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movement science II > week 10 > Flashcards

week 10 Flashcards

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1
Q

incidence of amputations

A

1:200
* 1.9 million amputees in US - expected to double by 2050
* vascular disease 54% - includes diabetes and peripheral arterial disease
* trauma 45%
* cancer < 2%
* 97% of all amputation are LE
* 130,000-180,000 LE amputations annual
* Black Americans are 4x more likely to have amputation than white Americans

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2
Q

LE amputation levels

A

transmetatarsal amputees often get further amputations further up

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3
Q

amputee timeline and presentation

A
  • pre-operative: what is their function, work on ROM/strength/CV if non-emergent
  • acute/post-operative: weeks 1-3, subacute/SNF, wound care, incision healing, mobility
  • pre-prosthetic: weeks 3-12 post-op, home health/SNF, protection and shaping residual limb, balance and pain control, home mobility
  • prosthetic and gait training/OP: weeks 6-8 to 16, fitting and components
  • long term f/u: 3-6 months/annually for VA
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3
Q

amputee timeline and presentation

A
  • pre-operative: what is their function, work on ROM/strength/CV if non-emergent
  • acute/post-operative: weeks 1-3, subacute/SNF, wound care, incision healing, mobility
  • pre-prosthetic: weeks 3-12 post-op, home health/SNF, protection and shaping residual limb, balance and pain control, home mobility
  • prosthetic and gait training/OP: weeks 6-8 to 16, fitting and components
  • long term f/u: 3-6 months/annually for VA
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4
Q

systems review for amputations

A
  • MSK: ROM, strength, deformity
  • NM: balance, coordination, MCML
  • CV: pulses, check reamining/sound limb
  • integumentary: skin quality on sound limb, skin under socket
  • nervous: sensation
  • other: depression screening
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5
Q

pain in amputees

A
  • phantom limb sensation (PLS): not pain, up to 100% of patients
  • phantom limb pain (PLP): UE > LE, F > M, cortical theory (filling void of missing cortical info), use gabapentin and compression and night, 60-80%
  • residual limb pain (RLP): neuromas/bone spur, OA, incisions
  • back pain/referral: up to 71% of amputees

neuroma: thickening of nerve, has to be burried

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6
Q

psychosocial considerations with amputees

A
  • decrease in QoL: F > M
  • depression: 20-45% amputees, dysvascular > traumatic (heal better, not as deconditioned)
  • anxiety
  • self-consciousness
  • grief
  • support groups, peer visitation, family
  • wrok/return-to-work
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7
Q

subjective amputee assessment

A
  • MOI
  • revisions
  • previous prosthetics
  • navigation/ambulation
  • work
  • ADLs
  • tobacco/ETOH use
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8
Q

residual limb assessment

A
  • level: right length
  • shape: bony prominences, length, contour/cylinder (trans-tib), trans-femoral are conical
  • skin condition: quality, wounds, color, red flags, drainage
  • swelling/edema: including circumferential measurements
  • incision/scar: quality, restrictions, invagination
  • proprioception/joint position
  • sound limb - same concerns
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9
Q

ROM for amputees

A
  • hip and knee ROM
  • ROM required for gait (knee needs 60 degrees flexion for walking, 110 for steps)
  • ROM required for functional mobility
  • pelvic mobility
  • lumbar mobility
  • contralateral ROM

prone lying in pre-prosthetic to avoid hip flexion contracture

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10
Q

strength for amputees

A
  • strength requirements for gait and function mobility/transfers (4/5 for standing)
  • sound limb: needs to stand alone for STS transfers
  • hip abductor/adductor strength
  • lever arm/length
  • UE strength if using AD
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11
Q

sensation for amputees

A
  • light touch
  • sharp - monofilament testing
  • protective - wear shoes in home
  • sound limb
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12
Q

gait and functional assessment in amputees

A
  • functional mobility/function: AMPpro/NoPRO, PSFS, socket comfort score
  • gait assessment/AD: 10m and 2m walk test, TUG, video analysis
  • balance - static and dynamic: ABC, AMPpro, TUG, FR
  • CV/endurance: 2 minute or 6 minute walk tests
  • K level: determinant of function/potential function and componentry
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13
Q

goals for amputees

A
  • dependent on prognosis
  • return to previous activity in 4-6 months
  • short term goals: wound care
  • long term goals: sound limb care, hobbies
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14
Q

pre-prosthetic strengthening

A
  • supine HS stretches
  • prone propping
  • seated quad sets, knee extension
  • functional mobility: transfers, wheelchair/bathroom mobility
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15
Q

pre-prosthetic functional mobility goals

A
  • transfers: independence with transfers between WC, bed, chairs
  • WC mobility: independent form a WC level
  • bathroom: transfers from WC <> commode
  • limited household ambulation: modified independent for 50 feet with LRAD
  • stairs: single limb hopping or bumping using LRAD and railings
16
Q

pre-prosthetic residual limb management

A
  • compression for shrinking and shaping: ACE wrapping, rigid removal dressing (cast), Shrinker sock
  • incision/wound management: skin checks for dehiscence, changes, signs of infection, proper healing, dressing
  • collaborate with prosthetist
17
Q

pre-prosthetic residual limb pain management

A
  • pharmaceutical vs non
  • phantom limb sensation/pain: mirror therapy, desensitization techniques (texture, touch, pressure), visual imagery
  • residual limb pain: movement and positioning, compression, habituation and desensitzation
18
Q

post-amputation/pre-prosthetic mobility training

A
  • strength training
  • functional mobility
  • residual limb management
19
Q

prosthetic training phase

A
  • residual limb managment
  • prosthesis management
  • pre-gait training
  • strength and balance training
  • functional mobility
20
Q

clinical indications for gait training with prosthesis

A
  • suffieicnt strength and independence for functional mobility
  • sufficient ROM
  • K3 (household) or K4 (community) predicted by Amputee Mobility Predictor
  • physician clearance for progressive weight bearing - incision is completely healed, compliance with wear schedule
  • well fitting socket with correct alignment
21
Q

progression of gait training activities - amputees

A
  • steps in bars
  • turn and pivoting: don’t pivot on prosthetic - aggravates stump skin
  • resisted gait
  • variable cadence
  • stepping over obstacles
  • lateral and retro-ambulation
  • reactive stepping
22
Q

progression of support - amputees

A
  • parallel bars
  • front wheeled walker
  • bilateral forearm walker
  • bilateral forearm crutches
  • unilateral forearm crutch
  • cane
  • no AD
23
Q

training common deviations and treatment

A
  • trendelenburg, pelvic stability: lateral walking, hip strengthening
  • decreased prosthetic stance time: part practice stance phase, pre-gait
  • poor initiation of gait with pelvis: resisted gait
  • poor weight shift: scales for visual and tactile feedback on weight acceptance, step ups
24
Q

walking with a mechanical knee – TFA

A
  • strong extension of glutes/HS are needed to control knee
  • lateral tilt of trunk is often substituted for correct trunk/pelvic rotation and knee flexion
  • often uneven stride length and rhythm
  • adaptive techniques are often used for descending stairs, ramps, hills
25
Q

benefits of a microprocessor knee (MPK)

A
  • stumble recovery - prevent falls
  • ability to ride the knee down stairs, ramps, rough terrain
  • stability on uneven surfaces
  • controlled sitting and kneeling movements are possible
  • less user concentration on the prosthetsis
  • energy efficient gait with greater symmetry

ability to place weight on knee as it is bending (ride resistance)

26
Q

MPK gait training progression

A
  • parallel bars activities - learning to trust the knee
  • practice riding the knee in standing
  • step length practice
  • weight shift/timing to activate knee - loading the toe, smooth rhythm, equal sound for heel strike
  • later: out of parallel bars, facilitate shoulder rotation, speed changes, flat treadmill
  • advanced skills: stand to sit, stairs, reverse incline on treadmill, ramps
27
Q

criteria for taking the leg home - 2-8 visits depending on progress

A
  • don/doff prosthesis independently and correctly without cuing
  • sit to stand performed independently with use of AD
  • able to stand 2 minutes independently with use of AD - socket tolerance
  • able to ambulate for 100 feet with least restrictive AD on surface compliant with home flooring
  • negotiates a single step with the least restrictive AD independently
  • able to negotiate stairs independently (if stairs at home)
28
Q

osseointegration

A
  • bone anchored prosthesis (BAP)
  • anchoring of a surgical implant by the growth of bone around it without fibrous tissue formation at the interface
  • initially dental implant
29
Q

OI rehab vs socket rehab

A
  • change in expectations
  • myodesis (muscle to bone) vs myoplasty (muscle to muscle)
  • contractures
  • improved biomechanics - glute med function, closed chain, proprioceptive feedback

short residual - good OI candidates

30
Q

screw fit (OPRA) OI

A
  • 2 stage surgery
  • stage 1 - 4-6 months rest
  • stage 2 - 3 weeks rest
  • long
  • FDA approved protocol
31
Q

press fit OI

A
  • 2 stage surgery
  • stage 1 - 6 weeks rest
  • stage 2 - 2 days rest
  • faster

movement science II (7 decks)

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