Rehabilitation of Lower Limb Amputee Jade

8/12/2019 Rehabilitation of Lower Limb Amputee Jade

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mputation

By

: MARIA JADE M. PINALBA


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Amputation: the surgical removal of a part of thebody, a limb or part of a limb


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Statistics Canadians with diabetes are 23 times more likely to be hospitalized for a

limb amputation than someone without diabetes

More than 4,000 Canadians with diabetes had a limb amputated in 2006.

30% of Canadians with diabetes will die within one year of amputation.69% of limb amputees with diabetes will not survive past five years

Lower limb amputations are 4 times more common than upper limb(infection) .

While over 90% of amputations caused by vascular disease involve the

lower limb, nearly 70% of amputations caused by trauma involve theupper limb


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Statistics

For both males and females, risk of traumatic amputations

increased steadily with age, reaching its highest level amongpeople age 85 or older

Limb amputations resulting from cancer most commonly

involved the lower limb; above-knee and below-kneeamputations alone accounted for more than a third (36 percent)of all cancer-related amputations.


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Causative Factors ofAmputations

Peripheral arterial disease

Diabetes Mellitus

Gangrene (due to thecomplication of & plaster cast ) .

Trauma (crushing, frost bite,

burns)Congenital deformities

Chronic Osteomyelitis

Malignant Tumor


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Complications of diabetes that contribute

to the increased risk of foot infection

include:

1. Neuropathy

a. Sensory

b. Autonomic

c. Motor2. Peripheral vascular disease .

3. Immuno-compromise


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High Risk Characteristics for

Developing Foot Infections

Duration of diabetes more than 10 years

Age > 40 years

History of smoking

Decreased peripheral pulses

Decreased sensation

History of previous foot ulcers or amputation


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Should be preserved

Should be resected

So&So


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Pre-operative Assessment

Neurovascular and functional status of extremity

Function and Condition of residual limb (in case of

traumatic amputation)

Circulatory status and function of unaffected limb

Signs & Symptoms of infection (culture required)

Nutritional Status

Concurrent medical problems

Current medications


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Emotional reaction to

amputation

Circumstances surrounding

amputation (ie. Traumatic versus

surgical)

Occupational and social

Rehabilitation


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Primary Amputation

Above the Knee PrimaryAmputation

Site of

Amputation
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Monitor for complications

Pain management

Education & support

Promote mobility/ independent self-careEnhancing Body Image

Promote wound healing


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Wash at night

Mild, fragrance free soap or antiseptic cleaner

Rinse well

Dry thoroughly

General wound care


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Hemorrhage

Infection


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Complication of

Amputations

Joint contracturesEnergy issues

Phantom limb pain

Bony growth

Skin Breakdown


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What is PLP?

The somatosensory homonculus


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Levels of lower limb amputation


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Lower Limb Prosthesis

Types of lower limbsprostheses :

Types of L.L. prosthesesdepend on different stages

after amputation. There arethree types:

- Immediate post-operative prosthesis.

- Temporary prosthesis

- Definitive prosthesis.


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Types of Prosthesis

BELOW KNEE

KNEE

DISARTICULATION ABOVE KNEE

HIP

DISARTICULATION

PROSTHETICS

LOWER EXTREMITY


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Prosthetics


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There are 5 Stages of Rehabilitation:

1. Healing and Starting Physiotherapy

2. Visiting the Prosthetist

3. Choosing an Artificial Limb

4. Learning to Use your Artificial Limb

5. Life as a New Amputee


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Rehabilitation of lower limb amputee :

Therapy plays an integral role in preparing a patient for a

lower-extremity orthotic or prosthetic device and training

them with that device once it has been fabricated.

Once a patient receives a prosthetic or orthotic device, thetherapist is then responsible for evaluating that patient with

their device


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Exercise After Amputation

ROM to prevent flexion

contractures, particularly of thehip and knee

Trapeze and overhead frame Firm mattress

Prone position every 3 to 4

hours Elevation of lower-leg residual

limb controversial


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Nursing Diagnosis

Impaired Physical Mobility

Risk for infection

Risk for injury

Risk for Ineffective Tissue

Perfusion

Disturbed Body Image Self Care Deficit


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Rehabilitation of Lower Limb Amputee Jade

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