Post Surgical Wheelchair Custom Lower Extremity Supports

Craig A. Kraft ATP; Shriners Hospital for Children, Tampa, FL

Surgical intervention to correct orthopaedic deformity or improve functional independence is regularly performed at our facility. Many of the various procedures result in post surgical casting applications that vary in configuration and duration of use. Not only full time wheelchair users but ambulatory children often require wheelchairs and lower extremity supports post surgically as a result of casting requirements and non-weight bearing status.

Two common procedures resulting in unique challenges when positioning lower extremities are the adductor tenotomy with hamstring release resulting in long leg casts and an abduction bar and the femoral varus derotational osteotomy of the hip resulting in pelvic/long leg cast with varying degrees of fixed hip and knee flexion within the cast. Other common procedures such as Achilles lengthening, posterior medial lateral release, planter fascia release, clubfoot correction, or tibia osteotomy are also commonly seen procedures that often require only elevating footrests with the proper fitting wheelchair.

Previously, we were cutting plywood, inserting foam, and stapling Naugahyde upholstery as a cover and strapping the system with webbing and Velcro into existing or loaner wheelchairs. We found several limitations with this approach. Fabrication and material cost for each application was costly. Reuse involved continuous modification to smaller sizes resulting in limited use before disposal. Transport and folding of the wheelchair was cumbersome, as the LE board must be removed from the wheelchair for folding and transport. Safety was also a concern when the parent was required to strap the LE board into the wheelchair frame themselves after transport. If not done carefully, the board could shift or even worse, fall out of the wheelchair with the child. A new lower extremity support system was necessary to prevent such an accident. In addition, we felt the wood and foam were a risk for absorbing spilled food or body fluids if the vinyl cover was breached.

The goal and solution to accommodating lower extremities with cast application post surgically was to design a modular system of clamps and tubing that could attach to the frame of a wheelchair, be removable or swing-away, and have multi-axis adjustment capability to safely support the lower extremities with casts in any configuration. Infection control and cleaning was a factor as well as being therapy friendly for post- operative therapy, transfer training, and transport.

We designed a series of clamps and round tubing with a cam locking receiver that would allow a swing-away or removal feature for transfer much like conventional swing-away footrests. We also made a calf support trough that is used with the modular lower extremity support system (MLES) that supports the child's lower extremity and interfaces with the hardware. The (MLES) can be used bi-lateral or unilateral as needed.

Caregiver and professional staff satisfaction of the newly designed modular lower extremity support system (MLES) has been very good. Ease of use as well as the ability of the system to support the lower extremities in any configuration was achieved. Physician feedback was very positive. We especially like the modular system as it can easily be cleaned and reused which keeps component inventory at lower levels. Fabrication costs are eliminated and delivery time is cut in half. Patient safety is improved as well as ease in transport for the family.