Amputations (AOTA)

Question 1

most common cause of UE amputation

Answer 1

trauma

Question 2

most common cause of LE amputation

Answer 2

peripheral vascular disease

Question 3

goals of surgery during amputation

Answer 3

preserve as much limb length as possible while providing healthy skin, soft tissue, vascularization, sensation, muscle, and bone

a residual limb that is pain free and functional

Question 4

common symptoms during postoperative and preprosthetic phase

Answer 4

1. pain
2. skin complications (delayed healing, necrosis, skin graft adherence to bone)
3. edema of residual limb
4. bone spurs
5. neuroma on distal end of residual limb
6. phantom limb (non-painful sensation that limb is still there; may remain forever)
7. phantom sensation

Question 5

common symptoms during prosthetic phase

Answer 5

1. skin ulcers as a result of poorly fitting prosthesis socket or wrinkles in prosthetic sock
2. sebaceous cysts from torque of prosthetic socket
3. edema from ill-fitting socket or too-tight prosthetic sock
4. sensory changes (hyper- and hyposensitivity, phantom limb, phantom sensation)

Question 6

above the knee amputation

Answer 6

transfemoral amputation

Question 7

below the knee amputation

Answer 7

transtibial

Question 8

below the ankle amputation

Answer 8

transmetatarsal

Question 9

below the elbow amputation

Answer 9

transradial

Question 10

above the elbow amputation

Answer 10

transhumeral

Question 11

below the wrist amputation

Answer 11

transmetacarpal

Question 12

disarticulation

Answer 12

amputation accross a joint

Question 13

Symes amputation

Answer 13

ankle disarticulation

Question 14

preprosthetic phase

Answer 14

from postsurgery until client receives permanent prosthesis

Question 15

goals of preprosthetic phase

Answer 15

1. address psychosocial aspects of limb loss
2. optimize wound healing
3. maximize residual limb shrinkage and shaping to distal end
4. desensitize residual limb
5. maintain/increase ROM and strength
6. facilitate independence in BADLs
7. explore prosthetic options

Question 16

optimal shape for prosthetic socket

Answer 16

tapered distal end

Question 17

goals of prosthetic training

Answer 17

1. teach client to don/doff prosthesis
2. train the client in care of prosthesis
3. increase wearing time to full day
4. encourage independent use of prosthesis

Question 18

most common limitations for people with UE amputation

Answer 18

manipulation of objects

Question 19

most common limitations for people with LE amputations

Answer 19

mobility and ADLs related to LE care

Question 20

how evaluation of self care activities should be done

Answer 20

both with and without prosthesis; include motor skills eval of uninvolved hand in prep for training in one handed techniques and in use of prosthesis when it is worn

Question 21

important client factors that should be evaluated in people with amputations

Answer 21

1. changes in sensation in residual limb
2. presence and severity of phantom sensations
3. pain
4. psychosocial
5. strength, flexibility, and endurance of residual limb and full body in preparation for prosthesis wearing
6. skin integrity

Question 22

Things to include in eval on pt with amputation

Answer 22

1. self care activities both with and without prosthesis
2. include motor skills eval of uninvolved hand in prep for training in one handed techniques and in use of prosthesis when it is worn
3. vocational and recreational interests
4. driving eval
5. environmental analysis of community, home, school, and work

Question 23

preprosthetic interventions

Answer 23

1. training in limb hygiene
2. wound healing, including whirlpool and massage
3. limb shrinkage and shaping
4. desensitization of residual limb through weight bearing on various surfaces, massage, tapping, and rubbing
5. maintain/increase flexibility and strength of residual limb
   - to prevent flexion contractures of knees and hips in LE amputations
6. maintain/increase strength of remaining limbs for propelling w/c, using mobility aids, and weight bearing
7. W/C adjustments

Question 24

wrapping residual limb training

Answer 24

pt should use elastic bandage to reduce edema and develop tapered shape

elastic shrinker or removable rigid dressing can be used if pt is unable to perform wrapping technique

Question 25

w/c fitting for person with LE amputation

Answer 25

large rear wheels should be placed further back to counterbalance missing limbs should have antitippers

Question 26

considerations for prosthesis prescription

Answer 26

1. length, strength, flexibility, and skin integrity of residual limb 2. patient preference of cosmetic appearance 3. hand dominance 4. typical activities to be performed with prosthesis 5. motivation and attitude 6. financial coverage 7. cognition

Question 27

passive TD

Answer 27

terminal device that is realistic, nonfunctional limb work for cosmetic purposes

Question 28

active TD

Answer 28

terminal device that assists with functional activity can be body powered, externally powered, or hybrid powered can be a hook or realistic looking limb

Question 29

attaches the prosthesis to the residual limb

Answer 29

socket

Question 30

positioning components of prosthesis

Answer 30

include wrist, elbow, shoulder, knee, and ankle devices may have locking system activated by user

Question 31

holds the prosthesis on the residual limb

Answer 31

UE: harness or suspension system (control system often combined with harness) LE: pylon (connects terminal device to socket

Question 32

initial wearing time of prosthesis

Answer 32

15-30 min

Question 33

process for progressing wear time of prosthesis

Answer 33

when removed, check residual limb for redness if no red areas are present after 20 min, increase time in 15-30 min increments if redness still present after 20 min, report areas of redness to prosthetist so adjustments can be made

Question 34

hygiene of limb

Answer 34

daily cleansing | daily skin inspection, especially areas with decreased sensation

Question 35

care of prosthesis

Answer 35

clean interior with mild soap and water clean hook or cosmetic hand with soap and water myoelectric prosthesis wearers must be taught to replace batteries

Question 36

UE prosthesis training includes (types of training)

Answer 36

``` prosthesis control training prosthesis use training prepositioning training prehension training functional training ```

Question 37

prosthesis control training

Answer 37

operation of each component of the UE prosthesis

Question 38

prosthesis use training

Answer 38

integration of prosthesis components for efficient assist during functional use

Question 39

prepositioning training

Answer 39

identification of the optimal postition of each positioning unit to perform activity or grasp an object

Question 40

prehension training

Answer 40

TD control during grasp activities

Question 41

functional training

Answer 41

control and use of prosthesis during functional activities | -incorporating TD as functional assist

Question 42

postprosthetic interventions

Answer 42

1. education about prosthesis 2. don/doff training (for myoelectric-proper alignment of electrodes for best contact) 3. wearing schedule 4. limb hygiene 5. care of prosthesis 6. UE prosthesis training 7. provision of AE PRN 8. work with client to gain repertoire of skills needed to complete ADLs IADLs - transfers, bedmobility, w/c mobility - methods to perform vocational and leisure activities 9. home eval PRN 10. psychosocial