This document discusses the phases of care and rehabilitation for individuals who have undergone amputation. It outlines the conventional approach, which includes 9 phases from pre-operative planning through long-term follow up. Key points covered include the goals of post-operative management to promote healing and shaping of the residual limb, the benefits of and potential losses from delays in post-op care, and different dressing strategies used during the acute postoperative and recovery phases based on factors like the amputation level and patient's condition.

1. Amputee care & rehabilitation
1. Post-operative and pre-prosthetic care, chapter 20; Orthotics
and Prosthetics in Rehabilitation, Lusardi, 4th edition
2. Lower Extremity amputation: Post amputation and residual
limb care, chapter 3; Prosthetic Restoration and Rehabiliation
of Upper and lower Extremity; Alicia J. Davis et. al.

2. Objectives of the session
• To understand different stages of amputee
care & rehabilitation as well as residual limb
dressing techniques

3. Content of the session
• Various phases of care and rehabilitation of
person with amputation (Conventional
approach)
• Post-Operative management goals
• Benefits of Post-operative stump care
• Losses due to delay in Post-op stump care
• Selection criteria for dressing strategy
• Dressing types

4. Phases of
amputee care
and
rehabilitation
for person
with
amputation
(Conventional
approach)

5. Phases of amputee care and
rehabilitation for person with
amputation

6. 1. Preoperative:
– Planning/stump surgical level decision,
– ROM and strengthening overall
– Patient education regarding amputation,
rehabilitation stages
– Training to use appropriate AD
– Expected goal discussion and counselling

7. 2. Amputation surgery and wound dressing:
– Amputation site
– Actual residual limb length determination,
– Soft-tissue coverage,
– Myoplasty/myodesis closure,
– Nerve handlining,
– Wound closure,
– Wound dressing,

8. 3. Acute postsurgical phase :
– Wound care and monitor
– Pain and edema control
– Shaping & shrinking of residual stump
– Residual limb positioning/preventing contracture
– Restoring patient sense of control by early
mobilization thereby preventing DVT/Pneumonia
or any deconditioning
– Increasing muscle strength of noninvolved
side/joint

9. Phases of rehabilitation for person
with amputation contd..
4. Pre-prosthetic/recovery phase:
– Wound healing and residual limb shaping
– Proximal body motion,
– Training to use AD for ADL,
– Emotional support,
– Phantom sensation therapy
– Prosthetic rehabilitation plan

10. Post-Operative management goals
1. To maintain full ROM of the hip and knee
2. To enhance functional strength of the
remaining musculature
3. To facilitate rapid healing of the suture line
4. To enhance static and dynamic balance
5. To maintain or improve cardiovascular and
pulmonary conditioning

11. 5. Prosthetic preparation and fabrication:
– Diagnostic socket/ diagnostic prosthesis
– Definitive prosthesis

12. 6. Prosthetic training:
– Weight bearing tolerance
– Static and dynamic balance
– Training to use in ADL/Specific ADL
– Prosthetic refinement
– Follow up care

13. Phases of rehabilitation for person
with amputation contd..
7.Community re-integration: family and
community role, regaining emotional
equilibrium, developing new coping strategy,
recreational activities
8. Vocational training: job modification
discussion, education and skill development
9. Follow-up : lifelong prosthetic, functional and
medical status assessment and care, emotional
support

14. Post-operative stump care
Phase 2 & 3

15. Benefits of Post-operative stump care
• Protect the incision from infection or direct trauma
• It contains post-operative drainage so that suture line
can remain healthy so that enhance wound healing
• Controls post-operative edema and pain
• Facilitate prosthetic fitment by shaping and
desensitization the residual limb volume
• Provides attachment of the prosthetic devices to
permit early walking in some cases (young
amputation)
• Decreases over-all time in hospital or on bed

16. Losses due to delay in Post-op care
• Contracture
• Musculo-skeletal deconditioning
• Cardio-vascular deconditioning
• Delay in prosthetic fitment
• Dependency
• Re-amputation risk
• Mortality

17. Selection criteria for stump-dressing
strategy
• Etiology (cause of amputation)
• Level of amputation
• Condition of skin
• Medical and functional status of the patient
• Access to prosthetics care
• Preferences and experience of rehabilitation
team/surgeon
• Established institutional protocol

18. Dressing types
1. Soft dressing with or without (ace-wrap)
compression
2. Semi-rigid dressings
3. Rigid: IPOP/EPOP are examples of rigid
dressing, attached to pylon and foot
4. RRD: removable rigid dressing (applied over
soft dressings)

19. Thank you
To be continued..