Crawling Kinematics in an Early Knee Protocol for Pediatric Prosthetic Prescription

Geil, Mark D.; Coulter-OʼBerry, Colleen; Schmitz, M; Heriza, Carolyn B.

doi:10.1097/jpo.0b013e31827afedd

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Children with amputations or limb differences through or above the knee can now be fitted with a prosthetic knee relatively early, even while still crawling. 29,30 Multiple pediatric-sized knees can be used as soon as the child and family are ready for them, but there is still not an ideally designed infant-sized knee for transitioning from crawling to walking. After moving through the toddler phase, children generally progress to faster walking and running.…”

Section: Technological Advancesmentioning

confidence: 99%

Innovations in Pediatric Prosthetics

Hall

Wustrack

Cummings

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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Although many of the surgical and technological advances for prosthetics have emerged from caring for adults, the pediatric patient with limb differences continues to provide unique challenges and demands appropriate, pediatric-specific innovation. Not only do children test the current technology with their size, weight, and potential growth, but also with their chosen activities, energy-level and drive to explore varied environments. This article explores the recent advances within the broader realm of prosthetics, primarily based on research in adult patients. It identifies technologies that have already been translated to pediatric populations and points out areas for potential pediatric applications. This review also highlights numerous needs and gaps in the currently available resources and tools for these patients, including surgical techniques, prosthetic componentry, and rehabilitation strategies. Further innovation and research are needed for pediatric patients to maximize their functional potential while using a prosthesis.

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Section: Technological Advancesmentioning

confidence: 99%

Innovations in Pediatric Prosthetics

Hall

Wustrack

Cummings

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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show abstract

“…New research has demonstrated that early fitting of a prosthetic knee, as the child pulls to a stand, can provide significant advantages in childhood development by allowing the patient to tall kneel and reciprocally crawl. 17 When do you fit a non-articulated, body-powered, versus myoelectric upper limb prosthesis?…”

Section: Table 2 Questions That Physicians Askmentioning

confidence: 99%

Essentials of Pediatric Prosthetics

Hall

Cummings

Welling

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Caring for the limb deficient child may be initially daunting, but typically is quite rewarding for the orthopaedist and medical team. This article serves as a primer to those surgeons who are in training or infrequently treating this population. Insights are provided throughout to aid the orthopaedist in maneuvering the many facets of pediatric prosthetic care, including answers to questions common asked by surgeons or families. Involvement of the prosthetist early and then throughout the child’s care is crucial in achieving optimal outcomes in prosthetic design, fit, function and utilization. Although a multi-disciplinary team may not be available at all institutions, it is important to aim for this approach whenever possible. With the right balance of surgical, functional, prosthetic and therapeutic considerations, children with limb differences typically are able to keep up with their peers and participate in a variety of activities, such as school, sports and music.

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“…Geil et al showed that infants with limb loss using a prosthetic knee locked in extension crawled with slower velocity and reduced cadence. However, a more typical "step-through" crawling pattern was seen in the unlocked knee condition, with less asymmetry [13,14]. Geil and Coulter showed that clearance adaptations were reduced in the EK protocol, and that children achieved an average of 70.4˚swing phase knee flexion in the articulated prosthesis side [12].…”

Section: Introductionmentioning

confidence: 99%

“…Alternatively, an "Early Knee" (EK) protocol prescribes an articulating knee joint in the child's first prosthesis, usually when the child achieves pull-to-stand around 12 to 18 months of age. The knee is a free-swinging joint with no active extension assistance or stance control [12][13][14][15]. Previous research has shown biomechanical advantages of the EK protocol.…”

Section: Introductionmentioning

confidence: 99%

Walking kinematics in young children with limb loss using early versus traditional prosthetic knee prescription protocols

et al. 2020

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The traditional treatment protocol for young children with congenital or acquired amputations at or proximal to the knee prescribes a prosthesis without a working knee joint, based in part on the assumption that a child learning to walk cannot properly utilize a passively flexing prosthetic knee component. An alternative to this Traditional Knee (TK) protocol is an "Early Knee" (EK) protocol, which prescribes an articulating prosthetic knee in the child's first prosthesis, during development of crawling and transitioning into and out of upright positions. To date, no study has compared samples of children with limb loss at or proximal to the knee using TK and EK protocols. The purpose of this multi-site study was to examine kinematic outcomes during walking in separate groups of young children in an EK and a TK prosthesis protocol, along with a population of children without lower limb amputations. Eighteen children aged 12 months to five years were recruited for this study at two clinical sites, six in each of the three groups. Children in the two prosthesis groups had unilateral limb loss and had been treated either at one site with the TK protocol or at another with the EK protocol. Children in the EK group achieved swing phase prosthetic knee flexion averaging 59.8±8.4 degrees. Children wearing prosthetic limbs walked slower than age-matched peers. In most instances, walking speed and step length increased with age in the EK group, similar to the control group. However, this trend was not observed in the TK group. Clearance adaptations were present in both limb loss groups. Observed adaptations were twice as prevalent in the TK group versus the EK group; however, the groups differed in age and etiology. Children with limb loss provided with an articulating knee component in their first prosthesis incorporated knee flexion during swing phase and showed fewer gait adaptations than children in the TK protocol.

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Crawling Kinematics in an Early Knee Protocol for Pediatric Prosthetic Prescription

Cited by 5 publications

References 16 publications

Innovations in Pediatric Prosthetics

Innovations in Pediatric Prosthetics

Essentials of Pediatric Prosthetics

Walking kinematics in young children with limb loss using early versus traditional prosthetic knee prescription protocols

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