|
Very few life events can match the challenges and changes in lifestyle as
those that face an amputee. Currently there are almost 350,000 amputees living
in the United States. Each year, another 135,000 receive an amputation. More
than 9 out of every 10 of these amputations involve the lower extremities.
The situations that lead to the need for amputation are many. For those occurring in
the lower extremities, the most common cause is disease. Disease accounts for nearly
three-quarters of all cases. Traumas account for another fifth of lower
extremity amputations, while birth defects and tumors each contribute low,
single-digit percentages. For the upper extremities, trauma and birth defects
are the most common causes.
While many amputations cannot be prevented, those that are the result of a
disease, particularly diabetes, can many times be avoided by taking the correct
precautions.
It is estimated that at least half of all amputations performed every year
are a result of complications with diabetes. People with diabetes have poor
circulation and are more susceptible to nerve damage, particularly in the feet,
than those who do not have the disease. These two factors make foot care
essential. If you are diabetic, some steps to take to help prevent
damage to your feet include:
- Stop smoking
- Eat healthy
- Monitor blood glucose levels
- Control your weight
- Check your feet every day for small cuts or
blisters
- Participate in doctor-prescribed exercise
- Report any loss of sensation in your
lower limbs to your doctor
Treatment and management
Once a limb has been amputated, physical
therapy begins. The timeline for physical therapy will depend on how well
the patient is recovering from surgery and the degree of amputation.
To prevent swelling and bleeding at the incision site, complete bed rest may
be required for the first one to three days following your surgery. For
patients with below the knee amputations, the bed rest period may be longer.
While in bed, frequently change your position to prevent pressure
sores or joint stiffness that may affect your ability to move later. Your nurses
can help you change your position. Your stump (residual limb) may be elevated on
a pillow for the first 24 to 48 hours to decrease swelling, but should not be
elevated afterward unless specifically ordered by your physician. When your leg is
elevated, your knee should not be bent.
Your stump should be kept in a straight and level position and should not be
rotated inward or outward while in bed or in a chair. It should be kept in close
alignment with the body by using towel or blanket rolls for positioning. If you
have a below the knee amputation, a padded board can be used to keep your stump
straight while sitting in a chair. You should avoid crossing your legs if you
have a long stump because this may interfere with your circulation.
Starting the second or third day after your surgery, the nurses will
encourage you to lie on your stomach (prone) flat in bed for short periods of
time. You should not have pillows under your stomach or your stump when you are
prone. You should try to lay in this position for 20 minutes twice each day to
help you maintain the normal hip motion needed for walking. In addition, this
position allows relief of pressure to your back and hips and helps prevent
pressure sores. You should continue to lay for periods of time on your stomach at home
until you are walking more than sitting.
Your surgeon will determine your
activity level following the amputation. Some patients may be allowed to sit up
in a chair as soon as the first day after surgery; others may not be allowed to
do so for several days. You will be taught how to use the chair arm rests to lift your body up from the seat
and how to move your stump to limit pressure points, promote
circulation, and prevent serious joint stiffness. You will perform the body
lifting and stump extending exercises every hour and several times an hour,
respectively, when in the sitting position.
Your physical therapist will begin developing an exercise program for you
after your therapy evaluation. Exercises will include upper body strengthening
along with stump mobility exercises. It is extremely important for you to
continue your exercise program when you go home from the hospital.
You will also be taught proper care for your stump, such as cleansing and
preventing infection.
As technology advances, so do the advances in prosthetics. Prosthetics are
more comfortable, stronger, lighter and more durable than ever before. Most
prosthetics are now adjustable, allowing knee or ankle joints to be adjusted for
activity, weight, and comfort level.
Prosthetic arms can be powered by a harness or cable attached from the stump to
control switches, which are then powered by flexing particular muscle groups.
For all prosthetics, the advent of microcomputers and tiny circuit boards has
given patients with prosthetic devices a greater range of motion and has allowed
more precise actions to be performed. They also help compliment a person’s
expended energy. A person with a prosthetic must use two to three times more energy
than a non-disabled person when performing basic tasks, such as climbing stairs
or walking from room to room.
Like many other conditions, education about one’s amputation and local
support groups can be the greatest tools for managing the injury and preventing
further complications. The following organizations can provide additional
information about amputations:
Amputee Coalition of America
900 East Hill Avenue, Suite 285
Knoxville, TN 37915-2568
(888) 267-5669
www.amputee-coalition.org
National Rehabilitation Information Center
4200 Forbes Blvd., Suite 202
Lanham, MD 20706
(800) 346-2742
www.naric.com
|
