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kirtley24
05-21-2007, 12:10 AM
PS: ...of course I meant transTIBIAL prostheses, i.e. feet!

Chis


On 5/21/07, Chris Kirtley wrote:
>
> Dear all,
>
> I wonder if I might raise a related question?
>
> These days transfemoral prostheses are so good that we may have reached
> the point where it may be worth considering amputation in cases where the
> foot is severely deformed or non-functional, e.g. as a result of
> neurological disorders (stroke, cerebral palsy etc.) or even such conditions
> as rheumatoid arthritis.
>
> Yet I have rarely heard this option raised with a patient - I wonder why?
>
> Chris
>
>
> On 5/20/07, Joe Laszlo wrote:
> >
> > Hi all,
> >
> > I only lurk on biomech-l periodically, but this topic and subsequent
> > discussion really caught my attention.
> >
> > I'll prefix by saying I would *love* to see Oscar run in the Olympics
> > and hate to say anything to discourage it. I think it *should*
> > happen, but not as part of the current 100m event. Instead, it should
> > be a separate 100m event class: the first(?) fully-peered "disabled"
> > event in the Olympics proper (vs. the Paralympic games). To me, this
> > seems to address many problems, both technical and political. It's
> > also a possible initial step on a path to (eventual)
> > Olympic-Paralympic integration IF that's desirable (I personally think
> > so, but it's not my opinion that matters). More below.
> >
> >
> > First, a few thoughts I *think* haven't been directly noted (fully, in
> > any case). My apologies if they have and I've missed them; I've tried
> > to read & catch up on the many good responses diligently. A great
> > topic and lots of fantastic points, BTW -- well done, all (especially
> > Ton, for helping "instigate" [in a positive sense!] so well :-)
> >
> > In particular, I love the points re "purity of sport" and the "Olympic
> > principles of inclusion and inspiration". We are, after all, talking
> > about the Olympics.
> >
> > ---
> > The thoughts:
> >
> > Reduced weight and some other potential mechanical advantages of
> > runners like Oscar have been noted. The weight/moment factor alone,
> > noted by Joel Perry (maybe others as well?), seems huge to me, even if
> > current prostheses aren't yet able to fully exploit it, but I *think*
> > two factors haven't been highlighted fully:
> > 1. potential advantages during training, as well as competition;
> > and
> > 2. energy/equivalence arguments *may* not be relevant, even if proven
> > "fair"
> >
> > Joel also pointed out the issue of "able-bodied" athletes body parts
> > surviving the high stress of near-maximal performance. IMO it's worth
> > noting that this also applies to training. *Potential* hamstring,
> > achilles or other injuries seem to be ever-present factors, maybe even
> > limiting factors, in training, at times. Prosthetics users will have
> > different potential injury factors, but any "fair equivalence" is
> > unclear. Steroids and other related substances enable higher training
> > loads and are banned, for example (not to say that they are directly
> > comparable!).
> >
> > Athletes using prostheses (note that I did NOT say disabled!) may have
> > significant advantage here both in training and competitive
> > performance (as well as disadvantages). Could external (or one day
> > even internal or hybrid) synthetic fibre functional "tendons" or
> > "ligaments" help mitigate weakest-link injuries allowing higher
> > performance? Synthetic joints? (& combinations thereof?) I think a key
> > point is that IF these would be disallowed for a competing field of
> > "able-bodied" athletes, allowing it for "disabled" athletes competing
> > directly with able-bodied athletes seems unfair. Similar prostheses
> > adapted to able-bodied runners would be illegal (according to the
> > noted "shoes with springs" rule) and as far as I know is untested, but
> > so-called "power stilts" are a current, clear, if more crude, example.
> > These are passive fibreglass-spring stilts which enable much higher
> > leaping heights and running speeds than unassisted. I don't know if
> > shoes which only extend the leg would be legal -- it seems hard to
> > argue that they wouldn't have explicit "springs" of some form. On the
> > other hand, could the soles of any sprint shoes currently in
> > competition use be considered spring-like (from the contact area)?
> >
> > So far a primary goal of prostheses has been to restore or match
> > equivalent function as much as possible. This seems mainly because we
> > just haven't really been quite as good as nature... yet. Make the
> > function very specific and we can probably already surpass it in some
> > cases. This _will_ become more general.
> >
> > For an athelete with part of the lower leg(s) missing, we are
> > effectively replacing part of the body with an artificial functional
> > unit. Eventually this will be able to exploit potential advantages.
> > Consider a mechanism that optimally varies effective leg length, to
> > reduce the moment of the return leg, say passively, for the sake of
> > argument -- is it still "fair"? Extend to above-knee amputees
> > (eventually). There's even an argument that this could potentially be
> > _electronically_ controlled (& thus much "smarter") in a "technically
> > fair", but probably not "fair in spirit", way -- if the power came
> > from the athlete's at-the-time motion. I'm not even certain if that's
> > still purely "future work", but it's surely not *too* far off.
> > There's a lot of kinetic energy in a sprint to play with trading off a
> > small percentage of it well, maybe even for "able-bodied" runners
> > (e.g. with some form of online "bio-cues" for optimal performance?).
> >
> > Regarding an upper-body amputee sprinter competing, personally, I
> > think that's fine with no prostheses, but that upper-body prostheses
> > could have similar (but probably reduced) advantages.
> >
> > Regarding energy-equivalence arguments, different events can have
> > equivalent energy or power requirements but should "clearly" still be
> > separate events -- in a sense, this is the very basis of most event
> > classifications. A swimming vs. running sprint is a somewhat
> > ridiculous example, to make the point. The distinction between
> > "traditional" and "skating" techniques in cross-country skiing events
> > in the winter Olympics is a more compelling example. This takes away
> > nothing, of course, from the great discussion on how best to do this
> > evaluation if it's considered salient.
> >
> >
> > I think it's, unfortunately, too *potentially* unfair to allow direct
> > head-to-head in this way, however inspirational and inclusive it may
> > be, especially when you consider that the Olympics and IOC are
> > inherently "long term" in outlook. Whatever you choose to call it,
> > it's effectively just too *different*. Different, not [dis]abled.
> >
> > ---
> > Which leads nicely to my proposed solution:
> >
> > 1. Have (add) a separate double-amputee class 100m sprint event in the
> > Olympics-proper.
> >
> > 2. IF there is effective consensus that Paralympic and Olympic events
> > should (eventually) be integrated: remove the event *from* the
> > Paralympic games - the first full step in the transition, regardless
> > of how long it will take.
> > Note: this is a purely political issue I'd rather support competitive
> > athletes' preference on. I'm not one myself, so I include it as part
> > of the greater "golden opportunity" I'm suggesting technical
> > justification (and some political opportunity) for.
> >
> > 3. Do it for 2008. Great potential benefits are there now; deferring
> > it risks being too late.
> >
> > 4. Promote it like crazy, hopefully making pretty much everybody happy
> > (win-win-win-win :-).
> >
> >
> > IOC and/or related governing bodies: if you do it for 2008, give
> > yourself a very well-earned pat on the back. Really.
> >
> >
> > I think doing this would maintain whichever form(s) of the "Olympic
> > spirit" you prefer, addresses many hairy political issues quite well,
> > and may even help pave the way to meaningful
> > "assistive-whatever-you-like" competition down the road ("able-bodied"
> > or not -- make the distinctions fairly categorical, not
> > "[dis]ability"-based!).
> >
> >
> > ---
> > Some thoughts on political and "Olympic principles" issues, since I
> > feel they do relate both back, to technical issues, and ahead, to
> > future biomech-related research and technology development:
> >
> > Foregoing direct head-to-head competition, could be viewed as a
> > "concession", but I think that the strong symbolic gesture & direction
> > alone could do and mean _much_ more for *all* so-called "disabled"
> > athletes, going forward, than any few individuals competing
> > head-to-head in any particular, probably questionably fair, and
> > politically fraught event. IMO, the proposed solution offers:
> > 1. The first-ever (I think) official Olympic event for so-called
> > "disabled" athletes; one which may have the potential to actually
> > exceed unassisted human performance;
> > 2. A (potential) clear path to eventual integration of the Paralympic
> > and Olympic games, on a piece-wise, "as appropriate" basis; if
> > desirable, this may be much a more likely path than doing it en-masse
> > - and what better event to first do this with than the current marquee
> > event of the Olympics? (!)
> > 3. On a more distant time horizon: a potential path (again, if
> > desired) to evaluate and advise competitive consideration of various
> > "biomechanically assistive performance technologies" that will surely
> > come along, as we push human performance limits. Who would be
> > surprised if future athletic disciplines of *public* interest involve
> > increasingly tightly integrated technology and surpass unassisted
> > human abilities? This is surely of *eventual* Olympic interest, even
> > if it is resisted initially. This opens the door to testing those in
> > a way that will hopefully be of wider general benefit.
> >
> > That most or all competitors (in the new 2008 double-amputee 100m
> > sprint) will probably perform well below the typical levels of the
> > marquee event doesn't matter. The top sprinters of some countries far
> > under-perform those that don't even make the national team in others.
> > That's the Olympic inclusion principle - everybody gets to compete if
> > they meet the standards bar _in the appropriate designated event(s)_.
> > The cross-country skiing styles is an example again. The clap-skate
> > is another which was also handled differently, but may even one day
> > spawn a "traditional" event(?).
> >
> > Regarding inspiration, what about when (if) a "disabled" athlete one
> > day shatters the human-propelled speed record? At some point, the
> > tables may even be exactly reversed, and the entire field of the 100m
> > assisted/amputee (and/or maybe the assisted/non-amputee?) race(s) will
> > blow away the top "unassisted" 100m sprinter and become the hallmark
> > event of the games. *That* would be landmark, but that's what I'd bet
> > on. I can't wait! ("Disability, schmisability!" :-)
> >
> > In the meantime, the Olympics would be taking a positive, proactive
> > direction and essentially bypass some of the political quagmire that
> > the spectre of head-to-head competition raises, in a way that would
> > hopefully lead to wide-spread (higher/faster/stronger) technological
> > benefits for everyday real people with disabilities & related
> > challenges. The main exception, politically, being the issue of
> > whether to begin "splitting off" Paralympic events.
> >
> > In fact, even head-to-head is still possible, outside the Olympics, or
> > in an "open" 100m event, perhaps better left to a future point,
> > if/when enough assisted-device sprinters approach and might surpass
> > unassisted Olympic competitive performance levels. That could be
> > quite a spectacular draw during the "transition period", if it ever
> > happens.
> >
> >
> > One thing I do hope is that IF there's strong consensus in principle
> > among the athletes for eventual integration of Olympic and Paralympic
> > events, and if the propsed approach seems sound, that all hands pull
> > together to help make it happen. The logistics alone, of shooting for
> > 2008, will be challenging enough, and if "assistive device" runners do
> > eventually outpace unassisted runners, it *may* be a much more thorny
> > issue for 2012, with the "transition" possibly already even well
> > underway.
> >
> >
> > My $.02 (perhaps $.04), for what it's worth. Sorry if I've gone a
> > little overboard with the length and any rhetoric; the topic got me
> > positively fired up. :-)
> > Please feel free to criticize as appropriate.
> >
> > Also, while I don't ever recall seeing or hearing such a suggestion
> > previously, if it pre-exists, please note it & advise me to attribute
> > credit appropriately(!)
> >
> > Cheers! (& thanks again for the great discussion!)
> > Joe.
> >
> > --
> > ------------------------------------------------------------
> > Joe Laszlo
> > jflaszlo@cs.toronto.edu
> > Ph.D. Candidate, Dept. of CS
> > Dynamic Graphics Project
> > University of Toronto
> > [ but I speak only for myself, of course ]
> > ------------------------------------------------------------
> >
> >
> > On 5/18/07, BIOMCH-L automatic digest system
> > wrote:
> > > There are 12 messages totalling 1182 lines in this issue.
> > >
> > > Topics of the day:
> > >
> > > 1. Biomechanics of the Lower LImb - Early Bird Registration
> > > 2. Last Minute Reminder - 2007 Injury Biomechanics Symposium
> > > 3.
> > > 4. amputee sprinter (7)
> > > 5. Quantifying Spasticity Using Isokinetic Dynamometry
> > > 6. PhD Positions at the University of Southampton, United Kingdom
> > >
> > > ---------------------------------------------------------------
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> > > ---------------------------------------------------------------
> > >
> >
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> >
>
>
>
> --
> Dr. Chris Kirtley MB ChB, PhD
> from 1 May to 31 July 2007 I am at:
> Stiftung Orthopädische Universitätsklinik Heidelberg
> Leiter Ganganalyselabor
> Anschrift: Schlierbacher Landstr. 200a
> 69118 Heidelberg
>
> Tel: 49+06221-96 6724
> Fax: 49+06221-96 6725
>
> Clinical Gait Analysis: http://www.univie.ac.at/cga
> Book: http://www.amazon.co.uk/exec/obidos/ASIN/0443100098/203-6674734-4427132
>




--
Dr. Chris Kirtley MB ChB, PhD
from 1 May to 31 July 2007 I am at:
Stiftung Orthopädische Universitätsklinik Heidelberg
Leiter Ganganalyselabor
Anschrift: Schlierbacher Landstr. 200a
69118 Heidelberg

Tel: 49+06221-96 6724
Fax: 49+06221-96 6725

Clinical Gait Analysis: http://www.univie.ac.at/cga
Book:
http://www.amazon.co.uk/exec/obidos/ASIN/0443100098/203-6674734-4427132