Exam 2: Post-op and Pre-prosthetic Care Flashcards
A patient is describing feelings of numbness, tingling, pressure and cramping. What is this classified as?
a. pain
b. sensation
c. circulation issues
c. none of the above
sensation
Pain is described as shooting, severe cramping, and distressing burning (true/false)
true
Psychological adjustment and early education in the rehabilitation process is key (true/false)
true
Which setting focuses on initial healing of the surgical site, pain management and volume control, bed mobility and transfers, readiness for single-limb amputation?
a. inpatient
b. outpatient
c. acute setting
d. subacute
acute setting
Other team members examination info is not helpful to your examination as a PT (true/false)
false
it can prevent redundancy
Which areas of the history should you focus on?
demographics and sociocultural info social history occupational history developmental status living environment current condition PMH medications functional status
Examination of amputation follows the patient-client management model (true/false)
true
It is not relevant to understand their functional status prior to amputation (true/false)
false
Your examination should not include communication, affect, cognition, language and learning style (true/false)
false
Anatomical and physiological status of these 5 systems is important to include
cardiovascular system cardiopulmonary system integumentary system musculoskeletal system neuromuscular system
It is important with tests and measures to modify and adapt the _ or _ of the residual limb
condition or length
Adaptation of tests and measures does not effect validity and reliability (true/false)
false
Document the _, _ and _ of pain
nature, location and intensity
What percentage of amputees experience sensations after recent amputation?
a. 54-99%
b. 46-89%
c. 60-99%
54-99%
What percentage of amputees experience phantom pain?
a. 40-60%
b. 54-99%
c. 46-63%
46-63%
More than 15% rate their phantom pain as severe or constant (true/false)
false
less than 15%
Pain is described as
shooting
severe cramping
distressing burning
How is length of the residual limb measured?
a. actual length of the tibia or femur
b. total length of residual limb including soft tissue
c. all of the above
all of the above
Measuring the medial joint line to end of bone or soft tissue
a. TF
b. TT
TT
Measuring greater trochanter to end of bone or soft tissue
a. TT
b. TF
TF
How is volume of the residual limb measured?
circumferential with tape measurements
The intact limb is not at risk of increased stress with ambulation (true/false)
false
It is important to assess circulation of both _ and _ limb
residual and intact limbs
What are ways to assess blood flow and circulation?
skin temp and turgor color at rest and with position change palpation of pedal or popliteal pulses segmental BP calculation of ABI
Amputees are at high risk for developing contractures in which areas mostly?
a. hip flexion
b. ankle flexion
c. knee flexion
d. hip and knee flexion
hip and knee flexion
It is important to maintain and improve what during the early stages of rehab?
a. ROM
b. muscle length
c. muscle strength
d. a and b
ROM and muscle length
What can you assess right away for muscle performance and motor control?
a. MMT
b. active movement
c. movement with resistance
d. active movement and anti-gravity movement
active movement and anti-gravity movement
Hip _ and _ should be tested
a. flexion and extension
b. flexion and adduction
c. flexion and abduction
d. abduction and extension
abduction and extension
Scores of _ will indicate some sort of cognitive impairment
a. <20
b. >24
c. <24
d. <14
<24
Cognition and ability to learn compromised with depression will not affect how long recovery takes (true/false)
false
Cognition and attention is common with which disease?
a. diabetes
b. cardiovascular disease
c. peripheral vascular disease
d. cancer
peripheral vascular disease
Which activities are harder than anticipated for an individual?
a. bed mobility
b. supine to sit
c. sit to stand
d. all of the above
all of the above
What complications need to be managed post op?
a. comorbidities
b. medications
c. all of the above
all of the above
What pre-morbid factors tend to predict successful prosthetic use
ability to walk functional distances prior to surgery
overall level of physical fitness
requiring little assistance with ADL’s
ability to maintain single limb stance without assistance
What can lengthen rehab?
a. wound healing
b. contractures
c. age
d. all of the above
all of the above
What percentage of amputees are able to return to independent living?
a. 75%
b. 80%
c. 90%
d. 100%
75%
Goals of wound closure, effective compression, supervision or min assist with transfers, locomotion using w/c or AD on level surfaces describes which setting:
a. sub-acute
b. home care
c. outpatient
d. acute care
acute care
Goals of strengthening core, strengthening key muscle groups, adequate ROM, improving cardiovascular fitness, advanced ADLs and IADL’s, advanced mobility skills should be done in which setting
a. acute care
b. sub-acute
c. home care
d. outpatient
e. sub-acute, home care, outpatient
sub-acute, home care, outpatient
What muscle groups are key to strengthen in rehab?
a. core
b. hip extensors
c. hip abductors
d. b and c
hip extensors and abductors
Medication does not need to be timed in correlation with PT sessions (true/false)
false
Which should be done first with GMI therapy?
a. mirror therapy
b. laterality
c. motor imagery
d. it doesn’t matter which one is done first
laterality
What is important to do with patients who have phantom limb pain?
a. laterality
b. motor imagery
c. mirror therapy
mirror therapy
Which shaping and volume control dressing is basically an ACE wrap?
a. shrinkers
b. pneumatic compression
c. soft dressing and compression
soft dressing and compression
What is the challenge with soft dressing and compression?
getting the pressure just right because you dont want to push pressure into the distal end of the limb
This type of dressing is a compressive type garment with graded pressure and is higher at the bottom and looser at the top
a. soft dressing and compression
b. shrinker
c. rigid removable dressing
d. pneumatic compression for early amputation
shrinker
Which dressing should NOT be used if there is circulation issues?
a. shrinker
b. soft dressing and compression
c. rigid removable dressing
d. non-removable dressing
non-removable rigid dressings
What is the biggest risk with a rigid removable dressing?
a. circulation issues
b. edema control
c. contractures
d. shear forces
contractures
This type of dressing is firm or hard enough to protect, shape, and prevent shear forces on the limb
a. shrinker
b. pneumatic compression
c. rigid removable dressing
d. soft dressing and compression
rigid removable dressing
This type of dressing helps with shear, compression and friction but is not as protective
a. rigid removable dressing
b. non-removable rigid dressing
c. shrinker
d. semi-rigid removable dressing
semi-regidi removable dressing
A limb with tough, dry, irritated skin is more tolerant of prosthetic wear (true/false)
false
want it to be soft, healthy, pliable skin
When is it permitted to massage over the incision?
a. right after surgery
b. during healing with steri-strips
c. once primary healing has taken place and the steri-strips are not needed
once primary healing has taken place and the ster-strips are not needed
Skin problems do not have to be resolved to wear a prosthetic (true/false)
false
Transtibial amputees are at high risk of _ and _ contractures
hip and knee
Transfemoral are at high risk of hip ,,_ contractures
a. flexion, internal rotation and adduction
b. extension, external rotation and abduction
c. flexion, external rotation and adduction
d. flexion, external rotation and abduction
flexion, external rotation and abduction
What can be problematic for prosthetic fit, alignment and efficiency with gait?
a. ROM
b. flexibility
c. contractures
d. muscle strength
contractures
How do contractures influence gait with a prosthetic?
affects their fit, alignment and efficiency
Proper _ is key
positioning
maintain knee _ as much as possible
a. flexion
b. extension
c. abduction
d. internal rotation
extension
What is a good stretch for the posterior knee and anterior hip?
prone leg hang
What are the 2 goals of strengthening programs?
- remediate specific weakness detected in examination
- max overall strength and muscle endurance for safe, energy-efficient gait
Stability of the _ is important to address with amputees
core
How long should contractions be held? How long for a break in between and how many reps?
a. 1 minute, 30 seconds break, 10 reps
b. 30 seconds, 10 second break, 5 reps
c. 10 seconds, 5-10 second break, 10 reps
d. 15 seconds, 5 second break, 10 reps
10 seconds, 5-10 second break, 10 reps
It is key to work knee _ and _ and hip _ and _ for TRANSTIBIAL
knee flexion and extension
hip extension and abduction
What two hip movements need to be strengthened for transfemoral amputees?
a. hip external rotation and abduction
b. hip extension and abduction
c. hip flexion and adduction
d. hip extension and adduction
hip extension and abduction
Transfemoral amputees must learn to control their
a. pelvis
b. trunk
c. hip
hip
What muscles are important to strengthen for postural alignment?
a. back flexors
b. back extensors
c. abdominal muscles
d. b and c
back extensors and abdominal muscles
Which machine is good for improving endurance in amputees?
a. LE bike
b. eliptical
c. UBE
d. treadmill
UBE
How does the COM shift after amputation?
a. slightly up, forward and toward the other limb
b. slightly down, forward and toward the other limb
c. slightly up, back and toward the remaining limb
d. slightly down, back and still over the center
slightly up, back and toward the remaining limb
What are the effects of walker ambulation once they get a prosthesis?
a. hip flexion is increased
b. knee is stuck extended
c. it does not effect their ambulation
d. lack trunk rotation
lack trunk rotation
What are the functional testing and outcome measures that can be used?
AMPpro or AMPnopro
TUG
L test
6MWT
What will you see if the wound is not healing and is potentially infected?
increased drainage, thickening and discolored exudate
You dont need to assess the intact limb first when assessing joint integrity and mobility (true/false)
false
Mobile scar without _ is important
adhesions
The actual length measured is of the _ or _
tibia or femur
The total length of the limb includes _ _
soft tissue
,, and _ systems all have age related changes that may affect pts
visual, auditory, and somatosensory
changes in COM affect _ and _ with mobility
balance and safety
Only need to assess posture in standing (true/false)
false
standing and sitting
What are the primary goals of acute care?
wound closure
effective compression
supervision or min assist with transfers
locomotion with W/C or AD on level surfaces
What are the primary goals of sub-acute, home care or outpatient?
stregnthening of core strengthening of key muscle groups adequate ROM improving cardiovascular fitness achieving more advanced ADL's and IADL's advance mobility skills
Goals should be linked to _ _
functional impairments
It is important to educate about _
phantom limb pain
The center rotation for a polycentric promotes _ _ during _
knee stability during stance
With postural control, it is important amputees learn _
how to control COM over their new BOS
Patient interview precedes a chart review (true/false)
false
poor ROM and muscle length has a poor impact on _
ambulation with a prosthesis
If your patient has a tendency to let their pelvis drop in standing, what intervention should you do?
strengthen the sound side
What type of disease can slow healing?
end stage renal disease
Acute care for uncomplicated cases is usually - days with PT daily - min each
4-7, 1-2 daily for 30-45 min
for frail or chronically ill, stay will be _ days or more
21
post op edema is important for these reasons:
pain control
wound healing
protection of incision with functional activity
shaping and desensitization of limb for prosthetic use
What 3 things help prevent soft tissue tightness?
manual stretching
active exericse
functional postural training
Strengthen remaining hip _, _, and _ for postural control
adductors, extensors, abductors
