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6 Prosthetics & Orthotics > L6 Amputee Post-op > Flashcards

L6 Amputee Post-op Flashcards

1
Q

Post Op Dressings are determined by

A

cause of amputation
level of amputation
potential for infection

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2
Q

Goals of post op dressing

A

protect the incision and residual limb
promote healing
control and reduce edema
control post-op pain
maintain extension ROM
facilitate advancement to prosthetic fitting

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3
Q

Types of post-surgical dressings

A

soft dressing
shrinker
IPOP
rigid removable
semi-rigid dressing

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4
Q

Soft Dressings Advantages

A

indicated in cases of local infection

easy to apply
inexpensive
easy to the incision
allow for active jt ROM

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5
Q

Soft Dressings Disadvantages

A

less edema control
minimal protection
requires frequent rewrapping
joint ROM may delay healing
can’t control amount of tension
can create tourniquet effect

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6
Q

Shrinkers can’t be used until

A

sutures are removed and drainage has stopped

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7
Q

Rigid Dressings Advantages

A

Non-removable thigh length cast

maintains knee in extension
promotes wound healing
helps with residual limb shaping
pain mgmt
protection against trauma
edema control
increased speed of prosthetic fitting

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8
Q

Disadvantages of Rigid Dressing

A

no ability to inspect the incision
requires skill and time under anesthesia to apply

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9
Q

Removable Rigid Dressings Advantages

A

easy to don/doff
allows access to healing wounds
good edema mgmt
protects the incision site
accommodates edema fluctuations
prevents contractures

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10
Q

Removable Rigid Dressings Disadvantages

A

not appropriate for someone w/drainage or bulbous limb shape

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11
Q

Rigid Dressing with IPOP/EPOP Advantages

A

edema control
RL protection
early ambulation
promotes circulation and healing
accelerated healing
facilitation of early definitive prosthetic fitting

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12
Q

IPOP

A

immediate postsurgical prosthesis
rigid dressing with attachment for a pylon and prosthetic foot

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13
Q

EPOP

A

early postoperative prosthesis
rigid dressing with attachment for a pylon and prosthetic foot

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14
Q

Disadvantages of IPOP/EPOP

A

limited WB
no access to incision
more expensive
requires proper training

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15
Q

Pre-prosthetic Phase

A

generally 6 weeks
goals are to protect the limb, prevent contractures, develop single limb mobility, prepare pt for prosthetic

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16
Q

Pre-prosthetic Eval includes

A

history/chart review
systems review
integumentary
residual limb shape
vascularity
ROM
msucle strength
neurological
mobility
balance
outcome measures

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17
Q

Serosanguineous Drainage

A

typical in wound healing
drainage should decrease over time

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18
Q

When should drainage be reported?

A

bright red or darker blood should be reported
thickening, discolored drainage, odor

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19
Q

Cylindrical Shape

A

distal circumference slightly less than proximal
ideal shape

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20
Q

Conical shape

A

distal circumference < proximal circumference

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21
Q

Bulbous shape

A

distal circumference > proximal circumference

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22
Q

Dog ears

A

squared off shape at the end of residual limb

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23
Q

Transfemoral measurement

A

measure from proximal thigh/ischial tuberosity and then every 8-10 cm distal

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24
Q

Transtibial measurement

A

measure from tibial tubercle and then every 8-10 cm distal

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25
Q

DIstal limb circumference should be …

A

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

26
Q

Residual Limb Length Components

A

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

27
Q

Transtibial Length Considerations

A

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

28
Q

Joint ROM

A

patients are at risk for developing contracture at joint proximal to the amputation

risk of hip and knee flexion contractures from increased time sitting

29
Q

Goni measurements with amputation

A

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

30
Q

Muscle Strength of RL

A

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

31
Q

Negative Prognostic Factors for Prosthetic Potential

A

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

32
Q

Preprosthetic Goals

A

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

33
Q

Pre-prosthetic PT interventions

A

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

34
Q

Transfemoral contractures

A

hip flexion, hip abduction, and hip ER

35
Q

Transtibial contractures

A

hip and knee flexion

36
Q

“Do’s” of positioning

A

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

37
Q

“do nots” for positioning

A

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

38
Q

Balance Training

A

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

39
Q

Sitting Balance

A

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

40
Q

Transferring

A

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

41
Q

W/C mobility

A

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

42
Q

W/out IPOP Gait

A

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

43
Q

w/IPOP Gait

A

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

44
Q

Hip extension stretching

A

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

45
Q

UE strengthening

A

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

46
Q

Core strengthening

A

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

47
Q

Transtibial residual limb strengthening

A

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

48
Q

Transfemoral residual limb strengthening

A

emphasize hip extensors and abductors for prosthetic use

49
Q

Hip disarticulation strengthening

A

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

50
Q

Hemipelvectomy strengthening

A

UEs, abdominals, contralateral lower limb must be maximized

51
Q

Compression devices are indicated for

A

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

52
Q

Shrinkers

A

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

53
Q

Residual Limb Wrapping

A

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

54
Q

Residual Limb Care

A

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

55
Q

Phantom Limb Sensation

A

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

56
Q

Phantom Limb Pain

A

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

57
Q

Central origin of pain

A

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

58
Q

Management of phantom limb pain

A

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

59
Q

Desensitization

A

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

60
Q

Mirror Therapy

A

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

61
Q
A

6 Prosthetics & Orthotics (11 decks)

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