Guidelines For Treatment Care And Support For Amputees-Books Pdf

Guidelines for treatment care and support for amputees
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Table of Contents,Table of Contents 2,Introduction 4. Background 5,Treatment 7, Phases of amputation rehabilitation and treatment required 7. Goals of Rehabilitation 8,Lower Limb Amputation Rehabilitation 8. Pre prosthetic intervention 9,Post prosthetic intervention 9. The Multidisciplinary Treating Team 10,Occupational Therapy Role 11.
Physiotherapy Role 12,Psychology Role 14,Prosthetist Role 15. Medical Treatment 15,Equipment 16,Upper Limb Amputees 17. Lower Limb Amputees 19,Prosthetics 20,Lower Limb Prosthesis 21. Recommendations for Prosthesis 22,Interim Prosthesis 23. Definitive Prosthesis 24,Prosthetic training 24,Lower Limb Amputees 24.
Repairs maintenance and servicing 25,Replacement 25. Specific considerations for prosthetic decision making 25. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 2 of 34. Upper Limb Amputees 26, Specialised higher end prosthesis and novel innovative and emerging technology. Attachments 26, Water limbs sporting and recreational activities 27. Working activities 27,Measuring prosthetic Outcomes 27. Upper Limb amputees 27,Lower Limb Amputees 28,Home Modifications 28.
Upper Limb amputees 28,Lower Limb Amputees 29,Attendant Care 30. Upper Limb amputees 30,Lower Limb Amputee 31,Considerations for Multiple Amputations 32. References 33,Disclaimer 34, Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 3 of 34. Introduction, The purpose of these Guidelines is to provide an evidence based approach for. provision of reasonable and necessary treatment equipment prosthetics home. modifications and attendant care for amputees accepted into the Lifetime Support. Scheme living in the community, In determining whether requests are necessary and reasonable the Lifetime Support.
Authority will consider a number of factors including the following. benefit to the participant,appropriateness of the service or request. appropriateness of the provider,cost effectiveness considerations and. relationship of the service or request to the injury sustained in the accident. Within the LSA eligible amputations injuries are defined as amputation or the. equivalent impairment of the following types, A brachial plexus avulsion or rupture equivalent to an amputation or. Single amputation of the following types, o forequarter amputation or shoulder disarticulation or. o amputation of the lower limb through or above 65 per cent of the femur. Multiple amputations there is more than one of the following amputations of. the upper and or lower limbs, o at or above 50 per cent of the tibia lower limb and or.
o at or above the first metacarpophalangeal joint of the thumb and index. finger of the same hand, Therefore where described upper limb amputees for the purpose of these guidelines. are considered to be above elbow full upper limb amputees and lower limb above. knee amputees with a short stump, These guidelines will have only broad application to other lesser levels of amputation. e g where there is more residual limb than indicated in the LSS Rules. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 4 of 34. Multiple amputations are only be briefly considered as a separate category due to the. multiple potential variations within this group which limit clear description of specific. recommendations for this group,Background, In Australia there currently exists a Model of Amputee Rehabilitation in South Australia. for SA Health Amputee Care Standards in NSW and Amputee Services and. Rehabilitation Model of Care through the Aged Care Network in WA. However these documents are specific to the health setting for which they were. developed describe state specific services and do not make detailed. recommendations about what should be considered necessary and reasonable. treatment care or support within a community setting nor do they provide extensive. consideration of the ongoing needs of amputees through their lifetime. These documents also primarily describe amputations as a result of vascular disease. or diabetes mellitus where age lifestyle and planning for the amputation may be more. prevalent issues and influences on the experience of the amputee as compared to. those experiencing a traumatic amputation as a result of a motor vehicle accident. Therefore the Guidelines for treatment care and support for amputees within the. LSS living in the community are proposed to fill this gap in the literature and to guide. the provision of treatment equipment prosthetics home modifications and attendant. care for upper limb lower limb and multiple limb amputees. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 5 of 34. The World Health Organisation s ICF Framework amputee elements shows the. impact of amputation primarily upon a person s activity participation1. 1 Adapted from Statewide Rehabilitation Clinical Network 2011. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 6 of 34. Rehabilitation of individuals post amputation is critical to maximise their physical. psychological and social wellbeing thereby optimising their independence function and. life roles Statewide Rehabilitation Clinical Network 2012 Rehabilitation and therapy. interventions encourage people to look to the future and to develop their full potential. as well as playing a vital role in motivation for participation in daily activities and. providing hope for the future Roberts 2008, The improvement of an individual post amputation is impacted by age physical and. mental health nutritional status tissue perfusion complications post amputation e g. poor wound healing or infection the individual s motivation level of amputation. presence of other medical conditions smoking habits suitability for prosthesis and the. availability of rehabilitation programs Statewide Rehabilitation Clinical Network 2012. While inpatient rehabilitation is often emphasised for lower limb amputees due to a. focus on mobility goals and prevention of falls inpatient rehabilitation is often not. provided for upper limb amputees as they can readily learn one handed techniques to. manage essential personal care tasks and thus can be discharged home often within 1. 2 weeks post injury depending on their wound healing and recovery However. rehabilitation remains an essential facet for treatment of individuals with upper limb. amputation to ensure they can maximise independence and optimal functioning of all. personal and domestic activities of daily living instrumental activities of daily living. transportation and achieve return to productive work roles where possible. It is estimated that recovery post amputation occurs over a 12 to 18 month post. operative period including activity recovery reintegration and prosthetic management. and training Berke 2004, Phases of amputation rehabilitation and treatment required.
The pathways and phases for amputees are described variously in the literature. however for the purpose of these Guidelines the following is indicative of the stages. 1 Pre Operative stage where a decision is made to amputate and of the level of. amputation including residual limb It is anticipated that in traumatic motor. vehicle accidents this phase may be very short due to the immediate urgency of. emergency surgery post accident, Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 7 of 34. 2 Acute hospital phase including surgery operative and post operative medical. care until medically stable This would include wound care management. 3 Rehabilitation phase including pre prosthetic and interim prosthetic phases. Rehabilitation aims to improve functional status with or without prosthesis and. to successfully reintegrate in to home and community. 4 Advanced rehabilitation in community setting including accessing definitive. prosthetic services and prosthetic training and rehabilitation. 5 Ongoing lifelong management where ongoing prosthetic review services and. rehabilitation may be required depending on changes throughout the. participant s lifespan, Statewide Rehabilitation Clinical Network 2012 Berke 2004 Agency for Clinical. Innovation 2008,Goals of Rehabilitation, Whole person goals of care for patients undergoing amputation have been described. as follows, Musculoskeletal reconditioning and cardiopulmonary training. Contralateral limb preservation, Emotional care related to concepts of loss mourning and the need for peer support.
and education,Minimisation of systemic complications. Social reintegration, Setting realistic patient expectations and functional outcome goals. Berke 2004, It is noted that healing of a residual limb is a continuous process and thus a limb does. not have a clear and decisive point of being healed Berke 2004. Lower Limb Amputation Rehabilitation, Wong and Bourke 2007 have described that limited access to community based. rehabilitation following lower limb amputation can result in increased length of stay in. inpatient rehabilitation as patients may remain in inpatient facilities until all. rehabilitation goals were met even if they were safe to go home earlier in a wheelchair. Thus access to community based rehabilitation and treatment organised to commence. in a timely manner post discharge is considered essential Community based treatment. and rehabilitation not only allows for early discharge but also enables the participant. the opportunity to develop and practice mobility skills in a functional and real context. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 8 of 34. such as their home and community sooner Wong Bourke 2007 which may. increase their rehabilitation outcomes, It should be noted that patients may be discharged for wound healing with intended.
rehabilitation in the future e g inpatient day rehabilitation or outpatient rehabilitation. and therefore suitable exercises including strengthening and endurance exercises. should be implemented during this time Statewide Rehabilitation Clinical Network. Access to structured centre based or community based rehabilitation including review. and reassessment as self progressive rehabilitation takes place needs to be available. for the remainder of the amputee s life Statewide Rehabilitation Clinical Network. Functional training to maximise independence in everyday activities needs to be. addressed in both a wheelchair and with a prosthesis Statewide Rehabilitation Clinical. Network 2012 Competent wheelchair skills are essential as even for those patients. prescribed a prosthesis there are likely to be times when it is not possible to use a. prosthesis including poor fitting and injury to residual limb Statewide Rehabilitation. Clinical Network 2012,Pre prosthetic intervention, Treatment and intervention may be required pre provision of prosthesis such as. Identifying the needs requirements for the prosthesis to achieve functional goals. Strategies aids and equipment to manage daily activities irrespective of prosthetic. Strategies intervention and support to manage phantom limb pain and. Support in relation to body image adjustment to body schema and preparation for. how this may alter or change positively or negatively with provision of prosthesis. or medical intervention,Post prosthetic intervention. Training to ensure maximal functional outcomes with the prosthesis Prosthetic. training both with prosthetist and with a suitably experienced health professional is an. essential element of provision of a prosthesis in order to ensure maximal use in daily. activities including donning and doffing the prosthesis. Lifetime Support Scheme Guidelines for treatment care and support for. amputees within the LSS living in the community Page 9 of 34. Identification of tasks that can be performed with the prosthesis and. Identification of tasks that cannot safely be performed with the prosthesis and. alternative methods strategies aids or devices to complete these tasks. The Multidisciplinary Treating Team, Multidisciplinary rehabilitation is recommended for people with amputations and should. Compression wrapping techniques to decrease oedema Berke 2004. Collaborative goal setting, Liaision with medical and nursing services as required. Ongoing management for prevention of contractures,Controlling residual limb volume changes.
Pain management, Residual limb activity including desensitisation muscle contractions and endurance. Berke 2004,Independence with activities of daily living. Musculoskeletal reconditioning Berke 2004, Driving and transport including for lower limb amputees potential left foot. accelerator use if the right leg is amputated potentially hand clutch if left foot. amputated and drives manual vehicle or potentially restrictions to driving automatic. only if the left foot has been amputated It should be noted that prosthesis with. appropriate flexed knee joints can indicate potential to driv. those experiencing a traumatic amputation as a result of a motor vehicle accident Therefore the Guidelines for treatment care and support for amputees within the LSS living in the community are proposed to fill this gap in the literature and to guide the provision of treatment equipment prosthetics home modifications and attendant

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