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3) P&O > 2) Amputee Management > Flashcards

2) Amputee Management Flashcards

1
Q

What things need to be considered when examining a pt for a LE prosthetic and why?

A
  • Skin → Sock/Sheath, Suspension, & Socket
  • Girth → Fit, Suspension
  • Shape → Fit, Suspension
  • Length → Suspension, Cosmesis, & Energy Expenditure
  • ROM → Fit, Stability, Cosmesis, & Energy Expenditure
  • Muscle Strength → Stability
  • Proprioception → Stability
  • UE strength & dexterity
  • CP Endurance → Prosthetic weight & type
  • Neuro
  • Vision → Stability, donning, & inspecting LE’s
  • Psychosocial/Emotional Compliance
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2
Q

Why are longer limbs better?

A

Improve balance & suspension

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3
Q

When examining a pt for an LE prosthetic, what muscles need to be especially strong?

A

Hip Extensors & Abductors

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4
Q

Give some examples of some bad things to find when doing a skin exam

A
  • Heat
  • Redness
  • Pain
  • Open Areas
  • Drainage
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5
Q

If a pt w/a prosthetic has a skin problem, what should you do?

A

Refer them to their physician

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6
Q

What causes verrucous hyperplasia and what does it look like?

A

Caused by repetitive skin trauma; Looks black & crumbly

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7
Q

What is the problem w/silicone liners?

A

Many pt’s are are allergic to them

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8
Q

What is this? Why does it happen? What would you do about it and why? *

A
  • Bulbous Skin - Caused by lack of venous return bc muscles are gone
  • Next step would be a shrinker once the scars are healed bc the residual limb should be conically shaped
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9
Q

Medicare Functional Classification Levels

A

Says what pt’s are capable of & relates them to their goals, which dictates what kind of parts insurance will pay for

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10
Q

K0

A

No potential for ambulation, even w/prosthesis; Pt’s will typically live in a facility

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11
Q

K1

A

Prosthesis would allow limited household on a level surface, w/little cadence change

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12
Q

K2

A

Prosthesis would allow limited community ambulation; Can navigate steps & curbs; Some cadence change

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13
Q

K3

A
  • Prosthesis would allow for independence in community
  • Ambulation w/varying cadence & activity levels
  • Prosthesis is needed for full participation in vocational or leisure activities
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14
Q

K4

A

Prosthesis would allow for full independence and high-level activity, athletics, vocational, or leisure

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15
Q

What factors affect classification/prognosis?

A
  • Age
  • Level of amputation
  • Time since amputation
  • Condition of intact limb
  • Comorbidities such as HTN, DM, OA
  • Fxnl abilities w/out prosthesis
  • AMPnoPRO score
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16
Q

What is the AMPnoPRO?

A

Predicts how well a pt will do w/a prosthetic, based on their performance w/an assistive device

  • Considers 21 items such as balance, gait, & fxnl tasks
17
Q

What does the AMPPRO look at?

A

Pt’s who want to upgrade their prosthetic

18
Q

What are some pre-prosthetic interventions?

A
  • Limb wrapping
  • Desensitization
  • Elevation
  • Scar Tissue Massage
  • Shrinkers
  • Positioning for contracture management
  • Strengthening
  • Balance training
  • Transfer training
19
Q

When should a pt wear their shrinker?

A

After stitches are removed, whenever prosthesis is not worn during the 1st post-op year

20
Q

If a pt is hypersensitive, what can PT do about it?

A

Find out what irritates them and have them do desensitization in HEP

21
Q

What interventions should be done for pt’s w/a prosthetic?

A
  • Wearing → Helps w/limb shape
  • Donning & doffing w/skin inspection
  • Pt ed
  • Balance & coordination training
  • Gait training
  • Fxnl task training
22
Q

What are some assessments you should do to a pt w/a prosthetic in sitting?

A
  • ID/eval each of the types of prosthetic components & suspension
  • # of ply socks pt is wearing
  • Donning and Doffing
  • Pt comfort
23
Q

What are some assessments you should do to a pt w/a prosthetic in standing?

A
  • Foot position (Too inset or outset)
  • Is foot flat on the floor?
  • Is there excessive lean of the pylon forwards or to the side?
  • Overall balance & symmetry btwn legs
  • Pt’s ability to stand w/6” BOS
  • Leg length symmetry
  • Prosthesis stability
  • Is the ischium contained w/in the socket?
  • Flesh roll above or to the sides of the socket?
  • Vertical pressure in the perineum
  • Socket fit
24
Q

What are some assessments you should do to a pt w/a prosthetic while ambulating?

A
  • Pistoning → Means socket is too large or there’s too much suspension
  • Pinching or gapping
  • Effective fxn of suspension
25
Q

What are the causes of lateral trunk bending?

A
  • Outset foot
  • Short prosthesis
  • Abducted socket

Problem w/prosthetic

26
Q

What gait deviations do you see and are they the result of a problem w/the prosthetic or the pt? *

A
  • Lateral Trunk Bending
    • ​​Weak abductors
    • Short residual limb
    • Distal lateral pain

Problem w/pt

27
Q

What causes abducted gait?

A
  • Prosthetic → High medial-lateral wall
  • Amputee → Distal lateral pain
28
Q

What causes circumducted gait?

A
  • Problem w/prosthetic:
    • Long prosthesis
    • Excessive knee friction
    • Excessive knee extension
29
Q

Vaulting commonly is accompanied by what problem w/the prosthesis?

A

Pistoning

30
Q

What causes problems w/terminal impact?

A
  • Prosthetic → Insufficient knee friction
  • Amputee → Lack of confidence in the prosthetic so pt snaps knee back into extension before heel strike
31
Q

What causes a whip gait deviation?

A

Prosthetic knee is set in too much rotation

32
Q

What interventions would you do for a patient with a hip flexor contracture?

A
  • Prone lying
  • Prone press-up if able
33
Q

What interventions would you do for a patient with a hip abductor contracture?

A
  • Side-lying
  • Lying supine w/towel roll, legs belted
34
Q

What interventions would you do for a patient with a hamstring contracture?

A
  • Amputee board for w/c
  • Limiting sitting in regular chair → Encourage w/c use
35
Q

What muscles need to be strong in pt’s w/transfemoral amputations?

A

Hip Abductors and Extensors

36
Q

What muscles need to be strong in pt’s w/transtibial amputations?

A

Hip abductors, extensors, and quads

37
Q

What muscles need to be strong in all amputees?

A
  • Triceps
  • Lower Traps
  • Core
38
Q

Is it ok to D/C a pt who cannot transfer?

A

No

39
Q

What kinds of things should be included in patient education?

A
  • Hygeine → Keeping socks and socket clean
  • Skin check
  • Gradually incr wearing time
  • Wear shrinker when not wearing prosthetic
  • Pain control
  • Emotional support
  • Vocational training
  • Financial assistance
  • Check vitals
  • Any problems, seek care

3) P&O (4 decks)

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