PT Intervention for Child with Limb Deficiency or Acquired Amputation Flashcards
Team/Goals/Exam
Parents play integral role in rehab team
Goals for PT: facilitate normal sequence of development, minimize developmental impairments/activity limitations/participation restrictions, prevention of contractures, minimize mm imbalances, prevent skin breakdown, develop independence in mobility and ADLs
- intensity of PT depends on- child’s age, type of limb deficiency, level of amp, and other medical factors influence PT
- impairments- joint contractures, weakness, reduced mobility, decreased indep with ADLs
Exam- follow guide to PT practice
- look at joint integrity, mobility, ROM, integumentary integrity, gait, balance neuromotor development, aerobic capacity/ endurance, community/work integration, self care
Functional outcome measures:
- The child amputee prosthetics project- functional status inventory (CAPP-FSI)- looks at 40 activities on 2 scales to determine whether the child performs that activity with or without a prosthesis, also rated for severity of limb loss—good reliability, used for children 4-7 and toddlers 1-4 (CAPP-FSIT)
Functional mobility assessment- used and validated for children and young adults with osteosarcoma
- looks at 6 categories (pain, function TUGS/TUG, use of support/AD, satisfaction with quality of walking, participation, endurance with 9MWT)
Infancy/Toddler
PT provide info regarding positioning and ROM
Children with multiple limb deficiencies or ue deficiencies tend to be more delayed–difficulty crawling, pulling up, pushing up to sitting
PT- monitor developmental progress, ROM and strength needed for later prosthetic use
- monitor ROM, strength, WB capabilities, posture in prone, sitting, standing
- –will often bear weight asymmetrically in prone and sitting— encourage weight shifting activities
Generally infants with congenital deficiency do not develop contractures after birth–ROM education still important especially in those with PFFD
Usually fitted for prosthetic when it is developmentally appropriate
- LE- fitted when WB is appropriate and when beginning to pull to stand (8-10m)
- UE- Can be fitted as early as 3 m, typically fitted at 5-7 m when they are able to sit indep
Assess fit and function after receiving prosthetic, instruct parents on how to don/doff, check skin, wearing schedule
- initial goal for child to wear for as many hours as possible—removed for naps and sleeping at night
- -Child with ue prosthesis may initialy ignore it– focus PT on wearing prosthetic and functionally playing–may have several terminal device options (may initially have a passive hand and as become more engaged in bimanual activities switch to body powered or external powered)
Children are not expected to operate terminal device until 18m or later when they understand simple commands and cause/effect. Training depends of childs level of development
Children younger than 2 w/lower limb deficiency or AKA- typically fitted with prosthetic without a knee– goal to start WB and progress learning to control knee when child is closer to 3
GOALS: symmetrical posture and movement, proper alignment and weight shifts and balance activities
May initially need AD for upright posture and promotion of reciprocal gait pattern
Preschool/School Age
Be sensitive to parent/child anxieties about school
UE- should be able to activate terminal device at this age
Emphasis on learning skills appropriate for age
LE- should be functional ambulators at this age
- BKA- should be wearing prosthetic most of day
- AKA- should be ready to begin ambulation with prosthetic around 3y/o
PFFD- arthrodesis of knee at 2.5-4 y/o
Trauma- can be fitted with immediate fit prosthesis depending on severity
Rotationplasty- preserve ankle ROM, will be casted after surgery
- must have 0-10d DF for sitting and ambulation, PF must be 45-50d
Children undergoing limb sparing will also need PT
Gait training- symmetry, normalization of gait pattern, participation in age appropriate activities, additionally teach running
Bilateral ue deficiencies- may need to use tape recorder or computer assist for writing- may opt to use feet for grasping
Adolescence and Transition to adulthood
Restrictions may become more apparent in adolescence
Psychosocial issues- more behavioral and emotional problems in children with congenital deficiency. More depression, grieving if teen gets amp
PT- teens more likely to develop edema– important to use wrap or shrinker
High AKA- opt for crutches and no prosthetic bc they are faster and more energy efficient
UE- body or external powered
Driving- hand controls for LE amp
- minimal adjustments needed for unilateral UE amp
