Part 1: Assessment for Prosthetic Use & Stump Management

 Obtain pertinent subjective information from a patient with amputation  Perform stump assessment on a patient with amputation  Perform prosthetic check-out ◦ Static ◦ Dynamic ◦ Functional Ax

Patient information  Demographic data  Diagnosis  Subjective information  Personal / Social history

 Diabetes  Heart condition  High blood pressure  Medications

 Living Status  Living conditions  Profession  Normal Daily activities  Recreation activities

 Anthropometric measurements  Knee stability  Shape of the stump  Incision  Skin  Bones  Subcutaneous tissue  Sensation  Phantom sensation / pain  Condition of the remaining lower extremity

 Length Measurements  Girth Measurements

 Cylindrical  Conical  Bulbous

 Location  Condition ◦ Inflammation? Open area? Scabbed area? Adhesions? Blisters?

 Delicate  Average  Tough

 Heavy  Average  Light

 Light touch  Dull / Sharp pain  Visual skin inspection

 Vascularity  Sensation  Skin  ROM  Muscle strength

Below-knee prosthetic users  Is the prosthesis as prescribed?  Is the patient experiencing discomfort while standing with equal weight on each side with the feet 4-6 inches apart?  Is the length of the prosthesis correct?

Below-knee prosthetic users  Is the knee stable without feeling pushed into excessive flexion and extension?  Is suspension adequate?  Can the patient sit comfortably with the knee flexed 90deg and shoe flat on the floor?

Above-knee prosthetic users  Is the ischial tuberosity properly located within the socket?  Is adductor longus channel properly located in the socket?  Is the knee unit stable on weight bearing?

Above-knee prosthetic users  Is suspension adequate to minimize pistoning of the residual limb when prosthesis is raised off the floor  Does the socket maintain its position on the residual limb in sitting?  Do the lengths of the prosthetic leg and thigh section approximate those of the sound side?

Above-knee prosthetic users  Does the knee remain flexed in sitting?  Does the patient experience pressure on the posterior thigh?

 Are the forces appropriately distributed over the residual limb? ◦ Discoloration ◦ Skin breakdown

 Groin area  Distal end  Suspension system  Weight of the prosthesis  Donning and doffing  Fatigue

 Ability of prosthesis to keep up with activities  Balance  Transfers  Ambulation ◦ Indoor ◦ Outdoor ◦ Speed ◦ Stairs

 Evaluate skills that the patient need to have in order to perform daily tasks  Frequency of performance of said tasks  Measures and considerations with regards the environment ◦ Environmental Ax ◦ Barriers?

 Ask if patient can do the task and if he can demonstrate  Safety issues

 Confidence of patient in using the prosthesis  Resemblance to sound side  Use of other assistive device  Injuries acquired  Other patient concerns

 Other members of the prosthesis team

 O’ Sullivan, A. & Schmitz, T. (2007). Physical Rehabilitation: Assessment & Treatment 5 th Ed. Philadelphia, F.A. Davis Company.  Patrick, D.G. (1995). Prosthetics. In R.S. Myers (Ed.) Saunders Manual of Physical Practice. USA: WB Saunders Co.  Mariano, L.M.M.Jr. (2007). PT150 archives.