Hard at Work

Work has been good lately. The last few weeks, things have picked up quite a bit, and I feel like I'm getting to make much more of an impact.

Fitting a handmade Giv Mohr sling. The P&Os were really excited about the possibility of using this sling for the many stroke patients they see.

I held a training last week to train the staff in the fabrication of two new devices and the method of serial casting. There is a ton of work that goes into creating a five day training from scratch so it's nice to feel like it's worth it. I feel like I'm starting to bond a little bit with my Lao P&Os which makes it much more enjoyable.

The training was structured so that the first three days, I worked with the P&Os lecturing on diagnoses, theory, and fabrication. Then the last two days of the course, their bench technicians came and worked with the P&Os to actually fabricate the devices. The idea is that the P&Os will gain a better understanding if they have to teach it to someone else, and hopefully it will promote teamwork, which from what I've been told is a problem, especially in the provinces.

Fitting a handmade Pavlik Harness. This is less likely to be used often, due to the fact that babies are NOT normally tested for developmental dysplasia of the hip (DDH). We hope to change that by educating the midwives, as we have about clubfoot and the Ponseti method.

I really enjoyed the training, although it's quite exhausting to lecture for five days. Luckily, I only have to do it a couple times a year. This training taught the staff to make a Giv Mohr sling, which is an upper extremity device for patients after a stroke. It helps support a flaccid arm, improves balance, prevents shoulder subluxation, and helps with gait symmetry. They also learned about the Pavlik Harness, which is a device babies are fit with if their hips are not forming correctly. The difficult part of this is getting the doctors to diagnose the hip problem. Currently, babies aren't screened for it and I've already had a couple cases where older children get xrays and have obvious DDH. Past a certain age, this becomes a surgical issue and one that we don't have the capacity to deal with, no it goes untreated.

Aside from our training course, I've also had the chance to see a couple of patients over the last few weeks. That's always fun and makes me realize how much I miss that part of my profession. Most of the patients I've been seeing are children, which I really enjoy. Although many of them have a strong aversion to foreigners and scream bloody murder when I come in the room.

I have been following up with a little boy (6 months) who was born without patellas and with extreme laxity in both his knees. So whenever he fully extends them, they dislocate. It's pretty painful to watch, although he doesn't seem to experience any pain. I've been talking with an orthopod in the UK but am really unsure what I can do.

This was her at 6 months.

The latest idea is to put him in some very simple long leg braces without any joints that hold him in about 80 degrees of knee flexion. So he won't be constantly dislocating his knees. Then hopefully the orthopod visiting in Sept. can take a look and see if there is any surgery that can be done. Not a great success story but a super sweet little boy with great parents.

Now an active, intelligent two year old.

I also got to see an adorable little two year old girl, who was terrified of foreigners. She apparently suffered a bilateral brachial plexus injury at birth. Without any intervention, her right upper extremity has improved dramatically and she almost has full function, minus a couple of flexed fingers. On her left, however, she has a flaccid wrist and hand, a 20 degree elbow flexion contracture and limited motion of her shoulder.

She does quite well, making do with what she has. But I made her a low temperature WHO (wrist hand orthosis) to try and stabilize her left wrist so she can use that hand as a support for bi manual activities. She tolerated it surprisingly well and hopefully will follow-up with OT and I'll get to see how she's doing. She sure wasn't happy to have me around, but she definitely made my day!