Consider Cognitive Impairment in Prosthetic Treatment Approach for Patients With Diabetes

Implementing a complete cognitive assessment into the prosthetic
treatment approach may help practitioners to better understand how cognitive
status can influence rehabilitation, especially among people with diabetes who
are more commonly at increased risk for both factors, according to Elisa de
Jong, CPO, LO.

Diabetics are particularly at risk for cognitive decline
compared to nondiabetics. The cognitive domains that are most affected in the
diabetic patient population are also important domains for prosthetic
use,” said de Jong, a certified prosthetist orthotist at Children’s
Memorial Hospital in Chicago.

Studies to date have indicated that diabetes is a risk factor for
cognitive decline. Along with impairment in cognitive function, comorbidities
that lead to nontraumatic amputations occur in more than 60% of this

“Cognitive status is a fundamental factor the prosthetic team
should consider when providing prosthetic restoration and education,” de
Jong told O&P Business News.

De Jong conducted a literature review as part of her prosthetics
residency program while at the University of Michigan. She reviewed more than
30 articles published from 1984 to 2010 in an effort to emphasize the
relationship between diabetes and associated cognitive impairment, which are
linked to implications for prosthetic rehabilitation.

These study results were presented at the American Academy of Orthotists
and Prosthetists 37th Annual Meeting and Scientific Symposium in Orlando, Fla.

Results of de Jong’s literature review confirmed that cognitive
impairment has been found to be associated with diabetes in varying degrees and
affects not only memory (particularly verbal memory), but also measures of
executive function, psychomotor speed, attention and concentration.

Cognitive status should be considered because it can influence all
aspects of health care, including compliance and rehabilitation potential, de
Jong said. Because people with diabetes are at greater risk for and have a
higher rate of cognitive decline, they may be even more likely to forget
instructions, misunderstand functional use of a prosthesis or have the
inability to problem solve. They may also lack understanding of the importance
of hygiene and care of the prosthetic components, according de Jong.

“These deficits can and will lead to a poorer functional outcome
for prosthetic use,” she said. “As this group comprises the majority
of the global amputee population, treatment protocols should be formulated with
cognitive status in mind.”

Current treatment plans focus on patients’ physical characteristics
such as their skin condition, muscle strength, range of motion and upper
extremity function to help determine which components to use, according to de
Jong. Based on her review analysis, she believes that special consideration and
effort toward improving patient education and care could help patients
strengthen their rehabilitation potential.

“Ultimately, if the patient is unable to mentally grasp the
information necessary for prosthetic use, their rehabilitation potential is
poor,” de Jong said.

Therefore, she recommended that practitioners providing prosthetic care
for patients with diabetes evaluate current education and treatment methods to
determine if they can be improved or modified. — by Tara Grassia

For more information:

  • de Jong E. Association between diabetes mellitus and cognitive
    impairment — implications for prosthetic rehabilitation. Presented at the
    American Academy of Orthotists and Prosthetists 37th Annual Meeting and
    Scientific Symposium. March 16-19, 2011. Orlando, Fla.

Disclosure:DeJong has no relevant
financial disclosures.

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