Amputation/Prosthetics & Orthotics Flashcards
Hybrid prosthesis
A type of UE or LE prosthesis that is dually powered by the body and an electrical component
Commonly used with a transhumeral amputation
Myosites
Muscle sites in a residual limb that produce electromyographic signals that can be used to activate a myoelectrical prosthesis
Halo vest
A brace that supports and immobilizes the cervical spine and neck after an injury or surgery
Consists of a ring that encircles the head and is secured by pins and rods to the skill and is connected to a brace around the chest
Restriction orthosis
Classification of an orthosis intended to limit partial mobility of one or more joints while allowing free movement through the remaining arc of motion, typically used to:
- allow controlled motion
- decrease risk of scar adhesions
- minimized risk of contracture
- improve functional use
Body-powered prosthesis
Type of upper limb prosthetic device that is operated using a harness and the movement of the body to generate forces through a cable control system
Body powered terminal device
Component attached to the distal end of a prosthesis that is operated by forces generated by the body and enable a person to hold and stabilize objects, types include hand and hook designs with voluntary opening/closing features
Myoelectric prosthesis
Type of prosthesis used for a person following amputation that uses electrical signals from existing muscles to control the movement of the artificial limb
Angle of application
Force of torque applied to a joint using the dynamic component of a mobilization orthosis, ideally 90º to body segment being moved
Performance characteristic of thermoplastic material: Perforations
Small holes distributed throughout thermoplastic material that allow for air flow to minimize risk of skin rash, sweating, and maceration
Performance characteristic of thermoplastic material: Rigidity
Capacity of thermoplastic material to maintain its strength and to prevent a change in the integrity of the custom fit against force and repetitive stress, material effective to stabilize a large joint
Handling characteristic of thermoplastic material: Bonding
Capacity of thermoplastic material for it to adhere to itself, beneficial characteristic when attaching dynamic orthotic components to an orthotic base
Palmar crease
A crease on the hand that indicate areas of joint mobility and must be considered when fabricating and fitting an orthosis
Types include:
- distal
- proximal
- thenar
- hypothenar
Handling characteristic of thermoplastic material: Memory
Capacity of thermoplastic material to retain its original properties when reheated, recommended when frequent re-molding may be necessary
Intrinsic-plus position
Term used in orthotic positioning, commonly referred to as the “anti-deformity” or “safe position” of the hand, intended to place the MCP joint collateral ligaments in an elongated position to reduce contracture risk
Consists of:
- wrist in neutral or slight extension
- finger MCP joints in 75-90° of flexion
- finger IP joints in complete extension
- thumb in abduction and opposition
Anticontracture position: Anterior neck burn
Characteristics of this anticontracture position includes:
- neck in extension
- do not use a pillow when supine in bed
- use a neck collar or neck extension orthosis
Anticontracture position: Burn on the volar surface of the hand
Characteristics of this anticontracture position includes:
- MCP joints in slight hyperextension
- use of a palm extension orthosis to prevent cupping of the hand
Anticontracture position: Burn on the dorsum of the wrist
Characteristics of this anticontracture position includes:
- wrist joint in neutral
- use of an immobilization orthosis to prevent wrist extension
Anticontracture position: Burn on the dorsum of the hand
Characteristics of this anticontracture position includes:
- MCP joints in 70-90° in flexion with IP joints in full extension and thumb in opposition
- maintain ROM of first web space
- use of a functional hand orthosis to avoid claw hand deformity
Anticontracture position: Anterior elbow burn
Characteristics of this anticontracture position includes:
- elbow joint in 5-10° of flexion
- use of a wrist extention orthosis to prevent flexion
Anticontracture position: Burn of the axilla
Characteristics of this anticontracture position includes:
- shoulder joint in 120° of abduction with slight external rotation
- use of an orthosis or wedge to prevent shoulder adduction
Body powered prosthetic
works off adjacent joint
Myoelectric prosthetic
Picks up muscle contraction
Only needs one viable muscle site
Terminal device
Thing on the end of prosthetic
Hand, claw
Voluntary closing
Body powered action to close claw; when relaxed it opens
Voluntary opening
Body powered action to open claw; when relaxed it closes
Desensitization
Weight bearing
Touch it
Textures
Builds tolerance for prosthetic
Oval 8
Used to manage: mallet finger, swan neck and boutonniere deformities, trigger finger and trigger thumb, lateral deviation, arthritis, fractures and hypermobility
Spring loaded extension splint (LMB)
FO
Ideal for finger flexion tightness and boutonniere deformities
It produces extension of the joints of the fingers and/or thumb.
Dressing tree
A dressing tree is a term that indicates a system of hooks and pegs that can help people with an upper limb difference put on and take off, or don and doff, their prostheses without the help of others.
dressing trees can also help with clothes
Cosmetic prosthetic
Use the term passive functional for insurance to cover it.
These prostheses are lightweight and while they do not have active movement, they may improve a person’s function by providing a surface for stabilizing or carrying objects.
Role of OT/PT in orthotics
Correct fit and type
- Pre surgery consult
Educate the client
- Terminology
- Expectations
Prep the stump
- Desensitization starting day 1 after surgery
- Molding
Application
- Don and doff
Functional use
Resting hand orthotic
WHFO
Resting pan
Antideformity
Antispasticity
Wrist 10-20º extension
Slight flexion of digits
Cock-up orthotic
WHO
Dorsal or volar based
Wrist immobilizer
Used with
- carpal tunnel
- wrist sprain
- carpal fx
- tendonitis
- ganglion cyst removal
- after an arthroplasty
- radial nerve palsy
- protect wounds
Support the wrist, cerebral palsy, stroke
Base of many dynamic splints
Thumb spica
WHFO
Used for
- DeQuervain’s
- athrtitis
- post CMC arthroplasty
- preventative for CMC arthritis
- scaphoid or thenar fx
- Gamekeeper’s thumb
- UCL tears
CMC splint
HO
Static articulated orthotic
They can be hinged and locked (don joy)
- If they hold the joint still, they are hinged static
Static progressive orthotic
This type applies force to the stiff joint or tissue, holding it at end-range position to improve passive motion.
May be articulated or not
Cannot be used on clients with abnormal tone
Adjustments can be made based on client’s pace and tolerance
How to prevent torque deformity?
Torque deformity occurs when fingers start to twist or cross over.
The lower the profile, the lower the chance of getting torque deformity.
There should be a 90º angle from the point of pull to joint it is closes to.
Orthotic functional position
Wrist 20-35º extended
Arches apparent
MPs slightly flexed
IPs 45-60º flexion
Thumb abducted and opposed
Intrinsic plus (antideformity) position
Wrist 10-20º extension
MPs 90º flexion
IPs 0º
Kleinert, Duran, or Chow orthotics
90º rule
Used for flexor and extensor tendon repairs
Takes the place of the affected tendon during the healing process
Functional orthotics
Tenodesis orthotic - used with C5-8 spinal cords to increase the strength of tenodesis action
Others for writing, creating a thumb or radial nerve
Mallet finger
Rupture or interruption of the terminal extensor tendon
It will not get better.
The only way it will heal without surgery is to leave it in place (extension) for 6-8 weeks and allow scar tissue to “glue” the tendon/rope back together. If you remove the splint and make ONE fist, prior to the 6-8 weeks, you will tear all the developing scar tissue and you have a cut tendon/ rope again! If you have to start over, it is less likely to heal!
Splint: the end joint (DIP) should be kept in an extension splint, it is best to tape it to the splint so that it will not move, the splint can be fabricated out of thermoplastics or you can use an aluminum splint, it can go on the top or bottom
