{Some remarks by the same prosthetist as in the previous post.}
Hi George, Some thoughts on your post:
>…. the area of the MOST central importance to the amputee (and to
the prosthetist) is never
discussed here, at least in the time during which I have read this
list. The area to which
I refer has to do CRITICALLY with the fit of the socket: casting
the stump and modifying.
(And just a little further on, in alignment.) It is in this
process that success or
difficulty is determined.
I firmly believe that AK modification is one of the more difficult
skills to acquire. It is definitely true that you can’t
“component” your problems away or align your fitting problems away if
the socket doesn’t fit right. I certainly am less
comfortable modifying an AK than a BK, Symes, KD, or even a PFFD. There
is so much to do and learn in this regard. I
imagine colleagues around the same age or with the same experience as me
(like maybe Mark B.?) might feel similarly.
>It is also just in these actions that the talent of the
‘operator’ is most obvious. All of the interactions between
amputee and ‘restorative
physician’ (This is a nice term) are focussed here in how the
hands perform in bringing to bear accumulated knowledge
of the amputee’s lifestyle and the measurements and the physical
examination and probing……it all comes together here,
in casting and modifying.
Yet there clearly is no rush to explore this critical part in
discussions and exchanges here.
Not exactly. It’s just that there are so many differing opinions, and
that if you put ten prosthetists in a room you’ll get 11
opinions. Not being able to listen and learn makes for no discussion.
Prosthetists (admittedly, the types that are on-line
and participating on this list and others are not whom I’m talking
about) tend to have a “know-it-all” attitude. I’m sure
everyone on the list knows someone who fits this description. They
exist everywhere.
There is also no consensus as to which way to modify an AK is correct,
because patient/clients are so individual in nature
that it is often difficult to really visualize these concepts in a
discussion. Also, it is possible to achieve patient comfort
with different techniques, even on the same patient. So then, how do we
make a true judgment as to which method is wrong
and which is right?
>In part, this reflects the fact that this part of the work is most
fully learned
under the direct tutelage of the master craftsman, part of the
extended residency. Still
one would imagine that there would be an eagerness evident in both
the masters and the
novices here to exchange to what ever extent possible in an effort
to improve
performance….SOOOOO much hardware (not blameworthy in itself)….
but SOOOOO little
‘laying on of hands’ (in fact nothing so far).
Much more should be discussed on this topic. Mark B. has proposed the
formation of special discussion panels in the
Academy, and I’m sure that would be a frequently discussed subject.
Most prosthetists want to make sure that, as they
hone their AK modification skills, they are at least not missing
anything in terms of the componentry. It is simply the
easiest and most convenient area to make a quick change in the function
of a prosthesis. And often, prosthetists are faced
with pressure from higher-ups to not make a new socket for free….
maybe it’s possible to pad the existing one, etc. This is
stuff (business stuff, that is) that undermines O&P’s efforts to strive
for improved professionalism. The “make-do”
mentality must go away. The patient/client suffers in the long run.
>To whatever extent possible I would think you people would venture
frequently into such
exchanges. From an amputee’s point of view, I could tolerate ANY
hardware so long as the
socket and alignment were optimal. What gives?? GB.
Probably true in many many cases. But once the socket and alignment are
optimized, componentry will play a larger role
because it will be the *only* variable in the equation. An ill-fitting
socket’s relationship is often affected by componentry
changes and as such the true benefit of the component change may not be
fully realized.
