Third world AK socket design- Responses

Third world AK socket design- Responses

Randy McFarland

12/21/2008

Original Post
I have an idea of what components to use for a third world AK
prosthesis, but I'm curious as to what casting technique and AK socket
design that has been proven most successful for a third world
prosthesis. What has been the most teachable and successful method,
presumably skipping the test socket stage? Randy McFarland, CPO
Fullerton, CA
 
Responses
I travel all over Latin America on my consultancy job for Ossur and the
most
common socket design I still see over here is the good old Quadrilateral

Laminated socket... I believe it is related to the easyness to cast and
modify and to the lack of information, schools and professional update
from
the local Practitioners. And the lack of access to good termoplastic
materials is also a reason why the Laminated process is still the most
used
overall..
 
Please stop using third world, as it is a derogatory term... There are
many other terms or simply use the country of intent. The quad socket is
still the technique taught most in ISPO credentialedschools, as it is
easily demonstrated, and not so open to interpretation like the
techniques used in the US. Plastic or metal quad brims are
available and provide a teachable, consistent result with limited
resources. The brims when wrapped can function like a test socket,
initiating weight bearing and helping with alignment lines. I have been
able to acquire donations of both metal Hosmer quad brim and plastic
IPOS brims. Ask around and you might be able to get donations of old or
used brims. If not I really like the Otto Bock ETS brim options and I
think they have a database showing the most common sizes and might be
able to fabricate some brims. I know Hanger used the IPOS brims, and
most of the US P&O schools have them, and maybe they could be
replicated.
 
So you mean to say.... US amputees are getting sockets that are costly,
requiring several adjustments, not practical and presumably more
complicated than third world countries? Is that why Prosthetics are
costing more and more money? I'm confused......
 
How much different is third world anatomy from first world anatomy
other than bulk and softness? <G>
 
polypro sockets. heat gun, grinder, pads, and good hands can do a lot to
it. plastic is commonly available everywhere. sock fit, you'll deal with
a lot of hygiene issues with liners of any kind.
 
Of course I know only part of what is done in third world sockets.
But I have seen nothing but Quadrilateral shapes usually in
Polypropylene. No suction sockets or silicon liners. So the suspension
is mainly through a pelvic band. For casting we use plastic brims to get

the proximal shape. No elastic bandages are available so they just shape

and extend the proximal part of the socket. However, I would like to
introduce the Ischial containment socket with a simple valve here in
Tibet.
 
Nice to see someone else with this ambition! I'm not sure if where you
are going will have someone available to follow up with the patients you
intend to treat, but I'll share a few thoughts based on my experience in
this kind of work, with the assumption that you do have that follow up
person... I've thought about this as well, and come to the conclusion
that the more education and knowledge available, the better. I figure,
problems will arise with say a quad socket, and at that point, if the
technician has been trained to make a narrow ML/ Ischial containment
design, it may make the difference in that person walking or going on
crutches... A few years ago, I took a trip to the Dominican Republic and
for three days, focused solely on AK. Patient care was limited that
trip so we could spend more time going over key theoretical points via
interactive lectures and hands on work... In preparation, I went through
a lot of my old text books and ABC material and really tried to come up
with what is essential... With their program, a lot of supplies are
donated from the US, so the material needed to include indications for
gel liners/ locking systems as well as things like hip joint and pelvic
bands and sock fit. Taking this approach- going over a broad spectrum
of options - we found to inspire creativity and get the technicians
thinking critically to address particular patient needs. Our program in
Guatemala is similar and since we've started that from the ground up,
i've been able to set up some things as I see appropriate from the
get-go... Appropriate design in this case has been dictated by material
resources. Flexible inner liners are not an option (although it is
possible to retrofit old ones over a similar cast). We are drape
molding polypro and using part of a suspension sleeve to cover a pull
hole if no valve is available. Silesian belts with sock fit is the most
common method even though suction is preferred. Again, teaching is the
main emphasis each trip, and we try to start with the most important
things first and build on this on subsequent visits... Follow up clinics
are a great way to see the tech's work and are useful for teaching. I
realize I'm getting off topic here, but I figured you might be
interested... One of our most notable achievements thus far has been
this past year. A team of therapist, doctor, and prosthetist held a
clinic to evaluate and teach patient evaluation skills to their
hospital's group of therapists, doctors, and prosthetists. A larger
team then visited on a subsequent trip to cast, fabricate, fit, deliver,
and gait train the same patients. This next trip will be one to follow
up on these patients and to teach more. This worked out very well so
far to bring their level of competence up to speed relatively quickly...
Back to your question... a cheap and successful way of doing a check
socket fitting, particularly for suction sockets is to take the modified
cast and copy-cast it with plaster then cut out large triangles. The
limb is pulled into the socket and is checked for total contact.