Rehabilitation of a lower limb amputee.
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Six adaptive aids were designed and fabricated to improve the classroom functioning of a 7-year-old boy with severe upper limb deficiencies. Most aids were lightweight and easily stored in the child's classroom desk. The pullover shirt aid, the largest device, was stored in an adjoining playroom area. Because these aids were inexpensive to fabricate, duplicates were made as needed for use at home. These aids could easily be modified by other therapists to meet the needs of patients with congenital or acquired limb deficiencies.
Non-immersive virtual reality (VR) game scenarios were developed to aid in the collection of EMG parameters from the biceps and triceps while subjects performed a sequenced series of tasks in the virtual environment. For each subject the best ANN configuration (combination of hidden layers and transfer functions) was chosen, with the resulting optimized algorithms used to classify the sequence of contractions and the function type of the subjects while playing new game scenarios. The wide variety of individually configured ANN developed show why it is difficult to train new users of myoelectric devices with a single algorithm. The use of VR-based games shows promise as a training technique for individuals needing to develop control for prosthetic limbs.
As a preparatory step towards the development of a complete habilitation program for children with congenital limb anomalies associated with maternal ingestion of thalidomide, the medical records of all patients with congenital limb anomalies referred to the Rehabilitation Institute of Montreal in the past decade were studied, and an examination and a thorough reassessment were made of 41 patients (21 males and 20 females). The medical and prosthetic aspects were dealt with in Part I of this paper. Part II describes, in a joint report, the results of psychiatric, psychological and educational assessments.There was no evidence of major emotional disorder in any of the patients, although conflicts were intensified by the presence of the physical anomaly. No relation was found between intelligence, emotional adjustment and disability. The patient's attitude towards his disability and prosthesis is definitely influenced by the degree of parental acceptance of the handicap and by the character of the emotional undertones in the total environment. In order to favour the occurrence of the healthiest modes of development in these children, the authors believe that the medical profession should be made fully aware of the physical and emotional problems which may arise after the birth of a deformed child. It is considered very important that the mother should receive psychotherapeutic support as soon as possible after the child is born.
Systematic methods for optimizing the fitting and alignment of artificial legs were developed in this study. The procedures were based on gait analysis and included the following aspects: stump-prosthesis interface or socket geometry, the selection of components from which the artificial leg was constructed, and dynamic alignment of the prosthesis. The amputee's adaptation to deliberately imposed perturbations in his prosthesis, and the resulting compensatory mechanisms are also discussed.
The degree of use made of artificial legs by a sample of primary amputees is investigated by means of a questionnaire survey. Only four respondents indicated non-usage, but, of the remainder, about half indicated that they had problems which prevented them from using their prostheses "fully"; the vast majority of these, however, stood and/or walked on their prostheses every day.
During 1983-1990, 113 patients with congenital choledochus cysts were operated upon with the procedure called the spur valve jejunal interposition following total cystectomy, and satisfactory results were recorded in two years follow-up. However, early complications happened in 26.5% patients e.g. postoperative bile leakage, blood vomiting, small intestinal intussusception, adhesive intestinal obstruction, chyliform ascites, and disruption of wound. Six months-2 years after operation, reflux into bile duct and rapid emptying were observed in some cases in barium examination, and abdominal pain was found in 10% of the patients. The latter was probably due to bile gastritis, which never occurred in conventional Roux-y. An experimental study showed two types of reflux into artificial bile duct. Reflux due to intestinal distention should be checked by an one way valve, while reflux due to normal peristalsis of intestine would be naturally prevented by the intrabiliary pressure formed by the normal bile flow in a narrow bile duct. A spur valve serves an one way stopper and makes the artificial bile duct narrow. In conventional Roux-y, the biliary drainage limb (the artificial bile duct) is the natural path from the distal jejunum while the duodenal drainage limb is just a side-path of the G. I. tract. A wedge anastomosis designed for Roux-Y may convert the natural and side path relationship of the two drainage limbs and would be benefit to avoid reflux into the artificial bile duct.
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