Health Professionals

Hand or arm deficiency is relatively rare, so many professionals involved in health care do not come across it very often, if at all.

In the first instance, all babies born with congenital limb deficiencies should be refered to a Disablement Services Centre (or equivalent specialist clinic for congenital hand problems) This referral should be made as soon as possible, certainly within the first few months.

Where the deficiency is spotted on an Ultra Sound Scan prior to birth, parents should be given the oportunity to visit the DSC.

Normally referral will be made to the Centre nearest the families' home, however, it should be realised that some centres have more experience and better facilities than others. Assessment by a multi-disciplinary team will ensure your child reaches full potential. Ideally this team should be experienced and trained to deal with the special needs of limb deficient children and should include -

* Rehabilitation Consultant
* Prosthetist
* Physiotherapist (less frequently included)
* Occupational Therapist
* Community Paediatrician

Other specialists you child may be referred to, depending on the nature of the deficiency, include Plastic/Reconstructive/Orthopaedic Surgeons for the improvement of function, or of appearance, or both.

The "official titles" above can be very daunting and intimidating, so here is a description for each professional.

Consultant in Rehabilitation	As head of the team, they will have the knowledge and experience needed to assess your child's needs. After careful consideration and consultation they will decide if a prosthesis (artificial arm) would be suitable and, if so, when and what to fit. It may not be necessary for they to see your child at every visit, but they will assess at regular intervals
Prosthetist	If the consuktant decides your child could wear an artificial limb, it is the prosthetist's job to measure, prepare a cast and eventually fit you child's limb. They are also often very inventive people and if your child comes across a particulr problem/task for which his artificial limb is not suitable, a prosthetist can often suggest or make adaptions.
Occupational Therapist/Physiotherapist	Whatever your child's deficiency an OT or PT can offer a wide range of assistance. They can suggest excercises and other simple devices to help your child to do day to day tasks. These can range from a simple wrist band to slot in a knife, fork pencil etc, to splinting to correct some functional deficiencies. The OT will also be the person responsible for teaching your child to use an artificial limb. Support and advice can be offered to the staff when your child starts play-school or nursery and when they move to main stream school
Orthopaedic Surgeon	Some, but not all, Orthopaedic Surgeons have specialised in corrective surgery for congenital limb anomolies, and it is a specialist in this work that your general practicioner should find for you. They should and would generally be a member of a team. Should your general practicioner have difficulty, Reach may be able to help.
Plastic Surgeon	Some, but again not all, Plastic Surgeons have specialised in hand and finger surgery. Whether an orthopaedic or a plastic surgeon should be consulted will depend on their respective areas of specialisation and their membership of a team. Once you have located an appropriate rehabilitation team, the appropraite referrals should be automatic. Again, in case of difficulty, Reach may be able to help.
Community Paediatrician	This is a Consultant Children's Specialist, with special training in children's development and growth. They may not be a member of the Rehabilitation team, but should be included as they can be extremely useful, having knowledge of local nurseries, schools etc. The involvement of the Community Paediatrician becomes obligatory when a child is likely to require special facilities for education.
Orthotist	Where additional or specialised splinting is required

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