amputations Flashcards
Amputation:
BE (below-the-elbow): A specific level of amputation; also known as transradial
Wrist disarticulation: An amputation through the wrist
A birth malformation such as an absent or poorly developed limb
Congenital anomaly
Congenital absence or partial absence of one or more limbs at birth. Cause may be environmental or genetic
Amelia
One or more limbs are missing, with the hand and/or foot attached directly to the trunk
Phocomelia
Causes of Limb Loss
Dysvascular related amputations (main cause)
Trauma related amputations
Cancer/infection related amputations
Congenital related amputations
Congenital related amputations
Amniotic Band Syndrome/ Constriction Band Syndrone: constriction of fibrous bands within the membrane that surrounds the developing fetus
Teratonegic Agents during 1st trimester such as, drugs, pesticides, thalidomide (60’s)
Genetics
97% of lower limb lost is from
dysvascular causes
most of upper limb lost is from
trauma
Removal of entire shoulder girdle
Interscapulothoracic Amputation
Amputation through the shoulder joint
Shoulder Disartication
Above the elbow (AE)
Transhumeral Amputation
Amputation through the elbow joint
Elbow disarticulation
amputation below elbow (BE)
transradial
amputation through the radiocarpal joint
wrist disarticulation
resection of partial hand
transcarpal amputation
Resection of the thumb or fingers at the MCP, PIP, and/or DIP
Transphalangeal Amputation
Prosthetic Options
No prosthetic Passive functional / Cosmetic Body Powered / Conventional Myoelectric / External Power Hybrid Adaptive
Many people with limb loss who are eligible of a prosthesis may choose not to wear one:
Bad first experience Unnatural look Reactions from others Adaptation of one-handed skills Financial concerns Unaware of options Limited functional ability Lack of sufficient prosthetic training
Passive Functional / Cosmetic Advantages
Cosmetic Lightweight Little maintenance Inexpensive (Non-custom silicone) Great for persons with partial hand amputations Provides Opposition
Passive Functional / Cosmetic Disadvantages
No active prehension Limited function Decreased durability Unreal expectations for cosmesis Custom silicone is very expensive
What is an advantage to wearing a passive functional / cosmetic prosthetic?
Requires little maintenance and is lightweight
Body-powered Prosthetics:
Socket or interface
Suspension system
Control cable
Harness
Terminal Devices (TD): hooks or mechanical hands
Wrist unit: connects the TD to the prosthesis and some anatomical wrist function
Possibly:
Triceps cuff (BE)
Hinges (BE)
Elbow (AE)
Shoulder (shoulder disarticulation of higher)
Body-Powered Prosthetic advantages
Heavy duty construction Provides proprioception Less expensive Light-weight Low maintenance
Body-Powered Prosthetic disadvantages
Limited grip force (shoulder strength and rubber band tolerance)
Limited functional ROM
Uncomfortable/restrictive harness
Poor cosmesis
Possibility of over-use, Nerve Entrapment Syndrome
Which of the following is an advantage to wearing a body-powered prosthetic?
propriception
Myoelectric / External Powered
Externally Powered Prosthesis: Components: Socket or Interface Suspension system Input device Microprocessor Battery TD
Moved by motors and powered batteries
Signal from body tells prosthesis what to
Signal generated by:
Electrical signals generated by muscles
Myoelectric / External Powered advantages
Greater functional capacity
Increases cosmesis
Greater grip forces
Reduced or eliminated harness system (increased comfort and ROM)
Myoelectric / External Powered disadvantages
Increased cost and maintenance (initially)
Increase weight
Battery
Amputation Level
Transradial myotesting
Flexor Carpi Radialis, Flexor Carpi Ulnaris, Extensor Carpi Radialis Longus * Breve, Extensor Digitorum
Amputation Level
Transhumeral
Biceps Brachii, Triceps Brachii, Deltoid
Amputation Level
Shoulder disarticulation
Pectoralis Major & Minor, Trapezius, Teres Minor, Latisimuss Dorsi, Supraspinatus, Infraspinatus
Which of the following is an advantage to wearing a myoelectric / externally powered prosthetic?
Increased grip force
Hybrid Prosthesis combination of
Combination of body-powered and electronically-powered components in one prosthesis
Hybrid Prosthesis advantages
Greater functional capacity Reduced weight Greater grip force Reduced harness system (Increased comfort & ROM) Feedback of forearm flexion velocity Reduced initial and maintenance costs
Hybrid Prosthesis disadvantages
Control harness typically required
Increased weight on harness
Adaptive Prosthesis
Customized for a specific function or activity
Consist of recreational and adaptive TD’s
Post-Operative and Pre-Prosthetic Therapy
Post-Operative
Wound healing, pain management, ROM, Psychosocial
Pre-Prosthetic
Preparing the residual limb to wear the prosthesis
Post-Operative and Pre-Prosthetic Therapy Goals
Edema control and residual limb shaping Residual limb desensitization Addressing phantom pain/ sensation Wound management Prevention of contractures Scar management Residual limb hygiene education A/AA ROM exercises Increase muscle strength HEP Exploration of psychological impact Adaptive Equipment Assessment for independence with ADLs Myoelectric evaluation Arrange appointment and attend prosthetic
Post-Operative and Pre-Prosthetic Therapy
Wound Care/ ROM/ Weight Bearing / Scar Massage/ Muscle Training / Phantom Pain
Pre-Prosthetic Assessment includes
ROM
MMT
Muscle site testing
Circumferential measurements
Phantom Limb Pain
Phantom Sensation in the missing part of arm or leg
Tingly, prickly, numb, hot/cold, burning, cramping or itching
Trigger’s of phantom limb pain: Lack of rest Excessive pressure on residual limb Changes in weather Stress Infection Poorly fitting prosthesis Lack of blood flow Edema Pain lessens over time with use of proper interventions
Phantom Limb Management Approaches
ROM Mirror therapy Biofeedback, Integrative and Behavioral Methods: Deep breathing techniques Warm towel wrap Taking mind off the pain (reading, music) Donning and doffing prosthesis Compression stocking
Post-Prosthetic Intervention
Residual limb monitoring and hygiene (bony changes, break down)
Wearing schedule
i.e. 30 min intervals 3X/day with frequent skin checks
Independence in donning/doffing (changing batteries, if applicable)
Muscle training
Repetitive drills and activities
Energy conservation and work simplification
Functional Use Training
Evaluation and modification of recreational tasks/ return to work or school
Introduction of resources
Support groups
Functional Use Training
Most difficult and prolonged stage of the prosthetic training process
Patient’s success depends on:
Motivation
Engagement in purposeful and functional activities
Experience of the therapist
Caregiving (changing diapers, etc.) Leisure (painting, kayaking) Specific works tasks May need work site evaluation Specific school tasks (handwriting, grasping and using tools, social-emotional) May need school evaluation Specific home tasks May need home evaluation
Adaptive Equipment
Rocker knife Swivel Spoon One handed cutting board Adaptive keyboard Soap dispenser Long handled equipment (sponge, brush, nail clipper, reacher, toilet aid) Dycem or electric can opener Elastic laces
Special Considerations
Patient/ Caregiver goals Short term goals Long term goals Cosmesis vs. Function Reimbursement issues Early fitting Kids vs. adults Grow rates in children Support at home Unilateral vs. bilateral
Modern Technologies
i-Limb, DARPA, 3D Printing
Interdisciplinary Team Approach
Ideal Situation Physician Nurse Occupational Therapy / Physical Therapy Prosthetic Manufacturer’s Clinical Representative Psychologist Case Manager Family / Vocational Counselor
