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amputations Flashcards

1
Q

Amputation:

A

BE (below-the-elbow): A specific level of amputation; also known as transradial

Wrist disarticulation: An amputation through the wrist

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2
Q

A birth malformation such as an absent or poorly developed limb

A

Congenital anomaly

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3
Q

Congenital absence or partial absence of one or more limbs at birth. Cause may be environmental or genetic

A

Amelia

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4
Q

One or more limbs are missing, with the hand and/or foot attached directly to the trunk

A

Phocomelia

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5
Q

Causes of Limb Loss

A

Dysvascular related amputations (main cause)
Trauma related amputations
Cancer/infection related amputations
Congenital related amputations

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6
Q

Congenital related amputations

A

Amniotic Band Syndrome/ Constriction Band Syndrone: constriction of fibrous bands within the membrane that surrounds the developing fetus

Teratonegic Agents during 1st trimester such as, drugs, pesticides, thalidomide (60’s)

Genetics

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7
Q

97% of lower limb lost is from

A

dysvascular causes

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8
Q

most of upper limb lost is from

A

trauma

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9
Q

Removal of entire shoulder girdle

A

Interscapulothoracic Amputation

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10
Q

Amputation through the shoulder joint

A

Shoulder Disartication

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11
Q

Above the elbow (AE)

A

Transhumeral Amputation

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12
Q

Amputation through the elbow joint

A

Elbow disarticulation

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13
Q

amputation below elbow (BE)

A

transradial

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14
Q

amputation through the radiocarpal joint

A

wrist disarticulation

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15
Q

resection of partial hand

A

transcarpal amputation

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16
Q

Resection of the thumb or fingers at the MCP, PIP, and/or DIP

A

Transphalangeal Amputation

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17
Q

Prosthetic Options

A 
No prosthetic 
Passive functional / Cosmetic
Body Powered / Conventional
Myoelectric / External Power
Hybrid
Adaptive
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18
Q

Many people with limb loss who are eligible of a prosthesis may choose not to wear one:

A 
Bad first experience
Unnatural look
Reactions from others
Adaptation of one-handed skills
Financial concerns
Unaware of options
Limited functional ability
Lack of sufficient prosthetic training
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19
Q

Passive Functional / Cosmetic Advantages

A 
Cosmetic
Lightweight
Little maintenance 
Inexpensive (Non-custom silicone)
Great for persons with partial hand amputations
Provides Opposition
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20
Q

Passive Functional / Cosmetic Disadvantages

A 
No active prehension
Limited function
Decreased durability
Unreal expectations for cosmesis
Custom silicone is very expensive
21
Q

What is an advantage to wearing a passive functional / cosmetic prosthetic?

A

Requires little maintenance and is lightweight

22
Q

Body-powered Prosthetics:

A

Socket or interface
Suspension system
Control cable
Harness
Terminal Devices (TD): hooks or mechanical hands
Wrist unit: connects the TD to the prosthesis and some anatomical wrist function
Possibly:
Triceps cuff (BE)
Hinges (BE)
Elbow (AE)
Shoulder (shoulder disarticulation of higher)

23
Q

Body-Powered Prosthetic advantages

A 
Heavy duty construction
Provides proprioception
Less expensive
Light-weight
Low maintenance
24
Q

Body-Powered Prosthetic disadvantages

A

Limited grip force (shoulder strength and rubber band tolerance)
Limited functional ROM
Uncomfortable/restrictive harness
Poor cosmesis
Possibility of over-use, Nerve Entrapment Syndrome

25
Q

Which of the following is an advantage to wearing a body-powered prosthetic?

A

propriception

26
Q

Myoelectric / External Powered

A 
Externally Powered Prosthesis:
Components:
Socket or Interface
Suspension system
Input device
Microprocessor
Battery
TD

Moved by motors and powered batteries
Signal from body tells prosthesis what to
Signal generated by:
Electrical signals generated by muscles

27
Q

Myoelectric / External Powered advantages

A

Greater functional capacity
Increases cosmesis
Greater grip forces
Reduced or eliminated harness system (increased comfort and ROM)

28
Q

Myoelectric / External Powered disadvantages

A

Increased cost and maintenance (initially)
Increase weight
Battery

29
Q

Amputation Level

Transradial myotesting

A

Flexor Carpi Radialis, Flexor Carpi Ulnaris, Extensor Carpi Radialis Longus * Breve, Extensor Digitorum

30
Q

Amputation Level

Transhumeral

A

Biceps Brachii, Triceps Brachii, Deltoid

31
Q

Amputation Level

Shoulder disarticulation

A

Pectoralis Major & Minor, Trapezius, Teres Minor, Latisimuss Dorsi, Supraspinatus, Infraspinatus

32
Q

Which of the following is an advantage to wearing a myoelectric / externally powered prosthetic?

A

Increased grip force

33
Q

Hybrid Prosthesis combination of

A

Combination of body-powered and electronically-powered components in one prosthesis

34
Q

Hybrid Prosthesis advantages

A 
Greater functional capacity
Reduced weight
Greater grip force
Reduced harness system (Increased comfort & ROM)
Feedback of forearm flexion velocity
Reduced initial and maintenance costs
35
Q

Hybrid Prosthesis disadvantages

A

Control harness typically required

Increased weight on harness

36
Q

Adaptive Prosthesis

A

Customized for a specific function or activity

Consist of recreational and adaptive TD’s

37
Q

Post-Operative and Pre-Prosthetic Therapy

A

Post-Operative
Wound healing, pain management, ROM, Psychosocial

Pre-Prosthetic
Preparing the residual limb to wear the prosthesis

38
Q

Post-Operative and Pre-Prosthetic Therapy Goals

A 
Edema control and residual limb shaping
Residual limb desensitization
Addressing phantom pain/ sensation
Wound management
Prevention of contractures
Scar management
Residual limb hygiene education
A/AA ROM exercises
Increase muscle strength
HEP
Exploration of psychological impact
Adaptive Equipment Assessment for independence with ADLs
Myoelectric evaluation
Arrange appointment and attend prosthetic
39
Q

Post-Operative and Pre-Prosthetic Therapy

A

Wound Care/ ROM/ Weight Bearing / Scar Massage/ Muscle Training / Phantom Pain

40
Q

Pre-Prosthetic Assessment includes

A

ROM
MMT
Muscle site testing
Circumferential measurements

41
Q

Phantom Limb Pain

A

Phantom Sensation in the missing part of arm or leg

Tingly, prickly, numb, hot/cold, burning, cramping or itching

Trigger’s of phantom limb pain:
Lack of rest
Excessive pressure on residual limb
Changes in weather
Stress
Infection
Poorly fitting prosthesis
Lack of blood flow
Edema
Pain lessens over time with use of proper interventions
42
Q

Phantom Limb Management Approaches

A 
ROM
Mirror therapy
Biofeedback, Integrative and Behavioral Methods:
Deep breathing techniques
Warm towel wrap
Taking mind off the pain (reading, music)
Donning and doffing prosthesis
Compression stocking
43
Q

Post-Prosthetic Intervention

A

Residual limb monitoring and hygiene (bony changes, break down)
Wearing schedule
i.e. 30 min intervals 3X/day with frequent skin checks
Independence in donning/doffing (changing batteries, if applicable)
Muscle training
Repetitive drills and activities
Energy conservation and work simplification
Functional Use Training
Evaluation and modification of recreational tasks/ return to work or school
Introduction of resources
Support groups

44
Q

Functional Use Training

A

Most difficult and prolonged stage of the prosthetic training process
Patient’s success depends on:
Motivation
Engagement in purposeful and functional activities
Experience of the therapist

Caregiving (changing diapers, etc.)
Leisure (painting, kayaking)
Specific works tasks
May need work site evaluation
Specific school tasks (handwriting, grasping and using tools, social-emotional)
May need school evaluation
Specific home tasks
May need home evaluation
45
Q

Adaptive Equipment

A 
Rocker knife
Swivel Spoon
One handed cutting board
Adaptive keyboard
Soap dispenser
Long handled equipment (sponge, brush, nail clipper,
reacher, toilet aid)
Dycem or electric can opener
Elastic laces
46
Q

Special Considerations

A 
Patient/ Caregiver goals
Short term goals
Long term goals
Cosmesis vs. Function
Reimbursement issues
Early fitting
Kids vs. adults
Grow rates in children
Support at home
Unilateral vs. bilateral
47
Q

Modern Technologies

A

i-Limb, DARPA, 3D Printing

48
Q

Interdisciplinary Team Approach

A 
Ideal Situation
Physician
Nurse
Occupational Therapy / Physical Therapy
Prosthetic Manufacturer’s Clinical Representative
Psychologist
Case Manager
Family / Vocational Counselor

human conditions (28 decks)

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