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&#13;
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P&amp;O Clearinghouse c/o Rob&#13;
1947 Briarwood Ct. NE&#13;
Atlanta, GA 30329</text>
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&#13;
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&#13;
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No. 1, H Abdulaev St. &#13;
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Uzbekistan</text>
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Freddie Ossimbe: operations@onestepafrica.org</text>
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Robert and Kit Frank&#13;
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 828 774 7222</text>
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Carlos Proaño 21-34 y&#13;
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Protesis Imbabura offers opportunities for student affiliations, training, internships and independent study in the areas of prosthetics, orthotics, engineering, occupational therapy, physical therapy, and others.  Our average stay is 4-6 weeks.  Inexpensive housing is available.</text>
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&#13;
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L Calle, 25-62, Zona 15&#13;
Colonia Vista Hermosa 2&#13;
Guatemala City, Guatemala&#13;
Abierto: Lunes a Viernes 9HR - 17HR&#13;
502-3049-9471&#13;
guatemala@rompglobal.org&#13;
&#13;
ROMP Ecuador&#13;
Madrid y Lugo 24-185, La Floresta, Quito, Pichincha, Ecuador&#13;
La Floresta, Quito&#13;
Pichincha, Ecuador&#13;
Abierto: Lunes a Viernes 9HR - 17HR&#13;
593 98 494 3141&#13;
ecuador@rompglobal.org</text>
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                <text>Demonstrated by Yeongchi Wu, MD;&#13;
Co-Editing: Josh Waller;&#13;
Editing and Technical Assistance: Kate Jackson.&#13;
&#13;
A full demonstration of the CIR Sand Casting System. The process offers a low-cost, high-quality alternative to traditional prosthetic fabrication methods.&#13;
&#13;
The contents of this presentation/publication were developed under a grant from the Department of Education, National Institute on Disability and Rehabilitation Research grant number H133E980031. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.</text>
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              <text>&lt;h2&gt;Survey Results&lt;/h2&gt;&#13;
&lt;p&gt;&lt;i&gt;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.&lt;/i&gt;&lt;/p&gt;&#13;
&lt;h3&gt;Scoliosis Orthoses&lt;/h3&gt;&#13;
&lt;i&gt;From the Summer, 1981 Issue, Vol. 5, No. 3&lt;/i&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;p&gt;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:&lt;/p&gt;&#13;
&lt;p&gt;"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."&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;h3&gt;Results of the Survey Concerning Endoskeletal Prostheses&lt;/h3&gt;&#13;
&lt;i&gt;From the Winter, 1982 Issue, Vol. 6, No. 1&lt;/i&gt;&#13;
&lt;p&gt;As of March 25, 1982: 27 responses&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;How many definitive endoskeletal prostheses does your facility fit a year?&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;ol&gt;&#13;
&lt;li style="list-style-type: none;"&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Total of 1,814 fit, an average of 67 per respondee&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Maximum of 380&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Minimum of 0, second lowest 5&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Indicate the percentages of the type fit.&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Which Endoskeletal Prosthetic System was used most frequently?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Otto Bock 20&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;AFP 2&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Both Otto Bock and AFP 2&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Both Otto Bock and USMC 2 IPOS 1&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Do you consider endoskeletal prosthetic systems light enough?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;11 said yes&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;14 said no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 said yes to AK's and no to BK's&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 said yes to AFP and USMC and no to Otto Bock&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Do you consider them reliable enough?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;19 said yes, one of whom qualified his response by saying for adults and geriatrics only&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;7 said no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 said yes and no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Are cosmetic covers and skins adequate?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;23 said no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;3 said yes, one qualified his answer by saying only the AFP system&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 said yes and no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Do you consider it necessary to have full capability to modify alignment in definitive endoskeletal prostheses?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 stated that he considered it desirable early in the patient's progress and unnecessary late&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;14 said no, one of whom indicated that he used the AFP system exclusively and revised 380 of them&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;1 ambiguous&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;How often do you make changes in alignment?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;7 said never&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;17 said occasionally, one of whom stated that he occasionally made changes early in the patient's progress and never in more advanced instances.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;3 said frequently. One was the individual in #7 who identified the need for alignment changes as an indication for prescribing an endoskeletal prosthesis.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Would you consider it satisfactory to trade alignment modification capability for lightness and durability?&lt;/p&gt;&#13;
&lt;ul&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;22 said yes, one of whom qualified his position by saying not at the expense of the ability to interchange components.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;5 said no&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ul&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;10. What changes would you like to see made?&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;11 specified improved cosmetic covers&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;4 specifically recommended a more durable cover at the knee, or a way to reinforce or prevent impingement at the knee.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;3 recommended more work on hydraulic and pneumatic knee control units, one of whom mentioned a hydraulic foot.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;2 mentioned a more secure system of maintaining alignment.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;2 mentioned waterproof skin for covers&lt;/p&gt;&#13;
&lt;p&gt;One each:&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;lighter safety knee&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;improved strengh&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;easier to operate and more cosmetic knee lock&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;interchangeability of knee units without necessity of altering pylon tube length.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;easier and better attachment of cover to foot and socket for improved cosmesis, yet allowing removal for adjustment of alignment.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;reduction in weight of single-axis feet and ankles&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;modular, removable, hip joint and pelvic belt m. more versatile socket for geriatrics to accommodate weight fluctuation and vascular problems&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;incorporation of cable systems in upper extremity prostheses.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;durable covers easily donned by the layman&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;easier access to the adjustment screws on top of the foot of the Otto Bock system.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Covers such as those used on Hydra-Cadence, but they must look better and last longer. Preferably in assorted sizes."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;noise reduction (spring squeaks)&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;system for small girls&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Additional comments:&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"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."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"I want full adjustability while aligning. After alignment on definitive prostheses the adjustability doesn't have much value."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"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."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"Most endoskeletal prostheses are for AK female amputees."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"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)."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"It is a good unit but needs improvement."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"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."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"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."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;"The endoskeletal system should only be used in those cases where lightness is desired and where changes in alignment are anticipated."&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;h3&gt;Questionnaire Summary Comments&lt;/h3&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;&#13;
&lt;p&gt;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.&lt;/p&gt;</text>
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              <text>&lt;h2&gt;Follow-up on Endoskeletal Article and Questionnaire: The Manufacturers Reply&lt;/h2&gt;&#13;
&lt;p&gt;&lt;i&gt;Summarized results of the survey concerning endoskeletal prostheses appeared in the Summer, 1982 issue of &lt;i&gt;C.P.O.&lt;/i&gt; (Vol. 6, No. 3). These compiled results were circulated among the manufacturers of endoskeletal prosthetic systems. The following responses were received.&lt;/i&gt;&lt;/p&gt;&#13;
&lt;p&gt;In regards to the "g" response in the additional comments section, [questioning whether the cost is justified] I will submit the following: Endoskeletal prosthetics is a poor excuse to charge more money, only when it is the excuse that it is being charged to the patient. I can also understand being afraid of the dollar sign where it prevails as fiscal remuneration for an excuse, rather than the patient's welfare. Endoskeletal prosthetics have consistently proven themselves a useful tool in developing value in the patients themselves, and in the patient's rehabilitation accomplishments .&lt;/p&gt;&#13;
&lt;p style="margin-left: 10%;"&gt;Michael T. Wilson, CPO&lt;br /&gt;Medical Center Prosthetics, Inc.&lt;/p&gt;&#13;
&lt;p&gt;Manufacturers must keep many things in mind when designing and building a modular system: weight vs. strength, added features vs. weight and strength, and cost to manufacture vs. simplicity. Research and development expenses are subsidized only by sales profits. A good example is that tooling for one simple item may run $80,000, while sales and volume of manufacture does not warrant this expense. In summary, manufacturers do have handicaps.&lt;/p&gt;&#13;
&lt;p&gt;In reviewing question number ten—what changes would you like to see?—we find 19 answers were provided. Eighteen of the 19 have been researched, and four of these are available now. The others will continue to be researched and will be available in the future.&lt;/p&gt;&#13;
&lt;p&gt;The field of prosthetics has come a long way in the past 20 years; let us look at what is available now in manufactured parts as to what was available in 1962. We at United States Manufacturing Company believe there will be even more improvements in the next 20 years compared to the last 20.&lt;/p&gt;&#13;
&lt;p style="margin-left: 10%;"&gt;Dan J. Edwards&lt;br /&gt;Sales Director&lt;br /&gt;United States Manufacturing Co.&lt;/p&gt;&#13;
&lt;p&gt;Otto Bock, along with several other manufacturers of endoskeletal prosthetic systems, was presented with the survey results from the Winter Issue of &lt;i&gt;C.P.O.&lt;/i&gt; and was asked for a response. While the total number of endoskeletal prostheses indicated as having been delivered to patients was significant, we must offer our opinion that the total of 27 returned questionnaires is a rather poor response and certainly does not represent a consensus upon which to base any conclusions.&lt;/p&gt;&#13;
&lt;p&gt;Each manufacturer is individually aware of how many endoskeletal units it produces and sells each year, which gives a general idea of market acceptance. Our experience has been that our endoskeletal units sold continue to increase in significant quantities year after year and this trend has shown no sign of reversing. This in itself is an indication to us that endoskeletal systems have attained a definite place in the armamentarium of components available for prosthetic patient management.&lt;/p&gt;&#13;
&lt;p&gt;A great number of people seem to support the belief that endoskeletal prostheses were designed to replace exoskeletal prostheses. It is certainly not our company philosophy that one is intended to replace the other. Both types of systems have their advantages and disadvantages and it ultimately should depend on the professional decision of the prosthetist as to which system will best fit the needs of each individual patient. Perhaps many of the complaints about endoskeletal systems are due to improper patient selection criteria rather than deficiencies in the systems themselves.&lt;/p&gt;&#13;
&lt;p&gt;Another source of trouble with endoskeletal systems is the improper application of fabrication techniques. Recognizing this possibility—and being one of the first manufacturers to offer a complete multiple option endoskeletal system for the lower extremity—we developed a seminar program for instruction in these new techniques. In addition, we have developed Technical Information Bulletins, slide programs and presentations for various technical meetings. Despite these efforts on our part, the sheer numbers of prosthetists in this country and their diverse geographical locations make it nearly impossible to personally instruct every one, even if we could increase the size and frequency of our seminars. Basically, we are able to trace many of the problems to not following technical recommendations. In many cases the problems have been cleared up rather quickly by following instructions.&lt;/p&gt;&#13;
&lt;p&gt;The prosthetist has the choice of using any of several manufacturers' systems, each with its own unique features. If alignment capability in the definitive prosthesis is desired, an IPOS or OTTO BOCK System can be used. If it is felt that this permanent adjustability is detrimental, the USMC or AFP Systems can be used instead. When the Otto Bock foam cover is too difficult or time consuming to shape, or lacking in durability, there are other alternatives. These include the foam-in-place technique offered by Medical Center Prosthetics, and the option of a prefabricated cover. Choices also exist for the prosthetic skin, such as our nylon stocking, USMC's newly developed cover, or a covering of the paint-on variety.&lt;/p&gt;&#13;
&lt;p&gt;The foregoing statements are not meant to give the impression that Otto Bock is insensitive to the needs of the prosthetist or, more importantly, to the desires of patients they serve. We recognize fully the need for improvement of endoskeletal systems. The covers need to be more durable and easier to fabricate. The structural and functional components need to be made lighter and more sophisticated. Unfortunately, many of these things are easier said than done, but our research department is constantly striving to develop new and better systems.&lt;/p&gt;&#13;
&lt;p&gt;We very much appreciate the opportunity to comment on this survey and would encourage a much greater response to such surveys in the future. This type of feedback on a much larger scale could be very helpful to all manufacturers. Along this line, we are wondering what suggestions might be offered for quickly disseminating information on new products or techniques so everyone interested could become qualified to use them for maximum benefit to the patient. If anyone has some workable ideas for accomplishing this objective, we are certain all concerned would benefit greatly.&lt;/p&gt;&#13;
&lt;p style="margin-left: 10%;"&gt;Jack Hendrickson, CP&lt;br /&gt;Otto Bock&lt;/p&gt;&#13;
&lt;h3&gt;More Endoskeletal Responses Added to Questionnaire Results&lt;/h3&gt;&#13;
&lt;p&gt;Two questionnaire responses were received too late to be included in the compiled results published in the Summer &lt;i&gt;C.P.O.&lt;/i&gt; One individual reported that 75% of definitive prostheses fit were of endoskeletal construction and the other reported fitting 150 endoskeletal prostheses (actual numbers, not a percentage). Their responses to questions two through nine were very much in line with the majority of others received. Their written responses are included below:&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;What changes would you like to see made?&lt;/p&gt;&#13;
&lt;p&gt;&lt;i&gt;First respondee:&lt;/i&gt;&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;improved covers&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;hydraulic knees&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;p&gt;&lt;i&gt;Second respondee:&lt;/i&gt;&lt;/p&gt;&#13;
&lt;ol&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Lighter in weight&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Improvements in the visual, tactile, and sound aspects of prostheses&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Longer lasting cosmetic covers, internally and externally&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;For H.D./H.P. prostheses, better sitting ability&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Standardization of tube sizes and connectors to facilitate "intermarriage" of components&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;More instructional courses by prosthetics/orthotics schools or manufacturers to deal with "practical every-day" problems&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;&#13;
&lt;/li&gt;&#13;
&lt;li&gt;&#13;
&lt;p&gt;Additional comments:&lt;/p&gt;&#13;
&lt;p&gt;&lt;i&gt;First Respondee:&lt;/i&gt;&lt;/p&gt;&#13;
&lt;p&gt;The ability to make either major or even subtle changes in a definitive prosthesis, months or even years after initial fitting, has always appealed to me. The more I use the Bock system the more confident I become of it and I find myself fitting a higher percentage [75% last year, Ed.] . . . every year. I find the poor durability of the cover a minor trade off . . . most of my patients agree. I practice in Montana, so you can guess my patients do not always give their prostheses the easiest use. I am a firm believer in the concept.&lt;/p&gt;&#13;
&lt;p&gt;&lt;i&gt;Second respondee:&lt;/i&gt;&lt;/p&gt;&#13;
&lt;p&gt;Our first choice of components for any amputee (re: level of amputation, sex, job or environmental factors) is the endoskeletal prosthesis. My first reason for this is ease of maintenance/replacement of components. This single factor keeps patients coming back knowing they can get things "fixed" quickly. In our present rush society this factor cannot be overlooked.&lt;/p&gt;&#13;
&lt;p&gt;Cosmesis is becoming a more important factor every day, regardless of the patient's sex or age.&lt;/p&gt;&#13;
&lt;p&gt;For too long, we have, as professionals, trained our patients to think: 'functional restoration is your main objective.' Having been involved with many patients who are "prosthetic failures," I have learned a few very important lessons as to why they are on crutches, in wheelchairs, or have empty armsleeves.&lt;/p&gt;&#13;
&lt;p&gt;Consumers in general, today, are more educated and interested in knowing their options. The prosthetist has the responsibility to inform his patient as clearly and completely as possible concerning what is available. He may end up referring the patient to a colleague if he does not have the necessary skills to satisfy his client. A satisfied, happy patient is not a side benefit to our existence. It is a must.&lt;/p&gt;&#13;
&lt;p&gt;Through publications such as this one and many others around the world, we have an obligation to keep up-to-date on new developments as well as contributing our findings in return. It is not necessarily always true that something we are having success with is known to most colleagues. Try and publish articles with photographs and you will be surprised at the response.&lt;/p&gt;&#13;
&lt;/li&gt;&#13;
&lt;/ol&gt;</text>
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