prosthetic and amputee rehabilitation Flashcards
amputation vs disarticulation (and when each is used)
amputation - the removal of a limb (part or total) from the body, this is generally the preferred method
disarticulation - removing the limb through a joint, preferred in children
prosthesis definition
artificial substitute/ replacement of part of the body
orthosis definition
devices externally applied to body segments to improve, support, correct or compensate weakness
below/above knee amputation name
transtibial; transfemoral
above/below elbow amputation name
transhumeral; tansradia
congenital limb deficiency name
transverse/longitudinal
residual limb name
stump
epi. of amputations
50-70yro men generally, lower limb more common
common causes for lower/upper limb amputation (4,3)
lower: vascular, traumatic, malignancy, congenital;
upper: trauma, malignancy, congenital
when may a hemipelvectomy be performed?
cancer that has spread so far up it affects other organs
what will energy requirement depend on (4)?
level of amputation; length of stump; patient’s health/comorbidities; reason for amputation
what are the components of the international classification of functioning (ICF)
health (disorder/disease); function (body structure, activities); disability (impairment, problems with body structure, activity limitation)
when does rehabilitation start
prior to amputation - counselling is provided for patient + family
what is considered when determining suitability for artificial limbs (4)
energy need; contractures; allodynia; cognition
what stages are included in rehab medicine - pre amputation (5)
patient education; defining expectations; determining suitability for artificial limb; working with surgeons to choose best operation; phantom limb pain prophylaxis
what stages are included in rehab medicine - post amputation (8)
immediately - reduce complications (compare and assess limbs, colour, pulses etc.), maximise independence, minimise pain and discomfort;
post acute - fitness training, preservation of knee function, improve QoL, return to work
what is involved in on ward post amputation rehab (5)
wound management (oedema reduction, contracture prevention etc.); preservation of strength + mobility in uninvolved limbs; stump preparation; wheelchair skills; artificial limb fitting/training (measurements, goal establishment, education on skin-care etc.)
what does stump preparation involve?
keeping the limb moving to prevent contractures and allows the limb to be straightened; making sure there is no oedema
complications of amputation (9)
oedema; infection; ischaemia; non-healing; joint contraction; neuroma forming; phantom limb pain; wound breakdown; bony overgrowth
what is a pneumatic post-amputation mobility aid
a prosthesis for a transtibial amp. that consists of a small inflated bag placed on the stump with a larger one outside; there is a metal frame w a simple rocker at the bottom; used early on to reduce stump oedema
what is a femurett
a transfemoral prosthesis that has an adjustable socket with a thigh tube; the knee can be locked for walking, unlocked for sitting or in free mode for spring assisted walking
gait retraining sequence
1.full weight-bearing and transfer
2.walking with parallel bars
3.walking with 2 sticks between parallel bars
4.walking with 1 stick outside bars
5.optimal gait (w/wo stick)
analgesia ladder
Paracetamol
NSAIDs (e.g. naproxen)
Aspirin
Weak opioids (e.g. codeine, tramadol)
strong opioid (e.g. oramorph)
how can phantom limb pain be managed (7)
mirror therapy (somatosensory overrides pain); massage; heat; acupuncture; TENS; electromagnestism; VR
what can cause stump skin breakdown/ulceration
(6)
poor donning technique; poor socket fit; associated neuropathy; change in stump volume; change in gait pattern; infection w/wo ischeamia
components of transtibial prosthesis (6)
socket; suspension mech; adaptor; shin tube; sock/torque absorber; foot
components of transfemoral prosthesis (7)
socket; suspension mech; adaptor; knee (locked/unlocked); shin tube; shock/torque absorber; foot
what must be considered when prescribing a prosthesis (6)
activity level; amputation level; functional goal; body mass; physical/cognitive abilities; passive/cosmetic/functional (what is it powered by)
K activity level
K0: non ambulatory
K1: limited to transfers or limited household ambulator
K2: unlimited household, limited community ambulator
K3: unlimited community ambulator
K4: high energy activities
pros/cons of a micro-processor knee prosthetic
pros: improved safety, computer adjusting knee for variable gait cycles, energy saving;
cons: high cost, heavy, daily charging, higher maintenance
