Health Tip of The Day

Thursday, October 28, 2010

ASSESSMENT OF THE AMPUTEE


• Assessment amputee patient may involve assessing a patient before the amputation or after the amputation has taken place.

• Preoperatively assess patient available muscle strength, ROM, and functional mobility bilaterally to provide a basal comparison.

• The size and position of any abnormal tissue degeneration or potential pressure areas

• If possible, give some instruction in bed mobility and climbing in and out of bed with or without support

• Teach how to use ambulatory aids

• Joint mobility exercises



SUBJECTIVE

Present medical history

What is patient ‘s occupation –need any vocational training

What is patients present medical status

• Reason for the amputation

• Have any systemic disease such as diabetic, cardio vascular or respiratory problem, arthritic joint

• How long ago amputation occur- If it is a revision procedure what is the reason for this and is there any complication occurred such as tissue breakdown ulcer formation or blisters

• if he has prosthesis check it is fit or not

• ensuring proper limb and sock hygiene

• phantom pain & phantom sensation

• stump pain



OBJECTIVE

• Swelling

• Condition of the skin-skin abration, skin break down, blisters or infection & healing is occurring properly

• check contracture

• sensation, pulses (femoral,tibial,dorsalis pedis) temperature, color of the stump

• check skin &nail is normal or any trophic changes –indicates circulatory impairment

• shape of the stump-cylindrical, conical, bony bulbous ,edematous



WITH PROSTHESIS

• Posture-if any deviations are structural or due to prosthesis

• Feels comfortable while standing

• ables to balance on prosthesis when standing on two legs or when weight shifting between two leg

• length of the prosthesis appearance of the prosthesis should be similar to the sound leg


IN SITTING POSITION

o Can the patient sit comfortably with minimal bunching of the soft tissue around the prosthesis?

o Does the socket remains securely on the stump

EXAMINATION

 check which muscle have been cut & how they have been stabilized, so examiner get some idea about muscle available to move the limb and prosthesis to provide stability during functional movement

 check length and circumference of the stump and scar length

 amputation type –Short (10 –33%of sound side length)

Medium (34-67%of sound side leg)

Long (68-1005%of sound side leg)



ACTIVE MOVEMENT

• ROM - to determine the patient ability to move and control the prosthesis and the muscles are able to control the available ROM and stability.

- Strength, endurance and ROM of opposite good limb must be assessed as greater stress will be placed on this limb.

PASSIVE MOVEMENTS

To ensure the necessary ROM and to prevent contracture

To restore ROM after contracture occurred

RESISTED ISOMETRIC MOVEMENT in both limb

To ensure strength and endurance



FUNCTIONAL ASSESSMENT

• The patient’s gait and endurance when walking and whether external support are necessary

• The patient’s bed mobility .can the patient moves easily or he require assistant. Patient can roll over, lying to sitting or lie prone

• Ability transfer from sitting to standing and from bed to wheelchair

• Ability to balance in sitting and standing

• Ability to get up from and down to different types of chairs

• Ability to use walking aids for gait training or wheel chair

• Ability to go up and down stairs

• Ability to get up from and down to the floor



SENSATION TESTING

• Hypersensitive - hot /cold sensation &light touch

• Hypo sensitive – no sensation

Pressure Sensitive Pressure Tolerant

Fibular head patellar tendon

Hamstring pretibial muscles

Anterodistal end of stump popliteal area

Tibial tubercle, crest gastroc-soleus

Distal tibia medial tibial flare

Characteristic of an Ideal Stump

BK – cylindrical shaped AK – cone shaped

No dog ears – cause: improper bandaging Intact sensation

No tenderness No phantom pain

No open wound No LOM

No contractures Good to normal MMT

Above and Below Knee Amputations

< 33 % short AK or BK stump

33 – 66 % Medium length BK or AK stump

> 66 % Long AK or BK stump





Energy Expenditure for the different levels of Amputation



BKA 10 – 40%

AKA 65%

BKA & AKA 75%

BILAT BKA 41%

CRUTCH w/o prosthesis 60%

Wheelchair 9%

BILAT AKA 110%

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