The Rehabilitation of a Paraplegic Child with a Very Short, Above-Knee Unilateral Amputation Utilizing Hip Disarticulation Prosthesis and Reciprocating Gait Orthosis
JUDI GLOVER, R.P.T., ANDREA MARTELL, R.P.T., JEFF LUTZ, C.P.O., AND RAOUL P. RODRIGUEZ, M.D.
A child who is paraplegic and has a very short, above-knee amputation is a very challenging, difficult problem in rehabilitation. A 41/2 year-old girl who was a motor and sensory T12 paraplegic from a spinal cord injury since birth and who had a very short, above-knee unilateral amputation due to infection shortly after birth was referred to the Juvenile Amputee Clinic of the State of Louisiana's Handicapped Children's Program Service at Children's Hospital of New Orleans.
On initial evaluation, she had good static and fair dynamic sitting balance. She was able to sit independently in a chair or on the floor and able to use a wheelchair. The child expressed a desire to walk.
The above-knee stump was extremely short, approximately three inches in length measured from the anterior superior iliac spine, and had a 45° abduction contracture. The contralateral, left lower extremity was completely flail and had passive range of motion within normal limits except for a plantar flexion contracture of the ankle of approximately 15°. The initial evaluation was done by the Physical Therapy Department in preparation for the prosthetic fitting. This child was fitted with a hip disarticulation prosthesis on the right side with a thermoplastic socket that enclosed the upper trunk control on standing. The left lower extremity was fitted with a knee-ankle foot orthosis. Reciprocating Gait Orthosis hip joints were attached to the brace and prosthesis. The details of the prosthesis and the Reciprocating Gait Orthosis fabrication will be presented. The gait training at the Physical Therapy Department at Children's Hospital of New Orleans will be presented including a video tape of her progress throughout.
This child is presently an independent household ambulator with the assistance of a child-sized walker.
Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, Louisiana 70112