Physical and Psychological Impact of Limb Loss Among Haiti Earthquake Survivors. Clinician Outreach and Communication Activity (COCA) Conference Call . March 3, 2010. Continuing Education Disclaimer.
Haiti Earthquake Survivors
Clinician Outreach and Communication Activity (COCA) Conference Call
March 3, 2010
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Terrence P. Sheehan, MD
Chief Medical Officer and
Director of Amputee Rehabilitation Program
Adventist Rehabilitation Hospital
Amputee Coalition of America (ACA)
Chair, ACA Medical Advisory Committee
Stephen T Wegener, PhD, ABPP
Director, Division of Rehabilitation
Psychology and Neuropsychology
Associate Professor of Physical Medicine and
Associate Professor of Health Policy and
Management, Bloomberg School of Public
Health, Johns Hopkins University
Moderator: Mary Helen Witten, Project Officer for Amputee Coalition of America in the National Center on Birth
Defects & Developmental Disabilities at the Centers for Disease Control and Prevention
At the conclusion of this hour, each participant should be able to:
Describe epidemiology, physiology and classifications of limb loss.
Compare and Contrast the incidence and management of limb loss in the United States with Post Earthquake Haiti.
Identify amputee pre-operative predictors of outcome for rehabilitation and lifelong follow through
Discuss essential information for the management of psychosocial issues following limb loss.
Terrence P.Sheehan, MD
NLLIC ACA Fact Sheet
should not be thought of as a failure of treatment, but as a treatment of choice.
Estimates of 2000 to 3000 people with limb loss
Majority are women and children
Majority below knee amputations
Numbers will grow over the next months to year because of poor infection treatment from traumaHaiti
Base decision on limb that can tolerate weight bearing, have sensation to provide protective feedback, and have durable skin and soft tissue cover.
The Amputation Surgery Education Center
Dedicated to helping surgeons improve technique and patient outcomes
Sherman, Richard A. Phantom Pain. New York: Plenum Press, 1997
Determining factors in choice of prosthetic
Patella Tendon Options
Medial Shaft of Tibia
Correct surgery, immediate rehabilitation/training, and a well-fitting prosthesis are all equallyimportant!
Rehabilitation should be both:
Surgeon needs limb
Levels of Amputation
Trans-humeral amputation performed at three levels:
Levels of Amputation
Prosthetic Fitting and Training
Global Assessment of Functioning
ICF Model: OptionsInteractive not linear/progressive
in Port-au-Prince, Haiti. By Deborah Sontag Published: New York Times
February 22, 2010
“I very much heard a number of people really wondering if something they did or thought prior to the earthquake essentially marred their relationship with God, causing this to happen to them. ”“Also heard, a number of the things that you would hear anywhere, about concerns about what their wife (or husband or children) might view them now--are they less a man (or woman).
“Also a great deal of concern (quite validly so) about how they will be able to support themselves or their families.”
Key Interventions Caryn Brady,
Disclaimer: The information and viewpoints in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry."
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