Recreational terminal devices for children with upper extremity amputations

Background: Children with upper extremity amputations are particularly challenged in sports and other recreational activities. Many find that a prosthesis is of no benefit in their routine daily activities. Although a number of recreational terminal devices are available for prosthetic modification, it is unclear how effective they are at improving a child's performance in sports or hobbies. METHODS: We evaluated the usefulness of 15 recreational terminal devices for upper extremity prostheses in 11 children by chart review and patient survey. All patients had functional elbows, and all but one was a unilateral amputee. All patients were instructed in their use by a prosthetist, and 3 patients received occupational therapy. RESULTS: Nine of 15 recreational terminal devices prescribed improved performance. However, they primarily were the adaptations for weight lifting and violin bows, where their use was obligatory for participation. The wholesale costs for the terminal devices ranged from $120 to $957, and many patients also required the construction of a prosthesis just for the activity. Only 4 of the 9 successful recreational terminal devices were still in use at average follow-up of 3.9 years because patients had lost interest in the activity or had designed something that worked better. CONCLUSIONS: Recreational terminal devices available for weight lifting and violin bows uniformly improved the child's ability to pursue those activities. These prosthetic adaptations are expensive and must be weighed individually by the family in light of children's fleeting interest in individual hobbies. LEVELS OF EVIDENCE: Level IV.