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Impact of Physical Growth and Development on Paediatric Lower-Limb Prosthetic Provision: Prosthetist Perspectives and
Claudia Ghidini1, Caitlin E Edgar1, Carson Harte2
1The Centre for Paediatric Blast Injury Studies, Department of Bioengineering, Imperial College London, UK.
Insights
Children
Area of Science:
- Paediatric Rehabilitation
- Prosthetics and Orthotics
- Biomedical Engineering
Background:
- Childhood growth presents unique challenges in prosthetic socket fit.
- Limited research exists on growth-related prosthetic issues in low-resource settings.
- Polypropylene (PP) technology is common in low-resource environments for paediatric prosthetics.
Purpose of the Study:
- To investigate growth-related challenges in paediatric prosthetic provision.
- To identify mitigation strategies used by prosthetists.
- To analyze clinical case files for growth-related issues and adjustments.
Main Methods:
- Qualitative interviews with prosthetists in Cambodia.
- Analysis of 62 paediatric prosthetic clinical case files.
- Thematic analysis of interview data and case file documentation.
Main Results:
- Sockets can accommodate growth via oversizing and liners/socks.
- Thermoplastic adjustments offer some growth accommodation.
- Lack of timely adjustments leads to waste, increased clinic visits, and patient pain.
- Growth issues universally cause socket fit problems and length discrepancies.
Conclusions:
- This study provides first-hand insights into paediatric prosthetist challenges and solutions.
- PP prosthetic systems offer cost-effectiveness but have limited adjustability for growth.
- Addressing growth-related limitations is vital for accessibility and preventing secondary impairments in low-resource settings.
Introduction:
Growth affects prosthetic provision in children, leading to socket fit issues and prosthetic length discrepancy. Despite increasing numbers of paediatric amputations, no studies have systematically analysed clinical casefiles or interviewed prosthetists to identify growth-related challenges and mitigation strategies, particularly in low-resource environments where polypropylene (PP) technology is used. This study addresses this gap by interviewing prosthetists and analysing clinical casefiles.
Methods:
This study combined qualitative interviews with Cambodian prosthetists and analysis of 62 clinical casefiles. Casefile analysis documented growth-related issues, adjustment methods, and time between interventions. Thematic analysis was applied to interviews.
Results:
Five themes were identified, highlighting that: sockets and their use can account for growth through careful oversizing and using liners/socks; handcrafted adjustments that rely on thermoplastic technology can also accommodate for growth; lack of adjustment increases waste and clinical attendance; poor socket fit causes pain and residual limb problems; and growth issues result in universal problems of socket fit issues and prosthetic length discrepancy.
Discussion:
This study is the first to interview paediatric prosthetists to assess growth-related challenges, identify mitigation strategies, and combine these qualitative findings with hard clinical evidence. PP prosthetic systems offer cost-effectiveness and increased adjustability compared to modular components and carbon fibre sockets. However, this adjustability is still limited, leading to waste of resources and increased clinical time. Finally, longer-than-recommended replacement timelines are concerning, and more research is necessary to understand these longer delays. Addressing these limitations is crucial, particularly in low-resource environments, to improve accessibility and prevent secondary impairments.
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