Assessment of Trans-tibial Amputee

 1. Demographic Data

Name 

Age 

Sex 

Diagnosis

Chief Complain

2. On Observation 

Whether patient came on wheel chair or with crutches or with support or in mother's lap.

- Gait pattern , ambulatory or non ambulatory 

- Body Build _ endo , ecto , meso.

- side of amputation

3. History 

Case History

- when amputation occurred ? 

- cause of amputation

PVD , gangrene , diabetes , trauma , burn

 

- whether amputee is previous prosthesis user or not .

Medical History

- which other institutions does he visited before.

- any other associated disease (diabetes or B.P. ) is present or not

4. Socio-Economic Factor

- family background

- occupation 

- financial condition

5. On Examination 

- range of motion of residual joint

- MMT

- VAS (visual analogue scale ,  if pain occurs ) 

- MAS (Modified Ashworth scale , if spasticity)

- Contracture 

- Stump evaluation 

i) shape 

ii) size 

iii) scar - positioning , adherent or non adherent

iv) abrasion

v) edema 

vi) neuroma

vii) end wt. bearing or not 

viii) bony prominences and muscular conditions

ix) skin grafting

x) phantom limb sensation and pain

6. Long term and short term goals

7. Type of prosthesis prescribed 

- socket type

- suspension type

- foot

                                            Under Guidance of-

                                Ms. Chandni Pandey(MPO)