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Parkwood, St. Joseph’s Health Care,

Amputee RehabilitationProgram

Kyle Goettl RN, BScN

Nurse Clinician Amputee Rehab

Objectives 1st Half

Understand the implications of disease resulting in amputation

Understand why patient education is so critical

Review the impact a prosthesis can have on the skin of the residual limb

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Objectives 2nd Half

Review some popular styles of prostheses

Observe tensor wrapping

Touch on wound care principles and products that are commonly used

Amputee “snapshot”aka The Typical Amputee

Diabetes (Glucagon), Renal Disease

Hypertension

Stroke, Arthritis

Dementia, Previous amputation

PVD, CHF, MI

Lack of knowledge

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The Facts About Amputation

• Very few people in society suffer a lower limb amputation 3- 5%

Statistics

Approximately 80 % of lower limb amputations occur to people who live with diabetes

50% will have a second amputation within 2-5yrs. of the first.(Reiber, G. 1995.)

Major contributing cause:

Poor sugar control, inappropriate foot care

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15% of people with diabetes will suffer a foot wound in their lifetime

85 % of amputations are preceded by foot ulcers(Reiber,G., 1995.)

The Good News

The American diabetes association estimates that 50% of amputations among people living with diabetes can be prevented by learning proper foot care and dealing with foot problems early.

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Amputee Admission Sources

0

10

20

30

40

50

60

70

80

90

Acute Home LTC Other

Home Location

London 27%

Outside London 73%

From a total of 109 patients in 2001

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Shaping of the residual limb (stump)

A few days after surgery3-4 hours on, remove x 20 minutes

and rewrapFigure 8 distal to proximalVideo on tensor wrapping is always

available

Extra Effort Required to walk

Unilateral Below Knee

10-40%

Unilateral Above Knee

60-100%

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How does the prosthesis fit?

Below Knee Amputation in a Prosthesis

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Prosthetic environment

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Above Knee

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Symes

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Fit Adjustment

Stump socks

Body weight

Prosthetic “tinkering”Prevention

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Prevention

PVD, Diabetes & The Other Foot

10g monofilament LOPS testing

Ankle brachial index

University of Texas diabetic foot classification

“Best practise” wound care

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Diabetic Neuropathy

Are your feet ever numb?

Do they ever tingle?

Do they ever burn?

Do they ever feel like insects are crawling on them?

Neuropathy after amputation

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Patient Education

Don & doffing of prosthesis

Wear schedule

All things Diabetes and risk for 2nd amp.

Skin and foot care

Knowledge of medications

U of T Diabetic Foot Classification

Stage Grade 0 Grade 1 Grade 2 Grade 3

A Pre-or post ulcerative, risk of further ulcers

Superficial ulcer not involving tendon, capsule,

bone

Ulcer down to tendon or joint capsule

Ulcer penetrates to

bone

B Infection present

Infection present

Infection present

Infection present

C Ischemia present

Ischemia present

Ischemia present

Ischemia present

D Infection & ischemia

Infection & ischemia

Infection & ischemia

Infection & ischemia

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Neuropathy has an effect on our daily lives

S A M

Sensory

Water temperature/ Pain

Pressure

Shoes - inside seams

- too tight a fit

- heels

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Autonomic

Dry and cracked skin (type of soap)

Calluses, corns

Toe nails (fungal infections)

Soap Comparison

Intn’l Journal of Dermatology 2002, 41Baranda et al

Brand name PH Irritation

Dove baby 7.0 1.133

Zest neutral 9.85 4.215

Camay soft 10.26 5.426

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Motor

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People with diabetes areVIP

Vascularity

Infection

Pressure

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Vascularity

Blood flow

Posterior tibial, Dorsal Pedis

80mm Hg pressure?

Posterior Tibial Pulse

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Dorsal Pedis

Ankle Brachial Pressure Index

> 0.8 to 1.1 normal

> 0.5 to 0.8 disease present

< 0.5 healability in question will not heal with moist or aggressive treatments

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Useful Web Sites

sjhc.london.on.ca

LEAP – bphc.hrsa.gov/leap

oandp.com/resources/patientinfo/manuals/index.htm

Cawc.net