amputation
- The removal or loss of a limb segment or an entire limb, due to medical illness, trauma/incident, and or surgical measures in order to prevent the spread of disease and/or control pain.
causes- congenital
- Results from failure of the fetus properly developing within the first 3 months of maturation.
- Congenital limb losses account for about 60% of all amputations
causes- acquired
-Can result from an incident site, animal attack, trauma, diabetes, tumor, any illness leading to surgical measurements.
- Acquired usually results in medical procedures which help control or eliminate the process of disease or the
already affected limb.
incidence
- About 185,000 amputations occur annually
- Below the knee are most common
- Leading causes of amputations are;
- Due to cancers or vascular diseases
- Example: Malignant tumor
- Second leading cause is trauma
- Such as accidents which will lead to a part of a limb or whole limb being severed.
classifications
Amputations can be classified according to level and site of limb absence and/or the functional point of view.
- They can be identified as above the knee(AK), below the knee(BK), above the elbow(AE), below the
elbow(BE).
9 classes
There are 9 classes: ● Class A1- Double above the knee ● Class A2- Single above the knee ● Class A3 - Double below the knee ● Class A4 - Single below the knee ● Class A5 - Double above the elbow ● Class A6 - Single above the elbow ● Class A7 - Double below the elbow ● Class A8 - Single below the elbow ● Class A9 - Combined lower plus upper limb amputations
diagnosis
- Chronic diseases such as peripheral artery disease (PAD) and foot ulceration
result in limb amputation - Critical limb ischemia (CLI) results in 25% of patients requiring an amputation
○ Diagnosis includes: vascular examination, ankle-brachial index (ABI), and imaging modalities - Diabetes mellitus is related to 40-60% of lower extremity amputations
○ 85% of these amputations are caused by a foot ulcer, resulting in an infection and/or destruction
of deep tissues - Amniotic band syndrome (ABS): Rare condition that can cause limb amputation
of a baby due to restricted blood flow
○ Diagnosis: ultrasound
treatment/preventative measures
Preventative Measures:
- Foot ulcers can be prevented by having regular foot inspections, having access to foot care and wearing proper footwear
Treatment:
- Treating a diabetic foot is a multidisciplinary approach which includes strategies for treatment of:
○ Peripheral ischemia, oedema, pain, infection, metabolic disturbances and malnutrition; non weight
bearing, topical treatment, foot surgery, aggressive management of intercurrent disease
- CLI treatment should be individualized to the patient
Recovery:
- After amputation it is important to avoid stump complication such as bleeding, infection, and contracture
- Appropriate care includes:
○ Proper elevation, regular repositioning, routine exercises to strengthen the stump and leg muscles
severity scores
- Injury severity scores include:
○ MESS (Mangled Extremity Severity Score)
○ PSI (Predictive Salvage Index)
○ LSI (Limb Salvage Index)
○ NISSA (Nerve injury, Ischemia, Soft tissue injury, Skeletal injury, Shock,
patient age)
○ HFS (Hannover Fracture Scale)
Critical Limb Ischemia
○ considered a severe form of PAD so it would
be classified on the severe end of the
Fontaine classification or the Rutherford
classification
○ Fontaine: defines the distances at which pain
occurs
○ Rutherford: describes 7 stages of PAD
Trauma
○ Can lead to emergency amputation
○ Polytrauma: amputation increases chance of survival
○ Single limb amputation can prevent further complications
types of amputations
- lower limb
- upper limb
lower limb
- Partial Foot Amputation
- Ankle Disarticulation
- Below Knee Amputation
- Through Knee Amputation
- Above Knee Amputation
- Hip Disarticulation
- Hemipelvectomy
upper limb
- Partial Hand Amputation
- Metacarpal Amputation
- Wrist Disarticulation
- Below Elbow Amputation
- Elbow Disarticulation
- Above Elbow Amputation
- Shoulder Disarticulation
and Forequarter
Amputation
life with amputation
Stages After Surgery
- Healing and Starting Physiotherapy
- Regaining Mobility and Independence
- Visiting the Prosthetist
- Choosing an Artificial Limb(s)
- Learning to Use Your Artificial Limb
- Life as a New Amputee
complications
- Phantom Limb Pain
- Chronic neuropathic pain that develops in 45–85% of patients
- Can affect an individuals capacity for self-care
- The pain can lead to depression and feeling of hopelessness - Infections
- consequences of infection may include the need for wound revision or re-amputation at a
higher level
- Can also potentially increase the rate of secondary postoperative complications, which
may include acute myocardial infarction, pneumonia and even death, or late complications
such as poor long-term mobility and independence
prosthetics
● Can be fit for almost any level of amputation
-knee disarticulation
-hip disarticulation
-elbow disarticulation,
-shoulder
● Can help restore locomotion and functional abilities
-potential to restore function and increase quality of life
● Require special training to use
types of prosthetics
- Mechanical
- Electrical
- Recreational arms and legs
- Myoelectric Arm
signal training
which teaches the amputee how to control the muscles used to control the prosthetic arm
control training
amputee learns to control the specific muscles
functional training
amputee must learn to become accustomed to wearing
the artificial limb and see it as part of their body
teaching considerations in classroom
- People with amputation will typically require accommodation to move from one place to another
- Create a physically accessible environment that is not mobility-limited.
- Big doors, ramps
- Be flexible with the schedule. Students may arrive late or have to leave before the class is over due to adapted transportation services.
- May need to recap the information given at the beginning of the lesson
- Location of where the student is seated
- Consider emergency situations
participation in PA
● People with amputation are generally inactive.
○ 68% of amputee population compared to 40% general population
● There is a decrease in the level or leisure activity following lower limb amputation.
● However, satisfaction with changed physical status remains high.
● Likelihood of participating in physical activity exercise and sport increased if they
participated prior to amputation.
● If they do return to physical activity they opt for less demanding activities where a
prosthesis is not required or not functionally dependent on a prosthesis to participate
- Example: fishing, swimming, etc.
barriers for PA
● Physical limitation ● Lack of confidence / embarrassment ● Body image ● attitude ● Services ● Climate/physical environment ● Income ● Stump pain ● Prosthesis
