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Rehabilitation of Functional Movement > Amputation > Flashcards

Amputation Flashcards

1
Q

Transtibial amputation technique includes what

A

most common =burgess technique
posterior flap made from lateral and medial gastrocnemius and soleus

Flap fixed by sutures

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2
Q

Standard post op care includes

A

consider effects of anaesthetics
pulmonary co-morbidities
circulation exercises for other limb - check for DVT
Sit out of bed early post op - check post op notes
Progress to W/C transfers, standing, mobility with aids

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3
Q

Stump management in acute care includes

A 
oedema reduction and prevention - compression therapy
wound cares, promotion of wound healing 
pain management and desensitisation 
early prosthetic fitting 
prevention of contractures 
exercise rehabilitation
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4
Q

Acute wound care includes

A 
suture splitting 
malodour, pus
redness, heat, swelling 
febrile, unwell, chest pain, dizziness
intense pain 
other leg is cold
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5
Q

Ongoing stump care includes

A 
swelling
rash
cysts, boils
lumps under skin 
inflammation of skin 
itching 
rough, dark skin 
flaking skin
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6
Q

encourage

A

daily washing, thorough drying, moisturise stump

manage perspiration ; baby powder, regular bandage/sock changes

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7
Q

Parameters and Benefits of scar massage

A 
5-10mins, 3-4 times a day 
decreases oedema 
reduce scar tissue 
reduce contractures 
improves healing 
assists desensitisation of stump 
can help with phantom pain 
helps to prepare for prosthesis 
May require massage in intact limb
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8
Q

Intact limb care includes

A

important, particularly if PVD or diabetes is present
encourage regular inspection by professionals
control diabetes, stop smoking
daily hygiene, skin moisturiser, good footwear
Check skin condition, particularly heels `

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9
Q

Be aware of new sensations and pain

A

stump pain

  • wound healing
  • requires good pain control
  • may occur later in healing stages
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10
Q

Phantom pain

A

20-50% of patients
crushing, toes twisting, hot iron, burning, tingling, cramping, shocking, shooting, p&n’s
decrease in severity and frequency over time
requires specialised pain control
can change with emotional state

phantom sensation/phantom limb syndrome

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11
Q

List some causes of ongoing stump pain

A

abscess, infection, skin conditions
muscle contractures
neuromas
bony spurs

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12
Q

pain management in amputees includes

A 
contracture prevention 
oedema management 
adequate post op analgesia 
desensitisation - massage, taping, bandaging
Get moving- distraction helps 
early prosthetic training

TENS, vibrations, acupuncture, hypnosis, biofeedback, ECT, mirror therapy, CBT

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13
Q

Compression therapy for oedema management includes

A 
RRDs removable rigid dressings 
post op silicone liners
stump bandaging
stump shrinkers
- controls oedema, stump shape (dog ear, adductor roll)
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14
Q

RRD usage, advantages

A

Usually applied immediately post op (20mins) for TTAs

Advantages

  • decrease oedema - facilitate wound healing
  • allows wound inspection
  • stump shaping - earlier time to prothetic fitting
  • pain management
  • prevent contractures
  • stump protection from trauma(falls)
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15
Q

Disadvantages of RRDs

A

specialist skill/therapist required for application
close monitoring required
can be heavy and affect bed mobility
lack of progressive compression

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16
Q

what does the research say about RRDs

A

most effective form of post op dressing in TTA

good prosthetic warm up indicator
do not remove the rigid dressing for more than 10 minutes at a time
wool socks should be added as the volume of the stump decreases

when the patient requires 3 or more wool socks or if there are problems fitting the cast - new cast
Worn 24/7, except bathing/limb inspection

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17
Q

RRD joint line

A

cast created up to knee joint line

held in place by suspension cuff

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18
Q

Pros of joint line RRD

A

allows knee flexion/ext
can easily pad with socks
easy to make

19
Q

cons of joint line RRD

A 
suspension cuff - risk of tourniquet 
does not prevent knee flexion contracture 
difficult to align when donning 
harder to shape stump
soft tissue can be pinched
20
Q

Thigh high RRD

A

knee fixed into extension

no suspension cuff required

21
Q

pros of thigh high RRD

A 
easier alignment when donning 
prevents flexion contracture 
don't need to pack socket 
less soft tissue pinching 
better fit
22
Q

cons of thigh high RRD

A

harder to make
requires more materials
needs removing for knee exercises

23
Q

Use of bandaging /shrinker socks has what effects

A

increases pressure tolerance
encourages conical shape
decreases swelling and readiness for casting
maintains constant volume
provides sensory feedback - minimising phantom sensations

24
Q

Bandaging/shrinker socks advantages

A

low cost
washable
easy to don/doff
easy to monitor wound

25
Q

disadvantages of bandaging /shrinker socks

A

may slip off, loosen easily
slower healing, longer hospital stay
elastic bandage can be inconsistent with application causing pressure problems
shearing over wound with shrinkers

26
Q

Bandaging guidelines

A

check stump first, dressing over wound
all bandages turns should be diagonal (not spiral) to avoid tourniquet (figure 8 dressing)
Never restrict blood flow - pain = reduced circulation
should be applied with extended knee
graduated pressure, firm at the end of stump, apply pressure on upwards turn. should be able to fit finger under top
re-apply ever 4h
no folds, creases, windows
no pins to secure, use only tape
worn 24/7

27
Q

Shrinkers suggestions

A

should be tight but not painful or restrict blood flow
make sure the top does not roll - can reduce blood supply
when starting to use a prosthesis the shrinker should be worn whenever the prothesis is off
seam should not shear over wound

28
Q

Contractures

A

tissue tightening resulting in pain and reduced ROM

Amputees are at risk of flex/ext contractures at the hip

29
Q

What to consider when looking at positioning

A 
no pillows under stump or thigh 
no crossing legs in bed
maintain knee extension (stump board) in sitting 
prone lying to maintain hip extension 
early ambulation/standing
active strengthening/AROM 
-hip extension 
-knee extension 
RRD
30
Q

What to consider when deciding exercises

A 
prone lying 
maintain joint ROM 
increase muscle strength 
- reduce LL atrophy as a result of poor positioning/reduced use of muscles 
-don't forget the intact limb 
-remember the upper limb

balance retraining- transfers

increase CV endurance
- self propelling in wheelchair and/or walking with prosthesis

31
Q

What to consider when looking at transfers

A 
key to independence 
reduces complications of bed rest 
practice bed mobility 
transfer practice 
- pivot practice 
-stand transfer 
-slide board (also helps to protect stump) 
STS transfer onto frame 
Floor to chair transfer - in case of fall
32
Q

Mobility aid options for gait reducation

A

hopper
two single sticks
one single stick
crutches

33
Q

Hopper got gait re-education

A

stable but slow and does not allow step through gait

34
Q

Two single sticks and gait reeducation

A

less stable but allows step through gait and reciprocal gait pattern

35
Q

one single stick and gait reeducation

A

enables good balance but need even WB and requires increased strength and balance

36
Q

crutches and gait reeducation

A

encourage stooping and does not allow effective use of glutes (major stability muscles when walking)

37
Q

PPAM aid

A

pneumatic post amputation mobility aid
-used for transtibial and transfemoral amputees
aluminium support frame with air bags to hold limb
PWB aid only
used primarily in parallel bars

38
Q

PPAM aid cont

A

use >7days post op (depends on wound healing)
can be applied over stump dressings, shrinkers etx
air bags cup around stump
- 40mmHg for mobilising
worn for 5-10 minutes initially - stump must be examined
gradually build up wearing time

39
Q

benefits of PPAM aid

A 
psychological boost
patient is upright and weight bearing 
provides total stump contact 
aids in oedema reduction 
can give indication about whether suitable for prosthesis 
Can be re-used for other amputees

but
- no natural knee movement used
gait tricks – circumduction
-time consuming set up

40
Q

Suitability for a prothesis includes

A 
good stump condition 
adequate ROM and strength 
Able to hop
no medical issues preventing training 
intact cognitive function 
- ability to learn complicated task of gait retraining and safety in using a prosthesis 
medical issues affecting cognitive function eg. dementia, stroke may limit ability 
social situation 
attitude and motivation
41
Q

Prosthetic considerations

A

TTA requires 40% more energy to walk with a prosthesis than walking with two legs
TFA requires 100% more energy to walk again
can preserve energy by slowing down when walking and /or using a walking aid

42
Q

If a patient is a prosthetic candidate

A

PWB as soon as surgeon allows (PPAM aid/interim)

FWB as soon as wound is healed with no open lesions which varies from 14 days to months

compression therapy is extremely important
- stump volume decreases rapidly in first 3 months, then gradually over next 15 months
refer to QALS

43
Q

interim prostheses

A

once the wound is healed (at least 8/52) post op

allow modifications to be made in the learning phase and while the stump stabilises in size

44
Q

Definitive prosthesis

A

fitted once learning phase is completed
finished to look like the intact leg
usually provides 3 years of use to an amputee before replacement

Rehabilitation of Functional Movement (12 decks)

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