Prostheses Less Effective in Children With Unilateral Congenital Below Elbow Deficiency

From the beginning of infancy, children with unilateral congenital below-elbow deficiency use their short limb as an exploratory, manipulatory and fixing tool. However, prosthetic use may lead to less effective performance, according to a study published in Early Human Development.

“The purpose of this study was to explore the use of the affected upper limb in young children with unilateral congenital below elbow deficiency (UCBED) with and without prosthesis during daily life activities because information on the development of the use of the affected limb of young children with UCBED with and without prosthesis was virtually lacking,” Mijna Hadders-Algra MD, PhD, professor of developmental neurology at Beatrix Children’s Hospital of the University Medical Center Groningen, Groningen, The Netherlands, told O&P Business News.

Play sessions with, without prosthesis

Researchers assessed four children with UCBED with a video-recorded, standardized 20-to 30-minute play session and a neurological examination every 6 months to 8 months at the University Medical Center Groningen. The children who were fitted with prostheses played half the session wearing the prosthesis and the other half without. Annually, researchers evaluated the children’s functioning in daily activities using the Pediatric Evaluation of Disability Inventory — Dutch Version (PEDI-NL).

Study results showed that all children efficiently used their affected arm during spontaneous play by manipulating toys, holding objects between the affected arm and trunk and for crawling. Three of four of the children consistently used the affected arm to get up from the floor when they developed the ability to stand up, while the remaining child only used the affected arm occasionally to get up. However, after the age of 34 months, researchers found that none of the children used their arms to get up from the floor.

When the prosthesis was in use, the arm was sometimes used for manipulation and holding an object, but on other occasions, the arm with the prosthesis was neglected. The children with prosthesis showed less exploration when wearing the prosthesis vs. without the prosthesis, according to the researchers.

All children had typical functional capabilities in self-care, mobility and social functioning, according to PEDI-NL, but three children showed minor neurological dysfunction.

“The study showed that infants with UCBED during specific phases of development may profit from a prosthesis; infants with UCBED use the affected limb frequently for object exploration and wearing of a prosthesis interfered with this exploration; and functional skills in daily life of young children with UCBED — with or without prosthesis — were well in the normal age-specific range,” Hadders-Algra said.

Future studies

According to the researchers, “this small and explorative study did not provide evidence for the idea that young children are functionally better when they are provided with prosthesis at early age.”

Since prosthesis use has many advantages and disadvantages in children with UCBED, Hadders-Algra and colleagues are continuing their research with longitudinal data collection of young children with UCBED.

“We are conducting several studies among upper limb reduction deficiencies and acquired upper limb amputations,” C.K. van der Sluis MD, PhD, professor of rehabilitation medicine at the department of rehabilitation medicine of the University Medical Center Groningen, said. “Some main research topics include training with myo-electric prostheses and overuse syndromes in upper limb amputees.”

For more information:
Hadders-Algra M, Reinders-Messelink HA, Huizing K, et al. Use and functioning of the affected limb in children with unilateral congenital below-elbow deficiency during infancy and preschool age: a longitudinal observational multiple case study. Early Hum Dev. Aug. 2, 2012. [Epub ahead of print]

Disclosure: Hadders-Algra and van der Sluis have no relevant financial disclosures. This study was supported by the University Medical Center Groningen.

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