O&P: We’ve Come a Long Way

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I’ve loved watching sci-fi movies since I was a kid. Star Wars was the first movie that I saw in the theater. Aliens and The Terminator were my go-to movies when I stayed home sick from school, the Matrix was the first DVD I owned, and Inception was the first Blu-ray I owned.

The endless possibilities of scientific advancement appeal to me. Technology intrigues me. Perhaps that’s what led me to engineering and then O&P for a career. The release of recent movies such as Iron Man and Elysium, coinciding with advancements in O&P technology, make me wonder where our profession will be in 20 years.

In Star Wars: The Empire Strikes Back, Luke Skywalker’s right hand is severed by a lightsaber and then replaced with a prosthesis via robotic surgery. At that time, it seemed like a far-fetched idea. Now surgeons use robotic arms to assist in certain surgeries, and there are several advanced prosthetic arms on the market with multiple articulations, more realistic functionality than in the past, and lifelike skins. Funding for military-related projects continues to allow researchers to advance this technology. For example, the Defense Advanced Research Projects Agency (DARPA) Revolutionizing Prosthetics program yielded the DEKA Arm System that has more than ten degrees of freedom. The latest generation of this prosthesis is now being submitted for U.S. Food and Drug Administration approval with the hope for commercialization in the future. Will self-adjusting or neural-interfaced lower limb-prosthetic sockets be next? What capabilities will these advancements yield to those with limb loss?

In Elysium, Matt Damon’s character has a surgically attached neural-interfaced exoskeleton. The exoskeleton provides him greater strength with less fatigue than his weakened body is capable of producing. This concept is the sci-fi version of DARPA’s Warrior Web project to develop a lightweight suit that offers soldiers a greater loadcarrying capacity without the associated fatigue or musculoskeletal injuries. Another type of exoskeleton, the Argo Medical Technologies ReWalk™, is already commercially available in Europe. Additionally, there is research being done to develop shapememory polymers that change states based on such variations as temperature and impedance. Although they are primarily being used experimentally, they may have orthotic implications. Will these types of polymers and exoskeletons replace polypropylene and copolymer orthoses as those plastics replaced metals 30 or more years ago?

With each technological advancement, we prosthetists, orthotists, and technicians must evolve our skills. Just as we once had to learn to work with acrylic laminates and plastics instead of wood and metals, we too will need to learn new techniques. It’s difficult to know what will be the next great technological advancement in O&P, but I do know that the American Academy of Orthotists and Prosthetists (the Academy) will help bring us the education we will need to adapt.

This year the Academy celebrates the 40th anniversary of its Annual Meeting & Scientific Symposium. In honor of this anniversary, I investigated the Academy’s first educational meeting, then called the Continuing Education Conference, which was held in Chicago, Illinois, in 1984. That was the year The Terminator and Indiana Jones and the Temple of Doom were released, experimental use of CAD/CAM systems began, and the Seattle foot and externally powered upper-limb prostheses were introduced. That first meeting focused on current clinical concepts in upper-limb prosthetics. This year’s meeting showcased research and clinical lectures related to multiarticulating advanced arm prostheses, 3D printing, outcome measures, and orthotic alignment, among other topics. What a long way we have come in 40 years!

Michelle Hall, CPO, FAAOP, is the president of the American Academy of Orthotists and Prosthetists. She is a practitioner and the prosthetics residency director at Gillette Children's Specialty Healthcare, St. Paul, Minnesota.

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