Week 4-Pediatrics Flashcards
What is an example of habilitation?
congenital deficiency or really young amputees.
What is an example of rehabilitation?
acquired amputations
What are the three different development indicators?
motor skills and milestones
physical growth
psychosocial
Who are the training goals for?
parents and patients
What are the two different classifications for amputations?
transverse
longitudinal
What is a transverse classification?
nothing exists below a certain point
What is a longitudinal classification?
reduction or absence of aspects in the longitudinal axis
What is phocomelia?
Distal segments are attached to the torso
What is amelia?
complete absence of the limb
What is hemimelia?
partial absence of the limb
What is the percent of congential pediatric patients?
73%
What is the percent of malignancy in pediatric patients?
9%
What is the percent of trauma causing pediatric amputation?
8%
What is the percent of bone infection in pediatric patients?
4%
What is the percent of other pathologies causing amputations in pediatric patients?
6%
What is the percent of 1,000 live births in the U.S have amputations?
.3-1%
How many children are affected with amputations each year?
15,000-45,000
What percent of children have upper limb deficiencies?
58.5%
What is the definition of milestone?
Predictable sequence of motor skill development, marking the achievement of important functional abilities.
What could be a reason for not reaching a milestone?
May have altered milestone that looks different and so is preceived as not reaching the milestone
What must be planned for in the prosthetic design?
Comfort
Symmetrical limb length
Use pelite liner-easy to mold and add to
What is the age range for infants?
0-12 months
What is being increased during infancy?
function strength gross motion coordination interest ROM Patterns
How often should a preschooler be schedules?
At least every year, usually every few months
How often should grade school patients be scheduled?
every 12-18 months
How often should high school students be scheduled?
18-24 months
What are some fit issues?
slipping in and out of socket
pistoning
pain
skin reddening
flesh rolls around prox/med side of socket
callous/blister
flesh rolls around prox brim for femorals
What is an optimal psychosocial environment?
whole-some environment and interactive experience
treating family and patient together
What is important psychosocially for infant patients?
early referral so family is shown possibilities to provide hope and less despair
What is the age range for toddlers?
1-3 years
What is developing for toddlers?
language playing with others mobility emotional development spatial awareness
What will help toddlers develop?
Doll play
What is important for school-aged children psychosocially?
don't inhibit make them try encourage creativity social connections thick skin and better body image
What is important for older age children psychosocially?
peer groups
counseling
social adjustment
acceptance of themselves
What can occur for patients who acquire an amputation during high school?
depression
time of mourning for their limb
What are the training goals for infant patients?
Comfort
Tolerance
Ability to stand and lean against a table
Ability to cruise around furniture
Ability to walk with and without assistance
What are the training goals for infant parents?
Be able to apply and remove device
Care for the skin
Care for the prosthesis
Recognize and report any problems
What are the training goals for toddler patients?
Full-time wear of the device, except for bathing and sleep
Use of the device for age appropriate ambulation activities
What are the training goals for toddler parents?
Encourage use of the device
Provide toys and an environment to stimulate and foster
age appropriate behavior and activities
Inspect and care for skin and report problems
What are the training goals for school age patients?
Monitoring and maintaining proper fit
Inspect and care for skin
Donning and doffing the deviceindependently
Dressing independently
Engaging in the full range of ambulation activities with the device
Recognizing when the device needs maintenance and repairs
What are the training goals for school age parents?
Encourage independence
Provide opportunities to participate in sports
What are the options for a first TT prosthesis?
SACH, thigh corset, silicon socket, COMFORT
What are the options for a first TF prosthesis?
Locked knee, SACH, waist belt, COMFORT
What are some other devices that can be used for a pediatric prosthesis?
Dynamic response feet, liners, polycentric knees
In the Uterus, what is the shape of the spine?
C-shaped
What strengthens the spine?
The Steps of development
What needs to be strengthened to help establish balance for sitting?
core muscles and neck muscles
What does crawling help develop?
vestibular system
What are the levels of foot deficiencies?
Toe and Longitudinal Partial Ray
Transmetatarsal
Lisfranc
Chopart
What is present for a chopart amputation?
talas and calcaneous
What are the prosthetic options for foot deficiencies?
toe fillers
soft silicone boots
carbon foot plates and posterior shells can assist ambulation
What can foot deficiencies result in?
hypermobility of the ankle joint
What are the different fibular deficiency classification systems?
Achterman & Kalamchi Classifications-bowing of the tibia and the % of fibula left
Letts Classification-comparing to sound side
Birch Classification-% of foot function remaining
What is required to see seriousness of deformity?
X-ray
What are treatment options for fibular deficiencies?
shoe lift
equinus device with prosthetic foot
leg lengthening procedures (epiphoseal-less than 5cm, Ilizerob procedure-5-10cm)
When can lengthening surgery be performed?
At the ages of 3-13 years
When should foot amputations occur for fibular deficiencies?
When the foot is not useful or the ankle is unstable.
What are the different options for foot stability?
Boyd-fuse ankle
Symes-remove foot
What are the prosthetic options for fibular deficiencies?
Symes
Step-in prosthesis
standard prosthesis
What are the different classification for tibial deficiencies?
Jones Classification-use X-rays and the outcome that is greatest effective, the ability of knee joint, extension power, leg length, extent of foot present
Kalamchi & Dawe-Same as Jones but with knee flexion contracture present, and foot deformity
The goal in mind for treatment options for tibial deficiencies is?
functional optimization of the limb
When will a knee disarticulation be performed for tibial deficiency patients?
When there is no extensor power
When will a symes procedure be performed for a tibia deficiency patient?
When the proximal tibial is present with good quad function
When will they try and keep the ankle for tibia deficiency patients?
When the proximal tibia and distal tibia are present and foot and ankle are able to function.
What does PFFD stand for?
Proximal Focal Femoral Disorder
What can also be used for PFFD?
Longitudinal Deficiency of the Femur, Partial (LDFP)
What is PFFD/LDFP?
The complex congenital absence of part or all of the femur that is associated with other limb soft tissue and osseous abnormlaities
What are the classifications of femoral deficiency?
Aitken Classification-femor development
Fixsen & Lloyd-Roberts-X-rays and friction of femur, location of femur shaft, and nature of acetabulum.
What is the clinical presentation of fibular deficiencies?
Shortened lower limb
Thick, funnel shaped thigh
Common: Fibular deficiency
Common: Foot deformity
What is the common position of femoral deficiencies?
Flexed
Abducted
Externally rotated
What other issues can be present for femoral deficiency patients?
spine
heart
upper limb deformities
contractures
What are the treatment options for femoral deficiencies?
Shoe lift, stabilize ankle Fuse knee Rotationplasty-fuse knee to hip with foot backwards ankle disarticulation limb reconstruction
What is required for limb reconstruction?
muscle strength
stable knee
functional foot
What are the prosthetic options available?
disartiuclated foot
transtibial with side joint and thigh lacer
transfemoral prosthesis
What often occurs with pediatric device treatment
A combination of orthotic and prosthetic devices
What is the device recommendation for Partial Foot?
plastic AFO with padded toe
What is the device recommendation for Fibular Deficiency
PTB or TSB design with
protective padding
What is the device recommendation forTibial Deficiency?
Knee disarticulation/Transfemoral, symes with/out SJTL, Transtibial with/out SJTL
What must be considered for component selelction?
weight
growth
activity
What is the 3R38 Aluminum?
Modular Single Axis Knee Joint 3R38 from Otto Bock
Lightweight aluminum single axis, pediatric knee
with proximal adjustment pyramid and distal
tube clamp.
What is the 3R65 Aluminum?
Hydraulic swing phase control, Integrated
terminal dampening, Dynamic adaptation to
various walking speeds, Adjustable
What is the 3R66 Aluminum?
Modular Knee Joint with Integrated Rotation 3R66 from Otto Bock.
Integrated rotation unit allows the
prosthetic foot to be rotated up to 90°, Large flexion angle of 165°, Allows users to kneel and crouch with ease, Adjustable
What is the 1E66 | Children’s Springlite® II?
crafted of carbon fiber that offers good energy return. Its pylon design provides additional flexibility that is well-suited to a
child’s activity level.
What is the 1E79 Children’s SL Profile of Otto Bock.?
A lightweight carbon foot with extremely low clearance, ideal for Symes amputees.
What is the 1K10?
A durable, dynamic foot with a natural shape, smooth surface, and formed toes. The contoured core design and the use of foams deliver a softer heel strike.
What is the 1K30 | Children’s SACH Foot?
A robust prosthesis foot adapted for the special needs of young prosthesis wearers. It has a natural shape, smooth surface, and formed toes.
What is the 1S30 Children’s SACH Foot of Otto Bock?
Is constructed in two sections and is especially suitable for younger children who require a stable foot. The sole of the SACH foot is replaceable
What are 8 other pediatric components?
Cheetah Junior Cheetah Xplore junior Flex-foot junior vari-flex junior total knee junior Iceross Dermo junior Iceross stabilo Junior icelock 700 series
