Occupational Therapy Transtibial Amputation (BKA) Residual Limb Care

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Before the Stitches & Staples Come Out

  • Educate on positioning in bed and sitting. No pillows under knees.
  • Promote stretching in prone position if tolerable (no low back pain).
  • Provide sitting support for wheelchair – residual limb supports.
  • Educate on precautions (non-weightbearing on residual limb).
  • Educate on the purpose of dressing and bandage is to absorb moisture and protect the healing wound.
  • Cover and teach protection of residual limb during showers from water contact.
  • Remind staff to assist with daily dressing changes.
  • Practice transfers onto commode/toilet and shower chairs/benches.
  • Advocate for the timing of Rx and pain management.
  • Prevent and manage pain and phantom limb pain (diary, breathing, distraction, mirror therapy).
  • Strengthen non-involved muscles (shoulder, upper extremities, etc.)
  • Provide psychosocial support and resources for support groups.
  • Prevent infection control – educate others including staff to wash hands or wear gloves when coming into contact with healing site.
  • Promote healthy diet, smoking/alcohol/recreational drug cessation.

After the Stitches & Staples Come Out

  • Depends on MD – approximately 3 weeks after surgery.
  • Begin desensitization (massage, tapping, rubbing).
  • Encourage daily washing with soap and water, patting dry.
  • Introduce A/E including hand-mirror, long handle sponge, reacher.
  • Teach scar massage.

Family Support

  • Emotional support.
  • Assisting with ADLs and IADLs (including cooking, driving, lifting, transport of wheelchair and equipment).
  • Assisting with wound care in all phases of rehabilitation.
  • Helping with desensitization.

Figure 8 Wrapping

Figure 8 Wrapping Directions

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Phantom Limb Pain Causes

  • Being too tired
  • Putting too much pressure on the stump or parts of the arm or leg that are still there
  • Changes in the weather
  • Stress
  • Infection
  • An artificial limb that does not fit properly
  • Poor blood flow
  • Swelling in the part of the arm or leg that is still there
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Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.