Age at First Prosthetic Fitting and Later Functional Outcome in Children and Young Adults with Unilateral Congenital Below-Elbow Deficiency

Abstract

The objective of this study was to evaluate whether prosthetic fitting before the age of one year is associated with better outcomes in children with unilateral congenital below-elbow deficiency compared to children fitted after the age of one. Twenty subjects aged 6-21 years were recruited (five prosthetic users and 15 non-users). The Child Amputee Prosthetics Project-Prosthesis Satisfactory Inventory (CAPP-PSI) and the Prosthetic Upper Extremity Functional Index (PUFI) were used to assess patient satisfaction and functional use of the prosthesis. Videotapes were used to assess motor performance. Initial prosthetic fitting before one year of age was related to use of a prosthesis for at least four years. Age at first fitting was not associated with satisfaction with the prosthesis, functional use of the prosthesis or motor skills. Discrepancies between ease of performance with prosthesis and usefulness of the prosthesis as well as between capacity and performance of activities were found. The video assessments showed impaired movement adaptation to some tasks in six subjects. In conclusion, early prosthetic fitting seems to have a limited impact on prosthesis use during later stages of life.

Influence of standardized activities on validity of Assessment of Capacity for Myoelectric Control

“…This is in accordance with the findings of a previous study in which functionality among children with ULRD was evaluated [29]. Adaptation to the prosthesis often encourages the users to increase their wearing time [29][30]. This may stimulate the clients to use their prostheses in daily activities and hence achieve better myoelectric control, which can explain the difference related to wearing pattern.…”

Use and functioning of the affected limb in children with unilateral congenital below-elbow deficiency during infancy and preschool age: A longitudinal observational multiple case study

“…Many studies have been performed to evaluate functioning in daily life of children with UCBED with or without prosthesis [1,2,6,[15][16][17][18]. However, our study is the first with a longitudinal and observational design starting in infancy.…”

“…e l s e v i e r . c o m / l o c a t e / e a r l h u m d e v indicated that children with UCBED may show impaired adaptation of motor behaviour [6]. We therefore started a longitudinal observational multiple case study in order to explore how young children with UCBED use the affected limb during a standardized play session.…”

“…Activities of daily life were assessed with the Pediatric Evaluation of Disability Inventory. In addition we evaluated neurological condition, as the presence of minor neurological dysfunction is associated with an impaired capacity for adaptive motor behaviour [6].…”

Evaluation of important factors in accepts or reject of upper limb prosthesis in children

“…In Wagner study (2007) on 489 upper limb amputee, data from 110 subject who reject prosthesis use, showed that "58% had been fitted befor age 1years of age and 18% had been fitted between 1 and 2 years of age" because of uncomfortability and not help to function. In another study Huizing (2010) concluded that prosthetic fittingt before 1 years age, leading to a longer use of prosthesis (more than four years), but does not improve motor behavior [16]. Some study showed that children in certain phases of the life (for example maturation) trend to reject of prosthesis [5,9,18].…”