Coelho, A

Martinho, C

Patinha, D

Pereira, I

Soares, MJ

Repositório do Hospital Prof. Doutor Fernando Fonseca

REAMPUTATION – A NEW OPPORTUNITY A CASE STUDY APPROACH Authors:, Coelho, A.*, Pereira, I**. Martinho, C.*, Patinha, D. ***, Soares M. J.* *Physiotherapist, **Rehabilitation Physician, ***Occupational Therapist AMPUTEES UNIT, Rehabilitation Department of Hospital Fernando Fonseca, Amadora, Portugal Physiotherapist Supervisor: Barreiros, J. DIRECTOR: Beckert, P., MD Introduction Limb amputation  causes important functional, psychological and social problems. To minimize these consequences a sucessfull rehabilitation programme is needed. Nowadays, the technical evolution in prosthesis construction offers plenty of choices to the rehabilitation team and makes functional goals more and more demanding, mainly when the amputee is an healthy young individual with traumatic limb amputation. Case Study Fig. 1 Stump with atrophic and bone adherent skin. Fig. 2 Exoskeletal prosthesis made to reduce distal weight-bearing Fig. 3 Protective sock with distal silicone Fig. 4 At the end of Rehabilitation programme he achieved a three-point gait due to pain during the stance phase. One year later c)  He was not using the prosthesis because residual limb was still painful and the skin easily broke. d) His balance and mobility at that time was reassessed by using the Community Balance and Mobility Scale (CB&M)1. e) He accepted a transtibial amputation proposed by the Plastic Surgeon and the Rehabilitation Department. f) He was submitted to a reamputation at the transtibial level of the same lower limb and restarted a new rehabilitation program.  g) After the surgery he made a functional adaptation to an endoskeletal prosthesis with silicone liner and dynamic foot.  h) The second rehabilitation program consisted in: proprioceptivity exercices, balance and coordination training, reinforcement of the stump muscles, stairs and gait training. At the end of the first rehabilitation programme it was proposed a surgical correction with possible re-amputation at a higher level, but it was refused by the patient. DATE CB&M Scale JULY/2003 ADMISSION - 22/96 FEBRUARY/2004 DISCHARGE- 47/96 Conclusion This study case shows that sparing the length of amputation, does not always mean a better functional result.  The rehabilitation team work, the will and the patient’s motivation, had an important and crucial role to the success of the treatment. Therefore, limb sacrifice produced a more functional life and better social integration for this patient.  i) After the rehabilitation program he was reassessed and achieved a normal locomotion pattern on irregular ground, walk up and down stairs. He also  was able to participate in some sports activities. Clinical History 21-Year-old male victim of car accident that caused partial left foot traumatic amputation. Cutaneous grafs were needed to recover  the wound. 1Inness L., Howe J., Verrier MC, Williams JI. Development of the Community Balance and Mobility Scale (CB&M) for Traumatic Brain Injury (TBI). Indianopolis, IN: American Congress of Rehabilitation Medicine; 1999. This scale has been used since 2003 at the amputee population by the Rehabilitation Department of G.F.Strong Centre, Vancouver-Canada. a) On the first rehabilitation episode, on which the patient had a left tarso-metatarsal amputation, he was integrated in a intensive rehabilitation treatment to make a functional adaptation to an exoskeletal prosthesis.This intensive rehabilitation treatment consisted in: proprioceptivity exercices, balance and coordination training, reinforcement of the stump muscles, stairs and gait training.  b) His balance and mobility was assessed at the beginning/end of the rehabitlitation process by using the Community Balance and Mobility Scale (CB&M)1.  DATE CB&M Scale JUNE/2005 ADMISSION - 67/96 OCTOBER/2005 DISCHARGE - 77/96 Fig. 5, 6, 7. Proprioceptivity exercices, balance and coordination training with his new prosthesis  

Reamputation: a new opportunity: a case study approach

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Reamputation: a new opportunity: a case study approach

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Repositório do Hospital Prof. Doutor Fernando Fonseca