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Prosthetics&Orthotics > L1: P&O INTRODUCTION > Flashcards

L1: P&O INTRODUCTION Flashcards

1
Q

OBJECTIVES:

GO OFF OF THESE WHEN REVIEWING DECK!!!

A
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2
Q

Many team members included with the P&O pt

These include…

A

Pt, family, ortho/vascular sx, social work, nurse, dietitian, psychologist, PCP, OT, CPO, PT***

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3
Q

Role of the Prosthetist

A
  • design, fabricate, fits prostheses or artif. limbs
  • create design to fit indiv’s particular functional and cosmetic needs
  • approp mats and components
  • casts, measurements and mods→ static/dynamic alignment
  • evals fit/function→ teaches pt how to take care of it
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4
Q

Role of the Orthotist

*often same person as prosthetist

A
  • Cares for pts w/ NMSK and MSK impairs that contribute to functional limits and disability→ design, fabricate and fitting orthoses/braces
  • functional and cosmetic needs
  • educates pt on proper use
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5
Q

Role of Physical Therapist

A
  • Assess pt as a WHOLE!
    • areas to be tx’d
      • skin, fine motor, strength, balance, ROM, pain, circulation
    • personality/condition
    • living arrangements
      • assist from others?
      • stairs?
      • activity lvls ***
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6
Q

Activity Lvl ex’s

A
  • Sedentary
  • Household or community ambulator
  • Athlete
  • etc..
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7
Q

Impairments, Functional Limits or Disabilities

Examples:

A
  • Dec comm access
  • Diff w/ manipulation skills
  • Edema
  • Jt contracture**
  • Impaired aerobic capacity (UBE***)
  • Impaired gait
  • Impaired integ and inadeq shape of RL
  • Impaired ADL perform.
  • RL pain
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8
Q

1 cause of amputations in Adults

A

PVD 82%

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9
Q

1 cause amputations in Children

A

Congenital 68%

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10
Q

Amputation and Gender/Age

A

Males 75%

Females 25%

Mean age amputation= 68yo

Mean age ambulatory amputee= 48yo

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11
Q

Top 3 Risk Factors/Predisposing factors for amputations

A
  1. Concurrent DM and HTN
  2. HTN w/o DM
  3. Dx w/o HTN

race, smoking, gender, vascular hx

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12
Q

Amputations occur _______ times more in diabetic pop

A

15x

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13
Q

___ to ___% amputations preventable w/ ______

A

50-70%

EDUCATION ***

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14
Q

Related to DM…

These 2 things together are the #1 cause of amputation

A

Chronic Arteriosclerosis Obliterans + DM

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15
Q

Half of neuropathic DM foot ulcers occur where

A

@ first three MET heads on plantar surface

most GRFs here***

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16
Q

Narrowing and hardening of arterial walls

pain, trophic changes such as hair loss and redness, intermittent claudication (pain w/ exercise or WB), swelling

A

PVD

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17
Q

MOST COMMON cause amputations in ADULTS

A

PVD***

ON TEST!!!!

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18
Q

EDUCATION for pts w/ fragile vascular limb

A
  • avoid trauma
    • footwear/avoid bare feet
  • skin inspection
    • cap refill, sensory, pulses
  • temp extremes
  • skin cleans
  • min. moisture
  • moisture— if too dry
  • med attn
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19
Q

GOAL of Sx if amputation necessary…

A

Preservation of as many anatomical joints as possible

*ESPECIALLY KNEE!!!

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20
Q

GOAL of amp. sx is preservation of as many jts as poss….

especially…

A

the Knee!!!!

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21
Q

Sx decision making process for amputation

What are we looking @?

A

Adequate Circulation

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22
Q

What goes into looking @ adequate circulation?

A
  • pulses in LE
  • skin color/condition
  • skin temp
  • ABI
  • TcPO2–transcutaneous oximetry
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23
Q

NOTE on ABI

A

Leg BP should be same or higher than arm @ rest AND after 5mins of exercise

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24
Q

During Amp Sx…. surgeon will traction the nerve

why?

A

Prevents retraction/recoil====Less phantom pain

25
This is an extreme WB'ing tendon and is attempted to be preserved when poss.
Patellar tendon
26
Myodesis
Re-attachment of mm's onto bone OR periosteum (top aspect) of bone
27
Myodesis and **Transfemoral Amputations (aka Above Knee Amputation)**
**Adductors** and **Extensors** lose their attachments and are reattached to **distal femur**
28
W/ Transfemoral amps….**Adductors** and **Extensors** lose their attachments and are reattached to **distal femur** ## Footnote **What does this slight ADD do?**
Slight ADD improves comfort during WB and **maximizes ABD length-tension**
29
Transfemoral amputations ## Footnote **IMMEDIATE Surgical/PT goals:**
* Center femur/tibia in muscle mass * Balance forces * Strengthen RL * Prevent ADD roll (**from adductor mm retraction)** * in TFAs\*\*\*
30
Myodesis ## Footnote **Downside (TFAs):**
* Muscle does not hold sutures well→ **not ideal for surgical attach's** * Fascia better @ holding sutures BUT **not much around thigh mm's** * Often times→ myodesis **unsuccessful** limiting mm output and resulting in less than ideal alignment * **SOME pts feel myodesis stretching out or pulling free**
31
This technique **predominates in Transtibial Amputations (Below Knee Amps)**
Myoplasty (muscle attached to opposing muscle)
32
Myoplasty (muscle to **opposing muscle)** tech **predominates in TTAs** ## Footnote **Explain it**
Long posterior myofascial flap sewn **anteriorly** to anterolateral deep fascia and tibial periosteum and provides **reasonable degree of muscle fixation w/out risk of strangulation**
33
Muscle-to-bone suture aka
Myodesis
34
Muscle-to-bone suture (myodesis) reserved for the _______ patient
**NONischemic** **(good/normal blood supply)**
35
REMEMBER…. ## Footnote **W/ TTAs….**
HS + Quads **INTACT** Soleus **REMOVED**
36
What is still intact w/ TTAs?
HS's + Quads
37
What is removed w/ TTAs
Soleus
38
Surgeries from **Distal→Proximal**
1. Phalangeal (**forefoot**) 2. Transmetatarsal (**midfoot)** 3. Lisfranc (**tarsometatarsal (TMT) joint)** 4. Chopart (**bw talus and navicular and calcaneus and cuboids→ still working ankle in sag. plane)** 5. Syme amputation (**talocrural _disarticulation)_** 1. shave malleoli to create flat WB surface and repositioning of fat pad under tib/fib
39
Surgery Phalangeal or
Forefoot
40
Surgery Transmetatarsal or
Midfoot
41
Surgery Lisfranc or
Tarsometatarsal
42
Surgery Chopart or
Bw **talus and navicular and calcaneous and cuboids** ## Footnote **\*still working ankle in sag. plane**
43
Surgery Symes Amputation or
Talocrural disarticulation \***shave malleoli to create flat WB surface and repositioning of fat pad under tib/fib → thickest fat pad in body**
44
Surgery ## Footnote **Transtibial (BKA)** **Ideal length**
40-50% of initial tib length
45
Surgery TTA (BKA) **Shorter Tibia Length**
\<33% ## Footnote **Very LITTLE control of prosthetic**
46
Surgery TTA (BKA) **Longer Tibia Length**
\>66% **BETTER control of prosthetic AND more surf area dispersion…BUT** often _chronic skin irritation and sharper distal tib_
47
Surgery ## Footnote **TTA** **pics**
see pics
48
Post-Sx Transtibial Length
see pics
49
Disarticulation safer vs Amputation Why?
Less blood loss Quicker sx + recovery (less chance for infx) Nothing cut
50
Sx: ## Footnote **Knee _Disarticulation_/Transcondylar** **aka Remove tib/fib** **Explain Benefits**
* LESS **blood loss** * Quicker **sx+recovery** * **less chance for infx** * Sx does NOT transect (cut) any mm mass * **\*\*Distal femur ideal for WB** * Growth plate remains intact (children)
51
Sx: ## Footnote **Knee _Disarticulation_/Transcondylar** **aka Remove tib/fib** **Explain Negatives**
Femoral condyles (size) make don/doffing prosthesis difficult \***need shaved or special socket**
52
Sx: ## Footnote **Transfemoral (AKA) Amputation** **Preserve length of femur allows for:**
* INCd prosthetic control * Improved **stabilization** of RL due to INCd ADD/ABD strength * LESS chance of hip ABD and hip flex contracture
53
Sx: ## Footnote **Hip Disarticulation** **What is removed + more info?**
* Entire **femur, tibia, fibula, and foot _removed._** * _Extreme_ sx and only performed under emergency cases * **very few functional ambulators**
54
Sx: uncommon ## Footnote **Hemipelvectomy**
* Innominate bone AND distal LE removed * No bony casing for abdom contents * Often need **NG tubes for feeding** * Min activity allowed post-op
55
Sx: uncommon ## Footnote **Hemicorporectomy**
* **Translumbar amputation→** removing _entire_ bony pelvis, pelvic contents, external genitalia, LEs * Rehab for **ADLs, upright postures and balance** * Typ NOT **gait candidates**
56
Post-Amputation Sx: ## Footnote **Rehab Day 2:** **Working on…**
* Pt and limb positioning * **adduction and extension\*\*\*** * length-tension and prevent contractures * Stump shaping * **shrinkers\*\*\*** * Wound care * Sitting balance * **COM shift, circulation changes\*\*\*** * SL gait w/out prosthesis
57
Post-Amputation Sx: ## Footnote **Depending on _condition of suture line_, fitting for _initial prosthesis_ from….**
From 3-6wks to several months
58
Post-amputation Sx: ## Footnote **_Regardless_ of lvl of amputee OR sx technique…….**
The **EARLIER** the **fitting** and **use** of a prosthesis the **BETTER** the **outcomes for _functional ambulation_**.\*\*\*\*

Prosthetics&Orthotics (19 decks)

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