what are the 2 conditions that account for majority of vascular related amputations? diabetes and PVD
individuals with diabetes have x greater lifetime risk of LE amputation compared to
30
those w/o diabetes.
leading causes of LE amputation dysvascular disease/ diabetes/ > 60 yo/ trauma/ malignancy/ infection
-above knee amputation
AKA -transfemoral
-represents 26.1% of unilateral LE amputations performed for dysvascular disease
-below knee amputation
BKA -transtibial
-represents 28.2% of unilateral LE amputations performed for dysvascular disease
the more of the LE preserved = the better post-procedure outcomes (always advocate for BKA rather than AKA)
in physical therapy, post amputations, in bed mobility we can work on rolling R/L, prone positioning, scooting, bridging
-supine to/from sit
-sit to/from stand
in physical therapy, post amputations, in transfers we can work on
-SPT to/from WC
-slide board transfers
-proper use
in physical therapy, post amputations, in WC education we can work on -instruction
-proper chair type (putting driving wheels more posterior to adapt to shifts in COM)
-COM changes within BOS
in physical therapy, post amputations, in balance training we can work on
-relearning or adjusting to new COM in sitting and standing
-increasing strength of unattected LE
in physical therapy, post amputations, in strengthening/ROM/ endurance activities we can -increasing ROM
work on -Education
-HEP for maintenance
-instability NWB
in physical therapy, post amputations, in gait training we can work on
-progress with prosthesis
-edema management
-wound healing
in physical therapy, post amputations, in other things we can work on
-energy conservation
-pain control
-ROM: full hip extension and knee extension
strength and ROM requirements post-amputation
-strength: hip extension and ABD/ knee extension and flexion
-place pillow under hip or knee or elevate the lower end of bed when in bed
-lie in bed with knees bent or crossed
patients with a lower limb amputee SHOULD NOT (for prolonged periods of time) -place pillow under back when laying supine
-allow hips to ER/IR while supine
-rest the residual limb over the EOB
-risk of hip flexion contracture
AKA contracture prevention -prone positioning stretch
-30 mins, 2-3x/day
-risk of knee flexion contracture
BKA contracture prevention -promote full knee extension in supine
-use of splint boards in sitting
1/3
individuals with diabetes have x greater lifetime risk of LE amputation compared to
30
those w/o diabetes.
leading causes of LE amputation dysvascular disease/ diabetes/ > 60 yo/ trauma/ malignancy/ infection
-above knee amputation
AKA -transfemoral
-represents 26.1% of unilateral LE amputations performed for dysvascular disease
-below knee amputation
BKA -transtibial
-represents 28.2% of unilateral LE amputations performed for dysvascular disease
the more of the LE preserved = the better post-procedure outcomes (always advocate for BKA rather than AKA)
in physical therapy, post amputations, in bed mobility we can work on rolling R/L, prone positioning, scooting, bridging
-supine to/from sit
-sit to/from stand
in physical therapy, post amputations, in transfers we can work on
-SPT to/from WC
-slide board transfers
-proper use
in physical therapy, post amputations, in WC education we can work on -instruction
-proper chair type (putting driving wheels more posterior to adapt to shifts in COM)
-COM changes within BOS
in physical therapy, post amputations, in balance training we can work on
-relearning or adjusting to new COM in sitting and standing
-increasing strength of unattected LE
in physical therapy, post amputations, in strengthening/ROM/ endurance activities we can -increasing ROM
work on -Education
-HEP for maintenance
-instability NWB
in physical therapy, post amputations, in gait training we can work on
-progress with prosthesis
-edema management
-wound healing
in physical therapy, post amputations, in other things we can work on
-energy conservation
-pain control
-ROM: full hip extension and knee extension
strength and ROM requirements post-amputation
-strength: hip extension and ABD/ knee extension and flexion
-place pillow under hip or knee or elevate the lower end of bed when in bed
-lie in bed with knees bent or crossed
patients with a lower limb amputee SHOULD NOT (for prolonged periods of time) -place pillow under back when laying supine
-allow hips to ER/IR while supine
-rest the residual limb over the EOB
-risk of hip flexion contracture
AKA contracture prevention -prone positioning stretch
-30 mins, 2-3x/day
-risk of knee flexion contracture
BKA contracture prevention -promote full knee extension in supine
-use of splint boards in sitting
1/3
