Exam 5: Prosthetics Quizes/InClassActivities

Question 1

Post-Op Amputee Rehab Review: Question 1

A diabetic should

1. apply lotion right after bathing between their toes only
2. apply lotion right after bathing to their entire foot and put cotton between their toes
3. apply lotion right after bathing to their foot, except between their toes
4. not apply lotion after bathing

Answer 1

3. Apply lotion right after bathing to their foot, except between their toes

Question 2

Post-Op Amputee Rehab Review: Question 2

A diabetic is most likely to get ulcers on their

1. dorsal great toe
2. posterior heel
3. medial malleolus
4. plantar metatarsal heads

Answer 2

plantar metatarsal heads

Question 3

Post-Op Amputee Rehab Review: Question 3

For an amputee who is fearful and has only fair balance, _____ would be the most appropriate assistive device.

1. cane
2. crutches
3. walker

Answer 3

walker

Question 4

Post-Op Amputee Rehab Review: Question 4

Which of the following interventions is most appropriate to minimize edema of the residual limb in the amputee with PVD?

1. compression
2. elevation
3. ice

Answer 4

Compression

elevation could cause a flexion contracture

ice can cause/exacerbate vascular issues (vasoconstrict), and may be dangourous for those with impaired sensation.

Question 5

Post-Op Amputee Rehab Review: Question 5

What is different about an amputee wheelchair, when compared to a traditional wheelchair?

1. axis
2. height
3. width

Answer 5

axis

Question 6

Post-Op Amputee Rehab Review: Question 6

A conical residual limb is an appropriate shape for prosthetic fitting.

1. True
2. False

Answer 6

True

It is not the best shape, but it is appropriate

Question 7

Post-Op Amputee Rehab Review: Question 7

Name two muscle groups that are likely to become adaptively shortened in the transfemoral amputee.

1. abductors and extensors
2. abductors and flexors
3. adductors and extensors
4. adductors and flexors

Answer 7

abductors and flexors

Question 8

Post-Op Amputee Rehab Review: Question 8

All amputees who need a wheelchair should be issued an amputee wheelchair.

1. True
2. False

Answer 8

false

(a normal wheel chair would be fine for someone with a partial foot, symes, or distal transtib amputation)

Question 9

Post-Op Amputee Rehab Review: Question 9

“My foot that’s not there anymore itches like crazy - I can’t stand it.” What’s being described

1. amputee pain
2. phantom pain
3. phantom sensation
4. residual limb pain

Answer 9

Dr. Mincer decided that both were correct, but she prefered phantom pain.

• phantom pain (dr. mincer’s preference)
• phantom sensation

Dr. mincer prefered phantom pain because she thinks of an itch she can’t stand as pain.

I prefer phantom sensation, because sometimes I feel I can’t stand an itch that does not feel like pain to me (like a misquito bite).

Question 10

Post-Op Amputee Rehab Review: Question 10

Assuming safety is assured with both, which would be preferred for gait outside the parallel bars in an acute amputee?

1. crutches
2. walker

Answer 10

Crutches

advantages to crutches:

• gait pattern
• easier on stairs
• easier to fit in small places
• can just one crutch (to transition to a lower level of assistance - but that wouldn’t be acute)

Question 11

Post-Op Amputee Rehab Review: Question 11

A cylindrical limb is an appropriate shape for prosthetic fitting.

1. True
2. False

Answer 11

true

a cylindrical limb is ideal for prosthetic fitting (conical is okay too). Bulbous is not an appropriate shape for a prosthetic fitting, but it can be accomodated.

The final shape of limb is usually between conical or cylindrical. It is based on atrophy. We can only influence if it gts bulbous or not.

Question 12

Post-Op Amputee Rehab Review: Question 12

Name two hip movements that the transfemoral amputee is most likely to lose range in, if they don’t pay attention to exercise and positioning instructions.

1. abduction and extension
2. abduction and flexion
3. adduction and extension
4. adduction and flexion

Answer 12

adduction and extension

Question 13

Post-Op Amputee Rehab Review: Question 13

A good way to minimize edema of the residual limb is RICE

1. True
2. False

Answer 13

false

You don’t want ice because it could exacerbate vascular issues

you don’t want elevation because it could encourage a (hip) flexion contracture

Question 14

Post-Op Amputee Rehab Review: Question 14

The axle of an amputee wheelchair is set one-inch more _______ than usual

1. anterior
2. posterior

Answer 14

posterior

to prevent pt from flipping over backwards since front of w/c is unweighted from lack of limb(s)

moving the axle posterior makes it harder to pop a wheelie

Question 15

Post-Op Amputee Rehab Review: Question 15

In the transfemoral amputee who anicipates receving a prosthesis, priority for strengthening should be given to what muscle groups?

1. abductors and extensors
2. abductors and flexors
3. adductors and extensors
4. adductors and flexors

Answer 15

abductors and extensors

Question 16

Post-Op Amputee Rehab Review: Question 17

The main advantage of a Syme’s amputation is

1. cosmesis
2. function when not wearing a prosthesis
3. function when wearing a prosthesis

Answer 16

function when not wearing a prosthesis

Question 17

Post-Op Amputee Rehab Review: Question 18

Which of the Semmes-Weinstein monofilaments differentiates whether an amputee does or does not have protective sensation?

1. 1 g
2. 10 g
3. 100 g
4. 1000 g

Answer 17

10 g

(same as 5.07 size filament)

Question 18

Post-Op Amputee Rehab Review: Question 19

A diabetic who can feel the 5.07 Semmes-Weinstein monofilament on the sole of their foot but not the 6.10 monofilament is

1. likely to develop an ulcer
2. not likely to develop an ulcer
3. probably confused

Answer 18

probably confused

(6.10 monofiliment is same as 100 g, so the pt is saying they can feel a tiny fillament but not the larger filament)

Question 19

Prescriptions for prosthetic componments should be based on all of the following EXCEPT:

1. Predicted amputee activity demands
2. reimbursement requirements
3. Functional Status at the time of amputation
4. Bony contours of residual limb

Answer 19

Functional Status at the time of amputation

Rationale: We should interpret this “Functional Status at the time of amputation” to mean immediately before or about the time of amputation. Many amputees could have been very sick or in a car accident that severely compromised function just before or at the time of amputation. This would not accurately reflect their potential future level of function.

**It might be different if it said something like “predicted future function based on a longstanding functional ability prior to amputation” but even then, someone may have been struggling with a non-healing wound for a long time that restricted their function and caused a functional decline that does not accurately reflect future functional potential after amputation.

Question 20

Which TT socket is more likely to be used in a new amputee (the current standard)?

1. Total Surface Bearing
2. Patellar Tendon Bearing
3. NA - They are equally current and useful
4. NA - There is another socket that is current standard

Answer 20

Total surface bearing

I don’t remember the reading saying this, but Dr. M said it is true when we discussed this question.

Question 21

Which of the following is true? The weight of omponents is

• Directly related to both financial and energy cost
• Directly related to financial cost but inversely related to energy cost
• Inversely related to financial cost but directly related to energy cost
• Ineversely related to both financial and energy cost

Answer 21

Inversely related to financial cost but directly related to energy cost

Rationale: requires an understanding of inverse and direct relationships. Requires understanding of the how financial and energy costs relate to weight in a prosthesis. It would also help to be able to climb inside dr. Mincer’s mind and see it from her perspective.

Direct/Indirect Relationships:

• Direct relationship is when one thing changes in a particular direction another thing changes in the same direction. Example weight increases and cost increases. Inverse relationship is when one thing changes in a particular direction and another thing changes in the opposite direction. Example: weight increases and cost decreases.

How financial costs and energy cost relates to prosthesis weight.

• It seems logical that when weight goes up, energy costs go up (and when weight goes down, energy cost goes down). Therefore, there is a direct relationship between weight and energy cost; weight is directly related to energy cost.
• Dr. M said typically lighter componenets are more expensive (like a bicycle), so when weight goes down, financial costs go up (said differently, when weight goes up, financial costs go down). Therefore, there is an inverse relationship between weight and financial cost; weight is inversely related to financial cost.
• Some of us read that often the addition of components that may enhance function cause the prosthesis to heavier and more costly, so we got this question wrong (financial cost and weight would be directly related). However, Dr. M wanted us to think of more expensive materials being lighter (not neccessarily addition of more components). I guess we would have to think of a financially more expensive prosthesis as a prosthesis with the same amount of components but that are made of more expensive lighter material instead thinking of a financially more expensive prosthesis as one that we are just adding more components to.

Question 22

The most preferred skin-socket interface is

1. Socks
2. Soft Inserts
3. Sleeve
4. Gel

Answer 22

Gel

Rationale: I’m pretty sure the book mentions this. The sleeve is actuall something used for suspension, not an interface material (I think). There could be a liner liner (type of sheath) between the skin and the gel liner, but that was not an option.

Question 23

Which of the following is the most important goal of prosthetic suspension?

1. Maximize comfort
2. Minimize pistoning
3. Minimize cost
4. Maximize cosmesis

Answer 23

Minimize pistioning

Rationale: Maximize comfort is not as right as minimize pistoning because lack of comfort due to faulty suspension is more a result of pistioning (more of a secondary problem, so maximizing comfort could be more of a secondary goal) instead of direct problem caused by pistoning.

Question 24

Which of the following types of suspension is located inside the socket?

1. Joint and corset
2. Sleeve
3. Supracondylar cuff
4. Locking liner

Answer 24

Locking liner

Rationale: Locking liner has the pin in the bottom of a gel liner that inserts into the hole inside the socket. Of the choices, it is the only one that has a connection inside the socket.

Question 25

Which of the following is NOT an advantage of an endoskeletal prosthesis over an exoskeletal one?

1. Very adjustable
2. More durable
3. Lighter
4. More cosmetic

Answer 25

More durable

Rationale: Very adjustable and more cosemtic are listed as advantages of an endoskeletal prosthesis. Being heavier is one of the disadvantages of an exoskeletal prosthesis (so being lighter would be an advantage of an endoskeleton)

Question 26

Bench alignment in slight flexion is done mainly in order to

1. Minimize pressure and increase comfort
2. Widen base of support and facilitate balance
3. Increase the mechanical advantage of the quad
4. Accommodate to knee flexion contracture

Answer 26

Increase the mechanical advantage of the quad

Question 27

Prosthetic socks are used for all the following except

1. Minimize moisture loss
2. Optimize fit
3. Increase comfort
4. Minimize shear

Answer 27

Minimize moisture loss

Question 28

Which of the following suspension types provides medial-lateral knee stability

1. Sleeve
2. Locking liner
3. Cuff Strap
4. None of the above

Answer 28

None of the above

Dr. M said none of these provide enough ML stability to matter to us.

Question 29

An outset foot in the transtibial amputee causes excess pressure in the proximal ___________ and distal _________ limb.

1. Lateral, medial
2. Medial, lateral

Answer 29

Lateral, medial

Question 30

A TT prosthesis that is too long is most likely to cause

1. Trunk flexion during stance
2. Flexion moment at the knee
3. Antalgic gait
4. Trendelenburg gait

Answer 30

Trunk flexion during stance

(Flexion moment at the knee could also be correct)

Rationale: Dr. M said Trunk flexion during stance is the most correct answer because this is for a transtib amputee. She also said Flexion moment at the knee could also be correct becouse a prosthesis that is too long could have more knee flexion forces. (there was much discussion about this in class, but that is all I wrote down)

Question 31

The PT just removed a PTB prosthesis, and sees redness over the patellar tendon. What is the est assessment of this?

1. Appropriate fit
2. Inadequate suspension
3. Caused by pistoning
4. Too tight

Answer 31

Appropriate Fit

Rationale: It is normal to see some redness over weight bearing surfaces (which is the patellar tendon and medial tibial flare in the PTB socket). If it said excessive redness, that would be a problem. If it was too tight, the redness would more likely be over the tibial tuberosity because the patellar bar would not come up far enough on the RL to reach the patellar tendon.

All that said, redness doesn’t always mean an appropriate fit. That was just the best answer of the options given.

Question 32

Pistoning due to inadequate suspension is a problem for an amputee because it creates all of the following EXCEPT

1. Functionally longer limb during swing
2. Excessive pressure within the socket during stance
3. Possible blistering or abrasion on the residual limb

Answer 32

Excessive pressure within the socket during stance

Rationale: Suspension is the problem which would cause limb to be functionally longer (be longer because there is a gap due to socket dropping, not because it is too long when fitting securely) or possible blistering or abrasion on the residual limb. The socket still fits well, so there should not be excessive pressure within the socket during stance (excessive pressure within the socket would be a socket problem not a suspension problem)

Question 33

A toe lever that is too short creates a(n)

1. Extension moment during initial contact
2. Extension moment during mid-late stance
3. Flexion moment during initial contact
4. Flexion moment during mid-late stance

Answer 33

Flexion moment during mid-late stance

Rationale: the toe rocker happens too quickly so the weight rolls over the toe sooner than it should and causes the knee to flex.

Question 34

A heel cushion that is too hard creates the potential for excessive pressure at the ________ residual limb in the transtibial amputee.

1. Distal anterior
2. Distal posterior
3. Proximal anterior
4. Proximal posterior

Answer 34

Distal anterior

Rationale: There could be pressure at the distal anterior and proximal posterior parts of the residual limb, but the distal anterior part is much more likely to be significant because there is not a lot of tissue there to pad excess pressure and there is more force acting on the limb because there is a shorter lever arm from the foot (where the heel cusion is transfering forces from the floor) to the residual limb. The proximal posterior part of the residual limb is less susceptible to pressure problems because of more soft tissue and a longer lever arm (which results in less force being applied to the tissue). Therefore the proximal posterior part is not as concerning.

So distal anterior is the best answer.

A hard heel cushion causes rapid foot flat, but there is too little PF available in a prosthetic foot to prevent it from pulling the tibia forward too quickly, which encourages knee flexion. The residual limb binds in the socket while it is trying to resist knee flexion. This results in pressure on the distal anterior and proximal posterior part of the RL (but only the distal anterior part really matters in this case).

Question 35

Where is excessive redness likely after doffing a PTB socket that is too tight?

1. Distal patella
2. Tibial tubercle
3. Patellar Tendon
4. Pressure wouldn’t be evident

Answer 35

Tibial tubercle

Rationale: The patellar tendon should only be interpreted as the soft tissue (not including the attachment points at the distal patella nd tibial tubercle). Because the socket is too tight, the person would not be able to get the RL fully into the socket. The patellar bar would only come up to the tibial tuberosity and put pressure there instead of on the patellar tendon.

Question 36

An inset foot is most likely to create excessive pressue at what two points on the residual limb

1. Distal lateral and proximal medial
2. Distal medial and proximal lateral

Answer 36

Distal lateral and proximal medial

Rationale: Inset foot cuases loss of lateral support which makes sort of a varus moment at the knee. The socket binds on the RL so that there is pressure on the distal lateral and proximal medial part of the RL which is trying to resist the varus force (since it doesn’t bend that way)

Question 37

What is the advantage of a split keel foot over a solid keel foot?

1. Stability on level surfaces
2. Stability on uneven terrain
3. Better energy return
4. Adaptable to more types of shoes

Answer 37

Stability on uneven terrain

Question 38

An amputee that puts on flat shoes instead of their usual sole with a 3/4 inch heel is _________ likely to fall.

1. less
2. more
3. equally

Answer 38

less

Rationale: We should always equate likely to fall in an amputee as knee buckling. A lower heel will create an extension moment on the knee, making it even harder to buckle.

Question 39

What is the main advantage of a dynamic response foot?

1. More neutral initial contact (this is how it was worded. not sure if this was meant to be natural)
2. More natural swing phase
3. More natural terminal stance

Answer 39

More natural terminal stance

Rationale: only foot that gives a more natural toe off. Other feet have achieved great initial contact, so more natural terminal stance is the best answer.

Question 40

An amputee with pin and shuttle suspension slips easily into their socket and gets more than the usually number of clicks in quick succession. What is the best assessment of their fit?

1. Correct
2. Too loose
3. Too tight

Answer 40

Too loose

Rationale: There are several notches (fenistrations) on the pin so that when someone is locked in, they usually have a few more or a few less available (so there is not just one fenistration to accomodated small volume changes). Amputees learn how many clicks are normal for them (1-2 more or less clicks than normal is generally okay). Too many clicks suggests the RL went further into the socket than normal which could indicate it is too loose.

Question 41

The amputee should always pull the silicone liner onto their residual limb using two hands

1. True
2. False

Answer 41

False

silicone liners (a type of gel oner) should never be pulled on! They must be rolled on.

Question 42

The pin and shuttle suspension is a good choice for the amputee with knee ligament damage

1. True
2. False

Answer 42

False

Rationale: the pin and shuttle suspension provides no additional ML support. A corset with joint would be more appropriate.

Question 43

What amputee is likely to use auxillary suspension?

1. Fluctuating volume
2. Poor dexterity
3. Poor endurance

Answer 43

Fluctuating volume

Question 44

The amputee with an IPOP should start full weight-bearing immediately after surgery to achieve the maximum benefit from this type of prosthesis

1. True
2. False

Answer 44

False

You should not weight bear more than TTWB with an IPOP

Question 45

Socks are used chiefly for

1. Absorbing perspiration
2. Adjusting fit
3. Providing padding

Answer 45

Adjusting fit

Question 46

Which type(s) of suspension would be most appropriate for the following persons with trans-tibial amputations?

• Traumatic amputation following motorcycle accident. RL is short, extensive knee ligament damage also sustained in accident.
  
  1. Corset and joint
  2. Supracondylar
  3. Sleeve
  4. Suction

Answer 46

Corset and joint

(it is the only one that provides ML support that matters)

Question 47

Which type(s) of suspension would be most appropriate for the following persons with trans-tibial amputations?

• Amputee with rheumatoid arthritis and moderately impaired dexterity
  
  1. Vacuum assisted
  2. locking liner
  3. supracondylar strap
  4. corset and joint

Answer 47

locking liner

Rationale: requires less fine motor skils than the others

Question 48

Which type(s) of suspension would be most appropriate for the following persons with trans-tibial amputations?

• Amputee receiving chemotherapy and with volume that fluctuates significantly
  
  1. Supracondylar/suprapatellar
  2. Supracondylar
  3. Waist belt
  4. Suction

Answer 48

Waist Belt

Rationale: Waist belt is the most appropriate for significant fluctuations. Suction could be appropriate for someone with moderate volume fluctuations (max 5 ply). Some suction suspensions can acocmodate up to 8-12 ply.

** this is what my notes said. I know it doesn’t fully make sense.

Question 49

Which type(s) of suspension would be most appropriate for the following persons with trans-tibial amputations?

• Amputee with very sensitive skin, abrades easily
  
  1. Supracondylar
  2. Pin and shuttle
  3. corset and joint
  4. waist belt

Answer 49

Pin and shuttle

Rationale: Gel liner is better for sensitive skin?

Question 50

Changing to a shoe that has a higher heel will create a ____________ moment at the knee.

1. Flexion
2. Extension
3. NA - this won’t affect the knee
4. It depends on how much higher the heel is

Answer 50

Flexion

Question 51

The heel cushion on a SACH foot simulates controlled

1. Dorsiflexion during initial stance
2. Dorsiflexion during late stance
3. Plantarflexion during initial stance
4. Plantarflexion during late stance

Answer 51

Plantarflexion during initial stance

Question 52

Too hard a heel cushion on a SACH foot will cause a(n) _____________ moment from initial contact to foot flat.

1. Extension
2. Flexion
3. Not enough info
4. The heel cushion wouldn’t affect the knee

Answer 52

Flexion

Question 53

Too soft a heel cushion in the SACH foot will cause ___________ movement from initial contact to foot flat.

1. Too rapid
2. Delayed
3. The heel cushion wouldn’t affect the knee

Answer 53

Delayed

Question 54

For the amputee with a SACH foot, moving too quickly from initial contact to foot flat cuases

1. Decreased knee stability
2. Increased knee stability
3. This won’t affect knee stability

Answer 54

Decreased knee stability

** remember in prosthetics, knee stability always refers to potential for buckling

Question 55

The posterior bumper in a SACH foot will affect

1. Early stance
2. Mid stance
3. Late stance
4. Not applicable

Answer 55

Not applicable

Rationale: SACH foot does not have bumpers (single axis foot does)

Question 56

The posterior bumper in a single axis foot will affect

1. Early stance
2. Mid stance
3. Late stance
4. Not applicable

Answer 56

Early stance

Rationale: posterior bumper influences plantar flexion of foot as it moves to foot flat after initial contact

Question 57

Which of the following will create a flexion moment at the knee during initial contact?

1. Mild hip flexion contracture
2. Soft posterior bumper
3. Too hard a heel cushion
4. Too long a keel

Answer 57

Too hard a heel cushion

Rationale: the hard heel cushion will cause force towards tibial advancement too quickly as the fixed foot goes to flat-foot too rapidly

Question 58

A multi-axis foot is always better choice than a single axis foot, assuming the weight is equal and payment is assured.

Answer 58

False

Single axis foot can provide more stability on flat surfaces. (as an example of when multi-axis is not better). I didn’t write down notes for this one.

Question 59

Changes to a softer anterior bumper is most likely to ___________ knee stability

1. Increase
2. Decrease

Answer 59

Decrease

Rationale: a softer anterior bumper will allow faster ankle rocker (tibial translation - like movement). The faster this happens, the more likely the knee wil flex too early.

Question 60

The knee disarticulation is advantageous for all of the following EXCEPT

1. Load bearing tolerance
2. suspension
3. Donning/doffing
4. knee control

Answer 60

Donning/Doffing

Rationale: the bulbous end of a knee disarticulation (becuase of the intact femoral condyles) make it more challenging to don/doff.

Question 61

Pressure on the ischial tuberosity is highest with which type of socket?

1. Quadrilateral
2. Ischial containment
3. Suction

Answer 61

Quadrilateral

**suction is a suspension type not a socket type

Question 62

Which of the following is NOT an advantage of the flexible socket?

1. Maintains suction better
2. Pressure distributed better
3. less bulky
4. more comfortable for sitting

Answer 62

Less bulky

Rationale: the flexible socket is more bulky because it has the hard outer shell plus the inner flexible component. The other options oare advantages of a flexible socket.

Question 63

The amputee with an ischial containment socket is likely to have ____ frontal plane stability than tone with the quadrilateral socket.

1. Worse
2. Better
3. Similar
4. NA-this is not affected by socket type

Answer 63

Better

Question 64

Which of the following knees swing freely (no swing control)?

1. Single axis
2. hydraulic
3. Microprocessor

Answer 64

Single axis

Question 65

During TF checkout, which of the following is most analogous to assessing knee flexion range in the transtibial amputee?

1. Assessing amputee hip flexion range
2. Assessing prosthetic knee flexion range
3. Verifying prostheti cfoot flat during sitting
4. Assessing amputee hip abduction range

Answer 65

Assessing amputee hip flexion range

rationale: We want to make sure the anterior trim line of a TF socket is not too high to allow the hip flexion required to sit. This is similar to examining the posterior wall on a TT socket when a pt is sitting to make sure it is low enough not to dig into the poplitial fossa/hamstrings while sitting.

Question 66

Transfemoral knee stability is

1. Inversely related to hip stability
2. Better with the quad socket
3. Mostly dependent on RL strength
4. Critical for overall safety

Answer 66

Critical for overall safety

Question 67

Which of the following is most analogous to transtibial sleeve suspension?

1. Silesian belt
2. Pull-in suction
3. Total elastic

Answer 67

Total elastic

Question 68

Which suspension would be most appropriate for the amputee with chronic, significant adductor weakness?

1. Traditional pull-on suction
2. Pelvic band and joint
3. TES belt
4. Pin and shuttle

Answer 68

Pelvic band and joint

Rationale: The joint will help with ML stability problems from weak adductor muscles. None of the other choices help with ML stability

Question 69

An amputee with poor standinb balance is MOST likely to have difficulty donning which of the following suspension types?

1. Traditional pull-on suction
2. Pelvic band and joint
3. Silesian belt
4. Active suction

Answer 69

Traditional pull-on suction

Rationale: This is the suspension where skin is against socket and you must stand while donning it!

Question 70

An amputee with poorly controlled diabetes and volume fluctuation is most likely to benefit from which of the following suspension types?

1. Traditional pull-on suction
2. Pelvic band and joint
3. Silesian belt
4. Active suction

Answer 70

Active suction

Rationale: Active suction is useful for minimizing volume fluxuation an may even help with vascular issues. The volume fluctuation is not extreme enough to make active suction fail.

Question 71

The pneumatic knee’s main advantage is that it _____________ than a hydraulic knee.

1. Weighs less than
2. provides a smoother gait
3. is more stable than
4. NA - they are equally applicable to most amputees

Answer 71

Weighs less than

Question 72

An amputee with PVD has been wearing his prosthesis for 5-10 minutes during the first checkout/training session. Which of the following are NOT reliable indicators of whether or not the socket fit is appropriate?

1. Absence of pistoning
2. Height of trimlines
3. Their report of pain
4. Them saying it feels OK

Answer 72

Them saying it feels OK

Rationale: Someone with PVD may have impared sensation, so there may be a problem even if they do not feel anything hurting.

Question 73

The wearing time for a new prosthesis should be gradually increased because

1. The amputee’s skin needs time to accommodate to the new forces
2. The components must be gradually “broken in” in order to last
3. Patients can’t be trusted to pay attention to warnting signs
4. The therapist needs time to thoroughly evaluate gate

Answer 73

The amputee’s skin needs time to accommodate to the new forces

Question 74

The most important reason to prevent hip flexion contracture in the transfemoral amputee is because it can cause problems with

1. Cosmesis
2. Knee stability
3. Skin intregrity
4. Socket fit

Answer 74

Knee stability

Rationale: The other reasons may be valid, but the most important one is knee stability

Question 75

Optimal alignment stability is important for all of the following EXCEPT

1. Increase safety
2. Decreased energy consumption
3. Increased confidence
4. Increased gait speed

Answer 75

Increased gait speed

Rationale: Increased gait speed is the best choice because increased gate speed is not unique to improving alignment stability. You may increase alignment stability and not improve gait speed because the speed is dependant on the extension aide setting (influencing how fast the knee extends), which I think is described as mechanical stability in the book.

Question 76

In a transfemoral socket that is too loose, which of the following are you most likely to see during stance?

1. Trunk lean due to inadequate suspension
2. Trunk lean due to pain
3. Longer prosthetic stance time
4. Shorter prosthetic swing

Answer 76

Trunk lean due to pain

Rationale: Always assume prosthetic side is being addressed if unspecified. Dr. Mincer said if the prosthesis is too loose, it will not be enough to slosh all around and totally prevent gait, but just enough for the proximal trim line to push into the groin and hit the pubic ramus causing pain. Then the pt would trunk-lean away from the pain (which she said would be towards the contralateral side of the prosthesis. I thought dr. Bringman said in orthotics that pain in this area would cause them to lean laterally towards the orthotic to unweight the groin. Definately go with what Dr. Mincer said for the exam, but I plan to pay attention in clinic to see what my pt’s do and learn from them. Dr. B’s explaination makes more sense to me. Maybe it just depends on pt preference though).

Question 77

A prosthesis that is too tight will create the appearance of a longer limb during stance

1. true
2. false

Answer 77

True

rationale: the RL will not be able to slide all the way into the socket, causing a functionally longer leg that might look too long (even though it is not a length adjustment that needs to be made; it is that the socket is too tight - maybe too many socks?, etc.)

Question 78

A rigid dressing would not be appropriate for shaping in an amputee with poor balance because the weight throws their balance off

• true
• false

Answer 78

False

Rationale: rigid dressing is not for weight bearing on. It is worn when not wearing a prosthesis. It’s primary purposes are to effectively control edema, prevent knee flexion contracture (for transtibial amputee), and protect the healing residual limb.

Question 79

The transfemoral amputee using traditional pull-in suction suspension does NOT wear socks

1. true
2. false

Answer 79

true

Rationale: Traditional pull-in suction is the one where the skin is up against the socket

Question 80

Vaulting is likely to result from wearing a prosthesis that is too short

1. true
2. false

Answer 80

false

Rationale: When vaulting occurs it occurs on the sound side (you cannot vault off of your prosthesis). Vaulting is a compensation for a limb that is too long. Therefore, short prosthesis will not cause vaulting.

Question 81

The normal width of the base of support during ambulation is

1. 1-2”
2. 2-4”
3. 3-6”

Answer 81

2-4”

Question 82

When gait training a new amputee in the parallel bars, the amputee should be instructed to remove the __________ side hand first.

1. Prosthetic
2. Sound

Answer 82

Sound

Question 83

A PT has an amputee in the parallel bards and is training him to rotate his pelvis in the transverse plane. The PT should use the following techniques, in order:

1. Resistance, rhytmic initiation, tactile cues
2. Rhytmic initiation, resistance, tactile cues
3. Tactile cues, resistance, rhythmic initiation

Answer 83

Rhytmic initiation, resistance, tactile cues

Rationale: in this case tactile cues is specific to gentle touching, not an overarching category. We start with rhytmic initiation where we help move the pt through the desired movement. This helps them feel where we want them, understand the movement, and find the muscles that will help them move that way. Then we transition to resistance, where we are resisting the movement we want the pt to perform. This gives the pt something to push into to help teach them to make the proper movements. Finally, we gradually remove resistance and only use gentle touching (tactile cues) to help remind pt of the movement without giving strong cuing. The final step she didn’t include would be transitioning to no cues at all (or maybe transitioning through using verbal cues only to no cues at all).

Question 84

Residual limb pain while wearing a prosthesis can be a reliable indicator of skin problems in a diabetic.

1. True
2. False

Answer 84

True

Rationale: Since someone with diabetes may have compromised sensation we cannot consider their reports of lack of pain reliable. But we CAN consider their report of pain reliable. Dr. Mincer wanted this question to reinforce the concept that we take reports of pain seriously even if a pt has compromised sensation (even if we do not take reports of lack of pain seriously). We should not interpret “Pain” in this question to mean “pain status” (meaning pain or absence of pain). In this question, pain should be interpreted to mean a positive report of pain (ie. “I have pain” as opposed to not reporting pain or saying “I do not have pain.”_

Question 85

The new prosthesis user tends to keep their _______ foot directly under their center of mass (midline).

1. prosthetic
2. sound

Answer 85

sound

Rationale: they have been ambulating on only thier sound leg for some time (at least since their amputation), so they have learned the habit of centering their center of mass over the sound side only. It has become a habit and a safe place for them.

Question 86

A transfemoral amputee with a mature residual limb has been wearing her prosthesis without any problems for several months. She uses a lanyard suspension with 3-4 socks. now she complains of it “not feeling right.” When you put your finger in the valve hole near the bottom of the socket, you feel space between the socks on her residual limb and the bottom of the socket. What is the most appropriate response?

1. Add a sock
2. No response needed
3. Remove a sock
4. Send them for a new socket immediately

Answer 86

remove a sock

Rationale: The sock layer should always be in direct contact with the residual limb (or whatever is over the RL, such as a sheath or gel liner) and the socket (or whatever is lining the socket). There should not be any space between layers of anything between the socket and the skin (total contact). SInce there is a gap at the distal end of the socket, it is most likely that the RL is not able to slide completely in for some reason. This may be due to an increase in RL volume. Removing a sock would compensate for an increase in RL volume and allow the RL to slide all the way into the socket. None of the other options adequately address the problem (or they jump to extreme measures too fast [send them for a new socket immediately])

Question 87

A circumducted gait can be caused by all of the following EXCEPT

1. Abduction contracture
2. Excessive length of the prosthesis
3. Insecurity of the amputee
4. Weak hip extensors

Answer 87

Abduction contracture

Rationale: this would cause an abducted gait, not a circumducted gait. Weak hip flexors could cause a circumducted gait for the following reason: In a transfemoral amputee, the hip extensors are the major stabilizing muscle group for the knee (contracting the hip extensors pull the femur back which extends the knee if the foot is on the ground - CKC). If the hip extensors are weak, the pt may be afraid to flex the prosthetic knee becuase they are afraid they will not be able to get it straight and stable again. Therefore, they elect to use a circumduction of the prosthesis (with the knee exteneded) instead of risking knee buckling by bending the knee during swing through.

Question 88

Which amputee is most likely to be able to kneel comfortably in their prosthesis?

1. Transfemoral
2. Transtibial

Answer 88

Transfemoral

Rationale: Putting weight on a flexed prosthetic knee should not hurt it and be relatively comfortable. Becuase of the need for a high posteriior wall in the transtibial prosthesis, knee flexion is limited to about 90 degrees. The foot will not plantar flex so kneeling would require more than 90 degrees of knee flexion to kneel without digging in to the poplitial fossa and/or hamstrings. Therefore, it would be very uncomfortable (if not impossible) to kneel in a transtibial prosthesis

Question 89

Hip flexion contractures DO NO affect a transtibial amputee’s ambulation.

1. true
2. false

Answer 89

false

Rationale: the book said it can/does. Forgot which page.

Question 90

Crotch pressure can cause all of the [following] EXCEPT

1. Short prosthetic stance
2. Long prosthetic swing
3. Vaulting
4. Trunk lean

Answer 90

Vaulting

Rationale: Crotch pressure would occur during stance phase of the prosthetic side. This might cause short prosthetic stance (because of pain), a long prosthetic swing (to make up for the short prosthetic stance and short sound swing phase taking place duirng the short prosthetic stance), or a trunk lean (to avoid the pain). The only thing that has nothing to do with crotch pressure is vaulting (which would only be used to help clear the ground with the prosthesis during swing phase)

Question 91

A TF amputee with an excessively high medial wall is likely to have an abducted gait

1. True
2. False

Answer 91

True

Rationale: They will abduct their prosthetic limb during stance to avoid pressure in the medial groin caused by the high trim line

Question 92

Too much external rotation at the prosthetic knee is likely to cause a _______ whip in a TF amputee.

1. Lateral
2. Medial
3. NA - knee rotation isn’t related to whips

Answer 92

Medial

Rationale: whips are most likely caused by attaching the knee joint in an internally or externally rotated position (usually slight). If you attach the prosthetic knee with too much external rotation, the heel will track medially during swing phase (when the prosthetic knee is bent) even though the socket and thigh are oriented correctly and are swinging straight through. Whips are named for where the heel is, so it would be called a medial whip when this happens. (externally rotated knee or socket causes medial whip; internally rotated knee or socket causes lateral whip).

Question 93

A prosthetist could increase the speed of swing by either increasing the extension aid or increasing friction in the knee.

1. true
2. false

Answer 93

false

Rationale: increasing the extension aid would increase swing speed, but increasing friction in the knee would decrease swing speed.

To be true, this statement would have to read as follows: “A prosthetist could increase the speed of swing by either increasing the extension aid or decreasing friction in the knee.”

Question 94

A TF amputee might be circumducting becuase their prosthesis is too short.

1. True
2. False

Answer 94

False

Rationale: circumduction is a compensation used to help clear the floor with a limb during swing phase. If anything a prosthesis that is too short would decrease the need for circumduction. (remember that when not specified, the question is referring to the prosthetic side). An amputee may still use circumduction if they are unable to bend their knee, but this would be adding possibilities to the question, so false is the best answer.

Question 95

The transfmeoral amputee should lead with the ____________ foot when going sideways down a steep incline.

1. prosthetic
2. sound
3. either
4. neither - inclines aren’t safe

Answer 95

prosthetic

Rationale: it is like stairs (up with the sound, down with the impaired)

picture is just for fun

Question 96

The transfemoral amputee should lead with the ______________ foot when stepping over an obsticle.

1. prosthetic
2. sound
3. either

Answer 96

prosthetic

Rationale: Even though clearing the obstical might be hard with your prosthetic limb, it is more desirable than creating a strong flexion moment while stepping over the object with your sound leg. Also, if you step over leading with sound leg, you will be left with an uncontrolled knee flexion moment on your prosthetic knee and little or no way to propell your body forward over the obstical to reach your sound leg. (in normal gait, you use momentum)

Question 97

The knee of a transfemoral prosthesis should not flex during any part of stance.

1. True
2. False

Answer 97

False

Rationale: Preswing is part of stance, and the knee bends during preswing.

Question 98

What is the function of friction in a prosthetic knee?

1. To counterbalance the extension aid
2. To add safetly and stability
3. Enables variable cadence

Answer 98

To counterbalance the extension aid

Question 99

Assuming the socket fit is still appropriate, the more socks the better.

1. True
2. False

Answer 99

False

Rationale: Closer contact between skin and socket gives better control. You would not want to have no socks either though because there would be no way to accomodate RL swelling.

Question 100

Stool stepping with the sound limb is a good activity for all of the following EXCEPT

1. Strengthening the sound hip flexors
2. Strengthening the residual hip extensors
3. Developing better dynamic balance
4. Increasing an amputee’s confidence

Answer 100

Strengthening the sound hip flexors

Rationale: First, you must know that by “stool stepping” Dr. Mincer means “stool tapping.” The pt is not stepping up onto the stool, they are tapping the top of the stool with their foot (like we practiced in lab). Then it makes more sense that this exercise is not primarily to strengthen the hip flexors of the sound leg, but to help strengthen and stablize the standing prosthetic side. Strenghening hte sound hip flexors is the least important of all the choices (and if you wanted to strengthen sound hip flexors, you would probably choose a different exercise that is better for targeting them).

Question 101

A PT should NOT try to wean a person with a transfemoral amputee from using their hands on the arms of a chair to asssist with sit-to-stand.

1. true
2. false

Answer 101

true

Rationale: Dr. Mincer said she meant the question to be asking if you would want a TF amputee to stop using their hands during sit to stand when possible. When possible, we should encourage our patient’s to use thier hands because it takes stress off their RL and is safer. However, it is fine to teach a pt how to sit to stand without hands for situations where they may not have free hands or chair arms available to use. Dr. Mincer awknowledged this question was not worded well.

Question 102

Which of the following is NOT a challange for the Syme’s amputee?

1. Weight bearing
2. Socket fit
3. Risk of residual limb deformity
4. Cosmesis

Answer 102

Weight bearing

Rationale: Easier weight bearing is an advantage of a Syme’s amputation

Question 103

Partial foot amputations are likely to lead to all of the following EXCEPT

1. Loss of anterior support in terminal stance
2. More rapid ambulation due to diminished foot surface area
3. Increased demand for quadriceps activity during late stance
4. Decreased shock absorption during initial contact

Answer 103

More rapid ambulation due to diminished foot surface area

Rationale: Dr. meant “rapid gait speed” when she said “rapid ambulation.” People with partial foot amputations have slower gait speed. Increased shock absorption during initial contact is wrong because people with dysvascular partial foot amputations often have weakn quads. Tehy compensate by keeping knee extended during loading response which sacrifices shock absorption mechanisms at the knee and hip joints. (pg 605, third edition)

Question 104

For the hip disarticulation, the weight bearing line should fall _________ to the hip, _________ to the knee, and __________ to the ankle.

1. Posterior, posterior, anterior
2. Anterior, anterior, posterior
3. Posterior, anterior, anterior
4. Anterior, posterior, anterior

Answer 104

Posterior, anterior, anterior

Question 105

A transection through the forearm is called a ____________ amputation.

1. below elbow
2. transradial
3. transulnar

Answer 105

transradial

Question 106

To assist the bilateral transfemoral amputee with ambulation, stubbies feature

1. locked knees
2. microprocessor knees
3. flat bottom feet
4. no knees

Answer 106

no knees

Rationale: Stubbies have rounded feet (special rocker platforms) (pg 692 in third edition)

Question 107

Myoelectric prostheses are __________ powered.

1. Cable
2. Externally
3. Electrically
4. Muscle

Answer 107

Muscle

Rationale: Muscle sends electricity to prosthesis. Dr. Mincer said she should have made this question more clear.

Question 108

The voluntary __________ terminal device is good for when the use needs to volitionally grade prehensile force.

1. Closing
2. Opening
3. NA - Neither do this
4. NA - Both do this

Answer 108

Closing