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Assistive Tech > P - Pre-Prosthetics Rehab > Flashcards

P - Pre-Prosthetics Rehab Flashcards

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1
Q

are UE or LE the majority of amps in congenital pop

A

UE (60%)

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2
Q

are UE or LE the majority of amps in secondary to CA pop

A

LE

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3
Q

what is the leading cause of limb loss in children

A

secondary to cancer

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4
Q

what type of cancers often lead to amputations

A

malignant bone tumors
- osteosarcoma (most common, 1/2 in knee region)
- chondrosarcoma (2nd most common)
- Ewing’s sarcoma

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5
Q

what is the most common reason for amputation

A

dysvascular

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6
Q

of the 4 main reasons for amputation, what is the order of how common they are

A
  1. dysvascular
  2. traumatic
  3. congenital
  4. secondary to cancer
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7
Q

what is the most common traumatic reason for amputation

A

motorcycle accidents

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8
Q

what scale is used in traumatic amputations

A

Mangled Extremity Severity Score (MESS)

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9
Q

what population is traumatic amputations most common in

A

males > females

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10
Q

what is the most common dysvascular reason for amputation

A

diabetes

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11
Q

are UE or LE the majority of amps in dysvascular pop

A

LE (98%)

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12
Q

what population is dysvascular amputations most common in

A

inc risk in elderly males and african americans

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13
Q

what are 2 questions asked in the exam if someone has a medical hx of diabetes

A

related complications?
hx of plantar ulcers?

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14
Q

what 3 types of peripheral vascular dz are screened for in the exam

A

arteriosclerosis
chronic venous insufficiency
thromboangitis obliterans (buergers dz)

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15
Q

what are 2 main things screened for in the medical hx as part of the exam

A

DM
PVD

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16
Q

why are additional surgeries a good Q to ask as part of the exam when finding out ab the CC

A

not uncommon to have cascade of surgeries leading up to the amp

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17
Q

why is the current and prior functional status is important to know

A

key in helping us to know what is realistic

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18
Q

why is CVP an important system to review and how wil amputations impact this

A

greater demands placed when amputated

TT - 15-40 % more energy
TF - 65% more

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19
Q

how is the walking speed impacted with a LE amp

A

self-selected walking speed are 35-45% slower

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20
Q

what is reviewed in the integ screen and what is the goal

A

post op and sound limb

“keep sound limb sound”
- will be more dependent on sound limb and don’t want it to become a BL amp

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21
Q

what are common MSK screen findings

A

lower back and hip pain
altered body mechanics

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22
Q

what is a common NM screen finding

A

impaired balance

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23
Q

what are tests and measures used to assess pre-prosthetic ability

A

functional assessment
anthropometrics
residual limb condition

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24
Q

what about residual limb condition do we want to know pre-prosthetically

A

dimensions-volume assess
shape = cylindrical
type & timing of Rx

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25
what about residual limb condition do we want to know pre-prosthetically
dimensions-volume assess shape = cylindrical type & timing of Rx
26
what amputations is the circumferential method reliable in measuring residual limb volume
TT amp - inadequate data for decisions ab volume measurement in other amps
27
what types of residual limb volume measurement have been found to be reliable
circumferential and water displacement
28
when measuring residual limb volume what should you wait for
8min between doffing prothesis and first measurement 20 min from mobilization of more than 200m
29
when measuring residual limb volume what should you standardize and record
participant and joint position ms activation during measure location of limb contact w support during measure location of limb markers relative to anatomical landmarks
30
when measu
31
at what point can casting for a prosthesis only occur
after distal portion is smaller circumference than proximal
32
what is a critical goal for the remaining sound limb and why
"keep sound limb sound" - assessments to prevent additional limb loss
33
what is the giant list functional assessment measures (10)
bed mobility wc mobility transfers amb ADs balance UE function strength bandaging ADLs/IADLs
33
what are 6 qualities of residual limb condition to assess
integumentary integrity sensory integrity palpation ROM flexibility strength
33
what is assessed in the remaining sound limb
integumentary integrity sensory integrity vascular ROM flexibility strength pain aerobic capacity/endurance
34
how is the sound limb assessed vascularly
temp pulses cap refill (norm = 3sec) ABI
35
how is the ROM measured in an amp limb
midline of long bone since landmarks have changed
36
why is UQ ROM important to screen
bed mobility and transfers
36
why is flexibility an important to screen for
for specific muscle length (hip flexor, psoas, and HS ms length) needed for gait and safe functional mobility - 0deg of knee ext - 10-15deg of hip ext
37
why is strength an important thing to screen for
loss of lever arm
38
where should strength be assessed and how
UQ and LQ trunk/core want to apply resistance at same spots on sound and residual
39
what tests can be used to screen for pain and what are their different uses
VRS/VAS McGill - type of pain phantom sensation phantom limb pain post op pain - ortho, meds neuropathic - CRPS
40
how common is phantom sensation and how is this different from phantom limb pain
almost all amps (90-95%) not pain, itch/tickle
41
what is phantom limb pain more common in
trauma
42
how is phantom limb pain treated
mirror therapy massage WBing TENS
43
how is neuropathic pain treated
desensitization
44
what are tests and measures assessing aerobic capacity and endurance
VS - rest, during, post BORG RPE UBE 6MWT
45
what is the common finding when assessing the posture of a STS in an amp
COM moves toward sound side and superior
46
while amps can have variable presentations, what are common goals for rehab determined in the eval
wound mgmt gait training w prosthesis secondary issue? (LBP, hip pain, etc.)
47
what is important to include in the dx
specific info as to the cause of the amp
48
what are 5 self report outcome measures
SF-36 Sickness Impact Profile Amp Activity Survey Locomotor Capabilities Index Prosthesis Eval Q (PEQ-17)
49
what are 5 performance based outcome measures
6MWT 2MWT TUG L-test of functional mob amputee mobility predictor
50
what is the MCD for 6MWT
147.5ft
51
what is the MCD for 2MWT
112.5ft
52
what does the L test of functional mobility test
STS, short distance amb, R turn, long distance amb, 180deg turn, long distance amb, L turn, short distance amb, STS
53
what is a valid outcome measure to determine K Levels
amputee mobility predictor (AMP)
54
what does the amputee mobility predictor (AMP) have a strong positive correlation with
6MWT amp activity survey
55
what is a good predictor of function post amp
pre amp status
56
what is the amputee mobility predictor (AMP)
instrument to assess determinants of lower limb amp ability to ambulate
57
what is the AMP a valid and reliable measure for
assessment of functional amb in lower-limb amps
58
what is the pre-prosthetic phase and its goals
prepares for prosthetic fitting and training addresses basic impairment levels - tissue healing, limb shape, edema, ROM, strength, flexibility, CV
59
what is the significance of pre-prosthetic phase goals
need to be accomplished to get to prosthetic phase
60
what is the prosthetic phase and its goals
prosthetic mgmt skills work on optimal gait pattern, ADLs, transfers
61
what are pre-op specific goals (2)
pt ed rehab course and post op POC
62
what are acute post op specific goals (7)
pt ed limb loss adjustment wound healing/skin care edema control (limb shape) positioning (contractures) pain control functional mobility
63
what are sub acute specific goals (7)
pt and family ed - skin care - app of dressings - home eval for fall risk strengthening core, key ms ROM for prosthetic use CV fitness sitting and standing balance advance mob skills - transfers, gait advance ADL skils
64
what became the mgmt focus of limb amp rehab
individualized POCs exercise to improve physical function and ADLs
65
what are warning signs to look for when doing skin checks
color temp pain blisters/open skin/corns/calluses
66
what are examples of skin care for the sound limb
daily inspection hygiene footwear footcare
67
what are objectives as part of wound care post op
education monitor incision scar closed - gentle scar massage
68
what are objectives as part of edema control post op
healing pain cylindrical shape
69
what are 4 ways to control edema
ace wrap (figure 8) shrinker pressure garment rigid removable dressing positioning
70
what are 5 ways to manage pain
desensitization edema control TENS meds mirror therapy
71
what are examples of desensitization techniques to manage pain
massage tapping WBing coordination exercises
72
how is mirror therapy used in pain management
reflection of sound limb, the brain's concept is that the residual limb is moving like that (of the sound limb) which helps dec pain sensation (also helpful in CRPS)
73
what is the biggest goal with ROM post op
PREVENT CONTRACTURES - hip flexor (psoas) - knee (HS)
74
what are ROM interventions
AROM positioning - avoiding hip and knee flex stretching - hip flex and HS - CRS / PNF splinting
75
why is it important to prevent flexion contractures in the hip and knee
need ext in both hip and knee to amb - 10-15deg in hip - 0 in knee
76
what does early post-op strengthening look like
isometrics quads, gluts, hip ABDs UE - shld depress, lats, tris - seated push up, wts, TB, pulley
77
what are strengthening progressions after early post op
add resistance trunk strengthening - rotation - plyoball - PNF - trunk/pelvis
78
what are all the positions that balance activities should be performed in
static -> dynamic sitting long sitting quadruped tall kneeling standing reach outside BOS
79
energy expenditure: TTA, TFA, BL TTA, BL TFA
TTA: 15-40% TFA: 40-65% BL TTA: 125% BL TFA: >200%
80
how can aerobic capacity be trained and why is this important
transfers, UBE, LEC, wc propulsion - aquatic later if not CI inc energy expenditure in amps

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