Physical Therapy for Lower Limb Amputees
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Questions and Answers

What is the medical term for the removal of a limb, part, or total from the body?

Amputation

What is the medical term for removing a limb through a joint?

Disarticulation

Amputations are more common in the upper limb than in the lower limb.

False

What is the most common age range for amputations?

<p>50-70 years</p> Signup and view all the answers

What percentage of amputations involve the lower limb?

<p>85%</p> Signup and view all the answers

Which of the following is NOT a common indication for amputation?

<p>Severe dehydration</p> Signup and view all the answers

What is a common cause of amputation in the developed world?

<p>Disease</p> Signup and view all the answers

What is the most common cause of amputation in developing countries?

<p>Trauma</p> Signup and view all the answers

What type of amputation is typically done as an elective procedure?

<p>Closed amputation</p> Signup and view all the answers

A guillotine amputation is considered a closed amputation procedure.

<p>False</p> Signup and view all the answers

Which of the following is NOT a principle of close amputation?

<p>Bone is sectioned below the level of muscle section</p> Signup and view all the answers

What is the primary reason for using a tourniquet during a close amputation?

<p>To reduce bleeding</p> Signup and view all the answers

What is the term for the procedure where muscle is sutured to bone during a close amputation?

<p>Myodesis</p> Signup and view all the answers

What is the term for the procedure where muscle is sutured to opposite muscle tissue during a close amputation?

<p>Myoplasty</p> Signup and view all the answers

Large nerves during a close amputation should be ligated before they are cut.

<p>True</p> Signup and view all the answers

When are drains typically removed after a close amputation?

<p>48-72 hours</p> Signup and view all the answers

What type of dressing is used for a close amputation immediately after surgery?

<p>Both B &amp; D</p> Signup and view all the answers

What is the recommended duration of bed rest after a closed amputation with adequate vascularity?

<p>8-12 weeks</p> Signup and view all the answers

A conventional prosthesis is usually fitted within 4 weeks of a close amputation.

<p>False</p> Signup and view all the answers

What is the primary indication for an open amputation?

<p>Severe infection</p> Signup and view all the answers

The wound is left open and not closed after an open amputation.

<p>True</p> Signup and view all the answers

What is the common approach for wound closure after a circular open amputation?

<p>All of the above</p> Signup and view all the answers

What type of dressing concept is typically used following an open amputation?

<p>Rigid dressing</p> Signup and view all the answers

What is the most common reason for non-traumatic lower limb amputations?

<p>Diabetic foot infection or gangrene</p> Signup and view all the answers

Which of the following is a common complication of amputation?

<p>All of the above</p> Signup and view all the answers

Phantom limb sensation is a common and persistent condition experienced by most amputees.

<p>False</p> Signup and view all the answers

Re-amputation is a generally effective treatment for hyperesthesia of the stump.

<p>False</p> Signup and view all the answers

What is the term for the phenomenon where amputees feel sensations in their missing limb?

<p>Phantom limb sensation</p> Signup and view all the answers

Phantom limb sensation can sometimes help amputees adapt to a prosthesis.

<p>True</p> Signup and view all the answers

Which of the following can contribute to the development of hip flexion deformity after an amputation?

<p>Prolong sitting on soft mattress</p> Signup and view all the answers

New bone formation at the amputation site is usually a cause for concern and requires immediate intervention.

<p>False</p> Signup and view all the answers

What is the most common type of neoplasm that can lead to amputation?

<p>Osteosarcoma</p> Signup and view all the answers

Which of the following is NOT a reason for amputation due to trauma?

<p>Severe muscle strain without bone involvement</p> Signup and view all the answers

The current terminology for below knee amputation is transtibial amputation.

<p>True</p> Signup and view all the answers

What is the level of amputation where the lower limb is removed below the L4-L5 level?

<p>Hemicorporectomy</p> Signup and view all the answers

The level of amputation can significantly influence the type of prosthesis that is used.

<p>True</p> Signup and view all the answers

Which of the following is NOT a principle consideration when deciding to amputate?

<p>Minimizing cost of treatment</p> Signup and view all the answers

The rehabilitation process for lower limb amputations typically includes a pre-operative period, a post-operative period, and a prosthetic stage.

<p>True</p> Signup and view all the answers

What is the primary goal of pre-operative training for amputees?

<p>Minimizing post-operative complications</p> Signup and view all the answers

Pre-operative training typically includes exercises to improve joint mobility, respiratory function, and balance.

<p>True</p> Signup and view all the answers

What is the primary goal of the pre-prosthetic stage of rehabilitation?

<p>Strengthening the stump</p> Signup and view all the answers

The pre-operative period involves a comprehensive assessment of the affected limb, the unaffected limb, and the patient's overall well-being.

<p>True</p> Signup and view all the answers

Which of the following is NOT a component of a pre-operative assessment for amputees?

<p>Financial</p> Signup and view all the answers

Which of the following is a common component of pre-operative training for amputees?

<p>Deep breathing exercises</p> Signup and view all the answers

Post-operative rehabilitation aims to reduce the risk of complications and help amputees regain functional independence.

<p>True</p> Signup and view all the answers

Which of the following is NOT a common aim of post-operative rehabilitation for lower limb amputees?

<p>Learning to drive a car</p> Signup and view all the answers

What is the primary purpose of breathing exercises in the post-operative period after amputation?

<p>Preventing respiratory complications</p> Signup and view all the answers

Brisk ankle and foot exercises for the unaffected leg are essential to prevent circulatory complications in the post-operative period.

<p>True</p> Signup and view all the answers

What is the recommended position for the stump during the post-operative period?

<p>Parallel to the unaffected leg and flat on the bed</p> Signup and view all the answers

Which of the following is NOT recommended for preventing hip flexion deformity in the post-operative period?

<p>Prolong sitting on a soft mattress</p> Signup and view all the answers

Stump compression socks or bandages are primarily used to control pain in the post-operative period.

<p>False</p> Signup and view all the answers

What is the purpose of stump exercises in the post-operative period?

<p>All of the above</p> Signup and view all the answers

Strengthening the muscles that control crutches is crucial for amputees during their rehabilitation.

<p>True</p> Signup and view all the answers

What is the primary goal of walking re-education for amputees?

<p>Developing a comfortable and efficient gait pattern</p> Signup and view all the answers

What is the purpose of pneumatic post amputation mobility assist devices (PPAM)?

<p>To allow early partial weight-bearing after amputation</p> Signup and view all the answers

PPAM devices should only be used under clinical supervision.

<p>True</p> Signup and view all the answers

What is a potential disadvantage of using PPAM devices?

<p>They can cause excessive pistoning in heavy amputees</p> Signup and view all the answers

Amputees who use crutches often find it takes them longer to adapt to a prosthesis.

<p>False</p> Signup and view all the answers

What is the primary focus of bandaging the stump during post-operative rehabilitation?

<p>To control edema and shape the stump</p> Signup and view all the answers

The pressure applied with a bandage should be consistent and uniform from the distal to the proximal end of the stump.

<p>False</p> Signup and view all the answers

Study Notes

Physical Therapy for Lower Limb Amputees

  • Amputation is the removal of a limb, part or all, from the body.
  • Disarticulation is the removal of a limb through a joint.
  • Lower limb amputations are more common than upper limb amputations.

Incidence

  • Amputations are common in individuals aged 50-70.
  • Males are affected 75% of the time.
  • Females are affected 25% of the time.
  • Lower limb amputations account for 85% of cases.
  • Upper limb amputations account for 15% of cases.

Indications for Amputation

  • Trauma (e.g., gun shot wounds)
  • Malignant tumors
  • Nerve injuries and infection
  • Extreme heat, cold, or burns (leading to gangrene)
  • Peripheral vascular insufficiency
  • Congenital absence of limbs or malformation
  • Severe infection

Causes of Amputation

  • Natural causes
  • Accidental causes
  • Ritual, punitive and legal amputations
  • Cold steel or gunshot wounds

Natural Causes of Limb Loss

  • Congenital absence
  • Arterial disease
  • Frostbite
  • Ergot and other toxins
  • Wound infections
  • Diabetes mellitus
  • Dietary deficiencies
  • Tumors

Relative Percentage of Lower Limb Amputation Causes

  • Developed World:
    • Peripheral vascular disease (PVD) (approximately 25-50%, often related to diabetes mellitus): 85-90%
    • Trauma: 9%
    • Tumor: 4%
    • Congenital deficiency: 3%
    • Infection: 1%
  • Developing World:
    • Trauma: 55-95%
    • Disease: 10-35%
    • Tumor: 5%
    • Congenital deficiency: 4%
    • Infection: 11-35%

Relative Percentage of Upper Limb Amputation Causes

  • Developed World:
    • Trauma: 29%
    • Disease: 30%
    • Congenital deficiency: 15%
    • Tumor: 26%
  • Developing World:
    • Trauma: 86%
    • Disease: 6%
    • Congenital deficiency: 6%
    • Tumor: 1%

Types of Amputation

  • Closed amputation (guillotine operation): A surgical procedure to remove a limb. Soft tissues are closed over the bone.
  • Open amputation (guillotine operation): An emergency procedure used when life-threatening infection is present. The wound is left open and not closed. It has two variations depending on skin flaps.

Principles of Closed Amputation

  • Tourniquets are desirable, except in ischemic limbs.
  • The level of amputation is important for proper prosthesis fitting.
  • Skin flaps should provide good coverage and be mobile and sensitive.
  • Muscle should be divided at least 5cm distal to the intended bone section.
  • Muscle should then be sutured.
  • Methods of muscle suture include myodesis (suture to bone) and myoplasty (sutured to opposite muscle).
  • Nerves should be cut proximally and allowed to retract. Large nerves should be ligated before division.
  • Blood vessels should be doubly ligated and cut.
  • Bone should be sectioned above the muscle section level.
  • Drains should be removed after 48-72 hours.
  • Compression dressings (elastic or rigid plaster) should be fitted immediately after surgery.
  • Absolute bed rest with limb elevation is recommended for patients with adequate vascularity.
  • Prosthetic fitting should occur at least 8-12 weeks after surgery.

Principles of Open Amputation

  • Indication: Severe infection or severe crush injuries.
  • Types:
    • Open amputation with inverted skin flaps
    • Circular open amputation: Wound left open for 2* by suture, skin graft or re-amputation.
  • Rx following amputation
  • Rigid dressing concept (Pylon): POP cast applied over the dressing after surgery.
  • Soft dressing concept: Sterile dressing and elastocrepe bandage applied over the stump.

Complications of Amputation

  • Hematomas
  • Infections
  • Necrosis
  • Contractures
  • Neuromas
  • Stump pain
  • Phantom limb sensation (feeling the missing limb)
  • Hyperesthesia (increased sensitivity)
  • Stump edema
  • Bone overgrowth
  • Causalgia (chronic pain)
  • Painful adhesive scar formation
  • New bone formation (5 weeks after electrical burns)
  • Flexion deformities

Reasons for Amputation

  • Circulatory disorders (e.g., diabetic foot infection or gangrene)
  • Sepsis with peripheral necrosis
  • Neoplasm (e.g., bone or soft tissue tumors)
  • Trauma (severe injuries that cannot be spared or attempts have failed)
  • Traumatic amputation (limb severed in an accident)
  • Amputation in Utero (Amniotic band)
  • Infection (e.g., bone infection or osteomyelitis)

Amputation Level Nomenclature

  • Old vs New Terminologies (table provided)

Levels of Amputation (table provided)

Principle Considerations to Amputate

  • Preservation of life
  • Improvement of general health
  • Restoration of function
  • Reduction of pain

Rehabilitation of Lower Limb Amputation

  • Pre-operative period
  • Post-operative period (pre-prosthetic stage)
  • Prosthetic stage

Pre-operative Period

  • Assessment: Physical, social, psychological
  • Re-assurance and Training

Pre-operative Assessment

  • Assessment of the affected and unaffected limb.
  • Assessment of the patient as a whole: Physical, Social, and Psychological status should be evaluated.

Physical Assessment

  • Muscle strength
  • Joint mobility
  • Respiratory function
  • Balance reaction
  • Functional ability
  • Vision and hearing status

Social Assessment

  • Family and friends support.
  • Living accommodation (stairs, ramps, rails, wheelchair accessibility, proximity of shops)

Psychological Assessment

  • Patient's psychological approach to amputation.
  • Motivation to walk
  • Other psychological problems.

Pre-Operative Training

  • Aim to prevent complications, lower rehabilitation costs, and duration.

Training Program

  • Prevent thrombosis (maintain circulation of unaffected limb, deep breathing, coughing)
  • Prevent chest complications (deep breathing and coughing, postural drainage)
  • Relieve pressure (pressure mobility of all joints, emphasis on susceptible joints).
  • Improve Mobility (mobility exercises for trunk, pelvic or shoulder girdle, mobility exercises compensate for prosthesis restriction)
  • Educate patients on transfer techniques (monitoring wheelchair movement, single limb standing, balancing, balance, equilibrium, and standing & walking techniques)
  • Education on complication detection (soft tissue tightness, pressure points, expected degrees of pain, phantom pain)

Reassurance

  • Play an important role during recovery.
  • Reassure with encouragement.
  • Practical demonstration by someone who has undergone similar surgery.

Post-Operative Period

  • Aims of Rx (Prevent complications, prevent deformities, control stump edema, control strength of whole body, increase strength, maintain general mobility, re-educate walking and address phantom pain, restore functional independence).
  • Prevention of complications (breathing exercises to prevent respiratory issues, brisk ankle and foot exercise to prevent circulatory issues.)
  • Prevention of deformities (positioning in bed, patient should lie flat and progress to prone lying.)
  • Control of stump edema (compression socks and bandaging).
  • Maintaining body strength & strengthening muscles controlling the stump.
  • Exercise for unaffected side (static quadriceps, static gluteal, SLR, alternate hip & knee bending and stretching).
  • Stump exercises (static to free active, resisted exercises).
  • Maintaining good mobility (exercises to move shoulder/trunk mobility)
  • Improving balance and transfer techniques (sitting in balance using encouragement, encouraging balance reaction, tapping, perturbation, trunk stabilization).

Walking Re-education

  • Partial weight bearing in parallel bars using pneumatic post-amputation mobility aid (PPAM) for 5-10 days post-op.
  • Patients wear normal dress and good walking shoes on unaffected side.
  • Initial training on stable surfaces, progressing to unstable surfaces such as walking in mud.

Pneumatic Post Amputation Mobility Aid (PPAM)

  • It's a partial weight-bearing walking aid.
  • It's used under clinical supervision only.
  • It can be used from 5-7 days postoperatively.

PPAM Advantages

  • Psychological boost via early walking after amputation.
  • Edema reduction via pressure in bag.
  • Educating postural reaction for partial weight bearing.
  • Preparation for prosthetic fit
  • Reducing Phantom pain sensation

PPAM Disadvantages

  • Fixed flexion contracture may lead to residual limb breakdown.
  • If the amputee is very heavy or has a heavy-footed gait, excessive pistoning (up-and-down movement) may occur, reducing support.
  • Stiff knee gait is unnatural for a trans-tibial level.
  • Inflation pressure may exceed arterial pressure in the residual limb.

Walking without a Prosthesis

  • Use of firm compression socks or bandage for gait training, in parallel bars.
  • Progress to frames or crutches based on stability.
  • Crutch usage allows for faster adaptation to prosthesis
  • Normal alignment of pelvis and reciprocal movement of the stump must be maintained

Principle of Bandaging of Stump

  • Moderate firm pressure
  • Even distribution of pressure.
  • Pressure decreases proximally.
  • Extra pressure over corners, creating a conical shape.
  • Diagonal, oblique or spiral bandage patterns, avoiding circular patterns.

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Physical Therapy For Lower Limb Amputee PDF

Description

Explore the essential aspects of physical therapy for lower limb amputees, including the causes, incidence, and indications for amputation. This quiz covers key factors affecting lower limb amputations and their rehabilitation. Understand the demographics and implications of limb loss through various conditions.

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