Amputation: Key Impairments, Interventions, & Introduction to Prosthetics Flashcards
What is the purpose of positioning?
- Prevent development of joint contracture while considering comfort & function
- Try to minimize edema
What are the general considerations for positioning?
- Do not put pressure on healing surgical sites or wounds on residual limb
- Change positions at least every 2 hours
- Positions should vary during the day
- Must teach patient & caregiver proper positioning
How long can volume fluctuations last post amputation?
12-18 months
What are common trans tibial contractures?
- Hip: flexion, abduction, & ER
- Knee: flexed
What are common transefemoral contractures?
Hip flexion, abduction & ER
How can contractures be caused?
- Poor positioning
- Prolonged sitting position/wheelchair use
What are the consequences of contractures?
- Functional leg length discrepancy
- Poor prosthetic alignment
What is the management of contractures?
- Appropriate positioning
- Ambulation
- Prosthetic modification
- Casts
- Surgical release if necessary
What are common transhumeral contractures?
GH flexion, add, & IR
What are common transradial contractures?
- GH: flexion, add, & IR
- Elbow: flexion
What is the proper position for prevention of contracture?
- Neutral hip extension
- Knee extension
- Hip & knee extension when prone
- Knee extension in sitting
- For TFA, avoid hip abduction
What are the 3 types of dressings?
- Rigid
- Semirigid
- Soft
What is the purpose of post-operative dressing?
- Control post-operative edema
- Pain control
- Enhancement of wound healing
- Protection of the incision during functional activities
- Shape & desensitization of the residual limb for prothesis
- Can allow early WB
- Acclimate patient to the idea of caring for residual limb
What is the difference between removable & non removable rigid post operative dressings?
- Removable: applied over soft dressings
- Non Removable: application of rigid cast dressing in the operating room or post op
Name some advantages of rigid post-operative dressings
- Allows early ambulation w/ pylon
- Promotes circulation & healing
- Stimulates proprioception
- Protection
- Soft tissue support
- Limits edema
- Ability to utilize an immediate post-op prosthesis (IPOP)
What is an IPOP?
- Immediate postoperative prothesis
- Used as an early form of prosthetic intervention
What is the benefit of an IPOP?
Early ambulation if allowed by your physician
What are the disadvantages of rigid post-operative dressings?
- Immediate wound inspection is not always possible
- Does not allow for daily dressing changes
- Requires professional application
What are complications of rigid post-operative dressings?
- Infection
- Damage to wound
- Pressure or traction from pistoning
What is a semi-rigid Post-Operative Dressing?
- Unna paste, air splints
- Unna paste wraps
- Specialized gauze banding impregnated with zinc oxide
- Typically 4 inches wide
What is the order of post- operative dressings, from best to least at edema control?
Rigid > Semi rigid > Soft
What are the advantages of semi-rigid post operative dressings?
- Reduces post-op edema
- Provides soft tissue support
- Provides protection
- Easily changeable
What are the disadvantages of semi-rigid post operative dressings?
- Does not protect as well as rigid dressing
- Requires more changing than rigid dressing
- may loosen & allow for development of edema
When should soft post-operative dressings be used?
If patient is at high risk for infection to allow for wound inspection
What are the 2 forms of soft post-operative dressings?
- Elastic (ace) wraps
- Shrinkers (soft like garments made of heavy, rubber - reinforced cotton)
What is the purpose of using a soft dressing for edema control?
Promote an ideal shape of the residual limb & stable volume to allow for receipt & use of prosthesis
What is a shrinker and when may it be used?
- Elastic garment shaped similar to a sock that encompasses the limb
- Used once a more consistent volume is reached
What is the average ace wrap size for UE limb?
3”
What is the ace wrap size for limb with TTA or a larger UE limb?
4”
What is the ace wrap size for TFA?
6”
In general how many bandages does a transtibial amputation need?
2-3 four inch bandages
In general how many bandages does a transfemoral amputation need?
2-3, four or six inch ace bandages
In general how many bandages does a transradial & transhumeral amputation need?
2-3, three inch ace bandages
What are the advantages of soft post-operative dressings?
- Reduces post operative edema
- Provides some protection
- Easily removed for wound inspection
- Allows for active joint ROM
What are some disadvantage of soft post-operative dressings?
- Relatively poor edema control
- Tissue healing is interrupted by frequent changes
- Joint ROM may delay healing of incision
- Less control of residual limb pain
- Cannot control the amount of tension in the bandage
- Risk for tourniquet effect
When can a shrinker be applied?
Until sutures/staples are removed
Can shrinkers be applied over dressings?
They can be applied as necessary but the dressings should be thin in order to not affect the pressure of the shrinker
What is the technique for applying a shrinker?
- Turn shrinker inside out & then stretch it open as you contact the residual limb
- Stretch the lower half of the shrinker firmly up towards the knee. Then let the material relax
- Pull the top half of the shrinker upwards
Where should more pressure be applied when wrapping a limb?
Distal pressure > Proximal pressure
What pattern should wrapping be applied in?
- Apply obliquely
- Never apply in circumferential pattern
How often is wrapping worn and how often should it be re-applied?
- Worn 24 hrs/day (w/ exception of bathing)
- Should be reapplied every 4-6 hours
When wrapping what should be avoided?
- Avoid medial & lateral wrapping in same turn
- Avoid wrinkles
- Avoid windows
What inch wrap should be used for transtibial wrapping?
3-4 inch
What inch wrap should be used for transfemoral wrapping?
6 inch wrap
What inch wrap and how many should be used for transradial & transhumeral?
Two - Three 3” wrap for average size UE limb
How long does Phantom limb pain/ sensation typically last?
- Typically episodic
- Lasts seconds to days or continuous
What are some treatment options for phantom limb pain/sensations?
- Manage, ultrasound, ice, TENS
- Non-narcotic analgesics
- Biofeedback, guided imagery
- Psychotherapy
- Nerve blocks
- Mirror therapy
As the incision heals, sensory input to the residual limb (increases or decreases)
Increases
What must occurs for resistance to be added when strengthening?
- Must have medical clearance for resistane
- Typically, 7-10 days w/ drains removed, sutures/staples removed & wound closed
How should a residual limb be cared for?
- Wash daily w/ warm water
- Shower at night w/ mild soap
- Pat limb dry
- Be careful of incision site
- Check limb daily (redness/blisters)
- Moisturize skin (fragrance free)
- When not wearing prosthesis (wear ace wrap or shrinker)
Where can sheaths be applied?
Underneath liner directly on the skin & can serve to relieve irritation when using prosthesis
When can patients begin to wear a shrinker?
Once sutures are removed
How should shrinkers be cleaned?
- Wash in luke warm water (hand wash or delicate)
- Hang to dry - rotate
What should be done if ply exceeds 12-15?
Prosthetist should be notified as recasting may be required
Why may a patient need prosthetic socks?
- Individual experience a decrease in residual volume (especially in 1st year)
- To accommodate for space prosthetic socks are used to maintain congruent & comfortable fit
How should socks be cared for?
- Wash in luke warm water (hand wash or delicate)
- Hang to dry - rotate
- Don clean socks/sheaths daily
How is a liner cared for?
- Turn inside out, wash w/ warm water/mild detergent & invert & allow to dry on stand provided by manufacturer
What is a gel liner?
Commonly made of silicone, used for cushioning residual limb & hosting a suspension mechanism such as pin or lanyard
How is a socket cared for?
- Inspect device for signs of wear prior to each use
- Do not make mechanical adjustments or minor repairs to the prosthetic device
- Inspect the connections points for stability
What is the socket?
Interface between the residual limb and the prosthesis
What does a properly fitting socket do?
Disperse pressure throughput the limb and providing more contact with the surface
What is the most common socket for transfemoral amputation?
Ischial containment socket
What is the most common socket for transtibial amputation?
Total surface bearing or patellar tendon bearing socket
What is the order of donning a prosthesis?
- Gel liner
- Socks (no wrinkles)
- Soft liner
- Prosthesis
What is the beginning wear schedule of a prosthesis?
- One hour a day with half the time spent ambulating
- Every 30 minutes or immediately after walking, skin should be inspected
- If wearer is tolerating the prosthesis well with no signs of breakdown, an hour is added each day while still respecting 50%rule
- If skin is showing no signs of breakdown, the amount of time between inspections is gradually expanded by 15-30 minutes
- Eventually the we are will be able to tolerate the prosthesis for extended periods of time w/o having to remove the prosthesis & inspect the skin
