Amputation Flashcards
Major cause of LE amputation?
- peripheral vascular disease (PVD) associated w/Dm
- 2/3 of all LE amputations due to DM
Second leading cause of amputation?
- trauma (MVA, war, gunshots)
- often young adults, more frequently men
Levels of amputation below the knee?
- Long transtibial (> 50% of tibial length)
- Transtibial (between 20-50% of tibia)
- Short transtibial (< 20%)
Levels of amputation above the knee?
- Long transfemoral (> 60% of femur length)
- Transfemoral (between 35-60% of femur)
- Short transfemoral (<35%)
T/F - many individuals with bilateral amputations can be successful rehabilitated.
true
T/F - older adults with unilateral tranfemoral amputations with good balance, coordination are potential prosthetic users?
true
Why are long posterior flaps used in transtibial amputations in patients compromised circulation?
-posterior tissues have better blood supply
what is a neuroma?
- collection of nerve cell ends
- can form close to scare tissue or bone causing pain in residual limb.
Surgical process of muscle and fascia is to?
- myoplasty, muscle to muscle closure
- myofascial, muscle to fascia closure
- properly stabilized to prevent sliding over the end of the bone
Surgical process of bone?
- anterior portion of distal tibia is beveled to reduce pressure between end of the bone and the prosthetic socket.
Greatest postoperative concern is?
- infection
How can PT influence positive wound healing?
- teach proper bed mobility and avoiding pressure on newly amputated limb
Post surgical dressing include?
- rigid
- semirigid
- soft dressing (elastic wraps, elastic shrinkers)
What post surgical dressing is best used after healing has taken place and the sutures have been removed?
- shrinkers
Goals of the 6 post surgical phase of care?
- healing residual limb
- protect remaining limb
- indépendant transfers and mobility
- demonstrate proper positioning
- begin psychological adjustment
- understand the process of prothetic rehab
Post surgical examination includes?
- general systems review
- post surgical status
- pain (incision, phantom, other)
- vascularity
- functional status
- ROM (amp and non-amp sides)
- UE limitations if any
Post surgical interventions?
- 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
Positioning guidelines (5)?
- 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
Early post surgical mobility should be performed how?
- 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.
Goals in the pre-prosthetic phase (4)?
- 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
What skin, vascularity items should you look at during a pre-prosthetic examination?
- 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)
Difference between phantom limb sensations and pain?
- 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.
True/False - older adults with transtibial amputations make excellent adjustments to prosthetic function.
- true
Pre-prosthetic phase interventions?
- residual limb care (wrapping, shrinkers, skin care, ROM, exercise)
- balance and mobility
- temporary prosthesis
- pt education
Bandaging basics include (8)?
- 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
Transfemoral bandaging should be done in what position?
- 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
Transtibial bandaging should be done with what?
- (2) 4in elastic bandages (very large limbs might need three)
- bandages should not be sewn together
What contracture are the greatest deterrents to functional prosthetic rehabilitation?
- hip flexion (need full ROM of extension for balanced upright posture)
- knee flexion contracture (<15° in usually not a problem)
Can contractors be corrected with stretching?
- 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.
What is the BEST treatment for contracture?
- prevention
Which muscles are particularly important for prosthetic ambulation?
- hip extensors and abductors
- knee extensors and flexors
- including trunk and extremities is often indicated, especially older adults
Pre-prosthesis interventions for balance and mobility?
- 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.
True/False - crutch walking is good preparation for prosthetic ambulation.
- true
True/False - walking with catches without a prosthesis requires greater energy expenditure than waling with a prosthesis?
- true
When education patients the PT needs to be careful to not overwhelm the patient, how?
- one new thing each session
- give written materials
- provide websites and video links
What things need to be considered when determining prosthetic potential (9)?
- 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
True/False - Many individuals previously ambulatory before amputation (unilateral transtibial) will be able to independently ambulate with prosthesis.
- true
