fact, to the younger, more aggressive amputee, the level of physical activity he is able to exert is critical. Today, despite this need for physical exercise, figures show that most amputees become limited in their ability to participate in physical exercise programs.<a></a> This disability seems greatest for the amputee who was active prior to amputation. Whether the patient was active prior to amputation or not, the end result is the same—inactivity. As one patient put it, "There are those of us in whom the spirit of physical exertion becomes tarnished ... it no longer becomes important to be so active. The effort is too much." While it is natural to decrease one's level of activity after amputation, some serious questions remain. Are the members of the rehabilitation team doing all they can to maximize the patient's level of activity? if everything is being done for amputees, why do so many continue to be physically inactive? Why do so many lose their ability to participate in physical exercise and lack the basic skills for sports activities despite the need for such physical outlets? Most patients lose their ability to participate in physical exercise programs not only as a result of amputation, but also, and perhaps more importantly, as a result of poor post operative care. <h3>Areas of Limitation</h3> There are many reasons why amputees are inactive, perhaps as many reasons as there are amputees. Age, level of amputation, and general physical condition of the patient are usually considered the primary reasons why amputees are limited. But the reason amputees are inactive, in the majority of cases, is not due to a physical cause, but to a lack of information. Not many people, including the rehabilitation team, know about extra-ambulatory activities. To illustrate this, examine the current level of rehabilitation. Presently, rehabilitation focuses most of its attention on a basic activity (walking), and once this minimal level of activity is achieved, assistance is usually discontinued. This in effect limits the patient's functional capabilities and discourages patient participation in physical activities. Stating that an amputee cannot participate in extra-ambulatory activities without knowing of the possibility is like asking someone a question in French without his knowing the language, and then saying "Look, I told you he didn't know the answer." A person needs to know how to do something or have knowledge about something before he can be expected to do it. The problem then, is not lack of ability, but lack of knowledge. If it is our purpose to increase the amputee's level of activity, a considerable amount of attention needs to be directed toward extra-ambulatory activities and the communication of this information. A recent survey on functional capabilities<a></a> discovered that of those amputees questioned, 60% currently participate in some form of sporting activity, indicating a definite desire on behalf of the patients to participate in physical activities. The most common activities (Table 1) are swimming and fishing, and the least common, due to discomfort, are running and walking long distances. During running, a substantial amount of irritation occurs because of the impact and the rotational forces within the prosthesis, which cause tissue irritation. Despite this irritation, however, amputees continue to run because running is a prerequisite for many other physical activities. The most active patients are young individuals whose amputation resulted from either congenital deformity or trauma. Sex and length of time since amputation have little effect on the patient's ability to exercise, while age and level of amputation play a definite role in determining functional ability.2 Other factors, including pain, social embarrassment, and lack of organized training programs, must also be considered. Table 1. Avocational Activities <img src="/files/original/0aebfe07b23f1c1385e5e11dabd23ab4.jpg" p="" />When asked about their prosthetist, 28% of the patients in the recent survey felt that their prosthetist knew about extra-ambulatory prostheses. However, of the prosthetists sampled, only 18% encouraged participation, indicating a high reluctance on the part of prosthetists. The reasons for this reluctance is not so much physical make-up, but, as stated earlier, lack of information. When making a prosthesis for extra-ambulatory activities, the prosthetist needs to have knowledge about the activity and must be able to design the prosthesis around the activity. Designing an extra-ambulatory prosthesis isn't easy. It often involves the incorporation of different materials and principals—a time consuming process. As one patient quoted his prosthetist when he was asked about extra-ambulatory prostheses, "'It is too much work and too much adjustment.'" Perhaps a reason why the level of physical activity is so low among amputees is the prosthetist's inability or unwillingness to design a prosthesis for extra-ambulatory activities. Despite the reluctance on behalf of the prosthetist, 6% of the patients sampled used special equipment for sporting activities while the remaining 94% either indicated a willingness to make do with their current prosthesis or were unaware of adaptive devices available to them. When informed about the existence of these devices, a majority asked why they had never been told about these prostheses before, indicating a need for additional information in the areas of prosthetic design, training programs, and support organizations. To make a patient more comfortable with his individual situation, he can often be directed toward meeting other amputees. Through this social interaction the patient can find support by sharing similiar situations with other amputees and by finding he is not alone in confronting the problems associated with amputation. Often it is this kind of support that can make the difference between the patient being successful or unsuccessful in obtaining his maximum potential. (For a list of organizations serving physically disabled persons interested in sports and recreation, see p. 7). <h3>Prosthetic Design</h3> Advances in prosthetics are based on two things: 1) patients' need for improved function, and 2) technical knowledge. Based on this need for improved function, advances in prosthetic components and systems will continue to be developed. Recently, with an increase in extra-ambulatory activities, prosthetists have begun to realize the need for extra-ambulatory prostheses. Some prosthetic innovations already exist,<a></a> but additional research is needed in this area. The most common activities requiring prosthetic modification are swimming, running, and skiing. Since each one of these activities is different, the prosthetist must design the prosthesis specifically for that activity. Swimming Of primary importance for a swimming prosthesis are: 1) its ability to hold up under water, and 2) its ability to float. A swimming prosthesis must be made out of waterproof materials. If not, special attention must be taken to seal any material that can absorb water such as wood or leather. When wood becomes wet, it swells and causes delamination. Regarding the question of buoyancy, the prosthesis must be able to float, yet give little resistance to immersion. If the prosthesis is too buoyant, the patient is unable to submerge the device while swimming, which can cause the prosthesis rather than the patient's head to be above the water. To solve this problem, some prosthetists have designed prostheses that fill with water, which solves the buoyancy problem associated with the use of foams. The only problem with this design is that the water also needs to drain out fairly rapidly and if it doesn't, the prosthesis will remain full of water or leave a trail of water in its path. Running As stated earlier, running is a prerequisite for most sports activities. Due to the rotational and impact forces on the residual limb during running, a considerable amount of attention is needed in this area. Of particular importance in the design of such a prosthesis is suspension. The prosthesis must be suspended securely so as to eliminate all or as much pistoning as possible. To do this, the prosthetist can incorporate a rubber suspension sleeve or a thigh lacer with waist belt. The thigh lacer aids in medial/lateral stability, and also decreases the rotational forces on the residual limb. Therefore, if the patient is extremely active, whether he has a short residual limb or not, it is recommended that a thigh lacer be used. As well as tackling the problem of suspension, the prosthetist also needs to consider the matter of interface/liner materials. The liner must be able to decrease the rotational forces inside the socket so as to eliminate friction. Conventional Kemblo®, leather, and Pelite® liners have been used in the past with little success. If the patient is extremely active or has residual limb problems caused by excess rotation, a silicone or sorbathane insert should be used. To further minimize the rotation inside the socket, the prosthetist can incorporate a rotator in the prosthesis. A Greissinger foot can be used to decrease rotational capabilities, and is strongly suggested for those patients engaged in physical activities. Skiing Various types of skiing prostheses have been made. Their designs have ranged from incorporating the prosthesis directly into the ski boot, to modifying the patient's existing prosthesis. What is of primary importance in either case is that one maximizes the patient's knee flexion and aligns the prosthesis so the patient's center of gravity lies in front of the ski boot. This is the section of the ski that initiates the turn and if one does not align the prosthesis so that the patient's weight is over the front of the ski, turning will be difficult. Depending on the patient's level of activity, knee stability and length of residual limb, the incorporation of a thigh lacer into a ski prosthesis may or may not be needed. A turn on skis is initiated by a varus or valgus movement of the knee. If the prosthetist incorporates a thigh lacer into a ski prosthesis, he is in effect limiting knee motion and making the ski harder to turn. Therefore, if the patient can do without a thigh lacer, let him do so, because it gives him more maneuverability. Before designing a prosthesis for a specific activity, it is critical that the prosthetist look at the functional ability of the patient and the specific activity, and then design a prosthesis around that activity. It is only through this process that the prosthetist can develop a prosthesis that satisfies the patient's individual needs. Ultimately it is the patient's individual needs that dictate prosthetic design. <h3>Conclusion</h3> Despite the limited amount of technical information available on extra-ambulatory activities, they have received a considerable amount of public attention. That attention must now be directed toward decreasing the physical limitations imposed on amputees. This can only be achieved through an increase in patient/team rehabilitation communication, improved prosthetic design, and direct therapy programs. It is only by such means that amputees can experience their true physical potential. <h3>Acknowledgements</h3> Appreciation is expressed toward Dr. Ernest M. Burgess,<a style="text-decoration: none;">*</a> Bernice Kegel, RPT,<a style="text-decoration: none;">*</a> and the staff of the Prosthetics Research Study Center for their assistance and cooperation in the preparation of this material. References: <ol> <li>Kegel, B.; Jeffrey C. Webster; Ernest M. Burgess, MD: Recreational Activities of Lower Extremity Amputees: A Survey. Arch. Phys. Med. Rehabil., Vol. 61, 258-264, 1980.</li> <li>Kegel, B.; Margaret L. Carpenter; Ernest M. Burgess, MD: Functional Capabilities of Lower Extremity Amputees. Arch. Phys. Med. Rehabil., Vol. 59, 109-120, 1978.</li> <li>Kegel, B. : Prostheses and assistive devices for special activities. Atlas of Limb Prosthetics, Surgical and Prosthetic Principles. American Academy of Orthopaedic Surgeons. The C.V. Mosby Company, 423-434, 1981.</li> </ol> Footnote Chief of Rehabilitation, Prosthetics Research Study Center, Seattle, WA Footnote Principal Investigator and Director, Prosthetics Research Study Center, Seattle, WA <div style="width: 400px;">*Drew A. Hittenberger, CP Director, Research Prosthetics, Prosthetics Research Study Center, Seattle, WA </div> <div style="width: 400px;"></div> Page Number(s) 1 - 4 Year 1982 Volume 6 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1982_04_001/1982_04_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 Extra-Ambulatory Activities and the Amputee Creator An entity primarily responsible for making the resource Drew A. Hittenberger, CP *