19 20 371 https://staging.drfop.org/files/original/dd8db7616001226c18971be2d8fcd283.pdf 1ad480aad4abe8298ef123b76f395b42 https://staging.drfop.org/files/original/d5b8d44b32ee77a3f0a1323a80a9afcc.jpg 2d03a3805b271567b07dc8e3a894f760 https://staging.drfop.org/files/original/beabbcc10d39750ad0df0029737fbb9a.jpg 2c4cecf0a116c3038089460eeeb1656d https://staging.drfop.org/files/original/eab5312062924db051a8886268065332.jpg 9a0e042d67cb98394cd3911b39aa9ef8 https://staging.drfop.org/files/original/6a6cd46dbbb7e7a257b0eb28b50d3729.jpg d75170a96119542a41e69cf1cdd9e7c9 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/1986_01_038.pdf Text Any textual data included in the document <h2>Use of a Bivalved Thoracic Suspension Jacket in the Orthotic Seating Management of Severe Arthrogryposis Multiplex Congenita</h2> <h5>Carrie L. Beets, CO. <a style="text-decoration: none;">*</a> Louis Whitfield, R.T. (O) <a style="text-decoration: none;">*</a> Jan Minnich, L.P.T. <a style="text-decoration: none;">*</a> J. Leonard Goldner, M.D. <a style="text-decoration: none;">*</a></h5> <h3> Introduction</h3> The thoracic suspension orthosis<a></a> was developed to aid in the management of patients with neuromuscular disease and has been used primarily in individuals with myelodysplasia. The principle of the device is to use the rib cage as a weight bearing structure and thus provide improved seating posture for the patient while attempting to limit spinal deformity and relieve excess ischial pressure. Additional benefits include improvement of balance and mobility and freeing of the hands and arms for feeding and other activities of daily living. The body image of the patient is improved while seated in a wheelchair, and the patient may interact better with the environment. The thoracic suspension orthosis should be considered for those patients who cannot tolerate surgery or when surgery should be delayed until they reach maturity. The patient presented in this paper does not fit the usual criteria for use of a thoracic suspension orthosis. The needs of this patient went beyond those provided by usual orthotic seating devices and led to the adaptation of established techniques and development of a different design to provide a functional seating arrangement for a severely involved child who had failed with other custom seating devices. This seven year old girl with severe generalized arthrogryposis multiplex congenita had functional limitation in the upper extremities and no voluntary action in the lower extremities. Surgical releases of soft tissue contractures and proximal and distal femoral osteotomies had been performed to adapt the patient to a sitting position. Past attempts to provide molded seating inserts to allow a comfortable sitting position had failed. She was most functional supine in a custom designed and portable bed-like seating insert which permitted feeding. Examination of the child revealed severe muscle atrophy of both upper extremities. There was active elbow extension but no active flexion. She was able to get her left hand to within several inches of her mouth by abducting and forward flexing her shoulder and then allowing gravity to bring her hand to the mouth. The spine revealed right thoraco-lumbar scoliosis, thoracic kyphosis, fixed lumbar lordosis, and a fixed pelvic obliquity in which the left pelvic brim was higher than the right. The left hip had a range of motion from 30 degrees flexion to about 90 degrees for a total of 60 degrees of flexion, with an external rotation deformity. The right hip was fixed in +20 degrees flexion. Both knees had flexion contractures of 70 degrees with 10 degrees motion. In order to flex the right femur for sitting, a subtrochanteric osteotomy had been performed with creation of a silicone capped pseudoarthrosis. While this was relatively successful, pain occurred when the patient was placed in a sitting position with any weight bearing occurring on the right ischium. For this reason, she was evaluated for use of a thoracic suspension orthosis. The patient was initially placed in a plaster cast thoracic suspension jacket for a three week trial. During this time, the periods of suspension were gradually increased. Her skin was not accessible for monitoring; however, since she had normal sensation and was cooperative, we depended on her complaints of pain to assess the support. She tolerated the three week trial period and experienced no skin breakdown or abrasion. At that time, a cast impression was taken for the fabrication and fitting of a thoracic suspension orthosis. <h3>Fabrication And Fitting</h3> Due to the lack of spinal flexibility, the need for easy and accurate application of the orthosis, and the need to make the device as simple as possible for the parents; a bivalved design was chosen rather than the traditional single anterior opening. The bivalved design (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg">Fig. 1</a>) necessitated fabrication of two plastazote™ linings complete with conventional additional plastazote™ layers over the inferior costal margins. Special attention was needed to insure that the anterior and posterior halves of the two linings matched up accurately during the vacuum forming process (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg">Fig. 2</a>). <a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg">Figure 1.</a> Lateral view of bivalved thoracic suspension orthosis showing anterior shell trimlines. <a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg">Figure 2.</a> View from above, the anterior and posterior linings match up to provide an even pressure just distal to the lateral and anterolateral inferior costal margins. The suspension spools were incorporated into the posterior shell, which was fabricated of low density polyethylene. High density polyethylene was chosen for the anterior shell, as it was felt that the additional rigidity provided by this material would be needed to maintain the integrity of the circumferential containment of the jacket under weight bearing. A large abdominal opening was provided in the anterior shell because the patient had experienced some distress in the plaster jacket, especially following meals, which had been relieved by the addition of an opening in the plaster cast (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg">Fig. 3</a>). The two half shells were held in place as a unit with Velcro® closures. <a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg">Figure 3.</a> Anterior view of bivalved thoracic orthosis showing abdominal opening. Fitting of the orthosis was followed by an in-hospital program of gradually increasing wearing time both in the nonsuspended and suspended states. Her original supine positioning device was modified to permit her to lie in this with the thoracic suspension jacket on, eliminating the need to take off the jacket between periods of suspension. Since she could not tolerate any weight bearing on her right hip, the suspension brackets on the wheelchair were positioned for full weight bearing suspension. She tolerated the conditioning program well. At the time of discharge, she was wearing the jacket all day long and was tolerating uninterrupted suspension for periods of two and one-half hours. Her electric wheelchair was outfitted with a chin operated joy stick control (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.jpg">Fig. 4</a>). While suspended, she could operate the wheelchair well. However, at the end of two and one-half hours in suspension, the patient would begin to complain of discomfort and would be transferred to her supine positioning device. <a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.jpg">Figure 4.</a> Patient sitting in suspension in wheelchair. <h3>Conclusion</h3> The application of a thoracic suspension jacket is a way of successfully providing a functional sitting position for a patient with severe arthrogryposis. In conjunction with a modified electric wheelchair, the patient was given an opportunity to interact actively with her environment, including a vertical position for eating. The bivalved design not only affords easy application and removal, but also permits visual monitoring of the skin. The crucial circumferential containment in the area of and just distal to the inferior costal margin was maintained satisfactorily with a bivalved design. *J. Leonard Goldner, M.D. J. Leonard Goldner, M.D., was former Chief of Orthopedics, Division of Orthopedic Surgery, Duke University Medical Center. *Jan Minnich, L.P.T. Jan Minnich, L.P.T., is with Lenox Baker Children's Hospital, Durham, North Carolina. *Louis Whitfield, R.T. (O) Louis Whitfield, R.T.(O), is with the Department of Prosthetics and Orthotics at Duke University Medical Center. *Carrie L. Beets, CO. Carrie L. Beets, CO., is with the University of Virginia. She was formerly with the Duke University Medical Center at the time of submission of this article. References: <ol> <li>Drennan, J.C.; Renshaw, T.S., and Curtis, B.H., "The Thoracic Suspension Orthosis," Clinical Orthopaedics and Related Research, No. 139, March/April, 1979, pp. 33-39.</li> <li>Drennan, J.C., Orthopedic Management of Neuromuscular Disorders, J.B. Lippincott Co., Philadelphia, p.83.</li> <li>Fillauer, C.E.; and Pritham, CH., "The Thoracic Suspension Jacket-Review of Principles and Fabrication, Orthotics and Prosthetics, Vol. 38, No. 1. Spring, 1984, pp. 36-44.</li> </ol> Page Number(s) 38 - 41 Year 1986 Volume 10 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.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 Use of a Bivalved Thoracic Suspension Jacket in the Orthotic Seating Management of Severe Arthrogryposis Multiplex Congenita Creator An entity primarily responsible for making the resource Carrie L. Beets, CO. * Louis Whitfield, R.T. (O) * Jan Minnich, L.P.T. * J. Leonard Goldner, M.D. * https://staging.drfop.org/files/original/4c1c2659ace14b6587c3c801d470aa96.pdf dbc48fb2203d6c75e5adce812a9b03de https://staging.drfop.org/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg 4c4de5849811d644713ec7230d7d0f02 https://staging.drfop.org/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg 131fef1ae751f64e310d683f6e52c098 https://staging.drfop.org/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg 0ceb64af346708b11b688bc9aec46035 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_005.pdf Text Any textual data included in the document <h2>Vacuum Forming</h2> <h5>Ben Wilson </h5> In an article I wrote in 1974 on vacuum forming of sheet plastics<a></a> I erred in stating that the first reference to vacuum forming of sheet plastics in orthotics and prosthetics was a paper by Gordon Yates in 1968<a></a>. I should have remembered that Dana Street presented this concept in Volume 1 of the Orthopedic Appliances Atlas<a></a> for the fabrication of cervical orthoses. This is certainly an excellent example of how long it takes to get a technological development from the idea stage to fairly widespread application. <a href="/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg">Fig. 1</a> Vacuum-forming a shank for a below-knee prosthesis using the hand-drape. In the time since my article was published in "Orthotics and Prosthetics" vacuum forming of sheet plastics has been used more and more by private practitioners in both orthotics and prosthetics. Although the educational programs, with a few exceptions, seem to have been very slow in teaching vacuum forming techniques, use of the technique seems to be expanding, owing in part to the several workshops sponsored by the American Academy of Orthotists and Prosthetists. Every process and system has its limitations, and we all recognize that each design in orthotics and prosthetics represents a compromise, but as time goes on the gaps that engender compromise are narrowed as experience is gained. Although the "Orthotics and Prosthetics Clinic Newsletter" has discussed several aspects of vacuum forming in the relatively recent past, in view of what seems to be a rapidly expanding program it seems appropriate that another survey be made concerning the uses of and problems encountered by the private practitioners. A questionnaire on this subject is included in this issue. It will be appreciated greatly if each recipient will complete the enclosed form and add any comments he or she feels that will be helpful in improving service to patients. <a href="/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg">Fig. 2</a>. Vacuum-forming thigh section of knee-ankle-foot prosthesis using automatic machinery. <a href="/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg">Fig. 3.</a> Vacuum-forming a below-knee socket with use of a platen and form for holding plastic sheet. <h3>References:</h3> <ol> <li>"Vacuum-Forming of Plastics in Prosthetics and Orthotics," A. Bennett Wilson, Jr., Orthotics and Prosthetics, Vol. 28, No. 1, March 1974.</li> <li>"A Method for the Provision of Lighweight Aesthetic Orthopedic Appliances," Gordon Yates, Orthopaedics, 1:2:153-162, 1968.</li> <li>"Plastic Braces," Dana M. Street; pp. 90-95 in Orthopaedic Appliances Atlas, Edwards Brothers, Ann Arbor, Michigan, 195.</li> </ol> <h3>Additional Bibliography:</h3> <ol> <li> "Fabrication and Application of Transparent Polycarbonate Sockets," Vert Mooney, M.D., Roy Snelson, Orthotics and Prosthetics, Vol. 26, No. 1, March 1972. </li> <li> "Fabrication of Vacuum-Formed Sockets for Limb Prostheses," Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 3, September 1973. </li> <li> "Report of Workshop on Below-Knee and Above-Knee Prostheses," Hector Kay, June D. Newman, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "The Use of Check Sockets in Lower-Limb Prosthetics," Samuel Hammontree, Roy Snelson, Orthotics and Prosthetics, Vol. 27, No. 4, December 1973. </li> <li> "A Thermoplastic Structural and Alignment System for Below-Knee Prostheses," Hans Richard Lehneis, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Development of a Thermoplastic Below-Knee Prosthesis With Quick Disconnect Feature," Charles H. Pritham, Orthotics and Prosthetics, Vol. 28, No. 4, December 1974. </li> <li> "Vacuum-Formed Sockets in Prosthetics Education," Bernard C. Simons, Alan V. Dralle, Orthotics and Prosthetics, Vol. 29, No. 2, June 1975. </li> <li> "Ultralight Prostheses for Below-Knee Amputees," A. Bennett Wilson Jr., Melvin L. Stills, Orthotics and Prosthetics, Vol. 30, No. 1, March 1976. </li> <li> "Use of Thermoplastic Components in Temporary Prostheses," Charles H. Pritham, Ivan E. Letner, David Knighton, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Applications of Transparent Sockets," S.I. Reger, I.E. Letner, CH. H. Pritham, M.D. Schell, and W.G. Stamp, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "Above-Knee Polypropylene Pelvic Joint and Band," Erich Fischer, Orthotics and Prosthetics, Vol. 30, No. 4, December 1976. </li> <li> "A Lightweight Above-Knee Prosthesis with an Adjustable Socket," George Irons, Vert Mooney, Sandra Putnam, Michael Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Welding Plastics," Neil R. Donaldson, Michael J. Quigley, Orthotics and Prosthetics, Vol. 31, No. 1, March 1977. </li> <li> "Functional Partial-Foot Prosthesis," Gustav Rubin, Michael Danisi, Bulletin of Prosthetics Research, BPR 10-16, Fall 1977. </li> <li><a href="http://www.acpoc.org/library/1972_06_003.asp"></a> <a href="http://www.acpoc.org/library/1972_06_003.asp">"A Functional Chopart Prosthesis," Gustav Rubin, Michael Danisi, Inter-Clinic Information Bulletin, Vol. 11, No. 6, March 1972.</a> <a href="http://www.acpoc.org/library/1972_06_003.asp"></a></li> <li><a href="http://www.acpoc.org/library/1972_10_009.asp"></a> <a href="http://www.acpoc.org/library/1972_10_009.asp">"Vacuum-Forming Techniques & Materials in Prosthetics & Orthotics," Alex Artamonov, Inter-Clinic Information Bulletin, Vol. 11, No. 10, July 1972.</a> <a href="http://www.acpoc.org/library/1972_10_009.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"A Foot Amputation Orthosis-Prosthesis," H.J. Ruben-stein, G.J. Sweeney, P. Strong, G. Durrett, Inter-Clinic Information Bulletin, Vol. 14, No. 4, April 1975.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <a href="http://www.acpoc.org/library/1975_04_011.asp">"Partial Foot Amputation-A Case Study," Charles H. Pritham, Newsletter. . . Prosthetics and Orthotics Clinics, Vol. 1, No. 3, Summer 1977.</a> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li> Manual for an Ultralight Below-Knee Prosthesis, A. Bennett Wilson, Jr., Charles H. Pritham, Melvin L. Stills, Rehabilitation Engineering Center, Moss Rehabilitation Hospital-Temple University-Drexel University (1977). </li> <li> The Rancho Ultralight Below-Knee Prosthesis, Michael Quigley, George Irons, Neal Donaldson, Rehabilitation Engineering Center, Rancho Los Amigos Hospital County of Los Angeles, University of Southern California (1977). </li> </ol> Page Number(s) 5 - 6 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Vacuum Forming Creator An entity primarily responsible for making the resource Ben Wilson https://staging.drfop.org/files/original/d73a255fee4b364de1484751b0070bc2.pdf f4268f1f8160ca988e58b8d68c70e4d7 https://staging.drfop.org/files/original/9cd3809f346695203e049ecda06076b9.jpg 4a70f8736bfa8404d75ca3f32d5a0525 https://staging.drfop.org/files/original/fe34c6884c1d4f9cd65bd37a903a8070.jpg b70af2800e997203f2319c46296de5b7 https://staging.drfop.org/files/original/30a3a403da09b29c8a7c41ae21ae5364.jpg 8449acd023022b2f713fc97fc94bb381 https://staging.drfop.org/files/original/a6edecd2ad6203347d70e896ca018d83.jpg 9ce2a9f49884881e3a6ed64718708be7 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/1986_02_082.pdf Text Any textual data included in the document <h2>Voluntary Closing Control: A Successful New Design Approach to an Old Concept</h2> <h5>Bob Radocy, M.S.T.R. <a style="text-decoration: none;">*</a></h5> The arrival in early 1980 of the "Prehensile Hand,"<a></a> a new design and concept for terminal devices, sparked a revitalized interest in body power and voluntary closing control. Voluntary closing control and terminal devices are not new to prosthetics, but little interest in this system and technology has existed since the 1950's. Retrospectively, voluntary closing control never achieved dramatic success nor did it have any permanent, positive influence on the direction of upper-extremity prosthetic development until recently, meaning 1980-1985. The acceptance and success of the "GRIP,"<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg">Fig. 1</a>) and more recently the children's "ADEPT"<a></a> terminal devices, are strong indicators that voluntary closing control is an extremely viable concept. Furthermore, it confirms previous opinions that poor performance characteristics, reliability factors, and the inappropriate design criteria of early volunteer closing control systems and terminal devices<a></a> were responsible for the demise of voluntary closing systems and correspondingly for the dominance of voluntary "opening" control systems and terminal devices in the profession today. <a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg">Figure 1. (Top to bottom) GRIP I, GRIP II, ADEPT B, ADEPT C, and ADEPT I.</a> This is not to say that voluntary closing devices and systems were not put to excellent use by certain amputees, but that they failed to appeal to the majority of the upper-extremity limb deficient population, i.e. the traumatic or congenitally limb deficient below-elbow unilateral amputee. The standard voluntary opening split hook has continued to be the primary body-powered prescription, while experience now strongly illustrates that correctly designed voluntary closing terminal devices offer superior performance to the limb deficient. Training is no more difficult with voluntary closing; gripping force range is expanded and directly proportional to output, reflex grasping actions are improved, muscles of the affected limb and shoulder are utilized continuously and more effectively, and "feedback" sensations (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.jpg">Fig. 2</a>) are produced inherently<a style="text-decoration: none;">*</a> and are more easily assimilated, thereby enhancing control, than in voluntary opening systems. The mere fact that children three to six years of age have accepted the concept and have either learned with or converted to voluntary closing control and achieved good to excellent performance should open the minds of even the most conservative in our profession as to the value of the voluntary closing control prescription. Recently, we have seen and heard a great deal about the success of myoelectric devices for children and how a child's performance is improved with myoelectric systems as compared to "body-powered" systems.<a></a> Unfortunately, body power in these comparisons refers only to the voluntary opening split hook systems, and not to voluntary closing systems. It is my firm belief that, if given proper training, limb deficient children will perform as well or better with voluntary closing body powered systems than with myoelectric systems. Furthermore, considering the cost and reliability of externally powered limbs, voluntary closing body powered terminal devices should be prescribed as the primary complements to external powered units, rather than voluntary opening split hook systems. The logic for this assertion is simple. First, muscles of the torso and limb are used more actively with the voluntary closing system, and healthy, strong muscles can only enhance externally powered control and utilization. Second, the new designs in voluntary closing terminal devices offer an opposed thumb and finger gripping configuration, similar to powered hands, enabling the user to incorporate already "learned" patterns of gripping behavior, rather than having to constantly switch patterns of grasp to accommodate "split hook" prehension. Third, children with voluntary closing systems can achieve gripping prehension which equals or exceeds their anatomical capabilities, while voluntary opening systems remain inferior in this area. Comparable prehension bilaterally can only encourage bilateral function and increase prosthetic usage, two primary goals in prosthetic rehabilitation. The success of voluntary closing systems can be related to the design rationale and criteria of the 80's systems. Rationale and criteria are as follows: <ol> <li> Utilize an accepted natural prehension configuration. Previous studies indicate that cylindrical, palmar, and lateral are the most often used gripping patterns.<a></a> Opposed thumb and forefinger prehension satisfies these patterns. </li> <li> Design gripping shapes and surfaces to allow for a wide variety of holding tasks. Complementary curved gripping surfaces enhance cylindrical control and are especially important due to the vast numbers of curved object surfaces we handle daily (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-3.jpg">Fig. 3</a>). Additionally, a "clevis" tip configuration imitates the three point chuck of the thumb, index and long finger, important for utensil and implement control (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.jpg">Fig. 4</a>). </li> <li> Emphasize a simple, anesthetic, easily maintained, reliable design that can be understood and accepted by the user- a design with positive psychological connotations, reflecting the capability of the user. </li> <li> Incorporate passive support and suspension capacity (internal hook or bump) for carrying objects with handles or for supporting body weight while climbing or hanging. </li> <li> Require continuous control for grasping and holding to discourage muscle atrophy, enhance muscle development and allow for rapid reflexive grasping. Continuous control also creates an uninterrupted flow of pressure feedback information required for performance handling of objects. </li> <li> Select materials suitable for individualized age groups, rather than a single material for all models. Consider both the needs and the characteristics required for each population and design the model accordingly for each targeted group. </li> <li> Consider weight as a factor, but balance the need for light weight against the strength requirements for the terminal device. Also consider the tolerance the need for light weight against cause variation in age and corresponding tolerances vary. </li> <li> Redesign models as necessary to better answer the needs of the population they serve. </li> </ol> Exclusive of these criteria, a variety of factors exist which have aided the reintroduction of voluntary closing systems and which will increase the use of these systems in the future. Compatibility, harnessing, prosthesis design, proper rehabilitation and weight conditioning are all important if good to excellent prosthetic use is to be achieved. Voluntary closing terminal devices are compatible with all standard prosthetic components. Minor cable modifications or adjustments are usually required to optimize the user's energy output. Unlike previous voluntary closing designs, the user is harnessed under "controlled tension" rather than into a "no tension" system. Accordingly the thumb of the terminal device is not fully open, but pulled partially closed when the arms are relaxed at the user's sides. This tension harnessing allows for improved control of objects, during initial training, and while objects are manipulated close to the medial line of the body. Harnessing should be as simple as possible. A modified Northwestern #9 when possible is excellent, utilizing a ring and "rapid adjust" type buckle.<a></a> This harness system will enhance range of motion control at the shoulder, improve object manipulation overhead, and enable quick excursion adjustments. Prosthesis design should lean towards self suspending (supracondylar) sockets to minimize harnessing. Modified Muenster, Otto Bock, and similar designs can be employed depending on the limb's morphology. New designs such as ISNY or similar flexible sockets may also prove valuable. New patients should be educated in range of motion and pre-prosthetic exercise techniques.<a></a> This is especially important for traumatic limb loss and in instances where complete rehabilitation was lacking and the shoulder girdle and upper limb-musculature is weak and atrophied. Similar atrophication can occur due to disuse of the prosthesis or lack of vigorous bilateral use. Initially, muscle soreness at the shoulder may be experienced by the converting amputee, or the new amputee undergoing rehabilitation. This early soreness is a positive sign of muscle rejuvenation and should be regarded as improved health. However, long term muscle aggravation and soreness may be an indicator that the prosthetic system is not operating optimally. Prior to prosthetic fitting and after initial rehabilitation with the new voluntary closing prosthesis, weight training can be encouraged. Pre-prosthetic training can be accomplished by a knowledgeable therapist and should include a range of motion exercises, dynamic tension, and active bilateral resistance exercises using cuff weights, specialized training equipment, or a simple weight harness in conjunction with dumbbells. Post-prosthetically, the voluntary closing terminal device is capable of handling adjustable resistive weight equipment or free weights, although the former are easier to use, safer, and enable rapid, satisfactory results. An emphasis on strength and endurance conditioning rather than muscle building is suggested due to the needs for adequate range of motion in prosthetic control. This dictates lower resistance loads with more repetitions of exercises. Special applications for voluntary closing systems have also arisen in recent years. Brown<a></a> has achieved excellent success in patients with partial hand amputations. The success, I believe, is due to the common sense simplicity of the prosthesis and harness design, and the utility of the terminal device, which allows prehension in excess of 100 lbs. This amount of gripping force enables the partial hand amputee to be functionally bilateral in a manual working environment. Other terminal devices applied to the case of partial hand amputation cannot offer all the advantages of the new voluntary closing systems. Obviously, the partial hand prosthetic user will not wear the prosthesis all the time, but it is an effective functional tool for many occupations. The increased potential may enable the partial hand amputee to maintain an existing vocation rather than consider retraining for an entirely new occupation. In summary, the new voluntary closing systems offer a great deal of potential for the upper-extremity limb deficient of all ages. They can offer superior performance compared to any other systems, body powered or externally powered, and complement the externally powered prescription, when cosmesis is the primary consideration and function considered only of secondary importance. Voluntary closing systems are not a cure-all for the upper limb deficient individual, and the system is not applicable to everyone, even though all types and levels of amputees including bilaterals have used the technology successfully (excluding shoulder disarticulates). Success also has a lot to do with the attitude of the amputee and the capability of the rehabilitation team, including the prosthetist. Voluntary closing systems will continue to increase in popularity because the technology is reliable, improves performance, and more closely imitates the natural system. The voluntary closing systems will also continue to improve as more innovative research and development in better "total" body powered and hybrid body powered/external powered prosthetic technology evolves. References: <ol> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Klopsteg, Paul E. and Philip Wilson, Human Limbs and Their Substitutes. Hafner Publishing Company; New York. 1964. Reprint of 1954 Edition by McGraw Hill Company.</li> <li>Weaver, S.A. and L.R. Lange, "Myoelectric Prostheses versus Body Powered Prostheses with Unilateral, Congenital, Adolescent, Below-Elbow Amputees," American Orthotic and Prosthetic Association National Assembly Scientific Presentation on October 16, 1985.</li> <li>Mann, R.W., "Evaluation of Energy and Power Requirements for Externally Powered Upper-Extremity Prosthetic and Orthotic Devices," American Society of Mechanical Engineers. Publication No. 62-WA-121, 1962.</li> <li>Radocy, Bob, "The Rapid Adjust Prosthetic Harness," Technical Note, Orthotics and Prosthetics, Volume 37, No. 1, pp. 55-56, 1983.</li> <li>Bates, Marion D. and J.C. Honet, "Isometric Exercises for the Upper-Extremity Stump," Physical Therapy, Volume 44, No. 12, pp. 1093-94, December 1964.</li> <li>Deaver, G.G. and E.H. Daniel, "The Rehabilitation of the Amputee," Archives of Physical Medicine, Volume 30, No. 10, p. 638, October 1949.</li> <li>Gullickson, G. Jr., "Exercises for Amputees," Therapeutic Exercise, 2nd Edition. Sidney Licht, Editor, pp. 581-640.</li> <li>Klopsteg, D.E. and P.D. Wilson, Human Limbs and Their Substitutes, Hafner Publishing Co., pp. 739-756, 1968.</li> <li>Reilly, G.V., "Preprosthetic Exercises for Upper Extremity Amputees," The Physical Therapy Review, Volume 31, No. 5, pp. 183-188, May 1951.</li> <li>Olivett, Bonnie L., "Management and Prosthetic Training of the Adult Amputee," Rehabilitation of the Hand, 2nd Edition, C.V. Mosby, 1984.</li> <li>Brown, Russell D., "An Alternative Approach to Fitting Partial Hand Amputees," Orthotics and Prosthetics, Volume 38, No. 1, pp. 64- 67, Spring 1984.</li> <li>Radocy, Bob and Ronald E. Dick, "A Terminal Question," Orthotics and Prosthetics, Volume 35, No. 1, pp. 1-6, March 1981.</li> </ol> *Bob Radocy, M.S.T.R. Bob Radocy, M.S.T.R. is President of Therapeutic Recreation Systems (TRS), Inc. 1280 28th Street. Suite 3, Boulder, Colorado 80303-1797. Footnote A major objective of externally powered systems is to develop a reliable 'feedback' system for improved prehension control. Voluntary closing, body-powered systems offer the feedback system inherent in the design. Page Number(s) 82 - 86 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.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 Voluntary Closing Control: A Successful New Design Approach to an Old Concept Creator An entity primarily responsible for making the resource Bob Radocy, M.S.T.R. * 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? 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For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_02_082.pdf Text Any textual data included in the document <h2>Wheelchairs for Paraplegic Patients</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a></h5> The best current estimates of the incidence and prevalence of spinal cord injury in the U.S. is 30-32 and 900 cases per million of population respectively.<a></a> About half of these cases are paraplegic. Added to this are paraplegics due to spina bifida, a few polio cases, etc. By definition, paraplegics have to rely on one or more assistive devices if mobility is to be achieved. Only a small segment of the paraplegic population make use of lower-limb orthoses, and even those who do have orthoses, and use them, need a wheelchair as well, in order to make the most of their available energy. For the very few who can "walk" enough not to feel the need for a wheelchair in work and activities of daily living, wheelchairs permit participation in athletic activities that would otherwise be impossible. Wheelchairs can be classified as either "manual" or "powered". The manual wheelchair is designed to be propelled by the occupant or by an attendant. Tests have shown that the energy cost of using a manual wheelchair for mobility on a smooth, level surface can be appreciably less than that of unimpaired persons walking on the same type of surface.<a></a> The conditions, of course, are reversed when uneven surfaces or ascending surfaces are encountered. The "powered" wheelchair is designed to be propelled by a battery-powered electric motor or motors. Originally conceived to be used by patients unable to propel themselves, powered chairs are sometimes indicated so that a paraplegic can make more effective use of his own energy. The basic manual wheelchair has two side-frames connected by a cross-bar that is pivoted about its intersection and a flexible seat and back to allow folding, two large driving wheels at the rear, and two caster wheels at the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg">Fig. 1</a>).<a></a> This is a configuration that has evolved over the years since the original patented design of Everest and Jennings<a></a> in 1936 for the folding mechanism, and represents a rather elegant compromise between maneuverability, stability, and portability. Many concerted attempts, especially in recent years, to develop better designs have not been very successful. The use of new materials has made it possible to produce significantly lighter wheelchairs, but the original configuration is basically the same. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg">Figure 1. The basic wheelchair-folding frame, 24-inch diameter wheels in the rear, 8-inch diameter casters in the front, flexible seat and back.</a> It must be remembered that a change in the design to emphasize one feature generally affects adversely one or more of the other features. An example is when the wheelbase of the basic chair is lengthened to provide more stability for the bilateral leg amputee; maneuverability is sacrificed. Designers of some of the "sports" chairs, in order to reduce weight, have eliminated the folding mechanism. Portability is achieved by connecting and disconnecting driving wheels for transport in an automobile. <h3>Prescription Considerations</h3> Variations of the basic chair are available for amputees, hemiplegics, and others, but the basic chair of proper dimensions is generally the most suitable for paraplegic patients. The range of dimensions of the basic wheelchairs available in the United States are shown in<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg"> Fig. 2.</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg">Figure 2. Dimension ranges for the basic adult wheelchairs from major U.S. manufacturers.</a> Even when sensation is present, the hammock type seat is seldom used without cushions, which are needed to provide a better distribution of pressure over the thighs and buttocks for comfort, if for no other reason. Cushions and other seating systems affect the relationship between the user and the chair and, therefore, must be selected and taken into account before the final dimensions of the chair are determined. The importance of selecting the most appropriate chair and seat cushion cannot be over emphasized. The dimensions of the chair must distribute the forces of the body properly while also placing the user in a position, with respect to the driving wheels, to provide maximum efficiency during propulsion. <h3>Seat Width And Depth</h3> Selection of the proper seat width is important to comfort and stability. A seat that is too narrow is not only uncomfortable, but access to the chair is made difficult. Furthermore, the chances of pressure sores developing is increased. A seat that is too wide encourages the user to lean toward one side, thus promoting scoliosis and increased pressure over the buttocks on one side. In addition, a seat wider than is necessary makes propulsion more difficult. A seat that is too shallow reduces the area in contact with the buttocks and thighs and causes more pressure on the soft tissues in contact with the seat than is necessary or safe. Furthermore, the location of the footrests is changed so that the feet and legs are not supported properly, and the balance of the user can be affected. A seat that is too long can restrict circulation in the legs. <h3>Seat Height</h3> The height of the seat above the ground of the basic adult chair is 19 1/2 - 20 1/2 inches. Tall persons require a seat that is higher and deeper; short persons require a seat that is lower. Usually these requirements can be met by a stock chair; if not, properly dimensioned units can be had on special order. Obviously, the cushion or seating system to be used will affect the end result. <h3>Seat Type</h3> Seats available from wheelchair manufacturers are sling or hammock types, made of a flexible material, and solid seats which are generally removable (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg">Fig. 3</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg">Figure 3. Seat types-a. hammock or sling; b. solid.</a> The sling seats are, by far, the type most used. A solid seat installed to permit folding is available, or a removable solid wooden seat may be purchased or made. <h3>Backrest</h3> The backrest of the basic chair is made of a flexible material stretched between the two side frames which are fixed with respect to the seat. The backrest should be high enough to provide support without inhibiting motion, yet not so low that the scapulae can hang over the back of the chair and cause discomfort. <h3>Arms</h3> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg">Fig. 4</a> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg">Figure 4. The basic wheelchair with the most popular types of arms-removable full-length, removable desk-type, and removable, adjustable desk-type.</a> The lightest chairs have fixed arms or none at all. But an overriding factor in wheelchair prescription is transfer into and from the wheelchair, especially when the patient is unable to stand for a brief period. For this reason, most patients require chairs with arms that can be removed easily. Chair arms not only provide support for the patient's arms in a resting attitude, but also provide lateral support and a reaction point for the hands when the asensitive patient elevates his body at regular intervals to prevent restriction of circulation and thus pressure sores. Both removable and fixed arms are available in full-length and desk models; both of these styles are available with the height fixed or adjustable. The desk models are foreshortened to permit the user to get closer to a desk or table top. The removable desk arm is by far the most popular type. The full length models are indicated when the forepart is needed to support the arms of the user in rising from the chair, or when lordosis, obesity, or some other physical factor makes it necessary to use the front part of the arm for support. The standard removable desk model can be reversed to provide this feature. <h3>Wheels And Tires</h3> The basic chair has two 24 inch diameter rear wheels and two eight inch caster wheels in the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg">Fig. 5</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg">Figure 5. Basic wheelchair with standard 24-inch diameter wire-spoke wheel and two options: the cast magnesium wheel and a wheel with special built in hand rim.</a> The standard rear wheel for many years has been a wire spoke wheel, but wheels of cast metal alloy and wheels of cast plastic have been made available recently to overcome the maintenance problems inherent in the wire wheel design without adding more weight. Three types of tires are available in several widths and tread types. Pneumatic, semi-pneumatic, and solid tires are available (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg">Fig. 6</a>). The eight inch diameter wheel with solid rubber tires is standard on the basic chair, and is suitable for use on smooth surface and indoors. The semi-pneumatic and pneumatic tires provide shock absorption, and, thus, are more suitable for rough surfaces and outdoor use. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg">Figure 6. Basic wheelchair and optional casters available. Shown on the chair is the standard 8-inch diameter wheel with solid rubber tire. Next in order are: the 8-inch wheel with the semi-pneumatic tire; the 8-inch wheel with pneumatic tire; a 5-inch diameter wheel with solid rubber tire.</a> Pneumatic tires provide a more cushioned ride and their shock absorber action tends to prolong the life of a wheelchair when kept inflated properly. <h3>Handrims</h3> Handrims are attached to the driving wheels of wheelchairs to permit control without soiling the hands. The standard handrim is a circular steel tube. For users who have problems gripping the smooth surface of a metal ring, vinyl coated rings and a variety of knobs and projections can be added to the ring. <h3>Casters</h3> Casters make steering possible and are available in two diameters: eight inches and five inches. The five inch model is available only with solid tires, and is used on children's chairs and in special circumstances on adult chairs and basketball chairs, when more maneuverability is desired. <h3>Parking Locks</h3> Most users need some means of securing one or more wheels to keep the chair from rolling down inclines or to provide stability during transfer to and from the chair. Two types of parking locks are available from the large wheel (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg">Fig. 7</a>): toggle and lever. Selection depends upon user preference. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg">Figure 7. Two types of parking locks-left, toggle type; right, lever type. Variations of these two types of locks are available.</a> Pin type locks are also available. These retain a caster in the trail position and are used to prevent swiveling during lateral transfer. <h3>Cushions</h3> The vast majority of paraplegics require, and can use successfully, seat cushions that are mass produced and are widely available at reasonable prices. A great many designs of seat cushions are available. Some have been developed by trial and error, the designs being based on what has proven to be acceptable to the inventor or his customers; other designs have a more scientific basis, but because the exact cause of decubitus ulcers is not known, precise criteria for design of wheelchair seating have not been established.<a></a> Although each of the cushion designs available has advantages and disadvantages, most of which are not clearly defined, selection of seat cushions for individual cases is seldom simple or straightforward. Commercially available cushions may be divided roughly into five categories, including "miscellaneous" or "other", based on material and design (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg">Fig. 8</a>). <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg">Figure 8. Various types of seat cushions that are available.</a> <ol> <li> Foam </li> <li> Viscoelastic foam </li> <li> Gel </li> <li> Fluid </li> <li> Other </li> </ol> Foam Cushions Foam cushions generally use polyurethane or polyether foam, and are available in various configurations. The simplest are homogeneous rectangular blocks 2-4 inches thick; some are contoured; and others are composed of two or more layers of material of different densities, some of which may contain hollow spaces or cores in an attempt to distribute the load to specific areas. Viscoelastic Foam Cushions Viscoelastic foam is less resilient than ordinary foam. Gel Cushions Gel cushions consist of rather firm emulsion enclosed in a "non breathing" plastic casing. Fluid Flotation Cushions Water, air, or water-and-foam particles are used in a flexible, tailored plastic bag to provide distribution of forces. The overall effect varies with the amount of fluid introduced. Other Types Many other designs that combine several elements are available. Prominent among these are the ROHO, which uses a collection of air-filled tufts to distribute the loads and the VASIO (Veterans Administration Spinal Injury Orthosis), in which foams of two different densities are combined and contoured to meet the special needs of paraplegic patients. Each type and design has advantages and disadvantages, and, therefore, selection of the type most appropriate for individual patients is not easy. Until more is known, selection has to be made on a trial basis. <h3>Sports Chairs</h3> Since the introduction of wheelchair basketball shortly after World War II, a constant stream of modifications and refinements has been made to the basic wheelchair to meet the needs of wheelchair athletes. Development of the lightweight, high-performance, sports chair has led to racing among wheelchair users and has made playing tennis from wheelchairs practical and enjoyable. These chairs have also been found useful in non-competitive recreation, such as camping and mountain climbing. Much that has been learned in developing and using sports chairs has resulted in improved performance and quality of prescription wheelchairs, just as automobile racing has led to improvements in the family car. At the same time, many of the people who have been using conventional wheelchairs are now using sports chairs full-time. Like the basic prescription wheelchair, the sports chair (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg">Fig. 9</a>) has evolved through a series of refinements to where the general configurations of most chairs are strikingly similar. At least 20 manufacturers at this time offer one or more models. Most use 24 inch diameter wheels; some use 27 inch wheels. Weight varies from 16 to 38 pounds, due mainly to material selection and whether or not the chair can be folded. A number of designs incorporate provisions for folding; Others use wheels that can be disconnected (and connected) quickly without tools to make transportation easier. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg">Figure 9. Three types of sports chairs. The one shown at the top is limited primarily for use in racing. The other two are more versatile.</a> Nearly all use five inch diameter front castors, except one manufacturer that uses four inch wheels. Two make eight inch castors available as an option. Nearly all, if not all, have a feature that permits a choice of rear wheel axle position with respect to the frame (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg">Fig. 10</a>). Only a very few offer arm rests. <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg">Figure 10. Schematic showing adjustability often found in sports chairs that permit an optimum relationship between position of the user and the wheels.</a> Many active wheelchair users prefer to use a sports type chair all the time, and in many instances options are offered that make regular use practical. Many models have adjustable features, and most manufacturers will provide a chair with dimensions to suit a given individual. A feature found on most sports chair, but not on other types, is the easy adjustability of wheelbase and seat height afforded by the positioning plate for the rear wheels. In many models, the position of the castor wheels can also be adjusted. Such adjustability, of course, permits the user to be seated in a position which puts the muscles in the upper limbs and shoulders in the optimum arrangements for maximum biomechanical efficiency. Because refinements and advances are being introduced so frequently, the periodical SPORTS 'N' SPOKES, published by the Paralyzed Veterans of America, has been devoting one issue each year to sports chairs and their specifications.<a></a> <h3>Summary</h3> Because of increased competition and refinements brought about by the sports chair movement, paraplegics now have available high quality wheelchairs. No single chair design is apt to meet all the needs of each individual, but careful thought and attention to detail in prescription preparation can result in a chair that meets most of the needs of the paraplegic. References: <ol> <li>Cochran, George Van B. and Vincent Palmieri, "Development of Test Methods for Evaluation of Wheelchair Cushions," Bulletin of Prosthetics Research, 10-22, 17:1:9-30, Spring 1980.</li> <li>Everest, H.A., et al., U.S. Patent No. 2,095.411, October 12, 1937.</li> <li>SPORTS 'N' SPOKES, 5201 N. 19th Avenue, Suite 111, Phoenix, Arizona 85015.</li> <li>Grimby, Gunnar, "On the Energy Cost of Achieving Mobility," Scand. J. Rehab. Med., Supplement 9, 1983, pp. 49-54.</li> <li>University of Alabama at Birmingham, Spinal Cord Injury Project, "Spinal Cord Injury - The Facts and Figures," 1986.</li> <li>Wilson, A. Bennett, Jr., Wheelchairs: A Prescription Aid, Rehabilitation Press, Charlottesville, VA, 1986.</li> </ol> *A. Bennett Wilson, Jr. A. Bennett Wilson, Jr. is an Associate Professor with the Department of Orthopedics and Rehabilitation at the University of Virginia, Charlotteville, Virginia 22908. Page Number(s) 82 - 90 Year 1987 Volume 11 Issue 2 Figure 2 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.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 Wheelchairs for Paraplegic Patients Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * https://staging.drfop.org/files/original/feebebaa37399c3b95576ae8e7aa803a.pdf e216245824105b9041905d276496dc47 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1965_01_001.pdf Year 1965 Volume 13 Issue 1 Page Number(s) 1 - 12 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1965_01_001.pdf"></a></td> <td></td> <td><a href="al/pdf/1965_01_001.pdf">View as PDF</a></td> </tr> <tr> <td>with original layout</td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Whither Prosthetics and Orthotics?</h2> <h5>George T. Aitken, M.D. <a style="text-decoration:none;">*</a> </h5> The publicity concerning scientific and technical advances keeps us constantly aware of man's increasing competence to master his environment. The technologies available make possible a wide variety of mechanisms that expand man's sphere of activity and make possible comfortable living in environments previously considered undesirable. Some of the modern techniques, when applied in the biological fields, have eliminated some diseases, controlled others, and have made possible medical and surgical procedures that extend the life expectancy of persons of all ages. Continuing research undoubtedly is going to demonstrate eventually the etiological factors in other disease entities and thus permit the development of a nonsymptomatic approach to therapy. Many of the current scientific advances have been the result of interdisciplinary effort, where two or more separate disciplines have worked together, hopefully synergistically. This interdisciplinary effort in prosthetics and orthotics has produced what is often described as a bioengineering effort. In the past twenty years increasing emphasis has been placed on the engineering aspects of this specific problem. These years have witnessed a rapid advance in the development of new industrial materials and hardware that have been readily applicable to artificial limbs and braces. Many improvements in previous fabrication techniques and components were facilitated by using these newly available industrial developments, and thus some advances were made in upgrading the quality of prosthetic and orthotic devices. There have been varying degrees of concurrent fundamental research in the biological aspects of this interdisciplinary approach. It seems at times, though, that the glamour of technology has overshadowed the purely biological problems. Research activities involving these glamour areas have been more attractive to many, and funds for such research have been more available in these sometimes esoteric areas. At times it would seem that many involved in prosthetics and orthotics research and development have failed to see the entire problem. Basically, it is the problem of achieving the optimum man-machine interface. The ultimate resolution of the problem is the production of designs that result in comfort, maximum function, and reasonable cosmetic restoration. There is little question that much has been accomplished. Certainly we have available currently biological and engineering techniques that are capable, in a high percentage of cases, of producing improved function and cosmesis. Continuing intelligent modification of techniques and components produces more and more improvement in all of these areas. It is fair to assume that amputees and others with orthopaedic impairments are now better served than ever before. Unfortunately, many in the field of prosthetics and orthotics research and development seem to have a tendency to relegate the patient to a secondary position. They appear to be bent on the perfection of the machine without due consideration to the education or alteration, or both, of the man to perfect the interface. It seems timely to give consideration to some of the areas in which continuing, accelerated investigation is desirable. Research in amputation surgery to provide more functional stumps and consequently more comfort to the patient has been significantly lacking. There is a multiplicity of amputation techniques. Myoplastic and osteoplastic techniques either alone or in combination have been recommended to promote comfort and improved function. In this country there has been no well-organized clinical evaluation of these claims made primarily from abroad. It seems logical that such procedures be investigated and evaluated thoroughly. There are good theoretical reasons to justify consideration of these procedures so that they not be simply rejected because of dissimilar training and experience. Cineplastic procedures were critically investigated, and well-established criteria have been developed for their use. A similar review should be made of some of the other surgical problems. The immediate postsurgical fitting of sockets with or without early weightbearing currently is being investigated. Undoubtedly, the results of this wellorganized investigation will develop proper indications and techniques for this procedure. Hopefully, such techniques will be of positive value in influencing the man aspect of the man-machine interface. There are in addition many areas of basic biological research that need further investigation. The problem of biological signal sources for control of external power comes to mind immediately. Other, perhaps less exotic, problems, such as analysis of joint motions to permit more satisfactory alignment and construction of braces, or the metabolic problems incident to amputation and use of prostheses as well as analogous problems in the orthotics field, need further investigation. These are but a few of the many fundamental problems that need clarification. In the truly engineering area, there is a large volume of continuing research and development of systems, components, and techniques to produce better artificial limbs and better braces. Much of this work is in the newer areas of technology and has increasing emphasis on the problems related to the use of external power in prostheses and orthotic devices. There may be a need to review some of our accepted designs in the light of our recent progress and perhaps an effort should be made to determine whether previously acceptable items are really the best that can be developed in relation to some of our improvements in materials and techniques. It may be the time to review terminal-device design. It is possible that we now need (particularly in the light of external power) to redefine the functional requirements of a terminal device and arrive at some design criteria that will permit more efficient utilization of our technical improvements in power sources and transmission. With an increasing emphasis on prosthetic restoration in congenitally limbdeficient children, it may develop that there must be a redefinition of goals, in the case of the upper-extremity patient, as related to age, rather than as related to the needs of an adult. Possibly a careful analysis of the functional needs of pre-school and primary and secondary school children would permit us to develop components for a system that would be more effective than simply using scaled-down adult components and systems. An overall review of research and development in prosthetics and orthotics over the past twenty years cannot help but emphasize that people requiring prostheses and orthotic devices are being increasingly better served. There seems little question but that the efforts of our schools of prosthetics and orthotics education have produced a marked upgrading of the skills in prescribing and fitting these devices as well as greater competency in the training of the patient in the use of such devices. As a clinician, I am very pleased with the improvement of patient care in these areas. As an interested participant in research and development endeavors, I am increasingly aware that there is much more that remains to be done. There exist the technical facilities to do both better research and better development. What is needed is the wisdom to direct our efforts in such a way that we adequately explore all areas of this man-machine problem and so correlate our activities that the result—the functioning man-machine combine— is a continually improving biomechanical unit. <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;">George T. Aitken, M.D. </td></tr><tr><td class="clsTextSmall">Chairman, Committee on Prosthetics Research and Development, July 1, 1962-June 30, 1965. Upon completion of his term as Chairman of CPRD, Dr. Aitken will continue to serve as a member of CPRD.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Whither Prosthetics and Orthotics? Creator An entity primarily responsible for making the resource George T. Aitken, M.D. * https://staging.drfop.org/files/original/2758dcc8f04d4645d2251d024de4b117.pdf 47ba774f7aaadae410bf2c3710d4d082 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_03_114.pdf Text Any textual data included in the document <h2>Winter Sports for the Amputee Athlete</h2> <h5>Doug Pringle <a style="text-decoration: none;">*</a></h5> Organized participation in winter sports by people with disabilities has a relatively short history. It began in the early 1950s when amputee veterans of World War II began to experiment with skiing despite the loss of limbs. The West Germans are credited with the invention of the outrigger, a crutch with ski tips attached, which are used as balance assisters. This invention helped popularize the sport and several amputee ski clubs were formed in the United States. During the late 50s and early 60s, amputee skiing was the mainstay of the sport. It was during the late sixties and early seventies that others with one "bad" leg, such as polio victims, began to ski using the technique developed for amputees. It was also during this time that amputees began experimenting with skiing with a prosthesis. Simultaneously, visually impaired people began to participate and the sport began to include more than amputees. In the late 70s, the major innovation was development of the "Four-Track" technique, which allowed many types of severely disabled people to ski. The 1980s have contributed the technique known as 'sit skiing.' This technique allows people who are wheelchair bound to participate in the sport. The benefits of participation in skiing are numerous. Physically the participant develops stamina, strength, balance, and coordination. These are all valuable physical traits for a person trying to compensate for a physical problem. Psychologically, participants begin to develop a positive self-image and a "can do" attitude. This positive thought cycle carries over into other aspects of life such as education and employment. Skiing offers a unique opportunity as a sport that can be done with family and friends in a facility open to the public. In that sense it is a mainstreamed activity done with everyone else rather than in a special facility. Finally, there is something wonderful and invigorating about the freedom of movement, speed, risk, and the natural environment of skiing. All these add to the experience. Skiing is the only winter sport offered to people with disabilities through formal programs. These programs offer adaptive equipment, qualified instruction and a competition system. Participation in other winter sports is not extensive. <h3>Downhill Skiing</h3> Alpine Skiing Alpine (or downhill) skiing is the most popular winter sport of people with disabilities in the United States. There are approximately 10,000 disabled skiers. The sport offers unique benefits to participants who are mobility impaired, not the least of which is that gravity supplies the means for movement. The development of adaptive equipment and techniques has made it possible for even the severely disabled to participate. Adaptive skiing is divided into five major categories or techniques: <ol> <li> Three track skiing </li> <li> Four track skiing </li> <li> Blind skiing </li> <li> Sit skiing </li> <li> Other adaptive techniques </li> </ol> Three Track Skiing Above-knee and below-knee amputees, persons with polio or birth defects, and those with a variety of other problems, ski three track in which the common element is having one good leg and two good arms. Above-knee amputees ski without their prosthesis because it is difficult to control. Below-knee amputees can ski with their prosthesis. The advantage is that they can stand on it when stopped. The disadvantage is increased risk of injury. Adaptive equipment for three trackers are outriggers. Outriggers are forearm crutches with ski tips attached. They act as balance as-sistors and are used to "walk" on the flats. Three track skiing derives its name from the three tracks made in the snow by two outriggers and the single ski. Some three trackers, especially racers, learn to ski with ski poles instead of outriggers. In fact, that is how people with one leg skied before the invention of outriggers. While more difficult, "one tracking" is also a possibility for many and skiing with poles is an advanced instructional method. Four Track Skiing Four track skiing is used by people with a wide variety of disabilities including: double leg amputees, spina bifida, cerebral palsy, muscular dystrophy, multiple sclerosis, stroke, head trauma, paraplegia, and polio. An individual with two legs and arms, natural or prosthetic, who is capable of standing independently (static balance), or with the aid of outriggers, could use this method. Many severely disabled people ski using this technique. In addition to outriggers, a lateral stability device is often used. This device is commonly referred to as a "ski bra." It helps keep the skiis parallel and also allows the student's strong side to help control the weaker side. Blind Skiing Visually impaired students are taught the same as any other skier with the exception that the instructor must learn to communicate more clearly. A number of holds or assists have been developed as well. Once the student can ski, the task becomes one of guiding or talking them down the hill. No adaptive equipment is required for the visually impaired. Often the student and instructor (or guide) wear bright bibs which signal to other skiers to be alert. Sit Skiing Sit skiing is the technique used by anyone who cannot ski standing. Sit skiers include people with muscular dystrophy, multiple sclerosis, cerebral palsy, spina bifida, paraplegia, and quadriplegia. This technique has been used since 1980 and it has opened skiing to people who are wheelchair bound. The sit ski has a fiberglass shell and metal edges. It is steered by leaning the body and by dragging a "pole" on the side to which the skier wants to turn. An instructor skies behind the device holding a length of nylon mesh cord in order to stop the skier and to assist with turns when necessary. Sit skiers often become proficient enough to ski "untethered" or without the instructor and safety line. The most recent development in sit skiing is the mono-ski. Here the fiberglass shell is mounted on a single ski and the skier uses outriggers. Use of a mono-ski requires good upper body strength. Therefore, it is a technique that is not suitable to quadriplegics and high-level paraplegics. Other Adaptive Techniques This catch-all category is used for a variety of people with disabilities who don't fit into any of the other four. Among them are upper extremity impairment: people who have lost the use of one or both arms. Those with one good arm use one ski pole and a pole can also be used with an arm prosthesis. Below-knee amputees may choose to ski using their artificial leg or legs. A heel line is usually necesary to achieve a bent knee position. Waist straps and thigh lacers help provide lateral stability, a snug fit, and reduced pis-toning and rotation. A special ski leg can be made if the student decides to seriously pursue skiing. The combination of disabilities and adaptive equipment are numerous. In competitions, some 19 different classes are recognized. But, generally, most people ski using one of the four major techniques. Instruction There are a number of programs of ski instruction available. Most are voluntary, weekend programs. There are five full-time professional ski schools which specialize in adaptive skiing and about 25 voluntary ones. All but a few of these programs are chapters or affiliates of the National Handicapped Sports and Recreation Association (NHSRA). The NHSRA has also developed a clinic team which trains instructors in adaptive ski teaching. The team also advises on program delivery. There is an instructor testing and certification program conducted by NHSRA which is approved and recognized by the Professional Ski Instructors of America. Competition A natural outgrowth of participation in sports is the development of competition. A very well developed system is in place. Learn to Race clinics and training camps are conducted by a few of the instructional programs locally and by the NHSRA nationally. Those interested in competition can race in any number of programs open to the public such as NASTAR and United States Ski Association races. Further, there are ten sanctioned regional championships at which racers can qualify for the nationals. Both the NHSRA and U.S. Association of Blind Athletes conduct annual national championships. Both organizations also select athletes for the U.S. Disabled Ski Team which competes in the World Winter Games for the Disabled and the Winter Olympics for the Disabled. In 1986, the U.S. Disabled Ski Team was number one in the world at the games in Sweden. Resources National Handicapped Sports and Recreation Association 4405 East West Highway, Suite 603 Bethesda, MD 20814 U.S. Association of Blind Athletes Professional Ski Instructors of America 5541 Central Ave. Boulder, CO 80301 Alpine Skiing, contact: Vineland National Center P.O. Box 308 Loretto, MN 55357 <h3>Nordic Skiing</h3> Nordic (or cross country) skiing is also popular among people with disabilities. Since the sport does require more muscular effort for motion than Alpine skiing, it is not an option for some severely disabled individuals. Among the participants are amputees skiing with their prosthesis and some who ski on one leg. Those on one leg must rely upon upper body strength and use their poles to push themselves along. Nordic skiing is well suited for the visually impaired. They may ski with a guide or follow pre-set tracks in the snow. Some more severely disabled people who would be four-trackers in Alpine skiing, such as those with cerebral palsy, muscular dystrophy, multiple sclerosis, stroke, head injury, etc., can also participate in Nordic skiing if they are able to ambulate well. Some will require assistance, pushing or pulling with a rope, and frequent rest breaks are always a safe practice. There is a sit ski for Nordic skiing. The sit skier will need excellent upper body strength to push themselves over any appreciable distance. Again, assistance and rest stops will help. Instruction There are very few Nordic skiing instructional programs in the U.S. The sport is just beginning to develop. Those interested in learning the sport should check with a local cross country ski resort to see if they have an instructor willing and qualified. Most will have difficulty finding a program nearby. Competition The competition program described under Alpine skiing exists for Nordic skiing. Nordic events are held separately from Alpine events, but the U.S. Disabled Ski Team includes both Alpine and Nordic competitors. <h3>Other Winter Sports</h3> Snowmobiling has been a sport in which people with disabilities have participated for at least 15 years. It was one option open to more severely mobility impaired individuals before development of four track and sit skiing. Ice boating and bike sailing are adaptable to a wide variety of mobility impairments. Ice fishing can also be enjoyed by many people. *Doug Pringle Doug Pringle is the past president of the National Handicapped Sports and Recreation Association, 5946 Illinois Avenue, Organeville, California 95662. <div style="width: 400px;"> </div> Page Number(s) 114 - 117 Year 1987 Volume 11 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 Winter Sports for the Amputee Athlete Creator An entity primarily responsible for making the resource Doug Pringle * https://staging.drfop.org/files/original/5a1dda96e4178cd06649ab215cbbe0d5.pdf 916f9e9ed1caca96356f3a227150715d https://staging.drfop.org/files/original/8636aa4e4c5c07d52b8abe2b11b37b34.jpg d84ef6ba41e554dcba230d9df535077a https://staging.drfop.org/files/original/5b4a9dbd8c695c2a35af0d77111fe2c1.jpg 8fbbd755ed8145a65a43809e70417f90 https://staging.drfop.org/files/original/8487fa7a9496454abdd425b5a0d7785f.jpg f87e785df8826fce7f9b25bbfa02d214 https://staging.drfop.org/files/original/6d91bb58231e3290cbcf8e2dd6de2830.jpg 8c72ee75f68585c21747347b7c6d1307 https://staging.drfop.org/files/original/1b17acd6b2b5de624697430d6894d59e.jpg a0c575e50cf69d22a6c74b5be9757d31 https://staging.drfop.org/files/original/07792a7c6f21b09b088faf9389ca2610.jpg da7f539b8006bf431baa7e3e5b8122f7 https://staging.drfop.org/files/original/11eb68ee39aa5ebeb200cda4a27eeebc.jpg 20f231014dcb6fa69b27864fb3ffa898 https://staging.drfop.org/files/original/197c2d8a6200d52ac28aef88fcc77fdd.jpg 801b1962726d6ad8ef106424aca27645 https://staging.drfop.org/files/original/afdc0eb1a348faf2d0c27285bcbb337e.jpg fd18d6f8a478bd70ef313e66aa24f6d3 https://staging.drfop.org/files/original/2250f8e6296a64f9cab5e169d1c2b241.jpg 516066b6193dbe1c2a6b992facb1be90 https://staging.drfop.org/files/original/6a4612dbdc98238350b49fd1d433b615.jpg 198d5a4e6535b9269b942902bc83a6d6 https://staging.drfop.org/files/original/013bbfd894737f6f6987e68067760431.jpg f272ceb4a5cfc69133ef0090cd118908 https://staging.drfop.org/files/original/6b60e9da47923de26b69a07869eb13ed.jpg 889d26201fbd7450b4346f43c42da7ee https://staging.drfop.org/files/original/b6a47343d2d4db601a1452d432a910bb.jpg d57c642323cf7ae5fe5d51d3c25f34e0 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/1988_03_128.pdf Text Any textual data included in the document <h2>With a Spring in One's Step</h2> <h5>D.D. Murray, M.D. <a style="text-decoration: none;">*</a> W.J. Hartvikson <a style="text-decoration: none;">*</a> H. Anton <a style="text-decoration: none;">*</a> E. Hommonay, C.P.O.(C) <a style="text-decoration: none;">*</a> N. Russell, C.P.(C) <a style="text-decoration: none;">* </a></h5> <h3>Introduction</h3> In recent years, there has been a significant number of new developments in prosthetics in both North America and Europe. New concepts for socket molding, knee control, dynamic foot action, and the utilization of space-age materials have expanded prosthetic development and performance. The traditional prosthetic foot had a keel and an articulated ankle. This concept has modern derivatives with multi-axis ankles, but the principle remains the same. The S.A.C.H. foot design is that of the solid ankle and cushioned heel. By virtue of a compressible heel of a selected rubber density, the wearer achieves a simulated ankle motion at heel strike.<a></a> This design has been a mainstay in prosthetic fabrication for several decades. These feet are both essentially passive and accommodating. The Seattle foot, with its cushioned heel and keel spring action, stores energy through the stance phase of gait and releases it at toe-off, thus imparting a dynamic component to gait.<a></a> An added feature of this foot is that of cosmetic molding. The principle of dynamic toe-off to improve the mechanical efficiency of the prosthesis is an attractive one, and it forms the basis for the design of the Seattle foot. The purpose of this study is to evaluate the performance of the Seattle foot and subjectively and objectively determine whether or not it improves prosthetic gait. <h3>Clinical Investigation</h3> A questionnaire was designed to gather general demographic data and review foot function in general living situations. Thirty-three patients were identified in the last two years as having been fit with a Seattle foot, and 31 (94%) responded to the questionnaire. There were 27 males and four females. The age range was from 24 years to 72 years (Fig. 1). <a href="/files/original/8636aa4e4c5c07d52b8abe2b11b37b34.jpg" target="_blank" rel="noopener">Figure 1</a>. The age range was from 24 to 72 years. The weight of the patients ranged from 95 pounds to 195 pounds and their height ranged from 5'1" to 6'4". Amputation dates ranged from 1930 to 1986, with over half of the respondents having been injured since 1975. On average, each patient had 3.75 surgical procedures, with a range from 1 to 24. The length of time from amputation to prosthetic fitting was, for the most part, under one year (Fig. 2). <a href="https://staging.drfop.org/files/original/5b4a9dbd8c695c2a35af0d77111fe2c1.jpg" target="_blank" rel="noopener">Figure 2.</a> The length of time from amputation to prosthetic fitting was, for the most part, under one year. The original foot supplied in most cases was a S.A.C.H. foot. The next most frequent, in order, was a single axis ankle with a keel foot. The remainder are unknown. A significant number of the candidates had been using their original foot an average of 14 years before having it changed to a Seattle foot. For the most part, people were attracted to the Seattle foot because of a better design and newer technology. They wished for added spring, flexibility, and mobility in the foot. Some simply tried it because it was recommended by staff, or because they liked the cosmetic appearance. The length of time for use of the Seattle foot ranges from one month to two years with an average of 8.5 months (Fig. 3). <a href="/files/original/8487fa7a9496454abdd425b5a0d7785f.jpg" target="_blank" rel="noopener">Figure 3.</a> The length of time for use of the Seattle foot ranges from one month to two years, with an average of 8.5 months. The Seattle foot was fit on 29 below-knee amputees and two above-knee amputees. The heel stiffness in the Seattle foot was rated as acceptable in 80% of cases. Twelve percent (12%) felt it was too stiff. Eighty-one percent (81%) of respondents felt that they had good ankle motion with the Seattle foot, and 19% felt they did not. Seventy-four percent (74%) of respondents felt that the ankle motion was greater than with the previous foot, 16% felt it was the same, and 10% felt less ankle motion. When questioned about the shock stress at the hip or knee, 55% felt there was decreased shock stress and 39% felt that there was no change. When questioned about the effect of the Seattle foot on changing gait, 87% felt it was better and 13% felt it was the same. Eighty-seven percent (87%) were aware of toe-off action in the Seattle foot and 13% were unaware of it. The toe-off action was most noticeable when accelerating quickly, climbing up or down, playing ball sports, and running or walking on uneven ground. Forty-eight percent (48%) of the respondents would have preferred greater toe-off action, whereas 52% were satisfied with the toe-off. Half the respondents felt the Seattle foot had made a general difference to their recreational pursuits. When specific activities were rated, at least 50% of respondents felt that walking, going up and down stairs, hiking, dancing, and jogging were consistently easier than with the previous foot. Balance and endurance on the prosthesis was felt to be easier by about 61% of the respondents and smoothness was better in 87%. Uneven terrain was considered easier by 74%, but 3% said it was more difficult. In fact, the Seattle foot does not provide as much forefoot flexibility in the medial-lateral plane as with an articulated ankle joint. Walking and running was easier for 67% of the respondents (48% of the patients jogged). Of the 61% who dance, 74% found it easier. Of those people responding negatively to the Seattle foot, the pattern was either negative responses throughout the questionnaire (by four respondents) or negative responses for certain functions, such as the half who felt there was no difference in the recreational pursuits. Of these negative responses, there was no pattern either in terms of age, weight, or amputation site. The greatest advantages with the Seattle foot were reported to be a more natural and smooth action, resulting in an improved gait (Fig. 4), better ability to handle stairs and uneven ground, and improved abilities in sports. <a href="https://staging.drfop.org/files/original/6d91bb58231e3290cbcf8e2dd6de2830.jpg" target="_blank" rel="noopener">Figure 4.</a> The greatest advantages with the Seattle foot were a more natural and smooth action. The cosmetic design and the anatomical detail were appreciated by 97% of the respondents. Residual limb pain was felt to be decreased in 39% of respondents and unchanged in 45%. Sixteen percent (16%) did not respond to this question. The foot design had not been expected to have any effect on this problem. Skin problems were felt to be decreased in 55% of the respondents. Thirty-five percent (35%) said there was no change. The foot design was not expected to improve this clinical problem either. The Department of Veterans Affairs in Seattle has reported an evaluation of the Seattle foot.<a></a> Although a comparison of amputee groups was not possible, the results of this clinical survey compare favorably with the original study. Fig. 5, <a href="/files/original/07792a7c6f21b09b088faf9389ca2610.jpg" target="_blank" rel="noopener">Fig. 6</a>, and <a href="/files/original/11eb68ee39aa5ebeb200cda4a27eeebc.jpg" target="_blank" rel="noopener">Fig. 7</a> graphically demonstrate the comparison. <a href="https://staging.drfop.org/files/original/1b17acd6b2b5de624697430d6894d59e.jpg" target="_blank" rel="noopener">Figure 5</a>. A comparison of two clinical surveys of the Seattle foot for running and walking. <h3>Laboratory Investigation</h3> Electrogoniometric Evaluation A gait study using a single amputee with many years experience with a S.A.C.H. foot and several years experience with the Seattle foot was undertaken at the G.F. Strong Gait Laboratory. Motion in the lower extremity was analyzed using a computerized electrogoniometric system. This system accurately measures movement in three planes at the hip, knee, and ankle and stores data for subsequent analysis.<a></a> The S.A.C.H. foot, Seattle foot, and non-prosthetic side were compared. Patterns of movement measured at the hip were similar for the S.A.C.H. and Seattle feet and resembled those seen on the non-prosthetic side. At the knee, the Seattle foot produced a more repeatable pattern of internal-external rotation and varus-valgus than did the S.A.C.H. foot (<a href="/files/original/197c2d8a6200d52ac28aef88fcc77fdd.jpg" target="_blank" rel="noopener">Fig. 8 </a>and <a href="/files/original/afdc0eb1a348faf2d0c27285bcbb337e.jpg" target="_blank" rel="noopener">Fig. 9</a>). The greatest differences between the S.A.C.H. and Seattle feet were seen at the ankle. The patterns of forefoot abduction-adduction, plantar flexion-dorsiflexion, and in-version-eversion were all more repeatable for the Seattle foot. Also, the pattern of plantar flexion-dorsiflexion for the Seattle foot more closely resembled that of the non-prosthetic side (<a href="https://staging.drfop.org/files/original/2250f8e6296a64f9cab5e169d1c2b241.jpg" target="_blank" rel="noopener">Fig. 10</a> and <a href="/files/original/6a4612dbdc98238350b49fd1d433b615.jpg" target="_blank" rel="noopener">Fig. 11</a>). In summary, the Seattle foot generally produced a more repeatable pattern of motion at the knee and ankle than the S.A.C.H. foot, and the pattern of plantar flexion-dorsiflexion for the Seattle foot appeared more normal. Force Plate Evaluation Through the facilities of Simon Fraser University Kinesiology Department, a force plate study was done on the same single subject. The vertical compression forces generated by the S.A.C.H. and Seattle feet during stance were measured. Fig. 12 demonstrates typical forces measured during stance in a below-knee amputee on the non-prosthetic side. A maximum peak is seen immediately after heel strike. This is followed by a trough in mid-stance and a second, lesser peak at push-off. <a href="/files/original/013bbfd894737f6f6987e68067760431.jpg" target="_blank" rel="noopener">Figure 12</a>. Typical forces measured during stance in a below-knee amputee on the non-prosthetic side. Fig. 13 illustrates the forces generated in the same individual during stance on his prosthetic side while using a Seattle foot. Fig. 14 shows stance forces generated in the same individual on his prosthetic side using a S.A.C.H. foot. <a href="/files/original/6b60e9da47923de26b69a07869eb13ed.jpg" target="_blank" rel="noopener">Figure 13</a>. The forces generated in the same individual during stance on his prosthetic side while using a Seattle foot. <a href="/files/original/b6a47343d2d4db601a1452d432a910bb.jpg" target="_blank" rel="noopener">Figure 14</a>. Stance forces generated in the same individual on his prosthetic side using a S.A.C.H. foot. The initial peak is greater for the S.A.C.H. than the Seattle foot. This suggests more effective shock absorption at heel strike for the Seattle foot than the S.A.C.H. foot. The second peak is less than that seen on the non-prosthetic side with both feet, but is greater for the Seattle foot than the S.A.C.H. foot. Thus, the Seattle foot more closely approximates normal push-off force than the S.A.C.H. foot. The trough at mid-stance is shorter with the S.A.C.H. foot than on the non-prosthetic side. The mid-stance trough for the Seattle foot more closely approaches that of the non-prosthetic side, suggesting a more normal pattern of foot-ankle motion than with the S.A.C.H. foot. In summary, the Seattle foot generally appears to produce a more normal pattern of vertical forces than the S.A.C.H. foot and produces a greater force at push-off. <h3>Conclusion</h3> The overall patient response to the questionnaire regarding the effectiveness of the Seattle foot was positive. Comparison with the Seattle Study revealed similar results. Gait studies undertaken tended to support the clinical impression with regard to both kinetics and kinematics. Overall, this dynamic foot design offers definite advantages to the prosthetic user. At best, prosthetic users seem to get an increased gait smoothness, with the dynamic toe action positively influencing their abilities on rough ground and inclines. At worst, their gait pattern is not negatively influenced by this spring action. <h3>Acknowledgments</h3> The authors wish to thank the G.F. Strong Gait Lab and Dr. Cecil Herschler, as well as the Simon Fraser Kinesiology Department and Dr. Arthur Chapman for their technical assistance in the preparation of this study. References: <ol> <li>Orthopaedic Appliances Atlas. Vol. 2, Artificial Limbs, Editor J.W. Edwards, Ann Arbor, Michigan, 1960, pp. 149-151.</li> <li>Reswick, J.B., "Evaluation of the Seattle Foot," J. Rehab Research and Development, Vol. 23, No. 3, pp. 77-94.</li> <li>Burgess, E.M. et al., "Development and Preliminary Evaluation of the V. A. Seattle Foot," Journal of Rehabilitation Research and Development, Vol. 22, No. 3, B.P.R. 10-42, pp. 75-84.</li> <li>Chao, Edmund, "Justification of Triaxial Goniometer for the Measurement of Joint Rotation," J. Biomechanics, Vol. 13, 1980, pp. 989-1006.</li> </ol> *N. Russell, C.P.(C) Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital. *E. Hommonay, C.P.O.(C) Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital. *H. Anton Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital. *W.J. Hartvikson Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital. *D.D. Murray, M.D. Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital. Page Number(s) 128 - 135 Year 1988 Volume 12 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-05.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/1988_03_128/1988_03_128-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-10.jpg Figure 11 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-11.jpg Figure 12 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-12.jpg Figure 13 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-13.jpg Figure 14 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-14.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 With a Spring in One's Step Creator An entity primarily responsible for making the resource D.D. Murray, M.D. * W.J. Hartvikson * H. Anton * E. Hommonay, C.P.O.(C) * N. Russell, C.P.(C) * https://staging.drfop.org/files/original/b7a7c2991bb26411ef0db53793bf980e.jpg 2a21cb6923a0656f39dbe945c56be667 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.worldrehabfund.org Contact Name/Title Chairman: Richard A. Drucker Vice Chair: Marilyn Moffat Salant, PT, Ph.D., FAPTA Address 16 E. 40th Street – Suite #700 City New York State/Province New York Countries Served Cambodia, Haiti, Lebanon, Pakistan, Philippines, Ukraine, Bolivia, Ecuador, Mexico, Cuba Postal Code 10016 Phone (212) 532-6000 Fax (212) 532-6012 Email info@worldrehabfund.org Organization Type Including ID and tax status Non-profit Tax ID 13-5647844 Not-for-profit Type 501C-3 Services Provided Prosthetic and Orthotic Services Capacity Building Education Vision & Hearing Community-based rehabilitation Need I Financial Assistance https://worldrehabfund.org/ways-to-get-involved/donate/ Need II Volunteers: https://worldrehabfund.org/ways-to-get-involved/volunteer-opportunities/ Need III Consultants World Rehabilitation Fund is seeking to recruit international and U.S. based experts of various professional fields pertaining to implementing the projects and fulfilling its mission. WRF intends to utilize the consultants’ expertise in its future and ongoing work. The sought expertise is pertaining but not limited to: Prosthetics and Orthotics Socio-Economic Rehabilitation Microfinance Vocational Rehabilitation Physical Medicine Physical Therapy Occupational Therapy Social Work and Service Delivery Program Development Organizational Capacity Building Mission WRF’s mission is to enable individuals around the world with functional limitations and participation restrictions to achieve community and social integration through physical and socio-economic rehabilitation and advocacy; and to prevent disability and reduce disadvantage. Volunteer Contact https://worldrehabfund.org/ways-to-get-involved/volunteer-opportunities/ Patient Contact WRF Lebanon Khodralian Building St. Marun Street Horsh-Tabet, Beirut Phone: 961-1502188 Fax: 961-1502189 Email: wrfleb@dm.net.lb Website: http://www.wrf.org.lb Artisans Association of Cambodia No. 150J, Street 134 Sangkat Vealvong, Khan 7 Makara Phnom Penh, Cambodia Phone: 855 23 882 949 Email: wrf@forum.org.kh or wrfcam@online.com.kh Website: http://www.aac.org.kh LinkedIN Page/Profile https://www.linkedin.com/company/world-rehabilitation-fund/ Facebook Page https://www.facebook.com/WorldRehabilitationFund 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 World Rehabilitation Fund Description An account of the resource WRF believes that all people, regardless of disability, have the right to participate fully in their communities, to attain education and viable employment. https://staging.drfop.org/files/original/165c0f0895c32010669e22cc3a0215af.jpg 39774beda32b03ad1ee3e25554135d2b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.worldvision.org Contact Name/Title Richard Stearns - Director Address PO Box 9716 City Federal Way State/Province Washington Countries Served USA Regions: Australia, Africa, North America, Central America, Middle East, Europe, Asia, South AmericaCountries: WorldwideSpecific cities, regions, or groups of people: Africa, Asia, Latin America, Middle East, Europe, United StatesAge Group: Adults, ChildrenFees Charged: No Postal Code 98063 Phone 253-815-1000 Email GIKDONATIONS@WORLDVISION.ORG Organization Type Including ID and tax status Non-profit Not-for-profit Type 501C-3 Services Provided Medical Equipment / Supplies, Education, Funding, Medical / Surgical Care, Rehabilitation / Training Need I Financial Assistance Need II Volunteers: Lay Persons, Other: OFFICE STAFF Need III Materials, Components, and Equipment: New, Equipment, Medical Supplies, Other: PHARMACEUTICALS 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 World Vision Inc. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Review Status Status of review after import from old O&P Library into Omeka platform. Not Performed