Pre-prosthetic care Flashcards
What are some factors that predict successful prosthetic use
- ambulate functional distance prior to surgery
- overall fitness level
- independent or minimal assistance with ADLs
- ability to maintain single limb stance without assistance
- fit for prosthesis ASAP after surgery
What are some factors that make prosthetic use less likely
- moderate to severe dementia (not safe w/ management)
- end-stage renal disease due to fluctuations with fluid
- advanced coronary artery disease
- underweight
- decreased hip extensor strength
- learning difficulty
Timeline: readiness for temporary prosthesis
- nondysvascular vs dysvascular
- nondysvascular amputation can heal and have sufficient volume control within 2 weeks
- dysvascular amputation can require 4-8weeks or longer to heal
- gait training with temporary prothesis can begin with approval of surgeon when clear evidence of primary healing
Preprosthetic examinations: assessing circulation
- important to monitor vascular status of the residual limb and intact limb
- residual limb: circulation can affect healing
- intact limb: more vulnerable to soft tissue damage due to increase biomechanics stress
Preprosthetic examinations: assessing sensation
- post-op pain
- phantom limb sensation: sense that the limb is present
- phantom limb pain: shooting pain, cramping, burning,
- phantom limb pain is more likely in those with longstanding pre-op dysvascular pain of after severe traumic injury
- vision and hearing
- somatosensation: altered sensation
- use to guide patient and family education on wound care and skin inspection
Preprosthetic examinations: ROM and muscle length
- effective prosthetic use requires near-normal ROM in remaining joints of residual limb
- measuring ROM is difficulty
Preprosthetic examinations: Assessing joint integrity
- transtibial amputation: alignment and ligamentous integrity of knee is important for socket design and suspension strategy
- usually defer specific assessment until there is primary healing at surgical site
- note history of previous injury, DJD, and bony deformity
Preprosthetic examinations: Assessing residual limb volume
- limb volume is important determinant of readiness for definitive prosthesis
- measure limbs volume frequently in pre prosthetic period
- look for distal end being smaller than proximal end
Measuring residual limb volume: transtibial landmarks
- medial joint line or tibial tubercle
measuring residual limb volume: transfemoral
- ischial tuberosity or greater trochanter
Preprosthetic examinations: readiness for prosthetic fitting in regards to limb volume
- compare proximal and distal circumference
- distal limb circumference should be equal to or no more than 1/4 inch great than proximal limb circumference
- if effective edema control residual limb will mature into conical shape with distal circumference is less than proximal
Measuring limb length: transtibial
- medial joint line or tibial tubercle to end of tibia or end of soft tissue
Measuring limb length: transfemoral
- greater trochanter to end of femur and end of soft tissue
PT intervention: post amputation
- focus: preparation for prosthetic use: shaping residual limb and desensitize residual limb
- monitor condition of remaining foot
- assess potential for prosthetic use
- functional training in self-care
Edema control
important elements
important element in preparation for prosthesis use can include
- ace wrap
- shrinker garment
- semi rigid dressing
- rigid dressing
