(Kiosk 6) Pediatric Use of a Modified Pneumatic Post Amputation Mobility Aid Following Amputation

Case Diagnosis: A pediatric patient underwent bilateral transtibial amputations and left upper extremity trans-humeral amputation after developing DIC-induced lower left extremity compartment syndrome and dry gangrene of all extremities.

Case Description or Program Description: A 9-year-old female with past medical history of congenital heart disease and asplenia presented with severe streptococcus pneumoniae sepsis complicated by cardiopulmonary arrest twice requiring ECMO and acute renal failure requiring continuous renal replacement therapy. After undergoing amputation, she was admitted to inpatient rehabilitation for deconditioning and amputation pre-rehabilitation. The patient’s extensive wound healing resulted in delayed clearance for her right lower extremity with no clearance for her left lower extremity during her rehabilitation stay.

Setting: Inpatient pediatric service at a freestanding rehabilitation hospital

Assessment/Results: In order to begin safe weight-bearing exercises for the right lower extremity, a pediatric pneumatic post-amputation mobility aid was fabricated using a knee immobilizer with air casting and foam padding. With the use of this cost-effective assistive device, the patient consistently improved the duration of weight-bearing activity by 150% from baseline until discharge.

Discussion (relevance): Patients with bilateral lower extremity amputations require early ambulation for optimal functional recovery. Maximizing weight-bearing activity in amputees has been shown to prevent immobilization bone loss and skeletal deformities, improve prosthetic fittings, reduce pain, and improve psychosocial status. Assistive devices like Pneumatic Post Amputation Mobility Aids can promote weight-bearing activity and ambulation post-amputation in order to improve gait reeducation, resulting in early mobilization and independence. However, there are no available devices on the market for pediatric patients.

This is the first reported case, to our knowledge, of creating a pneumatic post amputation mobility aid for a pediatric patient in order to encourage ambulation during rehabilitation.

Conclusions: Following amputation in pediatric patients, the rehabilitation team should prioritize early ambulation and consider modifications to therapeutic devices to allow for earlier mobilization.