War Vetern Case Presentation: Amputee Case Study: Difference between revisions
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== Title == | == Title == | ||
War Vetern Case Presentation: Amputee Case Study | |||
War Vetern Case Presentation: Amputee Case Study | |||
== Abstract == | == Abstract == | ||
The pt, KP is s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq with secondary dx of possible TBI from explosion. Pt was recommended to out-patient therapy to increase independence with ADL, IADL, mobility, regulate emotions, reduce pain/edema, sensitivity in residual limbs and improve overall cognitive ability. Pt has potential to improve with skilled healthcare services. | |||
The pt, KP is s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq with secondary dx of possible TBI from explosion. Pt was recommended to out-patient therapy to increase independence with ADL, IADL, mobility, regulate emotions, reduce pain/edema, sensitivity in residual limbs and improve overall cognitive ability. Pt has potential to improve with skilled healthcare services. | |||
== Key Words == | == Key Words == | ||
veteran, amputee, trans-radial, trans-femoral, ADL, phantom limb pain | |||
veteran, amputee, trans-radial, trans-femoral, ADL, phantom limb pain | |||
== Client Characteristics == | == Client Characteristics == | ||
KP is a 45 y/o women war veteran. KP lives with her husband, Sam, in a two-story house with no elevator. They have no children or pets. They live 3 hours from their closest family members. KP has a close group of friends that she goes out for lunch with and long walks frequently. Though, she fears that, with her amputation and mental health issues her friends are beginning to avoid her more. They have a cleaning woman that cleans the entire house and does the laundry once a week. Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional and unsure of future career status. | |||
* Primary dx: s/p R trans-radial BEA and L trans-femoral AKA, Amputation conducted at hospital | KP is a 45 y/o women war veteran. KP lives with her husband, Sam, in a two-story house with no elevator. They have no children or pets. They live 3 hours from their closest family members. KP has a close group of friends that she goes out for lunch with and long walks frequently. Though, she fears that, with her amputation and mental health issues her friends are beginning to avoid her more. They have a cleaning woman that cleans the entire house and does the laundry once a week. Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional and unsure of future career status. | ||
* Secondary dx: possible mild acquired brain injury (TBI) and/or PTSD | |||
* Precautions/contraindications: None | *Primary dx: s/p R trans-radial BEA and L trans-femoral AKA, Amputation conducted at hospital | ||
* Treatment setting client being seen in: out-patient rehabilitation; KP has received training in stump care, prosthetic hygiene, and physical therapy for training in ambulation with a focus returning to a high level of rehabilitation. | *Secondary dx: possible mild acquired brain injury (TBI) and/or PTSD | ||
*Precautions/contraindications: None | |||
*Treatment setting client being seen in: out-patient rehabilitation; KP has received training in stump care, prosthetic hygiene, and physical therapy for training in ambulation with a focus returning to a high level of rehabilitation. | |||
== Examination Findings == | == Examination Findings == | ||
<u>'''Subjective'''</u>: Patient complains of phantom limb pain and weakness. The patient hopes to successfully use a prosthetic limb to ambulate at a high fitness level and reduce or eliminate the phantom limb pain. Patient is currently working with PT, doctors, OT, Prosthesist, social worker and nursing staff. Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional and unsure of future career status. | |||
'''Self Report Outcome Measures ''' | |||
*Activity Specific Balance confidence scale UK (ABC-UK) - Results: 75% | |||
*The Amputee Mobility Predicator (AmpPro/AmpNoPro) - Results: 37/43 | |||
*Pain Scale: 6/10<br> | |||
'''Physical Performance Measures'''<br> | |||
*Barthel ADL index - Results: 80/100 | |||
*No Presence of ulcers or neuroma | |||
* Skin integrity: normal skin color, no signs of infection, and no potential areas for breakdown | <u>'''Objective:'''</u> | ||
* Shape of residual limb: conical | |||
* Balance: | Physical Examination Tests and Measures | ||
** Static sitting balance: Good | |||
**Dynamic sitting balance: Good | *Orientated to person, place and time | ||
**Static standing balance: Good | *Sensation is intact | ||
*Surgical incision are healed well | |||
*Edema present | |||
*No Presence of ulcers or neuroma | |||
*Skin integrity: normal skin color, no signs of infection, and no potential areas for breakdown | |||
*Shape of residual limb: conical | |||
*Balance: | |||
**Static sitting balance: Good | |||
**Dynamic sitting balance: Good | |||
**Static standing balance: Good | |||
**Dynamic standing balance Good- | **Dynamic standing balance Good- | ||
*Range of Motion (ROM) of residual limb joints and remaining extremities- WFL | *Range of Motion (ROM) of residual limb joints and remaining extremities- WFL | ||
*Vital Signs: | *Vital Signs: | ||
** HR: 72 | **HR: 72 | ||
**BP: 125/40 | **BP: 125/40 | ||
**SpO2: 95 | **SpO2: 95 | ||
**Temp: 97.4 F | **Temp: 97.4 F | ||
*Assess prosthesis: good | *Assess prosthesis: good | ||
* Fit of socket: good | *Fit of socket: good | ||
* Able to don/doff and care for prosthesis independently | *Able to don/doff and care for prosthesis independently | ||
* Pt participation in A | *Pt participation in A | ||
== Clinical Hypothesis == | == Clinical Hypothesis == | ||
s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq. Possible TBI from explosion. Possible PTSD. Restore self-care skills, establish transfer skills, and regain social cognition skills. Also, restore strength, sensitivity, reduce edema, reduce pain and establish relaxation techniques. Cognitive compensatory strategies include: AE training, Prosthetic training and ADL and mobility retraining. Long term increase ADL, IADL and mobility, regulate emotions and improve overall cognitive ability. | |||
s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq. Possible TBI from explosion. Possible PTSD. Restore self-care skills, establish transfer skills, and regain social cognition skills. Also, restore strength, sensitivity, reduce edema, reduce pain and establish relaxation techniques. Cognitive compensatory strategies include: AE training, Prosthetic training and ADL and mobility retraining. Long term increase ADL, IADL and mobility, regulate emotions and improve overall cognitive ability. | |||
== Intervention == | == Intervention == | ||
Goal Method | |||
*Educate on hygiene for residual limbs | Goal Method | ||
*Educate on dressing for residual limbs | *Educate on hygiene for residual limbs <ref name="3">Radomski M.V. & Latham C.A.T. (2008). Occupational therapy for physical dysfunction (6th ed.). Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins</ref> -Demonstrate how to clean skin and had her practice | ||
*Decrease edema in LUE and RLE -Retrograde massage, positioning in wheelchair, bed | *Educate on dressing for residual limbs <ref name="3" /> -Demonstrate how to properly dress and have him practice (stump shrinker) | ||
*Decrease pain in LUE and RLE -Desensitization, tapping, mirror therapy | *Decrease edema in LUE and RLE -Retrograde massage, positioning in wheelchair, bed <ref name="3" /><br> | ||
*Increase strength in LUE and RLE -Strengthening exercises (theraband, free weights, etc.) | |||
*Increase balance during ADLs/IADLs -Activities that take him off center of gravity (wiping a table, etc.) | *Decrease pain in LUE and RLE -Desensitization, tapping, mirror therapy<ref name="4">Timms, J., & Carus, C. (2015). Mirror therapy for the alleviation of phantom limb pain following amputation: A literature review. International Journal of Therapy & Rehabilitation, 22(3), 135-145.</ref><br> | ||
**AE training | *Increase strength in LUE and RLE -Strengthening exercises (theraband, free weights, etc.)<ref name="3" /> | ||
*Increase independence with IADLs - IADL re-training | *Increase balance during ADLs/IADLs -Activities that take him off center of gravity (wiping a table, etc.) <ref name="3" /> (I) with BADLs will increase -ADL re-training | ||
**AE training | **AE training<ref name="3" /> | ||
*Functional transfers independence will increase -Transfer training | *Increase independence with IADLs - IADL re-training | ||
*Increase sleep participation -Sleep schedule, sleep log | **AE training<ref name="3" /> | ||
*Increase emotional awareness for successful social interaction | *Functional transfers independence will increase -Transfer training<ref name="3" /> | ||
*Increase cognitive ability -Cognitive compensatory strategies -Sequencing tasks | *Increase sleep participation -Sleep schedule, sleep log <ref name="3" /> | ||
*Educate patient on prosthesis usage and management -Practice donning/doffing | *Increase emotional awareness for successful social interaction -Role play different scenarios, emotion reflection journal | ||
**Prosthetic training | *Increase cognitive ability -Cognitive compensatory strategies -Sequencing tasks <ref name="3" /> | ||
*Educate patient on prosthesis usage and management -Practice donning/doffing | |||
**Prosthetic training <ref name="3" /><br> | |||
== Outcome == | == Outcome == | ||
Goal | |||
*Educate on hygiene for residual limbs - | Goal Outcome | ||
*Educate on dressing for residual limbs | |||
*Decrease edema in LUE and RLE - | *Educate on hygiene for residual limbs - Pt able to perform cleaning stumps independently | ||
*Decrease pain in LUE and RLE - | *Educate on dressing for residual limbs - Pt able to dress residual limbs independently | ||
*Increase strength in LUE and RLE I - mproved UB strength to 4 from initial 3- and LB 4+ from initial 3, based on MMT. | *Decrease edema in LUE and RLE - Reduced pain | ||
*Increase balance during ADLs/IADLs Able to perform functional mobility during ADL performance with sup, requiring verbal and visual cues for correct hand/foot placement (I) with BADLs will increase | *Decrease pain in LUE and RLE - Desensitized to a tolerable level | ||
*Increase independence with IADLs Able to perform IADL with sup, requiring verbal and visual cues for correct hand/foot placement | *Increase strength in LUE and RLE I - mproved UB strength to 4 from initial 3- and LB 4+ from initial 3, based on MMT. | ||
*Functional transfers independence will increase Able to transfer with CG, requiring stand by assistance if balance is lost. | *Increase balance during ADLs/IADLs Able to perform functional mobility during ADL performance with sup, requiring verbal and visual cues for correct hand/foot placement (I) with BADLs will increase - Able to perform BADL performance with sup, requiring verbal and visual cues for correct hand/foot placement | ||
*Increase sleep participation - | *Increase independence with IADLs Able to perform IADL with sup, requiring verbal and visual cues for correct hand/foot placement | ||
*Increase emotional awareness for successful social interaction | *Functional transfers independence will increase Able to transfer with CG, requiring stand by assistance if balance is lost. | ||
*Increase cognitive ability | *Increase sleep participation - Sleeping 3/7 nights | ||
*Increase emotional awareness for successful social interaction - Able to recognize emotional awareness in social situations. | |||
*Increase cognitive ability - Cognitive compensatory strategies such as list making were successful | |||
*Educate patient on prosthesis usage and management Pt is able to don and dof socks/prosthesis (I)'ly. | *Educate patient on prosthesis usage and management Pt is able to don and dof socks/prosthesis (I)'ly. | ||
== Discussion == | == Discussion == | ||
KP had a R trans-radial BEA and L trans-femoral AKA with a secondary dx possible mild acquired brain injury (TBI) and/or PTSD, complicating KP's ability to retain new information. KP's case reinforces previous evidence that endorses the use of retrograde massage, positioning in wheelchair, bed for edema treatment. KP's case reinforces previous evidence that endorses desensitization, tapping, mirror therapy to decrease pain | |||
KP had a R trans-radial BEA and L trans-femoral AKA with a secondary dx possible mild acquired brain injury (TBI) and/or PTSD, complicating KP's ability to retain new information. KP's case reinforces previous evidence that endorses the use of retrograde massage, positioning in wheelchair, bed for edema treatment. KP's case reinforces previous evidence that endorses desensitization, tapping, mirror therapy to decrease pain <ref name="4" />. | |||
"Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain" <ref name="1">Ebrahimzadeh, M. H., & Rajabi, M. T. (2007). Long-term outcomes of patients undergoing war-related amputations of the foot and ankle. The Journal of foot and ankle surgery, 46(6), 429-433.</ref>. | |||
More research is needed on compensation strategies and coping mechanisms specifically for war veterans with amputations due to the psychological impacts of war. KP was referred to VA, veteran support group, OT for a driving evaluation and strength coach<ref name="2">Khadir, S.A. (2015). High-level rehabilitation of amputees. Retrieved from http://www.physiopedia.com/High_level_rehabilitation_of_amputees</ref>. | |||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Amputee_Case_Studies]] | [[Category:Amputee_Case_Studies]] | ||
Revision as of 21:01, 6 May 2016
Title[edit | edit source]
War Vetern Case Presentation: Amputee Case Study
Abstract[edit | edit source]
The pt, KP is s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq with secondary dx of possible TBI from explosion. Pt was recommended to out-patient therapy to increase independence with ADL, IADL, mobility, regulate emotions, reduce pain/edema, sensitivity in residual limbs and improve overall cognitive ability. Pt has potential to improve with skilled healthcare services.
Key Words[edit | edit source]
veteran, amputee, trans-radial, trans-femoral, ADL, phantom limb pain
Client Characteristics[edit | edit source]
KP is a 45 y/o women war veteran. KP lives with her husband, Sam, in a two-story house with no elevator. They have no children or pets. They live 3 hours from their closest family members. KP has a close group of friends that she goes out for lunch with and long walks frequently. Though, she fears that, with her amputation and mental health issues her friends are beginning to avoid her more. They have a cleaning woman that cleans the entire house and does the laundry once a week. Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional and unsure of future career status.
- Primary dx: s/p R trans-radial BEA and L trans-femoral AKA, Amputation conducted at hospital
- Secondary dx: possible mild acquired brain injury (TBI) and/or PTSD
- Precautions/contraindications: None
- Treatment setting client being seen in: out-patient rehabilitation; KP has received training in stump care, prosthetic hygiene, and physical therapy for training in ambulation with a focus returning to a high level of rehabilitation.
Examination Findings[edit | edit source]
Subjective: Patient complains of phantom limb pain and weakness. The patient hopes to successfully use a prosthetic limb to ambulate at a high fitness level and reduce or eliminate the phantom limb pain. Patient is currently working with PT, doctors, OT, Prosthesist, social worker and nursing staff. Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional and unsure of future career status.
Self Report Outcome Measures
- Activity Specific Balance confidence scale UK (ABC-UK) - Results: 75%
- The Amputee Mobility Predicator (AmpPro/AmpNoPro) - Results: 37/43
- Pain Scale: 6/10
Physical Performance Measures
- Barthel ADL index - Results: 80/100
Objective:
Physical Examination Tests and Measures
- Orientated to person, place and time
- Sensation is intact
- Surgical incision are healed well
- Edema present
- No Presence of ulcers or neuroma
- Skin integrity: normal skin color, no signs of infection, and no potential areas for breakdown
- Shape of residual limb: conical
- Balance:
- Static sitting balance: Good
- Dynamic sitting balance: Good
- Static standing balance: Good
- Dynamic standing balance Good-
- Range of Motion (ROM) of residual limb joints and remaining extremities- WFL
- Vital Signs:
- HR: 72
- BP: 125/40
- SpO2: 95
- Temp: 97.4 F
- Assess prosthesis: good
- Fit of socket: good
- Able to don/doff and care for prosthesis independently
- Pt participation in A
Clinical Hypothesis[edit | edit source]
s/p L trans-radial BEA and R trans-femoral AKA, injuries sustained from Improvised Explosive Device (IED) while deployed in Iraq. Possible TBI from explosion. Possible PTSD. Restore self-care skills, establish transfer skills, and regain social cognition skills. Also, restore strength, sensitivity, reduce edema, reduce pain and establish relaxation techniques. Cognitive compensatory strategies include: AE training, Prosthetic training and ADL and mobility retraining. Long term increase ADL, IADL and mobility, regulate emotions and improve overall cognitive ability.
Intervention[edit | edit source]
Goal Method
- Educate on hygiene for residual limbs Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title -Demonstrate how to clean skin and had her practice
- Educate on dressing for residual limbs Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title -Demonstrate how to properly dress and have him practice (stump shrinker)
- Decrease edema in LUE and RLE -Retrograde massage, positioning in wheelchair, bed Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
- Decrease pain in LUE and RLE -Desensitization, tapping, mirror therapyCite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Increase strength in LUE and RLE -Strengthening exercises (theraband, free weights, etc.)Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Increase balance during ADLs/IADLs -Activities that take him off center of gravity (wiping a table, etc.) Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title (I) with BADLs will increase -ADL re-training- AE trainingCite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
- AE trainingCite error: Invalid
- Increase independence with IADLs - IADL re-training
- AE trainingCite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
- AE trainingCite error: Invalid
- Functional transfers independence will increase -Transfer trainingCite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Increase sleep participation -Sleep schedule, sleep log Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Increase emotional awareness for successful social interaction -Role play different scenarios, emotion reflection journal
- Increase cognitive ability -Cognitive compensatory strategies -Sequencing tasks Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Educate patient on prosthesis usage and management -Practice donning/doffing
- Prosthetic training Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
- Prosthetic training Cite error: Invalid
Outcome[edit | edit source]
Goal Outcome
- Educate on hygiene for residual limbs - Pt able to perform cleaning stumps independently
- Educate on dressing for residual limbs - Pt able to dress residual limbs independently
- Decrease edema in LUE and RLE - Reduced pain
- Decrease pain in LUE and RLE - Desensitized to a tolerable level
- Increase strength in LUE and RLE I - mproved UB strength to 4 from initial 3- and LB 4+ from initial 3, based on MMT.
- Increase balance during ADLs/IADLs Able to perform functional mobility during ADL performance with sup, requiring verbal and visual cues for correct hand/foot placement (I) with BADLs will increase - Able to perform BADL performance with sup, requiring verbal and visual cues for correct hand/foot placement
- Increase independence with IADLs Able to perform IADL with sup, requiring verbal and visual cues for correct hand/foot placement
- Functional transfers independence will increase Able to transfer with CG, requiring stand by assistance if balance is lost.
- Increase sleep participation - Sleeping 3/7 nights
- Increase emotional awareness for successful social interaction - Able to recognize emotional awareness in social situations.
- Increase cognitive ability - Cognitive compensatory strategies such as list making were successful
- Educate patient on prosthesis usage and management Pt is able to don and dof socks/prosthesis (I)'ly.
Discussion[edit | edit source]
KP had a R trans-radial BEA and L trans-femoral AKA with a secondary dx possible mild acquired brain injury (TBI) and/or PTSD, complicating KP's ability to retain new information. KP's case reinforces previous evidence that endorses the use of retrograde massage, positioning in wheelchair, bed for edema treatment. KP's case reinforces previous evidence that endorses desensitization, tapping, mirror therapy to decrease pain Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
"Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain" Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
More research is needed on compensation strategies and coping mechanisms specifically for war veterans with amputations due to the psychological impacts of war. KP was referred to VA, veteran support group, OT for a driving evaluation and strength coachCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
