April 2007 • Vol. 3, No. 2
	Advancing Orthotic and Prosthetic Care Through Knowledge

The Academy’s Paul E. Leimkuehler Online Learning Center

Four New Courses Available

Prosthetic Foot/Ankle Mechanisms   (12 PCE Credits)

This article is an exerpt from a State-of-the-Science Conference proceedings. The confereence and original printing was made possible by an Academy grant from the U.S. Department of Education (H235J040017).

This interactive online course will guide you through the results of a consensus conference held in April 2005 and sponsored by the American Academy of Orthotists and Prosthetists (the Academy). The conference of engineers, biomechanists, prosthetists, physical therapists, and physicians set out to examine the body of scientific evidence that supports the clinical prescription and use of prosthetic foot and ankle mechanisms.

Members: $80
Nonmembers: $160

The Use of Dynamic Orthoses in Reducing Knee Flexion Contractures in a Pediatric Patient with Myelomeningocele—Phil Stevens, MEd, CPO, and Thomas DiBello, CO, LO, FAAOP    (2 PCE Credits)

Joint contractures may develop as a result of spastic muscle activity or prolonged immobilization. It has been observed that regardless of the etiology, the resultant pathophysiological changes are similar. These include the remodeling of both the associated connective tissues and the muscles themselves to accommodate their shortened state. Sound rationales have been presented on the importance of both “total end-range time,” and “low-load, prolonged stretching” in clinical attempts at reversing the biological processes of contracture development. Dynamic-assist orthotic joints represent another treatment modality in which the orthosis actively stretches the contracted joints at a clinically determined torque and duration.

Members: $20
Nonmembers: $50

Functional Limitations from Pain Caused by Repetitive Loading on the Skin: A Review and Discussion for Practitioners with New Data for Limiting Friction Loads—J. Martin Carlson, CPO   (2 PCE Credits)

Reddened, painful skin; areas where the outermost layer of skin has been rubbed off (abrasions); and blisters are very common problems observed daily by orthotists, prosthetists, pedorthists, athletic trainers, and a host of other caregivers. These examples of acute skin trauma and the pain that precedes and/or accompanies them are often what determine the limits of an individual’s functional performance. When these problems occur within footwear, orthoses, or prosthetic sockets, the cause is repetitive loading—a combination of peak-load magnitude and number of loading cycles sufficient to produce significant skin trauma. Walking, running, and many other activities involve movements of skeletal elements relative to surfaces such as shoe insoles, orthoses, and prosthetic sockets. Those relative movements are an inevitable consequence of transferring load through soft tissue and across the skin interface. The loads contain both normal components (perpendicular to the skin surface) and friction components (parallel to the skin surface). Historically, most instances of skin trauma have been attributed directly to excess pressure and have been dealt with using pressure-management techniques exclusively. Pressure-reduction tech­niques often lead to some improvement. However, the assumption that those problems are directly governed by excess pressure is substantially in error, leading to partial solutions and missed opportunities to achieve much higher levels of safe, pain-free function. Research has established the friction component of repetitive loadings to be the major factor governing how many load cycles a given area of skin can tolerate before the onset of pain and acute trauma. To increase comfortable, pain-free function, the magnitude of friction load peaks applied to each loading cycle must be reduced. This can be accomplished by reducing peak normal (pressure) load magnitudes and/or reducing the coefficient of friction (COF) operating between the skin and support surface in the problem area. Friction forces over the vast majority of the loaded skin surface area are useful for stability, suspension, and the transmission of functional forces. Friction creates a problem only in very limited areas. This is the rationale for reducing the operative COF in problem areas only.

Members: $20
Nonmembers: $50

Elbow Orthosis to Re-establish Elbow Extension Motion —Serap Alsancak, PhD, PT; Haydar Altinkaynak, MSc, ENG; (2 PCE Credits) and Hakan Kinik, MD    (2 PCE Credits)

This study describes a uniaxial elbow orthosis designed at the Ankara University Department of Prosthetics and Orthotics, Ankara, Turkey, as a custom-molded orthosis to improve elbow extension. Five children with post-traumatic elbow flexion contracture were treated using the static progressive elbow orthosis for a mean of 2.2 ± 0.8 months. None of the patients received any physical therapy or surgical treatment for flexion contracture. At the 18-month follow-up evaluation, the median correction was measured at 35 degrees in active extension limitation and 15 degrees in passive extension limitation. The findings show that the elbow orthosis is a safe and effective treatment to consider for children who present with elbow flexion contracture.

Members: $20
Nonmembers: $50