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Amputees (V2) - Coggle Diagram
Amputees (V2)
What I Learnt
Levels of amputation
Foot
symes, lis franc, transmetatarsal, chopart
Occurrence LL
27% uni trans-femoral
63% uni trans-tibial
2% bilat transfemoral
5% bilat trans tibial
Causes + frequency of LL
Vascular 80%
Infection 5-10%
Trauma 5-10%
War
Malignancy 2-5%
Congenital 1-2%
Average stats
Mid-late age vascular amputees most commonly
Pre-operative management
Necessity + elective
Physio
Assessment - general health, strength, function, ROM
Manage/maintain - mobility, ROM, Strength, balance
Introduction to alternate mobility methods, discharge planning, supports, other MDT
Post op
Assessment
ost op orders, meds, pmedhx, social hx, psychological state, assessment of physical function (ROM, mobility, strength, balance), remaining limb, amputated limb, phantom pain
Treatment
mobilisation + chest care
Don’t assume prosthetic candidate
Stump care - oedema, healing, pain
Education, dc planning
Pre-prosthetic
goal setting
stump care
Shape - important for prosthesis, type (bulbous, dogeared, cylindrical, conical) bandaging,s hrinkers, gel liners
Oedema control - elevation,
Scar/skin mx - dryness, hypersensitivity, scar massage once healed
Protection - RRD. High percentage of falls post-amputation (20-31%)
Protect from infection
Reduce contractures
Emotional supports
Functional activities - mobility, transfers, balance
Non prosthetic - mobility aid consideration, hopping
Training - CV fitness, strength, ROM, stump control
Prosthetic candidacy
Cause of amputation - trauma generally = younger = potentially better outcomes
○ Amputation type
Impacts energy expenditure - prosthetic may not be most efficient
§ Weight bearing characteristics
○ Stump condition
§ Healing
§ Contractures
○ Cognition
§ Monitoring limb condition
§ Effective Prosthesis usage
○ Weight
§ CV load
§ Increased load on joints + muscles
§ Load limits
○ Fotness
§ VO2 >50% = increased success
○ Motivation/confidence
§ Autonomy to decline
§ Goals, expectations
§ Influence of others
§ Not extensilvely researched
○ Balance + strength
○ Pre - level of mobility
§ Predictive of walking post
○ Age
§ Not excluding factor
○ Comorbidities
○ Funding
§ Interim - fovernment
Definitive - private, QALD NDIS
Prosthetic
osseointegration
Transtibial
Laced, supracondylar, sleeve, strap,pinlock
Transfermoral
Suction, elastic, pelvic band
Prosthetic rehab
Minimise skin damage
Donning+doffing
Gait retraining - goal oriented
Outcome measures - 6mwt, aMPPRO,
SOLUTIONS FOR DISCOMFORT
Gait analysis - why? Determin underlying cause of deviations
Overview
background
occurrence, causes etc
Physio
pre op
post op
pre-prosthetic
post-prosthetic
Prosthetic
care
candidacy
types
Opportunities
utilise knoweldge when treating patients with amputations /prosthetics
Further research
outcome measures
effective treatment strategies
Difficulties
limited knowledge
difficult to apply new knowledge
small knowledge base
practical application
Amputees sent to RBWH
amputee-specific centre
Feelings
Limited exposure
Acute stages
Pre-amputation
Post amputation
Pre-prosthetic
Current exposure
Amputees presenting with other concerns
not specific to amputation