Academic Topics

Academic Topics

Dear Colleagues:

Thank you for the abundant responses in proposing topics for discussion and
advanced training.

I will summarize rather than repost because many of them expressed similar
ideas. This is a lengthy post as it is.

People have expressed amazement that there seems to be no clear consensus
about many topics.

While it is important to acknowledge that there may be no one way to do
something, I believe with thoughtful discussion and research, we can find
more biomechanically sound ways of approaching problems and justifying what
is often intuitive for some.

People have suggested specific and detailed individual 2-3 day conferences on
Knees, Feet, BK socket design and suspension, AK socket design and
suspension, and Upper extremity advances. Also, one week advanced training
workshops were also suggested.

The emphasis was also on lower cost academic oriented courses versus the
standard luxury meetings outside the financial grasp of many practitioners
and companies

Topics

The Foot controversy remains and expands its scope.
- Articulating feet vs. dynamic feet vs. sach feet vs. flexible keel

-Some people are using single axis feet for BK's and others say it is
contraindicated. Distinctions need to be made between single axis feet
without a front bumper and ones with a front bumper. They create different
dynamics

-Have dynamic response feet been over prescribed. Not all patients can load
them properly and therefore get the intended benefit.

-Should patients be tried on a few different feet to see what they respond
best to before giving a final prescription

With the abundance of knees, how do we choose what is really optimal.
-Should we choose knees that give some stumble recovery help, or rely on a
patients strength and alignment to maintain stability.

-Are we over-prescribing weight activated stance control knees? Is there
anything wrong that

-Do all hydraulic units give true variable cadence?

-Should four bar geometry be used more often? research projects still leave
us wondering

-Should we pay closer attention to the different geometry of four bar knees?
How do we interpret the different centroids Do we need research to
determine optimal centroids or IRC for which pts

-How does a higher virtual center of rotation translate to benefits for the
patient? Is it easier to initiate flexion?

-How do we get significant pt feedback on what is important to the end users
on issues of weight, stability, flexibility, stumble protection? (We know the
answer about fit already.)

-Best knees for bilat AK?

-KD, beneficial or a liability

-Surgical techniques- what can we recommend to surgeons as optimal, how can
we increase our cooperation and communication.

-Immediate post op and early post op fittings: How many different ways-
early fitting criteria, where is it being done, should it be done more often.
Off-the-shelf post op fittings when to use?

BK socket design/suspension
Re-examining BK design options
- There are prosthetists that say their pt's do not have significant volume
loss, what can we learn from them?
-When to flatten gastroc walls & when we should be allowing for hypertrophy?

-Can we maintain true hydrostatic sockets once we start adding socks?

-Do pin suspension systems providing distal suspension require additional
supracondylar or sleeve suspension for proximal support as well?

-Is sleeve suspension with expulsion valve the most positive suspension.

-Gel liners- best techniques for good fit?

-BK suspension sleeves. The choice of neoprene is often the first choice. Is
compression the thing we want to do for vascular compromised patients? Should
we take advantage of the new sleeves which offer suction and friction without
compression, and easier donning?

-AK volume compensation techniques. What are peoples experiences with using
bladders and pin suspensions?
-AK ischial socket design variations
-Are we underprescribing torque and shock absorbing units for both AK and BK

Upper extremity
Courses requested for upper extremity include

-myoelectric with silicone suspension
-general myoelectrics using Otto Back AND other components
-New low friction cable systems
-Harness and sleeve suspension options
-Variations and other special adaptations

There is definitely an interest in practical and affordable University based,
or Academy based advanced courses in both upper extremity and lower extremity
prosthetics.

I hope that we can rejuvenate post graduate curriculums that will allow all
prosthetists to increase their skill level.

Mark Benveniste CP
VA Med Ctr
Houston, TX