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A Comparison of Alternative Knee Orthoses  By Thomas Lottermoser, CPO
The use of a knee orthosis for the purpose of external stabilization of the knee during physical activity is a common practice among orthopedic surgeons and other medical personnel. A knee orthosis is typically prescribed during the post-operative rehabilitation periodBut orthotic management utilizing a functional knee orthosis for support and stabilization is also useful for patients who prefer a non-operative approach to anterior cruciate ligament (ACL) insufficiency...  Read more

Accommodating Growth in the Pediatric Population  By Lindsay Homrich, Staff Prosthetist
Although some of the prosthetic principles apply to both the adult and pediatric populations, pediatric patients present with some clinical considerations unique to their cohort. One clinical consideration that presents on a continual basis is growth. A prosthetist has no way of predicting a patient’s growth spurts. As a result clinicians have developed techniques to accommodate unmarked growth.  Read more

Amyotrophic Lateral Sclerosis: Orthoses in the Treatment  By Gene Bernardoni, CO
Patients suffering from ALS often experience distal weakness in their arms and legs, and in the muscles of the neck. Additionally, generalized muscle weakness is common.  The ALS patient can benefit from a variety of symptomatic and supportive treatment modalities, including the use of orthotic braces...  Read more

Are Off-the-Shelf TLSOs Helpful or Harmful? By Gene Bernardoni, CO, and Thomas M. Gavin, CO
Since initial development in the early 1950s, custom molded TLSOs have come to be accepted among neurosurgeons and orthopedic surgeons as the best means of controlling spinal motion postoperatively and non-operatively. A number of studies have since been published demonstrating that superior alignment and triplaner motion control can be achieved with custom molded TLSOs as compared with various off-the-shelf (OTS) spinal orthoses...  Read more 

Buyer Beware: Not All Helmets Are Alike By Gene Bernardoni, CO 
In the world of cranial molding helmets, design plays an important role in determining patient outcomes. A good design can also reduce or eliminate the need to use multiple helmets throughout the course of treatment...  Read more 

Charcot-Marie-Tooth Disease: Orthotic management of the Charcot Foot  By Steve Galluzzo, CO
There are an estimated 16 million people in the United States with diabetes. Of these, as many as 40% of them have some degree of neuropathy. This disease often leads to Charcot foot and ankle deformities and continues to pose a challenge for physicians in terms of diagnosis and treatment. This is a condition of acute or gradual onset and, in its most severe form, causes significant disruption of the bony architecture of the foot. In this article, I focus on some of the critical aspects of recognizing and diagnosing this condition, as well as to some of the more prevalent and effective orthotic treatment methods...  Read more  

New Era In Prosthetic Knee Technology  By Harry Newman, CPO
Until recently, the options available to the transfemoral amputee had serious drawbacks. The traditional single axis hinges allowed the knee to flex and extend, but overly restricted many patients from engaging in a range of activities. Knees built to maximize stance phase stability tended to interfere with knee flexion, while those designed to enhance swing control tended to weigh more heavily and have complicated mechanical designs...  Read more 

New Orthotic Applications for Neuromuscular Disease Part 1  by Gene Bernardoni, CO
There are few radical discoveries in orthotics, but there are plenty of opportunities for practitioners to improve on old ideas. Innovations sometimes arise from the desire to increase patient compliance or capitalize on patient strengths while addressing their specific weaknesses. Over the past several years, I have had the privilege of collaborating with Dr. Irwin Seigel, Professor of Neurological Sciences at Rush-Presbyterian-St. Luke's Medical Center in Chicago.  Read more

New Orthotic Applications for Neuromuscular Disease Part 2  by Gene Bernardoni, CO
A simple modification was designed to overcome aversion to bracing in patients in the early stages of Charcot-Marie-Tooth Syndrome (CMT). Typically CMT patients are just beginning Spoon·Style AFO to experience weakness and imbalance, may have stumbled or tripped, but may be resi stant to the idea of wearing a brace.  Read more

Orthotic Management of Diabetic Neuropathic Foot By Harry Newman, CP, BOCO, LPO
Foot ulcerations represent one of the most important risk factors for lower extremity amputations in patients with diabetes mellitus. Peripheral neuropathy and increased dynamic foot pressures have been shown to be good predictors for an increased risk of foot ulceration. In the United States alone, there are nearly 70,000 diabetes-related lower extremity amputations performed annually...  Read more

Orthotic Treatment of the Spinal Muscular Atrophies By Gene Bernardoni, CO
The Spinal Muscular Atrophies (SMA) comprise a group of hereditary disorders in which there is degeneration of the anterior horn cells of the spinal cord and the motor nuclei of some cranial nerves. Generally inherited as an autosomal recessive gene, the disease poses unique challenges for orthotic treatment...  Read more

The Halo System Part I: History and Development By Gene Bernardoni, CO
The halo is used to minimize the movement of the cervical spine either in the treatment of traumatic injuries to the cervical spine or for post-operative support. The halo derives its name from the ring that surrounds the patient’s head. The ring is attached by metal or carbon fiber uprights to a jacket vest or TLSO around the patient’s chest. All of the halo’s components work to immobilize the patient’s head and cervical spine...  Read more

The Halo System Part II Problems & Solutions of Halo Fixation By Gene Bernardoni, CO
The halo is almost always used on patients who have undergone significant surgical procedures or have experienced severe trauma. This orthosis is considered to provide the highest degree of stabilization to the cervical spine. So, while the orthosis is cumbersome and can be uncomfortable, it allows the patient to remain ambulatory in cases where cervical traction, in bed, might otherwise prove necessary...  Read more

The Halo System Part III Popular Halo Systems: A Comparison By Gene Bernardoni, CO
The principal function of the halo is to reduce the motion of the cervical vertebrae. This is accomplished through the fixation of the skull’s position relative to the patient’s trunk. While the halo succeeds in reducing the motion in the vertebrae, it does not prevent all motion. The amount of motion will depend on the vertebral level in the cervical spine. The greatest absolute motion that the halo allows occurs at C4-5, while the greatest motion allowed, as a percent of normal motion, is at C2-3. The least motion, as a percent of normal, occurs at C7-T1...  Read more

The Use of Myoelectric Control in Upper Extremity Prostheses  By Robert Sobotka, CPO
Upper-limb amputations typically fall into one of three major categories: (1) those resulting from traumatic accidents, as with farmers and industrial workers; (2) those intended to correct congenital anomalies or deficiencies; and (3) those performed in an effort to contain or stem the effects diseases such as cancer.. Cancers are the principal disease related cause of amputations. Upper-limb amputations include all amputations made from the fingers to the shoulder...  Read more 

Efficacy of Ballert's Cranial Molding Orthosis in the Correction of Nonsynostotic Deformational Plagiocephaly - A Retrospective Analysis by Gene Bernardoni, CO and Stephen Kim CO

Integration of Soft-Band Bone-Anchored Hearing Aid (Baha) in Ballert’s Cranial Molding Helmet in the Aural Rehabilitation of Patients with Pediatric Syndromic Hearing Loss and Deformational Plagiocephaly by Gene Bernardoni, CO and Stephen Kim, CO

The Use of Non-operative Compressive Orthosis in the Correction of Pectus Carinatum by Gene Bernardoni, CO and Stephen Kim, CO