Ann Rehabil Med.  2013 Feb;37(1):33-40. 10.5535/arm.2013.37.1.33.

Changes of Musculoskeletal Deformity in Severely Disabled Children Using the Custom Molded Fitting Chair

• Kim MO
• Lee JH
• Yu JY
• An PS
• Hur DH
• Park ES
• Kim JH

• KMID: 2266648
• DOI: http://doi.org/10.5535/arm.2013.37.1.33

Abstract

OBJECTIVE
To know the effectiveness of a custom molded fitting chair between pre- and post-chair status through comparison of musculoskeletal indices in severely disabled children.
METHODS
We researched 34 severely disabled patients who had used a custom molded fitting chair continuously for more than a year. There were 27 cerebral palsy patients and 7 patients with other kinds of diseases that affect the brain such as chromosomal disease or metabolic disease. By radiographic studies, Cobb's angle, the femoral neck-shaft angle of the femur, and Reimers migration percentage were measured. The indices are analyzed before and after application.
RESULTS
The average period of application was 24 months. There was a significant reduction in the angles of femur neck-shaft, 163.4 degree before and 158.2 degree after the use of the chair (p<0.05), and 23 of 34 had demonstrated a reduced angle. Cobb's angle and Reimers migration percentage increased but the difference of pre- and post-chair status was not statistically significant. Seventeen of 33 children showed reduced Cobb's angle. Also, 19 of 37 showed a reduced degree of dislocation of the hip joints.
CONCLUSION
In spite of the use of a custom molded fitting chair, a significant improvement did not emerge for musculoskeletal deformity indices in severely disabled children. However, there was no significant aggravation of Cobb's angle or Reimers migration percentage in developing children. Therefore, it is thought be helpful to prevent rapid aggravation of musculoskeletal deformities.

Keyword

Orthotic devices; Musculoskeletal system; Disabilities; Disabled children

MeSH Terms

Brain
Cerebral Palsy
Child
Congenital Abnormalities
Disabled Children
Dislocations
Femur
Fungi
Hip
Humans
Metabolic Diseases
Musculoskeletal System
Orthotic Devices

Figure

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  Fig. 1 The blueprint making an inner for the chair.

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  Fig. 2 Manufacturing process of the custom molded fitting chair. Simulator scanned the body shape of the patient (A). The inner was reconstructed from the image scanned by the simulator (B). A frame of a manual wheelchair was selected to apply the inner (C). The seat portion of the inner was installed to the frame. A fan is attached under the back for ventilation (D). The back portion was installed (E). Applying the patient to the chair, a few adjustments were needed (F).

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  Fig. 3 Cobb's angle (*) measurement in scoliosis. (A) Before application of the chair. (B) After application of the chair.

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  Fig. 4 Reimers migration percentage in hip subluxation. Perkins' line (P), which is drawn perpendicular to Hilgenreiner's line (H). Reimers migration percentage is the percentage of the femoral head lying lateral to Perkins' line (P). Reimers migration percentage=X/Y×100. (A) Before application of the chair. (B) After application of the chair.

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  Fig. 5 Femoral neck-shaft (*) angle in coxa valga. (A) Before application of the chair. (B) After application of the chair.

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