Krzysztof Zajdel, Physiotherapist. Case presentation: Amputee Case Study

Title

Krzysztof Zajdel, Physiotherapist. Case presentation

Abstract

Case presentation based on one of my current patient and considering the following topics: High level of rehabilitation of amputees.

Key Words

High level of rehabilitation of amputees,Core stability, hip joint stability exercises,Swimming

Client Characteristics

Male, 31 years old, Occupation: Road Worker/ maintenance motorway.
Medical diagnosis if applicable:
Traffic accident resulting bilateral below knee injury. Client underwent bilateral below knee amputee in Dec 2013.
Co-morbidities:
Nil.
Previous care or treatment:
Nil.

Examination Findings

Young male, husband, having a wife and one child. Nil medical history prior incident. Before accident fully active and working in maintenance motorway industry.

Self Report Outcome Measures:

  • Subjective self assessment tests have been completed AmpPro / AmpNoPro and PEQ (33/38 AmpNoPro)

Physical Performance Measures:

  • Barthel scale 95-100, TUG tests 13 sec.

Objective:

  • Joint integrity and presence of contractures, especially of flexors of hip and knee joints
  • Muscle power and range of movement of upper and lower limbs as well as trunk (UL left/right 5/5; LL left/righ Hip flex 5/5, hip ext 4/5, hip abd/add 4/5, knee flex/ ext 4/5)
  • Hand function – functional capacity to donn and doff a prosthesis, and to use a manual wheelchair.
  • Independent status and dynamic balance in pitting, in standing client required walking stick to maintain dynamic balance.
  • Fully independent with transfer and mobility
  • Unlimited standing tolerance

ICF Framework:

  • Pathology – Amputation has been completed below the knee with mild difference between the Lower limb approx 2cm. Nil complication has been recognized.
  • Body Function and structure- Phantom sensation and pain; muscle waist occurred;
  • Limited activities -Mobility, driving, use of transport, transferring.
  • Participation / restriction -recreation and leisure activities, re-employment, re-housing.

Clinical Hypothesis

After 18 months of rehabilitation, client has developed independent transfer without equipment, independent mobility indoors and outdoors with two walking stick included stairs.
Client was able to achieve full range of movement in hip and knee joints and prevent contractions. Client demonstrate independent static and dynamic balance control in sitting and standing position.
Main problem was stamp pain, occasionally lower back pain, and mild gait issues which result in lateral track movement and abduction lower limbs.
Fear to the cars transport and public transport.

Intervention

Liaised with GP Dr, and pharmacist regard analgesia review.
Liaised with prosthetics regard review prosthesis.
Gait analysis.
Core stability and hip joint stability exercises.
Strengthening exercises hip abductors.

  • Strengthening and stretching session 2x a week 40-60 min,
  • Swimming pool session 2x a week 60-80 min,

Gait re-education
Pelvis rotation re-education.
Psychological practice – restart use the car with manual control break and acceleration.

Outcome

Swimming session has been very beneficial in order to decrease pressure on stamp on increase amount of resistance, reduce back pain/ache, client was able to performed more effective hip joint stability exercises.
Lack of gravity in a water allowed client focus on correct technique and on the tasks.
Client increased exercises tolerance, and reduced amount and level of lower back pain/ache. During exercises in swimming pool client also has been exposed on other stimulation which decreased sensitivity of the stamp. It included different temperature of the water, putting pressure on the surface of the water with different power, and received feedback to the stamps depend on intensity of the exercises which he applied.

Client was able to start drive car with supervision, and start to arrange a purchase the car.

Discussion

Client has been ready to start intensive intervention program and progress to high level rehabilitation included cardiovascular fitness (swimming session, and intensive strength training). Client was able to maintain systematic and regular program twice a week in gym and in the swimming pool. Supported from GP Dr, Pharmacist he was able to maintain level of pain. Regular session with psychologist; and stability and support from family maintain and encourage client to achieve high level of goals, and prevent from depression. Education and awareness of the client, maintained ”healthy level of the stamp”.
I have notice that patient has access to good financial resources which allowed him to apply for new prosthesis, two set of prosthesis for normal function, running and swimming set too. That environmental factor was important element to maintain his healthy psychological status and re-gain physical and mental stability.

Bibliography