The document summarizes the primary goals and treatment approaches for patients before and after receiving a lower extremity prosthesis from a physical therapist's perspective. Pre-prosthetic goals include contracture prevention, edema management, skin and wound care, pain management, and mobility training. Post-prosthetic goals include proper prosthetic donning and doffing, increasing wear time, managing fit, and normalizing gait. Key treatments involve exercise, positioning, wrapping, skin checks, massage, and mobility training to prepare the residual limb and patient for prosthetic use.
This document defines key terms related to orthotics and prosthetics. It describes different causes of amputation including trauma, vascular issues, infections, and tumors. The stages of rehabilitation for an amputee are outlined, including pre-amputation counseling, surgery, post-operative care, prosthetic training, and reintegration. Different levels of extremity amputation and criteria for a good stump are also defined. The roles of an interdisciplinary rehabilitation team are emphasized.
This document discusses amputation, including its definition, causes, types, surgical principles, complications, pain management, psychological adjustment, dressing, skin care, and exercises. It defines amputation as the removal of part of a limb through one or more bones. The main causes include peripheral vascular disease, injuries, infections, tumors, and congenital anomalies. There are two main types - guillotine/open and closed amputations. Key goals after amputation are pain management, psychological counseling, preventing deformities, and regaining range of motion and strength.
This document provides information about amputation, including:
1. Amputation is the removal of a limb or part of a limb through bone or joints. It can be caused by conditions like PVD, injuries, infections, tumors, or birth defects.
2. There are different types of amputations like guillotine (open) or closed amputations. Surgical principles involve using a tourniquet, controlling bleeding, choosing the amputation level, and closing skin and tissue.
3. After amputation, goals of management include pain management, psychological counseling, dressing the wound, skin care, and exercises to prevent deformities and improve range of motion. Regular dressing, skin care, and exercises
This document provides information about below knee amputation, including:
- Indications for below knee amputation include gangrene, peripheral vascular disease, trauma, burns, and severe loss of function.
- The level of amputation is determined by the disease process, tissue viability, and available prosthetics. Adequate blood flow is confirmed using clinical assessments and Doppler ultrasound.
- Postoperative care includes preventing complications, deformities, edema, strengthening muscles, and rehabilitating the patient for mobility and prosthetic use.
This document provides information for an orthopedic symposium on splinting and casting techniques. It includes:
- An agenda for the event with topics on splinting, casting, patient monitoring and discharge instructions.
- Learning objectives around hands-on skills for splinting and casting applications.
- Details and instructions for applying several common splints and casts including volar splints, thumb spica splints, ankle splints and short arm, thumb spica and short leg casts.
- Information is provided on indications, materials needed, techniques, precautions and patient instructions for each application.
1. The document discusses various musculoskeletal modalities including casts, splints, braces, traction, and external fixators. It describes their uses, types, and nursing management.
2. Specific types of casts, splints and braces are defined along with general nursing care such as circulation checks, pain management, and education.
3. Traction is described as applying a pulling force to immobilize or position body parts, and different types include skin, skeletal, and balanced suspension traction.
Cast and immobilization techniques in orthopaedics by Dr O.O. AfuyeAlade Olubunmi
Cast, similar in function to splints are used to immobilize broken bones. The principles of its application and cast care most be followed for effectiveness.
This document discusses various types of amputations and their management. It covers:
1. Definitions of different types of amputations including closed/open, levels of amputation for upper and lower limbs.
2. Guidelines for post-operative management and bandaging of the amputated limb to shape the stump and prevent complications.
3. Common issues after amputation like pain management, skin disorders, and the psychological impact of losing a limb.
This document defines key terms related to orthotics and prosthetics. It describes different causes of amputation including trauma, vascular issues, infections, and tumors. The stages of rehabilitation for an amputee are outlined, including pre-amputation counseling, surgery, post-operative care, prosthetic training, and reintegration. Different levels of extremity amputation and criteria for a good stump are also defined. The roles of an interdisciplinary rehabilitation team are emphasized.
This document discusses amputation, including its definition, causes, types, surgical principles, complications, pain management, psychological adjustment, dressing, skin care, and exercises. It defines amputation as the removal of part of a limb through one or more bones. The main causes include peripheral vascular disease, injuries, infections, tumors, and congenital anomalies. There are two main types - guillotine/open and closed amputations. Key goals after amputation are pain management, psychological counseling, preventing deformities, and regaining range of motion and strength.
This document provides information about amputation, including:
1. Amputation is the removal of a limb or part of a limb through bone or joints. It can be caused by conditions like PVD, injuries, infections, tumors, or birth defects.
2. There are different types of amputations like guillotine (open) or closed amputations. Surgical principles involve using a tourniquet, controlling bleeding, choosing the amputation level, and closing skin and tissue.
3. After amputation, goals of management include pain management, psychological counseling, dressing the wound, skin care, and exercises to prevent deformities and improve range of motion. Regular dressing, skin care, and exercises
This document provides information about below knee amputation, including:
- Indications for below knee amputation include gangrene, peripheral vascular disease, trauma, burns, and severe loss of function.
- The level of amputation is determined by the disease process, tissue viability, and available prosthetics. Adequate blood flow is confirmed using clinical assessments and Doppler ultrasound.
- Postoperative care includes preventing complications, deformities, edema, strengthening muscles, and rehabilitating the patient for mobility and prosthetic use.
This document provides information for an orthopedic symposium on splinting and casting techniques. It includes:
- An agenda for the event with topics on splinting, casting, patient monitoring and discharge instructions.
- Learning objectives around hands-on skills for splinting and casting applications.
- Details and instructions for applying several common splints and casts including volar splints, thumb spica splints, ankle splints and short arm, thumb spica and short leg casts.
- Information is provided on indications, materials needed, techniques, precautions and patient instructions for each application.
1. The document discusses various musculoskeletal modalities including casts, splints, braces, traction, and external fixators. It describes their uses, types, and nursing management.
2. Specific types of casts, splints and braces are defined along with general nursing care such as circulation checks, pain management, and education.
3. Traction is described as applying a pulling force to immobilize or position body parts, and different types include skin, skeletal, and balanced suspension traction.
Cast and immobilization techniques in orthopaedics by Dr O.O. AfuyeAlade Olubunmi
Cast, similar in function to splints are used to immobilize broken bones. The principles of its application and cast care most be followed for effectiveness.
This document discusses various types of amputations and their management. It covers:
1. Definitions of different types of amputations including closed/open, levels of amputation for upper and lower limbs.
2. Guidelines for post-operative management and bandaging of the amputated limb to shape the stump and prevent complications.
3. Common issues after amputation like pain management, skin disorders, and the psychological impact of losing a limb.
Orthotics and prosthetics provide artificial limbs and braces to replace missing or impaired body parts. Prosthetics deals specifically with replacing missing limbs or parts of limbs with artificial devices called prostheses. Prostheses come in different types depending on their intended use and stage of recovery or rehabilitation. Regular maintenance and care of prostheses is required to ensure proper functioning and avoid health issues.
Walking aids such as crutches, canes and walkers are used to provide stability and support mobility for individuals who have limited ability to walk independently due to injuries, pain or medical conditions. Crutches are commonly used to reduce weight bearing on one or both lower extremities and provide additional balance support. There are different types of crutches including axillary crutches, elbow crutches and gutter crutches. Proper fitting and training are important to ensure safe and effective use of walking aids.
Liposculpting cost in indiaHow much does liposuction cost In Indiapritishuklahyd9
The document provides postoperative instructions for a patient who underwent liposuction. It details what to expect in terms of pain, swelling, dressing changes, exercise restrictions, and follow-up care. The patient is advised to take all medications as prescribed, have someone with them for 24 hours, and contact the doctor if any unusual developments occur like fever or excessive swelling. The instructions emphasize rest, limiting activity for a few weeks, and regular follow-ups to monitor healing and ensure the best results.
Sprains and strains are musculoskeletal disorders caused by excessive exertion on muscles, tendons or ligaments. They are commonly caused by activities like lifting, pushing, carrying, repetitive tasks or awkward postures. A sprain specifically involves a stretched or torn ligament while a strain is an overstretched muscle or tendon. Treatment involves RICE therapy - rest, ice, compression and elevation of the injured area. Prevention strategies include warming up, stretching, wearing proper footwear and exercising caution.
This document discusses prosthesis care and maintenance. It defines a prosthesis as an artificial replacement for parts of the upper or lower extremities. Prostheses are used to provide mobility and function for individuals who have had limb amputations. Common types include lower leg/foot prostheses and leg prostheses with knee joints. Proper prosthesis care involves daily cleaning, maintenance to address issues like loose parts, regular check-ups with a prosthetist, and keeping the residual limb clean and moisturized.
The document discusses dressing and bandaging techniques for wounds. It defines dressing as a sterile pad or compression applied to a wound to promote healing. Bandages are used to wrap or cover wounds, apply pressure to bleeding areas, and support immobilization. The document provides examples of different types of dressings and bandages and demonstrates proper techniques for applying dressings and bandages to wounds in different locations on the body.
This document discusses casts and slabs for immobilizing musculoskeletal injuries. Casts fully surround the limb while slabs only partially surround. Casts provide better immobilization but have higher risks of complications like pressure sores. The document outlines indications, advantages, disadvantages and application steps for casts and slabs. It emphasizes the importance of monitoring for complications, starting physiotherapy early, and removing the cast or slab as soon as possible.
This document provides an overview of the Ponseti technique for treating clubfoot. It discusses the pathophysiology and classification of clubfoot, as well as the key steps of the Ponseti method including serial casting, Achilles tenotomy, and foot abduction bracing. The Ponseti technique uses gentle manipulation and serial casting to gradually correct the deformity, with a tenotomy sometimes needed to achieve full correction. Proper bracing is essential to maintain correction long-term. Recurrence rates are low (under 10%) when the Ponseti method is followed correctly. Surgery is rarely needed when this technique is used.
This document provides information about amputation, limb prostheses, and rehabilitation for lower limb amputees. It discusses the purpose of prostheses in replacing missing limbs and describes different types including immediate post-operative, temporary, and definitive prostheses. Characteristics of successful prostheses and considerations for choosing one are outlined. The rehabilitation process in 5 stages is summarized, from healing to learning to use the artificial limb. Exercise and complications of amputations are also briefly mentioned.
8.CONGENITAL ANOMALIES PPT orthopedic nursingRenjini R
Clubfoot, also known as congenital talipes equinovarus, is a birth defect where a baby's foot is twisted out of shape or position. Treatment options for clubfoot include stretching and casting (Ponseti method), stretching and taping (French functional method), or surgery. Nursing management of clubfoot focuses on assessing the family's ability to cope with treatment, preventing skin breakdown from serial casting, managing pain, and monitoring circulation and sensation after surgery. Developmental dysplasia of the hip (DDH) is an abnormality where the femoral head is not stable in the acetabulum. Risk factors include female sex, firstborn children, family history, and breech positioning. DDH ranges from mild
This document provides information on orthopedic injuries and immobilization. It discusses evaluating neurovascular status and injury mechanism upon presentation. Reduction and immobilization with splinting or casting is recommended for fractures and dislocations. Specific techniques are described for reducing various injuries like shoulder dislocations. Common fracture types and locations are outlined. Detailed instructions are provided on splint construction and types for different body parts like the forearm, wrist, fingers and ankle. Complications of splinting like burns and ischemia are also addressed.
The document provides information on assessing a patient's lower leg. It describes conducting a subjective assessment through questioning and an objective assessment involving
This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.
orthosis and prothesis pdf.Prosthesis - An artificial appliance which substitutes the anatomically missing component.
Orthosis - An artificial appliance that supports the body part for the purpose of stabilization, support or Movement reminder.The aim of orthotics is to increase the efficiency of function during acute or long-term injury. This includes soft-tissue and bony injury, as well as changes as a result of neurological changes. They can be an effective adjunct alongside physiotherapy techniques such as muscle strengthening and stretches, gait and balance retraining and reach and grasp strategies.
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The document discusses prosthetics and crutch walking. It defines prosthetics as artificial devices that replace missing body parts, describing different types including transfemoral, transtibial, transradial and transhumeral prosthetics. It also discusses crutch walking, defining crutches as orthopedic devices that assist weight bearing during leg injuries. Different crutch walking gaits are described including 4-point, 3-point and 2-point gaits. Patient education on crutch use and precautions for crutch walking are also summarized.
This document provides guidelines for conducting a physical examination of the musculoskeletal system. It outlines the standard protocol, including performing hand hygiene and explaining the procedure to the patient. It describes obtaining subjective information from the patient regarding joints, muscles, bones and functional assessment. It also lists the objective assessment steps including inspecting various areas like the temporomandibular joint, cervical spine, and shoulders while observing for any abnormalities.
This document covers assessment and treatment of bone and joint injuries commonly encountered in wilderness activities. It discusses muscle injuries, fractures, dislocations, splinting techniques, and guidelines for prevention and evacuation. The key points are: muscle injuries are assessed using RICE (rest, immobilization, cold, elevation); fractures should be splinted to prevent further damage, with specific splinting techniques for different bones; dislocations can sometimes be reduced at the injury site by putting gentle traction on the bone or joint; and complications may require rapid evacuation.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Orthotics and prosthetics provide artificial limbs and braces to replace missing or impaired body parts. Prosthetics deals specifically with replacing missing limbs or parts of limbs with artificial devices called prostheses. Prostheses come in different types depending on their intended use and stage of recovery or rehabilitation. Regular maintenance and care of prostheses is required to ensure proper functioning and avoid health issues.
Walking aids such as crutches, canes and walkers are used to provide stability and support mobility for individuals who have limited ability to walk independently due to injuries, pain or medical conditions. Crutches are commonly used to reduce weight bearing on one or both lower extremities and provide additional balance support. There are different types of crutches including axillary crutches, elbow crutches and gutter crutches. Proper fitting and training are important to ensure safe and effective use of walking aids.
Liposculpting cost in indiaHow much does liposuction cost In Indiapritishuklahyd9
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Sprains and strains are musculoskeletal disorders caused by excessive exertion on muscles, tendons or ligaments. They are commonly caused by activities like lifting, pushing, carrying, repetitive tasks or awkward postures. A sprain specifically involves a stretched or torn ligament while a strain is an overstretched muscle or tendon. Treatment involves RICE therapy - rest, ice, compression and elevation of the injured area. Prevention strategies include warming up, stretching, wearing proper footwear and exercising caution.
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The document discusses dressing and bandaging techniques for wounds. It defines dressing as a sterile pad or compression applied to a wound to promote healing. Bandages are used to wrap or cover wounds, apply pressure to bleeding areas, and support immobilization. The document provides examples of different types of dressings and bandages and demonstrates proper techniques for applying dressings and bandages to wounds in different locations on the body.
This document discusses casts and slabs for immobilizing musculoskeletal injuries. Casts fully surround the limb while slabs only partially surround. Casts provide better immobilization but have higher risks of complications like pressure sores. The document outlines indications, advantages, disadvantages and application steps for casts and slabs. It emphasizes the importance of monitoring for complications, starting physiotherapy early, and removing the cast or slab as soon as possible.
This document provides an overview of the Ponseti technique for treating clubfoot. It discusses the pathophysiology and classification of clubfoot, as well as the key steps of the Ponseti method including serial casting, Achilles tenotomy, and foot abduction bracing. The Ponseti technique uses gentle manipulation and serial casting to gradually correct the deformity, with a tenotomy sometimes needed to achieve full correction. Proper bracing is essential to maintain correction long-term. Recurrence rates are low (under 10%) when the Ponseti method is followed correctly. Surgery is rarely needed when this technique is used.
This document provides information about amputation, limb prostheses, and rehabilitation for lower limb amputees. It discusses the purpose of prostheses in replacing missing limbs and describes different types including immediate post-operative, temporary, and definitive prostheses. Characteristics of successful prostheses and considerations for choosing one are outlined. The rehabilitation process in 5 stages is summarized, from healing to learning to use the artificial limb. Exercise and complications of amputations are also briefly mentioned.
8.CONGENITAL ANOMALIES PPT orthopedic nursingRenjini R
Clubfoot, also known as congenital talipes equinovarus, is a birth defect where a baby's foot is twisted out of shape or position. Treatment options for clubfoot include stretching and casting (Ponseti method), stretching and taping (French functional method), or surgery. Nursing management of clubfoot focuses on assessing the family's ability to cope with treatment, preventing skin breakdown from serial casting, managing pain, and monitoring circulation and sensation after surgery. Developmental dysplasia of the hip (DDH) is an abnormality where the femoral head is not stable in the acetabulum. Risk factors include female sex, firstborn children, family history, and breech positioning. DDH ranges from mild
This document provides information on orthopedic injuries and immobilization. It discusses evaluating neurovascular status and injury mechanism upon presentation. Reduction and immobilization with splinting or casting is recommended for fractures and dislocations. Specific techniques are described for reducing various injuries like shoulder dislocations. Common fracture types and locations are outlined. Detailed instructions are provided on splint construction and types for different body parts like the forearm, wrist, fingers and ankle. Complications of splinting like burns and ischemia are also addressed.
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This document provides guidelines for conducting a physical examination of the musculoskeletal system. It outlines the standard protocol, including performing hand hygiene and explaining the procedure to the patient. It describes obtaining subjective information from the patient regarding joints, muscles, bones and functional assessment. It also lists the objective assessment steps including inspecting various areas like the temporomandibular joint, cervical spine, and shoulders while observing for any abnormalities.
This document covers assessment and treatment of bone and joint injuries commonly encountered in wilderness activities. It discusses muscle injuries, fractures, dislocations, splinting techniques, and guidelines for prevention and evacuation. The key points are: muscle injuries are assessed using RICE (rest, immobilization, cold, elevation); fractures should be splinted to prevent further damage, with specific splinting techniques for different bones; dislocations can sometimes be reduced at the injury site by putting gentle traction on the bone or joint; and complications may require rapid evacuation.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Pre and post Prostheitc reahb CG 2019.pdf
1. Penn Prosthetics Course
Pre and Post-Prosthetic Rehab from a
Therapist's Perspective
1
Christopher Gorrell PT, DPT
May 17, 2019
2. Objectives
• To review the primary goals related to treatment of a
patient with a new lower extremity amputation prior to
receiving their prosthesis
• Preparation of the residual limb for prosthetic use
• To review treatment basic treatment after the patient
receives their initial prosthetic
• Discuss collaboration between rehab team members
3. Goals of Pre-Prosthetic Phase Management
• Contracture Prevention
• Edema Management
• Skin/Wound Care
• Pain Management
• Strengthening/Flexibility
• Mobility Training with
appropriate device
• Coping/Adjustment to Limb
Loss and Changes to Body
Image
4. Contracture Prevention
• Most common contractures:
– Trans tibial amputation
• Knee flexion
– Trans femoral
• hip flexion
• hip abduction
• hip external rotation
http://mas-
nur.blogspot.com/2009/03/assessment-for-tf-
amputee.html
All photos taken with patient’s permission
6. Contracture Prevention
• Education
▫ Why is this important?
▫ Emphasize preparation for prosthesis
The entire team is responsible
Bent Knee Prosthetic
http://www.oandplibrary.org/popup.asp?frmItemId
=C3C636A9-90AA-43F4-A92C-
5AB2F26EDCF2&frmType=image&frmId=12
7. Methods of Volume Containment
• Ace wrapping
• Stump shrinker
• Tubigrip
• Semi-rigid
• Rigid removable
• Rigid non-removable-IPORD
• Immediate post-op pylon-IPOP
All photos taken with patient’s permission
8. Ace Wrap Technique-TTA
• All wraps on a
diagonal
• No circumferential
wraps
• Avoid wrinkles
• Avoid open areas
• Most will require 2
ace wraps
9. Ace Wrapping Technique:
• Must be re-applied
every 2-4 hours
• Wrap to above the
knee
• Be careful applying
pressure over tibial
crest.
10.
11. Ace Wrapping Technique-TFA
• All wraps on a
diagonal
• No circumferential
wraps
• Avoid wrinkles
• Avoid open areas
• Most will require 2-
3 ace wraps
12. Ace Wrapping Techniques-TFA
• Must be re-applied
every 2-4 hours
• Wrap to the groin
area. Enclose all
groin tissue-do not
create an adductor
roll.
• Hip Spica
13.
14.
15. Skin Care
• Wound Care
• Daily Skin inspection
• Protect
• Hydration
• Hygiene
• Skin/Scar mobilization
photos taken with his mother’s permission
16. Skin Inspection
• Systematic approach
• Bony Prominences
• Problem areas
– Toe nails
– Calluses/Cracks
– Corns
– Bunions
• Odor
• Drainage
• Can the patient see
their foot?
– Inspection Mirror
– Magnifying glass
– Family member
17. When?
• Before AND after volume
containment
• Before AND after prosthetic use
• Before and after shoe wear
▫ More often with new shoes
▫ Wearing schedule to allow for a break in
period
All photos taken with patient’s permission
Does this
Look OK?
18. Hydration
• Lotion
– Non-scented
– Alcohol free
– Perfume free
• Helps reduce friction
• Maintains elasticity of the tissue, decreasing
the risk for skin breakdown
• No lotion between the toes
19. Hygiene
• Daily (minimum)
• Mild Soap
– Non scented soap and lotion
– Alcohol free
– Perfume free
• No hot water
• No soaking either foot/residual limb
• Dry skin especially between the toes
20. Foot Care
• No home remedies or home surgeries
• Manage moisture
▫ Dry white cotton or wool socks
▫ Carry extra if living in a moist environment
▫ Incontinence
▫ Wound drainage
• Minimize friction
• No Extreme Temperatures-heating pads, hot water bottles,
soaks of any kind
• Tape
• No OTC products for corns, calluses or nails
• Proper shoe wear-(CMS)
21. Scar Mobilization
• Scar massage can begin
immediately-POD#1
– Be Cautions ….
– Approximate the incision
and move the skin up and
down
– Transverse friction massage
when incision healed
– Myofascial release later if
adhesions present
• Adhesions can lead to
breakdown when
prosthetic training begins
22. Pain Management
• Not the physician’s responsibility alone
– Medication
– Edema management
– Desensitization
– Mirror therapy
– Relaxation therapy
– Modalities
– Alternative Therapy
• The treatment depends on they type of pain
– Surgical/Residual limb
– Phantom limb
– Other
http://endthepainproject.org/
26. Coping/Adjustment to Limb Loss
• Stages of Grief
• Psychology/Psychiatry
• How to approach the topic with each patient
• Life long management/follow up
• Educate the patient about:
– Amputee clinics
– Prosthetists
– Therapists
• This is the patient’s choice not ours
27. What is Ther. Ex?
• ROM
– Not only the amputated side
– Specifically Ankle DF, hip and
knee extension on the intact
limb
• Strength Training
– Focus on anti-gravity muscle
groups
• Both limbs
– Muscle groups that aid in gait
– Assist with transfers prior to
receiving the prosthesis
– Core strengthening
• Endurance training
All photos taken with patient’s permission
29. √ ALL
THAT
APPLY
PRE-PROSTHETIC PHASE
"DAILY CHECKLIST"
WHEN
Wash and dry your residual limb. 1x/day.
Wash and dry your intact limb and
do skin checks: behind the heel,
between the toes, etc.
1x/day.
Skin Care Lotion to residual limb
and intact limb (not between toes)
2x/day.
Check your skin. Look for signs of
redness, irritation, bruising, or
drainage from your incision.
2x/day.
Wear your Stump Shrinker to
control your swelling. Apply a clean
shrinker sock every day.
24Hr/day
Wear your Ace Wrap to control
swelling. Change bandage if there
is any drainage or blood.
Re-Apply
ever 2-3 hr
wear
24Hr/day
Wear yourFlowtech Device/ Knee
Immobilizer /Cast as directed by
your therapy team to ensure your
knee satys straight.
24 Hr/day
Do your exercises as directed by
you therapy team.
2x/day.
Stretch on your stomach. 20minutes
2x/day.
Perform Limb Massage. -Avoid
your incision area.
5 minutes,
2-3x/day.
Perform Desensitization. Follow
instructions provided.
2-3 minutes,
2-3x/day.
Perform Scar Massage. Follow
instructions provided.
1x/day.
Wash your shrinker and allow to
dry completely. (should have 2)
1x/day.
updated
1
2/1
4/1
2 CG
29
30. Prosthetic Phase
• Goals
– Don and doff Independently
– Progress wear time daily
– Manage Prosthetic fit
• Prosthetic socks
– Skin care and hygiene
– Troubleshoot problems
– Weight bearing tolerance
– Normalize gait
32. 3S Donning
• Fully deflect liner
• Distal cup contacts
the end of the
residual limb
• Pt rolls the liner up
the leg
33.
34. • The end of the liner will have a pin
or lanyard the will need to be
attached
• Instruct the patient to make sure
the pin is straight in order to
properly engage the shuttle
mechanism
All photos taken with patient’s permission
35. Prosthetic Sock Management
Discuss in terms of thickness-
ply NOT the number of socks
Ply = thickness of the sock
They can come in any
number of thickness
depending on manufacturer
Typically use 1, 3, and 5 ply
Distinguished by the color of
the stripe across the top
Patients will need a lot of
assistance and reinforcement
to learn this skill
knitrite.com
White/no color=1 ply
Yellow=3
Green=5
36. Correct Sock Ply
• How do you know if
you have the
correct sock ply?
– Pt description of
pain
– Pistoning
– Lateral movement
with ambulation
37. TTA Fit
Not Enough Just Right Too Many
Look at Patella tendon
Too few socks PTB mark may be on the patella, and the pt. may have pain on the
distal tibia when WB on limb, abnormal thrusting, or pistoning during swing
Too many socks PTB will push on the proximal tibia, no distal end contact, may
see redness on the tibial Tubercle or tibial crest
All photos taken with patient’s permission
38. Proper TFA socket alignment
• Your Ischial tuberosity “Butt
bone” should be contained within
the this are of the socket.
• If you feel pressure on the
bottom of the stump add 1 sock
ply
• If you feel pressure in your groin
first check to make sure that the
socket is not twisted i.e. the knee
pointed in or out.
• If you do not feel pressure on the
butt bone or the pin is not
engaged then you have too many
socks on-remove one sock ply
All photos taken with patient’s permission
39. Wear Schedule for
I
In
nc
cr
re
ea
as
se
e b
by
y 3
30
0 -
-6
60
0 m
mi
in
n p
pe
er
r d
da
ay
y
Unless there is a new injury or change in
skin problem.
Date Sock Ply Wear
Time
Staff
Initial
40. 40
√ ALL
THAT
APPLY
PROSTHETIC PHASE "DAILY
CHECKLIST"
WHEN / HOW
OFTEN
Check your skin. Look for signs of redness, irritation, bruising,
blisters, or drainage. Use your mirror or ask for assistance to get
a "good look".
Every time you remove your
prosthesis
Do skin checks of intact limb: behind the heel, between the toes,
etc.
1x/day.
Wash and dry your residual limb. 1x/day.
Wash and dry your intact limb 1x/day.
Wear your stump Shrinker when ou are not wearing your
prosthesis
Continue to stretch on your stomach. 20 minutes, 2x/day.
Perform Limb Massage, Desensitization, and Scar Massage 5 minutes, 3x/day.
Wash and dry Stump Shrinker & change daily 1x/day.
Wash your prosthetic liner or "suspension sleeve" every evening
with mild soap or approved cleaner. Turn right-side-out and allow
to dry.
1x/day
Wash your prosthetic sock(s) and allow to dry completely. 1x/day (if they contact you skin)
Wipe out the inside of your socket with mild soap and water. Dry
completely.
Whenever soiled, or 1x/week.
Apply anti-persperant (not deodorant). Always allow ample drying
time before applying your liner.
1x/night
Check your wear Schedule and progress as instructed by your
therapy team
Updated 3/14/2013CG
41. Skin care & Hygiene
• Warm moist area with increased activity …..
• Clean the skin as well as everything touching
the skin
– Sheaths, socks, liners, socket, suspension sleeves
42. Problem List
• Pistoing
• Gait deviations
• Point tenderness or localized pressure
• Perspiration issues
What is the cause?
42
43. Normal Gait Pattern Progress
http://www.clinicalgaitanalysis.com/history/22107f2.gif
46. Questions?
Please feel free to contact me with any further
questions or comments
Christopher Gorrell PT, DPT
Penn Institute for Rehabilitation Medicine
3rd Floor Gym
1800 Lombard St
Philadelphia, PA 19146
Christopher.gorrell@uphs.upenn.edu
46