Prosthetics and Orthotics

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the patient lives within commuting distance only transportation arrangements need to be made. If the patient lives too far to commute, then the social worker tries to find a boarding house in the community where the patient can live during gait training. While there is one boarding house in the immediate vicinity, the patient must be independent in self-care to stay there. Sometimes a relative or friend can be found in the community but the problem of finding appropriate temporary living accommodation for our patients remains as one of the most persistent problems. Once the patient has been situated in the boarding house, the University's Public Safety department will provide transportation to and from the hospital and the prosthetic shop. Prosthetic problems that arise during gait training are quickly resolved between the therapist and prosthetist. The ready availability of the clinic chief for more major problems also enhances the total programme. Once the patient has attained a satisfactory prosthetic function, he is again checked by the clinic team and the limb is finished. During the time it takes to finish the limb the patient returns to his home. He comes back for the next clinic and may again undergo a few days of training to make sure he has retained his skill in the use of the appliance. Following initial discharge from the treatment the patient is expected to return for his first recheck in four to eight weeks. He is maintained on a regular review programme until the stump has stabilized. No patient is ever discharged from the clinic. Once the stump has stabilized he is placed on a yearly re-evaluation. When the patient returns he undergoes a complete evaluation to determine his general condition, his physical status, his level of prosthetic adjustment and use and the condition of the prosthesis. Necessary prosthetic adjustments and repairs are made during this visit to the extent possible. Minor prosthetic repairs can be made in the morning prior to the afternoon clinic if payment is not a problem. Close co-operation between all members of the prosthetic team makes this possible. Prior to the onset of the programme the clinic chief, physical therapists and prosthetists reviewed the types of problems that could be handled directly between physical and occupational therapists and prosthetists without first being evaluated by the physician. Routine repairs and upkeep fall into this category but if there is a question about the best course of action or if a new socket is indicated then the decision is delayed until the patient has been seen by the total team in the afternoon. The ability to tighten joints, replace worn leather, replace broken straps or broken feet without waiting for the afternoon clinic has greatly enhanced the use of the patient's time. Sometimes the social worker or the vocational counsellor will assist with a financial problem to further expedite repairs or maintenance of appliances. Conclusion This has been a brief description of a system that was devised to improve the quality and quantity of patient services and limit the number of trips a patient has to make to and from the prosthetic clinic. While it is not ideal and there are still problems to be resolved, the system does maximize the patient's time in Augusta through the co-operative efforts of all members of the team. The system is based on mutual respect, the ability of each health professional to work with other health care providers in the patient's best interest, the ability of one service to function as co-ordinator and of the other services to accept that role, and the ability to plan ahead and anticipate needs. The system worked so well in one hospital that it has been initiated in another hospital serviced by the clinic chief.
Abstract Problems in the rehabilitation of the physically disabled in rural areas of India* A. K. AGARWAL and M. K. GOEL Rehabilitation and Artificial Limb Centre, K.G.'s Medical College, Lucknow, 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 or 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. Introduction It has been observed that although the percentage of disabled people in our district of India was quite high, their attendance at our city-based comprehensive rehabilitation centre was comparatively poor. The disabled residing in rural areas were not utilizing the services available due to various reasons such as ignorance of the available facilities, socioeconomic causes, fears of surgery and city life, and lack of proper transportation facilities. It was therefore thought that keeping our personnel in the bigger cities with adequate rehabilitation services would not help the masses residing in rural areas. The ultimate goal of providing modern rehabilitation services to the disabled would not be complete unless we ourselves moved to help the rural population. With this in mind a camp was organized in the rural area of Meerut 60 km from New Delhi, the capital of India. A rehabilitation team comprising two orthopaedic surgeons, three resident doctors, an orthotist, a prosthetist, a leather worker, a medical social worker and three artisans, attended the camp. The team was equipped to fit temporary artificial limbs and to measure the patients for prosthetic and orthotic appliances. The funds for the camp were provided by philanthropic persons. Before the camp was set up it was publicised, patients were registered, and they were given appointments for their clinical examination. A pro forma was used for assessing the disability and all the patients were screened by the rehabilitation team. The measurements of patients who required artificial limbs and orthotic appliances were taken. A few of the patients wçre also provided with temporary artificial limbs for immediate walking. Observations The response of the rural population was very encouraging and a total of 550 patients attended the camp. It was found that 386 patients were below the age of thirty years and males outnumbered females by 4:1. In males the numbers of disabled were at a peak between 11 and 30 years of age, while in females the peak incidence was up to the age of ten years of age (Table 1). *Based on a paper presented at the Second World Congress ISPO, New York, 1977.
Page 1 and 2: The Journal of the International So
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Page 9 and 10: Abstract Ideas on the suspension of
Page 11 and 12: Fig. 2. The semi-rigid insert sucti
Page 13 and 14: The PTB-suction prosthesis is also
Page 15 and 16: Case illustration A thirty year old
Page 17 and 18: second set of stainless steel rods
Page 19 and 20: Information on new prostheses The a
Page 21 and 22: Abstract Rehabilitation engineering
Page 23 and 24: demands made on us in order to main
Page 25 and 26: measurement or the system of measur
Page 27 and 28: on segments of a general problem wh
Page 29 and 30: Phase X—field-test quantity produ
Page 31: on others for transportation to and
Page 35 and 36: 4. It was also observed that the co
Page 37 and 38: Fig. 1. The Chailey moulded seat mo
Page 39 and 40: Fig. 3. A second layer of ABS is va
Page 41 and 42: Abstract The Orlau swivel walker J.
Page 43 and 44: Fig. 3. Swivel walker patient sitti
Page 45 and 46: Clinical trials Five patients were
Page 47 and 48: Both swing through gait and the mod
Page 49 and 50: Abstract New plastics for forming d
Page 52 and 53: manufactured in sheets. A few are s
Page 54 and 55: The international organizations—W
Page 56 and 57: the shop and the physical therapy s
Page 58 and 59: It is recognized that terminology d
Page 62 and 63: 56 Calendar of events 5-21 July, 19
Page 64 and 65: 58 Index to Volume 1 Nickel, V. L.,
Page 66 and 67: 60 Index to Volume 1 Editorial J. H
Page 68 and 69: 62 Index to Volume 1 Spina bifida S
Page 70 and 71: an outstanding tool biomechanics: q
Page 72: ORTHOTIC PROSTHETIC MACHINERY S/J S
Page 75 and 76: Jiééauefi Specials TORONTO PERTHE
Page 77 and 78: ISPO INTERNATIONAL COURSE ON ABOVE-
Page 79 and 80: YOUR AMPUTEES mm: •The Best You C

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