1974 orthotics and prosthetics

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DE EM ER

1 9 7 4

Orthotics

and

Prosthetics



COPYR IGHT • 1974 BY THE AMERICAN ORTHOTIC AND PROSTHETIC

ASSOC IATION, PRINTED IN THE UNITED STATES OF AM ERICA,

ALL RIGHTS RESERVED



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)



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



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



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 .

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Glendale,

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IV



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

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T R °

Y

I N

METHODS—MATERIALS—COMPONENTS—COMPLETE APPLIANCES

Everything for the Prosthetic & Orthotic Man ufacturer



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



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



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



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



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



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 .

M O D E L 8 1 4 2 — L u m b o s a c r a l

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 .

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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



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 .



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 .



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.



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



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 .



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 .



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.



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 .



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.



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



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.



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.



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 .



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.



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 .



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.



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.



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 .



LITERATURE CITED

1. Corcoran,

P. J.,

Evaluation

of a

plastic short

leg

brace.

A

thesis

for

Degree

of

Master

of

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

of

Engineering

and

Science,

New

York Univer

sity, July

1965.

8. Lehmann,

J. F., B. J.

DeLateur,

C.G.

Warren,

and

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

1973.

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

1958.

13.

Mcllmurray, William,

and

Werner Greenbaum,

The application of SACH foot principles to orthotics.

Orth.

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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.

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52:11:503-510, November

1971.

15. Simons,

B. C , R. H.

Jebsen,

and L. E.

Wildman,

Plastic short

leg

brace fabrication.

Orth. and Pros.

21:3:215-218, September

1967.

16.

Veterans Administration Prosthetics Center, A

Manual for Fabrication and Fitting of the Below-Knee

Weight-Bearing Brace, April 1967.



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.



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.



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.



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.



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 .



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



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 .



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.



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).



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



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 ,



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 .



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.



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



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).



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 ) .



• 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 ) .



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).



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 .



• 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) .



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 .



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.



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.



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.



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 .



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



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.



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



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



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.



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 .



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 .



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 .



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 -



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.



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



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



66


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




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 .



68


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 . ,


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 . ,


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 .



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 .



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 .



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 .



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).



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 )


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 .


f o o t - p o u n d s - f o r c e


ergs

b.t u.


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 .



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.



READY TO

FIT

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AND SPECIAL

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AND LEG BRACES CUSTOM MANUFACTURED TO

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COMPLETE CATALOG AVAILABLE ON REQUEST

C. D. DEN ISO N

ORTHOPEDIC APPLIANCE

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220 W. 28th Street - Baltimore, Md. 21211

X I I I



dm

SUPPLIERS TO

PROSTHETIC ORTHOTIC FACILITIES

Complete Line Of

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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

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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

STU M P-SPR A Y

A M P U - B A L M

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S E ' S A L V E

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

C A N E C R U T C H

T I P S

P I L L O W S P L I N T S

F O R H I P A B D U C T I O N

D E N I S B R O W N E

N I G H T S P L I N T S

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

P H O N E : 8 1 6 - 2 2 1 - 0 2 0 6

X I V



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• ORTHOLEN

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FOAM

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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



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



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



<

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.

Write today

S u r e w e

t a k e t r a d e s

F i n a n c i n g m a y

b e a r r a n g e d

MADE IN USA

z

5 u f t a n

S4ee

7fC«c&£*vuf

P. O. »OX 99 *0 » SI. IOUIS, MO. 63122 • 1314) 22 S- 535 S

•

Send dope on SJ/4 and other jack sanders

• Send complete Sutton catalog

Name

Shop

Address

C i t y

.State.

- Z i p _

Telephone.



G

R€eman

Supports

'Dealer

^equiiements

from head

to toe

Dealers count on Freeman for a complete line of

Surgical Support garments

,

.

,

and wc don't disappoint

them. If it's a body support item from elastic hose

to cervical collars, chances are that Freeman makes it; at

reasonable cost. To insure prompt delivery Freeman

established four warehouses across the country. Dealers

call their nearest warehouse (collect) and receive shipment

within 24 h o u rs .. . less transportat ion charg e; less dealer

inventory required. Complete, high quality line and

fast service . . . just a few ways in which Freeman supp orts

dealer needs.

Write for free catalog and complete

information

on

Freeman

products.

Modti use

Chair Baca Biaca

Knlohttyp, AOov,

right. Modal Ml,

Aaoman

FREEMAN

MFG CO

Box

J,

Slurgis, Mich

49091

FREEMAN WAREHOUSES:

Ephrata, Pennsylvania

17522, P.O. Box 277, phone 717-733-4261

Sturgis, M ichigan

49091, P.O. Box J, phone 616-651-2371

Anniston, Alabama

36201, P.O. Box 1791, phone 205-237-0611

West Covina, California 91790, 1148

E.

Garvey, phone 213-338-1618

X I X



Cut

it.

Mold

it.

Bend

it.

Shape

it.

No other splint material works so easily.

Wrap around any contour Lena support to any injured

body pari W ith attractive ORT HOP LAS T* Splints, the

most versatile splinting material available

• A lightweighl low-heat thermoplastic featunng maxi

mum ability lo be molded

• Strong, co hesive, ca n be mad e to adhe re to itself

without g lue, simply by heating.

• Can bo riveted, strapped, braced , hinged, bonded ,

butt-bonded to suit all your splinl-ongineenng needs.

(Can also be reheated and remolded to retil an improv

ing patient whose splint needs have c han ge d)

Educational literature, medical reprints, splint pal-

terns and samples may be obtained by writing to De

partment J-23 5, Johnson Johnso n, New Brunswick,

New Jersey 08903

ORTHOPLAST Splints

xx



Sabel gets

all

the breaks..

with the all-purpose

AM-BOOT

T h e m o s t v e r s a t il e a n d a c c o m m o d a t i n g b o o t

e v e r d e s i g n e d t h r o u g h c l i n ic a l e x p e r i e n c e s

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

t h r o u g h o u t .

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

a n g u l a r b r a c e w o r k .

XXI



W A S H I N G T O N P R O S T H E T I C

SUPPLIES

W HY S P E N D Y O U R V A L U A B L E T I M E M A N U F A C T U R I N G S P I N A L O R T H O S E S ,

T - S T R A P - C E R E B R A L P A L S Y T Y P E B / K P R O S T H E T I C L E A T H E R C O M P O N E N T S

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

W a s h i n g t o n , D . C . 2 0 0 0 2 ( 2 0 2 ) 6 2 8 - 1 0 3 7

XXII



You Just Can't Beat Our Rover

For Fit And Comfort

Excellent

For

Brace Work

L o o k a t s o m e f e a t u r e s o f o u r f a m o u s

" B r a c e S h o e "

• L e a t h e r S o l e H e e l • L o n g C o u n t e r

• E x t r a

S t r o n g S t e e l S h a n k

Y o u c a n us e t h i s s h o e w i t h c o m p l e t e

c o n f i d e n c e .

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 .

W r i t e F o r F r e e C a t a l o g .

T he

Irving

Orew Corporation

L a n c a s t e r, O h i o 4 3 1 3 0

D R E W D R . H I S S - C A N T I L E V E R G R O U N D G R I P P E R - D I C K E R S O N

X X I I I



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

X X I V



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



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

1974 orthotics and prosthetics

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