Infants and Myoelectric Prostheses
R. N. SCOTT
It is evident that myoelectric prostheses can be fit successfully to below elbow amputee infants under one year of age, but serious questions remain for the clinician. Is the age of fitting a critical factor in determining long term benefit, and if so what is the age at which fitting of a myoelectric prosthesis becomes necessary to ensure optimum long term benefit? Why is the reported success with myoelectric fittings so highly variable among centres.
In an attempt to contribute to the resolution of these questions, the author enlisted the assistance of Dr Rolf Sorbye of Orebro Sweden, Dr. H. J. B. Day of Manchester England. Dr. David Lyttle of Winnipeg Canada, Sheila Hubbard Of Toronto Canada, Carl Brenner of Detroit, and Rosa Jacobs of Houston, each of whom contributed a manuscript outlining their clinical experience with infarct myoelectric fittings The manuscripts are being published, with a forward by Dr. Y. Setoguchi, as a monograph entitled "Infants and Myoelectric Prostheses by the Institute of Biomedical Engineering, University of New Brunswick. The purpose of this paper is to summarize the results of that survey, involving sonic 800 amputees with up to 20 years' followup, and to suggest further action.
Depending upon the clinic, from 50% to 100% of those amputees still use their prostheses at the time of reporting. While there is considerable variety in the hardware fitted over the past 20 years, all of the clinics have been fitting state-of-the-art hardware at any time, so results are to that degree comparable. There is agreement among the participants that fitting a myoelectric prosthesis by age 3 or 4 enhances the probability of long term use, but only very limited support for the necessity of earlier myoelectric fitting.
It is the author's opinion that the startling differences in reported use among these clinics may result primarily from differences in the amount of personal attention which they are able to provide to the amputees and their families both at the time of initial fitting and by way of long term followup. If this is true, those clinics struggling with severe funding limitations may be unable to achieve adequate clinical benefit even in cases where marginal support for "a bionic arm" is obtained. In any event, better measures of clinical success are needed, together with renewed efforts to cooperate in standardizing clinical databases to facilitate ongoing review.
Institute of Biomedical Engineering, University of New Brunswick, P.O. Box 4400, Fredericton, NB Canada E311 5A3