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Amputation and role of an occupational therapist in amputee
- 1. Amputation SUBMITTED BY: AMBREEN SADAF BSOT02153003 SUBMITTED TO:MISS WAJEEHA ABDUL AHAD 18/03/19
- 2. Introduction Classification Indications Types Complications Prevention Management References Objectives
- 3.
- 4. DEFINITION: Amputation is the removal of a limb by trauma, medical illness, or surgery. When it is through a joint then it is known as disarticulation It is not a failure of surgery but a reconstructive procedure Goal is surgical reconstruction that maintains most functional limb possible Introduction
- 5.
- 6. 350,000-1 mil amputees 20,000-30,000 new amputees a year > age 50-50 years More in Lower limbs More in males Epidemiology
- 7. Hand & Partial-Hand Amputations Finger, thumb or portion of the hand below the wrist Wrist Disarticulation Limb is amputated at the level of the wrist Trans-radial (below elbow amputations) Amputation occurring in the forearm, from the elbow to the wrist Amputation levels ( upper limbs )
- 8. Trans-humeral (above elbow amputations) Amputation occurring in the upper arm from the elbow to the shoulder Shoulder Disarticulation Amputation at the level of the shoulder, with the shoulder blade remaining. Forequarter Amputation Amputation at the level of the shoulder in which both the shoulder blade and collar bone are removed Continued..
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- 10. Foot Amputations Amputation of greater toes and other toes Amputation through the metatarsal bones Lisfranc`s operation : at the level of the tarsometatarsal joints Chopart`s operation : through the metatarsal joints Transtibial Amputations (below the knee) Amputation occurs at any level from the knee to the ankle Amputation levels ( lower limbs )
- 11. knee Disarticulation Amputation occurs at the level of the knee joint Trans-femoral Amputations (above knee ) Amputation occurs at any level from the hip to knee joint Hip Disarticulation Amputation is at the hip joint with the entire thigh and lower portion of the leg being removed. Continued..
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- 13. To get rid of all necrotic, infected & painful tissue. To have a wound that heals successfully. To have an appropriate remnant stump that is able to accommodate a prosthetic. Goals of amputation
- 14. Ascertain indication Site of amputation General medical condition Rehabilitation potential Counselling Consent Optimization Pre-Operative Assessment To
- 15. Assessment of The affected limb The unaffected limb The patient as a whole is conducted thoroughly. Assessment of physical, social & psychological status of the patient should be made Pre Operative Assessment
- 16. CLASSIFICATION: Amputation is classified into two categories: Open amputation Guillotine Modified guillotine Closed amputation Revised Planned Classification
- 17. INDICATIONS: Dead limbs Severe trauma Peripheral vascular disease Burns Frostbite Indications
- 18. Dangerous limb Crush injury Malignancy Lethal sepsis Damned nuisance Gross deformity Recurrent sepsis Loss of function Continued
- 19. Upper Limb Amputations Partial hand amputation Metacarpal Amputation Wrist disarticulation Below elbow amputation Elbow disarticulation Above elbow amputation Shoulder disarticulation and forequarter amputation Types
- 20. Lower Limb Amputations Partial foot amputation Ankle disarticulation Below knee amputations Through the knee amputations Above knee amputation Hip disarticulation Hemipelvectomy Continued..
- 21. Amputations in children is divided into two general categories—congenital (60%) and acquired (40%) Amputations In Children Amputations In Children Congenital Congenital deficiencies of the long bones Amniotic band syndrome Exposure to teratogens ( thalidomide ) AMPUTATIONS IN CHILDREN
- 22. Polydactyly Macrodactyly Congenital pseudo arthrosis of the tibia and fibula, radius and ulna Acquired Secondary to trauma Neoplasm Infection. Vascular disease Continued..
- 23. Early Bleeding and haematoma Flap necrosis Surgical wound infection Gas gangrene Late Phantom pain Phantom limb Joint deformity Complications
- 24. Maintain circulation through movement of other good limbs. Deep breathing, coughing and postural drainage to prevent chest complications. Pressure mobility of all the joints. Prevention
- 25. Exercise Compression socks Mobilization Rigid removable dressings Providing suitable positioning Providing skin care Management
- 26. Prosthetics It is a replacement of substitution of a missing or a diseased part Types of Prosthesis BELOW KNEE KNEE DISARTICULATION ABOVE KNEE HIP DISARTICULATION PROSTHETICS LOWER EXTREMITY Prosthetics
- 27. Ideal prosthesis 1. Fits comfortably 2. Function well 3. Looks presentable 4. Fit as soon after the operation Benefits
- 28. Goal is to achieve useful residual limb in an individual who is active with a positive attitude an continues to be a productive member of society Goal of prosthetics
- 29. Occupational therapy is a critical rehabilitation component, providing support to individuals and facilitating optimum performance of daily life activities as well as quality of life. A therapeutic team that includes the skills of an occupational therapy practitioner will provide the client with the most successful rehabilitation and prosthetic training. OT benefits in amputee
- 30. Upper-limb amputation not only affects a person’s physical functioning, but also psychological and emotional well-being. Occupational therapy practitioners recognize the complexity of this condition and use a holistic approach that emphasizes the client’s perspective the roles and activities they meaningful, and personal experiences and value in developing intervention plans and goals. Continued..
- 31. Identifying the client’s functional goals, which can include self-care, home management, work tasks, driving, child care, and leisure activities, and offering modifications to complete these goals if required Analyzing tasks and providing modifications to achieve functional goals Providing education on compensatory techniques and equipment to accomplish tasks and activities Providing prosthetic training Identifying and addressing psychosocial issues Adaptive equipment and assistive devices are provided. OT management
- 32. Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89, 422– 429. http://dx.doi.org/10.1016/j.apmr.2007.11.005 Developed by Kristin L. Gulick, OTR/L, CHT, for the American Occupational Therapy Association. Updated and copyright © 2016 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@aota.org. Current Diagnosis & Treatment in Orthopedics 3rd edition: by Harry Skinner (Editor) Publisher: Appleton & Lange (June 20, 2003) • Campbel Operative Orthopedics, 11th Edition CAMPBELL 13 TH EDITION [ CHAPTER 14- GENERAL PRINCIPLES OF AMPUTATION ] References
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Editor's Notes
- Upper Limb Amputations Upper limb amputations vary from the partial removal of a finger to the loss of the entire arm and part of the shoulder. The following list provides a summary of the typical forms of upper limb amputation: • Partial hand amputation - amputations can include fingertips and parts of the fingers. The thumb is the most common single digit loss. The loss of a thumb inhibits the ability to grasp, manipulate or pick up objects grasping ability. When other fingers are amputated, the hand can still grasp but with less precision. • Metacarpal Amputation – this involves the removal of the entire hand with the wrist still intact • Wrist disarticulation – this form of amputation involves the removal of the hand and the wrist joint • Below elbow amputation (transradial) – the partial removal of the forearm below the elbow joint • Elbow disarticulation – the amputation of the forearm at the elbow. • Above elbow amputation (transhumeral) - the removal of the arm above the elbow • Shoulder disarticulation and forequarter amputation is the removal of the entire arm including the shoulder blade and collar bone.
- Lower Limb Amputations Lower limb amputations vary from the partial removal of a toe to the loss of the entire leg and part of the pelvis. The following list provides a summary of the typical forms of lower limb amputation: • Partial foot amputation – this commonly involves the removal of one or more toes. This amputation will affect walking and balance. • Ankle disarticulation – an amputation of the foot at the ankle, leaving a person still able to move around without the need for a prosthesis • Below knee amputations (transtibial) – an amputation of the leg below the knee that retains the use of the knee joint. • Through the knee amputations – the removal of the lower leg and knee joint. The remaining stump is still able to bear weight as the whole femur is retained • Above knee amputation (transfemoral) - an amputation of the leg above the knee joint • Hip disarticulation – the removal of the entire limb up to and including the femur. A variation leaves the upper femur and hip joint for better shape/profile when sitting • Hemipelvectomy (transpelvic) – the removal of the entire limb and the partial removal of the pelvis