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Thread: Advice / Question

  1. #1

    Advice / Question

    Can someone please explain the problem and remedy in how to get my legs to go straight all the way. I have not had therapy in 16 years and my legs don't bend back straight any more. I am hoping to get them straighted before trying to stand in one of those standing things. I suppose a bone density test would be a good idea first. Is this problem fixed with surgery or not. I also was wondering if anyone knows of any wheelchairs that stand you/me/us up?


    God Bless,


    David

  2. #2
    Hip and knee contractures result due to failure to do regular range of motion exercises, often combined with poor positioning and spasticity.

    You would need to consult with your SCI physician and a good PT to see if your contractures are the type that can be stretched out with range of motion exercises, splints and stretching with weights. Proning (laying on your stomach) is an excellent way to both prevent these and to stretch.

    If your contractures have calcified, then stretching may not be enough, and surgery might be indicated, although it can be difficult surgery for both hips and knees and the outcome is not always ideal (infections and hematomas are common). A DEXA scan is a good idea before you start a standing program, but you do need to get your contractures addressed first. You would also need to get your range of motion corrected in order to properly use a standing chair.

    (KLD)

  3. #3
    Thanks nurse,


    I doubt if my hips are contracted any. I would not do surgery on these anyways right now because I don't think I could tolerate it yet.

    How do you know if a contrature is "calcified" ? I would almost bet my legs (kness) are. But what about the feet. I know there are many bones there.

    I would really like to try standing but not sure how long a muscle might take to stretch if nothing is calcified.

  4. #4
    Senior Member Belle's Avatar
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    SCI-nurse,

    We know that it is recommended to do ROM every day. Between standing, sitting up, lying prone (which he does do every night), and occasional ROM my husband probably gets about a quarter of that per week. Is it possible for that to be sufficient, or should we try harder to do it more often? He has only a very minimal amount of contracture since the accident 1 1/2 years ago, most of it occuring within the first three months or so - it does not seem to be getting any worse. He can still use his standing chair with no problems.

    *************
    AB wife of T8 complete para

  5. #5
    I've read when lying prone to have your feet hang off the end of the bed. Is this necessary? There is a board at the end of my bed so I can't do this. Will lying with them flat on the bed hurt them?

    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  6. #6
    Senior Member alan's Avatar
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    I get ROM four times a week, sometimes three (depends how often the one aide who knows how to do range comes in a week.) My joints are all fine - no contractures or other problems. I'd like to get ranged more often, but that's not the way it is.

    Alan

    "Was it over when the Germans bombed Pearl Harbor?"

  7. #7
    I am wondering still about how to rehabilitate my contractures. I am sure my legs are bent. Is there any hope that surgery and bone density drugs would allow me to stand. Also, is surgery for contractrures and rehab covered by medicare. Any experiences or advice is appreciated.



    David



    P.S. - I was skimming thru the topic of hip contracture and surgery. Is this a very effective operation. I am not sure yet if my hips are contracted some too? If surgery was done, then basically where is the muscle cut. I am not understanding this stuff too well yet. I was hoping a simple cut up front would release the tension. The main question is would a cast be necessary. Is the hip joint basically unsupported once the muscle is cut?

    [This message was edited by david65 on 02-24-05 at 09:06 PM.]

  8. #8
    Senior Member imnomis's Avatar
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    The standing wheelchair I have is made by The Standing Company in Bridgeport, MI. When I got mine a year ago the base price was $7,500 complete. It stands me up with very little effort in about 2 seconds. They have a series of pictures on the home page of their Web site that shows how easily it works. http://www.thestandingcompany.com/

    Mine is a folding chair so I can take it with me when my wife is along. It doesn't fold tight enough to fit behind the drivers seat in my Monte Carlo so I have to take my Quickie when I'm on my own.

    imnomis

  9. #9
    David, have you been proning (laying on your stomach) to try to stretch out as suggested last year? Have you seen a good SCI experienced physiatrist and PT? You have to have this type of evaluation PRIOR to going for a surgical intervention.

    As discussed here many times before, there is no indication that simply being on etidronate drugs is a successful way to increase bone density in people with SCI. Standing on bones that are very osteoporotic can cause fractures and slippage of the bone plate in some people. The advice of a good SCI trained physiatrist is essential prior to starting a standing program in someone who has not stood for many years.

    Surgery should be a last resort. It is unlikely that surgery will allow you to stand, as the most common way to treat this in a person with a SCI is through a girdlestone procedure, which detaches the femur from the pelvis, leaving it attached only by muscles. A cast is not used, but standing is not possible afterwards. Infections due to hematomas (bleeding into the soft tissues) are very common in this surgery.

    (KLD)

  10. #10
    I have not tried to lay on my stomach but once and that was in rehab from the very beginning. I have an external catheter now and may get a colostomy. So the stomach will have to wait.

    I will make an appointment to see if my hips are contracted and a bone density test. I was curious for now, if it is that important if the hips were contracted - could standing frames alot for an angle of posture. I would or could even modify something to lean forward more if necessary. The reason I am so adamant about gaining some standing, is that whenever I have a colostomy I get many uti's. My commode chair helped to flush my bladder during bowel programs and this kept uti's away. I don't heal well with constant uti's and the conmmode chair trick works to a point, when I have a colostomy.

    I still have contractures of the knees and no bone strengthening program.

    But, aside from the hip surgerey or not, would an operation on the knee flexons be too much to rehabilitate into a standing program like the hip. I sure hope it isn't as complicated.



    David

    [This message was edited by david65 on 02-24-05 at 10:02 PM.]

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