MotionIntentionAnalysis-BasedCoordinatedControlfor Amputee ...
Parkwood, St. Joseph’s Health Care, Amputee Rehabilitation...
Transcript of Parkwood, St. Joseph’s Health Care, Amputee Rehabilitation...
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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