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Physiotherapy Thtrough The Life > Amputations > Flashcards

Amputations Flashcards

1
Q

What are the general indications for amputation ?

A
  • trauma
  • burning
  • anaerobic infection
  • malignant tumor
  • vascular disease (ex: peripheral artery disease)/ diabetic ulcers
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2
Q

What may be an alternative to amputation (when relevant) ?

A

Limb salvage

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3
Q

How to determine the level of amputation ?

A
  • amount of tissue that could be saved
  • severity of the lesion
  • expected functionality with prosthesis
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4
Q

What are the two classifications for amputations ?

A
  • classified after-injury-period:
    Primary = within 24h
    Secondary = around one week after
    Re-amputation= at some point, after the first amputation
  • classified by surgical method:
    Flap amputations (single or double flap)
    Circular amputations (1 to 3 steps)
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5
Q

What are the different levels of amputations ?

A
  • hemicorporectomy
  • hemipelvectomy
  • hip disarticulation
  • transfermoral
  • knee disarticulation
  • transtibial
  • syme
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6
Q

What is the level of hemicorporectomy

A

Pelvis L4-L5

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7
Q

what is the level of hemipelvectomy

A

Mid sacrum
Resection of lower half of the pelvis, loss of ischial tuberosity

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8
Q

What is the level of hip disarticulation ?

A

Head of femur (non included)

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9
Q

What is the level of transfemoral amputation ?

A

Everywhere alongside the femur bone:
- short transfemoral = less than 35% of femoral length is kept
- transfemoral = between 35% and 60% of femoral length is kept
- long transfemoral = more than 60% of femoral length is kept

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10
Q

What is the level of knee disarticulation ?

A

Underneath patella, above tibial plateau
Femur remains intact
Patella is repositioned

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11
Q

What is the level of a transtibial amputation ?

A

Anywhere alongside tibia
- short transtibial = less than 20% of tibial length is kept
- transtibial = between 20% and 50% of tibial length is kept
- long transtibial = more than 50% of the tibial length is kept

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12
Q

What is the level of syme amputation ?

A

Through the ankle joint where the heel pad is saved and attached to the distal end of tibial so the patient can put weight on the leg
= partial foot ablation

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13
Q

What is the level of trans metatarsal amputation ?

A

Around the mid section of the metatarsals

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14
Q

What is the impact of amputation on energy level ?

A
  • Higher energy consumption than non-amputees
  • the more proximal the amputation, the more effort required to walk (ex: transtibial = 25% increase, transfemoral up to 65% of O2 consumption increase)
  • can be 20%-35% higher in patients whose amputation occurred due to vascular dysfunction (not traumatic)
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15
Q

List the components of prosthesis from pelvis to foot

A
  • socket
  • suspension system
  • knee assembly
  • shank
  • terminal device
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16
Q

Give examples of sockets

A

Silesian belt
Pelvic belt
Close fitting

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17
Q

Define socket

A

The connection between residual limb and prosthetic device.

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18
Q

List the pressure sensitive areas to prosthesis in case of transtibial amputation

A
  • patella
  • lateral tibial condyle
  • tibial tuberosity
  • tibial crest
  • anterior distal tibia
  • fibular head
  • distal end of fibula
  • distal end of residual limb
  • medial femoral condyle
  • lateral femoral condyl
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19
Q

List the pressure tolerant areas in case of transtibial amputation

A
  • supracondylar areas
  • suprapatellar area
  • patellar tendon
  • medial flare of tibia
  • lateral flare of tibia
  • lateral flare of fibula
  • posterior area of residual limb
  • popliteal are (less)
  • distal end of residual limb (contact only)
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20
Q

Give a list of terminal devices of prosthesis

A
  • SACH = solid ankle cushioned heel
  • EKF = elastic keel foot
  • single axis foot
  • multi axial foot
  • dynamic response
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21
Q

Shortly describe SACH

A

Solid Ankle Cushion Heel. Combined with EKF (elastic keel foot) : basic and durable, is less expensive, without hinged parts and with limited variations in walking speed

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22
Q

Briefly describe single axis foot

A

Contains an articulation that improves knee stability for amputations above the knee

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23
Q

Briefly describe multi axial foot

A

Similar to single axis, but allows a better stance in uneven terrain, due to a multi axial joint that also demands higher muscle activity during gate

24
Q

briefly describe dynamic response (prosthesis)

A

Stores and releases energy during the gait cycle. Often used in sports

25
Q

What are the specific considerations for hip disarticulation ?

A

Canadian prosthesis with pelvic nest: allows gait with quadratus lumborum as main active muscle, increasing the energetic cost. To reduce this problem patients often use crutches or walkers

26
Q

Give two brands of prosthesis for knee disarticulation

A

Genius X3 from Ottobock
C-Leg from Ottobock : allows to set the basic resistance during swing phase

27
Q

What are the different phases of evaluation ?

A

Pre-surgical phase
Post-surgical phase
Pre-prosthetic phase
Post prosthetic phase

28
Q

What is the evaluation in pre surgical phase ?

A
  • respiratory function
  • sensitivity
  • ROM
  • strength
  • motor control and proprioception
29
Q

What is the evaluation in post surgical phase

A
  • respiratory function
  • stump characteristics: circumference, skin, shape
  • pain
  • phantom limb sensation/pain
  • neuroma formation : positive tinel’s test
  • sensitivity
  • ROM
  • strength
  • motor control and proprioception
30
Q

What is the evaluation in pre prosthetic phase ?

A
  • stump characteristics: circumference, skin shape
  • pain
  • phantom limb sensation/ pain
  • neuroma formation: positive Tinel’s test
  • sensitivity
  • ROM
  • strength
  • Motor control and proprioception
  • trunk control in sitting and standing
31
Q

What is the evaluation in post prosthetic phase ?

A
  • stump characteristics: circumference, skin,n shape
  • pain
  • phantom limb sensation/pain
  • neuroma formation : positive Tinel’s test
  • ROM
  • strength
  • Motor control and proprioception
  • Trunk control in sitting and standing
32
Q

Which assessments must be performed in pre-surgical phase ?

A
  • muscle strength : UL muscles (crutches) and amputation area surrounding musculature
  • mobility of trunk and joints close to the amputation area
  • coordination and balance : one leg stand security, trunk control and proprioceptive training
  • patient education: possibilities, limitations, phantom limb pain and sensation and precautions related to the skin and wound management
33
Q

What are the physiotherapy goals from 1st week post op until patient is discharged (depending on stump-scar healing) ?

A
  • pain management
  • patient education
  • facilitation and promotion of function
  • prevention of respiratory, MSK and vascular disorders
  • scar tissue and stump management
34
Q

Is early mobilisation recommended in post surgical stage ?

A

Lack of evidence regarding prevention of MSK complications

35
Q

What are the post surgical complications of an amputation ?

A
  • massive have Orr have
  • skin damage and ulcers
  • formation of neuromas
  • phantom pain and sensation
  • terminal bone necrosis
  • formation of osteophytes
  • poorly shaped stump
  • erosive osteomyelitis
  • pneumonia
36
Q

Basic guidelines for stump wrapping

A

In figure of eight pattern
Circular pattern
The pressure of bandage should raise from distal to proximal, avoiding skin overlap and folds

37
Q

What are the 3 different types of dressing that can be used ?

A

Hard dressings
Semi-rigid dressing
Soft dressing

38
Q

Why is dressing necessary ?

A

To protect and shape the residual limb

39
Q

What is the purpose of hard dressing ?

A

To support healing, reduce pain and oedema, reduces the time between PO and prosthetic phase

40
Q

What is the purpose of semi-rigid dressing ?

A

Protects and shape the residual limb, but can get easily loose during movement

41
Q

What is the purpose of soft dressing ?

A

Very practical and helps protect and shape the residual limb, even during weight bearing exercises.

42
Q

What is the purpose of wrapping ?

A
  • decrease fluids
  • increase circulation
  • shape limb for prosthetic fittings
43
Q

What are the possible pain etiologies ?

A
  • neuroma formation
  • bony prominences
  • poorly prosthetic fitting
  • insufficient soft tissue coverage
  • reflex sympathetic dystrophy (complex regional pain syndrome)
  • phantom limb pain
  • phantom limb sensation
44
Q

What is a neuroma formation ?

A

It’s a benign tumor of nerve tissue. They develop as an injured nerve starts to heal in an uncontrolled manner resulting in a lump of unorganized axon fibers and non-neuronal tissue growth. It’s a physiological process of peripheral nerve regeneration. It occurs at the most distal area of the stump, needing to be stimulated through touch or pressure. The treatment can be surgical or thought the use of local analgesic/corticosteroids.

45
Q

What is the sensation of phantom limb ?

A

It’s a sensation of presence of the non-existing extremity.

46
Q

What is phantom limb pain ?

A

Various painful sensations, generally localized on the distal part of the non existing extremity.

47
Q

What causes phantom limb pain ?

A

It’s caused by peripheral neural damage, stimulation/desensitization of the area.
It’s caused by inadequate cortical reorganization

48
Q

What are the possible techniques to treat phantom limb pain ?

A
  • peripheral damage = pharmacological therapy
  • inadequate cortical reorganization = visual mirror feedback/ antidepressants
49
Q

What are the PT interventions in the post surgical phase ?

A
  • Prevention of cardio respiratory, dermatological and MSK complications
  • residual limb dressing :
    3 to 6 weeks post op => immediate post-operative prosthesis
    6 to 8 weeks post op => post operative soft dressing
  • attention to signs of mental health disturbances, such as depression
50
Q

What are the PT interventions in the pre-prosthetic phase ?

A
  • residual limb shaping
  • desensitization
  • ROM and strength
  • Motor control
  • patient education
51
Q

What are the the PT goals in prosthetic phase ?

A
  • strength
  • ROM
  • Balance
  • Motor control
  • ADLs
52
Q

What are the precautions in prosthetic phase ?

A
  • adaptation to prosthetic
  • skin damage
  • residual limb care
  • psychological effect of prosthetic use (expectations vs. limitations)
53
Q

What are the dermatological complications to prosthesis use ? How to react ?

A
  • friction to the skin caused by poorly regulated liner, improper socket and/or insufficient suspension system
  • blister
  • dermatitis
    => immediately halt the use of prosthesis
54
Q

What is a liner ?

A

A residual limb cover, designed to protect the residual limb’s skin, reducing the movement of the socket and chafing.
Each liner is designed to work with a specific suspension system.
Available materials :
- silicone, polyurethane, copolymer

55
Q

What are the three important aspects of prosthetic training ?

A
  • increase of function/ mobility
  • muscular and cardio respiratory demands
  • aspect of postural control and balance
56
Q

Describe the progression of gait training

A

Usually starts at 10 or 11 weeks post op
1) posture and weight bearing
2) proprioception and trunk control
3) weight shifting and stability in stance
4) symmetry during gait cycle
5) advanced training :
- uneven ground
- crowded places
- public transport

Physiotherapy Thtrough The Life (6 decks)

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