Re: G. Boyer/ "amputee Union" / Socket fit
ecat
Description
Collection
Title:
Re: G. Boyer/ "amputee Union" / Socket fit
Creator:
ecat
Date:
9/21/1999
Text:
Wade,
Allow me to add to your wise words.
Your comments about socket fit are so true. Hydrostatic containment is
absolutely critical: volume is the single most important variable
particularly in AK sockets. In the BK, this is modified by the need to
account for the shape inherent in the bony structures and the reliefs that
must be built in. However, in a normal human body, volume rarely remains
static. Immense changes are possible (and inevitable) in very short spaces
of time. As so many of our amps are older, fluid balance, influenced by
diuretics, beverages, etc can be a precarious variable which will very
quickly alter the socket fit. Stump preparation techniques like bandaging
and elastic socks are the only tools that we have to ameliorate the effect
of these variations, and stump socks are a common way to adjust the daily or
hourly fit of a socket. This is particularly evident in new amps.
I have often argued that we could probably impose whatever shape we like on
an AK socket and still have it work well (if aligned adequately), because
the AK stump is essentially a bag of viscous fluid. This idea is borne out
by the successes of the wide range of AK socket designs that we see
operating successfully as you mention.
Volume containment is so critical that even apparently tiny variations in
fluid content of the tissue will make a perceptible difference to the fit
for the amp.
The patient changes but the socket never does.
Kind regards, Richard Ziegeler
<Email Address Redacted>
-----Original Message-----
From: <Email Address Redacted> < <Email Address Redacted> >
To: <Email Address Redacted> < <Email Address Redacted> >
Date: Monday, 20 September 1999 10:20
Subject: G. Boyer/ amputee Union / Socket fit
>I have been following some of the rhetoric the past few days on this
>listserver regarding amputee unions, socket fit... etc....
>
>I am a practitioner in Tampa Florida... I don't profess to be the best,
I
>certainly hope I'm not the worst, I fancy myself a competent
practitioner.
>I would like to make a comment regarding my impression of socket fit
>arguments.
>
>there is no doubt that socket fit is important in all prosthetics. However,
>It is, in my opinion, no more important than proper allignment and
>appropriate design... here is my justification:
>
>If there was one way to make a proper AK socket, why would there be so many
>socket variations... Quadrilateral, Ischial containment, modified IC,
>suction, SSS... etc.... then bottom line is that AK's are mostly soft
>tissue, and so hydraulic containment is the universal critical aspect of
the
>socket. which one is the best socket Mr. Boyer? shall you or your amputee
>Union be made the authority of such decision?
>
>Prosthetists understand that alignment impacts the forces inside the
socket,
>so when the patient perceives and reports a poor socket fit, it can
actually
>be an alignment problem. Fine details of alignment have such a huge impact
on
>outcome, yet to the patient, the main perception of a prosthesis is
naturally
>the component that interface with his/her anatomy... the socket.... so
often,
>alignment problems are articulated as socket fit problems by the patient.
All
>competent prosthetists know this.....
>
>So when I hear this big uproar by the amputee community, (or is it just
>George Boyer), stating that if we all could just cast and modify
>appropriately, the world would be a better place for amputees... I don't
>think so... we work in a complex environment, juggling the business/cost
>containment aspects of the field, the technology of the field, the
>phsyco/social aspect of our work, and the actual evaluation, design and fit
>of the devices. So, when Mr. Boyer summarizes quality or competence to
>the taking of casts and modifying molds, I find those comments to be an
>insult to myself and this profession.
>
>Sincerely,
>
>Wade Bader, LCPO
>Tampa FL
>
>Those who don't practice, never make mistakes.....
>Those who speak on a foundation of ignorance, often put their foot in their
>mouth.....
>
>
Allow me to add to your wise words.
Your comments about socket fit are so true. Hydrostatic containment is
absolutely critical: volume is the single most important variable
particularly in AK sockets. In the BK, this is modified by the need to
account for the shape inherent in the bony structures and the reliefs that
must be built in. However, in a normal human body, volume rarely remains
static. Immense changes are possible (and inevitable) in very short spaces
of time. As so many of our amps are older, fluid balance, influenced by
diuretics, beverages, etc can be a precarious variable which will very
quickly alter the socket fit. Stump preparation techniques like bandaging
and elastic socks are the only tools that we have to ameliorate the effect
of these variations, and stump socks are a common way to adjust the daily or
hourly fit of a socket. This is particularly evident in new amps.
I have often argued that we could probably impose whatever shape we like on
an AK socket and still have it work well (if aligned adequately), because
the AK stump is essentially a bag of viscous fluid. This idea is borne out
by the successes of the wide range of AK socket designs that we see
operating successfully as you mention.
Volume containment is so critical that even apparently tiny variations in
fluid content of the tissue will make a perceptible difference to the fit
for the amp.
The patient changes but the socket never does.
Kind regards, Richard Ziegeler
<Email Address Redacted>
-----Original Message-----
From: <Email Address Redacted> < <Email Address Redacted> >
To: <Email Address Redacted> < <Email Address Redacted> >
Date: Monday, 20 September 1999 10:20
Subject: G. Boyer/ amputee Union / Socket fit
>I have been following some of the rhetoric the past few days on this
>listserver regarding amputee unions, socket fit... etc....
>
>I am a practitioner in Tampa Florida... I don't profess to be the best,
I
>certainly hope I'm not the worst, I fancy myself a competent
practitioner.
>I would like to make a comment regarding my impression of socket fit
>arguments.
>
>there is no doubt that socket fit is important in all prosthetics. However,
>It is, in my opinion, no more important than proper allignment and
>appropriate design... here is my justification:
>
>If there was one way to make a proper AK socket, why would there be so many
>socket variations... Quadrilateral, Ischial containment, modified IC,
>suction, SSS... etc.... then bottom line is that AK's are mostly soft
>tissue, and so hydraulic containment is the universal critical aspect of
the
>socket. which one is the best socket Mr. Boyer? shall you or your amputee
>Union be made the authority of such decision?
>
>Prosthetists understand that alignment impacts the forces inside the
socket,
>so when the patient perceives and reports a poor socket fit, it can
actually
>be an alignment problem. Fine details of alignment have such a huge impact
on
>outcome, yet to the patient, the main perception of a prosthesis is
naturally
>the component that interface with his/her anatomy... the socket.... so
often,
>alignment problems are articulated as socket fit problems by the patient.
All
>competent prosthetists know this.....
>
>So when I hear this big uproar by the amputee community, (or is it just
>George Boyer), stating that if we all could just cast and modify
>appropriately, the world would be a better place for amputees... I don't
>think so... we work in a complex environment, juggling the business/cost
>containment aspects of the field, the technology of the field, the
>phsyco/social aspect of our work, and the actual evaluation, design and fit
>of the devices. So, when Mr. Boyer summarizes quality or competence to
>the taking of casts and modifying molds, I find those comments to be an
>insult to myself and this profession.
>
>Sincerely,
>
>Wade Bader, LCPO
>Tampa FL
>
>Those who don't practice, never make mistakes.....
>Those who speak on a foundation of ignorance, often put their foot in their
>mouth.....
>
>
Citation
ecat, “Re: G. Boyer/ "amputee Union" / Socket fit,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 15, 2024, https://library.drfop.org/items/show/212934.
