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Prosthetics > 8: Phases of Rehab > Flashcards

8: Phases of Rehab Flashcards

1
Q

What are the three phases of rehabilitation?

A
  1. Pre-prosthetic phase
  2. Prosthetic training phases
  3. LTC
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2
Q

What are 6 key suggestions for all phases of amputation rehab?

A
  1. Pt education
  2. Measure pain intensity and interference with activity
  3. Document pain with standardized tools
  4. Offer multi-modal pain management
  5. Assess behavioral health and psychosocial functioning
  6. Offer peer support interventions
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3
Q

When is the pre-prosthetic phase?

A

Between surgery and prosthetic fitting

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4
Q

What factors influence rehab potential?

A

Level of amputation, prior level of functioning, motivation, comorbidities, support, cognitive, physical conditioning, smoking, compliance

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5
Q

How does the presence of comorbidities effect pt prognosis?

A

Increase mortality and negatively affect recovery

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6
Q

How does pre-op ambulatory status effect pt prognosis?

A

Non-ambulatory and homebound status is associated with inability to use a prosthesis post-op

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7
Q

How does age effect pt prognosis?

A

> 60 at the time of surgery is associated with decrease prosthetic use, increased mortality, and decreased ability to ambulate and be independent

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8
Q

How does the level of amputation effect pt prognosis?

A

Bilateral or AKA are less likely to ambulate, use prosthesis, and be independent

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9
Q

Describe the general rehab goals 1-2 days post-op

A

ROM, bed mobility, transfers, sound limb exercises, post-op dressings

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10
Q

Describe the general rehab goals 3-14 days post-op

A

Pre-prosthetic ambulation with crutches, post-op dressings

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11
Q

Describe the general rehab goals 2-3 weeks post-op

A

Staples removed, shrinker or wrap, dynamic resistive exercises, ROM and ambulation

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12
Q

Describe the general rehab goals 4-6 weeks post-op

A

Shrinker and monitor healing, prevention of complications, casting for prosthetic socket if incision healed

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13
Q

How long does it typically take for the incision to heal?

A

6 weeks

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14
Q

During the pre-prosthetic phases, intervention should include what two types of exercise?

A

Open and closed chain

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15
Q

What functional mobility is included in the pre-prosthetic phase of rehab?

A

Bed mobility, sit to stand, transfers, ambulation without prosthesis

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16
Q

During the pre-prosthetic phase, why is progressive resistance added?

A

To improve gait, mobility, strength, CV fitness, ADL performance in order to maximize function

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17
Q

What type of dressing is preferred when limb protection is a priority?

A

Rigid dressing

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18
Q

What should be assessed prior to setting goals and why?

A

Cognitive status to assess the pt’s ability and suitability for appropriate prosthetic tech

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19
Q

What treatment setting is recommended for the pre-prosthetic phase?

A

Acute inpatient

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20
Q

When should mobility training be initiated?

A

As soon as possible

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21
Q

What interventions are included in pre-prosthetic training?

A

Skin inspection, residual limb monitoring, ROM, sensation, strengthening, functional mobility, cardiopulmonary, psychosocial, preparation for prosthesis

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22
Q

How often doe pt’s initially have PT?

A

5-7x per week

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23
Q

What are the 10 short term goals for the first 3-5 days of acute care if a pt was independent prior to surgery?

A
  1. Independent bed mobility
  2. Independent transfers to wheelchair
  3. Independent ambulation > 100 ft with AT
  4. Independent or assisted stairs
  5. ROM WFL and strength >3/5
  6. Good balance in sitting and standing
  7. Perform initial independent HEP
  8. Good understanding of residual limb management
  9. Independent wrapping techniques
  10. Safety awareness
24
Q

What does the acute care length of stay depend on?

A

Payer source, ambulation level, comorbidities, age, social support, injury characteristics

25
Q

Pt’s with dysvascular amputation are likely to be discharged to where?

A

Nursing homes and inpatient rehab

26
Q

Likelihood to discharge to nursing facility is increased with what?

A

Age, higher level amputation, medicare with dysvascular amputees

27
Q

What type of patients are less likely to be discharged to skilled nursing facility?

A

Men and married patients

28
Q

Where are many pt’s discharged to to progress toward PT goals and initiate prosthetic fitting?

A

Inpatient acute, subacute, or skilled nursing facilities

29
Q

When will a pt be discharged directly home?

A

If they meet their short terms goals and they have an environment that is wheelchair and disability friendly to allow for better functional outcomes

30
Q

How long is a typical long-term goal for a pt following an amputation?

A

4-6 months

31
Q

What is a long term goal for a pt following an amputation?

A

The predicted optimal level of improvement for this pt population is to return to their previous life roles and lifestyles using a prosthetic and/or AD as appropriate

32
Q

What factors will modify the pt’s prognosis and setting long term goals?

A

Presence of comorbidities, post-op complications, barriers to returning to previous living environment, barriers to using prosthetic

33
Q

What are the dependent factors of the timing of prosthetic fitting and training?

A

Age, type of amputation (traumatic vs dysvascular)

33
Q

When should the fitting for the first prosthesis be?

A

As soon as possible after wound healing

33
Q

How should the choice of the prosthetic device be individualized to the patient?

A

Based on their functional capacity and goals with the intent to allow the highest possible level of function

33
Q

Describe the ideal prosthesis in terms of energy expenditure

A

Prosthesis should restore function with a minimal amount of energy expenditure

34
Q

How does oxygen consumption change following a transtibial amputation?

A

Oxygen consumption increases by 33%

34
Q

How does oxygen consumption change following a transfemoral amputation?

A

Oxygen consumption increases by 50%

34
Q

Why does the level of amputation have a direct effect of successful prosthetic rehabilitation in older patients?

A

Due to the increasing cardiopulmonary demands with more proximal or bilateral amputations

35
Q

What equipment is preferred to initial prosthetic training?

A

Parallel bars

36
Q

What are “stubbies”?

A

Short prosthetic limbs without a knee joint that are used in early prosthetic training

37
Q

What are five reasons for using “stubbies” for prosthetic training?

A
  1. COM is lover to the ground
  2. Easier to maintain balance
  3. Reduce fall risk
  4. Requires less energy expenditure
  5. Improve strength
38
Q

How long does the pre-prosthetic phase of rehab last?

A

Approximately 6 weeks

39
Q

What are the main goals for pre-prosthetic rehab?

A

Protecting the limb, preventing contracture, developing single limb mobility skills, preparing the patient for the prosthetic phase of rehab

40
Q

What is an IPOP?

A

Immediate post-op prosthesis to allow for immediate weight bering using a temporary device

41
Q

When can the pt begin to use a shrinker?

A

Once the sutures are removed

42
Q

When will a permanent prosthesis be manufactured?

A

During the prosthetic phase once modifications are made for function and comfort and the limb volume has stabilized

43
Q

How often should a pt receive a new prosthesis according to medicare?

A

Every 5 years

44
Q

What are the 5 key goals and interventions for the prosthetic training phase?

A
  1. Donning and doffing
  2. Hygiene
  3. Strengthening
  4. Balance and coordination
  5. Gait
45
Q

What are the three recommendations for long term care following an amputation?

A
  1. No long term opioid therapy for chronic pain
  2. Return to care team 1x per year
  3. Continue education
46
Q

Which limb is likely to develop osteoporosis following LE amputation?

A

The residual limb

47
Q

What is the cause of osteoporosis development following amputation?

A

Insufficient loading

48
Q

What secondary effects can the development of osteoporosis cause?

A

Residual limb pain and increased risk of fracture

49
Q

What limb is osteoarthritis likely to be found in following amputation?

A

Intact limb

50
Q

Why is osteoarthritis likely to develop?

A

Overloading of the sound limb

51
Q

What is heterotrophic ossification?

A

Formation of extraskeletal bone in muscle and other soft tissue

52
Q

What type of amputations is heterotrophic ossification more likely to develop in?

A

Traumatic

Prosthetics (13 decks)

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