6 20 371 https://staging.drfop.org/files/original/876ff6602d787cd8bb538c115168499b.pdf 4970b9dd38fb5c1f19b5d27c89c60acc Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_012.pdf Text Any textual data included in the document <h2>Orthotic Maintenance Program for the Myodysplastic Child</h2> <h5>Terry J. Supan, C.P.O. <a style="text-decoration: none;">*</a></h5> The faculty of the Southern Illinois University School of Medicine has been actively involved in a comprehensive, multidisciplinary approach to the management of the myelodysplasia child. Since the establishment of the orthotic clinic in July of 1982, a systematic approach to the orthotic-physical therapy needs has proven successful in providing a higher degree of function and fewer complications for these patients. The purpose of this article is to inform the reader of the appropriate orthotic involvement and the high degree of orthotic maintenance which is necessary for this type of patient. By describing the experiences of Southern Illinois University School of Medicine, it is hoped that the reader will gain a more realistic understanding of the orthotist's role in this situation. The types of orthoses run the full gambit from a simple UCB foot orthosis to a complex reciprocal gait orthosis. A consistency with these patients is that as children they develop at a normal rate. A second point with these children is the fact that without orthotic management, effective ambulation would not be possible. Higher levels of lesion necessitate a greater amount of orthotic management. When you combine an intimate fitting plastic orthosis with growth, you can understand the necessity for continuous maintenance and adjustments of their orthotic devices. A regular system of return visits is necessary. The relationship of the myodysplastic child to the orthotist is similar to that of a patient to their general practitioner. They are seen on a routine basis, unlike the medical specialists who only see a patient a limited number of times. This should be kept in mind if an orthotist is considering the possibilities of becoming involved in myodysplastic patient management. An orthotist involved with a clinical practice of scoliosis can associate the nature of their spinal practice with the ambulatory myelominengocele practice that we have developed at SIU School of Medicine. The repetition of clinic visits is very similar to that involved with scoliosis. However, there is an increase of time involvement with the child to make growth adjustments and maintain proper fitting plastic orthoses necessitated by the insensate skin in these children. If a CTLSO is improperly adjusted, it may affect the outcome of the scoliosis treatment, but it will not effect the activities of daily living of the individual. An improperly fitting RGO severely decreases function. Orthopaedic involvement with the myodysplastic child starts within the child's first few days of life. There is a high incidence of associated scoliosis, kyphosis, hip dysplasia and clubfoot deformities. Therefore, the infant must be continuously monitored. If any of these conditions exist, early orthotic intervention may be used effectively. Maintenance devices such as the Pavlik harnesses, thermoplastic TLSOs, and serial casting for clubfeet have all been used effectively. When the child reaches nine months of age, plans for ambulation are considered. If a resistant clubfoot exists, it is dealt with by surgical intervention at this time. A one stage Turco<a></a> procedure is accomplished with post surgical maintenance in an ankle-foot orthosis.<a></a> During this time period, if a dysplastic hip is also prevalent, bilateral molded knee orthoses connected with a spreader bar to maintain the hip in abduction and internal rotation are used. Since the ninth month is the milestone period for standing in the normal child, use of a parapodium<a></a> is considered. Because of the growth spurts which normally occur during this same time period, consistent monitoring of applied devices is necessary. The ankle-foot orthoses must not impinge on either the calcaneous, navicular or metatarsal heads. Proper knee and hip locations in both the knee orthoses and the parapodium must be checked. Children in these devices should return to the clinic or the orthotist every three months. Since the development of the reciprocal gait orthoses,<a></a> children with a thoracic level mye-lominengocele are now candidates for ambulation. This is only possible with aggressive orthopaedic and physical therapy management. Full range of motion of the paralyzed extremities and prevention of flexion contractures of the hip, knee, and ankle is necessary if effective use of the reciprocal gait orthosis is expected. If a dislocated hip exists unilaterally, which would impede the function of the orthosis, surgical intervention would be necessary prior to use of the RGO. Our experience has shown that twenty-four months of cognitive development is the ideal time frame for training of the reciprocal gait orthosis and fitting thereof. Prior to this milestone, communication with the child and the necessity of multiple adjustments to the orthosis limits the effectiveness of the RGO. Once it is determined that a child is a candidate for reciprocal gait ambulation, an extensive physical therapy program is initiated to improve upper extremity strength and increase standing balance. When the child is initially fitted with an orthosis, it is left in the adjustable state as recommended by the development team at Louisiana State University. Extensive post-fitting physical therapy is necessary. During the first week of physical therapy the orthotist repeatedly checks the device so that optimum orthotic ambulation can be achieved. Subtle adjustments of the cable housing length and hip joint locations can mean a difference between an ambulator and a nonambulator. After one month's use of the reciprocal gait orthosis, the correct location of the hip joints and cable should become evident. At that time the hip joints and knee joints can be attached on a more permanent basis. Because of the necessity of numerous adjustments on a growing child, screws instead of rivets are used. High strength Loctite® is used to prevent loosening of the screws. The child returns to the orthotic clinic one month after permanent attachment of the side bars to the RGO. Subsequent to that visit the child is seen every two months for the first five months. Thereafter return visits are decreased to four times a year. The physical therapy routine also diminishes as independence in use of assistance devices is decreased. Initially the child is seen on a daily basis for two weeks. Thereafter, a weekly therapy program is established. As the child progresses from parallel bars, to walker, to forearm crutches, it is no longer necessary to maintain a continuing outpatient physical therapy treatment. Parents and teachers have successfully been taught to monitor the fit of the devices and the ambulatory status of the patient. Periodic physical therapy evaluation for gait deviation prevention is all that is necessary. Growth adjustments and routine maintenance of both the reciprocal gait orthosis and parapodium are accomplished at approximately four month intervals. The use of the pop rivets on the parapodium, make it a relatively easy task to increase the distance between the floor and knee and hip centers. Increases up to one inch between each joint center can be accomplished before the tubular structures of the parapodium must be replaced. Since children are removed from the parapodium at age two, it is only necessary to maintain one size in stock. Because of the presence of static hip and knee joints in the parapodium, the exact alignment of anatomical/mechanical joint centers is not critical for standing. However, if the joint assemblies are extremely malaligned, they will cause impingement during seating. Because of the relative newness of the program, the first child fitted with the RGO has not had to have a replacement of any major component of the orthosis. However, since we are approaching the twenty-month time period, it appears that future replacement of the plastic sections of the KAFOs will be necessary. A review of the adjustments made for growth indicates that the first length corrections were between the knee centers and the ankles. Subsequent growth adjustments were made between the hips and the knees to improve seating comfort. Seating discomfort seems to be the first indicator of improper positioning of the hip joints. Maintenance of the devices have included replacement of Velcro® straps because of wear, replacement of the anterior cable due to breakage at the point of connection between the cable and connector to the hip joint, and the replacement of two thrust bearings in one hip joint. One child also has had the metal pelvic band increased in diameter secondary to pelvic growth. Although the metal pelvic band makes the orthosis heavier and cannot be as form-fitted as the thermoplastic pelvic section, it does have allowance for pelvic widening. In cases of pelvic obliquity, lumbar scoliosis, or lumbar kyphosis, a thermoplastic pelvic section is mandatory. There have been no increases in the maintenance of the thermoplastic versus the metal pelvic band. Because of longitudinal growth between the calcaneous and the malleoli, several of the children needed adjustments in the malleoli area of the ankle-foot section of the orthosis. This is accomplished by localized heating and expansion of the carbon inserts and the polypropylene material. Care should be taken not to overheat the materials. Initial assessment of the ambulatory program for thoracic level myelominengocele children at SIU has been favorable. All parties concerned-the clinic team, the parents, the funding agencies and the children themselves- seem to have accepted the program quite readily. Objective data cannot be determined on such a short range program. Only until such time as multiple years of experience has been gained in several centers will the determination of the cost/benefit ratio prove the worthiness of this program. Subjectively, however, the children seem to be much better off than they would be otherwise. In our own program, four children with spina bifida are in the pre-parapodium stage (younger than nine months). Seven children are in the preambulatory, parapodium stage of growth development. Two children are awaiting fitting of their orthoses pending authorization from state funding agencies. Eight children have been fitted with the reciprocal gait orthoses with wearing time ranging from twenty months to one month duration. Each of these children are followed on a three-month basis by the clinic team with subsequent visits to the orthotist for adjustments. No major deformities or pressure sores have developed on the children who are in the program during this time period. Urinary tract infections and stress fractures have been reduced in the patients fitted with the reciprocal gait orthoses, although every child in the program has had at least one long bone stress fracture prior to being fitted with the reciprocal gait orthoses. In summary, we have shown at SIU School of Medicine that a comprehensive team approach to myelomeningocele should include a program of ambulation for the thoracic level myodysplastic child. With a routine return visit program and follow-up adjustments on the orthotic devices, no major complications have arisen in the system. The use of pop rivets on the parapo-diums, and screws for attachment of side bars on the reciprocal gait orthoses, have contributed to the ready availability of adjustments to the devices. Although there are increases in time constraints involved in dealing with this severe level of disability, the program has subjectively proven to all concerned that this present technique for spina bifida management has proven successful. <h3>Acknowledgments</h3> The author wishes to thank Roy Douglas, C.R, and Carlton Filiauer, C.P.O., for their development of the RGO, and to acknowledge Barbara Sullivan, R.P.T., and John M. Mazur, M.D., for their assistance in the development of our program at Southern Illinois University School of Medicine. The assistance of Melenie Boiser in preparing the manuscript for this article is also acknowledged. References: <ol> <li>Turco, D.J., "Resistant congenital clubfoot (1979), A one-stage posterior medial release with internal fixation: a folio wup report of 15 year experience." Journal of Bone and Joint Surgery, 61A:805- 814.</li> <li>Supan, T.S., Mazur, J.M., and Johnson, B.S., "Postsurgical Orthotic Management of Resistant Clubfoot," 1984, AAOP National Seminar, Orlando, Florida, to be submitted for publication.</li> <li><a href="http://www.oandplibrary.org/al/1971_02_036.asp">Motlock, W., "The parapodium: an orthotic device for neuromuscular disorders." Artificial Limbs, 15, 13-17, 1971.</a></li> <li>Larson, Paul and Douglas, Roy, L.S.U. Reciprocating Gait Orthosis, Durr-Fillauer Medical, Inc., Chattanooga, TN, 25, 1983.</li> <li>Yngve, David, Douglas, Roy, and Roberts, John, "The Cable-Type Reciprocator's Gait Orthosis in Myelomeningocele," Developmental Medicine and Child Neurology, 25:116-117, 1983.</li> </ol> <div style="width: 400px;">*Terry J. Supan, C.P.O. Instructor, Division of Orthopaedics and Rehabilitation, Prosthetic/Orthotic Services, Dept. of Surgery, Southern Illinois University, School of Medicine, P.O. Box 39265, Springfield, Illinois 62708. </div> <div style="width: 400px;"></div> Page Number(s) 12 - 14 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Orthotic Maintenance Program for the Myodysplastic Child Creator An entity primarily responsible for making the resource Terry J. Supan, C.P.O. * https://staging.drfop.org/files/original/7a7cd68d5bd0095b317a4f44affc0941.pdf d7e865477f5445c4a9c985354cc6bd99 https://staging.drfop.org/files/original/8f0c35d069948e0004acb926243104e3.jpg d66267d487f5ad7b5cb149ee357ca97d https://staging.drfop.org/files/original/153e5ba3b516d61a2c180b74512debd5.jpg 181b23a4816351a5231a249d74444720 https://staging.drfop.org/files/original/88f27d9100c85efdefc153a74675137b.jpg 81d4538609ad379bbc4a53f1a5928edc https://staging.drfop.org/files/original/f98e862183e5762fac48c707098889f5.jpg c474c3993fb68bf29c0fdae290d520fb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_015.pdf Text Any textual data included in the document <h2>Dynamics and the L3 Through L5 Myelomeningocele Child</h2> <h5>John Glancy, CO <a style="text-decoration: none;">*</a></h5> Since 1970, the orthotic management of myelomeningocele children treated at Indiana University has focused primarily on musculoskeletal deformities that develop after birth. Much of our effort has been directed to children with L3 through L5 lesions, because of their potential to be community walkers.<a></a> The decision to direct our attention to the problems that these lesion levels present also relates to the fact that they constitute the majority group among the myelomeningocele population. The range of orthotic dysfunctions, in kind or degree, that children with these lesion levels are prone to today, are identical to the orthotic dysfunctions that like youngsters had to endure in 1970. Myelomeningocele remains "the most complex, treatable congenital anomaly consistent with life."<a></a> What has changed, in the interim, is our understanding of the pathodynamics acting upon the musculoskeletal systems of children with L3 through L5 lesions. The introduction of thermoplastic materials, along with vacuum forming techniques, now allow orthotists greater freedom of design. Consequently, there is a gradual change occurring in orthotic management, from the traditional approach based upon statics, to a growing appreciation of dynamics as a means of preserving function by preventing the formation of secondary dysfunctions caused by gravity, growth, and time. How may one describe the benefits these changes portend for the L3 through L5 myelomeningocele child, present and future? It now appears that while present-day children with L3 through L5 lesions may have the same vulnerability to secondary dysfunctions as the children of 1970 . . . they may not have to endure them, in kind or degree. Those concerned with the care of these children face the same dilemma today as was experienced in 1970-how to provide long-term protection from secondary dysfunctions without introducing unacceptable inhibitions to daily activities. Fortunately, some of the specific challenges within the makeup of this dilemma have been satisfactorily met: <ul> <li> The polypropylene Solid-Ankle Orthosis<a></a> offers long-term protection to the foot/ankle complex. The Carlson, Berglund technique<a></a> adds to the efficiency of this orthosis. </li> <li> Lightweight KAFO's that utilize a unilateral upright with offset free knee joint, modified quadrilateral thigh cuff and dynamic knee extension assist<a></a> offer long-term protection to myelomeningocele knees. </li> <li> A polypropylene thoracopelvic unit<a></a> offers a promising foundation for achieving acceptable, long-term control of the trunk with L3 through L5 lesion levels, without having to extend the exoskeletal system below the anatomic hip joints (<a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Fig. 4</a>). </li> </ul> Since the 1976 report on the dynamic orthotic system was published,<a></a> we have refined the modular aspects of the system for two primary reasons: (1) To ensure that each component meets the requirements for which it is designed, i.e., providing no more, nor no less control than needed, and (2) To encourage the night use of the daytime system by the utilization of quick releases, in order to remove any components unrelated to the areas requiring night-time dynamic control (<a href="/files/original/8f0c35d069948e0004acb926243104e3.jpg">Fig. 1</a>). These modular refinements were also prompted by our recognition of a correlation between early application and night-time dynamic control, to success in the prevention of secondary dysfunctions. Due to the complexities of the pathodynamics involved, particularly in the hip complex and lumbopelvic regions, an efficient night-time unit must be equally as functional as the daytime unit, hence the economic necessity that a single system provide both day and night protection against secondary dysfunctions. <a href="/files/original/8f0c35d069948e0004acb926243104e3.jpg">Figure 1.</a> Features of modular system: (A) Assembled system for fitting: elastic components to knee and pelvic extension assist are not attached. (B) Modified quadrilateral thigh cuff; showing Nylon receptacle and locking nut for quick release of AK module. (C) Solid-ankle AFO with lateral off-set knee joint and pivotable attachment portion of knee extension assist assembly. Shockcord is not shown. (D) Thoracopelvic unit; receptacles for the quick release of the KAFO's and reinforcing horizontal bar are visible. Note: The combination polycentric and lateral motion joint shown in A. The lock joint shown in B is used for post-op cases. The importance of night-time use became even more evident with an awareness of the startling amount of regression that often occurs during short periods of time when the system is not worn. Rapid regression occurs with discouraging frequency about the hips and lumbopelvic regions especially. Such 'down time' often is more frequent within the three-to-six month periods between orthotic checkup visits than we understood to be the case. For example, in addition to the usual childhood diseases, colds, etc, these children are subject to episodes of kidney and/or bladder infection and periodic revisions to their shunts. The success or failure of the dynamic orthotic system appears to be proportional to the frequency and duration of these occurrences. Without an appreciation for the circumstances just described, orthotists will experience constant frustration as they seek explanations for the gradual regression their patients present, because they will unintentionally attribute the cause to often non-existent weaknesses in the design of a given orthotic system. The answer lies not only with better control of the hip and lumbopelvic regions, but also with constancy of control. We must be as persistent with our applications of biodynamics as nature is with the pathodynamics acting upon these regions. There are three needs that must be considered, which hopefully can be met by a single dynamic thoracopelvic design. They are: <ol> <li> A reliable method of eliminating jack-knifing of the trunk during ambulation without the use of locks. </li> <li> Control of the lumbopelvic and hip regions in a manner which does not require extensions to the lower extremities. The need to protect the growing child's lumbar spine when his gluteous maximum muscles are paralyzed, but his hips and/or knees do not require protection (L4 and L5 levels), has yet to be met. </li> <li> The controls in 1 and 2 above, must operate with the same efficiency during night-time wear as they do during the day, in order to reverse the inevitable regression resulting from unavoidable periods when illness prohibits wearing the orthosis. </li> </ol> Granted, these design criteria demand a major breakthrough in the state-of-the-art. Nevertheless, using our current thoracopelvic unit as a point of departure, an acceptable solution seems within our grasp. <a href="/files/original/153e5ba3b516d61a2c180b74512debd5.jpg">Fig. 2</a>, <a href="/files/original/88f27d9100c85efdefc153a74675137b.jpg">Fig. 3</a>, and <a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Fig. 4</a> show our progress to date. A resolution to this problem would have broad orthotic applications-it should be vigorously pursued. Our work on this project is ongoing, and we invite our readers' active participation. <a href="/files/original/153e5ba3b516d61a2c180b74512debd5.jpg">Figure 2</a>. (A & B) Sitting stability and comfort is enhanced by the flat, posterior surfaces of the modified quadrilateral cuffs, abduction motion and polycentric feature of the hip joints. (C) Posterior view: Thoracopelvic unit on casts with the new pelvic extension assist showing right rubber strap detached from the upright. (Note how the model has dropped on the right side.) (D) Side view showing how rubber strap attaches to upright. AK and BK quick releases and Delrin fitting for shockcord of the knee extension assembly. (E) Posterior view with both rubber straps of the pelvic extension assist attached to the uprights. (Note the horizontally level suspension of the cast, demonstrating the force the rubber straps generate.) <a href="/files/original/88f27d9100c85efdefc153a74675137b.jpg">Figure 3.</a> Most recent prototype: (A) Dacron straps with slide-bar buckles serve as a passive, adjustable 'pelvic band.' Puhient weighs 43 lbs. Each rubber strap is set to generate 14 force pounds equal to 62 inch pounds of extension moment which resists the first 20 degrees of forward flexion of the lumbar spine. Any voluntary forward flexion of the trunk beyond 20 degrees overrides the dynamic extension. (Note: Posterior polypropylene bar must be slotted at pelvic end (drawn in) to permit forward rotation of lumbar spine, as the dacron straps check unwanted forward rotation of the pelvis.) (B) Side view: Lock used for 2-3 months post-op. Dynamic extension is fully operative even with locks. Patient has 45 degree hip contractures, which explains posterior gap of thigh cuff in post-op alignment. (C) Anterior view: Note Nyloplex stud medial to hip joint which is the pivotal attachment point for slide-bar buckle. (D) Posterior view of Plastazote® lining showing the sealed 'pockets' at waistline level. Pockets are filled with #382 Elastomer. (E) Model shown in seated position. Although 28 force lbs. (both rubber straps) are acting to extend the lumbar spine when sitting, this force has no effect upon the lower extremities. (F) Bottom view: showing 'shelves' formed with the lining and filled with Elastomer via the pockets shown in photo D. Their effectiveness in transferring the weight of the thorax to the uprights is well demonstrated. This technique prevents pressure sores to insensitive skin. <a href="/files/original/f98e862183e5762fac48c707098889f5.jpg">Figure 4</a>. Schematic lateral view of normal lumbopelvic relationship to the horizontal. Shaded areas show the optimum sacral angle of 30 degrees, with respect to the center of the hip joint, during normal standing posture. The normal amount of postural lordosis resulting from the optimum sacral angle is also depicted. The unshaded outline shows the pelvis rotated 20 degrees about the hip joint in an anterior direction, taking the entire trunk with it, indicated by arrow in upper left. The downward oblique line, originating from hip center, indicates the maximum distal point (gluteal fold), relevant to the horizontal at hip level, which is feasible as an attachment point for passive pelvic control when fitting small children (see A & B, Figure 3). The arrow between the horizontal and oblique lines, to the right of the figure, demonstrates that beyond 20 degrees of forward rotation of the pelvis, the distal attachment point will rise above the horizontal. The contribution of the passive pelvic control, relative to forward rotation of the pelvis above the horizontal, is nil. However, the intimate fit of the thoracopelvic unit (especially the abdominal position) ensures that the optimum relationship between the lumbar spine and the rotating pelvis is passively maintained throughout the full range of pelvic A-P rotation. Consequently, any involuntary forward rotation of the trunk about the hips (within the first 20 degrees) can be controlled as a single body segment. The functional status of the abdominal and particularly the hamstring muscles, may be expected to be crucial contributors to the system's success. Unless the pelvis and lumbar spine can be passively placed in a normal standing posture to begin with, neither can be controlled in an upright position without locks. <h3>Acknowledgment</h3> I wish to express my thanks to John G. Patsko, CO, whose fine photography adds so much to the text. References: <ol> <li>Glancy, J. and R.E. Lindseth, "A dynamic orthotic system to assist pelvic extension: A preliminary report," Orthotics and Prosthetics, 29:1, pp. 3-9, March, 1975.</li> <li>Bunch, W.H., A.S. Cass, A.S. Bensman and D.M. Long, "Modern management of Myelomeningocele," Pub. Warren H. Green, Inc., St. Louis, 1972.</li> <li>Glancy, J. and R.E. Lindseth, "The polypropylene solid-ankle orthosis," Orthotics and Prosthetics, 26:1, pp. 14-26, March, 1972.</li> <li>Glancy, J., "A dynamic orthotic system for young myelomeningoceles: A preliminary report," Orthotics and Prosthetics, 30:4, pp. 3-15, December, 1976.</li> <li>Carlson, J.M. and G. Berglund, "An effective orthotic design for controlling the unstable subtalar joint," Orthotics and Prosthetics, 33:1, pp. 39-49, March, 1979.</li> </ol> <div style="width: 400px;">*John Glancy, CO John Glancy, CO., is Assistant Professor and Director of Orthotics in the Orthotics Division at James Whitcomb Riley Hospital for Children, Room 1100, Indiana University Medical Center, 702 Barnhill Drive, Indianapolis, Indiana 46223. </div> Page Number(s) 15 - 23 Year 1984 Volume 8 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 4 http://www.oandplibrary.org/cpo/images/1984_04_015/1984_04_015-4.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dynamics and the L3 Through L5 Myelomeningocele Child Creator An entity primarily responsible for making the resource John Glancy, CO * https://staging.drfop.org/files/original/0dd9f601769f60d4d41eff49c4f7e903.pdf 6083dd5dd381a8def8f92abd19065155 https://staging.drfop.org/files/original/67b2bb7011e7d4265c42e6b2743f583c.jpg 973338862e76956d2630ed5644e0145b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_01_001.pdf Text Any textual data included in the document <h2>Endoskeletal Prostheses: Cause for Reflection</h2> <h5>Charles H. Pritham, C.P.O. <a style="text-decoration: none;">*</a></h5> American prosthetists have now accumulated a decade of experience with endoskeletal modular prostheses. In light of this experience, it seems logical to reassess the criteria and priorities that guided the development of this method of providing prosthetic care. If one were to choose two events more than others that marked the beginning of the "new era," they would have to be the introduction in the Fall of 1970<a></a> of the Otto Bock endoskeletal system and the convening in March 1971 by CPRD of a workshop entitled, "Cosmesis and Modular Limb Prostheses"<a></a>. Few are unfamiliar with the features of the Otto Bock system and they hardly need to be commented on here. Suffice it to say that the system undoubtedly represents the highest possible physical expression of the modular endoskeletal concept. The second development referred to, the CPRD workshop, is probably less familiar and merits closer attention, especially so since the report from the workshop states the philosophy of the endoskeletal modular approach to limb prosthetics. That philosophy finds its fullest and most concise exposition in the remarks of D.S. McKenzie, M.D.<a></a>, Table I. <img src="https://staging.drfop.org/files/original/67b2bb7011e7d4265c42e6b2743f583c.jpg" p="" width="503" height="296" />In other sections of the report, the CPRD workshop recommended improvements in cosmetic covers and prosthetic skins and development of endoskeletal upper limb prostheses employing center-pull cables and external power. Indeed, so sanguine were the attendees at the workshop about the future of endoskeletal modular limb prostheses that they essentially recommended that all future development be done in this context. Comparison of expectation with reality is very difficult in this situation as there is very little in the literature that describes field experience with endoskeletal modular prostheses. What information there is<a></a>, is largely anecdotal but it suggests that the problems encountered focus on weight and poorer durability than conventional exoskeletal prostheses. The upshot is that endoskeletal prostheses are fundamentally considered luxury items to be prescribed for light-activity, appearance-conscious wearers. Wider-spread acceptance has primarily occurred with hip disarticulation prostheses due to ease of fabrication and favorable weight competitiveness compared to conventional means of construction. It seems fair to conclude, therefore, that anyone who subscribed to the criteria developed in the CPRD workshop of 1971 would be disappointed with the rate of acceptance and continued improvements in endoskeletal prosthetic systems during the past decade. It is convenient to ascribe this failure to intransigent conservatism on the part of the third-party payers and of individual prosthetists. Perhaps a more proper explanation can be found in the precepts that shaped the development of the prostheses themselves. Endoskeletal modular prosthetic systems are intended by their very nature to encompass the needs of the vast majority of amputees. In effect, they represent a series of compromises: strong enough for all but the most punishing of patients and yet light enough for all but the most feeble of patients, etc. Anything or anyone who attempts to be all things to all men generally ends up satisfying no one. In this regard a fundamental fact about the nature of the amputee population needs to be acknowledged. The primary cause of amputation in western society is disease and this primarily affects the older age group. Comparison of amputee censuses<a></a> bears this out. Moreover, with declining birth rates and increased longevity, the age of the population in general is shifting to the higher decades. The one trend reinforces the other and we may confidently expect in the years ahead that even more of our patients will be 65 or over with circulatory disorders and multiple involvement. It is widely admitted that the needs of the geriatric amputee are different from the needs of the younger amputee. Sophisticated knee and ankle function become less important, and light weight, comfort, and ease of donning become more important. In effect, the nature of the amputee population and the precepts guiding development of prostheses have changed, but prosthetists and developers of prostheses have been slow to recognize the change. In part this is due to the fact that the needs of geriatrics are mundane and prosaic as compared to the challenge offered in designing a high performance, sophisticated prosthesis for a young vigorous user who uses a prosthesis maximally and thus offers maximum positive reinforcement to the designer. Another matter that deserves consideration is the concept that it should be readily possible by changing components or alignment to adapt the prosthesis to the changing needs of the amputee and that the same prosthesis that serves him 24 hours after surgery will still be suitable 24 months after surgery. Reference here is made to Table I where the different stages in the experience of an amputee are listed vertically and the various possible features of a prosthesis are listed horizontally. Advocates of the first viewpoint, such as D.S. McKenzie, would have it that at any given moment in the experience of an amputee, all possible features are present. Advocates of the second view would have it that for the sake of expediency, low weight, cost, durability, and other considerations, only those features absolutely necessary at any one stage of development would be present-in effect that form follows function. For example, while quick-disconnect of the pylon and foot from the socket is suitable and even necessary in an immediate post-operative prosthesis (I.P.O.P.), it is unnecessary and a possible source of trouble in a definitive prosthesis. An advocate of this second point of view might fill out the table much as it has been done. Central to this discussion is the question of what is an acceptable range of alignment adjustability at any one stage. Few would dispute that full range of alignment adjustability is necessary in I.P.O.P.s and temporary prostheses. Less unanimity greets the statement that it should be present in definitive prostheses. Some would maintain that it is not necessary in definitive prostheses and that, in any event, some range of adjustability (height, transverse rotation of foot, and in some cases, of the knee) is present and that this is all that is necessary in the vast majority of cases. They would further maintain that any increase in alignment adjustability represents an unacceptable increase in weight and decreases in reliability. Moreover, they would have it that should you have to change any of the other factors of alignment, something is so seriously wrong as to warrant starting over again completely from scratch. This second point of view is exemplified most strikingly in the Adaptive Fixation Prosthesis (A.F.P.) system of Medical Center Prosthetics of Houston, Texas. There is one final topic that merits discussion and that is the matter of cosmesis. Current techniques of providing cosmetic covers entail the carving of internal and external contours and are expensive and time consuming. Moreover, it is questionable as to whether or not the results merit the effort, as the covers for all levels of amputation are flimsy. For above-knee and higher, the one-piece covers inhibit function. Support hose currently used as prosthetic skins are even less durable, yet attempts to provide stronger skins have been defeated by the need to accommodate the extreme motion of the knee. (It remains to be seen whether it will be possible to devise successful one-piece cosmetic covers for above-knee prostheses with current technology or if we will eventually sacrifice some of the cosmesis of one-piece covers and adopt two-piece covers and improved durability.) Again, the work of Medical Center Prosthetics and their technique for foaming cosmetic covers in place are noted. In conclusion, it is possible to pose a number of questions: 1. Do available endoskeletal prosthetic systems meet the needs of the majority of amputees as well as do exoskeletal prostheses? 2. If they do, why are they not used with greater frequency than casual impression seems to imply that they are? 3. Is it desirable to use a common family of endoskeletal components at all stages of an amputee's progress post-amputation or can an increase in desirable qualities be achieved by more specifically matching the available components and the individual's progress? 4. Is it desirable and necessary to have full capability for alignment adjustability present in a definitive prosthesis or can some adjustability be sacrificed to decrease weight and heighten reliability? 5. If cosmetic covers were better than they are, would more endoskeletal prostheses be prescribed? Or is it that if more endoskeletal prostheses were prescribed, better cosmetic covers would be developed? The present group of endoskeletal systems (with one exception) can be considered as first generation systems. Extensive experience has been gained with them and it seems reasonable to assess this experience with an eye towards developing criteria for second generation systems. Further, it seems only just that those personnel who have day-to-day experience be canvassed in developing these criteria. References: <ol> <li>Below-Knee and Above-Knee Prostheses, Committee on Prosthetic Research and Development, National Academy of Sciences, Washington, D.C. 1973, page 21.</li> <li>Cosmesis and Modular Limb Prostheses, Committee on Prosthetic Research and Development, National Academy of Sciences, Washington, D.C. 1971.</li> <li>Wilson, A. Bennett, Jr., "Lower Limb Modular Prostheses, A Status Report," Orthotics and Prosthetics, Vol. 29, No. 1, pp. 23-32, March 1975.</li> <li>Kay, Hector W. and Newman, June D., "Amputee Survey 1973-74, Preliminary Findings and Comparisons," Orthotics and Prosthetics, Vol. 28, No. 2, pp. 27-32, June 1974.</li> </ol> <div style="width: 400px;">*Charles H. Pritham, C.P.O. Formerly Director, Prosthetic and Orthotic Laboratory, Rehabilitation Engineering Center, Moss Rehabilitation Hospital, Philadelphia, PA. Presently Manager, Snell's of Louisville, Louisville, KY</div> Page Number(s) 1 - 3 Year 1982 Volume 6 Issue 1 Figure 1 TABLE I http://www.oandplibrary.org/cpo/images/1982_01_001/1982_01_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Endoskeletal Prostheses: Cause for Reflection Creator An entity primarily responsible for making the resource Charles H. Pritham, C.P.O. * https://staging.drfop.org/files/original/f337a6d889d558b56f7603ac06e96231.pdf 26d6f3d8f69e84504a368e09c8b5db43 https://staging.drfop.org/files/original/4ba0e022e7651bf5a36b045a6168ac98.jpg 3ea9aebc91de4e8671fcea172dc4c9b2 https://staging.drfop.org/files/original/7b7fb17dbc1e54bd9317ab53fa1a6774.jpg f4b077a22c5f9973c9752101b7b664f0 https://staging.drfop.org/files/original/54f4c998ff0b12d9f2b0955afd658381.jpg 87e1bbb874cd86bc4295bc4da00c4375 https://staging.drfop.org/files/original/c87f8df1446c1a57754c6d380e1dc234.jpg e79dfcfb718efa0a42348f42453abbdd https://staging.drfop.org/files/original/aa356de1c97d7c797ba7399a8a358c73.jpg 9192c26c713613fe5afd6e6fcd9afb73 https://staging.drfop.org/files/original/4a16949b838f44f4b7bbfc854e44bbed.jpeg 84e45ae056e862a3d5e367fe7f109bbd https://staging.drfop.org/files/original/84863942578d92ee15a89ac6adee6168.jpeg dfae59cb8ee78783906dee0e5a97b696 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_01_005.pdf Text Any textual data included in the document <h2>Management and Construction Procedure of Bilateral Split-Bucket Type Hip Disarticulation Prosthesis</h2> <h5>Peter A. Ockenfels, C.P.O. <a style="text-decoration: none;">*</a></h5> Abstracted from an article that originally appeared in the June, 1968 issue of Orthotics and Prosthetics. The patient, a 37-year-old white male, received traumatic injuries while involved in an auto accident in October 1965. Both limbs were severely crushed, and very high amputations were necessary. The physical appearance of the patient resembled that of a bilateral hip disarticulation amputee; however, closer examination and X-rays of the patient revealed that femoral neck and head were present bilaterally. The remaining skeletal structures of the femurs are approximately 3" on the left and 4" on the right side (<a href="/files/original/4ba0e022e7651bf5a36b045a6168ac98.jpg">Fig. 1</a>). The patient was first hospitalized at the Allentown Hospital in Allentown, Pennsylvania, and then became a patient at the St. Vincent's Rehabilitation Center in Erie, Pa. There he received initial rehabilitation training and became ADL independent. On September 29, 1967 a prosthetic prescription for a definitive prosthetic unit was written. "Modified bilateral hip disarticulation prosthesis with modified plastic split hip disarticulation buckets for bilateral use, Northwestern stride control hip joints, single axis knee units with positive locks and SACH feet." The split bilateral hip disarticulation socket was prescribed with the hope that the patient would be able to advance one foot in front of the other and, consequently, walk with a semi-normal gait (taking full advantage of the remaining femurs). The stride control hip locks and positive knee locks were to give him stability during walking and stance. <h3>Taking of the Cast</h3> The negative mold of the patient's body was obtained by utilizing the Northwestern Type Four Point Suspension Technique. The patient was freely suspended approximately 3 feet off the floor in a double layer of 10" nylon stockinette and the body stocking conformed snugly to the patient's body (<a href="/files/original/7b7fb17dbc1e54bd9317ab53fa1a6774.jpg">Fig. 2</a>). The outlines of the prosthetic socket and all bony protuberances, such as the remaining femurs, the anterior superior iliac spines, the iliac crests, and the ischial tuberosities, were carefully marked with indelible pencil. Four inch fast setting plaster-of-Paris bandages were used for the cast. A rope of plaster-of-Paris bandage was pulled in deeply proximal to the iliac crests to supply suspension of the socket. After the plaster bandage was applied, the patient was lowered onto a stool until the ischial tuberosities were bearing moderate pressure and the patient's position was stable. Plumb lines on the anterior, posterior, and lateral midlines were drawn. The cast was then split anteriorly and posteriorly and removed from the patient's body (<a href="/files/original/54f4c998ff0b12d9f2b0955afd658381.jpg">Fig. 3</a>). <h3>Filling of the Negative</h3> The anterior and posterior openings were sealed and the negative was positioned on a table and all four vertical reference lines were aligned with a level. A 3/4" pipe was positioned and aligned with the four reference lines using a special holding device. The filling of the negative proceeded in the usual manner. After hardening of the plaster, the reference lines were punctured with an awl and marked on the top surface of the cast. The lateral reference lines were used to establish fictitious trochanters bilaterally. These trochanters were located 1 1/2" proximal from the distal end of the cast. A 45° triangle was cut from 1" thick plywood. The lines for positioning of the hip joints were marked by locating the plywood triangle exactly on the previously marked trochanters with the lower point anterior. The plaster-of-Paris bandage was then removed from the male mold. <h3>Modification of the Male Mold</h3> All reference lines punched with the awl were connected and retained. All marked bony protuberances were built up with plaster of Paris to approximately 3/8" to 1/2". Trimlines of the socket were drawn. These consisted of a proximal brim approximately 3/4" below the rib cage and anterior and posterior teardrop openings, 4" by 5", connected to each other distally by a channel 1 inch wide. The cast was then smoothed and the trimlines built up and molded to a flare of approximately 3/4" radius. This was for the patient's comfort. The mold was then allowed to dry in an oven for 24 hours at a temperature of 115°F. Then it was positioned in a vise exactly 45°, using a specially milled 45° steel positioning block so that the trochanteric reference lines were vertical. The alignment of both lines was checked with a plumb line. Two cardboard cylinders, 4" in circumference and 3" high, were taped to the cast, keeping the hip joint reference lines exactly centered. Both cylinders were covered on top, and only a hole the size of a quarter was left open on each cylinder through which the liquid foam was poured. <h3>Hip Joint Mounting</h3> The top of each block was cut square and level with the ground and as close to the mold as possible. The hip joint mounting reference lines were marked on the blocks, and both hip joints positioned. The outline of the base plates was marked, and the foam blocks were shaped to blend in with the entire cast. The base plates were attached with plaster of Paris, and the entire foam build-ups sealed with plaster of Paris. An extra build-up of plaster of Paris of approximately 3/4" thickness was provided over the entire seat area, which would later give space for a foam (silastic) seat pad. The cast was now air dried. <h3>Fabrication of the Socket</h3> The model was prepared for vacuum lamination, smoothed, lacquered, and a PVA sleeve applied. The first lamination consisted of four layers of 8" nylon stockinette and polyester resin (90% 4110 - 10% 4134). After this lamination was completed, the entire surface was roughened with coarse sandpaper and a reinforcement of nine feathered layers of fiber glass cloth and epoxy resin (C-8) applied over each hip joint attachment area. A final layer of three layers of stockinette and polyester resin completed the lamination process. The completed socket was removed from the model, cut to the trimlines, and all edges were smoothed. The foam blocks and plaster of Paris build-ups were carefully removed, and the entire cast smoothed, lacquered, and greased. The interior hip joint mounting plates were attached with two screws, leaving one screw hole and a 3/8" center hole open for injection of the silastic. The two half sockets were repositioned on the model and the silastic, 25% 385 and 75% 386, was injected into each side. After curing of the silastic the two halves were removed and the hip joints and thigh block installed. <h3>Alignment and Fitting</h3> The prosthetic feet were set up so that a reference line from the hip joints through the knee bolts would fall 2 1/2" posterior to the heel of the shoes. Subsequently during dynamic alignment this was increased to 3 inches. The height of the knee centers was set so that the patient would be able to sit in a normal chair with both feet flat on the floor (<a href="/files/original/c87f8df1446c1a57754c6d380e1dc234.jpg">Fig. 4</a>). Two cork seat blocks had to be added to the seat of the sockets to bring the patient up to a normal and level sitting position. A prelaminated flexible plastic tongue provided a closure of the anterior opening of the socket. Buckles and Dacron-reinforced leather straps were used instead of Velcro straps as the Velcro straps would be too inconsistent. The posterior opening of the socket was closed with a 4" by 6" by 1/8" Ortholene flexible hinge, so that the patient could walk with his semi-normal gait (<a href="/files/original/aa356de1c97d7c797ba7399a8a358c73.jpg">Fig. 5</a>). From the knee units, cables complete with housing and retainers were brought up laterally within easy reach of the patient's hands. For unlocking they hook onto small stainless steel hooks. The stride control hip locks were to lock automatically when the patient stood up. The patient is indeed able to ambulate, advancing consecutively one foot after the other. Ascending and descending stairs is accomplished by the patient hoisting himself on the banisters (<a href="/files/original/4a16949b838f44f4b7bbfc854e44bbed.jpeg">Fig. 6</a>, <a href="/files/original/84863942578d92ee15a89ac6adee6168.jpeg">Fig. 7</a>). After the patient became more skilled in ambulating, and due to the extreme stability, the hip stride control locks were removed and stride length control straps substituted, giving the patient a somewhat longer step. The patient was followed by the author for approximately two years, during which time he was wearing his prosthesis extensively. After one year he was fitted with a bucket-type prosthesis which was distally closed and not used as a split socket prosthesis. A platform was attached to this socket, and carpet rollers were used so that the patient could perform some mechanic's activities closer to the floor. He propelled himself with his hands, and used padded leather gloves for that purpose. *Peter A. Ockenfels, C.P.O. American Orthotic &Prosthetic Laboratory, Inc., Columbus, OH Page Number(s) 5 - 8 Year 1982 Volume 5 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-4.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-5.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-6.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1982_01_005/1982_01_005-7.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Management and Construction Procedure of Bilateral Split-Bucket Type Hip Disarticulation Prosthesis Creator An entity primarily responsible for making the resource Peter A. Ockenfels, C.P.O. * https://staging.drfop.org/files/original/d58593ef39362194114423665e739f0c.pdf fcbe907f83e666b1ec1ef034e62a0e0e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_01_010.pdf Text Any textual data included in the document <h2>Professionalism Or What?</h2> <h5>John Sabolich, C.P.O. <a style="text-decoration: none;">*</a></h5> Editor's note: This article originally appeared in the September, 1981 issue of the AOPA Almanac. Mr. Sabolich has kindly given his permission to reprint the article so that it may be shared with a larger audience. Are you a professional? If so, how do you know? Our field is struggling with this question. There must be more to being a professional than wearing a white lab coat! Let's start with us, the Prosthetist or Orthotist. Sometimes the words that come out of our own mouths are the greatest obstacles to being fully recognized as professionals. We are engaged in advertising and are placed next to store ads in many publications that medical personnel read. We call our patients "customers," our lab and office a "shop" or "store"; our fee schedules are called "price lists." We go to hospitals to "sell our wares" without even charging a consultation fee! Prostheses and orthoses are called "appliances." (Does this sound professional, or like a washing machine and dryer?) We are called "low bidder" on contracts in which we need not even be involved. Maybe we would be happy to move up one more notch to a "vendor"! I hope we shudder at the term! There are other areas in which we could improve our professional status in the community, such as what we call our facilities. The words "artificial limb," "brace" or "shop" are not conducive to our professional status. We refer to a patient's leg or residual leg as a "stump," prosthetic socks are called "stump socks." Patients feel rushed in clinical or office situations. Interoffice conduct, such as loud talk in patient care areas, the manner in which we answer our phones, or allowing patients in the lab, all reflect on our professionalism. Seemingly insignificant things are important, such as parking areas that say "customer parking" instead of "patient parking." Yes, we present ourselves to the patient in many ways. One of the most important is the appearance of our front offices, reception areas and examination rooms. Many times there are items for sale or on display, even prostheses and orthoses. This does not make us look professional to the patient but rather gives our office a store front appearance and lends to uncomfortable and impersonal feelings. A professional practitioner should be opposed to anything or anyone who blocks patient care. We avoid calling the doctor if we disagree with prescription rationale, when the patient is the ultimate beneficiary. All medical as well as paramedical people must realize they are not the most important person in a clinical situation. It must be made clear, the patient reigns supreme! The patient and medical community could view us as paramedical professionals. In this setting, it can be better understood that payment is not being made for a "piece of plastic" but for expert knowledge, ability and education. The device itself only represents a contributing factor in designing and implementing an efficient and successful prosthetic and orthotic program. A prosthesis or orthosis is the only tangible thing the patient sees, therefore patients tend to equate the fee charged with the plastic object provided for him. When a doctor operates, does he charge $5000.00 for the $1.50 worth of cat gut? Again, this is the only thing the patient can actually see and feel. The public at large is not familiar with the terms "Prosthetics" or "Orthotics". It would force them to become educated to these more professional terms if, under Artificial Limbs and Braces, the telephone books across the country referred the public to Prosthetics or Orthotics in a cross reference. Suppose you are John Doe looking up artificial limbs in the yellow pages. You simply would not find it because you would be referred to the word Prosthetic. Think how far that would go on a national scale to educate people to these important terms. In Oklahoma we were able to accomplish this goal. The practitioners in this state all agreed to be moved to the more professional title and even reduce their listings to only three lines. We will all feel more professional this year! We must strive to increase our credibility by being more precise in our practices, turning away from the empirical and moving toward the scientific and quantitative approaches by increasing our support dramatically which can effectively increase our knowledge and technology. Our educational criteria must remain high. Board certification exams should remain comprehensive with lower level technical schools to supply the manpower. I realize that I am also guilty; yet if we care enough, we must attempt to correct these problems for ourselves, our profession and, most importantly, for the patients who seek our help. My fellow practitioners, I suggest to you, this problem lies with us; our attitudes, what we say, what we do. <h3>Acknowledgements :</h3> I express my sincere appreciation to these people for directly influencing the contents of this article. Steven D. Prock, CPO Michael T. Wilson, CPO Henry L. Schufletowski, CO William J. Barringer, CO Thomas Haslam, CO Alvin C. Pike, CP Charles Pritham, CPO Lester Sabolich, CPO Melvin Stills, CO Lorene Sabolich Lee Sabolich Karen Mondie Tina Prince *John Sabolich, CPO. Sabolich Inc., Artificial Limb and Orthopedic Appliance Co. Oklahoma City, Oklahoma Page Number(s) 10 - 10 Year 1982 Volume 6 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Professionalism Or What? Creator An entity primarily responsible for making the resource John Sabolich, C.P.O. * https://staging.drfop.org/files/original/600929dee45085ca12ad1bf2f58a604b.pdf 96ef868f6a75c4473d81d11010115943 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_001.pdf Text Any textual data included in the document <h2>Influence of Government Funding on Prosthetics Research and Development</h2> <h5>Eugene F. Murphy, Ph.D. <a style="text-decoration: none;">*</a></h5> Historically, tragically, warfare has been the major stimulant for the development of prosthetic devices. Much of the early history is traced in the introductory chapter of the Orthopaedic Appliances Atlas, Volume 2, published by the American Academy of Orthopaedic Surgeons in 1960. A fascinating source is the book Historic Artificial Limbs by the Italian surgeon Putti, published by Hoeber, New York, 1930, based upon the outstanding collection of artificial limbs in the Stibbert Museum at Florence, Italy. With that museum's distinguished collection of armor, it was perhaps natural that the byproduct of artificial hands, arms, and legs made by armorers for knights should also be assembled there. The story of the German knight Goetz von Berlichingen, commemorated in a drama by Goethe, stresses the knight's iron artificial hand. Surgery generally and amputation surgery in particular were developed by the French surgeon Paré in connection with the religious wars in France; a corresponding development of artificial limbs was done by a locksmith known as "le petit Lorrain." Very likely only the relatively well-to-do knights and nobility were able to afford these early prostheses, with common people left to relatively crudely carved prostheses or crutches as illustrated, for example, by Breughel. After the American Civil War, the government provided an allowance for artificial limbs for Union veterans. This financial incentive, plus the rapid increase of amputees from industry and railroads, led to great competition among private developers. In that era artificial limbs were essentially sold as commodities rather than fitted as professional services. Some interesting patents are cited in the Orthopaedic Appliances Atlas, Volume 2. In World War I, countries among both the Central Powers and the Allies carried on simultaneous attempts to treat their patients and to develop better methods of surgery and fitting. Work in the Central Powers, notably in German military hospitals and in the Technical University of Berlin under Schlesinger, an engineering professor, was covered in great detail in the classic book Ersatzglieder und Arbeitshilfen (Substitute Limbs and Work Aids) published in 1919. Florent Martin worked extensively in Belgium, developing relatively early methods of fitting of temporary plaster-of-paris sockets on pylons for amputation of the lower extremity. His work was recorded particularly well in his critical analysis, Artificial Limbs; Appliances for the Disabled, published by the International Labour Office at Geneva in 1924. Efforts in England, including development of the specialty of limb fitting surgeon and the standardization of mechanical construction of a series of light metal limbs for many basic levels of amputation, are described in E. Muirhead Little's book Artificial Limbs and Amputation Stumps, published in England in 1922. During World War I, the Artificial Limb Manufacturers Association (ALMA) in the United States developed rapidly to advance the industry and cooperate with the government. Its descendant, the American Orthotics and Prosthetics Association (AOPA), along with the American Board for Certification (ABC), and the American Academy of Orthotists and Prosthetists (AAOP) continue today to develop the profession. In World War II, the ALMA set up a small laboratory on the premises of the Rowley prosthetics facility in Detroit, under the name of the Research Institute Foundation. Its extremely limited financial and technical resources allowed very meager efforts. Late in the war, partly because of growing demands from servicemen and unfavorable publicity, the Surgeon General of the United States Army asked the National Academy of Sciences (NAS) and its operating arm, the National Research Council (NRC), to select and standardize the best artificial limb designs. At a conference in 1945, the only unanimous agreement seemed to be on the concept that the best was not too good and that further improvements were needed on all aspects. The Surgeon General then asked the NAS-NRC to organize a systematic program "to conduct with utmost dispatch research and development in the field of prosthetic devices." The resulting interdisciplinary Committee on Prosthetic Devices initially was financed by the wartime Office of Scientific Research and Development, then the Army briefly, and later the Army and Veterans Administration (VA) jointly. On July 1, 1947, it was reorganized as the Advisory Committee on Artificial Limbs to provide advice to other agencies which wished to conduct their own programs. The NRC committee structure underwent a variety of changes from 1945 to the mid-1970's but has now disbanded. AOPA-ABC-AAOP members were frequent members of committees, subcommittees, and technical groups in this structure. The Army, Navy, and Veterans Administration each operated a laboratory. The VA, initially alone and later in parallel with other agencies, supported a series of projects with universities, industrial laboratories, and, in recent years, particularly through intramural projects in VA Medical Centers. After a change in its basic laws, the Office of Vocational Rehabilitation or its successors, now the National Institute of Handicapped Research (NIHR), has supported an increasing number of Rehabilitation Engineering Centers and projects. In addition to stimulating a wide variety of basic studies on locomotion and arm and hand motions, phantom limb pain, and psychological aspects, and development of a wide range of devices for all levels of upper-and lower-limb prostheses, the total government-supported program became a major force in educational efforts and dissemination of information. The early suction socket schools brought together distinguished surgeons and prosthetists, teaching the surgeons about mechanisms and the prosthetists about anatomy and physiology, as well as fostering team work between the two professions, promptly involving therapists, and helping to upgrade the entire field. Follow-up of the early suction sockets led to organization of formal clinic teams. The suction socket certification program, operated by Orthopedic Appliance and Limb Manufacturers Association (OALMA) in conjunction with the NRC committee and recorded in the Veterans Administration, led to joint certificates and helped to pave the way for the founding of the American Board for Certification with its remarkable interdisciplinary board of directors. The suction socket schools led, in 1953, to organized university-level post-graduate education in prosthetics and later in orthotics. Frustratingly slow as development often seems, nevertheless in retrospect it would appear that numerous major changes in devices, techniques, materials, and management methods were made in this continuing program. Voluntary cooperation was the key element in holding together this loose confederation. Diverse disciplines, many government agencies, some private foundations, separate organizations, sometimes competitive interests, and strong personalities worked together for the improvement of the lives of the disabled. The fact that substantial government funding was available, though never on the scale needed for the awesome task of truly replacing human parts and functions, tended to minimize the importance of private funding for the research and development and even for the dissemination of results. One chronic problem, though, has always been the transition from a reasonably well-developed laboratory model with a very limited clinical experience on "professional" pilot wearers into a routinely available, commercially manufactured component available in high quality and at low cost to skilled and trained practitioners throughout this country and abroad for fitting to large numbers of individual patients. Some devices were purchased in modest quantities for field tests through the National Academy of Sciences itself in the 1950's or through the Veterans Administration Prosthetics Center after that group was organized in 1956. Typically, AOPA was asked to suggest a group of potential bidders to make proposals for tooling and for construction of some modest number of models needed for a wide scale field trail or evaluation. Because of fiscal restraints and practical problems, numbers of copies were usually smaller, and statistical validity was low. (Early attempts to interest other organizations lacking experience and distribution facilities in the prosthetics field had been frustrating and largely disappointing.) Typically, the manufacturer of the initial test models has evolved into the principal, if not sole, manufacturer of the final device-if indeed it proved to be successful in the field trials. The field has been so small that there frequently has been no room for multiple manufacturers of a single relatively complex device, although other versions with somewhat comparable yet somewhat different functions sometimes evolve in parallel. Field trials should refine not only the hardware but the prescription, fitting, and training techniques, the manuals, and the maintenance procedures. All participants in a clinic team become familiar with the new development. There has long been interest in stimulating private support of research and development, presumably based upon the results of fundamental studies conducted under government auspices. The government-supported program has sometimes received or purchased a few early test models of private inventions and has had its intramural or contract laboratories conduct studies with these test models, thereby providing a useful consulting service to the inventor or manufacturer which he probably could not readily obtain otherwise. This kind of independent evaluation may well become increasingly important under the medical device amendments in order to prove safety and effectiveness of new devices. In any evaluation, there are problems in simultaneously assuring competence without bias and in providing constructive criticism in useful form which can be applied to improving the device for all disabled. With the continuing and indeed increasing pressure upon government budgets, it would seem that the developers must increasingly come from private industry. Karl Vesper, the engineer and investment expert who organized the original Hosmer Corporation in the 1940's, was an early participant in the NRC and VA programs. He pointed out that as a private entrepreneur he could effectively estimate the potential strengths of competitors and their ability to develop and market new products within given time periods, so he could make his own choice of development expenditures wisely. Conversely, though, he could not predict what a government agency might do, particularly under political and other pressures. Though the existing government research and development projects are public knowledge, for example through progress reports published in the Bulletin of Prosthetics Research, private developments may well be "proprietary secrets." The net balance between these and other disadvantages and advantages for private development is hard to estimate. From the standpoint of the disabled of the world, one can only hope for a frank, friendly, and cooperative relationship between private entrepreneurs, government sponsors and regulators, government purchasing or using services at all levels, third-party purchasers, and the several professions concerned. *Eugene F. Murphy, Ph.D. Director, Office of Technology Transfer Veterans Administration, New York, NY Page Number(s) 1 - 3 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Influence of Government Funding on Prosthetics Research and Development Creator An entity primarily responsible for making the resource Eugene F. Murphy, Ph.D. * https://staging.drfop.org/files/original/6438c2935f8cb41a327a7110da0804b6.pdf fed62d2cec4e0a2356a7a35ce7281034 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_006.pdf Text Any textual data included in the document <h2>Editorial: Prosthetic and Orthotic Support - The 1982 Budget</h2> <h5>Charles H. Epps, Jr., M.D. <a style="text-decoration: none;">*</a></h5> The past year has seen a series of legislative successes by the Reagan Administration in its efforts to reduce the federal budget. The budget for the current fiscal year totals roughly $720 billion of which almost $270 billion will go for defense and interest on the national debt. It is estimated that almost four out of five of the remaining dollars will go for entitlement programs. The balance comprises the part often referred to as the controllable budget and includes items such as high wages, veterans hospitals and medical research.<a></a> The experts at this point have been unable to fully sort out the impact of the proposed cuts but it is estimated that almost $20 million will be in health and human service programs. The cuts will not stop here as the Administration in September proposed another 12 per cent reduction in human services to offset the extra $25 billion budget deficiency caused by the personal income tax cut.<a></a> One does not have to be an economist to realize that the proposed changes will fundamentally alter the scope of federal programs, particularly health and human services. It also becomes apparent that prosthetic and orthotic services as well as training, research, and development in those areas will be affected. Historically, the level of federal involvement and support has been substantial when one considers that laboratories engaging in prosthetic-orthotic research were operated by the Army, the Navy and the Veterans Administration. The Veterans Administration alone and in parallel with other agencies has supported a number of projects with universities, industrial laboratories, and in recent years has sponsored intramural projects in Veterans Administration Medical Centers. The office of Vocational Rehabilitation and its successor, the National Institute of Handicapped Research, (NIHR), supported Rehabilitation Engineering Centers and projects throughout the United States. The budget reconciliation process has been utilized in the Congress to fashion this new reduction of the federal role. Funds administered through the NIHR vitally affecting prosthetic and orthotic research and training have been exposed to this budgetary process. The Appropriation Committees of the House and the Senate have reviewed this aspect of the budget. The programs for crippled children, which reach many children requiring prosthetic and orthotic devices, have not escaped budget cuts. Maternal and Child Health (MCH) and Crippled Children's Services (CC) have been consolidated into a block grant to the states under Title V of the Social Security Act. Included in this particular block grant are: supplemental security income for disabled children; lead-based paint poisoning prevention; sudden infant death syndrome; hemiphelia treatment centers, and adolescent pregnancy. The House-Senate Conference agreement currently under the continuing resolution provides for an authorization of $347.5 million for fiscal 1982 for the MCH block grant. This amount is 25 per cent less than the 1981 appropriation of $456.2 million. It is hoped that support will continue for valuable programs presently funded at least in part at CAPP in Los Angeles, the Area Wide Amputee Center in Grand Rapids, and at New York University. Presently there are five projects funded at a level of $1.3 million. It is proposed to accomplish a reduction of 77 percent to a level of $300,000 in fiscal 1982. These projects, considered an aspect of technology transfer, constitute an activity of vital national concern. A reduction of this magnitude (77 percent) will substantially impair the programs. These are areas where private initiatives and voluntarism cannot replace the federal support. The private sector has been unwilling or unable to support totally even the more glamorous and highly visible activities such as symphony orchestras, art and scholarship support. Prosthetic and orthotic projects pale by comparison in their ability to attract private support when compared to other highly visible programs. It remains, therefore, the task of each of us to write or wire our Representatives and Senators requesting support of action in the Appropriation Committees of Congress that will insure at least a continuation of the present level of support, if not an increase in the funding for prosthetic and orthotic research and training. The present level of funding will deprive patients of needed services and cripple the research and training efforts perhaps beyond recovery. References: <ol> <li>Editorial: "Who will Be Entitled?" The Washington Post, January 22, 1982, p. A14.</li> <li>England, M.J.: "The Health and Social Service Picture," Journal AMWA 36:350, 1981.</li> <li>"Health Programs Are Being Slashed," The Nation's Health, January 1982, p.1.</li> </ol> *Charles H. Epps, Jr., M.D. Professor and Chief, Division of Orthopaedic Surgery Howard University Hospital Washington, D.C. Page Number(s) 6 - 6 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Editorial: Prosthetic and Orthotic Support - The 1982 Budget Creator An entity primarily responsible for making the resource Charles H. Epps, Jr., M.D. * https://staging.drfop.org/files/original/c3460a2dab08b833441c25bf7385221d.pdf 07ff006625669bcbaab152e35ddbab6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_007.pdf Text Any textual data included in the document <h2>Letter To The Editor: A Return To Research?</h2> <h5>A. Bennett Wilson, Jr. </h5> Thirty-seven years ago, with funds from the United States Government, the National Academy of Sciences initiated a research and development program in artificial limbs because amputees in Army and Navy hospitals expressed quite vociferously their dissatisfaction with the artificial limbs provided at that time, and because there had never been, in this country, any concerted scientific effort to solve the problems of amputees. Although the research program, funded until the late 1950's largely by the Veterans Administration, was not looked upon with favor by many prosthetists during its early stages, with the help of a few of the more progressive prosthetists and orthopaedic surgeons sufficient progress was made by 1952 to warrant the initiation of a formal education project at the University of California at Los Angeles, which set the pattern for the present education program in prosthetics and orthotics. The Department of Health, Education, and Welfare, about 1955, joined the VA in supporting research, development, evaluation, and education; orthotics was added to the mission in the late 50's; and progress continued to the point that by the early 70's nearly every aspect of prosthetics had been replaced by newer techniques and devices, and work in orthotics was progressing rapidly. Although it was, and is, recognized by many that further, continuing research was needed, the government agencies have all but abandoned research and development in prosthetics and orthotics, and as a result very few improvements have been introduced to the practice of prosthetics and orthotics during the last few years. This unfortunate situation has been brought about because of a number of factors: the decision by the National Academy of Sciences to withdraw from the program; reorganization by the VA in 1973 that resulted in transferring research and development responsibility from the Prosthetic and Sensory Aids Service to general medical research, and to conduct most of the research and development in VA hospitals; and an unbelievable proliferation in all government agencies of "red tape" required in awarding contracts and grants. During these 37 years, the prosthetics and orthotics profession has become healthy and strong, in part because the research and development program has provided a teachable body of knowledge and an education program that has produced a group of practitioners who are capable of communicating effectively among themselves and with other groups. Given this set of circumstances, it seems reasonable that the prosthetists and orthotists in this country should consider taking responsibility for research, development, and evaluation, and relieve the government of most of the responsibility it has assumed in this area for the last 37 years. Certainly a program administered by AAOP-AOPA could be more efficient and more effective than one administered by the government. One way to finance this undertaking is to include in the price of each new prosthesis and orthosis an appropriate percentage of the price to be set aside for the research program. This sum would, of course, be a legitimate business expense. The coordination and "clearing-house" functions would reside in the National Office, and R&D would be carried out in appropriate facilities and institutions. If properly managed such a program would have many obvious advantages, not the least of which would be improved patient care. Page Number(s) 7 - 7 Year 1982 Volume 6 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Letter To The Editor: A Return To Research? Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. https://staging.drfop.org/files/original/6c0a91f3e6ca48a7d6eb71da9b638ef1.pdf 053df77f111f816175d9cd9b8a12a789 https://staging.drfop.org/files/original/56827526320afb7bc3726a24ed19a2e1.jpg 548798c301947254e31ac1fd04ba5be2 https://staging.drfop.org/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg 20141917fda2ff9c21dc4cd7f4f9579d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_02_008.pdf Text Any textual data included in the document <h2>Post Operative Management of Lower Extremity Amputees Using Tubular Elastic Compression Bandaging</h2> <h5>William M. Brady, C.P.O. <a style="text-decoration: none;">*</a></h5> <h3> Introduction</h3> Edema is inevitable in a postoperative limb and is a matter of concern to all who are involved in the postoperative care and rehabilitation of amputees. Persistent edema, that is edema that fails to subside over a period of weeks following amputation surgery, delays the rehabilitation process including the fitting of the definitive prosthesis<a></a>. Several systems of compression bandaging have been investigated and reported in various medical journals. These include soft dressings, pneumatic pressure sleeves, stump shrinkers, semirigid dressings, and rigid dressings with or without a program of early ambulation<a></a>. Of all of these systems, the most common one is the elastic wrap bandage<a></a>. It is readily available inexpensive, comes in a range of sizes and is washable. In spite of its advantages, however, its users are also aware that it is difficult to apply, doesn't maintain continuous pressure, must be reapplied frequently, cannot be reapplied the same way each time, and loses its compressibility after a few washings. Since the amount of external compression applied to the limbs seems to be a key factor in reducing edema, studies have been undertaken to define the "ideal" pressure. Some of the findings reported are as follows: <ol> <li> less than 5 to 10 mmHg of mercury is undersirable<a></a>; </li> <li> external pressure of 30 mmHg or greater decreased the venous flow rate of the leg<a></a>; </li> <li> external pressures above 25 to 30 mmHg, if sustained, may be potentially harmful<a></a>; </li> <li> pressures obtained from elastic wrap applied by skilled professionals ranged typically from 23 to 72 mmHg<a></a>; </li> <li> elastic compression to the lower limb markedly reduced the volume of the limb<a></a>. </li> </ol> <h3>Development of a Product</h3> Early in 1980 Knit-Rite, Inc.,<a style="text-decoration: none;">*</a> a manufacturer of prosthetic socks and stockinette tubing, initiated the development of a tubular elastic compression material that would be equal or superior to any compression bandage currently available on the market. Believing that such a product would have medical applications in the control of edema but uncertain of how it could be made to achieve the desired pressures and other characteristics, they contacted the Physical Medicine Department, University of Kansas Medical Center, for recommendations. Out of this inquiry evolved an amputee study involving 41 amputees, 35 below knee (B.K.) and 6 above knee (A.K.) and resulted in a paper entitled "Pressure Applied by Stump Bandages: A Comparative Study," by G. Varghese et al.<a style="text-decoration: none;">*</a> This study compared the elastic wrap, the Knit-Rite tubular elastic bandage and stump shrinker, and another brand of tubular elastic bandage. It supported some beliefs and established others: <ol> <li> Elastic wrap was the most difficult to apply. </li> <li> Pressures exerted by elastic wrap varied widely and the results were significantly different when applied by skilled and unskilled people. </li> <li> Elastic wrap failed to sustain constant pressures over a prolonged period of time and had a tendency to loosen with usage. </li> <li> Both tubular compression bandage products were more easily applied by patients and/or family members. </li> <li> More consistent pressure over a prolonged period of usage could be obtained with tubular elastic bandages. </li> <li> The Knit-Rite tubular compression bandage, when doubled, exerted a pressure which was in the "ideal" range, between 15 to 30 mmHg as measured by a solid state pressure transducer. </li> </ol> Actually, many changes in the product occurred during the course of this study.<a style="text-decoration: none;">*</a> Finally the acceptable tubular compression bandage was made available as a 10 meter Compressogrip® roll in a range of widths and lengths and as a stump shrinker item in a range of widths and lengths. The stump shrinker item is individually packaged and labeled with care instructions. <h3>Field Testing</h3> At the same time that the Kansas University Medical Center was conducting their research and continuing through the present time, Isle Orthotic-Prosthetic Services, of Kansas City, Missouri, was using the tubular compression bandage in the postoperative management of its referred amputee patients. Field testing was also conducted at a private prosthetics facility in the Kansas City area and at the V.A. Hospital. These findings, while empirical do confirm the results of the scientific researchers. The earlier a program of tubular compression bandaging is begun post-operatively, the sooner swelling will subside and tissues can be properly supported and correctly molded to a shape acceptable for prosthetic fitting. The correct size of bandage must be selected and patients or responsible family members instructed concerning the proper method of applying the tubular compression bandage and maintaining a controlled, total-contact fit throughout the period of wear. The recommendation, with the permission of the managing physician, is to wear the bandage 24 hours per day, except for bathing or during periods of muscle spasm, cramping or persistent pain. At least 2 to 3 bandages need to be supplied to the patient to allow for laundering. <h3>Selecting the Proper Size Bandage</h3> Care needs to be taken in fitting to insure that the width selected achieves adequate compression without overstretching the material (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>) and that the length selected allows for a double layer (<a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2</a>). Optimum compression occurs when the tubular compression bandage is stretched at least 50% but not more than 100% of the original width. For a B. K. amputee it is recommended that a circumference measurement be taken 2" below the medial tibial tubercle, and for an A. K. amputee, 2" proximal to the distal end. <a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a> Sizing Chart for Tubular Elastic Stump Shrinkers. <a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2.</a> Application Technique. Example: The measured circumference is 11 inches. From the chart (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>) we see that Size #3 is the correct size. The sizes #2 through #5 are approximately 2" through 5" in flat width. Thus Size #3 is approximately 6" in circumference and would best accommodate measurements from 9" to 12" in circumference. If the differential between distal and proximal circumferences, as in extremely tapered A. K.'s, is greater than 5", then the next size larger bandage should be selected to avoid overstretching the material and to insure ease of application. <h3>Applying the Bandage</h3> On a below knee amputee, apply the first layer so that the material extends approximately 3" proximal to mid-patella. Slide the nylon ring (supplied with and surrounding the bandage) forward until firm distal pressure occurs, then reflect the second layer over the first to no more than 1/2" proximal to the superior border of the patella (<a href="/files/original/3e0affd56b0e765df6a7a25041d5dc38.jpg">Fig. 2</a>). In this way, greater pressure is maintained distally than proximally. If necessary, excess material may be marked and cut off, folding inside the cut ends of the second layer to achieve a smooth edge; however, the cut edge may ravel. Different lengths are available to eliminate cutting as much as possible (<a href="/files/original/56827526320afb7bc3726a24ed19a2e1.jpg">Fig. 1</a>). Have the patient flex and extend the knee to check the security of the bandage. Then have the patient remove and re-apply the bandage several times until you are confident that the technique is mastered. Good follow-up is an important part of patient management. We recommend that the patient be rescheduled at 2 to 3 week intervals to check the progress of the shrinkage. Remeasuring and recording all pertinent circumference and diameter readings can then be done. When measurements have stabilized and no appreciable changes are noted from the last visit, casting for the definitive prosthesis can be initiated. The same basic procedure can be followed with A. K. amputees, except that some A. K. amputees will require the addition of a modified garter belt or webbing suspension to minimize the tendency of the bandage to roll proximally. <h3>Summary</h3> Our observations concur with recent research which suggests that the process of controlling and reducing edema is accelerated by using the Compressogrip® tubular compression bandage versus the conventional elastic wrap. Further, our experience indicates that the shaping of soft tissues is enhanced and that the post-operative period required to prepare the patient's residual limb for the definitive prosthesis is somewhat shortened when a tubular compression bandage is used. We project that patients managed in this fashion will have fewer post-fitting problems that are related to additional shrinkage occurring in the first few weeks of prosthetic wear and that the incidence and/or severity of phantom sensation will be reduced as a result of the controlled compression of the Compressogrip® tubular compression bandage. References: <ol> <li>Mooney, V.; Harvey, J.P.; McBride, E.; and Nelson, R.S., "Comparison of Post-Operative Stump Management: Plaster vs. Soft Dressings", Journal Bone and Joint Surg., 53-A, March 1971.</li> <li>Sher, M.H., "The Air Splint: An Alternative to the Immediate Postoperative Prosthesis", Arch Surg., 108: 746-747,1974.</li> <li>Puddifoot, P.C.; Weaver, P.C.; Marshall, S., "A Method of Supportive Bandaging for Amputation Stumps", Br. J. Surg., 60: 729-731.1973.</li> <li>Islerwood, PA; Robertson, J.C.; Rossi, A., "Pressure Measurements beneath Below Knee amputation stump bandages: Elastic Bandaging, the Puddifoot dressing, and pneumatic bandaging technique compared", Br. J. Surg., 62: 982-986,1975.</li> <li>Manella, K.J., "Comparing the Effectiveness of Elastic Bandages and Stump Socks for Lower Extremity Amputees", Physical Therapy, 61, March 1981.</li> <li>Holloway, G.A., Jr.; Daly, Colin H.; Kennedy,D.; Chemosky, J., "Effects of External Pressure Loading on Human Skin Blood Flow Measured by 133 Xe Clearance", Journal of Applied Physiology, 40 April 1976.</li> </ol> Footnote Field, M., Manager, Textile Research and Development, Knit-Rite, Inc., Kansas City, MO 64141. Footnote Varghese, G.; Hindle, P.; Zilber, S.; Perry, J.; Redford, J.B., 'Pressure Applied by Stump Bandages: A Comparative Study', American Congress of Rehabilitation Medicine, Oct. 1980. Footnote Kansas City, Missouri 64141. *William M. Brady, C.P.O. President, Isle Orthotic-Prosthetic Services, Kansas City, MO <div style="width: 400px;"></div> Page Number(s) 8 - 10 Year 1982 Volume 6 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1982_02_008/1982_02_008-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1982_02_008/1982_02_008-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Post Operative Management of Lower Extremity Amputees Using Tubular Elastic Compression Bandaging Creator An entity primarily responsible for making the resource William M. Brady, C.P.O. * https://staging.drfop.org/files/original/dbe2ac19d37adf6c68bc2cc2d6d7a9ee.pdf bab704eb64cc2396fb9d10d50719dee6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_03_001.pdf Text Any textual data included in the document <h2>Continuing Education: Past, Present, and Future for AAOP</h2> <h5>Charles H. Dankmeyer, Jr., CPO <a style="text-decoration: none;">*</a></h5> In 1978 the American Board For Certification in Orthotics and Prosthetics, Inc. (ABC) and the American Academy of Orthotists and Prosthetists (AAOP) reached an agreement which provided that AAOP would administer the continuing education program begun by ABC. The program is very similar to its original format developed by ABC, and remains a voluntary program. The Academy is responsible for processing applications, developing the standards to be met by the participants, and developing a recognition system for successful participants. ABC continues to accredit appropriate educational programs submitted to it and to designate the number of continuing education credits awarded for each program. The reason the organizations reached this agreement is two-fold. First, since the continuing education program that ABC was administering had no effect on certification outside of deciding the number of credit hours to be awarded for each program, ABC believed it should not be providing recognition to successful participants in a voluntary continuing education program. Second, AAOP believed that part of its responsibility was education. Since AAOP was directly involved in providing seminars, it seemed appropriate that AAOP should administer a continuing education program and provide recognition for successful participants. It should be remembered that both groups agreed to the continuing education program being administered by AAOP only to the extent that it did not affect certification. It should also be borne in mind that AAOP has no influence on the number of credits awarded or the approval of programs for credit. I stress that any continuing education program developed within the Academy does not affect an individual's certification by ABC. This emphasis is made because this is an area of grave misunderstanding by Academicians. Many members believe that if an individual does not participate in the continuing education program, he will lose his certification. Such is not the case. Any program developed by AAOP will affect only the membership within AAOP and not an individual's certification. The certification of an individual and the continuing certification of an individual remains the province of ABC. At the 1981 AAOP annual meeting the membership voted to convert the existing voluntary continuing education program to a mandatory program. This move by the membership has caused AAOP to search for an acceptable system for mandatory continuing education. Many approaches to converting the existing voluntary program to a mandatory one have been examined. None have been deemed acceptable. There are many problems within the continuing program which could lead to injustices for Academicians participating in a mandatory program. One of the things necessary, if we are to have a successful mandatory continuing education program, is the capability for an individual to plan ahead in meeting his continuing education requirements. Currently, there exists no publication which permits an Academician to sit down and look at all of the seminars and special programs being put on by other paramedical groups which may be acceptable for continuing education. Even if such a publication were available, there would be no listing of the number of credits allowed for each of these programs. Many programs which may well be suitable for credit are never even submitted to ABC to be approved. Program organizers are often not concerned about the need of orthotists or prosthetists to meet continuing education requirements and therefore never submit their programs for approval by ABC. Therefore, AAOP cannot recognize an Academician's attendance at many of the seminars and programs that are given locally by therapists and physicians groups. Additionally, there are extenuating circumstances which affect some Academicians' attendance at seminars. For example, I received a letter from an individual who was concerned that his membership in the Academy would be in jeopardy because he was unable to attend seminars on Saturday. As you know, most seminars are held on Friday, Saturday, and Sunday. This particular individual is a practicing Orthodox Jew and is unable to attend any seminars held on the Sabbath. It seems to me that it is in the best interest of the Academy to attempt to develop a program which will accommodate all individuals and not require them to travel in order to participate in the continuing education program. Such a program would allow individuals several choices to meet continuing educational requirements. I would suggest that reading of the AOPA Journal, Orthotics and Prosthetics, and clinical participation be the two mainstay requirements to maintain membership in the Academy. In fact under the current continuing education program, Journal reading is an acceptable means of obtaining credit. How does one know someone has really read the Journal? Journal reading could be verified by providing a group of questions at the end of a selected article within each issue. Academicians wishing to participate in a continuing education program would complete the questionnaire at the end of the selected article and return it to the National Office for approval. Although such a system appears to be a very minimal requirement, it would demonstrate that participants had at least read Orthotics and Prosthetics. There is currently such a system being used in a publication entitled Contemporary Orthopedics. This should satisfy the needs of those individuals who are unable to travel to seminars. Those individuals who decided to travel to seminars and meetings should be allowed to apply for credit for seminars attended. Therefore, they would not need the credits earned by responding to the questionnaires. An additional alternative could be a self-assessment examination. This could be required every three years of individuals who had not participated in a continuing education program designed around Journal reading or seminar attendance. Such a self-assessment examination could be structured in a manner which reported back to the individual his results without affecting his membership in the Academy. At the very least it would identify areas in which an Academician needed work. It is difficult to imagine that the Academy would be telling an Academician that he needed to bone up on a specific subject, because Academicians are currently practicing orthotics and prosthetics. To say that an Academician required additional work in a specific area is to say that orthotists and prosthetists are providing inadequate services. This is the same tack which therapists and physicians have taken with their mandatory continuing education programs. In essence, all of these programs state that practitioners who do not fulfill the requirements of the program are not maintaining competency. I do not believe that this is the case for orthotists and prosthetists. I believe that most orthotists and prosthetists have met the challenge of modern day orthotics and prosthetics practice. I further believe that if we are attempting to require continuing competency, and not continuing education, we should change our goals. The goal of all continuing education programs is to provide that practitioners maintain current standards which will benefit their patients. No continuing education program requires that a practitioner who attends a program utilize the material presented in that program. In other words, you can make someone sit down and listen to a different way of doing things, but you cannot make him practice it. This being the case, I do not believe that a mandatory continuing education program is in the best interest of the Academicians or the patients we serve. I suggest that continuing education not be a requirement for membership in the Academy. I further suggest that those practitioners who believe the ranks should be periodically reviewed for competency expend their efforts on obtaining a mandatory continued competency system. Continuing education is indeed the route that all other medical professions have followed. Continued competency remains the burr in every medical profession's side. To develop a continuing education program and to require that individuals participate in such a program appears to be the route that we must follow. I personally do not agree that this is the correct route. However, such a program has been requested by the membership. Academicians, I request that you submit to me your thoughts on such a mandatory continuing education program as a requirement for membership in the Academy. *Charles H. Dankmeyer, Jr., CPO Chairman, Continuing Education Committee President, Dankmeyer, Inc. Baltimore, MD <div style="width: 400px;"></div> Page Number(s) 1 - 2 Year 1982 Volume 6 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Continuing Education: Past, Present, and Future for AAOP Creator An entity primarily responsible for making the resource Charles H. Dankmeyer, Jr., CPO * https://staging.drfop.org/files/original/a6792a109f39ee50864e3cdc534b4712.pdf 9841f910ceaf33e1e3f1cc6914edbe70 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_03_008.pdf Text Any textual data included in the document <h2>Survey Results</h2> Below are the summarized results of two questionnaires that appeared in recent issues of this publication. These results are important tools for observing, recording, and predicting trends within the Academy and the profession. Your responses are greatly appreciated, and we ask that you encourage your colleagues to send us their thoughts by answering the questionnaire in this issue (see p. 3), and those in future issues. <h3>Scoliosis Orthoses</h3> From the Summer, 1981 Issue, Vol. 5, No. 3 A total of six responses have been received. Two respondents were institutional facilities and the rest were private. The six reported fitting a total of about 757 patients last year, an average of about 126 per facility. The maximum was 400 patients and the minimum was 8. Not too surprisingly, the maximum was an institutional facility (Newington Children's Hospital). The most commonly prescribed orthosis was the Boston System, and among four of the respondents it accounted for the majority of orthoses fit. One individual reported that the Boston System accounted for 100% of orthoses he fit for scoliosis (actual number, 13); however, two of these orthoses had been modified by the addition of a super structure, and 3 with anterior uprights. Only one respondent reported using more than 50% conventional Milwaukees (60%) and this individual, practicing in the Southwest, stated that all had leather girdles as plastic girdles were too hot. He also reported using 35% Orthomedics SOS Systems, the only mention of this style orthosis in the survey. Interestingly enough, one respondent reported that 36% of his scoliosis practice was comprised of Raney Flexion Jackets prescribed by a neurosurgeon for treatment of scoliosis and as positioning devices. Only one respondent, Richard D. Koch, CO of University Hospital, Ann Arbor, Michigan, reported using a preponderance (90-95%) of custom molded TLSO Body Jackets and Low Profile Orthoses combined (actual numbers fit 120-125). The rest of his scoliosis practice was comprised of conventional Milwaukee braces. Mr. Koch comments: "Through school clinics and early screening for scoliosis the range of curves have reduced in degree of their severity. Consequently, we find that TLSO Body Jackets and Low Profiles are in wider use than CTLSO's." Newington Children's Hospital, mentioned earlier, reported using 75% Boston Systems and 25% custom molded TLSO's primarily for treatment of non-idiopathic scoliosis secondarily to paralytic diseases. <h3>Results of the Survey Concerning Endoskeletal Prostheses</h3> From the Winter, 1982 Issue, Vol. 6, No. 1 As of March 25, 1982: 27 responses <ol> <li>How many definitive endoskeletal prostheses does your facility fit a year?</li> </ol> <ol> <li style="list-style-type: none;"> <ul> <li> Total of 1,814 fit, an average of 67 per respondee </li> <li> Maximum of 380 </li> <li> Minimum of 0, second lowest 5 </li> </ul> </li> <li> Indicate the percentages of the type fit. While it is difficult to give precise figures, roughly speaking the same trend prevailed for all respond-ees. About 95-100% of Below-Knee prostheses fit were exoskeletal and 95-100% of Hip Disar-ticulation/Hemipelvectomy prostheses were endoskeletal. Above-Knee prostheses occupied some middle ground with many respondents reporting fitting more than 50% endoskeletal Above-Knee prostheses. Only four respondents reported fitting as many as 50% endoskeletal Below-Knee prostheses. These four tended to be among the most frequent users of endoskeletal prostheses reporting 380, 170, 75, and 50 respectively. </li> <li> Which Endoskeletal Prosthetic System was used most frequently? <ul> <li> Otto Bock 20 </li> <li> AFP 2 </li> <li> Both Otto Bock and AFP 2 </li> <li> Both Otto Bock and USMC 2 IPOS 1 </li> </ul> </li> <li> Do you consider endoskeletal prosthetic systems light enough? <ul> <li> 11 said yes </li> <li> 14 said no </li> <li> 1 said yes to AK's and no to BK's </li> <li> 1 said yes to AFP and USMC and no to Otto Bock </li> </ul> </li> <li> Do you consider them reliable enough? <ul> <li> 19 said yes, one of whom qualified his response by saying for adults and geriatrics only </li> <li> 7 said no </li> <li> 1 said yes and no </li> </ul> </li> <li> Are cosmetic covers and skins adequate? <ul> <li> 23 said no </li> <li> 3 said yes, one qualified his answer by saying only the AFP system </li> <li> 1 said yes and no </li> </ul> </li> <li> Do you consider it necessary to have full capability to modify alignment in definitive endoskeletal prostheses? <ul> <li> 11 said yes, one stating that the need for making changes in alignment as the patient's condition changed was an indication for prescribing an endoskeletal prostheses. One specified the use in temporary prostheses. </li> <li> 1 stated that he considered it desirable early in the patient's progress and unnecessary late </li> <li> 14 said no, one of whom indicated that he used the AFP system exclusively and revised 380 of them </li> <li> 1 ambiguous </li> </ul> </li> <li> How often do you make changes in alignment? <ul> <li> 7 said never </li> <li> 17 said occasionally, one of whom stated that he occasionally made changes early in the patient's progress and never in more advanced instances. </li> <li> 3 said frequently. One was the individual in #7 who identified the need for alignment changes as an indication for prescribing an endoskeletal prosthesis. </li> </ul> </li> <li> Would you consider it satisfactory to trade alignment modification capability for lightness and durability? <ul> <li> 22 said yes, one of whom qualified his position by saying not at the expense of the ability to interchange components. </li> <li> 5 said no </li> </ul> </li> <li> 10. What changes would you like to see made? <ol> <li> 11 specified improved cosmetic covers </li> <li> 4 specifically recommended a more durable cover at the knee, or a way to reinforce or prevent impingement at the knee. </li> <li> 3 recommended more work on hydraulic and pneumatic knee control units, one of whom mentioned a hydraulic foot. </li> <li> 2 mentioned a more secure system of maintaining alignment. </li> <li> 2 mentioned waterproof skin for covers One each: </li> <li> lighter safety knee </li> <li> improved strengh </li> <li> easier to operate and more cosmetic knee lock </li> <li> interchangeability of knee units without necessity of altering pylon tube length. </li> <li> easier and better attachment of cover to foot and socket for improved cosmesis, yet allowing removal for adjustment of alignment. </li> <li> reduction in weight of single-axis feet and ankles </li> <li> modular, removable, hip joint and pelvic belt m. more versatile socket for geriatrics to accommodate weight fluctuation and vascular problems </li> <li> incorporation of cable systems in upper extremity prostheses. </li> <li> durable covers easily donned by the layman </li> <li> easier access to the adjustment screws on top of the foot of the Otto Bock system. </li> <li> Covers such as those used on Hydra-Cadence, but they must look better and last longer. Preferably in assorted sizes." </li> <li> noise reduction (spring squeaks) </li> <li> system for small girls </li> </ol> </li> <li> Additional comments: <ol> <li> "The Otto Bock System was the best of both worlds (lightweight and adjustable) until the alloys and tubing were changed for increased strength. A main selling point of the endoskeletal systems has always been improved cosmesis. This may be true for standing and during the first few months post-delivery. However, the common foam cover system deteriorates relatively rapidly-cuts, tears, folds, and compression of the foam remain common problems. Therefore, I feel the foam covers need refinement." </li> <li> "I want full adjustability while aligning. After alignment on definitive prostheses the adjustability doesn't have much value." </li> <li> "In regard to question #7. Depending on patient indications two systems would be desirable; one fully adjustable in terms of alignment, the other lighter and more reliable." </li> <li> "Most endoskeletal prostheses are for AK female amputees." </li> <li> "In reference to question #4 and #5 above, of course they could be more reliable and lighterweight if they could redesign the system (Otto Bock, Ed's note). As it is, they are doing the best they can with what they have to work with (design)." </li> <li> "It is a good unit but needs improvement." </li> <li> "Endoskeletal is a poor excuse to charge more money. Shell replacement is too costly too soon. I'm afraid the dollar sign prevails and not the patient's welfare." </li> <li> "For below-knee amputees, I do not feel an endoskeletal system is any advantage. For the young, active above-knee amputee, the foam cover is not durable enough. For the hip disarticulation of any age, it is usually preferred, except in special cases." </li> <li> "The endoskeletal system should only be used in those cases where lightness is desired and where changes in alignment are anticipated." </li> </ol> </li> </ol> <h3>Questionnaire Summary Comments</h3> The article on endoskeletal prostheses provoked an astonishing and gratifying response, something of a record in size, in the recent history of this publication. A surprising total number of prostheses are reported fit, and endoskeletal prostheses occupy a significant total in many individuals' overall practice. In assessing the results of this survey, it would do well to bear in mind, however, that according to the statistics, we are primarily talking about prostheses for the higher levels (Above-Knee, Hip Disarticulation, and Hemipelvectomy) fabricated with Otto Bock components. This fact is particularly interesting when considered in light of the fact that below-knee amputees are undoubtedly far more common in most practices. Despite the numbers fit, it is apparent that the re-spondees were less than totally satisfied with the components available. While somewhat ambivalent about weight, and in general satisfied as to reliability, they were almost unanimous in judging cosmetic covers inadequate. Taking questions 7, 8, and 9 together, it would seem that most of the prosthetists replying would feel comfortable using an endoskeletal system that did not have full indwelling alignment capability if it were clearly superior in other aspects. This is noted in light of the proponderent use of Otto Bock endoskeletal components. The written comments and suggestions for change are presented, with few exceptions, in toto to provide more than simple statistics, and some inkling of the thoughts of the respondees. Taken in conjunction with the rest of the survey, they should provide food for thought to all and stimulus to action for designers and manufacturers. Page Number(s) 8 - 10 Year 1982 Volume 6 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Survey Results https://staging.drfop.org/files/original/b226593ad4d658ae5abd8ff8f834848b.pdf 36ae121273f428280cbbd01d4ed8ba0d https://staging.drfop.org/files/original/0aebfe07b23f1c1385e5e11dabd23ab4.jpg 7b1f6e7332d2d1940d9f2014e8d0a872 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_04_001.pdf Text Any textual data included in the document <h2>Extra-Ambulatory Activities and the Amputee</h2> <h5>Drew A. Hittenberger, CP <a style="text-decoration: none;">*</a></h5> Extra-ambulatory activities and their use in the treatment of amputated individuals have received considerable publicity. Initially motivated by a personal drive for physical accomplishment, many patients have discovered unsuspected levels of performance. It is this high level of performance, combined with the sense of personal accomplishment, that has captured the public's attention. The purpose of this article is to examine the need for physical exercise among amputees in hopes of making such activities the norm rather than the exception in rehabilitation and daily activities. To better understand the physical limitations imposed on the amputee and their effect on exercise, the following areas will be discussed: <ol> <li> Need for physical exercise among amputees. </li> <li> Areas of limitation. </li> <li> Factors in extra-ambulatory prosthetic design. </li> </ol> <h3>Need for Physical Exercise</h3> The level of physical activity a person attains naturally affects his quality of life. This motivates a general public concern for physical fitness. The physically handicapped are no exception. In fact, to the younger, more aggressive amputee, the level of physical activity he is able to exert is critical. Today, despite this need for physical exercise, figures show that most amputees become limited in their ability to participate in physical exercise programs.<a></a> This disability seems greatest for the amputee who was active prior to amputation. Whether the patient was active prior to amputation or not, the end result is the same—inactivity. As one patient put it, "There are those of us in whom the spirit of physical exertion becomes tarnished ... it no longer becomes important to be so active. The effort is too much." While it is natural to decrease one's level of activity after amputation, some serious questions remain. Are the members of the rehabilitation team doing all they can to maximize the patient's level of activity? if everything is being done for amputees, why do so many continue to be physically inactive? Why do so many lose their ability to participate in physical exercise and lack the basic skills for sports activities despite the need for such physical outlets? Most patients lose their ability to participate in physical exercise programs not only as a result of amputation, but also, and perhaps more importantly, as a result of poor post operative care. <h3>Areas of Limitation</h3> There are many reasons why amputees are inactive, perhaps as many reasons as there are amputees. Age, level of amputation, and general physical condition of the patient are usually considered the primary reasons why amputees are limited. But the reason amputees are inactive, in the majority of cases, is not due to a physical cause, but to a lack of information. Not many people, including the rehabilitation team, know about extra-ambulatory activities. To illustrate this, examine the current level of rehabilitation. Presently, rehabilitation focuses most of its attention on a basic activity (walking), and once this minimal level of activity is achieved, assistance is usually discontinued. This in effect limits the patient's functional capabilities and discourages patient participation in physical activities. Stating that an amputee cannot participate in extra-ambulatory activities without knowing of the possibility is like asking someone a question in French without his knowing the language, and then saying "Look, I told you he didn't know the answer." A person needs to know how to do something or have knowledge about something before he can be expected to do it. The problem then, is not lack of ability, but lack of knowledge. If it is our purpose to increase the amputee's level of activity, a considerable amount of attention needs to be directed toward extra-ambulatory activities and the communication of this information. A recent survey on functional capabilities<a></a> discovered that of those amputees questioned, 60% currently participate in some form of sporting activity, indicating a definite desire on behalf of the patients to participate in physical activities. The most common activities (Table 1) are swimming and fishing, and the least common, due to discomfort, are running and walking long distances. During running, a substantial amount of irritation occurs because of the impact and the rotational forces within the prosthesis, which cause tissue irritation. Despite this irritation, however, amputees continue to run because running is a prerequisite for many other physical activities. The most active patients are young individuals whose amputation resulted from either congenital deformity or trauma. Sex and length of time since amputation have little effect on the patient's ability to exercise, while age and level of amputation play a definite role in determining functional ability.2 Other factors, including pain, social embarrassment, and lack of organized training programs, must also be considered. Table 1. Avocational Activities <img src="/files/original/0aebfe07b23f1c1385e5e11dabd23ab4.jpg" p="" />When asked about their prosthetist, 28% of the patients in the recent survey felt that their prosthetist knew about extra-ambulatory prostheses. However, of the prosthetists sampled, only 18% encouraged participation, indicating a high reluctance on the part of prosthetists. The reasons for this reluctance is not so much physical make-up, but, as stated earlier, lack of information. When making a prosthesis for extra-ambulatory activities, the prosthetist needs to have knowledge about the activity and must be able to design the prosthesis around the activity. Designing an extra-ambulatory prosthesis isn't easy. It often involves the incorporation of different materials and principals—a time consuming process. As one patient quoted his prosthetist when he was asked about extra-ambulatory prostheses, "'It is too much work and too much adjustment.'" Perhaps a reason why the level of physical activity is so low among amputees is the prosthetist's inability or unwillingness to design a prosthesis for extra-ambulatory activities. Despite the reluctance on behalf of the prosthetist, 6% of the patients sampled used special equipment for sporting activities while the remaining 94% either indicated a willingness to make do with their current prosthesis or were unaware of adaptive devices available to them. When informed about the existence of these devices, a majority asked why they had never been told about these prostheses before, indicating a need for additional information in the areas of prosthetic design, training programs, and support organizations. To make a patient more comfortable with his individual situation, he can often be directed toward meeting other amputees. Through this social interaction the patient can find support by sharing similiar situations with other amputees and by finding he is not alone in confronting the problems associated with amputation. Often it is this kind of support that can make the difference between the patient being successful or unsuccessful in obtaining his maximum potential. (For a list of organizations serving physically disabled persons interested in sports and recreation, see p. 7). <h3>Prosthetic Design</h3> Advances in prosthetics are based on two things: 1) patients' need for improved function, and 2) technical knowledge. Based on this need for improved function, advances in prosthetic components and systems will continue to be developed. Recently, with an increase in extra-ambulatory activities, prosthetists have begun to realize the need for extra-ambulatory prostheses. Some prosthetic innovations already exist,<a></a> but additional research is needed in this area. The most common activities requiring prosthetic modification are swimming, running, and skiing. Since each one of these activities is different, the prosthetist must design the prosthesis specifically for that activity. Swimming Of primary importance for a swimming prosthesis are: 1) its ability to hold up under water, and 2) its ability to float. A swimming prosthesis must be made out of waterproof materials. If not, special attention must be taken to seal any material that can absorb water such as wood or leather. When wood becomes wet, it swells and causes delamination. Regarding the question of buoyancy, the prosthesis must be able to float, yet give little resistance to immersion. If the prosthesis is too buoyant, the patient is unable to submerge the device while swimming, which can cause the prosthesis rather than the patient's head to be above the water. To solve this problem, some prosthetists have designed prostheses that fill with water, which solves the buoyancy problem associated with the use of foams. The only problem with this design is that the water also needs to drain out fairly rapidly and if it doesn't, the prosthesis will remain full of water or leave a trail of water in its path. Running As stated earlier, running is a prerequisite for most sports activities. Due to the rotational and impact forces on the residual limb during running, a considerable amount of attention is needed in this area. Of particular importance in the design of such a prosthesis is suspension. The prosthesis must be suspended securely so as to eliminate all or as much pistoning as possible. To do this, the prosthetist can incorporate a rubber suspension sleeve or a thigh lacer with waist belt. The thigh lacer aids in medial/lateral stability, and also decreases the rotational forces on the residual limb. Therefore, if the patient is extremely active, whether he has a short residual limb or not, it is recommended that a thigh lacer be used. As well as tackling the problem of suspension, the prosthetist also needs to consider the matter of interface/liner materials. The liner must be able to decrease the rotational forces inside the socket so as to eliminate friction. Conventional Kemblo®, leather, and Pelite® liners have been used in the past with little success. If the patient is extremely active or has residual limb problems caused by excess rotation, a silicone or sorbathane insert should be used. To further minimize the rotation inside the socket, the prosthetist can incorporate a rotator in the prosthesis. A Greissinger foot can be used to decrease rotational capabilities, and is strongly suggested for those patients engaged in physical activities. Skiing Various types of skiing prostheses have been made. Their designs have ranged from incorporating the prosthesis directly into the ski boot, to modifying the patient's existing prosthesis. What is of primary importance in either case is that one maximizes the patient's knee flexion and aligns the prosthesis so the patient's center of gravity lies in front of the ski boot. This is the section of the ski that initiates the turn and if one does not align the prosthesis so that the patient's weight is over the front of the ski, turning will be difficult. Depending on the patient's level of activity, knee stability and length of residual limb, the incorporation of a thigh lacer into a ski prosthesis may or may not be needed. A turn on skis is initiated by a varus or valgus movement of the knee. If the prosthetist incorporates a thigh lacer into a ski prosthesis, he is in effect limiting knee motion and making the ski harder to turn. Therefore, if the patient can do without a thigh lacer, let him do so, because it gives him more maneuverability. Before designing a prosthesis for a specific activity, it is critical that the prosthetist look at the functional ability of the patient and the specific activity, and then design a prosthesis around that activity. It is only through this process that the prosthetist can develop a prosthesis that satisfies the patient's individual needs. Ultimately it is the patient's individual needs that dictate prosthetic design. <h3>Conclusion</h3> Despite the limited amount of technical information available on extra-ambulatory activities, they have received a considerable amount of public attention. That attention must now be directed toward decreasing the physical limitations imposed on amputees. This can only be achieved through an increase in patient/team rehabilitation communication, improved prosthetic design, and direct therapy programs. It is only by such means that amputees can experience their true physical potential. <h3>Acknowledgements</h3> Appreciation is expressed toward Dr. Ernest M. Burgess,<a style="text-decoration: none;">*</a> Bernice Kegel, RPT,<a style="text-decoration: none;">*</a> and the staff of the Prosthetics Research Study Center for their assistance and cooperation in the preparation of this material. References: <ol> <li>Kegel, B.; Jeffrey C. Webster; Ernest M. Burgess, MD: Recreational Activities of Lower Extremity Amputees: A Survey. Arch. Phys. Med. Rehabil., Vol. 61, 258-264, 1980.</li> <li>Kegel, B.; Margaret L. Carpenter; Ernest M. Burgess, MD: Functional Capabilities of Lower Extremity Amputees. Arch. Phys. Med. Rehabil., Vol. 59, 109-120, 1978.</li> <li>Kegel, B. : Prostheses and assistive devices for special activities. Atlas of Limb Prosthetics, Surgical and Prosthetic Principles. American Academy of Orthopaedic Surgeons. The C.V. Mosby Company, 423-434, 1981.</li> </ol> Footnote Chief of Rehabilitation, Prosthetics Research Study Center, Seattle, WA Footnote Principal Investigator and Director, Prosthetics Research Study Center, Seattle, WA <div style="width: 400px;">*Drew A. Hittenberger, CP Director, Research Prosthetics, Prosthetics Research Study Center, Seattle, WA </div> <div style="width: 400px;"></div> Page Number(s) 1 - 4 Year 1982 Volume 6 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1982_04_001/1982_04_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Extra-Ambulatory Activities and the Amputee Creator An entity primarily responsible for making the resource Drew A. Hittenberger, CP * https://staging.drfop.org/files/original/b07addbca7cb05cba5493373ba37e4d5.pdf beaed1b03564c538ee3e1e8ec6019f68 https://staging.drfop.org/files/original/3315a246e37eef6187bbc4b8ea89f1ba.jpg 2cd16c71b05ac05e1bf1a8dec6934bc5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_04_005.pdf Text Any textual data included in the document <h2>Editorial: Special Prostheses Enhance Rehabilitation</h2> <h5>Charles H. Epps, Jr., MD <a style="text-decoration: none;">*</a></h5> In the case of a child, conventional wisdom has held that success of prosthetic rehabilitation can be measured by the ability of the child to play, as play may be considered child's work. In the adult, ultimate success was evidenced by the patient's return to his former job or to some other gainful employment. Special acclaim and attention have been given to amputees like Pete Gray, who succeeded as a professional baseball player. Today another criterion can offer a more valid assessment of success. The ability of the patient, child or adult, to participate in life's activities is a better measure. This assessment should include sports and athletic activities, especially those activities formerly enjoyed in the case of an acquired amputee. Fortunately, today's prosthetic armamentarium includes special techniques, components and prostheses that make participation possible in a variety of activities. On the basis of the experience gained in treating more than 700 juvenile amputees, R.C. Hamilton<a></a> formulated the conclusions about their role in competitive sports as shown in Table I. Most amputees are not interested in competition, but desire to engage in recreational athletic activities. Table I. Suggested Areas of Athletic Participation by Unimembral and/or Uncomplicated Amputees <img src="/files/original/3315a246e37eef6187bbc4b8ea89f1ba.jpg" p="" width="399" height="473" /> Beginning in Europe in the late 1940's, skiing was one of the first sports to be "adopted" for amputees. In the United States there has been a great interest in this activity, as manifested by the formation of the National Amputee Ski Association. Special ski boots and outriggers have been developed. The unilateral below-knee amputee can ski with or without a prosthesis. The bilateral below-knee uses the four track technique with two prostheses, two skis and outriggers. The unilateral above-knee usually must ski on the intact leg using the three track technique. The bilateral above-knee can use short prostheses without knee mechanisms. Cross-country skiing is recommended solely for the below knee amputee. According to Bernice Kegel, the average amputee can learn to ski intermediate and expert slopes in one fourth the time an abled-bodied skier needs, and with a far greater degree of proficiency.<a></a> Swimming is an activity that can be enjoyed by amputees of all ages. If the swimmer is able to stay afloat safely without a prosthesis, opportunities are plentiful as swimming facilities are fairly common in our society. For the amputee who wishes to enjoy aquatic activities, several options are available: <ol> <li> Swimming without a prosthesis </li> <li> Peg legs for use on the beach and possibly swimming </li> <li> Sockets attached directly to swim fins </li> <li> The utility or beach prosthesis used to ambulate on the beach but not for swimming </li> <li> The swimming leg worn while in the water<a></a> </li> </ol> Water skiing is another activity that can be enjoyed by amputees. Wheelchair sports have been organized for amputees, also. A rather detailed classification of degrees of disability has been developed to maintain fairness in competition for men and women. Competition is now commonplace in wheelchair basketball, marathon races, bowling, field events, table tennis, and archery; there are even international events. Special prosthetic adaptations have been developed for the lower extremity amputee who is interested in participating in the following activities. <ol> <li> Golfing—a rotor in the shank<a></a> </li> <li> Flying—portable hand controls and a special SACH foot<a></a> </li> <li> Boating<a></a> </li> <li> Horseback riding<a></a> </li> </ol> In the upper extremity, special adaptations may be necessary for certain activities. The standard terminal device may be used for given activities, especially in the case of the unilateral amputee. For other activities the amputee may find it more convenient to remove the prosthesis completely. By and large the ability of the bilateral upper limb amputee is dependent upon the strength and mobility of the residual limbs. For the upper limb amputee, M.D. Robb<a></a> has grouped activities into those requiring closed or open skills. When the environment or activity is highly unpredictable and constantly changing, open skills are needed to adjust to and/or regulate the environment. Closed skills are those such as swimming, bowling, and golf activities which are performed in a comparatively stable environment. Among the recreational activities for which adaptive devices have been developed are: <ol> <li> Rein bar for horseback riding<a></a> </li> <li> Special terminal device for fishing<a></a> </li> <li> Terminal device for bowling<a></a> </li> <li> Fletcher-Motis adapter for archery<a></a> </li> <li> Universal joint terminal device for golf<a></a> </li> <li> Additional devices adapted for hockey,<a></a> skiing,<a></a> and driving<a></a> </li> <li> Baseball glove terminal device for the unilateral below elbow (this has always been a popular item among teenage boys in our clinic)<a></a> </li> </ol> Swimming can usually be accomplished without prostheses and special appliances. However, it may require minor adaptations of stroke techniques, kick modifications and a special breathing pattern.<a></a> It should be apparent even to the casual observer that there are benefits to be derived from the use of secondary prostheses or adaptive devices by amputees. The physiological benefits will flow to the cardiopulmonary system as the result of the physical activity. However, there is another even greater benefit—the psychological uplift—realized by the patient who achieves new heights of pleasure, pride, and increased self esteem by participation in physical recreation and/or competition. This aspect is so important to the total treatment and rehabilitation of the amputee patient that we must educate clinicians and third party carriers so that ordering such devices will become routine for all who have the ability and desire to use them. Furthermore, third party carriers should pay for them as routinely as the standard prostheses. In this manner we can give our patients the opportunity to participate in and enjoy life more fully—the essence of rehabilitation. References: <ol> <li>Hamilton, R.C.: The juvenile amputee in athletics. Inter-Clinic Info. Bull., 6(1):1, 1966.</li> <li>Kegel, Bernice: Prostheses and assistive devices for special activities. Chapter 29, Atlas of Limb Prosthetics, American Academy of Orthopaedic Surgeons, St. Louis, C.V. Mosby, 1981.</li> <li>Racette, W., and Beraken, J.W.: Clinical experience and functional considerations of axial rotators for the amputee. Orthot. Prosthet. 31(2): 29,1977.</li> <li>Hughes, H. N. and Helmuth, G.: A modified prosthetic foot for pilots. Orthot. Prosthet. 29(1): 33,1975.</li> <li>Robb, M.D.: The dynamics of motor skill acquisition. En-glewood Cliffs, N.J., Prentice-Hall, Inc., 1972.</li> <li>Larkins, C: Horsemanship for the physically handicapped. Inter-Clin. Info. Bull., 9(7): 4-11, 1970.</li> <li>Sabolich, L.J.: An adapted fishing rod for arm amputees. Inter-clin. Info. Bull., 12(2): 13-15,1972.</li> <li>Kay, H.W.; Lewis, S.L.; and Steward, W.A.: A bowling device for bilateral arm amputees. Inter-Clin. Info. Bull., 9(7): 13-16, 1970.</li> <li>Bender, L.F.: Prostheses and rehabilitation after arm amputation. Springfield, Illinois, Charles C. Thomas, 1974.</li> <li>Redford, J.B.: Prostheses for hockey-playing upper limb amputees. Inter-Clin. Info. Bull., 14(6): 11-15,1975</li> <li>Stanek, W.F.: Report of the juvenile amputee ski program. Inter-Clin. Info. Bull., 8(9): 1, 1969.</li> <li>Wuttke, W.: New German foot-control system enables armless persons to drive. Rehabilitation World, pp. 12-13. Winter 1978-79.</li> <li>Shearer, J.D.; Buckner, M.L.; and Bowker, J.H.: Prostheses and assistive devices for special activities. Chapter 16, Atlas of Limb Prosthetics, American Academy of Orthopaedic Surgeons, St. Louis, C.V. Mosby, 1981.</li> </ol> <div style="width: 400px;">*Charles H. Epps, Jr., MD Professor and Chief Division of Orthopaedic Surgery, Howard University Hospital, Washington, DC </div> <div style="width: 400px;"></div> Page Number(s) 5 - 6 Year 1982 Volume 6 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1982_04_005/1982_04_005-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Editorial: Special Prostheses Enhance Rehabilitation Creator An entity primarily responsible for making the resource Charles H. Epps, Jr., MD * https://staging.drfop.org/files/original/1e1744490ce5197c6fbbd672bbe0ec51.pdf ae3011da56cde88195a6545638e8ac74 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1982_04_010.pdf Text Any textual data included in the document <h2>Follow-up on Endoskeletal Article and Questionnaire: The Manufacturers Reply</h2> Summarized results of the survey concerning endoskeletal prostheses appeared in the Summer, 1982 issue of C.P.O. (Vol. 6, No. 3). These compiled results were circulated among the manufacturers of endoskeletal prosthetic systems. The following responses were received. In regards to the "g" response in the additional comments section, [questioning whether the cost is justified] I will submit the following: Endoskeletal prosthetics is a poor excuse to charge more money, only when it is the excuse that it is being charged to the patient. I can also understand being afraid of the dollar sign where it prevails as fiscal remuneration for an excuse, rather than the patient's welfare. Endoskeletal prosthetics have consistently proven themselves a useful tool in developing value in the patients themselves, and in the patient's rehabilitation accomplishments . Michael T. Wilson, CPO Medical Center Prosthetics, Inc. Manufacturers must keep many things in mind when designing and building a modular system: weight vs. strength, added features vs. weight and strength, and cost to manufacture vs. simplicity. Research and development expenses are subsidized only by sales profits. A good example is that tooling for one simple item may run $80,000, while sales and volume of manufacture does not warrant this expense. In summary, manufacturers do have handicaps. In reviewing question number ten—what changes would you like to see?—we find 19 answers were provided. Eighteen of the 19 have been researched, and four of these are available now. The others will continue to be researched and will be available in the future. The field of prosthetics has come a long way in the past 20 years; let us look at what is available now in manufactured parts as to what was available in 1962. We at United States Manufacturing Company believe there will be even more improvements in the next 20 years compared to the last 20. Dan J. Edwards Sales Director United States Manufacturing Co. Otto Bock, along with several other manufacturers of endoskeletal prosthetic systems, was presented with the survey results from the Winter Issue of C.P.O. and was asked for a response. While the total number of endoskeletal prostheses indicated as having been delivered to patients was significant, we must offer our opinion that the total of 27 returned questionnaires is a rather poor response and certainly does not represent a consensus upon which to base any conclusions. Each manufacturer is individually aware of how many endoskeletal units it produces and sells each year, which gives a general idea of market acceptance. Our experience has been that our endoskeletal units sold continue to increase in significant quantities year after year and this trend has shown no sign of reversing. This in itself is an indication to us that endoskeletal systems have attained a definite place in the armamentarium of components available for prosthetic patient management. A great number of people seem to support the belief that endoskeletal prostheses were designed to replace exoskeletal prostheses. It is certainly not our company philosophy that one is intended to replace the other. Both types of systems have their advantages and disadvantages and it ultimately should depend on the professional decision of the prosthetist as to which system will best fit the needs of each individual patient. Perhaps many of the complaints about endoskeletal systems are due to improper patient selection criteria rather than deficiencies in the systems themselves. Another source of trouble with endoskeletal systems is the improper application of fabrication techniques. Recognizing this possibility—and being one of the first manufacturers to offer a complete multiple option endoskeletal system for the lower extremity—we developed a seminar program for instruction in these new techniques. In addition, we have developed Technical Information Bulletins, slide programs and presentations for various technical meetings. Despite these efforts on our part, the sheer numbers of prosthetists in this country and their diverse geographical locations make it nearly impossible to personally instruct every one, even if we could increase the size and frequency of our seminars. Basically, we are able to trace many of the problems to not following technical recommendations. In many cases the problems have been cleared up rather quickly by following instructions. The prosthetist has the choice of using any of several manufacturers' systems, each with its own unique features. If alignment capability in the definitive prosthesis is desired, an IPOS or OTTO BOCK System can be used. If it is felt that this permanent adjustability is detrimental, the USMC or AFP Systems can be used instead. When the Otto Bock foam cover is too difficult or time consuming to shape, or lacking in durability, there are other alternatives. These include the foam-in-place technique offered by Medical Center Prosthetics, and the option of a prefabricated cover. Choices also exist for the prosthetic skin, such as our nylon stocking, USMC's newly developed cover, or a covering of the paint-on variety. The foregoing statements are not meant to give the impression that Otto Bock is insensitive to the needs of the prosthetist or, more importantly, to the desires of patients they serve. We recognize fully the need for improvement of endoskeletal systems. The covers need to be more durable and easier to fabricate. The structural and functional components need to be made lighter and more sophisticated. Unfortunately, many of these things are easier said than done, but our research department is constantly striving to develop new and better systems. We very much appreciate the opportunity to comment on this survey and would encourage a much greater response to such surveys in the future. This type of feedback on a much larger scale could be very helpful to all manufacturers. Along this line, we are wondering what suggestions might be offered for quickly disseminating information on new products or techniques so everyone interested could become qualified to use them for maximum benefit to the patient. If anyone has some workable ideas for accomplishing this objective, we are certain all concerned would benefit greatly. Jack Hendrickson, CP Otto Bock <h3>More Endoskeletal Responses Added to Questionnaire Results</h3> Two questionnaire responses were received too late to be included in the compiled results published in the Summer C.P.O. One individual reported that 75% of definitive prostheses fit were of endoskeletal construction and the other reported fitting 150 endoskeletal prostheses (actual numbers, not a percentage). Their responses to questions two through nine were very much in line with the majority of others received. Their written responses are included below: <ol> <li> What changes would you like to see made? First respondee: <ol> <li> improved covers </li> <li> hydraulic knees </li> </ol> Second respondee: <ol> <li> Lighter in weight </li> <li> Improvements in the visual, tactile, and sound aspects of prostheses </li> <li> Longer lasting cosmetic covers, internally and externally </li> <li> For H.D./H.P. prostheses, better sitting ability </li> <li> Standardization of tube sizes and connectors to facilitate "intermarriage" of components </li> <li> More instructional courses by prosthetics/orthotics schools or manufacturers to deal with "practical every-day" problems </li> </ol> </li> <li> Additional comments: First Respondee: The ability to make either major or even subtle changes in a definitive prosthesis, months or even years after initial fitting, has always appealed to me. The more I use the Bock system the more confident I become of it and I find myself fitting a higher percentage [75% last year, Ed.] . . . every year. I find the poor durability of the cover a minor trade off . . . most of my patients agree. I practice in Montana, so you can guess my patients do not always give their prostheses the easiest use. I am a firm believer in the concept. Second respondee: Our first choice of components for any amputee (re: level of amputation, sex, job or environmental factors) is the endoskeletal prosthesis. My first reason for this is ease of maintenance/replacement of components. This single factor keeps patients coming back knowing they can get things "fixed" quickly. In our present rush society this factor cannot be overlooked. Cosmesis is becoming a more important factor every day, regardless of the patient's sex or age. For too long, we have, as professionals, trained our patients to think: 'functional restoration is your main objective.' Having been involved with many patients who are "prosthetic failures," I have learned a few very important lessons as to why they are on crutches, in wheelchairs, or have empty armsleeves. Consumers in general, today, are more educated and interested in knowing their options. The prosthetist has the responsibility to inform his patient as clearly and completely as possible concerning what is available. He may end up referring the patient to a colleague if he does not have the necessary skills to satisfy his client. A satisfied, happy patient is not a side benefit to our existence. It is a must. Through publications such as this one and many others around the world, we have an obligation to keep up-to-date on new developments as well as contributing our findings in return. It is not necessarily always true that something we are having success with is known to most colleagues. Try and publish articles with photographs and you will be surprised at the response. </li> </ol> Page Number(s) 10 - 11 Year 1982 Volume 6 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Follow-up on Endoskeletal Article and Questionnaire: The Manufacturers Reply https://staging.drfop.org/files/original/eaf0a7b425c90dc8b9205c09b4cfeddd.pdf 15e97b748c74abe2a1ca3e141ad14231 https://staging.drfop.org/files/original/b4340fe7dc6294b06bd93a46a9eefcfb.jpg 106945255e1ae54dde98455ab0a3f13e https://staging.drfop.org/files/original/eb21a4e75152f4ff61417686c70f9188.jpg 2bfb40cb9fe53bb031b025e027a5cc4b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_001.pdf Text Any textual data included in the document <h2>Prosthetics Up-Date 1980: Foot and Knee Components</h2> <h5>H. Richard Lehneis, Ph.D., C.P.O. </h5> This paper is, in part, based on a lecture given by the author at the International Congress on Technical Orthopedics, 1979, in Nurenburg, Germany. The data relating to prosthetic foot and knee components was obtained from a survey of the relative sales volume of the various components by three of the largest U.S. distributors of prosthetics components from practically all manufacturers. The distributors cooperating in this were Knit Rite, Inc., Kansas City, Missouri; Northeast Paramedical Industries, New York, New York; and PEL Supply Company, Cleveland, Ohio. These firms were requested to provide the relative percentage of sales of the various foot (Table 1) and knee components (Table II), rather than the absolute volume of sales. The table on knee components includes conventional versus modular constructions. The average (mean) percentages  of the various prosthetic feet and knee components sold by the three firms are listed in the last columns of Tables I and II respectively. On the basis of these data, one may infer current prescription and fitting practices in the United States. An attempt to get similar data on below-knee and above-knee suspension systems, based on the percentage of sales of supracondylar cuff, BK side joints, hip joints, suction socket valves, and Silesian belts, appeared not valid after analysing the data collected because of the possibility of various combinations of suspension systems that may be prescribed and used. It is, therefore, hoped that readers of the Newsletter will return the questionnaire on Page 10 which addresses the subject of BK and AK sockets and suspension systems with due consideration of the various possibilities of combination of suspension systems. <h3>Discussion</h3> Referring to Table 1, there appears to be a vastly increased use of SACH feet versus other types of prosthetic feet. This may be interpreted in terms of the far greater frequency in recent years of BK versus AK amputations due to improved surgical techniques. Although, from the author's experience, it appears that SACH feet are used to an increasing extent and with great frequency in AK prostheses. <img src="/files/original/b4340fe7dc6294b06bd93a46a9eefcfb.jpg" br="" /> In Table II, one notes a surprisingly low use of hydraulic mechanisms. This may be interpreted in terms of the increase in the geriatric population who, in general, do not benefit as much as younger amputees from the hydraulic systems. Support for this interpretation may be viewed in the larger percentage of safety knees, and single-axis knees with manual knee locks used which total 66 % of all knee units sold.<img src="/files/original/eb21a4e75152f4ff61417686c70f9188.jpg" br="" width="440" height="525" /> Page Number(s) 1 - 2 Year 1980 Volume 4 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1980_01_001/1980_01_001-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_01_001/1980_01_001-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosthetics Up-Date 1980: Foot and Knee Components Creator An entity primarily responsible for making the resource H. Richard Lehneis, Ph.D., C.P.O. https://staging.drfop.org/files/original/b55c999f394c95f22da4376f0a7fd130.pdf 5101740961929f47b6d05aa1fc10398e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_002.pdf Text Any textual data included in the document <h2>Guest Editorial: Of Prosthetics And 1980</h2> <h5>Anthony Staros <a style="text-decoration: none;">*</a></h5> The survey of prosthetics components shown in this issue yields conclusions mostly related to above-knee amputees, as indicated in the text associated with Tables I and II. Fortunately more lower-limb amputations today are below-knee, so one really cannot tell much about trends in prosthetics practice from these data except to note that the SACH foot is indeed a success. This however should not make us complacent about this design, for we should never be happy with anything that we have in prosthetics. Our objective should always be constant improvement. As suggested, data are needed on below-knee fittings to give us a better impression of the state of lower-limb prosthetics today. Surveys of suppliers will show little; needed are data from the fitters of the country. Many of you know that the support of the VA Research Program of the University of California at Berkeley and San Francisco many years ago yielded the crucial bio-mechanical parameters in lower-limb amputee prosthetic service associated with fit and alignment. But never to be overlooked as very significant to service is the "tender loving care" and the training provided to the patient by the emphatic prosthetist. In any case, components although secondary are still important. But clearly recognized is the need to get the prosthesis properly interfaced and the amputee motivated. Perhaps a survey covering rotators might produce helpful data about how these have been used to reduce fitting problems by the diminution in shear stresses. The post-World War II education program has been primarily based on the teaching of the biomechanics and techniques of fit, those of alignment and to some extent but a lesser one, teaching about components. Even though these are of lesser importance, have we overlooked some essentials? <h3>On Prosthetic Knees.</h3> We really don't fault the survey, but recognize its limitations. It nevertheless does show that for above-knee knee joints at least there may be some lapses in the teaching of prosthetists, in the teaching of other members of the clinic team and most importantly, in orienting the administrators representing third party payers. Perhaps the low number of hydraulic knees (as a %) can be attributed to the larger percentage of amputees who are geriatric. But aren't these supposed to be mostly below-knee amputees these days? Not to be overlooked is the value of properly selected hydraulic knee mechanisms for certain cases. The selection of large numbers of "safety" knees is noted; but isn't it that clinic teams seem to get hooked on these, not trying others, or perhaps they have become disillusioned with price or maintenance burdens? Today, the safety knee is the unit of choice but we wonder whether even these are being used properly. For example, are they in fact being used to exploit the value of the stance phase characteristics in initiation of swing phase? Are the alignments such that one provides more "trigger" for initiation of knee flexion? The low numbers for polycentric knees bother us. If properly understood, some of the polycentric knee systems can be very beneficial in providing improved function to amputees with very short above-knee residual limbs and those with very weak hip musculature. How about their use in geriatrics? Are indeed the polycentrics really understood? Are those that are being used being fitted and aligned properly? Do clinicians really understand the real values of the polycentric systems? The system developed at the Orthopaedic Hospital, Copenhagen for example, can be used not only for end-bearing above-knee amputees but can also be applied for shorter amputation levels. The University of California at Berkeley is now developing other improvements in polycentric systems; we hope to see some of those soon presented through manufacturers. Unfortunately we sense that clinics tend to adopt particular "pet" knee mechanisms or pet prescriptions. We worry that for various reasons (valid?) the full range of knee mechanisms has not been given a complete trial. Our publications have tried to get the information across about the pros and cons of each system. Perhaps we have failed. For example, some of the rehabilitation achievements we have been able to make in our own clinic with the hydraulic knees are in fact extraordinary. Alongside the other important factors, the Mauch SNS in particular has been a boon to many of our above-knee amputees, particularly bilateral cases we have had from the Viet-Nam conflict and some Israeli cases from the October (Yom Kippur) War which were referred to us. <h3>A Case in Point</h3> One interesting case from Viet-Nam, a bilateral above-knee amputee, not only now sky dives but snow skis and disco dances on his above-knee prostheses, both with SNSs. This gentlemen has personal drive and motivation; he was an athlete before he was wounded, but now and this is important, he has been given the "tools" in those knee mechanisms: tools which can be used by him to achieve activity levels to which some of us nonamputees could aspire. Here, the SNS provided the wherewithal; matching these with the man's motivation and well-fitted sockets properly aligned, we were able to provide what can be considered a maximum degree of rehabilitation. This is not an isolated case. There have been many people fitted with the SNS and with others that are spin-offs of this design. We in the Veterans Administration put money into these developments, and we continue to purchase them because we have confidence in them. And our patients do. The problem is that others don't. Perhaps primary cost and maintenance experiences detract. But more so, other third party payers do not or cannot value these units as we do for our service-connected amputees who we believe deserve no less. <h3>How about Modular Systems?</h3> We are concerned about the low percentage of modular systems used. Less than one in four are shown. But these, in this survey, are directly linked to above-knee and higher amputations. Again, the geriatric amputee experiences and thus the more common below-knee amputation levels are not reflected. For these, modular or endoskeletal systems may be used most commonly, more than the rugged, heavier crustacean systems of wood and the like. We hope at least that more and more lightweight below-knee prostheses either using endoskeletal systems or polypropylene would be used to the benefit of this group of amputees. <h3>Finally, on Research and Development</h3> The component survey also doesn't really indicate anything about the needs for research and development. Inferred are some gaps in our link with the prosthetist and the clinic team mainly in the channels of information flow about all kinds of hardware. But one cannot draw too many conclusions. We are pleased to inform you that the National Amputation Foundation with the assistance of Dr. Jerome Siller of New York University has now nearly completed for the VA Prosthetics Center a nation-wide survey of 900 service-connected veteran amputees. Provided from this survey will be data about prosthetic, medical, surgical, employment and psychosocial experiences and statuses of veterans from all wars since and including World War II. We expect the investigators to give a report at the 1980 World Congress of ISPO to be held in Bologna, Italy. From this, we expect to have some significant directions for research and development. On this matter of research and development, it seems to us that as soon as you become extremely successful with a particular item you might look at it again to see what you can do to improve on it. Besides more durable SACH feet more functional types of foot-ankle systems seem needed. Are there ways, for example of achieving the same function with less complexity than presented in the current "universal" ankle joints? There appears to be no need to focus again on knee joint development; we would seriously worry about a further proliferation of new knee mechanisms. A few research groups are working on EMG control of valves on hydraulic knees, to produce voluntary control of knee function. This we can accept as long-range. You should also know that Federal support of research and development in prosthetics and orthotics (our own Center's deemphasis is an example) has been decreased to some extent. We do assist in evaluations; we do a little bit of development, primarily as a result of case presentations in our clinics, but we offer no great effort in prosthetics and orthotics development at this time; we have diverted scarce resources to attack the problems of the very severely handicapped: the spinal cord injured, the blind, the non-vocal, and the cumbersome complexities of the debilitated aged. So there'll be no mistake, know that we're still involved in prosthetics and orthotics, but we honestly believe that prosthetics and orthotics development has come a long way. We in the VA believe we have done much to contribute to this process, especially in funding projects around the country. We have also had our own laboratories involved. But now with a mature profession in place, these responsibilities can be carried primarily by the professional with the Government only assisting when necessary. The manufacturers as a group are certainly participating in development, evaluation, and even in training. Outstanding examples are several in the United States and those from Europe who have done an extremely good job in making the quality and function of components of high quality. And the competition among them has been welcomed by us. We think that the prosthetics (and orthotics) professional especially when it comes to process and device development is contributing enormously. Therefore the Government can turn its attention to that which the private sector cannot economically handle. But we always will be ready to help. *Anthony Staros Director, VA Prosthetics Center New York, N.Y. 10001 Page Number(s) 2 - 4 Year 1980 Volume 4 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Needs Revision- See Trello Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guest Editorial: Of Prosthetics And 1980 Creator An entity primarily responsible for making the resource Anthony Staros * https://staging.drfop.org/files/original/14e71685d71f779f2e221b6ce3752c7b.pdf 7f5b513db755d91f0fee0e97ce868617 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_01_005.pdf Text Any textual data included in the document <h2>Prosthetic Knee Mechanisms: A Guide for the Prosthetist</h2> <h5>Bert Goralnik, CP </h5> <h3>Introduction</h3> A function of the Veterans Administration Prosthetics Center (VAPC) is to assist VA Clinic Teams nationally in prescribing prosthetic devices, including, of course, prosthetic knees. Prescribing knee mechanisms, however, is a complex task because of the large variety available. Most often these devices differ not that much in function but in size, type of material used for the setup, and additional characteristics related more to assembly and installation processes than prescription rationales. All too often clinicians prescribe either limited numbers or certain types of knee mechanisms found to be reliable in the past. Another inhibitor may be a lack of specific information on the full range and variety of all available systems. The clinician rarely has an opportunity to compare the relative merits of one knee with another. In 1972, the Veterans Administration, through the Department of Medicine and Surgery, Washington, D.C., published a program Guide (M-2, part IX, G7) on "The Selection and Application of Prosthetic Knee Mechanisms." The guide was slightly modified and updated in 1976. A new Program Guide, reflecting developments of recent years and incorporating most commercially available knee mechanisms, will soon be published. This later Program Guide will provide a summary description of the various knee mechanisms thus far evaluated by the VAPC. It is intended to help maximize patient benefits. <h3>Description of Program Guide</h3> The Program Guide comprises six sections: Knee Function, Definitions, Classification, General Requirements, Prescription of Prosthetic Knee Mechanisms, and Catalog of Knee Mechanisms. <ol> <li> Knee Function: Here are described the normal function of the anatomical knee, specifically the relationships of its various parts during the gait cycle, and alignment stability as a key factor in prosthetic fitting. Discussion centers on the TKA line relative to the center of the knee in maintaining stability during the stance phase. Understanding these relationships and utilizing the special features of knee mechanisms for the patient's benefit is an asset for the prosthetist. The Clinic Team thereupon must strive to provide the patient with the specific knee mechanism whose features most closely match his individual needs. </li> <li> Definitions: Reference terms are given to describe the variety of knee functions. </li> <li> Classification: A chart classifying all types of commercially available knee mechanisms is provided. The chart shows functional criteria, specifically swing phase control and stance phase control. Additional topics in this section include extension aids, extension stops, mechanical locks, mechanical friction, and fluid resistance of hydraulic and pneumatic knees. </li> <li> General Requirements: This section consists of a checklist on knee mechanism requirements. </li> <li> Prescription: Prescription rationale is discussed, emphasizing the needs of the individual patient. Although the Program Guide concerns knee mechanisms, socket, shank, foot and suspension are also discussed to achieve the best type of prosthesis available. A chart shows the type of prosthesis best suited for different types of amputees. A classification chart of knee mechanisms is also included. To further assist the clinician, variations of basic prescriptions are given, i.e., for a short residual limb, a very long residual limb, and differences based on level of activity. </li> <li> Catalogue of Knee Mechanisms: this section, the heart of the Program Guide, lists most commercially available knee mechanisms. Illustrations furnished by the manufacturers are included. A chart lists type of knee mechanisms, materials, exact dimensions, and types of control offered. </li> </ol> <h3>Conclusions</h3> The new Program Guide on "The Selection and Application of Prosthetic Knee Mechanisms," will be available on or about June 1, 1980. It should prove to be of significance to all clinic teams. To obtain a copy of this publication, please write to the Veterans Administration Prosthetics Center, Attention: Mr. Bert Goralnik, 252 Seventh Avenue, New York, New York 10001. I wish to thank Mr. Max Nacht, Technical Writer/ Editor, VA Prosthetics Center, for his aid in preparing this article. Page Number(s) 5 - 6 Year 1980 Volume 4 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosthetic Knee Mechanisms: A Guide for the Prosthetist Creator An entity primarily responsible for making the resource Bert Goralnik, CP https://staging.drfop.org/files/original/cb540e7ef43f29b8f2a54281780f08ca.pdf db1f8f57d64f091532e8e80aa08d9455 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_001.pdf Text Any textual data included in the document <h2>The Nature of Orthotics Practice</h2> <h5>Sidney Fishman, Ph.D. <a style="text-decoration: none;">*</a> Joan E. Edelstein, M.A. <a style="text-decoration: none;">*</a> Lynn Michaelson, B.S. <a style="text-decoration: none;">*</a></h5> How typical is YOUR orthotics practice? How extensively are plastic orthoses being utilized? How many KAFO wearers utilize a knee lock, and what kind? Examining the experience of a larger number of certified orthotists regarding these and other prescription issues is a logical way to gain perspective on contemporary orthotics management. Some time ago New York University Post-Graduate Medical School conducted a pilot survey of approximately sixty orthotists who were attending several short-term courses. While the sample was small and drawn largely from the Eastern seaboard, the completed questionnaires revealed a number of interesting trends regarding patient population, orthotic designs, and materials. Among the most important of the preliminary findings is the overwhelming predominance of lower limb orthotics (LLO) practice over spinal (SO) and upper limb (ULO) activities by a ratio of 5 to 1 to 1; the continued preference, although small, for metal rather than plastic materials, especially for LLO's. Lastly, middle aged adults with upper motor neuron disorders (stroke, etc.) constituted the largest single type of patients requiring services. <h3>Population</h3> Although orthotists reported that they treated substantial numbers of patients in all age brackets, about 55 % of the individuals fitted were between 18 and 60 years of age. Of the remaining 45% , the proportion of children below 18 years exceeded that of older adults (over 60) by a third. Patients presented a wide variety of disorders. Among LLO wearers, more than half had upper motor neuropathies; approximately 30 percent had skeletal disorders, and the remaining 20 percent had lower motor neuron diseases. In contrast, the greatest number of ULO's were worn by persons with lower motor neuron lesions (42%), while the remaining individuals wearing ULO's experienced upper motor neuron and skeletal disorders in nearly equal numbers. <h3>Materials</h3> The great majority (80%) of orthotists responding used both metals and plastics in their LLO practice, however 10 percent stated that plastics constituted the primary or sole material in all LLO's they made, while the remaining 10 percent used metals only. Overall, the ratio of usage of aluminum to plastic to steel was 5 to 4 to 1. <h3>Lower Limb Orthotic Designs</h3> Among the lower limb devices fabricated, 63 percent were AFO's while 37 percent were HKAFO's, KAFO's, and KO's. Forty-six percent were unilateral AFO's and 25 percent were KAFO's applied unilaterally; 17 percent of the LLO were AFO's fitted bilaterally. The solid stirrup was by far the most commonly used method of shoe attachment (42%), followed in turn by the split stirrup (20%), plastic shoe insert (18%), calipers (15%), and miscellaneous attachments (5%). About half of the LLO's prescribed permitted free or nearly free ankle motion of which 17 percent permitted free motion, and 37 percent utilized some form of motion assist, usually a coiled or wire spring. Approximately one-third of the ankle components limited motion in some way with 27 percent of such appliances utilizing stops, and 10 percent consisting of solid ankles. Such diverse components as dual action assists and double axis joints accounted for 11 percent of the orthotic ankles. In relation to specific AFO designs utilized, the most frequently identified were patellar tendon bearing, Denis Browne, posterior leaf spring (both Rancho polyethylene and TIRR polypropylene), VAPC shoe clasp and the NYU insert. As regards orthoses encompassing the knee and/or the hip, a single axis joint with drop lock, (with or without spring loading) accounted for nearly 70 percent of knee controls provided. Cam and plunger locks were very seldom used and only 13 percent of the orthoses had free knee joints, including single axis as well as offset and polycentric types. Regarding hip joints, the number of free single and double axis joints far exceeded that of any locking hip joints. Approximately half of the orthotists reported making fracture LLO's of one type or another. A third had fabricated both AK and BK fracture orthoses, while nearly 10 percent had made only BK fracture orthoses and 5 percent had fabricated AK designs exclusively. As for other specific KO and KAFO designs, orthotists constructed knee cages and trilateral Legg-Perthe's orthoses most commonly. <h3>Upper Limb Orthoses</h3> While as indicated, the survey focussed on LLO practice, several interesting facts concerning ULO management also emerged. The most frequently prescribed ULO was the opponens orthosis (70%), while 19 percent were provided with prehension orthoses with about 21 percent of this number being fitted bilaterally. External power was employed in only 3 percent of the fittings reported. Although these preliminary data indicate some interesting patterns there is no doubt that it is not possible, at the present time, to present a satisfactory overview of the nature of orthotics practice, with any degree of confidence. This fact presents particular problems for the educational institutions who are obliged to teach students those procedures and techniques which are most widely utilized by the practitioners. The same lack of information causes severe difficulties for potential researchers in relation to their ability to identify and undertake valuable and meaningful projects. Consequently there is a crying need for more comprehensive and reliable information than is presently available. We therefore propose to obtain such data from as many certified orthotics facilities in the country as possible. A revised questionnaire has been prepared which attempts to obtain the most important, precise information regarding lower limb orthotics practice. We request that each certified facility complete the questionnaire on pp. 8-10. It should take no more than 15-20 minutes. Return the completed form to Prosthetics and Orthotics, NYU Post-Graduate Medical School, 317 East 34th St., New York, NY 10016, by Sept. 15, 1980. Obviously only one questionnaire for each facility should be submitted, since any duplicate returns would tend to unbalance the information gathered. Lastly, in order to identify regional differences and to permit the possibility of follow-up contacts, we ask that each return be identified. In order to avoid any possible intrusion on confidential business statistics please note that all of the requested information is only in percentages of total practice. Following the necessary period of time to accumulate, tabulate and analyze the data, a report summarizing the results of the study will be published in a forthcoming issue of the Newsletter. At a later time similar surveys relating to spinal and upper limb practice will be undertaken. *Lynn Michaelson, B.S. New York University Post-Graduate Medical School *Joan E. Edelstein, M.A. New York University Post-Graduate Medical School *Sidney Fishman, Ph.D. New York University Post-Graduate Medical School <div style="width: 400px;"></div> Page Number(s) 1 - 2 Year 1980 Volume 4 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Nature of Orthotics Practice Creator An entity primarily responsible for making the resource Sidney Fishman, Ph.D. * Joan E. Edelstein, M.A. * Lynn Michaelson, B.S. * https://staging.drfop.org/files/original/f84bb0c475ca9d030e23df9e4e80658d.pdf 94375248bcccdaeab873ef4e4c97c777 https://staging.drfop.org/files/original/6ec0d5b59e7d232d595707c15372a97c.jpg de00e861806273a4296343544b6bf106 https://staging.drfop.org/files/original/15c0eaaa0b4778e274016ee3e4f0eaef.jpg 2a616dc0bb2ebcf0e39110254f7214fe https://staging.drfop.org/files/original/5349fa590d8d8b526c3f243a7bd1bdd1.jpg f22b164a89f5fea857cfaad0f802eacc https://staging.drfop.org/files/original/cab9f2ad9f641a085d9079b6e82bbc7e.jpg 98f7040eb022de51e27dbc7ee91ab790 https://staging.drfop.org/files/original/544d0554c74d2d5950384e2e1dfd6aff.jpg 559149ef240dff1d7a44a72d9e261ebf https://staging.drfop.org/files/original/cbd70b676214f45b70d3cf9ff79514fd.jpeg 355eedf11c055b25646f742ec329eb73 https://staging.drfop.org/files/original/9872c7817353817cc6a62cc57c60d007.jpeg f54103ca4b7342b6319599df2a9f0aeb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_003.pdf Text Any textual data included in the document <h2>Plastic Ankle-Foot Orthoses: Indications and Functions</h2> <h5>H. Richard Lehneis, Ph.D., C.P.O. </h5> Prescription of plastic ankle-foot orthoses at the Institute of Rehabilitation Medicine, New York University Medical Center (IRM-NYUMC) has, over approximately the past 12 years, been based on the identification of a pathomechanical condition affecting the ankle-foot complex for the purpose of matching that condition with a bio-mechanical device (plastic ankle-foot orthosis). Over the years, this basic system has been improved to include modifying factors such as spasticity and sensory status.  Table I. <img src="/files/original/6ec0d5b59e7d232d595707c15372a97c.jpg" p="" /> Table II.<img src="/files/original/15c0eaaa0b4778e274016ee3e4f0eaef.jpg" nbsp="" represents="" an="" elaboration="" of="" the="" system="" in="" describing="" addition="" to="" indications="" bio-mechanical="" actions="" each="" ankle-foot="" orthosis="" as="" well="" contraindications="" afo="" s="" described="" is="" shown="" b="" /> Fig. 1, Fig. 2, Fig. 3, Fig. 4, and Fig. 5. <a href="/files/original/5349fa590d8d8b526c3f243a7bd1bdd1.jpg">Figure 1.</a> Posterior Leaf Spring Ankle Foot Orthosis. <a href="/files/original/cab9f2ad9f641a085d9079b6e82bbc7e.jpg">Figure 2</a>. Hemi Posterior Leaf Spring Ankle Foot Orthosis. <a href="/files/original/544d0554c74d2d5950384e2e1dfd6aff.jpg">Figure 3</a>. Spinal Ankle Foot Orthosis. <a href="/files/original/cbd70b676214f45b70d3cf9ff79514fd.jpeg">Figure 4</a>. Hemi Spiral Ankle Foot Orthosis. <a href="/files/original/9872c7817353817cc6a62cc57c60d007.jpeg">Figure 5</a>. Posterior Solid Ankle Foot Orthosis. Table I and Table II have been used successfully in the training of physicians, orthotists, therapists, and other health-related personnel. We hope that the readers of the Newsletter find these tables useful in their respective clinics to clarify indications and contraindications for the various AFO's. Page Number(s) 3 - 6 Year 1980 Volume 4 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-3.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-4.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-5.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-6.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1980_02_003/1980_02_003-7.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Plastic Ankle-Foot Orthoses: Indications and Functions Creator An entity primarily responsible for making the resource H. Richard Lehneis, Ph.D., C.P.O. https://staging.drfop.org/files/original/09fe10baa626726ecfda342c957103aa.pdf d19f909aad10c8d77d23f58e47708607 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1980_02_007.pdf Text Any textual data included in the document <h2>Editorial: To Fill a Void</h2> <h5>A. Bennett Wilson, Jr. <a style="text-decoration: none;">*</a></h5> I believe that everyone familiar with the recent history of prosthetics and orthotics will agree that the results of the research program in artificial limbs initiated in 1945 by the National Academy of Sciences at the insistence of the Surgeon General of the Army has been very beneficial to amputees and to the prosthetists that serve them. Patients requiring orthopaedic bracing and orthotists have also benefited from this program, which has been supported from the beginning by the Veterans Administration and since about 1956 by the Department of Health, Education & Welfare. Yet for the first five years, or so, of the program, prosthetists and orthotists, not knowing how it would affect their "business," were quite wary of the government-supported research and development teams, and it was not an easy matter to induce practicing private prosthetists to attend the first series of formal education programs offered by the government at UCLA in 1953, even when their attendance was heavily subsidized. Today, the prosthetics and orthotics education programs are considered by all to be essential to the maintenance of a healthy prosthetics and orthotics service, and students pay substantial tuitions to obtain an education in this field. In recent years the AAOP has come forth with continuing education programs that are being improved steadily, and I am sure the younger practitioners probably find it difficult to imagine a world without formal education programs in prosthetics and orthotics. Although the original purpose of the educational programs was to introduce the results of research to practitioners as soon as possible, the government agencies, for reasons known only to the bureaucrats involved, have in recent years essentially abandoned support of research in prosthetics and orthotics. A review of the latest issue of the Bulletin of Prosthetics Research (BPR #10-32) which contains progress reports on all of the research and development efforts in prosthetics and orthotics supported by the VA and DHEW, indicates that less than a quarter of the projects devoted to "Rehabilitation Engineering" relate to prosthetics and orthotics. The percentage in terms of fiscal support is probably even less. This circumstance is reflected also in the source of manuscripts submitted to "Orthotics and Prosthetics." In the past, most of the articles were submitted by workers involved in government-supported research programs. Today, the majority of articles are being received from private practitioners. Perhaps this is as it should be, even though medical research is heavily subsidized, and maybe the prosthetics and orthotics profession has grown to the point where it can assume the leadership in the research, development, evaluation, and education needed if it is to continue to provide the increasingly better services expected of professional groups. In addition to the role of the AAOP in providing opportunities for continuing education, an encouraging signal seems to be coming recently through many of the manuscripts submitted to "O & P" in which practicing prosthetists and orthotists describe their own innovations. However, almost without exception, the authors include only their own experiences with patients, and it never fails to occur to me, as editor, what a pity it is that there exists no group to which these excellent ideas can be submitted for a non-biased evaluation conducted under typical clinical conditions, and thus, be channelled with confidence into the formal educational programs. Even if the federal bureaucrats feel that research and development in prosthetics and orthotics is not important or glamorous enough for support, perhaps AAOP could persuade them that it would be in the public interest to support, at least partially, a clinical evaluation program to be conducted by the Academy. I am confident that Academy members will gladly cooperate by fitting patients on a controlled, experimental basis, and, thus, the government will need to support only staff, travel expenses, and in some instances the cost of materials and devices in connection with this much needed function. If such a project is proposed, I recommend strongly that the universities and colleges offering educational programs in prosthetics and orthotics be given the opportunity to participate, for, in that way, any recommendation that a device or technique be added to their respective programs will come as no surprise, and therefore be accepted more readily. *A. Bennett Wilson, Jr. Director, Rehab. Engineering Program, University of Texas Health Science Center at Dallas; Editor, O &P Journal Page Number(s) 7 - 7 Year 1980 Volume 4 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Editorial: To Fill a Void Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. *