Evaluation of Casting and Alignment Procedures for Outreach ServicesTraditional prosthetic alignment involves bench alignment (when the prosthesis is assembled), static alignment (during the patient’s initial fitting) and dynamic alignment (conducted during a clinical gait analysis at the initial fitting and sometimes during subsequent visits). It is a time-consuming process that requires the skill of a trained prosthetist. The CIR has been evaluating two transtibial alignment techniques that can be used to capture alignment during the patient's first casting visit and which eliminate the need for static and dynamic alignment: Anatomically-Based-Alignment (ABA) and the Vertical Alignment Axis (VAA). The ABA method, originally developed by Prosthetic Research Study (PRS) of Seattle, Washington as a Transtibial Alignment System (TTAS), has two variations: a standing system for most patients and a supine system for bilateral amputees and other patients who cannot maintain a proper standing posture during the alignment capture process. These systems will facilitate the fabrication of monolimbs, copolymer prostheses where the socket, pylon and ankle bushing form one contiguous unit and have limited alignment adjustability. The ABA and VAA systems could be used to provide outreach prosthetic services to remote areas in landmine-affected regions. The prosthetist would visit remote areas, cast the patients and capture the alignment measures, fabricate the prostheses at a central facility, and then deliver the prostheses to the patients on a subsequent trip. We have developed training modules for both methods and carried out a clinical study with five subjects and five prosthetists in Chicago in May and June of 2005. A field study is currently being conducted in Nicaragua. Three prosthetists will use both the two variations of the ABA system and the VAA alignment system to create a total of 90 monolimbs for 30 subjects. The monolimbs will then be evaluated for alignment through traditional prosthetic evaluation methods and subjects will take each of their three monolimbs home for a one-month home evaluation. Results from both studies will help us to identify which system is a viable option for providing outreach prosthetic services in landmine-affected countries. |
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| ABA Standing Alignment System |
ABA Supine Alignment System | VAA Alignment System |
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| Clinical gait analysis during field study in Nicaragua | Clinical gait analysis during pilot study in Chicago |
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For more information contact RERC project investigators Kim D. Reisinger, Ph.D., Hector Casanova, C.P., BSc P&O, and Yeongchi Wu, M.D. at engineeringsupport@cirnetwork.org |
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