Pediatric Prosthetics PDF

Pediatric Prosthetics Rehabilitation for Children with Limb Deficiencies (Rehabilitation for Prostheses) Goal: facilitate normal development sequence & prevent the onset of secondary impairments. Secondary impairments and functional limitations such as contractures, weakness, and dependence in self-...

Pediatric Prosthetics Rehabilitation for Children with Limb Deficiencies (Rehabilitation for Prostheses) Goal: facilitate normal development sequence & prevent the onset of secondary impairments. Secondary impairments and functional limitations such as contractures, weakness, and dependence in self-care. Habilitation: care of an infant born with a limb deficiency Rehabilitation: care of a child who undergoes an amputation due to trauma/disease ISPO Classifications of Limb Deficiency ​ Transverse - no skeletal elements exist below the level of normal development ​ Longitudinal - reduction or absence of elements is present within the long axis of the bone, with normal skeletal elements distal. Old language: Phocomelia - distal segments of limbs attached to torso Amelia - complete absence of a limb Hemimelia - partial absence of a limb Etiology - Congenital (73%), Amputations (27% - cancer 9%, trauma 8%, infection 4%, and other 6%) -​ In congenital limb deficiencies, a transverse deficiency of the left upper limb is most common -​ Osteosarcoma or Ewing's sarcoma of the lower limb or pelvis are the most common pediatric cancers. Children with limb deficiencies tend to have lower energy output than unaffected kids their age due to the energy demands of prosthesis use. Growth, Children typically need a new prosthesis every: ​ Preschool age - 1 year ​ Grade school age - 12-18 months ​ Teens - 18-24 months As children grow, the genu varum seen in infancy shifts to genu valgum by 3 years of age. Boney overgrowth is especially common during growth spurts. Growth prosthetic strategies: thicker socks, thicker liners and distal end pads, pelite liners, adjustable componentry etc Pediatric outcome measures: Pediatric prehension assessment - for children with TR Prosthetic upper extremity index (parents and older children) Prosthetic Goals by Age Group Upper Extremity Infants Increase: -​ Comfort in the prosthesis -​ Wearing tolerance -​ Ability to clasp large objects -​ Ability to use prosthesis to aid in sitting and crawling -​ Typically not fit until at least 6 months of age (fit to sit). Initial fitting after 2 years results in a higher rejection rate. -​ 1st prosthesis: usually passive with a hook or passive mitt, Maybe a VO hook so that parents can place an object for the baby to hold Toddlers: control cables may be added to the prosthesis between 15-18 months Increase: -​ Control of TD -​ Control of elbow unit -​ Use of prosthesis in bimanual prehension -​ Use of prosthesis for functional activities -​ Children who are at least 3 years old have an easier time learning to contract appropriate flexors or extensors to close and open a myoelectric TD. Prosthetic activities for the toddler should include eating, drinking, dressing, and managing crayons and other writing implements. Three-year-olds blow soap bubbles, pull up pants, pull a belt through loops in pants, and fill a cup with water from a spigot. School Age Children -​ Maintain proper prosthetic fit -​ Grasp firm and fragile objects without dropping or crushing them (4 year olds) -​ Reliably open and close TD -​ Don/doff independently -​ Dress independently -​ Recognize when prosthesis needs repair or alterations Four-year-olds can pour from containers, peel a banana, sharpen a pencil with a hand-held sharpener, sew, hammer nails, and apply adhesive bandages (Figure 29-9). The average 5-year-old can open a milk container and sweep with a brush and dust pan. The 5-year-old should be independent in dressing, except for buttons, shoelaces, and pullover shirts and sweaters. Lower Limb Infants Facilitate: -​ Comfort in the prosthesis -​ Wearing tolerance -​ Ability to stand leaning against table  -​ Ability to cruise along furniture -​ Ability to walk with ot without support from support toys -​ Fit around 6 months of age for pull to stand activities, fitting before this time might hinder a babies effort to turn from prone to supine and back again 1st prosthesis - solid ankle, SACH foot, locked knee or polycentric if TF -​ By 3 years, unlocked knee. 4 bar common as CoRR is posterior in stance (stable) and anterior in swing which helps with clearance. The initial TT prosthesis usually has a thigh corset Toddler -​ Full time wear, except bathing and sleeping -​ Use of prosthesis in age appropriate ambulatory activities -​ Base of support starts to narrow -​ At 15 months, heel toe replaces flat foot gait. -​ Running between 2-4 years old The flight phase (double float), the period when both feet are off the ground, occurs by strong application of propulsive force during late stance. The prosthetic foot offers much less energy storage and release compared with the gastrocnemius. Consequently, the child with a prosthesis adopts an asymmetric running gait that emphasizes propulsion on the sound side. -​ Children rarely use parallel bars, walkers, or harness as falling is part of their natural discovery and not detrimental to them. The 3-year-old will probably leap, jump, gallop, climb stairs step over step, and ride a tricycle. School Age Children -​ 4 years - descend stairs step over step, ride a bike, roller skate -​ 5 years - skip rope, dodge ball -​ 6 years - most children can don and doff their prosthesis independently Rehab goals: -​ Monitor and maintain proper prosthetic fit -​ Inspect the skin -​ don/doff independently -​ Dress independently -​ Engaging in a range of different activities with the prosthesis -​ Recognizing when it needs repairs or alterations Children who undergo lower-limb amputation after 5 years may respond favorably to balance and gait training similar to that appropriate for adults. Milestones 1: 1-2: hug or hold things with both hands 2-3: 3 months attempt bimanual prehension, bringing objects to mouth 3-4: props up on forearms, shifts weight to reach, one hand stabilizes toy and one hand manipulates the object 5-6: crawling, transfer toys from one hand to another 6 months - generally optimal for upper extremity prosthesis fitting 6-7: 7-8: sits with support, bimanual grasp 8-9: stands with help, sits unsupported, pulls to kneel/stand, most babies can sit and manipulate objects with both hands, 9-10: creeps, quadruped position, cruises along furniture 11: walks when led ,, stands alone 12: pulls to stand independently , walks alone 13: climbs steps 14: stands independently 15: walks independently, use a crayon to scribble or spoon for feeding A 2-year-old with transhumeral amputation may have a prosthesis with an elbow unit, although mastery of the elbow-locking cable is unlikely to occur before the third birthday. Strategies to self-manage donning and doffing the prosthesis can be introduced to children as young as 3 years. They find removing the prosthesis easier than applying it. Remember Children are not just little adults. You must consider their families, self-esteem, milestones, and short attention spans. They have different considerations for prosthetic prescriptions based on their activity level, build height, suspension options, maturity & responsibility levels, prosthesis weight & durability. Paediatric Gait Generally, as walking skill improves, balance control improves, and movements become less variable The process of gait maturation is generally complete between 5-8 years, and coincides with the development of adult joint profiles. Supported walkers (push toys, holding hands, etc): -​ Slower walking speed -​ Shorter single support phase -​ Shorter stride length -​ Increased lateral stability -​ Longer stance phase -​ Increase base of support -​ Head and eyes downcast Independent Walkers: -​ Step length increases -​ Single support occupies more than -​ Base of support narrows stance phase -​ Average walking velocity increases -​ Cadence increases