Prep for Prosthesis (1) Flashcards
goals of prep for prosthesis (1)
prepare RL for prosthesis
increase mm strength
maintain or normalize ROM
goals of prep for prosthesis (2)
demonstrate full WBing as tolerated
independence in balance and gait w/ or w/o AD
independence in ADLs w/ and w/o prosthesis
K0
prosthesis doesnt enhance QOL
no prosthesis
K1
level surfaces
fixed cadence
household walker
K2
low level environmental barriers
limited community ambulatory
K3
fxnal level that depends prosthetic components beyond simple locomotion
K4
exhibiting high impact, stress or energy level
child, active adult, athlete
what is K level determined by
outcome measures
choose valid, reliable and responsive fxnal outcome measures
outcome measures
TUG
Berg
6MWT
AMP-PRO
how long is the pre prosthetic phase
2-8 wks
perioperative phase length
12-14 days
what is the perioperative phase (summary)
pre op phase
amputation/reconstruction
acute post-op
pre-prosthetic phase summary
prosthetic prep
prosthetic prescription/fabrication
evaluation/general re-eval
RL
what do we evaluate of the RL
integument
ROM
MMT
girth and length measurement
MMT –> evaluating RL
can add resistance
resistance more proximal than normal
girth and length measurements –> evaluating RL
re-assess and compare for shrinkage
treatment –> motor learning principles
focus on how to use the prosthetic
not on the design and fxn
tx –> goal setting
pt centered
task specific
STG
LTG
tx–> STG
donning/doffing prosthesis
tx–> LTG
walking in park or to church
tx–> variable practice
practice skills around the goal task
ex: ambulation at variable speeds/surfaces
tx–> random practice
vary order or exercises
improves retention and transfer or skills
tx–> when do we use block practice
early on then move to random
tx–> bandaging
continue
introduce shrinker
tx–> exercsie
UE, trunk and sound limb
RL
strengthening of RL
PRE, PNF, dynamic RL exercises
what are dynamic RL exercises
total body exercises that utilize BW for resistance
most common exercises for this population
less popular in recent years
what happened to dynamic RL exercises
modernized –> lots of benefits
how were dynamic RL exercises modernized
minimal equipment
total body strengthening
reinforces fxn
include core strengthening
description of dynamic RL exercises
strengthen muscles in RL as well as trunk and sound limb
uses whole body for resistance
facilitates restoration of body symmetry
uses movements similar to gait
dynamic RL exercises –> equipment
stool
towel roll
bolsters
balls
sandbag weights
how could we progress dynamic RL exercises
use BW as resistance
increase resistance
incorporate the trunk/core strengthening
exercise must be designed for success
increase resistance –> dynamic RL exercises
stool more distal
add manual pressure
added weight
increase ROM
decrease surface stability
remove assistance of other extremities
incorporate the trunk/core strengthening –> dynamic RL exercises
modernize exercise to fit with present evidence
what does tx prevent
muscle atrophy
skin breakdown
contractures
contractures –> prevention
prone lying
stretching
MFR for sore tissue and muscle tightness (iliopsoas,HS)
joint mobs (hip ext, SI joint nutation, L/S ext, knee ext)
how do we perform ambulation
with a temp prosthesis
progressive Wbing
progressive WBing
balance exercises
weight shift
gait training
balance exercises –> progressive WBing
must balance to walk
most important factor in gait ability (balance ability and confidence)
weight shift –> progressive WBing
decrease COG shift to sound side
gait training –> progressive WBing
work on control first
quality not quantity
what do we give the pt
HEP
HEP includes
exercises (in writing)
ambulation program
bandaging/shrinker
bandaging/shrinker –> HEP
x-silver shrinker
comfort silver liner sheath (worn under a liner)
anti-microbial
shrinker w/ gel band at top
goals at the end of this phase
good muscle strength and adequate ROM
have a RL that is prepared for definitive prosthesis
be independent in gait, balance w/ or w/o AD
be independent in ADLs w/ and w/o prosthesis
