Prosthetics and Orthotics Manufacturing Guidelines: Lower limb Orthotics: Patellar Tendon-Bearing Orthosis

8/9/2019 Prosthetics and Orthotics Manufacturing Guidelines: Lower limb Orthotics: Patellar Tendon-Bearing Orthosis

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Physical Rehabilitation Programme

Patellar

tendon-bearing orthosis

Manufacturing guidelines


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3/32Manufact uring Guid el ines P at el lar Tend on-Bearing Ort hosis

Tb o cott

Foreword 2

Introduction 4Choosingbetweentwomethods 4

1.Castingandrectication 5

2.PBOwithanterior-closingshell 6

2.1EVApreparationorincreasedweightrelie 6

2.2MouldingoEVA 7

2.3Orthosistrimline 8

2.4Plasticreinorcement 9

2.5Posteriorshell 10

2.6.Anteriorshell 12

2.7Preparationorinitialtting 14

2.8Initialttingandnishing 17

3.PBOwithposterior-closingshell 19

3.1EVApreparationorincreasedweightrelie 19

3.2MouldingoEVA 20

3.3Orthosistrimline 21

3.4Plasticreinorcement 22

3.5Anteriorshell 22

3.6Posteriorshell 25

3.7Preparationorinitialtting 26

3.8Initialttingandnishing 27

Listomanuacturingmaterials 28


4/32 ICRC P hysical Rehab i l i t at ion P rog ramme

Forwor

T ICRC poypropy tcooy

Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedtheuseotechnologythatisappropriatetothespeciccontextsinwhichtheorganizationoperates,i.e.,countriesaectedbywarandlow-incomeordevelopingcountries.

Tetechnologymustalsobetailoredtomeettheneedsothephysicallydisabledinthecountriesconcerned.

Tetechnologyadoptedmustthereorebe:

durable,comortable,easyorpatientstouseandmaintain; easyortechnicianstolearn,useandrepair; standardizedbutcompatiblewiththeclimateindierentregionsotheworld; low-costbutmodernandconsistentwithinternationallyacceptedstandards; easilyavailable.

Techoiceotechnologyisogreatimportanceorpromotingsustainablephysicalrehabilitationservices.

Forallthesereasons,theICRCpreerredtodevelopitsowntechniqueinsteadobuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.TecostothematerialsusedinICRCprostheticandorthoticdevices

islowerthanthatothematerialsusedinappliancesassembledromcommercialready-madecomponents.

WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanuacturedlocally.Intheearly1990stheICRCstartedtheprocessostandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,orthesakeoharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityoservicestopatients.

Polypropylene(PP)wasintroducedintoICRCprojectsin1988orthemanuactureoprostheticsockets.Terstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents

suchasvariousalignmentsystemswererstdevelopedinColombiaandgraduallyimproved.Inparallel,adurableoot,madeinitiallyopolypropyleneandEthylVinylAcetate(EVA),andnowopolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberoot.

In1998,aercareulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertoocusonpatientcareandtrainingopersonnelatcountrylevel.



Objctiv o t mu

TeICRCsManuacturingGuidelinesaredesignedtoprovidetheinormationnecessaryorproductionohigh-qualityassistivedevices.

Temainaimsotheseinormativemanualsareasollows:

opromoteandenhancestandardizationoICRCpolypropylenetechnology; oprovidesupportortrainingintheuseothistechnology; opromotegoodpractice.

Tisisanothersteporwardintheeorttoensurethatpatientshaveaccesstohigh-qualityservices.

ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme



Cooi btw two mto

Teollowingindicationsmighthelpinmakingachoicebetweenthetwopossiblemethods.

Wit ri: prti or compt?

Accordingtotheprescriptionand/orthepathology,theorthosismustpartiallyorcompletelyrelievetheweightappliedontheleg.

othisend,alayeroEVAisaddedundertheootpriortothedrapingothepolypropylene.

Teollowingguresgivearoughestimateothedegreeoweightrelie:

NoEVA:70%otheweightonthelegand30%ontheorthosis. 3mmEVA:50%onthelegand50%ontheorthosis. 6mmEVA:30%onthelegand70%ontheorthosis. 12mmEVA:0%onthelegand100%ontheorthosis.

Itrouctio

Teaimothisdocumentistodescribetwomethodsorproducingpatellar tendon-bearing (PTB)orthoses,workingwiththeICRCpolypropylenetechnologyandorthopaediccomponentsusedat

theICRCsphysicalrehabilitationcentres.

Anterior-closing shell Posterior-closing shell

Weak at ankle level, especially or heavy

patients or patients walking with ankle

dorsiexion.

Strong at ankle level, thus suitable or

overweight patients or patients walking with

ankle dorsiexion.

Easy to t into normal shoes.

Sometime difcult to t into normal shoes

because o the volume o the orthosis at

mid-oot.



Patientassessment,castingandrecticationopositivecastimpressionsareperormedinaccordancewithprostheticandorthotic(P&O)standards,takingintoaccounttheollowingpoints: Teproximalpartismanuacturedlikeatrans-tibialprosthesisandensurestheweight-bearing

unction. Tedistalpartismanuacturedlikeanankle-ootorthosis. Teremustbelittleornoweightborneonthelegwhilethecastisbeingtaken. Inthemethodinvolvingaposterior-closingshell,theEVAusedtoincreaseweightrelieisplacedonlyundertheheel,soitafects the position o the cast(seesection3.1,page19).

CasTIng and ReCTIF ICaTIOn1



2.1 eVa prprtio or icr wit ri

Followtheproceduredescribedbelow,orgoontothenextsectionithepatientdoesnotrequire

additionalweightrelie.

PTBO WITh anTeRIOR-ClOsIng shell2

4PlacetheplastermodelontheEVAsheetanddrawalinearoundit1cmwiderthantheoot.

4Holdtheplastermodelinavice.

HeattheEVAat120or3to5minutes,dependingonitsthicknessandontheeciencyotheoven.

PuttheEVAundertheootandholditrmlyinplacewithanelasticbandageoroneminute.

GrindtheedgeotheEVAuntilitisperectlyalignedwiththeshapeotheplastermodel.



6GluetheEVAundertheplastermodel.

2.2 Moui o eVa

EVA(6mm)canbemouldedpriortodrapingothepolypropylene: toimprovecomort; topreventskinbreakageinpatientswithsensationloss.

Followtheproceduredescribedbelow,orgoontothenextsectioniEVAisnotrequired.

4Positiontheplastermodelwiththeoreootpointingdownwards.

CutapieceoEVA: width,kneecircumerence; length,thelengthotheplastermodel(leg+oot);

thickness,6mm.

HeattheEVAat120or3to5minutes,dependingontheeciencyotheoven.

DrapetheEVAovertheplastermodelmanuallyandholditinplaceuntilithascompletelycooled.



2.3 Ortoi trim i

4Cutotheexcesswithacutterorapairoscissors.

StapletheEVAontotherontotheplastermodel.

4Marktheorthosistrimlineasollows:

A Tetopmustbehorizontal,6cmabovethepatellatendongroove.

B Tepatellaandthehamstringtendonsareleree.

C Teshelloverlapstheantero-posteriormid-lineby1.5cm.

D Attheankle,keeptheline1cmanteriortothetopothemalleoli.

E Teusualdistallimitotheanteriorshellishorizontal,at1/3othelengthotheleg,butmaybelongertoprovide

greaterprotection.

F Attheoreoot,clearthesidesothetoesandtheheadothemetatarsuscompletely,passingbeneaththem.Tiswill allow the polypropylene to ollow themovement o the metatarso-phalangeal

joints.



2.4 Ptic riorcmt

Teorthosismayneedreinorcement,especiallyatanklelevel.Ithisisthecase,ollowoneotheproceduresdescribedbelow;otherwisegoontothenextsection.

2.4.1 doub yr o poypropy

4Asecondlayeropolypropylenecoveringtheankleandtheootismouldedatthesametimeasthemainlayer.

Cutapieceopolypropylene: thickness,3mm; width,instepcircumerence;

length,lengthooot+10cm.

Grindthelast3cmattheproximalendtograduallyreducethethicknessothepolypropylene.

4Tetwolayersareheatedatthesametime.

Tereinorcementisplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelyaerwardstoobtainaperectsealbetweenthetwolayers.

Te double layer o polypropylene has the disadvantage o reducing exibility o the oreoot in relationto the metatarso-phalangeal joint.



2.4.2 ltr riorcmt (c)

4CuttwobandsoEVA: thickness,6mm; width,7mm;

length,15cm.

Pullastockingovertheplastermodel.

Gluethebandlightlyontothestocking.

Te more anterior the position o thechannel, the more the device will resistdorsiexion o the ankle.

Reinorcements prolonged along the side

o the mid-oot increase the volume othe orthosis so that it may no longer tinto the patients shoe.

2.5 Potrior

2.5.1 Vcuum moui o poypropy

Ithishasnotalreadybeendone,pullastockingovertheplastermodel.For maximum eciency, theEVA used to channel the polypropylene must not be covered with a stocking.

Dustthestockingwithtalcumpowder.

Measurementothepolypropylenesheet:

Kneecircumerence+10cm. Instepcircumerence+10cm. Legandootlength+10cm.

Tickness,4mmor5mm,dependingonthepatientsweight.

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Heatthepolypropyleneat180or20to25minutes,dependingonthethicknessothepolypropyleneandtheeciencyotheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheanteriorside.

ightenthepolypropylenearoundthesuctionconewitharopeorsomethingsimilar.

Openthevacuumvalve.

4Cutotheexcesswithapairoscissorswhilethepolypropyleneisstillhot.

2.5.2 Prprtio o t potrior

Drawthetrimlineonthepolypropyleneasexplainedinsection2.3(page8).

Cuttheorthosiswithanoscillatingsaw,ollowingtheoutline.

Removetheshellgentlytoavoiddamagingtheproximalpartotheplastermodel,asitwillbeusedtomouldthesecondshell.

Removethestockingrominsidetheorthosis.

Grindthetrimlineandsmoothit.

IanEVAhasbeenmoulded,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

Beore moulding the second shell,keep an angle o 90 at the cornero the anterior/proximal trim linebecause a rounded shape wouldcreate a notch in the polypropyleneo the posterior shell which might

prevent proper unctioning o the

hinged joint.

Keepthevacuumonuntilthepolypropylenecoolsdown.



2.6 atrior

Repairtheproximalpartotheplastermodelinecessary.

2.6.1 Moui eVa

oimprovecomort,6mmEVAcanbemouldedpriortodrapingothepolypropylene,whetherornotthesamehasbeendoneortheothershell.


4CutapieceoEVA6mmthickandlargeenoughtocovertheproximalhalotheplastermodel.


PuttheEVAovertheplastermodelandholdittightlyinplacewithanelasticbandageoroneminute.

4RemovetheEVAandcutit,ollowingthetrimline.

akethepolypropyleneshell(withitsEVA)andxthenewlymouldedEVAwithtwostaplesclosetotheproximal/medialtrimline.



2.6.2 Vcuum moui o poypropy o t trior

4GlueastripoEVA6mmthickand3cmwidearoundthemiddleotheplastermodel.Te polypropylene

draping will stop at this level, wherethe rope tightened around the EVA willensure a sucient vacuum.

GlueanotherstripoEVA6mmthickand3cmwideonthemiddleotherstpolypropyleneshellatrightanglestotherststrip.Tis will allow the

polypropylene to be cut afer drapingwithout damaging the shell beneath.

Coverwithastockingtheareareceivingthepolypropylene.Do not cover the strip o EVA where therope will be tightened because the vacuum may leak through the stocking mesh.

Placetheplastermodelwiththeoreootpointingupwards.


Cutapieceopolypropylene: width,kneecircumerence+5cm; length,haltheleglength+10cm; thickness,4mmor5mm,dependingonthepatientsweight.


4Drapethepolypropyleneovertheplastermodelandstickittogetheralong

thelongitudinalstripoEVA.

ightenthepolypropylenearoundthesuctioncone.

Openthevacuumvalve.

Cutotheexcesswithapairoscissorswhilethepolypropyleneisstillhot.




2.6.3 Prprtio o t trior


CutcareullyalongtheEVAstripinthemiddleotheposteriorshellwithanoscillatingsaw.

Removetheposteriorshellromtheplastermodel.

Removethestockingrominsidetheorthosisandcutotheexcesswithajigsaw.


IanEVAsheethasbeenmoulded,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

2.7 Prprtio or iiti ftti

2.7.1 Prprtio o t i joit

4

SecurethetwoshellsontheplastermouldwithScotchtape.

Markthepositionothehingedjointonthelateralandmedialsides: 4.5cmabovethepatellartendongroove;

inthemiddleotheantero-posteriordiameter.

Makesurethatthehingedjointson

bothsidesareatthesamelevel.



4Drillahole3mmindiameterthroughbothshells.

4

Assembletheanteriorandposteriorshellswith2slottedscrewsandnuts3mmindiameter(headinside).

Cutandgrindtheboltprotrudingromthenut.

2.7.2 Proxim trp

Useaready-madeVelcrostrap25mmwide,ormakeastrapwithnylonwebbingorsomeotherstrongmaterial.

4Withatubularrivet,xthebeltholdingthelooponthemedialsideotheposteriorshell,atthedistallimitotheanteriorshell.

Teloopshouldbelocated5mmromtheanteriorshell.



4Insertthebeltthroughthelooptomeasurethelength.

Fixthestrapwithatubularrivetonthelateralside.

Makesurethestrapisperectlyhorizontalbeorexingit.

2.7.3 dit trp

Tisstrapisnotalwaysneeded.Tedecisiontoinstallitorotherwisewilldependonthecapacityothepatientsshoetoholdtheootinsidetheorthosis.

Usea25mmVelcrostrap.

4Withalargetubularrivet,xthebeltholdingthelooponthemedialside,4cmabovethemalleoli.

Teloopshouldbeplacedonthepolypropyleneandnotbeincontactwiththe

patientsleg.

4Fixthestrapwithalargetubularrivetonthelateralside.Makesurethestrapisperectly

horizontalbeorexingit.

Coverthesuraceothestrapincontactwiththepatientslegwith3mmEVA.

2.7.4 Prprtio o t eVa

IEVAisused,glueittemporarilyinsidetheorthosis.



2.8 Iiti ftti fii

4Tepatientputsontheorthosisbyopeningtheanteriorshellandslidinghis/herootthroughtheproximalend.

TeinitialttingisperormedinaccordancewithP&Ostandards,takingtheollowingpointsintoaccount.

Shouldthepatientslegslipthroughthebrim,theproximalpartcanbepaddedwithEVAtodecreaseitswidth.

Whilethepatientisstanding,checkthedegreeoweightrelie. Aheellionthecontrolateralsidemightbeneededtoaccommodatetheincreaseinlengthothelegwiththeorthosis.

2.8.1 Fiii o t poypropy

4Roundothecornersobothanteriorandposteriorshells.

Carryoutanymodicationsrequiredonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutotheexcessandsmooththetrimline.



2.8.2 Fiii o t i joit

Usetwocopperrivets3mmindiameterwithtwobrassorstainlesssteelwashers.

Removethe3mmboltononesideoeachrivet.

Heatthecopperrivetwithaweldinggunandstampitsheadintothepolypropyleneotheanteriorshellinordertocreatedepressionstocountersinktherivethead.

4Placetherivetheadonananvilandhammergentlyonthepartotherivetprotrudingromthewasherinordertocreateasmooth,roundedshapeasshownonthepicture.Usearivetsettoroundito.

Inserttherivet,headinside,andinstallthewasheroutside.

Cuttherivetwithdouble-actioncuttingpliersorside-cuttingplierssothatonly2mmprotrudesromthewasher.

Dothesameortheotherside.



PTBO WITh POsTeRIOR-ClOsIng shell3

3.1 eVa prprtio or icr wit ri

Te EVA is placed only under the posterior part o the oot, in order to avoid an increase in volume at

the mid-oot which may prevent the patient rom wearing normal shoes.

Followtheproceduredescribedbelow,orgoontothenextsectionithepatientdoesnotrequireadditionalweightrelie.

4PlacethemetatarsalheadotheplastermodelattheedgeotheEVAsheetanddrawalinearoundit1cmwiderthantheoot.

4Holdtheplastermodelinavice.

HeattheEVAat120or3to5minutes,dependingonthethicknessotheEVAandtheeciencyotheoven.

PuttheEVAundertheposteriorpartotheootandholditrmlyinplaceoroneminutewithanelasticbandage.



GrindtheedgeotheEVAuntilitisperectlyaligned,aroundandbelow,withtheshapeotheplastermodel.

6GluetheEVAundertheplastermodel.

3.2 Moui o eVa

EVA(6mm)canbemouldedpriortodrapingothepolypropylenetoimprovecomort.

Do not cover the oot, as this would create an increase o volume which might prevent the patient romwearing normal shoes.


Placetheplastermodelwiththeoreootpointingupwards.

4CutapieceoEVA: width,kneecircumerence; length,leglength;

thickness,6mm.


DrapetheEVAovertheplastermodelmanuallyandholditinplaceuntilithascooledcompletely.



4Cutotheexcesswithacutterorapairoscissors.

Grindthedistaltrimlinetograduallyreduceitsthickness.

StapletheEVAontothebackotheplastermodel.

3.3 Ortoi trim i

4Markthetrimlineasollows:

A Tetopmustbehorizontal,6cmabovethepatellatendongroove.

B Tepatellaandthehamstringtendonsareleree.

C Teshelloverlapstheantero-posteriormid-lineby1.5cm.

D Attheankle,thelinemustremainabovethemalleolitoacilitatedonning.

E Teusualdistallimitotheposteriorshellishorizontal,at1/3othelength

otheleg,butitmaybelongertoprovidegreaterprotection.

F Attheoreoot,clearthesideandthetopothetoesandtheheadothemetatarsuscompletely,passingbeneaththem.Tis will allow the polypropyleneto ollow the movemento the metatarso-phalangeal joints.



3.4 Ptic riorcmt

Lateralreinorcements(channels)signicantlyimprovethestrengthotheorthosis.Tereareseveralwaysomakingthesereinorcements.

4CuttwostripsoEVA: width10mm; length20cm; thickness,6mm.

Grindbothdistalandproximalendstograduallyreducetheirthickness.

Gluethestripsontotheplastermodel,1cmanteriortothelateralandmediallongitudinalaxis.

Reinorcements prolonged along the sideo the mid-oot increase the volume o theorthosis so that it may no longer t into the

patients shoe.

3. 5 atrior

3.5.1 Vcuum moui o poypropy

Te procedure described below ensures uniorm thickness o the polypropylene all over the orthosis. Donot try to make a single seam on the anterior side, because the creases gathering at ankle level will makeit necessary to stretch the polypropylene too thinly.

Ithishasnotyetbeendone,pullastockingovertheplastermodel.For maximum eciency the EVAused to channel the polypropylene must not be covered with a stocking.



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2

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Manufact uring Guid el ines P at el lar Tend on-Bearing Ort hosis

Measurementothepolypropylenesheet:

Kneecircumerence+10cm. Instepcircumerence+10cm. Legandootlength+10cm.

Tickness,4mmor5mm,dependingonthepatientsweight.


Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheposteriorsideand

undertheoot.

ightenthepolypropylenearoundthesuctioncone.

Openthevacuumvalve.

4Cutotheexcesswithapairoscissorswhilethepolypropyleneisstillhot.




3.5.2 Prprtio o t trior


Cuttheorthosiswithanoscillatingsaw,ollowingtheoutline.

oremovetheshell,itmightbenecessarytobreakthedistalpartotheplastermodelbelowtheankle.However,caremustbetakennottodamagetheproximalpart,whichisneededtomouldthesecondshell.

Removethestockingrominsidetheorthosis.

Grindtheorthosistrimlineandsmoothit.

IanEVAhasbeenmoulded,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

Beore moulding the second shell, keepan angle o 90 at the corner o the

posterior/proximal trim line becausea rounded shape would create a notchin the polypropylene o the posteriorshell which might prevent proper

unctioning o the hinged joint.



3.6 Potrior

Repairtheupperhalotheplastermodelinecessary.

3.6.1 Moui eVa

Followtheproceduredescribedinsection2.6.1(page12).

3.6.2 Vcuum moui o poypropy o t potrior


3.6.3 Prprtio o t potrior


CutcareullyalongtheEVAstripinthemiddleotheanteriorshellwithanoscillatingsaw.

Removetheposteriorshellromtheplastermodel.

Removethestockingrominsidetheorthosisandcutotheexcesswithajigsaw.


IEVAhasbeenmoulded,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.



3.7 Prprtio or iiti ftti

3.7.1 Prprtio o t i joit


3.7.2 Prprtio o t trp

Followtheproceduredescribedinsection2.7.2(page15)ortheproximalstrap,andsection2.7.3(page16)orthedistalstrap.

3.7.3 Prprtio o eVa

IEVAisused,glueittemporarilyinsidetheorthosis.



3.8 Iiti ftti fii

Seesection2.8(page17).

4Itisoennecessarytofarethepolypropyleneattheposteriorpartotheheelinorderto

acilitatedonningandtoavoidpainulcontactwiththeedgeotheplastic.



ICRC Code DescriptionUnit ofmeasure

Quantity

For negative and positive cast :

ODROSTOCOT60 Tubular stockinet, 60 cm Cm 70

According to size: MDREBANDP10 MDREBANDP12 MDREBANDP15

Plaster of Paris bandages10, 12 or 15 cm x 3 m

Piece 3

OTOOPLASPW40 Plaster of Paris powder Each As required

For EVA and plastic moulding :

If required, according tocolour: OPLAEVAFERA06 OPLAEVAFLIV06 OPLAEVAFKIN06

EVA 6 mmTerra, olive or beige colour

Each As required

None Nylon stockinet Piece 1

According to colour andthickness: OPLAPOLYCHOC04 OPLAPOLYCHOC05 OPLAPOLYLIV04 OPLAPOLYLIV05 OPLAPOLYSKIN04 OPLAPOLYSKIN05

HomopolymerTerra, olive or beige colour,4 or 5 mm thick

Each As required

For the strap:

OSBOSTRVP325 Strap, Velcro, PVC, with loop, brown, 300 mm x 25 mm Piece 1

OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

or

OSBOVSBO24 Strap, Perlon webbing, 25 mm Cm 25

None Strap, Velcro, 25 mm Cm 20

OSBOVSBO35 Loop, 25 mm x 100 pieces Piece 1

OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

For the hinged joint:

OHDWRIVEC032 Rivet, copper, 3 mm x 20 mm Piece 2

OHDWWASHB133 Washer, brass, 13 mm dia. x 3.1 mm thick Piece 2

lit o mucturi mtri


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MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral andindependent organization whose exclusively humanitarian mission is to protect thelives and dignity of victims of war and internal violence and to provide them withassistance. It directs and coordinates the international relief activities conductedby the Movement in situations of conict. It also endeavours to prevent suffering

by promoting and strengthening humanitarian law and universal humanitarianprinciples. Established in 1863, the ICRC is at the origin of the International RedCross and Red Crescent Movement.

Acknowledgements:

Jean Franois GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard Matagne

Joel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.


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Documents

Prosthetics and Orthotics Manufacturing Guidelines: Lower limb Orthotics: Patellar Tendon-Bearing Orthosis