Form and Function Rehabilitation Considerations

8/6/2019 Form and Function Rehabilitation Considerations

1/15

by:

Paul Carlisle MPT, GCS

Rehabilitation CoordinatorLaguna Honda Hospital and Rehabilitation Center

Form and Function: Rehabilitation

Considerations


2/15

Introduction

64 yo male with history of DM

Infected toe in March of 2010

Trans-tibial amputation July

Days prior to admission had 3-4 falls At least 2 year history of peripheral neuropathy

Multiple areas of musculoskeletal pain

Lives alone in 3rd floor apartment no elevator

35 years in the same apartment Self described hoarder

On call bartender

Art dealer and collector


3/15

Themes in the Story

Peripheralneuropathy

Toes

Feet

Legs

Hands

Arms

Proximalneuropathy

Thighs

Hips

Buttocks

Autonomicneuropathy

Heart and BV

Digestive

Urinary

Sex Organs

Sweat Glands

Focalneuropathy

Facial Muscles

Ears

Pelvis and LowBack

Abdomen

Eyes


4/15

Diabetic Retinopathy

Mild background retinopathy few warning signs

spots in vision, blurring, and side (peripheral)vision loss

can change throughout the day, and day to day Severe proliferative retinopathy

hemorrhages will form scar tissue between retina& vitreous

retinal detachments can occur Secondary visual complications:

Cataracts

Macular edema

Glaucoma


5/15


http://en.wikipedia.org/wiki/File:Human_eyesight_two_children_and_ball_normal_vision.jpg

http://en.wikipedia.org/wiki/File:Human_eyesight_two_children_and_ball_with_diabetic_retinopathy.jpg
http://upload.wikimedia.org/wikipedia/commons/1/1e/Human_eyesight_two_children_and_ball_with_diabetic_retinopathy.jpghttp://upload.wikimedia.org/wikipedia/commons/0/04/Human_eyesight_two_children_and_ball_normal_vision.jpg


6/15


Symptoms:

Glare sensitivity

Decreasedaccommodation

Diplopia

Diminished color vision

Losses in central and/orperipheral visual fields

All ADLs and mobilitycan be affected


7/15

Self-Management

Almost all tasks requirevision

Areas affected:

Monitoring blood glucose

RX administration/usage

Meal planning

Exercise/physical activity

Oral health

Foot self-care

Emotional well-being andadjustment

Stress importance of annual

eye exams!

QuickTime and a

decompressorare needed to see this picture.


8/15

Neuropathic Pain

Dysesthesias

Parasthesias

Muscular

Burning Tingling Pain on contact

Pins/needles

Shock Numbness/achiness Shooting

Dull Aches/cramps


9/15

Bookmarks

Sensation

Vision

Balance

StrengthEndurance

Function

Range ofMotion


10/15

Assessment

Functional Potential

Component Selection

Rehabilitation Programming

Success/Potential for AdvancedComponents


11/15

Classification System

K Level 0 Does not have the ability or potential to ambulate or transfer safelywith or without assistance, and a prosthesis does not enhance qualityof life or mobility

K Level 1 Has the ability or potential to use a prosthesis for transfers orambulation in level surfaces at a fixed cadence. Typical of the limitedand unlimited household ambulator.

K Level 2 Has the ability or potential for ambulation with the ability to transverselow-level environmental barriers such as curbs, stairs, or unevensurfaces. Typical of the limited community ambulator

K Level 3 Has the ability or potential for ambulation with variable cadence.Typical of the community ambulator who has the ability to transversemost environmental barriers and may have vocational, therapeutic, or

exercise activity that demands prosthetic utilization beyond simplelocomotion.

K Level 4 Has the ability or potential for prosthetic ambulation that exceedsbasic ambulation skills, exhibiting high impact, stress, or energylevels. Typical of the prosthetic demands of the child, active adult, orathlete.


12/15

Functional Assessment

Source: HEROS Fall Prevention Project: Balance and Testing inOlder Adults, Temple University, College of Health Professions(E-Mail: [email protected])


13/15

AMP

Source: Gailey RS, Roach KE, Applegate EB, et al. The Amputee MobilityPredictor: an instrument to assess determinants of the lower limbamputees ability to ambulate. Arch Phys Med Rehabil 2002; 83: 613-627.


14/15

AMP and K Values

K Value AMP

K0 0-8

K1 9-20

K2 21-28

K3 29-36

K4 37-43


15/15

Final Chapters

Contralateral Limb Amputation

Falls

Pain, esp. low back pain

Osteoarthritis

Osteoporosis

Gait Abnormalities

Skin Irritation

Poor Prosthetic Fit General Deconditioning

Source: Gailey RS, Allen K et al. Review of secondary physical conditionsassociated with lower-limb amputation and long-term prosthesis use.Journal of Rehabilitation and Research Development. 2008. Volume 45Number 1, 15-30

Form and Function Rehabilitation Considerations

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