Amputation Rehab Flashcards
Evaluation
Residual Limb Length and Shape Vascularity ROM Muscle Strength Neuro Transfers Balance Mobility
ABI (ankle-brachial index)
Non-invasive measure of peripheral tissue perfusion
Used to rule out arterial disease
Should not be more than 10 mmHg difference in R to L sides
ABI: 1.1 -1.3
Vessel Calcification
ABI: 1.1 - 0.90:
Normal
ABI: 0.9-0.70:
Mild arterial insufficiency
ABI: 0.70-0.50:
Moderate arterial insufficiency, intermittent claudication
ABI: < 0.5:
Severe arterial insufficiency resting pain
ABI: < 0.3:
Ischemic or gangrenous extremity, Resting pain
Post-Operative Care
Reduce edema and promote healing Prevent contractures Increase UE and LE strength Increase mobility and self care Promote sound limb care Assist with limb loss adjustment
Soft dressing advantages:
ease of application
ability to monitor wound
ability to change wound environment as necessary
Soft dressing disadvantages:
application of elastic wrap may create varied pressure to limb creating a tourniquet effect
manipulation of soft tissue may promote prolonged and deep seated pain patterns
Positioning:
Most important to maintain neutral hip and knee extension for optimal prosthetic fit and ambulation
AVOID HIP FLEXION AND ABDUCTION
Phantom Sensation
Non-painful sensation or awareness experienced that gives form to a body part with specific dimensions, weight, or ROM
Categories of phantom sensation:
- Kinesthetic sensation
- Kinetic sensation
- Extroceptive sensation
Kinesthetic Sensation
posture
length
volume
Kinetic sensations
willed movements
spontaneous movements
associated movements
Extroceptive Sensations
touch
temperature
pressure
other (eg:coldness of limb in OR)
Phantom Pain
A painful sensation experienced within the limb that is now not part of the body.
Onset of phantom pain:
Onset=1 week to several months
Usually decreases within 6 months
What is phantom pain provoked and relieved by?
Provoked by emotional stress, cold, local irritants.
Relieved by wearing prosthesis, stroking,
heat, mental distraction
Residual Limb Pain
Pain arising in the residual limb from a specific anatomical structure that can be identified
Functional Level 0
no ability or potential for weight bearing or transfer
Functional Level 1
Ability or potential to transfer and ambulate within the household with an assistive device
Functional level 2
Community ambulator with the ability or potential to traverse minor environmental barriers, fixed cadence
Functional Level 3
Community ambulator with the ability or potential to traverse all environmental barriers with a variable cadence
Functional Level 4:
Exceeds basic ambulation, high impact, energy levels. Child, active adult or athlete.
Five Staged of Grief:
Denial Anger Bargaining Depression Acceptance
