Week 6 Flashcards
Amputations
Loss or removal of a body part (finger, toe, hand, foot, arm or
leg)
Diabetes is the leading cause of non-traumatic lower extremity
amputations
Lower Limb Amputations: Etiologies
- Diabetes
- Peripheral vascular disease
Trauma
Infection
Cancer
Congenital
Diabetic Neuropathy
High blood sugars can cause damage to the nerves and blood vessels that control the heart, brain and those that are outside of the heart and brain
Peripheral Neuropathy
Most common type type of diabetic neuropathy
Affects nerves in the feet and legs
Loss of sensation
Unsteady gait
Decreased circulation: leads to
diabetic ulcers,
slower healing of wounds
sometimes amputation
What is a major risk factor for developing type 2 diabetes
the amount of processed food and added sugar in the diet
Above Knee Amputation (_______)
Below Knee Amputation (________)
Above Knee Amputation (Transfemoral)
Below Knee Amputation(Transtibial)
Two main phases of rehabilitation for amputees
1) Pre prosthetic phase
2) Prosthetic phase
Preprosthetic Phase
The period between the amputation surgery and the fitting of a prosthesis
–> Wound still healing
–> Leads to increased difficulty to reorient once prosthetic limb is received.
–> Due to the loss of the limb = shifting of centre of gravity over the remaining leg.
Main goals (pre prosthetic phase)
Prevention of contractures
Swelling control
Shaping of the residual limb
Desensitizing techniques
Pressure injuries prevention
Strenghtening, ROM, general mobility
Proper caring of the residual limb
Regular inspections
(Color change, pain, swelling, drainage)
ADLS: washing/drying
(At night, every day
Mild soap
Pat dry with towel
Moisture (at night))
Low to high functioning
- What is the lowest functional to highest functional level for getting dressed?
1) Getting dressed in bed
2) Getting dressed sitting in chair 3) Getting dressed standing
Transfer training
Transfer training: various types and surfaces
Early rehab: transfers toward the non-affected leg.
As patient progresses: transfers in both directions are included.
Phantom Limb Pain Interventions
Mirror box
Exercise to increase circulation
Distraction, change position
Soak in warm bath, massage on residual limb
Pain diary
Relaxation techniques
Prosthetic Phase Interventions
Orientation of center of gravity and improve weight bearing on the prosthetic side
Gait re-education Personal Hygiene and Prosthetic Care
ADL training, including donning/doffing of prosthesis
ADL training: care of prosthesis
iADLS training as patient progresses
2 types of diabetes overview
Type I: (AKA insulin-dependent diabetes or juvenile diabete)
–> autoimmune disease that occurs when the pancreas no longer produces any
insulin or produces very little insu
Type 2: (AKA non-insulin-dependent diabetes or adult-onset
diabetes)
–> occurs when the pancreas does not produce enough insulin to meet the body’s
needs and/or the body is unable to respond properly to the actions of insulin
(insulin resistance)
diabetes treatment and complications
Type I: insulin, meal planning, exercise
Type 2: meal planning, exercise, medication
chronic kidney disease (nephropathy)
foot problems, lower limb (leg, foot, toe, etc.) amputation
eye disease (retinopathy) that can lead to blindness
cardiovascular disease (heart attack, stroke)
nerve damage (neuropathy
hypoglycemia vs Hyperglycemia
low blood sugar (< 3.9)
- Symptoms: unconsciousness, shaky, hungry, confused
- Should be treated immediatel
vs high blood sugar (> 11)
- Symptoms: increased thirst, urination, blurred vision
- Toxic (ketoacidosis): confusion, SOB, nausea/vomiting,
fruity-swelling breath
Neuropathy effects
- Gait imbalances
◦ Increased falls risk
◦ Increased attention to foot care – proper footwear
Exercise tips for diabetes
- Both resistance and aerobic exercise and is optimal to do both
At least 150 minutes per week of aerobic exercise + at least 2 sessions per week of
resistance exercise are
recommended
It is best to avoid prolonged sitting. Try to interrupt sitting time
by getting up briefly every 20 to 30 minutes
being sedentary is associated with far greater
health risks than exercise would be
symptoms of kidney disease
Symptoms range from
- none to tired,
- poor appetite,
- nausea,
- difficulty breathing,
- extreme itchines
Kidney disease treatment
- monitoring blood levels
◦ Dialysis
◦ transplant
Exercise benefits on renal failure
◦ Improved muscle function
◦ Better BP control
◦ Lowered cholesterol and triglyceride levels
◦ Improved sleep
◦ Better control of body weigh
Renal failure exercise tips
- choose aerobic exercises where you continuously move
large muscle groups (walking, swimming, dancing, skiing) - choose low level strength training
- choose to exercise 3 days/week on non-consecutive days
Hemodialysis
“cleaning the blood”
Dialysis on Renal failure - pros and cons
Pros
- Relieves symptoms of uremia
* Works quickly and efficiently
* Requires at least three treatments a week, each four to
eight hour
Cons
- You will have to take medications, learn new food
choices, and restrict your intake of fluids
* You must plan your week around your hemodialysis
schedule
* You may need to travel some distance to the
hemodialysis unit
Vascular Injury
Traumatic or complication from vascular disease
Peripheral artery disease (narrowing or blockage in
the arteries that supply blood to the leg)
Disease that develops in the peripheral arteries and veins,
usually lower extremities
Can cause you to start walking slowly and have difficulty keeping
up from fatigue, weakness, or discomfort/cramping.
Vascular Injury Risk factors + Treatment
Risk factors
Male
◦ Non-Caucasian
◦ Smoking
◦ High blood sugar, cholesterol , pressure
Treatment
- Bypass surgery, stenting
◦ Amputation
Exercise Prescription PAD (Peripheral artery disease)
Outcome Measures:
6MWT (6 minute walk test)
◦ TUG (timed up and go)
Supervised Treadmill Walking or Nordic Walking
Intensity 40%–60%
Session duration 30–50 min
Frequency 3 times per week supervise
Program duration At least 12 wk
Progression Every 1–2 wk: increase duration of training session
Rehab for amputees
- strength training: LE, UE and CORE!!
- endurance training
- ROM
- balance
Other things to consider:
- wound management
- proper positioning
Potential exercises for amputees
work from gravity assisted to again gravity
- inner range quads
- resisted hip adduction
- static glutes
- hip flexor stretching
- bridging
- hip flexion and extension
- hip abduction
more advanced:
pelvic tilts (anterior/posterior, lateral)
- trunk rotation
- reaching outside BOS
- unilateral hip flexion
- bridging
- core roll-outs
- knee extension,
- throwing/catching
- supine hand/foot passes
- crunches
Normal Responses to Acute
Aerobic Exercise
Heart rate (HR) increases
Blood flow increases. At rest, 15-20% of the cardiac output goes to muscle but during exercise
80-85% is distributed to working muscle and shunted away from the viscera.
Blood pressure: Systolic Blood Pressure (SBP) increases, Diastolic Blood Pressure (DBP) slightly
increases (less than 15mm Hg from resting value).
Pulmonary ventilation increases. Rate and depth of breathing increase the amount of air
exchanged/minute
Respiratory Rate increases
Abnormal Responses
to Aerobic Exercise
No rise in heart rate with increased intensity
Failure to rise, or a decrease in systolic blood pressure (SBP)
Increase in diastolic blood pressure (DBP)
Pediatric Perspectives
Children are less mechanically efficient than adults.
Children lose more energy than adults when performing
the same activity.
Children have a poorer ability to dissipate heat than adults
when exercising in hot environments.
HIIT and CHRONIC Conditions
HIIT = High Intensity Interval Training
-Intervals of higher intensity training (80-95% of peak
HR) mixed with lower intervals or rest
Intervals can be as short as 30 sec and up to 4 min
Nordic Walking
Combines aerobic & muscle endurance exercise
Ideal for those with chronic conditions and/or lower
Levels of mobility (esp HF
Benefits of Nordic walking
Simultaneously conditions the upper and lower body, abdominal and back
muscles
Increased oxygen consumption and caloric expenditure (20%);
Increased heart rate and blood pressure (5-10%);
Increased stride length and walking speed (5-10%);
No increase in RPE level;
Provides stability and aids in balance
