Responses to Limb Length Query
Velicky
Description
Collection
Title:
Responses to Limb Length Query
Creator:
Velicky
Date:
5/14/1999
Text:
Thank you all who responded to my question about limb length. Following is
my original question and the responses:
> I am a student at the Cambodian School of Prosthetics and Orthotics.
>
> Can anyone tell me the formula for determining the proper length for
> bilateral transtibial and transfemoral prostheses? Is there a definitive
> relationship between the length of the lower limb and the upper limb or
> trunk? Is there a difference between children and adults?
>
> Thank you for your help.
>
* Sisary Kheng
Hello Sisary,
Proper length of bilateral AK or BK prostheses is a subjective issue.
One thing you want to consider is, aside from asking the patient / client /
etc. how tall they want to be, is the height of their center of gravity.
Often a bilateral patient is lowered in order to lower their center of
gravity and therefore reduce the risk of falling. This is especially
important on transfemoral (above-knee) amputees.
You could check an anthropomorphic chart for approximate relationships
between the lengths and sizes of various body segments. Our Prosthetics
school (Newington in Connecticut, USA) gave us each one of these charts.
Perhaps if you're interested, I could contact them and get them to send
you one?
As far as children are concerned, it would seem that a child could be
placed proportionately higher than an adult due to their resiliency and no
fear attitudes.
Good luck,
Bill Lifford. C.P.
<Email Address Redacted>
In pediatric practice here in Salt Lake City, we used the length of
outstretched arms from middle finger tip to middle finger tip as the
approximate height of the individual.
You must be careful in a growing child not to lengthen them more than an
inch or so at a time, as this sudden growth affects their perceived
balance and makes them uncomfortable.
I have a list of proportional body measurement (ie. length of foot is the
same as length from olecranon process to the ulnar styloid). I will mail
this to you if I can find it.
Good Luck,
Timothy Bachman, CP
<Email Address Redacted>
Dear Sisary,
There are anthropomorphic tables to consult in some biomechanics texts,
from which you can obtain a ratio of leg and foot to thigh length or arm
etc. Sorry, I can't cite any. However, it may be more convenient,
practical, and possibly more accurate, to adjust the length of the
prosthesis to suit the persons trousers. If they wear them.
Cheers,
Mark Graf (B P&O)
<Email Address Redacted>
Dear Sisary Kheng,
i don't know if this can help you but we learned in school
the length from the toes to the pubis is equal to the lenght from
pubis to top of the head
the length from the maleoli to the top of the tibia is equal as the
lenght from knee to the hip joint
the foot is as long as the fore arm
the width from mid finger to mid finger is the same as the hight of
the person
although you need to make the limbs shorter in a bilateral femoral
amputee due to balance problems
hope this helps you some
sincerely
ina
<Email Address Redacted>
a good rule to follow is knee center no higher than a normal chair seat 450
to 460 mm
this allows the amputee to stand without having to vault over the device
Steve Smith
orthotist/prosthetist
<Email Address Redacted>
my height was always measured by the arm span
the span of the arms held straight out side to side with the measurement
taken from fingertip to fingertip was used to estimate height
it is usually the same
however, you have to be careful if the person has spent a lot of time
crawling as the jarring of the bones causes the arms to grow longer than
normal so if you see that to be the case, you may want to shorten just a
bit
Kimberley Barreda
<Email Address Redacted>
I also asked this question when a student. Remembering a chart I saw once
on comparative limb lengths, I looked for it in what literature I have and
cannot find it (possibly with good reason), but the answer to your question
is really in the practice. There is a good chance the exact limb length of
what the patient had before or would have compared to average body
proportions, will be superceded by what will function best for this
individual.
But ask:
1. original height, and do the math. How big is the wardrobe of the person,
this can be very important. Fit the pants.
2. what will the components you are using dictate? If using a prosthetic
knee on a Knee Disarticulation, for example, you have your question
partially answered.
3. What is practical and functional for stability and control? Often,
shorter is better. The person's ability to sit and arise from a chair will
be very important in making this determination.
Summary: Fit the individual's wardrobe when all other factors are
permitting safety and function.
4. MOST IMPORTANT! Make it a team decision. Enlist the patient in the
decision process and explain the pros and cons of length and
safety/control. Otherwise you may be resented. For example: tell the
person, now, they can be any height they wish to be, but...
Hope this is of some help.
John Zeffer, CP
<Email Address Redacted>
Sisary,
I have always attempted to maintain the normal height of the person,
taking into consideration their ability to balance and ease of standing
from a low seat such as a toilet. Keep in mind that lowering the center of
gravity will improve balance.
Joel Kempfer C.P.
<Email Address Redacted>
Generally accepted determination of one's height is the distance of the
armspan (arms spread wide apart).
C. Michael Schuch, C.P.O., F.I.S.P.O., F.A.A.O.P.
Assistant Clinical Professor & Director
Department of Prosthetics & Orthotics
Duke University Medical Center
DUMC 3885, M04 Davison Building
Durham, NC 27710
Voice: (919) 684-6890 Fax: (919) 681-8496
E-mail: < <Email Address Redacted> > or < <Email Address Redacted> >
Personal Web sites: <www.michaelschuch.com> &
<www.ExpertWitness.com/schuch>
Clinic Web site: <www2.mc.duke.edu/depts/pando/>
End of Resonses
begin 600 WINMAIL.DAT
M>)\^(B %`0:0 `$```````!``$``0>0!@`(````Y 0```````#H``$(@ <`
M& ```$E032Y-:6-R;W-O9G0@36%I;Y.;W1E`#$(`0V ! ``````@```$$
MD 8`B $```$````0`````P``, (````+``\.``````(!_P\!````9 ``````
M``U.\+ +'<0&J&\ `K*E;%0```.8ZXJV?J](1C5!$15-4``!DA0``````
M`($K'Z2^HQ 9G6X`W0$/5 (`````3&ES= !33510`$]!3D10+4Q 3$E35%,N
M549,+D5$50`>``(P`0````4```!33510`````!X``S !````%@```$]!3D10
M+4Q 3$E35%,N549,+D5$50````,`%0P!`````P#^#P8````>``$P`0````<`
M```G3&ES=<```(!S !````&P```%--5% Z3T%.1% M3$!,25-44RY51DPN
M1415```#```Y``````L`0#H!````'@#V7P$````%````3&ES= ``````?=?
M`0```P```_````M3OPQW$!JAO @`*RI6PA4```#F.N*MGZO2$8U01$53
M5 ``9(4```,`_5\!`````P#_7P``````?8/`0````0````````SD@!!( !
M`!\```!297-P;VYS97,@=&\@3&EM8B!,96YG=&@@475E<GD`(0L!!8 #``X`
M``#/!P4`#P`*`#<``P`&`#0!`2 `P`.````SP<%``\`@`@``H`!@`D`0$)
M@ $`(0```#@W04)#,#8Y0C$P040S,3$X1#4P-#0T-34S-30P,# P`-0&`0.0
M!@<'P``( ````L``@`!````P`C```````#`8```````L`*0```````P`V
M``````! `#D`8 ,IMH:>O@$>`' ``0```!\```!297-P;VYS97,@=&\@3&EM
M8B!,96YG=&@@475E<GD```(!<0`!````%@````&^GH:U:&G JY8*L1'3C5!$
M15-4`````!X`'@P!````!0```%--5% `````'@`?# $````7````5F5L:6-K
M>4!B:6=P;VYD+F-O;2YK: ```P`&$%]/PG$#``<0AQ(``!X`! !````90``
M`%1(04Y+64]504Q,5TA/4D534$].1$5$5$]-65%515-424].04)/551,24U
M3$5.1U1(1D],3$]724Y'25--64]224=)3D%,455%4U1)3TY!3D142$5215-0
M3TY315,Z24%-05,``````@$)$ $```#' ``?QP``$A)``!,6D9U4WB(:0,`
M@!R8W!G,3(U<C(,8&,Q`S !!PM@;I$.$# S,P\69F4/DD\!]P*D`V,`&-H
ML!SA&5T`M%P<G$R``2*@JA;F\24 P`=%`= V#Z P-3 T%'S`= 4$#1]
M!VT@P!0`]3[$?\3V(3X110$[(8]!30^P<3%>0T`N,6MPY0%V\4,$D<GWU7
MX!G9!W1<U<@ *1.8[6\P'R]E_0XP-2!:(7$A+R(Y($0B8G\@SR2?)%TC
MWR(/(%\08#+^.HJ*T$J_RP)($0L,BJ?WRYO+BTMKRO?+Z0Y#E R] \T42QS
M-% @G-T>6QU!Y!H>!T```34 /P9AC=&P*L5PVJ&%DS&IU-< %$&=H!4(6
M,AT,`6,)P#:P`S!S;F6^>!<P![ %L # `G-S`%!8<V(R%% UL&$3\%SZ:PG@
M< N0-H\V\PA@-N#UX!E-?!V/; !0#?K##!_.+0L4#N0!* =T2Q!.39B^F$7
M$&0(#GP.98V(#?@^1W1( <Email Address Redacted> \[_ST/_P!1/DP`H#B^0,]!UC5T#\#_
M0M]#[T3_#E ^/T=?2&]`_8S`H(3$&,ZL$_Q-^ >`1T:3W@($0!$&%U*FP%
M0% *P&$)P&%P.&@@1@(A.G0ID&9I^BT/D#@!0#V 5(-+7S;S>F(+('()4%:B
M%J!6HG?V-F1%P!P`=!1PC@/3N_?3_94(%+@!1 ,U3@ -A$#H@5&]<`%-U
M8@IJ!9!T7 !$871E^CHZ=#943U5?5F]7?UB)_S800?,.(4_Q/P8.4%F_6L[F
M4CW1%P$@2$'A!) Z=/XW7;]>SU_?8.T]7V(/#Y#+'* (T&(*L'0X3DH/5#]*
M8&0/919N4&8@U!Y+_]3D&$`Q%FE1Y!.I(L4&>/_VB?::]@_UB?;Z]POW'%
M7)[6\1<^3ET#S>/`S!N`SF'=^]X_W[P1&]C=0> _P(P!=!34$)D<_]];W??
M@ __.? &$ I `9!2( (@0F0`4/EKP#0S@E^#;X1_A8\;0'T.D$,)``0#W!
M9$*Q83\.((@_B4^*7XMO8^ @0IT$<'E<$#G!428R,U')<PQ@5!C9I(@D0=1
MH4CL>7 $D&O!:T)D&F%S,/XS2L%KP):BC?^/#Y ?BX[X-!,! !3Q XPEF@!
MP7^7/YA/F5^:;ULPFY))M3)_7:6Y(V?G=^>[Y__C#,V_Z%D% , N E!
M9&=@HQ_7I^E/XN.-P8`: D19A'V= AP`Z!!4? ?0 00'E/_$Q!KP#7 `9$U
M\ ``KK*NI!QE;0M171HX#8W-OPY.+P?%NL@0L!&O-7=L`W.0;!)N%L3
M4+)T:JYC<X%L$@(0; D`=[.EWS7 L'`;1VK!CFR='\+@ $``C !X6P#
M71 YT%Q4)S `4'66D#AS<!N/P*LH2!<&)R<QHT8OT','-/\99[LXNM0S!
MEJ&F(+BFZ%N80> (+EQ6ZZRJ. TL+!*8#D40#+_O#6OK[_L<^RW[/OM/^V
M#_^W'[@ON3^Z3[M?O&\N<!1 >#,W.;V =H^'[\C+>4!T#A=D#0W79 .4, /
M_\$?PB_#/\1/Q5_&;\=_R(__G*;*&@'!RP_,%+VRSMH@/HWKEAO9D$Y41<@
MKPC<QO?+_]Q[!:!UU,%SD#JPVC7_W?[;E]^/X).^!MW]O8?B__W@DS,>8*EB
MJ,I`'6A`8#^;ER `& )\%'P@5 `3HPOV*BWF#I,370E8 .4'8(D/QW:]2!
M&F#JH@3P!T 08;\!0 X`=7)!TNP%`A!O!4*/%R$2\K[6C) Z7%Q;4'IO4S%M
M4X #$ >0[K!-DPW@`V!S;P& ($\!(&L-X-Y@7/!F10# `Q N?4_ =-> %QI
M`#EQ:\)X^P% Z0%N-B ?0/($4H3*(,X@$O,`@ 60;'9%\ <Email Address Redacted>
M]2+4A)SB2R _%N /< ``2R ,T &0([_KE3TI@Y0]4)2P*E0];_VSW_WWP_
M2R %@?E_^H_[GVR[&F!+(&SY/_W__P4I^ R/*9#\WP&__O1B(@:$?\W_33
M7: `CP5/!E\';_4`_V=@++UCPH?R_X#Q0+__#C\/3Q!?]0!\4 T_$L\3
MW_\4Y!OQ[/#LL&\@'=#R8*B_$ZG/JMU[5/ZA:R!YK6N0(.N@]$!WK1 @K@&>
M<(8`U* Y<-RP(&V2<%YQ,C]088`'C!B:Y$@#VO UR @H#!@9W1H+OX@4X'2
M,D(2H8 ?@CH@3@#_E<#KH!^YU) ?4.QP'K5F<-!S.@T*&;(@)-49I-_R8I</
M&U].$E/P=I11C(#V/MHB*/))'C#O,/]0-<#>==2B'CAH/R0[RP(&!W4@!O
M,*SP8ZT0TB B@&:_6T&,P/QWK!1@.C3ZTP^ZT0+-(N)48HORX/*48K(/\C
MDAX`.; ?4&OP]$#+H2/R;^ER4K#_4.EQ(-TA/[!M]Y7 0A(C\G#O\)6!(/4R
M@O\OGRE&R-_$E,0]$ <,&\PO[U!R-'T0.S-Z+M@&TZ(.\B\311+)(DD3\I
ML) (_'_'L J`?/!,[%2(C5O*48>P&>_$8<QZ;!I<#;@[9!W_TL`K; C\C3%
M+#$^4R:@-)+S(,(CMG5P-(,@PC5/*2C;'##@<&LZ`#H;:?#P\T'^;M/P/<<K
MT/&0K?$CE!O@_U*Q.?!!?R\?*,X=J#,2'@'_)2#L<<`+?]'KACSU7(9R/_7
ME*LCJN&K98RP*] ;T->B_&1B3^/RT#V03^'7H?)@_=D<P#*<1F5R2TFGR<#
M_\H=]&3R8!&A]0O$+YP\9#_]0#G<P1!K:#M0 (RUZ(7)G]2PA?M48+GP5<B
M)_PH\E/GH8!]H))P($OL<&+P*5._DB E35-O=2=N@'79,_+0_W:_6S==#UX?
M)\]A_QH&@D^_8_\<;QUQ<C#2,5NU+&6O_QI/: ]I'QUQ:R]FM(U_;0\_;A\=
M->[1-(DL,3;X04N_(H&2, <Email Address Redacted> @B(BH1=>C K_(AD^*A@'?@94LV3S&B]SV0
M(@$>`G<@ <Email Address Redacted> \6H-T1)2A@P>,'KR,H![[_ I\7/JX3/UAQ&!DB]O
M15#R@'TT[9!C(6M$'?_'U >0B/QDG!Z1M<P>W B,>\C\NQP<U,_!&DE($2P
M37'_)2 L,>\!ZJ#J0%A\.#.(/\@,3;I?/8B,3]S'S%L,>F _WL2'V$_=($O
M@C0CIA[ Z7'_)!)&0$2Q(_.A@!W@+#'SX/_2,(SA(6$=H(Q(C$>T>! _3@1
M;))PSW&M(7I2($XFR8H(%'00UKD=!E*=TIT7 @@#X0+>=9'A'@4?]%D$51
MX$ =X#$S(4 T87P0O>F <%#Q15$6T3,#84P?>_P>,]P[E(]B) /=]HVRT$
MSV!Z=V$L,78E$#U0WW,0-N K8(>0],!GRZ 4L#\MX(*A2L$L:NN *^,H3O_J
MP'QW+ML&PQI[&;('@Q1F,@@'MP55-!C>!G_X) 0(&*P=/@/N$QH3\$],#[
MD226PE#>$ )PDT%$0!WR_%QR'\#M002A0$S<1_A_Z >W IP(]%I\'3XK#
M*?'](\%G[9?Y!]A], CP1X^S&11I9!(D#SX)&Q(D!%:/\Z@7K!1+MH)ZR
MAW ><(]3__3 H.(<J1152/-=<P-$#_[D!$L/0-%*M(2 1SA&+8?\]D'-@
MA@,Q,T8D,T ?T!]2[X8T'L'QD'TA8X>4T;!08/YLG:1Q@#* [(!RP.SPJY;_
M*J'>LI+>AF+6ZP\H#?`&]Q7W)O<W_T4$?M,/0;'WY(&MK'VPOL*^QOV]9
M0COQD/1 3$1!A4$A8$,NOE#W\&^'2\#)0-'P9/1B/F9%D/*0MI!;4US@($B
M65!%4DQ)3G9@^_%RW+ ZD4$Y`!<PZY#Q<)QN0*Q1(4#R@6LN\J#W\$!<E?1B
M9,X04!Z<O)@<C0;C'.T `T,D`ZGGYNLX1C((``*H`2ZD+`@`5P9 7P9$;
MP9%H`&$``'(`;0!O`&[P`&D`8\)1PJ#8,+@J$ `9<)3=,(Q;,+Q\<+@:P`N
MPM'#X,1 P9#ZX,=1,&1PV+#`,2 Q$#]PL ZPC_#3\1?Q6+X`+HR_461<ZEQ
M*6&W8-$0] !<L_^\_[X'RR-<S[3?7N]?_V1__\[OS_^V#]/?<$^OO]8/MN_]
M]%!)F3#J8MQVT&1$#10?Y^Q\)%*X9X#6[#KH/! 3/QA:^YQAW%[<#X`FK$?
M,O\^:R!QVS%^(>QP1A'ID7OD_S.@Z2#KL#* (?&%<CVA'V+_XG^B\2/RD=J
MBX4!*W#JH/]&0.N@CHHRP+M!IK'KD(@A__0`A0+_4&\P(=2E]%>1A9/_(1,^
M).)!B%*HQO*0FQ(E(/_P$JB_U!]$#(@>W)YDI?A_RI06(&K6NF2(4LBT11
MV>#_.C.&832!1+!X4::1?L @/]$L2.RO(#?`#HS*?!#('K _FTU,54A-,!+
M-BG `G!X8?__4%3B+*G61Y@E@,R('N0]TK ./ J<BB_H%@/I@U,/_J@8 5
MV3 R(:+Q-,9\`B&@_YF0C'$@(3111+!XH*G50)^;+@[/&<#]PV< I(6'_
M*<#9L#'RO)'N%'^A'@*=(>^>\2N1.O&$\72MWZ[OV:_WVK^R'[,A3+-OM'\
MGP.OUQTVBY#J@&B'D$*;`<UA>7MP0UYK[J_N\^\T$H5[PP4U1/3D!AW2&@
M+O/!OI^_J#/ 7\%H`A'!D4H`5P!,``!)`%,`5 !/`/Y.R3''`,A R@#%`,B@
MR$#SR#%CPLPQK\3; <Email Address Redacted> ]&OTK_7/W\=KP??(8\`;P'O
M)!\)'WO^1*Q1:J_8/]E/)_\I#PGS_SID.H*03?0C^]-ZPJEB!M'_[1#YL76P
M,R&1,<TA.C%-D3M[87OS=U#R2A/_0F]B_U4@Z4,Y(#U!=7+Z$'R00+_^-.I
MXR[1/H>1L<SP?A1;L/^0PKA_Q2=AB\`BR#P<5DP[8*2#^!>&!RI(.\@(>0
M_Z:QZ\-ZP7A@S2$(7MPW87??L![<4 QD)!XH&FLL/<!_XA2IP9T#9A?^%_
MH2YDX W_?+-V]?Y4=^DH7RSI##M$/\R@(Q1E<%#D?U@0-_,2IB_Y_R__\F
MI4ZA4J\M7RYOMVG^0X^P0Y$K#P;/2/]*#PGR=DVB4(EP1_L0=9-($+QES F
M3RD+;PQ_#8^\T50,BY0@D!N-/!C;G8ND,*(&'^T _/O[<U;C41CQ*7P<)-
MQ]/*8D?;Q_''`&;),<A@=\>QR*!OR&#%`,A R !GQ/''`'7[%5_!8#P6GUF_
M6L];VAG/_\PX5*]5LQQ_(K\>GQ^O(+__)3]EWTW?:;]&/T@?;$]/'^DJ2B!+
MZS%G2[],SW O?W$_M]DKCRR?=9]VKTKT:?^ID*?0.EB-H(7@_N+N(_]]X^P
M>G#^HV*9X-^^AB4/^D43+3F!.B%> 9XA.)`C(P^S($0=-U$2*E/! ]J'[
M]?_Z$GOQXA*B%8.DJ>* <Email Address Redacted> >V!/X)(O(#Z$)A ?2#_^_6&N>V0$2E
MT(0'Y-2B%9^%7X!I4#[YI,A(&K]`/^00(>I^-;YXJ?0-Q'Y-+D!_S!BA:;Y
M4GHA^E;CL>+'XY/_XL;Y+8WTYC2'J4.$HA7>H?V \'4X(?ZRC8'?\>.1WO+[
MX!/MH&+N48#PO>4(NE2_XL0IO>4?:AK$#KP=Z@EQ;^;8.@\'#?$*FE\C;V
M`?1!_^'@HA6 \-S@[A1_(NY0_K+_,Q)X'T;O1_]ZWWOOM^$_`/_R<>% J?
M_W2_HR^D/WSR__R 45]2;U-_O-J<>10,-!D0&.S4&(NWF^82[?Z)%6'U<H
M$7_!:!;!D<2B_\<`6_#)8,A@R< 8H,B@R@#]7%!BQ/'$HL4DQ0T4,E@_5Q_
MQ> QLZR_[0/M1AAG__,.*W_KP)DKVKO9L]GWVCO_VUOOL^H'\*OP[_$S\78
MZ7']!3)RZ1-HY#@_;!^,NY0_XUSW> PT.1AQ[5<^1B[-_ZF'AT/:A,['Q
M8=_0[4$T[C7`(>F0M TH<#W$)%8_X_RO+DY9PE0L+T(#=!Q]#?EZ*I4/41
MZ=(R,795X-ZQ_F\[X?E#[J#G(-W@I@^A#V^B'\B/J3]WX5/P</4Q4__CL._0
MU)^G']?/V-]WX?9!]X#P[9#H8]%=^JJ^KOS^LSZW0P=\07] KH!S0#N2
MP9M0+J[AKT\0R#0WB[$?$I<564%S`'WQ7\7(.C@N/+HP!B@MOY<&2?MN%@
ML&0N;2UGPLXML__Z,_IW^KFNI^[J./?KN&]G__'3[^_P,_!W\9?]$_<W_@O
MW]3_>8_Z7]V_<5M/(!+8-T``W>0<9> `?!Y-!4X/>0<#_@@'%B/(#0TSD!
M]U#_,]'J0/B098X\9[S=^#_T?^MD)6C?\$_`-0P0K,'$M(B_XD$`K24X(ZH
MF.';X(C#DP3_-H!_4,JBD<!\D0QF(,R`/\V@*V .Q$!A)<5/#&4440P_XNA
M/S&4AOQ/V]__#P`?=^%_@/ [Q9@2TJ&<M#T!,(%F_QL`?E1#9M*1F:&6L##0
MS1&OD5PHKA#P=C/_!WUI]D$AJ<J 2,-+A0:5BD##_,@%^X$0QT+4%HC(Q
M2O!^,?^0(LREEQ7-13,0?E*?<XV2_S/ -Z,\H92?N!$0!0$/&*_`? 6X4+
MF=,00$C89<5WXL0CK;Y3Q$/^V=+F7%+@/N(4#R 0AEA@'JG^&/XI^=K<%K
MF7N8!(P<'<Q4+WF0XR8#D0Y2_F-S-7S_WGZ!)905\0[PV\+BR7O#_[P#M
MH& 08+)>,.I@8)XT.=@L+;PZT\+,NQ_+J\OO__P#V***>_S'R+O]3_V3_=?
M__O?.3\D'ST?_*_]OS]/$A_]?+5)T%$=L9!PF/8@7ZB?WV0#&(60550;&+
M,@P=>/4, CP+B!2,$EHABC^\VBF? @1D!P'Y D#=4>\602K!1$'.,&G:
M09EBB$7N<Q0`1D0(&]&TI#A#;/_1]+.,=:0FM)(<)$!1D 48W_1XG[A0R%
M41 P@(%%(C^<-_P!P=L!!!^+*! *Q_9 P*10`?[+0TR@@$[#.\_^8$7*P
M1V>445'!#F(0,8-C[QA@0W#484C05,R1VE/PL_)],VQG4*4@F5X58%+RO^*
M<DWC@V-+<1;2%G #$15 _Y#R35$J8&+0=^ 48TL4F'3O%'$88),P&C%D`6=
M@50_PJ!D#!,@4- RO ?`@+0EK'_G5#4, ,33>->`Q50G4!'H_\?$@Q34+0
M$U 12Y3L(NAVTC0EQ5?\%&L3I!/]6OC]:_0_]%#W?A,2Y<*]#_3 ;8&=0
M\?(!=10`T>)]0/>)!=J@2-!(?C&+$-+PE%7_`? [49V@2L$5JA0`?I<?$;_3
ML531G A`2!Q2-!&#<'3650(\',NEQ4R:+1?:/\?0TLA&E%P`9@#%2$+T=+2
M]R@`9=:P3]*( 4P<S2+,%W?UV.-9!9!BS!+C8)$_Y102?'48+O02W%M8DU
M5['_G(4!0)4WQFH0J0#E-2U.N <' V,VBT5QZBE%%59?^+LM'Q8 :;`DU1
MT<&:D=J0/WI3W&0,&<PB9!T`$]FWR$A3)9QXOP'Q!TF@%5X_F6I5QRBY#?
M<)2AS1!^5?\'4Q;QT?&74)10CU&(TDFS_\WA7@9N;%3BF-'2TY[2U##_F@&3
MH+Q01Z)P-@^?9;]FS_=GVT$O0C4V915SXH?BR_-V<1USX74'DZ;U=A>+^!
MV&PG1_1>(=]PS))F58'_FV#0058Q%@':@0J0TN&.@/^;,'Z58 :(#V0O93^/
MKY_A8Q-&BT34]35$H@`$U03U)404Y4_B&>8 F1#;(7$ S =^#4(<9C:[8
M0B!%;IJ *#'_65I4]:!F72)70%P3T-7L/^(]%4DW_!^MMP!2%89='B[9=$
M+W\%2-!/E8*;`(/1_Q_F%.%6,!K0R^%ZT&]0=YC?DG ,P'&5;2::<&10X('T
M_YKA;8(E\6WU(' !9ZQ#I\'W $4PE(S+J[P@=K9YB/OXDOF[^<SVAQK]]
M1#6:/XWCK^R#[,?0,!K,!8`817OI7,6, *@!=)PF'^PW[=OH[A_C$)*;VB\
<Email Address Redacted> FGR>O*+\IP/E9D6% :W%:<-]P*K\KS?8Q+,_G]Q$N<>V@
M,D RH(LR0#-@8N[Q9P!F-!'O[V RH#!/QW<P,?_(S\G?_S5/\3C$'C@//D\Z
M+SL_/$__0,_3#[U_UN^TK[:/V7^^O_.1\':>2S;#[Q_W6_>?_^T'T(?X7_B
MCT5/3O41'OP_PS 2SI$5,R*7$(\*0VJTO_'6*O*0%V;+Z&A.MQ:GE0K\'
<Email Address Redacted> <(Q29$!?\<(!P`&M![\0XPA' 8
MTI_Q[F\ID(# 2-!+=: *L(9_U 2'I/T04E4'T.H\B(0!2'_1>!/$'Z7@-N
ML1O@3R'R!?^[7^$OYT_H7[^4!?#UX4LPX\!1P) N4[ S\'?PN]Y*<!!3&C@
M6H![\%J 0&YAIS'$[RO<.<;O+=<3\2YQ00!,S5'-H#0BS2)_-(S8#) ,L T
M8,I/!J<T_\O_!_\)#\[O-AP#+]'/V __T^_4_]8/VH\2S_Q?%J\`0NY'6'!.
M87HC8U= ZM.'.__N4G)!@=CM]6NU`4#S0DJRV^YT(@!M%>LH2@@4DI ^G 1
MP'(1P%20:' 8<4\Q_7G*?_(^E^U7[9O&2_]C[]H<?^0GF!5L'O@_N%3]/ G
M].' @?^A3RY,D$8NZ$DN4RGW02LQ*B#_L%T794%0L?-)Y!#FH!NO7RC4%U
MEVC@$U1)G9A]U8PE?(7943V$$GQ21!9X=_N82UA=056<X`3X P@!#K,&(N
MIG6?D54M`%QQ@R%M&^!-1N!\HT/W\RZF5<1-0WM0.#@U3)>8/PP-'9@^*%1
M\6*1P\#S@M4Q9W)[X&U,D$XT4'@T#<W,3 795;U@%= `Y)P4' Y,3DI(#9H
M.#0M./ Y%A!O4&$F>))P.)8Q+3D`.3;9%V5%+<.BDG \`&\!<@T2+#I2EC
M,# R0%AM8RYAT$T`+D;@=<XB!$$$SP70-#<&'P<GBA4+85,.06@`=0Y!>\O@
MR^ RS7',( Y0#C!D\4-!:P!E#B%$T$1RC_\S@+;T+_1 ]%%@[?T#CW/D\_
M44I2/EJR.[\\S\.E^3'20&^E`;M !!$_CP64U] P01\')P]&H41)1<V >\S
MS$!N22'-``F_4V<L_T:O5+]5RTI?T#A0;$U#%V7F4*K3?;%799Y0@R%@H \[
MGT[//; <Email Address Redacted> Z'@D#<RES6U$/!5@U4L_'Z!97H7?_9F-9\%I0
MS<!'TLQ 1- +\-YS1\='\%7_92<\5Z%'\._,H,R@S0#,X]K`69_9X]_6?9K
M$%I_T!IAOUSG`? F^R,_Y:0W)8\FGR>O7R]@/\UA246D`*K0=%>6T!N NZ.
M! (O8F1C#P64-P8/Q<?H'69)10!XS/%$T/L-$,R@5\VQS*!5D$30;+#/;+!M
M>&RZ:1\+2&I/:U;_1-!^R&M0?X^ GVX?;RYY/_]Z15TJ^L]S?W2/)^PLXUYG
MVU\!;^$R<! ^Z_P8.K0A',O()%D;R\^_]C_%^\3SQ3?%>_D?9.OC8]WD?>A
M`)W0[F%2J-E4:C0$<Q___@7(,;0E[^8SQF.G89]!5>A`*%P``,`$! `````
M`P`1$ `````#`( 0_____T `!S# `+:#@YZ^`4 `## `+:#@YZ^`0L``( (
M( 8``````, ```````!&``````.%`````````P`@ @@!@``````P ``````
M`$8`````$(4````````#``6 &``````# ````````1@````!2A0``MPT`
M``,`8 (( 8``````, ```````!&``````&%`````````P`0@ @@!@``````
MP ```````$8`````$84````````>`!> &``````# ````````1@````!4
MA0```0````0````X+C `P`;@ @@!@``````P ```````$8`````#H4`````
M```#`!V &``````# ````````1@`````8A0```````!X`+( (( 8`````
M`, ```````!&`````#:%```!`````0`````````>`V &``````# ````
M````1@`````WA0```0````$`````````'@`N@ @@!@``````P ```````$8`
M````.(4```$````!`````````!X`/0`!`````0`````````#``TT_3<``(#%
`
end
my original question and the responses:
> I am a student at the Cambodian School of Prosthetics and Orthotics.
>
> Can anyone tell me the formula for determining the proper length for
> bilateral transtibial and transfemoral prostheses? Is there a definitive
> relationship between the length of the lower limb and the upper limb or
> trunk? Is there a difference between children and adults?
>
> Thank you for your help.
>
* Sisary Kheng
Hello Sisary,
Proper length of bilateral AK or BK prostheses is a subjective issue.
One thing you want to consider is, aside from asking the patient / client /
etc. how tall they want to be, is the height of their center of gravity.
Often a bilateral patient is lowered in order to lower their center of
gravity and therefore reduce the risk of falling. This is especially
important on transfemoral (above-knee) amputees.
You could check an anthropomorphic chart for approximate relationships
between the lengths and sizes of various body segments. Our Prosthetics
school (Newington in Connecticut, USA) gave us each one of these charts.
Perhaps if you're interested, I could contact them and get them to send
you one?
As far as children are concerned, it would seem that a child could be
placed proportionately higher than an adult due to their resiliency and no
fear attitudes.
Good luck,
Bill Lifford. C.P.
<Email Address Redacted>
In pediatric practice here in Salt Lake City, we used the length of
outstretched arms from middle finger tip to middle finger tip as the
approximate height of the individual.
You must be careful in a growing child not to lengthen them more than an
inch or so at a time, as this sudden growth affects their perceived
balance and makes them uncomfortable.
I have a list of proportional body measurement (ie. length of foot is the
same as length from olecranon process to the ulnar styloid). I will mail
this to you if I can find it.
Good Luck,
Timothy Bachman, CP
<Email Address Redacted>
Dear Sisary,
There are anthropomorphic tables to consult in some biomechanics texts,
from which you can obtain a ratio of leg and foot to thigh length or arm
etc. Sorry, I can't cite any. However, it may be more convenient,
practical, and possibly more accurate, to adjust the length of the
prosthesis to suit the persons trousers. If they wear them.
Cheers,
Mark Graf (B P&O)
<Email Address Redacted>
Dear Sisary Kheng,
i don't know if this can help you but we learned in school
the length from the toes to the pubis is equal to the lenght from
pubis to top of the head
the length from the maleoli to the top of the tibia is equal as the
lenght from knee to the hip joint
the foot is as long as the fore arm
the width from mid finger to mid finger is the same as the hight of
the person
although you need to make the limbs shorter in a bilateral femoral
amputee due to balance problems
hope this helps you some
sincerely
ina
<Email Address Redacted>
a good rule to follow is knee center no higher than a normal chair seat 450
to 460 mm
this allows the amputee to stand without having to vault over the device
Steve Smith
orthotist/prosthetist
<Email Address Redacted>
my height was always measured by the arm span
the span of the arms held straight out side to side with the measurement
taken from fingertip to fingertip was used to estimate height
it is usually the same
however, you have to be careful if the person has spent a lot of time
crawling as the jarring of the bones causes the arms to grow longer than
normal so if you see that to be the case, you may want to shorten just a
bit
Kimberley Barreda
<Email Address Redacted>
I also asked this question when a student. Remembering a chart I saw once
on comparative limb lengths, I looked for it in what literature I have and
cannot find it (possibly with good reason), but the answer to your question
is really in the practice. There is a good chance the exact limb length of
what the patient had before or would have compared to average body
proportions, will be superceded by what will function best for this
individual.
But ask:
1. original height, and do the math. How big is the wardrobe of the person,
this can be very important. Fit the pants.
2. what will the components you are using dictate? If using a prosthetic
knee on a Knee Disarticulation, for example, you have your question
partially answered.
3. What is practical and functional for stability and control? Often,
shorter is better. The person's ability to sit and arise from a chair will
be very important in making this determination.
Summary: Fit the individual's wardrobe when all other factors are
permitting safety and function.
4. MOST IMPORTANT! Make it a team decision. Enlist the patient in the
decision process and explain the pros and cons of length and
safety/control. Otherwise you may be resented. For example: tell the
person, now, they can be any height they wish to be, but...
Hope this is of some help.
John Zeffer, CP
<Email Address Redacted>
Sisary,
I have always attempted to maintain the normal height of the person,
taking into consideration their ability to balance and ease of standing
from a low seat such as a toilet. Keep in mind that lowering the center of
gravity will improve balance.
Joel Kempfer C.P.
<Email Address Redacted>
Generally accepted determination of one's height is the distance of the
armspan (arms spread wide apart).
C. Michael Schuch, C.P.O., F.I.S.P.O., F.A.A.O.P.
Assistant Clinical Professor & Director
Department of Prosthetics & Orthotics
Duke University Medical Center
DUMC 3885, M04 Davison Building
Durham, NC 27710
Voice: (919) 684-6890 Fax: (919) 681-8496
E-mail: < <Email Address Redacted> > or < <Email Address Redacted> >
Personal Web sites: <www.michaelschuch.com> &
<www.ExpertWitness.com/schuch>
Clinic Web site: <www2.mc.duke.edu/depts/pando/>
End of Resonses
begin 600 WINMAIL.DAT
M>)\^(B %`0:0 `$```````!``$``0>0!@`(````Y 0```````#H``$(@ <`
M& ```$E032Y-:6-R;W-O9G0@36%I;Y.;W1E`#$(`0V ! ``````@```$$
MD 8`B $```$````0`````P``, (````+``\.``````(!_P\!````9 ``````
M``U.\+ +'<0&J&\ `K*E;%0```.8ZXJV?J](1C5!$15-4``!DA0``````
M`($K'Z2^HQ 9G6X`W0$/5 (`````3&ES= !33510`$]!3D10+4Q 3$E35%,N
M549,+D5$50`>``(P`0````4```!33510`````!X``S !````%@```$]!3D10
M+4Q 3$E35%,N549,+D5$50````,`%0P!`````P#^#P8````>``$P`0````<`
M```G3&ES=<```(!S !````&P```%--5% Z3T%.1% M3$!,25-44RY51DPN
M1415```#```Y``````L`0#H!````'@#V7P$````%````3&ES= ``````?=?
M`0```P```_````M3OPQW$!JAO @`*RI6PA4```#F.N*MGZO2$8U01$53
M5 ``9(4```,`_5\!`````P#_7P``````?8/`0````0````````SD@!!( !
M`!\```!297-P;VYS97,@=&\@3&EM8B!,96YG=&@@475E<GD`(0L!!8 #``X`
M``#/!P4`#P`*`#<``P`&`#0!`2 `P`.````SP<%``\`@`@``H`!@`D`0$)
M@ $`(0```#@W04)#,#8Y0C$P040S,3$X1#4P-#0T-34S-30P,# P`-0&`0.0
M!@<'P``( ````L``@`!````P`C```````#`8```````L`*0```````P`V
M``````! `#D`8 ,IMH:>O@$>`' ``0```!\```!297-P;VYS97,@=&\@3&EM
M8B!,96YG=&@@475E<GD```(!<0`!````%@````&^GH:U:&G JY8*L1'3C5!$
M15-4`````!X`'@P!````!0```%--5% `````'@`?# $````7````5F5L:6-K
M>4!B:6=P;VYD+F-O;2YK: ```P`&$%]/PG$#``<0AQ(``!X`! !````90``
M`%1(04Y+64]504Q,5TA/4D534$].1$5$5$]-65%515-424].04)/551,24U
M3$5.1U1(1D],3$]724Y'25--64]224=)3D%,455%4U1)3TY!3D142$5215-0
M3TY315,Z24%-05,``````@$)$ $```#' ``?QP``$A)``!,6D9U4WB(:0,`
M@!R8W!G,3(U<C(,8&,Q`S !!PM@;I$.$# S,P\69F4/DD\!]P*D`V,`&-H
ML!SA&5T`M%P<G$R``2*@JA;F\24 P`=%`= V#Z P-3 T%'S`= 4$#1]
M!VT@P!0`]3[$?\3V(3X110$[(8]!30^P<3%>0T`N,6MPY0%V\4,$D<GWU7
MX!G9!W1<U<@ *1.8[6\P'R]E_0XP-2!:(7$A+R(Y($0B8G\@SR2?)%TC
MWR(/(%\08#+^.HJ*T$J_RP)($0L,BJ?WRYO+BTMKRO?+Z0Y#E R] \T42QS
M-% @G-T>6QU!Y!H>!T```34 /P9AC=&P*L5PVJ&%DS&IU-< %$&=H!4(6
M,AT,`6,)P#:P`S!S;F6^>!<P![ %L # `G-S`%!8<V(R%% UL&$3\%SZ:PG@
M< N0-H\V\PA@-N#UX!E-?!V/; !0#?K##!_.+0L4#N0!* =T2Q!.39B^F$7
M$&0(#GP.98V(#?@^1W1( <Email Address Redacted> \[_ST/_P!1/DP`H#B^0,]!UC5T#\#_
M0M]#[T3_#E ^/T=?2&]`_8S`H(3$&,ZL$_Q-^ >`1T:3W@($0!$&%U*FP%
M0% *P&$)P&%P.&@@1@(A.G0ID&9I^BT/D#@!0#V 5(-+7S;S>F(+('()4%:B
M%J!6HG?V-F1%P!P`=!1PC@/3N_?3_94(%+@!1 ,U3@ -A$#H@5&]<`%-U
M8@IJ!9!T7 !$871E^CHZ=#943U5?5F]7?UB)_S800?,.(4_Q/P8.4%F_6L[F
M4CW1%P$@2$'A!) Z=/XW7;]>SU_?8.T]7V(/#Y#+'* (T&(*L'0X3DH/5#]*
M8&0/919N4&8@U!Y+_]3D&$`Q%FE1Y!.I(L4&>/_VB?::]@_UB?;Z]POW'%
M7)[6\1<^3ET#S>/`S!N`SF'=^]X_W[P1&]C=0> _P(P!=!34$)D<_]];W??
M@ __.? &$ I `9!2( (@0F0`4/EKP#0S@E^#;X1_A8\;0'T.D$,)``0#W!
M9$*Q83\.((@_B4^*7XMO8^ @0IT$<'E<$#G!428R,U')<PQ@5!C9I(@D0=1
MH4CL>7 $D&O!:T)D&F%S,/XS2L%KP):BC?^/#Y ?BX[X-!,! !3Q XPEF@!
MP7^7/YA/F5^:;ULPFY))M3)_7:6Y(V?G=^>[Y__C#,V_Z%D% , N E!
M9&=@HQ_7I^E/XN.-P8`: D19A'V= AP`Z!!4? ?0 00'E/_$Q!KP#7 `9$U
M\ ``KK*NI!QE;0M171HX#8W-OPY.+P?%NL@0L!&O-7=L`W.0;!)N%L3
M4+)T:JYC<X%L$@(0; D`=[.EWS7 L'`;1VK!CFR='\+@ $``C !X6P#
M71 YT%Q4)S `4'66D#AS<!N/P*LH2!<&)R<QHT8OT','-/\99[LXNM0S!
MEJ&F(+BFZ%N80> (+EQ6ZZRJ. TL+!*8#D40#+_O#6OK[_L<^RW[/OM/^V
M#_^W'[@ON3^Z3[M?O&\N<!1 >#,W.;V =H^'[\C+>4!T#A=D#0W79 .4, /
M_\$?PB_#/\1/Q5_&;\=_R(__G*;*&@'!RP_,%+VRSMH@/HWKEAO9D$Y41<@
MKPC<QO?+_]Q[!:!UU,%SD#JPVC7_W?[;E]^/X).^!MW]O8?B__W@DS,>8*EB
MJ,I`'6A`8#^;ER `& )\%'P@5 `3HPOV*BWF#I,370E8 .4'8(D/QW:]2!
M&F#JH@3P!T 08;\!0 X`=7)!TNP%`A!O!4*/%R$2\K[6C) Z7%Q;4'IO4S%M
M4X #$ >0[K!-DPW@`V!S;P& ($\!(&L-X-Y@7/!F10# `Q N?4_ =-> %QI
M`#EQ:\)X^P% Z0%N-B ?0/($4H3*(,X@$O,`@ 60;'9%\ <Email Address Redacted>
M]2+4A)SB2R _%N /< ``2R ,T &0([_KE3TI@Y0]4)2P*E0];_VSW_WWP_
M2R %@?E_^H_[GVR[&F!+(&SY/_W__P4I^ R/*9#\WP&__O1B(@:$?\W_33
M7: `CP5/!E\';_4`_V=@++UCPH?R_X#Q0+__#C\/3Q!?]0!\4 T_$L\3
MW_\4Y!OQ[/#LL&\@'=#R8*B_$ZG/JMU[5/ZA:R!YK6N0(.N@]$!WK1 @K@&>
M<(8`U* Y<-RP(&V2<%YQ,C]088`'C!B:Y$@#VO UR @H#!@9W1H+OX@4X'2
M,D(2H8 ?@CH@3@#_E<#KH!^YU) ?4.QP'K5F<-!S.@T*&;(@)-49I-_R8I</
M&U].$E/P=I11C(#V/MHB*/))'C#O,/]0-<#>==2B'CAH/R0[RP(&!W4@!O
M,*SP8ZT0TB B@&:_6T&,P/QWK!1@.C3ZTP^ZT0+-(N)48HORX/*48K(/\C
MDAX`.; ?4&OP]$#+H2/R;^ER4K#_4.EQ(-TA/[!M]Y7 0A(C\G#O\)6!(/4R
M@O\OGRE&R-_$E,0]$ <,&\PO[U!R-'T0.S-Z+M@&TZ(.\B\311+)(DD3\I
ML) (_'_'L J`?/!,[%2(C5O*48>P&>_$8<QZ;!I<#;@[9!W_TL`K; C\C3%
M+#$^4R:@-)+S(,(CMG5P-(,@PC5/*2C;'##@<&LZ`#H;:?#P\T'^;M/P/<<K
MT/&0K?$CE!O@_U*Q.?!!?R\?*,X=J#,2'@'_)2#L<<`+?]'KACSU7(9R/_7
ME*LCJN&K98RP*] ;T->B_&1B3^/RT#V03^'7H?)@_=D<P#*<1F5R2TFGR<#
M_\H=]&3R8!&A]0O$+YP\9#_]0#G<P1!K:#M0 (RUZ(7)G]2PA?M48+GP5<B
M)_PH\E/GH8!]H))P($OL<&+P*5._DB E35-O=2=N@'79,_+0_W:_6S==#UX?
M)\]A_QH&@D^_8_\<;QUQ<C#2,5NU+&6O_QI/: ]I'QUQ:R]FM(U_;0\_;A\=
M->[1-(DL,3;X04N_(H&2, <Email Address Redacted> @B(BH1=>C K_(AD^*A@'?@94LV3S&B]SV0
M(@$>`G<@ <Email Address Redacted> \6H-T1)2A@P>,'KR,H![[_ I\7/JX3/UAQ&!DB]O
M15#R@'TT[9!C(6M$'?_'U >0B/QDG!Z1M<P>W B,>\C\NQP<U,_!&DE($2P
M37'_)2 L,>\!ZJ#J0%A\.#.(/\@,3;I?/8B,3]S'S%L,>F _WL2'V$_=($O
M@C0CIA[ Z7'_)!)&0$2Q(_.A@!W@+#'SX/_2,(SA(6$=H(Q(C$>T>! _3@1
M;))PSW&M(7I2($XFR8H(%'00UKD=!E*=TIT7 @@#X0+>=9'A'@4?]%D$51
MX$ =X#$S(4 T87P0O>F <%#Q15$6T3,#84P?>_P>,]P[E(]B) /=]HVRT$
MSV!Z=V$L,78E$#U0WW,0-N K8(>0],!GRZ 4L#\MX(*A2L$L:NN *^,H3O_J
MP'QW+ML&PQI[&;('@Q1F,@@'MP55-!C>!G_X) 0(&*P=/@/N$QH3\$],#[
MD226PE#>$ )PDT%$0!WR_%QR'\#M002A0$S<1_A_Z >W IP(]%I\'3XK#
M*?'](\%G[9?Y!]A], CP1X^S&11I9!(D#SX)&Q(D!%:/\Z@7K!1+MH)ZR
MAW ><(]3__3 H.(<J1152/-=<P-$#_[D!$L/0-%*M(2 1SA&+8?\]D'-@
MA@,Q,T8D,T ?T!]2[X8T'L'QD'TA8X>4T;!08/YLG:1Q@#* [(!RP.SPJY;_
M*J'>LI+>AF+6ZP\H#?`&]Q7W)O<W_T4$?M,/0;'WY(&MK'VPOL*^QOV]9
M0COQD/1 3$1!A4$A8$,NOE#W\&^'2\#)0-'P9/1B/F9%D/*0MI!;4US@($B
M65!%4DQ)3G9@^_%RW+ ZD4$Y`!<PZY#Q<)QN0*Q1(4#R@6LN\J#W\$!<E?1B
M9,X04!Z<O)@<C0;C'.T `T,D`ZGGYNLX1C((``*H`2ZD+`@`5P9 7P9$;
MP9%H`&$``'(`;0!O`&[P`&D`8\)1PJ#8,+@J$ `9<)3=,(Q;,+Q\<+@:P`N
MPM'#X,1 P9#ZX,=1,&1PV+#`,2 Q$#]PL ZPC_#3\1?Q6+X`+HR_461<ZEQ
M*6&W8-$0] !<L_^\_[X'RR-<S[3?7N]?_V1__\[OS_^V#]/?<$^OO]8/MN_]
M]%!)F3#J8MQVT&1$#10?Y^Q\)%*X9X#6[#KH/! 3/QA:^YQAW%[<#X`FK$?
M,O\^:R!QVS%^(>QP1A'ID7OD_S.@Z2#KL#* (?&%<CVA'V+_XG^B\2/RD=J
MBX4!*W#JH/]&0.N@CHHRP+M!IK'KD(@A__0`A0+_4&\P(=2E]%>1A9/_(1,^
M).)!B%*HQO*0FQ(E(/_P$JB_U!]$#(@>W)YDI?A_RI06(&K6NF2(4LBT11
MV>#_.C.&832!1+!X4::1?L @/]$L2.RO(#?`#HS*?!#('K _FTU,54A-,!+
M-BG `G!X8?__4%3B+*G61Y@E@,R('N0]TK ./ J<BB_H%@/I@U,/_J@8 5
MV3 R(:+Q-,9\`B&@_YF0C'$@(3111+!XH*G50)^;+@[/&<#]PV< I(6'_
M*<#9L#'RO)'N%'^A'@*=(>^>\2N1.O&$\72MWZ[OV:_WVK^R'[,A3+-OM'\
MGP.OUQTVBY#J@&B'D$*;`<UA>7MP0UYK[J_N\^\T$H5[PP4U1/3D!AW2&@
M+O/!OI^_J#/ 7\%H`A'!D4H`5P!,``!)`%,`5 !/`/Y.R3''`,A R@#%`,B@
MR$#SR#%CPLPQK\3; <Email Address Redacted> ]&OTK_7/W\=KP??(8\`;P'O
M)!\)'WO^1*Q1:J_8/]E/)_\I#PGS_SID.H*03?0C^]-ZPJEB!M'_[1#YL76P
M,R&1,<TA.C%-D3M[87OS=U#R2A/_0F]B_U4@Z4,Y(#U!=7+Z$'R00+_^-.I
MXR[1/H>1L<SP?A1;L/^0PKA_Q2=AB\`BR#P<5DP[8*2#^!>&!RI(.\@(>0
M_Z:QZ\-ZP7A@S2$(7MPW87??L![<4 QD)!XH&FLL/<!_XA2IP9T#9A?^%_
MH2YDX W_?+-V]?Y4=^DH7RSI##M$/\R@(Q1E<%#D?U@0-_,2IB_Y_R__\F
MI4ZA4J\M7RYOMVG^0X^P0Y$K#P;/2/]*#PGR=DVB4(EP1_L0=9-($+QES F
M3RD+;PQ_#8^\T50,BY0@D!N-/!C;G8ND,*(&'^T _/O[<U;C41CQ*7P<)-
MQ]/*8D?;Q_''`&;),<A@=\>QR*!OR&#%`,A R !GQ/''`'7[%5_!8#P6GUF_
M6L];VAG/_\PX5*]5LQQ_(K\>GQ^O(+__)3]EWTW?:;]&/T@?;$]/'^DJ2B!+
MZS%G2[],SW O?W$_M]DKCRR?=9]VKTKT:?^ID*?0.EB-H(7@_N+N(_]]X^P
M>G#^HV*9X-^^AB4/^D43+3F!.B%> 9XA.)`C(P^S($0=-U$2*E/! ]J'[
M]?_Z$GOQXA*B%8.DJ>* <Email Address Redacted> >V!/X)(O(#Z$)A ?2#_^_6&N>V0$2E
MT(0'Y-2B%9^%7X!I4#[YI,A(&K]`/^00(>I^-;YXJ?0-Q'Y-+D!_S!BA:;Y
M4GHA^E;CL>+'XY/_XL;Y+8WTYC2'J4.$HA7>H?V \'4X(?ZRC8'?\>.1WO+[
MX!/MH&+N48#PO>4(NE2_XL0IO>4?:AK$#KP=Z@EQ;^;8.@\'#?$*FE\C;V
M`?1!_^'@HA6 \-S@[A1_(NY0_K+_,Q)X'T;O1_]ZWWOOM^$_`/_R<>% J?
M_W2_HR^D/WSR__R 45]2;U-_O-J<>10,-!D0&.S4&(NWF^82[?Z)%6'U<H
M$7_!:!;!D<2B_\<`6_#)8,A@R< 8H,B@R@#]7%!BQ/'$HL4DQ0T4,E@_5Q_
MQ> QLZR_[0/M1AAG__,.*W_KP)DKVKO9L]GWVCO_VUOOL^H'\*OP[_$S\78
MZ7']!3)RZ1-HY#@_;!^,NY0_XUSW> PT.1AQ[5<^1B[-_ZF'AT/:A,['Q
M8=_0[4$T[C7`(>F0M TH<#W$)%8_X_RO+DY9PE0L+T(#=!Q]#?EZ*I4/41
MZ=(R,795X-ZQ_F\[X?E#[J#G(-W@I@^A#V^B'\B/J3]WX5/P</4Q4__CL._0
MU)^G']?/V-]WX?9!]X#P[9#H8]%=^JJ^KOS^LSZW0P=\07] KH!S0#N2
MP9M0+J[AKT\0R#0WB[$?$I<564%S`'WQ7\7(.C@N/+HP!B@MOY<&2?MN%@
ML&0N;2UGPLXML__Z,_IW^KFNI^[J./?KN&]G__'3[^_P,_!W\9?]$_<W_@O
MW]3_>8_Z7]V_<5M/(!+8-T``W>0<9> `?!Y-!4X/>0<#_@@'%B/(#0TSD!
M]U#_,]'J0/B098X\9[S=^#_T?^MD)6C?\$_`-0P0K,'$M(B_XD$`K24X(ZH
MF.';X(C#DP3_-H!_4,JBD<!\D0QF(,R`/\V@*V .Q$!A)<5/#&4440P_XNA
M/S&4AOQ/V]__#P`?=^%_@/ [Q9@2TJ&<M#T!,(%F_QL`?E1#9M*1F:&6L##0
MS1&OD5PHKA#P=C/_!WUI]D$AJ<J 2,-+A0:5BD##_,@%^X$0QT+4%HC(Q
M2O!^,?^0(LREEQ7-13,0?E*?<XV2_S/ -Z,\H92?N!$0!0$/&*_`? 6X4+
MF=,00$C89<5WXL0CK;Y3Q$/^V=+F7%+@/N(4#R 0AEA@'JG^&/XI^=K<%K
MF7N8!(P<'<Q4+WF0XR8#D0Y2_F-S-7S_WGZ!)905\0[PV\+BR7O#_[P#M
MH& 08+)>,.I@8)XT.=@L+;PZT\+,NQ_+J\OO__P#V***>_S'R+O]3_V3_=?
M__O?.3\D'ST?_*_]OS]/$A_]?+5)T%$=L9!PF/8@7ZB?WV0#&(60550;&+
M,@P=>/4, CP+B!2,$EHABC^\VBF? @1D!P'Y D#=4>\602K!1$'.,&G:
M09EBB$7N<Q0`1D0(&]&TI#A#;/_1]+.,=:0FM)(<)$!1D 48W_1XG[A0R%
M41 P@(%%(C^<-_P!P=L!!!^+*! *Q_9 P*10`?[+0TR@@$[#.\_^8$7*P
M1V>445'!#F(0,8-C[QA@0W#484C05,R1VE/PL_)],VQG4*4@F5X58%+RO^*
M<DWC@V-+<1;2%G #$15 _Y#R35$J8&+0=^ 48TL4F'3O%'$88),P&C%D`6=
M@50_PJ!D#!,@4- RO ?`@+0EK'_G5#4, ,33>->`Q50G4!'H_\?$@Q34+0
M$U 12Y3L(NAVTC0EQ5?\%&L3I!/]6OC]:_0_]%#W?A,2Y<*]#_3 ;8&=0
M\?(!=10`T>)]0/>)!=J@2-!(?C&+$-+PE%7_`? [49V@2L$5JA0`?I<?$;_3
ML531G A`2!Q2-!&#<'3650(\',NEQ4R:+1?:/\?0TLA&E%P`9@#%2$+T=+2
M]R@`9=:P3]*( 4P<S2+,%W?UV.-9!9!BS!+C8)$_Y102?'48+O02W%M8DU
M5['_G(4!0)4WQFH0J0#E-2U.N <' V,VBT5QZBE%%59?^+LM'Q8 :;`DU1
MT<&:D=J0/WI3W&0,&<PB9!T`$]FWR$A3)9QXOP'Q!TF@%5X_F6I5QRBY#?
M<)2AS1!^5?\'4Q;QT?&74)10CU&(TDFS_\WA7@9N;%3BF-'2TY[2U##_F@&3
MH+Q01Z)P-@^?9;]FS_=GVT$O0C4V915SXH?BR_-V<1USX74'DZ;U=A>+^!
MV&PG1_1>(=]PS))F58'_FV#0058Q%@':@0J0TN&.@/^;,'Z58 :(#V0O93^/
MKY_A8Q-&BT34]35$H@`$U03U)404Y4_B&>8 F1#;(7$ S =^#4(<9C:[8
M0B!%;IJ *#'_65I4]:!F72)70%P3T-7L/^(]%4DW_!^MMP!2%89='B[9=$
M+W\%2-!/E8*;`(/1_Q_F%.%6,!K0R^%ZT&]0=YC?DG ,P'&5;2::<&10X('T
M_YKA;8(E\6WU(' !9ZQ#I\'W $4PE(S+J[P@=K9YB/OXDOF[^<SVAQK]]
M1#6:/XWCK^R#[,?0,!K,!8`817OI7,6, *@!=)PF'^PW[=OH[A_C$)*;VB\
<Email Address Redacted> FGR>O*+\IP/E9D6% :W%:<-]P*K\KS?8Q+,_G]Q$N<>V@
M,D RH(LR0#-@8N[Q9P!F-!'O[V RH#!/QW<P,?_(S\G?_S5/\3C$'C@//D\Z
M+SL_/$__0,_3#[U_UN^TK[:/V7^^O_.1\':>2S;#[Q_W6_>?_^T'T(?X7_B
MCT5/3O41'OP_PS 2SI$5,R*7$(\*0VJTO_'6*O*0%V;+Z&A.MQ:GE0K\'
<Email Address Redacted> <(Q29$!?\<(!P`&M![\0XPA' 8
MTI_Q[F\ID(# 2-!+=: *L(9_U 2'I/T04E4'T.H\B(0!2'_1>!/$'Z7@-N
ML1O@3R'R!?^[7^$OYT_H7[^4!?#UX4LPX\!1P) N4[ S\'?PN]Y*<!!3&C@
M6H![\%J 0&YAIS'$[RO<.<;O+=<3\2YQ00!,S5'-H#0BS2)_-(S8#) ,L T
M8,I/!J<T_\O_!_\)#\[O-AP#+]'/V __T^_4_]8/VH\2S_Q?%J\`0NY'6'!.
M87HC8U= ZM.'.__N4G)!@=CM]6NU`4#S0DJRV^YT(@!M%>LH2@@4DI ^G 1
MP'(1P%20:' 8<4\Q_7G*?_(^E^U7[9O&2_]C[]H<?^0GF!5L'O@_N%3]/ G
M].' @?^A3RY,D$8NZ$DN4RGW02LQ*B#_L%T794%0L?-)Y!#FH!NO7RC4%U
MEVC@$U1)G9A]U8PE?(7943V$$GQ21!9X=_N82UA=056<X`3X P@!#K,&(N
MIG6?D54M`%QQ@R%M&^!-1N!\HT/W\RZF5<1-0WM0.#@U3)>8/PP-'9@^*%1
M\6*1P\#S@M4Q9W)[X&U,D$XT4'@T#<W,3 795;U@%= `Y)P4' Y,3DI(#9H
M.#0M./ Y%A!O4&$F>))P.)8Q+3D`.3;9%V5%+<.BDG \`&\!<@T2+#I2EC
M,# R0%AM8RYAT$T`+D;@=<XB!$$$SP70-#<&'P<GBA4+85,.06@`=0Y!>\O@
MR^ RS7',( Y0#C!D\4-!:P!E#B%$T$1RC_\S@+;T+_1 ]%%@[?T#CW/D\_
M44I2/EJR.[\\S\.E^3'20&^E`;M !!$_CP64U] P01\')P]&H41)1<V >\S
MS$!N22'-``F_4V<L_T:O5+]5RTI?T#A0;$U#%V7F4*K3?;%799Y0@R%@H \[
MGT[//; <Email Address Redacted> Z'@D#<RES6U$/!5@U4L_'Z!97H7?_9F-9\%I0
MS<!'TLQ 1- +\-YS1\='\%7_92<\5Z%'\._,H,R@S0#,X]K`69_9X]_6?9K
M$%I_T!IAOUSG`? F^R,_Y:0W)8\FGR>O7R]@/\UA246D`*K0=%>6T!N NZ.
M! (O8F1C#P64-P8/Q<?H'69)10!XS/%$T/L-$,R@5\VQS*!5D$30;+#/;+!M
M>&RZ:1\+2&I/:U;_1-!^R&M0?X^ GVX?;RYY/_]Z15TJ^L]S?W2/)^PLXUYG
MVU\!;^$R<! ^Z_P8.K0A',O()%D;R\^_]C_%^\3SQ3?%>_D?9.OC8]WD?>A
M`)W0[F%2J-E4:C0$<Q___@7(,;0E[^8SQF.G89]!5>A`*%P``,`$! `````
M`P`1$ `````#`( 0_____T `!S# `+:#@YZ^`4 `## `+:#@YZ^`0L``( (
M( 8``````, ```````!&``````.%`````````P`@ @@!@``````P ``````
M`$8`````$(4````````#``6 &``````# ````````1@````!2A0``MPT`
M``,`8 (( 8``````, ```````!&``````&%`````````P`0@ @@!@``````
MP ```````$8`````$84````````>`!> &``````# ````````1@````!4
MA0```0````0````X+C `P`;@ @@!@``````P ```````$8`````#H4`````
M```#`!V &``````# ````````1@`````8A0```````!X`+( (( 8`````
M`, ```````!&`````#:%```!`````0`````````>`V &``````# ````
M````1@`````WA0```0````$`````````'@`N@ @@!@``````P ```````$8`
M````.(4```$````!`````````!X`/0`!`````0`````````#``TT_3<``(#%
`
end
Citation
Velicky, “Responses to Limb Length Query,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/211870.
