1. Brainstorming Bilaterals Case Studies

2. Bilateral amputees at RPC Rankin Park Statistics (Dec 02-Jan 06) LevelNo.Avg FIM Motor Change 2BKA47.2 BK/AK89.92 2AKA316

3. Bilateral BKA

4. Jake, 25 y/o male involved in a MVA resulting in bilateral BKA, # L femur, dislocated L shoulder, and extensive burns to torso and legs. Patient had ORIF L leg and is NWB for 12/52 post-op, and required skin grafts to legs and torso. His upper limbs have FROM and strength. Patient is now 6/52 and just arrived to the rehabilitation ward. Previously Jake was fit and active, played sport socially, lived independently and worked full time in a relatively sedentary job. He would like to return to his job and living independently after rehab.

5. Bilateral BKA 1.What are the treatment priorities for this patient given their goals? 2.What factors may limit the progress of this patient? 3.What level of mobility would you expect this patient to achieve? What issues may effect this outcome? 4.How would this differ for other 2BKAs?

6. Bilateral BK/AK

7. Bilateral AK/BK 75 yr old male admitted for rehab following a (R) AKA. Uncomplicated post op recovery. Pmhx: (L) BKA 8 yrs ago HT PVD ETOH abuse Ex heavy smoker

8. Bilateral AK/BK- Current status Independent with personal cares Requires assistance to t/f to wheelchair but is then independent on indoor surfaces D/C destination to be determined Demands a prosthesis to be able to walk

9. Bilateral AK/BK -Social history Previously lone liver, socially isolated. Received assistance for cooking,shopping,housework. Fitted with interim prosthesis 8 yrs ago but refused to use it. Poor compliance with rehab in past.

10. Bilateral AK/BK-Discussion Would bilateral prostheses be appropriate for this pt ? What should treatment focus on ? What else needs to be considered for this pt to return home ?

11. Bilateral BK/TMT 76 y.o. female. Background: NIDDM Traumatic L BKA 10 years ago Recent TMT amputation due to chronic toe ulceration Falls – 6 in the last 2 months Still drives Lives alone, no family near by (50klms away) Hobbies – sewing, bingo 3x/week, choir (U3A), baby sitting grandchildren some weekends.

12. Bilateral BK/TMT - Discussion What factors may have lead to the 2 nd amputation? (preventable or not) What issues may effect her recovery and discharge? What considerations need to be made regarding prosthetic prescription?

13. Bilateral AKA

14. 39 y.o. male Workplace injury – run over by forklift Degloving injuries Complications – sepsis, PE

15. Bilateral AKA Ongoing wound issues included: Hypergranulation Foreign bodies, debris surfacing after closure +/- breakdown “Tight” skin over residuum.

16. Bilateral AKA

17. Marked mechanical and phantom pain Psyche involvement – Post traumatic stress disorder?, depression, withdrawn.

18. Bilateral AKA Seen at the Limb Centre 4+ months post amputation. Initial program: Strengthening – hip, UL, core stability Hip F stretching Compression pump therapy Sitting balance General fitness Silicone liners - ? Precautions on grafted skin Transfers, floor drill, problem solving functional issues

19. Bilateral AKA First appt!

20. Bilateral AKA High level sitting balance / core stability exercises

21. Bilateral AKA Prosthetic fitting: “Seal in” liners Gait training –Where do you start? –what level of mobility is should you expect?

22. Bilateral AKA First time on legs / sockets!

23. Bilateral AKA

26. Complicating factors: Multiple falls (++++) – from chair as well as legs. Stump wounds Back pain Home modifications

27. Bilateral AKA Major house and car modifications Ongoing Vocational and Leisure pursuits: –Studying computers at TAFE (RTW strategy) –Exercise Swimming Gym program Ongoing physiotherapy. Prosthetic prescription – what is ideal?