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Advanced Patient Care > Amputations and Prosthetics > Flashcards

Amputations and Prosthetics Flashcards

1
Q

What is the most common cause of amputation?

A

peripheral vascular disease (PVD) (trauma also common)

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2
Q

what else can be treated with amputation?

A

some malignancies that affect bone

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3
Q

when would a viable body part be amputated?

A

when patients decide that their overall function would be better without it

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4
Q

what is partial foot amputation?

A

removal of any portion of the foot

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5
Q

what are the most common levels for partial foot amputation?

A

phalangeal, transmetatarsal, and midtarsal disarticulation

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6
Q

what do phalangeal amputations alter, and what would this increase the risk for?

A

alters weight distribution in the foot increasing the risk for areas of high pressure and subsequent tissue breakdown, and the need for further amputation

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7
Q

what are some major LE amputations?

A

syme’s amputation, ankle disarticulation, transtibial amputation, transfemoral amputation, hip disarticulation, transpelvic amputation (hemipelvectomy), translumbar amputation (hemicorporectomy)

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8
Q

what is syme’s amputation?

A

transection of the distal tibia and fibula through broad cancellous bone with preservation of the calcaneal fat pad

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9
Q

what is a minor UE amputation?

A

partial hand amputation or removal of any portion of the hand

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10
Q

what are some major UE amputations?

A

wrist disarticulation, transradial amputation, elbow disarticulation, transhumeral amputation, shoulder disarticulation, forequarter

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11
Q

what information should the therapist get regarding patient history?

A

arm and leg dominance, general health status, past medical history including surgery, and present functional status

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12
Q

what should be discussed when getting patient’s history?

A

patient’s expectations of therapy will likely be discussed

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13
Q

What should be measured?

A

– Postural assessment will focus on pelvic alignment, scoliosis, & kyphosis
– Length & the girth of the residual limb are measured
– Girth is measured over time; final prosthetic fitting is generally delayed until girth remains is stable
– ROM of all joints on the amputated & contralateral extremity will be measured
– Strength of the entire affected extremity will be tested
– Depression is common; phantom limb pain generally subsides within a year after amputation
– Residual limb must have an adequate blood supply to maintain viability
– Assessment of skin temperature is important
– Skin should be inspected for signs of excessive or persistent pressure

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14
Q

What is the preferred practice pattern 4J?

A

Impaired motor function, muscle performance, ROM, gait, locomotion,
& balance associated with amputation

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15
Q

Who is at high risk for another amputation?

A

Patients with an amputation caused by PVD, particularly those with concurrent diabetes, are at high risk for another amputation

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16
Q

Why would reintegration into the work force be delayed?

A

Reintegration into the work force is often delayed by

problems with the residual limb

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17
Q

What is the goal of preoperative care?

A

Goal of Preoperative Care is to prepare the patient for

life after amputation surgery & to begin rehabilitation

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18
Q

What does an optimum preoperative program involve?

A

Optimum preoperative program involves psychological
counseling, joint mobility, general conditioning, &
functional activities

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19
Q

What are goals of early postoperative management?

A

Goals of Early Postoperative Management are to foster

wound healing & promote maximum function

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20
Q

What should care focus on?

A

Care focuses on the residual limb, whether patient is a

candidate for a prosthesis or not

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21
Q

What does wound healing do?

A

Wound healing is fundamental to recovery
– Can be helped by using electrical stimulation,
ultraviolet, US, intermittent pneumatic compression,
hydrotherapy, & negative pressure

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22
Q

What does edema control do?

A

promotes wound healing, reduces
pain, & facilitates prosthetic fitting
– Larger the extremity circumference, the more
postoperative edema is likely to be present
– Should be used until the patient is wearing a
prosthesis for most of the day
– Elastic bandages should be applied in a figure-of-eight
pattern, avoiding circular turns
– Shrinker socks compress the limb uniformly

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23
Q

What is an unna dressing?

A

semirigid, adheres to the skin, &

accelerates rehabilitation

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24
Q

What does an inflated air splint do?

A

Inflated air splint ensures uniform pressure within
the splint because a gas in a closed container
distributes pressure uniformly

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25
Q

What dressing causes a reduction in pain?

A

Benefit of compressive amputation limb dressings is

reduction in pain

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26
Q

What causes local or phantom pain?

A

A neuroma near fascia can cause either local or

phantom pain

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27
Q

How should joint mobility be preserved?

A

Should be preserved with active exercise, positioning,

&/or splinting

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28
Q

What does strengthening facilitate?

A

Facilitates eventual prosthetic use

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29
Q

How do UE amputations affect strength?

A

usually younger males so

increased strength is more common

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30
Q

How do LE amputations affect strength?

A

often older & have more comorbidities

& less able to increase strength

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31
Q

How should pts care for the remaining LE?

A

Patient with lower extremity amputation should be
taught to inspect the sound foot as well as the residual
limb for redness, blisters, cuts, toenail discoloration, or
edema

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32
Q

What should a person with LE amputation practice?

A

Person with lower extremity amputation should practice
standing on the intact foot with the aid of a walker or a
pair of crutches

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33
Q

How much should a person bear weight?

A

Until sutures are removed, the person should bear only
as much weight as directed by the physician on this
temporary prosthesis

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34
Q

What is available for people using semirigid or soft dressings?

A

Adjustable sockets that can be attached to a pylon &
foot are available for people using semirigid or soft
dressings

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35
Q

What happens if the dominant hand was amputated?

A

If the dominant hand was amputated, the sound hand
will become the dominant extremity whether or not a
prosthesis is provided

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36
Q

What should a patient be taught?

A
  • How to don & doff the prosthesis
  • Transfers
  • Balance & gait
  • Wearing schedules
  • Gait compensations
  • Care for the residual limb & prosthesis
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37
Q

(Transtibial Prosthesis) Excessive knee flexion in early stance (buckling)

A

flexion contracture or weak quads

38
Q

(Transtibial Prosthesis) Insufficient knee flexion in early stance

A

extensor hyperflexion, weak quadriceps, anterodistal pain, arthritis

39
Q

(Transtibial Prosthesis) Excessive lateral thrust in midstance

A

no anatomical cause

40
Q

(Transtibial Prosthesis) Medial thrust in midstance

A

no anatomical cause

41
Q

(Transtibial Prosthesis) Early knee flexion in late stance (drop off)

A

flexion contracture

42
Q

(Transtibial Prosthesis) Delayed knee flexion in late stance (walking uphill)

A

extensor hyperreflexia

43
Q

(Transfemoral Prosthesis) Abduction stance with lateral displacements

A

abduction contracture, weak abductors, lateral distal pain, adductor redundancy, instability

44
Q

(Transfemoral Prosthesis) Circumduction swing with lateral displacements

A

abduction contracture, poor knee control

45
Q

(Transfemoral Prosthesis) Lateral bend stance with trunk shifts

A

abduction contracture, weak abductors, hip pain, instability, short amputation limb

46
Q

(Transfemoral Prosthesis) Forward flexion stance with trunk shifts

A

instability

47
Q

(Transfemoral Prosthesis) Lordosis stance with trunk shifts

A

hip flexion contracture, weak extensors

48
Q

(Transfemoral Prosthesis) Medial (lateral) whip with trunk shifts during heel off

A

with sliding friction unit: fast pace

49
Q

(Transfemoral Prosthesis) Foot rotation at heel contact with trunk shifts

A

no anatomical cause

50
Q

(Transfemoral Prosthesis) High heel rise during early swing with excessive knee motion

A

no anatomical cause

51
Q

(Transfemoral Prosthesis) Terminal impact during late swing with excessive knee motion

A

forceful hip flexion

52
Q

(Transfemoral Prosthesis) Vault during swing phase with reduced knee motion

A

with sliding friction unit: fast pace

53
Q

(Transfemoral Prosthesis) Hip hike during swing phase with reduced knee motion

A

no anatomical cause

54
Q

(Transfemoral Prosthesis) Uneven step length with reduced knee motion

A

hip flexion contracture, instability

55
Q

What are some partial foot amputation prosthetics?

A 
– No prosthesis is necessary after a
phalangeal amputation
– Patient will walk more comfortably &
the shoe will look better with a filler
in the toe box
56
Q

What are some prosthetics for Syme’s amputation and ankle disarticulation?

A 
– Gait is optimized with use of a
prosthesis with a foot specifically
manufactured for this type of
amputation
– Custom-made plastic socket that
encases the leg up to the level of the
tibial tuberosity
57
Q

What are some foot prosthetics for transtibial amputations?

A

– Nonarticulated feet have no separation between the
foot & the prosthetic shank (SACH foot)
– Dynamic or energy response feet store more energy;
incorporate an elastic element (Flex-Foot)
– Articulated feet have a separation between the foot &
the shank
– Some allow only sagittal plane motion (single-axis)

58
Q

What are some shank prosthetics for transtibial amputations?

A

– The shank is the portion of the prosthesis between the
foot and the socket
– Must be rigid enough to support the wearer’s weight

59
Q

What are some socket prosthetics for transtibial amputations?

A

– Considered the most important part of the prosthesis
because this component contacts the wearer’s skin
– Designed to contact portions of the residual limb
– Basic transtibial socket is known as patellar tendon
bearing (PTB)
– Most transtibial sockets are worn with one or more
interfaces or liners

60
Q

What are suspension prosthetics for transtibial amputations?

A

– Simplest, least expensive, & most adjustable
suspension is the supracondylar cuff
– Attached to the proximal portion of the socket &
buckled or strapped around the distal thigh
– Prosthesis can also be suspended using a silicone liner
& a metal pin that lodges in a receptacle in the
proximal portion of the shank
– Supracondylar suspension features a brim extending
over the medial & lateral femoral epicondyles & the
socket covers the patella to accommodate a very short
residual limb

61
Q

What is the prosthesis alignment for transtibial amputations?

A

– Adjusted to optimize the wearer’s stability & ease of
movement
– The farther anterior the prosthetic foot is placed relative
to the socket, the more stable the prosthesis

62
Q

What are some prosthetics for knee disarticulation?

A

– Any foot & shank can be used
– Knee unit should have a small vertical dimension
– Socket covers the residual limb to the proximal thigh
– Newer socket has a flexible liner, usually does not
require an additional suspension

63
Q

What prosthetic would be best for transfemoral amputation?

A

Basic SACH foot & the single-axis foot are more likely

to be used

64
Q

What is the axis?

A

connects the proximal & distal parts of the unit

65
Q

What is the friction mechanism?

A

resists shank movement during
the swing phase of gait to prevent excessive knee
flexion during early swing & abrupt extension at late
swing

66
Q

What is the extension aid?

A

mechanism for extending the shank at
the end of swing phase so wearer can be assured of a
straight knee at the time of heel contact

67
Q

What is the stabilizer mechanism?

A

manual lock, consisting of a
spring-loaded pin designed to lodge in a receptacle in the
proximal shank

68
Q

What is the sliding friction braking unit?

A

stabilizes the knee during
early stance if the wearer initiates stance phase with the
knee extended or flexed less than 25 degrees

69
Q

What are people with transfemoral amputation being fitted with?

A

Increasingly, people with transfemoral amputation are

being fitted with a flexible socket seated in a rigid frame

70
Q

What are prosthetics for hip articulation and transpelvic amputation?

A

– Prosthesis consists of a socket for weight bearing &
suspension, a hip joint, thigh section, knee unit, shank, &
foot
– Hip joint is either a single-axis joint or a ball & socket joint
& has an extension aid to limit flexion when the wearer
walks
– Knee unit must have an extension aid & can have any
type of axis, friction mechanism, & stabilizer

71
Q

What are translumbar amputations?

A

Patient is fitted with a socket to allow sitting in a

wheelchair

72
Q

How are bilateral amputations sustained?

A

Could be sustained simultaneously (usually due to
trauma or a congenital deformity) or more commonly,
sequentially (amputation of one leg followed by the
other)

73
Q

How is prosthesis selection for bilateral amputation?

A

Prosthesis selection is similar to unilateral, with much
attention paid to consistency & compatibility between
the two prostheses

74
Q

What is the emphasis on in training for UE prosthetics?

A

Emphasizes employing the prosthesis as an assistive

device, complementing maneuvers of the sound hand

75
Q

How do UE prosthetics help vocationally?

A

Prosthesis serves as a useful tool to aid in the
performance of the clerical aspects of most school &
professional endeavors

76
Q

How do you care for the UE residual limb and prosthesis?

A

– Residual limb must be kept clean & dry
– Device should be kept clean & wiped dry if
unintentionally immersed
– With a prosthetic hand, care of the glove includes
avoiding sharp or rough textured objects
– Socket should be wiped each evening with a moistened
soapy cloth

77
Q

What is controls training for transradial prosthesis?

A

– Patient first dons a T-shirt to protect the skin from
irritation by the harness straps
– Amputation limb is placed in a cotton, wool, nylon, or
silicone sock
– Patient then inserts the residual limb into the socket &
then places the sound hand through the axillary loop

78
Q

What is controls training for transhumeral prosthesis?

A

– Patient wears a T-shirt & a residual limb sock, inserts
the sound extremity into the axillary loop
– Patient places the residual limb in the socket
– TD operation & positioning is taught first with the elbow
lock engaged
– Elbow unit control begins with the elbow unlocked

79
Q

What is a partial hand prosthetic?

A

– Patient may choose to wear cosmetic replacements
– Patient may elect surgery to create a thumb-like
opposition post

80
Q

What is a transradial prosthesis terminal device?

A

– Mass-produced substitute for the anatomical hand &
may be in the form of a prosthetic hand or a hook
– Provides limited prehension pattern, grasp size, grasp
force, & sensation
– Passive TD has a wire armature in each finger to allow
the wearer to bend or straighten the digit with the
other hand, or with pressure against a firm surface
– Hooks are the primary alternative to prosthetic hands
– Allows greater force generation
– Relatively slender fingers of a hook TD allow the
wearer to see the object being manipulated better
than with a prosthetic hand

81
Q

What are some types of wearer-controlled mechanisms to allow prehension?

A
  • Myoelectric hands
  • Electric switch-controlled
  • Cable-controlled
82
Q

What is the most durable TD?

A

Cable-controlled hooks are the lightest, least

expensive, & most durable TDs

83
Q

What is a transradial prosthesis wrist unit?

A

Wrist should provide rotation to enable

pronation & supination of the TD

84
Q

What is a transradial prosthesis socket?

A

Plastic forearm proximal to the wrist
unit that attaches to a custom-made
plastic socket

85
Q

What is a transradial prosthesis suspension?

A 
– Prosthesis is secured to the patient’s
body either by a snugly fitted socket or
by a harness
– Prostheses require a control system to
control the TD & wrist unit
86
Q

What is a transhumeral prosthesis?

A

– Any type of TD & wrist unit can be included in a
transhumeral prosthesis
– Elbow unit should enable elbow flexion & extension,
locking, & rotation
– Elbow unit embedded in the proximal portion of the
forearm section
– Socket is custom made of plastic

87
Q

What do transhumeral prosthetics require?

A

Prostheses usually require harness suspension because
there are no bony prominences available for their
suspension

88
Q

What is the more common transhumeral prosthetics?

A

– Cable control is usually achieved with two cables, each
encased in steel housing
– Electrically powered elbow units are less commonly
prescribed

89
Q

What is pertinent in advanced activities?

A

Side of amputation is pertinent (e.g., riding in/driving a

car)

90
Q

What are some advanced activities that can be enjoyed by amputees?

A

– Bicycling is easier if a toe clip is added to the pedal on
the amputated side
– Sports that require running or jumping can be enjoyed
by people with leg amputation
– Musical instruments can be played by people with
upper extremity amputation

Advanced Patient Care (3 decks)

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