Below Elbow Child Amputee

[Music] the infant with a unilateral congenital limb deficiency normally develops patterns which compensate for the discrepancy in limb links this 10 month old girl who has not yet received her first prosthesis has achieved many developmental skills such as the ability to pull up to a standing position sitting balance is a prime criterion of readiness for prosthetic fitting this infant sitting balance is well established in addition she demonstrates other skills suggesting readiness such as the ability to grasp large toys with reasonable ease her creeping ability is well-developed even to the point of agility in handling toys she demonstrates skilful manipulative use of her stomp in general parents are encouraged to provide an environment which will stimulate the infant to make optimal use of the stump in preparation for beginning a prosthetic experience a practical consideration is to avoid dressing the infant in clothing which might limit freedom of movement active participation by the parents is indispensable to the child's progression toward the day when a prosthesis can be fitted once the infant has been fitted with a prosthesis it is expected that there will be a tendency to avoid inclusion of the extremity this is normal since there has been a lessening of the sense of touch and because some manipulative ability has been lost the tendency to ignore the prosthesis can be seen in this infant who has warned her prosthesis during waking hours for only three days the breast thesis while awkward at first will become a part of her developmental progression the role of the parents continues to be central parents are encouraged to place objects into the hook to stimulate the infant's awareness of its holding function although this infant now attempts to pull the object out of her hook she is beginning to be aware of the hooks holding function at this stage the prosthesis is used primarily in gross motions helping to clasp to manipulate objects and to support and balance the body following this period of adjustment to the first thesis the infant's performance and progress will be observed periodically and the prosthesis will be checked regularly for needed growth adjustments this two-year-old received his first prosthesis at 11 months of age during the last few months he has shown signs of readiness for introduction to the opening and closing of the hook which is possible through the use of a cable system for example he has become aware that the hook will hold objects and he has learned to open it with his sound hand and with his mouth his readiness for the addition of a cable is demonstrated by his awareness of the prehensile function of the hook and by his interest in toys and games for which prosthetic pretension would be beneficial in addition his attention span is of reasonable length and he shows readiness to accept simple directions from the therapist finally he is become increasingly spontaneous in including the prosthesis in his gross body activity although he will gain additional function after the control cable system is added he will continue to make spontaneous and appropriate use of the prosthesis is a non prehensile unit for many activities such as leaning on it for body support and using it to help clasp and manipulate objects a series of training sessions has begun immediately after the addition of the cable system and working with this two-year-old the therapist offers some manual assistance in moving the arm through the appropriate range of motion while doing so she points out to the child the effect this motion has on the hook humeral flexion causes it to open extending the arm permits the hook to close the amount of therapists assistance is gradually lessened as the child learns to operate the control system during this early period his active operation of the hook is accomplished in a gross and inefficient manner his sound hand is deprived of optimal use because he uses it to help operate the cable system he has not learned to stabilize his sound shoulder in order to provide the anchor or a reaction point for the control system he tends to maintain tension on the cable and therefore has difficulty in grasping and in maintaining his hold on objects he is not yet able to select suitable widths of hook opening for various sized objects nor does he know how to position objects of odd sizes and shapes so that they are held securely in the hook with appropriate assistance and supervised practice the young child is likely to gain enough function from the prosthesis to achieve satisfactory results for independent use in teaching the child to use the prosthesis as an assist or helper to the sound extremity activities such as handling a piece of paper are chosen this three-and-a-half-year-old has also learned to use the hook to hold the paper while her sound hand performs the more complex activity of cutting with scissors in training sessions activities have also been carefully selected for the purpose of teaching her to refine her operation of the cable in order that the hook may be skillfully controlled and dependable in use therapists and parents have the responsibility of stimulating the child's appropriate use of the prosthesis by encouraging activities which make its use beneficial to her this child has been encouraged to develop a problem-solving approach toward new activities so that she will become adept in your own methods of performance skill and spontaneity will come with experience and practice some outdoor activities in which the prosthesis is employed may appear to be quite hazardous but with normal precautions are actually safe children and their parents often require encouragement while acquiring the confidence to use the prosthesis freely in active play and sports holding the chain of a swing for example is an appropriate outdoor activity for parental function of the prosthesis non prehensile hooking action is used effectively in hanging and in swinging from a bar this boy uses the prosthesis for gross balance as he leans his bodyweight on the end to reach for a lost baseball he has also found the prosthesis to be very effective in handling a baseball bat although some children find they do not need it for this sport in some rough-and-tumble body contact sports such as football and wrestling it's quite appropriate for the prosthesis to be removed tossing and catching a volleyball is a sport which does not require prosthetic function but if the child has learned to include his prosthesis he will not have the bother of removing and reapplying it in trike riding balance and posture are aided by the prosthesis later in riding a two-wheel bicycle the prosthesis will provide additional stability and safety skill spontaneity and purposeful use of the prosthesis is largely the result of consistent prosthetic experience from infancy of training and selective assistance and of the opportunity to engage in a wide variety of activities commensurate with developmental age in addition the active support of the parents has immeasurable value in achieving a successful prosthetic experience [Music]