An Evaluation of the 1970 Summer Training Program for Children with Upper-Extremity Amputations

Elaine Trefler, P. & O.T. Reg., B.A.O.T.


Introduction

Children with unilateral upper-extremity lower-level amputations are often considered to be minimally handicapped. They attend normal schools and camps, they are able to participate in almost all sports activities, and sucess-fully pursue a large variety of occupations.

Because their disability is so obvious, they frequently suffer the humiliation of questioning stares and being called such names as "Captain Hook." Many shrug off the comments and ignore the taunts thrown their way, others explain the reason for the hook or prosthetic hand and show how it works. But some children cannot cope with the problem of being different. They withdraw, or rebel, or overreact.

At the Ontario Crippled Children's Centre the occupational therapy staff undertook an exploration of this problem area with a view to ascertaining what help could be offered to these children.

Approach

Two methods of approach were considered:

  1. Direct intervention: this method would entail using the occupational therapist in individual treatment sessions in conjunction with psychological counseling.
  2. Direct approach: this method would involve organizing a carefully planned summer day-camp program for a group of children all with upper-extremity amputations. The staff would act as participating observers.

The latter approach was taken.

Program Aims

  1. To give the children an opportunity to see, meet, talk to, and play with other children their own age who had similar disabilities and problems.
  2. To increase spontaneous use of their prostheses in a variety of activities.
  3. To promote a sense of individual worth and healthy competition among the children.

Program Participants

There were eight children-three girls and five boys between the ages of seven and eleven. Seven children had below-elbow amputations and one child had a below-wrist amputation (adactylia). Seven children were congenital amputees and one child had an acquired amputation. All but two children were known to have some difficulty in the operation of their prosthesis and/or its acceptance.

Staff

The staff consisted of two members of the recreation staff, two social caseworkers, an occupational therapist and, as the occasion warranted, a photographer. The occupational therapist was the program coordinator. She was also responsible for the pre-camp prosthetics orientation of the other staff members. The recreation staff planned and carried out the day-to-day program. The Social Service personnel were present at the group discussions but unfortunately, because of lack of time, were able to see only a few children individually. The photographer documented the entire program with an excellent series of slides.

Program

Swimming, gymnastics, nature study, carpentry, apartment activities including cooking, cleaning, and shopping, arts and crafts, archery, rifle shooting, a day's visit to a summer cottage out in the country, and an overnight sleep-out were some of the activities included in the program.

The children had picnic lunches every day, and participated in special day events at the Centre. On the next to last day of the camp the children invited their parents for dinner. This provided an excellent opportunity for the staff to hear the children give their reactions to the program and to listen to the common problems they discussed, especially those centred around school. This was the first time the parents had had an opportunity to share their concerns and perhaps learn from others.

Parents' Evaluation

The parents were asked for their evaluation of the program. They were in agreement that the summer program was most beneficial and that they would like to see it continued in future years. One parent commented that her child had never noticed that "girls have hooks too." Many parents took the time to write personal letters to the staff asking that their children be considered as applicants should the program be continued the following summer. During discussions with the parents' group, it became obvious that the most pertinent problems were in the area of the schools and the attitudes of teachers and pupils towards the child who was wearing an artificial limb. One mother suggested to the others that they visit the school well in advance of the first day and discuss any potential problems with the teacher to avoid the development of future crises.

Staff Evaluation

The separate detailed staff evaluations indicated that the pilot Summer Training Program was very successful and recommended that the activity be continued the following year.

Recommendations

  1. It was felt that the summer program should be extended to cover a period of three or four weeks since the children had only just begun to communicate with each other nicely after two weeks.
  2. The number of children in the program should be expanded to a total of about fifteen boys and girls combined, with different levels of amputations, between the ages of seven and eleven years.
  3. Either the Social Service or the Psychology Department should provide one full-time staff member who would be able to follow up the group discussions with individual sessions when necessary.
  4. More thorough orientation concerning the abilities, disabilities, and particular problems of the juvenile amputee for non-therapy staff members should be provided.
  5. Parents should be offered the opportunity to participate in post-camp group discussions. Many had never before had the opportunity to discuss apprehensions, difficulties, etc., with other adults who had similar problems.

Observations

What the therapist sees and hears pertaining to functional prosthetic use in a pre-clinic assessment and what she sees during a two-week Summer Training Program often varies considerably. Some children actually would not go to sleep at night without their prostheses on. Others incorporated the prosthesis in all daily activities. Others were constantly forgetting their prostheses, or stump socks, or found any excuse not to wear their arms.

After the two-week period of observation, the therapist was able to give the clinic team, with confidence, a realistic report concerning the skill and spontaneity, or lack of it, in use of the prostheses by the children.

Conclusions

All the children enjoyed and benefited from the Day Camp Recreation Program.

Staff observations indicated that one child was urgently in need of psychiatric assistance. This was brought to the attention of the parents and they have since made arrangements to get the necessary help. One child needed further social stimulation and exposure to a recreation program. Arrangements were made for him to attend the OCCC recreation program for the remainder of the summer.

The staff acquired deeper insights into the types of activities in which children with amputations can and do participate. Staff members are now more cognisant of the social and psychological problems encountered by juvenile amputees, and will be able to work more realistically with the children, their parents, and the community.

The parents benefited from seeing their children happily engaged in activities with their peers and seemed to appreciate the opportunity for group discussion.

Finally, children with social and/or psychological problems related to their upper-extremity amputations benefited from participation in the type of day-camp program offered.

Aftermath

At the time this article was written plans were being made to continue the program during the summer of 1971. Eighteen children were to attend for a period of three weeks.

Ontario Crippled Children's Centre Toronto 350, Ontario, Canada