Examination & Treatment of the Lower Extremity AmputeeFocused reading for class discussion:Learning ObjectivesWhat are likely limitations for Mr. Howard?Early Post-op care:How should Mr. Howard be taught to care for his residual limb?What functional activities should PT concentrate on for Mr. Howard in early post-op period?Should PT be concerned with the psychological impact of Mr. Howard’s amputation?What should PT include in Mr. Howard’s home program?Target Clinical Pathway (usually longer than this, though)Case ScenarioWhat are factors that can affect Mr. Howard’s prosthetic training success?What will the PT examination of Mr. Howard look like?Evaluation Data to CollectEvaluation ContinuedSlide 15Mr. Howard’s PT DiagnosisWhat are likely PT goals for Mr. Howard? Pair & ShareWhat is the likely plan of care for Mr. Howard?How would you teach Mr. Howard to don his prosthesis?What skin problems should PT look for with Mr. Howard’s use of LE prosthesis?Residual limb condition:Weight-shift activitiesStepping activitiesStool steppingStrideWhat might Mr. Howard’s assistive device progression look like?Advanced activities should include:What new information should be included in Mr. Howard’s HEP now that he has a prosthesis?How should Mr. Howard care for his prosthesis?When will PT discharge/ discontinue Mr. Howard from PT?Discharge/discontinue PTWhen will Mr. Howard most likely require a socket revision?Energy Expenditure5Medicare Functional LevelsTimelineProsthetic RehabilitationReferences:Examination & Treatment of the Lower Extremity AmputeeTraining the LE amputee in the use of a prosthesis4-17-07Focused reading for class discussion:O’Sullivanpp. 624-629 (from last week)Physical Therapy Management pp. 660-670Learning ObjectivesDiscuss and apply the psychological impact of an amputation.Discuss in detail and apply the progression followed in gait training an amputee with a prosthesis.Discuss and apply the aspects of the home program for a patient receiving a LE prosthesis (correct use, maintenance/care, exercise, skin care, sock care, etc.)When presented with a clinical case study, analyze & interpret patient data; determine realistic goals/outcomes and develop a plan of care.What are likely limitations for Mr. Howard?IMPAIRMENTSPainDecreased strength, ROM, mobilityDecreased skin integrityDecreased endurancePsychological issuesFUNCTIONAL LIMITATIONSInability to walk, work, playEarly Post-op care:How should Mr. Howard be taught to care for his residual limb?Wash nightly w/mild, nondrying soap (after sutures removed); pat dry with terry cloth towelSmall amt. of lotionsoft, pliable limb more tolerant of prosthetic wear than tough, dry limbDON’T use alcoholDaily skin inspectionsuse mirror if necessaryDesensitization;rub, tap, massage, touch w texturesSoft tissue mobilization*Don’t forget care of sound limbsame guidelines for washing & inspecting plus don’t walk barefoot, don’t soak feet, avoid extreme temperatures/binding socks, inspect shoeswatch for skin changes: color, temperature, loss of hair, sores, etc. 6What functional activities should PT concentrate on for Mr. Howard in early post-op period?Wheelchairpost-op & pre-prosthetic period & for long distances, very short TF & double amputees often need indefinitelyUse anti-tippers or amputee axle if no prosthesisBed mobility Transfers-try to use stand-pivotMonitor vitalsMay need sliding board Balance: sit, hands and knees, tall kneeling, stand activitiesGaitBegin in parallel barsSingle limb amb. with assistive device VERY energy intensiveOutside of bars try crutches, last resort wheeled walkerAll LE amputees will need an ambulation aid to use when prosthesis is off2Should PT be concerned with the psychological impact of Mr. Howard’s amputation?Absolutely!Affects all aspect of rehab.Often PT spends most time with pt. on team and pt. will open up to PTNeed to know what “normal” acceptance is compared to depressionWhat should PT include in Mr. Howard’s home program?Compression bandagingContracture preventionResidual limb care/remaining limb careStrengthening-UE/LEROMBalanceFunctional activitiesGeneral conditioningProvide in writing, in layman’s terms,teach pt.and familyTarget Clinical Pathway (usually longer than this, though)Day 0: Amputation surgeryDay 1-4: Acute hospital, pre-prosthetic PTDay 5-21: Sub-acute rehabilitation hospital or home for wound healing and continued pre-prosthetic PTDay 21-28: Suture/staple removal followed by casting for temporary prosthesis 7Case ScenarioMr. Howard has been at home for the past 5 weeks performing pre-prosthetic program with a home health PT. The prosthetist has fit him with his temporary prosthesis and Mr. Howard is now ready for OP daily physical therapy to work on walking.What are factors that can affect Mr. Howard’s prosthetic training success?Physical abilities (strength, ROM, endurance, skin, pain, etc.)Cognitive abilitiesProsthetic fitMotivationFinancial resources-insurance often determines LOS/type of prosthesisSocio-economic circumstances-caregiver, car, living situation, etc.What will the PT examination of Mr. Howard look like?Guide to PT practiceProsthetic checkoutStatic assessmentStand in parallel barssitDynamic assessmentEvaluation Data to CollectAerobic Capacity and EnduranceAnthropometric CharacteristicsArousal, Cognition, and AttentionAssistive/Adaptive Devices Circulation (Arterial, Venous, and Lymphatic)Cranial and Peripheral Nerve IntegrityEnvironmental BarriersBody MechanicsEvaluation ContinuedGait, other Locomotion, and BalanceIntegumentary IntegrityJoint Integrity and MobilityMotor Control and Motor LearningMuscle PerformanceOrthoses, and/or protective/supportive devicesPain – Location and IntensityEvaluation ContinuedPostureProsthetic RequirementsRange of Motion (include muscle length)Self-Care and Home ManagementSensory IntegrityWork (job/school/play) Community Integration/reintegrationMr. Howard’s PT DiagnosisImpaired Motor Function, Muscle Performance, Range of Motion, Gait, Locomotion, and Balance Associated With AmputationPractice Pattern: Musculoskeletal, 4J 1What are likely PT goals for Mr. Howard? Pair &