Any health care professional who works with people who have lost limbs recognizes that the psychological challenges their patients battle every day are tough. This is perhaps an understatement, since for most people, losing a limb profoundly impacts every aspect of their life — mentally, emotionally, physically and spiritually. De-pending upon age, psychological health before the loss, financial situation, circumstances of the loss (trauma, disease or congenital), society’s values and support or lack of support from family and friends, the road to recovery can be relatively quick or prolonged.

Most psychiatrists, psychologists and social workers who treat people who have lost a limb stress the importance of treating patients holistically. The totality of a patient’s life must be considered, e.g., work, family, gender, age, health and self-esteem. No two people will experience the processing of the natural feelings of grief, denial and anger at the same preconceived time or sequence, nor will the intensity of these feelings be identical. Some individuals never encounter certain feelings. While people who receive an amputation do tend to go through psychological stages, there is no standard pattern.

Any health care professional who works with people who have lost limbs recognizes that the psychological challenges their patients battle every day are tough. This is perhaps an understatement, since for most people, losing a limb profoundly impacts every aspect of their life — mentally, emotionally, physically and spiritually. De-pending upon age, psychological health before the loss, financial situation, circumstances of the loss (trauma, disease or congenital), society’s values and support or lack of support from family and friends, the road to recovery can be relatively quick or prolonged.

Most psychiatrists, psychologists and social workers who treat people who have lost a limb stress the importance of treating patients holistically. The totality of a patient’s life must be considered, e.g., work, family, gender, age, health and self-esteem. No two people will experience the processing of the natural feelings of grief, denial and anger at the same preconceived time or sequence, nor will the intensity of these feelings be identical. Some individuals never encounter certain feelings. While people who receive an amputation do tend to go through psychological stages, there is no standard pattern.

When Steve Strasburg, CO, thinks back on
the requirements he was expected to complete 20 years ago as he worked towards
becoming a certified orthotist, he remembers there were a number of programs to
choose from. Some were good and some were bad. Among the choices were some
internships that were “pretty loosely run,” he recalled.

“As long as you could get someone to say you completed
your 1,900 hours of work requirement, you could qualify to take the
tests,” he said.

They are not just small adults; some things are very different, though some are just smaller. I often tell our physical medicine and rehabilitation residents in training that there are only two differences between adult and pediatric rehabilitation: 1) growth and 2) development…and maybe a few conditions or diseases of childhood onset they will need to learn about. I then tell them that there are three kinds of people in the world, those who can count and those who can’t; and that they only have to read about two things: everything they see on the wards or in clinic, and everything they don’t. But today I will try to be more helpful. This article will focus mostly on functional lower extremity orthotic use and how the pediatric practitioner must think a little differently.

What Is Really Different: Growth

Children outgrow orthoses. They really do grow in spurts; if there was a Murphy’s Law of pediatric orthotics, it would be that all growth spurts occur immediately after receiving a new orthosis, if one did not occur between the casting and the fitting. And yet, accurate fit is at least as crucial as it is in adults for comfort and function. Frequent adjustments and replacements are to be expected. Many children “sprout up,” outgrowing the orthosis in length and height but actually having it become sloppy and loose in fit distally. If you use twister cables, particularly an articulated design, the joint must be kept close to the actual axis of rotation of the knee to avoid the mismatch gradually pulling the child down into a crouched position, with the waist belt falling down around his hips.

They are not just small adults; some things are very different, though some are just smaller. I often tell our physical medicine and rehabilitation residents in training that there are only two differences between adult and pediatric rehabilitation: 1) growth and 2) development…and maybe a few conditions or diseases of childhood onset they will need to learn about. I then tell them that there are three kinds of people in the world, those who can count and those who can’t; and that they only have to read about two things: everything they see on the wards or in clinic, and everything they don’t. But today I will try to be more helpful. This article will focus mostly on functional lower extremity orthotic use and how the pediatric practitioner must think a little differently.

What Is Really Different: Growth

Children outgrow orthoses. They really do grow in spurts; if there was a Murphy’s Law of pediatric orthotics, it would be that all growth spurts occur immediately after receiving a new orthosis, if one did not occur between the casting and the fitting. And yet, accurate fit is at least as crucial as it is in adults for comfort and function. Frequent adjustments and replacements are to be expected. Many children “sprout up,” outgrowing the orthosis in length and height but actually having it become sloppy and loose in fit distally. If you use twister cables, particularly an articulated design, the joint must be kept close to the actual axis of rotation of the knee to avoid the mismatch gradually pulling the child down into a crouched position, with the waist belt falling down around his hips.