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Falls in the elderly are a cause of substantial morbidity and mortality and consume enormous health resources. Causes of falls are multifactorial but reduced peripheral sensation as a result of diabetes mellitus or simply a result of deterioration of the sensory and motor nervous system in the elderly is thought to contribute. In order to address the sensory loss, some researchers have sought to enhance peripheral sensory input to the balance control system. A systematic review by Bagerzadeh Cham and co-workers (2016)published in the current (December) issue of Prosthetics and Orthotics International concluded that stimulation of the plantar surface of the foot with low levels of vibratory stimulation improved balance, sensation and gait. It may be that foot orthoses of the future will include mechanisms to stimulate peripheral nerve endings in the plantar surface.

We have reasonable evidence that orthotic management is effective for adolescents with idiopathic scoliosis (AIS) but we still search for ways to improve treatment. A paper published recently in OnlineFirst by Gür, Ayhan, and Yakuin (2016)demonstrates that specific core stability exercises are an effective adjunct to orthotic management. In a randomized control trial, the authors found that a group receiving core stabilization exercises in addition to traditional bracing and exercise had greater improvements in spinal curvature measures than a control group. The authors recommend that these exercises be added to routine management of AIS.

We think of a prosthetic socket as a means of transmitting mechanical loads from the body to the environment. Less consideration is given to the transmission of thermal loads. Amputees who live in warm and  tropical climates often complain of sweating and thermal discomfort as a result of prosthesis use and this discomfort is exacerbated by silicone liners. A technical note by Ghoseiri and co-workers (2016)in the current issue of POI describes a prototype heat transfer system for a prosthetic socket. An aluminium heat sink incorporated into the socket and a small fan are used to facilitate heat transfer to or from the residual limb. The paper demonstrates the proof-of-concept but user trials have yet to be undertaken.

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Tim Bach
Editor-in-Chief
Prosthetics and Orthotics International (POI)