Although this questionnaire did not cover the various facets of rehabilitation as well as had been hoped for, it revealed some interesting findings.
Greater stress should be placed on prevention, since the largest number of amputations were on a traumatic basis.
Definite conclusions could not be made about surgical treatment. However, the need for further study of growth patterns was definitely indicated. It was noted that although time greatest number of revisions were in the children with amputations below the knee, most of these were done for the acquired amputations due to trauma, malignant growth, and disease; very few revisions were done in the below-the-knee conversion amputations of congenitally anomalous lower extremities.
After the necessary surgery, aftereare of the stump is very important. Physical therapy to maintain, or obtain, full range of motion in the remaining joints is often started before surgery. Bandaging the stump to reduce induration and edema and to shape the stump is recommended. This study reveals the need to stress and to review instructions in stump hygiene with the patient and parents.
More investigation is needed as to the age when a child should be fitted with a prosthesis and the age when training should begin. Most physicians associated with amputee services recommend that a prosthesis be fitted at the earliest possible age, providing that the child is physically, emotionally, socially, and mentally ready. All agree that when a child with a lower-extremity amputation is ready to walk, he is ready for a prosthesis. If the amputation is acquired, the youngster should be fitted with a prosthesis as soon as the stump is in good condition.
There seems to be no universal agreement as to what is time earliest possible age for an upper-extremity prosthesis to be fitted. Passive prostheses have been put on children at about 4 to 6 months of age to teach them to hold or push an object against the normal hand and gross grasping, such as holding a nursing bottle; to have the child become accustomed to the added length of the stump; to encourage the youngster to tolerate an appliance; and to help in functional activities. Recommendations for fitting with a prosthesis depend on the child's development rather than his age.
Further investigation of the influence of the hand which is dominant seemed to be indicated.
The child with amputation above the elbow is as good a prosthesis wearer and user, within the limits of his increased handicap, as the child with below-the-elbow amputations.
The fitting of children with upper-extremity amputations with a hand terminal device did not improve their adjustment to the prosthesis. It has been our experience, with rare exception, that the anticipation of getting a hand is greater than the realization.
Children with lower-extremity amputations and those with traumatic amputations below the elbow wore their prostheses whether or not they had had training. However, training was very important to the adjustment to the prosthesis of the child with amputations above the elbow. Children with congenital below-the-elbow amputations were the poorest prosthesis wearers. This is not meant to imply that training is not important to all groups. Rather, it points out that some types of amputees find their prosthesis helpful to them whether or not they have had training. The initial preparation did not seem to be adequate for children with congenital below-the-elbow amputations. Perhaps they need a different approach or a different method of training. It may be that earlier fitting with a prosthesis, as is now done, may resolve this problem. It was definitely found that this group of children showed the best results when fitted with a prosthesis before they were 5 years of age.
The child's evaluation of himself, his parents' evaluation, and the attitude of the whole population were brought out repeatedly in these questionnaires as being very important factors in his rehabilitation.
The study also revealed the need for greater dissemination of the available information to the many disciplines concerned with the rehabilitation of the child amputee.
Copyright 1959 by The Journal of Bone and Joint Surgery, Incorporated