Preprosthetic evaluation of a patient with an amputation

Therapists evaluate patients simultaneously along several dimensions of their health and disease status. Models of disablement like the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) or the NCMRR help therapists to organize evaluation, goal setting, and treatment.

Evaluation of TISSUE RESPONSE TO INSULT (PATHOLOGY), FUNCTIONAL LIMITATIONS, AND DISABILITIES:

EVALUATE:

ESTABLISH GOALS IF THE PERSON'S PROBLEMS INCLUDE:

TREAT:

History of tissue insult

traumatic
metastatic
vascular
metabolic

possible medical complications

IF THE AMPUTATION'S CAUSE IS VASCULAR, CHECK THE CONDITION OF THE OTHER FOOT, INCLUDING THE PERSON'S FOOTWEAR.

Functional limitations
  • Strength and precision in grasping
  • Visual acuity
  • Standing on non-amputated limb

    • Limitations may require special prosthetic prescription

    Disabilities
  • Wheelchair mobility
  • Bed mobility
  • Transfers
  • Dressing
  • Toileting

    • Address problems in light of person's home and community environments

    Evaluation of IMPAIRMENTS:

    EVALUATE:

    ESTABLISH GOALS IF THE PERSON'S PROBLEMS INCLUDE:

    TREAT:

    Residual limb condition

    adhered, immobile scar

    unhealed incision

    poor circulation, evidenced in skin temperature or color, diminished pulses, hairlessness.

    poor hygiene with potential for infection

    edema or unstable, changing volume of residual limb

    friction massage/US to mobilize scar

     

    teach principles of foot care

     

     

    Teach patient to wrap residual limb using guidelines in this manual

    Order prosthetic shrinker and socks

    Sensation

    phantom sensation (common)

    pain, including phantom pain (usually resolves within 3-6 mo.)

    absent protective sensation with risk for skin breakdown

    hypersensitivity

    		 contrast baths, TENS, wrapping/weight-bearing, myofascial massage/release

     

    Instruct in principles of foot care

    desensitization

    knee ligaments (in persons with transtibial amputations)

    ligamentous laxity

    Suggest appropriate prosthetic socket and suspension

    Range of motion

    most common contractures:

    • AK: hip flexion, abduction, and external rotation

    • BK: knee flexion

     

    prone-lying 30 minutes twice a day.

    avoid resting with head of bed elevated.

    avoid resting supine with pillows under residual limb.

    avoid prolonged sitting
    and begin gait training as soon as possible.

    strength

    weakness of

    • hip extensors
    • hip abductors
    • hip adductors
    • knee extensors

    by first post-op day:

    Isometric exercise, SLR, and pain-free PROM.

    by third post-op day:

    AROM, bed mobility, transfers.

    by tenth post-op day:

    RROM as tolerated

    endurance

    deconditioning

    Activities to increase wheelchair and UE endurance

    Last updated 5-18-01 ©Dave Thompson PT