This standard of care applies to any patient after a lower extremity le amputation, including transfemoral aboveknee amputation or aka, transtibial belowknee amputation or bka, transmetatarsal amputation tma, and toe amputations. Introduction the physiotherapist will see fewer patients with knee disarticulation compared to patients with belowknee bk and above kne e ak amputations during lower limb rehabilitation. Get a printable copy pdf file of the complete article 573k, or click on a page image below to browse page by page. Aka above the knee amputation, transfemoral amputation bka below the knee amputation, transtibial amputation residual limb the portion of the leg remaining after an amputation, sometimes referred to as a stump or residuum. After a below the knee amputation, it is important to prevent the hip and knee from staying in a bent or flexed position. The activities and exercises will be supervised by your therapist.
Rehabilitation manual for persons with aboveknee amputation by. Transtibial amputation in a transtibial or below knee amputation, the procedure is done through the tibia. Physical therapy and aboveknee amputation preprosthetic. Walking requires 10 to 40% more energy after a belowtheknee amputation and 60 to 100% more. Rehabilitation manual for persons with aboveknee amputation. Therefore, where described upper limb amputees for the purpose of these guidelines are considered to be above elbow full upper limb amputees and lower limb above knee amputees with a short stump. Above knee amputee home exercise program premier surgical. Along with our peer visitor program, we offer plenty of services and support for those who will soon be undergoing amputation or already have. Amputations may become necessary for several reasons. The following exercises must be done every day to prevent any complications.
The prosthesis needed for an abovetheknee amputation weighs much more than that for a belowtheknee amputation, and controlling a prosthetic knee joint requires skill. The following exercises must be done every day to prevent complications. Osteomyelitis of the proximal femur, femoral head, or acetabulum. The above knee stump is generally problem free, functional and endbearing, allowing for a high rehabilitation rate in independent ambulation. A rotator unit can still be used on a long transfemoral amputation, but the knee center on the amputated leg will then be lower than the opposite knee center. This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. Pdf prognostic factors in rehabilitation of above knee amputees. While the exercises contained in this manual are a comprehensive guide to treating a patient with the. Compensatory mechanisms in belowknee amputee gait in response to increasing steadystate walking speeds. Above knee amputee exercise program it is important that you take an active role in your rehabilitation.
Below knee amputee home exercise program it is important that you take an active role in your rehabilitation. At amputee coalition, our mission is to make sure that no one going through limb loss feels alone. Higher rates of infection are seen in below knee compared with above knee amputations, in diabetic patients, patients with poor nutritional status, ongoing vascular compromise or if there has been preexisting infection in the amputated limb. Flexion contracture at the knee of greater than 15 degrees also precludes belowknee amputation. The main goal of rehabilitation after an amputation should be to return the amputee to the. Page 1 of 4 wrapping your limb will reduce swelling and prepare the limb for a prosthesis. Manual guidance encourages the re establishment of. With our nationwide network, you can expect the same excellent care across the u. Amputee rehabilitation magee rehabilitation hospital. Amputation causes, types of amputation and amputation. Amputee rehabilitation lynn cunningham, pt, dpt helena lax, md mark nielsen, cp, atc. The most common indication for amputation of an upper limb is severe trauma.
Rehabilitation, trans femoral amputation, case report. Hanger clinic is committed to helping you reach your full potential by providing the most appropriate orthotic and prosthetic technologies to restore your mobility and independence. Rehabilitation after limb amputation fundamentals msd. When the patient discharges from your care, be sure to educate them on the importance of continuing this. If there is anything you do not understand, please ask any member of the surgical team doctors, nurses, care workers, occupational therapists, and physiotherapists. Rehabilitation manual for persons with aboveknee amputation published on jan 6, 2014 this document was created by the prosthetics training across borders research group under the direction.
Introduction theoretically, finding a method to attach a prosthetic. After a below the knee amputation, it is important to prevent the. Following these guidelines will help maximize your level of function. Describe the va amputation system of care and why it was developed identify and describe the phases of rehabilitation care in the clinical practice guideline for the rehabilitation of lower limb amputation describe evidencedbased prosthetic and amputation rehabilitation outcomes understand the. Transtibial amputation in a transtibial or belowknee amputation, the procedure is done through the tibia. Aboveknee amputation definition of aboveknee amputation. After an above the knee amputation, it is important to prevent the hip from staying in a bent or flexed position. While you are a patient at wakemed, you will learn many important things about caring. The prosthesis needed for an above the knee amputation weighs much more than that for a belowthe knee amputation, and controlling a prosthetic knee joint requires skill. It is therefore well suited for the geriatric amputee. Gait analysis in lowerlimb amputation and prosthetic rehabilitation. This guide is meant as a starting point for new amputees.
Disarticulation through the knee has several advantages over above knee amputation. Rehabilitation of patients with throughknee amputation. The implementation of graded rehabilitation is considered to be of utmost importance for improved results. Amputation is a surgical procedure to remove a limb an arm or a leg or a portion of a limb a finger, hand, toe or foot. An aboveknee or throughknee amputation is the best option for a patient who is only ever likely to be mobile in a wheelchair. Disadvantages are a tendency to slow healing of the wound, lack of an internal knee mechanism in the artificial limb, and the bulky appearance of the limb. Disarticulation through the knee has several advantages over aboveknee amputation. Describe the va amputation system of care and why it was developed identify and describe the phases of rehabilitation care in the clinical practice guideline for the rehabilitation of lower limb amputation describe evidencedbased prosthetic and amputation rehabilitation outcomes understand the importance of good working. Objectives participants will be able to identify common causes for upper and lower extremity amputation and demonstrate an understanding of the medical. A flexion contracture at the knee of greater than 15 also precludes belowknee amputation. Single leg bridge on full leg unilateral hip extension bridge bend your full leg so your foot is flat on the floor or bed. Below knee amputee exercise program stage one it is important that you take an active role in your rehabilitation. International journal of health sciences and research. Vadod clinical practice guideline for rehabilitation of lower limb amputation goals and outcomes.
The likelihood of longterm prosthetic success, if an upper extremity amputee is fitted more than three months after amputation, seems to be small. The energy required for walking is inversely proportionate to the length of the remaining limb amputation of the lower extremity is often the treatment of choice for an unreconstructable or a functionally unsatisfactory limb the higher the level of a lowerlimb amputation, the greater the energy expenditure that is required. This standard of care applies to any patient after a lower extremity le amputation, including transfemoral above knee amputation or aka, transtibial below knee amputation or bka, transmetatarsal amputation tma, and toe amputations. This creates a situation similar to many knee disarticulation patients. The clinical practice guideline is designed to achieve several specific goals. The overall goal of amputation rehabilitation is to optimize health status, function, independence, and quality of life of patients with a lower limb amputation. Walking requires 10 to 40% more energy after a belowthe knee amputation and 60 to 100% more energy after an above the knee amputation. The exercises and stretches in this handout will help to prepare you to wear a prosthesis properly. The positioning instructions and exercises in this program are designed to help you.
Manual muscle testing mmt or gross measurement of the le and ue muscles is. In a transfemoral or aboveknee amputation, the limb is severed through the thigh bone. In addition, he attended 7 sessions for exercise and alterg walking. Participants will be able to identify each phase of rehabilitation for the lower extremity amputee and list several interdisciplinary goals related to each phase. Transfemoral above knee exercise manual how to use this manual how to use this manual use one new manual for each new patient you treat. It is important that you take an active role in your rehabilitation. Vadod clinical practice guideline for rehabilitation of. A belowknee stump is more liable to decubitus ulceration and is contraindicated in the bedbound patient. The patient was seen for a total of 11 physical therapy sessions for the above described treatment, 1on1 with the physical therapist. Physiotherapy following lower limb amputation protocols and reference material 2006 prepared by the physiotherapy departments in swahs western cluster nepean hospital, blue mountains hospital, springwood hospital. An above knee or through knee amputation is the best option for a patient who is only ever likely to be mobile in a wheelchair.
Pdf this study was undertaken to predict rehabilitation potential and prognostic factors of patients undergoing above knee amputation for. After below the knee amputation, it is important to prevent the hip from staying in a bent or flexed position. Limbs can be amputated as the result of an accident, or they can be removed surgically to treat a serious problem in the limb. In general, a belowknee amputation is preferred over an aboveknee amputation aka, because belowknee amputation bka has better rehabilitation and functional outcomes 10. In a transfemoral or above knee amputation, the limb is severed through the thigh bone.
The lower leg will also be shorter than the opposite leg. Lower extremity amputation and prosthetic rehabilitation. The rates of lower extremity amputation have declined in recent years, but still, 3,500 traumarelated amputations are performed in the united states each year 11. A below knee stump is more liable to decubitus ulceration and is contraindicated in the bedbound patient. Flexion contracture at the knee of greater than 15 degrees also precludes below knee amputation.
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