I recently asked this question on the OANDP-L listserv: Is anybody interested in how the mechanical design and clinical application of extracorporeal orthotics, prosthetics, and robotics (OPR) might directly influence active and voluntary or enactive and volitional control and manipulation strategies of an OPR device and how this mechanical influence might be physically measured? For example, to what extent does any one selection and arrangement of components affect the maintenance or re-acquisition of somatosensory and sensorimotor skills associated with and necessary for safe, consistent, and predictable operation of the OPR device? <span style="line-height: 120%; letter-spacing: -0.1pt;">I also suggested that physical measurements could influence the restorative and rehabilitative potential and have immediate and positive effects on clinical practice. One influence is easily demonstrated by having patients' family members or other interested parties wear low-profile prosthetic feet attached to post-acute fracture braces or boots to help them appreciate the intervention. Prosthetists can also use this inexpensive mechanical kinematic device for their own empathy training. It's an eye-opener to experience somatosensory and proprioception corresponding to the prosthetic foot rather than the receptor mediation modality being substituted (or being supported in the case of extracorporeal orthotics), and it clearly reveals a wider and deeper restorative dimension in and of OPR physical rehabilitation science and technology.</span> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">I find it rewarding to help patients' family members better understand what it's like to regain a sense of wholeness and normality when connected to and walking on these boots. I believe the idea and relevance of enactive and volitional control and manipulation of the mechanical extracorporeal device are most apparent and appreciated when we realize we really aren't attaching machines to people, but rather, we are attaching people to machines—sometimes on a permanent basis—and we must be very careful why and how we do this. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">Extracorporeal OPR technology contributes to the process of functional restoration, but physical rehabilitation remains the ultimate product that OPR technological intervention offers. Physical rehabilitation can be assessed and perhaps defined by the operator's acquired ability to think or conceive of themselves as whole and normal, to perceive or experience physical sensations of normality and to acquire somatosensory, proprioceptive, and sensorimotor skills that allow them to purposefully, meaningfully, and voluntarily interact with their environment using the OPR device. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">Since the inception and implementation of diagnostic related groups in the early 1980s, the O&P professional sphere of practice and influence has shrunk dramatically, and this development needs to be reversed. Somatosensory and sensorimotor skills associated with physical rehabilitation are much easier to maintain then they are to re-establish. This association should be reinforced pre-operatively and continue to be emphasized throughout the immediate post-operative, intermediate or preparatory, and definitive phases of OPR technological intervention. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">One respondent to the listserv post, Daniel Heitzmann, Dipl. Ing. (FH), provided documents about how applied mechanical engineering might influence enactive and volitional control and manipulation of the extracorporeal OPR device (<a href="https://opedge.dev/4403">www.dycormfg.com/content/research-development.html</a>). </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">There is so much more involved in clinical OPR then a strictly mechanical kinematic approach, and I think it's time for the OPR clinical profession to take due credit for our involvement in this critical area of physical rehabilitation science.</span><em style="font-size: 1.25em;"><span style="letter-spacing: -0.1pt;"> </span></em></p> <p style="text-indent: 0in;"><em><span style="letter-spacing: -0.1pt;">Michael Wilson, CPO/LP, is part of the research and development group at Dycor Manufacturing, Missouri City, Texas. He can be contacted at <a title="Email Michael" href="mailto:mwpilot1@comcast.net">mwpilot1@comcast.net</a>.</span></em></p>
I recently asked this question on the OANDP-L listserv: Is anybody interested in how the mechanical design and clinical application of extracorporeal orthotics, prosthetics, and robotics (OPR) might directly influence active and voluntary or enactive and volitional control and manipulation strategies of an OPR device and how this mechanical influence might be physically measured? For example, to what extent does any one selection and arrangement of components affect the maintenance or re-acquisition of somatosensory and sensorimotor skills associated with and necessary for safe, consistent, and predictable operation of the OPR device? <span style="line-height: 120%; letter-spacing: -0.1pt;">I also suggested that physical measurements could influence the restorative and rehabilitative potential and have immediate and positive effects on clinical practice. One influence is easily demonstrated by having patients' family members or other interested parties wear low-profile prosthetic feet attached to post-acute fracture braces or boots to help them appreciate the intervention. Prosthetists can also use this inexpensive mechanical kinematic device for their own empathy training. It's an eye-opener to experience somatosensory and proprioception corresponding to the prosthetic foot rather than the receptor mediation modality being substituted (or being supported in the case of extracorporeal orthotics), and it clearly reveals a wider and deeper restorative dimension in and of OPR physical rehabilitation science and technology.</span> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">I find it rewarding to help patients' family members better understand what it's like to regain a sense of wholeness and normality when connected to and walking on these boots. I believe the idea and relevance of enactive and volitional control and manipulation of the mechanical extracorporeal device are most apparent and appreciated when we realize we really aren't attaching machines to people, but rather, we are attaching people to machines—sometimes on a permanent basis—and we must be very careful why and how we do this. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">Extracorporeal OPR technology contributes to the process of functional restoration, but physical rehabilitation remains the ultimate product that OPR technological intervention offers. Physical rehabilitation can be assessed and perhaps defined by the operator's acquired ability to think or conceive of themselves as whole and normal, to perceive or experience physical sensations of normality and to acquire somatosensory, proprioceptive, and sensorimotor skills that allow them to purposefully, meaningfully, and voluntarily interact with their environment using the OPR device. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">Since the inception and implementation of diagnostic related groups in the early 1980s, the O&P professional sphere of practice and influence has shrunk dramatically, and this development needs to be reversed. Somatosensory and sensorimotor skills associated with physical rehabilitation are much easier to maintain then they are to re-establish. This association should be reinforced pre-operatively and continue to be emphasized throughout the immediate post-operative, intermediate or preparatory, and definitive phases of OPR technological intervention. </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">One respondent to the listserv post, Daniel Heitzmann, Dipl. Ing. (FH), provided documents about how applied mechanical engineering might influence enactive and volitional control and manipulation of the extracorporeal OPR device (<a href="https://opedge.dev/4403">www.dycormfg.com/content/research-development.html</a>). </span></p> <p style="text-indent: 0in;"><span style="letter-spacing: -0.1pt;">There is so much more involved in clinical OPR then a strictly mechanical kinematic approach, and I think it's time for the OPR clinical profession to take due credit for our involvement in this critical area of physical rehabilitation science.</span><em style="font-size: 1.25em;"><span style="letter-spacing: -0.1pt;"> </span></em></p> <p style="text-indent: 0in;"><em><span style="letter-spacing: -0.1pt;">Michael Wilson, CPO/LP, is part of the research and development group at Dycor Manufacturing, Missouri City, Texas. He can be contacted at <a title="Email Michael" href="mailto:mwpilot1@comcast.net">mwpilot1@comcast.net</a>.</span></em></p>