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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
What dressing causes a reduction in pain?
Benefit of compressive amputation limb dressings is | reduction in pain
26
What causes local or phantom pain?
A neuroma near fascia can cause either local or | phantom pain
27
How should joint mobility be preserved?
Should be preserved with active exercise, positioning, | &/or splinting
28
What does strengthening facilitate?
Facilitates eventual prosthetic use
29
How do UE amputations affect strength?
usually younger males so | increased strength is more common
30
How do LE amputations affect strength?
often older & have more comorbidities | & less able to increase strength
31
How should pts care for the remaining LE?
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
32
What should a person with LE amputation practice?
Person with lower extremity amputation should practice standing on the intact foot with the aid of a walker or a pair of crutches
33
How much should a person bear weight?
Until sutures are removed, the person should bear only as much weight as directed by the physician on this temporary prosthesis
34
What is available for people using semirigid or soft dressings?
Adjustable sockets that can be attached to a pylon & foot are available for people using semirigid or soft dressings
35
What happens if the dominant hand was amputated?
If the dominant hand was amputated, the sound hand will become the dominant extremity whether or not a prosthesis is provided
36
What should a patient be taught?
* How to don & doff the prosthesis * Transfers * Balance & gait * Wearing schedules * Gait compensations * Care for the residual limb & prosthesis
37
(Transtibial Prosthesis) Excessive knee flexion in early stance (buckling)
flexion contracture or weak quads
38
(Transtibial Prosthesis) Insufficient knee flexion in early stance
extensor hyperflexion, weak quadriceps, anterodistal pain, arthritis
39
(Transtibial Prosthesis) Excessive lateral thrust in midstance
no anatomical cause
40
(Transtibial Prosthesis) Medial thrust in midstance
no anatomical cause
41
(Transtibial Prosthesis) Early knee flexion in late stance (drop off)
flexion contracture
42
(Transtibial Prosthesis) Delayed knee flexion in late stance (walking uphill)
extensor hyperreflexia
43
(Transfemoral Prosthesis) Abduction stance with lateral displacements
abduction contracture, weak abductors, lateral distal pain, adductor redundancy, instability
44
(Transfemoral Prosthesis) Circumduction swing with lateral displacements
abduction contracture, poor knee control
45
(Transfemoral Prosthesis) Lateral bend stance with trunk shifts
abduction contracture, weak abductors, hip pain, instability, short amputation limb
46
(Transfemoral Prosthesis) Forward flexion stance with trunk shifts
instability
47
(Transfemoral Prosthesis) Lordosis stance with trunk shifts
hip flexion contracture, weak extensors
48
(Transfemoral Prosthesis) Medial (lateral) whip with trunk shifts during heel off
with sliding friction unit: fast pace
49
(Transfemoral Prosthesis) Foot rotation at heel contact with trunk shifts
no anatomical cause
50
(Transfemoral Prosthesis) High heel rise during early swing with excessive knee motion
no anatomical cause
51
(Transfemoral Prosthesis) Terminal impact during late swing with excessive knee motion
forceful hip flexion
52
(Transfemoral Prosthesis) Vault during swing phase with reduced knee motion
with sliding friction unit: fast pace
53
(Transfemoral Prosthesis) Hip hike during swing phase with reduced knee motion
no anatomical cause
54
(Transfemoral Prosthesis) Uneven step length with reduced knee motion
hip flexion contracture, instability
55
What are some partial foot amputation prosthetics?
``` – 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
What are some prosthetics for Syme's amputation and ankle disarticulation?
``` – 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
What are some foot prosthetics for transtibial amputations?
– 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
What are some shank prosthetics for transtibial amputations?
– 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
What are some socket prosthetics for transtibial amputations?
– 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
What are suspension prosthetics for transtibial amputations?
– 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
What is the prosthesis alignment for transtibial amputations?
– 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
What are some prosthetics for knee disarticulation?
– 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
What prosthetic would be best for transfemoral amputation?
Basic SACH foot & the single-axis foot are more likely | to be used
64
What is the axis?
connects the proximal & distal parts of the unit
65
What is the friction mechanism?
resists shank movement during the swing phase of gait to prevent excessive knee flexion during early swing & abrupt extension at late swing
66
What is the extension aid?
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
What is the stabilizer mechanism?
manual lock, consisting of a spring-loaded pin designed to lodge in a receptacle in the proximal shank
68
What is the sliding friction braking unit?
stabilizes the knee during early stance if the wearer initiates stance phase with the knee extended or flexed less than 25 degrees
69
What are people with transfemoral amputation being fitted with?
Increasingly, people with transfemoral amputation are | being fitted with a flexible socket seated in a rigid frame
70
What are prosthetics for hip articulation and transpelvic amputation?
– 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
What are translumbar amputations?
Patient is fitted with a socket to allow sitting in a | wheelchair
72
How are bilateral amputations sustained?
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
How is prosthesis selection for bilateral amputation?
Prosthesis selection is similar to unilateral, with much attention paid to consistency & compatibility between the two prostheses
74
What is the emphasis on in training for UE prosthetics?
Emphasizes employing the prosthesis as an assistive | device, complementing maneuvers of the sound hand
75
How do UE prosthetics help vocationally?
Prosthesis serves as a useful tool to aid in the performance of the clerical aspects of most school & professional endeavors
76
How do you care for the UE residual limb and prosthesis?
– 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
What is controls training for transradial prosthesis?
– 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
What is controls training for transhumeral prosthesis?
– 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
What is a partial hand prosthetic?
– Patient may choose to wear cosmetic replacements – Patient may elect surgery to create a thumb-like opposition post
80
What is a transradial prosthesis terminal device?
– 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
What are some types of wearer-controlled mechanisms to allow prehension?
* Myoelectric hands * Electric switch-controlled * Cable-controlled
82
What is the most durable TD?
Cable-controlled hooks are the lightest, least | expensive, & most durable TDs
83
What is a transradial prosthesis wrist unit?
Wrist should provide rotation to enable | pronation & supination of the TD
84
What is a transradial prosthesis socket?
Plastic forearm proximal to the wrist unit that attaches to a custom-made plastic socket
85
What is a transradial prosthesis suspension?
``` – 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
What is a transhumeral prosthesis?
– 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
What do transhumeral prosthetics require?
Prostheses usually require harness suspension because there are no bony prominences available for their suspension
88
What is the more common transhumeral prosthetics?
– Cable control is usually achieved with two cables, each encased in steel housing – Electrically powered elbow units are less commonly prescribed
89
What is pertinent in advanced activities?
Side of amputation is pertinent (e.g., riding in/driving a | car)
90
What are some advanced activities that can be enjoyed by amputees?
– 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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