Challenges involved in developing a personalized, tailor-made rehabilitation program for a child with congenital upper and lower limb deficiency

Congenital upper and lower limb deficiency in the same individual is a very rare condition. Here we report a case of bilateral transverse upper limb deficiency and right proximal focal femoral deficiency with fibular hemimelia in a 3 year old child. The child presented several rehabilitation challenges especially related to ambulation and activities of daily living. To aid ambulation, a modified lapboard walker was designed to enable the child to use the trunk to propel forward. The involvement of both upper limbs made ambulation training more challenging. A left universal cuff-based customized assistive device was employed to assist brushing, feeding and grooming. The fact that the child was in the growing phase was a significant factor that was considered during rehabilitation planning. Behavioural issues that interfered with the rehabilitation program were addressed with the help of a child psychiatrist. Parental counselling, re-assurance and adequate training were provided to ensure compliance to the rehabilitation program and to ensure a successful rehabilitation outcome.