Case Study - Amputation in Disasters and Conflicts: Difference between revisions
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== Patient Characteristics == | == Patient Characteristics == | ||
A six-year-old child presented to an EM | |||
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | [[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | ||
[[Category:Early Rehabilitation in disasters and Conflicts - Case Studies]] | [[Category:Early Rehabilitation in disasters and Conflicts - Case Studies]] | ||
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[[Category:Rehabilitation]] | [[Category:Rehabilitation]] | ||
[[Category:Nerves]] | [[Category:Nerves]] | ||
T for closure of a below-knee guillotine amputation, wearing | |||
a full leg cast on their other leg. On further investigation, it was revealed that this cast was hiding | |||
an open tibial fracture, with an associated peroneal nerve injury. The management of injuries to the | |||
non-amputated side was vital for the child to able to walk using a prosthetic. To complicate matters, | |||
the child was distressed by their injury and terrified of health staff. They were accompanied by a | |||
relative (not their parents). Managing their distress and educating them and their caregiver became | |||
an essential part of early rehabilitation – building trust before any physical rehabilitation could begin. | |||
Active exercise | |||
Active exercise aims to improve muscle strength and mobility, reduce oedema, reduce muscle | |||
atrophy, aid transfers and functional independence and aid psychological adjustment. Start active | |||
exercises for residual limb and whole body as soon as possible, taking appropriate precautions | |||
with any other injuries. | |||
Core exercises | |||
Core stability exercises are especially important with multiple limb injuries/patients with higher | |||
level amputations | |||
These exercises can start early, even on bed rest. Postural awareness is key, and continues | |||
its importance through to prosthetic gait education. Kneeling is especially good for bilateral | |||
transtibial amputations, including four-point kneeling in later stages. Hip extension and trunk | |||
stability exercise can also be helpful in earlier stages. | |||
Lower limb amputation exercises | |||
It is important that the patient maintains their strength and range of movement, post-amputation. | |||
The patient and their caregivers should be advised to keep all remaining joints moving throughout | |||
their full available range, especially the joints above the amputated site (hip and knee) to prevent | |||
contractures. | |||
The following exercises are good basic strengthening and ROM. | |||
Straight leg raise | |||
Put your legs out in front of you | |||
Tighten your thigh | |||
Lift your leg off the bed | |||
Hold for ten seconds | |||
Slowly lower | |||
Repeat ten times | |||
Repeat the above with the other leg | |||
Hip flexor stretch | |||
Lie on your back, preferably without a | |||
pillow | |||
Bring your thigh towards your chest | |||
and hold with your hands | |||
Push your opposite leg down flat on to | |||
the bed | |||
Hold for 30 – 60 seconds, then relax | |||
Repeat five times | |||
Repeat the above with the other leg | |||
Bridging | |||
Lie on your back with your arms at the | |||
side | |||
Place a couple of firm pillows or rolled- | |||
up blankets under your thighs | |||
Pull in your stomach, tighten your buttocks | |||
and lift your bottom up off the bed | |||
Hold for five seconds | |||
Repeat ten times | |||
To make this exercise more difficult, ask your | |||
patient to place their arms across their chest, | |||
as shown in the picture | |||
Hip abduction in side lying | |||
Lie on your side | |||
Bend the bottom leg | |||
Keep hips and top leg in line with your | |||
body | |||
Slowly lift your top leg up, keeping your | |||
knee straight | |||
Slowly lower | |||
Repeat ten times | |||
NB Do not to let the patient’s hips roll for- | |||
wards or backwards | |||
Repeat the above with the other leg | |||
Hip extension in prone | |||
Lie flat on your stomach for ten minutes, | |||
three time per day | |||
Lie flat on your stomach, keeping your hips | |||
flat on the bed left your leg off the bed | |||
Hold for five seconds | |||
Repeat ten times | |||
Upper limb amputation pre-prosthetic exercises | |||
Function, range and power of the upper limb are often neglected, but are key to good outcomes | |||
and quality of life. Scapular range is very important if using upper limb for greater function, e.g. | |||
following bilateral lower limb amputation, or a patient sustaining a triple amputation needing to | |||
achieve getting on and off the floor independently. Also note that pectoral major/minor tightness | |||
is very likely, due to greater sitting time, and needs to be counteracted. | |||
All these exercises should be completed through your patient’s full available range, unless | |||
indicated otherwise. | |||
== Examination Findings == | |||
== References == | |||
<references /> |
Revision as of 21:48, 3 March 2022
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Patient Characteristics[edit | edit source]
A six-year-old child presented to an EM T for closure of a below-knee guillotine amputation, wearing
a full leg cast on their other leg. On further investigation, it was revealed that this cast was hiding
an open tibial fracture, with an associated peroneal nerve injury. The management of injuries to the
non-amputated side was vital for the child to able to walk using a prosthetic. To complicate matters,
the child was distressed by their injury and terrified of health staff. They were accompanied by a
relative (not their parents). Managing their distress and educating them and their caregiver became
an essential part of early rehabilitation – building trust before any physical rehabilitation could begin.
Active exercise
Active exercise aims to improve muscle strength and mobility, reduce oedema, reduce muscle
atrophy, aid transfers and functional independence and aid psychological adjustment. Start active
exercises for residual limb and whole body as soon as possible, taking appropriate precautions
with any other injuries.
Core exercises
Core stability exercises are especially important with multiple limb injuries/patients with higher
level amputations
These exercises can start early, even on bed rest. Postural awareness is key, and continues
its importance through to prosthetic gait education. Kneeling is especially good for bilateral
transtibial amputations, including four-point kneeling in later stages. Hip extension and trunk
stability exercise can also be helpful in earlier stages.
Lower limb amputation exercises
It is important that the patient maintains their strength and range of movement, post-amputation.
The patient and their caregivers should be advised to keep all remaining joints moving throughout
their full available range, especially the joints above the amputated site (hip and knee) to prevent
contractures.
The following exercises are good basic strengthening and ROM.
Straight leg raise
Put your legs out in front of you
Tighten your thigh
Lift your leg off the bed
Hold for ten seconds
Slowly lower
Repeat ten times
Repeat the above with the other leg
Hip flexor stretch
Lie on your back, preferably without a
pillow
Bring your thigh towards your chest
and hold with your hands
Push your opposite leg down flat on to
the bed
Hold for 30 – 60 seconds, then relax
Repeat five times
Repeat the above with the other leg
Bridging
Lie on your back with your arms at the
side
Place a couple of firm pillows or rolled-
up blankets under your thighs
Pull in your stomach, tighten your buttocks
and lift your bottom up off the bed
Hold for five seconds
Repeat ten times
To make this exercise more difficult, ask your
patient to place their arms across their chest,
as shown in the picture
Hip abduction in side lying
Lie on your side
Bend the bottom leg
Keep hips and top leg in line with your
body
Slowly lift your top leg up, keeping your
knee straight
Slowly lower
Repeat ten times
NB Do not to let the patient’s hips roll for-
wards or backwards
Repeat the above with the other leg
Hip extension in prone
Lie flat on your stomach for ten minutes,
three time per day
Lie flat on your stomach, keeping your hips
flat on the bed left your leg off the bed
Hold for five seconds
Repeat ten times
Upper limb amputation pre-prosthetic exercises
Function, range and power of the upper limb are often neglected, but are key to good outcomes
and quality of life. Scapular range is very important if using upper limb for greater function, e.g.
following bilateral lower limb amputation, or a patient sustaining a triple amputation needing to
achieve getting on and off the floor independently. Also note that pectoral major/minor tightness
is very likely, due to greater sitting time, and needs to be counteracted.
All these exercises should be completed through your patient’s full available range, unless
indicated otherwise.
Examination Findings[edit | edit source]
References [edit | edit source]