Clinical guide

In this guide you check each of the following subjects, noting any points in the Patient Record that will need treatment.

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Multiple injuries

Are there multiple injuries?
YES prioritise treatment of significant injuries next NO next 2

Co-morbidities

Are there co-morbidities?
YES proceed with caution & treat as appropriate next NO next 3

Readiness to learn

Is the patient able to understand and remember new information?
NO monitor and query ability to use prothesis next YES next 4

Health of stump

Is the stump healthy? Check for signs of healing or infection
NO refer to medic next YES next 5
 
Is the stump oedematous? check for signs of oedema by pressing gently with flat of thumb
YES oedematous stump next NO next 6
 
Has the wound healed?
NO delayed healing next YES next 7
 
Is the scar tethered?
YES tethered scar next NO next 8

 

Pain

Is the patient in pain?
YES in pain next 9 NO next 12
 
Is the pain in the stump?
YES pain in the stump next NO next 10
 
Is there pain elsewhere?
YES pain elsewhere next NO next 11
 
Is the pain where the limb used to be?
YES phantom pain next NO next 12

 

Leg Range of Movement (ROM) tests

Key point:

Assess the ROM of your patient on both sides (left and right)

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Does either hip have reduced ROM?
YES reduced hip extension next NO next 13
 
Does either hip have reduced flexion?
YES reduced hip flexion next NO next 14
 
Does either hip have reduced lateral rotation?
YES reduced lateral rotation next NO next 15
 
Does either hip have reduced medial rotation?
YES reduced medial rotation next NO next 16
 
Does either hip have reduced abduction?
YES reduced abduction next NO next 17
 
Does either hip have reduced adduction?
YES reduced adduction next NO next 18
 
Does either knee have reduced flexion?
YES reduced knee flexion next NO next 19
 
Does either knee have reduced extension?
YES reduced knee extension next NO next 20
 
Is there reduced ankle dorsiflexion or plantarflexion?
YES reduced dorsiflexion or plantarflexion next NO next 21

Leg strength tests

Record whether testing left or right leg using this scale

To test strength, the physio will use resistance (marked by orange arrow)

measure muscle strength from 0-5;
0: no movement
1: flicker but no movement
2: able to move with gravity eliminated
3: able to move through full range against gravity
4: able to move through full range against gravity & with some resistance
5: normal strength

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Does either hip have reduced extension strength?
YES reduced hip extension strength next NO next 22
 
Does either hip have reduced flexion strength?
YES reduced hip flexion strength next NO next 23
 
Does either hip have reduced abduction strength?
YES reduced hip abduction strength next NO next 24
 
Does either hip have reduced adduction strength?
YES reduced hip adduction strength next NO next 25
 
Does either hip have reduced lateral rotation strength?
YES reduced hip lateral strength next NO next 26
 
Does either hip have reduced medial rotation strength?
YES reduced hip medial rotation strength next NO next 27
 
Does either knee have reduced extension strength?
YES reduced knee extension strength next NO next 28
 
Does either knee have reduced flexion strength?
YES reduced knee flexion strength next NO next 29
 
Does either ankle have reduced strength?
YES reduced ankle strength next NO next 30

 

Strength and range of movement in upper limbs

Does either arm have reduced ROM at shoulder?
YES reduced ROM in shoulder next NO next 31
 
Does either arm have reduced strength at the elbow?
YES reduced strength in elbow next NO next 32
 
Does either arm have reduced strength at the wrist or hand?
YES reduced strength in hand next NO next 33

 

Hand dexterity

Does the patient have good hand function?
NO make a note to inform prosthetist next YES next 34

 

Foot health

Is the contra-lateral foot healthy?
NO unhealthy foot next YES next 35

 

Bed mobility

Can the patient move safely around the bed?
NO teach bed mobility next YES next 36

 

Wheelchair safety

Does the patient know how to transfer?
NO teach wheelchair transfers next YES next 37
 
Is the patient safe to use a wheelchair?
NO teach safe use of wheelchair next YES next 38

 

Safety on crutches

Has the patient been measured for crutches?
NO measure for correct length of crutches next YES next
 
Is the patient safe to use crutches for transfer?
NO teach safe use of crutches for transfer next YES next 40
 
Is the patient safe to use crutches around location?
NO teach safe use of crutches around location next YES next

 

Floor transfer

Can the patient move from floor to chair/bed?
NO teach floor/chair transfer next YES next

 

Anxiety & depression

Does the patient have anxiety or depression?
YES refer to medic, monitor next NO, monitor next 43

 

Suitability for prosthetic

Based on this on-going assessment, is a prosthesis suitable for the patient?
NO discuss with prosthetist, continue with rehab and reassess next YES! next
Check list (to help decision)
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Independent mobility with appropriate aid (wheelchair or crutches)
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Independent transfers
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Able to stand for long enough to take a cast of the stump (can be holding on)
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Adequate ROM hips and knees - flexion contractures of less than 25 degrees hip and knee both sides
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Good muscle power in all limbs regardless of level of amputation
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Good understanding and insight

YES yes proceed to prosthetic assessment
no continue with rehab and reassess