Abstract
Severely involved patients with spastic diplegia or mild quadriplegia have increasing difficulty remaining ambulatory as they progress to adolescence and young adulthood, often becoming wheelchair bound. This presentation addresses effort to prevent or reverse this progressive state, allowing continued ambulation in a select group of patients. They must be highly motivated to keep walking, have a willingness to undergo extensive rehabilitation and have good psycholsocial support.
The program consists of multiple surgeries to the spine, pelvis/hip, knee, foot and ankle followed by a spika or long casts, leg braces (HKAFO to final GRO), 12–18 months of intense physical therapy and permanent use of crutches.
Seventeen patients, 16 adilescents and young adults, one adult over 50 adult, who were within 6 months of permanent wheelchair existence qualified and underwent this program. They were followed for a minimum of 10 years post surgery. All patients but one have remained supported community ambulators. The extent of the surgery, complications and problems are described.
An additional group of wheelchair bound patients with quandriplegia and severe diplegia were treated with extensive global surgery (described). The purpose was stabile symmetric seating with no pain and allowing the use of the hands and upper extremities for other than support in seating. The ability to achieve these goals has required addressing the controversy associated with extensive surgey in the non-ambulatory patient.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
