Week 11 - OT Management of Upper Limb Amputation Flashcards
why is the prevalence of UE amputations increasing. (name 2 reasons)
- diabetes epidemic
- risk of limb loss increases with age (greater risk after age 65)
what is the leading cause of UE amputations?
trauma
when would amputation be preferred over replanation?
- mangled/severely crushed extremity
- severe brachial plexus injury with insensate hand/arm - amputation with prosthesis may be more functional
name 2 causes of amputation that occur more in lower limbs than upper limbs.
- ischemia
- infection
a rare bacterial infection that spreads quickly in the body and can cause death. accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping this infection
necrotizing fascitis
name the 2 categories of pediatric amputations.
- congenital
- acquired
what percent of congenital limb deficiencies are UE?
58%
T/F - terminology for congenital amputations is not the same as acquired amputations.
true
disarticulation, forequarter, inter-scapulothoracic
shoulder
trans-humeral
above elbow
disarticulation
elbow & wrist
trans-radial
forearm
partial hand (through metacarpals)
hand
what is the level of amputation defined by?
the length of the residual limb relative to the non-injured limb
OT can help during pre-prosthetic training through ___ ___ on process of preparing residual limb for prosthesis.
patient education
what is involved in the post-operative care/pre-prosthetic phase? (name 9)
- shaping and shrinking of residual limb after stitches are removed.
- posture training
- desensitization
- scar management
- ROM - critical to maintain full ROM in remaining joints
- pain management
- strengthening of UEs
- conditioning and endurance training
- ADL training
how should residual limbs be wrapped?
always distal to proximal with DECREASING amount of pressure as you move proximally
how often must residual limbs be re-wrapped?
every 4 hours
in trans-humeral amputations it is crucial to maintain full ROM of which movements?
shoulder IR and ER
name 2 methods for pain management.
- TENS
- high-volt pulsed galvanic stimulation
how often should mirror therapy take place?
15 mins 5x each day for 1 month
when should strengthening of residual limb start?
once surgeon gives ok; must be sufficient healing that resistance with be safe
name 3 critical components of pre-prosthetic care for bilateral amputation.
- provide some sense in independence asap
- pts. must use whole body during ADLs ex: objects held btwn residual limb and body
- adaptation for ADL and equipment vital for gaining independence
lack of blood supply
ischemia
bacterial infection
necrotizing fascitis
name the 3 different types of malignancies that can cause UL amputations.
- chondrosarcoma
- ewing’s sarcoma
- osteosarcoma
comes outside the bone, can appear in young children
ewing’s sarcoma
what is a forequarter amputation?
1/2 the scapula and the entire arm
compression is used in scar management for what?
to flatten the scar
why are silicone gel pads used in scar management?
helps the scar heal
why is massage used for scar management?
helps desensitize and moves scar around so it doesn’t stick
phantom limb syndrome is mostly seen in which types of amputations?
finger amputations
receptors go over muscles for activation; we have to help train the muscles.
myoelectric prosthesis
can be voluntarily opening or closing (most people want opening but it depends)
hook
if children don’t receive prostheses in how many months for congenital amputations they may reject it.
6 months
name one of the most functional body power prostheses.
split hook
you need to have a ___ to operate 3d printed prostheses because they operate on tenodesis.
wrist
use of ___ to decrease incisional and phantom pain in conjuction with pain medication.
TENS
