Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Beverly Johnson

Keywords

Amputees -- education; Amputees -- rehabilitation; Prostheses and Implants; Case Reports

Abstract

Background and Purpose: Promotion of functional mobility through surgical and therapeutic interventions has seen a dramatic increase within the past decade due to the aging population and increased push for objective functional assessment data. A key to obtaining optimal functional performance is core stability and this can be applied to individuals with a variety of limitations including an amputation. The purposes of this case study are to look at the preprosthetic rehabilitation regimen of an individual with an above-knee amputation and discuss the importance of key elements that should be present in a pre-prosthetic training program to allow a patient optimal use with a prosthetic limb.

Case Description: The case study relates to the pre-prosthetic rehabilitation of a 53 year old morbidly obese male who underwent an above-knee amputation (AKA). The patient had a history of a motorcycle accident in 2007 that resulted in multiple surgeries, including TKA, confining him to primarily wheelchair mobility. The patient continued to have chronic pain and ultimately had an AKA in 2014.

Intervention: Pre-prosthetic rehabilitation included physical therapy interventions such as patient education, residual limb shaping and desensitization, and therapeutic exercises focusing on gait training, residual limb strengthening and restoration of optimal lower extremity range of motion.

Outcomes: The rehabilitation of the residual limb was successful in regards to favorable shaping and desensitization. Limitations remained for full knee extension by 25°. The patient's inability to complete self-care activities of daily living necessitated discharge to assisted living approximately twenty weeks post-amputation. Successful ambulation for distances of 170 feet with prosthetic limb and a standard walker was achieved at time of discharge.

Discussion: Key elements of a successful pre-prosthetic rehabilitation program were absent from this patient's care including a diagnosis specific functional assessment such as the Amputee Mobility Predictor (AMP), and a core stabilization regimen. The incorporation of these components in the patient's rehabilitation may have aided the patient in reaching functional mobility with a lower extremity prosthetic limb. The patient had superb compliance in wearing an elastic shrinker sock and completing mirror therapy assisting in favorable residual limb rehabilitation and reduction of phantom limb pain.

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