Post Amputation Assessment and Treatment Flashcards by Chance Lee Cauble

What are the 3 different post-op phases and describe them.

Acute Phase
-Time between surgery and discharge from acute care.
Pre-prosthetic Phase
-Time between discharge from acute care and fitting with a definitive prosthesis OR until medical decision is made not to fit with prosthesis.
Prosthetic Phase
-Long-term management including rehabilitation and training with prosthetic.

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Post-op dressings are primarily the _________ decision and is meant to protect the incision and residual limb as well as foster ________, control _______, and manage _____.

surgeons

- healing, control edema, manage pain

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What are the 4 types of post-op dressings?

Compressive Soft
Shrinker
Semi-rigid dressing
IPOP

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What does IPOP stand for?

- IPOP is a prosthetic socket allowing for limited ______-________ ambulation in the early stages.

Immediate Post-Surgical Prosthesis

- weight-bearing

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What are the advantages and disadvantages of IPOP?

Advantages
+great edema control
+excellent protection
+controls pain

Disadvantages

no access to incision*
expensive
requires training

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Rigid/Semi-Rigid Dressing (SRDs) is a “____-like” dressing that is applied in the OR or recovery room and allows for immediate ________ fitting.

cast-like

- prosthetic

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What are the advantages and disadvantages of SRDs?

Advantages
+better edema control
+protection of limb

Disadvantages

frequent changing
no pt application
no access to incision

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Splints/Immobilizers can be air or rigid and encourages full knee _________. This is worn ______ primary dressing.

extension

- over

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Soft Dressings are the most ________. They are done immediately post-op, wrapped with sterile gauze and covered with compressive elastic bandage in figure-8 fashion.

common

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What are the advantages and disadvantages of Compressive Soft dressings?

Advantages
+easy to apply
+inexpensive
+easy access to incision

Disadvantages

little edema control
frequent rewrapping
inconsistent technique

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Limb Shrinkers provide good _________ and ______ control, but cannon be worn _______.

compression, edema

- post-op

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What are the advantages and disadvantages of Shrinkers?

Advantages
+easy to apply
+inexpensive

Disadvantages

sutures removed
requires changing
tourniquet effect

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What is our preferred method of controlling edema before/after staples and sutures come out.

Before= soft dressing
After= shrinker

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Post-Surgical Eval and Treatment:
A.) General systems review/chart review
B.) \_\_\_\_-\_\_\_\_\_\_\_\_ status 
C.) Pain
D.) \_\_\_\_\_\_\_\_\_\_\_ limb assessment
E.) \_\_\_\_ and strength
F.) \_\_\_\_\_\_\_\_\_ status
G.) Cognition/emotion
H.) Post-op Complications

post-surgical
residual
ROM
functional

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Patients post-op are likely to be in significant pain. We need to determine what about the pain?

Location
Type
Nature
Intensity

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Pain can have a huge impact on __________ activities.

functional

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What is the difference between phantom limb sensation and phantom limb pain?

Phantom limb sensation is the awareness of the amputated limb, possibly accompanied by tingling.
Phantom limb pain is where the brain continues to receive painful sensory messages from the nerves that originally carried messages from amputated limb.

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What things can be done to treat pain?

dressings and compression help to desensitize limb
medications
pain education
movement
modalities

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What 4 things are we looking at when performing a Residual Limb Assessment?

) Length
) Volume
) Wound Healing
) Vascularity

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For length:

Transtibial measurement is from the ______ joint line to end of limb.
Transfemoral measurement is from the __________ or ______ to end of limb.

medial

- ischial tub. or GT

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For volume we take circumferential measurements over known ________ landmarks.

bony

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What is the intent of measuring length and volume?

Not for prosthetic fitting, but for monitoring of things such as edema.

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For wound healing we want to perform a typical assessment and look for S/S of infection such as what?

increased drainage
increased redness/warmth
seperation

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For vascularity we want to check _______ pulses as well as skin ____/______ (at rest and with position change).

distal

- temp/color

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Residual Limb Volume Assessment is very important in patients with _____ disease because they tend to have uncontrolled swelling.

renal

We also want to perform a _________ Limb Assesment in addition to our Residual Limb Assessment.

Intact

With an Intact Limb Assessment we want to do: - ____ screen - Diabetic ____ screen - _______ testing - _______/____ testing

- DVT - foot - sensory - strength/ROM

What can help us with finding issues with patient's intact limb?

Past medical history

What are some common symptoms of DVT?

- swelling (calf/entire leg) - local tenderness along deep venous system - increased redness/warmth

For all amputees, ____ is ESSENTIAL for normal prosthetic use.

ROM

Prevention of ___________ is primary goal in the acute/preprosthetic phase.

contracture

For ROM testing of a transtibial amputation, hip ROM will be performed the ______ as always, but knee ROM will involve using the midline of the ___________ as the movement arm.

- same | - residual limb

For ROM testing of transfemoral amputation we measure hip ______/_______ as well as hip ________/__________. Can muscle length tests still be performed?

- flexion/extension, abduction,adduction | - Yes

If left untreated, _____________ and _____________ contractures can start to present.

- hip flexor | - knee flexor

Hip flexor contractures can lead to things such as decreased _________ during gait and increased lumbar _____________.

- extension | - lordosis

Knee flexor contractures can lead to things such as decreased ___________ during gait, decreased ____ length, decreased _____ length.

- extension - limb - step

How do we measure hip flexion?

degree relative to hip vertical

- When treating amputees ROM, __________ is critical to prevent knee and hip _________, control _______, maintain patient _______. - This is done through patient _________.

- positioning - knee and hip contractures, control edema, maintain patient comfort. - education

In addition to positioning, we can also treat ROM via _______/_____.

-Stretching/AROM

- What are the key muscles to stretch in a transtibial amputation? - What are the key muscles to stretch in a transfemoral amputation?

- hamstrings, hip flexors, gastroc-soleus (contralateral) | - hip flexors, hip abductors, hip external rotators, lumbar extensors, contralateral LE

With AROM, we should perform this _____ and _______. Focus on knee and hip ___________ and work through the available range.

- early and often | - extension

For strength assessment in acute settings we DO NOT apply __________ over surgical incision. We DO test ______, non-resistive movement against gravity at the joint just proximal to amputation. At the next joint we can apply ______ MMT.

- resistance - active - normal

What are the 2 main goals for early post-op therex for strengthening?

- Address identified muscle performance impairments | - Maximize overall strength to prep for prosthetic gait

For early post-op therex, immediately post-op we want to focus on _______ and _____ of the joint proximal to amputation. It is also important to look at _____ strength as well as the contralateral limb.

- Isometric and AROM | - core

Is exercise progression the same for the amputation population compared to any other population?

Yes

- What are the muscles targeted for strengthening for a transtibial amputation? - What are the muscles targeted for strengthening for a transfemoral amputation?

- quadriceps, hamstrings, glute max, glute med, abdominals, UE - glute max, glute med, hip adductors, abdominals, lumbar spine, pelvic floor, UE

Stretching and Strengthening Overall: - Issue comprehensive ____ soon after surgery - Patients with _____ need to emphasize hip extension and abduction as well as pelvic movement - Frequent ______ laying or alternative _________ stretching must be emphasized - _____ and ________ are ESSENTIAL to prosthetic use - Intact limb - UE Strength

- HEP (home exercise program) - TFA (transfemoral amputation) - prone, iliopsoas - ROM and strength

- Why do amputation patients need upper extremity function? | - What should we test for?

- These patients will need to use assistive devices. | - Sensory loss, intrinsic hand strength

What are some other functional status we would be looking for in amputation patients?

- Aerobic capacity and endurance (vitals, RPE) - Postural control - Sitting balance - Bed mobility, transfers - Gait

Pre-amputation ___________ status a strong predictor of functional post-operative prosthetic use?

ambulatory

For balance and transfer activities we need to determine the safest and most efficient transfer methods possible. What does this depend on?

- Sitting/standing balance - Activity tolerance - UE/LE strength - core strength - body habitus - participation of patient

For our dysvascular patients, the underlying mechanism for their amputation is the same as it is for _________ disease and _______. Because of this we should test for attention and cognition, what are 3 ways to do this?

- cardiovascular disease and stroke | - MOCA, Mini-Cog, MMSE

In hospital mortality is as high as __%. What are some examples of patients that are more prone to mortality post-op?

- 20% | - older, TFA, COPD/CHF, Hx of stroke/renal disease/MI

Morbidity Post-Op Complications: - _______glycemia - _______ complications (MI, CHF exacerbation) - New CVA - Bed rest + surgery + inactivity = ↑ risk for _____, skin breakdown

- hyperglycemia - cardiac - DVT

``` Pre-Prosthetic Goals: A.) Independence with residual limb ____ B.) Independence in joint/soft tissue ________ -Maximize ROM C.) Demonstrate _____ accurately -Maximize strength and ROM -BALANCE D.) Care of intact LE if amputated for vascular reasons E.) _____ Prevention ```

- care - mobility - HEP - fall

- What are K levels? | - What 3 things are they based on?

- Medicare functional levels used to define amputees functional abilites. - Transfers, gait ability, gait cadence

What do K levels determine in regards to prosthetics?

What prosthetic components they will get.

List the K levels and their explanation.

``` K0 = No ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL K1 = Able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. Limited and unlimited household ambulators K2 = Ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Limited community ambulator K3= 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 K4= Ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. Typical of the child, active adult, or athlete. ```

What are some functional outcome measures that we can use to determine the K level a patient is?

- AMP-PRO (Amputee Mobility Predictor (w/ prosthesis) | - AMP-noPRO (Amputee Mobility Predictor (no prosthesis)

The AMP-noPRO predicts likelihood of prosthetic use, also used as a good outcome measure in the ___-____________ period.

pre-prosthetic

The AMP-PRO gives us an idea of whether or not the _________ is appropriate.

prosthesis

Main Takeaways: - Proper assessment and targeted interventions immediately after amputation have a huge impact on prosthetic use, and therefore _________. - Don’t forget about the contralateral limb (both assessment and treatment!) - Strive for ____________ and self-care - Concepts of muscle length, ROM, strength assessment and treatment hold true in this population - Functional ability (or predicted ability) impacts the _________ a patient receives

- function - independence - device

Post Amputation Assessment and Treatment Flashcards

(62 cards)