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Post-Polio Health (ISSN 1066-5331)

Vol. 19, No. 1, Winter 2003

Ocular Health and Pulmonary Assist Machines

Richard E. Hector, MD, FACS, Bradenton, Florida,

Maintaining good ocular health and comfort is a challenge even under "ordinary" conditions. It is especially difficult when you use a pulmonary assist machine, such as C-PAP, BiPAP, etc., with a face mask, because such use can affect the stability of your tear film. A stable protective three-layer tear film is partially responsible for good vision and comfortable, healthy eyes.

We are most familiar with reflex tears, those watery tears you experience while watching a sad movie or cutting onions. If these reflex tears are present for no particular reason, the culprit is usually a dry eye condition. This exists when the other, more protective, and less familiar "tear" is absent, either due to reduced production or increased evaporation.

Numerous small glands in your eyelids produce the protective three-layer tear film that is necessary for the health of the external surface of your eyes. If the tear film is absent, the external surface breaks down, which can be very painful and can increase the risk of severe infection, scarring, and loss of vision.

Using a pulmonary assist machine with a face mask can increase the rate of evaporation of your natural tear film, and will, at first, stimulate your reflex tears, causing your eyes to tear inappropriately. If other conditions are present that reduce the production of this valuable tear layer, an advanced dry eye condition can develop to the point that your eyes will not tear or water at all. The use of hormone replacement therapy that includes estrogen, allergy medications such as antihistamines and diuretics, and Rheumatoid arthritis and Parkinson's disease are all associated with an advanced dry eye condition.

The treatment is similar in most cases. Over-the-counter artificial tear solutions of various compositions and thickness need to be used. The frequency of applying these solutions depends on the severity of the dry eye condition. Avoid those that "take the red out" and look for a bland lubricating product such as Refresh Tears/Gel or Thera Tears/Gel; Bion Tears or Tears Naturel Forte; Hypotears or Tears Naturel Free; Genteal Tears/Gel; and Refresh Endura. If artificial tears are need-ed more than five times a day, preservative-free solutions should be used.

In very severe conditions of dry eye, the tear drainage system can be modified, either temporarily or permanently, by using small plugs that fit inside the eyelids and/or the eyelids themselves can be sutured partially closed to further protect the surface of the eye from exposure and drying.

Bracing Options: The Stance Control Orthotic KneeT

The mechanically-actuated Stance Control Orthotic Knee™ joint is the latest innovation from Horton Technology, a private laboratory headquartered in Little Rock, Arkansas. Horton's knee joints have been incorporated into custom-made leg braces and can prevent the knee from collapsing as polio survivors walk, automatically releasing to permit unimpeded knee flexing during the swing phase of gait.

Stance Control Orthotic Knee jointPreliminary scientific studies from the University of Central Arkansas (UCA) suggest that these braces provide a more normal gait pattern and reduce the effort required for people with lower limb weakness and paralysis to walk.

The mechanically-actuated version has been commercially available since January 2002. More than 400 orthotists in North America have successfully completed the advanced training course in the application of this innovative rehabilitation technology.

Stance Control KAFOAt the annual meeting of the American Orthotic & Prosthetic Association ( in the fall of last year, Horton Technology, Inc. unveiled an electronic version of the Stance Control Orthotic Knee™ joint. Polio survivor Paul Ellis demonstrated how the Smart Knee™, which can be powered for several days by ordinary AA batteries, enables him to walk safely up and down ramps despite knee muscle paralysis and weakness in both legs.

photo of SmartKneeHorton's electronic Smart Knee™ is currently undergoing final clinical trials in the United States and will be commercially available in early 2003.

Visit Horton Orthotic Lab, Inc. to see if a laminated brace is for you and to find a skilled orthotist in your area.

Bracing Options: Shadow Bracing System

Kyle Scott, CO, a certified orthotist for over 15 years, has been confronted with the same question from hundreds of polio survivors – "Where's the new technology in orthotics?"

"I find everyone wants to see the newest gizmos, but really wants someone else to try them," says Scott. In his experience, polio survivors fall into three main orthotic groups: those who have worn braces since contracting polio; survivors who wore braces after the acute disease, but who learned compensation techniques to overcome their weaknesses and, in turn, discontinued wearing braces; and those who had a less severe case of polio or those who had a full return to function and never had to wear braces, but now are experiencing new weakness.

Each group now has unique needs, both physically and psychologically, and each polio survivor's needs must be addressed individually.

Metal and leather (M&L) braces were the primary orthotic treatment in the early years. "My polio patients who wear M&L braces have a love/hate relationship with them," Scott reports. "They love the comfort, durability and very positive structural support, but hate the excessive weight, bulk and odor that is sometimes associated with the leather, and the limited footwear choices, as the M&L braces have to be at-tached to the outside of the shoe."

photo of two braces, one for entire leg; one for knee to ankleAny trim configuration is possible as long as the brace is structurally sound. Almost any color or skin tone can be reproduced and personalized fabrics (SpandexT) can also be laminated into the brace.

With the development of thermo-plastics over the past 20 years, the orthotics and prosthetics industry responded to these com-plaints with the next advancement in orthotics. Thermoplastic braces are lighter, less bulky, washable, more appealing and fit inside shoes, so polio survivors can wear different styles of shoes.

Scott continues, "However, experience has taught orthotists that all thermoplastics have an elastic property to them, so even when the brace looked to be structurally equal to M&L, the plastic material couldn't duplicate the structural support of metal."

Scott pondered his patients' comments that they didn't feel their brace was as supportive, would bend under their body weight, and that their brace had a "rubbery feel." What material could be used that would be structurally as strong as metal, but lightweight, less bulky, and fit into shoes easily as the plastic braces do?

After joining Oregon Orthotic System, the industry leader in laminated orthotic braces in 1990, Scott realized that lamination provided all the benefits of M&L combined with all of the benefits of thermoplastic.

The Shadow Bracing System combines time-tested (M&L) engineering, with today's cutting edge carbon-graphite lamination technology to keep it lightweight. Stainless steel knee and ankle joints are standard, with titanium ankle joints a popular option. A standard long leg brace with stainless steel components weighs between 2.75 and 3 pounds, while a short leg brace can weigh as little as a pound when titanium components are used.

Oregon Orthotic System, based in Albany, Oregon, knows no bracing system can meet every need, but offers the The Shadow Bracing System as newer technology that can address many of the concerns of polio survivors.

Visit Horton Orthotic Lab, Inc. to see if a laminated brace is for you and to find a skilled orthotist in your area.

Resources: - The American Board for Certification in Orthotics and Prosthetics (ABC) sets standards for quality. Find a certified orthotist in your area. The International Society for Prosthetics and Orthotics aims to promote high quality of care. Review their specific activities.

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