Moulded supportive seating for the disabled.

In severe cases of physical disability intimate supportive seating may be required to provide maximum comfort, a good position for functional activities, improved respiration, relief of localized pressure, control of spasm, protection, or improved management. A service for providing such seating has been developed at Chailey Heritage. The seat is vacuum-formed from thermoplastic materials, having a soft non-absorbent foam for the linear and a hard semi-rigid outer shell. A mould is obtained by casting the patient using the vacuum consolidation technique and by recording the resulting impression using plaster-of-Paris. Nearly 200 seats have been made using the technique with a high rate of success.     

Continuous ambulatory peritoneal dialysis in the physically disabled

Continuous ambulatory peritoneal dialysis (CAPD) has been increasingly used as maintenance home dialysis by patients in end-stage chronic renal failure since it was first described in 1976. The procedure is hazardous in the physically disabled and blind and in non-compliant patients. This paper describes 2 patients, one with rheumatoid arthritis and the other with Volkmann's ischaemic contracture of the left forearm, who are able to carry out CAPD successfully with the aid of bioengineering.     

Problems in the rehabilitation of the physically disabled in rural areas of India.

Some 550 disabled patients were examined by a rehabilitation team by organizing a rural camp at Meerut. This rehabilitation team consisted of orthopaedic surgeons, doctors, a prosthetist, an orthotist, a medical social worker and other skilled workers. Out of the 550 disabled patients, 271 were amputees, and 184 cases had poliomyelitis. Males predominated by 4:1. Disability was most common up to the age of 30 years. Of the 271 amputees, 146 were of upper limb while 125 were of lower limb. Only 86 lower limb amputees were suitable for fitting a prosthesis, while 39 others needed surgery of physiotherapy. Only 87 of the 184 polio cases were found suitable for appliances, the remainder needing surgery or physiotherapy. Ways of reducing the numbers of disabled were examined and improved rehabilitation procedures suggested.     

Constructing reasonableness: Environmental access policy for disabled wheelchair users in four European Union countries

This article aims to provide an understanding of responses to disability discrimination in the built environment within four member States of the European Union. Examples of contrasting policy constructions of “reasonableness” are provided in implementing reasonable adjustments in the United Kingdom, Ireland, France and Malta. The article provides a typology of policy intervention and a platform upon which an agenda of good practice can be formulated and initiated. In this respect, a primary objective is to define the parameters of what can be seen as “reasonable” in terms of accessibility for disabled people in wheelchairs and what enforcement procedures ought to be set in place to achieve the objective of equal access to the built environment.     

Sudden stop detection and automatic seating support with neural stimulation during manual wheelchair propulsion

Objective: Wheelchair safety is of great importance since falls from wheelchairs are prevalent and often have devastating consequences. We developed an automatic system to detect destabilizing events during wheelchair propulsion under real-world conditions and trigger neural stimulation to stiffen the trunk to maintain seated postures of users with paralysis.Design: Cross-over interventionSetting: Laboratory and community settingsParticipants: Three able-bodied subjects and three individuals with SCI with previously implanted neurostimulation systemsInterventions: An algorithm to detect wheelchair sudden stops was developed. This was used to randomly trigger trunk extensor stimulation during sudden stops eventsOutcome Measures: Algorithm success and false positive rates were determined. SCI users rated each condition on a seven-point Usability Rating Scale to indicate safety.Results: The system detected sudden stops with a success rate of over 93% in community settings. When used to trigger trunk neurostimulation to ensure stability, the implant recipients consistently reported feeling safer (P<.05 for 2/3 subjects) with the system while encountering sudden stops as indicated by a 1–3 point change in safety rating.Conclusion: These preliminary results suggest that this system could monitor wheelchair activity and only apply stabilizing neurostimulation when appropriate to maintain posture. Larger scale, unsupervised and longer-term trials at home and in the community are indicated. This system could be generalized and applied to individuals without an implanted stimulation by utilizing surface stimulation, or by actuating a mechanical restraint when necessary, thus allowing unrestricted trunk movements and only restraining the user when necessary to ensure safety.Trial Registration: {"type":"clinical-trial","attrs":{"text":"NCT01474148","term_id":"NCT01474148"}}NCT01474148     

Radiological assessment of the structural relationship between the trachea and the innominate artery in physically disabled and scoliotic children

Studies were made on the physically disabled and scoliotic children who underwent tracheostomy. The purpose was to clarify factors that might lead to the tracheo-innominate artery fistula, by use of three-dimensional helical CT (3 DCT). In a case of right scoliosis, the tracheo-innominate artery fistula may be caused by the left-ward displacement of the trachea from the vertebra, having the innominate artery ride over the trachea and compressing it. In a case of the physically disabled and scoliotic children, there may be more compression on the trachea by the innominate artery along with the worsening scoliosis. Therefore, we consider it necessary to examine the structural relationship between the trachea, the vertebra, and the innominate artery periodically by 3 DCT.     

The causes of developmental deformity and their implication for seating.

This article attempts to touch upon several different aspects of developmental deformity. It is intended to show that the position in which children are placed and the time these postures are maintained are important in preventing fixed and structural deformity. These are considered to be the prime causes of deformity. Whilst surgery is often necessary, it should be seen as complementary to an early postural regime, one part of which is the position in which a child sits.     

腹腔镜术中应用壶腹钟表定位法和胆囊废弃术新理念妥善处理胆囊管

腹腔镜胆囊切除术中发生医源性胆管损伤最常见的原因就是错误地把胆总管当作胆囊管施夹离断。为了增强术者对胆囊管各种形态的辨识能力,从不同角度将胆囊管分为11类33型,应用胆囊壶腹钟表定位法和胆囊废弃术新理念为指导,把妥善处理胆囊管作为手术的首要目标和核心技术加以高度重视,从而建立了有效避免胆管损伤的手术安全策略。     

Power seat function usage and wheelchair discomfort for power wheelchair users

Objectives: To investigate correlations between power seat functions (PSFs) usage and wheelchair discomfort.

Design: Quasi-experimental design: Time series design.

Setting: In-home trial in participants’ home/community.

Participants: Thirteen power wheelchair users who independently used power wheelchairs equipped with PSFs as their primary means of mobility.

Main Outcome Measures: PSF usage variables include the frequency of performing repositioning and using PSFs (tilt, recline, legrests and seat elevation), wheelchair occupancy, and driving distance. The Tool for Assessing Wheelchair disComfort (TAWC) were used to evaluate general discomfort and discomfort intensity.

Results: Spearman correlation coefficient showed that the frequency of using tilt, recline, and legrest is significantly correlated with discomfort intensity. Multiple regression analysis with backward stepwise indicated that these functions can explain 43.8% of the variance (R2?=?.438, F(3,33)?=?8.588, P?Conclusions: For people who used power wheelchairs equipped with PSFs, correlation analysis and regression modeling provided evidence from the quantitative data that increasing the frequency of using PSFs may decrease wheelchair discomfort. Future studies should include interventions to encourage people to use their PSFs appropriately.     

Cost effective moulded seating for the handicapped child

For many severely handicapped children requiring external trunk support there is probably no better solution than to provide custom moulded seating. This will improve the patient's posture, reduce the occurrence of pressure sores and facilitate such activities as feeding. However, if large numbers of patients are to be supplied with this type of equipment, it is important that it should be manufactured at the lowest cost compatible with an acceptable quality. These manufacturing problems have been studied in considerable detail and a production method using vacuum consolidation casting together with a modified vacuum forming process has been developed. This has made it possible to produce custom moulded seating efficiently with the minimum of capital equipment. Much attention has been paid to the final appearance of the article and this has been enhanced by the use of commercially available items for the supporting structure and for the finishing of edges, etc. It is suggested that other orthoses could be redesigned for production using an approach similar to that described in this paper.     

Sports for the physically challenged child

Participation in sports is important for the physical and emotional health of the physically challenged child. Sports can improve strength, endurance, and cardiopulmonary fitness while providing companionship, a sense of achievement, and heightened self-esteem. With interest in such participation increasing, it is necessary for the physicians, therapists, and families of children with special needs to understand the preparticipation evaluation, athletic options, specialized equipment, and sport-specific risks. Recommendations that provide guidelines for safe, effective participation in sports are currently available for common congenital and developmental disabilities such as Down syndrome, cerebral palsy, myelodysplasia, hemophilia, congenital amputations, and arthritic disorders.