TECHNICAL INFORMATION
 
   
 

Amputation  
The word amputation generally means the severing or removal of a limb or part of a limb.
It is important to differentiate between amputation as a result of a surgical procedure and amputation due to a traumatic accident. Amputation as a surgical procedure is usually only carried out as a last resort to save the life of a patient or when a limb is so severely diseased that no recovery is possible.

Causes of Amputation     
Some of the reasons that make a surgical amputation necessary may be: accidents, infections, gangrene or cancer. Emergency amputations are sometimes carried out at the scene of accidents by emergency medical teams when the victims are trapped in such a way that there is no other way to save their lives. There are still a number of amputations as a punishment for certain crimes.

   
 

Common Methods of Reducing The Swelling Of A Stump

The Above Knee Stump
Your residual limb consists of muscle and soft tissue that will need to be shaped and reduced in volume as soon as possible after surgery. A shrinker sock or compression wrap are used on the residual limb and are designed to apply the greatest amount of pressure at the lower end of the limb, gradually reducing pressure as you move upward. This pressure is what will reduce the swelling and shape your residual limb. Your age and overall health will ultimately determine the length of time it will take for the swelling to go down.
The shrinker sock is an elastic sock with an attached waistband, and is sized to fit your residual limb. You should check the sock 3-4 times a day to be sure that it is pulled up properly. If there is excess space at the bottom of the sock, the limb will swell into that space.
The Below Knee Stump
For below knee amputations, an immediate post-surgical fitting (IPSF) ( also referred above as IP) is used on the residual limb. This is a cast that extends above the knee, and is put on the residual limb immediately after the operation. This cast cannot be removed and is usually worn for the first two weeks following surgery. An aluminum pipe may be used to connect the cast to an artificial foot.
The cast serves several functions. It prevents excessive swelling, and also prevents knee flexion contractures, which occurs when the leg is bent for a long period of time and will cause the knee to lock in position. The cast also protects the limb from bumps and falls.
When the IPSF is removed, a removable rigid dressing (RRD) is applied. This is another type of cast, which can be removed, and should be done daily to clean and inspect the limb. The RRD extends only to the knee and protects from injury. As the swelling goes down, socks can be worn under the RRD to fill the extra space. Sometimes socks may be used in conjunction with the RRD to further reduce swelling.
Below knee amputees can also use a compression sock, which controls swelling by providing pressure from the bottom of the limb, decreasing toward the top.
Exercise can begin as soon as you can tolerate movement of your residual limb. Exercise serves as an important function in your recovery by helping to reduce swelling and muscle contractures, and will also help you to walk without a limp.
Exercise Examples
•           Lie on your back with your legs straight. Slowly slide residual limb out to the side, as far as possible, while keeping the limb in contact with the bed (or floor). Hold for a count of 5 and return to original position.
•           Lie on your back with legs straight. Put a towel roll between thighs and a resistance band around the outside of your thighs. Squeeze roll for a count of 5 and relax. Then spread legs apart, using band for resistance, and hold for a count of 5.
•           Lie on your stomach and raise limb backwards (up toward ceiling) as far as possible. Hold for a count of 5, while keeping your upper body in contact with the bed or floor.
•           Lie on your side with residual limb on top of your other leg. Flex leg at the knee.

 
 

Rehabilitation        
An amputation is a considerable intervention in the physical integrity of an individual and requires an equally high degree of readjustment to the normal routine of daily life. In the past, an amputation was an emergency life saving, but high risk operation with a high mortality rate. The main reasons for such operations were injuries in war or accidents. Today, modern surgical techniques are employed with the primary goal of creating a fully functional, load bearing stump. The causes for amputation have also changed. Today about 20% of all amputations are the result of accidents and the remaining 80% due to circulatory diseases or diabetes. Requirements for a successful rehabilitation are the recovery of full functionality and normal outward appearance by means of a well fitting prosthesis. Older patients, as opposed to younger physically active people have different requirements in terms of the type of prosthesis they need. Unfortunately, no prosthesis is able to replace the full functionality of a normal human limb. A prosthesis is not able to feel pain, warmth or cold. However, much has changed to the benefit of amputees. The statement: “there are no good prostheses” was the motivational spur for innovation and recent developments in this field and many orthopedic firms are continually striving for improvements.

Psychological Help
An amputation has a considerable negative effect on the self image of an individual and patients often require support from a sympathetic psychologist or social worker to help them cope. In addition, other social problems may arise due to the fact that the person may no longer be able to carry out his previous job or profession. Once again, in this situation the social services will be needed to organize rehabilitation courses after medical treatment is completed. 

   
 

Phantom Pain     
This pain is often felt by amputees in a part of the no longer existing limb, mostly in the distal area of the amputated extremity (hand or foot). Sometimes, as "Ablatio mammae" i.e. at tooth extraction level. Untypical pain characteristics are: burning, pins and needles, prickly, cutting, cramp or sometimes as if the limb is in the wrong position. 75% of patients complain of sudden attacks. 50% of patients complain of wandering symptoms. The onset of these symptoms can occur weeks or months after the amputation, but seldom after years. Phantom Pain That really did hurt! An amputation in the dark Middle Ages, when there were no anesthetics of any kind was a very unpleasant experience. Sometimes brandy was given to the patient to deaden the pain, but the experience was one, which was likely to have burnt itself in the memory of anyone who had undergone it for ever. Even when patients were anaesthetized during operations, many amputees were to discover that a leg, which is no longer there, can still hurt! This is called phantom pain and this is where the human memory plays a role. There is such a thing as a pain memory and phantom pain is a good example of this. It is estimated that more than half of all amputees suffer from phantom pain. As somewhere between 30 and 40,000 amputations are carried out in Germany each year, this means that there are a considerable number of patients suffering chronic pain. In times past, amputations were mostly the result of war wounds. Today they are often the result of circulatory disorders caused for example by smoking, diabetes or accidents. Where does phantom pain come from? Pain researchers discovered that war casualties who were operated on under battlefield conditions and after having received only a local anesthetic were less likely to experience phantom pain than those who were operated on under better hospital conditions and after the administration of a general anesthetic. How can this be explained? Pain in a foot or leg for example is transmitted by the nerves to the spinal cord where these impulses are then relayed to the brain and consciously experienced by the individual. When a general anesthetic is administered the conscious awareness of the brain is temporarily switched off. The nerves are functioning fully and continuing to send strong pain signals of the amputation to the brain. The brain is not able to consciously process these signals, but it is possible that a pain memory is created and stored in the nerves of the spinal cord. Normally, nerves forget these pain impulses, because new impulses are being sent all the time. However, after an amputation no new signals are being sent and a kind of "radio silence" ensues. At this point, it is possible that the nerve cells looking for signals to transmit are then able to call up the last impulses they received and continue to transmit them. This is the theory of pain memory. Signals are being sent to the brain that have no real source. If an amputation is carried out using a local anesthetic the nerves are blocked and no pain stimuli can reach the spinal cord that can be stored. For this reason, a local anesthetic is always given in addition to a general anesthetic. What can a sufferer do about phantom pain? Painkillers generally do not help. Many large clinics have special pain units, which try to provide relief with various drugs such as beta-blockers and anti-depressive medications. Blocking the pain transmission channels sometimes helps. Biofeedback or stimulation with low voltage electrical charges can cause nerves to sometimes lose their memory. These methods are not optimal and do not provide the best results.

   
 

Prosthetics

Replacements for Missing Limbs        
Prosthetics is the term used for all aids, which replace missing limbs or body parts. They are employed whenever a physical deficit needs to be compensated for, after for example the amputation of a body part caused through accident (trauma), vascular diseases, diabetes, congenital disorders, cancer or degenerative tissue disease. Prosthetics have a very wide range of applications, from replacement fingers to artificial legs. They vary greatly in appearance and in use. What was in the past a simple peg-leg, is today a highly specialized and individually tailored high tech carbon fiber prosthetic leg, sometimes with the refinement of knee joint controlled by a micro-processor. There have also been remarkable developments in the field of arm prosthetics. Steel and leather prosthetics, which are operated by means of belts and muscle movement alone, are now being replaced by myoelectric devices, incorporating small battery driven motors to carry out hand functions. Naturally, there are still wood and leather prosthetics around, but these are becoming rarer. New low weight materials (i.e. carbon fiber) with better functionality or with a more lifelike and natural appearance (silicon cosmetic covers) have greatly improved conditions for prosthetic wearers. The level of amputation and needs and abilities of the patient are paramount in deciding which prosthesis is most suitable for each individual. Training in the care and use of the prosthesis by specially trained therapists is essential.

   
 

Prosthetics in Pakistan

Recognized leader in Pakistan
The Hope Rehabilitation Center offers a full range of prosthetic/orthotic services. It is a recognized leader in improving the lives of people with disabilities through the use of the latest in prosthetic and orthotic technology.

Innovative Technology & Traditional Quality of ‘HOPE’
Hope’s modern facility is a key to providing best quality and superior patient care. We offer innovative technology and quality treatment combined with a professional "patient friendly" and respectful environment. Or patients and referring professionals continually comment to our staff that our facilities are the most professional, comfortable, and friendly they have ever visited. Such unique experiences are the essence of Hope Orthotic and Prosthetic Systems.
Our facility is managed by dedicated practitioners/partners who have spent years obtaining a formal education in medicine, surgery and engineering and expanding their knowledge by regularly attending continuing education programs. We stress on intensive continuing education for the entire staff. We regularly conduct in-service lectures and demonstrations for our practitioners and other members of the rehabilitation team at our facilities or in clinic or hospital settings.
In order for our referring physicians and patients we have 24-hour access to our staff. And true to our national tradition, neither snow nor rain deters us since most of our staff is equipped with at least one drive vehicle and also we have a mobile workshop unit.
Our location is close to the most prestigious hospitals, rehabilitation centers, and nursing homes in its area.
We are proud of our professional stature in the communities we serve and we have a close working relationship with our affiliating physicians, physical therapists, and rehabilitation team participants.
New components, innovative techniques, creative designs, and advanced technologies — are all a part of the compassionate, goal-oriented treatment each patient receives at House of Orthotic & Prosthetic Excellence (HOPE).

   
 

P & O
Prosthetics and orthotics combines knowledge and understanding of the human body with the application of forces and evaluation of mechanical components. Central to prosthetics and orthotics is the prosthetic and/or orthotic user and their psychological, social and cultural needs.
Prosthetics and orthotics is an autonomous profession and practice is characterised by reflection and systematic clinical reasoning, which combine to provide a problem solving approach to patient-centred care.

PROSTHETISTS & ORTHOTISTS
Prosthetists and orthotics assess, diagnose, treat, and manage a broad range of problems associated in particular with the neuromuscular and musculoskeletal systems.  They work collaboratively with other health-care professionals to provide integrated treatment.
Prosthetists provide prosthetic management for people who have an amputation or congenital loss of a limb. People can lose their limbs due to diseases such as diabetes, vascular disease, cancer or trauma.  Some other people are born without a limb.  Prosthetists analyse the mechanical loss and prescribe the most suitable prosthesis to meet these requirements.Orthotists provide orthotic management for people with a wide range of conditions such as rheumatoid arthritis, cerebral palsy, diabetes, and strokes. These conditions can affect all parts of the body from the feet up to the head.  Orthotists assess the patient’s needs, diagnose the problem and treat the patient by prescribing the most suitable orthosis to meet these requirements.

   
 

>Myoelectric Arm
New Technology Gives Upper Limb Amputees Sensation of Real Hand
An estimated 100,000 upper-limb amputees, including hundreds in Michigan, can benefit from a brand new product that can duplicate the feel of a normal hand. The new hand uses myoelectric technology with microprocessors that can sense, feel, and even automatically tighten when necessary.
Muscles in a person's arm control the movements of the hand and wrist. "When a person loses their hand, the muscles that control the hand remain in the arm," explained Ken Woodward, Director of Prosthetics at Wright & Filippis. "Sensors placed in the socket of the prosthesis are lined up with the arm muscles that control the movement. The sensors feel the electrical impulses that are emitted from the muscles when they contract. By contracting those muscles, the patient is able to open and close the prosthetic hand and also rotate the wrist."
The new prosthetic hand also has sensors in the fingers that can sense weight and will automatically tighten the grip without any effort by the user.
This new innovation has produced one additional benefit -- for the first time, it is possible to fit a partial-hand amputee using state-of-the-art microprocessor muscle control hands. Before the development of this new technology, surgeons would often have to amputate at a higher level and use a longer and bigger artificial hand because that was all that was available.

   
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