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Prosthetics/Orthotics > Amputation: Key Impairments, Interventions, & Introduction to Prosthetics > Flashcards

Amputation: Key Impairments, Interventions, & Introduction to Prosthetics Flashcards

1
Q

What is the purpose of positioning?

A
  • Prevent development of joint contracture while considering comfort & function
  • Try to minimize edema
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2
Q

What are the general considerations for positioning?

A
  • Do not put pressure on healing surgical sites or wounds on residual limb
  • Change positions at least every 2 hours
  • Positions should vary during the day
  • Must teach patient & caregiver proper positioning
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3
Q

How long can volume fluctuations last post amputation?

A

12-18 months

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4
Q

What are common trans tibial contractures?

A
  • Hip: flexion, abduction, & ER
  • Knee: flexed
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5
Q

What are common transefemoral contractures?

A

Hip flexion, abduction & ER

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6
Q

How can contractures be caused?

A
  • Poor positioning
  • Prolonged sitting position/wheelchair use
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7
Q

What are the consequences of contractures?

A
  • Functional leg length discrepancy
  • Poor prosthetic alignment
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8
Q

What is the management of contractures?

A
  • Appropriate positioning
  • Ambulation
  • Prosthetic modification
  • Casts
  • Surgical release if necessary
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9
Q

What are common transhumeral contractures?

A

GH flexion, add, & IR

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10
Q

What are common transradial contractures?

A
  • GH: flexion, add, & IR
  • Elbow: flexion
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11
Q

What is the proper position for prevention of contracture?

A
  • Neutral hip extension
  • Knee extension
  • Hip & knee extension when prone
  • Knee extension in sitting
  • For TFA, avoid hip abduction
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12
Q

What are the 3 types of dressings?

A
  • Rigid
  • Semirigid
  • Soft
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13
Q

What is the purpose of post-operative dressing?

A
  • Control post-operative edema
  • Pain control
  • Enhancement of wound healing
  • Protection of the incision during functional activities
  • Shape & desensitization of the residual limb for prothesis
  • Can allow early WB
  • Acclimate patient to the idea of caring for residual limb
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14
Q

What is the difference between removable & non removable rigid post operative dressings?

A
  • Removable: applied over soft dressings
  • Non Removable: application of rigid cast dressing in the operating room or post op
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15
Q

Name some advantages of rigid post-operative dressings

A
  • Allows early ambulation w/ pylon
  • Promotes circulation & healing
  • Stimulates proprioception
  • Protection
  • Soft tissue support
  • Limits edema
  • Ability to utilize an immediate post-op prosthesis (IPOP)
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16
Q

What is an IPOP?

A
  • Immediate postoperative prothesis
  • Used as an early form of prosthetic intervention
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17
Q

What is the benefit of an IPOP?

A

Early ambulation if allowed by your physician

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18
Q

What are the disadvantages of rigid post-operative dressings?

A
  • Immediate wound inspection is not always possible
  • Does not allow for daily dressing changes
  • Requires professional application
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19
Q

What are complications of rigid post-operative dressings?

A
  • Infection
  • Damage to wound
  • Pressure or traction from pistoning
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20
Q

What is a semi-rigid Post-Operative Dressing?

A
  • Unna paste, air splints
  • Unna paste wraps
  • Specialized gauze banding impregnated with zinc oxide
  • Typically 4 inches wide
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21
Q

What is the order of post- operative dressings, from best to least at edema control?

A

Rigid > Semi rigid > Soft

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22
Q

What are the advantages of semi-rigid post operative dressings?

A
  • Reduces post-op edema
  • Provides soft tissue support
  • Provides protection
  • Easily changeable
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23
Q

What are the disadvantages of semi-rigid post operative dressings?

A
  • Does not protect as well as rigid dressing
  • Requires more changing than rigid dressing
  • may loosen & allow for development of edema
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24
Q

When should soft post-operative dressings be used?

A

If patient is at high risk for infection to allow for wound inspection

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25
Q

What are the 2 forms of soft post-operative dressings?

A
  • Elastic (ace) wraps
  • Shrinkers (soft like garments made of heavy, rubber - reinforced cotton)
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26
Q

What is the purpose of using a soft dressing for edema control?

A

Promote an ideal shape of the residual limb & stable volume to allow for receipt & use of prosthesis

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27
Q

What is a shrinker and when may it be used?

A
  • Elastic garment shaped similar to a sock that encompasses the limb
  • Used once a more consistent volume is reached
28
Q

What is the average ace wrap size for UE limb?

A

3”

29
Q

What is the ace wrap size for limb with TTA or a larger UE limb?

A

4”

30
Q

What is the ace wrap size for TFA?

A

6”

31
Q

In general how many bandages does a transtibial amputation need?

A

2-3 four inch bandages

32
Q

In general how many bandages does a transfemoral amputation need?

A

2-3, four or six inch ace bandages

33
Q

In general how many bandages does a transradial & transhumeral amputation need?

A

2-3, three inch ace bandages

34
Q

What are the advantages of soft post-operative dressings?

A
  • Reduces post operative edema
  • Provides some protection
  • Easily removed for wound inspection
  • Allows for active joint ROM
35
Q

What are some disadvantage of soft post-operative dressings?

A
  • Relatively poor edema control
  • Tissue healing is interrupted by frequent changes
  • Joint ROM may delay healing of incision
  • Less control of residual limb pain
  • Cannot control the amount of tension in the bandage
  • Risk for tourniquet effect
36
Q

When can a shrinker be applied?

A

Until sutures/staples are removed

37
Q

Can shrinkers be applied over dressings?

A

They can be applied as necessary but the dressings should be thin in order to not affect the pressure of the shrinker

38
Q

What is the technique for applying a shrinker?

A
  • Turn shrinker inside out & then stretch it open as you contact the residual limb
  • Stretch the lower half of the shrinker firmly up towards the knee. Then let the material relax
  • Pull the top half of the shrinker upwards
39
Q

Where should more pressure be applied when wrapping a limb?

A

Distal pressure > Proximal pressure

40
Q

What pattern should wrapping be applied in?

A
  • Apply obliquely
  • Never apply in circumferential pattern
41
Q

How often is wrapping worn and how often should it be re-applied?

A
  • Worn 24 hrs/day (w/ exception of bathing)
  • Should be reapplied every 4-6 hours
42
Q

When wrapping what should be avoided?

A
  • Avoid medial & lateral wrapping in same turn
  • Avoid wrinkles
  • Avoid windows
43
Q

What inch wrap should be used for transtibial wrapping?

A

3-4 inch

44
Q

What inch wrap should be used for transfemoral wrapping?

A

6 inch wrap

45
Q

What inch wrap and how many should be used for transradial & transhumeral?

A

Two - Three 3” wrap for average size UE limb

46
Q

How long does Phantom limb pain/ sensation typically last?

A
  • Typically episodic
  • Lasts seconds to days or continuous
47
Q

What are some treatment options for phantom limb pain/sensations?

A
  • Manage, ultrasound, ice, TENS
  • Non-narcotic analgesics
  • Biofeedback, guided imagery
  • Psychotherapy
  • Nerve blocks
  • Mirror therapy
48
Q

As the incision heals, sensory input to the residual limb (increases or decreases)

A

Increases

49
Q

What must occurs for resistance to be added when strengthening?

A
  • Must have medical clearance for resistane
  • Typically, 7-10 days w/ drains removed, sutures/staples removed & wound closed
50
Q

How should a residual limb be cared for?

A
  • Wash daily w/ warm water
  • Shower at night w/ mild soap
  • Pat limb dry
  • Be careful of incision site
  • Check limb daily (redness/blisters)
  • Moisturize skin (fragrance free)
  • When not wearing prosthesis (wear ace wrap or shrinker)
51
Q

Where can sheaths be applied?

A

Underneath liner directly on the skin & can serve to relieve irritation when using prosthesis

52
Q

When can patients begin to wear a shrinker?

A

Once sutures are removed

53
Q

How should shrinkers be cleaned?

A
  • Wash in luke warm water (hand wash or delicate)
  • Hang to dry - rotate
54
Q

What should be done if ply exceeds 12-15?

A

Prosthetist should be notified as recasting may be required

55
Q

Why may a patient need prosthetic socks?

A
  • Individual experience a decrease in residual volume (especially in 1st year)
  • To accommodate for space prosthetic socks are used to maintain congruent & comfortable fit
56
Q

How should socks be cared for?

A
  • Wash in luke warm water (hand wash or delicate)
  • Hang to dry - rotate
  • Don clean socks/sheaths daily
57
Q

How is a liner cared for?

A
  • Turn inside out, wash w/ warm water/mild detergent & invert & allow to dry on stand provided by manufacturer
58
Q

What is a gel liner?

A

Commonly made of silicone, used for cushioning residual limb & hosting a suspension mechanism such as pin or lanyard

59
Q

How is a socket cared for?

A
  • Inspect device for signs of wear prior to each use
  • Do not make mechanical adjustments or minor repairs to the prosthetic device
  • Inspect the connections points for stability
60
Q

What is the socket?

A

Interface between the residual limb and the prosthesis

61
Q

What does a properly fitting socket do?

A

Disperse pressure throughput the limb and providing more contact with the surface

62
Q

What is the most common socket for transfemoral amputation?

A

Ischial containment socket

63
Q

What is the most common socket for transtibial amputation?

A

Total surface bearing or patellar tendon bearing socket

64
Q

What is the order of donning a prosthesis?

A
  • Gel liner
  • Socks (no wrinkles)
  • Soft liner
  • Prosthesis
65
Q

What is the beginning wear schedule of a prosthesis?

A
  • One hour a day with half the time spent ambulating
  • Every 30 minutes or immediately after walking, skin should be inspected
  • If wearer is tolerating the prosthesis well with no signs of breakdown, an hour is added each day while still respecting 50%rule
  • If skin is showing no signs of breakdown, the amount of time between inspections is gradually expanded by 15-30 minutes
  • Eventually the we are will be able to tolerate the prosthesis for extended periods of time w/o having to remove the prosthesis & inspect the skin

Prosthetics/Orthotics (12 decks)

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