The Quadrimembral Limb-Deficient Child
KAREN BOBALIK, RPT* Greenville, South Carolina
The quadrimembral limb-deficient child has significant impairment of all limbs, resulting from congenital loss, trauma, or purpura fulminans. Thirty-two such children were followed, and their deficiencies classified. Past histories were usually negative and family histories non-contributory, except for one set of twins, both with multiple anomalies. The most frequent upper-limb anomaly was transverse humeral deficiency. In the lower limbs, proximal femoral focal deficiency occurred most often, either unilaterally or bilaterally, and was frequently associated with other longitudinal deficiencies.
Clinical and familial experiences indicate that early prosthetic and adaptive equipment fittings are advisable. Initial training by occupational or physical therapists should be followed by interim training for any significant changes in prostheses. Physicians, prosthetists, therapists, and social workers are primarily sources of information. Therapists share ideas learned from others with the same disability. Parental education is essential for accepting and persevering to enable independence on the part of the child. Parental and patient ingenuity is tremendous. Children do not require long periods of training. They are very socially adept, and while they do not necessarily have superior intelligence, have learned to solve problems within their environment.
Most accept lower-limb prostheses but reject upper prostheses, although they can use upper prostheses satisfactorily, especially those with bilateral above-elbow deficiencies.
*Shriners Hospital for Crippled Children, 2100 North Pleasantburg Drive, Greenville, SC 29609