Evaluation of arm and prosthetic functioning in children with a congenital transverse reduction deficiency of the upper limb

Abstract

Objective: To assess upper extremity functioning of children with unilateral transverse upper limb reduction deficiency, using standardized instruments, and to investigate their validity and reliability. Design: Cross-sectional study. Subjects: Twenty subjects aged 4-12 years; 9 prosthetic users and 11 non-users. Methods: The Assisting Hand Assessment, Unilateral Below Elbow Test, Prosthetic Upper extremity Functional Index and ABILHAND-Kids were assessed in all children. Users were tested with and without their prosthesis. We compared results of users and non-users, and of users with and without their prosthesis. Validity was determined by testing hypotheses and correlations with other measures. Test-retest reliability was assessed from repeated measurements in 10 children. Results: Children with an upper limb reduction deficiency performed well on daily activities. They could use their prosthesis in 68% of the activities, but were currently using it in only 30%. Children find their prosthesis useful for specific activities, rather than for daily activities in general. The Assisting Hand Assessment and Prosthetic Upper extremity Functional Index showed best validity; test-retest reliability was good to excellent. Conclusion: The use of standardized instruments adds relevant information on functioning of children with an upper limb reduction deficiency. We found additional support for validity and reliability of, in particular, the Assisting Hand Assessment and Prosthetic Upper extremity Functional Index.Key words: upper extremity, prostheses and implants, activities of daily living, outcome assessment (healthcare), reproducibility of results.

Use and functioning of the affected limb in children with unilateral congenital below-elbow deficiency during infancy and preschool age: A longitudinal observational multiple case study

“…Many studies have been performed to evaluate functioning in daily life of children with UCBED with or without prosthesis [1,2,6,[15][16][17][18]. However, our study is the first with a longitudinal and observational design starting in infancy.…”

“…In many cases children with UCBED are fitted with a prosthesis to replace the missing part of the limb in an attempt to improve functioning in daily activities. Yet, evidence about the functional gain of a prosthesis is conflicting [1][2][3]. In addition, surprisingly little reduction in performance of daily activities has been reported in children with UCBED, which contrasts with the limited function found in adults who have lost a part of their arm [4].…”

“…Sensory behaviour Exploration Touching and gently rubbing the outer surface of objects with the affected limb (whether or not a prosthesis is present) 2 The child frequently touches, feels and explores the surface and shape of an object. 1 The child occasionally touches, feels and explores the surface and shape of an object 0…”

Age at First Prosthetic Fitting and Later Functional Outcome in Children and Young Adults with Unilateral Congenital Below-Elbow Deficiency

“…We considered 'bimanual use' to be the 'best' method of performance, irrespective of prosthetic use (actively or passively). The 'Prosthetic Activities Score (PAS) 14,15 was used to correct for the confounding effect of low scores on ease of performance and usefulness for activities during which the prosthesis was not used. In non-users, the assessment was limited to the method of use of the residual limb and ease of performance without prosthesis (see Figure 1).…”

“…The PUFI has shown acceptable validity and promising reliability. 13,14 We evaluated the quality of arm movements with and/or without prosthesis, by observing the performance of 10 tasks representing general activities of daily living: Cutting a big and small circle, peeling and cutting a banana, pouring water into a cup, opening a jar, spreading peanut butter on a sandwich and cutting it into four pieces, zipping a jacket, buttoning and unbuttoning a shirt and opening a wrapped sweet. Subjects who wore a prosthesis were tested first with their prosthesis and then without.…”