Amputations and Prosthetics: A Case Study Approach, 2d ed.

May BJ. Philadelphia, PA 19103, FA Davis Co, 2002, paperback, 290 pp, illus, ISBN: 0-8036-0839-X, $37.95.

The second edition of Amputations and Prosthetics incorporates the changes that have occurred in physical therapy and prosthetics since the first edition was published in 1996. The book contains language consistent with the Guide to Physical Therapist Practice (Guide). Advances in prosthetic technology and research are also included. The essential purpose of the book remains the same--to serve as a teaching text for physical therapists and physical therapist assistants. The format is also the same as in the first edition. Four patient cases are developed throughout the book. The reader can use these cases to discuss options for interventions throughout the rehabilitation phases of the patients.

The book has 11 chapters. The first 4 chapters provide the background information that the physical therapist and physical therapist assistant will need to provide interventions for a significant portion of those people seen in physical therapy for rehabilitation after an amputation--older adults with diabetes. Chapter 1 provides an interesting historical perspective on how surgery and prosthetics have developed over the centuries. It would have been helpful if the book provided the Guide preferred practice pattern related to amputation (Pattern 4K) as a reference for the patient cases in the text.

Chapters 2 through 4 are comprehensive in their coverage of peripheral vascular disease, the diabetic foot, and lower-extremity surgical amputation, respectively. Chapter 2 would have benefited from an overview table, because various sections in the chapter present information on the examination, assessment, and management of venous and arterial disease, which become difficult to follow. Chapter 3 provides an excellent overview of the risk factors for diabetes and the management and educational responsibilities of the physical therapist and physical therapist assistant who work with patients with diabetes. Chapter 4 offers sound information with good descriptions of the surgical process. This chapter provides an understanding of the surgical interventions and their application to rehabilitation management.

Chapters 5 through 9 cover the rehabilitation of the patient from the immediate postoperative period through the return to recreational activities. Chapter 5 covers a range of options for postoperative dressings; however, the information appears in 2 separate places in the chapter. It would have been easier to follow if the section on residual limb care was incorporated into the section on postoperative dressings. Examination and early physical therapy interventions are the remaining pieces of this chapter. Basic activities, which include mat, bed, positioning, and transfer skills, are presented. The case studies are detailed and offer students the opportunity to discuss a variety of options for each patient. However, putting the "Case Questions" and "Case Study Activities" in italics and text boxes would make the text easier to follow.

The brief chapter on psychosocial issues, chapter 6, does not provide information for patients in all age groups. This chapter briefly addresses the following age groups: children from infancy to adolescence and the elderly. Middle-aged adults and their concerns following an amputation are left out of the discussion, except by inference. The psychological implications of the numerous role disruptions, including changes in social roles, are not explored. The information provided on motivation and adherence, however, is useful for understanding patient outcomes and is an area rich for discussion in each patient case.

The chapter on prosthetics components, chapter 7, is a good overview of the major types of components. The tables in the chapter summarize the information in the text nicely. The chapter is up to date and includes microprocessor technology fur knee units, changes in socket designs, and advances in liners.

Chapter 8, "Lower Extremity Prosthetic Management," is extensive. The information on rehabilitation after transtibial and transfemoral amputations would have been easier to follow if it had been separated into 2 sections or chapters. In addition, the transtibial checkout form on page 169 contains an error--item 7 is incorrect because a vertical pylon is not the best indicator of correct alignment of the prosthesis in weight bearing. If this line is removed from the checkout form, the remainder is a helpful guide to the assessment of prosthetic fit. The descriptions of transtibial and transfemoral gait deviations are well written and represent a majority of the deviations that are likely to be observed in the clinic. Older observational gait analysis terminology of "heel-strike, foot flat, and toe-off" is used, and current students may be more familiar with the Rancho Los Amigos terminology of "initial contact, loading response, and preswing."

The chapter on long-term care, chapter 9, advances the information provided in chapter 5 by providing more detail about the daily use and care of a prosthesis and performing advanced activities. Information on ascending and descending steps and inclines and clearing obstacles could have been included in chapter 5. Running was described in the "skip-hop" style, but illustrated only in the "leg-over-leg" style. A physical therapist would need to find more information on running from an educational course or another text before teaching a patient or client to run with his or her prosthesis. Nevertheless, the student will find a great deal of information in these 2 chapters to use in developing a rehabilitation program for people with an amputation.

The final 2 chapters are good primers that will help the physical therapist or physical therapist assistant understand a less common patient population--people with an upper-limb amputation. Joan Edelstein, PT, is the author of chapter 10, which covers upper-limb amputations. It is a well-written chapter that provides a basic understanding of management of the patient with upper-extremity limb loss. Chapter 11 introduces the physical therapist and physical therapist assistant to children with amputations and contains sound, basic information. These chapters accomplish the task of providing introductory information for the prosthetic management of these patient populations.

The interactive questions and activities in the case studies highlight the types of decisions that physical therapists and physical therapist assistants need to make when working with this patient population. The specific questions posed to the physical therapist and physical therapist assistant identify the scope of practice for each, with real-world cases that are instructive and practical. The problem solving and class discussion that could develop from the use of the cases will provide the student with an excellent foundation for interacting successfully with people with an amputation who require rehabilitation. There are a few typographical and editorial errors that should have been identified before the book went to print. The text could still use updating in terminology and the layout of some sections is confusing.

This text can be used as a classroom teaching tool to introduce the basic procedures for rehabilitation of people with an amputation. Supplemental texts may be necessary, however, in order to incorporate additional aspects of rehabilitation of people with an amputation.

Melissa Wolff-Burke, PT, EdD, ATC
Shenandoah University
Winchester, Va

Dr Wolff-Burke teaches the prosthetics and orthotics curriculum, directs a camp for children with amputations, and has written for and is a member of the Amputee Coalition of America. She works with people with amputations at an outpatient orthopedic practice.