Term
| There are over 185,000 amputations per year. List the sites of amputations from greatest to least. |
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Definition
UE
Partial Foot/Toes
Below Knee
Above Knee |
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Term
| List the cause of amputations from greatest to least common. |
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Definition
Disease
Trauma
Tumor
Congenital |
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Term
| What is the #1 disease that causes amputations |
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Definition
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Term
| What is the PT role prior to amputation surgery? |
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Definition
-Pt/Family Education
-PT Goals:
-Education (what to expect post sx, how to care for sound limb)
-Exercise (especially sound limb, gait training with assistive device as needed)
-Team Approach (made up of OT, PT, nutritionist, prosthetist, Dr, family)
-Needed info prior to sx
-Support systems prior to sx (Arkansas Act 1020) |
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Term
| Which type of Dr often does amputation surgery, but was not required to study prosthetics? |
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Definition
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Term
| Which type of Dr often does amputation but did take a course in prosthetics? |
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Definition
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Term
| Name 4 Goals of Amputation |
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Definition
1. Elimination and/or removal of the pathology
2. Optimal healing level (as low as possible to get good tissue)
3. Optimal level for prosthetic fit (not right at a joint)
4. Optimal functional level for ambulation |
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Term
| It is almost always recommended to avoid amputation in the _____ of the tibia, as there is very little muscular tissue for padding in the distal most portion of the lower limb. |
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Definition
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Term
| Calves vary dramatically in thir anterior to posterior diameter, so ideally the tibia would be divided at a point where the distal edge of the appropriate length posterior flap would occur at the junction of the ___ and __ |
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Definition
| Soleus ms and achilles tendon |
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Term
| When the transtibial amputee is standing up, the distance between the ground and the end of the residual limb allows adequate space for what 6 things? |
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Definition
1. Liner
2. Socket
3. Proximal Connector
4. Pylon
5. Distal Connector
6. Foot |
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Term
| __ to __ inches of space allows for the use of most standard prosthetic feet and a pin lock suspension system. |
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Definition
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Term
| __ to __ inches allows for the addition of a shock absorbing component to the above standard prosthetic system. |
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Definition
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Term
| __ to __ inches is required for the use of most integrated high-impact foot/pylon/shock absorbing systems |
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Definition
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Term
| Practically, the tibial bone cut is planned to keep __ to __ length of the tibia. The exact location is based most commonly on the quality of the soft tissue envelope, the shape and size of the calf muscle, the overall height of the individual, and the location of scars, ulcerations or soft tissue defects. |
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Definition
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Term
| Amputation of any of one toe or more. This amputation includes toe plus metatarsal. Balance is way off if you lose your big toe. A toe plate may be placed in the shoe to help with gait. |
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Definition
| Partial Toe / Ray Amputation |
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Term
| Amputation through the midsection of the metatarsals (removal of the toes and distal ends of the metatarsals). Severely effects "toe off". May get a filler in shoes to help with gait. |
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Definition
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Term
| Amputation between the tarsals and metatarsals. Must have something in shoe to fill space. |
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Definition
| Lisfranc or Tarsometatarsal |
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Term
| Amputation at the midtarsal level leaving only the talus and calcaneus |
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Definition
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Term
| Heel pad is swung under and attached to the tibia and fibula to provide a weight bearing surface. No foot. Heel pad is pulled around and used as a weight bearing surface. Can walk on this for very short distances without prosthesis. |
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Definition
| Symes/Ankle Disarticulation |
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Term
| Amputation through the tibia and fibula. May be described as long, medium, or short depending on the length of the residual limb. A short one is hard to get a good prosthetic for. |
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Definition
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Term
| Amputation through the knee joint with the femur left intact. Difficult to make a prosthetic for b/c you have to make a knee joint. |
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Definition
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Term
| Amputation through the femur. May be described as long, standard/medium, or short. |
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Definition
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Term
| Walking is possible with this type of amputation, but the prosthetic is so heavy that it may not be efficient. Many of these occur from trauma, tumors, or maybe wounds that did not heal. |
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Definition
| Hip Disarticulation and Pelvic Amputations |
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Term
| Name 3 types of dressing post-op. |
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Definition
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Term
| What is the post-op care for soft dressings? |
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Definition
-Sterile dressing, cotton padding, and elastic wrap.
-Provides protection, support, and gradient pressure
-Wound can be easily monitored by removing the dressing
-Dressing can be changed as needed to promote healing
-However, donning and doffing can be difficult, tension may vary with application |
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Term
| This type of dressing is done when the wound must be very closely monitored |
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Definition
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Term
| This type of dressing is good to form the limb |
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Definition
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Term
| This type of dressing is done more in traumatic injuries and the wound needs to have good healing potential. |
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Definition
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Term
| Made of paste compound (unna paste) and felt or cotton padding |
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Definition
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Term
| Made of plaster bandages or fiberglass casting with cotton or felt pads. Prevents excessive post-surgical edema and to provide a dry sterile environment for healing |
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Definition
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Term
| Name 6 advantages of semi-rigid or rigid dressing post-operatively |
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Definition
1. Good support to surgical site and increased comfort
2. Improved wound healing environment (decrease edema)
3. The rigid dressing allows for early bipedal ambulation with the attachment of a pylon and foot (not full WB)
4. Allows for earlier fit of the definitive prosthesis
5. Can be made to be removed
6. Helps decrease phantom pain |
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Term
| Name 3 disadvantages of semi-rigid and rigid dressing post-operatively |
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Definition
1. Requires careful application by knowledgeable individuals
2. Requires close supervision during early stage of healing
3. Does not allow daily wound inspection and dressing changes. (May have window in the distal end of the cast to allow for dressing changes or be bivalved) |
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Term
| What does "bivalve" mean? |
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Definition
| Cut down side to look and can put back on |
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Term
| Name 9 Secondary Complications of Amputations |
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Definition
Pulmonary Complications
DVT
Infection
Formation of contractures
Physical de-conditioning
Phantom Pain
Back Pain
Wound Healing
Bowel and Bladder problems for some |
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Term
-Age of individual
-Physical de-condition prior to amputation
-Complications post amputation
-Prolonged bed rest
-Increased pneumonia risk
-Need to sit up in bed and mobilize ASAP
-Older people are at higher risk |
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Definition
| Pulmonary Secondary Complication |
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Term
-Prolonged bed rest
-Physical de-conditioning prior to amputation
-Poor circulation pre and post amputation |
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Definition
| DVT Secondary Complication |
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Term
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Definition
Redness
Pus
Drainage around suture lines
Odor |
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Term
| May occur due to poor circulation, primary diagnosis, and wound management. |
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Definition
| Infection secondary cause |
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Term
| Name the 3 most common areas for contracture of the LE's with transfemoral amputation |
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Definition
Hip Flexion #1
Hip abduction
Hip ER |
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Term
| Name the 4 most common areas for contracture of the LE's with transtibial amputation |
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Definition
Knee Flexion (#1)
Hip Flexion
Hip abduction
Hip ER |
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Term
| What ROM must you have to use prosthetic? |
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Definition
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Term
| When is the soonest after sx that you can start ROM? |
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Definition
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Term
| After healing of the surgical site, what are 4 things, other than ROM, that you can begin doing. |
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Definition
1. Scar massage
2. Muscle stretching
3. Deep friction massage
4. Joint mobilization if contractures has occurred |
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Term
| With this type of amputation, you should educate the pt to avoid positioning with a pillow under knees and prolonged sitting with knee flexed and in the fetal position. You always want knee extended. |
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Definition
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Term
| With this type of amputation, you should educate your patient to avoid prolonged sitting, placing pillows under residual limb and the fetal position. Encourage the prone position with hips in neutral. |
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Definition
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Term
| Pain following amputation may present in 3 different ways. |
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Definition
Phantom Sensation
Phantom Pain
Residual Limb Pain |
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Term
| A non-painful sensation or awareness of the body part no longer there. Usually occurs immediately post-op with varying degrees of intensity and changes over time. Described as pressure, tingling, numbness, itching, formication, general discomfort, phantom movement |
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Definition
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Term
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Definition
| Occurs especially in traumatic injuries. Pt feels like the limb is in the same position it was during the injury |
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Term
| A painful sensation perceived in the missing body part. Occurs in at least 70% of all amputees regardless of age, gender, race, health, or psychological status. May be local or diffuse, intermittent or continual and may be triggered by external stimuli. May become a disabling condition decreasing the patient's rehab potential. Typically described as dull ache, cramping, squeezing, burning, shooting, stabbing, limb being pulled off, unnatural position, and pre-op pain that continues post-op |
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Definition
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Term
| Pain caused by a specific anatomical structure that can be identified. Such as pain due to the prosthesis, abnormal residual limb tissue, joint pain, soft tissue pain, soreness, etc. Tends to be more localized. |
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Definition
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Term
| Decreases hypersensitivity of residual limb through progressive tactile stimulation, sensory overload and increased weight bearing |
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Definition
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Term
| What is the PT intervention methods for dealing with limb sensation/pain? |
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Definition
Very important to evaluate the exact type of sensation or pain the pt describes in order to treat effectively
-Desensitization
-Residual limb wrapping or use of semi-rigid or rigid dressings
-WB in prosthetic
-Modalities such as heat, US, TENS
-Massage, vibration, and sensory overload
-Distraction on healed residual limb
-In cases of severe/chronic pain, surgical intervention is needed, electric shock, analgesic meds or narcotics and psychological intervention |
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Term
| This is due to gait pattern and is most common in transfemoral amputations but can occur in any LE amputation. |
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Definition
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Term
| Name 5 PT treatments for back pain secondary to LE amputation |
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Definition
1. Normal gait pattern
2. Shock absorbing feet
3. Evaluation of proper fitting socket
4. Strengthening core muscles
5. Modalities as needed |
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Term
| What is a PT intervention to prevent edema? |
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Definition
Residual limb wrapping
-Critical for those patients without semi-rigid or rigid dressings post-op. Early education to both the pt and family is essential for correct application and understanding of the importance of the wrap. |
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Term
| Name 6 indication for residual limb wrapping |
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Definition
1. Decrease edema
2. Increase wound healing
3. Protection of residual limb
4. Aid in the shaping of the residual limb for better prosthetic fit (must be done quickly)
5. To decrease pain through sensory overload
6. Aid in achieving a permanent size to residual limb so prosthesis will fit |
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Term
| Name 4 advantages to residual limb wrapping |
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Definition
Inexpensive
Available almost anywhere
Washable
Can vary the amount of compression |
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Term
| Name 4 disadvantages of residual limb wrapping |
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Definition
1. wrap tends to loosen and slip
2. requires education to properly apply
3. reapplication is necessary throughout day
4. difficult for some clients to don/doff independently |
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Term
| A sock-like garment fit by the prosthetist, made of elasticized material used to reduce edema in a residual limb. Not appropriate until excessive edema decreases. |
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Definition
| Shrinker socks (residual limb shrinkers) |
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Term
| Name 5 advantages to shrinker socks |
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Definition
1. Available thru prosthetist
2. Washable
3. Various Sizes
4. Can have belt suspension for added fit
5. Easier to don/doff |
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Term
| Name 3 disadvantages of shrinker socks. |
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Definition
1. Expensive
2. Must go thru prosthetist to get
3. May need to change socks frequently until residual limb stabilizes in size |
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Term
| Can you use a shrinker inside the prosthetic? |
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Definition
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Term
| How often should you check the skin of your residual limb? |
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Definition
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Term
| Can you put residual limb into a socket if there is a wound? |
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Definition
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Term
Complications can arise secondary to surgery and bedrest especially for those pts with decreased conditioning prior to surgery
PT Intervention:
- Get the pt up ASAP
- Deep breathing exercises
- Positioning
- UBE (upper body ergometer)
- Education |
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Definition
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Term
| How long after surgery can you begin UE exercises, sound limb exercises, and trunk exercises? |
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Definition
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Term
| Initial strengthening of residual limb should be done only within __ limits. Must take care not to compromise healing. |
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Definition
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Term
| With this level amputation, really focus on strengthening the knee extensors. |
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Definition
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Term
| With this level amputation, really focus on strengthening the hip musculature |
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Definition
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Term
| Rehab potential greatly is greatly effected by psychosocial status. Name 3 issues. |
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Definition
1. Level of amputation
2. Social relationships
3. Reasons for amputation
- elimination of pain
- cancer |
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Term
| A good prosthetic will __ energy expenditure and __ walk distance and speed |
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Definition
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Term
| Vascular disease __ levels of O2 consumption which results in __ speed of walking |
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Definition
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Term
| Ambulation with prosthesis and crutches __ energy than ambulation with crutches and without prosthesis. |
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Definition
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Term
| The higher the level of amputation, __ waling speed. |
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Definition
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Term
| Name 4 PT intervention for energy expenditure |
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Definition
1. Frequent monitoring of vitals
2. Provision of equipment
3. Recommended the most efficient and greatest energy return
4. Promote normal gait pattern and posture (exercises with and without prosthesis) |
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