Orthoses, Prostheses & Assistive Devices for Physiotherapists Raju Sharma, Akhoury Gourang Sinha, Subrat Kumar Tripathy
INDEX
Page numbers followed by f refer to figure and t refer to table
A
Abduction sling 73
Abductor block 185
Absence of pressure points 12
Adequate shoe surface friction 125
Adjustable lock 148
Advanced reciprocal gait orthosis 156
Advantages of
Milwaukee brace 103
underarm TLSO 105
AE prosthesis 238f
AFO
metal design 130
plastic design 133
posterior spring design 134f
with flanges 135, 136f
with medial T strap 133f
with plastic shoe insert 139f
Air
cushion 187, 188
plane splint 71, 71f
splint 76
AK
prosthesis 220f
socket 219
suspension mechanism 221
Alignment of foot section with tibial section 141
Alterations in seat angulations 186
American Society of Hand
Therapists 26
Amputee chair 196
Ankle
foot
assembly 219, 223, 224
orthoses 129
joint 130, 132
and assists 132f
Anterior
elbow splint 74
hyper extension brace 97
wedge seat 184
Antispastic cone splint 65
Application of prosthesis 242
Arm rest 182, 193
Articular AFO 139
Articulated foot 209
Articulating AFO 134
Artificial feet 206
Asymmetrical seat 185
Auxilliary suspension 223
Axillary crutch 173, 174f
B
Backrest 182, 192
Basic protective splint 54
Basketball shoe 127
Belt suspension 221
Bilateral amputee 204
Biomechanical basis of orthosis 16
Biomechanics of Milwaukee brace 103
Bivalved cast 78
BK prosthesis 216f
Body powered prosthesis 230
Bone 20
Boston brace 6, 83, 104f
Boutonnière deformity 48, 49f
of thumb and finger 45
Brim suspension 218
Buddy splint 32, 33f
Burned hand 62
C
Calf
band 130, 131
strap 195
Cane
offset design 173f
telescopic design 173
Capners
design 48f
splint
design 48
spring coil extension splint 42
coil splint 42f
Carbon copy II foot 208
Cartilage 20
Cash brace 98f
Cervical
orthoses 82, 83
pillow 89, 89f
Cervicothoracic orthosis 83, 87
Chair back orthosis 94
Chapel hill 58
splint 60
design 60f
Checking fit of prosthesis 242
Checkout of
AFO 143
Milwaukee brace 103
shoe 114
Chest strap 195
Circumferential stretch 38
Classification of
AFO 129
orthosis 5
spinal orthoses 82, 82t
Clavicle strap/brace 69f
Claw hand 45
Cock-up splint 29, 29f, 58
Collagen fibers 21
Collar 83
Combination of electrical stimulation 159
Combined
heel and sole modifications 119
median and ulnar nerve palsy 60
nerve palsy 60
Common
fault of chair design 183
plastic AFO designs 134
shoe modifications 115
Complications of orthosis 10
Components of
AFO 130f
conventional body powered prosthesis system 232
hand splints 25
KAFO 146
lower limb prostheses 205, 206
TLSO 93f
Compression garment/glove 63
Congenital dislocation of hip 162
Connector bar 25
Constant friction knee unit 222
Construction of shoe 109
Contraindications of PTB orthosis 151
Control of edema 241
Conventional
HKAFO 155, 156f
upper limb prosthesis 232f
Correct width and depth 12
Correction of deformity 27
Corrective orthosis 5
Cosmesis 11
Cosmetic prosthesis 230
Cotton
and fabric cushion 187
cushion 187
Counter force brace 77
Court sports shoe 127
Cow horn orthosis 98
Cross
bars 25
chest strap harness with shoulder strap 238
Cuban heel 112
Curved elevated backrest 186
Cushion heel 116
Custom molded shoes 114
C-walk foot 208
Cylindrical bar 171
D
Deep curved backrest 186
Dennis Brown splint 167, 167f
Desensitizing stump 241
Design of
KAFO standard design 146
knee gaiter 152f
Milwaukee brace 102f
Somi brace 86f
TLSO triplanar control orthosis 99f
Desk armrest 193
Deviation bar 26
Dimension of
chair 182f
prone wedge 180
Direct drive wheelchair 197
Disadvantages of
Milwaukee brace 103
underarm TLSO 105
Disarticulation 223
Dorsal volar hand splint 65
Dorsiflexion
assist 132
stop 132
Drift splint 46
Drop lock 147
and pawl lock 147f
Dropout cast 78
Dynamic
anti-claw hand splint 46, 46f
extension splint with flexion block 55, 56f
orthosis 5, 50
PIP extension mobilization splint 42, 43f
prehension orthosis 52
progressive splint 35, 36
response foot 207
splints 35, 36, 55, 58
thumb MP flexion splint 43, 44f
ulnar
drift splint 47f
nerve splint 57
wrist splint 37, 38f
Wynn parry spring wire splint 61
E
Elastic
band 114
region 18
Elbow
amputation 238
and TDS control system 239
cast 77
component 235
crutches 173, 175, 175f
joints 237
orthoses 6, 74
unit 232, 239
Electric powered prosthesis 230
Electrically powered prosthesis 231
Endoskeletal shank 212
Ethylene vinyl acetate 123
Excessive motion of foot 126
Exoskeletal shank 212f, 213
Extensor tendon repair 55
External
fixator devices 82
power passive unit 57
Extra depth shoe 114
F
Facilitate
function 12
prone lying 180
side lying 181
sitting 181
Figure of
8 brace 70f
8 harness 237
8 ring design 48
8 swan neck splint metal ring design 48f
plastic design 48f
9 harness 237, 238
Finger
blocking splints 32
cuff 26
driven
hand orthosis 53
wrist hand orthosis 53
flexion glove 40, 41f
nail hook splint 41, 41f
sleeve 63
spreader 65, 65f
Flare heel 116
Flat
backrest 186
heel 112
Flex foot 208
Flexible elbow joint 237
Flexion
of shoulder 241
posturing of elbow 75f
tendon repair 54
Floor reaction orthosis 138
Foam splints 44
Folding wheelchair 196
Foot
ankle assembly 206, 216
made out of cadavaric skeleton 211
orthoses 109
Forearm
based dynamic MP flexion splint 39, 40f
crutch 173, 175
fracture bracing 80
support walker 177
trough 79
walker 178f
Forefoot relief 120
Forequarter amputation 240
Four postposter brace 85f
Free motion 133
knee joint 146
Frejka pillow 162, 164
Friction brake 222
Functional
electrical stimulation 5
fracture bracing 79, 80
knee brace 153
orthosis 5
prosthesis 230
splints 50
Functions of foot orthoses 108
G
Granger splint 59, 59f
Gunslinger splint 70, 70f
Gutter
crutch 173, 175f, 176
splint 32f, 42
H
Halo-vest apparatus 88
Hand rim 195
Hard cervical collar 84, 84f
Harness
and suspension system 232
suspended socket design 236
suspension 237
system 237f
Head and neck orthosis 6
Heel
cap 121, 121f
collar 111
cushion relief 120
seat 121
strap 195
wedge 117
Height of hand piece 174
Hemipelvectomy 204
and hip disarticulation amputation 224
Hemispiral
AFO 136f
design 134
High temperature thermoplastic 9
Hinged
elbow orthosis 76, 76f
knee orthosis 152f
Hip
disarticulation 204
prosthesis 224
guidance orthosis 156
joint 155, 224, 225
knee ankle foot orthoses 155
orthoses 162
History of orthosis 4
HKAFO with Silesian belt 156
Hollow splint 62
for burned hand 63f
Humeral
arm cuff sling 73f
cuff sling 72
Hybrid
AFO 134, 139
design 129
KAFO 146f
prosthesis 230, 231
Hypertrophic scar 62
I
Ilfeld
orthosis 162
splint 163, 163
Immobilization
orthosis 5
splints 27
of thumb joints 32
Improve alignment of lower limb 126
Incorporation of
hip joint having two locking position 158
Ratchet type knee joint 158
Inflatable pressure splint 65
Inner sole 111
Internal shoe modification 120
International standard organization 7
Intrinsic
minus hand 45
plus hand 45, 47
Ischial
containment socket 220
weight bearing orthosis 159, 160f
Isocentric RGO 159
J
Jaipur foot 209, 209f
Jewett brace 97f
Joint
and thigh corset suspension 218, 219
mobilization and muscle strength 241
Joystick control 198
K
K-2 sensation foot 208
KAFO
Scott-Craig design 148, 149f
standard design 145
Kleinert
extension blocking splint 55f
splint 55
Knee
ankle foot orthoses 145
blocks 185
brace 145
cap strap 148
disarticulation 223
prosthesis 223
gaiters 152 joint 146, 224
lock 147
mechanism 224
orthosis 24, 145, 152
pad and straps 148
prosthesis 216, 219
unit 219, 222
axis 222
Knight
brace 7
orthosis 95f
Taylors brace note position of lateral bar 96f
Knuckle bender 39
splint 39f, 61
L
Lacing system 110
Lap board 79
Lateral
heel wedge 117, 120
sole wedge 118
Legg-Calvé Perthes disease 162, 164
Length of crutch 174
Light weight chair 197
Limited motion 132
knee orthosis 153f
Long
arm cast 77
lateral counter 113
medial counter 113
opponence splint 7, 51, 52f
thumb spica 34f
Low
back pain 100
profile TLSO 103
temperature thermoplastic 9
Lower limb
orthosis 6
prosthesis 203
Lumbar spine 103
Lumbosacral
corset 91, 91f
orthoses 93
M
Mallet finger 45
deformity 49, 50f
splint 49
Management of upper limb
amputation 241
Manual
folding wheelchair 191f
lock 222
wheelchair 195
MCP flexion stretch splint 57
Measurement for wheelchair 199
Mechanical behavior of
soft tissue during injury 21
viscoelastic material 17
Mechanism of propulsion 196
Medial
heel
flare 116f
wedge 117, 117f, 120
sole wedge 118
Median nerve lesion 57
Metacarpal fracture brace 31
Metal
AFO 130f
design 129
uprights 130
Metatarsal
bar 119, 119f
inserts and MLA support 122
pad 120
Methods of shoe closure 114
Miami TLSO 83
Military heel 112
Milwaukee brace 7, 83, 102
Minerva jacket 7, 87, 87f
Mobile arm support 78
Mobilization
orthosis 5
splint for finger joints 38
wrist 37
splints 27, 35
of hand 37t
Model of Milwaukee brace 102f
Modi foot 210
Modification of
heel 115, 116
outer sole 118
sole 115
upper 115
Molded jacket 99
Motorized wheelchair 197
MP flexion
orthosis 39
stretch splint 39
Multiple
axis foot 209
strap sling 72, 72f
Muscle weakness and atrophy 10
N
Neck support 186
Negative and positive cast of lower
limb prosthesis 205f
Nerve
compression 10
injuries 56
Newington orthosis 165
Nomenclature 6
Nonarticulated foot 206
Nonarticulating
AFO 134
orthosis 6
O
Offset knee joint 146, 146f
One arm driven chair 196
Oppenheimer splint 58, 58f
Opponence splint with lumbrical bar 61
Original Syme's or enclosed metal
Syme's prosthesis 215
Orthoses for spinal deformities 101
Orthosis 4, 89
Orthotic
management of
congenital dislocation of hip joint 162
idiopathic scoliosis 105
Legg-Calve-Perthes disease 164
Prosthetic Society of India 5
treatment of kyphosis 106
Overhead suspension sling 73, 74f
P
Pad placement 103
Parallel walker 176
Parapodium 189, 189f
Paraspinal bars 92
Partial
foot amputation 214
hand 235
suction suspension 221
Parts of
AFO 130f
shoe 110, 110f
wheelchair 191
Passive
prehension orthosis 53
prosthesis 230
Patella tendon bearing 150, 151
orthosis 150
Patellar tendon strap 148
Pavlik harness 162, 163f
Pawl lock 147
Pelvic
band 92, 156
and belt suspension 221
strap 195
Philadelphia collar 84, 84
Planter flexion
assist 132
stop 132
Plaster cylinder casting 42
Plastic
AFO 130f
design 129
region 18
Platform crutch 173
Polycentric knee joint 146
Polyvinyl chloride 9
Pommel bar 185
Position of
palmar bar 51f
safe immobilization 29, 29t
Poster brace 82, 85
Posterior
elbow splint 74, 74f
entrance shoe 114
leaf spring 134
spring design 134
walker 178, 178f
wedge seat 184
Postoperative orthosis 101
Postprosthetic management 241
Powered wheelchair 195
Prehension orthoses 50
using external power source 54
Preprosthetic treatment 241
Prescription of
cervical 89
shoe modification 122
trunk orthosis 100
Principle of prescription of hand
splint 65
Process of orthotic 12
Prophylactic knee orthosis 152
Prostheses for
Syme's amputation 215
various levels of
lower limb amputation 214
upper limb amputation 235
Prosthetic
elbow joint 237f
feet 226
hand
and hook 234f
in closed position 234
hip joint 214
joints 213
K levels 225
knee 226
joint 213
orthotic engineering 5
socket 211, 227
training 242
Protective orthosis 5
PTB
orthosis 151
socket 217f
Pulling wire produced opening of
hand 234f
Q
Quadrilateral
and PTB socket 212
socket 220, 220f
Quantum modular foot 208
R
Radial
bliss 58
design 60
nerve lesion 57
Ratchet orthosis 54f
Rear wheel drive 196
Reciprocal
gait orthosis 156, 157
walker 177
Recognizing design fault of chair 182
Rehabilitative knee brace 153
Reinforcement bar 26
Removable
armrest 193
footrest 193
window design 216
Research on effect of
different prosthetic components 226
shoe modifications 120
Residual limb activated locking
elbow joint 237
Resting
hand splint 28f
splint 28
Restoration of
MP
extension 40
flexion 38
PIP extension 41
thumb
movements 43
web space 44
wrist extension 37
Restrictive orthosis 5
Reverse
knuckle bender splint 40, 40f
Thomas heel 116
Revises Oppenheimer splint 59f
Rigid
elbow joint 237
frame wheelchair 196
metal orthosis 83
shoe inserts 121
spinal orthoses 101
trunk orthoses 92
Rigidity of AFO 141
Ring walker 178, 178f
Rochester parapodium 189
Rocker bar 118
Role of physiotherapist in lower limb
amputation 227
Running shoes 127
S
Sach
foot 206, 207f
and Jaipur foot 210f, 210t
heel 117f
Sacroiliac corset 92, 92f
Safe foot 207, 207f
Sagittal coronal control orthosis 93
Scapular protraction and chest
expansion 241
Scheuermann's disease 106
Scottish Rite orthosis 165, 166, 167f
Seating adaptations 184
Seattle foot 208
Selection of cushion 187
Self
propelled chair 196
suspended socket designs 236
Semi-rigid inserts 122
Serial
long forearm slab 37
plaster digital casting 42
short arm cast 37
static splint 35, 44
Sesamoid insert 122
Shank 212, 216
filler 118
piece 111
pitch 111
Shaped side lying frame 181f
Shock absorption 123
Shoe
foot attachment
mechanism 130, 131
insert 121, 131, 132
lining 112
Short
leg caliper 7
opponence splint 7, 50, 51f
Shoulder
abduction stabilizer 71
and elbow orthoses 69
component 235
disarticulation 240
disarticulation and forequarter amputation 239
orthoses 6, 69
unit 232, 240
Silesian belt 221
Silicon sheets 63
Single
axis foot 209
strap sling 72, 72f
Skeletal external fixation 83
Skin damage 10
Sleeve suspension 218
Sliding armrest 193
Slings 71
Sock lining 112
Socket 216, 223, 224, 232, 236, 240
Soft
canvas seat 184
cervical collar 83, 83f
foot orthosis 122
heel insert 122f
shoe inserts 122f
sole insert 122f
Sole
flare 119
lift 119
Solid
ankle AFO 135f
flexible endoskeleton 207
orthosis 134, 135
flat seat 184
stirrup 131f
and split stirrup 131
Somi brace 86
Spike heel 112
Spinal
injuries 100
orthoses 6, 82
Spiral
AFO 136f
design 134, 135
Splint for
Boutonnière deformity 49f
mallet finger 50f
Splinting in
acute stage 62
spastic hand 64
Splints 27
for deformity correction 44
Sports
knee orthosis 152
shoes 122, 126
Standard
belt driven wheelchair 197
walker 177f
wheelchair 197
Standing frame 188, 188f
Static
anti-claw
deformity splint 45
hand deformity splint 46f
dorsal elbow extension orthosis 75, 75f
orthosis 5
prehension orthoses 50
progressive
elbow flexion harness 75
flexion harness 76f
splint 53
ulnar
deviation splint 31f
splint 57
wrist extension splint 58
Steel sole bar 119
Sternal occipital mandibular
immobilizer 86
Stiffness of joint 10
Stone heel 116
Straps 133, 186
Strength of material 17
Stress strain curve of
soft tissue 18f
solid 18f
Supracondylar
cuff suspension 218
KAFO 149, 150f
Suprapatellar strap 148
Sutter splint 59, 60f
Swan neck
deformity 45, 47, 48f
splint 48f
Swedish knee cage 149, 149f
Swivel walker 189, 189f
Syme's amputation 215
T
Taylor's brace 7, 95, 96f
TD control system 238
Telescopic height adjustment 177
Temporary and definitive
prosthesis 205
Tenodesis orthosis 53
Terminal devices 233
and wrist unit 236
Thenar amputation 235
Thigh band 148
Thomas heel 116
Thoracic
band 93
spine 103
Thoracolumbar
corset 91
orthoses 83, 89
Through knee 223
Throwing sports 127
Thumb
abduction loop 65
CMC immobilizer 33, 34f
opposition strap 43, 44f
Tilt in space 186
TLSO flexion control 98
Tocker bar 118
Toe
box 113
break 110
crest 120
recedes 110
region 18
Tone reducing AFO 136, 137f
Toronto orthosis 165, 165f
Torsional shaft orthosis 167
Total
contact
brace 100f
cervical brace 87
insert 121
orthosis 99
patellar tendon bearing socket 217
elastic suspension belt 221
suction suspension 221
Traction device 26
Training of user 199
Transfer board 195
Transphalangeal amputation 235
Transradial amputation 236
Trapezius muscle 103
Trilateral
abduction orthosis 166f
socket hip abduction orthosis 166
Triple palsy 61
Trunk orthosis 89
Tubular swing away 193
Types of
ankle joint used 140
chair on basis of frame type 196
weight 197
curve 103
cushions 187
hand splints 26
heel 112
tip of cane 173f
upper limb prostheses system 230
walking aids 171
wheelchair 195
U
UCBL insert 122f
Ulnar
deviation 46
drift and palmar subluxation of MP 46
nerve lesion 56
Ultra-light weight wheelchair 197
Underarm orthoses 103
Understanding working parts of prosthesis 242
Universal splint 52
Upper
designs 113f
limb
orthosis 6
prosthesis 229
Use of
prone wedge 180f
single Bowden cable 159
Utensil holder 52
splint 52f
V
VAPC shoe clasp AFO 140
Variable friction unit 222
Vascular compromise 10
Velcro straps 69, 114
Voluntary
closing
hand 233
hook 233
opening
hand 233
hook 233
Von Rosen splint 162, 164f
W
Walker 176
on wheel 177f
Walking shoes 127
Water cushion 187
Wearing orthoses 75f
Wheelchair training 199
Wheeled mobility 191
Williams brace 95f
Wilmington jacket 83
Wrist
component 234
disarticulation 236
driven hand orthosis 53
Writing splint 51
Wynn parry splint 57, 61
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1Orthoses, Prostheses and Assistive Devices for Physiotherapists2
3Orthoses, Prostheses and Assistive Devices for Physiotherapists
Author Akhoury Gourang Sinha BPT MSPT PhD Associate Professor Department of Physiotherapy Punjabi University Patiala, Punjab, India Co-Authors Subrat Kumar Tripathy DPOE (NIRTAR) CEO Orthotech Appliances Delhi, India Raju Sharma BPT MSPT Head Department of Physiotherapy Lyallpur Khalsa College Jalandhar, Punjab, India Foreword Jaswant Rai
4
Jaypee Brothers Medical Publishers (P) Ltd.
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© 2012, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the authors.
Orthoses, Prostheses and Assistive Devices for Physiotherapists
First Edition: 2012
9789350258989
Printed at
5Dedicated to
Aradhana6
7FOREWORD
Prevention and rehabilitation of the locomotor disability at some stage essentially require orthotic and prosthetic intervention. A suitable and timely prescription of aids and appliances greatly reduces the recovery time and adds restoration of function. Physiotherapists by its closest contact with the patient are the best positioned member of the rehabilitation team to delineate the orthotic and prosthetic needs of a patient. Therefore, it is essential that their curriculum includes a detailed study of this subject. Considering that not many books are written by Indian authors on this subject, I congratulate the authors for their effort in presenting a book that meets the academic requirements.
Various prescribing professionals dealing with locomotor disability long-felt the need for a text that presents the information with regards to the function, mechanics and clinical uses of orthotic and prosthetic devices in clear and concise manner. I am happy to observe that the book meets this requirement and provides all the relevant information in one place.
Though the main audience of the book are the practitioners and students of physiotherapy, I am sure that it will also be appreciated by the practitioners of orthopedics, sports medicine, physiatry, occupational therapy and other professional groups dealing with locomotor disability.
Jaswant Rai
Ex-Professor (Orthopedics)
Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh, Punjab, India
Director and Joint Replacement Surgeon
Alchemist Hospital
Panchkula, Haryana, India8
9PREFACE
Orthosis and prosthesis are important components of any rehabilitation strategy designed for locomotor disabled. Physiotherapists deal with the prevention and rehabilitation of the locomotor disability. A suitable and timely prescription of aids and appliances greatly reduces the recovery time and facilitates restoration of function.
There exists a dearth of books that present a comprehensive yet concise description of the orthoses and prostheses. Most books on the topic are written for the professionals who manufacture these devices. These books often contain details of the manufacturing process that increases the volume and cost of book. At times, it becomes a difficult task for a teacher to retrieve the relevant information pertaining to the prescription and uses of the devices. Most schools of physiotherapy started in the last decade do not have attachment with any orthotic center and in places where enough books are not available teaching of this subject becomes very problematic. As a result, over the years, deterioration has been observed in the teaching of this subject in the physiotherapy schools across the country.
A prescribing professional such as physiotherapist, orthopedician, or PMR specialist requires the information with regards to the function, mechanics and clinical uses of these devices along with the knowledge for distinguishing a good device from a bad one. There exists a need of a book that makes the subject meaningful from academic point of view keeping the requirement of audience in mind. The book intends to fulfill these requirements and attempts to provide all the relevant information in one place.
A device-centric approach is adopted in the book that helps a reader to select a device for the clinical uses. However, it is not a cookbook as it also provides sufficient theoretical framework and attempts to establish the orthosis as a therapeutic modality. The authors have been teaching the subject for past several years to the graduate and postgraduate physiotherapy students and the book is the result of that interaction between teacher and learner. The material presented in the book is class-tested as far as the language, flow and the arrangement of the content is concerned. Attempts are made to present the material in lucid and comprehensible style without compromising the informative aspect. The subject matter is presented in three sections each dealing with orthoses, prostheses and assistive devices.
The book intends to encourage the physiotherapists—both students and practioners—to identify the needs of patients and generate an effective prescription. In order to facilitate the understanding, the book contains a good number of figures and photographs of most of the devices described. The detail of manufacturing process is intentionally omitted. The main thrust of the book is to present the information in such a way that would be utilized in the clinics.
Although primarily written for the physiotherapists as a course book for bachelor and postgraduate classes, I earnestly hope that it would also serve as a useful reference to the member and students of other disciplines like orthopedics, sports medicine, physiatry, occupational therapy and other professional groups dealing with locomotor disability. Every attempt has been made to avoid errors though some might have crept in inadvertently. I shall be obliged if such error is brought to my notice. I solicit suggestion and criticism for further improvement.
10I take this opportunity to express my gratitude to all those who have helped me in the preparation of the book. The book would not have seen the light of the day without the cooperation and inputs of my friends Subrat Kumar Tripathy and Raju Sharma. In recognition to their involvement in this project, it would have been only appropriate to credit them with the tile of contributing authors. My thanks are also due to my guru Mr AG Dhandapani for reviewing the manuscript and offering valuable suggestions.
I would be failing in my duties if I do not acknowledge my gratitude to all those authors whose works have been consulted and quoted in the book. Mr Pritpal Singh Siddhu, In-charge, District Disability Rehabilitation Center (DDRC), Patiala, Punjab, India, and a finest Prosthetic Orthotic Engineering (POE) professional himself—had been kind enough to show me an assortment of prosthesis and orthotic devices from his personal collections so that those could be photographed and put in the text. Thanks are also due to my colleague Dr Sandeep Singh (PT), Lecturer, Department of Physiotherapy, Punjabi University, Patiala, Punjab, India, for drawing some diagrams and helping me in many ways during the writing of this text.
I express my sincere thanks to the publisher M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for making efforts in bringing out the text. I commend their efforts in making standard text available to the physiotherapy community.
Akhoury Gourang Sinha11121314