Week 6

Question 1

Amputations

Answer 1

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

Question 2

Lower Limb Amputations: Etiologies

Answer 2

• Diabetes
• Peripheral vascular disease

Trauma

Infection

Cancer

Congenital

Question 3

Diabetic Neuropathy

Answer 3

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

Question 4

Peripheral Neuropathy

Answer 4

Most common type type of diabetic neuropathy

Affects nerves in the feet and legs

Loss of sensation
Unsteady gait

Question 5

Decreased circulation: leads to

Answer 5

diabetic ulcers,

slower healing of wounds

sometimes amputation

Question 6

What is a major risk factor for developing type 2 diabetes

Answer 6

the amount of processed food and added sugar in the diet

Question 7

Above Knee Amputation (_______)

Below Knee Amputation (________)

Answer 7

Above Knee Amputation (Transfemoral)

Below Knee Amputation(Transtibial)

Question 8

Two main phases of rehabilitation for amputees

Answer 8

1) Pre prosthetic phase

2) Prosthetic phase

Question 9

Preprosthetic Phase

Answer 9

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.

Question 10

Main goals (pre prosthetic phase)

Answer 10

Prevention of contractures

Swelling control

Shaping of the residual limb

Desensitizing techniques

Pressure injuries prevention

Strenghtening, ROM, general mobility

Question 11

Proper caring of the residual limb

Answer 11

Regular inspections
(Color change, pain, swelling, drainage)

ADLS: washing/drying
(At night, every day
Mild soap
Pat dry with towel
Moisture (at night))

Question 12

Low to high functioning

• What is the lowest functional to highest functional level for getting dressed?

Answer 12

1) Getting dressed in bed

2) Getting dressed sitting in chair 

3) Getting dressed standing

Question 13

Transfer training

Answer 13

Transfer training: various types and surfaces

Early rehab: transfers toward the non-affected leg.

As patient progresses: transfers in both directions are included.

Question 14

Phantom Limb Pain Interventions

Answer 14

Mirror box

Exercise to increase circulation

Distraction, change position

Soak in warm bath, massage on residual limb

Pain diary

Relaxation techniques

Question 15

Prosthetic Phase Interventions

Answer 15

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

Question 16

2 types of diabetes overview

Answer 16

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)

Question 17

diabetes treatment and complications

Answer 17

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

Question 18

hypoglycemia vs Hyperglycemia

Answer 18

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

Question 19

Neuropathy effects

Answer 19

• Gait imbalances
  ◦ Increased falls risk
  ◦ Increased attention to foot care – proper footwear

Question 20

Exercise tips for diabetes

Answer 20

• 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

Question 21

symptoms of kidney disease

Answer 21

Symptoms range from
- none to tired,
- poor appetite,
- nausea,
- difficulty breathing,
- extreme itchines

Question 22

Kidney disease treatment

Answer 22

• monitoring blood levels
  ◦ Dialysis
  ◦ transplant

Question 23

Exercise benefits on renal failure

Answer 23

◦ Improved muscle function

◦ Better BP control

◦ Lowered cholesterol and triglyceride levels

◦ Improved sleep

◦ Better control of body weigh

Question 24

Renal failure exercise tips

Answer 24

• 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

Question 25

Hemodialysis

Answer 25

“cleaning the blood"

Question 26

Dialysis on Renal failure - pros and cons

Answer 26

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

Question 27

Vascular Injury

Answer 27

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.

Question 28

Vascular Injury Risk factors + Treatment

Answer 28

Risk factors Male ◦ Non-Caucasian ◦ Smoking ◦ High blood sugar, cholesterol , pressure Treatment - Bypass surgery, stenting ◦ Amputation

Question 29

Exercise Prescription PAD (Peripheral artery disease)

Answer 29

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

Question 30

Rehab for amputees

Answer 30

- strength training: LE, UE and CORE!! - endurance training - ROM - balance Other things to consider: - wound management - proper positioning

Question 31

Potential exercises for amputees

Answer 31

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

Question 32

Normal Responses to Acute Aerobic Exercise

Answer 32

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

Question 33

Abnormal Responses to Aerobic Exercise

Answer 33

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)

Question 34

Pediatric Perspectives

Answer 34

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.

Question 35

HIIT and CHRONIC Conditions

Answer 35

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

Question 36

Nordic Walking

Answer 36

Combines aerobic & muscle endurance exercise Ideal for those with chronic conditions and/or lower Levels of mobility (esp HF

Question 37

Benefits of Nordic walking

Answer 37

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