Prostheses,

orthoses and
technical aids
Prostheses, orthoses
and technical aids
Ramon Zambudio Periago

ELSEVIER
MASSON
Amsterdam Barcelona Beijing Boston Philadelphia London Madrid
Mexico Milan Munich Orlando Paris Rome Sydney Tokyo Toronto
Collaborators

Juan Andrade Ortega

Head of the Rehabilitation Service, Hospital Ciudad de Jaén (Jaén).

María del Mar Carrión Martín

Specialist physician in the Rehabilitation Service Area, Hospital Ciudad de Jaén (Jaén).

Francisca Carrión Pérez

UGLY of the Rehabilitation Service, San Cecilio Clinical Hospital (Granada).

Oriol Cohí Riambau

Managing Director, Orthopedic Technical Institute (Barcelona).

Carmen Echevarría Ruiz de Vargas

Head of the Rehabilitation Service, Virgen del Rocío University Hospital (Seville). Associate professor at the
Faculty of Medicine, University of Seville (Seville).

Alberto Esquenazi
Director of the Regional Amputee Center, head of the Prosthetics and Orthotics Clinic, director of the Gait
and Movement Analysis Laboratory, Albert Einstein Medical Center (Philadelphia, USA). USA).

Angel Fernandez Gonzalez

Head of the Prosthetics and Orthotics Unit, Physical Medicine and Rehabilitation Service, Central University
Hospital of Asturias (Oviedo, Asturias). Associate professor, University of Oviedo (Oviedo, Asturias).

Vicente Gomar Sancho

Professor at the School of Orthopedic Technique, Ausiàs March Institute (Valencia).

Alba Gómez Garrido

MIR of Rehabilitation and Physical Medicine, Vall d'Hebron Hospital (Barcelona).

Miguel Ángel González Viejo

Clinical head of the Spinal Cord Injury Unit of the Rehabilitation Service, Vall d'Hebron Hospital
(Barcelona).

Elsa Lopez de Lacey

Associate physician of the Physical Medicine and Rehabilitation Service, Hospital Clínico San Carlos
(Madrid). Associate professor of the Department of Physical Medicine and Rehabilitation of the Faculty of
Medicine, Complutense University of Madrid (Madrid).

v
 Angela Lopez del Rio
Occupational therapist, Virgen de las Nieves University Hospital (Granada). Professor at the School of
Health Sciences, University of Granada (Granada).
Collaborators

Felipe Pascual Gomez

Head of the Orthoprosthetics Section of the Physical Medicine and Rehabilitation Service, Hospital
Clínico San Carlos (Madrid). Associate professor of the Department of Physical Medicine and
Rehabilitation of the Faculty of Medicine, Complutense University of Madrid (Madrid).

Encarnacion Pina Paniagua

Physiotherapist of the Prosthetics and Orthotics Unit of the Rehabilitation Department, Virgen de las
Nieves University Hospital (Granada).

Mabel Ramos Sánchez

Professor of the Department of Physical Medicine and Rehabilitation, Complutense University of Madrid
(Madrid).

Manuel Rodríguez Piñero

UGLY of the Prosthetics and Orthotics Unit of the Rehabilitation Service, Virgen del Rocío University
Hospital (Seville). Associate professor at the Faculty of Medicine, University of Seville (Seville).

Jesus Salcedo Luengo

Orthopedic doctor, Salcedo Orthopedic Clinic (Madrid).

Felipe Salinas Castro

Orthopedic doctor, Orthopedic Technical Institute (Barcelona).

Judith Sanchez Raya

Associate physician in Physical Medicine and Rehabilitation, Vall d'Hebron Hospital (Barcelona).

Carlos Sotos Portales

Professor, University of Valencia (Valencia).

Raquel Valero Alcaide

Professor of the Department of Physical Medicine and Rehabilitation, Complutense University of Madrid
(Madrid).

Ramon Viladot Perice

Head of the Orthopedic Surgery and Traumatology Service, Tres Torres Clinic (Barcelona).

Ramon Zambudio Periago

Coordinator of the Prosthetics and Orthotics Unit of the Rehabilitation Department, Virgen de las Nieves
University Hospital (Granada).

v
i
Presentation

Prostheses, orthoses and technical aids are part of a field called ortho technical pedia. The idea
of writing this book arose after verifying the scarcity of biblio writing in Spanish on this
subject.

Technical orthopedics is subject to continuous advances, due to the development of new

materials and the growing demand for these products by an increasingly aging and dependent
population.

This book does not attempt to cover all topics in great detail, but rather attempts an initial
approach to orthopedics. It has been intended that the informative content is current, useful and
oriented towards clinical practice in aspects related to the rehabilitation of ampu upper and
lower limbs, orthoses of limbs, trunk and skull, and technical aids in their different sections.

There are several health specialties that must know this field: the rehabilitation doctor and the
orthopedic surgeon as prescribers of these products, orthopedic technicians as manufacturers,
and physiotherapists and occupational therapists as those in charge of the adaptation and
accommodation of these products to the patient.

Naturally, in order to write a book of this type, it is necessary to combine the efforts of many
professionals. In this case, a large group of prestigious spices has been brought together. lists
from the field of orthopedics, national and foreign, with extensive experience in these topics
and whom I take this opportunity to thank for the effort made. Without them the preparation of
this book would have been impossible.

RAMON ZAMBUDIO PERIAGO

vi
Foreword

It is not easy to present someone with the prestige of Dr. Ramón Zambudio, earned with his
effort and dedication, who honors me by inviting me to preface this book, not because of my
merits, which are few, but because of the close friendship that unites us. for more than twenty
years.

We met when he had just been nominated as head of the Prosthetics and Orthotics Unit that Dr.
Salinas had created in the Rehabilitation Department of the Virgen de las Nieves Health City in
Granada. At that time, we believed that there was a great lack of knowledge foundation of
orthopedic technique among medical and paramedical professionals. We agreed that the
Spanish university should provide teaching to orthopedic technicians, but it seemed a limitation
to us that the knowledge was not expanded to all rehabilitation professionals. Certainly, this
gap was later remedied by some Faculta from Medicine, at the same time as Drs. Salinas and
Zambudio organized the 1st Theoretical-Practical Update Course in Prosthetics and Orthotics,
to which I was invited and which was a resounding success with the public and critics. So
much so that every two years it has been repeated, expanded and improved with the
incorporation of topics as broad as technical aids or with the pre presentation of innovations
and research in the manufacturing industries of orthoprosthetic speakers. The course, over
time, has achieved international relevance, and the truth is that in 2009 the eighth edition is
already being held. I will be there on time mind, even if I miss the plane or storms get in the
way, and with me will also be rehabilitation and trauma residents from all over Spain, along
with physiotherapists, occupational therapists and anyone who has anything to do with
rehabilitation. empowerment of the disabled.

As it seems that my friend Ramón had time to spare, eight years ago he prepared another
course on Scientific Evidence in Rehabilitation and Physical Medicine, which has been as
successful as the previous one.

This ability to coordinate and direct successful courses is only possible when its director is a
man with enthusiasm and faith in what he does, has unusual organizational skills, honesty and
splendor to give everything in exchange for receiving little, and lives in this world convinced
and with beating others to be doing important work.

And now, a book! Years ago, in an informal meeting, someone thought of commenting: «As
stubborn as Ramón is, any day he will write us a book on orthopedics or rewrite El Qui for us.
jote ».

i
 Over the years, many well-known speakers have presented their experience on the most varied
topics in the courses, including the innovations that have occurred in orthopedic science. All
this accumulated scientific baggage has been a stimulus for Dr. Zambudio to present it in this
publication, which, from my point of view, is the twelfth effort something he has so longed to
Forewo

do for twenty years.

rd

Few areas of healthcare have achieved such important scientific advances as those that have
occurred in the field of orthoses and prostheses, which in this volume are also presented with
the vision and knowledge of experienced specialists. This book fills an important space in the
orthopedic bibliography, along with other magnificent monographs. spellings published years
ago by Professor Viladot and the IOC, which have provided and continue to provide such good
services to all those who want to know about prosthetics and orthotics.

Honestly, in my opinion, Dr. Zambudio with this book has rewritten the chapter of "Don
Quixote and the windmills."

JESUS SALCEDO LUENGO

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Chapter index
1 Introduction to biomechanics 1
Felip Salinas Castro and Oriol Cohí Riambau
2 Materials in technical orthopedics 9
Vicente Gomar Sancho
3 Epidemiology of amputation 15
María del Mar Carrión Martín and Francisca Carrión Pérez
4 Psychology of the amputee 21
María del Mar Carrión Martín and Francisca Carrión Pérez
5 27
Search for information on the Internet Juan Alfonso Andrade Ortega
6 Prostheses in partial foot amputations 33
Felip Salinas Castro and Oriol Cohí Riambau
7 prosthetic feet 43
Felip Salinas Castro and Oriol Cohí Riambau
8 Prostheses in tibial amputations 51
Felip Salinas Castro and Oriol Cohí Riambau
9 Prosthesis in knee disarticulation 63
Ramon Zambudio Periago
10 Prostheses in femoral amputations 69
Angel Fernandez Gonzalez
11 Hip disarticulation and hemipelvectomy 89
Angel Fernandez Gonzalez
12 Alignment of lower limb prostheses 97
Angel Fernandez Gonzalez
13 105
Rehabilitation of lower limb amputee Ramón Zambudio Periago
14 Assessment of gait in lower limb amputee 111
Alberto Esquenazi
15 Physiotherapy in the lower limb amputee 123
Encarnacion Pina Paniagua
16 Follow-up of the lower limb prosthetic amputee Ramón Zambudio 131
Periago
17 Introduction to upper limb prostheses 137
Angel Fernandez Gonzalez
18 Prostheses in hand and forearm amputations 143
Angel Fernandez Gonzalez
19 Prostheses in elbow, arm and shoulder disarticulation 155
Felipe Salinas Castro
20 Occupational therapy in the upper limb amputee 165
Angela Lopez del Rio

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 21 Malformations and orthoprostheses Jesús Salcedo Luengo 175

22 Osseointegration in amputees 191

Ramon Zambudio Periago
23 walking devices 197
Chapter index

Miguel Ángel González Viejo and Alba Gómez Garrido

24 hip orthosis 213
Manuel Rodríguez-Piñero Durán and Carmen Echevarría Ruiz de Vargas
25 knee orthosis 221
Manuel Rodríguez-Piñero Durán and Carmen Echevarría Ruiz de Vargas
26 Plantar orthoses. Orthopedic soles 229
Ramón Viladot Pericé, Felip Salinas Castro and Oriol Cohí Riambau
27 orthopedic footwear 237
Felip Salinas Castro, Oriol Cohí Riambau and Ramón Viladot Pericé
28 245
Shoulder and elbow orthosis
Carmen Echevarría Ruiz de Vargas and Manuel Rodríguez-Piñero Durán
29 hand orthosis 251
Carmen Echevarría Ruiz de Vargas and Manuel Rodríguez-Piñero Durán
30 Orthosis for thoracic deformities. Scoliosis and kyphosis 259
Miguel Ángel González Viejo and Judith Sánchez Raya
31 Cervical orthoses 281
Ramon Zambudio Periago
32 Dorsolumbar orthoses 285
Ramon Zambudio Periago
33 291
Orthosis for cranial deformities Jesús Salcedo Luengo
34 301
Aid for the march Ramón Zambudio Periago
35 Wheelchair 309
Carlos Sotos Portales
36 319
Technical aids versus support products Felipe Pascual Gómez
37 Technical aids in activities of daily living Mabel Ramos Sánchez and 323
Felipe Pascual Gómez
38 329
Cranes and transfer systems
Elsa López de Lacey and Felipe Pascual Gómez
39 333
Augmentative and alternative communication Felipe Pascual Gómez
40 339
Home automation and environmental control Felipe Pascual Gómez
41 Pressure ulcer prevention 345
Raquel Valero Alcaide and Felipe Pascual Gómez

Alphabetical index 349

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