| Popis: |
Rehabilitation of a child with complete absence of the upper limb requires a comprehensive team approach. The plan of rehabilitation is prepared and adjusted based on initial and follow-up assessments of functional abilities. It comprises the neurodevelopmental program with a biomechanical approach and later on, development and searching for alternative strategies for activities of daily life. The long-term goal is the independence of the child in all areas of life. In the article, we present a case of a child with bilateral congenital upper limbs dysmelia. He was fitted with body-powered prosthesis for disarticulation in right shoulder. The function of two long fingers, growing out of left shoulder, improved over time. The analysis of his development of daily life activities showed significant delay from six months up to two years in comparison to the normal development. Based on results of evaluation with the Paediatric Evaluation of Disability Inventory (PEDI), he was significantly delayed in the self-care domain (results between 10th to 19th percentile). By the age of 12 years, he was still not able to be independent in some activities of daily life. Rehabilitacija otroka s popolno odsotnostjo zgornjega uda zahteva celostni timski pristop. Načrt obravnave pripravimo in sproti prilagajamo glede na oceno funkcijskega stanja. Zgodnja obravnava vključuje razvojno nevrološko obravnavo z biomehanskim pristopom, kasneje pa obravnava vključuje tudi iskanje in razvijanje nadomestnih strategij za učinkovito izvedbo vsakodnevnih aktivnosti. Dolgoročni cilj je osamosvojitev otroka na vseh področjih življenja. V članku predstavljamo primer otroka z obojestransko prirojeno dismelijo roke, njegov razvoj funkcijskih sposobnosti, opremo s pripomočki in nadomestne strategije pri učenju vsakodnevnih aktivnosti. Opremljen je bil z mehansko protezo za eksartikulacijo v ramenskem sklepu na desni strani. Funkcija dveh prstov, ki sta izraščala iz leve rame, se je postopno izboljšala. Ob vključevanju v programe habilitacije je osvojil večino vsakodnevnih aktivnosti, čeprav z zamudo šest mesecev do dveh let. Glede na rezultate ocene z Vprašalnikom za oceno funkcijskih sposobnosti je na področju skrbi zase (PEDI) pomembno zaostajal za vrstniki (rezultati med 10. in 19. percentilom). Nekaterih veščin ni osvojil niti do starosti 12 let. |
