John Michael's Corner Welcome to the intersection of orthotics and prosthetics in cyberspace!
This month will highlight several national and international meetings, suggest two videos for your professional library, and offer a clinical tip on how to use hook and loop tape to suspend an upper limb prosthesis.

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Table of Contents
ISPO Caribbean Meeting - Curacao

The desert island of Curacao, located just off the coast of Venezuala, was the site for the second international congress hosted by the Latin American ISPO societies. Excellent simultaneous translations made it possible to freely exchange information and ideas with colleagues from this region despite my own monolingual limitations, although the concentration required to follow rapid-fire translation makes such meetings somewhat fatiguing. Based on the format from the excellent Pacific Rim meetings, the scientific sessions ran from 8AM to 1PM each day, leaving the afternoon and evenings free to learn more about the local culture.

CuracaoMany of the papers were outstanding. I particularly enjoy multilingual, multidisciplinary meetings because the lecturers generally focus on key points and principles rather than the same old "what's hot and what's not" of single discipline sessions. Engineers David Condie and Brendon McHugh from Scotland did a superb job of presenting the essence of practical biomechanics. Dr. Jose David Freire from Argentina showed a remarkable series of successful orthopedic surgery for neglected paraplegic people with massive decubitus ulcers who were successfully rehabilitated as bilateral hip disarticulation amputees. Actually, the Argentinians turned out in large numbers for this meeting and all their papers were interesting and thought provoking.

By the way, the next Latin American ISPO congress will be in the Argentinian capital city of Buenos Aires; I will post the dates once they have been finalized. BA is one of my favorite urban destinations as it combines the vitality of Latin American culture with a distinctly European flavor. It is also the site of the longest-running P&O school in the hemisphere. And, of course, the local cuisine features some of the finest and healthiest grass-fed beef in the world prepared in a variety of unique ways. Rent Evita one more time for a glimpse of this city and its beautiful surroundings, or visit www.buenosairesherald.com for more information.

Punda area in CuracaoVascular surgeon Nelson De Luccia from Brazil knocked everyone out with his integration of multiple full motion video clips into PowerPoint slides, setting a new standard for effective presentation of clinical case material. He showed successful use of a Utah electronic system by a young man who required surgical revision of a traumatic elbow disarticulation due to a massive and painful neuroma. Dr. De Luccia not only resected the neuroma but also used a mortise and tenon procedure to shorten the humeral diaphysis a few centimeters. The result was the functional equivalent of congenital elbow disarticulation: a self-suspending, rotation-controlling residual limb, permitting placement of the prosthetic elbow in an anatomically correct position.

Carnaval DancersLeaving Minnesota's sub-zero snow and Norwegian stoicism for a country with an Arizona climate and a multicultural historical heritage was an added attraction. Linda and I stayed at a local hotel, the Otrabanda, directly across from the main harbor. Every morning we could watch the sun rise over the quaint facades of the Dutch-influenced architecture in the shopping district, a few minutes walk across the world's only pivoting bridge.

A week was not enough time to see everything this island country has to offer, but the maritime museum and African slave museum were exceptional in their scope and displays. We also enjoyed many moderate cost meals in local restaurants with our friends from around the world as well as a couple of more elegant dinners in upscale venues. And of course, the Carnival parade was a cacophony of exotic sounds, smells, costumes, and dances as the Curacao citizens showed the results of a full year's preparations for this Lenten spectacle, which is held the day before New Orlean's holds its Mardi Gras celebration.

American Academy of Orthotists and Prosthetists

Pathfinder from Ohio Willow WoodThis year's Academy meeting was held in sunny San Diego, and was noteworthy due to the reorganization of the format to follow the ISPO model and emphasize more in-depth educational options including Instructional Courses and Symposia. Based on the standing room only crowds at many of the sessions, it appears that the attendees approved of the changes.

Most of the exhibits were familiar options, incremental improvements, or outright knock-offs of someone else's ideas. There at least two novel concepts revealed, however: the polycentric "Arthroglide" ankle from JMMR and the "Pathfinder" ankle-foot assembly from Ohio Willow Wood. This latter component looks a bit like a cross between a Flex-Foot and the old Habermann wooden foot with its fluid-controlled plantarflexion damper. Blatchford also showed their Adaptive Knee with microprocessor-controlled stumble recovery capabilities for the first time in this market. [This project was unveiled last year at the Amsterdam ISPO Congress, but is not yet commercially available.]

Due to the number of concurrent sessions scheduled, it is impossible for any one person to attend all of the available educational sessions at the Academy meeting. But, clearly one of the best overall presentations was Don Katz' retrospective study of thoracolumbar idiopathic scoliotic curves including the statistically significant finding that the lumbar-pelvic angle may be a key indicator to determine which double curves are likely to respond well to management with an orthosis. More importantly, the group at Texas Scottish Rite Hospital found that such cherished factors as the Cobb angle or Risser sign, which have been shown to be predictive in the management of idiopathic scoliosis in general, were not good discriminators for this subgroup of more difficult scoliotic curves. Look for these results to be published soon; this may well prove to be as significant as Don's landmark work investigating the effectiveness of the Charleston Bending Brace.

Next year's Academy meeting will be held in Dallas from March 7-10, 2001. Watch the Academy's web site at www.oandp.org for more details.

British Association of Prosthetists & Orthotists

I was honored recently by the invitation to participate in the BAPO meeting in Glasgow, Scotland as a keynote speaker. The venue was the ultra-modern Scottish Exhibition and Conference Center, pictured above. This was my first BAPO meeting, and I was very impressed by the overall quality and content of the scientific program and particularly by the questions and discussions that followed most presentations. The members' avid interest in finding evidence-based results to support clinical reports and practices is a commendable focus that other professional P&O groups would do well to adopt.

This video may take a minute or more to load; please be patient.

Richard Nieveen presented well-documented results from a survey on the training received and socket configurations the members use when managing transfemoral amputees. Remarkably, over 90% of the prosthetists in the UK responded to his questionnaire making this data quite comprehensive and therefore valuable. The number of BAPO members in the audience was equally astounding with approximately 75% of all practitioners in the country participating in this conference. [By way of comparison, a typical Academy annual meeting will attract about one third of all US CPOs.]

One of the most interesting topics was the report by John Sullivan on his experience with a small number of transfemoral amputees at Roehampton who have undergone Brannemark's osseintegration procedure and are using prostheses that are directly connected to their femurs. Successful candidates reported enhanced proprioception, suspension, control, and range of motion with the prosthesis, as well as a perceived reduction in the effort required to walk. This update was notable in the frank discussion of both minor and major post-operative complications as well as the limitations that the two-year rehabilitation protocol presents in the selection of potential subjects for further research into this area. This cohort all used the Bock 3R80 rotary hydraulic knee and 1D10 Dynamic foot, aligned and adjusted in the conventional manner.

KVS Orthosis, based on CARS-UBC concept by James Foort As you might expect, most of the commercial exhibits were familiar components and techniques. I was pleasantly surprised, however, to see that the very simple and clever telescoping knee orthosis designed by James Foort on behalf of the Canadian Arthritis and Rheumatism Society remains available in the UK. I used this device a number of times in the 1970s as an "unloader" to relieve pain secondary to unicompartmental arthritic pain from mild to moderate genu varum or valgum. The sling of this very lightweight orthosis gently unloads the medial [or lateral] compartment as the knee nears extension but relaxes automatically as the knee bends, making it easier to tolerate than many hinged KO's.

Kelvingrove Art Gallery in Glasgow On a cultural note, I did my best to join in the enthusiastic Scottish folk dancing that followed the closing reception. [Many of these tunes and steps were strangely familiar, as they have been Americanized on our side of the Atlantic into what we consider to be square dancing.] Fortunately, our UK colleagues graciously encouraged my efforts to learn how to dance "on the fly", ignoring the fact that I have two left feet and was conspicuously wearing trousers rather than a kilt.

There will be an excellent opportunity for interested rehabilitation professionals to visit Glasgow next year, when the ISPO Triennial World Congress will be held from July 1 to 6, 2001, at the same venue as this year's BAPO meeting. Visit www.i-s-p-o.org for more information. In addition to conducting a world-class international educational meeting, the ISPO organizers always offer numerous opportunities to sample traditional cuisine and culture, and to explore the many resources in this cosmopolitan and historic European city.

Sunset in Iceland I flew to Glasgow and back on Icelandair, with a plane change in Rejkyavik, and found the flight both comfortable and very inexpensive compared to better-known carriers. Rather than spending 8 hours in the plane and then taking a short hop flight from Amsterdam or Frankfurt to the final European destination, the Icelandicair option was 5 hours to Rejkyavik, with a chance to walk around a little before boarding the 3-hour flight into Glasgow. If you can take IcelandAir and have the time available, consider asking your travel agent to arrange at least a one day stop-over in this fantastic "Land of Ice and Fire" on your way to or from the ISPO meeting.

Recommended Resources

The Instructional Course at the Academy meeting highlighted two excellent, low-cost videotapes intended to help rehabilitation professionals and amputees understand more about use training and functional operation of upper limb prostheses. The tape set narrated by Denise Keenan, OTR is available from Motion Control [www.utaharm.com] and features a number of unilateral upper limb amputees with various levels of loss learning to use powered prostheses. Request video "V4" from the web site.

Art Heinze, OTR also has an outstanding tape available which demonstrates his virtuoso abilities with body-powered transradial and transhumeral body powered limbs. It also deals frankly, from his perspective as a bilateral amputee, with such key activities of daily living as toileting and personal hygiene and demonstrates how these tasks can be accomplished.

Contact Art at http://community-2.webtv.net/ArtHeinze/ArmAmputeeVideo/ for ordering information.

Clinical Tip

Bill Dykes from the University of Strathclyde tells me he has achieved excellent long term results using hook and loop tape to suspend lightweight "shoulder cap" prostheses for people with intrascapular-thoracic upper limb amputations. Bill cuts small strips from the "self-stick" loop used to Self-stick hook-and-loop tape can suspend a lightweight shoulder prosthesissuspend Amoena breast prostheses and has the amputee attach them directly to their skin in strategic locations. In his experience, the strips remain in place several days despite daily showers and normal perspiration.

The amputees simply apply new strips, as needed, whenever the old ones finally lose their adhesive properties. Corresponding segments of hook tape, recessed into the underside of the shoulder prosthesis, provide secure, comfortable, and convenient suspension - eliminating the need for straps or other mechanisms to stabilize such lightweight passive restorations.

Clinical Tip Documents - Forequarter Amputation: A Self-Suspending Shoulder Cap

Microsoft Word DocumentMicrosoft Word Document - Abstract.doc, 33KB
Microsoft PowerPoint PresentationMicrosoft PowerPoint Presentation - Self sus forequarter2.ppt, 2393KB

Handouts available

Several people have requested the text from one or another of the PowerPoint presentations I made at these meetings. As a service for the visitors to this corner, outlines of those presentations are available for download at below. The documents below are in PDF format and require the free Adobe Acrobat reader to view. If you don't already have the reader, you can download it from the Adobe web site.

Adobe Acrobat PDFManagement of the Bilateral UL Amputee (Bil_UL_Px_Mngmt.PDF, 27KB)
Adobe Acrobat PDFA Brief History of CADCAM in P&O Practice (History_of_CADCAM.PDF, 44KB)
Adobe Acrobat PDFIschial Containment: Priciples and Practices Worldwide (Ischial_Containment.PDF, 52KB)
Adobe Acrobat PDFTransfemoral Prostheses: Into the New Millennium (TF_Pxes_2000.PDF, 60KB)
Adobe Acrobat PDFWorld Wide Web Resources for O&P (wwwO_P.PDF, 756KB)
        • Selected Web Sites for O&P Information

See you next month...