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Prosthetics/Orthotics > Phases of Rehabilitation > Flashcards

Phases of Rehabilitation Flashcards

1
Q

What are the settings that rehabilitation may occur?

A
  • Acute care
  • Sub acute
  • Acute Rehab
  • Home health care
  • Outpatient
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2
Q

What are the phases of rehab?

A
  • Pre Prosthetic Phase (between surgery & prosthetic fitting)
  • Prosthetic Training (Starts with delivery of prosthesis)
  • Long term care/ Lifelong Care
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3
Q

Name some factors that influence rehab potential

A
  • Level of amputation
  • Prior level of functioning
  • Motivation
  • Comorbidity
  • Emotion/Social Support
  • Cognitive impairment
  • Physical conditioning
  • Smoking
  • Compliance
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4
Q

What may negatively affect a person’s prognosis following LE amputation?

A
  • Presence of morbidities
  • Pre-op ambulatory status
  • Age > 60
  • Level of amputation
  • Post-op complications
  • Cognitive status
  • Barriers to returning to previous living environment
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5
Q

If the prosthesis is a traditional one that uses suction to attach the remaining limb when does the patient usually receive it?

A
  • 6 wks later after the site is healed
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6
Q

In regards to the post-operative timeline what occurs during days 1-2?

A
  • ROM
  • Bed mobility
  • Transfers
  • Sound limb exercises
  • Post-op dressings
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7
Q

In regards to the post-operative timeline what occurs during days 3-14?

A
  • Pre Prosthetic ambulation w/ crutches
  • Post op dressings
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8
Q

In regards to the post-operative timeline what occurs during weeks 2-3?

A
  • Staples removed
  • Shrinker or wrap
  • Dynamic resistive exercises
  • ROM & ambulation
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9
Q

In regards to the post-operative timeline what occurs during weeks 4-6?

A
  • Shrinker & monitor healing
  • Prevention of complications
  • Casting for prosthetic socket if incision is healed
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10
Q

During the pre-prosthetic phase what does the interventions include?

A
  • Open & Closed chain exercises
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11
Q

During the pre-prosthetic phase what functional mobility activities are performed?

A
  • Bed mobility
  • STS
  • Transfers
  • Ambulation w/o Prosthesis
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12
Q

During the pre-prosthetic phase progressive resistance is used to improve?

A
  • Gait
  • Mobility
  • Strength
  • Cardiovascular fitness
  • ADL performance
  • All done to maximize function
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13
Q

During the pre-prosthetic phase what type of dressing is preferred when limb protection is a priority?

A

Rigid

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14
Q

During the pre-prosthetic phase what type of screening should be performed?

A

Cognitive

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15
Q

T/F: Rehab goals & outcome be included in shared decisions making about residual limb length & amputation level

A

True

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16
Q

Treatment should be recommended in (acute inpatient rehab or SNF) over (acute inpatient rehab or SNF)

A

Treatment should be recommended in acute inpatient rehab over a SNF

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17
Q

During the pre-prosthetic phase when should mobility training be implemented?

A

ASAP

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18
Q

During the pre-prosthetic phase to improve function & gait parameters mobility training may include what?

A

Ipsilateral WB ambulation w/ a pylon

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19
Q

T/F: During the pre-prosthetic phase there is no need for communication between surgical team & non-surgical team to occur

A

False

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20
Q

During the Pre-Prosthetic phase care team should ensure patient achieves what?

A

Their highest level of functional independence w/o prosthesis

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21
Q

Name what can all be included during Pre-Prosthetic Training

A
  • Skin inspection
  • Residual limb monitoring
  • ROM
  • Sensation
  • Strengthening
  • Functional mobility
  • Cardiopulmonary
  • Psychosocial
  • Patient is collaborating w/ medical team including prosthetist to prepare for prosthetic
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22
Q

During Pre-Prosthetic Phase what is the frequency of treatment?

A
  • 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
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23
Q

When is it suggested short term goals be achieved?

A
  • 3-5 days in patients who were independent prior to acute care hospital admission
24
Q

If STG do not appear to be met during the inpatient acute care hospital stay when what rehab should be considered?

A
  • Inpatient rehab
25
Q

Is the overall acute care length of stay (increasing or decreasing) in the US?

A

Decreasing

26
Q

A majority of persons with trauma-related amputation are able to discharge from acute directly where?

A

To home

27
Q

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?

A

Inpatient rehab among trauma related amputees

28
Q

For persons with dysvascular amputations there has been an increase in discharge to where?

A

Nursing home & inpatient rehab centers

29
Q

The likelihood of discharge to a nursing facility has been found to increase with what factors?

A
  • Age
  • Higher amputation levels
  • Those w/ Medicare insurance among dysvascular amputees
30
Q

T/F: Men & married patients are more likely to be discharged to a SNF

A

False- Less likely

31
Q

When may a person be able to discharge directly to home with services? What type of environment will allow better functional outcomes?

A
  • If they meet short term physical therapy goals
  • An environment that is wheelchair & disability friendly will allow for better functional outcome
32
Q

In regards to long term goals what is the predicted optimal level of improvement for this patient population? In what time frame?

A
  • Return to their previous life roles & lifestyle using a prosthetic and/or AD & adaptive equipment
  • 4-6 months
33
Q

What factors can cause the prognosis to reaching the long term goals to be modified?

A
  • 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
34
Q

Timing of prosthetic fitting and training varies widely and is dependent on what factors?

A
  • Age of patient
  • Type of amputation (traumatic vs dysvascular)
35
Q

When should fitting of the first prosthesis be implemented?

A

ASAP after wound healing

36
Q

Choice of prosthetic device should be individualized and based on what?

A
  • Functional capacity & goals of the person, with the intent to allow the highest possible level of function
37
Q

Prosthetic training may begin while a patient is in what type of settings?

A
  • Inpatient rehab setting
  • Home health care
  • During outpatient follow up
38
Q

A team approach to prosthetic prescription writing should be used and include what health care providers?

A
  • Physiatrist
  • PT
  • Prosthetist
39
Q

How much does oxygen consumption increases for transtibial amputee & transfemoral amputee?

A
  • Transtibilal: 33%
  • Transfemoral: Doubles
40
Q

Why does the level of amputation have a direct effect on successful prosthetic rehab in older patients?

A

Due to the increasing cardiopulmonary demands w/ more proximal or bilateral amputations

41
Q

T/F: Ideally the prosthesis should restore function with a minimal amount of energy expenditure

A

True

42
Q

What is preferred for initial prosthetic training?

A

Parallel bars

43
Q

What progressions should occur during prosthetic training?

A
  • Progression of patients confidence, stability, balance & ambulation pattern
  • Progression from parallel bars to least restrictive AD
44
Q

What should the emphasis be on during prosthetic training?

A
  • Transfers
  • Gait
  • Stairs
  • Uneven surface
  • Increasing functional mobility & independence
45
Q

When does the pre-prosthetic phase begin?

A

Immediately post-op

46
Q

How long does the pre-prosthetic phase typically last?

A

6 wks +/- depending on patient situation

47
Q

What does the therapist focus on during the pre-prosthetic phase?

A
  • Protecting limb
  • Preventing contracutres
  • Developing single limb mobility skills
  • Preparing the patient for the prosthetic phase of rehab
48
Q

During the pre prosthetic phase some patients are immediately fitted with IPOP which allows what?

A

Immediate WB using a temporary prosthetic device

49
Q

Commonly patient will be evaluated for their first prosthesis once what occurs?

A
  • Sutures & staples are removed & have healed & residual limb’s skin is intact
  • Usually between 4-6 wks
50
Q

When can a patient begin wearing a shrinker?

A

Once sutures are removed

51
Q

What all must occur before a permanent prosthesis may be ordered?

A
  • 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
52
Q

Every how many years does Medicare support a new prosthesis?

A

Every 5 years but based on activity level, repairs, replacements etc a new device may be needed prior

53
Q

What are the goals & interventions of the prosthetic training phase?

A
  • Donning & doffing prosthesis
  • Hygiene
  • Strengthening
  • Balance & coordination
  • Gait training
54
Q

What are the recommendations for long term care?

A
  • 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
55
Q

What side is osteoporosis more likely to develop?

A

amputated side

56
Q

What side is osteoarthritis more likely to develop?

A

Intact limb

57
Q

What is heterotropic ossification?

A
  • Formation of extra skeletal bone in muscle & soft tissue
  • Common complication of trauma & surgery
  • Complicates socket fit

Prosthetics/Orthotics (12 decks)

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