L8 Amputee Rehab Flashcards
Poor or incomplete donning may result in
- proximal soft tissue folding over socket
- gap of ≥1cm between distal limb and base of socket
- residual air expulsion w/movement
- pain
- prosthesis feeling too tall or unstable
- Unusual rotation of knee and foot
- risk to skin integrity
Sitting socket fit, TT
assess with knees flexed to 90° and foot flat
RL tends to move up a little when person sits. Knee may be extended if there is pressure on knee or RL. Also check for pressure on hamstrings
Sitting socket fit, TF
socket is securely fit on RL
length of shin/thigh correspond to shin/thigh length on intact limb
client can sit comfortably
can lean forward and reach shoes
Standing alignment, TT & TF
no pain with WB
knee stability
equal leg. length
WB should be equal between legs
shoes level on floor
pressure on pubic ramus or adductor roll
Suspension Check
have pt lift weight off of prosthesis and check for excessive movement
there should be no movement with suction or shuttlelock suspension, movement causes skin breakdown
Sleeve suspension
should have direct contact with skin for at least 2” above any socks or liners
Total Contact
limb is seated well in the socket while also not bottoming out
Powder Test
place a small amount of baby powder or cornstarch on sides and bottom of socket
don the prosthesis, stand/walk short distance
Powder on bottom or sides of socket
indicates loss of total contact fit
Minimal powder at bottom of socket
total contact fit
Ball of Clay Test
identifies if the residual limb is seated within socket
place little ball of clay at end o socket. have client WB
clay should be compressed into flat disk, indicating proper pressure on distal end
Clay ball is smashed or thin
indicates too much pressure on distal end of limb
Clay ball is not deformed
indicates that limb is not descending far enough into the socket for proper support
K Levels
as a means to quantify need and potential benefit of prosthetic devices for patients after lower limb amputations
guide prosthetists on component reimbursement
based on functional ability, potential ability to function, needs of pt
K-0 Level
pt does not have ability or potential to ambulate or transfer safely w/out assistance and a prosthesis does not enhance QOL or mobility
no eligible for prosthesis
K-1 Level
pt can do transfers, ambulate on level surfaces, fixed cadence, limited household ambulator
eligible for single axis, constant friction, SACH
K-2 Level
for tranverse low level barriers, like curbs, limited community ambulator
eligible for polycentric, constant friction, flexible keel foot, multi axial
K-3 Level
for variable cadence ambulator, unlimited community, traverse most environmental barriers, beyond simple locomotion
eligible for hydraulic pneumatic, microprocessor, variable friction, energy storing, dynamic response, multi-axial
K-4 Level
exceeds basic ambulation, exhibits high impact, typical for child/athlete/active adult
eligible for any system
10 meter walk test K-levels
K1 = .17m/s
K2 = .38m/s
K3 = .63m/s
K4 = 1.06 m/s
Amputee Mobility Predictor
used with LE amputees and assess functional mobility
can be performed with or without prosthesis
3.4 MDC
not recommended for pts with bilateral amputation at levels higher than transtarsal foot amputation
AMnoPRO scores and K Levels
K0 = ≤ 8
K1 = 9-20
K2 = 21-28
K3 = 29-36
K4 = ≥ 37
AMPPRO scores and K levels
K0 = N/A
K1 = 15-26
K2 = 27-36
K3 = 37-42
K4 = ≥ 43
Assistive Device Selection on AMP
0 = unable to leave bed
1 = w/c or parallel bars
2 = walker
3 = crutches
4 = cane
5 = none
