By Alberto E. Castillo Moreno, O.P.
The Mexican Society of Orthotists and Prosthetists A.C. (SMOPAC), in conjunction with Becker Orthopedic and Ortiz Internacional AC de C.V., presented an interesting seminar, "Update on Orthotic Componentry," October 23-24 in Mexico City.
SMOPAC President Dario Caballero Sandoval welcomed more than 70 orthotic and prosthetic practitioners, who represented the majority of the states in Mexico. He then introduced Gary Bedard, CO; Rosielena Jované, O.P., director of marketing for Latin America; and Ing. Marlo Ortiz Vázquez del Mercado, a prosthetist who is very well known in our country and abroad.
The work got underway Wednesday, October 23, at 9 A.M. as various innovative materials were presented, such as ShearBan low-friction adhesive interface. This product has been designed and developed to help in managing soft-tissue friction rapidly, simply, and cost-effectively. It is available in various precut forms and five convenient patches for use in orthotics and prosthetics. This material has proved its efficiency in clinics and laboratories.
After a brief recess, Gary Bedard discussed the Maple Leaf orthosis developed at the Bloorview MacMillan Centre in Toronto, Ontario, Canada. The orthosis is designed for children aged four to 15 who have cerebral palsy and who have undergone soft tissue release or other hip surgeries.
From the beginning of this seminar, attendees were aware that its content was not simply a presentation of new orthotic devices, but was a series of lectures relating to the pathology of each type of disability and which were supported by statistical data, history of the research and development of each component or material, mechanical and biomechanical data, causes of the disability, indications and contraindications, etc. This type of presentation was very much appreciated by the professionals attending the seminar, since the knowledge of the practitioners was enhanced by these related topics as well as by information about the new products.
The sessions continued with "Orthotic Management of Soft Tissue Contractures" by means of the Monodos joint with a clutch control, followed by a history of the development of components designed for thermoplastic fabrication.
That evening, attendees were invited to a Welcome Reception at the seminar site, the Holiday Inn, Plaza Dalí, which gave them an opportunity to enjoy an attractive buffet and chat with colleagues.
The sessions on Thursday began with a presentation on an indispensable tool for any orthotic lab-a Work Station which allows alignment and precise, convenient modification of the bars and lateral and medial joints over positive molds of the patient. The unique characteristics of this Work Station are that it retains the knee and ankle axes previously established by the practitioner, and it has the capability of forming the medial and lateral bar of the orthotic device. This useful tool allows sliding the bars without changing the mechanical axis.
Innovative Knee Joints
One of the most eagerly anticipated topics was stance-control orthotic knee joints, which are causing a true revolution in the world of orthotics.
Becker Orthopedic has designed a functional knee joint-Model 9003 B-Knee-which allows a patient with quadriceps weakness to walk with a free knee. This light and innovative design allows passive flexion of the knee during the swing phase of gait. A gas spring pushes the knee joint into full extension, providing stability of the knee during heel strike. This model also has a locking option. The sidebars can be either stainless steel or carbon fiber. The extension assist is available in different force units (N) required to accelerate the device and to meet the patient's individual requirements.
The US automotive industry has been an important ally in the research and development of new orthotic systems. An example is the LR-9002 Load Response Knee Joint, which has a preloaded spiral torsional spring (developed by the automobile industry), which maintains knee stability in patients with quadriceps weakness. The knee allows 18 degrees of knee flexion during the stance phase of gait, providing better lower-extremity stability to accept body weight and shock absorption to dissipate floor impact force. Do you remember the Stance Flex prosthetic knees, which allowed additional knee flexion in the moment of weight-bearing? This is a similar characteristic.
Another Becker Company step toward the feature is in the design of the Electromechanical Knee Joint, controlled by a microprocessor. Training seminars for certified and licensed orthotists are planned for Becker's Education Center in Troy, Michigan.
SARO for Brachial Plexus Injury
The following subject covered management of brachial plexus birth injury with the help of the SARO (Shoulder Abduction Rotation Orthosis). This innovative design, created through the clinical expertise of Max Lerman, CO, is light and adjustable. It is indicated for pre- and post-surgical management of the pediatric shoulder joint. The adjustments at the shoulder joint allow the clinician to precisely align the child's joint and upper extremity. This orthosis is indicated for paralysis or damage to the brachial plexus (Erb palsy), prevention of upper-extremity joint contractures, nerve repair and soft-tissue surgery, including tendon transfers.
As with all the subject, we were very much pleased with data provided, including statistics and etiology of brachial plexus birth injuries.
At the end of this presentation, an orthotic device designed for brachial plexus injuries in adults was introduced, called the "Holster Shoulder Orthosis." This device is totally adjustable in all planes and allows functional recuperation after fusion, dislocation, or repair of shoulder soft tissue. This is available in one adult size; however, it can be ordered for custom fitting through Becker's Central Fabrication Department.
The last session was a comprehensive discussion of thermoplastic technology. Gary Bedard is an expert on this material. He described step by step the types of thermoplastic, its composition, temperature control to maintain the needed temperature (he recommended a laser thermometer to measure oven temperature), care of the lab equipment (ovens), the influence of atmospheric pressure on fused material, and what's needed in equipment, such as length, the dimension of the extraction hoses, and above all the vacuum capacity. He discussed the importance of uniform cooling of the material in order to avoid weak areas and the risk of breakage, due to inadequate crystallization of the plastic. He also covered "prepreg" and composite materials, along with much other information. He recommended that all attendees research a bibliography on thermoplastics and composite materials on the Internet. For the search word, enter the word "thermoplastics, and you will find a comprehensive bibliography on this interesting and important subject.
It is important that Gary, in the near future, writes, edits, and publishes a manual on handling thermoplastic materials, which would surely become a valuable textbook for orthotic and prosthetic schools.
All the presentations were supported by impressive slides, graphics, video clips, and samples of the devices. An excellent simultaneous translation into Spanish was provided, and during breaks we enjoyed coffee, other beverages, and delicious pastries.
The closing ceremony and awarding of certificates for attending this important event, organized by SMOPAC in collaboration with Becker Orthopedic and Ortiz Internacional, was held about 5 P.M. on Thursday, October 24. In the name of the Society, we thank all the instructors who have contributed to the increase in knowledge of the attending orthotists. They have enhanced their professional development and thus will be able to provide better service to their patients.