Child Amputees Research Articles

Rescue & Jessica: A Life-Changing Friendship by J. Kensky & P. Downes

Kensky, Jessica and Patrick Downes. Rescue & Jessica: A Life-Changing Friendship. Illustrated by Scott Magoon. Candlewick Press, 2018 
 There are not many children’s books published about amputation, so a new book is always welcome. Jessica Kensky became a double leg amputee as a result of injuries sustained during the 2013 Boston Marathon bombing. Rather than writing a children’s book about amputation, she has written an autobiographical work in the form of a picture book. As a result, this is a strange mix of fiction, where readers hear the service dog’s thoughts, and strict adherence to autobiographical detail that is unnecessary in a picture book. For example, Jessica is depicted as a teenager, closer to the real age of the author, rather than as a young child, to whom young readers could more easily relate. Jessica goes through two amputations in the course of the story, reflecting the experience of the author, but this process is unusual for amputees and unnecessarily complicates the story for early readers. The text is also at a reading level that is higher than one would expect in a picture book, so younger children will need an adult to read the book with them.
 However, while it has flaws, the book is a comforting and positive story that will give child amputees hope as they see Jessica learn to be active again on her prosthetic legs. Scott Magoon’s simple and realistic illustrations will help children enjoy the dog, Rescue, and his role in Jessica’s healing process. Magoon does a good job depicting the dog in many states: readiness, happiness, resting, helping, playing and swimming. 
 This book should be included in public and school library collections. It should also be included in hospital library collections, particularly those where children receive amputation care, such as pediatric cancer clinics and prosthetic clinics. It would be of interest to both children undergoing amputations and their families. 
 Recommended: 3 out of 4 stars Reviewer: Sean Borle 
 Sean Borle is a University of Alberta undergraduate student who is an advocate for child health and safety.

Preparing the questionnaire to determine the functional level in children with limb loss/deficiency and pre-outcomes

To prepare an authentic scale for child amputees and to determine the functional level of amputee children with their prosthesis. Children with limb loss/deficiency (n=20) aged between 6-12 years who used their prosthesis at least for 1 year were enrolled in this study. The second group consisted of healthy children (n=25). Twenty-two disabled children with physically disabled and attending to special education school were enrolled to the control group. All the children were assessed with the Functional Level Determining Scale (FLDS) designed for the children between 6-12 ages. Demographic characteristics such as age, sex and body mass index were same for each group (p>0.05). Although the scores of FLDS were in similar in the groups of amputee and healthy children (p>0.05), their scores were higher than the children who had physical disabled (p<0.05). When the children with limb loss/deficiency were divided into two group as acquired and congenital, the congenital group were more functional (p<0.05). The children who used prosthesis for longer term were more successful in the activities (p<0.05). Although there is no difference statistically, the scale was recorded as sensitive to speed in functional activities. Regardless of the cause or level of amputation, amputation less affects than other physical disabilities on functional level. Early prosthetic applications contribute to the functional level of children. This outcome is thought that the scale is contributed to determine the functional level in children with limb loss/deficiency

Evaluation of functionality in acquired and congenital upper extremity child amputees

The aim of this study was to evaluate the functional level of children with congenital and acquired upper limb loss after a rehabilitation program. This study included a total of 40 children, aged 8 to 17 years with upper limb loss. Children were divided into two groups; congenital amputees (n=20) and acquired amputees (n=20). The children underwent prosthetic fitting, prosthetic training and rehabilitation. The Child Amputee Prosthetics Project - Functional Status Inventory (CAPP-FSI) and Prosthetic Upper Extremity Functional Index (PUFI) were used at the initial visit to the prosthetic unit without prosthesis, 3 weeks after the prosthetic training and 6 months after discharge with and without prosthesis. The results with and without the prosthesis were compared between the acquired and congenital amputee groups. There were significant differences in all tests performed at the baseline, at the 3rd week, and at the 6th month without prosthesis and at the 3rd week and at the 6th month with prosthesis (p<0.05). The congenital group received higher scores in the CAPP-FSI and PUFI at the baseline, at the 3rd week and at the 6th month (p<0.05). Patients in the congenital group used their prostheses for 8 hours a day and the acquired group for 4 to 8 hours. Daily prosthesis usage time and the child's experience with the prosthesis during daily activities are the determining factors for the functional level in upper limb child amputees. Functionality may improve based on these factors.

Adaptation and OT training for upper limb prostheses in child amputees

Adaptation and OT training for upper limb prostheses in child amputees

Adaptation of prosthetics and training for growing child amputees

Adaptation of prosthetics and training for growing child amputees

Dynamics of below-knee child amputee gait: SACH foot versus Flex foot

Gait kinematics and dynamics during stance of unilateral, below-knee child amputees were analyzed for self-selected, comfortable (0.9 m s −1) and fast (1.3 m s −1) speeds with the SACH foot and the energy-storing Flex-foot prostheses. The three-dimensional movements of the lower limbs were recorded and synchronized with ground reaction forces for 12 subjects (7 girls and 5 bodys, ages 6–16 yr). Each lower limb was modeled as a set of interconnected rigid links (thigh, leg, and foot) with frictionless joints (hip, knee, and ankle) to calculate moment and joint power profiles. Marked asymmetries were noted in ground reaction force, joint moment, and power profiles for the prosthetic versus the natural limb, but with the Flex foot the asymmetries were less pronounced than with the SACH foot. For the amputee wearing the Flex foot, greater moments and power were generated by the natural limb at the comfortable pace as compared to the SACH foot, but during fast walking, the SACH foot required greater output from the natural limb. With both prostheses, for the prosthetic limb the amputees used similar force, moment, and power patterns, but with significantly different amplitudes. At both speeds of walking, the Flex foot returned significantly more energy (66 % at comfortable and 70 % at fast walking) than the SACH foot (21 % at comfortable and 19 % at fast walking). Thus, the Flex foot had a greater potential for reducing the energy cost of walking at comfortable and fast speeds for the below-knee child amputee.

Management of the Upper-Limb-Deficient Child with a Powered Prosthetic Device

A long-term survey of a large number of children fitted with an electrically powered upper-limb prosthesis seems not to have been reported in the literature. Children with upper-limb deficiencies (congenital or traumatic) were fitted with an electrically powered upper-limb prosthesis in Ontario during the 18-year period of 1965-1983. Seventy-eight patients responded to a questionnaire or were interviewed by telephone. The dropout rate in children with a below-elbow amputation was similar to that reported in below-elbow child amputees wearing a conventional body-powered prosthesis (10% vs. 13%). The acceptance rate in children with above-elbow amputations was higher in those wearing an electrically powered prosthesis than in those using the conventional prosthesis, testifying for improved prosthetic function in the former group.

Gait kinematics in below-knee child amputees: a force plate analysis.

A complete gait analysis was performed on six children with below-knee amputations to determine the kinematics and kinetics of amputee gait in children. A relatively new method of analysis--the inverse dynamic relationship--was used to determine the joint moments in the sagittal plane of the joints in the intact limb and the remaining portion of the amputated limb. The joint moments in the sagittal plane of the intact limb in the child amputee were found to be normal or below normal during level walking. From this study, it was concluded that providing a child amputee has a good prosthetic fit, there will be no increased forces across the joints of the intact or amputated limb and consequently no predisposition to premature degenerative arthritis.

Characteristics of the child amputee population.

The characteristics and number of children with limb amputations in North America are not known. In an effort to secure information concerning the nature of the child amputee population (to 21 years of age) in the United States and Canada, a census of patients treated at member clinics of the Association of Children's Prosthetic-Orthotic Clinics (ACPOC) was conducted. It was designed to obtain a rational basis for children's prosthetic design, development, research, and educational activities. Of the 74 ACPOC prosthetic clinics to which the questionnaire was sent, 45 replies were analyzed, representing a total of 4,105 children under treatment at the reporting clinics during 1980, of which 679 cases (17%) were seen for the first time in that year. The results are consistent with prior unpublished censuses. Overall, congenital limb deficiencies outnumbered acquired losses by a ratio of 2:1, but among unilateral cases, more lower-limb amputations were acquired postpartum than congenitally. Eighty percent of all child amputees had had only one limb involved, and 54% of these unilateral cases were left amputees. Males outnumbered females 3:2, and over half of the children currently under treatment at the reporting clinics had been under 6 years of age at the time of first admission.

Balance in lower limb child amputees.

Postural stability of five unilateral above-knee amputee children was measured when wearing the SACH and the experimental Child Amputee Prosthetic Project (CAPP) prosthetic foot. Excursions of the centre of pressure of the supportive forces were recorded via force platform during sustained weight-shifting forward, backward, left, right, and during normal standing. Visual proprioception effects on upright stance were also demonstrated with these child amputees. Total base of support did not differ for the two types of prosthetic feet, but the functional base of support for SACH foot was significantly larger than CAPP. Fluctuations of centre of pressure about a mean position in normal standing were less when children used CAPP foot. Focusing on a static target had no effect on postural stability in either anterior-posterior or lateral direction for CAPP foot conditions, but lack of visual target had a deleterious effect on lateral stability when SACH foot was worn. Balance is one of the most difficult problems for a lower limb amputee (Hellebrandt et al, 1950; Moncur, 1969; Murdoch, 1969). The absence of part or all of a lower limb reduces the amount of proprioceptive information about the surfaces on which the foot is resting and the precise location of the prosthetic limb. While limited data have been reported on the balance and stability characteristics of adult amputees (Fernie and Holliday, 1978; Hellebrandt et al, 1950), information about balance of child amputees is almost non-existent. We have found only one report of the postural stability characteristics of a child amputee; Shambes and Waterland (1970) studied an 11-year-old quadrilateral amputee who had congenital Lisfranc amputations of both lower limbs, long above-elbow amputation of the left upper limb, and medium below-elbow amputation of the right upper limb. The purpose of this study was to detail the postural stability characteristics for lower limb child amputees. In addition, the conventional SACH prosthetic foot was compared with the experimental Child Amputee Prosthetic Project (CAPP) foot for various postural tasks. The SACH foot (Fig. la) is usually constructed with a moulded polyurethane material which incorporates a heel cushion to allow some compression of the heel during heel strike in walking to simulate plantar flexion of a normal foot. The CAPP foot (Fig. lb) is an experimental prosthesis undergoing development at the UCLA Child Amputee Prosthetic Project. It is designed to provide more knee stability during early stance phase during walking and also to respond to torsional loads occurring in the stance phase of walking. The heel projection of the CAPP foot is non-weight bearing and deflects upward at heelstrike. With the ground reaction forces shifted more anteriorly on the supporting foot there is an expected increase in dynamic knee stability during the stance phase of walking. While additional research is being conducted on the dynamic characteristics of the CAPP foot, the present study provides some preliminary information about the postural stability of child amputees using the experimental CAPP foot, as well as providing a comparison with the conventional SACH foot.

A Chest Strap Harness for Below-Elbow Child Amputees

A Chest Strap Harness for Below-Elbow Child Amputees

Habitation of Child Amputees*

Journal Article Habitation of Child Amputees Get access Mildred I. Lineberger, B.S. Mildred I. Lineberger, B.S. †Michigan Crippled Children Commission, Area Child Amputee Center, Grand Rapids, Michigan. Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 42, Issue 6, June 1962, Pages 397–401, https://doi.org/10.1093/ptj/42.6.397 Published: 01 June 1962

Psychological concomitants of amputation in children.

Most studies reported in the literature of orthopedically disabled children have been based upon heterogeneous groups and often treated as if they were unitary. In a single study of the orthopedically handicapped be found poliomyelitis, scoliosis, osteomyelitis, cerebral palsy, amputation, and other cases. While for many purposes conceptualizing these varied disabilities under one heading is justifiable, sometimes the characteristics and consequences of a particular disability are neglected. This be because of our emphasis upon the generality of the psychological effects of disability and a reluctance to impart specificity to the concomitants of individual type handicaps. For these reasons, and because in the past large numbers of child amputees have been unavailable for psychological study, there have not been any reports concerned solely with amputee children. Isolation of amputee children for special study is desirable for many reasons. Most important is that for the first time there is an organized national attempt to improve the prosthetic situation of the amputee child. Psychological insights which could help in the construction, design, prescription, and training in the use of prostheses would be of immediate value. In addition, data relevant to important theoretical problems as the development of body image, castration feelings, and dependency feelings may be elicited, as well as indications for the practical management of these children and their parents. Partially because of this lack of data, the Prosthetic Devices Studies of New York University, in cooperation with the Mary Free Bed Hospital at Grand Rapids, Michigan, did two clinical surveys of amputee children. Two reports published by New York University on the pros-