Principles of Contemporary Amputation Rehabilitation in the United States, 2013

Meier, Robert H.; Heckman, Jeffrey

doi:10.1016/j.pmr.2013.09.004

Cited by 21 publications

(9 citation statements)

References 2 publications

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“…Our multidisciplinary approach was informed by lessons from the military community where recent conflicts have necessitated medical advance. Programs such as the US Armed Forces Amputee Patient Care Program at Walter Reed National Military Medical Center, the Center for the Intrepid at Brooke Army Medical Center, and Veterans Administration Regional Amputation Centers provide a comprehensive medical home for the rehabilitation of combat‐related amputees and have been shown to have a positive impact on their patients’ recovery by providing durable provider‐patient relationships, open communication, easy accessibility, and peer support . The application of military medical practices in civilian medical institutions, specifically those caring for oncology populations, requires acknowledgment of their similarities and differences.…”

Section: Discussionmentioning

confidence: 99%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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Background We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. Methods Our TMR cohort was compared to a cross‐sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient‐Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. Results Thirty‐one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow‐up (mean follow‐up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159‐10.55; P = .015), 5.896 (95%CI 0.492‐11.30; P = .033), and 7.435 (95%CI 1.797‐13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528‐10.42; P = .031), 6.195 (95%CI 0.705‐11.69; P = .028), and 6.816 (95%CI 1.438‐12.2; P = .014), respectively. Fifty‐six percent took opioids before amputation compared to 22% at 1 year postoperatively. Conclusions Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee‐centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

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Section: Discussionmentioning

confidence: 99%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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“…1 Common causes of lower limb loss (LLL) include dysvascular conditions (e.g., peripheral vascular disease) and traumatic events (e.g., motor vehicle accidents). 2 Although LLL has been traditionally viewed as a focused, musculoskeletal condition, research suggests that people with LLL experience greater cognitive impairment (CI) than the general population.…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Cognitive Concerns in People With Lower Limb Loss

Morgan

Kelly

Amtmann

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objective To investigate differences between self-reported cognitive concerns in people with lower limb loss (LLL) and normative data derived from the U.S. general population. A secondary aim was to determine if there were cognitive differences based on amputation etiology or age. Design Survey. Setting General community. Participants A volunteer sample of 1086 persons with LLL resulting from trauma or dysvascular complications who regularly use a prosthetic limb. Interventions Not applicable. Main Outcome Measure The Quality of Life in Neurological Disorders Applied Cognition General Concerns v1.0 Short Form (Neuro-QoL ACGC), an eight-item self-report measure of general cognitive concerns. Results People with LLL reported significantly more cognitive concerns than the Neuro-Qol normative sample. Mean Neuro-QoL ACGC scores were significantly lower than normative values (p<0.001) across subgroups defined by age (i.e., <40, 40–49, 50–59, 60–69, and 70+ years) and subgroups defined by etiology (i.e., traumatic and dysvascular LLL). However, there were no significant differences in cognitive concerns among age subgroups (p=0.84) or between the etiology subgroups (p=0.58). Conclusions When compared to the Neuro-QoL normative sample, individuals with LLL report greater concerns with cognitive health. Cognitive concerns were not differentially affected by age or cause of amputation. The presence of cognitive concerns in people with LLL suggests a need to assess perceived cognitive function in order to tailor education and training in prosthetic use and care.

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Section: Introductionmentioning

confidence: 99%

“…Rehabilitation is a key strategy for this population, [14][15][16][17][18] and its main objective is to regain the highest possible level of function. [16,17] Through a holistic and multidisciplinary approach, [15,18] the rehabilitation process includes several stages of varying duration: preoperative phase; pre-prosthetic stage; and, if possible, prosthetic training. [16][17][18] The pre-prosthetic rehabilitation should be initiated as soon as possible and is mainly aimed at range of motion and strength, residual-limb shaping, nonprosthetic mobility skills (transfers and wheelchair mobility), independence in basic activities of daily living (ADL), and training with early walking aids.…”

Section: Introductionmentioning

confidence: 99%

“…[16,17] Through a holistic and multidisciplinary approach, [15,18] the rehabilitation process includes several stages of varying duration: preoperative phase; pre-prosthetic stage; and, if possible, prosthetic training. [16][17][18] The pre-prosthetic rehabilitation should be initiated as soon as possible and is mainly aimed at range of motion and strength, residual-limb shaping, nonprosthetic mobility skills (transfers and wheelchair mobility), independence in basic activities of daily living (ADL), and training with early walking aids. [14][15][16]18] The primary objective of the pre-prosthetic occupational therapy intervention is to facilitate independence in self-care activities, as early as possible, through training of skills for daily functioning and advice on adaptations and technology.…”

Section: Introductionmentioning

confidence: 99%

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Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

Celeiro

Sanjuán

Santos-del-Riego

2016

Disability and Rehabilitation

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A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies. Implications for Rehabilitation Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence. A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation. Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation. A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

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Principles of Contemporary Amputation Rehabilitation in the United States, 2013

Cited by 21 publications

References 2 publications

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Self-Reported Cognitive Concerns in People With Lower Limb Loss

Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

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