Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Prosthetics and Orthotics > Exam 1 Review > Flashcards

Exam 1 Review Flashcards

1
Q

Surgical Techniques for amputation (3)

A
  • Myoplasty: attach muscle to muscle
    • Better for patients with vascular problems
    • performed between the agonist and antagonist muscle groups) reestablishing a muscle pumping action
    • gives greater control to the limb and adds a muscle padding over the end of the limb.
  • Myodesis: Attach Muscle to periosteal bone
    • not recommended for ischemic patients
    • causes bone trauma
  • Myofascial: Attach muscle to fascia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of amputation (6)

A
  • Peripheral vascular disease
    • most common cause of amputation in adults
  • Diabetes
  • Trauma
  • Infections
  • Tumors
  • Limb deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Evaluating blood flow (techniques):

A
  1. Auscultation via a stethoscope
  2. Palpation
  3. Doppler Ultrasound Blood Pressure
  • most readily available objective measure of blood flow and perfusion
  • used to detect both arterial and venous blood flow
  1. Impedance plethysmography
    * Often used to detect DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In a straight vessel blood flow is termed _______. In a diseased vessel with plaque formation, blood flow has a higher velocity through the occlusion. Distal to the occlusion blood flow is _________.

A

– laminar

– turbulent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Factors that determine level of amputation:

A
  1. Adequate circulation
  2. Save as much length as possible while removing all non-viable tissue
  3. A residual limb that allows a pain free return to functional activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A residual limb that is very short may be:

A

Difficult to fit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A residual limb which is very long (trans-tib) may be:

A

Prone to circulatory problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Saving as much length and as many joints as possible allows:

A

– ↑ amount of surface area for suspension

– ↓ rotation of knee units and foot/ankle components

– Leaves more of the adductor longus attachment to minimize contractures

– Creates a longer limb for sitting and transfers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Too long transfemoral amputation:

A
  • Makes padding the residual limb more difficult
  • Leaves less room for prosthetic components
  • Difficulty matching leg length to prosthetic knee center
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

To Prevent neuromas

A

Resect nerves under gentle traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Minimize soft tissue trauma from sharp or irregular bone edges

A

Bevel bone ends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To improve function and shape

A
  • Muscle fixation
  • Fibula ~ 1cm shorter than tibia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Suture line should:

A

…avoid bony prominences and the distal end

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Transtibial amputations often use this closure:

A

Long posterior flap

  • provide better vascular supply
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transfemoral Amputation commonly use this closure:

A

Fishmouth

  • Equal length posterior/anterior flaps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

“Problems” with closures:

A
  • Dog ears
  • Adherent scars
  • Neuromas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Post-operative complications (Co-morbidities):

A
  • Wound infections
  • Cardio-vascular
  • DVT
  • Decubiti
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Residual limb shapes (3):

A
  1. Conical
  2. Cylindrical
    • Cylindrical shape is better suited for total contact prosthetic fitting devices
  3. Bulbous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Skin sensation may be assessed using

A

Semmes-Weinstein filaments

  • If a patient cannot consistently feel the touch of a 5.07 filament, the protective sensation has been lost
20
Q

Skin Inspection of the residual limb:

A
  • scar adherence
  • coolness
    • possible arterial insufficiency
  • abnormal warmth
    • possible infection
  • impaired sensitivity
21
Q

Phantom Limb Pain vs. Phantom Limb Sensation

A
  • Phantom pain is characterized by a perception of pain in the absent distal extremity
    • Often desribed as shooting, burning, stabbing or crushing
  • Phantom Limb Sensation is a perception of the absent distal extremity
22
Q

Components of an evaluation of a patient with amputation:

A
  • DEMOGRAPHIC INFORMATION
  • FUNCTIONAL ASSESSMENT
  • TESTS & MEASURES OF RESIDUAL LIMB
  • TEST & MEASURES OF INTACT LIMB
23
Q

Components of the functional evaluation:

A
  • Ambulation
  • Transfers
  • Bandaging/Use of a shrinker
24
Q

TESTS & MEASURES OF RESIDUAL LIMB

A
  • LENGTH
  • CIRCUMFERENCE
  • SHAPE
  • APPEARANCE
  • ROM
  • STRENGTH
  • STABILITY
  • SKIN
25
Q

TEST & MEASURES OF INTACT LIMB

A
  • STRENGTH
  • ROM
  • CIRCULATION
  • TEMPERATURE
  • SKIN
  • HAIR ON EXTREMITY
26
Q

Prosthetic/orthotic clinical procedure

A
  • PRE-PRESCRIPTION
    • PT (EVAL)
  • PRESCRIPTION
    • MD ONLY
  • PREFITTING
    • PT (WRAPPING, THEREX, ROM)
  • FABRICATION
  • INITIAL EXAM
  • TRAINING
    • PT (GAIT)
  • FINAL EXAM
    • PT
27
Q

Medicare Reimbursement Levels

A
  • 0 = No potential to ambulate/transfer with or without assistance
  • 1 = Potential to ambulate/transfer with fixed cadence in home
  • 2 = Potential to ambulate/transfer in low level environmental barriers
  • 3 = Potential to ambulate/transfer with variable cadence in community
  • 4 = Potential to exceed basic ambulation skills with high impact activities
28
Q

Cost is determined by:

A
  • sophistication of the components
  • types of materials used for construction
  • Costs of transtibial prostheses range:
    • 4,000 to 16,000 dollars
  • Costs of transfemoral prostheses range
    • 5,500 to 40,000 dollars
29
Q

Stages of Adjustment (Traumatic)

A
  • Shock
  • Anxiety
  • Denial
  • Depression
  • Anger
    • Toward self
    • Toward others
  • Acceptance
  • Adjustment
30
Q

Stages of adjustment (elective)

A
  • Preoperative Stage
    • realization that limb loss is a possibility
    • grief
    • concerns about pain
  • Immediate Postoperative Rehab Stage
    • realization that normal level of function is no longer possible
    • Denial replaces grief
    • euphoric mood, regression, withdrawal
  • Return Home Stage
    • Mixed reactions
      • leaving hospital means recovery
      • faced with lack of help available at hospital
    • Reorganization of how the individual views oneself and the world and attempts to regain maximal functional potential
31
Q

Psychological adjustment factors

A
  • ECONOMIC AND VOCATIONAL
    • Patients cannot do their former jobs or are facing a loss of income will have more adjustment problems
  • PSYCHOSOCIAL
    • Excellent family and peer support will have fewer problems with psychological adjustment
  • TRAUMATIC/ACCIDENTAL LOSS
    • Traumatic or accidental limb loss may react with varying forms of denial
    • Elective amputations may benefit from preparation and exploration of alternatives; may exhibit realistic expectations and cooperation
    • Disability caused by negligent care or behavior of others often produces self-doubt and bitterness
  • PREPARATION TIME
    • Individuals with adequate warning and preparation adjust better in the immediate postoperative stage
    • Support groups could provide safe environment for discussion
    • Speaking with previous amputees helps understanding of what is to come
  • REHABILITATION
    • Earlier a prosthesis or orthosis is used after the disabling event, the less psychological distress observed
  • AGE
    • Reaction by age varies
      • Often children and adolescents show resilience to acquired disability
      • Adults show little disruption of positive body-image after amputation
      • Younger patients who sustained traumatic amputations exhibited more anxiety and a more-negative body image
  • SOCIAL SUPPORT
    • Complications of disability can be lessened by involving family members in patient interventions
  • SEXUALITY
    • Sexuality may be affected by psychological and physical reasons
    • Resumption of sexual activity assists with self-esteem and self-confidence, which facilitates successful rehabilitation
  • COMMUNITY REINTEGRATION
32
Q

Open vs. closed kinematic chains

A
  • Open chain:
    • distal end is not fixed
    • limb moves independently and unpredictably
    • Increases degrees of freedom at distal joints
  • Closed chain:
    • Distal end is fixed
    • Movement is predictable
    • Movement at one joint imposes movement at another
      • ex. supination of the foot in standing incurs medial rotation of the hip
33
Q

Areas of relief and build up:

A
  • Pressure/Stress
    • Relief should be built in to areas:
      • that are firm
      • pressure sensitive
      • convex
    • Build-up [support] should be built into areas:
      • that are soft
      • pressure tolerant
      • concave
34
Q

Treatments/Interventions for Phantom Pain

A
  • Increasing peripheral input
    • massage, wrapping, application of heat, use of a prosthesis
    • tapping or rubbing the residual limb for 20-60 minutes
  • Local anesthetics
  • TENS
  • Psychotherapy
  • Mirror Therapy
  • Pharmacological agents:
    • Antidepressants
      • phantom pain is best treated with low doses of tricyclic antidepressants (ie, nortriptyline or amitriptyline 10-25 mg PO qhs) that aim to improve sleep. [Per instructor notes]
    • Narcotics/Opioids
    • Muscle relaxants
35
Q

Intrinsic Pain

A
  • Pain caused within the limb
    • Causes
      • ambulating on bone with minimal soft tissue covering
      • vascular spasm
      • Intermittent claudication
      • Neuroma
      • CRPS
36
Q

Extrinsic pain

A
  • Pain caused by sources external to the limb
    • examples:
      • overly constrictive prosthetic shrinkers
      • inadequate prosthetic or orthotic fitting
      • excessive end bearing
      • uneven skin pressure due to muscle hypertrophy, weight bearing, or edema
37
Q

Cost of prosthesis includes:

A
  • components
  • materials
  • labor
  • office visits
  • adjustments
    • usually covers adjustments for 90 days
  • (letter of justification usually required by insurance companies for reimbursement for an orthosis or prosthesis. May be completed by MD or PT depending on needs of insurance company)
38
Q

Oprtions for individuals who cannot pay for a prosthesis or orthosis:

A
  • Medicaid
    • approval based on need and income level
  • Local or national organizations for assistance
    • Muscular Dystrophy Association
    • National Cancer Society
  • The Barr Foundation
    • National tax-deductible, non-profit that often pays for prostheses
39
Q

Stress equation:

A
  • S = F/A
  • Stress = force per unit of area
  • amount of stress is determined by the magnitude of the force and the size of the area to which the force is applied
40
Q

Weakness of the Gluteus Medius results in:

A
  • Lateral trunk lean toward the side of weakness to shift the LOG closer to the joint axis
41
Q

Hip extensor weakness results in:

A
  • Posterior lean
    • changes flexion moment at the hip to extensor moment increasing hip joint stability
42
Q

Gait deviations due to limb length discrepancy (long limb):

A
  • Hip hiking on ipsilateral side
  • lateral trunk lean on contralateral side
  • circumduction
  • excessive hip and knee flexion to clear the limb
  • vaulting on the shorter limb to clear the longer one
43
Q

STATIC TRANSTIBIAL PROSTHETIC ALIGNMENT:

A
  • USES PLUMB LINE FROM THE CENTER OF THE POSTERIOR WALL OF THE SOCKET TO ½ INCH LATERAL TO THE CENTER OF THE HEEL
  • MAINTAINS NORMAL BOS
  • LOADS MORE PRESSURE TOLERANT AREAS ON THE MEDIAL RESIDUAL LIMB
  • Usually aligned with 5-10 DEGREES OF FLEXION OF THE SOCKET
44
Q

Three theories as to why patients experience phantom limb pain and sensation:

A
  • One theory is that the remaining nerves continue to generate impulses.
  • A second theory is that the spinal cord nerves begin excessive spontaneous firing in the absence of expected sensory input from the limb.
  • The third theory is that there is altered signal transmission and modulation within the somatosensory cortex.
45
Q

Phantom limb sensation may be described by the patient as:

A
  • From the amputated part
    • numbness
    • pressure
    • position
    • temperature
    • pins and needles sensation
46
Q

Three tasks of gait:

A
  • Limb advancement
  • Single limb support
  • Limb advancement
47
Q

If the ankle cannot dorsiflex normally:

A
  • Individual will
    • bear weight on the toe
      • or
    • the knee must hyperextend to get foot to flat on the ground

Prosthetics and Orthotics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions