State-of-the-Art: Upper-Limb Prosthetics Technology
While prosthetists and patients eagerly await the results of the Defense Advanced Research Projects Agency (DARPA) Revolutionizing Prosthetics 2009 (RP2009) initiatives, science fiction is meeting science fact right now in today's clinical practice. This article explores some of the upper-limb technologies that are commercially available now or are coming to market very soon.
The Cool Connection
Who says prostheses can't be cool? Not Bernie Diamond, who sports an iPod-enhanced prosthetic arm when he works out or takes to the ski slopes.
Motion Control Introduces Utah Hybrid Arm
Motion Control Inc. has added the new and exciting Utah Hybrid Arm to our product line, and it is now available. Lighter than a Utah Arm, it incorporates all of the hand control and lock/unlock features of the U3 arm.
Upper Limb: Kudos and Caveats
As major breakthroughs in upper-limb prosthetic technology continue to roll out in today's clinical practice, two specialists in upper-limb prosthetics describe what has most impressed them—and what challenges remain.
"The first multi-articulated object-compliant hand [the i-LIMB™] is an astounding advance," says Carl Brenner, CPO, FAAOP, director of prosthetic research for the Michigan Institute for Electronic Limb Development, Livonia.
The Otto Bock DynamicArm® elbow and microprocessor control system for transhumeral or higher limb loss/deficiency is the top choice for John Billock, CPO, CPO/L, FAAOP, executive/clinical director, Orthotics & Prosthetics Rehabilitation Engineering Centre Inc.
Alignment Systems Step Forward
Jay Martin, CP, uses the Compas system to calibrate Jim Bob Bizzell's alignment. Photograph courtesy of Orthocare Innovations.
Any prosthetist will tell you that a successfully fitted prosthesis depends, in part, on achieving the proper alignment.
Better Business Series: OrthoCare Innovations Is Changing the Game
Orthocare Innovations: Changing the Game
Jim Landrum: Doing Things Differently
If Jim Landrum had any doubt he'd be returning to the water sports he loves after losing his left hand and forearm due to a 2007 fireworks accident, his buddies quickly dispelled it.
"They told me I could either get in my car and drive over there, or they were going to come get me," says the 34-year-old from Missouri.
Searching for a Solution
For Landrum, operations manager at Ozark Physical Therapy, Poplar Bluff, Mississippi, recovery from his accident meant getting back on the river—to his favorite fishing spots that were inaccessible by motor boat, and to more challenging white-water adventures.
PLX-PAD: Stem Cell Treatment May Save Limbs
The use of stem cells is one of the most promising, yet ethically controversial issues in modern medicine. The primordial cells with the potential to become any tissue in the body—including the almost impossible to regenerate nerve, vascular, and ligamentous tissues—have sparked policy debates around the world because one of the most promising human sources for stem cells is blastocysts and embryos—specifically, those obtained after in vitro fertilization and abortions. Many governments, including the U.
Mary Novotny: Contributor to Humanity
Mary Novotny, RN, MS, is a visionary. For the past 35 years, the founder and former president of the Amputee Coalition of America (ACA) has been changing the landscape of prosthetic care by serving as a tireless leader, advocate, and activist.
Novotny with her husband, orthopedic surgeon Ed Jeffries, MD.
Challenged Athletes Foundation: Changing the World, One Athlete at a Time
"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. " —Margaret Mead
In 1994, a small group of thoughtful, committed triathletes came together to raise money for an injured comrade—famed endurance athlete and amputee Jim MacLaren. Their fundraiser, the first San Diego Triathlon Challenge (SDTC), brought the organizers not only funds, but an education in the financial, social, and technical barriers that many people with physical disabilities face when trying to achieve basic fitness, much less compete in sports.
On the Road
Just because school is out doesn't mean the learning stops. After an information-filled summer semester, it was time for the summer clinical rotations. During our clinical rotations, we followed a practitioner around full-time for a few weeks—100-plus hours.
Blake Barlow, CP, LPO, FAAOP
Blake Barlow says he's a believer in "prenatal destiny—the providence that drives my passion for O&P. " Born with proximal focal femoral deficiency (PFFD) in 1960, his path toward an accomplished career in prosthetics was set early on.
At the age of two, the Atlanta, Georgia, native received his amputation surgery from Richard King, MD, whom Barlow says "performed surgery on me that is still considered state-of-the-art to this day.
Billing and Collections Q&A
Denials are difficult to identify and time consuming to appeal. "Got FAQs?" is here to help answer your most pressing billing questions. This month's column addresses your questions about consignment closets, billing for CROW boots, modifiers to use when billing for replacement facial prostheses, and more.
ACA Calls on Supporters to Fight
Rick Castro's daughter was born missing part of her arm below the elbow. He worries about how he will cover the cost of the prosthetic devices she will need as she grows. David Ross lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway train.
If a Picture Is Worth a Thousand Words…
What is a video worth? That's what we'd like to find out, but we need your help to do it. The O&P EDGE , in coordination with oandp. com, is launching video streaming capability on The O&P EDGE website and throughout oandp.
Connecting Machines to the Body
'Bionanoelectronic' technology may help prosthetic devices talk to the body on a molecular level.
Neuroprosthetic devices of all kinds, from myoelectric prostheses to cochlear implants, depend on biological interfaces to function. Unfortunately, the juncture between human and machine has always been imperfect, with less than clear communication between nerves and componentry, and, in implanted devices, high risks of device corrosion and other problems.
Intended for patients up to 320 lb., or those individuals with a severe biomechanical deficit, the Model 1017-A38 Automatic Angled Lever-Lock Knee Joint is the latest addition to our comprehensive range of orthotic knee joints. Equipped with 3/8 in. x 3/4 in. (9.5mm x 19.1mm) aluminum uprights, the Model 1017-A38 is modular in design and may be used in either a unilateral or double upright configuration. The Model 1017-A38 can be fabricated into a variety of orthotic designs including conventional metal and leather, thermoplastics, and composites.
The OP4 boasts an innovative combination of friction brake and pneumatic swing control in one sleek package.
Features of the OP4 include:
Incredibly light (600g).
Friction brake is adjustable to release before toe-off for smoother ambulation.
Powerful pneumatic cylinder handles wide variations in cadence.
Patients can transition from security to dynamic capability due to combination of braking system and pneumatics.
Designed especially for the moderate to full K3 ambulator weighing up to 220 lb.
See our ad for our free gift promotion.
The Smart Adaptive is an MPK for K3-K4 active amputees with a moderate to high level of voluntary muscle control. The new Smart programming mode reduces programming time. Using hydraulics for stability and pneumatics for efficient swing control, the Smart Adaptive learns how amputees move to allow greater confidence during locomotion.
The Smart Adaptive includes the following features and benefits:
- Gives support for stairs and slopes.
- 140-degree knee flexion.
- Stumble and support mode.
- Stanceflex for comfort and smooth progression through the gait cycle.
- Amputee may use any foot of his or her choice.
The FullStride™ Shadow from Becker Oregon is a lightweight KAFO that combines structural strength and cosmetic appeal with the FullStride mechanical stance-control orthotic knee joint.
The inherent rigidity of the FullStride Shadow ensures that optimal joint alignment and function is maintained throughout the gaitcycle. Constructed of lightweight and rigid composite materials, the FullStride Shadow's sleek and open design offers patients an unparalleled blend of form and function.
The new dark-tone foot shell is available for the following new Endolite feet:
Endolite feet ship fully assembled and include the glide sock where applicable. The foot shell will continue to be supplied in either the light or dark tone with the purchase of these feet. Foot shells are also available for individual purchase.
Patient benefits: bolsters self-esteem, pride, and courage.
Founder Dan Horkey pioneered an innovative method for applying artwork to braces and prostheses, empowering fellow amputees to express their individuality through custom orthotic tattoos.
Custom painted finishes and tattoos include:
- Print method applied over carbon-braid substrates.
- Airbrushing, hand painting, and pin striping.
- Custom artist designs.
- Painted systems (choose your favorite car color).
Other painted finishes available. Call for details.
Proud to be serving veterans.
Sponsor logos available for triathletes and extreme-sport patients. Gift certificates are available.
Wound care centers trust Geritrex's tincture of benzoin product line because it provides effective skin protection. Available as a liquid (Benzoin Compound Tincture U.S.P.), topical spray (Sprayzoin™) and unit dose pouch (Benz-Protect™), these antiseptic formulas help toughen skin and increase adhesion of bandages, without irritation. Surgeons, orthopedists, orthotists, and prosthetists use Geritrex's benzoin product line and say that it helps shield skin during the healing process.
You may purchase Benzoin Compound Tincture U.S.P., Sprayzoin, and Benz-Protect through wholesalers, specialty distributors, or direct. Call today to order your free product sample!
Provel offers cost-effective, fast, easy-to-use, and reliable O&P automation. The D2 digitizer, C5 carver, and T6 thermoformer are appropriate for small clinics as well as large central fabs. All are AOP-file compatible and backed by a two-year warranty. The D2 digitizer allows automated shape capture of prosthetic casts with unmatched accuracy. The C5 carver is not only fast and precise, its self-contained dust-collection system is extremely quiet. The T6 thermoformer consistently produces high-quality thermoplastic sockets from industry-standard preforms.
Genesis II foot/ankle systems, from MICA Corp., provide theindustry's most natural range of motion. The systems feature 12 degrees of axial rotation and vertical deflection in both directions, 12-25 degrees of inversion and eversion, 20-30 degrees of plantarflexion, and 7-15 degrees of dorsiflexion, with a promise for free bumper replacement for the life of the foot.
Smooth, natural gait.
- Sizes 22-30cm for users up to 215 lb.
- Easily interchangeable bumpers with a lifetime guarantee.
- Thirty-day trial period from the time of fitting, with a 36-month warranty.
Get more use out of your PDQ Infrared oven by installing the Oven Fan Kit. Powered by shop air, the kit reduces production time for O&P plastics by up to 20 percent and provides controlled heating of pre-preg and TFC materials. Available as a factory-installed option on a new oven, the Fan Kit can also be retrofitted to an existing PDQ Infrared oven in about an hour. Fits all models except BT-1.
New Wedges, More Options, Same High Performance
The Axtion 1E56 is a lightweight, high-performance foot for active amputees. The foot's low structural height makes it a solution for patients with low clearance. New heel wedges make it easy to change heel stiffness, even without your tool bag. Plus, you can offer your patients multiple options with just one foot order.
Otto Bock HealthCare
Featuring a highly flexible fabric for greater comfort and flexibility, the new Alpha® AK Sleeve from Ohio Willow Wood was designed for transfemoral use with suction suspension as well as with the LimbLogic™ VS for creating an airtight seal. The sleeve combines a unique blend of Kevlar pulp and traditional Alpha gel with mineral oil for increased durability and greater puncture and abrasion resistance without compromising comfort.
- Features 3mm Kevlar®-reinforced Alpha gel.
- Flexible fabric for greater comfort and flexibility.
- Use with LimbLogic VS for airtight seal.
- Available in four sizes.
PEL Supply Company
The new LOMBAR orthosis is a streamlined, low-profile, customizable orthosis that promotes thoracic extension through targeted vertebral separation. The "aluminum spine" provides strength while conforming intimately to the patient's body to provide stability and pain relief. The apron front closes with hook and loop Velcro® via dual pull tabs with finger pockets for easy, independently controllable, adjustable abdominal compression. Features include a soft CoolFoam liner. The aluminum posterior frame is easily contoured to the patient's anatomy. Strap lengths are "one size fits all" and easily trimmed. Superior lateral control.
Available in standard and tall sizes.
Friddle's now offers the time-saving Blockers from Acor® with three different Swirl Microcel Puff® topcovers. These pre-laminated, pre-skived Blockers come with EFM® reinforcement and a Microcel Puff base that, when heated, allow you to fabricate a pair of custom foot orthoses quickly and easily. The rear-foot portion of the blocker material is thicker than the forefoot, allowing for grinding of posting and edges of the orthoses. Blockers save you inventory, space, and time. View them and order online at www.friddles.com
Friddle's Orthopedic Appliances
Orthofeet is now offering a large variety of shoes that feature the Tie-Less Lacing System. This patent-pending system combines laces with hook and loop straps that eliminate the need for lacing up, offering an ideal solution for people who have difficulties tying laces.
Additional features include:
- Soft, seamless lining, padded with extra foam.
- Lightweight Ergonomic Stride™soles.
- Supple leather uppers with non-binding design.
Visit us at AOPA booth 217.
OPIE Software users can now take advantage of the most advanced ordering system available to an O&P practice, through integration with Cascade Orthopedic Supply. The integration includes a complete digital Cascade catalog, updated daily, which is searchable from within OPIE. When placing an order, users see the date their items will arrive, and if any items are backordered, they are immediately notified and given additional options. When items are shipped, the order is automatically updated in OPIE with a tracking link. Contact us to find out how you can get started with OPIE Purchasing & Inventory with no upfront fees and no risk.
Mechanical advantage with no strings attached!
The innovative NINJA is a 6X mechanical-advantage orthosis, like a string brace, but using straps, not strings. The straps are more durable; they won't fray, tear, tangle, or wedge.
The NINJA belt is the foundation of each brace (L-0627, L-0631, and L-0637) in the NINJA Progressive Spinal System. It has a soft mesh inside and an aggressive loop outside. The one-pull strap is easy to tighten and fasten. The NINJA PRO is pictured.
HOPE Orthopedic: When you need it right fast!
With nearly effortless rollover, the Promenade prosthetic foot provides an excellent alternative for the diabetic and vascular amputees in your practice.
The dynamic heel combines with a supple toe to provide users who have low-impact ambulatory skills with a more symmetrical gait. The energy return of the Promenade will assist basic ambulators in achieving efficient stride lengths and facilitate greater comfort and increased participation in daily activities.
- Full-length sole plate.
- Partial split toe.
- Active heel with cushion wedge.
- 325 lb. weight rating with 60-day trial period and 36-month warranty.
Shape and skive foam, sand materials, and prep models at your station with our air belt sander. Save time and effort, and improve efficiency by bringing the equipment to your station with our portable, powerful tool. The 18 in. x 1 in.-wide belt creates a comfortable working area. Two hand grips are included for greater control. The sander comes with four belts.
The Ortho Remedy
The new Summit™ 631 LSO limits motion and provides effective compression for the relief of lower-back pain. Aspen Medical's new LSO utilizes innovative materials and an ergonomic design to conform to the vast majority of patient anatomies without compromising support.
Features of the Summit 631 LSO include:
- 4:1 mechanical advantage.
- Conform back panel provides custom- silhouette feel while administering direct pain relief to the lower back.
- Ergonomic, comfortable fit toaccommodate diverse anatomies and diagnoses.
- Independent upper-zone and lower-zone tightening with SlickTrack™ tightening system.
- Four sizes accommodate waist circumferences of 26-60 in.
Dycor's new CFS Partial Foot incorporates an integrated custom silicone liner with an advanced carbon-fiber/epoxy composite socket and urethane/nylon composite upper for enhanced pressure dissipation and bulk reduction. The custom silicone liner is available in 4, 5, and 6mm with optional zone padding. The cosmetic cover is available in either a silicone or urethane/nylon composite. Function is facilitated with either a passive or flexible-keel foot and optional Velcro closure, depending on ADLs and ablation level. Modified model, tracing of contralateral foot, and shoe are required. Weight, including 5mm liner and flexible-keel foot, is 8 oz. (26med.).
Treat your smallest patients with the best functional prefab for children. ProLab Kiddythotics™ are designed to produce the best outcomes by incorporating:
- Rigid polypropylene shell
- Deep heel cup
- 4mm medial heel skive
- Medial flange
- 4/4 rearfoot post
Available only through licensed practitioners.
The ParaPod comes in a kit form that can be sized and assembled easily for significantly less than conventional HKAFOs. The kit provides an exoskeleton worn over clothing that consists of shoe clamps, aluminum uprights, foam knee blocks, and upper back and chest supports. The aluminum uprights are sized at the knee and hip and cut to length. Additional tubes can be cut to a longer length to accommodate growth.
With one of the largest and most extensive selections of diabetic and orthopedic footwear, stepping in style has never been so easy!
Our footwear stock includes BoxerDogs, Mt. Emey, and Answer2. We also offer Medicare-approved custom diabetic inserts, as well as toe fillers, prefabricated diabetic inserts, and other products pertaining to diabetic-foot management. We guarantee value pricing, huge product selection, and a commitment to excellent service you have to experience. Our 2009 catalog is available.
Apis Footwear Co.
The Hottest Profit Center for Your Practice
ThermoTecc™ is the new heat-moldable orthotic system that saves you time and money. ThermoTecc orthotics provide maximum performance with a thin, full-length anatomically designed shell. The very dense 75-durometer lightweight EVA combines a flat bottom for stability with an extended longitudinal arch for mid-stance control and a lateral wall for better control. A deep heel seat with minimal heel raise allows for better biomechanical function, while the cuboid support minimizes lateral foot pain. The very thin and durable forefoot provides added control and is great for use in all types of footwear.
ThermoTecc can be purchased as moldable shells or as a complete device with the addition of a PTecLT™ cushioning mid layer and anti-odor, anti-microbial, and anti-fungal BambooTecc™ top cover. Firm, 70-durometer posting strips and heel pads are available for further customizing your device. ThermoTecc footbeds are easy to cut, grind, and glue and are easy to trim to sulcus or proximal to met heads, minimizing the need for additional inventory. ThermoTecc is the most versatile and flexible orthotic system available.
Peaster & Williams Central Fab is pleased to announce its primary focus is shifting to upper-extremity fabrication. With over 19 years of experience and a concentration on hybrid limbs, Jim Williams assists his clients with component selection and fabrication methods allowing them to provide their patient with the most functional and aesthetically pleasing limb.
Peaster & Williams would like to congratulate Johnny Peaster on his semi-retirement after 37 years in the industry. Johnny is available on an "as needed" basis for your lower-extremity needs. Consider Peaster & Williams Central Fab for you upper-extremity fabrication needs.
Peaster & Williams Central Fab
Liberating Technologies introduces the new M-Finger partial-hand kit, consisting of dexterous fingers, a multi-position friction thumb, and mounting plates for use in a mechanical hand assembly. The fingers and thumb have urethane covers to provide better grasp and molded-in finger nails for picking up small objects. The fingers are actuated by a Spectra™ cable that crosses the wrist and is controlled by simple wrist flexion. Each finger independently conforms to the shape of the object, allowing for multiple grasp patterns. M-Fingers are available in various segment lengths and can be customized to suit the patient.
Liberating Technologies Inc.
Fillauer's most popular stance-control orthotic joint, the Swing Phase Lock 2(SPL2) includes the following features and benefits:
- Enhanced position-dependent pendulum design.
- Multiple locking positions provide additional safety.
- Increased stability for patients with tentative gait.
- Easy fabrication with minimal follow-up maintenance.
- Works with any orthotic ankle design.
- Only design available for use in rehab knee orthoses.
- Bilateral or unilateral uprights for easy donning.
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 available in two sizes, small (6 to 9 in.) and regular (8 to 14 in.). The bar is adjustable through each size range to accomodate growth. 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