Pediatrics

Question 1

What is the peak age range for amputations?

Answer 1

41-70 years old (135K new cases each year in total)

Question 2

What % of pediatric amputations are acquired?

Answer 2

40% are acquired (60% are congential)

Question 3

Of the acquired amputations, how many are traumatic?

Answer 3

70% of acquired amputations (40% of total ampuations) are due to traumatic causes. The other 30% are a result of cancer

Question 4

How many children are born missing some portion of their limb?

Answer 4

1/2000 children are born missing some portion of their limb

Question 5

What are common causes of traumatic amputations in children?

Answer 5

DOORS, lawnmowers, BICYCLES (chains), power saws, and MVAs.

Question 6

What diseases cause acquired amputations?

Answer 6

Primarily cancers.

Osteosacroma (bone)
Ewing’s Sarcoma (lung?)

Question 7

What are some causes of congenital (embryonic) amputations? (2)

Answer 7

Tetrogenic factors

Banding syndromes

Question 8

How do you manage an acquired, traumatic amputation? (7)

Answer 8

Limb reattachment
Bone grafts
Surgical amputation
Skin grafts
Healing
IPOP
Shaping

Question 9

How do you manage an acquired amputation due to disease? (4)

Answer 9

Surgical removal of tumor
Chemotherapy
Radiation
Limb sparing strategies

Question 10

What are three goals for an acquired amputation due to disease? (3)

Answer 10

Control primary tumor
Control and disease
Preserve function

Question 11

When do errors in limb development usually occur?

Answer 11

4-7 weeks of gestation

Question 12

When must tetrogenic factors be present?

Answer 12

Some time between 3rd and 7th week

Question 13

What is amniotic band syndrome?

Answer 13

Occurs when the fetus becomes entangled in fibrous string-like amniotic bands in the womb, restricting blood flow and affecting the baby’s development.

Question 14

What are known tetrogenic factors for congenital limb deficiencies?

Answer 14

Thalidomide (morning sickness drug with side effect of fetal limb loss), contraceptives, irradiation.

Question 15

What are four genetic factors linked with limb deficincy?

Answer 15

Holt-Oram, Franconi, Nager, and thrombocytopenia-absent radius symdromes

(can also be sporadic mutation)

Question 16

How are acquired amputations classified?

Answer 16

Named for the segment which has been transected (transhumeral, knee disarticulation, etc.)

Question 17

What are the three Greek-based classifications of congenital limb loss (which we will probably never use but we must be able to recognize)?

Answer 17

Amelia, Hemimelia, Phocomelia

Question 18

What is Amelia?

Answer 18

Absence of a limb

Question 19

What is hemimelia?

Answer 19

A shortened or absent limb due to long bone absence or insufficiency

Question 20

What is phocomelia?

Answer 20

A congenital with a shortened or absent long bone and webbed hands and/or feet are attached to abbreviated arms and legs. This is often associated with, but not limited to, exposure to thalidomide. Also used when the top part of a limb is missing and distal part is attached to more proximal portion.

Question 21

How are congenital limb losses classified today?

Answer 21

Based on amount of development and level

Approved by ISPO and ISO

Question 22

What is the difference between a transverse and longitudinal deficiency?

Answer 22

Longitudinal - deficiency is up and down

Transverse - deficiency is L and R

Question 23

What is the clinical presentation of PFFD (a specific birth defect)? (5)

Answer 23

Hip in FABER (frog leg)
Knee flexion contracture
Hypoplasia (underdevelopment) of quads
Small or absent patella
Instability of knee joint due to absence of the ACL and PCL

(overall, ligamentously unstable and stuck in flexion)

Question 24

What is a non-surgical option to treat PFFD

Answer 24

“get a big shoe lift”

Question 25

How is PFFD classified?

Answer 25

Position of the foot Length of the femur and tibia Condition of the hip joint

Question 26

What is a type A PFFD?

Answer 26

Present femoral head Normal acetabulum Short femoral segment *Bony connections between components of femur; femoral head in acetebelum

Question 27

What is a type B PFFD?

Answer 27

Present femoral head Adequate or moderately dysplastic acetabulum Short, usually proximal bony tuft femoral segment *No osseus connections between head and shaft Femoral head in acetabulum

Question 28

What is a type C PFFD?

Answer 28

Absent femoral head (or represented by ossicle) Severely dysplastic acetabulum Short (usually proximally tapered) femoral segment *May be connection between shaft and proxminal ossicle *No articulation between femur and acetabulum

Question 29

What is a type D PFFD?

Answer 29

Absent femoral head Absent acetabulum, or obturator foramen enlarged; pelvis squared in bilateral cases Short, deformed femoral segment

Question 30

What are four non-surgical intervention prinicples for PFFD?

Answer 30

Encourage use of the limb; prevent any issues with ROM Allow for bone growth PRIOR to surgery (do not operate right away) - allow for WB on the natural foot Initial prosthesis may be fit to accommodate the foot while allowing for growth Initial prosthesis fit at developmentally apporpriate age (8-10 mo)

Question 31

What are 5 surgical interventions for PFFD?

Answer 31

Knee fusion with or without syme app Van Nes Procedure (similar to rotationplasty) Limb lengthening procedures such as Ilizarov Femoral or tibial epiphysoidesis Amputation of the limb

Question 32

Who is on the treatment team for peds amputees? (7)

Answer 32

``` Pediatrician/surgeon/oncologist/Nursing PT/OT Social worker Teacher/Early Intervention specialist Prosthesis Psychiatrist Parents/caregiver/family (can be more difficult than the children) ```

Question 33

What is the role of the PT in the Pre-Prosthetic phase? (3)

Answer 33

Promote normal development (interaction with peers/siblings may be most important intervention of all) EDUCATION of family on activities to prevent loss or ROM, facilitation of normal movement, and minimizing compensation EDUCATION (again) with care providers, teachers, coaches, etc. to promote inclusion

Question 34

What is the role of the PT in the Post-Prosthetic phase? (4)

Answer 34

Try to be involved in the selection of the prosthesis EDUCATION for donning and doffing of prosthesis Skin care and education with patient and/or family skin care and protection Promoting mobility with prosthesis

Question 35

What are 5 considerations for physical therapy?

Answer 35

``` Age and developmental level Body type Other medical management issues Family dynamics Interests ```

Question 36

What are 6 different prosthetic considerations?

Answer 36

``` Age and developmental considerations Strength and ROM Number and location of amputations Importance of cosmetics Activities/lifestyle Financial issues ```

Question 37

What are 7 considerations for Infants and Prosthetics?

Answer 37

``` ROM Developmental stimulation/positioning Include family - IMPORTANT! Encourage interaction with other infants Crawling, creeping Sitting balance Pull-to-stand (average 10-12 mo) - have to add LE pros. ```

Question 38

When do you introduce a child to a UE prosthesis?

Answer 38

When bilateral hand activities occur (3-4 mo. but could vary). Once you see unilateral activities occur, add UE pros. for bilateral activities.

Question 39

What are 4 considerations for Toddlers/Preschoolers and Prosthetics?

Answer 39

Pull-to-Stand (may have been delayed from infancy) Gait training Prosthetic training Family training

Question 40

How can you gait train with toddlers/preschoolers? (3)

Answer 40

With device, without prosthesis With device and prosthesis With prosthesis, without device

Question 41

What are 4 things you can train the family on if their toddler/preschooler has a prosthesis?

Answer 41

Limb shaping Don/doff Care of prosthesis Wearing schedules

Question 42

When along the age spectrum do you begin to involve a child in self-care of their prosthesis?

Answer 42

``` Elementary Age (8-10) -Don/doff/skin checks ```

Question 43

What are 6 considerations for elementary age kids and their prosthesis?

Answer 43

Growing prosthesis (kids grow fast) Environmental access (home/recreation; school/bus/playground/gym class) Begin to involve child in care! Adaptive equipment when appropriate Educate teacher and nurse on don/doff Can facilitate a classroom presentation with parents permission and typically child absent

Question 44

What are 4 considerations for adolescents and their prosthesis?

Answer 44

Should take on primary responsibility for prosthetic care (but may rebel!) May need more than one prosthesis to accommodate sports/special activities Peer support and opinion important Considerations for employment

Question 45

What are traumatic or new disease diagnosis for adolescents? (6)

Answer 45

Anger/psychological and psychosocial issues Phantom sensation issue Decreased trust of the prosthesis, changes in cog/balance May need wheelchair while awaiting healing Will need education: edema, positioning, healing Should be a part of setting goals

Question 46

What is the #1 cause of amputation in adults?

Answer 46

Disease (particularly diabetes and PVD)

Question 47

What are 3 considerations for adults and amputations?

Answer 47

Adult amputees are often multi medical pts Wound healing and closure may take increased time Childhood amputees grown into adults will experience same aging issues as everyone else