Jerod Steps Out: A Follow-up Report
STEPHEN F. MALO JACK F. BARGHAUSEN, C.P.
This report describes the progress of Jerod M., a five-year-old, bilateral below-knee amputee. Jerod's earlier prosthetics history was presented in the April 1971 issue of the INTER-CLINIC INFORMATION BULLETIN1.
A brief recapitulation of this boy's background may be appropriate at this time.
Jerod's bilateral below-knee amputations were due to juvenile diabetes mellitus and severe hyperglycemia without ketosis. At the age of one year, the patient was fitted with a pair of bilateral below-knee prostheses, with sidebars, corsets, and SACH-type feet. The prostheses and physical training proved to be very successful.
Since the initial pair of limbs, the patient has been fitted with three additional sets of the same type as the initial pair ( Fig. 1 ). When Jerod was five years old, a new pair of limbs was prescribed for him at the amputee clinic at the Home for Crippled Children in Pittsburgh, Pennsylvania, in preparation for his entry into school in September 1974. At the time of the treatment, the physician and the prosthetist carefully evaluated Jerod's progress and his ability to ambulate with his old limbs.
It was agreed that Jerod had reached an age at which the earlier conventional limbs should be discarded and his collateral ligaments should be put to work so that they could develop and stabilize his knees without help from the sidebars and corsets. A decision was made to fit him with standard patellar-tendon-bearing prostheses, elastic straps to a waist belt, and SACH-type feet.
When the patient was seen for casting and measurement, it was found that mediolateral stability could easily be established because of the child's use of artificial limbs over the prior four years. His ligaments were in good condition and needed only to be developed. The residual limbs* had good padding and were without severe bony prominences.
One habit that had to be contended with was that the patient, whenever he had the chance, would ambulate on bent knees, while wearing his limbs. Apparently this is a common juvenile tendency. However, any attempt to operate in this manner would present a problem since complete flexion of the knees would not be attained with the patellar-tendon-bearing limbs, and efforts at knee crawling would result in popliteal pressure, although in normal ambulation heel-to-toe roll-over would be smooth because of the use of SACH-type feet.
Careful casting of the residual limbs was done in order to provide relief for such bony prominences as were present ( Fig. 2 ). Special care was exercised to obtain accurate anterior, posterior, and mediolateral measurements. Landmarks were fairly easy to establish. The mediotibial plateaus were clearly marked in order to determine the proper knee centers and the correct height of the patient. Of course, the factor of age was taken into consideration, and the limbs were designed to accommodate anticipated growth. The medial and lateral trimlines of the sockets were raised to accommodate any ligamentous weakness about the knee. The sockets were set in 7 deg. of initial fiexion and approximately 2 deg. of lateral tilt at static alignment ( Fig. 3 ).
At initial fitting the patient seemed to adapt extremely well to the new type of limbs, taking into consideration the fact that he had worn conventional legs before and that these prostheses were new to him. Slight changes in alignment were made to correct for medial tilt and to reduce extreme plantar ftexion. The supracondylar suspension cuffs were attached at a posterior anchor point to afford greater mediolateral stability and suspension. The anteroproximal trimline of the left limb was above the patella to avoid hyperextension. Jerod seemed to enjoy the fact that he no longer needed to wear corsets around his thighs ( Fig. 4 ).
After the limbs were delivered to Jerod, he was sent to the Home for Crippled Children for final evaluation. In-house physical therapy and gait training were not prescribed as it was felt that these activities could best be carried out in the home environment based on the knowledge his parents had gained during his earlier prosthetics experience. It was felt that this approach would hasten his adaption to the new limbs.
At the time of this writing Jerod had not suffered any complications and seemed to be very content with his new limbs.
Thus, before Jerod had made the transition from pre-school to school life, he had successfully adapted to the use of lighter, less cumbersome limbs.
In conclusion, it is noteworthy that, while Jerod's case and the techniques used were not extraordinary, his progress from age 10 months documents the fact that the bilateral below-knee juvenile amputee can be successfully transferred from corset and sidebar limbs to supracondylar or suprapatellar-supracondylar devices prior to school entry.
J. E. Hanger Co. Pittsburgh, Pennsylvania
J. E. Hanger Co. Pittsburgh, Pennsylvania
1. Barghausen, Jack, Jerod's first steps. Inter-Clin. Inform. Bull., 10:7:9-16, April 1971.