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Brainstorming Bilaterals

Brainstorming Bilaterals. Case Studies. Bilateral amputees at RPC. Bilateral BKA. Bilateral BKA.

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Brainstorming Bilaterals

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  1. Brainstorming Bilaterals Case Studies

  2. Bilateral amputees at RPC

  3. Bilateral BKA

  4. Bilateral BKA • Jake, 25 y/o male involved in a MVA resulting in bilateral BKA, # L femur, dislocated L shoulder, and extensive burns to torso and legs. Patient had ORIF L leg and is NWB for 12/52 post-op, and required skin grafts to legs and torso. His upper limbs have FROM and strength. • Patient is now 6/52 and just arrived to the rehabilitation ward. Previously Jake was fit and active, played sport socially, lived independently and worked full time in a relatively sedentary job. He would like to return to his job and living independently after rehab.

  5. Bilateral BKA • What are the treatment priorities for this patient given their goals? • What factors may limit the progress of this patient? • What level of mobility would you expect this patient to achieve? What issues may effect this outcome? • How would this differ for other 2BKAs?

  6. Bilateral BK/AK

  7. Bilateral AK/BK • 75 yr old male admitted for rehab following a (R) AKA. Uncomplicated post op recovery. • Pmhx: (L) BKA 8 yrs ago • HT • PVD • ETOH abuse • Ex heavy smoker

  8. Bilateral AK/BK- Current status • Independent with personal cares • Requires assistance to t/f to wheelchair but is then independent on indoor surfaces • D/C destination to be determined • Demands a prosthesis to be able to walk

  9. Bilateral AK/BK -Social history • Previously lone liver, socially isolated. • Received assistance for cooking,shopping,housework. • Fitted with interim prosthesis 8 yrs ago but refused to use it. • Poor compliance with rehab in past.

  10. Bilateral AK/BK-Discussion • Would bilateral prostheses be appropriate for this pt ? • What should treatment focus on ? • What else needs to be considered for this pt to return home ?

  11. Bilateral BK/TMT • 76 y.o. female. Background: • NIDDM • Traumatic L BKA 10 years ago • Recent TMT amputation due to chronic toe ulceration • Falls – 6 in the last 2 months • Still drives • Lives alone, no family near by (50klms away) • Hobbies – sewing, bingo 3x/week, choir (U3A), baby sitting grandchildren some weekends.

  12. Bilateral BK/TMT - Discussion • What factors may have lead to the 2nd amputation? (preventable or not) • What issues may effect her recovery and discharge? • What considerations need to be made regarding prosthetic prescription?

  13. Bilateral AKA

  14. Bilateral AKA 39 y.o. male Workplace injury – run over by forklift Degloving injuries Complications – sepsis, PE

  15. Bilateral AKA • Ongoing wound issues included: • Hypergranulation • Foreign bodies, debris surfacing after closure +/- breakdown • “Tight” skin over residuum.

  16. Bilateral AKA

  17. Bilateral AKA • Marked mechanical and phantom pain • Psyche involvement – Post traumatic stress disorder?, depression, withdrawn.

  18. Bilateral AKA • Seen at the Limb Centre 4+ months post amputation. Initial program: • Strengthening – hip, UL, core stability • Hip F stretching • Compression pump therapy • Sitting balance • General fitness • Silicone liners - ? Precautions on grafted skin • Transfers, floor drill, problem solving functional issues

  19. Bilateral AKA • First appt!

  20. Bilateral AKA • High level sitting balance / core stability exercises

  21. Bilateral AKA • Prosthetic fitting: “Seal in” liners • Gait training • Where do you start? • what level of mobility is should you expect?

  22. Bilateral AKA First time on legs / sockets!

  23. Bilateral AKA

  24. Bilateral AKA

  25. Bilateral AKA

  26. Bilateral AKA Complicating factors: • Multiple falls (++++) – from chair as well as legs. • Stump wounds • Back pain • Home modifications

  27. Bilateral AKA • Major house and car modifications • Ongoing Vocational and Leisure pursuits: • Studying computers at TAFE (RTW strategy) • Exercise • Swimming • Gym program • Ongoing physiotherapy. • Prosthetic prescription – what is ideal?

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