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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Recognize, discuss, and respond appropriately to the anxieties, frustrations, and coping mechanisms used by individuals who need an external device for function.

  2. Compare and contrast the psychosocial and cultural responses to changes in body image among clients of all ages.

  3. Differentiate between phantom sensation and phantom pain, and discuss the effects of the phantom on prosthetic adjustment and function in clients of different ages.

  4. Discuss the major approaches to the treatment of disabling phantom pain.

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CASE STUDIES

Janice Simmons, a 65-year-old woman, had a left transtibial amputation yesterday secondary to diabetic gangrene and a nonhealing ulcer on the plantar surface of the right foot.

Linda Bean is a 12-year-old female who underwent a transfemoral amputation yesterday secondary to grade IIB osteogenic sarcoma of the proximal right tibia; the tumor was not appropriate for tumor resection and reconstruction.

Tyrone O'Neal, a 17-year-old high school football player, sustained a T8 fracture in an auto accident when he was thrown from the car. The accident occurred 3 months ago, and he received immediate decompression and spine stabilization surgery at a trauma center. Despite prompt treatment, he has a complete spinal cord injury (ASIA level A) with neural motor and sensory levels of T12 bilaterally.

Janice Dione, a 12-year-old child, was just diagnosed with Adolescent Idiopathic Scoliosis. She has a double thoracolumbar curve. The thoracic curve, which is the primary curve, is a right 30° curve with the apex at T9; the secondary lumbar curve is a left 26° curve at L3. She is premenarche, and her iliac apophyses are rated as Risser 1. Janice is very athletic and participates in many very active sports, including soccer and gymnastics.

Case Study Activities
  1. Compare and contrast the possible emotional responses of the patients presented above. What similarities and differences would you expect and why?

  2. What would you expect the major psychosocial and economic concerns to be for each of the clients?

  3. Which of the above patients are likely to experience phantom sensation or pain? Why? How may that affect their rehabilitation?

  4. In laboratory or group sessions, role-play the initial and ongoing contact between the therapist/assistant and the client.

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GENERAL CONCEPTS

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Our perception of our body is an integral part of how we see ourselves, our self-concept, our ego, how we perceive our place in the world, and how we think others see us. A change in body image may affect our self-concept, our psychological reactions, and our ability to adjust to the change; it will be influenced by our cultural and social heritage and current environment. Body image and our reactions to disability are complex structures that have been well explored in numerous texts and papers in the psychosocial literature. The role of the therapist and assistant is to recognize the effects of changes in body image ...

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