Externally Powered Management of the Quadramembral Amputee Using a Modified Thoracic Suspension Orthoses as a Platform

The female client was initially evaluated, at a regional rehabilitation center, specializing in early development and adolescent reintegration of children to maximum mainstream capacity. The initial presentation of this seven-year-old female multilevel congenital amputee was in the presence of the therapeutic rehabilitation team, the child presented with independent mobility in an externally powered wheelchair. Direction and speed of the wheelchair are controlled, utilizing a proportional multidirectional chin switch mounted on the right upper corner of the powered chair. The clients’ body position is maintained using custom fabricated seating interface system complete with bolsters. At the time of initial evaluation a platform based thoracic suspension orthoses was being fabricated. The design was to incorporate an erect posture when outside the chair. Removal of the bolsters from the seating system allowed the orthoses to be utilized in the chair. The objective of prosthetic intervention was to provide functional grasp and release as well as positioning of the terminal device in space. In an attempt to simplify and increase the utilization of a prosthetic device the decision was made to utilize the exterior wall of the suspension orthoses as the platform to incorporate an externally powered arm. Physical evaluation finds the patient’s anatomy compatible with a frame type, shoulder or scapular thoracic prosthetic socket. This alternative was rejected on the basis that it would require removal of the positioning orthoses for utilization. The positioning orthoses is modified proximally on the left upper margins so as to allow increased scapular and shoulder girdle movement. The left quadrant of the body was selected for prosthetic management so as not to interfere with the existing chin switch control of the powered wheelchair. It was believed that the ability to have independent mobility and grasp /release was a prerequisite for the patient to achieve maximal independence.