This classification originally produced by the ISPO “Kay” Committee in 1973, has now with minor modifications, become an International Standard (ISO 8548-1: 1989). It is limited to those deficiencies which are failures of formation and describes them on anatomical and radiological bases only. All are divided into transverse and longitudinal, and use simple terms and descriptors.
The activity achieved by a lower limb amputee is usually assessed by clinical judgement or physiological tests. The former is seldom absolute, being affected by factors such as patient age, and is expressed in categories which may not be equivalent to those used by other observers. Physiological testing provides a measure of the patient's capabilities, but not his activity which may be dependent more on social requirements than physical state. This paper describes a method of questioning the patient using multiple choice answers attracting positive and negative scores, which summate to provide an overall “Activity Score”. The procedure takes about 15 minutes and uses the minimum of observer judgement. The technique has been developed over six years and 2400 patients have been investigated. Validation procedures are described, including the use of step counters which show a substantially linear relationship between annual step rate and “Activity Score”.
The prosthesis required for a child with a transverse deficiency whilst a simple version of that appropriate for the adult follows the same principles. The child with a longitudinal deficiency may require an extension, or orthoprosthesis and this may be combined with surgical reconstruction. The principles, technique of measurement and fabrication methods using both traditional and modern composites are described.
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