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AMPUTEE THERAPY SURVIVAL GUIDE

Reasons for Amputation PVD (of which 25%-50% have diabetes) Trauma Malignant Disease Congenital Limb Deficiency Infection
Average age-69

Source- Murray, S (2001) Nursing & Management

Percentage % 85-90 9 4 3 1

Levels of Amputation S Toes E Partial Foot V “Symes”/ankle disarticulation E Transtibial/”Below Knee” R Knee disarticulation-uncommon I Transfemoral/”Above Knee” T Hip disarticulation Y Hemipelvictomy (Upper limb amputations occur but were not encountered) Assessment Normal musculoskeletal assessment- Contractures ROM Muscle Power Transfers Home circumstances AND Stump AssessmentWound Shape Oedema Level Compression Garment (“juzo”/”shrinker sock”, plaster cast, backslab, stump bandage) Stump pain Phantom pain and sensations Sensation

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TTA only in others Femurette. muscle strength and mobility Transfers Getting on and off the floor Balance EWA (early walking aids) Gait re-education Standing Balance Stair mobility Outdoor mobility Advanced wheelchair mobility Fitted Patient- Non-fitted Patient- EWAs PPAM aid- pneumatic post amputation mobility aid An inflatable bag and metal cage Used for TTA and TFA in some centres. look.Cosmesis applied Types of Prosthetic Limb Many variations with the prosthestist deciding on optimum for individual patient’s needs Suspension.ice ross Supracondylar suspension (TTA) Elastic suspension (TFA) Suction socket 2 . feel) Treatment For all patients- Bed and upper limb exercises to maintain ROM.Patient Goals- Patient to be fitted or not Introduction of patient to prosthetic limb (weight.rigid adjustable Velcro fastening socket Adjustable leg length TFA patients only Stages of Prosthetics CastingStump cast with POP to make individual socket FittingSocket Alignment Knee component (TFA only) Finishing.

assessment of driving required following amputation THINGS TO LOOK UP BEFORE ROTATION/PLACEMENT • Pathologies of PVD and diabetes • Transtibial and transfemoral gait deviations • Prosthetics • Grieving • Surgical procedures? • Walking aids Useful References Rehabilitation management of AmputeesTherapy for AmputeesAmputee Management-a handbookPsychological Aspects of AmputationAN AMPUTEE Banjeree Engstrom & Van de Ven Barsby et al Ham & Cotton 3 . Parkes 1996 and Zigmond 1996) Reason for amputation important in how patient copes with it Phantom sensations must be recognised and validated and treated AID (amputee identity disorder) Multi-disciplinary Team Prosthetist OT involvement may be much greater and combined with physiotherapy depending on centre Driving Centre.Locked knee Semi-automatic knee Free knee Donning and Doffing The process of putting on and taking off the prosthetic limb Patient may require maximal assistance to start with but independence should be encouraged with practice Socket- Psychological Aspects Grieving Processes (Kubler-Ross 1970.ischial weight bearing (TFA) Patella tendon weight bearing (TTA) Knee components.