most common cause of UE amputation
trauma
most common cause of LE amputation
peripheral vascular disease
goals of surgery during amputation
preserve as much limb length as possible while providing healthy skin, soft tissue, vascularization, sensation, muscle, and bone
a residual limb that is pain free and functional
common symptoms during postoperative and preprosthetic phase
- pain
- skin complications (delayed healing, necrosis, skin graft adherence to bone)
- edema of residual limb
- bone spurs
- neuroma on distal end of residual limb
- phantom limb (non-painful sensation that limb is still there; may remain forever)
- phantom sensation
common symptoms during prosthetic phase
- skin ulcers as a result of poorly fitting prosthesis socket or wrinkles in prosthetic sock
- sebaceous cysts from torque of prosthetic socket
- edema from ill-fitting socket or too-tight prosthetic sock
- sensory changes (hyper- and hyposensitivity, phantom limb, phantom sensation)
above the knee amputation
transfemoral amputation
below the knee amputation
transtibial
below the ankle amputation
transmetatarsal
below the elbow amputation
transradial
above the elbow amputation
transhumeral
below the wrist amputation
transmetacarpal
disarticulation
amputation accross a joint
Symes amputation
ankle disarticulation
preprosthetic phase
from postsurgery until client receives permanent prosthesis
goals of preprosthetic phase
- address psychosocial aspects of limb loss
- optimize wound healing
- maximize residual limb shrinkage and shaping to distal end
- desensitize residual limb
- maintain/increase ROM and strength
- facilitate independence in BADLs
- explore prosthetic options
optimal shape for prosthetic socket
tapered distal end
goals of prosthetic training
- teach client to don/doff prosthesis
- train the client in care of prosthesis
- increase wearing time to full day
- encourage independent use of prosthesis
most common limitations for people with UE amputation
manipulation of objects
most common limitations for people with LE amputations
mobility and ADLs related to LE care
how evaluation of self care activities should be done
both with and without prosthesis; include motor skills eval of uninvolved hand in prep for training in one handed techniques and in use of prosthesis when it is worn
important client factors that should be evaluated in people with amputations
- changes in sensation in residual limb
- presence and severity of phantom sensations
- pain
- psychosocial
- strength, flexibility, and endurance of residual limb and full body in preparation for prosthesis wearing
- skin integrity
Things to include in eval on pt with amputation
- self care activities both with and without prosthesis
- include motor skills eval of uninvolved hand in prep for training in one handed techniques and in use of prosthesis when it is worn
- vocational and recreational interests
- driving eval
- environmental analysis of community, home, school, and work
preprosthetic interventions
- training in limb hygiene
- wound healing, including whirlpool and massage
- limb shrinkage and shaping
- desensitization of residual limb through weight bearing on various surfaces, massage, tapping, and rubbing
- maintain/increase flexibility and strength of residual limb
- to prevent flexion contractures of knees and hips in LE amputations - maintain/increase strength of remaining limbs for propelling w/c, using mobility aids, and weight bearing
- W/C adjustments
wrapping residual limb training
pt should use elastic bandage to reduce edema and develop tapered shape
elastic shrinker or removable rigid dressing can be used if pt is unable to perform wrapping technique
w/c fitting for person with LE amputation
large rear wheels should be placed further back to counterbalance missing limbs
should have antitippers
considerations for prosthesis prescription
- length, strength, flexibility, and skin integrity of residual limb
- patient preference of cosmetic appearance
- hand dominance
- typical activities to be performed with prosthesis
- motivation and attitude
- financial coverage
- cognition
passive TD
terminal device that is realistic, nonfunctional limb work for cosmetic purposes
active TD
terminal device that assists with functional activity
can be body powered, externally powered, or hybrid powered
can be a hook or realistic looking limb
attaches the prosthesis to the residual limb
socket
positioning components of prosthesis
include wrist, elbow, shoulder, knee, and ankle devices
may have locking system activated by user
holds the prosthesis on the residual limb
UE: harness or suspension system (control system often combined with harness)
LE: pylon (connects terminal device to socket
initial wearing time of prosthesis
15-30 min
process for progressing wear time of prosthesis
when removed, check residual limb for redness
if no red areas are present after 20 min, increase time in 15-30 min increments
if redness still present after 20 min, report areas of redness to prosthetist so adjustments can be made
hygiene of limb
daily cleansing
daily skin inspection, especially areas with decreased sensation
care of prosthesis
clean interior with mild soap and water
clean hook or cosmetic hand with soap and water
myoelectric prosthesis wearers must be taught to replace batteries
UE prosthesis training includes (types of training)
prosthesis control training prosthesis use training prepositioning training prehension training functional training
prosthesis control training
operation of each component of the UE prosthesis
prosthesis use training
integration of prosthesis components for efficient assist during functional use
prepositioning training
identification of the optimal postition of each positioning unit to perform activity or grasp an object
prehension training
TD control during grasp activities
functional training
control and use of prosthesis during functional activities
-incorporating TD as functional assist
postprosthetic interventions
- education about prosthesis
- don/doff training (for myoelectric-proper alignment of electrodes for best contact)
- wearing schedule
- limb hygiene
- care of prosthesis
- UE prosthesis training
- provision of AE PRN
- work with client to gain repertoire of skills needed to complete ADLs IADLs
- transfers, bedmobility, w/c mobility
- methods to perform vocational and leisure activities - home eval PRN
- psychosocial