Amputation Exam Flashcards
Post-surgical Phase Goals
Healing of residual limb Protect intact limb Increase independence in transfers and mobility Demonstrate proper positioning Understand prosthetic rehab process
Pay attention to skin integrity, especially heel of good limb
Post-surgical Intervention
Positioning to avoid contractures Standing balance and transfers Mobility training (walker or crutches) Residual limb care and protection Care of the non amputated limb Education
Post Surgical Interventions: Positioning
Critical to prevent hip and knee flexion contractures
Spending time in prone is a must
Never put pillows under residual limb
Avoid prolonged sitting
When in sitting use an amputee board in the W/C for transtibial to keep knee in extension
In sidelying keep residual limb in slight hip and knee extension
Post Surgical Interventions: Balance and Transfers
During this phase….Stand and Transfer leading with unamputated limb to protect residual limb from possible injury against chair or bed
Be Creative (and SAFE) with Exercises
Post Surgical Interventions: Residual Limb Care
Manage Post-Surgical Dressing Limb Wrapping Lab Monday 3/13 Inspect Residual Limb Move Residual Limb Lift to MOVE, DO NOT DRAG AROM at hip and knee (if applicable) pain free, no shearing
Post Surgical Intervention: Strengthening
POD 1-7 Transfemoral Isometrics (glut sets, add) AAROM residual limb AROM and PRE’s of uninvolved limb Transtibial Isometrics (glut sets, quad sets) AAROM residual limb AROM and PRE’s of uninvolved limb
Resisted exercises of the residual limb are contraindicated during this phase
Preprosthetic Phase Goals
Indep in residual limb care
Bandaging/shrinker, skin care, positioning
Indep in mobility, transfers, and functional activities
Single leg ambulation with crutches/FWW if fitted with soft dressing
Demonstrate HEP
ROM progressing to resistive exercises for residual limb
ROM and strength for unamputated limb
Care of the unamputated limb if vascular issues
Preprosthetic Exam: Residual limb
Status of the residual limb Length of bone Circumference Shape Amount of redundant tissue Edema Pulses Scar Temperature Color
Residual Limb Measurement for Transtibial
Length – medial tibial plateau to end of bone AND end of soft tissue
Circumference – every 5-8 cm
Residual Limb Measurement for Transfemoral
Length – greater trochanter to end of bone AND end of soft tissue
Circumference – every 8-10 cm
Preprosthetic Examination: ROM/Strength
ROM
Unamputated limb: gross OK except hip ext and ankle DF
Transtibial – hip flex, ext, abd, add and knee flex, ext
Transfemoral – hip flex, ext, abd, add
Strength Gross strength UE and unamputated LE MMT residual limb once healed ***TT: hip ext, abd, knee ext, flex ***TF: hip ext, abd
Phantom Pain
Pain which originates from brain but is perceived as pain from the amputated portion of the limb
Affects quality of life
60-80% of patients with an amputation experience it
May be present for only days or weeks or as long as years and decades
Incidence higher after traumatic or preexisting painful condition vs. a planned surgical amputation or non-painful limb
Thought to be caused by:
A conflict between the visual and proprioceptive systems inducing body image distortion
Cortical remapping of the somatosensory cortex
K Levels
K0 – No Mobility. This base level is assigned to amputees who do not have the ability or potential to ambulate or transfer safely with or without assistance. A prosthesis does not enhance the quality of life or mobility of the amputee.
K1 – Very Limited Mobility. The amputee has the ability or potential to use a prosthesis for transfers or ambulation in level surfaces at a fixed walking pace. Typical household ambulator.
K2 – Limited Mobility. The amputee has the ability or potential to use a prosthesis for ambulation and the ability to adjust for low-level environmental barriers such as curbs, stairs, or uneven surfaces. K2 level amputees may walk for limited periods of time however, without significantly varying their speed. Typical limited community ambulator.
K3 - Basic to Normal Mobility. The amputee has the ability or potential to use a prosthesis for basic ambulation and the ability to adjust for most environmental barriers. The amputee has the ability to walk at varying speeds. Typical unlimited community ambulator.
K4 – High Activity. The amputee exceeds basic mobility and applies high impact and stress to the prosthetic leg. Typical of the prosthetic demands of the child, active adult, or athlete.
Interventions for Phantom Pain
Medications TENS Ice Massage Biofeedback Acupuncture Injections Spinal cord stimulation Intrathecal pain pump Brain stimulation Stump revision or neurectomy Nerve blocks Mirror Therapy
Once the incision is healed what intervention is recommended?
Gentle friction massage to Mobilize scar tissue
and Decrease hypersensitivity
