Responses to Bilat hip disartic
Gym Bunya Ward Physio
Description
Collection
Title:
Responses to Bilat hip disartic
Creator:
Gym Bunya Ward Physio
Date:
10/11/2001
Text:
Thank you so much to all the people who took the time to respond to my query. I'm sure my patient will benefit from the great suggestions, as we now have a much better idea now what path we should pursue, and some useful contacts as we proceed.
Andrea Bowen
Below is a summary of the responses:
A seating bucket must be utilized to ensure proper distribution of weight bearing and to prevent decubitus ulcers. This will also provide conditioning
for the potential of a future prosthetic fitting. I have had experience, and
success with the level of amputee you are describing. It is an extreme
benefit to have a young, and otherwise healthy candidate. Upper extremity strengthening is a must, and should be a high priority in his rehabilitation
immediately. The prosthetic gait will most likely require the use of
bilateral crutches and a swing-through gait.
I have no experience in regards to ambulation. However, I would refer you to an article in JPO, vol. 10, #4 by J. Martin Carlson,CPO. It is titled A flexible, air permeable socket prosthesis for bilateral hip dis. & hemicorporectomy amputees. I have been involved in several of these fittings and while each one evolves a little differently to meet each patients needs, the basic design is very functional. Let me know if you would like to discuss details.
I have some experience of bilateral hip disarticulation. It is extremely
possible for your subject to walk with a reciprocating gait. We have
designed and built a mechanism for such a case with very impressive results
... almost knocked my socks off!
Seriously it is easier that you may think. He is a young chap and should,
in my opinion, be given the opportunity to try. Our subject was a thirty
year old (at fitting) male who took to the device like a duck to water
although to be fair it takes a lot of determination and guts to use the
device. The patient must be up for it all the way.
Try Dr. Christina. Skoski's web site. She is HD and set up this site some time ago.
<URL Redacted>
A suspension jacket is one choice for long term chair use. It is a custom fabricated body jacket that has extension fabricated in to hook on a chair.
The components are available from Fillauer.
One of the Prosthetist's at Caulfield General Medical Centre currently
treats a similar pt.
As you might know, bilateral hip disarticulations are
very rare and many prosthetists have not dealt with
this type of patient. As a prosthetic resident, I
have been fortunate to have worked with a gentleman, a
bilateral hip disarticulation patient, who has worn a
bucket with cosmetic legs in the past. He is very
successful at his job, and manages to function almost
independently. He dons the prosthesis lying down,
over a body sock, and places his colosomy bag out a
cutout front. He then laces up the front of the
bucket and sits himself up with the legs hanging over
the bed. The original knees and hips are manual
locking, but we decided to move away from the locking
hips since they are biomechanically stable when he
stands. he then sits in the chair, which is a
challenge to scoot back and sit upright (we are
considering making knees that lock in ~45 degrees or
so flexion...Basically, the prosthesis enabled him to
wear pants and sit upright. A bucket may not be
needed if your patient can tolerate weight bearing and
is not concerned with cosmesis. Let me know if you
have any other questions or if you want to put my
patient in touch with yours.
There are definately prosthetists that can fabricate good hip
prosthesis. An idea that I saw presented about 15 yrs ago from a prosthetist
from the Springfield Mass. Shriners hospital may be of interest to you. He made a bilateral hip prosthesis and connected an RGO to it { Reciprocating
Gate Orthosis }. This devise advances one leg at a time by the patient weight
shifting. Jim Athern is the CPO at Shriners now, perhaps he will have some literature on this .
Fabricate a bucket for him to sit in/on.
I made one some time ago with a plywood base, durathane foam and
thermoplastic socket. With use I was amazed at just how low the
trimlines got
Contact Bill Contoyanos at Rehab Tech in Melb. A few years ago they had a
patient similar to yours. I recall that they had some kind of custom made
bucket arrangement attached to legs for standing and swingthrough gait and
sitting.
Andrea Bowen
Below is a summary of the responses:
A seating bucket must be utilized to ensure proper distribution of weight bearing and to prevent decubitus ulcers. This will also provide conditioning
for the potential of a future prosthetic fitting. I have had experience, and
success with the level of amputee you are describing. It is an extreme
benefit to have a young, and otherwise healthy candidate. Upper extremity strengthening is a must, and should be a high priority in his rehabilitation
immediately. The prosthetic gait will most likely require the use of
bilateral crutches and a swing-through gait.
I have no experience in regards to ambulation. However, I would refer you to an article in JPO, vol. 10, #4 by J. Martin Carlson,CPO. It is titled A flexible, air permeable socket prosthesis for bilateral hip dis. & hemicorporectomy amputees. I have been involved in several of these fittings and while each one evolves a little differently to meet each patients needs, the basic design is very functional. Let me know if you would like to discuss details.
I have some experience of bilateral hip disarticulation. It is extremely
possible for your subject to walk with a reciprocating gait. We have
designed and built a mechanism for such a case with very impressive results
... almost knocked my socks off!
Seriously it is easier that you may think. He is a young chap and should,
in my opinion, be given the opportunity to try. Our subject was a thirty
year old (at fitting) male who took to the device like a duck to water
although to be fair it takes a lot of determination and guts to use the
device. The patient must be up for it all the way.
Try Dr. Christina. Skoski's web site. She is HD and set up this site some time ago.
<URL Redacted>
A suspension jacket is one choice for long term chair use. It is a custom fabricated body jacket that has extension fabricated in to hook on a chair.
The components are available from Fillauer.
One of the Prosthetist's at Caulfield General Medical Centre currently
treats a similar pt.
As you might know, bilateral hip disarticulations are
very rare and many prosthetists have not dealt with
this type of patient. As a prosthetic resident, I
have been fortunate to have worked with a gentleman, a
bilateral hip disarticulation patient, who has worn a
bucket with cosmetic legs in the past. He is very
successful at his job, and manages to function almost
independently. He dons the prosthesis lying down,
over a body sock, and places his colosomy bag out a
cutout front. He then laces up the front of the
bucket and sits himself up with the legs hanging over
the bed. The original knees and hips are manual
locking, but we decided to move away from the locking
hips since they are biomechanically stable when he
stands. he then sits in the chair, which is a
challenge to scoot back and sit upright (we are
considering making knees that lock in ~45 degrees or
so flexion...Basically, the prosthesis enabled him to
wear pants and sit upright. A bucket may not be
needed if your patient can tolerate weight bearing and
is not concerned with cosmesis. Let me know if you
have any other questions or if you want to put my
patient in touch with yours.
There are definately prosthetists that can fabricate good hip
prosthesis. An idea that I saw presented about 15 yrs ago from a prosthetist
from the Springfield Mass. Shriners hospital may be of interest to you. He made a bilateral hip prosthesis and connected an RGO to it { Reciprocating
Gate Orthosis }. This devise advances one leg at a time by the patient weight
shifting. Jim Athern is the CPO at Shriners now, perhaps he will have some literature on this .
Fabricate a bucket for him to sit in/on.
I made one some time ago with a plywood base, durathane foam and
thermoplastic socket. With use I was amazed at just how low the
trimlines got
Contact Bill Contoyanos at Rehab Tech in Melb. A few years ago they had a
patient similar to yours. I recall that they had some kind of custom made
bucket arrangement attached to legs for standing and swingthrough gait and
sitting.
Citation
Gym Bunya Ward Physio, “Responses to Bilat hip disartic,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/217590.
