Amputee Management

Question 1

What are some prognostic factors for prosthetic use?

Answer 1

cardio-respiratory status, learning capacity, previous mobility, motivation, medications, muscle strength/joint ROM, concomitant disease, condition/length of stump, hand dexterity, vision

Question 2

What are some common co-morbidities in amputees?

Answer 2

age related problems (hearing/vision loss, poor cardio fitness, poor balance, fragile skin, poor cognition, poor muscle strength, poor joint ROM)

atherosclerosis related problems (stroke, cognitive impairment, ischaemia, poor skin integrity)

diabetes related problems (ulcers, slow wound healing, poor eyesight, peripheral neuropathy, renal disease)

Question 3

What does phantom limb pain feel like?

Answer 3

cold/warmth, touch, itching, cramping, telescoping, volume, length, posture, involuntary movements

Question 4

What does pain management for stump pain look like?

Answer 4

medication, stump revision, massage, compression, mirror therapy, TENS, nerve blocks, prosthetic use, psychological mechanisms, kinesiology taping

Question 5

What is the initial time frame for leaving hospital post amputee?

Answer 5

Earliest to walk on a prosthetic will be approx. 6 weeks:

21 days- stitches/clips out
2 weeks for shrinker sock/wound epothelialisation
must tolerate compression 24/7
would must be healed & stump volume stable for casting
1-2 weeks for manufacturing and then fitting of prosthetic

Question 6

What needs to be considered with prosthetic gait?

Answer 6

trans tibial: eccentric knee control & hip extension is important to control foot roll over & heel rise

trans femeral: power comes from hip extension so weight must come forward over the prosthetic leg first to allow extension

Question 7

What can cause gait deviations with a prosthetic?

Answer 7

old habits, fatigue, pain, joint contracture, muscle weakness, decreased proprioception, decreased confidence, poor balance, environmental, prosthetic socket/alignment

Question 8

What are the 4 different types of upper limb prosthetics?

Answer 8

cosmetic
body powered (harness & cable system)
myoelectric (electrical activity generated by muscle contraction)
bionic (brain activity initiates device)

Question 9

What is a physiotherapist’s role in UL amputations?

Answer 9

oedema management
stump shrinking 
maintain/improve ROM
maintain/improve muscle strength 
consider scapular movement/control
liase with OT/prosthetist

Question 10

What is the K-level of classification?

Answer 10

a scale provided by Queensland Amputee Limb Service which determines the likelihood of a patient to be capable of using a prosthetic

K0: no capacity to walk with a prosthetic
K1: potential to use a prosthetic indoors
K2: potential to use a prosthetic outdoors with minimal obstructions
K3: potential to use a prosthetic anywhere in community
K4: unlimited capacity (running, surfing)

guides funding

Question 11

What is the amputee mobility predictor?

Answer 11

a series of tests used by physiotherapists to determine how a patient might mobilise with their amputation (determines K-level)

Question 12

What is osseointegration?

Answer 12

a new technique involving direct skeletal attachment of a prosthesis to the bone

Question 13

What are some indications of osseointegration?

Answer 13

those with:
dissatisfaction with conventional prosthesis
skin problems
significant pain
chronic suspension difficulties

Question 14

What are some contraindications of osseointegration?

Answer 14

atypical skeletal anatomy (i.e. osteoporotic)
growing skeleton
high BMI
presence of systemic diseases (i.e. PVD, smoking)
poor compliance
high impact activity
swimming/spas

Question 15

What are some benefits of osseointegration?

Answer 15

osseoperception
ease of putting on/off
no limit to hip range and sitting comfort
no fitting issues with change in stump volume

Question 16

Where are the measurements taken for shrinker socks?

Answer 16

above knee: 1. thickest part of the thigh, 2. 5cm above distal part of the residual limb

below knee: 1. mid thigh, level of the patellar, 5cm above distal part of the residual limb

Question 17

In terms of the K classification, what does 0-4 predict someone may be able to do with a prosthetic?

Answer 17

0= cannot use prosthetic 
1= ambulation indoors 
2= some community ambulation
3= full community ambulation 
4= exceeds normal function (i.e. surfing)