Intro to Amputations Pt 2 Flashcards
during the perioperative phase, what should your rehab interventions focus on?
open and closed chain exercises
progressive resistance
– to improve gait, mobility, strength, CV fitness, and ADL performance in order to maximize function
during the perioperative stage, rehab goals and outcomes should include _______ about residual limb length and amputation level
shared decision making
what kind of dressing should you use during the perioperative stage?
– when limb protection is priority?
rigid or semi-rigid - to promote healing and early prosthetic use
– rigid
what kind of screening should you perform prior to setting goals, to assess the patients ability and suitability for appropriate prosthetic technology?
cognitive screening
in the perioperative phase, treatment should be done in what setting?
inpatient rehab over a SNF
during the perioperative phase, when should you initiate mobility training?
as soon as possible
may include ipsilateral WB ambulation with a pylon to improve function and gait parameters
during perioperative phase, what should the care team ensure the patient achieves?
the highest level of functional independence WITHOUT a prosthesis
there is insufficient evidence to recommend for or against:
one surgical procedure over another
post-op timeline for lower limb amputation:
– days 1-2:
– day 3-14:
– weeks 2-3:
– weeks 4-6:
– 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
when assessing ROM, you want to check for what?
contractures
what are common contractures for:
– transtibial:
– transfemoral:
– knee flexion, hip flexion
– hip flexion, hip abduction
what are causes for contractures in amputees? (2)
poor positioning
prolonged sitting position/wheelchair use
what are consequences of getting a contracture? (2)
functional leg length discrepancy
poor prosthetic alignment
how do you manage contractures for amputees?
appropriate positioning
ambulation
prosthetic modification
casts
surgery
what is proper positioning to prevent contractures in amputees?
– hip
– knee
– prone
– sitting
– avoid ____ for TFA
neutral hip rotation
knee extension
hip and knee extension
knee extension
hip abd
what is a common emotion for a patient to feel after a traumatic amputation?
disbelief
what things should you as a PT train your patients on in the perioperative phase?
enhancing mobility:
transfer training - stand-pivot for unilateral
crutch training or wheelchair training
what are PT focus areas in the perioperative stage of an amputation?
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
what benefits would a microprocessor knee provide over a non-mircoprocessor knee?
reduces fall risk
maximizes patient satisfaction
what must your patients undergo in order to determine the most appropriate device to achieve their functional goals?
pre-prosthetic training
when do you initiate UE prosthetic fitting?
as soon as patient can tolerate mild pressure on the residual limb
what recommendation is there insufficient evidence for during the pre-prosthetic phase?
to recommend any particular socket design, prosthetic foot categories, and suspensions and interfaces
– transdisciplinary team should consider patient goals and attributes
typically how long post-op would you wait to initiate fitting a prosthetic?
~1 month —> use in therapy only first
what are the 4 components of the Comprehensive High-Level Activity Mobility Predictor (CHAMP)?
single legged stance
edgren side step test
T-Test
illinois agility test
what is the total time for conducting the CHAMP?
– total score is the sum of:
– 15 minutes
converted scores based on percentiles
what does the 10 meter walk test tell us?
gait speed
what does the 2 or 6 minute walk test tell us?
measures distance walked
endurance
why would you have your patient perform the TUG in the prosthetic training phase?
determines fall risk
what is the L test?
like TUG but in an L shape (3m x 7m)
specifically designed for amputation population
during prosthetic training phase, what should be offered to active prosthesis users?
at least 1 backup device to ensure consistency with function
what are some complications that impact prosthetic fit?
edema
residual limb pain
contractures
neuromas
skin breakdown
ingrown hairs
hyperhidrosis (sweating)
how long can edema last post-amputation?
12-18 months
- post op edema
- muscle atrophy
- diet
- activity level
if a patient has volume fluctuations, what can you teach them to help?
sock ply management –> add or reduce sock ply
in suction suspension, why is it important to have sock ply?
you dont want a patient to bottom oout
areas with repetitive skin breakdown should be:
accommodated with prosthetic modifications –> consider not using prosthesis until healed
what can you do if a patient has adhesions?
friction massage
if the skin breakdown is pressure tolerant:
if the skin breakdown is pressure sensitive:
able to bear weight – muscle and tendon
bone
long term care:
– against:
– follow up every _____ months
– provide:
– long-term opioid therapy for chronic pain
– 12 months
– education to pt, family, caregiver regarding advancements in tech., surgical, and rehab procedures
what is a secondary complication to amputation found in the amputated side in patients with TTA and TFA?
osteoporosis
osteoporosis in TTA and TFA patients:
– may be due to:
– can cause:
– increases:
– insufficient mechanical loading
– residual limb pain
– fracture risk
what is a common secondary complication to amputation found in the intact limb knee and hip?
osteoarthritis
OA in amputees on sound limb may be due to: ___ and causes ____
overloading of sound limb
pain
true or false. a person with an amputation is at lower risk for OA
false - greater risk for OA in sound hip/knee
what is a secondary complication to amputation that causes formation of bone in non-osseous tissue and complicates socket fit?
heterotrophic ossification
heterotrophic ossification is more common in amputations due to _______
trauma
how can you accommodate for heterotrophic ossification in amputees?
socket modification or surgically excise
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
a)
