Reasons FOR upper extremity AMPUTATIONS
0-15 years
15-45 years: (typically in men)
Older than 60 years old
0-15 years
60% congenital
40% acquired: Trauma (power lawn mowers and ATV), CA, burns
15-45 years: (typically in men)
1st Trauma
2nd Tumor
Older than 60 years old
rare in patients who are older than 60 years,
but could happen secondary to tumor or medical disease.
UE amputations
60% congenital
40% acquired: Trauma (power lawn mowers and ATV), CA, burns
con·gen·i·tal = 1. (of a disease or physical condition) present from birth.
0-15 years
UE amputations
1st Trauma
2nd Tumor (important to know the signs and symptoms of osteosarcoma)
15-45 years: (typically in men)
UE amputations
could happen secondary to tumor or medical disease.
Older than 60 years old
terms with congenital UE loss
amelia
longitudinal deficiency or hemimelia
phocomelia
Loss of entire limb (amelia)
Loss of parts, such as fibula (longitudinal deficiency or hemimelia)
Loss of mid portion (phocomelia)
20%-30% - more than one limbs
congenital or aquired with peds UE loss
_______ complains of phantom pain or develop ulcers
Adapts more readily than adults
Have a growth factor to consider
rarely
*May have bony overgrowth due to the disproportionate growth of the bone over the soft tissues; may need bony excision; Most often - humerus, femur, tibia, fibula
UE loss of limb peds
Goals
Post Operative
Promote wound healing.
Usually not a problem in children
Volume stabilization (#2).
Usually not a problem with UE
-Shape residual limb
-Control edema
Increase strength, coordination, and endurance, ASAP
Decrease pain (#1).
Phantom pain seen in UE but not so much in children
-Desensitization
-Medications. Tricyclic for depression; opiates for pain; beta blockers for pain; antibiotics; NSAIDs
Restore function = Developmental activities in children
Promote wound healing.
Usually not a problem in children
Volume stabilization (#2).
Usually not a problem with UE
-Shape residual limb
-Control edema
Increase strength, coordination, and endurance, ASAP
Decrease pain (#1).
Phantom pain seen in UE but not so much in children
-Desensitization
-Medications. Tricyclic for depression; opiates for pain; beta blockers for pain; antibiotics; NSAIDs
Restore function = Developmental activities in children
post op care for UE limb loss
Post op Tests and measures for peds UE limb loss
Attention/cognition/emotion
Pain scale = FACES or FLACC
Anthropomorphic measurements
Wound assessment
Residual limb volume
Range of motion/muscle length
Joint integrity (look for symmetrical laxity) - in children we will get joint play because ligaments do not get taut like adults until puberty - symmetry more likely looking at
Muscle strength (WFL) = more likely rise from floor, step up steps
UE function
Play – The work of children Piaget Stages of Intellectual Development
years
0-2
2-7
7-12
12
0-2 = sensori motor stage = movement
2-7 = pre operational = pretending
7-12 = concrete operational stage = rules
12 = formal operational stage = competition
Sensori motor learning
learning through movement and the senses: Use toys. Be repetitive
Pre operational learning/thinking
pretending based on experience and imagination; egocentric. Around 4 they will follow rules, but the child is not logical
Concrete operational learning/thinking
can follow rules and understand how to play the game. Likes rules and repetition
Formal operational
will play competitively to win; logic, fairness, the roles of team members
Sensori motor stage
MOVEMENT
age?
0-2 years
pre operational stage
pretending
age?
2-7 years
Concrete operational stage
RULES
7-12 years
formal operational stage
competition
12 years
Gross Motor Skills
4 year old child
Begins to play __________; negotiates stairs
5 year old child
Can skip; begins to ride __________
6 year old child
Can _____ in patterns. Can gallop
7 year old child
Perform a __________; Coordinated movements UE/LE
10 year old child
Can throw and ______ a ball
12 year old child
Has the manipulation skills of an _______
4 year old child
Begins to play cooperatively; negotiates stairs
5 year old child
Can skip; begins to ride a 2-wheeled bike
6 year old child
Can hop in patterns. Can gallop
7 year old child
Perform a jumping jack; Coordinated movements UE/LE
10 year old child
Can throw and catch a ball
12 year old child
Has the manipulation skills of an adult ( why we wait until 16 to drive ;)
Intervention with UE limb loss (congenital or acquired loss)
1. Infancy & Toddler phase
Positioning (put them into shoulder____; elbow ______; forearm supination/pronation)
Stretching
Instructions about the care of the residual limb
Close monitoring of development
Positioning to maintain ROM in the joints
(put them into shoulder ER; elbow extension; forearm supination/pronation)
Stretching - soft tissue length to better use a prosthetic device
Instructions about the care of the residual limb
Close monitoring of development
Infant & Toddler Phase
Prosthetic fitting; coincides with normal growth & development:
LE - coincides with standing, cruising and walking (@ 8 to 10 months)
UE - a bit earlier to allow midline activities (bringing 2 hands together) & for creeping (@ 6 months), a PASSIVE prosthesis 1st
Child will require a new prostheses every ____ months.
Teenagers every ____ years.
Growth slows around 14-16 years for girls and 17 years of boys.
Longitudinal growth is more significant than girth.
Child will require a new prostheses every 12-18 months.
Teenagers every 2 years.
Growth slows around 14-16 years for girls and 17 years of boys.
Longitudinal growth is more significant than girth.
Infant & Toddler
Prosthetic training; donning, doffing, use of the device, wearing schedule & skin care
- For the UE:
Bimanual play activities & gross motor skills (e.g. pushing up to sit)
Operation of the TERMINAL DEVICE - not expected until _____ months (open the device, place objects in it, & release. Cause and effect)
Infant & Toddler
Prosthetic training; donning, doffing, use of the device, wearing schedule & skin care
- For the UE:
Bimanual play activities & gross motor skills
(e.g. pushing up to sit and quadruped and using prosthetic limb to stabilize while u manipulate with the other)
Operation of the terminal device - not expected until 18 months (open the device, place objects in it, & release. Cause and effect)
Myoelectric prosthesis
most successful, between _______ of age
most successful, between 3 & 5 yrs. of age
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3-6 years of age selected reading - timelines42
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6-12 the child19
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the adolescent 12-18 years6
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ICF domains, activities and participation12
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gestation23
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baby born, now what51
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last couple importance ones lecture 125
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movement key points11
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family centered / exam and eval77
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orthotics30
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questions i got had no idea about on exam14
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chapter 5 reading snippets41
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chapter 5 reading tests and measures and interventions ?14
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acute and op and caner and ped diagnosis36
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cancer types33
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cancer evals or whatevs23
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module 10 fitness in children35
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module 10 muscular dystrophy13
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module 10 obesity and CF and asthma35
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module 10 recap19
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module 9 early intervention under IDEA eligibility59
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module 9 down syndrome and others17
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module 9 spina bifida43
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Module 9 schools41
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module 9 schools 504 scoliosis and other stuff25
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week 8 module29
