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A broken leg isn't holding Brody back

Client profile

Brody is a nine year old boy who fractured his femur as a result of a falling off his dirt bike on the family property. He has had surgery to stabilise the fracture and is in plaster from his upper thigh to below his ankle.

He is currently in hospital, preparing for his discharge home to country NSW at the end of the week. Matt, the orthopaedic OT, is working with Brody and his parents to support Brody’s transport home from hospital in the family car.

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Step 1: Assess

Brody is a typically developing child with no previous health issues. He is 135 cm tall.

Brody is non weight bearing through his plastered left leg, and it needs to be elevated for as long as possible throughout the day and night.

Brody is learning to use crutches but is still unsteady, requiring close supervision. He is using a wheelchair, with a leg extension board so that his left leg is supported and elevated.

Brody lives with his parents and two younger siblings on a farm in rural NSW, located 2.5 hours from the hospital.

The family car is a 2018 Subaru Liberty. Brody typically travels in the back seat in an Australian standard booster seat next to his two siblings, aged 4 and 2, who both travel in Australian standard car seats.

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Step 2: Plan

Matt considers the information gathered during his assessment of Brody's transport needs and considers a few options in consultation with his family.

Option 1: Brody sits in the backseat using the vehicle's seatbelt with his legs positioned up across the backseat.

Option 2: Brody sits in the backseat using the vehicle's seatbelt, with the front seat pushed as far forward as possible to maximise leg room. A bean bag (in footwell) can be used to support his extended left leg.

Option 3: Brody sits in the front seat, with the seat reclined and pushed back as far as possible, with his left leg extended, supported by a bean bag in the footwell.

Matt discusses the options with Brody's parents and together they decide on option 3, as the family will all need to be able to travel in the vehicle together. Further the vehicle rear leg room was not sufficient for option 2 due to the length of Brody's plaster.

Matt advises the parents where to purchase a bean bag. Matt then arranges to trial option 3 with Brody, the physiotherapist and Brody’s parents, in the hospital car park. Brody manages the transfer into the front seat with support.

Matt and the physiotherapist work with Brody to help him practice his transfers on the ward – increasing his confidence in readiness for discharge.

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Step 3: Implement

Matt completes the Advice to Parent form and nominates a review period of six weeks.

As Brody is nine years old, he is legally able to travel in the front seat of the car. Therefore no medical certificate is required.

On the day of discharge, Matt accompanies the family to the car. The front seat is positioned as far back as possible to allow for maximum leg room and the seat back is reclined 20 degrees. The bean bag is placed in the footwell of the front passenger seat. Matt oversees Brody’s transfer from the wheelchair into the front passenger seat.

Matt also shows the family how to safely stow the wheelchair in the boot. The family then drive home.

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Step 4: Review

Six weeks later Brody returns to the hospital for the planned plaster removal.

After the plaster is removed, Matt assesses that Brody can return to his booster seat in the back seat, which is the safest way for a child of his size to travel. The front passenger seat is pushed forward to accommodate more leg room for Brody, until he can bend his knee fully.

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