Podcast
Questions and Answers
Assessment of an amputee should occur only after surgery.
Assessment of an amputee should occur only after surgery.
False
The decision to amputate should ideally involve a multi-disciplinary team.
The decision to amputate should ideally involve a multi-disciplinary team.
True
Preservation of the knee joint should always be prioritized during amputation assessment.
Preservation of the knee joint should always be prioritized during amputation assessment.
False
Patient education before amputation includes discussing both short-term and long-term goals.
Patient education before amputation includes discussing both short-term and long-term goals.
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Optimizing pain relief is only necessary after the operation.
Optimizing pain relief is only necessary after the operation.
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Discharge planning is unnecessary if the patient will return home after amputation.
Discharge planning is unnecessary if the patient will return home after amputation.
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It is essential to have realistic discussions with the patient to minimize adjustment problems.
It is essential to have realistic discussions with the patient to minimize adjustment problems.
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Referrals to other healthcare team members are considered unnecessary during the amputation assessment process.
Referrals to other healthcare team members are considered unnecessary during the amputation assessment process.
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Diabetes complications can include neuropathy and retinopathy.
Diabetes complications can include neuropathy and retinopathy.
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A patient's allergy history is irrelevant when considering treatment options.
A patient's allergy history is irrelevant when considering treatment options.
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The date of amputation is an important aspect of present medical history.
The date of amputation is an important aspect of present medical history.
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Assessments should only be conducted once to determine a patient's condition.
Assessments should only be conducted once to determine a patient's condition.
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Cognitive ability is not considered during the assessment process.
Cognitive ability is not considered during the assessment process.
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A wet environment around a wound can increase the risk of infections.
A wet environment around a wound can increase the risk of infections.
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Environmental factors can limit a patient's mobility during rehabilitation.
Environmental factors can limit a patient's mobility during rehabilitation.
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Pre-existing conditions do not need to be documented in a patient's medical history.
Pre-existing conditions do not need to be documented in a patient's medical history.
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Peripheral ankle reflexes are not assessed during the neurological examination.
Peripheral ankle reflexes are not assessed during the neurological examination.
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It is not necessary to evaluate the condition of the contralateral limb during a physical assessment.
It is not necessary to evaluate the condition of the contralateral limb during a physical assessment.
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Patient expectations of planned surgery can influence their recovery process.
Patient expectations of planned surgery can influence their recovery process.
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Wound approximation is an important aspect of wound assessment.
Wound approximation is an important aspect of wound assessment.
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A patient’s ability to climb stairs is not assessed during functional mobility evaluation.
A patient’s ability to climb stairs is not assessed during functional mobility evaluation.
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The presence of distal extremity pulses is irrelevant when assessing a vascular exam.
The presence of distal extremity pulses is irrelevant when assessing a vascular exam.
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Activities of daily living (ADL) include factors such as balance and mobility.
Activities of daily living (ADL) include factors such as balance and mobility.
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Neurological assessments should include evaluating for the presence of a neuroma when indicated.
Neurological assessments should include evaluating for the presence of a neuroma when indicated.
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The International Classification of Functioning, Disability and Health (ICF) is a framework used solely for physical disabilities.
The International Classification of Functioning, Disability and Health (ICF) is a framework used solely for physical disabilities.
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The Amputee Mobility Predictor is designed to assess the ability of lower-limb amputees to ambulate.
The Amputee Mobility Predictor is designed to assess the ability of lower-limb amputees to ambulate.
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The Trinity Amputation and Prosthesis Experience Scale (TAPES) focuses solely on physical rehabilitation outcomes.
The Trinity Amputation and Prosthesis Experience Scale (TAPES) focuses solely on physical rehabilitation outcomes.
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The Barthel scale is used to measure the performance in activities of daily living (ADL).
The Barthel scale is used to measure the performance in activities of daily living (ADL).
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An individualized approach is crucial when selecting outcome measures for lower limb amputation rehabilitation.
An individualized approach is crucial when selecting outcome measures for lower limb amputation rehabilitation.
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The Prosthesis evaluation questionnaire includes 100 items to assess various aspects of prosthetic function.
The Prosthesis evaluation questionnaire includes 100 items to assess various aspects of prosthetic function.
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The Timed Up and Go test is one of the outcome measures used to evaluate the rehabilitation process of amputees.
The Timed Up and Go test is one of the outcome measures used to evaluate the rehabilitation process of amputees.
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The Locomotor Capability Index questionnaire assesses an amputee's ability to perform only 5 different locomotor activities.
The Locomotor Capability Index questionnaire assesses an amputee's ability to perform only 5 different locomotor activities.
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Trans-tibial amputees typically have a lower risk of falling compared to trans-femoral amputees.
Trans-tibial amputees typically have a lower risk of falling compared to trans-femoral amputees.
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Trans-femoral prostheses can effectively help a patient to stand up.
Trans-femoral prostheses can effectively help a patient to stand up.
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The energy expenditure during gait is higher for trans-tibial amputees compared to trans-femoral amputees.
The energy expenditure during gait is higher for trans-tibial amputees compared to trans-femoral amputees.
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A hip flexion contracture of 10 degrees makes fitting a prosthesis difficult.
A hip flexion contracture of 10 degrees makes fitting a prosthesis difficult.
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Being cognitively impaired can make a patient unsuitable for prosthetic rehabilitation.
Being cognitively impaired can make a patient unsuitable for prosthetic rehabilitation.
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Trans-femoral prostheses are usually comfortable for prolonged sitting.
Trans-femoral prostheses are usually comfortable for prolonged sitting.
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Trans-tibial prostheses can be donned while sitting.
Trans-tibial prostheses can be donned while sitting.
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Successful prosthetic fitting relies solely on the patient's physical capability.
Successful prosthetic fitting relies solely on the patient's physical capability.
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Study Notes
Prosthetic & Orthotics Clinical Placement
- Assessment of amputees should ideally begin preoperatively, involving a multidisciplinary team to optimize outcome
- Amputation decisions should be made by the multidisciplinary team, and can occur before hospital admission
- Discussions with patients about short and long-term goals, as well as surgery expectations/feelings are crucial
- Assessment of the appropriate amputation level considers not only tissue viability but future mobility potential
- Preservation of the knee joint is ideal for maximizing function, but if fixed in flexion, may pose pressure risks if the patient is immobile
- The decision to preserve or amputate at a higher level may be considered based on the potential need for amputation to the other limb
- Patients and their families should be prepared for surgery, the hospital stay, and rehabilitation
- Mobility options (wheelchair, prosthesis) should be discussed based on assessment findings
- Open and realistic communication is important to minimize problems stemming from misinformation.
- Pain relief, phantom limb sensation, and referral to other specialists (occupational therapist, psychologist/counsellor, podiatrists, prosthetic service, dietician) is crucial
- Discharge planning must consider home environment modifications, residential/nursing home placement or care packages.
- Pre- and post-operative physiotherapy intervention planning should be realistic
- Assessment is not a one-time exercise, but an ongoing process.
Assessment of the Amputee
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A - Subjective Assessment:
- Past Medical History: Diabetes (neuropathy, retinopathy, poor glucose control), cardiac history/exercise tolerance, renal function/stump volume fluctuations, respiratory function/exercise intolerance, stroke history, trauma history, previous joint surgery, allergies, and medications
-
B - Objective Assessment:
- Physical Assessment: Pre or post amputation, specific to the patient, including inspection of remaining limbs, pressure areas, pain sites
- Wound assessment: Approximation, Peri-wound erythema (normally lessens after 72 hours, increase could signal infection), wound drainage (note quality/quantity changes), wound wetness (moist environments may increase infection risks), presence of scar tissue/skin grafts, contralateral limb/foot condition
- Vascular Exam (for vasculopathy): distal extremity pulses, color, skin temperature
- Joint integrity, range of motion, contractures
- Muscle power (especially core stability), hand function (prosthesis/wheelchair use)
- Neurological Exam: Peripheral and ankle reflexes, Tinel's test (for suspected neuromas)
-
Stump Assessment:
- Wound condition, edema, stump length, bone end prominence, sensation, tenderness
- Stump shape/mobility of scar/pain
- Activities of Daily Living (functional mobility): balance, sitting/standing, bed mobility, transfer/mobilization ability, standing tolerance, gait/assistive devices, staircase ability
Social History
- Housing: type of property, internal/external access, previous adaptations, bathroom layout
- Occupation: type of work, mobility requirements, wheelchair accessibility, travel needs, retraining
- Hobbies & interests: sedentary vs active
- Driving: manual/automatic
- Wheelchair use: duration, purpose
International Classification of Functioning
- ICF is a globally accepted framework and classification system to describe, assess, and compare function and disability (ADLs, mobility, body functions/structure)
- ICF can guide multidirectional rehabilitation for limb amputees
Outcome Measures
- Individualized approach is important when selecting outcome measures.
- Outcome measures evaluate the lower limb amputation rehabilitation outcome
- Outcome measures can detect the cause of the problem, as well as identify solutions and therapeutic interventions
- Examples of outcome measures: Amputee Mobility Predictor, Prosthesis evaluation questionnaire, Locomotor capability index, Trinity Amputation and Prosthesis Experience Scale, Barthel Index/ADL, Prosthetic Profile of the Amputee, Timed Up and Go test, 6-minute walk test
Additional Factors
- Patient's wants to participate in walking,
- Possibility of walking,
- Location of walking (home, community),
- Prosthetic rehabilitation potential for quality of life improvement
Patient Exclusion for Prosthetic Fitting/Rehabilitation
- Patients unable to independently transfer from a seat to bed or chair; toilet, or back using a standing pivot transfer.
- Inability to stand independently in parallel bars after pushing up from sitting in a wheelchair
- Lack of independent standing balance in parallel bars (unable to stand for 5 minutes)
- Cognitive impairment (unable to follow directions)
- Inability to mobilize within parallel bars using a walking aid.
- Repeated failure to achieve mobilization goals
- Other issues (e.g., Poor muscle strength, hand dexterity issues, inability to manage velcro fastening, independent wash/dress, other pathologies including CVA, RA, OA or respiratory problems, poor motivation, social support, home environment).
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Description
This quiz focuses on the principles of assessment and care for amputees in a clinical placement setting for prosthetics and orthotics. It covers multidisciplinary approaches, patient discussions, and considerations for amputation levels to optimize outcomes and mobility. Ideal for students and professionals involved in rehabilitation and post-operative care.
