TSB Modifications Responses Part 1

TSB Modifications Responses Part 1

Chet X Burdette

2/27/2001

ORIGINAL POST:

The following is more of an observation than a question. I have always
believed that a TSB socket should distribute pressure evenly to the
entire surface of the limb. I usually do a x-percent (percent of the
measured circumfurence) over the entire mold top to bottom. The
percentage I take off depends on several factors including tissue density
and thickness/style of liner.

Anyway, it has always bothered me that OWW suggests you take off an even
.5inch or 13mm of circumference from the entire mold. This in most cases
doesn't result in even pressure distribution since most limbs taper in
size from top to bottom. For example removing that 13mm from a level on
the mold with a circ. of 34cm results in a 3.8% reduction in circ. Now
lets say this patient's limb tapers to a circ. of 29cm further down.
Removing 13mm at this level results in a 4.5% reduction of circumference.
 So wouldn't this modification produce a socket that was tighter at the
bottom than the top? Is this their intended result or just a result of
oversimplified instructions?

Chet Burdette CPO
Mountain State Prosthetics LLC
Charleston, WV

RESPONSES:
_______________________
1
Chet:
A true TSB socket that was published by Tim Staats, PhD, CP in the early
80's gives very little indication of percentage reduction as a whole.
Only
using a hyrdocast system will give you consistent true values to work
from.
Even then, using the gel/silicone liners may distort these values
slightly.
The key I believe is to be consistent once a method is established with
positive outcomes.

Chad R. Marquis, C.P.O.
Certified Prosthetist/Orthotist
(949) 5828149

________________________
2.
<< Is this their intended result or just a result of
oversimplified instructions?

Chet Burdette CPO >>

Chet,
I agree with you. Futhermore the OWW liners and now the OSSUR Derma
liners
are not symetrical in their gel distribution and in some instances it is
significant (ie doesn't cover the fibular head). I do appreciate the
attempt
to improve flexion with the thinner posterior wall.

I think they are trying to make it easier with those instructions. Most
people I know find their own modifying technique.

Mark Benveniste CP

_____________________
3.
I still haven't figured it out yet. When they don't fit adequately by
following the manufacturer's recommendations, I've been doing my own
thing.
Sometimes I have to add distal/anterior in order to relieve the pressure
in
this area. Sometimes (if the last liner system did not work well) I'll
modify my cast to about 1/4 inch over the circumferences I've taken over
the
liner. Let me know if you do develop a consistant method of modifying.

_________________________
4.
All their instructions are intended to make their Alpo sleeves last
longer
and not to make a better socket. I'm surprised that more CP's don't get
a
little angrier about OWW telling them how to make a socket period.

Stan

____________________________
5.

Hello Chet,
I tend to stay away from these companys that don't warrant their products
if you don't do exactly what they say. Another one is TEC, anytime I've
had a problem with them, they say its always my fault. But yes your
thinking is right, it would make the distal area too tight for some in my
humble opinion.

Respectfully,
Bill Copeland CP LP

__________________________

I am limited to 200 lines so I had to split up the responses. Part 2 was
posted today as well. Parts 1 & 2 contain all of the responses I
received minus a few in which the author requested I not publish their
responses to the forum. I will continue to compile and post responses on
this topic on a weekly basis or until they stop coming.
Thanks,
Chet Burdette CPO

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