BACPAR Annual National Conference 2016: “Supporting the ... · Conference 2016: “Supporting the Challenging Patient” Gayle Arthur, Prosthetist. Thursday 10th November ... •Has

Gayle Arthur, Prosthetist.

Thursday 10th November

BACPAR Annual National Conference 2016:“Supporting the Challenging Patient”



Stubbies use in the civilian population: Case Studies

and Discussion



• Acquired:

• Traumatic

• Elective

• Vascular -> repeated revision

surgeries becoming more proximal

• Congenital

Causes of Bilateral Trans Femoral

Amputation:



A socket with either:

What Are Stubbies?



What Are Stubbies?

Prosthesis consisting of a socket plus a foot but no knee.



• 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:



• Good muscle power at the

hips

• Independent transfers –

forward / backward

• Independent in PADL

• Independent sitting balance



• Good cognition

• Setting relevant goals

• Motivation

• Compliance



Case Study

No 1

Paul



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



• 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:



• 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



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:



Case Study

No 2

Jamie



• 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



• Primary School: Jamie did not like wearing any

prosthetic limbs:

• Uncomfortable

• Frequent growth spurts

• Needed assistance to

don/doff

• Poor Motivation

Prosthetic Limb Wear:



•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



• 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:



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



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



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



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:



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



• 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





Thank You

Documents

BACPAR Annual National Conference 2016: “Supporting the ... · Conference 2016: “Supporting the Challenging Patient” Gayle Arthur, Prosthetist. Thursday 10th November ... •Has