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.