Amputee’s the most important considerations post operatively!
Updated: Nov 22, 2022
Most Amputations in Australia are secondary to vascular compromise (Vascular Disease) and in many cases these particular patients will have multiple medical problems that must be considered when planning their post-operative rehabilitation.
Common Concerns that we need to be mindful of include:
1. If one leg has poor vascular supply, it is highly likely the other leg will also have a poor vascular supply. Therefore, it is imperative that:
Great care is taken of the residual limb to maintain skin integrity (avoid a wound developing, wounds are potential infections sources especially when a patient does not have normal healing rates)
Start Burgers exercises to improve circulation
Watch for signs of claudication when the patient is using their residual limb
2. Other common problems that are needed to be managed may include:
Cognition / Cognitive Deficits
There are a number of Key Factors that will influence how far a patient can progress through the rehabilitation process. These include:
Their general health and other comorbidities
Their baseline level of function
Family or carer support
Stump integrity which includes:
Wound healing (this includes the healing of the wound and additional complications such as scar adherence)
Contracture's – which may occur at the hip or knee. In particular flexion contractures greatly impact a patient’s suitability for a prosthesis.
Pain level fluctuate greatly between individuals, and this can be influenced by many internal and external factors. As a physio it is important that we ensure our patients pain is well managed. If this is not achieved the patient tends to be more likely to develop contractures and is less likely to participate in therapy. Additionally, it is important to discuss and explain the concept of phantom pain / phantom sensations. If you don’t explain this key concept, it can be extremely unnerving for patients if they start to feel their foot or have pain located where their missing limb once was.
If a patient is having issues with phantom sensations, it is important to:
Discuss this with the patients treating Rehabilitation Doctor or flag this with their GP
Teach the patient techniques to de-sensitise the stump. This can include touching and rubbing, different texture over the stump. Additionally, you could even use TENS higher up the limb
Air-bagging and using a prosthesis also usually helps with phantom pain
This is an extremely important part of the rehab process. Especially in patients wanting to undertake prosthesis training. Key to preventing contractures include:
Make sure the patient’s pain is well managed as patients in pain are more likely to develop contractures
Below Knee Amputee (BKA) – patients tend to have a knee flexion contracture as they are in pain and the hamstrings are very overactive. Additionally, to this these patients often develop a hip flexor contracture as well. Great care needs to be taken to position them in full knee extension wherever they are by doing the following:
No pillows to be placed under the knee in bed
A Stump board must always be used on their wheelchair
Is sitting in a high back chair the stump must be elevated so that the knee is in extension
Encourage quads exercises
Utilise passive stretching techniques where required
In difficult cases forms of splinting may be needed
Above Knee Amputee (AKA) – patients tend to have a combined flexion and adduction contracture. Therefor it is important to:
Make sure that they spend some time 2-x daily in an extended and abducted hip position. Prone lying is your best option. If they can’t manage prone lying, then side lying is the next best but will probably mean that you will need to supervise as they may find it difficult to maintain the correct position
Push abduction and hip extension exercises
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