Weinstein Lovell and Winters Pediatric Orthopaedics 7e

1590

CHAPTER 30  |  The Child with a Limb Deficiency

physical abilities in the school and community settings. Gross motor achievements are a measure of a child’s development. Learning to toss a ball, jump, run, hop, and ride a bicycle are activities included on standardized developmental screenings and tests. It is important that these activities be included in the child’s plan of treatment, so that a child can be offered the same age-appropriate physical challenges as his or her peers. Special adaptations and specific sports-related prostheses are available, depending on the degree and level of the disability (Fig. 30-55). These adaptations are too numerous to mention. Recreational and sports-related terminal devices are available for the upper extremity amputee (232, 233). Adaptations can be as simple as raising the handlebars on a bicycle and add- ing a toe strap to highly sophisticated prosthetic components specific to each sport (234). Information and resources for sports and adaptive recreation for the amputee can be obtained through the Amputee Coalition of America (www.amputee- coalition.org; telephone 1-888-267-5669). The Association of Children’s Prosthetic and Orthotics Clinics is an excellent resource for services in geographical regions (www.acpoc.org; telephone 847-698-1637).

will usually dictate the needs. Appearance being important, more cosmetic prostheses and improved gait become impor- tant issues. At this time, driving becomes one of the major issues defining independence. The therapist can play a critical role in directing the child and parents to the appropriate agency for the rules of the state, and to a source for evaluation and modifica- tions to the vehicle. As with any adolescent, the amputee should attend driver education training, using modifications if needed. Modifications can range from simple to complex. Switching the brake and gas pedals to accommodate unilateral lower limb loss is one of the most common examples. Many amputees, even with bilateral lower extremity loss, drive without adaptations. This must be closely monitored and evaluated by the state’s examiners. Hand controls are used most commonly in bilateral lower extremity loss. A ring adaptation can be used to modify the steering wheel for upper extremity amputees. A handicap license is appropriate for individuals whose mobility is limited. The higher level amputee, and those with multilevel limb loss, may benefit from a handicap parking license. All modifications are listed on the amputee’s driver’s license. College is often the patient’s first test of complete inde- pendence, and the needs may be greater than what the child anticipates. The therapist can be of great value in assessing the situation, counseling the patient, and helping with the transi- tion. The Internet can prove to be a great resource in assisting college-bound students and their families. Children of all ages with limb deficiencies or amputations should be encouraged to participate in sports and recre- ational activities with their peers. The psychological impact of sports cannot be underestimated. Improving self-esteem and confidence, gaining independence, learning to win and lose, developing decision-making and problem-solving skills, and cooperating as a team member are a few of the benefits that a child carries throughout his or her life. Improving physical fitness, developing balance, strength, coordination and motor skills, increasing endurance, and weight control are benefits of physical activity. Over the years, there has been an increased awareness of adapted sports and recreation for individuals with physical and mental impairments. The Paralympic and Special Olympics initiatives have been the most obvious and have sparked an increase in availability of programs for special-needs children. Laws also have been passed for children to receive education in the least restrictive environments. PL 94-142 provides free and appropriate education for all children with disabilities (231). Physical therapy and recreation are related services included in this legislation. This allows for adapted physical education to be included in a child’s everyday school activities. Physical thera- pists need to be aware of the resources and adaptations that provide accessibility of a sport to a child within limits of his/her Adaptations for Activities and Sports

FIGURE 30-55.  As seen in this photograph, participation in high- level sports is possible for children and adolescents with limb defi- ciency. Advances in prosthetic modifications design and national organizations that promote athletics give patients the freedom to pur- sue a wide array of winter and summer sports.