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Prosthesis rejection in children with a unilateral congenital arm defect
K Postema1, V van der Donk, J van Limbeek
1St Maartenskliniek, Nijmegen, The Netherlands. kp_aro@universal.nl
Insights
Prosthetic rejection in children with congenital arm defects occurs in two main periods, often linked to perceived functional gain and parental involvement. Early fitting before age two may reduce rejection rates for prosthetic rehabilitation.
Area of Science:
- Pediatric Rehabilitation
- Prosthetics and Orthotics
- Biomedical Engineering
Background:
- Prosthetic use in children with congenital limb differences is common.
- Understanding rejection rates and contributing factors is crucial for successful rehabilitation outcomes.
Purpose of the Study:
- To determine the rejection rate of prosthetic devices in children with unilateral congenital arm defects.
- To identify key factors associated with prosthetic rejection in this pediatric population.
Main Methods:
- A cross-sectional study was conducted on 32 children (0-18 years) with unilateral congenital arm defects.
- Data was collected via questionnaires completed by parents and children aged six and older.
- Survival analysis was used to model prosthetic rejection over time.
Main Results:
- Eleven children (34%) rejected their prosthesis.
- Rejection rates peaked in the initial 40 months and after 162 months of prosthetic use.
- Lack of perceived functional gain, parental disappointment, and insufficient parental involvement were significantly associated with higher rejection rates.
Conclusions:
- Prosthetic rejection in children occurs in distinct periods, notably within 3.5 years of fitting and during puberty (around 13.5 years).
- Fitting prostheses before the age of two years appears to lower rejection rates.
- Optimizing prosthetic rehabilitation requires managing parental expectations, ensuring adequate parental involvement, and providing comprehensive psychosocial support.
Objective:
To determine the rate of rejection for prosthetic use in children and to investigate reasons for this rejection.
Design:
Cross-sectional study of a cohort of children.
Setting:
Rehabilitation centre, St Maartenskliniek, Nijmegen, The Netherlands.
Subjects:
Thirty-two children (0-18 years) with a unilateral congenital arm defect who visited the clinic between September 1991 and December 1996.
Methods:
Parents of all children and 19 children (> or =6 years) completed a questionnaire.
Results:
Eleven children (34%) rejected the prosthesis. A survival function shows that the rejection can be characterized by three periods: 0-40 months, 40-162 months and after 162 months. In the first and last period a high rate of rejection is seen, while in the second period a low rate exists. Fitting for the first time after 2 years of age seems to be related with higher rejection rate. Lack of functional gain with the prosthesis, as perceived by the subjects and the parents, is significantly associated with increased rejection rate. Increased rejection rate is associated with the parents' disappointment, insufficient involvement of the parents in treatment, and dissatisfaction pertaining to emotional and social guidance.
Conclusions:
Rejection seems to occur in two main periods: within 3.5 years after being provided with a prosthesis and after 13.5 years of prosthetic use, when most children experience puberty. Fitting before the age of 2 years seems to reduce rejection rate. Preventing the parents' disappointment about prosthetic benefits as well as providing them with sufficient involvement in treatment and adequate guidance are essential for optimal results of prosthetic rehabilitation.