Amputation

Question 1

limb salvage

Answer 1

depending on severity part of foot may be kept
eg just amputate toes/partial foot
depends on boundaries of dead tissue, prosthesis use, mobility/function, cosmetic appearance

Question 2

myodesis

Answer 2

muscle secured to bone by suturing distal tendon drilled into bone
done in amputation bka/aka to reduce residual limb deformity

Question 3

myoplasty

Answer 3

attach muscle to opposing muscle

Question 4

indications for amputation

Answer 4

PVD
diabetic wounds
trauma
infection
cancer
congenital deformity

Question 5

fall prevalence in amputees

Answer 5

50% of those using prosthetic fall at least once per year

Question 6

what contributes to worsened balance/increased fall risk after amputation

Answer 6

lose somatosensory input
reduced weight bearing
reduced confidence
loss of ankle strategy necessitates increased reliance on other balance strategies
reduced response to perturbation due to lack of kinesthetic awareness

Question 7

symes amputation

Answer 7

remove foot, med/lat malleoli removal, relocate heel pad to distal tibia

Question 8

chopart amputation

Answer 8

removal of foot distal to talus/calcaneus

Question 9

lisfranc amputation

Answer 9

removal of foot distal to tarsometarsal joint

Question 10

characteristics of BKA gait

Answer 10

decreased velocity
short step length
increased stance, especially on sound limb creating asymmetrical stance time
due to loss of mm. control in lower limb

Question 11

characteristics of AKA limb control

Answer 11

loss/impaired musculature below pelvis
hip preserved

Question 12

UE amputations types

Answer 12

interscapular thoracic: entire UE/clavicle/scapula
shoulder disarticulation: entire UE through shoulder joint
transhumeral: through humerus
elbow disarticulation: through elbow joint
transradial: through radius/ulna
wrist disarticulation: through wrist, removing carpals
partial hand/metacarpal/thumb/phalangeal removal
most often from trauma or cancer

Question 13

amputation rehab timeline

Answer 13

pre op
surgery
acute post op: wound healing/control pain/strength/ROM
pre prosthetic: limb shaping, manage edema, address any impairments before prosthetic
determine candidacy for prosthetic
prosthetic training: static and dynamic use
community reintegration
return to work
functional follow up throughout lifetime

Question 14

post op amputation rehab goals

Answer 14

wound healing
pain management, desensitization
ROM, avoid contractures
strength
protection
functional ADLs, transfers
ambulation
education

Question 15

amputee PT examination includes:

Answer 15

integumentary: residual limb
vascular: pulse, edema, etc of both limbs
neuro: sensation, phantom limb, pain
shape: cylinder is ideal, may be bulbous, dog eared
MSK: ROM, strength, contractures
vitals
functional mobility
gait
cognition
psych state

Question 16

pain management after amputation

Answer 16

phantom limb: perceive pain/tingling in missing limb
more in women>men
manage w meds, compression, relaxation, massage, biofeedback, TENS

Question 17

measure limb length

Answer 17

include soft tissue
take from bony landmarks to incision line or end of soft tissue
use greater troch or ischial tub

Question 18

ideal residual limb measurements

Answer 18

want distal circumference within 1/4 in of proximal limb circumference

Question 19

contraindications to post op amputee PT

Answer 19

excess wound drainage
sharp local pain
fever
foul odor/infection
hold until stable

considerations:
cognitive dysfunction, comorbidities, CV, ulcer/infection, flexion contracture, age, psychosocial factors

Question 20

compression dressings: ACE wrap

Answer 20

BKA: 4-6 in
AKA: 6 in
figure 8 pattern for edema control, easy to access wound
not very protective, needs to be reapplied, contractures

Question 21

compression dressings: shrinker

Answer 21

elastic compression sock
custom sizing
controls edema, easy wound access, even compression
may not be comfortable, not protective, contractures

Question 22

compression dressings: rigid dressing

Answer 22

plaster/rigid, place 7-10 days or removable
protects limb, prevent contractures
high infection risk if nonremovable bc decreased wound access, bulky and heavy

Question 23

IPOP

Answer 23

rigid dressing with stick for ambulation
control edema, protect, shape limb
no incision access, expensive, training

Question 24

AMPPro and AMPNoPro MDC

Answer 24

3.4 points
can be tested with or without prosthetic
AMPNoPro successful scores can indicate readiness for prosthetic

Question 25

residual limb wrapping

Answer 25

even pressure throughout with even bandage distribution
cylindrical shape
stretch to 1/2 elasticity
change every 4 hours

Question 26

principles of ACE wrapping residual limb

Answer 26

distal pressure more than proximal
no wrinkles
reapply every 4 hours
tape down wrap
remove if burning, N/T, aching
wear 23 hours day and remove for hygiene
wash daily

Question 27

pain management after amputation

Answer 27

imagery/relaxation
TENS
US
cold therapy
massage
compression
medications/injections/nerve block

Question 28

common contractures to prevent

Answer 28

hip flexion
knee flexion
hip ER/abduction
positions of comfort while laying in bed w legs ERed and elevated, muscle imbalance, and protective flexion reflex

Question 29

contracture management

Answer 29

avoid residual limb elevation
lie prone
manual stretching/PNF
avoid long periods of sitting

Question 30

strengthening after amputation

Answer 30

maximize trunk/UE/LE strength/endurance for prosthetic gait, prevent contractures
start isometric to avoid incision opening
no valsalva
AROM unaffected limb day 1
AROM affected limb day 1-3
bed mobility/transfers day 2
start large arcs of motion, active resistive
eccentric, etc

Question 31

when to prescribe prosthesis for transtibial amputation

Answer 31

transtibial:
patient has own knee power
if it would help w transfer
prothesis helps w STS

transfemoral:
pt has no knee power w or w/o prosthesis
transfers easier w prosthesis but STS harder
pt must be able to transfer/STS independently, walk in parallel bars w one leg gait 6-8 meters