Prosthetic-Orthotic Research - A New Thrust is Needed: A Clinician's Perspective
Charles H. Epps, Jr., M.D. *
Since the prime supporter of research, the federal government, has sharply reduced some areas of funding, the efforts of many established investigators and programs have been curtailed. Hardest hit has been the young aspiring investigator without a track record, who has found it virtually impossible to acquire funding for initial research efforts. Basic research as well as clinical research has suffered. Prosthetic and orthotic research programs which have never had abundant or even adequate funding also have been adversely affected.
In the area of upper extremity prosthetics, much research remains to be done. For the patient who wears a prosthesis, cosmesis is still a major concern. Cosmetic acceptability must be improved and sensory feedback must be developed; sockets must be made more comfortable and suspension must be improved. Myoelectric control systems and other methods of external power must be made more functional, more compact, and more economical.
In the lower extremity, newer materials and techniques must be developed to make prostheses lighter in weight, especially for the geriatric wearer. Although there seems to be less enthusiasm today for skeletal attachment of prostheses, the concept remains a challenge. The mechanical integrity and durability of knee devices can be improved along with fitting and alignment techniques.
Because of basic lack of knowledge about the effects of forces on bone, ligaments and tendons, the need for orthotic research is even greater than in prosthetics. More needs to be known about the magnitude and patterns of forces that are necessary and safe to orthotic applications. Workers in kinesiology and gait laboratories around the country are endeavoring to find more answers to diagnostic problems and to collect useful data for orthopaedic assessment and even surgical treatment. New materials offer the orthotist new versatility. The pneumatic orthosis, a new concept, is ready for full development. Electrical applications are at an embryonic stage in the stimulation of paralyzed muscles, inducing therapeutic exercises, and providing afferent or feedback systems. New interest has developed to improve powered mobility devices to replace the conventional electric wheelchair for the high level spinal cord injured patient. Specially adapted vans can be operated safely by paralyzed, limb deficient patients and other severely handicapped. In view of the potential offered by computer applications and rapidly improving robot technology, environment control devices are on the threshold of great advances. So much remains to be done in prosthetic-orthotic research that even the casual observer must be concerned.
At the same time that public research dollars have decreased, private research dollars have not increased sufficiently to fill the void. Obviously, research needs offer a challenge to orthopaedic surgeons who must increase the amount of personal time and funds given for research. At least one encouraging sign of private sector philanthropy exists. Bristol-Meyers/Zimmer U.S.A. has donated 1.2 million dollars to the Orthopaedic Research and Education Foundation (OREF) for the 1983-1984 Campaign. To date, more than 150 orthopaedic surgeons have given $1,000 each to OREF for the current campaign. This is in sharp contrast to the previous years' total of $200,000 from all sources. Other members of the industrial community should duplicate and even surpass the example set by the Zimmer group.
If this instance of giving by the orthopaedic surgeons and a prime industrial supplier is replicated by prosthetic-orthotic practitioners and members of the corresponding industrial manufacturing community, the funding for prosthetic-orthotic research can be adequately raised to support needed research programs.
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