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October 2006 • Vol. 2, No. 4
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Advancing Orthotic and Prosthetic
Care Through Knowledge
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Seven New Courses Available
Coronal Plane Trunk Shifts and Decompensational Perspectives in a New Design of an Asymmetrical TLSO Module—Keith M. Smith, CO, LO (0.75 PCE Credits)
Currently, two styles of thoracolumbosacral orthoses (TLSOs) are used in the conservative management of adolescent idiopathic scoliosis: molded or nonmolded (modules fabricated from measurements). The molded type allows the practitioner to shift coronal deviations in asymmetrical molds, and it is this shift principle that is being applied to a new design of a module made to measurements. The use of commercially available modules made with this shift applied to the trunk to decrease decompensation and trunk shift is presented. The prototype is fabricated with CAD/CAM technology, after which a series of measurements is fed into the computer to create a mold of the patient. The mold is modified on screen to translate or shift the trunk on the pelvis in an overcorrected or asymmetrical module. Radiographs are taken to determine the efficiency of the shift on coronal plane deviations and overall spine balance. The importance of overall spine balance in the conservative management of adolescent idiopathic scoliosis and the need to pay particular attention to coronal plane deviations, such as decompensation and trunk shift, are discussed.
Members: $20
Nonmembers: $50
Principles of Pediatric Halo Management—Nicole Parent-Weiss, CO, OTR, FAAOP (0.75 PCE Credits)
Halo use is a growing practice in pediatric care. It is very important to consider the thickness of a child’s skull compared with an adult’s when applying pins. When used correctly, halos can be equally effective in children and adults, but extra precautions must be taken. CT scans are recommended for children to determine safe sites for pins. The correct pin size and amount and well-calibrated torque wrenches are necessary to prevent skull penetration. In this study, similar rates of complications occurred with both children and adults. Forty-six percent of pediatric patients developed complications (compared with 54 percent of adults), of which pin site infection was most common. Pin site infections were effectively treated with oral antibiotics; one patient required pin removal; another needed a pin exchange. Children experienced higher rates of major complications such as falls. Under close supervision, halos for children under the age of three years old are very effective. Proper vest fit, ring fit, pin placement, number of pins used, and pin torque result in more successful use of the halo in children under age three.
Members: $20
Nonmembers: $50
A New Concept in Prosthetic Interface Design for Hemicorporectomy Amputees Utilizing ROHO Compression Therapy: A Case Study from a CPO’s Perspective—Jon Wilson, CPO, LP, LO
(0.75 PCE Credits)
The management of a patient who is a hemicorporectomy (translumbar) amputee requires a multifaceted approach in trying to improve the patient’s quality of life. In an effort to improve even weight distribution, heat dissipation and comfort, to avoid lower thorax shear forces, and to care for the overall well-being of the patient when prescribing a hemicorporectomy or bilateral hip disarticulation prosthesis, a new interface design is presented. The new design incorporates a custom two-in. ROHO low-profile therapeutic cushion (dry flotation) with drainage holes for ventilation, lining an adult polymer (thermoplastic) “bucket-type” prosthesis with an anterior panel for ease in donning and doffing. The prosthesis does not include any prosthetic components such as knees, ankles, or feet. Three patients with a primary diagnosis of hemicorporectomy amputation who were fit with this new design were followed with positive results. Clinical observations were found to be positive in all cases concerning ease of application in donning and doffing, heat dissipation, improved sitting posture and balance, comfort, even weight distribution, prosthesis function (skin health, usefulness, sounds, and appearance), regular hours of daily use, and mobility (transfers) with wheelchair function.
Members: $20
Nonmembers: $50
The Effect of Rest and Exercise on Residual Limb Skin Temperatures—Glenn K. Klute, PhD
(0.75 PCE Credits)
Increased residual limb skin temperatures due to prosthetic sockets have long been known to cause discomfort and skin injuries in lower-limb amputees. Various studies have resulted in the development of better prostheses for active lower-limb amputees. With the use of 16 sensors placed on residual limbs and prostheses, study participants were monitored seated and resting for 60 minutes, walking on a treadmill for 30 minutes, and again resting for another 60 minutes. The results showed that after 30 minutes of walking, the skin temperature had increased by two degrees Celsius. It took at least an hour for the limb to regain normal body temperature after the 30-minute walk. These results indicate a need for longer periods of rest between activities to avoid increased residual limb skin discomfort or irritation. The results also highlight the need for novel approaches to prosthetic socket systems using newer materials with higher coefficients of thermal activity.
Members: $20
Nonmembers: $50
Brachial Plexus Injury - A Case Study in Prosthoses—Lisa Schoonmaker, CPO, FAAOP
(2 PCE Credits)
This course describes the hybrid device using a thermoplastic custom elbow orthosis, cock-up splint with quick disconnect adapter to house a terminal device, and figure-eight harness providing limb safety, improved shoulder joint stability, and contralateral upper-extremity assist. In the past, surgical methods have been applied to aid in adult traumatic brachial plexus injuries. Recently, a hybrid device, or prosthosis, evolved through the combined efforts of the patient and the CPO to aid in ipsilateral limb function and safety. The upper-extremity prosthosis provides a neutral wrist, multiple locking elbow positions, and improved shoulder joint seating. Positive outcomes include contralateral limb assist and increased comfort for the patient. This course describes the fitting of a gentleman with a harness for traumatic brachial plexus injury. Unconventional thinking may be required when treating adult traumatic brachial plexus injury. The patient’s individual vocational and recreational activities must be considered when designing the orthopedic device. In this case, combining orthotic and prosthetic principles to create a hybrid prosthosis led to effective treatment and positive outcomes for this very active, highly motivated individual. The lesson for this course is available free of charge, but payment is required to take the exam for PCEs. Members: $20
Nonmembers: $50
Dynamic Analysis of an ARGO User—Brett Johnson, BE; Stephania Fatone, PhD, BPO (Hons.)
(2 PCE Credits)
The reciprocating gait orthosis (RGO) was greeted with much fanfare when it was introduced in the 1980s. It was hoped that this orthosis was the long-sought-after solution to enabling people with lower-limb paralysis to functionally walk. Unfortunately, these expectations were never fully realized despite many RGO designs and variants. While using RGOs, people with lower-limb paralysis walk seven times slower than able-bodied individuals while consuming seven times as much oxygen. This form of ambulation is far from functional. In addition, RGOs have a high abandonment rate with some studies reporting rates as high as 70 percent. Adults who continue using their RGOs mostly use them for a limited amount of time, a few sessions a week. In these cases, the RGO is more of an exercise device than a tool for daily living. Many researchers have attributed the lack of use to the RGOs high energy cost and have performed numerous studies measuring the oxygen consumption of RGO users. Considerably fewer studies have studied the dynamics of RGO gait. The purpose of this case study was to quantify the dynamics of an RGO user’s gait to identify possible mechanisms contributing to the high consumption of energy during ambulation. Members: $20 Nonmembers: $50
Upper-Extremity Limb Loss: Myoelectric Evaluation—Sponsored by: Otto Bock (0.5 PCE Credits)
Muscles when they contract generate an electric signal, the electromyogram or EMG, as a by-product of their contraction. Use of the EMG provides a continuous link from stimulus to function of the hand. With the EMG being proportional to muscle contraction it allows for variability. The contractions can speed up or slow down hand movements as well as increase or decrease pinch forces. Learn how the use of the MyoBoy hardware can improve EMG function. Address the computer prerequisites for use of the hardware. Discuss myoelectrode position, the principles of myotesting, myoelectric evaluation, and skin factors. The lesson for this course is available free of charge, but payment is required to take the exam for PCEs.
Members: $20
Nonmembers: $50
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