New Innovations in Pediatric Prosthetics

With few new prosthetic options, practitioners are offering more activity-specific prostheses.

Improvements in pediatric prosthetics

While there is focus on providing children with prostheses that will help them participate in different activities, there are still existing prostheses that need to be redesigned with children in mind, such as knee and ankle joints and prosthetic feet.

“The most sophisticated prosthetics, like the ankle and knee joints, especially the knee joints that are computer controlled, are getting a size reduction, but because there are so few children some of those things are just very slow to not available,” Miller said. “While it wouldn’t make sense to have a sophisticated computerized controlled knee for a 2-year-old it would make sense to have it for an 8-year-old [child]. It is a problem of numbers. We do have reasonably good options, but some of those sophisticated new recent developments are not available for kids.”

Miller also believes research on understanding the relationship to a child’s size and the benefit of having ankle articulation vs. simple feet that are lightweight would be beneficial to children in the long run. Since sophisticated knees and ankle joints are not yet available for children, often adolescents and teenagers are prescribed lightweight adult knees. However, not only are the lightweight adult knees too big for children, they also do not provide the best mobility for pediatric patients of any age.

“I have always thought kids with lower limb [amputations should have] knees that respond to speed. We concentrate hydraulic technology in the adult population, 
but the kids would really be the best beneficiaries for that because they go from walk to run to walk routinely and the prosthetic knees haven’t caught up with that yet,” Rotter said. “Adolescents are often forced to use lightweight adult knees, so I think that is an area for improvement with children.”

Besides developing better knee and ankle joints for children, Miller reminds practitioners it is important to keep an eye on the growth of their pediatric patients. Children experience a lot of growth in the length and alignment of the limb, but if they have a residual limb that is very short, there are advancements in orthopedic management so the residual limb can be lengthened for a better prosthetic fit.

“It is important to constantly pay attention to the length of the residual limb that we consider ideal for prosthetic fitting as the child grows,” Miller said. “I think sometimes, if we think about all of the modern sophisticated technology that’s available to build prostheses, we can lose sight of the fact that we also have to keep in touch with the child and continue to monitor the child’s growth, especially as it relates to the amputated limb so that we end up with an optimal limb.” — by Casey Tingle

For more information:
Murphy C. Young Innovators: Easton LaChapelle. www.healio.com/orthotics-prosthetics/prosthetics/news/print/o-and-p-business-news/%7B341ca740-9449-4891-bbc2-a003b4e1602e%7D/young-innovators-easton-lachappelle.
Mcfarland M. Using 3-D printing to address the need for prosthetics in Uganda. Available at: www.washingtonpost.com/blogs/innovations/wp/2014/01/17/using-3-d-printing-to-address-the-need-for-prosthetics-in-uganda/. Accessed Jan. 27, 2014.
Vincent J. 3D-printed prosthetics: How a $100 arm is giving hope to Sudan’s 50,000 war amputees. Available at: www.independent.co.uk/life-style/gadgets-and-tech/news/3dprinted-prosthetics-how-a-100-arm-is-giving-hope-to-sudans-50000-war-amputees-9071708.html. Accessed Jan. 27, 2014.
Winter L. Man Makes 3D Printed Prosthetic Hand For Son For Only $10. Available at: www.iflscience.com/technology/man-makes-3d-printed-prosthetic-hand-son-only-10. Accessed Jan. 27, 2014.

Disclosure: Miller is employed by Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del. Kanas is employed at Shriners Hospitals for Children, Tampa, Fla. Rotter is employed at Scheck and Siress, Chicago. Virostek is employed by Texas Scottish Rite Hospital for Children, Dallas.

Perspective

— Mark D. Geil

  • I think research and development is improving in its appreciation of the challenges associated with components for children. Kids are champs at giving components a real workout because they are active in such a wide variety of movements and environments. Companies who are trying to tailor existing adult products for children are much better at understanding these challenges than in the past. There is some research related to long-term use of upper limb prosthesis in kids, but I think there is more work to be done there. The questions people have tend to focus on understanding the economics when a child is fit with an expensive myoelectric arm that is ultimately rejected. I would like to see that sort of research married to biomechanical research on the functions and activities that are facilitated by different components and the efficiencies with which those activities can be done.

    • — Mark D. Geil, PhD
    • Associate professor, Georgia State University
      Director, Center for Pediatric Locomotion Sciences