Open articles

As Prosthetics and Orthotics International enters its 40th year of publication it is edifying to reflect on advances in prosthetic and orthotic technology and clinical care which have been documented in our forty volumes to date. This month we make available for free access some of our most recently published articles and thematically related articles from the first volume of our Journal published in 1977.

All who have studied lower extremity prosthetics will be familiar with the classic Radcliffe (1977) paper on the biomechanics of transfemoral prostheses. The paper, based on the 1977 Knud Jansen Lecture, focused on voluntary and alignment control of dynamic stability. A paper by Kendell and co-workers (2016)published in the February issue of POI describes an in-shoe pressure measurement system to monitor gait adaptations in transfemoral amputees. The authors describe the potential of the system to assess individual performance at the point of care or in the community to identify dynamic stability deficits and to optimise prosthetic fit and alignment.

Mathematical and computer modeling continues to be an important tool in prosthetics and orthotics research and teaching.  In 1977, Veres  published a series of simple two-dimensional graphical force analyses to show the effects on foot joint loading of changing the heel and sole profile of a shoe. The paper was intended to inform orthotists about the changes they could achieve in foot joint loading by modifying shoe design. A paper by Fatone, Johnson and Tucker (2016) in our April issue describes a three-dimensional computer model to estimate the effects of anatomical-mechanical axis misalignments in ankle-foot orthoses on tissue interface stresses. The authors have made the model freely available as a clinical and teaching tool.

The need to provide sensory information to improve function in upper limb amputees has been recognised since the early days of powered prostheses. In the first issue of POI, Schmidt (1977) described developmental systems which could provide information on finger position and grip force by variable electrical stimulation of the skin of the residuum. In a paper recently published in OnlineFirst, Herbert and colleagues (2016) describe three cases of targeted sensory reinnervation, a surgical technique which results in a sensory map of the hand transferred to the skin of the residuum and which can produce sensations reminiscent of the missing hand.

Our knowledge has advanced enormously over the forty years of publication of our Journal. In reading earlier works, one is struck by the very small number of included references. Much of the content of earlier work reflected the expert knowledge of the authors. Today we build on the foundations of these early researchers and others who have published more recently. Knowledge and techniques have advanced but many of the original problems remain.

Tim Bach