A Vocational Evaluation Of Juvenile Amputees Who Have Attained The Age Of Twenty-One Years: A Preliminary Report
Robert C. Hamilton, M.D.
This article is an abstract of a report given by Dr. Hamilton at the Conference of Clinic Chiefs on January 24 at Chicago.
In the course of evaluating the results of our Juvenile Amputee Program at the University of Illinois, two important questions arose:
1) What were we really accomplishing socially and/or economically in the long-term prosthetic treatment of these children? and 2) Did the end result justify the time, effort and expense involved?
In attempting to answer these questions, we decided to poll a certain segment of our juvenile amputees in order to evaluate their current status in the community. Since these individuals reach their majority at the age of 21, and, incidentally, are then no longer eligible for aid from the State of Illinois , University of Illinois Division of Services for Crippled Children, we thought that it would be of interest to determine the present socio-economic status of those patients whom we first saw as juveniles and who have since reached their twenty-first birthday.
It should be mentioned that the State of Illinois, Division of Vocational Rehabilitation assumes responsibility for patients who, because of age, become ineligible for aid from the Division of Services for Crippled Children. Thus, there is continuity of care in the program. The Division of Vocational Rehabilitation provides educational and vocational aid, and helps to underwrite the cost of prostheses.
There are 1,438 registrants in the University of Illinois Amputee Clinic, of whom 557 were registered as juveniles under the age of 21 years. Ninety-six of the 557 juveniles, who have passed their 21st birthday, were polled, and 82 replied, giving full answers to our questionnaire. The ratio of congenital to acquired amputations in the study series was 3 to 1, as compared to the ratio of 6 to 5 for all the patients. Of the 82 respondents, 49 were males and 33 were females. Eighteen of the 49 males and 19 of the 33 females were married - i.e., a total of 37 (45%) were married (and had 20 children among them). The age range was 21 to 31 years, the average being 24 years. The series was about equally divided between upper and lower-limb amputees. None of the patients polled was a so-called multi-handicapped child, although more than one amputation was present in 15 of the cases.
Seventy-two of the 82 patients wore their prostheses all day every day, four used them occasionally, and six not at all. All of the occasional wearers and non-users were upper-limb amputees. It was interesting to note that there was 100% use of the lower-limb prostheses.
The reported use of the prostheses provided was most encouraging. However, what of the purely economic factors involved? The Division of Services for Crippled Children in the State of Illinois, which provides financial help to our juvenile amputees, will bear 10% to 1007. of the cost of the prostheses. In 1962, the Division spent an average of $343 for a lower-limb prosthesis and $257 for an upper. Our experience indicates that a child will require a lower-limb prosthesis annually up to the age of five years, biannually from age five to 12, then one every three to four years to the age of 21.
On the basis of these estimated requirements, a terminal transverse partial lower-limb hemimelia (T-3) fitted toward the end of the first year of life would require $2,800 to $3,200 worth of prostheses by the time he reached the age of 21. For an upper-limb amputee, the cost would be approximately $2,000. While these figures can only be considered approximations, because of the many variables encountered, and do not take the multi-handicapped child into consideration, they are reasonable estimates. Based on these calculations, the entire amount spent on a child amputee from birth to adulthood just about equals the payments made to an adult over a period of one to two years on disability or social security.
Amount of Education
The next important question was the amount of education the patients had had and how they had put it to use. In general, the boys had progressed further in school than the girls, as is typical of the population at large. Only one of the entire series of 82 patients did not attend high school. Forty-seven had high school diplomas, and five others had had three years of high school.
Nineteen patients had attended college three years or less; five were college graduates; and six were junior college graduates. One boy was graduated from the University of Illinois College of Pharmacy; another was completing his pre-medical training; and a third was about to receive his law degree. Eleven members of the group were attending college, and six were enrolled in on-the-job training programs. Of the entire group, 28 had received their training through the Division of Vocational Rehabilitation.
The occupations of the patients covered a wide range, including Chemical Engineer, Pharmacist, Draftsman, Minister, Gas Station Attendant, Beautician, Switchboard Operator, Avon Representative, and even a Well Digger.
Only one reported that he was unemployed, and one unfortunate boy was known to be in jail. Many of the women in the group were housewives. In essence, we learned that 60 of the 82 patients replying to the survey were wage earners or housewives. Seventeen of the remaining 22 were either in college or equivalent training programs, with excellent potential for ultimate self-support. Only four were institutionalized and/or unemployed and thus remained a burden on the tax-payer. (One patient moved to another state and was lost to our records. We do not know if he is currently a wage earner.)
The following conclusions have been drawn from our preliminary study:
The long-range prosthetic treatment of these patients from infancy to adulthood has yielded excellent results.
Socially, most of the amputees have made normal adjustments and now have families of their own.
Utilization of the prostheses provided has been excellent - 100% for the lower-limb cases, and 88% for the uppers (part-time wearers included).
The cost of providing prostheses over an extended period is commensurate with other welfare programs. However, the important exception in the amputees studied is that the payments ultimately ceased in almost every case and the patients were able to provide for themselves.
The educational level attained by this group of amputees is well above the national average.
Only a few of the patients studied (5%) are not self-supporting citizens or do not have the potential for financial independence.
Robert Hamilton is Associate Clinic Chief, University of Illinois Amputee Clinic, Chicago, Illinois