Week 7 - OT Management of Selected LE Conditions (after midterm) Flashcards
Name 4 OT general roles and goals for LE conditions.
- general conditioning exercises (GCE’s) to bilateral UEs
- BADLs, IADLs, mobility
- psychological adaptation
- return to physical activity
what % of the individuals who have an amputation due to vascular disease die within 5 years of amputation?
nearly half
Of persons with diabetes who have a LE amputation, up to what % will require amputation of the second leg within 2-3 years?
55%
most amputations occur in which people (age and why)?
people older than 65 and are due to some type of associated disease like peripheral vascular disease (PVD) or diabetes.
name 4 main causes of LE amputation.
- PVD (peripheral vascular disease - arteriosclerosis)
- trauma (GSW, MVA, war)
- cancer
- congenital
name the 7 stages of rehab after limb loss.
- pre-operative phase
- acute post-operative phase
- pre-prosthetic phase
- prosthetic prescription phase
- prosthetic training phase
- reintegration phase
- maintenance phase
name 7 roles of OTs in lower limb amputations.
- BADLs (bed mobility, dressing)
- identify falls risk factors
- environmental modification
- assess for psychological issues
- consider body image issues
- consider reintegration to or maintenance of work role
- participation in recreational activities
name 7 OT assessments for lower limb amputations.
- premorbid functional level and cognition
- support systems
- discuss goals/expectations: realistic?
- home assessment
- environmental factors
- transfers/mobility
- BADLs and IADLs
name 7 OT assessments for lower limb amputations.
- premorbid functional level and cognition
- support systems
- discuss goals/expectations: realistic?
- home assessment
- environmental factors
- transfers/mobility
- BADLs and IADLs
with an increase in amputations due to war, there has also been in increase in what 2 things?
- research
- development of prostheses
Name some OT interventions during the pre-prosthetic phase.
ADL intervention in activities defined by the Barthel index:
- bed to chair transfer
- bathing/showering
- dressing
- toileting
- feeding
- grooming
what should the frequency of OT interventions be during the pre-prosthetic phase?
45 minute session, 5x/week
what is an indicator of success of OT interventions during the pre-prosthetic phase of OT?
independence in all 6 activities without supervision/physical assistance
what is the goal of limb shrinkage?
to have a tapered distal end so that the prosthetic will fit
wrap limb in a figure 8 pattern - pt. should be able to do this independently
elastic bandage
used in lieu of the bandage
elastic shrinker
must be replaced frequently as limb shrinks
removable rigid dressing
ideal for ensuring success in rehab
immediate post-op prosthesis
- strongly recommended for bilateral amputations
- reduces dependency for self-care activities
- increases the likelihood of acceptance of the permanent prosthesis
early post-op prosthesis
what is the goal of desensitization?
accustom the limb to touch and pressure for wearing of the prosthesis
name 4 methods of desensitization.
- weight bearing on various surfaces
- massage
- tapping and rubbing
- wrapping
increase or maintain ROM at all joints ___ to the amputation.
proximal
____ ____ increases balance, postural control, and endurance.
core strengthening
___ level amputations can cause a shift in the COG.
high
high level amputations can cause a shift in the ___.
COG
incorporate ___ ___ into bilateral tasks during ADLs.
residual limb
incorporate residual limb into ___ ___ during ADLs.
bilateral tasks
feels as if part is still there
phantom limb sensation
phantom limb sensation is most common in what type of amputations?
traumatic amputations
phantom limb sensation is a ___ part of ___ post surgery.
normal, healing
phantom limb sensation feelings are strongest in what type of amputations?
UE amputations
why does phantom limb sensation occur?
due to the neural connections which exist within the brain even after the limb has been removed
limb sensation often remains, but patients learn to ___ it.
accept
phantom limb sensation may be useful for control of prostheses which use ___ ___.
myoelectric control
- feels as if part is still there but painful
- may be short or long term
- felt as an intense burning, crushing, shooting, stabbing pain
phantom limb pain
which types of amputations is phantom limb pain most common in?
hand and foot and traumatic amputations
phantom limb pain increases with ___.
stress
what has the best results for phantom limb pain?
desensitization
name 4 roles of the OT during prosthetic training phase.
- mobility
- ADLs
- strengthening
- psychological (body image)
for loss of the dominant limb, ___ ____ will be foremost
dominance retraining
t/f - amputees must be able to perform ADLs without the prosthesis as well.
true
Name 4 roles of the OT for bilateral amputees.
- decrease dependence, frustration
- post op. provide pt. with universal cuff (UE)
- early fitting of at least one prosthetic
- encourage the use of other body parts to get activities done
Name 3 roles of the OT in the reintegration phase.
- environment - home modification, W/C evaluation
- pre-vocational exploration - functional capacity eval.
- to assist vocational counselor - interest inventory, work skills/habits, motivation
designed with the incorporation of an increased wheelbase width, creating a better balanced, more stable chair to offset the imbalance created due to a missing limb.
Series 1 Amputee W/C
what are the energy requirements for ambulation with prosthesis for a unilateral BK amputee?
10-20%
what are the energy requirements for ambulation with prosthesis for a bilateral BK amputee?
20-40%
what are the energy requirements for ambulation with prosthesis for a unilateral AK amputee?
60-70%
what are the energy requirements for ambulation with prosthesis for a bilateral AK amputee?
> 200%
hip fractures are associated with what?
increased mortality and morbidity
which types of fractures are most common in females before 75 y/o?
distal radius fractures
which types of fractures are most common in females after 75 y/o?
hip fractures
the ability of the patient to regain ____ is DIRECTLY related to his/her ability to survive.
ambulation
Name ambulation precautions for total hip replacement (THR) pts.
- assistive devices as per MD and PT
- frequent, short walks
Name sitting precautions for total hip replacement (THR) pts.
- use chair with arms
- NO: low chairs, recliners, sit in bottom of tub, bending forward, crossing legs
Name sleeping precautions for total hip replacement (THR) pts.
- on back, legs abducted with pillow
- no waterbeds
Name standing precautions for total hip replacement (THR) pts.
- no bending at waist.
- no stooping, kneeling, squatting
Name car precautions for total hip replacement (THR) pts.
- no driving for 6 weeks
- use pillow to elevate if necessary
Name exercise and activity precautions for total hip replacement (THR) pts.
- continue with exercise as per PT.
- sex after 6 weeks, passive position
Name household changes precautions for total hip replacement (THR) pts.
- no scatter rugs
- raised toilet seat if necessary
- stool/bench in tub for shower
Name 3 roles of the OT in treatment of back pain.
- using proper body mechanics which include using larger joints in movement
- conserving energy by balancing work and rest
- listening to pain signals to avoid overexertion.
what is the most proximal LE amputation?
hemipelvectomy
what is a disarticulation amputation?
occurs through the joint
what do the classifications of short/medium/long have to do with?
how much and level of disability person is given after amputation
surgeon determines level of amputation based on blood flow
severe gangrene
OTs generally not involved in this stage
pre-operative phase
stage that occurs right away after surgery
acute post-operative phase
critical that pt. is getting ready for a prosthesis and back to activities during this stage.
pre-prosthetic phase
to see what’s available , what can pt. do, what is his/her ADL status and COGNITIVE STATUS
prosthetic prescription phase
getting person ready to do their ADLs with and without prosthesis.
prosthetic training phase
helping pt. get back into their lives
reintegration phase
helping pt. get back into their lives
reintegration phase
how they maintain function, the prosthesis, etc.
maintenance phase
what is one of the main OT assessments for amputees?
cognition
___ ___ & ___ is critical for getting ready for prosthesis.
limb shaping and shrinking
immediate post-op prosthesis is not the ____ ____.
permanent prosthesis
name 3 purposes for limb wrapping.
- decrease fluids
- increase circulation
- shape limb for prosthetic fittings
which motion should you avoid in limb wrapping? & why?
circular motion - creates a problem bc it contains fluid and doesn’t push it out, creates additional swelling
describe the progression of wrapping movements.
-start from medial side, across distal end, around back, in a figure 8 motion.
why is the figure 8 motion beneficial for limb wrapping?
forces fluids up and out, and doesn’t allow it to pool in distal end and create additional swelling
how should a LE amputee be positioned in a W/C?
-keep knees extended so he/she is not developing knee flexion contractures
what should be done to prevent hip contractures occuring from sitting in a W/C?
lie on stomach afterwards
the amputee W/C is made specifically for a shift in what?
COG
- ___ level amputations can cause a shift in the ___.
high, COG
in an amputee w/c the __ wheels are set __ more bc ___ is further ___ for the individual.
back, back, COG, back
