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Assistive Tech > P - Pre-Prosthetics Rehab > Flashcards

P - Pre-Prosthetics Rehab Flashcards

1
Q

are UE or LE the majority of amps in congenital pop

A

UE (60%)

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2
Q

are UE or LE the majority of amps in secondary to CA pop

A

LE

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3
Q

what is the leading cause of limb loss in children

A

secondary to cancer

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4
Q

what type of cancers often lead to amputations

A

malignant bone tumors
- osteosarcoma (most common, 1/2 in knee region)
- chondrosarcoma (2nd most common)
- Ewing’s sarcoma

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5
Q

what is the most common reason for amputation

A

dysvascular

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6
Q

of the 4 main reasons for amputation, what is the order of how common they are

A
  1. dysvascular
  2. traumatic
  3. congenital
  4. secondary to cancer
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7
Q

what is the most common traumatic reason for amputation

A

motorcycle accidents

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8
Q

what scale is used in traumatic amputations

A

Mangled Extremity Severity Score (MESS)

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9
Q

what population is traumatic amputations most common in

A

males > females

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10
Q

what is the most common dysvascular reason for amputation

A

diabetes

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11
Q

are UE or LE the majority of amps in dysvascular pop

A

LE (98%)

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12
Q

what population is dysvascular amputations most common in

A

inc risk in elderly males and african americans

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13
Q

what are 2 questions asked in the exam if someone has a medical hx of diabetes

A

related complications?
hx of plantar ulcers?

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14
Q

what 3 types of peripheral vascular dz are screened for in the exam

A

arteriosclerosis
chronic venous insufficiency
thromboangitis obliterans (buergers dz)

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15
Q

what are 2 main things screened for in the medical hx as part of the exam

A

DM
PVD

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16
Q

why are additional surgeries a good Q to ask as part of the exam when finding out ab the CC

A

not uncommon to have cascade of surgeries leading up to the amp

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17
Q

why is the current and prior functional status is important to know

A

key in helping us to know what is realistic

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18
Q

why is CVP an important system to review and how wil amputations impact this

A

greater demands placed when amputated

TT - 15-40 % more energy
TF - 65% more

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19
Q

how is the walking speed impacted with a LE amp

A

self-selected walking speed are 35-45% slower

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20
Q

what is reviewed in the integ screen and what is the goal

A

post op and sound limb

“keep sound limb sound”
- will be more dependent on sound limb and don’t want it to become a BL amp

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21
Q

what are common MSK screen findings

A

lower back and hip pain
altered body mechanics

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22
Q

what is a common NM screen finding

A

impaired balance

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23
Q

what are tests and measures used to assess pre-prosthetic ability

A

functional assessment
anthropometrics
residual limb condition

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24
Q

what about residual limb condition do we want to know pre-prosthetically

A

dimensions-volume assess
shape = cylindrical
type & timing of Rx

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25
Q

what about residual limb condition do we want to know pre-prosthetically

A

dimensions-volume assess
shape = cylindrical
type & timing of Rx

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26
Q

what amputations is the circumferential method reliable in measuring residual limb volume

A

TT amp
- inadequate data for decisions ab volume measurement in other amps

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27
Q

what types of residual limb volume measurement have been found to be reliable

A

circumferential and water displacement

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28
Q

when measuring residual limb volume what should you wait for

A

8min between doffing prothesis and first measurement

20 min from mobilization of more than 200m

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29
Q

when measuring residual limb volume what should you standardize and record

A

participant and joint position

ms activation during measure

location of limb contact w support during measure

location of limb markers relative to anatomical landmarks

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30
Q

when measu

A
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31
Q

at what point can casting for a prosthesis only occur

A

after distal portion is smaller circumference than proximal

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32
Q

what is a critical goal for the remaining sound limb and why

A

“keep sound limb sound”
- assessments to prevent additional limb loss

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33
Q

what is the giant list functional assessment measures (10)

A

bed mobility
wc mobility
transfers
amb
ADs
balance
UE function
strength
bandaging
ADLs/IADLs

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33
Q

what are 6 qualities of residual limb condition to assess

A

integumentary integrity
sensory integrity
palpation
ROM
flexibility
strength

33
Q

what is assessed in the remaining sound limb

A

integumentary integrity
sensory integrity
vascular
ROM
flexibility
strength
pain
aerobic capacity/endurance

34
Q

how is the sound limb assessed vascularly

A

temp
pulses
cap refill (norm = 3sec)
ABI

35
Q

how is the ROM measured in an amp limb

A

midline of long bone since landmarks have changed

36
Q

why is UQ ROM important to screen

A

bed mobility and transfers

36
Q

why is flexibility an important to screen for

A

for specific muscle length (hip flexor, psoas, and HS ms length) needed for gait and safe functional mobility
- 0deg of knee ext
- 10-15deg of hip ext

37
Q

why is strength an important thing to screen for

A

loss of lever arm

38
Q

where should strength be assessed and how

A

UQ and LQ
trunk/core

want to apply resistance at same spots on sound and residual

39
Q

what tests can be used to screen for pain and what are their different uses

A

VRS/VAS
McGill - type of pain
phantom sensation
phantom limb pain
post op pain - ortho, meds
neuropathic - CRPS

40
Q

how common is phantom sensation and how is this different from phantom limb pain

A

almost all amps (90-95%)
not pain, itch/tickle

41
Q

what is phantom limb pain more common in

A

trauma

42
Q

how is phantom limb pain treated

A

mirror therapy
massage
WBing
TENS

43
Q

how is neuropathic pain treated

A

desensitization

44
Q

what are tests and measures assessing aerobic capacity and endurance

A

VS - rest, during, post
BORG
RPE
UBE
6MWT

45
Q

what is the common finding when assessing the posture of a STS in an amp

A

COM moves toward sound side and superior

46
Q

while amps can have variable presentations, what are common goals for rehab determined in the eval

A

wound mgmt
gait training w prosthesis
secondary issue? (LBP, hip pain, etc.)

47
Q

what is important to include in the dx

A

specific info as to the cause of the amp

48
Q

what are 5 self report outcome measures

A

SF-36
Sickness Impact Profile
Amp Activity Survey
Locomotor Capabilities Index
Prosthesis Eval Q (PEQ-17)

49
Q

what are 5 performance based outcome measures

A

6MWT
2MWT
TUG
L-test of functional mob
amputee mobility predictor

50
Q

what is the MCD for 6MWT

A

147.5ft

51
Q

what is the MCD for 2MWT

A

112.5ft

52
Q

what does the L test of functional mobility test

A

STS, short distance amb, R turn, long distance amb, 180deg turn, long distance amb, L turn, short distance amb, STS

53
Q

what is a valid outcome measure to determine K Levels

A

amputee mobility predictor (AMP)

54
Q

what does the amputee mobility predictor (AMP) have a strong positive correlation with

A

6MWT
amp activity survey

55
Q

what is a good predictor of function post amp

A

pre amp status

56
Q

what is the amputee mobility predictor (AMP)

A

instrument to assess determinants of lower limb amp ability to ambulate

57
Q

what is the AMP a valid and reliable measure for

A

assessment of functional amb in lower-limb amps

58
Q

what is the pre-prosthetic phase and its goals

A

prepares for prosthetic fitting and training

addresses basic impairment levels
- tissue healing, limb shape, edema, ROM, strength, flexibility, CV

59
Q

what is the significance of pre-prosthetic phase goals

A

need to be accomplished to get to prosthetic phase

60
Q

what is the prosthetic phase and its goals

A

prosthetic mgmt skills

work on optimal gait pattern, ADLs, transfers

61
Q

what are pre-op specific goals (2)

A

pt ed
rehab course and post op POC

62
Q

what are acute post op specific goals (7)

A

pt ed
limb loss adjustment
wound healing/skin care
edema control (limb shape)
positioning (contractures)
pain control
functional mobility

63
Q

what are sub acute specific goals (7)

A

pt and family ed
- skin care
- app of dressings
- home eval for fall risk
strengthening core, key ms
ROM for prosthetic use
CV fitness
sitting and standing balance
advance mob skills - transfers, gait
advance ADL skils

64
Q

what became the mgmt focus of limb amp rehab

A

individualized POCs
exercise to improve physical function and ADLs

65
Q

what are warning signs to look for when doing skin checks

A

color
temp
pain blisters/open skin/corns/calluses

66
Q

what are examples of skin care for the sound limb

A

daily inspection
hygiene
footwear
footcare

67
Q

what are objectives as part of wound care post op

A

education
monitor incision
scar closed - gentle scar massage

68
Q

what are objectives as part of edema control post op

A

healing
pain
cylindrical shape

69
Q

what are 4 ways to control edema

A

ace wrap (figure 8)
shrinker pressure garment
rigid removable dressing
positioning

70
Q

what are 5 ways to manage pain

A

desensitization
edema control
TENS
meds
mirror therapy

71
Q

what are examples of desensitization techniques to manage pain

A

massage
tapping
WBing
coordination exercises

72
Q

how is mirror therapy used in pain management

A

reflection of sound limb, the brain’s concept is that the residual limb is moving like that (of the sound limb) which helps dec pain sensation

(also helpful in CRPS)

73
Q

what is the biggest goal with ROM post op

A

PREVENT CONTRACTURES
- hip flexor (psoas)
- knee (HS)

74
Q

what are ROM interventions

A

AROM
positioning
- avoiding hip and knee flex
stretching
- hip flex and HS
- CRS / PNF
splinting

75
Q

why is it important to prevent flexion contractures in the hip and knee

A

need ext in both hip and knee to amb
- 10-15deg in hip
- 0 in knee

76
Q

what does early post-op strengthening look like

A

isometrics
quads, gluts, hip ABDs
UE - shld depress, lats, tris
- seated push up, wts, TB, pulley

77
Q

what are strengthening progressions after early post op

A

add resistance
trunk strengthening
- rotation
- plyoball
- PNF - trunk/pelvis

78
Q

what are all the positions that balance activities should be performed in

A

static -> dynamic
sitting
long sitting
quadruped
tall kneeling
standing
reach outside BOS

79
Q

energy expenditure: TTA, TFA, BL TTA, BL TFA

A

TTA: 15-40%
TFA: 40-65%
BL TTA: 125%
BL TFA: >200%

80
Q

how can aerobic capacity be trained and why is this important

A

transfers, UBE, LEC, wc propulsion
- aquatic later if not CI

inc energy expenditure in amps

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