Campaign for Prosthetic Coverage

ACA Advocacy Staff

Almost two million Americans are living with limb loss or limb deficiency as a result of disease, trauma or birth defect.

In a December 2005 to January 2006, a poll of 660 users of the ACA web site, 423 (72%) of respondents had private insurance. In return for premiums paid for group health insurance, consumers expect to be covered for catastrophic illness or injury. Sadly, without legislation to ensure coverage, many people living with the loss or absence of a limb are facing discouraging obstacles when trying to obtain prosthetic care. Current changes in insurance plans are having a devastating effect on amputees and their families:

62% reported that their prosthetic coverage had remained the same in the past three years.
31% indicated that it had been reduced,
7% said that it had been eliminated.
In answer to a growing number of calls from our members and friends who are finding it difficult to afford an appropriate prosthesis, the Amputee Coalition of America (ACA) launched the Action Plan for People with Limb Loss (APPLL).

APPLL works nationwide at the grassroots level to motivate people to inform lawmakers about the critical need for all amputees to have access to an appropriate prosthesis, regardless of their financial circumstances.

Our goals:

1) Pass prosthetic parity laws in all 50 states.

2) Work at the federal level to ensure that all amputees receive the help they need to obtain adequate and appropriate prosthetic care.

We have already made exciting progress! In 2006, we worked with eight states to advance legislation requiring coverage for prosthetic devices and components. Three of the eight states passed legislation.

In 2007, eleven states will introduce or re-introduce legislation for prosthetic coverage. Another eight states are working to build campaign committees to advance legislation.

But we need your help!

Learn More
Donate
Get involved
Check out our APPLL brochure! (link to come!)

2007 Face of America Bike Ride April 28 & 29

World T.E.A.M. Sports is excited to again have the opportunity and privilege to honor and include servicemen who have been severely injured in the wars in Iraq and Afghanistan in our 2007 Face of America Bike Ride. This ride offers the unique opportunity for EVERYBODY to ride side by side with these heroes and personally encourage them and let them know that they can still be active athletes and still be a part of the TEAM.

REGISTRATION: if you would like to ride, volunteer, or be asponsor please Click Here

Take this two day bicycle ride from Gettysburg, PA to Washington, DC !

for additional information you may contact Rod Miller at (c) 240-508-2881, (w) 301-341-4991, (h) 301-464-2796 or e-mail rmiller.des@comcast.net

Bionic Leg Helps One Man Walk Tall

It may sound like something from a science fiction movie, but a bionic leg with a computerized brain is helping one Georgia man do something he hasn't done in six years, walk without a limp.When Mario Cieplinski was just 20-years-old, he lost his left leg in a conveyor belt accident, but he never lost his spirit."That's not going to stop me. I was going to enjoy life," said Cieplinski.Cieplinski started with a mechanical knee and then he got his lighter, sleeker C-leg. Then he got a huge boost with a power knee, a bionic leg with a computerized brain."It's truly the future of prosthetics," said Nancy Kaselak of Hanger Prosthetics and Orthotics.The small device is strapped to Cieplinski's good leg and Bluetooth technology mimic his movements and sends the information to the power knee which can propel up and down inclines and push through obstacles like tall grass or rocks."We see so many amputees and what they lack and we wish we could give back to them and can't. This knee can," said Kaselak.Cieplinski is the first Georgian to try out the power knee and one of only 12 people in the world who has one, and it's a gift he is well aware of."To have something basically as close as my real leg, it means a lot. Even if it makes sounds, it's so close to a normal person," said Cieplinski.Cieplinski hopes that other amputees will soon be able to follow in his footsteps.

ACA Offers a Chance to Meet Emmanuel of EMMANUEL'S GIFT!

ACA Offers a Chance to Meet Emmanuel of EMMANUEL'S GIFT!

The Amputee Coalition of America (ACA) is pleased to announce an exciting opportunity for the limb loss community!

The ACA has partnered with America Online (AOL) and invites you to join us for a preview of the film EMMANUEL'S GIFT followed by conversation with Emmanuel and the director. Lunch will be provided. For information about the documentary EMMANUEL'S GIFT, read below.

Following the screening and luncheon at the AOL Headquarters, we will be returning to the ACA office for a volunteer opportunity from 2:00 pm to 4:00 pm. Volunteers will be assisting with a mailing appeal to raise funds for the ACA's national campaign for prosthetic coverage.

The 2007 legislative sessions are in full swing and we are working hard to advance legislation in 21 states. We need your help to keep the national momentum moving forward!

Day Event & Volunteer Opportunity

DATE: Thursday, February 15.

TIME: 10:00 am - 4:00 pm

WHERE: 1436 U Street, NW, Suite #104, Washington, D.C., between 14th and 15th Street.

For those who are unable to attend during the day, please come out and show your support for prosthetic parity by helping the ACA Volunteer Night. Dinner will be provided. Thank you to those who have already RSVPed for the ACA Volunteer Night!

Evening Volunteer Opportunity

DATE: Thursday, February 15.

TIME: 6:30 pm - 8:30 pm

WHERE: 1436 U Street, NW, Suite #104, Washington, D.C., between 14th and 15th Street.


PUBLIC TRANSPORTATION: The closest Metro is U Street/African-American Civil War Memorial/Cardozo (Green Line). The Metro is about three long blocks to the office. The office can also be reached by several bus lines, including 52, 53, 54, 90, 92, 93, 96, 98, S1, S2 and S4.

PARKING: Reeves Center Garage. The entrance is behind the Reeves Center on U Street, just west of 14th Street across the street from Extra Storage Space. The flat rate is $7, or metered parking is available on the street.

R.S.V.P.: Please, R.S.V.P. to Jeremiah at 202/742-1885 or jperez@amputee-coalition.org. Specify weather you would like to attend the day event or the volunteer night.

NOTE: The day event is filling up fast, space is limited. R.S.V.P. today!


About EMMANUEL'S GIFT: Narrated by Oprah Winfrey, EMMANUEL'S GIFT tells the powerful and passionate story of a disabled orphan, Emmanuel Ofosu Yeboah from Ghana, who has risen above poverty and severe physical challenge to become a hero and inspiration to people around the world. His first stunning act of heroism was riding a bike across Ghana on one leg in order to change his county's negative perception of the disabled. EMMANUEL'S GIFT is a compelling story of courage and determenation about a man who had nothing, but gave everything and changed a nation and its people forever. Find out more by clicking here.

_____

©2006 Amputee Coalition of America. All rights reserved. All trademarks and service marks contained herein are property of their respective owners.

Amputee Coalition of America 900 East Hill Avenue, Suite 285 Knoxville, Tennessee 37915-2568
Toll-free: 888/AMP-KNOW Knoxville: 865/524-8772 Fax: 865/525-7917
www.amputee-coalition.org

Tsunami survivors face future

ALMOST two years ago, in the wake of the deadly Boxing Day tsunami, Acehnese girl Delisa had a couple of wishes.

One was for a new leg to replace the one she lost in her battle to survive the mountainous waves that swamped her homeland. The other was that she be able to return to school and keep learning.
Now, as the second anniversary of the earthquake and tsunami approaches, Delisa has a new leg but she still relies on crutches to get around the house, only utilising the new limb when she is going out.

She has gone back to a new school but not to her old classmates – most of whom were killed in the tsunami – and is now ranked fourth in the class.

Delisa's mother and older brother and sister were all killed in the tsunami – among the 160,000 killed or missing in the Indonesian province of Aceh, which was closest to the earthquake's epicentre and bore the brunt of the resulting tsunami.

On November 12 this year, a date circled on the family's calendar, her father Bachtiar married Sabariah, a widow who had lost her husband and baby in the tsunami.

"Delisa used to go to her house often and one day she asked Sabariah if she would like to be her new mum. She came home and told me to marry her," Bachtiar tells from the home, where the family has set up a small convenience shop in the front section.

Authorities say it will take another three years to rebuild Aceh and that 48,000 of the 128,000 new homes needed have so far been built.

And Delisa is not unlike other amputees. Her prosthetic left leg was donated by a Malaysian charity – however it is not the right size, the knee is in the wrong place, it is uncomfortable to wear and she cannot walk without crutches.

A second prosthetic, from Indonesia, is even worse. It is old-fashioned and so heavy she can barely lift her leg with it on.

"I wish I could have a proper one, a good one. I only wear it to school but for other daily activities I don't wear it because it's not comfortable," she said.

"Sometimes I feel sad because I can't follow my friends to play around."

Delisa still has vivid memories of the tsunami, of her battle to survive and of losing her family but, like so many others, says she "tries to forget".

The Open Prosthetics Project

The Open Prosthetics Project is producing useful innovations in the field of prosthetics and giving the designs away for free. By substituting public good for profits we believe that we can generate far more societal benefit than if we commercialized and sold our ideas. This project is an open source collaboration between users, designers and funders with the goal of making our creations freely available for anyone to use and build upon.

Prosthetics Research Study "Replacing limbs. Restoring lives."

Prosthetics Research Study is a multidisciplinary research team with a goal to preserve the limb at risk and improve function for the amputee. PRS was founded in 1964 with Dr. Ernest M. Burgess, orthopaedic surgeon, as Director and Principal Investigator. Its inception followed an international conference in Copenhagen where Dr. Michel Berlemont of Berck-Plage, France and Dr. Marion Weiss of Warsaw, Poland introduced new ideas of lower limb amputee surgery. They provided a way to shorten the amount of time spent before an amputee was rehabilitated and walking with a prosthesis. Dr. Robert E. Stewart (Veterans Administration Chief of Prosthetics and Sensory Aids) decided to set up research in this area of Immediate Post-Operative Prosthetics (IPOP), and he asked Dr. Burgess to head a center to do this.

Prosthetics Research Study has followed their mission by working with patients all the way through the process, from risk evaluation through amputation and rehabilitation. Since 1964 our research has included varying areas along this path.

PROSTHETIC HEAD

Here is something just for the fun of it!
I knew it was only a matter of time!

Defense Advanced Research Projects Agency

History
Since its inception in 1958, DARPA has utilized the existing contracting organizations in the military services to award DARPA-funded contracts. These contracting organizations, along with the financial management activities that support them, are referred to as DARPA "Agents". DARPA's use of these 89+ agents has been governed by memoranda of agreement with the three services. In FY87, DARPA created its own internal contracting agent called the Contracts Management Office (CMO). CMO was never intended to replace the contracting agents in the military services, but rather to provide DARPA with additional contracting capability and flexibility in certain restricted areas critical to the DARPA mission. At first, CMO concentrated on prototyping projects. Over the years that mission concentration shifted to special support for consortium programs, fast-reaction projects, and awards under the DARPA agreement authority of 10 USC 2371. The CMO staff deliberately has been kept small (a total of 15 billets), but is highly-trained, highly-graded, and extremely productive, awarding approximately 27% of the total contracting dollars.
Statistics
CMO has the authority to award contracts, grants, cooperative agreements, and "other" transactions. Although this provides great flexibility, it creates statistical and record-keeping problems which are not evident in most contracting organizations. For example, the CMO statistics on contract awards only are reported to the U.S. Army Contracting Support Agency through the DD350 system, the same system to which Army and other DoD agencies report their contract statistics. These CMO statistics, however, do not reflect the many millions of dollars awarded by CMO under grants, cooperative agreements, or other transactions. Those dollars must be captured in other data systems and combined with the Army contracting figures to give the true picture.

Otto Bock Bionic Arm and some other new devices from Otto Bock

July 2005Otto Bock Bionic Arm - World First for MelbourneThe 11th of July 2005 saw the release of the 12K100 ‘Dynamic Arm’ by Otto Bock. This ground breaking Electronically Powered Elbow had its premier world wide fitting at Caulfield General Medical Centre. The Premier of Victoria, the Honorable Mr Steve Bracks, officially released the 12K100 at a ceremony held at Caulfield General Medical Centre. Mr Bracks was very pleased to announce that Australia had been chosen as the site for the market release of such a technically advanced product in the field of Upper extremity prosthetics.
The 12K100 utilises state of the art mechatronics, battery technology, as well as CPU technology that has recently been developed for the automobile industry. This means that the 12K100 is considerably faster and stronger than other elbow units (able to lift approx. 6 times more weight), as well as having a longer battery activity time.
Peter Eberle, the patient fitted at Caulfield, was wearing another type of elbow unit at the time he was fitted with the 12K100. He was amazed with responsiveness as well as the reduced weight of the 12K100. A first for Peter was that he was able to flex/extend his elbow at the same time he could open/close his hand or rotate his wrist. The ‘Axon Bus’ system of the 12K100 meant Peter was able to carry out two tasks at once, which also is a first for powered elbows.
Kevin Harrison, Professional Services Specialist, will be running workshops to demonstrate the 12K100 ‘Dynamic Arm’ in the future. Therefore if you would like to have a first hand demonstration, or maybe you have a client who you would think may benefit from this revolutionary elbow unit, please do not hesitate to call our customer service on 1300 136 053 for more details

The Utah Arm 3

Since 1981, the Utah Arm has been the premier myoelectric arm for above elbow amputees. It was originally developed at the University of Utah by the Center for Engineering Design, led by Dr. Steve Jacobsen. In 1987, Motion Control released the Utah Arm 2, with entirely re-engineered electronics that made the Utah Arm the most durable and dependable myoelectric arm avaialable.

The Utah Arm 3 - One Step Closer to Nature
In 2004, Motion Control introduced microprocessor technology into the Utah Arm 3 (U3), with a Computer Interface that allows the prosthetist or wearer to fine-tune the adjustments to achieve maximum performance. A variety of inputs may be used, so more options are available to more wearers. Meanwhile, the U3 still delivers the same sensitive, proportional control of elbow, hand and wrist (optional), letting the wearer move the arm and hand slowly or quickly in any position.This provides a more natural response with less effort than the traditional on/off movement.

WHAT’S NEW ABOUT THE U3?
Simultaneous Elbow and Hand control! Because the Utah Arm 3 has two microprocessors, two functions can be controlled at once (optionally), thus producing a more natural movement.
More Input Options

EMG Preamps using disc or snap-type electrodes
Motion Control Linear Potentiometer
Motion Control Force Sensor
Otto Bock Linear Transducer

NEW Touch Pad design!

Allows convenient placement wherever a "push" input is available
Protects the sensitive transducer from water, sweat and sharp edges
Compatible with U3, ProControl and ProHand controllers.

Easy to Use Computer Interface- For adjustments by the prosthetist
The Set-Up Wizard guides you through the process of setting up your system step-by-step. Once set up, users can readjust by routing directly to the adjustment screens.

The wearer's input signals are shown in real time on the Computer Interface,
so adjustments can be made quickly for immediate testing and training.
Download free demo software

Maximum Function
The Utah Arm 3’s mobility and fine tuning allow any patient to achieve maximum function, including transhumeral, forequarter amputees and shoulder disarticulation. Many arm wearers master function quickly, after training with a qualified Therapist.

New Quiet Lock Option
Optionally the "click" of the lock pin is eliminated with this new component. Can be retrofitted to earlier Utah Arm 2 or 3.

Technique for using snap-on electrodes with roll-on gel liners. Instructions

The Utah Arm 3 Technical Specifications:
Excursion Range: 135o
Excursion Time With Myoelectric Hand TD: 1.20 seconds
Active Lift: 1 kilogram (2.2 lbs.) in the Terminal Device and using a fully charged Battery
Load Limit: 22.7 kg (50 lbs.), w/ elbow locked at 90o flexion
15.9 kg (35 lbs.), when forearm extension installed
Humeral Rotation: Unlimited
Wrist Rotation: Quick-Disconnect Wrist: 360o in each direction
Weight: Without Hand: 913 grams (2 lbs.)
Hand Weight: 450 gm (1lb.), plus glove
Heat Tolerances: Operating Temperatures: 0o to 44oC (32o to 110oF)
Storage Temperatures: -18o to 60o C (0o to 140o F)
Current: Maximum: 4.0 Amps Quiescent: 10 mA
Battery Specifications: (5 Battery Packs supplied) Rechargeable NiMH, (1100 mA Hours capacity)
Voltage: Dual Supply, ± 6 Volts D.C. (total 12 V.)
Charge Time: 2.5 Hours, maximum
Forearm Length: (from rearmost point of the forearm to the end of the wrist)
Standard: 27.3 cm (10.75 in.)
w/Extension: 32.4 cm (12.75 in.)
Minimum: 24.8 cm (9.75 in.)

The Proprio Foot

The world's first intelligent foot module, the PROPRIO FOOT provides unprecedented physiological benefits for transtibial amputees. A wide and automated range of ankle flexion with proven Flex-Foot dynamics means function is as close as you can get today to the human foot.

The PROPRIO FOOT thinks for itself, responding beautifully to changing terrain and transforming the approach to stairs and slopes, as well as level-ground walking. Angling itself appropriately, it also helps amputees to sit and stand up easily and more naturally. The PROPRIO FOOT™ also has a calibrated alignment control feature. Overall, the effect is a feeling of improved proprioception with a more balanced, symmetric and confident gait with reduced wear and tear on the back, hips and knees.

Performance benefits:

Cutting edge sensor technology and artificial intelligence identifies sloping gradients and the ascent or descent of stairs after the first step, and instructs the ankle to flex appropriately. Users can place the foot fully on a step when climbing or descending stairs and it will automatically adapt its ankle position to enable the next step.

This active ankle motion also allows users to tuck both feet back behind their knees when getting up from a chair or sitting down. It also points the 'toe' down for a more natural appearance once seated. When walking, it automatically gives the 'toe' a lift at the exact moment in swing phase that will allow sufficient ground clearance.

This anatomically correct response creates a more symmetrical and balanced gait, reducing the need both to ?hip hike? when walking or compromise stability by rolling over the edge of a step when going down stairs. Nor is there any need to load the entire body weight on the sound limb when getting out of a chair.

Despite its sophisticated technology, the PROPRIO FOOT has an extremely user-friendly design and is easy to set up and operate. During a simple calibration process involving 15 steps the device evaluates and memorizes an individual?s unique gait pattern. It also has a calibrated alignment control feature.

OMEGA Tracer System

OMEGA Tracer System provides practitioners with the latest in CAD software, shape capture devices, and tools designed specifically for the O&P industry. Plus, Ohio Willow Wood offers complete training and support. OMEGA Tracer allows prosthetists to set themselves apart as professionals.

Powerful CAD Software
• Prosthetics Software provides practitioners the ability to capture upper and lower limb shapes via the OMEGA Scanner, T-Ring™ II, or the Tracing Pen and Tracing Wand. AK shapes can also be created by measurements of the limb. An amazingly broad suite of modification tools are included that allow practitioners to replicate plaster modification techniques within this unique software. Sockets and custom liners of all types, including upper extremity, are created more efficiently.

• Orthotics By Measurement Software enables practitioners to create and modify shapes with the user-friendly Tracer Technology. This proven software allows practitioners to develop accurate spinals, AFOs, and knee braces with amazing time-savings. The spinal software utilizes a library of hundreds of templates to combine with patient measurements to create a customized spinal shape. AFOs are similarly created through the use of templates, measurements and a unique set of shape modification tools that allow practitioners to clearly customize the shape to match the patient's anatomy.

• Alpha DESIGN® Liner Software is the tool that allows prosthetists to create new custom Alpha Liners for transtibial, transfemoral, transradial and transhumeral amputees. Practitioners can tailor the gel pattern and thickness to the unique contours of residual limbs. Type and color of fabric can also be custom.
Once practitioners are satisfied with their patient-specific liner design, files can be sent to Ohio Willow Wood electronically via Internet access.
Transfemoral amputees can take advantage of the AK Comfort Cuff, an add-on feature that provides more comfort and extends liner life. The AK Comfort Cuff is fabric placed on a DESIGN AK Liner's interior, that when donned, is rolled down over the socket brim. The cuff protects the Alpha gel from exposure to harmful wear and tear. Additionally, silver microbial fabric is used on the cuff to reduce any odors from wearing the liner all day.
The software includes enhanced Alpha DESIGN Liner Modification Tools, allowing any aspect of a previously created DESIGN Liner to be modified without losing the existing gel pattern. The improved modification tools allow practitioners increased control and flexibility.

Extremely Accurate Shape Capture Devices
• OMEGA Scanner is the latest in shape capture technology. It is a 3-D laser imager that utilizes reflectors on the limb to capture limb shapes accurately. Limited patient movement during scanning does not impact the scanner's ability to capture an extremely accurate shape. The hand scanner can be used for both prosthetic and orthotic applications. It is fully integrated with OMEGA Tracer software.

• The T-Ring™ II captures shapes in less than a second with its four digital imagers and four projectors. White socks or liners are all that is necessary for the T-Ring II to capture prosthetic limb shapes accurately with a simple click of a button.

• Tracing Hardware provides practitioners the ability to capture and make modifications directly on the patient's limb. Tracing a limb is an interactive process that allows a more "hands-on" approach for the practitioner. The Tracing Hardware (Black Bag) includes the Tracing Pen, Tracing Wand, and Digital Calipers. Practitioners can also use the Tracing Wand to duplicate an existing socket shape digitally.

Innovative Shape Modification Tools
• Advanced Dual Model View Tools provide the ability to visually compare two shape files simultaneously. The new view tool allows practitioners to align files proximally, distally, or by landmark location, to change color of each model, and to specify if views of models are to be solid, transparent or wire frame. This feature allows practitioners to see and/or prove clinical and patient advancement that can be used for clinical analysis of patient progress over a period of time.

• Ramus Containment Socket Tools enables the design of a new AK socket style. A tab locks the socket onto the medial side of the descending ramus and the socket brim is no longer under the ischium, allowing AK amputees more comfort and freedom.

• Relief Pads and Symmetry Tools allow practitioners to make relief pads in custom shapes and for reliefs to be easily transposed to the opposite socket side. These tools can be used on prosthetic and orthotic shapes.

• The Trimline Tool enables practitioners to draw a trimline on prosthetic or orthotic models created by measurements or to existing shape files. The tool includes several options such as smoothing and enhancing the trimline, symmetry, and adding ridges to the trimline among others. These options can make the trimline more efficient and accurate.

Ohio Willow Wood and oandp.com have partnered. OMEGA Tracer now has integration functions with the OPIE Practice Management Suite software. For practitioners who own both OPIE Suite and OMEGA Tracer, the two programs work together and interact seamlessly. This integration permits OMEGA Tracer patient files to be added easily to the digital patient records within OPIE Suites and to track Ohio Willow Wood product purchases within OPIE.

Education and Technical Help
• OMEGA Training and Support is geared to shorten the learning curve and permit the software system to be implemented successfully. For an introduction to CAD, Ohio Willow Wood representatives will visit current and prospective customers' offices to conduct in-facility demonstrations with patients.
Once a facility purchases an OMEGA Tracer system, Ohio Willow Wood wants to make certain the transition to CAD goes smoothly and will troubleshoot any problems or challenging shapes. New users are offered several phases of training, from installation and orientation to prosthetic applications. Practitioners also earn Continuing Education Credits for their efforts with the OMEGA Tracer training, at no additional cost.
Customers receive free software upgrades as developed, keeping control of the latest technology in the hands of owners. Unlimited toll-free phone tech support is also available at no charge. In addition, our OMEGA FAB department is available to help with fabrication.

BioSculptor Othotic and Prosthetic CAD/CAM Systems

The latest addition to the BioSculptor CAD/CAM solutions is the BioScanner™ laser line scanner. The BioScanner™ laser line scanner is capable of scanning any body segment. Direct scan to produce a prosthesis, orthosis, custom liner, knee brace, AFO, seating, TLSO or cranial helmet. This laser scanner produces extremely detailed scans due to its dual camera system. The two cameras give the scanner the ability to "see" the laser line from both sides, which captures the cleanest data. This data is imported directly into the BioSculptor software where shape manipulation is performed.

Osseointegration

Osseointegration - Bone anchored prostheses for above knee amputated patients!

Hundreds of thousands of people all over the world have had a leg amputated due to accidents, diseases or landmines. In 2005 Sahlgrenska University Hospital will be seeing
40-50 above knee amputated patients from outside of Sweden, in order to attach leg prostheses using titanium screws, a process known as osseointegration. The method, in
which Sweden is a world leader, enables above knee amputated patients to live virtually normal lives. Patients with other types of amputation also receive osseointegration treatment.

M.A.S. Socket: A Transfemoral Revolution

M.A.S. Socket: A Transfemoral Revolution
By Miki Fairley

The M.A.S.® socket design is an evolution--and perhaps even a "revolution"--in the development of ischial containment (IC) socket concepts. Since 1999, when Marlo Ortiz Vazquez del Mercado, Ortiz Internacional, Jalisco, Mexico, first unveiled his new design, it has continued to arouse interest throughout the O&P worldwide community. Recently the design was featured in the Thranhardt lecture series during the American Academy of Orthotists & Prosthetists 2004 Annual Meeting and Scientific Symposium.

The new design provides several clinical benefits: patients can sit more comfortably; there is no plastic beneath the gluteus; the prosthesis is easier to don; patients enjoy full range of motion, better functional gait--and important to patients and family members too--much better cosmesis. Seeing a video of patients walking, sitting, and demonstrating the range of motion possible is truly amazing.

Ortiz, who is a prosthetist and engineer, has fit hundreds of patients with the design to date. These patients reportedly have had no difficulty in wearing the socket for long periods of time. In fact, one amputee, due to his work schedule, actually wore the socket for 28 straight hours with no discomfort.

Agnes Curran, CP, OPGA prosthetist, pointed out that the design seems to be surprisingly skin-friendly despite the intimately fitting contours. Generally there is no skin irritation, and some amputees who had worn previous prostheses found that existing skin problems cleared up.

OPGA, Waterloo, Iowa, along with O&P1, Waterloo, hosted an initial seminar in January 2004 in which Ortiz taught how to cast, modify, and fit the design. An office worker who came with prosthetists from Nebraska attending the first seminar served as one of the patient models. She wore her check socket all the way home to Nebraska and asked the prosthetists to come in over the weekend to laminate it so she could begin wearing it immediately. Another patient waited all day for his new socket rather than go home with the old one. This patient enthusiasm is testimonial to their acceptance of this new design.

Bob Tillges, CPO, FAAOP, Tillges Certified Orthotic Prosthetic Inc., Maplewood, Minnesota, is enormously enthusiastic about the new design. At the time of this writing, Tillges, who attended the initial OPGA seminar, has fit nine amputees with the socket and is in the process of fitting two more.

"All my patients have been very satisfied," he said. "They have no discomfort; there's better ischial containment and range of motion. In fact, one of my patients' wives called me and said, "This is the most awesome prosthesis my husband has ever worn! I can't even see it under his slacks." She added that it had always bothered her before when her husband's prosthesis outline was visible.

"I'm taking time to learn and understand the mechanics of Marlo's system, and I'm getting very good results," Tillges added. Although most of Ortiz's patients are younger, Tillges has a large percentage of geriatric amputees. He has fit amputees aged from 44 to 81, including several in their 70s. Four of the 11 use some auxiliary suspension, but the others use true suction suspension only. "These sockets stay in total contact with flexion, extension, adduction, and abduction," Tillges said. "Something that has always bothered me as a professional is when you can see gapping, spaces, or outline of the socket under clothing." Although many were skeptical at first and thought the design would cause proximal tissue roll development, Tillges said, "We have not experienced that problem." He added, "With better ischial containment, you reduce the amount of tension values needed for suction, get more comfort, and achieve better suspension."

Tillges started his O&P career carving and fitting wood sockets in the 1970s; he has seen socket technology develop through 30 years up to the present. Some iterations of the ischial containment concept through the years have included the quadrilateral "quad" socket shape taught by the O&P schools at New York University (NYU), Northwestern, and the University of California-Los Angeles (UCLA). Ivan Long, CP, developed his Long's Line, and John Sabolich, CPO, came up with the Contoured Anterior Trochanteric Controlled Alignment (CAT/CAM) method. Tillges feels that Ortiz has gone beyond these in IC design excellence. He noted how much his patients who have worn other socket designs appreciate the new sockets: "No way do they want to go back to what they had before." Tillges is also educating his company's residents and young practitioners in the technique.

The Design: What Is It?
So, what is the M.A.S. socket? Ortiz describes his design: "It is very important to consider the angle of the ischial ramus. The ischial tuberosity and part of the ramus as well as the medial aspect of the ramus are encapsulated within the medial aspect of the socket brim." Generally, the medial wall is lowered anteriorly to avoid pressure on the ascending ramus; effectively ischioramal weight-bearing eliminates the need for gluteal support, so those tissues can be excluded from the socket, he explained.

In the conventional design, posterior trim lines include part of the gluteus maximus. In the M.A.S. design, the height of the posterior wall has been lowered to the gluteal fold, so the entire muscle belly can be free of the socket. "This will not only improve cosmesis but with this configuration, we have found that ischial tuberosity and part of the ischial ramus are encapsulated more effectively with no restriction in hip movement," Ortiz said.

"With the gluteal cutout, no weight bearing occurs in this area, and weight-bearing forces are vectored from the captured medial aspect of the ramus with a resultant force projecting to the anterior/lateral area of the socket," explained Al Pike, CP, in "A New Concept in Above-Knee Socket Design" (The O&P EDGE, November 2002).

What About CAD/CAM?
Can the design be adapted to CAD/CAM? Perhaps "down the road," is the answer. "The difficulty is not in measuring; it's in being able to modify the complex individual anatomical shapes correctly," said Dennis Clark, CPO. However, he foresees a time when the necessary tools can be incorporated into the CAD software to accomplish the socket design.

"Once people under-stand all the concepts of the design, they can identify what they are not getting from current CAD tools--and then it will be easier to develop what's needed," said John Michael, CPO, FAAOP, who also participated in the January seminar. Michael is a consultant to OPGA and is assisting in the development of the course series.

C-Leg, The Prosthetic High-Tech Explosion

The Otto Bock C-Leg® and Otto Bock Compact™ microprocessor-controlled knees are designed to deliver the best in stability and reliability. Both knees utilize easy-to-charge lithium ion batteries with 40-45 hours of power.

They are appropriate for people who:

Are transfemoral amputees, including those with bilateral limb deficiencies or hip disarticulation amputations
Are involved in activities that require a high level of stance stability
Walk or have the potential to walk on uneven terrain
Frequently descend stairs or negotiate slopes
The C-Leg is Ideal for people who:
Currently are or have the potential to be unlimited community ambulators
Can utilize Second Mode for varied activities such as bicycling, roller-blading, or extended periods of standing
Have the ability or potential to walk faster than 3 mph/5 kph and walks up to or more than 3 miles/5 km a day.
Are involved in activities requiring a high level of stance phase safety as well as efficient swing phase control
Change direction and speed suddenly for work, sport, or home activities.
Would benefit from automatic swing phase adjustments because of their activity level.
Would improve their gait when using stance extension damping
Second Mode Adds Options
C-Leg wearers can choose between two modes that are programmed by their practitioners. The first mode would be optimized for the patient's daily activities while the second mode would be programmed for activities in which the amputee participates. With just a few simple taps of the toe the C-Leg can switch between modes and go from a secure walking knee to a locked knee, such as for a surgeon to lean on during long procedures-or less resistance for a bicyclist who needs a freely swinging knee.

RHEO KNEE® technology in depth

RHEO KNEE® technology in depth
Perhaps a product designer's greatest challenge is to replace all physiologic function of the anatomical limb. Emulating the human anatomical, physiological and neurological system is a holistic task that is both complex and humbling. Anatomically, the designer must recreate structures of the body by using materials that enable everything from fine motor skills to ambulation. Neurologically, the designer must create a feedback mechanism that senses changes in the external stimuli and that uses the character of these changes to alter physiological responses in real-time.

The difficulty of meeting these challenges explains why commonly available prosthetic devices have such limited functionality. It also explains why Ossur turned to the Massachusetts Institute of Technology (MIT) to identify the state-of-the-art software, hardware and biomechanical technologies needed to make bionic prosthetics a reality. The results as realized in the RHEO KNEE® are striking: a synergy of artificial intelligence, advanced sensor and magnetorheological actuator technologies that give the user the unprecedented natural movement essential for embracing life without limitations. The specific technologies that achieve this synergy are the:

Dynamic Learning Matrix Algorithm™ (DLMA).
The RHEO KNEE® utilizes a software based artificial intelligence to learn the individual's walking style and provide a mechanism for continual monitoring and optimization of swing control. From the moment the first step is taken, the Rheo Knee compares the maximum degree of knee flexion achieved in each step during swing phase to targeted values set by the prosthetist with the Rheo Logic software. Swing flexion resistance values are then updated to limit excessive heel rise or promote heel rise depending on the walking speed. Swing flexion resistance values will influence extension rate and extension dampening making the swing phase adaptation process complete. Sampling and optimization of values is continual within the RHEO KNEE® even after the initial program has been set for the user by the prosthetist. Through constant monitoring and optimization, the Rheo Knee provides a virtual prosthetic adjustment to ensure that the individual?s walking style is targeted most appropriately.


This advanced technology uses magnetic fields, MR fluid, and rotary blades to vary the RHEO KNEE?s resistance in real-time. Microprocessor control initiates rapid kinetic response to sensory inputs through inductance command as frequently as 1000 times/second. With application of the magnetic field, carbyliron spheres are drawn together in electromagnetic chains. As the knee rotates into flexion or extension, fine rotary blades shear the particle chains to create resistance. The result is minimized fluid drag within the knee restoring more natural pelvic position during pre-swing and reducing fatigue levels.

Microprocessor Controlled Stance.
Through advanced sensing and processing, the RHEO KNEE® provides multiple safeguards against inadvertent stance release. The knee must be fully extended, momentarily still, and achieve 20% of the average maximum extension moment during each step to release. The microprocessor samples force measurements at a rate of 1000 times per second and is always aware of how the user is loading the prosthesis. Disturbances in the user's path are automatically recognized by the force sensors. Stance support is instantaneously activated to protect the user from a potential stumble and fall. By detecting these patterns in their earliest stages, the RHEO KNEE® can take the preventive actions to reduce the likelihood of a fall.

Rheo Logic Software.
This intuitive icon-based programming software runs on an HP iPAQ palm-based computer and makes operation simple. With the use of specialized SETUP modes, initial programming is automatic. You simply power the unit and have the user walk. SETUP modes calculate baseline starting values for swing and stance control. When manual adjustments are necessary to further customize the RHEO KNEE®, the software makes this task a fast and easy one. Multiple users and settings per user may be stored on the PDA and transferred to a PC making this tool very versatile.


No magnetic field applied to the MR fluid. Ironparticles are diffusing randombly allowing the disks to rotate freely in the opposite direction. Low magnetic field applied to the MR fluid. The iron particles start forming chains and resistance between the blades increases. The strong magnetic field has now caused the fluid to form continous chains and the knee can now been felt as rigid through the joint.


Clinical test results
In 2003, a study described in Industrial Robot (International Journal, Vol. 30, ~1 2003, P 42-55) assessed the clinical effects of the RHEO KNEE® by examining kinematic data from four subjects who were unilateral, transfemoral amputees. The investigators concluded that a user-adaptive control scheme and local mechanical sensing were minimally sufficient to enable amputees to ambulate in a biologically realistic manner (as compared against the schemes and sensing available in mechanically passive prostheses).

i-LIMB, The Prothetic High-Tech Explosion

Touch Bionics is the UK-based award winning company focusing on the supply of electrically powered Upper Limb Prostheses (ULP).

The Touch Bionics i-LIMB™ Hand offers users a step-change in functionality and performance, enabling patients to do more with their prosthetic hand. For example, the i-LIMB Hand has individually articulating fingers, a rotating thumb and a range of grip patterns. All these features are combined in a hand that is more anatomically correct than any other hand available.

Furthermore, the modularity of the i-LIMB System gives Touch Bionics’ customers the ability to fit clients with powered digits through to a complete arm, left or right, child to adult, from a small number of components. The products are also more anatomically
correct than any currently on the market, which allows for increased
functionality and improved cosmesis.

The i-LIMB Hand will be the first product available from the Touch Bionics i-LIMB System. The entire i-LIMB System, available in 2006/2007, will be the world’s first complete endoskeletal modular arm system.

Real Life Prosthetics

Now Open in Glasgow, DE!
Real Life Prosthetics (RLP), LLC, an advanced prosthetics practice headquartered in Abingdon, MD, now serves physicians and patients from its new office in Glasgow, DE. Located at Springside Plaza in the Christiana Care Building, the new facility is easily accessible from Routes 40 and 896 (next to People's Plaza). For additional information and directions to our new office, visit our website, www.reallifeprosthetics.com.
Utilizing cutting-edge technology such as presented in this newsletter and patient management expertise, the RLP team is dedicated to restoring each patient entrusted to our care to the full quality of life of which he or she is capable. All of our practitioners have met the rigorous training requirements and passed the required examinations of the American Board for Certification (ABC), recognized in the United States as the highest standard of education and professionalism in prosthetics.
To contact us or schedule an appointment, call (302) 392-1947.