578
CHAPTER 34
delivered by the maker. Particular care has to be taken to ensure that those areas of
legs and hips such as trochanters, epicondyls and malleoli, are completely free of pressure
from the caliper, and ill-fitting appliances should be returned immediately to the maker
for re-adjustment.
Paraplegics walk with the aid of arm or elbow crutches. Therefore, shoulder and arm
muscles must be strong enough to ensure this task. If the triceps muscles are weak, a
posterior gutter splint must be attached to the crutches to stabilize the arms. Patients
using elbow crutches or sticks may complain at first of paraesthesia, aching or cramp in
the palm of the hand and, in particular, in the thenar muscles, as a result of pressure.
Periods of rest should be included, and the patient should exercise his hands. Long arm
crutches may produce too much pressure in the arm pits, resulting in irritation or pressure
palsy of parts of the brachial plexus. As there are now various walking aids of tripod type
available, the physiotherapist may choose one of them at one stage or another for restoring
the walking capability of paraplegics. Fig. 246 demonstrates the type of leg brace which
for many years has proved satisfactory for paraplegics.
In certain cases, it becomes necessary to attach the caliper to a pelvic band or short
leather corset, and in these cases a hip joint hinge connects the caliper with the pelvic
band or corset which allows flexion and some abduction of the leg. However, pelvic
bands and short corsets are ordered only after careful consideration in selected cases
with deformity of pelvis or spine. This is contrary to the practice of authors in U.S.A.,
FIG. 246.
