Occupational Therapy For Lower Limb Amputation Rehabilitation Lauren
Occupational Therapy For Lower Limb Amputation Rehabilitation Lauren Hawkins, OTS & Jennifer Tom, OTS Touro University Nevada
Purpose • Outline the role occupational therapy in lower extremity amputation care • Provide evidence-based occupational therapy practice • Discuss protocol for mirror therapy to reduce phantom limb pain
Causes • Dysvascular • Trauma • Cancer-related • Congenital (Center for Orthotic & Prosthetic Care, N. D. )
Statistics • More than 500 Americans lose a limb daily • An estimated 1. 9 million people living with limb loss in the United states • Annually, the immediate health care costs of limb amputations-not including costs for prosthetic devices or rehabilitation costs, total more than $8. 3 billion (CDC, 2015)
Evidenced-Based Research • College of Occupational Therapists Specialist Section – Trauma and Orthopaedics is a subsidiary of the British Association of Occupational Therapists • 29 critically appraised papers • Articles are assigned • An evidence score V-I (Low-high) • A quality score 0 -10 (Low-high) (College of Occupational Therapists, 2011)
Areas of OT Interventions • Functional rehabilitation • Environment • Psychology • Prosthetic use • Assessment tools and outcome measures • Cognition • Work • Leisure and recreation (College of Occupational Therapists, 2011)
Functional Rehabilitation (College of Occupational Therapists, 2011)
Environment (College of Occupational Therapists, 2011)
Psychology (College of Occupational Therapists, 2011)
Prosthetic Use (College of Occupational Therapists, 2011)
Assessment Tools and Outcome Measures (College of Occupational Therapists, 2011)
Assessment Tools Cont. (College of Occupational Therapists, 2011)
Cognition (College of Occupational Therapists, 2011)
Work (College of Occupational Therapists, 2011)
Leisure and Recreation (College of Occupational Therapists, 2011)
Areas of OT Intervention Con’t • Prevention of contractures at hip and knee • Edema reduction • Fall prevention • Trunk stability • Assist with other deficits/comorbidities
Care of the Remaining Limb • Skin inspection to avoid skin breakdown and infections • Do not cut on corns or calluses • Have a podiatrist cut your nails • Avoid walking barefoot • Do not wear socks that have holes, change socks daily • Break in new shoes slowly • Wear only well-fitting shoes
Foot Care for People with Diabetes • Foot care • Check feet daily • Wash feet daily • Keep skin soft and smooth • Smooth corns and calluses • Trim toenails regularly • Wear shoes and socks • Keep blood flowing to the feet (National Institute of Health, 2014) Steri Shoe. (2014). Retrieved from http: //www. sterishoe. com/foot-care-blog/diabetes/smarttools-improve-diabetic-foot-outcomes/
Care for the Residual Limb • Wash residual limb regularly • Inspect residual limb daily and can be completed using a long-handled mirror • Skin desensitization • Do not shave residual limb • Do not soak residual for prolonged time to prevent swelling (Hall, 2009)
Prosthesis and Socks • Prosthesis and socks should be cleaned and dried • Wear new socks daily • Inspect residual limb with a mirror for signs of irritation/infection • Don sock prior to prosthesis to protect skin from sores and injury with seams facing out • Ensure socks fit without folds or wrinkle as this can irritate the skin (Hall, 2009)
Management of Phantom Pain • Phantom limb pain: Painful sensation that is perceived in a body part that no longer exists • Exercise limb to increase circulation • Distraction, change position • Soak in warm bath or shower massage on residual limb • Massage gently to increase circulation • Keep a diary of pain to help identity recurring causes • Relaxation techniques (Hall, 2009)
Mirror Therapy for Phantom Limb • >90% experience phantom limb • Experimental groups: Mirror group, covered mirror, visual imagery • Sample size: 18/22 completed the study • Results: After 4 weeks of therapy, findings indicated mirror therapy reduced phantom limb pain in patients with lower limb amputation (Chan, B. , Witt, R. , Charrow, A. , Howard, R. , Pasquina, P. , Heilman, K. , &Tsao, J, 2007)
Protocol for Mirror Therapy • • Condition of limb: normal and pain-free ROM No visual impairments Normal cognition level Remove all jewelry and cover tattoos or scars Sitting tolerance WFL Complete daily for at least 10 mins Some patients are unable to tolerate the image of having two intact limbs • May sweat, become dizzy or emotional • Have patient focus on another point in the room, the intact (Rothgangel, Braun, Witte, Beurskens, & Smeets, 2015) limb or stop the session all together
Protocol for Mirror Therapy • Sit without prosthesis with mirror in between legs at patient’s midline in a comfortable and supported position • Start with simple motor or sensory exercises • Increase difficulty as sessions continue • Aim for high repetitions (at least 15) • Try to include patient’s hobbies or interests in sessions • Prepare patient at end of session to view the amputated limb (Rothgangel et al. , 2015)
Examples of Interventions (Rothgangel et al. , 2015)
April is Limb Loss Awareness Month • CDC supports and provides funding for Amputee Coalition National Limb Loss Resource Center (http: //www. amputeecoalition. org/limb-loss-resource-center/) • In 2013, the Amputee Coalition launched Show Your Me tal with the goal of showing that amputees are resilient by encouraging amputees to display their strength of character by showing their metal, such as prosthetic devices or wheelchairs (CDC, 2015)
References CDC (Apr. 20, 2015). Limb loss awareness. Retrieved from http: //www. cdc. gov/ncbddd/disabilityandhealth/features/limb-loss-awareness. html Center for Orthotic & Prosthetic Care. (N. D. ). Amputation statistics. Retrieved from http: //www. centeropcare. com/Portals/COPC/Amputation%20 Statistics. pd Chan, B. , Witt, R. , Charrow, A. , Howard, R. , Pasquina, P. , Heilman, K. , &Tsao, J. ( 2007). Mirror therapy for phantom llimb pain. The New England Journal of Medicine, 357, 2206 -2207. doi: 10. 1056/NEJMc 071927 College of Occupational Therapists. (2011). Occupational therapy with people who have had lower limb amputations. Retrieved from https: //www. cot. co. uk/publication/z-listing/occupational-thera people-who-have-had-lower-limb-amputations-evidence-bas-0
References cont. Hall, C. (2009). Occupational therapy toolkit. Timonium. MD. National Institute of Health. (2014). Diabetic Foot. Retrieved from https: //www. nlm. nih. gov/medlineplus/diabeticfoot. html NCBDE. (n. d. ). Eligibility requirements. Retrieved from http: //www. ncbde. org/certification_info/eligibility-requirements Rothgangel, S. A. , Braun, S. M. , Witte, L. D. , Beurskens, A. J. , & Smeets, R. J. (2015). Practical protocol mirror therapy phantom limb pain. Retrieved from https: //www. researchgate. net/publication/275038036_Practical_protocol_mirror_thera py_phantom_limb_pain
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