upper extremity amputee

Question 1

complications with ue limb loss

Answer 1

Edema
Contracture
Body asymmetry
Skin breakdown
Cosmetic acceptability
Neuroma

Question 2

what is neuroma in limb loss

Answer 2

nerves are severed and then they grow back in a cluster in tissue. can be painful.

Question 3

What healthcare professionals are involved with UE limb loss

Answer 3

MD, prosthetist, nurse, OT, PT (maybe), SW (social worker), psychologist, vocational rehabilitation

Question 4

When is the best time for UE prostethics?

Answer 4

right away! within the first 30 days

Question 5

What assessment would you choose for UE amputee?

Answer 5

Occupational Profile
ADL
UE AROM
Edema
Pain
Strength
Sensation
Cognition
Balance
Fine motor
Prosthesis check out
Activities Measure for Upper Limb Amputees (AM-ULA)

Question 6

How do we build muscle strength for a person with UE amputee

Answer 6

isometrics, tightening the limb, squeezing muscles, weighted cuff, once skin is healed, use a thera band, tuba grip sleeve and then thera band on there.

Question 7

What cognition test would you do with UE amputee

Answer 7

start small, mini mental, then progress to performance based.

Question 8

Why would we check balance with UE amputee

Answer 8

reduce chance of falling.

Question 9

WHat is the assessment designed specifically for UE amputee

Answer 9

activities measure for upper limb amputees (AM-ULA)

Question 10

Why do we care about wound care if the nurse is watching it?

Answer 10

because our treatment will be guided by it.

Question 11

What’s an intervention for edema control

Answer 11

movement, strength

Question 12

how would we intervene for scar management

Answer 12

teach them how to do a scar massage

Question 13

intervention for pain management

Answer 13

mostly desensitization. see what they can tolerate. smooth fabric - have them rub that on residual limb. rub lotion after bathing gradually work towards more textured fabrics. Eventually have them weight bear in a rice bucket. Soft brisle brushes.

Question 14

how can help managing pain help emotionally

Answer 14

it will help limb loss acceptance

Question 15

What is peri operative care in OT?

Answer 15

promote wound care and healing, edema control, scar management, pain managment, Optimize joint ROM
Maximize strength
Emotional /psychological support
Connect patient with peer mentor

Question 16

What is some pre-prosthetic training?

Answer 16

Emotional support
Stabilize limb volume
shrinkage , shaping and desensitization
Limb hygiene
Optimize limb ROM & strength
Prepare to change limb dominance
Maximize ADL indep
Myoelectric site testing

Question 17

With a bilateral UE amputee what is the dominant side?

Answer 17

The longer limb is the dominant limb.

Question 18

OT role before prosthetic training

Answer 18

we need to make sure they are independet without the prosthetic. so they have options

Question 19

What is myoelectric site testing

Answer 19

for the myoelectric site testing, find out where the nerves end to see where the prosthetic can be useful.

Question 20

when does limb shaping start?

Answer 20

right away

Question 21

What soft dressing do we use for limb shaping?

Answer 21

ace wrap, tubi grip

Question 22

What shape do we need to make the limb when limb wrapping for shaping?

Answer 22

cone shape

Question 23

How do we wrap the residual limb for shaping

Answer 23

distal to proximal figure 8

Question 24

how often whould yuou clean shaping wrap?

Answer 24

every 2 days

Question 25

how often should a shrinker be worn?

Answer 25

all the time

Question 26

phantom limb pain

Answer 26

pain in the absent limb

Question 27

residual limb pain

Answer 27

pain that is present in residual limb

Question 28

phantom sensation

Answer 28

non-painful sensation in absent limb

Question 29

incisional pain

Answer 29

acute, localized along the incision, improves with healing

Question 30

What is effective with phantom limb pain?

Answer 30

mirror therapy and VR mirror therapy

Question 31

What is the amputee coalition of america protocol for desentization?

Answer 31

Increase tolerance to prosthetic socket s/p wound closure - Massage - Tapping - Long handled sponge - Sensory bins - Baby brush - Towel circular motion for 2-3 minutes. start 2x/day then progress to more frequently.

Question 32

pain is correlated with

Answer 32

emotional state

Question 33

if the emotional state is higher what may take longer

Answer 33

management of pain and acceptance of body image

Question 34

pain management for UE amputee

Answer 34

mirror, tens, compression, analgesics (meds) gabbapentin for nerve pain.

Question 35

Check the weather to manage

Answer 35

pain. weather / pain pregame

Question 36

prosthetic training steps

Answer 36

- Skilled instruction in the functional use of the prosthesis - Limb hygiene and care - Care of the prosthetic limb - Donning and doffing -Clean liner and socket - Wearing schedule

Question 37

What is dominent when a pt has a Unilateral prosthesis -

Answer 37

always non-dominant

Question 38

What body function is needed for body powered prosthetic

Answer 38

shoulder movements

Question 39

Voluntary opening (VO) TD

Answer 39

stays closed all the time but need to voluntarily open. With elbow locked, upper arm comes forward to open TD

Question 40

prosthetic training repetitive activities

Answer 40

Manipulate various sizes and shapes Seated, standing and walking Clothes pins Pens and pencils Small wooden blocks Cup Softball Deck of cards

Question 41

What is the standard for using sound arm vs. prosthesis?

Answer 41

Sound arm used with bilateral tasks only All unilateral tasks are with prosthesis

Question 42

wearing schedule for prosthatic

Answer 42

Begin with no more than 15-30 min with skin checks Frequent checks of socket fit If redness > 20 min after removal, prosthetist will adjust socket Increase wearing time by 30 min if no issues Goal is to wear prosthesis all day within 1 week

Question 43

different types of prosthetic

Answer 43

passive or cosmetic (finger) active - body powered prosthetic, myoelectric, hybrid, activity

Question 44

myoelectric are

Answer 44

battery powered, they have sensors on the nerves of the patient.

Question 45

How do prosthetics help physical health?

Answer 45

Protect sound side, provide symmetry, avoid overuse

Question 46

how does prosthetic improve social help

Answer 46

Enhance work roles and ADLs

Question 47

how does prostehtic improve psychological well being

Answer 47

Independence, support positive body image, enhance self confidence, reduce depression

Question 48

how does prosthetic help with reinegration>

Answer 48

Family, society, work roles

Question 49

advantages of prosthetic

Answer 49

Body image Provides non-dominant hand Enhances bimanual activities Accelerates function Better function if injury or loss of other limb occurs

Question 50

downside of prosthetics

Answer 50

Sensory feedback & movement Comfort Skin reaction Frequent visits to prosthetist & OT

Question 51

reimbursement for prosthetics

Answer 51

Health Insurance Worker’s Compensation Private Payment Liability Insurance Auto insurance & homeowners Government Agencies Veteran’s Affairs Vocational Rehabilitation

Question 52

instances when you couldn't use a prosthetic

Answer 52

Unilateral amputee may forego prosthesis Partial hand amputee can function well without prosthesis Patient with cognitive or psychiatric issues may function without