An Approach To The Rehabilitation Of The Child Amputee

Maurice Mongeau, M.D.

For the past 15 years, all types of physically disabled individuals, including adult and juvenile amputees, have been evaluated, treated, and followed up at this rehabilitation centre. We have constantly had in mind the philosophy of considering each patient as a whole and the importance of being concerned not only with his physical but also with his social and psychological needs.

As a result of the experience gained from clinical work and research with juvenile amputees, especially those with congenital deficiencies, our concepts of total care of the limb-deficient child have progressively changed and improved. We have come to realize that positive and active participation by the parents is essential in the rehabilitation of the child amputee.

During the past four years, an increasing number of juvenile amputees have been referred to the Rehabilitation Institute of Montreal. In 1965 we had a total of 181 active cases—109 with congenital deficiencies and 72 with acquired amputations. Sixty-four were new patients—38 with congenital malformations and 26 with acquired amputation involving a total of 97 limb deficiencies.

In order to maintain and improve our standards of treatment for this group of patients, we established a special programme for the juvenile armputee. We realized the need for a special and well-organized clinic for those juvenile amputees who required a real team effort. This clinic should have all the facilities for complete evaluation, for fabricating any type of prosthetic appliances, for training the amputee, for follow-up, and also for research. Every member of the rehabilitation team should be up-to-date in his own field.

It is obvious that total rehabilitation of the child amputee must involve a cooperative and interdisciplinary effort, but it is also essential that the child and his parents be part of the rehabilitation team. Following a complete eval uation, each case is discussed in depth and a realistic and functional rehabilitation programme is formulated. Following the team discussion the programme is then discussed in detail with the parents. We believe that the situation should be presented honestly and exactly but with a positive approach.

Before any active rehabilitation programme is started, it may be necessary to help, guide, and treat the parents in order to gain their acceptance. In fact, we consider the parents' cooperation and active participation so essential that we may delay the commencement of the child's rehabilitation programme and the prescription of the prosthesis until their acceptance has been gained. It is necessary that we win the confidence of the child and parents, and that we establish a good relationship between the members of the child clinic team and the parents. If we can obtain the parents' full cooperation, the habilitation of the child amputee can be successfully accomplished: he will gradually accept his disability, he will learn to compete with normal children at school, and he will become a useful and active citizen in the community.

Following the intensive rehabilitation programme at the clinic, in which the parents have had to play a very active part, and just before the child is discharged from the Centre, it should be impressed upon the parents that they are not left alone with their problems and that they can communicate with clinic team members at any time if they need help. The establishment of a well-organized and regular follow-up programme after discharge is essential, as the child amputee and his parents will probably need help and guidance until the child has reached adulthood.

Maurice Mongeau, M.D. is the Clinic Chief of the Children's Amputee Clinic Rehabilitation Institute of Montreal Montreal, Quebec