Basic rehabilitation protocol in a low resource setting or conflict/desaster context: Amputation

Original Editor - Cornelia Barth

Top Contributors - Cornelia Barth and Claire Knott  

Pre- and post-fitting rehab cycle for patients with a lower limb amputation

The following table is a suggestion for a relatively normal rehab cycle of patients without complications. For more complex cases additional sessions will be necessary based on case-by-case-evaluation.

___________________________________________________________________________________

Session (1) assessment => decision:

A no fitting => go to table & see A
B fitting after preparation start directly after surgery => go to table & see B
C fitting after preparation start with healed stump => go to table & see C
D postfitting => go to table & see D

___________________________________________________________________________________

Final outcome 

& procedure/ objectives

Nr of sessions Content[1][2][3]

A No Fitting

Maintenance of a good stump; 

Prevention of complications

 Up to 6

(1) assessment[4]; bandaging

(2) donation of mobility aids & training; bandaging (pt education); positioning & mobilization of the stump; scar treatment; transfers

(3) training with mobility aids; all of (2) with focus on independence (pt education)

(4) like (3) but more independence

(5) taking care of the stump: hygiene, skin care, automassage

(6) roundup of previous sessions, re-assessment[4]

B Fitting

Pre-fitting rehabilitation directly after surgery

 Up to 6

(1) assessment[4]; bandaging

(2) donation of mobility aids & training; bandaging; positioning & careful mobilization of the stump, until wound is healed then continue with (3) below (after wound closure)

C Fitting

Pre-fitting rehabilitation after wound closure

 Up to 6

(1) assessment[4]; bandaging

(2) donation of mobility aids & training; bandaging; positioning & mobilization of stump; scar treatment; desensitization; transfers

(3) training with mobility aids; all of (2) with focus on independence; start weightbearing on stump; strengthening (classical & in function eg. football)

(4) like (3) but more independence

(5) taking care of the stump[5]: hygiene, skin care, automassage; continue like in (4)

(6) roundup of previous sessions, re-assessment[4]

 D Fitting

Post-fitting rehabilitation[6][7]

 6

(1) first assessment with prosthesis[4]; static exercises; handling prosthesis (donning & doffing); taking care of prosthesis & stump[5]

(2) continue with (1); weight shift in parallel bars; gait training with mobility aid

(3) static balance exercises; simple transfers; continue gait training

(4) dynamic balance exercises; advanced transfers; advanced gait training; obstacle course

(5) like (4); start sports activity

(6) roundup of previous sessions, re-assessment[4]

The most important of the cited references can be downloaded for free as pdf-booklets. They give an overview of the whole amputation and fitting process. They also give instructions and ideas for rehabilitation activities and are useful for all physiotherapists, occupational therapists and rehabilitation workers. It is also a good idea to give or borrow them to patients and carers who are interested and able to read English. 

In the following videos the contents of the table are shown in more detail:


For further reading click HERE

References

References will automatically be added here, see adding references tutorial.

  1. World Health Organisation (WHO). The rehabilitation of people with amputations, 2004. http://www.posna.org/news/amputations.pdf (accessed 14 May 2014)
  2. Demey Didier. PT Training Manual - Physiotherapy for patients with lower limb amputation. Handicap International, 2010.
  3. Broomhead et al. Evidence Based Clinical Guidelines for the Managements of Adults with Lower Limb Prostheses. 2nd Edition. London: Chartered Society of Physiotherapy, 2012. Full version: http://www.csp.org.uk/sites/files/csp/secure/bacpar_amputee_rehab_guidelines_2012_1.pdf (accessed 17 May 2014)
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Gailey RS et al. The Amputee Mobility Predictor: an instrument to assess determinants of the lower-limb amputee ability to ambulate. Arch Phys Med Rehabil 2002;83:613-27.
  5. 5.0 5.1 State of Queensland (Queensland Health). Caring for your stump. http://www.health.qld.gov.au/qals/docs/stump_care.pdf (accessed 14 May 2014)
  6. International Committee of the Red Cross et al. Exercises for lower limb amputees, gait training. http://www.icrc.org/eng/assets/files/other/icrc_002_0936.pdf (accessed 14 May 2014)
  7. Rau et al. Short-term effect of physiotherapy rehabilitation on functional performance of lower limb amputees. Prosthetics and Orthotics International 2007;31:258-270