PTAP Woundcare > Amputation/Prosthetics > Flashcards

Amputation/Prosthetics Flashcards

(50 cards)

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1
Q

Primary causes of Amputations.

A

PVD - primary
Trauma - 2nd
Cancer - osteogenic sarcoma

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2
Q

Amputations performed at partial foot, transtibial or transfemoral levels are for…

A

Vascular Disease

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3
Q

Amputation of all structures below L4-L5 level.

A

Hemicorporectomy

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4
Q

What are the locations for hemipelvectomy
hip disarticulation
knee disarticulation?

A
  • resection of lower 1/2 of pelvis
  • femur removal, pelvis intact
  • tibia removal, femur intact
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5
Q

Amputation thru MTP, can do at any toe joint.

A

toe disarticulation

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6
Q

Amputation thru middle of all MTs.

A

transmetatarsal

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7
Q

Amputation at ankle articulation, attached heel pad to distal tibia and may include removal of malleoli and distal tib-fib.

A

Syme’s Amputation

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8
Q

Expected PT goals for amputation patients.

A 
1 - Reduce post-op edema
2 - Promote healing of residual limb**
3 - Prevent joint contractures**
4 - Improve strength
5 - Adjust to loss of body part
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9
Q

Rigid postoperative dressing that is not adjustable, not removeable and is fitted by the surgeon or prosthetist.

A

IPOP - Immediate Postoperative Prosthesis

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10
Q

Rigid postoperative dressing that is prefabricated, adjustable as limb changes and may be removed as needed for wound inspection.

A

Removeable rigid dressings

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11
Q

Advantages of Rigid Post-op Dressings

A
  • greatly reduces development of post op edema & pain
  • increases wound healing
  • allows for earlier ambulation and fitting of permanent prosthesis
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12
Q

Disadvantages of Rigid Post-op Dressings

A
  • can be expensive
  • requires special training for fabrication
  • requires close supervision during healing stage
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13
Q

Advantages of Semi-rigid Dressings

A
  • specific for shaping and edema control.
  • increases edema control better than soft
  • easy to apply
  • increases healing
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14
Q

Advantages of Soft Dressings

A
  • relatively inexpensive
  • lightweight and readily available
  • easily laundered
  • can be used with TT or TF
  • easier to apply than bandage
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15
Q

Disadvantages of Soft Post-op Dressings

A
  • cant be used until sutures removed
  • poor control of edema
  • can become tourniquet
  • need to replace if limb shrinks
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16
Q

Which member of the Rehab team deals mainly with the UE amputations.

A

Occupational Therapist

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17
Q

Specific Questions to ask patient during rehab process.

A
  • activity?
  • social opportunities?
  • prosthetic wear time
  • skin inspection habits
  • contracture prevent
  • pain level/phantom pain
  • how many socks/shrinks worn
  • any patterns?
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18
Q

Important items from Chart Review of Post-surgical amputation.

A
  • Cause of amputation, type of closure
  • Labs: hematocrit and hemoglobin
  • Medications: pain
  • Comorbidities (PAD, PVD, Respiratory, DM)
  • Social history (smoker, alcohol)
  • Discharge destination
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19
Q

Sensation that the limb is present, described as a burning, tingling, pressure, numbness, itching. may be painless but uncomfortable and dissipates over time.

A

Phantom Sensation

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20
Q

Higher pre-op pain, cramping, shooting, squeezing, burning sensation. Can be continuous or intermittent, triggered by external stimuli. May diminish or become permanent.

A

Phantom Pain

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21
Q

Interventions/Modalities that can be used to treat Phantom Pain

Study These Flashcards
A

Ultrasound
TENS
Icing
Massage

22
Q

What is the minimum of strength needed for prosthetic ambulation?

Study These Flashcards
A

MMT 4/5 in
TT: hip ext and ABD, knee ext and flexion
TF: hip ext and ABD

23
Q

What info should be collected for the Functional Status of an amputation patient?

Study These Flashcards
A 
Transfers/ bed mobility
Mobility - ADs
Balance
Home environment
ADLs and IADLs
PLOF
Expected outcomes - patient and provider
24
Q

What are some examples of desensitization techniques?

Study These Flashcards
A
  • gentle friction massage
  • prevent adhesions
  • mobilize adherent scar tissue
  • decrease hypersensitivity to touch/pressure
25
PT treatment interventions for Residual Limb Care. | think modalities
- Whirlpool - Reflex heating - Hyperbaric oxygen or medication - UV irradiation - caution if vascular disease present!
26
Residual Limb Wrapping Guidelines. (Transtibial)
- two 4 inch bandages - firm pressure - do not sew bandages together - figure 8 (basket weave) pattern - cover areas evenly
27
Contracture Prevention for TT amputation
- full ext of hip/knee - use posterior splint/board while seated - in high TT amputation, prosthesis placed to stretch hamstrings with each step
28
Contracture Prevention for TF amputation
- emphasize full hip ext and adduction - avoid prolonged sitting - intermittent prone lying
29
Management for Moderate to Severe contractures.
- decreased response to manual mobilization | - increased response to PNF stretching (HR and HR with antagonist contract)
30
What is the major psychosocial factor that determines the successful outcome of therapy for an amputee?
motivation
31
Lateral Bending
``` Prosthetic - too short - high medial wall Amputee - abduction contracture - short residual limb ```
32
Abducted Gait
``` Prosthetic - too long - high medial wall - excessive knee friction Amputee - abduction contracture - weak hip flexors and adductors ```
33
Circumducted Gait
``` Prosthetic - prosthesis too long - socket too small Amputee - abduction contracture - weak hip flexors - lacks confidence to flex knee ```
34
Excessive Knee Flexion During Stance
``` Prosthetic - socket set forward in relation to foot - excessive dorsiflexion - prosthesis too long Amputee - knee flexion contracture - hip flexion contracture - weak quadriceps ```
35
Vaulting
``` Prosthetic - prosthetic too long - excessive plantar flexion Amputee - residual limb discomfort - short residual limb - painful hip/limb ```
36
Rotation of Forefoot at Heel Strike
``` Prosthetic - excessive toe-out built in - loose fitting socket - rigid SACH heel cushion Amputee - poor muscle control - weak medial rotators - short residual limb ```
37
Forward Trunk Flexion
``` Prosthetic - socket too big - knee instability Amputee - hip flexion contracture - weak hip extensors - inability to initiate prosthetic knee flexion ```
38
Medial or Lateral Whip
``` Prosthetic - excessive rotation of the knee - tight socket fit - valgus in the prosthetic knee Amputee - weak hip rotators - knee instability ```
39
Disease of the blood vessels, including peripheral vascular disease, peripheral arterial disease, and complications related to diabetes.
Dysvascular
40
The translation of the prosthetic limb from the residual limb. It is the result of inadequate suspension and can result in distal residual limb skin issues.
Pistoning
41
Pressure Sensitive areas of a Transtibial Residual Limb
``` fibular head lateral tibial flare tibial crest distal end of tib/fib patella anterior tibial tubercle peroneal nerve adductor tubercle ```
42
Pressure Sensitive areas of a Transfemoral Residual Limb
``` greater trochanter pubic tubercle pubic ramus pubic symphysis distal end of femur perineum ```
43
Pressure Tolerant areas of a Transtibial Residual Limb
patellar ligament lateral fibula shaft medial tibial shaft lateral tibial shaft
44
Pressure Tolerant areas of a Transfemoral Residual Limb
ischium | soft tissues of residual limb
45
What does the acronym "SACH" stand for?
solid ankle cushion heel
46
What does the acronym "SAFE" stand for?
stationary ankle flexible endoskeleton
47
What are 5 components of a transfemoral prosthesis?
``` shank/pylon (endo/exoskeleton) knee (single/polycentric) socket (partial/full suction/pin lock) ankle (non-articulate/articulate) *also single or multi-axis foot ```
48
What are the 3 major Brim Variants for a transtibial prosthesis?
total surface bearing patella-tendon bearing supra-condylar *supra-condylar/supra-patellar
49
A surgical approach to distal attachment in which a surgeon implants a metal post in the distal bone to secure prosthetic to socket.
osseointegration
50
The 3 most important muscles to strengthen on a new transtibial amputee for ambulation?
Quads Hip Abductors Hip Extensors
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