Needs and Perspectives on Upper Limb Prostheses Among Children and Adolescents With Upper Limb Differences.

Importance: In low- and middle-income countries (LMICs), limited access to adequate prosthetic care hinders the psycho-socio-motor development and educational progress of children and adolescents with upper limb differences. The suitability of current pediatric prosthetic solutions and the needs and expectations of children and adolescents with upper limb differences regarding upper limb prostheses (ULPs) remain understudied in LMICs. Objectives: To examine and characterize the needs, expectations, and perceptions of Nigerian children and adolescents with upper limb differences regarding ULPs, assessing contextualized specifications for prosthetic development. Design, Setting, and Participants: This qualitative study was conducted from July 20 to July 23, 2024, in Lagos, Nigeria, among 25 children and adolescents with upper limb differences purposively selected from The IREDE Foundation prosthetic care program; recipients were aged 5 through 20 years who possessed at least 1 ULP. This study involved semistructured interviews and focus groups of Nigerian children and adolescents with upper limb differences. Transcripts were analyzed using thematic analysis between August 2024 and May 2025. Main Outcomes and Measures: The needs and perceptions of children and adolescents with upper limb differences regarding ULPs. Results: A total of 25 children and adolescents with upper limb differences (mean [SD] age, 13.5 [4.2] years; 15 male [60%]) enrolled in the study; 14 were interviewed, and 11 engaged in focus groups. The predominant cause of upper limb differences was traumatic amputations (16 [64%]), and the predominant level of upper limb differences was transhumeral (16 [64%]). Seven themes were identified from the interviews and focus groups. First, the children and adolescents with upper limb differences described the technical specifications of an ideal ULP by (1) highlighting the functionalities and task performance it should enable; (2) expressing their need for an active ULP and the characteristics of effective terminal devices; (3) specifying user-defined requirements for quality of prostheses components; (4) describing factors contributing to comfortable wear and use; and (5) explaining the necessity for anthropomorphism (shape and color) of ULP designs. Second, the psychosocial consequences of the conditions of the children and adolescents with upper limb differences and ULP use emerged: adverse repercussions (6) on self-concept and (7) in interactions with their social network, which were major factors in ULP acceptance. Overall, children and adolescents with upper limb differences expressed the need for an active, anthropomorphic, sturdy ULP, enabling them to actively engage with their peers. Conclusions and Relevance: In this qualitative study, children and adolescents with upper limb differences expressed perceptions regarding their current ULP and described the requirements of prosthetic devices meeting the psychosocial and occupational needs within their socialcultural environment. Future studies could incorporate these findings into the development of environment-specific pediatric ULPs.