UE AMPUTATION- SYNCH Flashcards

(32 cards)

1
Q

Functions of the upper limb

A

fine manipulation

power grasp

communication

interaction with the environment

self-image

completion of most ADL

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2
Q

Most common cause of UE amputation

A

trauma

-50% of those with UE acquired amputation choose to wear prosthesis

-majority are young males

-male to female ratio 8:1

-21-64 years old make up 80%

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3
Q

Congenital amputation

A

-transverse: limb is absent across the longitudinal axis

-longitudinal: the deficiencies are along the axis of the limb but do not cross it (radial or ulnar deficiencies)

-upper limb absences are more common than lower limb by a ratio of 60:40%

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4
Q

acquired amputation

A

Traumatic: machinery, explosives, projectiles, MVA, burns, electrical and cold exposure injury

Dysvascular: necrotizing fasciitis, toxic shock, DM, etc

Malignancy of bone/joint

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5
Q

Questions to ask during exam/subjective

A

current thoughts and info regarding prosthesis (before pt has their own)

any visual or short term memory problems which may affect treatment

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6
Q

Signs of PTSD:

A

sleep pattern changes

presence of night/daymares or flashbacks

occurrence of sudden or disruptive anxiety/depression causing immobility/feeling of a loss of control

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7
Q

Assessment of the residual limb:

A

-wound
-skin/scar: adherent, flabby/firm, flap coverage, palpable neuroma
-length
-shape
-bony prominences (for suspension)
-sensation
-A/PROM: primarily proximal, including scapula
-the strength of remaining mm. noting weakness which may be related to a peripheral nerve injury
-residual pain
-phantom sensation/phantom pain

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8
Q

Levels of UE amputation

A

forequarter- loss of scapula and clavicle

shoulder disarticulation

transhumeral= above elbow (very short, short, standard, long)

elbow disarticulation

transradial - below elbow (very short, short, standard, long)

wrist disarticulation

carpal disarticulation

transmetacarpal

digital

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9
Q

Options for a prosthesis for the UE:

A

no prosthesis

a passive or oppositional prosthesis

body-powered prosthesis

externally powered prosthesis

use of a combination of each (hybrid)

task-specific prosthesis

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10
Q

Phases of UE amputation rehab

A

pre-op: acute rehab, 1-2 visits to talk about edema control, residual limb shaping and 1-handed ADLs
-team consult or while patient is in critical care (limb salvage)
-may occur before elective amputation for malignancy, brachial plexus injury, or revision of present amputation
-discuss: amputation level, collaboration between IP and OP staff, patient goals, plan for prosthetic use and strengthening
-address one-handed use and change of dominance
**often the patient and family are not ready to see or hear about the prosthesis at this time

post-op:
- in inpatient physical therapy
-grief
-one-handed ADLs

pre-prosthetic

prosthetic prescription and fabrication

prosthetic training

** need 3 months or more

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11
Q

Incisional pain and phantom pain management

A

INCISIONAL:
-generally managed by narcotic agents delivered IV or IM in the first 3-4 post-op days, TENS

PHANTOM:
-amitriptyline (Elavil)
-isometric exercise
-guided imagery/mirror therapy (Ramachandran)

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12
Q

Phantom sensation vs phantom pain

A

SENSATION
-feeling that the limb is still present or partially present
-can be helpful for prosthetic training

PAIN
-feeling or sensation of pain in the limb that was removed
-abnormal
-treated aggressively

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13
Q

Where is UE ROM most commonly lost following amputation?

A

GH and elbow joints

-can begin AROM of the residual limb as early as POD 2

-gentle isometric contractions can begin at POD 5, isotonic 7-10

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14
Q

What is the necessary shape of the residual limb needed for prosthetic fitting?

A

conical shape

-achieve this shape with ace wrapping in a figure-of-eight fashion with more pressure distally than proximally
-can also perform tubular elastic bandaging

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15
Q

ROM, strengthening, and hygiene

A

-address chest expansion with burns due to scar tissue formation
-address scapular and glenohumeral mobility and strengthening
-distal weighting with cuff weights
-residual limb to be washed daily with soap and water, patted dry

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16
Q

Strengthening during post-operative pre-prosthetic phase

A

-scapular stabilization BL

-functional strength training for core strengthening (ball)

-balance/symmetry of gait and arm swing

-strengthening of unaffected uE

-strength of remaining mm. of residual limb

-** Strengthening helps to reduce phantom limb pain

-lifting hook

17
Q

Things to watch out for when using a prosthesis during strength training

A

-blisters, abrasions and rashes due to harnessing on a body-powered prosthesis or from hanging unsupported and then being subjected to the opposite forces with sudden suction on closed chain contact

–> swelling, dark, red discoloration and a bulbous end of the limb

18
Q

Overuse of the unaffected limb- things that can be examined/ addressed

A

-activity analysis needs to be performed to address repetitive, forceful, or awkward ADL

-joint protection training

-energy conservation training

-can also have dental damage due to donning and doffing with teeth

19
Q

Two important things to focus on to maximize an individual’s independence after an UE amputation

A

-interventions to adapt to one-handed ADLs

-change of hand dominance if necessary

20
Q

Most important/impactful reason why individuals choose not to get an upper extremity prosthesis:

A

-too much time was taken before fitting–> they adapted to life without one

-easiest to accept one within the first 3 months

21
Q

Something to consider with insurance

A

-a lot of patients opt for the myoelectric prosthesis because most third-party payers will only cover one prosthetic

22
Q

Types of UE prostheses

A

IPOP - immediate post-operative prosthesis
-passive or oppositional

Body Powered -
-powered an controlled by gross body movements captured by a harness system through a cable

Externally Powered - myoelectric, switch controlled, touch pad controlled, servo controlled

Hybrid

Activity Specific/Recreational

23
Q

Where are BUE patients often seen for rehab care?

A

inpatient setting (regional amputee programs)

TIRR - Texas Institute for Rehabilitation and Research

RIC - rehab institute of chicago

24
Q

Order of how much training time is required for body powered prostheses

A

transradial (5 hours) –> transhumeral and shoulder disarticulation–> bilateral transradial –> bilateral transhumeral (20 hours)

25
Donning a body bowered prosthesis
"coat method" -most often used by unilateral amputees "pullover sweater method" -bilateral amputees most common
26
Prosthetic wearing schedule:
start with <15 min at a time with frequent skin checks if no skin problems--> increase wear time to 30 increments 3x/day then at the end of the week --> patient wearing all day clean res. limb and prosthetic socket with soap and water change stump socks often
27
Body control Motions for Body Powered Prosthesis
OPENING THE TD -scapular abduction and shoulder flexion -hook opens as you move the arm forward -elbow must be locked first LOCKING/UNLOCK THE ELBOW UNIT - Scapular Depression/Extension/Abduction; this “down, back and out” combined motion is required to lock and unlock an elbow unit with an AE prosthesis; this is a “two-click” cycle -elbow must be locked before the TD can be operated ELBOW FLEXION/EXTENSION - Accomplished using a forearm- lift device which responds to scapular abduction and chest expansion when the elbow is unlocked CHEST EXPANSION - Used for harnessing with a forequarter, shoulder disarticulation or high AE amputee with a cross-chest strap
28
Manual controls training for body powered prosthesis:
Positioning of the shoulder joint: -manually adjusted by sound hand or against an object with a friction unit internal/external rotation -controlled by rotation of the elbow turnable by leaning the prosthesis against an object in an internal or external rotation fashion wrist flexion -operate unit by pushing on the button on the forearm by sound hand or against object for BL amputee positioning the TD in the wrist unit: -done by passive rotation with the sound hand into pro/supination for UL -force against another object or between the patient's knees for BL
29
How is elbow lock/unlock accomplished for forequarter or shoulder disarticulation amputees?
chin nudge control button attached to the thoracic socket
30
Functional use training
-most difficult, prolonged stage during which acceptance of the prosthesis is determined -pre-positioning of the TD is emphasized: aided with phantom limb sensation and mirroring sound hand
31
What level of amputation requires prostheses to function independently?
bilateral above the elbow amputees
32
Electrically powered prostheses
* Clinical use of these devices began in Europe due to government-supported healthcare and a large patient population of congenital amputees (post- thalidomide) * The term myoelectric is often used interchangeably with electric prosthesis * Myoelectric prosthesis uses mm. surface electricity to control the prosthetic hand function