Week 10 PT exam intervention LE LL Flashcards
What is gangreen
death to body tissue due to lack of blood flow or a serious bacterial infection
week 1-3 acute care goals
wound care
Pre prosthetic week 3-12
limb shaping
Prosthetic 6-8 to 16 weeks
gait training
equiptment modification
patient education
CV health
transfers
long term 3-6 months follow up
need for additional legs for activity or function
What are the 4 types of pain an individual with LL experiences
1.phantom limb sensation - can feel the limb that is gone
2.phantom limb pain- can feel pain in the limb that is gone
3.residual limb pain- neuromas or bone spurs
4.back pain
What should you do if you notice a patient has a bone spur
want to unload/ofload the area so that it doesnt cause more pain to the nerve
What are some psychosocial aspects that need to be considered
decreased QoL
depression
anxiety
self consciousness
grief
What is included in residual limb assessement
level
shape
skin condition
swelling/edema
incision/scar
proprioception/joint position
sound lim
What is one simple exercise that should be prescribe to prevent hip flexion contratures
prone lying
If the quads are gone what muscle does the body rely on for stability
glutes
Gait and functional assessments valid in amputee population
AMPpro/NoPRO
PSFS
Tapes-R
Socket comfort score
Gait assessment: 10m and 2 min walk test, TUG
Balance: ABC, AMPpro, TUG
CV: 2min 6min walk test
what is the prognosis for return to previous activities
4-6 months
What are the main short term goals
wound healing
edema management
independent in mat program
taking care of sound limb
assistive device management
What can be used for compression for shrinking and shaping the limb
ACE wrapping
rigid removal dressing
shirker sock
what is incorporated in an incision/wound management
skin checks, changes, signs of infection and proper healing
dressing
What can be used for phantom limb sensation/pain
mirror therapy
desensitization techniques
visual imagery
5 Clinical indications for gait training
- sufficient strength and independence for functional mobility
- sufficient range of motion
- K3 or K4 predicted by amputee mobility predictor
- physician clearance for progressive weight bearing
- well fitting socket with correct alignment
What can be used to promote weight acceptance phase
lateral weight shifts
anterior/posterior weight shift
circumduction
avoid postural deviation
What is dynamic weight acceptance
stepping in place
step ups
proprioception
pregait
Pre-gait activities for balance
static balance: reaching, trunk twists, single leg stance
dynamic balance: lateral stepping, reactive stepping, altered base of support, altered surface compliance
common gait deviation: trendelenburg, pelvic instability
hip weakness
decreased confidence in prosthesis
decreased prosthetic stance time and associated contralateral step length
poor weight shift and weight acceptance onto prosthetic side
impaired hip ROM
poor initiation of gait with pelvis
decreased trust on initial contact and through stance
poor weight shift
pain
poor confidence in weight acceptance
Best outcome measures
AmpPro
10 meter walk test
6 min walk test
TUG
Dynamic Gait index
What criteria needs to be met to disengage knee microprocessor
knee in full extension
70% of BW toe load (DF moment)
walking with a mechanical knee requires
- strong extension of glutes/hams to control knee
What is the mainbenefit of a microprocessor knee
ability to place weight on the knee as it is bending
What are other benefits of a microprocessor knee
stumble recovery- prevents falls
ability to ride the knee down stairs, ramps
stability on uneven surfaces
controlled sitting and kneeling movements are possible
less user concentration on the prosthesis
energy efficient gait with greater symmetry
Use _____ to practice learning to trust the knee
parallel bars
how many visits are necessary depending on progress to take the leg home
2-8 visits
what is the criteria for taking the leg home
- dons/doffs prosthesis independently and correctly without cueing
- sit to stand performed independently with use of AD
- able to stand x2 min independently with out use of AD
- 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 present in the home
