FAQs about Prosthetics and Orthotics for Children

There are some allowances for growth build into some braces.  There is a small space between the end of the brace and the toes.  When your child’s toes extend over that area, it is time for a new brace.  If the sides and top of the foot show a significant amount of redness and indentation, it also indicates the need for a new brace.

Plagiocephaly is a condition that causes a baby’s head to have a flat spot (flat head syndrome) or be misshapen.

Positional plagiocephaly is the most common form of plagiocephaly. It occurs when a baby’s head develops a flat spot due to pressure on that area. Babies are vulnerable because their skull is soft and pliable when they’re born.  Positional plagiocephaly typically develops after birth when babies spend time in a position that puts pressure on one part of the skull, such as the spot where their head presses against the mattress.   Your Sunshine P&O Orthotist will measure your baby’s head with our newest 3D scanner, in a simple, pain-free, short procedure and fit your baby with the most efficient helmet for his needs.

Torticollis occurs when a tight or shortened muscle on one side of the neck causes the chin to tilt to the other side. Premature babies are especially prone to torticollis. Babies with torticollis can also develop a flat spot on their skull because they often sleep with their head turned to one side.

In many cases, a flat spot on a baby’s head will round out on its own around 6 months of age, as he starts crawling and sitting up.  But to be safe, if you see a flattening of your baby’s head at any time, don’t wait – talk with his doctor immediately.   If you do need to take steps to correct the condition, the younger your baby is, the easier it will be.

A prosthesis is an external device designed to replace a missing part of the body, including arms, hands, fingers, legs, toes, breasts and even eyes.

A prosthetist is a healthcare professional, specifically educated and trained to manage comprehensive prosthetic patient care.  This involves patient assessment, treatment plan formation and implementation and follow-up management.

Amputations may be the result of diabetes, bacterial infections, circulatory diseases and trauma.  Some people may be born with congenital birth defects which leave them with non-functioning limbs that may become more useful once removed and replaced with prostheses.

Although a prosthesis will never completely replace your natural limb, it can help restore all or most of your original functioning.  This is partially reliant on your level of amputation.  Below the Knee amputees usually do well in returning to former lifestyles.  Above the knee amputees may proceed more slowly but usually can return to former lifestyles as well.  Depending on personal goals and needs, patients with upper limb amputations have varied rates of success in restoring former lifestyles.

We can help you find other health professionals such a physical or occupational therapists for additional instruction and training on using your prosthesis as well as necessary strengthening programs.  We can also get you products needed to wear and care for your prosthesis, including socks and liners.

It is not recommended that you wear your prosthesis to bed because excessive wear may cause harm to your residual limb.

If your limb changes volume and the socket feels loose or moves while walking, or there is pain on the bottom of the limb, ask your Sunshine P&O prosthetist about obtaining socks.

Donning refers to putting the prosthetic or orthotic device onto the body.

Doffing refers to removing the prosthetic or orthotic device from the body.

There are several ways for an amputee to don a prosthetic, depending on their individual anatomy, preference and the design of the prosthesis.  Pull-in: Most users work with a donning sock to be sure that all necessary tissue is contained within the suction socket.  The donning sock is used where there is no liner interface and requires a lotion (wet fit)  or powder (dry fit).  The choice is up to the comfort and convenience of the amputee.  Push-in donning is for amputees with longer above knee residual limbs, some prefer to push the residual limb into the prosthetic’s socket, using a wet or  dry fit.

There are cosmetic coverings for the outer structure of a prosthetic (“endoskeletal structure”).  They are more than just for looks;  they protect the inner components from exposure to harmful external elements.   There are also foam covers which can be applied to the outside of the prosthesis.  These covers can be custom shaped, based on the patient’s measurements.  At Sunshine P&O, we use a state-of-the-art technology – a 3D scanner to get the exact measurements and shape.  There are also custom protective skins which can be painted or sprayed onto the foam cover.  Whether or not you cover a prosthetic is a personal decision.  Many athletes chose not to cover their prosthetic legs in order to keep it as lightweight as possible.

Prosthetic socks area work over the residual limb.  They come in various thicknesses and materials and provide cushioning, reduce and absorb friction, protect the skin, absorb perspiration and compensate for any shrinkage and/or swelling of the residual limb.  A residual limb will change size and shape over time.  Different thicknesses of socks (ply) are used to compensate for any increase or decrease in size of the residual limb.   Your prosthetist will show you how to put on the sock, when to put it on and how to use the most efficient one for your needed fit.

This depends on changes in the residual limb size, activity levels, body weight/height and general wear and tear on the components.  In early stages, residual limbs frequently change size and shape, most often within the first 6 months after amputation.  This may require socket changes or adjustments. We recommend an evaluation at least every 6 months by a certified prosthetist.  Early detection of a problem can prevent major problems.

We at Sunshine P&O attend conferences all throughout the year to learn about new devices and equipment.  Our Resource page will provide you with a list of organizations that support, educate and advocate the amputee community. Among these are:

360 O&P – online Orthotics and Prosthetics Community

American Academy of Orthotists & Prosthetists (AAOP) – a resource for the latest prosthetic and orthotics information

American Orthotics & Prosthetics Association (AOPA) –  Mission: to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.

Amplitude Media Group (AMG) – AMG recently launched a website and is offering bimonthly e-newsletters to subscribers. Both are geared toward amputees, their families, and their caregivers. It is a sister company to O&P Edge.

Amputee Coalition – Mission: to reach out to and empower people affected by limb loss to achieve their full potential through education,support and advocacy, and to promote limb loss prevention.

Active Amp – an online community for amputees with an active lifestyle – amputee sports directories and links, resources for adults and children, legislation and technology

Adaptive Action Sports – the first adaptive snowboard and skateboard specific non-profit organization, Adaptive Action Sports creates skateboard, snowboard and other action sport camps, events and programs for youth, young adults and wounded veterans living with permanent physical disabilities, TBI and PTSD.

Adaptive Climbing Group – a community for people with disabilities to have opportunities to inclusively participate in the sport of climbing. Adaptive Climbing is taking the already existing abilities of a person and helping them participate in the sport. They work with the Brooklyn Boulders Foundation, which assists children in local urban areas to have access to affordable climbing and mentorships they work to make sure that children with disabilities are included in this popular initiative. (newsletter)

Athletes with Disabilities Network – ADN’s mission is to promote a better quality of life for people with physical disabilities by creating awareness and offering opportunities to get involved with athletic, recreational and educational activities nationwide.

Disabled Sports USA –  Disabled Sports USA provides national leadership and opportunities for individuals with disabilities to develop independence, confidence, and fitness through participation in community sports, recreation and educational programs.

Extremity Games – The Extremity Games is an adaptive sports competition, similar to the X Games, for athletes with amputations and limb differences.

National Amputee Golf Association (NAGA) – First Swing Program teaches adaptive golf to people with physical disabilities.

Wounded Warrior Amputee Softball Team – WWAST athletes are examples of amputees who continue to push the limits of modern prosthetic technology with more and more applications. It is comprised of young competitive, athletic veterans and active duty soldiers who have lost limbs post-9/11, while serving their country in the military/war. The team includes individuals with a variety of amputations of the arm, above knee, below knee, bilateral below knee and foot.

Barr Foundation – Mission:  a non-profit organization established in 1993 to assist amputees with prosthetic rehabilitation. They provide assistance to amputees domestically and internationally who would otherwise have no other financial resources.

Camp No Limits – Mission: Camp No Limits is a non-profit organization 501 (c)(3) providing camps for children with limb loss, and education, mentorship, and support to these children and their families.

Challenged Athletes Foundation (CAF) – Mission: to provide opportunities and support to people with physical disabilities so they can pursue active lifestyles through physical fitness and competitive athletics. CAF believes that involvement in sports at any level increases self-esteem, encourages independence and enhances quality of life.

Never Say Never Foundation – The Never Say Never Foundation was formed to help disabled youth overcome adversity with a positive attitude. Focusing on amputee athletes, their goal is to push the limits of adaptive sports and show the world that anything is possible! Mentoring and sponsoring athletes, fund raising, hosting adaptive events and stunt shows, motivational speaking, and providing disabled youth with the necessary tools to compete at the highest level of sports.

Orthotic and Prosthetic Activities Foundation – Mission: Enabling individuals served by the orthotic and prosthetic community to enjoy the rewards of personal achievement, physical fitness and social interaction. FIRST Activity clinics available in swimming, diving, horseback riding, rock climbing, golf and more.

Wounded Warriors Project – Mission: To raise awareness and to enlist the public’s aid for the needs of injured service members; to help injured servicemen and women aid and assist each other; and to provide unique, direct programs and services to meet their needs.

Amputee Coalition – Mission: to reach out to and empower people affected by limb loss to achieve their full potential through education, support and advocacy, and to promote limb loss prevention. Their website contains information on the latest legislation for the disabled and updates on states which have passed Fair Insurance for Amputees laws. Updates on Federal legislation and resources for discrimination issues.

American Orthotic Prosthetic Association – updates on their pending lawsuits and advocacy efforts on behalf of fairness in health insurance coverage for those with orthotics and prosthetics.

The National Association for the Advancement of Orthotics and Prosthetics is a non-profit trade association dedicated to educating the public and promoting public policy that is in the interest of the O&P patient.

Phantom pain describes the sensations felt by amputees which may include itching, pins and needle feelings, stabbing pains, pressure, tingling, cramping, a sense of swelling – all in the area of the missing limb.  Most amputees experience these sensations althouigh the degree to which they are felt will vary.  The sensations come and go.  They may occur several times a day, for a few hours at a time.  After time passes after the amputation, they will become less frequent and intense and short lasting.  Your prosthetist will discuss options for helping reduce the pain.

Generally, your prosthesis should be kept as dry as possible to protect the components.  However, there are covers which go over them to help prevent water from entering.  There are also special prostheses designed for water activities such as swimming and showering.

A well fitting prosthesis will allow you to regain much of the function you have lost.  There are limitations depending on the type of prosthesis and your personal health and abilities.  Your prosthetist, physical therapist, and doctor, will work with you to ensure you get the most from your prosthesis.

There are different ways a prosthetic limb stays on, depending on the device itself.  Some use suction and a suspension sleeve, others may use straps or have a pin mechanism and roll on liner.  Your prosthetist will discuss the details with you.

Exercise plays a very important role in being prepared for your first prosthesis.  You will find that the stronger and more flexible you are, the easier it will be to work with your new prosthesis.  Your physical therapist will help by teaching you some exercises specific to your unique needs.  People often can begin their exercising while they are on bed rest and then increase the amount and type of exercise as they heal.  There are massage exercises to prepare the stump for continual contact with the prosthetic.

Once your residual limb, your stump, has healed and swelling has gone down and it is wrapped properly, you should be able to use your prosthetic leg with little to no pain.  You may feel some pressure but pain should be minimal.  Your prosthetist will give you a specific schedule for using your new prosthesis which will allow the residual limb to gradually adjust.  If you do feel pain while wearing your prosthetic leg, you should let your prosthetist know right away.

Your first fitting for your temporary prosthetic limb will be after your surgical wounds have healed and swelling is minimal.  This is usually 6-8 weeks after surgery, depending on how quickly you heal.

While most medical insurance coverage will include prosthetic limbs with a prescription from your doctor, it is best to check your policy and call your insurance company to be sure.

Lifetime of a prosthesis varies depending on the specific limb, usage, and your age, but it is typically 3-5 years.  During the first year of recovery after amputation, parts of your “temporary” prosthesis may have to be replaced, usually the portion that surrounds your residual limb.  This piece is called the “socket”.  Your limb will change in size during the first year as part of the normal healing process (“limb maturation”) and the socket may be replaced several times.

A spinal orthotic device (orthosis) is an external apparatus that is applied to the body to limit the motion of, correct deformity in, reduce axial loading on, or improve the function of a particular spinal segment of the body.  This includes the area from the lower spine to the cervical (neck) area.  They are used to stabilize the spine after surgery and healing fractured vertebrae.

Scoliosis is a curvature of the spine into a “C” or “S” shape.  One hip may be higher than the other or one shoulder raised, or the child may lean to one side.  There is congenital scoliosis which is caused by vertebral anomalies,  idiopathic scoliosis which may not have an identifiable cause or neuromuscular, which has developed as a symptom of another condition such as cerebral palsy, physical trauma, spina bifida.

A brace is an effective nonsurgical way to prevent the curve from getting larger. Braces are usually prescribed for children who are still growing and the curves have exceeded 25 degrees.

The custom fitted scoliosis brace should not hurt but it is important to know that, in order for it to be effective, it applies pressure to the side of the chest to correct the curve.  It may be uncomfortable at first but if it continues to hurt, your orthotist can see if it needs to be adjusted.

Your doctor will monitor how fast the child is growing and the bones maturing so that the correction can take place during the growth period, usually adolescent years.

For scoliosis, the amount of time your child will wear the brace each day depends on his orthopedic doctor’s prescription.  It may be 20-23 hours or less or it might be a night time brace, depending on the extent of the curvature and age of the patient. For other purposes such as injury or post surgery, your doctor will provide the answer  depending on the condition.

Your child can participate in almost every activity in which he/she currently.  Depending on the brace, it can be worn to school but with the doctor’s agreement, may be removed for specific activities or sports.

TSLO stands for thoracic-lumbar-sacral orthosis.  They are used to treat scoliosis, custom molded and padded to keep the scoliosis curve from getting worse.  This brace is also called a “Boston Brace”.

CTLSO stands for cervical-thoracic-lumbar-sacral orthosis.  It can be custom molded and fitted to support a weak or damaged area of the spine as well as treat scoliosis. This is also called a “Milwaukee Brace.”

LSO stands for Lumbar-Sacral orthosis, restricting movement and reducing stress on the spine.

A Charleston brace is a nighttime brace, worn while sleeping.  This type of brace is also called a “nighttime” brace because it is only worn while sleeping.

There should be a balance between these two which will change as the child grows. Small children will need the guidance from their parents; as they become teenagers, they will want to make their own decisions. At this point they will also be more influenced by peers, and amputee role models.

Replacing the prothesis every time the child grows (ie every few months) can be a mistake because it takes several months for the child to get adapted to a new prosthesis. The good news is that there are adjustable features which can be built into a prosthesis for a child to make minor adjustments until a whole new device is needed. In addition, a new prosthesis for a child may come with padding built in which can be adjusted to accommodate growth. Sometimes the length can also be adjusted to match the length of the other limb. A new prosthesis may be required in cases where there is a significant change in body weight, skin ulceration, bone overgrowth or trauma to the residual limb. Your Sunshine Prosthetics & Orthotics prosthetist is able to tell you when a change is necessary.