14 20 371 https://staging.drfop.org/files/original/a6792a109f39ee50864e3cdc534b4712.pdf 9841f910ceaf33e1e3f1cc6914edbe70 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_03_008.pdf Text Any textual data included in the document <h2>Survey Results</h2> Below are the summarized results of two questionnaires that appeared in recent issues of this publication. These results are important tools for observing, recording, and predicting trends within the Academy and the profession. Your responses are greatly appreciated, and we ask that you encourage your colleagues to send us their thoughts by answering the questionnaire in this issue (see p. 3), and those in future issues. <h3>Scoliosis Orthoses</h3> From the Summer, 1981 Issue, Vol. 5, No. 3 A total of six responses have been received. Two respondents were institutional facilities and the rest were private. The six reported fitting a total of about 757 patients last year, an average of about 126 per facility. The maximum was 400 patients and the minimum was 8. Not too surprisingly, the maximum was an institutional facility (Newington Children's Hospital). The most commonly prescribed orthosis was the Boston System, and among four of the respondents it accounted for the majority of orthoses fit. One individual reported that the Boston System accounted for 100% of orthoses he fit for scoliosis (actual number, 13); however, two of these orthoses had been modified by the addition of a super structure, and 3 with anterior uprights. Only one respondent reported using more than 50% conventional Milwaukees (60%) and this individual, practicing in the Southwest, stated that all had leather girdles as plastic girdles were too hot. He also reported using 35% Orthomedics SOS Systems, the only mention of this style orthosis in the survey. Interestingly enough, one respondent reported that 36% of his scoliosis practice was comprised of Raney Flexion Jackets prescribed by a neurosurgeon for treatment of scoliosis and as positioning devices. Only one respondent, Richard D. Koch, CO of University Hospital, Ann Arbor, Michigan, reported using a preponderance (90-95%) of custom molded TLSO Body Jackets and Low Profile Orthoses combined (actual numbers fit 120-125). The rest of his scoliosis practice was comprised of conventional Milwaukee braces. Mr. Koch comments: "Through school clinics and early screening for scoliosis the range of curves have reduced in degree of their severity. Consequently, we find that TLSO Body Jackets and Low Profiles are in wider use than CTLSO's." Newington Children's Hospital, mentioned earlier, reported using 75% Boston Systems and 25% custom molded TLSO's primarily for treatment of non-idiopathic scoliosis secondarily to paralytic diseases. <h3>Results of the Survey Concerning Endoskeletal Prostheses</h3> From the Winter, 1982 Issue, Vol. 6, No. 1 As of March 25, 1982: 27 responses <ol> <li>How many definitive endoskeletal prostheses does your facility fit a year?</li> </ol> <ol> <li style="list-style-type: none;"> <ul> <li> Total of 1,814 fit, an average of 67 per respondee </li> <li> Maximum of 380 </li> <li> Minimum of 0, second lowest 5 </li> </ul> </li> <li> Indicate the percentages of the type fit. While it is difficult to give precise figures, roughly speaking the same trend prevailed for all respond-ees. About 95-100% of Below-Knee prostheses fit were exoskeletal and 95-100% of Hip Disar-ticulation/Hemipelvectomy prostheses were endoskeletal. Above-Knee prostheses occupied some middle ground with many respondents reporting fitting more than 50% endoskeletal Above-Knee prostheses. Only four respondents reported fitting as many as 50% endoskeletal Below-Knee prostheses. These four tended to be among the most frequent users of endoskeletal prostheses reporting 380, 170, 75, and 50 respectively. </li> <li> Which Endoskeletal Prosthetic System was used most frequently? <ul> <li> Otto Bock 20 </li> <li> AFP 2 </li> <li> Both Otto Bock and AFP 2 </li> <li> Both Otto Bock and USMC 2 IPOS 1 </li> </ul> </li> <li> Do you consider endoskeletal prosthetic systems light enough? <ul> <li> 11 said yes </li> <li> 14 said no </li> <li> 1 said yes to AK's and no to BK's </li> <li> 1 said yes to AFP and USMC and no to Otto Bock </li> </ul> </li> <li> Do you consider them reliable enough? <ul> <li> 19 said yes, one of whom qualified his response by saying for adults and geriatrics only </li> <li> 7 said no </li> <li> 1 said yes and no </li> </ul> </li> <li> Are cosmetic covers and skins adequate? <ul> <li> 23 said no </li> <li> 3 said yes, one qualified his answer by saying only the AFP system </li> <li> 1 said yes and no </li> </ul> </li> <li> Do you consider it necessary to have full capability to modify alignment in definitive endoskeletal prostheses? <ul> <li> 11 said yes, one stating that the need for making changes in alignment as the patient's condition changed was an indication for prescribing an endoskeletal prostheses. One specified the use in temporary prostheses. </li> <li> 1 stated that he considered it desirable early in the patient's progress and unnecessary late </li> <li> 14 said no, one of whom indicated that he used the AFP system exclusively and revised 380 of them </li> <li> 1 ambiguous </li> </ul> </li> <li> How often do you make changes in alignment? <ul> <li> 7 said never </li> <li> 17 said occasionally, one of whom stated that he occasionally made changes early in the patient's progress and never in more advanced instances. </li> <li> 3 said frequently. One was the individual in #7 who identified the need for alignment changes as an indication for prescribing an endoskeletal prosthesis. </li> </ul> </li> <li> Would you consider it satisfactory to trade alignment modification capability for lightness and durability? <ul> <li> 22 said yes, one of whom qualified his position by saying not at the expense of the ability to interchange components. </li> <li> 5 said no </li> </ul> </li> <li> 10. What changes would you like to see made? <ol> <li> 11 specified improved cosmetic covers </li> <li> 4 specifically recommended a more durable cover at the knee, or a way to reinforce or prevent impingement at the knee. </li> <li> 3 recommended more work on hydraulic and pneumatic knee control units, one of whom mentioned a hydraulic foot. </li> <li> 2 mentioned a more secure system of maintaining alignment. </li> <li> 2 mentioned waterproof skin for covers One each: </li> <li> lighter safety knee </li> <li> improved strengh </li> <li> easier to operate and more cosmetic knee lock </li> <li> interchangeability of knee units without necessity of altering pylon tube length. </li> <li> easier and better attachment of cover to foot and socket for improved cosmesis, yet allowing removal for adjustment of alignment. </li> <li> reduction in weight of single-axis feet and ankles </li> <li> modular, removable, hip joint and pelvic belt m. more versatile socket for geriatrics to accommodate weight fluctuation and vascular problems </li> <li> incorporation of cable systems in upper extremity prostheses. </li> <li> durable covers easily donned by the layman </li> <li> easier access to the adjustment screws on top of the foot of the Otto Bock system. </li> <li> Covers such as those used on Hydra-Cadence, but they must look better and last longer. Preferably in assorted sizes." </li> <li> noise reduction (spring squeaks) </li> <li> system for small girls </li> </ol> </li> <li> Additional comments: <ol> <li> "The Otto Bock System was the best of both worlds (lightweight and adjustable) until the alloys and tubing were changed for increased strength. A main selling point of the endoskeletal systems has always been improved cosmesis. This may be true for standing and during the first few months post-delivery. However, the common foam cover system deteriorates relatively rapidly-cuts, tears, folds, and compression of the foam remain common problems. Therefore, I feel the foam covers need refinement." </li> <li> "I want full adjustability while aligning. After alignment on definitive prostheses the adjustability doesn't have much value." </li> <li> "In regard to question #7. Depending on patient indications two systems would be desirable; one fully adjustable in terms of alignment, the other lighter and more reliable." </li> <li> "Most endoskeletal prostheses are for AK female amputees." </li> <li> "In reference to question #4 and #5 above, of course they could be more reliable and lighterweight if they could redesign the system (Otto Bock, Ed's note). As it is, they are doing the best they can with what they have to work with (design)." </li> <li> "It is a good unit but needs improvement." </li> <li> "Endoskeletal is a poor excuse to charge more money. Shell replacement is too costly too soon. I'm afraid the dollar sign prevails and not the patient's welfare." </li> <li> "For below-knee amputees, I do not feel an endoskeletal system is any advantage. For the young, active above-knee amputee, the foam cover is not durable enough. For the hip disarticulation of any age, it is usually preferred, except in special cases." </li> <li> "The endoskeletal system should only be used in those cases where lightness is desired and where changes in alignment are anticipated." </li> </ol> </li> </ol> <h3>Questionnaire Summary Comments</h3> The article on endoskeletal prostheses provoked an astonishing and gratifying response, something of a record in size, in the recent history of this publication. A surprising total number of prostheses are reported fit, and endoskeletal prostheses occupy a significant total in many individuals' overall practice. In assessing the results of this survey, it would do well to bear in mind, however, that according to the statistics, we are primarily talking about prostheses for the higher levels (Above-Knee, Hip Disarticulation, and Hemipelvectomy) fabricated with Otto Bock components. This fact is particularly interesting when considered in light of the fact that below-knee amputees are undoubtedly far more common in most practices. Despite the numbers fit, it is apparent that the re-spondees were less than totally satisfied with the components available. While somewhat ambivalent about weight, and in general satisfied as to reliability, they were almost unanimous in judging cosmetic covers inadequate. Taking questions 7, 8, and 9 together, it would seem that most of the prosthetists replying would feel comfortable using an endoskeletal system that did not have full indwelling alignment capability if it were clearly superior in other aspects. This is noted in light of the proponderent use of Otto Bock endoskeletal components. The written comments and suggestions for change are presented, with few exceptions, in toto to provide more than simple statistics, and some inkling of the thoughts of the respondees. Taken in conjunction with the rest of the survey, they should provide food for thought to all and stimulus to action for designers and manufacturers. Page Number(s) 8 - 10 Year 1982 Volume 6 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Survey Results https://staging.drfop.org/files/original/dbe2ac19d37adf6c68bc2cc2d6d7a9ee.pdf bab704eb64cc2396fb9d10d50719dee6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_03_001.pdf Text Any textual data included in the document <h2>Continuing Education: Past, Present, and Future for AAOP</h2> <h5>Charles H. Dankmeyer, Jr., CPO <a style="text-decoration: none;">*</a></h5> In 1978 the American Board For Certification in Orthotics and Prosthetics, Inc. (ABC) and the American Academy of Orthotists and Prosthetists (AAOP) reached an agreement which provided that AAOP would administer the continuing education program begun by ABC. The program is very similar to its original format developed by ABC, and remains a voluntary program. The Academy is responsible for processing applications, developing the standards to be met by the participants, and developing a recognition system for successful participants. ABC continues to accredit appropriate educational programs submitted to it and to designate the number of continuing education credits awarded for each program. The reason the organizations reached this agreement is two-fold. First, since the continuing education program that ABC was administering had no effect on certification outside of deciding the number of credit hours to be awarded for each program, ABC believed it should not be providing recognition to successful participants in a voluntary continuing education program. Second, AAOP believed that part of its responsibility was education. Since AAOP was directly involved in providing seminars, it seemed appropriate that AAOP should administer a continuing education program and provide recognition for successful participants. It should be remembered that both groups agreed to the continuing education program being administered by AAOP only to the extent that it did not affect certification. It should also be borne in mind that AAOP has no influence on the number of credits awarded or the approval of programs for credit. I stress that any continuing education program developed within the Academy does not affect an individual's certification by ABC. This emphasis is made because this is an area of grave misunderstanding by Academicians. Many members believe that if an individual does not participate in the continuing education program, he will lose his certification. Such is not the case. Any program developed by AAOP will affect only the membership within AAOP and not an individual's certification. The certification of an individual and the continuing certification of an individual remains the province of ABC. At the 1981 AAOP annual meeting the membership voted to convert the existing voluntary continuing education program to a mandatory program. This move by the membership has caused AAOP to search for an acceptable system for mandatory continuing education. Many approaches to converting the existing voluntary program to a mandatory one have been examined. None have been deemed acceptable. There are many problems within the continuing program which could lead to injustices for Academicians participating in a mandatory program. One of the things necessary, if we are to have a successful mandatory continuing education program, is the capability for an individual to plan ahead in meeting his continuing education requirements. Currently, there exists no publication which permits an Academician to sit down and look at all of the seminars and special programs being put on by other paramedical groups which may be acceptable for continuing education. Even if such a publication were available, there would be no listing of the number of credits allowed for each of these programs. Many programs which may well be suitable for credit are never even submitted to ABC to be approved. Program organizers are often not concerned about the need of orthotists or prosthetists to meet continuing education requirements and therefore never submit their programs for approval by ABC. Therefore, AAOP cannot recognize an Academician's attendance at many of the seminars and programs that are given locally by therapists and physicians groups. Additionally, there are extenuating circumstances which affect some Academicians' attendance at seminars. For example, I received a letter from an individual who was concerned that his membership in the Academy would be in jeopardy because he was unable to attend seminars on Saturday. As you know, most seminars are held on Friday, Saturday, and Sunday. This particular individual is a practicing Orthodox Jew and is unable to attend any seminars held on the Sabbath. It seems to me that it is in the best interest of the Academy to attempt to develop a program which will accommodate all individuals and not require them to travel in order to participate in the continuing education program. Such a program would allow individuals several choices to meet continuing educational requirements. I would suggest that reading of the AOPA Journal, Orthotics and Prosthetics, and clinical participation be the two mainstay requirements to maintain membership in the Academy. In fact under the current continuing education program, Journal reading is an acceptable means of obtaining credit. How does one know someone has really read the Journal? Journal reading could be verified by providing a group of questions at the end of a selected article within each issue. Academicians wishing to participate in a continuing education program would complete the questionnaire at the end of the selected article and return it to the National Office for approval. Although such a system appears to be a very minimal requirement, it would demonstrate that participants had at least read Orthotics and Prosthetics. There is currently such a system being used in a publication entitled Contemporary Orthopedics. This should satisfy the needs of those individuals who are unable to travel to seminars. Those individuals who decided to travel to seminars and meetings should be allowed to apply for credit for seminars attended. Therefore, they would not need the credits earned by responding to the questionnaires. An additional alternative could be a self-assessment examination. This could be required every three years of individuals who had not participated in a continuing education program designed around Journal reading or seminar attendance. Such a self-assessment examination could be structured in a manner which reported back to the individual his results without affecting his membership in the Academy. At the very least it would identify areas in which an Academician needed work. It is difficult to imagine that the Academy would be telling an Academician that he needed to bone up on a specific subject, because Academicians are currently practicing orthotics and prosthetics. To say that an Academician required additional work in a specific area is to say that orthotists and prosthetists are providing inadequate services. This is the same tack which therapists and physicians have taken with their mandatory continuing education programs. In essence, all of these programs state that practitioners who do not fulfill the requirements of the program are not maintaining competency. I do not believe that this is the case for orthotists and prosthetists. I believe that most orthotists and prosthetists have met the challenge of modern day orthotics and prosthetics practice. I further believe that if we are attempting to require continuing competency, and not continuing education, we should change our goals. The goal of all continuing education programs is to provide that practitioners maintain current standards which will benefit their patients. No continuing education program requires that a practitioner who attends a program utilize the material presented in that program. In other words, you can make someone sit down and listen to a different way of doing things, but you cannot make him practice it. This being the case, I do not believe that a mandatory continuing education program is in the best interest of the Academicians or the patients we serve. I suggest that continuing education not be a requirement for membership in the Academy. I further suggest that those practitioners who believe the ranks should be periodically reviewed for competency expend their efforts on obtaining a mandatory continued competency system. Continuing education is indeed the route that all other medical professions have followed. Continued competency remains the burr in every medical profession's side. To develop a continuing education program and to require that individuals participate in such a program appears to be the route that we must follow. I personally do not agree that this is the correct route. However, such a program has been requested by the membership. Academicians, I request that you submit to me your thoughts on such a mandatory continuing education program as a requirement for membership in the Academy. *Charles H. Dankmeyer, Jr., CPO Chairman, Continuing Education Committee President, Dankmeyer, Inc. Baltimore, MD <div style="width: 400px;"></div> Page Number(s) 1 - 2 Year 1982 Volume 6 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Continuing Education: Past, Present, and Future for AAOP Creator An entity primarily responsible for making the resource Charles H. Dankmeyer, Jr., CPO * https://staging.drfop.org/files/original/6c0a91f3e6ca48a7d6eb71da9b638ef1.pdf 053df77f111f816175d9cd9b8a12a789 https://staging.drfop.org/files/original/56827526320afb7bc3726a24ed19a2e1.jpg 548798c301947254e31ac1fd04ba5be2 https://staging.drfop.org/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg 20141917fda2ff9c21dc4cd7f4f9579d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_008.pdf Text Any textual data included in the document <h2>Post Operative Management of Lower Extremity Amputees Using Tubular Elastic Compression Bandaging</h2> <h5>William M. Brady, C.P.O. <a style="text-decoration: none;">*</a></h5> <h3> Introduction</h3> Edema is inevitable in a postoperative limb and is a matter of concern to all who are involved in the postoperative care and rehabilitation of amputees. Persistent edema, that is edema that fails to subside over a period of weeks following amputation surgery, delays the rehabilitation process including the fitting of the definitive prosthesis<a></a>. Several systems of compression bandaging have been investigated and reported in various medical journals. These include soft dressings, pneumatic pressure sleeves, stump shrinkers, semirigid dressings, and rigid dressings with or without a program of early ambulation<a></a>. Of all of these systems, the most common one is the elastic wrap bandage<a></a>. It is readily available inexpensive, comes in a range of sizes and is washable. In spite of its advantages, however, its users are also aware that it is difficult to apply, doesn't maintain continuous pressure, must be reapplied frequently, cannot be reapplied the same way each time, and loses its compressibility after a few washings. Since the amount of external compression applied to the limbs seems to be a key factor in reducing edema, studies have been undertaken to define the "ideal" pressure. Some of the findings reported are as follows: <ol> <li> less than 5 to 10 mmHg of mercury is undersirable<a></a>; </li> <li> external pressure of 30 mmHg or greater decreased the venous flow rate of the leg<a></a>; </li> <li> external pressures above 25 to 30 mmHg, if sustained, may be potentially harmful<a></a>; </li> <li> pressures obtained from elastic wrap applied by skilled professionals ranged typically from 23 to 72 mmHg<a></a>; </li> <li> elastic compression to the lower limb markedly reduced the volume of the limb<a></a>. </li> </ol> <h3>Development of a Product</h3> Early in 1980 Knit-Rite, Inc.,<a style="text-decoration: none;">*</a> a manufacturer of prosthetic socks and stockinette tubing, initiated the development of a tubular elastic compression material that would be equal or superior to any compression bandage currently available on the market. Believing that such a product would have medical applications in the control of edema but uncertain of how it could be made to achieve the desired pressures and other characteristics, they contacted the Physical Medicine Department, University of Kansas Medical Center, for recommendations. Out of this inquiry evolved an amputee study involving 41 amputees, 35 below knee (B.K.) and 6 above knee (A.K.) and resulted in a paper entitled "Pressure Applied by Stump Bandages: A Comparative Study," by G. Varghese et al.<a style="text-decoration: none;">*</a> This study compared the elastic wrap, the Knit-Rite tubular elastic bandage and stump shrinker, and another brand of tubular elastic bandage. It supported some beliefs and established others: <ol> <li> Elastic wrap was the most difficult to apply. </li> <li> Pressures exerted by elastic wrap varied widely and the results were significantly different when applied by skilled and unskilled people. </li> <li> Elastic wrap failed to sustain constant pressures over a prolonged period of time and had a tendency to loosen with usage. </li> <li> Both tubular compression bandage products were more easily applied by patients and/or family members. </li> <li> More consistent pressure over a prolonged period of usage could be obtained with tubular elastic bandages. </li> <li> The Knit-Rite tubular compression bandage, when doubled, exerted a pressure which was in the "ideal" range, between 15 to 30 mmHg as measured by a solid state pressure transducer. </li> </ol> Actually, many changes in the product occurred during the course of this study.<a style="text-decoration: none;">*</a> Finally the acceptable tubular compression bandage was made available as a 10 meter Compressogrip® roll in a range of widths and lengths and as a stump shrinker item in a range of widths and lengths. The stump shrinker item is individually packaged and labeled with care instructions. <h3>Field Testing</h3> At the same time that the Kansas University Medical Center was conducting their research and continuing through the present time, Isle Orthotic-Prosthetic Services, of Kansas City, Missouri, was using the tubular compression bandage in the postoperative management of its referred amputee patients. Field testing was also conducted at a private prosthetics facility in the Kansas City area and at the V.A. Hospital. These findings, while empirical do confirm the results of the scientific researchers. The earlier a program of tubular compression bandaging is begun post-operatively, the sooner swelling will subside and tissues can be properly supported and correctly molded to a shape acceptable for prosthetic fitting. The correct size of bandage must be selected and patients or responsible family members instructed concerning the proper method of applying the tubular compression bandage and maintaining a controlled, total-contact fit throughout the period of wear. The recommendation, with the permission of the managing physician, is to wear the bandage 24 hours per day, except for bathing or during periods of muscle spasm, cramping or persistent pain. At least 2 to 3 bandages need to be supplied to the patient to allow for laundering. <h3>Selecting the Proper Size Bandage</h3> Care needs to be taken in fitting to insure that the width selected achieves adequate compression without overstretching the material (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>) and that the length selected allows for a double layer (<a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2</a>). Optimum compression occurs when the tubular compression bandage is stretched at least 50% but not more than 100% of the original width. For a B. K. amputee it is recommended that a circumference measurement be taken 2" below the medial tibial tubercle, and for an A. K. amputee, 2" proximal to the distal end. <a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a> Sizing Chart for Tubular Elastic Stump Shrinkers. <a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2.</a> Application Technique. Example: The measured circumference is 11 inches. From the chart (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>) we see that Size #3 is the correct size. The sizes #2 through #5 are approximately 2" through 5" in flat width. Thus Size #3 is approximately 6" in circumference and would best accommodate measurements from 9" to 12" in circumference. If the differential between distal and proximal circumferences, as in extremely tapered A. K.'s, is greater than 5", then the next size larger bandage should be selected to avoid overstretching the material and to insure ease of application. <h3>Applying the Bandage</h3> On a below knee amputee, apply the first layer so that the material extends approximately 3" proximal to mid-patella. Slide the nylon ring (supplied with and surrounding the bandage) forward until firm distal pressure occurs, then reflect the second layer over the first to no more than 1/2" proximal to the superior border of the patella (<a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2</a>). In this way, greater pressure is maintained distally than proximally. If necessary, excess material may be marked and cut off, folding inside the cut ends of the second layer to achieve a smooth edge; however, the cut edge may ravel. Different lengths are available to eliminate cutting as much as possible (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>). Have the patient flex and extend the knee to check the security of the bandage. Then have the patient remove and re-apply the bandage several times until you are confident that the technique is mastered. Good follow-up is an important part of patient management. We recommend that the patient be rescheduled at 2 to 3 week intervals to check the progress of the shrinkage. Remeasuring and recording all pertinent circumference and diameter readings can then be done. When measurements have stabilized and no appreciable changes are noted from the last visit, casting for the definitive prosthesis can be initiated. The same basic procedure can be followed with A. K. amputees, except that some A. K. amputees will require the addition of a modified garter belt or webbing suspension to minimize the tendency of the bandage to roll proximally. <h3>Summary</h3> Our observations concur with recent research which suggests that the process of controlling and reducing edema is accelerated by using the Compressogrip® tubular compression bandage versus the conventional elastic wrap. Further, our experience indicates that the shaping of soft tissues is enhanced and that the post-operative period required to prepare the patient's residual limb for the definitive prosthesis is somewhat shortened when a tubular compression bandage is used. We project that patients managed in this fashion will have fewer post-fitting problems that are related to additional shrinkage occurring in the first few weeks of prosthetic wear and that the incidence and/or severity of phantom sensation will be reduced as a result of the controlled compression of the Compressogrip® tubular compression bandage. References: <ol> <li>Mooney, V.; Harvey, J.P.; McBride, E.; and Nelson, R.S., "Comparison of Post-Operative Stump Management: Plaster vs. Soft Dressings", Journal Bone and Joint Surg., 53-A, March 1971.</li> <li>Sher, M.H., "The Air Splint: An Alternative to the Immediate Postoperative Prosthesis", Arch Surg., 108: 746-747,1974.</li> <li>Puddifoot, P.C.; Weaver, P.C.; Marshall, S., "A Method of Supportive Bandaging for Amputation Stumps", Br. J. Surg., 60: 729-731.1973.</li> <li>Islerwood, PA; Robertson, J.C.; Rossi, A., "Pressure Measurements beneath Below Knee amputation stump bandages: Elastic Bandaging, the Puddifoot dressing, and pneumatic bandaging technique compared", Br. J. Surg., 62: 982-986,1975.</li> <li>Manella, K.J., "Comparing the Effectiveness of Elastic Bandages and Stump Socks for Lower Extremity Amputees", Physical Therapy, 61, March 1981.</li> <li>Holloway, G.A., Jr.; Daly, Colin H.; Kennedy,D.; Chemosky, J., "Effects of External Pressure Loading on Human Skin Blood Flow Measured by 133 Xe Clearance", Journal of Applied Physiology, 40 April 1976.</li> </ol> Footnote Field, M., Manager, Textile Research and Development, Knit-Rite, Inc., Kansas City, MO 64141. Footnote Varghese, G.; Hindle, P.; Zilber, S.; Perry, J.; Redford, J.B., 'Pressure Applied by Stump Bandages: A Comparative Study', American Congress of Rehabilitation Medicine, Oct. 1980. Footnote Kansas City, Missouri 64141. *William M. Brady, C.P.O. President, Isle Orthotic-Prosthetic Services, Kansas City, MO <div style="width: 400px;"></div> Page Number(s) 8 - 10 Year 1982 Volume 6 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1982_02_008/1982_02_008-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1982_02_008/1982_02_008-2.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 Post Operative Management of Lower Extremity Amputees Using Tubular Elastic Compression Bandaging Creator An entity primarily responsible for making the resource William M. Brady, C.P.O. * https://staging.drfop.org/files/original/c3460a2dab08b833441c25bf7385221d.pdf 07ff006625669bcbaab152e35ddbab6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_007.pdf Text Any textual data included in the document <h2>Letter To The Editor: A Return To Research?</h2> <h5>A. Bennett Wilson, Jr. </h5> Thirty-seven years ago, with funds from the United States Government, the National Academy of Sciences initiated a research and development program in artificial limbs because amputees in Army and Navy hospitals expressed quite vociferously their dissatisfaction with the artificial limbs provided at that time, and because there had never been, in this country, any concerted scientific effort to solve the problems of amputees. Although the research program, funded until the late 1950's largely by the Veterans Administration, was not looked upon with favor by many prosthetists during its early stages, with the help of a few of the more progressive prosthetists and orthopaedic surgeons sufficient progress was made by 1952 to warrant the initiation of a formal education project at the University of California at Los Angeles, which set the pattern for the present education program in prosthetics and orthotics. The Department of Health, Education, and Welfare, about 1955, joined the VA in supporting research, development, evaluation, and education; orthotics was added to the mission in the late 50's; and progress continued to the point that by the early 70's nearly every aspect of prosthetics had been replaced by newer techniques and devices, and work in orthotics was progressing rapidly. Although it was, and is, recognized by many that further, continuing research was needed, the government agencies have all but abandoned research and development in prosthetics and orthotics, and as a result very few improvements have been introduced to the practice of prosthetics and orthotics during the last few years. This unfortunate situation has been brought about because of a number of factors: the decision by the National Academy of Sciences to withdraw from the program; reorganization by the VA in 1973 that resulted in transferring research and development responsibility from the Prosthetic and Sensory Aids Service to general medical research, and to conduct most of the research and development in VA hospitals; and an unbelievable proliferation in all government agencies of "red tape" required in awarding contracts and grants. During these 37 years, the prosthetics and orthotics profession has become healthy and strong, in part because the research and development program has provided a teachable body of knowledge and an education program that has produced a group of practitioners who are capable of communicating effectively among themselves and with other groups. Given this set of circumstances, it seems reasonable that the prosthetists and orthotists in this country should consider taking responsibility for research, development, and evaluation, and relieve the government of most of the responsibility it has assumed in this area for the last 37 years. Certainly a program administered by AAOP-AOPA could be more efficient and more effective than one administered by the government. One way to finance this undertaking is to include in the price of each new prosthesis and orthosis an appropriate percentage of the price to be set aside for the research program. This sum would, of course, be a legitimate business expense. The coordination and "clearing-house" functions would reside in the National Office, and R&D would be carried out in appropriate facilities and institutions. If properly managed such a program would have many obvious advantages, not the least of which would be improved patient care. Page Number(s) 7 - 7 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Letter To The Editor: A Return To Research? Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. https://staging.drfop.org/files/original/6438c2935f8cb41a327a7110da0804b6.pdf fed62d2cec4e0a2356a7a35ce7281034 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_006.pdf Text Any textual data included in the document <h2>Editorial: Prosthetic and Orthotic Support - The 1982 Budget</h2> <h5>Charles H. Epps, Jr., M.D. <a style="text-decoration: none;">*</a></h5> The past year has seen a series of legislative successes by the Reagan Administration in its efforts to reduce the federal budget. The budget for the current fiscal year totals roughly $720 billion of which almost $270 billion will go for defense and interest on the national debt. It is estimated that almost four out of five of the remaining dollars will go for entitlement programs. The balance comprises the part often referred to as the controllable budget and includes items such as high wages, veterans hospitals and medical research.<a></a> The experts at this point have been unable to fully sort out the impact of the proposed cuts but it is estimated that almost $20 million will be in health and human service programs. The cuts will not stop here as the Administration in September proposed another 12 per cent reduction in human services to offset the extra $25 billion budget deficiency caused by the personal income tax cut.<a></a> One does not have to be an economist to realize that the proposed changes will fundamentally alter the scope of federal programs, particularly health and human services. It also becomes apparent that prosthetic and orthotic services as well as training, research, and development in those areas will be affected. Historically, the level of federal involvement and support has been substantial when one considers that laboratories engaging in prosthetic-orthotic research were operated by the Army, the Navy and the Veterans Administration. The Veterans Administration alone and in parallel with other agencies has supported a number of projects with universities, industrial laboratories, and in recent years has sponsored intramural projects in Veterans Administration Medical Centers. The office of Vocational Rehabilitation and its successor, the National Institute of Handicapped Research, (NIHR), supported Rehabilitation Engineering Centers and projects throughout the United States. The budget reconciliation process has been utilized in the Congress to fashion this new reduction of the federal role. Funds administered through the NIHR vitally affecting prosthetic and orthotic research and training have been exposed to this budgetary process. The Appropriation Committees of the House and the Senate have reviewed this aspect of the budget. The programs for crippled children, which reach many children requiring prosthetic and orthotic devices, have not escaped budget cuts. Maternal and Child Health (MCH) and Crippled Children's Services (CC) have been consolidated into a block grant to the states under Title V of the Social Security Act. Included in this particular block grant are: supplemental security income for disabled children; lead-based paint poisoning prevention; sudden infant death syndrome; hemiphelia treatment centers, and adolescent pregnancy. The House-Senate Conference agreement currently under the continuing resolution provides for an authorization of $347.5 million for fiscal 1982 for the MCH block grant. This amount is 25 per cent less than the 1981 appropriation of $456.2 million. It is hoped that support will continue for valuable programs presently funded at least in part at CAPP in Los Angeles, the Area Wide Amputee Center in Grand Rapids, and at New York University. Presently there are five projects funded at a level of $1.3 million. It is proposed to accomplish a reduction of 77 percent to a level of $300,000 in fiscal 1982. These projects, considered an aspect of technology transfer, constitute an activity of vital national concern. A reduction of this magnitude (77 percent) will substantially impair the programs. These are areas where private initiatives and voluntarism cannot replace the federal support. The private sector has been unwilling or unable to support totally even the more glamorous and highly visible activities such as symphony orchestras, art and scholarship support. Prosthetic and orthotic projects pale by comparison in their ability to attract private support when compared to other highly visible programs. It remains, therefore, the task of each of us to write or wire our Representatives and Senators requesting support of action in the Appropriation Committees of Congress that will insure at least a continuation of the present level of support, if not an increase in the funding for prosthetic and orthotic research and training. The present level of funding will deprive patients of needed services and cripple the research and training efforts perhaps beyond recovery. References: <ol> <li>Editorial: "Who will Be Entitled?" The Washington Post, January 22, 1982, p. A14.</li> <li>England, M.J.: "The Health and Social Service Picture," Journal AMWA 36:350, 1981.</li> <li>"Health Programs Are Being Slashed," The Nation's Health, January 1982, p.1.</li> </ol> *Charles H. Epps, Jr., M.D. Professor and Chief, Division of Orthopaedic Surgery Howard University Hospital Washington, D.C. Page Number(s) 6 - 6 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Editorial: Prosthetic and Orthotic Support - The 1982 Budget Creator An entity primarily responsible for making the resource Charles H. Epps, Jr., M.D. * https://staging.drfop.org/files/original/600929dee45085ca12ad1bf2f58a604b.pdf 96ef868f6a75c4473d81d11010115943 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_001.pdf Text Any textual data included in the document <h2>Influence of Government Funding on Prosthetics Research and Development</h2> <h5>Eugene F. Murphy, Ph.D. <a style="text-decoration: none;">*</a></h5> Historically, tragically, warfare has been the major stimulant for the development of prosthetic devices. Much of the early history is traced in the introductory chapter of the Orthopaedic Appliances Atlas, Volume 2, published by the American Academy of Orthopaedic Surgeons in 1960. A fascinating source is the book Historic Artificial Limbs by the Italian surgeon Putti, published by Hoeber, New York, 1930, based upon the outstanding collection of artificial limbs in the Stibbert Museum at Florence, Italy. With that museum's distinguished collection of armor, it was perhaps natural that the byproduct of artificial hands, arms, and legs made by armorers for knights should also be assembled there. The story of the German knight Goetz von Berlichingen, commemorated in a drama by Goethe, stresses the knight's iron artificial hand. Surgery generally and amputation surgery in particular were developed by the French surgeon Paré in connection with the religious wars in France; a corresponding development of artificial limbs was done by a locksmith known as "le petit Lorrain." Very likely only the relatively well-to-do knights and nobility were able to afford these early prostheses, with common people left to relatively crudely carved prostheses or crutches as illustrated, for example, by Breughel. After the American Civil War, the government provided an allowance for artificial limbs for Union veterans. This financial incentive, plus the rapid increase of amputees from industry and railroads, led to great competition among private developers. In that era artificial limbs were essentially sold as commodities rather than fitted as professional services. Some interesting patents are cited in the Orthopaedic Appliances Atlas, Volume 2. In World War I, countries among both the Central Powers and the Allies carried on simultaneous attempts to treat their patients and to develop better methods of surgery and fitting. Work in the Central Powers, notably in German military hospitals and in the Technical University of Berlin under Schlesinger, an engineering professor, was covered in great detail in the classic book Ersatzglieder und Arbeitshilfen (Substitute Limbs and Work Aids) published in 1919. Florent Martin worked extensively in Belgium, developing relatively early methods of fitting of temporary plaster-of-paris sockets on pylons for amputation of the lower extremity. His work was recorded particularly well in his critical analysis, Artificial Limbs; Appliances for the Disabled, published by the International Labour Office at Geneva in 1924. Efforts in England, including development of the specialty of limb fitting surgeon and the standardization of mechanical construction of a series of light metal limbs for many basic levels of amputation, are described in E. Muirhead Little's book Artificial Limbs and Amputation Stumps, published in England in 1922. During World War I, the Artificial Limb Manufacturers Association (ALMA) in the United States developed rapidly to advance the industry and cooperate with the government. Its descendant, the American Orthotics and Prosthetics Association (AOPA), along with the American Board for Certification (ABC), and the American Academy of Orthotists and Prosthetists (AAOP) continue today to develop the profession. In World War II, the ALMA set up a small laboratory on the premises of the Rowley prosthetics facility in Detroit, under the name of the Research Institute Foundation. Its extremely limited financial and technical resources allowed very meager efforts. Late in the war, partly because of growing demands from servicemen and unfavorable publicity, the Surgeon General of the United States Army asked the National Academy of Sciences (NAS) and its operating arm, the National Research Council (NRC), to select and standardize the best artificial limb designs. At a conference in 1945, the only unanimous agreement seemed to be on the concept that the best was not too good and that further improvements were needed on all aspects. The Surgeon General then asked the NAS-NRC to organize a systematic program "to conduct with utmost dispatch research and development in the field of prosthetic devices." The resulting interdisciplinary Committee on Prosthetic Devices initially was financed by the wartime Office of Scientific Research and Development, then the Army briefly, and later the Army and Veterans Administration (VA) jointly. On July 1, 1947, it was reorganized as the Advisory Committee on Artificial Limbs to provide advice to other agencies which wished to conduct their own programs. The NRC committee structure underwent a variety of changes from 1945 to the mid-1970's but has now disbanded. AOPA-ABC-AAOP members were frequent members of committees, subcommittees, and technical groups in this structure. The Army, Navy, and Veterans Administration each operated a laboratory. The VA, initially alone and later in parallel with other agencies, supported a series of projects with universities, industrial laboratories, and, in recent years, particularly through intramural projects in VA Medical Centers. After a change in its basic laws, the Office of Vocational Rehabilitation or its successors, now the National Institute of Handicapped Research (NIHR), has supported an increasing number of Rehabilitation Engineering Centers and projects. In addition to stimulating a wide variety of basic studies on locomotion and arm and hand motions, phantom limb pain, and psychological aspects, and development of a wide range of devices for all levels of upper-and lower-limb prostheses, the total government-supported program became a major force in educational efforts and dissemination of information. The early suction socket schools brought together distinguished surgeons and prosthetists, teaching the surgeons about mechanisms and the prosthetists about anatomy and physiology, as well as fostering team work between the two professions, promptly involving therapists, and helping to upgrade the entire field. Follow-up of the early suction sockets led to organization of formal clinic teams. The suction socket certification program, operated by Orthopedic Appliance and Limb Manufacturers Association (OALMA) in conjunction with the NRC committee and recorded in the Veterans Administration, led to joint certificates and helped to pave the way for the founding of the American Board for Certification with its remarkable interdisciplinary board of directors. The suction socket schools led, in 1953, to organized university-level post-graduate education in prosthetics and later in orthotics. Frustratingly slow as development often seems, nevertheless in retrospect it would appear that numerous major changes in devices, techniques, materials, and management methods were made in this continuing program. Voluntary cooperation was the key element in holding together this loose confederation. Diverse disciplines, many government agencies, some private foundations, separate organizations, sometimes competitive interests, and strong personalities worked together for the improvement of the lives of the disabled. The fact that substantial government funding was available, though never on the scale needed for the awesome task of truly replacing human parts and functions, tended to minimize the importance of private funding for the research and development and even for the dissemination of results. One chronic problem, though, has always been the transition from a reasonably well-developed laboratory model with a very limited clinical experience on "professional" pilot wearers into a routinely available, commercially manufactured component available in high quality and at low cost to skilled and trained practitioners throughout this country and abroad for fitting to large numbers of individual patients. Some devices were purchased in modest quantities for field tests through the National Academy of Sciences itself in the 1950's or through the Veterans Administration Prosthetics Center after that group was organized in 1956. Typically, AOPA was asked to suggest a group of potential bidders to make proposals for tooling and for construction of some modest number of models needed for a wide scale field trail or evaluation. Because of fiscal restraints and practical problems, numbers of copies were usually smaller, and statistical validity was low. (Early attempts to interest other organizations lacking experience and distribution facilities in the prosthetics field had been frustrating and largely disappointing.) Typically, the manufacturer of the initial test models has evolved into the principal, if not sole, manufacturer of the final device-if indeed it proved to be successful in the field trials. The field has been so small that there frequently has been no room for multiple manufacturers of a single relatively complex device, although other versions with somewhat comparable yet somewhat different functions sometimes evolve in parallel. Field trials should refine not only the hardware but the prescription, fitting, and training techniques, the manuals, and the maintenance procedures. All participants in a clinic team become familiar with the new development. There has long been interest in stimulating private support of research and development, presumably based upon the results of fundamental studies conducted under government auspices. The government-supported program has sometimes received or purchased a few early test models of private inventions and has had its intramural or contract laboratories conduct studies with these test models, thereby providing a useful consulting service to the inventor or manufacturer which he probably could not readily obtain otherwise. This kind of independent evaluation may well become increasingly important under the medical device amendments in order to prove safety and effectiveness of new devices. In any evaluation, there are problems in simultaneously assuring competence without bias and in providing constructive criticism in useful form which can be applied to improving the device for all disabled. With the continuing and indeed increasing pressure upon government budgets, it would seem that the developers must increasingly come from private industry. Karl Vesper, the engineer and investment expert who organized the original Hosmer Corporation in the 1940's, was an early participant in the NRC and VA programs. He pointed out that as a private entrepreneur he could effectively estimate the potential strengths of competitors and their ability to develop and market new products within given time periods, so he could make his own choice of development expenditures wisely. Conversely, though, he could not predict what a government agency might do, particularly under political and other pressures. Though the existing government research and development projects are public knowledge, for example through progress reports published in the Bulletin of Prosthetics Research, private developments may well be "proprietary secrets." The net balance between these and other disadvantages and advantages for private development is hard to estimate. From the standpoint of the disabled of the world, one can only hope for a frank, friendly, and cooperative relationship between private entrepreneurs, government sponsors and regulators, government purchasing or using services at all levels, third-party purchasers, and the several professions concerned. *Eugene F. Murphy, Ph.D. Director, Office of Technology Transfer Veterans Administration, New York, NY Page Number(s) 1 - 3 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Influence of Government Funding on Prosthetics Research and Development Creator An entity primarily responsible for making the resource Eugene F. Murphy, Ph.D. * https://staging.drfop.org/files/original/d58593ef39362194114423665e739f0c.pdf fcbe907f83e666b1ec1ef034e62a0e0e 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_01_010.pdf Text Any textual data included in the document <h2>Professionalism Or What?</h2> <h5>John Sabolich, C.P.O. <a style="text-decoration: none;">*</a></h5> Editor's note: This article originally appeared in the September, 1981 issue of the AOPA Almanac. Mr. Sabolich has kindly given his permission to reprint the article so that it may be shared with a larger audience. Are you a professional? If so, how do you know? Our field is struggling with this question. There must be more to being a professional than wearing a white lab coat! Let's start with us, the Prosthetist or Orthotist. Sometimes the words that come out of our own mouths are the greatest obstacles to being fully recognized as professionals. We are engaged in advertising and are placed next to store ads in many publications that medical personnel read. We call our patients "customers," our lab and office a "shop" or "store"; our fee schedules are called "price lists." We go to hospitals to "sell our wares" without even charging a consultation fee! Prostheses and orthoses are called "appliances." (Does this sound professional, or like a washing machine and dryer?) We are called "low bidder" on contracts in which we need not even be involved. Maybe we would be happy to move up one more notch to a "vendor"! I hope we shudder at the term! There are other areas in which we could improve our professional status in the community, such as what we call our facilities. The words "artificial limb," "brace" or "shop" are not conducive to our professional status. We refer to a patient's leg or residual leg as a "stump," prosthetic socks are called "stump socks." Patients feel rushed in clinical or office situations. Interoffice conduct, such as loud talk in patient care areas, the manner in which we answer our phones, or allowing patients in the lab, all reflect on our professionalism. Seemingly insignificant things are important, such as parking areas that say "customer parking" instead of "patient parking." Yes, we present ourselves to the patient in many ways. One of the most important is the appearance of our front offices, reception areas and examination rooms. Many times there are items for sale or on display, even prostheses and orthoses. This does not make us look professional to the patient but rather gives our office a store front appearance and lends to uncomfortable and impersonal feelings. A professional practitioner should be opposed to anything or anyone who blocks patient care. We avoid calling the doctor if we disagree with prescription rationale, when the patient is the ultimate beneficiary. All medical as well as paramedical people must realize they are not the most important person in a clinical situation. It must be made clear, the patient reigns supreme! The patient and medical community could view us as paramedical professionals. In this setting, it can be better understood that payment is not being made for a "piece of plastic" but for expert knowledge, ability and education. The device itself only represents a contributing factor in designing and implementing an efficient and successful prosthetic and orthotic program. A prosthesis or orthosis is the only tangible thing the patient sees, therefore patients tend to equate the fee charged with the plastic object provided for him. When a doctor operates, does he charge $5000.00 for the $1.50 worth of cat gut? Again, this is the only thing the patient can actually see and feel. The public at large is not familiar with the terms "Prosthetics" or "Orthotics". It would force them to become educated to these more professional terms if, under Artificial Limbs and Braces, the telephone books across the country referred the public to Prosthetics or Orthotics in a cross reference. Suppose you are John Doe looking up artificial limbs in the yellow pages. You simply would not find it because you would be referred to the word Prosthetic. Think how far that would go on a national scale to educate people to these important terms. In Oklahoma we were able to accomplish this goal. The practitioners in this state all agreed to be moved to the more professional title and even reduce their listings to only three lines. We will all feel more professional this year! We must strive to increase our credibility by being more precise in our practices, turning away from the empirical and moving toward the scientific and quantitative approaches by increasing our support dramatically which can effectively increase our knowledge and technology. Our educational criteria must remain high. Board certification exams should remain comprehensive with lower level technical schools to supply the manpower. I realize that I am also guilty; yet if we care enough, we must attempt to correct these problems for ourselves, our profession and, most importantly, for the patients who seek our help. My fellow practitioners, I suggest to you, this problem lies with us; our attitudes, what we say, what we do. <h3>Acknowledgements :</h3> I express my sincere appreciation to these people for directly influencing the contents of this article. Steven D. Prock, CPO Michael T. Wilson, CPO Henry L. Schufletowski, CO William J. Barringer, CO Thomas Haslam, CO Alvin C. Pike, CP Charles Pritham, CPO Lester Sabolich, CPO Melvin Stills, CO Lorene Sabolich Lee Sabolich Karen Mondie Tina Prince *John Sabolich, CPO. Sabolich Inc., Artificial Limb and Orthopedic Appliance Co. Oklahoma City, Oklahoma Page Number(s) 10 - 10 Year 1982 Volume 6 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. 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Creator An entity primarily responsible for making the resource John Sabolich, C.P.O. * https://staging.drfop.org/files/original/f337a6d889d558b56f7603ac06e96231.pdf 26d6f3d8f69e84504a368e09c8b5db43 https://staging.drfop.org/files/original/4ba0e022e7651bf5a36b045a6168ac98.jpg 3ea9aebc91de4e8671fcea172dc4c9b2 https://staging.drfop.org/files/original/7b7fb17dbc1e54bd9317ab53fa1a6774.jpg f4b077a22c5f9973c9752101b7b664f0 https://staging.drfop.org/files/original/54f4c998ff0b12d9f2b0955afd658381.jpg 87e1bbb874cd86bc4295bc4da00c4375 https://staging.drfop.org/files/original/c87f8df1446c1a57754c6d380e1dc234.jpg e79dfcfb718efa0a42348f42453abbdd https://staging.drfop.org/files/original/aa356de1c97d7c797ba7399a8a358c73.jpg 9192c26c713613fe5afd6e6fcd9afb73 https://staging.drfop.org/files/original/4a16949b838f44f4b7bbfc854e44bbed.jpeg 84e45ae056e862a3d5e367fe7f109bbd https://staging.drfop.org/files/original/84863942578d92ee15a89ac6adee6168.jpeg dfae59cb8ee78783906dee0e5a97b696 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_01_005.pdf Text Any textual data included in the document <h2>Management and Construction Procedure of Bilateral Split-Bucket Type Hip Disarticulation Prosthesis</h2> <h5>Peter A. Ockenfels, C.P.O. <a style="text-decoration: none;">*</a></h5> Abstracted from an article that originally appeared in the June, 1968 issue of Orthotics and Prosthetics. The patient, a 37-year-old white male, received traumatic injuries while involved in an auto accident in October 1965. Both limbs were severely crushed, and very high amputations were necessary. The physical appearance of the patient resembled that of a bilateral hip disarticulation amputee; however, closer examination and X-rays of the patient revealed that femoral neck and head were present bilaterally. The remaining skeletal structures of the femurs are approximately 3" on the left and 4" on the right side (<a href="/files/original/4ba0e022e7651bf5a36b045a6168ac98.jpg">Fig. 1</a>). The patient was first hospitalized at the Allentown Hospital in Allentown, Pennsylvania, and then became a patient at the St. Vincent's Rehabilitation Center in Erie, Pa. There he received initial rehabilitation training and became ADL independent. On September 29, 1967 a prosthetic prescription for a definitive prosthetic unit was written. "Modified bilateral hip disarticulation prosthesis with modified plastic split hip disarticulation buckets for bilateral use, Northwestern stride control hip joints, single axis knee units with positive locks and SACH feet." The split bilateral hip disarticulation socket was prescribed with the hope that the patient would be able to advance one foot in front of the other and, consequently, walk with a semi-normal gait (taking full advantage of the remaining femurs). The stride control hip locks and positive knee locks were to give him stability during walking and stance. <h3>Taking of the Cast</h3> The negative mold of the patient's body was obtained by utilizing the Northwestern Type Four Point Suspension Technique. The patient was freely suspended approximately 3 feet off the floor in a double layer of 10" nylon stockinette and the body stocking conformed snugly to the patient's body (<a href="/files/original/7b7fb17dbc1e54bd9317ab53fa1a6774.jpg">Fig. 2</a>). The outlines of the prosthetic socket and all bony protuberances, such as the remaining femurs, the anterior superior iliac spines, the iliac crests, and the ischial tuberosities, were carefully marked with indelible pencil. Four inch fast setting plaster-of-Paris bandages were used for the cast. A rope of plaster-of-Paris bandage was pulled in deeply proximal to the iliac crests to supply suspension of the socket. After the plaster bandage was applied, the patient was lowered onto a stool until the ischial tuberosities were bearing moderate pressure and the patient's position was stable. Plumb lines on the anterior, posterior, and lateral midlines were drawn. The cast was then split anteriorly and posteriorly and removed from the patient's body (<a href="/files/original/54f4c998ff0b12d9f2b0955afd658381.jpg">Fig. 3</a>). <h3>Filling of the Negative</h3> The anterior and posterior openings were sealed and the negative was positioned on a table and all four vertical reference lines were aligned with a level. A 3/4" pipe was positioned and aligned with the four reference lines using a special holding device. The filling of the negative proceeded in the usual manner. After hardening of the plaster, the reference lines were punctured with an awl and marked on the top surface of the cast. The lateral reference lines were used to establish fictitious trochanters bilaterally. These trochanters were located 1 1/2" proximal from the distal end of the cast. A 45° triangle was cut from 1" thick plywood. The lines for positioning of the hip joints were marked by locating the plywood triangle exactly on the previously marked trochanters with the lower point anterior. The plaster-of-Paris bandage was then removed from the male mold. <h3>Modification of the Male Mold</h3> All reference lines punched with the awl were connected and retained. All marked bony protuberances were built up with plaster of Paris to approximately 3/8" to 1/2". Trimlines of the socket were drawn. These consisted of a proximal brim approximately 3/4" below the rib cage and anterior and posterior teardrop openings, 4" by 5", connected to each other distally by a channel 1 inch wide. The cast was then smoothed and the trimlines built up and molded to a flare of approximately 3/4" radius. This was for the patient's comfort. The mold was then allowed to dry in an oven for 24 hours at a temperature of 115°F. Then it was positioned in a vise exactly 45°, using a specially milled 45° steel positioning block so that the trochanteric reference lines were vertical. The alignment of both lines was checked with a plumb line. Two cardboard cylinders, 4" in circumference and 3" high, were taped to the cast, keeping the hip joint reference lines exactly centered. Both cylinders were covered on top, and only a hole the size of a quarter was left open on each cylinder through which the liquid foam was poured. <h3>Hip Joint Mounting</h3> The top of each block was cut square and level with the ground and as close to the mold as possible. The hip joint mounting reference lines were marked on the blocks, and both hip joints positioned. The outline of the base plates was marked, and the foam blocks were shaped to blend in with the entire cast. The base plates were attached with plaster of Paris, and the entire foam build-ups sealed with plaster of Paris. An extra build-up of plaster of Paris of approximately 3/4" thickness was provided over the entire seat area, which would later give space for a foam (silastic) seat pad. The cast was now air dried. <h3>Fabrication of the Socket</h3> The model was prepared for vacuum lamination, smoothed, lacquered, and a PVA sleeve applied. The first lamination consisted of four layers of 8" nylon stockinette and polyester resin (90% 4110 - 10% 4134). After this lamination was completed, the entire surface was roughened with coarse sandpaper and a reinforcement of nine feathered layers of fiber glass cloth and epoxy resin (C-8) applied over each hip joint attachment area. A final layer of three layers of stockinette and polyester resin completed the lamination process. The completed socket was removed from the model, cut to the trimlines, and all edges were smoothed. The foam blocks and plaster of Paris build-ups were carefully removed, and the entire cast smoothed, lacquered, and greased. The interior hip joint mounting plates were attached with two screws, leaving one screw hole and a 3/8" center hole open for injection of the silastic. The two half sockets were repositioned on the model and the silastic, 25% 385 and 75% 386, was injected into each side. After curing of the silastic the two halves were removed and the hip joints and thigh block installed. <h3>Alignment and Fitting</h3> The prosthetic feet were set up so that a reference line from the hip joints through the knee bolts would fall 2 1/2" posterior to the heel of the shoes. Subsequently during dynamic alignment this was increased to 3 inches. The height of the knee centers was set so that the patient would be able to sit in a normal chair with both feet flat on the floor (<a href="/files/original/c87f8df1446c1a57754c6d380e1dc234.jpg">Fig. 4</a>). Two cork seat blocks had to be added to the seat of the sockets to bring the patient up to a normal and level sitting position. A prelaminated flexible plastic tongue provided a closure of the anterior opening of the socket. Buckles and Dacron-reinforced leather straps were used instead of Velcro straps as the Velcro straps would be too inconsistent. The posterior opening of the socket was closed with a 4" by 6" by 1/8" Ortholene flexible hinge, so that the patient could walk with his semi-normal gait (<a href="/files/original/aa356de1c97d7c797ba7399a8a358c73.jpg">Fig. 5</a>). From the knee units, cables complete with housing and retainers were brought up laterally within easy reach of the patient's hands. For unlocking they hook onto small stainless steel hooks. The stride control hip locks were to lock automatically when the patient stood up. The patient is indeed able to ambulate, advancing consecutively one foot after the other. Ascending and descending stairs is accomplished by the patient hoisting himself on the banisters (<a href="/files/original/4a16949b838f44f4b7bbfc854e44bbed.jpeg">Fig. 6</a>, <a href="/files/original/84863942578d92ee15a89ac6adee6168.jpeg">Fig. 7</a>). After the patient became more skilled in ambulating, and due to the extreme stability, the hip stride control locks were removed and stride length control straps substituted, giving the patient a somewhat longer step. The patient was followed by the author for approximately two years, during which time he was wearing his prosthesis extensively. After one year he was fitted with a bucket-type prosthesis which was distally closed and not used as a split socket prosthesis. A platform was attached to this socket, and carpet rollers were used so that the patient could perform some mechanic's activities closer to the floor. He propelled himself with his hands, and used padded leather gloves for that purpose. *Peter A. Ockenfels, C.P.O. American Orthotic &Prosthetic Laboratory, Inc., Columbus, OH Page Number(s) 5 - 8 Year 1982 Volume 5 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-6.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-7.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 Management and Construction Procedure of Bilateral Split-Bucket Type Hip Disarticulation Prosthesis Creator An entity primarily responsible for making the resource Peter A. Ockenfels, C.P.O. * https://staging.drfop.org/files/original/0dd9f601769f60d4d41eff49c4f7e903.pdf 6083dd5dd381a8def8f92abd19065155 https://staging.drfop.org/files/original/67b2bb7011e7d4265c42e6b2743f583c.jpg 973338862e76956d2630ed5644e0145b 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_01_001.pdf Text Any textual data included in the document <h2>Endoskeletal Prostheses: Cause for Reflection</h2> <h5>Charles H. Pritham, C.P.O. <a style="text-decoration: none;">*</a></h5> American prosthetists have now accumulated a decade of experience with endoskeletal modular prostheses. In light of this experience, it seems logical to reassess the criteria and priorities that guided the development of this method of providing prosthetic care. If one were to choose two events more than others that marked the beginning of the "new era," they would have to be the introduction in the Fall of 1970<a></a> of the Otto Bock endoskeletal system and the convening in March 1971 by CPRD of a workshop entitled, "Cosmesis and Modular Limb Prostheses"<a></a>. Few are unfamiliar with the features of the Otto Bock system and they hardly need to be commented on here. Suffice it to say that the system undoubtedly represents the highest possible physical expression of the modular endoskeletal concept. The second development referred to, the CPRD workshop, is probably less familiar and merits closer attention, especially so since the report from the workshop states the philosophy of the endoskeletal modular approach to limb prosthetics. That philosophy finds its fullest and most concise exposition in the remarks of D.S. McKenzie, M.D.<a></a>, Table I. <img src="https://staging.drfop.org/files/original/67b2bb7011e7d4265c42e6b2743f583c.jpg" p="" width="503" height="296" />In other sections of the report, the CPRD workshop recommended improvements in cosmetic covers and prosthetic skins and development of endoskeletal upper limb prostheses employing center-pull cables and external power. Indeed, so sanguine were the attendees at the workshop about the future of endoskeletal modular limb prostheses that they essentially recommended that all future development be done in this context. Comparison of expectation with reality is very difficult in this situation as there is very little in the literature that describes field experience with endoskeletal modular prostheses. What information there is<a></a>, is largely anecdotal but it suggests that the problems encountered focus on weight and poorer durability than conventional exoskeletal prostheses. The upshot is that endoskeletal prostheses are fundamentally considered luxury items to be prescribed for light-activity, appearance-conscious wearers. Wider-spread acceptance has primarily occurred with hip disarticulation prostheses due to ease of fabrication and favorable weight competitiveness compared to conventional means of construction. It seems fair to conclude, therefore, that anyone who subscribed to the criteria developed in the CPRD workshop of 1971 would be disappointed with the rate of acceptance and continued improvements in endoskeletal prosthetic systems during the past decade. It is convenient to ascribe this failure to intransigent conservatism on the part of the third-party payers and of individual prosthetists. Perhaps a more proper explanation can be found in the precepts that shaped the development of the prostheses themselves. Endoskeletal modular prosthetic systems are intended by their very nature to encompass the needs of the vast majority of amputees. In effect, they represent a series of compromises: strong enough for all but the most punishing of patients and yet light enough for all but the most feeble of patients, etc. Anything or anyone who attempts to be all things to all men generally ends up satisfying no one. In this regard a fundamental fact about the nature of the amputee population needs to be acknowledged. The primary cause of amputation in western society is disease and this primarily affects the older age group. Comparison of amputee censuses<a></a> bears this out. Moreover, with declining birth rates and increased longevity, the age of the population in general is shifting to the higher decades. The one trend reinforces the other and we may confidently expect in the years ahead that even more of our patients will be 65 or over with circulatory disorders and multiple involvement. It is widely admitted that the needs of the geriatric amputee are different from the needs of the younger amputee. Sophisticated knee and ankle function become less important, and light weight, comfort, and ease of donning become more important. In effect, the nature of the amputee population and the precepts guiding development of prostheses have changed, but prosthetists and developers of prostheses have been slow to recognize the change. In part this is due to the fact that the needs of geriatrics are mundane and prosaic as compared to the challenge offered in designing a high performance, sophisticated prosthesis for a young vigorous user who uses a prosthesis maximally and thus offers maximum positive reinforcement to the designer. Another matter that deserves consideration is the concept that it should be readily possible by changing components or alignment to adapt the prosthesis to the changing needs of the amputee and that the same prosthesis that serves him 24 hours after surgery will still be suitable 24 months after surgery. Reference here is made to Table I where the different stages in the experience of an amputee are listed vertically and the various possible features of a prosthesis are listed horizontally. Advocates of the first viewpoint, such as D.S. McKenzie, would have it that at any given moment in the experience of an amputee, all possible features are present. Advocates of the second view would have it that for the sake of expediency, low weight, cost, durability, and other considerations, only those features absolutely necessary at any one stage of development would be present-in effect that form follows function. For example, while quick-disconnect of the pylon and foot from the socket is suitable and even necessary in an immediate post-operative prosthesis (I.P.O.P.), it is unnecessary and a possible source of trouble in a definitive prosthesis. An advocate of this second point of view might fill out the table much as it has been done. Central to this discussion is the question of what is an acceptable range of alignment adjustability at any one stage. Few would dispute that full range of alignment adjustability is necessary in I.P.O.P.s and temporary prostheses. Less unanimity greets the statement that it should be present in definitive prostheses. Some would maintain that it is not necessary in definitive prostheses and that, in any event, some range of adjustability (height, transverse rotation of foot, and in some cases, of the knee) is present and that this is all that is necessary in the vast majority of cases. They would further maintain that any increase in alignment adjustability represents an unacceptable increase in weight and decreases in reliability. Moreover, they would have it that should you have to change any of the other factors of alignment, something is so seriously wrong as to warrant starting over again completely from scratch. This second point of view is exemplified most strikingly in the Adaptive Fixation Prosthesis (A.F.P.) system of Medical Center Prosthetics of Houston, Texas. There is one final topic that merits discussion and that is the matter of cosmesis. Current techniques of providing cosmetic covers entail the carving of internal and external contours and are expensive and time consuming. Moreover, it is questionable as to whether or not the results merit the effort, as the covers for all levels of amputation are flimsy. For above-knee and higher, the one-piece covers inhibit function. Support hose currently used as prosthetic skins are even less durable, yet attempts to provide stronger skins have been defeated by the need to accommodate the extreme motion of the knee. (It remains to be seen whether it will be possible to devise successful one-piece cosmetic covers for above-knee prostheses with current technology or if we will eventually sacrifice some of the cosmesis of one-piece covers and adopt two-piece covers and improved durability.) Again, the work of Medical Center Prosthetics and their technique for foaming cosmetic covers in place are noted. In conclusion, it is possible to pose a number of questions: 1. Do available endoskeletal prosthetic systems meet the needs of the majority of amputees as well as do exoskeletal prostheses? 2. If they do, why are they not used with greater frequency than casual impression seems to imply that they are? 3. Is it desirable to use a common family of endoskeletal components at all stages of an amputee's progress post-amputation or can an increase in desirable qualities be achieved by more specifically matching the available components and the individual's progress? 4. Is it desirable and necessary to have full capability for alignment adjustability present in a definitive prosthesis or can some adjustability be sacrificed to decrease weight and heighten reliability? 5. If cosmetic covers were better than they are, would more endoskeletal prostheses be prescribed? Or is it that if more endoskeletal prostheses were prescribed, better cosmetic covers would be developed? The present group of endoskeletal systems (with one exception) can be considered as first generation systems. Extensive experience has been gained with them and it seems reasonable to assess this experience with an eye towards developing criteria for second generation systems. Further, it seems only just that those personnel who have day-to-day experience be canvassed in developing these criteria. References: <ol> <li>Below-Knee and Above-Knee Prostheses, Committee on Prosthetic Research and Development, National Academy of Sciences, Washington, D.C. 1973, page 21.</li> <li>Cosmesis and Modular Limb Prostheses, Committee on Prosthetic Research and Development, National Academy of Sciences, Washington, D.C. 1971.</li> <li>Wilson, A. Bennett, Jr., "Lower Limb Modular Prostheses, A Status Report," Orthotics and Prosthetics, Vol. 29, No. 1, pp. 23-32, March 1975.</li> <li>Kay, Hector W. and Newman, June D., "Amputee Survey 1973-74, Preliminary Findings and Comparisons," Orthotics and Prosthetics, Vol. 28, No. 2, pp. 27-32, June 1974.</li> </ol> <div style="width: 400px;">*Charles H. Pritham, C.P.O. Formerly Director, Prosthetic and Orthotic Laboratory, Rehabilitation Engineering Center, Moss Rehabilitation Hospital, Philadelphia, PA. Presently Manager, Snell's of Louisville, Louisville, KY</div> Page Number(s) 1 - 3 Year 1982 Volume 6 Issue 1 Figure 1 TABLE I http://www.oandplibrary.org/cpo/images/1982_01_001/1982_01_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Endoskeletal Prostheses: Cause for Reflection Creator An entity primarily responsible for making the resource Charles H. Pritham, C.P.O. * https://staging.drfop.org/files/original/7a7cd68d5bd0095b317a4f44affc0941.pdf d7e865477f5445c4a9c985354cc6bd99 https://staging.drfop.org/files/original/8f0c35d069948e0004acb926243104e3.jpg d66267d487f5ad7b5cb149ee357ca97d https://staging.drfop.org/files/original/153e5ba3b516d61a2c180b74512debd5.jpg 181b23a4816351a5231a249d74444720 https://staging.drfop.org/files/original/88f27d9100c85efdefc153a74675137b.jpg 81d4538609ad379bbc4a53f1a5928edc https://staging.drfop.org/files/original/f98e862183e5762fac48c707098889f5.jpg c474c3993fb68bf29c0fdae290d520fb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_015.pdf Text Any textual data included in the document <h2>Dynamics and the L3 Through L5 Myelomeningocele Child</h2> <h5>John Glancy, CO <a style="text-decoration: none;">*</a></h5> Since 1970, the orthotic management of myelomeningocele children treated at Indiana University has focused primarily on musculoskeletal deformities that develop after birth. Much of our effort has been directed to children with L3 through L5 lesions, because of their potential to be community walkers.<a></a> The decision to direct our attention to the problems that these lesion levels present also relates to the fact that they constitute the majority group among the myelomeningocele population. The range of orthotic dysfunctions, in kind or degree, that children with these lesion levels are prone to today, are identical to the orthotic dysfunctions that like youngsters had to endure in 1970. Myelomeningocele remains "the most complex, treatable congenital anomaly consistent with life."<a></a> What has changed, in the interim, is our understanding of the pathodynamics acting upon the musculoskeletal systems of children with L3 through L5 lesions. The introduction of thermoplastic materials, along with vacuum forming techniques, now allow orthotists greater freedom of design. Consequently, there is a gradual change occurring in orthotic management, from the traditional approach based upon statics, to a growing appreciation of dynamics as a means of preserving function by preventing the formation of secondary dysfunctions caused by gravity, growth, and time. How may one describe the benefits these changes portend for the L3 through L5 myelomeningocele child, present and future? It now appears that while present-day children with L3 through L5 lesions may have the same vulnerability to secondary dysfunctions as the children of 1970 . . . they may not have to endure them, in kind or degree. Those concerned with the care of these children face the same dilemma today as was experienced in 1970-how to provide long-term protection from secondary dysfunctions without introducing unacceptable inhibitions to daily activities. Fortunately, some of the specific challenges within the makeup of this dilemma have been satisfactorily met: <ul> <li> The polypropylene Solid-Ankle Orthosis<a></a> offers long-term protection to the foot/ankle complex. The Carlson, Berglund technique<a></a> adds to the efficiency of this orthosis. </li> <li> Lightweight KAFO's that utilize a unilateral upright with offset free knee joint, modified quadrilateral thigh cuff and dynamic knee extension assist<a></a> offer long-term protection to myelomeningocele knees. </li> <li> A polypropylene thoracopelvic unit<a></a> offers a promising foundation for achieving acceptable, long-term control of the trunk with L3 through L5 lesion levels, without having to extend the exoskeletal system below the anatomic hip joints (<a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Fig. 4</a>). </li> </ul> Since the 1976 report on the dynamic orthotic system was published,<a></a> we have refined the modular aspects of the system for two primary reasons: (1) To ensure that each component meets the requirements for which it is designed, i.e., providing no more, nor no less control than needed, and (2) To encourage the night use of the daytime system by the utilization of quick releases, in order to remove any components unrelated to the areas requiring night-time dynamic control (<a href="/files/original/8f0c35d069948e0004acb926243104e3.jpg">Fig. 1</a>). These modular refinements were also prompted by our recognition of a correlation between early application and night-time dynamic control, to success in the prevention of secondary dysfunctions. Due to the complexities of the pathodynamics involved, particularly in the hip complex and lumbopelvic regions, an efficient night-time unit must be equally as functional as the daytime unit, hence the economic necessity that a single system provide both day and night protection against secondary dysfunctions. <a href="/files/original/8f0c35d069948e0004acb926243104e3.jpg">Figure 1.</a> Features of modular system: (A) Assembled system for fitting: elastic components to knee and pelvic extension assist are not attached. (B) Modified quadrilateral thigh cuff; showing Nylon receptacle and locking nut for quick release of AK module. (C) Solid-ankle AFO with lateral off-set knee joint and pivotable attachment portion of knee extension assist assembly. Shockcord is not shown. (D) Thoracopelvic unit; receptacles for the quick release of the KAFO's and reinforcing horizontal bar are visible. Note: The combination polycentric and lateral motion joint shown in A. The lock joint shown in B is used for post-op cases. The importance of night-time use became even more evident with an awareness of the startling amount of regression that often occurs during short periods of time when the system is not worn. Rapid regression occurs with discouraging frequency about the hips and lumbopelvic regions especially. Such 'down time' often is more frequent within the three-to-six month periods between orthotic checkup visits than we understood to be the case. For example, in addition to the usual childhood diseases, colds, etc, these children are subject to episodes of kidney and/or bladder infection and periodic revisions to their shunts. The success or failure of the dynamic orthotic system appears to be proportional to the frequency and duration of these occurrences. Without an appreciation for the circumstances just described, orthotists will experience constant frustration as they seek explanations for the gradual regression their patients present, because they will unintentionally attribute the cause to often non-existent weaknesses in the design of a given orthotic system. The answer lies not only with better control of the hip and lumbopelvic regions, but also with constancy of control. We must be as persistent with our applications of biodynamics as nature is with the pathodynamics acting upon these regions. There are three needs that must be considered, which hopefully can be met by a single dynamic thoracopelvic design. They are: <ol> <li> A reliable method of eliminating jack-knifing of the trunk during ambulation without the use of locks. </li> <li> Control of the lumbopelvic and hip regions in a manner which does not require extensions to the lower extremities. The need to protect the growing child's lumbar spine when his gluteous maximum muscles are paralyzed, but his hips and/or knees do not require protection (L4 and L5 levels), has yet to be met. </li> <li> The controls in 1 and 2 above, must operate with the same efficiency during night-time wear as they do during the day, in order to reverse the inevitable regression resulting from unavoidable periods when illness prohibits wearing the orthosis. </li> </ol> Granted, these design criteria demand a major breakthrough in the state-of-the-art. Nevertheless, using our current thoracopelvic unit as a point of departure, an acceptable solution seems within our grasp. <a href="/files/original/153e5ba3b516d61a2c180b74512debd5.jpg">Fig. 2</a>, <a href="/files/original/88f27d9100c85efdefc153a74675137b.jpg">Fig. 3</a>, and <a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Fig. 4</a> show our progress to date. A resolution to this problem would have broad orthotic applications-it should be vigorously pursued. Our work on this project is ongoing, and we invite our readers' active participation. <a href="/files/original/153e5ba3b516d61a2c180b74512debd5.jpg">Figure 2</a>. (A & B) Sitting stability and comfort is enhanced by the flat, posterior surfaces of the modified quadrilateral cuffs, abduction motion and polycentric feature of the hip joints. (C) Posterior view: Thoracopelvic unit on casts with the new pelvic extension assist showing right rubber strap detached from the upright. (Note how the model has dropped on the right side.) (D) Side view showing how rubber strap attaches to upright. AK and BK quick releases and Delrin fitting for shockcord of the knee extension assembly. (E) Posterior view with both rubber straps of the pelvic extension assist attached to the uprights. (Note the horizontally level suspension of the cast, demonstrating the force the rubber straps generate.) <a href="/files/original/88f27d9100c85efdefc153a74675137b.jpg">Figure 3.</a> Most recent prototype: (A) Dacron straps with slide-bar buckles serve as a passive, adjustable 'pelvic band.' Puhient weighs 43 lbs. Each rubber strap is set to generate 14 force pounds equal to 62 inch pounds of extension moment which resists the first 20 degrees of forward flexion of the lumbar spine. Any voluntary forward flexion of the trunk beyond 20 degrees overrides the dynamic extension. (Note: Posterior polypropylene bar must be slotted at pelvic end (drawn in) to permit forward rotation of lumbar spine, as the dacron straps check unwanted forward rotation of the pelvis.) (B) Side view: Lock used for 2-3 months post-op. Dynamic extension is fully operative even with locks. Patient has 45 degree hip contractures, which explains posterior gap of thigh cuff in post-op alignment. (C) Anterior view: Note Nyloplex stud medial to hip joint which is the pivotal attachment point for slide-bar buckle. (D) Posterior view of Plastazote® lining showing the sealed 'pockets' at waistline level. Pockets are filled with #382 Elastomer. (E) Model shown in seated position. Although 28 force lbs. (both rubber straps) are acting to extend the lumbar spine when sitting, this force has no effect upon the lower extremities. (F) Bottom view: showing 'shelves' formed with the lining and filled with Elastomer via the pockets shown in photo D. Their effectiveness in transferring the weight of the thorax to the uprights is well demonstrated. This technique prevents pressure sores to insensitive skin. <a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Figure 4</a>. Schematic lateral view of normal lumbopelvic relationship to the horizontal. Shaded areas show the optimum sacral angle of 30 degrees, with respect to the center of the hip joint, during normal standing posture. The normal amount of postural lordosis resulting from the optimum sacral angle is also depicted. The unshaded outline shows the pelvis rotated 20 degrees about the hip joint in an anterior direction, taking the entire trunk with it, indicated by arrow in upper left. The downward oblique line, originating from hip center, indicates the maximum distal point (gluteal fold), relevant to the horizontal at hip level, which is feasible as an attachment point for passive pelvic control when fitting small children (see A & B, Figure 3). The arrow between the horizontal and oblique lines, to the right of the figure, demonstrates that beyond 20 degrees of forward rotation of the pelvis, the distal attachment point will rise above the horizontal. The contribution of the passive pelvic control, relative to forward rotation of the pelvis above the horizontal, is nil. However, the intimate fit of the thoracopelvic unit (especially the abdominal position) ensures that the optimum relationship between the lumbar spine and the rotating pelvis is passively maintained throughout the full range of pelvic A-P rotation. Consequently, any involuntary forward rotation of the trunk about the hips (within the first 20 degrees) can be controlled as a single body segment. The functional status of the abdominal and particularly the hamstring muscles, may be expected to be crucial contributors to the system's success. Unless the pelvis and lumbar spine can be passively placed in a normal standing posture to begin with, neither can be controlled in an upright position without locks. <h3>Acknowledgment</h3> I wish to express my thanks to John G. Patsko, CO, whose fine photography adds so much to the text. References: <ol> <li>Glancy, J. and R.E. Lindseth, "A dynamic orthotic system to assist pelvic extension: A preliminary report," Orthotics and Prosthetics, 29:1, pp. 3-9, March, 1975.</li> <li>Bunch, W.H., A.S. Cass, A.S. Bensman and D.M. Long, "Modern management of Myelomeningocele," Pub. Warren H. Green, Inc., St. Louis, 1972.</li> <li>Glancy, J. and R.E. Lindseth, "The polypropylene solid-ankle orthosis," Orthotics and Prosthetics, 26:1, pp. 14-26, March, 1972.</li> <li>Glancy, J., "A dynamic orthotic system for young myelomeningoceles: A preliminary report," Orthotics and Prosthetics, 30:4, pp. 3-15, December, 1976.</li> <li>Carlson, J.M. and G. Berglund, "An effective orthotic design for controlling the unstable subtalar joint," Orthotics and Prosthetics, 33:1, pp. 39-49, March, 1979.</li> </ol> <div style="width: 400px;">*John Glancy, CO John Glancy, CO., is Assistant Professor and Director of Orthotics in the Orthotics Division at James Whitcomb Riley Hospital for Children, Room 1100, Indiana University Medical Center, 702 Barnhill Drive, Indianapolis, Indiana 46223. </div> Page Number(s) 15 - 23 Year 1984 Volume 8 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 4 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-4.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dynamics and the L3 Through L5 Myelomeningocele Child Creator An entity primarily responsible for making the resource John Glancy, CO * https://staging.drfop.org/files/original/876ff6602d787cd8bb538c115168499b.pdf 4970b9dd38fb5c1f19b5d27c89c60acc Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_012.pdf Text Any textual data included in the document <h2>Orthotic Maintenance Program for the Myodysplastic Child</h2> <h5>Terry J. Supan, C.P.O. <a style="text-decoration: none;">*</a></h5> The faculty of the Southern Illinois University School of Medicine has been actively involved in a comprehensive, multidisciplinary approach to the management of the myelodysplasia child. Since the establishment of the orthotic clinic in July of 1982, a systematic approach to the orthotic-physical therapy needs has proven successful in providing a higher degree of function and fewer complications for these patients. The purpose of this article is to inform the reader of the appropriate orthotic involvement and the high degree of orthotic maintenance which is necessary for this type of patient. By describing the experiences of Southern Illinois University School of Medicine, it is hoped that the reader will gain a more realistic understanding of the orthotist's role in this situation. The types of orthoses run the full gambit from a simple UCB foot orthosis to a complex reciprocal gait orthosis. A consistency with these patients is that as children they develop at a normal rate. A second point with these children is the fact that without orthotic management, effective ambulation would not be possible. Higher levels of lesion necessitate a greater amount of orthotic management. When you combine an intimate fitting plastic orthosis with growth, you can understand the necessity for continuous maintenance and adjustments of their orthotic devices. A regular system of return visits is necessary. The relationship of the myodysplastic child to the orthotist is similar to that of a patient to their general practitioner. They are seen on a routine basis, unlike the medical specialists who only see a patient a limited number of times. This should be kept in mind if an orthotist is considering the possibilities of becoming involved in myodysplastic patient management. An orthotist involved with a clinical practice of scoliosis can associate the nature of their spinal practice with the ambulatory myelominengocele practice that we have developed at SIU School of Medicine. The repetition of clinic visits is very similar to that involved with scoliosis. However, there is an increase of time involvement with the child to make growth adjustments and maintain proper fitting plastic orthoses necessitated by the insensate skin in these children. If a CTLSO is improperly adjusted, it may affect the outcome of the scoliosis treatment, but it will not effect the activities of daily living of the individual. An improperly fitting RGO severely decreases function. Orthopaedic involvement with the myodysplastic child starts within the child's first few days of life. There is a high incidence of associated scoliosis, kyphosis, hip dysplasia and clubfoot deformities. Therefore, the infant must be continuously monitored. If any of these conditions exist, early orthotic intervention may be used effectively. Maintenance devices such as the Pavlik harnesses, thermoplastic TLSOs, and serial casting for clubfeet have all been used effectively. When the child reaches nine months of age, plans for ambulation are considered. If a resistant clubfoot exists, it is dealt with by surgical intervention at this time. A one stage Turco<a></a> procedure is accomplished with post surgical maintenance in an ankle-foot orthosis.<a></a> During this time period, if a dysplastic hip is also prevalent, bilateral molded knee orthoses connected with a spreader bar to maintain the hip in abduction and internal rotation are used. Since the ninth month is the milestone period for standing in the normal child, use of a parapodium<a></a> is considered. Because of the growth spurts which normally occur during this same time period, consistent monitoring of applied devices is necessary. The ankle-foot orthoses must not impinge on either the calcaneous, navicular or metatarsal heads. Proper knee and hip locations in both the knee orthoses and the parapodium must be checked. Children in these devices should return to the clinic or the orthotist every three months. Since the development of the reciprocal gait orthoses,<a></a> children with a thoracic level mye-lominengocele are now candidates for ambulation. This is only possible with aggressive orthopaedic and physical therapy management. Full range of motion of the paralyzed extremities and prevention of flexion contractures of the hip, knee, and ankle is necessary if effective use of the reciprocal gait orthosis is expected. If a dislocated hip exists unilaterally, which would impede the function of the orthosis, surgical intervention would be necessary prior to use of the RGO. Our experience has shown that twenty-four months of cognitive development is the ideal time frame for training of the reciprocal gait orthosis and fitting thereof. Prior to this milestone, communication with the child and the necessity of multiple adjustments to the orthosis limits the effectiveness of the RGO. Once it is determined that a child is a candidate for reciprocal gait ambulation, an extensive physical therapy program is initiated to improve upper extremity strength and increase standing balance. When the child is initially fitted with an orthosis, it is left in the adjustable state as recommended by the development team at Louisiana State University. Extensive post-fitting physical therapy is necessary. During the first week of physical therapy the orthotist repeatedly checks the device so that optimum orthotic ambulation can be achieved. Subtle adjustments of the cable housing length and hip joint locations can mean a difference between an ambulator and a nonambulator. After one month's use of the reciprocal gait orthosis, the correct location of the hip joints and cable should become evident. At that time the hip joints and knee joints can be attached on a more permanent basis. Because of the necessity of numerous adjustments on a growing child, screws instead of rivets are used. High strength Loctite® is used to prevent loosening of the screws. The child returns to the orthotic clinic one month after permanent attachment of the side bars to the RGO. Subsequent to that visit the child is seen every two months for the first five months. Thereafter return visits are decreased to four times a year. The physical therapy routine also diminishes as independence in use of assistance devices is decreased. Initially the child is seen on a daily basis for two weeks. Thereafter, a weekly therapy program is established. As the child progresses from parallel bars, to walker, to forearm crutches, it is no longer necessary to maintain a continuing outpatient physical therapy treatment. Parents and teachers have successfully been taught to monitor the fit of the devices and the ambulatory status of the patient. Periodic physical therapy evaluation for gait deviation prevention is all that is necessary. Growth adjustments and routine maintenance of both the reciprocal gait orthosis and parapodium are accomplished at approximately four month intervals. The use of the pop rivets on the parapodium, make it a relatively easy task to increase the distance between the floor and knee and hip centers. Increases up to one inch between each joint center can be accomplished before the tubular structures of the parapodium must be replaced. Since children are removed from the parapodium at age two, it is only necessary to maintain one size in stock. Because of the presence of static hip and knee joints in the parapodium, the exact alignment of anatomical/mechanical joint centers is not critical for standing. However, if the joint assemblies are extremely malaligned, they will cause impingement during seating. Because of the relative newness of the program, the first child fitted with the RGO has not had to have a replacement of any major component of the orthosis. However, since we are approaching the twenty-month time period, it appears that future replacement of the plastic sections of the KAFOs will be necessary. A review of the adjustments made for growth indicates that the first length corrections were between the knee centers and the ankles. Subsequent growth adjustments were made between the hips and the knees to improve seating comfort. Seating discomfort seems to be the first indicator of improper positioning of the hip joints. Maintenance of the devices have included replacement of Velcro® straps because of wear, replacement of the anterior cable due to breakage at the point of connection between the cable and connector to the hip joint, and the replacement of two thrust bearings in one hip joint. One child also has had the metal pelvic band increased in diameter secondary to pelvic growth. Although the metal pelvic band makes the orthosis heavier and cannot be as form-fitted as the thermoplastic pelvic section, it does have allowance for pelvic widening. In cases of pelvic obliquity, lumbar scoliosis, or lumbar kyphosis, a thermoplastic pelvic section is mandatory. There have been no increases in the maintenance of the thermoplastic versus the metal pelvic band. Because of longitudinal growth between the calcaneous and the malleoli, several of the children needed adjustments in the malleoli area of the ankle-foot section of the orthosis. This is accomplished by localized heating and expansion of the carbon inserts and the polypropylene material. Care should be taken not to overheat the materials. Initial assessment of the ambulatory program for thoracic level myelominengocele children at SIU has been favorable. All parties concerned-the clinic team, the parents, the funding agencies and the children themselves- seem to have accepted the program quite readily. Objective data cannot be determined on such a short range program. Only until such time as multiple years of experience has been gained in several centers will the determination of the cost/benefit ratio prove the worthiness of this program. Subjectively, however, the children seem to be much better off than they would be otherwise. In our own program, four children with spina bifida are in the pre-parapodium stage (younger than nine months). Seven children are in the preambulatory, parapodium stage of growth development. Two children are awaiting fitting of their orthoses pending authorization from state funding agencies. Eight children have been fitted with the reciprocal gait orthoses with wearing time ranging from twenty months to one month duration. Each of these children are followed on a three-month basis by the clinic team with subsequent visits to the orthotist for adjustments. No major deformities or pressure sores have developed on the children who are in the program during this time period. Urinary tract infections and stress fractures have been reduced in the patients fitted with the reciprocal gait orthoses, although every child in the program has had at least one long bone stress fracture prior to being fitted with the reciprocal gait orthoses. In summary, we have shown at SIU School of Medicine that a comprehensive team approach to myelomeningocele should include a program of ambulation for the thoracic level myodysplastic child. With a routine return visit program and follow-up adjustments on the orthotic devices, no major complications have arisen in the system. The use of pop rivets on the parapo-diums, and screws for attachment of side bars on the reciprocal gait orthoses, have contributed to the ready availability of adjustments to the devices. Although there are increases in time constraints involved in dealing with this severe level of disability, the program has subjectively proven to all concerned that this present technique for spina bifida management has proven successful. <h3>Acknowledgments</h3> The author wishes to thank Roy Douglas, C.R, and Carlton Filiauer, C.P.O., for their development of the RGO, and to acknowledge Barbara Sullivan, R.P.T., and John M. Mazur, M.D., for their assistance in the development of our program at Southern Illinois University School of Medicine. The assistance of Melenie Boiser in preparing the manuscript for this article is also acknowledged. References: <ol> <li>Turco, D.J., "Resistant congenital clubfoot (1979), A one-stage posterior medial release with internal fixation: a folio wup report of 15 year experience." Journal of Bone and Joint Surgery, 61A:805- 814.</li> <li>Supan, T.S., Mazur, J.M., and Johnson, B.S., "Postsurgical Orthotic Management of Resistant Clubfoot," 1984, AAOP National Seminar, Orlando, Florida, to be submitted for publication.</li> <li><a href="http://www.oandplibrary.org/al/1971_02_036.asp">Motlock, W., "The parapodium: an orthotic device for neuromuscular disorders." Artificial Limbs, 15, 13-17, 1971.</a></li> <li>Larson, Paul and Douglas, Roy, L.S.U. Reciprocating Gait Orthosis, Durr-Fillauer Medical, Inc., Chattanooga, TN, 25, 1983.</li> <li>Yngve, David, Douglas, Roy, and Roberts, John, "The Cable-Type Reciprocator's Gait Orthosis in Myelomeningocele," Developmental Medicine and Child Neurology, 25:116-117, 1983.</li> </ol> <div style="width: 400px;">*Terry J. Supan, C.P.O. Instructor, Division of Orthopaedics and Rehabilitation, Prosthetic/Orthotic Services, Dept. of Surgery, Southern Illinois University, School of Medicine, P.O. Box 39265, Springfield, Illinois 62708. </div> <div style="width: 400px;"></div> Page Number(s) 12 - 14 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Orthotic Maintenance Program for the Myodysplastic Child Creator An entity primarily responsible for making the resource Terry J. Supan, C.P.O. * https://staging.drfop.org/files/original/16eacc2e24fa11ba24117d1fb85c931c.pdf de0c0a58e9193f24569f1c879ad120b2 https://staging.drfop.org/files/original/606a6c31866c4d006f77d0445e543cae.jpg f4ab710fe6f916f4722e405866dc107d https://staging.drfop.org/files/original/91cd0ddfaca05e2bdc88e8aef7411353.jpg 7a64b2419fe01ec7ad868c5979c7bfa3 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_009.pdf Text Any textual data included in the document <h2>Orthotic Philosophies of Treatment</h2> <h5>Wallace Motloch, CO <a style="text-decoration: none;">*</a></h5> In situations when a medical condition places a physical limitation on a growing child, the orthotic treatment and devices are aimed at minimizing that limitation. Through the combined knowledge and skills of the orthotist, medical team, and family, as well as the child, the orthotic program maximizes that child's assets. To illustrate how the various aids and braces work within the orthotic program, one can compare the developmental milestones of a child with normal body to that of a child with spina bifida (<a href="/files/original/606a6c31866c4d006f77d0445e543cae.jpg">Fig. 1</a>). As the developmental need for sitting, crawling, and ambulating is encountered, an orthotic device is introduced to the spina bifida child who cannot accomplish these tasks well. Depending on the availability of funds and clinical resources, the orthotic care may start at infancy with the fabrication of devices for safe handling of the newborn, modifying equipment for play, bathing, and safe transportation. The orthotic involvement continues for the rest of that person's life as various braces for ambulation, support of the spine, contracture management, and general development of a lifestyle are designed and manufactured. <a href="/files/original/606a6c31866c4d006f77d0445e543cae.jpg">Figure 1</a>. Comparison of the developmental milestones of a normal child to a spina bifida child. As the children progress from one developmental milestone to another and their needs change, so must orthotic devices. Often these needs overlap, calling for a "wardrobe" of devices (<a href="/files/original/91cd0ddfaca05e2bdc88e8aef7411353.jpg">Fig. 2</a>). To illustrate this point let's imagine a person developmentally ready to crawl. To accomplish such exploration safely one will best be served by a wheeled device called a Caster Cart. While the Caster Cart is not a brace per se, it provides a vital part of the program by helping in a way that no brace or wheelchair can. It allows the child to move around safely, positions him close to the floor, allows for retrieving playthings from the floor, and it aids in "hand-free" sitting. <a href="/files/original/91cd0ddfaca05e2bdc88e8aef7411353.jpg">Figure 2</a>. Wardrobe of devices for a child who is ready to stand and ambulate (brace and walker). At the same time, the child retains a Caster Cart for exploration and Body Jacket for support of collapsing spine. Even though the Caster Cart has so many advantages, many parents are hesitant at this juncture, primarily because they imagine braces or some other bionic devices as restoring greater normalcy to their children. The orthotist must be very aware of the great pressure that drives the parents. They are desperate to do something! They are anxious to get the child into the best braces. They want to see the child up and ambulating. They want to see what it will be like—and that is the most normal behavior of any person. The orthotist must be compassionate at this point. He must know the dynamics of this situation. This is the most crucial moment in the parent-orthotist relationship; it will set the stage for many future meetings and achievements. Having seen several hundred Spina Bifida children and their parents go through this stage, personally I believe that not one but three devices are in order: a Caster Cart, Standing Brace (It should be pointed out here that the name "Standing Brace" is a misnomer as the device facilitates much more than standing), and Parallel Walker. The reason that this combination works the best is that crawling is very quickly followed by standing and ambulation. Oftentimes these are not demarcated clearly, and as the functions are accomplished, the devices continue to be used in an overlapping fashion—so why not have all three at once and let the child dictate the progress. While the actual design of braces can vary at this stage, as long as the child is upright safely and can stand "hand-free," the purpose is achieved. As the child gets older (two to three years), another crucial bracing decision has to be made. It has to be decided if the child is capable of ambulating with a reciprocal gait (one leg in front of the other) or whether he/she must ambulate by swing-to, swing-thru, or pivoting. It has been my experience that whenever possible the Reciprocal Gait Brace (Dual cable type) should be considered, as it has particular importance for the Spina Bifida person. The Reciprocating Gait Brace (RGB) is a dynamic orthosis unlike any conventional device made. It provides: <ul> <li> Standing Balance and Support: Wearers can have their hands free for activities of function while standing. </li> <li> Automatic Hip Joint Locking: This provides for ease of locking the brace with hands on crutches or walkers. </li> <li> Efficient Ambulation: Compared to conventional orthosis, RGB was tested (distance walked with same increase in heart rate) to be two to three times more efficient. This saves energy for people with muscle weakness, and for people likely to gain weight, it encourages more physical activity. </li> <li> Dynamic Hip Reciprocating: The special hip mechanism couples the hip joint motion so that flexing of one side causes forced extension of the opposite side (a mechanical hip extensor). This function facilitates walking, but in people prone to hip flexion contractures it also stretches the hip contractures with every step. </li> </ul> Around the age of ten another crucial decision comes up: the use of the wheelchair. There are many reasons for this. A few are: lack of physical strength for ambulation, cosmetic appearance and peer pressure, ease of assistance from others and general convenience of getting around. Many people with Spina Bifida find that ambulation in braces becomes quite energy consuming and that in the school setting in particular, it makes the carrying of books inconvenient. Many slowly, but surely, drift to greater use of the wheelchair. They find that their shorter stature in braces doesn't serve them as well as the sitting posture in a wheelchair. Also, it is harder for them to get help from others now that they are bigger and heavier. When need for assistance arises, say to go up ten steps, it is harder to help a brace wearer than a wheelchair rider. In any case, because many people choose a wheelchair in addition to, or instead of, braces, the orthotist stays involved in design and fabrication of special pressure sore prevention aids like contoured seat cushions and Suspension Body Jackets. Unfortunately, for many spinal cord injured teenagers and adults we do not have braces that can compete effectively with the wheelchair's efficiency and convenience. As things are, while there are a fair number of devices to choose from for the under-ten-years-old group, the choice is very limited for the older group. Much more ingenuity and research is needed to develop designs that will prove useful to the latter group. References: <ol> <li>W. Motloch, "Human Needs and Orthotic Goals for Spina Bifida Patients," Canadian Ortho-Pros., Summer 1975.</li> <li>W. Motloch, "Wardrobe Devices," Inter-Clinic Information Bulletin, January 1974.</li> <li>W. Motloch, "Crutchless Standing," Canadian Ortho-Pros., Spring 1973.</li> <li>W. Motloch, "New Items for Spina Bifida Programs," Inter-Clinic Bulletin, July 1970.</li> <li><a href="http://www.oandplibrary.org/al/1971_02_036.asp">W. Motloch, "Parapodium: an Orthotic Device for Neuro-Muscular Disorders," Artificial Limbs, Autumn 1971.</a></li> <li>W. Motloch, "Analysis of Medical Costs Associated with Healing of Pressure Sores in Adolescent Paraplegic," B.S. Thesis, University of San Francisco, February 1978.</li> <li>W. Motloch, "Seating and Positioning for the Physically Impaired," Orthotics and Prosthetics, June 1977.</li> <li>Personal communication with E. Hamilton, S. Walder, C. McLaurin, Dr. N. Carrol, and others from Ontario Crippled Children's Centre.</li> </ol> *Wallace Motloch, CO Wallace Motloch, CO is the Director of the Center for Orthotic Design, Inc. Page Number(s) 9 - 11 Year 1984 Volume 8 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1984_04_009/1984_04_009-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_04_009/1984_04_009-2.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 Orthotic Philosophies of Treatment Creator An entity primarily responsible for making the resource Wallace Motloch, CO * https://staging.drfop.org/files/original/f2f2342e1e6c5a7524fbbb113dcd429d.pdf b5a27a06fe4080ab7de494f9ef3f12a2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_006.pdf Text Any textual data included in the document <h2>What is Spina Bifida?</h2> <h5>Jeannie Gruse </h5> I have chosen to do this report on spina bifida because of little Stephen Smith, a happy, loving, well-adjusted boy, who was born thirteen years ago with this condition. Stephen's parents are friends and neighbors, and I well remember the day that Kent came over to tell us about the birth of their first son. When he described their handsome baby boy, and then explained that he had a birth defect called spina bifida, I had no idea what he was saying; I had never heard of this condition. Pam and Kent knew very little at that time, either, but in nine years of surgery, emergencies, difficult care, exercising, training, and learning, this has certainly changed for them. Kent is currently the Executive Director of The Spina Bifida Association of America, dedicated to "making the public, professional and all governmental agencies more aware of this worldwide health problem and assisting parents in helping their children." The program is also directed toward improving comprehensive medical care for children and adults with spina bifida, and expanding research programs which will search for the cause of this birth defect. Spina bifida is a serious condition, and until thirty years ago, few babies born with it survived beyond infancy. The treatment techniques developed within the last two decades make it possible for the majority of these children to grow to adulthood and live happy, productive lives in spite of their disability. Spina bifida is not a new birth defect; it was referred to 2,000 years ago, and was described by a Dutch physician, Nicholas Tulp, friend of Rembrandt, in 1652. The technical terms, spina bifida aperta or spina bifida manifesta relate to a structural defect caused by failure of the neural plate to develop into a tubular structure. In the area where this occurs, the defect is technically referred to as myelomeningocele (G. myelos = marrow; meninx = membraine; kele = hernia). In development, plates of bone fail to close over the defective area of the spinal cord and there is a short spine on each side of open spinal cord rather than a single one in the midline, therefore the term spina bifida. If the bony plate does not close over the spinal cord during infancy, this defect is referred to as spina bifida occulta (hidden). This type generally causes no problems. The newborn baby will have an obvious lump or cyst-like lesion on the back. It may be covered with skin, or more often wholly or partially covered with translucent bluish or white membranes. There may be a flat plate of imperfectly formed spinal cord on the surface of the cyst which may be leaking cerebro-spinal fluid. While there are many claims or suggestions of causes of spina bifida, it is generally considered to be caused by an unknown environmental agent interacting with genetic factors, according to Dr. Swinyard, Stanford University authority on spina bifida. Multiple complex problems presented by newborns with spina bifida have discouraged some physicians from applying the available intensive medical care and technologies to preserve lives of the more severely defective newborns. A number of physicians have advocated strongly that such treatment be withheld from newborns, presenting certain criteria with the expectation that these babies would soon die. This presents serious moral and legal problems, obviously, relating to rights of the children and the rights of parents to make such decisions, and since the predictability of death is quite uncertain, those who survive may have unnecessarily serious and lasting damage. There are many problems associated with spina bifida besides the obvious surgery necessary, often immediately, to correct the condition. There is loss of awareness of touch, pain, pressure, and heat or cold in those areas of skin normally innervated by nerves involved in the spinal cord defect. There is muscle weakness in the lower limbs and lower trunk, the latter often resulting in weakness in muscles of the bladder and bowel, preventing normal control. Nearly 70 percent of infants with spina bifida develop an associated defect known as hydrocephalus, causing a rapid enlargement of the head from the abnormal accumulation of fluid inside the brain. Although it does not occur in all of the infants, this problem is potentially a life threatening one which requires prompt attention of a neurosurgeon, and even then may often result in varying degrees of brain damage. The degree of severity of these conditions associated with spina bifida varies widely. Some children will be able to walk without assistance, others may need braces or a wheelchair. Because spina bifida is such a complex condition, these cases are usually referred to a pediatric neurosurgeon who is part of an organized team. He will decide on the surgical closure of the myelomeningocele, carefully watch for signs of hydrocephalus, and be responsible for the management of this condition if it occurs. Development of hydrocephalus would involve a serious neurosurgical emergency, as severe brain damage or death could result from the pressure of the fluid within the brain. A shunting procedure is used to reduce this condition, which consists of inserting one end of a flexible tube info a brain ventricle and passing the tube through a small opening in the skull. It is then passed underneath the skin from the head, either to the heart or to the abdomen, and includes a one-way valve which prevents the backward flow of spinal fluid. Even this procedure, a vital one to prevent pressure on the brain, is not totally free of dangers, as shunts can be obstructed or collapse, and revision is often necessary. However, it is the best procedure, and the only effective treatment currently available to allow the brain to develop more normally. Besides the neurosurgeon, spina bifida children will be seen by a number of different specialists. A urologist may be necessary to control urinary infections, and to keep the lack of bladder control from becoming a problem. The pediatrician will watch the child's general health and work on management of the problems relating to lack of bowel control. The orthopedic surgeon will have as his primary concern the growth and development of the bones and muscles. Children with spina bifida often have hip dislocation, club feet, scoliosis, kyphosis or lordosis. He will suggest surgery, braces or crutches when needed. An orthotist will fill the surgeon's prescriptions and work with the child as he grows. In conjunction with the orthotist, a physical therapist will also help carry out the plans made by the orthopedic surgeon and will suggest others designed to strengthen weak muscles. Finally, an occupational therapist may also aid in carrying out the physician's suggestions. She will work primarily with motor coordination and preceptual-motor impairment, and will assist in helping the child adapt to his physical environment in activities. Even with all of these trained experts' help, it is obviously the parents who are chiefly involved in the daily training and care of spina bifida children. I feel fortunate to have been involved, along with my daughter, friends, relatives, and church member volunteers in a program of "patterning" with little Stephen a few years ago. The theory of the program was that an infant's ordinary body movements stimulate brain development through sensory-motor input. Gradually the child's movements become coordinated in cross-patterned crawling, creeping, and walking. By stimulating the body in various ways it was hoped we could "wake up" and condition the pathways to the brain and activate the millions of unused cells within the brain. The method involved artificially recreating patterns of movement in hopes of reaching the brain and having the brain take over these same movements on its own. With three people helping three or four times a day, we helped Stephen and his mother go through his prescribed exercise schedule according to the training his mother had previously received. While some individuals with spina bifida have average or above average intelligence, those who also have hydrocephalus may, as a result, have some degree of mental retardation. The best school placement and curriculum planning will depend also upon physical limitations. The main consideration is mat the child be placed in a flexible situation for effective learning. Since many spina bifida children do have learning problems, teaching must be individualized, based on strengths and weaknesses. This may be possible in a regular classroom, mainstreamed partially, or in a self-contained situation, depending on the severity of the physical condition and the extent of the learning disability. When Stephen was nine years old, he was completing first grade work, and beginning second, at the Fullerton School, in Addison. He was in a structured, protective environment with reinforcement of one full-time teacher and an aide to six or seven students; this was a self-contained room called Orthopedic-Learning Disabilities, with mainstreaming for music and art. Having spina bifida means different things to different people. The actual physical condition varies greatly from person to person. How a person manages in life depends not only on the severity of the actual physical condition, but also upon the support he gets from others, the adaptations in the environment, and most of all, how the person feels about himself. With the tender, loving care and dedication of parents such as Pam and Kent Smith, spina bifida children like Stephen have a chance to grow up, able to cope with their own limitations, and to manage very well in life, feeling good about themselves. References: <ol> <li>Anderson, Elizabeth M., and Spain, Bernie, The Child With Spina Bifida, London: Methuen and Co. Ltd., 1977.</li> <li>Kieran, Shari Stokes, Ed.D., and Connor, Frances Partridge, Ed.D. "Mainstreaming Preschoolers," Children With Orthopedic Handicaps, U.S. Department of Health, Education, and Welfare.</li> <li>Klein, Stanley D., Ph.D., Psychological Testing of Children. The Exceptional Parent Press, 1977.</li> <li>Lindsay, Carolyn N., M.Ed., An Educator's Guide to Spina Bifida, U.S. Department of Health, Education, and Welfare, 1978.</li> <li>Osman, Betty B., Learning Disabilities, A Family Affair, New York: Random House, 1979.</li> <li>Pieper, Betty, By, For and With . . . Young Adults With Spina Bifida, Chicago: Spina Bifida Association of America, 1979.</li> <li>Pieper, Betty, Sticks and Stones, The Story of Loving a Child, Syracuse: Human Policy Press.</li> <li>Pieper, Betty, The Teacher and the Child With Spina Bifida, Chicago: Spina Bifida Association of America, 1979.</li> <li>Pieper, Betty, When Something is Wrong With Your Baby. Chicago: Spina Bifida Association of America, 1977.</li> <li>Reid, Robert, My Children, My Children, New York: Har-court Brace Jovanovich, 1977.</li> <li>Swinyard, Chester A., M.D., Ph.D., Decision Making and the Defective Newborn, Springfield: Charles C. Thomas, 1978.</li> <li>Swinyard, Chester A., M.D., Ph.D., The Child With Spina Bifida, Chicago: Spina Bifida Association of America, 1977.</li> </ol> Page Number(s) 6 - 8 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Expert 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 What is Spina Bifida? Creator An entity primarily responsible for making the resource Jeannie Gruse https://staging.drfop.org/files/original/0fd16e6b909f7130aea2a750ca50a40a.pdf 853cb1beca60fbae264611089e78bb36 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_005.pdf Text Any textual data included in the document <h2>A Need for Information</h2> <h5>Kent Smith </h5> April 6, 1971. My wife and I were eagerly anticipating the birth of our second child. I accompanied her to the hospital in suburban Chicago. It had been a normal pregnancy, much like the pregnancy two years earlier when our daughter was born. Shortly after midnight the joyous moment arrived. The doctor came to the father's waiting room; he was not smiling. Our son was born with a birth defect known as spina bifida. As we look back on that moment, we've realized how much the birth of our son Stephen has affected our lives. As a news writer/producer for a major television station in Chicago, I had access to a great deal of information. I had been trained to ask the right question, investigate the story thoroughly, and report both sides equally. My wife had received her education in library science and enjoyed the research involved in establishing a library and developing good reference systems. Nowhere in our professional experience had either of us come across information on the birth defect spina bifida, nor were we to realize how difficult it would be to get the information that should be so readily available to new parents of a spina bifida child. Parents find themselves very vulnerable after having given birth to a child with spina bifida. The hospital and medical staff appeared intimidating. We knew little about birth defects in general and nothing about our own child's specific needs. We looked to the "experts" whom we hoped would help. Our first attempt to get information was through the local chapter of the March of Dimes. Their personnel were courteous, sympathetic to our needs, but could not answer specific questions on how other families were coping with a child with spina bifida. We tried to gain understanding on a variety of terms. How did it affect our Stephen? Were we unique with this problem? What was the outlook for our son's future? Those questions went unanswered, although we did receive some pages copied directly from a well-known book on birth defects. Good friends stood by us trying to provide a sympathetic ear. They couldn't answer questions, but wanted to do the best for our family, even encouraging us to look at places where our child could be placed and be raised in a loving atmosphere; then we could go on with our own lives. This only frustrated us, for we wanted to help our son, who—by some quirk of fate—had problems that we knew were serious but we didn't understand. He was part of our family and we wanted to provide him with the best medical care available. As parents, we had to depend on others for guidance. The most obvious person to turn to is the family physician. Clearly, new parents of a disabled child need information on the disability and its treatment, as well as the names of agencies and support groups available to assist the family unit. Other parents who have faced the same situation can share their knowledge and give comfort and assistance. My wife and I were steered to a support group of parents and adults with spina bifida. This group met every month at the hospital. Our physician had been working with this parent group. Although he could not share the parental experience of raising a handicapped child, he respected the support that was freely given by parents "sharing their experiences." From our point of view, it was the best medicine that he could provide. It gave us hope that our son might make advances similar to other children. Information is the key to knowledgeable parents raising their children with spina bifida. My wife and I became active in this parent support group to learn more about the birth defect. From those adults with spina bifida we learned some problems they had faced and how we could help our son. Our involvement with a national organization wasn't something we planned, it evolved. In 1979, I was asked to establish a central office to provide information to new parents and be a resource to chapters consisting of parents, adults, and professionals in many cities. Under a letter of agreement with my employer, the American Broadcasting Company, I took a year's leave of absence to establish the office. I've never gone back to ABC. The leadership of Spina Bifida Association of America (SBAA) comes from the active participation of adults with spina bifida and parents working together. When SBAA was formed as a volunteer group in 1972, the greatest need was to provide printed information written in lay language. Today, the Association has 11 booklets directed to educators, new parents, adults with spina bifida, and to children. As a journalist, I was able to work with the writers in developing a distribution system that now has over 50,000 pieces of literature circulated each year. One concern we have is the misinformation that others continue to tell new parents regarding the current treatment or the lack of potential of people born with the birth defect today. In 1979, the SBAA established a policy that encourages early evaluation and medical/surgical treatment of every infant with spina bifida, and recommends that the evaluation be performed by professionals experienced in that care and treatment. Improved medical treatment within the last 25 years minimizes the disabling effects of spina bifida. Recent statistics from major treatment centers in New York, Pittsburgh, Chicago, Seattle, and elsewhere indicate that approximately 90 percent of those infants born today with spina bifida can lead a competitive life with some adjustments for physical disabilities. The majority of infants who receive aggressive treatment early do not suffer mental retardation. Lack of bowel and bladder control can be dealt with and should not take the "opportunity for life" away from the child. Some amount of paralysis often occurs, but the degree of involvement varies widely and cannot be determined at birth. The SBAA also sponsors an Adoption Referral program which offers a viable alternative to parents who feel unprepared to raise a child with a disability. The program has placed 70 babies in loving homes and has a waiting list of parents willing to take infants with spina bifida. During these last five years I have met hundreds of parents with similar stories, all with a commitment to provide information to a new parent who, like each of us, needed someone or some group to answer questions. The adults with spina bifida hold challenging jobs, and in general make worthwhile contributions to society. They have devised innovative ways in which to overcome their disabilities. Each represents a realistic goal which our child born with this birth defect can hope to achieve. If you would like further information on Spina Bifida and our Association, please call 1-800-621-3141. Page Number(s) 5 - 6 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Need for Information Creator An entity primarily responsible for making the resource Kent Smith https://staging.drfop.org/files/original/33ac5f83c3b345c7f45c737170f43aa0.pdf 7e4f270c0b93c37ded6218cb290d8afb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_003.pdf Text Any textual data included in the document <h2>A Personal Experience</h2> <h5>Cynthia L. Cuchna <a style="text-decoration: none;">*</a></h5> Most people would say, "It would be terrible to be born with a birth defect." Well, I know firsthand that it really isn't so terrible. I have been blessed with family and friends who have not let me feel that my disability should get in the way of reaching my goals. My parents have never let me use my handicap as a way of getting out of responsibilities. I have the same responsibilities around the house as my sisters and if I don't take care of them I am equally disciplined just as my sisters would be if they didn't do their share of the work. I feel my oldest sister, Sherri, has helped me the most in believing that I am just as capable as anyone else in doing things for myself. If I would ask her to get me a book or a glass of water or something, Sherri would probably say something like, "Get it yourself, you aren't helpless!" I wouldn't want it any other way between us. People have asked me if I feel my sisters are allowed to go more places and do more things than me. I don't feel that I've missed out on any of the experiences my sisters have had. I go to football games, movies, go shopping, and go to the local disco just like my sisters. The only problem I have is that most of my friends live too far away from me to just "drop by" whenever they feel like it. My friends are my classmates from the high school I had to attend, which is outside my local school district and is the only school in the county capable of handling my special problems. We can't even call one another very often because it is long distance. Hospitals have been a vey important part of my life, since I was in and out of them quite frequently when I was young. I never really minded going into the hospital because the doctors and nurses were always nice and I knew they would take good care of me. Along with hospitals comes bills. Our family has never been eligible for financial aid because my parents always made "too much money." I know that at times it has been tough for my parents to make ends meet because I am such an "expensive kid." Sometimes I feel guilty about having my parents pay such big bills just because of me. I have been in braces ever since I was four years old. I know that they have helped me considerably, but I often have negative feelings about my braces. There was a time when I was unable to wear my braces due to pressure sores. I like being out of them because my clothes weren't torn by the locks on my braces and I liked getting dressed faster. I thought I looked prettier without all of that plastic and metal sticking out of my clothes. I am finally starting to realize that I look better in them because they make me straighter. I don't look like I'm a "pretzel" when I'm in them. I have greater mobility in them, which enables me to do things and go places that I couldn't in my wheelchair. Even though the negative feelings may resurface in the future, I plan on wearing my braces a lot more than I have for the past two years. When I go out to a movie or go shopping, sometimes people stare at me. This has never really bothered me. It just shows me that they are interested in my disability and are curious to see how my braces, crutches and/or wheelchair works. I especially like it when little children come up to me and ask, "What happened to you?" I am glad that children aren't afraid to ask questions. I wish that adults would open up and ask, because I would be more than willing to tell them about anything they would want to know. My plans for the future are to graduate from college with a degree in psychology. I think that I would like to be a school psychologist because I love children. I know that the road ahead will have some rough spots, but I know that I can make it with the love and support of my family behind me. *Cynthia L. Cuchna Cynthia Cuchna was born with spina bifida on March 21, 1966. Now she is 18 years old and is entering her first year of college. <div style="width: 400px;"></div> Page Number(s) 3 - 4 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Personal Experience Creator An entity primarily responsible for making the resource Cynthia L. Cuchna * https://staging.drfop.org/files/original/6390d2b802a51debf473b9656b992a03.pdf 5239891523840188e87e90863af212cf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_002.pdf Text Any textual data included in the document <h2>The Parents Experience</h2> <h5>James R. Cuchna <a style="text-decoration: none;">*</a> Anna Mae Cuchna <a style="text-decoration: none;">*</a></h5> A new birth . . . another miracle . . . a baby is born . . . but why is our baby not made perfect like our friends and relatives? Life began, but it was not surrounded by complete joy. We were confronted with the inevitable—"Your child was born with spina bifida. She will, probably, live no longer than a week." We were asked, "Do you want to put her in an institution or leave her in the hospital?" Try to imagine the feeling that would rush through your mind at the onset of this occasion. It is unbelievable. Our immediate and only reaction was to take this child and love her just as if she were born "perfect." We accepted our daughter and were determined to treat her as if nothing was wrong. We had faith that God would help us through the problems we might encounter. This happened on March 21, 1966. Today, Cindy is 18 years old and is entering her first year of college. We also have a 17 year old daughter and a 9 year old daughter. We feel we have been richly blessed. Even though our first child was the one born with a physical problem, spina bifida, we really don't feel she has ever been "the problem." Society in general . . . everyone else's opinion, the medical profession, the people in government passing legislature, etc. are "the problems." Everyone thinks they know what "life is going to be like" for these children, what a "burden" they will be on the family. These statements infuriate us. Having had other children helped us substantiate our thoughts and feelings that a child born with a physical problem is "no different" than a child born "normal." We have had to deal with medical problems, hospital stays, doctors visits, etc. with all our children—maybe not as many problems as with Cindy, but, all have been traumatic for us. We have also had parents inflicted with cancer and have cared for them. To us, life is what a person makes of it. It is the positive attitude that surrounds any child or person that is so important. One can only try to make the best of things and live each day to the fullest. We are concerned for the babies that have doctors who perceive spina bifida as a dreadful defect/disability and make the decision of whether to treat or not. Cindy was not treated at birth but survived. Thoughts arise as to what more she could do had she been treated. Would her degree of paralysis and the kidney damage be less severe? We'll never know. Some doctors hesitate on treating babies born with spina bifida, but wouldn't give a second thought to treating victims of automobile, industrial or other accidents even though the outlook may be very bleak. An example of this is the president's aide, James Brady. What makes the difference? Another concern lies in the high cost of the medical supplies and equipment she will need the rest of her life. It doesn't seem fair that urostomy bags bought 11 years ago cost $13.95 and today are $42.50, that a set of full braces is $5,000 or more, that a wheelchair is over $1,000, that vans with lifts are $20,000, or that urine analysis that were $2.00 are now $10.00. Most of the people with physical problems have limitations in job opportunities. Very few will be able to hold high paying jobs. Where will the money come from to pay for their needs? Some places now want the money first and then they will bill your insurance. Where will she get the start to save money when she needs something? What happens when our 80 percent group insurance coverage lapses because she is an adult and then she cannot get insurance of her own because of her medical/physical involvement? Cindy feels good about herself and has accepted her handicap. She realizes that she has limitations but that these should not preclude her from being able to achieve the goals she sets. The fact she is paralyzed from the waist down and requires orthopedic bracing brought Cindy to the realization that she would have to work very hard for what she wants very early in life. She knows that nothing is going to be handed to her on a silver platter and does not think that she deserves special treatment because she is "physically challenged." All she wants is an equal opportunity to contribute to society and earn her way. Cindy has been a constant source of strength, love, and courage for us. As we watch her grow and see her achieve, our admiration for the child/young lady/soon-to-be woman grows. We truly believe that we have been more dependent on Cindy than she has been, or ever will be, upon us. We have been very fortunate in having benefitted from the professional services of very dedicated, talented, competent, and caring people in the areas of medicine, education, and orthotics. Yes, there have been differences of opinions between themselves as well as with us. There were goals that took longer than anticipated to be reached. But, can't we all say this happened to us also in our "normal" lives. It is one of our dreams and goals to see more medical professionals get involved with the National Spina Bifida Associaion of America and its local chapters. We don't need people to be afraid of spina bifida. We need help to spread a positive image, to achieve the establishment of a hospital for research and for the needs of all people with spina bifida. People need to know that children who are physically challenged don't need sympathy and things done for them. What they need is the opportunity to live, learn, grow in love and be loved—just as we all do. *Anna Mae Cuchna Mr. and Mrs. Cuchna reside in Ohio and are the parents of Cynthia Cuchna. *James R. Cuchna Mr. and Mrs. Cuchna reside in Ohio and are the parents of Cynthia Cuchna. <div style="width: 400px;"></div> Page Number(s) 2 - 3 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Parents Experience Creator An entity primarily responsible for making the resource James R. Cuchna * Anna Mae Cuchna * https://staging.drfop.org/files/original/7b50b9442fee7b3a075030bce26d5247.pdf c642ea8fa545bc78a7515b88282350b9 https://staging.drfop.org/files/original/1bf96f25f8dad3e8a90a0f93f54b53e3.jpg 5be960caa128ae75975d9e0ace0cc9a0 https://staging.drfop.org/files/original/3c801b7d07539462b4ac10842de5efcd.jpg a96f3e7dc9ed31455ba28a3c1da6dfe8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_03_022.pdf Text Any textual data included in the document <h2>Follow-up Experience with an Orthosis Combining the Supracondylar Knee Orthosis and the Spiral Orthosis</h2> <h5>Thomas A. Marün, CPO <a style="text-decoration: none;">*</a></h5> Fig. 1, Fig. 2 <a href="/files/original/1bf96f25f8dad3e8a90a0f93f54b53e3.jpg">Fig 1</a>. Side view of orthoses similar to that described by Mr. Martin in his article. (The photographs supplied by Mr. Martin proved to be unusable.) <a href="/files/original/3c801b7d07539462b4ac10842de5efcd.jpg">Fig 2.</a> Posterior view of the same orthoses as in Fig. 1. These photos are supplied courtesy of H. Richard Lehneis, Ph.D., CPO. A seventy-one year old woman, post polio of long duration, presented herself to our facility with a Supracondylar Knee Orthosis<a></a> that had a spiral type AFO<a></a> attached to it over ten years ago. She had fractured the AFO component just proximal to the malleolus, about one year ago. Another facility had attempted to replace the Nyloplex® spiral AFO with polypropylene material. Her ankle was fixed at 120 degrees plantar flexion. Our investigation indicated that her knee went into genu recurvatum despite the SKO, hence the problem-how to attach the spiral unit to the SKO and duplicate the same alignment that she had been comfortable with after all these years. It is noteworthy that the SKO was held in position by a waist strap. It was our opinion that the SKO no longer fit due to laxity within the knee cavity itself. She was quite adamant, however, that her brace system had been working well and it was our job to fix it. She declared that the waist belt was no problem and further stated, in no uncertain terms, that she wanted what she had because it had been of good service for over a decade. Possibly being more persistent than intelligent, we proceeded. We were unsuccessful in our attempts on three separate occasions in reapplying the spiral type AFO. We finally tried #4134-30 percent and #4110-70 percent polyester resin, laminated with four layers of fiberglass and two layers of glass, and used 1/16" polypropylene welding rods that ran the entire length, one inch apart. Using the old holes of the SKO, we were unsuccessful in obtaining satisfactory alignment when attaching the spiral unit. Therefore we were forced to tape the two units together until we had a compatible arrangement. Once the two components were riveted together, she had some problems in gait, especially between heel strike and foot flat, clearly indicating that the SKO was affecting the knee by not allowing it to go into recurvatum. In summary, we feel that in using the resin as opposed to the Nyloplex® (we used the same plaster mold) we may have compromised some flexibility, but gained, through rigidity, a successful duplication of past gait patterns. Presently this woman is walking better than formerly and is quite satisfied with our results. References: <ol> <li>Dr. H. Richard Lehneis, CPO, "Bio engineering Design and Development of LE Devices, " Institute of Rehabilitation of Medicine, New York University Medical Center, p. 55, October, 1972.</li> <li>ibid., p. 60.</li> </ol> <div style="width: 400px;">*Thomas A. Marün, CPO President Baja Orthotic and Prosthetic Services, 205 Church Street, Chula Vista, California 92010 </div> Page Number(s) 22 - 22 Year 1984 Volume 8 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1984_03_022/1984_03_022-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_03_022/1984_03_022-2.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 Follow-up Experience with an Orthosis Combining the Supracondylar Knee Orthosis and the Spiral Orthosis Creator An entity primarily responsible for making the resource Thomas A. Marün, CPO * https://staging.drfop.org/files/original/0af497bc37cfab2a9a00a17b1ca6d86f.pdf cf8cb41e194e0ee4499e4051dda5f85e https://staging.drfop.org/files/original/5ea3581f6ee975d42c43106821fad3e2.jpg 313f93afd5728940fede23af77bc8aeb https://staging.drfop.org/files/original/2716c0dfa81b724004f4e14015781792.jpg 6e2dfd49d5e2c1b0b0b628b8a3211b60 https://staging.drfop.org/files/original/576707f40e83237ed35a081d709ab88c.jpg aa88f323501ce5eda2721634bd997f66 https://staging.drfop.org/files/original/581c053fd31ab1f812407ca84373b090.jpg cd646856608dc4c29841ec43ea7d2aa1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_03_018.pdf Text Any textual data included in the document <h2>The Application of Ionomer Resins in Definitive Below Knee Prostheses: A Limited Study</h2> <h5>Bruce P. McCleUan, CPO <a style="text-decoration: none;">*</a> Susan Kapp, CP <a style="text-decoration: none;">*</a> Melvin Stills, CO <a style="text-decoration: none;">* </a></h5> <h3>INTRODUCTION</h3> For the past 30 years, polyester resins have been the material of choice for socket fabrication and exoskeletal lamination for all types of prostheses.<a></a> Without question, these thermosetting plastics have proven to be strong, durable, and effective for such application, and, at the time of their introduction, thermosetting plastics provided a quantum leap forward from the age of wood. The advent of plastics allowed for a more hygienic and less bulky prosthesis. More importantly, lamination provided a medium for duplicating a modified replica of the patient's residual limb. Thus, a more intimate fitting socket with greater weight-bearing characteristics was possible. In fact, the use of thermosetting resins continues today as the accepted state-of-the-art. As with any material, the polyester resins have certain characteristics which are not ideally suited for all situations. With this as a basis, the University of Texas Health Science Center at Dallas, in conjunction with the Dallas Rehabilitation Institute, began investigating the use of alternative materials for definitive prosthetic design. One of the most attractive substitutes appeared to be thermoplastics. A clinical study was undertaken to evaluate the group of thermoplastics known as ionomer resins and their role in definitive prosthetic application, as opposed to the polyester resins in use today. <h3>Thermosetting Resins</h3> As indicated, thermosetting-resins such as 4110 laminae have many positive attributes when used in the prosthetic arena. Some of the negative characteristics which prompted the investigation into other materials are equally impressive. The toxicity of the fumes given off during the lamination stage is certainly a matter of concern. The ability to modify a socket fabricated from polyester resin to accommodate residual limb change or pressure on bony prominences is essentially limited to grinding away an area for relief, or adding material to reduce socket dimensions. The cured polyester resin also is fairly rigid in nature—a factor which formed the major emphasis for research into the area of alternative materials. <h3>Ionomer Resins</h3> The thermoplastics which were utilized in this particular study of prosthetic application are classified as ionomer resins. The resins are based on copolymers of ethylene and metha-crylic acid, which are partially reacted with metallic salts to form ionic crosslinks between acid groups of single chain or between neighboring chains.<a></a> The name Surlyn® is the registered trademark of the ionomer resins produced by DuPont and was the material used in the fabrication of the prosthetic sockets. Some of the characteristics which made Surlyn® an attractive option for prosthetic use are as follows: Clarity Surlyn® is virtually transparent even in thicknesses up to 1/4 inch. This allows the prosthetist to evaluate socket fit visually while the patient is standing with full weight bearing on the residual limb (Fig. 1). <a href="/files/original/5ea3581f6ee975d42c43106821fad3e2.jpg">Figure 1</a>. Symes amputee with clear Surlyn® prosthesis. Adjustability The nature of ionomer resins is compatible with heat induced molding which greatly facilitates modifications to the socket. Areas of pressure over bony anatomical structures are simply heated and relieved with no adverse affect on integrity or clarity of material. Surlyn® may also be buffed, sanded, drilled, and riveted in the same manner as the laminates. Ease of Fabrication Surlyn® comes in a sheet form and is heated and softened in an oven to allow drape vacuum forming. Unlike other thermoplastics, Surlyn® can be formed directly over a wet cast with no need for a lacquer coating or nylon stocking interface. This differs greatly from polycarbonates which require prefabrication dehydration and a dry cast for good results. Additionally, no post-fabrication curing is required to drive off skin irritating styrene gas, as in the case of polyester resin which has a greater than 25 percent flexible resin content. Additional fabrication time is required, however, in the case of long below knee and Symes level amputations because of the need to weld the posterior seam of the Surlyn® socket. Flexibility This factor has proven to be the most significant advantage of ionomer resins from the patient's standpoint. Sockets fabricated from Surlyn® have much greater flexibility than those fabricated from polyester resin. Patients report that the socket feels more like a part of them and is appreciably more comfortable. The exact deformation occuring in the socket during ambulation has not been quantitatively measured at this point, but clinical trials indicate that anatomical weight-bearing surfaces are not adversely affected by the dimensional changes. <h3>Clinical Applications</h3> Initially, the ionomer resin sockets were used only as "test" sockets prior to fabrication of an intermediate or definitive prosthesis. Later, use broadened to include intermediate prostheses, and eventually definitive application. The move toward definitive use was prompted by the patients themselves. Those who had been wearing intermediate prostheses made of Surlyn® complained of the rigidity of the laminated socket when their permanent prosthesis was delivered. This provided a significant clue as to the direction which should be taken in regard to providing a more comfortable definitive prosthesis. <h3>FABRICATION PROCEDURE</h3> Though the technique is very similar to standard vacuum forming of orthotic devices, some specific steps are employed when making the definitive prostheses. To prepare the Symes cast for vacuum forming, the Symes foot retainer is attached to the modified positive model with plaster, using the vertical fabrication jig for alignment. A small hole is drilled into the popliteal area and the patellar bar of the cast to assure a good vacuum in these depressions. A piece of cotton stockinette is stapled above the trimline and stretched over the cast mandrel and the holes in the hand drape pipe. Pressure sensitive tape is used to hold the stockinette in place on the pipe. The thickness and dimension of the Surlyn® sheet to be used will vary according to type of prosthesis (i.e., Symes or BK) and the size of the patient. Most Symes casts require no more than a 24" x 24" sheet of 3/16" Surlyn® (for the lighter or less active patient 1/8" Surlyn® may be sufficient). The sheet is heated on a teflon rack for approximately seven minutes in a 350°F oven. The heated sheet is draped over the cast and sealed down the posterior side with the vacuum turned on. Excess plastic is cut away and trimmed almost flush with the socket before it is allowed to completely cool, eliminating the need for excessive grinding. Once cool, the posterior seam is grooved in preparation for welding. Three welds are run over the entire seam. The socket is then removed from the cast and trimmed. The foot is attached and the prosthesis is ready for fitting and delivery. The below knee prosthesis is fabricated in the same manner one would fabricate a thermoplastic test socket. It is frame draped with a 12" x 12" sheet of 1/2" Surlyn.® Care must be taken to not create webs below the trimline. It is then formed onto the Berkley alignment fixture for dynamic alignment. The socket may be permanently incorporated into an endo skeletal system or be finished in an exo skeletal manner using acrylic resin for the outside lamination. Using acrylic resin will not impair the flexibility of the socket to the extent that polyester resin will. <h3>CLINICAL RESULTS</h3> The fittings of the ionomer resin sockets for definitive use began in April, 1982. Of the ten patients who were definitively fitted with Surlyn,® eight were Symes level amputees. The remaining two patients were below knee amputees (Fig. 2). <a href="/files/original/2716c0dfa81b724004f4e14015781792.jpg">Figure 2</a>. Below knee type prosthesis with ionomer resin socket. In the Symes amputee group, five of the eight patients experienced failure of the prosthesis at the ankle/foot juncture (Fig. 3). The shortest use time until breakage was 14 days and the longest was five months, with a mean of 11 weeks for the group experiencing breakage. Two of these patients were refitted with a second Surlyn® definitive, one of which failed again after two months, while the other prosthesis continued to function one year after a modified ankle/foot juncture was devised (Fig. 4). The modification made was one of reinforcing the distal end of the socket with glass cloth adhered with acrylic resin. <a href="/files/original/576707f40e83237ed35a081d709ab88c.jpg">Figure 3</a>. Stress fracture at ankle/foot juncture of Symes prosthesis. <a href="/files/original/581c053fd31ab1f812407ca84373b090.jpg">Figure 4</a>. Closed socket design type now being used with reinforced ankle. Suspension is provided by a closed-cell polyethylene shim or pad encompassing the leg proximal of the malleoli and retained in place with a cast sock. Prosthetic socks are worn beneath the shim as usual. This same method has since been used on two other prostheses in the Symes group. However, over a period of one year, both of these prostheses failed at a level just proximal to where the glass cloth reinforcement stopped. The remaining patient in this group was an elderly lady who is a limited household ambulator and has experienced no known problems to this date. One of the two below knee patients wore his Surlyn® socket prostheses for 11 months before a crack developed. That patient weighed in excess of 230 pounds and participated in sports on a routine basis. His socket developed a crack in the proximal posterio-lateral corner which eventually migrated down the posterior wall. He was subsequently refitted with a polyester laminate socket. The other BK amputee was a 110 pound woman in her twenties who continues to ambulate with her Surlyn® socket prosthesis one year and seven months after fitting. <h3>CONCLUSION</h3> As indicated by Stills and Wilson,<a></a> Surlyn® may not be ideal for applications where high unit stresses are anticipated. Although this seems to have been borne out in this initial group of patients, we still believe that ionomer resins might play an important role in definitive prosthetic fittings. This may be accomplished by reinforcement at crucial stress points, a variation in the ionomer resin itself, or by finding a different material that is better suited to long term stresses. The frame type design being used in the above knee Scandinavian socket may also hold significant promise in a below knee configuration. The potential benefits of ionomer type resins to the amputee population are too great to dismiss without further evaluation and clinical analysis. It is hoped that others in our profession will actively participate in seeking viable materials for definitive socket application. References: <ol> <li>Aylesworth, R. Dean, ed., Manual of Upper Extremity Prosthetics, Artificial Limbs Project, University of California, Los Angeles, 1952.</li> <li>DuPont, E.I. De Nemours and Company (Inc.), Surlyn® Ionomer Resins Industrial Extrusions Manual, p. 3.</li> <li>Stills, Melvin, and A. Bennett Wilson, Jr., A New Material in Orthotics Prosthetics, Vol. 34, No. 3, pp. 29-37, September 1980.</li> </ol> <div style="width: 400px;">Melvin Stills, CO Melvin Stills, CO, Assistant Director, University of Texas Prosthetics-Orthotics Program. Susan Kapp, CP Susan Kapp, CP, Prosthetic Instructor, University of Texas Prosthetics-Orthotics Program. Bruce P. McCleUan, CPO Bruce P. McClellan, CPO, Assistant Professor and Director, University of Texas Prosthetics-Orthotics Program, School of Allied Health Sciences, Health Science Center at Dallas, 5323 Harry Hines Blvd., Dallas, Texas 75235. </div> Page Number(s) 18 - 21 Year 1984 Volume 8 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1984_03_018/1984_03_018-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_03_018/1984_03_018-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_03_018/1984_03_018-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1984_03_018/1984_03_018-4.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 The Application of Ionomer Resins in Definitive Below Knee Prostheses: A Limited Study Creator An entity primarily responsible for making the resource Bruce P. McCleUan, CPO * Susan Kapp, CP * Melvin Stills, CO * https://staging.drfop.org/files/original/9719948f0ff1fbce02da39e6232a4372.pdf 5e4f12bcbae522e74f4012c60724a3a5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_03_011.pdf Text Any textual data included in the document <h2>Evolution of the AK Socket</h2> <h5>H. R. Lehneis, Ph.D., CPO </h5> The lead article for this issue of C.P.O., "Sockets, Linings, and Interfaces," by Dr. Eugene Murphy represents the culmination of many years of research, writing, and studying the principles of socket design and interfaces. Admittedly, very little advance has been made in AK socket design since the development of the total contact socket. Today, the principles espoused by Dr. Murphy of selective flexibility/rigidity of socket interfaces can be realized in clinical practice. There is a pressing need to re-evaluate the traditional quadrilateral AK socket design in light of the drastic changes over the years in the amputee patient population. Today, the vast majority of AK amputees are geriatrics—a complete reversal from the time of development of the quadrilaterally-shaped socket. Most practitioners would agree that the most prevalent complaint of geriatric amputees is discomfort. This is not surprising, considering that most geriatric amputees suffer from reduced muscle tone, sensation, and vascularity. Thus, it has been proposed by this author to re-examine the cross-sectional configuration of AK sockets to specifically address the physiological alterations in stump shape and consistency of geriatric amputees, to evolve a socket design specific for this patient population. Such new configuration, combined with contemporary interface materials, e.g., silicone, copolymer inserts, and selective flexibility/rigidity, should lead to much improved physiological and biomechanical function and comfort (see <a href="cpo/1984_01.asp">Winter issue C.P.O.—Vol. 8, No. 1</a>). Other attempts to improve comfort are seen in Scandinavian socket designs in which the entire socket is semi-flexible except for the medial wall and a portion of the proximal brim area. In the Ockenfels design, the socket contains selective fenestrations and an inner elastic cloth liner or sock to prevent window edema. The so-called Contoured Adducted Trochanteric Controlled Alignment Method (CAT-CAM), developed by Sabolich, is to not only improve comfort but supposedly the patient's gait pattern. Now that these new developments are emerging, it seems rather puzzling, in retrospect, that there was such a long hiatus in the application of soft or flexible interface materials in AK sockets. And so it appears that we are on the verge of a major breakthrough, particularly in AK socket design and interface materials. Though not universally practiced, these noteworthy developments will change the practice of prosthetics in dramatic ways to improve comfort and function our patients so much deserve. Page Number(s) 11 - 11 Year 1984 Volume 8 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 Evolution of the AK Socket Creator An entity primarily responsible for making the resource H. R. Lehneis, Ph.D., CPO https://staging.drfop.org/files/original/995448e86e0b5f119a7459b183fd0e92.pdf b21593810340917c87578b184eb75be6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_03_004.pdf Text Any textual data included in the document <h2>Sockets, Linings, and Interfaces</h2> <h5>Eugene F. Murphy, Ph.D. <a style="text-decoration: none;">*</a></h5> A prosthesis, whose Greek source means "put to," must of necessity have contact with the residual limb or stump. The functions of this contact region or socket (perhaps supplemented with lining, sock, and further attachments or harness), are to allow the transmission of forces, bending moments, and torques between the amputee and the prosthesis to be as comfortable as feasible in order to sustain body weight and permit locomotion for lower-limb amputees, and to allow purposeful activities by upper-limb cases. Prolonged and vigorous use of a prosthesis should not cause pain, pressure sores, blisters or corns from friction, nor edema from restricted return circulation. Proper ventilation should also prevent such accumulation of moisture as to cause skin maceration. Challenging as these major tasks are, they should not lead to neglect of some of the less obvious functions of a prosthesis. The changing pattern of pressure distribution on the body from the prosthesis should provide important sensory feedback on external forces, on positions of remote portions of the prosthesis, and on events such as knee extension. Professor Ernst Marquartdt,<a></a> realizing the value of the limited sensory information transmitted to the residual limb of an upper-limb amputee by the older soft leather socket, was reluctant to change to rigid plastic laminates despite their other advantages. It should also be possible to control remote joints and locks or external sources of power by small reflex or voluntary motions of remaining muscles in the residual limb and through sensing of mechanical motion or myoelectric activity. Historical Notes Naturally there is a long history of attempts to meet these challenges, that is scattered in patents, papers, catalogs, and atlases.<a></a> There are records of wooden prostheses and peg legs since antiquity, which presumably were padded with fabric or leather. Medieval prostheses, made by armorers, probably had leather or other materials for liners. In the past century, molded leather shells or lacers supported by metal side bars and cuffs, adapted from orthopedic appliances, were used extensively. These allowed slow adaptation to radial displacement and deliberate readjustment of circumference, and provided some tapered flexibility of radial stiffness above and below the proximal and distal reinforcing cuffs. The typical American artificial limb carved out of wood was completely rigid, though it could be carved deliberately to produce enlargements as desired and could be lined, completely or in selected portions of the circumference, with leather. Felt, wax-impregnated materials slowly displaced under pressure at body temperature, and resilient or slowly compacted foam plastics or rubbers have been used by various developers. Diagonally woven straps or cords (sometimes called Chinese Magic Finger Grip in the U.S., or Nuremberg Witch's Finger in Germany) have been suggested repeatedly as resilient sockets and perhaps as suspension. Parallel vertical cords between upper and lower rigid frames have also been used for both flexibility and ventilation. End-Weight-Bearing Some early sockets attempted to provide direct end-weight-bearing on the unrestrained end of the amputated residual limb. Typically, the amputated end of the bone without deliberate plugging developed only a thin and flexible closure to resist transmission of end load to the medullary canal, causing discomfort or pain. In addition, the ring of bony cortex tended to produce painful direct loading on the skin at the distal end of the residual limb. Early attempts to leave flaps or pads of muscles or other tissues across the distal end merely led to atrophy. Grey, a former apprentice of James Potts who developed the coordinated-motion above-knee prosthesis later called the Anglesea Leg, was very critical of such misguided efforts to develop end-weight-bearing.<a></a> Except for the Syme,<a></a> the knee disarticulation, the Gritti-Stokes amputation levels, and some attempts to deliberately plug the end of a long bone<a></a>—all relatively rare—there were few attempts to attain any end contact, let alone end-weight-bearing. For generations most prostheses, especially the typical above-knee, caused considerable constriction in the proximal third of the socket, required trial-and-error fitting, and left relatively unsupported the distal end of the residual limb. Because the residual limb was considered "a bowl of jelly," it was constricted proximally but extruded distally in an attempt to secure a firm grip to assist both axial support and control of bending moments. Fortunately, the common firmly-knitted woolen stump sock between the limb and the prosthetic socket—folded over the socket brim and closed at the distal end—supported the skin, fascia, and internal tissues in resisting this distal extrusion and lengthening. Stump Socks One or more stump socks were typically worn between a hard socket wall and the residual limb. Stump socks were worn for reasonable as well as fallacious purposes.<a></a> Knitted fleece socks provided a slight degree of resiliency and thus redistribution of local radial pressure, especially when freshly laundered. Inevitably, there were mismatches between the residual limb and socket wall caused by slow changes in the limb with edema, atrophy, obesity, or sometimes growth or muscle development. Axial displacement, inaccuracies in the trial-and-error carving of a wooden socket, or even of modification of a plaster model of the residual limb before preparing a plastic socket also led to mismatches. Sock resiliency can overcome minor discrepancies and improve comfort and addition of a sock can help compensate for shrinkage of the residual limb. A major function of the sock is to cling to the residual limb but slide with respect to the socket wall if there are relative motions between stance and swing phases of walking or caused by discrepancy between the natural proximal joint and an external mechanical joint. (This important function is impeded if the socket wall is rough or if a perspiration-soaked sock can stick to the wall but chafe the skin.) The sock should also absorb perspiration, provide wick-like action, and allow for ventilation. The closed end or "toe" should provide some support of the distal tissue. Other than a circular cross-section, addition of one or more socks inevitably distorts the fit. In the triangular below-knee case, although the soft tissues in the posterior portion can change, the bony portions do not, so a spot liner is more appropriate than additional socks. Sometimes the stump sock was misused by patients to compensate for gross changes which required major refitting, or because of misunderstandings or lack of training. About 1947 Dr. John Young of Mellon Institute and this author met a below-knee amputee who wore five firmly packed socks. Though he did not believe in a "green sock," we finally persuaded him to purchase new socks in order to accompany a newly refitted prosthesis adapted to only one or two socks and to wash the socks daily. Such distortions, however, should not distract from the legitimate uses of stump socks. Suction Socket The suction socket above-knee prosthesis was and is routinely fitted with direct contact against the skin of the residual limb. The original suction socket of the Parmelee patent of 1863<a></a> may have been intended as total contact, though the evidence is not clear. A version of the suction socket which came from Germany in 1946-47, was routinely fitted with a "suction chamber" extending below the end of the residual limb. During donning, the tissues were pulled down through a snugly fitted proximal third by a tube of stockinet which was withdrawn through the valve hole in a side wall, thereby creating a significant distortion and elongation of the residual limb. In some cases, the distal end developed chronic edema or discoloration from disturbed return circulation or small hemorrhages. These problems, as well as basic principles, contact dermatitis, blisters and corns from friction, and cysts just proximal to the brim, were among the major difficulties discussed by Barnes<a></a> and Levy<a></a> in their classic treatment of dermatological problems of the amputee. They emphasized the importance of avoiding stasis in the distal residual limb in encouraging total contact and reducing proximal constriction. <h3>Thoughts And Theories</h3> After the issue of Artificial Limbs by Barnes and Levy was published in 1956, this author was appointed Fulbright Lecturer, based at the Orthopedic Hospital in Copenhagen. In an informal memorandum<a></a> based on years of observations and discussions concerning fitting of both dental and limb prostheses, three major themes were developed: <ol> <li> Minimize the stiffness gradient between the rigid socket wall and the flexible skin; i.e., taper flexibility of the socket brim. </li> <li> Approximately match wall stiffness to that of the tissue supported. </li> <li> Provide a porous wall capable of "breathing" slowly. </li> </ol> We may consider each theme in turn. Both theory and practice can be useful. Practice can develop to a considerable extent without theory; we walked before we learned about the biomechanics of locomotion, and Watt built steam engines before Carnot developed the basic cycle for all heat engines or Rankine the cycle for steam engines. Yet theory can guide our efforts toward improvements, show the areas where greatest progress can occur, and point out the ultimate limits so we do not waste our efforts. Tapered Flexibility The first theme was eventually published as the introduction to an extensive series of theoretical and experimental papers by Bennett.<a></a> The series ended with limited clinical trials of sockets with flexible brims made of plastic laminates. These sockets appeared to be helpful for patients previously troubled by chronic or recurrent cysts, but the mechanical durability of the laminate was so poor that the sockets often lasted only six months. After the National Institute of Handicapped Research (NIHR) project at Moss Rehabilitation Hospital began working with polyethylene and polypropylene thermoplastics,<a></a> Bennett collaborated with that group on some attempts to develop more durable flexible-brim sockets using thermoplastics. These appeared to be promising, but the major focus of the project was on light-weight prostheses. There have been numerous recent efforts to produce a thermoplastic flexible (and often transparent) inner socket or liner supported by an outer shell or other structure. The Scandinavian Flexible Socket or the similar Icelandic-Swedish-New York (ISNY) Socket, and two recent designs from the New York University Institute of Rehabilitation Medicine<a></a> are examples. If, as in Figure 5 of "Flexible Prosthetic Socket Techniques" by Lehneis et al., the flexible inner liner projects proximally above the more rigid outer laminate shell, it helps to provide the tapered flexibility and transition from rigid socket to flexible skin which was suggested in theme I,<a></a> and which seemed desirable from Bennett's work. Matching Wall Stiffness to Tissues Supported First, consider the principles. The bony prominences near the surface are very stiff against radial indentation under load, but they do not bulge during walking or change appreciably in size or shape over extremely long periods. In contrast, soft tissues may change much more rapidly by brief displacement of body fluids or in moderate time periods (e.g., weeks) by growth or atrophy. Soft tissues are also much less stiff under loads from internal muscular or hydraulic forces, or from external pressure, provided they can be displaced. Conversely, if fluid-filled soft tissues are sufficiently trapped to avoid displacement, they will behave like an enclosed fluid under hydrostatic pressure. Within the limits allowed by connective tissue, unsupported soft tissue can be displaced a considerable amount, at the expense of distorting blood vessels from their usual circular cross-sections to oval shapes with the same perimeter but a smaller area. Such displacement can also stimulate nerve endings. These displacements may give the illusion of tissue "compressibility." Soft tissue can also accumulate excessive fluid, creating flushing and edema, if free to expand radially from the center of the body mass. External support will assist the "milking" effect from the pulsating action of muscles contracting within fascial compartments in pushing fluid into the veins and lymphatics, while on the contrary either external suction or restriction of the return ducts proximal to the tissue considered will favor edema. Similarly, a localized area, with little or no muscular activity that is free from support within a larger region otherwise firmly supported, will cause "window edema" with bulging of skin and tissue through the opening, as in a small opening in a large plaster cast. Many clinical observations and some systematic tests with sockets, plaster casts, and different designs of prostheses and orthoses relate to this problem of matching socket to residual limb, even though they have been viewed as specific rather than general. The direct comparison of two theories or designs is difficult because methods for preparing the socket and aligning it to the remainder of the prosthesis usually differ. It would seem useful to compare sockets with varying degrees and locations of softness or of flexibility, but similar as to cast, model, and alignment. If different methods or alignments really are needed to optimize results, the reasons should be studied. The original Navy "soft" socket for below-knee amputees of the late 1940's, provided a limited but equal degree of softness in all regions of the circumference. The cast was prepared with the residual limb dipped in relatively dense dental stone while it hardened. Weight was shifted to the cast after the impression was firm but not quite completely set. The socket was formed over a plaster model without modification or contact with the sock-covered distal end of the residual limb. The distal wall was intended to be tangent to the tapering residual limb. The later Navy "closed-end" socket also provided some additional thickness of cellular rubber in contact with the entire distal end of the residual limb, tapering toward the side walls, with the entire socket lined with vinyl. The Schindler soft socket was formed with gores of foam rubber tailored to fit the warped surface of the plaster model, more precisely than was possible with the single sheet wrapped around the model in the simpler Navy technique. The Blevens below-knee socket provided an oval pad of sponge rubber, with tapered edges, trapped between layers of stump sock over the calf region of the residual limb. After this pad was compressed and forced through a snugly fitted proximal portion, it could expand into an enlargement in the rigid socket wall below the popliteal region. It permitted both activity of the remaining remnants of calf musculature, which tended to atrophy in conventional hard sockets, and provided or assisted in support of the prosthesis in swing phase. Its possibilities for control signals remain unexplored. Fabrication Methods Carved sockets obviously required skill of the prosthetist and tolerance of the user, who was initially asked to try to fit the residual limb into an unduly tight space which was gradually enlarged until a tolerable fit was achieved. Did the residual limb become engorged or injured in the process? Did the amputee eventually tolerate a certain amount of discomfort as he "broke in " the hard limb—or perhaps broke down the soft tissues to conform more closely to the not-quite-perfect fit? Or did he become sensitized to discomfort, aware of its location and cause, and even more demanding? Sockets made over plaster models prepared from plaster casts seem more likely than those carved purely from measurements for an immediate accurate fit, or a fit with minimal trials and adjustments. Even so, the prosthetist usually considers that the manual distortion of the wet plaster during the process of taking the cast and "rectification " of the positive plaster model is necessary to avoid an unduly loose fit, often regardless of the resiliency of stump sock or foam lining. Could this view be the result of past experience in preparing casts from residual limbs which have become enlarged from being unsupported while below the body during the preparation period? Would little or no rectification be needed if the amputee were supine with the residual limb elevated for an "appropriate" period immediately before casting? Have a few anecdotal accounts of such attempts leading to excessively tight sockets reflected unduly long elevation times? Did the Navy dip impression allow the denser dental stone, while still fluid, to squeeze fluids from the tissues by an approximately correct amount before solidifying? Because the socket must transmit the necessary axial forces, bending moments, and torques described by Radcliffe<a></a> for all major levels of the lower limb, and Taylor<a></a> for the upper, the socket wall must be reasonably firm in at least some areas and the interior bone(s) must transfer forces through the skin to the wall in both proximal and distal regions. Retention of Fit A precisely made hard socket fit with direct contact (as in the suction socket) or with a single thin stump sock might be effective for a time, but it might encounter difficulties even with muscular activities or large motion of the proximal joint as in sitting and bending. More important discrepancies would occur over longer periods from edema, growth, or atrophy. Completely uniform softness might also be questioned because it does not match just those relatively limited areas which alter cyclically with muscular activity or over some time span. Perhaps more critically, uniform softness allows areas of high pressure, intended to match individual tolerance to high pressure, to sink into the soft material and thus to shift some load to areas where the designer desired lower pressure. Beginning in the prosthetics schools in 1957-58, emphasis upon socket planning based on anatomical and physiological considerations and upon avoidance of erratic constriction and looseness was a healthy development. Some Suggestions The local radial stiffness of the socket wall might be approximately comparable to the stiffness and physiological motion of the tissue which it touches, though changes should occur gradually from place to place to avoid high local shear stresses in tissue. Thus, the wall near bony prominences might be quite firm if precisely fitted to a nonedematous limb. Obviously this notion seems the opposite of the usual concept of cushioning the bony prominences. Much of the traditional objection to a hard socket wall in contact with a bony prominence may be due to two difficulties: (1) unduly concentrated pressure because of poor fitting or displacement from the correct position, or (2) slippage and friction from inadequate suspension or joint location, leading to formation of blisters and bursae. Relatively soft walls opposite soft tissue might allow muscle bulging or tendon tightening at every motion of the limb yet rebound to prevent window edema when relaxed. The stiffness might be chosen to allow deliberate gripping of the wall for control and suspension, somewhat comparable to the German "Haft-prothese"<a></a> with muscular bulging to grip a rigid wall to supplement an above-knee suction socket as well as to help support the Blevens below-knee prosthesis. Some softness opposite tissues which tend to change rapidly might also compensate for slight changes such as growth. Adequate, relatively firm areas must be found for biomechanically necessary forces, including those generating bending moments and torques. In the below-knee case, for example, counterpressure from the posterior wall is needed to hold the condyles anteriorly on their sloping supports. In the above-knee case, the distal lateral and the proximal medial aspects of the femur must generate, yet tolerate, substantial forces to oppose the moment created by body weight acting upon it through the center of gravity appreciably medial to the center of support of the prosthesis during stance phase. The soft tissues, usually present at the distal end, should be encased thoroughly to prevent displacement, extrusion, and edema, yet held precisely in a wall and floor soft enough to prevent localized painful loading. Page,<a></a> an engineer interested in dental prostheses, discussed with this author in 1946 the concept of "muco-static" fitting with tissues trapped so that, much like fluids, they behave almost hydrostatically. The tissues should not be distorted from resting position when the cast is taken, nor should they be displaced towards hollows left by grinding away apparent ridges actually needed to fit into folds in the tissue. Past failures to create end-weight-bearing simply by taking an impression under load or placing a pad of foam rubber on a flat socket floor need not eliminate the possibility of total contact or end-weight-bearing by more sophisticated methods. A socket of the style described might have variable but tapered thickness of resilient material, such as closed-cell foam rubber or plastic. Muscular bulging into such material might be developed as a control signal. Alternatively, but perhaps less precisely, a thin resilient liner might be supported by an outer shell providing firm support where needed but having rounded and outwardly flared windows where expansion should be possible. The thin resilient liner opposite the windows could improve heat transfer, awareness of adjacent surfaces, and comfort when seated. The sockets illustrated by Lehneis, et al.<a></a> seem reasonable steps, though one wonders whether "selected fenestration over pressure sensitive areas " would be as logical as carefully molded and slightly relieved or padded areas. Certainly the transparent socket materials are advantageous for checking fit, supplementing their value in the flared flexible brim. Porous Materials The skin, as Barnes<a></a> pointed out, normally excretes water, gases and various compounds. An impermeable wall pressed tightly against the skin for many hours at a time can lead to dermatological difficulties. Leather allows some absorption and passage of these excretions, but deteriorates from their presence. Organic materials trapped in the fine pores of leather tend to decompose. The Army Prosthetics Research Laboratory (APRL) developed a protective slightly permeable coating for leather consisting of a particular grade of nylon dissolved in isopropyl alcohol. It is not still commercially available, as it was not very widely used. Care had to be taken to avoid traces of oil on the leather in order to be coated. APRL also developed a "starved resin" process, producing a somewhat porous thermosetting plastic laminate. Unfortunately, the irregular holes tended to become plugged with debris from the stump sock, dead skin cells, etc., and no adequate cleansing method was found. Late in World War II, Quamco was developed for raincoats and aviation clothing to resist penetration by rain or sea water yet allow slow transfusion of perspiration. It received brief attention in the early suction socket program. In recent years, Gore-tex has become increasingly popular for sportswear. Though it is difficult to tailor Gore-tex to complex shapes, the recent availability of a molded sports hat may indicate the possibility of considering an individually shaped socket or at least gently warped segments to mount in a fenestrated socket. Simple mechanical perforations of the socket wall were used, for example, with aluminum sockets, particularly in England. The holes had to be small enough so that the tissue, presumably supported by a stump sock, did not bulge through them. At the other extreme, the mechanically or electrically perforated plastics, studied around 1949 by the Mellon Institute, sometimes had such tiny holes that organic materials became clogged in them as in leather. One could imagine a wick-like, minutely perforated liner—and perhaps wall—permitting rapid and effective cleaning and drying. Air flow must permit ventilation yet allow adequate suction suspension, perhaps assisted by muscular gripping as in the Haftprothese, or by a very flexible inner liner collapsing against and adhering to the residual limb, as in a Northwestern University design<a></a> tested upon both upper- and lower-limb amputees. Care must be taken to provide a suitable balance of wicking capillary pressure in excess of negative air pressure so that moisture is not drawn back into the socket during swing phase. Conceivably, a porous supporting liner within an outer supporting structure might provide total contact and biomechanical reactions for the residual limb, but for a small and slowly ventilated chamber between the two, perhaps serving as a suction chamber during swing phase. One hopes that a simple, inexpensive, individually moldable material with appropriate range of perforations will become available. Ideally it would be available in various thicknesses, stiffnesses, resiliencies, and strengths and in a choice of transparency or appropriate skin colors. Of course it must also be nontoxic, noncarcinogenic, and odorless. Until then, however, we must make do with the increasing array of compromise materials and our growing but imperfect understanding of principles of sockets, linings, and interfaces. Bit by bit, we can improve service to the severely disabled patients whom we serve. References: <ol> <li>Marquardt, Ernst, Heidelberg, Germany, personal communication, 1961.</li> <li>American Academy of Orthopaedic Surgeons, Orthopaedic Appliances Atlas, Volume 2, J.W. Edwards, Ann Arbor, Michigan, 1960, esp. Chapters 1, 5, and 6.</li> <li>Gray, Frederick, Automatic Mechanism as Applied in the Construction of Artificial Limbs in Cases of Amputation, London, [the NML catalog card did not indicate publisher], 1855 [1857, second edition]; a copy at National Library of Medicine, Bethesda. See also the advocacy of suturing of the deep fascial envelope, criticism of muscles pulled over the end of the bone, but presumption of no end-weight-bearing in Alldredge, Rufus H., and Eugene F Murphy, "The Influence of New Developments on Amputation Surgery," 11, in Paul E. Klopsteg, Philip D. Wilson, et al., Human Limbs and their Substitutes, Chapter 2, p. 19, McGraw-Hill, New York, 1954; reprint edition with additional bibliography, Hafner, New York, 1968.</li> <li>Harris, R.I., "The History and Development of Syme's Amputation," Artificial Limbs, 6:1, 4-43, April 1961; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</li> <li><a href="http://www.oandplibrary.org/al/1962_02_086.asp">Loon, Henry E., "Below-Knee Amputation Surgery," Artificial Limbs, 6:2, 86-99, June 1962; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li>Murphy, Eugene F., "The Fitting of Below-Knee Prostheses, " Chapter 22 in Paul E. Klopsteg, Philip D. Wilson, et al., Human Limbs and their Substitutes, McGraw-Hill, New York, 1954; reprint edition with additional bibliography, Hafner, New York, 1968.</li> <li>Parmelee, Dubois D., Artificial Leg, U.S. Pat. 37,637, Feb. 10, 1863. See also Murphy, Eugene F., "Patents, Patients, and Patience," commentary on centennial, Artificial Limbs, 7:2, 69-72, Autumn, 1963; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</li> <li>Barnes, Gilbert H., "Skin Health and Stump Hygiene," Artificial Limbs, 3:1, 4-19, Spring 1956; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</li> <li>Levy, S. William, "The Skin Problems of the Lower-Extremity Amputee," Artificial Limbs, 3:1, 20-35, reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</li> <li>"Murphy, Eugene F., "Some Thoughts on Fitting of Prosthetic and Orthopedic Appliances to be Checked and Refined," 10/11/57; mimeographed by Research and Development Division, Prosthetic and Sensory Aids Service, Veterans Administration, New York, 1957, 1961.</li> <li>"Murphy, Eugene F., "Transferring Load to Flesh- Part I: Concepts," Bull. Prosthetics Res. BPR 10-16: 38-44, Fall 1971.</li> <li>Bennett, Leon, "Transferring Load to Flesh," Bull. Prosthetics Res.; Series of Parts: —Part II. "Analysis of Compressive Stress," BPR 10-16:45-63, Fall 1971. —Part III. "Analysisof Shear Stress, "BPR 10-17:38-51, Spring 1972. —Part IV. "Flesh Reaction to Contact Curvature," BPR 10-18:60-67, Fall 1972. —Part V. "Experimental Work," BPR 10-19, Spring 1973. —Part VI. "Socket Brim Radius Effects," BPR 10-20:110-117, Fall 1973. —Part VII. "Gel Liner Effects," BPR 10-21:23-53, Spring 1974. —Summary report at conference research project leaders, with title Transferring Load to Flesh, BPR 10-22, 13-143, Fall 1974. —Part VIII. "Stasis and Stress," BPR 10-23:202-210, Spring 1975. —(See also later progress reports on applying the same concepts under title "Stump Stress Analysis" in BPR 10-24:217-218; BPR 10-25:182-183-inadequate service life despite previous fatigue tests-; BPR 10-26:275-285-fatigue tests of various composites; problems of porosity.)</li> <li>Wilson, A. Bennett, Pritham, Charles, and Stills, Melvin, Manual For An Ultralight Below-Knee Prosthesis, Rehabilitation Engineering Center, Moss Rehabilitation Hospital, Temple University, and Drexel University, Philadelphia, Second Edition, 1979.</li> <li>Lehneis, H.R., Chu, Don Sung, and Adelglass, Howard, "Flexible Prosthetic Socket Techniques," Clinical Prosthetics and Orthotics, 8:1, 6-8, Winter 1983-84.</li> <li><a href="http://www.oandplibrary.org/al/1961_01_076.asp">Radcliffe, Charles W., "The Biomechanics of the Syme Prostheses," Artificial Limbs, 6:1, 76-85, April, 1961; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li><a href="http://www.oandplibrary.org/al/1962_02_016.asp">Radcliffe, Charles W., "The Biomechanics of the Below-Knee Prostheses in Normal, Level, Bipedal Walking," Artificial Limbs, 6:2, 16-24, June, 1962; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li><a href="http://www.oandplibrary.org/al/1955_01_035.asp">Radcliffe, Charles W., "Functional Considerations in the Fitting of Above-Knee Prostheses," Artificial Limbs, 2:135-60, Jan. 1955; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li><a href="http://www.oandplibrary.org/al/1957_02_029.asp">Radcliffe, Charles W., "The Biomechanics of the Canadian-Type Hip-Disarticulation Prosthesis," Artificial Limbs, 4:2, 29-38, Autumn 1957; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li><a href="http://www.oandplibrary.org/al/1955_02_022.asp">Taylor, Craig L., and Schwarz, Robert J., "The Anatomy and Mechanics of the Human Hand," Artificial Limbs, 2:2, 22-35, May 1955; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York, 1970.</a></li> <li><a href="http://www.oandplibrary.org/al/1955_03_004.asp">Taylor, Craig L., "The Biomechanics of Control in Upper-Extremity Prostheses," Artificial Limbs 2:3, 4-25, Sept. 1955; reprinted in Selected Articles from Artificial Limbs, Krieger, Huntington, New York 1970.</a></li> <li>Hepp, Oskar, "Haftprothesen," Zeitschrift fuer Orthopaedic und ihre Grenzgebiete, Band 77, 1947-48, 219-279.</li> <li>Page visited the offices of the Committee on Prosthetic Devices, then at Evanston, Illinois, in 1946.</li> <li>ChiIdress, Dudley S., Billock, John N., and Thompson, Robert G., "A Search for Better Limbs: Prosthetics Research at Northwestern University," Bull. Prosthetics Res., BPR 10-22:200-212, Fall 1974, especially p. 204 on "Self-Contained and Self-Suspended Devices," including atmospheric-pressure suspension. See also Progress Reports, BRP 10- 27:129, Spring 1977, and BPR 10-30, 177-178, Fall 1978.</li> </ol> <div style="width: 400px;">*Eugene F. Murphy, Ph.D. Retired, Veteran's Administration-Director, Office of Technology Transfer and Director, Research Center for Prosthetics </div> <div style="width: 400px;"></div> Page Number(s) 4 - 10 Year 1984 Volume 8 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 Sockets, Linings, and Interfaces Creator An entity primarily responsible for making the resource Eugene F. Murphy, Ph.D. *