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Ministry Notes

COP is the largest compassion orthopaedic ministry in the medical world.

All volunteer staff, directors receive no salary.

Seating Children Without Legs

Our primary task in Colombia, in early July 2001, was to seat two little boys born without legs, which required a seating system that would prevent pressure areas, and provide for safety in transfers and mobility. The request had come from Cirec, a modern rehabilitation facility in Bogota. The chairs selected by Hope Haven for these children were Enduro chairs, low to the ground and with the large wheels in front. These chairs would make it easier for the boys to learn to climb in and out, and would be a safer alternative to chairs of standard height, increasing their independence. Three chairs were sent: 10, 12 and 14 inches in width. We had no idea the ages of the children or their sizes, but were trusting in the Lord's provision.

The first little boy arrived on Tuesday morning, sound asleep. As soon as he woke up, it was obvious from the start that he was a man with his own mind, even at two years of age! A little explorer, he examined each chair and quickly bonded to the smallest one (10-inch). A blue color, it was apparent that this was the chair for him. The next size up (a 12-inch chair) was just too large for him to handle. His parents were concerned that there was little room for growth, but we assured them that the chair would most likely last for at least a year, at which time they could return to Cirec and trade it in for the next size up.

The task continued with designing a cushion that would relieve pressure on his buttocks, plus help him maintain his balance in the chair while pushing. Without the presence of even limb buds, his entire body weight (torso, arms and head) was supported entirely on his ischial tuberosities when he was upright. Minimal soft tissue covered the bony areas. Additionally, without the leverage of legs for counter-balance, he required his hands for support. However, he couldn't use his hands to push the chair and at the same time use them for balance. The director of prosthetics at Cirec was consulted, and he allowed one ofhis staff to work with the team. Starting with foam, pressure relief areas were cut out to accommodate his ischial tuberosities. A few extra layers in front of his lower torso were added for additional stability, creating a low bucket-like area in the cushion. This was covered in vinyl and velcro was used to attach it to the hard seat of the wheelchair. A seat-belt was not possible, due to the absence of hips, but a chest strap with a moderate amount of elastic give was added for safety. Success! The little boy and his parents loved it, and he happily wheeled himself around the center and out the door.

The second little boy had also been born without legs, and lived in a distant part of Colombia. He, his mom and older brother left their home at 2:00 in the morning and walked several hours before being able to catch a bus into Bogota. They arrived shortly before noon. This little one was four years old, and wise beyond his years. He quickly became part of the team, helping with adjustments by holding wrenches while the therapist loosened and tightened bolts. The 12-inch chair was a little big, but fit him well enough that the team knew that this was meant to be his. The same cushion system was designed, and custom fitted to size. However, an additional problem quickly became apparent. He appeared to also suffer from a relatively mild form of arthrogryposis, as his arms were shortened by elbow contractures, with his elbows locked at about a 45 degree angle. He was unable to flex or extend his elbows. All arm movements took place at the shoulders, which were also underdeveloped. His pectoral muscles and back extensors were functional, but his deltoids and lats were weak. His hands were also contracted, and his grip strength was limited. While he was able to push the wheelchair fairly efficiently, it was impossible for him to reach the brakes. The team designed a brake extension that was fabricated in the prosthetic shop, and the child learned quickly how to use it. He was also a quick learner at getting himself into and out of the chair, even over the top of the cushion, despite his upper body limitations! His mom was instructed in how to help him without doing the job for him, and with practice he should be independent within a few weeks.

It was difficult to say goodbye. There really is no stopping point in terms of need, but the team felt that they had accomplished something of eternal value and had been able to ease, if only slightly, the burden for a few children and their parents in this often difficult life.