1 / 25

Physical Therapy and the Amputee Patient

Physical Therapy and the Amputee Patient. Christopher Runkle PT, DPT April 30, 2010. Patient Subjective. 53 y/o female Right above knee amputation (AKA) Right leg pain Script: Evaluate and Treat for R AKA. Question 1.

madge
Download Presentation

Physical Therapy and the Amputee Patient

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Physical Therapy and the Amputee Patient Christopher Runkle PT, DPT April 30, 2010

  2. Patient Subjective • 53 y/o female • Right above knee amputation (AKA) • Right leg pain • Script: Evaluate and Treat for R AKA

  3. Question 1 All of the following are signs/symptoms of peripheral arterial disease EXCEPT… a. Leg pain that doesn’t stop after exercising b. Toe Wounds that will not heal c. An increase in skin temperature d. Gangrene

  4. What do you want to ask?

  5. Medical History • Significant surgical history • HTN; High Cholesterol • Current Medications: • Metoprolol, Crestor, Gabapentin, Delaudid, Coumadin, Notryptilene • Smoked for 25 years, quit 10 years ago • Significant difficulty healing • “Active” individual

  6. Question 2 • Beta blockers work by… a) decreasing heart rate and decreasing contractility b) increasing heart rate and decreasing contractility c) decreasing heart rate and increasing contractility d) increasing heart rate and increasing contractility

  7. Subjective • 5/10 Right leg pain. Sharp shooting pain • Received home physical therapy and wound care. • Received prosthesis 1 day ago • Lives in a 2 story home, first floor bedroom, 14 steps to second floor, 7 STE.

  8. Goals • “I want to be able to walk without needing to use anything”

  9. What do you want to measure? Why?

  10. Question 3 Which contracture would be unlikely in an AKA? a) hip flexion b) hip adduction c) hip abduction d) hip external rotation

  11. Objective • Residual limb tissue intact. Small scab on distal end without drainage • Short and cylindrical shape • Left LE good skin tone, decreased dorsalis pedal pulse. • Intact proprioception LLE at ankle. • TTP over distal incision line and distal femur

  12. Objective (Cont.)

  13. Objective (Cont.)

  14. What do you want to do? • What would your treatment plan consist of?

  15. Patient Treatment Plan • Patient education! • Prosthetic progression/wear schedule • Sock ply and fit management • Co-morbidity management • Acceptance of responsibility for success • 3 Phases of Prosthetic Gait Training for the above knee amputee

  16. Gains and status after 4-6 weeks… • Gross strength throughout right hip increased at most ½ MMT grade from IE • Wearing leg all day without skin breakdown • Independent Don/Doff and sock ply management • RW for all activities outside of therapy and not doing well with transition to SPC. • Gait deviations galore…

  17. Gait Observation • Little to no pelvic transverse plane movement • Long right step length • Left step-to pattern • Large right trunk lateral lean in right stance • Right step placement and step width very narrow < 2 inches • 4-6 visit plateau with regards to success of transition to SPC.

  18. Question 4 What can cause a short intact step length? a) improper socket fit/alignment b) weak prosthetic side hip musculature or ROM defecits c) lack of confidence in device d) all of the above

  19. Communication with the Team • Express therapy concerns with your team – BE AN ADVOCATE • Many times changes can be made to give a mechanical advantage and assist with progressing your therapy success.

  20. Key Points for Success • Adequate strength and ROM • Proper sock ply management • Proper Alignment/therapist knowledge • Pelvis/Trunk dissociation and transverse plane movement • Proper progression of abilities and therapy • Internal motivation and drive • Good Communication with your team

  21. Question 5 The rehabilitation team for an amputee patient should include… • Rehab M.D. / Physiatrist • Physical therapist • Prosthetist • All of the above

  22. Advanced Skill Training

  23. References • Physical Therapy Management of Adult Lower-Limb Amputees. Robert S. Gailey, Jr., M.S.Ed., P.T.  Curtis R. Clark, P.T.  Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation principals. Chapter 23. http://www.oandplibrary.org/alp/chap23-01.asp • The Rehabilitation Specialists Handbook. Rothstein, JM, Roy, SH, Wolf, SL. F.A. Davis. 701-774. • National Amputee Golf Association. http://www.nagagolf.org/index.shtml • Osullivan and Siegelman. National Physical Therapy Examination Review and Study Guide.

More Related