What are the major causes of lower extremity amputation? (4)
Risk factors for _ _ _ include: diabetes, poorly managed HTN, high cholesterol, and smoking.
_______ _______: significant cramping pain, usually in the calf that is induced by walking or other prolonged muscle contraction and relieved by a short period of rest. (ischemic response)
intermittent claudication (indication of vascular insufficiency also includes vascular pain, and loss of one or more of lower extremity pulses)
- must be able to perceive _._ _ semmes-weinstein monofilament.
What should be the primary goal be with PVD/DM in regards to feet?
What are the 5 levels/classifications of amputations?
The higher the amputation, the (more or less) difficult the rehab. The (older/younger) the more difficult the treatment.
When should mmt and ROM be assessed after amputation?
-can be done post-operatively immediately but is non-resisted
-once the incision is healed, full grade of motion and strength can be determined
-i'm a trickster
How can a PT record measurements of residual limbs?
measurements are taken from an easily ID'd bony landmark to the palpated end of the long bone, to the incision line, or to the end of the soft tissue
Once primary healing has established, teach pt. scar massage where?
Once wound is well closed, and no steri strips, can begin to?
above and below (not across)
mobilize scar itself (reduces skin breakdown)
_____ _____ _____: (70%) experience numbness, tingling, pressure, itching, and mild cramping in non-existent limb.
_____ ____ ____: shooting limb pain, severe cramping, severe burning in amputated foot/limb. More common in dysvascular limb pt.s
phantom limb sensation
phantom limb pain
How would you explain phantom limb pain to a pt?
all nerves that once had branches to LE are still present, but end at a new place. it takes time for the brain to learn this fact. also, these nerves may be very sensitive from the amputation surgery as they are pulled and then severed and allowed to retract.
Why is compression bandaging important for all amputees? (5)
enhance wound healing
pacilitate prep for prosthetic limb
What are the most common contractures?
transtibial: hip flexion, knee flexion
transfemoral: hip flexion, hip abduction, hip lateral rotation
The shorter the residual limb, the more you need to build in _____ in the design of the prosthetic componets.
Care for residual limb post op:
-wash nightly with mild, ___-___ soap.
-small amnt of ____ to make skin soft and pliable and more tolerant of the posthetic.
-do not use _____ to clean.
Target clinical pathway:
Day _: amputation surgery
Day _-_: acute hospital, pre-prosthetic PT
Day _-_: sub-acute rehab hospital or home for wound healing and continued pre-prosthetic PT
Day _-_: suture/staple removal followed by casting for temporary prosthesis.
How would you teach a pt to don his prosthesis?
-sit in firm chair with arms
- identify and check prosthesis
-inspect condition of residual and remaining limb
-place sheath, socks, or gel liner over residual limb (no wrinkles)
-insert residual limb
-step into prosthesis while sitting
-reverse to doff
Skin-check every __ minutes in inital prosthetic wear. look for texture, appearance, color and condition. Reddened areas should disappear in __ minutes
Problem solving abnormal pressure patterns:
-Pressure on inferior pole of patella? going (too far or too short in) socket. Solution?
-Pressure on tibial tuberosity? going (too far or too short in) socket. Solution?
too far. add socks
too short. decrease socks
_______: movement between skin and the socket, excessive drop of socket away from reisdual limb in swing (problem with suspension).
_____ _____: in order to initiate the progression towards normal gait, the primary goal is to get the pt to stand in parallel bars with an ____ hand, feet 4 inches apart and to move side to side, front to back, and diagnolly. Progress to one hand, and no hands
What info should be included in a HEP for a prosthesis? (5)
-care for prosthesis
-care of sound limb
-changes in weather and weight
When will PT discharge/discontinue pt?
-when pt can do all functional skills without pain, huge energy cost or abnormal gait
-when pt has reached maximal potential (no more progress)
Before discharge or discontinuation of care
-Transtibial amputee should be able to wear prosthesis __-__ hours a day, with good knowledge of skin and prosthetic management, and proficient with prosthetic skills.
-Transfemoral amputee may only wear prosthesis for __-__ minutes.
______: ending PT secondary to pt. reached anticipated goals/outcomes.
_____: ending PT secondary to: patient request, unable to continue secondary to insurance, finances, transportationl or medical complications, and or Pt. no longer benefits
Most new wearers need a major socket revision/new socket within (how long?) to accomodate shrinkage.
-Transmetatarsal: %functional recovery? increased energy requirement?
-Transtibial: %functional recovery? increased energy requirement?
-transfemoral: %functional recovery? increased energy requirement?
Level _: pt. is non ambulatory;medicare wont pay for prosthesis.
Level _: transfers or limited household ambulator; single axis foot/manual knee lock
Level_: limited community ambulator; multi-axis foot/polycentric knee
Level_: unlimited community ambulator
Level_: high energy activities; energy storing feet and hydraulic/microprocessor knee
Identify four possible forms of compression bandaging commonly used after amputation.
rigid removable dressing
What is the purpose of compression bandaging for the amputee? (5)