Rehabilitation presentations
- Community living
- Inpatient, outpatient, and community rehabilitation options
- Postoperative care
- Pre-operative assessment
Conditions
- Congenital limb deficiency versus acquired
- Upper limb versus lower limb amputation
Acquired amputation
- Traumatic versus non-traumatic
- Non-traumatic:
- diabetes mellitus
- infections:
- necrotising fasciitis
- severe sepsis
- peripheral vascular disease
- tumours:
- Ewing sarcoma
- osteosarcoma
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
Examples could include (please note this is not an exhaustive list)
- Amputations – traumatic digit and digit ischemia
- Burns
- Malignancy and tumours
- Multiple amputations
- Pain
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Biomechanics of normal gait
- Causes of amputation
- Epidemiology, aetiology, incidence and prevalence, mortality and morbidity of acquired major limb loss in Australia and Aotearoa New Zealand
- Haptics
- Osseointegration
- Sensory feedback
- Targeted muscle reinnervation (TMR):
- TMR at time of amputation (or as a revision) and integrated with multiple site sensors for myoelectric componentry
- Types of amputation
- Types of prosthetic designs
- VR training
Investigations
- Amputee mobility predictor with prosthesis (AMPRO) and amputee mobility predictor without prosthesis (AMPnoPRO)
- Angiography
- Ankle brachial index
- Arterial doppler ultrasound
- Functional classification (K level)
- MRI
- Ultrasound to assess for neuroma
- X-rays
Examples could include (please note this is not an exhaustive list):
Community services and reintegration
- Aids/Modifications in home environment
- Artificial limb funding schemes and services
- Community organisations
- Discharge planning
- Family and social reintegration
- Transport and driving
- Work and sports activities, including vocational retraining
Complications of amputation
- Common problems and faults in prosthetic ambulation
- Distortion of body image
- Heterotopic ossification
- Increased risk of falls
- Neuroma formation
- Skin infections and breakdowns
- Stump pain, phantom pain, and phantom sensation
- Swelling
Components and characteristics of prostheses for specific functions
- Showering
- Sport and recreation
- Swimming
- Work
Goals of prosthetic training
- Cosmetic
- Functional
- Recreational
- Social
- Vocational
Postoperative patient management
- Care of the surgical wound
- Control stump oedema – bandaging and rigid dressings
- Coping with loss, altered body image, and change in life roles
- Early resumption of assisted ambulation and self-care activity
- Level of amputation and healing of wound
- Maintenance of strength and ROM of residual limb
- Management of wound infection
- Pharmacological and non-pharmacological pain management
- Potential for prosthetic training
- Prevention of limb contractures and weakness
- Promotion of wound healing
- Psychological support
- Treatment of associated injuries
- Use of desensitisation techniques
Potential for prosthetic training
- Amputee mobility predictor with prosthesis (AMPRO) and amputee
- mobility predictor without prosthesis (AMPnoPRO)
- Functional classification (K level)
- General physical and psychological health
- Level of amputation
- Previous prosthetic use
- Surgical wound, limb contractures, and general condition of stump and residual limb
Pre-prosthetic patient management
- Age-related or other impairments of cardiopulmonary function, cognitive state, sensory deficits and neuromusculoskeletal function that might impact on prosthetic management
- Assess psychological adjustment to upcoming surgery
- Carers, social set up, home care environment assessment
- Condition of affected and unaffected limbs, and limb dominance
- Education and counselling regarding the phases of amputee rehabilitation
- Premorbid domestic, leisure, psychosocial, and vocational function
- Premorbid ambulation and mobility
- Range of motion, strength, and function of affected and unaffected limbs
Prosthetic management
- Adaptation or replacement of prosthesis with maturation of stump
- Application of prosthesis and liners
- Early fitting and training with an interim prosthesis
- Monitoring of wound and residual limb
- Prescription of appropriate prosthetic components
- Prosthetic alignment and adjustment
- Repairs and changes to the prosthesis as required over time
- Techniques of casting and fabrication of prosthetic socket
- Timing of definitive prosthesis
Prosthetic training
- Activity limitations and participation limitations
- Application of prosthesis and suspension
- Care and maintenance of prosthesis
- Haptics
- Muscle strength and conditioning exercise
- New techniques to improve prothesis control, including targeted muscle reinnervation (TMR) and myoelectrics
- Patient expectations of prosthetic use
- Self-care and domestic activities
- Special needs of the bilateral amputee
- Training in prosthesis operation
- Virtual reality training
Sports amputation
- Implications for the athlete
- Unique prosthetic needs and mobility goals
