Introduction to Post Op Prosthetic Care Flashcards
What are the primary goals of post-operative rehabilitation for early amputee care?
- reduce edema & promote healing
- prevent contractures
- increase strength
- improve mobility
- facilitate limb care and adjustment
What key information is reviewed in a general post-surgical assessment?
- past medical history
- pre-amputation status
- prosthetic goals
- cause of amputation
- associated diseases/symptoms
- prior prosthesis use
What specific factors are evaluated in residual limb assessment?
- Residual limb length, shape, redundant tissue, circumferential measurements
- Vascularity (pulses, color, temperature), and scars/skin lesions.
Ankle-Brachial Index (ABI)
- What is it?
- Why is it used?
- Normal values?
Ankle-Brachial Index (ABI) is a measure to screen for peripheral arterial disease.
- Assess the severity of arterial insufficiency.
Normal Values:
- Normal = 1.1-0.9
- Mild = 0.9-0.7
- Moderate = 0.7-0.5
- Severe = < 0.5
What types of dressings are used in post-op prosthetic care?
- Soft dressings →
- Rigid dressings →
- Immediate non-removable prostheses (INR) →
- Immediate removable prostheses (IRP) →
- Rigid removable dressings → Provide relatively dry and sterile environment while immobilizing the residual limb and providing constant compression to control post-surgical edema.
- Materials: fiberglass casting tape, polyurethane reticulated pad, stump socks to manage volume, protective gel liner (optional)
- Advantages: excellent support of surgical site, improved wound environment, protection against injury to residual limb, maintains limb in neutral position, Ability to monitor wound site, Able to adjust to changes in limb volume with the use of prosthetic socks
- Disadvantages: Skilled application required, Higher level of patient compliance required, Poor suspension or application could contribute to skin breakdown
What are the advantages and disadvantages of soft dressings?
- Advantages: easy application, wound monitoring.
- Disadvantages: risk of uneven pressure, potential tourniquet effect.
What is the primary objective of rigid removable dressings?
To provide a dry, sterile environment, immobilize the limb, and control edema while allowing for wound monitoring.
What materials are advantages & disadvantages in Immediate Post-Operative Prostheses (IPOP)?
Advantages:
- Improves physiological and psychological response to amputation
- Custom measured device utilizing prosthetic design principles.
- Allows wound to be monitored
- ability to adjust for volume reduction
Disadvantages:
- potential for overuse
- cost
What is the purpose of stump wrapping?
To reduce edema, shape the residual limb, and provide compression for improved healing.
What are the three theories explaining phantom limb pain?
- Nerve impulses from remaining nerves
- Spinal cord spontaneous firing
- Altered transmission in the somatosensory cortex
What is the difference between phantom sensation and phantom pain?
- Phantom sensation is non-painful awareness of the limb
- Phantom pain is a painful sensation in the absent limb
What factors can provoke phantom limb pain?
Emotional stress, cold, and local irritants.
How is phantom limb pain typically relieved?
- wearing a prosthesis
- stroking the residual limb
- applying heat
- mental distraction
What are the main goals of compression and edema control post-amputation?
- decrease edema
- shape the residual limb
- decrease phantom limb pain
- promote quicker healing
What types of exercises are recommended for below-knee (BK) amputees during rehab?
Quadriceps strengthening, single-leg balance, and prone lying to prevent hip and knee contractures.
What exercises are recommended for above-knee (AK) amputees during early rehab?
Hip abduction, core strengthening, and bridging exercises.
What techniques are used for desensitization?
Tapping, massaging, rubbing with different textures, and gentle friction massage.
What are the functional ‘K-Levels’ used to categorize prosthetic potential?
- K-Level 0: no ambulation potential
- K-Level 1: household ambulation
- K-Level 2: limited community ambulation
- K-Level 3: full community ambulation
- K-Level 4: high-impact ambulation
What characterizes a K-Level 1 ambulator?
Ability to ambulate within the household with an assistive device at a fixed cadence.
What characterizes a K-Level 2 ambulator?
Ability to traverse low-level barriers like curbs and stairs with a fixed cadence.
What characterizes a K-Level 3 ambulator?
Ability for variable cadence and to traverse most environmental barriers.
What characterizes a K-Level 4 ambulator?
High-impact ambulation, typical of active adults, children, or athletes.
What are the recommended wheelchair positioning strategies for amputees?
Use of a stump board to keep the limb elevated and avoid dependent positions.
Why is prone lying recommended for amputees during early rehab?
To prevent hip flexion contractures and promote hip extension.
What functional training should be included in post-op care?
Bed mobility, transfers, wheelchair mobility, and sound limb skin care.
What are the typical pain descriptions of phantom limb pain?
Dull, aching, stabbing, burning, and electric shock sensations.
What specific criteria must be met for a patient to qualify as a K-Level 4 ambulator?
Ability for high-impact ambulation, involving high energy expenditure typical of athletes.
