Prosthesis For The Child-Research Notes
Harry E. Campbell, C.P.†
Editor's Note: This report on current research is reprinted by permission from the Third Annual Report, 1957, of the Child Amputee Prosthetics Project (Department of Pediatrics, School of Medicine, University of California at Los Angeles.)
A systematic approach to the fabricating, fitting, and maintaining of prostheses for child amputees is beginning to evolve from the experience at the CAPP. Questions frequently asked of the prosthetist include: How frequently does a new prosthesis have to be made for a growing child? What components of a prosthesis have to be replaced because of malfunction or damage? How can a prosthesis be made to last longer? How do you fit the malformed child? What special devices can be provided the child amputee so he can enjoy more fully the activities engaged in by other children? These and many other questions have formed the basis for the present methods of data collection and of experimental studies.
Methods of Recording Data
In order to secure information relating to the need for prosthesis and component repair or replacement, two methods of tabulation are in use:
- Prosthesis History Card-In addition to the identifying information of each child, the following data are recorded on each card: prescription, date of prescription, date of wrap, date of final fitting, date of check-out. date of photos, and the type of terminal device, wrist unit, elbow unit, etc., where applicable. This card is set up to record this information on five prostheses with space available for other pertinent data, including modifications.
- Adjustment Frequency Tabulation Card-A system that provides information concerning prosthetic experience by age groups, amputee types, frequency and nature of adjustments. It is from this system that predictive information can be utilized in determining the need for replacement and repair of prostheses and components by age groups and amputee types.
For more than a year and a half prostheses, described as standard, have been fabricated for the CAPP patients by private limb makers. This procedure has meant that the prosthetist's time and effort has been devoted to the refinement and development of methods for fitting the more complex types of amputations and malformations. The following examples in no way represent the extent of the work with these special problems, but are only illustrative of some of the approaches in meeting the needs of these children.
Elbow-lock Mechanisms for Phocomelias-In several of our phocomelias it has been found advantageous to use finger flexion for elbow lock control. The nature of the malformation of the musculature or the absence of some of the muscles has resulted in limited sources of power and limited ranges of motion for the operation of prosthetic devices.
A 16 year old girl with bilateral upper extremity phocomelias was initially fitted two years ago. She was fitted with modified short above elbow type prostheses because of poor shoulder function. Elbow lock control was achieved by a cable loop through which she could insert her fingers. Active finger flexion through this loop connected to standard cable control, tripped the mechanism to lock and unlock the joint, (
Modification of such finger control is possible to meet the demands of individual cases, (
a rod and lever mechanism activated by finger flexion was used to activate the elbow lock. With another patient wearing a child's external elbow joint, activation of the elbow is obtained by finger flexion against a single push rod mechanism instead of through cable pull, (
Harness Application-The need to stabilize the prosthesis in order to provide function for an above-elbow amputee who was quite obese produced modifications of the standard type of harnessing, (
Walking Mechanism for a Bilateral Lower Extremity Amelia-A six-year-old girl who is a congenital bilateral above elbow amputee and bilateral lower extremity amelia had been furnished with standard above elbow prostheses. For her lower extremities she was initially provided with a bucket type pelvic platform set on two stubby legs. By alternate pelvic rotation and without crutches, she could ambulate in the house quite well. A pair of Canadian hip disarticulation prostheses were later substituted. With the free knee she lacked stability and could not ambulate independently. The research group from the University of California at Berkeley devised a prosthesis that would provide the beginning steps in ambulation, A modification of the Canadian hip disarticulation prosthesis was used, (
The advantage of this type of device is that prosthetic function is initiated by spine flexion and moving the center of gravity forward, rather than rotating the pelvis. For details of biomechanics, fabrication, and fitting of this type of prosthesis, see articles by Radcliffe, C. W. (Page 29) and Foort, J. (Page 39) in Volume 4 of Artificial Limbs, Autumn 1957.
Canted Shoulder plates - The conventional canted shoulder plates for a shoulder disarticulation prosthesis permit flexion at the shoulder in a sagittal plane. It has been demonstrated that abduction combined with flexion to bring the elbow forward and out places the elbow and hand in a more favorable functional position. One forequarter and several shoulder disarticulation amputees have been fitted with this type of shoulder plate, externally rotated 20 degrees from the sagittal plane (
The more active prosthesis users are motivated to make use of their prosthetic skill beyond the usual self-care, education, and vocational activities. They request help with the development of special devices and contribute ideas as to the ways in which they believe these devices can be developed.
Swim fins, violin bow holders, baseball mitts are included among these special devices. Illustrated and described below are some of these special devices developed during this past year.
Pistol Attachment Device
An 18 year old boy with bilateral long below elbow amputations, who had been an adept prosthesis user for 3 years, requested an instrument which would enable him to shoot a target pistol. A standard 22 Colt pistol on a 38 frame was modified in our laboratory for this patient. The grips were removed and replaced with specially constructed grips of laminated plastic with glass reinforcement, (A in
). A housing containing a threaded stainless steel insert was incorporated into the left side grip. The pistol was firmly affixed to the prosthesis by means of a 1/2" threaded stainless steel rod, (B in
). By a special trigger attachment an adapter was led from the cable end to trigger, (C in
). Tension on the cable fires the weapon.
A fifteen year old girl with a very short below elbow amputation, who had been an excellent prosthetic user for three years, requested a swim fin to improve her swimming ability. This was supplied in May 1957. The device consists of a laminated plastic fin reinforced with glass cloth and nylon stockinette, (
). This was fitted to a standard VA 600 wrist unit, which was incorporated in a short below elbow socket. The socket is secured to the arm by a [link 8] strap around the lower arm.