P-3-03-07
AMPUTATIONS AMONG ADULT SPINA BIFIDA PATIENTS: A CASE REVIEW
Marlowe E.S. (The Graduate Hospital, Philadelphia, Pennsylvania) Jacob J. (Mediplex Rehabilitation Hospital, Marlton, New Jersey) Wu, D. (Mediplex)
Adults with spina bifida are at an increased risk for lower extremity amputation. Patients with foot rigidity or nonplantigrade position due to arthrodesis are susceptible to develop neuropathic skin changes. Other factors that predispose to skin breakdown, osteomyelitis, cellulitis, and amputation include lack of aggressive follow-up into adulthood, the presence of abnormal plantar sensation, and conceivably decline in cognition due to hydrocephalus. Three cases of adult amputees with spina bifida were reviewed. One amputation was due to extensive gas gangrene that necessitated a transfemoral approach. While management of children in special clinics has been successful, we find that many of these patients are lost to follow-up once they reach adulthood. Subsequently, we hypothesize, these adults are at greater danger of becoming amputees. Areas for future investigation include the exact incidences of various levels of amputation in relation to the level of cord lesion, educational achievement, and socioeconomic status. While the need for a multi-disciplinary approach headed by a single coordinator has been illustrated, we suggest this may best be achieved in an interdisciplinary rehabilitation setting.
P-3-04-01
Designing a Hip Joint Moment Reduction Brace by Using Finite Element Method.
Shigeaki Matsuo, Y. Tagawa, K. Yamamoto, Y. Watanabe, N. Shiba, A. Inoue
(Kurume Univ. and Kurume Institute of Technology, Kurume, Japan)
The forces, over three times the body weight, are applied across the hip joint during level walking. Such large forces on the hip joint may cause, or worsen, the coxarthrosis. Before considering the operations, such as osteotomy and THA, the surgeons may also prescribe some nonsurgical methods that may provide substantial symptomatic relief and allow the patient to maintain a reasonable level of activity. We have designed and constructed a thigh brace, the Hip Joint Moment Reduction Brace (HMRBrace). The HMRBrace reduces the moment of the applied force against which the abductors must contract, reducing the forces across the hip joint. The purpose of this study is to examine the biomechanical effect of the HMRBrace.
Braces have been designed and developed through knowledge and experience of prothetists and orthotists. It is, hence, difficult for a beginning prothetist and orthotist to attain every technical knowledge and skill to be needed in a short time. Computer simulation, however, helps them to make braces quickly and rationally. It economizes time and production cost. We examined a shape of HMRBrace, analyzing the stress distribution of the brace by using a finite element method. This approach is prospective for a low-cost designing.
