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S3- Amputation And Prosthetics > Post Amputation Assessment and Treatment > Flashcards

Post Amputation Assessment and Treatment Flashcards

1
Q

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

A

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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2
Q

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

A
  • surgeons

- healing, control edema, manage pain

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3
Q

What are the 4 types of post-op dressings?

A
  • Compressive Soft
  • Shrinker
  • Semi-rigid dressing
  • IPOP
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4
Q
  • What does IPOP stand for?

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

A
  • Immediate Post-Surgical Prosthesis

- weight-bearing

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5
Q

What are the advantages and disadvantages of IPOP?

A

Advantages
+great edema control
+excellent protection
+controls pain

Disadvantages

  • no access to incision*
  • expensive
  • requires training
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6
Q

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

A
  • cast-like

- prosthetic

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7
Q

What are the advantages and disadvantages of SRDs?

A

Advantages
+better edema control
+protection of limb

Disadvantages

  • frequent changing
  • no pt application
  • no access to incision
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8
Q

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

A
  • extension

- over

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9
Q

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.

A

common

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10
Q

What are the advantages and disadvantages of Compressive Soft dressings?

A

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

Disadvantages

  • little edema control
  • frequent rewrapping
  • inconsistent technique
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11
Q

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

A
  • compression, edema

- post-op

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12
Q

What are the advantages and disadvantages of Shrinkers?

A

Advantages
+easy to apply
+inexpensive

Disadvantages

  • sutures removed
  • requires changing
  • tourniquet effect
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13
Q

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

A 
Before= soft dressing
After= shrinker
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14
Q 
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
A
  • post-surgical
  • residual
  • ROM
  • functional
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15
Q

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

A
  • Location
  • Type
  • Nature
  • Intensity
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16
Q

Pain can have a huge impact on __________ activities.

A

functional

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17
Q

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

A
  • 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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18
Q

What things can be done to treat pain?

A
  • dressings and compression help to desensitize limb
  • medications
  • pain education
  • movement
  • modalities
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19
Q

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

A
  1. ) Length
  2. ) Volume
  3. ) Wound Healing
  4. ) Vascularity
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20
Q

For length:

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

- ischial tub. or GT

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21
Q

For volume we take circumferential measurements over known ________ landmarks.

A

bony

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22
Q

What is the intent of measuring length and volume?

A

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

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23
Q

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

A
  • increased drainage
  • increased redness/warmth
  • seperation
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24
Q

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

A
  • distal

- temp/color

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25
Q

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

A

renal

26
Q

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

A

Intact

27
Q

With an Intact Limb Assessment we want to do:

  • ____ screen
  • Diabetic ____ screen
  • _______ testing
  • _______/____ testing
A
  • DVT
  • foot
  • sensory
  • strength/ROM
28
Q

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

A

Past medical history

29
Q

What are some common symptoms of DVT?

A
  • swelling (calf/entire leg)
  • local tenderness along deep venous system
  • increased redness/warmth
30
Q

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

A

ROM

31
Q

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

A

contracture

32
Q

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.

A
  • same

- residual limb

33
Q

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

A
  • flexion/extension, abduction,adduction

- Yes

34
Q

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

A
  • hip flexor

- knee flexor

35
Q

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

A
  • extension

- lordosis

36
Q

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

A
  • extension
  • limb
  • step
37
Q

How do we measure hip flexion?

A

degree relative to hip vertical

38
Q
  • When treating amputees ROM, __________ is critical to prevent knee and hip _________, control _______, maintain patient _______.
  • This is done through patient _________.
A
  • positioning
  • knee and hip contractures, control edema, maintain patient comfort.
  • education
39
Q

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

A

-Stretching/AROM

40
Q
  • What are the key muscles to stretch in a transtibial amputation?
  • What are the key muscles to stretch in a transfemoral amputation?
A
  • hamstrings, hip flexors, gastroc-soleus (contralateral)

- hip flexors, hip abductors, hip external rotators, lumbar extensors, contralateral LE

41
Q

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

A
  • early and often

- extension

42
Q

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.

A
  • resistance
  • active
  • normal
43
Q

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

A
  • Address identified muscle performance impairments

- Maximize overall strength to prep for prosthetic gait

44
Q

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.

A
  • Isometric and AROM

- core

45
Q

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

A

Yes

46
Q
  • What are the muscles targeted for strengthening for a transtibial amputation?
  • What are the muscles targeted for strengthening for a transfemoral amputation?
A
  • quadriceps, hamstrings, glute max, glute med, abdominals, UE
  • glute max, glute med, hip adductors, abdominals, lumbar spine, pelvic floor, UE
47
Q

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
A
  • HEP (home exercise program)
  • TFA (transfemoral amputation)
  • prone, iliopsoas
  • ROM and strength
48
Q
  • Why do amputation patients need upper extremity function?

- What should we test for?

A
  • These patients will need to use assistive devices.

- Sensory loss, intrinsic hand strength

49
Q

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

A
  • Aerobic capacity and endurance (vitals, RPE)
  • Postural control
  • Sitting balance
  • Bed mobility, transfers
  • Gait
50
Q

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

A

ambulatory

51
Q

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

A
  • Sitting/standing balance
  • Activity tolerance
  • UE/LE strength
  • core strength
  • body habitus
  • participation of patient
52
Q

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?

A
  • cardiovascular disease and stroke

- MOCA, Mini-Cog, MMSE

53
Q

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

A
  • 20%

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

54
Q

Morbidity Post-Op Complications:

  • _______glycemia
  • _______ complications (MI, CHF exacerbation)
  • New CVA
  • Bed rest + surgery + inactivity = ↑ risk for _____, skin breakdown
A
  • hyperglycemia
  • cardiac
  • DVT
55
Q 
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
A
  • care
  • mobility
  • HEP
  • fall
56
Q
  • What are K levels?

- What 3 things are they based on?

A
  • Medicare functional levels used to define amputees functional abilites.
  • Transfers, gait ability, gait cadence
57
Q

What do K levels determine in regards to prosthetics?

A

What prosthetic components they will get.

58
Q

List the K levels and their explanation.

A 
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.
59
Q

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

A
  • AMP-PRO (Amputee Mobility Predictor (w/ prosthesis)

- AMP-noPRO (Amputee Mobility Predictor (no prosthesis)

60
Q

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

A

pre-prosthetic

61
Q

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

A

prosthesis

62
Q

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
A
  • function
  • independence
  • device

S3- Amputation And Prosthetics (10 decks)

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