Management of the multiple limb amputee

Issue : Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization. Method : A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation. Conclusion : Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.     

An amputee visitor program as an adjunct to rehabilitation of the lower limb amputee.

Based on evaluation of the rehabilitative needs of patients who have had a leg amputated because of cancer, an amputee visitor program was developed. The visitor is a cancer amputee who has successfully completed rehabilitation. About 5 days after a patient's amputation, the visitor sees the patient, telling of personal experiences, answering the patient's questions, and showing the prosthesis. The visitor later evaluates the visit on a data collection sheet. From 1 to 6 months after the visit, the patient and, if possible, a relative are interviewed to determine their long-term reaction to the program. During a 30-month period, 65 new patients were seen and evaluated by two visitors. Sixty (92%) responded favorably to the visit. In follow-up interviews with 36 patients, 33 (92%) said the visit substantially improved their outlook. In summary, our data indicate that the amputee visitor contributes significantly to rehabilitation.     

Body image and prosthesis satisfaction in the lower limb amputee

Purpose: This study examines the relationship between prosthesis satisfaction and body image in lower limb prosthesis users, and the gendered variations within these relationships.

Method: A total of 44 valid responses were obtained to an internet survey regarding prosthesis satisfaction, body image and phantom pain. Spearman Rho correlations were calculated for these three domains.

Results: Moderate to high negative correlations were observed between body image disturbance and prosthesis satisfaction. These were consistent across genders. Other relationships were also revealed, including positive correlations between prosthesis satisfaction with hours of use and negative correlations between prosthesis satisfaction and pain experience, although strong differences between genders were observed for these. The length of time for which respondents had had their prosthesis bore little relation to other variables.

Conclusion: The present research is instructive of the close relationship between body image and prosthesis satisfaction, as well as gender variations in these relationships, in lower-limb prosthesis users. These findings have implications for targeted service provision in prosthetic rehabilitation.     

Body image and prosthesis satisfaction in the lower limb amputee

Purpose: This study examines the relationship between prosthesis satisfaction and body image in lower limb prosthesis users, and the gendered variations within these relationships. Method: A total of 44 valid responses were obtained to an internet survey regarding prosthesis satisfaction, body image and phantom pain. Spearman Rho correlations were calculated for these three domains. Results: Moderate to high negative correlations were observed between body image disturbance and prosthesis satisfaction. These were consistent across genders. Other relationships were also revealed, including positive correlations between prosthesis satisfaction with hours of use and negative correlations between prosthesis satisfaction and pain experience, although strong differences between genders were observed for these. The length of time for which respondents had had their prosthesis bore little relation to other variables. Conclusion: The present research is instructive of the close relationship between body image and prosthesis satisfaction, as well as gender variations in these relationships, in lower-limb prosthesis users. These findings have implications for targeted service provision in prosthetic rehabilitation.     

Phantom limb pain: the ghost that haunts the amputee.

Phantom limb pain is a potential complication for all amputees. Current theories consider peripheral, CNS, and psychologic causes, along with other combinations of factors. Treatment modalities include pharmacologic and neurosurgical treatment, psychologic support, and family involvement. Through preoperative teaching, the nurse can help prospective amputees through the grieving process. In addition, the nurse's initial assessment can help identify predictors for phantom limb pain.     

Topiramate for phantom limb pain in an upper limb amputee: A case report

Objective: To increase the awareness of topiramate as a phantom limb pain treatment. Setting: Outpatient rehabilitation office in an urban academic center. Patient: 34-year-old white female who suffered a traumatic right upper limb amputation. Intervention: Oral topiramate at an initial dosage of 100 milligrams per day increased to 200 milligrams per day. Results and conclusion: After failure of multiple medications traditionally used to control phantom pain, the patient described significant relief with the use of oral topiramate. The authors suggest topiramate as an alternative approach to phantom limb pain treatment.     

膝上假肢使用者步态对称性分析

在对膝上假肢使用才健侧和残侧的步态进行检测的基础上、对健、则在步态周期内的地面反力、下肢 时相对称性进行了对比和分析，时相对生差异是膝上截肢者步态的主要问题，指同了产生时相不对称的原因并对则对健侧的影响进行了探讨。由于受残侧的影响，健侧的步态与正常步态相差也很大，所得结论对改进假肢性能１假肢装配和患者的训练有重要意义。     

Inter-observer reliability of clinical outcome measures in a lower limb amputee population

Purpose : In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood - Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper. Methods : An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months. Results : The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes. Conclusions : This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.     

Inter-observer reliability of clinical outcome measures in a lower limb amputee population

Purpose : In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood - Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper.

Methods : An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months.

Results : The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes.

Conclusions : This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.     

A survey of physiotherapists involved in paediatric lower limb amputee rehabilitation in the British Isles

Objectives

Children require extensive rehabilitation following lower limb amputation and there are few reports describing this rehabilitation process. A survey to assess opinions, practice and caseloads amongst physiotherapists involved with paediatric amputee rehabilitation in the British Isles was therefore undertaken.

Design

A 17-item structured telephone survey was developed to include the main aspects of physiotherapy rehabilitation of children following lower limb amputation. Physiotherapists working in paediatrics and/or amputee rehabilitation in a range of acute, outpatient and community settings were surveyed.

Results

Data were collected between November 2001 and October 2002. Physiotherapists from 70 centres were contacted, and 52 treated paediatric lower limb amputees. A variety of causes of amputation were managed. All physiotherapists commented that they saw very few paediatric patients. No centre had protocols in place for any stage of management. In all geographical areas, rehabilitation was available throughout recovery for all causes of lower limb amputation. Core elements of rehabilitation were similar; however, additional elements differed between centres.

Conclusions

This survey indicates that the small population of children with lower limb amputation has access to rehabilitation throughout their recovery. However, there is variation in the provision of physiotherapy rehabilitation services throughout the British Isles. Redesigning physiotherapy rehabilitation services for paediatric lower limb amputees, and formalisation of cross-speciality links between paediatric and amputee physiotherapists may help to address these issues and better equip these children for future function.     

对电击伤截肢后幻肢痛病人的心理因素分析及行为治疗

目的分析电击伤截肢后幻肢痛病人的心理因素及观察对其施以行为治疗的疗效。方法取42例电击伤截肢后出现幻肢痛的患者,随机分为观察组与对照组。两组病人在截肢手术后及出院前分别采用麦基尔疼痛量表和情境一特质焦虑量表进行测评。对照组常规药物止痛;观察组则在此基础上增加认知行为调整及放松训练等。结果经过3～4周的治疗,观察幻肢痛减轻或消失,两组比较差异有显著性P<0.05。结论电击伤截肢病人的焦虑程度与幻肢痛相关;行为治疗对幻肢痛的疗效明显。