1 20 371 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Review Status Status of review after import from old O&P Library into Omeka platform. Not Performed https://staging.drfop.org/files/original/165c0f0895c32010669e22cc3a0215af.jpg 39774beda32b03ad1ee3e25554135d2b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.worldvision.org Contact Name/Title Richard Stearns - Director Address PO Box 9716 City Federal Way State/Province Washington Countries Served USA Regions: Australia, Africa, North America, Central America, Middle East, Europe, Asia, South AmericaCountries: WorldwideSpecific cities, regions, or groups of people: Africa, Asia, Latin America, Middle East, Europe, United StatesAge Group: Adults, ChildrenFees Charged: No Postal Code 98063 Phone 253-815-1000 Email GIKDONATIONS@WORLDVISION.ORG Organization Type Including ID and tax status Non-profit Not-for-profit Type 501C-3 Services Provided Medical Equipment / Supplies, Education, Funding, Medical / Surgical Care, Rehabilitation / Training Need I Financial Assistance Need II Volunteers: Lay Persons, Other: OFFICE STAFF Need III Materials, Components, and Equipment: New, Equipment, Medical Supplies, Other: PHARMACEUTICALS Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource World Vision Inc. https://staging.drfop.org/files/original/b7a7c2991bb26411ef0db53793bf980e.jpg 2a21cb6923a0656f39dbe945c56be667 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Humanitarian Organizations Subject The topic of the resource Humanitarian organizations serving the worldwide O&P/Rehab community. Humanitarian Organization Humanitarian organizations serving the worldwide O&P/Rehab community. URL www.worldrehabfund.org Contact Name/Title Chairman: Richard A. Drucker Vice Chair: Marilyn Moffat Salant, PT, Ph.D., FAPTA Address 16 E. 40th Street – Suite #700 City New York State/Province New York Countries Served Cambodia, Haiti, Lebanon, Pakistan, Philippines, Ukraine, Bolivia, Ecuador, Mexico, Cuba Postal Code 10016 Phone (212) 532-6000 Fax (212) 532-6012 Email info@worldrehabfund.org Organization Type Including ID and tax status Non-profit Tax ID 13-5647844 Not-for-profit Type 501C-3 Services Provided Prosthetic and Orthotic Services Capacity Building Education Vision & Hearing Community-based rehabilitation Need I Financial Assistance https://worldrehabfund.org/ways-to-get-involved/donate/ Need II Volunteers: https://worldrehabfund.org/ways-to-get-involved/volunteer-opportunities/ Need III Consultants World Rehabilitation Fund is seeking to recruit international and U.S. based experts of various professional fields pertaining to implementing the projects and fulfilling its mission. WRF intends to utilize the consultants’ expertise in its future and ongoing work. The sought expertise is pertaining but not limited to: Prosthetics and Orthotics Socio-Economic Rehabilitation Microfinance Vocational Rehabilitation Physical Medicine Physical Therapy Occupational Therapy Social Work and Service Delivery Program Development Organizational Capacity Building Mission WRF’s mission is to enable individuals around the world with functional limitations and participation restrictions to achieve community and social integration through physical and socio-economic rehabilitation and advocacy; and to prevent disability and reduce disadvantage. Volunteer Contact https://worldrehabfund.org/ways-to-get-involved/volunteer-opportunities/ Patient Contact WRF Lebanon Khodralian Building St. Marun Street Horsh-Tabet, Beirut Phone: 961-1502188 Fax: 961-1502189 Email: wrfleb@dm.net.lb Website: http://www.wrf.org.lb Artisans Association of Cambodia No. 150J, Street 134 Sangkat Vealvong, Khan 7 Makara Phnom Penh, Cambodia Phone: 855 23 882 949 Email: wrf@forum.org.kh or wrfcam@online.com.kh Website: http://www.aac.org.kh LinkedIN Page/Profile https://www.linkedin.com/company/world-rehabilitation-fund/ Facebook Page https://www.facebook.com/WorldRehabilitationFund Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource World Rehabilitation Fund Description An account of the resource WRF believes that all people, regardless of disability, have the right to participate fully in their communities, to attain education and viable employment. https://staging.drfop.org/files/original/5a1dda96e4178cd06649ab215cbbe0d5.pdf 916f9e9ed1caca96356f3a227150715d https://staging.drfop.org/files/original/8636aa4e4c5c07d52b8abe2b11b37b34.jpg d84ef6ba41e554dcba230d9df535077a https://staging.drfop.org/files/original/5b4a9dbd8c695c2a35af0d77111fe2c1.jpg 8fbbd755ed8145a65a43809e70417f90 https://staging.drfop.org/files/original/8487fa7a9496454abdd425b5a0d7785f.jpg f87e785df8826fce7f9b25bbfa02d214 https://staging.drfop.org/files/original/6d91bb58231e3290cbcf8e2dd6de2830.jpg 8c72ee75f68585c21747347b7c6d1307 https://staging.drfop.org/files/original/1b17acd6b2b5de624697430d6894d59e.jpg a0c575e50cf69d22a6c74b5be9757d31 https://staging.drfop.org/files/original/07792a7c6f21b09b088faf9389ca2610.jpg da7f539b8006bf431baa7e3e5b8122f7 https://staging.drfop.org/files/original/11eb68ee39aa5ebeb200cda4a27eeebc.jpg 20f231014dcb6fa69b27864fb3ffa898 https://staging.drfop.org/files/original/197c2d8a6200d52ac28aef88fcc77fdd.jpg 801b1962726d6ad8ef106424aca27645 https://staging.drfop.org/files/original/afdc0eb1a348faf2d0c27285bcbb337e.jpg fd18d6f8a478bd70ef313e66aa24f6d3 https://staging.drfop.org/files/original/2250f8e6296a64f9cab5e169d1c2b241.jpg 516066b6193dbe1c2a6b992facb1be90 https://staging.drfop.org/files/original/6a4612dbdc98238350b49fd1d433b615.jpg 198d5a4e6535b9269b942902bc83a6d6 https://staging.drfop.org/files/original/013bbfd894737f6f6987e68067760431.jpg f272ceb4a5cfc69133ef0090cd118908 https://staging.drfop.org/files/original/6b60e9da47923de26b69a07869eb13ed.jpg 889d26201fbd7450b4346f43c42da7ee https://staging.drfop.org/files/original/b6a47343d2d4db601a1452d432a910bb.jpg d57c642323cf7ae5fe5d51d3c25f34e0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1988_03_128.pdf Text Any textual data included in the document <h2>With a Spring in One's Step</h2> <h5>D.D. Murray, M.D.&nbsp;<a style="text-decoration: none;">*</a><br />W.J. Hartvikson&nbsp;<a style="text-decoration: none;">*</a><br />H. Anton&nbsp;<a style="text-decoration: none;">*</a><br />E. Hommonay, C.P.O.(C)&nbsp;<a style="text-decoration: none;">*</a><br />N. Russell, C.P.(C)&nbsp;<a style="text-decoration: none;">*<br /><br /></a></h5> <h3>Introduction</h3> <p>In recent years, there has been a significant number of new developments in prosthetics in both North America and Europe. New concepts for socket molding, knee control, dynamic foot action, and the utilization of space-age materials have expanded prosthetic development and performance.</p> <p>The traditional prosthetic foot had a keel and an articulated ankle. This concept has modern derivatives with multi-axis ankles, but the principle remains the same. The S.A.C.H. foot design is that of the solid ankle and cushioned heel. By virtue of a compressible heel of a selected rubber density, the wearer achieves a simulated ankle motion at heel strike.<a></a> This design has been a mainstay in prosthetic fabrication for several decades. These feet are both essentially passive and accommodating. The Seattle foot, with its cushioned heel and keel spring action, stores energy through the stance phase of gait and releases it at toe-off, thus imparting a dynamic component to gait.<a></a> An added feature of this foot is that of cosmetic molding.</p> <p>The principle of dynamic toe-off to improve the mechanical efficiency of the prosthesis is an attractive one, and it forms the basis for the design of the Seattle foot. The purpose of this study is to evaluate the performance of the Seattle foot and subjectively and objectively determine whether or not it improves prosthetic gait.</p> <h3>Clinical Investigation</h3> <p>A questionnaire was designed to gather general demographic data and review foot function in general living situations. Thirty-three patients were identified in the last two years as having been fit with a Seattle foot, and 31 (94%) responded to the questionnaire. There were 27 males and four females. The age range was from 24 years to 72 years (<b>Fig. 1</b>).</p> <strong><a href="/files/original/8636aa4e4c5c07d52b8abe2b11b37b34.jpg" target="_blank" rel="noopener">Figure 1</a>. The age range was from 24 to 72 years.</strong><br /> <p>The weight of the patients ranged from 95 pounds to 195 pounds and their height ranged from 5'1" to 6'4".</p> <p>Amputation dates ranged from 1930 to 1986, with over half of the respondents having been injured since 1975.</p> <p>On average, each patient had 3.75 surgical procedures, with a range from 1 to 24.</p> <p>The length of time from amputation to prosthetic fitting was, for the most part, under one year (<b>Fig. 2</b>).</p> <strong><a href="https://staging.drfop.org/files/original/5b4a9dbd8c695c2a35af0d77111fe2c1.jpg" target="_blank" rel="noopener">Figure 2.</a> The length of time from amputation to prosthetic fitting was, for the most part, under one year.</strong><br /> <p>The original foot supplied in most cases was a S.A.C.H. foot. The next most frequent, in order, was a single axis ankle with a keel foot. The remainder are unknown. A significant number of the candidates had been using their original foot an average of 14 years before having it changed to a Seattle foot. For the most part, people were attracted to the Seattle foot because of a better design and newer technology. They wished for added spring, flexibility, and mobility in the foot. Some simply tried it because it was recommended by staff, or because they liked the cosmetic appearance.</p> <p>The length of time for use of the Seattle foot ranges from one month to two years with an average of 8.5 months (<b>Fig. 3</b>).</p> <strong><a href="/files/original/8487fa7a9496454abdd425b5a0d7785f.jpg" target="_blank" rel="noopener">Figure 3.</a> The length of time for use of the Seattle foot ranges from one month to two years, with an average of 8.5 months.</strong><br /> <p>The Seattle foot was fit on 29 below-knee amputees and two above-knee amputees.</p> <p>The heel stiffness in the Seattle foot was rated as acceptable in 80% of cases. Twelve percent (12%) felt it was too stiff. Eighty-one percent (81%) of respondents felt that they had good ankle motion with the Seattle foot, and 19% felt they did not. Seventy-four percent (74%) of respondents felt that the ankle motion was greater than with the previous foot, 16% felt it was the same, and 10% felt less ankle motion.</p> <p>When questioned about the shock stress at the hip or knee, 55% felt there was decreased shock stress and 39% felt that there was no change.</p> <p>When questioned about the effect of the Seattle foot on changing gait, 87% felt it was better and 13% felt it was the same.</p> <p>Eighty-seven percent (87%) were aware of toe-off action in the Seattle foot and 13% were unaware of it. The toe-off action was most noticeable when accelerating quickly, climbing up or down, playing ball sports, and running or walking on uneven ground. Forty-eight percent (48%) of the respondents would have preferred greater toe-off action, whereas 52% were satisfied with the toe-off.</p> <p>Half the respondents felt the Seattle foot had made a general difference to their recreational pursuits. When specific activities were rated, at least 50% of respondents felt that walking, going up and down stairs, hiking, dancing, and jogging were consistently easier than with the previous foot.</p> <p>Balance and endurance on the prosthesis was felt to be easier by about 61% of the respondents and smoothness was better in 87%.</p> <p>Uneven terrain was considered easier by 74%, but 3% said it was more difficult. In fact, the Seattle foot does not provide as much forefoot flexibility in the medial-lateral plane as with an articulated ankle joint.</p> <p>Walking and running was easier for 67% of the respondents (48% of the patients jogged). Of the 61% who dance, 74% found it easier.</p> <p>Of those people responding negatively to the Seattle foot, the pattern was either negative responses throughout the questionnaire (by four respondents) or negative responses for certain functions, such as the half who felt there was no difference in the recreational pursuits. Of these negative responses, there was no pattern either in terms of age, weight, or amputation site.</p> <p>The greatest advantages with the Seattle foot were reported to be a more natural and smooth action, resulting in an improved gait (<b>Fig. 4</b>), better ability to handle stairs and uneven ground, and improved abilities in sports.</p> <strong><a href="https://staging.drfop.org/files/original/6d91bb58231e3290cbcf8e2dd6de2830.jpg" target="_blank" rel="noopener">Figure 4.</a> The greatest advantages with the Seattle foot were a more natural and smooth action.</strong><br /> <p>The cosmetic design and the anatomical detail were appreciated by 97% of the respondents.</p> <p>Residual limb pain was felt to be decreased in 39% of respondents and unchanged in 45%. Sixteen percent (16%) did not respond to this question. The foot design had not been expected to have any effect on this problem.</p> <p>Skin problems were felt to be decreased in 55% of the respondents. Thirty-five percent (35%) said there was no change. The foot design was not expected to improve this clinical problem either.</p> <p>The Department of Veterans Affairs in Seattle has reported an evaluation of the Seattle foot.<a></a> Although a comparison of amputee groups was not possible, the results of this clinical survey compare favorably with the original study. <b>Fig. 5</b>, <a href="/files/original/07792a7c6f21b09b088faf9389ca2610.jpg" target="_blank" rel="noopener"><b>Fig. 6</b></a>, and <a href="/files/original/11eb68ee39aa5ebeb200cda4a27eeebc.jpg" target="_blank" rel="noopener"><b>Fig. 7</b></a> graphically demonstrate the comparison.</p> <strong><a href="https://staging.drfop.org/files/original/1b17acd6b2b5de624697430d6894d59e.jpg" target="_blank" rel="noopener">Figure 5</a>. A comparison of two clinical surveys of the Seattle foot for running and walking.<br /></strong><br /> <h3>Laboratory Investigation</h3> <p><i>Electrogoniometric Evaluation</i></p> <p>A gait study using a single amputee with many years experience with a S.A.C.H. foot and several years experience with the Seattle foot was undertaken at the G.F. Strong Gait Laboratory.</p> <p>Motion in the lower extremity was analyzed using a computerized electrogoniometric system. This system accurately measures movement in three planes at the hip, knee, and ankle and stores data for subsequent analysis.<a></a> The S.A.C.H. foot, Seattle foot, and non-prosthetic side were compared.</p> <p>Patterns of movement measured at the hip were similar for the S.A.C.H. and Seattle feet and resembled those seen on the non-prosthetic side. At the knee, the Seattle foot produced a more repeatable pattern of internal-external rotation and varus-valgus than did the S.A.C.H. foot (<a href="/files/original/197c2d8a6200d52ac28aef88fcc77fdd.jpg" target="_blank" rel="noopener"><b>Fig. 8</b> </a>and <a href="/files/original/afdc0eb1a348faf2d0c27285bcbb337e.jpg" target="_blank" rel="noopener"><b>Fig. 9</b></a>).</p> <p>The greatest differences between the S.A.C.H. and Seattle feet were seen at the ankle. The patterns of forefoot abduction-adduction, plantar flexion-dorsiflexion, and in-version-eversion were all more repeatable for the Seattle foot.</p> <p>Also, the pattern of plantar flexion-dorsiflexion for the Seattle foot more closely resembled that of the non-prosthetic side (<a href="https://staging.drfop.org/files/original/2250f8e6296a64f9cab5e169d1c2b241.jpg" target="_blank" rel="noopener"><b>Fig. 10</b></a> and <a href="/files/original/6a4612dbdc98238350b49fd1d433b615.jpg" target="_blank" rel="noopener"><b>Fig. 11</b></a>).</p> <p>In summary, the Seattle foot generally produced a more repeatable pattern of motion at the knee and ankle than the S.A.C.H. foot, and the pattern of plantar flexion-dorsiflexion for the Seattle foot appeared more normal.</p> <p><i>Force Plate Evaluation</i></p> <p>Through the facilities of Simon Fraser University Kinesiology Department, a force plate study was done on the same single subject. The vertical compression forces generated by the S.A.C.H. and Seattle feet during stance were measured. <b>Fig. 12</b> demonstrates typical forces measured during stance in a below-knee amputee on the non-prosthetic side. A maximum peak is seen immediately after heel strike. This is followed by a trough in mid-stance and a second, lesser peak at push-off.</p> <strong><a href="/files/original/013bbfd894737f6f6987e68067760431.jpg" target="_blank" rel="noopener">Figure 12</a>. Typical forces measured during stance in a below-knee amputee on the non-prosthetic side.</strong><br /> <p><b>Fig. 13</b> illustrates the forces generated in the same individual during stance on his prosthetic side while using a Seattle foot. <b>Fig. 14</b> shows stance forces generated in the same individual on his prosthetic side using a S.A.C.H. foot.</p> <strong><a href="/files/original/6b60e9da47923de26b69a07869eb13ed.jpg" target="_blank" rel="noopener">Figure 13</a>. The forces generated in the same individual during stance on his prosthetic side while using a Seattle foot.</strong><br /><br /><strong><a href="/files/original/b6a47343d2d4db601a1452d432a910bb.jpg" target="_blank" rel="noopener">Figure 14</a>. Stance forces generated in the same individual on his prosthetic side using a S.A.C.H. foot.</strong><br /> <p>The initial peak is greater for the S.A.C.H. than the Seattle foot. This suggests more effective shock absorption at heel strike for the Seattle foot than the S.A.C.H. foot. The second peak is less than that seen on the non-prosthetic side with both feet, but is greater for the Seattle foot than the S.A.C.H. foot. Thus, the Seattle foot more closely approximates normal push-off force than the S.A.C.H. foot. The trough at mid-stance is shorter with the S.A.C.H. foot than on the non-prosthetic side. The mid-stance trough for the Seattle foot more closely approaches that of the non-prosthetic side, suggesting a more normal pattern of foot-ankle motion than with the S.A.C.H. foot. In summary, the Seattle foot generally appears to produce a more normal pattern of vertical forces than the S.A.C.H. foot and produces a greater force at push-off.</p> <h3>Conclusion</h3> <p>The overall patient response to the questionnaire regarding the effectiveness of the Seattle foot was positive. Comparison with the Seattle Study revealed similar results. Gait studies undertaken tended to support the clinical impression with regard to both kinetics and kinematics. Overall, this dynamic foot design offers definite advantages to the prosthetic user. At best, prosthetic users seem to get an increased gait smoothness, with the dynamic toe action positively influencing their abilities on rough ground and inclines. At worst, their gait pattern is not negatively influenced by this spring action.</p> <h3>Acknowledgments</h3> <p>The authors wish to thank the G.F. Strong Gait Lab and Dr. Cecil Herschler, as well as the Simon Fraser Kinesiology Department and Dr. Arthur Chapman for their technical assistance in the preparation of this study.</p> <p><b>References:</b></p> <ol> <li>Orthopaedic Appliances Atlas. Vol. 2, <i>Artificial Limbs</i>, Editor J.W. Edwards, Ann Arbor, Michigan, 1960, pp. 149-151.</li> <li>Reswick, J.B., "Evaluation of the Seattle Foot," <i>J. Rehab Research and Development</i>, Vol. 23, No. 3, pp. 77-94.</li> <li>Burgess, E.M. et al., "Development and Preliminary Evaluation of the V. A. Seattle Foot," <i>Journal of Rehabilitation Research and Development</i>, Vol. 22, No. 3, B.P.R. 10-42, pp. 75-84.</li> <li>Chao, Edmund, "Justification of Triaxial Goniometer for the Measurement of Joint Rotation," <i>J. Biomechanics</i>, Vol. 13, 1980, pp. 989-1006.</li> </ol> <em><b>*N. Russell, C.P.(C) </b> Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital.</em><br /><br /><em><b>*E. Hommonay, C.P.O.(C) </b> Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital.</em><br /><br /><em><b>*H. Anton </b> Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital.</em><br /><br /><em><b>*W.J. Hartvikson </b> Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital.</em><br /><br /><em><b>*D.D. Murray, M.D. </b> Department of Medicine, Shaughnessy Hospital, Vancouver, British Columbia V6H 3M1. Dr. Murray is Professor and Head of the Department of Medicine at Shaughnessy Hospital.<br /><br /><br /></em> Page Number(s) 128 - 135 Year 1988 Volume 12 Issue 3 Figure 1 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-05.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 6 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-10.jpg Figure 11 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-11.jpg Figure 12 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-12.jpg Figure 13 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-13.jpg Figure 14 http://www.oandplibrary.org/cpo/images/1988_03_128/1988_03_128-14.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource With a Spring in One's Step Creator An entity primarily responsible for making the resource D.D. Murray, M.D. * W.J. Hartvikson * H. Anton * E. Hommonay, C.P.O.(C) * N. Russell, C.P.(C) * https://staging.drfop.org/files/original/2758dcc8f04d4645d2251d024de4b117.pdf 47ba774f7aaadae410bf2c3710d4d082 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_03_114.pdf Text Any textual data included in the document <h2>Winter Sports for the Amputee Athlete</h2> <h5>Doug Pringle&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Organized participation in winter sports by people with disabilities has a relatively short history. It began in the early 1950s when amputee veterans of World War II began to experiment with skiing despite the loss of limbs. The West Germans are credited with the invention of the outrigger, a crutch with ski tips attached, which are used as balance assisters. This invention helped popularize the sport and several amputee ski clubs were formed in the United States.</p> <p>During the late 50s and early 60s, amputee skiing was the mainstay of the sport. It was during the late sixties and early seventies that others with one "bad" leg, such as polio victims, began to ski using the technique developed for amputees. It was also during this time that amputees began experimenting with skiing with a prosthesis.</p> <p>Simultaneously, visually impaired people began to participate and the sport began to include more than amputees. In the late 70s, the major innovation was development of the "Four-Track" technique, which allowed many types of severely disabled people to ski.</p> <p>The 1980s have contributed the technique known as 'sit skiing.' This technique allows people who are wheelchair bound to participate in the sport.</p> <p>The benefits of participation in skiing are numerous. Physically the participant develops stamina, strength, balance, and coordination. These are all valuable physical traits for a person trying to compensate for a physical problem.</p> <p>Psychologically, participants begin to develop a positive self-image and a "can do" attitude. This positive thought cycle carries over into other aspects of life such as education and employment.</p> <p>Skiing offers a unique opportunity as a sport that can be done with family and friends in a facility open to the public. In that sense it is a mainstreamed activity done with everyone else rather than in a special facility.</p> <p>Finally, there is something wonderful and invigorating about the freedom of movement, speed, risk, and the natural environment of skiing. All these add to the experience.</p> <p>Skiing is the only winter sport offered to people with disabilities through formal programs. These programs offer adaptive equipment, qualified instruction and a competition system. Participation in other winter sports is not extensive.</p> <h3>Downhill Skiing</h3> <p><i>Alpine Skiing</i></p> <p>Alpine (or downhill) skiing is the most popular winter sport of people with disabilities in the United States. There are approximately 10,000 disabled skiers. The sport offers unique benefits to participants who are mobility impaired, not the least of which is that gravity supplies the means for movement.</p> <p>The development of adaptive equipment and techniques has made it possible for even the severely disabled to participate. Adaptive skiing is divided into five major categories or techniques:</p> <ol> <li> <p>Three track skiing</p> </li> <li> <p>Four track skiing</p> </li> <li> <p>Blind skiing</p> </li> <li> <p>Sit skiing</p> </li> <li> <p>Other adaptive techniques</p> </li> </ol> <p><i>Three Track Skiing</i></p> <p>Above-knee and below-knee amputees, persons with polio or birth defects, and those with a variety of other problems, ski three track in which the common element is having one good leg and two good arms. Above-knee amputees ski without their prosthesis because it is difficult to control. Below-knee amputees can ski with their prosthesis. The advantage is that they can stand on it when stopped. The disadvantage is increased risk of injury.</p> <p>Adaptive equipment for three trackers are outriggers. Outriggers are forearm crutches with ski tips attached. They act as balance as-sistors and are used to "walk" on the flats. Three track skiing derives its name from the three tracks made in the snow by two outriggers and the single ski.</p> <p>Some three trackers, especially racers, learn to ski with ski poles instead of outriggers. In fact, that is how people with one leg skied before the invention of outriggers. While more difficult, "one tracking" is also a possibility for many and skiing with poles is an advanced instructional method.</p> <p><i>Four Track Skiing</i></p> <p>Four track skiing is used by people with a wide variety of disabilities including: double leg amputees, spina bifida, cerebral palsy, muscular dystrophy, multiple sclerosis, stroke, head trauma, paraplegia, and polio. An individual with two legs and arms, natural or prosthetic, who is capable of standing independently (static balance), or with the aid of outriggers, could use this method. Many severely disabled people ski using this technique.</p> <p>In addition to outriggers, a lateral stability device is often used. This device is commonly referred to as a "ski bra." It helps keep the skiis parallel and also allows the student's strong side to help control the weaker side.</p> <p><i>Blind Skiing</i></p> <p>Visually impaired students are taught the same as any other skier with the exception that the instructor must learn to communicate more clearly. A number of holds or assists have been developed as well. Once the student can ski, the task becomes one of guiding or talking them down the hill.</p> <p>No adaptive equipment is required for the visually impaired. Often the student and instructor (or guide) wear bright bibs which signal to other skiers to be alert.</p> <p><i>Sit Skiing</i></p> <p>Sit skiing is the technique used by anyone who cannot ski standing. Sit skiers include people with muscular dystrophy, multiple sclerosis, cerebral palsy, spina bifida, paraplegia, and quadriplegia. This technique has been used since 1980 and it has opened skiing to people who are wheelchair bound.</p> <p>The sit ski has a fiberglass shell and metal edges. It is steered by leaning the body and by dragging a "pole" on the side to which the skier wants to turn. An instructor skies behind the device holding a length of nylon mesh cord in order to stop the skier and to assist with turns when necessary. Sit skiers often become proficient enough to ski "untethered" or without the instructor and safety line.</p> <p>The most recent development in sit skiing is the mono-ski. Here the fiberglass shell is mounted on a single ski and the skier uses outriggers. Use of a mono-ski requires good upper body strength. Therefore, it is a technique that is not suitable to quadriplegics and high-level paraplegics.</p> <p><i>Other Adaptive Techniques</i></p> <p>This catch-all category is used for a variety of people with disabilities who don't fit into any of the other four. Among them are upper extremity impairment: people who have lost the use of one or both arms. Those with one good arm use one ski pole and a pole can also be used with an arm prosthesis.</p> <p>Below-knee amputees may choose to ski using their artificial leg or legs. A heel line is usually necesary to achieve a bent knee position. Waist straps and thigh lacers help provide lateral stability, a snug fit, and reduced pis-toning and rotation. A special ski leg can be made if the student decides to seriously pursue skiing.</p> <p>The combination of disabilities and adaptive equipment are numerous. In competitions, some 19 different classes are recognized. But, generally, most people ski using one of the four major techniques.</p> <p><i>Instruction</i></p> <p>There are a number of programs of ski instruction available. Most are voluntary, weekend programs. There are five full-time professional ski schools which specialize in adaptive skiing and about 25 voluntary ones. All but a few of these programs are chapters or affiliates of the National Handicapped Sports and Recreation Association (NHSRA).</p> <p>The NHSRA has also developed a clinic team which trains instructors in adaptive ski teaching. The team also advises on program delivery. There is an instructor testing and certification program conducted by NHSRA which is approved and recognized by the Professional Ski Instructors of America.</p> <p><i>Competition</i></p> <p>A natural outgrowth of participation in sports is the development of competition. A very well developed system is in place. Learn to Race clinics and training camps are conducted by a few of the instructional programs locally and by the NHSRA nationally.</p> <p>Those interested in competition can race in any number of programs open to the public such as NASTAR and United States Ski Association races. Further, there are ten sanctioned regional championships at which racers can qualify for the nationals.</p> <p>Both the NHSRA and U.S. Association of Blind Athletes conduct annual national championships. Both organizations also select athletes for the U.S. Disabled Ski Team which competes in the World Winter Games for the Disabled and the Winter Olympics for the Disabled. In 1986, the U.S. Disabled Ski Team was number one in the world at the games in Sweden.</p> <p><i>Resources</i></p> <p>National Handicapped Sports and Recreation Association<br />4405 East West Highway, Suite 603<br />Bethesda, MD 20814</p> <p>U.S. Association of Blind Athletes</p> <p>Professional Ski Instructors of America<br />5541 Central Ave.<br />Boulder, CO 80301</p> <p>Alpine Skiing, contact:<br />Vineland National Center<br />P.O. Box 308<br />Loretto, MN 55357</p> <h3>Nordic Skiing</h3> <p>Nordic (or cross country) skiing is also popular among people with disabilities. Since the sport does require more muscular effort for motion than Alpine skiing, it is not an option for some severely disabled individuals.</p> <p>Among the participants are amputees skiing with their prosthesis and some who ski on one leg. Those on one leg must rely upon upper body strength and use their poles to push themselves along.</p> <p>Nordic skiing is well suited for the visually impaired. They may ski with a guide or follow pre-set tracks in the snow.</p> <p>Some more severely disabled people who would be four-trackers in Alpine skiing, such as those with cerebral palsy, muscular dystrophy, multiple sclerosis, stroke, head injury, etc., can also participate in Nordic skiing if they are able to ambulate well. Some will require assistance, pushing or pulling with a rope, and frequent rest breaks are always a safe practice.</p> <p>There is a sit ski for Nordic skiing. The sit skier will need excellent upper body strength to push themselves over any appreciable distance. Again, assistance and rest stops will help.</p> <p><i>Instruction</i></p> <p>There are very few Nordic skiing instructional programs in the U.S. The sport is just beginning to develop. Those interested in learning the sport should check with a local cross country ski resort to see if they have an instructor willing and qualified. Most will have difficulty finding a program nearby.</p> <p><i>Competition</i></p> <p>The competition program described under Alpine skiing exists for Nordic skiing. Nordic events are held separately from Alpine events, but the U.S. Disabled Ski Team includes both Alpine and Nordic competitors.</p> <h3>Other Winter Sports</h3> <p>Snowmobiling has been a sport in which people with disabilities have participated for at least 15 years. It was one option open to more severely mobility impaired individuals before development of four track and sit skiing.</p> <p>Ice boating and bike sailing are adaptable to a wide variety of mobility impairments. Ice fishing can also be enjoyed by many people.</p> <em><b>*Doug Pringle </b> Doug Pringle is the past president of the National Handicapped Sports and Recreation Association, 5946 Illinois Avenue, Organeville, California 95662.</em> <div style="width: 400px;"><br /><br /></div> Page Number(s) 114 - 117 Year 1987 Volume 11 Issue 3 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Winter Sports for the Amputee Athlete Creator An entity primarily responsible for making the resource Doug Pringle * https://staging.drfop.org/files/original/feebebaa37399c3b95576ae8e7aa803a.pdf e216245824105b9041905d276496dc47 DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1965_01_001.pdf Year 1965 Volume 13 Issue 1 Page Number(s) 1 - 12 Text Any textual data included in the document <table><tbody><tr><td> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <table> <tbody><tr> <td><a href="al/pdf/1965_01_001.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1965_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>Whither Prosthetics and Orthotics?</h2> <h5>George T. Aitken, M.D. <a style="text-decoration:none;">*</a><br /></h5> <p>The publicity concerning scientific and technical advances keeps us constantly aware of man's increasing competence to master his environment. The technologies available make possible a wide variety of mechanisms that expand man's sphere of activity and make possible comfortable living in environments previously considered undesirable. Some of the modern techniques, when applied in the biological fields, have eliminated some diseases, controlled others, and have made possible medical and surgical procedures that extend the life expectancy of persons of all ages. Continuing research undoubtedly is going to demonstrate eventually the etiological factors in other disease entities and thus permit the development of a nonsymptomatic approach to therapy.</p> <p> Many of the current scientific advances have been the result of interdisciplinary effort, where two or more separate disciplines have worked together, hopefully synergistically. This interdisciplinary effort in prosthetics and orthotics has produced what is often described as a bioengineering effort. In the past twenty years increasing emphasis has been placed on the engineering aspects of this specific problem. These years have witnessed a rapid advance in the development of new industrial materials and hardware that have been readily applicable to artificial limbs and braces. Many improvements in previous fabrication techniques and components were facilitated by using these newly available industrial developments, and thus some advances were made in upgrading the quality of prosthetic and orthotic devices.</p> <p> There have been varying degrees of concurrent fundamental research in the biological aspects of this interdisciplinary approach.</p> <p> It seems at times, though, that the glamour of technology has overshadowed the purely biological problems. Research activities involving these glamour areas have been more attractive to many, and funds for such research have been more available in these sometimes esoteric areas.</p> <p> At times it would seem that many involved in prosthetics and orthotics research and development have failed to see the entire problem. Basically, it is the problem of achieving the optimum man-machine interface. The ultimate resolution of the problem is the production of designs that result in comfort, maximum function, and reasonable cosmetic restoration.</p> <p>There is little question that much has been accomplished. Certainly we have available currently biological and engineering techniques that are capable, in a high percentage of cases, of producing improved function and cosmesis. Continuing intelligent modification of techniques and components produces more and more improvement in all of these areas. It is fair to assume that amputees and others with orthopaedic impairments are now better served than ever before.</p> <p>Unfortunately, many in the field of prosthetics and orthotics research and development seem to have a tendency to relegate the patient to a secondary position. They appear to be bent on the perfection of the machine without due consideration to the education or alteration, or both, of the man to perfect the interface.</p> <p>It seems timely to give consideration to some of the areas in which continuing, accelerated investigation is desirable.</p> <p>Research in amputation surgery to provide more functional stumps and consequently more comfort to the patient has been significantly lacking. There is a multiplicity of amputation techniques. Myoplastic and osteoplastic techniques either alone or in combination have been recommended to promote comfort and improved function. In this country there has been no well-organized clinical evaluation of these claims made primarily from abroad. It seems logical that such procedures be investigated and evaluated thoroughly. There are good theoretical reasons to justify consideration of these procedures so that they not be simply rejected because of dissimilar training and experience.</p> <p>Cineplastic procedures were critically investigated, and well-established criteria have been developed for their use. A similar review should be made of some of the other surgical problems.</p> <p>The immediate postsurgical fitting of sockets with or without early weightbearing currently is being investigated. Undoubtedly, the results of this wellorganized investigation will develop proper indications and techniques for this procedure. Hopefully, such techniques will be of positive value in influencing the man aspect of the man-machine interface.</p> <p>There are in addition many areas of basic biological research that need further investigation. The problem of biological signal sources for control of external power comes to mind immediately. Other, perhaps less exotic, problems, such as analysis of joint motions to permit more satisfactory alignment and construction of braces, or the metabolic problems incident to amputation and use of prostheses as well as analogous problems in the orthotics field, need further investigation. These are but a few of the many fundamental problems that need clarification.</p> <p>In the truly engineering area, there is a large volume of continuing research and development of systems, components, and techniques to produce better artificial limbs and better braces. Much of this work is in the newer areas of technology and has increasing emphasis on the problems related to the use of external power in prostheses and orthotic devices.</p> <p>There may be a need to review some of our accepted designs in the light of our recent progress and perhaps an effort should be made to determine whether previously acceptable items are really the best that can be developed in relation to some of our improvements in materials and techniques. It may be the time to review terminal-device design. It is possible that we now need (particularly in the light of external power) to redefine the functional requirements of a terminal device and arrive at some design criteria that will permit more efficient utilization of our technical improvements in power sources and transmission.</p> <p>With an increasing emphasis on prosthetic restoration in congenitally limbdeficient children, it may develop that there must be a redefinition of goals, in the case of the upper-extremity patient, as related to age, rather than as related to the needs of an adult. Possibly a careful analysis of the functional needs of pre-school and primary and secondary school children would permit us to develop components for a system that would be more effective than simply using scaled-down adult components and systems.</p> <p>An overall review of research and development in prosthetics and orthotics over the past twenty years cannot help but emphasize that people requiring prostheses and orthotic devices are being increasingly better served. There seems little question but that the efforts of our schools of prosthetics and orthotics education have produced a marked upgrading of the skills in prescribing and fitting these devices as well as greater competency in the training of the patient in the use of such devices.</p> <p>As a clinician, I am very pleased with the improvement of patient care in these areas. As an interested participant in research and development endeavors, I am increasingly aware that there is much more that remains to be done. There exist the technical facilities to do both better research and better development. What is needed is the wisdom to direct our efforts in such a way that we adequately explore all areas of this man-machine problem and so correlate our activities that the result—the functioning man-machine combine— is a continually improving biomechanical unit.</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>George T. Aitken, M.D. </b></td></tr><tr><td class="clsTextSmall">Chairman, Committee on Prosthetics Research and Development, July 1, 1962-June 30, 1965. Upon completion of his term as Chairman of CPRD, Dr. Aitken will continue to serve as a member of CPRD.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Whither Prosthetics and Orthotics? Creator An entity primarily responsible for making the resource George T. Aitken, M.D. * https://staging.drfop.org/files/original/22f2bcc00fd13d3ee3dbba5a01cf9dfd.pdf f5dcb905e27a0297a27464a85893dcbb https://staging.drfop.org/files/original/739b1a9158b00278582d96d76ac19145.jpg 925b8b94e9c4b16ea14a5b8e612748f3 https://staging.drfop.org/files/original/c03ea9b706c703a0c23b955ca07c7da5.jpg 6114438d0c7b0f11b4f55fa8ed817d8b https://staging.drfop.org/files/original/13144e1ac56398758d04b22fc4b25fc5.jpg 464fa1a98a48cb3d50fe5a79ca02b7ba https://staging.drfop.org/files/original/d621137e255ef9d7c7e242e2122776f2.jpg 3a8ed62b5588399a696c3c1e1529768f https://staging.drfop.org/files/original/360efe6c756b05e84d50d65ed85add45.jpg cb981259d0b15353cd7336e14fd68c8c https://staging.drfop.org/files/original/8d2cd187f502495317c736775b95b3b1.jpg 7fe8a40aa682646a3bc9513370614734 https://staging.drfop.org/files/original/12aab77dddaf713fca6201a3a944eb99.jpg 89aa7327ec6c0d36aaacad28471c6ea0 https://staging.drfop.org/files/original/743a4583056a4ffceb44d54938b38c0f.jpg c26243f82589c6280ee0cb1f38b09bd7 https://staging.drfop.org/files/original/7bde68b6fc67e46a86f42233817d383a.jpg 8f117df5f4cf67539777c80e85427227 https://staging.drfop.org/files/original/2c4626ebe0deef97dca3a79434d65014.jpg 1774df62ca57088bb04d63e5bfb1501e 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_02_082.pdf Text Any textual data included in the document <h2>Wheelchairs for Paraplegic Patients</h2> <h5>A. Bennett Wilson, Jr.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>The best current estimates of the incidence and prevalence of spinal cord injury in the U.S. is 30-32 and 900 cases per million of population respectively.<a></a> About half of these cases are paraplegic. Added to this are paraplegics due to spina bifida, a few polio cases, etc. By definition, paraplegics have to rely on one or more assistive devices if mobility is to be achieved.</p> <p>Only a small segment of the paraplegic population make use of lower-limb orthoses, and even those who do have orthoses, and use them, need a wheelchair as well, in order to make the most of their available energy. For the very few who can "walk" enough not to feel the need for a wheelchair in work and activities of daily living, wheelchairs permit participation in athletic activities that would otherwise be impossible.</p> <p>Wheelchairs can be classified as either "manual" or "powered". The manual wheelchair is designed to be propelled by the occupant or by an attendant. Tests have shown that the energy cost of using a manual wheelchair for mobility on a smooth, level surface can be appreciably less than that of unimpaired persons walking on the same type of surface.<a></a> The conditions, of course, are reversed when uneven surfaces or ascending surfaces are encountered. The "powered" wheelchair is designed to be propelled by a battery-powered electric motor or motors. Originally conceived to be used by patients unable to propel themselves, powered chairs are sometimes indicated so that a paraplegic can make more effective use of his own energy.</p> <p>The basic manual wheelchair has two side-frames connected by a cross-bar that is pivoted about its intersection and a flexible seat and back to allow folding, two large driving wheels at the rear, and two caster wheels at the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg"><b>Fig. 1</b></a>).<a></a> This is a configuration that has evolved over the years since the original patented design of Everest and Jennings<a></a> in 1936 for the folding mechanism, and represents a rather elegant compromise between maneuverability, stability, and portability. Many concerted attempts, especially in recent years, to develop better designs have not been very successful. The use of new materials has made it possible to produce significantly lighter wheelchairs, but the original configuration is basically the same.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg"><strong>Figure 1. The basic wheelchair-folding frame, 24-inch diameter wheels in the rear, 8-inch diameter casters in the front, flexible seat and back.</strong></a><br /> <p>It must be remembered that a change in the design to emphasize one feature generally affects adversely one or more of the other features. An example is when the wheelbase of the basic chair is lengthened to provide more stability for the bilateral leg amputee; maneuverability is sacrificed. Designers of some of the "sports" chairs, in order to reduce weight, have eliminated the folding mechanism. Portability is achieved by connecting and disconnecting driving wheels for transport in an automobile.</p> <h3>Prescription Considerations</h3> <p>Variations of the basic chair are available for amputees, hemiplegics, and others, but the basic chair of proper dimensions is generally the most suitable for paraplegic patients. The range of dimensions of the basic wheelchairs available in the United States are shown in<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg"> <b>Fig. 2</b>.</a></p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg"><strong>Figure 2. Dimension ranges for the basic adult wheelchairs from major U.S. manufacturers.</strong></a><br /> <p>Even when sensation is present, the hammock type seat is seldom used without cushions, which are needed to provide a better distribution of pressure over the thighs and buttocks for comfort, if for no other reason.</p> <p>Cushions and other seating systems affect the relationship between the user and the chair and, therefore, must be selected and taken into account before the final dimensions of the chair are determined.</p> <p>The importance of selecting the most appropriate chair and seat cushion cannot be over emphasized. The dimensions of the chair must distribute the forces of the body properly while also placing the user in a position, with respect to the driving wheels, to provide maximum efficiency during propulsion.</p> <h3>Seat Width And Depth</h3> <p>Selection of the proper seat width is important to comfort and stability. A seat that is too narrow is not only uncomfortable, but access to the chair is made difficult. Furthermore, the chances of pressure sores developing is increased. A seat that is too wide encourages the user to lean toward one side, thus promoting scoliosis and increased pressure over the buttocks on one side. In addition, a seat wider than is necessary makes propulsion more difficult.</p> <p>A seat that is too shallow reduces the area in contact with the buttocks and thighs and causes more pressure on the soft tissues in contact with the seat than is necessary or safe. Furthermore, the location of the footrests is changed so that the feet and legs are not supported properly, and the balance of the user can be affected.</p> <p>A seat that is too long can restrict circulation in the legs.</p> <h3>Seat Height</h3> <p>The height of the seat above the ground of the basic adult chair is 19 1/2 - 20 1/2 inches. Tall persons require a seat that is higher and deeper; short persons require a seat that is lower. Usually these requirements can be met by a stock chair; if not, properly dimensioned units can be had on special order. Obviously, the cushion or seating system to be used will affect the end result.</p> <h3>Seat Type</h3> <p>Seats available from wheelchair manufacturers are sling or hammock types, made of a flexible material, and solid seats which are generally removable (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg"><b>Fig. 3</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg"><strong>Figure 3. Seat types-a. hammock or sling; b. solid.</strong></a><br /> <p>The sling seats are, by far, the type most used. A solid seat installed to permit folding is available, or a removable solid wooden seat may be purchased or made.</p> <h3>Backrest</h3> <p>The backrest of the basic chair is made of a flexible material stretched between the two side frames which are fixed with respect to the seat. The backrest should be high enough to provide support without inhibiting motion, yet not so low that the scapulae can hang over the back of the chair and cause discomfort.</p> <h3>Arms</h3> <p><a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg"><b>Fig. 4</b></a></p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg"><strong>Figure 4. The basic wheelchair with the most popular types of arms-removable full-length, removable desk-type, and removable, adjustable desk-type.</strong></a><br /> <p>The lightest chairs have fixed arms or none at all. But an overriding factor in wheelchair prescription is transfer into and from the wheelchair, especially when the patient is unable to stand for a brief period. For this reason, most patients require chairs with arms that can be removed easily.</p> <p>Chair arms not only provide support for the patient's arms in a resting attitude, but also provide lateral support and a reaction point for the hands when the asensitive patient elevates his body at regular intervals to prevent restriction of circulation and thus pressure sores.</p> <p>Both removable and fixed arms are available in full-length and desk models; both of these styles are available with the height fixed or adjustable.</p> <p>The desk models are foreshortened to permit the user to get closer to a desk or table top. The removable desk arm is by far the most popular type. The full length models are indicated when the forepart is needed to support the arms of the user in rising from the chair, or when lordosis, obesity, or some other physical factor makes it necessary to use the front part of the arm for support. The standard removable desk model can be reversed to provide this feature.</p> <h3>Wheels And Tires</h3> <p>The basic chair has two 24 inch diameter rear wheels and two eight inch caster wheels in the front (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg"><b>Fig. 5</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg"><strong>Figure 5. Basic wheelchair with standard 24-inch diameter wire-spoke wheel and two options: the cast magnesium wheel and a wheel with special built in hand rim.</strong></a><br /> <p>The standard rear wheel for many years has been a wire spoke wheel, but wheels of cast metal alloy and wheels of cast plastic have been made available recently to overcome the maintenance problems inherent in the wire wheel design without adding more weight.</p> <p>Three types of tires are available in several widths and tread types. Pneumatic, semi-pneumatic, and solid tires are available (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg"><b>Fig. 6</b></a>). The eight inch diameter wheel with solid rubber tires is standard on the basic chair, and is suitable for use on smooth surface and indoors. The semi-pneumatic and pneumatic tires provide shock absorption, and, thus, are more suitable for rough surfaces and outdoor use.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg"><strong>Figure 6. Basic wheelchair and optional casters available. Shown on the chair is the standard 8-inch diameter wheel with solid rubber tire. Next in order are: the 8-inch wheel with the semi-pneumatic tire; the 8-inch wheel with pneumatic tire; a 5-inch diameter wheel with solid rubber tire.</strong></a><br /> <p>Pneumatic tires provide a more cushioned ride and their shock absorber action tends to prolong the life of a wheelchair when kept inflated properly.</p> <h3>Handrims</h3> <p>Handrims are attached to the driving wheels of wheelchairs to permit control without soiling the hands. The standard handrim is a circular steel tube. For users who have problems gripping the smooth surface of a metal ring, vinyl coated rings and a variety of knobs and projections can be added to the ring.</p> <h3>Casters</h3> <p>Casters make steering possible and are available in two diameters: eight inches and five inches. The five inch model is available only with solid tires, and is used on children's chairs and in special circumstances on adult chairs and basketball chairs, when more maneuverability is desired.</p> <h3>Parking Locks</h3> <p>Most users need some means of securing one or more wheels to keep the chair from rolling down inclines or to provide stability during transfer to and from the chair. Two types of parking locks are available from the large wheel (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg"><b>Fig. 7</b></a>): toggle and lever. Selection depends upon user preference.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg"><strong>Figure 7. Two types of parking locks-left, toggle type; right, lever type. Variations of these two types of locks are available.</strong></a><br /> <p>Pin type locks are also available. These retain a caster in the trail position and are used to prevent swiveling during lateral transfer.</p> <h3>Cushions</h3> <p>The vast majority of paraplegics require, and can use successfully, seat cushions that are mass produced and are widely available at reasonable prices. A great many designs of seat cushions are available. Some have been developed by trial and error, the designs being based on what has proven to be acceptable to the inventor or his customers; other designs have a more scientific basis, but because the exact cause of decubitus ulcers is not known, precise criteria for design of wheelchair seating have not been established.<a></a> Although each of the cushion designs available has advantages and disadvantages, most of which are not clearly defined, selection of seat cushions for individual cases is seldom simple or straightforward.</p> <p>Commercially available cushions may be divided roughly into five categories, including "miscellaneous" or "other", based on material and design (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg"><b>Fig. 8</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg"><strong>Figure 8. Various types of seat cushions that are available.</strong></a> <ol> <li> <p>Foam</p> </li> <li> <p>Viscoelastic foam</p> </li> <li> <p>Gel</p> </li> <li> <p>Fluid</p> </li> <li> <p>Other</p> </li> </ol> <p><i>Foam Cushions</i></p> <p>Foam cushions generally use polyurethane or polyether foam, and are available in various configurations. The simplest are homogeneous rectangular blocks 2-4 inches thick; some are contoured; and others are composed of two or more layers of material of different densities, some of which may contain hollow spaces or cores in an attempt to distribute the load to specific areas.</p> <p><i>Viscoelastic Foam Cushions</i></p> <p>Viscoelastic foam is less resilient than ordinary foam.</p> <p><i>Gel Cushions</i></p> <p>Gel cushions consist of rather firm emulsion enclosed in a "non breathing" plastic casing.</p> <p><i>Fluid Flotation Cushions</i></p> <p>Water, air, or water-and-foam particles are used in a flexible, tailored plastic bag to provide distribution of forces. The overall effect varies with the amount of fluid introduced.</p> <p><i>Other Types</i></p> <p>Many other designs that combine several elements are available. Prominent among these are the ROHO, which uses a collection of air-filled tufts to distribute the loads and the VASIO (Veterans Administration Spinal Injury Orthosis), in which foams of two different densities are combined and contoured to meet the special needs of paraplegic patients.</p> <p>Each type and design has advantages and disadvantages, and, therefore, selection of the type most appropriate for individual patients is not easy. Until more is known, selection has to be made on a trial basis.</p> <h3>Sports Chairs</h3> <p>Since the introduction of wheelchair basketball shortly after World War II, a constant stream of modifications and refinements has been made to the basic wheelchair to meet the needs of wheelchair athletes. Development of the lightweight, high-performance, sports chair has led to racing among wheelchair users and has made playing tennis from wheelchairs practical and enjoyable. These chairs have also been found useful in non-competitive recreation, such as camping and mountain climbing. Much that has been learned in developing and using sports chairs has resulted in improved performance and quality of prescription wheelchairs, just as automobile racing has led to improvements in the family car. At the same time, many of the people who have been using conventional wheelchairs are now using sports chairs full-time.</p> <p>Like the basic prescription wheelchair, the sports chair (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg"><b>Fig. 9</b></a>) has evolved through a series of refinements to where the general configurations of most chairs are strikingly similar. At least 20 manufacturers at this time offer one or more models. Most use 24 inch diameter wheels; some use 27 inch wheels. Weight varies from 16 to 38 pounds, due mainly to material selection and whether or not the chair can be folded. A number of designs incorporate provisions for folding; Others use wheels that can be disconnected (and connected) quickly without tools to make transportation easier.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg"><strong>Figure 9. Three types of sports chairs. The one shown at the top is limited primarily for use in racing. The other two are more versatile.</strong></a><br /> <p>Nearly all use five inch diameter front castors, except one manufacturer that uses four inch wheels. Two make eight inch castors available as an option. Nearly all, if not all, have a feature that permits a choice of rear wheel axle position with respect to the frame (<a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg"><b>Fig. 10</b></a>). Only a very few offer arm rests.</p> <a href="http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg"><strong>Figure 10. Schematic showing adjustability often found in sports chairs that permit an optimum relationship between position of the user and the wheels.</strong></a><br /> <p>Many active wheelchair users prefer to use a sports type chair all the time, and in many instances options are offered that make regular use practical. Many models have adjustable features, and most manufacturers will provide a chair with dimensions to suit a given individual.</p> <p>A feature found on most sports chair, but not on other types, is the easy adjustability of wheelbase and seat height afforded by the positioning plate for the rear wheels. In many models, the position of the castor wheels can also be adjusted. Such adjustability, of course, permits the user to be seated in a position which puts the muscles in the upper limbs and shoulders in the optimum arrangements for maximum biomechanical efficiency.</p> <p>Because refinements and advances are being introduced so frequently, the periodical <i>SPORTS 'N' SPOKES</i>, published by the Paralyzed Veterans of America, has been devoting one issue each year to sports chairs and their specifications.<a></a></p> <h3>Summary</h3> <p>Because of increased competition and refinements brought about by the sports chair movement, paraplegics now have available high quality wheelchairs. No single chair design is apt to meet all the needs of each individual, but careful thought and attention to detail in prescription preparation can result in a chair that meets most of the needs of the paraplegic.</p> <p><b>References:</b></p> <ol> <li>Cochran, George Van B. and Vincent Palmieri, "Development of Test Methods for Evaluation of Wheelchair Cushions," <i>Bulletin of Prosthetics Research</i>, 10-22, 17:1:9-30, Spring 1980.</li> <li>Everest, H.A., et al., U.S. Patent No. 2,095.411, October 12, 1937.</li> <li><i>SPORTS 'N' SPOKES</i>, 5201 N. 19th Avenue, Suite 111, Phoenix, Arizona 85015.</li> <li>Grimby, Gunnar, "On the Energy Cost of Achieving Mobility," <i>Scand. J. Rehab. Med.</i>, Supplement 9, 1983, pp. 49-54.</li> <li>University of Alabama at Birmingham, Spinal Cord Injury Project, "Spinal Cord Injury - The Facts and Figures," 1986.</li> <li>Wilson, A. Bennett, Jr., <i>Wheelchairs: A Prescription Aid</i>, Rehabilitation Press, Charlottesville, VA, 1986.</li> </ol> <em><b>*A. Bennett Wilson, Jr. </b> A. Bennett Wilson, Jr. is an Associate Professor with the Department of Orthopedics and Rehabilitation at the University of Virginia, Charlotteville, Virginia 22908.<br /><br /><br /></em> Page Number(s) 82 - 90 Year 1987 Volume 11 Issue 2 Figure 2 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 8 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-08.jpg Figure 1 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-01.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1987_02_082/1987_02_082-10.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Wheelchairs for Paraplegic Patients Creator An entity primarily responsible for making the resource A. Bennett Wilson, Jr. * https://staging.drfop.org/files/original/f2f2342e1e6c5a7524fbbb113dcd429d.pdf b5a27a06fe4080ab7de494f9ef3f12a2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1984_04_006.pdf Text Any textual data included in the document <h2>What is Spina Bifida?</h2> <h5>Jeannie Gruse&nbsp;</h5> <p>I have chosen to do this report on spina bifida because of little Stephen Smith, a happy, loving, well-adjusted boy, who was born thirteen years ago with this condition. Stephen's parents are friends and neighbors, and I well remember the day that Kent came over to tell us about the birth of their first son.</p> <p>When he described their handsome baby boy, and then explained that he had a birth defect called spina bifida, I had no idea what he was saying; I had never heard of this condition. Pam and Kent knew very little at that time, either, but in nine years of surgery, emergencies, difficult care, exercising, training, and learning, this has certainly changed for them. Kent is currently the Executive Director of The Spina Bifida Association of America, dedicated to "making the public, professional and all governmental agencies more aware of this worldwide health problem and assisting parents in helping their children." The program is also directed toward improving comprehensive medical care for children and adults with spina bifida, and expanding research programs which will search for the cause of this birth defect.</p> <p>Spina bifida is a serious condition, and until thirty years ago, few babies born with it survived beyond infancy. The treatment techniques developed within the last two decades make it possible for the majority of these children to grow to adulthood and live happy, productive lives in spite of their disability.</p> <p>Spina bifida is not a new birth defect; it was referred to 2,000 years ago, and was described by a Dutch physician, Nicholas Tulp, friend of Rembrandt, in 1652. The technical terms, spina bifida aperta or spina bifida manifesta relate to a structural defect caused by failure of the neural plate to develop into a tubular structure. In the area where this occurs, the defect is technically referred to as myelomeningocele (G. myelos = marrow; meninx = membraine; kele = hernia). In development, plates of bone fail to close over the defective area of the spinal cord and there is a short spine on each side of open spinal cord rather than a single one in the midline, therefore the term spina bifida. If the bony plate does not close over the spinal cord during infancy, this defect is referred to as spina bifida occulta (hidden). This type generally causes no problems.</p> <p>The newborn baby will have an obvious lump or cyst-like lesion on the back. It may be covered with skin, or more often wholly or partially covered with translucent bluish or white membranes. There may be a flat plate of imperfectly formed spinal cord on the surface of the cyst which may be leaking cerebro-spinal fluid.</p> <p>While there are many claims or suggestions of causes of spina bifida, it is generally considered to be caused by an unknown environmental agent interacting with genetic factors, according to Dr. Swinyard, Stanford University authority on spina bifida. Multiple complex problems presented by newborns with spina bifida have discouraged some physicians from applying the available intensive medical care and technologies to preserve lives of the more severely defective newborns. A number of physicians have advocated strongly that such treatment be withheld from newborns, presenting certain criteria with the expectation that these babies would soon die. This presents serious moral and legal problems, obviously, relating to rights of the children and the rights of parents to make such decisions, and since the predictability of death is quite uncertain, those who survive may have unnecessarily serious and lasting damage.</p> <p>There are many problems associated with spina bifida besides the obvious surgery necessary, often immediately, to correct the condition. There is loss of awareness of touch, pain, pressure, and heat or cold in those areas of skin normally innervated by nerves involved in the spinal cord defect. There is muscle weakness in the lower limbs and lower trunk, the latter often resulting in weakness in muscles of the bladder and bowel, preventing normal control.</p> <p>Nearly 70 percent of infants with spina bifida develop an associated defect known as hydrocephalus, causing a rapid enlargement of the head from the abnormal accumulation of fluid inside the brain. Although it does not occur in all of the infants, this problem is potentially a life threatening one which requires prompt attention of a neurosurgeon, and even then may often result in varying degrees of brain damage.</p> <p>The degree of severity of these conditions associated with spina bifida varies widely. Some children will be able to walk without assistance, others may need braces or a wheelchair. Because spina bifida is such a complex condition, these cases are usually referred to a pediatric neurosurgeon who is part of an organized team. He will decide on the surgical closure of the myelomeningocele, carefully watch for signs of hydrocephalus, and be responsible for the management of this condition if it occurs.</p> <p>Development of hydrocephalus would involve a serious neurosurgical emergency, as severe brain damage or death could result from the pressure of the fluid within the brain. A shunting procedure is used to reduce this condition, which consists of inserting one end of a flexible tube info a brain ventricle and passing the tube through a small opening in the skull. It is then passed underneath the skin from the head, either to the heart or to the abdomen, and includes a one-way valve which prevents the backward flow of spinal fluid. Even this procedure, a vital one to prevent pressure on the brain, is not totally free of dangers, as shunts can be obstructed or collapse, and revision is often necessary. However, it is the best procedure, and the only effective treatment currently available to allow the brain to develop more normally.</p> <p>Besides the neurosurgeon, spina bifida children will be seen by a number of different specialists. A urologist may be necessary to control urinary infections, and to keep the lack of bladder control from becoming a problem. The pediatrician will watch the child's general health and work on management of the problems relating to lack of bowel control.</p> <p>The orthopedic surgeon will have as his primary concern the growth and development of the bones and muscles. Children with spina bifida often have hip dislocation, club feet, scoliosis, kyphosis or lordosis. He will suggest surgery, braces or crutches when needed. An orthotist will fill the surgeon's prescriptions and work with the child as he grows. In conjunction with the orthotist, a physical therapist will also help carry out the plans made by the orthopedic surgeon and will suggest others designed to strengthen weak muscles.</p> <p>Finally, an occupational therapist may also aid in carrying out the physician's suggestions. She will work primarily with motor coordination and preceptual-motor impairment, and will assist in helping the child adapt to his physical environment in activities. Even with all of these trained experts' help, it is obviously the parents who are chiefly involved in the daily training and care of spina bifida children.</p> <p>I feel fortunate to have been involved, along with my daughter, friends, relatives, and church member volunteers in a program of "patterning" with little Stephen a few years ago. The theory of the program was that an infant's ordinary body movements stimulate brain development through sensory-motor input. Gradually the child's movements become coordinated in cross-patterned crawling, creeping, and walking. By stimulating the body in various ways it was hoped we could "wake up" and condition the pathways to the brain and activate the millions of unused cells within the brain. The method involved artificially recreating patterns of movement in hopes of reaching the brain and having the brain take over these same movements on its own. With three people helping three or four times a day, we helped Stephen and his mother go through his prescribed exercise schedule according to the training his mother had previously received.</p> <p>While some individuals with spina bifida have average or above average intelligence, those who also have hydrocephalus may, as a result, have some degree of mental retardation. The best school placement and curriculum planning will depend also upon physical limitations. The main consideration is mat the child be placed in a flexible situation for effective learning.</p> <p>Since many spina bifida children do have learning problems, teaching must be individualized, based on strengths and weaknesses. This may be possible in a regular classroom, mainstreamed partially, or in a self-contained situation, depending on the severity of the physical condition and the extent of the learning disability.</p> <p>When Stephen was nine years old, he was completing first grade work, and beginning second, at the Fullerton School, in Addison. He was in a structured, protective environment with reinforcement of one full-time teacher and an aide to six or seven students; this was a self-contained room called Orthopedic-Learning Disabilities, with mainstreaming for music and art.</p> <p>Having spina bifida means different things to different people. The actual physical condition varies greatly from person to person. How a person manages in life depends not only on the severity of the actual physical condition, but also upon the support he gets from others, the adaptations in the environment, and most of all, how the person feels about himself. With the tender, loving care and dedication of parents such as Pam and Kent Smith, spina bifida children like Stephen have a chance to grow up, able to cope with their own limitations, and to manage very well in life, feeling good about themselves.</p> <p><b>References:</b></p> <ol> <li>Anderson, Elizabeth M., and Spain, Bernie, <i>The Child With Spina Bifida</i>, London: Methuen and Co. Ltd., 1977.</li> <li>Kieran, Shari Stokes, Ed.D., and Connor, Frances Partridge, Ed.D. "Mainstreaming Preschoolers," <i>Children With Orthopedic Handicaps</i>, U.S. Department of Health, Education, and Welfare.</li> <li>Klein, Stanley D., Ph.D., <i>Psychological Testing of Children</i>. The Exceptional Parent Press, 1977.</li> <li>Lindsay, Carolyn N., M.Ed., <i>An Educator's Guide to Spina Bifida</i>, U.S. Department of Health, Education, and Welfare, 1978.</li> <li>Osman, Betty B., <i>Learning Disabilities, A Family Affair</i>, New York: Random House, 1979.</li> <li>Pieper, Betty, <i>By, For and With . . . Young Adults With Spina Bifida</i>, Chicago: Spina Bifida Association of America, 1979.</li> <li>Pieper, Betty, <i>Sticks and Stones, The Story of Loving a Child</i>, Syracuse: Human Policy Press.</li> <li>Pieper, Betty, <i>The Teacher and the Child With Spina Bifida</i>, Chicago: Spina Bifida Association of America, 1979.</li> <li>Pieper, Betty, <i>When Something is Wrong With Your Baby</i>. Chicago: Spina Bifida Association of America, 1977.</li> <li>Reid, Robert, <i>My Children, My Children</i>, New York: Har-court Brace Jovanovich, 1977.</li> <li>Swinyard, Chester A., M.D., Ph.D., <i>Decision Making and the Defective Newborn</i>, Springfield: Charles C. Thomas, 1978.</li> <li>Swinyard, Chester A., M.D., Ph.D., <i>The Child With Spina Bifida</i>, Chicago: Spina Bifida Association of America, 1977.</li> </ol> Page Number(s) 6 - 8 Year 1984 Volume 8 Issue 4 Review Status Status of review after import from old O&P Library into Omeka platform. Expert Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource What is Spina Bifida? Creator An entity primarily responsible for making the resource Jeannie Gruse  https://staging.drfop.org/files/original/d73a255fee4b364de1484751b0070bc2.pdf f4268f1f8160ca988e58b8d68c70e4d7 https://staging.drfop.org/files/original/9cd3809f346695203e049ecda06076b9.jpg 4a70f8736bfa8404d75ca3f32d5a0525 https://staging.drfop.org/files/original/fe34c6884c1d4f9cd65bd37a903a8070.jpg b70af2800e997203f2319c46296de5b7 https://staging.drfop.org/files/original/30a3a403da09b29c8a7c41ae21ae5364.jpg 8449acd023022b2f713fc97fc94bb381 https://staging.drfop.org/files/original/a6edecd2ad6203347d70e896ca018d83.jpg 9ce2a9f49884881e3a6ed64718708be7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1986_02_082.pdf Text Any textual data included in the document <h2>Voluntary Closing Control: A Successful New Design Approach to an Old Concept</h2> <h5>Bob Radocy, M.S.T.R.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>The arrival in early 1980 of the "Prehensile Hand,"<a></a> a new design and concept for terminal devices, sparked a revitalized interest in body power and voluntary closing control. Voluntary closing control and terminal devices are not new to prosthetics, but little interest in this system and technology has existed since the 1950's. Retrospectively, voluntary closing control never achieved dramatic success nor did it have any permanent, positive influence on the direction of upper-extremity prosthetic development until recently, meaning 1980-1985.</p> <p>The acceptance and success of the "GRIP,"<a></a> (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg"><b>Fig. 1</b></a>) and more recently the children's "ADEPT"<a></a> terminal devices, are strong indicators that voluntary closing control is an extremely viable concept. Furthermore, it confirms previous opinions that poor performance characteristics, reliability factors, and the inappropriate design criteria of early volunteer closing control systems and terminal devices<a></a> were responsible for the demise of voluntary closing systems and correspondingly for the dominance of voluntary "opening" control systems and terminal devices in the profession today.</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg"><strong>Figure 1. (Top to bottom) GRIP I, GRIP II, ADEPT B, ADEPT C, and ADEPT I.</strong></a><br /> <p>This is not to say that voluntary closing devices and systems were not put to excellent use by certain amputees, but that they failed to appeal to the majority of the upper-extremity limb deficient population, i.e. the traumatic or congenitally limb deficient below-elbow unilateral amputee.</p> <p>The standard voluntary opening split hook has continued to be the primary body-powered prescription, while experience now strongly illustrates that correctly designed voluntary closing terminal devices offer superior performance to the limb deficient. Training is no more difficult with voluntary closing; gripping force range is expanded and directly proportional to output, reflex grasping actions are improved, muscles of the affected limb and shoulder are utilized continuously and more effectively, and "feedback" sensations (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.jpg"><b>Fig. 2</b></a>) are produced inherently<a style="text-decoration: none;">*</a> and are more easily assimilated, thereby enhancing control, than in voluntary opening systems.</p> <p>The mere fact that children three to six years of age have accepted the concept and have either learned with or converted to voluntary closing control and achieved good to excellent performance should open the minds of even the most conservative in our profession as to the value of the voluntary closing control prescription.</p> <p>Recently, we have seen and heard a great deal about the success of myoelectric devices for children and how a child's performance is improved with myoelectric systems as compared to "body-powered" systems.<a></a> Unfortunately, body power in these comparisons refers only to the voluntary opening split hook systems, and not to voluntary closing systems. It is my firm belief that, if given proper training, limb deficient children will perform as well or better with voluntary closing body powered systems than with myoelectric systems. Furthermore, considering the cost and reliability of externally powered limbs, voluntary closing body powered terminal devices should be prescribed as the primary complements to external powered units, rather than voluntary opening split hook systems.</p> <p>The logic for this assertion is simple. First, muscles of the torso and limb are used more actively with the voluntary closing system, and healthy, strong muscles can only enhance externally powered control and utilization. Second, the new designs in voluntary closing terminal devices offer an opposed thumb and finger gripping configuration, similar to powered hands, enabling the user to incorporate already "learned" patterns of gripping behavior, rather than having to constantly switch patterns of grasp to accommodate "split hook" prehension. Third, children with voluntary closing systems can achieve gripping prehension which equals or exceeds their anatomical capabilities, while voluntary opening systems remain inferior in this area. Comparable prehension bilaterally can only encourage bilateral function and increase prosthetic usage, two primary goals in prosthetic rehabilitation.</p> <p>The success of voluntary closing systems can be related to the design rationale and criteria of the 80's systems. Rationale and criteria are as follows:</p> <ol> <li> <p>Utilize an accepted natural prehension configuration. Previous studies indicate that cylindrical, palmar, and lateral are the most often used gripping patterns.<a></a> Opposed thumb and forefinger prehension satisfies these patterns.</p> </li> <li> <p>Design gripping shapes and surfaces to allow for a wide variety of holding tasks. Complementary curved gripping surfaces enhance cylindrical control and are especially important due to the vast numbers of curved object surfaces we handle daily (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-3.jpg"><b>Fig. 3</b></a>). Additionally, a "clevis" tip configuration imitates the three point chuck of the thumb, index and long finger, important for utensil and implement control (<a href="http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.jpg"><b>Fig. 4</b></a>).</p> </li> <li> <p>Emphasize a simple, anesthetic, easily maintained, reliable design that can be understood and accepted by the user- a design with positive psychological connotations, reflecting the capability of the user.</p> </li> <li> <p>Incorporate passive support and suspension capacity (internal hook or bump) for carrying objects with handles or for supporting body weight while climbing or hanging.</p> </li> <li> <p>Require continuous control for grasping and holding to discourage muscle atrophy, enhance muscle development and allow for rapid reflexive grasping. Continuous control also creates an uninterrupted flow of pressure feedback information required for performance handling of objects.</p> </li> <li> <p>Select materials suitable for individualized age groups, rather than a single material for all models. Consider both the needs and the characteristics required for each population and design the model accordingly for each targeted group.</p> </li> <li> <p>Consider weight as a factor, but balance the need for light weight against the strength requirements for the terminal device. Also consider the tolerance the need for light weight against cause variation in age and corresponding tolerances vary.</p> </li> <li> <p>Redesign models as necessary to better answer the needs of the population they serve.</p> </li> </ol> <p>Exclusive of these criteria, a variety of factors exist which have aided the reintroduction of voluntary closing systems and which will increase the use of these systems in the future. Compatibility, harnessing, prosthesis design, proper rehabilitation and weight conditioning are all important if good to excellent prosthetic use is to be achieved.</p> <p>Voluntary closing terminal devices are compatible with all standard prosthetic components. Minor cable modifications or adjustments are usually required to optimize the user's energy output. Unlike previous voluntary closing designs, the user is harnessed under "controlled tension" rather than into a "no tension" system. Accordingly the thumb of the terminal device is not fully open, but pulled partially closed when the arms are relaxed at the user's sides. This tension harnessing allows for improved control of objects, during initial training, and while objects are manipulated close to the medial line of the body.</p> <p>Harnessing should be as simple as possible. A modified Northwestern #9 when possible is excellent, utilizing a ring and "rapid adjust" type buckle.<a></a> This harness system will enhance range of motion control at the shoulder, improve object manipulation overhead, and enable quick excursion adjustments.</p> <p>Prosthesis design should lean towards self suspending (supracondylar) sockets to minimize harnessing. Modified Muenster, Otto Bock, and similar designs can be employed depending on the limb's morphology. New designs such as ISNY or similar flexible sockets may also prove valuable. New patients should be educated in range of motion and pre-prosthetic exercise techniques.<a></a> This is especially important for traumatic limb loss and in instances where complete rehabilitation was lacking and the shoulder girdle and upper limb-musculature is weak and atrophied. Similar atrophication can occur due to disuse of the prosthesis or lack of vigorous bilateral use.</p> <p>Initially, muscle soreness at the shoulder may be experienced by the converting amputee, or the new amputee undergoing rehabilitation. This early soreness is a positive sign of muscle rejuvenation and should be regarded as improved health. However, long term muscle aggravation and soreness may be an indicator that the prosthetic system is not operating optimally.</p> <p>Prior to prosthetic fitting and after initial rehabilitation with the new voluntary closing prosthesis, weight training can be encouraged. Pre-prosthetic training can be accomplished by a knowledgeable therapist and should include a range of motion exercises, dynamic tension, and active bilateral resistance exercises using cuff weights, specialized training equipment, or a simple weight harness in conjunction with dumbbells. Post-prosthetically, the voluntary closing terminal device is capable of handling adjustable resistive weight equipment or free weights, although the former are easier to use, safer, and enable rapid, satisfactory results. An emphasis on strength and endurance conditioning rather than muscle building is suggested due to the needs for adequate range of motion in prosthetic control. This dictates lower resistance loads with more repetitions of exercises.</p> <p>Special applications for voluntary closing systems have also arisen in recent years. Brown<a></a> has achieved excellent success in patients with partial hand amputations. The success, I believe, is due to the common sense simplicity of the prosthesis and harness design, and the utility of the terminal device, which allows prehension in excess of 100 lbs. This amount of gripping force enables the partial hand amputee to be functionally bilateral in a manual working environment. Other terminal devices applied to the case of partial hand amputation cannot offer all the advantages of the new voluntary closing systems. Obviously, the partial hand prosthetic user will not wear the prosthesis all the time, but it is an effective functional tool for many occupations. The increased potential may enable the partial hand amputee to maintain an existing vocation rather than consider retraining for an entirely new occupation.</p> <p>In summary, the new voluntary closing systems offer a great deal of potential for the upper-extremity limb deficient of all ages. They can offer superior performance compared to any other systems, body powered or externally powered, and complement the externally powered prescription, when cosmesis is the primary consideration and function considered only of secondary importance.</p> <p>Voluntary closing systems are not a cure-all for the upper limb deficient individual, and the system is not applicable to everyone, even though all types and levels of amputees including bilaterals have used the technology successfully (excluding shoulder disarticulates). Success also has a lot to do with the attitude of the amputee and the capability of the rehabilitation team, including the prosthetist.</p> <p>Voluntary closing systems will continue to increase in popularity because the technology is reliable, improves performance, and more closely imitates the natural system.</p> <p>The voluntary closing systems will also continue to improve as more innovative research and development in better "total" body powered and hybrid body powered/external powered prosthetic technology evolves.</p> <p><b>References:</b></p> <ol> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Trade name of product manufactured by T.R.S., Inc. of Boulder, Colorado.</li> <li>Klopsteg, Paul E. and Philip Wilson, <i>Human Limbs and Their Substitutes</i>. Hafner Publishing Company; New York. 1964. Reprint of 1954 Edition by McGraw Hill Company.</li> <li>Weaver, S.A. and L.R. Lange, "Myoelectric Prostheses versus Body Powered Prostheses with Unilateral, Congenital, Adolescent, Below-Elbow Amputees," American Orthotic and Prosthetic Association National Assembly Scientific Presentation on October 16, 1985.</li> <li>Mann, R.W., "Evaluation of Energy and Power Requirements for Externally Powered Upper-Extremity Prosthetic and Orthotic Devices," American Society of Mechanical Engineers. Publication No. 62-WA-121, 1962.</li> <li>Radocy, Bob, "The Rapid Adjust Prosthetic Harness," Technical Note, <i>Orthotics and Prosthetics</i>, Volume 37, No. 1, pp. 55-56, 1983.</li> <li>Bates, Marion D. and J.C. Honet, "Isometric Exercises for the Upper-Extremity Stump," <i>Physical Therapy</i>, Volume 44, No. 12, pp. 1093-94, December 1964.</li> <li>Deaver, G.G. and E.H. Daniel, "The Rehabilitation of the Amputee," <i>Archives of Physical Medicine</i>, Volume 30, No. 10, p. 638, October 1949.</li> <li>Gullickson, G. Jr., "Exercises for Amputees," <i>Therapeutic Exercise</i>, 2nd Edition. Sidney Licht, Editor, pp. 581-640.</li> <li>Klopsteg, D.E. and P.D. Wilson, <i>Human Limbs and Their Substitutes</i>, Hafner Publishing Co., pp. 739-756, 1968.</li> <li>Reilly, G.V., "Preprosthetic Exercises for Upper Extremity Amputees," <i>The Physical Therapy Review</i>, Volume 31, No. 5, pp. 183-188, May 1951.</li> <li>Olivett, Bonnie L., "Management and Prosthetic Training of the Adult Amputee," <i>Rehabilitation of the Hand</i>, 2nd Edition, C.V. Mosby, 1984.</li> <li>Brown, Russell D., "An Alternative Approach to Fitting Partial Hand Amputees," <i>Orthotics and Prosthetics</i>, Volume 38, No. 1, pp. 64- 67, Spring 1984.</li> <li>Radocy, Bob and Ronald E. Dick, "A Terminal Question," <i>Orthotics and Prosthetics</i>, Volume 35, No. 1, pp. 1-6, March 1981.</li> </ol> <b><em>*Bob Radocy, M.S.T.R. </em></b><em>Bob Radocy, M.S.T.R. is President of Therapeutic Recreation Systems (TRS), Inc. 1280 28th Street. Suite 3, Boulder, Colorado 80303-1797.</em><b><br /><br />Footnote</b> A major objective of externally powered systems is to develop a reliable 'feedback' system for improved prehension control. Voluntary closing, body-powered systems offer the feedback system inherent in the design. Page Number(s) 82 - 86 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-2.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_082/1986_02_082-4.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Voluntary Closing Control: A Successful New Design Approach to an Old Concept Creator An entity primarily responsible for making the resource Bob Radocy, M.S.T.R. * https://staging.drfop.org/files/original/4c1c2659ace14b6587c3c801d470aa96.pdf dbc48fb2203d6c75e5adce812a9b03de https://staging.drfop.org/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg 4c4de5849811d644713ec7230d7d0f02 https://staging.drfop.org/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg 131fef1ae751f64e310d683f6e52c098 https://staging.drfop.org/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg 0ceb64af346708b11b688bc9aec46035 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_005.pdf Text Any textual data included in the document <h2>Vacuum Forming</h2> <h5>Ben Wilson&nbsp;</h5> <p>In an article I wrote in 1974 on vacuum forming of sheet plastics<a></a> I erred in stating that the first reference to vacuum forming of sheet plastics in orthotics and prosthetics was a paper by Gordon Yates in 1968<a></a>. I should have remembered that Dana Street presented this concept in Volume 1 of the Orthopedic Appliances Atlas<a></a> for the fabrication of cervical orthoses. This is certainly an excellent example of how long it takes to get a technological development from the idea stage to fairly widespread application.</p> <p><b><a href="/files/original/97b98628d90aad9bfbaac84c646fe3fe.jpg">Fig. 1</a> Vacuum-forming a shank for a below-knee prosthesis using the hand-drape.</b></p> <p>In the time since my article was published in "Orthotics and Prosthetics" vacuum forming of sheet plastics has been used more and more by private practitioners in both orthotics and prosthetics.</p> <p>Although the educational programs, with a few exceptions, seem to have been very slow in teaching vacuum forming techniques, use of the technique seems to be expanding, owing in part to the several workshops sponsored by the American Academy of Orthotists and Prosthetists.</p> <p>Every process and system has its limitations, and we all recognize that each design in orthotics and prosthetics represents a compromise, but as time goes on the gaps that engender compromise are narrowed as experience is gained.</p> <p>Although the "Orthotics and Prosthetics Clinic Newsletter" has discussed several aspects of vacuum forming in the relatively recent past, in view of what seems to be a rapidly expanding program it seems appropriate that another survey be made concerning the uses of and problems encountered by the private practitioners.</p> <p>A questionnaire on this subject is included in this issue. It will be appreciated greatly if each recipient will complete the enclosed form and add any comments he or she feels that will be helpful in improving service to patients.</p> <p><b><a href="/files/original/9bf2b7836dee688f0bca62bfc38c7209.jpg">Fig. 2</a>. Vacuum-forming thigh section of knee-ankle-foot prosthesis using automatic machinery.<br /><br /><a href="/files/original/27a2d16cac19d4fe68e3aead92053f88.jpg">Fig. 3.</a> Vacuum-forming a below-knee socket with use of a platen and form for holding plastic sheet.<br /></b></p> <h3><b>References:</b></h3> <ol> <li>"Vacuum-Forming of Plastics in Prosthetics and Orthotics," A. Bennett Wilson, Jr., <i>Orthotics and Prosthetics</i>, Vol. 28, No. 1, March 1974.</li> <li>"A Method for the Provision of Lighweight Aesthetic Orthopedic Appliances," Gordon Yates, <i>Orthopaedics</i>, 1:2:153-162, 1968.</li> <li>"Plastic Braces," Dana M. Street; pp. 90-95 in Orthopaedic Appliances Atlas, Edwards Brothers, Ann Arbor, Michigan, 195.</li> </ol> <h3>Additional Bibliography:</h3> <ol> <li> <p>"Fabrication and Application of Transparent Polycarbonate Sockets," Vert Mooney, M.D., Roy Snelson, <i>Orthotics and Prosthetics</i>, Vol. 26, No. 1, March 1972.</p> </li> <li> <p>"Fabrication of Vacuum-Formed Sockets for Limb Prostheses," Roy Snelson, <i>Orthotics and Prosthetics</i>, Vol. 27, No. 3, September 1973.</p> </li> <li> <p>"Report of Workshop on Below-Knee and Above-Knee Prostheses," Hector Kay, June D. Newman, <i>Orthotics and Prosthetics</i>, Vol. 27, No. 4, December 1973.</p> </li> <li> <p>"The Use of Check Sockets in Lower-Limb Prosthetics," Samuel Hammontree, Roy Snelson, <i>Orthotics and Prosthetics</i>, Vol. 27, No. 4, December 1973.</p> </li> <li> <p>"A Thermoplastic Structural and Alignment System for Below-Knee Prostheses," Hans Richard Lehneis, <i>Orthotics and Prosthetics</i>, Vol. 28, No. 4, December 1974.</p> </li> <li> <p>"Development of a Thermoplastic Below-Knee Prosthesis With Quick Disconnect Feature," Charles H. Pritham, <i>Orthotics and Prosthetics</i>, Vol. 28, No. 4, December 1974.</p> </li> <li> <p>"Vacuum-Formed Sockets in Prosthetics Education," Bernard C. Simons, Alan V. Dralle, <i>Orthotics and Prosthetics</i>, Vol. 29, No. 2, June 1975.</p> </li> <li> <p>"Ultralight Prostheses for Below-Knee Amputees," A. Bennett Wilson Jr., Melvin L. Stills, <i>Orthotics and Prosthetics</i>, Vol. 30, No. 1, March 1976.</p> </li> <li> <p>"Use of Thermoplastic Components in Temporary Prostheses," Charles H. Pritham, Ivan E. Letner, David Knighton, <i>Orthotics and Prosthetics</i>, Vol. 30, No. 4, December 1976.</p> </li> <li> <p>"Applications of Transparent Sockets," S.I. Reger, I.E. Letner, CH. H. Pritham, M.D. Schell, and W.G. Stamp, <i>Orthotics and Prosthetics</i>, Vol. 30, No. 4, December 1976.</p> </li> <li> <p>"Above-Knee Polypropylene Pelvic Joint and Band," Erich Fischer, <i>Orthotics and Prosthetics</i>, Vol. 30, No. 4, December 1976.</p> </li> <li> <p>"A Lightweight Above-Knee Prosthesis with an Adjustable Socket," George Irons, Vert Mooney, Sandra Putnam, Michael Quigley, <i>Orthotics and Prosthetics</i>, Vol. 31, No. 1, March 1977.</p> </li> <li> <p>"Welding Plastics," Neil R. Donaldson, Michael J. Quigley, <i>Orthotics and Prosthetics</i>, Vol. 31, No. 1, March 1977.</p> </li> <li> <p>"Functional Partial-Foot Prosthesis," Gustav Rubin, Michael Danisi, <i>Bulletin of Prosthetics Research</i>, BPR 10-16, Fall 1977.</p> </li> <li><a href="http://www.acpoc.org/library/1972_06_003.asp"></a> <p><a href="http://www.acpoc.org/library/1972_06_003.asp">"A Functional Chopart Prosthesis," Gustav Rubin, Michael Danisi, <i>Inter-Clinic Information Bulletin</i>, Vol. 11, No. 6, March 1972.</a></p> <a href="http://www.acpoc.org/library/1972_06_003.asp"></a></li> <li><a href="http://www.acpoc.org/library/1972_10_009.asp"></a> <p><a href="http://www.acpoc.org/library/1972_10_009.asp">"Vacuum-Forming Techniques &amp; Materials in Prosthetics &amp; Orthotics," Alex Artamonov, <i>Inter-Clinic Information Bulletin</i>, Vol. 11, No. 10, July 1972.</a></p> <a href="http://www.acpoc.org/library/1972_10_009.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <p><a href="http://www.acpoc.org/library/1975_04_011.asp">"A Foot Amputation Orthosis-Prosthesis," H.J. Ruben-stein, G.J. Sweeney, P. Strong, G. Durrett, <i>Inter-Clinic Information Bulletin</i>, Vol. 14, No. 4, April 1975.</a></p> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li><a href="http://www.acpoc.org/library/1975_04_011.asp"></a> <p><a href="http://www.acpoc.org/library/1975_04_011.asp">"Partial Foot Amputation-A Case Study," Charles H. Pritham, <i>Newsletter. . . Prosthetics and Orthotics Clinics</i>, Vol. 1, No. 3, Summer 1977.</a></p> <a href="http://www.acpoc.org/library/1975_04_011.asp"></a></li> <li> <p><i>Manual for an Ultralight Below-Knee Prosthesis</i>, A. Bennett Wilson, Jr., Charles H. Pritham, Melvin L. Stills, Rehabilitation Engineering Center, Moss Rehabilitation Hospital-Temple University-Drexel University (1977).</p> </li> <li> <p><i>The Rancho Ultralight Below-Knee Prosthesis</i>, Michael Quigley, George Irons, Neal Donaldson, Rehabilitation Engineering Center, Rancho Los Amigos Hospital County of Los Angeles, University of Southern California (1977).</p> </li> </ol> Page Number(s) 5 - 6 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1978_04_005/1978_04_005-3.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Vacuum Forming Creator An entity primarily responsible for making the resource Ben Wilson  https://staging.drfop.org/files/original/dd8db7616001226c18971be2d8fcd283.pdf 1ad480aad4abe8298ef123b76f395b42 https://staging.drfop.org/files/original/d5b8d44b32ee77a3f0a1323a80a9afcc.jpg 2d03a3805b271567b07dc8e3a894f760 https://staging.drfop.org/files/original/beabbcc10d39750ad0df0029737fbb9a.jpg 2c4cecf0a116c3038089460eeeb1656d https://staging.drfop.org/files/original/eab5312062924db051a8886268065332.jpg 9a0e042d67cb98394cd3911b39aa9ef8 https://staging.drfop.org/files/original/6a6cd46dbbb7e7a257b0eb28b50d3729.jpg d75170a96119542a41e69cf1cdd9e7c9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1986_01_038.pdf Text Any textual data included in the document <h2>Use of a Bivalved Thoracic Suspension Jacket in the Orthotic Seating Management of Severe Arthrogryposis Multiplex Congenita</h2> <h5>Carrie L. Beets, CO.&nbsp;<a style="text-decoration: none;">*</a><br />Louis Whitfield, R.T. (O)&nbsp;<a style="text-decoration: none;">*</a><br />Jan Minnich, L.P.T.&nbsp;<a style="text-decoration: none;">*</a><br />J. Leonard Goldner, M.D.&nbsp;<a style="text-decoration: none;">*</a></h5> <h3><br />Introduction</h3> <p>The thoracic suspension orthosis<a></a> was developed to aid in the management of patients with neuromuscular disease and has been used primarily in individuals with myelodysplasia. The principle of the device is to use the rib cage as a weight bearing structure and thus provide improved seating posture for the patient while attempting to limit spinal deformity and relieve excess ischial pressure. Additional benefits include improvement of balance and mobility and freeing of the hands and arms for feeding and other activities of daily living. The body image of the patient is improved while seated in a wheelchair, and the patient may interact better with the environment.</p> <p>The thoracic suspension orthosis should be considered for those patients who cannot tolerate surgery or when surgery should be delayed until they reach maturity.</p> <p>The patient presented in this paper does not fit the usual criteria for use of a thoracic suspension orthosis. The needs of this patient went beyond those provided by usual orthotic seating devices and led to the adaptation of established techniques and development of a different design to provide a functional seating arrangement for a severely involved child who had failed with other custom seating devices.</p> <p>This seven year old girl with severe generalized arthrogryposis multiplex congenita had functional limitation in the upper extremities and no voluntary action in the lower extremities. Surgical releases of soft tissue contractures and proximal and distal femoral osteotomies had been performed to adapt the patient to a sitting position. Past attempts to provide molded seating inserts to allow a comfortable sitting position had failed. She was most functional supine in a custom designed and portable bed-like seating insert which permitted feeding.</p> <p>Examination of the child revealed severe muscle atrophy of both upper extremities. There was active elbow extension but no active flexion. She was able to get her left hand to within several inches of her mouth by abducting and forward flexing her shoulder and then allowing gravity to bring her hand to the mouth.</p> <p>The spine revealed right thoraco-lumbar scoliosis, thoracic kyphosis, fixed lumbar lordosis, and a fixed pelvic obliquity in which the left pelvic brim was higher than the right.</p> <p>The left hip had a range of motion from 30 degrees flexion to about 90 degrees for a total of 60 degrees of flexion, with an external rotation deformity. The right hip was fixed in +20 degrees flexion. Both knees had flexion contractures of 70 degrees with 10 degrees motion.</p> <p>In order to flex the right femur for sitting, a subtrochanteric osteotomy had been performed with creation of a silicone capped pseudoarthrosis. While this was relatively successful, pain occurred when the patient was placed in a sitting position with any weight bearing occurring on the right ischium. For this reason, she was evaluated for use of a thoracic suspension orthosis.</p> <p>The patient was initially placed in a plaster cast thoracic suspension jacket for a three week trial. During this time, the periods of suspension were gradually increased. Her skin was not accessible for monitoring; however, since she had normal sensation and was cooperative, we depended on her complaints of pain to assess the support. She tolerated the three week trial period and experienced no skin breakdown or abrasion. At that time, a cast impression was taken for the fabrication and fitting of a thoracic suspension orthosis.</p> <h3>Fabrication And Fitting</h3> <p>Due to the lack of spinal flexibility, the need for easy and accurate application of the orthosis, and the need to make the device as simple as possible for the parents; a bivalved design was chosen rather than the traditional single anterior opening. The bivalved design (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg"><b>Fig. 1</b></a>) necessitated fabrication of two plastazote™ linings complete with conventional additional plastazote™ layers over the inferior costal margins. Special attention was needed to insure that the anterior and posterior halves of the two linings matched up accurately during the vacuum forming process (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg"><b>Fig. 2</b></a>).</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg">Figure 1.</a> Lateral view of bivalved thoracic suspension orthosis showing anterior shell trimlines.</strong><br /><br /><strong><a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg">Figure 2.</a> View from above, the anterior and posterior linings match up to provide an even pressure just distal to the lateral and anterolateral inferior costal margins.</strong><br /> <p>The suspension spools were incorporated into the posterior shell, which was fabricated of low density polyethylene. High density polyethylene was chosen for the anterior shell, as it was felt that the additional rigidity provided by this material would be needed to maintain the integrity of the circumferential containment of the jacket under weight bearing. A large abdominal opening was provided in the anterior shell because the patient had experienced some distress in the plaster jacket, especially following meals, which had been relieved by the addition of an opening in the plaster cast (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg"><b>Fig. 3</b></a>). The two half shells were held in place as a unit with Velcro® closures.</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg">Figure 3.</a> Anterior view of bivalved thoracic orthosis showing abdominal opening.</strong><br /> <p>Fitting of the orthosis was followed by an in-hospital program of gradually increasing wearing time both in the nonsuspended and suspended states. Her original supine positioning device was modified to permit her to lie in this with the thoracic suspension jacket on, eliminating the need to take off the jacket between periods of suspension. Since she could not tolerate any weight bearing on her right hip, the suspension brackets on the wheelchair were positioned for full weight bearing suspension. She tolerated the conditioning program well. At the time of discharge, she was wearing the jacket all day long and was tolerating uninterrupted suspension for periods of two and one-half hours. Her electric wheelchair was outfitted with a chin operated joy stick control (<a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.jpg"><b>Fig. 4</b></a>). While suspended, she could operate the wheelchair well. However, at the end of two and one-half hours in suspension, the patient would begin to complain of discomfort and would be transferred to her supine positioning device.</p> <strong><a href="http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.jpg">Figure 4.</a> Patient sitting in suspension in wheelchair.</strong><br /> <h3>Conclusion</h3> <p>The application of a thoracic suspension jacket is a way of successfully providing a functional sitting position for a patient with severe arthrogryposis. In conjunction with a modified electric wheelchair, the patient was given an opportunity to interact actively with her environment, including a vertical position for eating.</p> <p>The bivalved design not only affords easy application and removal, but also permits visual monitoring of the skin. The crucial circumferential containment in the area of and just distal to the inferior costal margin was maintained satisfactorily with a bivalved design.<br /><br /><em><b>*J. Leonard Goldner, M.D. </b>J. Leonard Goldner, M.D., was former Chief of Orthopedics, Division of Orthopedic Surgery, Duke University Medical Center.<br /><br /><b>*Jan Minnich, L.P.T. </b>Jan Minnich, L.P.T., is with Lenox Baker Children's Hospital, Durham, North Carolina.<br /><br /><b>*Louis Whitfield, R.T. (O) </b>Louis Whitfield, R.T.(O), is with the Department of Prosthetics and Orthotics at Duke University Medical Center.<br /><br /><b>*Carrie L. Beets, CO. </b>Carrie L. Beets, CO., is with the University of Virginia. She was formerly with the Duke University Medical Center at the time of submission of this article.</em></p> <p><b>References:</b></p> <ol> <li>Drennan, J.C.; Renshaw, T.S., and Curtis, B.H., "The Thoracic Suspension Orthosis," <i>Clinical Orthopaedics and Related Research</i>, No. 139, March/April, 1979, pp. 33-39.</li> <li>Drennan, J.C., <i>Orthopedic Management of Neuromuscular Disorders</i>, J.B. Lippincott Co., Philadelphia, p.83.</li> <li>Fillauer, C.E.; and Pritham, CH., "The Thoracic Suspension Jacket-Review of Principles and Fabrication, <i>Orthotics and Prosthetics</i>, Vol. 38, No. 1. Spring, 1984, pp. 36-44.</li> </ol> Page Number(s) 38 - 41 Year 1986 Volume 10 Issue 1 Figure 1 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-1.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-2.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-3.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_01_038/1986_01_038-4.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Use of a Bivalved Thoracic Suspension Jacket in the Orthotic Seating Management of Severe Arthrogryposis Multiplex Congenita Creator An entity primarily responsible for making the resource Carrie L. Beets, CO. * Louis Whitfield, R.T. (O) * Jan Minnich, L.P.T. * J. Leonard Goldner, M.D. * 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://www.3d4e.org/freehand Contact Name/Title Madelina Pratt - Director Address 3670 Trousdale Pkwy City Los Angeles State/Province California Countries Served USA Postal Code 90089 Email 3d4e.freehand@gmail.com Services Provided Prosthetic Fitting, Medical Equipment / Supplies, Adaptive Mission Printing customizable 3D- printed prosthetic hands free of charge for children in need in the Los Angeles area Additional Info & Comments "The prostheses that we assemble are all based on digital 3D model files created by Enabling the Future, an organization dedicated to promoting the usage and distribution of 3D printed prostheses. If you would like to learn more about them, their website can be found at http://enablingthefuture.org/. " Facebook Page https://www.facebook.com/usc3d4e/ Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. 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Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1987_03_131.pdf Text Any textual data included in the document <h2>Upper-Extremity Prosthetics: Considerations and Designs for Sports and Recreation</h2> <h5>Bob Radocy&nbsp;<a style="text-decoration: none;">*</a></h5> <p>The population of upper-extremity amputees, including congenitally limb-deficient persons, in the United States and abroad is placing increased demand upon the profession for improved prosthetic designs and devices which will allow its members to participate competitively in sports and recreation activities.<a></a> Recreation trends indicate that these demands will most likely increase.</p> <p>Until recently, prosthetics did not directly address the needs of the sports-oriented amputee. Prosthetic designs focused on domestic and vocational needs and did not necessarily target the criteria necessary to perform in the vigorous environments of sports or recreation. Over the years, select prosthetists working with individual amputees have developed "one of a kind" sports devices for their patients. These devices sometimes proved adequate, but most were never made available commercially.</p> <p>Two commercially available sports terminal devices have been available for many years: the Baseball Glove Attachment and the Bowling Attachment.<a></a> Recently, other specialized prosthetic devices have become available to meet the sports-minded amputee's needs. These are the SUPER SPORTs,<a></a> Amputee Golf Grip,<a></a> and the Ski Hand.<a></a> Additionally, new variations in the designs of body-powered terminal devices are allowing amputees to participate in many sports activities without the need for specialized aids or radical modifications.<a></a></p> <p>The measure of performance by the amputee in any activity, as always, depends upon proper limb design. Socket design, materials, alignment, and components all play a vital role in any amputee's ability to perform competitively. Another important factor is the amputee's physical condition. The prosthesis, no matter how well designed and constructed, cannot supplement atrophied muscle, limited range of motion, or inadequate strength.</p> <p>Sports prosthetics begins with the evaluation of the need and of the capacity of the amputee being served. A physical therapist and potentially a clinic physician will be important components in the rehabilitation of an amputee wishing to become active in sports and recreation.</p> <p>Exercise and conditioning with or without a prosthesis will be required as a preliminary step for an amputee who wishes to excel without injury in sports. Exercise can take multiple forms. Proven exercise techniques exist. Isometric, isotonic, and passive and active resistance all have specific goals and methods. Education is required so that the amputee is knowledgeable about how to proceed with an exercise program and to determine the objectives, i.e. is muscle hypertrophy (bulk) required for strength or is muscle endurance more appropriate? Additionally, how are flexibility and range of motion impacted?</p> <p>Preprosthetic exercise may be required or desired. Weight harnesses<a></a> (<b>Figs. 1, 2, and 3</b>) rather than strap or cuff weights are a better way to approach exercise without a prosthesis. A properly designed harness will prevent weight slippage during exercise and will enable many variations of upper-extremity conditioning (<b>Figs. 4, 5, and 6</b>).</p> <strong>Figures 1, 2, and 3. Weight harnesses, rather than strap or cuff weights, are a better way to approach exercise without a prosthesis.</strong><br /><br /><strong>Figures 4, 5, and 6. A properly designed harness will prevent slippage during exercise and will enable many variations of upper extremity conditioning.</strong><br /> <p>Bilateral exercise using a dumbbell on the non-affected side is important to maintain muscle balance and reduce spinal stress. A full length mirror aids the amputee in viewing him or herself in order to correct postural deficiencies or extraneous movements to optimize resistance exercise efforts.</p> <p>Certain weight machines also allow for non-prosthetic exercise, but exercise will be limited to specific muscle groups (<b>Fig</b><strong>s. 7, 8, 9, and 10</strong>). Complete upper-body conditioning will be most effectively accomplished while wearing a prosthesis. Furthermore, exercise while wearing a prosthesis will help condition the residual limb to the skin stresses and shears a prosthesis will create when under load. Modern exercise equipment systems, such as Nautilus, Hydra-Fitness, and Universal, are available virtually everywhere in YMCAs, community recreation centers, health and sports clubs. A planned program for the amputee can be structured by professional instructors to the amputee's goals. Free weights are another alternative or can complement a weight conditioning program with the convenience of low cost and home use. Equipped with a proper terminal device (<b>Fig. 11</b>), an arm amputee can safely handle dumbbells or barbells in weight training.</p> <strong>Figures 7, 8, 9, (above) and 10 (right). Certain weight machines also allow for non-prosthetic exercise, but exercise will be limited to certain muscle groups.</strong><br /><br /><strong>Figure 11. Amputee lifting dumbbell with a terminal device.</strong><br /> <p>Proper conditioning balanced by flexibility achieved through passive stretching, aerobics or any number of alternatives will result in the range of motion and strength an amputee will need for high performance in sports and recreation. A regular conditioning program will especially enhance the use of body-powered prostheses which require activation through body-controlled movements.</p> <p>Sound limb design, mentioned previously, is a major component in an amputee's performance potential. Lightweight yet strong prostheses are ideal, but strength should not be sacrificed just to achieve reduced weight. Socket design is dictated to a certain extent by stump configuration, but it is the author's belief that, if at all possible, a supra-condylar socket should be used.<a></a> Supra-condylar sockets with all their variations (Muenster, Bock, etc.) have evolved rapidly with advances in electromechanical limbs. A supra-condylar socket need not be unduly restrictive, and such a limb allows for less complicated harnessing.</p> <p>Carbon fiber and acrylic resins are two materials which lend well to the lightweight but high strength prosthetic objectives. Socket padding,<a></a> whether fully or partially lined, aids in protecting the condyles, olecranon, and distal residual limb end from trauma. If adequately reinforced, ISNY<a></a> style sockets may prove to be applicable for sports as well, but the published data on below-elbow applications is scarce.</p> <p>In addition to padding, the author recommends a heavy residual limb sock or two regular weight socks for most sports activities. Highly absorbent terry lined socks (designed for athletic footwear) are excellent. A polypropylene sock can be used effectively as a liner if heavy perspiration is a problem.</p> <p>An adjustable excursion harness,<a></a> such as the modified Northwestern (<b>Fig</b>. <strong>9</strong>) which allows for excellent range of motion and terminal device control, can be applied, although other designs will work. Rapidly adjustable excursion is a plus for actuation of voluntary closing terminal device systems and in sports where gross motion of the arms is required, i.e. archery, golf, baseball, etc. Cable efficiency may also be targeted for consideration. Several experienced amputees known to the author wax the stainless steel cables before assembly into the cable housing. The wax is clean and reduces cable to cable housing friction, thus improving efficiency.</p> <p>Alignment of the prosthesis on the residual limb also requires consideration, depending upon the amputee's sports needs. Preextended, as opposed to pre flexed, socket designs have useful applications in sports. They allow for full elbow extension while limiting flexion only slightly and usually not unacceptably. Wrist alignment is also of consequence and affects the manner in which the prosthesis torques on the residual limb when load is applied. It is important to emphasize the need for prosthetists to be concerned with dynamic forces on the prosthesis. A mere static fitting with a check socket will not suffice because it doesn't accurately duplicate what will occur in the definitive prosthesis. A secondary fitting session with a foamed, but unlaminated, prosthesis donned and the chosen wrist unit and terminal device in place can determine the optimum alignment of the components. Changes can be made accordingly and retested so that the definitive prosthesis will fit correctly. Testing the prosthesis in this manner will also determine if undesirable trim lines exist in the socket or whether extended padding is required. A supra-condylar fit socket on short residual limbs can cantilever on the epicondyles and cut in proximal to the olecranon when the prosthesis is loaded distally making it impossible to carry any significant load (<b>Fig. 12</b>). Extending the trim line can direct pressures to the back of the humerus instead of into the joint.</p> <strong>Figure 12. A supra-condylar fit socket with an undesirable trim line.</strong><br /> <p>Two other techniques which can aid in creating a more suitable sports prosthesis are external padding and suspension sleeves. Nylon covered neoprene rubber, such as a diver's wet suit material, is readily available and makes an excellent "stretch to fit" cover for a prosthesis (<b>Fig. 13</b>). Thicknesses from 3 mm to 1/4" are available. The material provides a good cushion for contact sports, helps reduce limb trauma during a fall, and the thicker materials have enough bouyancy to float a prosthesis. This technique has satisfied the requirements for a padded prosthesis in several school systems around the country.</p> <strong>Figure 13. Nylon covered neoprene rubber, such as a diver's wet suit material, is readily available and makes an excellent "stretch to fit" cover for a prosthesis.</strong><br /> <p>Suspension sleeves can improve a supracondylar fit, especially when using a passive recreational device where the cable is absent or does not play a role in prosthetic suspension. Both latex and neoprene sleeves designed for below-knee amputees are available and can be modified for upper-extremity use simply by cutting them down in length (<b>Fig. 14</b>). The advantages of using a commercially available below-knee sleeve is that angulation for a joint is already built in. The author prefers neoprene due to its durability. Both cause increased perspiration within the socket. Designed properly, a neoprene prosthetic cover can function as a suspension sleeve as well.</p> <strong>Figure 14. Both latex and neoprene sleeves designed for below-knee amputees are available and can be modified for upper extremity use.</strong><br /> <p>The remainder of this article will focus on modifications for specific sports and recreation to which the author has been exposed either directly or indirectly. In some cases, the solutions are simple; in others, performance dictates a more complex technical solution. Photographs and drawings have been used as often as possible rather than the written descriptions to illustrate a modification, device, or technique. Activities are dealt with alphabetically for convenience sake.</p> <h3>Archery</h3> <p>Modern archery equipment is easily adaptable to certain types of terminal devices. <b>Fig. 15</b> illustrates how a bow riser (handle) can be wrapped with consecutive layers of rubber, foam, and bicycle inner tube to create a durable, functional bow grip.<a></a> A chuck or pin can be used to jam the thumb of the terminal device closed around the riser or the amputee can just "hold on" as illustrated by <b>Fig. 16</b>.<a></a> Performance capabilities are exemplified by the amputee archer in this photo. He is a skilled hunter who has harvested three deer in a four year period.</p> <strong>Figure 15. A bow riser (handle) can be modified to create a functional bow grip.</strong><br /><br /><strong>Figure 16. An amputee can simply hold on to the bow as shown.<br /></strong><br /> <h3>Basketball, Soccer, Volleyball, and Football</h3> <p>Until recently, aids for amputees in ball-sports were limited to padded hooks, cosmetic hands, and custom one-of-a-kind terminal devices. Although these devices were useful, they rarely provided the type of high performance characteristics the sports-minded amputee required to compete successfully.</p> <p>One possible answer or solution is now available. The SUPER SPORTs devices, sized for all ages, are designed specifically for ball-sports and other rigorous recreations in which hand/wrist flexion/extension is needed. Additionally, they absorb shock as well as store and release externally applied energy (<b>Figs. 17, 18, and 19</b>). SUPER SPORTs are passive, not cable activated, but are helpful in catching and ball control when used in opposition to an anatomical hand or another device. SUPER SPORTs combined with padded arm covers create a safe, effective prosthesis for sports, such as football, basketball, and soccer in which interpersonal contact is inevitable.</p> <strong>Figures 17, 18 and 19. The SUPER SPORTs devices sized for all ages, designed specifically for ball sports and other rigorous recreations in which hand/wrist flexion/extension is needed.<br /></strong><br /> <h3>Bicycling, Tricycling, and Motorcycling</h3> <p>Bicycling or tricycling has proven to be an aggravation for amputees equipped with conventional style hooks. Lack of adequate gripping strength and finger shapes have hampered performance. Presently, however, children and adults equipped with newer style voluntary closing terminal devices (<b>Figs. 20 and 21</b>) can control two or three wheeled cycles as well as their two-handed peers. No modifications are required except when hand brakes are present. Front and rear brakes can be actuated from a single hand lever. Brake pressure must be regulated so that braking forces are always applied to the rear wheel first for safe handling. Your local bicycle shop can usually solve hand brake complications.</p> <strong>Figures 20 and 21. Children and adults equipped with newer style voluntary closing devices can control two or three wheeled cycles as well as their two handed peers.</strong><br /> <p>Special adapters have been designed for or by individuals interested in competitive bicycle racing (<b>Fig. 22</b>).<a></a> The prototype illustrated is simple and is designed for safety to "quick disconnect" or "break away" at certain levels of force.</p> <strong>Figure 22. Special adapter for use in bicycle racing.</strong><br /> <p>Motorcycling is a natural extension of bicycling. Again, hand brakes and, in this case, a clutch hand lever complicate the situation. Unilateral amputees missing their left hands can shift and clutch with one hand with practice. Brakes again can be combined. A single foot lever is practical for driving dual master cylinders for hydraulic brakes. The rear wheel braking must occur first however. A local motorcycle mechanic or custom motorcycle shop can provide ideas or adaptations and modifications to standard equipment.</p> <h3>Canoeing and Kayaking</h3> <p>The author's experience with conventional terminal devices proved frustrating during these types of recreation. Split hook finger shapes did not adequately adapt to a paddle or oar. Lack of prehension inhibited the bilateral arm function required for these activities. Locking type terminal devices should never be used in water sports activities. <b>Figs. 23 and 24</b> illustrate how new technology and minor modifications to paddles can overcome problems in canoeing.</p> <strong>Figures 23 and 24. New technology and minor modifications to paddles can overcome problems in canoeing.</strong><br /> <p>Kayaking (<b>Fig. 25</b>) with a double-bladed paddle requires only coordination and practice. Rubber rings on the paddle which are used to keep water off the central shaft work equally well in preventing terminal device slippage.</p> <strong>Figure 25. Kayaking with a double-bladed paddle requires only coordination and practice.</strong><br /> <p>Gross arm movements, such as paddling or rowing, inherently activate voluntary closing devices and keep them closed. Rowing using an oar and oar lock can be enhanced by adding a stop or flange to the oar handle to prevent the terminal device from inadvertently pulling off during a power stroke.</p> <h3>Dance/Floor Exercise and Gymnastics/Tumbling</h3> <p>Activities, such as dance, tumbling and floor exercise gymnastics, have been treated similarly to ball sports in the past due to a lack of specialized terminal devices that were readily available. Padded hooks, cosmetic hands and some custom pedestal style terminal devices have been applied to attempt to satisfy the amputees' needs for balanced bilateral function. <b>Fig. 26</b> illustrates how the SUPER SPORT terminal devices can be applied to satisfy these specialized recreation niches.</p> <strong>Figure 26. SUPER SPORT terminal devices can be applied to satisfy specialized recreation niches.<br /></strong><br /> <h3>Fishing</h3> <p>Fishing is a sport and pastime everyone has access to and should be able to enjoy. Amputees using split hooks who wish to have improved control of reels might want to consider the Ampo Fisher I<a></a> which adapts to their prosthesis and reel (<b>Fig. 27</b>).</p> <strong>Figure 27. Amputees using split hooks may want to consider the Ampo Fisher I which adapts to their prosthesis and reel.</strong><br /> <p>Another alternative for the high level amputee is the Royal Bee Electric Retrieve Fishing Reel system (<b>Fig. 28</b>).<a></a></p> <strong>Figure 28. The Royal Bee Electric Retrieve Fishing Reel systems.</strong><br /> <p>Amputees equipped with voluntary closing terminal devices do not require many modifications to fish. A handle modified with some rubber inner tube or tape is usually all that is required to operate a spinning or bait casting reel, due to the improved prehension of these types of terminal devices (<b>Figs. 29 and 30</b>).</p> <strong>Figures 29 and 30. A handle modified with some rubber inner tube or tape is usually all that is required to operate a spinning or bait casting reel.</strong><br /> <p>Casting with a prosthesis is awkward due to lack of wrist flexibility. Amputees usually control the pole with their natural hand then switch hands to reel or reel with the terminal device. Most reels are available in left and right handed models to suit various physical conditions.</p> <p>Fly fishing poses more of a challenge due to the two-handed dexterity required in handling the fly line. One alternative is the Fly Fishing Reel for Amputees<a></a> (<b>Figs. 31 and 32</b>). This system has been used successfully, although the author feels there is still a need for improved alternatives.</p> <strong>Figures 31 and 32. The Fly Fishing Reel for Amputees.</strong><br /> <p>Automatic fly reels have been experimented with unsuccessfully due to the difficulties involved in "pulling out line" to wind up the return spring in these reels. Additionally, it was discovered that the spring force was only sufficient to pull in slack line, not with line under drag or a fish engaged.</p> <h3>Golf</h3> <p>Due to its popularity, golf has rules (USGA 14-3/15) regarding artificial limbs established by U.S. Golfing Association for tournament play.</p> <p>Variations in golf aids have evolved over the years primarily as individual designs to suit specific amputee's needs. Recently, however, a device called the Amputee Golf Grip (AGG)<a></a> has been introduced. The AGG is a standardized manufactured product which meets the USGA requirements (<b>Figs. 33 and 34</b>). The device is somewhat similar to the Robin-Aids Golfing device<a></a> (<b>Figs. 35 and 36</b>). Both devices utilize a flexible member to attach to the prosthesis and do not require club modification. They allow for <i>complete</i> wrist/club flexion and extension. The Amputee Golf Grip also allows for unrestricted rotation.</p> <strong>Figures 33 and 34. The Amputee Golf Grip is a standardized manufactured product which meets the USGA requirements.</strong><br /><br /><strong>Figures 35 and 36. The Robin-Aids golfing device.</strong><br /> <p>Other attempts to produce a functional aid should also be noted. One custom device is designed to have clubs attach directly to the prosthesis (<b>Fig. 37</b>).<a></a> Similarly, another model, the Atkins Golf Aid,<a></a> also attaches into the end of the club, but uses a ball-socket swivel. The swivel allows for a limited degree of wrist/ club, flexion/extension, and complete rotation.</p> <strong>Figure 37. A custom device designed to have clubs attach directly to the prosthesis.</strong><br /> <p>The author has tried several devices and prefers those that do not require club modification and which provide for total flexion/extension/rotation at the wrist/club interface. This allows for a complete back swing and smooth follow through capability.</p> <p>It is important to note that certain of these designs function more easily with one hand than another and must be played cross-handed for opposite side amputations.</p> <h3>Guns/Hunting</h3> <p>Almost any amputee can redevelop the skills necessary to handle a firearm safely with some simple gun modification. In many cases, a standard military sling can prove useful for handling a rifle. Another technique is to add a ring to a forearm sling mount which can then be grasped or engaged with a terminal device. Improved control can be created by adding a custom pistol grip to the forearm of the rifle or shotgun (<b>Figs. 38 and 39</b>). This modification will even allow for the safe operation of pump style shotguns or rifles. Consult with your local gunsmith for help in this regard as he has the knowledge and the tools to perform the modifications correctly.</p> <strong>Figures 38 (above) and 39 (left). Improved control can be created by adding a custom pistol grip to the forearm of the rifle or shotgun.</strong><br /> <p>Terminal devices can be used to trigger guns as illustrated in <b>Fig. 40</b>, but practice is obviously important.</p> <strong>Figure 40. Terminal devices can be used to trigger guns, but practice is obviously important.</strong><br /> <p>Other modifications/aids like the Blevin's gun yoke (<b>Fig. 41</b>) illustrate what inexpensive devices amputees have designed for themselves to regain access to a favorite recreation.</p> <strong>Figure 41. The Blevin's gun yoke illustrates what inexpensive devices amputees have designed for themselves.</strong><br /> <p>Persons with higher level amputations, multiple leg/arm amputations, strokes, or paralysis resulting in para or quadreplegia can also participate in shooting and hunting. Many states have now legalized hunting from parked vehicles to aid severely disabled sportsmen. Additionally, devices such as the SR-7721 (<b>Fig. 42</b>) or home-made Para-Quad Shooting System<a></a> (<b>Fig. 43</b>) offer capabilities not easily accessed in the past.</p> <strong>Figure 42. The SR-77.</strong><br /><br /><strong>Figure 43. The Para-Quad shooting system.</strong><br /> <p>One final design illustrates how an over and under shotgun can be modified to shoot one handed (<b>Fig. 44</b>).</p> <strong>Figure 44. An over and under shotgun modified to shoot one-handed.<br /></strong><br /> <h3>Hockey</h3> <p>A terminal device for hockey<a></a> (<b>Fig. 45</b>) developed in Canada is an ingenious aid for the hockey enthusiast. It is composed of an adjustable tension ball socket which fits with an adaptor onto the end of a hockey stick. The design allows for the stick to pivot under external force and quick release/flex during a fall. The original model pictured was custom designed for the young hockey player, but if modified with stronger materials, it would be applicable to adults as well.</p> <strong>Figure 45. A terminal device for hockey developed in Canada.<br /></strong><br /> <h3>Mountaineering</h3> <p>Mountaineering is a less accessible, less popular sport for most of the population, but it does attract enthusiasts and disabled persons. <b>Figs. 46 and 47</b> illustrate the author during a technical climbing training session. Voluntary closing devices, because of their ability to grasp rope and control gripping force, have proved useful to mountaineering. Instruction and guidance by professional climbing instructors is a must, and "safety first" procedures are always dictated.</p> <strong>Figures 46 and 47. The author during a technical climbing training session.<br /></strong><br /> <h3>Music</h3> <p>Information and devices to aid amputees playing instruments is scarce. Recently, however, information on a new guitar prosthesis was published in Canada<a></a> (<b>Fig. 48</b>). Dan Roy, the guitarist, in conjunction with specialist Armand Viau have developed a prosthesis which allows Roy to use his shoulder to strum the guitar. The arm is lighter than a conventional prosthesis and can hold a guitar pick.</p> <strong>Figure 48. A new prosthesis which enables guitarists to strum their instrument using their shoulders.</strong><br /> <p>Figures <b>Figs. 49 and 50</b> illustrate how some newer terminal devices, such as the ADEPT,<a></a> have proved to be viable solutions for children wishing to "play" musician.</p> <strong>Figures 49 and 50. Newer terminal devices, such as the ADEPT, have proved to be viable solutions for children wishing to "play" musician.</strong><br /> <h3>Photography</h3> <p>Custom photography and camera adapters have been fabricated for years. Now a device called the Amp-u-Pod<a></a> (<b>Fig. 51</b>) is a standardized, manufactured product which has proved to be an extremely effective aid for the amputee photographer. Designed to replace the amputee's regular terminal device, the Amp-u-Pod mounts directly to the prosthesis and adapts to any 35mm, movie, or video camera equipped to receive a tripod.</p> <strong>Figure 51. The Amp-u-Pod has proven to be extremely effective for amputee photographers.<br /></strong><br /> <h3>Sailing</h3> <p>Amputees are less restricted in this recreation, but handling rope lines and other types of sailing gear can place demands on the sailor to have two-handed capabilities. <b>Fig. 52</b><a></a> illustrates a triple amputee who found a GRIP<a></a> terminal device to be one of his best assets for sailing.</p> <strong>Figure 52. A GRIP terminal device used for sailing.<br /></strong><br /> <h3>Snow Skiing</h3> <p>Amputees have experimented with a number of ways to attach a ski pole to a prosthesis with little functional success. The Ski Hand<a></a> (<b>Fig. 53</b>) is the first standardized manufactured terminal device designed specifically for skiing. Available in varying sizes, the amputee force fits the Ski Hand over a ski pole after removing the standard hand grip. The Ski Hand proved worthwhile for cross-country skiing where upper-body strength is required for propulsion. During downhill skiing, the author found the device of less advantage due to the shallow angle to which the pole enters the hand. The pole basket had a tendency to drag in the snow and was therefore more difficult to control. Novice skiers, however, will find the Ski Hand useful because it enhances maintaining balance and getting up after a tumble.</p> <strong>Figure 53. The Ski Hand.<br /></strong><br /> <h3>Swimming</h3> <p>Swimming for many upper-limb amputees requires no aid whatsoever. However, for those individuals who wish to perform better or compete in the water, several devices have evolved as custom, one-of-a-kind solutions. The Viau-Whiteside Swimming Attachment<a></a> (<b>Fig. 54</b>) and the P.O.S.O.S./Tablada Swimming Hand Prosthesis<a></a> (<b>Figs. 55 and 56</b>) are two with which the author is most familiar, although others may exist.</p> <strong>Figure 54. The Viau-Whiteside swimming attachment.</strong><br /><br /><strong>Figures 55 and 56. The P.O.S.O.S./Tablada Swimming Hand Prosthesis.</strong><br /> <p>The Tablada hand is flat rather than curved to prevent submarining of the prosthesis during pre-stroke arm extension (Australian Crawl) in order to generate greater stroke volume. Additionally, note that the Tablada system uses a prosthesis which is close to actual anatomical arm length, whereas the Viau system has a shortened forearm section. Both utilize a pre-flexed, rigid elbow design. The Viau arm was designed primarily for back stroke swimming and may therefore account for the curved terminal device shape which would not hamper this style of swimming.</p> <p>The author is also aware of the use of SUPER SPORT devices for swimming, especially for children unaccustomed to the water.</p> <p>Pistoning of the prosthesis can be one of the most common occurrences during swimming. A suspension sleeve can aid in eliminating this action. An additional consideration related to swimming and skin or scuba diving is that the prosthesis is not as buoyant as the body and can seem heavier than normal in water and sometimes will impair performance.</p> <h3>Water-Skiing</h3> <p>Water-skiing can be an extremely dangerous recreation if not approached with caution. The author suggests the following rules of good judgment if water-skiing is on an amputee's wish list of recreational pursuits. First, don't ever lock onto a ski rope handle with any terminal device or use a terminal device which requires a cable and harness system. Second, use a ski rope equipped with a single handle. Third, wear a self-suspending, condylar socket that can be twisted free of under stress. A suspension sleeve will aid support but not impair release of the socket due to the flexibility of the material. Fourth, have a neoprene arm cover for the prosthesis which will float the arm in the water if it comes off. Fifth, <i>always</i> wear an approved floatation vest.</p> <p>The Water Ski Hook<a></a> (<b>Fig. 57</b>) is a simple solution to water skiing that has proved safe when set up and used properly. The Ski Hook should be mounted on the prosthesis in a canted position and tightened into place so that it cannot rotate freely. The shallow hook design provides support, yet will twist off a ski rope handle. Should a fall occur where twisting off is impaired, the supra-condylar socket can be "torqued off" the arm and save the amputee's shoulder from potential trauma.</p> <strong>Figure 57. The Water Ski Hand is a simple solution to waterskiing problems.</strong><br /> <p>Another solution to prevent injury is to have the tow rope attached to the boat with a quick release, or equipped with a second handle (for small children only) and always manned by an observer/handler. Should the amputee skier go down, the observer can release the rope instantly, preventing injury.</p> <p>The Ski Seat<a></a> (<b>Fig. 58</b>) and E-Ski<a></a> illustrated in <b>Fig. 59</b> are viable answers for the high level bilateral amputee and the paraplegic or quadraplegic who wishes to enjoy the thrill of skiing. The sled is custom constructed and has two skis. The E-Ski, a newer device, has only one ski and a cage seat.</p> <strong>Figure 58. The Ski Seat.</strong><br /><strong><br /></strong><strong>Figure 59. The E-Ski.<br /></strong><br /> <h3>Wind Surfing</h3> <p>Wind surfing is a relatively new recreation which combines aspects of sailing, surfing, and hang gliding. Load coordination and balance compounded by the need to grasp, maneuver, and rapidly let go of a cylindrical boom as well as uphaul a rope with mast and sail in tow are some of the obstacles the amputee windsurfer faces. A prototype voluntary closing wind surfing terminal device is illustrated in <b>Figs. 60 and 61</b>. Other considerations should include special adjustable harnesses and cable systems for ocean or cold water sailing. Salt accumulation can foul cable function and negate terminal device operation. Wet suits, due to their tight elastic fit, will also interfere with cable function if the cable is worn inside the suit. The harness and cable system must be designed to fit on the outside of the wet suit for unrestricted terminal device operation. Leather on the prosthesis or harness should be avoided, as well as hardware which corrodes. Performance wind surfing is a physically and mentally demanding sport, and the amputee needs to be cautious and prepared to participate safely.</p> <strong>Figures 60 (above) and 61 (right). A prototype voluntary closing wind surfing terminal device.<br /></strong><br /> <h3>Summary</h3> <p>The varied demands of sports and recreation create a multitude of factors which impact the design, construction, and use of a sports prosthesis.</p> <p>Physical fitness and conditioning, prosthetic design and materials, harness styles, and terminal devices all have roles in determining whether an amputee can engage in a sports activity successfully and safely.</p> <p>New improved prosthetic devices and designs will continue to evolve to meet these varying demands. Communication between professionals is important in order to share information on the improvements which are made. Designs for high performance limbs and devices for sports and recreation may well pave the way for improved prosthetic technology as a whole.</p> <p>An open mind, a fresh outlook, an understanding attitude, as well as the patience and willingness to experiment and develop, will inevitably lead to a brighter future for the disabled in sports and recreation.</p> <p><b>References:</b></p> <ol> <li>Chadderton, O.C., C.A.E., "Survey: Consumer Interests," <i>The Fragment</i>, Winter, 1986, Vol. 151, pp. 29-31.</li> <li>Robinson, W.D., B. Pflanz, B. Watkins, and A. Viau "Recreational Limbs AMPUTATION III," <i>The War Amputations of Canada</i>, April, 1986, pp. 19-33.</li> <li><a href="poi/1986_03_129.asp">Mensch, G. and P.E. Ellis, "Running Patterns of Transfemoral Amputees: A Clinical Analysis," <i>Prosthetics and Orthotics International</i>, 1986, Vol. 10, pp. 129-134.</a></li> <li>Products and trade names of Hosmer-Dorrance Corporation, Campbell, California.</li> <li>Products and tradenames of T.R.S., Inc. of Boulder, Colorado.</li> <li>Product and tradename of Recreational Prosthetics, Inc., North Dakota.</li> <li>Radocy, R., "Sports Designs for Upper Extremity Amputees," a symposium presentation at the National Sports Prosthetics and Orthotics Symposium, U.C.L.A. Prosthetics/Orthotics Education Program, October, 1985.</li> <li>"Bow Modifications Serve Amputees," <i>Archery World</i>, February, 1987, p. 22.</li> <li>Weight harnesses designed and tested by Bob Radocy, T.R.S., Boulder, Colorado {not commercially available}.</li> <li>Radocy, B. and Randall D. Brown, "Technical Note: An Alternative Design for a High Performance Below-Elbow Prosthesis," <i>Orthotics and Prosthetics</i>, 1986, Vol. 40, No. 3, pp. 43-47.</li> <li>Billock, John N., "Northwestern University Supracondylar Suspension Technique for Below-Elbow Amputations," <i>Orthotics and Prosthetics</i>, December, 1972, Vol. 26, No. 4, pp. 16-23.</li> <li>Berger, N., et al, "The Application of ISNY Principles to the Below-Elbow Prosthesis," <i>Orthotics and Prosthetics</i>, Winter, 1985/86, Vol. 39, No. 4, pp. 10-20.</li> <li>Radocy, Bob, "The Rapid Adjust Prosthetic Harness," <i>Orthotics and Prosthetics</i>, 1983, Vol. 37, No. 1, pp. 55-56.</li> <li>Courtesy of Bill White, bilateral amputee using two GRIP terminal devices, Waterford, Pennsylvania.</li> <li>Courtesy of Kent Barber &amp; Bill Dalke, Prototype bicycle aid not commercially available. Inquiries to T.R.S. of Boulder, Colorado.</li> <li>Courtesy of Bassamatic, Inc. of Canton, Ohio.</li> <li>Courtesy of Royal Bee Corporation, Pawhuskas, Oklahoma.</li> <li>Courtesy of Robin-Aids Prosthetics of Vallejo, California.</li> <li>Courtesy of The War Amputations of Canada, Ottawa, Ontario.</li> <li>Tradename and product of Innovation Research Corporation, Milwaukie, Oregon.</li> <li>Courtesy of SR-77 Enterprises, Inc. of Chadron, Nebraska.</li> <li>Courtesy of R.F. Meyer's photograph of R. Wityczak, a triple amputee.</li> <li>Courtesy of Carmen Tablada, CP., Professional Orthopedic Systems of Sacramento, California.</li> <li>Ski Seat, Mission Bay Aquatic Center of San Diego, California.</li> <li>E-Ski, Courtesy of E.S.C.I. of Gretna, Louisiana.</li> <li>Courtesy of the Rehabilitation Centre for Children, Winnipeg, Manitoba, Canada.</li> </ol> <em><b>*Bob Radocy </b> Bob Radocy is President, TRS, Inc. 1280 28th St., Suite 3, Boulder, CO. 80303-1797<br /><br /></em> <div style="width: 400px;"></div> Page Number(s) 131 - 153 Year 1987 Volume 11 Issue 3 Figure 2 FIGURES 4,5,&6 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-02.jpg Figure 3 FIGURES 7,8,9,& 10 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-03.jpg Figure 4 FIGURE 11 ttp://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-04.jpg Figure 6 FIGURE 13 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-06.jpg Figure 7 FIGURE 14 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-07.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Needs Revision-See Trello Figure 8 FIGURE 15 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-08.jpg Figure 1 FIGURES 1,2,& 3 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-01.jpg Figure 5 FIGURE 12 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-05.jpg Figure 9 FIGURE 16 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-09.jpg Figure 10 FIGURE 17,18,19 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-10.jpg Figure 11 FIGURE 20 & 21 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-11.jpg Figure 12 FIGURE 22 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-12.jpg Figure 13 FIGURE 23 & 24 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-13.jpg Figure 14 FIGURE 25 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-14.jpg Figure 15 FIGURE 26 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-15.jpg Figure 16 FIGURE 27 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-16.jpg Figure 17 FIGURE 28 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-17.jpg Figure 18 FIGURE 29 & 30 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-18.jpg Figure 19 FIGURE 31 & 32 http://www.oandplibrary.org/cpo/images/1987_03_131/1987_03_131-19.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 Upper-Extremity Prosthetics: Considerations and Designs for Sports and Recreation Creator An entity primarily responsible for making the resource Bob Radocy * https://staging.drfop.org/files/original/74c6246acf34d3fe13807d14ce98dc43.pdf 6441dedb6d6cc9c3408c00c008e17f34 https://staging.drfop.org/files/original/5fad73a9eef3f2a1ab53ce2f213efece.jpg 087d0de996c5b8aedb032fcd6c2b18af https://staging.drfop.org/files/original/46e79972c3cbe07d3d9a3bf9ee340543.jpg ed3a48b7a53ce8a61cd8625552177b7e https://staging.drfop.org/files/original/e6c3404c22e5309a73c20747e6ed1a13.jpg 9272df686c0c19c8ad1dda4d9c346ec6 https://staging.drfop.org/files/original/281142d97946d38fc471de221b5faf8f.jpg bf1e5c9c2e488ceb7a1e4cfe23204140 https://staging.drfop.org/files/original/c47ee86296fe96d24d9bd4f980c48f92.jpg b3b28bcd274b720de45e627bfb56fb30 https://staging.drfop.org/files/original/6428da51018c9c2b4e7abbee2e25edb7.png 1647605a0dec60c4196c094faf88d769 https://staging.drfop.org/files/original/68cd1ff085e2984407091e0d7a6c5d37.png 9904eb51a9b616c598335dfad75c4a5e https://staging.drfop.org/files/original/0615e189294ec61bfdf16988f8a7b884.png c338f0114ebb1696a89da2d560ae081c https://staging.drfop.org/files/original/7ec5171e3138ef5823db95a0fc0c969c.png b27d019d267f9fe4bf3c8a2e1dcbf8f3 https://staging.drfop.org/files/original/371c70ccf0c7354316fbbb481fe93334.png 66509ce03e3cd337dcfb9ff45cd414eb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1986_02_057.pdf Text Any textual data included in the document <h2>Upper Limb Prosthetic Terminal Devices: Hands Versus Hooks</h2> <h5>John N. Billock, C.P.O.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>No one would argue that the human hand is the most complex and challenging structure of the human anatomy to replace and restore. The hand is an extremely complex structure which moves with a precision and dexterity that has long challenged the minds of researchers in medicine and engineering. Beyond its kinematic capabilities, the hand is also one of the most intricate sensory mechanisms of the human body-with unequaled proprioceptive and sensory feedback capabilities. With this in mind, it is easy to understand why prosthetic terminal devices today (hand and/or hook) offer very little in the way of true functional restoration to individuals with upper limb deficiencies.</p> <p>This is not meant to be critical of past developments, but puts into proper perspective the complexities and challenges of duplicating the human hand. Further emphasis of this is found in a commentary by Murphy<a></a> in which he stated, "Though engineers and prosthetists have made substantial contributions, they need perspective and humility to inspire and guide the very long, sustained efforts required to replace even a few of the roles of the hand." This challenge will doubtlessly keep researchers in prosthetics, and now those involved in robotics, busy with the task of trying to duplicate the kinematic and sensory capabilities of the human hand for years to come.</p> <h3>Prosthetic Terminal Devices Today</h3> <p>There exists today a significant number of prosthetic terminal devices for treating both adult and juvenile complete hand deficiencies. These terminal devices are designed as either mechanical or electromechanical systems and, as such, are either body-powered or electric powered. The body powered terminal devices function by utilizing forces generated by body movement as described by Taylor.<a></a> An electric powered terminal device functions by utilizing the electrical force stored within and generated from a battery. Further, these sources of power can activate or control a terminal device in different ways. The three most commonly used control systems are the Bowden cable control, myoelectric control, and switch control. In order to fully understand the functional potential of a particular terminal device, it is important to understand the control approach or system being used to actuate the device.</p> <h3>Prosthetic Control Systems</h3> <p>Professional opinions vary considerably regarding the most appropriate terminal device and control system to utilize in the design and development of a functional upper limb prosthesis. Bowden cable control systems harness the motions and forces generated by gross body movement to actuate and control, primarily, a mechanical terminal device. They require an adequate degree of force and excursion to actuate and control an upper/limb mechanical terminal device.<a></a> The most common example of this would be the Bowden cable control system of a totally mechanical below-elbow prosthesis (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-01.jpg"><b>Fig. 1</b></a>). This type of control system harnesses the body motion and forces generated by flexion-abduction movements at the glenohumeral joint to actuate and control the terminal device. It is important to note that this form of control does produce a certain degree of sensory feedback related to force and position.<a></a></p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-01.jpg"><span><strong>Figure 1. Illustration of a typical conventional body powered Bowden cable controlled below-elbow prosthesis with a mechanical hook terminal device actuated by "gross" body movements</strong>.</span></a><br /> <p>Myoelectric control systems utilize the existing neuro-muscular system for actuation and control of an electromechanical terminal device (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-02.jpg"><b>Fig. 2</b></a>). EMG potentials are monitored with surface electrodes placed over appropriate muscle or muscle groups within the residual limb and are used for either digital or proportional control of the terminal device. This type of control is considered to be quite natural since it utilizes the existing residual neuromuscular system for control.<a></a> This is especially true with synergistic muscle contractions, particularly related to natural hand functions, which can be selected for actuation and control of the terminal device. The use of myoelectric control enhances the feasibility of designing a totally self-contained and self-suspended prosthesis which has proven to be an acceptable and reliable design approach.<a></a></p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-02.jpg"><strong>Figure 2. Illustration of a typical electric powered, myoelectrically controlled below-elbow prothesis with an electromechanical hand terminal device actuated by EMG potentials.</strong></a><br /> <p>Switch control systems are those which utilize the motions and forces generated by "fine" body movements to actuate and control an electromechanical terminal device (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-03.jpg"><b>Fig. 3</b></a>). They require considerably less force and excursion than a Bowden cable controlled system to actuate and control a terminal device. Switch control systems can incorporate a variety of different types of switches, such as, pull, rocker, push-button or toggle type switch for activation of the terminal device (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-04.jpg"><b>Fig. 4</b></a>). This type of control is typically indicated in situations when limited body motion and forces are available for Bowden cable control and/or when EMG potentials are inadequate or inappropriate for control of the terminal device.</p> <span><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-03.jpg"><strong>Figure 3. Illustration of a typical electric powered switch controlled below-elbow prosthesis with electromechanical hand terminal device actuated by "fine" body movements.</strong></a><br /></span><br /><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-04.jpg"><strong>Figure 4. The actuation characteristics of a typical pull, rocker, push button and toggle switch are illustrated. Switches are generally designed to produce one or more functions such as opening and/or closing of an electromechanical terminal device, (a) Pull (sliding) switch for actuation of two functions; (b) Rocker switch for actuation of two functions; (c) Push Button switch for actuation of one function; (d) Toggle switch for actuation of two functions.</strong></a><br /> <h3>Mechanical Hooks And Hands</h3> <p>Following World War II and especially since the development of the APRL Voluntary Closing Hand and Hook in 1945, considerable controversy has existed regarding the functional aspects of hands versus hooks as terminal devices. Prior to the introduction and clinical use of electric hands in the early 1960's, this controversy only related to mechanical hands and hooks. Mechanical hands, although certainly more aesthetic, were felt by many professionals to be too heavy and awkward for fine prehension activities. Mechanical hooks, by way of contrast, weigh approximately one third the weight of a mechanical hand and provide dexterity comparable to a pair of tweezers. Mechanical hooks were also considered to be more durable because of their simple mechanical design, and the fact that a cover to protect internal mechanisms or provide aesthetics is unnecessary. Because of these mechanical advantages, very little regard was given to the social-psychological advantage and need for a prosthetic hand versus the hook terminal device.</p> <p>In fact, it became common practice within prosthetic clinics and teaching institutions to encourage use of a hook terminal device first before providing the individual with a hand terminal device. The purpose of this practice, which continues today, is to develop the individual's appreciation for the functional advantage of the mechanical hook over the mechanical hand. Further, it was the opinion and experience of many clinics and prosthetists that many individuals, if provided a hand and hook terminal device simultaneously, tended to reject the hook for aesthetic reasons and not develop an appreciation for its functional advantage. Conservative estimates indicate, however, that approximately only fifty percent of those individuals provided with conventional type mechanical prostheses are wearing their prosthesis as reported by LeBlanc.<a></a> This estimate does not distinguish between actual functional use versus simple wearing of the prosthesis.</p> <p>It is the author's opinion and experience that the introduction of a hook terminal device in the early stages of the prosthetic rehabilitation process may in fact be the primary cause of the high incidence of total prosthetic rejection since little, if any, attention is given to the social-psychological aspects of the individual's limb deficiency. The social-psychological aspects of an acquired or congenital upper limb deficiency should be regarded as the first and most significant problem which has to be understood and dealt with appropriately if successful prosthetic rehabilitation and functional use of a prosthesis is to be achieved. Dembo, Leviton, and Wright<a></a> clearly identified the social-psychological problems individuals, as well as those around them, have to deal with in accepting limb loss as part of the total rehabilitation process. If an individual has not accepted a limb loss, or in the case of a congenital limb deficiency, the parents have not accepted the limb loss, it is unlikely that successful prosthetic rehabilitation and functional use of a prosthesis will be achieved.</p> <p>Dr. Howard A. Rusk, recognized by many as the "father of physical medicine and rehabilitation," has identified motivation and timely rehabilitation services as the key elements to achieving successful rehabilitation of an individual's disability.<a></a> An individual can receive the best rehabilitation services available and be provided with the best prosthesis today's technology has to offer. However, if they are not motivated to overcome their disability or adjust to it, acceptable rehabilitation is unlikely. Likewise, the child born with a congenital limb deficiency will not be encouraged to adapt to or functionally utilize a prosthesis if the parents have not accepted their child's disability.</p> <h3>Electric Powered Hooks And Hands</h3> <p>The introduction of electric powered hands into clinical practice in the early 1960's brought about a new era in prosthetics. Acceptance of these "electric hands" by the American prosthetics profession was much slower than in the European countries where they were initially developed. They are, moreover, still considered by many to be not as functional as mechanical hook terminal devices. It is felt that much of this belief can be traced to the attitude that regards mechanical hands as being less functional than mechanical hooks. Electric powered hands, however, have one primary major functional advantage over mechanical hooks and hands.</p> <p>Electric hands can produce finger prehension force which is equal to, and in some cases greater than, that of an adult or juvenile human hand. The average adult male, for instance, can produce an average of 20 to 24 lbs. of finger prehension. The average tolerable amount of prehension that an adult male can generate with a Bowden cable controlled prosthesis and the more commonly used voluntary opening mechanical hook terminal device is approximately 8 to 10 lbs. Voluntary closing mechanical hands and hooks obviously are able to provide greater finger prehension than voluntary opening hooks or hands; however, they have not been widely accepted or used.</p> <p>Another key advantage of an electric powered hand is that it provides forceful "3 jaw chuck" palmar type prehension. This type of prehension has been identified as early as 1919 by Schlesinger,<a></a> to be the most commonly utilized hand-finger prehension pattern for picking up and holding objects in activities of daily living (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-05.jpg"><b>Fig. 5</b></a>). <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-01.jpg"><b>Fig. 1</b></a> shows the percentage of use to pick up and hold objects with an electric powered hand. The predominance of "3 jaw chuck" palmar prehension in our activities of daily living accounts for the reason all mechanical and electric powered hands of today are designed with the thumb in opposition to the second and third fingers. The forceful palmar prehension of the electric powered hand, therefore, enhances its overall functional value as a prosthetic terminal device.<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-05.jpg"><strong>Figure 5. Of the six commonly used hand/finger prehension patterns, described by Schlesinger, "3 jaw chuck" palmar type, tip type and lateral type prehension are considered to be the most frequently used during activities of daily living.</strong></a></p> <p>The only electric powered hook available for clinical use at this time is the Otto Bock "Griefer"<a></a> which was introduced in the U.S. in the late 1970's. As an electric powered terminal device, it has the quality of providing "forceful" prehension. Along with this, it is uniquely designed with multi-axis fingers to keep the grasping surfaces parallel during the entire range of opening and closing (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-07.jpg"><b>Fig. 6</b></a>). This design feature allows for even pressure throughout its range of opening and closing which enhances its grasping ability over mechanical hooks. The grasping surfaces of a mechanical hook angle away from one another as the active finger moves in relationship to the stationary finger (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-08.jpg"><b>Fig. 7</b></a>). Therefore the larger the object to be held in the mechanical hook terminal device, the less contact with the object and, consequently, the more force required to stabilize the object, dependent upon its shape. The "Griefer," on the other hand, is heavier than the heaviest stainless steel mechanical hook and is not as durable, primarily because its design is more complex than the single axis mechanical hooks.<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-06.jpg"><b>Table 1</b></a></p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-07.jpg"><strong>Figure 6. This diagram illustrates the angular relationship of the prehension surfaces and the object being held, utilizing a multi-axis prehension design approach, such as in the Otto Bock "Griefer."</strong></a><br /> <p><b><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-08.jpg"><span>Figure 7. This diagram illustrates the angular relationship of the prehension surfaces and the object being held, utilizing a single-axis prehension design approach, such as in the Hosmer/Dor-rance</span></a><span><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-08.jpg"> mechanical hook series.</a><br /><br /></span></b>Clinical Experience<b><span><br /></span></b></p> <p>The terminal device of the prosthesis plays an important key role in developing the motivation which will, hopefully, lead to successful prosthetic rehabilitation. It has been the author's experience, in over 300 cases involving individuals with congenital and acquired limb deficiencies from the wrist to the shoulder, that 95 percent or better of those individuals preferred to have a prosthetic hand rather than a hook terminal device (<a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-09.jpg"><b>Table 2</b></a> and <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-09.jpg"><b>Table 3</b></a>). In all cases involving juvenile subjects (which represents approximately ten percent of the total case load), the parents and children over the age of five years preferred hand terminal devices to hooks. Forty percent of the total juvenile case load involved children under the age of five years, and in all cases, the parents preferred hand terminal devices. Parents were also found to prefer a passive nonfunctional hand as opposed to the more typically used passive type nonfunctional mitten for children up to 1 1/2 years of age.</p> <a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-09.jpg"><strong>Table 2</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-10.jpg"><strong>Table 3</strong></a><br /> <p>One might quickly draw the conclusion that this preference was specifically related to the aesthetics of the hand and not necessarily related to function. There is no doubt that the aesthetics of the hand played a key role in the decision. However, this preference also emphasizes the strong social-psychological need for individuals, as well as the parents of children with limb deficiencies, to visually feel as normal as possible within our society. The aesthetics of a hand terminal device obviously satisfies this need more appropriately than a hook terminal device.</p> <p>Beyond this, it is also interesting to note that approximately only one percent of those provided a prosthesis with hand are utilizing a mechanical hand terminal device. Therefore, 99 percent utilize electric powered hands in their prostheses; eighty percent of these are controlled myoelectrically. It is estimated that total rejection of an electric powered hand prosthesis has been approximately 15-20 percent. Actual percentages of rejection have been difficult to verify because of lack of follow-up by the patients, and it is felt that 5-10 percent of the patients are now being followed-up elsewhere. Nevertheless, total prosthetic rejection is considerably less than those provided with conventional upper limb prostheses.<a></a> It is not felt that the acceptance rate of electrically powered hand prostheses is specifically related to aesthetics of the hand. If this were the case, one would expect more individuals to have been utilizing mechanical or passive hands prior to the development of electric powered hands.</p> <h3>Conclusion</h3> <p>Clinical experience has definitely proven, in the author's experience, that an electrically powered prosthetic hand terminal device which is proportionally controlled, utilizing myoelectrical EMG potentials from synergistically related muscles within the residual limb, is the most acceptable and functional upper limb prosthetic design for individuals with complete hand deficiencies.</p> <p>It is further felt that the terminal device is the most important component of the prosthesis; just as the hand is to the normal upper limb. Whenever possible, a prosthetic hand should be preferred to a hook terminal device, in consideration of the individual's social-psychological needs. The individual's social-psychological needs must be of primary concern initially and must be considered before vocational needs can be effectively addressed. This is also true when managing children and is especially important in addressing the social-psychological needs of parents of children born with congenital upper limb complete hand deficiencies.</p> <p>If the vocational or avocational needs clearly indicate the need for a hook terminal device, this must be clinically tested and proven, or the individual must personally desire the hook terminal device. This has been found to be true for all levels of upper limb deficiencies involving the hand, wrist, elbow, and shoulder. This criteria is obviously not the case for everyone with an upper limb deficiency; however, it is felt to be true for the majority and especially those with unilateral upper limb involvement.</p> <p>The prosthetic hand should be thought of as an assistive device to the sound limb, just as the nondominant normal hand is to the dominant normal hand. Many have felt it is important to be able to perform fine motor prehension activities with a prosthetic terminal device and this has been a major argument in favor of hook terminal devices. The fact is, the majority of those individuals with upper limb deficiencies are unilaterally involved and do not use their prosthesis for fine motor prehension activities; just as a non-involved individual does not typically utilize the nondominant hand for such activities. The prosthetic terminal device is most important for gross prehension activities, to hold and stabilize objects while the sound limb performs the fine motor prehension activities. An electrically powered hand terminal device, with adequately controlled functional prehension, best serves this need for the majority of an individual's activities of daily living. It is important to remember that we live in a world made for hands, and most everything we encounter in our activities of daily living is made to be hand held.</p> <h3>Acknowledgments</h3> <p>The author is deeply indebted to those individuals who have sought and benefited from the research which made this paper possible. Special appreciation is given to my wife, Dottie, Jean Ann Pasini, and Gordon L. Grimm for their editorial input and assistance in preparation of this paper, and to the other staff members of the Orthotics and Prosthetics Centre of Warren for their continued understanding and support of the author's professional interests. The illustrations and art work of Jean Ann Pasini are particularly appreciated.<br /><br /><em><b>*John N. Billock, C.P.O. </b>John N. Billock, C.P.O. is Clinical Director at the Orthotics and Prosthetics Centre of Warren in Warren, Ohio. He is also Chairman of the Research and Evaluation Committee of the American Academy of Orthotists and Prosthetists.</em></p> <p><b>References:</b></p> <ol> <li>Billock, J.N., "The Northwestern University Supracondylar Suspension Technique for Below Elbow Amputations," <i>Orthotics and Prosthetics</i>, Vol. 26, No. 4, pp. 16-23, 1972.</li> <li>Billock, J.N., "Upper Limb Prosthetic Management: Hybrid Design Approaches," <i>Clinical Prosthetics and Orthotics</i>, Vol. 9, No. 1, pp. 23-25, 1985.</li> <li>Childress, D.S. and Billock, J.N., "Self-containment and Self-suspension of Externally Powered Prostheses for the Forearm," <i>Bulletin of Prosthetics Research</i>, Vol. 10, No. 14, pp. 4-21, 1970</li> <li>Childress, D.S., "Powered Limb Prostheses: Their Clinical Significance," <i>IEEE Transactions on Biomedical Engineering</i>, Vol. BME-20, No. 3, pp. 200-207, May, 1973.</li> <li>Childress, D.S.; Holmes, D.W.; and Billock, J.N., "Ideas on Myoelectric Prosthetics Systems for Upper-Extremity Amputees," <i>The Control of Upper-Extremity Prostheses and Orthoses</i>, pp. 86-106, 1974.</li> <li>Dembo, T.; Leviton, G.L.; and Wright, B.A., "Adjustment to Misfortune: A Problem of Social-Psychological Rehabilitation," <i>Selected Articles from Artificial Limbs</i>, pp. 117-175, New York, July, 1970.</li> <li>Gwynne, G., "Mechanical Components," <i>Manual of Upper Extremity Prosthetics</i>, Department of Engineering, University of Southern California at Los Angeles, Second Edition, pp. 33-68, 1958.</li> <li>Le Blanc, M.A., "Patient Population and Other Estimates of Prosthetics and Orthotics in the USA," <i>Orthotics and Prosthetics</i>, Vol. 27, No. 3, p. 38-44, 1973.</li> <li>Murphy, E.F., "Commentary," <i>Selected Articles from Artificial Limbs</i>, New York pp. vii-xii, July, 1970.</li> <li>Rusk, H.A., "Rehabilitation," <i>Journal of the American Medical Association</i>, Vol. 140, pp. 286-292, 1949.</li> <li>Rusk, H.A., "Advances in Rehabilitation," <i>Practitioner</i>, Vol. 183, pp. 505-512, 1959.</li> <li>Schlesinger, G., "Der Mechanische Aufbau der kunstlichen Glieder," <i>Ersatzglieder und Arbeitshilfen</i>, Vol. 3, Berlin, 1919.</li> <li>Taylor, C.L., Schwarz, R.J., "The Anatomy and Mechanics of the Human Hand," <i>Selected Articles from Artificial Limbs</i>, New York, pp. 49-62, 1970.</li> <li>Taylor, C.L., "Biomechanics of Control," <i>Selected Articles from Artificial Limbs</i>, New York, pp. 63-84, July, 1970.</li> <li>Otto Bock "Griefer" is a registered trade mark of the Otto Bock Orthopedic Industry, Inc., Duterstat, West Germany/Minneapolis, Minnesota.</li> <li>Hosmer Dorrance is a registered trade mark of the Hosmer Dorrance Corporation, Campbell, California.</li> </ol> Page Number(s) 57 - 65 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-05.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 6 TABLE I http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-06.jpg Figure 7 FIGURE 6 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-07.jpg Figure 8 FIGURE 7 http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-08.jpg Figure 9 TABLE II http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-09.jpg Figure 10 TABLE III http://www.oandplibrary.org/cpo/images/1986_02_057/1986_02_057-10.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 Upper Limb Prosthetic Terminal Devices: Hands Versus Hooks Creator An entity primarily responsible for making the resource John N. Billock, C.P.O. * https://staging.drfop.org/files/original/3eac73a4c08366301177654204d8badb.pdf 6c0ab74d419d52358a0371839fc85799 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_01_023.pdf Text Any textual data included in the document <h2>Upper Limb Prosthetic Management Hybrid Design Approaches</h2> <h5>John N. Billock, C.P.O.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>With the advent of electric powered components and control systems in the past 20 to 25 years, there has been considerable transition in the prosthetic management and rehabilitation of individuals with traumatic and congenital upper limb deficiencies. Furthermore, it has only been within the past 5 years that electrically powered upper limb prostheses have gained clinical acceptance in the U.S. There now exists a complex variety of approaches from which the prosthetics practitioner must choose, in order to provide appropriate prosthetic restoration services. Along with the traditional variety of bowden cable control systems for actuating mechanical components, there now exists a number of myoelectric and switch control systems for use with electrically powered hands, wrists, and elbows. The introduction of these new components and control techniques has greatly increased the complexity of designing an appropriate upper limb prosthesis.</p> <p>As a result, some researchers and manufacturers have worked to develop total systems for the various levels of upper limb deficiencies. These systems generally are designed around a modular concept, where the batteries, electronics, electrodes, etc., are packaged as individual modules for easier handling and assembly. They also utilize a common electrical connection system, which may or may not be compatible with other components and control systems. The modular systems approach reduces the overall complexity in designing prostheses. However, it does not always provide the patient with the most appropriate prosthesis when his individual physiological and psychological needs are considered. It is in such a situation that thought must be given to the possibility of developing a hybrid prosthesis. A hybrid designed prosthesis utilizing components and control methods from various "systems" can, in many cases, enable the prosthetist to design and develop a prosthesis which is more functional and acceptable.</p> <p>The hybrid design approach becomes even more important when managing individuals with upper limb deficiencies above the elbow and higher. Many cases require a combination of electrically powered components that are switch and/or myoelectrically controlled and mechanical body powered bowden cable controlled components. A classical example of this situation occurs in the design of an above elbow prosthesis for an individual with a distal humeral deficiency. A limb deficiency at this level generally does not require the use of an electrically powered elbow since the individual should have sufficient range of motion at the shoulder joint and adequate muscle strength to control a mechanical elbow. A myoelectrically controlled hand introduced into the design of the prosthesis, for this level, can significantly improve it's functional capabilities and aesthetics. This particular hybrid design allows the individual to simultaneously control the elbow and hand rather than sequentially. It has been the author's experience that individuals with this particular design infrequently utilize the mechanical elbow lock to maintain the hand and forearm in a fixed locked position for functional activities. Rather, the elbow is allowed to flex freely and is held momentarily stable with cable tension. The overall control of the prosthesis is more natural since use of the elbow lock is not necessary the majority of the time.</p> <p>Unfortunately, many of the electric powered components and control systems are not designed for hybrid use even though they may have application. In many cases, they are not compatible and require electronic and/or mechanical changes before they can be incorporated into an appropriately designed prosthesis which best meets an individual's needs. Prosthetists of today must expand their technical expertise and knowledge in the areas of electronics and engineering to meet this challenge. With all the complexities surrounding the design and development to today's upper limb prostheses, this additional technical expertise and knowledge becomes even more essential when assessing and evaluating the particular needs of a patient.</p> <p>The clinical assessment and evaluation of individuals with upper limb deficiencies should involve a careful study of their psychological, as well as their psychological needs. All too often, this is an area of overall prosthetics management that receives too little attention. In the author's opinion, it is an essential foundation for successful prosthetic management and rehabilitation. The psychological aspects of an upper limb amputation and its resulting disabilities are too often considered secondarily when determining what will be the most appropriate prosthesis for an individual patient. As professionals, we tend to stress function over aesthetics, when in fact, a primary concern of the majority of patients is the appearance of the prosthesis. These psychological aspects are the greatest barriers an individual patient must overcome if successful prosthetic management and rehabilitation is to be achieved. Their personal acceptance of their disability and motivation to return to society is essential for successful rehabilitation. Their reaction to the prosthesis plays a major role in this acceptance and motivation.</p> <p>The reaction of their immediate family and friends also plays an important role in their acceptance of the prosthesis. Many patients have rejected a prosthesis not because of their own personal feelings, but because of the reaction of others. This is most apparent in the management of children with congenital upper limb deficiencies, since in most situations when the child is under the age of 5, you are managing the parent's desires and not the child's. If the parents have difficulty accepting the child's disability or the prosthesis, they will not encourage normal development and use of the prosthesis. Unfortunately, because many profesisonals are not responding to the psychological needs of the parents, many children are going with a prosthesis today.</p> <p>With adequate information gathered in the initial prosthetic evaluation, further clinical assessment and evaluation procedures should be carried out to determine the most appropriate interface design, control source, and components to be used in the fabrication of the prosthesis. These procedures initially involve the development of a test interface (check socket) for determining the best fitting and suspension techniques to be utilized in the prosthesis. A variety of interface designs and suspension techniques exists for both adults and juveniles at all levels of upper limb deficiencies. All require the development of an appropriate test interface.</p> <p>The development of a test interface is also necessary for use in establishing definitive E.M.G. potential sites when myoelectric control is being considered. When the E.M.G. potential are not adequate or when the patient requires further E.M.G. training, the test interface becomes essential for maintaining consistent placement of the electrodes relative to muscle stress. Further, the test interface allows the practitioner to evaluate a variety of optional control sources and components by developing a test prosthesis around it. This allows pre-prosthetic training and evaluation of the prosthesis in a variety of configurations before the development of a definitive prosthesis. The use of a test prosthesis is essential in evaluating "hybrid" and "system" design approaches for the definitive prosthesis.</p> <p>Myoelectric control systems vary considerably depending on the desired function and availability of adequate muscle sites. In some cases, it is necessary to utilize more than one type of myoelectric control system to achieve the desired functions in a prosthesis. Some systems utilize a single E.M.G. potential from a single site to control a single function, such as in the traditional Otto Bock or Veterans Administration/Northwestern University (VANU) myoelectric control systems. This type of control system would, therefore, require two E.M.G. potential sites to control two functions, such as, hand opening and hand closing. It is suggested that this type of system should commonly be referred to as a "2-site/2-function myoelecric control system." Another system may utilize a single E.M.G. potential from a single site to control two functions, such as in the University of New Brunswick system. This system utilizes one E.M.G. potential site to control two functions. In this type of system a light or low level contraction produces one function and a strong or high level contraction produces another function. It is suggested that this type of system be referred to as a "l-site/ 2-function myoelectric control system." Yet another system may utilize two E.M.G. potentials from two sites to control multiple functions, such as in the Utah Artificial Arm elbow-hand system. This system utilizes two E.M.G. potential sites to control five functions. In this system a single E.M.G. potential from each site (biceps and triceps) controls one function in each electric powered component (hand and elbow), while a co-contraction of both muscles together unlocks the elbow, switching from hand control mode to elbow control mode. It is suggested that this myoelectric control technique be referred to as a "2-site/5-function myoelectric control system."</p> <p>Switch control systems also vary depending upon the desired function and availability of body motions to actuate them. In many cases, in order to provide the desired functions in a switch controlled prosthesis, various types of switch control systems must be incorporated, achieving a hybrid design approach. The most commonly used switch control systems utilize a pull type switch which is actuated by a single body motion to actuate two functions, such as hand opening and hand closing. It is suggested that this switch control technique be referred to as a "1-motion/2-function pull switch control system." Another type of system utilizes a push button type switch, to operate the opposing function. It is suggested that this switch control technique be referred to as a " 1 -motion/1-function push button switch control system." Yet another type of system utilizes a rocker type switch which is actuated by two body motions to actuate two functions in the prosthesis, which in most cases oppose each other. It is suggested that this control technique be referred to as a "2-motion/2-function rocker switch control system."</p> <p>When body motion is being used to actuate a bowden cable control system in a hybrid manner along with switch and/or myoelectric control, it should always be remembered to activate the mechanical component with the primary body motion available. The theory behind this approach is that a bowden cable control system requires significant muscle activity and body motion to produce the force and excursion necessary to actuate a mechanical component. Myoelectric and switch control systems require less muscle activity to produce the force and excursion necessary for actuation of an electric component.</p> <p>The choice of controls utilized in the design and development of an upper limb prosthesis should involve a careful study of an individual's particular needs. Since the terminal device is the most important component of the prosthesis, it is necessary to choose a control technique which will provide the most appropriate actuation of that device. It is felt that myoelectric control provides the most physiological and natural source of control and that whenever possible, it should be given primary consideration. Furthermore, the majority of individuals with upper limb deficiencies generally prefer a hand as a terminal device. In many cases, this desire may be purely psychological, and as professionals we should respect that need. The majority of individuals with upper limb deficiencies are unilateral with the prosthesis obviously becoming the nondominant side. Therefore, it is important that the prosthesis first meet the individual's psychological needs, and secondarily, that it be easily controlled and provide adequate prehension for stabilizing objects, which is the primary function of the non-dominant side during bilateral hand activities. This would obviously seem to indicate that myoelectric control, which best utilizes the residual neuro-muscular system, and an electric powered hand, which provides forceful prehension, should be the first choices in developing a functional prosthesis.</p> <p>Electric powered components have been felt by many not to be sufficiently reliable and durable. This, however, has not proven to be the case when they are appropriately incorporated into a prosthesis and the patient is properly orientated to their care and use. There are those individuals and situations who are abusive to an electric powered prosthesis as well as a mechanical prosthesis. However, they are not the majority and require appropriate consideration prior to design and development of a prosthesis. Hybrid design concepts can also be utilized to enhance the reliability and durability of a prosthesis by allowing the encapsulation of components within the prosthesis that would otherwise be external. This is a concept known as self-containment.</p> <p>Hybrid prostheses can significantly improve the functional restoration and rehabilitation of an individual with an upper limb deficiency. They are an important consideration in the prosthetic management of such individuals and can be the difference between total rejection or functional use of a prosthesis. Unfortunately, upper limb prostheses of this type will most likely continue to be provided in specialized centers and not find their place in common practice unless developers and manufacturers work towards making their components more compatible and interchangeable with those of other systems.</p> <em><b>*John N. Billock, C.P.O. </b> John N. Billock, C.P.O. is with the Orthotic and Prosthetic Centre of Warren, 145 Shaffer Drive, N.E., Warren, Ohio 44484.<br /><br /><br /></em> Page Number(s) 23 - 25 Year 1985 Volume 9 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Upper Limb Prosthetic Management Hybrid Design Approaches Creator An entity primarily responsible for making the resource John N. Billock, C.P.O. * https://staging.drfop.org/files/original/6c2c63ddffe3d550de617cddd2fd3dd0.pdf a968d5b9bd58a10b866f2865888702c4 https://staging.drfop.org/files/original/f79b3b23e95dbeb5afa6c8473cde777c.jpg 8fb5942309fbf39e9a7f9d5b0faa3ad4 https://staging.drfop.org/files/original/c220a5b7800edb8c2f03fbae92a1461e.jpg 87cbf6d646ea79dfe843e1acabdda96f https://staging.drfop.org/files/original/c51a8772e852e3c455899c6ff2c762ce.jpg 33046249d3204db97c4c086dfd5599b3 https://staging.drfop.org/files/original/6900141d8663452725d64428373f8d50.jpg 53e19138614db7dc6c7fb8957ab80aae https://staging.drfop.org/files/original/d95b5a36a5716b9d244ed4df81c74f3e.jpg 4b6a6d211a5d773b43c6faab345690df https://staging.drfop.org/files/original/c9e2d2419431e40d357277310450bc3e.png afc4e7e2abd9dbe853ea3aae3159c753 https://staging.drfop.org/files/original/7097692bfc548e8b707cf8c2c5d4cd0d.png 5eceeff5f79d833e8f2e3a8c26694e06 https://staging.drfop.org/files/original/90edd7a8ef69e6ec44df2371f663927a.png c617fbfef726b1388adcfd1e4d2c584e https://staging.drfop.org/files/original/d1b765c7055d84a8a7222ccbc9c30ff1.png 7cbeda763ee9076246a237debce1071b https://staging.drfop.org/files/original/584c3a08b5ad54660112b465920dd0d6.png d9a078f202590efd229a906944609682 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1986_02_066.pdf Text Any textual data included in the document <h2>Upper Limb Powered Components and Controls: Current Concepts</h2> <h5>John W. Michael, M.Ed., C.P.O.&nbsp;<a style="text-decoration: none;">*</a></h5> <p>In order to review the current offerings in powered upper limb components, it is necessary to agree upon certain standardized terms. The following suggestions, based upon a survey of the existing literature, are intended to help insure we are all speaking a common language.</p> <p>Practitioners with strong opinions regarding alternate definitions are encouraged to publish their views as well. It is critical that we agree upon some definition; which particular version is of much less importance.</p> <p>The focus of this paper will be on externally powered prostheses—specifically, those that are electrical in nature. The opposite concept is the familiar body powered prosthesis, which is powered by muscular action and transmitted from remote body locations.</p> <p>Many prosthetists have some experience at the below-elbow level with the components produced by Otto Bock, and assume they have fitted myoelectric devices. Technically, that is not completely correct.</p> <p>The MyoBock system is most accurately termed "Myoswitch" control. This is a much simpler version than true myoelectric control. In the Otto Bock system, the residual myoelectric signal does not directly control the terminal device. Instead, the patient must generate a sufficiently strong signal to cross a threshold, which triggers an electronic switch.</p> <p>A good analogy would be that of sound-activated devices which can be installed in lieu of a standard light switch. Clapping one's hands turns the light on. If the clap is too faint, nothing will happen, but an extremely loud clap has no more effect than one just loud enough to trigger the switch. This is sometimes described as "digital control."</p> <p>This approach does not allow proportional control. That is, the light is either all on, or all off. There is no in-between. Proportional control is provided by a rheostat, which allows one to gradually dim or brighten the lights as the mood dictates.</p> <p>Proportional control is, in this author's opinion, the key distinction in true myoelectric systems. The below-elbow system marketed by Fidelity Electronics is an example of such a design. In this version, a mild myoelectric impulse causes a slow, gentle movement of the hand, while a strong impulse creates a rapid, powerful movement of the hand. Many authorities feel this is the most physiologically natural control, and offers the greatest degree of prehension control as well.<a></a></p> <p>A good analogy is the accelerator in an automobile, which allows proportional control of the speed of the vehicle. Imagine a switch-controlled car with the throttle either at idle or wide open! Otto Bock has a very clever solution to this dilemma: the automatic transmission.</p> <p>The MyoBock prosthesis has two speeds: a quick, gentle motion when opening and closing, and a slow, powerful motion once the fingers grip an object. This might not be a reasonable solution for the auto industry, but it has proved to be clinically acceptable in prosthetics.</p> <p>The third available control mode is pure Switch Control. This is the least expensive approach and generally requires less bulky electronics. For these reasons, it is often used in juvenile below-elbow designs (for example, Variety Village). It also does not require any myoelectric signals, which can be helpful when control sites are limited or unavailable.</p> <p>Switch controls come in three basic varieties.</p> <ol> <li> <p><b>Rocker Switches</b> are similar to the on-off control for stereo equipment, and are sometimes used where a mobile acromion is present.</p> </li> <li> <p><b>Button Switches</b> are also adaptable for acromion control, for use with phoco-melic digits, and any other mobile body parts. They are the electronic analogue of mechanical nudge control.</p> </li> <li> <p><b>Pull Switches</b> are useful when harness control is desired. Most are multiposi-tional, where initial excursion will cause one motion, and further excursion the opposite motion. These are somewhat analogous to the alternating lock used in the conventional elbows with one motion controlling two or more functions.</p> </li> </ol> <p>These are simply the most common types; literally hundreds of variations can be obtained from electronic supply stores. On rare occasions, they can be arranged in a piano keyboard array, allowing several degrees of freedom to be controlled from one location.<a></a></p> <p>Another set of related concepts are "site and state."12 Site refers to the number of distinct muscle signals required. Thus, the original Myobock system was a "two site" version, requiring one myosignal for hand opening and a separate signal for hand closing.</p> <p>The University of New Brunswick (UNB) was one of the first groups to develop a commercial system that required only one myosignal. This is particularly advantageous when dealing with young congenital below-elbow patients. Very often they can only generate one mass contraction in the residual limb, and space considerations alone may preclude more than one electrode. UNB termed their system "Single Site/Three State" control. The term "Three State" means that the myopulse both opens and closes the hand; the "third" state is "off."</p> <p>In the last couple of years, Otto Bock has introduced their version of this concept. As in the UNB design, it is a digital "Myoswitch." A quick, hard myopulse causes the hand to open, while a slow, gentle myopulse causes closure. Bock calls this "Double Channel Single Site" control. "Double Channel" accurately identifies the capabilities: one channel opens and the other closes.</p> <p>Unfortunately, the word "channel" has established meanings in other fields that may be a source of confusion. For maximum clarity, the term "Function" is probably preferable.<a></a> This has a clear intuitive meaning. Thus, the system just described would be termed a "One Site-Two Function" system.</p> <p>With suitable changes in the terminal device electronics, Otto Bock can offer what they term "Grip Force" control which is a kind of psuedo-proportional control. In this application, the patient can use the quick, strong pulse to automatically downshift the transmission, thereby increasing the grip strength.</p> <p>A logical extension of this approach is Bock's "Four Channel" design. One electrode controls terminal device opening and closing while the other controls electric wrist pronation and supination—four distinct functions.</p> <p>Clearly, if suitable sites could be found, additional degrees of freedom could be controlled using existing technology. Experience has shown, however, that this is rarely feasible.</p> <p>In the above-elbow realm, the developers at Motion Control argue strongly that proportional control is the ideal. Therefore, they avoid the digital control mentioned thus far. Yet, they have developed a system permitting only two muscle sites to operate elbow raising and lowering, as well as terminal device opening and closing. Thus far, their solution is unique in the field of powered components.</p> <p>The Motion Control design uses a very clever method of electronic switching to separate elbow and terminal device functions. When the arm is first powered on, the two muscle sites proportionally control elbow flexion and extension. (In an ideal candidate, biceps and triceps are the remnant muscles yielding physiologically normal control as well.) Whenever the elbow is in motion, things remain in this mode.</p> <p>However, if the elbow is stopped in a flexed position and held steady for a moment, the arm "senses" that one intends to perform a grasping function. It then locks the elbow and automatically switches itself into a "grasping" mode. The same two sites now control proportional, bidirectional grasp. To return to the "elbow" mode, the patient co-contracts in a specific fashion. The co-contractures cancel each other out so that no motion of the TD occurs, and the electronic switch senses this and changes modes.</p> <p>This strategy can be termed "Sequential Control", and is directly analogous to the familiar mechanical elbow joint where the same shoulder motion moves first the elbow and then the terminal device.</p> <p>The most sophisticated control for a high level amputee would be Simultaneous Proportional Control. Northwestern has done some fascinating work in this area,<a></a> as has the Illinois Institute of Technology and others.<a></a> This would be the most natural-appearing motion, since our biological arms move through multiple degrees of freedom simultaneously with every gesture.</p> <p>However, there are numerous technical and control difficulties with this approach, and all seem to be far from commercial production right now. One major issue is control site availability. Even if one conceives of an arm offering twenty simultaneous degrees of freedom, where on the high-level amputee are twenty independent controlable sites to be found?</p> <p>Much of the current research involves reading data from a few sites and using computer algorithms to simulate multi-degree control.<a></a> Most currently require a mainframe computer to process the data in real time, but perhaps the future will see microchip processors with these capabilities built into upper limb devices.</p> <p>But, for now there are less spectacular components to choose from. What follows is an overview of currently available hardware. Specific details change almost weekly; contact the manufacturer for the latest updates.</p> <p>The final caveat is: the ideal system does not exist. All the components have strengths and weaknesses. When prescribed correctly, one can achieve very satisfying results. When used inappropriately, failure is the inevitable result. As prosthetists gain more collective experience and confidence in the realm of powered upper limb prosthetics, perhaps we can learn to "mix and match," as we do in body powered fittings, to maximize the benefits for our patients.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-01.jpg"><b>Fig. 1. <span>Otto Bock electric hand and electric hook (Greifer). Bilateral powered fittings can be successful in carefully selected cases. (Courtesy of Otto Bock Industries.)</span></b></a></p> <h3>Otto Bock</h3> <p>In the United States, Otto Bock is viewed as the "father" of electrically controlled prostheses. Although all their current designs are digital controls, they offer one of the largest arrays of interchangeable electric components of any manufacturer. At this time, all Otto Bock components are designed for below-elbow use, although they are equally adaptable for higher levels.</p> <p>One ramification of this is that since 1976, they have been using six volts as their standard. (Twelve volt terminal devices can be obtained for use with other manufacturers' systems.) Six volts offers lower battery weights while still providing adequate power for terminal device operation.</p> <p>Otto Bock's battery is a relatively small package, easily interchangeable, but for slow recharge only. Their "Griefer" is the only adult-sized powered hook currently on the market, and it readily interchanges with their adult hands. They also have the only electric wrist rotator currently available.</p> <p>They currently offer four hand sizes, for older children, teens and ladies, standard adult, and large adult males. These have become the <i>de facto</i> standard in the industry; virtually every other company can interface their system with a MyoBock hand. An assortment of wrists are also available.</p> <p>All their electrodes are digital, myoswitch types, as already discussed. They offer optional floating electrode mounts for cases where a change in residual limb volume is anticipated.</p> <p>Since their terminal devices are set up for myoswitch control, it is relatively easy to use regular switch control as well. Otto Bock offers both a rocker switch and a harness pull switch version.</p> <p>With their typical attention to detail, a complete set of <i>Technical Information Bulletins</i>, courses, and specialized tools are available. Otto Bock also offers a variety of well thought out accessories, such as a tweezer (pincer) for the hands, blank Griefer tips for machining custom gripping surfaces, and so on.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-02.jpg"><b>Fig. 2. <span>Variety Village VV2-6 electric hand: the smallest and lightest powered hand commercially available. (Courtesy of Variety Village Electrolimb Production Centre.)</span></b></a></p> <h3>Variety Village</h3> <p>Variety Village components complement Otto Bock's nicely, as they are targeted for smaller children, and include a powered elbow. All their components are switch controlled.</p> <p>They market three switch types: a toggle for phocomelics, a button type, and a pull strap version. In addition, their elbow can have the pull switch built in, or be ordered for use with remote switches.</p> <p>Their elbow is available in either 6 or 12 volts; their hands are 6 volts exclusively. Their smallest hand (for 2-6 year olds) has just been redesigned. Although similar to the Swedish hand, it is three ounces lighter.</p> <p>Their original hands (Models 105 and 106) have been discontinued. Research is currently underway to create the smallest electric hand yet available: thirty percent smaller than their VV2-6. Only prototypes exist at this time, however.</p> <p>They market several battery configurations, including a "Battery Saver Circuit" designed to prevent children from draining the electrical charge by stalling the motor. None are of the quick-charge variety, however.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-03.jpg"><b>Fig. 3. <span>Electric hands imported by Liberty Mutual. The smallest is the System-Teknik from Sweden; balance are Steeper hands from England. (</span><i>Courtesy of Liberty Mutual Research Center.</i><span>)</span></b></a></p> <h3>Hugh Steeper Limited</h3> <p>Steeper is the British corporation responsible for upper limb prosthetics in the United Kingdom. They have recently announced the availability of powered hands for small children.</p> <p>These are now being distributed by Liberty Mutual in the United States. The sizes complement the Swedish hand, in that the Steeper hands are a bit larger than either Swedish version. Sometime in 1986, they will probably offer a larger hand for the early teen.</p> <p>These are 6 volt, switch controlled devices for the most part. However, Steeper also offers a "Servo-Control" option. This is a unique kind of proportional switch control: the harder the child pulls on the switch cable, the stronger the grasp. With minor adaptations (which Liberty Mutual will make), they can also be controlled by Otto Bock or UNB myos witches.</p> <h3>System-Teknik</h3> <p>System-Teknik is a Swedish company with two children's hands on the American market. Production rights for these hands have just been aquired by Steeper, so design changes can be expected. Liberty Mutual is the American distributer.</p> <p>At the present time, two Swedish hands are available: one for 2-6 year olds and another for 5-9 year olds. Both are 6 volts, and they use the same size forearm laminating ring for easy interchange.</p> <p>They can be controlled by either the UNB or Otto Bock myoswitches and switch controls. UNB designed its batteries to be mounted within the forearm shell. If space permitted, Otto Bock's could be used as well.</p> <p>To simplify the fitting procedure, Liberty Mutual plans to offer a special wrist unit option, containing all necessary electronics. Planned for use with both the System Teknik and Steeper hands, it will come in one version containing the battery supply, and a shorter version for longer residual limbs with remote battery mounting.</p> <p><b><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-04.jpg">Fig. 4. <span>Variety of powered components supplied by Liberty Mutual, including the UNB Toy Controller. (</span><i>Courtesy of Liberty Mutual Research Center.</i><span>)</span></a><br /><br /></b><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-05.jpg"><b>Fig. 5. <span>Fidelity components, including harness pull switch, electric elbow, and VANU hand. (</span><i>Courtesy of Fidelity Biomedical Products.</i><span>)</span></b></a></p> <h3>University Of New Brunswick</h3> <p>All UNB products are available through Liberty Mutual in the United States. When ordering their "Single Site" system, there are three options for battery placement: built-in to the electronics package, mounted inside the forearm section, or mounted externally. As is the case with all manufacturers, you must purchase their particular myotester/trainer to properly adjust their system.</p> <p>In addition, UNB offers a unique single site system with built-in sensory feedback. To aid in myotraining small children, they also market a "Toy Controller," which can be adapted to run with Otto Bock electrodes as well.</p> <h3>Fidelity Electronics</h3> <p>Fidelity Electronics distributes the proportional below-elbow system originally developed at Northwestern University. At one time the United States Manufacturing Company also carried these components, but Fidelity is currently the sole source. This is sometimes referred to as the "VANU" hand.</p> <p>Several things are unique about this product. First, it is a 12 volt system. Secondly, all the electronics are located in a "wrist module," including the battery. Therefore, it is self-contained with minimal risk of wire damage. However, this also prevents fitting very long residual limbs and concentrates all the weight at the distal portion of the prosthesis.</p> <p>Long residual limbs require the use of a switch-controlled version, thus eliminating the wrist module. This hand is sized for adult males only (7 3/4).</p> <p>Fidelity also offers a switch-controlled elbow (again, in adult size only). This is an 8.75 volt system, with its own built-in battery pack. It utilizes an exoskeletal soft foam forearm set-up.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-06.jpg"><b>Fig. 6. <span>The Prehension Actuator provides powered opening for a variety of conventional hooks. Closing force is controlled by the number of rubber bands applied. (</span><i>Courtesy of Hosmer Dorrance Corporation.</i><span>)</span></b></a></p> <h3>Hosmer Dorrance</h3> <p>As the "grandfather" of upper limb prosthetics in North America, Hosmer is in a unique position to develop a system of powered components. Their basic philosophy has been to focus on light-weight, straightforward, relatively inexpensive designs.</p> <p>For years, they have offered the "Michigan Hook," which is the familiar child's hook, closed by a rubber band, but opened with a small motor winding a string. Last year, they announced an adult version of this concept, called the "NYU Prehension Actuator." This is a conventional forearm set-up with an electric "winder" included. It can be mated with a variety of voluntary opening hooks, using up to five rubber bands or so. Although it is currently switch-controlled, a single-site "MyoPack" will soon be available, offering the option to convert both the Michigan Hook and the Prehension Actuator to myoswitch control.</p> <p>Hosmer has also released the "NYU Hush" elbow. This is unique in several respects. First, it is designed to permit the familiar mechanical elbow to be substituted for the electric one, even in a finished prosthesis. Secondly, they elected to use standard "grocery store" nickel cadmium batteries to power the system. This dramatically reduces the cost to the consumer. Four AA NiCad cells yield a 5 volt system; if desired, five can be used for 6.25 volts. Either version is rechargable with an inexpensive "dimestore" trickle charger.</p> <p>Hosmer hopes to offer in 1986 a "Free Swing" option for their elbow, which could be retro-fitted to existing units in the field. Once the elbow attains full extension, it would automatically enter the free-swing mode. In addition to enhancing the dynamic cosmesis during ambulation, this may offer some special benefits to bilateral patients. Those who depend on the prosthesis for feeding would then have the option of resting the forearm against the table and using "body English" for elbow flexion.</p> <p>Finally, it can be used with either an endo-skeletal or exoskeletal forearm, as desired. This is a switch-controlled elbow, again keeping the costs lower, which is currently available in a large and medium size, corresponding to the familiar E-400 and E-200 mechanical elbows. Thus, it is suitable for many older children as well as adult men and women.</p> <p>Hosmer's switches have recently been redesigned to increase reliability. In addition to the familiar button and harness switches, they also offer a "Three-Position Harness Switch," permitting one control motion to operate both elbow flexion-extension and the NYU Prehension Actuator.</p> <p>The latest addition to the Hosmer line is an adult male (7 3/4) switch-controlled hand to complement their elbow. This also uses readily available NiCads for 5 or 6.25 volt operation. The "Synergetic Hook" designed by Dr. Dudley Childress at Northwestern University<a></a> should be available sometime in 1986. Beyond that, work is ongoing for a myoelectric elbow and hand, but neither is presently available.</p> <p><b><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-07.jpg">Fig. 7. <span>Boston elbow, combined with a Hosmer mechanical shoulder joint and Otto Bock electric hand. Combining various international components can enhance prosthetic restoration. (Prosthetic Design by John C. Hodgins, C.P.O.; (</span><i>Courtesy of Liberty Mutual Research Center.</i><span>)</span></a><br /><br /></b><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-8.jpg"><b>Fig. 8. <span>Exploded view of the Utah elbow. Highly modular construction facilitates servicing in the field. (</span><i>Courtesy of Motion Control, Inc.</i><span>)</span></b></a></p> <h3>Liberty Mutual</h3> <p>Liberty Mutual is the world's largest workmen's compensation insurer. In the United States, one in fifteen workers is insured by this company. Thus, they have a dual motivation in offering sophisticated prosthetic components: both to help the clients they insure, and also to enable the clients to return to work, thus reducing the company's liability.</p> <p>The 12 volt Liberty Mutual "Boston Elbow" can be categorized as a working man's device. And, in fact, it is one of the most durable electric elbows on the market. Although the original version was widely criticized because of the noise it made when operating, the current generation is markedly improved.</p> <p>This is the only elbow offering dual battery chargers. Although Liberty Mutual recommends overnight "trickle" charging for longer battery life, they offer a "quick charge" option, in case the internal battery becomes discharged before the day is over.</p> <p>This is also the only elbow designed to easily convert from proportional myoelectric control to switch control. Simply altering one wire makes the conversion. This can be very useful, for example, in fitting patients early with switch control, then later upgrading to myo-control as their residual limb matures.</p> <p>As mentioned elsewhere, Liberty Mutual also distributes the UNB, System-Technik, and Steeper components.</p> <h3>Motion Control</h3> <p>Motion Control is marketing the powered elbow system originally developed by the University of Utah. In contrast to Hosmer's strategy, this group sought to offer the most technologically advanced components possible. Undoubtedly, they have succeeded in this goal.</p> <p>However, most sophisticated does not necessarily mean best; simpler technology is often more reliable than state-of-the-art. Nevertheless, Motion Control has a unique addition to the prosthetic armamentarium.</p> <p>Their electronic locking mechanism and Sequential Proportional Control have already been discussed. Originally designed for mechanical terminal device operation, this 12 volt elbow can also be ordered with an Otto Bock hand. In this case, however, Motion Control discards the electronics and substitutes their own, thus offering true proportional myoelectric control of the Otto Bock hand.</p> <p>Of all the systems on the market, particularly above-elbow systems, this is the most "pros-thetist friendly." All the inner components are modular and easily exchangeable in the field. The quick-change battery pack is built into the humeral section, but below the elbow axis. This permits fitting longer residual limbs than is possible with other systems, and means there are no external wires to fray and fail.</p> <p>Further, this version offers by far the most adjustments to "fine tune" the elbow for a particular patient. There is a price to pay for this degree of technology, of course. In addition to being the most sophisticated, the Utah Arm is also by far the most expensive powered device available today.</p> <p>It is now possible to add an Otto Bock powered wrist rotator to the Utah Arm, using a variety of control strategies, including UNB or Otto Bock's single-site electrodes, two-site electrodes, and assorted switches. If a mechanical terminal device has been used, the Utah Arm mechanism can be modified to provide dedicated proportional control of the wrist unit. Also, their highly sensitive myotester is finally a commercial reality.</p> <p>Beyond that, Motion Control has just announced the availability, to prosthetists trained in the elbow fitting procedures, of a proportionally controlled below-elbow system, using Motion Control electronics to power an Otto Bock hand with 12 volts in a below-elbow prosthesis. Currently, this requires mounting two Otto Bock batteries, which can present some difficulties, although other battery sources can be utilized in selective cases.</p> <p>Finally, and perhaps most significantly, Motion Control has become the first supplier to offer a rental program for myoelectric components. In marginal cases, if funding has been conditionally approved, the components can be rented on a monthly basis for about ten percent of the total cost. Most of the rental is applied toward purchase of the arm if the fitting proves successful; if not, the parts are returned to Motion Control.</p> <p><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-09.jpg"><b>Table 1</b></a>, <b><a href="http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-10.jpg">Table 2</a><br /><br /></b><strong>Summary</strong></p> <p>Our powered upper limb armamentarium is now surprisingly complete. Although one must select components from all over the world, it is possible to fit virtually any patient from two years old to adulthood with an externally powered prosthesis.</p> <p>Otto Bock components remain the most widely utilized, and their hands and connectors are becoming the <i>de facto</i> standards in the field. Their own components are designed for below-elbow use, but are routinely adapted to higher levels. Otto Bock has chosen to develop a variety of myoswitch controls, but does not offer true proportional control.</p> <p>Although several voltages are used, a general trend toward 12 volts for above-elbow systems and 6 volts for below-elbow is apparent. And, switch control is used almost exclusively for very small children, progressing to myoswitch control as they mature; proportional control is most commonly reserved for adults.</p> <p>The children's components are all from outside the United States: Sweden, England, and Canada currently offer toddler hands. American designs are often targeted to adults: the Hosmer and VANU hands and Boston Elbow toward males, in particular.</p> <p>Hosmer is aggressively pursuing the inexpensive, low-tech end of the market, emphasizing interchangeability with the familiar mechanical counterparts. Motion Control is equally aggressive in pursuing the high tech, high cost end.</p> <p>Lack of funding is probably the major factor limiting the number of powered fittings currently undertaken. With the ready availability of various switch, myoswitch, and proportional controls, virtually any patient could operate an electric prosthesis.</p> <p>Questions about who is a suitable candidate for powered fittings are still largely unanswered. The evidence suggests that the highest failure rate is with bilateral fittings.<a></a> Perhaps the simplicity and resultant reliability of body powered prostheses makes mechanical solutions more succcessful here.</p> <p>The best system cannot be found, and few practitioners are brave enough or experienced enough to freely mix these international components. The issues of proportional vs. digital control, high tech vs. low tech design, hybrid vs. purely mechanical vs. purely powered fittings are all open to debate.</p> <p>And some very provocative data is emerging suggesting that the issue of when to fit is at least as significant as the issue of what to fit.<a></a></p> <p>It is beyond the scope of this paper to resolve these complex issues. Rather, the intent is simply to bring into focus the basic concepts, components, and controversies in the field of powered upper limb fittings. It is hoped that clarifying these issues will encourage prosthetic practitioners to deepen their involvement and understanding in this rapidly evolving area. As we struggle collectively with these problems, our patients and our profession will ultimately reap the benefits.</p> <h3>Appendix</h3> <p><i>V.A.N.U. Products</i><br />Fidelity Biomedical Products<br />6000 N.W. 153 Street<br />Miami Lakes, Florida 33014<br />(800) 327-7939</p> <p><i>Hush Elbow; Prehension Actuator</i><br />Hosmer-Dorrance Corporation<br />561 Division Street<br />P.O. Box 37<br />Campbell, California 95008<br />(800) 538-7748</p> <p><i>Boston, UNB, Steeper, Systek Products</i><br />Liberty Mutual Research Center<br />71 Frankland Road<br />Hopkinton, Massachusetts 01748<br />(617) 435-9061</p> <p><i>Utah Elbow, BE System</i><br />Motion Control, Inc.<br />1005 South 300 West<br />Salt Lake City, Utah 84101<br />(800) 621-3347</p> <p><i>MyoBock Products</i><br />Otto Bock Industry<br />4130 Highway 55<br />Minneapolis, Minnesota 55422<br />(800) 328-4058</p> <p><i>Variety Village Products</i><br />Variety Village Electrolimb Production Centre<br />3701 Danforth Avenue<br />Scarborough, Toronto<br />CANADA MIN 2G2<br />(416) 698-1415</p> <p><em><b>*John W. Michael, M.Ed.</b>,<strong> C.P.O.</strong> John W. Michael is Director of Prosthetics and Orthotics, Duke University Medical Center, Box 3885, Durham, North Carolina 27710.<br /></em><b><span><br /></span><br />References:</b></p> <ol> <li><a href="poi/1981_02_092.asp">Agnew, J.P., "Functional Effectiveness of a Myo-Electric Prosthesis Compared with a Functional Split-Hook Prosthesis: A Single Subject Experiment," <i>Prosthetics and Orthotics International</i>, 5(2), pp. 92-96, 1981.</a></li> <li><a href="cpo/1985_01_023.asp">Billock, John N., "Upper Limb Prosthetic Management-Hybrid Design Approaches," <i>Clinical Prosthetics and Orthotics</i>, 9(1), pp. 23-25, 1985.</a></li> <li>Childress, D.S., "An Approach To Powered Grasp," <i>Proceedings of the Fourth International Symposium on External Control of Human Extremities</i>, Dubrovnik, Yugoslavia; pp. 159-167, 1973.</li> <li>Doubler and Childress (1984), "Design and Evaluation of a Prosthesis Control System Based on the Concept of Extended Physiological Proprioception," <i>Journal of Rehabilitation Research and Development</i>, 10(39), pp. 19-31.</li> <li><a href="http://www.acpoc.org/library/1983_04_001.asp">Ferguson, Shirley, "Electric Power In Upper Limb Prosthetics: The Michigan Experience," <i>Inter-Clinic Information Bulletin</i>, 18(4), pp. 1-8, 1983.</a></li> <li>Graupe, et al., "A Multifunctional Prosthesis Control System Based on Time Series Identification of EMG Signals Using Microprocessors," <i>Bulletin of Prosthetics Research</i>, 10(27), pp. 4-16, 1977.</li> <li>Jacobsen, et al., "Development of the Utah Artificial Arm," <i>IEEE Transactions on Biomedical Engineering</i>, BME-29, (4), pp. 249-269, 1982.</li> <li>Malone, et al., "Immediate, Early, and Late Post-surgical Management of Upper-Limb Amputation," <i>Journal of Rehabilitation Research and Development</i>, 21(1), pp. 33-42, 1984.</li> <li>Millstein, Heger, and Hunter, "A Review of Failures in Use of the Below-Elbow Myoelectric Prosthesis," <i>Orthotics and Prosthetics</i>, 36(2), pp. 29-34, 1982.</li> <li>Murphy and Horn, "Myoelectric Control Systems- A Selected Bibliography," <i>Orthotics and Prosthetics</i>, 35(1), pp. 34-47, 1981.</li> <li>Northmore-Ball, et. al., "The Below-Elbow Myo-Electric Prosthesis: A Comparison of the Otto Bock Myo-Electric Prosthesis with the Hook and Functional Hand," <i>Journal of Bone and Joint Surgery</i>, 42-B(3), pp. 363-367, 1980.</li> <li>Scott, Robert NL, "My?-Electric Control of Prostheses," <i>Archives Of Physical Medicine and Rehabilitation</i>, 47(3), pp. 174-181, 1966.</li> <li>Scott, R.N., <i>An Introduction to Myoelectric Prostheses</i>. Bio-Engineering Institute, University of New Brunswick, Fredricton, N.B., pp. 37, 1984.</li> <li>Spaeth and Klotz, <i>Handbook of Externally Powered Prostheses for the Upper Extremity Amputee</i>, C. Thomas, Springfield, IL, p. 107, 1981.</li> <li>Wirta, Taylor, and Finley, "Pattern-Recognition Arm Prosthesis: A Historical Perspective-A Final Report," <i>Bulletin of Prosthetics Research</i>, 10(30), pp. 8-35, 1978.</li> </ol> Page Number(s) 66 - 77 Year 1986 Volume 10 Issue 2 Figure 1 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-05.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 6 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-8.jpg Figure 9 TABLE I http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-09.jpg Figure 10 TABLE II http://www.oandplibrary.org/cpo/images/1986_02_066/1986_02_066-10.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 Upper Limb Powered Components and Controls: Current Concepts Creator An entity primarily responsible for making the resource John W. Michael, M.Ed., C.P.O. * https://staging.drfop.org/files/original/527606029dde597c9241e01480a56072.pdf 4c755f2a1ca5cf1398a468e307fd2dea Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1986_02_087.pdf Text Any textual data included in the document <h2>Upper Extremity Cosmetic Gloves</h2> <h5>Sandra Bilotto, M.A., C.P.O.&nbsp;<a style="text-decoration: none;">*</a></h5> <h3>Introduction</h3> <p>Upper extremity rehabilitation includes the restoration of function and cosmesis to simulate the human hand.<a></a> Producing a replica of the hand which is functionally and psychologically beneficial to the amputee and quite importantly, acceptable to those with whom the amputee socially interacts,<a></a> is both challenging and of high priority.</p> <p>The technology for producing either custom made or mass produced cosmetic gloves has changed little in more than 20 years.<a></a> However, within the last several years, with the advent of new materials, there have been new developments. More specifically, there have been developments in a family of silicone elastomers the application of which offers solutions to problems associated with existing cosmetic glove technology.</p> <p>Briefly, cosmetic gloves have been made with latex, urethanes, and RTV silicones, but these materials were not successful because they had serious drawbacks. Latex skins were impermanent, coloration was unacceptable, tear strength was very low, absorption of clothing dyes was common,<a></a> and they did not last very long before deteriorating. Urethanes held promise, but the components to produce a plastic film are very difficult to control in small laboratories. They are too sensitive to moisture and extraneous contaminants, and require precise measuring. After limited use, they are weakened by ultraviolet light and thus their useful life as terminal device coverings is limited.<a></a> RTV or room temperature curing silicones, when first utilized in prosthetic restorations and glove-making, proved ineffective because the material required complicated molding procedures, was often manufactured pre-colored, had extremely low tear strength, and had very low elasticity and flexibility. In addition, one small tear would easily propagate, rendering the glove useless.</p> <h3>PVC Gloves</h3> <p>PVC, or polyvinyl chloride, has dominated glove making and still does to the present. Historically PVC is inexpensive and readily available. Gloves can be fabricated en masse in metal molds or custom made in flexible slush molds. In either technique, the plastisol cures against the wall of the mold, producing a thin skin of vinyl which can either be intrinsically and/or extrinsically colored.<a></a> Stabilizers and plasticizers are introduced to make the cosmetic glove flexible and resistant to degradation by ultraviolet light. Replication of the human hand has been adequate using PVC and thus these gloves have been widely available for most amputees. However, there are disadvantages associated with PVC as a material for use in prosthetic gloves.</p> <p>First and foremost is the inability of PVC to resist attack by most chemicals, soiling and staining agents, and newsprint. These substances are absorbed by the plasticizing agents and are impossible to remove. At temperatures close to freezing, the PVC stiffens and its flexibility is greatly reduced. This can inhibit the proper functioning of an electric or mechanical hand as the inability to open a finger or thumb can render a terminal device useless.<a></a> In warm temperatures, the plasticizers and stabilizers tend to bleed to the surface of the glove, causing peeling of the extrinsic coloring, as well as darkening and stiffening. PVC "feels" like plastic and not like human tissue, and for the most part, unless a PVC glove is custom made and tinted, the surface is rather opaque and cadaverous looking. Custom made PVC gloves present all of the above problems, but do match skin tone, hand shape, and surface characterization of the intact hand better. The time required to fabricate a custom glove is much longer because the technique is more elaborate, and as a result more expensive. Of course, the success of the glove is directly proportional to the ability of the prosthetist to make the cosmetic glove appear natural and reasonably well matched to the other hand.</p> <p>No matter what technique is utilized, the consensus is that PVC gloves are rather short lived: two weeks to eight months on average. Efforts to strengthen the glove with nylon fabric reinforcement or to retard discoloration by spraying clear solutions on the surface of the glove produce disappointing results.<a></a> Finally, there is a problem donning and doffing a PVC glove due to the inflexibility of the material proximal to the wrist. This gave rise to the practice of sewing zippers into gloves. Besides being bulky and unsightly, zipper installation is time consuming and the zipper may be easily jammed or broken. Thus, a better material which might resolve some of the above problems is needed.</p> <h3>Silicone Gloves</h3> <p>Silicone rubber offers excellent solutions to some of the aforementioned problems, and they now have properties which make them more readily processed in glove making.<a></a> In general, the new generation of silicones are tougher, more resilient, more durable, and more permanent than previously utilized materials. While not ideal, the silicone gloves presently being developed resist chemicals, dyes, soiling, and staining almost completely. The skins may be washed with mild detergents and water for cleaning. Unlike PVC, lower or higher temperatures have little effect on the strength, flexibility, or elasticity of the glove.<a></a> The result is better functioning of electro/mechanical hands, and in some cases, the elastic resistance of gloves can actually enhance functioning of the terminal device.</p> <p>Unlike PVC, silicone rubber may be modified to increase its elasticity where necessary without loss of tear strength. Cosmetic gloves of silicone elastomers may be intrinsically or extrinsically colored as with PVC. However, there is much greater adhesion of external pigments to silicone gloves and the resultant glove rarely sheds its external tinting. It is more color stable and is less affected by ultraviolet light than its PVC counterpart; Silicone neither darkens nor stiffens with the passage of time. Once fabricated, the glove is non-toxic as compared with PVC. This is an obvious advantage when fabricating gloves for babies and toddlers, as harmful agents do not leach out to the surface of the glove to enter the baby's mouth. Silicone can be formulated to reflect and absorb light in much the same way human skin does, producing a more natural and life like appearance. Likewise, silicone also simulates the "feel" of skin more closely as it relates to softness and texture.<a></a> Its higher coefficient of friction helps prevent glasses and other objects from falling out of the hand's grasp.</p> <h3>Discussion</h3> <p>There are some disadvantages in the production of silicone gloves which need to be addressed. The cost of manufacturing, the increase in fabrication time, and the slightly higher cost of silicone rubber<a></a> is retarding the availability of such gloves.</p> <p>However, if the technology to produce silicone gloves improves, and if they become more widely available, their cost and fabrication time should decrease. They have greater durability and esthetic appeal than PVC, and there can be no doubt that silicone offers possibilities heretofore unavailable with PVC.</p> <p>Silicone cosmetic coverings for the lower extremity are a future possibility. Swim and sport legs could be greatly inhanced by these tough, resilient and cosmetic coverings. Silicone compounds are presently used in maxillofacial prosthetics, breast prostheses, partial hands, partial feet, leg and arm buildups, and other body restorations.<a></a></p> <p>There is no doubt that a more natural, functional, esthetically and psychologically appealing cosmetic glove is needed by upper extremity amputees and that silicone gloves, despite some imperfections, will prove to be more promising and acceptable than PVC gloves.</p> <p><b>References:</b></p> <ol> <li>Arkles, B., "Look what you can make out of Silicones," <i>Chemteck</i>, Vol. 13, No. 9, pp. 542-555, September 1983.</li> <li><a href="al/1955_02_057.asp">Carnelli, W.A.; Defries, M.G.; and Leonard, F., "Color Realism in the Cosmetic Glove," <i>Artificial Limbs</i>, Vol. 2, pp. 57-65, May 1955.</a></li> <li>Davies, E.W.; Douglas, W.B.; and Small, A.D., "A Cosmetic Functional Hand Incorporating a Silicone Glove," <i>Journal of International Society of Prosthetics and Orthotics</i>, Vol. 1, No. 2, pp. 89-93, September 1977.</li> <li><a href="al/1955_02_047.asp">Dembo, T. and Tane-Baskin, E., "The Noticeability of the Cosmetic Glove," <i>Artificial Limbs</i>, Vol. 2 pp. 47-56, May 1955.</a></li> <li>Fillauer, C and Quigley, M., "Clinical Evaluation of an Acrylic Latex Material used as a Prosthetic Skin on Limb Prostheses," <i>Orthotics and Prosthetics</i>, Vol. 33, No. 4, pp. 30-38, December 1979.</li> <li><a href="al/1955_02_078.asp">Fletcher, M. and Leonard, F., "Principles of Artificial Hand Design," <i>Artificial Limbs</i>, Vol. 2, pp. 78-94. May 1955.</a></li> <li>Lee, D. and Harlan, W., "Medical Sculpture: A Valuable Aid to Patient Rehabilitation," <i>American Family Physician</i>, Vol. 15, pp. 110-114, February 1977.</li> <li>Journal American Dental Assoc., "Maxillofacial Prosthetic Materials," <i>Council on Dental Materials and Devices</i>, Vol. 90, pp. 834-848, April 1975.</li> <li>Klasson, Bo, Personal communication, Een-Holmgren, Stockholm, Sweden.</li> </ol> <em><b>*Sandra Bilotto, M.A., C.P.O. </b> Sandra Bilotto, M.A., C.P.O., currently resides in Yonkers, N.Y. She received her education in prosthetics and orthotics at N.Y.U. Prior to that she received training in sculpture. Cosmetic restoration is a particular interest of hers.<br /><br /></em> <div style="width: 400px;"></div> Page Number(s) 87 - 89 Year 1986 Volume 10 Issue 2 Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Upper Extremity Cosmetic Gloves Creator An entity primarily responsible for making the resource Sandra Bilotto, M.A., C.P.O. * https://staging.drfop.org/files/original/a16c64d7ccf859685483448cdaa30655.pdf 030e2ddd7f33ca508ab0109a9cb77990 https://staging.drfop.org/files/original/20971c1df6a94f651c41c24f4b2fa35b.jpg 2531dc6b54ab731bd857b99ad1648727 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1978_04_001.pdf Text Any textual data included in the document <h2>Up-Date on Immediate Post Surgical Fittings</h2> <h5>Robert F. Hayes, CP.&nbsp;</h5> <p>I would like to express some thoughts regarding the use of the technique of immediate post-surgical fittings of prostheses for below-knee amputees.</p> <p>Nearly all of us certainly agree that there are definite advantages to the patient in the use of prosthesis immediately after amputation, especially in the case of the BK amputee. However, the I.P.S.F. technique is not being used as standard practice in many areas. Perhaps one of the reasons is the lack of continuing education courses dealing with immediate postsurgical procedures.</p> <p>When the concept of immediate postsurgical fitting was first introduced approximately fifteen years ago there was a heavy concentration to the point of saturation on the application of prostheses in the operating room. This was good, because it gave us all an opportunity to be educated in such a revolutionary technique of treatment. However, today, there are many people entering the field involving amputation and amputee care every year, surgeons and prosthetists and in most cases they have only a limited knowledge of the I.P.S.F. techniques.</p> <p>Obviously, and for good reason, most surgeons are reluctant to use a technique with which they themselves are not familiar. It then becomes the role of the prosthetist to educate and encourage the use of I.P.S.F. and, ideally, apply the concept himself.</p> <p>Another reason for lack of use of I.P.S.F. is the inconvenience created by scheduling between doctor, prosthetist, and operating room. Often hours of valuable time are wasted when things are not proceeding on schedule, which is the norm rather than the exception.</p> <p>Another reason why I.P.S.F. techniques are abandoned is that when a surgeon and prosthetist first attempt this technique, they sometimes use a patient whose probability of healing is marginal under the best of circumstances. And sometimes ambulation is attempted too early, causing stump breakdown. The result is a surgeon convinced that this technique is not for his patients.</p> <p>Still another factor that discourages use of the I.P.S.F. concept is the application of a poorly fitting weight-bearing cast by individuals not fully trained. There have been individuals who, after reading an article or hearing a thirty-minute lecture on I.P.S.F., attempted to apply a weightbearing cast. Some of the more skilled are able to do this, but most have problems. If a cast is intended to bear weight, it must fit well, have proper relief areas and distal padding to provide relief if the patient should atrophy and settle in the socket.</p> <p>It is my opinion that no weight-bearing cast at all is better than a poor application of one that is supposed to bear weight. Please note, I said "weightbearing cast" and not a rigid dressing, which is and should be more readily applied immediately after the operation and does not require the same precision as does the weight-bearing cast. This will be taken up later.</p> <p>Now that we have discussed some of the problems that may have discouraged the utilization of I.P.S.F.- and I'm sure there are many more- let's constructively consider a couple of approaches that seem to work well.</p> <p>Since the inception of I.P.S.F., most of us have changed our thinking for some very solid reasons. One of the primary problems arose in the attempt to have the patient weightbearing and often ambulating within forty-eight hours postoperatively. We have learned that, in most cases, this concept is a disadvantage rather than an advantage and can be the cause of stump breakdown. If we agree that early ambulation is not intended, we may apply an immediate rigid dressing with the appropriate snugfitting sterile stump sock.</p> <p><b><a href="/files/original/20971c1df6a94f651c41c24f4b2fa35b.jpg">Fig 1:</a> Schematic lateral view of method first recommended in the U.S. for immediate past surgical fitting of below-knee prostheses. From "<i>Immediate Postsurgical Prosthetics in the Management of Lower Extremity Amputees</i>, Ernest M. Burgess, Joseph E. Traub, and A. Bennett Wilson, Jr., Veterans Administration, TR 10-5, April 1967.</b></p> <p>When the rigid dressing is not intended for weightbearing, most surgeons will make the application since they need not be concerned about felt pads for relief over pressure areas. The initial rigid dressing can be left on for approximately two weeks. During this time we have:</p> <ol> <li> <p>Protected the wound by</p> <ol> <li> <p>Keeping external contaminates out</p> </li> <li> <p>Preventing injury to the stump</p> </li> <li> <p>Protecting the posterior flap from undue pressure</p> </li> </ol> </li> <li> <p>Maintained the size of the stump, preventing edema, which alleviates pain</p> </li> <li> <p>Made the patient more comfortable and able to move about without fear of injury to the stump</p> </li> <li> <p>Prevented knee flextion contracture</p> </li> <li> <p>Greatly reduced complaints of phantom limb</p> </li> </ol> <p>After two weeks the initial rigid dressing is removed; or, in some cases, the surgeon will remove the sutures and wait for an additional week or two. At the end of the two-week postoperative period, the prosthetist is called in to apply an early post-surgical prosthesis usually with a plaster socket and a pylon with a SACH foot.</p> <p>In the fabrication of our plaster sockets, we strive to keep the plaster high up over the condyles to the mid thigh area. We find this is beneficial in eliminating knee flexion contractures and, most importantly, eliminating piston action within the socket, a very hazardous condition, especially in the early stages of fitting.</p> <p>I know attempts are made to trim plaster to a P.T.B, level for increased knee motion. The advantages of enclosing the knee offset the short time needed for patients to regain knee motion. I also use a waist belt and fork strap for added suspension. This temporary prosthesis is worn for approximately six weeks.</p> <p>The very thin patient may not need a cast change before the end of six weeks, but more muscular and fatty tissue will require cast changes according to the amount of atrophy.</p> <p>After the patient has been ambulating for approximately six weeks, the plaster socket is bi-valved and a negative mold is taken for the definitive prosthesis. The plaster socket is then put back on the patient and closed with plaster or tape. The plaster socket and pylon stay on the patient until delivery of the definitive prosthesis and removed as needed for fittings. When minor changes in stump size occur, stump socks may be added while using the plaster pylon prosthesis.</p> <p>To reduce some expense to the patient, the hospital can inventory several pylon assemblies suitable for temporary use. We also supply various sizes of used SACH feet that can be used temporarily. The patient is then charged only for the professional services of the prosthetist, thus saving the considerable expense of components.</p> <p>I hope that some of my comments may be of assistance to others who would like to employ more immediate postsurgical prosthetic care for patients, and hopefully stimulate others to respond with other approaches so that we may all benefit.</p> <p>I would like to acknowledge Dr. Elmer Franseen, from whom I have used references many times in this paper. Dr. Franseen is an Orthopedic Surgeon at Baystate Medical Center, Springfield, Mass. I am sad to say that Dr. Franseen is retiring this month, and I will miss working with this truly professional man. In the past fifteen years of working with Dr. Franseen, I have witnessed him employing I.P.S.F. on all of his B.K. amputees and only on rare occasions was a revision necessary.</p> Page Number(s) 1 - 3 Year 1978 Volume 2 Issue 4 Figure 1 http://www.oandplibrary.org/cpo/images/1978_04_001/1978_04_001-1.jpg Review Status Status of review after import from old O&P Library into Omeka platform. Content Review Complete Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Up-Date on Immediate Post Surgical Fittings Creator An entity primarily responsible for making the resource Robert F. Hayes, CP.  https://staging.drfop.org/files/original/06ff7c1b1ffe661ec3d52637ad1de5da.pdf d8e5e270866afbfeb1b0266021a3a456 https://staging.drfop.org/files/original/804147ec07f70a2ca9e68a7b5ad89752.jpg b8a5d08a40fc781da05fe270deedf973 https://staging.drfop.org/files/original/8060708851663a4e6b62705fd7673f48.jpg 48236d34b6e57e8fa3a8387180393966 https://staging.drfop.org/files/original/2621e70fa9f05b60c976cc6cd29949c0.jpg e16ad7168af90c3478c397208003756c https://staging.drfop.org/files/original/ea8672ccbfec15496887409c07bc2c68.jpg 4daa18a0bad84c931e0b84608e5180cb https://staging.drfop.org/files/original/ffda58be9b5b16824849380aef2798af.jpg df73e68e301073a206b5d54d322da7de https://staging.drfop.org/files/original/7dae03305294afa143bc899a07a7129e.jpg 81d0d6713066127f6689dd6f0bcef436 https://staging.drfop.org/files/original/9cba1e671bf7f65cc2aeac456c3cf265.jpg 25fa44df76c98369324d4692347573fd https://staging.drfop.org/files/original/0beb3fc2157b3219025430a21eb0f941.jpg bfc34be909d07c0f42d627d81681018e https://staging.drfop.org/files/original/c08f7b6c633291f9377ffe0a0662c0c7.jpg 8f0942b1cf85ffb6fd1e0cf158bf0400 https://staging.drfop.org/files/original/5ae9805eeac3afaf5817bc688515587d.jpg aaba8ada7145d82e8f00581e1b5f39cd https://staging.drfop.org/files/original/d24fb122adb3f7233341da58b557dd98.jpg a40ceb0ba4464673b1acc2d203cbe62e https://staging.drfop.org/files/original/5622b27f22b681d9faa779542276d256.jpg f3c6445361e54a612ebe16c8e7d71793 https://staging.drfop.org/files/original/e6be1213fe9bee96128e219d45e6bcf4.jpg 91ab67336ea16438dae2c542ec1a7d5d https://staging.drfop.org/files/original/839347574cabd58a2ec12adb88564d53.jpg 8504e432305c805881c15fe15c27eb1f DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout http://www.oandplibrary.org/al/pdf/1971_02_025.pdf Year 1971 Volume 1 Issue 2 Page Number(s) 25 - 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/1971_02_025.pdf"></a></td> <td></td> <td><p><b><a href="al/pdf/1971_02_025.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>Ulnar Hemimelia</h2> <h5>Charles H. Frantz, M.D. <a style="text-decoration:none;">*</a><br />Ronan O'Rahilly, M.D. <a style="text-decoration:none;">*</a><br /></h5> <p>Isolated deficits of the long bones form a well-recognized group of anomalies. They may be described as <i>terminal, </i>in which there are no unaffected parts distal to and in line with the deficient portion (<b>Fig. 1</b>); or <i>intercalary, </i>in which a middle part is deficient while those portions proximal and distal to it are present. (<b>Fig. 2</b>)<a></a></p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 1. Terminal longitudinal paraxial hemimelia, ulnar. There is absence of one or more digits (the absent parts have been ghosted in). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 2. Intercalary longitudinal paraxial hemimelia, ulnar. Note that all five fingers are present. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>Ulnar hemimelia is a postaxial longitudinal deficiency of the upper limb, wherein the ulna is completely or partially absent. Clinically, because of the multiplicity of forearm and hand deformities or contours, it may be very difficult to recognize precisely the deficiency without roentgen studies (<b>Fig. 3</b> and <b>Fig. 4</b>). The elbow joint may be in extension or in acute flexion. There may be fusion of the radiohumeral joint. The range of motion, if present, may be markedly limited. The proximal part of the radius may articulate with the underdeveloped capitulum, or it may be completely luxated. If the deficiency is incomplete, the ulnar remnant may vary in length and contour. The digits of the hand may vary greatly in number (<b>Fig. 5</b> and <b>Fig. 6</b>). At the shoulder girdle, one may observe considerable muscular atrophy, ligamentous relaxation, and a deep web in the axilla.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 3. <i>Left, </i>the short left upper limb is phocomelic. Note the severe atrophy of the left shoulder girdle. There are three digits in the hand. The right arm (ulnar hemimelia) demonstrates good shoulder musculature and motion. <i>Center, </i>abduction and forward flexion are limited by the axillary web. <i>Right, </i>X-rays reveal fused right radiohumeral joint (failure of cavitation). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 4. <i>Left, </i>bilateral ulnar hemimelia, with monodigital hands. <i>Right, </i>note the deep web at the cubital fossa (pterygium). <i>Center, </i>X-rays reveal the radiohumeral relationship. There is no true elbow joint. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 5. <i>Left, </i>bilateral ulnar hemimelia. The left is intercalary, since there are five digits; the right is terminal because there are only four digits. Patient has complete anonychia with distinctive pulp prints on the dorsum of the fingers. <i>Right, </i>X-rays reveal complete dislocation of the radiohumeral joints. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /><table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 6. <i>Left, </i>monodigital ulnar hemimelia, incomplete. <i>Right, </i>X-rays reveal proximal remnant of the ulna with a bowed radius. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>In 1932, Kanavel<a></a> reported 60 cases of ulnar deficiencies. Comparison of Kanavel's findings with those of the cases presented here reveals the digit deficits as shown in <b>Table 1</b>.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p>O'Rahilly<a></a> presented a resume of 65 cases in the literature up to 1950. This deficit is seen much less frequently than is radial hemimelia, the literature indicating a ratio of 18:1. O'Rahilly's analysis revealed that 67% of the cases were unilateral, and 69% involved the right upper limb. The incidence in males was more common, with a ratio of 2:1. Radiohumeral fusion and/ or digital syndactyly were not mentioned.</p> <p>The absence of a radiohumeral joint (fusion) indicates the failure of cavitation of this structure. It is suggested that the lack of cavitation is an integral part of the total deficit seen in some cases of ulnar hemi-melia (38.5% of Frantz's patients).</p> <p>During the past 15 years, the staff at the Area Child Amputee Center has examined and managed 26 children with ulnar hemi-melia. An analysis of these cases reveals a follow-up of from 1 to 15 years. There were 16 males and 10 females.</p> <p>This deficit appears to be a sporadic lesion, in that there were 59 normal siblings of the 26 patients studied. One patient had a fraternal twin who had no skeletal deficits.</p> <p>Ten of the patients (38.5%) had unilateral ulnar hemimelia with no other skeletal deficiencies. Three children (11.5%) had bilateral ulnar hemimelia; seven also had lower-limb deficits. Six patients with unilateral ulnar hemimelia had varying deficiencies in the contralateral upper limb. These included terminal transverse hemimelia, phocomelia, absent thumb, and absent fifth finger. Ten patients (38.5%) had radiohumeral fusion accompanying the ulnar hemimelia.</p> <p>The involvement of carpals and metacarpals is complex. The triquetrum and capitate often are absent. There is an increasing frequency of metacarpal failure as one passes from the radial to the ulnar side of the hand.</p> <p>The frequency of digital absence is shown in <b>Table 2</b>. It is of interest to note that the three-fingered hand is preponderant, followed closely in occurrence by the mono-digital hand.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Management</h3> <p>In our experience, most of these children can be managed without surgical intervention. The goal, of course, is to improve function, with or without the use of a prosthesis. Whether surgery is indicated depends upon whether both arms are involved, and on the range of motion, the number of digits present, and the presence or absence of syndactyly (<b>Table 3</b>).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Nonsurgical</h4> <p><i>No Fitting</i></p> <p>Some of these children had radiohumeral synostosis (<b>Fig. 3</b> and <b>Fig. 7</b>).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 7. <i>Left, </i>ulnar hemimelia with three-digit hand (left). The right upper limb is phocomelic. <i>Right, </i>X-rays show radiohumeral fusion (failure of cavitation). </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Opponens Post</i></p> <p>Children with one digit (monodigital hand) possessing good flexion power and lateral stability of the metacarpophalangeal joint were fitted to advantage (<b>Fig. 8</b>).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 8. This boy was born with bilateral ulnar hemimelia with monodigital hands (see fig. 4). At 4 years of age the right upper limb was fitted with an opponens post. The left limb was managed by elbow disarticulation and prosthetic replacement. The elbow unit has 11 positions, allowing from 45degrees flexion to 180degrees extension. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Below-elbow Prosthesis</i></p> <p>Modified below-elbow sockets were sometimes prescribed (<b>Fig. 9</b>). However, range of elbow motion is significantly lacking.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 9. <i>Left, </i>monodigital ulnar hemimelia, with extension limited to 70degrees. Web release in the cubital fossa offered little additional motion. Initially the child was fitted with a below-elbow type of prosthesis <i>(center). </i>After a 2-year trial, the family expressed dissatisfaction with the limited motion and function of the arm. At 4 years of age an elbow disarticulation was performed and prosthetically fitted <i>(right).</i> </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <p><i>Above-elbow Prosthesis</i></p> <p>This is a highly satisfactory method of fitting patients with unilateral, monodigital, ulnar hemimelia. The forearm segment is acutely flexed against and parallel to the humeral shaft and then encased within the humeral socket. The elbow-locking mechanism has a lever with which the single digit controls the elbow lock and unlock mechanism (<b>Fig. 10</b>).</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 10. <i>Left, </i>ulnar hemimelia with a monodigital hand. Note the acute flexion and the deep cubital web. <i>Center, </i>the radiohumeral angle is 20degrees. <i>Right, </i>the monodigital segment is encased in a fenestrated humeral socket in an elbow-disarticulation type of prosthesis. The digit operates the elbow lock. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h4>Surgical</h4> <p><i>Elbow Z-plasty</i></p> <p>Z-plasty in the cubital fossa was performed in two instances in an endeavor to decrease the cubital web and in the hope of allowing a greater range of elbow flexion and extension. This procedure is somewhat advantageous in that it allows a better fit of the forearm socket, but it fails to offer any significant increased range of motion and therefore is not recommended (see <b>Fig. 9</b>).</p> <p><i>Elbow Disarticulation</i></p> <p>This surgical procedure is followed by fitting the limb with an elbow-disarticula-tion type of prosthesis. The surgeon should be meticulous in his technique so as not to disturb the distal humeral epiphysis during the disarticulation procedure.</p> <p>The application of the elbow-disarticulation type of prosthesis with an outside locking elbow offers 11 different positions of the elbow joint.</p> <p><i>Humeral Derotation Osteotomy</i></p> <p>Two children received a humeral derotation osteotomy of at least 90 degrees (<b>Fig. 11</b>). One was lost to follow-up after early union.</p> <table> <tbody><tr> <td> <table> <tbody><tr> <td> <p class="clsTextCaption"><br /> Fig. 11. <i>Left, </i>ulnar hemimelia, left; there is radiohumeral fusion (failure of cavitation) with 90degrees rotation. <i>Center, </i>derotation osteotomy of the humerus at 4 years of age. <i>Right, </i>arm position following derotation osteotomy. Note the three-fingered hand; the parents refused to have a syndactyly-release performed. </p> </td> </tr> </tbody></table> </td> </tr> </tbody></table><br /> <h3>Discussion</h3> <p>From this brief outline of management, it is obvious that the treatment of these children is highly individualized. The timing and procedure may be dictated by the age of the patient, the question of bilateral-ity, and the scope of the handicap. The decision as to whether or not to prescribe a prosthesis may be a difficult one. The approach to handling these children with ulnar hemimelia has been developed over the years by trial and error and by functional analysis.</p> <p>In <b>Fig. 3</b>, severe as the deformities may appear to be, the right shoulder functions normally, and the boy is able to abduct and forward-flex the shoulder, which allows him to prehend with his right hand. The left upper limb is phocomelic; however, he has a functional "pinch force" with the digits for close-in functioning. In the occupational therapy department, he demonstrated a very acceptable level of accomplishment in the activities of daily living and therefore was not fitted with prostheses.</p> <p>This logic is in accord with the problem faced by the boy shown in <b>Fig. 7</b>. The ef-ficency of this four-year-old's performance in dressing, undressing, and toilet care is such that he needs no prosthetic aids. Utilizing the ulnar hemimelic limb, this boy is able to feed himself and care for most of his daily living demands.</p> <p>Bilateral ulnar hemimelia with monodi-gital hands is a severe handicap (see <b>Fig. 4</b>). One male in this group had the Cornelia de Lange syndrome. If a child is seen at an early age (i.e., before two years), one may be tempted to procrastinate. How long? The major question is whether one should fit one or both sides with a passive type of prosthesis (terminal devices with no cables, but with small rubber bands on the hooks) or whether to interfere surgically.</p> <p>It has been stated that a Z-plasty at the cubital fossa offers little improvement of the radiohumeral arc of motion.</p> <p>One approach may be to fit one side with an opponens post and the opposite side with a modified below-elbow prosthesis. Should the prosthetic side prove to be inadequate with a below-elbow type of prosthesis, one may then elect to perform an elbow disarticulation one year before kindergarten, allowing a year of prosthetic wearing before formal schooling. This was done in the patient shown in <b>Fig. 8</b>. At this writing, the boy is 14 years old. He is in junior high school and is the manager of the football team. Also, he is a fair bowler, for which he utilizes a special attachment to his prosthesis.</p> <p>Unilateral, monodigital, ulnar hemimelia with a normal contralateral upper limb is not as serious a handicap. The patient shown in <b>Fig. 9</b> was fitted at two years of age with a modified standard below-elbow pros- thesis. At the age of four years, the patient and her mother were dissatisfied with the function afforded, because of limited elbow motion. (The Z-plasty at the cubital fossa offered little additional motion.) The child received an elbow disarticulation and was subsequently fitted with a standard elbow-disarticulation prosthesis with a medially placed outside-locking elbow. At the time of writing, she is 18 years of age, ready to enter college, and is considered a very good prosthesis-wearer.</p> <p>The patient in <b>Fig. 10</b> was seen in 1964 at 15 years of age; she has a monodigital, left-sided, ulnar hemimelia. Her degree of radiohumeral flexion was more severe than that of the girl in <b>Fig. 9</b>. This patient was not particularly concerned with the cosmetic effect (and still is not). She was fitted with a prosthesis that encased the acutely flexed forearm within the humeral socket. The anterior, or ventral, wall of the socket was then fenestrated and a lever was attached to the elbow-locking cable, which permitted her to use the single digit to operate the elbow locking/unlocking mechanism. At this writing, she is in her second year in college and now wears a mechanical hand with a cosmetic glove. The upper arm is usually covered by a fluffy-sleeved blouse.</p> <p>To summarize, there are four approaches to treatment of the monodigital hand: op-ponens post; below-elbow prosthetic fitting; elbow-disarticulation prosthetic fitting, encasing the forearm in the humeral socket; or no fitting, which is the least recommended procedure.</p> <p>Rotational deformities occasionally are seen in which there may be up to 180 degrees of medial rotation of the forearm on the humerus. The hand rests at the side of the thorax, pointing dorsally. One patient was seen at eight months of age (see <b>Fig. 11</b>). There were three digits in the left hand with soft-tissue syndactyly. She received a derotation osteotomy of the humerus at the age of four years, and a fair result was ob- tained. Unfortunately, she was lost to clinic follow-up shortly after surgery.</p> <p>Dislocation of the radiohumeral joint is rare. One such patient was first seen at four years of age. He has five digits on the left hand and four on the right. There were no fingernails. It is of interest to note that this boy has distinctive prints on both the palmar and dorsal surfaces of his fingers. His radiohumeral joint anatomically is nonexistent (see <b>Fig. 5</b>). The intrinsic muscles of the hands are weakened, and the wrists are unstable. The forearms and hands have been encased in a half-sleeve of plastic attached to crutches (he also has bilateral amelia of the legs). He is now 18 years old and attends a trade school.</p> <p>Incomplete ulnar hemimelia occurred twice in this series. The proximal portion of the ulna is present, thus affording a normal-appearing elbow joint with an excellent range of motion (see <b>Fig. 6</b>). That child was seen at four years of age and fitted with a standard below-elbow prosthesis, which she is currently wearing.</p> <p>Syndactyly was encountered four times in 26 cases. Two cases have been corrected surgically.-<i>Charles H. Frantz, M.D.</i></p> <h3>Pathogenesis</h3> <p>The term "hemimelia" was introduced in 1836-37 by Isidore Geoffroy Saint-Hilaire <i>, </i><a></a> who also introduced the term "teratology". In 1877, Verneuil proposed subdivision (of "ectromelia") into longitudinal and transverse varieties <i>. </i><a></a> In addition to absence of the distal half (two of the four segments) of a limb, it became clear that, in some cases, only one side of the distal half was affected, and such instances were named (after the defective portion) "radial," "ulnar," "tibial," and "fibular" hemimelia. By 1903, a further distinction, that between terminal and intercalary varieties of hemimelia, had been made<a></a>. Finally, in 1951, O'Rahilly suggested the term "paraxial hemimelia" for the longitudinal variety, because either the preaxial or postaxial side of the limb is involved in such cases.</p> <p>It is not proposed to discuss here either the terminological basis<a></a> or the terato- genesis<a></a> of limb malformations in general, as these aspects have been considered recently elsewhere.</p> <p>Ulnar hemimelia was first reported in 1683 by Goller<a></a> and hence is probably the first of the paraxial hemimelias to be identified as such, there being some doubt about the true identity of the case of hemimelia described by Pare in 1573 <i>.</i><a></a> Although chronological tables of all the early cases of radial, tibial, and fibular hemimelia are available in the literature, no such list other than the bibliography provided by Rabaud and Hovelacque<a></a> seems to have been prepared for ulnar hemimelia.</p> <p>Among the hemimelias involving one of the four bones of the third limb segment, or "zygopodium" (forearm and leg), the ulnar type occurs the least. It differs from the others also in that a partial deficiency is more commonly found than complete absence. However, it resembles radial, tibial, and fibular hemimelia in that it is more frequently unilateral, more commonly seen on the right side, and more often observed in the male <i>. </i><a></a> Of particular interest are those cases in which thorough dissection has been possible <i>.</i><a></a> Several additional cases of ulnar hemimelia have been reported in the literature during the past two decades. The higher incidence of unilaterality and of right-sided involvement has been confirmed.<a></a> It is important to appreciate that the hemimelias may occur as isolated anomalies, or they may, as shown in this paper, be associated with other malformations. Ulnar hemimelia, for example, is sometimes a component of a sporadic syndrome that includes femoral and fibular defects.<a></a> The cause of the "FFU" (femur, fibula, ulna) syndrome is unknown; such factors as parental age and thalidomide have been ruled out, and familial occurrence has not been observed.</p> <p>A striking example of familial occurrence in several generations was recounted to Roberts<a></a> by a patient with ulnar hemimelia. Partial ulnar hemimelia of the intercalary type, together with hypoplasia of the thumbs and fibular hemimelia, has more recently been described and illustrated in two brothers <i>. </i><a></a> A different condition, ulnofibular dysplasia, characterized by shortening of the ulna and fibula, was found to be inherited as an autosomal dominant <i>.</i><a></a> Ulnar hemimelia accompanied by Polydactyly is not unknown <i>, </i><a></a> and the coexistence of Polydactyly and a long-bone deficiency in the same limb has been noted previously (e.g., heptadactyly and tibial hemimelia) <i>. </i><a></a> In such cases, it has been suggested that this seeming paradox of excess associated with deficiency may perhaps result from an excessive outgrowth, which occurs relatively late in the early embryonic period, "involved only the digital area, and attracts some of the tissue immediately proximal to the area of excess outgrowth" <i>. </i><a></a> In the human, the hand appears in mesenchyme at about 41 postovulatory days (stage 17), so that it may be expected that Polydactyly would be observable by about six weeks after fertilization. Indeed, an example of this as an isolated anomaly has been described <i>.</i><a></a> What are generally termed "fusions" of skeletal elements-that is, the occurrence as a single structure of something that is usually composed of two or more elements-may be found either as an isolated anomaly or in association with other disturbances. Carpal and tarsal fusions, for example, are not infrequent in the paraxial hemimelias, and, as emphasized in this paper, ulnar hemimelia may include humeroradial fusion. Normally, of course, certain bony fusions, such as those between the epiphyses and their diaphyses and between the neural arches and their centra, are of constant occurrence. Even in areas where synovial cavities might be expected, however, fusions are not infrequent, such as symphalangia between the middle and distal phalanges of the little toe. The histological development of phalangeal fusion has been studied in detail<a></a>, and it is of interest to note that carpal and tarsal fusions have been observed in both the embryonic and the fetal period.<a></a> That such fusions arise early during embryonic development as an absence of joint cavitation<a></a> is also suggested by studies of experimentally paralyzed chick embryos, in which articular cavities do not form.<a></a> The cartilaginous skeletal elements, which are at first united by mesenchyme, become, under these conditions, joined together by fibrous tissue or by cartilage. In other words, fusion takes place across the presumptive joint regions.</p> <p>That hemimelia occurs at a very early stage of embryonic life is indicated by the important, but neglected, observations of Hovelacque and Noel<a></a> on a strain of mice presenting tibial hemimelia. It was found that "the first manifestations of the anomaly are disclosed at a very early stage of development. They can be detected in embryos when the undifferentiated blastema begins to undergo change." In the tibial zone of the blastema, a "fibrous tract" appeared, and was connected to the fibula by the interosseous membrane. In some of these embryos, cartilaginous nodules developed in the area (especially proximally) where the tibia would normally form. Such nodules were in direct continuity with the fibrous tract; both constituted a unit that represented the tibia. The vascularization of the limbs was entirely normal. It was concluded<a></a> that "the tibia is never completely absent despite appearances; one can always find a trace of the element although it may be represented by only a nodule of pinhead size." There is no reason to believe that the above statements would not apply equally to the other types of paraxial hemimelia.</p> <p>To return to the human-the mesenchymal femur, tibia, and fibula appear at about 41 postovulatory days (stage 17), and the humerus, radius, and ulna appear at about 37 postovulatory days (stage 16). In other words, it may be expected that, in the light of the French workers' observations, paraxial hemimelia could be detected in the human before six weeks after fertilization.</p> <p>Prior to the first appearance of these specific skeletal elements, a sensitive period for teratogenic agents exists, as have been shown by correlations between the time of ingestion of thalidomide during pregnancy and the types of resultant anomalies.<a></a> Thus, tibial defects occurred mostly when ingestion began before the 46th menstrual day (perhaps about 32 post-ovulatory days). In one illustrated case, ingestion that commenced at 46 menstrual days resulted in bilateral radial hemimelia and malformations of the femur and tibia.</p> <p>Finally, it may be mentioned that ulnar hemimelia has been found sporadically in various animals, such as the pig.<a></a> It also has been produced experimentally by the inclusion of large doses of acetazol-amide (a carbonic anhydrase inhibitor) in the diet of rats during pregnancy <i>. </i><a></a> Of particular interest in these experiments is the circumstance that the ulnar hemimelia was practically restricted to the right side of the body.-<i>Ronan O'Rahilly, M.D.</i></p> <h3>Summary</h3> <p>The management of 26 cases of ulnar hemimelia has been discussed. This deficit is seen 18:1 less frequently than radial hemimelia. Bilaterality was present in 23% of the cases. Prior to determining the plan of treatment, a complete functional analysis should be carried out. Most of these children do not need surgery and may be treated by prosthetic fitting only. The pathogenesis of paraxial hemimelia and the embryogenesis of associated conditions, such as Polydactyly and joint fusions, are discussed.</p> <p><b>References:</b></p> <ol> <li>Drachman, D. B., and Sokoloff, The role of movement in embryonic joint development, <i>Develop. Biol. </i>14:401-420, 1966.</li> <li>Duken, J., Uber der Beziehungen zwischen As-similationshypophalangie und Aplasie der Inter-phalangealgelenke, <i>Virchows Arch. Path. Anat. Physiol. </i>233:204-225, 1921.</li> <li>Frantz, C. H., and R. O'Rahilly, Congenital skeletal limb deficiencies, <i>J. Bone Joint Surg. </i>43-A: 1202-1224, 1961.</li> <li>Gardner, E., D. J. Gray, and R. O'Rahilly, The prenatal development of the skeleton and joints of the human foot, <i>J. Bone Joint Surg. </i>41-A: 847-876, 1959.</li> <li>Hovelacque, A., and R. Noel, Processus embryo-logique de l'absence congenitale du tibia, C. <i>R. Soc. Biol. Paris </i>88:577-578, 1923.</li> <li>Kanavel, A. B., Congenital malformations of the hands, <i>Arch. Surg. </i>25:1-53, 282-320, 1932.</li> <li>Klippel, M., and E. Rabaud, Sur une forme rare d'hemimelie radiale intercalaire, <i>Nouu. Ponograph. Salpetriere </i>16:238-251, 1903.</li> <li>Ku'hne, D., W. Lenz, D. Petersen, and H. Schoneberg, Defekt von Femur und Fibula mit Amelie, Peromelie oder ulnaren Strahldefekten der Arme, Ein Syndrom, <i>Humangenetik </i>3: 244-263, 1967.</li> <li>Laurin, C. A., and A. W. Farmer, Congenital absence of ulna, <i>Canad. J. Surg. </i>2:204-207, 1959.</li> <li>Layton, W. M., and D. W. Hallesy, Deformity of forelimb in rats: association with high doses of acetazolamide, <i>Science </i>149:306-308, 1965.</li> <li>Lenz, W., Zur Genese der angeborenen Hand-fehlbildungen, <i>Chir. Plast. Reconstr. </i>5:3-15, 1968.</li> <li>Lenz, W., Der Zeitplan der menschlichen Organogenese als Massstab fur die Beurteilung teratogener Wirkungen, <i>Fortschr. Med. </i>87: 520-526, 1969.</li> <li>Malgaigne, J. F., <i>Oeuvres Completes d'Ambroise Pare, </i>vol. 3, Paris, Bailliere, 1841.</li> <li>Meckel, J. F., <i>Handbuch der pathologischen Ana-tomie, </i>Leipzig, Reclam, 1812.</li> <li>Murray, P. D. F., and D. B. Drachman, The role of movement in the development of joints and related structures: the head and neck in the chick embryo, <i>J. Embryol. Exp. Morph. </i>22:349-371, 1969.</li> <li>Nishimura, H., <i>Chemistry and Prevention of Congenital Anomalies, </i>Springfield, HI., Charles C Thomas, 1964.</li> <li>O'Rahilly, R., Morphological patterns in limb deficiencies and duplications, <i>Amer. J. Anat. </i>89: 135-193, 1951.</li> <li>O'Rahilly, R., The development and the developmental disturbances of the limbs, <i>Irish J. Med. Sci. </i>pp. 30-33, January 1959.</li> <li>O'Rahilly, R., The nomenclature and classification of limb anomalies, <i>Birth Defects: Original Article Series </i>5:14-17, 1969.</li> <li>Pfeiffer, R. A., and K. Reinhardt, Ulno-fibulare Dysplasie, Eine autosomaldominant vererbte Mikromesomelie ahnlich dem Nievergeltsyndrom, <i>Fortschr. Roentgenstr. </i>107:379-391, 1967.</li> <li>Rabaud, E., and A. Hovelacque, Etudes sur l'ectromelie, I. L'ectromelie longitudinale intercalaire hemisegmentaire, <i>Bull. Biol. France Belg. </i>57:401-468, 1923.</li> <li>Roberts, A. S., A case of deformity of the fore-arm and hands, with an unusual history of hereditary congenital deficiency, <i>Ann. Surg. </i>3:135-139, 1886.</li> <li>Stoffel, A., and E. Stempel, Anatomische Studien iiber die Klumphand, <i>Z. Orthop. Chir. </i>23:1-157, 1909.</li> <li>Stroer, W. F. H., Die Extremitatenmissbildungen und ihre Beziehungen zum Bauplan der Extremitat, <i>Z. Anat. Entwicklungsgesch </i>108:136-160, 1938.</li> <li>Trucchi, O., Ectromelie longitudinali estese e sistematiche in due fratelli, <i>Nunt. Radiol. </i>26: 1040-1054, 1960.</li> <li>Zwilling, E., and J. F. Ames, Polydactyly, related defects and axial shifts, a critique, <i>Amer. Naturalist </i>92:257-266, 1958.</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>10.</b> </td><td class="clsTextSmall">Layton, W. M., and D. W. Hallesy, Deformity of forelimb in rats: association with high doses of acetazolamide, Science 149:306-308, 1965.</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>23.</b> </td><td class="clsTextSmall">Stoffel, A., and E. Stempel, Anatomische Studien iiber die Klumphand, Z. Orthop. Chir. 23:1-157, 1909.</td></tr><tr><td class="clsTextSmall"><b> 24.</b> </td><td class="clsTextSmall">Stroer, W. F. H., Die Extremitatenmissbildungen und ihre Beziehungen zum Bauplan der Extremitat, Z. Anat. Entwicklungsgesch 108:136-160, 1938.</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>12.</b> </td><td class="clsTextSmall">Lenz, W., Der Zeitplan der menschlichen Organogenese als Massstab fur die Beurteilung teratogener Wirkungen, Fortschr. Med. 87: 520-526, 1969.</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>21.</b> </td><td class="clsTextSmall">Rabaud, E., and A. Hovelacque, Etudes sur l'ectromelie, I. L'ectromelie longitudinale intercalaire hemisegmentaire, Bull. Biol. France Belg. 57:401-468, 1923.</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">Hovelacque, A., and R. Noel, Processus embryo-logique de l'absence congenitale du tibia, C. R. Soc. Biol. Paris 88:577-578, 1923.</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>1.</b> </td><td class="clsTextSmall">Drachman, D. B., and Sokoloff, The role of movement in embryonic joint development, Develop. Biol. 14:401-420, 1966.</td></tr><tr><td class="clsTextSmall"><b>15.</b> </td><td class="clsTextSmall">Murray, P. D. F., and D. B. Drachman, The role of movement in the development of joints and related structures: the head and neck in the chick embryo, J. Embryol. Exp. Morph. 22:349-371, 1969.</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>17.</b> </td><td class="clsTextSmall">O'Rahilly, R., Morphological patterns in limb deficiencies and duplications, Amer. J. Anat. 89: 135-193, 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>4.</b> </td><td class="clsTextSmall">Gardner, E., D. J. Gray, and R. O'Rahilly, The prenatal development of the skeleton and joints of the human foot, J. Bone Joint Surg. 41-A: 847-876, 1959.</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">Duken, J., Uber der Beziehungen zwischen As-similationshypophalangie und Aplasie der Inter-phalangealgelenke, Virchows Arch. Path. Anat. Physiol. 233:204-225, 1921.</td></tr><tr><td class="clsTextSmall"><b>4.</b> </td><td class="clsTextSmall">Gardner, E., D. J. Gray, and R. O'Rahilly, The prenatal development of the skeleton and joints of the human foot, J. Bone Joint Surg. 41-A: 847-876, 1959.</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>16.</b> </td><td class="clsTextSmall">Nishimura, H., Chemistry and Prevention of Congenital Anomalies, Springfield, HI., Charles C Thomas, 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>26.</b> </td><td class="clsTextSmall">Zwilling, E., and J. F. Ames, Polydactyly, related defects and axial shifts, a critique, Amer. Naturalist 92:257-266, 1958.</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>18.</b> </td><td class="clsTextSmall">O'Rahilly, R., The development and the developmental disturbances of the limbs, Irish J. Med. Sci. pp. 30-33, January 1959.</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>25.</b> </td><td class="clsTextSmall">Trucchi, O., Ectromelie longitudinali estese e sistematiche in due fratelli, Nunt. Radiol. 26: 1040-1054, 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>Reference</b></td></tr><tr><td class="clsTextSmall"><b>20.</b> </td><td class="clsTextSmall">Pfeiffer, R. A., and K. Reinhardt, Ulno-fibulare Dysplasie, Eine autosomaldominant vererbte Mikromesomelie ahnlich dem Nievergeltsyndrom, Fortschr. Roentgenstr. 107:379-391, 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>25.</b> </td><td class="clsTextSmall">Trucchi, O., Ectromelie longitudinali estese e sistematiche in due fratelli, Nunt. Radiol. 26: 1040-1054, 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>Reference</b></td></tr><tr><td class="clsTextSmall"><b>22.</b> </td><td class="clsTextSmall">Roberts, A. S., A case of deformity of the fore-arm and hands, with an unusual history of hereditary congenital deficiency, Ann. Surg. 3:135-139, 1886.</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>8.</b> </td><td class="clsTextSmall">Ku'hne, D., W. Lenz, D. Petersen, and H. Schoneberg, Defekt von Femur und Fibula mit Amelie, Peromelie oder ulnaren Strahldefekten der Arme, Ein Syndrom, Humangenetik 3: 244-263, 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>9.</b> </td><td class="clsTextSmall">Laurin, C. A., and A. W. Farmer, Congenital absence of ulna, Canad. J. Surg. 2:204-207, 1959.</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>23.</b> </td><td class="clsTextSmall">Stoffel, A., and E. Stempel, Anatomische Studien iiber die Klumphand, Z. Orthop. Chir. 23:1-157, 1909.</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>17.</b> </td><td class="clsTextSmall">O'Rahilly, R., Morphological patterns in limb deficiencies and duplications, Amer. J. Anat. 89: 135-193, 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>21.</b> </td><td class="clsTextSmall">Rabaud, E., and A. Hovelacque, Etudes sur l'ectromelie, I. L'ectromelie longitudinale intercalaire hemisegmentaire, Bull. Biol. France Belg. 57:401-468, 1923.</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>13.</b> </td><td class="clsTextSmall">Malgaigne, J. F., Oeuvres Completes d'Ambroise Pare, vol. 3, Paris, Bailliere, 1841.</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>14.</b> </td><td class="clsTextSmall">Meckel, J. F., Handbuch der pathologischen Ana-tomie, Leipzig, Reclam, 1812.</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>11.</b> </td><td class="clsTextSmall">Lenz, W., Zur Genese der angeborenen Hand-fehlbildungen, Chir. Plast. Reconstr. 5:3-15, 1968.</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>19.</b> </td><td class="clsTextSmall">O'Rahilly, R., The nomenclature and classification of limb anomalies, Birth Defects: Original Article Series 5:14-17, 1969.</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">Klippel, M., and E. Rabaud, Sur une forme rare d'hemimelie radiale intercalaire, Nouu. Ponograph. Salpetriere 16:238-251, 1903.</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>21.</b> </td><td class="clsTextSmall">Rabaud, E., and A. Hovelacque, Etudes sur l'ectromelie, I. L'ectromelie longitudinale intercalaire hemisegmentaire, Bull. Biol. France Belg. 57:401-468, 1923.</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>19.</b> </td><td class="clsTextSmall">O'Rahilly, R., The nomenclature and classification of limb anomalies, Birth Defects: Original Article Series 5:14-17, 1969.</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>17.</b> </td><td class="clsTextSmall">O'Rahilly, R., Morphological patterns in limb deficiencies and duplications, Amer. J. Anat. 89: 135-193, 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>6.</b> </td><td class="clsTextSmall">Kanavel, A. B., Congenital malformations of the hands, Arch. Surg. 25:1-53, 282-320, 1932.</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">Frantz, C. H., and R. O'Rahilly, Congenital skeletal limb deficiencies, J. Bone Joint Surg. 43-A: 1202-1224, 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>Ronan O'Rahilly, M.D. </b></td></tr><tr><td class="clsTextSmall">Director of the Carnegie Collection, Dept. of Embryology, Carnegie Institution of Washington, Baltimore, Md. 21210; Professor of Anatomy, Wayne State Univ. School of Medicine, Detroit, Mich.</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 H. Frantz, M.D. </b></td></tr><tr><td class="clsTextSmall">Medical Codirector, Area Child Amputee Program (Mich. Dept. of Public Health), 920 Cherry St., S.E., Grand Rapids, Mich. 49506.</td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div> Figure 1 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-28.jpg Figure 2 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-29.jpg Figure 3 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-30.jpg Figure 4 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-31.jpg Figure 5 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-32.jpg Figure 6 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-33.jpg Figure 7 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-39.jpg Figure 8 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-40.jpg Figure 9 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-41.jpg Figure 10 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-34.jpg Figure 11 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-35.jpg Figure 12 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-36.jpg Figure 13 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-37.jpg Figure 14 http://www.oandplibrary.org/al/images/1971_02_025/ArtificialLimbs-Autumn1971-38.jpg Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. 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For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Clinical Prosthetics & Orthotics Description An account of the resource The American Academy of Orthotists and Prosthetists published this periodical from 1977 through 1988, when it was replaced with the Journal of Prosthetics & Orthotics (JPO). Earlier issues went under the heading Newsletter: Prosthetics & Orthotics Clinic. The name was changed to Clinical Prosthetics & Orthotics (CPO) in Spring of 1982 (Vol. 6 No. 2). Creator An entity primarily responsible for making the resource The American Academy of Orthotists and Prosthetists Language A language of the resource English DRFOP - Legacy Full Text PDF PDF Including Full Text and Original Layout https://www.oandplibrary.org/cpo/pdf/1985_01_030.pdf Text Any textual data included in the document <h2>Two-Stage Cast-taking Procedure for PTS Prosthesis</h2> <h5>Kurt Marschall, CP&nbsp;<a style="text-decoration: none;">*</a></h5> <p>Proper cast-taking and accurate measurements of a patient's remaining extremity, combined with careful evaluation and modification of the positive mold, are the most important steps in the fabrication and fitting of any prosthetic-orthotic device. Success or failure in prosthetic-orthotic fitting is directly related to the cast taken and the modifications incorporated in the positive mold.</p> <p>It is my firm belief that the person taking the cast should also be the one to modify it. Ideally, the modification of any master mold should be accomplished as soon after cast-taking as possible. The reasons are obvious. It makes it possible to recall the characteristics of the patient's extremity and to pay special attention to particular landmarks and problem spots that have been identified. Long delays will only serve to wipe out the memory of these characteristics. Granted, the caseload in some facilities does not permit this ideal situation of an immediate cast-modification procedure. Therefore, it should be the aim that the cast-taker produce a cast that can be easily understood and interpreted by the person modifying it. In the case of the PTS cast, landmarks should be well identified, circumference and length measurements should be accurate and special consideration or conditions should be carefully recorded. These are preconditions for proper cast modification and subsequent fabrication of a superior fitting socket, and form the foundation of any successful below knee fitting procedure.</p> <p>It is now well over twenty years since I first introduced, together with my colleague and partner, Robert Nitschke, CP, the American concept of the PTS prosthesis in Palm Springs, California. It now enjoys a widespread acceptance in the field of prosthetics and has become an integral part of the prosthetic armamentarium.</p> <p>Since then, deviations from the original PTS concept, dictated by physiological reasons, geographic location or climactic conditions have been introduced. The Fillauer removable medial wedge,<a></a> as well as the removable medial brim version,<a></a> are such a case in point. The supracondylar fitting with the anterior portion of the socket cut distal to the midpatella level, which thus sacrifices intimate contact with the quadriceps, should also be mentioned.</p> <p>All of these different techniques have their place. They work well, if, as a prerequisite to socket fabrication, a cast of superior quality and accurate cast modification can be supplied.</p> <p>Twenty years ago, we advocated a one step cast-taking technique, necessitating the use of a cast cutter in the posterior portion of the medial and lateral hamstrings for cast removal. The noise of the cast cutter, accompanied by some heat development when the blade oscillates through the cast, proved to be quite troublesome and sometimes frightening, especially to children and geriatrics. For these reasons we have employed for many years now a two-stage casting procedure in our facilities that produces a cast of superior quality with built-in characteristics that are easily identifiable in our positive molds prior to modification.</p> <h3>MEASURING AND CASTING PROCEDURE</h3> <ol> <li> <p>Materials and tools necessary for cast-taking procedure (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-01.jpg"><b>Fig. 1</b></a>):<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-01.jpg"><strong>Figure 1. Materials and tools necessary for PTS prosthesis cast-taking procedure.</strong></a></p> <blockquote> <p>2 light cast socks<br />1" elastic belt and 2 holding clamps<br />PTS caliper<br />A-P tension clamp<br />Bandage scissor<br />Goniometer<br />Modified Ritz stick<br />Orthoflex plaster bandage, 4"<br />Regular plaster of Paris bandages, 4", extra fast setting<br />Revere rubber bands, size 33 or equivalent<br />Otto Bock separation gel (Gipsisoliercreme) or vaseline</p> </blockquote> </li> <li> <p>After positioning patient properly and comfortably on table, examine and palpate extremity carefully. Record findings on measurement sheet. Apply two light cast socks over patient's extremity and identify with indelible pencil all pertinent landmarks and bony protuberances (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-02.jpg"><strong>Fig. 2</strong></a>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-02.jpg"><strong>Figure 2. Identify all landmarks and bony protuberances.</strong></a></p> <ol> <li> <p>Record circumference at three levels: mid-patellar tendon, mid-portion and around distal end of extremity.</p> </li> <li> <p>Record length of amputated extremity with modified Ritz stick (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-03.jpg"><b>Fig. 3</b></a>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-03.jpg"><strong>Figure 3. Record length of extremity with modified Rita stick.</strong></a></p> </li> <li> <p>Record M-L dimension with PTS caliper at widest margin of knee (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-04.jpg"><b>Fig. 4</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-04.jpg"><strong>Figure 4. M-L dimension at the widest margin</strong></a></li> <li> <p>Record M-L dimension above the medial and lateral femoral condyles (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-05.jpg"><b>Fig. 5</b></a>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-05.jpg"><strong>Figure 5. M-L dimension above medial and lateral femoral condyles.</strong></a></p> </li> <li> <p>Record A-P dimension with knee relaxed and slightly flexed. The amount of flexion depends on the length of the remaining extremity. Seven-10 degrees is usually sufficient for medium sized amputations. Shorter ones may require more flextion (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-06.jpg"><b>Fig. 6</b></a>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-06.jpg"><strong>Figure 6. A-P dimension with knee relaxed and slightly flexed.</strong></a></p> </li> </ol> </li> <li> <p>Wrap the amputated extremity with Ortho-flex bandage starting at distal end and terminating at the mid-patella level. Reinforce with regular, extra fast setting plaster of Paris bandage, and identify with thuimbs the patellar-tendon bridge (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-07.jpg"><b>Fig. 7</b> </a>and <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-08.jpg"><b>Fig. 8</b></a>).</p> </li> <li> <p>With plaster of Paris cast still soft and moldable, apply A-P tension clamp (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-09.jpg"><b>Fig. 9</b></a>). This makes it possible to shape the cast with both hands while it hardens, thus keeping later cast modifications to a minimum (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-10.jpg"><b>Fig. 10</b></a>). Please note clamp and hand-induced characteristics of hardened first stage of mold (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-11.jpg"><b>Fig. 11</b></a>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-09.jpg"><strong>Figure 9. Apply A-P tension clamp.</strong></a></p> </li> <li> <p>Use Otto Bock separating gel or vaseline and apply a thin layer to the proximal 1 1/2" of the superior portion of the cast (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-12.jpg"><b>Fig. 12</b></a>). Measure out six layers of 4" regular, extra fast setting plaster of Paris bandage or splints, sufficient in length to reach slightly past medial and lateral hamstrings (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-13.jpg"><b>Fig. 13</b></a>). Apply to patient's extremity, overlapping first stage cast by at least one inch and extending over the patella and covering quadriceps tendon by one inch. Use six inch wide splints if necessary. Apply two thin rubber bands to superior edge of wings (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-14.jpg"><b>Fig. 14</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-14.jpg"><strong>Figure 14. Apply two rubberbands to superior edge of wings.&nbsp;</strong></a></li> <li> <p>Place thumbs in the indentations of the mid-patellar tendon bridge and use the index and middle fingers of both hands to apply sufficient pressure to reach the depth of the recorded narrow M-L dimension just superior to the femoral condyles. The fingers should always straddle the ilio-tibial band on the lateral side (<b>Fig. 15</b>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-15.jpg"><strong>Figure 15. Apply sufficient pressure to reach the depth of the recorded narrow M-L dimension.&nbsp;</strong></a></li> <li> <p>After the second stage of the cast has set enough to hold finger impressions in place, remove the rubber bands and mark juncture between first and second stage with indelible pencil (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-16.jpg"><b>Fig. 16</b></a>). Remove second stage by carefully lossening and lifting medial and lateral wings free (<b>Fig. 17</b>).<br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-16.jpg"><strong>Figure 16. Mark juncture between first and second stage.</strong></a><br /><br /><a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-17.jpg"><strong>Figure 17. Carefully loosen and lift medial and lateral wings free</strong></a></p> </li> <li> <p>Reflect the top cast sock distally. Let patient's musculature relax completely. While pulling the bottom cast sock proximal, slowly remove first stage (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-18.jpg"><b>Fig. 18</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-18.jpg"><strong>Figure 18. Slowly remove first stage while pulling the bottom cast sock proximal.</strong></a><br /> <p>Cut off excess cast sock adhering to first stage (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-19.jpg"><b>Fig. 19</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-19.jpg"><strong>Figure 19. Cut off excess cast sock adhering to first stage.</strong></a></li> <li> <p>Join both stages together again by matching the separation marks exactly (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-20.jpg"><b>Fig. 20</b></a>).</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-20.jpg"><strong>Figure 20. Join both stages together, matching the separate marks exactly.</strong></a><br /> <p>While holding both stages securely together with the left hand, place plaster of Paris bandage about the juncture and wrap all the way to the top of cast.</p> </li> <li> <p>The negative wrap should display all landmarks clearly (<a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-21.jpg"><b>Fig. 21</b></a>). Check for correct flexion angle. Negative cast can now be filled.</p> <a href="http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-21.jpg"><strong>Figure 21. The negative wrap should display all landmarks clearly</strong></a></li> </ol> <p>During the cast-taking procedure, I make it a point to involve the patient by explaining each and every step. I use proper nomenclature and anatomical description of the remaining extremity. We should remember that each patient has gone through a very traumatic, cosmetically and functionally destructive surgical procedure. His or her spirits need to be lifted and encouraged. Most patients appreciate an intimate involvement in their prosthetic rehabilitation. Some of them even retain the knowledge gained during their cast and fitting procedures and answer subsequent questions on a sophisticated level. Treatment of your patient as a human being, rather than as a number among many makes being in this profession such an outstanding experience.</p> <h3>Conclusion</h3> <p>The importance of a good cast-taking technique has been stressed. Ideally, the positive mold should be modified by the cast-taker. In the absence of such a luxury, the cast modifier, with the aid of the measurements and the recording of special considerations, should be able to readily understand the characteristics that have been built into the cast. Proper cast modification will contribute immeasurably to good socket fit and superior function and performance by the amputee.</p> <p>Where the above guidelines have not been followed, an inferior socket fit will result. In such a case, the cast-taking procedure should be repeated and a new socket should be fabricated. Successfully fitting 10 to 20 patients in a row does not make any of us an infallible super-prosthetist. Every once in a while we all have to admit defeat due to oversight of basic principles or failure to adhere to prescribed guidelines and procedures. These infrequent failures will keep us on our toes and make us humble again. But, admitting defeat or failure and correcting it without a moment's hesitation, will make you, in the eyes of your peers, in the eyes of your physician, but foremost, in the eyes of your patient, the better practitioner.</p> <p><b>References:</b></p> <ol> <li>Marschael, K. and Nitschke, R., "Principles of the Patellar Tendon Supracondylar Prostheses," <i>Orthopedic Appliance Journal</i>, Vol. 21, No. 1, March, 1967, pp. 33-38.</li> <li>Fillauer, C., "Supracondylar Wedge Suspension of the PTB Prostheses," <i>Orthotics and Prosthetics</i>, Vol. 22, No. 2, June, 1968, pp. 39-44.</li> <li>Fillauer, C., "A Patellar-Tendon-Bearing Socket with a Detachable Medial Brim," <i>Orthotics and Prosthetics</i>, Vol. 25, No. 4, December, 1971, pp. 26-34.</li> </ol> <div style="width: 400px;"><em><b>*Kurt Marschall, CP </b> Kurt Marschall, CPO is President of Empire Orthopedic Laboratories, a division of Rochester Orthopedic Laboratories, Inc., 249 East Adams Street, Syracuse, New York 13202.</em><br /><br /><br /></div> Page Number(s) 30 - 34 Year 1985 Volume 9 Issue 1 Review Status Status of review after import from old O&P Library into Omeka platform. Assigned to Expert Review Figure 1 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-01.jpg Figure 2 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-02.jpg Figure 3 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-03.jpg Figure 4 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-04.jpg Figure 5 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-05.jpg Figure 6 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-06.jpg Figure 7 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-07.jpg Figure 8 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-08.jpg Figure 9 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-09.jpg Figure 10 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-10.jpg Figure 11 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-11.jpg Figure 12 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-12.jpg Figure 13 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-13.jpg Figure 14 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-14.jpg Figure 15 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-15.jpg Figure 16 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-16.jpg Figure 17 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-17.jpg Figure 18 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-18.jpg Figure 19 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-19.jpg Figure 20 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-20.jpg Figure 21 http://www.oandplibrary.org/cpo/images/1985_01_030/1985_01_030-21.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 Two-Stage Cast-taking Procedure for PTS Prosthesis Creator An entity primarily responsible for making the resource Kurt Marschall, CP *