Rehabilitation of an amputee with Parkinson's: Amputee Case Study: Difference between revisions
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== Clinical Hypothesis == | == Clinical Hypothesis == | ||
Summary of problems
: | Summary of problems
: | ||
*Complex social situation
| *Complex social situation
| ||
*Inappropriately donning prosthesis | *Inappropriately donning prosthesis | ||
*Decreased mobility
| *Decreased mobility
| ||
*Decreased range of movement
| *Decreased range of movement
| ||
*Decreased strength in his left leg
| *Decreased strength in his left leg
| ||
*Freezing of gait
| *Freezing of gait
| ||
*Shuffling gait | *Shuffling gait | ||
== Intervention == | == Intervention == | ||
*Consultant led management of PD medications with pre and post 10m walk test.
| *Consultant led management of PD medications with pre and post 10m walk test.
| ||
*CBT therapy led and directed by occupational therapists for the management of his psychological distress and coping with losing his favourite prosthesis | *CBT therapy led and directed by occupational therapists for the management of his psychological distress and coping with losing his favourite prosthesis | ||
*Gait re-education
| *Gait re-education
| ||
*Targeted specific lower limb strengthening programme in supine, sitting and standing
-Gait re-education PD related as there were no typical abnormalities seen when considering amputees including external cueing.
| *Targeted specific lower limb strengthening programme in supine, sitting and standing
-Gait re-education PD related as there were no typical abnormalities seen when considering amputees including external cueing.
| ||
*MDT discharge planning
Medical management of the UTI
-Change to modern and well fitting PTB socket. The previous prosthesis had become poor fitting and several socks were being used by the patient to fill in caps and subsequently he was at very high risk of developing pressure area complications<br> | *MDT discharge planning
Medical management of the UTI
-Change to modern and well fitting PTB socket. The previous prosthesis had become poor fitting and several socks were being used by the patient to fill in caps and subsequently he was at very high risk of developing pressure area complications<br> | ||
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== Discussion == | == Discussion == | ||
An interesting consideration in this case is the impact psychologically when asking this gentleman to stop using the incorrect prosthesis he preferred using and was comfortable with and using a new and unfamiliar albeit safer and more appropriate prosthesis. Considering that this could be interpreted by this patient as a second time he has gone through the bereavement process of losing a limb and how the MDT help deal with this a second time around<ref name="Pantera">Pantera, E., Pourtier-Piotte, C., Bensoussan, L.,Coudeyre, E. (2014). Patient education after amputation: Systematic review and experts' opinions. Annals of physical and rehabilitation medicine, 57(3), 143-158.</ref>. | An interesting consideration in this case is the impact psychologically when asking this gentleman to stop using the incorrect prosthesis he preferred using and was comfortable with and using a new and unfamiliar albeit safer and more appropriate prosthesis. Considering that this could be interpreted by this patient as a second time he has gone through the bereavement process of losing a limb and how the MDT help deal with this a second time around<ref name="Pantera">Pantera, E., Pourtier-Piotte, C., Bensoussan, L.,Coudeyre, E. (2014). Patient education after amputation: Systematic review and experts' opinions. Annals of physical and rehabilitation medicine, 57(3), 143-158.</ref>.<br> | ||
<br> | |||
== References == | == References == | ||
Revision as of 16:59, 21 March 2016
Title[edit | edit source]
Rehabilitation of an amputee with Parkinson's Disease
Abstract[edit | edit source]
This case study involves a 72-year-old gentleman who is a left transtibial amputee who is also a person with idiopathic Parkinson’s disease. Additionally there was an underlying complex cognitive and social aspect to this case, which was as difficult to find a holistic solution to as well as find a solution to his unique gait difficulties.
Key Words[edit | edit source]
Transtibial, Parkinson’s disease, geriatrics, rehabilitation, freezing
Client Characteristics[edit | edit source]
The patient in question was 72 year old, overweight gentleman with a left transtibial amputation secondary to peripheral vascular disease of which he has surgery for several years previously. His relevant past medical history includes Parkinson's disease, which under treated through levodopa therapy.
He was admitted with falls secondary to a urinary tract infection as well as decreasing mobility over the past 3 months. At home he had no care provider other than his 75-year-old wife. He lives in a house with one flight of stairs, which he was unable to do and had been sleeping down stairs for approximately 3 weeks. He was incorrectly fitting his prosthesis. Additionally he was using an old prosthesis he was not supposed to be wearing, clarified by his prosthetist through MDT collaboration (CSP 2012).
Examination Findings[edit | edit source]
Subjectively this gentleman was very reluctant to accept any alterations to his current prosthesis but demonstrated full capacity and ability to make his own decisions. His Parkinson’s disease was also at play here, he suffered from lower limb mid-walk freezing as well as a shuffling-type gait which made him prone to falls.
In terms of range of movement he demonstrated a 10 degree loss of full extension in his amputated limb and this is typical of transtibial amputees[1] and not as a consequence of weak quads but due to a long-term contracture which had developed over time[2]. Overall his strength was 5/5 on the oxford scale on his right leg however his left was 3+/5 in his quadriceps, hamstrings and gluts all of which are integral to his mobility whilst using his prosthesis and would be a large focus of our rehabilitation in keeping with national guidelines[3].
Clinical Hypothesis[edit | edit source]
Summary of problems :
- Complex social situation
- Inappropriately donning prosthesis
- Decreased mobility
- Decreased range of movement
- Decreased strength in his left leg
- Freezing of gait
- Shuffling gait
Intervention[edit | edit source]
- Consultant led management of PD medications with pre and post 10m walk test.
- CBT therapy led and directed by occupational therapists for the management of his psychological distress and coping with losing his favourite prosthesis
- Gait re-education
- Targeted specific lower limb strengthening programme in supine, sitting and standing -Gait re-education PD related as there were no typical abnormalities seen when considering amputees including external cueing.
- MDT discharge planning
Medical management of the UTI
-Change to modern and well fitting PTB socket. The previous prosthesis had become poor fitting and several socks were being used by the patient to fill in caps and subsequently he was at very high risk of developing pressure area complications
Outcome[edit | edit source]
Overall the MDT collaboration can be deemed a success. A valid and appropriate outcome measured was used to assess this patient’s falls risk as well as progression of his rehabilitation; in this case it was the timed-up-and-go[4]. His time improved from 1 minute 46 seconds to 59 seconds, which is a statistically significant improvement and demonstrated the effectiveness of the MDT intervention[5].
From a psychological perspective our management through CBT[6] was moderately successful as the patient was willing to accept further rehabilitation which he initially declined as well as accepting that his 'newer' prosthesis was more suitable than his favored 'old' one. It is possible that he was going though the bereavement cycle for a second time after having his mobility taken away from him for a second time[7].
Discussion[edit | edit source]
An interesting consideration in this case is the impact psychologically when asking this gentleman to stop using the incorrect prosthesis he preferred using and was comfortable with and using a new and unfamiliar albeit safer and more appropriate prosthesis. Considering that this could be interpreted by this patient as a second time he has gone through the bereavement process of losing a limb and how the MDT help deal with this a second time around[8].
References[edit | edit source]
- ↑ Bella J. May, AMPUTATIONS AND PROSTHETICS, F.A Davis Company, 2rd Edition, 1996
- ↑ Kishner's Gait Analysis after Amputation updated July 2013 http://emedicine.medscape.com/article/1237638-overview (accessed 3 February 2015)
- ↑ British Association of Chartered Physiotherapists in Amputee Rehabilitation (BACPAR). (2006). Clinical Guidelines for the Pre and Post Operative Physiotherapy Management of Adults with Lower Limb Amputation.
- ↑ Resnik, L. and Borgia, M., (2011). Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Physical Therapy, 91(4), pp. 555-565.
- ↑ Huang S, Hsieh C, Wu R, Tai C, Lin C, Lu W. Minimal detectable change of the timed "up go" test and the dynamic gait index in people with parkinson disease. Phys Ther. 2011;91(1):114-121.
- ↑ Beck J. Cognitive Therapy: Basics and Beyond, 2nd ed. New York: Guildford Press, 2011.
- ↑ Morris P. 2008. Psychological aspects of amputation [Online] available from http://www.amputee-coalition.org/first_step_2003/psychological-a spects-amputation.html accessed 10/07/2015.
- ↑ Pantera, E., Pourtier-Piotte, C., Bensoussan, L.,Coudeyre, E. (2014). Patient education after amputation: Systematic review and experts' opinions. Annals of physical and rehabilitation medicine, 57(3), 143-158.
