Amputations Flashcards
Major limb amputations vs Minor limb amputtaions
major= above wrist or ankle
minor= below wrist or ankle
Causes of amputation
vascular disease
Trauma
cancer
infection
congenital
Most common cause for LE amputation vs UE
LE= vascular disease
UE= trauma
Goal of surgical amputtaion
preserve as much as possible
making sure amputation is removed at the right level with enough tissue for wound healing
rehab potential
prosthetic availability
Risk factors for Amputation
poor nutrition
decreased exercise and increased weight gain
poor skin integrity
diabetes and cardiac disease
Risk factors for UE amp
MSK pain in neck, back, contralateral limb and shoulder
Risk factor for LE amp
nerve entrapment due to new weight bearing pattern
3 phases of rehab
peri-operative phase (UE and LE)
Pre-prosthetic training (UE only)
Prosthetic training (UE only)
Beginning and end marker for peri-operative phase
beginning- decision to amputate
end- all wound healed, sutures removed, medical clearance, mod independence with ADLs
Intervention focus in peri-operative phase
independence in ADL’s
Wound care
edema, scar and pain control
joint mobility and increase endurance
psychosocial support
Beginning and end marker for pre-prosthetic training
Beginning- post-surgical period ends
End- pt receives prosthetic
Intervention during pre-prosthetic training phase
emotional support
Shape and stabilize the residual limb
PREs to proximal joints
Desensitization
Independence in all daily activities
Change of dominance if needed
Beginning and end marker for prosthetic training phase
Beginning- delivery of prosthetic
end- pt. demo’s functional performance with prosthetic during desired activities
Intervention focus during prosthetic training phase
control training
repetitive activities
Safety education- skin integrity, body mechanics, prevent further injury
functional training to integrate prosthetic into daily activities
Eval after UE amputation
Pain- residual limb pain, phantom pain m phantom sensations
Neuromusculoskeletal- residual limb shape, edema, skin integrity, AROM and MMT, hand function (BBT, Jebsen), sensation (light and deep)
ADL and IADL- Barthel, DASH, COPM
Intervention after UE amp
Residual managment- wound healing, protection, edema, reduce hypersensitivity and pain
What modalities can be used after UE amp
Figure 8 wrapping- during wound healing up to 21 days
Compression shrinker once drainage stop, can be up to 18 months
Pain intervention after amp
team approach with pharmo and non-pharmo approaches
non-pharmo approach
TENS
desensitization
mirror therapy
scar management
relaxation techniques
Intervention after LE amputtaion
closely collaborative with PT
PT role- limb wrapping, strengthening and ROM, training
Collab- functional mobility, education on wound care, safety, desensitization
OT- impact of amp and co-morbidities on ADL’s, IADLs and other occupations, home mods, AE
