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Flashcards in Post Amp Trx Deck (40)
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1

List and describe the phases following post-ampuation surgery

  1. acute phase → time between surgery and D/C from acute care
  2. pre-prosthetic phase → time between D/C from acute care and fitting with a definitive prosthesis 
  3. prosthetic phase → long term management (includes rehab and training w/prosthetic)

 

2

what is the primary goal in the acute/pre-prosthetic phase of trx?

prevention of contracture

3

what is the purpose of the post-op dressing?

meant to protect the incision and residual limb as well as foster healing, control edema, and manage pain

(primarily surgeon decision, but PTs can get some say if involved in prehab/pre-op care)

4

List the different types of post-op dressing

  1. compressive soft
  2. shrinker
  3. semi-rigid dressing
  4. IPOP

 

5

what is an IPOP?

immediate post-surgical prosthesis → prosthetic socket allowing for limited weight-bearing ambulation in the early stages

6

List the advantages/disadvantages of IPOPs

  1. Advantages
    • great edema control
    • excellent protection
    • controls pain
  2. Disadvantages 
    • access to incision difficult
    • more expensive
    • requires training

 

7

what is a rigid/semi-rigid dressing (SRDs)?

list a cast or rigid dressing applied in the OR/recovery room

allows for immediate prosthetic fitting

dressing adheres to the skin

8

List the advantages/disadvantages of SRDs

  1. Advantages
    • better edema control
    • protection of limb
  2. Disadvantages
    • frequent changing required
    • no pt application
    • no access to incision

 

9

what is a soft dressing?

most common/preferred post-op dressing

immediately post-op, limb is wrapped w/sterile gauze and covered w/compressive elastic bandage in figure 8 fashion

10

List the advantages/disadvantages of soft dressings

  1. Advantages
    • easy to apply
    • inexpensive
    • easy access to incision 
  2. Disadvantages 
    • little edema control
    • frequent rewrapping
    • inconsistent technique

 

11

why might a splint/immobolize be used during post-op?

encourages full knee extension (prevent knee flexion contracture)

*this is worn over the primary dressing

12

What things are included in a post-surgical evaluation/trx?

  1. General systems review/chart review
  2. post-surgical status
  3. pain level
  4. residual limb assessment
  5. ROM and strength
  6. functional status
  7. cognition/emotion
  8. post-op complication

 

13

what needs to be determined during a pain assessment post-operatively?

  1. location of pain
  2. type of pain 
  3. nature of pain
  4. intensity of pain
  5. impact on functional activities

 

14

define phantom limb sensation

painless awareness of the amputated limb, possibly accompanied by tingling

15

what is phantom limb pain?

brain continues to recieve painful sensory messages from the nerves that originally carried messages from amputated limb

feelings of cramping, burning, pain

16

how might a PT treat pain in an amputee?

  1. dressing and compression help to desensitize limb
  2. pain education
  3. movement
  4. modalities

 

17

what is included in the residual limb assessment?

  1. limb length
  2. volume (circumference)
  3. degree of wound healing
  4. vascularity

 

18

where are the staring and ending points for measuring limb length in a TTA? TFA?

  1. TTA → medial joint line to end of limb
  2. TFA → ischial tub. or GT to end of limb

 

19

what things are included in the contralateral limb assessment?

  1. DVT screen
  2. diabetic foot screen (if appropriate)
  3. sensory testing
  4. Strength/ROM testing

 

20

List common DVT symptoms

  1. swelling (calf/entire leg)
  2. local tenderness along deep venous system
  3. increased redness/warmth

 

21

how do the landmarks change for goni placement in amputees?

if bony landmarks are still available use them,

but now the moving arm is the midline of the residual limb

all proximal joints remain the same

22

T/F: a contracture is the tightening of the muscle 

FALSE
it is also changes to the joint capsule 

23

why is positioning important for post-op care in amputee?

  1. critical to prevent contractures
  2. edema control
  3. patient comfort
  4. patient education

 

24

what key muscles are targeted in a TTA during AROM/stretching?

hamstrings

hip flexors

gastroc-soleus (contralateral)

25

what key muscles are targeted in a TFA during AROM/stretching?

hip flexors

hip abductors

hip ERs

lumbar extensors

contralateral LE

26

what are some general principles to remember when working on AROM with an amputee?

  1. early and often
  2. focus on knee and hip extension
  3. work through available range

 

27

how is strength assessment different in an acute setting for amputees?

  • do not apply resistance over surgical incision
  • Test active but w/o resistance, 
  • normal MMT of next proximal joint
  • def apply resistance once suture and staples have been removed and wound has healed 

 

28

what are the 2 main goals in strengthening for early post-op Therex?

  1. address identified muscle performance impairments
  2. maximize overall strength to prep for prosthetic gait

 

29

immediately post-op what type of strength should we focus on with amputee pts?

  1. isometric and AROM, focusing on joint proximal to amp
  2. core strength
  3. contralateral limb 

 

30

what types of things should be emphasized in a comprehensive HEP for amp pts following surgery?

  1. pts with TFA need to emphasize hip ext and abd as well as pelvic movement
  2. frequent prone laying or alternative iliopsoas stretching
  3. ROM and strength are essential for prosthetic use
  4. strengthen intact limb
  5. UE strength