Self-mobility System Design for Paraplegic Patients
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Self-mobility System Design for Paraplegic Patients Ing. Mauricio Plaza Torres, Ph.D. and Ing. William Aperador, Ph.D. Universidad Militar Nueva Granada, Carrera 11, N° 101-80, Bogotá, Colombia. ABSTRACT Tumors of the distal and proximal femur are treated by total femur resection. A hip disarticulation sometimes is a result of massive trauma with crush injuries to the lower extremity. This article discusses a system designed for patient rehabilitation with bilateral hip disarticulations. The prosthetics designed allowed a patient to attain natural gait suspended between parallel articulate crutches with the body weight supported between the crutches. The design is patent pending and it could be used in people with a simple ankle sprain, people with partial immobilizations in inferior members, or people with bilateral hip disarticulation. The final design system allows patients with bilateral hip replacement or partial immobilizations to attain mobility in a natural way. INTRODUCTION Amputations with disarticulation are relatively rare [1-3]. Hip disarticulation is the removal of the entire lower extremity from hip joint to some part of the leg. For this reason, there is no much research on this area to develop a self-mobility specific solution. Bilateral hip disarticulation is usually performed when malignant disease of the pelvis, hip joint or upper thigh cannot be treated by more conservative means. Sometimes they are performed if osteomyelitis of the pelvis or proximal femur or certain massive benign tumors in the pelvic region have not responded to less radical procedures [4,5]. Patients with amputations of bilateral hip disarticulation, including transection of ischia to the level of the horizontal ramus of the pubis, are treated prosthetically and then rehabilitated. Prosthetic fitting fails because of chronic tissue breakdown over the remaining bony prominences [6-8] (Figure 1). The prosthesis must provide mobility by gait training and the design of the mat must avoid tissue breakdown. Paraplegics face a number of medical, psychological and emotional issues, which can usually be managed in rehabilitation centers with adequate social support [9-11]. However, in developing countries, with some limited resources, patients must live with paraplegia and its associated complications, and it is considerably more difficult to carry out self-mobility actions [12-14]. Hip disarticulation orthosis has some advantages for the paraplegic patient, such as increased independence, a lighter body weight on the healthy articulation and minimization of local infection. Disadvantages, however, include impaired cosmetic appearance; some training is needed to acquire stability and good balance and there is a loss of the body shape (Figure 2).
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Figure 1. Surgical procedure. EXPERIMENTAL DETAILS The support mold was designed to distribute weight primarily to the shelf created by the spinal and posterior thorax region. Adequate reliefs were provided to bony prominences via plaster build-ups on the mold. The mold designed provide
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