Acute Care

Working with Bariatric Amputees

Bariatric amputees present particular challenges during the rehabilitation process. Their size may at times cause difficulty with finding appropriate equipment, such as beds, chairs, wheelchairs, slideboards, crutches, and frames. There are the obvious manual handling risks, and the need to often require multiple assistants for transfers and mobility practice. And they may also require specialised, or more expensive prosthetic components, due to the higher load ratings those components may have.

This page lists information submitted by members to assist with management of this complex group of patients. If you do find any more useful tips, suppliers, or techniques to assist with this complex group of patients, please let us know so we can share your insights with others. Email on support@austpar.com.

Prosthetics in NSW

• EnableNSW has produced guidelines for prosthetic prescription and provision for bariatric patients, located at:
  www.enable.health.nsw.gov.au

Stump Management

In the acute stages, the size & circumference of the stump often precludes use of normal methods of managing stump oedema. The following ideas have been submitted by members:

• Custom-made stump shrinkers can be ordered, although may need to come from overseas, so in the meantime efforts at bandaging through use of larger sizes of tubigrip may be required if possible, so that the stump size is reduced as much as possible prior to measuring for the custom-made shrinker, and the expense is not wasted.
• Above-knee shrinkers may be adapted to fit larger transtibial stumps.
• Intermittent compression pump therapy could be used to try to reduce volume, and maintained with tubigrip until alternate methods of volume maintenance / reduction are possible.
• Intense program of stump massage & elevation to reduce stump size for those bordering on being able to fit into a standard shrinker.
• As silicon liners are now usually supplied with interim prostheses, the liner may be ordered earlier and funded by the state Prosthetic Limb Services, prior to casting or fitting the interim prosthesis. The properties of the liner can assist with volume reduction and stabilisation. The bariatric patient is likely to have specialised prosthetic needs due to weight and suspension difficulties, so liason with the Prosthetists / Limb Services may assist with funding.

Exercises

This site was sent to us as an example of simple exercises for wheelchair or bed bound amputees: www.livestrong.com/amputee. Probably more of an example of a site to refer your patients to.