Progressive Habilitation Protocol for Bilateral Lower-Limb Amelia

MICHAEL SCHUCH, CPO**, BEV GRYTH, RPT, BOB VILLWOCK,AND MARY WILLIAMS CLARK, MDCharlottesville, Virginia


Habilitation of congenital amputees should parallel the developmental stages of normal children as closely as possible. Opportunities for sitting, crawling, pulling to stand, and progressive ambulation should be provided in a timely manner in conformance with individual developmental patterns. Prosthetic replacement of deficient limbs is part of management. The protocol for the congenital bilateral lower-limb amelic child is difficult because suitable prosthetic systems have not been available.

A child with multiple congenital deficiencies, including bilateral lower-limb amelia, was first seen at 10 months of age. During the last year his management has included three distinct prosthetic systems fitted at times dictated by his growth and functional development. The first system, a molded thermoplastic base mounted bucket, was followed by a parapodium-type standing frame with the bucket suspended above the base of support by lateral uprights, to place the child at an appropriate height for his age. To provide an opportunity for hip joint system from the LSU reciprocal gait orthosis, thigh-shank components, and SACH feet. He was discharged after training in swing-through and basic reciprocal gaits. Follow-up two months later revealed that he used a reciprocal gait pattern which was quite functional for his age and level of development, and heretofore unattainable with his limb deficiency.

**University of Virginia Medical Center, Box 467, Charlottesville, VA 22908