How can diabetes cause damage to microvasculature?
Peripheral neuropathy- undetected injury- poor circulation and poor healing- infection- osteomyelitis (infection of bone)
Benefits of amputation?
- pain relief
- improved mobility
- prevention of further infection
- prevention of growth/spread of tumour
- quality of life
- life saving
Older patients with PAD- frequent dressings, reduced mobility, lack of social contact due to malodorous ulcers and pain
Younger patients with disabilities/ following RTA- frequent hospital visits and operations, lack of social contact and difficulty accessing areas, reduced mobility, pain.
Complications of amputation?
- pain (post-operative, neural and phantom) phantom sensation, immobility and wheelchair dependence
- infection, injury or failure to heal- further resection
- falls, grief, contractures, biomechanical compensations, psychological impact and death
- prosthetic complications- COG, muscle action, uncomfortable, sore, rubbing
MDT members?
Immediate team-
Consultant, medical team, nursing team, tissue viability nurse, diabetes team, psychologist, social worker, pain management team, pharmacist, dietician, physiotherapist and OT
Wider team-
Prosthetic services, social services/carers, wheelchair centre, GP, district nurse, mental health team
Role of Physiotherapist?
- contribute to decision to amputate and which level
- pre- operative assessment
- early post-Op rehabilitation
- respiratory care
- wheelchair use
- discharge planning
- follow- up rehabilitation
- gait re-education
- education/support/advice
- prosthetic rehabilitation
Early post-operative rehab ?
- residual limb assessment and management
- compression therapy
- Massage stump
- active exercises (PIRPAG)
- Bed mobility
- transfers- bed to chair, bed to wheelchair, wheelchair to toilet
- safety
- falls awareness- on and off floor, crawl/shuffle to furniture
- mobility
What are the types of early walking aids?
Pneumatic post amputation mobility aid
Femurette
Advantages and disadvantages of PPAMaid?
TFA and TTA
Can be used at 5 days post-op
Common practice to start at 10 days
Can aid oedema reduction
PWB- partial weight bearing
Looks nothing like a limb
Start with parallel bars and progress gradually to quad sticks
Can only be used to fixed knee, hip hitching style for TTA
Does not work well with TFA
Advantages and disadvantages to a femurette?
TFA with ‘fixed’ or ‘free’ knee options
Can be used from 1st day post-op
FWB
Used to practice stairs, outdoor mobility
More like a prosthesis
Patient can don themselves
Only for TFAs
Can progress to sticks
What to include In a lower limb prosthetic rehab?
- weight transference, side stepping, backwards walking, heel strike, stride stand
- single leg stand, tight rope walking, step ups, grape vine
- wobble cushions/boards, STS
- un-squash ball under sound foot
- rolling small ball under sound foot
- sidestep over with prosthetic leg
- step forwards over an object
- upper limb exercises
- wall squat
- resisted walking
- carrying objects
Outcome measures to use for prosthesis?
- locomotor capabilities index
- distance walked over a certain time
- 4 square step tests
- balance tests
- 3m timed up and go
- falls measure
