Exam 2 Flashcards
what is aitken classification B
No osseous connection
what are some muscles for testing the transhumeral
biceps
triceps
deltoid
what must you do for a kid right after post opt
you must fit the kid with a prothetic right away
what is sleeve suspension
neoprene or gel sleeve that fits over the socket and rolled onto the thigh
what are some physical therapy goals
Facilitate as normal a developmental sequence
Prevent or minimize impairments, activity limitations, and participation restrictions
Look at slides
38 , 39, and 40 of amputation powerpoint
what are the elements of LE prosthetic prescription
- socket
- feet
- interface
- suspension
- knees
- additional componenets
what is anatomical suspension
Use of the shape of the patient’s residual limb as a means of maintaining the prosthesis during use.
what is the expected outcomes of a child with bilateral transfemoral amputation
they will require manual locks at knees until age 6 or older
what is K3
The patient has the ability or potential for ambulation with variable cadence. A person at level 3 is typically a community ambulator who also has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.
what are the K level ratings
0-4
what is osteosarcomas
this is about 50% of disease amputations
- peak incidence coincides with puberty
- distal femur, proximal tibia and proximal humerus
what are some system complications of sensation
Neuromas, residual limb pain, phantom pain
what are some muscles for testing at the transradial level
FCR FCU ECRL ECRB EC
what happens within 5 years after the 1st amputations
if it is due ot vascular disease they will die
what are some suspension methods for the UE
pin/locking liner suspension
liner wtih lanyard suspension
anatomical suspension
what is sach foot prosthetic
solid ankle cushion heel: Simple and stable, low cost, heavy, no flexibility
how many births are are born with limb deficiencies
2-7/10,000
what need to be done for the prostheiss for RL
Clean daily
• Routine maintenance
(knee/foot)
what is Powered knee:
Powered extension with MPK hydraulic knee stability
what does pistoning mean
problems with suspension
what is blistering
- Friction
- Reduce friction by improving the suspension or with nylon sheath.
- See CPO ASAP
how do you fix bottoming out
socks
what is tendoesis
Tendon to bone
what is myofascial
outer fascial layer of the muscle is attached to deeper muscle
what are some problems with radiation
long term effects decreased use in children
what are some problems with chemotherapy
know specific agents and side effects
what is the bilateral body powered prostheses
The prostheses may be tethered with the same harness for suspension, as shown here. Or, the prostheses may fabricated with harnesses that are independent from the other.
The prosthetist balances the need to suspend and control the prostheses with the need for ease of donning
what are the components of the feet
- sach
- single axis
- multi axial
- flexible keel
- dynamic response
what is the development of prescription (RX)
Primary: prosthetist and the physiatrist
Therapy team input
what are some other UE amputations
forequarter
wrist disarticulation
shoulder disarticulation
what are some goals for adolescents for prosthesis
- Monitor and maintain proper fit
- Skin inspection
- Independent donning and doffing
- Independent dressing
- Engage in full range of ambulatory activities
- Recognize when prosthesis needs repair or alteration
how many amputations occur in the usa and the cost
185,000
$8.3 billion
what are some post surgical phase PAIN
- residual limb pain
- phantom sensation
- phantom pain
what are somethings that need to be addressed for positioning someone after limb loss surgery
Avoid prolonged sitting
Watch pillow placement
what is the team approach for limb loss
They are ALL working together to make it work
- family
- social workers
- psychologist
- peer support
- case manager
- chaplain
- pt
- therapy
- prosthetist
- nurse
- physiatrist
- surgeon
what is the critical period of limb development
4-6 wk
what happens with you fit a child for a UE prothetic after the age of 2
they will think that their arm is just gets in the way BUT if they fit before the age of 2 it will use the arm as a normal part of their body
what contractures are common after limb loss surgery
hip and knee
Develop as a result of muscle imbalance, tightness, withdrawal reflex
what needs to be protected during amputations
protection of the neuroma (severed peripheral nerves) allow for faster return to mobility
what are some system complications after post surgical phase
cardiovascular integumentary musculoskeletal sensation cognitive psychological
what is bench of prosthetic alignement
the initial position of the socket relative to the foot and knee. Each foot/knee has a specified bench alignment.
what is the body powered motion of the scapular abduciton
Spreading the shoulder blades apart in combination with humeral flexion, or alone will open the terminal device.
what is residual limb pain
– Confined to residual limb
– Usually recovers after 4-6 weeks
– Primary cause is the prosthesis. Or may be due to ischemia, inflammation, infection, bone spurs, neuroma, referred pain
what is static of prosthetic alignement
the initial alignment as the person stands on the prosthesis.
what is the body powered motion of the shoulder depression , extension , abduction
This will simulate the motion required to lock and unlock the elbow in the individual with transhumeral amputation.
what are some types of disease related amputations
osteosarcoma
ewings sarcoma
what is Fluid-controlled:
allows for variable cadence, increased weight and cost
what is Microprocessor knee (MPK):
maximum knee stability with computer driven swing and stance and variable cadence, expensive
what kind of cognition support after surgery of a limb
- Entire Rehab Team is responsible for reassurance and education
- Clear expectations
- Steps to rehab mapped out
- Education & PMH guidance
- Open environment
what is aitken classification D
Absent femoral head and acetabulum
what are the 5 classic stages of grief
1 denial and isolation (this isnt happening to me )
2 anger (why is this happening to me)
3 bargaining (i promise ill be a better person if)
4 depression ( i dont care anymore )
5 acceptance and hope ( im ready for whatever comes)
what is phantom pain
– Chronic pain syndrome felt in the phantom limb
– Interferes with mood and participation in activities
what is body symmetry awareness for UE amputations
Scapular stabilization exercises and core strengthening Decreased edema Accelerate wound heeling Decrease hospital stay Improve proprioceptive input
what are the components fo the TF prosthesis
- foot-ankel assembly
- shank
- knee unit
- socket
- suspension device
what are some physial therapy goals for infancy and toddler
monitor developmental progress, rom, and strength needed for prosthetic use
what is the expected outcomes of a child with unilateral transtibial amputations and walking
they woudl achieve an almost normal gait
- no difficulty with stairs
what is K2
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. This is typical of the limited community ambulator.
what are some system complications of musculoskeletal
Weakness, contractures, boney overgrowth,heterotrophic ossification, bone density
what is the exoskeleton of the shank
Wood or rigid plastic
- shaped to simulate the contour of an anatomical leg
- Lack the ability to change angulation
Cosmetic purpose
how to treat aitkens B and C
amputation/ revision
prosthetic fitting
what should the wearing schedule be like for someone with a UE amputation
start with 15-30 min and increase to 8 hours within 1-2 weeks.
what are some skin problems
- bottoming out
- distal edema
- pistoning
- bell capping
what is a key part of intervention after limb loss
mobility
-Specific and Individually developed
-Hip Extension, Hip abductors, knee extensors, knee flexors
======Indicator for prostatic ambulation potential
-Include Trunk Strength
-Don’t forget about coordination & motor control
Prosthetics PP slide
30
what si the clinical presentation of PFFD
- Shortened thigh held in flexion and abduction and external rotation
- Hip and knee flexion contractures
- Severe leg length discrepancy with the foot often at the level of potilital crease
- Knee instability due to absence or deficient crucitate ligaments
what are some kinds of control systms of the UE
passive
body powereed
externally powered
hybrid
what is dynamic response foot prosthetic
Patients feel dynamic response at push-off, shock absorption, costly
what is flexible keel foot prosthetic
: Allows smooth rollover, but limited push-off
what is a post surgical phase complications
infection
- this should be monitor throughout phases
- look for warmth, redness, pain, swelling
what are some cognition issues after surgery
Initial Reactions
Future Unknown, body image sexual function, support system responses, employment, Long-Term Adjustments
what are the different types of TF sockets
- quadrilateral socket
- ischial weight bbearing
- sub ischial socke t
what are some interventions for phantom pain
- Distraction
- Exercise and Diet
- Biofeedback
- Relaxation training and hypnosis
- Massage: Acupressure, Acupuncture, Topical Agents
- Visual feedback: Mirrors, Virtual Reality
- Neuro-stimulation (TENS)
- Surgery
- Injection
- Medication
what is the elevatd vacuum suspension
The use of a pump to reduce the atmospheric pressure within the socket there by maintaining the prosthesis on the residual limb during use.
what is Manual Locking knee:
flexion is locked for maximum knee stability
what are some training goals for infants
- Comfort with the prosthesis
- Wearing tolerance
- Ability to stand by leaning against a table
- Ability to cruise around furniture
- Ability to walk with and without support from toy grocery cart or other supporting toy
what is some surgical management for children
- amputations
- –skin healing
- –termial overgrowth
- –phantom limb sensation
- limb lengthening
- limb sparing
what race has the most amputationts
African Americans
what is the main cause of limb loss (from the 1st slide)
vascular diseases (54%)
trauma (45%)
cancer (less than 2%)
what are some comorbities that need to be addressed pre op of a amputations
Cardiovascular
Pulmonary
Metabolic
Nutrition
what is ewings sarcoma
this is about 40% of disease amputation
-weight bearing bones of LE and pelvis
what is K4
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. This is typical of the prosthetic demands of the child, active adult or athlete.
what are some other complications that can happen post surgical phase
- blood loss requiring transfusion
- deep vein thrombosis
- pulmonary embolism
- systemic complication (pneumonia, renal failure, stroke, sepsis)
- complications at the surgical site include hemorrhage or hematoma, wound infection, and failure to heal requiring additional operative interventions
Prosthetics PP
slide 22
what are some training goals for toddlers
= Full–time wear of prosthesis, except
= Use of the prosthesis in age-appropriate ambulation activities
Parents
how do you have a high success rate for UE rehab
if fitted asap after surgery
what are the knee components
- single axis
- polycentric
- fluid controlled
- microprocessor knee
- powered knee
- powered knee
- stance control
- manual locking knee
what is surgical phases and the skin flaps
most common: equal length of both and anterior and posterior flaps
- long posterior flap for increased blood supply
- skew flap (angular)
what is important for a kid to get an UE prothetic
to resotre symmetry
what are some signs and symptoms of the PVD and limb loss
- rest leg pain
- gatigue with mobility
- col ot touch
- ulcer that isnt healing
- lack of toenail growth
- little to no leg hair
- pale/blue tint to toes and feet
what is a post surgical phase PT examination
History
Systems Review: Vitals
Cognition: Emotional Status, Alert and Orientation
Integumentary: Skin, Vascularity
Sensory: Pain
Motor: Strength, Range of Motion, Limb Length
Balance: Sitting & Standing, Static and Dynamic
Function: Transfers, Mobility
UE amputation look at slide
20
what is the body powered motion of the humeral flexion
allows the terminal device to open. Scapular abduction and humeral flexion are the basic motions for the individual with transradial amputation.
what is a prosthesis
this is a tool
what is the standard approach to getting a new limb
3-6 months after complete wound feeling
what is the optimum time for fitting for UE in a kid
6 months (but you have to start 3 months)
what are some PT interventions after limb loss
Pain control Edema control Prevent contracture: Positioning, Range of motion Strengthening Cardiovascular Balance/Mobility Home exercise program Functional Activities and ADLs
what is the semirigid dressing
Unna Boot: gauze impregnated with zinc oxide
what are the 2 limb lengths that can happen after limb loss
TT: Medial Tibial Plateau
TF: Ischial Tuberosity/Greater Trochanter
what are the driving factor for a prosthetic
Rating system used by Medicare to indicate a persons rehab potential & indicates a person’s potential to use a prosthetic device
-this allows set up for payment for that prosthetic device
what ismyotraining of the UE
proportional contorl
–myosite testing and training may begin 2-3 wk post injury
sequential vs simultaneous
what are the risks factors of the PVD and limb loss
- age
- diabetes
- smoking
- high blood pressure
- high cholesterol
- race
- dialysis
- family hisotry
what is the surgical phase acute goals
- removal of part of the limb
- allow for primary and secondary wound healing
- construct a residual limb for optimal prosthetic fitting
- —skin flaps
- —-scarring
what is the success rate if someone is fitted within a month of surgery
93% of success rate
how do they do leg reconstruction
allograft or endo prosthetic implant
what are some shanks of TT
- endoskeleton
- exoskeleton
what is K1
The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. This is typical of a household ambulator or a person who only walks about in their own home.
what are the medical management of cancer
- radiation
- chemotherapy
what is Stance-control:
for knee stability, delayed swing phase, fixed cadence
what are some limitations to the wound healing post surgical phase
Smoking, severity of preexisting vascular problems, diabetes, renal disease, physiological problems, cardiac disease
what is Single axis (constant friction):
simple, inexpensive, fixed cadence and low stability
what are the socks
Fabric socks come in various thickness or Ply’s
(1,2,3-5 ply)
Allows for adjustments to be made with changes in edema
> =15ply sock need to see the prosthetist for adjustments
what is the surgical phase muscle stabilization
- myoplasty
- myofascial
- myodensis
- tendoesis
what are the primary goal for socket of TT
Provide fit for residual limb
interface between the residual limb and the rest of the prosthesis
fits securely on the residual limb, providing a comfortable surface for weight bearing and stability for the transmission of forces between the body and the environment.
are limb loss in PVD patients preventable
yes about 60% of them are preventable
what is myodensis
muscle to bone
what are the types of limb shapes
Cylindrical, conical, bulbous end
“Dog Ears”
“Adductor Roll”
what is single axis foot prosthetic
Simple and low cost, knee stability for low level AK, keel is not flexible
what is the proximal femoralfocal deficiency
- Absence of part of the proximal femur
- Underdevelopment of some or all of the acetabulum, femoral head, patella, tibia and fibula
- Aitken Classification A-D
- 1:50,000 births
- 15 % are bilateral
- instability of the knee joint
- totla longitudinal deficiency of the fibula
what are the different socket types fo TT
- patellar tendon bearing
- total surface bearing
what is pre prosthetic and prosthetic training of the UE amputations
within a month after amputations which is the golden window
what is microprocessor foot prosthetic
very high tech
what is the hard socket
rarely provided anymore.
what are some congenitial limb issues
Critical period of limb development
20% genetic
10% environmental
60-70% unknown
what is the success rate if someone is fitted after a month of surgery
42% of success rate
what are the types of dressings for the post surgical phase
- rigid
- semirigid
- soft
what are some post surgical phase RED flags
- Increased pain
- Excessive swelling
- Decreased muscle strength or sensation along a motor and/or sensory nerve distribution
- Sudden shortness of breath
- Decreased oxygen saturation increased resting heart rate
- Change in mental status
what needs to be done for liners the RL
Clean daily
what happens with the shorter level arm
the harder it is to control flexion concentrates
what are the most common amputations
Amputations of the Toes Metatarsal Head Resection Ray Resection Transmetatarsal Amputation Midfoot Amputation – Lisfranc and Chopart -ankle disarticulation transtibial amputation transfemoral amputation
what are some positioning goal after limb loss surgery
Extension
TT: full ROM of hips and knee
TF: full ROM of hip extension and adduction
how to asses pre and post amputations fx status
-amputee mobility predictor amp
- -tools specific to amputation and prosthetics
- 21 item outcome measure to assess activity level
- designed to measure fxal capabilities w/o a prostheiss and to predict ability to ambulate with prosthesis
what is phantom sensation
– Sense or feeling of the presence of the limb
what are the process of TT prosthesis
- tib and fib transected
- retention of anatomical knee
- indicated in vascular diseases
1foot/ankle assembly
2 shank
3 socket
4 suspensino system
what are the longitudinal deficiency
Reduction or absence
May have normal distal elements
Named in a proximal-distal sequence
(this is basically missing a bone)
Prosthetics PP slide
32-36
what is strap suspension
may be a cuff strap or a waist belt
what is aitken classification C
Severe dysplasia, absent femoral head
Preventing contractures picutres
slide 36
what is the skeletal deficiency
Anatomic and radiologic basis
what is the acute care goals for UE amputations
promote healing of the wound, mobility and education
what is the pin or lanyard suspension
use of a gel liner that includes a physical connection to the prosthesis. May include tab suspension systems.
what are some expectations for a child and amputations
- variation in rate of neromuscular deve.
- lower energy output
- accommodate growth
Is a child with an amputation different than an adult?
Yes due to the fact that they are still growing
what is the advantages of the rotationplasty
Increased limb length Improved prosthetic function Improved weight bearing capacity Elimination of terminal overgrowth and pain Run, jump and play
how to treat aitkens A
lengthening only
what shoudl an evaluation of the UE amputation
limb volume measurements, wound description, scar evaluation, sensitivity, pain (surgical/limb pain vs phantom pain), FIM psychological support gross motor: posture desensitization compression garments
what are some limb sparing procedures
- an option for children with bony malignancies
- resection of tumor
- leg reconstruction
- contraindication
what is the expected outcomes of a cld and bike riding
25 children with unilateral and 5 with bilateral TTA rode tricycles and bicycles
13/14 children with TFA rode while wearing limb
what are some common skin problems
abrasion
blistering
what are the causes of limb loss
1 peripheral vascular disease (PVD)
2 trauma
what is bell clapping mean
distal end shrinkage
what are some accommodate growth for a child with amputations
New prosthesis
Socket liners
Compliment developmental alignment
what are some system complications of integumentary
Wound care, edema, early post-op complications
Skin: Skin adherence to bone, skin grafts, burns,
how do you select the amputation level
based on many factors
- vascularization
- neuropaty
- infection
- malignancy
- function and rehabilitation potential
what is surgical phases pre-op
- selection of appropriate amputation level
- optimize medical comorbidities
- develop treatment plans
- patient and caregiver education
what are 8 steps of applying RRD
1) apply the wound dressing as needed,
2) wear proper layers of socks of various lengths,
3) apply the plaster cast; use a plastic sheath to reduce friction,
4) pull the suspension stockinette upward covering the plaster cast,
5) place the supracondylar cuff and fasten the Velcro closure,
6) pull the suspension stockinette tight,
7) fold suspension stockinette downward and anchor on the suspension cuff
8) knee flexion is possible and encouraged.
what are some interventions for edema control
Postoperative Dressings
• Soft dressing
– Ace wrap
– Shrinker (After removal of sutures)
– Compression pump
• Rigid dressing
– a. Non-weight bearing rigid dressing (NWB)
– b. Immediate postoperative prosthesis (IPOP)
– c. Custom rigid removable dressing (RRD)
– d. Prefabricated rigid removable dressing (RRD)
– e. Prefabricated pneumatic immediate postoperative prosthesis (AirPOP)
what are the socks for the RL
Clean daily
• No wrinkles
what is donning
putting ON the prosthetic
- this will depend on the type of socket • Cuff • Sleeve suspension • Liner – pelite foam – gel: cushion, pin, lanyard, seal-in • Socks (Altered by limb volume) • Pull-in
what are some muscles for testing the shoudler disarticulation
pec major or minor trap teres minor lats supraspinatus infraspinatus
what are some everyday care fo the prothetic
limb and skin care
prosthesis
socks
liners
what are the most common UE amputations
Transhumeral
Transradial
what needs to be done mandatory everyday
- skin checks
- build up wear time and document
- blanchable redness OK
- education patients on how to check skin
how do you fix distal edema
needs to see cpo asap
what are some goals of preschool and shcool age kids for prosthesis
- Independence in self-care skills, mobility including running
- —–Use of feet or mouth is acceptable
- Acquire school skills such as coloring, cutting and writing
- Surgeries in PFFD
- ——Limb length on prosthetic side is 5 cm shorter than other femur
what is the rigid dressing
Immediate postop prosthesis (IPOP) “total contact cast”
Removable Rigid Dressing (RRD): adjustable, AirLimb
what are some contraindications fo children and limb sparing
Extensive invasion of surrounding soft tissue, neurovascular supply or intramedullary cavity
what is a the limb loss time line
- surgical phase
- post surgical phase
- prosthetic phase
How many people live with limb loss
2 million
what should be some patient education for UE amputation
- RL tolerance/ care
- frequent inspection of limb
- wearing schedule
- daily washing of limb
what is the prosthetic liner (gel)
A skin prosthesis interface typically made of silicon or mineral oil gel to provide cushion to the residual limb. This is often a component of the suspension system.
what are the early goals for wearing prosthesis
- comfortably
- begin to use for bimanual play
- pushing up to sitting or quadruped, protective reactions and propping in sitting
- shake or remove toys placed in terminal device by an adult
what is Polycentric:
raises the knee center for knee stability, better cosmetic for longer limbs
what are some system complications of psychological
Adaptation, PTSD
what do new amputees go through
the 5 classic stages of grief
what is cushion liner with air expulsion valve
there was nothing
what is the primary goals for shank of a prosthesis of TT
Substitute for the human leg
Above the foot ankle/ Below the socket
how common are the diseasee- related amputations
they are rare
what is soft dressing
Elastic Wraps – indicated with infections
Elastic Shrinkers – socklike garments, only used after incisions are healed
what is multi axial foot prosthetic
Accommodates uneven terrain and reduces stress on skin
what is myoplasty
muscle to muscle
what is a K level
Rating system used by Medicare to indicate a persons rehab potential & indicates a person’s potential to use a prosthetic device
what are some primary goals for TT prosthesis
restore the general contour of the foot
- adsorb shock at heel strike
- restore as much as foot function
is rehabilitation for the UE or LE harder for rehabilitation
UE
Prosthetics PP slide
28
what will happen in 2-3 years for someone with diabetes of the 1st amputations
55% will reuire amputation of the second leg
what are some body powered motions for UE amputations
- scapular abduction
- humeral flexion
- shoulder depression , extension , abduction
what are the factors that influence prescription
– Residual limb level, shape and condition
– Boby Function (MMT, ROM, Sensaation)
– Presences of Co-morbidities
– Activity/Mobility level and activity potential (pre and post)
– Environment factors
– Personal factors
what is post surgical phase
Monitor Complications
Select and Apply dressings
Examination
Initiate Treatment
what is aitken classification A
Bony connection between components of femur
what is dynamic of prosthetic alignement
changes are made to the alignment based on the individual’s gait pattern.
what are some of the ISO classification
- skeletal definciencies
- transverse
- longitudinal
what is K0
The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. This level does not warrant a prescription for a prosthesis.
what are some age appropraite ambulation activites for toddlers
- encourage use of prosthesis
- provide toys and equipment
- inspect the skin for undue irritation
what needs to be done for limb and skin care of a RL
Watch for skin irritation
what are some system complications of cardiovascular
arrhythmia, congestive heart failure (CHF),myocardial infarction (MI).
what is the prosthetic liner (foam)
A prosthesis interface used for cushion of the residual limb. Commonly used with anatomical suspension.
what are the transverse deficiency
Limb develops normally
Named for where the limb terminates
where are abrasion most common
- Fibular head
- Tibial tubercle
- Tibial condyles
- Anterior distal tibia
- Hamstring tendons
what is the endoskeleton of the shank
Central aluminum or rigid plastic pylon Adjusts to angulation Absorbs vertical shock Reduces stress on joints Most commonly prescribed