Responses to Post: "Curious about transradial socket and fitting method"

Responses to Post: "Curious about transradial socket and fitting method"

Jeff Erenstone

1/4/2021

*.....Original Post.....*

Dear Listserv,

I am curious if anyone has seen or has been involved with a remote fitting
of a transradial socket that resembles the one in this video...
<URL Redacted> .

The person who is remote in this video is not a clinician. He is a
mechanical engineer.

Initially I see significant concerns with this socket design regarding
vascular constraints and window edema. With the absence of a conventional
harness or epicondyle regional control (used in self suspending sockets), I
fear the high circumferential forces applied by the adjustable socket,
required to maintain suspension, will be so significant that the prosthesis
will cause harm. Personally I would like to know if a study has been
performed under the supervision of an IRB committee and if so I would like
to see the results.

Do you see any concerns with this process or socket design?

best regards

Jeff Erenstone CPO

Mountain Orthotic and Prosthetic Services
<Email Address Redacted>


*.....Responses......*

1.
I was just talking with my dad about this. I think a simple BK water leg
system using a similar idea would be great.

Thoughts?


2.
I certainly have an issue from a licensure standpoint if they are
“delivering” here in Texas.


3.
I always wonder why we need to be certified to provide a prosthesis when it
seems like anyone with a 3D printer can do it. I hope the guy on the
computer has malpractice and product liability insurance like I had to
have. Oh by the way it looks like junk to me on such a short arm.


4.
 I share your physiological concerns and implications of this socket design
and for this reason alone I would not willingly become directly involved in
this approach to functional restoration and physical rehab. science let
alone dispensation of extracorporeal OPR products and services. From a
broader perspective, this socket approach will unnecessarily compromise
perceptual contact. I also think this approach puts to much emphasis on
attaching a machine to a person and in attachment and connection the person
becomes more mechanical rather than attaching a person to a machine and in
attachment and connection the machine becomes more biological. It's
interesting to note how little attention is being given to the afferent
phase of sensorimotor function to include perceptual contact (as you have
noted), exteriorization, sptialization, comprehension and immersion in and
with the OPR device that ultimately leads to enhanced client satisfaction,
sense of well being and functionality.

In short and in spite of the incredible technological ingenuity, this
approach to clinical prosthetics is indicative of extracorporearl OPR
professional disintegration and yet remains trendy and in vogue. I'm glad
to hear you raising questions about this selective and exclusionary
clinical approach.

I wish you and yours a wonderful Christmas and New Year's Holiday,


5.
Thanks for passing this along. Very interesting.

Of course it is difficult for us to evaluate the fit on the YouTube video.
But I, as far as the remote fitting session demonstration, I liked the
patient/clinician interaction. I liked the weighted adaptor for evaluating
suspension, comfort, and control. It was interesting that the fact that it
is 3D fabricated allowed for providing three socket configurations, which
saves a lot of time and sending the socket back and forth. This kind of a
fitting would give the prosthetist a lot of information that can then be
used to optimize the definitive socket or a subsequent test socket.

To more thoroughly evaluate the socket fit, I would have liked her to do
some axial loading and some flexion and extension against force, plus some
more specific questions with regard to possible pressure areas or loose
areas. I am not sure what the ultimate functional goal of this is (passive
or body powered).

In general she seemed to be comfortable and did not complain of the socket
being circumferentially too tight. I got the impression there is some
suspension over the olecranon process but it was hard to see. I was not
too concerned about window edema based on what I saw. And there have been
other socket designs with open areas that have not reported window edema
problems in upper limb sockets.


6.
 My observation was a little different from yours. First of all, I’m with
you… mechanical engineers don’t know what they are doing without clinical
training in prosthetics. Trust me… they are linear thinkers by nature and
there’s so much going on during a prosthetic fitting from so many
directions that they inevitably get overwhelmed. I even met with mechanical
engineering students at the QLplus lab at Cal Poly and they were amazed at
my insights regarding some prosthetic projects they were working on. I was
shocked at the oversights and shortcomings of their CPO-absent mentors.
Thus, I’m not surprised at this…nor am I optimistic of his chances of
succeeding.



I kept looking at the video and when I wasn’t thinking about how her hair
kept getting in the way, I was thinking how I would improve the platform… A
telescoping volar tongue… Velcro pads for finding suspension superior to
the epicondyles. But my thought is that the company is eventually going to
crash and burn. Not enough arms… I’m not sure what their funding is in
Florida… I feel a little awkward that I’m Limbitless LLC and they are
Limb.itless Solutions (maybe we could have a knife fight and only one would
survive!)



But here’s my thought… Why not hang around to pick up the good pieces after
it crashes and burns? If there’s a 3D printing program code… maybe they
have IP… this could be used for humanitarian preliminary fittings… I’m not
saying you should be his guardian angel. I’m saying that after they make a
mess of it, perhaps it could find a better next life in the capable hands
of a prosthetist! My point is that I was looking to learn whatever I could
from the video.



The number for arms just isn’t there. It’s nifty, but they’ll run out of
steam.

However, while I’m sure they would get edge pressure from that thing, I
believe that window edema won’t happen with a properly constructed socket
with openings. Lol… see? We couldn’t have two CPO’s agree on everything,
could we?






Jeff Erenstone, CPO

Mountain O & P Services
7 Old Military Road
Lake Placid, NY 12946
Phone (518) 523-2419
Fax (518) 523-7192