Prosthetic Rehabilitation Issues in the Diabetic and Dysvascular Amputee

Uustal, Heikki

doi:10.1016/j.pmr.2009.06.014

Cited by 22 publications

(13 citation statements)

References 25 publications

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“…Most clients with bilateral transfemoral amputation received 10-12 weeks or more than 12 weeks of in-patient rehabilitation, whereas outpatient rehabili tation was mostly more than 12 weeks. Our findings were similar to US data, which show that the length of pros thetic rehabilitation for clients with transtibial amputa tion is the shortest-approximately 4-6 weeks; 14 for clients with transfemoral amputation, rehabilitation is longer (6-12 weeks); and for clients with bilateral transfe moral amputation, it is usually 12 weeks or more. 14 Generally, clients with a higher level of bilateral ampu tation require longer periods of prosthetic rehabilitation because higher levels of amputation are associated with a greater degree of loss of function.…”

Section: Discussionsupporting

confidence: 89%

“…Our findings were similar to US data, which show that the length of pros thetic rehabilitation for clients with transtibial amputa tion is the shortest-approximately 4-6 weeks; 14 for clients with transfemoral amputation, rehabilitation is longer (6-12 weeks); and for clients with bilateral transfe moral amputation, it is usually 12 weeks or more. 14 Generally, clients with a higher level of bilateral ampu tation require longer periods of prosthetic rehabilitation because higher levels of amputation are associated with a greater degree of loss of function. 14 In addition, the amount of energy that clients expend in prosthetic walk ing increases significantly for higher level and bilateral amputations because of the weight of the prosthesis.…”

Section: Discussionsupporting

confidence: 89%

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Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study

Imam¹,

Miller²,

Finlayson

et al. 2019

Physiotherapy Canada

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Purpose: This study describes prosthetic rehabilitation services provided to individuals who have had a lower limb amputation in Canada. Method: This cross-sectional survey study used an online survey to collect data from facilities that provide lower limb prosthetic rehabilitation; it included questions about approaches and types of service, therapies, focus of service, and health care providers. One representative from each facility was asked to complete the survey. Results: Of the 65 identified eligible facilities, 59 completed the survey (response rate = 90.8%). The majority of facilities ( n = 39; 66.1%) indicated that they provided both in-patient and outpatient prosthetic rehabilitation services. All facilities provided balance, coordination, and gait training as well as prosthetic fit education. Most facilities indicated that they had a physical therapist ( n = 58; 93.8%), an occupational therapist ( n = 52; 88.1%), and a prosthetist ( n = 52; 88.1%) on their team. Conclusions: The majority of the facilities surveyed provided both in-patient and outpatient services and had specialized health care provider teams. Future surveys are required to collect more specific information about prosthetic rehabilitation in Canada.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study

Imam¹,

Miller²,

Finlayson

et al. 2019

Physiotherapy Canada

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show abstract

“…Even with early prosthetic fitting followed by aggressive rehabilitation, this population are often requiring near-max (80%) cardiorespiratory capacity to ambulate before additional energy costs (rates of oxygen uptake divided by maximum aerobic capacity) are incurred from biomechanical adaptation to prosthetic ambulation. 114,115 Additionally, multimorbidity demands greater resting metabolism, resulting in low energy reserves. 116 For these reasons, unsatisfactory prosthetic compliance are seen across multiple studies.…”

Section: Amputation Versus Reconstructionmentioning

confidence: 99%

Amputations versus Salvage: Reconciling the Differences

Black

Ormiston

Fan

et al. 2019

J Reconstr Microsurg

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Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

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“…For example, limb loss occurring as a result of trauma [7], diabetes [8], osteosarcoma [9], vascular diseases [10] and the effects of aging [11] is a major injury that currently affects nearly 20,00,000 people in the USA. Such conditions are often treated by intra-osseous transcutaneous implantable devices that penetrate through the depth of the skin and provide support to the natural tissue to maintain normal function [2,12].…”

Section: Introductionmentioning

confidence: 99%