Post-Op Treatment

Question 1

Goals

Answer 1

• Decrease Edema (residual limb shaping)
• Prevent Contracture
• Maintain or increase strength/flexability
• Balance and Mobility
• Teach Residual Limb care

Question 2

Decreasing Edeam

Answer 2

• Early Pressure
  ie: wrap with shrinker 24 hours/day except for bathing, wound care, prosthetic training. Continue until patient has definitive prosthesis and is wearing it regularly
• Elevation (avoid contracture positions

Question 3

Preventing Contractures

Answer 3

• Prone Lying
• No pillow under knee for transtibial amputee
• Distal limb support in sitting for transtibial amputee (knee Immobilizer)

Question 4

Maintain or increase Strength and Flexability

Answer 4

• Transtibial Exercises

- Transfemoral Exerciese

Question 5

Transitbial Exercises

Answer 5

• Quad Sets ( supine, no towel)
• Hip extension with knee straight (prone)
• Straight leg raise (supine) can add knee flex/ext at approximately 90 degrees
• Extension of the residual limb with the knee of opposite leg held against chest (supine, isometric contraction)
• Hip abduction with resistance (supine-TB, can perform against gravity in side lying)

Question 6

Tansfemoral Exercise

Answer 6

• Gluteal Sets (Supine/Prone)
• Hip abduction (supine with or without resistance or in sidelying)
• Hip Extension (prone)
• Bridging
• UE strengthening
• HEP

Question 7

Balance and Mobility

Answer 7

• Poor balance and the fear of falling have negative effect on prosthetic rehabilitation
• Usually no problem sitting
• Practice supported vs. unsupported single limb stance

Question 8

Teach Residual Limb Care

Answer 8

• Wrapping Techniques and schedule (teach family)
• Positioning
  ie: Critical for BKA/AKA to prevent hip contractures
  Spend time in prone if possible
  No pillow under RL in supine or prolonged sitting
• Desensitization
  ie: Begin with wash cloth and light pressure
  Gradually increase pressure/tapping
  Massage
  OT can help

Question 9

Regain independent mobility

Answer 9

• Bed mobility / transfers

- Gait training with crutches or walker (without prosthesis)

Question 10

Phantom Limb

Answer 10

• Sensation of the amputated limb
• Usually occurs distally
• Typically a tingling, pressure or numbness
• Occurs in very few patients
• May go away but usually persists

Question 11

Phantom Pain

Answer 11

• Pain perceived in the amputated extremity
  ie: Usually cramping, shooting or burning pain
  May be localized
  May be constant or intermittent
• More common in patients who experienced sever preoperative pain
• Treated with desensitization techniques
  ie: Many other types of pain treatment have also been used including steroids and local anesthetics
  Results of treatment are inconsistent
• Usually resolves within 1 year, but may become disabling