Replies--Forearm WHFO Support for use with forearm crutches

Replies--Forearm WHFO Support for use with forearm crutches

Kevin Matthews

7/10/2008

Thanks to all who responded.
   
  Original question:
   
  I have a child that I very recently fit with AFO's, post-operatively. She was my first pediatric referral from a local physician I sincerly want to impress. He e-mailed and said he very much liked the fit and design (whew), but had another another request for her.
   
  He said she has never stood up straight (she's 10 and ambulatory) and he wants her to stand up straighter in her forearm crutches. Her problem is hand strength and volitional control (diplegic). He asked me to make splints to assist in stability and control. I almost said no, there's no such thing, but remember, I'd like to impress.
   
  I've never seen such a thing in my 25 plus years, and I've seen a bit. Is there such a design out the that's functional? I'd like your thoughts and also comments on my current line of thinking.
   
  My thought was to make an external frame (dorsal WHFO). I'd take the mold, in the optimal position, over forearm, wrist, hand, and fingers while holding on to crutch (supported). I'd make the support from a flexible plastic to minimize risk of proximal fracture and use a 3/4 wrap. The idea is to provide added support, not rigid support. Does that make sense? Does it sound like it involves risk of significant injury. Is there such an animal out there?
  
  By the way, what flexible prosthetic plastic takes paper transfers? I'll post responses with names unless asked not to. I hope I made you think. Kevin
   
  REPLIES
   
  Dear Mr Matthews,

I've been doing something like that for high spine injurie's patients
 that
uses an ARGO from Steeper and needs some help to grab the walker and
 then
the crutches.We have used low temperature plastics because they are not
 
rigid and in case of fall they tend to break or flex and not the bone
 of the
patient.
Sincerely,

Mario Cesar Carvalho
Biomedical engineer/O&P
Rio de Janeiro/Brazil

   
  Hello Kevin,

I have recently started to work more with our OT department and hence
 have started doing much more upper extremity management then I have
 previously done, mostly contracture management though. One thought that I
 had was to use more of a urethane resin material to make your WHFO in
 question. I haven't had a whole lot of experience with it by there are
 several durometers of shore values of urethane resin available from Renew
 Materials. They also have a DVD that goes through the fabrication
 process for the urethane WFHO, it is similar to a lamination set up, just
 with urethane resin rather then acrylic. You could decide what shore
 value you wanted to use and then incorperate more of a circumferential
 design to improve the stability and strength you get with a more flexible
 material like urethane if you take a lower shore value.
I have also been using Thermoplastic Elastomer (TPE) plastic from
 American Plastics for some peds AFOs and SMOs, may be an alternative for
 your uppers depending on patient size and weight load the WHFO will be
 taking.
If you have any questions please let me know. Look forward to hearing
 how it turns out.

Sincerely,

Andrew Sawers CPO

  Kevin... I am on the list because of my son who is a BK... Although this is not an issue that currently involves him... I have some input...
  My dad had a stroke, right after my son had his amputation he was using the forearm crutches... My dad not having any strength and no left side, was trying to use them as he hates his cane.. As both my son and I watched it was apparent that if we could modify them someway, my dad may be able to use them... My son does a lot of modifications to his cars... He took one of the crutches, heated it up, bent it so it would change the center of gravity... He then replaced the hand bars with a type of grip used on bicycles so his brace that kept his hand straight at the wrist and separated at the fingers would slip over the grip between his thumb and pointer finger... After some adjustments, my dad was able to use it. Remember the legs of the crutches have to change the center of gravity or the idea won't work... Also, we tried using Velcro, and other different items to attach him to the crutches, They are totally not safe... if she falls, there is no release... This way, if she
 falls, the crutches release and she falls free...
  Hope this helps...Let me know..
  Thanks
  Danielle Stem
  Boise ID
  208-713-5667
   
    We have done this before and the patient was able to manipulate her hand into position. A custom infra structure to attach the who's to the crutches was required. The problem is there is no code for this service and rearranging the device to the structure for patient functionality and comfort is time consuming. You can do it!!
   
  Rick Lehneis, CPO
   
    Hi Kevin.
  Sounds intriguing, please post the results of your findings.
  I believe that Bioelastic takes transfers, but it tends to look washed out or blurry.
  North Sea plastic carries a product called sea flex that takes transfers as well. I do not know who distributes to the usa, but it is carried in canada by Orto-Ped.
  Jen Halliday BSc CO(c)




   
    Hands and grasp you sound as if you got that licked, but for trunk stability, have you thought about www.WearableTherapy.com? Theratogs at www.gaitways.com? Or www.spioworks.com? Or even Benik's core stabilization? I have had marvelous success with the Spio and Gaitways. Let us know.
   
  Gina

   
   
  Kevin;
  Although I can't seem to locate a specific image right now I have
 seen
a platform attachment like the one in this link attached to a cane
instead of a walker or crutches. You could modify it with a custom
molded hand piece.


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Good luck-Dave Benson CO