Fitting Infants and Children with Electronic Limbs "The Detroit Experience from 1981 to 1990"
CARL D. BRENNER, C.P.O.
In the last nine years over 185 electronic upper limb prostheses have been fitted to 83 children seen at the Variety Club Myoelectric Center. The age of the patients fitted has ranged from 12 months to 19 years, with approximately 50% of the prostheses being provided to children between one and four years of age.
What follows is a review of some of the technical and logistical implications related to providing electronic prostheses to this type of a population. The issues addressed in this analysis parallel many of the common concerns dealing with funding, downtime, glove life, electromechanical failure, prosthetic weight and duration of functional fit.
Although the cost of an electronic prosthesis is considerably higher than a conventional mechanical alternative, it has been found that a majority of patients have had sufficient health insurance to generally cover 80% of the total cost. It should also be noted that a family with two incomes will frequently have 100% coverage through their combined insurance plans.
A major stumbling block, in any electronic limb program, has been the problem of downtime when electromechanical failures occur. This has been effectively neutralized by the aggressive use of an electronic limb banking program, whereby faulty components can be replaced by refurbished units, at a fraction of the cost and time.
The most fragile component of even the most sophisticated electronic prosthesis has proven to be the protective outer glove. Over the last nine years, gloves have been replaced on an average of about every four months.
When this program began in 1981, one of the biggest concerns centered on the expectation of frequent and incessant electromechanical failure. This fear has proven to be grossly exaggerated. On the average, the frequency of repairs to electronic prostheses has been similar to that of mechanical systems, about twice a year.
The weight of a self suspended electronic prosthesis has sometimes been considered as a contraindication to fitting infants and small children. It is now possible to obtain light weight, injection molded, electronic hands for infants, that yield a total prosthetic weight of nine ounces. Prosthetic weight has proven not to be a major problem, since only one or two percent of this series has failed because of it.
The period of time over which a prosthesis will provide a comfortable and functional fit can have a significant impact on long range costs to a third party payer. Routine fabrication methods have provided a functional fit for about 14 months. However, the introduction of laminated growth liners in 1986 has added over 20% to the useful life of these prostheses.
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