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jpowell22
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What may a pre-op exers program involve?
- deep breathing and coughing
- general ex
- increase proximal m strength
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What are some goals of rehab?
- regain pre-surgical function
- help function at higher level
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What are some goals of the post-surgical program?
- promote healing of residual limb
- reduce/prevent edema
- reduce pain
- prevent contractures/complications
- maintain mobility of all proximal jts
- maintain/regain strength of all proximal jts
- increase/maintain strength in remaining limbs
- pt education/independence
- learn proper care of remaining limb
- achieve max independence with ADLs
- assist with adjustment to the loss of a body part
- determine feasibility of prosthetic fitting
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What are the 3 types of dressings post-op?
- rigid
- semi-rigid
- soft dressing
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What are the advantages of a rigid dressing (cast)?
- controls edema the best
- decreases pain
- increases healing
- can serve as a foundation for immediate post-op prosthesis (IPOP) for early weight bearing
- pt can use the limb for function soon after surgery
- early prosthetic use is associated with a greater likelyhood of eventual acceptance of final prosthesis
- prevents contractures
- protects limb from trauma
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What are the disadvantages of a rigid dressing?
- need trained personnel to appy
- cant check suture line
- not removable or adjustable
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What are the advantages of a removeable rigid dressing (RRD)?
- can be removed to check wound/incision healing
- gives immediate post op fit for prothesis for early WBing
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What is a disadvantage of a removable rigid dressing?
physician applies and must closely supervise
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What are the advantages of a semirigid dressing?
semirigid unna dressing (not as hard as regular cast..type of medication in dressing)
- limits edema formation
- increase healing, decrease pain
- limb can be placed in a temp prosthesis for earling WBing
- prevents contractures
- protects against trauma
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What are the disadvantages of a semirigid dressing?
- need trained personnel to apply and reapply
- cant check suture line
- cant be done by pt/pta
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What are the advantages of a soft dressing?
- easy to remove for wound/incision inspection
- mid-mod edema control
- shapes the limb
- can be done by pt/pta
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What are some disadvantages of a soft dressing?
- least amt of edema control
- doesnt allow for attachment of a temp prosthesis
- must reapply every 3-4 hours
- no protection of limb
- must use proper technique
- no contracture prevention
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What are the advantages of shrinker socks?
- better with edema control than ace wraps
- easier to apply
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What are disadvantages of shrinker socks?
- need new socks with edema changes
- no prevention for contractures
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What are the advantages of an air splint?
- same advantages as removable rigid dressing
- allows for early amb (can be used for attachment for prosthesis
- provides uniform pressure
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What are disadvantages of an air splint?
- can be hot and increase moisture against skin
- can be cumbersome
- costly
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What will the post op therapist measure the residual limb for?
- length
- girth
- measurements taken as soon as the dressing allows
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What is important for residual limb care?
- edema control
- proper hygiene
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What can pot begin to do once sutures are removed?
- begin bathing normally
- begin friction massage
- inspect limb with mirror daily
- nightly bathing/wrapping
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What is the proper skin care for the residual limb?
- promote soft pliable skin
- decrease use of home remedies
- pt should never shave the residual limb
- should not use lotions unless directed by physician
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How should an effective bandage wrap be?
- smooth and wrinkle free
- has angular turns (figure 8)
- encourages proximal jt extension
- ends are fastened with tape
- if incision is ant-attempt to bring bandage from post-ant over the distal end
- limbs should be rewrapped at least every 4 hours
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How should you take care of the elastic bands and shrinkers?
- hand wash daily with mild soap and wring out
- lay flat to dry on clean towel
- should be allowed to dry for 12 hrs overnight
- alternate between 2 sets of bandages
- never dry elastic bandages or shrinkers on a radiator or in a dryer
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What is good positioning techniques for prosthetic pts?
- goal is to prevent secondary complications like contractures
- avoid prolonged sitting
- pt should lie in prone for some each day
- do not position limb over a pillow to elevate it
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What types of ROM should you perform?
- hip flex/ext
- hip abd/add
- knee flex/ext
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What types of strengthening should you perform?
- bilateral UEs
- uninvolved LE
- involved LE when healing allows
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For effective prosthetic ambulation, pts need good strength in the involved LE consisting of what? (most important)
- hip ext
- hip abd
- knee flex/ext
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What type of general strengthening/conditioning should you perform?
- trunk
- all extremities
- proprioception
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What types of gait patterns should a prosthetic pt use?
3 point with crutches
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What types of mobility should you work on?
- transfers
- bed mobility
- w/c mobility
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What are some advantaged of a temp prosthesis?
- can enhance post op program
- can be fit as soon as the wound is healed
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What do you need to increase with bilateral amputation pts?
- more mat activities to increase a sense of body position and balance
- more UE strength
- independent in bed mobility, transfers, and w/c mobility
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Why would a pt not be appropriate for a prosthetic?
- amb was contraindicated prior to surgery
- transfemoral amputees that lack the balance/strength/energy reserves required
- those that lack the mental facilities to follow the limb and prosthetic care required
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