Chapter 4- Prosthetic Management Flashcards
When should the patient be informed about future rehabilitation?
As early as possible
What are usual feelings felt by the patient?
Depression
Feeling withdrawn
Angry
Relief
What is an unusual feeling after an amputation?
Feeling no difference at all.
What are the usual purposes of the support groups?
Introduce the recent amputee to realistic role models who have gone through the rehabilitation process and are functioning normally in society
Provide ongoing social and educational programs
How can prosthetists speed up the preprosthetic management?
With use of rigid dressings
elastic bandaging
Prosthetic shrinkers
What should be told to the patient when they are ready for the prosthetic fitting?
Explanation of the different stages of the rehabilitation process
Length of wear of preparatory prosthesis
When evaluation of definitive prosthesis will occur
About when are prosthetic patients seen in the clinic?
1 or more months following surgery
What should the prosthetist assume, when the new patient is seen?
That no one has explained the process and then offer a concise overview of the prosthetic procedure
What are the five general types of prostheses?
Postoperative Initial Preparatory definitive Special purpose
When are postoperative prostheses provided?
24 hours of amputation
What does IPSF stand for?
Immediate postsurgical fitting
What does IPOP stand for?
Immediate postoperative prosthesis
Postoperative fittings should be given to, who?
Younger, healthier people needing amputations due to tumors, trauma, or infection
Postoperative fittings should not be given to who, if not under close supervision?
The elderly
Dysvascular patients
When is the initial prosthesis provided?
As soon as the sutures are removed
What is another name for initial prosthesis?
Early Postsurgical Fitting (EPSF)
How long are initial prostheses worn?
1-4 weeks after amputation
Where are Postoperative and initial prostheses more commonly used?
In rehabilitation units or hospitals with very active amputee programs
What are preparatory prosthesis used for?
Rehabilitation
Assess ambulatory or rehabilitation potential
Help clarify details of the prosthetic prescription
When can a preparatory prosthesis be applied?
A few days following suture or staple removal
The modern preparatory prosthesis incorporates what?
Definitive-quality endoskeletal componentry but lacks the protective and cosmetic outer finishing
How long are preparatory prostheses generally worn?
3-6 months following amputation
What can cause the patient to need to wear a preparatory prosthesis to be worn longer?
Speed of maturation of the residual limb
Weight gain
Weight loss
Health problems
How do you determine when a definitive prosthesis should be prescribed?
When the number of plies of prosthetic socks worn remains the same over several weeks
What do prosthetic socks provide to the patient?
Cushioning Comfort Prevent sheer force Absorb perspiration Adjustment to volume changes
When should prosthetic socks not be worn?
When using a suction system
At what plie should a replacement socket be prescribed?
10 plie
What is the cause of the limb shrinkage?
Atrophy
Weightloss
What is a definitive prosthesis not?
A permanent prosthesis because mechanical devices will wear out
What is the lifespan of a definitive prosthesis?
3-5 years
What can cause a change in the prosthetic prescription?
Substantial change in Amputees lifestyle or activities
What is usually required for special-use prostheses?
Special alignment
What is done to the foot of a patient wanting to swim?
Plantarflex the foot
What is done to the foot if the patient wants to snow ski?
Dorsiflex the foot
What factors influence the prosthesis?
Weight bearing Suspension Activity level General Prosthesis structure Components Expense Unique circumstances
What is the first concern for lower-limb prostheses?
Weight bearing
Why might a clinician provide special provisions to the weight bearing component of a prosthesis?
Scarring
Neuromas
Sensitive areas
What is a big factor for deciding on the suspension of the prosthesis?
Volume changes
What are the two major structural types of a prosthesis?
Endoskeletal
Exoskeletal
What should the componentry be based on?
Activity level
Body weight
Functional Goals
What is the expense of the prosthesis based on?
Componentry
What should the clinician record when evaluating a patient?
Scar tissue Neuromas ROM Edema Muscular development Personal history
What is involved in the personal history?
Weight fluctuations Medical factors Previous fractures Visual impairments Concomitant disease- diabetes, arthritis
Where should measurements be taken?
Length of residual limb
Circumferences- both limbs
Myoelectric control sites- if needed
negative impression of residual limb
How should initial static alignment be recorded?
Plumb line
What does CAD/CAM stand for?
Computer aided design/ Computer aided manufacturing
What four factors are evaluated in a test socket fitting?
Comfort
Even distribution of weight-bearing pressure and biomechanical forces
Suspension
Freedom of motion at next proximal joint
What is the purpose of dynamic alignment?
Provide maximum comfort
Efficient function
Cosmesis
What is the procedure of the alignment process?
Function of the prosthesis is explained
Instruction on how to don/doff device
Contours are checked for comfort
Length and angulation of prosthesis is checked
Suspension tested
Instructed in standing in a relaxed attitude
Static alignment
Controlled ambulation in parallel bars
Adjustments to device for sitting comfort
What minor problems can occur after a week or two after the initial alignment?
Pressure areas in socket
Discomfort while sitting
Wearing different shoes
How often should patients be seen after their fitting?
Every 4-6 months
Why should a patient come in for follow up care even after he/she has their definitive prosthesis?
The mechanical components require cleaning
Maintenance
Replacement at intervals
Joint cleaning
What should the clinician keep track of at the follow up visits?
Alignment adjustments
Socket adjustments
