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INTRODUCTION

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LEARNING OBJECTIVES

  1. Discuss the role of the physical therapist in the care of any individual following lower extremity amputation.

  2. Describe the major etiological factors leading to lower extremity amputation.

  3. Explain the major concepts involved in lower extremity amputation surgery.

  4. Develop an evaluation plan for any individual following lower extremity amputation.

    1. Prioritize data gathering for the immediate postsurgical period and the preprosthetic phase.

  5. Design an effective plan of care for the immediate postsurgical period.

    1. Explain the rationale for and teach patient and caregiver proper positioning.

    2. Teach sitting and standing balance to enhance transfers and mobility.

    3. Ensure continuity of care following discharge from acute care.

  6. Design an effective plan of care for the preprosthetic period.

    1. Teach proper residual limb care including bandaging as indicated.

    2. Teach standing balance to help the patient attain the highest functional level of mobility with appropriate ancillary support.

    3. Teach residual limb strengthening exercises to facilitate eventual prosthetic fitting.

    4. Teach ROM exercises to prevent/alleviate secondary contractures.

  7. Respond appropriately to patient/family from an awareness of the psychological impact of lower extremity amputation.

  8. Analyze and interpret patient data, formulate realistic anticipated goals and expected outcomes, and develop a plan of care when presented with a clinical case study.

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The major cause of lower extremity (LE) amputation today continues to be peripheral vascular disease (PVD), particularly with associated diabetes. Two-thirds of all LE amputations in the United States today are due to complications of diabetes.1 Approximately 16 per 1,000 individuals with diabetes over age 75 will undergo an LE amputation as compared with 1.78 of similar individuals who do not have diabetes. Major improvements in noninvasive diagnosis, revascularization, and wound healing techniques have increased the age at which individuals with diabetes may come to amputation. Perioperative mortality has been variously reported between 7% and 13% and is usually associated with other medical problems such as cardiac disease and strokes.2,3,4 There are approximately 20.8 million children and adults with diabetes and about 5% of the population is affected with some form of vascular disease.5 Many of the patients we treat in all types of settings have diabetes although we are usually treating them for some other problem. Physical therapists can help by learning more about diabetes and diabetic foot care and by making patient education an integral part of the plan of care (POC). Several studies have indicated a positive relationship between early patient education and proper foot care and a reduction in amputations.6,7

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The second leading cause of amputation is trauma, usually from motor vehicle accidents, war, or gunshots. Individuals with traumatic amputations are often young adults, more frequently men, and have often been involved in an active lifestyle before amputation. The incidence of amputation from osteogenic sarcoma has been reduced owing to improved imaging techniques, more effective chemotherapy, and better limb salvage procedures. Amputation may be necessary if the tumor is large and cannot be resected without ...

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