2) Amputee Management Flashcards
What things need to be considered when examining a pt for a LE prosthetic and why?
- Skin → Sock/Sheath, Suspension, & Socket
- Girth → Fit, Suspension
- Shape → Fit, Suspension
- Length → Suspension, Cosmesis, & Energy Expenditure
- ROM → Fit, Stability, Cosmesis, & Energy Expenditure
- Muscle Strength → Stability
- Proprioception → Stability
- UE strength & dexterity
- CP Endurance → Prosthetic weight & type
- Neuro
- Vision → Stability, donning, & inspecting LE’s
- Psychosocial/Emotional Compliance
Why are longer limbs better?
Improve balance & suspension
When examining a pt for an LE prosthetic, what muscles need to be especially strong?
Hip Extensors & Abductors
Give some examples of some bad things to find when doing a skin exam
- Heat
- Redness
- Pain
- Open Areas
- Drainage
If a pt w/a prosthetic has a skin problem, what should you do?
Refer them to their physician
What causes verrucous hyperplasia and what does it look like?
Caused by repetitive skin trauma; Looks black & crumbly
What is the problem w/silicone liners?
Many pt’s are are allergic to them
What is this? Why does it happen? What would you do about it and why? *
- Bulbous Skin - Caused by lack of venous return bc muscles are gone
- Next step would be a shrinker once the scars are healed bc the residual limb should be conically shaped
Medicare Functional Classification Levels
Says what pt’s are capable of & relates them to their goals, which dictates what kind of parts insurance will pay for
K0
No potential for ambulation, even w/prosthesis; Pt’s will typically live in a facility
K1
Prosthesis would allow limited household on a level surface, w/little cadence change
K2
Prosthesis would allow limited community ambulation; Can navigate steps & curbs; Some cadence change
K3
- Prosthesis would allow for independence in community
- Ambulation w/varying cadence & activity levels
- Prosthesis is needed for full participation in vocational or leisure activities
K4
Prosthesis would allow for full independence and high-level activity, athletics, vocational, or leisure
What factors affect classification/prognosis?
- Age
- Level of amputation
- Time since amputation
- Condition of intact limb
- Comorbidities such as HTN, DM, OA
- Fxnl abilities w/out prosthesis
- AMPnoPRO score
What is the AMPnoPRO?
Predicts how well a pt will do w/a prosthetic, based on their performance w/an assistive device
- Considers 21 items such as balance, gait, & fxnl tasks
What does the AMPPRO look at?
Pt’s who want to upgrade their prosthetic
What are some pre-prosthetic interventions?
- Limb wrapping
- Desensitization
- Elevation
- Scar Tissue Massage
- Shrinkers
- Positioning for contracture management
- Strengthening
- Balance training
- Transfer training
When should a pt wear their shrinker?
After stitches are removed, whenever prosthesis is not worn during the 1st post-op year
If a pt is hypersensitive, what can PT do about it?
Find out what irritates them and have them do desensitization in HEP
What interventions should be done for pt’s w/a prosthetic?
- Wearing → Helps w/limb shape
- Donning & doffing w/skin inspection
- Pt ed
- Balance & coordination training
- Gait training
- Fxnl task training
What are some assessments you should do to a pt w/a prosthetic in sitting?
- ID/eval each of the types of prosthetic components & suspension
- # of ply socks pt is wearing
- Donning and Doffing
- Pt comfort
What are some assessments you should do to a pt w/a prosthetic in standing?
- Foot position (Too inset or outset)
- Is foot flat on the floor?
- Is there excessive lean of the pylon forwards or to the side?
- Overall balance & symmetry btwn legs
- Pt’s ability to stand w/6” BOS
- Leg length symmetry
- Prosthesis stability
- Is the ischium contained w/in the socket?
- Flesh roll above or to the sides of the socket?
- Vertical pressure in the perineum
- Socket fit
What are some assessments you should do to a pt w/a prosthetic while ambulating?
- Pistoning → Means socket is too large or there’s too much suspension
- Pinching or gapping
- Effective fxn of suspension
