SWASH Hip Orthiosis

The patient was seen today for measuring and fit for a SWASH hip orthosis.

Cerebral Palsy - Swash Hip Orthosis

SWASH hip orthosis

Cerebral palsy.

This patient will be 7 years old in a few more weeks. She will be receiving Botox injections in the adductor muscle groups in both legs in the next couple of weeks.

Measurements were taken of the patient today and an appropriate SWASH hip orthosis was fit to the patient. Proper donning and doffing instructions were given to mom. Several adjustments were made to properly fit the patient. Growth adjustments can be made to this orthosis. While she was wearing the orthosis, standing and attempting to take steps, she could adequately clear her feet without scissoring. When she was sitting, she had very good sitting balance. Mom informed me that the therapist also wanted her to sleep in this orthosis. I instructed the mom to begin the patient on a gradual wearing schedule starting with 2 hours today, 4 hours tomorrow, 6 hours the next day and 8 hours the following day. Once she has reached the 8-hour point, she was told to allow the patient to sleep in the orthosis. I encouraged her to allow the patient to wear something snug fitting under the orthosis, possibly tights. The patient appeared to tolerate the device well. I gave mom the Alien wrenches if changes needed to be made in therapy. I marked the initial spots of the settings. I told mom if she has any problems or questions, or if she did not feel comfortable making changes, or if the therapist did not feel comfortable making the changes, to please return. The patient will be seen as needed.

Evaluation, measurement and fitting.

AFO-Free Ankle

The patient was seen today for a recheck of her bilateral AFO-FAs. The patient reports that these are much more comfortable now and she is not having any problems with them except that she and her husband are having difficulty donning the shoes. They report that the back is crumpling even with the use of the shoehorn. I added leather loops to the posterior of both shoes to help pull the heel of the shoe out during donning. I instructed the patient's husband on how to don the shoes again, and he successfully donned the shoes today in the office. The patient is going directly to therapy today, and they will contact us should they have any further problems or questions.

C-5 Tetraplegic - Spinal Cord Injury

Spinal cord injury C-5 tetraplegic.

This 21-year-old male is allergic to AMOXICILLIN. He takes Neurontin and medication to control his bladder muscles. He had a motorcycle accident in July 2000. He had spinal fusion of C-4-5 and a trach. He is nonambulatory and will begin physical and occupational therapy after he receives the braces, and his parents stated they have changed insurance companies and are working out the details with the prescriptions with the insurance. He has bilateral dorsal WHOs.

The patient was left-handed but his right arm now has greater strength. He is able to raise his arms at the shoulders, the right to 90 degrees and the left to 75 degrees. He has bilateral elbow flexion on the right. On the right it is grade 4, and on the left it is grade 3. The patient requests black straps with his orthoses. I have contacted the occupational therapist, and have received a complete description of the type of brace that she wants. She requested a tubular-type static WHO with C-bars bilaterally.

Fabricate tubular-type WHOs with C-bars bilaterally. Casting and measurement. In several weeks for fitting.

WHO with Tool Attachments

The patient was seen today for casting and measurement for a left static WHO and right static WHO with tool attachments, swivel fork, spoon and standard fork.

Shoe Fitting

The patient was seen today for an initial fit of his shoes. A good fit was achieved. The shoes will be used in the fabrication of a brace for the left side. He ambulated in the hall and commented that they felt very comfortable. The shoes appeared appropriate; therefore, we will proceed with the brace.

Soto's Syndrome and Planovalgus

Bilateral UCBs.

Planovalgus and Sotos' syndrome.

This is a 9-year-old female with no known allergies. She is taking Ritalin. She is an active community ambulator, and she does not us any assistive devices. She had bladder reconstruction in 06/2000 and she had 2 hernias prior. Her previous devices were bilateral SAFOs made by Muilenburg Prosthetics.

The patient presents as a pronator. Her heels are in valgus but correctable bilaterally. Her forefeet are abducted and correctable. She presents with no knee recurvatum. Range of motion at the ankles with the knees flexed is to +10 degrees. With the knees straight, the range of motion is to +5 degrees bilaterally. The casting procedure went well. Mom knows what to expect in regards to overall design of the braces.

Fabricate bilateral UCBs.