M. Azaria

Silicone suspension of external prostheses

The use of silicone inner sockets, with or without the incorporation of shuttle locks, has greatly improved the function of artificial limbs. They cushion and protect the stump and provide a means for prosthetic suspension, allowing more comfortable use, especially in patients with ischaemic stumps. They also allow greater movement at the proximal joint.

SILICONE SUSPENSION OF EXTERNAL PROSTHESES: A NEW ERA IN ARTIFICIAL LIMB USAGE

The use of silicone inner sockets, with or without the incorporation of shuttle locks, has greatly improved the function of artificial limbs. They cushion and protect the stump and provide a means for prosthetic suspension, allowing more comfortable use, especially in patients with ischaemic stumps. They also allow greater movement at the proximal joint.

Rehabilitation considerations of prosthetic fittings for Kaposi's sarcoma amputees.

Purpose : We report on cutaneous limb manifestations of Kaposis sarcoma and the secondary infection of these lesions that necessitated five lower-limb amputations. Method : The cases are briefly described and prosthetic adaptations in respect to pressure, traction and sweating on the skin are considered. Results : All four patients ambulated initially; one lady died, the double amputee stopped walking owing to the excessive physical demand, and two patients ambulate freely. Conclusion : Special considerations to the cutaneous/prosthesis interface are necessary in order to provide these patients with optimal ambulatory ability.

Why knee disarticulation (through-knee-amputation) is appropriate for non ambulatory patients.

Purpose : To determine the reason why 79% of knee disarticulation amputees had not received a prosthesis. Method : A 10 year survey was carried out of all patients who had undergone a knee disarticulation at our medical centre. Results : Seventeen of the 37 patients that had not received a prosthesis were recognized to be non-ambulators prior to the surgery. Four patients died after the surgery and in 16 of the patients their general condition limited functional ambulation. An effort had been made to ambulate the patients but had failed. Conclusions : From a biomechanical point of view many advantages are to be gained for sedentary and bedridden amputees when the level of amputation is through-the-knee.

Successful fitting of a prosthesis for a child amputee suffering from scleroderma

A few anecdotal cases of limb amputations owing to scleroderma have been described in the literature. This article outlines the salient problematic features of a residual stump and provides the prosthetic considerations and appropriate design that eventually facilitated ambulation.A few anecdotal cases of limb amputations owing to scleroderma have been described in the literature. This article outlines the salient problematic features of a residual stump and provides the prosthetic considerations and appropriate design that eventually facilitated ambulation.

Why did the patient choose an inappropriate orthosis

Purpose/Method: A 70-year-old engineer, suffering from drop foot, designed and produced a strange orthosis. Although on ambulation the orthotic device elevated his foot, an abnormally strange walking pattern was required. Of his own volition the patient attended an orthotic clinic requesting that a local manufacturer produce a replica of the orthosis. The patient received an explanation pertaining to the range of regular orthotics available and in what way they would improve his functional ability. Results/Conclusion: The patient saw all the options available and physically tried several. The patient was afforded the opportunity of free choice and chose his own, self-designed orthotic. From a professional point of view this was the most inappropriate option. The rehabilitation team erred in its psychological management of the case, for it overlooked the question of the patients motivation and commitment to change.

The will to walk—a partnership involving dual dynamics

A case report is used as an example of how the will of a patient convinced an entire rehabilitation team to alter its assessment of the patients ambulatory potential. The question of dual dynamics is discussed in the light of the realities of the honest desire and motivation to walk and regain independence.