Amputation

Question 0

Steps for amputation rehab: Pre-prosthetic training (5)

Answer 0

1. Psychological support
2. Residual limb shrinkage
3. Residual limb conditioning
4. ADL training
5. Residual limb training

Question 1

What’s more common UE vs LE? What are the common causes for each?

Answer 1

LE more common - peripheral vascular disease (secondary to diabetes)
UE - due to trauma

Question 2

Steps for amputation rehab: prosthetic training (5)

Answer 2

1. Orientation
2. Donning/doffing prosthesis
3. Prosthetic tolerance building
4. Control training
5. Use training

Question 3

Sensation issues after amputation (5)

Answer 3

1. Loss of sensory feedback
2. Hyperesthesia (overly sensitive)
3. Neuroma (painful ball of nerves)
4. Phantom limb (sensation limb is still there)
5. Phantom sensations (eg pain, cramp, mvmt)

Question 4

Components of residual limb use training (3)

Answer 4

1. Bilateral activities with u-cuff
2. Use RL to stabilize
3. Encouraging use hastens acceptances and use of RL

Question 5

Prosthetic training

Answer 5

1. Orientation (parts, functions, maintenance)
2. Donning & doffing
3. Prosthetic tolerance
4. Control training
5. Use training

Question 6

Steps of prosthetic tolerance building (5)

Answer 6

1. Initial wear 1/2hr, 3x/day
2. Add 1/2hr w/ no irritation
3. Grade to 2hrs “
4. Grade to full tolerance in 2hr increments
5. Skin irritation lasting more than 1/2hr indicates need for prosthetic revision

Question 7

Use training (4)

Answer 7

1. Grasp/release - hard to soft objects, large to small
2. Pre-positioning - set-up in proximal to distal order, plan ahead of activity
3. ADL training using prosthesis
4. Vocational/avocational assessment & training

Question 8

Methods for desensitization (12)

Answer 8

Massage, tapping, exposure to textures, electrical stimulation, exercise, hot & cold therapy, mirror box therapy, biofeedback, ultrasound, progressive relaxation, deep breathing, possible nerve blocking

Question 9

Intervention for phantom limb (4)

Answer 9

1. Education
2. Supportive counseling
3. Use of residual limb
4. In many cases, it’s best not to dwell on phantom limb, but focus on prosthetic training & return to former lifestyle

Question 10

Wound healing: massage (4)

Answer 10

1. Massage (discourage scar adhesions, increase circulation, aid in desensitization, reduce swelling)
2. Begin massage after incision had stabilized
3. Progress from light to deep massage
4. Check status with MD first

Question 11

Wrapping (3)

Answer 11

1. Shrinking & wrapping necessary to form tapered limb that will tolerate socket
2. Compression: elastic bandage, tubular bandage, or shrinker sock
3. Socks are preferable because they are easier for ct to manage