Amputation/Prosthetics Flashcards
Primary causes of Amputations.
PVD - primary
Trauma - 2nd
Cancer - osteogenic sarcoma
Amputations performed at partial foot, transtibial or transfemoral levels are for…
Vascular Disease
Amputation of all structures below L4-L5 level.
Hemicorporectomy
What are the locations for hemipelvectomy
hip disarticulation
knee disarticulation?
- resection of lower 1/2 of pelvis
- femur removal, pelvis intact
- tibia removal, femur intact
Amputation thru MTP, can do at any toe joint.
toe disarticulation
Amputation thru middle of all MTs.
transmetatarsal
Amputation at ankle articulation, attached heel pad to distal tibia and may include removal of malleoli and distal tib-fib.
Syme’s Amputation
Expected PT goals for amputation patients.
1 - Reduce post-op edema 2 - Promote healing of residual limb** 3 - Prevent joint contractures** 4 - Improve strength 5 - Adjust to loss of body part
Rigid postoperative dressing that is not adjustable, not removeable and is fitted by the surgeon or prosthetist.
IPOP - Immediate Postoperative Prosthesis
Rigid postoperative dressing that is prefabricated, adjustable as limb changes and may be removed as needed for wound inspection.
Removeable rigid dressings
Advantages of Rigid Post-op Dressings
- greatly reduces development of post op edema & pain
- increases wound healing
- allows for earlier ambulation and fitting of permanent prosthesis
Disadvantages of Rigid Post-op Dressings
- can be expensive
- requires special training for fabrication
- requires close supervision during healing stage
Advantages of Semi-rigid Dressings
- specific for shaping and edema control.
- increases edema control better than soft
- easy to apply
- increases healing
Advantages of Soft Dressings
- relatively inexpensive
- lightweight and readily available
- easily laundered
- can be used with TT or TF
- easier to apply than bandage
Disadvantages of Soft Post-op Dressings
- cant be used until sutures removed
- poor control of edema
- can become tourniquet
- need to replace if limb shrinks
Which member of the Rehab team deals mainly with the UE amputations.
Occupational Therapist
Specific Questions to ask patient during rehab process.
- activity?
- social opportunities?
- prosthetic wear time
- skin inspection habits
- contracture prevent
- pain level/phantom pain
- how many socks/shrinks worn
- any patterns?
Important items from Chart Review of Post-surgical amputation.
- Cause of amputation, type of closure
- Labs: hematocrit and hemoglobin
- Medications: pain
- Comorbidities (PAD, PVD, Respiratory, DM)
- Social history (smoker, alcohol)
- Discharge destination
Sensation that the limb is present, described as a burning, tingling, pressure, numbness, itching. may be painless but uncomfortable and dissipates over time.
Phantom Sensation
Higher pre-op pain, cramping, shooting, squeezing, burning sensation. Can be continuous or intermittent, triggered by external stimuli. May diminish or become permanent.
Phantom Pain
Interventions/Modalities that can be used to treat Phantom Pain
Ultrasound
TENS
Icing
Massage
What is the minimum of strength needed for prosthetic ambulation?
MMT 4/5 in
TT: hip ext and ABD, knee ext and flexion
TF: hip ext and ABD
What info should be collected for the Functional Status of an amputation patient?
Transfers/ bed mobility Mobility - ADs Balance Home environment ADLs and IADLs PLOF Expected outcomes - patient and provider
What are some examples of desensitization techniques?
- gentle friction massage
- prevent adhesions
- mobilize adherent scar tissue
- decrease hypersensitivity to touch/pressure
PT treatment interventions for Residual Limb Care.
think modalities
- Whirlpool
- Reflex heating
- Hyperbaric oxygen or medication
- UV irradiation - caution if vascular disease present!
Residual Limb Wrapping Guidelines. (Transtibial)
- two 4 inch bandages
- firm pressure
- do not sew bandages together
- figure 8 (basket weave) pattern
- cover areas evenly
Contracture Prevention for TT amputation
- full ext of hip/knee
- use posterior splint/board while seated
- in high TT amputation, prosthesis placed to stretch hamstrings with each step
Contracture Prevention for TF amputation
- emphasize full hip ext and adduction
- avoid prolonged sitting
- intermittent prone lying
Management for Moderate to Severe contractures.
- decreased response to manual mobilization
- increased response to PNF stretching (HR and HR with antagonist contract)
What is the major psychosocial factor that determines the successful outcome of therapy for an amputee?
motivation
Lateral Bending
Prosthetic - too short - high medial wall Amputee - abduction contracture - short residual limb
Abducted Gait
Prosthetic - too long - high medial wall - excessive knee friction Amputee - abduction contracture - weak hip flexors and adductors
Circumducted Gait
Prosthetic - prosthesis too long - socket too small Amputee - abduction contracture - weak hip flexors - lacks confidence to flex knee
Excessive Knee Flexion During Stance
Prosthetic - socket set forward in relation to foot - excessive dorsiflexion - prosthesis too long Amputee - knee flexion contracture - hip flexion contracture - weak quadriceps
Vaulting
Prosthetic - prosthetic too long - excessive plantar flexion Amputee - residual limb discomfort - short residual limb - painful hip/limb
Rotation of Forefoot at Heel Strike
Prosthetic - excessive toe-out built in - loose fitting socket - rigid SACH heel cushion Amputee - poor muscle control - weak medial rotators - short residual limb
Forward Trunk Flexion
Prosthetic - socket too big - knee instability Amputee - hip flexion contracture - weak hip extensors - inability to initiate prosthetic knee flexion
Medial or Lateral Whip
Prosthetic - excessive rotation of the knee - tight socket fit - valgus in the prosthetic knee Amputee - weak hip rotators - knee instability
Disease of the blood vessels, including peripheral vascular disease, peripheral arterial disease, and complications related to diabetes.
Dysvascular
The translation of the prosthetic limb from the residual limb. It is the result of inadequate suspension and can result in distal residual limb skin issues.
Pistoning
Pressure Sensitive areas of a Transtibial Residual Limb
fibular head lateral tibial flare tibial crest distal end of tib/fib patella anterior tibial tubercle peroneal nerve adductor tubercle
Pressure Sensitive areas of a Transfemoral Residual Limb
greater trochanter pubic tubercle pubic ramus pubic symphysis distal end of femur perineum
Pressure Tolerant areas of a Transtibial Residual Limb
patellar ligament
lateral fibula shaft
medial tibial shaft
lateral tibial shaft
Pressure Tolerant areas of a Transfemoral Residual Limb
ischium
soft tissues of residual limb
What does the acronym “SACH” stand for?
solid ankle cushion heel
What does the acronym “SAFE” stand for?
stationary ankle flexible endoskeleton
What are 5 components of a transfemoral prosthesis?
shank/pylon (endo/exoskeleton) knee (single/polycentric) socket (partial/full suction/pin lock) ankle (non-articulate/articulate) *also single or multi-axis foot
What are the 3 major Brim Variants for a transtibial prosthesis?
total surface bearing
patella-tendon bearing
supra-condylar
*supra-condylar/supra-patellar
A surgical approach to distal attachment in which a surgeon implants a metal post in the distal bone to secure prosthetic to socket.
osseointegration
The 3 most important muscles to strengthen on a new transtibial amputee for ambulation?
Quads
Hip Abductors
Hip Extensors
