Presentations at the Academy Meeting in San Diego

This year's Academy Annual Meeting was filled with Manufacturer's Workshops and concurrent Scientific Sessions. It was literally impossible to attend even half of the educational opportunities, so the best I can do is to comment briefly on just a sampling of the best presentations I was able to attend. As always, many of the most substantive talks were the opening Thranhardt sessions.

Don Katz CO, FAAOP gave one of the most important lectures in the history of the Academy: the summary report from the first Clinical Standards for Practice consensus conference. The topic of this landmark work was the orthotic management of adolescent idiopathic scoliosis. This was an excellent topic for this first step toward defining the standards for care within our own profession because there exists a large body of clinical knowledge gathered over time on this pathology and its treatment, and clear evidence that properly designed spinal orthoses can influence the natural history of the disorder.

Supported by partial funding from the Centers for Disease Control, the Academy convened a group of recognized multidisciplinary experts from the field to review the available scientific literature and summarize the best available evidence regarding orthotic management. They were able to reach consensus on about a dozen basic treatment principles that form the foundation for successful use of custom spinal orthoses for this population. Equally importantly, they were also able to identify a similar number of major questions where the evidence was equivocal or lacking. These were formulated into research questions to provide guidance for future investigations.

The Academy will shortly be publishing an official document with all of the findings in detail, so I won't attempt to summarize the results here. Keep your eyes open for this report: it will be a must have publication for every orthotist worldwide. This is the first of many planned steps by the Academy to elevate the rationale for what we do based on the principles of evidence-based practice. Having an objective scientific basis for the care will offer will become increasingly critical in coming decades.

Bob Gailey PT, PhD did another excellent presentation on his ongoing research into lower limb prosthetic components and their influence on amputee function. He surveyed 133 transtibial amputees who used prostheses. One of his findings was that receiving a functionally appropriate ankle-foot mechanism is one of the most significant predictors of how far an amputee can walk.

While this result may have been predictable, not all of Bob's results were so intuitive. For example, his work also showed that receiving an ankle-foot component that is equivalent to the patient's Medicare Functional Level made a proportionately greater contribution to the Level Two limited community ambulator's independence in activities of daily living than to the Level Three unlimited community ambulator. These data contradict the notion that "limited ambulators won't derive much benefit from advanced components" and suggest that prescribing responsive components for the transtibial amputee with limited strength or endurance one important aspect of facilitating functional independence.

Another interesting part of Bob's research involved calculating the percentage of cases where the amputee's prosthetic components did not correspond to their actual Medicare Functional Level. Contrary to occasional speculation, only a small percentage of these transtibial amputees [7%] received components that were higher than their actual Functional Level. It is quite possible that this subset of patients were considered by the clinical team to have the potential to achieve the next higher Functional Level of performance, per current Medicare Policy guidelines, so this is not necessarily of any great note.

A much larger percentage of amputees in this study [36%] received components that were considered justified for significantly less active individuals. This raises the questions whether these transtibial amputees could have benefited from receiving more advanced ankle-foot components. The reasons for this apparent "under-prescribing" were not clear, although funding restrictions imposed by Managed Care organizations may play a role. It is also possible that the clinic team underestimated how rapidly the amputee's functional performance would improve over time, although these latter questions could not be answered by this study.

These results are being prepared for submission to the Archives of Physical Medicine and Rehabilitation later this year. Check the Medline or RECAL databases to see when the study is published, probably late in 2003 or early in 2004.

Finally, Tom Colburn CO, FAAOP reported promising short-term results managing selected cases of single curve scoliosis by placing the corrective pads superior to the measured curve apex. He advocated trying this approach only for certain curves that do not cross the midline, and recommended using the Lemke classification scheme to identify potential candidates for consideration.

Despite the current lack of long-term evidence supporting the approach, this was a very thought-provoking paper because it demonstrated good short-term results treating a limited number of cases with a pad placement that violates one of our cherished historic guidelines for designing a scoliosis orthosis. Tom is to be congratulated for documenting his results and sharing his iconoclastic experiences in managing these curves in this manner.

Reader Comments: Read all user comments The Pedorthist. Ciudad de Mexico 24 de Junio, 2003. Estimado John Michael, CPO, FAAOP, FISPO: estoy leyendo un articulo titulado "The Pedorthist" y mi pregunta es ¿como se traduce al Español el termino - pedorthist? Sabemos que es un especialista en el tr... read more - Alberto E. Castillo Moreno O.P.   6/24/2003 Re: The Pedorthist. Thank you for the inquiry, Alberto. I suppose the best translation for the English word "Pedorthist" might be something like "foot orthotist". As you may know, the Certified Pedorthist is a recognized health care professional in the USA. ... read more - John Michael   6/24/2003 Mike's Corner Hi John, I enjoyed reading your "corner". Keep up up the good work. I just requested info on the quick release "hook tools". I am working with two amputees now. Art Heinze - Art heinze, OTR   6/23/2003 Re: Mike Glad to have been of service to your patients, Art. The photos you took arrived today and should be just perfect for the new edition of the Atlas. Thanks again for your help with this project. Best professional regards. --John Michael C... read more - John Michael   6/24/2003 Proyect Ortho Children of El Salvador. Mexico City June 19, 2003. Hello friends and colleagues: Is it possible for professional prosthetic and orthotic associations and manufacturers / suppliers to send donations of orthopedic devices and supplies for children to the proyect "... read more - Alberto E. Castillo Moreno O.P.   6/19/2003 Re: Proyect Ortho Children of El Salvador. Thank you for posting this request, Sr. Castillo. With Heinz Trebbin supervising the use of these donations, readers can be confident that the patients will receive biomechanically correct prosthesis that fit well and are appropriate for t... read more - John Michael   6/21/2003 Ertl procedure I originally posted this plea yesterday as a response to the comment made by Marilyn Nyhus on 5/8/2003. Since it is now June, I'm afraid no one will see it there so I'm reposting it here. Please forgive me for posting the same message tw... read more - Chris Schuler   6/5/2003 Re: Ertl procedure There has been tremendous interest in this issue. I think it would be helpful to all readers to repost ALL the over twenty (20) comments provided in John Michaels Corner May edition to the June Forum. In those comments, I posted the ... read more - anthony barr/president/ barr foundation   6/18/2003 Re: Re: Ertl procedure Hi Tony- The flurry of comments regarding the Ertl started late last month, after I had already submitted in this month's Corner for translation and publication. Starting in July, I will be posting an ongoing series of monthly articles ab... read more - John Michael   6/18/2003 Re: Re: Re: Ertl procedure Hey John, I was one of the prosthetists that made the recommendation to have the Ertle Procedure of Osteomyoplastic Amputation to Mrs. Marilyn Nyhus. I have seen this procedure first hand before and after on a bi-lateral transfemoral patien... read more - Bill G. Copeland C.P.,L.P.   6/22/2003 Re: Re: Re: Re: Ertl procedure Thanks for sharing your experience, Bill. Keep track of your patients who have had Ertl revisions because I am hoping that some controlled studies will be undertaken to help objectively document the results of such revisions. If there is ... read more - John Michael   6/29/2003 Re: Ertl procedure I First worked with Drs. John & William Ertl, MD's from Hinsdale Illinois. They were brothers and did all their surgery together. They were general and plastic surgeons - the rarest breed of true HUMANE human medicine, health, and caring I ... read more - Jan Stokosa, C.P.   6/17/2003 Re: Re: Ertl procedure HI John, I am fairly new to this forum, however I would like to pose a question concerning Bob Gailey's presentation at the annual meeting. I have a particular interest in his research concerning the Amputee Mobility Predictor (AMP). His i... read more - Colleen Talt, PT   6/30/2003 Re: Re: Re: Ertl procedure Thanks for the inquiry, Colleen- As of March of this year, it was my understanding that the cutoff scores were potential future work, but your best bet would be to email Bob directly at rgailey@bellsouth.net. He has many projects underway... read more - John Michael   6/30/2003