Guest Editor's Note: The Progress of
Science
John W. Michael, MEd, CPO
In 1905, A.A. Marks published a Manual of
Artificial Limbs. Chapter XVIII begins as
follows:
If I procure an artificial arm, will I
make any practical use of it? If I do not,
can it in any way contribute to my physical or mental comfort? Is the risk
worth taking?
These are the questions that have to
be answered. They weigh heavily upon
the minds of those who find it necessary to exercise economy in their purchases.
Whether male or female, rich or
poor, the feasibility of substituting a
member that has been lost must be
thoughtfully considered.1
Nearly a century later, such fundamental
questions remain just as pertinent as the day
Marks first posed them. Nowhere is this
more apparent than in the realm of children's prosthetics, although Marks could not
possibly have imagined the remarkable technical advances beyond the leather-thong-actuated arms of his day.
In this special issue of JPO, several authors discuss fitting infants with myoelectrically controlled prostheses. The range of
opinions on this issue-from the perspective
of engineer, prosthetist, parent and
spouse-clearly illustrates the depth of the
controversies the modern practitioner must
face. Openly acknowledging frank differences of opinion can be the first step toward
resolving such fundamental issues.
"The child is NOT a small adult"2 aptly
summarizes the fundamental tenet of pediatric practice. Although children's orthoses
and prostheses may incorporate miniaturized components, fundamental design criteria are quite different from the adult's. Simplicity, durability, growth adjustability and
developmental appropriateness are among
the key criteria for effective pediatric treatment. Articles based on the rich experience
From years of practice specializing in pediatric O&P provide a conceptual overview to
help the general practitioner treat pediatric
clients in a psychologically and technically
effective manner.
Pediatric problems are much the same
worldwide, and the free exchange of technical information internationally has become
the hallmark of modern O&P care. This special pediatric issue of JPO concludes with
two reports from our Canadian colleagues
on recent orthotic developments.
In considering the range of challenges
highlighted in this pediatric issue, it is apropos to reflect once again on the words from
Marks' turn-of-the-century treatise:
The successful maker cannot confine
himself to the narrow methods of former times. Specific treatment is now
called for in almost every case, the peculiarities of each require closer study;
separate methods must be devised by
which complicated cases can be treated
more skillfully and reparation more
complete. These are advanced methods, called for by the progress of the
science and necessitated by the importance of the work required.3
This special issue of JPO, devoted to the
principles and controversies of pediatric
practice, frankly acknowledges the limitations in our understanding and thereby reflects both the progress of our science and
the importance of the work yet to be done.
John W. Michael, MEd, CPO
Guest Editor
References:
- Marks A.A. Manual of Artificial Limbs. New
York: A.A. Marks, 1906:183.
- Michael JW. Pediatric prosthetics and orthotics. Physical and Occupational Therapy in Pediatrics 1990;10:2:123-146.
- Marks A.A. Manual of Artificial Limbs. New
York: A.A. Marks, 1906:3.
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