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Is the Future of Spinal Bracing for the Child with europathic Scoliosis
WWW.ACPOC.ORG Fall Issue, September 2012 Is the Future of Spinal Bracing for the Child with europathic Scoliosis Rigid Page 5 President’s Message Page 3 Call for Papers and Deadline Page 11 2012 Annual Meeting in Review Page 13 Vol. 183 ew Prosthetic Alignment Challenges Page 22 Email addresses Page 28 / 29 2013 Annual Meeting Update Page 30 / 31 Product and Industry ews Page 32 Advertisers Index Page 38 Membership Corner Page 39 The ORIGINAL Carbon Composite Floor Reaction Dynamic Response AFO Allard ew ...there is a ToeOFF® Family Product for every need! EWS ACPOC EWS PRESIDET’s’S PRESIDET’s’S MESSAGE rterly as low: is published quarterly as indicated below: ARCH 15SPRIG — MARCH 15 JUE 15SUMMER — JUE 15 MBER 15FALL — SEPTEMBER 15 EMBER 15 WITER — DECEMBER 15 ssions are: Deadline for submissions are: MESSAGE Dear Colleagues and Friends: Dear Colleagues and Friends: This is my first opportunity to address This is my youfirst opportunity to address you of the our position as of the president of our as from the position of the president from sociation. Needless to say, I amsociation. extremelyNeedless to say, I am extremely honored by your confidence in honored my ability bytoyour confidence in my ability to be your president for the next year be your and president a for the next year and a half. half. As most of you know, our organization As most of you know, our organization UARY 01SPRIG — FEBRUARY 01 benefit from an influx of new mem benefit from an influx of new mem could could MAY 01SUMMER — MAY 01 bers across the Association’s subspecialties. bers across the Association’s subspecialties. UGUST 01FALL — AUGUST 01 The issue would appear to be most The pressing issue would appear to be most pressing MBER 01WITER—OVEMBER 01 on the physician side. I will therefore on the physician try to side. I will therefore try to ———— ——————————— extend my efforts in this particular extend direction my efforts and emphasize in this particular communications direction and emphasize communications GHT: COPYRIGHT: with two main organizations with with potential two main physician organizations recruits. with These potential are the physician recruits. These are the and Pe (POSNA) and European Pe Pediatric Orthopedic Society ofPediatric North America Orthopedic (POSNA) Society ofEuropean North America OF THE USE OFOrthopaedic ANY OF THE diatric Society (EPOS). diatric Both Orthopaedic of theseSociety organizations (EPOS). attract Both of these organizations attract IN THIS INFORMATION IN THIS members from around the globemembers besides the from obvious aroundNorth the globe America besides andthe obvious North America and ER IS NEWSLETTER IS to increase Europe. It is my goal Europe. awareness It is of myour goal organization to increase among awareness theirof our organization among their LONG AS AUTHORIZED of potential membership AS andLONG meetingAS attendees. membership An additional and meeting sourceattendees. Anmem additional source of potential mem THORSHIP THEbership PROPER AUTHORSHIP These have been for tradi should be the Shriners Hospitals bership should for Children. be the Shriners Hospitals Children. These have been tradi to reengage strong players and we need tionally to extend strong additional players andefforts we need to extend additional efforts to reengage E IS ALSO ANDtionally / OR SOURCE IS ALSO as many of them as possible. as many of them as possible. D. QUOTED. ————– ———————————– effort in your I would also like to encourage all I would of youalso to exert like toanencourage all ofown youinsti to exert an effort in your own insti tutions to promote participationtutions of yourtocolleagues promote participation in all the subspecialties of your colleagues of in all the subspecialties of annual and meeting by submit the Association by joining and to theparticipate Association in by thejoining to participate in the annual meeting by submit MER DISCLAIMER ting presentations or at least attending. ting presentations Clearly better or at academic least attending. contentClearly and better academic content and better attendance of our annual better meeting attendance should beofthe ourgoal annual of all meeting of us. should be the goal of all of us. OES OTACPOCEWS DOES OT ORSE OR SUPPORT, EDORSE OR I hope you all had a wonderful Isummer hope you andallare had alla recharged wonderfuland summer energetic and are to all recharged and energetic to D AY RECOMMED AY work on your ACPOC meetingwork presentation on yourabstracts. ACPOC meeting presentation abstracts. HOD OR SIGLE METHOD OR MEDIAL PRODUCT, REMEDIAL The upcoming annual meeting is The shaping upcoming up toannual be a great meeting meeting is shaping with a up very to be a great meeting with a very RAM OR CETER, PROGRAM OR accessible location from all of North accessible America location and from Europe. all of We North all hope America to and Europe. We all hope to HILDREPERSO, FORattendance CHILDRE see a record and a magnificent see a recordeducational attendance program. and a magnificent educational program. WITH OR ADULTS WITH IT DOES DISABILITIES. IT DOESor ideas Any of your suggestions Any onof how your to suggestions improve ourororganization ideas on how andtothe improve our organization and the DEAVOR HOWEVER EDEAVOR annual meeting are, of course, always annual welcome. meeting are, Soofkeep course, in touch always andwelcome. let me So keep in touch and let me THE TO IFORM I THE know. know. OU HAVEBELIEF THAT YOU HAVE KOW. THE KOW. email is:TO [email protected]. MyRIGHT My email is: [email protected]. J. Ivan Krajbich, MD, FRCS (C) J. Ivan Krajbich, MD, FRCS (C) Association of Children’s ProstheticOrthotic Clinics 6300 . River Road, Suite 727, Rosemont, Illinois 600184226 TEL (847) 6981637 FAX (847) 8230536 Email: [email protected] ACPOC BOARD President Ivan Krajbich, MD Portland, OR 97239 VicePresident David B. Rotter, CPO Chicago, IL SecretaryTreasurer Jorge Fabregas, MD Atlanta, GA Directors: Bob Radocy TRS Boulder, CO Joanne ShidaTokeshi, OTR Santa Clarita, CA Brian Giavedoni, MBA, CP, LP Atlanta, GA Robert Lipschutz, CP Chicago, IL Eric Lee Miller, CP Frankfort, KY Colleen Coulter, PT, PhD, DPT, PCS Atlanta, GA ewsletter Eugene Banziger, CPO Kelowna, BC, Canada Immediate Past President Janet G.Marshall, CPO Tampa, FL ACPOC Staff Angela Schnepf, MBA ACPOC Mission The Association of Children's ProstheticOrthotic Clinics (ACPOC) provides a comprehensive resource of treatment options provided by professionals who serve children, adolescents, and young adults with various orthopaedic impairments. Vision The Association of Children's ProstheticOrthotic Clinics (ACPOC) is recognized as the worldwide leader of multidisciplinary rehabili tative care of children, adolescents, and young adults with ortho paedic impairments. Objectives ACPOC will provide information to allow patients and patients’ families to access specialized clinics and healthcare providers. ACPOC endeavors to provide opportunities to educate its member ship through newsletters, the Web site, annual conferences and other programming. ACPOC seeks to stimulate clinical research, which will further ad vance the technology and treatment approaches for orthopaedic im pairments. ACPOC offers an environment that promotes team collaboration with all medical professionals including, but not limited to, physi cians, orthotists, prosthetists, therapists, and nurses. All correspondence with respect to the ewsletter, such as comments, suggestions and contributions may be addressed to the Editor of ACPOC EWS. Eugene Banziger, CPO Editor / Publisher, ACPOC EWS ACPOC Head Office 6300 . River Road, Suite 727 Rosemont, IL 600184226 Email—[email protected] Is the Future of Spinal Bracing for the Child with Neuropathic Onset Scoliosis Rigid A Timeline of Development? Matthews MJA1; Smith MB2 1 Orthotic Clinical Specialist (DM Orthotics Ltd)/ Associate Lecturer (University of East Anglia), UK 2 Certified Orthotist (Korthotics), Australia A Discussion Document Introduction For many years, orthotists have been involved in cor rective casting and manufacturing spinal braces to contain and correct the scoliosis of children present ing with neurological onset scoliosis. In many cases, casting frames have been used to enable corrective positioning and distraction, to ensure good correction of the scoliotic curves. Safe in the knowledge that the curve and the child’s quality of life have im proved. In the short term this is achieved, however, is this, the case in the long term? It is known that there are two types of scoliosis pres entations in neuropathic presentations; one originat ing from low core tone due to lack of core stability seen in children with cerebral palsy, and the second caused by other neurological presentations (SOSORT 2012). As young children, low muscle tone spines are often easy to position, however, they present with very flaccid trunks, which often lean to one side or the other if unsupported. These chil dren, however, become the most difficult to con trol in later life as natural maturation occurs, often requiring surgery to reduce pain, subluxed hips and high Cobb angle scoliosis. Surgery endeavours to provide some stability and comfort. It is known that 62% of the cerebral palsy popula tion experiences pain; of which 70% is experi enced in the lower limbs and pelvis and 9% is re ported in the lower back (1). The pain is often a result of poor balance and spinal alignment, coupled with long durations of fixed sitting positions. The pressures provided by rigid orthotic interventions to this client group also do not assist in the long term, even if well designed and con structed. As infants the braces are tolerated well, however, as the child grows and the low muscle tone enables postural curves to become structural. Once structural, bracing can at best reduce migra tion. The experienced clinician will recognise a typical annual cyclic presentation of seeing the same pa (Continued on page 7) Fillauer EZ- Crawl Orthosis Pediatric Portfolio When it comes to pediatric products, PEL Supply has been your best independent resource for practitioner-preferred children’s products for over 50 years. Like the products featured here, some have been around for years and are proven winners. And some are new products that expand on the latest technologies or fill a specific market niche. 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Pediatric Portfolio_E.indd 1 4/27/12 3:37:31 PM (Continued from page 5) tient return year on year for new spinal braces, with the Cobb angle continuing to worsen each year. This is due to a vicious cycle, caused by the response pattern to a neurological insult, where the central nervous system lesion initiates an abnormal postural muscle tone reaction. This often shows as weakness in one of the muscles providing spinal balance. The resultant unbalanced posture will en sure abnormal quality of movement which pro vides abnormal sensory feedback and feed forward to the brain. The brain recognises this as normal and compensates. This continues as worsening ab normal quality of movement and worsening abnor mal postural tone(2) resulting in unbalanced body awareness and postural scoliosis. The resultant typical long “C” curve continues to develop, despite the best efforts of the clinical team to stretch out and counterrotate the spine. Even when aggressive cast rectification over the Iliac crests to ensure a good pelvic fixation to counter the pelvic obliquity is incorporated. This fixation also enables spinal distension. In adoles cence, the muscle pull becomes stronger and the curve develops unrestrained eventually requiring surgery to improve positioning and alignment, coupled with all of the resultant surgical risks. It is known that the first stages of correction are easily maintained by sitting systems and sleeping systems now known generically as 24 hour pos tural management. Simple soft spinal brace using circumferential pressure also can provide some midline experience. However, even soft spinal braces become the scaffolding around the spine encouraging the spinal muscles atrophy. The same muscles are already affected by imbalance of mus cle tone due to the central nervous system infarct. Even with a supportive bracing, the imbalance is uncontrolled and over time the postural curve develops into a structural curve with the wedged vertebra and rotation over the long “C” curve typical of this client group. It has been suggested that in adolescent idiopathic scoliosis, changes occur in the molecular structure of the intervertebral disc leading to an unloading of the vertebral body. This initiates a reduction of pressure on the convex side enabling the bone to grow and resulting in a wedging of the verte bra (3). This could be the same mechanism in neuropathic onset cases. The muscle imbalance appears to continue even when braced. This suggests that the brace is treating the result (scoliosis) and not the cause (muscle imbalance) (4) . Method In the 2003, a suit was used to control a spinal curve of a child with scoliosis caused by a cys tic tumour which caused a T9 apex curve of 33° (5). As the patient , a 7 year old girl did not want further spinal bracing, a Dynamic Elastomeric Fabric Orthosis (DEFO)scoliosis suit was designed based on the blueprinting of the Boston Brace system (6) using derotational and compressive translation panels (7) to laterally shift the thoracic curve, historically used in the treatment of neuropathic onset scoliosis (Fig 1). It was found that the close fit of the suit and corrective effects of the panels enabled a change in Cobb angle, reducing the curve down to 15° within a short period of time. (Continued on page 8) (Continued from page 7) Fig 1. Before and in DEFO Scoliosis Suit intervention ORTHOTYKES™: Your First Source for Pediatric Orthopedic Products SOCS® PAD SYSTEM for AFOs Toe Riser Pads (5 sizes, left or right) Hallux Relief Pads (5 sizes, left or right) ● Ankle Pad Set (3 sizes, medial and lateral) ● Heel Pad Set (2 sizes, medial and lateral) ● Metatarsal Pad Set (Set 0f 3, 1 each S,M,L) SOCS® AFO SYSTEM ● ● R J Industries POPULAR SELF-STICK PADS Pick up FIT TO MEASUREMENT No cast impression required Only 4 measurements needed (Arch, Calf ML, Ankle ML, Met ML) ● 44 sizes, 4 styles, ages 0-12 ● ● These tapered pads save time and can be repositioned, eliminating the need to grind and glue pads. ORDER BY THE DOZEN or as needed. Available in white or multi-colored. READILY AVAILABLE ● SOCS® PAD KIT 114 pads (6 of ea. style S,M,L) SSK-01T with Toe Riser ● SSK-01H with Hallux Relief ● ● RJ Industries, Inc. ● 1.800.560.3255 ● www.orthotykes.com ● Easily modified, stocked AFO Plastic choices MPE, PP, CP The first pediatric AFO System to provide the fit of a custom orthosis and the simplicity of an off-the-shelf brace! ● Solid Ankle ● UCB ● Articulated ● Dorsi-Assist ● Foam Lined ● Soft Foam AFO Initially the client felt offbalance, but quickly adapted to the new position, suggesting that the suit had affected spatial awareness. Prior to this case, the use of DEFO suits in children as young as 2 year of age had been developed in the Jenny Lind Children’s physiotherapy de partment within the Norfolk & Norwich Uni versity Hospital to stabilise children with low tone cerebral palsy based on work done else where in the UK (8). The clinical team discovered that if the child was placed into a suit for a period of 34 years the child appeared to learn body and spatial awareness and therefore no longer required orthotic intervention. Previous studies re ported high compliance (9), which has been mirrored with children preferring to wear the suits. Extra Lycra based reinforcement panels could be placed on one side or the other to stiffen up the suit to prevent and encourage im proved spinal alignment, reducing development of postural curves. Innovation through research into the reinforcement panel designs, has en abled different client presentations to be success fully treated. Immediate effects could be seen in children, pre senting with low muscle tone and identified by flared inferior, dorsal ribs and typical patterning of protraction of the shoulders; a mechanism children use to stabilise their head. This pattern ing also severely affects the child’s range of up per limb movement; therefore affect their school ing and quality of life, both current and in the future. It was noted that once the DEFO suits were worn, the children did not need to support themselves by holding on to chairs or benches. This is clearly shown in Fig 2. Fig2 : Immediate results before and in the suit. ote the improved spinal alignmentand reduced protrac tion at the shoulders in the second Initially it was thought that DEFO scoliosis suits could only be affective on curves up to 30°, however a 5 year old child presenting with myotonic dystro phy, coupled with pectus carinatum, required a non rigid intervention. The thoracic T8 apex curve meas ured 70° with over 20° of vertebral rib angle differ ence. Using the xray to provide a blueprint the DEFO scoliosis orthosis was designed. One year later the child was routinely xrays and had a re duced scoliosis curve of 35° and vertebral rib angle (Fig 3). This confirmed that the orthosis could cope with curves in excess of 45°, the current recom mended cut off for rigid bracing. (Continued on page 10) rotation bands, also have a similar effect that would explain the results we have seen to date. (Continued from page 9) Conclusion 35 Figure 3: Showing before and in DEFO scoliosis suit (one year later) for a child presenting with myotonic dys trophy. Discussion The use of this type of scoliosis orthosis does question whether rigid bracing is appropriate for the treatment of the neuropathic onset scoliosis. Clinician’s long term ex periences must question the situations where rigid brac ing will be the best option. In the earlier stages there is now limited evidence for the use of dynamic spinal brac ing in various guises. The use of strapping systems to initiate corrective responses and some localised effects can have mild effects in the early stages (10). Repeatability, however, often rely on the clinician and carer expertise. By fixing down the reinforcement panelling, the suits are able to be truly dynamic in that they will continue to provide a local deeper pressure gra dient. This enables the body segments to be “encouraged” to move laterally to a more symmetrical position. Compression, coupled with designed counter The use of DEFOs have been proven in the treatment of other neurological presenta tions (11, 12) and have become an important orthotic option in the developmental training in young children with cerebral palsy. As orthotists we need to gain a better understanding of the neurophysiological effects of deep pressure on muscle tone and corrective positioning. Although all orthotists are trained in the skills of alignment of body segments, perhaps the profession should investigate using other less rigid methods of re alignment. Look ing to the future, more scientific studies into this area are required, but one thing is certain the future is definitely not rigid. Acknowledgements The physiotherapy services of Norfolk & Norwich University Hospital NHS Founda tion trust, Cambridge University Hospital NHS Trust and Pace Centre, Aylesbury. UK Photos reprinted by kind permission of Or thopaedic & Spinal News ©November 2011 1. Ramstad KJ, R; Skejeldal,O; Diseth,T;. Characteristics of recurrent mus culoskeletal pain in children with cerebral palsy aged 8 to 18 years. Developmental Medicine & Child Neurology. 2011;53 (11):10138. (Continued on page 12) Childrenʼs Powered Prostheses Childrenʼs Powered Prostheses Childrenʼs Powered Prostheses VASI prosthetic products for children include; powered hands, wrists, elbows and cosmetic gloves. These are suitable for children from 1 to 12 years of age. The electric hands and elbows have microprocessor-based controllers with several control strategies to choose from. This allows the clinician to select the best control for the child and change it as they develop. These controllers also enable the clinician to tailor the prosthesis to suit each childʼs capabilities. LTI has an extensive line of associated products such as batteries, chargers, electrodes and Touch Pads™. As a stocking U.S. Pick up distributor, LTI provides quick delivery, technical support and service for all VASI VASI prosthetic products for children include; powered hands, wrists, elbows and cosmetic gloves. These are suitable for children from 1 to 12 years of age. The electric prosthetic products. hands and elbows have microprocessor-based controllers with several control strategies to choose from. This allows the clinician to select the best control for the child and change it as they develop. 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As a stocking U.S. distributor, LTI provides quick delivery, technical support and service for all VASI prosthetic products. Liberating Technologies, Inc. 325 Hopping Brook Road, Suite A, Holliston, MA 01746-1456 Phone 508-893-6363 FAX 508-893-9966 Liberating Technologies, VASI prosthetic products for children include;Inc. powered hands, wrists, elbows and www.liberatingtech.com 325 Hopping Brook Road, Suite A, Holliston, MA 01746-1456 Phone 508-893-6363 FAX 508-893-9966 cosmetic gloves. These are suitable forwww.liberatingtech.com children from 1 to 12 years of age. The electric hands and elbows have microprocessor-based controllers with several control strategies to choose from. This allows the clinician to select the best control for the child and Liberating Technologies, change it as they develop. These controllersInc. also enable the clinician to tailor the 325 Hopping Road, Suite A, Holliston, MA 01746-1456 Phone 508-893-6363 FAX prosthesis to suitBrook each childʼs capabilities. LTI has an extensive line of 508-893-9966 associated www.liberatingtech.com ™ products such as batteries, chargers, electrodes and Touch Pads . As a stocking U.S. distributor, LTI provides quick delivery, technical support and service for all VASI prosthetic products.ProstheticOrthotic Clinics (ACPOC) invites professionals interested in Pedi The Association of Children’s 2013 Annual Meeting CALL FOR PAPERS DEADLINE: OCTOBER 15, 2012 atric Prosthetics and Orthotics to begin planning for their involvement in ACPOC’s 2013 Annual Meeting being held in Atlanta, GA. Please visit www.acpoc.org for more information to submit an abstract online. TOPICS REQUESTED We are particularly Liberating interested in the following topicsInc. for symposia and instructional course development: Technologies, · spinal orthoses, 325 Hopping Brook Road, Suite A, Holliston, MA 01746-1456 Phone 508-893-6363 FAX 508-893-9966 www.liberatingtech.com · orthoses used with limb lengthening, · tibial deficiency: salvage vs. amputation, · clubfoot orthoses, · limb salvage in the treatment of malignant tumors, and · orthotic use in arthrogryposis Surgical presentations require a review of appropriate imaging studies for proper planning and execution. All presenters are strongly encouraged to include not only clinical photos, but also radiographs in their presenta tions. (Continued from page 10) 6. Hall JM, ME; Cassella, MC. Man ual for the Boston Brace Workshop. Boston: Boston : Children's Hospi tal Medical Centre; 1976. 3. Stokes A, editor. Scoliosis: discs or vertebrae. Cobb an gle freind or foe? 7th International Conference on Con servative Management of Spinal Deformities Monteal, Canada 2022 May 2010; 2010; Montreal, Canada: Bio med Central. 7. Matthews M, Crawford R. The use of dynamic Lycra orthosis in the treatment of scoliosis. A treatment case study. Journal of International Society of Prosthetics and Orthot ics. 2006;30(2):17481. 4. Matthews MR, AS; Chatterjee, S, editor. Does rigid bracing provide the best outcome for children with neu rological onset scoliosis. 9th International Conference on Conservative Management of Spinal Deformities; 2012; Milan, Italy: Scoliosis Journal. 8. Edmondson J. How effective are lycra suits in the management of children with cerebral palsy? APCP Journal. 1999;March 1999:4957. 2. Edwards S. Abnormal Tone and movement as a result of neurological impairment:considerations for treatment. In: Edwards S, editor. Neurological Physiotherapy. Lon don: Churchill Livingstone; 2003. p. 89114. 5. Matthews M, The use of Dynamic Lycra Garments in the treatment of Scoliosis. 2005; Glasgow: British Asso ciation of Prosthetists and Orthotics. NEW! GREEK SERIES PEDIATRIC HANDS . . . Alpha, Beta, Gamma 9. Bridges S, Mayston M, Peirson J. The effects of dynamic socks in ambulant cildren with cerrebral palsy:a pilot study: University Col lege London; 2004. 10. Maguire CS, JM; Frank,M; Rom kes,J;. Hip abductor control in walking following stroke the im mediate effects of canes, taping and TheraTogs on gait. Clin Rehab. 2009(November). Epub November 11th 2009. 11. Elliott CR, S.; Hamer, P.; Alderson, J.; Elliott, B.;. Lycra arm splints improve movement fluency in chil dren with cerebral palsy. GaitPos ture. 2011;33:2149. TRS Pick up . . . exceeding the challenge. Alpha Beta 12. Matthews MW, M.; Richardson, B.;. Effects of dynamic elastomeric fabric orthoses on children with cerebral palsy. Prosthetics & Or thotics International. 2009;33 (4):33947. Gamma www.facebook.com/TRSprosthetics Follow us on Facebook and Twitter: www.twitter.com/TRSprosthetics Bringing Education to ew Heights The Association of Children Prosthetic Orthotic Clinics, (ACPOC) Annual Meeting in Review By Eugene Banziger, CPO ACPOC (the Association of Children’s Prosthetic and Orthotic Clinics) held its annual meeting at the Banff Center in Banff, Alberta, Canada. The Banff Center consists of a campus where professionals come for meetings and retreats for higher learning in arts, sciences and sports and medicine. Banff is located in Banff Na tional Park, at the border between British Columbia and Alberta in the Canadian Rockies. What an ex traordinary location to learn and share! ACPOC is an international, multidisciplinary organi zation comprised of professionals who have an inter est in the treatment of children and young adults with orthopedic and neurological involvement, e.g. physicians, prosthetists, orthotists, physical and oc cupational therapists, engineers, nurses etc. This year we had attendees from Denmark, South Africa, the Netherlands, Portugal and India amongst others. Each year, ACPOC is getting more international rec ognition. The annual meet ing is a mix of highly educational content, consisting of paper presenta tions, guest lectur ers, symposia, workshops and poster presentations. A buzzing vendor area with exhibits from manufacturers who displayed and explained the function and properties of their products was also a focal point. Other highlights are the social events, from the early bird reception and dinner event, to other recreational activities immediately after the meeting. Day one of the meeting took off with 2 work shops: one by Sandra Ram Janet Marshall, CPO dial, CP from Otto Bock on President their custom Silicone prod ucts and the second by Mark De Harde from the Ultraflex company explaining the components allowing new avenues in the treatment of children with Cerebral Palsy. (Continued on page 14) (Continued from page 13) orthopedic services in the vast Pacific its is lands, many different cultures and limited re sources. Another presentation Dr. Vipal Shah from India focused on the use of Botulin Toxins in treatment of Clubfoot and Cerebral Palsy. The day included a business meeting where members are provided an opportunity to give in put in the association’s affairs. Elections are held so as to have changes and representation from all Janet Marshall, CPO President, formally opened the meeting on Day 2. The first section of the presentation consisted of excellent papers from multidigit partial hand prostheses to innovative TLSO design for chil dren with Spinal Muscular Atrophy. Others were a longtime follow up of rotation plasty after PFFD and challenging cases of children with quadrimemberal congenital ampu Janet Marshall and Presidential Guest tations. The Lively Paper Discussions Speaker Diane L. Damiano, PhD Presidential Guest speaker, Diane L. Damiano, PhD, PT enlightened us with her pres entation entitled “Do Today’s Orthotics Opti mize LongTime disciplines on the Board. Janet Marshal handed Function in Children with Cerebral Palsy”. The day the gavel over to Dr. Ivan Krajbich’s capable concluded with two Physician Guided Forums where hands; Dr. Krajbich is ACPOC’s newly elected members from the audience bring Janet Marshall, outgoing president and Ivan president. Krajbich, MD, Incoming President their challenging cases to the ACPOC is not only about group and seek advice, recom education, but also about mendations and answers to the networking and having fun problems presented. at social gatherings. This The third day was a continuation year’s event was a dinner of the previous day with more pa dance at a Greek restaurant pers on challenging cases and and let me assure you every studies in prosthetics, e.g. bilateral one had fun. We had the op knee disarticulations, more portunity to practice belly quadrimemberal treatment op dancing with the guidance of tions, Boyd amputations etc. Dr. an attractive professional Crandall, president of the Ortho belly dancer from Greece. pedic Rehabilitation Association, The food and entertainment gave a presentation on selections on lower extremity were great, but most importantly new and old amputation levels. The Hector Kay lecture was by friendships were built at the gathering. Ellen M. Raney, MD from the Shrine Hospital in (Continued on page 16) Honolulu, HI. She shared her experience in providing Ohio Willow Wood EW LimbLogic Technology Evolves! Our revolutionary LimbLogic System provides the ultimate in suspension and stability. It’s a complete evolution of comfort and performance from a prosthesis. Visit willowwoodco.com to learn more. The Ohio Willow Wood Company willowwoodco.com (Continued from page 14) Janet Walker, MD, Program Chair The last day’s focus was on lower extremity cerebral palsy bracing treatment approaches. The real eyeopener was to learn how the paradigm shift is lead ing us to look at brac ing for this population in a different way. The symposium by the group from the Rehab Institute of Chicago led by Donald McGovern was inspiring and will definitely change my approach. Bracing for children with CP has traditionally been seen as orthopedic bracing. Learning from this symposium includes looking at bracing as a neuroorthotic as CP is considered a dis ease of the brain. Further papers were on bracing for crouch gait and hamstring tightness, and here also the thinking is changing from our standard approaches we have followed traditionally. As you can see the meet ing had much to offer for all attending, but there is not enough space here to include all details! This is why I encourage all O & P, Therapists and other professionals to attend at least one ACPOC meeting. Undoubtedly, you will be back again! The meeting closed at noon and the afternoon Ellen M. Raney, MD Hector Kaye Speaker is reserved for social activities such as dog sledding, skiing, ice walk and other activi ties in the beautiful Banff National Park. The next ACPOC meeting will be in Atlanta, GA. See for more details on ACPOC.org. Hope to see you there! Support ACPOC and ORA through OREF Donors contributing $1,000+ to the OREF annual campaign: The first $500 or more supports OREF annual research and education— the remainder may be shared with any partner organization, including ACPOC and ORA Donors contributing under $1,000: up to 50% may be shared with any partner organizations, including ACPOC and ORA Online contributions to ACPOC or ORA can be made at www.oref.org/ora or www.oref.org/acpoc OREF—making more possible More Pictures From Banff U g D b w U b ra K h st Ultraflex New Colm R w n p is a re fo W “My braces keep me mobile and help straighten my posture.” U. p TROY’S PATIENT INSPIRED SOLUTION Ultraflex addresses the multiple treatment goals associated with Camurati–Engelmann Disease (CED), a rare disease, characterized by proximal muscle weakness, a wide-based, waddling gait, and joint contractures. Ultraflex stretching KOs (worn at rest) are being used bilaterally to maintain passive range of motion. Since wearing his stretching KOs, Troy has noticed that the tightness in his legs has lessened and that he can stand straighter. Ultraflex Adjustable Dynamic Ultraflex New Colm worn bilaterally to augment muscles, provide Response™ (ADR™) AFOs (daytime) are normal range, increase stability, and improve posture/balance. With his ADR™ braces, Troy is able to walk to his classes at school without an additional mobility device. Troy’s mom reports, “Troy’s braces enable him to stand for a long period of time and to walk. Without his braces he is unable to walk.” For education for you and your team, please call: 800-220-6670 www.ultraflexsystems.com Existing coding and coverage applies to all ADR™ technology. Thank you to Lawall Orthotic & Prosthetic Services, Philadelphia, PA, for their clinical contributions. A special thanks to Troy and his family. U.S. and International Patents Issued and Pending. ©2012 Ultraflex Systems Inc. ew Prosthetic Alignment Challenges Gerald Stark, MSEM, CPO/L, FAAOP The Fillauer Companies, Inc. Chattanooga, Tennessee Compared to older exoskeletal construction, modern endoskeletal componentry offers both benefits and constraints to proper alignment. In many instances current suspension and componentry dictate the alignment of the prosthesis rather than the patient presentation with adverse affects to alignment. Al though materials and component design have greatly changed, alignment challenges persist and are more pronounced with more active users who demand not only stability, but optimized movement. Alignment parameters established historically by Radcliffe, Foort, Inman, Hampton, McClaurin and others should be revisited to avoid common gait deviations and provide the basis for changing componentry properties. Unfortunately many of these principles, proved valu able with empirical clinical observation, have been largely forgotten and gait deviations, unacceptable in earlier times such as uneven step length, hyperstabil ity, lateral trunk bending, abducted gait, and rota tional whips, have reemerged. Alignment for exo skeletal systems had to be established with strict ad herence to established principles since changing the alignment later was difficult and costly. Currently bench alignment is not as stringently observed since it is perceived that endoskeletal componentry will allow for correction later in the fitting. This freedom of adjustment has not translated into better align ment, but primarily into speedier fittings. Unfortu nately endoskeletal systems do not have the range of adjustment or easy linear capability to “dial” in the alignment. This explains the popu larity of slide and attachment devices which promise to compensate for poor bench alignment and achieve acceptable rather than optimal place ment. Endoskeletal componentry, which also promised to lighten the prosthesis, has gradually increased in weight with extra componentry. Compared to the 2 ½3 lb. transtibial proposed by EenHolmgren and Fillauer, the modern lower limb prostheses easily weigh much more. Com bined with poor alignment, this would indicate that endoskeletal use is not fully optimized. Although many patients prefer dynamic response feet, this has not been corroborated by laboratory by numerous studies. Roll over shape, a principle first discussed by Hansen et al at Northwestern University Prosthetic Research Laboratory, may help explain the advantage as a certain roll over late in stance1. The center of pressure can be eas ily plotted on a force plate then placed in relation to the anklefoot or the kneeanklefoot. An arc of motion can be defined which describes motion late in stance1. Different foot designs were shown to have different rollover shapes. In a sense the SACH foot represented the first roll (Continued on page 23) over shape with subsequent designs influencing that shape with keels of various stiffnesses due material and geometry design. What was most interesting is that the various prosthetist equalized the rollover shape to have them be very similar1. Rollover shape also showed climbing a ramp to be primarily a func tion of the anklefoot and going down an incline to be a function of the kneeanklefoot. The relative heel height had little effect on the rollover shape except with extreme high heels of 5060mm2. In a related study AFO’s had the effect of elongating the length and radius of the rollover shape. especially relevant to replace the absence of the ankle and knee joint along with transverse rotation. In earlier times a SACH foot with thicker foam rubber in the heel presented with substantial shock absorption. Newer dynamic response feet have less since the heel lever is longer or the heel material has been minimized. Linear shock absorption is relatively nonphysiologic in that the limb tele scopes rather than using rotary joint motion. Gard has shown that true shock absorption really only takes place with faster walkers at higher speeds generating greater force11. Components that combine the suspension pin lock with the distal attachment have, in effect changed alignment. The suggested posterior placement of the transtibial foot is 1865mm with a bench alignment for a SACH foot at 37mm9. Since the distal attach ment is in line with the midpoint this has shifted the alignment more anterior. Although this is more ac ceptable with dynamic response feet that flex more late in stance, this may demand that the foot be dorsi flexed for the more anterior position resulting in an excessive toe clearance at heel contact. This can be compensated with a slight anterior lean as a result of a linear AP adjustment. While this adjustment is not often done it would help to adjust for the relative keel stiffness of the foot. This would also have the effect of shifting the rollover shape anterior or posterior. Coronal plane alignment has also changed as a re sult of combined suspension/attachment compo nents. The relative inset guideline has changed from 012 mm inset9 depending on the limb length to very little, if any, inset. The inset that is present is usually dependent on the varus presentation of the distal end since most technicians simply posi tion the attachment at the distal end apex. The main challenge is that alignment has become less narrow which for the most part is acceptable for greater stability, but sacrifices a much more nar row energy efficient, cosmetic gait. The relative inset should be measured from the MTP level not the distal end as is common practice. Emperically the distal end is usually more medial and “hangs off” of the foot shell with longer limb lengths or Syme’s ankle disarticulations. Another biomechanic principle is to dorsiflex the transtibial prosthesis to unweight the heel. This is es pecially relevant for heavy heel walkers who have a tendency to crush the heel. Dorsiflexing the foot helps initiate roll over sooner before excessive pres sure is observed9. Shock absorbers as they are termed in prosthetics are primarily shock dampers11. A spring mechanism is the primary shock absorber and the damper works to slow the response of the spring. These devices are In general transfemoral alignment has over empha sized involuntary knee stability with respect to alignment and knee design. Transfemoral align ment has also been compromised with sleeve sus pension/distal attachment components. Preflexion of the interface, so essential for normal step length, is often not present unless using a series of offset plates. This remains a critical factor when using microprocessor controlled knees that depend on the accurate assessment of the reaction line. If the Quadrilateral socket. Never intended to be an emu lation of the reaction line, the Alignment Refer interface is not preflexed their may be a greater ten dency to unlock stance beyond the knee’s capability to ence Line was a convention to provide stability. adjust stance. Preflexion must be 5 in addition to the The proximal mark can also be approximated with hip flexion contracture9. In normal human locomotion the medial bisection. The knee pivot should fall 3 6 mm posterior to the projection of ankle bisec the pelvis lordoses 3, 5 hip extension, and 15 knee tion4. Unfortunately the medial bisection is diffi flexion for a total of 23. The 5 preflexion compen sates for the patients inability to provide hip extension. cult to assess during dynamic alignment. The lat Pelvic lordosis must compensate with an increased 10 eral bisection is slightly different due to the exter nal rotation of the knee. The knee center should and 5 preflexion amounting to 15. This may be one then be placed 610 mm posterior. The Berkeley reason active, short, transfemoral amputees and hip method did not employ anterior placement of the disarticulation patients often experience lower back knee, but rather anterior placement of the interface. pain. The European Alignment method utilizes a plum line from the bisector with the knee 610 mm pos Although the Berkeley and European plum line align terior (depending on knee design) and the mid ment methods are utilized the nuances often obviate point of the foot 1025mm anterior (also depend the original intention of the methods. Radcliffe recom ing on the foot design). This creates an anterior mended the Berkeley method originally with the lean of the pylon possible only with a distal pyra (Continued from page 23) DAFO EW 6XQVHW$YH )HUQGDOH:$ DFSRFBIDOOLQGG SK ID[ LQWO ZZZFDVFDGHGDIRFRP $0 (Continued from page 24) mid. The Berkeley method sets the knee center in alignment and increases stability with increased pre flexion and knee design. The method compensates for the stiffness of the keel and incorporates the slight “safety factor” of plantarflexion also advocated originally by the European method. Radcliffe re marks that the ultimate alignment arrived at should look very similar in both cases. Radcliffe emphasizes the importance of preserving voluntary control with the transfemoral prosthesis. Through hip extension and limb length the patient influences the placement of the alignment line. At initial contact the patient uses their limb length and hip musculature to influence the position of the reac tion line. A patient with strong musculature and longer limb length can shift the reaction line more anteriorly. Conversely the late in stance the amputee can shift the reaction line anterior to flex the knee. Some knee designs, very stable by design, require an extra toe moment to aid in the flexion of the knee. The Zone of Stability and Control proposed by Rad cliffe projects the reaction line in early stance and late in stance. The area between these two lines represents the area in which the knee center may be placed to insure stability early in stance and easy flexion late in stance. The area is greater more proxi mally making the use of polycentric knees, which place the knee center proximal, advantageous. The patient with good voluntary control can influence this area by shifting the reaction lines to increase stability and control4. Knee stability is frequently increased by shifting the knee center more posterior. This increases the rela tive involuntary locking of the knee flexion late in stance5. At the same time moving the knee posterior is counteracted by also moving the foot posterior in creasing knee flexion moment. Plantarflexing the foot has the effect of shifting the Zone of Stability and Control anterior. The foot reaches foot flat faster and then pops up on the metatarsal heads to allow for easy knee flexion late instance to provide better stability without sacrificing voluntary con trol. This heel airspace may feel strange to the pa tient during standing at first but provides 36mm of posterior knee stability for every 1 of plantar flexion with out sacrificing voluntary control5. Ivan Long in the late 1970’s advocated strong femoral adduction as the goal of narrow ML type interface designs. Although different nuances on this principle have emerged, Mr. Long reminds of the importance of adduction the limb. His use of the mechanical axis line utilized by orthopedic sur geons advocated a 4 line from the mid femoral neck to the bisection of the femur. With shorter limb lengths this can be difficult to achieve. Uel lendahl established a simple parameter of having the medial 25mm brim intersect the medial socket distally. All to often the line of femoral adduction is established by the distal attachment which is not easily offset with three prong attachments. If the correct adduction is established the foot may be too far inset. Many times a linear shift is required. Technicians will often “correct” socket adduction by making the socket more vertical. The transverse alignment is important not only to eliminate whips but also the rotation of the foot late in stance affecting the relative keel loading. The knee and the foot are to be 5 externally ro tated to approximate the 15 of external rotation of the trailing limb to allow for the transverse rotation of the pelvis. A common error is to not have the foot and knee in the same plane. Although not a classic whip, which is a result of improper knee rotation, the foot and knee appear to track uncos metically in different arcs. Coronal alignment (Continued on page 36) MiniMacStabiLity Knee Lightweight 4HE-INI-AC+NEEISALIGHTWEIGHTSINGLEAXISKNEE INCORPORATINGAMECHANICALLOCKDURINGTHESTANCEPHASEOF GAITALONGWITHASTANCEmEXIONFEATUREUTILIZINGMECHANICAL mEXIONTOCONTROLTHERATEOFSWINGOFTHEPROSTHESIS s !UTOMATICKNEELOCKSATFULLEXTENSION s 2ATEDFORUPTOPOUNDS s !DJUSTABLESTANCEmEXION s ,OWPROlLEPROXIMALADAPTER s &REESWINGDESIGN s &RICTIONSWINGCONTROLADJUSTMENT AD238/11-09/09-02 -11 Fillauer ew WWWlLLAUERCOMss& WWWHOSMERCOMss& s !LLOWSGREATERFREEDOMOFMOVEMENTFORCRAWLINGAND OTHERACTIVITIES s !DHERESTOMODERNTREATMENTPROTOCOLFOR4ALIPES %QUINOVARUSCLUBFOOT s 1UICKANDEASYDETACHMENTFORDIAPERCHANGESDONNING ANDDOFlNG s 0ERMITSSTANDINGANDFULLWEIGHTBEARING s !DJUSTABLEBARWIDTHTOACCOMMODATEGROWTH s !LLOWSSHOEWEARWITHORTHOSIS s ,IGHTWEIGHTANDVERSATILEDESIGN s $EVELOPEDBYLEADINGCLINICPEDIATRICORTHOTISTS AD238 06-09 / 09-02-11 WWWlLLAUERCOMss& WWWHOSMERCOMss& Close Contour Pediatric Knee Joint 4HE#LOSE#ONTOURPEDIATRICKNEEJOINTFROM/43ISTHESMALLESTINFANTANDPEDIATRICJOINT AVAILABLEONTHEMARKET4HE#LOSE#ONTOURHASANICKELPLATEDlNISHFORDURABILITYAND UNPARALLELEDSTRENGTHTOWEIGHTRATIOWITH/43ALLOY s $ESIGNEDFORUSEONTRADITIONALLEATHERMETALORTHERMOPLASTICORTHOSES s #ONTOURWITHINOFKNEECENTER s !VAILABLEINBOTHTHERATCHETING3TEP,OCK®JOINTTHATFEATURESABUILTINLOCKRETAINER s !VAILABLEINSIZEFORAMBULATORYUSE AD238/11-09/05-31-11 WWWOTSCORPCOMss& Fillauer WWWlLLAUERCOMss& EW Isocentric RGO adVantage ® the VerticaL 4HE)SOCENTRIC2'/ISAREVOLUTIONARYWALKINGBRACEFOR INDIVIDUALSWITHLITTLEORNOCONTROLOFTHEIRLOWEREXTREMITIESOFTEN DUETONEUROMUSCULARDISORDERSORINJURIES4HE)SOCENTRIC®2'/IS IDEALLYSUITEDFORCHILDRENWITHSPINABIlDATRAUMATICPARAPLEGIA MUSCULARDYSTROPHYANDOSTEOGENISISIMPERFECTA s %FlCIENTAMBULATION s 2OBUSTCONSTRUCTION s h(ANDSFREEvSTANDINGBALANCEANDSUPPORT s $YNAMIChHIPSTRETCHINGvMUSCULATURE s !CHIEVESRECIPROCATINGGAITWITHHIPmEXING AD238 06-09 / 05-31-11 WWWCENTERFORORTHOTICSDESIGNCOMss& WWWlLLAUERCOMss& EMAIL ADDRESSES ADDERSON, JIM ANDREWS, J. THOMAS, ANGELICO, JOHN A. ARMSTRONG, PETER ARTERO, LISA ATHEARN, JIM BANZIGER, EUGENE BARRINGER, WILLIAM J. BEAUCHAMP, RICHARD BELBIN, GREG BENNETT, JAMES T. BERG, RANDY BERNSTEIN, ROBERT BICKLEY CHRISTINA BLISS, KIERAN BOUTIN, BARBARA BOUTIN, BRETT BRENNER, JOSEPH BROOKS, JEFFREY BUSH, GREG CHRISTENSON, DONALD CLARK, MARY COCKERELL, GARY COULTER, COLLEEN COLE, DANIEL COLLIER, DOYLE CRANDALL, ROBIN DRYGAS, THADDEUS DECKER, LOREN EDMUNDS, M. CRAIG EVANS, TIMOTHY FAIRBANKS, PATRICIA FIELDEN, ROBERT FISK, JOHN GENAZE, ROBERT GLASFORD, SHANE GREENBERG, SHARON GUIDERA, KENNETH HANSEN DEANNA HANSON, WILLIAM HARDER, JIM HEELAN, JAMEE HEIFETZ, JONATHAN HEIM, WINFRIED HILL, WENDY HONEYCUTT, JULIE HORTON, GARY HOYT, KIMBERLY HUBBARD, SHEILA HYLTON, NANCY JENKINS, FRAN KALLEN, JAMES KANIEWSKI, BARB KATZ, DONALD LARSON, OWEN LECKEY, J ROBERT [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] EMAIL ADDRESS ADDITIOS / CHAGES ew Addresses: Kieran Bliss, C.P. Design Prosthetics Appliance Company, Oshawa, Ontario Canada Gary Cockerell, C.P. Design Prosthetic Appliance Company Oshawa, Ontario Canada Address Changes William J. Barringer, CO Greg Belbin, CO Mary Williams Clark, MD Colleen P Coulter, PT, PhD Robin C Crandall, MD Loren J Decker, CP Shane Glasford, CP Deanna J Hanson, CO Julie A Honeycutt, PT Fran Jenkins, Fillauer Michael Link, CP Dayle Maples, MD James O Sanders, MD Cathy Schroeder, R Craig S Smith, CP Terry J Supan, CPO LINK, MIKE LIPSCHUTZ, ROBERT LYTTLE, DAVID MALAGAI, MIKE MANDELBAUM, MARTY MAPLES, DAYLE MARSHALL, JANET MCCARTHY, MEGAN MODRCIN, ANN C. MILLER, ERIC MORRISSY, RAY MUILENBURG, TED NEFF, GEORG NEFF, GEORG NICHOL, BILL NOLIN, WILLIAM NOVOTNY, MARY P. OKUMURA, RAMONA OPPENHEIM, WILLIAM M. OSEBOLD, WILLIAM PADILLA, TOM PANSIERA, TERRY PAULSEN, DOUG RADOCY, BOB RAMEY, KIM RAMDIAL, SANDRA RANEY, ELLEN, M ROTTER, DAVID SANDERS, JIM SCADUTO, ANTHONY SCHROEDER, CATHY SCHMITZ, MIKE SHIDATOKESHI, JOANNE SHORGAN, NOELLA SIMON, MARNO SMITH, CRAIG SMITH, SANDRA STEINMANN, ROBERT SUPAN, TERRY TOMHAVE, WENDY TROST, FRANK UELLENDAHL, JACK VANDENBRINK, KEITH VAN WIERINGEN, RENE VALERI, JOHN VAUGHN, PAULETTE VIGNA, OLGA WATTS, HUGH WEINSTEIN, STUART WESTBERRY, DAVID WHITE, HANK WHITESIDE, JOSEPH, W WILLIAMS, T. WALLEY, III link@collegepark.com [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]berlin.de toc[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] terry@otscorp.com [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] stuart[email protected] [email protected] [email protected] [email protected] [email protected] PLEASE OTE To have access to correct email address listings, please check your listed address so it may be updated. Email changes to [email protected] This registry is updated on a regular basis. Should you like to have your address listed or updated, please email me at: [email protected] I wish to encourage you to add your email ad dress to this list, as this is an efficient way to stay in touch with each other. 2013 Annual Meeting CALL FOR PAPERS DEADLINE: OCTOBER 15, 2012 The Association of Children’s ProstheticOrthotic Clinics (ACPOC) invites professionals interested in Pedi atric Prosthetics and Orthotics to begin planning for their involvement in ACPOC’s 2013 Annual Meeting being held at the Grand Hyatt Atlanta in Buckhead, Atlanta, Georgia from April 1013, 2013. Please visit www.acpoc.org for more information and to submit an abstract online. Grand Hyatt Atlanta in Buckhead Grand Hyatt Atlanta is located in the city’s most exclusive neighborhood, Buckhead, and is one of the top rated hotels in Atlanta, Georgia. Surrounded by popular area attractions, our Atlanta hotel is located close to the World of CocaCola Museum, the Georgia Aquarium, High Museum of Art, Legoland Discovery Center and Atlanta History Center. Many of these attractions are easily accessible using convenient MARTA trans portation. We are within walking distance to luxury shopping at Lenox Square and Phipps Plaza Malls. Travel to this elegant Buckhead hotel is seamless; Hartsfield Jackson International Airport is just 20 minutes away. TOPICS REQUESTED We are particularly interested in the following topics for symposia and instructional course development: clubfoot orthoses, limb salvage in the treatment of malignant tumors, orthoses used with limb lengthening, orthotic use in arthrogryposis, spinal orthoses, and tibial deficiency: salvage vs. amputation ABSTRACT FORMAT Please use Times New Roman 12 point type or similar font and format the pages with 1inch margins all around. The abstract title should appear in BOLD AD I ALL CAPITAL LETTERS on the top line, fol lowed by the author(s) name(s) on the third line in upper and lowercase letters. Please list the institution on the next line in upper and lowercase letters, followed by City, State and/or Country. The body of the ab stract should not exceed 500 words. For Workshops and Symposia, please include with the abstract a list of goals and learning objectives for the workshop or symposium. Examples – evaluation techniques, ad vanced and future developments, analyze overall functional advantages and challenges; assessment of cur rent studies. TYPES OF PRESETATIOS New Investigator Research Award Scientific Paper Scientific Poster Creative Solutions Challenging Case Presentations Symposia Scientific Workshops PhysicianGuided Case Study Forum Association of Children’s Prosthetic Orthotic Clinics SAVE THE DATE! 2013 Annual Meeting, April 1013 Grand Hyatt Atlanta in Buckhead, Atlanta, GA Highlights of the Meeting New Investigator Research Award Physician Guided Case Study Forum Scientific Papers and Posters Creative Solutions Challenging Case Presentations Technical & Scientific Workshops Commercial Exhibitors Who Should Attend Pediatric & Orthopaedic Physicians Rehabilitation Physicians Physical & Occupational Therapists Orthotists & Prosthetists Nurses & Social Workers Come join us for intensive learning as well as some FU! For more information, please visit the ACPOC website at www.acpoc.org Industry ews / ew Products PEL Supply Offers Pediatric Impulse® Foot WillowWood's Research and Development staff studied the way children walk at various stages of development and found that, as children develop a more mature gait that follows the normal progres sion of heel strike through toe off, they need a foot that offers more toe response and increased durabil ity. The Pediatric Impulse Foot provides the func tions that they need: energy return, dynamic re sponse, and outstanding durability—three of the most important characteristics for active children in the second stage of gait development. PEL Supply offers the Pediatric Impulse Foot as well as the full line of WillowWood Pediatric com ponents including Alpha® Pediatrc Liners and a complete line of pediatric endoskeletal and exoskele tal components. Each component has been tested to meet ISO 10328 standards, meaning the prod ucts are solid and dependable foundations for pediatric applications. Product Highlights: · Substantial Energy Return · Durable Composite Materials · Three Toe Resistances · Weight: 155 g (.34 lb)* · Patient Weight Limit: 132 lb (60 kg) · Available Sizes: 13 to 22 cm · Toe Resistance: Low, Regular, High · Cosmesis: Unisex, Lifelike in Buff, Tan or Medium Brown Fillauer MiniShock from PEL Supply The Fillauer MiniShock is a smaller version of the Fillauer DuraShock, with the same function ality and durability, but in a smaller, lightweight size for children and lightweight adults. The smooth motion of the MiniShock is due to the dynamic elastomer, which requires no lubrica tion or bumper changes, resulting in increased comfort for higher activity amputees. Fillauer’s compact design requires minimal clearance due to the 2.38" (6cm) build height and carries a weight rating of 132 lbs. (Continued on page 35) I N N OVAT E rugged flexibility The durable Truper was designed to combine stability, dynamic response and two flexible size ranges to take on the toughest of childhood challenges. The foot’s dynamic response stores and releases energy for a smooth and controlled transition from standing to running. GROWTH COMPONENTS College Park Interchangeable foreheels and foot shells allow ew for simple modifications. Complimenting exo applications, growth plate kits provide further room to adjust height for ever-changing kids. individualized solutions. thousands of possibilities. 800.728.7950 CPI_Truper_Hero-ACPOC.indd 1 I www.college-park.com/truper 1/30/12 4:19 PM STARscanner for Starband Cranial Remolding Orthoses ™ ® MORE THAN 100 STARSCANNERS ARE IN USE AT PRESTIGIOUS INSTITUTIONS SUCH AS… t"MUSV3FIBC$FOUFS/PSUI%BLPUB t$BSSJF5JOHMFZ)PTQJUBM/FX.FYJDP t$IJMESFOT)FBMUIDBSFPG"UMBOUB t$IJMESFOT)PTQJUBM.FEJDBM$FOUFS0NBIB/& t$IJMESFOT)PTQJUBMPG$PMPSBEP%FOWFS$0 t$IJMESFOT.FEJDBM$FOUFS%BMMBT59 t$IJMESFOT.FNPSJBM)PTQJUBM$IJDBHP*t.BSTIGJFME$MJOJD.BSTIGJFME8* t.BSZ'SFF#FE0SUIPUJDTBOE1SPTUIFUJDTo )PMMBOE.* t.BSZ'SFF#FE3FIBCJMJUBUJPO)PTQJUBM (SBOE3BQJET.* t.BTTBDIVTFUUT(FOFSBM)PTQJUBM t.BZP$MJOJD3PDIFTUFS./ t.FEJDBM$JUZ)PTQJUBM%BMMBT59 t.JBNJ$IJMESFOT)PTQJUBM%BO.BSJOP$FOUFS t5VGUT.FEJDBM$FOUFS#PTUPO." t1BSL/JDPMMFU.JOOFBQPMJT./ t3FIBCJMJUBUJPO.FEJDBM4VQQMZ4PVUI%BLPUB t4FBUUMF$IJMESFOT)PTQJUBM t6OJWFSTJUZPG3PDIFTUFS.FEJDBM$FOUFS t6OJWFSTJUZPG5FYBT)FBMUI4DJFODF$FOUFSBU )PVTUPO t6OJWFSTJUZPG5FYBT)FBMUI4DJFODF$FOUFSBU 4BO"OUPOJP t8PMGTPOT$IJMESFOT)PTQJUBM+BDLTPOWJMMF'- ...INCLUDING LEADING CLINICS & HOSPITALS THROUGHOUT THE WORLD. t"MCFSUB$IJMESFOT)PTQJUBM$BMHBSZ"MCFSUB t")4+BQBO$PSQPSBUJPO/JTIJPOPNJZB,ZPSJUTV Orthomerica /FVSP)PTQJUBM EW t#BTLP)FBMUIDBSF5IF/FUIFSMBOET t#$$IJMESFOT)PTQJUBM7BODPVWFS#$ t$SBOJBM$BSF4ÍP1BVMP#SB[JM t&FNMBOE0SUIPQFEJF5FDIOJFL#7"NFSTGPPSU /FUIFSMBOET t&'.0(BCJOFUF45"3DFOUFS.BESJE4QBJO t015FDIOJRVF%FONBSL t0SUIPLPSFB4FPVM,PSFB t0SUIP1SP"TTPDJBUFT&DVBEPS $VNCBZB2VJUP&DVBEPS t0TBLB)PTQJUBM+BQBO t05)EF)PPHTSBBU6USFDIU)PMMBOE t1SP8BML(NC)&HFMTCBDI(FSNBOZ t34-4UFFQFS-FFET6OJUFE,JOHEPN t5BJXBO0SUIPUJDTBOE1SPTUIFUJDT$PNQBOZ 5BJQFJ5BJXBO t7JUBMJUZJO.PUJPO4PVUI8BMFT6OJUFE,JOHEPN In less than 2 seconds, UIF FZFTBGF MBTFS DPMMFDUT UIF CBCZT IFBE TIBQF EBUB SFQMBDJOH UIF OFFE GPS QMBTUFS DBTUJOH % EBUBDBOCFWJFXFEJONVMUJQMFQMBOFTXJUI EFUBJMFE BOBMZTFT UP EPDVNFOU USFBUNFOU QSPHSFTT PGGFSJOH RVBOUJUBUJWF PVUDPNFT UP JOTVSBODF DBSSJFST QIZTJDJBOT BOE QBSFOUT 5IJT DBQUVSFE EBUB JT USBOTNJUUFE UP0SUIPNFSJDBGPSGBCSJDBUJPOPGUIFDSBOJBM SFNPMEJOHPSUIPTJT 877-737-8444 | orthomerica.com Cascade Dafo: dedication to continuous improvement Anatomical Concepts Pick up from Spring The advantage of a bad memory is that one en joys several times the same good things for the first time. Friedrich ietzsche Advertiser Index Allard USA allardusa.com Page 2 Anatomical Concepts anatomicalconceptsinc page 37 Cascade DAFO cascadedafo.com Page 24 College Park collegepark.com Page 33 Fillauer fillauer.com Page 26/27 KnitRite knitrite.com Insert Liberating Technologies liberatingtech.com Page 11 Ohio Willow Wood owwco.com Page 15 Orthomerica orthomerica.com Page 34 PEL Supply pelsupply.com Page 6 RCAI rcai.com Page 40 R J Industries orthotykes.com Page 8 TRS oandp.com/trs Page 12 Ultraflex Systems ultraflexsystems.com Page 20/21 Membership Corner We asked our members, “What makes ACPOC Membership valuable to you?” “I believe that the educational programs during the annual meetings and the support of the clinic team approach, are both important, and in the best interest of the child and the parent.” – Owen Larson, CP “I’ve been a member of ACPOC since 1990 and have attended the annual conference each year. I particu larly enjoy ACPOC meetings since the focus is on a multidisciplinary approach to caring for children with prosthetic and orthotic needs plus I get to meet many wonderful colleagues who offer advice and support. I especially value all the time spent network ing and gaining information that is useful to help chil dren and families in my clinic. I encourage you to be a part of our organization and share your knowledge and experience with all of us.” – Joanna Shida Tokeshi, MA, OTR/L "To me, ACPOC is the embodiment of a true multid isciplinary meeting. It is the only forum that exists in the field of P&O where specialists representing the entire spectrum of care, from surgeon to so cial worker, come together to collectively share ideas to improve the care of children with P&O needs. Having attended all meetings relating to P&O I can say with total confidence that you will not find higher caliber presentations any where. ACPOC embodies the very best special ists that are involved with and passionate about the care of children with P&O needs." David Rotter CPO Logging into the membersonly section of the ACPOC web site If you haven’t checked out the membersonly section of the ACPOC website, it’s time to visit it again. Log in to view and updated your con tact information, search archived copies of our newsletter and view abstracts and presentations from past meetings. To login in, visit www.acpoc.org and click on “Members Only”. Then, just enter your member number and your password. If you don’t remember your password or never set one up, simply click on “Forgot Password” to have a link to create a password sent to you via email. ® RCAI Pediatric Line Restorative Care of America To order, phone (727) 573-1595 or (800) 627-1595. Fax toll-free: (800) 545-7938 I N C O R P O R A T E D To view the entire RCAI product line, visit us on the web at www.rcai.com. 29RHO Pediatric Resting Hand • Offers a functional resting hand position following injury or surgery, burns, provides support to unstable wrists, and can be used for the prevention and treatment of wrist and finger contractures. • Lightweight, durable Kydex® plastic. • Heat moldable at low temperature. • Washable breathable wicking liner. • Available with closed cell foam liner for burn patients. 76BHAO Pediatric Hip Orthosis 29RHO • Molded hip girdle. RCAI EW • Bilateral thigh cuffs. • Flexion/extension ROM hip control. • Abduction/adduction adjustments from 0º to 45º in 5º increments. • Circumferential hip adjustment. Shown in use with Universal Leg Braces 87Pd-ULB • Vertical adjustablility at hip and thigh. • Removable, replaceable, washable liner pads. 445-WDO • Hip girdle and hinge assembly can be ordered separately. 76BHAO 445-WDO Wrist Drop Orthosis • Holds the hand in extension. 11DFMP • Heat-moldable Kydex®. • Universal Cuff, accommodates eating and writing utensils. • Removable, washable, foam liner. 30CHK (Kydex®) Pediatric Contour Hand 11DFMP Dorsi-Flexion Multi Podus® • For the moderate to severely contracted hand and wrist. • For adjustable static stretch of the plantar flexors, treating neuromuscular conditions. • Medial/lateral straps attached to the sides of the brace allow the foot and ankle to be controlled, as needed, in the desired dorsi-flexed position prescribed. • Heat-moldable Kydex®. • Positionable to meet progressive patient needs. • Washable breathable wicking liner. 30CHK
