Development of Upper-Extremity Myoelectric Training Methods for Preschool Congenital Amputees
S. HUBBARD, R. KOHEIL, H. HEGER, H. R. GALWAYAND M. MILNER*Toronto, Ontario
The Ontario Crippled Children's Centre has completed a two-year research project designed to develop effective strategies for training the preschool child to use a myoelectric prosthesis. Two training protocols were developed: one, home-based with the parent as primary trainer and the other, a Centre-based program with the therapist as the trainer. The primary aim of the study was to compare the cost effectiveness of the two protocols.
Seventeen children have been wearing myoelectrically controlled prostheses for periods ranging from 12-15 months. Sixteen subjects were able to use Otto Bock controls with a Swedish hand while one child required a University of New Brunswick control system.
A functional evaluation was carried out on a one-month, three-month and six-month review basis. Comparison of the total test scores for each group revealed that both training protocols were equally effective, proving that informed parents can assume responsibility for the training of their children and achieve the same efficacy as therapists. The parent-training protocol also proved to be cost-saving when compared with therapist training. Five times as many therapy hours were devoted to the therapist-trained group.
As a result of the study, effective training strategies have been developed which can now be used in routine clinical service. In addition, a manual has been prepared to provide training guidelines for parents at home.
The training protocol allowed for the use of adapted electrical toys and the Swedish training hand. The toy interface and modified toys that were developed for the project have proven useful in training and reliable for home use. An assortment of training aids is essential in order to capture and maintain the varied interests of the preschool child.
Age is not necessarily a determinant of the amount of time required for training. Adaptation to the prosthesis and daily wearing patterns varied considerably among the children. The follow-up reveals one child who rejected the prosthesis, one having limited use and the rest continuing as full-time wearers.
Functional assessment of the children's abilities with their prostheses is very impressive; however, long-term studies are indicated for adequate assessment of the cost effectiveness of early myoelectric fitting.
We gratefully acknowledge the support of the Hospital for Sick Children Foundation and the War Amputations of Canada for this work.
*Ontario Crippled Children's Centre, 350 Rumsey Road, Toronto, Ontario M4G 1R8 Canada