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1407 E. Michigan Ave., Jackson 517-784-1142 770 Riverside Ave., Suite 101, Adrian 517-263-3310
Important News for Above-Knee Amputees
Ted A. Trower C.P.O.
The comfort and function available to the Above-Knee (AK) amputee has just taken a huge leap forward. The 1950ís brought us the Quadrilateral socket and its scientific, anatomically based design. The 1980ís brought the Ischial Containment (I.C.) design with its improved stability and control when it worked well. Unfortunately, it didnít always work well.

Today we have a new, and vastly superior socket design available to the AK amputee. Dubbed the Marlo Anatomical Socket it is commonly referred to by itís acronym MAS. Marlo Ortiz in Guadalajara, Mexico developed this design and it offers a number of major advantages over the Quad or I.C. socket with the primary advantage being comfort. When it is properly fitted the amputee does not have any areas of concentrated pressure on their limb. When I have asked an amputee about pressure they are actually unable to tell me where they are carrying their weight. The second major advantage is stability and thus control of the prosthesis. Although the I.C. socket offers improved stability over the Quadrilateral design, it was still common to see the amputee experience irritation on the skin to the inner/upper thigh from the prosthesis shifting laterally under the amputee when carrying the amputeeís weight in ambulation. In the MAS socket lateral shifting of the socket on the limb is completely eliminated. This results in the amputee having complete control and balance on the prosthesis.

The third advantage is unexpected and very welcome. The MAS socket is extremely cosmetic when worn. Both the Quad and the I.C. socket were quite uncosmetic in that they pushed the buttock on the affected limb upward as much as three or four inches. Imagine if you were forced to wear a device that lifted your right cheek three inches above your left one, wouldnít it make you self conscious? Now imagine that every time you sat down you had a piece of hard plastic under your cheek on one side, sound uncomfortable? You bet it is, and especially so on an unpadded chair! This is the fourth, and most unexpected of all, advantage. The MAS socket is fitted in such a way that when the amputee flexes their hip to sit down the socket falls away from the buttock and the pelvis and allows the amputee the comfort of sitting only on the chair and not on the top of their prosthesis!

Iíve been in the prosthetic profession for over twenty-three years and Iíve seen grand claims made before. Iíve not found anything that has impressed me as being so real as the benefits of this change on a socket design. Iíve also seen systems that seemed to work for the developer but no one else could repeat their results. Thatís not the case here! This is a design that has been completely thought out and described so that it can be applied by any skilled prosthetist. I know this is true because Iíve tried it in my own office and it delivers everything it promises. Amputees with thirty and forty years of experience wearing prostheses describe it as the most comfortable socket they have ever worn. The quality of their gait is improved as well. And because they are spending less effort trying to maintain their balance they have more energy for doing other things, the things that they want to do.

This is a new technique and only a very limited number of prosthetists have been trained in it to date. Even fewer have significant experience applying the technique. It does require extra time and effort to make it fit properly but it is worth it in every way and remarkably it doesnít cost the amputee any more than a more conventional design would. The MAS socket can be used with any of the existing systems of socket suspension and with all available prosthetic knees and feet. This is not some sort of gimmick to make the developer money or to sell some product. Itís just a major advance in the history of prosthetic design, nothing more, and certainly nothing less.

Please feel free to contact us for a free evaluation on this new design.

Prosthetics and Orthotics Today
Ted Trower C.P.O.
The common image of a prosthesis (artificial limb) or orthosis (brace) is a far cry from todayís reality. As with so many others areas, technology has radically altered the very nature of modern artificial limbs and limb braces. Where wood, leather and steel were once the primary elements from which prostheses and orthoses were crafted, todayís devices are made with sophisticated thermoplastics and carbon graphite fibers.

With regard to prosthetics, the options available to amputees vary according to the level of amputation but include sophisticated high-tech elements in every portion of the prosthesis. Socket designs have changed as our understanding of soft tissue health has improved. Total surface bearing designs provide improved comfort, increased circulation, and reduced skin irritation. Socket materials have changed radically. Flexible plastics reduce edge pressures and allow muscle movement. Urethane and silicone gels cushion the interior of sockets to eliminate pressure points and abrasion. Modular components made of carbon fiber and titanium reduce the weight of prostheses profoundly. A below knee prosthesis that would have weighed eight to ten pounds in the early 1970ís will weigh as little as two pounds today. Shock absorbing devices allow the amputee to jump down from platforms or loading docks without feeling any significant impact on their limb.

The variety of feet available to choose from has mushroomed. Special purpose feet are available for sprinting, jumping, swimming, and rough terrain, as well as for milder everyday activities and for individuals who require extremely lightweight and or energy efficient designs. Prosthetic feet have undergone a revolution in concept and design. Dynamic spring designs have greatly reduced the effort in prolonged or rapid walking and are now available for virtually all lower-limb amputees.

Above knee amputees have recently seen a revolution in prosthetic knee design. The development of practical microprocessor-controlled knees has meant that above knee amputees are no longer in danger of falling down when descending ramps or if they accidentally stub the toe of their prosthesis.

Even how a prosthesis is held in place has changed dramatically. Systems for suspension and volume control use vacuum pumps to remove air and moisture form the interior of the prosthesis, stabilizing limb volume and preventing any slippage of the prosthesis. Other prostheses are suspended from an attachment to the bottom of the previously mentioned gel socket liners. The need for using uncomfortable waist belts to hold the prosthesis on has virtually been eliminated.

For the amputee concerned about appearances our ability to apply a lifelike cosmetic skin over the prosthesis has also vastly improved. Some silicone skins are virtually indistinguishable from the real thing at even a small distance.

Amputees are not the only one to benefit from the new technologies, exciting changes are happening in Orthotics as well. Just as dynamic response, or energy storing, feet revolutionized prosthetics twenty years ago, dynamic response A.F.O.ís (ankle-foot orthoses or short leg braces) and K.A.F.O.ís (knee-ankle-foot orthoses or long leg braces) are entering the field today. The most sophisticated of these designs are still quite expensive but can actually allow most individuals who wear a KAFO to be fitted with an AFO, eliminating the bulk and weight of the knee joints entirely! For those individuals who do still require the use of knee joints there are now several designs available that allow the knee joint to unlock / relock automatically with each step. This ends the need to walk with a stiff legged gait that is both uncosmetic and very inefficient.

The materials revolution hasnít overlooked Orthotics either. Engineered thermoplastics allow greater flexibility without sacrificing all-important stability. Carbon composite materials allow lightweight systems that are among the strongest of all possible options.

All this enthusiasm for the new technologies and techniques should not be construed a criticism of more traditional designs. They still have their place and have a proven track record that no new design or component can offer. For those folks who are happy with their existing prosthesis or orthosis there is no need to rush out and change what they are wearing. For anyone who isnít content with what they are wearing now, a consultation with a well informed and progressive prosthetist or orthotist could yield just the kind of change they are hoping for.

Comment from follow-up survey
Exceptional excellent well above standard.