One severely involved patient (fig. 153) came to us after a thresher accident at her family's farm resulted in multilateral deficiencies. Following traumatic amputation and subsequent treatment of infections, this 19-year-old patient eventually stabilized after undergoing a right hemipelvectomy, left hip disarticulation with ischial bone removal, right shoulder disarticulation, and left forequarter and clavicular amputation. Her upper body result was considered particularly unfortunate, as the patient reported being left-handed before her accident.

At her family's insistence, aggressive prosthetic intervention was prescribed almost immediately upon the patient's recovery, so that she could return to work at the family farm in some capacity.

Her upper body was fitted first, with a cutting-edge bilateral shoulder disarticulation prosthesis with chest and back straps, constant-friction shoulder joints, elbow locks with nudge controls, constant-friction elbow turntables and wrist units, wrist-flexion units, forearm-flexion assists, and 99X hooks. Previous attempts at such prosthetic units for other patients had included a thigh cuff to provide a more stable reaction for the control cables, but due to this patient's total lack of thighs, this was obviously not an option. Therefore the prosthesis was reinforced with a full pectoral girdle, with cutouts for the patient's well-developed chest, which was thankfully unaffected by the accident; and additional chin nudge controls were added.

Several lower-body fittings were attempted, including a wheeled bucket that could be pushed around with crutches; a pelvic platform with a molded leather socket, short pylons and SACH feet; and a Canadian Hip Disarticulation unit with a split socket, free knee joints, hip flexion control straps and solid ankle feet. These were rejected due to difficulty of use, and insufficient height to allow the patient to return to her assigned duties at home.

Eventually, a state-of-the-art unit was tested, consisting of a pelvic bucket with gyroscopically-balanced exoskeletal legs, operable with a swing-through gait. Size six foot shells were attached so that the patient could wear her existing shoes, and have many options for heels and other feminine footwear for special occasions. Energy expenditure to operate these legs was extraordinarily high, but the patient was advised that it would help her maintain a consistent weight and increase her odds of finding a suitable partner as she grows older.

After several months of intense training, despite steady progress, this patient frequently complained about the weight and difficulty of her new limbs, often becoming belligerent and combative. An intense psychological evaluation of her irrational behavior was performed, and the patient was diagnosed with Female Hysteria. After a prescription of Valium and mood-enhancing medications, and the addition of locking mechanisms to prevent her from doffing her prostheses herself, this patient became much more cooperative.

The patient has now happily returned home and is proudly contributing once again, performing many of her old chores in modified ways. She recently returned to the clinic to be fitted with special terminal devices for cow milking and horse fertilization assistance, eager to broaden her horizons.

EDITORS NOTE: To offset some of the costs of her therapy, patient has agreed to have her likeness used for the cover of this year's publication. Some minor airbrushing techniques were used to enhance her appearance. See attached submission.