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Amp/Pros > Lecture 3: Post Amp Assessment Treatment > Flashcards

Lecture 3: Post Amp Assessment Treatment Flashcards

1
Q

Acute postoperative phase -

A

Time between surgery and discharge from acute care

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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
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3
Q

Prosthetic postoperative phase -

A
  • Long term management

- Includes rehabilitation and training with prosthetic

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4
Q

Postoperative dressings are primarily up to who?

A
  • Primarily the surgeon’s decision

- Interdisciplinary team is critical in recommendations =

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5
Q

The purpose of Postoperative dressings:

A
  • protect the incision and residual limb
  • foster healing
  • control edema
  • manage pain
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6
Q

3 Advantages of compressive soft dressings:

A
  1. Easy to apply
  2. Inexpensive
  3. Easy access to incision
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7
Q

3 Disadvantages of compressive soft dressings:

A
  1. Little edema control
  2. Frequent rewrapping
  3. Inconsistent technique
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8
Q

2 Advantages of shrinker dressings:

A
  1. Easy to apply

2. Inexpensive

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9
Q

3 Disadvantages of shrinker dressings:

A
  1. Sutures removed
  2. Requires changing
  3. Tourniquet effect
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10
Q

2 Advantages of semi-rigid dressings:

A
  1. Better edema control

2. Protection of limb

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11
Q

3 disadvantages of semi-rigid dressings:

A
  1. Frequent changing
  2. No pt application
  3. No access to incision
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12
Q

3 Advantages of IPOP dressings:

A
  1. Great edema control
  2. Excellent protection
  3. Controls pain
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13
Q

3 Disadvantages of IPOP dressings:

A
  1. Access to incision*
  2. More expensive
  3. Requires training
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14
Q

Immediate Post-Surgical Prosthesis (IPOP) -

A

Prosthetic socket allowing for limited weight-bearing ambulation in the early stages

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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
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16
Q

Splints/Immobilizers -

A
  • Can be air or rigid
  • Encourages full knee extension
  • Worn over primary dressing
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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
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18
Q

Post-Surgical Evaluation & Treatment:

A
  1. General systems review/chart review
  2. Post-surgical status
  3. Pain
  4. Residual limb assessment
  5. ROM and strength
  6. Functional status
  7. Cognition/emotion
  8. Post-op Complications
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19
Q

Need to determine what during pain assessment?

A

Location
Type
Nature
Intensity

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20
Q

Phantom limb sensation -

A

Painless awareness of the amputated limb, possibly accompanied by tingling

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21
Q

Phantom limb pain -

A

Brain continues to receive painful sensory messages from the nerves that originally carried messages from amputated limb

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22
Q

Pain treatment post op amputation -

A
  • Dressings and compression (ACE wrapping) help to desensitize limb
  • Medications
  • Pain education
  • Movement
  • Modalities
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23
Q

How measure length of TT?

A

medial joint line to end of limb

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24
Q

How measure length of TF?

A

ischial tub. or GT to end of limb

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25
Q

How measure volume of residual limb?

A

Circumferential measurements over known bony landmarks

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26
Q

What vascularity characteristics when assessing residual limb?

A
  • Distal pulses

- Skin temp/color (at rest and with position change)

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27
Q

Contralateral/Intact Limb Assessment (4) -

A
  1. DVT Screen
  2. Diabetic foot screen (if appropriate)
  3. Sensory testing
  4. Strength/ROM testing
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28
Q

Common DVT symptoms -

A
  • Swelling (calf/entire leg)
  • Local tenderness along deep venous system
  • Increased redness/warmth
29
Q

T/F For all amputees, ROM is ESSENTIAL for normal prosthetic use.

A

True

30
Q

What is the primary goal in the acute/preprosthetic phase?

A

prevention of contracture

31
Q

Positioning postoperative -

A
  1. Critical to prevention contractures
    - Hip
    - Knee
  2. Edema control
  3. Patient comfort
  4. Patient education
32
Q

Key muscles of TT ROM Treatment: Stretching/AROM -

A
  • Hamstrings
  • Hip flexors
  • Gastroc-soleus (contralateral)
33
Q

Key muscles of TF ROM Treatment: Stretching/AROM

A
  • Hip flexors
  • Hip abductors
  • Hip External rotators
  • Lumbar extensors
  • Contralateral LE
34
Q

What 3 things should we focus on when working on AROM with LE amputee?

A
  1. Early and often
  2. Focus on knee and hip extension
  3. Work through available range
35
Q

In acute settings, what focus on for strength assessment?

A
  • 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
Q

2 main goals of Strengthening: Early Post-op Therex?

A
  1. Address identified muscle performance impairments

2. Maximize overall strength to prep for prosthetic gait

37
Q

Immediate post operative strengthening focus on what 3 things?

A
  1. Isometric and AROM, focusing on joint proximal to amp.
  2. Core strength!
  3. Contralateral limb
38
Q

What muscles do you target with TT amputee?

A
  • Quadriceps
  • Hamstrings
  • Glute Max
  • Glute Med
  • Abdominals
  • UE
39
Q

What muscles do you target with TF amputee?

A
  • Glute Max
  • Glute Med
  • UE
  • Abdominals
  • Hip adductors*
  • Lumbar spine*
  • Pelvic floor*
40
Q

T/F Issue comprehensive HEP soon after surgery

A

True

41
Q

Patients with TFA need to emphasize what 3 motions?

A
  1. hip extension
  2. abduction
  3. pelvic movement
42
Q

T/F Frequent prone laying or alternative iliospoas stretching must be emphasized

A

True

43
Q

T/F ROM and strength are ESSENTIAL to prosthetic use

A

True

44
Q

Functional status of what 6 things should be evaluated post-operative amputation?

A
  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
Q

What status is very strong predictor of functional post- operative prosthetic use?

A

Pre-amputation ambulatory status

46
Q

Safest and most efficient transfer method should be determined by what 6 things?

A
  1. Sitting/standing balance
  2. Activity tolerance
  3. UE/LE strength
  4. Core strength
  5. Body habits
  6. Participation of patient
47
Q

What tests can be used to determine attention and cognition postoperative amputation?

A
  • MOCA
  • Mini-Cog
  • MMSE
  • Also screening for delirium, depression, fear
48
Q

In hospital mortality (as high as 20%) risk factors:

A
  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
Q

Pre-Prosthetic Goals:

A
  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
Q

No ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL

A

K0

51
Q

Able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. Limited and unlimited household ambulators

A

K1

52
Q

Ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Limited community ambulator

A

K2

53
Q

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

A

K3

54
Q

Ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. Typical of the child, active adult, or athlete.

A

K4

55
Q

FOM: AMP-noPRO -

A
  • Amputee Mobility Predictor (no prosthesis)

- 20 Item assessment administered without the use of a prosthesis

56
Q

Score range of FOM: AMP-noPRO? With AD? MDD?

A
  • Score range 0-38
  • 43 if AD is used
  • MDD = 3.4
57
Q

FOM: AMP-noPRO predicts what?

A
  • Predicts likelihood of prosthetic use

- also used as a good outcome measure in the pre-prosthetic period

58
Q

FOM: AMP-PRO -

A
  • Amputee Mobility Predictor – with Prosthesis

- 21 item static and dynamic standing balance, sitting balance, gait, transfers – progressing difficulty

59
Q

T/F Can use AD if needed for AMP-PRO.

A

True

60
Q

Score range of FOM: AMP-PRO? If AD used?

A

Range 0-42 (0-47 if AD is used)

61
Q

K0 AMPRO score -

K0 AMPnoPRO score -

A

K0 AMPRO score - n/a

K0 AMPnoPRO score - 0-8

62
Q

K1 AMPRO score -

K1 AMPnoPRO score -

A

K1 AMPRO score - 15-26

K1 AMPnoPRO score - 9-20

63
Q

K2 AMPRO score -

K2 AMPnoPRO score -

A

K2 AMPRO score - 27-36

K2 AMPnoPRO score - 21-28

64
Q

K3 AMPRO score -

K3 AMPnoPRO score -

A

K3 AMPRO score - 37-42

K3 AMPnoPRO score - 29-36

65
Q

K4 AMPRO score -

K4 AMPnoPRO score -

A

K4 AMPRO score - 43-47

K4 AMPnoPRO score - 37-43

66
Q

T/F Proper assessment and targeted interventions immediately after amputation have a huge impact on prosthetic use, and therefore function

A

True

67
Q

T/F Contralateral limb not important

A

False, Don’t forget about the contralateral limb (both assessment and treatment!)

68
Q

T/F Strive for independence and self-care

A

True

69
Q

T/F Functional ability (or predicted ability) impacts the device a patient receives

A

True

Amp/Pros (12 decks)

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