Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

<p>Abstract</p> <p>Background</p> <p>Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components.</p> <p>Case presentation</p> <p>We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA.</p> <p>Conclusions</p> <p>Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.</p

Adversarialism in informal, collaborative, and 'soft' inquisitorial settings : lawyer roles in child welfare legal environments

This article explores the challenges and benefits of increased legal representation in child welfare hearings, with reference to the Scottish Children’s Hearings System. We look at the role and impact of adversarial behaviours within legal environments intended to follow an informal, collaborative approach. We analyse the views of 66 individuals involved in the Hearings System, including reporters, social workers, panel members and lawyers, collected through four focus groups and 12 interviews held in 2015. We place this analysis in the context of previous research. Our findings identify concern about adversarialism, inter-professional tensions and various challenges associated with burgeoning legal representation. Difficulties stem from disparate professional values and perceived threats to the ethos of hearings. We conclude it is difficult, but possible, to incorporate an adversarial element into such forums. Doing so may help to protect rights and potentially improve decision-making for children and families. The article concludes by considering implications for the practice of lawyers and others

The GENTLE/S project: a new method of delivering neuro-rehabilitation

Stroke is a leading cause of disability and in particular effects older people. Although the causes of stroke are well known and it is possible to reduce these risks. there is a need to improve rehabilitation techniques and delivery so as to allow as full as possible a recovery. This paper explores new techniques for machine mediated stroke rehabilitation that seeks to provide motivating and intensive therapies that improve outcomes and reduce healthcare costs. Funded by the European Commission under the programme 'Quality of Life and Management of Living Resources', Contract No. QLK6 -1999-02282

Gesture recognition for control of rehabilitation robots

The development of a control user interface for a wheelchair mounted manipulator for use by severely disabled persons is described, explaining the construction of the interface using task analysis. The prototype robot used several gesture recognition systems including Neural Networks to achieve a level of usability better than other robots used for rehabilitation at the time, demonstrating the possibility of control using a simple head mouse. The major impact of this research has been to illustrate the poor performance of existing design methods for dynamic user interfaces. This work has been confirmed by experiments of other workers

‘What happened next’: a study of outcomes for maltreated children following care proceedings

This is the first report from a study of outcomes for 114 children from 49 families assessed in an expert multi-disciplinary service during care proceedings. The study investigated the extent of children’s adaptation following judicial decisions made in the proceedings and what factors might be involved in changes in the children’s adaptation and well-being. We also aimed to investigate the reliability of the expert placement and treatment recommendations made to the court. The original assessment reports for the court were independently coded using a comprehensive child adaptation measure (Target and Fonagy, 1992). At follow-up, mean time of 26 months after their assessment, the researchers re-employed the child adaptation measure in semi-structured interviews with carers in birth, adoptive, foster and kinship placements. The data were independently coded and the results compared with the child’s original score as a measure of change in adaptation post proceedings in their substitute family or birth family. Researchers also collected information about the children’s placement(s) and any support or treatment received. The study found that children’s well-being significantly improved by an average of +6.7 points between initial assessment (M = 68.13; SD = 9.86) and follow-up (M = 74.82; SD = 7.84), (t (67) = −5.0, p < .001, d = 0.76). Children whose global adjustment scores were clinically concerning at the time of assessment hardly improved their scores (.44), compared to children whose global adjustment scores were within the normal range at the time of assessment. Interestingly, the majority (88%) of expert placement recommendations had been accepted and implemented. However, less than 50% of the children and only 30% of parents received the support and treatment recommended in the experts’ reports in the proceedings. The implications for both policy and practice in working with children and their families during and after care proceedings are explored