Amputations

Question 1

Major limb amputations vs Minor limb amputtaions

Answer 1

major= above wrist or ankle
minor= below wrist or ankle

Question 2

Causes of amputation

Answer 2

vascular disease
Trauma
cancer
infection
congenital

Question 3

Most common cause for LE amputation vs UE

Answer 3

LE= vascular disease
UE= trauma

Question 4

Goal of surgical amputtaion

Answer 4

preserve as much as possible
making sure amputation is removed at the right level with enough tissue for wound healing
rehab potential
prosthetic availability

Question 5

Risk factors for Amputation

Answer 5

poor nutrition
decreased exercise and increased weight gain
poor skin integrity
diabetes and cardiac disease

Question 6

Risk factors for UE amp

Answer 6

MSK pain in neck, back, contralateral limb and shoulder

Question 7

Risk factor for LE amp

Answer 7

nerve entrapment due to new weight bearing pattern

Question 8

3 phases of rehab

Answer 8

peri-operative phase (UE and LE)
Pre-prosthetic training (UE only)
Prosthetic training (UE only)

Question 9

Beginning and end marker for peri-operative phase

Answer 9

beginning- decision to amputate
end- all wound healed, sutures removed, medical clearance, mod independence with ADLs

Question 10

Intervention focus in peri-operative phase

Answer 10

independence in ADL’s
Wound care
edema, scar and pain control
joint mobility and increase endurance
psychosocial support

Question 11

Beginning and end marker for pre-prosthetic training

Answer 11

Beginning- post-surgical period ends
End- pt receives prosthetic

Question 12

Intervention during pre-prosthetic training phase

Answer 12

emotional support
Shape and stabilize the residual limb
PREs to proximal joints
Desensitization
Independence in all daily activities
Change of dominance if needed

Question 13

Beginning and end marker for prosthetic training phase

Answer 13

Beginning- delivery of prosthetic
end- pt. demo’s functional performance with prosthetic during desired activities

Question 14

Intervention focus during prosthetic training phase

Answer 14

control training
repetitive activities
Safety education- skin integrity, body mechanics, prevent further injury
functional training to integrate prosthetic into daily activities

Question 15

Eval after UE amputation

Answer 15

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

Question 16

Intervention after UE amp

Answer 16

Residual managment- wound healing, protection, edema, reduce hypersensitivity and pain

Question 17

What modalities can be used after UE amp

Answer 17

Figure 8 wrapping- during wound healing up to 21 days
Compression shrinker once drainage stop, can be up to 18 months

Question 18

Pain intervention after amp

Answer 18

team approach with pharmo and non-pharmo approaches

Question 19

non-pharmo approach

Answer 19

TENS
desensitization
mirror therapy
scar management
relaxation techniques

Question 20

Intervention after LE amputtaion

Answer 20

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