Intro to Amputations Pt 2

Question 1

during the perioperative phase, what should your rehab interventions focus on?

Answer 1

open and closed chain exercises
progressive resistance
– to improve gait, mobility, strength, CV fitness, and ADL performance in order to maximize function

Question 2

during the perioperative stage, rehab goals and outcomes should include _______ about residual limb length and amputation level

Answer 2

shared decision making

Question 3

what kind of dressing should you use during the perioperative stage?
– when limb protection is priority?

Answer 3

rigid or semi-rigid - to promote healing and early prosthetic use
– rigid

Question 4

what kind of screening should you perform prior to setting goals, to assess the patients ability and suitability for appropriate prosthetic technology?

Answer 4

cognitive screening

Question 5

in the perioperative phase, treatment should be done in what setting?

Answer 5

inpatient rehab over a SNF

Question 6

during the perioperative phase, when should you initiate mobility training?

Answer 6

as soon as possible
may include ipsilateral WB ambulation with a pylon to improve function and gait parameters

Question 7

during perioperative phase, what should the care team ensure the patient achieves?

Answer 7

the highest level of functional independence WITHOUT a prosthesis

Question 8

there is insufficient evidence to recommend for or against:

Answer 8

one surgical procedure over another

Question 9

post-op timeline for lower limb amputation:
– days 1-2:
– day 3-14:
– weeks 2-3:
– weeks 4-6:

Answer 9

– ROM, bed mobility, transfers, sound limb exercises, post-op dressings
– pre-prosthetic ambulation with crutches, post-op dressings
– staples removed, shrinker or wrap, dynamic resistive exercises, ROM, ambulation
– shrinker and monitor healing, prevention of complications, casting for prosthetic socket if incision is healed

Question 10

when assessing ROM, you want to check for what?

Answer 10

contractures

Question 11

what are common contractures for:
– transtibial:
– transfemoral:

Answer 11

– knee flexion, hip flexion
– hip flexion, hip abduction

Question 12

what are causes for contractures in amputees? (2)

Answer 12

poor positioning
prolonged sitting position/wheelchair use

Question 13

what are consequences of getting a contracture? (2)

Answer 13

functional leg length discrepancy
poor prosthetic alignment

Question 14

how do you manage contractures for amputees?

Answer 14

appropriate positioning
ambulation
prosthetic modification
casts
surgery

Question 15

what is proper positioning to prevent contractures in amputees?
– hip
– knee
– prone
– sitting
– avoid ____ for TFA

Answer 15

neutral hip rotation
knee extension
hip and knee extension
knee extension
hip abd

Question 16

what is a common emotion for a patient to feel after a traumatic amputation?

Answer 16

disbelief

Question 17

what things should you as a PT train your patients on in the perioperative phase?

Answer 17

enhancing mobility:
transfer training - stand-pivot for unilateral
crutch training or wheelchair training

Question 18

what are PT focus areas in the perioperative stage of an amputation?

Answer 18

enhance self care
assess for prosthetic potential
control edema
pain management
optimal shaping of residual limb
prevent secondary complications
function within home and community
care for sound limb

Question 19

what benefits would a microprocessor knee provide over a non-mircoprocessor knee?

Answer 19

reduces fall risk
maximizes patient satisfaction

Question 20

what must your patients undergo in order to determine the most appropriate device to achieve their functional goals?

Answer 20

pre-prosthetic training

Question 21

when do you initiate UE prosthetic fitting?

Answer 21

as soon as patient can tolerate mild pressure on the residual limb

Question 22

what recommendation is there insufficient evidence for during the pre-prosthetic phase?

Answer 22

to recommend any particular socket design, prosthetic foot categories, and suspensions and interfaces
– transdisciplinary team should consider patient goals and attributes

Question 23

typically how long post-op would you wait to initiate fitting a prosthetic?

Answer 23

~1 month —> use in therapy only first

Question 24

what are the 4 components of the Comprehensive High-Level Activity Mobility Predictor (CHAMP)?

Answer 24

single legged stance
edgren side step test
T-Test
illinois agility test

Question 25

what is the total time for conducting the CHAMP?
– total score is the sum of:

Answer 25

– 15 minutes
converted scores based on percentiles

Question 26

what does the 10 meter walk test tell us?

Answer 26

gait speed

Question 27

what does the 2 or 6 minute walk test tell us?

Answer 27

measures distance walked
endurance

Question 28

why would you have your patient perform the TUG in the prosthetic training phase?

Answer 28

determines fall risk

Question 29

what is the L test?

Answer 29

like TUG but in an L shape (3m x 7m)
specifically designed for amputation population

Question 30

during prosthetic training phase, what should be offered to active prosthesis users?

Answer 30

at least 1 backup device to ensure consistency with function

Question 31

what are some complications that impact prosthetic fit?

Answer 31

edema
residual limb pain
contractures
neuromas
skin breakdown
ingrown hairs
hyperhidrosis (sweating)

Question 32

how long can edema last post-amputation?

Answer 32

12-18 months
- post op edema
- muscle atrophy
- diet
- activity level

Question 33

if a patient has volume fluctuations, what can you teach them to help?

Answer 33

sock ply management –> add or reduce sock ply

Question 34

in suction suspension, why is it important to have sock ply?

Answer 34

you dont want a patient to bottom oout

Question 35

areas with repetitive skin breakdown should be:

Answer 35

accommodated with prosthetic modifications –> consider not using prosthesis until healed

Question 36

what can you do if a patient has adhesions?

Answer 36

friction massage

Question 37

if the skin breakdown is pressure tolerant:
if the skin breakdown is pressure sensitive:

Answer 37

able to bear weight – muscle and tendon
bone

Question 38

long term care:
– against:
– follow up every _____ months
– provide:

Answer 38

– long-term opioid therapy for chronic pain
– 12 months
– education to pt, family, caregiver regarding advancements in tech., surgical, and rehab procedures

Question 39

what is a secondary complication to amputation found in the amputated side in patients with TTA and TFA?

Answer 39

osteoporosis

Question 40

osteoporosis in TTA and TFA patients:
– may be due to:
– can cause:
– increases:

Answer 40

– insufficient mechanical loading
– residual limb pain
– fracture risk

Question 41

what is a common secondary complication to amputation found in the intact limb knee and hip?

Answer 41

osteoarthritis

Question 42

OA in amputees on sound limb may be due to: ___ and causes ____

Answer 42

overloading of sound limb
pain

Question 43

true or false. a person with an amputation is at lower risk for OA

Answer 43

false - greater risk for OA in sound hip/knee

Question 44

what is a secondary complication to amputation that causes formation of bone in non-osseous tissue and complicates socket fit?

Answer 44

heterotrophic ossification

Question 45

heterotrophic ossification is more common in amputations due to _______

Answer 45

trauma

Question 46

how can you accommodate for heterotrophic ossification in amputees?

Answer 46

socket modification or surgically excise

Question 47

a patient with a LE amputation complains that the bottom of their residual limb is hitting their socket (bottoming out). what is your recommendation?
a) add sock ply
b) decrease sock ply
c) elevate limb for 15 minutes
d) no changes needed

Answer 47

a)