Dear Listserve members,
The following is my original post and a summary of the responses.
Thanks again to all who responded and took the time to share their experiences and suggestions. This is a great example of the listserve working as intended!
Here is an unusual one: I have a 60 year old female client who has left side weakness due to polio at an early age. She wears a left KAFO and has a
paralyzed left upper extremity. Last week I saw her for a follow-up to her KAFO
and she asked if I could provide a shoulder cap so that her clothes would fit right. The polio has resulte in left shoulder and upper arm atrophy and her clothes don’t fit well. She said that she has tried the shoulder pads that come with some of the women’s outfits, but that these slip out of place and don’t do the job. She asked me to make a latex shoulder cap that she could wear and would make the left side of her clothes fit like they are supposed to do (match the right side.)
I have some ideas and have discussed these with her, but I suggested that I post her concerns and needs to the listserve and see if we could gather any ideas from the collective wisdom and experience of the profession before we come up with a plan. So, does anyone have any suggestions? Thanks in advance for your responses. I will post summaries. Keever Wallace, CO
Have made very lightweight soft foam shoulder caps in the past. Easy to make and adjust…inexpensive.
Hi, I used to make up littler shoulder pads pedelin covered inside and out with 3 mm pelite for forequarter patients who did not want to wear a limb but wanted their clothes to sit correctly……I feel in your case you may have an issue with arm lenths if the shoulder is subluxing….ie the upper shoulder profile looks correct as a match with the pad in place, but the arm hangs low and so it will hang out of the sleeve and hence these may need lengthening.
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Cast over shoulder and shape a 3mm liner over the surface of the positive to contact the shoulder.
Mix up and foam up over the lining. when hard buff to shape….wit clothes on as well as off.
Heat and mould a finishing 3mm layer over the top and use velcro onto a tee shirt to fix in place.
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You are opening a potential hornets nest, cosmesis is all in the eyes of the beholder or as in this case the wearer, not the provider.
It can be done, but will never pay you back for the energy invested.
A simple piece of foam carved with an electric carving knife is the simplest place to start, then with a rubber cement you can lay on a piece of stockinette cut open and laid flat. Sprinkle some talc on it to catch any bleed through of the cement. Do a simple stitch around the edges of the prosthesis and leave about 3/4″ of excess material. Let a seamstress come up with a set of small snaps to hold it in place in her clothes, your suspension straps with give you more aggravation than making the prosthesis.
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I have made a similar shoulder cap for a brachial plexus client. I first molded 1/8 “pelite to the shoulder (because of extensive scarring) then fabricated the cap with plastazote and slipped it into a coutil material cover (similar to a pillowcase principle) with elastic and velcro straps.
It was fiddly – but worth it.
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I have done this in the past. The best choice is to cast both the involved and non involved sides. Use a plumb line and transfer this to the plaster impression prior to removal. Fill the mold and level the cast sagital/coronal planes, figure the amount of filler material necessary for symmetry and outline with indelelble. Place another plaster mold over the areas marked and make a rigid shell thermoplastic or laminate. I have used Bock foam material and custom shaped. I then cover the foam with flesh tone stockinette.
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A while back, while I was working at the Hittenberger office in San Francisco, I had a client who had a similar problem. He had a vest made with padding to compensate for the atrophy. With a shirt on, it was unnoticeable. He had gone to a tailor in China Town and had it custom made in the 70’s. He had come into the office to see if technology had come up with anything better.
Alas, it has not.
The advantage he had, was he could machine wash his garment. Repair it with sewing needle and thread.
The disadvantage was the heat of the item. It was like wearing a down vest all day long.
He had tried everything, from foams to polyfil. but he kept going back to batten, a cotton fluff.
the whole thing was made of linen over batten
********************************* Have you tried using an inexpensive breast prosthesis form and attaching it on her body directly with an adhesive product like It Stays? She might even try that with shoulder pads first and save you all alot of money. The Camp and Coloplast companies sell foam breasts in many shapes and sizes and configurations and if you guys don’t do mastectomy stuff – send her to someone who does personal and creative fittings and they will be able to help her.
