www.a c p oc.

or g
a lwa ys online on y o u r time

Volunteering in
Underserved Regions
Ma king a Lif e . . . Pa g e 7

U n iq u e L o we r Ex tr em ity
Or th o tic In te r v e ntions
F o r C h ild r e n With
A r th r o g r y posis:
A S in g le C ase
Customiz a tion f or optimiz a tion . . . Pa g e 1 7

H a n d Or th o s es For
C o m p le x C a s e s Wit h N ew
Te c h nology
Fr om molding to mode ling . . . Pa g e 2 1

In the N ew s
Ca ll f o r Pa p e r s
...P a g e 1 2 - 1 3
Sa v e th e D a te
. . . Pa g e 2 4
Ne w Pr oduc ts Aim f or G r e a tn e s s
... Pa g e s 2 5 & 2 6

Whos w ho
Le tte r f r om th e E d ito r
. . . Pa g e 3
We know you, ge t to k n o w u s
. . . Pa g e 4
Pr oduc ts tha t ma ke it p o s s ib le
. . . Pa g e 2 5
Me mbe r s Ke e pin g in To u c h
... Pa ge s 2 8 & 2 9

FALL ISSUE - 2014

VOLUME 20
3RD EDITION
increased levels of Function
while sitting, walking, and standing

Sitting

Hip Walking

orthosis And Standing

A LETTER
FROM THE [ EDITOR ]
Greetings -

It was a year ago this issue that the new format for ACPOC News debuted. Our
staff hopes that all of our membership and advertisers have welcomed the changes and
enjoyed the articles provided. The ongoing challenge is to continue to draw from our
resources (that means you), so that your expertise can be published in upcoming issues of
ACPOC News and shared with our vast readership. It is an opportunity, and somewhat
of an obligation, for all of you to be part of the continued education that reaches different
levels of our combined professions. My thanks extend to all of the contributing authors
for the Fall Issue and also those who made the previous year successful.

A very special Perspective from Hugh Watts, MD is featured in this issue on
the volunteer work he has been involved with internationally. He has mentored so many
of ACPOCs members, influencing their lifes work and the resultant care of our patients.
Dr. Watts shows new paths for charitable acts through his article that may encourage you
to direct your own talents and expertise to needs in our world. I feel indebted to Hugh for
his contributions and offer him sincere gratitude.

The Call for Papers is upon us once again for the Spring Annual ACPOC
Meeting at the beautiful setting of Clearwater Beach, Florida. Be certain to get your
abstract written and submitted by the October 1st deadline. ACPOC is counting on you.

Enjoy your reading,

Janet

ACPOC NEWS
FALL 2014
3
ACPOC
The Association of Childrens Prosthetic-Orthotic Clinics
6300 N. River Road, Suite 727, Rosemont, IL 60018-4226
Telephone|847.698.1637 F a x | 8 4 7 . 8 2 3 . 0 5 3 6
Email|acpoc@aaos.org W e b | w w w . a c p o c . o r g
ABOUT US ...

MISSION
The Association of Childrens Prosthetic-Orthotic Clinics
ACPOC BOARD & LEADERSHIP
President (ACPOC) provides a comprehensive resource of treatment
David B. Rotter, CPO options provided by professionals who serve children,
Chicago, IL adolescents, and young adults with various orthopaedic
Vice-President
impairments.
Jorge Fabregas, MD
Atlanta, GA
Secretary-Treasurer

VISION
Hank White, PT, Ph.D. The Association of Childrens Prosthetic-Orthotic Clinics
Lexington, KY (ACPOC) is recognized as the worldwide leader of
Immediate Past President
multidisciplinary rehabilitative care of children, adolescents,
Ivan Krajbich, MD
Portland, OR and young adults with orthopaedic impairments.
Directors:
Wendy L Hill, Bsc, OT
Fredericton, NB ACPOC will provide information to allow patients and
OBJECTIVES

Phoebe R Scott-Wyard, DO patients families to access specialized clinics and healthcare

Los Angeles, CA providers.
Bob Radocy
Boulder, CO ACPOC endeavors to provide opportunities to educate
Brian Giavedoni, MBA, CP, LP its membership through newsletters, the web site, annual
Atlanta, GA conferences and other programming.
Anna Cuomo, MD
ACPOC seeks to stimulate clinical research, which will
Los Angeles, CA
further advance the technology and treatment approaches for
Todd DeWees, CPO
orthopaedic impairments.
Portland, OR
Bylaws Chair ACPOC offers an environment that promotes team
Owen Larson, CP collaboration with all medical professionals including, but
Mesa, AZ not limited to, physicians, orthotists, prosthetists, therapists,
Newsletter and nurses.
Janet G. Marshall, CPO
Tampa, FL
Robert Lipschutz, CP
Chicago, IL
Rachel Marshall, M.Arch, MLA
Tampa, FL
ACPOC Staff
Angela Schnepf, MBA
Susan Shannon
Liz Frale

ACPOC NEWS
FALL 2014
4
ABOUT YOU AND THE NEWS ...
Please submit work for consideration by:
February 1st [Spring Issue Publication]
May 1st [Summer Issue Publication]
August 1st [Fall Issue Publication]
November 1st [Winter Issue Publication]

Copyright:
Use of any of the information in this newsletter is authorized as long as the proper authorship
and/or source is also quoted.

Disclaimer:
ACPOC News does not support, endorse or recommend any single method or product,
remedial center, program or person, for children or adults with disabilities. It does however
endeavor to inform in the belief that you have the right to know.

GET INVOLVED
ACPOC News stays current with quarterly issues and
supports our members professional innovation.
Send us your research articles or patient perspectives, and
we will do our best with the rest.

IDEAS FROM THE MEMBERSHIP

If you have any suggestions to improve the ACPOC website,
please E-Mail them to acpoc@aaos.org
ACPOC NEWS
FALL 2014
5
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still growing.
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 Volunteering in
[ Underserved Regions ]
Author: Hugh G. Watts, MD
Los Angeles, CA, USA

We make a living by what we get, we make a life by what we give.

Winston Churchill

One measure of a civilized society is the care it provides for its disabled
members, and those less fortunate. Now that we have almost become a
world wide globalized society we have to think more broadly than our own
country or society, let alone our neighborhood.

In this spirit of wanting to help those less fortunate than yourself, perhaps youve often thought about donating
your hard earned knowledge and training to some place in the world that is woefully lacking and you want to
know more about how to volunteer. Is it realistically something for you to do? How can you find out more about
it? Where and how do you look for a place? If, indeed, such thoughts have crossed your mind, maybe I can help.
In that regard, first let me describe the need for your help, then discuss some practical ways to get involved.

Right from the beginning, I used the term Underserved Regions and not Developing Countries. Anyone who
has travelled, even a little bit, knows that the life and living in the capital of most any country is far, far different
from that in even a nearby village. We have underserved regions in the USA and Canada.

Also keep in mind as you read, that I am a pediatric orthopedic surgeon; I am male; I have lots of biases, and they
will be different from your biases, so you will have to extrapolate what I say so that you can fit it into your own
skills and experiences.

JUST WHAT IS THE NEED?

It is always difficult to get such a number. World wide the number of people with physical disabilities is estimated
at greater than 250 million. I am not sure just how accurate this number is, but it is an awful lot of people. Now
from an orthopedic surgery point of view, two thirds of the world goes without any orthopedic care. Africa is
short some 20,000 orthopedic surgeons and that if the USA had the same number of orthopedic surgeons as
Tajikistan there would be less than 13 orthopedic surgeons for each state in the USA. What about some other care
providers again these numbers will be approximations, but the number of physical therapists per disabled is
grossly disparate between the United States and other countries. Can you imagine as a physical therapist having a
caseload of 21,000 children all to yourself, as in Uganda? It is just an unthinkable number. What about occupational
therapy? Those data are more scant, partly because in many of these countries the functions of PT and OT are
intertwined and they dont necessarily separate those numbers. What is the orthotic need? Those of us in ACPOC

ACPOC NEWS
FALL 2014
7
who are dealing with children with cerebral palsy know
they need orthoses. There are also all those people, children
and adults, that have had polio and are paralyzed for life.
They need a lifetime of orthoses. Once again, the data are
scant. More data are available concerning prosthetists and
prosthetics. Three to four million patients are waiting for
prostheses 160,000 worker days worth. There would be
less than one O & P facility per state if we had the same, for
example as El Salvador or Lithuania. Obviously the needs
vary from region to region. Most capitol cities in most
underserved countries are reasonably provided. It is only
when you go outside of the city limits that the problems
soar. Is there a war going on or not? Are we talking about
adults or children? Children are always under served, and
women are very under served. In Saudi Arabia, if a woman
gives birth to a daughter, you say, Mabrook, which is
congratulations. If she gives birth to a son, you say Alf
Mabrook, a thousand congratulations. Right from the
minute of birth, the female is valued at one one-thousandth
of a male, and this reflects in their education, and in their
healthcare.
Anti-personnel mines, increased mechanization, bone
and joint infections, difficulties of immunization, poor
prenatal care, poverty, all of these thing make their impact.
Consider the effects of anti-personnel mines there are
estimated to be 50 to 100 million unexploded land mines,
(a US state department figure). Now many of you were
appalled when, some years ago now, you heard about the
Oklahoma bombing. These land mine numbers are the
equivalent of an Oklahoma bombing each day for 1700
years. That is a lot of damage. The anesthetic affect of
high numbers, numbs the mind every decade the deaths
from landmines is equal to Hiroshima plus Nagasaki. Land
mines are a weapon of mass destruction in slow motion. To
dig a hole in the ground and put a high explosive in it and
walk away is immoral in anybodys
culture. And yet it continues to
happen.
This little butterfly land mine can be
dropped from the air by helicopter.
It is about the size of the palm of
your hand. What child seeing this,
wouldnt pick it up?
ACPOC NEWS
FALL 2014
8
This boy from Columbia
couldnt leave it alone.
He lost both his hands
and was blinded, when it
blew up in his face.
Increased mechanization
is a real problem. The
transition from walking,
bicycle, motorcycle,
cars, and trucks takes its toll. Hanoi noted a 400%
increase in open lower extremity fractures with the
increase in automobiles. Poor orthopedic care such
as surgeons closing wounds that should be left
open for later closure, poor sanitation, and limited
availability of antibiotics, are additional problems
everywhere.
Every time I mention Polio, people in this
country are amazed that it hasnt died out entirely. It
is much better than 30 years ago, but did you know
there were 500 new cases in Tajikistan in 2010?
In most underserved regions, it has been estimated
that probably only one in ten are reported. The
difficulties of immunization are enormous. The
biggest obstacle is war. You have to have peace if
you are going to immunize. Polio vaccine also has
to remain at 4 degree centigrade if you are going
to use the oral variety (it is much too expensive to
use the injected variety). Can you imagine trying
to keep a vial of the vaccine refrigerated when
that vaccine is made in Milan, Italy then has to
go the airport, and then has to go to the airport
in Zimbabwe, then sits in the hot tarmac, then it
has to go into the customs shed, (and the person
in customs couldnt give much of a care, he just
wants the papers filled out). And eventually the
vaccine will get to the ministry of health and from
there to the village. The amazing thing is that any
of the attenuated virus is alive when it gets there. In
addition, keep in mind that even if we obliterated
polio today, there are decades of rehabilitation care
needed while those currently affected live through
their paralyzed lives.
A few things are getting better. However, for most people
in the world, they are getting worse. Populations are
getting larger, resources are diminishing. Unfortunately,
the relative difference is increasing and the relative
difference is becoming more and more visible as
television and the Internet show the world our profligate
ways.
Huge numbers are always difficult to deal with. A few
years ago, a note came across the Internet from the
library of the University of California, San Diego. They
suggested that we should try to imagine how things
would look if we could shrink the earths population
to a village of precisely 100 people, with all existing
human ratios remaining the same. What would the world
look like? There would be 57 Asians, 21 Europeans, 14
from the Western hemisphere (North and South) and 8
Africans. 70 would be non-white, 30 white, 70 would be
non-Christian, 30 Christian, 80 would live in substandard
housing, 50 would suffer from malnutrition, 1 would be
near death, 1 would be near birth, (and I will add that 5
will have a physical disability), 70 will be unable to read,
one would have a college education, no one would own
a computer. Fifty percent of the entire village wealth
would be in the hands of only six villagers and all
six would be citizens of the United States.
Clearly there is a need. Now what can you do about
it? You may just get so overwhelmed that you just say
NIMBY (not in my backyard). Sorry, thank you very
much, no thank you. Or you can be a help in a number
of different ways, perhaps in ways that only you have the
talents for.
Now the urge to help is there, almost everywhere.
Certainly it is in a group like ACPOC. What can be
done? What should be done? Those are two very different
questions. Do we simply export our American version?
Do we focus on prevention, rather than cure? we leave? Are we doing this because it makes us
We cannot be the World Health Organization, Mother
Theresa, and Albert Schweitzer to all countries. We
must make choices. Lets talk about ways we could,
should or shouldnt be helping. Most of us are in the
ACPOC NEWS
FALL 2014
10
curing part of the medical world we probably
are not going to go out there with our shovels and
dig latrines or drill for fresh water. We are going to
use the expertise we already have. Clearly, in most
situations prevention is the best, but it requires
peace you cant immunize with a war going on.
When we talk about curing we can talk about doing,
and/or providing supplies versus teaching. And the
question is, Are there enough hours in the day, to
make any kind of an impact with just doing?
In 1992 at an AAOS Instructional Course on
International Medicine, the late Dr. Mercer Rang,
a pediatric orthopedic surgeon in Toronto who had
worked in a number of foreign regions, established
a principle that I would like to reiterate the needs
are too great to provide purely service assistance.
We must have a multiplier effect. We simply cannot
treat everybody. Whatever services we provide must
lead to self-sufficiency. The main thrust must be to
teach. You have all heard the proverb, (probably too
often): give a man a fish and he eats a meal; teach
the man to fish and he eats for a lifetime. While
you may think the proverb trite, it is still all too true.
We must include multiplier effects in anything we
do (By the way, the most recent version of the fish
parable is Teach a man to fish and hell call in
sick every Friday).
And in many diseases, it is important not only to
rehabilitate patients, we must work to make them
useful members of their community. Dr. Ronald
Huckstep, of Australia, from his days in Uganda had
disabled people making braces in the local brace
shop, so that the patients not only were able to walk
after polio, but they were able to earn a living.
We always must ask ourselves, What happens when
feel good? Are we doing something worthwhile
that will be left behind? If teaching is the primary
goal, whom should we teach? We must be willing to
train people who are not our educational equals. It
does not mean that they are not our equals as human
beings, just because they may have a high school
education where you have a zillion years beyond that.
Do we focus on generalists or specialists, e.g. orthotists
or orthotic techs, keeping in mind that these are not
inferior people; they have just had less opportunity
and lesser education. Obviously, whom to teach will
depend on the local situation. In Tajikistan, where I
was three months ago, there are no PTs or OTs zero!
They started by retraining some of the nurses, which
is what happened in the USA 80 years ago when there
was no such professions as Physical or Occupational
Therapy at the time.
If teaching is the primary goal, there is the issue of
training people in their own country or here in the
USA. After a trainee has come to the land of milk and
honey, it is awfully hard to go home. And even if he
or she wants to go home, the chances are high that the
spouse or children will want to stay in the USA. For
most of us, the adage Train at Home, Stay at Home
has become our mantra.
The help we provide must be appropriate appropriate
to the culture, the religions, the climate and the
geography. Culture and the religions, may well shape
a peoples expectations of cures. People differ in what
they expect.
Treatments need to be simple and the benefits obvious.
And very importantly, you must learn when not to
treat. It is very easy as a surgeon, say from the USA,
thinking Im from the West, I know more than anyone
else around here and you take on the most difficult
of all patients and the patient dies or the patient is no
better as a result of your care. That doesnt do anybody
any good, besides being a waste of resources. Trying
to fit a child from a big city slum who has a four-limb
deficiency (congenital or acquired) is seldom a recipe
for success. And so one of the best bits of advice I have
had given to me is treat patients that you can win on.
Know when not to treat.
I dont want you
to be turned off
by the reality
of the many
problems,
because there
is an enormous
amount to
do. There is
a childrens
riddle: How do you eat an elephant? The answer
One bite at a time. And while there is, indeed, a
mighty big elephant out there, that is what you are
going to have to do take it on one bite at a time, and
not be overwhelmed.
IS THERE A PLACE FOR YOU?
The answer is very definitely Yes. Some questions
come to mind: With whom to volunteer? Short term
(a few weeks or months) or longer (a year or more)?
When to go (e.g. now or when I retire)?
With whom can I volunteer? How long should I go
for? When should I think of going?
These questions are intertwined. Different organizations
are focused on specific goals and may only be willing to
consider taking you for shorter or longer periods. Most
government organizations such as Peace Corps. dont
have places for a person who wants to go for one or two
weeks or even months. NGOs (i.e. Non-Governmental
Organizations) and religious organizations vary. Trying
to sort them out can be difficult even with the help of
the Internet since the organizations are frequently just
known by their initials, so it rather a mush of alphabet
soup.
ACPOC NEWS
FALL 2014
11
CALL FOR ABSTRACTS
ACPOCs 2015 Annual Meeting
 PRESENT
@
ACPOC
Submission Deadline
October 1, 2014

acpoc@aaos.org

The Association of Childrens Prosthetic-Orthotic Clinics (ACPOC)

invites professionals interested in pediatric prosthetics and orthotics to begin planning
for their involvement in ACPOCs 2015 Annual Meeting being held at the Hilton
Clearwater Beach in Clearwater Beach, Florida from May 13-16, 2015.

In order to submit your abstract(s) using the on-line system, you will
need to log in. If you are a member or have attended an ACPOC Meeting in the
past, you have an ACPOC user-id already set up. If you dont know your user-id or
need to create a customer record in our database for your unique user-id, please
Email: acpoc@aaos.org or phone (847)698-1637,
We recommend you review the abstract Instructions and Guidelines on
the submission page before proceeding to submit.

Please visit http://www.specacpoc.org/abstracts defaultmenu.aspx to

upload your abstract today.
Lets start with When should I think of going? There
are a number of choices:
during your training;
between basic training & specialty training;
right after specialty training;
during active practice for short stints;
after retirement for short stints or longer periods.
Obviously these are not mutually exclusive (and once
hooked by a trip you may find that you will indulge
yourself in a variety of these).
Going during your training years can be enormously
rewarding. You will be amazed at how much you
have to contribute even if you have had only a year
or two of training. The problem is that there are not
many organizations that are willing to take trainees.
Usually the way to find out is to ask a member of your
faculty for suggestions. Even if the faculty person has
no personal experience, they will usually know of other
faculty members to direct you to.
Going after youve finished your basic degree and
before going on to, say, a residency program again is
similar to the problems of finding organizations willing
to take you. At least with your basic degree, and
presumably having passed your licensing exam, you
are more useful, and religious organizations are more
likely to be interested in you. An advantage of going at
this time is that you can see if you like the activity and
then go and get the training you see you need, which is
what I did in Afghanistan right after my internship in
general medicine.
Going over after you have completed specialty training
makes you a sought after person. Since you wont have
commitments to a practice, you can consider going
for one or two years. This is a great way to get some
excellent experience under your belt, (usually with
a vast array of complex cases) making you a much
sought after person when it comes to looking for a
career position on your return.
Usually after you have started into a practice, long-term
trips of more than a week or two or maybe a month
ACPOC NEWS
FALL 2014
14
become very much more difficult. At this period in life
you will generally do better turning to independent
groups (that you usually hear about through friends
or your professional organization). An extremely
important resource is Health Volunteers Overseas
(their new web address is www.hvousa.org). This is a
consortium that began 30 years ago with Orthopedics
Overseas, and now includes Anesthesia, Dermatology,
Hand Surgery, Hand Therapy, Hematology, Internal
Medicine, Nurse Anesthesia, Nursing Education,
Oncology, Oral Health, Pediatrics, Physical Therapy,
Wound & Lymphedema. Their usual expectation is a
commitment of at least one month. For the Orthotists
and Prosthetists, their professional organizations
AOPA, AAOP, as well as ISPO (the International
Society for Prosthetics and Orthotics) have been very
active in these endeavors and should be a rich source
of information.
Who pays your expenses? With longer-term
commitments, the organization usually pays for your
transportation and up-keep. For short trips it varies.
Many organizations will pay for the transportation
and upkeep, or some combination. On the other hand,
Health Volunteers expects the volunteers to pay for
their transportation and their in-country upkeep. Check
it out so you dont have any surprises.
What about going with a Religious Group? This can be
very easy to very tricky. Some religious organizations
dont care a great deal about your personal religious
beliefs. Others very strongly do care. To find yourself
going with a group that expects your primary function
to be that of a proselytizer rather than a health-care
worker has proven to be very awkward for some.
On the other hand, a number of religious organizations
have been involved in many decades of overseas work
and have very well established programs that some find
very comforting to work with, especially newcomers to
the field of volunteering.
Issues of children small, and bigger: Usually, taking
the children along for the one or two week trips is not
a good idea, unless youve been there before
and know what the children will get into. Poorly
supervised teen-agers, while you are busy seeing
patients, can present special problems.
On the other hand for longer trips, the experience
for the children can be life changing. Usually
there is plenty of help with childcare. The
obvious worry is health care, and it is difficult
to give advice in the abstract and will obviously
differ with the anxiety level of the parents. My
oldest child was born in Afghanistan and lived
there for a year and a half, so I have my bias.
What about personal safety? Again, this is
difficult to answer in the abstract. Countries may-
be at war. HIV may be rampant, so obviously
common sense is needed to assess the situation.
Most organizations arent the least bit interested
in being responsible for you if there is any real
danger, and so wont send you there. Ask around,
search the Internet, but bear in mind that if you
give mind to all the State Departments travel
advisories youd have to live under your bed.
Ask around: I can assure you, that will find that if
you ask people who have worked overseas they
will give you all the time you want perhaps a
lot more than you want since people do become
enthralled with their volunteer work.
OTHER WAYS TO TAKE A BITE OUT OF
THE ELEPHANT:
Maybe you have small kids at home, so you dont
want to go overseas now, are there other things
you can do to help? Indeed there are.
1) Translating to Break the Logjam of
Literature: Sending your old journals and text
books overseas, is not helpful if they cant read
English. And English is certainly the lingua
Franca in the medical world. If you have another
language, or a friend that does, you could do a
great service by translating simple patient instructions
that many therapists hand out on a fairly regular basis. What
a joy this would be for somebody to have it in Swahili, or
Russian, or Farsi.
2) Help another person who is going over to collect things
that may be useful. There are things that you can do even if
you cant personally get over there. It takes lots of strands
to give a rope its strength. Everyone can contribute and be
important.
Let me end by repeating the quotation from that master of
words, Winston Churchill, who said, We make a living by
what we get, we make a life by what we give.
I know that many of you in ACPOC have been trying to
get a life by giving. However, it is a constant battle not to
focus on making a living, particularly in these more difficult
times when American health economics is in such flux. But,
please, focus on making a life.
Call for Papers
Due October 1st, 2014
Join Us for ACPOCs Annual Meeting
Clearwater Beach, Florida
May 2015
Email acpoc@aaos.org
for more information
ACPOC NEWS
FALL 2014
15
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AD343/03-01-13
 UNIQUE LOWER EXTREMITY ORTHOTIC
INTERVENTIONS FOR CHILDREN WITH
ARTHROGRYPOSIS: A SINGLE CASE
Lampasi, Antonioli and Donzelli
(2012) state that arthrogryposis
is a heterogeneous disorder that
is characterized by the congenital
contractures of multiple joints.
Subluxation, dislocation and soft-tissue contractures
of the knee joint are common in patients with
amyoplasia. Of the various forms of knee involvement
flexion contractures are more common in addition to
being more disabling then the extension contractures.
These contractures also show substantial resistance
to treatment and have a higher rate of occurrence.
Arthrogryposis is part of the diagnosis for a large
spectrum of congenital disorders characterized by
multiple congenital contractures.
In this case study, the patient has been diagnosed with
arthrogryposis also referred to as amyoplasia. She
presents with symmetrical limb involvement, some
truncal sparing, above-average
intelligence and a midfacial
hemangioma on her forehead.
She came to the hospital at the
age of 5 untreated for any of her
deformities or contractures. She
had corrective surgery for her
club feet and right knee flexion
contracture. She still had residual valgus at the
knee with some knee flexion and varus at the ankle
on the right. She was initially fit with a traditional
double upright knee ankle foot orthosis (KAFO) with
a thermoplastic thigh cuff and ankle foot sections.
The knee joint needed to be set in approximately 20
degrees of flexion to accommodate fixed deformity
at the knee. The Ankle Foot (AFO) section of the
Justina Shipley CO, MEd, FAAOP
Shriners Hospitals for Children, Shreveport, Louisiana USA
device accommodated ankle varus and approximately 20
degrees of ankle plantar flexion. Due to the weight of the
orthosis and the severity of the valgus deformity at the
knee, alternative interventions needed to be considered.
The new orthosis was fabricated with no moving knee
joint. The device was fabricated out of 3/8 copolymer
with a single aluminum upright attached to the lateral
side at the knee center extending approximately 3
inches proximal and distal to the
knee joint. The valgus deformity
of the knee was accommodated
for through modifications to
the plaster model. Extra p-lite
padding in addition to a custom
molded insert was added at the
time of vacuum forming in the
medial knee area and at the lateral aspect of the ankle to
assist with skin integrity.
The device was fit and delivered with four straps and felt
pads to keep the orthosis donned. It had two Velcro straps
at the thigh, proximal to the knee, a calf strap at distal
to the knee and a figure 8 strap at
the ankle. The orthosis was then
with inside of a sneaker provided
by the family. In addition to the
modified nontraditional KAFO,
the patient also wore an ankle
foot orthosis on the contralateral
side with a shoe lift of 1.5 cm.
After fitting of the new KAFO, she was able to ambulate
more efficiently and she also had less incidence of skin
breakdown.
ACPOC NEWS
FALL 2014
17
Arthrogryposis encompasses a vast variety of diseases;
they range from being mildly involved to the severely
impaired. Recommendations for treatment are based
on individual practitioner experience; there is limited
research on the outcomes of the treatment for these
deformities with orthotic intervention (Amor, Spaeth,
Chafey & Gogola, 2011). The purpose of this case
study was to validate the use of unique interventions
custom designed for an individual patient based on her
specific needs. The follow-up analysis performed by a
motion analysis shows improvement in the aspects of
ambulation of the patient while wearing the orthosis
vs. no orthosis. The following tables show percentages
that are closer to those listed as normal with the orthosis
wear on the right side.
The management of musculoskeletal problems
associated with arthrogryposis presents many
challenges. Pediatric patients are best managed by a

comprehensive care team that includes an orthopedic

The results and the surgeon, physical therapist, orthotist, a pediatric
graph above from geneticist and a physiatrist. There are a high percentage
the motion analysis of these children that will be able to achieve some
display the associated measure of functional ambulation with a treatment plan
gait improvements of surgical intervention and unique orthotic devices
that are the result of that are custom designed for each individual (Bevan,
the custom orthotic Hall, Bamshad, Staheli, Jaffe & Song, 2007).
prescription.
References
Amor, C. J., Spaeth, M. C., Chafey, D. H., & Gogola,

ACPOC NEWS
FALL 2014
18
G. R. (2011). Use of the pediatric outcomes data collection instrument to evaluate functional outcomes in
arthrogryposis. Journal Pediatric Orthopedic, 31(3), 293-296.
Bevan, W. P., Hall, J. G., Bamshad, M., Staheli, L. T., Jaffe, K. M., Song, K. (2007). Arthrogryposis multiplex
congenital (amyoplasia): An orthopaedic perspective. Journal Pediatric Orthopedics, 27(5), 594-600.
Lampasi, M., Antonioli, D. & Donzelli, O. (2012). Management of knee deformities in children with arthrogryposis.
Musculoskeletal Surgery, 96(3), 161-169.

FDA Disclosure:
The FDA has cleared all pharmaceuticals and/or medical devices for the use described in this presentation.
Financial Disclosure:
Justina S. Shipley, CO, MEd, FAAOP: 3C (Comfort Products; Fillauer Companies); 9 (Louisiana Association of
Orthotists and Prosthetists; Orthotics and Prosthetics Activities Foundation)

All aspects of this device were financed by the Shriners Hospital for Children in Shreveport, Louisiana

Better
PERFORMANCE n QUALITY n RELIABILITY
Toll Free: 800.279.1865
on The Web: www.trsprosthetics.com n www.oandp.com/trs

ACPOC NEWS
FALL 2014
19
EXPLORE
YOUR MARKET ...
EXPOSE
YOUR PRODUCT ...
EXPAND
YOUR BUSINESS...

ADVERTISE
here with
ACPOC
NEWS
acpoc@aaos.org
 HAND ORTHOSES FOR COMPLEX CASES
[ WITH NEW TECHNOLOGY ]
Michael Ceder, CPO
Teamolmed Orthopedic Department
Jnkping, Sweden

Patients who need upper limb orthotics present to our orthopedic department often have problems that are
difficult for occupational therapists to solve. Many times this is due to lack of materials and/or lack of knowledge
of manufacturing skills. One reason could also be that prefabricated orthoses do not work satisfactorily. This
particular group of patients is often spastic with more or less intractable deformities.

When treating complex upper extremity patients there are many difficulties to overcome, but one important
element is a good shape of the orthosis. This increases the potential acceptance of the device, also increases
comfort of an orthosis and consequently the compliance of usage.

Traditionally, orthoses for complex upper extremity problems are made by using a plaster mold or
manufactured directly on the patient with a low temperature plastic. In both methods, achieving the desired
final position of the hand and finger joints is difficult and time consuming for both the patient as well as the
manufacturer.
Since 2008, we have worked with CAD/CAM technology and accumulated experience. The technology has a
great potential for correcting, copying and mirroring any body shape. It is also possible to effectively save digital
images and reproduce them.

1) New technology has made the

process easier in many ways especially
for the patient, but also for us as
professionals. It is rapid, comfortable,
and precise.

One difficulty with CAD/CAM has

been to scan patients who cannot keep
their body still and/or maintain the
desired position for the relatively short
time it takes to scan. Hands have been
especially hard to deal with when there
are many parts to be held in the right
position at the same time, and this

ACPOC NEWS
FALL 2014
21
is not easy with plaster either. As a result, we have the technique for manufacturing AFOs for the same
developed tools to facilitate this problem and achieved types of diagnoses and achieved similar result as
good results in producing all kinds of orthoses from with the hand patients. My experience in using this
head to foot, for all types of patient cases. Patients are manufacturing method is very positive and I am
delighted with this development. happy and proud to say that it is now possible to scan
100% of my patients.
It is world news that with this tool we now can scan
100% of our patients with satisfactory results. We
have developed bags for the hand and foot in different
sizes. By adapting the bag over the patients hand and
using a vacuum technique, we stabilize the body part of
interest in the position desired and are then able to scan
the patient without further correction or disturbing the
scanning process. Because the bags are transparent, the
scanner ignores the plastic. The acceptance from the
patients is very good and the scanning runs smoothly.
If we need to change the position, it is simple to let the
air go into the bag, reposition and stabilize in a new
position.

The use of foam molds, instead of plaster, has also

forced us to consider new materials and manufacturing 2) A good aid for controlling the finger position
methods. Synthetic felt has been a common material is to tape a plastic sheet to the fingers to control
for the last years in many ways at our company, and them. This technique has been used for plaster and
is a material made of 100% Polyester. We have found scanning.
it suitable for hand orthoses. Felt is a light material,
easily shaped, washable, has good breathability, and
also good acceptance and comfort. However, felt has
the negative side of being difficult to adjust with heat
and is time consuming in production.

Some of the advantages of CAD/CAM are that,

even if we were not scanning at the perfect angle,
the software makes it possible to alter and produce
orthoses in the desired position. Children are growing
individuals who frequently require new molds for
manufacturing. Contracture treatment with the goal of
improving angles, often requires new molds when, due
to treatment, conditions are improving. CAD/CAM
allows us to adjust models for growth or change in
angles without making a new model. 3) Stabilization of hand before scanning, with
help of the vacuum bag.
Until now, I have been treating patients with 33 different
WHFOs. These patients include mostly Cerebral Palsy
diagnoses, but also strokes, acquired brain injuries,
muscle diseases, and total paresis. I have also used
ACPOC NEWS
FALL 2014
22
 4) This is a woman with
Cerebral Palsy, GMFCS level 5.
It was difficult to hold the hand
in a stable neutral position. The
scanning was fast, but it took a
long time to get her relaxed and
position the hand, fingers and
thumb. The measurements were
equal between right and left, but
the angles were different.

5) This is the scanning

before modeling and the shape
when finished.

6) Here we bake two layers of felt together with a reinforcement of 2 mm

Polypropylene.

7) After modeling the right hand, we mirrored it and just

changed the angle alignment on the left side. Finally, this is a
picture of first fitting, but not trimmed yet.

ACPOC NEWS
FALL 2014
23
ACPOC
The Association of Childrens Prosthetic-Orthotic Clinics
6300 N. River Road, Suite 727, Rosemont, IL 60018-4226
Telephone|847.698.1637 F a x | 8 4 7 . 8 2 3 . 0 5 3 6
Email|acpoc@aaos.org W e b | w w w . a c p o c . o r g
CURRENT EVENTS, PRODUCTS, AND INFORMATION ...

SAVE THE DATE

ACCOMMODATIONS:
[ MAY 13 - 16,
ACPOCS ANNUAL MEETING ] 2015

HILTON CLEARWATER BEACH HOTEL MEETING HIGHLIGHTS

CLEARWATER BEACH, FLORIDA _ New Investigator Research Award
_ Physician Guided Case Study Forum
Come one, Come all: _ Scientific Papers and Posters
- Pediatric & Orthopaedic Physicians - Rehabilitation
Physicians - Physical & Occupational Therapists - _ Creative Solutions
Orthotists & Prosthetists - Nurses & Social Workers - _ Challenging Case Presentations

_ Technical and Scientific Workshops

_ Commercial Exhibitors

ABSTRACT SUBMISSION
DEADLINE

OCTOBER 1, 2014

For more information:

WWW.ACPOC.ORG

ACPOC NEWS
FALL 2014
24
 PEL Editorial
Professionalism a Key Factor in Success of Health Care Organizations
Help us stay current!!
PEL understands the importance of professionalism in the workplace.
Send in your new products,
The health care industry has undergone major changes, threatening the
company announcements,
confidence of patients. As complex as the system has become, health care
or involvment in the field and
organizations must remember the patients always take precedence. Achieving
well spread the word.
this priority starts with professionalism.

Professionalism has been largely explored the past three decades, because of the
expansion of healthcare. A recent study conducted by the Mayo Clinic explains
Contributing Advertisers:
professionalism is essential in healthcare, specifically in the relationships Allard USA pg. 2
formed between practitioners and patients. However, there has been a recent
shift in focus on this topic from individuals to organizations. The article College Park pg. 6
goes on to state that organizational professionalism leads to several benefits,
including improvements in patient trust, patient approval and organizational PEL Supply pg. 9
performance.
Fillauer pg. 16
PEL earns the trust of its customers, through its quality products and professional
services. The company puts the needs of its customers before anything else so Knit-Rite insert
that peoples lives can be improved. Despite the ever-changing environment
of the industry, PEL is always committed to providing the very best service TRS pg. 19
available and in a timely manner.
Cascade DAFO pg. 27
Our company understands this can be a challenging time for health care
practitioners, as they are often forced to redefine their relationships with OrthoAmerica pg. 31
patients, said PEL CEO, Mike Sotak. That is why we strive to make the O&P
Restorative Care Inc. pg. 32
buying process as stress-free as possible and at the best value. We want our
customers to know we are always on their side.

The professionalism of PEL is a big reason why its customers keep coming back.
The staff is friendly and always willing to help. No matter the circumstances, Interested in Advertising??
PEL is there to solve issues and provide the best solutions. This level of service
is why over 250 companies trust PEL to carry their products. Contact Us at

Professionalism is extremely important at PEL, added Sotak. We instill acpoc@aaos.org

values like teamwork, responsibility and integrity into our staff members so
they can not only succeed at our company, but also become better people as a OR
result.
jmarshallacpoc@gmail.com

ACPOC NEWS
FALL 2014
25
News from Cascade Dafo, Inc.
Practical education for exceptional care
Our popular in-person workshop curriculum is now available for you to take online --anytime, anywhere. The Cascade Dafo
Institute features a series of six courses that teach practical, real life skills to enhance your clinical practice. Highly interactive with
130 videos featuring more than 40 patients, these courses are self-paced pick and choose the content that best meets your
unique needs.

Visit the Cascade Dafo Institute online today to get started and earn up to 6.25 (free!) ABC credits:
http://www.dafo.com/cascade-dafo-institute/

DAFO FlexiSport strut flexibility options

The DAFO FlexiSport can now be ordered with your choice of
posterior strut flexibilitymoderately flexible or semi-rigid. This
plantarflexion / dorsiflexion resist brace design is ideal for larger,
active patients, especially teens, who need moderate to strong ankle
control, sturdy support, and flexibility. Weve increased the flexibility
selection of the posterior strut, making it easier to ask for exactly
what you want.

The versatile DAFO Tami2

Tami2 without inner liner

You asked; we listened. Were pleased to announce our popular articulated DAFO
Tami2 can now be ordered without a polyethylene inner liner. Available with straight
or dorsi-assist Tamarack hinges, the Tami2 without the inner liner is best suited for
patients who have a stable, neutral foot position but are in need of lightweight
sagittal plane support to control foot drop. Simply choose no liner on order form.

An alternative to polyethylene:
OP Flex

Weve expanded our material choices to include OP Flex, a soft and flexible
liner for inner boots. This option is now available for all DAFO Softy brace
stylessimply write OP Flex
in the Special Instructions section of order form.

Now with adjustable hinges

The DAFO Tami 2 can now be ordered with an adjustable hinge: the Flexion Control
Ankle Joint (FC2) from Lower Extremity Technology, Inc.
Manufactured from annealed stainless steel, the FC2 features a proprietary spherical
axis that provides up to 70 degrees of adjustability.
This optimization is designed for patients in need of control in the sagittal plane
whose improvements in range, strength, and, coordination may warrant adjustments
to the PF/DF angle of their orthosis.
To order, use the Special Instructions box on the DAFO Tami 2 order form. Indicate
replace standard hinges with FC2.

Helping kids lead healthier, happier lives cascadedafo.com

acpoc-news_jul-sep.indd 2 8/1/2014 11:20:08 AM
ACPOC
The Association of Childrens Prosthetic-Orthotic Clinics
6300 N. River Road, Suite 727, Rosemont, IL 60018-4226
Telephone|847.698.1637 F a x | 8 4 7 . 8 2 3 . 0 5 3 6
Email|acpoc@aaos.org W e b | w w w . a c p o c . o r g
MEMBERS KEEPING IN TOUCH ...
ADDERSON, JIM james.adderson@cdha.nshealth.ca FAIRBANKS, PATRICIA pfairbanks@ddiinfo.org
ALEJANDRO, RUTH rutha@blythedale.org FIELDEN, ROBERT drfielden@yahoo.com
ANDREW, J. THOMAS jta@abilityprosthetics.com FISK, JOHN sailingfisk@gmail.com
ANGELICO, JOHN A. john.angelico@schekandsiress.com GLASFORD, SHANE sglasford@hollandbloorview.ca
ARMSTRONG, PETER parmstrong@shrinenet.org GREENBERG, SHARON sharongreenberg@comcast.net
ARTERO, LISA lartero@hollandbloorview.ca GUIDERA, KENNETH kguidera@shrinenet.org
ATHEARN, JIM jathearn@shrinenet.org HANSEN DEANNA deanna@donnanddoff.com
ATKINS, DIANE djatkind@yahoo.com HANSON, WILLIAM william.hanson@liberatingtech.com
BANZIGER, EUGENE eugene.banziger@gmail.com HARDER, JIM jharder@ucalgary.ca
BARRINGER, WILLIAM J. wjbarringer@hanger.com HEELAN, JAMEE jheelan@ric.org
BEAUCHAMP, RICHARD rbeauchamp@cw.bc.ca HEIFETZ, JONATHAN Jheifetz@piol.us
BELBIN, GREG gbelbin@aodmobility.com HEIM, WINFRIED winfried.heim@sunnybrook.ca
BERG, RANDY randy@troppman.ca HILL, WENDY whill@unb.ca
BERNSTEIN, ROBERT robert.bernstein@cshs.org HONEYCUTT, JULIE julie.honeycutt@maryfreebed.com
BLISS, KIERAN designprosthetic@bellnet.ca HOYT, KIMBERLY khoyt@ecentral.com
BOUTIN, BARBARA barb@orthoticspecialists.com HUBBARD, SHEILA Sheila.hubbard087@sympatico.ca
BOUTIN, BRETT brett@orthoticspecialists.com HYLTON, NANCY nhylton1@comcast.net
BRENNER, JOSEPH jbsyntax@hotmail.com JENKINS, FRAN fjenkins@fillauer.com
BROOKS, JEFFREY jebrooks@hanger.com KALLEN, JAMES precisionpando@telus.net
BUSH, GREG gbush@unb.ca KATZ, DONALD don.katz@tsrh.org
CHRISTENSON, DONALD dchris10son@icloud.com LARSON, OWEN owen@limbspecialists.com
CLARK, MARY mwilclark@att.net LINK, MIKE link@college-park.com
COCKERELL, GARY designprosthetic@bellnet.ca LIPSCHUTZ, ROBERT rlipschutz@ric.org
COLE, DANIEL danielcoleco@aol.com LYTTLE, DAVID drlyttle@hotmail.com
CORDONE, JOHN jcordone@cbsortho.com MALAGARI, MIKE mmalagari@comcast.net
COULTER, COLLEEN colleen.coulter@choa.org MANDELBAUM, MARTY marty@mhmoandp.com
CRANDALL, ROBIN rcrandall50@gmail.com MAPLES, DAYLE dayle.maples@maryfreebed.com
CUOMO, ANNA avcuomo@gmail.com MARSHALL, JANET jmarshallACPOC@gmail.com
DECKER, LOREN loren@capitolorthopedic.com MCCARTHY, MEGAN megan@ astepforwardpdx.com
DRYGAS, THADDEUS teddrygas@carecrafters.com MILLER, ERIC emilleruk1@yahoo.com
EDMUNDS, M. CRAIG cedmunds@nationalrehab.com MODRCIN, ANN C. amodrcin@cmh.edu
EVANS, TIMOTHY timothytevans@gmail.com MORRISSY, RAY rtmorrissy@mindspring.com

ACPOC NEWS
FALL 2014
28
MUILENBURG, TED ted@mpohouston.com WESTBERRY, DAVID dwestberry@shrinenet.org
NEFF, GEORG toc-neff@gmx.net WHITE, HANK hwhite@shrinenet.org
NELSON, CHRISTOPHER cnelson@bostonbrace.com WILCOX, RICHARD L. rwilcox@shrinenet.org
NICHOL, BILL nicholortho@shaw.ca WILLIAMS III, T. WALLEY twalley.williams@liberatingtech.com
NOLIN, WILLIAM wnolin@gillettechildrens.com ZUNIGA, JORGE M. jorgezuniga@creighton.edu
NOVOTNY, MARY P. MaryPNovotny@gmail.com
OKUMURA, RAMONA okumura@u.washington.edu
OPPENHEIM, WILLIAM M. woppenhe@ucla.edu
PADILLA, TOM tom@brownfieldstech.com
PANSIERA, TERRY terry@ots-corp.com
PAULSEN, DOUG dougp@rccinc.ca
PLANK, LAURA rlplank@hotmail.com
We want our members to be in
contact, please help us in achieving
RADOCY, BOB bob@trsprosthetics.com
this by assuring your email address
RAMDIAL, SANDRA sandra.ramdial@ottobock.com
is correct or adding your name to
RAMICONNE, JOE joe.ramicone@scheckandsiress.com
our registery.
RANEY, ELLEN M eraney@shrinenet.org
ROTTER, DAVID david.rotter@scheckandsiress.com
SANDERS, JIM james_sanders@urmc.rochester.edu E-mail changes and additions to
SCADUTO, ANTHONY
SCHMITZ, MIKE
tscaduto@mednet.ucla.edu
mikeschmitz@earthlink.net
acpoc@aaos.org
SHIDA-TOKESHI, JOANNE jshidatokeshi@gmail.com
SHORGAN, NOELLA nshorgan@yahoo.ca
SHNIER, GAVIN gavin@orthocast.co.za
SMITH, CRAIG 1sps@rogers.com
SMITH, SANDRA sbsmith@shrinenet.org
STEINMANN, ROBERT steinmannoandp@comcast.net
SUPAN, TERRY supanpoc@wildblue.net
TROST, FRANK frank_trost@yahoo.com
UELLENDAHL, JACK juellendahl@hanger.com
VALERI, JOHN jvaleri@gillettechildrens.com
VANDENBRINK, KEITH kcv638@charter.net
VIGNA, OLGA olga_vigna@hotmail.com
WATTS, HUGH hwatts@ucla.edu
WEINSTEIN, STUART stuart-weinstein@uiowa.edu

ACPOC NEWS
FALL 2014
29
 Scientific Research

?
SHARE YOUR KNOWLEDGE...
Challenging Case Study

Creative Solutions

Professional or Personal
Perspectives

New Product Reviews

acpoc@aaos.org
GET PUBLISHED in
ACPOC NEWS
 Complete System for the Orthotic
Management of Plagiocephaly,
Brachycephaly & Scaphocephaly.

Over 150 STARscanners in use at prestigious

institutions across the globe.
UNITED STATES WORLDWIDE
Altru Rehab Center, North Dakota AHS Tokyo, Japan

150,000 infants successfully treated with
theSTARband
Largest selection of cranial remolding orthoses
for treatment of deformational plagiocephaly
& Post-operative Craniosynostosis
Scan infants head shape in 2 seconds or less
eliminating the need for plaster casting
Capture 3-D Data that can be viewed in
multiple planes
Arnold Palmer Hospital for Children -
Orlando, FL
Carrie Tingley Hospital - New Mexico
Childrens Healthcare of Atlanta
Childrens Hospital & Medical Center -
Omaha, NE
Childrens Hospital of Colorado - Denver, CO
Childrens Medical Center - Dallas, TX
Hasbro Childrens Hospital - Providence, RI
Lutheran General Hospital - Chicago, IL
Marshfield Clinic - Marshfield, WI
Mary Free Bed Orthotics and Prosthetics
Holland, MI
Mary Free Bed Rehabilitation Hospital -
Grand Rapids, MI
Massachusetts General Hospital
Alberta Childrens Hospital - Calgary, Alberta
Bandagist Jan Nielsen A/S - Denmark
BC Childrens Hospital - Vancouver, BC
Beagle Orthopedics Blackburn, United Kingdom
Clnica del Country Bogota, Colombia
Clinical Orthotic Consultants - Windsor, ON
CranialCare - So Paulo, Brazil
Eemland Orthopedie Techniek B.V. - Amersfoort,
Netherlands
EFMO, Gabinete STARcenter - Madrid, Spain
Hospital for Sick Children Toronto, Canada
Matsumoto P&O Manufacturing Co. Aichi, Japan
Mediclinic Welcare Hospital - Dubai, UAE
Nishinomiya Kyoritsu Neuro Hospital -
Hygo, Japan

Mayo Clinic - Rochester, MN Orthokorea - Seoul, Korea

Miami Childrens Hospital - Dan Marino Center
Oakland Childrens Hospital - Oakland, CA
Park Nicollet - Minneapolis, MN
Rehabilitation Medical Supply, South Dakota
Seattle Childrens Hospital
Tufts Medical Center- Boston, MA
University of Missouri Hospital
Ortho Pro Associates - Cumbaya,
Quito Ecuador
Orthotic Solutions Ltd. - Edmonton, Alberta
OTH De Hoogstraat - Utrecht, Holland
Pro Walk GmbH - Egelsbach, Germany
RSL Steeper - Leeds, United Kingdom
Taiwan Orthotics and Prosthetics Company -
Taipei, Taiwan

University of Rochester Medical Center

Scores morethroughout
University of Texas Health Science Center local O&P facilities in the
at Houston US and overseas.
University of Texas Health Science Center
at San Antonio

Wolfsons Childrens Hospital - Jacksonville, FL

www.orthomerica.com
2014 Orthomerica Products, Inc. All Rights Reserved. 877-737-8444

Restorative Care of America
29RHO
Pediatric Resting
Hand
Offers a functional resting
hand position following
injury or surgery, burns,
provides support to un-
stable wrists, and can be
used for the prevention
and treatment of wrist
and finger contractures.
Lightweight, durable
Kydex plastic.
Heat moldable at low
temperature.
Washable, breathable,
wicking liner.
Available with closed
cell foam liner for burn
patients.
445-WDO
Wrist Drop
Orthosis
Holds the hand in
extension.
Heat-moldable Kydex.
Universal Cuff,
accommodates eating
and writing utensils.
Removable, washable,
foam liner.
30CHK (Kydex)
Pediatric
Contour Hand
For the moderate to
severely contracted
hand and wrist.
Heat-moldable Kydex.
Positionable to meet
progressive patient
needs.
Washable, breathable,
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RCAI Pediatric Line
To order, phone (727) 573-1595 or (800) 627-1595.
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96HD-BHAO
HD Pediatric Hip
The new HD Pediatric Hip
controls or prevents deformity
after soft tissue release and
other hip surgeries for children
with Cerebral Palsy. It pro-
vides a higher level of support
and stabilization of the pelvic
region due to greater coverage
of the mid spine.
Heat moldable Kydex hip
girdle.
Bilateral thigh cuffs.
Flexion/extension ROM
control from 0 120 in
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29RHO
Abduction/adduction
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96HD-BHAO
Circumferential hip and thigh
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Vertical adjustability at hip and thigh.
29RHO-I
Adjustable rotational control hinges.
Removable, replaceable, washable liner pads.
Adjustable rotational control hinges
67RKPOP Pediatric Ratchet
POP Knee Brace
The Pediatric Ratchet POP Knee Brace is
designed for post surgical ROM limitations,
ligament repairs, instability and soft tissue
445-WDO contractures.
Flexion/extension ROM control in 7 1/2
increments.
Ratchet type mechanism that allows
incremental, locked positioning.
With the flip of a lever, the angle of the limb
can be extended in 10 increments from
60 0 without the use of settings or tools.
Hinges may be ordered separately by the
pair for custom bracing.
Anti-microbial liner. 67RKPOP-P
11DFMP Dorsi-Flexion Multi Podus
For adjustable static stretch
of the plantar flexors, treating
neuromuscular conditions.
Medial/lateral straps attached
to the sides of the brace allow
the foot and ankle to be
controlled, as needed, in the
desired dorsi-flexed position
prescribed.
30CHK 11DFMP