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  • Re: amputee sprinter

    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
    > > >
    > > > ---------------------------------------------------------------
    > > > Information about BIOMCH-L: http://www.Biomch-L.org
    > > > Archives: http://listserv.surfnet.nl/archives/Biomch-L.html
    > > > ---------------------------------------------------------------
    > > >
    > >
    > > ---------------------------------------------------------------
    > > Information about BIOMCH-L: http://www.Biomch-L.org
    > > Archives: http://listserv.surfnet.nl/archives/Biomch-L.html
    > > ---------------------------------------------------------------
    > >
    >
    >
    >
    > --
    > 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
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