P - Pre-Prosthetics Rehab Flashcards
are UE or LE the majority of amps in congenital pop
UE (60%)
are UE or LE the majority of amps in secondary to CA pop
LE
what is the leading cause of limb loss in children
secondary to cancer
what type of cancers often lead to amputations
malignant bone tumors
- osteosarcoma (most common, 1/2 in knee region)
- chondrosarcoma (2nd most common)
- Ewing’s sarcoma
what is the most common reason for amputation
dysvascular
of the 4 main reasons for amputation, what is the order of how common they are
- dysvascular
- traumatic
- congenital
- secondary to cancer
what is the most common traumatic reason for amputation
motorcycle accidents
what scale is used in traumatic amputations
Mangled Extremity Severity Score (MESS)
what population is traumatic amputations most common in
males > females
what is the most common dysvascular reason for amputation
diabetes
are UE or LE the majority of amps in dysvascular pop
LE (98%)
what population is dysvascular amputations most common in
inc risk in elderly males and african americans
what are 2 questions asked in the exam if someone has a medical hx of diabetes
related complications?
hx of plantar ulcers?
what 3 types of peripheral vascular dz are screened for in the exam
arteriosclerosis
chronic venous insufficiency
thromboangitis obliterans (buergers dz)
what are 2 main things screened for in the medical hx as part of the exam
DM
PVD
why are additional surgeries a good Q to ask as part of the exam when finding out ab the CC
not uncommon to have cascade of surgeries leading up to the amp
why is the current and prior functional status is important to know
key in helping us to know what is realistic
why is CVP an important system to review and how wil amputations impact this
greater demands placed when amputated
TT - 15-40 % more energy
TF - 65% more
how is the walking speed impacted with a LE amp
self-selected walking speed are 35-45% slower
what is reviewed in the integ screen and what is the goal
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
what are common MSK screen findings
lower back and hip pain
altered body mechanics
what is a common NM screen finding
impaired balance
what are tests and measures used to assess pre-prosthetic ability
functional assessment
anthropometrics
residual limb condition
what about residual limb condition do we want to know pre-prosthetically
dimensions-volume assess
shape = cylindrical
type & timing of Rx
what about residual limb condition do we want to know pre-prosthetically
dimensions-volume assess
shape = cylindrical
type & timing of Rx
what amputations is the circumferential method reliable in measuring residual limb volume
TT amp
- inadequate data for decisions ab volume measurement in other amps
what types of residual limb volume measurement have been found to be reliable
circumferential and water displacement
when measuring residual limb volume what should you wait for
8min between doffing prothesis and first measurement
20 min from mobilization of more than 200m
when measuring residual limb volume what should you standardize and record
participant and joint position
ms activation during measure
location of limb contact w support during measure
location of limb markers relative to anatomical landmarks
when measu
at what point can casting for a prosthesis only occur
after distal portion is smaller circumference than proximal
what is a critical goal for the remaining sound limb and why
“keep sound limb sound”
- assessments to prevent additional limb loss
what is the giant list functional assessment measures (10)
bed mobility
wc mobility
transfers
amb
ADs
balance
UE function
strength
bandaging
ADLs/IADLs
what are 6 qualities of residual limb condition to assess
integumentary integrity
sensory integrity
palpation
ROM
flexibility
strength
what is assessed in the remaining sound limb
integumentary integrity
sensory integrity
vascular
ROM
flexibility
strength
pain
aerobic capacity/endurance
how is the sound limb assessed vascularly
temp
pulses
cap refill (norm = 3sec)
ABI
how is the ROM measured in an amp limb
midline of long bone since landmarks have changed
why is UQ ROM important to screen
bed mobility and transfers
why is flexibility an important to screen for
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
why is strength an important thing to screen for
loss of lever arm
where should strength be assessed and how
UQ and LQ
trunk/core
want to apply resistance at same spots on sound and residual
what tests can be used to screen for pain and what are their different uses
VRS/VAS
McGill - type of pain
phantom sensation
phantom limb pain
post op pain - ortho, meds
neuropathic - CRPS
how common is phantom sensation and how is this different from phantom limb pain
almost all amps (90-95%)
not pain, itch/tickle
what is phantom limb pain more common in
trauma
how is phantom limb pain treated
mirror therapy
massage
WBing
TENS
how is neuropathic pain treated
desensitization
what are tests and measures assessing aerobic capacity and endurance
VS - rest, during, post
BORG
RPE
UBE
6MWT
what is the common finding when assessing the posture of a STS in an amp
COM moves toward sound side and superior
while amps can have variable presentations, what are common goals for rehab determined in the eval
wound mgmt
gait training w prosthesis
secondary issue? (LBP, hip pain, etc.)
what is important to include in the dx
specific info as to the cause of the amp
what are 5 self report outcome measures
SF-36
Sickness Impact Profile
Amp Activity Survey
Locomotor Capabilities Index
Prosthesis Eval Q (PEQ-17)
what are 5 performance based outcome measures
6MWT
2MWT
TUG
L-test of functional mob
amputee mobility predictor
what is the MCD for 6MWT
147.5ft
what is the MCD for 2MWT
112.5ft
what does the L test of functional mobility test
STS, short distance amb, R turn, long distance amb, 180deg turn, long distance amb, L turn, short distance amb, STS
what is a valid outcome measure to determine K Levels
amputee mobility predictor (AMP)
what does the amputee mobility predictor (AMP) have a strong positive correlation with
6MWT
amp activity survey
what is a good predictor of function post amp
pre amp status
what is the amputee mobility predictor (AMP)
instrument to assess determinants of lower limb amp ability to ambulate
what is the AMP a valid and reliable measure for
assessment of functional amb in lower-limb amps
what is the pre-prosthetic phase and its goals
prepares for prosthetic fitting and training
addresses basic impairment levels
- tissue healing, limb shape, edema, ROM, strength, flexibility, CV
what is the significance of pre-prosthetic phase goals
need to be accomplished to get to prosthetic phase
what is the prosthetic phase and its goals
prosthetic mgmt skills
work on optimal gait pattern, ADLs, transfers
what are pre-op specific goals (2)
pt ed
rehab course and post op POC
what are acute post op specific goals (7)
pt ed
limb loss adjustment
wound healing/skin care
edema control (limb shape)
positioning (contractures)
pain control
functional mobility
what are sub acute specific goals (7)
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
what became the mgmt focus of limb amp rehab
individualized POCs
exercise to improve physical function and ADLs
what are warning signs to look for when doing skin checks
color
temp
pain blisters/open skin/corns/calluses
what are examples of skin care for the sound limb
daily inspection
hygiene
footwear
footcare
what are objectives as part of wound care post op
education
monitor incision
scar closed - gentle scar massage
what are objectives as part of edema control post op
healing
pain
cylindrical shape
what are 4 ways to control edema
ace wrap (figure 8)
shrinker pressure garment
rigid removable dressing
positioning
what are 5 ways to manage pain
desensitization
edema control
TENS
meds
mirror therapy
what are examples of desensitization techniques to manage pain
massage
tapping
WBing
coordination exercises
how is mirror therapy used in pain management
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)
what is the biggest goal with ROM post op
PREVENT CONTRACTURES
- hip flexor (psoas)
- knee (HS)
what are ROM interventions
AROM
positioning
- avoiding hip and knee flex
stretching
- hip flex and HS
- CRS / PNF
splinting
why is it important to prevent flexion contractures in the hip and knee
need ext in both hip and knee to amb
- 10-15deg in hip
- 0 in knee
what does early post-op strengthening look like
isometrics
quads, gluts, hip ABDs
UE - shld depress, lats, tris
- seated push up, wts, TB, pulley
what are strengthening progressions after early post op
add resistance
trunk strengthening
- rotation
- plyoball
- PNF - trunk/pelvis
what are all the positions that balance activities should be performed in
static -> dynamic
sitting
long sitting
quadruped
tall kneeling
standing
reach outside BOS
energy expenditure: TTA, TFA, BL TTA, BL TFA
TTA: 15-40%
TFA: 40-65%
BL TTA: 125%
BL TFA: >200%
how can aerobic capacity be trained and why is this important
transfers, UBE, LEC, wc propulsion
- aquatic later if not CI
inc energy expenditure in amps
