A Supporting Device For Children With Severe Malformations Of The Extremities (Dysmelia)
Ilse Ehmann, M.D.
(The following article by Ilse Ehmann, M.D., appeared originally in Muenchener Medizinische Wochenschrift, a weekly published in Munich, West Germany, by J. F. Lehmann, Volume 195, Number 11, 1963, pages 591-2. This English translation is printed with the permission of the author.)
The apparatus described in this article was developed as a result of experience in the treatment of children with severe malformations or complete absence of the extremities. The apparatus is designed to bring children to a sitting position when they are unable to achieve this position on their own, thus widening their field of vision and their development. Additional accessory devices stimulate the child to move the stumps of the extremities. As the child develops, supplementary parts may be added to the apparatus and the movement of the child (according to individual adaptation) may be utilized to propel the device.
Children with severe malformations of the extremities are always of special concern to the attending physician. Confronted with a 10-month-old child with a dysmelia of all extremities, my immediate task was to bring him to a sitting position. At this point I was not specifically concerned with plans for future orthopedic treatment. My chief aim was to widen the child's range of vision and provide him with the possibilities for development which a normal child finds in a sitting position. It was also important that a kyphosis, which might result from a sitting position, be avoided, and that the child's feet should not be compressed.
Our considerations led to the development of an apparatus which has met with the approval of the child and the mother.
Description of the Apparatus
The device is of lightweight white aluminum sheet construction, padded with a cloth-covered foam rubber layer (Fig. 1 ). A mechanism beneath the flat back rest can be utilized to raise the apparatus to almost 90° (Fig. 2 ). The child rests on a saddle-like seat, which can be adjusted easily to any height and is so narrow that an abducted position of the feet is avoided (Fig. 3 ).
The anterior part of the saddle is curved upward so that the child will not fall from the seat while bouncing. The side bars are adjustable; they can either fit closely to the body for support, or be applied to permit freedom of motion of the trunk yet preventing the child from falling sidewards when movements are excessive. In addition, the side bars carry a large eyelet which can accommodate a belt to protect the child from falling forward.
As we gain experience by observation of children in the apparatus, further improvements in the apparatus are certain.
Since a child tends to move the upper part of his body from an erect position of almost 90° into a complete vertical position, the apparatus should be constructed so as to permit this movement. The seat, which is padded, can be supplied with a strong spring to enable the child to bounce on it and thus experience the pleasure of self-initiated movements.
A grooved roller can be installed at the level of the feet. This will serve initially as a stimulus for the child to move his lower extremities, which are generally inactive, and to create sensation in the feet. Older children and those who have had adequate experience could transfer the motion of the roller to wheels which propel the seat shell. In addition, appliances could be attached for traction bandages of the lower extremities.
Furthermore, we have devised a plan to mount the apparatus for an older child on an under-carriage which could be moved close to a table. A small, adjustable table will be mounted on top of the larger table at the height of the shoulder girdle. In this way, the child will be stimulated to grasp a small toy with his fingers. An older child could eat from the table top with a small fork and cut a sandwich and meat and potatoes.
While the aid provided a child by this apparatus may be small, it can be very significant in cases of complete helplessness. It should also be noted that the cost of the device, which is now very reasonable, would be lowered considerably by larger scale production (individual fitting for each child is possible).
The manufacturer of the apparatus is Hubert Wolff, Siegburg. My address is 521 Troisdorf, von Loe Street, 45, West Germany. The registered patent is pending.
Translated from the German by Maurice M. Schweizer, Ph.D., New York University-Child Prosthetic Studies.