Pre-Fitting Management of the Patient with a Lower Limb Amputation
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Original Editor - Liezel Wegner
Top Contributors - Sheik Abdul Khadir, Admin, Leslie Angama, Tarina van der Stockt, Lucy Aird, Kim Jackson, Tony Lowe, Simisola Ajeyalemi and Amrita Patro
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]
Physiotherapist preparation[edit | edit source]
Assessment of the amputee (see section 6 not covered in this section)
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Patient education
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Stump management
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Exercise therapy
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Restoring locus of control
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Referral
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References
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- ↑ 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.
- ↑ 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.
