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Landmark Article by Robert S. Gailey PhD, PT
Bob Gailey is a physical therapist from Miami who has devoted his professional career to helping increase the quality of therapy available to lower limb amputees who wear prostheses. He is an excellent teacher and has inspired countless of his colleagues to improve their ability to teach patients how to fully benefit from the functional performance inherent in their prosthetic devices.
The results of several years' effort to develop a practical test instrument to objectively determine an amputee's Medicare Functional Level have just been published in the Archives of Physical Medicine and Rehabilitation. [Gailey et al, The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate, Arch Phy Med Rehab 83[5]:613-627; May 2002] Gailey and colleagues worked very hard to come up with a practical method that can be used by any interested clinician in the real world, despite the time pressures of Managed Care restrictions and similar barriers.
The results of their investigation are very encouraging. Inter-rater and intra-rater reliability were between 97% and 99%, suggesting that this is a very accurate determination and that it corresponds very closely to the subjective decisions made by experienced clinicians. Since it takes less than 15 minutes to administer and requires little equipment or space, the Amputee Mobility Predictor © should prove to be practical in a clinical setting. This is one of the first critical steps in establishing objective data about amputee rehabilitation that will help us make more defensible decisions about the level of technology individual patients receive.
Equally significantly, Gailey et al's research showed that a version of the instrument that did not require wearing a prosthesis was also highly predictive. This may help in determining the components for the initial prosthesis, and ultimately minimize the widespread tendency toward being too conservative in the prescription and therefore failing to offer every amputee the most functional level of technology that they can utilize.
Kudos to the folks at OSSUR for immediately picking up on this important scientific work, and for incorporating the information into their training courses, starting at the CAPO meeting. The abstract for this article is posted on the Web at http://www.idealibrary.com/links/doi/10.1053/apmr.2002.32309 and a PDF file of the entire text can be downloaded [for a fee] from the same site.
It is heartening to see that using functional performance as the basis for prescription criteria, as has been advocated by expert prosthetists for many decades, is proving to be such a sensible way to allocate rehabilitation resources. The development of objectively valid instruments based on clinical insights is one step in the long process of developing realistic outcome measurements of the results of individual patient care.
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Laminated Orthotics
What is the deal with laminating AFOs and KAFOs. I work with Children, and occasionally one breaks a device. We have done hundreds of the typical coploy AFO, KAFO and semirigid foot orthotics. We have a new guy working here and he loves lam... read more
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Re: Laminated Orthotics
The short answer, Greg, is that laminated structures can be more precisely controlled than thermoplastic ones and can also be made far more rigid, either selectively or globally. When those are important clinical criteria, then lamination ... read more
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Trans-Tibial Sockets
Dear folks in the US,
What do you think about one of my websites?
http://home.t-online.de/home/markusthonius/bufa-sockets.html
I don't know, how much this philosophy is known in the US?
Regards from Germany,
Markus Thonius
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about KAFO+ C-leg
stance and swing control of postpolio cases joints instability by a prosthetic joint is a good idea, but demands for a special design and features like as: low-weight, durability, and spe.
small-size. it seems with new-born joints having ... read more
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Re: about KAFO+ C-leg
Ivan's point was to generate just the sort of speculation that you have offered, and you are correct in commenting that a stance control orthosis must be more than just a prosthetic joint grafted onto a KAFO. Ivan just wanted to investigat... read more
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Liners de Silicón para pacientes diabéticos?
Ciudad de México 9 de Septiembre, 2002.
Estimado John Michael, C. P. O. FAAOP:
recibimos un correo de Quito, Ecuador con las siguientes preguntas: ¿Que tipo de forros (liners) son recomendables para pacientes diabéticos? Algunos pacient... read more
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Re: Liners de Silicón para pacientes diabéticos?
Thanks for forwarding this inquiry. I don't think we have any evidence that one brand of liner is superior to another for diabetic patients: they have all been generally but not universally successful. Hygeine is important so both liner a... read more
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Re: Re: Liners de Silicón para pacientes diabéticos?
Ciudad de Mexico 11 de Septiembre, 2002.
Estimado John Michael C. P. O., FAAOP:
gracias por su acertada respuesta y la enviaremos al colega Marco Muñóz técnico en prótesis de la Fundación Hermano Miguel en Quito, Ecuador.
Aprovechamos ... read more
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Re: Re: Re: Liners de Silicón para pacientes diabéticos?
You are welcome to post my comments on any professional forum where they may be helpful. It is always difficult to respond intelligently when there is no opportunity to examine the individual patient, but I try to limit my answers to the g... read more
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Diferencias en la Alineacion de Protesis Transfemorales.
Ciudad de Mexico 13 de Septiembre, 2002.
Estimado John Michael, C. P. O. FAAOP:
nuevamente solicitamos su ayuda profesional. Un colega de Buenos Aires, Argentina esta elaborando su Tesis para graduarse como Licenciado en Ortesis y Protes... read more
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Re: Diferencias en la Alineacion de Protesis Transfemorales.
Clinicians worldwide have been trying to pinpoint the differences between US and German static alignment. To the best of my knowledge, there is no one reference that concisely compares and contrasts these theories. So, I'd recommend a sea... read more
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Congreso Interbor 2002 Valladolid España.
Ciudad de Mexico 18 de Septiembre, 2002.
Estimado John Michael, C. P. O. FAAOP: muchas gracias por su respuesta con relacion a las diferencias en la alineación estática americana y europea. Esta información ha sido enviada a Buenos Aires, ... read more
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Re: Congreso Interbor 2002 Valladolid España.
The Secretariat of INTERBOR can be reached at l.fischer@ueapme.kmonet.be; he can probably provide details on the meeting in Spain. The Spanish Federation of Orthotists and Prosthetists web site is at http://www.fedop.org/index.htm but I di... read more
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