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MVMT SCI II > LE EXAMINATION OF AMPUTEE > Flashcards

LE EXAMINATION OF AMPUTEE Flashcards

1
Q

Common causes of LE amputation

A

infection, gangrene, trauma, congenital, necrosis, necrotizing fasciitis, cellulitis, PAD, frostbite, tumor (osteosarcoma), complications from DM

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2
Q

Pre-prosthetic phase of treatment

A

weeks 2-12

-in home health or SNF

-want to help the individual to be safe at the wheelchair level

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3
Q

Post-operative phase timeline and care

A

weeks 1-3

-acute care, SAR, acute rehab

-functional mobility and wound assessment

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4
Q

Prosthetic training phase of treatment

A

weeks 12-16

outpatient or acute rehab

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5
Q

Long term follow phase of treatment

A

3 months and beyond

outpatient

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6
Q

What types of pain may you ask about in a subjective evaluation of pain?

A

phantom limb sensation

phantom limb pain

residual limb pain

referred pain - neuroma or heterotopic ossification

MSK pain - back pain is common

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7
Q

What is a very important area to inquire about in a subjective eval post-amputation?

A

psychosocial factors

-grief assessment
-coping strategies
-QOL
-dep/anxiety
-PTSD
-self-perception of body or self defense
-housing instability

-consider home and social environment

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8
Q

Areas of subjective evaluation post-op

A

-systems review
-cognition
-pain
-psychosocial
-home and social environment
-prior level of function: ex: occupation, driving
-GOALS
-patient preferences and values

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9
Q

Components of physical evaluation

A

-vitals
-observation
-vision/vestibular/hearing
-skin
-residual limb assessment
-contralateral limb inspection
-sensation
-ROM
-strength
-functional mobility
-gait
-outcome measure assessment

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10
Q

Assessment of residual limb

A

-level
-type
-overall observation: shape and swelling
-incision: sutures, staples, eschar, slough, drainage, dehiscence
-scar mobility and invagination

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11
Q

Sensation assessment on the residual limb

A

BLUE BLE dermatomes

light touch

sharp/protective sensation

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12
Q

Coordination assessment

A

hand function and dexterity

donning and doffing ability

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13
Q

ROM assessment

A

-hip and knee ROM

-lumbar/pelvic mobility
–> have the hamstrings impacted pelvic and lumbar positioning and pain?

-development of contractures

-contralateral ROM

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14
Q

Strength assessment

A

-the affected limb may be limited by post-surgical pain
-assess upper extremity strength!

KEY CONSIDERATIONS
-hip abduction and adduction
-gluteus activation
-quad activation

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15
Q

Components of functional evaluation

A

Functional mobility
-bed mobility
-transfers
-W/C mobility

Gait

Stairs
-hopping vs bumping

Balance
-static and dynamic

Cardio/endurance
-functional tolerance to intervention

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16
Q

Patient-reported outcome measures

A

PSFS
GAS - goal attainment scale
ABC - Activities of Balance Confidence Scale
PLUS-M (prosthetic limb users survey of mobility)

17
Q

Performance outcome measures

A

Functional mobility
-amputee mobility predictor, AMP-B, 5TSTS, 30sec STS

Gait
-10MWT
-TUG

Balance
-SL balance, AMP, TUG

Endurance
-2MWT, 6MWT

Higher level
-CHAMP, FGA, DGI

18
Q

Goals for pre-prosthetic management

A

-patient education on amputation and rehab

-CV endurance

-residual limb management
–positioning and contracture
–residual limb care and protection
–strength and ROM
–compliance

-balance training

-transfer training

-mobility training
–single limb ambulation
–w/c mobility

19
Q

Residual limb management/assessment

A

-what is the level of the residual limb?

PAIN MANAGEMENT
-scar tissue massage
–> approximate tissue and move it around, prevent invagination
-desensitization
–> diff pressures, diff temperatures, diff textures
-mirror therapy
–> reflect the sound side
–> AROM and take adv. of mirror neurons
-compression

OTHER:
-positioning, edema management
-compression for shrinking and shaping
–> ACE, cast, shrinker sock (whenever not wearing prosthetic)
-incision and wound management
-compliance with wear schedule and residual limb management
-proprioception/joint position

20
Q

Clinical indications for prosthetic candidacy

A
  1. sufficient strength and independence for functional mobility
  2. sufficient ROM
  3. K level predicted by Amputee Mobility Predictor
    -household vs community
  4. Physician clearance for progressive weight-bearing
    -incision healed
    -compliance with wear schedule
  5. well-fitting socket with correct alignment
21
Q

Blistering/things to look out for with prosthetic use:

A

-ring on the bottom of limb–> pistoning

-blanching that does not go back to pink in 5-10 min

-dark pink color of skin–> bad

22
Q

Evaluation components

A

-residual limb management

-prosthetic use and compliance
–> wear schedule, donning/doffing liners, socks, socket, suspension
–compliance with shrinker use

-fit and alignment of prosthetic

-skin inspection and tolerance

-functional mobility
–level of support
–AD use
–history of falls

23
Q

Possible causes of gait deviations seen on assessment

A

range of motion requirement

torque demand

muscle action

functional significance

24
Q

Goals for prosthetic training

A

-patient engagement and compliance

-independence/safety with residual limb management and functional mobility

-sufficient strength, ROM, and endurance for functional activities

-full-weight acceptance on new prosthesis
–> Symmetrical and appropriate gait mechanics

-safety with balance, transfers, gait, stairs

-assistive device progression

-Ability to adapt to enviro demands while walking

-return to PLOF and recreational/vocational activities

25
Q

3 most common causes of amputation

A

1.) vascular disease

2.) trauma

3.) cancer

97% of all amputations are LE amputations

African Amercians are up to 4x more likely to have an amputation than white Americans

26
Q

Amputation timeline and presentation

A

pre-op

acute/post-op: weeks 1-3

pre-prosthetic: week 3-12 post-op
-home health/SNF
-shaping and compression of limb
-protection of residual limb at this time (hard cast)

prosthetic and gait training/OP: week 6-8 to 16

long term f/u: 3-6 mo follow-up/ annually for life in the VA

27
Q

CV, integumentary screen, and other screening post-op

A

CV
-look at all pulses

Integumentary
-hair growth
-swelling
-irritation from socket
-look at scar
-teach family how to check skin

OTHER
-psychosocial concerns/depression

28
Q

Interventions for phantom limb pain

A

-Compression at night
-Gabapentin
-targeted muscle re-innervation:

28
Q

Types of pain following amputation

A

phantom limb sensation (upwards of 100% of amputees experience)

phantom limb pain
-ex: inability to empty bowel and bladder can increase PLP because bladder and bowels right next to LE on somatosensory cortex (homunculus)

residual limb pain
-neuromas, bone spur

back pain/referral (S1, L4, L5)

29
Q

What are dysvascular amputees more at risk for?

A

psychosocial considerations such as depression, anxiety, grief

30
Q

What is targeted muscle re-innervation?

A

Targeted muscle reinnervation (TMR) is essentially a way to give nerves affected by an amputation procedure something to do. When they’re rerouted into muscle as motor nerves, they’re less likely to send pain signals to the brain while they are attempting to regenerate properly.

31
Q

ROM assessment

A

hip and knee ROM–> risk of contracture

ROM needed for gait and functional mobility
-60 knee flexion for gait
-110 knee flexion for stairs
-about 10-degrees hip extension for walking

pelvic mobility

lumbar mobility

contralateral ROM

32
Q

What muscle is key in both the sound and residual limb to help prevent an individual from falling?

A

hip extensor strength

*UE strength needed for use of an AD

33
Q

Sensation testing on residual and sound limb

A

light touch

sharp

** protect yourself by wearing shoes around the house/or socks due to lack of sensation

34
Q

Why is it important to do an ortho exam for the sound limb?

A

predisposed to overuse and OA of sound limb

MVMT SCI II (9 decks)

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