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Case Report - 2800: Tracking Functional Development
II. Case Presentation
III. Discussion
All Pages

August 2, 2010

I. Introduction

In the United States, approximately 133,000 amputation-related hospital discharges occur each year, with 31% occurring at the transfemoral level.1 Assessing and improving mobility are among the primary concerns for new amputees.  In a study of 25 transtibial and transfemoral amputees, Deans et al. found that there was a significant relationship between amputees’ functional ability and their physical, psychological and social well-being.2 This finding shows that an assessment of the patient’s functional development throughout the recovery process is instrumental to his or her reintegration into the community.  However, very little has been studied about the use of the prosthesis after discharge and if the attained function is maintained thereafter. 

Technological advances within the field of prosthetics such as energy storing feet, microprocessor controlled knees, ankle rotators and shock absorbers have attempted to mitigate negative functional effects associated with prosthesis use.  However, van der Linde et al.’s literature review highlighted a lack of unbiased information about the direct effects of these different components on patient functional ability.  Only two significant comparative studies each were found on the effect on gait of prosthetic feet and on prosthetic knees.3 The vast majority of clinical studies have used standardized gait assessment protocols with limited ecological validity, making them inappropriate to use in making a prosthetic prescription.3 In conclusion, the authors suggest that research is needed to illustrate the long-term functional impact of both prosthetic training of lower limb amputees and the use of advanced prosthetic components.

Each phase of amputee rehabilitation has distinct challenges, goals and outcomes (Table 1).  The aim of this case report is to show the functional development of one patient from prosthetic training stage to follow-up, quantitatively and qualitatively assessing her functional status at intervals.

Table 1. Phases of amputee rehabilitation 11

Phase

Hallmark

Preoperative

Assess body condition, patient education, surgical level discussion, postoperative prosthetic plans.

Amputation Surgery & Reconstruction

Length, myoplastic closure, soft tissue coverage, nerve handling, rigid dressing.

Acute Post Surgical

Wound healing, pain control, proximal body motion, emotional support.

Pre-prosthetic

Shaping, shrinking, increase muscle strength, restore patient locus of control.

Prosthetic Prescription

Team consensus on prosthetic prescription and fabrication.

Prosthetic Training

Increased prosthesis wear and functional utilization.

Community Integration

Resumption of roles in family and community activities. Emotional equilibrium and healthy coping strategies. Recreational activities.

Vocational Rehabilitation

Assess and plan vocational activities for future. May need further training or job modification.

Follow-up

Lifelong prosthetic, functional, medical assessment and emotional support.



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