limb loss Flashcards
Causes of amputation
diabetes
peripheral vascular disease
trauma
correction, tumours, infections
why diabetes and PVD leading cause
decreased circulation
decreased sensation
foot deformities
toe amp effects
prosthetic
decreased push off / balance
insoles , stiff soled shoe
partial foot / fore foot amp effects / presthetic
lose push off, balance, risk for tissue breakdown
toe filler, slipper boot, AFO
lisfranc you leave the
metatarsals
tarsometatarsal
chopart you leave
calc / talus
midtarsal
symes amp effects
more stable and easier to control
good functional outcome if wounds not an issue
symes
ankle disarticulation
distal end of Tib and fib intact while foot bones are removed
can WB (hell pad preserved) but prosthesis for regular walking
transtibial amputaion
no WB
calf mm attached to front of limb
transtibial effect on function
good function
can aid with transfers
knee disarticulation
tib and fib removed
patella may or may not be
may WB
transtibial and transfemoral can you WB
no
knee articulation and ankle can you WB
yes
knee articulation effects
ind w gait aids
better balance that TF
knee disarticulation prosthetic
knee axis is lower than normal
transferral amp effects
no WB
takes more energy to walk
good balance, may or may not need gait aid
stand step transfers only
longer limbs will have __ balance, short limbs will ___
better
contractors and more energy expenditure
transferral amp what kind of contraction is unique
abd
hip disarticulation effects
walking aid/ w/c, asymmetrical gait
can do functional tasks
high energy consumption
education for amputees
pain skin edema falls contractures
knee / hip flexion contraction __ may prevent the client from being a prosthetic candidate
> 20 degrees
common contractures in TT
knee and hip flexion
common contractors in TF
hip flexion, abd and ER
how to prevent contractures
bed positioning chair positioning (straight leg)
5 pain management ideas
education meds exercise relaxation compression mirror
when should someone casted
conical and cylindrical
do you wear a shrinker right away all the time
gradually until able to wear 24 hrs a day
when are amputees at fall ris
first waking
do you moisturize between toes toes
no
TF exercises
hip extension/ add
TT exercises
hip and knee extention
pre prosthetic exercises
core, UL, balance
TF: hip ext, abd, add
TT: knee ext/flex, hip ext/adb/add
why might someone not be a prosthetic candidate
cognition motivation ROM contracture medically fragile
what does pink
red
purple mean
on skin inspection
good
too much ressure
not enough contact
pressure tolerant areas
ischial tuberosity hydrostatic loading (total surface)
pressure sensitive areas
distal end of residual limb
adduct tendon
ramus
TT skin inspection
tolerant areas:
patella tendon
medial / lateral tibia
posterior mm mass
sensitive areas: patella, tibial tuberosity, fib head
how to check TT fit
position of patella
how to check fit on TF
ischial tuberosity
signs of needing more or less socks
redness in sensitive areas
phantom pain
prosthesis feels heavy, too talk or short
can’t don
gel liner worn at __ shrinker worn at
night
day or night
initial contact considerationa
dont pull into mid stance with hamstring on effected side
push from contralateral foot
watch for __ during terminal stance
early knee flexion , decreased hip extension and retracted pelvis
should step lengths be equal
yes
common gait deviations
abducted leg lateral shift less stance on prosthesis excessive knee flexion absent push off
