Basic rehabilitation protocol in a low resource setting or conflict/disaster context: Amputation
Original Editor - Cornelia Barth
Top Contributors - Cornelia Barth, Admin, Laura Ritchie, Kim Jackson and Claire Knott
Pre- and post-fitting rehab cycle for patients with a LL-amputation[edit | edit source]
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.
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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
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Final outcome & procedure/ objectives |
Nr of sessions | Content[1][2] |
A No Fitting Maintenance of a good stump; Prevention of complications |
Up to 6 |
(1) assessment[3]; bandaging (2) donation of mobility aids & training; bandaging (pt education); positioning & mobilization 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[3] |
B Fitting Pre-fitting rehabilitation directly after surgery |
Up to 6 |
(1) assessment[3]; bandaging (2) donation of mobility aids & training; bandaging; positioning & careful mobilization of 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[3]; bandaging (2) donation mobility aids & training; bandaging; positioning & mobilization stump; scar treatment; desensitization; transfers (3) training with mob.aid; 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[4]: hygiene, skin care, automassage; continue like in (4) (6) roundup of previous sessions, re-assessment[3] |
D Fitting Post-fitting rehabilitation[5] |
6 |
(1) first assessment with prosthesis[3]; static exercises; handling prosthesis (donning & doffing); taking care of prosthesis & stump[4] (2) continue with (1); weight shift in parallel bars; gait training with mob.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[3] |
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 as well as advice for rehabilitation activities. It is advisable to give or borrow these booklets to patients and carers who are interested and able to read English.
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ World Health Organisation (WHO). The rehabilitation of people with amputations, 2004. http://www.posna.org/news/amputations.pdf (accessed 14 May 2014)
- ↑ Demey Didier. PT Training Manual - Physiotherapy for patients with lower limb amputation. Handicap International, 2010.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 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.
- ↑ 4.0 4.1 State of Queensland (Queensland Health). Caring for your stump. http://www.health.qld.gov.au/qals/docs/stump_care.pdf (accessed 14 May 2014)
- ↑ 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)