bka w/ paraplegia - responses

bka w/ paraplegia - responses

Justin Foster

4/21/2003

List,

Thanks for the reply's, here's what came through... (each seperated by a >
symbol)

-----Original Message------------------------------------------------
Dear List,

Any considerations/experience out there in fitting a person with long hx. of
lower thoracic paraplegia with a bk prosthesis? Weightbearing in transfers
only, full community wheelchair ambulation, cosmesis a vocational concern...
Here are some specific thoughts:

Is a locking liner OK??? Without the force of full weightbearing, will the
liner cause pooling of blood/fluids in the distal end?

Will limb reduce in size, as a standard bk would? - (muscle already fully
atrophied due to long-term para.)

Any socket design ideas beyond lowering posterior wall for sitting???
---------------------------------------------------------------------

>I have fit a para with prostheses, and have used locking liners very
effectively. There is no problem with lowering the posterior walls, and, in
fact, it should be done to avoid any pressure on the popliteal region. As
the limbs are used only for transfers, the wall height is less critical. I
would use at least 6 mm liners, if you can't go with 9 for cosmetic reasons.
There will be some shrinkage, but not as much as normal. You'd be
surprised at the atrophy that does occur now that the muscles aren't
anchored at both ends.

>My experience has been a locking liner is a good way to secure the
prosthesis in place but it has to be a pre-flexed liner, because the patient
is sitting 99% of the time. If the liner is applied without air pockets
there will be no pooling, if there is use a SPOT pad. Shrinkage should be
minimal. The lower posterior wall is good but not so low it encourages
posterior migration of the knee leaving a large gap anteriorly (a cosmetic
problem).

>I fit one pt. a couple of years ago with a hard socket and cuff strap. He
>went out on the ck socket and then finished it. I did lower the back wall.
>Ive seen him for follow up and he has shrunk over time. I was reluctant to
>fit him but it does help him with transfers and sitting balance .

>I have been working with a young (22 y/o) male who is a recent
(B) TTA following a long course of treatment of osteo related to insensate
feet and ulceration due to spina bifida. He was ambulatory preoperatively
using (B) AFO's. He used a pretty typical lordotic hip hyperextended gait
pattern. He was in (B) IPOP's with WBAT immediately. He is currently fully
ambulatory using locking liners, PTB/TC sockets and only using his
wheelchair occasionally. I have not seen any locking liner-related problems.

I have worked with transtibial amputees in the past who were hemiparetics on
their amputated side and had pretty good luck with joints and corset with
drop locks.

As far as volume reduction goes, simply having a prosthesis on will apply
more pressure than a shrinker with expected volume reduction over a few
weeks. I would recommend keeping them in a test socket wrapped in deltalite
until their their volume stabilizes, then adjust the model for volume or
recast if necessary.

For socket design, you may want to consider a SC brim to help stabilize the
knee if you are not using joints and corset.


>I have experience with only one individual. For him a locking liner works
>well. Trim the liner very low, without the forces of gait suspension needs
>are minimal and with constant sitting we experienced breakdown on the
>hamstrings and superior patella. Cutting the liner short eliminated this.
>An external sleeve suspension is more cosmetic but hamstring pressure is
>more likely than with a short locking liner.

I have seen atrophy and shrinkage but at a slower rate.

A wide posterior flare can help to stabilize against rotation on the
extremity.

Alignment calls for fitting the foot to the wheelchair footrest. This is an
extremely dorsiflexed position in my case. I had to use a double adaptor at
the ankle to get enough adjustment range. Also para's use their lap for
carrying a wide variety of items. It is essential that the prosthesis holds
the knees level to provide a stable surface.

>What are your goals? My guess is your just looking for cosmetic prosthesis,
>right? If this is true, make the most simple design. A prosthesis that is
>easily donnable. That may not mean any pin attachment liner.



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