Psychosocial Issues Flashcards
The general variables associated with psychological response post-amputation
- age
- level of maturity
- personality traits
- coping skills
- flexibility
- social support
- coexisting medical conditions
- amputation planned or sudden
- UE>LE (use hands more from functional aspect & prosthetics are better for LE)
Stages of adjustment
- Awareness of possible amputation (before sx)
- Relief (very brief stage, after sx, they’re alive)
- Grief; comprehends loss of limb & function
- Acceptance; reintegration into functional life
PT works through grief and acceptance
Worden’s tasks of mourning
- Accept reality of loss
- Process the pain of grief
- Adjust to world without deceased (limb)
- Find and enduring connection w/o the deceased
Grief
- Feelings of mutilation; mourn the loss of extremity
- Females; concern with loss of body image
- Males; concern with loss of function
- Degree of impairment not related to overall adjustment
Depression
- Experienced by 21-35% amputees
- May start at time of prosthetic fitting (reality)
- Never say prosthesis with replacement their own limb
Anxiety
- Mild to moderate amount is normal
- May develop during post-acute period (thinking about ability to do x,y,z once leaving hospital)
Post-traumatic stress disorder
- Persistently re-experiences the traumatic event in intrusive thoughts, flashbacks, nightmares
- Intense distress, insomnia, autonomic arousal
- May develop months after initial event
- Group therapy may be helpful but Steve Dubovsky recommends re-immersion therapy is better
How to spot ASD/PTSD
- Pt has nightmares related to injury
- Pt describes vivid and repeated memories of their injury
- Pt tries to avoid talking about injury
- Pt tries to avoid talking about topics related to injury
- Pt gets startled easily
- Pt seems detached
- Pt expresses guilt about their injury
- Pt blames themselves for their injury
Sexual function following amputation
- Men; fear loss of sexual capability & potency
- Sexual function affected by vascular, neurological, physical and mechanical causes
- Diabetes, PVD, loss of ROM
- Psychological issues; rejection by partner, low self-esteem, performance anxiety
- Most male amputees report erectile dysfunction
- Most male amputees report sexually active
Children and amputation
Adjust relatively well (same can’t be said for parents)
Adolescents and amputation
Greater adjustment difficulties (body image, peer relationships)
Young adults and amputations
Often caused by trauma (MVA, assault, industrial accidents) PTSD often present
- Unable to prepare emotionally for loss of limb
Older adults and amputations
- 2/3 of all amputations
- Often secondary to chronic conditions
- Likely to suffer from adjustment problems due to anticipation of physical limitations with aging (less active lifestyle)
- Allow pts to have as much control over decision making as possible (goals & progressions) often helpful
Motivation and compliance with amputee pts
- If you can match the patients desires with your expectations, then you are less likely to have a noncompliant patient
Motivation = (wants x beliefs x rewards) / costs
Amputee bill of rights
Right to: receive clear, complete info about surgery, medical care & therapy. Take part in decisions affecting health and well being. Be involved in developing POC. Set goals for what you want to achieve, for physical & emotional well-being, and preventing other health conditions that may result from amputation. Receive support from certified peer visitor, be involved formed about funding for healthcare, returning to work & opportunities for recreation, prosthetic & orthotic services, healthcare products and new technology. Select qualified healthcare providers, ask for help when you are unhappy with healthcare products or care.
Responsibility to: stay informed about healthcare products & services, learn about healthcare products & services that are appropriate, safe and effective. Express concerns about quality care, billing, & healthcare products/services.
