FW: Stance Control knee joints
Warren Mays
Description
Collection
Title:
FW: Stance Control knee joints
Creator:
Warren Mays
Date:
11/3/2008
Text:
Hello!
The original question:
What has been your experience with stance control knee joints for KAFO's?
Which ones are the least fussy and temperamental? Easiest to fabricate? Most
reliable for the patient?
The replies:
-There is an excellent article including a matrix comparing all the stance
control options in March '08 O&P edge. It saved me from making a big
mistake!!
-You are correct to ask, there are a number of Stance Control knee joints
available however, all of them, save Fillauer's Swing Phase Lock require a
connection between the Knee joint and the mfg's Ankle joint. The SPL works
simply with a pendulum moment in the joint that locks and unlocks it. You
can use any mfg's joint or use it as a stand alone KO. The issue associated
with it is if the wearer has a 'shuffle' gait, the unlocking moment can be
inconsistent. It is easy to adjust and fairly bullet proof and has the
ability to function as a single bar device. With most others, the mfg. must
do the fabrication but the SPL is easily fabricated in your lab or through a
number of fabrication labs as well as Fillauer's C- fab. Bill Messer in
Grand Rapids Michigan uses a fair number of them in his practice on a
variety of patient types including SCI patients. He is in private practice
there. If you give Fillauer a call, they can send you a CD that explains the
joint and shows patient applications. I find it a useful tool to show the
referral or potential patient and family.
-And, finally, a few were kind enough to include a copy of the responses
from a similar question posted last month.
-I did not give an evaluation of the patient as I was not
looking to see if I had the right patient model, but rather looking for
everyones experience with stance control kafo's. This is a personal friend
who had a T11 kink, has grade 3 hip flexors, grade 1 hip extensors. Grade 2
quads and hamstrings and flaccid ankles. I am donating my services and
spent a lot of money with little success. I recast and laminated carbon
afos with 5 degree dorsiflexion and thigh shells, then swapped SPL knee
joints over from plastic system. Patient can walk on treadmill supporting
his upper body with the bars. He is very strong and flexible at 170lbs.
When on ground with crutches the system does not work that well. He has a
harder time moving, locks don't function and now the joint just broke and
these are almost new. I was thinking of making carbon kafo's with posterior
offset knee joints and an extension assist. I would use a double action
ankle joint for proper functional postitioning. I would love to get away
from a locked knee, but may need a drop or lever lock just in case. Patient
is comfortable in dorsiflextion with hips anterior to midline for balance.
He cannot recover if he starts to fall backward. He is very determined to
walk and without a doubt I believe he will with the right system. Again,
Thank you for all the great responses! I will have to read through and
decide what I want to try next. Everyone have a great holiday!
-You are right. The SPL stance control are not the most
impressive. I have only used them a couple of times. My luck was good, but
the selection of the right patient is critical and the fine tuning is time
consuming. Durability is definately a factor and I do not know how long my
patients actually wore the KAFO. The best bet for a long term is a
conventional orthosis.
I have fit all but the Horton SCO, 40+ over the last 3 years in total. They
all have durability issues compared to standard thermoplastic KAFO's when
used on community ambulators, especially bilateral applications. I have
found the SPL to be the most reliable and durable for bilateral application
or when you have a very active patient. I had 1 problem with the SPL on a
young 240 lb. 6' 2 that beat the H out of them which led to having the
distal joint head replaced $$$ due to a malfunction. Otherwise, I have had
an overall good experience with the SPL system other than the inherent
weight and bulk. UTX in my experience has not worked on active community
male ambulators weighing 210 lbs. +, had stirrups break on both patients
along with wire that releases knee locking mechanism breaking. Otherwise
UTX works well and light weight for all other patients. Otto Bock's free
walk - bulky padding covering metal anterior bands, only used once. have
not fit newer Otto Bosk SCO's. Becker safety stride worked very well but
does have an audible clicking noise from locking mechanism.
I have become very selective, primarily to get optimal results as the
fitting and follow up care can become tedious. I have resorted to more
traditional designs when not using the SCO design. Traditional design
consists of a thermoplastic design with offset knee joints, stirrup with
footplate having DAAJ's with anterior pins and posterior springs
-The knee load on the hinge didn't allow the hinge to unlockor
react properly to the motion required for swing. I am working with the
freewalk from Otto bock right now. So far it'spretty good but needs lots of
training. Have you used the Scott-Craig Paraplegic style KAFO's. They
areconventional style KAFO's but were designed specifically for para's and
haveeffectively been utilized for them since the 1960's. They are
extremelystrong, durable and functional for this population. If interested I
couldfind some of the old articles on them and forward them to you. The
FreeWalk. I've fit 12 to 15 stance phase KAFOs of this design. The Free Walk
has been my best experience so far. It's crucial to use Otto Bocks'
selection sheet which helps ensure good candidates and the proper design.
The starter kit enables you to make many of your own adjustments rather than
having to return the brace to a company at $50 for each shipping (not to
mention the time wasted). Otto Bock support was timely and helpful during my
learning phase. I send in casts for fabrication and have had quite good
fits with minimal adjustments. The most usual adjustments would be to tweak
the thigh band ML on larger patients. This is easy with the tools provided.
Patients tend to walk much better right away. Follow-up appointments for
adjustments or repairs are minimal to none. Diagnoses have been CVA, post
Polio, MS and non-spastic SCI, Three patients received bilateral but I
wouldn't try that unless you have some good experience with this kind of
bracing. Bilateral works well because there are no medial bars to catch
together. Otto Bock provides a good manual to give to PTs so they can
provide the necessary training and strengthening for best results. With a
post Polio patient in particular I advise PT (it also helps progress them
through that discomfort with brace design change - if they had a brace
previously). Some patients will need PT to help problem solve stairs, ramps
and sitting but these usually aren't big problems. When you fit the brace
don't explain anything about how to walk in it. I put it on them then tell
them to walk a little so I can check the alignment - anything to keep them
from TRYING TO WALK RIGHT in it. I found that comments such as try to push
you knee back just before you start to swing the leg through is sure to
change their gait from normal which is all it takes to not work. I really
encourage you to try this brace. After 25+ years of working with locked knee
KAFOs and all of the residual problems, putting a patient in a stance phase
is a trip. When I called my last two patients for one month follow-up they
both said to effect that they usually forget they even have it on. SOME
ADDITIONAL THOUGHTS, CHRIS: Does the patient have adequate strength proximal
to the brace? Also, I see the SPL is double upright - The FreeWalk is a
single lateral upright (but very strong) The FreeWalk ankle is very flexible
so it only provides the DFA of a thin posterior leafspring but on the
positive side the flexibility allows the wearer to position the feet and
legs better for standing up and sitting down. I think all of these braces
involve more of a learning curve than the manufacturers let on in their
inservices. But there's a learning curve for standard KAFOs too.
I've used the Becker UTX stance phase KAFO with good success. Aslong as the
patient doesn't have any moderate to severe knee instability inthe M-L
plane. If the patient is active they make a stainless steel versionthat I
strongly recommend. I initially had a problem with the aluminumupright
stretching at the joint. They added a clamp to prevent any
furtherstretching. The cable inside does require adjustments initially.
Afterabout six months the cable reaches its stretching point and I haven't
had tohave it adjusted anymore. Patient has been wearing it for 3 years now
and isa young 23 year old. Hope this helps.
-I have used just about all of the Stance Locking Free Swinging
joints for ko's and kafo's, and they all have their roles. I have found the
Fillauer Spl to work very well in a KO configuration with ONLY quad weakness
(the client accepts it as a ko vs. a kafo. and the set screw/ pendulum set
up is only just adequate), other then that its role is limited. With poor
abdominal, hip flexors and extensor that a t11 may exhibit: I would think
that a Horton, e-knee, Becker's new version of the Full Stride, with
flexion lock and the with extension assist would be good choices. They all
have the ability to ratchet from flexion to extension if the client does
not make it to full extension. ......We currently have a young man in
kafo's with the Up and Around GSO design that we are looking into stance
phase joints for. I am not sure if you wanted to use Kafo's, and link them
to the Up an Around, or if an RGO would make more sence. I am currently
conflicted with my client as well. My thoughts at this point is that an RGO
with minimal trim lines is the most functional option. This would replace
the antigravity groups, and also provide a much better platform to mount to.
The tip bar replacing hip flexors just conceptually seems to be the right
idea....... The Horton has been used in this capacity before, but may
not be warateed from the manufacturer in this application- Google Horton RGO
and find some motivation from the results. I like the horton knee and have
used many in the past. It has been revised and is now a better system.
Still i think it will need many tune ups over its life span to keep the
unlocking mechanism in tip top shape. The E-Knee form Becker is very
excessive, and heavy, but may be my choice. The set up is quite easy, and
the foot plate/ pressure sensor is very easy to modify. The battery life
seem quite good as well. The thing i really like about it is the pressure
switch: you can run sensors all the way to the end of the toes or you can
block some and only have them for heel strike thew mid stance. As the
client goes to heel off, the pressure sensors are disengaged and you have
free swing. The down side to this system (and most other systems) is that
the knee must find extension before it is allowed to unlock. The Becker
full stride can be had with the g-knee extension assist which i have used in
cases of mild quad weakness and fell in love with. For our application this
would be a great option. I hope this helps.... Also keep in mind all the
clients I have fit have had decent hip extensor. For the right patient,
carefully selected they are a good option. It takes a lot more precise
fabrication and then much more clinical time to fine tune the whole
mechanism and patience, patience and more patience on the part of the client
to make it work well. The Fillauer joint is one of the best and also the
simplest to use. I feel your pain and agree, the last thing you need is a
sales pitch! I usedthose SPL on a unilateral Polio patient. They worked, but
the real problemis the pair of joints only has an extension stop on the
lateral joint. Fitthese to any patient with recurvatum or that needs
hyperextension tostabilize the knee joint and watch out, they break. Funny
thing is, mostpatients with a unstable knee, position themselves this way,
so this designis actually for very few patients. The more robust unit would
be the design from Becker that utilizes,conventional joints with a cable
that attached to the footplate. The jointdesign is proven/durable and you
have two extension stops so joint alignmentis not hypercritical. I only used
them with high activity patient singlesided, with excellent results.
Remember that these patients need to stand with their pelvis forward,hanging
on the Y alignments of the hip, feet in dorsiflexion. So non ofthese designs
are really perfect from them. The stance control knee works like the Total
prosthetic knee. You have to hyper extend in standing to unlock the knee.
With you case your patient does not have this mobility. I would use RGO's,
-Stance control when properly applied can be an amazing thing,
but of all the systems out there the SPL seems to be the most problematic.
Especialy with bilateral patients! We make as many SCO orthoses as any one
in the country and have had a lot of succesfull cases, so don't give up on
the concept, just try a less cantancerous system. The Horton is big and
bulky, and it works so well almost no one seems to care, they have a great
track record of function and reliabilty.We also do a groing number of the
full stride and safty stride from Becker Ortho. both units have done really
well with no maintenance issues so far. Both are easy to tune and easy to
repair if they break, the Becker joints are smaller and less expensive but
the Hortons lock ROCK SOLID in any flexion angle. Hope this helps, good luck
in your quest.
-I am sorry you have been having trouble with the SPL, but you
really need to have hip flexors to make that joint work. At very least the
patient needs to ballistically position the leg with an inverted Y strap
with abdominal control. Is that T11 paraplegia complete? I would think a
bilateral T11 with paraplegia would be indicated for RGO's for ambulation,
but even at that level hip flexors may not be present. If there are no hip
extensors to help out, you will only have frustrations. Hip extensors are
critical for the proper use of these so called stance control systems. I
think T11 could be above truly capable bounds of use for stance control
without some type of microprocessor control. I have been using becker
fullstride on polio and cva successfully. I have not had a T11, but based on
the last 6 patients I have fit, there certainly seems to be a need for some
minimal control around the waist or hip. Sensation of the joint releasing
seems to be a huge help as well in ambulating. Hope this helps you. The
issue I had with the Fillauer was that the lock is activated by the swing
and angle of the knee, and not load bearing (similar to a seat belt). The
load bearing locking mechanisms seem to be a better choice in many cases.
You really need to evaluate your patient on where the lock needs to be
established, as well as their strength and ROM.
Thank you for all of your input.
Warren R Mays, CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
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OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
The original question:
What has been your experience with stance control knee joints for KAFO's?
Which ones are the least fussy and temperamental? Easiest to fabricate? Most
reliable for the patient?
The replies:
-There is an excellent article including a matrix comparing all the stance
control options in March '08 O&P edge. It saved me from making a big
mistake!!
-You are correct to ask, there are a number of Stance Control knee joints
available however, all of them, save Fillauer's Swing Phase Lock require a
connection between the Knee joint and the mfg's Ankle joint. The SPL works
simply with a pendulum moment in the joint that locks and unlocks it. You
can use any mfg's joint or use it as a stand alone KO. The issue associated
with it is if the wearer has a 'shuffle' gait, the unlocking moment can be
inconsistent. It is easy to adjust and fairly bullet proof and has the
ability to function as a single bar device. With most others, the mfg. must
do the fabrication but the SPL is easily fabricated in your lab or through a
number of fabrication labs as well as Fillauer's C- fab. Bill Messer in
Grand Rapids Michigan uses a fair number of them in his practice on a
variety of patient types including SCI patients. He is in private practice
there. If you give Fillauer a call, they can send you a CD that explains the
joint and shows patient applications. I find it a useful tool to show the
referral or potential patient and family.
-And, finally, a few were kind enough to include a copy of the responses
from a similar question posted last month.
-I did not give an evaluation of the patient as I was not
looking to see if I had the right patient model, but rather looking for
everyones experience with stance control kafo's. This is a personal friend
who had a T11 kink, has grade 3 hip flexors, grade 1 hip extensors. Grade 2
quads and hamstrings and flaccid ankles. I am donating my services and
spent a lot of money with little success. I recast and laminated carbon
afos with 5 degree dorsiflexion and thigh shells, then swapped SPL knee
joints over from plastic system. Patient can walk on treadmill supporting
his upper body with the bars. He is very strong and flexible at 170lbs.
When on ground with crutches the system does not work that well. He has a
harder time moving, locks don't function and now the joint just broke and
these are almost new. I was thinking of making carbon kafo's with posterior
offset knee joints and an extension assist. I would use a double action
ankle joint for proper functional postitioning. I would love to get away
from a locked knee, but may need a drop or lever lock just in case. Patient
is comfortable in dorsiflextion with hips anterior to midline for balance.
He cannot recover if he starts to fall backward. He is very determined to
walk and without a doubt I believe he will with the right system. Again,
Thank you for all the great responses! I will have to read through and
decide what I want to try next. Everyone have a great holiday!
-You are right. The SPL stance control are not the most
impressive. I have only used them a couple of times. My luck was good, but
the selection of the right patient is critical and the fine tuning is time
consuming. Durability is definately a factor and I do not know how long my
patients actually wore the KAFO. The best bet for a long term is a
conventional orthosis.
I have fit all but the Horton SCO, 40+ over the last 3 years in total. They
all have durability issues compared to standard thermoplastic KAFO's when
used on community ambulators, especially bilateral applications. I have
found the SPL to be the most reliable and durable for bilateral application
or when you have a very active patient. I had 1 problem with the SPL on a
young 240 lb. 6' 2 that beat the H out of them which led to having the
distal joint head replaced $$$ due to a malfunction. Otherwise, I have had
an overall good experience with the SPL system other than the inherent
weight and bulk. UTX in my experience has not worked on active community
male ambulators weighing 210 lbs. +, had stirrups break on both patients
along with wire that releases knee locking mechanism breaking. Otherwise
UTX works well and light weight for all other patients. Otto Bock's free
walk - bulky padding covering metal anterior bands, only used once. have
not fit newer Otto Bosk SCO's. Becker safety stride worked very well but
does have an audible clicking noise from locking mechanism.
I have become very selective, primarily to get optimal results as the
fitting and follow up care can become tedious. I have resorted to more
traditional designs when not using the SCO design. Traditional design
consists of a thermoplastic design with offset knee joints, stirrup with
footplate having DAAJ's with anterior pins and posterior springs
-The knee load on the hinge didn't allow the hinge to unlockor
react properly to the motion required for swing. I am working with the
freewalk from Otto bock right now. So far it'spretty good but needs lots of
training. Have you used the Scott-Craig Paraplegic style KAFO's. They
areconventional style KAFO's but were designed specifically for para's and
haveeffectively been utilized for them since the 1960's. They are
extremelystrong, durable and functional for this population. If interested I
couldfind some of the old articles on them and forward them to you. The
FreeWalk. I've fit 12 to 15 stance phase KAFOs of this design. The Free Walk
has been my best experience so far. It's crucial to use Otto Bocks'
selection sheet which helps ensure good candidates and the proper design.
The starter kit enables you to make many of your own adjustments rather than
having to return the brace to a company at $50 for each shipping (not to
mention the time wasted). Otto Bock support was timely and helpful during my
learning phase. I send in casts for fabrication and have had quite good
fits with minimal adjustments. The most usual adjustments would be to tweak
the thigh band ML on larger patients. This is easy with the tools provided.
Patients tend to walk much better right away. Follow-up appointments for
adjustments or repairs are minimal to none. Diagnoses have been CVA, post
Polio, MS and non-spastic SCI, Three patients received bilateral but I
wouldn't try that unless you have some good experience with this kind of
bracing. Bilateral works well because there are no medial bars to catch
together. Otto Bock provides a good manual to give to PTs so they can
provide the necessary training and strengthening for best results. With a
post Polio patient in particular I advise PT (it also helps progress them
through that discomfort with brace design change - if they had a brace
previously). Some patients will need PT to help problem solve stairs, ramps
and sitting but these usually aren't big problems. When you fit the brace
don't explain anything about how to walk in it. I put it on them then tell
them to walk a little so I can check the alignment - anything to keep them
from TRYING TO WALK RIGHT in it. I found that comments such as try to push
you knee back just before you start to swing the leg through is sure to
change their gait from normal which is all it takes to not work. I really
encourage you to try this brace. After 25+ years of working with locked knee
KAFOs and all of the residual problems, putting a patient in a stance phase
is a trip. When I called my last two patients for one month follow-up they
both said to effect that they usually forget they even have it on. SOME
ADDITIONAL THOUGHTS, CHRIS: Does the patient have adequate strength proximal
to the brace? Also, I see the SPL is double upright - The FreeWalk is a
single lateral upright (but very strong) The FreeWalk ankle is very flexible
so it only provides the DFA of a thin posterior leafspring but on the
positive side the flexibility allows the wearer to position the feet and
legs better for standing up and sitting down. I think all of these braces
involve more of a learning curve than the manufacturers let on in their
inservices. But there's a learning curve for standard KAFOs too.
I've used the Becker UTX stance phase KAFO with good success. Aslong as the
patient doesn't have any moderate to severe knee instability inthe M-L
plane. If the patient is active they make a stainless steel versionthat I
strongly recommend. I initially had a problem with the aluminumupright
stretching at the joint. They added a clamp to prevent any
furtherstretching. The cable inside does require adjustments initially.
Afterabout six months the cable reaches its stretching point and I haven't
had tohave it adjusted anymore. Patient has been wearing it for 3 years now
and isa young 23 year old. Hope this helps.
-I have used just about all of the Stance Locking Free Swinging
joints for ko's and kafo's, and they all have their roles. I have found the
Fillauer Spl to work very well in a KO configuration with ONLY quad weakness
(the client accepts it as a ko vs. a kafo. and the set screw/ pendulum set
up is only just adequate), other then that its role is limited. With poor
abdominal, hip flexors and extensor that a t11 may exhibit: I would think
that a Horton, e-knee, Becker's new version of the Full Stride, with
flexion lock and the with extension assist would be good choices. They all
have the ability to ratchet from flexion to extension if the client does
not make it to full extension. ......We currently have a young man in
kafo's with the Up and Around GSO design that we are looking into stance
phase joints for. I am not sure if you wanted to use Kafo's, and link them
to the Up an Around, or if an RGO would make more sence. I am currently
conflicted with my client as well. My thoughts at this point is that an RGO
with minimal trim lines is the most functional option. This would replace
the antigravity groups, and also provide a much better platform to mount to.
The tip bar replacing hip flexors just conceptually seems to be the right
idea....... The Horton has been used in this capacity before, but may
not be warateed from the manufacturer in this application- Google Horton RGO
and find some motivation from the results. I like the horton knee and have
used many in the past. It has been revised and is now a better system.
Still i think it will need many tune ups over its life span to keep the
unlocking mechanism in tip top shape. The E-Knee form Becker is very
excessive, and heavy, but may be my choice. The set up is quite easy, and
the foot plate/ pressure sensor is very easy to modify. The battery life
seem quite good as well. The thing i really like about it is the pressure
switch: you can run sensors all the way to the end of the toes or you can
block some and only have them for heel strike thew mid stance. As the
client goes to heel off, the pressure sensors are disengaged and you have
free swing. The down side to this system (and most other systems) is that
the knee must find extension before it is allowed to unlock. The Becker
full stride can be had with the g-knee extension assist which i have used in
cases of mild quad weakness and fell in love with. For our application this
would be a great option. I hope this helps.... Also keep in mind all the
clients I have fit have had decent hip extensor. For the right patient,
carefully selected they are a good option. It takes a lot more precise
fabrication and then much more clinical time to fine tune the whole
mechanism and patience, patience and more patience on the part of the client
to make it work well. The Fillauer joint is one of the best and also the
simplest to use. I feel your pain and agree, the last thing you need is a
sales pitch! I usedthose SPL on a unilateral Polio patient. They worked, but
the real problemis the pair of joints only has an extension stop on the
lateral joint. Fitthese to any patient with recurvatum or that needs
hyperextension tostabilize the knee joint and watch out, they break. Funny
thing is, mostpatients with a unstable knee, position themselves this way,
so this designis actually for very few patients. The more robust unit would
be the design from Becker that utilizes,conventional joints with a cable
that attached to the footplate. The jointdesign is proven/durable and you
have two extension stops so joint alignmentis not hypercritical. I only used
them with high activity patient singlesided, with excellent results.
Remember that these patients need to stand with their pelvis forward,hanging
on the Y alignments of the hip, feet in dorsiflexion. So non ofthese designs
are really perfect from them. The stance control knee works like the Total
prosthetic knee. You have to hyper extend in standing to unlock the knee.
With you case your patient does not have this mobility. I would use RGO's,
-Stance control when properly applied can be an amazing thing,
but of all the systems out there the SPL seems to be the most problematic.
Especialy with bilateral patients! We make as many SCO orthoses as any one
in the country and have had a lot of succesfull cases, so don't give up on
the concept, just try a less cantancerous system. The Horton is big and
bulky, and it works so well almost no one seems to care, they have a great
track record of function and reliabilty.We also do a groing number of the
full stride and safty stride from Becker Ortho. both units have done really
well with no maintenance issues so far. Both are easy to tune and easy to
repair if they break, the Becker joints are smaller and less expensive but
the Hortons lock ROCK SOLID in any flexion angle. Hope this helps, good luck
in your quest.
-I am sorry you have been having trouble with the SPL, but you
really need to have hip flexors to make that joint work. At very least the
patient needs to ballistically position the leg with an inverted Y strap
with abdominal control. Is that T11 paraplegia complete? I would think a
bilateral T11 with paraplegia would be indicated for RGO's for ambulation,
but even at that level hip flexors may not be present. If there are no hip
extensors to help out, you will only have frustrations. Hip extensors are
critical for the proper use of these so called stance control systems. I
think T11 could be above truly capable bounds of use for stance control
without some type of microprocessor control. I have been using becker
fullstride on polio and cva successfully. I have not had a T11, but based on
the last 6 patients I have fit, there certainly seems to be a need for some
minimal control around the waist or hip. Sensation of the joint releasing
seems to be a huge help as well in ambulating. Hope this helps you. The
issue I had with the Fillauer was that the lock is activated by the swing
and angle of the knee, and not load bearing (similar to a seat belt). The
load bearing locking mechanisms seem to be a better choice in many cases.
You really need to evaluate your patient on where the lock needs to be
established, as well as their strength and ROM.
Thank you for all of your input.
Warren R Mays, CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Warren Mays, “FW: Stance Control knee joints,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/229802.
