Lecture 3: Post Amp Assessment Treatment Flashcards
1
Q
Acute postoperative phase -
A
Time between surgery and discharge from acute care
2
Q
Pre-prosthetic postoperative phase -
A
- Time between discharge from acute care and fitting with a definitive prosthesis
- Or until the medical decision is made not to fit with prosthesis
3
Q
Prosthetic postoperative phase -
A
- Long term management
- Includes rehabilitation and training with prosthetic
4
Q
Postoperative dressings are primarily up to who?
A
- Primarily the surgeon’s decision
- Interdisciplinary team is critical in recommendations =
5
Q
The purpose of Postoperative dressings:
A
- protect the incision and residual limb
- foster healing
- control edema
- manage pain
6
Q
3 Advantages of compressive soft dressings:
A
- Easy to apply
- Inexpensive
- Easy access to incision
7
Q
3 Disadvantages of compressive soft dressings:
A
- Little edema control
- Frequent rewrapping
- Inconsistent technique
8
Q
2 Advantages of shrinker dressings:
A
- Easy to apply
2. Inexpensive
9
Q
3 Disadvantages of shrinker dressings:
A
- Sutures removed
- Requires changing
- Tourniquet effect
10
Q
2 Advantages of semi-rigid dressings:
A
- Better edema control
2. Protection of limb
11
Q
3 disadvantages of semi-rigid dressings:
A
- Frequent changing
- No pt application
- No access to incision
12
Q
3 Advantages of IPOP dressings:
A
- Great edema control
- Excellent protection
- Controls pain
13
Q
3 Disadvantages of IPOP dressings:
A
- Access to incision*
- More expensive
- Requires training
14
Q
Immediate Post-Surgical Prosthesis (IPOP) -
A
Prosthetic socket allowing for limited weight-bearing ambulation in the early stages
15
Q
Rigid/Semi-Rigid Dressing (SRDs) -
A
- Applied in the OR or recovery room
- Allows for immediate prosthetic fitting
- Dressing adheres to the skin
16
Q
Splints/Immobilizers -
A
- Can be air or rigid
- Encourages full knee extension
- Worn over primary dressing
17
Q
Soft dressings -
A
- Immediately post-op, wrapped with sterile gauze and covered with compressive elastic bandage in figure-8 fashion
- Can be performed with ace-wrap, Compressogrip, Tubigrip, or shrinker
18
Q
Post-Surgical Evaluation & Treatment:
A
- General systems review/chart review
- Post-surgical status
- Pain
- Residual limb assessment
- ROM and strength
- Functional status
- Cognition/emotion
- Post-op Complications
19
Q
Need to determine what during pain assessment?
A
Location
Type
Nature
Intensity
20
Q
Phantom limb sensation -
A
Painless awareness of the amputated limb, possibly accompanied by tingling
21
Q
Phantom limb pain -
A
Brain continues to receive painful sensory messages from the nerves that originally carried messages from amputated limb
22
Q
Pain treatment post op amputation -
A
- Dressings and compression (ACE wrapping) help to desensitize limb
- Medications
- Pain education
- Movement
- Modalities
23
Q
How measure length of TT?
A
medial joint line to end of limb
24
Q
How measure length of TF?
A
ischial tub. or GT to end of limb
25
How measure volume of residual limb?
Circumferential measurements over known bony landmarks
26
What vascularity characteristics when assessing residual limb?
- Distal pulses
| - Skin temp/color (at rest and with position change)
27
Contralateral/Intact Limb Assessment (4) -
1. DVT Screen
2. Diabetic foot screen (if appropriate)
3. Sensory testing
4. Strength/ROM testing
28
Common DVT symptoms -
- Swelling (calf/entire leg)
- Local tenderness along deep venous system
- Increased redness/warmth
29
T/F For all amputees, ROM is ESSENTIAL for normal prosthetic use.
True
30
What is the primary goal in the acute/preprosthetic phase?
prevention of contracture
31
Positioning postoperative -
1. Critical to prevention contractures
- Hip
- Knee
2. Edema control
3. Patient comfort
4. Patient education
32
Key muscles of TT ROM Treatment: Stretching/AROM -
- Hamstrings
- Hip flexors
- Gastroc-soleus (contralateral)
33
Key muscles of TF ROM Treatment: Stretching/AROM
- Hip flexors
- Hip abductors
- Hip External rotators
- Lumbar extensors
- Contralateral LE
34
What 3 things should we focus on when working on AROM with LE amputee?
1. Early and often
2. Focus on knee and hip extension
3. Work through available range
35
In acute settings, what focus on for strength assessment?
- Do NOT apply resistance over surgical incision
- Do test active, non-resistive movement against gravity at the joint just proximal to amputation
(Adjust hand position as necessary)
- Normal MMT of next proximal joint
36
2 main goals of Strengthening: Early Post-op Therex?
1. Address identified muscle performance impairments
| 2. Maximize overall strength to prep for prosthetic gait
37
Immediate post operative strengthening focus on what 3 things?
1. Isometric and AROM, focusing on joint proximal to amp.
2. Core strength!
3. Contralateral limb
38
What muscles do you target with TT amputee?
- Quadriceps
- Hamstrings
- Glute Max
- Glute Med
- Abdominals
- UE
39
What muscles do you target with TF amputee?
- Glute Max
- Glute Med
- UE
- Abdominals
- Hip adductors*
- Lumbar spine*
- Pelvic floor*
40
T/F Issue comprehensive HEP soon after surgery
True
41
Patients with TFA need to emphasize what 3 motions?
1. hip extension
2. abduction
3. pelvic movement
42
T/F Frequent prone laying or alternative iliospoas stretching must be emphasized
True
43
T/F ROM and strength are ESSENTIAL to prosthetic use
True
44
Functional status of what 6 things should be evaluated post-operative amputation?
1. Upper extremity function – sensory loss, intrinsic hand strength
2. Aerobic capacity and endurance – vitals, RPE
3. Postural control
4. Sitting (and standing) balance
5. Bed mobility, transfers
6. Gait
45
What status is very strong predictor of functional post- operative prosthetic use?
Pre-amputation ambulatory status
46
Safest and most efficient transfer method should be determined by what 6 things?
1. Sitting/standing balance
2. Activity tolerance
3. UE/LE strength
4. Core strength
5. Body habits
6. Participation of patient
47
What tests can be used to determine attention and cognition postoperative amputation?
- MOCA
- Mini-Cog
- MMSE
- Also screening for delirium, depression, fear
48
In hospital mortality (as high as 20%) risk factors:
1. Age
2. TFA
3. COPD/CHF
4. Hx of stroke, renal disease, MI
5. New CVA
6. Hyperglycemia
7. Bed rest + surgery + inactivity = ↑ risk for DVT, skin breakdown
49
Pre-Prosthetic Goals:
1. Independence with residual limb care
2. Independence in joint/soft tissue mobility
- Maximize ROM
3. Demonstrate HEP accurately
- Maximize strength and ROM
- BALANCE
4. Care of intact LE if amputated for vascular reasons
5. Fall Prevention
50
No ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL
K0
51
Able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. Limited and unlimited household ambulators
K1
52
Ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Limited community ambulator
K2
53
Ability for ambulation with variable cadence. Community ambulator who has the ability to traverse most barriers and may engage in vocations, therapeutic, or exercise that demands a prosthesis beyond simple locomotion
K3
54
Ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. Typical of the child, active adult, or athlete.
K4
55
FOM: AMP-noPRO -
- Amputee Mobility Predictor (no prosthesis)
| - 20 Item assessment administered without the use of a prosthesis
56
Score range of FOM: AMP-noPRO? With AD? MDD?
- Score range 0-38
- 43 if AD is used
- MDD = 3.4
57
FOM: AMP-noPRO predicts what?
- Predicts likelihood of prosthetic use
| - also used as a good outcome measure in the pre-prosthetic period
58
FOM: AMP-PRO -
- Amputee Mobility Predictor – with Prosthesis
| - 21 item static and dynamic standing balance, sitting balance, gait, transfers – progressing difficulty
59
T/F Can use AD if needed for AMP-PRO.
True
60
Score range of FOM: AMP-PRO? If AD used?
Range 0-42 (0-47 if AD is used)
61
K0 AMPRO score -
| K0 AMPnoPRO score -
K0 AMPRO score - n/a
| K0 AMPnoPRO score - 0-8
62
K1 AMPRO score -
| K1 AMPnoPRO score -
K1 AMPRO score - 15-26
| K1 AMPnoPRO score - 9-20
63
K2 AMPRO score -
| K2 AMPnoPRO score -
K2 AMPRO score - 27-36
| K2 AMPnoPRO score - 21-28
64
K3 AMPRO score -
| K3 AMPnoPRO score -
K3 AMPRO score - 37-42
| K3 AMPnoPRO score - 29-36
65
K4 AMPRO score -
| K4 AMPnoPRO score -
K4 AMPRO score - 43-47
| K4 AMPnoPRO score - 37-43
66
T/F Proper assessment and targeted interventions immediately after amputation have a huge impact on prosthetic use, and therefore function
True
67
T/F Contralateral limb not important
False, Don’t forget about the contralateral limb (both assessment and treatment!)
68
T/F Strive for independence and self-care
True
69
T/F Functional ability (or predicted ability) impacts the device a patient receives
True
