Bilateral BKA and Equine Assisted Activities and Therapies

Introduction

Research shows that amputations on patients help in preventing public health challenges related to profound psychological, social and economic effects on families and patients in developing nations (Rasmussen et al., 2016). The procedure helps in controlling disease or pain in the affected body part, such as gangrene and malignancy. Rasmussen et al. (2016) claim that there are different types of amputations. They include limb, genitals, face and breasts amputations. The limb categories comprise of the lower and the upper limp amputation categories. Facial amputation involves the eye, ear, tongue, nose and teeth amputations. However, this paper focuses on the lower limb amputation, which is below knee amputation. 

Purpose of BKA

According to the study, below-knee amputation aims to eliminate the unhealthy tissue in the leg and ensure that the remaining part becomes useful and less painful so that to enhance the life of the patient (Byun et al., 2016). The performance of BKA helps in solving ankle and foot problems. After BKA the patient would get provided with the artificial leg which will enable him or her to walk. In many cases, the process occurs in the region between the knee and the ankle. The procedure helps patients in solving issues regarding different injuries and diseases. 

Signs and Symptoms 

BKA procedure is a procedure applied in case a patient is experiencing a severe infection or severe injuries. For instance, BKA is applicable in situations where a patient is facing conditions such as congenital disabilities, tumor, non-healing cancer and chronic pain (Byun et al., 2016). However, the decision to implement BKA involves consideration of various factors and requires a detailed conversation between the surgeon and the patient. 

Precautions

Even though the procedure has positive impacts on patients, various medical concerns limit performing BKA on specific patients (Byun et al., 2016). Some of the reasons include poor blood flow. The study indicates that patients who have poor blood flow need to undergo assessment before any form of surgery, such as BKA. The wound of a patient whose blood flow is adequate is likely to heal as compared to one with poor blood flow (Byun et al., 2016). Meaning that there is a need to refer the patient to a specialist before performing BKA. If a patient has bleeding problems, poor immune system, and severe lung or heart disease, he or she should not undergo the process. 

Additionally, patients with tumors or infections above the knee would need a higher level of amputation. Thus, there should not undergo the procedure. Also, the patients with muscle and scar tissue loss should not be BKA candidates (Byun et al., 2016). The reason is that they would not have adequate muscles or skin that would support the use of the artificial leg or healing the wound. Furthermore, patients with knee pain or limited knee function should not undergo BKA. The patients who have knee pain or are experiencing challenges with straightening their knees would have a problem in using the artificial leg. Also, there is a need to consider patients who can neither stand nor walk (Byun et al., 2016). Therefore, there is need to take caution of such patients to avoid any further complications. 

Treatment Procedure

After deciding that BKA is appropriate, there is a need to use a team approach in handling the process. The process should include various specialists in the sector such as the orthopedic surgeon, medical doctor, a therapist and a prosthetist (Byun et al., 2016). Also, the process should include patients who have undergone the process due to similar complications and support groups. This team is significant during and after the procedure. 

During BKA, the specialist would amputate the leg so that he or she can remove the unhealthy tissues (Byun et al., 2016). The procedure should ensure that there are adequate inches of the leg remaining below the knee, the length will help the team to be able to fix the artificial leg properly. However, it is not appropriate to have a very long residual limb; this would not help in improving the ability to wear and put the artificial leg. 

After the BKA process, the patient would need to get admitted in the hospital for a minimum of one day (Byun et al., 2016). However, many patients always can get back home after the process so long as they can walk with crutches and have people who can assist them at home (Byun et al., 2016). On the other hand, some would require help with walking and others may have complications, thus would need to stay in the hospital so that they can recover to return home.  

The study shows that the wound is likely to heal between two and six weeks (Byun et al., 2016). The research indicates that the healing process depends on the quality of skin, the presence of soft tissue, the blood flow and medical conditions in a patient (Byun et al., 2016). In some cases, the incision would swell. Thus the patient would require a specialist to decrease the swelling through the use of compression stocking. If the situation does not get addressed, then it will affect the effectiveness of the use of the artificial leg. The artificial leg will be loose If the swelling of the limb increases. Hence, a swollen leg would not be appropriate for fitting an artificial leg.  The patient would take about a year to heal. Thus, there will need to adjust the artificial leg regularly to ensure that it fits properly. 

Byun et al. (2016) indicate that many surgeons propose that the patient should wait for the incision to heal so that they can be able to walk with the artificial leg. Thus, it is advisable to fit the patients with a temporary artificial leg, then fix a permanent one after a year of the process. 

Physical Impact of Equine Assisted Activities and Therapies

One EAAT gets placed on the horse; the driver can prevent extension spasticity of the legs. The strategy helps in reducing the high tone of the patient’s muscle (Rigby & Grandjean, 2016). The process can improve the balance if vestibular, and the neuromuscular gets affected. As the horse tries to walk, there is displacement of gravity that occurs with a rhythmic movement that is the same to the human pelvis when one is walking. The rhythmic and smooth gait of the horse causes motor responses in the rider which are significant to the pattern of movement of the human pelvis when the patient is walking (Rigby & Grandjean, 2016). As a result, the center of gravity of the driver will change with the moving horse, bringing equilibrium ad righting the reactions to enhance the posture and stability of the body. Furthermore, to motor control and functioning of musculoskeletal, EAAT reactions would cause improvement in the digestive, circulatory and respiratory health of the patient. 

Adaptations to Facilitate EAAT

Based on the condition addressed in the above paragraph, an instructor would need adaptations that would facilitate a lesson of an individual with a physical disability. According to the study, various adaptations help in promoting Equine Assisted Activities and Therapies, such as Adaptive horseback riding, equine-assisted learning, trail riding and (García et al., 2016). All these adaptations are appropriate since they would assist patients with physical disabilities. These adaptations would help the patient to realize the impacts with the horse that reach beyond the actual time. The horse would help in creating a relationship between the patient and the instructor. The patient would be able to transfer these skills to personal relationships (García et al., 2016). The instructor can use these adaptations to help the patient grow and develop his or her potential. 

Conclusion

The purpose of this paper was to provide information relevant to below knee amputation. It gives various symptoms that would influence the implementation of procedure such as severe medical conditions and injuries. The text indicates that even though BKA helps in removing unhealthy tissues and reducing pain, there are conditions where the process is not applicable, such as when the patient has poor blood flow. Thus, it is advisable to refer the patient to a specialist before conducting the operation. The paper provides a treatment procedure and gives the physical effects of EAAT. It suggests that EAAT will help in improving the digestive, circulatory and respiratory health of the patient. In conclusion, the premises proposes the adaptations that an instructor should consider to facilitate EAAT lesson to a patient who has undergone BKA. 

References

Byun, S. H., Lee, J., & Kim, J. H. (2016). Ultrasound-guided bilateral combined inguinal femoral and subgluteal sciatic nerve blocks for simultaneous bilateral below-knee amputations due to bilateral diabetic foot gangrene unresponsive to peripheral arterial angioplasty and bypass surgery in a coagulopathic patient on antiplatelet therapy with a history of percutaneous coronary intervention for ischemic heart disease: A case report. Medicine, 95(29).

García-Gómez, A., Rodríguez-Jiménez, M., Guerrero-Barona, E., Rubio-Jiménez, J. C., García-Peña, I., & Moreno-Manso, J. M. (2016). Benefits of an experimental program of equestrian therapy for children with ADHD. Research in developmental disabilities, 59, 176-185.

Rasmussen, B. S., Yderstraede, K. B., Carstensen, B., Skov, O., & Beck-Nielsen, H. (2016). Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years. Diabetologia, 59(1), 121-129.Rigby, B. R., & Grandjean, P. W. (2016). The efficacy of equine-assisted activities and therapies for improving physical function. The Journal of Alternative and Complementary Medicine, 22(1), 9-24.