Amputation

Question 1

Major cause of LE amputation?

Answer 1

• peripheral vascular disease (PVD) associated w/Dm

- 2/3 of all LE amputations due to DM

Question 2

Second leading cause of amputation?

Answer 2

• trauma (MVA, war, gunshots)

- often young adults, more frequently men

Question 3

Levels of amputation below the knee?

Answer 3

• Long transtibial (> 50% of tibial length)
• Transtibial (between 20-50% of tibia)
• Short transtibial (< 20%)

Question 4

Levels of amputation above the knee?

Answer 4

• Long transfemoral (> 60% of femur length)
• Transfemoral (between 35-60% of femur)
• Short transfemoral (<35%)

Question 5

T/F - many individuals with bilateral amputations can be successful rehabilitated.

Answer 5

true

Question 6

T/F - older adults with unilateral tranfemoral amputations with good balance, coordination are potential prosthetic users?

Answer 6

true

Question 7

Why are long posterior flaps used in transtibial amputations in patients compromised circulation?

Answer 7

-posterior tissues have better blood supply

Question 8

what is a neuroma?

Answer 8

• collection of nerve cell ends

- can form close to scare tissue or bone causing pain in residual limb.

Question 9

Surgical process of muscle and fascia is to?

Answer 9

• myoplasty, muscle to muscle closure
• myofascial, muscle to fascia closure
• properly stabilized to prevent sliding over the end of the bone

Question 10

Surgical process of bone?

Answer 10

• anterior portion of distal tibia is beveled to reduce pressure between end of the bone and the prosthetic socket.

Question 11

Greatest postoperative concern is?

Answer 11

• infection

Question 12

How can PT influence positive wound healing?

Answer 12

• teach proper bed mobility and avoiding pressure on newly amputated limb

Question 13

Post surgical dressing include?

Answer 13

• rigid
• semirigid
• soft dressing (elastic wraps, elastic shrinkers)

Question 14

What post surgical dressing is best used after healing has taken place and the sutures have been removed?

Answer 14

• shrinkers

Question 15

Goals of the 6 post surgical phase of care?

Answer 15

• healing residual limb
• protect remaining limb
• indépendant transfers and mobility
• demonstrate proper positioning
• begin psychological adjustment
• understand the process of prothetic rehab

Question 16

Post surgical examination includes?

Answer 16

• general systems review
• post surgical status
• pain (incision, phantom, other)
• vascularity
• functional status
• ROM (amp and non-amp sides)
• UE limitations if any

Question 17

Post surgical interventions?

Answer 17

• position to avoid contracture
• sit/stand balance and transfers
• mobility training with AD’s if appropriate
• residual limb care, bandaging
• care of remaining limb (if circulation is compromised)
• EDUCATION on amputation, residual limb care, HEP and prosthetics

Question 18

Positioning guidelines (5)?

Answer 18

• prevent hip contractors
• encourage pt to spend time in prone
• do NOT put pillow under residual limb in supine
• avoid prolonged periods in sitting
• early on avoid sidling on residual limb, keep residual limb in hip/knee extension when sidling on opposite hip.
• *basically avoid flexion positions

Question 19

Early post surgical mobility should be performed how?

Answer 19

• pt should stand/transfer leading with unamputated side (to protect residual limb from possible injury from chair/bed)
• training with walker or crutches (depending strength/balance)
• if pt has Dm/PVD they need to wear a shoe on remaining foot to prevent skin break-down or injury.

Question 20

Goals in the pre-prosthetic phase (4)?

Answer 20

• indep with residual limb care (bandaging/shrinker/skin care/positioning)
• indep mobility, transfers, functional activities
• demonstrate HEP accurately
• care of remaining LE if vascular compromise

Question 21

What skin, vascularity items should you look at during a pre-prosthetic examination?

Answer 21

• skin (scar, other lesions, moisture, sensation, grafts, dermatological lesions)
• vascularity (pulses, color, temp, edema, pain, trophic changes)
• residual limb length (measured from medial tibial plate or from ishcial tuberosity)
• residua limb shape (abnormalities/”dog ears”, adductor rolls)

Question 22

Difference between phantom limb sensations and pain?

Answer 22

• sensations (tingling, burning, itching, pressure)
• pain generalized noxious sensation so strong it interferes with prosthetic fitting.
• mixed results with pain meds, US, TENS, massage, etc.

Question 23

True/False - older adults with transtibial amputations make excellent adjustments to prosthetic function.

Answer 23

• true

Question 24

Pre-prosthetic phase interventions?

Answer 24

• residual limb care (wrapping, shrinkers, skin care, ROM, exercise)
• balance and mobility
• temporary prosthesis
• pt education

Question 25

Bandaging basics include (8)?

Answer 25

- purpose is to shrink/shape residual limb in prep for prothetic fitting - begin with dry, rolled bandage - limb is dry - always use diagonal turns (circular restrict circulation) - greater pressure distally (to eliminate edema) - re-bandage 3-4 times/day - secure with tape - wear bandage at all times except (bathing, massaging limb, exercising, wearing prosthesis

Question 26

Transfemoral bandaging should be done in what position?

Answer 26

- side-lying - (2) 6in and (1) 4in bandage - 6in bandages can be sewn together to make a smoother wrap. - start medially so the hip wrap (hip spica) will encourage extension

Question 27

Transtibial bandaging should be done with what?

Answer 27

- (2) 4in elastic bandages (very large limbs might need three) - bandages should not be sewn together

Question 28

What contracture are the greatest deterrents to functional prosthetic rehabilitation?

Answer 28

- hip flexion (need full ROM of extension for balanced upright posture) - knee flexion contracture (<15° in usually not a problem)

Question 29

Can contractors be corrected with stretching?

Answer 29

- mild contractors may respond to manual mobilization and active exercise. - almost impossible to reduce moderate to severe contracture by manual stretching, especially hip flexion. - facilitated stretching techniques (PNF) are more effective than passive stretching.

Question 30

What is the BEST treatment for contracture?

Answer 30

- prevention

Question 31

Which muscles are particularly important for prosthetic ambulation?

Answer 31

- hip extensors and abductors - knee extensors and flexors * including trunk and extremities is often indicated, especially older adults

Question 32

Pre-prosthesis interventions for balance and mobility?

Answer 32

- early mobility is important, want pt to resume indep activities ASAP - important to develop good standing balance on remaining limb - care must be taken to protect remaining foot but training should include activities with and without shoes, eye's open/closed.

Question 33

True/False - crutch walking is good preparation for prosthetic ambulation.

Answer 33

- true

Question 34

True/False - walking with catches without a prosthesis requires greater energy expenditure than waling with a prosthesis?

Answer 34

- true

Question 35

When education patients the PT needs to be careful to not overwhelm the patient, how?

Answer 35

- one new thing each session - give written materials - provide websites and video links

Question 36

What things need to be considered when determining prosthetic potential (9)?

Answer 36

- cost - energy demands of training (especially transfemoral) - pre surgical activity level - level of activity participation in pre-prosthetic program - contractures - obesity - weakness/paralysis of key muscles - balance/coordination - motivation

Question 37

True/False - Many individuals previously ambulatory before amputation (unilateral transtibial) will be able to independently ambulate with prosthesis.

Answer 37

- true