Post Amp Trx

Question 1

List and describe the phases following post-ampuation surgery

Answer 1

1. acute phase → time between surgery and D/C from acute care
2. pre-prosthetic phase → time between D/C from acute care and fitting with a definitive prosthesis
3. prosthetic phase → long term management (includes rehab and training w/prosthetic)

Question 2

what is the primary goal in the acute/pre-prosthetic phase of trx?

Answer 2

prevention of contracture

Question 3

what is the purpose of the post-op dressing?

Answer 3

meant to protect the incision and residual limb as well as foster healing, control edema, and manage pain

(primarily surgeon decision, but PTs can get some say if involved in prehab/pre-op care)

Question 4

List the different types of post-op dressing

Answer 4

1. compressive soft
2. shrinker
3. semi-rigid dressing
4. IPOP

Question 5

what is an IPOP?

Answer 5

immediate post-surgical prosthesis → prosthetic socket allowing for limited weight-bearing ambulation in the early stages

Question 6

List the advantages/disadvantages of IPOPs

Answer 6

1. Advantages
   
   • great edema control
   • excellent protection
   • controls pain
2. Disadvantages
   
   • access to incision difficult
   • more expensive
   • requires training

Question 7

what is a rigid/semi-rigid dressing (SRDs)?

Answer 7

list a cast or rigid dressing applied in the OR/recovery room

allows for immediate prosthetic fitting

dressing adheres to the skin

Question 8

List the advantages/disadvantages of SRDs

Answer 8

1. Advantages
   
   • better edema control
   • protection of limb
2. Disadvantages
   
   • frequent changing required
   • no pt application
   • no access to incision

Question 9

what is a soft dressing?

Answer 9

most common/preferred post-op dressing

immediately post-op, limb is wrapped w/sterile gauze and covered w/compressive elastic bandage in figure 8 fashion

Question 10

List the advantages/disadvantages of soft dressings

Answer 10

1. Advantages
   
   • easy to apply
   • inexpensive
   • easy access to incision
2. Disadvantages
   
   • little edema control
   • frequent rewrapping
   • inconsistent technique

Question 11

why might a splint/immobolize be used during post-op?

Answer 11

encourages full knee extension (prevent knee flexion contracture)

*this is worn over the primary dressing

Question 12

What things are included in a post-surgical evaluation/trx?

Answer 12

1. General systems review/chart review
2. post-surgical status
3. pain level
4. residual limb assessment
5. ROM and strength
6. functional status
7. cognition/emotion
8. post-op complication

Question 13

what needs to be determined during a pain assessment post-operatively?

Answer 13

1. location of pain
2. type of pain
3. nature of pain
4. intensity of pain
5. impact on functional activities

Question 14

define phantom limb sensation

Answer 14

painless awareness of the amputated limb, possibly accompanied by tingling

Question 15

what is phantom limb pain?

Answer 15

brain continues to recieve painful sensory messages from the nerves that originally carried messages from amputated limb

feelings of cramping, burning, pain

Question 16

how might a PT treat pain in an amputee?

Answer 16

1. dressing and compression help to desensitize limb
2. pain education
3. movement
4. modalities

Question 17

what is included in the residual limb assessment?

Answer 17

1. limb length
2. volume (circumference)
3. degree of wound healing
4. vascularity

Question 18

where are the staring and ending points for measuring limb length in a TTA? TFA?

Answer 18

1. TTA → medial joint line to end of limb
2. TFA → ischial tub. or GT to end of limb

Question 19

what things are included in the contralateral limb assessment?

Answer 19

1. DVT screen
2. diabetic foot screen (if appropriate)
3. sensory testing
4. Strength/ROM testing

Question 20

List common DVT symptoms

Answer 20

1. swelling (calf/entire leg)
2. local tenderness along deep venous system
3. increased redness/warmth

Question 21

how do the landmarks change for goni placement in amputees?

Answer 21

if bony landmarks are still available use them,

but now the moving arm is the midline of the residual limb

all proximal joints remain the same

Question 22

T/F: a contracture is the tightening of the muscle

Answer 22

FALSE
it is also changes to the joint capsule

Question 23

why is positioning important for post-op care in amputee?

Answer 23

1. critical to prevent contractures
2. edema control
3. patient comfort
4. patient education

Question 24

what key muscles are targeted in a TTA during AROM/stretching?

Answer 24

hamstrings

hip flexors

gastroc-soleus (contralateral)

Question 25

what key muscles are targeted in a TFA during AROM/stretching?

Answer 25

hip flexors hip abductors hip ERs lumbar extensors contralateral LE

Question 26

what are some general principles to remember when working on AROM with an amputee?

Answer 26

1. early and often 2. focus on knee and hip extension 3. work through available range

Question 27

how is strength assessment different in an acute setting for amputees?

Answer 27

* do not apply resistance over surgical incision * Test active but w/o resistance, * normal MMT of next proximal joint * def apply resistance once suture and staples have been removed and wound has healed

Question 28

what are the 2 main goals in strengthening for early post-op Therex?

Answer 28

1. address identified muscle performance impairments 2. maximize overall strength to prep for prosthetic gait

Question 29

immediately post-op what type of strength should we focus on with amputee pts?

Answer 29

1. isometric and AROM, focusing on joint proximal to amp 2. core strength 3. contralateral limb

Question 30

what types of things should be emphasized in a comprehensive HEP for amp pts following surgery?

Answer 30

1. pts with TFA need to emphasize hip ext and abd as well as pelvic movement 2. frequent prone laying or alternative iliopsoas stretching 3. ROM and strength are essential for prosthetic use 4. strengthen intact limb 5. UE strength

Question 31

what is a strong predictor of functional post-op prosthetic use?

Answer 31

pre-amp ambulatory status

Question 32

what must a pt be able to do before they are considered a candidate for a prosthetic?

Answer 32

must be able to ambulate foward/backward and change direction by the time they leave acute care must be able to turn around

Question 33

List pre-prosthetic goals a pt should meet

Answer 33

1. independent w/residual limb care 2. independence in joint/soft tissue mobility 3. demonstrate HEP accurately 4. care of intact LE if amputated for vascular reasons 5. fall prevention

Question 34

what are K-levels?

Answer 34

medicare functional levels used to define out amputee functional capabilities, they range from 0-4

Question 35

describe K0

Answer 35

No ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL ​

Question 36

describe K1

Answer 36

Able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. Limited and unlimited household ambulators​

Question 37

Describe K2

Answer 37

Ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Limited community ambulator​

Question 38

describe K3

Answer 38

Ability for ambulation with variable cadence. Community ambulator who has the ability to traverse most barriers and may engage in vocations, therapeutic, or exercise that demands a prosthesis beyond simple locomotion​

Question 39

describe K4

Answer 39

Ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. Typical of the child, active adult, or athlete.​