Amputations and Prosthetics

Question 1

Post-op dressing: Rigid (Plaster of Paris)

Answer 1

Allows for early ambulation (can use IPOP - immediate post op prosthesis), promotes circulation and healing, stimulates proprioception, provides protection, soft tissue support, limits edema.
Immediate wound inspection not possible, does not allow for daily dressing changes, requires professional application.

Question 2

Post-op dressing: Non-weight bearing rigid removable limb protector

Answer 2

Removable, accommodates edema fluctuation, easily applied, prevents contracture, provides protection.
Not for ambulation.

Question 3

Post-op dressing: Semi-rigid (Unna paste, air splints)

Answer 3

Reduces post-op edema, provides soft tissue support, allows for earlier ambulation, provides protection, easily changeable.
Not as protective as rigid dressing, requires more changing than rigid dressing, may loosen and allow for development of edema.

Question 4

Post-op dressing: Soft (Ace wrap, shrinker)

Answer 4

Reduces post-op edema, some protection, inexpensive, easily removed for wound inspection, allows for active joint ROM.
Tissue healing interrupted by frequent dressing changes, joint ROM may delay healing of incision, less control of residual limb pain, cannot control amount of tension in bandage, risk of a tourniquet, shrinker can’t be applied until staples/sutures removed.

Question 5

Medicare Classification K Level 0

Answer 5

Prosthesis will not enhance quality of life or mobility
Knee unit: not eligible
Ankle/foot assembly: not eligible

Question 6

Medicare Classification K Level 1

Answer 6

Transfers, ambulate on level surfaces, fixed cadence, limited or unlimited household ambulator
Knee unit: Single axis, constant friction mechanism
Foot/ankle assembly: SACH, single axis

Question 7

Medicare Classification K Level 2

Answer 7

Traverse low-level barriers: curbs, stairs, uneven surfaces. Limited community ambulator.
Knee unit: Polycentric, constant friction mechanism
Foot/ankle assembly: flexible-keel foot, multi-axial foot/ankle

Question 8

Medicare Classification K Level 3

Answer 8

Traverse most environmental barriers, variable cadence, unlimited community ambulator, prosthetic use beyond simple locomotion.
Knee unit: hydraulic/pneumatic, microprocessor, variable friction mechanism
Ankle/foot assembly: energy storing, dynamic response foot, multi-axial foot/ankle

Question 9

Medicare Classification K Level 4

Answer 9

Exceeds basic ambulation skills; high impact, stress, or energy levels; typical of child, athlete, or active adult.
Knee unit: any system
Ankle/foot assembly: any system

Question 10

Knee Single axis

Answer 10

Difficult to reciprocate during gait.
May or may not have knee extension assist and/or weight-activated stance phase control.
Constant friction mechanism.

Question 11

Knee Polycentric

Answer 11

Heavier than single axis
Reciprocal gait more fluid
May or may not have knee extension assist and/or weight-activated stance phase control.
Constant friction mechanism.

Question 12

Hydraulic

Answer 12

Variable friction for improved swing and stance phase control

Question 13

Microprocessor

Answer 13

Multiple programs to accommodate the activity level of the user.
Fluid management of descending stairs
Requires charging
Variable friction for improved swing and stance phase control

Question 14

Foot system SACH

Answer 14

Non-articulating with a rigid keel
Inexpensive
Low maintenance
Cushioned heel for shock absorption
Lacks energy return
Cannot accommodate uneven surfaces

Question 15

Foot system single axis

Answer 15

Motion in single plane
Improved knee stability during weight acceptance
Lacks energy return if not paired with a dynamic response foot

Question 16

Foot system dynamic response

Answer 16

Can be articulating or non-articulating
Keel can store and return some energy
May have split keel for improved surface accommodation

Question 17

Foot system Hydraulic/microprocessor

Answer 17

Finer control over the stability/mobility of motions
Improved shock absorption
Not appropriate for all environmental conditions and demands

Question 18

Timeline Post-Amputation

Answer 18

Pre-prosthetic phase of rehab: immediately after amputation. 6 weeks in length. PT focuses on protecting the limb, preventing contractures, and developing single limb mobility skills.
Sometimes, pt is given IPOP for immediate WB, but more often, pt will be evaluated for first prosthesis once suture/staples have healed, usually between 4-6 weeks. Pt can wear shrinker once suture are removed.
Pt will receive temporary prosthesis to participate in prosthetic phase of rehab.
Modifications to prosthesis will need to be made for comfort and function. After several months, if the pt feels comfortable with fit and if residual limb volume fluctuations have stabilized, a permanent prosthesis may be made.
Medicare pays for new prosthesis every 5 years.

Question 19

Amputee Mobility Predictor (AMPPRO)

Answer 19

Measures ambulatory potential of lower-limb prosthesis users. Balance, gait, and transfers assessed. Score correlates to K-level, which can help to make a prosthesis prescription. AMPnoPRO can be used for those who do not have a prosthetic limb.

Question 20

L-Test

Answer 20

Similar to TUG but has a 90 deg turn after walking 3 m, total length ambulated is 20 m instead of 6 in the TUG, 4 turns are involved. Mean times established based on amputation level, age, and use of AD.

Question 21

Prosthesis Evaluation Questionnaire (PEQ)

Answer 21

Patient-based outcome measure that uses 9 scales to evaluate prosthesis and life with a prosthesis. Uses VAS to assess satisfaction, well-being, frustration, pain, and residual limb health. Can be performed in part or whole.

Question 22

Orthotics Prosthetics User Survey (OPUS)

Answer 22

Patient-based outcome measure that consists of functional status, QOL, and satisfaction modules. Can be performed in part or whole.

Question 23

Trinity Amputation and Prosthesis Experience Scales-revised (TAPES-R)

Answer 23

Patient-based outcome measure that examines psychosocial processes involved in adjusting to using an amputation and prosthesis. Consists of 4 sections: activity restriction, psychosocial adjustment, satisfaction with prosthesis, and factors influencing health both related and unrelated to amputation. Takes about 15 minutes and can be performed in part or whole.

Question 24

Extension assist

Answer 24

Mechanism that assists the knee joint into extension during swing phase

Question 25

Myodesis

Answer 25

Anchoring of muscle or tendon to bone through holes drilled in bone as part of the amputation closure process

Question 26

Myoplasty

Answer 26

Suturing muscle flaps together over the end of a bone following an amputation

Question 27

Pistoning

Answer 27

Translation of the prosthetic limb from the residual limb due to inadequate suspension. Can result in limb skin issues.