Rehabilitation following such an amputation is a long process that requires a great deal of. However, belowknee amputations are best performed 12. Belowknee amputation same technique as the above knee amputation. All below knee bk amputations were per formed by means of a long posterior flap. Chair pushups triceps pushups sit in a chair with elbows bent.
There was insufficient viable plantar skin to allow reconstruction as a symes amputation at the ankle joint. For these reasons myodesis is not recommended for use in the belowknee amputation for vascular disease. Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to. Apr 17, 2017 this article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. Belowknee or transtibial amputation comprises 23% of lowerlimb amputations. Participants will be able to identify each phase of rehabilitation for the lower extremity amputee and list several interdisciplinary goals related to each phase. Rehabilitation after limb loss tirr memorial hermann.
This report deals with 40 patients for whom 43 belowknee amputations have been managed personally. Rehabilitation of lower limb amputation 2017 vadod. One hundred sixteen patients with bilateral amputation as a result of severe ischemia. Transtibial below knee amputation advanced prosthetics center. 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. Aboveelbow amputation same technique as the above knee amputation. Limbs can be amputated as the result of an accident, or they can be removed surgically to treat a serious problem in the limb. Stirnemann, p, mlinaric, z, oesch, a, kirchhof, b, and althaus, u. A belowknee amputation bka is a transtibial amputation that involves removing the foot, ankle joint, and distal tibia and fibula with related soft tissue structures. A manual for the rehabilitation of people with limb amputation i. Increase l knee extension flexibility to 63 degrees supine to optimize le alignment for improved fit of prosthesis. The most frequent level of amputation is the below the knee amputation. Postoperatively, 183 amputation stumps were placed in a soft dress. Surgical considerations in lower extremity amputation.
This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. Instructions about activities and exercises to help you maximize your. In general, a belowknee amputation is preferred over an aboveknee amputation aka, because belowknee amputation bka has better rehabilitation and functional outcomes 10. Feb 26, 2010 however, below knee amputations are best performed 12. Rehabilitation of lower limb amputation 2017 the guideline describes the critical decision points in the rehabilitation of lower limb amputation and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the dod and va health care systems. Below knee amputee home exercise program premier surgical. Journal of rehabilitation research and development.
Amputation causes, types of amputation and amputation. Learn the below knee amputation surgical technique with step by step instructions on orthoracle. Amputation occurs at any level between the knee and the ankle. Dec 17, 2019 a belowknee amputation bka is a transtibial amputation that involves removing the foot, ankle joint, and distal tibia and fibula with related soft tissue structures. Pdf rehabilitation of amputees represents a complex process during. Our team of prosthetists provide customized, high function prosthetic devices while our staff therapists provide the most advanced limb loss physical therapy treatments available. Exercises for strength and range of motion rehabilitation home program. Straighten your elbows to lift yourself up from the chair. If there is anything you do not understand, please ask any member of the surgical team doctors, nurses, care workers, occupational therapists, and physiotherapists. Aboveknee amputation or as posted at bedside by physiotherapist is very important. After an amputation it is important to maintain the strength of your.
Flexion contracture at the knee of greater than 15 degrees also precludes below knee amputation. Rehabilitation after amputation loss of a limb produces a permanent disability that can impact a patients selfimage, selfcare, and mobility movement. Successful prosthetic rehabilitation in the bilateral amputee appears primarily dependent on. The following exercises must be done every day to prevent any complications. Advanced prosthetics is a center of excellence for limb loss rehabilitation. The inherent benefits of removing the painful foot or partial limb are realized very soon after surgery. Amputee rehabilitation magee rehabilitation hospital. Rehabilitation for belowknee amputation healthfully. Amputation is possible in any age group, but the prevalence is highest among people aged 65 years and older. Below knee amputation most common longer is better always.
This includes a syme amputation through ankle, forefoot amputation transmetatarsal, and toe. Physiotherapy exercises following transtibial below knee amputation information for patients msk mobility and specialised rehabilitation therapy page 2 of 12 introduction this sheet has been designed to help you remember the exercises. This is a forefoot amputation of the type that typically results from the detonation of a buried antipersonnel mine. For those patients, other approaches need to be considered to allow these patients to be functionally independent. A below knee stump is more liable to decubitus ulceration and is contraindicated in the bedbound patient. Pdf rehabilitation of lower limb amputees researchgate. After below the knee amputation, it is important to prevent the hip from staying in a bent or flexed position. Chapter 4 rehabilitation of the injured combatant vol 1. Below knee amputation rehabilitation iwalkfree official youtube channel. Lowerlimb amputation is a surgical procedure performed to remove a limb that has been damaged due to trauma or disease. Long transtibial amputation occurs when more than 50% of tibial length is preserved. Physiotherapy exercises following transtibial below knee. The likelihood of longterm prosthetic success, if an upper extremity amputee is fitted more than three months after amputation, seems to be small. In most cases, the predominant experience of the amputee is one of loss.
Lower limb amputation patient education notebook wakemed. In general, a bka is preferred over an aboveknee amputation aka, as the former has better rehabilitation and functional outcomes. According to the centers for disease control and prevention, in 2009 there were 68,000 amputations due to complications from diabetes of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within 2. Regain full motion at your hip and knee decrease stiffness. While you are a patient at wakemed, you will learn many important things about caring. The advantages of a below knee level of amputation are several. 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. Below knee amputation bka statpearls ncbi bookshelf. Amputee rehabilitation lynn cunningham, pt, dpt helena lax, md mark nielsen, cp, atc. Do not cross your legs do not let your residual limb hang over the edge of the bed or couch. Physiotherapy exercises following transtibial below knee amputation information for patients msk mobility and specialised rehabilitation therapy. 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. Inpatient acute rehab for patients with preexisting le amputations. Belowknee amputation in patients with diabetes mellitus.
The positioning instructions and exercises in this program are designed to help you. A belowknee stump is more liable to decubitus ulceration and is contraindicated in the bedbound patient. Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to the transgenicular amputation. Our experience also justi fies its routine use in belowknee amputation. An aboveknee or throughknee amputation is the best option for a patient who is only ever likely to be mobile in a wheelchair. The operation of the below knee amputation is sadly not an infrequent operation in the foot and ankle surgical world. Get a printable copy pdf file of the complete article 548k, or. It is important that you take an active role in your rehabilitation. Longterm goals of upper extremity amputation rehabilitation care. Of the 78 patients unable to use a bilateral prosthesis, 68 87% were able to function independently and 10 became bedridden. Objectives participants will be able to identify common causes for upper and lower extremity amputation and demonstrate an understanding of the medical.
The advantages of a belowknee level of amputation are several. As the patients condition improves, a more extensive rehabilitation program is often. Below knee amputation surgical technique orthoracle. A belowtheknee amputation, where the lower portion of the leg is removed, may be performed because of disease or severe injury that eliminates the function of your lower leg. Smith dg, michael jw, bowker jh, american academy of orthopaedic surgeons. L knee catching sensation and often commented about fatigue andor a heaviness in his l le during ambulation.
Refer to below knee or above knee amputation manual provided by physiotherapy for residual limb care at home. Many people who opt for below knee amputation were living in tremendous pain prior to surgery. Information about pain management following amputation. 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. A flexion contracture at the knee of greater than 15 also precludes belowknee amputation. The ultimate goal of rehabilitation after limb loss is to ambulate successfully with the use of a prosthesis3 and to return to a high level of social reintegration. Rehabilitation of the patient with an amputation begins after surgery during the acute treatment phase. Full text full text is available as a scanned copy of the original print version. Apr 18, 2016 below knee amputation rehabilitation iwalkfree official youtube channel.
Below knee amputation goals patient had rom goals established at the time of his initial evaluation 8910. The activities and exercises will be supervised by your therapist. We may also ask you to keep doing your strength and rangeofmotion. This report deals with 40 patients for whom 43 below knee amputations have been managed personally. A pneumatic weightbearing temporary prosthesis for belowknee amputees. If you have a below knee or below elbow amputation, make sure you wrap your limb to allow your knee or elbow to move to avoid a contracture.
Muscletobone suture does add operative handling of tissues and en circling sutures carry the potential of local muscle constriction. Following these guidelines will help maximize your level of function. Standard transtibial amputation occurs when between 20% and 50% of tibial length is preserved. Secure bandage by wrapping around the distal thigh above the knee joint. Our elearning platform contains high resolution images and a certified cme of the below knee amputation surgical procedure. While below knee amputation surgery is a lifechanging event, the aftermath, once perceived to be negative, is actually quite positive. The following exercises must be done every day to prevent complications.
Emotional and psychological reactions to amputation. The exercises and stretches in this handout will help to prepare you to wear a prosthesis properly. Flexion contracture at the knee of greater than 15 degrees also precludes belowknee amputation. Below knee amputee exercise program stage one it is important that you take an active role in your rehabilitation. The psychological reactions vary greatly and depend on many factors and variable. How to tensor wrap below the knee amputation duration. Get a printable copy pdf file of the complete article 548k, or click on a page image below to browse page by page. Below knee amputee home exercise program it is important that you take an active role in your rehabilitation. Postop information this package contains information to help as you begin the recovery process following your amputation. 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. Prosthetic rehabilitation is a complex task that ideally requires input from a transdisciplinary rehabilitation team.
986 181 157 1470 77 1097 726 507 1135 200 10 1597 1387 1409 1170 359 1420 7 712 1321 233 1608 675 394 1538 786 614 280 572 263 1498 64 1180 710 1453 1277 1218 164 86