Abstract
Upper extremity replantation is attempted in 15% of amputations, with 80%-90% success. This case study shows a 3-year-old’s progress using functional electrical stimulation (FES) postreplantation, improving function.
Primary Author and Speaker: Shannon R. Hemberger
Research indicates that upper extremity (UE) replantation is attempted in about 15% of amputations, with success rates typically ranging from 80% to 90%. Outcomes of replantation are influenced by several factors, including nature of the injury, tissue viability, level of amputation, rehabilitation process, patient’s age, and existing medical conditions (Oleck et al., 2020). UE amputations in pediatric patients can lead to decreased independence in self-care, school tasks, and play/leisure. However, due to children’s enhanced plasticity and wound healing capabilities compared to adults, an increasing number of UE replantations are being attempted (Hee et al., 2021). This poster presents an ongoing case study of neurorehabilitation using functional electrical stimulation (FES) for a 3-year old girl who underwent a right UE replantation at the distal humerus following a motor vehicle accident in 2023 (2 years of age at the time of injury). By utilizing FES in more than 50% of her therapy sessions, the child has shown preliminary progress, as indicated by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2), Pediatric Evaluation of Disability Inventory (PEDI), and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). Active and passive range of motion, as well as manual muscle testing, are also utilized throughout treatments to assess the functionality of her right UE and show improvement proximally. Data collected during sessions also reveal an increase in bimanual hand use. Prior to therapy, the child had no functional use of her replanted right UE. However, with the use of FES and targeted neurorehabilitation principles, she now demonstrates greater functional use of her right UE and improved integration of both UEs into her daily routine. Based on these results, Occupational Therapists should more frequently consider the use of neurorehabilitation interventions like FES to maximize functional gains for children with UE replantation.
Deodhe, N. P., Pooja Dhage, & Pallavi Harjpal. (2023). Functional Electrical Stimulation in Conjunction With Proprioceptive Neuromuscular Facilitation (PNF) Technique to Improve Upper Limb Function in Traumatic Brachial Plexus Injury: A Case Report. Cureus. 15(10). https://doi.org/10.7759/cureus.46386
Hee, L. S., Hyung-Sik, K., & Hong-Chul, L. (2021). Distal forearm replantation in a child: A case report with a 30-year follow-up. Strategies in trauma and limb reconstruction, 16(3), 179–183. https://pmc.ncbi.nlm.nih.gov/articles/PMC8778723/
Marquez-Chin, C., & Popovic, M. R. (2020). Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review. BioMedical Engineering OnLine, 19(1). https://doi.org/10.1186/s12938-020-00773-4
Oleck, N. C., Malhotra, R., Ayyala, H. S., & Datiashvili, R. O. (2021). Pediatric Replantation after Traumatic Amputation at the Distal Forearm: Rehabilitation Protocol and Outcomes. Journal of Hand and Microsurgery. 13(3), 169–172. https://doi.org/10.1055/s-0040-1703096