Demography and function of children with limb loss

Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study

PURPOSE

The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia.

METHODS

This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss.

RESULTS

A total of 122 children aged 2-16 years were included of whom 52% were boys. Congenital limb loss represented 57% of the sample with upper extremity loss accounting for 63.7% of all limb loss in this type. Trauma-related limb loss represented the most frequent etiology (88.2%) in the acquired limb loss group. Road traffic accidents accounted for 51.7% of the mechanism of injuries in trauma-related limb loss. Child's sex was not associated with the type of limb loss nor the extent of limb loss ( p > 0.05). In addition, child's age was not associated with the mechanism of injury in traumatic limb loss ( p > 0.05).

CONCLUSION

Child's sex was not a determinant of type nor the extent of limb loss. Most of the acquired limb loss was trauma-related with road traffic accidents as the most common mechanism of injury. The findings of this study illuminate the importance of ongoing prosthetic care for children with a limb loss because young children may require multiple prostheses as they grow in age and size.

Lived experience of children and adolescents with lower-limb loss who used a prosthesis: A qualitative study

PURPOSE

Children's and adolescents' level of activity, the type of activity, and other features are special to them and can result in unique experiences with lower-limb prosthesis. The specific objective of this study was to explore the lived experience of children and adolescents with lower-limb loss (LLL) who used a prosthesis.

METHODS

We used a descriptive qualitative study design and in-depth, semistructured, face-to-face interviews. Accordingly, 35 participants, including children and adolescents with LLL who used a prosthesis, their parents, and prosthetists, were interviewed. The collected data were analyzed thematically.

RESULTS

One hundred sixty-eight codes about the experiences of children, parent(s), and prosthetists were extracted from the transcripts and categorized into 32 subthemes. Finally, 7 broad themes including suitability, provoke reactions, intrinsic nature, infrastructures, the school, availability, and parenting role were extracted.

CONCLUSION

The experiences of children and adolescents with lower-limb prosthesis are specific as each may face unique challenges and deal with different difficulties. In this study that has been conducted in a developing country, the main challenges faced by children using lower-limb prosthesis and their parents are the prosthetic components, social reactions, long distance, and costs of services. Moreover, designing a more natural prosthesis and gait training for children with LLL were the most important issues faced by prosthetists. However, close relationships with friends and family members, and children's amazing ability to adapt can aid in facilitating prosthetic management.

Prenatal radiographic evaluation of congenital transverse limb deficiencies: A scoping review

BACKGROUND

Congenital transverse deficiencies are horizontal deficiencies of the long bones that occur with a reported incidence as high 0.38%. They can occur alone or represent a manifestation of a various clinical syndromes. Diagnosis has traditionally comprised of conventional radiography and prenatal imaging studies. There has been much advancement regarding prenatal imaging modalities to allow for early diagnosis and appropriate treatment.

AIM

To summarize the current state of knowledge on congenital transverse limb deficiencies and to provide an update regarding the radiographic evaluation of congenital transverse limb deficiencies.

METHODS

This IRB-exempt scoping review followed the PRISMA-ScR checklist for scoping reviews strictly. Five search engines were searched for a total of 265 publications. Four authors reviewed these during the screening process. Of these, 51 studies were included in our article. Prenatal magnetic resonance imaging (MRI), 3D Ultrasound, and multidetector Computed tomography (CT) exist are emerging modalities that have the potential to improve diagnosis.

RESULTS

Use of the appropriate classification system, three-dimensional ultrasonography with a maximum intensity projection, and appropriate use of prenatal MRI and prenatal CT can improve diagnosis and inter-provider communication.

CONCLUSION

Further scholarly efforts are required to develop improve standardized guidelines regarding the pre-natal radiographic evaluation of congenital limb deficiencies.

Participation in sports of Dutch children with lower limb deficiencies

PURPOSE

The primary aim was to describe sports participation of Dutch children and adolescents with lower limb deficiencies (LLD). The secondary aim was to explore perceived limitations concerning sports participation.

METHODS

A total of 103 children and adolescents with LLD, aged 8-18 years (mean 11.7 years), were asked about their sports participation using a study-specific self-report questionnaire.

RESULTS

Children and adolescents with LLD frequently (78%) participated in sports activities, and most of them (68%) participated in the sport of their preference. Just over half of all children (52%) perceived an inability to participate in specific sports. Physical performance (running) and endurance were mentioned as the most limiting factors in participating in certain sports.

CONCLUSION

Children and adolescents with LLD in the Netherlands participate in a variety of sports. Despite dependency on lower limb prostheses in most cases, children and adolescents with LLD have a high potentiality of participating in sports.

Prosthetic rehabilitation in a bilateral lower limb pediatric amputee: Case report

CASE DESCRIPTION

A 2-month-old child required a bilateral limb amputation, right transtibial, and left transfemoral after a deep burn compromising one-third of the body surface area. Traumatic amputations of lower limbs at such an early age are uncommon and underreported in the literature, especially in middle-income countries.

OBJECTIVE

To describe the long-term follow-up of the prosthetization process after traumatic bilateral amputation of a 2-month-old patient.

TREATMENT

The process started with compensatory prostheses for independent sitting, followed by exoskeletal devices with SACH feet, and finally introduced dynamic feet and knee to achieve progressively independent gait.

OUTCOMES

The patient achieved functionality, autonomy, and social interaction for his age. The habilitation process continues to improve his independent gait and support upcoming life changes.

CONCLUSION

Through a multidisciplinary approach, family support, and timely changes of device components according to the child's development, this patient has been able to achieve a normal life.

The prevalence of lower limb loss in children and associated costs of prosthetic devices: A national study of commercial insurance claims

BACKGROUND

Although the incidence of major pediatric lower limb loss secondary to either congenital deficiencies or acquired amputations is relatively low, the prevalence of lower limb loss among children in the United States (US) remains unknown.

OBJECTIVES

To estimate the prevalence of major lower limb loss, and the associated prosthetic services use and costs among commercially-insured children in the US.

STUDY DESIGN

Observational, retrospective, longitudinal cohort study.

METHODS

The IBM MarketScan®Commercial Database was used to identify children (<18 years) with major lower limb loss in the US between 2009 and 2015. Descriptive statistics were used to characterize pediatric cases according to sociodemographic and limb loss characteristics. Multivariate models assessed factors associated with annual prosthetic visits, prosthetic-related costs, and overall medical costs.

RESULTS

Of the 36.5 million children in the MarketScan database, 14,038 had a major lower limb loss, yielding a prevalence estimate of 38.5 cases per 100,000 commercially insured children in the US during the 7-year study period. Congenital deficiencies accounted for 84% of cases, followed by 13.5% from trauma. Only 10.1% had at least one prosthesis-related visit during any 12-month period following their cohort entry. Among those, the mean annual prosthetic-related costs ranged from $50 to $29,112 with a median annual cost of $2778 (interquartile range = $4567). Annual coinsurance and copays for prosthetic services accounted for nearly half of the overall annual out-of-pocket outlays with medical care for these children.

CONCLUSION

Pediatric lower limb loss results in lifelong prosthetic needs. This study informs insurers and policy-makers regarding the prevalence of these patients and the medical costs for their care.

Body image disturbance, psychosocial adjustment and quality of life in adolescents with amputation

BACKGROUND

Physical and emotional situations experienced by amputees can affect body image and quality of life (QoL). Although adolescence is a time when appearance becomes more important, there are insufficient studies in literature examining the effect of body image disturbance (BID) on QoL and psychosocial adjustment in adolescents with amputation.

OBJECTIVE

To investigate the BID, psychosocial adjustment and QOL in adolescents with amputation.

METHODS

This cross-sectional study included individuals aged 11-18 years with amputation. The Amputee Body Image Scale was used to determine BID, the psychosocial adjustment subscale of Trinity Amputation and Prosthesis Experience Scale was used to investigate the psychosocial adjustment to amputation, and the Pediatric Quality of Life Inventory was used to determine the QoL.

RESULTS

Evaluation was made of 42 adolescents (26 boys, 16 girls) with a mean age of 14.24 ± 2.25 years. Significant correlations were found between BID and age of fitting of the first prosthesis, psychosocial adjustment and QoL (p < 0.05). 38% of the variance of QoL was predicted by perceived body image and income of the family. 34% of the variance of psychosocial adjustment was predicted by perceived body image (p < 0.05). Adolescents suffering phantom limb pain were seen to have lower QoL scores (p < 0.05).

CONCLUSION

BID is an important predictor of psychosocial adjustment and QoL in adolescent amputees. Therefore, a prosthesis that ensures the integrity of the body image should be fitted at an as early age as possible before the onset of body image disorder.

Perceptions of ability among adults with upper limb absence: impacts of learning, identity, and community

Aims: The purpose of this research was to examine the lived experiences of adults with upper limb absence, specifically the interplay of device use, ability, and quality of life through semi-structured interviews. We sought to draw insight from these experiences to improve the practice and perceptions of adults with upper limb absence, prosthetists, and technology designers.Methods: Semi-structured interviews were conducted and interpreted with phenomenological analysis for fourteen individuals with acquired or congenital limb absence. Through an interpretive phenomenological analysis approach, researchers employed an inductive approach to coding and identification of central themes.Results: Participants shared high perceptions of ability and function, regardless of prosthesis or assistive technology use. Life experiences related to three dimensions strongly influenced perceptions of ability: (1) learning to live with upper limb absence, (2) developing their identity, and (3) connecting with their community. The diversity of experiences across participants highlighted the limitations of identifying "normative" pathways of recovery or device use, emphasizing the need for flexible and adaptable systems that can creatively support personal goals and needs.Conclusions: Integration of novel platforms for professional practice, supportive communities, and technology innovation can support the evolving needs and care of individuals with upper limb absence.Implications for rehabilitationIn this study, perceptions of ability were largely independent of prosthetic use and each individual developed a unique toolkit of devices and strategies to support function in daily life.Clinicians can support perceptions of ability by promoting opportunities for community development and life-long learning.Informal communities, such as online networks, can provide novel device designs, resources for learning, and societal awareness to empower individuals with limb absence.

Successful First Gait of a Child With Hip-Disarticulation Prosthesis

An infant boy underwent hip disarticulation for infantile fibrosarcoma immediately after birth. His rehabilitation began when he was 4 mos old and involved training with his left (residual) leg. He could stand with support at 12 mos. His initial prosthesis fitting was performed at the age of 13 mos. He could stand and walk with support at 15 mos of age and could walk with no additional support and go up and down stairs at 2 yrs. A single-axis prosthetic knee joint was introduced at the age of 2 yrs 3 mos. His first gait using a hip prosthesis was successful, and his prosthesis was replaced at appropriate intervals with no major problems. The authors believe that the key to achieving a successful prosthetic gait in children is good communication among the medical team, which should comprise an orthopedic doctor, rehabilitation doctor, nurse, physical therapist, prosthetist/orthotist, and the patient's parents.

Traumatic amputations in children and adolescents: A demographic study from a tertiary care center in Northern India

PURPOSE

To determine the demographic pattern, level, mechanism of traumatic amputation in children and adolescent age group and to compare findings with other studies.

METHODS

Patients aged less than 18 years with traumatic amputation attending Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, India between July 2013 and January 2016 were enrolled and their demographic characteristics were analyzed.

RESULTS

Fifty-three patients were included aged less than 18 years when injured. Mean age of the population studied was 9.89 ± 4.13 with male to females ratio of 3:2. Majority (69.81%) of traumatic amputations involved lower limb. Most common level was unilateral transtibial (35.85%), followed by transfemoral (16.98%). In upper limb, most common type was transradial. RTA followed by train accidents was most common mechanism of traumatic amputation. 8 patients needed revision surgery. 52.8% patients of acquired amputations complained of phantom sensation and 37.74% phantom pain.

CONCLUSIONS

This study aims to visualize the current scenario and the data generated could be possibly helpful in planning policies and programs at institutional as well as at higher levels for prevention, treatment and distribution of resource to the young amputee population, to ensure their better health care and also opportunities in life.

Physical and Psychosocial Functions of Adults with Lower Limb Congenital Deficiencies and Amputations in Childhood

Objectives. (1) To describe the epidemiological and medical features of a sample with LLA and LLD in childhood and (2) to explore their relationship with subsequent physical and psychosocial functions in adulthood. Methods. Cross-sectional survey. Demographics, medical data, Locomotor Capabilities Index (LCI), and Discomfort-Engagement in Everyday Activities Involving Revealing the Body Scale (D-EEARB) were collected from thirty-two adults who suffered from LLA in childhood or LLD. Results. Most of the sample (53.1% males) was working (84.4%), living independently (75%), and single (75%). Mean age was 33.16 (SD = 7.64, range 18–50). Leading causes for LLA were traumatic (40.6%) and oncologic (25%). LLD was present in 6 cases (18.8%). LCI scores revealed a high performance among males (t_17,464 = 2.976, p = .008). D-EEARB scores showed that 56.25% stated feeling “quite” or “totally comfortable” in situations which involved revealing their body, but 43.75% stated the contrary (“uncomfortable” or “very uncomfortable”). LLD and traumatic LLA show higher scores in D-EEARB than vascular and oncological LLA (χ² = 7.744, df = 3, p = .05). Conclusions. Adults suffering from LLDs and LLAs during childhood seem to perform well once they are adults. However, 43.75% of patients express considerable discomfort in situations that involve revealing the body.

Priorities in lower limb prosthetic service delivery based on an international survey of prosthetists in low- and high-income countries

BACKGROUND

Prosthetic services, including the provision of an appropriate prosthesis, are a crucial part of the rehabilitation process for individuals with lower limb amputations. However, globally there exist unique challenges in the delivery of prosthetic services that are limiting rehabilitation outcomes and consequently the well-being and socio-economic status of individuals with lower limb amputations.

OBJECTIVES

The objective of this work was to explore the issues related to the provision of appropriate prosthetic technologies and to compare these across different economies of the world.

STUDY DESIGN

Cross-sectional survey.

METHODS

An online survey was developed and distributed to prosthetic practitioners providing services in countries around the world. An open-coding thematic content analysis procedure was applied to extract key themes from the data.

RESULTS

The response codes defined three overall themes of lower limb prosthetic delivery, and several key differences between higher and lower income countries emerged. Namely, a higher emphasis on part/material availability, practitioner training and durability in lower income countries was found. High costs were an issue raised by practitioners in all countries.

CONCLUSION

Practitioners around the world share many of the same concerns; however, some lower income countries face important and pressing issues that limit their ability to provide adequate prosthetic services.

CLINICAL RELEVANCE

This work highlights the most crucial service and technology-related needs, as perceived by trained prosthetic practitioners, of populations requiring lower limb prosthetic treatment around the world. Additionally, the results may be used to prioritize prosthetic-related health-care initiatives led by other researchers, governments and organizations working to improve services internationally.

Comparison of gait after Syme and transtibial amputation in children: factors that may play a role in function

BACKGROUND

Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes.

METHODS

Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted.

RESULTS

Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05).

CONCLUSIONS

Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Radiographic parameters improve lower extremity prosthetic alignment

PURPOSE

The goal of prosthetic fitting is to provide comfort and functionality to the patient. It is thought that incorporating the use of standing anterior-posterior long leg radiographs (LLR) into the fitting of lower extremity prostheses will provide an objective guide when making adjustments, and be a better assessment of alignment. This study compares prosthetic alignment before and after radiography-guided adjustments.

METHOD

This retrospective study was performed at a multidisciplinary amputee clinic on patients with congenital and/or acquired limb deficiencies. Their prosthetic alignment was evaluated by LLR and adjusted as needed. Satisfactory alignment was defined as a mechanical axis angular deviation of ≤1° and a leg length discrepancy of ≤10 mm.

RESULTS

A total of 45 unique prostheses from 24 subjects (10 female and 14 male) were included. Post-adjustment radiographs were obtained from 29 prostheses. After the initial prosthetic fitting, the probability of a satisfactory fit was 20.0 % (95 % CI 10.9-34.9 %). Following the baseline adjustment, the probability of a satisfactory fit improved to 53.3 % (95 % CI 37.5-70.9 %). After adjustment number 4, the probability of a satisfactory fit further improved to 76.7 % (95 % CI 41.9-98.0 %). There were also significant improvements in distal offset distance (p = 0.0040) and leg length discrepancy (p = 0.0206). The distal offset distance decreased by an average of 10.7 mm (95 % CI 3.6-17.8), and leg length discrepancy decreased by an average of 3.0 mm (95 % CI 00.48-5.5).

CONCLUSIONS

The addition of LLRs to existing fitting methods significantly improves prosthetic alignment and length.

Compliance to service standards for congenital upper limb deficiency: the Northern Ireland experience

BACKGROUND

In 2003, the British Society of Rehabilitation Medicine (BSRM) published guidelines on amputee and prosthetic rehabilitation, including those with congenital limb deficiency.

OBJECTIVES

The aim of the study was to evaluate the service provided by the Regional Disablement Service (RDS) to children with congenital upper limb deficiency, against BSRM guidelines.

STUDY DESIGN

Retrospective chart review.

METHODS

Chart review.

RESULTS

Analysis of the group (n = 44) showed 52% were male, with 61% of children affected on the left side, and 73% having a transverse deficiency. Compliance to individual aspects of the guidelines varied considerably. Only 14 (32%) of children had met with the multidisciplinary team by the recommended age of six months. Analysis of referral sources and timings suggested that children were initially seen elsewhere and later referred to RDS after consultation with a surgeon.

CONCLUSIONS

RDS compliance with the BSRM guidelines was variable. Particularly disappointing was the low rate of children and families meeting the multidisciplinary team at an early age (< 6 months). The low rate of early referral prompted us to contact all paediatricians in Northern Ireland highlighting the guidelines, the benefits of early contact with RDS and encouraging referral on diagnosis.

Survey of upper limb prosthesis users in Sweden, the United Kingdom and Canada

BACKGROUND

As part of the process of improving prosthetic arms, it is important to obtain the opinions of the user population.

OBJECTIVES

To identify factors that should be focused on to improve prosthesis provision.

STUDY DESIGN

Postal questionnaire.

METHODS

The questionnaire was sent to 292 adults (aged 18 to 70 years) with upper-limb loss or absence at five centres (four in Europe) Participants were identified as regular attendees of the centres.

RESULTS

This questionnaire received a response from 180 users (response rate 62%) of different types of prosthetic devices. Responses showed that the type of prosthesis generally used was associated with gender, level of loss and use for work (Pearson chi-square, p-values below 0.05). The type of prosthesis was not associated with cause, side, usage (length per day, sports or driving) or reported problems. The findings did not identify any single factor requiring focus for the improvement of prostheses or prosthetic provision.

CONCLUSIONS

Every part of the process of fitting a prosthesis can be improved, which will have an effect for some of the population who use their devices regularly. There is, however, no single factor that would bring greater improvement to all users.

CLINICAL RELEVANCE

Based on information gained from a broad range of prosthesis users, no single aspect of prosthetic provision will have a greater impact on the use of upper limb prostheses than any other. Efforts to improve the designs of prosthetic systems can cover any aspect of provision.

Use of a Tailor-Made Feeding Device to Improve the Self-Feeding Skills of a Woman with Congenital Upper Limb Deficiency

This case report illustrates a feeding device prescription process for a Chinese woman with congenital upper limb deficiency, using the Human Activity Assistive Technology (HAAT) model. Positive experience was identified through a semi-structured interview after the participant had used the tailor-made feeding device. This report supports the HAAT model application and the importance of the sociocultural contexts in the assistive device prescription process.

Children with limb deficiencies: demographic characteristics

The aim of this study is to determine the demographic data for amputations in children in relation of age, sex, level and cause of amputation. Data were collected from the records of amputees who attended the prosthetic clinic at the Royal Rehabilitation Center, King Hussein Medical Centre, Jordan, between 1 January 1995 and 31 December 2005. Demographic data (age, sex, level and cause of amputation) were analyzed. Some 120 children with different levels of amputation were included with mean age of 6.2 years. There were 64 (53.3%) males and 56 (46.7%) females. Male to female ratio was 1.15:1. The dominant level of amputation was trans-radial in 10 patients (15.62%) in the upper limb and trans-tibial in 18 patients (28.12%) in the lower limb. The dominant cause of amputation was congenital deficiency in 56 patients (46.67%) followed by trauma in 48 (40%). The results of this study presented greater similarities to others in the literature, congenital limb deficiency being the dominant cause of amputation in children. This study helps in planning the needs for materials and budgets for the treatment of amputee children in Jordan.