Patient Safety in the Rehabilitation of the Adult with an Amputation

Needs of Family Caregivers of People with Lower Limb Amputations: A Scoping Review

Lower limb amputation affects several parameters of a patient's life. Family caregivers providing care for these patients experience multiple feelings and needs; knowing caregivers' needs is essential to prepare them for this new role, as well as the health planning of this type of care. This scoping review aimed to identify and map the needs of family caregivers of people with lower limb amputations. This scoping review was conducted in accordance with the JBI methodological framework and the PRISMA-ScR reporting guidelines. A bibliographical search was carried out on the needs of family caregivers of lower limb amputees in 15 databases. Two independent reviewers extracted data using a data extraction tool developed for this scoping review. Eight studies were included in the present review (n = 6 quantitative studies; n = 2 reviews). Results indicate that family caregivers of people with lower limb amputations may experience an extensive range of needs, as follows: (i) mental health and psychological support, (ii) physical health, (iii) health and well-being, (iv) supportive care, (v) social support, and (vi) educational/informational support. The needs identified in this review can help to develop interventions and programs that provide better support during the situational transition process.

The Assessment and Response of Rehabilitation Professionals to Sudden Deterioration in Symptoms: An Analysis of the National Database in Japan

OBJECTIVE

There are few analyses of the current status of and responses to acute deteriorations encountered by physiotherapists, occupational therapists, and speech-language pathologists (rehabilitation professions [RPs]). The purpose of this study was to analyze the responses of RPs to acute deterioration in patients using the functional resonance analysis method (FRAM) based on the descriptions in "the Medical Accident Database".

METHODS

Subjects were 413 cases with medical incidents reported by RPs to the database from 2012 to 2021. Life-threatening cases with changes in consciousness, circulation, and respiration were selected. Descriptions regarding findings assessed by RPs and support team, and requests for assistance were extracted. We also attempted to construct appropriate respond in RPs by using the FRAM.

RESULTS

Thirty-nine cases of acute deterioration were included in the analysis, and descriptions by RPs of consciousness (35 cases), circulation (18 cases), and respiration (36 cases) were identified. Blood pressure and percutaneous oxygen saturation measurement were frequently presented in the assessment by RPs, whereas the support team assessed cardiac arrest and respiratory arrest in high frequency. The FRAM analysis indicated that appropriate and rapid post-response by RPs requires patient information in prior, appropriate assessment and integration/interpretation.

CONCLUSION

We attempted to identify problems analyzing the response by RPs to acute deterioration using the database and construct an appropriate response model. It resulted that RPs need to obtain patient information in advance and integrate/interpret it appropriately based on accurate assessment of conscious, circulation and respiration for rapid response. A model including integration/interpretation for appropriate post-response by RPs was constructed using the FRAM.

Gait Alteration in Individual with Limb Loss: The Role of Inertial Sensors

Amputation has a big impact on the functioning of patients, with negative effects on locomotion and dexterity. In this context, inertial measurement units represent a useful tool in clinical practice for motion analysis, and in the development of personalized aids to improve a patient's function. To date, there is still a gap of knowledge in the scientific literature on the application of inertial sensors in amputee patients. Thus, the aim of this narrative review was to collect the current knowledge on this topic and stimulate the publication of further research. Pubmed, Embase, Scopus, and Cochrane Library publications were screened until November 2022 to identify eligible studies. Out of 444 results, we selected 26 articles focused on movement analysis, risk of falls, energy expenditure, and the development of sensor-integrated prostheses. The results showed that the use of inertial sensors has the potential to improve the quality of life of patients with prostheses, increasing patient safety through the detection of gait alteration; enhancing the socio-occupational reintegration through the development of highly technologic and personalized prosthesis; and by monitoring the patients during daily life to plan a tailored rehabilitation program.

Materials for lower limb prosthetic and orthotic interfaces and sockets: Evolution and associated skin problems

Introduction: Sockets and interfaces are important elements for lower limb orthoses and prostheses, as they allow for proper contact and fit between the devices and the affected limb or stump.Objective: To review the different polymers used in the development of lower limb sockets and external prosthetic and orthotic interfaces, their functional requirements and the possible skin problems caused by their use.Materials and methods: A literature review was conducted using the databases EBSCO, Embase, LILACS, SciELO, ScienceDirect and Scopus.Results: 47 articles and papers that met the inclusion criteria were retrieved. Thermoplastics, thermosets, foams, gels and elastomers are among the polymers used for manufacturing prosthetic and orthotic interfaces and sockets. However, studies estimate that between 32% and 90.9% of the population that use these devices have experienced skin problems on the affected stump or limb, such as excessive sweating, wounds and irritation.Conclusion: There is a clear need for further research to develop prosthetic and orthotic interfaces and sockets for lower limbs that can prevent or control damage to the skin of users.

ATENÇÃO EM REDE ÀS PESSOAS COM AMPUTAÇÃO: A AÇÃO DA ENFERMAGEM SOB O OLHAR DA BIOÉTICA

RESUMO Objetivo: analisar o processo de referência e contrarreferência na assistência à saúde das pessoas com amputação, na perspectiva dos enfermeiros, sob o olhar da bioética. Método: estudo descritivo, exploratório-analítico com abordagem qualitativa, realizado por entrevista semiestruturada com 21 enfermeiros que prestam assistência à pessoa com amputação alocada na rede de atenção à saúde de Florianópolis. Os dados foram organizados com auxílio do software Atlas ti 7.5.6 e analisados com base na análise de conteúdo temática. Resultados: emergiram duas categorias temáticas: O fazer do enfermeiro no processo de referência e contrarreferência e Avanços e desafios de um processo em construção. Evidenciou-se que sem o respaldo legal, a maioria dos encaminhamentos são realizados com base nas relações interpessoais e na informalidade. Logo, a responsabilização compartilhada e a troca de saberes possibilitam ações fundamentadas nas necessidades e complexidades intrínsecas na assistência à saúde dessa população. Conclusão: a análise sob o olhar da bioética permitiu concluir que, não só a pessoa com amputação como também o enfermeiro, ocupam posição de vulnerabilidade. Estes mostraram o empenho para oferecer um atendimento integral. O comprometimento ético, a criatividade profissional, o matriciamento e a interconsulta foram pontuadas como potencialidades. As fragilidades foram a inexistência de protocolos, a comunicação ineficaz entre os níveis de atenção, o acesso restrito à informação e a lentidão nos referenciamentos.

The importance of orthoses on activities of daily living in patients with unilateral lower limb amputations

BACKGROUND

The role of the selected prothesis on activities of daily living (ADL).

OBJECTIVE

To evaluate the impact of prothesis on ADL in patients with lower-limb amputations.

METHODS

The data of 500 patients with unilateral lower limb amputation were recorded. The activity level was defined based on the Medicare Functional Classification Level. Old and new prescribed prosthesis were recorded. Nottingham Extended Activities of daily living activities Daily Living Scale was used to evaluate ADL.

RESULTS

Amputation levels were transfemoral (TF) in 268 (53.6%), transtibial (TT) in 178 (35.6%), knee disarticulation (KD) in 54 (10.8%). In patients with TF and KD amputation active vacuum system, pin modular system, hydraulic system and mechanical modular prosthesis were replaced with the swing stance phase microprocessor-controlled prostheses. In patients with TT amputation pin modular system, hydraulic system and mechanical modular prosthesis were converted to active vacuum system prostheses. Prescribed new prosthesis has caused a statistically significant increase in all amputation levels in ADL of patients (p≤ 0.05).

CONCLUSIONS

We observed that there was significant improvement in ADL when conventional prostheses replaced with advanced technology prostheses in unilateral lower extremity amputation patients.

Development of Standardized Material Testing Protocols for Prosthetic Liners

A set of protocols was created to characterize prosthetic liners across six clinically relevant material properties. Properties included compressive elasticity, shear elasticity, tensile elasticity, volumetric elasticity, coefficient of friction (CoF), and thermal conductivity. Eighteen prosthetic liners representing the diverse range of commercial products were evaluated to create test procedures that maximized repeatability, minimized error, and provided clinically meaningful results. Shear and tensile elasticity test designs were augmented with finite element analysis (FEA) to optimize specimen geometries. Results showed that because of the wide range of available liner products, the compressive elasticity and tensile elasticity tests required two test maxima; samples were tested until they met either a strain-based or a stress-based maximum, whichever was reached first. The shear and tensile elasticity tests required that no cyclic conditioning be conducted because of limited endurance of the mounting adhesive with some liner materials. The coefficient of friction test was based on dynamic coefficient of friction, as it proved to be a more reliable measurement than static coefficient of friction. The volumetric elasticity test required that air be released beneath samples in the test chamber before testing. The thermal conductivity test best reflected the clinical environment when thermal grease was omitted and when liner samples were placed under pressure consistent with load bearing conditions. The developed procedures provide a standardized approach for evaluating liner products in the prosthetics industry. Test results can be used to improve clinical selection of liners for individual patients and guide development of new liner products.

Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis

We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information.

Health care for people with amputation: analysis from the perspective of bioethics

A qualitative, descriptive and exploratory study was conducted through semi-structured interviews with 18 people undergoing amputation in the period 2008-2010, in public hospitals in Florianópolis. The objectives were to analyze the care provided by health professionals throughout the amputation process in the perspective of the amputee patient; and discuss the process of health care to the person with amputation in the bioethical analysis perspective. Data were analyzed according to content analysis. Three thematic categories emerged: the process of amputation; team performance and rehabilitation. Bioethics permits reflection on the care provided to amputees and problematizes the relationship of the health care process with support available through public health policies. The professional involved in this process has to take responsibility for putting the process in practice and interdisciplinary is essential for the recovery of the amputated patient.