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Wednesday, August 27, 2014
Double amputee in 1977
I am portraying a Vietnam vet who lost both his legs in Lanford Wilson`s award-winning play "Fifth of July." My character has prosthetics which, according to the script, are fiberglass. He walks with forearm crutches. I need some guidance as to what type of prosthetics would have been used in the mid-1970`s. How should I be walking? I am using my abs, leaning slightly on the crutches, and using my hips to swing one leg forward at a time. Would I be able to go up and/or down one or two steps of a porch? How would I lower myself into a chair? How would I stand up again? Would the knee have been manually operated in some way? Thanks for any suggestions, links, advice you can offer. I`d like my portrayal to be real and respectful at the same time.
If both legs were lost below the knees, the prosthetic components available in the 1970's would have enabled walking, including going up and down stairs, without too much difference from a nonamputee.
If, however, both legs were lost at or above the knee level, the prosthetic components available then did not allow controlled knee flexion - as is required at the knee of the upper leg when descending stairs. They also did not provide controlled knee extension - as is required at the knee of the upper leg when going up stairs.
So, for a bilateral ("double") amputee with amputation at or above the knee level, going up, or down, stairs would require most of the effort to come from the arms and upper body - via crutches or railings. Similarly, lowering the body down into a chair, or going from a sitting to standing position, would require most of the force to come from the arms/upper body pushing down onto something - such as crutches or the chair's armrests.
The prosthetic knee components available in the 1970's certainly included - but wouldn't necessarily require the use of - a manually-locking knee unit. If a person's strength and balance are sufficient, that type of knee unit is best avoided. This is because with the knee maintained in full extension during the gait cycle, more gait deviations and compensatory motions elsewhere in the body - and therefore greater energy expenditure and a slower gait speed -necessarily result.
Rather, either a "friction knee" or a "hydraulic knee" would have been preferable, with the latter preferred if walking speed is able to be varied. Each of those knee types are designed to be fully extended and stable during the initial part of "stance phase" of the gait cycle... that is, from "Heel strike," to "Foot flat," to "Midstance" (when the body is directly centered over the weight-bearing foot) on one side. After Midstance on the right, for example, Heel strike on the left occurs soon afterwards, which allows the right knee to begin bending at "Heel-off", and then more right knee bending occurs at "Toe-off" on the right.
When walking with a pair of forearm - or any - crutches, right "crutchtip strike" should coincide with left Heel strike, and "left crutchtip strike" should coincide with right Heel strike. Placing both crutches in front of the body and then either "dragging to" - or "hopping to" - the crutches can also be done if upper body strength and balance are sufficient, but this requires much greater effort compared to the alternating/reciprocal crutch gait pattern.
If you've not already done so, consider contacting a local Prosthetics facility to speak with a prosthetist regarding the above, and to also perhaps speak with a patient who has undergone bilateral amputations. One last thought is to consider browsing and possibly submitting any further questions you may have to one of the websites dedicated entirely to amputees, for example:
- The Amputee Coalition of America: http://www.amputee-coalition.org/ - including http://www.amputee-coalition.org/nllic_about.html,
- The Americal Academy of Orthotists and Prosthetists: http://oandp.org/
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University