Progress by Challenging Assumptions
August 2016 Issue
In this issue of The O&P EDGE, dedicated to meeting the challenges of lower-limb O&P interventions, several of our articles have an underlying theme about examining assumptions.
Our first feature tackles a subject that can be sensitive-patients with a greater body mass index and the issues that poses in amputation rehabilitation. With an increasing number of people in the general population who are overweight or obese and who also have diabetes and vascular disease, which are leading causes of amputation, prosthetists are more likely to encounter patients with this profile. "Meeting the Prosthetic Needs of Patients With Greater Body Mass" provides insight into component options to meet higher weight limits, strategies for designing sockets that are strong yet not too heavy, and working with patients to meet their mobility goals within the confines of the appropriate, available prosthetic options.
In "Symmetry for Symmetry's Sake: A Beneficial Goal in Prosthetic Gait?," Phil Stevens, MEd, CPO, FAAOP, reviews research that counters the assumption that gait symmetry is the optimal goal in prosthetic rehabilitation. Of note is the revelation that what may at first appear to be a symmetrical gait is, in fact, the result of asymmetrical trunk and forward foot placement. And, improving visual kinematic symmetry does not necessarily improve the underlying kinetic symmetry. Thus, the article invites practitioners to reconsider this general preconception regarding successful prosthetic ambulation.
Finally, we have two articles that touch on the way in which practitioners and patients view orthosis usage. "Adherence Among Users of Orthopedic Footwear and Lower-limb Orthoses" reviews several studies related to compliance to wear schedules of prescribed orthopedic footwear and lower-limb orthoses. Ultimately, the article suggests that nonuse or a patient-chosen wear schedule may not automatically indicate a problem. Awareness that the patient's wear patterns take into account myriad intentional factors can guide the practitioner in recognizing whether that is detrimental or just different than the practitioner's goals and expectations. In "Max Conserva: Self-advocacy Fuels an Improved KAFO Design," we learn how a patient's research into his own complicated orthopedic condition has helped him work and communicate more effectively with his orthotists, empowering them to create a more useful KAFO for him.
Progress is often linked to new technology, but as the articles in this issue attest, sometimes it's in challenging the approach that progress occurs.