Lauren Hawkins OTS amp Jennifer T om OTS Touro University Nevada Purpose Outline the role occupational therapy in lower extremity amputation care Provide evidencebased occupational therapy practice ID: 525570
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Slide1
Occupational Therapy For Lower Limb Amputation Rehabilitation
Lauren Hawkins, OTS & Jennifer
T
om, OTS
Touro University NevadaSlide2
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 painSlide3
Causes
Dysvascular
Trauma
Cancer-related
Congenital
(
Center for Orthotic & Prosthetic Care
,
N.D.
) Slide4
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)Slide5
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)Slide6
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)Slide7
Functional Rehabilitation
(College of Occupational Therapists, 2011)Slide8
Environment
(College of Occupational Therapists, 2011)Slide9
Psychology
(College of Occupational Therapists, 2011)Slide10
Prosthetic Use
(College of Occupational Therapists, 2011)Slide11
Assessment
T
ools and
O
utcome
Measures(College of Occupational Therapists, 2011)Slide12
Assessment
T
ools
C
ont.
(College of Occupational Therapists, 2011)Slide13
Cognition
(College of Occupational Therapists, 2011)Slide14
Work
(College of Occupational Therapists, 2011)Slide15
Leisure and
R
ecreation
(College of Occupational Therapists, 2011)Slide16
Areas of OT Intervention Con’t
Prevention of contractures at hip and knee
Edema reduction
Fall prevention
Trunk stability
Assist with other deficits/comorbidities Slide17
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
(Hall, 2009) Slide18
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/smart-tools-improve-diabetic-foot-outcomes/Slide19
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)Slide20
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)Slide21
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)Slide22
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)Slide23
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 limb or stop the session all together
(Rothgangel, Braun, Witte, Beurskens, & Smeets, 2015)Slide24
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)
Slide25
Examples of Interventions
(Rothgangel et al., 2015)Slide26
April is Limb Loss Awareness
Month
CDC supports and provides funding for Amputee Coalition National Limb Loss Resource Center (
http://www.amputee-coalition.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)Slide27
References
CDC (Apr. 20, 2015).
Limb loss awareness.
Retrieved from
http://www.cdc.gov/ncbddd/disabilityandhealth/features/limb-loss-awareness.htmlCenter for Orthotic & Prosthetic Care. (N.D.).
Amputation statistics.
Retrieved from http://www.centeropcare.com/Portals/COPC/Amputation%20Statistics.pdf
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/NEJMc071927
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-therapy-people-who-have-had-lower-limb-amputations-evidence-bas-0Slide28
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).
P
ractical protocol mirror therapy phantom limb pain.
Retrieved from https://www.researchgate.net/publication/275038036_Practical_protocol_mirror_therapy_phantom_limb_pain