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25 Cards in this Set
- Front
- Back
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Transfemoral Checkout
STATIC: Before Donning Sitting Standing DYNAMIC: Walking See handout from May, B 20002 |
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Impaired motor function, muscle performance, range of motion, gait, locomotion, and balance associated with amputation
Physical Therapy Interventions |
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EXAMINATION
History Review of systems Tests and Measures Guide to PT Practice |
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History
General demographics Social history Employment/work Living environment Social/Health habits (Post and Current) Behavioral health risks (eg, smoking, level of physical fitness, drug abuse) Family History |
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History
General health Preexisting medical and other health- related conditions Psychological Pulmonary Medical/Surgical History: Cardiovascular Integumentary Musculoskeletal Neuromuscular Prior hospitalizations, surgeries, and |
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History
Current Condition(s)/Chief Complaint(s) Previous occurrence of chief complaint(s) Prior therapeutic interventions Functional Status and Activity Level Current and prior functional status work (job/school/play), community, and leisure actions, tasks, or activities |
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History
Medications for current condition previously taken for current condition for other conditions Other Clinical Tests Laboratory and diagnostic tests Review all available records |
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Review of systems / Screening
Cardiovascular/Pulmonary blood pressure/edema/heart rate/respiratory rate Integumentary scar formation/Skin color/Skin integrity Musculoskeletal ROM/Strength/Height/Weight Neuromuscular Coordination/balance Communication, Affect, Cognition, Language, and Learning Style |
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Tests and Measures
Aerobic Capacity Arousal Assistive devices Circulation Pain Posture Prosthetic requirements ROM/Muscle length Environmental barriers Gait, locomotion, and balance Integumentary Joint integrity Motor function Muscle performance Self-care Sensory integrity |
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EVALUATION
Synthesize information from examination decision regarding suitability for PT Expected number of visits 15 to 45 ( to me, or me & prosthetist) 80% of patients will achieve expected outcomes |
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Factors to consider
Accessibility and availability of resources Adherence Age Caregiver consistency or expertise Chronicity/severity Cognitive status Comorbitities, complications, or secondary impairments Concurrent interventions Decline in functional independence Level of impairment Level of physical function Living environment Multisite or multisystem involvement Nutritional status Overall health status Potential discharge options Premorbid conditions |
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INTERVENTION
Acute post-op (maximum protection: 0-48hrs): limb elevation isometrics ROM begin WBing if in IPOP positioning bed mobility transfer training home evaluation |
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INTERVENTION
Preprosthetic (up to 8 weeks before get temp prosthesis): bandaging shrinkers desensitization coordination aggressive strengthening UE and LE CV functional activities gait balance |
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INTERVENTION
Prosthetic: balance gait Stairs ramps floor to chair/stand obstacles |
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INTERVENTION
Therapeutic exercise Increase circulation increase strength and ROM prevent/correct contractures Desensitization (massage, tapping) increase CV fitness promote mobility and self care |
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INTERVENTION
desensitization Massage Rubbing, tapping, effluerage Electrotherapy Weight-bearing Therex |
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Types of exercise
Positioning prevention of contractures areas prone to contracture |
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Flexibility
Emphasize areas prone to contracture |
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Strengthening
Isometric may be only exercise tolerated post-op Isotonic or Dynamic lower extremity upper extremity |
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Strengthening
Functional progressions to include trunk Entire kinetic chain Move to more unstable environment Standing-throwing Medicine balls Pulleys Foam rolls Etcetera, etcetera |
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Must get used to feeling RL inside that socket to get better balance.
10 reps, 10x per day – key point – body weight exercises! Excellent HEP. Towel roll with tape to keep it in place Hip extension – pt supine, towel roll in posterior aspect of RL, push down and butt lifts up (for gluts and hams) Hip abduction – pt. sidelying, residual limb side down on mat, place sound leg on stool w/ pillow on it. Abduct to lift body off mat Hip flexion – pt. prone, put towel in front of residual limb, flex hip until butt lifts off mat Back extension – “supermans” – lift LEs and head and shoulders (UEs by sides of body) Hip adduction – sidelying, sound side down. RL on stool w/ pillow. Adduct RL to lift hip off mat Bridging – supine, RL will be in air, make it parallel to sound limb Sit ups – clear scapulae off mat Pre-gait training exercise program Parallel bars SLS sound limb, keep COG over BOS 2-4 inches between feet Lateral, anterior, posterior weight shifting (both hands on parallel bar, then take off sounds side hand [so more WB on prosthetic limb), then prosthetic side hand Diagonal weight shift – done in tandem. First – sound limb forward, then switch. Progress with ball throwing. Maintain 2-4 inch standing width. Stool stepping – step up on stool w/ sound limb, slow and controlled (hold with both hands, then take off sounds side arm, then both arms off) – the slower the better SLS on prosthetic limb Part 3. Step forward and backward w/ sound limb. Keep normal BOS approx 4 inches. Both hands on bars. Keep hands on ASIS – make sure transverse forward rotation Rhythmic initiation – forward transverse pelvic rotation Step forward and backward with prosthetic LE. – vary stride length with verbal cues Make sure sound limb does not cross midline Walk back and forth in parallel bars – give resistance to ASIS with hands. Sidestepping – if glut med weakness Trunk rotation and arm swing – opp pelvis and shoulder rotate forward Pt. walks with arms on therapist’s shoulders, while therapist places resistance on ASIS Trunk rotation – RI w/ hands on shoulders while standing behind patient as she takes steps Advanced balance training Tandem walking – in straight line Side stepping Kariokas – first sound limb over prosthetic repeatedly, then do same with prosthetic, then alternate – improve pelvis and trunk dissociation! Follow the leader – random small turns is practiced Backward walking |
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Weight shifting and rhythmic stabilization
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Gait Training Progression
Parallel Bars: Weight shifts –find center of gravity Weight bearing on prosthesis Steps Side stepping Outside Bars: Resisted gait –cues on pelvis or alternate pelvis & shoulder Braiding Close quarter turns |
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Functional activities
Getting up and down from chair Stairs Inclines Picking up objects from floor Clearing obstacles Falling Getting down to and up from the floor |
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Equipment needs
Bathroom items Raised toilet seat Grab bars Hand shower Tub seat Wheelchair Cushioning anti-tip bars Ramps Car modifications Hand controls |
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