Post Op Management Amputee

Question 1

Post Op PT Assessment

Answer 1

pain

residual limb size

would healing

circulation

ROM

joint mobility

muscle performance

gait/balance

Question 2

Residual Limb Size Considerations

Answer 2

• management of limb edema is important
• post surgical dressings
  
  • soft - better access less protection
  • semi rigid - easy to clean more expensive
  • rigid - decreased hospital time but less access to wound

Question 3

Post Op Prosthesis Management

Answer 3

wear waist belt at all time

remove pylon in bed

touch down WBAT

Question 4

Post Op Alerts

Answer 4

loose cast, slippage, rotation

pt reports sharp localized pain

pt reports severe tightness or pain

patient febrile with no other known cause

signs of infection (smell)

Question 5

Timeline Post Amp

Answer 5

Day 1-2 = srugery, RD (with pylon and foot) applied, min WB

Day 7-10 = first cast removed, 2nd RD applied, PWB

Week 2-3 = 2nd cast removed, check circumerfences, may cast intermediate or RRD

Week 3-4 = 3rd cast removed, sutures removed, cast for intermediate prosthesis

8-12 months = cast for definitive prosthesis when RL atrophy stabilizes

Question 6

Post Op Management of New Amputee

Answer 6

protection from falls

contracture prevention!!

early ambulation = sooner the better

desensitization

Question 7

What can PT do Post Op?

Answer 7

• positioning - prevent contractures hip fl/abd/add and knee flexion
• residual limb care
• mobility - transfers etc
• post op protocols - ace wraps and shrinkers

Question 8

Post op jt mobility

Answer 8

• often deferred until primary healing at surgical site
• examine jt play, med/at gapping, ant/post drawer
• adapt special tests for length of residual limb
• compare with uninvolved

Question 9

Muscle Performance Post Op

Answer 9

• standard MMT for next proximal joints
• altered hand placement affects mechanical advantage
• test uninvolved limb too
• only apply pressure for knee extension if and when the suture line can be observed
• generally resistive exercise can be initiated a few days after the stitches have been removed

Question 10

Gait and Balance Post Op

Answer 10

• pre amputation ambulatory status is a strong indicator of functional post op prosthetic use
• quality and precision of gait pattern are not as important as safety and functionality of walking at this stage
• familiarit and effectiveness of using w/c important during preprosthetic period
• COM has shifted so adaptive strategies for postural control needed