My Capstone Project
The Significance of Occupational Therapy
in the
Rehabilitative Care of Individuals with Limb Loss and Prosthetic Devices
This website began as a piece of a much larger capstone project focused on advocating for the role of Occupational Therapists as a part of the rehabilitation team for individuals with prosthetic devices. Here is an overview of the need, the problem, the significance, and the role of occupational therapy.
The Why
~185,000 individuals undergo an amputation a year
(Ziegler-Graham et al., 2008)
1 in 10 amputees do not receive medical care when needed (Amputee Coalition of America, n.d.)
The Problem
+ Physical Impacts
Decreased occupational participation at home, in the workplace, and the community (Day et al., 2019; Melcer et al., 2016)
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+ Psychosocial Impacts
Neural changes profoundly impact motor planning, execution, and learning (Wheaton, 2017)
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+ Economic Impacts
High rates of device abandonment and increased rates of depression (Resnik et al., 2012; Boone, 2019)
The Purpose
+ Raise awareness of the needs of individuals with limb loss and prosthetic devices
​
+ Understand the role of occupational therapy services
​
+ Distribute resources advocating for the improved quality of care and inclusion of OT
The Significance
+ Advocate for the OT profession and individuals with limb loss and prosthetic devices
-
Raise awareness of the needs of this population
-
Educate on OT services and skills
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+ Improve overall quality of life for individuals with limb loss and prosthetic devices
-
Promote better quality of care
-
Educate on the lasting impacts of OT services
OTs Role in the Therapeutic Process
+ Acute Phase
Identify client-centered short- and long-term goals
+ Pre-Prosthetic Training
Prepare clients for fitting and optimal use of
prosthesis
+ Basic Prosthetic Training
Monitor ability to perform specific activities, provide modifications, and provide support for coping
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+ Advanced Prosthetic Training
Integration of prosthesis into more advanced activities
(Gulick, 2016)
Occupational Therapy Philosophy
+ Occupations are fundamental to health and well-being
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+ Treatment should be purposeful, meaningful, and goal-directed
​
+ Client-centered care
(AOTA, 2016; Wressle & Sammelsson, 2004)
Theoretical Support
+ Occupational Adaptation Model
Being adaptive allows individuals to choose and engage in occupations they find meaningful, respond to the challenges and adversities of life, and navigate their environment (Grajo & Boisselle, 2018).
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+ Cognitive Behavioral Model
The mental changes following amputation directly affect the physical abilities and occupational engagement of individuals with limb loss and prosthetic devices, therefore increasing the need to provide interventions founded in the cognitive behavioral frame of reference (Bourque et al., 2019).
​
+ Biomechanical and Rehabilitative Frame of Reference
Provides a foundation for activity analysis, breaking down each skill needed to complete a task, and providing varying, graded levels of engaging in necessary occupations (Jack & Estes, 2010).
REFERENCES
American Occupational Therapy Association. (2016). Occupational therapy’s distinct value: Rehabilitation practice. https://www.aota.org/~/media/Corporate/Files/Secure/Practice/distinct-value-rehab.pdf
Amputee Coalition of America. (n.d.). People with amputation speak out with the Amputee Coalition of America (ACA). https://www.amputee-coalition.org/wp-content/uploads/2014/11/lsp_people-speak-out_120115-113243.pdf
Boone, D. A. (2019). The economic value of mobility with a prosthesis. Journal of Prosthetics & Orthotics (JPO), P32–P36.
Bourque, M. O., Schneider, K. L., Calamari, J. E., Reddin, C., Stachowiak, A., Major, M. J., Duncan, C., Muthukrishnan, R., & Rosenblatt, N. J. (2019). Combining physical therapy and cognitive behavioral therapy techniques to improve balance confidence and community participation in people with unilateral transtibial amputation who use lower limb prostheses: a study protocol for a randomized sham-control clinical trial. Trials, 1. https://doi.org/10.1186/s13063-019-3929-8
Day, M. C., Wadey, R., & Strike, S. (2019). Living with limb loss: everyday experiences of “good” and “bad” days in people with lower limb amputation. Disability and Rehabilitation, 41(20), 2433–2442. https://doi.org/10.1080/09638288.2018.1467502
Grajo, L., & Boisselle, A. (2018). Occupational adaptation as a construct: A scoping review of literature. Open Journal of Occupational Therapy (OJOT), 6(1), 1–12. https://doi.org/10.15453/2168-6408.1400
Gulick, K. L. (2016). Fact sheet: The occupational therapy role in rehabilitation for the person with an upper-limb amputation. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/upper-limb-amputation.aspx
Jack, J., & Estes, R. I. (2010). Documenting progress: Hand therapy treatment shift from biomechanical to occupational adaptation. American Journal of Occupational Therapy, 64(1), 82–87. https://doi.org/10.5014/ajot.64.1.82
Melcer, T., Pyo, J., Walker, J., & Quinn, K. (2016). Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat. Journal of Rehabilitation Research & Development, 53(6), 1045–1059.
Resnik, L., Meucci, M. R., Lieberman-Klinger, S., Fantini, C., Kelty, D. L., Disla, R., & Sasson, N. (2012). Advanced upper limb prosthetic devices: Implications for upper limb prosthetic rehabilitation. Archives of Physical Medicine & Rehabilitation, 93(4), 710–717.
Wheaton, L. (2017). Neurorehabilitation in upper limb amputation: Understanding how neurophysiological changes can affect functional rehabilitation. Journal of Neuroengineering and Rehabilitation, 14(1), 1-12. doi:10.1186/s12984-017-0256-8
Wressle E, & Samuelsson K. (2004). Barriers and bridges to client-centered occupational therapy in Sweden. Scandinavian Journal of Occupational Therapy, 11(1), 12–16. https://doi.org/10.1080/11038120410019135
Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89(3), 422–429. https://doi.org/10.1016/j.apmr.2007.11.005