The Quadrimembral Limb-Deficient Child

LESLIE C. MEYER, MD, KAREN BOBALIK, RPT,JAMES LITTLE, RPT, AND CHERYL WITHROW, OT*Greenville, South Carolina


The quadrimembral limb-deficient child has significant absence or impairment of each of the four limbs interfering with effective function. Etiology, usually congenital, may be trauma or purpura fulminans. Thirty-two cases classified as longitudinal or transverse deficiencies were followed in an active clinic. Most past medical and family histories were negative. Transverse humeral and proximal femoral focal deficiency occurred most frequently, either unilaterally or bilaterally, often associated with other longitudinal deficiencies. The clinic's philosophy of habilitation of the child into the mainstream suggests:

  1. Early prosthetic and adaptive equipment fittings. Initial training should be instituted, as well as interim training for any significant prosthetic changes.
  2. Physicians, prosthetists, therapists and social workers should be storehouses of information. Therapists share ideas learned from other patients. The team provides the atmosphere for changes to occur for each patient.
  3. Most accept lower-limb prostheses but reject upper ones. The majority of patients, however, can use upper prostheses satisfactorily, especially those with bilateral above-elbow deficiencies.
  4. Parental education is essential for acceptance and pursuit of independence for their child.
  5. Parental and patient ingenuity and innovations are tremendous.
  6. All are average children who are very socially adept and have physically adapted to their environment.

*Shriners Hospital for Crippled Children, 2100 North Pleasantburg Drive, Greenville, SC 29609-3194