9 20 371 https://staging.drfop.org/files/original/fd344d1bf2adb584d43dc2883f0c31f1.jpeg 9901599437049b07b6803e1ba24f1ff8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.limbsforlife.org Contact Name/Title Randy Titony - Executive Director Address 9604 N May Ave. City Oklahoma City State/Province Oklahoma Countries Served USA Regions: Africa, North America, Central America, Middle East, Asia, South AmericaCountries: Ecuador, Guatemala, Haiti, Mexico, Panama, Philippines, Dominican Republic, AfricaAge Group: Adults, ChildrenFees Charged: No Postal Code 73120 Phone 405-843-5174 Fax 405-843-5123 Email admin@limbsforlife.org Organization Type Including ID and tax status Non-profit Tax ID 73-1422414 Not-for-profit Type 501C-3 Need I Financial Assistance Need II General Background Information Need III Volunteers Additional Info & Comments Mission StatementLimbs for Life is a global nonprofit organization dedicated to providing fully functional prosthetic care for individuals who cannot otherwise afford it and raising awareness of the challenges facing amputees. Historic Information The Limbs for Life Foundation was established in 1995. Prosthetist John A. Sabolich saw a need to assist amputees who did not have insurance coverage for prosthetics. His passion for helping amputees was deep-rooted in his family’s history, as his father Lester opened his first prosthetic clinic in Oklahoma City in 1947. Sabolich grew up watching his father give the gift of movement through prosthetic care. His vision for a global network comprised of clinics and partners to assist amputees in need continues through Limbs for Life Foundation. ​ Since its inception, Limbs for Life has provided thousands of new prosthetic limbs to amputees across the United States. Many more amputees are helped with the distribution of used prosthetic parts and components shared through international partnerships and missions, empowering amputees on five continents. 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 Limbs for Life Foundation https://staging.drfop.org/files/original/2004b9922067489189c4d3ae92485e41.pdf b5adf4cefb2c7793eaa0d0c236efe080 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1954_02_001.pdf Year 1954 Volume 1 Issue 2 Page Number(s) 1 - 3 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1954_02_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1954_02_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Limbs in Limbo</h2> <h5>Herbert Elftman, Ph.D. <a style="text-decoration:none;">*</a><br /></h5> <p>To stand on his feet and to walk with his legs wherever his heart desires are natural rights guaranteed to man by his own constitution. Heads may plan and hands may build, but only where legs and feet have brought them. Loss of the lower limb is therefore a major catastrophe.</p> <p>When loss of leg occurs, replacement becomes the primary hope. Ages past, an unknown man hobbled forth from his cave in search of a willow; with one of its limbs adopted as his own, he walked back with majesty. Since then the stage of history has resounded with the staccato echo of countless amputees marching with peg-leg, grit, and gumption.</p> <p>Rapid perfection of limb construction was to be anticipated after these early ventures had focused human ingenuity upon the problem. To the superlative talent which mankind has shown in the production of machinery both intricate and sturdy, the building of a mechanical leg would appear to offer little difficulty. Why is it, then, that artificial limbs have so generally belonged to the limbo of things undeserving either of unstinted praise or of utter condemnation? Failure of artificial legs to satisfy our hopes results less from the imperfection of their mechanisms than from the extravagance of our expectations. People who do not expect a glass eye to see or a prosthetic hand to play the piccolo are disappointed when an artificial leg squeaks while dancing the polka. Man has never commanded clear appreciation of his means of locomotion. From time to time he has been ecstatic about the eye and the liver, the heart, the brain, the hand. Legs have been referred to most frequently as symbols of neighboring functions, so lightly have their own merits been regarded.</p> <p>Why is the performance of the lower extremity so much less spectacular than that of the upper? Independence of the upper limb from obligation to the rest of the body allows it to indulge in ornamentation of movement, so impressive to the eye. The lower limb, sandwiched between the ground and the torso, must ever be responsive to the needs of the body as a whole. It cannot choose to support some parts of the body and not others or to walk with the body through only portions of each step. The intricacy of function of knee and ankle does not exhibit itself in capricious movements but excels when it modulates countless disturbing factors so that no tremor mars the stark simplicity of normal locomotion.</p> <p>No one can rightly expect an artificial limb to take over completely the functions of its predecessor unless it is endowed with an equivalent of muscular and nervous control. Difficult as it is to provide substitutes for bones and joints, such provision is simplicity itself compared with the incorporation within the prosthesis of its own control. Although considerable progress has been made in the field of decelerating mechanisms for lower-extremity prostheses, the leg amputee must still use his own resources when he needs to supply energy or to exercise discretion.</p> <p>The contribution which the amputee makes to the over-all prosthetic result far exceeds that of acting as a model for exhibiting the achievements of inventors. It is he who must finish creation of the new locomotor mechanism by reshaping the pattern of his muscular activity and establishing alertness to new sensory cues. The success of the artificial leg depends on how thoroughly it becomes a part of the form and the function of the amputee after he has blended its metal, wood, and plastic with his muscle and perception. It is only appropriate that the new mechanism, having superseded the natural limb, should contribute to amputee gait that special accent which identifies the supernatural walk.</p> <p>The complexity of human motion makes it inevitable that fundamental improvement in leg prostheses must come slowly, since it is based on factors so numerous that no one individual can comprehend them all. In addition to the profession of engineering, there is needed the cooperation of the physician, the physicist, the physiologist, the physiotherapist, the prosthetist, and the psychologist-to list them in alphabetical order—so that the patient may get the total care he deserves.</p> <p>The problems which need attention are of different degrees of complexity and must be approached by different methods. Choice of materials, details of construction, and provisions for repair require less consideration of the over-all characteristics expected in the rehabilitated amputee than do problems of fit and socket shape. More general considerations must be weighed in projects concerned with alignment, basic design of mechanisms, and evaluation of performance. For these there should be a conscious choice of a realizable objective, the attainment of which requires integration of man and machine into a functional unit.</p> <p>All of these are practical problems amenable to increasingly useful solutions year by year, provided we do not surrender to the impatience of those who must have the answer to the question of the century today and of the millennium tomorrow. It is necessary to preserve clear vision of long-term objectives, although some members of every team find the environment more familiar when details arise.</p> <p>Had trial-and-error and serendipity been able to produce truly satisfactory lower limbs, we would not still be waiting for such. It was left for the National Academy of Sciences-National Research Council to initiate the development of artificial limbs on a modern basis by creating the Committee on Prosthetic Devices and, later, its successor, the Advisory Committee on Artificial Limbs. By carefully balancing the fundamental and the practical in their program, these Committees have laid a firm basis for some progress today, much more tomorrow.</p> <p>This is the key to the future in lower-extremity prosthetics. Used wisely, it will allow us eventually to rescue the limb problem from limbo and to provide the amputee of the future with a fitting legacy.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Herbert Elftman, Ph.D. </b></td></tr><tr><td class="clsTextSmall">Associate Professor of Anatomy, College of Physicians and Surgeons, Columbia University; member, Lower-Extremity Technical Committee, ACAL, NRC.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Limbs in Limbo Creator An entity primarily responsible for making the resource Herbert Elftman, Ph.D. * https://staging.drfop.org/files/original/2ceacdccf427d5e5be414c6e8d78cb68.jpg 7765cad0740c16b17e66a61f6c6a8e63 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.limbsinternational.org Contact Name/Title Roger V. Gonzalez - Director Address 500 West Overland Suite 230 City El Paso State/Province Texas Countries Served USA Regions: Africa, Central America, Asia, South AmericaCountries: Kenya, Senegal, India, Bangladesh, Bolivia, Domnican RepublicSpecific cities, regions, or groups of people: Kijabe, Dakar, New Delhi, Dhaka, La Paz, Santo DomingoAge Group: Adults, ChildrenFees Charged: No Postal Code 79901 Phone 915.321.3126 Email info@limbsinternational.org Services Provided Education, Prosthetic Fabrication, Rehabilitation / TrainingThere is a facility/physical building for patient care at the specified location. Accomodations for volunteers near or at the specified location. Need I Financial Assistance Need II Volunteers Additional Info & Comments This organization has endorsed the ISPO Code of Conduct for International Non-Governmental Prosthetics, Orthotics, and Mobility Assistance. 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 LIMBS International 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.&nbsp;<a style="text-decoration: none;">*</a></h5> <p><i>Abstracted from an article that originally appeared in the June, 1968 issue of Orthotics and Prosthetics.</i></p> <p>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"><b>Fig. 1</b></a>).</p> <p>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.</p> <p>On September 29, 1967 a prosthetic prescription for a definitive prosthetic unit was written.</p> <p>"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."</p> <p>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.</p> <h3>Taking of the Cast</h3> <p>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"><b>Fig. 2</b></a>).</p> <p>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.</p> <p>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"><b>Fig. 3</b></a>).</p> <h3>Filling of the Negative</h3> <p>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.</p> <p>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.</p> <p>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.</p> <h3>Modification of the Male Mold</h3> <p>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.</p> <p>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.</p> <h3>Hip Joint Mounting</h3> <p>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.</p> <h3>Fabrication of the Socket</h3> <p>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.</p> <p>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.</p> <h3>Alignment and Fitting</h3> <p>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.</p> <p>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"><b>Fig. 4</b></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.</p> <p>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"><b>Fig. 5</b></a>).</p> <p>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"><b>Fig. 6</b></a>, <a href="/files/original/84863942578d92ee15a89ac6adee6168.jpeg"><b>Fig. 7</b></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.</p> <p>The patient was followed by the author for approximately two years, during which time he was wearing his prosthesis extensively.</p> <p>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.</p> <b>*<em>Peter A. Ockenfels, C.P.O. </em></b><em> American Orthotic &amp;Prosthetic Laboratory, Inc., Columbus, OH<br /><br /><br /></em> 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/ffc8eca439bcae403581feacfc98144e.pdf 4193bb67ab6993250dcf123adae8278b DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1964_01_001.pdf Year 1964 Volume 8 Issue 1 Page Number(s) 1 - 2 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1964_01_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1964_01_001.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Measurement and Evaluation</h2> <h5>Herbert R. Lissner, M.S. <a style="text-decoration:none;">*</a><br /></h5> <p>"I often say that when you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it in numbers your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge but you have scarcely in your thoughts advanced to the stage of science, whatever the matter may be."</p> <p>-<i>Lord Kelvin</i></p> <p>Most of us devote appreciable time in the course of daily activity to making evaluations and forming value judgments. Every time we make a purchase, watch television, eat a meal-the list is endless-we make evaluations. Factors considered may involve monetary costs, saving of labor and time, ethical principles, aesthetic enjoyment, and many other matters.</p> <p>In order to reach a final decision, it is usually necessary to combine, or even to counterbalance, evaluations made in many subsidiary categories. Those subgroups to which numbers can be applied, such as initial monetary cost and maximum attainable speed, are the easiest to consider, while those to which numbers cannot be easily assigned are more difficult to evaluate.</p> <p>The establishment of standards is a recognized aid in the making of evaluations. Standards may consist simply of a set of lower limits; any product which fails to meet them is automatically eliminated from consideration. Examples of this hurdle or barrier type are some of the standards of the Underwriters' Laboratories for electrical appliances. A variant of this kind of standard may involve an upper as well as a lower limit, such as the "go-no-go" type. Conversely, a standard may involve the expression of a ratio of the specific item to the ultimate attainable, so each evaluation is a rating indicating how closely the limit is approached. A standard of this type is involved in the grading of examinations. (Even then the relationship between the score and the practical application is not always clear; the "A" student is not always successful in later life.) An intermediate form of standard is a rank ordering of individual items, along some defined scale, thus allowing comparison of each item with the average and its fellows.</p> <p>All these types of standards are clearly of value, so the establishment of standards, at least tentatively, should generally precede the process of evaluation. In the production of materials and the fabrication of products of all kinds, industry and Government depend on established standards in making purchases, compliance testing, and the design of more complex products. For many years the American Society for Testing and Materials, the American Standards Association, numerous trade associations, and various Government agencies have sponsored development of standards and specifications.</p> <p>Now what has all this to do with artificial limbs and braces? Evaluation serves one primary purpose in this case-the improvement of the product, a special type of man-machine combination. If the artificial limb could duplicate exactly all the functions of the natural limb in spite of the limited resources of power, sensibility, and control remaining available to the amputee, presumably we would have an ideal prosthesis. Minimal standards can rule out gross malfunctions, frequent and hazardous physical breakdowns, and obvious discomfort. Reasonably accurate lower and upper boundaries of physical dimensions to match specific categories of amputees can be established from anthropometric data illuminated by the best experience of the industry. In another sense, the physical strengths and practical minimal wall thicknesses set lower limits to weights, while maximal tolerable weights and inertias can also be estimated. By specifying the functional capabilities of the human limb we can establish the maximum standards we would like to achieve with our replacement. (The frequent recent suggestions of servo systems or "man amplifiers," though, imply that merely human performance may not be an upper bound.)</p> <p>These standards of several types should be specified in many categories. Any problem, no matter how complex, can be approached by breaking it down into small segments which can be analyzed. It is only as we define the significant categories, establish and progressively refine standards, and make objective evaluations that further appreciable advances in artificial limbs and braces will be made.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Herbert R. Lissner, M.S. </b></td></tr><tr><td class="clsTextSmall"> Professor and Chairman of the Department of Engineering and Mechanics, and Coordinator, Biomechanics Research Center, Colleges of Engineering and Medicine, Wayne State University, Detroit, Mich. 48202; Chairman, Subcommittee on Evaluation, Committee on Prosthetics Research and Development.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Measurement and Evaluation Creator An entity primarily responsible for making the resource Herbert R. Lissner, M.S. * https://staging.drfop.org/files/original/cd2773276c38e31c5de8654b32560573.pdf 87b82fb3ff0928e5a56676a56b7cbdcf https://staging.drfop.org/files/original/a78493f4da7fe644e100ca7cd8f56d1e.jpg e073105d25ced27a5e34a054493e1b9b 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 Fig. 1. 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Radcliffe, M.S.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>If a prosthetic device is to give optimum service to the amputee, it must always be properly fitted, regardless of its mechanical excellence. This is especially true in the case of the lower extremity, where the prosthesis must function continually and where poor fit or alignment will lead quickly to rejection of the device by the wearer. Among prosthetists there seems to be general agreement that by far the most important factors in the success of any artificial leg relate to fit and alignment on the subject. Fit and alignment are usually considered together, since they are mutually interdependent.</p> <p>Over the years many different mechanical devices to aid in fitting and alignment of lower-extremity prostheses have been developed to help in the application of one or another particular set of alignment principles in use by individual fitters. Others of these devices are more general in application and are adaptable for use by any prosthetist regardless of the particular alignment principles he advocates. In every case, however, an attempt has been made to improve the fitting and alignment technique by adopting one definite set of principles and using a mechanical device to aid in the application of those principles.</p> <h3>Historical Background</h3> <p>In 1919 Franz Schede<a></a> wrote <i>Theoretische Grundlagen fiir den Bau von Kunstbeinen, </i>a work generally considered to be one of the first important contributions in the field of prosthetic devices. In this volume Professor Schede established for the alignment of lower-extremity prostheses a set of principles based on application of known laws of mechanics. He was particularly concerned with alignment of the joints in a lower-extremity prosthesis so as to provide sufficient stability during the stance phase. As a result of the interest in his work, there was developed the so-called "plumb-line" method of alignment, a method which, essentially, assumes that the prosthesis carries weight along a vertical plumb line, the elements of the prosthesis then being arranged using this line as a reference. Still in general use throughout Europe and the United States, this system involves the problem of determining the location of the plumb line in the socket so that it can be extended down to the foot and used as a reference. For this purpose, many mechanical devices have been used.</p> <h4>The Fitting Stool</h4> <p>One of the oldest devices to aid in the fitting of lower-extremity sockets is the common fitting stool (<b>Fig. 1</b>). This device was well known as early as 1915 and is still in general use. When it is used to aid in establishing a "weight line," wedges are employed to tilt the socket block until the desired orientation is achieved. The hydraulic fitting stool of Habermann (<b>Fig. 2</b>) is a recent refinement. It requires that the location of one point on the weight line be assumed, usually at the socket brim, and that the plumb line be drawn vertically downward from this point.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 1. Common type of fitting stool in use as early as 1915.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 2. Modern fitting stool with hydraulic height adjustment. Manufactured in Germany by Habermann.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p><i>Pivot-Point Balancing Devices</i></p> <p>In an attempt to eliminate the necessity for the assumption of one point on the weight line of the socket, various modifications of the standard fitting stool have been tried.<a></a> <b>Fig. 3</b> is a schematic diagram of a fitting stool which uses a fixed ball as the lower contact point. The point of contact of the ball locates one point on the plumb line, which is then extended upward through the socket.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 3. Point-balance fitting stool with a fixed ball as the supporting point</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>In a further refinement of this technique, introduced into this country in 1947, the plumb line is located at the intersection of two vertical planes (<b>Fig. 4</b>). The lower edge of each plane is determined by use of a triangular block giving a line contact along the bottom of the socket.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 4. Line-balance fitting stool with triangular block as a support.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>Another pivot-point balancing device (<b>Fig. 5</b>) locates a similar point near the top of the socket block by supporting the socket in a clamp which pivots about a fore-and-aft axis and allows the pivot point to be moved medially or laterally as desired. Weight is transmitted to the floor through a connecting pylon.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 5. Pylon-type fitting stand with support at a point near the top brim of the socket.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p><i>Vise-Type Fitting Stand</i></p> <p>Another school of thought in the alignment of the above-knee socket believes that establishment of a plumb line is not as important as is establishment of the proper inclination of the socket in space. In the vise-type fitting stand (<b>Fig. 6</b>) of Habermann<a></a>, the socket can be adjusted in inclination to any position desired. Once the proper inclination and height have been established, the socket is clamped rigidly in space, and the amputee "marks time" in the socket. If necessary, changes are made until the amputee is able to bear weight comfortably and to use his stump efficiently in the control of body movements. After an arbitrary plumb line has been assumed, the optimum socket orientation is incorporated into the final prosthesis.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 6. Vise-type fitting stand.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>All of these mechanical aids have helped in the so-called "static alignment" of the prosthesis, a condition which determines the stability of the artificial limb in the stance phase. The "dynamic" factors, which affect the swing phase of the prosthesis, and which account for the differences between the static and dynamic conditions in the stance phase, are adjusted as necessary after the amputee is walking on the rough leg.</p> <h4>Schneider's "Gehmaschine"</h4> <p>Hans Schneider<a></a> of Nuremberg, Germany, has long advocated the use of an adjustable leg or "walking machine." Essentially, his method is to allow the amputee to walk on a trial prosthesis (<b>Fig. 7</b>), changes being made empirically until the alignment is considered satisfactory. Then, as the optimum alignment is being duplicated in the final prosthesis, various measurements are read from the adjustable leg and a measuring stand (<b>Fig. 8</b>). It is claimed that from these measurements the fit and alignment can be duplicated in additional prostheses ordered later.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 7. Schneider's "Gehmaschine."</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 8. Schneider's alignment stand.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <h3>The University of California Above-Knee Adjustable Leg</h3> <p>A study of methods for alignment of the above-knee suction-socket prosthesis was started at the University of California, Prosthetic Devices Research Project, in the autumn of 1946. As one of the first phases of investigation, two adjustable prostheses were designed and constructed. These experimental devices (<b>Fig. 9</b> and <b>Fig. 10</b>) allowed adjustment of a large number of variables, and data were collected having to do with the effect of a change in one of the many alignment variables upon the behavior of the prosthesis<a></a>. It soon became apparent that devices of this nature were not only useful as research instruments but that they might also have some practical use as limbshop tools. Accordingly, there was designed and constructed for limbshop purposes a series of models of a simplified device in- corporating only those adjustments found most important, as determined using the research devices.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 9. Experimental adjustable above-knee leg used for research at the University of California.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 10. Experimental adjustable below-knee leg (University of California).</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>The initial effort was to develop a device for alignment of the above-knee suction-socket prosthesis. Out of this work came the above-knee adjustable leg shown in <b>Fig. 11</b>. Several units of this design were used in the experimental program at the University of California and were given shop trials in the San Francisco Bay Area. They were found very useful in the alignment of above-knee prostheses in the shops and, in addition, were widely used for demonstration of alignment principles. But use of the above-knee adjustable leg was then limited because of the difficulty in transferring the optimum relationships from the adjustable trial prosthesis to the final setup.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 11. The UC adjustable leg.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <h3>The UC Alignment Duplication Jig</h3> <p>To fill this need, the designers produced the Alignment Duplication Jig (<b>Fig. 12</b>), which is essentially a rather specialized set of clamps and an associated saw guide to maintain the socket, knee axis, ankle axis, and foot in a fixed position, thus permitting the temporary adjustable knee to be removed and replaced with wood, plastic, or metal structural members and joints. Three models of the alignment duplication jig were constructed and loaned, along with models of the above-knee adjustable leg, to the representatives of the Orthopedic Appliance and Limb Manufacturers Association who were then serving as the Technical Advisory Committee to the Lower-Extremity Technical Committee of ACAL. The representatives of the limb industry were unanimous in their conclusion that use of these devices offered considerable advantage to the prosthetist for alignment of all above-knee suction-socket prostheses.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 12. The alignment duplication jig.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>On the basis of the experience gained, the above-knee adjustable leg was redesigned, as shown in <b>Fig. 13</b>, and drawings for both the adjustable leg and the duplication jig were made available to the artificial-limb industry.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 13. Revised design of the adjustable leg as released to the artificial-limb industry.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <p>Devices similar to those shown in <b>Fig. 12</b> and <b>Fig. 13</b> are now being manufactured<a style="text-decoration: none;">*</a> and can be purchased by limbshops.</p> <h3>The UC Combination Adjustable Leg</h3> <p>Because of the acceptance of the above-knee adjustable leg during its trial period of limbshop use, the Technical Advisory Committee of OALMA recommended that a similar unit be developed for alignment of below-knee prostheses. As a result, the combination above-knee/below-knee adjustable leg (<b>Fig. 14</b>) was designed and constructed at the University of California. Its use as a below-knee alignment device is indicated in <b>Fig. 15</b>. The principal advantage of this unit over previous designs is that no tools are required in making adjustments.</p> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 14. Combination above-knee/below-knee adjustable leg in use as a trial above-knee prosthesis</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <table> <tbody> <tr> <td> <table> <tbody> <tr> <td> <p class="clsTextCaption"><br />Fig. 15. Combination above-knee/below-knee adjustable leg in use as a trial below-knee prosthesis.</p> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> <br /> <h3>Use of the Adjustable Leg and Alignment Duplication Jig</h3> <p>The basic difference in the use of the University of California alignment devices, as compared with Schneider's apparatus, lies in the manner of duplication of the optimum alignment. The adjustable leg is used in much the same manner as is Schneider's device. A set of guiding principles for filling and alignment has been established, and the adjustable leg is used as a means of applying these principles to the conditions existing with a particular amputee. But the devices serve as shop tools only, and any set of principles can be applied by the prosthetist.</p> <p>In the use of the alignment duplication jig, the (assumption is made that the optimum alignment will be influenced considerably by the fit of the socket. Since subsequent sockets for a particular amputee are not apt to be exactly alike, it is considered unnecessary to try to duplicate in all later prostheses the alignment of the first. Each socket is considered as a separate alignment prob- lem, and the alignment duplication jig helps in the construction of the final prosthesis rather than as a measuring instrument.</p> <p>In the prior art of lower-extremity limb-fitting, there has naturally been the tendency to stop making adjustments as soon as the prosthesis is just "good enough," especially so when a further change would mean breaking a glued connection or resetting a joint. The principal advantage of the UC alignment equipment is that, since all adjustments in the trial prosthesis are easily and quickly made, the prosthetist can make very small changes until both he and the amputee are satisfied that the best job has been done. The alignment of a leg prosthesis is especially critical in the swing phase and during the periods of transition from stance to swing. Very small changes in alignment can have very noticeable effects upon the performance of the prosthesis at these times. Since small adjustments can be made accurately using the adjustable leg, the prosthetist is able to obtain optimum performance where that is difficult, if not impossible, to achieve by trial-and-error methods. Besides this, the adjustable leg has found considerable use as an educational aid in teaching prosthelisls the fundamentals of limb alignment in suction-socket schools and in demonstration of alignment principles before groups of orthopedic surgeons, physical therapists, and others.</p> <p><b>References:</b></p> <ol> <li>Habermann, Alfred, <i>Mechanische Hilfsmittel fur denstatischen Aufbau des Kunstbeines, </i>Medizinische-Technik, 4(3) :60 (March 1950).</li> <li>Schede, Franz, <i>Theorelische Grundlagen fur den Bauvon Kunstbeinen; Insbesondere fur den Oberschenkel-amputierten, </i>Ztschr. f. orthopad. chir., Supplement 39, Enke, Stuttgart, 1919.</li> <li>Schnur, Julius, <i>BeinbelasiungsUnie und Schwerlinie,</i>edizinische-Technik, 5(3):54 (March 1951).</li> <li>Schnur, Julius, <i>Die Aquilibral-Kontakt Prolhese,</i>rthopadie-Technik, 4(2) :36 (February 1952).</li> <li>University of California (Berkeley), Prosthetic De-ices Research Project, [Report to the] Advisory Committee on Artificial Limbs, National Research Council, <i>Functional considerations in fitting and alignment of the suction socket prosthesis, </i>March 1952.</li> <li>War Department, Office of the Surgeon General,ommission on Amputations and Prostheses, <i>Report on European observations, </i>Washington, 1946. <b>p.92.</b></li> </ol> <br /> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Footnote</b></td> </tr> <tr> <td class="clsTextSmall">By the Plastic Fibre Limb Company, Minneapolis Minnesota.</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Reference</b></td> </tr> <tr> <td class="clsTextSmall"><b>5.</b></td> <td class="clsTextSmall">University of California (Berkeley), Prosthetic De-ices Research Project, [Report to the] Advisory Committee on Artificial Limbs, National Research Council, Functional considerations in fitting and alignment of the suction socket prosthesis, March 1952.</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Reference</b></td> </tr> <tr> <td class="clsTextSmall"><b>6.</b></td> <td class="clsTextSmall">War Department, Office of the Surgeon General,ommission on Amputations and Prostheses, Report on European observations, Washington, 1946. p.92.</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Reference</b></td> </tr> <tr> <td class="clsTextSmall"><b>1.</b></td> <td class="clsTextSmall">Habermann, Alfred, Mechanische Hilfsmittel fur denstatischen Aufbau des Kunstbeines, Medizinische-Technik, 4(3) :60 (March 1950).</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>References</b></td> </tr> <tr> <td class="clsTextSmall"><b>3.</b></td> <td class="clsTextSmall">Schnur, Julius, BeinbelasiungsUnie und Schwerlinie,edizinische-Technik, 5(3):54 (March 1951).</td> </tr> <tr> <td class="clsTextSmall"><b>4.</b></td> <td class="clsTextSmall">Schnur, Julius, Die Aquilibral-Kontakt Prolhese,rthopadie-Technik, 4(2) :36 (February 1952).</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Reference</b></td> </tr> <tr> <td class="clsTextSmall"><b>2.</b></td> <td class="clsTextSmall">Schede, Franz, Theorelische Grundlagen fur den Bauvon Kunstbeinen; Insbesondere fur den Oberschenkel-amputierten, Ztschr. f. orthopad. chir., Supplement 39, Enke, Stuttgart, 1919.</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="width: 400px;"> <table style="background: #003399;"> <tbody> <tr> <td> <table> <tbody> <tr> <td style="text-align: left; padding: 3px;"> <table> <tbody> <tr> <td class="clsTextSmall" style="border-bottom: 1px #666666 solid;"><b>Charles W. Radcliffe, M.S. </b></td> </tr> <tr> <td class="clsTextSmall">Acting Assistant Professor of Engineering Design, University of California, Berkeley; member, Lower-Extremity Technical Committee, ACAL, NRC.</td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> Figure 1 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-10.jpg Figure 2 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-11.jpg Figure 3 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-12.jpg Figure 4 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-13.jpg Figure 5 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-14.jpg Figure 6 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-15.jpg Figure 7 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-16.jpg Figure 8 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-17.jpg Figure 9 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-18.jpg Figure 10 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-19.jpg Figure 11 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-20.jpg Figure 12 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-21.jpg Figure 13 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-22.jpg Figure 14 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-23.jpg Figure 15 http://www.oandplibrary.org/al/images/1954_02_020/May-1954OCRBatch1-24.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 Mechanical Aids for Alignment of Lower-Extremity Prostheses Creator An entity primarily responsible for making the resource Charles W. Radcliffe, M.S. * https://staging.drfop.org/files/original/00aef4cd6df4fe2afbe93e23bb1aa9a0.pdf 27266064d8bfe3c96f4086c7204d1b26 https://staging.drfop.org/files/original/08880a20a3c0f8fd3794a62b5e39233d.jpg 79a06756e4f898cff5eebb111185d355 https://staging.drfop.org/files/original/f314fd85de1bb9acb2edfc3629026582.jpg 38d5c67d49c718680e501e2c20e483ff https://staging.drfop.org/files/original/56dbb5a30ba120dc374233660a6d08f2.jpg 66064d3a55ad5117af2b25623bc9cc92 https://staging.drfop.org/files/original/2d2151c41c8d769207ce1150be49de3c.jpg a9ad2494375193603f1088dc4f80b52f https://staging.drfop.org/files/original/35ce4605762acb542ff3e5cfb0953f88.jpg 338a3e36c40cb57d3a465aa7b51a0fed https://staging.drfop.org/files/original/1a6880facfd5db40696e5d6d3e54f5c7.jpg 9f7281a6ee94e4e07aa0cb3a096b65a9 https://staging.drfop.org/files/original/0cb44f1af50f82e37a10bcf6655eef8f.jpg d39462496db66313910dd49940ae4454 https://staging.drfop.org/files/original/1568f3bda968608839fa654316c6fcdf.jpg 751c90e73f3344c1b5bd104bcd06bcde Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_04_235.pdf Text Any textual data included in the document <h2>Mechanical Comparison of Terminal Devices</h2> <h5>James D. Corin, M.S.&nbsp;<a style="text-decoration: none;">*</a><br />Teresa M. Holley, CP.&nbsp;<a style="text-decoration: none;">*</a><br />Rodney A. Hasler, M.E.&nbsp;<a style="text-decoration: none;">*</a><br />Richard B. Ashman, Ph.D.&nbsp;<a style="text-decoration: none;">*<br /><br /></a></h5> <h3>Introduction</h3> <p>Considerable controversy has developed over the appropriateness of fitting "functional hand" prostheses to juvenile and adolescent amputees. This controversy is further enhanced by the cosmetic advantages of functional hands over the more traditional hook terminal devices. Conversely, experience has shown the hook terminal devices to offer greater functional control. Prosthetists often feel obliged to fit the amputee with a more functional terminal device, while the amputee often wishes to relinquish some function for cosmesis. Because the functional hands available today do not approach the necessary control, and because hooks are so uncosmetic, a significant percentage of upper limb amputees tend not to wear their prosthesis. The fundamental question presented to the prosthetist in fitting an amputee is how much function can be gained with a particular device. If function is defined simply as prehension grip force and grip width, the next question is whether an amputee can fully operate the particular device completely and comfortably.</p> <p>To date, very little objective data has been available on the comparison of terminal devices. Hence, prescription principles on the part of most prosthetists have been somewhat subjective. Quantitative force and excursion are not usually critical in fitting low level amputees; but the strength adolescents, juveniles, and higher level adult amputees can induce, becomes quite variable. The study presented here is an objective comparison of several terminal devices for mechanical function. The measured parameters were prehension grip force, grip width at full open, excursion range, and the excursion force required to fully open the terminal devices.</p> <h3>Methods</h3> <p><i>Test Protocol</i></p> <p>All test data presented here was accomplished on a MTS-858 universal materials testing machine. With this hydraulically powered machine, a piston-like cross-head can be positioned accurately, while loads created on the test specimens are monitored. The degree of sophistication of this machine is not critical to the test protocol. Any testing apparatus can be used as long as displacement and created force can be measured accurately.</p> <p>Two different tests were performed on each terminal device at each of the different tension settings available. The first test will be referred to as the excursion test. Here, the cross head and load cell of the test machine were attached to the cable actuator of the terminal device (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-01.jpg"><b>Fig. 1</b></a>). The terminal device itself was mounted rigidly to the machine base. The result of this test was a plot of excursion of the cable actuator against the tensile force generated in pulling the cable (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-02.jpg"><b>Fig. 2</b></a>). The rate of pull was constant at 4" per minute and, because of this slow rate, loading was considered to be static. The plots of excursion force verses excursion of the cable actuator were all of the same general form. <a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><b>Fig. 3</b></a> shows generalized force versus excursion plot. To present the actual loading curves for each device tested would have taken considerable space, therefore, for each device the only parameters that were tabulated are "A," "B," "C," "D," and "E." The portion of the curve up to "A," "C," represents the pre-loading of the terminal device. Excursion of the cable up to this point does not significantly move the appendages of the terminal device and is primarily due to slack in the system. The pre-load force "C," is the force necessary to overcome preloading of the spring or bands. The force constant "D," of a particular terminal device is the slope of the loading curve between the end of preloading and full open excursion of the cable. The full open excursion of the cable actuator is the distance "B," while the force required to fully open the device is labeled "E." It should be noted that with the five parameters, an estimation of the excursion-load curve of a particular device can be reconstructed. It should also be noted that the tabulated excursion parameters were measured by pulling the terminal devices open. If one was to continue to plot force versus excursion while the device was allowed to close, one would find much lower forces for a given excursion. This hysterisis in the loading curve is due primarily to friction. The loading curves are presented, rather than the unloading curves, because this is the manner in which the devices are operated.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-01.jpg"><strong>Figure 1. A 2.5" U.N.B. STEEPER set up for excursion testing on the MTS-858 universal machine.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-02.jpg"><strong>Figure 2. Experimental plot of excursion force vs. excursion travel on a 2.5" U.N.B. STEEPER terminal device. Notice that at 0.45" the characteristics of the curve changes. This is the point (A,C) at which the hand just begins to open.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>Figure 3. Generalized version of excursion force vs. excursion with parameters indicated.</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>A-Pre-load excursion (inches)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>B-Full opening excursion (inches)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>C-Pre-loading force (lb.)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>D-Force constant in loading (lb./in.)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><strong>E-Total excursion force at full open (lb.)</strong></a><br /> <p>The second test performed was to assess the prehension gripping forces that are created with each device. With the hand in a horizontal position, the base of the test machine was attached to the thumb, or one hook half, with a cable. The phalanges, or other hook half, were attached to the cross head and load cell of the test machine via a cable (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-04.jpg"><b>Fig. 4</b></a>). The prosthesis was started in the full open position. A plot of grip force verses grip width was created by allowing the device to close at a constant rate of 4" per minute (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-05.jpg"><b>Fig. 5</b></a>). From these plots, the parameters "G," "H," and "I," were calculated for use with the generalized graph (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><b>Fig. 6</b></a>). It should be noted that the plotting direction of these curves was opposite to those discussed in Figures 2 and 3. Since the hand was started full open, maximum prehension grip force "I" and the full open grip width "F" are plotted first. The force plotted here represents the force created by the device upon its own closing. The force necessary to pull the appendages open would be greater than this force, due to friction. In <a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><b>Fig. 6</b></a>, "G" is referred to as the initial prehension force. This is the force created just prior to the grip closing completely. Also, the prehension grip force constant, "H" is the slope of the unloading curve between fully open and closed positions of the terminal device. With the parameters "F," "G," "H," and "I," an approximate reproduction of prehension grip force verses grip width can be created.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-04.jpg"><strong>Figure 4. A 2.5" U.N.B. STEEPER set up for prehension grip testing on the MTS-858 universal machine.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-05.jpg"><strong>Figure 5. Experimental plot of prehension grip force vs. grip width for a 2.5" U.N.B. STEEPER. This plot was started with the hand full open, a 2.25" grip width, and 2.5 lb. grip force. The steep slope at approximately 0.4" is where the inner locking mechanism activates. The hand is essentially closed at this time.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><strong>Figure 6. Generalized version of prehension grip force vs. grip width, with parameters listed.</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><strong>F-Full opening grip width (inches)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><strong>G-Initial prehension grip force (lb.)</strong></a><br /><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg"><strong>H-Prehension grip force constant (lb./in.)</strong></a><br /><strong><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.jpg">I-Total prehension grip force (lb.)</a><br /></strong><br /> <h3>Results</h3> <p>Table I lists the measured parameters derived from the two tests of 33 terminal devices. Of the 12 parameters listed, the first nine were described previously in the test protocol section. The J-th parameter is the number of different devices tested of each type. When more than one device was tested of a particular type, results were averaged. The criteria for testing most of the devices was based on local availability. The ratio of maximum prehension grip force to excursion force is often called the efficiency of a terminal device. The K-th parameter is the measured efficiency. The last parameter, listed as "L," is that of the work required to open the terminal device by pulling the actuator cable. Work is defined as the excursion force times excursion length and is measured by calculating the area under the force-excursion curve. This parameter can be estimated to reasonable accuracy by considering the area under the generalized force-excursion curve (<a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg"><b>Fig. 3</b></a>). The work, or area under this curve can be calculated as:</p> <p>work = (1/2)*(A*C) + (B-A)*C + (1/2)*(E-C)*(B-A)</p> <p class="clsTextCaption"><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-08.jpg"><strong>Table I. Values measured from hook and hand type terminal devices.</strong></a></p> <h3>Description of Terminal Devices Tested</h3> <p>The following list of terminal devices corresponds to the device number of Table I.</p> <ol> <li> <p>CAPP regular spring, center pull, nylon cabled</p> </li> <li> <p>CAPP soft spring, center pull, nylon cabled</p> </li> <li> <p>HOSMER SSS-555, 1 band, steel cabled</p> </li> <li> <p>HOSMER SSS-555, 2 bands, steel cabled</p> </li> <li> <p>HOSMER SSS-555, 3 bands, steel cabled</p> </li> <li> <p>HOSMER 10P, 1 band, steel cabled</p> </li> <li> <p>HOSMER 10P, 2 bands, steel cabled</p> </li> <li> <p>HOSMER 10P, 3 bands, steel cabled</p> </li> <li> <p>HOSMER 10X, 1 band, steel cabled</p> </li> <li> <p>HOSMER 10X, 2 bands, steel cabled</p> </li> <li> <p>HOSMER 10X, 3 bands, steel cabled</p> </li> <li> <p>HOSMER 12P, 1 band, steel cabled</p> </li> <li> <p>HOSMER 12P, 2 bands, steel cabled</p> </li> <li> <p>HOSMER 88X, 1 band, steel cabled</p> </li> <li> <p>HOSMER 88X, 2 bands, steel cabled</p> </li> <li> <p>HOSMER 88X, 3 bands, steel cabled</p> </li> <li> <p>HOSMER 99X, 1 band, steel cabled</p> </li> <li> <p>HOSMER 99X, 2 bands, steel cabled</p> </li> <li> <p>HOSMER 99X, 3 bands, steel cabled</p> </li> <li> <p>U.N.B. STEEPER, 2.0" w/glove, nylon pull</p> </li> <li> <p>U.N.B. STEEPER, 2.25" w/glove, tension #1 (softest), nylon pull</p> </li> <li> <p>U.N.B. STEEPER, 2.25" w/glove, tension #2, nylon pull</p> </li> <li> <p>U.N.B. STEEPER, 2.25" w/glove, tension #3, nylon pull</p> </li> <li> <p>U.N.B. STEEPER, 2.50" w/glove, steel cabled</p> </li> <li> <p>U.N.B. STEEPER, 2.75" w/glove, steel cabled</p> </li> <li> <p>HOSMER SIERRA, gloved, steel cabled</p> </li> <li> <p>HOSMER ROBINS-AIDS, soft-mechanical, gloved, steel cabled</p> </li> <li> <p>HOSMER BECKER-IMPERIAL, gloved, steel cabled</p> </li> <li> <p>HOSMER, #201 gloved, steel cabled</p> </li> <li> <p>HOSMER, #301 gloved, steel cabled</p> </li> <li> <p>HOSMER, #401 gloved, steel cabled</p> </li> <li> <p>OTTO-BOCK, 6.75", gloved, steel cabled</p> </li> <li> <p>OTTO-BOCK, 7.75" gloved, steel cabled</p> </li> </ol> <h3>Discussion</h3> <p>General trends in the measured parameters become evident on closer examination of <a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-08.jpg"><b>Table I</b></a>. Organization of these tables is such that devices with numbers less than 20 were hook type terminal devices, while those with numbers 20 and over were functional hands. Preload excursion, parameter "A," can be thought of as the excursion necessary to take up slack in the system. Some functional hand units require as much as 1/2" of excursion before any opening occurs. Full opening excursion, parameter "B," and the total excursion force necessary to open the terminal device, parameter "E," are self explanatory. If an amputee cannot generate either the excursion or the necessary force, a different terminal device should be considered. It should be noted that children usually have trouble operating a device with an excursion force greater than ten pounds.</p> <p>The pre-loading force "C" and the force constant "D" are useful parameters in assessing the function of a terminal device when the amputee can marginally create the forces and excursion necessary for full opening. In marginal cases, large pre-loading forces will limit the function of a device. For example, although the UCLA CAPP, device number one, only takes eight pounds to open fully, a patient must be able to create at least 4.5 pounds to start the device in motion. Without regard for the pre-load, one might incorrectly think that four pounds of excursion force would open the device halfway. A terminal device with a high pre-opening excursion (more prominent in hands) could be used on an amputee with good strength initially, but might have weakness toward the end of the excursion range. This is particularly true for higher levels of amputation which rely more on scapular abduction and less humeral flexion. Another important factor to note is the grip performance of the terminal devices. Here the full open grip width "F" and maximum prehension grip force "I" are the important notable values.</p> <p>The parameter that includes both grip and excursion is "K," the ratio of maximum grip force to excursion force. This term was measured to be greater than 0.40 for all of the hook type devices examined, and less than 0.40 for the functional hands. Some hooks revealed efficiencies as high as 0.70. It should be noted that the ratio of maximum grip force to excursion force can be calculated from the geometry of a particular device and is independent of the spring or rubber band tension. The measured results show this to be the case, in that parameter "K" did not significantly vary when spring tensions or the number of rubber bands were changed. Measured efficiencies for the functional hands were, in general, less than hook terminal devices. This consistent discrepancy is due largely to friction in the mechanics of the internal hinges within the hands in addition to glove attachments.</p> <p>The final parameter "L" which is the total amount of work required to operate the terminal device is also of extreme importance. Hands compare more favorably to hooks because on a general basis hands require less excursion than hooks for full opening. This is an important factor for children as well as higher levels of amputation, because of less available excursion.</p> <p>Plotting maximum prehension grip force against total excursion force, the relative performance between hooks and hands can be compared (<b>Fig. 7</b>). For clarity, the hand device numbers were plotted with a preceding dash. For any particular excursion force, it can be easily seen that grip force is greater for the hook devices. The devices 7, 8, 10, 11, and 19, were particularly good performers, which required excursion forces less than 15 pounds, and created prehension grip forces greater than seven pounds. In light of this comparison, it should be challenging for terminal device designers to come up with functional hand devices that approach the efficiencies of hooks.</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-07.jpg">Figure 7. Graph of prehension grip force vs. excursion force for all terminal devices. Note that all hand terminal devices have a preceding dash.</a><br /></strong><br /> <h3>Conclusions</h3> <p>This comparison of terminal devices is only preliminary in that many more terminal devices have yet to be analyzed. Furthermore, the number of devices tested was very small. In spite of these limitations, the best protocol allowing comparisons between the different terminal devices was felt to be objective and reflect the relative performance of different devices.</p> <h3>Acknowledgments</h3> <p>This research was funded by the King Foundation, Dallas, Texas and the Research Fund of Texas Scottish Rite Hospital for Crippled Children.</p> <p>We wish to also thank Hosmer Dorrance and Liberty Mutual for the donation of their terminal devices.</p> <p><em><b>*Richard B. Ashman, Ph.D. </b> Texas Scottish Rite Hospital for Crippled Children, 2222 Welborn Street, Dallas, Texas 75219.</em></p> <p><em><b>*Rodney A. Hasler, M.E. </b> Texas Scottish Rite Hospital for Crippled Children, 2222 Welborn Street, Dallas, Texas 75219.</em></p> <p><em><b>*Teresa M. Holley, CP. </b> Texas Scottish Rite Hospital for Crippled Children, 2222 Welborn Street, Dallas, Texas 75219.</em></p> <p><em><b>*James D. Corin, M.S. </b> Texas Scottish Rite Hospital for Crippled Children, 2222 Welborn Street, Dallas, Texas 75219.<br /><br /><br /></em></p> Page Number(s) 235 - 244 Year 1987 Volume 11 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-01.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-05.jpg Figure 7 TABLE I http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-08.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 FIGURE 7 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-07.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-02.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_04_235/1987_04_235-06.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 Mechanical Comparison of Terminal Devices Creator An entity primarily responsible for making the resource James D. Corin, M.S. * Teresa M. Holley, CP. * Rodney A. Hasler, M.E. * Richard B. Ashman, Ph.D. * https://staging.drfop.org/files/original/2d1df247a4d344f570af5665bd9065ba.jpg 625200ea15936f1ed6e85fc9a9254686 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.mend.org.nz Contact Name/Title Rob Buchanan - Director Address PO Box 94 City Kerikeri State/Province Northland Countries Served New Zealand Regions: Africa, AsiaCountries: Zambia, Kenya, Uganda, Ghana, India, Nepal, PhilippinesSpecific cities, regions, or groups of people: Those challenging disabilities and disability service providers Age Group: Adults, ChildrenFees Charged: Sometimes Postal Code 230 Phone 64210609631 Email mend@xtra.co.nz Organization Type Including ID and tax status Non-profit Tax ID CC32353 NZ Charity Not-for-profit Type Non Govt Org NGO Services Provided Prosthetic Fitting, Orthotic Fitting, Medical Equipment / Supplies, Education, Funding, Prosthetic Fabrication, Orthotic Fabrication, Medical / Surgical Care, Rehabilitation / TrainingThere is a facility/physical building for patient care at the specified location. Accomodations for volunteers near or at the specified location. Need I Financial Assistance Need II Volunteers: Prosthetists, Orthotists, Technicians, Lay Persons, Nurses, Therapists Need III Materials, Components, and Equipment: New, Disassembled, Equipment, Used, Medical Supplies, Other: Hearing aids, used prostheses 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 MEND https://staging.drfop.org/files/original/8a6810f7870614f995ac2e6396e843c8.jpg 315b4d9d14e19624376961ff68a2c7f8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.mercyships.org Address P.O. Box 1930 City Garden Valley Countries Served Mercy Ships is a global organization with offices around the world to further our mission of increasing healthcare for all. Phone (903) 939-7000 Email info@mercyships.org Organization Type Including ID and tax status Non-profit Not-for-profit Type 501C-3 Services Provided Eye care, mental health, general surgery, oral health, maxillofacial surgery, orthopedic surgery, palliative care, women's health, plastic reconstruction , medical training - mentoring, courses, and infrastructure renovations Need I Financial Assistance Need II Volunteers Mission We follow the 2,000-year-old model of Jesus, bringing hope and healing to the world’s forgotten poor. State/Province Texas Postal Code 75771 Facebook Page https://www.facebook.com/MercyShips 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 Mercy Ships Description An account of the resource In regions where resources are scarce, our state-of-the-art hospital ships are the most efficient way to deliver medical care to those in need. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL https://mirehabassociation.org/ Countries Served USA Email info@mirehabassociation.org Services Provided The Michigan Rehabilitation Association (MRA) advocates for individuals with disabilities, rehabilitation services providers, and rehabilitation counseling practitioner causes and issues in Michigan. Mission Promote and support professional growth and leadership to empower rehabilitation professionals to passionately serve people with disabilities through innovation, education, and advocacy. Additional Info & Comments Vision: -Advocacy: To remove barriers that prevent people with disabilities from being fully included in all areas of society. -Education and Training: Provide excellent professional development activities within the field of rehabilitation. -Community: Function as a networking hub for the community of rehabilitation professionals. 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 Michigan Rehabilitation Association Description An account of the resource Michigan Rehabilitation Association is an interdisciplinary professional, consumer-oriented rehabilitation organization that functions in both the public and private sectors, and at the national, state, and local levels. https://staging.drfop.org/files/original/15815c49a6adce1760436c8f5ae00753.pdf ccf779f3680911a29673df7262a2d03a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_04_215.pdf Text Any textual data included in the document <h2>Mobility and Mobility Devices for the Spinal Cord Injured Person</h2> <h5>Samuel R. McFarland, MSME&nbsp;<a style="text-decoration: none;">*<br /><br /></a></h5> <h3>Introduction</h3> <p>In the dictionary, the preferred definition of mobility is "the quality of being movable."<a></a> A second definition, more sociological in scope, defines mobility as "the movement of people in a population, from place to place, or job to job, or social position to social position." The second concept captures the significance of mobility as it relates to the life of a spinal cord injured individual. Spinal cord injury is a condition that most commonly affects young, physically active adults who have already established a social pattern in their lives. Certainly, spinal cord injury (SCI) causes impairment of movement, but more importantly, it may constrain a person's capacity for self-di-rected, purposeful movements, which are important to almost all activities. Much of the medical rehabilitation of a SCI patient involves therapeutic interventions aimed at increasing the range, strength, and coordination of body movements that have been impaired by an insult to the central nervous system. To fully appreciate the scope of mobility impairments encountered by SCI patients, we must examine the entire spectrum of activities that can be affected by limitations of movements. Independence, social and personal interactions, career development, and access to public facilities are some of the freedoms that can be adversely affected by mobility impairment.<a></a></p> <p>A thorough discussion of the methodology for reestablishment of mobility for SCI patients must include topics such as therapeutic interventions, orthotic appliances for stabilizing and enhancing the performance of musculoskeletal components, devices for extending the range or speed of movements, and substitutions for lost or severely limited functions. This article will not dwell on therapy, which is more appropriate for other authors, nor on orthotic appliances, since that subject is covered well in the accompanying articles on spinal stabilization and upper limb orthotics. Rather, it will attempt to represent some of the mobility considerations that are common to SCI and to discuss the application of products and techniques associated with ameliorating movement limitations. For the sake of simplifying the myriad array of details that can be covered under the general heading of mobility, this article will survey a sequence of activities that start with static support of the body and proceed to increasingly more complex movements in terms of range, speed, and energy demand.</p> <p>The author admits to a bias toward devices and technologies, which will be reflected in the discussions that follow, but he wishes to emphasize his belief that the only successful technical solution to a mobility problem is the one that integrates well with other rehabilitation interventions and withstands the test of time and use by the patient. Simplicity, cosmetic design, and reliability are essential to the immediate and long-range acceptance of adaptive technology by the user.<a></a></p> <h3>Background</h3> <p>Spinal cord injury commonly results in permanent paralysis of some of the large and powerful skeletal muscles of the body. The location of the injury along the spine correlates roughly to the cumulative amount of paralysis that results. The closer the injury site is to the head, the greater the involvement. Trauma incurred at the spinal column can affect the transmission of the nerve signals to all parts of the body served by the injury site and beyond. However, functional deficits incurred by SCI are almost always incomplete, meaning seldom is there complete loss of function or bilateral symmetry of effects below the site of the injury (lesion). For the sake of this paper, however, it will suffice to consider only two general types of functional paralysis: paraplegia and quadriplegia.</p> <p>Impaired voluntary control of skeletal muscles is not the only significant impediment resulting from SCI. Other organ functions can be affected as well. Bowel elimination, bladder voiding, sexual function, sweating, bone strength, and peripheral vascular circulation can all be altered in response to spinal cord insult. A common and troublesome side-effect is involuntary contraction of a muscle, spasm. Not only is the motor function of a nerve network affected, but also the sensory aspect. The combination of loss of sensation and reduced tissue blood circulation resulting from everyday bumps and pressures incur a high risk of undetected soft tissue damage. In insensate tissues, such seemingly minor injuries can easily progress into massive tissue death in the form of a decubitus ulcur. "Decubiti" are immensely threatening to a spinal injured person, not only because of the irreversible tissue damage, but also due to the extensive time loss and expense incurred in the treatment. All of these conditions must be kept in the forefront of planning for mobility and will be mentioned from time to time in the text that follows.</p> <h3>Transfer</h3> <p>The initial and simplest tasks of SCI mobility begin with rising from a reclining position, from which seated tasks, ambulation, or wheeled mobility can proceed. If starting from a bed, the person must first be able to sit up. A paraplegic or quadriplegic with good shoulder strength, may be able to sit up without assistance. Some may prefer to use an overhead handle, often called a trapeze, or a looped strap, to pull up into a sitting position. Sometimes a hospital type bed, with a powered drive to the articulated back section, can raise the person to a sitting position from which he can turn and let his legs off the bed in preparation for standing. A standing transfer, even with an attendant assisting is desirable because the weight is borne on the legs, but not by the attendant or a transfer device. If the legs are capable of supporting body weight, with or without bracing, the person may develop greater independence.</p> <p>When the quadriplegic or high paraplegic is not able to stand without braces, the transfer from a sitting position to another seat is somewhat more complicated because of the physical strength required to lift the body, change levels between sitting surfaces, and traverse the distance. Transfer aids foster independence and supplement the work of an attendant. For wheelchair transfers, it may be helpful to use a sliding board (also called a "transfer board"), a short length of wood or rigid artificial material that bridges the gap between two sitting surfaces, such as the bed and wheelchair. A paraplegic, and some low level quadriplegics, can momentarily life his weight and move in short, sideways increments from one surface to another. A strong and active paraplegic will probably vault by pushing downward with his hands or swing from an overhead handle, in lieu of being burdened with a transfer board. Even a person who cannot transfer himself can be aided by sitting on a piece of sturdy fabric which may be pulled sideways across the sliding board by an attendant.</p> <p>If a sliding transfer is not possible, a person can be lifted while sitting in a fabric hammock by a mechanical patient lift that incorporates an electrical motor or hydraulic jack mechanism to provide the lifting force. The hammock is attached overhead to the lifting device which is usually operated by an attendant. Some can be self-operated if appropriate fail-safe or emergency mechanisms are built in to compensate for equipment failure. Elaborate custom installations of overhead tracks can allow a person to be transported from bedroom to bathroom and beyond. Overhead lifts are also available for transferring from a wheelchair into a car, but with the advent of van adaptations, they are losing acceptance among users.</p> <p>The lifting and sliding principles used in transfer aids are applied in many products used in home and institutional settings, especially in the bedroom and bathroom. A common application of the sliding-lifting principle is the bathtub transfer aid, a device used to help a person transfer safely into the bathtub and lower himself into the tub for bathing. Some products are completely passive, incorporating a sliding pathway for the user to traverse across the tub rim. Some are powered seats, often driven by faucet water pressure, that raise and lower the seated occupant relative to the tub bottom.</p> <p>A more expensive form of lifting aid for the home is the vertical shaft home elevator that is used to give mobility between vertically separated living areas. Installation usually requires alterations to the structure of the building. A somewhat less expensive approach, where applicable, is the stairway elevator, which can be added to an existing staircase. Available as a chair for ambulatory persons and a platform for wheelchair riders, it typically follows the path and incline of the stairs and usurps a portion of the walking path. The least expensive adaptation for moving between levels, especially from outside, is the ramp. Ramps have been well defined in standards produced by the American National Standards Institute.<a></a> Outdoor elevators that are added on, rather than built into a building, usually called porch lifts, are made primarily for wheelchair users where ramp construction is impractical and a landing platform can be placed next to an outer door. Home elevators of all forms are usually sold and custom-installed by specialty vendors that are associated with vendors of other mobility aids.</p> <h3>Standing Aids</h3> <p>Paraplegics and quadriplegics, although unable to stand unassisted, can derive both physiological and psychological benefits from standing.<a></a> Being able to stand allows a wheelchair user to reach work surfaces and interact with standing people at their level. There are static devices, called standing frames, that hold a person in a standing position by binding him to an upright, rigid structure. The user must pull himself up from a seated position into the device and secure the binding straps or close and latch a supporting gate. The manipulations involved may require the assistance of another person.</p> <p>A more complicated device that allows more independent operation by the user is the mobile Stander that uses a power source to raise the person to a standing position and support him there. This principle has been incorporated into two forms of wheeled mobility. In the one form, the person may move slowly around for short distances on smooth surfaces after he rises to the standing position by controlling an electrically powered drive mechanism. In the other form, the assistive force standup mechanism has been added to a wheelchair. When the occupant is standing, the device is immobile. When the occupant is seated, it functions as a regular wheelchair.</p> <p>Another standing device, but one that provides a modicum of mobility is the swivel walker, or "parapodium," that is used by a very few paraplegic adults.</p> <h3>Ambulation</h3> <p>Walking is the most common form of mobility for humans and the mode most desired by people who have limitations that diminish or eliminate their ambulation abilities. Where there is any possibility of a mechanism to regain the ability to walk or move about in a standing posture, even if it is slow and requires great expenditure of energy, a person often prefers to ambulate rather than use wheeled mobility. Even temporary standing, without walking, can be used to enable a person to get through narrow entry ways, such as toilet compartments, bathrooms, and closets. The desire to remain upright has sustained the development and application of torso and leg braces, standing aids, and even artificial stimulation of paralyzed muscles by externally supplied electrical signals. At a lesion level around high thoracic, the instability of the torso suggests that ambulation may be less secure and more demanding of energy than wheeled mobility.</p> <h3>Stability</h3> <p>One of the more important considerations in assuring the fullest functional mobility of the SCI patient is stabilizing the proximal parts of the body in order to facilitate the most controlled movements of the distal portions. The person fitted with the finest of upper limb orthoses or supplied with the most elaborate vehicle control system will be substantially incapable of adequate performance if the body is not appropriately stabilized. Securing the proximal portions of the body is a critical consideration and can easily be both underestimated and overdone. It is quite common that a patient will be trained to substitute certain spared muscle functions for those that have been impaired. If a substitute muscle is occupied with stabilizing the torso, it will be effectively unavailable for its substitute function. Similarly, if the proximal base of distal limb segments has been too severely confined, the distal functions will be limited. In general, the SCI patient will be concerned with use of the upper body for control and work tasks, so the primary concern should be focused on providing a secure base for the torso, while retaining a sufficient range of upper body motion to allow the arms and hands to perform functional tasks. These principles will be restated more specifically in the sections that follow.</p> <h3>Wheeled Mobility</h3> <p>When walking is not an option, or when the upper limits of speed and range of ambulation are too low for the mobility needs of the person or the occasion, the indicated mobility aid is the wheelchair or any one of a variety of wheeled devices. The basic, most familiar form of the wheelchair is a shiny, tubular metal, open-framed structure that has four wheels, two small casters in front and two large drive wheels in the rear. Details of implementation vary slightly, but the design remains essentially the same from brand to brand. They are intended to fit an average sized person, withstand heavy use with minimal maintenance, and be propelled primarily by an attendant. A wheelchair produced for these purposes is known in the industry as a commodity wheelchair and is intended for temporary use by any one person but repeated use by many people. This is the type of wheelchair that insurance companies and government-based reimbursement programs provide for nursing home and convalescent use.</p> <p>Chronic users of wheelchairs should not use a commodity chair, but should be guided toward the use of a prescription wheelchair, which looks similar to the commodity chair, but is available in a variety of dimensions that can be more carefully sized to the user and embodies some optional features that better suit the demands of everyday, independent usage. Prescription wheelchairs tend to be lighter in weight, more durable, and offer less resistance to rolling than the commodity type because of the use of more specifically suitable materials and components and more exacting tolerances in their manufacture. Available options include variations in wheel and tire size and type, variable seating dimensions and configurations, removeable armrests and footrests, and selection of frame and upholstery material and color.<a></a> The diameter of the wheel and type of tire affect the maneuverability, rolling resistance, and riding comfort. Hard rubber or polymeric tires offer less rolling resistance than pneumatic tires, but transmit more of the shock of pathway irregularities to the rider than the softer, pneumatic tires. Similarly, small diameter wheels offer less inertial resistance to rolling than larger diameters, but the greater curvature imparts higher impact forces to the rider and inhibits movement over rough surfaces.</p> <p>For a chronic user, a wheelchair should be very carefully sized and the components and accessories selected to assure efficiency of operation, postural support, and prevention of medical complications of disability. In general, a wheelchair should be as narrow as possible without pressing against the hips, thereby allowing the greatest freedom of access through narrow passageways and the maximum of mechanical advantage for propulsion and control. The back height should provide good postural support, but minimize interference with the arms during a propulsion stroke. Low level, active paraplegics may prefer a very low back to maximize freedom of arm and upper body movements. The height of the seat bottom is governed by three dependent variables; arm access to the pushrims, footplate clearance above the ground, and even distribution of the sitting load along the underside of the thighs and buttocks (taking the compressed thickness of any cushion into consideration).<a></a></p> <p>The wheelchair seat cushion is a crucially important accessory component for a person who does not have sensation in the lower body and legs.<a></a> A cushion is intended to help distribute the gravitational loading forces of the occupant over the broadest possible area of the sitting surface and minimize the point pressure that occurs near the bony prominences of the pelvis and hips. There are many types of cushions that utilize a broad variety of materials and configurations, such as polyethylene foam, air and fluid-filled pillows, and semirigid and custom contoured devices. Each design has proponents who claim it is the best universal solution to the problem of pressure sores (decubitus ulcers), a major health problem for paralyzed persons with diminished or absent sensation. Since the formation of de-cubiti is related to many factors, such as pressure distribution and duration, temperature, moisture, diet, activity level and seating geometry,<a></a> it follows that no cushion can serve as a universal preventative measure. However, it is generally accepted by clinicians and users that there is a type of cushion best suited to each individual and careful selection for each person is important.</p> <p>It has also become increasingly more common for wheelchair seating experts to recommend that the hammock-style seat be replaced with a rigid member to provide a solid support structure for the type of cushioning material that is chosen. Hammock seats tend to wrap around the buttocks, creating a squeezing and shearing force pattern that tends to restrict tissue circulation. Also, the hammock is inherently unstable as a support for a high center of mass.</p> <p>The prescription wheelchair has recently undergone a rapid evolution in materials and design, resulting in lighter weight, smoother operation, greater durability and a change of image for the user. Wheelchairs are now offered in a mosaic of materials, colors, frame styles, and applications.<a></a> Largely because of the demand and innovations arising from the wheelchair sports movement, a new breed of daily use wheelchair has been developed and the market has accepted it with enthusiasm and buyer support. The new breed of wheelchair, now being labelled the "ultralight," embodies higher performance materials and design innovations including radial, rather than crossed (bicycle style) spoke patterns, aluminum alloy rims and hubs, die cast metal or injection molded polymeric wheels, adjustable position (fore/aft and up/down) and angle of axles, rigid (non-folding) and take-apart frames, and designer colors in anodized and polymeric finishes. The new product is less medical in appearance, more energy efficient to use, and more reliable and durable to the user. Although most of these changes have been directed at the manually propelled wheelchair for active adult paraplegics, some of the same innovations are beginning to be applied to powered chairs as well.</p> <p>The addition of mechanisms that propel the vehicle using electric motor power has provided a means of independent mobility for previously dependent users with quadriplegia. The most commonly used powered wheelchairs are supplied from the manufacturer as an integrated product that combines conventional frame and seating design with motorized propulsion. The power drive wheelchair (also called "electric" and "battery powered") was originally the result of relatively minor design improvements to the basic tubular metal wheelchair.</p> <p>Beginning in the early 1970s, the concept of a wheeled device, especially for severely disabled users, was reexamined by designers in North America and Europe. The result of that scrutiny was a proliferation of design ideas and clinical studies, some of which have resulted in commercially viable products. Out of that innovation revolution, stimulated in part by government supported research programs and workshops,<a></a> have come significant changes in propulsion and control of the electrically powered vehicle, an understanding of the health and performance benefits of carefully seating and positioning the occupant, and two new distinctly different types of powered vehicles.</p> <p>The first thrust of innovation dealt with obtaining new control modes for the user who could not operate the conventional joystick controller. One of the most common modifications of the powered wheelchair, and most important to the independence of the user, is the relocation or other alteration of the operator control device (typically an electromechanical joystick). It is now possible, with the purchase of options from the wheelchair manufacturer, or modifications developed by separate suppliers, for a severely impaired person to drive a powered wheelchair using any available physical movement on the body, including the head, chin, eyes and feet. It is also possible now to control a powered wheelchair with oral modulation of the breath and pneumatically powered electronic switching (the "sip and puff" control).</p> <p>The second most noteworthy trend in the redesign of the basic vehicle has been the separation of the seating function from the vehicular function. Conventional wheelchairs had been designed so that the chassis of the vehicle and the frame supporting the seat were the same. Therefore, changing the seat meant changing the total unit. The current focus on separating the functions has freed the vehicle designers and body positioning designers to pursue independent courses of study, resulting in both improved vehicle performance and enhanced comfort and health for the user. Scientific knowledge of the biomechanics and physiology of the wheelchair occupant is now being more appropriately applied to the development of specialized seating systems that position the body statically, and periodically reposition it, to promote improved vascular circulation and breathing, pressure relief and posture, leading to greater comfort, health, and prolonged periods of functional independence for the user.<a></a></p> <p>An entirely different form of vehicle, the powered cart, has also been developed during the past decade, primarily for people who are ambulatory, but limited in speed and range of ambulation. The cart does not look like the basic wheelchair, rather a scaled-down, one person version of the familiar golf cart. Intended primarily for public use by less severely disabled people, the cart is available in a variety of three and four-wheel versions with either tiller or joystick control. People who might otherwise use ambulatory aids or manually-propelled wheelchairs may choose a cart to gain greater speed, range, and (in some models) rough terrain travelling capabilities. Use of the cart should be confined, however, to areas where motor vehicles are not likely to travel. On the road travel for wheelchair users should be limited to persons riding in specially adapted automobiles, trucks, and buses.</p> <h3>Adapted Motor Vehicles</h3> <p>As a passenger or as an operator, a spinal cord injured person can greatly extend his range of travel by using a motor vehicle. The motor vehicle, whether a passenger car, a truck, or a mass transit vehicle, presents some significant impediments to use by an SCI person and typically must be modified to accommodate him. The impediments can be roughly grouped into three categories: access, securement, and control. In order to safely and comfortably use a motor vehicle, a person must be able to get into (and out of) the vehicle, be seated comfortably and secured against any hazards that are presented by vehicle motion, and, if feasible, he must be able to exercise guidance or accessory control over the vehicle.</p> <p>Access to the vehicle is the pivotal concern, for if the individual cannot enter the vehicle, securement and control functions are moot. Entry into a vehicle is affected by the size and shape of the doorway, the height and slope of the ground just outside the vehicle, and the amount of time consumed in the boarding process; these parameters can be effectively controlled with an adapted personal vehicle.</p> <p>Mass transit vehicles, which are designed to quickly transport large numbers of people, present a great challenge to people who use ambulation aids and wheelchairs because transit systems typically operate on hurried schedules and boarding occurs in tight spaces. Access to busses, trains, and airplanes is a problem if the person cannot enter the vehicle where it is normally available for boarding without displacing other passengers or delaying the route schedule. Despite these conflicts, many of the modern mass transportation systems have incorporated accommodations for mobility limited people and their mobility devices.<a></a> Older systems are typically not accessible and not feasible for retrofit. Personal vehicles and small busses for groups of mobility impaired people, however, can be selected and effectively adapted with structural modifications and add-on products.</p> <p>Personal vehicles are more adaptable. Many people prefer to use a passenger sedan, rather than a van or bus, simply because it is smaller and less costly to own and operate. Paralyzed people, except for those who ride power drive wheelchairs, can get into a sedan without using special access equipment, but may need a little more time than able-bodied people. They must learn to be selective about the place on the sidewalk, at the curb, or in the garage where they board, because the height and slope of the ground often affect the ease of boarding. Generally desirable features in a car include a tall, wide door opening, a door that swings open to a large angle, and a seat at chair height with firm padding and low friction upholstery. A broad driprail or handle located overhead near the door opening can give a person something to hold or pull against during the transfer process. Large interior leg space is important, especially to someone who wears a long leg brace.</p> <p>Seating is only part of the access problem, since once the person is seated, the mobility aid must be stowed. A crutch or cane can be stowed inside the car, but a walker may be too bulky unless it is the type that folds up for storage. A wheelchair creates a special problem which will be discussed later.</p> <p>The person who can enter a passenger car, even with difficulty, may find entry to a van or bus to be impossible because the height of the seat from the ground is typically too great to enable direct sitting from outside the van. The person must enter the van before sitting. Van seats more nearly resemble a chair in height and attitude, so they are more accommodating to a mobility impaired person than the seats of a passenger car, but the height of the entry step on a van is as much an impediment to an ambulatory SCI person as stairsteps in a building. Even if he can surmount the stepwell and get inside, he cannot stand upright either for sitting or moving about, unless the roof has been extended. On vans that have been modified for a raised roof, the side or rear cargo doorway is also modified to give more head clearance to people entering and leaving the passenger area.</p> <p>To accomplish the transition from ground level to the level of the van floor, both ambulatory people and wheelchair users can be aided by a ramp or a platform lift. The ramp is the least expensive access device and offers the most trouble free service, but another person is needed both to deploy it into operating position and to assist the user while he is traversing the bridge. The lift, though more expensive, is frequently preferred over the ramp. For attendant operation, a lift carries the load, thereby reducing the labor and risk of injury. Unlike a ramp, certain types of lifts can be self-operated by a passenger in a wheelchair. There are two general designs of platform lifts: the folding lift (also called flop-out) and the swinging lift (also called rotary). A lift of the folding type consists of a platform for supporting and carrying the passenger and an electromechanical or electrohydraulic power mechanism that provides the lifting force. Deployed for operation, it unfolds outward to a horizontal attitude ready for moving the passenger between the floor and ground levels. The folding lift is usually offered in semi or fully automatic operating modes. The semi-automatic version raises and lowers under power while an attendant provides the controlling function as well as the stowage operation (opening/closing doors and folding/ unfolding the platform). The more complicated, and more costly, fully automatic version is further equipped with switches and drive mechanisms that allow the user to control the entire process independently. Typically, the installation of a fully-automatic lift is accompanied by the installation of a powered door opener and an external lift access control panel to complete the total system of components that provide the user with a capability for independent access to the vehicle.</p> <p>The swinging lift is almost always provided in a fully-automatic configuration. The platform travels vertically outside the opened cargo door between ground and vehicle floor levels. At the floor level, the platform swings (rotates) about a vertical axis into the vehicle and remains there for its stowed position, thereby limiting the available floor space inside the vehicle. This type of lift is somewhat less expensive to purchase and is lighter in weight than the folding type, but typically will not accommodate a full-sized powered wheelchair or cart.</p> <p>Many users of wheelchairs can transfer to the automobile or van seat without assistance. Often the transfer is aided by the sliding across a transfer board and sometimes by pulling up on an overhead handle or wriststrap. Each person must develop his own transfer technique based on the spatial geometry of the opened doorway, the location of the seat and vehicle interior appointments, and the nature of his physical ability. The transfer process will also vary with the vehicle being used and nature of the trip. Use of a taxicab, rental car, or a friend's car presents a greater challenge because of the variability of vehicle type, many of which are not suitable to the individual wheelchair user. After transferring themselves into the car, passengers (or drivers) of sedan-type vehicles must load the wheelchair into the car or park it at the debarkation point before they can close the door. If an attendant (or cab driver) is present, the chair can be placed in the trunk, in the back seat, or on a special rack attached to the back bumper. The independent wheelchair user must either stow the wheelchair (folded or dismantled) inside the car behind the front seat or on the roof outside. Strong and agile paraplegics can usually fold the chair and pull it inside. Those who are less able sometimes use a rooftop carrier to stow the chair. A passenger who transfers to a seat inside a van (a desirable practice from the standpoint of safety) can usually tether the empty wheelchair next to him inside the van, making it readily accessible for re-transfer and exiting the vehicle.</p> <p>Access to the vehicle seat does not complete the process of safely preparing for travel. The passenger should be secured. With many SCI people, safety securement is more than a crash protection mechanism, because they may have insufficient upper body strength to withstand common vehicle accelerations. A seatbelt or over-the-shoulder harness can be very important for both purposes. When an ambulatory person is seated in a vehicle, he can almost always use the conventional safety restraint belt for passenger security. So can a wheelchair user who is able to transfer from the wheelchair to the vehicle seat. When a wheelchair user cannot transfer, he should use some form of restraining device. As a general rule, both the wheelchair and its occupant should be restrained (separately) by a vehicle structural member. Many designs of restraining devices have been tried and tested by researchers and manufacturers. To date, only two relatively satisfactory approaches have been produced. In one, the wheelchair is permanently fitted with an additional structural subassembly which serves to reinforce the structural integrity of the wheelchair and engage a mating assembly that is securely anchored to the frame of the van. Though demonstrated to be an impact resistant combination,<a></a> this approach has the disadvantage of restricting a passenger to the use of a van that carries the mating structure and of imposing additional weight on the routine mobility of the wheelchair, demanding additional propulsive energy from either the arms of the occupant or the batteries of the power system. A second approach separately tethers the wheelchair and the wheelchair occupant to the vehicle structure, using belts. The tethering operation is virtually impossible for a wheelchair user to perform independently and is time-consuming even for an attendant. Some of the restraint devices that are provided for wheelchairs, however adequate to the task for wheelchairs of the basic design, will not engage certain forms of wheeled mobility aids at all. Passengers using such non-standard aids must often travel unrestrained.</p> <p>Many SCI people can be adapted to driving.<a></a> Although they may lack the leg and arm function required to operate the pedals and steering wheel, they may employ specialized products called automotive adaptive controls (also called hand controls and foot controls). Such devices transfer the locus of driving control from its conventional position in the vehicle to a location and configuration that can be operated effectively by parts of the body that are functionally able to handle the task. If the feet are not able to operate the throttle or brake pedals, a mechanical linkage can be added to transfer the input to a hand-operated lever. For most products, the throttle and brake are combined into a single lever.</p> <p>Since the hand-control completely occupies one hand with starting and stopping, the other hand must do all the steering. If that hand is limited in strength, common to quadriplegics, a steering wheel spinner may be needed to assure constant hand contact with the wheel throughout its rotational circuit. Spinners are available in a variety of configurations, depending on the nature of the hand disability. Other adaptive devices take the form of extensions of vehicle control levers, shafts, and pedals (such as turn signal, gear selector, steering column, throttle, brake, and emergency brake) that improve the mechanical advantage, extend the locus of activation, or transfer the operation to the opposite side. Hand controls typically do not prevent another person, who is not disabled in driving function, to drive the car since the conventional controls remain intact, having been added-to rather than replaced.</p> <p>Just extending and relocating the application of forces is sometimes inadequate to enable a quadriplegic to drive. Where conventional power assisted steering and braking requires more force than the driver can exert, it is possible to further reduce the force or range of movement required to operate the controls by performing a more extensive modification of the vehicle control components. Reduced effort steering, throttle, and brake conversions diminish the force the driver must supply. Since the driver who needs force amplification is unable to operate the vehicle without the modification, the complete reduced-effort system should be supplied with backup power that will sustain hydraulic and vacuum reserves, even if the engine (the primary source) fails. With the use of a reduced-effort system, the mechanical advantage of a large diameter steering wheel and extended lever arms is no longer needed, so the range of movement of the input controls can be reduced to accommodate limitations in upper extremity movement. A small diameter steering wheel, even one that is repositioned through universal joints and angular drives (so-called "horizontal steering"), extends the possibility of driving to people with even greater limitations of limb movement.</p> <p>As with all mobility aids, professional help with selection and training is very important to the ultimate successful application of automotive adaptive aids. Specialized assessment and training facilities have been established in conjunction with major rehabilitation centers worldwide. The staff of these centers typically includes a therapist, a driver trainer, and an equipment specialist who combine their expertise to provide the disabled driver candidate with comprehensive assessment, equipment selection, vehicle modification, and driver training.<a></a> In some areas, the vendor of vehicle adaptive equipment and modifications is responsible for the recommendation of products and services, but the more comprehensive clinical team approach seems to be more objective.</p> <h3>Conclusion</h3> <p>Helping to attain mobility for the spinal cord injured individual is a multiparameter equation. Mobility is key and essential to almost all aspects of the process of rehabilitation and return to active life postinjury. Many products and technologies are available to help extend the residual capabilities of the patient. A team approach to mobility assessment, prescription, and training will greatly encourage the development of a system approach that can lead to a well integrated plan for the user.</p> <p><b>References:</b></p> <ol> <li>Axelson, Peter W., Dennis Gurski, and Ann Lasko-Harvill, "Standing and Its Importance in Spinal Cord Injury Management," <i>Proceedings of the Tenth Annual Conference on Rehabilitation Technology</i>, San Jose, California, June, 1987, pp. 477-479.</li> <li>Bolton, Michael, "The Ann Arbor Transportation Authority's Experience," Proceedings of the National Workshop on Bus-Wheelchair Accessibility, Seattle, Washington, May 7-9, 1986, U.S. Urban Mass Transportation Administration, DOT-1-87-11, pp. 2-16-2-21.</li> <li>Brubaker, Clifford, Ph.D., "Fitting a Person with a Chair," Clinical Supplement No. 2, "Choosing a Wheelchair System," <i>Journal of Rehabilitation Research and Development</i>, Veterans Administration Rehabilitation Research and Development Service, Baltimore, Maryland (in press).</li> <li>Crase, Nancy (editor), "Fourth Annual Survey of the Lightweights," <i>Sports 'N Spokes</i>, 11:6, March/April, 1986, pp. 19-30.</li> <li>Hobson, Douglas A. and Elaine B. Treffler, "Towards Matching Needs with Technical Approaches in Specialized Seating," Proceedings of the Seventh Annual Conference of the Rehabilitation Engineering Society of North America, June, 1984, Ottawa, Canada, pp. 486-488.</li> <li>Luce, Thomas P., <i>The Handicapped Driver's Mobility Guide</i>, American Automobile Association, Traffic Safety Department, Falls Church, Virginia, 1984.</li> <li>McFarland, Samuel R., "Personal Licensed Vehicles for Disabled Persons," <i>Paraplegia News</i>, 36(6), June, 1982, pp. 33-38.</li> <li>McFarland, Samuel R. and Lawrence A. Scadden, "Marketing Rehabilitation Engineering," <i>SOMA, Engineering for the Human Body</i>, 1:2, American Society of Mechanical Engineers, New York, July, 1986, pp. 19-23.</li> <li>Phillips, Lynn, Peter Axelson, Mark Ozer, M.D., and Howard Chizeck, <i>Spinal Cord Injury, A Guide for the Patient and Family,</i> Raven Press, New York, New York, 1987.</li> <li>Proceedings of the National Symposium on "Care, Treatment and Prevention of Decubitis Ulcers," Sponsored by the Paralyzed Veterans of America, Washington, D.C, November, 1984.</li> <li>Schneider, Lawrence W., Ph.D., "Sled Impact Tests of Wheelchair Tie-Down Systems for Handicapped Drivers," Project Report, University of Michigan Transportation Research Institute, Ann Arbor, 1985.</li> <li>"Specifications for Making Buildings and Facilities Accessible to and Usable by Handicapped People," ANSI Standard No. A117.1-1980, American National Standards Institute, New York, New York.</li> <li><i>The American College Dictionary</i>, Random House, New York, New York, 1967, p. 780.</li> <li>Wheelchair III, Report of a Workshop on "Specially Adapted Wheelchairs and Sports Wheelchairs," Sponsored by the Veterans Administration Rehabilitation Research and Development Service and the Rehabilitation Engineering Society of North America, LaJolla, California, September, 1982.</li> <li>Wilson, A. Bennett, Jr., <i>Wheelchairs, A Prescription Guide</i>, Rehabilitation Press, Charlottesville, Virginia, 1986.</li> <li>Zacharkov, Dennis, <i>Wheelchair Posture and Pressure Sores</i>, Charles C. Thomas, 1984.</li> </ol> <em><b>*Samuel R. McFarland, MSME </b> Samuel R. McFarland, MSME, is Director of Rehabilitation Engineering at the National Rehabilitation Hospital, 102 Irving Street, N.W., Washington, D.C. 20010.<br /><br /><br /></em> Page Number(s) 215 - 224 Year 1987 Volume 11 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 Mobility and Mobility Devices for the Spinal Cord Injured Person Creator An entity primarily responsible for making the resource Samuel R. McFarland, MSME * https://staging.drfop.org/files/original/07dce99db5c9faeb43792e40432d571f.png 3e46a0bb9e70e471c6c49bfe6bece8b0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.mobilityoi.org Address 192 Nickerson St. Suite 201 City Seattle State/Province Washinton Countries Served Vietnam, Haïti, Sierra Leone, and Bangladesh Postal Code 98109 Phone 206-726-1636 Email info@mobilityoi.org Organization Type Including ID and tax status Non-profit Not-for-profit Type 501C-3 Services Provided Clubfoot Treatment, Orthopedic Surgery Outreach, Prosthetics and Orthotics, Prosthetics and Orthotics Repair Stations, Mobile Health Program Need I Financial Assistance Need II Volunteers Need III Materials, Components, and Equipment Mission Mobility Outreach International (MOi) is a Seattle-based nonprofit that enables physically disabled individuals in under-resourced areas of the world to improve their lives. MOi provides treatment to children with clubfoot, and prosthetic and orthotic services, physical rehabilitation, advocacy, and orthopedic surgical outreach to adults and children, through MOi-assisted programs in Vietnam, Haïti, Sierra Leone, and Bangladesh. LinkedIN Page/Profile https://www.linkedin.com/company/mobility-outreach-international/about/ 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 Mobility Outreach International Description An account of the resource Mobility Outreach International (MOi) is a Seattle-based nonprofit that enables physically disabled individuals in under-resourced areas of the world to improve their lives. https://staging.drfop.org/files/original/3ffbae347395bd6358c27cde8e640cb0.pdf 3c1e43504bc5fe368e6d0b52b9ee3f23 https://staging.drfop.org/files/original/9ac99d90904964fbf707150717e8a50d.jpg e8ed5e738c54bbb55d742a611ae695ee https://staging.drfop.org/files/original/ae0d69cc03a931e61faf1371e769a573.jpg d2fbffa8ce932cf04e3bbdd2c30ac089 https://staging.drfop.org/files/original/d14a435b32caa77db0a8b81558fc2602.jpg 7ce6b179856dd2279ee95f246865d131 https://staging.drfop.org/files/original/ae0b927d201ab181204f175621d042cd.jpg 83325cd779700fe7327eb2b2a9fe16c2 https://staging.drfop.org/files/original/579595b2c3c9b825d4166f0f46b2ddcb.jpg b4f9c82d3f4974e187d4f4d785cde9cb https://staging.drfop.org/files/original/5ec23f79cd46fa212e8306f193030545.jpg e405e2a5b3e94e3baf1ae65b44e6f8c6 https://staging.drfop.org/files/original/b0762e6b36e5df9b2a7e8c7426c8d107.jpg 2c44ad68219084068c067bd70e3bf532 https://staging.drfop.org/files/original/9cfc6bce48e4a77f4899bd6853abaaca.jpg 7559251e1534b6a37a9dafafac9208f5 https://staging.drfop.org/files/original/f0f4b6501a67d0595fce6cd598f39cdb.jpg b7c470836998260c1b30dccb65f3d5e6 https://staging.drfop.org/files/original/b5efb724727d5b4455261299add09b51.jpg 7cbd41bff0429cfb9b1ca402ec264ca7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_01_049.pdf Text Any textual data included in the document <h2>Modular Seat-Shells and Standardized Manufacture of Individually Shaped Seats for the Severely Disabled: The Tubingen Experience</h2> <h5>George Neff&nbsp;<a style="text-decoration: none;">*</a><br />Klaus Fischer&nbsp;<a style="text-decoration: none;">*</a></h5> <p><i>From the Editor: This article was received too late for inclusion in the Fall, 1986 issue devoted to seating and thus is presented in this issue. The authors' effort in submitting it is greatly appreciated.</i></p> <p>Over the years, proper seating for the severely disabled has been neglected. Often, an approximate position of the patient in commercially available "grandfather-chair" seats, upholstered with cushions, seemed to be sufficient for the needs of these individuals. Custom shaped seats manufactured in the usual manner to taking a plaster cast, and molding the seat-shell of plastic material on this plaster model, after rectification, have proven to be helpful at least for limited periods, especially for growing children. However, often, during the time of plaster taking, an unfavorable position of a child, especially in cerebral palsy children, could be achieved, causing a permanently defective position for the child in such a seat. Moreover the entire process was time consuming, requiring the presence and active participation of an experienced and, therefore, expensive orthotic specialist. Also, the presence of the patient for a long period was necessary in comparison to our present procedure.</p> <p>In 1978, we started a program for the improved manufacture of seats, using prefabricated seat shells and standardized patterns for the manufacture of individually shaped and adjusted seats for patients with seating problems, due mainly to neuromuscular diseases like cerebral palsy, muscle dystrophy, multiple sclerosis, and so on.</p> <p>The idea was to improve the seating comfort of our patients and to increase the adjustability for growth and clothing. At the same time we wanted to reduce the amount of work necessary, especially for the orthotist.</p> <p>Presently, there are six different sizes of prefabricated seat shells made from glassfiber-reinforced polyester resin. These are divided in the seat and the back section and are connected with strong hinges integrated into the laminated resin (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-01.jpg"><b>Fig. 1</b></a>). For each size of these seat shells, standardized inserts of polyethylene are necessary to form a second, innershell. The inner shells consist of one seat, one back, two upper and lower lateral parts (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-02.jpg"><b>Fig. 2</b></a>). The parts of the innershell are fixed to the outer seat-shell with screws. The holes are drilled with the use of a permanent pattern or die (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-03.jpg"><b>Fig. 3</b></a>). This allows for the quick exchange of one or the other part of the seat. They can also be removed for easy cleaning, reshaping, or for the addition of spacers between the inner and outer wall for proper fit with respect to clothing and climate (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-04.jpg"><b>Fig. 4</b></a>). Foot-rests, headsupports, handles, quick-exchange boards are also prefabricated in standardized sizes and on stock in the workshop. By this means, the orthotist gains more time to devote attention to the needs of the patient and to optimize his position, because he does not need to devote time to the production of these items.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-01.jpg"><strong>Figure 1. Four of six sizes of the modular seatshell. Two hinges connect the back and seat sections.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-02.jpg"><strong>Figure 2. Seat, back, two upper side, and two lower side inner sections to be mounted in the seatshell.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-03.jpg"><strong>Figure 3. Use of the permanent pattern, or die, for drilling of screw holes, in a standardized array, in the seatshell for mounting of the inner sections.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-04.jpg"><strong>Figure 4. In the foreground, spacers for insertion between seatshell and inner shell to allow for seasonal variation in clothing. In the background can be seen foam rubber pieces to be glued to the inner shell.</strong></a><br /> <p>Prior to the initiation of this fitting procedure, the responsible physician, physiotherapist, occupational therapist, and the orthotist have to decide what they want and how the patient is to be best positioned with respect to his daily living and physical abilities.</p> <p>The individual fitting of the module is achieved by optimal positioning of the patient in a seat shell of appropriate size and by positioning roughly cut foam rubber pieces between the patient's body and the sidewalls, seat, and back of the seat shell.</p> <p>After having made a rough alignment of the foam rubber pieces, they are glued to the inner parts of the seat. Then they are removed entirely and ground down to the proper shape until each of the six pieces fit properly (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-05.jpg"><b>Fig. 5</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-05.jpg"><strong>Figure 5. Foam rubber pieces have been glued in place and ground to proper contour and fit.</strong></a><br /> <p>Another solution is used for children with extensive spasticity. After selection of the proper size seat shell and inner-liner, the child is covered completely, including legs, arms and head, with layer of foam rubber and isolated by a piece of plastic foil or film. This is to prevent polyurethane foam from coming into direct contact with the patient's clothing or skin and to prevent burns. The patient is then positioned as well as possible in the modular seat shell. This is preferably done by the therapist or the mother of the child so as to prevent spasticity as much as possible and to optimize the posture of the child.</p> <p>If necessary, a foam rubber wedge is placed between the knees to create slight abduction of the legs. Then, the free space between the body and the seatshell module is filled with polyurethane foam (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-06.jpg"><b>Fig. 6</b></a>). After the foam hardens, the child is removed from the seat and the foam is cut along the borderlines of the six parts of the insert, including the lengthened backpart for a headsupport if its use is necessary (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-07.jpg"><b>Fig. 7</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-06.jpg"><strong>Figure 6. The child is held in place while the void between him and the seat is filled with polyurethane foam. Child is protected against exposure to foam with a layer of plastic film and against thermal burns with a layer of foam rubber. This also allows for the layer of foam rubber to be subsequently added for comfort.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-07.jpg"><strong>Figure 7. Seat following completion of the foaming procedure.</strong></a><br /> <p>Each piece of foam is then ground to the proper fit and covered with a layer of foam rubber to prevent pressure sores and for sitting comfort.</p> <p>The same procedure is carried out for those seats for which polyurethane foam was not used. By adding more foam rubber and grinding the six different parts to proper fit, an individually optimized shape of the interior of the modular seat shell is achieved.</p> <p>A headrest may be made from a separate piece of polyethylene padded with foam rubber and shaped to properly fit the individual patient. It is fixed with adjustable metal bars on the backside of the seatshell. Another solution is the so-called integrated headsupport which is not removable, in contrast to the above-mentioned type. It is made from a sheet of polyethylene as an elongation of the polyester inner-layer of the back (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-08.jpg"><b>Fig. 8</b></a>) on which foam rubber is glued and shaped to size. An additional pillow for the neck and head is easily removed and attached to the headrest by means of Velcro® fasteners.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-08.jpg"><strong>Figure 8. Section of polyethylene added to the top of the innershell to serve as the foundation upon which an integrated headrest will be built.</strong></a><br /> <p>In most cases, additional fixation of the patient is necessary to prevent him from falling out of the seat, e.g. during a sudden spastic convulsion. In moderate cases, safety belts adapted to the seat may be sufficient. If a more secure purchase is necessary, the lateral parts of the backrest are elongated at the level of the sternum and closed in around the front of the chest by an additional belt (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-09.jpg"><b>Fig. 9</b></a>); or, an entire thoracic pad, made of a sheet of polyethylene, covered with foam rubber and ground to a snug fit, is fixed firmly to the seat by a hinge on one side and a clasp on the other to provide proper hold of the body. In severe cases, for example in athetoid spasticity, we use a kind of apron with a belt-system (<a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-10.jpg"><b>Fig. 10</b></a>) to keep the pelvis and the trunk in proper position within the seat.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-09.jpg"><strong>Figure 9. Completed seat showing restraint system and anterior thoracic extension.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-10.jpg"><strong>Figure 10. Completed seat showing apron and belt arrangement for restraint.</strong></a><br /> <p>It is essential to provide enough free space for the bent knee joints. If necessary, the module and the seat part have to be cut out to allow for comfortable sitting. The abduction wedge must fit correctly too; otherwise it may increase spastic adduction patterns.</p> <p>Due to the hinges between the seat and the backpart, and a stop on either side of the seat module, the patient can be leaned back in his seat, if desired.</p> <p>In patients with limited movement in the hip joints, the seat part may be divided longitudinally. Then, each half can be adjusted independently to the individual position of either leg.</p> <p>Additional armrests are used to prevent injuries to hands and arms if they are uncontrollable. For children and wheel-chair-bound adults a removable table may be added to the seat within the range of motion of both arms and the body, providing enough space for playing with toys, eating, paper work, and so on.</p> <p>Finally, prefabricated footrests make sure that the entire body is in a proper and comfortable position. Our footrest is adjustable to height and inclination as dictated by the patients' needs.</p> <p>The quick-exchange board system allows for easy removal of the entire seat from the wheel chair, normal chair, or the regular seat of a car. The wooden board of the seat is fixed with one or two special clasps and a "U" shaped metal stop to a second board which is screwed to the wheel chair or another chassis. This disconnecting device provides stable and safe fixation of the seat and the patient to the respective underlying surface.</p> <p>If it seems preferable to first try the unfinished seat before finishing, the patient uses the seat at home for one or two weeks. After a final check and correction, the different parts of the insert are removed once more and covered with a strong and long lasting colored nylon-velour. This gives the entire assembly a lively appearance, quite different from the ordinary "medical" wheelchair design.</p> <p>Since we started this seating program, approximately 500 patients have been fit with this device. Each was provided with an individually shaped seat by using modular seat shells and pre-fabricated componentry to the largest extent possible. Only a few severely handicapped individuals had to be fit in the conventional manner by taking an individual plaster of Paris cast to create a mold for a seat. Thus, we recommend the use of prefabricated modular seat shells and componentry for satisfying the seating needs of the physically disabled.</p> <p><em><b>*Klaus Fischer </b> Klaus Fischer, Orthopadie-Mechanikermeister, can be contacted c/o Fa. Brillinger at Orthopadie-Technik, Rhein-landstraBe 18, D-7400 Tubingen, Federal Republic of Germany.</em></p> <p><em><b>*George Neff </b> Priv. Doz. Dr. Med. Georg Neff is with the Department Technical Orthopaedics at the Orthopaedic University Hospital, Calwer Straße 7, D-7400 Tubingen, Federal Republic of Germany.<br /><br /><br /></em></p> Page Number(s) 49 - 54 Year 1987 Volume 11 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1987_01_049/1987_01_049-10.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Modular Seat-Shells and Standardized Manufacture of Individually Shaped Seats for the Severely Disabled: The Tubingen Experience Creator An entity primarily responsible for making the resource George Neff * Klaus Fischer * Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. Contact Name/Title Ministry of Welfare and Social Security City Khartoum Countries Served Sudan Organization Type Including ID and tax status For Profit Government Services Provided Prosthetic Fitting, Orthotic Fitting, Education, Prosthetic Fabrication, Orthotic Fabrication, Rehabilitation Need I Financial Assistance Need II Materials, Components, and Equipment Additional Info & Comments This organization does not have an active webpage. However, many members have NAPO listed on their LinkedIn and can be contacted/found that way. LinkedIN Page/Profile https://www.linkedin.com/in/mahmoud-hagar-37a1a3134/ https://www.linkedin.com/in/awwab-mohammed-a90034a0/ 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 National Authority for Prosthetics and Orthotics (Sudan) https://staging.drfop.org/files/original/bc9523cd81a3db7e15e5978454317e7d.pdf 57089e6c60b72cafca746442fcb5429d DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1967_02_024.pdf Year 1967 Volume 11 Issue 2 Page Number(s) 24 - 27 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1967_02_024.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1967_02_024.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Need for Research in Fundamental Biomechanical Studies</h2> <h5>J. Raymond Pearson, M.S.M.E. <a style="text-decoration:none;">*</a><br /></h5> <p>The Subcommittee on Fundamental Studies of the Committee on Prosthetics Research and Development is interested in the promotion of scientific and technological investigations that are fundamental to applied research studies of prosthetic and orthotic devices. Hopefully, the results of the subcommittee's efforts will lead to the establishment and dissemination of knowledge that is of common interest to researchers and clinicians concerned with the design and development of assistive devices.</p> <p>Past experience with such research and its current state of development suggest that future studies should be made in the areas outlined in this article.</p> <h3>Concepts of Methodology</h3> <h4>Systems Analysis</h4> <p>It is believed that the application of modern techniques of systems analysis to discern and clearly define the needs of the disabled could lead to the establishment of appropriate specifications for use in the design of devices.</p> <h4>The Disabled Condition as it Affects Experimentation and Evaluation</h4> <p>Studies of the disabled condition should include investigation of psychological reactions to the use of prosthetic and orthotic devices. Thought should be given to the interplay of psychological and physiological reactions to the application of constraints and restraints. A study of the interactions of physiological systems might prove to be beneficial since it is apparent that there is an interplay of effects from one anatomical system to another.</p> <h4>Disability Evaluations</h4> <p>Corrective assistive devices alter the joint of the musculoskeletal system. Since positions, forces, kinematics, or stresses of the original condition may be changed by the therapeutic device, it is essential that the biomechanics of the normal, abnormal, and treated condition be well understood. This information is necessary for the proper use of such devices and the design of improved devices.</p> <p>The biomechanical analysis of any system must necessarily be preceded by an adequate, accurate description of the system. If forces are involved, it is essential to know the points of application of the forces and the direction of forces applied either by muscles or by constraining passive tissues such as ligaments.</p> <p>The addition of an assistive device to any part of the anatomy results in a hybrid mechanical-anatomical system. Complete understanding of the effect of such assistive devices rests upon the proper analysis of the hybrid system as a whole.</p> <p>Analysis rests upon quantitative data which can be secured only by measurement. Taking</p> <p>such measurements often involves the design and development of the experiment and instruments. This subject in itself is a worthwhile area of investigation.</p> <h3>Specific Research Areas</h3> <h4>Fundamental Physiology Of Muscle</h4> <p>Inconvenience, negative psychological reactions, and the complexity of design of exo-skeletal devices all lead to the hope that one day it may be possible in appropriate cases to stimulate muscles which have been denervated by trauma or disease. Some research in this area has been conducted, but very little is known about the optimum type of stimulation, the response characteristic of stimulated muscle in the disabled condition, and the ultimate possibility of using electromyographic signals of one muscle to control stimulation of another.</p> <p>Since muscles represent the actuators of the musculoskeletal system, it would be helpful to know more about the mechanical characteristics of muscle in terms of its strength, endurance, and efficiency. Hopefully, modern methods of measurements would permit the accumulation of quantitative data <i>in vivo </i>if research were pursued in this direction.</p> <p>While upper and lower motor neuron lesions usually lead to atrophy of associated muscles, it has been shown that exogenous stimulation of muscle counteracts atrophy to some degree. If research should lead to solutions of this type, it will be necessary to know more about stimulative hypertrophy of muscle.</p> <h4>Body and Device Mechanics</h4> <p>Data for proper design of orthotic and prosthetic devices require a knowledge of existing force capacity and range of motion for both normal and various selected abnormal conditions of frequent occurrence. It would be of much benefit to the designers to have such data assembled in a convenient reference volume.</p> <p>More knowledge of the kinematics and kinetics of the upper extremity, comparable to that of the ambulation cycle in the lower extremity, would also represent essential and valuable data for the design of devices. The existence of accelerometers and potentiometers for measurement of inertia forces and position facilitates the gathering of such information by experimental means.</p> <p>Recent advances in the art of simulation of linkages in engineering suggest that the musculoskeletal system of the upper extremity can be treated in a manner that will permit study of the effects of constraints or supplemental power to upper-extremity orthoses. It may prove to be possible to optimize designs with regard to various possible constraints to meet the needs of common motion patterns.</p> <h4>Comparison Of Mechanical Work and Physiological Energy Consumption of Natural As Well As Pathological Movements</h4> <p>Since one of the important criteria of evaluation of assistive and prosthetic devices is the conservation of the energy of the patient, it would be most helpful to devise ways and means of measurement of physiological energy consumption of discrete muscles or muscle systems for a determinable quantity of mechanical work output in the performance of needed tasks. While total oxygen-consumption measurements have been made for subjects with and without assistive devices in ambulation, very little has been done with regard to the upper extremity, particularly for discrete activities.</p> <h4>Control Modes and Locations on Patients</h4> <p>Underlying the problem of control of external power by electromyographic signals is the problem of proper association of biological signal and motion to be executed. In the case of amputation, the existence of the electromyographic signal of a remote muscle might be used as a control signal. However, this involves a retraining procedure for the subject. The improper or irrational selection of a control site may lead to an excessively complex learning procedure that would defeat the purpose of the design. The effects of paralysis may bring about a similar situation where the cause is a pathologic condition other than amputation. In any event, the success of any external power system controlled by electromyographic signals is highly dependent upon the rational selection of the site from which the biological signal is taken. The pursuit of such knowledge is highly important to the success of electromyographic control.</p> <p>Recent investigations of the feasibility of single motor units of muscles as a source of biological signal for controlled purposes indicate the value of pursuing this idea as an eventual method of associating thought processes with limb action. Such solutions should lead to utilizing a portion of the muscle signal without impairing the usefulness of the muscle for its original intended purpose. As this study is in its infancy, considerably more information is needed in order to evaluate its potential.</p> <h4>Rheology of Human Tissue</h4> <p>In the study of the biomechanics of joints, it becomes evident that the forces applied through bones find their reactions in the soft, passive tissues of constraint. Relative displacements of the bones of the joint are then a function of the mechanical characteristics of these tissues. The stress-strain ratio of the collagen tissue of tendon has been shown to be rate dependent for low and moderate rates of loading. Also, strain is a function of time; the tissue shows a recovery capacity when unloaded, demonstrating that viscosity plays a role in the mechanism of response. Investigations of some of the factors of some discrete tissues are examples of what can and should be done in the future by way of establishing factual knowledge of the response of component tissues and joints as a whole to the types of loading brought to bear by corrective devices.</p> <p>Past achievements have demonstrated that this kind of information is also useful in detecting the reasons for certain types of deformities. Such understanding leads to better therapy and to devices designed to counteract the system of forces causing the deformity.</p> <p>It is hoped that future research in this area will bring more knowledge of the factors involved. Investigation of more of the tissues involved is also essential.</p> <p>Further studies of the mechanical characteristics of bone, especially under loadings of the type encountered in orthoses and prostheses, are, of course, part of this picture.</p> <h4>Phyiological and Rheological Characteristics of the Stump</h4> <p>In addition to knowledge of the rheological characteristics of the tissues of the stump, which is needed for the determination of pressure and tension on skin and subcutaneous tissue, knowledge of tissue compartitions and the interplay of effects of forces thereon is also necessary. Interference with the flow of blood brings deleterious effects to the health of the tissue, and faulty distribution of pressure or skin tension can affect nerves and bring pain, Knowledge of the type proposed here would assist in avoiding these dangers.</p> <p>One of the problems encountered in the fitting of prostheses is that of edema. Measurement of the pressure encountered and the deformations involved should permit compensatory procedures providing better design.</p> <p>Since rheological experimentation has shown that the stress-strain ratios are rate dependent and load dependent, it seems that special studies of the properties of compressed and deformed tissues should prove to be beneficial.</p> <h4>Response of Bone and Connective Tissue to External Loads</h4> <p>Knowledge of the nature of the distribution of stress and strain in bone as a response to the implantation of pins in the marrow, such as those encountered in endoprosthetic joints and transcutaneous pylons, will be essential if these experimental methods are to develop into practical, clinical therapies.</p> <p>The tolerance of the tissues to implantation and to the magnitudes and types of loading will also be an important factor in this research.</p> <h4>Implantation of Artificial Organs of the Musculoskeletal System</h4> <p>Another aspect of the possibility of utilizing as much as possible of the natural anatomical system instead of exoskeletal devices is the use of implanted artificial muscles. It is envisioned that plastics capable of contraction excited by external signal will become available. Study of the materials and the tolerance of biological tissues for them will be required to realize this possibility.</p> <p>The effects of implantation on endoprostheses and endoorthoses need more comprehension if materials are to be developed to make approaches practicable. This will include the chemical and physiological reactions as well as the biomechanics of the arrangements.</p> <p>Of vital importance is knowledge of the tissue reactions to implants if methods of this type are to succeed.</p> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>J. Raymond Pearson, M.S.M.E. </b></td></tr><tr><td class="clsTextSmall">Professor of Mechanical Engineering, University of Michigan, Ann Arbor, Mich. 48104; Chairman, Subcommittee on Fundamental Studies, Committee on Prosthetics Research and Development. Professor Pearson served as Chairman of the Panel on Fundamental Studies of the Conference on Prosthetics and Orthotics.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Need for Research in Fundamental Biomechanical Studies Creator An entity primarily responsible for making the resource J. Raymond Pearson, M.S.M.E. * https://staging.drfop.org/files/original/7b8252c8f883f24af6692bb69c37688d.pdf 295a867a36ca94a6cf7d56daa6aa3e46 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1967_02_022.pdf Year 1967 Volume 11 Issue 2 Page Number(s) 22 - 23 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1967_02_022.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1967_02_022.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Need for Research in Surgical and Medical Considerations Dealing with Prosthetics and Orthotics</h2> <h5>George T. Aitken, M.D. <a style="text-decoration:none;">*</a><br /></h5> <p>The discussion of the Panel on Surgical and Medical Considerations at a Conference on Prosthetics and Orthotics sponsored by the Committee on Prosthetics Research and Development was divided into two parts-those considerations dealing with prosthetics and those dealing with orthotics.</p> <h3>Prosthetics</h3> <p>Much fundamental work in the area of amputation surgery remains to be done, as briefly outlined in this article.</p> <h4>Indicators For Amputation</h4> <p>It is believed that the modern methods of amputee management may have made amputation a more desirable procedure now than some reconstructive procedures currently in use, and the entire field needs a comprehensive review.</p> <h4>Selection Of Level Of Amputation, Especially In Cases With Vascular Insufficiency</h4> <p>No reliable test for measurement of circulation in the extremities exists. As a result, it is the practice in many centers to amputate above the knee in virtually all cases with peripheral vascular disease. However, it has been shown that many times the knee joint can be saved even when standard tests indicate that the blood supply is apt to be insufficient. Objective tests of circulation coupled with surgical studies should result in more below-knee amputations and fewer above-knee amputations.</p> <h4>Sites Of Election Of Amputation</h4> <p>Although it is generally agreed that all length possible should be saved, a study should be made in which length of stump is correlated with function and comfort when current fitting practices are used.</p> <h4>Surgical Techniques</h4> <p>A comprehensive review of surgical techniques should be made. This should include special attention to the care of transected muscles.</p> <p>The advantages of end-bearing and how much should be carefully reviewed in order to determine whether different techniques, such as myoplasty, osteoplasty and nonviable implants, should be vigorously tested in order to obtain varying degrees of end-bearing. Muscles that must be transected may eventually be control points for externally powered devices and careful attention must be focused on the preservation of their optimal ability to provide control sources such as myoelectric signals or pure biomechanical motion.</p> <h4>Postsurgical Procedures</h4> <p><i>Rigid Postsurgical Dressing</i></p> <p>There was agreement that the application of a rigid dressing postsurgically is desirable. To achieve the best results consistently it is necessary to determine the range and distribution of pressures that bring about the best results. Techniques for achieving and maintaining proper pressure will then need to be developed. Included in this study, of course, will be the problems of suspension of the cast.</p> <p><i>Ambulation</i></p> <p>Studies of the effect of ambulation should be made. Included in such studies would be such factors as time to begin ambulation, the amount of weight-bearing that should be taken, and alignment.</p> <p><i>Effect of Immediate Postsurgical Fitting on Cases with Vascular Problems</i></p> <p>In the opinion of some, immediate postsurgical fitting permits amputation at a lower level than is the case with conventional procedures, but no data have been accumulated to substantiate this opinion. This should be investigated, because the presence of the "normal" knee joint permits meaningful function that cannot be approached with an artificial limb and provides a much better chance for rehabilitation measures to succeed.</p> <p><i>Immobilization of the Next Proximal Joint</i></p> <p>Although it is recognized that a study of the effect of immobilization of the next joint in the early stage of immediate postsurgical fitting is a part of the overall suspension problem, it was recommended that attention be given this matter.</p> <h4>The Phantom Sensation</h4> <p>Although a good deal of work has been carried out in the study of the phantom sensation, especially in reference to phantom pain, very little is understood about these phenomena. It is felt that attention should be continued in this area.</p> <h3>Orthotics</h3> <p>Out of a general discussion of the surgical and medical considerations in orthotics, three broad recommendations developed.</p> <ol> <li>There is an urgent need for the development of criteria for the design of bracing based on the biomechanical needs of patients. Perhaps a system of classification of disability based on biomechanics is not only the proper approach to criteria development but, when brace components are related to it, a sounder basis for prescription can be developed.</li><li>Little is known about the response of human tissues to the application of pressure, yet every function of an orthopaedic brace involves the application of pressure. Studies on the effect of pressure are needed before it is possible to determine the efficacy of certain treatment procedures, especially some of those for children.</li><li>Studies involving buried and partially buried implants for facilitating control of externally powered devices should be continued.</li></ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>George T. Aitken, M.D. </b></td></tr><tr><td class="clsTextSmall">Orthopaedic surgeon, College Avenue Medical Building, 50 College Ave., S.E., Grand Rapids, Mich. 49503; Chairman, Subcommittee on Child Prosthetics Problems, Committee on Prosthetics Research and Development. Dr. Aitken served as Chairman of the Panel on Surgical and Medical Considerations of the Conference on Prosthetics and Orthotics.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Need for Research in Surgical and Medical Considerations Dealing with Prosthetics and Orthotics Creator An entity primarily responsible for making the resource George T. Aitken, M.D. * https://staging.drfop.org/files/original/34801932f31180cf39fb42463e18ca64.pdf b4ff1b0359d2a02dba24114047c1044d https://staging.drfop.org/files/original/6809b2f2afa3773a2820029b18b49a0b.jpg b8e4c1286250c652a53ec2b688db1acb https://staging.drfop.org/files/original/57e50e2a54f0ed529988256cbb6dd943.jpg aaac9f8f9b8b2b5bf8bab18389269d28 https://staging.drfop.org/files/original/69330701385993f53424c16d9fd378d8.jpg 53eb4adca9de07365f0faacc7c1b2bfa https://staging.drfop.org/files/original/f4181d44fd6538734307d9ea8b28ee4d.jpg e62d56cac139627fc1c316f26e860671 https://staging.drfop.org/files/original/d486cbde489421e053211e9332e2c877.jpg 79345ea5bfda40249c1da95de22377db https://staging.drfop.org/files/original/e6f7827c015798b9284c3ad7bce99e38.jpg ff99b290faf944d9eebd1823beba3dee https://staging.drfop.org/files/original/5155ade9bfc40b5ca7f8f0ffd21b75b7.jpg 63ded18f1ee6bf58ba96d15ebbbd68a0 https://staging.drfop.org/files/original/c14fa38126fa67950a300f4f17a45399.jpg 03b0ad5b1d067e9071f0fa40d0d0fd4c https://staging.drfop.org/files/original/23b23cf47b748b0346de8afd3db7a6c1.jpg 50ec8dabc7e88784dc0fc29ba58bfb93 https://staging.drfop.org/files/original/5d0a16bddb915f4ed3e31d89b05da45e.jpg abb09ce6db620b6606f9e0aac650b94e https://staging.drfop.org/files/original/5ac7ebb70decd31ce91601a4ac4da9a3.jpg 04eb1f4faa9d34d5281ad3d69e9e9810 https://staging.drfop.org/files/original/3677c02db76680b30ae38c40228c41b5.jpg 75c09a73c1870f3807933653b49680d3 https://staging.drfop.org/files/original/07dd115ef89f6e6ef005fb07d990dd9a.jpg 7a6534119ecd4981b5a7fb1b7cf37739 https://staging.drfop.org/files/original/0a4c66d644160de8fd4f209c4af5be31.jpg c243901ecf8305a715c919c7ee9e9ca8 https://staging.drfop.org/files/original/284b966aa49d3e57ea60dffeb209a3f4.jpg 34a52cafac6420239a7e937c337dda16 https://staging.drfop.org/files/original/7a18444d44b13d13f4e58b5f7788a592.jpg 7a7490de4b0d6b9ce087c838b433bea6 https://staging.drfop.org/files/original/535a6901340cdd81ec7457c80224e031.jpg c5033dc23af49069a08349ed2d3ef192 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/1985_04_035.pdf Text Any textual data included in the document <h2>New Concepts in Post-Operative Scoliosis Management</h2> <h5>Robert D. Fitch, M.D.&nbsp;<a style="text-decoration: none;">*</a><br />Carrie Louise Beets, CO.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>As improved surgical techniques and stronger spinal instrumentation are developed, the need for external stabilization post-operatively and the design of post-operative orthotics have also evolved. The purpose of this article is to review the many recent advances in the surgical technique and spinal instrumentation, and the early results of a new management protocol (both surgical and orthotic) in the treatment of selected spinal deformities.</p> <h3>Evolution Of Spinal Stabilization</h3> <p>The goal in the surgical treatment of scoliosis is to correct the deformity and maintain correction until fusion of the spine occurs. It is the surgical technique of fusion that provides long term spinal stability. Until the fusion mass matures, we must rely on stability provided through surgical instrumentation (internal support) and casts or orthoses (external support). If the spine is not stabilized sufficiently internally and externally, then a non-union of the spine will occur similar to that which occurs with inadequate immobilization of long bone fractures. Once a non-union develops, the deformity may gradually recur.</p> <p>Prior to the advent of the Harrington rod, correction of the spinal deformity was obtained through complicated casting techniques. Risser described the turnbuckle in 1927<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-01.jpg"><b>Fig. 1</b></a>). Later he developed the localizer cast.<a></a> A cast technique similar to this was perfected by Dr. Cotrel of France<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-02.jpg"><b>Fig. 2</b></a> and <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-03.jpg"><b>Fig. 3</b></a>). These casting techniques allowed correction of the deformity in the cast. The spine was then operated upon in the corrected position through the cast and the patient was maintained in a cast postoperatively for a period of nine to 12 months. With this form of treatment, there was a high incidence of failure, primarily due to the development of cast complications, or pseudoarthroses.<a></a> Many surgeons advocated routine exploration of the fusion mass six months postoperatively to identify any areas of non-union.</p> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-01.jpg"><strong>Figure 1. Turnbuckle cast as devised by Risser. Patient had to remain in bed for six months. (Photo reproduced with permission from Scoliosis by J.I.P. James, Williams &amp; Wilkins Publishers, 1967.)</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-02.jpg"><strong>Figure 2. Localizer cast which extends up over the occiput and mandible. (Photo reproduced with permission from Scoliosis, ibid.)</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-03.jpg"><strong>Figure 3. Posterior view of localizer cast showing window through which surgery was performed. (Photo reproduced with permission from Scoliosis, ibid.)</strong></a><br /> <p>In 1960, Paul Harrington reported on the use of a stainless steel distraction rod for the correction and stabilization of spinal deformities.<a></a> The Harrington device has since become the mainstay of surgical treatment for scoliosis. It has shown to be of great benefit in experienced hands and has shortened hospitalization time, avoided the need for preoperative correction with casting, permitted early mobilization of the patient in a well-fitted cast or orthosis, and has markedly decreased the pseudoarthrosis rate following fusion. What it has not accomplished, however, is the ability to provide sufficient internal stabilization to allow the abandonment of external support either by cast or orthosis.</p> <p>There are many instances in which external immobilization is undesirable. These include patients with insensitive skin, spasticity, or respiratory compromise. During the early 1970's, Edwardo Luque, M.D. from Mexico City was faced with many complex spinal deformities similar to those just mentioned. This led him to develop a new form of spinal instrumentation called segmental spinal instrumentation.<a></a> Unlike the Harrington rod, which uses distraction forces and is fixed to the spine at the top and bottom so that all the forces are concentrated at the bone-hook interface superiorly and inferiorly, segmental instrumentation provides corrective forces in a transverse manner at each spinal segment and, therefore, the distribution of forces is spread out over the whole length of the instrumentation. This has been shown to be much stronger biomechanically than the Harrington system and is extremely stable<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-04.jpg"><b>Fig. 4</b> </a>and <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-05.jpg"><b>Fig. 5</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-04.jpg"><strong>Figure 4. X-ray showing Harrington rod system.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-05.jpg"><strong>Figure 5. X-ray showing Luque rod instrumentation.</strong></a><br /> <p>Segmental spinal instrumentation has become the preferred method of treatment of complex spinal deformities, especially those associated with neuromuscular conditions such as muscular dystrophy, myelodysplasia and cerebral palsy. However, it has not replaced the Harrington rod for the management of idiopathic scoliosis. This is primarily because of the added neurologic risk that is involved when performing segmental spinal instrumentation. Wires must be passed sublaminarly within the spinal canal at every level to perform this technique. The potential for neurologic complications is related to invasion of the spinal canal with these wires and the potential for vascular compromise to the cord by correction of the deformity, which leads to elongation of the spinal canal and vascular stretch.</p> <p>It must be kept in mind that segmental spinal instrumentation does not take the place of a meticulous fusion, and if fusion does not occur, then instrumentation failure in inevitable. In general, patients who have been treated with segmental spinal instrumentation are not placed in any cast or orthosis post-operatively. This is based on the assumption that the Luque instrumentation is so strong that no external support is needed. However, recently some surgeons have questioned the requirement for external support even with Luque instrumentation. Although the early instrumentation failures have been solved with segmental spine instrumentation, some surgeons have found increased loss of correction over the first few months in patients not treated with orthoses, compared to those who have been treated with orthoses postoperatively. Also, the question of late pseudoarthroses must yet be resolved; and if there is a significant incidence of pseudoarthroses with Luque instrumentation, would post-operative orthotic support decrease this incidence?</p> <p>Because of the added neurologic risk, we have opted not to use segmental instrumentation in dealing with most idiopathic spinal deformities. Rather, we continue to use the Harrington rod with some recent modifications. The modified Harrington rod provides enough internal stability to allow us to use a post-operative orthosis that is comfortable, convenient, and cosmetic. Added stability to the Harrington system has been achieved by a simple modification of the Harrington hooks. This was devised by Dr. Bobechko of Toronto. The new hook has a cam placed inside a slot which allows two hooks, rather than one hook, to be utilized at the upper level. Since most of the early instrumentation failures with Harrington rods have been with the cut-out of the upper hook, two hooks allow the forces to be distributed over a larger surface area, and when the technique is properly performed, corrects that problem. At the bottom end, a specially designed hook with a longer shoe is used to prevent dislodgement of the hook in this area, which can occur when the patient flexes forward.</p> <p>With the degree of stability provided by this method, post-operative cast immobilization is unnecessary. In addition, currently available orthoses such as the Greenville spinal orthosis, the SOS modular orthosis, or the Milwaukee brace also provide more external support than we feel is necessary. This has led us to adopt the use of a posterior plastic shell with corset front and shoulder straps.</p> <h3>Current Management Protocol</h3> <p>This post-operative orthosis is used in two situations: (1) in the patient with idiopathic scoliosis who has undergone Harrington rod instrumentation with modified hooks as described above, and (2) in patients with more complex spinal deformities who have had segmental instrumentation and are at risk for loss of correction or late pseudoarthrosis.</p> <p>Our post-operative regimen consists of taking a mold at the time of surgery. The patient is then mobilized quickly beginning on the first post-operative day. The patient is allowed to stand at the bedside twice a day until the orthosis is ready and applied, usually on the third post-operative day. At that point, the patient is allowed to begin ambulation and sit with the orthosis on. Following discharge, the patient is allowed to doff the orthosis at night and once a day for showering. The orthosis is worn for four months post-operatively.</p> <h3>Orthosis Design</h3> <p>The posterior shell orthosis used at Duke University Medical Center is based on an orthosis design that was originally used at the Texas Scottish Rite Hospital for Crippled Children in Dallas, Texas. At the Scottish Rite Hospital a Surlyn® posterior shell, with a special order Camp corset front riveted to the shell, is used. It is cast and delivered post-operatively, or sometimes on an outpatient basis.</p> <p>At Duke, the design was modified by the addition of shoulder straps for provision of an anti-rotatory movement reminder. The shoulder straps and the corset front are removable for easy laundering. The Duke protocol is for its use as an immediate post-operative orthotic device.</p> <h3>Casting</h3> <p>The Department of Prosthetics and Orthotics at Duke University Medical Center has the advantage of being located on site. This permits close coordination with the physician and his operating room schedule. The dates for which an orthotist is needed in the operating room are known in advance, as well as the time and estimated length of surgery. The surgeon notifies the orthotist as the surgical team prepares to close the case. The orthotist arrives in the operating room while the case is being closed. Adequate time is available to set up splints and water, inspect operative x-rays, and confirm the length of the instrumentation (helpful in determining proximal trimline of orthosis).</p> <p>Following closure of the surgical site, a small temporary sterile dressing is placed over the suture line for protection. The orthotist places a split piece of cotton stockingette over the patient's back and buttocks. Using an indelible pencil, the axillary and proximal trimlines are marked, C-7 is marked for reference, the waist and the gluteal fold and a horizontal line across the top of the gluteal fold are also marked (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-06.jpg"><b>Fig. 6</b></a>). Six inch wide plaster splints, three layers thick, are applied lengthwise starting with the center back and overlapping towards both sides. Attention is paid to apply the plaster splints as far anteriorly on the patient as possible to make sure the cast impression has been taken to midline or just beyond. If a patient appears large busted or overweight, the sides of the impression can be compressed while the plaster is setting up (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-07.jpg"><b>Fig. 7</b></a>). This will afford a truer M-L measurement for the patient when standing and sitting. The cast impression is removed (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-08.jpg"><b>Fig. 8</b></a>) and the post-operative bandages are applied.</p> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-06.jpg"><strong>Figure 6. With the patient still on the operating room table, a split piece of stockinette is placed over the patient's back and landmarks and trimlines are marked.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-07.jpg"><strong>Figure 7. If a patient is large busted, the sides of the cast impression can be compressed while the plaster is setting, allowing a truer M-L dimension for when the patient will be sitting and standing.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-08.jpg"><strong>Figure 8. Cast impression simply lifts off. Operating room nurses replace temporary bandage, protecting the suture site with a regular post-op dressing.</strong></a><br /> <h3>Fabrication</h3> <p>Any number of thermoplastics can be used to fabricate this orthosis, however, we have found Surlyn® to be sufficiently rigid and cosmetic. The advantage of fabricating with Surlyn® is that the standard practice of pouring, stripping, and modifying a positive model can be completely eliminated.</p> <p>In the fabrication lab, the cast impression is allowed to dry 30 minutes to an hour. The stockinette is then powdered. The impression is placed into an adjustable support to prevent any M-L spreading during the plastic molding. A piece of 3/16" thick Suryln®, large enough to cover the inside of the impression, is placed in the oven and allowed to heat just until it is pliable (about five minutes). The heated plastic is placed in the impression and pressed into the contours of the cast impression (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-09.jpg"><b>Fig. 9</b></a>). The plastic is then rapidly cooled by a wet towel or air (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-10.jpg"><b>Fig. 10</b></a>). When completely cooled, the plastic shell is lifted off the cast impression and the stockinette is stripped, exposing trimlines and reference marks made at the time of casting. The plastic shell is set back on top of the cast impression and the trimlines are transferred to the shell (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-11.jpg"><b>Fig. 11</b></a>). The shell is trimmed and the edges finished (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-12.jpg"><strong>Fig. 12</strong></a><b> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-13.jpg">and 13</a></b>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-09.jpg"><strong>Figure 9. Surlyn®, heated just until pliable, is pressed into the contours of the cast impression.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-10.jpg"><strong>Figure 10. Surlyn® is rapidly cooled with a wet towel.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-11.jpg"><strong>Figure 11. Trimlines are transferred from the cast impression to the Surlyn® shell.</strong></a><br /><br /><strong>Figures 12 and 13. Drape forming the Surlyn® to the cast impression without pouring a positive mold gives excellent contour detail to the resulting posterior shell.</strong><br /> <p>The posterior shell is ready for the attachment of the corset front and shoulder straps. We use a standard corset front available from Truform in either a 9", 10", or 12" abdominal length, depending on the patient's stature. Holes corresponding to the corset eyelets are drilled in the lateral edges of the posterior shell and the corset front is laced onto the posterior shell (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-14.jpg"><b>Fig. 14</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-14.jpg"><strong>Figure 14. Finished posterior shell with corset front laced in place and shoulder straps also removable for laundering.</strong></a><br /> <p>The shoulder straps, which are also removable for laundering, are attached to the posterior shell via Velcro® on the ends which double back on themselves after slipping through loops permanently riveted to the posterior shell. The shoulder straps are attached to the shell just proximal to the interscapular level. They cross the shoulders and attach laterally several inches distal to the axillae via a standard corset style hook. Placement of the lateral hooks midway between the axillae and the waistline prevents binding in the axillae when the straps are tightened. Total fabrication time from casting to initial fit is approximately four hours.</p> <h3>Fitting</h3> <p>Though the fabrication of the posterior shell orthosis is fast enough to permit fitting the same day as the cast impression is taken, the orthosis is usually delivered on the third post-operative day. This is done to allow post-operative illeus with accompanying abdominal distention to resolve. If the orthosis is fit too soon, the corset front invariably needs to be altered or the size of the front changed altogether. By the third day, the patient is alert and tolerant of being log-rolled, and the majority of abdominal distention has subsided. The posterior shell is tried for initial fit in bed and the patient is measured for the corset front with the shell in place. The accuracy of the trimlines is noted and the shell is marked if any adjustments are needed.</p> <p>After the corset front is attached, the orthosis is delivered to the patient, along with two pieces of stockinette to serve as in-hospital t-shirts and a written information/instruction sheet which covers care of the orthosis and basic "do's and don'ts."</p> <p>When providing this orthosis for community physicians at nearby hospitals, rather than trying to coordinate with their operating room schedule since travel time is involved, we cast the patient several days post-operatively. The patient is log-rolled in bed to a prone position and the plaster impression is taken the same way as in the operating room. If thick bandages are still over the patient's surgical area, the impression will be slightly deeper than the final product. Trimlines must be adjusted accordingly. The community hospital patient is measured for the corset front at the same time as casting since he can be log-rolled back to a supine position for measuring. The M-L measurement for the corset front is taken midline to midline. The shell is then delivered in 24-48 hours. By either method, the patient is up and walking in the orthosis at four days postoperative and is usually discharged at 6-7 days post-operative.</p> <h3>Summary</h3> <p>As of this writing, the protocol described above had been utilized in 44 patients over a period of 18 months. Diagnoses include adolescent idiopathic scoliosis, myelodysplasia, adult scoliosis, and adult spinal tumor. There has been one occurrence of instrumentation failure in a patient with adolescent scoliosis who had dislodgement of the upper hooks as a result of improper hook placement at the time of surgery.</p> <p>We feel that with the increased internal support provided by the Bobechko hooks in the Harrington rod instrumentation that the modified bracing provided by the posterior shell (versus Milwaukee or Greenville orthosis) has provided satisfactory restriction of gross motions which might endanger the success of surgery. Forward bending and twisting are restricted and the shoulder straps add an upper torso anti-rotatory reminder for the patient. We have had no problems with lack of compliance in brace wearing, even though both the shoulder straps and the corset front are removable.</p> <p>The orthosis has been well received by the patients. It is cooler and more comfortable than many of its counterparts. It is also cosmetically acceptable and is easily donned and doffed. Hygienic maintenance requires minimal time and effort. Finally, it has been well received by both adolescent and adult patients (<a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-15.jpg"><b>Fig. 15</b></a>, <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-16.jpg"><b>Fig. 16</b></a>, <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-17.jpg"><b>Fig. 17</b></a>, and <a href="http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-18.jpg"><b>Fig. 18</b></a>).</p> <strong>Figures 15(above) and 16(below). The orthosis is easily donned by the patient.</strong><br /><br /><strong>Figures 17(above) and 18(below). Posterior shell orthosis is very cosmetic.</strong><br /><br /><em><b>*Carrie Louise Beets, CO. </b> Carrie L. Beets, CO., is formerly of the Department of Prosthetics &amp;Orthotics, Duke University Medical Center. She is presently with the University of Virginia, Department of Prosthetics and Orthotics, 1224 W. Main Street, Charlottesville, Virginia 22908.</em><br /><br /><em><b>*Robert D. Fitch, M.D. </b> Robert D. Fitch, M.D., is Assistant Professor at the Division of Orthopaedic Surgery, Duke University Medical Center.</em><br /><br /><br /> <p><b>References:</b></p> <ol> <li>Cotrel, Y., "Le corset de platic E.D.F. dass le treatment de la scoliose idiopathegirel," <i>Med. Hyg.</i>, 28:1032, 1970.</li> <li>Harrington, P.R., "Correction and internai fixation by spine instrumentation," <i>J. Bone Joint Surg.</i>, 42A:1448, 1960.</li> <li>Luque, E.R., "The anatomic basis and development of segmental spinal instrumentation," <i>Spine</i>, 7:256-259, 1982.</li> <li>Ponseti, E.V. and Friedman, B., "Changes in the scoliotic spine after fusion," <i>J. Bone Joint Surg.</i>, 32A:751-766, 1950.</li> <li>Risser, J.C., "The application of body casts for the correction scoliosis," Am. Acad. Orthop. Surg., Instructional Course Lect., 12:255-259, 1955.</li> <li>Risser, J.C.; Lauder, CH.; Norquist, D.M.; and Craig, W.A., "Three types of body casts," Am. Acad. Orthop. Surg., Instructional Course Lect., 10:131-142, 1953.</li> <li>Wenger, D.R.; Eurollo, J.J.; Wilkerson, J.A.; Wau-ters, K.; and Herring, J.A., "Laboratory testing of segmental spine instrumentation versus traditional Harrington instrumentation for scoliosis treatment," <i>Spine</i>, 7:265-269, 1982.</li> </ol> Page Number(s) 35 - 42 Year 1985 Volume 9 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-10.jpg Figure 11 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-11.jpg Figure 12 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-12.jpg Figure 13 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-13.jpg Figure 14 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-14.jpg Figure 15 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-15.jpg Figure 16 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-16.jpg Figure 17 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-17.jpg Figure 18 http://www.oandplibrary.org/cpo/images/1985_04_035/1985_04_035-18.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 New Concepts in Post-Operative Scoliosis Management Creator An entity primarily responsible for making the resource Robert D. Fitch, M.D. * Carrie Louise Beets, CO. * https://staging.drfop.org/files/original/43d2e80bb7287060417ad2e656a4a222.pdf 1e835407f00822f0f13ceb8823bc60bb https://staging.drfop.org/files/original/4883a90da6034c4c1b32440d97b3755d.jpg 6be8ba96a52feee7928cfa58d70a9cb1 https://staging.drfop.org/files/original/30087b0ad704d400a5301996e194aa1b.jpg 03b421194ff589844bf70b4d3b6137c3 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1967_01_047.pdf Year 1967 Volume 11 Issue 1 Page Number(s) 47 - 50 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1967_01_047.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1967_01_047.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>New Concepts in the Management of Lower-Extremity Amputees</h2> <h5>A. Bennett Wilson, Jr., B.S.M.E. <a style="text-decoration:none;">*</a><br /></h5> <p>For many years the acceptable practice in management of lower-extremity amputation after wound closure consisted of the application of a reinforced gauze dressing and the confinement of the patient to bed until the wound was healed. Fitting of a prosthesis was seldom attempted until edema was reduced to a more or less stable point by means of elastic bandages which had to be removed and reapplied at regular intervals during the day. Elaborate precautions had to be taken so that muscle contractures would not occur. With this method of treatment it was rare for a patient to be fitted less than six weeks after surgery, most patients requiring a much longer period.<a></a></p> <p>The reluctance to fit patients before the stump was "stabilized" was, in a large part, due to the need for one or more socket replacements shortly after the initial fitting. A number of physicians advocated the use of temporary prostheses usually consisting of a plaster-of-Paris socket and a peg leg to hasten stabilization of the stump, but this practice never became widespread, probably because no adequate documentation was made of the various series that were reported, and many physicians realized that it was extremely difficult to obtain adequate fit and alignment with the techniques existing then.</p> <p>The introduction of the patellar-tendon-bearing socket, total-contact sockets, new stump-casting techniques, adjustable legs, and plastic-laminate sockets led the Department of Orthopaedic Surgery, Duke University, to embark on a study to determine the earliest practical time for fitting. The project has demonstrated clearly that successful application of prostheses can be made as soon as it is safe to remove the sutures.</p> <p>In the late fifties Berlemont of France <a></a> began providing patients with leg prostheses immediately upon completion of surgery and initiating ambulation training the following day. Berlemont's technique was modified somewhat by Weiss of Poland <a></a>, who brought it to the attention of Americans in a lecture given at the Sixth International Prosthetics Course in Copenhagen in July 1963. A tour of the United States by Weiss later that year, sponsored by the Vocational Rehabilitation Administration and the Committee on Prosthetics Research and Development, stimulated sufficient interest at the University of California, San Francisco, and the U.S. Naval Hospital, Oakland, for these groups to experiment with the concepts reported by Weiss.</p> <p>Initial results led the Veterans Administration to support an experimental program proposed by the Prosthetics Research Study of Seattle, Washington. Other groups, notably Duke University, the University of Miami, Marquette University, and a group in New York City centered around the Hospital for Joint Diseases, became interested and embarked on modest experimental programs.</p> <p>Because there was not available any written or visual material covering European experience, each group approached the problem along somewhat different lines. From time to time through the efforts of the Committee on Prosthetics Research and Development and the University Council on Orthotic-Prosthetic Education, these groups were brought together for the purpose of exchanging ideas and coordinating the efforts of all involved. Meanwhile, the Vocational Rehabilitation Administration made it possible for a number of the research teams to visit Weiss. Experience with more than 400 cases has now been accumulated.</p> <p>At its meeting January 20, 1967, which was preceded by a conference of research teams involved in immediate postsurgical fitting, UCOPE decided to offer courses in the technique to qualified teams.</p> <p>The basic technique consists of the application of a nonadherent silk mesh dressing and fluffed gauze over the wound and a sterile stump sock and plaster-of-Paris cast (which is also the socket for the prosthesis) over the stump (<b>Fig. 1</b>). To the socket is attached an adjustable pylon-type prosthesis suitable for the level of amputation. Provisions are made for easy removal and reattachment of the prosthetic unit to prevent the prosthesis from being wrapped in the bedclothes and causing undue stresses on the stump. A drain is usually used.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. An example of immediate postsurgical fitting of prosthesis to a below-knee amputee. Note the waist-belt suspension, the cast-socket carried above the knee, the pylon, and the foot. See also Figure 18 in Limb Prosthetics-1967, the preceding article in this issue. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>The patient is encouraged to stand <i>between parallel bars or with the aid of a "walker" </i>about 24 hours after surgery if there are no physical or medical contraindications. The amount of weight-bearing and ambulation is increased daily and the patient is graduated to crutches, to canes, and to unaided walking as his physical condition permits. The drain is removed 48 hours after surgery, and the cast-socket is kept in place until time for removal of the stitches- some 10 to 14 days after surgery.</p> <p>A new cast-socket is applied immediately, and the pylon-type prosthesis is replaced. The second cast is removed 8 to 10 days later when it is generally possible to make a cast for fabrication of a plastic socket.</p> <p>The advantages of treating patients in this manner are a reduction in the formation of edema, a reduction in the incidence of pain, elimination of the formation of contraction, decreased hospitalization time, and less time lost from work. The technique appears to permit improved wound healing, and a number of investigators feel that in cases of amputations because of vascular disorders many more knee joints may be preserved than when conventional methods of treatment are used. In one series of a hundred cases, the average time between surgery and delivery of the "permanent" prosthesis was 28 days. The shortest time was 17 days <a></a>. <b>Fig. 2</b></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. Progress of 80-year-old patient whose leg was amputated because of vascular disease and diabetes. A, First day postoperative; B, seventh day postoperative; C, seventeenth day postoperative; D, twenty-sixth day postoperative. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Patients of all types and all ages have been treated successfully by fitting prostheses immediately after surgery. However, success depends upon many factors, and the technique should not be undertaken unless the team has a thorough understanding of proven methods. For this reason, courses are being offered at Northwestern University, the University of California, Los Angeles, and New York University.</p> <p>In spite of the success achieved by the research teams and others that have been trained by them, it is not clear why certain of the advantages accrue, and to what degree the various factors that enter into success are critical. Continued research is expected to answer these questions.</p> <p><b>References:</b></p> <ol> <li>Alldredge, Rufus H., The principles of amputation surgery, Chap. 10 in Orthopaedic Appliances Atlas, Vol. 2, J. W. Edwards, Ann Arbor, Mich., 1960.</li> <li>Berlemont, M., Notre experience de l'appareillage precoce des ampules des membres inferieurs aux Etablissements Helio-Marins de Berck, Annales de Medecine Physique, Tome IV, No. 4, Oct.-Nov.-Dec, 1961.</li> <li>Berlemont, M., L'appareillage des amputes des membres inferieurs sur le table d''operations, paper given at the International Congress of Physical Medicine, Paris, 1964.</li> <li>Burgess, Ernest M., Joseph E. Traub, and A. Bennett Wilson, Jr., Management of lower-extremity amputees using immediate postsurgical fitting techniques, Prosthetic and Sensory Aids Service, U.S. Veterans Administration, 1967.</li> <li>Weiss, Marian, The prosthesis on the operating table from the neurophysiologies point of view, Report of Workshop Panel on Lower-Extremity Prosthetics Fitting, Committee on Prosthetics Research and Development, National Academy of Sciences, February 1966.</li> </ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>4.</b> </td><td class="clsTextSmall">Burgess, Ernest M., Joseph E. Traub, and A. Bennett Wilson, Jr., Management of lower-extremity amputees using immediate postsurgical fitting techniques, Prosthetic and Sensory Aids Service, U.S. Veterans Administration, 1967.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Weiss, Marian, The prosthesis on the operating table from the neurophysiologies point of view, Report of Workshop Panel on Lower-Extremity Prosthetics Fitting, Committee on Prosthetics Research and Development, National Academy of Sciences, February 1966.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>References</b></td></tr><tr><td class="clsTextSmall"><b>2.</b> </td><td class="clsTextSmall">Berlemont, M., Notre experience de l'appareillage precoce des ampules des membres inferieurs aux Etablissements Helio-Marins de Berck, Annales de Medecine Physique, Tome IV, No. 4, Oct.-Nov.-Dec, 1961.</td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Berlemont, M., L'appareillage des amputes des membres inferieurs sur le table d''operations, paper given at the International Congress of Physical Medicine, Paris, 1964.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>1.</b> </td><td class="clsTextSmall">Alldredge, Rufus H., The principles of amputation surgery, Chap. 10 in Orthopaedic Appliances Atlas, Vol. 2, J. W. Edwards, Ann Arbor, Mich., 1960.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>A. Bennett Wilson, Jr., B.S.M.E. </b></td></tr><tr><td class="clsTextSmall">Executive Director, Committee on Prosthetics Research and Development. National Academy of Sciences-National Research Council, 2101 Constitution Ave., N.W., Washington, D.C. 20418.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1967_01_047/1967_01_047-1.jpg Figure 2 http://www.oandplibrary.org/al/images/1967_01_047/1967_01_047-2.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 New Concepts in the Management of Lower-Extremity Amputees Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr., B.S.M.E. * Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. Address 1614 Camden Ave. City Jacksonville State/Province FL, USA Countries Served Uzbekistan and surrounding countries Postal Code 32207 Phone 904.534.3236 Email newhope.rf@gmail.com Organization Type Including ID and tax status Non-profit Services Provided Prosthetic fitting, prosthetic devices, therapies Need I Financial Assistance - 904.534.3236 Need II Materials, Components, and Equipment: New, Disassembled, Used URL https://www.newhoperf.org/about Mission New Hope’s main purpose is the manufacture of donated prosthetic devices to the disabled individual’s specifications. They have an up to-date workshop on site with the tools they need to make prosthetics and braces, and a large physical therapy room so that the patients can learn how to use the devices correctly. Several full-time technicians assist in these vital tasks. The prosthetic devices give the patients the ability to walk, but New Hope goes a step further by offering them the opportunities for better lives by teaching them vocation skills such as English or Korean language and computer training. Patient Contact Rehabilitation Center: No. 1, H Abdulaev St. Tashkent 700007 Uzbekistan 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 New Hope Rehabilitation Foundation Description An account of the resource This non-profit is the only provider of modern artificial legs and braces in a country of 25 million people. These prosthetic devices and other supplies are given free of charge. https://staging.drfop.org/files/original/4dd6d94c1daa2cb68cd4f392331932db.pdf 259046e83e06f18b250ccc9220f4934a https://staging.drfop.org/files/original/2d3c637c51e5be4ea4a9b4f22c646846.jpg 11fee075823dd0fa5b865a8e747525dc https://staging.drfop.org/files/original/71f334ea18c694ea04b3d9b1f08a2253.jpg f7ec0a39eb5bbe47b310aa1f57a3d155 https://staging.drfop.org/files/original/6a0443994001a210b073e6923907b80a.jpg f8dcbc9d4224aa5e9cbb3f44145131fb https://staging.drfop.org/files/original/9263685d4481876c0d4e9272dd4ebeea.jpg d0d533d69cdfefbd4d631caee28aa13c https://staging.drfop.org/files/original/98f2d20450ad3768fbb296aef6b3bf20.jpg 74771fdcfdd89388647e71b2b29d843c https://staging.drfop.org/files/original/c55b28bda436388da75e3eee453c6c75.jpg 722fd6cb26bbb613bcdda96faad136a5 https://staging.drfop.org/files/original/46575d89fa490b67fd583a23dbb0eba1.jpg 1d6a709393590127cca18e095b03d7c1 https://staging.drfop.org/files/original/03efb5bd9a7aa0a4e0c7536b11d81944.jpg b8ab156ee418e2e7f14c6f781ad91ddc https://staging.drfop.org/files/original/9b3dd80c9f94cac1f8d03173ac09fa29.jpg 2cc8730d37d1046df4e01ae577b08e1a DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1966_01_024.pdf Year 1966 Volume 2 Issue 1 Page Number(s) 24 - 35 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1966_01_024.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1966_01_024.pdf">View as PDF</a></b></p></td> </tr> <tr> <td><p class="clsTextSmall">with original layout</p></td> </tr> </tbody></table> </td> </tr> </tbody></table> </td> </tr> </tbody></table> </td></tr></tbody></table> <h2>Nomenclature for Congenital Skeletal Limb Deficiencies, a Revision of the Frantz and O'Rahilly Classification</h2> <h5></h5> <!--Page 24--><!--====NEW ARTICLE====--> <p><i>Report of the Consultants to the Subcommittee on Child Prosthetics - Problems of the Committee on Prosthetics Research and Development:</i></p> <p><i>Cameron B. Hall, M.D., Los Angeles, Calif.<br /> Claude N. Lambert, M.D., Chicago, Ill.<br /> Ronan O'Rahilly, M.D., St. Louis, Mo.<br /> Chester A. Swinyard, M.D., Ph.D., New York, N.Y.</i></p> <p><i>Prepared by Robert L. Burtch, M.A.,<a style="text-decoration:none;">*</a> Research Scientist, Prosthetic and Orthotic Studies, New York University Post-Graduate Medical School, under the supervision of Sidney Fishman, Ph.D., Project Director, and Hector W. Kay, M.Ed.,<a style="text-decoration:none;">*</a> Associate Project Director, Prosthetic and Orthotic Studies, New York University Post-Graduate Medical School.</i></p> <p>At the request of the Subcommittee on Child Prosthetics Problems of the Committee on Prosthetics Research and Development, Child Prosthetic Studies, New York University, initiated a study of congenital skeletal limb deficiencies during March 1963<a></a>. The primary purpose of this initial effort was to determine the adequacy of the classification nomenclature for congenital skeletal limb deficiencies proposed by Drs. Charles H. Frantz and Ronan O'Rahilly<a></a> and of a description-classification form developed by NYU Child Prosthetic Studies. The results of the evaluation<a></a> indicated that 471 of 577 limbs (85 per cent) were classifiable within the framework of the Frantz-O'Rahilly system.</p> <p>In the light of these generally favorable results, the Subcommittee on Child Prosthetics Problems appointed a group of consultants (Drs. Cameron B. Hall, Claude N. Lambert, Ronan O'Rahilly, and Chester A. Swinyard) to consider possible ways and means by which the Frantz-O'Rahilly plan might be modified to provide an even more comprehensive system for classifying limb deficiencies.</p> <p>In the course of several joint meetings of the consultants and the NYU staff, a revised system was developed. The revised system generally follows the basic principles proposed by Drs. Frantz and O'Rahilly, in that: <i>first</i>, it is based on a description of <i>absent </i>skeletal parts; <i>second, </i>deficiencies are classified under the two basic headings, Terminal and Intercalary, with subgroups of Transverse and Longitudinal under each of these headings. However, the use of anatomical terms has been extended significantly and is included in the classification of all deficiencies. Thus the use of such clinical descriptive terms as hemimelia, peromelia, ectromelia, phocomelia, dysmelia, etc., has been eliminated. Only two basic descriptive <!--Page 25--> terms are now proposed: Amelia, or <i>complete </i>absence of a free limb, and meromelia, or <i>partial </i>absence of a free limb. The latter term is a derivative of the Greek <i>meros </i>(part or partial) and <i>melos </i>(limb).</p> <p>The use of the revised nomenclature adheres to procedures set forth in the <i>Standard Nomenclature of Diseases and Operations </i><a></a>. The classification of a given deficiency, therefore, proceeds from the general to the specific, citing absent skeletal elements for definitive identification. For example, Meromelia: Terminal Longitudinal; Metacarpal: I, II, III describes a terminal longitudinal deficiency of the hand involving absence of digital rays I, II, and III. To provide a basis for possible international consideration, the anatomical terminology utilized in this system is consistent with <i>Nomina Anatomica.</i><a></a> Since x-rays and the resulting classification may be expected to change depending on the degree of maturation (for example, tarsals and carpals), cases where ossification is continuing must be reclassified periodically.</p> <p>The material related to the revised classification system is presented in five parts:</p> <blockquote> <ol> <li>A definition of the terms and symbols employed.</li><li>Two charts (II. a. and II. b.) adapted from articles by Dr. Hall <i>et al. </i><a></a> and Dr. O'Rahilly<a></a> to facilitate understanding of the basic principles involved.</li><li>A detailed, illustrated description of the classification plan.</li><li>A description-classification form used for recording purposes.</li><li>Instructions for use of the description-classification form.</li></ol> </blockquote> <ol> <li>TERMS AND SYMBOLS <ul> <li>TERMS <ul> <li>Amelia - <i>Complete </i>absence of a free limb (exclusive of girdle).</li> <li>Meromelia - <i>Partial </i>absence of a free limb (exclu- sive of girdle).</li> <li>Terminal - Absence of all skeletal elements distal Deficiency to the proximal limit of the defi- ciency, along the designated axis (longitudinal or transverse).</li> <li>Intercalary Deficiency - Absence of middle part(s) lying between a proximal-distal series of limb components; elements proximal to and distal to the absent part(s) are present.</li> <li>Transverse - Absence extending across the width of the limb.</li> <li>Longitudinal - Absence extending parallel with the long axis of the limb (forearm and/or hand, or leg and/or foot), either pre-axial, postaxial, or (as in the hand or foot) central in nature.</li> <li>Pre-axial Absence of the portion of the fore- arm and/or hand, or leg and/or foot on the thumb or the great-toe side of the limb (radial or tibial portion).</li> <li>Postaxial - Absence of the portion of the fore- arm and/or hand, or leg and/or foot on the side of the limb opposite the thumb or the great toe (ulnar or fibular portion).</li> <li>Central - Absence of one or more of the intermediate digital rays (for example, Ray III).</li> <li>Rudimentary - A remnant of an osseous element. If the remnant is identifiable (for example, the humerus), the term "rudimentary humerus" would be applicable. If the remnant cannot be identified, the symbol "X" (unknown) would be cited (for example, "rudimentary X").</li> <li>Ray - A digit.</li> </ul></li> <li>SYMBOLS <ul> <li>I - Intercalary.</li> <li>T - Terminal.</li> <li>- - Transverse.</li> <li>/ - Longitudinal</li> <li>Pre - Pre-axial.</li> <li>Post - Postaxial.</li> <li>? - Questionable identity of element cited (for example, radius <b>?</b>).</li> <li>X - Unknown (unidentifiable).</li> <li>:I, II, III, IV, or V - Digital ray(s) involved, starting from pre-axial to postaxial side of limb.</li> </ul></li> <li>SKELETAL ELEMENTS<br />Capital letters are used to identify skeletal elements that are <i>completely </i>absent; small (lower case) letters are used to identify skeletal elements that are <i>partially </i>absent. If the word identifying the skeletal element is written out, the first letter of the word is capitalized when the element is completely absent (for example, Humeral), and in lower case when only partially absent (for example, humeral). <ul> <li>HU or hu - Humeral.</li> <li>U or u - Ulnar.</li> <li>R or r - Radial.</li> <li>CA or ca - Carpal.</li> <li>TI or ti - Tibial.</li> <li>FI or fi - Fibular.</li> <li>TA or ta - Tarsal.</li> <li>MT or mt - Metatarsal.</li> <!--Page 26--> <li>MC or mc - Metacarpal.</li> <li>PH or ph - Phalangeal.</li> <li>FE or fe - Femoral.</li> <li>PP or pp - Phalanx Proximal.</li> <li>PM or pm - Phalanx Middle.</li> <li>PD or pd - Phalanx Distal.</li> </ul></li> <li>SKELETAL SEGMENTS <ul> <li>P - Proximal third of element cited.</li> <li>M - Middle third of element cited.</li> <li>D - Distal third of element cited.</li> <li>The symbols P, M, and D are used to indicate thirds of the skeletal elements cited, which may be completely or partially absent. Utilization of the three symbols requires the following clarification:</li> </ul></li> <li>TERMINAL TRANSVERSE (T-) DEFICIENCIES <ul> <li>P - absence of <i>part </i>of the proximal third of the skeletal element cited <i>and everything distal to it.</i></li> <li>M - absence of <i>all or part </i>of the middle third of the skeletal element cited <i>and everything distal to it.</i></li> <li>D - absence of <i>all or part </i>of the distal third of the skeletal element cited <i>and everything distal to it.</i></li> </ul></li> <li>TERMINAL LONGITUDINAL (T/) DEFICIENCIES <ul> <li>P - absence of <i>part </i>of the proximal third of the skeletal element cited and everything distal to it <i>parallel with the same axis. </i></li> <li>M - absence of <i>all or part </i>of the middle third of the skeletal element cited and everything distal to it <i>parallel with the same axis. </i></li> <li>D - absence of <i>all or part </i>of the distal third of the skeletal element cited and everything distal to it <i>parallel with the same axis.</i></li> </ul></li> <li>INTERCALARY TRANSVERSE (I-) DEFICIENCIES AND LONGITUDINAL (I/) DEFICIENCIES <ul> <li>P - absence of <i>all or part </i>of the proximal third of the skeletal element cited.</li> <li>M - absence of <i>all or part </i>of the middle third of the skeletal element cited.</li> <li>D - absence of <i>all or part </i>of the distal third of the skeletal element cited.</li> </ul></li> </ul></li><li> <ol> <li>BASIC SCHEMA FOR CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES - <b>Fig. 1</b> presents a basic schema for the classification of congenital skeletal limb deficiencies which has been adapted from one originally presented by Dr. Cameron B. Hall <i>et al. </i>.<a></a></li><li>BASIC SCHEMA FOR CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES - <b>Fig. 2</b> presents a basic schema for the classification of congenital skeletal limb deficiencies which has been adapted from one originally presented by Dr. Ronan O'Rahilly.<a></a></li></ol> </li><li>CLASSIFICATION NOMENCLATURE <ol> <li>Terminal Transverse (T-) Deficiencies ( <b>Fig. 3</b> and <b>Fig. 4</b>)</li><li>Amelia - complete absence of a free limb (exclusive of girdle). (For example, Amelia: T-; Upper Right.)</li><li>Meromelia - partial absence of a free limb (exclusive of girdle). <ol> <li>Humeral or Femoral (P, M, or D) - Partial absence of the humerus or femur and all distal elements.(For example, Meromelia: T-; humeral D (distal third above-elbow-type stump).)</li><li>Radio-Ulnar or Tibio-Fibular <ol> <li>Complete absence of the Radius and Ulna or Tibia and Fibula, and all distal elements. (For example, Meromelia: T-; Radio-Ulnar (elbow-disarticulation-type stump).)</li><li>Partial absence of the radius and ulna or tibia and fibula, and all distal elements. Use P, M, or D, as appropriate.(For example, Meromelia: T-; radio-ulnar M (short below-elbow-type stump).)</li><li>Complete absence of <i>one </i>of the forearm or leg elements, and all distal elements. (For example, Meromelia: T-; Radius (wrist-disarticulation-type stump).)</li></ol> </li><li>Carpal or Tarsalol - Complete absence of all hand or foot elements. (For example, Meromelia: T-; Tarsal (ankle-disarticulation-type stump).)</li><li>Carpal or Tarsal, Distal - Absence of the distal row of carpals or tarsals, and all other hand or foot elements distal to this level.(For example, Meromelia: T-; carpal, Distal (mid-carpal-type stump).) <ol> <li>Carpal or tarsal, Pre- or Postaxial - Absence of either the pre- or postaxial carpal or tarsal bones, <i>and all other hand or foot elements. </i>(For example, Meromelia: T-; carpal, Pre-axial (carpal-metacarpal-type stump).)</li><li>Metacarpal or Metatarsal <ol> <li>Absence of all metacarpals or metatarsals and all hand or foot elements distal to this level. (For example, Meromelia: T-; Metatarsal (tarsal-metatarsal-type stump).)</li><li>Absence of a portion of metacarpals or metatarsals and all hand or foot elements distal to this level. Use P, M, or D to indicate absent segment(s) of each metacarpal or metatarsal. (For example, Meromelia: T-; metacarpal: I D, II D, III D, IV M, V M (trans-meta-carpal-type stump).)</li></ol> </li><li>Phalangeal <ol> <li>Absence of all phalanges from all five digits. (For example, Meromelia: T-; Phalangeal, Upper Right (metacarpo-phalangeal-type stump).)</li><li>Complete or partial absence of <i>one or more phalanges from all five digits </i>(but not all phalanges from all five digits).(For example, Meromelia: T-; phalangeal, Upper Right: I, II; III PM, IV PM, D; V PD (trans-phalangeal-type stump).)</li></ol> </li></ol> </li><li>Terminal Longitudinal (T/) Deficiencies (<b>Fig. 5</b>) <ol> <li>Major Long Bones <ol> <li>Complete absence of one of the forearm or leg elements and of the corresponding portion of the hand or foot. The skeleto-anatomical terms Radial (R), Ulnar (U), Tibial (TI), or Fibular (FI) are used to indicate the absent long bone. In order to provide greater precision, the identifying number of each absent ray is included in the nomenclature. (For example, Meromelia: T/; Radial: I, II.) If all but one unidentifiable ray or rudimentary <!--Page 28--> ray is absent, the symbol "X" (unknown) or term "rudimentary X" is used.</li><li>Partial absence of one of the forearm or leg elements and absence of the corresponding portion of the hand or foot. P, M, or D is used to indicate the absent segment (s) of the long bone. Lower case letters are used, and the absent ray(s) is cited. (For example, Meromelia: T/; fibular M: IV, V.)</li></ol> </li><li>Carpal or tarsal, Pre- or Postaxial - Absence of <i>either </i>the pre- or postaxial carpal or tarsal bones, <i>and </i>corresponding digital rays.(For example, Meromelia: T/; carpal, Pre-axial: I, II.)</li><li>Metacarpal or metatarsal (P, M, or D) <ol> <li>Absence of all phalanges of one to four digits <i>and </i>complete or partial absence of their respective metacarpals or metatarsals.(For example, Meromelia: T/; metacarpal: I, II, III, V.)</li><li>In the case of partial absence of a specific metacarpal or metatarsal, P, M, or D is used to indicate the absent segment (s).(For example, Meromelia: T/; metatarsal: I, II; III D; V M.)</li></ol> </li><li>Phalangeal Absence of all or part of one or more phalanges from one to four digits.(For example, Meromelia: T/; phalangeal, Upper Right: I, II, III.)</li></ol> </li><li>Intercalary Transverse (I-) Deficiencies (<b>Fig. 6</b> and <b>Fig. 7</b>)<br /> A minimum of at least two digital rays (two metacarpals or metatarsals and their associated phalanges) must be present to permit classification as an Intercalary Transverse (I-) deficiency of the major long bones. In such cases, the hand or foot deficiencies (if any) are classified separately. Where there are fewer than two complete digital rays, the deficiency is classified as Terminal Transverse (T-), with a description of the distal digital elements that are absent (for example, "all but one ray absent"). <ol> <li>Major Long Bones <ol> <li>Humeral, Radio-Ulnar; or Femoral, Tibio-Fibular - Complete absence of all three major long bones in the limb with hand or foot elements attached directly to the trunk. (For example, Meromelia: I-; Humeral, Radio-Ulnar.)Concomitant hand or foot deficiencies are classified independently of the major long bone deficit. (For example, Meromelia: I-; Humeral, Radio-Ulnar; plus T/; metacarpal: I, II, V.)</li><li>Humeral or Femoral - Complete or partial absence of the long bone cited. (For example, Meromelia: I-; Humeral.) <!--Page 30--> If a partial absence exists, P, M, or D is added to indicate the absent segment (s) of the bone cited.(For example, Meromelia: I-; humeral M, D.)</li><li>Radio-Ulnar or Tibio-Fibular - Complete or partial absence of the long bone cited.(For example, Meromelia: I-; Radio-Ulnar.)If a partial absence exists, P, M, or D is used to indicate the absent segment (s) of each bone.(For example, Meromelia: I-; tibio-fibular P, M.)</li><li>Humeral, radio-ulnar; or femoral, tibio-fibular - Partial absence of <i>all three major long bones </i>in the upper or lower limb. P, M, or D is used to indicate the absent segment (s) of each long bone.(For example, Meromelia: I-; humeral D; radio-ulnar M, D.)</li></ol> </li><li>Carpal or Tarsal - Complete absence of the carpal or tarsal bones, with proximal and distal skeletal elements present.(For example, Meromelia: I-; Carpal.)</li><li>Metacarpal or Metatarsal - Complete absence of the metacarpals or metatarsals, with proximal and distal skeletal elements present. (For example, Meromelia: I-; Metacarpal.)</li><li>Phalangeal - Absence of all or part of the proximal and/or middle phalanx from all <i>five </i>digits. (For example, Meromelia: I-; phalangeal, Lower Right: I PP; II PP; III PM; IV PM; V PP.)</li></ol> </li><li>Intercalary Longitudinal (I/) Deficiencies (<b>Fig. 8</b>) <ol> <li>Major Long Bones <ol> <li>Complete absence of one of the forearm (R or U) or leg (TI or FI) elements with hand or foot elements intact along the same axis as the deficient long bone. (For example, Meromelia: I/; Fibular.)</li><li>Similar to above except that <i>only part </i>of the long bone cited is absent. P, M, or D is used to indicate the absent segment(s).(For example, Meromelia: I/; radial P, M.)</li></ol> </li><li>Carpal or tarsal, Pre- or Postaxial - Absence of <i>either </i>the pre- or postaxial carpal or tarsal bones with all other hand or foot elements present. (For example, Meromelia: I/; tarsal, Pre-axial.)</li><li>Metacarpal or metatarsal - Absence of <i>all or part </i>of one to four metacarpals or metatarsals.(For example, Meromelia: I/; metatarsal: I, II.) If only part of a metacarpal or metatarsal is absent, P, M, or D is used to indicate the absent segment(s) of the involved ray.(For example, Meromelia: I/; metatarsal: I D; II M, D.)</li><li>Phalangeal - Absence of <i>all or part </i>of the proximal and/or middle phalanx of from one to four digits. (For example, Meromelia: I/; phalangeal, Upper Left: I PP; II PM; IV PP.)</li></ol> </li></ol> </li><li>DESCRIPTION-CLASSIFICATION FORM <b>Fig. 9</b> presents the description-classification form developed by NYU Child Prosthetic Studies for recording congenital skeletal limb deficiencies.</li><li>CLASSIFICATION OF CONGENITAL SKELETAL LIMB DEFICIENCIES The following instructions were developed by NYU Child Prosthetic Studies to accompany the description-classification form: <ol> <li>Fill in the identification items at the top of the page.</li><li>Indicate in the space provided the presence or history of congenital visceral, soft-tissue or skeletal anomalies other than those of the limbs; that is, cardiac, pulmonary, gastrointestinal (esophageal and/or duodenal atresia, imperforated anus, etc.); genito-urinary, for example, cryptorchidism; cleft palate, hare lip, congenital and/or structural scoliosis, spina bifida, etc.</li><li>Using a <i>black </i>pencil or pen, shade in all <i>absent </i>skeletal elements or parts of elements. If an anomaly has been converted to an amputation, describe and classify the <i>original </i>anomaly. Care should be taken to retain the approximate length and girth proportions when shading in partial elements. Using a <i>red </i>pencil or pen, also indicate on the appropriate limb the approximate <i>site </i>and <i>date </i>of the surgical conversion (s).</li><li>In cases where prosthetic restoration is appropriate, indicate the analogous functional level of amputation for prosthetic purposes (for example, short above-elbow, short below-elbow, long above-knee, etc.) in the space provided. Consult <i>Upper </i>and <i>Lower Extremity Manual(s) </i>for functional amputation levels.</li><li>Indicate next to the appropriate skeletal part on the diagram any of the following conditions that exist. Also, include any unlisted conditions present, as well as any additional information that will enhance the completeness of the description. <ul> <li>Synostosis - Contracture</li> <li>Hypoplasia - Pseudoarthrosis</li> <li>Bifurcation</li> <li>Valgus - Dislocation</li> <li>Varus - Subluxation</li> <li>Syndactylism - Supernumerary digit(s)</li> <li>Torsion - Soft-tissue nubbin(s)</li> </ul></li><li>After completing the description of each affected<!--Page 34-->limb, insert in the appropriate space the appropriate classification nomenclature.</li></ol> </li></ol> </li></ol> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. Basic schema adapted from Dr. Cameron B. Hall <i>et al. </i>(5). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. Basic schema adapted from Dr. Ronan O'Rahilly <i>(6). </i>The term "meromelia," denoting <i>partial </i>absence of a free limb, is applicable to all examples in the schema with the exception of the transverse deficiency of the <i>complete </i>limb which has been denoted as "amelia." </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 3. Terminal transverse (T-) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 4. Terminal transverse (T-) deficiencies (continued). The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 5. Terminal longitudinal (T/) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 6. Intercalary transverse (I-) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 7. Intercalary transverse (I-) deficiencies (continued). The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 8. Intercalary longitudinal (I/) deficiencies. The shaded areas in the example sketches represent absent elements or parts thereof. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 9. Description-classification form for recording congenital skeletal limb deficiencies. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table> <p><b>References:</b></p> <ol> <li>Burtch, Robert L., <i>A study of congenital skeletal limbdeficiencies, </i>Inter-Clinic Information Bulletin, May 1963, pp. 1-6.</li> <li>Burtch, Robert L., <i>The classification of congenitallimb deficiencies: A preliminary report, </i>Inter-Clinic Information Bulletin, October 1963, pp. 4-9.</li> <li>Excerpta Medica Foundation (Amsterdam, London,ilan, New York), <i>Nomina anatomica, </i>2nd ed., 1961.</li> <li>Frantz, C. H., and Ronan O'Rahilly, <i>Congenitalskeletal limb deficiencies, </i>J. Bone &amp; Joint Surg., Boston, 43A:1202-1224, December 1961.</li> <li>Hall, C. B., M. B. Brooks, and J. F. Dennis, <i>Congenital skeletal deficiencies of the extremities, </i>J.A.M.A., Chicago, 181:590-599, August 1962.</li> <li>O'Rahilly, Ronan, <i>Morphological patterns in limbdeficiencies and duplications, </i>Am. J. Anat., Philadelphia, 89:155-187, September 1951.</li> <li>Thompson, Edward T., ed., <i>Standard nomenclatureof diseases and operations, </i>McGraw-Hill, New York, 1961.</li> </ol> <br /> <div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>6.</b> </td><td class="clsTextSmall">O'Rahilly, Ronan, Morphological patterns in limbdeficiencies and duplications, Am. J. Anat., Philadelphia, 89:155-187, September 1951.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Hall, C. B., M. B. Brooks, and J. F. Dennis, Congenital skeletal deficiencies of the extremities, J.A.M.A., Chicago, 181:590-599, August 1962.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>6.</b> </td><td class="clsTextSmall">O'Rahilly, Ronan, Morphological patterns in limbdeficiencies and duplications, Am. J. Anat., Philadelphia, 89:155-187, September 1951.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>5.</b> </td><td class="clsTextSmall">Hall, C. B., M. B. Brooks, and J. F. Dennis, Congenital skeletal deficiencies of the extremities, J.A.M.A., Chicago, 181:590-599, August 1962.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>3.</b> </td><td class="clsTextSmall">Excerpta Medica Foundation (Amsterdam, London,ilan, New York), Nomina anatomica, 2nd ed., 1961.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>7.</b> </td><td class="clsTextSmall">Thompson, Edward T., ed., Standard nomenclatureof diseases and operations, McGraw-Hill, New York, 1961.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>2.</b> </td><td class="clsTextSmall">Burtch, Robert L., The classification of congenitallimb deficiencies: A preliminary report, Inter-Clinic Information Bulletin, October 1963, pp. 4-9.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>4.</b> </td><td class="clsTextSmall">Frantz, C. H., and Ronan O'Rahilly, Congenitalskeletal limb deficiencies, J. Bone &amp;Joint Surg., Boston, 43A:1202-1224, December 1961.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Reference</b></td></tr><tr><td class="clsTextSmall"><b>1.</b> </td><td class="clsTextSmall">Burtch, Robert L., A study of congenital skeletal limbdeficiencies, Inter-Clinic Information Bulletin, May 1963, pp. 1-6.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Footnote</b></td></tr><tr><td class="clsTextSmall">Since April 1, 1965, Mr. Kay has been serving as Assistant Executive Director, Committee on Prosthetics Research and Development, National Academy of Sciences—National Research Council, 2101 Constitution Ave., N.W., Washington, D. C. 20418.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style="width:400px;"><table style="background:#003399;"><tbody><tr><td><table><tbody><tr><td style="text-align:left;padding:3px;"><table><tbody><tr><td class="clsTextSmall" style="border-bottom:1px #666666 solid;"><b>Footnote</b></td></tr><tr><td class="clsTextSmall">Since September 1, 1965, Mr. Burtch has been serving as Coordinator of the Physical Medicine and Rehabilitation Service, Maimonides Hospital—Coney Island Division, Ocean and Shore Parkways, Brooklyn, N.Y. 11235.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-001.jpg Figure 2 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-002.jpg Figure 3 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-003.jpg Figure 4 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-004.jpg Figure 5 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-005.jpg Figure 6 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-006.jpg Figure 7 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-007.jpg Figure 8 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-008.jpg Figure 9 http://www.oandplibrary.org/al/images/1966_01_024/sp66c-009.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 Nomenclature for Congenital Skeletal Limb Deficiencies, a Revision of the Frantz and O'Rahilly Classification