Amputations Flashcards
Etiology
PVD (most common- Type 2 diabetics)
Trauma
Malignancy
Infection
Congenital deficiency
Residual limb
The part of the limb that is left
Common levels of amputation- LE (foot)
Partial toe amputation
Toe disarticulation
Ray resection
Transmetatarsal
Lisfranc (not done anymore commonly)
Chopart (not done anymore commonly)
Syme’s
Amp through malleoli
Transtibial
Amp through tibia
Knee disarticulation
Disarticulation at the tibiofemoral jt
Transfemorla
Above knee through femur
Transtibial amp ad and disad
Ad
- greater potential of ambulation
- decreased energy expenditure w ambulating
Disad
- not a weight bearing end
- bony prominences are at increased risk for skin breakdown
Transfemoral amp
Ad
- greater healing in vascular amputees
Disad
- not a weight bearing end
- lower potential for ambulations
- increased energy expenditure
Rotationplasty
Take the thigh and replace with tibia and foot and rotate it backwards at the knee. So the ankle acts as a knee
Removal of a boney tumor
Postsurgical dressings
Rigid dressing
Semi-rigid
Soft
Goals of post surgical dressings
Control edema
Prevent infections
Protect limb from external, trauma
Shape residuum in preparation for prosthesis
Rigid dressing- types
Non-removable
- immediate postoperative prosthesis (IPOP)
Removal
- removable rigid dressing
Semi-rigid- paste and ads/disad
Unna’s paste
Good edema control, removable for inspection
May loosen easily and needs frequent changes
Sorts dressings- types and ads/disads
Elastic wraps
-Easily removable if there is an infection and cheap
-Poor edema control and minimal protection
Elastic Shrinkers
- socklike garment
- easily to apply with good edema control and stump shaping
- requires changing of size as residuum shrinks (correct size essential)
Phases of care
Postsurgical (time b/w surgery and hospital discharge)
Preprosthetic (time b/w hospital discharge and prosthetic fitting)
Prosthetic (time after fitting)
Post surgical phase- goals
Healing residuum
Protecting unamputated limb
Increase independence in transfers and mobility
Understanding and demonstrating proper positioning
Post surgical phase Common contracture for Transtibial
Knee flexion and hip flexion
To prevent, encourage client to lie prone
Post surgical phase Common contracture for Transfemoral
Hip flexion, abduction and ER
Encourage to spend time in prone (15-20 mins/ day)
Post surgical phase Balance training
COG will be change
Sitting and single leg balance (on unamputaed limb) balance
Post surgical phase Transfer training
Transfer leading with unamputated limb
Post surgical phase Mobilty training
Fit patient with appropriate mobility aid
Walker= greater stability, crutches= greater mobility
Wear shoe on the remaining limb to prevent slippage and protect remaining foot
Post surgical phase Residual limb care
Teach wrapping to patient and family
Teach how to protect limb while moving in bed and transferring (don’t drag residual limb)
Gentle ROM
No strength on residual care
Post surgical phase REmaining limb car
Foot care
Preprosthetic phase- Goals
Independent residual limb care, and mobility and transfers
Home exercise care understanding
Unaffected limb care
Preprosthetic phase- residual limb care
Skin
Shape
Length
Circumference
Pain
Preprosthetic phase- strength and ROM
ROM to prevent the common contractures
Strength for gross motor strength (functional activities- like arm strength for movement)
MMT of residuum must wait until most healing has occurred
Preprosthetic phase- remaining limb inspection
Skin
Pulses
Sensations
Temp
Edema
Pan on exercise or at rest
ROM
Strength
Preprosthetic phase- functional status
ADLS
Functional mobility skills
Balance
Preprosthetic phase- phantom limb
Sensations and pain in the area of the limb that has been amputated
Preprosthetic phase- Intervnion
Residual limb care (desensitizing skin where the prosthetic will be fitted
Skin care
ROM
Strengthening
- key muscles for ambulations:
- TF: hip extensors, abductors, and adductors
- TT: hip extensors, abductors, adductors, knee flexors and extensors
Balance and mobilty exercises
Prosthetic phase- Goals
Smooth and energy efficient gait so ADL’s are okay
Slowly get off stability structures
Prosthetic phase- pressure sensitive and tolerant areas
Areas where are more sensitive and areas where they are not
Prosthetic phase- Donning Prosthesis
1 roll liner over amputated lib
2 Fill up socket with socks
3 fit prosthesic
4 stand on prosthetic
5 continue to bear weight until prosthesis is locked in place
Prosthetic phase- prosthetic training (critical training elements)
Stability ove both legs
Knee control
Stability on prosthesis
Prosthetic control
Proprioception
Pelvic control
Stepping with prosthesis
Stepping with sound leg
Side stepping/ backward stepping
Prosthetic phase- Advanced Training (in gym before going home)
Going up and down stairs and ramp
Sitting on the floor
Getting up from the floor
Kneeling
Picking up and object from the floor
Clearing obstacles
Gait Deviations
Look into it
