what are the two phases of the postoperative program after amputation?
phase 1: post surgical; from surgery -> fitting of prosthesis
phase 2: prosthetic phase; learning to use the permanent replacement limb
what are some of the goals for the postoperative phase after amputation?
I bed mob & t/f
I with wc and self care
demo proper residual limb positioning, bandaging and care
mod-min A short distance gait with walker or crutches
what are the post op dressings used mainly for?
how would you instruct a patient to wrap their residual limb?
start at the top and pull down in a diagnal direction and wrap around the back in a figure 8 shape putting more tension at the bottom. Make sure to cover every inch of skin and that there are no wrinkles in the elastic.
how would a patient typically describe their phantom limb pain?
tingling, burning, itching, pressure, cramping, squeezing, shooting or burning pain
up to ______% of amputees complain of phantom limb pain
what are some other considerations to have when treating amputees?
your treatment with an amputee would include what kind of activities?
residual limb care and wrapping
management of contractures
what is the purpose of a partial foot prosthesis?
restore as much of the foot function as possible
simulate as much of the shape of the missing foot segment
what do transtibial and symes prosthesis have in common?
both retain the natural knee, motor and sensory function
what are the basic componets of a transtibial and symes prosthesis?
what is the difference between an articulated and non-articulated prosthesis?
the articulated has an ankle joint
there is some movement with the nonarticulated, but there is more with the articulated which makes it better to the younger, more active populatin
why is the nonarticulated prosthesis more popular?
lighter, more durable, more attractive
some even fit high heel shoes
what are the 3 types foot prosthetics?
SACH: solid ankle cushion heel
SAFE: stationary attachment flexibe endoskeleton
carbon copy II: funny skis
which type is the most popular foot prosthetic?
comes in a wide array of sizes
allows for minimal medal lateral motions
what is the differences between the SACH and SAFE foot?
the safe allows for more medial lateral motion, is heavier, and more expensive
the foot assembly is chosen with what three things to consider?
patients age and lifestyle/activity level
length of residual limb
what are the rotators?
component placed above the prosthetic foot to absorb shock in the transverse plane
protects skin from chafing
mostly used by very active individuals
what is the shank?
sub for the leg
what are the two types of shanks?
why do symes prothesis not have a shank?
describe an exoskeltal shank
made of wood or rigid plastic
simulates the look of a lower leg
very durable, water proof
dont permit for changes in angulation > less prescribed
describe and endoskeletal shank
made of central aluminum pylon
cosmetic cover to appear like the natural lower leg
angulation abilities, more comfort and easier to walk with
what is the socket?
receptacle where the amputated limb sits
how the socket designed?
contact all portions of the amputated limb which allows for maximal load distribution
what is a lined socket?
foam liner that cushions the residual limb
is removable and insulates heat
how would you make an unlined socket more comfortable?
liner socks and cushion placed at the bottom of the socket
what are the 5 different ways of suspending the prosthesis?
rubber sleeve: need strong hands and no excessive adipose
brim variants: supracondylar suspension
thigh corset: increases frontal plane stability, prone to pistioning
sheath with distal metal pin: very secure
what is the most commonly used foot with the transfemoral prosthetic?
what are the 4 main features of the knee joint replacement?
not all knees have all 4
what is the purpose of the knee joint replacement?
allows the patient to bend during sitting and kneeling
allows for knee flexion during the later stance phase throughout swing phase
what is the knee axis?
connects the thigh piece to the shank
what is the most common type of knee axis?
what is the friction mechanism of the knee?
changes the knee swing by modifying the speed of knee motion during swing phase according to the walking speed
what happens if the knee friction is not modulated?
excessive knee flexion at the beginning of swing phase and vice versa
what is the extension aid of the knee?
mechanism to assist knee extension during the latter part of swing phase
Do most knee's have stabilizers?
what do the knees depend on for stabilization mostly?
what is suction suspension?
atmospheric pressure causes the socket to remain on the thigh.
what are the two grades of suction suspension?
total: maximal control
partial: wearer uses socks and an external suspension aid
when might you see the patient for physical therapy due to amputation?
pre amputation (if available) and post amputation
what do you examine the prosthesis for once the patient receives it?
fit and function in standing and gait
what does the prosthetic training include?
socks and sheaths
donning and doffing
transfers, curbs, ramps
pt education & skin inspection
what are the three tunics of the blood vessles?
tunica adventitia: outer most
tunica media: middle
tunica intima: inner most
what are the three types of arteries?
small arteries and arterioles
describe large arteries
receive blood from the ventricles and pumps it to the medium arteries
describe medium arteries
walls consist of circular smooth muscle
have the ablility to vasocontstrict
ex: brachial, femoral
describe small arteries and arterioles
have narrow lumnia and thick muscular walls
have no name and arterioles can only be seen under a microscope
what is the difference between veins and arteries when it comes to their tunics?
tunica media is thinner in the companion veins
do veins pulsate or spurt blood when severed?
what are the three types of veins?
describe the venules
smallest veins that drain capillary beds that join similar vessles to form small veins that form venous plexuses
describe medium veins
accompany medium arteries (which they are named after) and drain venous plexuses
in the limbs that contain venous valves that pump blood towards the heart
describe a large vein
wide bundles of longtiduinal smooth muscle and well developed tunica adeventita
T/F: there are more arteries than veins.
T/F: the walls of veins are thinner than arteries, but veins are bigger than arteries
what are simple endothelial tubes connecting the arterial and venous circulation and are arranged in beds/networks
what is the purpose of capillary beds?
allow for the exchange of materials in the extracellular space
what is an "over flow system" for surplus tissue fluid and leaked plasma proteins in the extracellular space that is responsible for removal of debris form cellular breakdown and infection and is essential for survival?