L20 - LE Amputee Flashcards
What is relevant about the biomechanics of a transfemoral amputation (hint: has to do with adduction)?
Loss of attachment points for adductor magnus (which provides 70% of adduction strength and provides extension force) results in hip being positioned in flexed and abducted position.
The loss of AM muscle attachment shortens the lever arm for adduction, requiring the remaining adductor muscles to work harder to produce the same movement.
When is a knee disarticulation performed?
Trauma: when the residual length of the tibia is less than 4 cm
PVD: surgeon’s choice
When are the advantages and disadvantages of a knee disarticulation?
Advantages: WB distally is possible, better lever arm and prosthesis control
Disadvantages: Long and bulbous residual limb, less aesthetic, and knees of different lengths when seated
Describe the surgery behind a symes disarticulation
The foot is amputated, and the heel pad is repositioned and stitched to distal tibia and fibula. A cast is then used to help the heel pad attach properly, followed by the smoothing of malleoli.
What are the advantages of a symes disarticulation?
WB is possible at distal end of residual limb after healing. The residual limb can function effectively with a prosthetic limb.
What are the disadvantages of a symes disarticulation?
The appearance is not cosmetically pleasing and can result in a limb that looks like an elephant’s leg due to its shape.
What determines amputation level for people with PVD?
Healing potential established by clinical examination and laboratory tests.
What are the considerations for amputation level in cases of trauma or cancer?
Nature of the trauma or tumor and tissue viability.
What are the consequences of choosing an amputation segment length that is too long?
Bony prominence, non-aesthetic prosthesis, limits on prosthesis components, reduced moment of force.
What are the consequences of choosing an amputation segment length that is too short?
Decreased stability, suspension issues with the prosthesis, reduced moment of force.
How does energy expenditure differ between vascular transtibial and traumatic transfemoral amputations?
They are roughly equal. Energy expenditure from transfemoral vascular is much higher than transfemoral traumatic.
How long does rehabilitation following a lower limb amputation take on average?
Between 12 and 18 months
What are the objectives of PT in the pre-operative phase?
Improve pain management, minimize deconditioning, improve patient participation, and inform about rehabilitation and the impact of amputation.
What are the PT interventions in the pre-operative phase?
Positioning for comfort, education on pain, encouraging mobilization, falls prevention, ROM/STR exercises, and general endurance exercises.
Why is pain management a crucial part of the PT’s role in the pre-operative phase?
Studies showed that the more stable and well-managed the pain is before the amputation, the less likely the pt is to get phantom pain
What is the PT intervention for preventing lower extremity contractures in the acute post-op phase?
Positioning the LE in extension and teaching ROM exercises for knee/hip extension.
What is the recommended practice for edema management post-op?
Introduce compression at the residual limb as tolerated and educate on positioning the limb in elevation intermittently.
What is the focus for mobility in the acute post-op phase?
Practice bed mobility, basic transfers, and unipodal mobility with walking aid.
What positioning should be avoided when sitting post-op?
Positioning where skin is pulled at the staples and where knee and hip are in flexion should be avoided.
What is the duration of pre-prosthetic training?
4 to 8 weeks
When does pre-prosthetic training phase end?
When the surgical wound is healed and the residual limb is mature and ready for prosthetic training
What are the overall PT objectives during pre-prosthetic training?
- Restore and maximize autonomy in unipodal and/or with wheelchair 2. Evaluate potential for prosthetic prescription 3. Prepare the residual limb to prosthetic fitting
What are the most 4 common residual limb shapes?
Cylindrical, conical, bulbous, dog eared
What are common joint contractures for transtibial amputation?
Knee flexion contracture
What are common joint contractures for transfemoral amputation?
Hip flexion contracture > hip abduction
What are the main muscles to target strengthening following a TT amputation?
Knee flexors, knee extensors, hip muscles
What is the purpose of the AMPPRO/AMPnoPRO questionnaire?
Standardized test used to predict functional mobility protential after prosthetic fitting
How can joint contractures be prevented/treated?
Positioning education, stretching agonist muscle, strengthening antagonist muscle, manual therapy
What are some immediate post-op compression methods?
Rigid dressing, Immediate post-op cast/prosthesis, Semi-rigid dressing
What is the purpose of immediate post-op compression?
To provide constant pressure on soft tissue and improve circulation
What are some drawbacks of immediate post-op compression methods?
Risk of infection, Requires specialized expertise, Must be redone once edema decreases
What are the advantages of elastic bandages in wound care?
Low cost, able to visualise the wound, allow limb mobility and strength training, can be adapted to the individual’s shape of residual limbs
What are the disadvantages of elastic bandages in wound care?
Requires proper patient education to apply it, has to be redone regularly, careful of tourniquet (when applied in circular manner vs figure of 8), elastic bandaging is unreliable and unsafe in terms of pressure distribution
