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Introduction I am very grateful to be given this opportunity to show my appreciation of Knud Jansen, who believed that the rehabilitation of the amputee was best organised by a clinic team. As one of the founders and the first president of ISPO he promoted the multi-disciplinary interest and membership of this society. The theme of this World Congress of technology and services in the field of prosthetics and orthotics for the different age groups reflects this wide interest. I shall be talking more about service than the details of technology, as I want to consider the nature of our rehabilitation goals and now these may be achieved. Another great orthopaedic surgeon, Sir Harry Platt, disliked the term rehabilitation, which he thought was a “mischievous word‘’, and he was extremely dismissive of rehabilitation medicine. I quote from a lecture, in which he said, “Rehabilitation medicine, so called, is a form of managerial medicine,” spoken with a downward inflection of the voice. Despite this condemnation, he was right in his choice of words, because rehabilitation of the amputee is the active management of his problems and disability. Let us consider the situation. The locomotor and manipulation capability of the human increases until maturity and falls off in old age. For an infant or child we should try to restore any abilities which have been lost and encourage normal increase in capability as the child’s mental and physical skills develop. The rehabilitation process for the adult should aim to restore an ability which matches the normal, even though it may be at a lower level, whereas the process for the elderly person has to recognise that their pre-amputation ability may

The prosthesis required for a child with a transverse deficiency whilst a simple version of that appropriate for the adult follows the same principles. The child with a longitudinal deficiency may require an extension, or orthoprosthesis and this may be combined with surgical reconstruction. The principles, technique of measurement and fabrication methods using both traditional and modern composites are described.

This classification originally produced by the ISPO "Kay" Committee in 1973, has now with minor modifications, become an International Standard (ISO 8548-1: 1989). It is limited to those deficiencies which are failures of formation and describes them on anatomical and radiological bases only. All are divided into transverse and longitudinal, and use simple terms and descriptors.

Hugh G. Watts, Mary Williams Clark The American Academy of Orthopaedic Surgeons Illinois, USA, 1998 ISBN 0–89203–179–4, pp59

The activity achieved by a lower limb amputee is usually assessed by clinical judgement or physiological tests. The former is seldom absolute, being affected by factors such as patient age, and is expressed in categories which may not be equivalent to those used by other observers. Physiological testing provides a measure of the patient's capabilities, but not his activity which may be dependent more on social requirements than physical state. This paper describes a method of questioning the patient using multiple choice answers attracting positive and negative scores, which summate to provide an overall "Activity Score". The procedure takes about 15 minutes and uses the minimum of observer judgement. The technique has been developed over six years and 2400 patients have been investigated. Validation procedures are described, including the use of step counters which show a substantially linear relationship between annual step rate and "Activity Score".