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PT 942 Phys Rehab II > Amputation > Flashcards

Amputation Flashcards

1
Q

Major cause of LE amputation?

A
  • peripheral vascular disease (PVD) associated w/Dm

- 2/3 of all LE amputations due to DM

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2
Q

Second leading cause of amputation?

A
  • trauma (MVA, war, gunshots)

- often young adults, more frequently men

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3
Q

Levels of amputation below the knee?

A
  • Long transtibial (> 50% of tibial length)
  • Transtibial (between 20-50% of tibia)
  • Short transtibial (< 20%)
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4
Q

Levels of amputation above the knee?

A
  • Long transfemoral (> 60% of femur length)
  • Transfemoral (between 35-60% of femur)
  • Short transfemoral (<35%)
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5
Q

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

A

true

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6
Q

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

A

true

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7
Q

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

A

-posterior tissues have better blood supply

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8
Q

what is a neuroma?

A
  • collection of nerve cell ends

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

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9
Q

Surgical process of muscle and fascia is to?

A
  • myoplasty, muscle to muscle closure
  • myofascial, muscle to fascia closure
  • properly stabilized to prevent sliding over the end of the bone
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10
Q

Surgical process of bone?

A
  • anterior portion of distal tibia is beveled to reduce pressure between end of the bone and the prosthetic socket.
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11
Q

Greatest postoperative concern is?

A
  • infection
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12
Q

How can PT influence positive wound healing?

A
  • teach proper bed mobility and avoiding pressure on newly amputated limb
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13
Q

Post surgical dressing include?

A
  • rigid
  • semirigid
  • soft dressing (elastic wraps, elastic shrinkers)
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14
Q

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

A
  • shrinkers
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15
Q

Goals of the 6 post surgical phase of care?

A
  • healing residual limb
  • protect remaining limb
  • indépendant transfers and mobility
  • demonstrate proper positioning
  • begin psychological adjustment
  • understand the process of prothetic rehab
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16
Q

Post surgical examination includes?

A
  • general systems review
  • post surgical status
  • pain (incision, phantom, other)
  • vascularity
  • functional status
  • ROM (amp and non-amp sides)
  • UE limitations if any
17
Q

Post surgical interventions?

A
  • 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
18
Q

Positioning guidelines (5)?

A
  • 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
19
Q

Early post surgical mobility should be performed how?

A
  • 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.
20
Q

Goals in the pre-prosthetic phase (4)?

A
  • 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
21
Q

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

A
  • 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)
22
Q

Difference between phantom limb sensations and pain?

A
  • 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.
23
Q

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

A
  • true
24
Q

Pre-prosthetic phase interventions?

A
  • residual limb care (wrapping, shrinkers, skin care, ROM, exercise)
  • balance and mobility
  • temporary prosthesis
  • pt education
25
Q

Bandaging basics include (8)?

A
  • 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
26
Q

Transfemoral bandaging should be done in what position?

A
  • 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
27
Q

Transtibial bandaging should be done with what?

A
  • (2) 4in elastic bandages (very large limbs might need three)
  • bandages should not be sewn together
28
Q

What contracture are the greatest deterrents to functional prosthetic rehabilitation?

A
  • hip flexion (need full ROM of extension for balanced upright posture)
  • knee flexion contracture (<15° in usually not a problem)
29
Q

Can contractors be corrected with stretching?

A
  • 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.
30
Q

What is the BEST treatment for contracture?

A
  • prevention
31
Q

Which muscles are particularly important for prosthetic ambulation?

A
  • hip extensors and abductors
  • knee extensors and flexors
  • including trunk and extremities is often indicated, especially older adults
32
Q

Pre-prosthesis interventions for balance and mobility?

A
  • 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.
33
Q

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

A
  • true
34
Q

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

A
  • true
35
Q

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

A
  • one new thing each session
  • give written materials
  • provide websites and video links
36
Q

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

A
  • 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
37
Q

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

A
  • true

PT 942 Phys Rehab II (15 decks)

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