Lecture 9 - Amputation

Question 1

Why are amputations performed?

2

Answer 1

improve health

improve function

Question 2

what are the main reasons for amputation

Answer 2

peripheral vascular disease (PVD) (diabetics)

Traumatic - mostly MVA or MBA

Question 3

What are the levels of lower limb amputations

Answer 3

Toe disarticulation - at MTP jt
transmetatarsal - through midsection of all MTs
Transtibial - 20-50% of tibail length
Knee disarticulation - through knee
transfemoral -  35-60+% through femur 
hip disarticulation - through hip jt

Question 4

Describe briefly the 4 K-levels

Answer 4

K0 - no ability or potential to transfer - not eligible
K1 - ability to use prosthesis for transfer
K2 - ability to traverse low level environmental barriers
K3 - ambulation with variable cadence
K4 - patient has ambulation that exceeds basic ambulation skills, high impact stress - athlete

Question 5

Aims of physio

Answer 5

assessment of goals, needs, abilities
promote independence
re-educate movement patterns 
optimize function for ADLS
wheelchair/prosthetic use

Question 6

What does a physio do pre-op and post-op

Answer 6

pre

• physical, functional, psychological assessment
• education on rehab
• wheelchair/mobility practice

post

• sutures: 3 w
• dressings for wound for limb shaping
• drains
• physical and functional assessment
• pain and swelling
• transfers
• walking aids
• exercise for strength, balance

Question 7

what are the two types of pain a patient gets from amputation

Answer 7

residual = trauma, pressure on nerve endings causes pain - 3 weeks to heal - physio massage and US

Phantom limb = pain in missing limb,

• 2 reasons: 1) nerves have been severed - causing injury to nerve tissue and pain messages are sent to the brain. 2) brain has an area of tissue dedicated to that body part and expects sensory info
• burning, electric, cramping, foot facing backwards
• management: reassure, TENS, compression, massage, analgesia

Question 8

What does a physio do before prosthetic and after

Answer 8

Pre

• compression and shaping of residual limb
• CV fitness, strength, balance, ROM
• improve coordination - balance, WB through limb

Prosthetic

• gait re-education
• pain control
• exercise - strength, balance, stretching