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Nothing About Us Without Us
Developing Innovative Technologies
For, By and With Disabled Persons

PART FOUR
WHEELS TO FREEDOM

235

CHAPTER 37

Martin Builds a Jointed Gurney
to Keep His Hips from Stiffening

Martin

MARTIN Perez, since he was 10 years old, lived on the streets in Culiacan, the capital city of the state of Sinaloa, Mexico. He survived by stealing, doing odd jobs, and trafficking drugs. At age 15, as a result of a gang dispute, he was shot through the spine and became paraplegic (paralyzed from the middle of the back down). Upon his release from the hospital, he was sent to PROJIMO.

On his arrival, Martin was near death from a urinary infection and pressure sores that had developed in the hospital. He was angry and depressed, but had the will and spirit of a survivor.

PROJIMO staff built a wheeled cot, or gurney, so that he could be active while lying on his stomach, and so his sores (on his backside) would heal.

As is usual in PROJIMO, other spinal-cord injured persons took over the management of Martin's urinary problem and pressure sores. In the wheelchair shop, they built a wheeled cot, or gurney, so that he could be active while lying on his stomach, and so his sores (on his backside) would heal.

Jaime rides a gurney because his hips do not bend. Here he paints the frame of a tricycle trailer (see page 201).

Frozen hips. Martin recovered his health, and his sores healed in record time. But a new problem was developing. His hip joints were beginning to ossify - in other words, the flesh around the hip joints was beginning to turn into bone.

This problem, called myositis ossificans, occurs occasionally in spinal-cord injured persons. It happened to Jaime, a worker in PROJIMO's wheelchair shop. Because his hips are solidly fused into a straight position, Jaime works while lying on a gurney (see photos on pages 195, 200 and 247).

There is a debate among specialists as to what to do when myositis ossificans starts to develop. Some recommend very limited motion of the hips, in the belief that movement causes irritation and speeds the deposit of bone. Others argue in favor of aggressive range-of-motion exercises, to try to stop the joints from freezing up. Martin learned that Jaime had not exercised during the time when his hips became ossified. Therefore - at a stage when Martin's hips had almost no movement left - he set about exercising to bring back flexibility. Every morning his hips were so stiff he could barely move them. But he would diligently exercise for an hour or more to recover lost range of motion.

First, Martin would brace his feet against the wall and pull on a rope for several minutes, until his hips started to bend. Then, he would sit on the edge of his cot, grasp first one knee and then the other, and steadily pull them toward his body.

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With his persistent exercise program, Martin managed, in time, to regain complete range of motion of his hips. Nevertheless, every morning his hips would partially "freeze up." For years, he had to keep up his morning exercise routine to maintain flexibility.

Martin's great strengths and weaknesses. In PROJIMO, Martin's presence was a mixed blessing. On the negative side, he had a violent temper which sometimes led to acts of physical violence. He also used drugs (mainly marijuana) on the PROJIMO grounds, even though drug use was prohibited by group decision. He was also openly critical of weaknesses in the organization and its leadership, which caused his own errors to be less tolerated. (Eventually he was expelled.)

Martin was very friendly and helpful to some of the neediest disabled children at PROJIMO.

On the positive side, Martin developed into an extremely innovative and creative wheelchair builder. He solved design problems in the Whirlwind wheelchair that disability engineer Ralf Hotchkiss had struggled with for years (such as a very simple mechanism to adjust the angle of the footrests).

Ralf was so impressed with Martin's abilities that he invited him to live in his home and to work in his shop for a number of months. Martin even became a teaching assistant in Ralf's course in rehabilitation design and engineering at San Francisco State University, in California.

Also on the positive side, Martin was very friendly and helpful to some of the neediest disabled children at PROJIMO. Whenever they needed help with their aids or equipment, they went to Martin, who would always help them in a warm, personal, and effective way.

A Jointed Gurney for Post-Surgery Recovery

Martin was sometimes too active and hard working for his own good. He had begun to use a wheelchair before the last pressure sore on his backside had healed. As a result, the sore - although it had healed except for a small opening on the surface - had formed a large and stubborn cavity underneath. Periodically this cavity became infected. Surgeons from Interplast (International Plastic Surgery) who examined Martin decided he needed surgery to repair the deep sore. They offered to do the operation free of charge, in Stanford, California.

Martin's biggest worry was the post-operative period. The surgeons told him he would need to lie on a special "air bed" for 6 weeks, to allow healing. But Martin - who knows his own body well - feared his hips would freeze up forever if he lay flat for so long and could not do his daily bending exercises. In order to maintain flexibility, he felt that during the post-surgery period he needed to be positioned at different and changing hip angles. He told the surgeons he could make a jointed gurney with adjustable hip and knee angles to use post-operatively. But the surgeons were skeptical.

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The surgeons doubted that Martin could make a satisfactory gurney. And if he did, they doubted that he would be able to lie on it face down all day long.

But Martin was persistent. The doctors decided to test him. They insisted that he spend three days and nights continuously on the gurney, to prove that he could do it without complications. Martin did this successfully, and the doctors at last agreed to let him use the gurney following surgery, instead of being on the special hospital bed.

Excellent results. To the doctors' amazement, on his jointed gurney Martin's post-operative recovery went remarkably quickly and well. They observed that Martin was very active on the gurney. They agreed that such activity increased blood circulation, which probably speeded surgical healing. (This finding is consistent with other observations by the PROJIMO team on the healing of pressure sores, after surgery and otherwise. See "Medical Treatment of Osvaldo's Pressure Sores," page 252.)

Martin trying out his new gurney

THE GURNEY

The flexible gurney that Martin made for his post-surgical recovery period was built on top of a standard donated wheelchair. The hip and knee angles could be easily adjusted by hand. He upholstered each section of the gurney with water-resistant vinyl (plastic cloth).

3 of the many different positions

The above photos show Martin trying out his new gurney, and the gurney alone in 3 of the many different positions to which it can be adjusted.

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Different Kinds of Jointed Gurneys

Other jointed gurneys have been custom-built at PROJIMO and used by persons with a variety of needs. Here is a gurney for a boy, DANIEL, who is paraplegic due to tuberculosis of his spine. When Daniel came to PROJIMO, his body, hips and knees were contracted in a sitting position, and he had severe pressure sores. Therefore, the team built for him an adjustable, jointed gurney that could gradually straighten him out.

The team built for Daniel an adjustable, jointed gurney that could gradually straighten him out. The gurney has a hole in it through which the boy can pass urine - with or without a catheter - into a bag or bottle.

The gurney has a hole in it through which the boy can pass urine - with or without a catheter - into a bag or bottle. (Spinal-cord injured persons usually lack urine control. See page 147.)

In contrast, the next chapter describes a jointed gurney that was built for a boy (Osvaldo) to gradually bend his hips and knees, which had stiffened in an extended (straight) position.

Additional information on designs for wheeled cots or gurneys can be found in the book, Disabled Village Children. Also see the next chapter, pages 246-248.

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Nothing About Us Without Us
Developing Innovative Technologies
For, By and With Disabled Persons
by David Werner

Published by
HealthWrights
Workgroup for People's Health and Rights
Post Office Box 1344
Palo Alto, CA 94302, USA