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Prosthetic management of children in The Netherlands with upper limb deficiencies
M A Kuyper1, M Breedijk, A H Mulders
1Revalidatie Centrum De Hoogstraat, Utrecht, The Netherlands. Laane@worldonline.nl
Insights
This study reviewed 224 children with upper limb deficiencies, finding that 54% with congenital unilateral deficiencies and 67% with acquired deficiencies received prostheses. Prosthesis use at age 12 was encouraging for congenital cases.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Congenital and acquired upper limb deficiencies significantly impact a child's development and functional independence.
- Prosthetic interventions aim to restore function and improve quality of life for affected children.
- Understanding prescription patterns and long-term prosthesis use is crucial for optimizing rehabilitation strategies.
Purpose of the Study:
- To determine the prevalence of prosthesis fitting in children with upper limb deficiencies.
- To analyze the types of prostheses prescribed as first, second, and third interventions.
- To investigate the age of first prosthesis prescription and the duration of prosthesis wear.
Main Methods:
- Retrospective chart review of 224 children with congenital or acquired upper limb deficiencies at De Hoogstraat Rehabilitation Centre (1972-1996).
- Data collection included patient demographics, prosthesis prescription details, and prosthesis usage.
- Analysis focused on fitting rates based on deficiency type, prosthesis types, age at prescription, and duration of use.
Main Results:
- 92% of the children had congenital deficiencies; 54% with unilateral and 3% with bilateral congenital deficiencies were fitted with prostheses.
- Children with acquired deficiencies had a 67% fitting rate. Transverse forearm defects (one-third to two-thirds) had the highest fitting rate (85%) in the congenital group.
- Passive prostheses were common first prescriptions for congenital cases (80%), while active prostheses were more frequent for acquired defects (8/12). Body-powered prostheses were common second prescriptions.
Conclusions:
- A significant proportion of children with upper limb deficiencies, particularly unilateral congenital and acquired types, received prosthetic fitting.
- Prosthesis prescription policies varied based on deficiency type and anticipated functional benefits.
- Early fitting (mean age 2.6 years) showed encouraging long-term use, with two-thirds of congenital cases still using prostheses at age 12, warranting further functional outcome studies.
Abstract:
The aim of the study was to assess which children with congenital and acquired upper limb deficiencies were fitted with prostheses, what types of prostheses were prescribed as first, second and third prostheses, at what age prostheses were first prescribed and how long the children wore their prostheses. The design was a retrospective chart review at De Hoogstraat Rehabilitation Centre, Utrecht (The Netherlands). Medical files of all patients with congenital or acquired upper limb deficiencies who visited the outpatient clinic between 1972 and 1996 were reviewed, collecting data on patient characteristics, prosthesis prescription and use of prostheses. The group included 224 children, of whom 206 (92%) had congenital deficiencies. Of all children with unilateral congenital deficiencies, 54% had been fitted with prostheses, against 3% of all children with bilateral congenital deficiencies and 67% of all children with acquired deficiencies. In the congenital group, it was children with transverse defects of one-third or two-thirds of the forearm who had most frequently had prostheses fitted (85% of the children). Most of the children with unilateral congenital deficiencies had received passive prostheses as their first prostheses (80 of the 90 prescribed prostheses); children with acquired defects usually had active prostheses (8 of the 12 prescribed prostheses). Body-powered prostheses were most commonly prescribed as the second type of prosthesis. In the group of 119 children who had been seen before the age of 4 years and had been followed for at least three years, 63 had been fitted with one or more prostheses at a mean age of 2.6 (SD 2.5) years. Of the 46 children with congenital defects, 30 had been fitted with prostheses, and at the age of 12, two-thirds of them still used their prostheses (63%, 19/30). "De Hoogstraat" rehabilitation centre uses a restrained prosthesis prescription policy, depending on the type of deficiency and the expected functional benefits. Data on prosthesis use are encouraging, although a follow-up study is required to determine the functional outcome for prosthesis users and non-users.