Transcript Presentation Slides Part #1

Lower Extremity Amputee/Prosthetic Rehabilitation: A Team
Approach
Fred Lerche PT, C.Ped Administrative Director OP Rehab. And Prosthetics and Orthotics
2224 West Sunset Springfield, MO
730-2000
417-
CoxHealth Center for
Prosthetics
And Orthotics
Our Clinical Model ???
Demographics of
Amputees in the United
States
In 2009, there were approximately
1.9 million persons with
amputations in the United States.
Each Year an additional
80,000 lose a limb as a result
of an accident or disease 2009
study
2010 Study
19,000,000 people living with
DM
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•
4% will develop an ulcer
6% will have an amputation
45% mortality rate with an ulcer
or amputation at 1 year
2010 507 amputations done
each day
WOW 85% are preventable
Sound Limb Care
Sound Limb Inspection
 Shoe recommendations
 Orthotics
 Transfer Techniques to
decrease Shear
 Adaptive Equipment-sliding
board????


CASE REPORT
April 2014
CASE REPORT
February 2015
CASE REPORT
LEAP PROGRAM
REASON FOR
AMPUTATION
Disease
Trauma
Congenital
Tumor
70%
22%
4%
4%
STATISTICS
 Gender
Male
75%
Female 25%
STATISTICS
 Hours
of Prosthetic Use
per day
>12 hrs
60%
1-12 hrs
34%
no use at all 6%
Pre-surgical Visit
Provide time for introductions
Discuss level of activity over the past two years
• Support medical team’s decisions
Explore patient expectations after amputation
Explain the sequence of events from surgery
through rehabilitation
• Reinforce realistic expectations
Answer any questions of the patient and family
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Post Operative Care
Goals for the Post-Op (Acute)
Treatment Phase
PRIMARY GOAL -- HEALING
WITHOUT COMPLICATIONS
Reduce edema and promote healing
 Prevent Loss of Motion – a MUST
 Increase upper and lower extremity
strength- think function
 Promote mobility and self care
 Promote sound limb care- a Must
 Assist with limb loss adjustment

Goals for the Post-Op (Acute)
Treatment Phase
Residual limb dressing care
 Positioning
 Transfer skills
 Exercise program – keep it simple for
home – the Essential Basic Four

1. Supine A/AROM alternating hip and knee flexion
2. Supine A/AROM hip abd and add
3. Side lying AROM hip flexion and extension
4. Sitting AROM knee flexion and extension

Early ambulation- Very Controlled
PROSTHETIC CRITERIA
1.
2.
3.
Independent with Bed mobility
Independent with transfers
Independent with Ambulation
Douglas G. Smith MD
INTERDISCIPLINARY
REHABILATION TEAM
 The
Key to Successful Outcomes
Fred Lerche PT, C.Ped
AMPUTEE REHABILITATION
A TEAM APPROACH

Team Members
Physician
Physical Therapist
Occupational Therapist
Orthotist/Prosthetist
Psychologist
Social worker/Case management
Nutritionist
Support Volunteers
Family
Nursing
Patient
POSSIBLE REASONS FOR FAILURE OF AN AMPUTEE PROGRAM
 Too
little early education pre-and post
prosthesis. Education is important both to
patient and family.
 Amputee has an overly optimistic attitude.
 Prosthetist and physical therapist must be
honest with patient.
 Let patient know artificial limb will never be
as good as anatomical limb.
 Involving patient, family and rehab as much
as possible is a great asset. Robert S. Gailey PhD, PT
Amputation is the first step in
the Rehabilitation process

“Too often amputation is performed
without thought for biomechanical
principles or preservation of muscle
function.”
Frank Gottschalk MD
Incisional line causing excessive
shear and pressure
Case Report
In My opinion, the key to a
successful Amputee
Rehabilitation Program and
Positive Outcomes is a
Functional Progressive
Pre-Prosthetic Program
Fred Lerche PT C.Ped
Must Improve
Cardiovascular
Status
Why ??????
Energy Expenditure
 Long
BKA 20% additional energy
 Short BKA
40%
 Long AKA
60%
 Short AKA
80%
 Hip Disartic 100%
W
Must Improve
Functional Muscle
Strength
Must Prevent
Joint
Contractures
Bella May
Do Not……
Do……..
Bella May
Do Not……
Do……..
Bella May
Must be able to
Control the
repositioned C.O.M.
over the altered B.O.S.
Controlled Ambulation
Postoperative day 10 - 21
Regular dressing changes
 Residual limb wrapping or compression
RRD ect.
 Assess Ambulation skills
 PROM and AROM to all joints
 Initiate balance and coordination
 Increase endurance training

Postoperative day 21-30
Sutures or staples removed at day 21
 Aggressive ROM for knee flexion if rigid
dressing was used
 Continue residual limb compression
 Begin Dynamic residual limb exercises as
healing permits- hold 4 weeks if Myodesis
 Increase endurance program
 Progress with balance and agility training

A timeline for Patients or
Treatment guidelines
 Week
3 : Sutures or staples removed
 Week 4: Shrinker and healing
monitoring
 Week 6-8: Cast for Diagnostic socket
 Week 10-11: Prosthetic Gait training
Pre-Prosthetic Program
 Stretching
 Strengthening
 Progressive
coordination
Balance, agility, and
Robert Gailey
ACUTE CARE AMPUTEE
EXERCISES
ACUTE CARE AMPUTEE
EXERCISES
ACUTE CARE AMPUTEE
EXERCISES
ACUTE CARE AMPUTEE
EXERCISES
STRENGTHENING
STRENGTHENING
STRENGTHENING
STRENGTHENING
Functional Progression
exercises
Start
Long Sitting
Quadruped Position
High kneeling