Ptolemy Reid Rehabilitation Centre’s work with prosthetics

One of the greatest benefits of modern technology is its ability to improve the lives of people. In Guyana, this positive impact of modern technology is especially evident in the field of medical rehabilitation, particularly in the areas of orthotics and prosthetics.

Access to more technologically advanced assisted devices is aiding the Ptolemy Reid Rehabilitation Centre in providing better care and in helping patients to return to their normal lives.

The Ptolemy Reid Rehabilitation Centre (PRRC) celebrated its 50th Anniversary just last year. Administrator, Cynthia Massay explained that it has grown greatly since its founding in 1967. She noted that the Centre is officially known as the National Rehabilitation Complex. “But, over the years, we still trade under the name of the Ptolemy Reid Rehab Centre because that’s how we’re known,” she said. Massay explained that PRRC was initially founded at another location as a polio rehabilitation centre.

The current location was named the Ptolemy Reid Rehabilitation Centre when it was set up by the then Minister of Health. All that existed at that time was a single building which contained a physiotherapy department, a dormitory, three small classrooms and the administrative department.

Today, contained within the complex are separate buildings housing the Harvey B. Davis Special School, the National Orthotic and Prosthetic Appliance Workshop (O&P Workshop) and the vocational/technical training unit, in addition to the rehabilitation centre housed within the original building and a daycare that has been in operation for almost 10 years.

Work with prosthetics
The National Orthotic and Prosthetic Appliance Workshop, the only one of its kind in the country,

has its roots in PRCC’s beginnings. In the days of the Polio Centre a small unit was established to build braces for children with polio. Collin Charles, Chief Prosthetic Technician, explained that both orthotics and prosthetic appliances are manufactured at the Workshop. He explained that orthotics are devices which are used to control voluntary movement while prosthetics are used to replace missing body parts.

“We work in conjunction with the [physio] therapy department,” he noted. Individuals are sent to undergo rehabilitation in the physiotherapy department before they are fitted with a prosthesis. Then, after the fitting of the prosthesis, they are once more sent to the physiotherapy department for continued rehabilitation.

The types of prosthetics the Workshop is able to create have been expanded as a result of a recent visit by ProsthetiKa, a California based non-profit corporation which aims to provide assistance to disabled people in developing countries. Charles related that ProsthetiKa introduced the Workshop personnel to different socket designs, namely the Ischial-Ramal Containment (IRC) socket which is an above-the-knee design. “We used to do mainly the quadrilateral socket for our above knee patients and now we do both,” he explained. He noted that the objective is to move away from exoskeletal type prostheses toward more modular or endoskeletal prostheses.

There are numerous benefits to utilising new technology in orthotics and prosthetics. Referring to leg prostheses, Charles noted that the IRC socket hugs more closely to the skin. The ischium (lower and back part of the hip bone), fits inside the IRC socket, in contrast to the quadrilateral socket where it fits outside the socket. He explained that sitting while wearing a socket like the quadrilateral creates a lot of pressure on the ischium seat. “The gait with the [IRC] prosthesis is by far much better,” he said. “It’s more comfortable for the patient, it has a more natural appearance when they walk in comparison to the quadrilateral socket.”

Additionally, Charles related that the Workshop technicians once used mainly resin to create sockets. Having the backing of ProsthetiKa, he said, they can go directly to using polypropylene, a thermosetting plastic which makes the socket design lighter in comparison to the resin. He noted that the components are the same but the weight has shifted.
ProsthetiKa’s team also worked with the Centre’s technicians in the area of orthotics. Charles related that they worked with two-stroke patients.

They were taught the method of taking impressions or negative moulds. “They also went ahead and taught us the fabrication of the AFO, the ankle-foot orthosis,” he said. “We also did gait training which is something I think we haven’t been practising [as much as] the technician there.” He opined that it is necessary to have the physiotherapist present when the AFO is being fitted to observe how it fits and how the patient is able to move using it. Massay noted too that the Centre’s technicians learnt to be more careful with their alignment when fitting assisted devices.

The ProsthetiKa team, which included Founder and President Jon Batzdorff, was in Guyana from April 9 to 13. Massay related that Guyana Goldfields/Aurora Gold Mine (AGM), one of the Centre’s sponsors and supporters, helped make the visit possible. “For the last seven years they have been supporting the work of the Centre,” she said. She explained that the ProsthetiKa team paid its own travel expenses while the Centre was able to, with the aid of AGM, cover the team’s local expenses, including the cost of accommodation and transportation. Massay pointed out that without the collaboration there was a possibility that the Centre would not have been able to facilitate the ProsthetiKa team’s visit.

Endgame
The ultimate goal of the use of new technology, as Massay noted, is for persons with disabilities who have to use assisted devices to become more independent. The use of prostheses makes it possible for individuals to return to their normal lives and careers or facilitates retraining for other occupations. “But basically you can become independent, you can live quite a full life which is the whole goal,” she related.

There was another added benefit to the visit – ProsthetiKa’s team was also able to impart some of its knowledge to the Centre’s physiotherapists. “[In] fitting a prosthesis there is a team,” noted Charles. This team he said comprises a doctor, prosthetist, social worker and physiotherapist working together. After a prosthesis is fitted by the prosthetist, the physiotherapist takes over and trains the patient to use their new assisted device.

Since the visit, “Our methodologies have improved,” said Massay. “And that was just by one week’s visit.” She related that in that one week they were able to note ways in which they could improve the service they offer at PRRC. They have already begun to implement some of the practices they learnt from the ProsthetiKa team.

The importance of the access to new technology in prosthetics and the knowledge gained cannot be underscored. “It is very meaningful,” Massay said emphatically. She related that, in the past, many persons fitted with prosthetic devices would not use them because of their inability to adjust due to the type of prosthesis.

“But, with this new type of technology they’re using, the prosthesis is far more natural and easier to manipulate,” she said. Modern technology has enabled the gait when walking with leg prostheses to become more natural. “It has made a difference and will continue to do that so that persons with prostheses will now be much happier.”