Phases of Rehabilitation Flashcards
What are the settings that rehabilitation may occur?
- Acute care
- Sub acute
- Acute Rehab
- Home health care
- Outpatient
What are the phases of rehab?
- Pre Prosthetic Phase (between surgery & prosthetic fitting)
- Prosthetic Training (Starts with delivery of prosthesis)
- Long term care/ Lifelong Care
Name some factors that influence rehab potential
- Level of amputation
- Prior level of functioning
- Motivation
- Comorbidity
- Emotion/Social Support
- Cognitive impairment
- Physical conditioning
- Smoking
- Compliance
What may negatively affect a person’s prognosis following LE amputation?
- Presence of morbidities
- Pre-op ambulatory status
- Age > 60
- Level of amputation
- Post-op complications
- Cognitive status
- Barriers to returning to previous living environment
If the prosthesis is a traditional one that uses suction to attach the remaining limb when does the patient usually receive it?
- 6 wks later after the site is healed
In regards to the post-operative timeline what occurs during days 1-2?
- ROM
- Bed mobility
- Transfers
- Sound limb exercises
- Post-op dressings
In regards to the post-operative timeline what occurs during days 3-14?
- Pre Prosthetic ambulation w/ crutches
- Post op dressings
In regards to the post-operative timeline what occurs during weeks 2-3?
- Staples removed
- Shrinker or wrap
- Dynamic resistive exercises
- ROM & ambulation
In regards to the post-operative timeline what occurs during weeks 4-6?
- Shrinker & monitor healing
- Prevention of complications
- Casting for prosthetic socket if incision is healed
During the pre-prosthetic phase what does the interventions include?
- Open & Closed chain exercises
During the pre-prosthetic phase what functional mobility activities are performed?
- Bed mobility
- STS
- Transfers
- Ambulation w/o Prosthesis
During the pre-prosthetic phase progressive resistance is used to improve?
- Gait
- Mobility
- Strength
- Cardiovascular fitness
- ADL performance
- All done to maximize function
During the pre-prosthetic phase what type of dressing is preferred when limb protection is a priority?
Rigid
During the pre-prosthetic phase what type of screening should be performed?
Cognitive
T/F: Rehab goals & outcome be included in shared decisions making about residual limb length & amputation level
True
Treatment should be recommended in (acute inpatient rehab or SNF) over (acute inpatient rehab or SNF)
Treatment should be recommended in acute inpatient rehab over a SNF
During the pre-prosthetic phase when should mobility training be implemented?
ASAP
During the pre-prosthetic phase to improve function & gait parameters mobility training may include what?
Ipsilateral WB ambulation w/ a pylon
T/F: During the pre-prosthetic phase there is no need for communication between surgical team & non-surgical team to occur
False
During the Pre-Prosthetic phase care team should ensure patient achieves what?
Their highest level of functional independence w/o prosthesis
Name what can all be included during Pre-Prosthetic Training
- Skin inspection
- Residual limb monitoring
- ROM
- Sensation
- Strengthening
- Functional mobility
- Cardiopulmonary
- Psychosocial
- Patient is collaborating w/ medical team including prosthetist to prepare for prosthetic
During Pre-Prosthetic Phase what is the frequency of treatment?
- Initially pts seen 5-7 times weekly in hospital or rehab
- Treatment can be decreased when pt is independent w/ exercises & positioning
- Frequency will decrease when pt is receiving home health care or outpatient services
When is it suggested short term goals be achieved?
- 3-5 days in patients who were independent prior to acute care hospital admission
If STG do not appear to be met during the inpatient acute care hospital stay when what rehab should be considered?
- Inpatient rehab
Is the overall acute care length of stay (increasing or decreasing) in the US?
Decreasing
A majority of persons with trauma-related amputation are able to discharge from acute directly where?
To home
Where are patients with more proximal amputation levels, bilateral LE amputations, presence of severe injuries to other body systems & acute care at a designated trauma center more likely to be discharged?
Inpatient rehab among trauma related amputees
For persons with dysvascular amputations there has been an increase in discharge to where?
Nursing home & inpatient rehab centers
The likelihood of discharge to a nursing facility has been found to increase with what factors?
- Age
- Higher amputation levels
- Those w/ Medicare insurance among dysvascular amputees
T/F: Men & married patients are more likely to be discharged to a SNF
False- Less likely
When may a person be able to discharge directly to home with services? What type of environment will allow better functional outcomes?
- If they meet short term physical therapy goals
- An environment that is wheelchair & disability friendly will allow for better functional outcome
In regards to long term goals what is the predicted optimal level of improvement for this patient population? In what time frame?
- Return to their previous life roles & lifestyle using a prosthetic and/or AD & adaptive equipment
- 4-6 months
What factors can cause the prognosis to reaching the long term goals to be modified?
- Presence of morbidities
- Post op complication or secondary impairments
- Decreased cognitive status
- Barriers to returning to previous living environment
- anything that may influence patients ability to use prosthetic
Timing of prosthetic fitting and training varies widely and is dependent on what factors?
- Age of patient
- Type of amputation (traumatic vs dysvascular)
When should fitting of the first prosthesis be implemented?
ASAP after wound healing
Choice of prosthetic device should be individualized and based on what?
- Functional capacity & goals of the person, with the intent to allow the highest possible level of function
Prosthetic training may begin while a patient is in what type of settings?
- Inpatient rehab setting
- Home health care
- During outpatient follow up
A team approach to prosthetic prescription writing should be used and include what health care providers?
- Physiatrist
- PT
- Prosthetist
How much does oxygen consumption increases for transtibial amputee & transfemoral amputee?
- Transtibilal: 33%
- Transfemoral: Doubles
Why does the level of amputation have a direct effect on successful prosthetic rehab in older patients?
Due to the increasing cardiopulmonary demands w/ more proximal or bilateral amputations
T/F: Ideally the prosthesis should restore function with a minimal amount of energy expenditure
True
What is preferred for initial prosthetic training?
Parallel bars
What progressions should occur during prosthetic training?
- Progression of patients confidence, stability, balance & ambulation pattern
- Progression from parallel bars to least restrictive AD
What should the emphasis be on during prosthetic training?
- Transfers
- Gait
- Stairs
- Uneven surface
- Increasing functional mobility & independence
When does the pre-prosthetic phase begin?
Immediately post-op
How long does the pre-prosthetic phase typically last?
6 wks +/- depending on patient situation
What does the therapist focus on during the pre-prosthetic phase?
- Protecting limb
- Preventing contracutres
- Developing single limb mobility skills
- Preparing the patient for the prosthetic phase of rehab
During the pre prosthetic phase some patients are immediately fitted with IPOP which allows what?
Immediate WB using a temporary prosthetic device
Commonly patient will be evaluated for their first prosthesis once what occurs?
- Sutures & staples are removed & have healed & residual limb’s skin is intact
- Usually between 4-6 wks
When can a patient begin wearing a shrinker?
Once sutures are removed
What all must occur before a permanent prosthesis may be ordered?
- Individual will be fitted for prosthetic device (may take weeks for device to be done)
- Patient gets 1st prosthetic limb
- Modification may be made
- Several months of working w/ prosthesis, the wearer may feel the comfort & size is appropriate & that residual limb volumes have stabilized
Every how many years does Medicare support a new prosthesis?
Every 5 years but based on activity level, repairs, replacements etc a new device may be needed prior
What are the goals & interventions of the prosthetic training phase?
- Donning & doffing prosthesis
- Hygiene
- Strengthening
- Balance & coordination
- Gait training
What are the recommendations for long term care?
- Against long term opioid therapy for chronic pain
- Return to care team at least once a year for follow up (prosthetic or no prosthetic)
- Continue education to ensure long term success
What side is osteoporosis more likely to develop?
amputated side
What side is osteoarthritis more likely to develop?
Intact limb
What is heterotropic ossification?
- Formation of extra skeletal bone in muscle & soft tissue
- Common complication of trauma & surgery
- Complicates socket fit
