AMPUTEE THERAPY SURVIVAL GUIDE

Reasons for Amputation Percentage %

PVD (of which 25%-50% have diabetes) 85-90
Trauma 9
Malignant Disease 4
Congenital Limb Deficiency 3
Infection 1
Source- Murray, S (2001) Nursing & Management
Average age-69

Levels of Amputation
S Toes
E Partial Foot
V “Symes”/ankle disarticulation
E Transtibial/”Below Knee”
R Knee disarticulation-uncommon
I Transfemoral/”Above Knee”
T Hip disarticulation
Y Hemipelvictomy
(Upper limb amputations occur but were not encountered)

Assessment
Normal musculoskeletal assessment- Contractures
ROM
Muscle Power
Transfers
Home circumstances
AND
Stump Assessment- Wound
Shape
Oedema
Level
Compression Garment (“juzo”/”shrinker sock”,
plaster cast, backslab, stump bandage)
Stump pain
Phantom pain and sensations
Sensation

1
Patient Goals- Patient to be fitted or not
Introduction of patient to prosthetic limb (weight,
look, feel)

Treatment
For all patients- Bed and upper limb exercises to maintain ROM,
muscle strength and mobility
Transfers
Getting on and off the floor
Balance

Fitted Patient- EWA (early walking aids)

Gait re-education
Standing Balance
Stair mobility
Outdoor mobility

Non-fitted Patient- Advanced wheelchair mobility

EWAs
PPAM aid- pneumatic post amputation mobility aid
An inflatable bag and metal cage
Used for TTA and TFA in some centres, TTA only in others
Femurette- rigid adjustable Velcro fastening socket
Adjustable leg length
TFA patients only

Stages of Prosthetics
Casting- Stump cast with POP to make individual socket
Fitting- Socket
Alignment
Knee component (TFA only)
Finishing- Cosmesis applied

Types of Prosthetic Limb

Many variations with the prosthestist deciding on optimum for individual
patient’s needs
Suspension- ice ross
Supracondylar suspension (TTA)
Elastic suspension (TFA)
Suction socket

2
Socket- ischial weight bearing (TFA)
Patella tendon weight bearing (TTA)
Knee components- Locked knee
Semi-automatic knee
Free knee
Donning and Doffing
The process of putting on and taking off the prosthetic limb
Patient may require maximal assistance to start with but independence
should be encouraged with practice

Psychological Aspects
Grieving Processes (Kubler-Ross 1970, Parkes 1996 and Zigmond 1996)
Reason for amputation important in how patient copes with it
Phantom sensations must be recognised and validated and treated
AID (amputee identity disorder)

Multi-disciplinary Team
Prosthetist
OT involvement may be much greater and combined with physiotherapy
depending on centre
Driving Centre- assessment of driving required following amputation

THINGS TO LOOK UP BEFORE AN AMPUTEE

ROTATION/PLACEMENT
• Pathologies of PVD and diabetes
• Transtibial and transfemoral gait deviations
• Prosthetics
• Grieving
• Surgical procedures?
• Walking aids

Useful References
Rehabilitation management of Amputees- Banjeree
Therapy for Amputees- Engstrom & Van de Ven
Amputee Management-a handbook- Barsby et al
Psychological Aspects of Amputation- Ham & Cotton