International Terminology In Prosthetics
A paper prepared for presentation at Holte, Denmark, July 4, 1968.
Standardized Nomenclature Systems
The adoption of a universal tongue for prosthetics seems as remote as achieving acceptance of one for diplomacy. However, if we could at least agree upon standardization of nomenclature systems referring to important aspects of prosthetics technology, this standardization would assist in future prosthetics training courses, especially international ones.
Communication in the Clinic
Communication among the various professional disciplines involved in prosthetics (within any given language) is essential to the effectiveness of a prosthetics program. The clinic team concept, for example, is based on the use of interdisciplinary synergisms to formulate the best solution to a prosthetics problem. Presently, no one discipline involved in prosthetics can be omniscient, thus the need for the interplay of thought and ideas at the clinical level. In this particular process, the expressions verbalized by the participants must be understandable to all in order to have full effect, whether the discussion be about surgery, a medical rehabilitation process, a physiotherapy technique, a prosthetics procedure or device, or engineering principles which apply to prosthetics. Thus the language of the clinic should at least be selective enough to be comprehended by all and thus stimulate the necessary responses.
Problems at the International Level
At another level of prosthetics activity, the international one, we encounter a formidable difficulty in translations which amplify the interdisciplinary problem. Many of our languages contain words which are almost synonomous but which have significant differences in shades of meaning from language to language. In fact, an impedance to the growth of a technology is often to be found in the limitations of the language. For advancement, terms used in specifying an idea must be quite definitive. Moreover, words must constantly be invented to effect the communication on which further technical growth depends.
Anatomical terminology is close to being universal since the words used are usually based on Latin or Greek. Both of these languages have infiltrated much of our modern terminology regardless of the native tongue. A standardization of international terminology in prosthetics should use such words as much as possible. Even though prosthetics terms may be nationalized as are the anatomical terms presently used, at least there would be consistency in the word roots.
A Nomenclature for Skeletal Limb Deficiencies
When specific problems can be identified, we should make a concerted effort to overcome them. For example, in 1967 the Committee on Prosthetics Research and Development in the United States published a proposed nomenclature1 for the classification of congenital skeletal limb deficiencies which might be used nationally and internationally. The system presented is consistent with Nomina Anatomica2 and adheres to recommendations of the U.S. publication Standard Nomenclature of Diseases and Operations3. The original Frantz-O'Rahilly system4published in the United States in 1961 was discussed at a conference in The Hague in 1963 and produced no international agreement. The revised system attempts to overcome some of the objections to the original, and consideration of standardization based on this new presentation may have a greater possibility for success.
Some may believe that standardization of nomenclature in this instance should be based more on functional than on anatomical loss. But there is need for both sets of nomenclature. First, the anatomical losses should be defined as in the proposed revision. Later, biomechanical descriptions of dysfunction can be developed but for other purposes.
Resolution of this particular problem is quite important, as has been pointed out by V. P. Kennedy of Edinburgh, Scotland5. He pleads for epidemiological analysis of birth defects. He states however that it is mandatory to have "international agreement for standardization of diagnoses so that statistically accurate incident rates may be recorded." His quest is for a standardization of nomenclature on congenital malformations so that epidemiological research into possible causes could proceed on a rational basis.
We think that the nomenclature proposed by the Committee on Prosthetics Research and Development constitutes a new start. Therefore, it is being submitted for international consideration through the International Committee on Prosthetics and Orthotics. We hope that a constructive critique will ensue.
Terminology used to describe dysfunction and function directly related to prosthetics and orthotics might be based on mechanical terms such as "rotation" and "forces and moments." Expressions of the limitations of motion and force capabilities of a patient are certainly more meaningful than a statement that he has "somebody's disease" which can have a variable pattern of dysfunction. Instead of speaking of "hip extension" one can think in terms of a rotation at the hip in the sagittal plane. In such an example we avoid trying to translate the term "extension," which can have many meanings, yet still use terms conceptually related to the jargon of physicians and surgeons. Employed are engineering terms which more often than not, at least in the English language, have been based on Latin and Greek roots.
Recent work on this problem by the American Academy of Orthopaedic Surgeons should be described. Through one of the Academy's committees, development of new concepts for expressing function and dysfunction in orthotics is now under way. While not yet finalized, the system will provide for the description of a functional pathology in terms of a diagram of the pathomechanics of the lower extremity. This diagram will involve appropriate notations on a three plane (sagittal, frontal and transverse) skeletal depiction of the lower limb. These notations can give a very clear indication of disability (once the rules are known) without resorting to extensive use of written terms. This type of information display will orient clinicians involved in the prescription process. Perhaps it might even get them to think of the type of function needed to offset the diagrammed dysfunction. Of equal significance perhaps will be the contribution of this system in expediting the education of new people coming into this field. Moreover, this system could provide a basis for international communications about disability with a minimum of translation required.
Description of Components
To develop a terminology in prosthetics or orthotics that will be internationally acceptable, we must also have functional terms for appliances and components. Table 1 presents a list of orthotic components* whose functional characteristics are described under the heading "Biomechanical Function." These terms identify the items more precisely than do the common "trade" terms which inhibit communications even within language groups. Also, too often an appliance is designed and given the name of some person associated with it. Unfortunately confusion develops from such a system. Better are the assignments of functional descriptions similar to the ones presented here, even though some of the terms used, such as "hyperextension," are not the best, especially for international communications. These functional descriptions could also be displayed in diagrams like those being developed for functional pathology. Then such diagrams of function could be matched to diagrams of dysfunction.
Standard Terminology Systems
Related to the need for standardization of criteria for prosthetics and orthotics training programs is the need for standardized systems of terminology. We urge that medical descriptions of loss be one level of standardization. For example, anatomical terms such as presented in the document on skeletal deficiencies due to congenital malformations should be employed. A second level of classification is that of the description of functional loss using biomechanical terminology or pictorial displays. A third level is in that of describing appliances and hardware in functional terms with a reasonably precise relationship to the system employed in the biomechanical description of dysfunction. At all levels, simplicity should be sought to the maximum degree; words must be chosen to avoid interpretations different from those intended, especially in translation.
The items listed in the table are arranged in categories related to the segment of the lower extremity to which they apply. Also included are the sources, materials, and the typical applications for each component. (Because of space limitations, only the section of the table related to the hip joint is included in the present article.-Editor)
Anthony Staros is associated with the Veterans Administration Prosthetics Center in New York, New York
1. Burtch, Robert L., "Nomenclature for Congenital Skeletal Limb Deficiencies, a Revision of the Frantz-O'Rahilly Classification," Artificial Limbs, Spring 1966.
2. Excerpta Medica Foundation (Amsterdam, London, Milan, New York), Nomina Medica, 2nd Edition, 1961.
3. Thompson, Edward T., ed., Standard Nomenclature of Diseases and Operations, McGraw-Hill, New York, 1961.
4. Frantz, Charles H., and O'Rahilly, Ronan, "Congenital Skeletal Limb Deficiencies," Journal of Bone and Joint Surgery, Vol. 43-A, No. 8, December 1961.
5. The National Foundation-March of Dimes, "Epidemiologic Aspects of the Problem of Congenital Malformations," in Birth Defects Original Article Series, Vol. III, No. 2, December 1967.