Practical Prompt Questions

Question 1

Typically what size ace wraps and how many should the physical therapist anticipate needing?

Answer 1

Transfemoral: 2 6-inch wraps and 1 4-inch wrap

Transtibial: 2 4-inch wraps

Question 2

How might the physical therapist recognize if the ace wrap is an incorrect size?

Answer 2

Covers too much or not enough

Question 3

How long should the physical therapist leave the ace wrap in place?

Answer 3

Until it gets loose or if patient complains of pain. Per Shelly, it is good to change at dressing changes, or roughly every 4 hours.

Question 4

Should the physical therapist educate the patient regarding ace wrap use? (Considerations/Options?)

Answer 4

Yes, so they can better manage their own care

Have them get you if it is loose, oozing fluid, etc.

Question 5

Upon inspection of the RL, what should the physical therapist be assessing?

Answer 5

Skin color, temp, pain, protective sensation, etc.

Question 6

What recommendation might the physical therapist make to the physician in terms of patient safety?

Answer 6

Be safe

Check the skin first!

Question 7

Should the physical therapist use a donning tube? Why or why not?

Answer 7

Yes, it makes it easier and reduces chances of shearing and irritation during application

Question 8

How long should the physical therapist leave the shrinker in place?

Answer 8

FIRST, CHECK THE SKIN!

At first, wear for 60 minutes. If tolerable (and/or if normal redness subsides after 15-20 mins), add an hour. But the next day, take away one hour (e.g. if you end the day at 3 hours wear time, start tomorrow at 2 hours)

Progress up to 8 hours, at which point the patient can wear it overnight

Question 9

How should the physical therapist educate the patient regarding shrinker use?

Answer 9

Stop if it gets painful. Redness is normal as long as it fades in 15-20 mins. Redness that lasts over an hour is concerning

Question 10

How should the physical therapist mobilize this patient?

Answer 10

Do AROM to prevent contractures; do PROM if AROM is not tolerable (which may be the case due to AC separation and rib fx)

Question 11

What is the goal for length of wear of the shrinker on a daily basis?

Answer 11

As long as possible (23-24 hours). At the least, overnight (8+ hours)

Question 12

What are the pros/cons of a RR dressing?

Answer 12

Sturdy but troubling

Question 13

How should physical therapist assess fit? How should the physical therapist adjust fit if needed?

Answer 13

Should be snug, but not too tight

Question 14

Could you use a shrinker for the same pt under the RR?

Answer 14

Yes

Question 15

What concerns would require alerting the healthcare team

Answer 15

Redness, pain, swelling, etc.

Question 16

What does the AMP assess?

Answer 16

Mobility and functionality in certain scenarios

Question 17

What might you be concerned about regarding the contralateral foot?

Answer 17

Possible amputation (if first foot was cut off for CV reasons, 2nd one might be cut too)

Overuse

Conditioning, skin, etc.

Question 18

Vital signs a concern- what might you be concerned about? Why? How will you monitor?

Answer 18

HR, BP

Check BP in different positions to address syncope (orthostatic hypotension likely)

Question 19

What areas of education might you touch on during your session?

Answer 19

Weight management, how to improve CV system (e.g. walking routine), smoking cessation, etc.

Question 20

How long should the patient wear/use the prosthesis?

Answer 20

Start with 20 minutes use time (WB) and 45 minutes wear time. Progress accordingly.

You can take home the prosthesis if you can tolerate 45 minutes of wear time during therapy

Question 21

How should PT educ pt re sock fit?

Answer 21

If it is too loose, add sock layers

If it is too tight, remove sock layers

Question 22

Discuss advantages & disadvantages of a pin suspension?

Answer 22

Ad: secure

Dis: sometimes people don’t make pin “click” enough - could lead to safety fail, getting stuff stuck in the way of pin when locking may make it stuck, possible pistoning, etc.

Question 23

What should the physical therapist do to address the maceration between the toes?

Answer 23

Care for the skin but don’t put lotion there

Use lambwool to wick away excess moisture, per The Colleague

Question 24

How can PT tell if the patient is too far into the socket (end bearing)? What is the solution?

Answer 24

They’ll probably have gait deviations and feel too much pressure distally. If this is the case, add a foam pad to reduce how far down pin goes.

Question 25

What might the clues be if the patient is not fully engaged in the socket? What is the solution?

Answer 25

Not enough clicks
Not secure
Hear more clicks during gait/WB
Patient falls out of leg

Solution: educate, adpat, be safe.

Question 26

What might you expect in terms of postural bias for this patient?

Answer 26

It depends.

Question 27

What gait deviation(s) does this patient demonstrate?

Answer 27

Depends on the video man

Question 28

List one potential patient cause and one potential prosthetic cause for one deviation.

Answer 28

See Gait PPT

Question 29

Assuming this deviation is patient related, name one treatment task the physical therapist might use as a treatment tool?

Answer 29

Address muscle weakness that is causing the problem?

Question 30

Based on journal club discussions, what task(s) might be appropriate for the physical therapist to implement to improve gait efficiency and oxygen consumption?

Answer 30

Didn’t pay attention, but working on their CV system or doing gait training during visits would probably help.

Question 31

What are the typical areas of concern for contracture or tightness for a pt with a TTA?

Answer 31

Hip flexion
Knee flexion
ABD
etc.

Question 32

What suggestions might you have for the rehab team in terms of patient positioning when in her room?

Answer 32

Prevent contractures

No pillow under knee. Favor ADD more than ABD. See handout on BB

Question 33

-What are the benefits of the RR that the pt should be aware of to increase compliance (short term and long term benefits)?

Answer 33

There are many (e.g. can lead to earlier WB)

Question 34

If the pt reports she is removing her RR due to RL discomfort (despite the prosthetist adjusting fit), what non pharmacological interventions might the PT suggest?

Answer 34

(Pharm: Medicinal marijuana (may vary by state) and other pain relievers)

Non-pharm:

• Add/remove socks
• GMI
• ACE Wrapping
• eStim
• Desensitization
• Massage (not over staples)