Prosthetic Rehabilitation Considerations Flashcards
Pre and Post Op consultations
- important to introduce team approach to patient from very beginning
- allows patient and family time to ask questions with educational materials
Initial Evaluations and Recommendation Principles
- Standard outcome measures
- understand pt expectations and goals
- pts first question - when will i get my leg? not until limb has healed
- weight loss goals etc
Energy Expenditure of Amp Gait
- pts with higher level amputations = less efficicent gait and higher 02 cost than those with a lower level
- amputees slow their chosen walking speed to keep the rate of 02 consumption from rising above normal
Measure/Cast/Scan
do initial eval before they are ready for this step
diagnostic evaluation and dynamic alignment
walking in parallel bars
fabrication of definitive prosthesis
lamination utilizing acrylic resin and carbon fiber
delivery assessment
utilize standard outcome measures
Follow up on a routine schedule
- skin checks!!!!
- checking dynamic alignment
- continued PT for gait training
- discuss volume management (socks)
- ply number - change based on edema
- usually shouldnt be WB on bottom of residual limb
- amputations for WB
- ankle disartic
- knee disartic
- ertyl prodecure - bone bridge, take extra piece of tibia and attach to fibula
Prosthetics and Physical Therapy
- need to be able to fxn w/o prosthesis
- acute management and wound healing
- pre-prosthetic training (ROM/Strength)
- basic prosthetic training
- advanced prosthetic training
- d/c planning
- focus
- strength, ROM
- residual limb characteristics
- ADL status
- prostehtics hx
- goals
- TUG
- 10MWT
- Berg
- AMP = ****
Medicare K Levels
- 0 = does not have ability or potential to ambulate safely with or without assistance and prosthesis doesnot enhance their QOL or mobility
- 1 = has ability or potential to use a prosthesis for transfers or ambulation on level surfaces at a fixed cadence
- typical of the limited and unlimited household ambulator
- 2 = has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces
- 3 = has ability to vary the cadence (feet chosen based on 2 or 3) - community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activities that demands utilization beyond simple locomotion
- 4 = high end athletes and children
Wound Care and Skin integrity
- Limb hygiene
- wound cleansing
- decrease scarring/edema - massage, cream
- desensitize - tapping, massage, vibration, pressure, texture
Sensory Problems and Neuromas
- sensitivity
- pain
- shrink and shape
- elastic bandage - figure 8 pull up
- elastic shrinker
- removable rigid dressing
- post op prosthesis
- Joint Mobility
- limb mobilization - decrease edema increase circulation
- maintain ROM
- dont neglect contral leg
- redness that lasts more than 20 min = concern
G Walk
3 axis accelerometer
gives kinematic data on walking - stride, step length, speed
shows that pt cant walk at variable speed (K3)
Step Watch
- specific to prosthetics
- pedometer attached to prosthesis
- tells cadence and waling voume
- predicts K level
- lifetime estimate of prosthetic device
AMP Pro and NoPro
amputee mobility predictor
utilized to assess amputees k level
score can change as patient progresses
