Amputations and Adaptive Equipment / Orthoses

Question 1

For a patient who has undergone a transtibial amputation, which of the following seated positions is MOST appropriate?

1.High Fowler position with the residual limb supported by pillows and the knee resting in 45° of flexion

2.Residual limb supported by pillows and the knee resting in full extension

3.Residual limb supported by pillows and the knee resting in 30° of flexion

4.Upright with bilateral hips and knees in 90° of flexion

Answer 1

2. The residual limb supported by pillows and the knee resting in full extension is the preferred position, because it decreases the risk for knee flexion contracture

Incorrect Answers
1. High Fowler position is defined as a position in which the head of the patient’s bed is raised 80° to 90° with knees flexed (p. 173). Over time this position increases the risk of development of a knee flexion contracture

3. In this position the residual limb is supported, but the knee is still flexed, creating pressure on the distal end of the residual limb that could lead to pressure injuries
4. In this position the residual limb is in a dependent position, which promotes swelling, and the knee is flexed, which promotes knee flexion contracture

Question 2

ADA Guidelines:
What is the minimum width for a doorway?
What is the minimum width for a hallway?

Answer 2

1. Doorway = 32 inches
2. Hallway = 36 inches for turns

Question 3

How do you determine the appropriate back height of a wheelchair?

Answer 3

Measure from the seat of the chair to the bottom of the axilla and subtract 4 inches. So of the distance from the seat to the armpit is 20 inches, 16 inches is the appropriate seat height. If the pt has no abdominal control adding an additional inch may provide more support.