Amputee

• Write three goals for vascular amputee rehabilitation from a physiotherapist’s

  perspective:

  • improve independence and quality of life
  • manage phantom limb pain/sensation
  • improve gait/balance in different terrains
• Which level of amputation typically requires the least energy for ambulation?

  • transtibial
  • Preserves the knee joint – The knee plays a crucial role in stability, balance, and efficient walking. Retaining it allows for a more natural gait pattern.
  • Less muscle loss – Compared to higher level amputations, BKA retains more of the quadriceps and hamstrings, reducing the strain on the rest of the body.
  • Lower energy cost – Studies show that transtibial amputees use about 25 - 40% more energy than non-amputees, while transfemoral (above knee) amputees use 60 - 100% more energy
• Write the main reasons why vascular amputees often have reduced healing

  capacity? Support your answer by describing the pathophysiology of reduced wound healing

  • poor blood supply - ischemia and hypoxia
  • atherosclerosis means decrease in blood flow to tissues -> decrease in oxygen and nutrients to tissues -> impairs angiogenesis (new blood vessel formation) + impairs fibroblast function
  • chronic inflammation + impaired immune response
  • in PAD theres a high level of proinflammatory cytokines such as TNF, resistin, interleukin 6 -> disrupts normal healing cascade
  • poor circulation also limits the delivery of white blood cells -> decrease in bodys ability to fight infection
  • increased risk of infection
  • ischaemic tissues have low oxygen tension -> impairs neutrophil function
  • hyperglycemia in diabetes weakens immune responses
  • neuropathy
  • diabetes related neuropathy reduced pain sensation -> unnoticed ulcers
  • poor collagen synthesis
• Match the phase with the appropriate intervention:

  • Acute post-operative phase:
  • wound healing
  • pain management
  • acceptance
  • Pre-prosthetic phase:
  • residual limb shaping
  • strength
  • cardiovascular conditioning
  • Prosthetic training phase:
  • balance
  • functional gait and mobility
• List 5 factors which you would expect to see on a post-op vascular amputee

  problem list:

  • phantom limb pain
  • phantom sensation
  • residual pain
  • muscle atrophy
  • reduced balance
  • impaired wound healing and risk of infection
  • emotional adjustments
• Design a one-day rehabilitation plan for a vascular amputee in the post-op phase:

  • wound inspection
  • pain management
  • psychosocial support
  • bed mobility + transfers
  • residual limb care
  • breathing + cardiovascular conditioning
  • balance + core strength
  • education
• Design a one-day rehabilitation plan for a vascular amputee in the pre-prosthetic phase. What exercises would you perform? What early mobility aids would you use? How would you ensure patient safety?

  • residual limb management and shaping
  • pain management
  • strength and flexibility
  • mob aids w parallel bars then WC and wheelchair
  • balance
  • functional tasks
  • education
• What is the most effective position to prevent hip flexion contractures in a transfemoral amputee?

  • prone lying
  • Keeps the hip extended, preventing it from staying in a flexed position.
  • Stretches the hip flexors, which tend to tighten due to prolonged sitting.
  • Helps maintain proper alignment for future prosthetic use
• Case Study: A 60-year-old vascular amputee with a right transtibial prosthesis exhibits circumduction during walking. Using the provided case study, identify two gait deviations and suggest corrective strategies

  • Gait Deviation 1: Circumduction
  • Inadequate knee flexion → Encourage knee flexion exercises and hip strengthening to improve clearance.
  • Weak hip flexors → Strengthen hip flexors with seated knee raises, resistance band hip flexion drills.
  • knee instability → Train weight shifting and balance with parallel bars or walker support
  • Gait Deviation 2: Reduced Stance Phase Stability on Prosthetic Side
  • Weak residual limb or core → Strengthen glutes, quadriceps, and core through seated and standing exercises.
  • fear of falling → Perform standing balance drills, weight shifts, and parallel bar training to improve confidence.
  • Pain or discomfort in the residual limb → Assess for pressure points or skin issues and adjust prosthetic fit
• List three exercises to improve balance in prosthetic gait training:

  • Weight Shifting (Side-to-Side & Forward-Backward)
  • Single-Leg Stance on Prosthetic Side
  • Step-Tap Balance Drill