Occupational Therapy In The Amputee Program

J. Hutchison, P/OT Regd.

The role of the occupational therapist in the rehabilitation of the child amputee is to conduct many types of evaluations and to provide prosthetic training. At the Rehabilitation Institute of Montreal, the evaluations conducted include:

  1. Negative evaluation of phocomelic hand function.

  2. Use of the feet by amelic and phocomelic patients.

  3. Evaluation of upper-extremity prosthetic function with amelics and phocomelics.

  4. Upper-extremity prosthetic function with unilateral and bilateral above-elbow and below-elbow amputees.

  5. Evaluation of activities of daily living.

  6. Evaluation of motor development .

Many of these tests and the associated training are standard procedures in other institutions. Hence, in this paper I would like to emphasize the first item listed-negative evaluation of phocomelic hand function-and its importance in the treatment program.

While a child amputee may be intelligent, well-coordinated, and well-motivated, the sheer physical limitations of foreshortened phocomelic arms may pose insurmountable difficulties. Thus, it is of utmost importance to know whether or not he is capable of performing activities appropriate to his age level without the aid of assistive devices. This determination may greatly influence the parents' decision as to whether or not to accept a prosthesis which in many cases enlarges the child's field of activities.

If a child is to attend kindergarten, he will face tasks which he may not be able to perform, e.g., cutting with scissors. Therefore, he may suffer frustration and his development may be retarded. If the negative evaluation is made following the original function evaluation, we can compile a list of activities which cannot be performed by the foreshortened limbs, analyze them, and judge whether or not a prosthesis will be of assistance. Or perhaps the child needs to have materials adapted to his capacities in order to become more active and independent either with or without a prosthesis.

Another critical area of evaluation and training concerns the activities of daily living. The problems in this area increase with the age of the child, and unfortunately we have not yet found solutions to all of them. Since prostheses are not yet sufficiently functional, we encourage foot use for the performance of certain of these activities.

In dealing with the thalidomide children at the Rehabilitation Institute of Montreal, we have used a number of items to reduce their problems:

  1. Velcro on the prostheses permits a phocomelic child to undo the harness independently (Fig. 1 ).

  2. Hooks attached to the bed at the proper level (Fig. 2 ) assist the child in doffing and donning the prostheses. Once the harness is undone, the child can back into the hooks and suspend the prostheses by their back straps. Similarly, the child backs into the prostheses hanging on the hooks and shrugs into them.

  3. A ring soldered to the handle of a spoon and covered with Plastisol can be grasped with much more stability than an ordinary spoon (Fig. 3 ).

  4. The use of a special protective helmet was suggested to us by Roehampton, where many congenitally malformed children are trained in the use of prostheses. This helmet is easy to make, costs little, and assures adequal protection when a child falls. It is ventilated and adjustable to the circumference of the child's head (Fig. 4 )

J. Hutchison, P/OT Regd. is Head of Occupational Therapy Section Rehabilitation Institute of Montreal Montreal, Quebec