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Background: The aim of prosthetic fitting and associated (re)habilitation is promotion of functional, psychological, cognitive and social development with the prosthesis as a new biomechanical entity. The primary prosthesis for children with unilateral congenital below-elbow deficiency (UCBED) is aesthetic. It is applied in outpatient setting, usually at the age of 7-9 months, along with developmental physiotherapy. The objective of such an early prosthetic fitting is the timely creation of engrams through early psychomotor development. The large variety of wrist and hand movements with all modes of power, coordination, agility and precision of movement cannot be fully restituted with the prosthesis. Hence, the prosthesis is utilised along with the dominant hand as an aid for fixation and synergy. Methods: A survey was conducted at the Clinical Institute for Rehabilitation and Orthopedic Aids in Zagreb in the period from 2012 to 2015 on 12 children (7 girls and 5 boys) with UCEBED aged 3-5 years, primarily fitted with pasive prosthesis at the age of 7-9 months. Functionality in bimanual activities was tested using the ABILHAND-Kids scale. Self-assessment of body image was performed using a reverse visual analogue scale (VAS). Results: The raw ABILHAND-Kids scores were statistically significantly lower on average when performing functional tasks with the prosthesis as compared to performing them without the prosthesis (mean score 26.1 vs. 30.9, p < 0.001). However, satisfaction with body image related to social acceptance and passive application of prosthesis in everyday life was statistically significantly higher on average with the prosthesis than without it (mean VAS rating 9.8 vs. 3.7, p < 0.001). Conclusion: The comprehensive habilitation of children with a prosthetic limb requires an individual, holistic and team-based problem-oriented approach. It is necessary to enable the child%s freedom of movement and unrestricted play, along with his/her expression of personality, needs, desires and abilities. Early prosthetic fitting, continuous training for carrying out activities appropriate for the given age, involvement of parents and permanent wearing of the prosthesis are the most important factors for the acceptance of pasive prosthesis, which has a significant impact on the normal psychological, social and motor development and growth of the child. Uvod: Cilj opreme s protezo in (re)habilitacije otroka po amputaciji je celostni funkcijski razvoj otroka. Primarna oprema otrok z enostransko prirojeno podlaketno amputacijo je estetska. Opremo s podlaketno protezo lahko izpeljemo v okviru ambulantne obravnave, običajno v starosti otroka od sedem do devet mesecev, pri čemer mora biti otrok vključen tudi v program fizioterapije. Cilj tako zgodnje opreme s protezo v zgodnjem psihomotoričnem razvoju je razvoj ustrezne predstave o telesu v možganih. S pomočjo proteze ne moremo povsem povrniti zmožnosti najrazličnejših vrst gibanja zapestja in roke, zmožnosti prilagajanja moči, koordinacije gibanja, spretnosti in natančnosti gibanja. Glede na to lahko otrok protezo uporablja skupaj z dominantno roko kot pomoč pri soročnih dejavnostih in stabilizaciji predmetov. Metode: Raziskava je bila izvedena na Kliničnem inštitutu za rehabilitacijo in ortopedske pripomočke v Zagrebu, v obdobju od leta 2012 do leta 2015. Vključenih je bilo 12 otrok (sedem deklet in pet fantov) z enostransko prirojeno podlaketno amputacijo roke, v starosti od tri do pet let, ki so bili opremljeni s prvo estetsko protezo v starosti od sedem do devet mesecev. Za oceno soročnih dejavnosti smo uporabili lestvico ABILHAND-Kids. Za oceno lastne telesne podobe smo uporabili vizualno analogno lestvico (VAS). Resultati: Rezultati ocene z lestvico ABILHAND-Kids so bili v povprečju statistično značilno nižji pri izvedbi nalog s protezo (povprečni rezultat 26,1) v primerjavi z izvedbo nalog brez proteze (povprečni rezultat 30,9; p < 0,001). Hkrati pa smo ugotovili, da je bilo zadovoljstvo s telesno podobo, povezano z družbeno sprejemljivostjo in pasivno uporabo proteze v vsakdanjem življenju v povprečju statistično značilno višje, kadar so otroci uporabljali protezo, kot takrat, ko je niso uporabljali (povprečna VAS oceno 9,8 oziroma 3,7; p < 0,001). Zaključek: Celovita (re)habilitacija otrok s protezo za zgornji ud zahteva celostni individualni pristop, ki je usmerjen v otrokove težave in se odvija v okviru strokovne skupine. Takšna (re) habilitacija je potrebna, da bi otroku lahko omogočili svobodo gibanja in neomejeno igro, izražanje njegove lastne osebnosti, potreb, želja in sposobnosti. Zgodnja oprema s protezo, stalno usposabljanje za opravljanje dejavnosti, ki so primerne za določeno starost, vključevanje staršev in stalno nošenje proteze so najpomembnejši dejavniki, ki vplivajo na otrokovo sprejemanje estetske proteze in ki imajo velik vpliv na otrokov normalni psihološki, socialni in gibalni razvoj ter rast otroka. |
