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NPTE > Amputation and Prosthetics > Flashcards

Amputation and Prosthetics Flashcards

1
Q

Primary etiology for amputation
Second

A

peripheral vascular disease
diabetes

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2
Q

forequarter (scapulothoracic) amputation

A

upper extremity including the shoulder girdle

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2
Q

shoulder disarticulation

A

UE through shoulder

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2
Q

Transhumeral

A

UE proximal to elbow joint

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3
Q

elbow disarticulation

A

lower arm and hand through elbow joint

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4
Q

transradial

A

UE distal to the elbow joint

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5
Q

wrist articulation

A

hand through wrist joint

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6
Q

partial hand

A

portion of the hand and/or digits at either the transcarpal, trasmetacarpal or transphalangeal

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7
Q

digital amputation

A

removal of a digit at either metacarpophalangeal, proximal interphalangeal or distal interphalangeal

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8
Q

Hemicorporectomy

A

removal of pelvis and both LE

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9
Q

hemipelvectomy

A

removal of on half the pelvis and LE

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10
Q

knee disarticulation

A

removal of the LE through knee joint

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11
Q

Syme’s

A

removal of the foot at the ankle joint with removal of the malleoli

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12
Q

transvers tarsal (Chopart’s)

A

through talonavicular and calcaneocuboid joints. preserves plantar flexors but sacrifices the DF resulting in equinus contracture

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13
Q

Tarsometatarsal (Lisfranc)

A

removal of the metatarsals
preserves DF and PF

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14
Q

Transradial socket covers….
may be shortened to allow for ….
supracondylar sockets are …. and require no additional harness

A

2/3 of forearm
increased pron/sup
self-suspending

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15
Q

Transradial suspension options

A

triceps cuff
harness
cable sys

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16
Q

Transradial elbow unit attaches to either … or upper arm pad.
… or….connects socket to proximal component.

A

triceps cuff
flexible or rigid

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17
Q

Transradial wrist unit has what options

A

quick change unit
wrist flexion unit
ball and socket
constant friction

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18
Q

Transradial terminal device has voluntary … or…
powered by….
type of hand

A

opening or closing
body-powered, externally powered, myoelectric or hybrid
hook, mechanical hand, cosmetic glove

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19
Q

Transhumeral socket extends to …
modified design allows for stability with…
….units may be used with passive prosthetic arms

A

acromion level
rotational movements
lightweight friction

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20
Q

Transhumeral suspension

A

harness
cable sys
suction

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21
Q

Transhumeral elbow unit

A

internal or external locking elbow unit

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22
Q

Transhumeral wrist unit and terminal device

A

same as transradial

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23
Q

Transfemoral socket

A

quadrilateral socket
ischial containment socket

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24
Q

Transfemoral suspension

A

lanyard strap
shuttle lock
suction
partial suction
vacuum

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25
Q

Transfemoral knee

A

single axis
polycentric
hydraulic
microprocessor

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26
Q

Transfemoral shank

A

exoskeleton-rigid
endoskeleton-pylon covered with foam

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27
Q

Transfemoral foot system

A

solid ankle cushion heel
stationary attachment flexible endoskeleton
single axis
multi-axial
hydraulic
powered
dynamic response

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28
Q

Transtibial socket

A

patella tendon bearing
supracondylar patella tendon socket
supracondylar suprapatellar socket

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29
Q

Transtibial suspension

A

supracondylar cuff
thigh corset
supracondylar brim
rubber sleeve
waist bel with fork strap
suction with knee sleeve
shuttle lock
vacuum

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30
Q

Transtibial knee

A

is not needed

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31
Q

Transtibial shank and foot sys

A

same as transfemoral

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32
Q

Rigid plaster of paris allows for early…
promotes…
stimulates…
provides… and …
limits….
ability to utilize…

A

ambulation with pylon
circulation and healing
proprioception
protection and soft tissue support
edema
IPOP

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33
Q

Rigid plaster of Paris make immediate … inspection not possible.
Does not allow for …
Requires…

A

wound inspection
daily dressing change
professional application

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34
Q

NWB Rigid removable limb protectors are …. accomodate…. are easily ….prevent… and provides….

A

removable
edema fluctuation
applied
contracture
protection

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35
Q

NWB rigid removable limb protectors are not used for …

A

ambulatory purposes

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36
Q

Semi-rigid (unna paste, air splint) reduces….provides… and …. and are easily…

A

post-op swelling
soft tissue support and protection
changeable

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37
Q

Semi-rigid does not protect as well as ….requires more….may loosen and allow for …

A

rigid dressing
more changing than rigid
development of edema

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38
Q

Soft (ACE wrap, shrinker) reduces …, provides some…, relatively ….., easily removed for ….. allows for active joint ….

A

post-op edema
protection
inexpensive
wound inspection
ROM

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39
Q

Soft causes interruption of…. due to frequent dressing changes.
Joint ROM may…. healing of incision.
Less control of ….
cannot control amount of …. on bandage.
Risk of …. effect.
Shrinker cannot be applied until…

A

tissue healing
delay
residual limb pain
tension
tourniquet
sutures/staples are removed

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40
Q

K level is associated with

A

componentry that will be used for prothesis
current level of function, potential ability for function and patients particular needs.

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41
Q

K level is determined by

A

AMPPRO or through a thorough history and examination of patient. PT can make this level

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42
Q

K level 0

A

prothesis will not enhance quality of life or mobility
will not be eligible for prosthesis

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43
Q

K level 1

A

transfers
ambulate on level surfaces
fixed cadence
limited or unlimited household ambulator
knee will be single axis or constant friction
ankle will be SACH or single axis

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44
Q

K level 2

A

traverse low-level barriers
limited community ambulator
knee will be polycentric or constant friction
ankle will be flexible keel foot and multi-axial ankle

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45
Q

K level 3

A

variable cadence ambulator
unlimited community ambulator
traverse most environmental barrers
prosthetic use beyond simple locomotion
knee will be hydralic, microprocessor, or variable friction.
ankle will be energy storing, dynamic response, mutli-axial foot

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46
Q

K level 4

A

exceeds basic ambulation skills
exhibits high impact levels
child, athlete or active adult
any systems for knee and foot

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47
Q

What areas are more tolerant for a socket?

A

muscular

48
Q

common design for transfemoral

A

ischial containment

49
Q

common design for transtib

A

total surface bearing or patellar tendon bearing socket

50
Q

liners are typically

A

gel and non-breathable so need to dry it.

51
Q

An insert can accomodate for …

A

space in socket
foam or flexible plastic

52
Q

hard insert can

A

relieve pressure through a series of buildups and reliefs molded in the insert

53
Q

Sock is worn to decrease limb volume especially in

A

first year

54
Q

Common plys of sock are

A

1,3,5

55
Q

General rule of thumb with socks

A

number of socks exceed 12-15, prosthetist needs to recast

56
Q

Pressure tolerant areas on transtib

A

patellar ligament
lateral fibula shaft
medial tibial shaft
lateral tibial shaft

57
Q

Pressure sensitive areas on transtib

A

fibular head
lateral tibial flare
tibial crest
distal end of fibula and tibia
patella
anterior tibial tubercle
peroneal nerve
adductor tubercle

58
Q

Pressure tolerant areas on transfem

A

ischium
soft tissues of residual limb

59
Q

Pressure sensitive areas on transfem

A

greater trochanter
pubic tubercle
pubic ramus
pubic symphysis
distal end of femur
perineum

60
Q

Lotion for limbs should be….and should not be applied prior to ….because it might inhibit suspension. If there is any breakdown of skin it should be….

A

not be petroleum based
donning prosthesis
prosthestist or physician before donning

61
Q

Break in schedule for prosthetic

A

first few weeks
start with one hour of wear time a day with half of that being walking
every 30 min inspect skin
if tolerating all this well increase time to one more hour each day.
When skin is doing well with no signs of breakdown, amount of time between inspections becomes 15-30 min more

62
Q

Most common complaint with a new prothesis is the

A

comfort of the socket

63
Q

Pre-prosthetic phase

A

6 weeks immediately post-op
focus on protecting limb, preventing contractures, developing single limb mobility skills and preparing for prosthetic phase
sometimes will be fit with IPOP-allows for immediate WB

64
Q

Patient will be evaluated for first prosthesis once ..

A

.sutures or staples are healed and skin integrity is intact 4-6 weeks.
can begin wearing a shrinker when staples are removed

65
Q

First get a temporary prosthesis then go to

A

prosthetic phase of rehab

66
Q

How long does it take to get a good comfort and fit and what is required to get a permanent prosthesis

A

several months
volume fluctuations have stabilized

67
Q

What wrapping strategies should you use with residual limbs?

A

no wrinkles
diagonal and angular pattersn
no circular patterns
provide pressure distally to enhance shaping
anchor wrap above knee for transtib and around pelvis for transfem
promote full elbow extension for transradial
promote full knee extension for transtib
promote full hip extension for transfem
secure wrap with tape not clips
use 2-4 in wrap for UE
3-4 in wrap for transtib
6 in wrap for transfem
rewrap frequently

68
Q

Common complications followed amputation

A

contractures
DVT
hypersensitivity
neuroma
phantom limb
phantom pain
psychological impact
wound infections

69
Q

most likely contractures for transmet and Symes

A

equinus

70
Q

most likely contracture for transtib

A

knee flexion

71
Q

most likely contracture for transfem

A

hip flexion and abduction

72
Q

Most common cause for forequarter amputation
loss of all what joint movements

A

malignancy
shoulder, elbow and hand
functional prosthetic is common

73
Q

Shoulder disartic is the loss of what joint movements?
Most commonly result of …?
Functional prosthetic use ….
What kind of shoulder?

A

all shoulder, elbow and hand function
malignancy and severe electrical injuries
is possible
external prosthetic shoulder joint is typically required

74
Q

Two most common UE amputations

A

transradial
transhumeral

75
Q

Transhumeral is the loss of all…
most commonly due to…
typically __-___cm proximal to the distal humeral condyles.
If trauma associated fracture, dislocation or peripheral nerve injury it may….

A

elbow and hand function
trauma
7-10
delay prosthetic interventions

76
Q

Elbow disarticulation is the loss of all…
most commonly due to …
allows for …. socket.
an external prosthetic …. is required.

A

elbow and hand function
trauma
self-suspending
elbow joint

77
Q

Transradial is the loss of all …
must be a minimum of ___cm proximal to distal radius.
Typically caused by…
If it is trauma, dislocation or peripheral nerve injury it may…
Functionally perferred over …. or …

A

all hand function
5
trauma
delay prosthetic interventions
wrist disarticulations or selected partial hand amputations

78
Q

Wrist disarticulation is ….
loss of all…
.. and …. prosthetic disadvantages

A

uncommon
hand function
cosmetic and functional

79
Q

Partial hand amputation is the loss of a …
limb sparing technique utilized when…
toe transfer to replace … may be considered if prosthesis fails

A

digit/hand function
functional pinch can be preserved
thumb

80
Q

Digit amputation preserved function is highly variable depending on ….
protheses are ….
long transradial amputation may be more… if multiple digits are involved at proximal levels.

A

number of digits involved and level of amputation
not typically utilized
functional

81
Q

Hip disarticulation/hemipelvectomy all functions of ….
most common cause…
does not allow for activation of….
prosthetic limb advancement is initiated through…

A

hip, knee, ankle, and foot are absent
malignancy
prosthesis through residual limb
pelvic motion

82
Q

Transfem length of residual limb with regard to…
knee componentry will determine ability to …
stance control may not activate until…
donning can be more difficult than with …
WB through ischium in an ….
susceptible to ….
adaptation required for balance….

A

leverage and energy expenditure
functionally reciprocate gait
WB occurs through limb
transtib
ischial containment socket
hip flexion contracture
weight of prosthesis and energy expenditure

83
Q

Knee disartic loss of all ….
residual limb can …
susceptible to ….
knee axis of prosthesis is…
gait deviations can occur secondary to…

A

knee, ankle and foot function
WB through its end
hip flexion contractures
below the natural axis of the knee
malalignment of knee axis

84
Q

Transtib loss of …
WB in prosthesis should be …
areas of primary WB should be…
adaptations required for…
susceptible to both …

A

active foot and ankle motions
distributed over the total residual limb
pressure tolerant
balance
knee and hip flexion contractures

85
Q

Symes loss of …
residual limb can WB…
residual limb is … with non-cosmetic appearance.
dog ears must be …. for proper prosthetic fit.
adaptation required for increased…
adaptation required due to ….

A

all foot functions
through its end
bulbous
reduced
weight
diminished toe off

86
Q

Trasmet and choparts is loss of ___,___,___,___ and tendency to develop.

A

forefoot leverage
balance
WB surface
proprioception
equinus deformity

87
Q

Prosthetic causes of lateral bending

A

too short
improperly shaped lateral wall
high medial wall
prosthesis aligned in abd

88
Q

Amputee causes of lateral bending

A

poor balance
abd contracture
improper training
short limb
weak abd on prosthetic side
hypersensitive and painful residual limb

89
Q

Prosthetic causes of abducted gait

A

too long
high medial wall
poorly shaped lateral wall
prosthesis positioned in abd
inadequate suspension
excessive knee friction

90
Q

Amputee causes of abducted gait

A

abd contracture
improper training
adductor roll
weak hip flexors and adductors
pain over lateral residual limb

91
Q

Prosthetic causes of circumducted gait

A

too long
excessive knee friction
socket is too small
excessive PF

92
Q

Amputee causes of circumducted gait

A

abd contracture
improper training
weak hip flexors
lacks confidence to flex knee
painful anterior distal residual limb
inability to initiate prosthetic knee flexion

93
Q

Prosthetic causes of excessive knee flexion during stance

A

socket set forward in relation to foot
excessive DF
stiff heel
too long

94
Q

Amputee causes of excessive knee flexion during stance

A

knee flexion contracture
hip flexion contracture
pain anteriorly in residual limb
decrease in quad strength
poor balance

95
Q

Prosthetic causes for vaulting

A

too long
inadequate socket suspension
excessive alignment stability
excessive PF

96
Q

Amputee causes for vaulting

A

residual limb discomfort
improper training
fear of stubbing toe
short residual limb
painful hip/residual limb

97
Q

Prosthetic cause for rotation of forefoot at heel strike

A

excessive toe-out built in
loose fitting socket
inadequate suspension
rigid SACH heel cusion

98
Q

Amputee causes for rotation of forefoot at heel strike

A

Poor muscle control
improper training
weak medial rotators
short residual limb

99
Q

Prosthetic causes for forward trunk flexion

A

socket too big
poor suspension
knee instability

100
Q

Amputee causes for forward trunk flexion

A

hip flexion contracture
weak hip extensors
pain with ischial WB
inability to initiate prosthetic knee flexion

101
Q

Prosthetic causes for medial or lateral whip

A

excessive rotation of the knee
tight socket
valgus in prosthetic knee
improper alignment of toe break

102
Q

Amputee causes for medial or lateral whip

A

improper training
weak hip rotators
knee instability

103
Q

Limb loss specific out come measures: functional

A

AMPPRO-Amputee mobility predictor
L-test

104
Q

AMPPRO

A

measure ambulatory potential of lower-limb prosthesis users. K-level

105
Q

L-test

A

assess amputee mobility
Like the TUG but some differences: 90 degree turn is performed after initial 3 meters, total length ambulated is 20 meters not 6 like the TUG, four turns are involved.

106
Q

Limb loss specific outcome measures: patient based outcomes

A

Prosthesis Evaluation Questionnaire (PEQ)
Orthotics Prosthetics User Survey (OPUS)
Trinity Amputation and Prosthesis Experience Scales-revised (TAPES-R)

107
Q

PEQ

A

evaluate the prosthesis and life with it
9 scales that can be administered together in independently.
Visual analog scale to assess satisfaction, well-being, frustration, pain, and residual limb health.

108
Q

OPUS

A

functional status, quality of life, satisfaction modules
simple and be performed in part or in whole

109
Q

TAPES-R

A

multidimensional instrument examines psychosocial process involved in adjusting to using an a prosthesis.
Four sections: activity restriction, psychosocial adjustment, satisfaction with prosthesis, and factors influencing health both related to and unrelated to amputation.
Takes 15 min to administer and may be given in part or in whole.

110
Q

Acquired amputation

A

disease, trauma, infection
traumatic or non-traumatic

111
Q

Endoskeletal shank

A

rigid pylon covered in material designed to simulated the contour and color of the contralateral limb

112
Q

Exoskeletal shank

A

rigid external frame covered with a thin layer of tinted plastic to match the skin color distally

113
Q

myodesis

A

anchoring muscle or tendon to bone using sutures drilled in bone. Help in closure process on residual limb.

114
Q

myoplasty

A

suturing amputated muscle flaps together over the end of a bone

115
Q

osseointegration

A

process of implanting a prosthetic device directly into residual limb of a person with limb loss. Negates the need for socket component.

116
Q

polycentric knee

A

multiple axes of rotation for more natural gait cycle

117
Q

pylon

A

pipe like structure used to connect the socket to the foot/ankle components assists with WB and shock absorption

118
Q

/

A

NPTE (54 decks)

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