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PTAP Woundcare > Amputation/Prosthetics > Flashcards

Amputation/Prosthetics Flashcards

1
Q

Primary causes of Amputations.

A

PVD - primary
Trauma - 2nd
Cancer - osteogenic sarcoma

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2
Q

Amputations performed at partial foot, transtibial or transfemoral levels are for…

A

Vascular Disease

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3
Q

Amputation of all structures below L4-L5 level.

A

Hemicorporectomy

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4
Q

What are the locations for hemipelvectomy
hip disarticulation
knee disarticulation?

A
  • resection of lower 1/2 of pelvis
  • femur removal, pelvis intact
  • tibia removal, femur intact
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5
Q

Amputation thru MTP, can do at any toe joint.

A

toe disarticulation

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6
Q

Amputation thru middle of all MTs.

A

transmetatarsal

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7
Q

Amputation at ankle articulation, attached heel pad to distal tibia and may include removal of malleoli and distal tib-fib.

A

Syme’s Amputation

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8
Q

Expected PT goals for amputation patients.

A 
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
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9
Q

Rigid postoperative dressing that is not adjustable, not removeable and is fitted by the surgeon or prosthetist.

A

IPOP - Immediate Postoperative Prosthesis

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10
Q

Rigid postoperative dressing that is prefabricated, adjustable as limb changes and may be removed as needed for wound inspection.

A

Removeable rigid dressings

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11
Q

Advantages of Rigid Post-op Dressings

A
  • greatly reduces development of post op edema & pain
  • increases wound healing
  • allows for earlier ambulation and fitting of permanent prosthesis
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12
Q

Disadvantages of Rigid Post-op Dressings

A
  • can be expensive
  • requires special training for fabrication
  • requires close supervision during healing stage
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13
Q

Advantages of Semi-rigid Dressings

A
  • specific for shaping and edema control.
  • increases edema control better than soft
  • easy to apply
  • increases healing
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14
Q

Advantages of Soft Dressings

A
  • relatively inexpensive
  • lightweight and readily available
  • easily laundered
  • can be used with TT or TF
  • easier to apply than bandage
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15
Q

Disadvantages of Soft Post-op Dressings

A
  • cant be used until sutures removed
  • poor control of edema
  • can become tourniquet
  • need to replace if limb shrinks
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16
Q

Which member of the Rehab team deals mainly with the UE amputations.

A

Occupational Therapist

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17
Q

Specific Questions to ask patient during rehab process.

A
  • activity?
  • social opportunities?
  • prosthetic wear time
  • skin inspection habits
  • contracture prevent
  • pain level/phantom pain
  • how many socks/shrinks worn
  • any patterns?
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18
Q

Important items from Chart Review of Post-surgical amputation.

A
  • Cause of amputation, type of closure
  • Labs: hematocrit and hemoglobin
  • Medications: pain
  • Comorbidities (PAD, PVD, Respiratory, DM)
  • Social history (smoker, alcohol)
  • Discharge destination
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19
Q

Sensation that the limb is present, described as a burning, tingling, pressure, numbness, itching. may be painless but uncomfortable and dissipates over time.

A

Phantom Sensation

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20
Q

Higher pre-op pain, cramping, shooting, squeezing, burning sensation. Can be continuous or intermittent, triggered by external stimuli. May diminish or become permanent.

A

Phantom Pain

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21
Q

Interventions/Modalities that can be used to treat Phantom Pain

A

Ultrasound
TENS
Icing
Massage

22
Q

What is the minimum of strength needed for prosthetic ambulation?

A

MMT 4/5 in
TT: hip ext and ABD, knee ext and flexion
TF: hip ext and ABD

23
Q

What info should be collected for the Functional Status of an amputation patient?

A 
Transfers/ bed mobility
Mobility - ADs
Balance
Home environment
ADLs and IADLs
PLOF
Expected outcomes - patient and provider
24
Q

What are some examples of desensitization techniques?

A
  • gentle friction massage
  • prevent adhesions
  • mobilize adherent scar tissue
  • decrease hypersensitivity to touch/pressure
25
Q

PT treatment interventions for Residual Limb Care.

think modalities

A
  • Whirlpool
  • Reflex heating
  • Hyperbaric oxygen or medication
  • UV irradiation - caution if vascular disease present!
26
Q

Residual Limb Wrapping Guidelines. (Transtibial)

A
  • two 4 inch bandages
  • firm pressure
  • do not sew bandages together
  • figure 8 (basket weave) pattern
  • cover areas evenly
27
Q

Contracture Prevention for TT amputation

A
  • full ext of hip/knee
  • use posterior splint/board while seated
  • in high TT amputation, prosthesis placed to stretch hamstrings with each step
28
Q

Contracture Prevention for TF amputation

A
  • emphasize full hip ext and adduction
  • avoid prolonged sitting
  • intermittent prone lying
29
Q

Management for Moderate to Severe contractures.

A
  • decreased response to manual mobilization

- increased response to PNF stretching (HR and HR with antagonist contract)

30
Q

What is the major psychosocial factor that determines the successful outcome of therapy for an amputee?

A

motivation

31
Q

Lateral Bending

A 
Prosthetic
- too short
- high medial wall
Amputee
- abduction contracture
- short residual limb
32
Q

Abducted Gait

A 
Prosthetic
- too long
- high medial wall
- excessive knee friction
Amputee
- abduction contracture
- weak hip flexors and adductors
33
Q

Circumducted Gait

A 
Prosthetic
- prosthesis too long
- socket too small
Amputee
- abduction contracture
- weak hip flexors
- lacks confidence to flex knee
34
Q

Excessive Knee Flexion During Stance

A 
Prosthetic
- socket set forward in relation to foot
- excessive dorsiflexion
- prosthesis too long
Amputee
- knee flexion contracture
- hip flexion contracture
- weak quadriceps
35
Q

Vaulting

A 
Prosthetic
- prosthetic too long
- excessive plantar flexion
Amputee
- residual limb discomfort
- short residual limb
- painful hip/limb
36
Q

Rotation of Forefoot at Heel Strike

A 
Prosthetic
- excessive toe-out built in
- loose fitting socket
- rigid SACH heel cushion
Amputee
- poor muscle control
- weak medial rotators
- short residual limb
37
Q

Forward Trunk Flexion

A 
Prosthetic
- socket too big
- knee instability
Amputee
- hip flexion contracture
- weak hip extensors
- inability to initiate prosthetic knee flexion
38
Q

Medial or Lateral Whip

A 
Prosthetic
- excessive rotation of the knee
- tight socket fit
- valgus in the prosthetic knee
Amputee
- weak hip rotators
- knee instability
39
Q

Disease of the blood vessels, including peripheral vascular disease, peripheral arterial disease, and complications related to diabetes.

A

Dysvascular

40
Q

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.

A

Pistoning

41
Q

Pressure Sensitive areas of a Transtibial Residual Limb

A 
fibular head
lateral tibial flare
tibial crest
distal end of tib/fib
patella
anterior tibial tubercle
peroneal nerve
adductor tubercle
42
Q

Pressure Sensitive areas of a Transfemoral Residual Limb

A 
greater trochanter
pubic tubercle
pubic ramus
pubic symphysis
distal end of femur
perineum
43
Q

Pressure Tolerant areas of a Transtibial Residual Limb

A

patellar ligament
lateral fibula shaft
medial tibial shaft
lateral tibial shaft

44
Q

Pressure Tolerant areas of a Transfemoral Residual Limb

A

ischium

soft tissues of residual limb

45
Q

What does the acronym “SACH” stand for?

A

solid ankle cushion heel

46
Q

What does the acronym “SAFE” stand for?

A

stationary ankle flexible endoskeleton

47
Q

What are 5 components of a transfemoral prosthesis?

A 
shank/pylon (endo/exoskeleton)
knee (single/polycentric)
socket (partial/full suction/pin lock)
ankle (non-articulate/articulate) *also single or multi-axis
foot
48
Q

What are the 3 major Brim Variants for a transtibial prosthesis?

A

total surface bearing
patella-tendon bearing
supra-condylar
*supra-condylar/supra-patellar

49
Q

A surgical approach to distal attachment in which a surgeon implants a metal post in the distal bone to secure prosthetic to socket.

A

osseointegration

50
Q

The 3 most important muscles to strengthen on a new transtibial amputee for ambulation?

A

Quads
Hip Abductors
Hip Extensors

PTAP Woundcare (9 decks)

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