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Lower Extremity Mobility Aid: The LEMA Strap
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Raymond Joyce CO is the inventor of the LEMA strap, a very simple orthosis to assist in swing phase for patients with weak musculature.
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I have been doing a series of training courses for orthotists interested in Horton's Stance Control Orthotic Knee Joint. One of the benefits of traveling around the country and meeting with so many colleagues is the opportunity to learn little tips and tricks from other clinicians. I am always delighted to learn from others' success, and often amazed at how effective seemingly simple solutions can be.
After the Dallas SCOKJ Qualifying Course concluded, I had the pleasure of chatting with Raymond Joyce CO and his wife, and learned that Ray the inventor of the LEMA strap. I have recommended this device from time to time as therapy equipment, to help the PT train patients with hip flexion weakness. Ray tell me the he has patients who have elected to wear the LEMA strap long term, if their paresis is permanent, in which case he modifies the "shoe stirrup" so the straps attach to chafes on the patient's shoe.
This product is a great example of how a good orthotist identifies a clinical problem and comes up with a practical clinical solution. Ray designed the LEMA strap to provide an external hip flexion moment, and suggested it may be useful for some SCOKJ candidates with weak or absent hip flexors. Consumers and health care professionals can learn more about this slick and simple orthosis at www.lemastrap.com and order one directly from Ray.
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Positioning the shin straps more or less anterior to the knee and ankle joints increases the knee extension and ankle dorsirflexion moments, according to each individual's needs.
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We spend a fair bit of time reviewing the kinematics and kinetics of normal and pathologic gait during the SCOKJ Qualification Course, and one of the key points is how hip flexors disrupt swing phase kinematics, resulting in minimal toe clearance. Now that the SCOKJ is available, and for the first time we have an alternative to locking the patient's knee in full extension, hip control becomes an increasingly important consideration.
The power source for the LEMA strap is a 2-inch piece elastic billet attached to a fabric waist belt. The balance of the device is made from non-elastic strapping and Velcro. The patient adjusts the billet tension to create the desired hip flexion moment.
The Velcro strap behind the knee can be used to fine-tune the knee extension effect. The looser the popliteal strap, and the more anterior the shin straps are positioned, and the greater the knee extension moment created during swing phase. In like fashion, the more anterior the leather "shoe stirrup" is placed, the greater the ankle dorsiflexion moment created. It is very simple to find, through iterative trials, the optimal position for each individual that provides the best biomechanical forces to supplement their voluntary muscle control.
Ray also tells me that he has patients who have learned to rotate the belt to create an internal or external rotation moment at the hip, to compensate for muscular imbalances. This can be very useful in helping to insure that knee flexion is congruent with the line of progression.
To apply these concepts to a KAFO, the fork strap can be attached to the thigh or shin section of the orthosis, depending on the biomechanical functions desired. Now that Horton's SCOKJ has ushered in a new era in orthotic management where we can offer much more normal swing phase motion to many patients, hip control strategies such as these will become increasingly important.
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Positioning the belt so that the billet pulls toward the midline adds an internal rotation moment at the hip.
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Conversely, when the billet pulls away from the midline, and external rotation moment at the is created.
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Ohio O&P Association meeting 4/12/02
John,
Thanks again for your participation!
I am wanting to get a copy of the presentation you gave on Thursday.
Joe
PS I hope this is the correct venue to request the info!
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Re: Ohio O
This is fine. You can also request copies of the handout from the lecture on "How To Make A Presentation" via my personal email: JWM@CPOServices.com. Either way, I'm happy to send the outline. I will post it on next month's Corner as a d... read more
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Orlando Academy Meeting - Rheo?
Are you able to provide any information about the Ossur "Rheo" knee (workshop 20) that took place at the meeting on March 20th? Thank you.
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Re: Orlando Academy Meeting - Rheo?
I was unable to attend that workshop because I was conducting the training for Horton's Stance Control Orthotic Knee Joint, but I understand that the topic was changed to OSSUR's new Ceterus foot and the knee was not mentioned. --John Mich... read more
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Re: Re: Orlando Academy Meeting - Rheo?
In response to intense interest in Ceterus, the new Flex-Foot® with responsive rotation, the decision was made to present this currently available product at the Academy meeting. The Ossur Mechatronix team is currently verifying the 'Rheo' ... read more
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Re: Orlando Academy Meeting - Rheo?
That means the "Rheo" is likely behind schedule as I have heard rumored. Thank you very much for the info and the quick reply. You have been a great source for info on the C-Leg, I will keep a close eye on this web space for updates on thes... read more
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La Esquina de John Michael en Español.
Ciudad de México 1° de Abril, 2002.
Estimado John Michael C. P. O.
Interesantes los artículos presentados en esta Esquina del mes de Abril. Esperamos la publicación en Español, para beneficio de los ortesistas de América Latina.
Le envia... read more
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Re: La Esquina de John Michael en Español.
Dear Alberto- Please resend your translation to oandp.com; I think there was a problem with the email. Thanks. --John Michael CPO
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Re: Re: La Esquina de John Michael en Español.
Ciudad de México 2 de Abril, 2002.
Estimados John Michael y Jon Shinn:
enviamos nuevamente la edición de abril de La Esquina de John Michael traducida al idioma Español. Los articulos que se presentan son muy importantes para los practica... read more
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Re: Re: Re: La Esquina de John Michael en Español.
Estimado John Michael C. P. O. FAAOP:
le enviamos un cordial saludo y le informamos a usted como miembro del Comité Iberoamericano de Educación en Ortésis y Prótesis que la Universidad Don Bosco y la Escuela de Protesistas y Ortesistas de ... read more
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Re: Re: Re: Re: La Esquina de John Michael en Español.
I am very pleased to learn that Don Bosco University will be conducting a Spanish language Distance Learning program for P&O faculty, under the auspices of ISPO. That is a wise idea and a very sensible way to implement DL. I'm sure the fa... read more
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Re: Re: Re: Re: Re: La Esquina de John Michael en Español.
Estimado John Michael: recibí su pregunta sobre la busqueda de un diccionario en español relacionado con Ortésis y Prótesis. No conocemos este tipo de diccionarios de términos médicos. Nosotros nos basamos para el trabajo de traducción en "... read more
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Re: Re: Re: Re: Re: Re: La Esquina de John Michael en Español.
Thanks Alberto- Hopefully the dictionaries you suggest will help the translator even though they are not specific to P&O. Best regards. --John Michael CPO
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