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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
Which of the following is an advantage to wearing a body-powered prosthetic?
propriception
26
Myoelectric / External Powered
``` 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
Myoelectric / External Powered advantages
Greater functional capacity Increases cosmesis Greater grip forces Reduced or eliminated harness system (increased comfort and ROM)
28
Myoelectric / External Powered disadvantages
Increased cost and maintenance (initially) Increase weight Battery
29
Amputation Level | Transradial myotesting
Flexor Carpi Radialis, Flexor Carpi Ulnaris, Extensor Carpi Radialis Longus * Breve, Extensor Digitorum
30
Amputation Level | Transhumeral
Biceps Brachii, Triceps Brachii, Deltoid
31
Amputation Level | Shoulder disarticulation
Pectoralis Major & Minor, Trapezius, Teres Minor, Latisimuss Dorsi, Supraspinatus, Infraspinatus
32
Which of the following is an advantage to wearing a myoelectric / externally powered prosthetic?
Increased grip force
33
Hybrid Prosthesis combination of
Combination of body-powered and electronically-powered components in one prosthesis
34
Hybrid Prosthesis advantages
``` 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
Hybrid Prosthesis disadvantages
Control harness typically required | Increased weight on harness
36
Adaptive Prosthesis
Customized for a specific function or activity | Consist of recreational and adaptive TD’s
37
Post-Operative and Pre-Prosthetic Therapy
Post-Operative Wound healing, pain management, ROM, Psychosocial Pre-Prosthetic Preparing the residual limb to wear the prosthesis
38
Post-Operative and Pre-Prosthetic Therapy Goals
``` 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
Post-Operative and Pre-Prosthetic Therapy
Wound Care/ ROM/ Weight Bearing / Scar Massage/ Muscle Training / Phantom Pain
40
Pre-Prosthetic Assessment includes
ROM MMT Muscle site testing Circumferential measurements
41
Phantom Limb Pain
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
Phantom Limb Management Approaches
``` 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
Post-Prosthetic Intervention
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
Functional Use Training
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
Adaptive Equipment
``` 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
Special Considerations
``` 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
Modern Technologies
i-Limb, DARPA, 3D Printing
48
Interdisciplinary Team Approach
``` 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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