O&P Library > Orthotics and Prosthetics > 1958, Vol 12, Num 2 > pp. 57 - 63

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Functional Bracing of the Upper Extremities-Pilot Class at UCLA

The completion of the "Pilot Class" in "Functional Bracing of the Upper Extremities" at the University of California, Los Angeles, Medical School marks a historical event in the field of orthotics, as this is the first time an educational program has been offered by a medical school for the benefit of those engaged in the fabrication and fitting of braces.

The purpose of the "Pilot Class" was to bring in a group of experts in the field of orthotics and have them take the course in a "trial run" so that any inaccuracies and errors could be spotted and corrected. The students in the "Pilot Class" were largely from polio respiratory centers where they had considerable experience in upper extremities paralytic cases, since functional arm braces and splints are used chiefly on patients suffering from various degrees of paralysis of the hands and arms. The members of this first class were: John J. Bray , U.C.L.A. Medical Center, Los Angeles: Lawrence Czap , University Hospital, Ann Arbor Mich.; Stephen Hall , Institute for Crippled and Disabled, New York City, N.Y.; W. Frank Harmon , Atlanta Brace Shop, Atlanta. Georgia; Frank R. Jones , Georgia Warm Springs Foundation, Warm Springs. Georgia; Clyde E. Peach , Pope Brace Division, Kankakee, III.; Fred J. Sanders , U.C.L.A. Medical Center, Los Angeles; Paul B. Shipp , Mid-South Brace Shop, Nashville, Tenn.; Walter Stauffer , Edmonton Artificial Limb Co., Edmonton, Canada; Edward L. Thompson , Cuyahoga County Hospital, Cleveland, Ohio; Bert R. Titus , Duke University, Durham, N.C.; and William A. Tosberg , Institute of Physical Medicine and Rehabilitation, New York, N.Y.

The class started April 7 and was completed April 23, a total of fifteen days. The work was divided into four sections: functional hand splints , feeders , special assistive devices , and junctional arm braces . The material on splints, feeders, and special assistive devices was taught by Roy Snelson, Chief. Orthotics Department. Rancho Los Amigos Hospital, and a member of the instructional stall in the Prosthetics Education Program at U.C.L.A. Medical School. He was assisted by Jack Conry, orthotist at Rancho Los Amigos Hospital, and formerly of Georgia Warm Springs Foundation. Functional arm bracing was taught by George Robinson, of "Robin Aids Co.", also a member of the instructional staff for the Prosthetics Education Program at U.C.L.A.

The instructional manual used in the course was written and illustrated by Dr. Miles H. Anderson, Director of the Prosthetics Education Program at U.C.L.A. The manual has 480 pages and 1057 illustrations, and explains the principles of operation of each of the devices in addition to showing step-by-step exactly how they are fabricated and fitted. The manual is available to anyone interested in obtaining a copy, and may be ordered from Charles C. Thomas Publishers, Springfield. Illinois, under the title "Functional Bracing of the Upper Extremities".

Classes to be Available

When the "Pilot Class" students completed their evaluation of the course, it was revised and corrected into the version that will be used when offered for regular enrollees in September. The first such class will start September 10 and be completed September 26. Others will follow on November 5 to 21, February 4 to 20 (1959), and April 8 to 24 (1959).

During the last week of each of these courses, concurrent sessions for therapists and doctors will be offered, following the same "clinic team pattern" established by the U.C.L.A. Prosthetics Education Program when it was started in 1952 with the "arm schools". The emphasis in the doctor-therapist classes will be ......valuation of the patient's condition, prescription of the correct device, how to train the patient to use the device, re-evaluation, and principles of operation of the various devices available. The fact that functional splints and arm braces are very useful for patients suffering from paralysis caused by spinal cord lesion, hemiplegia, brachial plexus injury, arthrogryposis, muscular atrophies and dystrophies, and post-traumatic conditions, as well as post-poliomyelitis paralysis, will he stressed in the classes for physicians. In addition, excellent material will he offered on the relation, ship between surgical procedures and the use of splinting and bracing.

When more physicians understand the many uses of these versatile devices other than for post-polio cases, they will find more occasions to prescribe them. However, it will do no good for physicians to prescribe them if no one is available to fill the prescription, which certainly points up the importance of the team as a whole. Also, the availability of the services of occupational and physical therapists means the difference between success and failure, as the patients must be carefully trained or they will refuse to wear a splint or brace. Because it has been found that the therapists fill an important role on the team, every course given at U.C.E.A. for prosthetists or orthotists has always been accompanied by related courses for the other members of the group.

Lectures, Demonstrations, and Laboratories Used

Several subjects in the pilot course followed the same general pattern, lecture, demonstration, and laboratory practice. Taught in this manner were: How to: Make and Fit the Basic Opponens Hand Splint with Spring Swivel Thumb; Make a First Dorsal interosseus Assist; Make and Fit the Lumbrical Bar: Make and Fit a Dynamic Finger Flexion Assist; Make a Long Opponens Hand Splint with "C" Bar and Thumb Interphalangeal Wist: Make an Interphalangeal Extension Assist with Metacarpophalangeal Extension Stop: Install and Adjust a Ball-Bearing Feeder: Make an Action Wrist with Dorsiflexion Assist: Make and Fit the Adjustable Metacarpophalangeal Flexion Control; Make and Fit a Flexor Hinge Splint-Wrist Driven: Make the Splint Portion of the Flexor Hinge Splint. Wrist-Driven, and Assemble the Splint: Make a Flexor Hinge Splint. Shoulder-Driven, with Pressure Belief Control; Fit the Cable-Controlled Hook, including Wrist Splints: Fit Straight Shoulder Suspension Hoop and Forearm Cuff Elbow Flexion Assist; Assemble and Fit the Axillary Shoulder Suspension Hoop and the Abduction

Outrigger; Fit a Shoulder Rotation Stabilizer, Shoulder and Elbow Flexion Assists with Locking Elbow on a By-Pass Shoulder Suspension Hoop; Fit the Shoulder Rotation Stabilizer, Free Elbow, Shoulder and Elbow Flexion Assists with Forearm Cuff; and Fit a Shoulder Supported Functional Arm Brace.

Anatomy Related to Corrective Devices

In addition to the "How to Do If variety of subjects, the following studies were covered: Functional Anatomy of the Hand: Hand Measurements. Use of Hand Measurement Data Sheet: Functional Hand Splints and Attachments, Nomenclature, Application, Description, Indications, Contraindications: Review and Critique of Patients and their Splints. Discussion of Various Applications for them other than Polio. Discussion of Proper Splint for Each Patients Needs: Review of Hand Splint and Feeder Patients at Rancho. Analysis of Needs of Each Patient. Discussion of Proper Equipment for Each Patient; Special Assistive Devices. Suspension Type Feeders, with Lecture and Demonstration; Application of Outside Power Sources to Activate Flexor Hinge Splints. Carbon Dioxide Gas and Artificial Muscle, with Lecture, Demonstration, and Film: Biomechanics of Splints. Feeders and Functional Arm Braces: Kinesiology of the Hand and Wrist: Functional Anatomy of the Arm and Shoulder: Review of Names and General Function and Uses of Each Type of Functional Arm Brace; Analysis of Patients (Measurements, Strength, Range of Motion, and Determination of Device Needed); and Leg Reciprocator and Control Cable Operation of Forearm Cuff Type Elbow Flexion Assist.

Discussions, Reviews, and Practice

With most of these courses, there were opportunities for laboratory practice. One session was devoted to final fitting of patients with equipment they would keep and wear. There were many importunities for discussion, review, and for covering questions related to the entire program, as well as clinic team procedures and practice in clinic team prescriptions.

An example of one day's schedule in the course is given to show the way the lectures and lab practices were, and will be. related as the school continues.

The Prosthetics Education Program at U.C.L.A. is supported by funds granted by the U.S. Office of Vocational Rehabilitation, directed by Miss Mary Switzer. A limited amount of money is granted for traineeships to help defray the cost to the student of travel, expenses, and tuition in attending the courses. Traineeship application forms may be obtained from U.C.L.A. on request.

Last year all the U.C.L.A. classes in prosthetics for prosthetists, therapists and doctors were filled many weeks ahead, and because of this many who applied late were disappointed. It is strongly recommended that applications for enrollment be sent in early to assure places in the classes.

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O&P Library > Orthotics and Prosthetics > 1958, Vol 12, Num 2 > pp. 57 - 63