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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. Implement an intervention program designed to meet the special needs of individuals with amputations at the foot, ankle, knee, or hip disarticulation levels or with bilateral lower extremity amputations.

  2. Describe the major prosthetic components and their function for the levels of amputation included in this chapter.

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Physical Therapy students are expected to:

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  1. Determine the diagnosis for patients with levels of amputation included in this chapter.

  2. Select, implement, and interpret the results of all appropriate tests and measures.

  3. Design an appropriate plan of care including selecting interventions for all patients included in this chapter.

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CASE STUDIES

Zach Fells, a 39-year-old high school math teacher, was in a severe motorcycle accident 2 weeks ago and had to have his right leg amputated through the knee. Mr. Fells is an active weekend athlete who is married with four children. He rides his motor bike to and from school daily. He has insurance through the county school system.

Penny Griger, a 42-year-old drugstore clerk, was recently diagnosed with a sarcoma of the upper thigh and had a left hip disarticulation amputation a week ago. She is a single mother of two small children and lives with her mother who takes care of the children while Penny is at work.

Case Study Activities

All Students

  1. Functionally compare and contrast the transtibial, knee disarticulation, transfemoral, and hip disarticulation levels of amputation.

Physical Therapy Students

  1. Develop a physical therapy diagnosis for each of these patients.

  2. Design a preprosthetic examination and intervention program for each assuming you are seeing each at the time stated above. Assume additional information you might want to develop the intervention program.

Physical Therapist Assistant Students

  1. What part of the preprosthetic intervention program would you be comfortable doing?

  2. What information would you want from the physical therapist to treat each of these patients at this time?

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Although the transtibial and transfemoral are the most common levels of amputation, an individual may sustain an amputation through any structure of the lower extremity. Figure 4.1 in Chapter 4 outlines the different levels of amputation. Many of the patients presented in this chapter can be treated through the postsurgical and gait training program outlined in previous chapters. Prosthetically, they may require slightly different or modified components that will be presented here. This chapter focuses on the special needs of individuals amputated at other than transtibial and transfemoral levels as well as the needs of individuals who have bilateral amputations.

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AMPUTATIONS THROUGH THE FOOT

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Surgical Considerations

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The majority of partial foot or transmetatarsal amputations are performed because of infection usually related to dysvascularity and diabetes. Many individuals will lose one or more toes, a total ray, or the front part of the foot over a period of time before sustaining a transtibial or ...

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