Education in prosthetic and orthotic training: Looking back 50 years and moving forward.

There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.

Historical review: suspension therapy for the treatment of tabes dorsalis.

BACKGROUND: Suspension therapy was developed by a Russian doctor, A. Motschutkovsky and at the end of the 19th century it was a popular treatment for tabes dorsalis. It was endorsed by Jean-Martin Charcot in France and Weir Mitchell in the United States; but after 10 years, it was abandoned because it proved to be useless and some patients developed paralysis. SUMMARY: The effect of suspension upon a spinal cord affected by tabes dorsalis and a healthy spinal cord has been analyzed in the light of current knowledge. The benefits of suspension were thought to be due to an improvement in the blood supply to the spinal cord and due to the suggestibility or the placebo effect. Key Message: Analysis of the contemporary literature in the light of current research shows that suspension therapy was a powerful weapon that could cause impairment to the conductivity of the spinal cord and this has important implications for current therapy such as the use of Harrington rods.

Prostheses and orthoses in the collections of the Auschwitz-Birkenau State Museum.

The authors described 424 orthopaedic appliances left by the prisoners of the Nazi Concentration Camp in Oswiecim. A collection of prostheses and orthoses, which is currently a part of the Auschwitz-Birkenau State Museum's exhibition, is extraordinary as it illustrates the fate of innocent, crippled people, who were incarcerated and murdered. Another point of value of the collection is its technical aspect, as it provides a clear picture of construction of prostheses and orthoses at the beginning of the 20th century.

[History of the treatment of scoliosis]. / Histoire du traitement de la scoliose.

Scoliosis remains a challenge to treatment, in spite of continuous efforts since the earliest times. The author describes the technical innovations with added efficiency, but even today one cannot avoid treatment without instrumentation and fusion, an always difficult indication on account of the variety of cases. Research is very active worldwide and accounts for great expectations (the role of the melatonin complex, the genetics of evolution factors, or the imagery of the EOS system). For the more deformed however treatment still remains unchanged in its principle: correction and fusion.

The modern era of orthotics.

The past 40 years has seen the field of orthotics change from a craft-based industry into a modern clinical specialty. The author describes his personal view of some of the most important developments during this period in the areas of manufacturing and materials, patient/orthosis matching, biomechanics, joint design and standards. Some likely areas of future development are suggested.

Pavlik: the man and his method.

Because of the high rate of avascular necrosis, Pavlik developed his harness and method of treating developmental dysplasia of the hip in infants. This historical review highlights Pavlik's career from the time he worked with Frejka and then later in his own clinic in Olomouc, Czech Republic (1938). In the 1950s, he wrote five articles on the results of his harness use in developmental dysplasia of the hip. Subsequently, Pavlik's harness has become the orthosis of choice worldwide for treatment of infants with hip dysplasia because of the principles he espoused.

Hyphenated history: the Böhler-Braun frame.

Throughout the history of medicine, many great physicians have originated or popularized ideas that have resulted in their names being attached to a device, procedure, or disease process. Hyphenated eponyms are especially interesting, for there are always underlying stories that explicate how people became associates in history. This paper will describe a bit of hyphenated history regarding orthopaedic trauma, specifically, the development of the Böhler-Braun frame. The lives of two great surgeons associated with this device, Lorenz Böhler, the "father of traumatology," and Heinrich Braun, the "father of local anesthesia," will also be reviewed.

[Idiopathic scoliosis and Scheuermann's kyphosis. Historical and current aspects of conservative treatment]. / Idiopathische Skoliose und Scheuermann-Kyphose. Historische und aktuelle Aspekte der konservativen Behandlung.

Although in practice since antiquity the nonoperative treatment of spinal deformities is still controversial. Giving preference to orthotic treatment and physiotherapy the historical development of nonoperative treatment will be demonstrated by the examples of idiopathic scoliosis and Scheuermann's kyphosis. It is surprising how early essential and still valuable principles of nonoperative treatment had been acquired and how many of the present-day concepts have remarkable forerunners in the 19th century. In the light of previous knowledge and personal experience the indication, practice and realistic capabilities of modern nonoperative treatment of idiopathic scoliosis and Scheuermann's kyphosis are pointed out.

Podiatric biomechanics. An historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty.

This article attempts to review comprehensively the development of the established Root Model and to appraise dispassionately its place and role in today's field of clinical podiatric biomechanics. It also discusses several important emergent models (the models of Dananberg, Kirby, Fuller, McPoil, Hunt, and Demp) that have gained increasing popularity among the podiatric and nonpodiatric clinical communities over the last 10 to 15 years. All of these models (the Root model and emergent models) have been analyses against the background of the Kuhnian concepts of "paradigm" and "preparadigm." Discussion has been provided as to whether the domain of podiatric biomechanics presently resides in a paradigm driven normal science phase, or whether it is still functioning within a preparadigm phase with its defining hallmark of community nonconsensus. Suggestions are then made as to possible ways for research to progress within the present ferment of debate and theoretic uncertainty.

The change in orthotic making techniques with the development of current biomechanical theories.

In the early 1960s, a few orthopedic practitioners, following the work and example of Dr Merton Root, decided to pursue new orthopedics, which became known as biomechanics. In the 1970s, after years of encountering resistance, a few laboratories were available to fabricate the Root orthotic and offer advice and education on the management of the orthopedic patient. Eventually, runners turned to podiatrists for conservative care so they could continue to participate in their sport; biomechanics had become established. Presently, podiatrists have not performed the research necessary to document and further Root's work; however, as stated in one of life's axioms, the only credentials one needs are results. William Eric Lee's article is a thorough, comprehensive documentation of events and background of Root and his theory. Lee set out to provide a detailed picture of Root's clinical system of approach toward the treatment of mechanically induced foot ailments. His article is a splendid achievement.

Crónica de las lesiones infligidas en campaña a San Ignacio de Loyola en el sitio de Pamplona a principios del siglo XVI / Chronicle of injuries underwent by Saint Ignatius of Loyola in the siege of Pamplona at the begining of the XVI Century

San Ignacio de Loyola, originalmente militar y defensor en el sitio de Pamplona, que fue ejercido por los franceses en 1521, sufrió durante esa campaña un impacto de piedra, material del que estaban elaborados los proyectiles de guerra una vez que se empezó a utilizar la pólvora con fines bélicos, mismo que le produjo lesiones en las partes blandas de la pierna izquierda y una fractura expuesta de la tibia derecha en sus tercios medio y proximal. Tratado en primera instancia por los propios médicos franceses mediante cauterización de las heridas, se pudo librar de la ulterior aplicación de ciertos aceites hirvientes, complemento necesario según creencia de la época, para tratar las heridas envenenadas por la pólvora. Sorprendentemente hubo consolidación primaria a pesar de la infección. Inhabilitado para combatir y transladado a Guipúzcoa, la consolidación viciosa fue motivo de que los cirujanos del lugar lo sometieran a procesos correctores de enderezamiento, que San Ignacio soportó estoicamente. Sin embargo y como podría esperarse, a pesar del tratamiento, tanto la infección como su estado general se agravaron y la desalineación subsistió. Después de una recuperación literalmente milagrosa, ya que las fracturas expuestas infectadas, eran casi sinónimo de muerte, una prominencia ósea que le impedía calzar las botas militares, debió ser "aserrada" en una tercera cirugía, lo cual tampoco fue suficiente. Toda una serie de procesos ortopédicos con recursos mecánicos similares a los de las inquisiciones, tampoco fue suficiente para corregir la deformación y el acortamiento de su pierna. Imposibilitado definitivamente por desgracia (o por ventura.....) para la vida militar, se vio obligado a abandonarla, consagrándose entonces a la vida religiosa que lo llevaría a la santidad.

[Crooked and short legs. Historical retrospect]. / Krumme und kurze Beine. Historischer Rückblick.

In the past rickets, poliomyelitis, and tuberculosis of the knee joint were the main causes for deformities and shortening of the children's legs. Orthotics played a major role in treatment and rehabilitation, and they were often used for life. In the nineteenth century orthopaedic surgeons developed procedures such as tenotomy, osteoclasis, osteotomy, excision of joints and arthrodesis, combined with conservative therapy or instead of it. In an incessant attempt to control wound suppuration--before Lister's antiseptic principle and aseptic practices were available--the "subcutaneous" approach was inaugurated for tendon and bone surgery.

Hyphenated history: Knight-Taylor spinal orthosis.

This paper offers some interesting biographic information on the two men from whom the Knight-Taylor spinal orthosis takes its name. James Knight and Charles Taylor were two orthopedists from New York City who were interested in spinal care. They prescribed and fashioned their distinctive braces, aspects of which were combined by others, thus linking these two men in orthopedic hyphenated history.

The past, present, and future of podiatric biomechanics.

The author places the history and development of podiatric biomechanics, as well as current thinking about its underpinnings and future, in the context of a theoretical framework drawn from the philosophy and sociology of science. This analysis sets the stage for an exploration of the possible future directions in which podiatric biomechanics could develop.