ELSEVIER

MASON
Collaborators

John Andrade Ortega

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

Maria del Mar Carrión Martín

Specialist Area Physician of the Rehabilitation Service, Ciudad de Jaén Hospital (Jaén).

Francisca Carrión Pérez

F.E.A. 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
from the Faculty of Medicine, University of Seville (Sevilla).

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

Ángel Fernández González

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

Vicente Gomar Sancho

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

Alba Gómez Garrido

M.I.R. of Rehabilitation and Physical Medicine, Vall d'Hebron Hospital (Barcelona).

Miguel Ángel González Viejo

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

Elsa López de Lacey

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

v
 Ángela López del Río
Occupational therapist, Virgen de las Nieves University Hospital (Granada). Teacher at the School
Health Sciences, University of Granada (Granada).

Felipe Pascual Gómez

Head of the Prosthetics Section of the Physical Medicine and Rehabilitation Service, Clinical Hospital
San Carlos (Madrid). Associate professor in the Department of Physical Medicine and Rehabilitation
from the Faculty of Medicine, Complutense University of Madrid (Madrid).

Encarnation Pina Paniagua

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

Mabel Ramos Sánchez

Full professor of the Department of Physical Medicine and Rehabilitation, Complutense University
from Madrid (Madrid).

Manuel Rodríguez Piñero

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

Jesús Salcedo Luengo

Orthopedic doctor, Salcedo Orthopedic Clinic (Madrid).

Felip Salinas Castro

Orthopedic doctor, Technical Orthopedic Institute (Barcelona).

Judith Sánchez Raya

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

Carlos Sotos Portalés

Professor, University of Valencia (Valencia).

Raquel Valero Alcaide

Full professor in the Department of Physical Medicine and Rehabilitation, Complutense University
from Madrid (Madrid).

Ramón Viladot Perice

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

Ramón Zambudio Periago

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

I
Presentation

Prosthetics, orthotics, and technical aids are part of a field called ortho-
technical encyclopedia. The idea of writing this book arose after realizing the scarcity of bibliographies.
writing in Spanish on this subject.

Technical orthopedics is subject to continuous advancements, due to the development of new materials and the
growing demand for these products due to an increasingly aging and dependent population.

This book does not aim to cover all topics in great detail, but rather seeks to attempt a
initial approach to orthopedics. It has been intended for the informational content to be current,
useful and oriented towards clinical practice in aspects related to the rehabilitation of amputees
upper and lower limb prosthetics, orthotics for limbs, torso, and skull, and technical aids
in its various sections.

There are several medical specialties that must be aware of this field: the rehabilitation physician.
and the orthopedic surgeon as prescribers of these products, the orthopedic technicians as
manufacturers, and physiotherapists and occupational therapists as responsible for the adaptation
and the fitting of these products to the patient.

Naturally, to be able to write a book of this kind, the efforts of many need to be combined.
professionals. In this case, a large group of prestigious specialists has been gathered.
lists from the field of orthopedics, national and foreign, with extensive experience in this
themes and I take this opportunity to thank for the effort made. Without them, it would have been impossible.
the creation of this book.

RAMÓN ZAMBUDIO PERIAGO

seven
Prologue

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 write the preface to this book, not for my merits, which
they are few, but by the heartfelt friendship that has united us for more than twenty years.

We met when I had just been nominated as the head of the Prosthetics and Orthotics Unit.
that Dr. Salinas had created in the Rehabilitation Department of the Sanitary City
Virgin of the Snows of Granada. At that time, we believed that there was a great unknown.
rise of orthopedic techniques among medical and paramedical professionals. We were
agreed that the Spanish university would teach orthopedic technicians, but
we thought it was a limitation that knowledge was not extended to the entire group of professionals
the rehabilitation. Certainly, this gap was later remedied by some faculties-
From Medicine, at the same time that Drs. Salinas and Zambudio organized the I Course
Theoretical-Practical Update on Prosthetics and Orthotics, to which I was invited and which turned out to be a
resounding success with the public and critics. So much so that it has been repeated every two years, expanded
and improved with the incorporation of topics as broad as technical aids or with the pre-
presentation of the innovations and research of the manufacturing industries of com-
orthopedic and prosthetic components. The course, over time, has gained relevance
international, 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 they will be with me
also rehabilitation and traumatology residents from all over Spain, along with
physiotherapists, occupational therapists, and anyone involved in rehabilitation
rehabilitation of the disabled.

As it seems that my friend Ramón had some free time, eight years ago he prepared another course.
about Scientific Evidence in Rehabilitation and Physical Medicine, which has achieved such success
like the previous one.

This ability to coordinate and lead successful courses is only possible when its director is a
A man with enthusiasm and faith in what he does, has exceptional organizational skills, honesty.
and splendor to give everything in exchange for receiving little, and live in this world convinced and with-
overcoming others by doing important work.

And now, a book! Years ago, in an informal meeting, someone suggested: 'With
How stubborn Ramón is, any day he will write us a book about orthopedics or rewrite El Qui-
jote.

ix
 Over the years, many well-known speakers have presented their expertise in the courses.
experience on a variety of topics, including the innovations that have occurred in the
orthopedic science. All this accumulated scientific knowledge has been a stimulus for the
Dr. Zambudio exposes it in this publication, which, in my opinion, is the effort of a dozen.
that you have yearned to do for twenty years.

Few areas of healthcare have achieved such significant scientific advances as those that have
have been produced in the field of orthoses and prostheses, which are presented in this volume.
In addition, with the vision and knowledge of experienced specialists. This book comes
to fill an important space in the orthopedic bibliography, along with other magnificent mono-
graphs published years ago by Professor Viladot and the IOC, which have provided such good services
loaned and provide to all those who want to know about prosthetics and orthotics.

Honestly, in my understanding, Dr. Zambudio has rewritten the chapter of 'Don

Don Quixote and the Windmills.

JESUS SALCEDO LUENGO

x
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 Information search on the Internet 27
Juan Alfonso Andrade Ortega
6 Prosthesis in partial foot amputations 33
Felip Salinas Castro and Oriol Cohí Riambau
7 Prosthetic feet 43
Felip Salinas Castro and Oriol Cohí Riambau
8 Prosthetics in tibial amputations 51
Felip Salinas Castro and Oriol Cohí Riambau
9 Prosthesis in knee disarticulation 63
Ramón Zambudio Periago
10 Prosthetics in femoral amputations 69
Angel Fernández González
11 Hip disarticulation and hemipelvectomy 89
Ángel Fernández González
12 Alignment of lower limb prostheses 97
Angel Fernández González
13 Rehabilitation in the lower limb amputee 105
Ramón Zambudio Periago
14 Assessment of gait in lower limb amputees 111
Alberto Esquenazi
15 Physiotherapy in lower limb amputation 123
Incarnation Pina Paniagua
16 Follow-up of the prosthetized lower limb amputee 131
Ramón Zambudio Periago
17 Introduction to upper limb prosthetics 137
Ángel Fernández González
18 Prosthetics in hand and forearm amputations 143
Ángel Fernández González
19 Prosthesis in elbow, arm and shoulder disarticulation 155
Felip Salinas Castro
20 Occupational therapy in upper limb amputees 165
Ángela López del Río

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 21 Malformations and orthopedic prostheses 175
Jesus Salcedo Luengo
22 Osteointegration in amputees 191
Ramón Zambudio Periago
23 Walking apparatus 197
Miguel Ángel González Viejo and Alba Gómez Garrido
24 Hip orthosis 213
Manuel Rodríguez-Piñero Durán and Carmen Echevarría Ruiz de Vargas
25 Knee brace 221
Manuel Rodríguez-Piñero Durán and Carmen Echevarría Ruiz de Vargas
26 Orthotic insoles. Orthopedic inserts 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 Shoulder and elbow orthosis 245
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 Orthoses for thoracic deformities. Scoliosis and kyphosis 259
Miguel Ángel González Viejo and Judith Sánchez Raya
31 Cervical orthoses 281
Ramón Zambudio Periago
32 Lumbosacral orthoses 285
Ramón Zambudio Periago
33 Orthosis for cranial deformities 291
Jesus Salcedo Luengo
34 Walking aids 301
Ramón Zambudio Periago
35 Wheelchairs 309
Carlos Sotos Portalés
36 Technical aids versus support products 319
Felipe Pascual Gómez
37 Technical aids in daily life activities 323
Mabel Ramos Sánchez and Felipe Pascual Gómez
38 Cranes and transfer systems 329
Elsa López de Lacey and Felipe Pascual Gómez
39 Augmentative and alternative communication 333
Felipe Pascual Gómez
40 Home automation and environmental control 339
Felipe Pascual Gómez
41 Prevention of pressure ulcers 345
Raquel Valero Alcaide and Felipe Pascual Gómez

Alphabetical Index 349

twelve