What is the ideal residual limb?
- No excessive redundant tissue - Decreased chance of skin breakdown
- Incision is not under tension - Ex: Adductors
- Circulation is good to all distal tissues, especially the skin flaps
- Bone ends are smoothed and rounded - Distal tibia is beveled
- Save as much bone length as possible
What defines a long, standard , and short TT amputation?
- Long TT = > 50% tibial length
- Standard TT = 20-50% tibial length; Preferred level is at taper of gastrocnemius
- Short TT = < 20% tibial length
What defines a long, standard , and short TF amputation?
- Long TF = >60% femoral length
- Standard TF = 35-60% femoral length
- Short TF = <35% femoral length
Advantages and disadvantages of an elastic bandage (ace wrap)
Advantages:
- Easy to apply
- inexpensive
- easy access to incision
Disadvantages:
- Little edema control
- minimal RL protection
- Requires frequent rewrapping (every 2 hrs)
Advantages and disadvantages of a shrinker
Advantages:
- Easy to apply
- inexpensive
- easy access to incision
- can be applied by pt
Disadvantages:
- little edema control
- requires changing as RL shrinks
- not used until sutures are removed
- pt will wear this the rest of their life
Advantages and disadvantages of semirigid dressing (Unna’s dressing or air splint)
Advantages:
- better edema control than soft dressings
- RL protection
Disadvantages:
- Needs frequent changing
- cannot be applied by pt
- no access to incision
- pts younger, no trauma, no PVD, healthy skin, want pt to get up and moving early
Advantages and disadvantages of IPOP or EPOP (immediately/ early post surgical prosthesis)
Advantages:
- Excellent edema control
- Excellent RL protection
- Control of RL pain
Disadvantages
- No access to incision
- most expensive
- requires proper training for use
- not adjustable or removable
- pts younger, no trauma, no PVD, pt to get up and moving early
What strengthening exercises are indicated in the post-surgical phase?
TF: Isometrics (glut sets, ADD), AAROM residual limb, AROM and PRE’s of uninvolved limb
TT: Isometrics (glut sets, quad sets), AAROM residual limb, AROM and PREs of uninvolved limb
resisted exercises of the residual limb are contraindicated during this phase
Name the postsurgical phase goals
- Healing of residual limb
- Protect intact limb - Primarily Concerned with Skin Integrity, Esp Heel; Stand pivot transfer (shearing); Less mobile than they were before
- Increase independence in transfers and mobility
- Demonstrate proper positioning
- Understand prosthetic rehab process - Goal is to make it so the pr’s limb is able to be fit for prosthetic
- What contributes to the success of this phase
Name the preprosthetic phase goals
- Indep in residual limb care - Bandaging/shrinker, skin care, positioning
- Indep in mobility, transfers, and functional activities - Single leg ambulation with crutches/ FWW if fitted with soft dressing
- Demonstrate HEP - ROM progressing to resistive exercises for residual lim; ROM and strength for unamputated limb
- Care of the unamputated limb if vascular issues
How do you measure the residual limb for a TT?
Length – medial tibial plateau to end of bone AND end of soft tissue (2 measurements)
Circumference – every 5-8 cm
Dist → Prox
How do you measure the residual limb for a TF?
Length – greater trochanter to end of bone AND end of soft tissue (2)
Circumference – every 8-10 cm
Dist → Prox
What muscles do you NEED to MMT for TT?
hip ext, abd, knee ext, knee fl (p)
What muscles do you NEED to MMT for TF?
hip ext (p), abd (S/L)
This base level is assigned to amputees who do not have the ability or potential to ambulate or transfer safely with or without assistance. A prosthesis does not enhance the quality of life or mobility of the amputee.
K0 - no mobility
The amputee has the ability or potential to use a prosthesis for transfers or ambulation in level surfaces at a fixed walking pace. Typical household ambulator.
K1 - very limited mobility
The amputee has the ability or potential to use a prosthesis for ambulation and the ability to adjust for low-level environmental barriers such as curbs, stairs, or uneven surfaces. K2 level amputees may walk for limited periods of time however, without significantly varying their speed. Typical limited community ambulator.
K2 - limited mobility
- parking sticker
- well in home
- trouble in a cross walk; can’t accelerate
- NO VARIABLE CADENCE
- doesn’t get anything better than K1
The amputee has the ability or potential to use a prosthesis for basic ambulation and the ability to adjust for most environmental barriers. The amputee has the ability to walk at varying speeds. Typical unlimited community ambulator.
K3 - Basic to Normal Mobility
- can do what someone w/o a prosthetic can do, including exercise
The amputee exceeds basic mobility and applies high impact and stress to the prosthetic leg. Typical of the prosthetic demands of the child, active adult, or athlete.
K4 - high activity
- doesn’t get anything better than K3
