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41 Cards in this Set
- Front
- Back
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4 important things to think of "before the prosthesis"
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1. ROM - 15 degree contracture at most
2. Strength (hip - determines type of prosthesis) 3. Wound care - infected vs. healed 4. Shaping of stump - upside down cone |
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Example strenghtening before the prothesis
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Hip flex, abd, add, ext - you stool and lift torso up with stump
Bridging Sit ups |
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Gait training examples with prosthetic device
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Weight shifts all directions
Foot taps Forward/backward stepping - don't allow NBOS Gait training Side stepping Tandem walking |
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Dressings to use when bony prominence exists vs. doesn't exist
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Exists: rigid removable dressings
DOesn't: Elastic stockings |
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Ingenious way to apply shrinker
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Coffee can
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How to suspend elastic stockineets with transfemoral amputation?
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Cut two holes (one in front and one in back) and pass waistband suspension through it
Place long strip of tape on lateral side to prevent slippage |
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Function of stockings?
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Control pain/edema
Reduce further trauma Stability of soft tissue |
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How can you promote shaping with limb?
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Add material in area you want to shape before adding compressive wrappings
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Volume changes t/o day? What do we educate pt on?
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prosthesis shrinks with compression t/o day
Put on extra socks Vacuum pumps maintain t/o day |
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Why elastic stockings instead of ACE wrap on transfemoral amputation?
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ACE harder to apply and need to be reapplied more often
Coffee can application of stockings make it a breeze |
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How many inches below should subsequent layers be on transfemoral stump elastic stockings?
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1 inch
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What type of dressing is often used with transtibial and symes amputees? Sequence of donning?
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Removable rigid dressing
Tube socks, plaster cast, suspension stocking |
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How do get initial WBing on amputated leg after surgery?
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Unilateral: car jack
Bilateral: tilt table |
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How to approach steep ramps with unilateral BKA?
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Side stepping, up with good and down with bad
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How to get up and down from floor with unilateral BKA?
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Lower with sound leg onto both hands
Place sound leg in WB when getting up from floor More advanced can lead with prosthetic |
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How to step over objects with unlateral BKA? Pick up object?
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Step over with sound leg first
Pick up by putting sound leg out in front like a lunge |
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How to do stairs wtih bilateral BKA?
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Up with stronger/longer
Down with weaker/shorter *same with ramps |
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How to step over LARGE objects with bilateral BKA?
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Side approach, using stronger/longer leg to step over first
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Stairs with unilateral AKA? Advanced?
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Rare to do reciprocal, and impossible with locking knee
Up with good, down with bad Advanced: use hip extensors like a mofo to ascend step over step. Use jackknife to descend (half foot over step and fall onto next step) |
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What type of prosthetics allow more controlled reciprocal step?
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Prosthetics with hydraulics (going down stairs, not so sure about upstairs)
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How is descending ramps different with BKA vs. AKA
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AKA must use hip EXT to contol stance prosthetic limb
Heel impact is the breaking force Can use jacknife if you're a pro like me |
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How to get up and down from floor with AKA
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Ext/ABd prosthetic out the way
Ue strong leg and UE to lower down to ground Or can go on all 4's and use prosthetic for balance |
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How is stepping over an object different between AKA and BKA?
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It's not
Step wtih sound limb or use side step approach |
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How to step off of escalators?
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Step with sound leg (this is just like walking b/c it is actually level)
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One AKA and one BKA:
How to do steps |
Pretend BK is the good leg
Up with good, down with bad Take shorter steps with AKA b/c knee hip EXT like a mofo |
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How to do stairs with bilateral AKA
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Use one crutch on step above and other hand on rail to push up (with railing limb leading)
Down: crutch on bottom step |
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How to do ramps with bilateral AKA
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Weight on balls of feet to keep COM anterior to knee joint
Short steps, cane forward Side approach; crutches in front of pt |
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How to pick up objects with bilateral AKA
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STand wth one foot behind other
Put cane out in front, and WB through cane Push through cane to come back up |
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How to step over objects wtih bilateal AKA
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SHoud be avoided
Very small: use can on sides of object Large: side approach, cane over first, then leg, then cane, then other leg |
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How to get on floor with bilateral AKA?
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Canes both in one hand in front of you
Lower down to get one hand on ground (with legs ABD) and then drop canes and lower yourself down To get up: side sit with both legs EXT, come to hands, walk hands back, grab one can, push up, grab other cane |
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bilateral AKA: direct ascent/descent of curb
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STand at 45 degree angle: cane, leg, leg, cane
Descent: cane off curb, leg down (and lock it), other leg, and cnae |
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bilateral AKA: backward ascent of curb
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45 degree angle with back to curb
Circumduct leg posterior, canes remain on lower level Bring scond leg up |
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Pre-op training
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Crutch training with one leg
Prone positioning ROM ex Transfers with one leg Strengthen core |
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Post-op tx for psychological acceptance
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Gentle massage
Friction massage Tapping Pushing leg into soft pillow Positioning |
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Important positioning guidelines post op
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Prone 2x15 min/day to prevent contracture
Don't use pillows under knee Don't allow BK to hang in flexed position Minimize W/C use Firm bed No elevation unless hip/knee extended |
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Leg hygeine post op
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Wash 2x/day with mild warm soapy water
Pat leg dry Insepct condition of leg Lotion if doc wants |
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Benefits of cast appilcation post-op
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WB 24 hours after surg
Prevents injury Changed 7-10 days after surgery |
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When to add socks with BK prosthesis
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1. Pressure under patella
2. Pressure under distal tibia 3. Stump feels loose |
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When to substract socks with BK prosthesis
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Pressure at tib tub
Not getting enough powder on limb |
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Optimal socket fit
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ADD tendon ANT-MED socket
Toe turned slightly out total contact with socket Snug feeling all over |
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Why put prosthesis on at beginning of day?
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Leg will swell if left hanging down and unsupported
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