Module Group 3

Treatment is by analgesic,antidepressants, reassurance and sometimes TENS

Transcutaneous electrical nerve stimulation

Goal: controls oedema, reduces pain, limits inflammation and allows early mobilisationSoft dressingElstoplast dressingRigid dressingElasticated shrinker socksIntermittent compression system

Gauze and soft crepe. Tends to lead to an oedematous stump that is easily traumatised by both staff and patient and thus inhibits healing

Popular for trans-femoral stumps. Controls some of the oedema and because of ist adhesive nature, restricts wound access by staff and patient to the stump, which allows epithelialisation to take place uninterrupted.

Controlls oedema extremely well, is comfortable, inhibits interference by staff and patients and can allow early mobilisation. Requires a high level of skill for application, careful monitoring and it is more useful for the lower limb than the upper limb since suspension of the plaster is difficult in the upper limb.

Used on top of dressings from one week post-amputation as long as the wound is healing satisfacrorily. They restrict the amount of oedema, allowing early mobilisation and prosthetic fitting.

In conjunction with dressing helps in faster reduction in stump volume and is useful in certain circumstances.

To control oedema, reduce pain, limit inflammation and allow early mobilisation

Soft dressingElastoplast dressing: trans-femoralRigid dressing: ankle disarticulation, trans-tibial, knee disarticulationElastic socks

The nurses provide the overall care of the amputee, particularly in relation to pressure areas, stump care and psychological help

Rehabilitation medical specialistNursing staffPhysiotherapistOccupational therapistProsthetistSocial workerchiropodistGeneral practitioner and Community serviceOutside groups

The physiscian who usually co-ordinates the rehabilitation programme and provides the medical care of the amputee

Provide overall care, wound dressing and stump bandaging, general hygiene, dentition, nutrition, chiropody and general nursing care

Provides assessment for early mobilisation of the patient, the use of early walking aids and restoration of the patients physical well-being.

Provides domiciliary enviromental assessment evaluation of aids to daily living skills and liaises with the community services to ensure the patient is able to function as independetly as possible at home.

The spacialist responsible for the manufacturing, fitting and maintenance of the prosthesis. They work closely with the therapists during the walking training phase of the rehabilitation programme.

Liaises with the hospital and community services and provides advise on financial and domestic problems.

Provides care for the remaining foot.

Provides care for both medical and social needs after discharge home.

Includes self help groups who may be able to provide the support needed once the patient is discharged.

Weekly MDT meetings are held with all members of the team present to discuss goals, prosthesis prescriptions and the rehabilitation programme. Discharge planning is also an important topic for discussion.

Rehabilitaion medical specialist; nursing staff; physiotherapist; occupational therapist; prosthetist; social worker; chiropodist; family practitioner and outside support groups

A case conference is an event during which the team and preferably the patient and relatives will discuss the overall care of the amputee with frank discussion resulting in goal setting for the patient.

The physiotherapist is closely and actively involved in all stages of the rehabilitation programme.A high level of communication is important.

The trans-tibial amputee (TTA) will have a tendency to flex the knee, although this is not such a problem if the patient hase been placed, after the operation, in a plaster of paris cast (rigid dressing) the maintains the knee in extension. Once the plaster of paris dressing has been removed, the patient is taught to extend the knee joint and contract the thigh muscles. A plaster of paris back-slab can be used to maintain the knee in extension after the plaster of paris rigid dressing has been removed. The trans-femoral amputee (TFA) will tend to flex abductt the hip joint, and is instructed to extend the hip and bring it to the neutral position. The TFA is encouraged to lie prone daily for a minimum of twenty minutes.

Aetiology and history of the amputation, co-morbidites, social history, patient's expectations, patient's psychological state, prescribed medication, functional abilites 6 months prior o amputation

Muscle strenth, joint range, phantom limb pain, balance, condition of contralateral limb and foot, including any use of orthotic devices, transfer ability, residual limb condition.

Felxion and abduction of the hip joint

From around one week after amputation, the patient is mobilised with the use of an early walkong aid. The device used for the trans-tibial amputee is the Pneumatic Post Amputation Mibility Aid. The equipment consists of a small cushion which fits over the lower end of the stump and a long bag which fits over the leg. This is encased by a metal frame with a rocker foot and a suspension strap is fixed to the frame to support the distal end of the outer bag. The outer bag is inflated to amaximum pressure of 40mmHg and is worn for a maximum of 1.5 h, twice per day. For the Trans-femoral amputee the LIC Femurett is the most commen one. Composed of an open ended socket, an adjustable tubular thig section, a single articulated knee joint extension spring, an adjustable shin section and a foot. It is suspended by tightening velcro fasteners round the socket and by the use of a shoulder strap.

For the Trans-femoral amputee the LIC Femurett is the most commen one. Composed of an open ended socket, an adjustable tubular thig section, a single articulated knee joint extension spring, an adjustable shin section and a foot. It is suspended by tightening velcro fasteners round the socket and by the use of a shoulder strap. Training my be either with the knee locked or free to swing.

The device used for the trans-tibial amputee is the Pneumatic Post Amputation Mibility Aid. The equipment consists of a small cushion which fits over the lower end of the stump and a long bag which fits over the leg. This is encased by a metal frame with a rocker foot and a suspension strap is fixed to the frame to support the distal end of the outer bag. The outer bag is inflated to amaximum pressure of 40mmHg and is worn for a maximum of 1.5 h, twice per day.

it provides a means of assessing the patient's potential to use a prosthesis it improves exercise tolerance it improves balance reactions it strengthens muscles used in walking it promotes wound healing as it aids circulation it assists in the reduction of residual limb oedema which can lead to earlier casting for a prosthesis it boosts the patient's psychological well-being

PPAM Aid and the LIC Femurret