• Document: Occupational Therapy and Upper Limb Amputee Rehabilitation: Occupational Focused Intervention. Matthew Sproats (BaAppSc OT)
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Occupational Therapy and Upper Limb Amputee Rehabilitation: Occupational Focused Intervention Matthew Sproats (BaAppSc – OT) Declaration of Conflict The author and co authors declare no conflict of interest Upper Limb Amputation  The consequences of having an amputation are catastrophic, not only for the individual involved, but also their family and friends (Davidson, 2004)  Upper limb amputation leads to difficulty performing everyday activities that were previously easy and routine (Schabowsky, et. al. 2008) Occupational Therapy  Occupational therapists believe that appropriate engagement in relevant occupations has the potential to structure, shape and transform the lives of individuals (O’Toole, 2011)  Occupational therapy services are integral to enabling individuals with an amputation to participate in daily tasks (Smur, et al., 2008)  Occupational therapists are involved in all aspects of rehabilitation Three stages of Rehabilitation  Pre-prosthetic training -  Focus on preparing the limb for a prosthesis -  Address and discuss pain -  One handed training begins, with a focus on self-care tasks -  If myo-electric control is expected, myo site training can begin here.  Prosthetic control training -  Training is focused on gaining control and understanding the prosthesis. Three stages of Rehabilitation  ADL or Functional use training -  Incorporation of the prosthesis into everyday activities -  Refinement of control of prosthesis -  Return to productivity and driving -  One handed training and prosthetic use are balanced to assist the greatest independence (Celikyol, 1995; Rock & Atkins, 1996) The OPMA (Chapparo and Ranka, 2006) What is the impact of amputation? (Chapparo and Ranka, 2006) Component skills  Bio-mechanical  Sensory-motor  Cognition  Inter-personal  Intra-personal “Impairment” What is the impact of amputation? (Chapparo and Ranka, 2006) Categories of Occupation  Self-maintenance  Rest  Leisure  Productivity “Activity Participation” Occupational Roles  Roles help us apply meaning to our lives  Amputation impacts our ability to participate in all the tasks and occupations that make up these roles  The role of a father - -  Self-maintenance -  Rest -  Leisure -  Productivity Top Down  Occupational therapy is concerned with the performance of everyday tasks.  Occupations are used not only as the goal, but also the modality of intervention  Assessment and treatment of occupations occurs in real world contexts  Outcome measures are focused around participation in occupations. (Mackenzie & O'Toole, 2011) ( Functional prosthetic use  How would the person normally use their limb? (dominant vs non-dominant)  What are the expectations of the role of the prosthetic limb?  What are the demands of everyday life? What are the functional performance goals? Core principles in training  Active stabilisation -  The non-dominant limb is used predominantly as an active stabiliser, the prosthesis (regardless of dominance) is used for this role  Pre-positioning -  The wrist and elbow are difficult to activate whilst carrying out a task, and so organising the limb prior to starting the task is important Core principles in training  Task specific use -  A prosthesis will be used differently for each task and will not be used for all tasks  Generalisation is planned -  The generalisation of skills used in everyday tasks are not spontaneously generalised, so generalisation must be incorporated into treatment plans and goals Final Points  Prosthetic rejection rates for upper limb amputations remains high.  Occupation based interventions can lead to greater independence in everyday activities.  Prosthetic use can assist with independence in everyday activities  Occupational therapy is key in providing interventions required to maximise function Any Questions? Contact Details matthew.sproats@swahs.health.nsw.gov.au matthew.sproats@iinet.net.au 0404 333 750 References Celikyol, F. (1995). Amputation and Prosthetics. In C. A. Trombly (Ed.), Occupational therapy for physical dysfunction (4th ed., pp. 849-870). Baltimore: Williams and Wilkins. Chapparo, C., & Ranka, J. (2006). Occupational Performance Model (Australia) Illustration Retrieved September 2012, from www.occupationalperformance.com Davidson, J. (

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