An abstract and a summary

(The following is a brief abstract of an article entitled The Physical Therapist's Responsibility to the Lower Extremity Child Amputee, which appeared in the October, 1961 (Vol.41, No.10) issue of The Physical Therapy Review. The article was written by Betty Kitabayashi, research physical therapist, Child Amputee Prosthetics Project, University of California at Los Angeles.)

A comprehensive research program conducted by the Child Amputee Prosthetics Project of the University of California at Los Angeles has studied many aspects of the total treatment program for the child amputee. Contrary to procedures established with adult amputees, the child must be followed closely by all members of the research team over a period of many years.

Close supervision of the fit and a-lignment of the prosthesis is necessary due to rates of growth and development and differences in walking patterns at various age levels. The CAPP staff found that the child who does not have two points of support when attempting to stand has great difficulty achieving the balance and actual reciprocation needed for walking. Accordingly, it is advisable that a prosthesis be fabricated as soon as the child shows signs of wanting to pull himself up to a standing position.

Pre-Fitting Preparations

Thorough physical examinations, which include muscle tests, range of motion tests, X-rays and orthopedic consultations, are given each child prior to, and periodically after fitting. Psychological preparation of the parents for acceptance of the child's disability and the prosthesis is essential. It has been found that the attitude of parents is the key to the child's acceptance of his disability and the use of his prosthesis.

It has become increasingly evident that information derived from adult studies is not always applicable to the pre-school child amputee. Scaled down adult components and "standard" techniques of alignment must often be altered to meet the specialized requirements of the gait patterns and posture of youngsters. Training techniques must utilize play activities based upon the child's neuromuscular maturations.

The article stresses the role of the physical therapist in preventing deformities and training the child in the use of his prosthesis. It sheds light on the difficulties pertaining to the juvenile amputee population and points out areas in need of research and investigation.

(The following is a summary of a report entitled Amputation and Prosthesis as Definitive Treatment in Congenital Absence of the Fibula, read by Dr. Leon M. Kruger and Dr. Richard D. Talbott, of the Shriners' Hospital for Crippled Children, Springfield, Mass., at the Annual Meeting of the American Academy of Orthopedic Surgeons, January 13, 1961 at Miami Beach, Florida. The report appeared in the July 1961 (Vol. 43-A, No. 5) issue of The Journal of Bone and Joint Surgery)

This is a report on sixty-two instances of congenitally absent fibula in forty-eight patients treated at the Shriners Hospital for Crippled Children in Springfield between 1925 and 1960. Etiology and clinical picture of the deformity are described. A review of treatment of these sixty-two instances is presented, emphasizing that prior to 1950 treatment was practically always conservative, with amputation reserved as a last resort and carried out in only five patients. Subsequent to 1950, however, twenty children with this anomaly were treated by amputation and a prosthesis.

Leg Length Discrepancy

Leg length discrepancy is emphasized as the major deforming factor in these patients and the major indication for amputation. The authors feel that leg length discrepancy in these unilateral cases is a progressive discrepancy, that one should be extremely wary of efforts to equalize leg lengths of three inches or more, and that except in the unusual case, the discrepancy will progress to at least three inches by the time the child is three to seven years of age. Uniform success in prosthetic acceptance and utilization is reported. Eight cases are reported in detail, including the only individual treated successfully by conservative means without amputation.