Yoshio Setoguchi

Determinants of Self-Esteem in Children with Congenital/Acquired Limb Deficiencies

Social support, family functioning, self-perceptions of appearance, school, behavior, athletics, and social competence, as well as daily hassles/microstressors, were investigated as determinants of general self-esteem in 41 children with congenital/acquired limb deficiencies. Classmate, parent, teacher, and friend social support all were significant predictors of self-esteem. Family conflict and organization were also significantly associated with self-esteem, as were microstressors. The overall model of significant predictor variables accounted for 66% of the variance in general self-esteem. General self-esteem also was significantly predictive of depressive symptomatology. The findings suggest a number of factors which are potentially modifiable and which might enhance general self-esteem in children with visible physical handicaps.

Psychological adjustment and perceived social support in children with congenital/acquired limb deficiencies

The negative impact on psychological adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support. A multifactorial investigation was conducted to identify empirically psychological adjustment correlates of perceived social support in 49 children with congenital/acquired limb deficiencies. A multiplicity of adjustment factors (depression, trait anxiety, self-esteem) was variously related to perceived parent, teacher, classmate, and friend social support. Hierarchical multiple regression analyses provide initial evidence of the potentially powerful effects of the social environment of the school setting, with perceived classmate social support the only significant predictor variable across depressive symptomatology, trait anxiety, and general self-esteem. The results are discussed as the first step in identifying the potential correlates of multiple perceived social support domains, which may provide empirical guidance for future intervention studies designed to modify adjustment factors in chronically ill and handicapped children.

DYNAMICS OF BELOW-KNEE CHILD AMPUTEE GAIT: SACH FOOT VERSUS FLEX FOOT

Gait kinematics and dynamics during stance of unilateral, below-knee child amputees were analyzed for self-selected, comfortable (0.9 m s-1) and fast (1.3 m s-1) speeds with the SACH foot and the energy-storing Flex-foot prostheses. The three-dimensional movements of the lower limbs were recorded and synchronized with ground reaction forces for 12 subjects (7 girls and 5 boys, ages 6-16 yr). Each lower limb was modeled as a set of interconnected rigid links (thigh, leg, and foot) with frictionless joints (hip, knee, and ankle) to calculate moment and joint power profiles. Marked asymmetries were noted in ground reaction force, joint moment, and power profiles for the prosthetic versus the natural limb, but with the Flex foot the asymmetries were less pronounced than with the SACH foot. For the amputee wearing the Flex foot, greater moments and power were generated by the natural limb at the comfortable pace as compared to the SACH foot, but during fast walking, the SACH foot required greater output from the natural limb. With both prostheses, for the prosthetic limb the amputees used similar force, moment, and power patterns, but with significantly different amplitudes. At both speeds of walking, the Flex foot returned significantly more energy (66% at comfortable and 70% at fast walking) than the SACH foot (21% at comfortable and 19% at fast walking). Thus, the Flex foot had a greater potential for reducing the energy cost of walking at comfortable and fast speeds for the below-knee child amputee.

Correlates of perceived physical appearance in children with congenital/acquired limb deficiencies

Social support, daily hassles, marital discord, competence/adequacy, and psychological adjustment were investigated as hypothesized correlates of perceived physical appearance in 51 children with congenital or acquired limb deficiencies. Higher classmate, parent, and teacher social support were statistically predictive of higher perceived physical appearance. Higher daily hassles and marital discord were statistically predictive of lower perceived physical appearance. Higher peer acceptance, scholastic competence, and athletic competence were statistically predictive of higher perceived physical appearance. As a group, classmate, parent, and teacher social support, daily hassles, maternal and paternal perceived marital discord, peer acceptance, scholastic and athletic competence accounted for 78% of the variance in perceived physical appearance. Higher perceived physical appearance was in turn statistically predictive of lower depressive and anxious symptoms and higher general self-esteem. The findings are discussed in terms of the potentially modifiable predictors of perceived physical appearance and in terms of the role cosmetic differences play in psychological and social adaptation in children with visible physical handicaps.

Functional Status in Children With Limb Deficiency: Development and Initial Validation of an Outcome Measure

OBJECTIVE To develop a new outcome measure in response to the increasing demands for cost effectiveness analyses and empirically derived outcome instruments in the treatment of pediatric limb deficiency. This article describes the development, refinement, and initial psychometric properties of the Child Amputee Prosthetics Project-Functional Status Inventory (CAPP-FSI). DESIGN Parents of children with limb deficiency were surveyed during routine clinic visits. SETTING Two outpatient pediatric clinics. PARTICIPANTS Seventy-five parents and their children with limb deficiency (ages 8 to 17 years) participated in the study as part of annual physical evaluations or routine follow-up care. MAIN OUTCOME MEASURE The newly developed CAPP-FSI. RESULTS Internal consistency reliability (Cronbachs alpha) = .96 for the CAPP-FSI. Content validity is described and initial construct validity is empirically confirmed. CONCLUSION The CAPP-FSI is a promising assessment instrument for measuring important health outcomes in children with upper or lower limb deficiency.

Effects of parental adjustment on the adaptation of children with congenital or acquired limb deficiencies.

Maternal and paternal depression, anxiety, and marital discord were investigated as predictors of depression, anxiety, and self-esteem in 54 children with congenital or acquired limb deficiencies. Higher paternal depression predicted higher child depression and higher anxiety. Higher paternal anxiety predicted higher child depression and anxiety and lower self-esteem. Higher marital discord predicted higher child depression and anxiety and lower self-esteem. Maternal depression and anxiety did not predict child psychological adaptation. Family support had a positive effect on child adaptation, as did parent, classmate, teacher, and friend social support. The findings are discussed in terms of the risk and protective effects of parental distress, marital discord, and social support on the psychological adaptation of children with visible chronic physical disorders. J Dev Behav Pediatr 14:13–20, 1993. Index terms: limb deficiencies, children, adjustment, social support, parental distress, family functioning, marital discord.

Prosthesis satisfaction outcome measurement in pediatric limb deficiency

OBJECTIVE To describe the development and initial psychometric properties of a new outcome measure to assess satisfaction with prosthesis in children with limb deficiencies. DESIGN Parents of children with limb deficiency were surveyed during routine outpatient clinic visits. SETTING Two outpatient pediatric clinics. PARTICIPANTS Ninety-seven parents of children with limb deficiency aged 1 to 17 years. MAIN OUTCOME MEASURE The newly developed Child Amputee Prosthetics Project-Prosthesis Satisfaction Inventory (CAPP-PSI). RESULTS Internal consistency reliability is high. Zero-order correlations with prosthesis wear/use patterns and with parent ratings of prosthesis appearance provide support for the construct validity of the CAPP-PSI. CONCLUSION The CAPP-PSI is a promising, brief, parent-administered inventory for the assessment of prosthesis satisfaction in children with limb deficiency. It may be useful in future research for predicting prosthesis wear and use patterns in this population.

Functional Status in Limb Deficiency: Development of an Outcome Measure for Preschool Children

OBJECTIVE To develop an outcome measure of functional status in preschool children with limb deficiency. DESIGN Parents of preschool children with limb deficiency completed self-report measures during a routine medical clinic visit. SETTING Outpatient pediatric clinic. PARTICIPANTS Fifty-two parents of children (ages 4 to 7) with acquired or congenital limb deficiency. MAIN OUTCOME MEASURE The newly developed Child Amputee Prosthetics Project-Functional Status Inventory for Preschool children (CAPP-FSIP). RESULTS Initial psychometric studies indicate high internal consistency reliability of the new instrument. Content validity was established through expert clinician review. Initial construct validity analyses confirm that the CAPP-FSIP discriminates between children with upper and lower deficiency and their prosthesis use for functional activities. CONCLUSION The CAPP-FSIP is a promising new measure for evaluating preschool age children with limb deficiency.

Toddlers with limb deficiency: conceptual basis and initial application of a functional status outcome measure.

OBJECTIVE To describe the conceptual foundation, development, and initial psychometric analyses of a new outcome measure of functional status in toddlers with limb deficiency. DESIGN Parents of children with limb deficiency completed self-report measures during a routine medical clinic visit. SETTING Outpatient orthopedic pediatric clinic. PARTICIPANTS Twenty parents (mothers) of children (ages 1 to 4 years) with acquired or congenital limb deficiency. MAIN OUTCOME MEASURE The newly developed Child Amputee Prosthetics Project-Functional Status Inventory for Toddlers (CAPP-FSIT). RESULTS Estimates of internal consistency reliability of the measure are high, suggesting conceptual congruence among the items. Initial validity studies confirm the CAPP-FSIT differentiates between toddlers with upper limb deficiency and lower limb deficiency in terms of functional activity and prosthesis use. The new measure does not appear to be contaminated by gender or socioeconomic status. CONCLUSION The CAPP-FSIT is a promising measure for assessing functional abilities in toddlers with limb deficiency.

Typical facial clefting and constriction band anomalies: an unusual association in three unrelated patients.

The amniotic band sequence is a rare congenital condition in which it is hypothesized that fibrous band of amniotic tissue result in variable soft tissue derangements. Other terms that have been used to describe this condition are amniotic band syndrome and amnion rupture sequence. Patients may present with craniofacial, thoracic, abdominal, and/or limb involvement. Previous reports have described the association between the amniotic band sequence and unusual patterns of facial clefting, as described by Tessier, that do not follow normal embryonic lines of fusion [Keller et al., 1978 ; Bagatin et al., 1997 ]. We describe three successive cases of the amniotic band sequence, which presented with rather typical facial clefts (cleft lip and palate) in unrelated patients.