L6 Amputee Post-op Flashcards

Question

DIstal limb circumference should be ...

Answer 1

equal to or no more than 1/4 in greater than proximal limb circumference smaller distal circumference is desirable so that shear forces on soft tissue will be minimal when the prosthesis is donned and used

Answer 2

actual length of residual tibia or femur total length of limb including soft tissue

Answer 3

5-6 in of tibia ensures sufficient lever arm for prosthetic control <3" may be insufficient for prosthetic control and poor skin tolerance due to reduced surface area longer limbs may be unable to flex knee beyond 90° in sitting

Answer 4

patients are at risk for developing contracture at joint proximal to the amputation risk of hip and knee flexion contractures from increased time sitting

Answer 5

lack of distal malleolus as landmark accuracy decreases as limb length decreases hip contracture can be eval with thomas test

Answer 6

MMT should be avoided in acute post surgical period on residual limb to avoid undue stress on surgical site subjective strength grade may be somewhat inflated due to RL length consider UE and hand function as an assessment for strength

Answer 7

presence of co-morbidities pre-operative ambulatory status age > 60 level of amputation presence of post op complications/impairments impaired cognitive status environmental barriers preventing return to previous living environment

Answer 8

Overall goal of preprosthetic period is to prepare the pt for fitting and training protect remaining limb independence in transfers, mobility, etc proper positioning independence in residual limb care HEP independence with ROM, strength adequate ROM

Answer 9

postioning bed mobility training mobility training stretching program strengthening balance training transfer training pain management residual limb care

Answer 10

hip flexion, hip abduction, and hip ER

Answer 11

hip and knee flexion

Answer 12

knee in extension while in bed knee in extension while sitting residual limb support in w/c keep limb adducted in bed for TF

Answer 13

place pillow under knee in bed keep knee in flexed/hanging position sitting keep RL in abducted position TF

Answer 14

falls occur often during transfers, and due to reduced awareness also loss of mass and change in COM affects balance. COM shifts upward, backwards, towards intact extremity

Answer 15

more often affected in BL amputation or higher TF/hip disarticulation

Answer 16

easiest to transfer toward intact side helps to protect RL from injury

Answer 17

shift in COM posterior following amputation move the wheels more posterior or adding anti-tippers

Answer 18

work toward swing through gait patterns. start in bars and progress to crutches are able

Answer 19

teach the pt how to limit WB on IPOP PWB restrictions on IPOP

Answer 20

watch for excessive lumbar lordosis to make up for hip flexor contracture encourage periods of lying supine or prone to provide prolonged low-load stretch on hip flexors SL active hip motion through pain free ROM

Answer 21

important for supporting the body during transfers and with use of an AD emphasize shoulder stabilizers, adductors, depressors, elbow extensors, wrist

Answer 22

functional mobility and balance need strong and flexible back/abdominal flexors, rotators, extensors and hip extensors

Answer 23

emphasize hip extensors and abductors, knee flexors and extensors for eventual prosthetic use

Answer 24

emphasize hip extensors and abductors for prosthetic use

Answer 25

must be able to perform posterior pelvic tilt to initiate swing phase with prosthesis

Answer 26

UEs, abdominals, contralateral lower limb must be maximized

Answer 27

residual limb shaping edema management prevention of contractures reducing adductor roll in TF amputations desensitization

Answer 28

used once the incision is healed worn 24 hours/day except when bathing supplied by prosthetist

Answer 29

pressure distal > proximal smooth, wrinkle free application to avoid excessive pressure should be worn 24 hours a day helps to promote full knee extension for TT and full hip extension for TF

Answer 30

scar tissue mob once primary healing has occurred pt should handle RL to adapt to new body visually inspect skin daily

Answer 31

erroneous interpretation of sensory nerve impulses traveling along the pathway of nerves that formerly provided sensory feedback from RL includes numbness, tingling, pressure, itching, muscle cramps

Answer 32

shoot pain, severe cramping, burning sensation localized in amputated limb typically more episodic or intermittent than phantom sensation those that have dysvascular pain are more likely to have phantom pain

Answer 33

hyperirritable foci develop in dorsal horn of SC after peripheral nerve transection possibly as result of loss of high threshold input to dorsal horn neurons

Answer 34

desensitization techniques heat modalities TENS firm pressure applied to RL massage consistent use of prosthesis mirror therapy

Answer 35

helps make RL less sensitive to touch and improves tolerance 2-3x/day when soft dressing is off start with soft material, and rub in circular motion. Progress to rougher materials

Answer 36

Can be used as treatment for phantom limb pain perform gentle movements while looking in mirror for 20-25 min daily cortical restructuring hypothesized to occur by activating mirror neurons of contralateral side, can help recreate body image and impact internal motor control