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Bimanual skill development in pediatric below-elbow amputation: a multicenter, cross-sectional study
1Massachusetts General Hospital Institute of Health Professions, Boston.
Insights
Children with below-elbow amputation show delayed bimanual activities of daily living (ADL) skills. Prosthetic wear duration did not significantly correlate with these functional performance improvements.
Area of Science:
- Pediatric rehabilitation
- Occupational therapy
- Prosthetics and orthotics
Background:
- Unilateral below-elbow amputation presents unique challenges for children's development.
- Understanding bimanual functional skill acquisition is crucial for effective intervention.
Purpose of the Study:
- To investigate bimanual functional skill development in children with unilateral below-elbow amputation.
- To compare their development patterns with able-bodied children.
- To examine the relationship between prosthetic wear duration and functional performance.
Main Methods:
- Assessed 69 children under ten with unilateral below-elbow amputation.
- Evaluated 14 prosthesis-assisted bimanual activities of daily living (ADL).
- Compared performance against established standards for able-bodied children.
Main Results:
- Bimanual ADL skill development was not delayed in 5 of 14 comparisons.
- Most development patterns exhibited multimodal, nonmonotonic profiles.
- Prosthetic wear duration showed weak correlation (r < .52) with ADL skills.
Conclusions:
- Below-elbow amputation impedes pediatric ADL skill development, even without central nervous system dysfunction.
- Developmental delays are complex and not uniformly expressed across all children.
- Delays are not solely attributable to mechanical prosthetic deficiencies.
Abstract:
The purpose of this study was to investigate the following in children with unilateral below-elbow amputation: (1) development of bimanual functional skills, (2) development patterns relative to able-bodied children, and (3) the relationship between duration of prosthetic wear and bimanual functional performance. Sixty-nine children with unilateral below-elbow amputation, all less than ten years old, were assessed on 14 prosthesis-assisted bimanual ADL, including play, feeding, dressing, and hygiene activities, which have been studied previously in able-bodied children. Bimanual ADL skill development was not delayed in five of the 14 comparisons to previously published standards, but most development patterns had multimodal, nonmonotonic performance profiles. Duration of prosthetic wear and other factors previously believed to contribute to good prosthetic function were not well correlated to ADL skills (r less than .52). Although these children had no CNS dysfunction, it is apparent that below-elbow amputation impedes pediatric ADL skill development. The cause of these delays appears to be complex and is not expressed uniformly among all children; thus, the delays observed are not simply due to mechanical deficiencies of the prosthetic restoration.