ABSTRACT
This report describes a case of an amputee with a lumber spinal cord injury who successfully recovered ambulation with the use of prosthesis.A 30-year-old man with schizophrenia underwent amputation of the lower legs and concurrently developed lumbar spinal cord injury from of a suicide attempt. After the treatment of stump plasty and posterior fusion, the patient was transferred to our facility. Lower-extremity prostheses for both legs were fitted, and orthostatic training was commenced following admission. During the initial evaluation, the patient could not maintain a stable standing position because of weakness in the hip extensor muscle. An inflexion angle of the prosthesis was set to 0° to extend the knee joint and achieve standing stability. Appropriate adjustments of the prosthesis were made as required, specifically addressing the paraplegia caused by his lumbar spinal cord injury. Thus, the patient successfully regained ambulation with the treatment.Recovering walking independence after bilateral lower leg amputations or paraplegia caused by lumber spinal cord injury is not uncommon. However, this case is unique in that the muscle weakness caused by lumbar spinal cord injury presented unforeseen difficulties for the patient to achieve ambulation, which is not ordinarily observed in amputation rehabilitation cases. No similar cases have been reported in which patients concurrently suffered from both these conditions in Japan；therefore, this case is extremely rare.
ABSTRACT
This report describes a case of an amputee with a lumber spinal cord injury who successfully recovered ambulation with the use of prosthesis.A 30-year-old man with schizophrenia underwent amputation of the lower legs and concurrently developed lumbar spinal cord injury from of a suicide attempt. After the treatment of stump plasty and posterior fusion, the patient was transferred to our facility. Lower-extremity prostheses for both legs were fitted, and orthostatic training was commenced following admission. During the initial evaluation, the patient could not maintain a stable standing position because of weakness in the hip extensor muscle. An inflexion angle of the prosthesis was set to 0° to extend the knee joint and achieve standing stability. Appropriate adjustments of the prosthesis were made as required, specifically addressing the paraplegia caused by his lumbar spinal cord injury. Thus, the patient successfully regained ambulation with the treatment.Recovering walking independence after bilateral lower leg amputations or paraplegia caused by lumber spinal cord injury is not uncommon. However, this case is unique in that the muscle weakness caused by lumbar spinal cord injury presented unforeseen difficulties for the patient to achieve ambulation, which is not ordinarily observed in amputation rehabilitation cases. No similar cases have been reported in which patients concurrently suffered from both these conditions in Japan；therefore, this case is extremely rare.
ABSTRACT
A questionnaire-based survey of board-certified rehabilitation physicians was conducted to identify issues in multidisciplinary interprofessional collaboration and to assess the abilities of board-certified rehabilitation physicians needed to develop assistive devices for individuals requiring long-term care. From the 366 responses, it was revealed that they consider “the ability to gain an insight into what patients need from assistive devices” and the “ability to communicate” as essential abilities needed to develop assistive devices. The respondents considered the ability to communicate and convey information important to overcome differences in thought-process between disciplines；the sharing of information, objectives, and knowledge as a requirement for teamwork；and collaboration, including with the patients, to be important. This approach to device development fits well with “design thinking” and “biodesign.” Unfortunately, more than 70％ of the respondents were unfamiliar with these concepts. Therefore, it is necessary to provide opportunities for rehabilitation physicians to learn innovative biodesign approaches.
ABSTRACT
A questionnaire-based survey of board-certified rehabilitation physicians was conducted to identify issues in multidisciplinary interprofessional collaboration and to assess the abilities of board-certified rehabilitation physicians needed to develop assistive devices for individuals requiring long-term care. From the 366 responses, it was revealed that they consider “the ability to gain an insight into what patients need from assistive devices” and the “ability to communicate” as essential abilities needed to develop assistive devices. The respondents considered the ability to communicate and convey information important to overcome differences in thought-process between disciplines；the sharing of information, objectives, and knowledge as a requirement for teamwork；and collaboration, including with the patients, to be important. This approach to device development fits well with “design thinking” and “biodesign.” Unfortunately, more than 70％ of the respondents were unfamiliar with these concepts. Therefore, it is necessary to provide opportunities for rehabilitation physicians to learn innovative biodesign approaches.
ABSTRACT
<b>BACKGROUND</b> : In Japan, clinical ethics support services are only available at certain institutions. The actual conditions surrounding ethics consultation are unclear with few resources available for determining its efficacy. The object of this study is to clarify the expected outcome of ethics consultation and identify the appropriate mode. We also aim to elucidate the ideal consultant and the obstacles to achieving full utilization of ethics consultation.<br><b>METHODS</b> : Eighteen medical practitioners participated in the study. We held semi-structured interviews and analyzed these interviews by qualitative content-analysis technique.<br><b>RESULTS</b> : This study suggests that specific advice, new insights from outside parties, emotional support, and an appropriate process based on a division of labor between medicine and ethics all contribute to a team-based practice of medicine that avoids the arbitrariness and dogmatism of single practitioners. It is also indicated that timeliness and swift answers are required. Knowledge of medicine and ethics, communication skills, a close familiarity with actual conditions in medical practice, and empathy toward the medical staff were found to be as important as the qualifications of consultants. Contrarily, the participants suggested that the busy pace, lack of psychological breathing room, medical practitioners' pride, lack of awareness of ethical issues, and the negative image of the word “ethics” were significant impediments to achieving full utilization of ethics consultation.<br><b>CONCLUSIONS</b> : The present study is the first of its kind to reveal the views of medical professionals regarding clinical ethics consultation in Japan. Further research is required to identify the features of a consultation system that can be easily accessed and effectively utilized in Japan.