Patient Resource Center / Innovations

Innovations

Prosthetic Innovations:	Orthotic Innovations:
• M.A.S. Socket Design	• Stance Control Orthotic Knee Joint
• Utah Arm 3
• C - Leg Prosthetic Knee System

PROSTHETIC INNOVATIONS

M.A.S. Socket : A Transfemoral Revolution

Full range of motion with the M.A.S. Socket

The M.A.S.® socket design is an evolution--and perhaps even a "revolution"--in the development of ischial containment (IC) socket concepts. Since 1999, when Marlo Ortiz Vazquez del Mercado, Ortiz Internacional, Jalisco, Mexico, first unveiled his new design, it has continued to arouse interest throughout the O&P worldwide community. Recently the design was featured in the Thranhardt lecture series during the American Academy of Orthotists & Prosthetists 2004 Annual Meeting and Scientific Symposium.

The new design provides several clinical benefits: patients can sit more comfortably; there is no plastic beneath the gluteus; the prosthesis is easier to don; patients enjoy full range of motion, better functional gait--and important to patients and family members too--much better cosmesis. Seeing a video of patients walking, sitting, and demonstrating the range of motion possible is truly amazing.

Patients can sit more comfortably with the M.A.S. Socket

Ortiz, who is a prosthetist and engineer, has fit hundreds of patients with the design to date. These patients reportedly have had no difficulty in wearing the socket for long periods of time. In fact, one amputee, due to his work schedule, actually wore the socket for 28 straight hours with no discomfort.

Agnes Curran, CP, OPGA prosthetist, pointed out that the design seems to be surprisingly skin-friendly despite the intimately fitting contours. Generally there is no skin irritation, and some amputees who had worn previous prostheses found that existing skin problems cleared up.

OPGA, Waterloo, Iowa, along with O&P1, Waterloo, hosted an initial seminar in January 2004 in which Ortiz taught how to cast, modify, and fit the design. An office worker who came with prosthetists from Nebraska attending the first seminar served as one of the patient models. She wore her check socket all the way home to Nebraska and asked the prosthetists to come in over the weekend to laminate it so she could begin wearing it immediately. Another patient waited all day for his new socket rather than go home with the old one. This patient enthusiasm is testimonial to their acceptance of this new design.

Bob Tillges, CPO, FAAOP, Tillges Certified Orthotic Prosthetic Inc., Maplewood, Minnesota, is enormously enthusiastic about the new design. Tillges, who attended the initial OPGA seminar in 2004, has since successfully fit over 150 amputees with the socket. He is receiving continual inquiries from local and out-of-state amputees that are interested in coming to Tillges Certified orthotic Prosthetic, Inc. in Maplewood, Minnesota for socket replacement with the MAS style.

"All my patients have been very satisfied," he said. "They have no discomfort; there's better ischial containment and range of motion. In fact, one of my patients' wives called me and said, "This is the most awesome prosthesis my husband has ever worn! I can't even see it under his slacks." She added that it had always bothered her before when her husband's prosthesis outline was visible.

"I'm taking time to learn and understand the mechanics of Marlo's system, and I'm getting very good results," Tillges added. Although most of Ortiz's patients are younger, Tillges has a large percentage of geriatric amputees. He has fit amputees aged from 44 to 81, including several in their 70s. Four of the 11 use some auxiliary suspension, but the others use true suction suspension only. "These sockets stay in total contact with flexion, extension, adduction, and abduction," Tillges said. "Something that has always bothered me as a professional is when you can see gapping, spaces, or outline of the socket under clothing." Although many were skeptical at first and thought the design would cause proximal tissue roll development, Tillges said, "We have not experienced that problem." He added, "With better ischial containment, you reduce the amount of tension values needed for suction, get more comfort, and achieve better suspension.

"Tillges started his O&P career carving and fitting wood sockets in the 1970s; he has seen socket technology develop through 30 years up to the present. Some iterations of the ischial containment concept through the years have included the quadrilateral "quad" socket shape taught by the O&P schools at New York University (NYU), Northwestern, and the University of California-Los Angeles (UCLA). Ivan Long, CP, developed his Long's Line, and John Sabolich, CPO, came up with the Contoured Anterior Trochanteric Controlled Alignment (CAT/CAM) method. Tillges feels that Ortiz has gone beyond these in IC design excellence. He noted how much his patients who have worn other socket designs appreciate the new sockets: "No way do they want to go back to what they had before." Tillges is also educating his company's residents and young practitioners in the technique.

Medial Ramus Containment with the M.A.S. Socket

The Design: What Is It?
So, what is the M.A.S. socket? Ortiz describes his design: "It is very important to consider the angle of the ischial ramus. The ischial tuberosity and part of the ramus as well as the medial aspect of the ramus are encapsulated within the medial aspect of the socket brim." Generally, the medial wall is lowered anteriorly to avoid pressure on the ascending ramus; effectively ischioramal weight-bearing eliminates the need for gluteal support, so those tissues can be excluded from the socket, he explained.

In the M.A.S. design, the height of the posterior wall has been lowered to the gluteal fold, so the entire muscle belly can be free of the socket

In the conventional design, posterior trim lines include part of the gluteus maximus. In the M.A.S. design, the height of the posterior wall has been lowered to the gluteal fold, so the entire muscle belly can be free of the socket. "This will not only improve cosmesis but with this configuration, we have found that ischial tuberosity and part of the ischial ramus are encapsulated more effectively with no restriction in hip movement," Ortiz said."With the gluteal cutout, no weight bearing occurs in this area, and weight-bearing forces are vectored from the captured medial aspect of the ramus with a resultant force projecting to the anterior/lateral area of the socket," explained Al Pike, CP, in "A New Concept in Above-Knee Socket Design"

www.opga.com/MAS

Utah Arm 3

Since 1981, the Utah Arm has been the premier myoelectric arm for above elbow amputees. It was originally developed at the University of Utah by the Center for Engineering Design, led by Dr. Steve Jacobsen. In 1987, Motion Control released the Utah Arm 2, with entirely re-engineered electronics that made the Utah Arm the most durable and dependable myoelectric arm avaialable.

The Utah Arm 3 - One Step Closer to Nature
In 2004, the Utah Arm 3 introduced microprocessor technology into the Arm, with a Computer Interface that allows the prosthetist or wearer to fine-tune the adjustments to achieve maximum performance. A variety of inputs may be used, so more options are available to more wearers. Meanwhile, the U3 still delivers the same sensitive, proportional control of elbow, hand and wrist (optional), letting the wearer move the arm and hand slowly or quickly in any position.This provides a more natural response with less effort than the traditional on/off movement.

What's new about the U3?

Simultaneous Elbow and Hand control! Because the Utah Arm 3 has two microprocessors, two functions can be controlled at once (optionally), thus producing a more natural movement.
More Input Options
- EMG Preamps using disc or snap-type electrodes
- Motion Control Linear Potentiometer
- Motion Control Touch Pads
- Motion Control Force Sensor
- Otto Bock Linear Transducer
Easy to Use Computer Interface. For adjustments by the prosthetist The Set-Up Wizard guides you through the process of setting up your system step-by-step. Once set up, users can readjust by routing directly to the adjustment screens.
Maximum Function. The Utah Arm 3's mobility and fine tuning allow any patient to achieve maximum function, including transhumeral, forequarter amputees and shoulder disarticulation. Many arm wearers master function quickly, after training with a qualified Therapist.

The Utah Arm 3 Technical Specifications:

Excursion Range: 135°
Excursion Time With Myoelectric Hand TD: 1.20 seconds
Active Lift: 1 kilogram (2.2 lbs.) in the Terminal Device and using a fully charged Battery
Load Limit: 22.7 kg (50 lbs.), w/ elbow locked at 90o flexion15.9 kg (35 lbs.), when forearm extension installed
Humeral Rotation: Unlimited
Wrist Rotation: Quick-Disconnect Wrist: 360° in each direction
Weight: Without Hand: 913 grams (2 lbs.)Hand Weight: 450 gm (1lb.), plus glove
Heat Tolerances: Operating Temperatures: 0° to 44°C (32° to 110°F)
Storage Temperatures: -18° to 60°C (0° to 140°F)
Current: Maximum: 4.0 Amps Quiescent: 10 mA
Battery Specifications: (5 Battery Packs supplied) Rechargeable NiMH, (1100 mA Hours capacity)
Voltage: Dual Supply, ± 6 Volts D.C. (total 12 V.)
Charge Time: 2.5 Hours, maximum
Forearm Length: (from rearmost point of the forearm to the end of the wrist)
- Standard: 27.3 cm (10.75 in.)
- w/Extension: 32.4 cm (12.75 in.)
- Minimum: 24.8 cm (9.75 in)..

www.utaharm.com

C - Leg Prosthetic Knee System

Otto Bock HealthCare introduced the C-Leg® microprocessor-controlled knee-shin system to the United States in 1999. Since then, thousands of wearers have benefited from this quantum leap in prosthetics - a dramatic improvement over all other prosthetic knees. Featuring unique microprocessor swing and stance phase control, its customized settings and constant readjustments, the C-Leg is truely one of a kind. The efficiency of the C-Leg's swing phase dynamics, even at varying walking speeds and uneven terrain, provides a more secure, natural, and efficient gait.

Getting started is easy. Using a PC-based custom software, a C-Leg Qualified Prosthetist customizes the C-Leg®'s settings to fit the individual's optimal gait pattern. The wearer is also trained and observed while walking on level and uneven terrain, and down stairs. In addition, a second set of settings can be created for a different activity, which the wearer can access by simply tapping their toe - offering choice without mechanical changes!

ORTHOTIC INNOVATIONS

Over 600 types of upper and lower extremity orthoses are currently available.

Stance Control Orthotic Knee Joint

Designed for patients with weak or absent quadriceps and varying degrees of knee instability. This lightweight orthosis will allow patients to regain their mobility and assist them in a more energy-efficient ambulation. The Horton SCOKJ® blocks flexion at any degree.

Our experienced practitioners are familiar with a range of custom fit and fabricated devices in such materials as metal, carbon graphite, and thermoformed plastic. Varieties of knee/ankle/foot and ankle/foot orthoses both correct and protect joint and muscle impairments as do upper extremity devices that focus on shoulders, elbows and wrists. An orthosis may consist of a single unit or an entire system of components tailored to a specific condition.