ATLANTIC CITY, NJ — Practitioners who fit pediatric amputees for prosthetic devices should remember to focus on, and accommodate, their patients’ anticipated growth as they age to improve outcomes, according to Jackie Valdez, BSc, CO, BOCP, FAAOP, clinical education specialist for Fillauer.
Speaking at the New Jersey Chapter of the American Academy of Orthotists and Prosthetists (NJAAOP) Annual Meeting, Valdez said that, when a child is very young, it is important to construct and use sockets that are flexible and accommodate circumferential growth.
“Growth is a huge factor, and we must be able to accommodate for that growth over time,” Valdez said. “When you’re working on and building a socket, are you going to think about what you are doing, whether you are going to use silicone liners or not, because as you know, within 6 months our kids might be back for some changes. I heard at one point that some insurance companies were going to provide one socket per lifetime. How is that going to work for a child who hasn’t even hit those growth spurts, who is not skeletally mature? We need to make sure we are doing what we can to make sure these patients get what they need.”
According to Valdez, 60% of childhood amputations are congenital in origin and 40% are “acquired amputations” that are secondary to either trauma or disease. For such young children, Valdez said the key principals of amputation are to preserve as much length in the residual limb as possible, as well as the growth plates, to disarticulate wherever possible, and to preserve the knee joint whenever possible.
For O&P practitioners, Valdez stressed the importance of designing around the needs of the pediatric patient, taking into account the functionality and sustainability of the device, as well as the weight, independence and skeletal maturity of the child.
In addition, it is important to work with the patient’s doctor to produce the correct prescription.
“I had a doctor that I worked with a number of years ago that insisted that I made a device from polyethylene — he wrote out all these prescriptions for polyethylene,” Valdez said. “However, that’s not really what he wanted — he wanted polypropylene — but the prescription said polyethylene. So, I met with him and went through all the different materials with him. It is hard to change a prescription, so if you have an opportunity to meet with your doctor and go through the materials, you should, because they can be very precise with their prescriptions.” – by Jason Laday
Valdez J. Restoring function: Just let me be a kid: Critical thinking for better pediatric outcomes. Presented at: New Jersey Chapter of the American Academy of Orthotists and Prosthetists Annual Meeting; Nov. 9, 2017; Atlantic City, New Jersey.
Disclosure: Valdez reports employment with Fillauer.