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7/23/2019 1974 Orthotics and Prosthetics
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DE EM ER
1 9 7 4
Orthotics
and
Prosthetics
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COPYR IGHT • 1974 BY THE AMERICAN ORTHOTIC AND PROSTHETIC
ASSOC IATION, PRINTED IN THE UNITED STATES OF AM ERICA,
ALL RIGHTS RESERVED
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E D I T O R
A . B e n n e t t W i l s o n , Jr.
M A N A G I N G E D I T O R
P h i l i p
M.
P a y n e
E D I T O R I A L B O A R D
B e r t
R.
T i t u s , C.P.O.
C h a i r m a n ( 1 9 7 4 )
H . B l a i r H a n g e r , C P . (1974-75)
A l v i n
L.
M u i l e n b u r g ,
C . P . O . ( 1 9 7 4 - 7 5 )
S i e g f r i e d
P a u l ,
C.P.O. (1974-76)
R o y S n e l s o n ,
C.P.O. (1974-75)
R o b e r t
E.
T o o m s ,
M,D. (1974)
D a v i d A.H. R o e t h e l ,
M.S.
E x
Of f i c io
Orthot ics
and
Prosthetics is is
s u e d
in
M a r c h , J u n e , S e p
t e m b e r
and
D e c e m b e r . S u b
scr ipt ion pr ice , payable
in ad
v a n c e ,
is
$10.00
a
yea r
in the
U . S .
and
C ana da . R a t e e l s e
wher e
is
$11.00
a
yea r. Single
issues, $3.00 each. Publication
does
not
consti tute official
en
d o r s e m e n t
of
o p i n i o n s p r e
sented
in
ar t ic les . The Journal
is
the
official o rga n
of
t he pub
lisher,
The
American Or thot ic
and Prosthet ic Associa t ion
in
col laborat ion wi th
the
Ameri
can Academy
of
Or thot i s t s
and
Prosthet i s t s ,
and
s e r ves
as the
U . S .
o r gan
for
I n t e r b o r .
All
cor r e spondence shou l d
be ad
dr es sed
to:
Edi tor : Or thot ics
an d
P r os t he t i c s ,
1444 N St.,
N . W . , W a s h i n g t o n ,
D.C.
20005.
T e l ephone , Ar ea C ode
202,
234-8400.
Or thot ics and Prosthetics is
i n d e x e d
by
C u r r e n t C o n
tents/Clinical Practice.
*****
I N T E R B O R
Orthotics
and
Prosthetics
V O L U M E 28, NO. 4
D E C E M B E R 1974
C O N T E N T S
E D I T O R I A L
I
Bert R. Titus
S O M E O B S E R V A T I O N S
ON
U P P E R - L I M B
P R O S T H E T I C S AND O R T H O T I C S 3
David
G.
Murray
E X P E R I E N C E W I T H P L A S T I C P A T E L L A R - T E N D O N -
B E A R I N G O R T H O S E S 5
James T. Demopoulos and John E. Escften
A
T H E R M O P L A S T I C S T R U C T U R A L AND A L I G N M E N T
S Y S T E M FOR B E L O W - K N E E P R O S T H E S E S 23
Hans Richard Lehneis
D E V E L O P M E N T OF A T H E R M O P L A S T I C B E L O W - K N E E
P R O S T H E S I S W I T H Q U I C K - D I S C O N N E C T F E A T U R E
31
Charles H. Pritham
A P R O P O S E D N O M E N C L A T U R E FOR L I M B P R O S T H E T I C S 37
Hector W. Kay
A P R O P O S E D P R O S T H E T I C S T E R M I N O L O G Y
49
E. E. Harris
X - R A Y S : A " F I T T I N G T O O L " FOR T HE P R O S T H E T I S T 55
James
L.
Byers
T H E P R E S E N T USE OF T HE U C B L F O O T O R T H O S I S 59
Michael
J.
Quigley
N E W P U B L I C A T I O N S 65
M E T R I C S Y S T E M C O N V E R S I O N F A C T O R S 70
N E W 1974 ABC C E R T I F I E D P R A C T I T I O N E R S 74
(US ISSN 0030-5928)
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Index to Advertisers
B E C K E R
O R T H O P E D I C A P P L I A N C E CO.
VIII
CAMP I N T E R N A T I O N A L
I X , X , X I , X II
C .
D.
D E N I S O N CO.
XIII
IR V I N G D R E W C O R P .
X X I I I
F I L L A U E R
O R T H O P E D I C
X V
F L O R I D A B R A C E C O R P .
X V I
F R E E M A N M A N U F A C T U R I N G CO.
X I X
J O H N S O N & J O H N S O N
X X
J A M E S R . K E N D R IC K C O .
V I
K I N G S L E Y M A N U F A C T U R I N G CO.
X V I I
K N I T - R I T E
X I V
P E L
S U P P L Y CO.
V I I
R O D E N L E A T H E R CO.
VI I I
E .
J .
S A B E L
CO.
X X I
S O U T H E R N P R O S T H E T I C
V
S U T T O N S H O E
X V I I I
U N I T E D S T A T E S M A N U F A C T U R I N G CO.
IV
W A S H IN G T O N P R O S T H E T I C S U P P L I E S
X X I I
Classified
Advertisements
X X I V
A d v e r t i s e r s s h o w n in b o l d - f a c e t y p e a r e m e m b e r s o f
T h e A m e r i c a n O r t h o t i c & P r o s t h e t i c A s s o c i a t i o n .
II
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THE AMERICAN ORTHOTIC AND PROSTHETIC ASSOCIATION
OFFICERS
P r e s i d e n t —
R a l p h
R.
( R o n n e y ) S n e l l ,
C P . ,
Memphis, Tennessee
P r e s i d e n t - E l e c t —
H o w a r d R. T h r a n h a r d t , Secretary-Treasurer—Daniel G. R o w e ,
C P . , Atlanta, Georg ia C.P.O., St. Paul, Minnes ota
Vice-President— Ben B. M o s s , Immediate-Past
P r e s i d e n t — R o b e r t
V. B u s h ,
Winter Park, Florida C.P.O., Albuqu erqu e, New Mexico
REGIONAL
DIRECTORS
Region I — M i c h a e l M. A m r i c h , CP.
Needham, Massachusetts
Region I I —K u r t M a r s c h a l l , CP.
Syracuse, New York
Region III—J . D o n a l d C o g g i n s , CP.
Berwyn, Pennsylvania
Region
I V — W i l l i a m H e a t h H a r v e y ,
CP.O.
Columbus, Georgia
Region
V —
E u g e n e F i l i p p i s , CP.O.
Detroit, Michigan
Region
V I — S t e p h e n K r a m e r ,
CP.O.
Chicago, Illinois
Region V I I — R o b e r t
A.
B r o w n , CP.
Minneapolis, Minnesota
Region V I I I —
G e o r g e E.
S n e l l , CP.O.
Little Rock , Ark ans as
Region I X — D o n a l d
F.
C o l w e l l , CP.
Downey, California
Region X — W a l t e r
M.
J o s l i n , CP.O.
Albuquerque, New Mexico
Region X I — L o r e n
R.
C e d e r , CP.O.
Tacoma, Washington
P r e s i d e n t - E l e c t — W a d e
B a r g h a u s e n , CP.
Columbus, Ohio
V i c e - P r e s i d e n t — L o r e n R.
C e d e r , CP.O.
Tacoma, Washington
F r e d
L.
H a m p t o n , CP.
Miami, Florida
P a u l
R.
M e y e r ,
Jr.
M.[
Chicago, Illinois
J o s e p h
H.
Z e t t l , CP.
Seattle, Washington
THE AMERICAN BOARD FOR CERTIFICATION IN
ORTHOTICS
AND PROSTHETICS INC.
OFFICERS
P r e s i d e n t — W i l l i a m B.
S m i t h , CO.
Kansas City, Missouri
S e c r e t a r y - T r e a s u r e r — C h a r l e s
D a n k m e y e r ,
Jr.
CP.O.
Baltimore, Maryland
Immediate-Past
P r e s i d e n t — R o b e r t F.
H a y e s , CP.
W. Springfield, Massa ch us et ts
DIRECTORS
N e w t o n C. M c C u l l o u g h , I I I M.D.
Miami, Florida
R o b e r t
L.
R o m a n o , M.D.
Seattle, Washington
THE AMERICAN ACADEMY OF ORTHOTISTS AND PROSTHETISTS
OFFICERS
P r e s i d e n t — R i c h a r d D.
K o c h ,
CO.
Ann Arbor, Michig an
P r e s i d e n t - E l e c t —
J o s e p h
M.
C e s t a r o , CP. O. Secretary-Treasurer
Washingt on, D.C Houston, Tex as
V i c e - P r e s i d e n t —
H o w a r d
E.
T h r a n h a r d t , CP.O. Immediate-Past Pres ide nt-
Orlando, Florida New York City, New York
T h o r k i l d E n g e n , CO.
H e n r y
F.
G a r d n e r ,
CP.O.
DIRECTORS
S t e p h e n K r a m e r , CP.O.
Chicago, Illinois
M i c h a e l J . Q u i g l ey , CP.O.
Washington, DC.
NATIONAL
OFFICE
D a v i d
A. H.
R o e t h e l ,
Executive Director
III
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u.s.NEW
L O W P R O F I L E
M O L D E D S . A . C .H . F O O T PartNo.guso
F E A T U R E S :
Th e U.S . Low Profi le Mold ed S.A.C.H. Foo t i s the c los es t to the ana tom ica l foo t and g ive s th e mo st
n a tu r a l a p p e a r a n c e . I t i s m a d e o f t h e h ig h e s t q u a l i t y m o ld a b le p l a s t i c wh ic h i s l o n g l a s t i n g a n d a l so
very f lex ib le . The mater ia l has an exce l len t "memory" wi th the ab i l i ty to re tu rn to i t s o r ig ina l
sh a p e . T h e h e e l we d g e is a v a i l a b l e in t h r e e d e n s i t i e s — so ft , m e d iu m o r firm a n d i s i n t e r c h a n g e
a b l e .
T h e k e e l i s m a d e of h ig h e s t g r a d e , s t r a ig h t g r a in e d m a p le h a r d wo o d .
This foo t o f fe r s the pa t ien t the poss ib i l i ty o f hav ing a smoother s t r ide f rom hee l - s t r ike to
toe-off.
Eac h foo t i s su pp l ied wi th a %" bo l t and a sh or t inv er ted S .A.C.H. nu t .
W h e n o r d e r in g sp e c i f y :
• Ca ta lo g No . • S h o e S i z e • L e n g th in i n c h e s o r c e n t i m e te r s
• Left or right • He e l d e n s i t y — Soft , M edium or Firm
Sold on p rescr ip t ion on ly
U N I T E D S T A T E S M A N U F A C T U R I N G CO .
P.O. Boi 110,623 South Central Ave.,
Glendale,
CA 91209, U.S.A. • Phone (213) 245-6855 Cable: LIMBRACE
IV
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P R O S T H E T I C S O P P L Y
C O .
9 4 7 JUNIPER STREET, N . E. • P. O . BOX 7 4 28
A T L A N TA , G E O R G I A 3 0 3 0 9
Te lephone 87 5 - 00 66 A rea C ode 40 4
Distributor For
1*1
41
X ,
/A v
c
X
6
0
T R °
Y
I N
METHODS—MATERIALS—COMPONENTS—COMPLETE APPLIANCES
Everything for the Prosthetic & Orthotic Man ufacturer
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D E M A N D T H E F I N E S T
F O R Y O U R
C U S T O M E R S
KENDRICK'S
sacro-lumbar
supports of
dacron mesh
N o . 8468-S Kendrick Sacro-lumbar Sup
porter with Dacron Mesh. Available in
sizes 32 to 44 (hip measure).
P R E S C R I B E D BY P H Y S I C I A N S . . . S O LD W I T H C O N F I D E N C E
F o r y o u r c u s t o m e r s , t h e r e s h o u l d b e n o s u b s t i t u t e fo r t h e fin es t. K e n d r i c k ' s
S a c r o - l u m b a r S u p p o r t s of D a c r o n , a n a m a z i n g s y n t h e t i c fa b r i c , p r o v i d e t h e
m o s t r e l ia b l e a n d c o m f o r t a b l e s u p p o r t p o s s i b l e . T h e p o r o u s w e a v e o f D a c r o n
i s i d e a l f o r s u m m e r w e a r — l e t s t h e s k i n b r e a t h e — o r a l l - t h e - y e a r a r o u n d .
K e n d r i c k ' s D a c r o n S a c r o - l u m b a r S u p p o r t s a r e l ig h t e r a n d f ar m o r e c o m
f o r t a b l e — t h e i r d u r a b l e , p o r o u s c o n s t r u c t i o n g i v e s s a f e , l o n g - l a s t i n g s u p p o r t t o
t h e w e a r e r . L u m b a r s t a y s a r e r e m o v a b l e s o t h e s u p p o r t s a r e e a s y t o w a s h , q u i c k
t o d r y . S t y l e s f o r m a l e o r f e m a l e .
S p e c i f y s u r g i c a ll y c o r r e c t K e n d r i c k p r o d u c t s f o r y o u r c u s t o m e r s . T h e i r
c o n f i d e n c e i n y o u w i l l r e s u l t i n m o r e f r e q u e n t r e p e a t s a l e s a n d h i g h e r p r o f i t s .
You can recommend Kendrick with Confidence
J A M E S R . K E N D R I C K C O M P A N Y , I N C .
P h i la d e lp h i a , P a . 19144 N e w Y o r k , N . Y . 10016
Kendrick
N C E
i a s 3
VI
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POST-SURGICAL SUPPLIES
ABOVE-KNEE SUSPENSION CORSET
Heavy
canvas belt with suspension and
shoulder straps used to suspend above-knee.
cast in the
immediate
post-surgical routine.
May be used as right or left, with full felt
apron.
Small, medium and large sizes.
Small 27 * to 32 circumference
Medium
3 1
to 39* circumference
Large 40 * to 46 circumference
Heavy duty cables in housing with
strap attachment hangers on each
end
of cable
To
be
used w ith
the above knee suspension
corset to provide controlled
suspension of the cast.
Short cable 20
Long cable 2 4
BELOW-KNEE
SUSPENSION BELT
(LEFT AND RIGHT)
Light weight webbing waist
belt,
with elastic suspension
strap, and cast attachment
strap with buckle.
fozr-uo
MO V UM EE CASTING FIXTURE
(LEFT MO RIGHT)
Light weight plastic casting fixture for
abo rt knee am putations features an
adjustable anterior-posterior
i, flexib le plastic SCARPA 'S
plastic posterior and medial contoured
brim and extension.
No. 21-245
ADJUSTABLE B/K
PROSTHETIC UNIT
SuppNed with anterior
and posterior tHt ad
justments and quick
disconnect Tubing cut
to length at time of
No. 2L-241
ADJUSTABLE A/K
PROSTHETIC UNIT
Features all the align*
ment •djustability of
the B/K, plus selective
manual knee lock and
adjustable knee fric-
SPLIT
QUADRILATERAL
SOCKETS
RUHRSTERN ELASTIC
PLASTER BANDAGE
r .«\ r widths
LAMB'S WOOL
STUMP SOCKS
(SPANDEX)
Especially woven for
immediate F7S pros*
theses. Rolled top to
toe for ease of appk-
Len
14
18
la
i r
18-
Toe
Width
314
4
5-
6
7
BELOW-KNEE
FELT PADS
Felt pads tor relief
of pressure-sensitive
areas in immediete
post-surgical casting of
B/K stumps. In sets of
three:
1 .
Pre-patella pad
2 Medial tibial crest
3. Litem tibial crest
P E L S U P P L Y C O M P A N Y
4 4 7 2 W E S T 1
C
T
O
T H
S T . , C L E V E L A N D . O H I O 4 4 1 3 5 — P H O N E : 2 1 6 . 2 6 7 - 5 7 7 5
P A U L E . L E I M K U E H L E f l . p o t s i D l H T
VII
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BECKER ORTHOPEDIC APPLIANCE COMPANY
1776 SOUTH WOODWARD AVE.
B IR M IN G H A M , M IC H IG A N 48011
BYWORD J
LEATHERS FOR THE
O R T H O P E D I C a n d P R O S T H E T I C T R A D E
LIMB B R A C E LEATHERS:
HOSP ITAL
LEATHERS:
O r t h o p e d i c H o r s e h i d e
O r t h o p e d i c C o w h i d e
O r t h o p e d i c E l k h i d e
G l a z e d M o l d i n g C o w h i d e
C a l f — K i p — S h e e p — P i g s k i n
Satisfied Cu stomers Throughout the United S tates Sin ce 1924
• S h e a r l i n g s f o r P a d s
• C a r v i n g T o o l i n g
• M o l d i n g
• R usse t S t ra p
O R D E R S S H I P P E D
T H E S A M E D A Y
RODEN LEATHER CO., INC.
1725 CROOKS ROAD
ROY AL OAK, MICH. 4 8 0 6 8
A r e a C o d e 3 1 3 - 5 4 2 - 7 0 6 4
V II I
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Choose
it
-
Because body conditions can vary so greatly with individual patients,
Camp makes a variety of spinal orthoses.
And there 's only one method to insure the patient gets the right
support , and the results the physician wants.
Choose a Camp orthot ic support .
Camp offers the widest selection of orthoses available — including
Taylor-type and Knight-type spinal orthoses. Made to strict quality
control s tandards, each is designed to help solve specific orthotic
support problems.
A nd each C am p orthosis is designed and man ufactu red to allow you
to fit i t more precisely to the individual patient.
With the complete Camp l ine, you don't have to choose a support
that is "generally" right. You can be precise.
All this, plus your own fitting skill (assisted by our free training
seminars which you may at tend), means the patient is much more
likely to leave your store with an orthotic support that he or she can
wear with confidence. And i t is better designed to achieve the re
sults prescribed by the physician.
Make sure your l ine of Camp products is complete. (Today, many
doctors are prescribing them by name and number.) Send for our
complete set of Camp Orthotic Support Selector catalogs.
When you want to make certain you've fi t ted a patient with the best
possible appliance, choose Camp.
Precisely.
C A M P
T U M ^t^k M M
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preci
MODEL C35 — Hyperextens ion
or thos is uses pe lv i c bas in as
foundation. Pelv ic band creates
lateral stability by anchoring on
lateral halves of I l ium, e liminates
bladder pressure. Swivel sternal
pad and adjustable lumbar pad.
Aluminum, covered wi th N auga-
hide.
r
I
i
i
i
i
i
i
i
i
c/yy\
C A M P I N T E R N A T I O N A L , I N C .
Let me be specific. Please send me your Orthotic Support Selector.
Nj-TM-
Address
Cily Stale
Zio
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C A M P T A Y L O R - T Y P E O R T H O S E S
a r e fu ll b a c k a p p l i a n c e s c o v e r i n g
b a c k f r o m c o c c y x t o u p p e r t h o r a c i c s p i n e . T h e y l im i t m o t i o n in l u m b a r a n d l o w e r
t h o r a c i c s p i n e , l im i t r o t a t i o n of t h o r a c i c s p i n e , a n d p r o v i d e m i l d h y p e r e x t e n s i o n o r
f l e x i o n of l u m b o s a c r a l j o i n t .
M O D E L 8 0 5 7 - T a y l o r - ty p o o r
t h o s i s ,
a p r o n p a d fr o n t , M o d e l
8 4 6 2 . S t r a p s c o m p l e t e w i t h s id e
b u c k l e s f o r a t t a c h i n g f r o n t p a d
t r u s s h o o k s .
M O D E L 8 1 7 7 - T a y l o r - t y p e o r
t h o s i s w i t h l e a t h e r s li p c o v e r f o r
m e n o r w o m e n . A l u m i n u m f r a m e ,
l e a t h e r c o v e r . W h i t e c o t t o n c o u
t h g a r m e n t f r o n t , M o d e l 2 8 3 2 .
M O D E L 8 1 6 6 - M e n s T a yl or -
t y p e o r t h o s i s w i t h s l i p - o n c o v e r .
M o d e l 2 8 3 0 . P e r i n e a l s t r a p s o r
h o s e s u p p o r t e r s m u s t b e o r d e r e d
s e p a r a t e l y . F r o n t , M o d e l 2 8 3 2 ,
a t t a c h e d t o o r t h o s i s b y s i d e l a c e .
A l u m i n u m f r a m e , w h i t e c o t t o n
c o u t i l c o v e r .
K N I G H T -T Y P E S P I N A L O R T H O S E S
a r e e f f e c t i v e in l i m i t i n g a n t e r i o r ,
p o s t e r i o r a n d l a t e r a l m o v e m e n t s of s p i n e . P a r t i c u l a r l y a p p l i c a b l e f o r s u p p o r t o f
l u m b a r s p i n e . F u n c t i o n a l l y c o r r e c t a n a t o m i c a l d e s i g n g i v e s s u p p o r t a n d m il d h y p e r
e x t e n s i o n o r f l e xi o n t o l u m b a r c u r v e a s r e q u i r e d .
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f l e x i o n o r t h o s i s e x e r t s c o n s t a n t
f o r c e o n l u m b a r s p i n e , l u m b o
s a c r a l j o i n t , a n d p e l v i s r e d u c i n g
e x c e s s i v e lo r d o t ic c u r v e . P e r
m i t s f r e e f l e x i o n o f l u m b a r s p i n e .
R e d u c e s e x t e n s i o n a n d l a te r a l
b e n d i n g .
M O D E L 8 1 1 5 - M e n ' s K n i gh t -
t y p e o r t h o s i s w i t h g a r m e n t f r o n t ,
M o d e l 2 8 5 2 . N o p e r i n e a l s t r a p s .
W h i t e c o t t o n c o u t i l . F r o n t l a c e s
i n t o p o s t e r i o r c o v e r . A l t e r n a t i n g
t r u s s h o o k c l o s u r e .
M O D E L 8 1 1 5 - B a c k v i e w o f
M o d e l 8 1 1 5 .
N o
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Fi r st C la ss Pe r m i t No 1 6 6 . Ja c k so n . M ic h .
P o s t a g e w i l l b e p a i d b y :
C A M P I N T E R N A T I O N A L , I N C .
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S P R E A D I N G T H E W O R D
S e v e r a l y e a r s a g o , s o m e o n e a s k e d , W h e r e m a y I find l i t e ra t u r e o n P r o s t h e t i c s
a n d O r t h o t i c s ? I f t h i s p e r s o n h a d b e e n f r o m t h e m e d i c a l o r a l l i e d h e a l t h f i e l d s , h e
c o u l d h a v e b e e n r e f e r r e d t o t h e m e d i c a l li b r a r y b u t t h e f in d i n g s w o u l d h a v e b e e n
m e a g e r . I f t h e y w e r e n o t r e l a t e d t o t h e m e d i c a l field , t o t e l l t h e m t o g o t o t h e p u b l i c
l i b r ar y w o u l d h a v e b e e n v i r t u a ll y u s e l e s s b e c a u s e t h e y w o u l d p r o b a b l y f i n d o n l y
s o m e f a i r y t a l e s o f p i r a t e s w i t h e i t h e r a h o o k o r a p e g l e g .
I n 1 9 72 o n e o f t h e f e w p u b l i c a t i o n s in t h e f i e l d s o f p r o s t h e t i c s a n d o r t h o t i c s
s t a t e d , U n t i l r e l a t i v e l y r e c e n t l y , t h e r e w a s e s s e n t i a l l y n o p r o f e s s i o n a l l i t e r at u r e t o
b e f o u n d p e r t a i n i n g t o t h e field o f p r o s t h e t i c s a n d o r t h o t i c s . W h y h a s t h i s b e e n s o ?
I s i t b e c a u s e w e h a v e n o t h i n g n e w t o t e l l ? I c a n n o t b e l i e v e t h a t t h i s i s s o . E v e r y
p a t i e n t p r e s e n t s a n e w c h a l l e n g e t o t h e p r o s t h e t i s t o r o r t h o t i s t a n d o t h e r m e m b e r s
o f t h e c l i n i c t e a m , a n d t h u s t h e r e s h o u l d b e a g o o d d e a l o f m a t e r i a l t h a t s h o u l d b e
p r e s e n t e d .
I s i t b e c a u s e w e d o n ' t h a v e t i m e ? W e s e e m t o f i n d t i m e t o d o m o s t o f t h e t h i n g s
t h a t w e r e a l l y w a n t t o d o .
I s it b e c a u s e w e a re a f r ai d t h a t w e m a y b e c r i t i c i z e d b y s o m e o f o u r c o l l e a g u e s ?
T h i s m a y b e tr u e i n s o m e s i z a b l e p r o p o r t i o n .
I s i t b e c a u s e w e d o n ' t k n o w h o w t o w r i t e o r d o n ' t k n o w h o w t o o r g a n i z e t h e
m a t e r i a l t o w r i t e a n e d u c a t i o n a l , i n f o r m a t i v e a n d i n t e r e s t i n g a r t i c l e ? P e r h a p s , b u t
m o s t o f u s a r e m a n a g i n g a v e r y s u c c e s s f u l o r g a n i z a t i o n t h a t r e q u i r e s m a n y l e t t e r s
a n d o t h e r f o r m s o f c o m m u n i c a t i o n .
M a n y o f u s u s e o n e o r m o r e o f t h e s e r e a s o n s f o r n o t w r i t i n g a r t i c l e s t h a t s h o u l d b e
p u b l i s h e d a n d t h u s m a d e a v a i l a b l e t o o u r c o l l e a g u e s a r o u n d t h e w o r l d . V e r y f e w
u s e f u l b o o k s , j o u r n a l s , a n d o t h e r p u b l i c a t i o n s ar e a v a i l a b l e to c l i n i c i a n s in p r o s t h e
t i c s a n d o r t h o t i c s , p a r t l y b e c a u s e o f t h e r ap i d r a t e o f c h a n g e t h a t h a s b e e n m a d e
d u r i n g t h e p a s t c o u p l e o f d e c a d e s .
Orthotics and Prosthetics a n d i ts p r e d e c e s s o r s h a v e b e e n a s o u r c e o f r e f e r e n c e
f o r m a n y y e a r s , a n d is n o w a v a i l a b l e i n m a n y m e d i c a l l i b r a r i e s . I t s q u a l i t y h a s
v a r i e d , b u t s i n c e 1 9 7 2 it h a s d e v e l o p e d i n t o a t r u l y p r o f e s s i o n a l s o u r c e o f i n f o r m a
t i o n . T h e E d i t o r i a l B o a r d h a s h a d l it t le t o d o w i t h t h i s , a n d t h e b u l k o f t h e c r e d i t
s h o u l d g o t o A . B e n n e t t W i l s o n , J r . , w h o h a s s e r v e d a s t h e e d i t o r d u r i n g t h e s e p a s t
t h r e e y e a r s .
I f m e m b e r s o f A O P A , A A O P , a n d o t h e r r e a d e rs w a n t
Orthotics and Prosthetics
t o c o n t i n u e a s a p r o f e s s i o n a l p u b l i c a t i o n , w e m u s t p r e p a r e a n d s u b m i t a r t i c l e s f o r
p u b l i c a t i o n . S t y l e i s n o t i m p o r t a n t . T h e e d i t o r i a l st a f f c a n r e m e d y a n y l a c k o f s t y l e .
T h e i m p o r t a n t f a c t o r i s t h e p r e s e n t a t i o n o f i d e a s a n d m e t h o d s o f p r o v i d i n g s e r v i c e
t h a t w i l l b e u s e f u l t o f e l l o w p r a c t i t i o n e r s .
I t h a s b e e n a v e r y e n l i g h t e n i n g e x p e r i e n c e f o r m e t o s e r v e a s C h a i r m a n o f t h e
E d i t o r i a l B o a r d fo r t h e p a s t t w o y e a r s . T h e c o m p l e t e c o o p e r a t i o n o f a l l m e m b e r s o f
t h e c o m m i t t e e , t h e s t a ff i n t h e W a s h i n g t o n o f f ic e , a n d t h e o f f i c e r s o f A O P A , A A O P
a n d A B C h a v e m a d e t h i s j o b v e r y e a s y . I w i s h t h e n e w C h a i r m a n t h e s a m e p l e a s u r e .
B e r t R . T i t u s , C P . O .
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E d i t o r i a l C o m m i t t e e
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7/23/2019 1974 Orthotics and Prosthetics
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S O M E O B S E R V A T IO N S O N U P P E R -L IM B
P R O S T H E TIC S A N D O R T H O T I C S
1
D a v id G . M u r r a y , M . D .
2
O n b e h a l f o f t h e S t a t e U n i v e r s i t y o f N e w Y o r k
U p s t a t e M e d i c a l C e n t e r , t h e D e p a r t m e n t o f O r
t h o p e d i c S u r g e r y , a n d t h e D i v i s i o n o f O r t h o t i c s
R e s e a r c h a n d E d u c a t i o n , I w o u l d l i k e t o t a k e t h i s
o p p o r t u n i t y t o w e l c o m e y o u to S y r a c u s e .
I t h a s b e e n m y o b s e r v a t i o n t h a t w h e n p e r s o n s
o r g a n i z i n g a s e m i n a r o r c o n f e r e n c e i n t h e w i n t e r
t i m e w a n t t o i n s u r e a g o o d a t t e n d a n c e , t h e y
s c h e d u l e t h e m e e t i n g f o r s o m e p l a c e l i k e A s p e n
o r a c r u i s e s h i p i n t h e C a r i b b e a n . W h e n y o u a r e
c a u g h t w i t h S y r a c u s e , N e w Y o r k , d u r i n g o n e o f
th e r a in i e s t M a y ' s in h i s to r y , y o u a r e l ef t w i th
o n l y o n e a l t e r n a t i v e t o a t t r a c t a g r o u p of p e o p l e ;
t h a t i s , t o a s s e m b l e t h e b e s t p r o g r a m a n d f a c u l t y
p o s s i b l e . J u d g i n g f ro m t h e n u m b e r I s e e h e r e
t o d a y . I w o u l d s a y t h a t t h e p r o g r a m C h a i r m e n
h a v e b e e n e x t r e m e l y s u c c e s s f u l ; a n d i t i s c e r
t a in ly a t r i b u t e t o t h e i r o r g a n i z a t i o n a b i l i t y a n d
th e q u a l i t y o f t h e p a p e r s y o u a r e g o in g to h e a r .
I h a v e a n o t h e r o b s e r v a t i o n I w o u l d l ik e t o p a s s
o n t o y o u a f t e r h a v i n g l o o k e d o v e r t h e s o p h i s t i
c a t e d l i st o f t o p i c s in t h i s p r o g r a m . F i f t e e n y e a r s
a g o a s I w a s t r a i n i n g i n O r t h o p e d i c S u r g e r y , I
d e v e l o p e d a n i n t e r e s t i n p r o s t h e t i c s a n d s p e n t
so m e t im e a t t h a t p o in t wo r k in g o n e a r ly f i t t i n g o f
b e l o w - k n e e a m p u t e e s w i t h p l a s t e r s o c k e t s a n d
p y l o n s . I n t h e c o u r s e o f t h i s w o r k , I a t t e n d e d t h e
s t a n d a r d c o u r s e s in p r o s t h e t i c s a n d o r t h o t i c s
— l e a r n e d a b o u t p l a s t i c l a m i n a t e d s o c k e t s ,
t r i c e p s p a d s , c o n t r o l c a b l e s , D o r r a n c e t e r m i n a l
d e v i c e s , s h o u l d e r h a r n e s s e s , a n d s o f o r t h .
O v e r t h e y e a r s , t h e n u m b e r o f o t h e r r e s p o n
s i b il i ti e s h a s e n c r o a c h e d n e a r l y 1 0 0 p e r c e n t o n
th e a m o u n t o f tim e I h a v e h a d to d e v o te t o a
c o n t i n u i n g i n t e r e s t in p r o s t h e t i c s . S u d d e n l y ,
a f t e r a l o n g h i a tu s , I w a s c a l l e d u p o n to a t t e n d a
p r o s t h e t i c s c l i n i c a t t h e U p s t a t e M e d i c a l C e n t e r
l a s t m o n t h a s a su b s t i t u t e . M in d y o u , i n t h e i n t e r
v a l , w e h a v e s e e n t h e d e v e l o p m e n t o f p o r t a b l e
c o l o r t e l e v i s i o n , t h e l a n d i n g o f m e n o n t h e m o o n ,
t h e p r o d u c t i o n o f p o c k e t - s i z e d e l e c t r o n i c c o m
p u t e r s , a n d c a m e r a s w h i c h s p i t o u t i n s t a n t a n e
o u s l y a s n a p s h o t t h a t is d e v e l o p e d b e f o r e y o u r
e y e s .
T h e r e f o r e , i t w a s w i t h a c e r t a i n a m o u n t o f
u n c e r t a i n t y a n d a f e e l i n g o f i n a d e q u a c y t h a t I
a p p r o a c h e d m y a s s i g n m e n t t o t h e p r o s t h e t i c s
c l i n i c . T h e f i r s t p a t i e n t wa s a y o u n g s t e r w i th a
c o n g e n i t a l b e l o w - e l b o w a m p u t a t i o n . W o u l d y o u
b e l i e v e I su d d e n ly f o u n d m y se l f b a c k in t h e o ld
w o r l d , t a l k i n g a b o u t p l a s t ic l a m i n a t e d s o c k e t s ,
t r i c e p s p a d p l a c e m e n t , s h o u l d e r h a r n e s s a d j u s t
m e n t , r i n g p o s i t i o n , a n d c a b l e t e n s i o n ? E v e n t h e
p l a s t i so l wa s p e e l in g o f f t h e t e r m in a l d e v i c e ( a
h o o k ) i n t h e sa m e wa y th a t i t u se d t o p e e l o f f
w h e n 1 wa s a t t e n d in g c l i n i c 15 y e a r s a g o . I n a
w a y , it wa s c o m f o r t i n g t o r e a l i z e t h a t i n t h i s
d y n a m i c d e c a d e , s o m e t h i n g a t l e a s t h a d n ' t
c h a n g e d . O n s e c o n d t h o u g h t , it w a s a b i t s u r p r i s
i n g a n d n o t a l i t t le d i s a p p o in t in g .
M y o w n p a r t i c u l a r e f f o r t s o v e r t h e p a s t f e w
y e a r s h a v e b e e n d e v o t e d f o r t h e m o s t p a r t t o
s t u d y i n g a n d u ti l i z i n g i n t e r n a l p r o s t h e s e s s u c h a s
h i p j o i n t s a n d k n e e j o i n t s . O v e r t h e y e a r s , t h e r e
h a v e b e e n t w o w a y s in a p p r o a c h i n g t h e p r o b l e m
o f a d e s t r o y e d j o i n t . O n e g r o u p h a s a t t a c k e d t h e
p r o b l e m b y a t t e m p t i n g t o r e p l a c e t h e j o i n t w i t h a
b i o l o g ic s u b s t i t u t e — e i t h e r a j o i n t f ro m a n o t h e r
h u m a n b e i n g o r a m e c h a n i s m f o r i n t e r n a l r e p a i r of
t h e d a m a g e d j o i n t . T h e o t h e r g r o u p h a s a p
p r o a c h e d t h e p r o b l e m f r o m t h e s t a n d p o i n t o f
c r e a t i n g a n a r t i f i c i a l su b s t i t u t e o f i n e r t m a te r i a l
w h i c h c o u l d b e i m p l a n t e d i n t h e b o d y . T h e r e is n o
q u e s t i o n a s t o w h i c h g r o u p h a s b e e n t h e m o s t
s u c c e s s f u l . W e a r e c u r r e n t l y i m p l a n t i n g a r t if i c ia l
j o i n t s in g r e a t n u m b e r s a n d t h e c u r r e n t s u c c e s s o f
t h e s e a r ti f ic i a l s u b s t i t u t e s h a v e e c l i p s e d a t t e m p t s
t o i m p r o v e o n m e t h o d s o f b i o l o g i c s u b s t i t u t i o n .
M u c h t h e s a m e t h i n g s e e m s t o b e g o i n g o n i n
1 W e l c o m i n g r e m a r k s g i v e n a t t h e A d v a n c e d S e m i n a r
o n E x t e r n a l E n e r g y i n U p p e r - L i m b P r o s t h e t i c s a n d
O r t h o t i c s s p o n s o r e d b y t h e A m e r i c a n A c a d e m y o f O r th ot is ts a n d P r o s t h e t i s t s , S y r a c u s e , N e w Y o r k , M
3 1 , 1974 .
2
P r o f e s s o r , O r t h o p e d i c S u r g e r y , U p s t a t e M e d i c a l
C e n t e r , S y r a c u s e , N e w Y o r k .
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t h e a r e a o f s u b s t i t u t i o n f o r d e s t r o y e d o r m i s s i n g
l i m b s . A t t h e V e t e r a n s A d m i n i s t r a t i o n H o s p i t a l
s e v e r a l b l o c k s a w a y , D r . R o b e r t B e c k e r i s w o r k
i n g o n m e t h o d s f or r e g r o w i n g n o r m a l l i m b s
t h r o u g h e l e c t r i c a l s t i m u l a t i o n o f t i s s u e a t t h e e n d
o f t h e a m p u t a t i o n s t u m p . I t i s h i s c o n t e n t i o n t h a t
l o s t l i m b s w i ll e v e n t u a l l y b e r e p l a c e d b i o l o g i
c a l l y . H o w e v e r , a s e v i d e n c e d b y t h i s p r o g r a m ,
o t h e r g r o u p s a r e a c t i v e l y a t w o r k d e v e l o p i n g
s o p h i s t i c a t e d p r o s t h e t i c r e p l a c e m e n t s . I f I ha d to
b e t o n w h i c h a p p r o a c h w o u l d t u r n o u t t o b e t h e
m o s t f e a s i b l e , t h e r e i s n o q u e s t i o n b u t t h a t l o g i
c a l l y I w o u l d p l a c e m y m o n e y o n t h e p r o s t h e t i c
r e p l a c e m e n t s . J u d g i n g f ro m m y r e c e n t e x p e r i
e n c e , h o w e v e r , o n t h e p r a c t i c a l i m p r o v e m e n t s
m a d e in t h i s fi e ld o v e r t h e p a s t 15 y e a r s , I a m
a f r a id I m ig h t h a v e t o h e d g e m y b e t .
T h e r e a r e g e n e r a l l y t h r e e t y p e s o f s t i m u l i f o r
a c c o m p l i s h m e n t i n a n y p a r t i c u l a r s p h e r e . F i r s t o f
a l l , t h e r e m a y b e a c r y i n g n e e d f o r a s o l u t i o n . T h e
d e v e l o p m e n t of t h e p o l i o v a c c i n e i s a n e x a m p l e o f
a r e s p o n s e t o t h i s s t i m u l u s . S e c o n d l y , a p r o b l e m
m a y s i m p l y p r e s e n t a c h a l l e n g e . T h e c l i m b i n g o f
M t . E v e r e s t f it s in t h i s c a t e g o r y a s b e i n g a d r a m a
t i c f e a t , b u t o f n o p a r t i c u l a r p r a c t i c a l b e n e f i t .
T h i r d l y , t e c h n o l o g i c a l a d v a n c e s m a y s u d d e n l y
m a k e s o m e t h i n g p o s s i b l e t h a t h a d b e e n m e r e l y a
p i p e d r e a m u p t o t h a t p o i n t . W e c o u l d p l a c e s p a c e
e x p l o r a t i o n i n t h i s c a t e g o r y .
No w a s we lo o k a t t h e f i e ld o f u p p e r - l im b
p r o s t h e t i c s a n d o r t h o t i c s , I t h i n k t h a t a ll t h r e e o f
t h e s e f a c t o r s a p p l y . T h e r e is u n q u e s t i o n a b l y a
c r y i n g n e e d f or i m p r o v e m e n t — t h e c h a l l e n g e o f a
d i f f ic u l t p r o b l e m i s i n e sc a p a b le a n d I h a v e t o
b e l i e v e t h a t t h e t e c h n o l o g i c c a p a b i l i t i e s a r e n o w
a t h a n d .
I t s e e m s l i k e t h e t i m e h a s a r r i v e d f or e d u c a t o r s
a n d in n o v a to r s i n t h i s fi e ld t o g e t o f f t h e m a r k , t o
s t o p t a l k i n g a b o u t t h e a m a z i n g f e a t u r e s o f t h e
D o r r a n c e 5 X A h o o k a n d t o a p p l y t h e i r t a l e n t s t o
t h e o b v i o u s , u n s o l v e d p r o b l e m s . F r o m t h e to p i c s
l i s t e d f o r d i s c u ss i o n a t t h i s m e e t in g , I s e n s e t h a t a
s t a r t i s b e i n g m a d e . I a m su r e t h a t i t w i l l b e a
v a l u a b l e d a y a n d a half, a n d I h o p e t h a t s e m i n a r s
s u c h a s t h i s , c o m b i n i n g t h e t a l e n t s o f t h e l e a d e r s
in t h i s f ie ld , a r e h e r a ld in g a n e r a o f i n n o v a t iv e
a d v a n c e m e n t i n t h e o r t h o t i c s a n d p r o s t h e t i c s
f ie lds .
7/23/2019 1974 Orthotics and Prosthetics
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E X P ER IE N C E W I TH P L A S T IC
P A T E L L A R - T E N D O N - B E A R I N G O R T H O S E S
J a m e s T . D e m o p o u l o s , M . D . ,
1
a n d
J o h n E . E s c h e n , C . P . O .
2
T h e m a n a g e m e n t o f p a t i e n t s w i t h l o w e r - l i m b
d e f i c i e n c i e s t h a t p r o d u c e g a it a b n o r m a l i t i e s h a s
u n d e r g o n e c o n s i d e r a b l e e v o l u t i o n d u r i n g t h e l a s t
d e c a d e . C u r r e n t c o n c e p t s i n l o w e r - l i m b o r t h o t i c s
i n c l u d e t h e d e v e l o p m e n t a n d u s e o f p l a s t i c s , c r e
a t i o n o f a n e w f u n c t io n a l n o m e n c l a t u r e , i n t r o d u c
t i o n o f t h e m u l t i d i s c i p l i n a r y a p p r o a c h p r o v e n s o
v a l i d i n p r o s t h e t i c s , a n d t h e u s e o f i n s t r u m e n t a
t i o n a n d d a t a s y s t e m s t o m o n i t o r r e s u l t s .
T h e a p p l i c a t i o n o f t h e a b o v e c o n c e p t s t o t h e
fie ld o f " l o w e r - l i m b b r a c i n g " is a r a t h e r r e c e n t
d e v e l o p m e n t , d e m o n s t r a t i n g n e w tr e n d s a s r e
v i e w e d b y L e h m a n a n d h is c o l l e a g u e s (8, 9).
O t h e r i n v e s t i g a t o r s , i n c l u d i n g C o r c o r a n ( 1 ) , J eb se n ( 5 ) , S i m o n s (15), L e h n e i s (10, 11), a n d S a r
(14),
h a v e u t i l i z e d p l a s t i c m a t e r i a l s a n d t e c h n o l -
o g y in p r e s c r i b i n g l o w e r - l i m b o r t h o s e s . A d d i
t i o n a l l y , t h e a u t h o r s h a v e p r e s c r i b e d a n d f a b r i
c a t e d o v e r 2 0 0 l o w e r - l i m b p l a s t i c o r t h o s e s f o r a
w i d e r a n g e o f m u s c u l o s k e l e t a l d e f e c t s f o u n d i n
a d u l t s a n d c h i l d r e n ( 2 , 3, 4).
T h e p r in c i p l e o f u s i n g t h e p a t e l l a r - t e n d o n a n d
c o n d y l a r a r e a s o f t h e t i b i a f o r w e i g h t - b e a r i n g i n
t h e b e l o w - k n e e a m p u t e e w a s s u c c e s s f u l l y t r a n s
f e r r ed t o t h e d i s c i p l i n e o f o r t h o t i c s by Mcllm urray
t h e d e v e l o p m e n t o f t h e V A C P p a t e l l a r - te n d o n -
b e a r i n g " b r a c e . " T h e e ar l y d e s i g n c o m b i n e d a
p r e t i b i a l p l a s t i c s h e l l a n d c o n v e n t i o n a l m e t a l u p
r i g h t s t o " u n l o a d " t h e ti b ia a n d t h e f o o t - a n k l e
c o m p l e x . I n a n e f f o r t t o a c h i e v e r e d u c t i o n o f
w e i g h t , t o i m p r o v e c o s m e s i s a n d c o m f o r t , a n d t o
p r o v i d e m o r e p h y s i o l o g i c a l m o t i o n , t h e a u t h o r s
h a v e d e v e l o p e d a n a l l - p l a s ti c p a t e l l a r - t e n d o n -
b e a r i n g o r t h o s i s .
T h i s p a p e r r e la t e s o u r e x p e r i e n c e w i t h t h e p l a s
t ic p a t e l l a r - t e n d o n - b e a r i n g o r t h o s i s a n d d e
s c r i b e s t h e d e t a i l s o f f a b r i c a t i o n .
1D irector , Rehab i l i t a tion M edicine , Hospi ta l for
Jo in t Diseases and Medical Center , 1919 Madison
Ave. , New York , N.Y. 10035.
2
Eschen Pros thet ic and Orthot ic Laborator ies Inc . ,
156-158 East 116th St . , New York, N.Y. 10029.
7/23/2019 1974 Orthotics and Prosthetics
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T A B L E 1 . D I A G N O S I S A N D A G E O F R E V I E W E D P O P U L A T I O N
C L I N I C A L M A T E R I A L
T h e p a t i e n t - s t u d y p o p u l a t i o n c o n s i s t e d o f t e n
p a t i e n t s w h o w e r e e v a l u a t e d a n d p r o v i d e d w i t h
p l a s ti c p a t e l l a r - t e n d o n - b e a r i n g o r t h o s e s .
O u r i n it i a l e x p e r i e n c e d a t e s t o Ju l y 1 9 72 a n d
o u r f o l l o w - u p e x t e n d s o v e r a n 1 8 - m o n t h p e r i o d .
C h r o n o l o g i c a l l y , o u r y o u n g e s t p a t i e n t w a s 7
y e a r s o l d ; t h e o l d e s t , 7 2 . T h e s t u d y g r o u p i n
c l u d e d t h r e e f e m a l e s a n d s e v e n m a l e s . T h e d i a g
n o se s o f t h e p o p u la t i o n a r e l i s t e d in T a b le 1 .
M E T H O D
E ig h t o f t h e t e n p a t i e n t s wh o r e c e iv e d a p l a s t i c
p a t e l l a r - t e n d o n - b e a r i n g o r t h o s i s w e r e r e f e r r e d t o
u s b y t h e s t a f f o f t h e D e p a r t m e n t o f O r
t h o p a e d i c s , a n d t h e r e f o r e h a d t h e b e n e f i t o f c o m
p l e t e o r t h o p a e d i c e v a l u a t i o n s , i n c l u d i n g r a d i o
g r a p h i c d e t e r m i n a t i o n s , p r i o r t o p r e s c r i p t i o n .
T h e m e m b e r s o f t h e O r t h o t i c C l i n i c T e a m o f
t h e D e p a r t m e n t o f R e h a b i l i t a t i o n M e d i c i n e , in
c l u d i n g t h e p h y s i c i a n s a n d a l l i e d h e a l t h p r o f e s
s i o n a l s , m e a s u r e d a n d r e c o r d e d d a t a r e l a t i n g t o
m u s c l e s t r e n g t h , j o i n t m o t i o n , p r e s e n c e of c o n
t r a c t u r e s , g a i t , e l e v a t i o n a b i l i ty , s p a s t i c i t y , s e n
sa t i o n , j o in t s t a b i l i t y , a n d th e d e g r e e o f e d e m a if
p r e s e n t . T h e u n i t ' s o r t h o t i s t p r o v i d e d t h e t e c h n i
c a l e x p e r t i s e n e e d e d t o f o r m u l a t e t h e f in a l p r e
s c r i p t i o n . A s r e q u i r e d , p r e - o r t h o t i c a n d p o s t -
o r t h o t i c p h y s i c a l t h e r a p y w a s p r e s c r i b e d . I n a d
d i t i o n , t h e p a t i e n t s ' p s y c h o s o c i a l a n d v o c a t i o n a l
c h a r a c t e r i s t i c s w e r e m e a s u r e d .
T h e c o m p l e t e d o r t h o s i s w a s d e l i v e r e d a n d b o t h
p a t i e n t a n d d e v i c e w e r e s u b j e c t e d t o a fi n al
a n a l y s i s , w i t h a t t e n t i o n f o c u s e d o n r e li e f o f p a i n ,
c o m f o r t , f i t , a p p e a r a n c e , a l i g n m e n t , d e g r e e o f
d e f o r m i t y c o r r e c t i o n , a n d t o t a l o v e r a l l f u n c t i o n a l
i m p r o v e m e n t . B o t h s t a t i c a n d lo a d i n g c o n d i t i o n s
w e r e u s e d in o u r d e t e r m i n a t i o n s . F i n a l l y , s e r i a l
r e e x a m i n a t i o n s w e r e c o n d u c t e d o v e r a p e r i o d o f
m o n t h s , o u r l o n g e s t fo l l o w - u p b e i n g 1 8 m o n t h s .
R E S U L T S
O u r e x p e r i e n c e w i t h t h e p l a s t i c p a t e l l a r -
t e n d o n - b e a r i n g o r t h o s i s i n t e n p a t i e n t s i n d i c a t e s
t h a t m a n y m u s c u l o s k e l e t a l d e f e c t s of t h e l o w e r
l im b c a n b e m a n a g e d w i th t h i s d e v i c e , o f f e r in g
m a n y a d v a n t a g e s o v e r c o n v e n t i o n a l d e s i g n s . T h e
a d v a n t a g e s a r e :
• S u p e r i o r c o s m e s i s
• L i g h t e r w e i g h t
• I m p r o v e d c o m f o r t
• S u p e r i o r a l i g n m e n t
• I m p r o v e d b i o m e c h a n i c s
• F a v o r a b l e s t r e n g t h - w e i g h t r a t i o
• E a s e a n d c o n s t a n c y o f a p p l i c a t i o n
• M i n i m a l m a i n t e n a n c e
H o w e v e r , n o t a ll a d v a n t a g e o u s f e a t u r e s w e r e
p r e s e n t i n e a c h c a s e . D i s a d v a n t a g e s i n c l u d e d t h e
c o n s i d e r a b l y h i g h e r c o s t o f t h e p l a s t i c o r t h o s i s .
P r o b l e m s w e r e e n c o u n t e r e d w i t h g r o w i n g c h i l
d r e n w h o r e q u i r e d f r e q u e n t r e p l a c e m e n t . I t w a s
m o s t i m p o r t a n t t o o b s e r v e c a r e f u l l y t h o s e p a
t i e n t s w i t h v a s c u l a r a n d s e n s o r y p r o b l e m s s i n c e
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t h e p l a s t i c o r t h o s i s is a p p l i e d s n u g l y . E d e m a o f
t h e f o o t - a n k l e a r e a h a d t o b e c a r e f u l l y c o n t r o l l e d
a l s o .
T h e v a r i o u s d i s a b i l i t i e s t h a t a r e a m e n a b l e t o
o r t h o t i c s m a n a g e m e n t u t i l i z i n g t h e p l a s t i c
p a t e l l a r - t e n d o n - b e a r i n g o r t h o s i s a r e l i s t e d b e l o w :
• C o n g e n i t a l d e n e r v a t i o n o f a n k l e j o i n t
• A c q u i r e d d e n e r v a t i o n o f a n k l e j o i n t
• D e l a y e d o r n o n u n i o n o f f r a c t u r e d t i b i a
• I m m i n e n t f r a c t u r e o f t i b i a , s e c o n d a r y t o
t u m o r , b o n e a t r o p h y a n d d e v e l o p m e n t d e
f e c t s
• D e g e n e r a t i v e d i s e a s e o f a n k l e j o i n t
• I n f l a m m a t o r y d i s e a s e o f a n k l e j o i n t
• T r a u m a o f f o o t - a n k l e j o i n t
• F a i l e d f o o t - a n k l e s u r g e r y
• I n f e c t i o u s d i s e a s e o f f o o t
• D i s e a s e o f t r a u m a o f s o l e o f f o o t
T h e a l t e r n a t i v e o r t h o s i s r e q u i r e d f o r m o s t o f t h e
d i s a b i l i t i e s l i s t e d w o u l d b e a h e a v y , b u l k y , i s c h i a l
w e i g h t - b e a r i n g o r t h o s i s ( F i g . 1 ).
T h e l i g h t e r , m o r e c o s m e t i c , p l a s t i c p a t e l l a r -
t e n d o n - b e a r i n g o r t h o s i s is s h o w n in F i g u r e s 2 a n d
3 .
T h e o r t h o s i s is d o n n e d p r o p e r l y w i t h e a s e ; t h e
s e p a r a t e p a t e l l a r - t e n d o n - b e a r i n g p a n e l i s i n
s e r t e d w h e n t h e k n e e is f l e x e d a t 9 0 d e g . T h e
o r t h o t i c f o o t - a n k l e s e c t i o n is m o l d e d s o t h a t i t i s
h i g h l y c o n g r u o u s w i t h t h e p a t i e n t ' s f o o t a n d
a n k l e ; a n d t h e p o s i t i o n o f t h e p a t i e n t ' s a n k l e c a n
b e f i x e d in t h e d e s i r e d a t t i t u d e . A s p e c i a l s h o e
h e e l i s u s e d ( c o m p a r a b l e t o a p r o s t h e t i c S A C H
h e e l ) , t o g e t h e r w i t h a r o c k e r a s s e m b l y w h e n " u n
l o a d i n g " o f t h e p o s t e r i o r a s p e c t o f t h e f o o t is
d e s i r a b l e . In o t h e r i n s t a n c e s , a n o r d i n a r y s h o e
s u f f i c e s .
A n u m b e r o f c a s e d i s c u s s i o n s w il l i l l u s t r a t e t h e
c r i t e r i a u s e d i n p r e s c r i b i n g t h e p a t e l l a r - t e n d o n -
b e a r i n g o r t h o s i s ; f a b r i c a t i o n d e t a i l s a p p e a r a t t h e
e n d o f t h e p a p e r .
F i g . I. C o n v e n t i o n a l is
c h i a l w e i g h t - b e a r i n g o r
t h o s i s is h e a v y a n d
b u l k y .
F i g . 2 . F r o n t v i e w o f
t h e p l a s t i c p a t e l l a r -
t e n d o n - b e a r i n g o r t h o
s is .
F i g . 3 T h e r e m o v a b l e P T B s e c t i o n is e a s i l y d o n n e d .
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C A S E P R E S E N T A T I O N S
Ca se N o . 1 . F .G . is a 9 - y e a r - o ld b o y w i th c o n
g e n i t a l a b s e n c e o f i n t r a - a r t i c u l a r i n n e r v a t i o n o f
h i s k n e e s a n d a n k l e s ( F i g . 4 ) . F u n c t i o n a l l y , t h e
l ef t k n e e a n d r i g h t a n k l e c r e a t e d c o n s i d e r a b l e
d i ff i c ul t ie s i n a m b u l a t i o n a n d e l e v a t i o n a c t i v i t i e s .
I n o u r i n it ia l e x p e r i e n c e w i t h p a t e l l a r - t e n d o n -
b e a r i n g o r t h o s e s , w e a d h e r e d t o t h e o r i g i n al c o n
c e p t o f u s in g p l a s t i c m a te r i a l s f o r p a t e l l a r a n d
t i bi a l c o n d y l a r w e i g h t s u p p o r t a n d c o n v e n t i o n a l
m e t a l u p r i g h t s a t t a c h e d t o a m o l d e d l e a t h e r -
c o v e r e d f o o t p l a t e ; t h e u p r i g h t s w e r e e x t e n s i b l e
a n d th e a n k le - jo in t p o s i t i o n wa s a d ju s t a b l e ( F ig .
5 ) .
A p l a s t i c q u a d r i l a t e r a l s o c k e t , a t t a c h e d t o
c o n v e n t i o n a l u p r i g h t s , w a s u s e d t o r e d u c e
we ig h t - b e a r in g f o r c e s a t t h e l e f t k n e e a n d a n k le
( F i g . 6 ) . C l e a r l y , t h e r i g h t p a t e l l a r - t e n d o n -
Fig. 4. Congenital absence of intra-articular innerva
tion produced severe deformities of left knee and right
ankle. Case No. 1 .
Fig. 5. The early design combined plastic and metal
c o m p o n e n t s .
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b e a r i n g o r t h o s i s w a s m o r e a c c e p t a b l e t o t h e p a
t i e n t . A s w e e v o l v e d t h e a l l - p l a s t i c P T B o r t h o s i s ,
w e s u b s t i t u t e d t h i s d e v i c e f o r t h e o r ig i n a l o r
t h o s i s . A 6 5 p e r c e n t w e i g h t r e d u c t i o n w a s a c
c o m p l i s h e d , w i t h m o r e e f f i c i e n t a l i g n m e n t o f t h e
f o o t a n d a n k l e , w i t h r e s u l t a n t r e d u c t i o n o f t h e
a b n o r m a l l y h i g h i n t r a - a r t i c u l a r f o r c e s a t t h e
a n k l e .
C a s e N o . 2 . L . H . is a 5 4 - y e a r - o l d w o m a n w i t h
s e v e r e d e f o r m i t y o f t h e t i b ia f o l l o w i n g m a l u n i o n
o f p a t h o l o g i c a l f r a c t u r e s . F i g u r e 7 i l l u s t r a t e s t h e
o r i gi n a l P T B o r t h o s i s ; t h e n e w e r p l a s t i c P T B o r
t h o s i s p r e v e n t e d r e c u r r e n c e o f f r a c t u r e s f o r a n
1 1 - m o n t h p e r i o d , u n t i l t h e p a t i e n t s u c c u m b e d t o
m e t a s t a t i c d i s e a s e .
Fig. 6 . An "early" PTB orthosis is used to reduce
trauma to the r ight ankle. Case No. 1 .
Fig. 7 . Use of a PTB orthosis prevented recurrence of
pathological f ractures of the t ibia. Case No. 2.
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C a s e N o . 3 . A . S . , a 5 8 - y e a r - o ld m e c h a n i c a l
e n g i n e e r , w a s a d m i t t e d t o o u r h o s p i t a l w i t h a
h i s t o r y o v e r s e v e r a l y e a r s o f p r o g r e s s i v e
C h a r c o t ' s a r t h r o p a t h y of b o t h a n k l e s . T h e r i g ht
f o ot r e q u i r e d a b e l o w - k n e e a m p u t a t i o n s e c o n
d a r y t o i n t r a c t a b l e o s t e o m y e l i t i s . I n a n e f f or t t o
p r e v e n t a s im i l a r p r o c e s s i n t h e a n e u r a l l e ft a n k l e ,
w e p r e s c r i b e d a p l a s t ic p a t e l l a r - t e n d o n - b e a r i n g
o r t h o s i s . T h e p a t i e n t w a s a b l e t o r e t u r n t o w o r k
a s a n e n g i n e e r , w i t h a b e l o w - k n e e p r o s t h e s i s a n d
a PT B o r th o s i s ( F ig 8 ) . F ig u r e s 9 a n d 10 a r e ,
r e s p e c t i v e l y , f ro n t a n d l a t e r a l v i e w s o f t h e p a t i e n t
w e a r i n g t h e P T B o r t h o s i s . N o t e t h e r e m o v a b l e
panel in Figure 10 .
Fig. 8 . The patient 's functional level
was signif icantly improved with pro
vision of a PTB orthosis. Case No. 3 .
Fig. 9 . The PTB orthosis
r e d u c e d a n k l e i n t r a
ar t icu la r fo rces and p ro
v id e d m e d io l a t e r a l k n e e
stabil i ty . Case No. 3 .
Fig. 10. The PTB panel is inserted
with the knee flexed to 90 deg.
Case No . 3 .
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C a s e N o . 4 . H . S . , a 6 1 - y e a r- o l d i n d i v i d u a l e m
p l o y e d a s a t r u c k d r i v e r , s u s t a i n e d a c h r o n i c s u b
l u x a t i o n o f h is s u b t a l a r j o i n t w i t h i n c r e a s i n g p a i n
a n d in a b i l i t y t o wa lk m o r e t h a n a f e w s t e p s . T h e
a b n o r m a l i t i e s a r e s h o w n o n t h e r a d i o g r a p h i n
F i g u r e 1 1 . A p l a s t i c p a t e l l a r - t e n d o n - b e a r i n g o r
t h o s i s p r e v e n t e d f u r th e r m a l a l i g n m e n t , r e d u c e d
t h e p a i n c o n s i d e r a b l y , a n d p e r m i t t e d r e s u m p t i o n
o f r e l a t i v e l y u n l i m i t e d a m b u l a t i o n .
C a s e N o . 5 . M . R . , a 4 8 - y e a r - o l d w o m a n , s u s
t a i n e d s e v e r e b u r n s o f t h e p l a n t a r s u r f a c e o f h e r
f o o t , w i th m u l t i p l e g r a f t i n g t h a t r e p e a t e d ly f a i l e d
b e c a u s e o f i n a d e q u a t e o r t h o t i c m a n a g e m e n t .
F i g u r e 12 d e p i c t s t h e p a t h o l o g y , w h i l e F i g u r e 13
d e m o n s t r a t e s u s e o f t h e p l a s t i c P T B o r t h o s i s .
Fig. 11. Subtala r subluxation produc ed conside rable
pain and l imited ambulation. Case No. 4 .
Fig. 12. Multiple grafting of the plantar surface was
required prior to prescription of a PTB orthosis. Case
N o . 5.
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Fig. 13. The pla stic PTB orth osis effectively elim i
nated contact between the orthosis-shoe unit and the
ground. Case No. 5 .
Fig. 14. The major bony lan dma rks are outl ined on the
cotton stockinette; elast ic plaster-of-Paris bandage is
used to wrap the foot while it is positioned on a last.
F A B R I C A T I O N D E T A I L S
M A T E R I A L S A N D E Q U I P M E N T N E E D E D
F O R C A S T I N G
T w o r o l ls o f e l a s t i c p l a s t e r b a n d a g e s
C o t t o n s t o c k i n e t t e 3 i n . w i d e , t o p l a c e o v e r
k n e e d o w n t o a n d i n c l u d i n g t h e f o o t
I n d e l ib l e p e n c i l
W a t e r in b a s i n 6 i n . d e e p
S u r g i c a l t u b i n g o r w e b b i n g s t r i p
C a s t c u t t e r
B a n d a g e s h e a r s
Y a r d s t i c k
T a p e m e a s u r e
Ri t z s t i c k
M e a s u r e m e n t c h a r t
Ca s t i n g l a s t s f o r m a tc h in g h e e l h e ig h t o f sh o e
t o o r t h o s i s
C A S T I N G
T h e c a s t is t a k e n in tw o se c t i o n s . T h e f ir st
s e c t i o n i n c l u d e s t h e f o o t - a n k l e t o t h e m i d - c a l f
a r e a s . T h e s e c o n d s e c t i o n i n c l u d e s t h e m i d - c a l f
a r e a t o a p o i n t a b o v e t h e f e m o r a l c o n d y l e s .
First Section (F ig . 14)
1 . Pa t i e n t is s e a t e d o n a p l i n th o r c h a i r w i th t h e
f o o t h e ld i n 5 d e g . o f d o r s i f l e x io n o n t h e p r o p e r ly
s e l e c t e d l a s t .
2 . S t o c k i n e t t e , s e w n a t t h e t o e s , i s p l a c e d o n
t h e le g a n d b r o u g h t a b o v e t h e k n e e .
3 .
T h e l e g i s b r o u g h t i n to 5 d e g . o f d o r s i f l e x io n
r e l a t i v e t o t h e f l o o r .
4 . Wi th t h e i n d e l ib l e p e n c i l t h e p a t e l l a i s l o
c a t e d a n d i ts b o r d e r s m a r k e d ; ti b ia l t u b e r c l e ,
c r e s t o f t i b i a , h e a d o f f i b u l a , l a t e r a l f l a r e o f t i b i a ,
m e d i a l c o n d y l e f l a r e , b o t h m e d i a l a n d l a t e r a l m a l
l e o l i , f i r s t a n d f if th m e ta t a r sa l h e a d s , a n d a n y
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o t h e r p e r t i n e n t b o n y p r o m i n e n c e s . T h e m i d p o i n t
o f t h e p a t e l l a r t e n d o n i s a l so m a r k e d ( F ig . 1 4 ) .
5 . A s t r i p o f su r g i c a l t u b in g i s p l a c e d a lo n g th e
m e d ia l s i d e o f t h e k n e e a n d d o w n th e a n t e r io r
m id l in e o f t h e l e g , e x t e n d in g to t h e t o e s , t o p e r m i t
r e m o v a l o f t h e c a s t l a t e r ( F ig . 1 5 ) .
6 . E l e v a t e t h e f o o t a n d wr a p w i th e l a s t i c p l a s
t e r b a n d a g e g o in g to t h e m id - c a l f l e v e l .
7 . R e p la c e t h e f o o t o n t h e l a s t a n d h o ld i n t h e
c o r r e c t p o s i t i o n u n t i l p l a s t e r h a s h a r d e n e d ( F i g .
14).
Second Section
1 . Af t e r t h e f o o t - a n k le c a s t h a s h a r d e n e d
suf
f i c i e n t ly , e x t e n d th e k n e e t o 3 0 d e g . o f f l e x io n .
2 . W r a p f ro m th e m id - c a l f a r e a t o a p o in t
a b o v e t h e f e m o r a l c o n d y l e s w i t h t h e s e c o n d
p l a s t e r - o f - P a r i s b a n d a g e .
3 .
L o c a t e t h e p a t e l l a r t e n d o n a n d p o p l i t e a l
f o ssa , a n d c o m p r e s s a s i s d o n e r e g u la r ly f o r a n y
P T B c a s t i n g p r o c e d u r e .
4 . A f t e r t h e p l a s t e r h a s h a r d e n e d , s e v e r a l
h o r i z o n t a l o r i e n t a t i o n l i n e s a r e p l a c e d a l o n g t h e
o u t l i n e o f t h e su r g i c a l t u b in g . Re m o v a l o f t h e c a s t
is n o w a c c o m p l i s h e d b y c u t t i n g d o w n t h e o u t l i n e
o f t h e su r g i c a l t u b in g w i th a c a s t c u t t e r ( F ig . 1 5 ) .
T h e h a sh l i n e s a r e u se d t o r e e s t a b l i sh t h e c a s t ,
which i s then f i l led wi th p las te r o f Par is (Fig . 15) .
T h e p l a s t e r b a n d a g e i s s t r i p p e d o f f i n t h e c o n v e n
t i o n a l m a n n e r .
M E A S U R E M E N T S
T h e m e a s u r e m e n t s r e q u i r e d a r e :
• C a l f c i r c u m f e r e n c e
• A n k l e c i r c u m f e r e n c e
• F e m o r a l c o n d y l e s w i d t h
• M a l l e o l i w id th
• H e i g h t f r o m f l oo r t o m i d - p a t e l l a r - t e n d o n
leve l
• A n t e r o p o s t e r i o r w i d t h o f k n e e a t m i d -
p a t e l l a r - t e n d o n l e v e l
Fig. 15. The negative wrap has been removed. Note
the patellar-tendon indentions and cast reference lines.
Fig. 16. The comp leted negativ e wrap is read y forfilling
with plaster of Paris.
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C A S T M O D I F I C A T I O N
1 . T h e p r o x im a l se c t i o n o f t h e c a s t is m o d i f i e d
in t h e s a m e m a n n e r r e c o m m e n d e d f or t h e c o n
v e n t io n a l PT B d o wn to t h e m id - l e g l e v e l ( F ig s .
17, 18, an d 19) .
2 . E x t r a r e l i e f i s g iv e n to t h e m e d ia l a n d l a t e r a l
m a l l e o l i a n d a n y o t h e r p r o m i n e n c e s a s a p p r o
p r i a t e .
3 .
A m e ta t a r s a l a r c h i s c u t i n to t h e so l e o f t h e
f o o t — l o c a t e d 1 /2 i n . b e h i n d t h e a p i c e s o f t h e
m e t a t a r s a l s , t h e h i g h p o i n t b e i n g u n d e r t h e s e c
o n d m e t a t a r s a l a n d e x t e n d i n g i n t o a t r i a n g u l a r
sh a p e u n d e r t h e sh a f t o f t h e m e ta t a r sa l s ( F ig . 20 ) .
4 . T h e l o n g i t u d i n a l a r c h i s d e f i n e d f u r t h e r
(Fig . 21) .
5 . T h e c a s t is t h e n s m o o t h e d a n d p r e p a r e d f or
l a m i n a t i o n in t h e c o n v e n t i o n a l m a n n e r ( F i g . 2 2 ) .
Fig. 17. The negative wrap has been stripped away,
and reference l ines outl ining bony prominences have
been reinforced on the crude posit ive model.
Fig. 18. Plaster has been removed in the area of the
patellar tendon, under the medial condyle, and along
the proximal part of the tibia and fibula.
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F i g . 1 9. P l a s t e r o f P a r i s h a s b e e n a d d e d o v e r t h e h e a d
of t he f i bu l a , l a t e r a l t i b i a l co nd y l e , p r o x i m a l t ib i a l sh a f t ,
a n d t h e t i b i a l t u b e r c l e . P o s t e r i o r l y , t h e p o p l i t e a l a r e a i s
b u i l t u p a n d f la r e d f o r t h e h a m s t r i n g t e n d o n s .
F i g . 2 0 . F i n i s h e d p l a n t a r s u r f a c e o f p o s i t i v e m o l d ; n o t e
f o r m a t i o n o f m e t a t a r s a l a n d l o n g i t u d i n a l a r c h e s a n d
r e l i e f f o r ba se o f f if th m e t a t a r sa l .
F i g . 2 1 . T he f i n i shed p os i t i v e mol d i s r e ad y f o r t he f i r s t
l a m i n a t i o n p r o c e s s : n o t e r e l i e f f o r m a l l e o l i .
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P L A S T I C L A M I N A T I O N
T h e l a m i n a t i o n p r o c e s s is c a r r i e d o u t in t w o
s t e p s .
Anterior-Proximal Section
( F ig s . 22 , 23 , a n d 24 ) .
1.
A l a y e r o f P V A fo il is p l a c e d o v e r t h e m o d
i f ied cas t .
2 . F o u r l a y e r s o f P e r l o n s t o c k i n e t t e a r e a p
p l i e d t o t h e d i s t a l s e c t i o n .
3 . F o u r l a y e r s o f f i b e r g l a s s s t o c k i n e t t e a r e a p
p l i e d .
4 . O n e l a y e r o f r e in f o r c e d f i b e r g l a s s m a t t i n g is
a d d e d .
5 .
F o u r a d d i t i o n a l l a y e r s o f P e r l o n s t o c k i n e t t e
a r e a p p l i e d .
6 . T h e s e c o n d P V A b a g i s t h e n a p p l i e d .
7 . A m i x t u r e o f 8 0 % L a m i n a r H a r z * a n d 2 0 %
D e g a p l a s t * w i t h 4 % c o l o r a n d 3 % c a t a l y s t i s l a m i
n a t e d u n d e r su c t i o n ( F ig . 25 ) . A b a t c h o f 3 0 0 g i s
u su a l ly a su f f i c i e n t q u a n t i t y .
8 . T h e l a m i n a t i o n i s r e m o v e d t a k i n g c a r e n o t
t o d a m a g e t h e a n t e r i o r s e c t i o n o f t h e c a s t .
*Ot to Bock Indust r ies , Duders tad t , West G ermany
Fig. 22. The com plete d positive mold has been lacquere d and sprayed with silicone; the first
PVA foil has been applied and the pipe cast drilled for the suction attachment.
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Fig . 23 . T h e pos i t ive mo ld has
been wra ppe d with 4 laye rs of Perlon and 3 laye rs of f iber glas s stoc k
inette ; a s ingle layer of f iberglass
s toc k ine t te has be e n appl i e d to the
ante r ior mo ld sur fac e .
F i g . 2 4 . T h e p r e p a r e d p o s i t i v e
m o l d , c o v e r e d b y a s e c o n d P V A
foi l , i s ready for lamination.
Fig . 25 . Laminar Harz (dark
ar e a ) i s f l ow in g thr ough a P V C
tube , impr e gnat ing the s toc k
inette and f iberglass areas of
the pr ox imal kne e se c t io n .
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9 . T h e a n t e r i o r s e c t i o n i s m a r k e d a n d t r i m m e d
( F i g . 2 6) a c c o r d i n g t o t h e f o l l o w i n g c r i t e r i a :
a . m i d p a t e l l a a n t e r i o r l y ;
b .
g o i n g p r o x i m a l l y a t l e a s t 2
-2 1/2
in .
a b o v e t h e m i d - p a t e l l a r t e n d o n m e d i a l l y a n d
l a t e r a l l y ;
c . a t mid A -P o f the l eg , tw o ve r t i ca l l ines
a r e d r o p p e d a n d t h e l a m i n a t i o n t r i m m e d t o
th i s l ine ;
d . the d i s t a l ed ge i s a ho r i zo n ta l l ine an y
w h e r e b e t w e e n t h e p r o x i m a l t h i r d t o p r o x i
mal half of the leg .
10 .
T h e a n t e r i o r s e c t i o n is r e a p p l i e d t o t h e c a s t
a f t e r a ll e d g e s h a v e b e e n s m o o t h e d .
Shank Section
1.
A s t r i p o f D a c r o n w e b b i n g is p l a c e d d o w n
t h e c e n t e r o f t h e a n t e r i o r s e c t i o n ( F i g . 2 7 ) .
2 .
Th e h ind fo o t s ec t io n is bu i l t up to a th ick
ne s s b e t w ee n 3 /8 and 1 /2 in . w i th a m a te r i a l s uc h as
S A C H f o o t r u b b e r t o a l l o w re l i e f d u r i n g w e i g h t -
b e a r i n g ( F i g . 2 8 ) .
Fig. 26. The firs t lamination has been completed; the
anterior insert (shell) has been marked prior to its re
moval from the cast.
Fig 27. The an teri or PTB shell is placed on the cas t. A strip of 1 in. Pelite is placed on the shell
prior to the second lamination process.
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3 .
A PV A b a g is p l a c e d o v e r t h e c a s t a n d th e
a n t e r i o r s e c t i o n .
4 . W h e n p a t i e n t we ig h s l e s s t h a n 1 7 5 lb , f o u r
l a y e r s o f P e r l o n s t o c k i n e t t e a r e a p p l i e d t o c a s t .
F o r h e a v i e r p a t i e n t s , t w o l a y e r s o f f i b e r g l a s s a r e
u s e d .
5 . On e p i e c e o f f i b e r g l a s s m a t a b o u t 2 i n .
w i d e i s p l a c e d u n d e r t h e m e d ia l f la r e o f t h e t i b i a
r u n n in g d i s t a l l y a lo n g th e m e d ia l s i d e u n d e r t h e
so l e o f t h e f o o t , g o in g p r o x im a l a lo n g th e l a t e r a l
s id e o f f o o t a n d e n d in g u n d e r h e a d o f t h e f i b u l a .
6 . A T - s h a p e d f i b e r g l a s s m a t i s p l a c e d u n d e r
th e so l e o f t h e f o o t c u p p in g th e h e e l a n d g o in g
p r o x im a l ly h a l f wa y u p th e m e d ia l a n d l a t e r a l
s i d e s .
7 . T w o l a y e r s o f f i b e r g l a s s s t o c k i n e t t e a r e
a p p l i e d .
8 . F o u r a d d i t i o n a l l a y e r s o f P e r l o n s t o c k
i n e t t e a r e a p p l i e d .
9 . T h e s e c o n d P V A b a g is a p p l i e d .
10. L a m i n a t i o n i s t h e n a c c o m p l i s h e d w i t h
7 0 0 g o f r e s in - 8 0 % L a m in a r H a r z - 20 % De ga pla st
t h a n 1 75 lb . , a n a d d i t i o n a l f i b e r g l a s s m a t is p l a c e d
u n d e r t h e m e d ia l f l a r e a n d u n d e r t h e so l e o f t h e
foo t to ne ck o f the f ibu la .
11 . L a m i n a t i o n is c a r r i e d o u t u n d e r a v a c u u m
o f 20 k g / sq c m .
12 .
L a m i n a t i o n i s r e m o v e d b y c u t t i n g t h r o u g h
t h e a n t e r i o r p a r t o f t h e s h a n k s e c t i o n , t a k i n g c a r e
n o t t o c u t t h r o u g h th e f i r s t s e c t i o n .
13. T h e t r i m l i n e s o f t h e s h a n k s e c t i o n a r e t h e n
d r a w n ( F i g . 3 0 ) .
Fig. 28. The hindfoot section of the cast has been built
up with hard SACH-foot rubber to allow relief of the
hindfoot during weight-bearing.
Fig. 29. The second lamination process is begun fol
lowing the addition of layers of Perlon, fiberglass stock
inette, fiberglass matting, and a PVA foil.
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Fig. 30. Following completion of the second lamina
tion, the or thosis is marked for cutt ing away from the
cast .
Fig. 31. During donning of the or thosis, the patient
inserts the anter ior PT B shell ; f inal f i tt ing and "c he ck
ou t" comple te the p rocess .
F I T T I N G
1 . A l e n g th o f s t o c k in e t t e i s a p p l i e d t o t h e
p a t i e n t ' s l e g .
2 . T h e s h a n k s e c t i o n is d o n n e d b y s p r e a d i n g
a p a r t t h e p a t e l l a r - t e n d o n g r o o v e a n d s l i d i n g t h e
f o o t t h r o u g h ( F ig . 3 1 ) .
3 .
T h e se c t i o n i s a p p l i e d b y s l i d in g in f r o m th e
a n t e r i o r s e c t i o n u n t i l t h e s e c t i o n k e y s i n t o t h e
s h a n k s e c t i o n .
4 . V e l c r o i s p l a c e d a r o u n d t h e p a t e l l a r - t e n d o n
a r e a a n d t h e m i d - p o i n t o f t h e a n t e r i o r s e c t i o n .
5 . T h e p a t i e n t ' s s h o e i s p l a c e d o n t h e o r t h o s i s
a n d t h e p a t i e n t is a s k e d t o s t a n d .
6 . N o r m a l c h e c k o u t f o r t h e P T B i s p e r f o r m e d
m a k i n g s u r e w e i g h t - b e a r i n g is o n t h e p a t e l l a r t e n -
d o n a n d m e d ia l f l a r e o f t i b i a . I f t h e o r th o s i s i s
f i t t e d c o r r e c t l y , t h e p a t i e n t s h o u l d e x p e r i e n c e a
c o n t a c t o f t h e s o l e o n t h e f o o t p l a t e o f t h e o r t h o s i s
b u t n o w e i g h t - b e a r i n g .
S U M M A R Y
O u r e x p e r i e n c e w i t h p l a s t i c p a t e l l a r - t e n d o n -
b e a r i n g o r t h o s e s in t e n i n d i v i d u a l s w i t h v a r y i n g
m u s c u l o s k e l e t a l d e f e c t s o f t h e i r l o w e r l i m b s h a s
b e e n p r e s e n t e d . W e c o n c l u d e d t h a t s e v e r a l d i s
a b i l i t i e s o f t h e l o w e r l im b c a n b e su c c e s s f u l l y
m a n a g e d w i t h t h i s d e v i c e , a f f o r d i n g s u p e r i o r
c o s m e s i s , r e d u c e d o r t h o t i c w e i g h t , m o r e c o m
f o r t , a n d i m p r o v e d p h y s i o l o g i c a l a n d a n a t o m i c a l
a l i g n m e n t . D i s a d v a n t a g e s i n c l u d e d i n c r e a s e d
c o s t , f r e q u e n t r e p l a c e m e n t i n c h i l d r e n , a n d p o
t e n t i a l s k i n p r o b l e m s i n t h o s e i n d i v i d u a l s w i t h
i m p a i r e d v a s c u l a r a n d s e n s o r y a r e a s .
O u r p r e l i m i n a r y 1 8 - m o n t h e x p e r i e n c e l e d u s t o
t h e c o n c l u s i o n t h a t t h e p l a s t i c p a t e l l a r - t e n d o n
o r t h o s i s i s a v a lu a b l e t o o l in t h e c a r e o f d i s a b l e d
a d u l t s a n d c h i l d r e n ; w e a r e c o n t i n u i n g o u r c l i n i
c a l t r i a l s a n d w i l l p u b l i s h a s u b s e q u e n t p a p e r
o u t l i n i n g o u r e x p e r i e n c e s w i th n e u r o m u s c u l a r
d i s a b i l i t i e s .
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LITERATURE CITED
1. Corcoran,
P. J.,
Evaluation
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brace.
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Degree
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Master
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Science, Uni
versity of Washington, May 1968.
2. Demopoulos,
J. T., and A.
Cassvan, Experience
with plastic orthoses
in
children: preliminary observa
tions.
Bull Hosp. Joint
Dis. 32:148-167, October 1971.
3. Demopoulos,
J.T., A.
Cassvan,
and J. M.
Snowden, Experience with plastic lower extremity othoses.
Bull. Hosp. Joint Dis. 33:22-46, April 1972.
4.
Demopulos, J. T., and J. E. Eschen, Modification
of plastic orthoses
for
children.
Bull. Hosp. Joint Dis.
34:156-160, October
1973.
5. Jebsen,
R.H., B.C.
Simons,
and P. J.
Corcoran,
Experimental plastic short leg braces.
Arch Phys.
Med.
Rehabil. 49:2 :108-109,
February
1968.
6.
Kay, H. W.,
Clinical applications
of
the Veterans
Administration Prosthetics Center patellar-tendon-
bearing brace. Artif.
Limbs
15:1:46-67, Spring
1971.
7.
Kay, H. W., and H.
Vorchheimer,
A Survey of
Eight Wearers of the Veterans Admin istration
Prosthetics Center Patellar Tendon -Bearing Brace.
School
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Engineering
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Science,
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York Univer
sity, July
1965.
8. Lehmann,
J. F., B. J.
DeLateur,
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B.C.
Simons, Trends
in
lower extremity bracing.
Arch. Phys. Med. Rehabil. 51:6:338-353, June 1970.
9. Lehmann,
J .F., and C. G .
Warren, Ischial
and
patellar-tendon weight-bearing braces: function,
de
sign, adjustment, and training.
Bull Pros.
Res.
10-19:6-19, Spring
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10. Lehneis,
H.R.,
Brace alignment consideration,
Orthop. Pros. Appl. J., 18:2:110-114, June 1964.
11.
Lehneis, H.R., New concepts in lower extrem
ity orthotics. Med. Clin. N. Amer. 53:3:585-592, May
1969.
12. Mcllmurray, William,
and
Werner Greenbaum,
A below-knee weight bearing brace.
Orth. Pros.
Appl.
J.
12
:2:81-82, June
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Mcllmurray, William,
and
Werner Greenbaum,
The application of SACH foot principles to orthotics.
Orth.
Pros.
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13:4:37-40, December 1959.
14. Sarno,
J . E. , and H. R.
Lehneis, Prescription
considerations
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plastic below-knee orthoses.
Arch.
Phys.
Med.
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52:11:503-510, November
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15. Simons,
B. C , R. H.
Jebsen,
and L. E.
Wildman,
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Orth. and Pros.
21:3:215-218, September
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Veterans Administration Prosthetics Center, A
Manual for Fabrication and Fitting of the Below-Knee
Weight-Bearing Brace, April 1967.
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A T H E R M O P L A S T I C S T R U C T U R A L A N D
A L I G N M E N T S Y S T E M F O R
B E L O W - K N E E P R O S T H E S E S
H a n s R i c h ar d L e h n e i s , C . P . O .
1
B e c a u s e c h a n g e s i n a l i g n m e n t a r e o f t e n i n d i
c a t e d a s t h e a m p u t e e p a t i e n t p r o g r e s s e s t h r o u g h
t h e v a r i o u s s t a g e s o f g a i t t r a i n i n g , i d e a l l y p r o s
t h e s e s s h o u l d b e p r o v i d e d w i t h r e l a t i v e l y s i m p l e
m e a n s o f c h a n g i n g a l i g n m e n t , d a y s , w e e k s , o r
e v e n m o n t h s a f t e r t h e p r o s t h e s i s i s f i rs t a p p l i e d .
U n t i l t h e a m p u t e e i s a b l e t o w a l k u n a i d e d , i . e . ,
w i t h o u t c r u t c h e s o r c a n e s , o f t e n c h a n g e s a r e r e
q u i r e d i n t h e a l i g n m e n t o f t h e p r o s t h e s i s o w i n g t o
t h e i n c r e a s e d s h i ft o f w e i g h t t o w a r d s t h e i n j u r e d
s i d e a n d o t h e r c h a n g e s i n h i s g a i t p a t t e r n .
A l t h o u g h t h e s y s t e m d e s c r i b e d in t h i s p a p e r
w i ll n o t l e n d it s e l f c o m p l e t e l y t o e x t e n d e d p o s t -
f i t t i n g c h a n g e s , i t r e p r e s e n t s a s t e p i n t h a t d i r e c
t i o n . T h e s y s t e m c o n s i s t s o f a t h e r m o p l a s t i c
p o l y v i n y l c h l o r i d e ( P V C ) t u b i n g t h a t i s a v a i l a b l e
c o m m e r c i a l l y f ro m p l u m b i n g s u p p l y h o u s e s .
D u r i n g t h e e a r l y f i t t i n g s t a g e o f a m p u t e e m a n
a g e m e n t , t h i s t u b i n g r e p r e s e n t s b o t h t h e s t r u c
t u r a l c o n n e c t i o n b e t w e e n t h e s o c k e t a n d f o o t a s
w e l l a s a m e a n s o f a l i g n i n g t h e p r o s t h e s i s .
S T A T I C A L I G N M E N T
F o r t h e p u r p o s e o f s t a t i c a l l y a l i g n i n g t h e p r o s
t h e s i s , a v e r t i c a l a l i g n m e n t j i g
2
i s used wi th a
m i n o r m o d i f i c a t i o n w h i c h c o n s i s t s o f t h e e x
c h a n g e o f t h e m a n d r e l b u s h i n g w i t h a m e t a l
1Dire c to r , Or tho t ics and Pro sthe t ics , New York
Universi ty Medical Center , 400 East 34th St . , New
York. N.Y. 10016.
2
VFJ- 1 0 0 ; A . J . Ho sm e r Co r p o r a t i o n , P .O . Bo x 3 7 ,
Ca m p b e l l , Calif. 95008.
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s p h e r e w h i c h i s h e l d in t h e m a n d r e l c l a m p ( F i g .
1) .
T h e s p h e r e i s d r i l l e d t o r e c e i v e a s t a n d a r d
7 /8 - in . p ip e i n s e r t e d i n t h e p l a s t e r c a s t so a s t o
p e r m i t u n i v e r s a l m o v e m e n t o f t h e c a s t - s o c k e t u p
o n t h e a l i g n m e n t j i g fo r p r o p e r o r i e n t a t i o n o f t h e
s o c k e t i n s p a c e .
A p o l y v i n y l c h l o r i d e ( P V C ) f o o t p l u g a n d a
w o o d b a se o f p ly w o o d 1 .5 t o 2 c m th i c k i s f a s
t e n e d to t h e f o o t b a se o f t h e v e r t i c a l a l i g n m e n t j i g
w i t h s c r e w s ( F i g . 2 ) . T h e r e l a t i o n s h i p b e t w e e n
t h e s o c k e t a n d t h e f o o t i s e s t a b l i s h e d , u s i n g s t a n
d a r d p r o c e d u r e s w h i c h n e e d n o t b e e l a b o r a t e d
u p o n h e r e .
O n c e t h is re l a t i o n s h i p h a s b e e n e s t a b l i s h e d ,
t h e s o c k e t i s m o v e d p r o x i m a l l y o n t h e v e r t i c a l
b a r o f t h e a l i g n m e n t j i g , a n d a P V C t u b e w i t h t w o
Fig. 1. Sph erical insert for use with VF J-100 fabricating jig.
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l o n g i tu d in a l c u t s o f 15 c m d e p th a t r i g h t a n g l e s t o
e a c h o th e r o n t h e p r o x im a l e n d o f t h e t u b in g is
i n s t a l l e d o n t h e f o o t b lo c k w i th a h o se c l a m p ( F ig .
3 ) Be f o r e t h e t u b in g is c u t l o n g i tu d i n a l ly , tw o
h o le s sh o u ld b e d r i l l e d t h r o u g h th e t u b in g a t t h e
d i s t a l e n d o f e a c h o f t h e p l a n n e d c u t s t o p r e v e n t
Fig 2 A PVC footplug on a plywoo d base is placed in
the alignment jig.
Fig. 3. Installation of the PVC tube.
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s t r e s s c o n c e n t r a t i o n s a t t h e e n d o f t h e s a w c u t s .
T h e p r o x im a l e n d o f t h e t u b e i s h e a t e d t o a l l o w
s p r e a d i n g o f t h e t u b i n g a t t h e s a w c u t s m a d e
p r e v i o u s l y , a n d t h u s t o p r o d u c e f o u r s t r a p s f o r
a t t a c h m e n t o f t h e t u b e t o t h e s o c k e t .
T h e s o c k e t w i t h i t s o u t e r s u r f a c e r o u g h e d u p i s
l o w e r e d t o t h e a p p r o p r i a t e l e ve l i n to t h e s p r e a d e d
se c t io n o f t h e t u b in g a t t h e p r o x im a l e n d ( F ig . 4 ) .
T h e p l a s t i c s t r a p s a r e h e a t e d , a r e m a d e t o c o n
f o r m to t h e sh a p e o f t h e so c k e t , a n d a r e h e ld i n
p l a c e t e m p o r a r i l y b y m a s k i n g t a p e ( F i g . 5 ) . O n e
la y e r o f f i b e r g l a s s s t o c k in e t t e is t h e n p u l l e d o v e r
th e PVC tu b in g f r o m th e f o o t b lo c k to t h e i n t e r
se c t i o n o f t h e p l a s t i c s t r a p s a n d th e so c k e t , a t
wh ic h p o in t t h e f i b e r g l a s s i s t i e d t o t h e PVC tu b
in g ( F ig . 6 ) , A m ix tu r e o f r i g id p o ly e s t e r r e s in a n d
s i l ic a p o w d e r is t h e n s p r e a d o v e r t h e s o c k e t a n d
t h e p l a s t i c - s t r a p a r e a , a n d t h e t u b u l a r s t o c k i n e t t e
i s p u l l e d u p t o c o v e r t h e p o r t i o n o f t h e so c k e t
o v e r w h i c h t h e p l a s t i c s t r a p s e x t e n d .
W h e n t h e s t o c k i n e t t e h a s b e e n p u l l e d o v e r t h e
s o c k e t , a d d i t i o n a l a m o u n t s o f t h e r e s i n - s i l i c a
m i x t u r e a r e s p r e a d o n t o t h e s t o c k i n e t t e ( F i g . 7 ) .
T h i s m a y b e d o n e e a s i l y w h e n p l a s t i c g l o v e s a r e
wo r n . Af t e r t h e r e s in h a s h a r d e n e d , t h e f o o t i s
a t t a c h e d t o t h e f o o t b l o c k a n d w o o d e n b a s e , a n d
th e p r o s th e s i s i s r e a d y f o r f i t t i n g ( F ig .8 ) .
D Y N A M I C A L I G N M E N T
A n y a l i g n m e n t c h a n g e s c a n b e a c c o m p l i s h e d
r e a d i l y b y h e a t i n g t h e P V C t u b i n g fo r e i t h e r a n g u
l a r o r t r a n s l a t o r y a l i g n m e n t a d j u s t m e n t s . F o r e x
a m p l e , t o i n c r e a s e s o c k e t fl e x i o n , t h e p r o x i m a l
Fig. 4 . View of setup showing the at tac hm ent straps
before being formed in place.
Fig. 5 First step in attaching the tube to the socket.
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t u b i n g a r e a s h o u l d b e h e a t e d n e a r t h e a t t a c h m e n t
t o t h e s o c k e t . If, h o w e v e r , a t r a n s l a t o r y m o v e
m e n t is d e s i r e d , e . g . . a n t e r i o r m o v e m e n t o f t h e
s o c k e t o v e r t h e f o o t , t h e p r o x i m a l a r e a o f t h e
t u b i n g i m m e d i a t e l y b e l o w t h e s o c k e t a s w e l l a s a t
i ts a t t a c h m e n t t o t h e P V C p l u g m u s t b e h e a t e d i n
o r d e r to m o v e t h e s o c k e t a n t e r i o r l y o v e r t h e f o o t
( F i g . 9 ) . T h e s e a d j u s t m e n t s c a n b e m a d e b y
m e a n s o f a h e a t g u n d i r e c t l y o n t h e t u b e w h i l e t h e
p a t i e n t is s t a n d i n g b e t w e e n p a r a l l e l b a r s o r , a l
t e r n a t e l y , t h e a d j u s t m e n t s i n d i c a t e d m a y b e
m a d e b y p l a c i n g t h e p r o s t h e s i s i n t h e v e r t i c a l
a l i g n m e n t j i g a n d b y a p p r o p r i a t e l y i n d e x i n g t h e
v a r i o u s a d j u s t m e n t s c a l e s o n t h e j i g w h e r e t h e
a l i g n m e n t c h a n g e s n e e d t o b e m a d e . T h e t u b i n g
c a n t h e n b e h e a t e d a n d a m o r e a c c u r a t e a d j u s t
m e n t c a n b e c a r r i e d o u t .
F I N I S H I N G
I f a h a r d e x t e r i o r f i n i s h i s d e s i r e d , a r i g i d f o a m
b u i l d u p i s m a d e , s h a p e d , a n d l a m i n a t e d i n t h e
c o n v e n t i o n a l m a n n e r , i . e . . e x t e n d i n g f r o m t h e
w o o d a n k l e b a s e o v e r t h e s o c k e t .
W h e n a s o f t e x t e r i o r f i n i s h is d e s i r e d , t h e P V C
t u b i n g i s r e i n f o r c e d b y l a m i n a t i n g t w o l a y e r s o f
n y l o n s t o c k i n e t t e o v e r t h e t u b e a n d e x t e n d i n g
o v e r t h e w o o d b a s e a n d t h e s o c k e t . A s o f t f o a m
c o v e r i s t h e n a p p l i e d , s h a p e d , a n d f i n i s h e d a p
p r o p r i a t e l y .
F i g . 6 . A p p l i c a t i o n o f f i b e r g l a s s s t o c k i n e t t e u s e d in
a t t a c h i n g t u b e t o s o c k e t .
F i g . 7 . I m p r e g n a t i n g th e s t o c k i n e t t e w i t h p o l y e s t e r
r e s i n a n d s i l ic a p o w d e r .
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Fig. 8. Pro sth esi s ready for fitting. Fig. 9. Aligned pro sth esi s.
I M M E D I A T E P O S T O P E R A T I V E
P R O S T H E T I C S F I T T IN G
T h e t u b e s y s t e m h a s a l s o b e e n a p p l i e d i n a
n u m b e r o f c a s e s of b e l o w - k n e e i m m e d i a t e p o s t
o p e r a t i v e f i t t i n g s , r e s u l t i n g i n a c o n s i d e r a b l e
w e i g h t r e d u c t i o n , a c o n d i t i o n e s p e c i a l l y i m p o r
t a n t t o g e r i a t r i c a m p u t e e s . T h e r e a r e n o p r o v i
s i o n s f o r q u i c k d i s c o n n e c t i o n , b u t t h e l i g h t
w e i g h t o f t h e p r o s t h e s i s s e e m s to a l l e v i a t e t h e
n e e d fo r r e m o v a l of t h e p r o s t h e t i c c o m p o n e n t s
f r o m t h e s o c k e t .
S U M M A R Y
A b e l o w - k n e e p r o s t h e t i c s s t r u c t u r a l s u p p o r t
a n d a l i g n m e n t s y s t e m c o n s i s t i n g o f a P V C t u b e
h a s b e e n d e s c r i b e d . I t r e s u l t s in e x t r a o r d i n a r y
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w e i g h t r e d u c t i on , e sp e c i a l l y w h e n a so f t e x te r i or
f in ish i s intended and, at least in the ear ly s tages
o f p r os th e t i c s f i t t i n g , p r ov i d e s th e p os s i b i l i ty o f
i n fi n it e a l i g n m e n t c h a n g e s t o a c c o m m o d a t e t h e
p at i e n t ' s c h an g i n g ga i t p a t te r n . Wh e n a r i g i d e x
ter ior f in ish i s indicated , th is type of prosthes is i s
a t l e as t o f th e sam e or su p e r i or s tr e n gth as th e
c on ve n t i on a l BK p r o s th e s i s , an d w i th a so f t e xter ior f i n i sh o f ad e q u ate s tr e n gth w h e n r e i n for c e d
w i th fi b e r g l as s l am i n ate as d e sc r i b e d ab ov e . I t
h as a l so b e e n fou n d to p os se s s d e f i n i te ad van
t a g e s in p o s t o p e r a t i v e p r o s t h e t i c s f it t i n g s in
ge r i a tr i c am p u te e s to r e d u c e th e w e i gh t su b s tan
t i a l ly . Th e u t i li ty o f th i s sys te m , i . e . , w h e th e r a
r igid or soft exter ior f in ish i s des ired , or for the
p u r p ose o f i m m e d i a te p os top e r at i ve f i t t i n gs , h as
p r ov e n to b e su c c e s s fu l i n i t s e xc l u s i ve ap p l i c a
t i on for b e l ow -k n e e am p u te e s ove r th e p as t th r e e
ye ar s a t th e In s t i tu te o f R e h ab i l i ta t i on M e d i c i n e ,
N e w Y o r k U n i v e r s i t y M e d i c a l C e n t e r .
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D E V E L O P M E N T O F A T H E R M O P L A S T I C
B E L O W - K N E E P R O S T H E S I S
W I T H Q U I C K - D I S C O N N E C T F E A T U R E
C h a r l e s H . P r i t h a m , C . P .
I n r e c e n t y e a r s , c o n s i d e r a b l e i n t e r e s t h a s b e e n
f o c u s e d o n t h e d e v e l o p m e n t o f e n d o s k e l e t a l ,
m o d u l a r s y s t e m s f o r t h e v a r i o u s l e v e l s o f a m p u
t a t i o n . L o g i c a l l y , s u c h s y s t e m s s h o u l d b e f u l l y
c o m p e t i t i v e w i t h c o n v e n t i o n a l fa b r i c a ti o n t e c h
n iq u e s i n r e g a r d t o c o s t , e a se a n d sp e e d o f f a b r i
c a t i o n , f u n c t i o n , a n d w e i g h t . I n a d d i t i o n , t h e y
s h o u l d o f f e r i m p r o v e d c o s m e s i s a n d i n t e r -
c h a n g e a b i l i t y o f c o m p o n e n t s . T h e m o s t s u c c e s s
f ul a p p l i c a t i o n h a s b e e n in t h e h ip - d i sa r t i c u l a t i o n
c a s e ,
a n d p e r h a p s t h e l e a s t s a t i s f a c t o r y h a s b e e n
i n t h e b e l o w - k n e e c a s e , p a r t i c u l a r l y i n r e f e r e n c e
t o w e i g h t a n d e x p e n s e . I n a n a t t e m p t t o r e d r e s s
t h i s s i t u a t i o n , R i c h a r d L e h n e i s i n c o n j u n c t i o n
w i t h v a r i o u s c o - w o r k e r s h a s d e v e l o p e d a b e l o w -
k n e e p r o s t h e s i s u t i l i zi n g a p y l o n o f c o m m e r i c a l l y
a v a i l a b l e p o l y v i n y l c h l o r i d e p i p e , a t h e r m o p l a s
t i c .
(See preceding article. Ed.)
I n t h e i r t e c h n i q u e , o n e e n d o f a p i e c e o f a p
p r o x i m a t e l y 1 1 n . I .D . p ip e i s a t t a c h e d to a
so c k e t , c u t t o l e n g th , a n d a f o o t is a p p l i e d b y
u s in g a n a n k le p lu g o f m e ta l o r PVC. An y a l i g n
m e n t c h a n g e s i n d i c a t e d b y w a l k i n g t r ia l s a r e
m a d e b y h e a t i n g a n d b e n d i n g t h e p i p e . T h e p r o s
t h e s i s c a n t h e n b e e q u i p p e d w i t h a c o s m e t i c
c o v e r . T h i s p y l o n h a s b e e n u s e d f o r i m m e d i a t e
p o s t o p e r a t i v e p r o s t h e s e s e v e n t h o u g h n o q u i c k -
d i s c o n n e c t f e a t u r e i s p r o v i d e d .
I n sp i r e d b y t h i s , a n d a t t h e i n s t i g a t i o n o f V i r g i l
F a u l k n e r , C . P . O . , t h e a u t h o r la t e i n t h e w i n t e r o f
1 9 73 b e g a n in v e s t i g a t i n g t h e p o s s ib i l i t i e s o f d e
v e lo p in g a s im i l a r sy s t e m fr o m lo c a l ly a v a i l a b l e
m a t e r i a l s . I t s o o n b e c a m e a p p a r e n t t h a t t h e s m a l l
e s t s i z e p ip e su i t a b l e a n d a v a i l a b l e l o c a l l y i s o f
a b o u t 1 5 /8 i n . I . D . w i th a 3 /1 6 i n . wa l l t h i c k n e ss .
PVC p ip e o f t h i s s i z e i s u se d e x t e n s iv e ly i n t h e
p l u m b i n g t r a d e , a n d t h e r e f o r e a w i d e v a r i e t y o f
f i t t i n g s is a v a i l a b l e f or u se w i t h t h i s s i z e . C o n se
q u e n t l y , th e d e c i s i o n w a s m a d e to p r o v i d e a
q u i c k - d i s c o n n e c t f e a t u r e b y u t i l i z i n g s o m e o f
t h e s e f i t t i n g s . O n e m e t h o d u s e d c o n s i s t s o f c e
m e n t i n g a t h r e a d e d m a l e c o n n e c t o r t o t h e p i p e
a n d a d d i n g s o c k e t - a t t a c h m e n t s t r a p s t o th e
m a t c h i n g f e m a l e c o n n e c t o r . ( F i g s . 1 a n d 2 ) .
F o r t h e i r o r i g i n a l p u r p o s e , t h e m a t i n g p i e c e s
w e r e d e s i g n e d t o b e s o f t e n e d b y h e a t a n d / o r a
s o l v e n t c e m e n t b e f o r e be i n g s c r e w e d t o g e t h e r .
F o r o u r p u r p o s e s , it h a s b e e n n e c e s s a r y t o r e f o r m
t h e t h r e a d s u s i n g h e a t a n d a t a p a n d d i e i m p r o -
1Staff Prosth etist , Dep artme nt of Orth oped ics, Divi
sion of Prosthetics and Orthotics, Universi ty of Vir
ginia Medical Center , 1224 West Main Street , Char
lottesville, Va. 22903.
Fig. 1 . Various components of the plast ic pylon. The
primer and solvent cement are shown also.
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F i g .
2 .
A n a s s e m b l e d p y l o n w i th g a l v a n i z e d s t r a p s .
F i g . 3 . I m p r o v i s e d t a p a n d d i e s h o w i n g f l a ts a n d
g r o o v e s n e e d e d f or c u t t i n g t h r e a d s .
F i g . 4 . P y l o n l a m i n a t e d i n t o a r i g id d r e s s i n g .
F i g . 5 . P y l o n l a m i n a t e d i n t o a L i t e - C a s t I I s o c k e t w i t h
f o o t a t t a c h e d .
v i s e d f r o m c o r r e s p o n d i n g m e t a l f i t t in g s ( F i g . 3 ) .
S o c k e t - a t t a c h m e n t s t r a p s o f c o n v e n t i o n a l ( a n d
e x p e n s i v e ) s t a i n l e s s s t e e l h a v e b e e n u s e d a s w e l l
a s l e s s e x p e n s i v e s t r a p s o f g a l v a n i z e d m a t e r i a l
t h a t i s g e n e r a l l y u s e d t o h a n g w a t e r p i p e s ( F i g . 1 ).
T h e s e s t r a p s a r e a t t a c h e d t o t h e f e m a l e r e c e p t a
c l e w i t h m a c h i n e s c r e w s , b u t p o p r i v e t s m a y b e
s a t i s f a c t o r y . T h e r e s u l t i n g a s s e m b l y c a n b e la m i
n a t e d i n t o a p l a s t e r - o f - P a r i s r i g i d d r e s s i n g , a
L i t e - C a s t II t e m p o r a r y s o c k e t , o r a p o l y e s t e r
l a m i n a t e d s o c k e t ( F i g s . 4 . 5 , a n d 6) . T h e l a s t
m e n t i o n e d p r o c e d u r e r e s u l t s in a t e m p o r a r y p r o s
t h e s i s o f p a r t i c u l a r l y p l e a s i n g a p p e a r a n c e ( F i g .
7).
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Fig. 6. Cu taw ay view of pylon laminated into a polyes
ter socket.
Fig. 7 . Assembled temporary prosthesis.
V a r i o u s a n k l e p l u g s h a v e b e e n u s e d i n c l u d i n g
s o m e of m o d i f i e d P V C f i t t i n g s , w o o d w i t h a d a p
t o r n u t s , a n d c u t - d o w n a l u m i n u m p y l o n t u b e s
( F ig . 8 ) . T h e l a t t e r h a v e p r o v e n to b e t h e m o s t
p r a c t i c a l t o d a t e . C u r r e n t l y , w o r k is u n d e r w a y t o
d e v e l o p a n k l e p l u g s o f e i t h e r a l u m i n u m o r P V C
s t o c k .
W h e n u s i n g t h e p y l o n f or a n i m m e d i a t e p o s t
o p e r a t i v e p r o s t h e s i s , a l o c k i n g p in is p r o v i d e d t o
a s s u r e p r o p e r a l i g n m e n t of t h e v a r i o u s s e g m e n t s
w h e n t h e l o w e r a s s e m b l y i s r e m o v e d a n d r e
p l a c e d b y t h e n u r s e s a n d th e r a p i s t s ( F i g s . 1 , 4 ,
a n d 9 ) . I n s u r g e r y , t h e s o c k e t - a t t a c h m e n t s t r a p s
a r e i n c o r p o r a t e d in t h e c a s t a n d a l i g n e d wh i l e t h e
p i p e is s ti ll a t t a c h e d . T h e p a t i e n t is " s q u a r e d - u p "
a n d th e p ip e i s m a r k e d a t a p o in t c o r r e sp o n d i n g to
th e so l e o f t h e o p p o s i t e f o o t : t h e p ip e i s t h e n
r e m o v e d . T h e f o o t i s t h e n a t t a c h e d t o t h e p i p e
m a k in g su i t a b l e a l l o wa n c e f o r t h e h e ig h t o f t h e
foo t .
W h e n t h e f e m a l e r e c e p t a c l e is l a m i n a t e d i n t o a
p o l y e s t e r s o c k e t , c o n s i d e r a b l e c a r e m u s t b e
t a k e n in a l i g n in g it t o a v o id t h e n e c e s s i t y o f m a k
i ng e x c e s s i v e b e n d s . W h i l e n o t d e t r a c t i n g m a t e
r i a l ly f r o m th e s t r e n g th of t h e p r o s th e s i s , t h e se
b e n d s c a n p r e s e n t q u i t e a p e c u l i a r a p p e a r a n c e . I n
th i s i n s t a n c e , n o p in i s u se d a n d th e two se c t i o n s
a r e f o r ce f u l ly " s c r e w e d h o m e " s o a s t o i n s u r e
t h a t n o s l i p p a g e o c c u r s d u r i n g u s e . F o r m a x i m u m
s t r e n g t h , t h e t h r e a d e d e n d o f e a c h f i tt i ng s h o u l d
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Fig.
8.
Various ankle plugs
and 1/4. n.
spacers .
Fig.
9.
Disassembled immediate postoperative pros
thesis with locking
pin.
b e r e s t i n g so l i d ly
on the
s h o u l d e r
of the
o p p o s i t e
p i e c e . T h i s
has
p r o v e n s a t i s f a c to r y
to
d a t e ,
al
t h o u g h a d d i t i o n a l s e c u r i t y
can be
o b t a i n e d
by
h e a t i n g
the
m a l e c o n n e c t o r s li g h t ly b e f o r e h a n d .
I f d e s i r e d ,
the two
s e c t i o n s c o u l d a l s o
be
c e m e n t e d t o g e t h e r ,
of
c o u r s e .
T o m a k e h e i g h t c h a n g e s r e a d i l y p o s s i b l e ,
the
p r o s t h e s i s
is
a s s e m b l e d
1/2 in.
s h o r t
and the dif
f e r e n c e
is
m a d e
up
w i t h
1/4
,
n.
s p a c e r s ,
a
n u m b e r
o f w h i c h
are on
h a n d
at the
t i m e
of
fi t ti n g ( F ig s .
5
a n d
8). Any
b e n d s
in the
p i p e s h o u l d
be
m a d e
in
t h e p r o x i m a l p o r t i o n
so as to
l e a v e
the
d is ta l
p o r t i o n u n a f f e c t e d
for
b e t t e r o b s e r v a t i o n
of re
s u l t s .
W h i l e s u c h c h a n g e s
are
m a d e r e a d i l y , c o n
s i d e r a b l e h e a t
is
n e e d e d .
The
n e c e s s i t y
for
e x t e n
s i v e a l i g n m e n t c h a n g e s can be a v o i d e d w i t h ex
p e r i e n c e
and if
d u e c a r e
is
t a k e n
in the
l a m i n a t i n g
p r o c e d u r e .
T h i s s y s t e m has not yet b e e n u s e d in a d e f in i
t i v e p r o s t h e s i s
as it is
st i l l
in the
p r o c e s s
of
b e in g
p r o v e n and r e f in e d . H o w e v e r , no s ig n i f i c a n t dif
f i c u l t i e s
can be
s e e n
as the
w o r k
of
o t h e r s b e a r s
o u t . T h i s s y s t e m
has
b e e n
in
g e n e r a l
use for
s o m e t i m e
now, and no
s ig n i f i c a n t f a i l u r e s h a v e
o c c u r r e d . S o m e
15
t e m p o r a r y
and 5
i m m e d i a t e
p o s t o p e r a t i v e p r o s t h e s e s h a v e b e e n fitte d o v e r
a
p e r i o d
of 6 to 9
m o n t h s u s i n g t h e s e c o m p o n e n t s .
In
the
a u t h o r ' s o p i n i o n , t h i s c o n s t i t u t e s
a
suffi
c i e n t s a m p l i n g o v e r
a
su f f i c i e n t ly l o n g p e r io d
to
w a r r a n t s e r i o u s c o n s i d e r a t i o n
of
f u r t h e r
de
v e l o p m e n t .
C O N C L U S I O N S
T h e f o r e g o i n g p o r t i o n
of
t h i s a r t i c l e d e s c r i b e s
o u r e a r l y e x p e r i e n c e
in the use of PVC
p y l o n s .
S i n c e J a n u a r y
of 1974, ou r
e x p e r i e n c e w i t h t h i s
e a r l y s y s t e m
and our
d i s s a t i s f a c t i o n w i t h
it
h a v e
r e s u l t e d
in
a d o p t i o n
of the
s y s t e m
we are
p r e s
e n t l y u s i n g . T h i s s y s t e m c o n s i s t s of a f e m a l e c o n
n e c t i o n m a d e f r o m a c o m m e r i c a l l y a v a i l a b l e PV C
s l i p - f i t t i n g c o u p l in g w i th t h r e e sh o r t g a lv a n i z e d
s t r a p s f a s t e n e d
to the
p r o x i m a l p o r t i o n w i t h
pop
r i v e t s .
The
c o n n e c t i o n
to the
p ip e d i s t a l l y
is
m a d e
b y e i t h e r
a
s i m p l e
pin or two
m a c h i n e s c r e w s
and
n u t s .
T h i s m o d i f i c a t i o n e l i m i n a t e s
the
t e d i o u s
re-
c u t t i n g
of
t h r e a d s t h a t
was
n e c e s s a r y
in the
p r e
v i o u s d e s i g n
as
w e l l
as
b r e a k a g e .
At the
d i s t a l
p o r t i o n
of
t h e p i p e ,
a PVC
a n k l e p l u g f a s t e n e d
to
t h e p ip e
by
s h e e t m e t a l s c r e w s
is
u s e d
to
c o n n e c t
th e f o o t .
Due to the
fu r o r o v e r
the
p o s s i b i l i t y
of
P V C c a u s i n g c a n c e r ,
the use of
P V C s o l v e n t g l u e
h a s b e e n a v o i d e d l a t e l y .
T h e s e c h a n g e s h a v e s i m p l i f i e d p r o d u c t i o n and
r e d u c e d the t i m e r e q u i r e d as we l l as e l i m i n a t i n g
t h e b r e a k a g e t h a t o c c u r r e d f o r m e r l y
at the
b a s e
of
t h e t h r e a d s
of the
m a l e c o n n e c t o r . A l i g n m e n t
c h a n g e s
of
t e m p o r a r y p r o s t h e s e s h a v e
not
p r o v e n
to be a
p r o b l e m
as
a t t e n t i o n
to
d e t a i l
d u r i n g s o c k e t l a m i n a t i o n r e s u l t s
in an
a l i g n m e n t
t h a t c o m m o n l y n e e d s o n l y m i n o r c h a n g e s .
Be
c a u s e
of the
l ar g e e x t e r n a l d i a m e t e r
of
l o o s e l y
a v a i l a b l e c o m p o n e n t s ( w h i c h r e s u l t s
in
i n c r e a s e d
b u l k
and
w e i g h t ) ,
the
s y s t e m
is not
c o m m o n l y
u s e d for d e f in i ti v e p r o e s t h e s e s . E a r l y a t t e m p t s at
f a b r i c a t i n g s o f t c o s m e t i c c o v e r s for a w a t e r -
b a s e d f o a m r e c e n t l y a v a i l a b l e on an e x p e r i m e n t a l
b a s i s f r om A l i m e d h a v e b e e n i n c o n c l u s i v e . H e r e ,
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t o o ,
th e e x te r n a l d i am e te r o f th e p y l on p ose s a
p r o b l e m .
T h e a u t h o r w i s h e s t o m a k e fu ll a c k n o w l e d g
m e n t o f th e w or k o f M e ss r s . Le h n e i s an d Wu n de r, a s w e l l a s o th e r s i n th e N e w Yor k ar e a , an
to p o i n t ou t th a t h i s ow n c on tr i b u t i on h as b e e n i n
th e m at te r o f a q u i c k -d i sc o n n e c t f e a tu r e w h i c h
se e m s to o f fe r s i gn i f i c an t ad van tage s . Fu r th e r
m o r e , t h e d e v e l o p m e n t o f a c o m p a r a b l e
c o m m e r c i a l s y s t e m a t r e a s o n a b l e c o s t i n v o l v i n g
th e u se o f su c h a d i s c on n e c t f e a tu r e an d a sm al l e r
s i z e p i p e a p p e a r s t o b e f e a s i b l e . S u c h a c o m m e r
c i a l sys te m sh ou l d l og i c a l l y i n c l u d e an an k l e p l u g
of PV C an d a l oc k i n g p i n on a l an yar d for op t i on a l
u se .
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A P R O P O S E D N O M E N C L A T U R E
FO R L IM B P R O S T H E TIC S
H e c t o r W . K a y
This report reflects decisions made at two 1974
meetings of the Task Force on Standardization of
Prosthetic-Orthotic Terminology, one on Feb
ruary 21 at Rancho Los Amigos Hospital, Inc., in
Down ey, California, and the other on July 9 at
the Rehab ilitation Institute of Chicago, Illinois.
Jacquelin Perry, M.D., is the General Chairman
of the Task Force; Pa ul R. Meyer, Jr., M.D., and
Robert G. Thompson, M.D., were Acting Chair
men,
respectively, at the two sessions under dis
cussion, which dealt primarily with prosthetics
matters. Present at both meetings were Task
Force mem bers; liaison representatives from the
prosthetics education institutions; the American
Academy of Orthotists and Prosthetists; the
American Board for Certification in Orthotics
and Prosthetics, Inc.; the American Orthotic and
Prosthetic Association; and the Veterans Ad
ministration. A list of participants is appended to
this report.
T h e T a s k F o r c e o n S t a n d a r d i z a t i o n o f
P r o s t h e t i c - O r t h o t i c T e r m i n o l o g y , e s t a b l i s h e d b y
t h e C o m m i t t e e o n P r o s t h e t i c -O r t h o t i c E d u c a t i o n
( C P O E ) , N a t i o n a l A c a d e m y of S c i e n c e s
— N a t i o n a l R e s e a r c h C o u n c i l , w i t h J a c q u e l i n
P e r r y a s C h a i r m a n m e t o n J a n u a r y 2 1 , 1 9 7 1 . A t
t h i s i n i t i a l m e e t i n g b o t h H e r b e r t W . W a r b u r t o n ,
o n b e h a l f o f t h e A m e r i c a n O r t h o t i c a n d P r o s t h e t
ic A s s o c i a t i o n — A m e r i c a n B o a r d f or C e r t i f ic a
t i o n ( A O P A - A B C ) , a n d A n t h o n y S t a r o s fo r t h e
V e t e r a n s A d m i n i s t r a t i o n p r e s e n t e d r e a s o n s f o r
t h e d e v e l o p m e n t of a s t a n d a r d i z e d p r o s t h e t i c s
a n d o r t h o t i c s n o m e n c l a t u r e . S o m e o f t h e n e e d s
a d v a n c e d w e r e :
• T h e e s t a b l i s h m e n t o f b a s e s fo r p r i c e s of d e
v i c e s in c o n n e c t i o n w i t h M e d i c a r e , M e d i c a i d ,
a n d s i m i l ar p r o g r a m s . P r o p o s e d c o m p u t e r i z a t i o n
o f g o v e r n m e n t b i l li n g i n f o r m a t i o n r e i n f o r c e d t h e
n e e d in t h i s a r e a .
• T h e e l i m i n a t i o n o f p r o b l e m s r e s u l t i n g f r o m
i n c o n s i s t e n c i e s in n o m e n c l a t u r e a s t h e y a f f ec t
e x a m i n a t i o n s f o r c e r t i f i c a t i o n o f p r o s t h e t i s t s a n d
o r t h o t i s t s .
• C o n s i s t e n c y i n t h e u s e o f o r t h o t i c s t e r m s in
t h e fi e l d , i n c l i n i c a l a n d e d u c a t i o n a l s i t u a t i o n s ,
a n d i n V o l u m e 1 o f t h e
Orthopaedic Appliances
Atlas n o w b e i n g r e w r i t t e n .
• D e v e l o p m e n t o f a g l o s s a r y o f p r o s t h e t i c s
a n d o r t h o t i c s t e r m s in r e s p o n s e t o a s u g g e s t i o n
m a d e b y t h e I n t e r n a t i o n a l S o c i e t y f o r P r o s t h e t i c s
a n d O r t h o t i c s ( I S P O ) . T h e p r o p o s e d g l o s s a r y
s h o u l d l e n d i t s e l f t o t r a n s l a t i o n i n t o o t h e r l a n
g u a g e s , m a k e m a x i m u m u s e o f L a t i n a n d G r e e k
t e r m s , a n d a v o id " A m e r i c a n i s m s . "
• C o m p l e t i o n o f a V A p r o j e c t t o s t a n d a r d i z e
n o m e n c l a t u r e f o r p r e p a r a t i o n of c o n t r a c t s , f o r
c o n t r o l o f s t a t i s t i c a l i n f o r m a t io n , a n d f o r u se i n
c o d i n g , f i li n g , a n d r e t r i e v i n g n u m e r o u s d o c u
m e n t s a n d o t h e r t y p e s o f l i t e r a t u r e s t o r e d b y t h e
V e t e r a n s A d m i n i s t r a t i o n .
T h e T a s k F o r c e h a s m e t o n a c o n t i n u i n g b a s i s ,
u s u a l l y o n c e o r t w i c e a y e a r , a n d h a s m a d e m a j o r
p r o g r e s s i n t h e a r e a o f o r t h o t i c s n o m e n c l a t u r e .
A s a r e s u l t o f t h e T a s k F o r c e ' s e f f o r t s a n e w s e t o f
t e r m s — a c t u a l l y a c r o n y m s — h a s b e e n d e v e l o p e d ,
a n d t h i s l a n g u a g e i s a l r e a d y b e i n g u s e d e x t e n
s i v e l y . T h e b a s i c p r i n c i p l e o f t h e o r t h o t i c s
n o m e n c l a t u r e i s e s s e n t i a l l y s i m p l e , b e i n g t h a t o f
c a t e g o r i z i n g o r t h o s e s b y t h e j o i n t s t h e y e n c o m
p a s s .
T h u s , a n " F O " ( fo o t o r t h o s i s ) i s o n e w h i c h
p e r t a i n s t o t h e j o i n t s o f t h e f o o t ; a n " A F O "
( a n k l e - fo o t o r t h o s i s ) e n c o m p a s s e s t h e a n k l e a s
1 A s s i s t a n t E x e c u t i v e D i r e c t o r , C o m m i t t e e s o n
P r o s t h e t i c s R e s e a r c h a n d D e v e l o p m e n t a n d
Pr o s th e t i c - Or th o t i c E d u c a t io n ( CPRD- CPOE ) , Na
tional Academy of Sciences, Washington, D.C. 20418.
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w e l l a s t h e f o o t; a n d a " K A F O " ( k n e e - a n k l e - fo o t
o r t h o s i s ) s p a n s t h e k n e e a s w e l l a s t h e a n k l e a n d
f o o t , e t c . T h i s n e w o r t h o t i c s n o m e n c l a t u r e h a s
n o w b e e n i n c o r p o r a t e d i n t o t e c h n i c a l a n a l y s i s
f o r m s f o r t h e u p p e r a n d lo we r l im b s a n d th e
s p i n e ; a p r e s c r i p t i o n p r o c e d u r e ; a n d c o m
p u t e r i z e d b il li n g p r o c e d u r e s . T h e n o m e n c l a t u r e
i s a l so b e in g i n c lu d e d in t h e r e v i s io n o f Vo lu m e 1
o f t h e
Orthopa edic Appliances Atlas
n o w in p r o
c e s s ,
o n e o f i t s a p p l i c a t i o n s b e i n g t o p r o v i d e a
b a s i s f o r t h e d e s c r i p t i o n o f o r t h o t i c c o m p o n e n t s
a n d s y s t e m s f o r t h e u p p e r l i m b , l o w e r l i m b , a n d
s p i n e . C o g n i z a n c e o f t h e n e w s y s t e m i s a l s o t a k e n
i n t h e r e v i s i o n o f d e s c r i p t o r s , o r k e y w o r d s , f o r
t h e W i n n i p e g I n f o r m a t i o n R e t r i e v a l S y s t e m . A
c o m p r e h e n s i v e r e p o r t c o v e r i n g t h e a p p l i c a t i o n s
o f t h e n e w o r t h o t i c s n o m e n c l a t u r e i s i n p r e p a r a
t i o n a n d w i l l b e p u b l i sh e d in t h e n e a r f u tu r e .
D e s p i t e t h e m a r k e d p r o g r e s s m a d e w i t h t h e
s t a n d a r d i z a t i o n o f o r t h o t i c s n o m e n c l a t u r e , v e r y
l i t t l e p r o g r e s s w a s m a d e w i t h r e g a r d t o t h e s t a n
d a r d i z a t i o n o f p r o s t h e t i c s t e r m s . T h e r e a s o n s f o r
t h e l a c k o f p r o g r e s s i n t h e p r o s t h e t i c s a s p e c t o f
t h e T a s k F o r c e ' s a s s i g n m e n t p r o b a b l y w e r e :
• P r o s t h e t i c s n o m e n c l a t u r e w a s m u c h l e s s
c o n f u s i n g t h a n w a s t h e c a s e in o r t h o t i c s w h e n t h e
1To identify the level whe n the amp utati on was close to a join t, it was agreed that the epiphy seal g row th plate o r
scar would be the reference l ine, e .g . , an amputation at or above the proximal humeral growth plate would be
"a rm , co m pl ete "; one a l i tt le lower than this would be "ar m , part ial (or upper 1/3).
2
" Part ial arm" would be the new general term for above-elbow (AE); "part ial forearm" for below-elbow (BE).
T A B L E I . A M P U T A T I O N L E V E L S — U P P E R L I M B
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T a s k F o r c e b e g a n it s m e e t i n g s . T h u s , t h e r e h a s
b e e n le s s i n c e n t i v e o r u r g e n c y t o c h a n g e t h e c u r
r e n t t e r m i n o l o g y , w h i c h m a n y p e o p l e f i n d q u i t e
a c c e p t a b l e .
• F o l l o w i n g t h e s u c c e s s a c h i e v e d in t h e re v i
s i o n o f t h e o r t h o t i c s n o m e n c l a t u r e , a n a t t e m p t
w a s m a d e t o f o l l ow t h e s a m e o r g a n i z a t i o n a l p a t
t e r n in p r o s t h e t i c s . I t t o o k t w o o r t h r e e u n p r o
d u c t i v e t r i a l s t o c o n v i n c e t h e g r o u p t h a t t h e a p
p r o a c h u s e d i n o r t h o t i c s w a s n o t a p p l i c a b l e t o
p r o s t h e t i c s .
C o n v e r s e l y , n u m e r o u s i n d i v i d u a l s c o n t i n u e d
to b e d i s tu r b e d b y t h e f a c t t h a t su c h t e r m s a s
" k n e e d i s a r t i c u l a t i o n , " " k n e e e x a r t i c u l a t i o n , "
" t h r o u g h k n e e , " " G r i t t i - S t o k e s , " a n d
" S t o k e s - G r i t t i " w e r e a ll a p p l i e d t o a m p u t a t i o n s
w h i c h w e r e o r a p p e a r e d t o b e e s s e n t i a l l y t h e
s a m e f r om a f u n c t io n a l s t a n d p o i n t . M o r e o v e r ,
t h e n e e d s of t h e V e t e r a n s A d m i n i s t r a t i o n a n d
o t h e r p u r c h a s e r s o f p r o s t h e t i c d e v i c e s a n d s e r
v i c e s f o r a n o m e n c l a t u r e w h i c h d e s c r i b e d c o m
p o n e n t s in f u n c t i o n a l t e r m s r a t h e r t h a n b r a n d
n a m e s c o n t i n u e d t o e x i s t , a n d s o t h e s e a r c h f o r a
s t a n d a r d i z e d p r o s t h e t i c s n o m e n c l a t u r e c o n
t i n u e d .
A t t h e F e b r u a r y 1 9 7 4 m e e t i n g o f t h e g r o u p a
Fig. 1 . An Arm , comp lete am putatio n (shoulder dis
ar t iculation) .
Fig. 2. An Fo , com plete amp utation (elbow disar t icu
lation).
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f r e s h a p p r o a c h t o t h e p r o b l e m w a s m a d e a l o n g
t w o l i n e s :
• A m p u t a t i o n L e v e l s a n d P r o s t h e s i s T y p e s
H e r e t h e i n c e n t i v e w a s a r e p o r t o n a n e w t e r
m i n o l o g y f o r t h e c l a s s i f i c a t i o n o f c o n g e n i t a l l i m b
d e f i c i e n c i e s d e v e l o p e d a t a n i n t e r n a t i o n a l w o r k
s h o p h e l d i n D u n d e e , S c o t l a n d , in J u n e 1 9 7 3 . I t
a p p e a r e d l i k e l y t h a t t h i s n e w t e r m i n o l o g y w o u l d
b e a c c e p t e d i n t e r n a t i o n a l l y . I n t h e n e w s y s t e m
f o r t h e c l a s s i f i c a t i o n o f l im b d e f i c i e n c i e s , a l l d e
f e c t s w e r e c l a s s i f ie d u n d e r o n e o r t w o m a j o r
c a t e g o r i e s — t r a n s v e r s e o r l o n g i t u d in a l . T h e
t r a n s v e r s e d e f i c i e n ci e s p r e s e n t a s a m p u t a t i o n
l ik e s t u m p s , a n d p r o s t h e t i c s m a n a g e m e n t i s e s
s e n t i a l l y t h e s a m e a s w i t h s u r g i c a l a m p u t a t i o n s
d e r i v i n g f r o m t r a u m a o r d i s e a s e . A f t e r e x t e n s i v e
c o n s i d e r a t i o n a n d d i s c u s s i o n , t h e r e f o r e , t h e T a s k
F o r c e d e c i d e d t o a d o p t t h e n o m e n c l a t u r e f o r
t r a n s v e r s e c o n g e n i t a l d e fe c t s i n d e s i g n a t i n g a m
p u t a t i o n l e v e ls f o r n o n - c o n g e n i t a l a m p u t a t i o n s .
T h e p r e s e n t r e p o r t d e s c r i b e s t h i s p r o p o s e d n e w
n o m e n c l a t u r e . I t h a s b e e n d e s i g n a t e d a s P a r t I o f
t h e T a s k F o r c e ' s r e c o m m e n d a t i o n s o n p r o s t h e t
i c s n o m e n c l a t u r e .
F i g .
3 .
A C a , c o m p l e t e a m p u t a t i o n ( w r i s t d is a r t i c u la
t ion) .
F i g .
4 .
An Arm, p ar t i a l or u p p er 1
/3
a m p u t a t i o n
( s h o r t a b o v e - e l b o w ) .
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• T e r m i n o l o g y of P r o s t h e t i c C o m p o n e n t s
B a s e d o n F u n c t i o n
H e r e t he T a s k F o r c e s i m p l y t o o k e a c h c o m p o
n e n t o f a p r o s t h e s i s — s o c k e t , k n e e j o i n t , a n k l e
j o i n t , e t c . — a n d a t t e m p t e d t o c l a s si f y e a c h i n
f u n c t i o n a l y e t r e l a t i v e l y s i m p l e t e r m s . T h e o u t
c o m e o f t h i s wo r k i s b e in g wr i t t e n u p a s Pa r t I I o f
t h e T a s k F o r c e ' s p r o s t h e t i c s r e p o r t .
T h e e s s e n c e o f t h e n e w s y s t e m f or n a m i n g
t r a n s v e r s e c o n g e n i t a l d e f i c i e n c i e s o r s u r g i c a l
a m p u t a t i o n s is t h a t t h e n a m e d e s i g n a t e s t h e l e v e l
a t w h i c h t h e li m b t e r m i n a t e s ( o r t h e m o s t p r o x i
m a l s e g m e n t t h a t is m i s s i n g ) . I t i s u n d e r s t o o d t h a t
a l l e l e m e n t s d i s t a l t o t h e l e v e l n a m e d a r e a l s o
a b s e n t . F o r e x a m p l e , a s h o r t b e l o w - e l b o w a m p u
t a t i o n w o u l d b e i d e n t i fi e d a s a " f o r e a r m , u p p e r
1/3. A n e l b o w d i s a r t i c u l a t i o n o r t h r o u g h - e l b o w
a m p u t a t i o n w o u l d b e n a m e d " f o r e a r m , c o m
p l e t e , " t h u s i n d i c a t i n g t h e m o s t p r o x i m a l m i s s i n g
p o r t i o n ( T a b l e 1 a n d F ig s . 1 -5 ).
T h e n e w t e r m i n o l o g y f o r l o w e r - l i m b a m p u t a
t i o n s ( w i t h a b b r e v i a t i o n s ) a n d t h e e q u i v a l e n t
l e v e l s in c u r r e n t t e r m s a s s h o w n in T a b l e I I a n d
i l l u s t r a t e d i n F i g u r e s 6 - 10 a r e in c o n f o r m i t y w i t h
t h e f o r m a t p r e v i o u s l y p r e s e n t e d f o r u p p e r l i m b s .
Fig . 5. A n F o , par t ia l or low e r 1/3 amputa t ion ( long
b e l o w - e l b o w ) .
F i g . 6 . A T h , c om ple te amput a t ion (h ip d i sar t i c u la
t i on ) .
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T A B L E I I. A M P U T A T I O N L E V E L S — L O W E R L I M B
1W hen the amputa tion w as close to a joint , the epiphyseal grow th plate or scar would be the reference l ine, e .g . ,
an amputa tion just a bove the level of the distal femoral growth s car would be "T h, p art ial (or lower 1/3) ; one at the
scar or betwe en the scar and joint would be "leg, c om ple te. "
2
"Partial thigh" would be the new general term for above-knee (AK); and "part ial leg" for below knee (BK).
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P R O S T H E T I C S T Y P E S
D u r i n g t h e c o u r s e o f t h e d i s c u s s i o n o n n o m e n
c l a t u r e t o d e s c r i b e a m p u t a t i o n l e v e l s , it b e c a m e
a p p a r e n t t h a t t h e s a m e n o m e n c l a t u r e s h o u l d b e
u s e d t o i d e n ti f y t h e p r o s t h e s e s w h i c h w o u l d b e
f i t t e d t o t h e s e l e v e l s . F o r e x a m p l e , a c o m p l e t e l e g
p r o s t h e s i s w o u l d be f it te d t o a " l e g , c o m p l e t e "
( o r k n e e d i s a r t i c u l a t i o n ) a m p u t a t i o n ( F i g s .
1 1 - 1 3 ) .
N E X T S T E P S
A M P U T A T I O N L E V E L S
F o l l o w i n g a d o p t i o n o f t h e n e w n o m e n c l a t u r e
t o d e s i g n a t e a m p u t a t i o n l e v e l s a n d t y p e s o f
p r o s t h e s e s , t h e T a s k F o r c e m a d e t h r e e a d d i t i o n a l
r e c o m m e n d a t i o n s :
• T h a t a n a r t i c l e d e s c r i b i n g t h e n e w n o m e n
c l a t u r e b e d e v e l o p e d f o r p o s s i b l e p u b l i c a t i o n i n
Orthotics and Prosthetics a n d o t h e r j o u r n a l s .
3
Fig. 7 . A Leg, com plete amp utation (knee disar t icu
lation).
Fig. 8 . A Ta, comp lete amp utation (ankle disar t icula-
3
This document was p repared in response to th is
request .
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• T h a t f r o m s ix t o t e n p r o s th e t i c s f a c i l i t i e s
w i th l a r g e c a s e l o a d s b e a s k e d to f i e ld - t e s t t h e
n e w p r o s t h e t i c s n o m e n c l a t u r e . ( T h i s r e c o m m e n
d a t i o n i s n o w b e i n g i m p l e m e n t e d a n d t h e r e s u l t s
w i l l b e r e p o r t e d a t a l a t e r d a t e . )
• T h a t t h e a r t i c l e d e s c r i b i n g t h e n e w n o m e n
c l a t u r e f o r a m p u t a t i o n l e v e l s a n d p r o s t h e s i s
ty p e s ( a n d th e r e su l t s o f t h e f i e ld s tu d y wh e n
a v a i l a b l e ) b e t r a n s m i t t e d t o t h e I n t e r n a t i o n a l S o c
i e t y f o r P r o s t h e t i c s a n d O r t h o t i c s f o r c o n s i d e r a
t i on b y t h a t b o d y ' s S u b c o m m i t t e e o n O r t h o t i c s
a n d P r o s t h e t i c s N o m e n c l a t u r e a t i t s m e e t i n g i n
O c t o b e r 1 9 7 4 .
F U N C T I O N A L D E S C R I P T I O N S
S i m i l a r l y it w a s r e c o m m e n d e d t h a t t h e T a s k
F o r c e ' s w o r k o n t h e f u n c t i o n a l d e s c r i p t i o n o f
p r o s t h e t i c c o m p o n e n t s b e w r i t t e n fo r p u b l i c a
t i o n , f i e l d - t e s t e d , a n d r e f e r r e d t o t h e I S P O S u b
c o m m i t t e e o n O r t h o t i c s a n d P r o s t h e t i c s
N o m e n c l a t u r e . I m p l e m e n t a t i o n of t h e s e r e c o m
m e n d a t i o n s i s n o w u n d e r w a y ( s e e t h e f o l l o w i n g
a r t i c l e b y E . E . H a r r i s ) .
S U M M A R Y
I n th e c o u r se o f two m e e t in g s h e ld i n 1 9 7 4 , t h e
T a s k F o r c e o n S t a n d a r d i z a t i o n o f P r o s t h e t i c -
O r t h o t i c T e r m i n o l o g y o f C P R D - C P O E e n d o r s e d
a n e w p r o s t h e t i c s n o m e n c l a t u r e t o d e s i g n a t e 1)
Fig . 9 . A Th , par t ia l o r midd le 1 /3 am put a t io n
(medium above-knee) .
Fig. 10. A Leg, partial or upp er 1/3 am puta tion (short
be low-knee) .
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a m p u t a t i o n l e v e l s . 2 ) p r o s t h e s i s t y p e s , a n d 3 ) t h e
f u n c t i o n a l d e s c r i p t i o n o f c o m p o n e n t s .
I n t h e f i r s t t w o c a t e g o r i e s t h e n e w n o m e n c l a
t u r e ( a s d e s c r i b e d i n t h i s r e p o r t ) is e s s e n t i a l l y
i d e n t i c a l w i t h t h e t e r m i n o l o g y d e v e l o p e d b y t h e
I S P O S u b c o m m i t t e e o n N o m e n c l a t u r e a n d C l a s
s i f i c a t i o n in C o n g e n i t a l L i m b D e f i c i e n c y fo r t h e
c l a s s i f i c a t i o n o f c h i l d r e n ' s t r a n s v e r s e c o n g e n i t a l
d e f i c i e n c i e s . T h e r e c o m m e n d e d n e w n o m e n c l a
t u r e is b e i n g f i e l d - t e s t e d i n s e l e c t e d f a c i l i t i e s i n
N o r t h A m e r i c a .
A d e t a i l e d r e p o r t o n t h e T a s k F o r c e ' s r e c o m
m e n d a t i o n s c o n c e r n i n g t h e f u n c t i o n a l d e s c r i p
t io n o f p r o s t h e t i c c o m p o n e n t s h a s b e e n p r e p a r e d
a n d i s p u b l i s h e d i n t h i s i s s u e o f
Orthotics and
Prosthetics.
F i g . 11 . A L e g , c o m p l e t e , p r o s t h e s i s f o r a c o m p l e t e l e g
a m p u t a t i o n .
F i g . 12. A T a r s a l , c o m p l e t e , p r o s t h e s i s fo r a c o m p l e t e
t a r s a l a m p u t a t i o n .
F i g . 1 3 . A T h i g h , m i d d l e 1 /3 , p r o s t h e s i s f o r a m i d d l e
1/3 t h i g h a m p u t a t i o n .
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A C K N O W L E D G M E N T S
T h e T a s k F o r c e w a s i n i t i a l l y e s t a b l i s h e d by the
C o m m i t t e e
on
P r o s t h e t i c - O r t h o t i c E d u c a t i o n
( C P O E ) , and is n o w j o i n t l y s p o n s o r e d by C P O E
a n d the C o m m i t t ee on P r o s t h e t i c s R e s e a r c h and
D e v e l o p m e n t ( C P R D ) . The j o i n t c o m m i t t e e s
c o n d u c t t h e i r ac t i v i ti e s u n d e r C o n t r a c t V101
( 1 3 4 ) P-75 b e t w e e n the V e t e r a n s A d m i n i s t ra t i o n
a n d the N a t i o n a l A c a d e m y of S c i e n c e s , and C o n
t r a c t No. SRS 72-6 b e t w e e n the S o c i a l and Re
h a b i l i t a t i o n S e r v i c e , D e p a r t m e n t of H e a l t h , E d u
c a t i o n , and W e l f a r e, and the N a t i o n a l A c a d e m y
o f S c i e n c e s .
A p p r e c i a t i o n
is
e x p r e s s e d
to Mrs.
J u n e
D.
N e w m a n , C P R D - C P O E
staff,
for her v a l u a b l e
a s s i s t a n c e in the p r e p a r a t i o n of t h i s r e p o r t .
L I T E R A T U R E C I T E D
1. Am e r i c a n Ac a d e m y of Or thopa ed ic Surgeons ,
Orthopaedic Appliances Atlas, Vol.1, J. W. Edwards,
Ann Arbor , Mich . , 1952.
2.
C o m m i t t e e on P r o s th e t i c - Or th o t ic E d u c a t io n ,
Report of First Workshop-Standardization of Prosthet
ic
and
Orthotic Terminology. Dal las , Tex as , March
28-30, 1971, Nationa l Ac adem y
of
Sc iences .
3.
C o m m i t t e e on P r o s th e t i c - Or th o t ic E d u c a t io n ,
Report on Second W orkshop-Task Force on Standar
dization of Prosthetic-Orthotic Terminology. Washing
t o n, D . C , S e p te m b e r 9 - 1 1 ,
1971,
National Academy of
Sciences .
4. Ha r r i s ,
E . E. , A new
or thotic s term inology:
a
guide to its use for prescription and fee schedules. Orth.
and Pros.
27
:2:6-19, June 1973.
5.
Kay,
H e c t o r
W.,
W hen information
is
needed .
Inter-Clinic Inform. Bull. 13:3 December 1973.
6 . McCol lough , Newton
C , III,
Char les
M.
Fryer ,
and John Glancy ,
A new
approach
to
patient analysis
for or thotic prescription—part I: the lower extrem ity.
Artif. Limbs
14
:2:68-80, A utumn 1970.
7.
W o r k i n g G r o u p , I n t e r n a t i o n a l S o c i e t y for
Prosthe t ics and Or tho t ics , A proposed international
terminology for the classification of congenital l imb
deficiencies, (prepared by Hector W . Kay) . Orth.
and
Pros.
28
:2:33-48, June 1974.
P A R T I C I P A N T S
(In one or both of the 1974 Meetings of the Task Force
on Standardization of Prosthetic-Orthotic Terminol
ogy.)
Perry, Jacquelin , M.D. (Chai rman) ,
Chief,
Research
and Deve lopm ent Gr oup , Kinesiology Servic e, Rancho Los Amigos Ho spital , Inc . , Dow ney, California.
Meyer, Paul R., Jr . M.D.. (Acting Chairman), Assistant
Professor of Or thopaed ic S urgery , N or thwestern
Universi ty Medical School, Chicago, I l l inois.
T h o m p so n , Ro b e r t
G., M.D.
(Act ing Chai rman) ,
As
sociate Professor of Or thopaed ic Surgery , N or th
western Universi ty Medical School, Chicago, Il
linois.
Billock, John N., Research Prosthetist , Prosthetic Re
s e a r c h L a b o r a t o r y , N o r t h w e s t e r n U n i v e r s i t y
Prosthe t ic -Or tho t ic Cen ter , Ch icago , I l l ino is .
B r a y , J o h n J. , D i r e c t o r , T r a i n i n g P r o g r a m in
P r o s t h e t i c s - O r t h o t i c s E d u c a t i o n , U n i v e r s i t y of
California
at
Los Angeles Rehabil i tat ion Center ,
Los
Angeles, California.
C o m p e r e , C l i n t o n L., M.D., P r o g r a m C h a i r m a n ,
N o r t h w e s t e r n U n i v e r s i t y P r o s t h e t i c - O r t h o t i c
C e n t e r ,
and
P r o f e sso r
of
Or th o p a e d ic Su r g e r y ,
Nor thwestern Univers i ty Medica l School , Ch icago ,
Illinois.
Cor t r igh t , Evere t t S., Staff Assistant , Prosthetics Re
search and Developm ent , Depar tm ent of Medicine
and Surgery , Veterans Admin is t ra t ion , W ash ing ton ,
D . C .
Fann in , Rober t E., Columbus O r thopaed ic Appl iance
Co.,
Columbus, Ohio .
F r y e r , C h a r l e s M., D i r e c t o r , P r o s t h e t i c - O r t h o t i c
Center , Nor thwestern Univers i ty Medica l School ,
Chicago, I l l inois.
Har r i s , E .E . , M.R.C.S. , S ta f f Surgeon , Commit tees on
P r o s t h e t i c s R e s e a r c h and D e v e l o p m e n t and
Prosthe t ic -Or tho t ic Educa t ion (CPRD-CPOE) , Na
t iona l Research Counci l , Wash ing ton , D. C.
Hayes, Rober t F. , Preside nt, S tarkey Artif icial Lim b
Co. , Inc . , West Spr ingf ie ld, M assach use t t s .
Kay , Hector W., Assis tan t Execu t ive Direc to r, C om
mit tees on Prosthe t ics Research and Development
and Prosthe t ic -Or tho t ic Educa t ion (CPRD-CPOE) ,
Nat iona l Research Counci l , Wash ing ton ,
D. C.
K o l a n o w s k i , S t a n l e y J. , T e c h n i c a l I n f o r m a t i o n
Specia l i s t , Research Cen ter for Prosthe t ics , V eter
ans Admin is t ra t ion , New Yo r k , New York.
Lewis , Ear l A., Assis tan t Direc to r , Research Cen ter
f o r P r o s th e t i c s , Ve te r a n s Ad m in i s t r a t i o n , New
York , New York .
McCol lough , Newton
C , III, M.D.,
D irec to r
of Re
hab i l i ta t ion , Depar tment of O r th o p a e d ic s and Re
h a b i l i t a t i o n , U n i v e r s i t y of M i a m i S c h o o l of
Medicine, Miami, Florida.
Murphy , Eugene F . , Ph . D. , Direc to r , Research Cen ter
f o r P r o s th e t i c s , Ve te r a n s Ad m in i s t r a t i o n , New
Yo r k ,
New
York .
N e l s o n , P e t e r
J. ,
P r o j e c t E n g i n e e r , L i b r a r y ,
P r o s t h e t i c - O r t h o t i c R e s e a r c h and De v e lo p m e n t
Uni t , Heal th Sc iences Cen t re , Winn ipeg , Canada .
Pe izer , Edward , Ph. D., Assis tan t Direc to r , Veterans
Admin is t ra t ion Prosthe t ics Cen ter , New York , New
York.
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Pellicore, Raymond, M.D., Clinical Assistant Profes
sor of Orthopaedic Surgery, Abraham Lincoln
School of Medicine, University of Illinois, Chicago,
Illinois.
Sim ons, Bernard C , Director, Prosthetics and Orthot
ics Division, Rehabilitation Medicine, University
Ho sp i t a l , U niv ers i t y o f W a shing t o n , S ea t t l e ,
Washington.
Snell, Ralph R., Snell's Limbs and Braces, Memphis,
Tennessee .
Springer, Warren, Assistant Coordinator, Prosthetics
and Orthotics, New York University Post-Graduate
Medical School, New York, New York.
Staros, Anthony, Director, Veterans Administration
Prosthetics Center, New York, New York.
Storrs, Ralph A., General Manager, Pope Brace Com
pany, Kankakee, Illinois.
Zet t l , Joseph H. , Director , Prosthet ics Research
Study, University of Washington, Seattle, Washing
ton.
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A P R O P O S ED P R O S TH E TIC S T E R M I N O L O G Y
E . E . H a r r i s , M . R . C . S .
1
This report has been prepared for the Task
Force on the Standardization of Prosthetic-
Orthotic Terminology established by the Com
mittee on Prosthetic-Orthotic Education of the
National Academy of Sciences—National Re
search Coun cil which first met on January 21,
1971, under the chairman ship of Jacquelin Perry,
M.D.
Many informed m embers of the various
professions concerned with prosthetics from uni
versity, governm ent, and private sectors have
over the years c ontribu ted to the discussions at a
numb er of meetings under the general chairman
ship of Dr. Perry. The proposed terminology pre
sented here was mostly formulated at the two
meetings at Ranch o Los Amigos H ospital, Inc.,
Dow ney, California, and the Rehab ilitation Insti
tute of Chicago, Illinois, under the acting chair
manship of Robert G. Thompson, M.D., and
Paul R. Meyer, Jr., M.D . The participants of
these tw o meetings are listed in the previous arti
cle by Hector W. Kay.
T h e T a s k F o r c e o n S t a n d a r d i z a t i o n o f
P r o s t h e t i c - O r t h o t i c T e r m i n o l o g y ( C P R D - C P O E )
h a s a g r e e d t h a t t h e a c c e p t e d n o m e n c l a t u r e f o r
a m p u t a t i o n a n d p r o s t h e t i c s l e v e l s s h a l l b e t h a t
d e v i s e d f o r t r a n s v e r s e c o n g e n i t a l d e f i c i e n c i e s b y
t h e S u b c o m m i t t e e o n N o m e n c l a t u r e a n d C l a s
s i f ic a t i o n in C o n g e n i t a l L i m b D e f i c i e n c y , I n t e r
n a t i o n a l S o c i e t y f o r P r o s t h e t i c s a n d O r t h o t i c s , a s
d e s c r i b e d b y H e c t o r K a y in t h e p r e c e d i n g a r t i c l e .
T h e n o m e n c l a t u r e c a n b e u s e d i n d e p e n d e n t l y o f
a n y t e r m i n o l o g y o f s y s t e m s , c o m p o n e n t s , o r
m a t e r i a l s . I t is c u r r e n t l y u n d e r g o i n g f ie l d t r ia l s in
s e l e c t e d c e n t e r s .
T E R M I N O L O G Y
A d e s c r i p t i v e t e r m i n o l o g y o f s y s t e m s , c o m p o
n e n t s ,
a n d m a t e r i a l s w a s d e v i s e d b y t h e T a s k
F o rc e a t i t s m ee t ing on J u l y 9 , 1974, in Ch ic ag o ,
a n d is d e s c r i b e d h e r e . T h i s t e r m i n o l o g y c a n b e
u s e d w i t h a n y r e q u i r e d d e g r e e o f d e t a i l f o r p r e
s c r i p t i o n , e d u c a t i o n , f a b r i c a t i o n m a n u a l s , f e e
s c h e d u l e s , i n f o r m a t i o n r e t r i e v a l s , o r c o m p o n e n t
c a t a l o g s . It i s i n t e n d e d t o b e u s e d w i t h t h e
n o m e n c l a t u r e d e s c r i b e d in t h e p r e c e d i n g a r t i c l e ,
b u t c o u l d a l s o b e u s e d i n d e p e n d e n t l y . I t h a s b e e n
proposed that a f ie ld t r ia l be s tar ted in the fa l l of
1974,
p r e f e r a b l y a s a n i n t e r n a t i o n a l e v a l u a t i o n
p r o j e c t t h r o u g h I S P O .
T h e f o ll o w i n g i s a d e s c r i p t i o n o f t h e p r o p o s e d
t e r m i n o l o g y o f systems, components, a n d
materials. I t i s p r o p o s e d t h a t a p r o s t h e s i s b e d e
s c r i b e d in a n o r d e r l y m a n n e r , p r o c e e d i n g f r o m
t h e g e n e r a l t o t h e m o r e d e t a i l e d a s f o l l o w s :
A . G e n e r a l C h a r a c t e r i s t i c s
1.
P r o s t h e t i c s L e v e l
2. M a j o r S t r u c t u r a l F e a t u r e
3. D u r a b i l i t y
4.
C o s m e t i c T r e a t m e n t
B .
I n t e r f a c e C h a r a c t e r i s t i c s
1. S o c k e t
2.
S u s p e n s i o n
3.
F o r c e D i s t r i b u t i o n
C . S y s t e m s a n d M e c h a n i c s
1.
J o i n t s a t E a c h L e v e l f r o m P r o x i m a l t o D i s
tal
2.
J o i n t C o n t r o l s
3. P o w e r S o u r c e o f C o n t r o l s
4. A l i g n m e n t D e v i c e s
5. T e r m i n a l D e v i c e s - U p p e r L i m b
D .
M a t e r i a l s
G E N E R A L C H A R A C T E R I S T I C S
1. P r o s t h e t i c s l e v e l s h o u l d b e d e s c r i b e d a c
c o r d i n g t o th e d e s c r i p t i o n i n t h e p r e c e d i n g
ar t i c l e by K ay (2 ) .
2.
M a j o r S t r u c t u r a l F e a t u r e . B y i n t e r n a
t i o n a l a g r e e m e n t p r o s t h e s e s a r e e nd osk ele ta l o r
b e a h y b r i d e l e m e n t b u t o n e o r t h e o t h e r
w i ll b e t h e " m a j o r " f e a t u r e . T h e r e f o r e
p r o s t h e s e s a r e :
E n d o s k e l e t a l
E x o s k e l e t a l
1 S t a ff S u r g e o n , C o m m i t t e e o n P r o s t h e t i c s R e s e a r c h
a n d D e v e l o p m e n t , N a t i o n a l A c a d e m y o f S c i e n c e s ,
Washington, D . C .
20418.
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3 . D u r a b i l i t y . S o m e in d i c a t i o n o f t e m p o r a r i -
n e s s o r p e r m a n e n c e o f a p r o s t h e s i s i s
n e e d e d a n d w h e t h e r it i s r o b u s t . S o m e
a g r e e m e n t w a s r e a c h e d a t H e a t h r o w ( 1 )
a b o u t t h e n e e d f o r d i f f e r e n t s t r e n g t h s o f
p r o s t h e s e s . D u r a b i l i t y , t h e r e f o r e , n e e d s
t w o d e s c r i p t o r s , o n e fr o m li s t " a " a n d o n e
f r om l is t " b . "
a
I m m e d i a t e P o s t s u r g i c a l
T r a i n i n g ( D i a g n o s t i c )
D e f i n i t i v e
b
G e r i a t r i c
S t a n d a r d
H e a v y D u t y
4 .
C o s m e t i c T r e a t m e n t . A t C h i c a g o it w a s
a g r e e d t h a t " a n t h r o p o m o r p h i c " a n d
" n o n a n t h r o p o m o r p h i c " w e r e c l u m s y
w o r d s , a n d s i n c e " c o s m e s i s " w a s a n a c
c e p t a b l e a n d u s e d t e r m , " a c o s m e t i c " w a s
s u g g e s t e d .
I t h a s b e e n s u g g e s t e d f u r t h e r b y A n
t h o n y S t a r o s t h a t w e d o n o t w a n t t o s a y
t h a t a p r o s t h e s i s i s " a c o s m e t i c " ; t h a t i s t o
s ay i t i s ug ly . Wha t i s in t ended i s to d i s t in
g u i s h b e t w e e n s p e c i a l c o s m e t i c t r e a t m e n t
a n d s t a n d a r d p r o c e d u r e s .
C o s m e s i s s h o u l d t h e r e f o r e r e f e r t o s p e
c i al c o s m e t i c t r e a t m e n t a n d w o u l d b e :
C o s m e t i c C o v e r
P l a s t i c o n W o o d o r M e t a l
P l a s t i c F o a m a n d S k i n
N o n e
T o s a y t h a t t h e r e is n o s p e c i a l c o s m e t i c
t r e a t m e n t d o e s n o t i n f e r t h a t t h e p r o s
t h e s i s i s n e c e s s a r i l y u g l y .
I N T E R F A C E C H A R A C T E R I S T I C S
T h e r e a c t i o n o f t h e w o r k l o a d a c r o s s t h e i n t e r
f a c e b e t w e e n p r o s t h e s i s a n d p a t i e n t t a k e s
p l a c e i n t h e s o c k e t a n d s o m e t i m e s i n t h e s u s
p e n s i o n . W h e r e t h a t m a j o r r e a c t i o n o c c u r s
m u s t b e s p e c i f i e d b u t i s r e c o r d e d i n t h e d e
s c r i p t i o n of t h e s o c k e t a n d s u s p e n s i o n .
1. S o c k e t s . S o c k e t s n e e d t h r e e d e s c r i p t o r s
a n d m a y n e e d a f o u r t h f o r s u s p e n s i o n . T h e
f i rs t d e s c r i p t o r is t h e n a t u r e o f t h e s o c k e t ;
t h e s e c o n d i s t h e n a t u r e o f t h e m a t e r i a l s
c o n s t r u c t i n g t h e s o c k e t ; t h e t h i r d is t h e s i t e
o f m a j o r f o r c e d i s t r i b u t i o n . T h e f o u r t h w i l l
b e t h e s o c k e t ' s c o n t r i b u t i o n t o s u s p e n
s i o n . S o c k e t s a r e t h e r e f o r e :
a
T o t a l C o n t a c t
N o n - t o t a l
C o n t a c t
b
Rigid
S e m i r i g i d
(e .g . , l i ne r )
C o m p l i a n t
H y b r i d
c
P r o x i m a l B e a r i n g
D i s t a l B e a r i n g
T o t a l B e a r i n g
M a t e r i a l s ( s e e s e c t i o n o n M a t e r i a l s ) c a n
a l s o b e d e s c r i b e d , fo r e x a m p l e , t h e P T B a i r
c u s h i o n s o c k e t c o u l d b e " p l a s t i c ( o r e v e n
e p o x y r e s i n g l a s s f i b e r ) t o t a l - c o n t a c t
s e m i r i g i d d i s t a l c o m p l i a n t p r o x i m a l b e a r
i n g s o c k e t . "
2 . S u s p e n s i o n . I d e a l l y , s u s p e n s i o n is f r om t h e
s o c k e t w h e r e it m a y b e " p r e s s u r e d i f fe r e n
t i a l " o r " s u c t i o n " o r it m a y b e b o d y c o n t o u r
a s in t h e c o m p l e t e t a r s u s , c o m p l e t e l e g , c o m
p l e t e h i p , s o m e p a r t i a l l e g , a n d s o m e p a r t i a l
f o r e a r m p r o s t h e s e s , e t c .
M a n y p r o s t h e s e s n e e d a d d i t i o n a l s u s p e n
s i o n b y a h a r n e s s , b e l t , e t c . T h i s i s c a l l e d
a u x i l i a r y h a r n e s s . T h e T a s k F o r c e d i d n o t
c o n s i d e r t h a t d i s t i n c t i o n n e e d b e m a d e b e t
w e e n c u f f s , b a n d s , c o r s e t s , e t c .
T h e c o n n e c t i o n b e t w e e n t h e s u s p e n s i o n
and th e p ro s th es i s i s a " j o in t " and i f i t i s a
s t r a p o r s t r a p s , it i s i n d i c a t e d u n d e r t h e j o i n t a t
t h e a p p r o p r i a t e l e v el a s " f l e x i b l e . "
W h e n t h e a u x i l i a r y s u s p e n s i o n a l s o a c c e p t s
a w o r k l o a d a d d i t i o n a l t o t h e f o r c e s r e q u i r e d t o
s u s p e n d , t h e a n a t o m i c a l s i te o f t h a t l o a d
s h o u l d b e i n d i c a t e d . S u s p e n s i o n i s t h e r e f o r e :
P r e s s u r e D i f f e r e n t i a l ( s o c k e t )
B o d y C o n t o u r ( s o c k e t )
A u x i l i a r y T h i g h B e a r i n g
I s c h i a l B e a r i n g
A r m B e a r i n g
S h o u l d e r B e a r i n g
e t c .
3 . F o r c e D i s t r i b u t i o n . T h i s i s a f u n c t i o n o f t h e
i n t e r f a c e b u t i s d e s c r i b e d i n t h e a p p r o p r i a t e
p l a c e u n d e r s o c k e t o r a u x i l i a r y s u s p e n s i o n .
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The nature of the distr ibut ion wi l l i t se l f deter
m ine so m e o f t he cha ra c t er o f the so ck e t a nd
a ux i l ia ry susp ens io n , e .g . , in a pa rt ia l leg pro s
t h e s i s , the presence of uniaxia l jo ints and the
need for thigh and ischia l bearing require a ful l
length corset or thigh lacer .
S Y S T E M S A N D M E C H A N I S M S
1. J o in t s . J o int s are des cr ibe d by t he nu m ber
o f a x es a nd t he num ber o f p la nes in which
t h e y m o v e . T h e r e w a s s o m e d i s c u s s i o n
a bo u t t he use o f r ig id wh ere no m e cha n
ica l jo int e x i sts , but it wa s agree d that
wh ere t here is no pro s t he t i c m ech a nica l
j o i n t a t a n a n a t o m i c a l j o i n t l e v e l , t h i s
sho uld be so descr ibed . J o int s a re t here
fore:
N o m o t io n a t a n a na t o m ica l j o int l ev e l
Rigid
M o t io n in o n e p la n e
a bo ut o ne a x i s
a bo ut m ul t ip le a x es
Unia x ia l
Po ly cent r ic
M o t io n in t w o p la n es
a b o u t t w o a x e s
Dual ax is
M o t io n in t hree p la n es
about f inite axes
about inf ini te axes
Mult iax ia l
F lex ib le
2 . C o n t r o l M e c h a n i s m s . I n t h e l o w e r l i m b ,
descr ipt o rs f ro m
a b c
a nd d , be lo w, wi l l
ha v e t o be g iv e n a s requ ired fo r bo t h
s t a nce a nd swing pha ses . S ince s t a nce i s
usua l ly a g rea t er requirem ent t ha n sw ing ,
this should be stated f irst .
a . P la ne a nd d irec t io n o f m o v e m en t ( p la ne
need no t be s t a t ed)
Sagit ta l
E x t e n s i o n
F l e x i o n
Co ro na l
A b d u c t i o n
A d d u c t i o n
V a l g u s
Va rus
Axia l
Internal rotation
External rotat ion
Pro na t io n
S u p i n a t i o n
E v e r s i o n
Inv ers io n
O p p o s i t i o n
b.
T y p e o f c o n t r o l m e c h a n i s m s
Co nst a nt o r
Intermit tent and are:
M echa nica l l inka g e
Hy dra ul i c
P n e u m a t i c
Electr ic
Ot her
T h e t e r m c o n s t a n t i s n e c e s s a r y t o
d e s c r i b e c e r t a i n t y p e s o f l o w e r - l i m b
s w i n g p h a s e c o n t r o l s a n d s o m e u p p e r -
l im b po we r a c t ua t o rs , e t c . In t erm i t
t en t ind ica t e s t he rev er se .
c . Purp o se o f co nt ro l m e ch a ni sm s a t ea ch
j o i n t m o v e m e n t
Fre e mod if ied as required by
Ass i s t Va r ia b le
R e s i s t L o c k
S t o p
Ho ld
d . M e t h o d o f c o n t r o l l in g m e c h a n i s m s
A u t o m a t i c
B i o m e c h a n i c a l , D i r e c t
B i o m e c h a n i c a l , T r a n s d u c e r
B io e lec t r i c
3.
P o w e r S o u r c e
N o n e ( e . g . , p a s s i v e t e r m i n a l d e v i c e s )
B o d y
E lec t r i c
Hy dra ul i c
M e c h a n i c a l
Hy br id
4. A l i g n m e n t
B en ch M e cha nic a l S ing le Int egra l
D u a l R e m o v e d
B ench a l ig nm ent i s a lwa y s present a nd
need no t be spec i f i ed . When a n a l ig nm ent
dev ice i s used , i t sho uld ha v e t wo descr ip
tors to denote whether i t i s a t a s ing le s i te
o r i s a t bo t h en ds o f a b o d y seg m e nt . It
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m u s t a l s o s a y w h e t h e r i t r e m a i n s a s a n
i n t e g r a l p a r t o r is r e m o v e d a t c o m p l e t i o n
o f f a b r i c a t i o n .
5 .
T e r m i n a l D e v i c e s
C o s m e t i c
F u n c t i o n a l
H o o k o r S p e c i a l T o o l s
T h e y m a y b e :
V o l u n t a r y o p e n i n g
V o l u n t a r y c l o s i n g
B o t h
N e i t h e r
T h e y m a y b e :
P o w e r e d a s a b o v e
P a s s i v e
M A T E R I A L S .
T h e n e e d to s p e c i f y m a t e r i a l s d e p e n d s u p o n a
n u m b e r o f f a c t o r s . I n p r e s c r i p t i o n , i t w i ll d e
p e n d u p o n t h e r e l a t i v e k n o w l e d g e o f t h e
p h y s i c i a n a n d p r o s t h e t i s t w h i c h v a r i e s
gre a t l y in the in te rna t io na l f ie ld . I t m ay a ls o
b e n e c e s s a r y i n s o m e c o u n t r i e s t o g i v e f a b r i
c a t i o n d e t a i l s t o s a t i s fy g o v e r n m e n t a l s p e c i f i
c a t i o n s . In s t r u c t i o n a l a n d f a b r i c a t io n m a n u
a l s w i l l n e e d f a r g r e a t e r d e t a i l t h a n a r e r e
q u i r e d i n o r d i n a r y u s a g e .
T e r m i n o l o g y f o r m a t e r i a l s c a n b e i n g e n e r a l
t e r m s o r c a n b e s p e c i f i c ; it c a n b e a d e s c r i p
t i o n i n g e n e r a l o f a wh o le sy s t e m o r c a n b e
a p p l i e d t o a c o m p o n e n t , e . g . , o n e c a n r e f er t o
a " w o o d e n l e g " o r " a w o o d e n f o o t , " a " p l a s
t ic a r m " o r a " p l a s t i c s o c k e t . " T h e r e a r e
th r e e g r a d e s o f sp e c i f i c a t i o n : f ir st , g e n e r a l
t e r m s ; s e c o n d , s e m i s p e c i f i c t e r m s ; a n d t h i r d ,
s p e c i f i c t e r m s . T h e f i r s t a n d s o m e t i m e s t h e
s e c o n d g r a d e s a r e u s u a l l y s u f f i c ie n t f o r p r e
s c r i p t i o n o r n o r m a l d e s c r i p t i o n . T h e t h i r d w i l l
b e n e c e s s a r y i n p r o f e s s i o n a l i n s t r u c t i o n a n d
f a b r i c a t i o n m a n u a l s . F o r t h i s t h i r d g r a d e o f
s p e c i f i c a t i o n , t h e n a t i o n a l o r i n t e r n a t i o n a l
d e s c r i p t i o n a n d s t a n d a r d s s h o u l d b e u s e d .
1 . G e n e r a l
W o o d
L e a t h e r
M e t a l
W e b b i n g
R u b b e r
P la s t i c
e t c .
a r e o f t e n s u f f ic i e n t t o d i s t i n g u i s h b e t w e e n
c o m p a r a b l e p r o s t h e s e s o r p r o s t h e t i c c o m
p o n e n t s w h i c h a r e m a d e t o a k n o w n
s p e c i f i c a t i o n o n c e t h e m a j o r g r a d e h a s
b e e n d e c i d e d .
2 . S e m i s p e c i f i c
W i l l o w
e t c .
Bo x c a l f
C h a m o i s
B l o c k l e a t h e r
e t c .
A l u m i n u m
S t a i n l e s s S t e e l
e t c .
N y l o n w e b b i n g
C o u t i l
e t c .
S i l a s t i c
P o l y p r o p y l e n e
P o l y c a r b o n a t e
Gla ss f i b e r
e t c .
T h e s e t e r m s a r e r a t h e r m o r e s p e c i fi c a n d
a r e s o m e t i m e s d e s i r a b l e i n d e s c r i p t i o n a n d
p r e s c r i p t i o n .
3 .
S p e c i f i c . W h e n s p e c i f i c m a t e r i a l s n e e d t o
b e d e t a i l e d , t h e r e a r e s p e c i f i c t e r
m i n o l o g i e s w h i c h a r e i n u s e e i t h e r i n t e r n a
t i o n a l l y o r n a t i o n a l l y . M o s t o f t h e s e t e r
m i n o l o g i e s a r e a l s o g i v e n s p e c if i c m e c h a n
i c a l s t a n d a r d s , a n e x c e p t i o n b e i n g l e a t h e r
w h i c h h a s n o t y e t b e e n s u c c e s s f u l l y s t a n
d a r d i z e d .
E a c h n a t i o n s h o u l d u s e it s o w n n a t i o n a l
sp e c i f i c a t i o n f i r s t ; if n o n e i s a v a i l a b l e , i t
s h o u l d b e t h e i n t e r n a t i o n a l s t a n d a r d ; a n d i f
n e i t h e r i s a v a i l a b l e , it s h o u l d c h o o s e f r o m
a n o t h e r n a t i o n ' s t e r m i n o l o g y .
F o r m s t h a t h a v e b e e n p r o p o s e d f o r u s e
i n t h e f ie ld t r i a l s a r e s h o w n i n A p p e n d i x e s
A a n d B .
L I T E R A T U R E C I T E D
1 . D e p a r t m e n t o f H e a l t h a n d S o c i a l S e c u r i t y , E n
g l a n d a n d W a l e s ,
Report of Conference on Physical
Testing of Prostheses. S k y w a y M o t e l , H e a t h r o w , L o n
d o n , E n g l a n d , M a r c h 25-27, 1974 ( i n p r e s s ) .
2 . K a y , H e c t o r W . , A p r o p o s e d n o m e n c l a t u r e f o r
l i m b p r o s t h e t i c s , Orth . and Pr os . , 2 8 :4 , D e c e m b e r
1974.
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APPENDIX A
P R O S T H E T I C S F O R M / U p p e r L im b
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APPENDIX B
P R O S T H E T I C S F O R M / L o w e r L i m b
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X -R A Y S: A F I T T IN G T O O L
FO R T H E P R O S T H E T I S T
1
J a m e s L . B y e r s
2
T h e p u r p o s e o f t h i s a r t i c l e is t o d e m o n s t r a t e
t h e u s e f u l n e s s o f x - r a y s a s a " f i t t i n g t o o l " f o r t h e
p r o s t h e t i s t , i . e . , a s a m e a n s o f c h e c k i n g f it o f t h e
p r o s t h e s i s b e f o r e c o m p l e t i o n o f f a b r i c a t i o n . T h e
u s e o f x - r a y s e l i m i n a t e s s o m e q u e s t i o n a b l e p o i n t s
t h a t m a y a r i s e a t t i m e a b o u t p r o s t h e s i s f i t,
w e i g h t - b e a r i n g a r e a s , t r i m l i n e s , r e l i e fs , e t c . ,
w h e r e c o n v e n t i o n a l m e t h o d s m a y f ai l o r a r e n o t
w h o l l y s a t i s f a c t o r y .
C O N V E N T I O N A L M E T H O D S O F
C H E C K I N G C O N T A C T B E T W E E N
P R O S T H E S I S A N D P A T I E N T
T o c h e c k f o r total contact, t h e p r o s t h e t i s t g e n
e r a l l y u s e s e i t h e r a b a l l o f c l a y o r p o w d e r i n t h e
d i s t a l e n d o f t h e s o c k e t . T h i s m e t h o d d o e s s h o w
t h a t t h e p a t i e n t h a s c o n t a c t o n t h e d i s t a l e n d o f hi s
s t u m p , b u t d o e s n o t s h o w t h a t t h e p a t i e n t h a s
total contact a r o u n d t h e p e r i p h e r y o f t h e d i s t a l
e n d o f t h e s t u m p .
A f t e r s t a t i c a l i g n m e n t of t h e p r o s t h e s i s h a s
b e e n e s t a b l i s h e d t o t h e p r o s t h e t i s t ' s s a t i s f a c t i o n ,
t h e p r o s t h e s i s is r e m o v e d , a n d v i s u a l i n s p e c t i o n
a n d p a l p a t i o n o f t h e s t u m p a r e e m p l o y e d t o c h e c k
for f i t o f the socke t .
M a r k s m a d e b y e i t h e r t h e c a s t o r s t u m p s o c k
a r e r e f l e c t e d o n t h e p a t i e n t ' s s t u m p . T h i s m e t h o d
c a n s o m e t i m e s b e m i s l e a d i n g b e c a u s e s o c k
m a r k s o v e r t h e e n t i r e s u r f a c e o f h i s s t u m p
do not
n e c e s s a r i l y m e a n t h a t total contact i s p r e s e n t .
W i t h t h e s o c k s t r e t c h e d t i g h t l y o v e r t h e s t u m p
a n d t h e n p l a c e d i n t o t h e p r o s t h e s i s , t h e s o c k
m a y , s o m e t i m e s , r e f le c t m a r k s d u e t o t h e t e n s i o n
in a sn u g f i t ti n g so c k .
W e i g h t - b e a r i n g a r e a s w i ll a l s o r ef l e c t s o c k
m a r k s , b u t s h o u l d s h o w i n c r e a s e d p r e s s u r e b y
s o m e d i s c o l o r a t i o n ( i . e . , r e d n e s s ) i n t h e s e a r e a s .
H o w e v e r , i n c a s e s o f o b e s e p a t i e n t s o r p a t i e n t s
w i t h r e d u n d a n t s t u m p t i s s u e , t h e s e a r e a s h a v e a
t e n d e n c y t o m o v e d is t a l ly o n c e t h e p r o s t h e s i s h a s
b e e n r e m o v e d . A p r o s t h e t i s t m u s t r e l y o n h i s
j u d g m e n t a n d e x p e r i e n c e to k n o w w h e n t h e s e
a r e a s a r e i n t h e p r o p e r lo c a t i o n w h e n t h e c h e c k
o u t is m a d e b y v i s u a l i n s p e c t i o n .
T h e m e d i o l a t e r a l t r i m l i n e s o f t h e p r o s t h e s i s a r e
c h e c k e d w h i l e t h e p a t i e n t b e a r s w e i g h t o n t h e
p r o s t h e s i s a n d w h i l e s i t t in g w i t h t h e k n e e f l e x e d
t o 9 0 d e g . T h e m e d i o l a t e r a l a n d a n t e r i o r t r i m l i n e s
a r e c h e c k e d b y p a l p a t i o n o f t h e s t u m p a r o u n d t h e
p r o x i m a l b o r d e r o f t h e s o c k e t t o d e t e r m i n e t h e
d e g r e e o f fit w i t h r e s p e c t t o t h e f e m o r a l c o n d y l e s ,
t h e p a t e l l a r , a n d t h e p o p l i t e a l a r e a s . W i t h o b e s e
p a t i e n t s , it i s s o m e t i m e s d i f fi c u lt t o p a l p a t e t h e s e
a r e a s , a c o n d i t i o n t h a t lim i t s t h e r e l i a b i l i t y of t h e
t e c h n i q u e .
T h e r e l a t i o n s h i p o f t h e p a t e l l a r - t e n d o n p r o
t u b e r a n c e t o t h e p o s t e r i o r t r i m i s c h e c k e d a f t e r
t h e p r o s t h e s i s h a s b e e n r e m o v e d . A g a i n , t h i s d e
p e n d s o n t h e p r o s t h e t i s t ' s e x p e r i e n c e a n d j u d g
m e n t .
P R O C E D U R E
T h e x - r a y s a r e t a k e n u s i n g t h e s t a n d a r d k n e e
t e c h n i q u e a n d t a k e n f o r s o f t t i s s u e . T h e s a m e
p r o c e d u r e i s a l s o u s e d f o r o t h e r l e v e l s o f a m p u t a
t ions . X- rays a re taken a t the in i t ia l f i t t ing a f te r
s t a t i c a n d d y n a m i c a l i g n m e n t h a v e b e e n c o m
p l e t e d a n d t h e p a t i e n t is c o m f o r t a b l e . A t t h i s
p o i n t , t h e i n f o r m a t i o n p r o v i d e d b y t h e x - r a y s i s
m o s t u s e fu l t o t h e p r o s t h e t i s t . A f t e r e x a m i n a t i o n
o f t h e x - r a y s , a d j u s t m e n t s a r e m a d e t o t h e p r o s
t h e s i s .
W h e n p r o b l e m s a r i s e , t h e y a r e r e v i e w e d
a n d d i s c u s s e d w i t h t h e c l i n i c c h i e f a n d a p p r o
p r i a t e r e m e d i a l m e a s u r e s a re t a k e n . G e n e r a l l y ,
t w o w e i g h t - b e a r i n g v i e w s o f t h e s t u m p - s o c k e t
r e l a t i o n s h i p a r e t a k e n : a n t e r o p o s t e r i o r a n d l a t
e r a l ( F i g s . 1 a n d 2 ) . I f n e c e s s a r y , a t h i r d v i e w i s
t a k e n w h i l e t h e p a t i e n t i s s i t t i n g .
1This
work w as performed with fiscal suppo rt u nder
Veterans Administrat ion Contract V663P-656.
2
Chief o f Prosthe t ics and Or tho t ics , Prosthe t ics Re
search Study, 1102 Columbia Street , Room 409, Seat
tle,
Wash. 98104.
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F i g .
1.
A n t e r o p o s t e r i o r v i e w r e f l e c t s m e d i o l a t e r a l r e l a
t i o n s h i p
of
s t u m p
to
s o c k e t . X - r a y
is
o u t l i n e d for c l a r i t y
o f i n t e r f a c i n g and s o c k e t s h e l l .
F i g .
2.
L a t e r a l v i e w has a l s o b e e n o u t l i n e d
for
c l a r i t y .
( a ) A r e a b e t w e e n the tw o s o l i d l i n e s r e p r e s e n t s s o c k e t
she l l .
( b ) A r e a b e t w e e n d o t t e d l i n e
and
s o l i d li n e r e p r e s e n t s
" C o r d o " i n t e r f a c i n g .
A N T E R O P O S T E R I O R V I E W
(Fig .
1)
T h e p r o x i m a l m e d i o l a t e r a l t r i m l i n e s
are
c h e c k e d
for
a d e q u a t e h e i g h t
an d fit
a r o u n d
the
f e m o r a l c o n d y l e s .
T h e m e d i o t i b i a l f l a r e is c h e c k e d for a d e q u a c y
a n d l o c a t i o n of th e m e d i o t ib i a l shelf.
T h e a d e q u a c y
of
r e l i e f
for th e
h e a d
of th e
f ibul a, t h e d i s t a l
en d of
the fibula,
and the
s h a f t
of
t h e f i b u l a
a re
c h e c k e d .
T h e d i s t a l
en d of
the s t u m p
is
c h e c k e d
for
total
contact
(The d i s t a l total
contact
is
a l s o c h e c k e d
f r o m
t he
l a t e r a l v i e w . )
L A T E R A L V I E W ( F i g s .
2. 3. an d 4)
T h e lo c a t i o n
a n d
a d e q u a c y
of fit in t he
a r e a
of
t h e p a t e l l a r - t e n d o n p r o t u b e r a n c e
is
d e t e r m i n e d .
A t the s a m e t i m e , t he p o s t e r i o r b r i m is c h e c k e d
f o r h e i g h t
a n d
a m o u n t
of
f l a r e
in
t e l a t i o n s h i p
to
t h e p a t e l l a r - t e n d o n p r o t u b e r a n c e .
R e l i e f
of
t i b i al t u b e r c l e
is
c h e c k e d .
T h e f l e x i o n a n g l e
of th e
s o c k e t
is
c h e c k e d .
T h e o v e r a l l fit of t he p r o s t h e s i s for p e r i p h e r a l
c o n t a c t
is
a s s e s s e d .
T h e d i s t a l
en d of
the s t u m p
is
v i e w e d a g a i n
for
total
contact.
F i g u r e 3 is a l a t e r a l v i e w of a c o n d i t i o n w h e r e
t h e p a t e l l a r - t e n d o n
ba r is
l o c a t e d
t oo far
d i s t a l l y
a n d
a
l a c k
of
t o t a l c o n t a c t
in th e
r e g i o n
of th e
a n t e r o d i s t a l t i b i a .
7/23/2019 1974 Orthotics and Prosthetics
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F i g . 3 . L a t e r a l v i e w .
F i g . 4 . C l o s e d S y m e ' s p r o s t h e s i s ; a a n d b i l l u s t r a t e
m e d i a l a n d l a t e r a l a r e a s t h a t h a v e n o t m a i n t a i n e d t o t a l
c o n t a c t u n d e r w e i g h t - b e a r i n g c o n d i t i o n s .
( a ) I m p r o p e r l o c a t i o n o f p a t e l l a r - t e n d o n p r o t u b e r a n c e .
I t shou ld be loc a t e d in fe r io r t o t he pa t e l l a a t t he l e ve l o f
the t i b i a l p l a t e a u .
( b ) T o t a l c o n t a c t n o t m a i n t a i n e d a t t h e a n t e r o d i s t a l
t i b i a .
F i g u r e 4 is a l a t e r a l v i e w o f a S y m e ' s p r o s t h e s i s
a n d s t u m p w h e r e t o t a l c o n t a c t h a s n o t b e e n
a c h i e v e d .
L A T E R A L V I E W I N S I T T I N G P O S I T I O N
( O p t i o n a l )
P r o x i m a l d i s p l a c e m e n t o f t h e s t u m p i n t h e
p r o s t h e s i s is r e l a t e d t o t h e c o n f i g u r a t i o n o f t h e
p o s t e r i o r b r i m o f t h e s o c k e t ; w h e n t h e b r i m i s n o t
o f t h e p r o p e r h e i g h t , t h e d i s p l a c e m e n t w il l b e
e i t h e r i n a d e q u a t e o r e x c e s s i v e . T h e f a r e o f t h e
p o s t e r i o r b r i m s h o u l d b e r o u n d e d s o a s n o t to c u t
i n t o t h e h a m s t r i n g s o r c a u s e e x c e s s i v e d i s p l a c e
m e n t o f t h e s t u m p i n t h e s o c k e t .
T h e l o c a t i o n o f t h e p a t e l l a r - t e n d o n p r o t u b e r
a n c e i n r e l a t i o n s h i p t o t h e t ib i a l t u b e r c l e i s e x
a m i n e d t o m a k e c e r t a i n t h e r e is a d e q u a t e relief.
T h i s v i e w i s u s e d o n l y if d o u b t s a b o u t t h e f i t t i n g
h a v e b e e n r a i s e d b y t h e o t h e r x - r a y s .
T h e m o r e c o n v e n t i o n a l m o d e s of p r o s t h e t i c s
c h e c k o u t s h o u l d n o t b e d i s r e g a r d e d ; b u t , u n d e r
p r o p e r s u p e r v i s i o n , x - r a y s c a n b e a v a l u a b l e " f i t
t i n g t o o l " fo r t h e p r o s t h e t i s t a s s u r i n g h i m t h a t t h e
p a t i e n t i s g i v e n t h e m o s t e f f e c t i v e f i t a v a i l a b l e i n
p r o s t h e t i c s s e r v i c e .
A C K N O W L E D G M E N T
T h e a u t h o r w i s h e s to e x p r e s s h i s a p p r e c i a t i o n
t o D r . G u s t a v R u b i n , O r t h o p e d i c C o n s u l t a n t ,
V e t e r a n s A d m i n i s t r a t i o n P r o s t h e t i c s C e n t e r .
N e w Y o r k . N e w Y o r k , f or h i s i n t e r e s t , c o o p e r a
t i o n , a n d a i d w i t h t h e p r e p a r a t i o n o f t h i s a r t i c l e .
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7/23/2019 1974 Orthotics and Prosthetics
http://slidepdf.com/reader/full/1974-orthotics-and-prosthetics 73/104
T H E P R E S E N T U S E O F T H E
U C B L F O O T O R T H O S I S
M i c h a e l J . Q u i g l e y , C . P . O .
1
I n A u g u s t 1 9 7 1 , t h e C o m m i t t e e o n P r o s t h e t i c s
R e s e a r c h a n d D e v e l o p m e n t ( C P R D ) o f t h e N a
t i on a l R e s e a r c h C o u n c i l c o m p l e t e d a n e v a l u a t i o n
o f f o u r l o w e r - l i m b o r t h o s e s . T h e y w e r e t h e
V A P C S i n g l e - B a r K n e e - A n k l e - F o o t O r t h o s i s
( K A F O ) . t h e U C B L D u a l A x i s A n k l e - F o o t O r
t h o s i s ( A F O ) , t h e N e w Y o r k U n i v e r s i t y i n s e r t
A n k l e - F o o t O r t h o s i s , a n d t h e U C B L S h o e I n s e r t
F o o t O r t h o s i s ( F O ) ( F i g s . 1 a n d 2 ) . T h e l a t t e r t w o
o r t h o s e s w e r e c o n s i d e r e d t o b e v a l u a b l e a d d i
t i o n s t o p a t i e n t s e r v i c e s , a n d it w a s r e c o m
m e n d e d t h a t t h e y b e i n c l u d e d in o r t h o t i c s e d u c a
t i o n p r o g r a m s ( 2 ) .
T o d e t e r m i n e t h e a c c e p t a n c e o f t h e U C B L
s h o e in s e r t f o o t o r t h o s i s , h o w t h e t e c h n i q u e w a s
l e a r n e d , a n d s o m e t h i n g a b o u t t h e e x p e r i e n c e s i n
t h e f i e l d , a l i m i t e d s u r v e y w a s c o n d u c t e d .
T h i r t y - f i v e c e r t i f i e d o r t h o t i c s a n d p r o s t h e t i c s -
o r t h o t i c s f ac i l i t i e s w e r e s e l e c t e d r a n d o m l y f r o m
t h e 1 9 7 4 Registry of Accred ited Facilities (1).
T h i s r e p r e s e n t e d a n e q u a l d i s t r i b u t i o n o f p r a c
t i t i o n e r s f r o m t w e n t y c i t ie s . T h e q u e s t i o n n a i r e s
( A p p e n d i x A ) c o n s i s t e d o f a s e c t i o n t o b e c o m
p l e t e d b y t h e p h y s i c i a n a n d a s e c t i o n t o b e c o m
p l e t e d b y t h e o r t h o t i s t . T h e o r t h o t i s t w a s r e
q u e s t e d t o f o r w a r d t h e q u e s t i o n n a i r e t o t h e
p h y s i c i a n a f t e r h i s s e c t i o n w a s c o m p l e t e d . T h e
q u e s t i o n n a i r e s w e r e s e n t o u t in J a n u a r y 1 9 7 4 . B y
M a r c h 1 9 7 4 . t w e n t y - n i n e o f t h e f o r m s w e r e r e -
1 S t a ff P r o s t h e t i s t / O r t h o t i s t . C o m m i t t e e o n P r o s t h e t
i c s R e s e a r c h a n d D e v e l o p m e n t . N a t i o n a l A c a d e m y o f
S c i e n c e s , W a s h i n g t o n , D . C . 2 0 4 1 8 .
F i g . 1. T h e U C B L f o o t o r t h o s i s .
F i g . 2 . P r i n c i p l e s o f t h e U C B L fo o t o r t h o s i s a p p l i e d t o
t h e fo o t s e c t i o n of a p o l y p r o p y l e n e a n k l e - f o o t o r t h o s i s .
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t u r n e d . T h e f o l l o w i n g i n f o r m a t i o n w a s t a k e n
f r o m t h e s e f o r m s .
T h e U C B L f o ot o r t h o s i s w a s u s e d b y 7 5 p e r
c e n t [2 1 ]o f t h e s u r v e y e d p r a c t i t i o n e r s . H o w e v e r ,
o n l y s e v e n of t h e t w e n t y - o n e p r a c t i t i o n e r s w h o
u s e t h i s o r t h o s i s d o s o r e g u l a r l y . O f t h e r e m a i n i n g
f o u r t e e n r e s p o n d e n t s , fi ve u s e t h e o r t h o s i s o n l y
w h e n i t is r e q u e s t e d b y a c e r t a i n p h y s i c i a n , f i v e
r a r e ly u se i t, tw o u se i t f o r sp e c i a l c o n d i t i o n s
o n l y , a n d o n e s t a t e d h e u s e s t h e o r t h o s i s o n l y a s a
l a s t r e so r t .
A n a t t e m p t w a s m a d e t o d e t e r m i n e h o w t h e
p r a c t i t i o n e r s w e r e m a d e a w a r e of t h e U C B L f o o t
o r t h o s i s . T h e l i t e r a t u r e r a t e d a s t h e m o s t c o m
m o n s o u r c e o f i n f o r m a t i o n . A r t i c l e s o n t h e
U C B L f oo t o r t h o s i s a p p e a r e d i n t h e Bulletin of
Prosthetics Research (3) in S e p t e m b e r 1 9 6 9 a n d
in Orthotics and Prosthetics
( 4 ) i n M a r c h 1 9 7 2 . I n
a d d i t i o n . N e w Y o r k U n i v e r s i t y p u b l i s h e d a n
e v a l u a t i o n r e p o r t ( 5 ) o n t h e o r t h o s i s i n 1 9 69 . T h e
p r o s t h e t i c s - o r t h o t i c s e d u c a t i o n c o u r s e s w e r e t h e
s e c o n d m o s t c o m m o n s o u r c e o f i n f o r m a t i o n o n
t h e s u b j e c t . W o r d o f m o u t h r a t e d a s th e t h i r d
m a i n c h a n n e l o f c o m m u n i c a t i o n s , s i n c e s o m e r e
s p o n d e n t s s t a t e d t h a t o r t h o t i s t s , p o d i a t r i s t s , e t c . ,
h a d i n f o r m e d t h e m o f t h e t e c h n i q u e .
P R E S C R I P T I O N C O N S I D E R A T I O N
E i g h t a r e a s c o n s i d e r e d t o i n f l u e n c e t h e p r e
s c r i p t i o n a n d u s e o f t h e U C B L f o ot o r t h o s i s w e r e
c o v e r e d i n t h e q u e s t i o n n a i r e . T h e m o s t c o m m o n
p r e s c r i p t i o n w a s b i l a t e r a l o r t h o s e s f o r a p a t i e n t
2 5 - 4 0 y e a r s o l d w i t h p e s p l a n u s .
T h e p a t h o l o g i e s m o s t c o m m o n l y t r e a t e d w i t h
t h e U C B L f o o t o r t h o s i s a r e p e s p l a n u s a n d a r
t h r i t i s . F o l l o w i n g t h e s e , i n o r d e r of f r e q u e n c y ,
a r e p l a n t a r f a s c i i t i s , m e t a t a r s a l g i a , p o l i o , c e r e
b r a l p a l s y a n d p e r o n e a l p a l s y .
R e s p o n d e n t s i n d i c a t e d t h a t t h e o r t h o s i s i s u s e d
e q u a l l y o n m a l e s a n d f e m a l e s a n d i s f i t te d b i l a t e r
a l l y t h e v a s t m a jo r i t y o f t h e t im e . T h e a g e g r o u p s
t h a t u s e t h e U C B L f o o t o r t h o s i s m o s t o f t e n a r e
b e tw e e n 1 -12 y e a r s o f a g e a n d b e tw e e n 25 - 4 0
y e a r s o f a g e .
T h e m a j o r d i s a d v a n t a g e o f u s i n g t h i s o r t h o s i s i s
t h e e x p e n s e , a f a c t t h a t w a s u n d e r s c o r e d b y h a l f
o f t h e r e s p o n d e n t s . T h e o t h e r d i s a d v a n t a g e s
c h e c k e d o f f b y t h e p r a c t i t i o n e r s a r e t h a t a w i d e r
s h o e is s o m e t i m e s n e e d e d , t h a t t h e o r t h o s i s s l i p s
u p a n d d o w n in t h e s h o e , a n d t h a t b r e a k a g e o c
c u r s . T w o p r a c t i t i o n e r s f e l t t h e o r t h o s i s i s dif
f icult to f i t .
T h e m a j o r a d v a n t a g e s o f u s i n g t h i s o r t h o s i s i s
t h a t is p r o v i d e s p r o p e r fo o t s u p p o r t , a l l o w s t h e
p a t i e n t t o c h a n g e s h o e s , e l i m i n a t e s s h o e m o d i f i
c a t i o n s a n d t h e n e e d f o r o r t h o p e d i c s h o e s . T h e
p r a c t i t i o n e r s a l s o f e lt t h a t th e U C B L f o o t o r
t h o s i s p r o v i d e s i m p r o v e d c o s m e s i s a n d g i v e s
c o n s i s t e n t re l i e f f r o m p a i n .
M o s t o f t h e r e s p o n d e n t s i n d i c a t e d t h a t th e o r
t h o s i s u s u a l l y l a s t s l o n g e r t h a n a y e a r b e f o r e r e
p l a c e m e n t i s n e c e s s a r y , a l t h o u g h a f ew p r a c
t i t i o n e r s s t a t e d t h a t it o n ly l a s t s u p t o o n e y e a r .
T h e m a j o r r e a s o n t h a t t h e U C B L f oo t o r t h o s i s
n e e d s r e p l a c e m e n t i s a l o s s o f f it w i t h t i m e .
B r e a k a g e i s t h e s e c o n d m o s t c o m m o n r e a s o n r e
p l a c e m e n t w a s n e e d e d . O n e p r a c t i t i o n e r s t a t e d
t h a t h e r e p l a c e s t h e o r t h o s e s i n c a s e s w h e n h e
w a n t s t o i n c r e a s e p r o g r e s s i v e l y t h e a m o u n t o f
f o o t c o r r e c t i o n .
C A S T I N G , F A B R I C A T I O N A N D F I T T I N G
T h i s p a r t o f t h e s u r v e y w a s s t r u c t u r e d t o d e
t e r m in e i f t h e o r ig in a l t e c h n i q u e is s t il l p r a c t i c e d ,
w h a t m a t e r i a l s a n d m e t h o d s a r e p r e s e n t l y u s e d
f o r f a b r i c a t i o n , f i tt i n g p r o b l e m s e n c o u n t e r e d a n d
s o l u t i o n s to t h e s e p r o b l e m s .
N e a r l y e v e r y p r a c t i t i o n e r s t a t e d t h a t h e u s e s
t h e s a m e m e t h o d of w r a p p i n g t o o b t a i n t h e m o l d
a s w a s d e s c r i b e d o r i g i n a l l y i n t h e l i t e r a t u r e .
M a n u a l a l i g n m e n t o f t h e f o o t a n d a n k l e is p r a c
t i c e d b y a l l r e sp o n d e n t s , a s is t h e u se o f t h e
c o n t o u r e d c a s t i n g b o a r d s f o r p o s i t i o n i n g t h e p a
t i e n t . O n e - q u a r t e r o f t h e o r t h o t i s t s u s e s t a n d a r d
p l a s t e r b a n d a g e r a t h e r t h a n t h e e l a s t i c t y p e o r i g i
n a l ly r e c o m m e n d e d , a n d o n e - t h i r d of t h e o r
t h o t i s t s n o l o n g e r u s e t h e b a l l o o n m e t h o d f o r
c a s t i n g .
P o l y e s t e r r e s i n i s u s e d e x c l u s i v e l y b y e i g h t o f
t h e o r t h o t i s t s , f o u r u s e b o t h p o l y e s t e r r e s i n a n d
p o l y p r o p y l e n e , fi ve u s e p o l y p r o p y l e n e e x c l u
s i v e l y , o n e u s e s p o l y e t h y l e n e a n d o n e u s e s a c r y l
ic.
I t i s i n t e r e s t i n g t h a t o f t h e s e v e n p r a c t i t i o n e r s
t h a t h a d b r e a k a g e p r o b l e m s , s i x u s e p o l y e s t e r
r e s i n f o r f a b r i c a t i o n a n d o n e u s e s p o l y e t h y l e n e .
N o n e o f t h e o r t h o t i s t s t h a t u t i l i z e p o l y p r o p y l e n e
e x c l u s i v e l y m e n t i o n e d b r e a k a g e p r o b l e m s .
T h e m o s t c o m m o n f i t ti n g p r o b l e m is p a i n a t t h e
l o c a t i o n o f t h e n a v i c u l a r ( s c a p h o i d ) b o n e , w h i c h
i s l o c a t e d m e d ia l l y a t t h e a p e x o f t h e a r c h o f t h e
f o o t . S h o e s b e i n g t o o t ig h t w h e n t h e o r t h o s i s i s
w o r n is t h e n e x t m o s t c o m m o n p r o b l e m , f o l lo w e d
b y p i s to n in g o f t h e f o o t i n t h e sh o e , a n d d i f f ic u l -
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t i e s
in
e s t a b l i s h i n g
the
t r i m l i n e
at the
m e t a t a r s a l
a r e a . One p r a c t i t i o n e r s t a t e d t h a t he has his pa
t i e n t s a c q u i r e a p a i r of s h o e s t h a t wi ll a c c o m m o
d a t e
the
o r t h o s i s .
N o n e
of the
o r t h o t i s t s
do any
s h o e m o d i f i c a
t i o n s
in
a d d i t i o n
to
u s i n g t h e U C B L f o o t o r t h o s i s .
S i x o r t h o t i s t s c o n s i s t e n t l y m o d i f y
the
f o o t
or
t h o s i s . W e d g e s and m e t a t a r s a l r e l i e f p a d s are
a d d e d by tw o p r a c t i t i o n e r s . One o r t h o t i s t u s e s
S p e n c o * b u i l d u p s , p r e s u m a b l y
for
b e t t e r w e i g h t
d i s t r i b u t i o n
and
r e d u c t i o n
of
s h e a r s t r e s s e s .
A n o t h e r a d d s a V e l c r o s t r a p o v e r the d o r s u m of
t h e f o o t
to
p r e v e n t
the
f o o t f r o m p i s t o n i n g .
To
d e c r e a s e
the
s l i d in g
of the
f o o t o r t h o s i s
on the
i n s o l e
of
t h e s h o e ,
one
o r t h o t i s t l i n e s
the
b o t t o m
s u r f a c e of the o r t h o s i s w i t h m o l e s k i n or t h in
n o n - s k i d r u b b e r .
D I S C U S S I O N
T h e U C B L fo o t o r t h o s i s
was
f i r s t pub l ic ized
in
S e p t e m b e r 1 9 6 9 ,
and
i n t r o d u c e d
in the
e d u c a t i o n
p r o g r a m s in l a t e 1 9 7 1 . Th e f a c t t h a t 75 p e r c e n t of
t h e s u r v e y e d p r a c t i t i o n e r s
had
u s e d
the
o r t h o s i s
b y J a n u a r y
1974 is a
t e s t i m o n y
to the
s p e e d t h a t
p r o v e n r e s e a r c h
in
th is field
is
a p p l i e d
to the
p a t i e n t . P r o b a b l y no o t h e r m e d i c a l or p a r a m e d i
c a l s p e c i a l t y can r e a l i z e t h e s e p a t i e n t b e n e f i t s
f r o m r e s e a r c h o n l y f o u r
and
o n e - h a l f y e a r s a f t e r
t h e i n i t i a l i n t r o d u c t i o n
of a
t e c h n i q u e .
T h e u t i l i z a t i o n o f t h i s o r t h o s i s
may
d e c r e a s e
in
t h e f u t u r e as t h e r m o p l a s t i c , t h e r m o f o r m e d
l o w e r - l i m b o r t h o s e s ga i n a c c e p t a n c e . H o w e v e r ,
t h e U C B L f o o t a l i g n m e n t p r i n c i p l e s s ti ll a p p l y
to
, t h e f o o t s e c t i o n o f t h e r m o p l a s t i c a n k l e - f o o t o r t h o
s e s and k n e e - a n k l e - f o o t o r t h o s e s , and s h o u l d be
u s e d w h e n e v e r p o s s i b l e .
R E F E R E N C E S
1. Amer ican Board for C ertif ication in O r tho t ics &
Prosthetics, Inc.,
1974 Registry of Accred ited Facilities
and Certified Individuals
in
Orthotics
and
Prosthetics,
Washing ton , D.C. ,
1974.
2. C o m m i t t e e
on
P r o s th e t i c s R e se a r c h
and De
velopment, A
Clinical Evaluation of Four Lower-Limb
Orthoses, National Acad emy of Scien ces, W ashington ,
D.C., 1971.
3.
H e n de r so n , W . H . ,
and J. W.
Ca m p b e l l , U C - BL
shoe insert : casting
and
fabrication.
Bull. Pros. Res.
10-11
:215-235, Spring
1969.
4. LeB lanc, Maurice A., Aclinical evaluation offour
lo we r - l im b o r th o se s . Orth. and Pros. 26:1:27-47,
March
1972.
5.
M e r e d a y ,
C.,
C .M .E . D o la n ,
and R.
Lussk in ,
Evaluation of the UCBL Shoe Insert
in
Flexible
Pes
Planus. New
York Univers i ty , Sep tem ber
1969.
*A
foam rubbe r that
is
impregnated with n itrogen
bubbles.
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A P P E N D I X A
C O M M I T T E E O N P R O S T H E T I C S R E S E A R C H A N D D E V E L O P M E N T
D I V I S I O N O F M E D I C A L S C I E N C E S — N A T I O N A L R E S E A R C H C O U N C I L
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N E W P U B L I C A T I O N S
P R O C E E D I N G S , F I R ST I N T E R N A T I O N A L
C O N G R E S S O N P R O S T H E T I C S T E C H
N I Q U E S A N D F U N C T I O N A L R E H A B I L I
T A T I O N , s p o n s o r e d b y t h e W o r l d V e t e r a n s
F e d e r a t i o n , w i t h t h e c o o p e r a t i o n o f t h e I n t e r
n a t i o n a l S o c i e t y f o r P r o s t h e t i c s a n d O r t h o t i c s ,
M a r c h 1 9 - 24 , 1 9 7 3 , V ie n n a , Au s t r i a , 4 Vo l
u m e s , 1 15 7 p p . , 3 0 0 A u s t r i a n S c h i l l i n g s , A v a i l
a b l e f ro m W e i n e r M e d i z i n i s c h e A k a d e m i e ,
S t a d i o n g a s s e 6 - 8 , A 1 0 1 0 V i e n n a , A u s t r i a .
T h i s r e p o r t c o n t a i n s m o r e t h a n 2 0 0 p a p e r s p r e
s e n t e d a t t h e F i r s t I n t e r n a t i o n a l C o n g r e s s o n
P r o s t h e t i c s T e c h n i q u e s a n d F u n c t i o n a l R e h a b i l i
t a t i o n . A l t h o u g h t h e p a p e r s a r e s h o r t , a v e r a g i n g
a b o u t fi v e p a g e s e a c h , a n d m o s t , t h e r e f o r e , d o
n o t g o i n t o d e t a i l , n e a r l y e v e r y a s p e c t o f r e s e a r c h
a n d p r a c t i c e i n l im b p r o s th e t i c s a n d o r th o t i c s i s
t o u c h e d u p o n . M o s t o f t h e p r e s e n t a t i o n s a r e c o n
c e r n e d w i t h p r o s t h e t i c s , a n d a r e i n E n g l i s h , a l
t h o u g h a f e w a r e in G e r m a n a n d F r e n c h . A l
th o u g h f e w o f t h e a r t i c l e s a r e we l l i l l u s t r a t e d , t h i s
4 - v o l u m e p u b l i c a t i o n is a n e x c e l l e n t r e f e r e n c e
s o u r c e a n d s h o u l d b e a v a i l a b l e t o e v e r y o n e i n
v o l v e d i n r e s e a r c h i n p r o s t h e t i c s a n d o r t h o t i c s . I t
w i ll b e a l s o o f t r e m e n d o u s i n t e r e s t t o c l i n i c i a n s
w h o w a n t t o k e e p u p t o d a t e b y i n t r o d u c i n g i n t o
th e i r p r a c t i c e t h e l a t e s t f i n d in g s f r o m r e s e a r c h .
C O M P R E H E N S I V E M A N A G E M E N T O F
M U S C U L O S K E L E T A L D I S O R D E R S I N
H E M O P H I L I A , ( R e p o r t o f) A S y m p o s i u m
h e l d i n M i a m i B e a c h , F l o r i d a , O c t o b e r 1 2 - 1 4 ,
1972 ;
e d i t e d b y N e w t o n C . M c C o l l o u g h , I I I ,
C o m m i t t e e o n P r o s t h e t i c s R e s e a r c h a n d D e
v e l o p m e n t , N a t i o n a l A c a d e m y o f S c i e n c e s ,
W a s h i n g t o n , D . C . , U . S . A . , 2 1 4 p p , $ 6 . 2 5 .
T h i s b o o k c o n t a i n s t h e l e c t u r e s a n d f o l l o w i n g
d i s c u s s i o n s w h i c h w e r e g i v e n d u r i n g a s y m
p o s i u m a b o u t t h e m e t h o d s of t r e a t i n g m u s c u l o
s k e l e t a l d i s o r d e r s i n h e m o p h i l i a .
T h e r e s u l t i s a r a t h e r c o m p l e t e s y n o p s i s o f t h e
p r e s e n t l e v e l o f k n o w l e d g e i n t h e p r o b l e m s o f
h e m o p h i l i a . B e s i d e s a l u c id a n d u n d e r s t a n d a b l e
r e p r e s e n t a t i o n o f q u e s t i o n s c o n c e r n i n g
p a t h o g e n e s i s a n d p a t h o l o g i c a l p h y s i o l o g y , t h e
a u t h o r s h a v e c l i n ic a l p r o b l e m s p r i m a r i l y in v i e w ,
a n d t h e r e f o r e c o n c e n t r a t e o n t h e p o s s i b i l i t i e s a n d
n e c e s s i t i e s fo r p r o v i s i o n o f o r t h o s e s f or t h e
h e m o p h i l i c p a t i e n t . F u r t h e r m o r e , t h e a u t h o r s d e
sc r ib e t h e p o ss ib i l i t i e s o f su r g i c a l p r o c e e d in g s i n
c a s e o f d e f o r m i t i e s a n d s e v e r e a r t h r o s i s d e f o r
m a n s o c c u r r i n g b e c a u s e o f in t r a - a r ti c u l a r b l e e d
i n g . I t a l s o r e f e r s to s y n o v e c t o m y w h e n c o n s e r
v a t i v e t r e a t m e n t h a s f a i l e d .
I n c o n c l u s i o n , o n e f i n d s d i r e c t i o n s o f m a n a g e
m e n t wh ic h a r e v a lu a b l e i n c a se o f p l a n n in g a
h e m o p h i l i a c e n t e r . T h e a c t u a l p r o b l e m s a r e
c l e a r l y d e s c r i b e d i n t h i s b o o k , a n d w h i l e r e a d i n g
t h e p a p e r s t h o r o u g h l y , o n e c a n f i n d m u l t i p l e i m
p u l se s f o r f u r th e r r e s e a r c h i n t h i s f i e ld .
F .
K o c h ( H e i d e l b e r g )
A D V A N C E S I N E X T E R N A L C O N T R O L O F
H U M A N E X T R E M I T I E S , P r o c e ed i n g s o f t h e
F o u r t h I n t e r n a t i o n a l S y m p o s i u m o n E x t e r n a l
C o n t r o l o f H u m a n E x t r e m i t i e s , D u b r o v n i k ,
A u g u s t 2 8 - S e p t e m b e r 2 , 19 7 2; E d i t e d b y M o m -
c i l o M . G a v r i l o v i c a n d A . B e n n e t t W i l s o n , J r . ,
Y u g o s l a v C o m m i t t e e f o r E l e c t r o n i c s a n d A u
t o m a t i o n ( E T A N ) , B e l g r a d e , Y u g o s l a v i a , 8 0 3
p p . $ 20 .
As in d i c a t e d i n t h e t i t l e , t h i s m a ss i v e v o lu m e i s
c o m p o s e d o f t h e p a p e r s p r e s e n t e d a t t h e F o u r t h
I n t e r n a t i o n a l S y m p o s i u m o n E x t e r n a l C o n t r o l o f
H u m a n E x t r e m i t i e s . T h i s se r i e s o f s y m p o s i a c o n
t i n u e s t o a t t r a c t m o r e a n d m o r e w o r k e r s
t h r o u g h o u t t h e w o r l d w h o a r e e n g a g e d i n r e
s e a r c h a n d d e v e l o p m e n t c o n c e r n i n g e x t e r n a l l y
p o w e r e d p r o s t h e s e s a n d o r t h o s e s a n d r e l a t e d
w o r k s u c h a s t h e s t i m u l a t i o n o f d e n e r v a t e d m u s
c l e f o r f u n c t io n . T h i s i s n o t a b o o k th a t m o s t
c l i n i c i a n s w i l l wa n t t o d o m o r e t h a n p e r u se , b u t i t
i s a p u b l i c a t i o n t h a t a l l p e o p le i n v o lv e d in r e
h a b i l it a t io n e n g i n e e r i n g r e s e a r c h a n d d e v e l o p
m e n t s h o u l d h a v e b e c a u s e it c o n t a i n s i n f o r m a t i o n
c o n c e r n i n g n e a r l y e v e r y p a s t a n d p r e s e n t p r o j e c t
i n t h e fi eld o f e x t e r n a l ly p o w e r e d p r o s th e s e s a n d
o r t h o s e s , p l u s a g r e a t d e a l m o r e i n a l li e d a r e a s .
65
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66
N E W P U B L I C A T I O N S
T H E C A R E O F T H E R H E U M A T O I D H A N D ,
T h i r d E d i t i o n , b y A d r i a n F l a t t , T h e C . V .
M o s b y C o . , S t . L o u i s , 1 9 7 4 , 2 9 6 p p . , $ 2 4 . 7 5 .
T h e t h i r d e d i t i o n o f " T h e C a r e o f t h e
R h e u m a t o i d H a n d " is a r a t h e r m a j o r r e v i s i o n o f
th e se c o n d e d i t i o n o f t h i s d e f in i t i v e t e x t o n t h e
r h e u m a t o i d u p p e r l i m b w h i c h w a s p u b l i s h e d i n
1968.
R E H A B I L I T A T I O N A F T E R C E N T R A L
N E R V O U S S Y S T E M T R A U M A , e d i te d by
H a r r y B o s t r o m , T a g e L a r s s o n , a n d N i l s
L j u n g s t e d t , N o r d i s k a B o k h a n d e l n s F o r l a g ,
S t o c k h o l m , 2 5 5 p p . , 1 9 7 4 .
T h i s b o o k i s a r e p o r t o f a n i n t e r n a t i o n a l sy m
p o s i u m s p o n s o r e d i n 19 73 b y t h e S k a n d i a G r o u p .
F i f t e e n p a p e r s , a n d e n s u i n g d i s c u s s i o n , o n v a r i
o u s a s p e c t s o f r e h a b i l i t a t i o n o f i n d i v i d u a l s s u f fe r
i ng f r o m c e n t r a l n e r v o u s s y s t e m d i s o r d e r s a r e
i n c l u d e d .
1 9 7 4 C O N F E R E N C E O N E N G I N E E R I N G
D E V I C E S IN R E H A B I L I T A T I O N , B i om e d
i ca l E n g i n e e r i n g C e n t e r , T u f t s U n i v e r s i t y ,
B o s t o n , M a s s a c h u s e t t s , R i c h a r d A . F o u l d s
a n d B r e n d a L . L u n d , e d s . , 1 50 p p . , $ 2 0 .
T h i s i s a c o l l e c t i o n o f 3 6 p a p e r s g iv e n a t t h e
1 97 4 C o n f e r e n c e o n E n g i n e e r i n g D e v i c e s i n R e
h a b i l i t a t i o n , h e l d M a y 2 - 3 , a n d s p o n s o r e d b y t h e
B i o m e d i c a l E n g i n e e r i n g C e n t e r , T u f t s - N e w E n
g l a n d M e d i c a l C e n t e r , M e d i c a l R e h a b i l i t a t i o n
R e s e a r c h a n d T r a i n i n g C e n t e r , T u ft s U n i v e r s i t y ,
t h e D e p a r t m e n t o f P h y s i c a l a n d R e h a b i l i t a t i o n
M e d i c i n e , T u f t s U n i v e r s i t y , a n d t h e R e h a b i l i t a
t i o n I n s t i t u t e o f t h e N e w E n g l a n d M e d i c a l C e n t e r
H o s p i t a l . I n c l u d e d a r e p a p e r s o n " S e n s o r y I m
p a i r m e n t , " " B l i n d n e s s a n d L o w V i s i o n s , "
" T e l e p h o n e A i d s , " " S e n s o r y C o n t r o l a n d F e e d
b a c k , " " L o c o m o t i o n a n d M o b i l i t y , " " I n n o v a
t iv e P r o g r a m s , " a n d " D e a f n e s s . " B e c a u s e th e
p a p e r s w e r e p r e s e n t e d v o l u n t a r i l y , t h i s r e p o r t b y
n o m e a n s c o v e r s t h e f i e l d s .
N e v e r t h e l e s s , s o m e r e l a t i v e l y n e w c o n c e p t s
a r e o f f e r e d i n t h i s we l l - e d i t e d a n d n i c e ly p r e
s e n t e d p u b l i c a t i o n , a n d t h o u g h t h e p r i c e s e e m s
e x c e ss iv e , it sh o u ld b e i n c lu d e d in e v e r y l i b r a r y
c o l l e c t i o n o n r e h a b i l i t a t i o n r e s e a r c h .
B U L L E T I N O F P R O S T H E T I C S R E S E A R C H ,
F A L L 1 9 7 3 , ( B P R 1 0- 2 0) , U . S . V e t e r a n s A d
m in i s t r a t i o n , 3 9 0 p p . , 1 90 i l l u s . , a v a i l a b l e f r o m
S u p e r i n t e n d e n t o f D o c u m e n t s , U . S . G o v e r n
m e n t P r i n t i n g O f f i c e , W a s h i n g t o n , D . C . 2 0 4 0 2 ;
$ 3 . 1 5 ( p a y a b l e i n a d v a n c e ) .
Featured in This Issue:
" T h e M o r e T h i n g s C h a n g e , t h e M o r e T h e y S t a y
t h e S a m e " — T . J . R a d l e y
D i s p l a c e m e n t S e n s o r s a n d T h e i r A p p l i c a t i o n t o
C o n t r o l o f S y n t h e t i c a l l y P o w e r e d P r o s t h e s e s
a n d O r t h o s e s — C . H . H o s h a l l
E x p e r i m e n t a l E v a l u a t i o n o f W h e e l c h a i r C u s h
i o n s : R e p o r t o f a P i lo t S t u d y — G . V . B . C o c h r a n
a n d G . S l a t e r
S w i v e l W a l k e r s f or P a r a p l e g i c s — C o n s i d e r a t i o n s
a n d P r o b l e m s in T h e i r D e s i g n a n d
A p p l i c a t i o n — G . K . R o s e a n d J . T . H e n s h a w
F u n c t i o n a l E l e c t r i c a l S t i m u l a t i o n — A N e w H o p e
f o r P a r a p l e g i c P a t i e n t s ? — A . K r a l j a n d S .
G r o b e l n i k
T r a n s f e r r i n g L o a d to F l e s h — P a r t V I . S o c k e t
B r i m R a d i u s E f f e c t s — L . B e n n e t t
A M e t h o d o f R e c o r d i n g P r e s s u r e D i s t r i b u t i o n
U n d e r t he S o le o f t h e F o o t — P . L e r e i m a n d F .
S e r c k - H a n s s e n
T h e E x t r a - A m b u l a t o r y L i m b C o n c e p t a s i t A p
p l ie s t o t h e B e l o w - K n e e A m p u t e e S k i e r — J . M .
G r a v e s a n d E . M . B u r g e s s
B i o e n g i n e e r i n g D e s i g n a n d D e v e l o p m e n t o f
L o w e r - E x t r e m i t y O r t h o t i c D e v i c e s — H . R .
L e h n e i s , W . F ri s i na , H . W . M a r x , a n d T a m a r a
T . S o w e l l
S e m i f l e x i b l e B o d y J a c k e t w i t h I n f l a t a b l e
P a d s — J . M . M o r r i s , K . L . Markolf, a n d H .
H i t t e n b e r g e r
A b s t r a c t of a S u m m a r y R e p o r t o n R e s e a r c h a n d
D e v e l o p m e n t in t h e F i e l d o f A r t i fi c i al L i m b s
( J u l y 1 9 7 3 ) — H . A . M a u c h
A b s t r a c t of a S u m m a r y R e p o r t o n t h e D e v e l o p
m e n t o f a R e a d i n g M a c h i n e f o r t h e B l i n d ( J u l y
1 9 7 3 ) — G . C . S m i t h a n d H . A . M a u c h
C o m m i t t e e o n P r o s t h e s t i c s R e s e a r c h a n d D e
v e l o p m e n t , C o m m i t t e e o n P r o s t h e t i c - O r t h o ti c
E d u c a t i o n , D i v i s i o n o f M e d i c a l S c i e n c e s
— N a t i o n a l R e s e a r c h C o u n c i l , N a t i o n a l
A c a d e m y of S c i e n c e s — N a t i o n a l A c a d e m y o f
E n g i n e e r i n g , A n n u a l S u m m a r y R e p o r t A c
t i v i t i e s f o r Y e a r E n d e d Ju n e 3 0 , 1 97 3
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N E W P U B L I C A T I O N S
6 7
V A P r o s th e t i c s C e n t e r R e s e a r c h R e p o r t — A .
S t a r o s a n d E . P e i z e r
H i g h l i gh t s o f O t h e r V A R e s e a r c h P r o g r a m s
P r o s t h e t i c s — E d i t e d b y E . F . M u r p h y
S e n s o r y A i d s — E d i t e d b y H . F r e i b e r g e r
R e l a t e d I t e m s o f I n t e r e s t
How to Purchase Previous Issues:
S t il l a v a i l a b l e fo r p u r c h a s e f r o m t h e S u p e r i n t e n
d e n t o f D o c u m e n t s a r e :
B PR 1 0 -1 3 Sp r in g 1 9 70 a t $ 1 .5 0 e a c h
B PR 10-14 Fa l l 1970 a t $1 .2 5 ea ch
B PR 1 0- 17 Sp r in g 1 9 72 a t $ 1 .25 e a c h
B P R 10-18 Fa l l 1972 a t $2 .3 5 e ac h
BP R 1 0 -1 9 Sp r in g 1 9 73 a t $ 2 .0 5 e a c h
Remittances From Abroad:
N o a d d i t i o n a l c h a r g e i s r e q u i r e d i f m a i l i n g is
w i t h i n t h e U n i t e d S t a t e s , i ts p o s s e s s i o n s ,
C a n a d a , M e x i c o , a n d a ll C e n t r a l a n d S o u t h
A m e r i c a n c o u n t r i e s e x c e p t A r g e n t i n a , B r a z i l ,
B r i t i s h G u i a n a , F r e n c h G u i a n a , a n d S u r i n a m
( D u t c h G u i a n a ) , a n d B r i t i s h H o n d u r a s . W h e r e
f o r e ig n m a i l i n g is r e q u i r e d , a d d 25 % to t h e t o t a l
c o s t o f t h e n u m b e r o f B u l l e t i n s o r d e r e d . R e m i t
t a n c e s f r o m o t h e r c o u n t r i e s s h o u l d b e b y i n t e r n a
t i o n a l m o n e y o r d e r o r d r a f t o n a U n i t e d S t a t e s
b a n k , p a y a b l e to t h e S u p e r i n t e n d e n t o f D o c u
m e n t s . U N E S C O c o u p o n s m a y a l so b e u s e d .
Foreign money orders and postage stamps are
not acceptable.
T H E M A N A G E M E N T O F M U S C U L O
S K E L E T A L P R O B L E M S I N T H E
H A E M O P H I L I A S , b y R . B . D u t h i e , J . M .
M a t t h e w s , C . R . R i z z a , a n d W . M . S t e e l ,
B l a c k w e l l S c i e n t i f ic P u b l i c a t i o n s , O s n e y
M e a d , O x f o r d O X 2 O E L , E n g l a n d , 1 7 9
p p . £ 5 . [ I n t h e U . S . a n d C a n a d a , o r d e r f r o m J .
B . L i p p i n c o t t C o m p a n y , P . O . B o x 7 , P h il a d e l
p h i a , P e n n s y l v a n i a 1 9 1 0 5 , $ 2 0 . 0 0 ]
T h e " b l e e d i n g " d i s e a s e h as b e e n d i s a s t r o u s t o
d y n a s t i e s . I t c a n a l s o b e d i s a s t r o u s t o f a m i l i e s .
F o r m o s t s u f f e r e rs i n d e v e l o p e d c o u n t r i e s , t h e
f e a r o f b l e e d i n g t o d e a t h f r o m m i n o r t r a u m a h a s
b e e n l a r ge l y r e m o v e d b y t h e t r e a t m e n t s d e
v e l o p e d o v e r t h e p a s t f o r t y y e a r s . T h e f ea r o f
p r o g r e s s i v e a n d d i s a s t r o u s c r i p p l i n g h a s r e
m a i n e d a n d i n d e e d b e c o m e s g r e a t e r w i t h t h e s u r
v iv a l i n to a d u l t l i f e . T h e p r o p e r u se o f b lo o d
d e r i v a t i v e s w h i c h a r e n o w a v a i l a b l e s h o u l d n o w
p r e v e n t s e v e r e m u s c u l o s k e l e t a l c o m p l i c a t i o n s i n
a ll b u t e x c e p t i o n a l c i r c u m s t a n c e s . T h i s n e e d s
c o n s t a n t s u p e r v i s i o n a n d s k i l l e d c a r e .
A r e c e n t s u r v e y ( 1 9 7 2 ) b y t h e U . S . N a t i o n a l
H e a r t a n d L u n g I n s t i t u t e s h o w e d t h a t t h e r e a r e
a p p r o x i m a t e l y 2 5 ,5 0 0 m o d e r a t e t o s e v e r e
h a e m o p h i l i a c s i n t h e U n i t e d S t a t e s . A n e s t i m a t e d
1 0 , 8 0 0 p h y s i c i a n s w e r e t r e a t i n g t h e s e p a t i e n t s o f
w h o m o v e r 6 0 p e r c e n t h a d o n l y o n e p a t i e n t .
O t h e r c o u n t r i e s m a y h a v e b e t t e r m a n a g e m e n t
th a n th i s ; b u t u n ti l a ll su f f e r e r s f r o m h a e m o p h i l i a
a r e u n d e r e x p e r t c a r e , it w i l l r e m a in a g r o s s c r ip
p l i n g d i s e a s e .
Ox f o r d h a s b e e n in t h e f o r e f r o n t o f r e s e a r c h
i n t o t h e c a u s e a n d c a r e o f t h e s e d i s e a s e s . T h i s
b o o k i s a d i s t i l l a t e of t h e i r e x p e r i e n c e o f t h e m a n
a g e m e n t of m u s c u l o s k e l e t a l s e q u e l a e i n o v e r
1 ,0 0 0 p a t i e n t s .
T h e fi rs t t h r e e c h a p te r s r e v i e w th e e t i o lo g y a n d
m e d i c a l m a n a g e m e n t . F o l l o w i n g c h a p t e r s d is
c u s s t h e m a n a g e m e n t o f a c u t e e p i s o d e s s u c h a s
b l e e d i n g i n to j o i n t s , m u s c l e s , n e r v e s a n d t h e
m a n a g e m e n t o f f r a c t u r e s . A c h a p t e r o n c y s t s a n d
p s e u d o t u m o r s p r o v i d e s a b r i d g e b e t w e e n t h e
a c u t e a n d c h r o n i c . C h a p t e r s o n c h r o n i c a r
t h r o p a t h y a n d r e c o n s t r u c t i v e s u r g e r y fo l lo w . F i
n a l l y , t h e r e i s a c h a p t e r o n p h y s i o t h e r a p y .
T h e r e w i l l b e m i n o r d i f f e r e n c e s o f o p i n i o n
a b o u t s o m e a s p e c t s of t r e a t m e n t s u c h a s t h e u s e
o r a b u s e o f b l o o d d e r i v a t i v e s in l o n g - t e r m
p r o p h y l a x i s , p a r t i c u l a r l y s e l f - a d m i n i s t e r e d i n t h e
h o m e . T h e r e a r e t h o s e w h o w o u l d n o t a g r e e w i t h
t h e p o l i c y o f a s p i r a t i o n o f h a e m a r t h r o s i s .
T h e r e i s n o r e f e r e n c e t o o r t h o t i c s p r i n c i p l e s ,
e i t h e r o f a t e m p o r a r y o r p e r m a n e n t m a t e r i a l o r
f o r i n t e r m i t t e n t o r p r o l o n g e d u s e . T h e i n d e x g i v e s
t w o r e f e r e n c e s t o c a l i p e r s a n d a n u m b e r o f r e f e r
e n c e s t o sp l i n t s , b u t t h e t e x t g iv e s n o d e t a i l o f f i t
o r s t r u c t u r e .
T h e l a y o u t a n d p r in t i n g a r e o f h ig h q u a l i t y . T h e
i l l u s t r a t i o n s a r e w e l l r e p r o d u c e d a n d o p p o s i t e t o
t h e t e x t . T h e u n i n f o r m e d s h o u l d n o t b e t r e a t i n g
h a e m o p h i l i a . T h e i n f o r m e d wi l l f i n d m u c h in t h i s
b o o k t o s u p p l e m e n t t h e i r k n o w l e d g e , a n d i t w i l l
su re ly f ind a p lace in the i r l ib rar ies .
E . E . H a r r i s . M . R . C . S .
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68
N E W P U B L I C A T I O N S
P U B L I C A T I O N S A V A I L A B L E
F R O M C P R D / C P O E
The fo l lowing i s a par t ia l l i s t o f repor ts o f
w o r k s h o p s , s y m p o s i a , e t c . , s p o n s o r e d b y t h e
C o m m i t t e e s o n P r o s t h e t i c s R e s e a r c h a n d D e
v e l o p m e n t a n d P r o s t h e t i c - O r t h o t i c E d u c a t i o n
( C P R D - C P O E ) , N a t i o n a l A c a d e m y o f
S c i e n c e s — N a t i o n a l R e s e a r c h C o u n c i l , w h i c h a re
c u r r e n t l y a v a i l a b l e .
I n d i v i d u a l c o p i e s o f t h e s e r e p o r t s a r e a v a i l a b l e
a s l o n g a s t h e su p p ly l a s t s w i th o u t c h a r g e u n l e s s
o t h e r w i s e i n d i c a t e d . A d d r e s s r e q u e s t s t o C o m
m i t t e e o n P r o s t h e t i c s R e s e a r c h a n d D e v e l o p
m e n t , N a t i o n a l A c a d e m y o f S c i e n c e s , 2 1 01 C o n
s t i tu t i o n A v e n u e , N . W . , W a s h i n g t o n , D . C .
2 0 4 1 8 .
Annual summary report,
a c t i v i t i e s f o r y e a r e n d
i ng J u n e 3 0 , 1 97 3 , C o m m i t t e e o n P r o s t h e t i c s
R e s e a r c h a n d D e v e l o p m e n t , N a t i o n a l
A c a d e m y o f S c i e n c e s .
Below-knee and above-knee prostheses,
r e p o r t o f
a w o r k s h o p h e l d J a n u a r y 2 7 - 2 9 , 1 9 7 3 , i n S e a t
t l e ,
W a s h i n g t o n .
Below-knee prosthetics,
r e p o r t o f a s y m p o s i u m
h e l d D e c e m b e r 1 6 - 1 8 , 1 9 6 8 , in N e w Y o r k C i t y .
Bracing of children with paraplegia resulting
from spina bifida and cerebral palsy,
r e p o r t o f
a w o r k s h o p h e l d O c t o b e r 2 - 4 , 1 96 9 , i n C h a r
lo t t e sv i l l e , V i r g in i a .
The cane as a mob ility aid for the blind,
r e p o r t o f
a c o n f e r e n c e h e l d S e p t e m b e r
1 0 - 1 1 ,
1 9 7 1 ,
W a s h i n g t o n , D . C .
Cast-bra cing of fractures,
r e p o r t o f a w o r k s h o p
h e l d J a n u a r y 2 7 - 2 8 , 1 9 7 1 , in D e n v e r , C o l o r a d o .
The child with an acquired amp utation,
r e p o r t o f
a s y m p o s i u m h e l d J u n e 9 - 1 1 , 1 9 7 0 , i n T o r o n t o ,
O n t a r i o , C a n a d a . A v a i l a b l e f r o m : N a t i o n a l
A c a d e m y o f S c i e n c e s , P r i n t i n g a n d P u b l i s h i n g
O f f i c e , 2 1 0 1 C o n s t i t u t i o n A v e n u e , N . W . ,
W a s h i n g t o n , D . C . 2 0 4 1 8 . P r i c e $ 5 . 5 0 .
Clinical evaluation of the Ljub ljana functional
electrical peroneal brace,
R e p o r t E - 7 , 1 9 7 3 .
Clinical evaluation of a compreh ensive approach
to below -knee orthotics,
R e p o r t E - 6 , 1 9 7 2 .
Comprehensive management of musculoskeletal
disorders in hemop hilia,
r e p o r t o f a s y m
p o s iu m h e ld O c t o b e r 1 2 - 14 , 19 7 2 , i n M ia m i
B e a c h , F l o r i d a . A v a i l a b l e f r o m : N a t i o n a l
A c a d e m y of S c i e n c e s , P r i n t i n g a n d P u b l i s h i n g
O f f i c e , 2 1 01 C o n s t i t u t i o n A v e n u e , N . W . ,
W a s h i n g t o n , D . C . 2 0 4 1 8 . P r i c e $ 6 . 2 5 .
Cosmesis and modular limb prostheses,
a r e p o r t
o f a c o n f e r e n c e h e ld M a r c h 3 - 7 , 1 9 7 1 , i n Sa n
F r a n c i s c o , C a l i f o r n i a .
The effect of pressure on soft tissues,
a r e p o r t o n
a w o r k s h o p h e ld S e p t e m b e r 2 1 -2 2 , 1 9 7 1, i n
H o u s t o n , T e x a s .
Eighth worksho p panel on lower-extremity
prosthetics fitting
o f t h e S u b c o m m i t t e e o n D e
s i gn a n d D e v e l o p m e n t , D e c e m b e r 1 4, 1 9 64 ,
M i a m i B e a c h , F l o r i d a .
Evaluation of sensory aids for the visually
handicapped,
a r e p o r t o n a c o n f e r e n c e h e l d
N o v e m b e r 1 1- 12 , 1 9 7 1 , i n W a s h i n g t o n , D . C .
Evaluation of synthetic b alata for fabricating
sockets for below -knee amputation stumps,
Re p o r t E - 3 , 1 9 7 0 .
Functional neurom uscular stimulation
, r e po r t o f
a w o r k s h o p h e l d A p r i l 2 7 - 2 8 , 1 9 72 , a t
B e t h e s d a , M a r y l a n d .
The geriatric am putee: principles of man age
ment,
p r o c e e d i n g s o f a w o r k s h o p h e l d J u n e 9 -1 0 ,
1969 ,
i n W a s h i n g t o n , D . C . A v a i l a b l e f r o m : N a
t i o na l A c a d e m y o f S c i e n c e s , P r i n t i n g a n d P u b
l i s h in g O f f i ce , 2 1 0 1 C o n s t i t u t i o n A v e n u e , N . W . ,
W a s h i n g t o n , D . C . 2 0 4 1 8 . P r i c e $ 3 . 5 0 .
Internal structural prostheses,
r e p o r t o f a w o r k
sh o p h e ld Ap r i l 1 3 - 1 5 , 1 9 72 in Ch a r lo t t e s v i l l e ,
V i r g i n i a .
A preliminary evaluation of the Bionic
Instruments — Veterans Adm inistration,
S e p t e m b e r 1 9 7 3 .
Pressure and force measurement
, r e p o r t o f a
w o r k s h o p h el d M a y 2 7 - 2 8 , 19 6 8 , i n N e w Y o r k
C i t y .
Rehab ilitation engineering: a plan for continued
progress,
A p r i l 1 9 7 1 , W a s h i n g t o n , D . C .
Selected lower-limb anom alies—surgical and
prosthetics management,
r e p o r t o f a s y m
p o s i u m h e l d M a y 8 -9 , 1 9 6 9, i n W a s h i n g t o n , D .
C . A v a i l a b l e f r o m N a t i o n a l A c a d e m y o f S c i
e n c e s , P r in t i n g a n d Pu b l i s h in g Of f i c e . 21 01
C o n s t i t u t i o n A v e n u e , N . W . , W a s h i n g t o n ,
D . C , 2 0 4 1 8 . P r i c e $ 2 . 9 5 .
Seventh worksho p panel on lower-extremity
orthotics
o f t h e S u b c o m m i t t e e o f D e s i g n a n d
D e v e l o p m e n t , M a r c h 9 - 12 , 1 97 0, D o w n e y ,
Ca l i f o r n i a .
7/23/2019 1974 Orthotics and Prosthetics
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Seventh worksho p panel on upper-extremity
prosthetics
o f t h e S u b c o m m i t t e e o n D e s i g n a n d
D e v e l o p m e n t , E x t e r n a l l y P o w e r e d T e rm i n a l
D e v i c e s J u l y
3 0 - 3 1 ,
1 9 6 9 , S a n t a M o n i c a ,
Cal i fornia .
Spinal orthotics, r e p o r t o f a w o r k s h o p h e l d
M ar c h 28 -29 , 1969 , i n Sa n Fr an c i sc o , C a l i for
nia .
The Veterans Adm inistration Prosthetics Center
patellar-tendon-bearing brace-clinical
applications,
R e p o r t E-2 , 1970 .
W orkshop on knee-disarticulation prosthetics
o f
t h e S u b c o m m i t t e e o n D e s i g n a nd D e v e l o p
m e n t , h e l d J u n e 2 2 - 2 3 , 1 9 7 0 , S a n F r a n c i s c o ,
Cal i fornia .
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70
I N F O R M A T I O N F O R A U T H O R S
O R T H O T I C S A N D P R O S T H E T I C S
I N V IT E S T H E S U B M I S S I O N O F A L L A R T I C L E S A N D M A N U S C R I P T S
W H I C H C O N T R I B U T E T O O R T H O T I C A N D
P R O S T H E T I C P R A C T I C E , R E S E A R C H , A N D
E D U C A T I O N
All s u b m i t t e d m a n u s c r i p t s s h o u l d i n c l u d e :
1 . T H E O R I G I N A L M A N U S C R I P T A N D T W O C O P I E S . If p o s s i b l e , t h e d u p l i c a t e m a n u s c r i p t s
s h o u l d b e c o m p l e t e w i t h i l l u s t r a t i o n s t o f a c i l i ta t e re v i e w a n d a p p r o v a l .
2 . B I B L I O G R A P H Y . T h i s s h o u l d b e a r r a n g e d a l p h a b e t i c a l l y a n d c o v e r o n l y r e f e r e n c e s m a d e in
t h e b o d y o f t h e t e x t .
3 .
L E G E N D S . L i s t a l l i l l u s t r a ti o n l e g e n d s i n o r d e r , a n d n u m b e r t o a g r e e w i t h i l l u s t r a t i o n s .
4 . I L L U S T R A T I O N S . P r o v i d e a n y o r a ll o f t h e f o l l o w i n g :
a . B l a c k a n d w h i t e g l o s s y p r i n t s
b .
O r i g i na l d r a w i n g s o r c h a r t s
Donot s u b m i t :
a . S l i d e s ( c o l o r e d o r b l a c k & w h i t e )
b . P h o t o c o p i e s
P R E P A R A T I O N O F M A N U S C R I P T
1 . M a n u s c r i p t s m u s t b e T Y P E W R I T T E N , D O U B L E - S P A C E D a n d h a v e W I D E M A R G I N S .
2 .
I n d i c a t e F O O T N O T E S b y m e a n s o f s t a n d a r d s y m b o l s (*).
3 .
I n d i c a t e B I B L IO G R A P H I C A L R E F E R E N C E S by m e a n s of A r a b i c n u m e r a l s in p a r e n t h e s e s (6 ).
4 .
W r i t e o u t n u m b e r s l e s s t h a n t e n .
5 . D o n o t n u m b e r s u b h e a d i n g s .
6 . U s e t h e w o r d " F i g u r e " a b b r e v i a t e d t o i n d i c a t e r e f e r e n c e s t o i l l u s t r a t i o n s in t h e t e x t (. . . a s
s h o w n i n F i g . 1 4)
P R E P A R A T I O N O F I L L U S T R A T I O N S
1 . N u m b e r a ll i l l u s t r a t i o n s .
2 . O n t h e b a c k i n d i c a t e t h e t o p o f e a c h p h o t o o r c h a r t .
3 . W r i t e t h e a u t h o r ' s n a m e o n t h e b a c k o f e a c h i l l u s t r a t i o n .
4 .
D o n o t m o u n t p r i n t s e x c e p t w i t h r u b b e r c e m e n t .
5 . U s e c a r e w i t h p a p e r c l i p s ; i n d e n t a t i o n s c a n c r e a t e m a r k s .
6 . D o n o t w r i t e o n p r i n t s ; i n d i c a t e n u m b e r , l e t t e r s , o r c a p t i o n s o n a n o v e r l a y .
7 . If t h e i l l u s t r a t i o n h a s b e e n p u b l i s h e d p r e v i o u s l y , p r o v i d e a c r e d i t l in e a n d i n d i c a t e r e p r i n t
p e r m i s s i o n g r a n t e d .
N O T E S :
— M a n u s c r i p t s a r e a c c e p t e d f or e x c l u s i v e p u b l i c a t i o n in O R T H O T I C S A N D P R O S T H E T I C S .
— A r t i c l e s a n d i l l u s t r a t i o n s a c c e p t e d f o r p u b l i c a t i o n b e c o m e t h e p r o p e r t y of O R T H O T I C S A N D
P R O S T H E T I C S .
— R e j e c t e d m a n u s c r i p t s w ill b e r e t u r n e d w i t h in 6 0 d a y s .
— P u b l i c a t i o n o f a r t ic l e s d o e s n o t c o n s t i t u t e e n d o r s e m e n t of o p i n i o n s a n d t e c h n i q u e s .
— A ll m a t e r i a l s p u b l i s h e d a r e c o p y r i g h t e d b y t h e A m e r i c a n O r t h o t i c a n d P r o s t h e t i c A s s o c i a
t i o n .
— P e r m i s s i o n t o r e p r i n t i s u s u a l l y g r a n t e d p r o v i d e d t h a t a p p r o p r i a t e c r e d i t s a r e g i v e n .
— A u t h o r s w ill b e s u p p l i e d w i t h 2 5 r e p r i n t s .
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RESOLUTION CONCERNING THE METRIC SYSTEM
T h e f o l l o w i n g r e s o l u t i o n w a s a d o p t e d b y t h e B o a r d o f D i r e c t o r s o f t h e A m e r i c a n
O r t h o t i c a n d P r o s t h e t i c A s s o c i a t i o n a t i ts m e e t i n g in S a n D i e g o O c t o b e r 3 , 1 9 73 :
W H E R E A S b y A c t o f C o n g r e s s it h a s b e e n d e t e r m i n e d th a t t h e U n i t e d
S t a t e s s h o u l d p r o c e e d t o w a r d s a d o p t i o n o f t h e m e t r i c s y s t e m a s u s e d
a l m o s t u n i v e r s a l l y t h r o u g h o u t t h e r e s t o f t h e w o r l d , a n d
W H E R E A S t h e t e c h n o l o g ic a l p r o f e s s i o n s a n d m a n y s e g m e n t s o f t h e
h e a lt h p r o f e s s i o n s h a v e c o m m o n l y u s e d t h e m e t r i c s y s t e m o v e r a n e x
t e n d e d p e r i o d o f t i m e , a n d
W H F R E A S it i s i m p o r t a n t f or m e m b e r s o f t h e o r t h o t i c / p r o s t h e t i c p r o
f e s s i o n s t o i n t e r a c t w i t h t h e i r c o l l e a g u e s in t h e m e d i c a l a n d t e c h n o l o g i
c a l c o m m u n i t i e s f o r o p t i m u m p a t i e n t s e r v i c e b e it h e r e b y
R E S O L V E D t ha t t h e A m e r i c a n O r th o t ic a n d P r o s t h e t i c A s s o c i a t i o n
e n d o r s e s t h e u s e o f t h e m e t r i c s y s t e m b y it s m e m b e r s a n d o t h e r o r t h o t i c
a n d p r o s t h e t i c p r a c t i t i o n e r s in t h e U n i t e d S t a t e s , a n d in w i t n e s s o f t h i s
e n d o r s e m e n t a n d A s s o c i a t i o n u r g e s th e e d i t o r s o f i ts j o u r n a l
Orthotics
and Prosthetics
t o c o m m e n c e th e d u a l r e p o r t i n g o f w e i g h t s a n d
m e a s u r e m e n t s in b o t h t h e E n g l i s h a n d m e t r i c s y s t e m s a t t h e e a r l i e s t
p o s s i b l e d a t e w i t h t h e o b j e c t i v e o f e m p l o y i n g t h e m e t r i c s y s t e m s o l e l y
b y t h e t i m e o f t h e 2 9 t h V o l u m e in 1 9 7 5 .
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72
METRIC SYSTEM
Conversion Factors
LENGTH
Equivalencies
angstrom
millimicron*
micron micrometer) =
x 10-
6
meter 0.00 0 001 m)
1 x 10-
1 0
meter 0.0 00 0 00 0 001 m)
) x 10-
9
meter 0.0 00 000 001 m)
To Convert from
inches
feet
yards
miles
To
meters
meters
meters
kilometers
Multiply by
0.0254+
0.30480+
0.91440+
1.6093
AREA
To convert from
square inches
square feet
square meters
square meters
VOLUME
Definition
1 liter = O.OOlt cubic meter or one cubic decimet er d m
3
)
1 milliliter = It cubic centimeter)
To convert from
cubic inches
ounces U.S. fluid)
ounces Brit, fluid)
pints U.S. fluid)
pints Brit, fluid)
cubic feet
MASS
To convert from
pounds (avdp.)
slugs*
FORCE
To convert from
ounces-force ozf)
ounces-force ozf)
pounds-force lbf)
pounds-force lbf)
To
cubic centimeters
cubic centimeters
cubic centimeters
cubic centimeters
cubic centimeters
cubic meters
To
kilograms
kilograms
To
newtons
kilogram-force
newtons
kilogram-force
0.00063616+
.092903
•This double-prefix usage is not desirable. This unit is actually a nanometer 10 -
9
meter = 10-
+ For practical purposes all subsequent digits are zeros.
Multiply by
16.387
29.574
28.413
473.18
568.26
0.028317
Multiply by
.45359
14.594
Multiply by
0.27802
0.028350
4.4732
0.45359
centimeter).
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73
S T R E S S ( O R P R E S S U R E )
T o co nv er t f ro m
p o u n d s - f o r c e / s q u a r e i n c h ( p s i )
po unds- f o rce / squa re inch ( ps i )
po un ds- f o rce / sq ua re inch ( ps i )
T O R Q U E (O R M O M E N T )
T o co nv er t f ro m
po und- f o rce - f ee t
po und- f o rce - f ee t
E N E R G Y ( O R W O R K )
T o
n e w t o n / s q u a r e m e t e r
n e w t o n / s q u a r e c e n t i m e t e r
k i lo g ra m - f o rce / squa re cent im et er
T o
n e w t o n m e t e r
k i lo g ra m - f o rce m et ers
Def in i t io n
One j o u le ( J ) is the wo rk do n e by a o n e - n ew t o n f o rce m o v ing t hro ug h a
disp la cem ent o f o ne m et er in t he d irec t io n o f t he f o rce .
T o co nv er t f ro m
f o o t - p o u n d s - f o r c e
f o o t - p o u n d s - f o r c e
ergs
b.t u.
f o o t - p o u n d s - f o r c e
1 ca l (gm) = 4 .1840 j o u l e s
T o
j o u l e s
m et er - k i lo g ra m - f o rce
j o u l e s
ca l (gm)
cal (gm)
M ul t ip ly by
6 8 9 4 . 8
0.68948
0.070307
Mult iply by
1.3559
0.13826
M ult ip ly by
1.3559
0.13826
1 x 1 0 -
7
f
2 5 2 . 0 0
0.32405
T E M P E R A T U R E C O N V E R S I O N T A B L E
To convert °F to °C
°F
9 8 . 6
9 9
9 9 . 5
1 0 0
1 0 0 .5
101
1 0 1 .5
102
1 0 2 .5
1 0 3
1 0 3 .5
1 0 4
1 .8
°C
3 7
3 7 . 2
3 7 . 5
3 7 . 8
3 8 .1
3 8 . 3
3 8 . 6
3 8 . 9
3 9 . 2
3 9 . 4
3 9 . 7
4 0 . 0
* A s l u g .is a u n i t o f m a s s w h i c h i f a c t e d o n b y a f o r c e o f o n e p o u n d w i l l h a v e a n a c c e l e r a t i o n o f o n e f o o t p e r
s e c o n d p e r s e c o n d .
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74
NEW ABC CERTIFIED PRACTITIONERS
T h e f o l lo w i n g c a n d i d a t e s s u c c e s s f u l l y p a r t i c i p a t e d i n t h e 1 9 74 p r a c t i t i o n e r e x a m i n a t i o n s o f t h e
A m e r i c a n B o a r d f o r C e r t i f i c a t io n i n O r t h o t i c s a n d P r o s t h e t i c s , I n c . a n d h a v e b e e n a w a r d e d c e r t if i c a
t i o n in t h e i n d i c a t e d d i s c i p l i n e .
C e r t i f i e d O r t h o t i s t
C e r t i f i e d P r o s t h e t i s t
Sandberg , Daryl W.
Barney, James A.
Blommaer ts , Frank J .
Boles ,
Marvin L.
Bos tock, Frank H.
Burgess , Morgan L.
But ler , Vernon H.
Campbel l , John W.
Cash, Lewis W., J r .
Craig, John G.
Daniels , Frank S.
Ar thur , Rober t W.
Barnhar t , David W.
Barton, Calvin C.
Berman , K enne th M .
Byer s ,
James L.
Chadwel l , Benjamin E.
Chagnon, Kenneth L.
Chang, Chung-Woo S .
Chang, Thomas C.
Cummings , Wil l iam L.
S hamp , N . J os eph
Sosnoff,
H arvey
Tempfel , Ernes t F .
Tindall , David N.
Tirimacco, Philip S.
Wake, Char les F .
Warren , Jonathan P .
Wooten, Jan L.
Ybarra , Rober t
Yennie , Marvin D.
Det tmer , Mark S .
Erskine, S tevan A.
Dillard, John C.
DiPompo, Michael
Certified P ros the t i s t /Or thot i s t
Finger, Joe M.
DiSanto , Anthony R.
Booden, Jack , J r .
Griffith, Steven T.
Doran, Rober t E.
Brace, David A.
Guenther , Galen G.
Douglas, Roy D.
Brelsford, Bill B.
Hall, Michael T.
Dralle, Alan J .
Brown, Rober t N.
Hardcas t le , David D.
Ellepola, Wijegupta M.B.
Caspers , Car l A.
Hoo per, Claren ce R. Elliott , Gen e
Conner , Roger D.
Kince r, Richard D. Eng land, Michael F.
Doyle, William
Koch, Larry D.
Floyd, F. Michael
Filippis , Eugene D.
Lam ber ty , Eugenio A. Garcia , Manuel R. Ful ler ton , Jer ry D.
Long, Danny E.
Garret t , James A.
Goller , Herbert
Luri, Alan E.
Goff, James B.
Green, Kenneth D.
Mattingly, Leslie G.
Goodman, Donald O.
Kintz, John J .
McCulloch, Rober t S .
G u th , Thomas
Kramer , Herber t E.
Newton, Timothy J .
Gruman, Gregory S .
Lane, L. D. , J r .
Palumbo, Rober t L.
Hall, Larry J .
Lindberg, Paul T.
Pascavage , Joseph L. Hal l , Robe r t C.
Marvin , Raymond W.
Quirantes , Alber to
Hansford, David P.
Mereday, Clif ton S.
Ram charran , Sooklall Harshberge r , Jera ld J .
Meyers , Gerald G.
Rom an, Donald A. Hen son, Rodney D.
M cM anamon , P a t r i ck J .
San che z, Teofilo Janu laitis , Erdvilis
Morr is , Louis C.
Schul te , John F . J iu iden, Roger L. Neumann, Wil l iam C.
Showers , David C.
Kegg, Larry O.
Panton, Hugh J .
S ims , Terry T.
Kidd, Ronald L.
Parmley, Andrew J .
Strasser, Jarl V.
Klotz , John S .
Pr ince, Marvin M.
Supan, Terry J .
Konigismann, Gunter
Schumacher , Paul
Tazaw a, Eiji Leimku ehler , Rober t V.
Shal low, S teven C.
Thom pson, Harold E. , J r . Lessa r , John J .
Silver, Eugene P.
Topolew ski , Ralph T. Logo s , Jame s F .
Sima, Francis R.
Tosoonia n , Ronald F . Lo ve, Jer ry E.
S imons , Bernard C.
Trexler, Gary S.
McMorr is , J . R.
Stubbs, William V.
Tucker , Lonnie B.
Mitchell , Walter R.
Thranhardt , Howard E.
Weintrob, Joan C.
Nederveld , Douglas A.
Tippy, Leo V.
Whites ide , S teven R. Potter , Gordon J . Trautman, Paul A.
Racet te , Walter L.
Truesdale , Donald C.
Reger, Steven I .
Vinnecour , Kei th E.
Rodr iguez, Jose R.
Wunder , K enne th E .
Ross, Ralph J .
Yanke, Mark J .
Ruzich , John W.
Yocham, Johnie L.
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READY TO
FIT
HAND, WRIST AND FINGER BRACES,
CERVICAL
BRACES,
TRAINING
AIDS
AND SPECIAL
APPLIANCES - PLUS
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LINE
OF SPINAL
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YOUR MEASUREMENTS.
COMPLETE CATALOG AVAILABLE ON REQUEST
C. D. DEN ISO N
ORTHOPEDIC APPLIANCE
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X I I I
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dm
SUPPLIERS TO
PROSTHETIC ORTHOTIC FACILITIES
Complete Line Of
Components Supplies
For
Immediate Post Operative
Prosthetic Fittings
Write for Comp lete Information
O R L O N ® L Y C R A ® S T U M P S O C K S
4
Par Carton
Rotted
Ready For
Application
FOR IMMEDIATE
P o s t O p e r a t i v e P r o s t h e t ic F i t t i n g
C U R I T Y
L A M B S
W O O L
1
oz
Packages
COMFORT Alt
A M P U T A L C
A M P - A I D
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A M P U - B A L M
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M A N N E Q U I N F I N I S H
F O R A R T I F I C I A L L I M B S
F I V E C O L O R S T O C H O O S E
F R O M
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K N I T -R I T E, I N C
1 1 2 1 G R A N D A V E N U E • K A N S A S C I T V. M I S S O U R I 6 4 1 0 6
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X I V
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T O R O N T O TRILATERAL
• ORTHOLEN
• ARCH SUPPORTS
• POSTERIOR SPLINTS
• SHEETS
* PELITE
SOFT , M ED., & FIRM
P O L Y E T H Y L E N E
FOAM
PADDING
O R T H O P E D I C
E stab l i she d 1914
P . O . B O X 1 6 7 8 C H A T T A N O O G A . T E N N . 3 7 4 0 1
X V
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Riaidlv
im
'I
f
o r
m a x i m u m a c c e p t a n c e b y y o u r
S p i n a l a p p l i a n c e s a r e o u r o n l y
p r o d u c t . T h e y ' r e so ld o n l y t h r o u g h
e t h i c a l d i s p e n s i n g o r t h o t i s t s . S o
w e t r y t o m a k e e a c h o f o u r c o l l a r s a n d
b r a c e s t h e b e s t o f i t s k in d - l i k e
o u r n e w T w o - P o s t C e r v i c a l B r a c e -
spinal
d o c t o r s a n d p a t i e n t s . A n d w e
b a c k t h e m u p w i t h s e r v i c e t o y o u .
S e r v i c e l i k e 2 4 - h o u r d e l i v e r y o f
p r e s c r i p t i o n b r a c e s a n y w h e r e
i n t h e c o u n t r y . P l u s a p r i c e
s t r u c t u r e t h a t c a n m a k e
o u r s e r v i c e y o u r m o s t
p r o f i t a b l e wa y - to f i l l sp in a l
a p p l i a n c e p r e s c r i p t i o n s .
F o r m o r e i n f o r m a t i o n ,
w r i t e P . 0 . B o x 1 2 9 9 ,
W i n t e r P a r k , F l o r i d a 3 2 7 8 9 .
F lor id a Brace C orp orat ion
X V I
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T h e Kingslcy S a c h F o o t
For m en, wom en , and children,
t he K i n g s l e y S a c h F o o t is
a un ion of durable M edatha ne
and natural carved hardw ood.
The K in gs le y pr oc ess
features three densities
of M edath ane in one mo ld,
curing simultaneously.
Th e entire length
of the sole is reinforced
with two-ply nylon fabric
for long term durability.
The K in gs le y S a c h Fo ot o ffers
every patient the essential security
wh ich leads to m aximu m independence.
Write
for com plete catalog.
W
1984 PLACENTIA AVENUE • COSTA MESA CALIFORNIA 92627 • (714) 5
XVII
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<
Sutton's SJ/4 Jack
Sander..
.
YOU'LL HAVE AN ATTACHMENT FOR IT
Or maybe 23 optional attachments. Sutton is an old pro at
making jack sanders. They know what limb brace makers
want and
need
and you can get it all in the
SJ/4.
Two
4"
x
60" fast cutting, quick-change
belts;
a great dust
collector;
front-opening dust drawer; iy
2
hp
motor;
big
shelf.
Use full
belt width for faster leveling. Three other models available.
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36201, P.O. Box 1791, phone 205-237-0611
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a n d m e d i c a l r e q u i r e m e n t s . H e l p s p u t a p o s t
s u r g i c a l p a t i e n t b a c k o n
h i s f e e t . . . m a k e s h i m
a m b u l a t o r y b y p r o v i d i n g
c u s t o m f e a t u r e s th a t
a n t i c i p a t e p r a c t i c a l l y
a ll p o s t s u r g i c a l
p r o b l e m s .
W r i t e : E . J . S a b e l C o . , B o x 6 4 4 , J e n k i n t o w n , P a . 1 9 0 4 6
S l o p i n g , p a d d e d , n o - c h a f e t o p l in e .
E x t r a w i d e ,
7
p a d d e d t o n g u e
a c c o m m o d a t e s s w e l l in g s a n d b a n d a g i n g .
H e a v y f o a m
i n t e r l i n i n g w i t h
s o f t , g l o v e
l e a th e r l i n i n g
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P r e - d r i l l e d h o l e s
i n s t e e l s h a n k
a r e m a r k e d a n d
l o c a t e d o n
l e a t h e r i n s o l e .
N a tu r a l l a s t w i th f u l l ,
s q u a r e d - o f f t o e . N e i t h e r
r i g h t n o r l e f t E l o n g a t e d
h e e l .
S t e e l s h a n k i s p r e -
d r i l l e d f o r e a s y b r a c e
a t t a c h m e n t . H e e l is
e x t r a l o n g t o a c c e p t
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4 0 P a t t e r s o n S t r e e t , N . E . T e l e p h o n e
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S i z e s 4 - 1 3 i n v a r y i n g w i d t h s . E x t r a
l a r g e s i z e r a n g e a l so a v a i l a b l e .
C o l o r s : B l a c k , W h i t e B r o w n ,
S m o k e , B l u e G r e e n , T a u p e , M i s -
m a t e S e r v i c e o n B l a c k O n l y .
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T he
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C L A S S I F I E D A D V E R T I S E M E N T S
A dver t i s ing Ra tes
R e g u l a r — F i r s t 3 5 w o r d s , $ 2 4 . 0 0 ( m i n i m u m ) . A d d i t io n a l w o r d s $ 1 . 0 0 e a c h . S i t u a t i o n s
w a n t e d a d v e r t i s e m e n t s ha lf r a t e . S p a c e r a t e a d d i t i o n a l : 1 3 X 1 3 p i c a s - $ 1 0 5 . 0 0 ; 1 3 X 1 8 p i c a s -
$ 1 8 0 . 0 0 .
S p e c i a l — M e m b e r s of t h e A m e r i c a n A c a d e m y of O r th o t i s ts a n d P r o s t h e t i s t s w h o w i s h to
adv er t i s e the i r ava i lab i li ty on a s ig ne d o r un s ig ne d ba s i s a r e en t i t l ed to do s o a t the s pe c ia l r a t e
o f $5 .00 pe r f ive l ine in s e r t ion pe r i s s ue . Each add i t iona l l ine , $1 .00 .
M a il a d d r e s s e d t o N a t i o n a l O f fi ce f o r w a r d e d u n o p e n e d a t n o c h a r g e . C l a s s i fi e d A d v e r
t i s e m e n t s a r e t o b e p a i d in a d v a n c e ; c h e c k s s h o u l d b e m a d e p a y a b l e t o " O r t h o t i c s a n d P r o s t h e t i c s " .
S e n d t o : E d i to r , O r t h o t i c s a n d P r o s t h e t i c s , 1 4 4 4 N S t . , N . W . , W a s h i n g t o n , D . C . 2 0 0 0 5 .
C A N A D A
P R O S T H E T I S T - O R T H O T I S T
C e r t i f i e d o r e l i g i b l e f o r c e r t i f i c a t i o n t o
w o r k in a c o m p r e h e n s i v e P r o s t h e t i c a n d
O r t h o t i c D e p a r t m e n t s e r v i n g p a t i e n t s o f a ll
a g e s w i t h i n a R e g i o n a l R e h a b i l i t a t i o n
C e n t e r a f f i li a t e d w i t h M c M a s t e r U n i v e r s i t y .
S a l a r y c o m m e n s u r a t e w i t h e x p e r i e n c e .
E x c e l l e n t f r i n g e b e n e f i t s .
A p p l y t o :
P e r s o n n e l D i r e c t o r ,
C h e d o k e H o s p i t a l s ,
P o s t O f f i c e B o x 5 9 0 ,
H a m i l t o n , O n t a r i o ,
C a n a d a .
L8N 3L6 .
C E R T I F I E D P R O S T H E T I S T - O R T H O T I S T
E x p a n d i n g u n i v e r si t y m e d i c a l c e n t e r in a
c h a r m i n g S o u t h e a s t l o c a t i o n i s s e e k i n g a
q u a l if i ed i n d iv i d u al t o a s s u m e d e p a r t m e n
t a l d i r e c t o r s h i p . C o m p l e t e l i n e o f f r i n g e
b e n e f i t s a v a i l a b l e , i n c l u d i n g e d u c a t i o n a l
o p p o r t u n i t i e s ; s a l a r y n e g o t i a b l e . P l e a s e
r e p l y , i n c o n f i d e n c e , t o :
S t a f f P l a n n i n g S u p e r v i s o r
T h e N . C . M e m o r i a l H o s p i t a l
C h a p e l H i ll, N . C . 2 7 5 1 4
AN E Q U A L O P P O R T U N I T Y E M P L O Y E R
O R T H O T I S T O R O R T H O T I S T
P R O S T H E T I S T
O u r b u s i n e s s is g r o w i n g s o w e n e e d t o
g r o w a l s o . O u r p r e f e r e n c e is f or a n e x p e r i
e n c e d m a n a n d c e r t i fi c a t i o n i s n o t n e c e s
s a ry . S a l a r y c o m m e n s u r a t e w i t h e x p e r i
e n c e . B e n e f i t s .
B u r g e - L l o y d S u r g i c a l C o . , I n c .
4 6 0 C a l i f o r n i a A v e n u e
R e n o , N e v a d a 8 9 5 0 2
p h o n e — 3 2 2 - 3 4 8 8 ( a r e a c o d e - 7 0 2 )
P R O S T H E T I S T A N D / O R O R T H O T I S T
M a j o r h o s p i t a l s y s t e m in N o r t h e r n V i r g i n i a
( m e t r o p o l i t a n W a s h i n g t o n ) is s t a ff i n g i t s
n e w O r t h o t i c s - P r o s t h e t i c s L a b o r a t o r y . D e
s i r e c e r t i f ie d o r e x p e r i e n c e d p e r s o n w i t h
r e a l i n t e r e s t in a d v a n c e d p l a s t i c s a n d e l e c
t r o n i c s t e c h n o l o g i e s . C o n t a c t P e r s o n n e l
D e p t . , T h e F a i r fa x H o s p i t a l , 3 3 0 0 G a l l o w s
R o a d , F a l l s C h u r c h , V i r g i n i a , 2 2 0 4 6 . (7 0 3 )
6 9 8 - 3 1 5 6 E . O . E .
C E R T I F I E D P R O S T H E T I S T
A N D / O R O R T H O T I S T
D e l g a d o C o l l e g e o f f e r s a f a c u l t y p o s i t i o n
in it s g r o w i n g O & P D e p a r t m e n t . M a k e
t e a c h i n g y o u r s a t is f y in g a n d r e w a r d i n g
c a r e e r . R e s u m e w il l b e c o n f i d e n t i a l .
C h a r l e s R . G o l d s t i n e
D e l g a d o J u n i o r C o l l e g e
6 1 5 C i t y P a r k A v e n u e
N e w O r l e a n s , L A 7 0 1 1 9
O R T H O T I C S C H I E F
C e r t i fi e d O r t h o t i c s C h i e f f or p i o n e e r i n g o r
t h o t i c s d i v i s io n of t h i s m a j o r c h r o n i c d i s
e a s e h o s p i t a l . M u s t b e e x p e r i e n c e d in
l o w e r a n d u p p e r e x t r e m i t y o r t h o t i c s , i n
c l u d i n g e x t e r n a l p o w e r a n d p l a s t i c s . A p
p l i c a t i o n s t o D r. C h a r l e s L o n g , II, C o -
D i r e c t o r , P . M . & R ., C u y a h o g a C o u n t y
H o s p i t a l , H i g h l a n d V i e w H o s p i t a l , C l e v e
l a n d , O h i o 4 4 1 2 2
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C A N A D A
P R O S T H E T I C - O R T H O T I C
T E C H N I C I A N
To pe r fo rm du t ies o f a t echn ica l na tu re in a
w e l l -equ ipped Pros the t i c and Or tho t i c D e
par tm en t w i th in a R eg iona l R eha b i l it a t i on
Center a f f i l ia ted w i th McMaster Univers i ty .
S a la r y c o m m e n s u r a t e w i t h e x p e r i e n c e .
Exce l lent f r inge benef i ts .
App ly t o :
Personne l D i rec tor ,
Chedoke H osp i t a l s ,
Post Of f ice Box 590,
H a m i l t o n ,
On ta r io ,
C anada , L8N 3L6 .
P R O S T H E T I S T A N D O R T H O T I S T
A N D
P R E S C R I P T I O N S H O E F I T T E R
New York C i ty fac i l i t y has above pos i t ions
ava i lab le . C e r t i f ica t i on no t r equ i red . Sa la ry
neg o t iab le .
E s c h e n P r o s t h e t i c a n d O r t h o t i c
La bo rato r ies, In c. , 156 E. 116th Street , N.Y.,
N.Y. 10029 (212) 369-7575.
O R T H O P E D I C B U S I N E S S
Estab l i shed Or thoped ic /Su rg ica l app l i ance
bus iness . Eastern & Southern s ta tes . Send
i n f o r m a t i o n t o :
T . K. H as t ing s , C O .
C e r t i f i e d O r t h o p e d i c C o .
1904 F la tbu sh Ave .
B r o o k l y n ,
N.Y. 11210
O R T H O T I S T
Exper ienced Or tho t i s t needed , no t neces
sa r il y ce r t i f ied . P ro f i t - shar ing , r e t i r em en t
p lan , and o the r f r i ng e bene f i t s . Con tac t :
D a n fo r th Or tho ped ic B race
1820 N. Orange Ave .
Or lando , F lo t i da 32804
(305) 898-4251
P R O S T H E T I S T A N D O R T H O T I S T
W a n t e d :
P r o s t h e t i s t a n d o r t h o t i s t , c e r
t i f i ed .
C om m u n i t y w he re the qu a l it y o f l if e
and qual i ty o f p rac t ice are not exc lus ive .
Ou ts tan d ing opp or tu n i t y ex i s ts i n a com
m u n i t y i n t h e U p p e r P e n i n s u l a o f
M i c h i g a n . Base popu la t i on 300 ,000 . Spe
c ia l t y g rou p o f 45 board ce r t i f i ed phys i
c ians i nc lu d ing 6 o r thoped is t s , 1 phys ia -
t r i s t and 1 neu rosu rg eon and a C r ipp led
C h i l d r e n ' s C l i n i c .
An ou ts tand ing p lace to l i ve and ra ise
c h i l
d r e n ,
a l o n g w i t h e x c e l l e n t o p p o r t u n i t i e s
for hunt ing , f i sh ing , sk i ing , sa i l ing and cu l
t u r e .
I f in te rested, p lease contact :
J .
M ichae l Coyne , M.D .
Med ica l Cen te r
1414 W. Fa i r Avenue
Marquet te , Mich igan 49855
M A N A G E R O R T H O T I C -
P R O S T H E T I C F A C I L I T Y
Needed—Orthot is t o r Prosthe t is t to m a n
age com ple te O/P Fac i l i ty . S ta f f o f 7 in
c lu des o r tho t i s t s , p ros the t i s ts , f ab r i ca t i on
techn ic ians and o f f i ce pe rsonne l . Fac i l i t y
l oca ted i n t he Sou thw es t . M anag em ent Ex
pe r ience R equ i red . Sa la ry com m ens u ra te
w i th ab i li ty . Bonu s based on pe r fo rm anc e .
O R T H O T I S T S - P R O S T H E T I S T S
N e e d e d — O r t h o t i s t s a n d P r o s t h e t i s t s i n
t e re s t e d in a d v a n c e m e n t to m a n a g e m e n t o f
O/P pat ient care fac i l i t ies . Shou ld be Board
C er t i fi ed o r E l ig ib le . Sa la ry com m ensu ra te
w i th ab i l i ty . Bonu s based on pe r fo rm an ce .
O r thom ed ics i s a leade r i n t he o r tho t i c -
p ros the t i c f i e l d . We have 8 pa t ien t ca re
fac i l i ti es . Gene rou s com pan y be ne f i t s a re
p r o v i d e d .
C o n t i n u i n g e d u c a t i o n o p p o r
tu n i t i es i n t he p ro fess ion a re p rov ided , as
w e l l as t r a in ing in bus iness m ana g em ent ,
pe rsonne l r e la t i ons and su pe rv i s ion .
A l l c o m m u n i c a t i o n s a r e c o n f i d e n t i a l . W r i te
o r
ca l l :
S am E. H a m o n t re e , C P .
Execu t i ve V i ce Pres iden t
O r t h o m e d i c s , I n c .
8332 Iowa Street
D ow ney , Ca l i f o rn ia 90241
(213) 862-2117
X X V
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A M E R I C A N B O A R D F O R C E R T I F IC A T I O N IN
O R T H O T I C S A N D P R O S T H E T I C S , IN C .
Eligibility Requirements for Practitioner
Examinat ion
V a l i d T h r o u g h
E x a m Y e a r
E duca t io n
E x per ience
1 9 7 5
H . S . + 3 s h o r t c o u r s e s 4 y e a r s
1 9 7 5
H . S . o r l e s s f o r e x t e n s i o n
o f t i t l e *
N o t a p p l i c a b l e
1 9 7 5
A . A . i n O r t h o t i c s o r P r o s t h e t i c s
f r o m al l s c h o o l s e x c e p t N o r t h w e s t e r n
U n i v e r s i t y
3 y ea rs
1 9 7 7
H . S . + 3 s h o r t c o u r s e s f o r
e x t e n s i o n o f t i t l e
N o t a p p l i c a b l e
1 9 7 9 A . A . i n O r t h o t i c s o r P r o s t h e t i c s
v i a N o r t h w e s t e r n U n i v e r s i t y
2 y e a r s
1 9 7 9 A . A . i n O r t h o t i c s a n d / o r
P r o s t h e t i c s f r o m a l l o t h e r
s c h o o l s + 3 s h o r t c o u r s e s
3 y ea rs
1 9 7 9
2 y e a r s o f c o l l e g e t r a i n i n g ,
i n c l u d i n g p re s c r ib e d c o u r s e s * *
+ 3 s h o r t c o u r s e s
3 y ea rs
1 9 7 9 M i n i m u m o f b a c c a l a u r e a t e i n o t h e r
field , i n c l u d i n g p r e s c r i b e d c o u r s e s * *
+ 3 s h o r t c o u r s e s
2 y ea rs
1 9 8 0 +
B a c h e l o r s d e g r e e in O r t h o t i c s
a n d P r o s t h e t i c s
1 y ea r
* M ust me et educat ion al qua l i f icat ions in ef fect a t t im e of or ig inal cert i f icat ion.
• •P res cr i be d co u rse wo rk co ns i s t s o f a t l ea s t 3 2 sem est er h o urs ( 4 8 qua r t er ho urs )
in t he f o l lo wing co urses , t o inc lude , ho wev er , no m o re t ha n 8 sem est er ho urs
(12 quarter hours) in any one subject area: Engl ish and speech, bio log ica l
sc i ences , phy s ic s a nd eng ineer ing , chem is t ry , m a t hem a t ic s , psy cho lo g y , a nd sho p
t ra in ing .
As a ppro v ed by B o a rd o f Direc t o rs , Aug ust 3 ,1 9 7 4
X X V I
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