habilitatino
care of an infant born with a limb anomoly
rehabiliiation
management of an infant/child who undergoes amputation because of trauma
limb deficiency
designates both congenital and acquired limb absence
transverse deficiency
no skeletal element exists below level of normal development
Longitudinal deficiencies
a reduction or absence of elements is present within the long axis of the limb with normal skeletal elements usually present distal to the affected bone
stats for limb deficiencies
overall prevalence .7/1000 live births
genetic factors 30%
teratogens 4%
vascular disruption 35%
unknown 32%
Energy demands
using a prosthesis increases energy demands
need for physical condition
Need for prosthesis changes
- preschool child may need new prosthesis annually
- growth in addition to volume fluxuations
- endoskeletal facilitates easier lengthening
- girth changes accomodated with socks and flexible sockets
- signs of overgrown socket
- pistoning/slipping out of socket
- pain or skin reddening
- flesh roll over margin
- PT will see pt most often
- delays may develop scoliosis
Post OP Care
children heal faster with less edema
phantom sensations are less common in children
surgery will try to preserve growth plates to increase fit of prosthesis as adult
Factors to consider for patient care
parents are key
parents attitudes are key
parents should be present to learn
appointment scheduling with naps/snacks
short attention spans
Children with UE deficiency
children are very adaptable
prosthetic training should complement development
usually fitted around 6 mo
fitting before 2 yo decreases chances of rejection
babies are fitted with passive device
UE Prosthetic goals for infants and their parents
children
- comfort with device
- wearing tolerance
- clasp big objects
- usedevice to aid in sitting and crawling
Parents
- apply and remove prosthesis correctly
- care for skin
- care for device
- recognize and report problems to clinical team
UE Goals for toddlers and their parents
toddlers
- control of terminal device
- control of elbow unit
- use of device for bimanual prehension
- use of device for functional activities
parents
- provide toys that require bimanual prehension
- encourage use of device as AD
- inspect skin
UE Prosthetic goals for children of school age
children
- maintain proper fit
- grasp firm objects without dropping them
- open and close terminal device reliably
- don/doff device independently
- recognize problem with prosthesis for repair
parents
- encourage childs independence in ADLs and play
LE limb loss
- child not fitted w/ LE device until developmentally ready for it (pull to stand) 9 mo old
- with TF amputation - not given knee until 3yo
- usually get a SACH foot initially
- child will grow and need revisions often
- children often play through pain
- parents often want cosmesis over function
LE Goals for Prosthesis
Infants
- comfort with device
- wearing tolerance
- ability to stand by leaning against table
- ability to cruise around furniture
- ability to walk with and without support
for Parents
- apply and remove prosthesis
- care for skin
- care for device
- recognize and report problems
LE Prosthetic Goals for toddlers and parents
child
- full time wear or device
- use of device in age appropriate play
parents
- encourage use of device
- provide toys and equipment that require activities
- inspect skin etc
LE Goals for school aged and parents
Child
- monitor and maintain proper fit
- inspect skin
- don/doff device ind
- engage in full range of ambulatory activities with device
- recognize when device needs repair
parents
- encourage young persons independence
