Thursday, 6 August 2015

Lower-Limb Amputation

Lower-limb amputation refers to the surgical removal of the lower limb (leg) or part of the lower limb. Of course, amputations of the upper limb, or arm, also exist, but due to the non-weight-bearing nature of the arm, this is much less complicated and so will not be discussed in this blog article.

Lower-limb amputations are caused by the following:
·         Circulatory and vascular diseases associated with type 2 diabetes and peripheral vascular disease – 70%
·         Trauma to the limb itself – 23%
·         Removal of tumours – 4%
·         Congenital deformities – 3%

Lower-limb amputations caused by vascular diseases are more common in individuals over the age of 55 years; whereas, those caused by trauma, tumours or congenital deformities are more common in individuals under the age of 50 years.

It is important to know the cause of an amputation from an exercise perspective because the purpose of the exercise therapy will differ slightly. If an amputation was caused by a vascular disease, then it is important that the exercise programme focuses on reducing the progression of the associated vascular condition. On the other hand, the purpose of the exercise programme for those with amputations caused by trauma, tumours or congenital deformities is the same as that for able-bodies individuals, the aim being, to reduce the risk of diseases associated with a sedentary lifestyle, such as high cholesterol, high blood pressure, diabetes and obesity. Individuals who have had an amputation are at greater risk of developing these diseases, as they are more likely to be sedentary, purely because of their physical limitation. However, this should not be an excuse not to exercise, as there is a wide variety of exercises that can still be performed.

Depending on the level of amputation – at the foot, below the knee, above the knee or at the hip – various factors must be considered when planning an exercise programme. Appropriate exercise modalities need to be chosen according to the individual’s physical capabilities and current level of fitness. Swimming and arm ergometry are generally both safe and appropriate forms of exercise for most lower-limb amputees. Strengthening exercises are important and can usually be done with minor adaptations. It is generally more safe to use machines, rather than free weights, because an amputee’s balance is more likely to be compromised.

Walking is important to enable individuals to become as independent as possible; however, one cannot overdo it. Individuals with a prosthetic leg are susceptible to sores and infections, as a result of the prosthesis rubbing on the skin. This can cause further disability if the sores do not heal. These individuals also expend more energy when walking than able-bodied individuals and so cannot walk as far or for as long. Phantom pain, a common complaint of amputees, is pain experienced in the amputated limb. This pain ranges from mild to severe and can also hinder one’s exercise ability.

Although amputation is considered a disability, there is still a wide range of movement and functional exercises that amputees can achieve, ranging from the normal daily activities to competitive sport. It is crucial that one does not give up following an amputation, but rather seeks professional advice, such as that of a biokineticist, to assist in implementing an appropriate exercise programme that focuses on the needs and goals of the individual.

References
ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities

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