Pre-Prosthetic Management Flashcards
1
Q
Key issues to address
A
- Control edema and pain
- Prevent contracture
- Bed and transfer mobility
- Specific strengthening
- Cardiovascular endurance
- Integument health
- Improve psychological well being
2
Q
Post-op dressings
A
Acutely: soft
Maintenance: rigid
- Soft dressings more frequently used compared to rigid
- Worn 24 hours a day
3
Q
Soft dressings
A
- Bandages cover the wound
- Either ace wraps or sprinklers used over bandages to control edema and shape residual limb
- Cheap & washable
- Skill required for proper application, shrinkers and ace wraps slip and can tourniquet, wraps need frequent reapplication, shrinkers need to be replaced as the limb shrinks
4
Q
Elastic wrap
A
- Figure 8 pattern
- Applied immediately post surgery
Transtibial: two 4” bandages
Transfemoral: two 6” & one 4” bandage
5
Q
Shrinkers
A
- Started when sutures are removed and drainage has stopped
- May use tubigrip too
- Start prosthetic fitting when residual limb size stable for 2-3 weeks —> typically 6-8 weeks post surgery
6
Q
Rigid dressings
A
- Immediate postoperative prosthesis (IPOP) is a plaster cast applied in the OR
- Good edema control and shaping control decreases pain and speeds healing, allows for attachment of a pylon and foot for early ambulation, reduces overall time for final residual limb shrinking
- Skill required for application, can’t visualize the wound, needs close supervision and follow up
7
Q
Immediate postoperative prosthesis
A
- Usually begin with eggshell WB within 24 to 48 hours post-op if there are no complications
- May be diffuse aching in residual limb with WB but if pt reports localized sharp/burning pain, indicative of abnormal pressure and the fit needs to be reassessed
- Not changes until 2-2.5 weeks when sutures are removed
- WB is progressive as a percentage of total body weight with restrictions set by surgeon
- Almost exclusively reserved for trauma pts
8
Q
Non-weightbearing removable rigid dressings
A
- Faster healing times, reduced limb edema, better limb contouring, prevention of knee flexion contracture, reduced external trauma to residual limb compared to soft dressings
- Increase probability of successful prosthetic use and pain reduction
9
Q
Pt evaluation post amputation
A
- General medical info
- Skin
- Residual limb
- Vascularity
- ROM
- Strength
- Neurological
- Functional status
10
Q
Phantom limb sensation vs. pain
A
- Sensation that amputated limb is still attached and moving appropriately with other body parts
- 60% sensations bothersome (not pain)
- 20% pain severely bothersome
90% still have sensation >2 years after - Must report as painful (cramping, squeezing, shooting or burning)
- May describe limb feeling like it is stuck in an awkward position resulting in symptoms
11
Q
Phantom pain treatment
A
- Touch and massage (start right away)
- TENS
- Mirror boxes
- Virtual reality
- Antidepressants, anticonvulsants, narcotics (limited effect)
12
Q
Phantom pain physiology
A
- Ensure it is not a neuroma**
- Neural plasticity within the somatosensory primary cortex homonculus
- Pain intensity correlated with extent of cortical reorganization
- Mirror therapy results in pain relief and reversion of cortical reorganization along with early touch and movement
13
Q
Skin care following amputation
A
- Check residual limb with mirror daily
- Dry skin should be treater with non-water based skin lotion
- Friction massage to mobilize adherent scar tissue
- LEAP program (10 gm filament)
14
Q
Positioning
A
- Keep residual limb flat on bed with legs together when lying on your back
- Lie on stomach as much as possible to help stretch hip joint
- Equal weight through both hips with legs together when sitting
- Contract-relax techniques work well
15
Q
Bed mobility and transfers following amputation
A
- Starts asap
- Stand-pivot appropriate (wear shoes d/t shear force created)
- Care taken for sound side limb
- Concept of limb sparring (not hopping or over working the sound side)
- WB mobility (not ambulating at this time)
16
Q
Early exercises for Transtibial amputee
A
- Quad set
- Hip extension (straight knee)
- SLR
- Extension of residual limb with opposite leg against chest
17
Q
Early exercises for transfemoral amputee
A
- Glute sets
- Hip extension
- Hip abduction with band
- Sidelying hip extension/flexion
18
Q
Prone-lying
A
For 30 minutes twice a day prevents hip flexor tightness
- Person can perform either or both active hip extension and thoracic extension exercises from this position
19
Q
Modified weight bearing exercises
A
- Small stool placed under the residual limb for series of bridging exercises
- Hip extension
- Hip abduction
- Hip adduction
(Can be performed bilaterally but focus is on residual limb)
20
Q
Modified sit-ups
A
- Helper stabilized amputated limb while pt flexes and rotates trunk toward amputated limb
- Requires abdominal activity in combination with hip flexion, adduction, and internal rotation
- Hip muscle activity helps balance and prevent abductor and ER tightness that is common among people with transfemoral amputations
- Targets obliques for propulsion and trunk/pelvis rotation through gait cycle
21
Q
Readiness for prosthetic fitting
A
- Start process when residual limb size stable for 2-3 weeks (generally 6-8 weeks post surgery)
- Extend hip or both hip and knee of residual limb to within 15 degrees of full extension (want as close to neutral as possible)
- Ability to perform recumbent exercise for hip extension, abduction, knee extension bilaterally
22
Q
General readiness criteria
A
- Stable medical status
- No open areas larger than 1 cm
- Ability to stand on intact leg
- Adequate bilateral strength
- Adequate short-term memory
Areas for problems: cardiopulmonary disease, cognition, motivation
