Amputations Flashcards
(68 cards)
1
Q
Limb salvage vs. amputation
A
severity scores are used by a healthcare team to make decisions
- mangled extremity severity score, limb salvage index, nerve injury, ischemia, soft tissue injury, skeletal injury, shock, age of patient score
2
Q
What are some considerations for salvage vs. amputation?
A
- boundaries of dead tissue or diseased tissue
- consideration for prosthesis
- mobility and function
- cosmesis (aesthetic appearance)
3
Q
Myodesis
A
the muscle is secured to bone by the distal tendon through holes drilled in the bone
4
Q
Myoplasty
A
attaching sectioned muscles to opposing muscles
5
Q
Minor amputation
A
toe and partial foot amputations
6
Q
Major amputation
A
proximal to tarsometatarsal joint
7
Q
What happens when someone looses an ankle joint?
A
- loss of somatosensory input
- reduced weight bearing through residual limb
- reduced confidence
- limitations with ADLs
- higher fall risk
- limits of stability is reduced in the residual limb compared to healthy individuals
- lack of kinesthetic awareness increases response time to adjust surface changes
8
Q
Partial foot amputation
A
transmetatarsal
- maintains ankle integrity
9
Q
What is another word for ankle disarticulation?
A
syme’s
10
Q
What are the 2 main things to look at for return to function?
A
- prosthetic device
- standard shoe wear
11
Q
Gait characteristics for LLA (lower limb amputation)
A
- loss of power generation
12
Q
BKA
A
also known as transtibial
- 20-50% of tibial length is spared
- preserves the knee
13
Q
LE problems seen with a BKA
A
loss of muscular control of lower limb muscle groups and foot/ankle
14
Q
Knee disarticulation
A
femur remains completely intact
15
Q
Gait characteristics seen with BKA
A
- decreased velocity
- shorter step length
- increased stance phase on sound limb
- decreased stance phase on amputated limb
- asymmetrical stance phase duration
16
Q
AKA
A
also known as transfemoral
- 35-60% of femur length is spared
- preserves hip joint
- loss of joints below and impaired musculature below pelvis
17
Q
What is the energy expenditure for walking with an AKA?
A
it increases to 60-65% vs normal walking
18
Q
Gait characteristics seen with AKA
A
- lateral trunk lean during stance (trunk bends toward the prosthetic side)
- widened BOS
- circumduction
- abducted gait (prosthetic laterally displaced)
- uneven step length
- exaggerated lordosis
19
Q
BE (below the elbow)
A
also known as transradial
- >80% of UE amputation are a result of trauma
- common in men 15-45 yrs
- cancer/tumor
- increased risk 65+
20
Q
AE (above the elbow)
A
also known as transhumeral
21
Q
Elbow disarticulation
A
through the elbow joint
22
Q
Shoulder disarticulation
A
entire upper limb through the shoulder joint
23
Q
Wrist disarticulation
A
through wrist joint removing carpal bones
24
Q
Amputation rehab phases
A
- pre operative
- amputation with surgical reconstruction
- acute post operative
- pre prosthetic
- prosthetic prescription and fabrication
- prosthetic training
- community reintegration
- vocational rehab
- functional follow up
25
Phantom sensation
feeling that the missing limb is still there, may involve uncomfortable and/or painful sensations
26
Phantom Pain
Pain coming from amputated limb that may interfere or limit participation in rehabilitation
Perception of pain in the missing limb, often described as tingling, prickling, pins and needles
More common women > men
27
What to do for Pain?
Medication
Compression
Breathing
Massage
Biofeedback
TENS
28
PT EXAM: Integumentary
Look at the scar, open wounds, skin texture, scar tissue
Inspect the incision
29
PT EXAM: Vascular System
Look at pulse, color, temp, edema, pain, tropic changes, intermittent claudication
30
PT EXAM: Neuro System
Proprioception, Visual, and Vestibular function, pain
Cognition, Neuropathy
31
PT EXAM: MSK System
Look at ROM, Strength
Common contracture sites: Hip flex, Hip abduction, Hip ER, Knee flex
Hip ext and Hip abduction both critical for gait training
32
PT EXAM: Residual Limb
Look at Circumferential, measurement, length, shape (Cylindirical)
Bulbous, dog ears, adductor roll
33
PT EXAM: Amputee Mobility Predictor
34 point change = MDC
GOLD STANDARD - Used clinic and research
34
PT EXAM: Gait Velocity 10 MWT
Range: 0.8 - 1.2+ m/s
35
PT EXAM: Patient-Specific Functional Scale
Self-selected goals applied to a scale of measure over time
36
PT EXAM: 2 MWT, 6 MWT
34m, 45m = MDC
37
PT EXAM: TUG or L-Test
3.6 sec = MDC
>19 sec =0.317 mins increased risk of fall with amputation
38
Amputee Mobility Predictor AMP-PRO
Analyzes general mobility, strength, balance
Determine the contribution of function ability
Determine what physical systems need to be addressed in rehab
39
Amputee Mobility Predictor
Has 21 categories, out of 47 points
40
Outcome Measures for Amputation
AMP-Pro
Locomotor Capabilities Index
Gait Speed
ABC Scaleq
41
Activities-Specific Balance Confidence Scale
16 item self-administered balance questionnaire
Subjects rate their balance confidence
Rating scale of 0-100
Score Range (0-1600)
Overall Score = Total Score / 16
42
ABC Scale for Older Adults Percentages
< 67% Indicates fall risk
< 50% Low Level of Physical
50-80% Moderate Level Physical Function
> 80% High Level Physical Function
43
Post-Op Pre-Prosthetic Rehab Goals
Post-operative dressing on residual limb to aid in Edema Mgmt, Healing, shaping
Optimize ROM and Strength
Desensitize Residual Limb
Functional Balance
Mobility/Transfers
Pain and Education
44
When to DISCONTINUE Interventions
Excess drainage through bandages or rigid dressings
Sharp localized pain in residual limb
Fever or Foul odor identifying infection
Hold PT - Communicate with interdisciplinary team
45
Joint Mobility Strengthening and Function
Maintain or restore ROM
Prevent Joint Contractures
Limb positioning (BKA & AKA)
Wound Healing
46
Prosthetic Components
All prosthetics contain a socket and terminal
Sockets = Custom molded to Residual limb
Liners = Silicone or gel to protect the skin
Socks = Help accommodate volume changes
Terminal Device = Interface between socket & ext. environment
47
Inspection after Prosthetic Wear
When proper loading of residual limb with the prosthesis
Pressure Tolerant Area: Transient redness is to be expected after prosthetic use
Pressure Sensitive Areas: No redness should be observed in these areas after prosthetic use
48
Transtibial Amputation (BKA)
Pressure Sensitive Areas
- Patella, Tibial Tuberosity, Crest, Anterior Distal Tibia, Fibular head and neck, Fibular nerve
Pressure Tolerant Areas
- Patellar tendon, Supracondylar areas and Supra patellar area, Tib and Fib shafts, Distal end
49
Transfemoral Amputation (AKA)
Pressure Sensitive Areas
- Greater trochanter, ASIS, distal end of femur, Pubic ramus, adductor tendon, pubic tubercle sutures
Pressure Tolerant Areas
- Ischial Tuberosity, Lateral/Medial and A/P flare of stump, Distal end of stump for total contact only
50
Amputee Gait Observation
Essential to observe from at least two planes
Sagittarius-plane motions are best seen from the side
Frontal-plane motions are best seen from the front
In normal pattern the key is symmetry
For the unilateral amputees its asymmetry
51
Analyzing the Prosthesis
Gait deviation may be prosthetic or anatomical in nature
Some deviations will need adjustment in the prosthetic
Some will require further PT treatment
52
Post Op Dressing: ACE Wrap
BKA: 4-6 inch
AKA: 6 inch
Figure 8 Patterns
Compression reduces proximally
ADVANTAGES
Edema control, easy access, inexpensive
DISADVANTAGES
Doesn’t protect, Hard application, Contracture
53
Post Op Dressing: Shrinker
Elastic compression sock
ADVANTAGES
Edema control, easy access, inexpensive, even layers
DISADVANTAGES
May catch on staples, increases pain during applying, contracture
54
Post Op Dressing: Rigid Dressing
Made of plaster, rigid outer layer
BKA extends to mid-thigh
ADVANTAGES
Protects residual limb, best edema control, contracture prevention
DISADVANTAGES
Higher risk for infection, bulky, requires monitoring
55
Types of Dressing: Elastic Roller
ADVANTAGES
Readily available, inexpensive, easy access
DISADVANTAGES
Difficult to apply, Produce high pressure, minimal protection, contractures
56
Types of Dressing: Semirigid
ADVANTAGES
Better edema control, Protection
DISADVANTAGES
Frequent changing needed, can’t be applied by patient
57
Types of Dressing: Removable Rigid
ADVANTAGES
Edema control, protection, access to incision
DISADVANTAGES
Requires skills to fabricate and is expensive
58
Types of Dressing: IPOP
ADVANTAGES
Excellent edema control, protection, controlled pain
DISADVANTAGES
No access to incision, More expensive, proper training
59
Stump Wrapping
Distal to Proximal
Figure 8, Partially overlap each layer, no gaps in bandage
Shape should be cylindrical, even pressure throughout
Stretch to about 1/2 of elasticity, secured with tape
60
Transtibial (BKA) Wrap
2 4 inch bandages
61
Transfemoral (AKA
1 4 inch, 1 6 inch
Remove every 4 hours or sooner
62
Amputee Rehab: Clinical Considerations
Cognitive Dysfunction
Comoribidites
Cardiopulmonary conditions
Ulcers or infections
Contractures
Age
Psychosocial
63
Medicare Functional Classification Scale
K0
K1
K2
K3
K4
64
Medicare Functional Classification Scale K0
Patient doesn’t have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis doesn’t enhance their quality of life or mobility
65
Medicare Functional Classification Scale: K1
Patient has the ability to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence (Limited Household Ambulator)
66
Medicare Functional Classification Scale: K2
Patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surface (Community Ambulatory)
67
Medicare Functional Classification Scale: K3
Patient has the ability for ambulation with variable cadence, typical community ambulator with the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic use beyond simple locomotion
68
Medicare Functional Classification Scale: K4
Potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult or athlete
