Pre-Fitting Management of the Patient with a Lower Limb Amputation: Difference between revisions
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Your patient will look to you to provide early information about the possibilities for a prosthesis. Ensure that you have a basic knowledge and understanding of the prosthetic technology that is available and could be appropriate for your patient (refer to Section 9 on [[Prosthetics]]).<br> | Your patient will look to you to provide early information about the possibilities for a prosthesis. Ensure that you have a basic knowledge and understanding of the prosthetic technology that is available and could be appropriate for your patient (refer to Section 9 on [[Prosthetics]]).<br> | ||
=== | === Assessment of the amputee <br> === | ||
In order to formulate an appropriate patient-centred prosthetic rehabilitation plan for any amputee, the patient needs to be adequately assessed. Refer [[Assessment_of_the_amputee]] | |||
=== Patient education<br> === | === Patient education<br> === |
Revision as of 17:15, 2 March 2015
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INTRODUCTION[edit | edit source]
The loss of a lower limb has severe implications for a person’s mobility, and ability to perform activities of daily living [1]. This negatively impacts on their participation and integration into society [2].The ultimate goal of rehabilitation after limb loss, is to ambulate successfully with the use of a prosthesis[3] . Prosthetic rehabilitation is a complex task that ideally requires input from a transdisciplinary rehabilitation team. However, most often physiotherapists are in charge of the physical rehabilitation process [4].
OVERVIEW OF THE REHABILITATION PROCESS[edit | edit source]
The rehabilitation process of the lower limb amputee consists of nine phases [5] , namely:
- pre-operative,
- amputation surgery,
- acute post-surgical,
- pre-prosthetic,
- prosthetic prescription,
- prosthetic training,
- community integration,
- vocational rehabilitation and
- follow up.
Table 1: Phases of amputee rehabilitation: Modified from Esquenazi &Meier (1996) cited in Esquenazi (2004).
Phase | Hallmark |
---|---|
Pre-operative | Assess body condition, patient education, surgical level discussion, postoperative prosthetic plans |
Amputation Surgery/Reconstruction | Length, myoplastic closure, soft tissue coverage, nerve, handling, rigid dressing |
Acute post-surgical | Wound healing, pain control, proximal body motion, emotional support |
Pre-prosthetic | Shaping, shrinking, increase muscle strength, restore patient locus of control |
Prosthetic Prescription | Team consensus on prosthetic prescription and fabrication |
Prosthetic Training | Increase prosthetic wearing and functional utilization |
Community Integration | Resumption of roles in family and community activities. Emotional equilibrium and healthy coping strategies. Recreational activities. |
Vocational Rehabilitation | Assess and plan vocational activities for future. May need further education, training or job modification. |
Follow-up | Life-long prosthetic, functional, medical assessment and emotional support |
PRE-PROSTHETIC REHABILITATION PHASE[edit | edit source]
The PRE-PROSTHETIC rehabilitation phase of the lower limb amputee will include six components:
- Physiotherapist preparation
- Assessment of the amputee (see section 6 not covered in this section)
- Patient education
- Stump management
- Exercise therapy
- Restoring locus of control
- Referral
1. Physiotherapist preparation[edit | edit source]
As you approach an amputee, the therapist have to physically and mentally prepare for the interaction with the patient. Some questions to consider include:
- Who is my patient? (young / old)
- What was the cause of the amputation? (traumatic / dysvascular)
- Where (what level) was the amputation performed? (implications for rehabilitation outcome)
- What is the patient’s goal? (Is the patient aware of the possibilities, are they being realistic?)
- What prosthetic options are available for this particular patient? (self-study and preparation)
1.1 Awareness of stages of grief process[edit | edit source]
A young patient who suffered an amputation as result of a traumatic experience will most likely be in some stage of the grieving, and in acute post-surgical pain. An older patient who suffered a dysvascular or neuropathic limb loss, might have had some time to psychologically and physically prepare for the loss of their limb [3]. Either way, your patient might be psychologically and physically distressed when you start the rehabilitation process, so early discussion and education about the patient’s expectations and goals are essential [6] .
- Link to full-text articles: www.amputee-coalition.org/first_step_2003/psychological-aspects-amputation.html
- Reaction to amputation: Recognition and treatment : www.ncbi.nlm.nih.gov/pmc/articles/PMC2018851/pdf/i1523-5998-9-4-303.pdf
- Slideshow on grief amongst amputees: www.slideshare.net/jrod_reggie/grieving-and-psychological-impact-on-amputees-presentation
1.2.Knowledge of appropriate outcome measures and assessment tools[edit | edit source]
Be prepared with the appropriate assessment tools and outcome measures to assess your patient’s potential for prosthetic use, and not create false hope (refer to section 19 Outcome measures for amputees )
1.3 Knowledge of the appropriate assistive technology available[edit | edit source]
Your patient will look to you to provide early information about the possibilities for a prosthesis. Ensure that you have a basic knowledge and understanding of the prosthetic technology that is available and could be appropriate for your patient (refer to Section 9 on Prosthetics).
Assessment of the amputee
[edit | edit source]
In order to formulate an appropriate patient-centred prosthetic rehabilitation plan for any amputee, the patient needs to be adequately assessed. Refer Assessment_of_the_amputee
Patient education
[edit | edit source]
Stump management
[edit | edit source]
Exercise therapy
[edit | edit source]
Restoring locus of control
[edit | edit source]
Referral
[edit | edit source]
References
[edit | edit source]
- ↑ Dillingham TD & Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations. Archives of Physical and Medical Rehabilitation 2008; 89; 1038-1045.
- ↑ World Health Organisation (WHO). International classification of functioning disability and health (ICF). World Health Organisation 2001. Geneva.
- ↑ 3.0 3.1 Lusardi MM, Postoperative and preprosthetic care. In Lusardi, MM, Jorge, M & Nielsen, CC editors. Orthotics and Prosthetics in Rehabilitation, Third Edition. Missouri: Elsevier, 2013.p. 532-594.
- ↑ Kaplan SL, Outcome measurement and management: First steps for the practicing clinician. Philadelphia, FA Davis Company, 2007.
- ↑ Esquenazi A. Amputation rehabilitation and prosthetic restoration: from surgery to community reintegration. Disability and Rehabilitation, 2004; 26,(14/15); 831–6.
- ↑ Livingstone W, Van de Mortel TF, Taylor B. A path of perpetual resilience: Exploring the experience of a diabetes related amputations through grounded theory. Contemporary Nursing. 2011; 39(1):20-30.