Week 4 Lower Limb Amputation

Question 1

Why are amputations performed (i.e aetiology of amputations) and what are the main reasons amputations are performed?

Answer 1

• To improve function
• To improve health

Main reasons:

1. PVD (e.g diabetes) - 85% of diabetes related LL amputations are preceded by an ulcer!
2. MVA or MBA

Question 2

At what levels might amputations be performed?

Answer 2

1. Hip or knee joint - hip/knee disarticulation

2. Mid femur/tibia - transfemoral/transtibia

Question 3

Describe the K levels in regards to prothesis suitability

Answer 3

K0

• no ability/potential to ambulate without assistance
• prosthesis won’t help

K1

• has ability/potential for level surface ambulation
• fixed cadence
• good for the household

K2

• ability/potential for low level barriers (curbs/steps)
• variable cadence
• good for community ambulation

K3

• ability to traverse most environmental barriers
• has needs that require prosthetic for more than just locomotion (exercise, job)

K4

• ability/potential for ambulation that far exceeds basic locomotion
• for child/active adult/athlete

Question 4

What are the AIMS of physio following amputation?

Answer 4

1. Assessment of goals/needs/ability
2. Treatment plans
3. Independence
4. Reeducate movement patterns for ADLs

Question 5

In amputation, what would you do pre-operatively?

Answer 5

1. Educate about rehab
2. Physical, functional, psycho assessment
3. Mobility practice (wheelchairs, transfers)

Question 6

What happened post-operatively?

Answer 6

Sutures stay in upto 3 weeks (helps with shaping)
Drains stay in for a few days
Dressing for wound/shaping of stump (figure 8)

Physical/functional assessment
Pain/edema
Wound healing/pressure care
Walking aids + wheelchairs
Exercises

Question 7

What are the 2 main types of pain experienced following amputation?

Answer 7

1. Residual pain
   - tissue disruption + trauma d/t surgery = inflammation+edema = pressure on nerve endings
   - managed with analgesia; elevation + I/T elastic compression + ex = reduced swelling/pain + improved healing (3 weeks)
2. Phantom limb pain
   - burning, shooting, electirc, cramping, twisting
   - felt in amputated limb
   - could be d/t damage to severed nerves OR brain expecting sensory info on homunculus - not getting it - so altered info processed as pain

Question 8

How can a physio manage phantom limb pain?

Answer 8

1. Reassure/counselling
2. TENS/massage/relaxation
3. Compression

Question 9

What can the physio do for the pt before the prosthetic is fitted?

Answer 9

1. Shape the stump
2. CV fitness
3. Exercises to strengthen, stretch, improve balance
4. Use MDT when needed

Question 10

What can the physio do for the pt after the prosthetic is fitted?

Answer 10

1. Measure physical/functional/psychosocial
2. Pain control
3. Gait retraining
4. Exercises
5. Progress skills with prosthesis
6. Education about limb/prosthesis care

Question 11

How can you help improve gait veloicty post prosthetic?

Answer 11

1. Gait specific training
2. Strengthen/stretch
3. Measure swelling, gait velocity