Wednesday, April 21, 2010

Amputees Require Individual Care

So does one care for the pregnant woman with an above-the-knee amputation (AKA) and prosthesis any differently than the average non-pregnant woman with the same amputation? Is the prosthesis made any differently? What does the practitioner like me need to know or be concerned about, in caring for her? Is she any more susceptible to falls? Will she need to have a new socket made? Or are major adjustments necessary before and after the baby is born? If so, what adjustments and how quickly after the delivery should this occur?

These are some of the questions I asked myself after learning that one of our prosthesis candidates, Patient S, is five-months pregnant. With all these questions flowing through my head and without any good answers, I decided to direct them to the experts in this area, the prosthetist and the physical therapist.

As I spoke with the prosthetist, Dale, about my concerns and lack of knowledge regarding pregnant prosthetic wearers, he indicated that it is necessary to make prosthesis with a socket that splits from the proximal to the distal end. This therefore makes it possible to adjust the socket to the desired size, thereby increasing support and comfort as the candidate’s weight and size increases and decreases throughout her pregnancy. The split is made on the thigh over the rectus femoris muscle, and straps are secured to the socket to allow easy adjustments. As per the prosthetist, this particular prosthesis with adjustable socket is not very comfortable and or durable, but it allows for accommodation of the inevitable weight changes, as the woman progresses through her pregnancy.

The physical therapist Candace stated that most pregnant women usually do very well, but they do need to use assisted devices, such as crutches or a four-pronged cane as they advance in their pregnancies. This is to ensure greater stability with ambulation as size and weight increases over the course of the pregnancy.

Patient S is already a mother of six children, and she is very anxious to complete her physical therapy and be rid of the crutches, so she can be more independent, and hands-free to care for her home and her children. She was not very happy when she was informed that she will need to continue using assisted devices as she advances in her pregnancy.

As the discharge planner, I tried to provide re-enforcement about the special care she will need to take during her pregnancy, and also provide her with encouragement. Soon, our patient realized that the extra care and precaution, while inconvenient, was all was for the safety and wellbeing of herself and her unborn child. Patient S will be discharged from the physical therapy program soon, of course with frequent follow-ups to monitor her progress.

Thanks for reading-Project HOPE volunteer Joy Williams

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