Early Prosthetic Fit: Yes or No?
Children with Unilateral Congenital Below-Elbow Deficiency
"How the parents accept a limb deficiency and how well they cope with it has a great deal to do with how well the child does, either with or without a prosthesis. " -Yoshio Setoguchi, MD Caroline is a lively, redheaded fifth-grader. She is a straight-A student who is into dancing, cheerleading, gymnastics, acting, and modeling.
Better than Spinach: Young Minds and Muscles Benefit Equally with Activity
Micael McHugh. Photograph courtesy of Adaptive Sports Foundation.
Michael McHugh was afraid to fall and hurt
The Right Resources Make All the Difference
Limb loss or limb difference can be difficult to cope with for children and parents alike-albeit for different reasons. According to Rebeca Guajardo, CP, of the Amputee and Prosthetic Center at TMC Orthopedic, Houston, Texas, parents are often concerned with how their child will fit in with their peers and whether or not their child will be able to keep up with other kids. "Children will usually have no problem fitting in because they do so well with prostheses," Guajardo says.
Ankle-Foot Bracing for Young Athletes
The Practitioner as a Team Player
The key for bracing young athletes is to identify
the appropriate amount of support without over-bracing the patient
and restricting movement. As a clinician, it is a great pleasure to have the
opportunity to help those with mobility challenges accomplish what
they otherwise couldn't. Helping a young athlete who dreams of
being the next Michael Jordan or Mia Hamm step out and play
alongside his or her peers is truly a rewarding experience.
The Battle of Compliance: How to Keep Kids in Their Braces
At least dental braces are securely attached. Orthotic braces are another story. Given the chance, many children would prefer to toss their orthosis-along with all the time and effort spent diagnosing the situation and fitting the brace-in the hallway closet and forget about it.
Is Your O&P Practice the Best It Can Be?
As the challenges of the 21
present themselves to the O&P profession, independent practices often face insurmountable struggles when balancing the rising costs of keeping their doors open and maintaining the same quality of care that they have been providing for years.
Education is a clear solution to the challenges facing our profession-good, solid, hands-on education taught by some of the finest and brightest educators in the world. However, education in and of itself is not enough.
SureStep Shrinks HEKO Brace for Young Patients
Traditionally, the smallest patients with genu recurvatum-hyperextension of the knee--have been treated with a basic ankle-foot orthosis (AFO). For many years, that was the only treatment option for toddlers as young as a year old, simply because there wasn't a small-enough hyperextension knee orthosis (HEKO) available.
Bernie Veldman, CO, owner of Midwest Orthotic & Technology Center, South Bend, Indiana, says fitting younger pediatric patients with an AFO was a necessary evil.
Brianna Barner: Life's Twists Stun, Inspire Healthcare Family
Tiny Brianna Barner of Atlanta,
Georgia, slowly crosses the finish line as her parents'
eyes gleam with pride. Their joy is heightened as they remember the
battles fought as a family to reach this moment, including moving
across the country and disregarding doctors who took one look at
Briannas club feet at birth and said she would never walk.
Today Brianna is all smiles as she unknowingly proves that
Innovative Crutch Designs: More Gain, Much Less Pain
Photographs courtesy of Thomas Fetterman.
Although ambulating with crutches
would probably not rank on anyone's A-list of favorite activities, it can solve the problem of mobility after injury. Crutches have a long history.
The Winter of My New-Found Reality
By the time you read this I will have begun my spring thaw.
I made it through my first Chicago winter relatively unmarred. Despite the wind tunnels and icy patches, it has been manageable navigating the different pathways on my way to work.
Father, Son Begin 3,300-mile Freedom Run Across the United States
A father-and-son team has begun a 3,300-mile trek
across the United States to raise funds for the Wounded Warrior Project (WWP), Jacksonville, Florida, the Challenged Athletes Foundation (CAF), San Diego, California, and the Sunshine Foundation, Feasterville, Pennsylvania.
Courtney Arciaga (in red) leads the charge, with Warren and Tom Knoll close behind, during the March 1 kick off of the 2008 Freedom Run. Photograph courtesy of the Sunshine Foundation.
University of Pittsburgh Adds Orthotics and Prosthetics Master’s Program
The University of Pittsburgh School of Health and
Rehabilitation Sciences (SHRS), Pennsylvania, announced
the addition of a new master's program to its curriculum. The
Master of Science in Health and Rehabilitation Science, with a
concentration in prosthetics and orthotics (MSPO), will be
available to students in the 2008 fall semester. This two-year
program within the Department of Rehabilitation Science and
Technology is designed to prepare students to be certified
prosthetists and orthotists.
Hanger Education Fair Boasts Record Attendance
The 2008 Hanger Education Fair,
held January 28 to February 2 in Reno, Nevada, was marked by record attendance and a major announcement as Ivan R. Sabel, CPO, chief executive officer and chairman of the board, used the occasion to announce that he would be stepping down as CEO. Sabel, who has been Hanger's CEO since 1995, will remain chairman of Hanger's board.
Five Questions for Jean Williams Gonzalez, CPO
Jean Williams Gonzalez, CPO,
decided in her 30s to make a career change. She took the first major step by quitting her job in the banking industry, knowing only that she wanted to "do something of service. " Gonzalez soon started work as an attendant for a close friend with muscular dystrophy who was a wheelchair user and wore a metal TLSHO.
Denials are difficult to identify and time consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, and increased billing erros, running an O&P show gets more complicated each year.
I have a question regarding the use of patient digital photographs for the sole purpose of fabricating either an orthosis or a transtibial prosthetic socket.
Connecticut Amputees Rally for Prosthetic Coverage
On February 7, almost 100 amputees flooded the capitol in Hartford, Connecticut, to lobby for the state's parity bill. The activists were pushing for legislation that would require insurance companies to cover prostheses in the same way or on par with other basic medical services. The rallying cry in Hartford was "Parity Works," not only because this policy will work to get people the care they need, but also because it helps keep amputees working and paying taxes.
'Big Things Come in Small Packages'
This was my mother's mantra
when I was growing up and expressing my frustration at always being smaller than other kids my age. Of course as a child, her words of encouragement didn't mean a lot to me, but as I read through the pages of this month's issue of
The O&P EDGE,
those words certainly resonate. In this issue, we focus on the smallest O&P patients-but we do so in a big way.
Velocity Introduces Expulsion Valve
The new Velocity Expulsion Valve works in combination with
Velocity's standard mounting plate and is hidden in the distal end
of the socket. The use of a dummy during lamination creates a void
in the distal end of the socket which accepts the Velocity valve.
The valve has a large duckbill for quick air expulsion and easy
Squid Beaks for a Better Prosthetic Fit?
The razor-sharp beaks that giant squids use to
attack whales--and maybe even Captain Nemo's submarine--might one
day lead to improved artificial limbs for people, according to an
article by the Associated Press (AP). That deadly beak may be a
surprise to many people, and has long posed a puzzle for
scientists. They wonder how a creature without any bones can
operate it without hurting itself.
Advancing liner technology one step further, the
new Iceross® Seal-In® is as close as we
have come to complete prosthetic attachment, with the convenience
of a simple step-in-and-go system. The new system for transtibial
users applies pure suction but does not require an external sleeve,
saving time and money.
A proprietary design with five separate seals bridges between
the residual limb and the internal socket wall. Unique seal design
conforms and clings tightly, guaranteeing suspension, rotation
control, and proprioception, while allowing for unprecedented knee
freedom. This retrofitable liner provides unmatched performance and
favorable patient outcomes, making the user more confident and
better able to perform activities.
Don't be fooled by imitations. The Summit
Lock was the first proximal lock designed to control
rotation, and the only lock with zero clearance required. The
Summit Lock was specifically designed for long
limbs. There is no need to purchase a locking liner, and you can
use the socket adaptor of your choice. Weve improved the design and
created the LowPro Summit Lock for even easier
All tooling for fabrication is included, except adhesive,
Coyote® Quick Adhesive (CD4120).
- Immediate cash: plan your future.
- We solve business issues, allowing you to focus on your
- We are not a broker, buyout fund, or corporate CPA.
- We are well-funded, have experienced O&P management, and
are focused on creating a great company.
- If you are interested in finding a partner to run the business
side of your practice, contact us. All discussions are
Two different insoles are included for flexibility
in fitting and are easily removable to accommodate custom orthoses
and AFOs. Our exclusive Insta-Flex sole construction provides the
lightweight cushioning and flexibility you expect from an EVA
outsole. SoleTech adds a "wears-like-iron" rubber
outsole bottom, making it the easiest athletically styled shoe to
modify. Available in white and a wide range of sizes for men and
Practitioners who have called for a component to
help them easily and dynamically achieve equal limb height without
changing pyramids have just been answered. Prosthetic Design Inc.
introduces the Double Ended Pyramid Receiver
(DEPR-1). The DEPR-1 allows practitioners
to easily make height and rotational adjustments without removing
the socket from the patient.
The DEPR-1 height-adjustment range is 6.3mm and
offers 360 degrees of rotational adjustment. Alignment marks help
practitioners to visually reference adjustments. The
DEPR-1 will accept industry standard male pyramids
and is double-female capable. Height is 55.6mm (2 3/16 in.), and it
weighs 118g (4.2 oz).
Prosthetic Design (PDI)
Cascade Dafo Inc. is the leader in design,
innovation, and manufacture of dynamic orthoses for children and
adults. Cascade's products are primarily geared toward the
pediatric patient, most of whom have neuromuscular challenges, but
adults also benefit from the innovative design concepts. Cascade's
entire focus is helping those with mobility challenges live better
The companys new off-the-shelf orthoses line, the
JumpStart bracing system, is revolutionizing the
way bracing is done. JumpStart braces require no
casting -- they can be ordered by measurement aloneand they are an
affordable bracing option. See the full JumpStart
ad in the advertisers' section under Cascade Dafo.
Knit-Rite has added a Regular
Medium to its line of Liner-Liner
prosthetic socks. Liner-Liner is a prosthetic sock
designed to be worn under a suspension liner next to the skin. It
relieves skin shear irritations and improves comfort with liners.
Liner-Liner has been tested and proven to be
beneficial for amputees who wear liners as their primary
Ultra-thin material minimizes compromise to liner suction grip
on skin. X-Static® silver fibers fight bacteria and odor and
transport heat and moisture from the limb.
Available in Narrow X-Short, Narrow Short, Regular X-Short,
Regular Short, Regular Medium, Wide Short, and Wide Medium.
Weighing in at only 12.5 oz., Dycor's
Dynamic Response ExtraADL
"E"Foot is ideal for wearers who require
more stability than a flexible keel with articulated ankle, and
where resiliency is preferred. The optional aggressive gait
management (AGM) torque absorber provides appropriate yield and
return for moderate-level extra-ambulatory activity. Available in
uni, bi, or triaxial with low (½-1 in.) and medium (1-1½
in.) heel-height options. Weight includes an integrated EVA foot
shell. Titanium option available.
The new, comprehensive 2008 Pediatric
Products Catalog from PEL Supply
showcases 98 pages of pediatric orthotic and prosthetic products,
components, and accessories, including new products from 49 quality
manufacturers, shown in clear, close-up photographs. Detailed
product descriptions include specifications, options, measuring
instructions, warranty, and weight limit information, as well as
easy-to-follow ordering instructions and examples.
User-friendly, the catalog is spiral bound with
an all-inclusive master index for quick reference. Its an essential
O&P product catalog and a valuable reference tool for those
working with pediatric patients. The catalog and
price list are also available on CD.
PEL Supply Company
The FullStrideTM is
now available in "B" size for youth and adult
patients. Offering a 25-percent reduction in weight to enhance
clinical application, the "B" size gives you new
possibilities in offering stance control to your patients.
Delivering maximum control of varus/valgus instability and knee
hyperextension, the FullStride automatically locks
and unlocks during the gait cycle, providing natural movement with
superior stability and comprehensive knee joint control.
Easy to fabricate and fit, you can pair the
FullStride with any ankle joint on the market.
It's the logical next step in orthotic stance control knee
A Revolution in Clubfoot Treatment
Matthew Dobbs, MD, designed this new
dynamic clubfoot bar to allow active movement,
preserve muscle strength in the foot and ankle, and be less
restrictive to the child than traditional fixed-bars. Children
using the Dobbs Bar can crawl and kick their legs
independently. Children will sleep better because they can get
comfortable in the Dobbs Bar,
and heel blisters commonly associated with fixed-bars are no longer
a problem. The Dobbs Bar is completely adjustable
from 8 to 14 inches to accommodate growth; no need to buy
replacement bars. The foot plates are universal and can be attached
to shoes and AFOs. The results are better compliance, a more active
child, and happier parents.
D-Bar Enterprises LLC
TRS introduces a new, high-performance prosthetic
device for playing hockey. The "Power Play" terminal device
(TD) is designed to securely slide/fit over the last five
inches of the hockey stick. The safe, all-polymer construction is
available in two stiffness models (80 and 95) to suit a variety of
teenage and adult players. The energy-storing design performs much
like the human forearm and wrist. The Power Play
flexes and rebounds for shots and bends away under load to prevent
The new Dynamic Walk AFO from
Fillauer Companies is now available at all four of the SPS
distribution centers. The Dynamic Walk is made of lightweight thermoformable
carbon-fiber composite (TFC) and double-sided PEEK rods that
provide high strength and flexibility. The high-activity design and
material selection are chosen to allow users to walk, run, and
squat without the need for straps to maintain position on the leg
Lighter and less bulky than other dynamic AFOs, the moldable,
thermoformable construction of the Dynamic Walk
provides the capability for maximum comfort in various shoe
The BRAE Orthosis is designed for
the management of forearm rotation contractures using a static
progressive stretching protocol. The orthosis is
useful for treatment of forearm contractures as a result of
upper-extremity fractures and injuries. Forearm rotation is
adjusted by a dual-offset channel with a patented, overlapping
Benefits of the BRAE Orthosis include:
- Maintains post-surgical forearm rotation positioning.
- Decreases substitution that can result from misalignment of the
mechanical-to-anatomical axis for forearm rotation.
- Maintains static progression of infinite positions in
supination and pronation.
- Controls forearm rotation position while allowing free motion
in the sagittal plane.
The BRIO allows instant heel
height changes while maintaining optimal alignment.
- Pyramid receiver attaches to any foot with a proximal male
- Single push button allows wearer to quickly adjust the foot for
different shoes or activities.
- Maintains optimum alignment, reducing stress on residual
- Adjusts up to 1¼ in., 26cm foot
- 275-lb. weight limit.
- Two-year warranty.
Ossur's PROPRIO FOOT® is an
artificially intelligent, motor-powered prosthesis that helps
replace the function that the body's central nervous system would
- Sense: Using advanced motion sensing
accelerometers, the PROPRIO FOOT can "sense" the
surroundings of each step and accommodate for action.
- Think: As fast as it measures, the data is fed
into the "brain" of the device through TerrainLogicTM,
identifying specific motions to enable a response to
- Act: Foot motion is continuously analyzed. For
each stride, gait pattern recognition algorithms in the foot are
used to detect and identify when and where a user is walking.
New from Endolite, the TT PRO
perfectly balances shock absorption and energy management.
- Energy-efficient coil spring for vertical compression.
- New torsion rod provides 30 degrees of rotation each direction
from neutral position.
- New bearing surface responds over a greater range of the stance
- Instant compression at heel strike and smoother energy return
- 30mm pylon and clamp option available.
provides reliable, controllable, and quiet vacuum suspension. Key
features include easy, inline mounting in a prosthesis, "set and
forget" intelligent monitoring of vacuum, remote-control operation,
and water-resistant controller.
The systems vacuum level is adjustable from zero to 20 inHg.
Practitioners can program LimbLogic VS with vacuum
settings. Once programmed, LimbLogic VS will
monitor a sockets vacuum and maintain secure, comfortable
suspension of the prosthesis. This technology allows users to
maintain the proper amount of vacuum without continual adjustment.
The controller simply runs when needed.
Ohio Willow Wood
Friddle's latest introduction to the orthotic and
pedorthic equipment market -- the Friddle VAC-MAX
24-in. vacuum press -- is the largest available in the industry.
With a useable work space of 22 in. by 22 in., you have plenty of
room to vacuum form more foot orthotics at once, leaving you more
time for your patients rather than for fabricating. Coupled with
our ¾-horsepower vacuum system, you will have a pedorthic lab
to be envied by all.
- Overall dimensions: 25 in. by 24 in.
- Total weight: 29 lb.
- Minimum vacuum source required: ¼ to ½
- Tubing required: 3/8-in. I.D., 5/8-in. O.D.
Friddles Orthopedic Appliances
Not every patient with unicompartment OA is an
appropriate candidate for a rigid-frame unloading knee brace. For
certain sizes, shapes, and lifestyles, a soft-shell brace can
produce higher levels of patient satisfaction and compliance.
With this in mind, Townsend Design offers the SoftForce
Reliever, a single-hinge compression sleeve brace that
provides comfortable opposing forces intended to reduce pain and
inflammation. The SoftForce is easy for the
patient to put on and doesnt have complex instructions. The brace
provides compression and stabilization while helping to prevent the
leg from thrusting into an abnormal alignment.
The new Runway HX has been
designed to ensure finite and exacting height adjustments with
ease. The Runway HX utilizes a simple 3mm hex key
(provided with the foot) to increment an internal worm gear to
exactly the height desired by the user, from zero to two inches.
Tighter tolerances and hardened materials have been incorporated
into the Runway HX to ensure robustness and
Specifications of the Runway HX include:
- Weight Limit: 255 lb. (categories 1-6).
- Warranty: 36 months on foot module; 24 months on ankle
- Sizes: 22 to 27cm.
- Product Weight: 383g.
- Average clearance: 3.25 in.
OPTEC's new VertaMax offers
maximum support, quality, and profit. The VertaMax
orthosis is designed to support your patients at every stage of
recovery. The breathable, highly consistent elastic material
provides 50 percent more compression than those conventionally used
to increase lumbar containment.
VertaMax features front and back moldable
polymer panels, a unique closure system for maximum compression,
and arthritic grips for ease of donning and doffing.
Detachable polymer panels can be removed as the patient
progresses in rehabilitation. The VertaMax's
sizing system includes five unisex sizes ranging from a 22½-
to a 60½-in. waist with neutral or pendulous abdomen.
The unique, low-profile
DuroFlexTM Foot with vertical shock is
maintenance free and exhibits superior energy storage and return
characteristics. The subtalar and midtarsal joints are simulated by
the foot's combination of articulating ankle and
vertical shock absorption features, as well as within the
changeable keel and heel plugs. The foot's various
metatarsal plugs create a natural toe break point. Manufactured by
American Prosthetic Components, Inc.
Features of the DuroFlex Foot include:
- Titanium pyramid with rotation and build-height
- Rated up to 500 lb.
- Includes Spectra sock and foot shell.
- Three-year warranty.
PEL Supply Company
KiddieGAITTM is an
engineered composite frame with anterior shell, lateral strut, and
an energy-reflecting footplate with open calcaneus, all designed to
allow customization of the frame into a ground-reaction AFO or a
partial-foot prosthesis. The energy-reflecting properties of this
system reduce the amount of energy required to lift and move the
The anterior shell design triggers enhanced "position in space"
proprioceptive response and assists in management of proximal
deficits by helping to overcome either knee hyperextension or
crouch gait. Functional environments can be created that supplement
gait function instead of immobilizing and inhibiting function.