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60 Cards in this Set
- Front
- Back
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AMPUTATION
3 main causes in descending order |
Disease- PVD
Trauma- usually GSW or MVA's Congenital |
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AMPUTATION: which is more common?
LE or UE BKA or AKA Males or Females |
1. LE 85%, UE 15%
2. BKA>AKA 3. male>female |
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AMPUTATION, at what age most common?
Congenital Trauma Tumor PVD |
a. congenital: birth
b. trauma: 21-30 c. tumor: 11-20 d. PVD: 61-70 |
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Levels of Amputations...
Partial Toe Toe Disarticulation Partial Foot/ Ray Resction |
Partial toe- excision of part or total toe
Toe disarticulation- disarticulation at MTP Partial foot/ ray resection- 3,4,5 metatarsals and digits |
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Levels of Amputations
Syme's BKA Knee Disarticulation |
Syme’s- ankle disarticulation
BKA- below knee amputation- can be long , med or short Knee disarticulation- through knee joint |
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Levels of Amputations
Transfemoral/AKA Hip Disarticulation |
Transfemoral-AKA- above knee amputationlong, med or short
Hip disarticulation- amputation through hip joint |
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Levels of Amputations
Hemipelvectomy Hemicorporectomy |
Hemipelvectomy- resection of lower half of the pelvis
Hemicorporectomy- both legs and pelvis below L4-L5 level |
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Rehab Goals (preprosthetic period)
Long term goals... |
a. Promote high level independent function
b. Guide the development of the necessary physical and emotional level for eventual prosthetic rehab. |
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Rehab Goals (preprosthetic period)
Short term goals... |
1) reduce/prevent postop edema and promote healing 2) prevent contractures 3) promote strength in residuum and unaffected areas 4) adjust to psychological loss 5) regain independence in mobility and self care 6) learn care of remaining extremity
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Members of the Amputee Team:
7 groups of people |
1. Physician
2. PT/PTA 3. Prosthetist 4. OT 5. SW 6. Dietician 7. Vocational counselor |
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Post op Dressings:
Rigid dressing... key points? |
Rigid dressing: usually applied immediately post op for immediate wt bearing. Is comprised of a plaster socket with an attached pylon. Major disadvantage is it does not allow for daily wound inspection and dressing changes.
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Post op Dressings:
Semirigid Dressing... key points? |
Semirigid dressing: Una boot - applied in the OR, not as rigid as plaster, air splint (allows wound inspection)
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Post op Dressings:
Soft dressings... key points? |
Soft dressings: usually an elastic wrap or a stump shrinker. Its advantages are that it is relatively inexpensive, it weight and readily available, and can be washed. Its disadvantages are poor edema control, requires skill in application, needs frequent reaaplication, and it can slip and form a tourniquet.
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Post op Dressings:
Soft dressings... how often worn, how wrapped, how many bandages required for AKA and BKA? |
worn 24 hours a day unless wound care or bathing
angular dressing distal to proximal BKA 2 4inch elastic bandages AKA 2 6 inch and 1 4 inch bandages. |
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Pre-prosthetic Assessment
what to look for in...? Skin Length Vascularity |
1. skin: scars, open lesions, moisture, sensation, grafts.
2. Length 3. vascularity: pulses, color, temp, edema, pain, tropic changes (loss of hair, shiny and dry) |
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Pre-prosthetic Assessment
what to look for in...? ROM Strength Neuro |
4. ROM: UE and LE
5. Strength 6. neuro: phantom pain, diabetic neuropathy, mental status |
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Pre-prosthetic Assessment
what to look for in...? ADLs Psych Status Medical Prior prosthesis |
7. ADL's
8. psych status: emotional, family, work, prosthetic goals 9. medical: cause of amputation, meds, associated diseases 10. prior prosthesis |
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Phantom Limb
Key points,,,? |
The majority of amputees will encounter a phantom limb post amputation. This refers to the sensation of the limb that is no longer there. The sensation may last only a few weeks after surgery or continue throughout their lifetime. It is usually painless and does not interfere with rehab. It is described as a tingling, numbness, or pressure sensation
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Phantom Pain
Key points...? |
Phantom pain, is usually characterized by a cramping or squeezing, along with a shooting or burning pain. The pain may be localized or diffuse. It may diminish over time or become a permanent, disabling, condition. Phantom pain sometimes responds to the wearing of a prosthesis, ultrasound, icing, TENS, massage or the use of silver thread in stump shrinkers (due to electromagnetic waves from neural impulses).
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POSITIONING with an amputation
Main Reason? |
to prevent joint contractures. BKA's especially need full ROM of hip and knee, especially extension. AKA's need full ROM of the hip especially in extension and adduction. (Due to adductors no longer connected, easy to get abduction contracture). Pt should be positioned in prone at least 1 x a day. (see handout) Remember to caution your patient against staying in any one position too long.
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EXERCISE with an amputation
Key points...? |
The exercise program is individualized but should focus on strengthening, balance and coordination activities. The hip extensors and abductors, and knee extensors and flexors are particularly important during prosthetic ambulation. Transfers supine-sit, sit -stand are preliminary to ambulation activities and should be begun early. Care must be taken during transfers to protect the residual limb from trauma
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MOBILITY with an amputation
Key points,,,? |
Gait should be incorporated into your tx program as early as possible. An emphasis should be in attaining independent swing through crutch gt. A walker can be used with the elderly or as a starting point but crutch ambulation should be emphasized.
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Patient Education with an amputation
Care of both the...? |
residual limb and uninvolved extremity, especially if diabetic
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Patient Education with an amputation
what kinds of topics in regards to health? |
3. positioning
4. exercise 5. diet 6. PVD education program 7. Signs of over work on the remaining extremity: a. edema b. pain c. changes in skin color or temperature d. intermittent claudication (cramps) |
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Bilateral amputation
what is the emphasis in regards to mobility and why the use of temporary prostheses? |
program is similar with emphasis on strengthening, balance and transfers. Temporary prostheses may be utilized to determine candidacy for ambulation potential
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Nonprosthetic management
will every Pt be a candidate for a prosthesis? |
not all pts will be a candidate for a prosthesis (cost, energy expenditure)
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Nonprosthetic management
energy expenditure in comparison to normals? BKA, AKA, HEMIPLEGICS |
person with a BKA has a 41% increase in energy expenditure person with an AKA has an 89% increase in energy expenditure hemiplegics consume 63% more calories during gt
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PROSTHETICS
definition? |
an artificial substitute for a missing body part, ie: ears, limb, breast First prostheses was made around 3500 BC and it was made of iron.
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PROSTHETICS
indications for? |
amputation
nonfunctional body part (valve) |
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PROSTHETICS
who makes them? |
prosthetist: board certified, college educated professional
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PROSTHETICS
Exoskeletal... what provides the support? |
: a prosthesis where the outside of the structure provides the required support.
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PROSTHETICS
Endoskeletal... what provides the support? |
a prosthesis where the internal skeleton supports the load
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PARTS OF A PROSTHESIS
Socket... key points? |
portion of the prosthesis that incorporates the residual limb. Can be hard plastic, silicone
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PARTS OF A PROSTHESIS
Suspension System... key points? |
system that holds the prosthesis on the residual limb. Can be locking screw, suction, suspension sleeve, or leather straps with buckles
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PARTS OF A PROSTHESIS
Weight Bearing Surface... key points |
Usually full contact with residual limb for increase surface area included in Patellar Tendon Bearing (PTB)
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PARTS OF A PROSTHESIS
Joints... key points? |
foot, knee, and hip joints depending on level of amputation
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FOOT PROSTHETICS
SACH... key points? |
(most commonly used) – solid ankle cushion hee
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FOOT PROSTHETICS
Single Axis... key points? |
(allows plantar and dorsi)
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FOOT PROSTHETICS
Multi Axis... key points? |
(allows more motion)
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FOOT PROSTHETICS
Seattle... key points? |
(energy storing foot, biomechanically no better than SACH)
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KNEE PROSTHETICS
SACF... meaning? |
single axis constant friction
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KNEE PROSTHETICS
SACF with manual locks... key points? |
has a stiff knee
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KNEE PROSTHETICS
SACF with stance phase lock... key points? |
has a safety knee that is weight activated
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KNEE PROSTHETICS
Polycentric... key points? |
works like a normal knee, hydraulic
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MAINTENANCE OF PROSTHETICS
what should be kept clean and dry? |
sockets and socks should be kept clean and dry
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MAINTENANCE OF PROSTHETICS
how often should they be checked and what should be looked for? |
components should be checked periodically for wear and loosening or cracks
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ROLE OF THE PT/PTA WITH PROSTHETICS
Assess... Contribute to the... |
preprescription assessment
2. contributes to prosthetic prescription |
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ROLE OF THE PT/PTA WITH PROSTHETICS
When assessing the device what should be considered? |
a. ease of don ~ doff
b. Standing c. fit in standing- use of socks d. sitting: comfort I ease e. gt: comfortable, quiet, adequate suspension f. skin check g. wearer satisfaction |
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ROLE OF THE PT/PTA WITH PROSTHETICS
Help the Pt accept...,? |
facilitate prosthetic acceptance
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PROSTHETIC TRAINING
how much weight should Pt bear at beginning? |
weight bearing should be done on a gradual basis as tolerated and by MDs prescription
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When starting gait training with prosthetic, what assistive device should be used?
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gait should be performed in parallel bars first
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at the beginning of gait training what is most important?
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control of the prosthesis during gait
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in terms of gait training, what counts as functional mobility?
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turning, stooping, kneeling, floor to stand, irregular terrain, sit to stand, falling and return to stand, up and down inches and stairs
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Common Prosthetic Gait Deviations
Abducted Gait... meaning and possible cause? |
possible causes: pain in crotch from pressure of socket, prosthesis too long, insecurity, mechanical problem)
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Common Prosthetic Gait Deviations
Lateral trunk bend toward the prosthesis... possible cause? |
possible causes: abducted gt, insufficient lateral wall of socket, weak gluteus medius, short prosthesis
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Common Prosthetic Gait Deviations
Circumduction... possible casue? |
prosthesis too long, foot in plantar flexion
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Common Prosthetic Gait Deviations
Whips or foot rotation on toe off and heel strike... possible cause? |
alignment, tight socket, poor socket control
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Common Prosthetic Gait Deviations
Uneven Step Length... possible cause? |
fear, flexion contracture of the hip
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Common Prosthetic Gait Deviations
Parkinsons Gait (festinating)... typified by? |
difficult to get started, then goes to a slow shuffle in a forward progression, ends with short rapid steps (has diminished step length and arm swing, decreased extension at ankles and knees)
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Common Prosthetic Gait Deviations
Equinous Gait... typified by? |
up on toes
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