bacpar annual national conference 2016: “supporting the ... · conference 2016: “supporting the...
TRANSCRIPT
Gayle Arthur, Prosthetist.
Thursday 10th November
BACPAR Annual National Conference 2016:“Supporting the Challenging Patient”
Gayle Arthur, Prosthetist.
Thursday 10th November
Stubbies use in the civilian population: Case Studies
and Discussion
Gayle Arthur, Prosthetist.
Thursday 10th November
• Acquired:
• Traumatic
• Elective
• Vascular -> repeated revision
surgeries becoming more proximal
• Congenital
Causes of Bilateral Trans Femoral
Amputation:
Gayle Arthur, Prosthetist.
Thursday 10th November
A socket with either:
What Are Stubbies?
Gayle Arthur, Prosthetist.
Thursday 10th November
What Are Stubbies?
Prosthesis consisting of a socket plus a foot but no knee.
Gayle Arthur, Prosthetist.
Thursday 10th November
• Medically well –> comorbidities?
• Some level of general fitness
• Good core strength – for balance
• Good upper body strength
• Good range of motion at the hips
Criteria For Stubbies:
Gayle Arthur, Prosthetist.
Thursday 10th November
• Good muscle power at the
hips
• Independent transfers –
forward / backward
• Independent in PADL
• Independent sitting balance
Gayle Arthur, Prosthetist.
Thursday 10th November
• Good cognition
• Setting relevant goals
• Motivation
• Compliance
Gayle Arthur, Prosthetist.
Thursday 10th November
Case Study
No 1
Paul
Gayle Arthur, Prosthetist.
Thursday 10th November
Amputations:
• Right TT Aug ‘11
• Right TF Nov ‘11
• Left PF ‘12
• Left TT July ‘12
• Left TF Aug ‘14
• 48 year old male
• DVT and Pulmonary Embolism 2005
• Smoker
• Rectal Cancer:
• Radiotherapy
• Chemotherapy
Gayle Arthur, Prosthetist.
Thursday 10th November
• Started with full length prosthetic legs
(PFTD 29/1/15)
• Could not sit to stand from wheelchair
• Did not progress further than walking
within parallel bars at physio
Bilateral TF Prosthetic Rehabilitation:
Gayle Arthur, Prosthetist.
Thursday 10th November
• Stubbies prescribed April 2015, FD May
and didn’t see patient until July when the
feet broke.
• Pt reported to using the stubbies all the
time indoors
• +++ freedom
• Still used wheelchair for outdoor mobility
Gayle Arthur, Prosthetist.
Thursday 10th November
Why did we not
do them sooner?
In hindsight Paul
would have had
another 3-4 months
“freedom” walking
on stubbies if we
had done them
straight away as he
sadly passed away
in August 2016
Considerations:
Gayle Arthur, Prosthetist.
Thursday 10th November
Case Study
No 2
Jamie
Gayle Arthur, Prosthetist.
Thursday 10th November
• Has always tended
to prefer pelite
stubbies “slippers”
for walking
• Manual wheelchair
for longer distances
• I’ve been his
prosthetist since
January 2012.
• 16 year old male
• Transverse
congenital
deficiency at knee
level
• Has worn
prostheses of some
kind since 13
months old
Gayle Arthur, Prosthetist.
Thursday 10th November
• Primary School: Jamie did not like wearing any
prosthetic limbs:
• Uncomfortable
• Frequent growth spurts
• Needed assistance to
don/doff
• Poor Motivation
Prosthetic Limb Wear:
Gayle Arthur, Prosthetist.
Thursday 10th November
•Secondary School:
• Matured – compliance increased
• Identified where he could use them in school
• However still tended to not wear prosthesis
into LTCC would bring them with him rather
than walk
• Would go months without wearing them if
had problems before making a review appt
Gayle Arthur, Prosthetist.
Thursday 10th November
• He has consistently worn his pelite stubbies
and ambulates with them every day
• January 2014 he wore his prosthetic legs into
LTCC for first time since I started treating him.
• Limited at school:
• The lift was consistently out of order
• Stairs very challenging for him
Prosthetic Limb Wear:
Gayle Arthur, Prosthetist.
Thursday 10th November
2016:
• Wearing prostheses almost all day at
school
• New sockets and stubbies in April
• Jamie also agreed to a “growth spurt”
and we lengthened his prosthetic legs
and fitted larger prosthetic feet
Gayle Arthur, Prosthetist.
Thursday 10th November
October 2016:
• Has started college and has been attending in his wheelchair to get used to new location
• Plans to use prostheses once happy with routine
• “Grown” again at this appt but happy with current foot size
Gayle Arthur, Prosthetist.
Thursday 10th November
Has always had
stubbies to wear to
keep him active and
walking
Wheelchair for long
distances (and now
wheelchair basketball)
Patient Choice:
Has always had
prosthetic limbs to
use if he chose to
Gayle Arthur, Prosthetist.
Thursday 10th November
Come round full
circle that at 16
years old he has
decided for himself
to mobilise with his
prosthetic limbs.
This ability to have
choice was facilitated
by his consistent use of
stubbies to keep him
walking and not
wheelchair bound.
Regular reviews by
prosthetic team so that
he always had the
option of full length
prosthetic use.
Patient Choice:
Gayle Arthur, Prosthetist.
Thursday 10th November
Recommendations:
• Arrange peer to peer meeting
• Consider stubbies and full length
prostheses at same time
• Psychological support – body image
• OT support - equipment for home to
facilitate rehab
Gayle Arthur, Prosthetist.
Thursday 10th November
• Physio Input is essential
• Must ask if there is the experience and
time available to lead an intensive long
haul rehab programme?
• Refer to in-house rehab facility?
• Refer to prosthetic centre physio?
• Encourage other physical activity to
maintain a general fitness level
• Rehab can take years
Gayle Arthur, Prosthetist.
Thursday 10th November
Gayle Arthur, Prosthetist.
Thursday 10th November
Thank You