- patient education is vital - supportive environment - cognitive eval

- any painful sensation in the residual limb - "stump pain, incisional pain, surgical pain" - may include prox RLP (cramps, spasms)

- sensation of actual pain (per pt) in amputated limb - patient education is essential

- GABA anolog - neuropathic pain agent

Exam 2 -prosthetic stuff Flashcards by nikolai M

most common causes of LE amputation (0-5, 5-15, 15-50, 50+)

0-5 = congential
5-15 = cancer
15-50 = trauma
50+ = vascular disease

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most common causes of UE amputation

trauma (80%)

Most commonly a finger amputation

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Myoplasty surgical technique

-opposing muscles sutured to each other and to periosteum at end of cut bone

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Myodesis surgical techniques

muscles and fascia sutured directly to bone
structurally more stable

*contraindicated if blood supply to muscle is suspect

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Unsatisfactory sites for elective amputations

distal 1/3 of leg (inf to gastro-soleus)
very short BKA (prox to tin tubercle)
very high AKA

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Functional K levels: Level 0

-would not enhance life

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Functional K levels: Level 1

household ambulator

- level surfaces

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Functional K levels: Level 2

limited community ambulator

- uneven surfaces

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Functional K levels: Level 3

variable cadences

- unlimited community ambulator

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Functional K levels: Level 4

-very active

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Relative prosthetic contraindications

sig cognitive impairment
severe hip or knee contracture
severe cardiac dysfunction

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Pro-op amputation

patient education is vital
supportive environment
cognitive eval

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6 goals of post op limb care

1 - control edema
2- promote wound healing
3 - protect residual limb
4 - pain control
5 - shaping limb
6 - prep for ambulation

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residual limb pain

any painful sensation in the residual limb
“stump pain, incisional pain, surgical pain”
may include prox RLP (cramps, spasms)

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phantom limb sensation (what is it and what is treatment)

any non-painful sensation of the amputated limb

- treatment = patient edu. NOT meds

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phantom limb pain

sensation of actual pain (per pt) in amputated limb

- patient education is essential

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phantom limb pain is magnified by several conditions (3)

anxiety
stress
depression

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criteria for treatment of phantom limb pain

1 - interferes with AD:s

2 - impedes prosthetic use/gait training

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Physical modalities for phantom limb pain

temporary relief - gait theory
desensitization
acupuncture
TENS
vibration
ultrasound

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Gabapentin (neurontin)

anticonvulsant

- Ca channel blocker

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Pregabalin (lyrica)

GABA anolog

- neuropathic pain agent

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Tramadol (ultram)

-pain reliever

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Amitriptyline (elavil)

antidepressant

- avoid in elderly due to anti ACh side effects

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Baclofen

-muscle relaxant

Phantom limb pain - psychological treatment

-mirror therapy

What is the most effective treatment for phantom limb sensation???

-patient edu and reassurance

Limb shape - cylindrical

ideal shape

Limb shape - bulbous end

-makes prosthetic fitting difficult

Positioning to avoid with BKA

-AVOID: knee flexion, hip flex/abd/ER

Positioning to avoid with AKA

AVOID: Hip flex/abd/ER

Position to avoid with partial foot

AVOID: plantar flexion

positioning to avoid contractors in amputees

- start ROM immediately. PROM with sustained hold at end range - progress to AROM ASAP

Rooke BK rigid protector

-best splint for pt with compromised skin conditions

Shaping limb with ACE wrap

- ASAP with surgeon approval - distal to prox pressure gradient - wrap AKA to facilitate hip IR

Desensitization

- progressive tactile stim - sensory overload *start ASAP, 20-30 mins, 3x/day

Mirror therapy -start with?

- slow, big movements | - symmetrical movements

relative criteria for readiness for temporary prosthesis (5)

- staples/sutures removed - dec edema/proper limb shaping - stable weight - min open/draining wound - dec hypersensitivity *approx time frame 2-6 months after amputation

Amputee mobility predictor (test)

- predict functional mobility (k level) with or without prosthesis - tests wide range of mobility skills

prosthesis skin checks

- every 10-15 minutes | - inc time slowly

when can a patient use prosthesis at home? (4)

- (I) with don/doff - adjust ply socks prn - skin checks - safe ambulation on even surfaces

initial wearing schedule of prothesis

- 1 hour BID | - add 1/2 hour every other day prn

Deviation: modified trandelenburg

- generally lean towards prosthetic side - weak hip, short limb *focus on glut medius

Deviation: abducted gait

- wide based gait with prothesis held away from midline | - limb too long, hip ABd contracture

Deviation: circumduction

- swings | - difficulty flexing knee, hip abd contracture, habit, limb too long

Deviation: vaulting

- up on toes of good leg | - habit, difficulty flexing knee, fear of hitting toe, residual limb discomfort, limb too long

Deviation: med/lat heel whip

-prosthesis is rotated

Deviation: foot rotated at heel strike

- poor socket fit, not controlling rotation | - forcible "driving" heel into ground

Deviation: uneven heel rise

- more power to flex knee it goes up higher - knee flexion contracture - alignment issues

Deviation: terminal swing impact

-not confident in leg so they forcibly extend knee to make sure it is extended

Deviation: uneven step length

- typically longer on prosthetic side (inc WBing on sound limb) - hip flexor contracture

Deviation: exaggerated lordosis/trunk extension

- hip flexion contracture - weak hip ext - weak abs - slows forward momentum

SACH - solid ankle cushion heel

for K1-2 (household/limited community ambulator)

Dynamic motion, single axis foot (what K level)

for K2-3 - allows some ankle PF/DF - stable in ML direction

Multi-axial/dynamic response foot (k level)

- for k3-4 - carbon fiber - heel shock absorption - energy return - variable walking speed

Locking knee (K level)

- for K1 | - must unlock to sit

extension assist knee (k level)

- for k2-3 - tries to avoid knee buckle when loaded in flexion - assists ext with spring mechanism

hydraulic knee (k level)

- for k 3-4 | - can inc resistance to allow for uneven surfaces, ramps, steps

Microprocessor knee (k level)

- c-leg - for k4 - need to charge - monitors where you are in gait cycle

Stubbies for bilateral AKA

- prevent LOB posteriorly | - no knee joint