VI Nordic P&O Congress in Iceland - Part Two

Reception:

Ossur hosted a very nice reception at the nearby Asmundur Sveinsson Sculpture Museum. The artist built this gallery-studio-home over a period of years based on his own vision of how such a structure should be constructed. Natural light streams in through many glass windows and skylights, and reflects off the stark white walls to light the entire structure. The dome-shaped center and surrounding white concrete building seems to fit well in the Reykjavik landscape, and was a very interesting location for what might otherwise have been just another boring industry cocktail party.

Sveinsson was born on a remote farm in Iceland in 1893, studied art in Copenhagen and the Academy of Fine Arts in Stockholm, and spent three years studying and working in Paris, before returning to the capital city where he lived and worked until his death in 1929. He bequeathed his home and studio, and the modernistic sculptures in wood, metal, and concrete within, to the City of Reykjavik.

For more information on this creative artist, go to www.listasafnreykjavikur.is/Asmundarsafn/asmundarsafn.en.shtml .

Exhibit Hall:

Most of the exhibits contained familiar US, German, and Scandinavian technology, although it is always intriguing to see multinational companies distributing products from people who would be considered competitors in the US market. As the old saying goes, "Necessity sometimes makes strange bedfellows"....

The only unique component that I spotted was a polycentric knee with hydraulic swing phase control called the "Magic Knee", which is apparently imported from Japan. As the position of the polycentric axes suggest, this is an extremely stable knee that requires significant effort to flex, somewhat reminiscent of the TehLin designs. I always wonder about the logic of combining a hyper-stable knee with cadence-responsive swing control, since those characteristics seem somewhat contradictory.

I did have a chance to look in more detail at several of the Centri items since they were a local supplier at this meeting. Their new coated PVC gloves look much better in reality than in a photo, and is worth closer examination. Through a proprietary method, Centri has been able to apply an ultra-thin, clear protective coating over the traditional PVC stock glove.

The coating is actually vaporized and then deposited as an incredibly thin layer that adds only one gram of total material to the entire glove, which is good because the coating material costs several thousand US dollars for one gallon! This process was originally developed to protect electronic circuit boards, but in this prosthetic application it adds impressive stain resistance to the other well-known characteristics of PVC gloves: decent appearance, low manufacturing costs, reasonable flexibility, and good durability against abrasion or tearing. Since this "hybrid" glove is far less costly than silicone equivalents and more abrasion resistant as well, it may prove to be a very practical addition to our upper limb armamentarium.

Centri is now owned by Fillauer, so they displayed many of the Fillauer products as well. This was my first chance to take a close look at their micro-valve, which looks quite useful. It is a simple one-way expulsion style suction valve that can be screwed into their threaded pyramid adapter, or into a fairly small housing that may be laminated into various sockets. It should work particularly well for providing suction suspension of roll-on liners, as well as in pediatric and upper limb "push in" suction sockets.

One unique piece of software I noticed at the Nordic meeting was the Empower SMART™ program for quality assurance in the rehabilitation of transtibial and transfemoral amputees. The acronym stands for Standardized Multi-disciplinary Amputee Rehabilitation & Training.

This is a software-driven approach to coordinate five phases of prosthetic management:

1. Pre-operative treatment
2. Amputation and immediate post-operative treatment
3. Active post operative treatment
4. Prosthetic fitting
5. Follow-up

Empower is a wholly owned subsidiary of OSSUR, and they have a fledgling web site at www.empower-health.com/template47.asp . The director is Catarina Löwenadler, who is a Scandinavian prosthetist-orthotist, and the employers include another CPO as well as a part-time physician.

I didn't have sufficient time to learn about the program in detail, but what I found intriguing was that the CPOs were trying to drive the QA process rather than waiting passively for someone else to implement such controls. It will be interesting to see if this approach proves successful in the Scandinavian world and if it is exported to other parts of the world.

Most CPOs are aware of the Semmes-Weinstein filaments that can be used to objectively determine when sensation in the diabetic foot is sufficiently diminished that the skin is at risk. One of the exhibitors was importing a clever "filament pen" that was made by a US supplier.

Perhaps the most unique exhibit at this meeting was that manned by Scandinavian Orthopedic Laboratories personnel, since it featured a full complement of gait lab software and hardware, a microprocessor-controlled step counter, remote heart telemetry devices, and other methods to gather objective data from prosthetic and orthotic patients. More information about this interesting phenomenon will follows in the summary of Bengt Soderberg's lecture, which will appear in a future Corner.

Reader Comments: Read all user comments ertl procedure Please help! After 3 failed total ankle replacement surgeries (along with a subtalar fusion) I am exploring the option of a bka in the hope of getting on with my life. I have been trying to do as much research and be as informed as possib... read more - robyn hanek   9/13/2004 Need referral I need a referral to a doctor that performs the ertl procedure in either Kern County, Tulare County, or Kings County. Bakersfield, Porterville, Visalia or Fresno. Please respond. Thanks, Sharon LaScala (559) 784-3604 - Sharon LaScala   1/13/2004 Re: Need referral I think the most updated source for such information is the Ertl web site at www.ertlreconstruction.com. Since Dr. Jan Ertl is in Sacramento, you may wish to speak with him. --John Michael CPO - John Michael   1/13/2004 Need to find out about limb extention    I have not heard from any doctor yet, so I am going to put my self out on all the medical sites I can find, and maybe just maybe, I can get someone who will be willing to help me reach my goal.  I can wear my leg to do stuff around th... read more - George L. Velazquez   1/10/2004 Re: Need to find out about limb extention If I understand correctly, you are interested in learning whether you are a candidate for surgical limb lengthening. You will need to meet with an orthopedic surgeon with experience in this technique. I'm not aware of any lengthenings for... read more - John Michael   1/10/2004 Feliz Navidad y Prospero Año Nuevo 2004. Ciudad de Mexico 24 de Diciembre, 2003. Estimado John Michael, CPO: le enviamos un afectuoso saludo con motivo de esta Navidad y le deseamos lo mejor para el proximo año 2004. Muchas gracias por su arduo trabajo de informacion, en favor de... read more - Alberto E. Castillo Moreno O.P.   12/23/2003 Re: Feliz Navidad y Prospero Año Nuevo 2004. Thank you, Sr. Castillo, for these kind words of encouragement. Despite the ongoing work required to keep this forum timely, I am honored by the scope of readers worldwide who share my passion for P&O information. As we end another year, ... read more - John Michael   12/24/2003 The Ertle Procedure As a physical therapist and athletic trainer, who has focused on comprehensive rehabilitation following limb amputation, I find this interaction regarding surgical technique very exciting. I have had the privilage of training Paralympic at... read more - David A. Lawrence   12/9/2003 ertl controversy Greetings; in my exploration of the Ertl Procedure, I've found much positive commentary on the results. However, on a few occasions I've seen reference to a controversy around the procedure, although there was no information regarding said... read more - Robert Mercereau   12/6/2003 Re: ertl controversy Robert, I know all the ins and outs of the Ertl because I'm an Ertl amputee myself. My surgery was 6/3/03 in Columbus, Ohio so it's all still very fresh in my mind. The pros for me were (and still are) numerous--I can walk, jump, jog, bike,... read more - AJ Johnson   12/9/2003 Re: Re: ertl controversy AJ....I posted a message on this site but have not gotten any feedback yet so I'm hoping you have some info on my questions about the ertl procedure...1) why aren't there more surgeons who perform it since it seems to be a better amp proced... read more - robyn hanek   9/14/2004 Re: ertl controversy Why the use of the word controversy? Before John Michael’s columns the only other place I could find the word used in connection with the Ertl Procedure was for presentations at the annual meeting of the American Academy of Orthopedic Surge... read more - Vicki Anderson   12/9/2003 Re: ertl controversy The previous Corners on this topic are archived and represent my best effort to present the available information without either excessive hype or blatant prejudice. The Drs. Ertl's clarifications and comments are posted this month. Start... read more - John Michael   12/6/2003 Re: ertl controversy Robert, you can get a lengthy review at the newly launched Ertl website www.ertlreconstruction.com . I agree, you are certainly entitled to look at ALL available options. In my mind, having personally witnessed the procedure performed in ... read more - Anthony T. Barr / President of the Barr Foundation   12/6/2003 REQUESTING ADVISE DRs, BOTH OF MY SHOES HAVE SHOWN SIGNS OF UNEVEN/EXCESSIVE WEAR ON THE OURSIDE OF THE HEEL--MY FEET BEND OUTWARD. I HAVE TRIED TO CORRECT THE MISALIGNMENT PROBLEM BY WEARING A PRODUCT CALLED "PHASE 4 ORTHOTICS." I HAVE LITERALLY BROKEN... read more - RONALD BIDERMAN, MS, LADC, ICADC   12/3/2003 Re: REQUESTING ADVISE Thank you for this question. You don't need a different product until you are evaluated by someone who knows something about the biomechanics of foot orthoses. Once an office exam has established the biomechanical reason why your shoes we... read more - John Michael   12/6/2003