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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 acute postsurgical period and the preprosthetic phase.

  5. Design an effective plan of care for the acute 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 range of motion 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 goals and expected outcomes, and develop a plan of care when presented with a clinical case study.

There are about 1.9 million people living with limb loss in the United States today with an estimated 185,000 new amputations per year.1 This number of individuals with limb loss is expected to increase and it has been projected that by 2050 the prevalence of amputation will reach 3.6 million Americans.2 The most common causes of amputation are peripheral vascular disease (about 54%), trauma (about 45%), malignancy (< 1%), and congenital limb deficiency (< 1%).3

CAUSES OF AMPUTATION

The primary cause of lower extremity (LE) amputation continues to be peripheral vascular disease (PVD), particularly with associated diabetes. The Centers for Disease Control (CDC) reports that 9.3% (29.1 million people in 2014) of the U.S. population has diabetes.4 About 60% of non-traumatic LE amputations among individuals 20 years of age or older occur in people with diabetes.4 Stated another way, an adult with diabetes is 10 times more likely to have an amputation than a nondiabetic individual.5 However, among those with diabetes some are disproportionally affected by amputation. Amputation has its highest incidence in diabetics who are 75 years of age or older, male, and black.6 It is also interesting to note that 90% of diabetics who undergo LE amputation had a preexisting foot ulcer.7 Overall, in the U.S. Medicare population, the incidence of diabetic foot ulcers is approximately 6 per 100 individuals with diabetes per year and the incidence of LE amputation is about 4 per 1,000 persons with diabetes per year.8 Despite these data, the rate of amputation as a complication of diabetes has been decreasing in the United States over the past two decades.9 Much of the credit for this reduction in amputation rates has been attributed to improved ...

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