Monday, 16 March 2015

Orthotics and Prosthetics In The Twentieth Century

A fundamental concept and the common goal of the professions of orthotics, prosthetics, and rehabilitation is the standard form of restoration and function after injury or disease. To accept this challenge, the fields of orthotics and prosthetics have evolved into uniquely specialized professions. In addition to training in the basic biological and medical sciences, orthotics and prosthetist have an understanding of biomechanics, kinesiology, and the material sciences complemented by highly developed technical skills.

Knowledge of the physical properties of materials and the techniques to manipulate and use them is essential to the design and fabrication of orthoses and prostheses. The topic is presented here as a general overview so that the rehabilitation clinician can develop a basic understanding of current design and fabrication processes used by orthosis and prosthetists.


Orthotics and prosthetics have a rich history of research and development. Many innovative devices have been designed to restore function and provide relief from various medical ailments. Although progress can document throughout human history, the most significant contributions to orthotics and prosthetics were made in the twentieth century, stimulated by the aftermath of the world wars. Injured veterans who returned home from battle with musculoskeletal and neuromuscular impairments or traumatic amputation dramatically demand increased the orthotic and prosthetic services.

Although World War I stimulated some clinical progress in the two disciplines, notable scientific advancements did not occur until World War II. To improve the performance and quality of assistive devices at the end of World War II, particularly for veterans with amputation. U.S government sponsored a series of development and research projects under the auspices of the National Academy of Sciences (NAS) that would forever change the manner in which orthotics and prosthetics would practiced.

Orthotics and prosthetics have played and important historical role in the development of medical and surgical orthopedics and rehabilitation. Orthotics and prosthetics have evolved as sister professions because the technical skills and knowledge base to prescribe, fabricate, and fit the respective mechanical devices are similar. Because of this, material and technological advancements have been shared between these two rehabilitation specialties.

A research effort was initiated by the NAS in late 1945, when a consensus revealed conference that few scientific principles or developments had introduced in prosthetics. Research and educational committees were formed between 1945 and 1976 to advise and work with the research groups.

In summarizing the most notable achievements in prosthetics during this period, Wilson cites the development of the total contact transfemoral socket; the quadrilateral socket design and hydraulic Swing-phase knee control units for the transfemoral prosthesis.

The patellar tendon bearing (PTB) trans-tibial prosthesis; the solid ankle, cushioned-heel prosthetic foot; several new designs for the Syme's Prosthesis; and the Canadian hip disarticulation prosthesis. He also notes the implementation of immediate postsurgical and early fitting as having a significant impact on the rehabilitation process for persons with lower extremity amputation. The most notable improvements in upper extremity prosthetics were the lyre-shaped three-jaw chuck terminal device and more efficient harnessing systems. In addition, modular components and advances in bioengineering have permitted increased use and availability of the myoelectric prosthesis since it first proposed in 1950.

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