STANCE – It is clear by observing current research and commercial development that the simple activity of supporting one's body while upright is still not completely understood. Nor have we settled on optimal strategies for orthotic management of stance deficiencies or control of knees and ankles during stance with a prosthesis. These basic challenges have been central for the entire history of our profession. Perhaps because stance function can be so basic, so static, it can be under-appreciated. Consider the limits in reimbursement for stance control technology in orthoses. Probably one of the most significant functional developments in orthotic care in the past several decades, active stance control for KAFOs is not supported at a level that fosters innovation and greater use. It is a similar problem with functional electrical stimulation (FES)-based electronic orthoses. Orthosis ankle stance control is another area that could benefit from further study and development. The functional impact of effective stance control is evident to the clinician, and research (including important new articles in JPO) is verifying and quantifying it, but improved stance function can be a hard sell to the payers in our system.
Prosthetics technologies have fared somewhat better. The benefits of active electronic stance control in prosthetic knees have been recognized and are broadly utilized now. Perhaps that is because there was a considerable history of alternative and increasingly sophisticated technologies applied to improve stance: mechanical locks, brakes, hydraulics, and electronics. Similar benefits at the ankle level are being pursued by many because the world is not flat and our ankles are very useful for adjusting our stance to our environment. Our ankles help us transfer power in the gait cycle, and active stance control can greatly assist the efficiency and comfort of normal gait.
To a great degree, to be expert in orthotics and prosthetics of the lower limb, to be able to best address the needs of our patients, is simply to understand stance. Oh, if only it were simple!
David A. Boone, CP, MPH, PhD
Journal of Prosthetics and Orthotics