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A Call to Improve Advanced Science Content: Part III
By Edward S. Neumann, PhD, PE, CP Editor’s Note: In the previous articles in this
series, Dr. Neumann called for a strengthening of advanced science
courses in O&P education in seven areas: biomechanical tissue
factors; biomechanical gait factors, physiologic factors,
psychophysical factors, motor control factors, material strength
factors, and economic factors. This article discusses the last
three areas and presents Dr. Neumann’s recommendations and
conclusions.
Motor Control Factors
 Motor control factors of importance in
O&P include hand-eye coordination, balance, and the ability to
reprogram muscles and learn new motor activities.
Despite the potential importance of this area, there is little
scientific literature on motor control in the context of O&P
clinical work.
It is somewhat surprising that Fitt's Law, which identifies the
trade-off between the speed of a movement and the accuracy of the
movement-one of the fundamental concerns and guiding principles in
the design of man-machine interactions and controls-is never
mentioned in O&P scientific literature. Fitt's Law is helpful
in understanding the limitations of upper-extremity prostheses and
the importance of the speed with which terminal devices open and
close.
The balance skills of a patient are also important to O&P
outcomes for the lower extremity, and influence component selection
as well as alignment. The sense of balance worsens with increasing
age and can be affected by specific pathologies. Balance assessment
is an emerging specialization in the field of physical therapy,
with amputees being one of the populations of interest. It may be
desirable to introduce O&P students to the concepts and
experimental methods employed in assessing balance skills, in order
to better understand how balance affects the patient and to foster
effective communications with balance specialists.
Material Strength Factors
Material strength factors will not be addressed here
at length, except to note that, as mentioned below, both an
excellent textbook and continuing education courses are currently
available.
Based on my engineering knowledge of materials and my experience
in the lab, I have concluded that many laminated sockets are
probably over-designed. However, because consistent quality control
is somewhat difficult to achieve during fabrication, and lawsuits
are costly, it is probably better to err on the side of
conservative design.
Weight and bulk remain important concerns though, and it would
be desirable to introduce students to the basic strength properties
of composite materials, which are influenced by the direction in
which the fibers in the matrix run. Also, an overview of the
scientific methods used to determine stress patterns in components
would be valuable, along with examples and interpretations of the
stress patterns found in components when they are placed under the
loads associated with gait.
Economic Factors
Economic factors in the context of O&P science
concern measuring and comparing the cost-effectiveness of
alternative designs and components. Research in this
area has rarely been conducted explicitly in the context of O&P
decision-making. However, subjective cost-effectiveness judgments
are made by practitioners whenever the choice of a brand-name
component is based on an estimate of whether the performance,
initial cost, fabrication problems, maintenance requirements and
cost, and expected life of the component merits its selection.
Thus, students should be exposed to the concepts underlying the
science used to make economic evaluations and comparisons of
alternatives.
Recommendations and Conclusions
Because the essential content of O&P advanced science
coursework has not been fully identified yet for each of the seven
areas, it is not possible at this time to recommend the precise
number of credits needed to provide students with a minimally
useful background. Also, accreditation criteria are shifting from
credit hour requirements to outcomes assessment, and innovative
teaching methods tend to make it more difficult to measure content
in terms of credit hours. However, I estimate that eventually it
would involve the equivalent of between six and nine credit hours
to cover the areas adequately. Initially, the amount of relevant
material readily available might limit content to less than six
credits, but as knowledge is developed, it might easily approach
nine credits.
Identification of the content should be undertaken by a team
comprising individuals working directly in O&P with backgrounds
in traditionally strong science-based disciplines, including
engineering, medicine, and kinesiology, and professionals from
related healthcare disciplines such as orthopedic surgery, vascular
surgery, plastic surgery, physical therapy, and occupational
therapy, who have an appreciation of-and a vested interest in-the
clinical aspects of O&P.
A balance should exist between educators, individuals with
extensive O&P clinical experience, and individuals who
primarily have research backgrounds and interests. A major
challenge will be to establish a mechanism for ensuring that the
content of the educational materials remains current, since O&P
is highly interdisciplinary, and advancements in measurement
techniques and scientific knowledge are evolving rapidly in most of
the seven areas.
A sequence of advanced science courses could be more easily
integrated into the bachelor of science programs than the
short-duration certificate programs. For the certificate programs,
a "just-in-time" or "integrated" approach might be appropriate.
Several engineering programs are experimenting with these types of
curricula, in which the advanced science topics are presented "as
needed" during the various stages of an open-ended design problem
which is introduced early in the academic program; however, the
logical progression from basic science to engineering science to
application is maintained.
The author notes that progress has been made in the development
of course content in the area of materials science through the
publication of a book by T. Lunsford, and continuing education
workshops have been developed and offered recently through the
American Academy of Orthotists and Prosthetists (AAOP) in the areas
of materials science and gait analysis. But from a instructional
perspective, elements of this material should be presented prior
to, or integrated with, third-level clinical experiences in
academic programs.
The author recognizes that National Commission on Orthotic and
Prosthetic Education (NCOPE) guidelines specify only a minimum
content for advanced science, that institutions can choose to
exceed them, and that some already have. However, all the
educational programs should be motivated to improve their advanced
science course materials, and accreditation guidelines can be an
extremely strong and effective motivator.
The goals of the advanced science component should be:
1) to develop in students the ability to interpret and apply
scientific principles for the prescribing, fitting, and aligning of
prostheses and orthoses in a clinical setting;
2) to develop a level of scientific knowledge that enables
graduates to understand the advances being made in O&P-specific
domains of science by related disciplines such as engineering,
medicine, physical therapy, and kinesiology; and
3) to develop skills that enable graduates to evaluate the
potential contribution of these scientific advances to clinical
practice.
Achieving these goals will improve the capabilities of the
practitioner, strengthen the position of the O&P profession
within the healthcare field, create a more stimulating environment
for students and faculty in O&P programs, attract stronger
interest from the related disciplines, and possibly encourage more
graduates of the programs to continue their education at the
Masters or PhD level. Edward S. Neumann, PhD, PE, CP, professor of Civil and Environmental Engineering at the University of Nevada, Las Vegas (UNLV), is currently involved in efforts to establish a degree program in biomedical engineering at UNLV. He is developing and teaching courses in prosthetic systems, assistive technology, and ergonomics. 
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OSU-Okmulgee Announces O&P Technician Program
- October 2006
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The Orientation of a Homing Pigeon
- October 2006
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Northwestern Survey Identifies Research Priorities
- October 2006
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Exciting Vision for Practitioners in the Future
- October 2006
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O&P Ascends Professional Summit
- October 2006
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Is O&P Education Doing Its Job?
- September 2006
These words sum up the paradigm shift sweeping through US healthcare, including the educational field. Orthotics and prosthetics too is running with the tide, and is in fact, ahead of the wave, according to Robin Seabrook, executive director of the National Commission on Orthotic and Prosthetic Education (NCOPE)
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Advancing O&P Education: How Are We Doing?
- February 2004
In talking with educational experts and O&P professionals closest to the subject, one can't help realizing that there is "buzz," enthusiasm, anticipation, positive energy--and above all, there is real PROMISE in the record of what's been happening recently and what's going forward already in 2004 with regard to O&P education.
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Distance Learning: A New Era In Orthotic/Prosthetic Education
- June 2003
Education Outlook
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Table Of Contents - September 2002
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