Is Your Amputation Case Fully Supportable for the Client/Claimant’s Care?
A knowledgeable Expert (a Certified Life Care Planner) can provide the best outcome with the research and references needed.
Ron Smolarski is a Certified Life Care Planner with decades of experience researching and preparing complete Life Care Plans for Amputation Cases. This knowledge will give your case the fully supported, reasonable, usual and customary support needed.
Above the elbow and below the elbow cases have vast differences not readily apparent to a layman.
Below the knee and above the knee cases affect the person’s gait and can cause other physical complications throughout the body.
The engineering of prosthetics is advancing with electronic joints and software.
People with amputations have many phases of rehabilitation that need to be addressed in a life care plan. Preoperative care and assessment, inpatient surgical and acute post-surgical, preprosthetic, prescription, fabrication, training and acclimation, community reentry, vocational and avocational rehabilitation, and follow up periodically for life.
Delayed phase of rehabilitation care can detract from the best functional or psychological outcome and add to the cost of health care.
Amputation Surgery & Reconstruction phase:
Surgery usually includes orthopedic surgery to improve the boney elements of the residual limb and plastic surgery to prepare the skin for comfortable use of the prosthetic.
Preprosthetic phase
Sutures are removed and attention is paid to shaping and shrinking the residual limb prosthetic casting, aerobic conditioning, strengthening training & emotional stresses need to be dealt with – this is outlined with items in the Life Care Plan.
Lower limb amputees should be fitted within 8 weeks of amputation and arm amputees should be fitted with 4 to 6 weeks of an amputation surgery, if not done the chance of using a prothesis decreases bimanual activities significantly.
Maladaptation is more frequently seen in persons who have chronic pain, this also needs to be addressed in the life care plan. Phantom & residual limb pain is related to the level of anxiety, depression and altered sleep. Residual pain is usually caused by poorly fitting prosthesis and can be alleviated with socket modifications. Neuromas are also caused by a severed peripheral nerve at the time of amputation. The certified life care planer will address these concerns and how to manage the outcome.
Vocational Rehabilitation in the life care plan should be started shortly after amputation and will impact wage capacity & wage loss.
Follow up care in the life care plan should include regular preventive care & prosthetic adjustments.
The process of amputation & its rehabilitation takes about 12-18 months.
Ron’s knowledge has been gleaned from research with Doctors, Prosthetists, Amputees, and other care professionals. Following are some Amputation and Prosthetic basics, for your use:
Amputation of the leg is more common than the arm. Most frequently the arm amputation involves the right arm below the elbow.
Levels of limb amputation: Below the knee – lower energy expenditure than the above the knee prothesis
Gel liners achiever ideal prosthetic function when dealing with scarred skin & poor soft tissue coverage in a more satisfactory manner.
Conclusion
Usual components:
Prosthetic leg includes: socket, foot/ankle complex, and a means of suspension
Arm amputation: wrist joint, terminal devices, suspension system
Basic prosthetic design:
A. Passive prosthesis (cosmetic restoration)
B. Cable controlled by body
C. Electric moving parts (improve gait or grasping)
Prosthetic complications:
1. Shearing forces applied to skin
2. Direct pressure applied from the prosthesis
3. These pressures can cause skin pressure problems
Aging with Amputation
A. Low back pain develops in 75% of lower limb amputees
B. Opposite extremity has additional stress and strain to compensate for the amputee
With this knowledge on your client’s side, the case will have the strongest foundation for the damages.
