In the Department of Technical Orthopedics and Rehabilitation, University of Münster/West-Germany, patients with all sorts of handicaps were supplied with technical aids. Beside prosthesis and orthosis very often devices, which are not worn at the body, were ordered, which make certain activities for patients possible or make them easier to them.
I will introduce some of those devices by means of slides. First a selection of eating and writing devices for several handicaps is shown. In the providing with wheel chairs it is often necessary to built for certain handicaps special constructions. Seat-devices and special drives are demonstrated. Also some electric wheel chairs with electronic control systems for special handicaps like a system controlled by blowing, a sensor control system, a system for athetotics, a phonoacustical system and a system, which is controlled by shifting body weight.
The physical possibilities of the patients were tested on a simulator, which is also useful to train driving a wheel chair.
Then I will show some aids for nursing, like special beds, and some devices to use on the toilet, in the bath and for dressing, and some lifts for patients.
At last some technical aids for workshop places are demonstrated.

View full abstract

The natural history of muscular dystrophy is such that force imbalances, produced by muscle weakness and contracture, cause progressive postural decompensation. Ultimately, the patient loses the ability to position his center of gravity over the base of support, becoming wheelchair-bound by late puberty. After this, the disease follows a rapidly declining course, terminating in early death.
In selected patients, properly timed surgery and bracing has enhanced standing balance and significantly extended the ability to ambulate. Because severe weakness can result from prolonged restraint, operative procedures must permit immediate mobilization without excessive pain or wound dehiscence. Conditions requiring surgical correction are lower extremity flexion contracture, metatarsus adductus, rigid forefoot equinovarus and calcaneocavus. Techniques designed to correct these deformities, and still permit early postoperative mobilization, include subcutaneous tenotomy and percutaneous tarsal medullostomy. Postoperative plastic bracing improves walking mechanics through mild knee flexion and ischial seating.
Progressive disability in these diseases can be delayed by a variety of physiatric techniques, including the prescription of appropriate orthoses and aids to daily living. Where feasible, fractures are treated with minimal splintage and early ambulation. After patients are no longer ambulatory, they require suitable wheelchairs and a variety of special devices to facilitate ongoing care. Orthotic and operative treatment of scoliosis provides wheelchair-confined patients, with either myopathy or neuropathy, increased comfort and improved cardio-respiratory function, while freeing the upper extremities for functional tasks.
Although most muscle diseases are incurable, this is not synonymous with untreatable Optimal therapy for the patient with muscle disease should be multidisciplinary, aggressive, and conducted in an atmosphere of intelligent concern. This approach minimizes the frustrating aspects of these conditions, while maximizing the benefits obtained through available care, enabling the patient to live as fully as possible for as long as possible.

View full abstract

The relationship between the occurrence of mental retardation and risk factors was studied, based on Prechtl scores, in 79 mentally retarded children not having obvious hereditary involvement. The average scores of mentally retarded children, cerebral palsy children, and normal children were 3.86, 5.67, and 1.96, respectively. Mantally retarded children had higher associations with high maternal age at delivery and with small-for-date births than did cerebral palsy children and normal children. Mentally retarded children had high incidences of toxaemia, infection, psychological stress, and other problems due to environmental factors. Certain characteristics were also noted in the course of pregnancy and delivery of mentally retarded children. We thus found that Prechtl scores could provide the initial clue leading to an early diagnosis of mental retardation.
We examined symptomatic characteristics in the developmental course of infancy for 71 cases of mental retardation. The general trend during one year after birth included the following facts. 1) The children were poor in activity and quiet in behavior. 2) The rhythm of sleeping and waking was irregular, with many hours spent in sleep. 3) The orientation response to visual or auditory stimulation was poor. 4) These children disliked the prone position. 5) They were not easy to hold in arms and did not like being held. 6) Behavioral development was retarded in comparison to motor capacity.
The most characteristic findings in initial diagnosis for 21 cases diagnosed within six months after birth were poor head control, abnormal postural tone, poor spontaneous reactions towards the environment, and lack of facial expression.
We used behavioral developmental indices in the evaluation of development. Instructions on habilitation were provided for children who showed developmental retardation for more than three months within the first year of age.

View full abstract

Although the abdominal muscles are believed to play a significant role in maintaining postural stability, in addition to the back muscles, little knowledge is now available about the control mechanisms of these muscles. In this study, the stretch reflexes of the human rectus abdominis were recorded myographycally, and the influence of respiratory states, neck position and pyramidal tract disorders on their amplitude was investigated.
In the first series of experiments, the abdominal walls were repeatedly hit with a solenoid hammer with the subject in the supine position, and the stretch reflexes (T-waves) were continuously recorded from surface electrodes placed on each side of the rectus abdominis. During the procedure, the head position was changed from facing forward, to facing right and to facing and the respiratory phases were simultaneously recorded. A total of 55 persons were examined, and 19 satisfactory records were obtained from 5 normal subjects, 7 lt. hemiplegics and 7 rt. hemiplegics. Six persons showed fairly regular changes in T-reflex-amplitudes in accordance with the respiratory phases. Turning the neck also seemed to modulate the amplitudes, especially in hemiplegis, suggesting that the T-reflexes are augmented when the neck is rotated to the affected side.
In the second series of experiments, the same procedures were performed on breath-hold states, and 5 consecutive T-reflex-waves were recorded on electromyograms. A total of 48 persons were examined, and 21 satisfactory records were obtained from 7 normal subjects, 7 lt. hemiplegics, and 7 rt. hemiplegics. Each of them showed considerable variation in amplitude during breath-hold periods in spite of the constant tapping strength.
The maximum amplitudes were higher during inspiration than during expiration, and higher in the head-down positions than in head-up positions. The influences of lateral neck rotations on the amplitudes were also noted, but showed great variance. As a whole, in the hemiplegics, higher T-reflex amplitudes were recorded from the affected side, while no significant laterality was noted in normal subjects. These results suggest the existance of neuronal linkages between the somatic afferents around the neck, inputs from the respiratory system and tha motor neurons of the rectus abdominis.

View full abstract

During the past few years electrical stimulation has become a substitute for the ordinary muscle strengthenning exercise program, but as yet research information about the effect of electrical stimulation on the healthy skeletal muscle is still largely lacking.
Hence, this study was undertaken to obtain a more definite information regarding the adaptive effects of electrical stimulation on the healthy skeletal muscle.
Right sciatic nerve of male Wistar albino rats was electrically stimulated daily 30 minutes at the frequency of 5Hz for two weeks and they were allowed to survive until the second week, when appropriate leg muscles of both sides were removed for the wet muscle weight measurements, succinic dehydrogenase (SDH) staining and microangiogram.
The mean relative wet weight of sitmulated tibialis anterior, extensor digitorum longus and extensor hallucis longus muscle was 105.8, 110.2 and 137.1 per cent comparing with that of the non-stimulated muscles. Electrically stimulated muscle fibers became thickly stained for SDH which made the difference of individual muscle fiber type indistinct.
Microangiography done with India black ink showed the dilatation of vessels as well as the increase in number of capillaries in electrically stimulated muscles.
In view of these results, electrical stimulation can be utilized as a therapeutic procedure to encourage muscle strengthening exercise.

View full abstract

Our series included 50 children with their ages ranging from 1 month to 7 years. Most of them had been hyper- or hypotonic at the time of study and over 8 months after this investigation the definite diagnosis was made in each cases in a retrograde manner. Cutaneous reflex responses have been recorded from the flexor digitorum sublimus by stimulating the index finger electrically.
Short latency exitation (E₁) and long latency excitation (E₂) were observed in those responses. The short latency exitation is considered as a spinal response and the long latency excitation is considered as a cortical response.
In our series, in 11 of total 33 spastic and athetotic children the spinal response did not reduse its amplitude and the transcortical response did not increase its amplitude during the development of the infants, inspite of Issler's documents. Motor and postural reflex also did not develop in about one third of the spastic and athetotic infants. We used E₂/E₁ ratio as a parameter, and studied the value of this ratio in relation to infantile motor development and postural reflex (Fiorentino).
E₂/E₁ ratio was found to be highly correlated with postural reflex in spastic or athetotic groups as well as in normal groups. In 9 of 15 cases with E₂/E₁ ratio larger than 0.5 and smaller than 1.0, their postural reflex belonged to the cortical level. In all cases with E₂/E₁ ratio larger than 1.0, postural reflex belonged to the cortical level.
In all groups, E₂/E₁ ratio was found to be correlated with motor developmnt. In the cases with E₂/E₁ ratio smaller than 0.5 the patients were usually impossible to sit, stand or walk.
From these results, it is concluded that the long latency transcortical response of cutaneous reflex may closely correlate with motor. In other words, transcortical reflex may play an important role in the mortor required balance.

View full abstract