Notes From The Physical Therapy Department

By Hans Hillander - Sunnyview Rehabilitation Center Schenectady, N.Y.

New Wheelchair Comfort For The Above-Knee Amputee

The prosthesis has long been a source of discomfort to the above-knee amputee while he sits in a wheelchair, primarily because of the chair's hammock-like seat and the protrusion of the posterior wall of the socket, which forces the thigh of the amputated extremity into an unnatural and uncomfortable position.

An amputee cushion has been designed to provide clearance for the protruding prosthesis, thus giving the wearer a balanced sitting posture. A piece of 1/2-inch plywood is used to bridge over the canvas seat of the wheelchair and form a firm base for a recessed foam rubber cushion (Fig. 1 ). The whole assembly is covered by plastic. This arrangement keeps the bottom of the seat level and provides a recessed area for the prosthesis, thus vastly increasing the comfort of the amputee.

This cushion has been used by many patients, most of whom want to take it with them when they leave the hospital-proof of its effectiveness.

The model shown in the photograph is designed for the amputee with a right above-knee amputation and is sized to fit all standard adult wheelchairs. A different cushion with the recess appropriately placed is used for left amputations. The dimensions would have to be reduced to fit smaller chairs.

A "Knee-Krutch" Walkerette

By Pat McGiffin

This walkerette (Fig. 2 and 3 ) was designed to assist an elderly below-knee patient to walk when he was not wearing his prosthesis. Because of the condition of his other leg, general debility, and poor vision, he was unable to hop with a conventional walkerette or perform a swing-through gait with his crutches. In addition, he had an 80-degree flexion contracture at the knee and an open ulcer at the tip of his stump.

The device was constructed by attaching a commercially available "Knee-Krutch" to the walkerette. Had more time been available, a less expensive modification could have been constructed.

Using a flexible pad on his walkerette (Fig. 2 and 3 ), this patient was able to ambulate both safely and comfortably. By resting weight on his knee and on his hands he moved about very easily.

Except for stair climbing, when his prosthesis, a crutch, and a sturdy railing were used, this patient was actually more at ease with the walkerette than with his prosthesis and crutches.

A Width Adjuster For Wheelchairs

By Hans Hillander

Doorways to bathrooms and lavatories are typically narrower than standard bedroom and corridor doorways. Consequently, they present a problem in accommodating standard-width wheelchairs.

A simple, inexpensive device, costing about 30 cents, has been designed as a "wheelchair narrower." It consists of two "S" hooks joined by a piece of sash-weight chain approximately 6 inches long. These items are available at any hardware store. The length of the chain between the hooks is determined by the width reduction necessary to get the chair through the door. Prior to moving onto the wheelchair, the amputee fastens the hooks to the upright bars of the chair, pulling them together to the appropriate width and holding them in that position.

The hook-chain has an additional application. It can be used to hold the front of a wheelchair to the bed, and thus amputees, paraplegics, and quadriplegics can maneuver themselves from the bed to the chair and back again without having the chair slide away from them.