Treatment protocol for Neuromusculoskeletal conditions: Amputations

Condition:

Amputation post trauma, diabetes, peripheral vascular disease, tumours, infection

Aim of Physiotherapy Treatment:

Objectives:

  • Maintain respiratory function
  • Prevent contractures around joint involved
  • Improve mobility balance and strength to prepare for prosthesis
  • Stump care education
  • Choice of suitable mobility aids

Precautions and contra indications:

  • Care for amputated limb during exercise.

Treatment Guidelines:

Pre-op:

  • Education, explanation of procedure, what they can expect post-op (stages of grief, phantom pain, procedure and therapy post-op and opportunity for prosthetic leg if pt is able to do all that is necessary to qualify for limb.)
  • Explanation of WHY amputation required, and how to minimize further complications (usually diabetes or peripheral vascular disease secondary to HIV): refer to dietician and or councilor if needed

Post-op:

Day 1:

  • Respiratory mantainence
  • Exercise: strengthening, mobility, balance
  • Lie prone half an hour

Day 2:

  • Mobilise into chair
  • Strengthening: static quads, UL ex’s, knee flex ex’s, bridging
  • Transfers
  • Stretching to prevent contractures
  • Wheelchair assessment (if needed- dissuade all but the very unsafe)
  • Lie prone half an hour

Day 3:

  • Standing with frame (static and dynamic balance)
  • Balance ex’s
  • Lie prone half an hour

Day 4:

  • Walking with frame
  • Transfer practice
  • Maintenance of stump (desensitizing, start educationg on how to stump bandage etc.)
  • Balance ex’s

Day 7-10:

  • Re-education of posture, balance in gym
  • Cont with above

Day 10:

  • Discharge with HEP, desensitization and coning. Make sure has f/u date at clinic and at prosthetics clinic (if necessary)

Follow up at Orthotics and Prosthetics clinic:

  • Pt should be made aware that they are able to get a prosthetic limb, on the condition that they work hard in therapy and follow guidance of therapist and doctor. It is preferable that a CRF talks with the patient first- many a patient has received a prosthetic limb unnecessarily, only to let it lie under their bed at home. Explain that it is A LOT OF WORK IN REHAB and not the easy route. It will also depend on stump healing and coning.
  • Pre-requisites for prosthetic limb:
  • Stump healed, no open wounds
  • Stump has been adequately shaped, oedema has resolved
  • Adequate range of joint above amputation
  • Pt is able to mobilize with crutches with adequate endurance and stability
  • Pt is looking after his/her health (ie, stopped smoking if PVD, diabetes is being managed etc.)

PATIENT SHOULD BE FOLLOWED UP AT CLINIC MONTHLY AFTER RECEIVING PROSTHESIS FOR RETRAINING AND COMPLIANCE. TAKE CRF DIRACTIONS WHEN RECIEVES LIMB, JUST IN CASE DEFAULTS.

Compiled by: Samantha Martin

Date: 13/06/07

Reviewed: M Bez, Jan 2010.