Coccydenia - Assistive Technology Devices - Essay Example

Coccydenia - Assistive Technology Devices (present and not present). What can be done to advance diagnosing and especially the treatment of Tail bonepain/ Coccydenia Abstract Assistive Technology (AT) Devices are equipments or product system, items acquired either commercially, modified, or customized, and that are used to increase, maintain, or improve functional capabilities of individuals with coccydenia or any other disabilities. They are designed as per the requirements of coccydenia patient and are user friendly to provide maximum comfort to the patient. These AT devices are available at varied costs and modifications, patient can acquire one based on the financial condition and also the console he gets from it. By adopting these AT devices, day-to-day activities, both professional and personal are not hampered. The article presents an insight about the AT devices for coccydenia patient to make them self reliant and confident to execute their routine tasks in a normal way. Introduction Coccydenia or coccygodynia is pain in the area of the coccyx (tailbone). It is also known as "tailbone pain", coccygeal pain, coccyx pain, coccaglia. Medically it is recognized as an inflammation of the tailbone or coccyx, a hollow region present between the buttocks. It is a discomfort or acute pain in the coccyx, this pain varies from mild to extreme. There are various factors that trigger the onset of Coccydenia, an injury or trauma to the coccyx; injury may extend to severe bruising, dislocation, fracture of the coccyx, or other factors like constant sitting posture, fall, childbirth, repetitive strain, surgery or due to journey discomfort. The reason could be any one of these but the condition is extremely painful. The pain can disappear on its own, lasting only for a short span or may require treatment if it persist for year(s) (What is Coccydenia). It is unfortunate that inspite of the fact that it is painful inflammation, common coccygodynia or Coccydenia is poorly understood. In order o understand the origin of the syndrome, along with pain in pericoccygeal soft tissue, spasm of the muscles of the pelvic floor, referred pain from the lumbar pathology, arachnoiditis of the lower sacral nerve roots, local posttraumatic lesions, somtization etc (Howorth 1959, Nelson 1991, Postacchini & Massobrio 1983, Stern 1967). It is therefore no specific reason of coccydenia has come up. In most of the reported cases it is often associated with the fall on buttocks or a delivery as precipitating event or is associated with the constant sitting position. The victims may feel pain due to movement from constant sitting to standing position. It is also reported that sufferers feel pain when sitting on a hard, unyielding surface for too long. Other aspects encompassing coccydenia are deep pain in the tailbone region, pain during bowel movements or sex and development of sensitivity to pressure on the back especially buttocks along with shooting pain moving down the leg similar to sciatica (What is coccydynia, its symptoms and cure). These aspects have enabled Maigne et al, (1992, 1994) to develop a protocol to document the painful coccyx with dynamic films and coccygeal discography. Dynamic films are characterized as X-ray films in the lateral sitting position (the painful position) and they are compared with the standard lateral roentgenograms. The percentage is more in females as compared to males due to anatomical reasons. In females the pelvis leaves the coccyx more exposed causing chronic inflammation. Gray (1973) has defined sacrococcygeal joints as thin intervertebral discs of fibrocartilage. The intercoccygeal joints are synovial infrequently. There are various speculations reported about the sacrococcygeal joint, it is disc, a synovial joint, an extensive cleft, with a frame of annual fibers or synovial cells (Maigne et al, 1992). In some patients ossification of coccyx was reported (Saluja, 1988). Coccyx depicts the flexion and extension physiological movements. Active flexion is the movement in the forward direction, performed with the co-ordination of levator ani and the sphincter ani externus muscles. Extension is the movement in a backward direction, it is due to relaxation of levator ani and the sphincter ani externus muscles, and it is also attributed to the increased intra-abdominal pressure which occurs during the passive movements of defecation and parturition (Smout 1969). Various intervening factors responsible for coccydenia are (a) The angle between the sacrum and the coccyx (an acute angle makes the coccyx prone to flex, a flat angle makes it more prone to extend). (b) The sagittal pelvic rotation when sitting (a high degree of pelvic rotation when sitting brings the coccyx parallel to the seat, leading to flexion, a low rotation let it more or less vertical, prone to extension). (c) The body mass index (BMI) is closely related to the pelvic rotation (d) the angle of coccygeal incidence, which is also related to the pelvic rotation (Maigne, 1996). Considering the anatomical and physiological aspects of coccydenia, Maigne et al have developed a protocol to understand the pain of coccyx with the aid of dynamic films (or X-ray films in lateral sitting positions and compared with standard lateral roentgenograms) and coccygeal discography (Maigne, 1996). Technique of Dynamic/ X-ray films A comparative study was performed between a "standard film" and a "dynamic film". In the standard film the X-ray of lateral standing position is performed. In this posture the coccyx is in a neutral position. Prior to the X-ray the patient must avoid sitting for at least 5-10 minutes, as in the case of hypermobility or luxation, time may not be sufficient for coccyx to come back into the neutral position. This is must to have a comparison with the dynamic film which is an X-ray taken, by making a patient sit on a hard stool in a position which encounters prominent pain. Both these films are then superimposed to have a comparative account of movement of the coccyx. The degree of flexion or extension is recorded (Maigne, 1994). Patients suffering from coccydenia show variation from the normal control individuals these are summarized in the table. It is also evident that higher Body Mass index (BMI) is also responsible for the coccydenia. Studies Control Patient Number 47 320 BMI Lower Higher Mean mobility (flexion or extension) 9.35.7 15-25 Luxation and Subluxation No effect Affects sacrococcygeal disc and intercoccygeal disc Hypermobility (always in flexion) 0-25 Flexion of coccyx 25-70 Coccygeal spicule: An abnormality in the manner of a small bony outgrowth on the dorsal position of the tip of the coccyx this is termed as 'spicule'. It can be quickly palpated, protruding out under the skin may result in irritation on sitting. This could be fairly prudent, or may turn into retrococcygeal pilonidal sinus (without any discharge or abscess). It could be manifested to have embryonic origin. It is prevalent in non mobile coccyges, where pressure from the spicule makes the coccyx unable to take evasive action (Maigne, 1996). Coccyges without radiologic abnormality There could be some abnormality which is not detected radiologically, e.g. lesion and therefore a normal dynamic film is obtained, such condition represents the actual "idiopathic" coccydynia. This is related with (a) Intradiscal inflammation which respond to an intradiscal (coccygeal) injection (b) Chronic bursitis a pain is generally located at the tip, although spicule (c) Injection of the subcutaneous tissues with anaesthetic (d) pain located in sacral insertion of sacrotuberous ligament (e) Psychogenic pain (f) The research data depicts that sacroiliac joint or lumbosacral area is considered as the possible origin of coccydenia (Maigne, 1994). Diagnosis: Medical trials have shown that coccydynia can be cured eventually in the great majority of cases, given the right treatment at right time. X-rays, CAT scans, MRI scans and colonoscopy may be used for the diagnosis of coccydenia. Palpation over the coccygeal area demonstrates tenderness corresponding precisely to the 'pathologic' level (i.e. coccygeal disc). When there is no obvious lesion on the radiological films, meticulous palpation is the only option to detect the tender level of coccydenia (Maigne, 1994). Treatment of common coccygodynia Manual treatments The foremost treatment of the coccyx is massages of the pelvic muscles (levator ani or piriformis). This encompass mobilizations of the coccyx in circumduction or stretching of the coccyx along with the associated musculature or with the rectal finger. A comparison was made in three sessions of coccygeal manipulations vs. massages of the Levator Ani (20 patients each, all without any previous local treatment, after oral consent), with a six-month record. An assessment was made by an independent observer using a verbal scale and a clinical check. The observer was not informed about the radiological assessments. Only 5% of the cases could be completely relieved at six months (Maigne, 1994). Intradisc injection under fluoroscopy In a recent study, it has been established that patients with luxation or hypermobility were better responders to a local intradiscal corticosteroid injection than patients with normal coccyges. After the duration of about two months following the injection, 65% of the patients with luxation or hypermobility were improved or healed, whereas only 27% of the patients with normal coccyges improved (Maigne, 1996).. The technique of coccygeal discography is uncomplicated and easy. In this process the patient is posed to lie on his/her left side with the hips flexed. The first step is the disinfection of the skin. This is done carefully to avoid establishment of any infection. The whole process is carried out under aseptic condition. Every disc or synovial joint is entered with a 25g, 25 mm needle under using a posterior approach through the midline, to evade minor blood vessels. A small amount of dye is used to control the position of the needle and a steroid. In a week time the effect of the injection can be seen. Under the condition of partial relief, another injection can be given in a month's duration (Maigne, 1996). Surgical Coccygectomy Coccygectomy is used in the treatment of coccydenia; however, indications for surgery may turn out to be vague, inconsistent, and based upon subjective evaluation. It provides an explanation for its present and not present nature for the treatment of coccydenia. It is therefore, this technique Coccygectomy is a controversial subject. In some cases positive results are obtained whereas in others negative results are obtained. According to Pyper 'there is no stable factor in the history, no reliable physical sign, and no specific radiographic transformation that can be regarded as a definite parameter to opt for surgery. (Pyper, 1957). Radiological instability of the coccyx (intermittent luxation, or hypermobility of the coccyx) can be documented. 37 patients with chronic coccygodynia are admitted due to coccygeal instability (intermittent luxation, or hypermobility). These patients could not gain any relief form conservative treatment, and not involved in litigation. Operation was carried out and patients were followed up for a minimum of two years after coccygectomy, with independent assessment at two years. Of these 91 % cases were in excellent condition, only 11 of the 37 patients were good and 3 were in poor condition. This marks the success of the technique. There were 23 excellent and eleven good (91%), and three poor results. When improvement is slow to appear, Amitriptyline, was prescribed. It provides a psychological implications on the patient and hence mark the success of the technique (Maigne, 1996). Assistive Technology Devices for Coccydenia Necessisity is the mother of invention. Apart from all the above mentioned methodology there are various options which are available to keep concern with the coccydenia patient. These Assistive Technology or AT encompass assistive, adaptive and rehabilitative devices for people with coccydenia or any similar disabilities. According to The Technology-Related Assistance for Individuals with Disabilities Act of 1988 (US Public Law 100-407) "Technology designed to be utilized in an assistive technology device or assistive technology service". These are certain equipments promoting greater independence by enabling coccydenia patients or people suffering from related disorders to carryout tasks which otherwise was impossible to be accomplished or they had enormous difficulty in undertaking. AT provides enhancement in the methodologies for making the already existing technology more user friendly and capable of providing comfort to the patient (Rose, 2000). It is rewarding to use AT devices and good and accessible design is universal design. For the coccydenia patient it is difficult to walk and sit for longer duration so equipments like computer with their peripheral devices for editing, spell checking and speech synthesis software are well accepted. These aids reduce their sitting time and hence provide relief to the patient (Rose, 2000). In the modern era, computer is becoming the most dependable source of information and communication. It not only enhances the speed, quality and perfection in the work but keep us connected with the entire world. People in computer profession or otherwise those who operate computer for longer duration are highly susceptible to coccydenia, it is therefore essential for them to adopt ergonomic accessories especially with height-adjustable furniture, foot-rests, wrist rests and arm supports to ascertain correct sitting position and body posture. The keyboard can have key guards to prevent key presses. They can have expanded keyboards with larger, more widely spaced keys. Moreover, coccydenia patients can have trackballs, joysticks, graphic tablets, touchpads, touch screens, speech recognition softwares, switch access in their computer system to provide comfort to the spine and hence to the coccyx. There are certain other devices like stick keys or commands to be typed without holding a modifier and also clicklock software programs, toggle keys, spell checkers and grammar checkers are various user friendly devices, can be adopted to minimize pressure of work and hence strain on coccyx (Rose, 2000). Apart from computer devices there are various medical equipments called as Durable Medical Equipment (DME) which promote and advocates seating products to provide sit comfort. The devices can be innovated as per the needs of the patient incorporated with cushions and therapeutics seats. Along with this, since the coccydenia patient encounter difficulty in standing also so equipments like standing frame, standing wheelchair are made o support people with disabilities in the standing position. Also walking products are available to help people walk or stand with assistance. With the recent advances in Science and Technology, Robotics are playing crucial role in assisting the people with disabilities (Rose, 2000). Other aid for coccydenia patients is in the form of Painwave X4000 which is known to relive pain. It is based on bio-electromagnetic ecosystem. For this technique, no side effects have been reported so far (What is coccydynia, its symptoms and cure). It has been observed that sedentary life style is becoming prevalent in the present scenario and hence people are more prone to coccydenia. More emphasis is laid on adopting means that keep pace with their routine life style and demanding competition. For this they have choice of adopting: Spongy wonder bike seats- it is an innovation. These are special bikes with especially designed seats to eliminate all damaging and irritating pressures related with the spine and especially with coccydenia. These seats are scientifically designed and are available in four different models: MK6 (cost = $72) incorporated with small foam pads to provide comfort while riding and is for riders up to 170 pounds; MK7 (cost = $ 72) incorporated with large foam pads, for riders between 170 and 220 pounds; MK9 is spongy wonder bicycle saddle, they are easy on dirt roads and are high performance bikes. Rough terrain puts pressure on the seat and coccyx therefore, MK9 A (cost = $123.00) and MK9 B ($ 123.00) are designed for providing comfort and high quality performance for off roads also. They come along with the covers to provide support to the seat and hence the sitting posture. They can be purchased to minimize the pain caused by the coccyx inflammation (Spongy Wonder Bike Seats). It is very essential to have a comfortable working place where one can work with concentration to provide dedication to the work without ailments. Research has been carried out not only to eliminate the sufferings but also in the direction to provide a good working atmosphere in the form of seats at the work place. These seats are especially designed to minimize sufferings of the individuals. They are in the form of desk and work stations like sit/stand shelf for computer; sit/stand workstation; sit/stand keyboard tray and computer shelf. In UK employers could get funding towards furniture to help the employees work with peace. Arrangement is also made in the form of a mini bed to lying around in the office. It not only provides comfort to the back but also enables the patient to work while in the lying position. It is adjustable as per the requirement (Work). The lever underneath the chair/table can be locked and unlocked to fix the position or change the position as per the requirement. It is not only the sitting position or standing position that matters in the office or work place. A person may work with various equipments also. For this, position of the equipments must be maintained at particular level and they can be placed on stands or at particular angles to provide convenience in operation (Work). Insurance on Assistive Technology Devices Insurance provides aids at the time of need. Various Private Insurance companies are coming forward to provide help in AT but not reports are available to report authentically about the insurance policy available for AT. One of the resources available from Medicaid program provides insurance on assistive technology. It is evident that assistive technology can be covered as "durable medical equipment" and is incorporated under "home health care services" (Allen, J.). Conclusion The paper concludes with highlighting the difficulties in understanding the coccydenia as there is no specific cause of the disease. The physician is required to take the history of the patient along with the working condition incase when a patient approaches him with severe back pain. Common coccydynia is related to coccygeal instability in almost half of the cases. The diagnosis should be documented with dynamic X-ray films to evidence luxation and hypermobility, which may need specific treatments. All the treatment encompasses simple and easy methodologies and is easy to adopt to overcome sufferings and pain. Along with the treatment there are various resources available to in the form of sitting comfort, driving comfort, sleeping comfort and also for the work comfort. It is becoming evident that in the modern lifestyles most of the people have sedentary life. Knowing the implications of the pain and its causes one has to take utmost care to avoid such situation by adopting essential measures to make a comfortable and healthy sitting arrangements at workplace and at home. Moreover proper exercise and dietary habits must be avoided to keep a check on the BMI. Bibliography 1. What is coccydynia, its symptoms and cure http://www.merinews.com/catFull.jsparticleID=142329 [Accessed on 15th April 2009]. 2. What is Coccydenia http://www.coccyx.org/whatisit/index.htm [Accessed on 15th April 2009]. 3. Spongy Wonder Bike Seats http://www.spongywonder.com/ [Accessed on 15th April 2009]. 4. Work http://www.coccyx.org/coping/work.htm [Accessed on 15th April 2009]. 5. Allen, J., Private Insurance Medicaid and Assistive Technology: Where are we headed http://www.resnaprojects.org/nattap/goals/other/healthcare/medicaid.html [Accessed on 16th April 2009]. 6. Gray, H. (1973). Gray's Anatomy, 35th ed. Longman, Edinburgh 7. Howorth, B. (1959). The painful coccyx. Clinical Orthopedics, 14, 145-150 8. Maigne, J. Y, Guedj, S, Straus, C. (1994). Idiopathic Coccygodynia : Lateral Roentgenograms in the Sitting Position and Coccygeal Discography. Spine, 19, 930-934. 9. Maigne, J. 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G. (1988). The incidence of ossification of the sacrococcygeal joint. Journal of Anatomy, 156, 11-15 16. Stern, F. H. (1967). Idiopathic coccygodynia among the geriatric population. Journal of the American Geriatric Society, 15, 100-102 17. Smout, C. F., Jacoby, F., Lillie, E. W., (1969) Gynaecological and Obstetrical Anatomy, 12th edn. Oxford University Press, Oxford Read More