Introduction
Lower limb amputees are conventionally prescribed with prosthesis that can both assist gait and standing position. The most commonly used type is the endo-skeletal type prosthesis. It has articulations, socket, and screw type components that are related to gait function. However, for amputees combined with motor complete spinal cord injury, gait related functions are not essential because they are unable to walk. Moreover, gait related components can cause discomfort (weight, cost, and shape) and eventually lead to low compliance. Therefore, we propose a new cosmetic prosthesis with components related to gait removed. Comparison was done between the cosmetic prosthesis and the endo-skeletal prosthesis.
Method
This study involved a 52-year-old T1/T3 American Spinal Injury Association Impairment Scale (AIS)-A spinal cord injury patient combined with left transtibial amputation. The underlying causes of amputation were deep vein thrombosis and atherosclerosis obliterans. The patient received an endo-skeletal prosthesis but refused to use it. The causes of refusal were heavy weight and asymmetrical appearance compared to the non-amputation side. Patient refused to show her amputated leg, hiding it with blanket even in summer and never applied it.
The new cosmetic prosthesis was made to meet the following goals: (1) Durability for standing position and cycle exercise, (2) Easy to apply and light to carry, (3) Same circumference as right leg.
The patient received standing position training and cycle exercise for one month with new cosmetic prosthesis applied. We compared it with the endo-skeletal prosthesis. We also measured the satisfaction of the prosthesis with Quebec user evaluation of satisfaction with assistive technology (QUEST) Version 2.0
Result
In comparison between the two types, the new cosmetic prosthesis was lighter than endo-skeletal type prosthesis (0.25kg vs 1.25kg, respectively). QUEST (Version 2.0) score was higher in cosmetic prosthesis (4.5 vs 3.2, respectively). The cosmetic prosthesis was durable enough to perform standing position and cycle exercise.
Conclusion
For complete paraplegia patients who are unable to walk functionally and/or not willing to train gait, cosmetic prosthesis can be a feasible option. Cosmetic prosthesis is lighter, cost effective, easy to apply, and has better cosmetic appearance. |
