Pre-Prosthetics Training

Question 1

When doing your exam, what are some things to consider specifically for amputees?

Answer 1

• can they don/doff prosthetics and shrinker
• positioning of limb
• fit of prosthetics
• equipment
• fit of protector

Question 2

T or F: amputees should always have something on the residual limb

Answer 2

T

Question 3

what are some equipment amputees may need?

Answer 3

• slide board
• at least 2 shrinkers
• donner
• possibly knee immobilizer

Question 4

household ambulators should be able to ambulate ______ feet while community ambulators should be able to ambulate _______ feet

Answer 4

50
150

Question 5

Do pts with traumatic or vascular amputations have a better prognosis

Answer 5

traumatic

Question 6

usually traumatic amputations discharge to _________

Answer 6

home

Question 7

Phase 1 of rehab

Answer 7

pre-operative
*not always possible to have

Question 8

T or F: you should go ahead and start ordering equipment in the pre-operative phase

Answer 8

T: if you know it is going to be an amputation

Question 9

phase 2 of rehab

Answer 9

surgery day

Question 10

when is PT usually starter for amputees

Answer 10

post-op day 1

Question 11

phase 3 of rehab

Answer 11

acute post-operative
2-5 days without complications

Question 12

what is one of the most important things in the acute postoperative phase and why?

Answer 12

POSITIONING
*you want to prevent contractures because the prosthetic can only account for so much loss of ROM

Question 13

what motions do you want to focus on to prevent joint contractures?

Answer 13

1 - hip ext
2 - hip adduction
3 - knee ext

Question 14

how much knee and hip flexion can a prosthetic compensate for

Answer 14

5 knee flexion
15 hip flexion

Question 15

stump protector/knee immobilizers are worn _____ in the acute postop phase

Answer 15

23/7
*take off to shower

Question 16

what kind of transfer usually works well for a LE amputation in the acute post-op phase

Answer 16

slide board

Question 17

3 positioning DOs for amputees

Answer 17

• lay prone several times a day
• use a limb protector
• minimize prolonged hip/knee flexion

Question 18

3 positioning DONTs for amputees

Answer 18

• place pillow under knee or thigh
• place pillow between legs
• sit with knee flexed or without support

Question 19

what are some benefits of postop dressings

Answer 19

• control swelling
• shape limbs
• protect incision
• desensitize
• assist with drainage

Question 20

you want the residual limb to be ______ shaped

Answer 20

cylindrical

Question 21

how should you wrap an ACE wrap

Answer 21

• figure 8
• distal compression more than proximal
• no clips or tape to skin, no wrinkles

Question 22

what population are non-removable rigid dressings good for

Answer 22

cognitively impaired

Question 23

IPOPs

Answer 23

immediate post-op prosthesis
*these are great, by typically only used with young/traumatic (insurance coverage)

Question 24

if you walk into a pts room 3 days postop and there is no dressing what should you do

Answer 24

ask questions! there should be a dressing
*risk of limb developing abnormal shape

Question 25

3 stages of incisional healing

Answer 25

1 - inflammatory (0-5 days) 2 - fibroblastic (5-21 days) 3 - remodeling (>21 days)

Question 26

phase 4 of rehab

Answer 26

pre-prosthetic phase (weeks 2-3)

Question 27

what are some exercises you can do in the pre-prosthetic phase for transfemoral amputation

Answer 27

- bridge over bolster - SAQ (unaffected leg) - SLR (unaffected leg) - side-lying hip add with bolster - prone hip ext - prone add squeeze - prone knee flex (unaffected leg) - quadriped leg lift - bosu ball

Question 28

what are some exercises you can do in the pre-prosthetic phase for transtibial amputation

Answer 28

-quad set -SAQ -SLR -bridging w/ bolster -prone knee flex -push ups -tall kneeling rotation *and all of the transfemoral ones!

Question 29

phase 5 of rehab

Answer 29

prosthetic prescription

Question 30

staples are usually removed about _______ month(s) postop and then you can get prescribed a prosthetic

Answer 30

1

Question 31

what are some criteria that affect prosthetic prescription

Answer 31

- skin integrity - shape of limb - strength/ROM/mobility - financial - pt desire

Question 32

phase 6 of rehab

Answer 32

prosthetic training

Question 33

L-test

Answer 33

basically a TUG for amputees... involves 90 degree turns though

Question 34

T or F: post amputation pain is typically normal

Answer 34

T

Question 35

phantom sensations

Answer 35

feelings other than pain in missing body part

Question 36

are phantom sensations usually more distal or proximal

Answer 36

distal

Question 37

are phantom sensations painful

Answer 37

no

Question 38

T or F: phantom sensations usually decrease with time

Answer 38

T

Question 39

phantom pain

Answer 39

pain associated with the amputated segment

Question 40

T or F: prosthetic limb use has been correlated to decrease phantom pain

Answer 40

T

Question 41

T or F: phantom pain is more common in patients who had pain prior to surgery

Answer 41

T

Question 42

T or F: there is a single mechanism for phantom pain

Answer 42

F: not really sure what causes it

Question 43

what are some possible PT treatments for phantom pain

Answer 43

- nerve stimulation - KT tape - mirror therapy - desensitizing program - virtual reality

Question 44

phase 7 of rehab

Answer 44

community integration

Question 45

phase 8 of rehab

Answer 45

follow up *every few months for the first 18 months