Introduction
This week we are exploring the acute care phase of the individual following amputation surgery. Many of these topics will be relevant for the entire pre-prosthetic period.
Objectives for this week
At the end of this week you should be able to:
- Assess an individual undergoing amputation and have an understanding of the management of their physical, psychological and social needs.
- Identify and appropriately manage complications of amputation.
- Identify common challenges associated with amputees post operatively and their management
- Recognise and understand pain related conditions.
Topic 1: Assessment
The surgical removal of a limb(s) due to complications associated with disease or trauma is considered as an “acquired amputation”[1].
To appropriately assess individuals undergoing acquired amputation you must have an understanding of the management of their physical, psychological and social needs. This is done by performing an assessment which includes asking questions about past medical history, medication, present medical history and social history as well as performing a physical/objective assessment.
- For an overview of the the assessment of an individual undergoing amputation read Topic 2: Pre-operative physiotherapy
In an ideal situation all individuals facing amputation surgery would have a full interdisciplinary assessment pre-operatively. In reality this is not always possible for a number of reasons, including the urgency of the surgery, patient level of consciousness, or even poor planning and communication. In this situation it is important to include this aspect of your patient management into the post-operative assessment.
A pre-operative consultation enables the physiotherapist to give appropriate advice, information and reassurance. Early assessment and planning can commence at this stage when possible and helps to prepare the patient for rehabilitation, prevent secondary complications and maximise the patient’s physical outcome.
- In the Topic 3: Acute post-operative physiotherapy
Goals of the acute post operative phase are to prevent complications, manage the wound and stump, restore mobility and independence, manage pain and commence discharge planning. This topic will give you knowledge and strategies to work towards these goals.
- For an overview of Topic 4: Post-operative complications
Post surgical complications can create a challenge to successful rehabilitation. This topic will give you an understanding of the complications that can be associated with amputation surgery and provide therapeutic answers to these complications.
- This Physiopedia page Topic 5: Pain management
Post-amputation pain is experienced by most individuals who have undergone amputation surgery. This topic will explore the different types of pain that amputees experience and also the strategies used to deal with the pain.
- Read this short overview on Phantom limb pain read this page in Physiopedia (be sure to click through the link to read more about mirror therapy)
- Optional – In this video from Peter Le Feuvre we discuss important aspects of pain management in the individual with amputation:
Key to preventing secondary pain after limb loss is preventing complications. As Peter mentions in the video, along side early prosthetic fitting and management of musculoskeletal imbalances, patient education is key to managing pain. Below are a variety of patient education leaflets from the Quiz
You are not assessed on this quiz, it is designed for you to test your knowledge on the topics this week.
Case Study
Watch this video:
Discussion
Go to the Optional: Explore other resources
The following resources are optional for you to read/view but will further expand your knowledge on this week’s topics:
If you can get hold of these articles you may find them useful:
- Jensen TS, Krebs B, Nielson J, et.al: Phantom Limb, Phantom Pain, and Stump Pain in Amputees During the First Months Following Limb Amputation. Pain 1983, 17:243- 256.
- Jensen TS, Krebs B, Nielson J, Rasmussen P: Immediate and Long Term Phantom Pain in Amputees: Incidence – Clinical Characteristics in Relationship to Pre-amputation Pain. Pain 1985, 21:256-78.
- Nikolajsen L, Jensen TS. Phantom Limb Pain. British Journal of Anaesthesia 2001, 87:107-116, 2001.
Kalauokalani DAK, Loeser JD: Phantom Limb Pain. In: Crombie IK: Epidemiology of Pain. IASP Press: Seattle. pp.143-53, 1999. - Nikolajsen L, Hansen CL, Nielsen J, et. al: The Effect of Ketamine on Phantom Limb Pain: a Central Neuropathic Disorder Maintained by Peripheral Input. Pain 1996, 67:69- 77.
- Ramachandran VS, Rogers-Ramachandran D: Synaesthesia in Phantom Limbs included with Mirrors. Biological Sciences 1996, 263:377-86.
- Dworkin RH, Backonja M, Rowbotham MC, et.al: Advances in Neuropathic Pain: Diagnosis, Mechanisms, and Treatment Recommendations. Arch Neurol 2003, 60: 1524-34.
- Flor H: Phantom Limb Pain: Characteristics, Causes, and Treatment. Lancet Neurology 2002, 1:182-189.
- Sherman RA: Postamputation Pain. In: Jensen TS, Wilson PR, Rice ASC (eds.): Clinical Pain Management: Chronic Pain. Arnold Press: London. pp. 239-49, 2003.
Prosthetic Gait Analysis for Physiotherapists
This is the course textbook from ICRC which will be available to all participants of the course.
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- This Physiopedia page Topic 5: Pain management
- For an overview of Topic 4: Post-operative complications
- In the Topic 3: Acute post-operative physiotherapy
