Prescription of the First Prosthesis and Later use in Children with Congenital Unilateral Upper Limb Deficiency

Abstract

Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: ''prostheses, upper limb, upper extremity, arm and congenital''. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR ¼ 3.6, 95% CI 1.6 -8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.

Opinions of Youngsters with Congenital Below-Elbow Deficiency, and Those of Their Parents and Professionals Concerning Prosthetic Use and Rehabilitation Treatment

“…One may argue that the age of fitting the first prosthesis varies between the groups and might have had an influence on reporting reasons for prosthetic use. No clear proof exists in the literature regarding possible relationships between age of fitting and prosthetic use in later life [15], [16].…”

“…Advantages of early fitting with a prosthesis in children with UCBED are inconclusive in the literature [13]–[15] and are not associated with satisfaction with the prosthesis, functional use of the prosthesis, or motor skills [16].…”

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

“…Early prosthetic fitting may prevent other functions from taking over the cortical area that would normally control the limb, i.e., may result in larger primary neuronal networks involved in motor control of the limb than after prosthetic fitting later in life. [9][10][11] Ultimately, this might lead to a larger repertoire of motor strategies, better motor skills and therefore more satisfaction and functional use of the prosthesis.…”

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

“…In this regard it is essential for prosthetic designers to Re-evaluate of the real role of prosthesis for improve the quality of life according to the expectations of the children and age. It should be noted that the Prostheses only will be accepted by children when it is a real assistance to help them and improve quality of life [20] The prosthesis acceptance by the children and family could raise by direct contact with the therapist or the same group as group therapy and training techniques and children education of alternative functional methods without the use of prosthetic [1,3]. Therapists should be aware of new prosthetic rehabilitation and technique to help this group [4,8].…”