Orthotics, spinal cord injury, and other severe disabilities.

On a purely personal note, may I suggest as we turn from the prosthetics side to orthotics that this area has a historic interest for me . After I had poliomyelitis 50 years ago, in July 1924, I became involved a great deal in the era of the wooden wheelchair, crutches, canes, full-length leg braces, and then short ones . I still use orthopedic shoes and two canes. The number of patients requiring orthotic and other aids is perhaps 10 times as great as the number of amputees . Though there is a good deal of interrelationship among these various areas of orthotics, spinal cord injury, and aids for other severe disabilities, there is also great diversity . We have not entirely postponed this area, though it received a lesser share of the available limited budgets . There are much more diffuse, much more difficult problems in orthotics than in limb prosthetics . There is a much larger diversity of indications, which creates more problems in selecting a type of device or orthosis for an individual than in the case of a prosthesis for an amputee . An amputation is literally clean cut. Anybody can look at the result and diagnose that the patient is an amputee at a certain level . Any observer knows what is missing — everything beyond that point . Thus prostheses, though individualized, fall into a relatively few major groups . But a patient may require an orthosis from a defect of a long bone, the joints, the muscles, the brain, the spinal cord, or the peripheral nerves; he may or may not have sensory feedback, and he may or may not have spasticity . These variables and their many combinations greatly complicate the problems of design as well as of prescription . Though orthotics problems long have received some attention by intramural and contractual efforts, they are now gaining greater momentum. The group at the Miami VA Hospital has been involved in a number of basic studies related to spinal cord injury, some of which provide a transition from the preceding papers on electrical stimulation to other experiments as well . (Dr. Ross Davis was unable to attend the confer-